Evaluation of Left Ventricular Diastolic Function by 2-D Speckle Tracking Echocardiography in Patients with Connective Tissue Disease-Associated Pulmonary Artery Hypertension

The purpose of this study was to evaluate the role of 2-D speckle tracking imaging in assessing left ventricular diastolic function in patients with connective tissue disease (CTD). A total of 98 CTD patients and 32 healthy controls were prospectively recruited. Early (E) and late (A) diastolic velocities of the transmitral flow were measured by pulsed Doppler echocardiography. Peak early diastolic myocardial velocity (E') was calculated on tissue Doppler echocardiography. The longitudinal strain rate (SR) was calculated as the average of three apical views, while circumferential and radial SRs were measured in three short-axis views. Pulmonary arterial hypertension (PAH) was defined as systolic pulmonary arterial pressure (sPAP) >36 mm Hg. Compared with the control group, CTD patients exhibited significant impairment of left ventricular diastolic function, manifested as lower global SR during early diastole (SRe) in the longitudinal deformation and higher E/SRe in both longitudinal and radial deformation. CTD-PAH patients had significantly lower SRe and higher E/SRe values in both the longitudinal and radial deformation compared with the patients with CTD without PAH. Pearson's correlation analysis revealed that sPAP levels correlated positively with E/E′, longitudinal E/SRe, circumferential E/SRe and radial SRe, and it correlated negatively with septal E′ and radial E/SRe. Receiver operating characteristic curve analysis suggested that E/E′, longitudinal E/SRe and radial SRe could be used to predict PAH. The present study indicates that 2-D speckle tracking imaging is a useful method for evaluation of left ventricular diastolic function, and these derived parameters can serve as good predictors of PAH, but it may not be superior to the commonly used E/E′ in CTD patients.     

改良Duplay术和Duckett术在儿童中重度尿道下裂中的临床应用比较

目的 比较改良分期尿道板纵切卷管尿道成形术（改良Duplay术）和一期横形带蒂岛状包皮皮瓣尿道成形术（Duckett术）治疗儿童中重度尿道下裂的疗效。方法 收集81例中重度尿道下裂患儿的临床资料,根据术式不同分为改良Duplay术式组45例和Duckett术式组36例。比较2组的手术时间、出血量、住院费用、术后并发症和患儿家属对手术的满意度及治愈率。结果 与Duckett术式组比较,改良Duplay术式组的手术时间较短,尿道狭窄和尿道憩室的发生率较低（P均< 0.05）。2组的出血量、住院费用、尿瘘和龟头裂开的发生率和治愈率比较差异均无统计学意义（P均> 0.05）。Duckett术式组患儿家属对手术的满意度高于改良Duplay术式组患儿家属对一期手术的满意度（P < 0.05）,与改良Duplay术式组患儿家属对二期手术的满意度相近（P > 0.05）。结论 改良Duplay术治疗中重度尿道下裂手术时间短、尿道狭窄和尿道憩室的发生率低,其临床应用优于Duckett术。     

Clinical and Contrast-enhanced Ultrasound Characteristics of Epithelioid and Classic Hepatic Angiomyolipoma: Comparison With Alpha-fetoprotein–negative Hepatocellular Carcinoma

Hepatic angiomyolipoma (HAML) comprises epithelioid angiomyolipoma (EAML) and classic hepatic angiomyolipoma (CAML). The imaging appearance of HAML varies widely, and EAML is more easily misdiagnosed as hepatocellular carcinoma (HCC) than as CAML. The clinical and contrast-enhanced ultrasound (CEUS) features of CAML, EAML and HCC with negative alpha-fetoprotein protein expression (HCC[AFP–]) were retrospectively reviewed. The hyper-vascular type was more commonly found in CAML and EAML lesions than in HCC lesions. Most lesions were hyper-enhanced in the arterial phase. CAMLs showed prolonged hyper-enhancement or iso-enhancement during the portal and late phases on CEUS, making them easily distinguishable from HCC(AFP–). Some EAML lesions (41.7%) were hypo-echoic, similar to HCC(AFP–). However, the hypo-enhancement of EAML lesions occurred later than that of HCC(AFP–) lesions. Thus, our findings may be useful in distinguishing among these lesions to improve diagnostic accuracy.     

温经汤治疗原发性痛经的网络药理学作用机制＊

目的 本文将通过网络药理学结合分子对接对温经汤治疗原发性痛经作用机制进行预测。方法 利用TCMSP、TCMID及BATMAN-TCM数据库，收集温经汤活性成分并预测其作用靶标。通过GeneCards数据库、OMIM数据库筛选原发性痛经的靶标，并运用R软件获取疾病交集靶标，绘制韦恩图。运用Cytoscape软件构建温经汤治疗原发性痛经的成分-靶标网络图，通过STRING数据库构建PPI靶标蛋白互作网络，并进行核心靶标的GO功能富集分析及KEGG通路富集分析。通过Autodock Vina软件对药物活性成分与疾病核心靶标进行分子对接验证。结果 筛选得到温经汤治疗原发性痛经的124个活性成分和31个药物-疾病共同靶标，并推断其作用机制可能与介导HIF-1、TNF、PI3K-Akt等105条信号通路相关。槲皮素、山柰酚、豆甾醇等活性成分与PTGS1、ESR1、PGR等核心靶标对接结果良好。结论 温经汤活性成分可能通过发挥镇痛、抗炎、调节激素水平、缓解平滑肌痉挛和改善缺氧状态等药理作用来治疗原发性痛经。     

