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E. Albrecht D. Capel J. B. Rossel M. R. Wolmarans A. Godenèche D. De Paulis J. Cabaton 《Anaesthesia》2023,78(3):315-319
Prolongation of peripheral nerve blockade by intravenous dexamethasone may be extended by intravenous dexmedetomidine. We randomly allocated 122 participants who had intravenous dexamethasone 0.15 mg.kg−1 before interscalene brachial plexus block for day-case arthroscopic rotator cuff repair to intravenous saline (62 participants) or intravenous dexmedetomidine 1 μg.kg−1 (60 participants). The primary outcome was time from block to first oral morphine intake during the first 48 postoperative hours. Fifty-nine participants reported taking oral morphine, 25/62 after placebo and 34/60 after dexmedetomidine, p = 0.10. The time to morphine intake was shorter after dexmedetomidine, hazard ratio (95%CI) 1.68 (1.00–2.82), p = 0.049. Median (IQR [range]) morphine doses were 0 (0–12.5 [0–50]) mg after control vs. 10 (0–30 [0–50]) after dexmedetomidine, a difference (95%CI) of 7 (0–10) mg, p = 0.056. There was no effect of dexmedetomidine on pain at rest or on movement. Intra-operative hypotension was recorded for 27/62 and 50/60 participants after placebo vs. dexmedetomidine, respectively, p < 0.001. Other outcomes were similar, including durations of sensory and motor block. In conclusion, dexmedetomidine shortened the time to oral morphine consumption after interscalene block combined with dexamethasone and caused intra-operative hypotension. 相似文献
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Sodium-glucose cotransporter 2 inhibitors as the first universal treatment of chronic kidney disease
《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2022,42(4):390-403
In the last five years, the medical community was astonishingly surprised by the sequential large outcome trials that displayed the renal effects of sodium glucose co-transporter inhibitors (SGLT2Is) in type 2 diabetes mellitus (T2DM) patients with or without chronic kidney disease (CKD). This favorable effect was later disclosed in non-diabetic CKD patients. The EMPA-REG OUTCOME trial was the first trial that showed a reduction for the need for dialysis in patients suffering diabetic kidney disease (DKD) by 55%. This figure is double the score achieved by the angiotensin receptor blocker, Losartan, in RENAAL trial. The need for dialysis in DAPA-CKD trial was reduced in diabetic and non-diabetic CKD patients by 33%. The renal-specific composite outcome was reduced by 39% in EMPA-REG trial, 40% in CANVAS study, 47% in DECLARE-TIMI 58 study, 34% in CREDENCE trial, and 44% in DAPA-CKD trial. The greater surprise is the significant favorable effect of SGLT2Is on overall mortality in CKD patients with or without T2DM. Similar survival benefit was not previously encountered with any of the medications used in CKD patients with or without diabetes. In this review, we disclose the results of the DAPA-CKD trial, the CREDENCE trial and those of several cardiovascular outcome trials (CVOT) that used different SGLT2Is and showed that patients with lower eGFR levels may have greater benefit with respect to cardiovascular morbidity than patients with normal kidney function. In addition, we discuss the different mechanisms of action that explain the renal beneficial effects of SGLT2Is. 相似文献
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《Nutrition, metabolism, and cardiovascular diseases : NMCD》2022,32(2):436-446
