Disease In Middle-aged Patients Research Articles

Serum C-peptide as a Predictor of Coronary Artery Disease in Middle-Aged Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Analytical Study

Serum C-peptide as a Predictor of Coronary Artery Disease in Middle-Aged Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Analytical Study

The effect of blood flow-restrictive resistance training on the risk of atherosclerotic cardiovascular disease in middle-aged patients with type 2 diabetes: a randomized controlled trial.

The aim of this study was to investigate the effects of blood flow-restrictive resistance training (BFR-RT) on improving metabolic abnormalities, blood pressure (BP), obesity, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk in middle-aged patients with type 2 diabetes mellitus (T2DM). We conducted a parallel-group, single blind randomized controlled trial. Participants who met the inclusion criteria were randomly divided into control group, BFR-RT group and aerobic exercise (AE) group. Control group received health education and follow-up; Two exercise groups received supervised collective training for a period of six months, three times per week. AE group trained at moderate-intensity for 60 minutes each time, while BFR-RT group trained at low-intensity for 40 minutes each time. The primary outcomes were change in 10-year ASCVD risk index and level, and the secondary outcomes included changes in fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), blood lipids, BP, and obesity level within and across the three groups at baseline, the third and sixth months of intervention. Among 93 individuals (control group, n=31; AE, n=30; BFR-RT, n=32) were analyzed. At baseline, there were no significant differences in various indicators among the three groups (p>0.05). After intervention, the 10-year ASCVD risk index and risk level of both exercise groups significantly decreased compared to the control group and baseline (p<0.05), and the risk reduction became more pronounced over time. In the sixth month of intervention, the 10-year ASCVD risk index in the AE group decreased by 27.40%, and that in the BFR-RT group decreased by 26.78%. Meanwhile, apart from lipoprotein (a) and diastolic blood pressure, both exercise groups showed significant improvements in FPG, HbA1c, dyslipidemia, systolic blood pressure, and obesity indicators compared to the control group and baseline (p<0.05). There was no significant difference in various indicators between the two exercise groups (p>0.05). BFR-RT could reduce the 10-year ASCVD risk in middle-aged T2DM patients for by improving metabolic abnormalities, BP and obesity, and its effect was similar to that of moderate-intensity AE. https://www.chictr.org.cn/showproj.html?proj=178886, identifier ChiCTR2300074357.

Visual and previsual MRI-criteria for early diagnosis of cerebral small vessels disease in middle-aged patients: clinical and neuroimaging correlations

Background. The urgency of cerebral small vessel disease (cSVD) in modern neurology is considered mainly in terms of the development of vascular dementia and early diagnosis of Alzheimer’s disease. Minimal changes in MRI images and indistinct cognitive disorders in SNAMA-type cSVD (sporadic non-amyloid microangiopathy) last for a long time until they manifest as acute cerebrovascular disorders and/or significant mental deficits. However, clinical and neuroimaging criteria for early diagnosis of the disease have not been established yet, and the nature of the correlations between the indicators of neuropsychological and multiparametric MRI studies has not been clarified. Purpose – to develop criteria for early diagnosis of SNAMA cerebrovascular disease in middle-aged patients using neuropsychological studies and high-field multiparametric MRI. Materials and methods. The study enrolled 34 middle-aged patients (52.5 ± 10.8) with hypertension of stage 1–2, stage I–II and cSVD (women – 11 (32.4%), men – 23 (67.6%)). The control group (19 healthy individuals) was identical in age, gender and total duration of education. MRI (3T) was performed in the following modes: T1-2WI, DWI, 3D Brain FLAIR SHC, 3D tra, VEN BOLD, DTI medium iso SENSE. Neuropsychological studies were performed using the MoSA questionnaire evaluating the EIS, VIS, AIS, LIS, MIS, OIS domains. Results and discussion. We developed and introduced a modified scoring system for determining the severity of the burden of cerebral small vessels disease (BcSVDearly) in clinical practice. Among the early visual MRI markers, the expansion of the perivascular spaces was dominated in 27 (79.4%) of participants. A minor increase in Σ BcSVDearly to 6–7 points was found in 10 (29.4%) patients. The age norm (0–4 points) corresponded to the indicators of Σ BcSVDearly 23 out of 34 (67.6%) in the main group. Additional evidence of the disease was obtained by DTI MRI. The most significant decrease in FA was recorded in belt fibers (Δ: up to – 31.4%) and semioval centers (Δ: up to – 33.6%), the largest increase in MD was recorded in hooked bundles (Δ: up to 24.4%); right prefrontal, orbitofrontal and parietal areas (Δ up to 28.0%). According to the MoSA scale, moderate cognitive impairment was detected in 29 of 34 (85.3%) patients with a significant decrease in scores in the domains of EIS, VIS, LIS and AIS (p &lt;0.001). The severity of early clinical manifestations of cSVD (non-amnestic polydomain moderate disorders of attention, speech, visual-spatial and executive cognitive functions) has been found to be moderately / markedly correlated with THMS, MD (positive) and FA (negative).Conclusions. We determined early visual signs of cSVD associated with arterial hypertension: dilated perivascular spaces, hyperintensity of the periventricular deep white matter of the brain, decrease by 9–33.6% of FA coefficient and increase by 20.8% – 28.0% MD. Moderate correlations between neuropsychological and neuroimaging studies have been demonstrated.