胶质瘤合并动静脉畸形一例报道并文献复习

患者男性,42岁,因突发头痛、呕吐后昏迷,于2017年7月收治于贺州市人民医院神经外科。入院时体检:格拉斯哥昏迷量表(GCS)评分5分。双侧瞳孔大小不等,左侧直径2.0 mm、右侧直径4.0 mm,对光反射消失。双侧巴宾斯基征(+)、查多克征(+)、奥本海姆征(+)、戈登征(+)。脑膜刺激征阴性。四肢肌力检查不能配合、刺激有回缩反应,肌张力高。头颅CT扫描提示右侧额部团片状低密度影(范围约55 mm×92 mm),颞部周围见团状高密度影(范围约50 mm×44 mm×36 mm),占位效应明显,脑室、脑沟及脑裂明显受压变窄、消失,中线结构向左侧偏移,脑疝形成(图1)。     

血脂异常患者中医体质与钙镁锌的相关性研究＊

目的 探讨血脂异常患者中医体质与钙、镁、锌之间的相关性。方法 2019年4月至2020年10月在上海熙康门诊部收集血脂异常患者200例，血脂正常人群100例为对照组。检测血脂指标（TC、TG、LDL-C、HDL-C）及血钙、镁、锌指标，并对血脂异常组进行中医体质评估。使用方差分析、多元线性回归和Logistic回归分析异常组体质类型与钙、镁、锌及血脂指标的相关性。结果 ①血脂异常组钙、镁、锌水平均低于对照组（P < 0.001）；②不同体质之间的钙均值有差异（P < 0.001）；③多元线性回归分析显示钙与LDL-C相关（P = 0.039），锌与TC相关（P = 0.03）；④Logistic回归分析显示钙与阳虚质及痰湿质相关，TG与阳虚质相关（P < 0.001），TC与痰湿质相关（P < 0.001）。结论 血脂异常患者血钙、镁、锌微量元素水平及血脂指标与中医体质分型存在一定相关。     

The effectiveness of specialized nursing interventions for patients with Parkinson disease: A randomized controlled study protocol

Background:The purpose of this experiment is to evaluate the impact of the care of Parkinson disease nurse specialist on improving motor symptoms and life quality for patients with Parkinson disease (PD).Method:This is a randomized controlled research, and it will be conducted from April 2021 to October 2021 at Sichuan Provincial People''s Hospital. The experiment was granted through the Research Ethics Committee of Sichuan Provincial People''s Hospital (004510293). All the patients suffer from PD, age 18 years or older, both female and male, regardless of the duration or severity of this disease are eligible. The exclusion criteria contains: lack sufficient knowledge to complete questionnaires, serious physical comorbidities or refuse to take part in the program. In our experiment, the major result measures are motor symptoms and life quality. For the measurement of life quality, we will utilize Parkinson disease Questionnaire-39, the most extensively utilized the scale of life quality in PD. The evaluation of motor symptoms severity is carried out with the revision of Unified Parkinson Disease Rating Scale sponsored by Movement Disorder Society.Results:Table 1 indicates clinical outcomes at different time points.Conclusion:The Parkinson''s disease nurse specialist care may promote the life quality in the PD patients.Trial registration number:researchregistry 6284.     

The impact of dusk phenomenon on total glucose exposure in Chinese people with type 2 diabetes

This study was aimed at assessing the impact of the dusk phenomenon on the total glucose exposure in Chinese people with type 2 diabetes.A total of 380 type 2 diabetes who received a retrospective continuous glucose monitoring system (CGMs) for 72 hours were enrolled in our study, 32 of them failed in CGMs. The patients were first divided into 2 groups: dusk phenomenon (n = 95) and non dusk phenomenon group (n = 253). The magnitude of the dusk phenomenon (δDusk) was quantified by pre-dinner glucose minus post-lunch 2 hours glucose. A persistent δDusk ≥ 0 or a once only δDusk < 0 can be diagnosed with the dusk phenomenon. The participants were secondarily matched for the post-lunch 2 hours glucose to assess the impact of the dusk phenomenon on the overall glucose exposure. The impact of the dusk phenomenon was assessed on high-performance liquid chromatography assay (HbA1c) and 24-hour mean glucose.There were 95 of 348 (27.3%) participants with the dusk phenomenon in the overall population, and the median of δDusk level was –0.8 (–1.8, 0.2) mmol/L. The median of glucose differences between the 2 paired groups were 0.4 (–0.4, 1.0)% for HbA_1c, 0.9 (0.2, 1.4) mmol/L for 24 hours mean glucose. The correlation analysis showed no relationship between the magnitude of dawn phenomenon and the dusk phenomenon (r = 0.052, P = .472).The incidence of dusk phenomenon is about 27.3% in people with type 2 diabetes. The impacts of dusk phenomenon on HbA1c and 24-hour mean glucose were about 0.4% and 0.9 mmol/L and the dusk phenomenon was not related with the dawn phenomenon.