丹参川芎联合骨瓜或骨肽对糖尿病骨质疏松患者糖代谢和骨代谢的影响

目的:探讨在丹参川芎治疗基础上,结合骨瓜或骨肽应用于糖尿病骨质疏松症对糖代谢、骨代谢作用价值。方法:选取2016年3月至2017年9月湖北省黄石市第二医院受诊的糖尿病骨质疏松症患者253例作为研究对象。将应用丹参川芎结合骨瓜治疗的128例归为骨瓜组,将予以丹参川芎结合骨肽治疗的125例归为骨肽组,分析2组糖化血红蛋白(Hb A1c)、空腹血糖(FBG) N-端中段骨钙素(N-MID-OT)、骨特异性碱性磷酸酶(BAP),骨形态发生蛋白-2(BMP-2),骨钙素(BBGP)。骨密度(BMD),甲状旁腺素(PTH)、碱性磷酸酶(ALP),β-胶原特殊序列(β-CTx),并比较药物安全性。结果:1)骨瓜组糖代谢Hb A1c(7. 41±0. 64)%、钙离子(2. 21±0. 28) mmol/L、FBG(6. 12±0. 59) mmol/L、血磷(1. 42±0. 25)mmol/L在治疗后与骨肽组Hb A1c(7. 79±0. 51)%、钙离子(2. 27±0. 33) mmol/L、FBG(6. 37±0. 83) mmol/L、血磷(1. 35±0. 31) mmol/L差异无统计学意义(P 0. 05); 2)骨肽组N-MID-OT(16. 37±2. 83) ng/m L和骨瓜组差异无统计学意义(P0. 05),BAP(142. 26±10. 66)μg/L、BGP(5. 07±1. 32)μg/L显著低于骨瓜组,BMP-2 (86. 35±6. 24) ng/L显著高于骨瓜组,差异有统计学意义(P 0. 05); 3)骨肽组BMD(0. 57±0. 13) g/cm3显著高于骨瓜组,PTH(32. 26±2. 15) pg/m L、ALP(72. 35±5. 19) U/L显著低于骨瓜组,差异有统计学意义(P 0. 05),β-CTx(0. 39±0. 02) ng/m L和骨瓜组(0. 42±0. 04)ng/m L差异无统计学意义著(P 0. 05); 4)骨瓜组不良反应率(3. 13%)显著低于骨肽组(9. 60%),差异有统计学意义(P 0. 05)。结论:对于糖尿病骨质疏松症的治疗,基于丹参川芎,增加注射用骨肽比较注射用骨瓜提取物,更能促进患者多项骨代谢指标、血清生化指标及BMD的恢复,二者具有相似的调节糖代谢的作用,但骨肽不良反应相对较高,临床上应结合患者实际情况进行药物的选择。     

Effect of compression stockings on overnight rostral fluid shift and obstructive sleep apnea: A meta-analysis

ObjectiveThe overnight rostral fluid shift from the lower limbs is one of the causes of obstructive sleep apnea (OSA). Compression stockings (CS) prevent lower limb fluid retention and have been reported to decrease nighttime fluid shift. The aim of this study is to evaluate the effect of CS on fluid shift and the severity of OSA.MethodsA systematic literature search was performed in the PubMed, EMBASE and Cochrane Library databases. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). Studies evaluating the effect of CS on the overnight fluid shift and OSA severity were included in the analysis.ResultsA total of 4 studies were included in this meta-analysis. The pooled analysis showed that the apnea-hypopnea index (AHI) of the overall study group was significantly lower after using CS (SMD, -1.08; 95% CI, -1.49 to -0.67). Decreases in the AHI were also observed in the normal fluid status (SMD, -1.05; 95% CI, -1.73 to -0.37) and fluid overload status (SMD, -1.17; 95% CI, -1.76 to -0.58) populations. The overall study group had significant decreases in overnight changes in neck circumference (SMD, -1.05; 95% CI, -2.06 to -0.03) and leg fluid volume (SMD, -1.14; 95% CI, -1.88 to -0.41) after using CS. However, no significant differences in overnight changes in neck circumference and leg fluid volume were observed in normal fluid status patients.ConclusionCS may help decrease overnight fluid shift and could be a treatment option for OSA.     