Genetic Deletion of Syndecan-4 Alters Body Composition, Metabolic Phenotypes, and the Function of Metabolic Tissues in Female Mice Fed A High-Fat Diet.

Syndecans are transmembrane proteoglycans that, like integrins, bind to components of the extracellular matrix. Previously, we showed significant associations of genetic variants in the Syndecan-4 (SDC4) gene with intra-abdominal fat, fasting plasma glucose levels, and insulin sensitivity index in children, and with fasting serum triglyceride levels in healthy elderly subjects. An independent study also reported a correlation between SDC4 and the risk of coronary artery disease in middle-aged patients. Here, we investigated whether deletion of Sdc4 promotes metabolic derangements associated with diet-induced obesity by feeding homozygous male and female Sdc4-deficient (Sdc4-/-) mice and their age-matched wild-type (WT) mice a high-fat diet (HFD). We found that WT and Sdc4-/- mice gained similar weight. However, while no differences were observed in males, HFD-fed female Sdc4-/- mice exhibited a higher percentage of body fat mass than controls and displayed increased levels of plasma total cholesterol, triglyceride, and glucose, as well as reduced whole-body insulin sensitivity. Additionally, they had an increased adipocyte size and macrophage infiltration in the visceral adipose tissue, and higher triglyceride and fatty acid synthase levels in the liver. Together with our previous human genetic findings, these results provide evidence of an evolutionarily conserved role of SDC4 in adiposity and its complications.

PDB1 - COMPARATIVE SAFETY OF SGLT2 AND DPP-4 INHIBITORS ON RISK OF ADVERSE EVENTS IN MIDDLE-AGED ADULTS WITH TYPE 2 DIABETES MELLITUS

To evaluate the risk of adverse events associated with the use of oral antidiabetic agents in middle-aged patients with type II diabetes mellitus (T2DM). This retrospective-cohort study used propensity score matching to identify patients in a large nationally representative administrative claims database. The sample consisted of T2DM patients aged 30-64 years who were new users of Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors or Dipeptidyl Peptidase-4 (DPP-4) inhibitors between 2013 and 2015. Patients were excluded if they: (a) were prescribed polytherapy of diabetic drugs within seven days of the index prescription; (b) were not continuously enrolled during the 12 months before initiation of treatment; (c) did not have medical or pharmacy benefits; or (d) had a diagnosis of a serious medical condition (i.e., active cancer, HIV/AIDS, organ transplant, and ESRD) at baseline. Cox proportional hazards models were performed and eligible patients were followed to the time of adverse event or up to 180 days after the index date. They were censored if switched to another drug agent, disenrolled from the health plan, or end of study period. A total of 11,734 T2DM patients were identified as new users of SGLT2 or DPP-4 inhibitors after matching (female = 53.7%, age = 54.0[± 7.6], history: mild liver disease = 8.0%, retinopathy = 11.4%, neuropathy = 16.2%). Compared to patients treated with DPP-4 inhibitors, those with SGLT2 inhibitors had a significantly lower risk of cardiovascular disease (HR = 0.766, 95% CI: 0.633-0.927) after controlling for potential confounders. There were no significant differences in the risk of developing ketoacidosis (DKA) or osteoporotic fractures between treatments. This study provides new evidence that use of SGLT2 inhibitors decreases the risk of cardiovascular disease in middle-aged patients with T2DM. This suggests that DPP-4 inhibitors should be prescribed with caution in this patient population, particularly in patients with other risk factors for cardiovascular events.

