Stroke Risk among Patients with Type 2 Diabetes Mellitus in Zhejiang: A Population-Based Prospective Study in China

Machine learning-based nomogram: integrating MRI radiomics and clinical indicators for prognostic assessment in acute ischemic stroke

Background

Acute Ischemic Stroke (AIS) remains a leading cause of mortality and disability worldwide. Rapid and precise prognostication of AIS is crucial for optimizing treatment strategies and improving patient outcomes. This study explores the integration of machine learning-derived radiomics signatures from multi-parametric MRI with clinical factors to forecast AIS prognosis.

Objective

To develop and validate a nomogram that combines a multi-MRI radiomics signature with clinical factors for predicting the prognosis of AIS.

Methods

This retrospective study involved 506 AIS patients from two centers, divided into training (n = 277) and validation (n = 229) cohorts. 4,682 radiomic features were extracted from T1-weighted, T2-weighted, and diffusion-weighted imaging. Logistic regression analysis identified significant clinical risk factors, which, alongside radiomics features, were used to construct a predictive clinical-radiomics nomogram. The model's predictive accuracy was evaluated using calibration and ROC curves, focusing on distinguishing between favorable (mRS ≤ 2) and unfavorable (mRS > 2) outcomes.

Results

Key findings highlight coronary heart disease, platelet-to-lymphocyte ratio, uric acid, glucose levels, homocysteine, and radiomics features as independent predictors of AIS outcomes. The clinical-radiomics model achieved a ROC-AUC of 0.940 (95% CI: 0.912-0.969) in the training set and 0.854 (95% CI: 0.781-0.926) in the validation set, underscoring its predictive reliability and clinical utility.

Conclusion

The study underscores the efficacy of the clinical-radiomics model in forecasting AIS prognosis, showcasing the pivotal role of artificial intelligence in fostering personalized treatment plans and enhancing patient care. This innovative approach promises to revolutionize AIS management, offering a significant leap toward more individualized and effective healthcare solutions.

Vascular complications of diabetes: A narrative review

Diabetes mellitus is a complex chronic metabolic disease characterized by hyperglycemia and various complications. According to the different pathophysiological mechanisms, these complications can be classified as microvascular or macrovascular complications, which have long-term negative effects on vital organs such as the eyes, kidneys, heart, and brain, and lead to increased patient mortality. Diabetes mellitus is a major global health issue, and its incidence and prevalence have increased significantly in recent years. Moreover, the incidence is expected to continue to rise as more people adopt a Western lifestyle and diet. Thus, it is essential to understand the epidemiology, pathogenesis, risk factors, and treatment of vascular complications to aid patients in managing the disease effectively. This paper provides a comprehensive review of the literature to clarify the above content. Furthermore, this paper also delves into the correlation between novel risk factors, such as long noncoding RNAs, gut microbiota, and nonalcoholic fatty liver disease, with diabetic vascular complications.

Association between dietary patterns and stroke in patients with type 2 diabetes mellitus in China: a propensity score-matched analysis

OBJECTIVE

This study aimed to examine the impact of different dietary patterns on stroke outcomes among type 2 diabetes mellitus (T2DM) patients in China.

DESIGN

Participants were enrolled by a stratified random cluster sampling method in the study. After collecting dietary data using a quantified food frequency questionnaire, latent class analysis was used to identify dietary patterns, and propensity score matching was used to reduce confounding effects between different dietary patterns. Binary logistic regression and conditional logistic regression were used to analyze the relationship between dietary patterns and stroke in patients with T2DM.

SETTING

A cross-sectional survey available from December 2013 to January 2014.

PARTICIPANTS

A total of 13731 Chinese residents aged 18 years or over.

RESULTS

Two dietary patterns were identified: 61.2% of T2DM patients were categorized in the High-fat dietary pattern while 38.8% of patients were characterized by the Balanced dietary pattern. Compared to the High-fat dietary pattern, the Balanced dietary pattern was associated with reduced stroke risk (OR=0.63, 95%CI: 0.52-0.76, P<0.001) after adjusting for confounding factors. The protective effect of the balanced model did not differ significantly (interaction P>0.05).

