替米沙坦对高血压合并糖尿病患者血清脂联素的影响

目的观察替米沙坦治疗前、后高血压合并糖尿病患者血清脂联素水平的变化。方法将50名门诊高血压合并糖尿病病人分为替米沙坦和氨氯地平两组。观察治疗前及治疗10周后患者血压、脂联素及血糖、胰岛素变化。结果与治疗前相比,替米沙坦组与氨氯地平组收缩压和舒张压均显著降低(P<0.01),替米沙坦组血清脂联素水平较治疗前显著升高(P<0.01),血糖、胰岛素和胰岛素抵抗较治疗前显著降低(P<0.01);氨氯地平组治疗前后血清脂联素、血糖、胰岛素和胰岛素抵抗无明显改变(P>0.05)。结论与氨氯地平相比,替米沙坦在降压的同时,显著增高了血清脂联素水平并显著改善胰岛素抵抗,显示其具有降压外良好的代谢效应。     

病友支持团队对慢性阻塞性肺疾病患者治疗依从性的影响

目的探讨病友支持团队对慢性阻塞性肺疾病患者治疗依从性的影响。方法将2011年3月~2014年3月间收治的112例慢性阻塞性肺疾病患者按住院号的奇偶分为观察组和对照组,每组56例。对照组给予慢性阻塞性肺疾病的健康教育常识和饮食运动指导。观察组在此基础上由呼吸专科护理人员组织的"病友支持团队"支持教育。观察两组患者干预前及干预后6个月的依从性、自我效能和疗效。结果 6个月后,观察组的依从性、自我效能和疗效均优于对照组,差异有统计学意义(P<0.05)。结论病友支持团队能有效地提高患者的依从性和治疗疗效,增加患者的自我效能感。     

Carto 3系统指导下导管消融频发性室性早搏的有效性观察

目的 探讨Carto 3三维电生理导航系统指导消融频发性室性早搏(PVC)的临床疗效,以及射频消融术(RFCA)前后血浆氨基末端B型利钠肽(NT-pro BNP)、心脏结构功能的变化。方法 选取2011年至2013年47例频发室性早搏患者行射频消融治疗的患者为病例组,根据标测系统的不同,分为传统组(n=17)和三维组(n=30)。观察比较两组手术时间、X线曝光时间、放电次数及手术即刻成功率、远期成功率。同时监测所有病例行导管消融前及消融3个月后的NT-pro BNP、左室射血分数(LVEF)及左室舒张末期内径(LVEDd)值,另选取51例健康体检者为对照组。结果 三维组在手术时间、X线曝光时间、消融放电次数上明显优于传统组,且差异有统计学意义(P<0.05)。两组即刻成功率(82.35% vs 93.33%)、远期成功率(76.47% vs 86.67%)相近,差异无统计学意义(P>0.05)。对照组、病例组术前、病例组术后3个月NT-pro BNP浓度、LVEDd以及LVEF值比较,差异均无统计学意义(P>0.05)。结论 较二维影像,在Carto 3三维电生理导航系统下行射频消融治疗频发性室性早搏具有较高的即刻及远期成功率,且安全、有效。     

Peripherally inserted central catheter-related bloodstream infections in patients with hematological malignancies: A retrospective 7-years single-center study

ObjectivesWe sought to investigate the nature and incidence of bloodstream infection complications and to identify the risk factors of central catheter-related bloodstream infections (CRBSI).MethodsDuring the study period, 291 consecutive patients with hematological malignancies who underwent PICC placement were retrospectively enrolled. We analyzed the covariates that were specified a priori for their association with CRBSI through multivariate Cox proportional hazards regression models. The association between each predictor and the related outcome was expressed using hazard ratios (HRs) with corresponding 95% confidence intervals (CIs).ResultsOf 391 peripherally inserted central catheter (PICCs) were inserted in 291 patients for a total of 63,714 catheter days during 7 years, with an infection rate of 0.71/1,000 catheter days. Among the patients with hematological malignancies, those with acute leukemia were prone to CRBSI. Having previous bloodstream infection (BSI) (HR 18.139; 95% CI, 8.19-40.174; P < .0001), the number of PICCs insertions (HR 4.695; 95% CI, 1.842-11.967; P = .001) (twice), (HR 6.794; 95% CI, 1.909-24.181; P = .003) (≥3 times) were significantly associated with CRBSI. Not accompanied by chronic comorbidities (HR 0.34; 95% CI, 0.131-0.887; P = .028) and longer duration of PICC use (days) (HR 0.997; 95% CI, 0.994-0.999; P = .008) might be protective factors preventing CRBSI.ConclusionsOur finding suggests that previous BSI and a higher number of PICC insertions are associated with an increased risk of CRBSI. A lack of chronic comorbidities may help prevent CRBSI.     