The diagnostic value of circulating microRNAs for middle-aged (40–60-year-old) coronary artery disease patients

OBJECTIVE:Circulating microRNAs have been recognized as promising biomarkers for various diseases. The present study aimed to explore the potential roles of circulating miR-149, miR-424 and miR-765 as non-invasive biomarkers for the diagnosis of coronary artery disease in middle-aged (40–60-year-old) patients.METHODS:Sixty-five stable coronary artery disease patients (49–57 years old), 30 unstable coronary artery disease patients (49–58 years old), and 32 non-coronary artery disease patients (49–-57 years old) who were matched for age, sex, smoking habits, hypertension and diabetes were enrolled in this study. Total RNA was isolated from plasma with TRIzol reagent. Circulating miRNA levels were measured by quantitative real-time polymerase chain reaction.RESULTS:Circulating miR-149 levels were decreased 4.49-fold in stable coronary artery disease patients (1.18 ± 0.84) and 5.09-fold in unstable coronary artery disease patients (1.04 ± 0.65) compared with non-coronary artery disease patients (5.30 ± 2.57) (p<0.001). Circulating miR-424 levels were reduced 3.6-fold in stable coronary artery disease patients (1.18 ± 0.60) and 5-fold in unstable coronary artery disease patients (0.86 ± 0.54) compared with non-coronary artery disease patients (4.35 ± 2.20) (p<0.001). In contrast, circulating miR-765 levels were elevated 3.98-fold in stable coronary artery disease patients (6.09 ± 2.27) and 5.33-fold in unstable coronary artery disease patients (8.17 ± 2.77) compared with non-coronary artery disease patients (1.53 ± 0.99) (p<0.001). Receiver operating characteristic curve analysis revealed that the respective areas under the curve for circulating miR-149, miR-424 and miR-765 were 0.938, 0.919 and 0.968 in stable CAD patients and 0.951, 0.960 and 0.977 in unstable coronary artery disease patients compared with non-coronary artery disease patients.CONCLUSION:Our results suggest that circulating miR-149, miR-424 and miR-765 might be novel, non-invasive biomarkers for the diagnosis of coronary artery disease in middle-aged patients. However, future prospective trials in large patient cohorts are necessary before reaching a solid conclusion.

Lunate Excision and Tendon Ball Implantation in Lichtman Stage IIIB Kienböck's Disease in Middle-Aged Patients

Received: June 11, 2015 Revised: [1] July 22, 2015 [2] July 26, 2015 Accepted: July 27, 2015 Correspondence to: Sang Jin Cheon Department of Orthopedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea TEL: +82-51-240-7531 FAX: +82-51-247-8395 E-mail: scheon@pusan.ac.kr Purpose: Our purpose was to assess the results of lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienbock’s disease in middle-aged patients. Methods: Ten patients with Lichtman stage IIIB Kienbock’s disease who underwent lunate excision and tendon ball implantation and followed up at least 24 months were analyzed. There were 4 males and 6 females. The mean age at the time of surgery was 55.4 years (range, 48-67 years), and follow-up period ranged from 24 to 68 months (mean, 46 months). Radiocarpal joint pain, grip strength, return to daily living activity, range of motion were evaluated and radiologic findings of preoperative, postoperative and last follow-up were evaluated. Results: All patients returned to daily living activity after 6 months of surgery. At the last follow up, 8 patients had no pain and 2 patients experienced mild pain occasionally. The mean improvement of extension arc was 14.5°, and the mean flexion arc improved 8.5°. The mean grip strength was 88% of unaffected side. The mean carpal height ratio was 0.49 preoperatively, 0.47 at final followup. No patients showed osteoarthritis change at the last follow-up. The mean Cooney’s wrist function were 83, 4 patients had excellent, 4 had good, and 2 had fair. Conclusion: Lunate excision and tendon ball implantation with temporary scaphocapitate fixation for Lichtman stage IIIB Kienbock’s disease in middleaged patients showed satisfactory clinical, functional and radiological results. So this can be a reasonable treatment option.

Cerebrospinal fluid levels of Alzheimer's disease biomarkers in middle-aged patients with type 1 diabetes.

