SUMMARY OBJECTIVE: This study aimed at the oral health problems of elderly patients with diabetes. A training course of integrated traditional Chinese and Western medicine was constructed, helping patients improve their oral health quality of life. METHODS: A randomized controlled prospective experimental study was conducted. A total of 190 elderly patients were divided randomly into an observation group and a control group with 95 cases in each. The control group received regular health education, while the observation group was based on the control group to implement the integrated experiential learning of traditional Chinese and Western medicine in small groups. The oral health knowledge, attitude, behavior, and blood glucose control status along with the oral health quality of life of the two groups were compared before the intervention and at 3-month postintervention. RESULTS: Three months after the intervention, the fasting blood glucose control and the 2-h postprandial blood glucose/glycosylated hemoglobin levels in the observation group were significantly better than in the control group, and the difference was statistically significant (p<0.05). The oral health quality of life in the observation group was significantly better than in the control group, and the difference was statistically significant (p<0.05). CONCLUSION: The small-group experiential learning model of integrated Chinese and Western medicine can promote the transformation of knowledge–beliefs–behaviors in elderly patients with diabetes, which is conducive to controlling blood sugar levels and improving the quality of oral health.

ABSTRACT Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

Abstract: Introduction: the type 1 diabetes mellitus is related with thyroid alterations. Objective: to determine the behaviour of thyroid diseases in pediatric patients with type 1 diabetes mellitus. Material and method: descriptive cross-sectional study in 56 adolescents with diagnostic of type 1 diabetes mellitus assisted in the service of Endocrinology of the Juan Manuel Márquez hospital in the period between October 2015 and October 2016. The variables in study were: age, sex, time of evolution of the diabetes mellitus, nutritional state, thyroid function and autoimmune thyroid disease. The qualitative variables were statistically sescribed by absolute and relative frequencies; the association among the categorical variables was explored with the χ2 test and Fisher's exact probability. In all the statistical tests, it was considered a significance level of alpha equal to 0.05. Results: 46.29% of the studied patients presented autoimmune thyroid disease; of them, 33.33% were female. The highest degree of thyroid dysfunction was present in older patients (36.0%), with normal weigh (68.0%) and time of evolution of the diabetes mellitus among 5-9 years (52.0%). 32.0% vs 80.0% of the patients presented antithyroglobulin antibodies and antithyroperoxidase antibodies respectively, being related this last one with the age and the time of evolution of the diabetes mellitus. Conclusions: thyroid dysfunction was presented in the patients with autoimmune thyroid disease related to the age and the time of evolution of the type 1 diabetes mellitus. The antithyroperoxidase antibodies were related with the age and the time of evolution of type 1 diabetes mellitus.

Resumen: Objetivo: determinar el comportamiento de enfermedades tiroideas en pacientes pediátricos con diabetes mellitus tipo 1. Material y método: estudio descriptivo, transversal, en 56 adolescentes con diagnóstico de diabetes mellitus tipo 1 atendidos en el Servicio de Endocrinología del Hospital Juan Manuel Márquez (La Habana, Cuba) en el periodo de octubre de 2015 a octubre de 2016. Las variables en estudio fueron: edad, sexo, tiempo de evolución de la diabetes mellitus, estado nutricional, función tiroidea y enfermedad tiroidea autoinmune. Las variables cualitativas se describieron estadísticamente mediante frecuencias absolutas y relativas, la asociación entre las variables categóricas se exploró con el test χ2 y la probabilidad exacta de Fisher. En todas las pruebas estadísticas se consideró un nivel de significación de α igual a 0,05. Resultados: el 46,29% de los pacientes estudiados presentaron enfermedad tiroidea autoinmune; de ellos, el 33,33% eran del sexo femenino. El mayor grado de disfunción tiroidea se presentó en pacientes con mayores edades (36,0%), normopesos (68,0%) y con tiempo de evolución de la diabetes mellitus de entre 5-9 años (52,0%). El 32,0 frente al 80,0% de los pacientes presentaron respectivamente anticuerpos antitiroglobulina y antitiroperoxidasa positivos, relacionándose este último con la edad y el tiempo de evolución de la diabetes mellitus. Conclusiones: se presentó disfunción tiroidea en los pacientes con enfermedad tiroidea autoinmune relacionado con la edad y el tiempo de evolución de la diabetes mellitus tipo 1. Los anticuerpos antitiroperoxidasa se relacionaron con la edad y el tiempo de evolución de la diabetes mellitus tipo 1.

