摘要:目的: 观察格列美脲对2型糖尿病患者心血管的保护作用并探讨其可能的机制。 方法 :112例T2DM患者随机分为格列美脲组(格列美脲+二甲双胍)和对照组(格列本脲+二甲双胍),观察治疗前后两者空腹及餐后两小时血糖(FBG,2hPBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、HOMA模型胰岛素抵抗指数(HOMAIR)、甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、同型半胱氨酸(HCY)、血浆脂联素的变化。 结果 :两组患者的TC、LDLC、TG、FBG、2hPBG都较治疗前降低,连续服用6个月以上格列美脲的T2DM患者其血浆HCY、HOMAIR、血糖水平明显下降,血浆脂联素水平明显升高,与对照组相比差异有统计学意义(〖WTBX〗P lt;005)。 结论 :格列美脲能降低多项心血管危险因子水平,对血脂、HCY和动脉粥样硬化都有良性调节作用,其作用基础可能与改善胰岛素抵抗,增加血浆脂联素相关。Abstract: Objective: To observe the protective effects and to explore mechanisms of glimepiride on cardiovascular system of Type 2 Diabetes Mellitus. Methods : 112 patients with type 2 diabetes mellitus were randomly divided into treatment group (glimepiride combined with metformin) and control group (glibenclamide combined with metformin). The fasting blood glucose (FBG), 2hPBG, hemoglobin A1c (HbA1c), FINS, HOMAIR, blood lipid (TC, TG, LDLC and HDLC), HCY (homocysteine) and adiponectin were detected before and after treatment. Results : In all cases, the level of TC、LDLC、TG、FBG、2hPBG were decreased after treated with glimepiride or glibenclamide combined with metformin for 6 monthes. Moreover, the level of HCY, HOMAIR and blood glucose were decreased and the level of adiponectin was increased significantly than that of in control group (Plt;005). Conclusion : Glimepiride showed the effective on decreasing the risk factor of cardiovascular system disease with regulation of blood lipid, HCY, and improve the atherosclerosis. The effective of glimepiride on cardiovascular system was relation to improved the insulin resistance and increase the adiponectin.
ObjectiveTo summarize the research progress of ultrasmall superparamagnetic iron oxide (USPIO) enhanced magnetic resonance imaging (MRI) in normal-sized lymph node metastasis of colorectal cancer.MethodThe relevant literatures published recently at domestic and abroad about USPIO enhanced MRI in normal-sized lymph node metastasis of colorectal cancer were collected and reviewed.ResultsUSPIO, a kind of lymph node targeted magnetic resonance contrast agent, could be used to evaluate lymph node metastasis of malignant tumors. USPIO enhanced MRI could detect normal-sized lymph node metastasis in colorectal cancer effectively compared with normal MRI. It provided a higher diagnostic performance than normal enhanced MRI. In addition, USPIO enhanced MRI could also distinguish inflammatory and metastatic lymph nodes better that were difficult to be distinguished by normal enhanced MRI.ConclusionUSPIO enhanced MRI shows a certain potential for clinical application in detecting normal-sized lymph node metastasis of colorectal cancer, but it has not been widely used in China.
摘要:目的: 探讨非体外循环冠状动脉旁路移植术(offpump coronary artery bypass grafting,OPCABG)患者的围术期管理。 方法 : 回顾分析2005 年7 月至2008 年6 月的200 例择期非体外循环下冠状动脉旁路移植术患者200例,诱导用咪唑安定005～01 mg/kg,依托咪酯03 mg/kg,芬太尼5～15 μg／kg,罗库溴铵05～10 mg／kg,麻醉维持采用持续泵注异丙酚1～4 mg/kg·h,,间断辅以05%～20%异氟烷吸入,术中随手术操作时出现的血流动力学变化,用血管活性药物调整。 结果 : 麻醉效果满意,术中血压心率基本满意。本组患者苏醒时间,拔管时间和ICU停留时间为(178±42) min、(105±40)h、(18±63)h。术毕180例患者在12 h内拔管。180例预后良好,无麻醉并发症。 结论 :非体外循环下冠状动脉旁路移植术麻醉管理的关键是合理的应用麻醉药和血管活性药来维持血流动力学平稳。Abstract: Objective: To summarize the technique and evaluate the effect of anesthesia for offpump coronary artery bypass surgery (OPCAB). Methods :From July of 2005 through June of 2008,two hundred consecutive patients undergoing OPCAB were retrospectively studied. Anesthesia was induced with midazolam 00501mg/kg, or etomidate 03mg/kg and fentanyl 515μg/kg. Anesthesia was maintained with isoflurane 05%20% and oxygen, combined with propofol 14mg/(kg·h). Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately. Results :Intraoperative hemodynamics deviation was tolerated with the support of inotropics. The mean of patients of consciousness recovery time, tracheal extubation time and stay in ICU time were 178±42 min,105±40 hours and 18±63 hours. The patients were discharged in 80±12 days. Racheal intubation were remained 12 hours in 180 patients after operation, 180 patients had good recovery without any anesthesia complications. Conclusion : Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.