Background and aimsSkin autofluorescence (SAF) can non-invasively assess the accumulation of tissue AGEs. We investigated the association between SAF and kidney dysfunction in participants with T2D.MethodsOf 4030 participants consecutively measured SAF at baseline, 3725 participants free of end-stage kidney disease (ESKD) were included in the analyses. The association of SAF with incident ESKD or ≥30% reduction in estimated glomerular filtration rate (eGFR) was examined with Cox regression, linear mixed-effects model for the association with annual eGFR decline, and mediation analyses for the mediating roles of renal markers.ResultsDuring a median (IQR) 1.8 (1.1–3.1) years of follow-up, 411 participants developed the outcome. SAF was associated with progression of kidney disease (hazard ratio 1.15 per SD, 95% confidence interval [CI] [1.04, 1.28]) and annual decline in eGFR (β ?0.39 per SD, 95% CI [?0.71, ?0.07]) after adjustment for risk factors, including baseline eGFR and urinary albumin-creatinine ratio (UACR). Decreased eGFR (12.9%) and increased UACR (25.8%) accounted for 38.7% of the effect of SAF on renal outcome.ConclusionsSAF is independently associated with progression of kidney disease. More than half of its effect is independent of renal markers. SAF is of potential to be a prognostic marker for kidney dysfunction. 相似文献
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背景 清热消癥方对糖尿病肾病(DKD)肾损伤有保护作用,然而机制尚不十分明确。 目的 探讨清热消癥方在单侧肾切除联合链脲佐菌素(STZ)诱导的DKD大鼠肾损伤中的保护作用及机制。 方法 2019年7—11月,将30只SPF级健康雄性SD大鼠随机分为假手术组(NC组,n=10)和模型组(n=20)。NC组大鼠于右肾体表解剖位置做1 cm的横行切口并缝合;模型组大鼠予右侧肾切除。1周后,大鼠伤口愈合后,NC组大鼠给予等量柠檬酸缓冲液腹腔注射;模型组大鼠予单次腹腔注射STZ(55 mg/kg)的方法构建DKD模型。成模后将模型组大鼠随机分为DKD亚组(n=10)和清热消癥方亚组(QRXZF亚组,n=10)。NC组和DKD亚组大鼠灌服等量(1 ml/100 g)0.9%氯化钠溶液,1次/d。QRXZF亚组大鼠以7.92 g·kg-1·d-1的剂量予中药灌胃。干预期间每周对大鼠称重。干预16周后留取大鼠24 h尿、血清、肾组织标本,并称取肾脏重量,计算肾重指数。采用酶联免疫吸附试验(ELISA)检测大鼠24 h尿微量白蛋白(24 hUpro)水平,全自动生化分析仪检测大鼠血肌酐(Scr)、血清尿素氮(BUN)和血清白蛋白(ALB)。将肾脏组织进行苏木素-伊红(HE)染色、糖原(PAS)染色、Masson染色,观察大鼠肾脏组织损伤程度。免疫组化法(IHC)检测各组大鼠肾组织Caspase-3和p16表达情况。原位末端脱氧核苷酸转移酶标记技术(TUNEL)法检测肾小管细胞凋亡率。 结果 DKD亚组、QRXZF亚组体质量均低于NC组、肾重指数均高于NC组(P<0.01);QRXZF亚组体质量高于DKD亚组、肾重指数低于DKD亚组(P<0.01)。DKD亚组24 hUpro、Scr、BUN水平均高于NC组,ALB水平低于NC组(P<0.01);QRXZF亚组24 hUpro、BUN水平均高于NC组,ALB水平低于NC组(P<0.01);QRXZF亚组24 hUpro、Scr、BUN水平均低于DKD亚组,ALB水平高于DKD亚组(P<0.01)。与NC组相比,DKD亚组和QRXZF亚组大鼠肾脏均出现明显病理损伤,肾小球肥大和间质小管纤维化,但QRXZF亚组病变程度较DKD亚组明显减轻。免疫组化结果表明,DKD亚组、QRXZF亚组肾组织p16、Caspase-3表达水平均高于NC组,QRXZF亚组肾组织p16、Caspase-3表达水平均低于DKD亚组(P<0.01)。DKD亚组、QRXZF亚组大鼠肾小管细胞凋亡率高于NC组,QRXZF亚组肾小管细胞凋亡率低于DKD亚组(P<0.01)。 结论 清热消癥方可有效改善DKD大鼠的肾功能,抑制肾脏病理损伤和纤维化,抑制DKD大鼠肾组织中Caspase-3和p16的表达,降低肾小管细胞凋亡率。提示清热消癥方发挥肾保护作用的机制可能与抑制肾脏细胞衰老和凋亡有关。 相似文献
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目的探讨白介素-6(interleukin-6,IL-6)对糖尿病周围神经病变大鼠的干预性作用及可能的机制。方法选取2015年10月至2018年12月80只健康雄性wistar大鼠作为研究对象,随机分为对照组、糖尿病非干预组、糖尿病低剂量IL-6干预组(1μg/kg,每周3次,皮下注射)和糖尿病高剂量IL-6干预组(10μg/kg,每周3次,皮下注射),每组20只。糖尿病大鼠造模应用尾静脉注射链脲菌素45 mg/kg方法,随机血糖>16.7 mmol/L为造模成功。检测各组大鼠外周血IL-6、腓肠神经形态学改变,以及腓肠神经NF-κB、I?Bα、IL-6mRNA及蛋白表达。结果糖尿病大鼠的糖化血红蛋白、血IL-6水平、腓肠神经IL-6、NF-κB、I?Bα表达水平均高于对照组,差异有统计学意义(P<0.05)。腓肠神经病理可见纤维密度减少,截面积减小,呈萎缩趋势,可见少量异常有髓纤维。应用IL-6干预后大鼠的腓肠神经病理改变较非干预组明显改善,且IL-6,NF-κB,I?Bα的mRNA及蛋白表达水平低于非干预组,高剂量IL-6干预后上述炎症因子的表达与非干预组比较差异有统计学意义(P<0.05)。结论 IL-6可通过抑制腓肠神经NF-κB的表达,缓解糖尿病大鼠周围神经病变的进展。 相似文献
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电磁导航支气管镜在肺外周病变诊断及治疗的临床应用 《首都医科大学学报》2022,43(4):570-575
随着低剂量螺旋电子计算机断层扫描(computed tomography,CT)应用于肺癌高危人群中的筛查越来越普及,肺外周病变(peripheral pulmonary lesions,PPLs)发现概率也随之增加。电磁导航支气管镜(electromagnetic navigation bronchoscopy,ENB)是一种能够进行肺部外周病变诊断、定位及治疗的工具,由于它的安全性和可靠性更高,ENB在未来有可能会改变肺部疾病的诊断和治疗方式,从而缓解病情甚至治愈肺癌,为肺癌的治疗开辟了新的路径。 相似文献
9.