Objetivo: Este estudo tem como objetivo apresentar a patologia do enxerto no momento da coleta e do impacto na sobrevida a longo prazo. Métodos: Os remanescentes de pontes de safena de 66 pacientes consecutivos com doença arterial coronária que receberam uma cirurgia de revascularização coronariana foram investigados patologicamente, e os fatores de risco preditivos e a sobrevivência foram analisados. Resultados: Alterações degenerativas da artéria medial, com ou sem proliferação da íntima estavam presentes em 36,8%, 37,8% e 35,6% de pontes da artéria torácica interna esquerda (ATIE), artéria radial e veia safena. Houve dois (3,0%) óbitos hospitalares e nove (14,1%) óbitos tardios. A regressão logística multinomial revelou que alterações patológicas na ATIE, dislipidemia, história de angioplastia/stent implantação coronariana transluminal percutânea e Y-enxerto foram significativos fatores de risco preditivos que influenciam negativamente a sobrevivência a longo prazo dos pacientes. Análise de sobrevida de Kaplan- Meier revelou que a sobrevivência a longo prazo de pacientes com alterações patológicas da ATIE foi significativamente reduzida em comparação com aqueles sem (74,1% vs. 91,4%, P=0,002), considerando que não foram observadas diferenças na sobrevivência de longo prazo entre pacientes com e sem alterações patológicas dos enxertos da artéria radial ou de veia safena. Conclusão: As alterações patológicas podem se desenvolver na revascularização no momento da coleta. As modificações ultraestruturais sutis e as expressões de reguladores do tônus vascular podem ser responsáveis pela patência tardia do enxerto. As alterações patológicas da ATIE no momento da coleta, em vez do enxerto da artéria radial ou da veia safena, podem afetar significativamente a sobrevida de longo prazo. Manobra não traumática da ATIE na coleta, bom controle da dislipidemia e para evitar uso de enxertos compostos pode ser útil na manutenção da arquitetura dos enxertos.

Objective: This study aims to present the graft pathology at the time of harvest and its impact on long-term survival. Methods: The remnants of the bypass grafts from 66 consecutive patients with coronary artery disease receiving a coronary artery bypass grafting were investigated pathologically, and pertinent predictive risk factors and survival were analyzed. Results: Medial degenerative changes with or without intimal proliferation were present in 36.8%, 37.8% and 35.6% of left internal mammary artery (IMA), radial artery and saphenous vein grafts. There were 2 (3.0%) hospital deaths and 9 (14.1%) late deaths. Multinomial logistic regression revealed left IMA pathological changes, dyslipidemia, history of percutaneous transluminal coronary angioplasty/stent deployment and Y-graft were significant predictive risk factors negatively influencing the patients’ long-term survival. Kaplan-Meier survival analysis revealed that the long-term survival of patients with left IMA pathological changes were significantly reduced compared with those without (74.1% vs. 91.4%, P=0.002); whereas no differences were noted in long-term survivals between patients with and without pathological changes of the radial arterial or saphenous vein grafts. Conclusion: Pathological changes may be seen in the bypass graft at the time of harvest. The subtle ultrastructural modifications and the expressions of vascular tone regulators might be responsible for late graft patency. The pathological changes of the left IMA at the time of harvest rather than those of the radial artery or saphenous vein graft affect significantly longterm survival. Non-traumatic maneuver of left IMA harvest, well-controlled dyslipidemia and avoidance of using composite grafts can be helpful in maintaining the architecture of the grafts.

In order to understand the mechanisms of poor osseointegration following dental implants in type 2 diabetics, it is important to study the biological properties of alveolar bone osteoblasts isolated from these patients. We collected alveolar bone chips under aseptic conditions and cultured them in vitro using the tissue explants adherent method. The biological properties of these cells were characterized using the following methods: alkaline phosphatase (ALP) chemical staining for cell viability, Alizarin red staining for osteogenic characteristics, MTT test for cell proliferation, enzyme dynamics for ALP contents, radio-immunoassay for bone gla protein (BGP) concentration, and ELISA for the concentration of type I collagen (COL-I) in the supernatant. Furthermore, we detected the adhesion ability of two types of cells from titanium slices using non-specific immunofluorescence staining and cell count. The two cell forms showed no significant difference in morphology under the same culture conditions. However, the alveolar bone osteoblasts received from type 2 diabetic patients had slower growth, lower cell activity and calcium nodule formation than the normal ones. The concentration of ALP, BGP and COL-I was lower in the supernatant of alveolar bone osteoblasts received from type 2 diabetic patients than in that received from normal subjects (P < 0.05). The alveolar bone osteoblasts obtained from type 2 diabetic patients can be successfully cultured in vitro with the same morphology and biological characteristics as those from normal patients, but with slower growth and lower concentration of specific secretion and lower combining ability with titanium than normal ones.

