Subclinical and clinical atherosclerosis in non-alcoholic fatty liver disease is associated with the presence of hypertension

Background and aimsNon-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular (CV) risk. However, it is unclear whether NAFLD contributes independently to the development of CV disease. Our study aimed at assessing the differences in several indices of atherosclerosis, arterial stiffness and cardiac morphology among patients with isolated NAFLD, isolated hypertension (HT) or a combination of the two conditions.Methods and resultsA total of 169 participants (mean age = 50.4 ± 10.2 yrs; males = 73.6%) were divided according to the presence of NAFLD and HT into three groups: only NAFLD (55 patients), only HT (49 patients), and NAFLD + HT (65 patients). Exclusion criteria were a BMI≥35 kg/m² and a diagnosis of diabetes mellitus. Carotid ultrasonography was performed to measure markers of atherosclerosis and arterial stiffness. Cardiac remodeling was analyzed using echocardiography. The prevalence of subclinical and overt atherosclerosis was significantly higher in the NAFLD + HT patients as compared to the other two groups (atherosclerotic plaques: 43.1%, 10.9%, and 22.4% (p < 0.001) in NAFLD + HT, NAFLD, and HT groups, respectively). No differences were found among indices of arterial stiffening and cardiac remodeling across the three groups. In multivariate regression analysis, the coexistence of NAFLD and HT was an independent risk factor for overt atherosclerosis (OR = 4.88, CI 95% 1.14–20.93), while no association was found when either NAFLD or HT was considered alone.ConclusionOvert atherosclerosis was significantly present only in NAFLD + HT patients, but not in patients with isolated NAFLD. This implies that the impact of NAFLD on vascular structure and function could depend on the coexistence of other major CV risk factors, such as HT.     

Relation of genetic polymorphisms in microRNAs with diastolic and systolic function in type 2 diabetes mellitus

Background and aimsType 2 diabetes mellitus (T2DM) has high risk of developing cardiac dysfunction, increasing of either cardiovascular death or hospitalization for heart failure. MicroRNAs (miRNA) affect cardiac function of T2DM. The aim of this study was to investigate the relationships between five miRNA single nucleotide polymorphisms (SNP) and diastolic and systolic function of T2DM.Methods and resultsThree hundred untreated T2DM subjects were included. Each subject underwent SNP genotyping, conventional echocardiography, tissue doppler imaging, and speckle tracking imaging. The effects of miRNA SNPs on diastolic and systolic function were evaluated. The diastolic function of T2DM subjects with miR-133a-1-rs8089787 wild genotype or let-7f-rs10877887 variant genotype was lower than those with miR-133a-1-rs8089787 variant genotype or let-7f-rs10877887 wild genotype, manifesting as higher left atrial volume index, lower mean E′, and higher E/E’ (P < 0.05). There were no significant effects of miR-133a-2-rs13040413, let-7a-1-rs13293512 and miR-27a-rs895819 on the diastolic function of T2DM subjects (P > 0.05). These five miRNA SNPs had no effect on the systolic function of T2DM subjects (P > 0.05).ConclusionsMiRNA-133a-1-rs8089787 and let-7f-rs10877887 were associated with impaired cardiac diastolic function in T2DM. The findings may be a promising therapeutic targets for preventing diastolic dysfunction in T2DM.     

估算的肾小球滤过率、血尿酸和纤维蛋白原与缺血性脑卒中溶栓后脑出血转化的关系及对结局的预测价值

目的探讨估算的肾小球滤过率(eGFR)、血尿酸(SUA)、纤维蛋白原(FIB)与缺血性脑卒中溶栓后脑出血转化及临床结局的关系。方法选取158例缺血性脑卒中用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓患者,包括无脑出血转化121例、脑出血转化37例。采用Logistic回归方程分析rt-PA静脉溶栓后脑出血转化影响因素;对比不同早期神经功能患者eGFR、SUA、FIB水平;评价eGFR、SUA、FIB对早期神经功能恶化(END)的预测价值;比较不同eGFR、SUA、FIB水平患者的累积生存率。结果rt-PA静脉溶栓2 h、24 h后,脑出血转化者eGFR、SUA、FIB水平较无脑出血转化者降低(P<0.05)。Logistic回归分析显示,年龄、基线NIHSS评分、基线舒张压、大面积脑梗死及溶栓后2 h和24 h的eGFR、SUA、FIB均为rt-PA静脉溶栓后脑出血转化的影响因素(P<0.05)。END患者溶栓后2 h和24 h的eGFR、SUA、FIB均低于非END患者(P<0.05)。ROC曲线分析显示,溶栓后24 h的eGFR、SUA、FIB联合预测END的曲线下面积为0.809,大于任一单一指标,其灵敏度、特异度分别为80.95%、74.14%。生存分析结果表明,溶栓后24 h的eGFR、SUA、FIB高水平组的累积生存率高于低水平组(P<0.05)。结论eGFR、SUA、FIB与缺血性脑卒中预后密切相关,监测上述指标有助于脑出血转化诊断及END预测。     

Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

特发性高嗜酸性粒细胞综合征1例报告

特发性嗜酸性粒细胞增多综合征（idiopathic hypereosinophilic syndrome，IHES）是一组病因未明、发病机制也了解不多、临床表现多种多样、以成熟嗜酸粒细胞增多为主伴有多脏器损害的综合征，有关文献报道较少见。本文对1例IHES伴多脏器损害病例进行分析并复习有关文献，以增进临床医生对该病的认识。     

阶段性康复联合治疗性沟通对胆囊癌患者术后心理状态及生活质量的影响

目的探讨并分析阶段性康复联合治疗性沟通系统(TCS)干预模式对胆囊癌患者术后心理状态及生活质量的影响。方法采用便利抽样法,选取2019年2月—2020年2月郑州大学第一附属医院肝胆胰外二科收治的170例胆囊癌患者为研究对象,按照随机数字表法将其分为观察组(n=86)和对照组(n=84)。对照组患者采用常规护理,观察组实施阶段性康复联合TCS干预模式。比较两组患者干预前后的简明健康量表、SAS和SDS得分,比较两组并发症发生情况。结果干预后两组患者的简明健康量表得分均高于干预前,且观察组得分高于对照组,差异均有统计学意义(P<0.01)。干预后两组患者的SAS和SDS得分均低于干预前,且观察组得分低于对照组,差异均有统计学意义(P<0.01)。观察组术后并发症总发生率为4.65%(4/86),低于对照组的23.81%(20/84),差异有统计学意义(P<0.01)。结论阶段性康复联合TCS干预能有效降低胆囊癌患者术后并发症发生率,改善患者心理状态,提高其生活质量。