Role of arterial stiffness and endothelial dysfunction on lower limb performance in older adults with type 2 diabetes: A cross-sectional study

AimTo verify whether arterial stiffness and endothelial dysfunction influence lower limb muscle strength and gait speed in older adults with type 2 diabetes mellitus (T2DM).MethodsCross-sectional study including seventy-eight older adults with T2DM (aged 67 ± 6 years and 42 % male). Arterial stiffness was assessed using pulse wave velocity (PWV), while endothelial function was measured by flow-mediated dilation (FMD). Lower limb muscle strength and gait speed were assessed using the 30-second chair stand test (30s-CST) and 10-Meter Walk Test, respectively.ResultsBoth PWV (m/s) and FMD (%) were univariately associated with number of repetitions in 30s-CST and gait speed (P < 0.05). After control for age, sex and body mass index, PWV remained associated with repetitions in 30s-CST (95 % CI: ?0.494 to ?0.054; P = 0.015) and gait speed (95 % CI: ?0.039 to ?0.002; P = 0.031). After adjustments for control variables, T2DM duration and glycemic control, FMD was associated with repetitions in 30s-CST (95 % CI: 0.008 to 0.324; P = 0.039) and gait speed (95 % CI: 0.011 to 0.038; P = 0.001).ConclusionIn older adults with T2DM, both arterial stiffness and endothelial dysfunction are associated with decreased leg muscle strength and slower gait speed.     

Gender difference in association between diabetes mellitus and all-cause mortality in atrial fibrillation patients

ObjectiveThere may be gender difference in correlation of diabetes mellitus (DM) and cardiovascular events. We attempt to investigate whether there is gender-heterogeneity in one-year outcomes of atrial fibrillation (AF) patients with DM or not.MethodsPatients who were diagnosed with AF admitted to the emergency departments in the Chinese AF Multicenter Registry study were enrolled. Basic demographics information, initial Blood Pressure and heart rate, medical histories, and treatments of each patient were collected. Follow-up was carried out with a mean duration of one year. The primary endpoint was all-cause mortality and systemic embolism.ResultsA total of 2016 patients were selected from September 2008 and April 2011. All-cause mortality was significantly higher in male AF patients with DM than those without (21.8 % & 13.6 %, P = 0.014). Cox regression analysis showed that there was an interaction between gender and DM for one-year all-cause mortality (P = 0.049). DM was significantly associated with one-year all-cause mortality regardless of univariate analysis (HR = 1.436, 95%CI:1.079–1.911, P = 0.013) or multivariate analysis (HR = 1.418, 95%CI: 1.059–1.899, P = 0.019). For male patients with AF, DM was significantly associated with one-year all-cause mortality (P = 0.048), but not for female patients with AF (P = 0.362).ConclusionDM was independently associated with one-year all-cause mortality in the entire cohort of AF patients. This association was found mainly in male patients with AF, but not in female patients. DM management programs may need to reflect gender difference.     

硬膜下积液治疗经验总结（附27例临床分析）

目的总结不同类型硬膜下积液治疗经验。 方法对解放军总医院第六医学中心神经外科自2009年1月至2014年10月手术治疗并完整随访的27例硬膜下积液患者进行回顾性分析。根据术前影像学特征鉴别积液是否为血性，将患者分为血性硬膜下积液患者（9例）和非血性硬膜下积液患者（18例）。根据积液是否为血性选择个性化治疗方案，观察其疗法。 结果9例血性硬膜下积液患者接受钻孔外引流手术，8例积液消退，另外1例无效，之后接受硬膜下腹腔分流后治愈。非血性硬膜下积液患者中14例接受硬膜下腹腔分流，12例有效，2例术后出现脑积水，经脑室-腹腔分流术治愈；2例术前合并脑积水接受脑室-腹腔分流术，均有效；另外2例最初接受积液外引流，无效，之后行硬膜下腹腔分流后积液消退。 结论对于硬膜下积液患者，术前需仔细评估积液是否为血性，是否合并脑积水。血性积液采取钻孔外引流，非血性积液采取硬膜下腹腔分流，合并脑积水的积液采取脑室-腹腔分流手术方式，给予个体化治疗，可获得满意疗效。     

