住院糖尿病患者周围动脉疾病危险因素及临床特点分析

目的探讨住院糖尿病患者周围动脉疾病的主要危险因素及临床特点。方法选择609例糖尿病患者测定踝臂指数(ankle arm index,ABI)。ABI≤0.9的184例患者纳入糖尿病周围动脉疾病组,0.9ABI≤1.3的425例患者纳入糖尿病非周围动脉疾病组。比较两组患者年龄、性别、临床特点。对糖尿病周围动脉疾病危险因素进行非条件Logistic回归分析。结果病例组原发性高血压(高血压)、冠状动脉粥样硬化性心脏病(冠心病)、脑血管疾病、糖尿病肾病、糖尿病神经病变、足部溃疡、高尿酸血症的患病率及吸烟患者比例明显高于对照组,差异有统计学意义(P0.05)。184例糖尿病周围动脉疾病患者中79.89%无临床症状,3.26%间歇性跛行;14.67%足部溃疡,2.17%足部坏疽。单因素非条件Logistic回归分析提示年龄、病程、高血压、糖尿病周围神经病变、糖尿病肾病、冠心病、脑血管疾病、足部溃疡、尿酸、肌酐、纤维蛋白原、卵泡雌激素、黄体生成素、尿白蛋白肌酐比值和下肢动脉B超动脉粥样硬化为糖尿病周围动脉疾病的危险因素(P0.05)。多因素非条件Logistic回归分析提示,年龄、收缩压、足部溃疡以及纤维蛋白原等是糖尿病周围动脉疾病的危险因素(P0.05)。结论住院糖尿病周围动脉疾病患者大多无明显临床症状,易合并高血压、糖尿病肾病、糖尿病神经病变、冠心病、脑血管等疾病,临床上应重视糖尿病周围动脉疾病筛查及危险因素控制。     

糖尿病足患者并存无症状性心肌缺血危险因素分析

目的 探讨糖尿病足患者并存无症状性心肌缺血(SMI)的危险因素. 方法 采用病例对照研究方法,选取2008年1月至2014年5月在我院住院的糖尿病足患者318例,根据是否存在SMI分为糖尿病足并存SMI者(SMI组)256例和糖尿病足无SMI者(对照组)62例.收集患者一般临床资料,采用多因素非条件Logistic回归分析糖尿病足并存SMI的危险因素. 结果 SMI组男性、体质指数≥25 kg/m2、高尿酸血症及左心室射血分数(LVEF)＜55％的比例高于对照组(P＜0.05);与对照组比较,SMI组糖尿病病程≥10年、足部皮肤温度降低、踝臂指数(ABI)≤0.9、肾小球滤过率(eGFR)＜60 ml·min-1·1.73m-2的比例升高,差异有统计学意义(P＜0.01).Logistic回归分析显示,男性(OR=3.444,95％CI:1.328～8.937,P=0.011)、体质指数≥25 kg/m2(OR=3.363,95％ CI:1.337～8.461,P=0.010)、糖尿病病程≥10年(OR=4.164,95％CI:1.796～9.654,P=0.001)、ABI≤0.9(OR=4.741,95％ CI:1.953～11.508,P=0.001)、eGFR＜60 ml· min-1·1.73m-2(OR=4.537,95％CI:1.333～15.440,P=0.016)是糖尿病足并存SMI的危险因素. 结论 男性、体质指数≥25 kg/m2、糖尿病病程≥10年、ABI≤0.9、eGFR＜60 ml·min-1·1.73 m-2是糖尿病足并存SMI的危险因素,对有上述危险因素的糖尿病足患者应及早筛查SMI.     

踝肱指数高值糖尿病患者下肢动脉粥样硬化病变的超声特点

目的分析踝肱指数(ABI)高值糖尿病患者下肢动脉粥样硬化病变的超声特点。方法随机选取糖尿病患者92例,根据ABI值分为:ABI高值组(23例,ABI>1.3)、AB1正常组(39例,ABI 0.9～1.3)及ABI低值组(30例,ABI<0.9),根据下肢动脉超声结果,对下肢动脉粥样硬化病变进行分析。结果与ABI低值组比较,ABI高值组患者下肢动脉病变闭塞率明显降低(63.3%vs 4.3%,P<0.05);ABI高值组患者下肢动脉粥样硬化病变主要表现为弥漫性斑点状强回声及小斑块病变(82.6%),并且,病变主要分布于下肢远端(44.4%)。ABI正常组患者下肢动脉粥样硬化病变以近端为主(81.8%)。结论 ABI高值患者下肢动脉粥样硬化病变的临床特征与动脉内膜中层钙化的病变特征一致,表明ABI高值对糖尿病患者动脉内膜中层钙化具有较高的预测价值。     