OBJETIVOS: Fator transformador de crescimento (TGF) -β/ Smad como via de sinalização em casos de dissecção aórtica e indivíduos normais não foi descrito anteriormente. O presente estudo foi elaborado para avaliar as expressões TGF-β/Smad como via de sinalização nos pacientes com dissecção aguda da aorta, em comparação com que nos pacientes com aneurisma da aorta torácica e com doença arterial coronariana, e (ou) com indivíduos saudáveis. MÉTODOS: Pacientes cirúrgicos consecutivos para o tipo A de dissecção aguda da aorta (20 pacientes), aneurisma da aorta (nove pacientes) ou doença arterial coronária (20 pacientes) foram selecionados para este estudo. Amostras de sangue (4 ml) foram obtidas a partir do cateter arterial radial direito após heparinização sistêmica antes do início da circulação extracorpórea na sala de cirurgia. Vinte e um voluntários jovens e saudáveis, sem problemas de saúde subjacentes que doaram amostras de sangue venoso do antebraço (4 ml) foram tomados como controle. Os espécimes cirúrgicos de tecidos aórtico foram obtidos imediatamente após terem sido cortados durante as operações da substituição da aorta nos pacientes com dissecção aórtica ou aneurisma da aorta. Em pacientes que foram submetidos à cirurgia de revascularização miocárdica, os tecidos da aorta minúsculos foram obtidos quando os orifícios da anastomose proximal na parede anterior da aorta ascendente foram feitos. Os tecidos da aorta foram para a RNA, proteínas ou preparações sobrenadantes até a detecção de TGF-β1 mRNA pela reação de transcrição reversa quantitativa em tempo real em cadeia da polimerase, de TGF-β1, receptor I de TGF-β, Smad2/3, Smad4 e Smad7 por Western Blot, e de TGF-β1 pelo teste de ELISA, respectivamente. Em particular, as correlações lineares dos tons de cinza relativo entre diferentes proteínas de cada grupo, e aquelas correlações entre os quantitativos TGF-β1 pelo teste de ELISA e o intervalo de tempo desde o início da cirurgia ou as dimensões máximas da aorta do grupo de dissecção da aorta foram avaliados. RESULTADOS: Reação de transcrição reversa quantitativa em tempo real em cadeia da polimerase mostrou que o mRNA TGF-β1 foi supra-regulado em todos os grupos cirúrgicos (1,59 ± 0,33 vs 1,45 ± 0,34 vs 1,48 ± 0,48, P> 0,05). Western blot revelou que as expressões de TGF-β1, receptor I de TGF-β, Smad 2/3, Smad4 e Smad7 foram positivos nos tecidos da aorta de todos os três grupos investigados. Dos tons de cinza quantitativa relativa, uma correlação inversa significativa foi observada entre TGF-β1 e Smad 2/3 (Y = 1,6417 +-0.8552X, r = -0,759, P <0,0001), e uma estreita correlação direta entre Smad4 e Smad7 (Y = 0,5905X + 0,2805, r = 0,781, P <0,0001) no Grupo de dissecção da aorta. No Grupo de Aneurisma da Aorta, Smad4 e Smad7 estavam também estreitamente correlacionados (Y = 0,1642 + 0.5228X, r = 0,727, P = 0,026), e no Grupo de Coronariopatias, TGF-β1 e Smad7 estavam muito significativamente correlacionados (Y = 0.5301X + 0,5758, r = 0,917, P = 0,004). Por meio do teste de ELISA, o nível de TGF-β1 do tecido aórtico foi menor na dissecção aórtica do que no aneurisma da aorta e nos grupos de doença arterial coronariana sem significância estatística (319,52 ± 129,21 proteína pg/mg vs 324,09 ± 49,70 pg/mg de proteína vs 304,15 ± 29,39 proteína pg/mg, P> 0,05). Os níveis de plasma TGF-β1 foram 1.158,30 ± 11,54 pg/ml, 1.170,27 ± 8,26 pg/ml, 1225,00 ± 174,42 pg/mL e 1.160,25 ± 13,01 pg/mL nos quatro grupos, respectivamente, mostrando diferenças significativas entre grupos (P <0,05). Nenhuma correlação significativa foi encontrada entre a aorta ou níveis plasmáticos de TGF-β1 e o intervalo de tempo desde o início da cirurgia ou as dimensões máximas da aorta nos pacientes do grupo de dissecção da aorta. CONCLUSÕES: A dissecção aórtica, aneurisma da aorta e arterosclerose podem estar associadas a uma via de sinalização TGF-β/Smad elevada, com dissecção aórtica exibindo uma suprarregulação menos proeminente. Isso poderia ter implicações para a ativação do sinal a jusante, presumivelmente, traduzindo-se em degradação da matriz na condição de dissecção da aorta, em comparação com deposição de matriz no aneurisma da aorta e doença arterial coronariana