Type 1 diabetes is associated with moderate cognitive decline and cerebral alterations and may lead to an increased risk of dementia, including Alzheimer's disease. This study aimed to investigate the levels of risk markers for Alzheimer's disease in middle-aged patients with type 1 diabetes and controls, and their potential associations with cognitive and cerebral measures. Levels of β-amyloid (Aβ) 42, Tau, phosphorylated Tau (pTau), the soluble form of low-density lipoprotein receptor-related protein 1 (sLRP1) and macrophage colony-stimulating factor (MCSF) were quantified by ELISA in serum and cerebrospinal fluid (CSF) collected from 37 patients with type 1 diabetes and 15 controls. Associations between biomarkers and determinants of cognitive function and white matter integrity were assessed using hierarchical regression analysis controlling for age, HbA1c and estimated intelligence quotient (IQ). CSF levels of pTau, Aβ42 and LRP1 were higher in patients with type 1 diabetes than in controls (all p < 0.05). There was a trend towards increased Tau levels in patients with type 1 diabetes (p = 0.056), while CSF levels of MCSF were similar between patients with type 1 diabetes and controls. Regression analysis showed that elevated CSF sLRP1 levels were associated with better attention (β = 0.518; p = 0.002) and a better speed of information-processing (β = 0.368; p = 0.034), as well as increased integrity of the white matter of the right inferior fronto-occipital tract (β = 0.395; p = 0.022). Furthermore, elevated Tau levels were associated with decreased integrity of the white matter of right inferior fronto-occipital tract (β = -0.584; p = 0.002). CSF levels of biomarkers for Alzheimer's disease are altered in patients with type 1 diabetes compared with controls, but the observed profile does not match the profile characterising pre-Alzheimer's disease patients.

Arterial stiffness and chronic kidney disease in middle-aged patients with type 2 diabetes mellitus

Objectives: Cardio-Ankle Vascular Index (CAVI) was developed as index of arterial stiffness and early marker of atherosclerosis, independent by blood pressure.The aim of our study was to evaluate the correlation between CAVI and kidney function in patients with type 2 diabetes mellitus (T2DM) compared with normoglycemic subjects.

Percy Jewsbury

A study is described in which three general practices were provided with low cost, low technology support from a "facilitator" and were compared with control practices in the ascertainment of...

Atypical manifestation of late onset limb girdle muscular dystrophy presenting with recurrent falling and shoulder dysfunction: a case report

IntroductionMyopathies can be sub-classified into congenital, hereditary, mitochondrial, and secondary myopathies.Congenital myopathies are usually diagnosed post partal or in early childhood. Manifestation in adolescence is uncommon and most cases occur as sporadic mutations. Therefore, there is a risk of under diagnosing this disease in middle-aged patients showing pain, dysfunction, recurrent trauma or falls, where muscle atrophy is seen as a secondary injury.Case presentationOur report is about a 54 year old Caucasian woman with an extended history of pain, loss of function and weakness in her right shoulder. The clinical picture showed a frozen right shoulder. The main finding was a marked limb-muscle atrophy of both delta- und biceps-muscles and a rotator cuff tear that had developed over years. Previous medical consultations attributed the atrophy to recurrent falls, shoulder dysfunction and pain. Conservative treatment (analgesics, physiotherapy, training) had failed.The familiar anamnesis was free of any neurological diseases or other genetic diseases.MRI showed a sub-total proximal muscular limb atrophy and a rotator cuff tear in both shoulders. An incision-biopsy of the right delta- and biceps-muscle revealed a chronical myopathy. The level of creatinkinasis was expected to be high but measurements showed values only slightly above normal. Immunohistochemistry, eventually revealed a mild form of LGMD (type 2I). Due to the pattern of symptoms and diagnostic results we described the case as atypical LGMD.ConclusionOur case presents a phenotype of a late onset of limb girdle muscular dystrophy syndrome associated with shoulder pain and dysfunction and recurrent falls. This kind of disease is not very common. In particular, muscle atrophy in the elderly is generally seen as a secondary injury. This case should remind us of the importance of a differential diagnosis of a late onset of muscular dystrophy-syndrome in the elderly, since an early diagnosis offers more treatment options, therefore preventing a rapid progression.

Prevalence of angina, myocardial infarction and intermittent claudication assessed by Rose Questionnaire among patients with Behcet's syndrome

To determine the risk of clinical cardiovascular disease in middle-aged patients with Behcet's syndrome (BS) compared with gender-matched non-BS subjects. The prevalence of angina, myocardial infarction (MI), doctor diagnosed ischaemic heart disease (IHD) and intermittent claudication were sought by the Rose Angina Questionnaire in 225 (141 M/84 F) BS patients (mean age: 52 +/- 8) with BS and 117 (74 M/43 F) controls (mean age: 50 +/- 5). Information on atherosclerotic risk factors was also collected. The prevalence of angina, MI and doctor-diagnosed IHD were not different between BS patients and non-BS controls in the whole study population and when males and females were separately analysed. Angina tended to be more common among females compared with males among both patients and controls. Intermittent claudication was found to be significantly more common among BS patients, especially in males with venous disease. The findings in this cross-sectional clinical study are in line with previous observations not indicating accelerated atherosclerosis in BS. Intermittent claudication might not be a suitable tool for the detection of peripheral atherosclerotic disease especially among BS patients having venous disease.