踝臂指数大于或等于0.9患者的下肢动脉粥样硬化病变情况分析

目的探讨踝臂指数(ABI)≥0.9患者的下肢动脉粥样硬化病变情况。方法选取在我院就诊的心血管疾病患者,且1周内同时完成ABI和下肢动脉超声检查,且ABI值≥0.9的331例患者。以患者ABI值为依据,分为临界值组(31例,ABI:0.9～0.99)、低值组(111例,ABl:1.0～1.09)、正常值组(157例,ABI:1.1～1.29)及高值组(32例,ABI≥1.3),比较各组患者下肢动脉粥样硬化病变的情况。结果临界值组及高值组患者的动脉内膜中层厚度增厚比例显著高于正常值组(P<0.05);动脉粥样斑块病变发生率明显高于正常值组(P<0.05),井均存在下肢动脉狭窄病变(血管直径狭窄≥50%)。临界值组患者主要以动脉粥样斑块为主,而高值组患者以弥漫性病变为主;低值组与正常值组患者的下肢动脉粥样硬化病变程度差异无统计学意义(P>0.05);高值组患者的下肢动脉粥样硬化病变以膝以下动脉病变为主。结论对ABI临界值及高值患者,应及时采取预防动脉粥样硬化措施。     

2型糖尿病踝肱指数和颈动脉硬化及其斑块面积的相关性研究

对251例2型糖尿病患者采用多普勒超声检测患者ABI,并依据ABI值分为2组(ABI≤0.9和ABI0.9)。同时超声检测所有患者颈动脉内中膜厚度(CIMT)。结果 ABI低值组与对照组在年龄、性别等匹配的情况下,ABI与颈动脉粥样硬化发生率仍然有统计学意义(P0.05),ABI与颈动脉粥样斑块面积具有统计学意义(B=-51.1,P0.05)。结论2型糖尿病患者ABI值与颈动脉粥样硬化发生率、斑块面积有显著相关性。     

门诊2型糖尿病足高危患者的踝肱指数与糖尿病足的相关性研究

目的 对有下肢症状的门诊2型糖尿病患者进行踝肱指数(ankle-brachial index,ABI)监测,了解糖尿病下肢血管病变的患病率并探讨ABI与糖尿病足的关系.方法 在上海市糖尿病临床医学中心门诊就诊的1010例有下肢症状的2型糖尿病患者中测定ABI,同时测定空腹和餐后血糖、糖化血红蛋白(HbA1e)、血压、体重指数(BMI)、双下肢的振动感觉阈值等,按ABI结果将患者分为5组:A组(ABI>1.3,35例)、B组(0.91.3占3.5%(35/1010).合并足病者83例(8.02%),包括溃疡50例(4.95%),坏疽13例(1.29%),感染20例(1.98%).相关分析显示ABI与年龄、病程、收缩压、HbA1c和糖化血清白蛋白呈显著负相关(r值分别为-0.201、-0.171、-0.113、-0.160、-0.137,均P<0.01).Logistic回归分析显示ABI是糖尿病足病的独立危险因素(t=6.805,P=0.00).结论 门诊2犁糖尿病足高危患者中26.4%存在下肢动脉病变,8.02%存在足病.年龄、病程、血糖控制不佳是影响ABI的关键因素.ABI的降低与足病的发生密切关联.     

踝肱指数在诊断2型糖尿病患者下肢动脉病变中的临床意义

目的:了解踝肱指数(ABI)在诊断2型糖尿病下肢动脉病变(LEAD)的临床意义和影响因素。方法:对231例2型糖尿病患者测定ABI,以ABI值0.9为异常分为LEAD组(46例)和非LEAD组(对照组,185例),所有患者均进行体重量指数,腰臀比,血糖、血脂、血压、尿微量白蛋白等检查,并对其结果进行分析。结果:在231例2型糖尿病患者中,46例ABI0.9的LEAD患者的病程[(9.1±6.3)年:(4.5±5.7)年]、糖化血红蛋白[10.9±3.3)%:7.8±1.2)%]、低密度脂蛋白-胆固醇[(3.1±0.9)mmol/L:(2.6±1.1)mmol/L]及脉压[(59±15)mmHg:(52±14)mmHg],均明显高于对照组(P均0.05)。结论:糖尿病合并下肢动脉病变者具有病程长、血糖高、脉压差大、血脂紊乱等特点,踝肱指数是一项花费小、简单无创的诊断下肢动脉病变的可靠指标。     