Objective To explore key genes and mechanisms of depression aggravating Crohn disease. Methods In March 2023, the Public Health Genomics and Precision Health Knowledge Base and Gene Expression Omnibus database were used to identify the overlapping differentially expressed genes between Crohn disease and depression and the key genes were screened by Metascape, STRING, Cytoscape, and protein interaction network analysis. The Gene Expression Omnibus database was used to analyze the correlations between key genes and clinical pathologies such as Crohn Disease Endoscopic Index of Severity and intestinal microvilli length. Results There were 137 overlapping differentially expressed genes between Crohn disease and depression, and 25 key genes were further screened out. Among them, CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A genes were significantly correlated with multiple clinical parameters. The functions of PROK2 and PROK2-related genes were mainly enriched in neutrophil and granulocyte migration, neutrophil and granulocyte chemotaxis, etc. Conclusions There are 25 key genes, especially CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A, that possibly contribute to the establishment and deterioration of Crohn disease caused by depressive disorder. Among these genes, PROK2 showes the possibility of regulating immune cell (neutrophils and CD8+ T cells) infiltration.
Abstract： Objective To summarize early clinical result of total cavopulmonary connection, and analyze the risk factors contributing to prolonged postoperative recovery. Methods Between February 2009 and August 2010, 58 patients with functional univentricular complex congenital heart disease received total cavopulmonary connection in Beijing Fu Wai Hospital. All of them were diagnosed by echocardiogram and angiography including 26 patients with single ventricle, 10 patients with tricuspid atresia, 4 patients with pulmonary artery atresia, 5 patients with double outlet rightventricle, 1 patient with transposition of great arteries, and 12 patients with corrected transposition of the great arteries.Fifty seven patients underwent extracardiac conduit total cavopulmonary connection, and only one patient underwent total cavopulmonary connection with an intracardiac lateral tunnel. According to their postoperative pleural drainage volume and duration, these 58 patients were divided into a large pleural drainage volume group (17 patients with 10 males and 7 females, mean age of 8.61±6.73 years）that included patients with large volume and long duration of pleural drainage, and a little pleural drainage volume group (41 patients with 15 males and 26 females, mean age of 7.21±4.24 years) . A univariable analysis was conducted to compare the risk factors that effected recovery result between the two groups. Results There was no death in hospital period. The average length of hospital stay was 12.30±9.80 d . Average drainage time (18.00±5.50 d versus 5.00±2.20 d , t= -1.967, P ＜ 0.05）, drainage volume (12.30±2.60 ml/(kg·d) versus 2.80±1.70 ml/(kg·d), t=-3.221, P ＜ 0.05), and hospital stay (20.10±7.20 d versus 7.20±1.10 d, t=-2.003, P ＜ 0.05） of the large pleural drainage volume group were significantly larger or longer than those of the little pleural drainage volume group. Univariate analysis showed that preoperative pulmonary pressure measured by catheter in the large pleural drainage volume group was significantly higher than that in the little pleural drainage volume group (17.42±5.34 mm Hg versus 13.91±5.22 mm Hg，t=-2.073，P ＜ 0.05). Conclusions The mortality and major morbidities after total cavopulmonary connection are low in the current era. Preoperative high pulmonary pressure is a risk factor for large amount of pleural drainage and prolonged recovery.
Objective To investigate the evaluation value of serum interleukin-34 (IL-34), macrophage migration inhibitor (MIF), osteopontin (OPN) and hypersensitive C-reactive protein (hs-CRP) in the diagnosis and prognosis of active pulmonary tuberculosis. Methods Clinical data of 100 patients with active pulmonary tuberculosis admitted from June 2019 to June 2022 were selected as an observation group and retrospectively analyzed. All patients received standardized anti-tuberculosis therapy for 6 months and were divided into a good prognosis group (76 cases) and a poor prognosis group (24 cases) according to the prognosis. Another 80 healthy volunteers who underwent physical examination during the same period were selected as the control group. Serum levels of IL-34, MIF, OPN and hs-CRP were detected in each group, and the value of serum IL-34, MIF, OPN and hs-CRP in the diagnosis and prognosis of active pulmonary tuberculosis was analyzed by receiver operating characteristic curve (ROC curve). Results Serum levels of IL-34, MIF, OPN and hs-CRP in the observation group were higher than those in the control group (all P<0.05). ROC curve showed that serum IL-34, MIF, OPN, hs-CRP had a certain diagnostic value in active pulmonary tuberculosis, with area under ROC curve (AUC) of 0.864, 0.870, 0.865, and 0.880, respectively (all P<0.01), and the combination of the four indexes had a higher diagnostic value (AUC=0.902, P<0.01). Serum levels of IL-34, MIF, OPN and hs-CRP in the good prognosis group were lower than those in the poor prognosis group (all P<0.05). ROC curve showed that serum IL-34, MIF, OPN, hs-CRP had a certain value in evaluating the prognosis of active pulmonary tuberculosis, with AUC of 0.850, 0.874, 0.837, and 0.842, respectively (all P<0.01), and the combined value of the four indexes was higher (AUC=0.923, P<0.01). Conclusion The combined detection of serum IL-34, MIF, OPN and hs-CRP has high value in the diagnosis and prognosis assessment of active pulmonary tuberculosis.