Objective: To systematically evaluate the effect of Yiqi Wenyang Huoxue therapy in treating diabetic kidney disease(DKD) of stage Ⅲ-Ⅳ. Method: The relevant literature was retrieved by computer from CNKI, Wanfang and VIP databases,CBM,PubMed,EMBase,Cochrane Library and Web of Science. Articles screening and data extraction were performed by two researchers separately and independently. The Meta-analysis was conducted with RevMan 5.3. Results: A total of 10 randomized controlled trials were collected,including 778 cases with DKD. Meta-analysis showed that the Yiqi Wenyang Huoxue Method combined with western medicine basic treatment could reduce 24hUTP[MD=-0.36, 95%CI (-0.46, -0.26), P <0.00001], UAER[MD=-36.72,95%CI (-47.21, -26.23), P<0.00001], Scr[MD= -16.28, 95%CI(-20.59,-11.97),P<0.00001],BUN[MD=-1.45,95%CI(-1.76,-1.14), P <0.00001], TC[MD=-0.64, 95%CI(-1.07,-0.21), P=0.004].There was also a reduction in HbA1c[MD=-0.50,95%CI (-0.94, -0.05),P =0.03], but the difference is not significant. Conclusion: Based on the current evidence, for the treatment of DKD of stage Ⅲ-IV, basic western medicine treatment combined with Yiqi Wenyang Huoxue method may better reduce urine protein, total cholesterol levels and improve renal function. The conclusion of this study needs to be further researched by high-quality studies, because that the quality of the included studies is generally low. 相似文献
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背景糖尿病心脏自主神经病变(DCAN)是糖尿病常见且严重的慢性并发症之一,但目前关于甲状腺功能与DCAN关系的研究报道较少。目的探讨亚临床甲状腺功能减退症(SCH)对DCAN的影响。方法选取2019年10月至2020年10月在首都医科大学附属北京友谊医院住院及门诊就诊的2型糖尿病患者564例。所有患者均完成Ewing试验。收集患者一般资料、体格检查结果、实验室检查结果,并依据Ewing试验评估并筛查DCAN。相关性分析采用Pearson相关分析和Spearman秩相关分析,采用多因素Logistic逐步回归分析探究2型糖尿病患者并发DCAN的影响因素。结果564例2型糖尿病患者中,129例并发DCAN(DCAN组),435例未并发DCAN(对照组),DCAN发生率为22.9%。2型糖尿病患者中合并SCH者84例(14.9%),DCAN组患者中合并SCH者36例(28.0%),对照组患者中合并SCH者48例(11.0%),DCAN组患者合并SCH患病率高于对照组(χ2=22.346,P<0.001)。2型糖尿病并发DCAN患者Valsalva试验动作期间最大R-R间距与最小R-R间距比值(VAL R-R比值)与糖尿病病程、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TC)、超敏C反应蛋白(hs-CRP)、促甲状腺激素(TSH)、尿微量白蛋白/肌酐(UACR)呈负相关,与舒张压(DBP)呈正相关(P<0.05)。多因素Logistic逐步回归分析结果显示,SCH〔OR=1.717,95%CI(1.246,2.365)〕是2型糖尿病患者并发DCAN的独立影响因素(P<0.05)。结论2型糖尿病患者TSH水平与DCAN相关,且SCH是2型糖尿病患者并发DCAN的独立影响因素。 相似文献