Cholesterol Management in Patients Hospitalized for Coronary Heart Disease

There is now substantial scientific evidence that patients with coronary heart disease (CHD) have a high prevalence of hypercholesterolemia and stand to benefit significantly from efforts to lower cholesterol levels. To evaluate physician practice patterns and attitudes concerning cholesterol assessment and management of patients hospitalized with an admitting diagnosis of CHD, one-month medical record audits were performed during 1983, 1984, and 1985, and a physician survey was administered in early 1986. Medical records of 154 inpatients hospitalized with a diagnosis of CHD before 60 years of age showed that, on the average, 18% had lipid profiles ordered and 11% received a low-fat diet in the hospital. The admission history and follow-up notes mentioned the presence or absence of lipid abnormalities in 53% of CHD inpatients. No significant changes occurred from 1983 to 1985. Survey results from 184 hospital staff physicians caring for these patients showed that less than half believed that a reduction in blood cholesterol lowers risk for heart disease in middle-aged patients with CHD. Interns and residents indicated less confidence in the efficacy of cholesterol-lowering diet and drug therapy than did attending physicians. The implications of these findings for physician training are discussed in light of recent studies of the efficacy of cholesterol lowering in secondary prevention.

Promoting prevention in primary care: controlled trial of low technology, low cost approach.

A study is described in which three general practices were provided with low cost, low technology support from a "facilitator" and were compared with control practices in the ascertainment of major risk factors for cardiovascular disease in middle aged patients. Patients who were attending for a consultation with their general practitioners were recruited to make an appointment with a practice nurse for a health check, and this was compared with ordinary consultations in the control practices. Practices were helped by the facilitator to develop the nurse's role. During the study the increase between intervention and control practices in blood pressure recording was doubled and in the recording of smoking habit it was quadrupled, and there was a fivefold increase in the recording of weight. This model can be applied to other aspects of prevention and general practice care.

Unsuspected coronary artery disease as cause of chronic atrioventricular block in middle age.

Attention has recently been drawn to the relatively poor prognosis of middle aged patients paced for chronic atrioventricular block when age-linked expectation of life is taken into account, and it has been suggested that this may be the result of underlying coronary artery disease, despite the absence of symptoms to suggest this. It was the purpose of this study to determine the incidence of unsuspected coronary artery disease in middle aged patients presenting with chronic atrioventricular block. Studies were made on a consecutive series of 30 patients aged 45 to 65 (mean age 56 years) with chronic atrioventricular disease who had been referred for pacing. Patients presenting with acute myocardial infarction or angina or with sinuatrial disease without atrioventricular disease were excluded. Coronary arteriography disclosed the presence of severe coronary artery disease in 13 patients. Of the remaining 17 patients, four had congestive cardiomyopathy, two had hypertrophic cardiomyopathy, one had aortic stenosis, and in 10 patients the aetiology of the heart block was unknown. Myocardial revascularisation was undertaken in six patients with paroxysmal atrioventricular block caused by coronary artery disease. Operation did not result in any sustained improvement in atrioventricular conduction.

The ataxic (cerebellar) form of Creutzfeldt-Jakob disease.

Creutzfeldt-Jakob disease (CJD) may present itself with cerebellar signs initially and in the course of the disease. In addition to the classical triad of morphological changes, i.e. status spongiosus, neuronal loss and astrocytic proliferation, in the cerebral cortex and basal ganglia, there may be cerebellar involvement with selective loss of the granule cells with associated astrocytic gliosis or sponginess and relative sparing of the Purkinje cells. Occasional systematized degeneration of the paleocerebellum, “kuru-like” plaques in the cerebellum and chromatolytic neurons in the striatum are similarities between CJD and kuru. Among 17 proven cases of CJD cerebellar onset with or without mental changes was present in 47%, and cerebellar ataxia in the course of the disease was prominent in 75%. Cerebellar lesions were noted in 81%, and were more severe and advanced than cerebral involvement in 5 cases with cerebellar onset. Kuru plaques were not seen. CJD presenting with ataxia and cerebellar symptoms constitutes about 17% of all cases of CJD reported to date, and should be considered in the differential diagnosis of cerebellar disease in middle-aged patients. The similarities and dissimilarities of this subtype of CJD to kuru and other transmissible slow virus spongiform encephalopathies in man and animals are discussed.