去肾交感神经术治疗难治性高血压

难治性高血压(resistant hypertension, RH)是指在改善生活方式基础上应用可耐受的足够剂量且合理的3种降压药物(包括一种噻嗪类利尿剂)治疗至少4周后, 诊室和诊室外(包括家庭血压或动态血压监测)血压值仍在目标水平之上, 或至少需要4种降压药物才能使血压达标, 目前尚缺乏有效的治疗方案。去肾交感神经术(renal sympathetic denervation, RDN)作为RH的一种治疗手段, 在病理生理机制上已被基础实验证实。早期Ⅰ代RDN的临床试验结果并不统一, Ⅱ代RDN改进了消融技术并在最近的高血压临床试验应用中得到了阳性结论, 同时RDN用于治疗其他疾病的临床试验也产生了阳性结果。但由于目前尚无对肾交感神经活动的具体评估方法, 无法准确筛选出适宜行RDN的人群, 故其临床应用仍存在争议。     

提高选题策划质量 提升行业期刊品牌影响力——以金属加工杂志社实践为例

【目的】 探讨行业期刊进行选题策划的方法,提升选题策划的质量。【方法】 利用互联网技术及新媒体资源,结合金属加工杂志社选题策划实例,归纳出几种选题策划的途径及方法。【结果】 结合行业热点进行选题策划,注重实效性和内容深度,提升期刊内容的可读性,可使期刊获得更多读者的关注和认可,提升期刊的行业影响力。【结论】 提高选题策划质量,可有效提升期刊内容的可读性,从而进一步提升期刊在行业的影响力。     

外科治疗56例心脏非黏液性肿瘤的临床分析

目的探讨心脏非黏液性肿瘤临床特点,总结外科治疗经验。方法对我院1996年10月至2005年3月进行外科治疗的56例心脏非黏液性肿瘤的临床资料进行回顾性分析,总结其临床表现、发生部位、肿瘤性质和外科治疗特点等。结果心脏非粘液性肿瘤占本院同期手术患者的0.14%,良性肿瘤28例,恶性肿瘤28例,其中继发性心脏肿瘤8例。良性肿瘤最常见的是生长在心室,共18例;恶性肿瘤最常见的生长部位是心房,共15例。外科治疗行急诊手术者12例。心包开窗引流术2例,探查术1例,术中肿瘤全部切除者26例,部分切除27例,术后住院期间死亡1例。结论心脏非黏液性肿瘤临床表现各异、病理类型多样、病变广泛,手术原则为尽可能切除肿瘤和保持心脏结构的完整性和功能。     

机械通气在胸部开放伤后海水灌入胸腔致急性肺损伤救治中的应用

目的探讨机械通气在胸部开放伤后海水灌入胸腔致急性肺损伤（ALI）救治中的应用。方法锐器致胸部开放伤后胸腔内灌注海水（35ml／kg）制备ALI成年杂交犬动物模型，随机分为未救治组、普通救治组、机械通气组，每组6只。未救治组在ALI出现后不实施任何救治措施，普通救治组给以鼻导管吸氧、胸腔闭式引流、静脉输入5％葡萄糖液等，机械通气组将普通救治组鼻导管吸氧改为机械通气。动态观察血气分析、血流动力学变化，检测外周血中炎症介质的变化。结果胸部开放伤后海水灌入胸腔可导致ALI，普通救治组PaO2虽有所升高但仍显著低于正常，机械通气能快速纠正低氧血症，两组在纠正高渗、高钠、高氯血症和改善血流动力学方面无显著差异。结论胸部开放伤后海水灌入胸腔引起严重ALI，机械通气具有良好的治疗效果。     