糖尿病下肢动脉病变的早期诊断指标研究

回顾资料完整的2型糖尿病病历105例,根据脉冲多普勒测定的ABI分组(ABI≤0.9为I组,ABI>0.9为II组),观察踝部动脉频谱波形、峰值流速的变化,彩色多普勒超声对下肢动脉病变发现率,及ABI与性别、年龄、BMI、血压,HbA1c、糖尿病病程、血脂、尿酸等的关系。结果ABI与动脉频谱波形吻合很好,且有统计学意义。ABI与峰值流速吻合度不高。彩色多普勒超声提示下肢动脉硬化的发现率I组高于II组,差异有显著性意义,ABI>0.9组也有58.2%患者发现动脉硬化或斑块。年龄、糖化血红蛋白、胆固醇在ABI不同的两组中是有区别的I,组大于II组,差异有统计学意义。结论多普勒频谱波形变化是发现PAD的一个有价值的线索,峰值流速则是一个多变的参数,彩色多普勒超声发现的下肢动脉病变早于ABI。     

无创影像检查方法诊断糖尿病下肢动脉病变的价值

目的临床探讨无创影像检查方法在糖尿病下肢动脉病变中的诊断价值。方法选取该院2015年1月—2016年1月收治的61例II型糖尿病患者,作为研究组。同时,选择61同期健康人员,作为对照组。对两组人员的ABI踝臂指数、PWV脉搏波传导速度、脉压指数进行检测,计算研究组患者的下肢动脉斑块状况。结果经过检测分析,研究组ABI值为(1.02±0.09),比对照组(1.11±0.07)明显更低,研究组PWV值为(18.53±5.12)m/s,比对照组的(15.32±3.28)m/s明显更高,研究组脉压指数值为(0.40±0.03),比对照组(0.33±0.04)明显更高,两组患者各项指标对比具有统计学意义(P0.05)。研究组有8例ABI小于0.9,给予下肢动脉彩超检查显示,有6例患者存在动脉斑块。结论针对糖尿病下肢动脉病变患者,采用无创动脉检测技术,具有良好敏感性,可及时检测动脉硬化情况,发现动脉阻塞状况,对临床干预治疗、护理具有良好诊断价值。     

白蛋白球蛋白比值与老年糖尿病患者下肢动脉疾病的关系

目的 探讨老年糖尿病患者白蛋白球蛋白比值(AGR)与下肢动脉疾病(LEAD)的关系.方法 收集2019年1月21日～2021年8月4日南方医科大学南方医院内分泌科行踝肱指数(ABI)检测的老年糖尿病患者266例,根据诊断分为LEAD组81例,非LEAD组185例.又根据ABI水平分为低ABI组81例(ABI≤0.9),...     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.     

Formoterol Delivered via the Dry Powder Aerolizer® Inhaler Versus Albuterol MDI and Placebo in Mild-to-Moderate Asthma: A Randomized, Double-Blind, Double-Dummy Trial

The objectives of this study were to compare the efficacy and tolerability of twice-daily formoterol dry powder 12 µg and 24 µg (Foradil) delivered via Aerolizer inhaler with four times daily albuterol (salbutamol) 180 µg delivered via metered dose inhaler (MDI) and placebo. A total of 554 adolescents and adults (ages 12-75 years) with mild-to-moderate asthma were randomized to this 12-week, multicenter, double-blind, double-dummy, placebo-controlled, parallel-group study. Twelve-hour spirometry measurements were taken at weeks 0, 4, 8, and 12. A total of 484 patients completed the study (122, 116, 127, and 119 given formoterol 12 µg, formoterol 24 µg, albuterol, and placebo, respectively). For the primary efficacy variable, the forced expiratory volume in 1 second (FEV₁), both formoterol 12 µg and 24 µg were statistically superior to placebo at all time points on all test days (p ≤ 0.017) and to albuterol at most time points on all test days (p ≤ 0.001). The onset of improvement in FEV₁ was rapid, with 15% increase within 5 min in 57%, 71%, and 65% of formoterol 12 µg, formoterol 24 µg, and albuterol patients, respectively. Formoterol was also superior to placebo and albuterol in terms of secondary efficacy variables: FEV₁ area under the curve, percentage of predicted FEV₁, forced vital capacity and forced expiratory flow, asthma symptom scores, and peak expiratory flows. In conclusion, both formoterol doses were superior to placebo in all lung function measurements. Overall, compared with albuterol, both formoterol doses produced superior bronchodilation. Formoterol and albuterol were safe and well-tolerated.