目的：研究银杏达莫对糖尿病大鼠肾功能的影响，并从抗氧化应激反应的角度探讨其可能的作用机制。方法：50只Wistar大鼠随机分为正常组（10只），糖尿病模型组（20只）及糖尿病模型加银杏达莫组（20只）。采用单次腹腔注射链脲佐菌素（55 mg/kg）诱导糖尿病肾病（DN）大鼠模型，腹腔注射银杏达莫水溶液。生化法测定血糖，血、尿肌酐及尿白蛋白；尾静脉取血ELISA法检测血清血管内皮先长因子（VEGF）水平；肾脏匀浆后测肾脏丙二醛（MDA）、一氧化氮（NO）的含量。结果：糖尿病模型组和银杏达莫组生化指标均高于正常组（Plt;0.05），银杏达莫组MDA、NO及VEGF的表达减少与模型组比较差异有显著性（Plt;0.05）。结论：银杏达莫具有减轻糖尿病大鼠蛋白尿，提高尿肌酐排泄，减轻肾脏损害的作用，其机制可能与提高肾脏抗氧化系统功能有关。
Objectives We aimed to assess the methodological qual ity of RCT on acupuncture for migraine prophylaxis. Methods With the searching terms including acupuncture, migraine, prophylaxis and prevent, etc, the database of the Cochrane Library (Issue 4, 2007), MEDLINE (1966-2007), EMBase (1966-2007), CBM (1978-2007) and CMCC (1994-2007) were searched from their date of start publ ication. Chinese medical journals and relevant academic conference proceedings were hand searched as well. Several items in included trials were assessed, including methodology, diagnostic criteria, inclusion/exclusion criteria, acupuncture/control interventions, outcome measures and follow-up, etc. Result Among the 12 included trials, 9 trials overseas were high-qual ity and 3 in China were low-quality. Frequency or days of migraine attacks and SF-36/SF-12 were often evaluated as outcome measures in western countries, while headache index was used in China. Among the 12 trials, 9 reported the follow-up outcomes and 8 mentioned adverse events. Conclusion There was no high qual ity trial on acupuncture for migraine prophylaxis in China. The outcome measures in trials published in China by now can not evaluate the outcomes of acupuncture for migraine prophylaxis accurately. To study designs, advantages of trials oversea can be used for reference. To Chinese cl inical physicians, prophylactic therapy and abortive therapy of migraine should be distinguished in order to design high-qual ity study on acupuncture for migraine prophylaxis.
Abstract： Objective To analyze the mid-term outcomes after correction of type Ⅰ and type Ⅱ persistent truncus arteriosus in all patients operated in our institution over the past 5 years. Methods Between May 2006 and October 2010, 17 patients, mean age 4.7（ 0.7-19.0）years, underwent repair of truncus arteriosus（ type Ⅰ in 13 and type Ⅱ in 4） in Fu Wai Cardiovascular Hospital. Some other concomitant cardiovascular malformations included truncal valve regurgitation, partial anomalous pulmonary venous connection, mitral regurgitation and atrial septal defect. Their average pulmonary vascular resistance was （4.4±2.2） Wood units detected by cardiac catheterization before operation. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in all 17 patients （aortic homografts in 3, pulmonary homografts in 2, and bovine jugular vein in 12 patients）. Survivors were followed up for assessment of residual heart lesions. Results The early mortality was 5.8% （1/17）. The mean cardiopulmonary bypass time was （165±52） min, mean aortic cross-clamping time was （114±29） min, and mean postoperative ventilation time was （106±148） h. Two patients had pleural effusion after surgery, 2 patients underwent tracheostomy, and other patients recovered uneventfully. The surviving 16 patients were followed up for 0.6-5.0 years. All patients were alive with their original conduit during follow-up. No patient required re-operation for conduit dysfunction after correction. Conclusion Truncus arteriosus remains a challenging congenital heart disease. For patients with type Ⅰ and type Ⅱ persistent truncus arteriosus who have missed their best age for correction, cardiac catheterization should be routinely examined, and the operation should be performed if the pulmonary vascular resistance is under 8 Wood units before operation. Although the short- and mid-term results of surgery are good, more observations are needed to assess its long-term effect.
Objective To summarize the diagnosis and treatment of fibular fracture in ankle fracture. MethodsRelevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification. ResultsConservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment. ConclusionFirst of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.