OBJECTIVES: Transforming growth factor (TGF)-β/Smad signaling pathway in aortic dissection patients and normal subjects has not been previously described. The present study was designed to evaluate the TGF-β/Smad signaling expressions in the patients with acute type A aortic dissection in comparison with those in the patients with thoracic aortic aneurysm and with coronary artery disease, and (or) the healthy subjects. METHODS: Consecutive surgical patients for acute type A aortic dissection (20 patients), aortic aneurysm (nine patients) or coronary artery disease (20 patients) were selected into this study. Blood samples (4 ml) were obtained from the right radial arterial indwelling catheter after systemic heparinization prior to the start of cardiopulmonary bypass in the operating room. Twenty-one young healthy volunteers without underlying health issues who donated forearm venous blood samples (4 ml) were taken as control. The surgical specimens of the aortic tissues were obtained immediately after they were severed during the operations of the replacement of the aorta in the patients with aortic dissection or aortic aneurysm. In patients receiving coronary artery bypass grafting, the tiny aortic tissues were taken when the punch holes of the proximal anastomosis on the anterior wall of the ascending aorta were made. The aortic tissues were for RNA, protein, or supernatant preparations until detection of TGF-β1 mRNA by quantitative real-time reverse transcription polymerase chain reaction, of TGF-β1, TGF-β receptor I, Smad2/3, Smad4 and Smad7 by Western blot, and of TGF-β1 by enzyme-linked immunosorbent assay, respectively. In particular, the linear correlations of the relative grayscales between different proteins of each group, and those correlations between the quantitative TGF-β1 by enzyme-linked immunosorbent assay and the time interval from the onset to surgery or the maximal dimensions of the aorta of the aortic dissection group were assessed. RESULTS: Quantitative real-time reverse transcription polymerase chain reaction showed that TGF-β1 mRNA were upregulated in all surgical groups (1.59 ± 0.33 vs. 1.45 ± 0.34 vs. 1.48 ± 0.48, P > 0.05). Western blot revealed that the expressions of TGF-β1, TGF-β receptor I, Smad2/3, Smad4 and Smad7 were positive in the aortic tissues of all three investigated groups. Of the quantitative relative grayscales, a significant reverse correlation was noted between TGF-β1 and Smad2/3 (Y = -0.8552X + 1.6417, r = -0.759, P < 0.0001), and a close direct correlation between Smad4 and Smad7 (Y = 0.5905X + 0.2805, r = 0.781, P < 0.0001) in the Aortic Dissection Group. In the Aortic Aneurysm Group, Smad4 and Smad7 were also closely correlated (Y = 0.5228X + 0.1642, r = 0.727, P = 0.026), and in the Coronary Artery Disease Group, TGF-β1 and Smad7 were much significantly correlated (Y = 0.5301X + 0.5758, r = 0.917, P = 0.004). By enzyme-linked immunosorbent assay, TGF-β1 level of the aortic tissue was lower in the aortic dissection than in the aortic aneurysm and coronary artery disease groups with no statistical significance (319.52 ± 129.21 pg/mg protein vs. 324.09 ± 49.70 pg/mg protein vs. 304.15 ± 29.39 pg/mg protein, P > 0.05). The plasma TGF-β1 levels were 1158.30 ± 11.54 pg/ ml, 1170.27 ± 8.26 pg/ml, 1225.00 ± 174.42 pg/mL and 1160.25 ± 13.01 pg/mL in the four groups, respectively, showing significant intergroup differences (P < 0.05). No significant correlation was found between the aortic or plasma TGF-β1 levels and the time interval from the onset to surgery or the maximal dimensions of the aorta in the patients of the aortic dissection group. CONCLUSIONS: Aortic dissection, aortic aneurysm and atheroslerosis might be associated with an enhanced TGF β/Smad signaling function, with aortic dissection exhibiting a less prominent upregulation. It might have implications for downstream signal activation presumably translating into matrix degradation in the condition of aortic dissection in comparison to matrix deposition in aortic aneurysm and coronary artery disease