CONCLUSION

This study provides sufficient evidence to support the dietary intervention strategies to prevent stroke effectively. Maintaining a Balanced dietary pattern, especially with moderate consumption of foods rich in quality protein and fresh vegetables in T2DM patients, might decrease the risk of stroke in China.

The Impact of Diabetes on Vascular Disease: Progress from the Perspective of Epidemics and Treatments

At present, the global incidence of diabetes has increased in countries with large populations, and the changes in developing regions are particularly worthy of attention. In the past 40 years or so, the income situation in China, India, and other countries has exploded, leading to changes in the way of life and work as well as an increase in the prevalence of diabetes. Metabolic disorders caused by diabetes can lead to secondary vascular complications, which have long-term malignant effects on the heart, kidneys, brain, and other vital organs of patients. Adequate primary prevention measures are needed to reduce the incidence of diabetic vascular complications, and more attention should be given to treatment after the disease. To this end, it is necessary to determine a standardized drug and physical therapy system and to build a more efficient and low-cost chronic disease management system.

Factors associated with stroke among patients with type 2 diabetes mellitus in China: a propensity score matched study

OBJECTIVE

This study aimed to examine the prevalence of stroke and associated factors of stroke in patients with type 2 diabetes(T2DM) in China.

METHODS

Participants were 18,013 T2DM patients recruited with stratified random cluster sampling method from December 2013 to January 2014 in China. Propensity score matching was used to eliminate confounding effects between groups and logistic regression analysis was used to examine factors associated with stroke among T2DM patients.

RESULTS

Overall, the prevalence of stroke in the subjects with T2DM was 9.5%. After nearest neighbor matching, smoking (OR = 1.60, 95%CI: 1.26-2.03), hypertension (OR = 2.96, 95%CI: 2.55-3.43), dyslipidemia (OR = 2.00, 95%CI: 1.71-2.33), family history of stroke (OR = 2.02, 95%CI: 1.61-2.54), obesity (OR = 1.21, 95%CI: 1.01-1.45) and sleep duration < 6 h/day (OR = 1.44, 95%CI: 1.20-1.73) or > 8 h/day (OR = 1.22, 95%CI: 1.05-1.42) were positively associated with stroke, whereas drinking 1-3 days/week (OR = 0.64, 95%CI: 0.45-0.90) or daily (OR = 0.45, 95%CI: 0.33-0.60), effective exercise (OR = 0.65, 95%CI: 0.57-0.73) and underweight (OR = 0.30, 95%CI: 0.13-0.71) were negatively related to stroke. Besides, the risk of stroke increased substantially with accumulation of above seven modified risk factors. The odds ratio values of stroke in patients having ≥ 5 of the above seven risk factors was 14.39 (95% CI: 8.87-23.26).

CONCLUSIONS

The prevalence of stroke was high among T2DM in China. It is of great significance to strengthen comprehensive management of health-related behaviors including smoking cessation, moderate alcohol consumption, effective exercise, 6-8 h of sleep duration, keeping normal weight and the prevention of hypertension and dyslipidemia to have sustained beneficial effects on improvements of stroke risk factors.

Stroke among Type 2 Diabetes Mellitus Patients at Haji Adam Malik General Hospital, Medan, Indonesia

BACKGROUND

Increasing Blood Sugar Level (BSL) in Diabetes Meletus can be various microvascular and macrovascular changes, in the end, will cause complications. The complications can occur in some organs, such as the heart, blood vessels, eyes, kidney, and nerves. Stroke is one of the complications from diabetes that is increasing in every year.

AIM

The study aims to analyse the relationship between diabetes and the prevalence of stroke at Haji Adam Malik General Hospital Medan.

METHODS

This study is an analytical study with a cross-sectional approach. The population was all Integrated Inpatient ward at Haji Adam Malik General Hospital Medan. The subjects were 180 people chosen by consecutive sampling technique.