A Prenatal Ultrasound Scanning Approach: One-Touch Technique in Second and Third Trimesters

This study was aimed at evaluating the performance of the innovative technique Smart Fetus (SF) developed to recognize the planes and obtain the basic biometric measurements of fetuses automatically. This prospective study included 1005 uncomplicated singleton pregnancies undergoing routine examinations. For every pregnancy, planes, including the transverse section of the thalami, transverse section of the abdomen and longitudinal section of the femur, were acquired, and standard biometric measurements, including biparietal diameter, head circumference, abdominal circumference and femur length, were obtained using SF and traditional ultrasound technique (TUT). The accuracy, reproducibility and time required for the analysis of SF were compared with those of TUT. In 998 of 1005 cases (99.30%), SF successfully acquired the sections and made all measurements. The agreement between the techniques was high for all measurements. The time to obtain sections and measure biometric parameters or solely measure biometric parameters was significantly shorter with SF than with TUT. No significant differences were found in SF repeated measurements obtained by two independent observers. The SF technique helped in the acquisition of reliable standard sections and biometric measurements and saved time. It might serve as a novel ultrasound scanning approach and improve workflow efficiency.     

Prevalent diabetes and risk of total,colorectal, prostate and breast cancers in an ageing population: meta-analysis of individual participant data from cohorts of the CHANCES consortium

Background We investigated whether associations between prevalent diabetes and cancer risk are pertinent to older adults and whether associations differ across subgroups of age, body weight status or levels of physical activity.Methods We harmonised data from seven prospective cohort studies of older individuals in Europe and the United States participating in the CHANCES consortium. Cox proportional hazard regression was used to estimate the associations of prevalent diabetes with cancer risk (all cancers combined, and for colorectum, prostate and breast). We calculated summary risk estimates across cohorts using pooled analysis and random-effects meta-analysis.Results A total of 667,916 individuals were included with an overall median (P25–P75) age at recruitment of 62.3 (57–67) years. During a median follow-up time of 10.5 years, 114,404 total cancer cases were ascertained. Diabetes was not associated with the risk of all cancers combined (hazard ratio (HR) = 0.94; 95% confidence interval (CI): 0.86–1.04; I² = 63.3%). Diabetes was positively associated with colorectal cancer risk in men (HR = 1.17; 95% CI: 1.08–1.26; I² = 0%) and a similar HR in women (1.13; 95% CI: 0.82–1.56; I² = 46%), but with a confidence interval including the null. Diabetes was inversely associated with prostate cancer risk (HR = 0.81; 95% CI: 0.77–0.85; I² = 0%), but not with postmenopausal breast cancer (HR = 0.96; 95% CI: 0.89–1.03; I² = 0%). In exploratory subgroup analyses, diabetes was inversely associated with prostate cancer risk only in men with overweight or obesity.Conclusions Prevalent diabetes was positively associated with colorectal cancer risk and inversely associated with prostate cancer risk in older Europeans and Americans.Subject terms: Risk factors, Cancer epidemiology     

左炔诺孕酮宫内缓释系统对预防子宫内膜息肉宫腔镜电切术后复发的效果观察

目的:探讨左炔诺孕酮宫内缓释系统对预防子宫内膜息肉(Endometrialpolyps,EP)宫腔镜电切术后复发的效果。方法:选择江西省妇幼保健院2017年5月至2019年12月采取宫腔镜电切术的60例EP患者,根据术后治疗方法不同随机分为观察组(36例)与对照组(24例),其中观察组给予含有左炔诺孕酮52 mg缓释系统,对照组给予屈螺酮炔雌醇片口服21片。于术前、术后12个月采用全自动血细胞分析仪测定血清血红蛋白水平,采用超声检查观察子宫内膜厚度,采用血液检查测定性激素变化,并记录两者术后复发情况。结果:与术前相比各组月经失血图评分(Pictorial Blood loss Assessment Chart,PBAC)、子宫内膜厚度、血红蛋白均改善(P<0.05),且观察组更为显著(P<0.05);观察组复发率显著低于对照组(P<0.05)。结论:左炔诺孕酮宫内缓释系统能改善术后子宫内膜厚度、月经恢复及血红蛋白水平,降低复发率,稳定性激素水平。     

钙离子通道蛋白TRPV6及其相关疾病的研究进展

瞬时受体电位亚家族V成员6 (Transient Receptor Potential Channel Subfamily V Member 6, TRPV6) 是一种钙离子高度选择性离子通道，在多种组织中均有表达，控制细胞顶端钙离子的进入，在维持钙稳态中发挥重要作用。TRPV6功能异常会影响体内钙稳态，进而引发新生儿骨骼发育异常、甲状旁腺功能亢进、骨与软骨代谢异常、肾结石和高尿钙症、 以及炎症性肠病和慢性胰腺炎等多种疾病。近年来研究也表明，TRPV6的上调与多种肿瘤的侵袭性增加有关，具有作为肿瘤检测的标志物以及治疗靶点的潜力。本综述将聚焦于TRPV6与其在相关疾病中发挥的作用，旨在为TRPV6作为药物靶点实现临床转化提供理论依据。     