多巴酚丁胺负荷用于猪缺血心肌18F-FDG代谢显像的价值

目的 探讨多巴酚丁胺负荷情况下实验猪缺血心肌对18F-脱氧葡萄糖(FDG)的摄取情况.方法 15头中华小型猪,于冠状动脉左前降支近中段放置动脉环,造成慢性冠状动脉狭窄.分别在静息和多巴酚丁胺负荷试验时,进行99Tcm-甲氧基异丁基异腈(MIBI)心肌灌注和18F-FDG心肌代谢SPECT显像.99Tcm-MIBI心肌血流灌注图像用17段4分法进行半定量分析,通过测量心肌短轴感兴趣区(ROI)放射性计数,对缺损的可逆程度进行定量分析.18F-FDG心肌代谢图像分析通过在原始投影数据上勾画ROI,计算心脏与肝脏的平均放射性比值(H/Li)、心脏与右肺尖的平均放射性比值(H/L).所有实验猪均行冠状动脉造影检查.结果 冠状动脉造影发现,所有实验猪的冠状动脉左前降支狭窄均大于50%.99Tcm-MIBI药物负荷和静息显像时的心肌血流灌注半定量评分分别为(9.5±8.3)和(8.3±8.4)分,两者差异有显著性(P＜0.05).缺损可逆程度比值为1.17±0.14.18F-FDG图像分析发现在静息情况下,H/Li比值为1.06±0.10,H/L比值为1.40±0.18;而在多巴酚丁胺负荷情况下,心脏对18F-FDG的摄取相对增加H/Li比值为1.25±0.15(P＜0.0001),与缺血可逆程度呈明显正相关(r=0.64,P=0.007),H/L比值为1.77±0.33(P=0.001),与缺血可逆程度呈明显正相关(r=0.51,P＜0.05).结论多巴酚丁胺负荷可使缺血心肌增加对18F-FDG的摄取.     

Dexamethasone treatment attenuates early seawater instillation-induced acute lung injury in rabbits.

There is very little evidence on the value of giving corticoids in cases of seawater drowning induced acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Therefore, this study aimed to investigate whether dexamethasone treatment can attenuate seawater instillation-induced acute lung injury in rabbits. Seawater (4 ml/kg body weight) was instilled into the lower trachea of ventilated, anesthetized rabbits. Then these rabbits were assigned randomly 20 min later to receive intravenous injection of 1mg/kg body weight of dexamethasone (dissolving in 2 ml of normal saline) or 2 ml of normal saline. All animals demonstrated immediate drops in arterial oxygen tension (PaO2) and the total thoracic compliance, which were significantly improved after 2 h of dexamethasone treatment. Histopathological study also indicated that dexamethasone treatment markedly attenuated lung histopathological changes, alveolar hemorrhage and inflammatory cells infiltration with evidence of decreasing of myeloperoxidase (MPO) activity and tumor necrosis factor-alpha (TNF-alpha) concentration in lung tissue. In addition, dexamethasone treatment reduced extravascular lung water and lung epithelial-endothelial barrier permeability, up-regulated the expression of surfactant protein-A (SP-A) and alpha-epithelial Na+ channel, and increased Na+/K+-adenosine triphosphatase (Na+/K+-ATPase) activity and Na+/K+-ATPase-alpha1 protein abundance. Thus, these data indicate that dexamethasone treatment might be of benefit in patients with seawater aspiration-induced ALI.     

吸入不同浓度异氟醚对喉返神经肌电活动的影响

目的观察不同浓度的异氟醚吸入对喉返神经肌电活动的影响。方法30例择期甲状腺手术患者,ASAⅠ～Ⅱ级,采用异氟醚吸入复合静脉麻醉。于分离甲状腺前诱导恢复自主呼吸,调整异氟醚呼出浓度为0.1、0.2、0.3、0.4、0.5、0.6、0.7MAC时,观察血压、心率及喉返神经肌电活动波的振幅变化,记录喉返神经肌电波形振幅等于100μV时的异氟醚呼出浓度。结果当异氟醚呼出浓度为0.1、0.2、0.3、0.4MAC时,喉返神经肌电活动显示良好,当异氟醚呼出浓度为0.5、0.6、0.7MAC时,喉返神经肌电活动振幅降低,随异氟醚吸入浓度增高直至消失。结论低浓度异氟醚吸入,基本不会影响喉返神经功能的监控。