RESULTS

The results showed that diabetes has a relationship with the prevalence of stroke (p < 0.05; CI = 95%). The risk of diabetes is 1.34 times higher than those without diabetes at Haji Adam Malik General Hospital Medan.

CONCLUSION

Based on the results, the diabetic patient has a higher risk of incidence of stroke. Excellent control for diabetic patients will prevent them from stroke and any complication.

A novel anti‑proliferative pentapeptide (ILYMP) isolated from Cyclina sinensis protein hydrolysate induces apoptosis of DU‑145 prostate cancer cells

Prostate cancer is the main causes of cancer associated mortality in men worldwide, cancer patients often suffer serious side effects when treated with chemotherapy or radiotherapy, therefore novel drugs are in high demand to treat prostate cancer. In the present study, a pentapeptide (Ile‑Leu‑Tyr‑Met‑Pro; ILYMP) with a molecular weight of 635.71 Da was isolated from the protein hydrolysate of Cyclina sinensis via ultrafiltration and chromatographic methods, and subsequently named Cyclina sinensis pentapeptide (CSP). The activity of CSP was first investigated in prostate cancer (PCa) DU‑145 cells. CSP was demonstrated to significantly inhibit DU‑145 cell proliferation at a half‑maximal inhibitory concentration of 11.25 mM at a 72 h time interval. In addition, the results of acridine orange/ethidium bromide double staining, scanning electron microscopy and flow cytometry analyses suggested that CSP inhibited DU‑145 cell proliferation via the induction of apoptosis. Following treatment with CSP, Bcl‑2‑associated X (Bax), cleaved caspase‑3 and cleaved caspase‑9 protein expression levels were enhanced in DU‑145 cells; whereas B‑cell lymphoma 2 expression was suppressed in DU‑145 cells. In conclusion, to the best of the authors' knowledge, this is the first study to investigate the effects of an anti‑proliferative peptide derived from Cyclina sinensis on DU‑145 cells, and the results suggested that CSP may represent a therapeutic nutraceutical agent for the treatment of patients with PCa.

THE RATIO OF P53-PROAPOPTOTIC AND BCL-2 ANTIAPOPTOTIC ACTIVITY IN THE HIPPOCAMPUS OF RATS WITH BRAIN ISCHEMIA-REPERFUSION AND EXPERIMENTAL DIABETES

The dynamics of the balance of indices of pro- and p53- Bcl-2 anti-apoptotic processes in the hippocampus of rats with experimental diabetes mellitus (DM) complicated by incomplete global cerebral ischemia-reperfusion was investigated. It is shown that p53 proapoptotic processes in animals without diabetes after 20 minutes of ischemia/l hour reperfusion in all fields of the hippocampus are activated in the background of increasing Bcl-2 antiapoptotic processes in the fields CAl, CA2, CA4 and depression of it - in the CA3 field. In the early postischemic period in rats with DM activity of the p53-proapoptotic processes in fields CAl, CA3, CA4 significantly exceeds that in non-diabetic rats (area of p53- IRM increases on 110, 60 and 27 %), and was significantly lower than that detected in CA2 field. On the 12th day of post-ischemic period, activation of apoptosis in field CAl occurs in the background of inert antiapoptotic processes, in animals without diabetes, as well as in diabetic rats, but the indicators characterizing of apoptotic activity in rats with diabetes were higher (specific contents of p53 protein and area ofp53 -IRM increases on 38 and 43 %). During this period, in the CA2 region of the non-diabetic animals, some depression of the antiapoptotic processes with a slight predominance of proapoptotic processes was detected. In the field of CA3 region of rats without diabetes, the retention of activity of proapoptotic processes and the deepening in the dynamics of depression of antiapoptotic processes were showed. In rats with DM, the oppression of both mechanisms with a significant depression of antiapoptotic processes was observed. On the 12th day of experiment in the field CA4, the most balanced relationship were detected between the studied of the processes due to their parallel and unidirectional changes both in the rats without diabetes as well as with DM. The results point on the modifying effect ofDM on susceptibility ofhippocampal fields to ischemic-reperfusion injury.