XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Serum albumin (ALB), one of the most important proteins in human physiology, has the main functions of maintaining plasma oncotic pressure and plasma volume, transporting hormones, vitamins, oligominerals and drugs, and exerting a powerful antioxidant-anti-inflammatory role. Its prognostic value in liver and malabsorption syndromes is well known. In this narrative review, an analysis of the most important studies evaluating the prognostic significance of low serum ALB levels in hospitalized patients was performed. Specifically, the risk in emergency medicine, cardiovascular diseases, Coronavirus Disease 19 (COVID-19) infection, nephrology, oncology, and autoimmune rheumatic diseases has been examined to fully explore its clinical value. ALB is a negative acute-phase reactant and the reduction in its serum levels represents a threatening parameter for long-term survival in several clinical settings, and a strong biomarker for a poor prognosis in most diseases. Therefore, clinicians should consider serum ALB as a valuable tool to assess the efficacy of specific therapies, both in hospitalized patients and in chronic follow-up.

Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice

Serum albumin (ALB), one of the most important proteins in human physiology, has the main functions of maintaining plasma oncotic pressure and plasma volume, transporting hormones, vitamins, oligominerals and drugs, and exerting a powerful antioxidant-antiinflammatory role. Its prognostic value in liver and malabsorption syndromes is well known.&#x0D; In this narrative review, an analysis of the most important studies evaluating the prognostic significance of low serum ALB levels in hospitalized patients was performed. Specifically, the risk in emergency medicine, cardiovascular diseases, COVID-19 infection, nephrology, oncology and autoimmune rheumatic diseases has been examined to fully explore its clinical value. &#x0D; ALB is a negative acute-phase reactant and the reduction of its serum levels represents a threatening parameter for long-term survival in several clinical settings, and a strong poor prognostic biomarker in most diseases. Therefore, clinicians should consider serum ALB as a valuable tool to assess the efficacy of specific therapies, both in hospitalized patients and in chronic follow-up. 

Albumin: A Biomarker to Be Repurposed

The diagnostic usefulness of ischemia-modified albumin in acute coronary syndrome (ACS) has been questioned. The goal of this systematic review and meta-analysis was to see how accurate ischemia-modified albumin (IMA) was in diagnosing ACS in patients admitted to emergency departments (EDs). We searched for relevant literature in databases such as MEDLINE, EMBASE, and the Cochrane Library. Primary studies that reliably reported on patients with symptoms suggestive of ACS and evaluated IMA on admission to emergency departments were included. The QUADAS-2 tool was used to assess the risk of bias in the included research. A total of 4,761 patients from 19 studies were included in this systematic review. The sensitivity and specificity were 0.74 and 0.40, respectively, when the data were pooled. The area under the curve value for IMA for the diagnosis of ACS was 0.75, and the pooled diagnostic odds ratio value was 3.72. Furthermore, ACS patients with unstable angina had greater serum IMA levels than those with non-ischemic chest pain. In contrast to prior meta-analyses, our findings suggest that determining whether serum IMA levels are effective for diagnosing ACS in the emergency department is difficult. However, the accuracy of these findings cannot be ascertained due to high heterogeneity between studies.

/pdf/diagnostic-accuracy-of-ischemia-modified-albumin-for-acute-1zyp8abv.pdf

Diagnostic Accuracy of Ischemia-Modified Albumin for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Cardiovascular diseases, a global health issue, claim the lives of many every year. Lifestyle changes and genetic predisposition are the key drivers for the development of CVDs. In many of the patients, the disease is detected at the end stage making heart transplantation the only treatment option. Hence every attempt should be made to identify the risk at an early stage and initiate preventive measures to improve the quality of their life. Biomarkers are one of the critical factors that aid in the early diagnosis of CVDs. More specific and highly sensitive biomarkers have been discovered lately and have been employed for prognosis and diagnosis of CVDs. The present review briefs about the various categories of cardiovascular biomarkers with emphasis on novel biomarkers and discusses the biomarkers employed for different purposes in CVDs. The biomarkers have also helped in identifying COVID-19 patients with increased risk for developing cardiovascular complications. Being non-invasive makes biomarkers advantageous over other methods for evaluating the pathophysiological status of CVDs. 

Multifaceted role of cardiovascular biomarkers

To investigate the correlation between ischemia-modified albumin (IMA) levels and coronary collateral circulation (CCC) in patients with chronic total occlusive (CTO). Coronary angiography was performed in the Department of Cardiology, Zhongnan Hospital of Wuhan University from 2017 to 08 to 2019–02 to identify 128 patients with CTO lesions in at least one major coronary artery. According to the Rentrop evaluation criteria, the degree of CCC formation was divided into the poor CCC formation group (Rentrop0–1 grade,n = 69) and the good CCC formation group (Rentrop2–3 grade,n = 59). The IMA level of the patients was measured using an albumin-cobalt binding assay. The general data, routine blood panel, total bilirubin (TBIL), blood lipids, uric acid (UA), left ventricular ejection fraction (LVEF) and other indicators of the patients were recorded and analyzed while assessing the patients’ blood vessel occlusion. The proportion of platelet count and diabetes in the poor CCC group was higher than that in the good CCC group (P < 0.05). The ratio of ischemia-modified albumin and total bilirubin in the poor CCC group was lower than that in the good CCC group (P < 0.05). Multivariate logistic regression analysis showed that ischemia-modified albumin was positively correlated with CCC formation [OR = 1.190,95% CI (1.092–1.297),P < 0.001], while diabetes was negatively correlated with CCC formation [OR = 0.285,95% CI (0.094–0.864), P < 0.05]. Ischemic modified albumin predicted good formation of CCC according to the ROC curve, and the area under the ROC curve was 0.769(95% CI,0.686–0.851, P<0.001); the optimal cut-off value was 63.35 KU/L, and the sensitivity was 71.2%,specificity is 71%. The IMA level is closely related to good formation of CCC. Higher IMA levels can be used as an effective predictor of good CCC formation in patients with CTO.

