Objectives Alzheimer’s disease (AD), impaired fasting glucose (IFG), and Type 2 diabetes mellitus (T2DM) were reported associated with smaller brain volumes. Nevertheless, the association of hyperglycemia with brain volume changes in AD patients remains unclear. To investigate this issue, structural magnetic resonance imaging was used to compare brain volumes among AD patients with different fasting glucose levels. Methods Eighty-five AD patients were divided into three groups based on their fasting glucose level as suggested by the American Diabetes Association: normal fasting glucose group (AD_NFG, n = 45), AD_IFG group (n = 15), and AD_T2DM group (n = 25). Sagittal 3D T1-weighted images were obtained to calculate the brain volume. Brain parenchyma and 33 brain structures were automatically segmented. Each regional volume was analyzed among groups. For regions with statistical significance, partial correlation analysis was used to evaluate their relationships with fasting glucose level, corrected for Mini-Mental State Examination score, age, education level, cholesterol, triglyceride, and blood pressure. Results Compared with the AD_IFG and AD_NFG groups, the volume of pons in AD_T2DM group was significantly smaller. Fasting glucose was negatively correlated with pontine volume. Conclusions T2DM may exacerbate pontine atrophy in AD patients, and fasting glucose level is associated with pontine volume.
C oronary artery bypass grafting (CABG) has prognostic benefit in patients with severe coronary disease and left ventricular dysfunction. It is particularly important in diabetic patients where CABG confers greater long term protection against coronary events than percutaneous angioplasty. However, up to 32% of saphenous vein grafts (SVGs) and 31% of radial artery grafts (RAGs) may be non-patent by one year.1 Hypertriglyceridaemia is associated with increased mortality after CABG, particularly among diabetics, but its relation to early graft patency is unknown.2 3 We investigated the association between metabolic risk factors and early graft occlusion by using non-invasive computed tomography (CT) angiography. METHODSThe study was approved by the institutional review board ethics committee. All patients attending a preoperative clinic for elective CABG between October 2002 and January 2004 in sinus rhythm with normal serum creatinine, but without a history of intravenous contrast allergy, were invited to participate. Written informed consent was obtained. Of 94 consecutive participants, 14 were subsequently excluded: two died postoperatively, one had a stroke, three developed renal impairment, and eight withdrew from the study.Recorded baseline characteristics were age, sex, history of smoking, hypertension (blood pressure . 140/90 mm Hg or pharmacological treatment for hypertension), hypercholesterolaemia (fasting cholesterol . 5.5 mmol/l or taking a cholesterol lowering agent), diabetes, and body mass index (BMI). Fasting preoperative total, low density lipoprotein, and high density lipoprotein cholesterol, triglycerides, glucose, insulin, C reactive protein, haemoglobin A 1c, fibrinogen, activated partial thromboplastin time, and white cell count were measured at a government certified laboratory. Insulin resistance and pancreatic b cell secretory capacity were calculated by means of the homeostasis model assessment for insulin resistance (HOMA-R) and for b cell function (HOMA-b), according to the formulas HOMA-R = fasting glucose (mmol/l) 6 fasting insulin (mU/l)/22.5, and HOMAb = fasting insulin (mU/l)/[fasting glucose (mmol/ l) 2 3.5]. 4 Graft patency was assessed by multislice computed tomographic (CT) angiography (Lightspeed Plus, GE Medical Systems, Waukesha, Wisconsin, USA) at 4-6 weeks postoperatively. Forty three patients were given oral metoprolol to achieve an average (SD) scan heart rate of 62 (9) beats/min. The scan parameters were 4 6 2.5 mm collimation, 1.3-1.5 pitch, 0.5 seconds rotation time, 120 kV, 270 mA, and 150 ml of intravenous non-ionic contrast medium (Ultravist 300, Schering AG, Berlin, Germany) at 3.5 ml/s. The mean breath hold was 27 seconds (range 22-32 s). Two analysers independently assessed each graft for patency (Card IQ, Advantage Workstation 4.0, GE Medical Systems) and, as there was complete agreement, consensus evaluations were not required. The reference diameter and the target native artery stenosis were measured from the preoperative conventional coronary angiograms by ...
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