Five-year follow-up observation of interventional therapy for lower extremity vascular disease in type 2 diabetes and analysis of risk factors for restenosis

Angiogenic and Microvascular Status Alterations after Endovascular Revascularization of Lower Limb Arteries among Patients with Diabetic Foot Syndrome: A Prospective 12-Month Follow-Up Study

Peripheral arterial disease (PAD)-induced ischemia is an important component of diabetic foot syndrome (DFS). The results of revascularization of the lower extremity arteries (including percutaneous transluminal angioplasty [PTA]) do not always give satisfactory long-term results, which is due to many factors. The aim of the study was to investigate the alterations in selected circulating angiogenic factors and microcirculation parameters in 41 patients with DFS following PTA and analyze their relationships with clinical outcomes during 1-year follow-up. Our study revealed a general decrease in pro-angiogenic factor levels after PTA and their subsequent stabilization during subsequent observation. The results indicated a significant association between plasma circulating FGF-2 level and poor outcomes (including the incidence of restenosis/reocclusion of treated arteries) during 12 months of observation. The perioperative changes in FGF-2 showed a significant association with LDF alterations after PTA. Follow-up 1-3 months post-intervention showed a tendency towards elevated TcpO2, VEGF-A, and VEGF-R2 levels in patients free from adverse events. These results may provide a basis for further research on the potential use of selected circulating angiogenic factors for monitoring the treatment of patients with DFS following PTA.

Evaluation of Therapeutic Effects of Computed Tomography Imaging Classification Algorithm-Based Transcatheter Arterial Chemoembolization on Primary Hepatocellular Carcinoma

To investigate the evaluation of therapeutic effects of computerized tomography (CT) imaging machine learning classification algorithm-based transcatheter arterial chemoembolization (TACE) on primary hepatocellular carcinoma (PHC), machine learning algorithm was optimized to propose the feature extraction of soft margin, analyze CT images, and acquire relevant texture features to assess if it can predict the multistage features of PHC for the application of the therapeutic effects of TACE on PHC. Besides, PHC patients receiving surgical excision were retrospectively collected, and then 483 patients with hepatocellular carcinoma (HCC) were determined from cases. After that, a total of 162 cases meeting the standards were selected. Besides, the features of images were classified and analyzed by machine learning algorithm, and volume of interest (VOI) images of patients in each group were acquired by image segmentation layer by layer. In addition, the texture features of images were extracted. The results showed that 5 CT image-based texture features, including 2 histogram features and 3 matrix-based features, all described the specificity and heterogeneity of tumors. The analysis of the diagnostic effectiveness of the evaluation of response group by each texture parameter demonstrated that its sensitivity, specificity, and area under curve (AUC) were 83.63%, 90.91%, and 0.08%, respectively. Based on CT prediction, machine learning algorithm was fused to realize excellent classification effects on multistage and multiphase features and offer imaging support to the clinical selection of reasonable therapeutic plans. In addition, multiphase and multifeature-based medical tumor classification method was put forward.

The Scope of HbA1c Variability and Risk of Vascular Complications Among Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Prospective Studies

Glycated hemoglobin (HbA1c) variability is emerging as an indicator of long-term glycemic control, which may play a significant role during vascular complications. We conducted a systematic review and meta-analysis to assess the association between the scope of HbA1c variability and vascular complications in patients with type 2 diabetes mellitus. PubMed and Embase were searched for studies that evaluated the association of HbA1c variability with vascular complications in patients with type 2 diabetes. Two reviewers independently completed data extraction. Random-effects meta-analysis was conducted with stratification according to the type of vascular complications. Nine studies were eligible for inclusion in our systematic review and meta-analysis. Six studies evaluated the impact of the standard deviation of HbA1c (HbA1c-SD) on cardiovascular events and showed an association of HbA1c-SD with cardiovascular events (HR: 1.25, 95% CI 1.18-1.32, 5 studies). Six studies evaluated renal disease associated with HbA1c-SD and showed that HbA1c-SD was correlated with an increased risk of renal disease (HR: 1.19, 95% CI 1.13-1.24). Two studies evaluated HbA1c-SD and the risk of retinopathy and showed that no significant association was found between retinopathy and HbA1c-SD (HR 1.08, 95% CI 0.92-125). For HbA1c-SD ranging from 0.6 to 0.8%, HbA1c-SD was associated with an increased risk of cardiovascular events (HR: 1.25, 95% CI 1.15-1.35) and renal disease (HR: 1.16, 95% CI 1.11-1.22). For individuals with index HbA1c variability greater than or equal to 0.6%, HbA1c variability was significantly associated with vascular complications in patients with type 2 diabetes mellitus.