Impacts of frailty on health care costs among community-dwelling older adults: A meta-analysis of cohort studies

BackgroundThe demands for health care services from the frail elderly individuals in the community continue to increase, which will exert a tremendous burden on health care costs. However, little is known regarding the magnitude of these impacts. In this study, we performed a systematic review and meta-analysis of the evidence to explore the impact of frailty on health care costs among community-dwelling older adults.Materials and methodsRelevant published articles were searched from PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Full-text Database (VIP), Wanfang Database, Chinese Biomedical Literature Database (CBM), and the reference lists of articles. Publishedcohort or cross-sectional studies assessing the impacts of frailty on health care costs among community-dwelling older adults were identified (to June 2020). The outcomes on health care costs before and after baseline were stratified by frailty status.ResultsA total of 7 cohort studies comprised of a total of 3,750,611 participants were included in our study. Our analyses showed that: (1) compared with the robust group, health care costs increased by $79–13,423.83 (standardized mean difference, SMD = 0.22, 95% Confidence interval, 95% CI, 0.22–0.22; P < 0.00001) in the pre-frail elderly and by $616–32,549.96 (SMD = 0.55, 95% CI, 0.44–0.67; P < 0.00001) in the frail elderly in the community. A significantly higher in the increase of health care costs was observed in the frail group compared with the pre-frail group(SMD = 0.35, 95% CI, 0.19–0.51; P < 0.0001); (2) the frailty phenotype components increased the health care costs of the elderly in community (weight loss: $1,630–6,209, SMD = 0.43, 95% CI, 0.17–0.69; P = 0.001; weakness: $275–7,586, SMD = 0.24, 95% CI, 0.08–0.40; P = 0.001; exhaustion: $1,545–10,559, SMD = 0.31, 95% CI, 0.13–0.49; P = 0.0006; slowness: $352–1,1891, SMD = 0.40, 95% CI = 0.14–0.65; P = 0.003; low physical activity: $512–3,459, SMD = 0.26, 95% CI, 0.16–0.36; P < 0.00001); (3) the increase in the frailty index was parallel with the increase in health care costs by $12,363–21,066 (SMD = 0.41, 95% CI, 0.29–0.53; P < 0.00001).Conclusions and ImplicationsThis study revealed the adverse economic impacts of frailty status, frailty phenotype components, and frailty index on health care costs in community-dwelling older adults. Future research is warranted to investigate costs incurred by interventions to improve frailty, which will provide further insights into additional health care costs due to frailty.     

A high-fat maternal diet decreases adiponectin receptor-1 expression in offspring

In early life, over-nutrition may increase the risk of insulin resistance in the adult stage. Adiponectin and its receptor may play a key role in this process. This study aimed to identify the effect of a high-fat (HF) maternal diet on metabolic parameters and muscle adiponectin signaling in young adult offspring. We found that offspring born to dams fed HF chow (HF; 31% of calories from fat) had elevated body and adipose tissue weight and higher serum glucose levels after glucose challenge at three weeks (W3) and eight weeks (W8) of age. Offspring exposed to a HF diet also had higher serum adiponectin levels at W3 compared to controls. However, adiponectin levels were significantly decreased compared to controls by W8. Adiponectin receptor 1?mRNA expression in skeletal muscle was decreased in the HF group at W3 and W8, and there was no difference between the two groups in adiponectin receptor 2 expression. Furthermore, glucose transporter 4?mRNA and protein expression was decreased in the skeletal muscle of the HF group at W3 and W8. Our results suggest that a HF maternal diet decreases adiponectin receptor 1 expression in the offspring, which could contribute to reduced sensitivity to adiponectin and to adverse nutritional programing outcomes.     

siRNA靶向干扰IL28RA基因对缺氧复氧心肌细胞损伤的保护作用

目的:探讨小干扰RNA(small interference RNA,siRNA)靶向干扰白细胞介素28受体α(interleukin 28 receptor alpha,IL28RA)基因对心肌细胞缺氧复氧损伤的保护作用?方法:设计合成干扰IL28RA基因表达的3对siRNA(siRNA-6158?siRNA-6160?siRNA-6162),采用脂质体转染原代乳大鼠心肌细胞,分为正常对照组?单纯缺氧复氧组?缺氧复氧+阴性对照转染组?缺氧复氧+siRNA-6158转染组?缺氧复氧+siRNA-6160转染组?缺氧复氧+siRNA-6162转染组,探索siRNA转染心肌细胞的合适浓度,检测心肌细胞存活率?培养液中LDH的水平及心肌细胞IL28RA蛋白表达,观察siRNA干扰IL28RA基因对心肌细胞缺氧复氧过程中的保护作用?结果:采用脂质体转染法,siRNA浓度在80 nmol/L对心肌细胞具有较高的转染效率?与单纯缺氧复氧组和缺氧复氧+阴性对照转染组比较,缺氧复氧+siRNA-6158转染组和缺氧复氧+siRNA-6160转染组的LDH活性明显降低(P < 0.05),心肌细胞存活率明显升高 (P < 0.05),IL28RA蛋白表达明显减少(P < 0.05)?结论:干扰IL28RA基因的表达有望成为保护缺氧复氧心肌损伤的重要手段?     

长链非编码RNA H19基因多态性与早发冠心病患者易感性研究

目的:探讨编码一段长链非编码RNA的 H19基因多态性与早发冠心病(pCAD)患者易感性的相关关系?方法:采用TaqMan技术分析 213 例早发冠心病患者和 776 例对照的H19基因 4个多态位点(rs2067051?rs2251375?rs217727?rs4929984)的基因型,用 SPSS 软件进行统计学分析?结果:早发冠心病组H19基因rs217727位点的CT基因型?TT基因型及T等位基因分布频率均高于对照组?多元Logistic回归分析显示:rs217727多态性与早发冠心病发病独立相关(P < 0.01)?T等位基因携带者?TT纯合基因患早发冠心病的风险分别是CC纯合基因型的2.42倍(OR=2.42,95%CI=1.55~3.71)和3.01倍(OR=3.01,95%CI=1.87~4.85)?结论:H19 rs217727多态性与早发冠心病易感性有关,T等位基因可能是早发冠心病的遗传易感因素?