Intercostal Nerve Block Using an Innovative Intraneedle Ultrasound Transducer: A Proof-of-Concept study

Intercostal nerve block is a widely used and effective approach to providing regional anesthesia in the thoracic region for pain relief. However, during ultrasound-guided intercostal nerve block, inaccurate identification of the anatomic structures or suboptimal positioning of the needle tip may result in complications and blockade failure. In this study, we designed an intraneedle ultrasound (INUS) system and validated its efficacy in identifying anatomic structures relevant to thoracic region anesthesia. The 20-MHz INUS transducer comprised a single lead magnesium niobate–lead titanate crystal, and gain was set to 20 dB. It fit into a regular 18G needle and emitted radiofrequency-mode ultrasound signals at 1 mm from the needle tip. One hundred intercostal punctures were performed in 10 piglets. Intercostal spaces were identified by surface ultrasound or palpation and located by inserting and advancing the INUS transducer needle until the appropriate anatomy was identified. Blockade success was defined by ideal saline and dye spreading and confirmed by dissection. The pleura had a distinctive ultrasound signal, and successful detection of the intercostal muscles, endothoracic fascia and double-layered parietal and visceral pleura was achieved in all 100 puncture attempts. INUS allows real-time identification of intercostal structures and facilitates successful intercostal nerve blocks.     

Metabolism studies on hydroxygenkwanin and genkwanin in human liver microsomes by UHPLC-Q-TOF-MS

Hydroxygenkwanin (HYGN) and genkwanin (GN) are major constituents of Genkwa Flos for the treatment of edema, ascites, cough, asthma and cancer. This is a report about the investigation of the metabolic fate of HYGN and GN in human liver microsomes and the recombinant UDP-glucuronosyltransferase (UGT) enzymes by using ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF-MS). An on-line data acquisition method multiple mass defect filter (MMDF) combined with dynamic background subtraction (DBS) was developed to trace all probable metabolites. Based on this analytical strategy, three phase I metabolites and seven glucuronide conjugation metabolites of HYGN, seven phase I metabolites and 12 glucuronide conjugation metabolites of GN were identified in the incubation samples of human liver microsomes. The results indicated that demethylation, hydroxylation and o-glucuronidation were main metabolic pathways of HYGN and GN. The specific UGT enzymes responsible for HYGN and GN glucuronidation metabolites were identified using recombinant UGT enzymes. The results indicated that UGT1A1, UGT1A3, UGT1A9, UGT1A10 and UGT2B7 might play major roles in the glucuronidation reactions. Overall, this study may be useful for the investigation of metabolic mechanism of HYGN and GN, and it can provide reference and evidence for further experiments.     

Clinical characteristics of bacteraemia caused by Burkholderia cepacia complex species and antimicrobial susceptibility of the isolates in a medical centre in Taiwan

This study investigated the clinical characteristics and outcomes of bacteraemia due to Burkholderia cepacia complex (BCC) species among 54 patients without cystic fibrosis from January 2013 to February 2015. BCC isolates were identified to the species level by the Bruker Biotyper MALDI-TOF MS system and by sequencing analysis of the 16S rRNA and recA genes. Antimicrobial susceptibilities of the isolates were determined by the agar dilution method. Sequencing of the recA gene in the 54 blood isolates revealed 37 (68.5%) isolates of B. cenocepacia, 9 (16.7%) of B. cepacia, 4 (7.4%) of B. multivorans and one isolate each of B. arboris, B. pseudomultivorans, B. seminalis, and B. vietnamiensis. The overall performance of the Bruker Biotyper MALDI-TOF MS system for correctly identifying the 54 BCC isolates to the species level was 79.6%, which was better than that (16.7%) by 16S RNA sequencing analysis. Bacteraemic pneumonia (n?=?23, 42.6%) and catheter-related bacteraemia (n?=?21, 38.9%) were the most common types of infection. Higher rates of ceftazidime and meropenem resistance were found in B. cepacia isolates (33.3% and 22.2%, respectively) than in isolates of B. cenocepacia (21.6% and 10.8%, respectively) and other species (12.5% and 12.5%, respectively). Overall, the 30-day mortality rate was 38.9% (21/54). Bacteraemia caused by BCC species other than B. cenocepacia and B. cepacia (adjusted odds ratio [aOR] 20.005, P?=?0.024) and high SOFA score (aOR 1.412, P?=?0.003) were predictive of higher 30–day mortality. Different BCC species are associated with different outcomes of bacteraemia and exhibit different susceptibility patterns.