/pdf/correlation-between-ischemia-modified-albumin-level-and-1qjaemdlgh.pdf

Correlation between ischemia-modified albumin level and coronary collateral circulation

The simultaneous saccharification and fermentation (SSF) technique holds promise for the conversion of lignocellulose to ethanol. However, the optimal fermentation temperature of yeast is lower than the enzymatic hydrolysis temperature of the saccharification process, which leads to the temperature of the actual production process of SSF usually being lower than 38 °C. In this work, two ultraviolet (UV)-induced mutations were performed step by step using Saccharomyces cerevisiae BY4742 as the original strain to enable the yeast to perform well at higher temperatures. Thermotolerant strains obtained through mutagenesis and screening, YUV1-1 and YUV2-2, were utilized for fermentation and SSF at a targeted temperature of 40 °C. They obtained ethanol yields comparable to those at 38 °C in SSF, whereas the ethanol yields of the original strain at 40 °C decreased by about 10% compared to those at 38 °C. This study proves that thermotolerant strains adapted to elevated fermentation and SSF temperatures can be obtained through UV mutagenesis and screening, thereby increasing the stability of the fermentation and SSF processes and lowering the subsequent distillation costs.

/pdf/screening-of-ultraviolet-induced-thermotolerant-yeast-15t6lw0l.pdf

Screening of Ultraviolet-Induced Thermotolerant Yeast Mutants and Their Performance

Background Primary cardiac lymphoma (PCL) is a rare cardiac neoplasm. The most common type is diffuse large B-cell lymphoma, which mainly involves the right atrium and right ventricle. Its clinical manifestations are not specific. It is usually found late and the prognosis is poor. PCL is more common in immunodeficient patients. In view of the rarity of PCL, we have made a case report and a brief literature review. Case presentations We documented an elderly male patient with Burkitt's lymphoma diagnosed by echocardiography and percutaneous biopsy because of chest tightness. Chemotherapy was given to the patient, and the patient's condition was alleviated without recurrence. Conclusions Primary cardiac lymphoma is a highly malignant tumor. Early detection, diagnosis and treatment are crucial to the prognosis of PCL. At present, the most effective treatment is chemotherapy. There are more chemotherapy schemes and treatment methods worth studying.

Primary cardiac lymphoma: a case report and review of literature.

Background Coronary microvascular dysfunction (CMVD), an important etiology of ischemic heart disease, has been widely studied. D-dimer is a simple indicator of microthrombosis and inflammation. However, whether an increase in D-dimer is related to CMVD is still unclear. Materials and Methods This retrospective study consecutively enrolled patients with myocardial ischemia and excluded those with obstructive coronary artery. D-dimer was measured at admission and the TIMI myocardial perfusion grade (TMPG) was used to distinguish CMVD. Patients were divided into the two groups according to whether the D-dimer was elevated (>500 ng/ml). Logistic models and restricted cubic splines were used to explore the relationship between elevated D-dimer and CMVD. Results A total of 377 patients were eventually enrolled in this study. Of these, 94 (24.9%) patients with CMVD had older age and higher D-dimer levels than those without CMVD. After full adjustment for other potential clinical risk factors, patients with high D-dimer levels (>500 ng/ml) had a 1.89-times (95% CI: 1.09–3.27) higher risk of CMVD than patients with low D-dimer levels. A non-linear relationship was found between concentrations of D-dimer and CMVD. With increased D-dimer level, the incidence of CMVD increased and then remained at a high level. Stratified analysis was performed and showed similar results. Conclusion Elevated D-dimer level is associated with the incidence of CMVD and potentially serves as a simple biomarker to facilitate the diagnosis of CMVD for patients with angina.

D-Dimer Is Associated With Coronary Microvascular Dysfunction in Patients With Non-obstructive Coronary Artery Disease and Preserved Ejection Fraction

Background: Coronavirus infection disease 2019 (COVID-19) occurred in Wuhan in December 2019. With the spread of the virus, the global epidemic situation has become extremely serious, especially in the United States, Spain and Italy. Due to a series of control measures, the epidemic situation in Wuhan has been alleviated to a certain extent, and this region has entered into a post-epidemic period. The treatment of some acute and worsened cardiovascular diseases has become more complex because of epidemic prevention measures. Patients and Methods: We examined cardiovascular patients in the emergency department, as well as outpatient clinics and inpatient units in the Zhongnan Hospital of Wuhan University, from March 20th to April 17th, 2020, as the study subjects, and we performed standard medical activities according to the principles of border treatment and border protection. Additionally, we aimed to minimize the adverse effects of the epidemic on the therapy that was administered to cardiology patients. Results: Due to this standard and feasible strategy, the cardiology department admitted a total of 97 patients, with 36 patients being discharged. No patients have been observed to become infected with SARS-CoV-2 in the cardiology department. In addition, we have no outpatient, caregivers or medical staff infected. Conclusion: Our study aimed to provide prevention and treatment strategies for the rapid and effective medical recovery of patients in non-COVID-19 designated hospitals in high-risk areas after remission, as well as in low- and medium-risk areas.

Prevention and Treatment Strategies for the Cardiology Department of a Non-COVID-19 Designated Hospital in the Post-Epidemic Period.

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