The hypoglycaemic action of metformin

Twenty-four-hour excretion of D-xylose after oral administration in nine diabetic patients, and of 3-0-methyl-D-glucose in six patients, showed no significant change after treatment with metformin. There was, however, a significant reduction in mean fasting blood glucose levels in thirteen patients from 160 to 115 mg/100 ml (P <0·001), and the intravenous glucose tolerance improved in twelve of these patients (P <0·01), during treatment with metformin.     

Treatment of severe hypertension and hypertensive emergencies with intravenous clonidine hydrochloride

Eleven severely hypertensive patients, median age 54 years, were treated with intravenous (i.v.) clonidine hydrochloride (Catapres). In nine there were life-threatening complications: severe left ventricular failure (LVF), hypertensive encephalopathy, cerebral haemorrhage, dissecting aortic aneurysm, renal failure, and severe epistaxis. In two patients there was pronounced, but uncomplicated, elevation of blood pressure. 0·15 mg or 0·3 mg clonidine was given every 40 min with electrocardiographic (ECG) monitoring. The mean systolic and diastolic blood pressures in the eleven patients were respectively 266 and 165 mmHg before treatment falling to 165 and 109 mmHg after treatment (P < 0·001). The mean decrease in heart rate was 26 beats/min (P < 0·001). Doses of clonidine required for control ranged from 0·15 mg (one ampoule) to 0·9 mg (mean 0·56 mg), although one patient received a total of 0·9 mg without an adequate response. The presenting condition caused the eventual death of two patients. There were no serious side effects, except for one transient episode of sino-atrial heart block. It is concluded that clonidine is effective and safe in the treatment of hypertensive emergencies.     

Transplacental transfer of 25-hydroxy-cholecalciferol

Plasma calcium, inorganic phosphorus, alkaline phosphatase, magnesium and 25-hydroxy-cholecalciferol (25-OH-D3) levels were determined on venous blood in 60 Indian mothers during labour. The same analyses were carried out on the cord blood and the infant''s venous blood 96 hr after birth. The mean values of plasma calcium, inorganic phosphorus and magnesium were significantly raised in the cord blood compared to those in the maternal blood (calcium and phosphorous P<0·001 and magnesium P<0·01). The mean plasma levels of 25-OH-D3 in the maternal and cord blood were 11·7 ng/ml and 9·6 ng/ml respectively, the cord blood level being about 81% of the maternal. There was a highly significant correlation between these concentrations (r=0·80, P<0·001). The plasma 25-OH-D3 was subnormal in 12 pregnant mothers at labour and 14 infants.     

Intraperitoneal noxythiolin and povidone-iodine in experimental peritonitis

The efficacy of intraperitoneal noxythiolin and povidone-iodine was compared in mice and rats with induced Gram-negative peritonitis. Noxythiolin 1% solution reduced the mortality of mice from 65 to 41% (P<0·1) but was ineffective in rats. Povidone-iodine (6·0-7·5 mg available iodine/kg body weight) significantly reduced the mortality of both mice (P<0·001) and rats (P<0.01) in treated animals compared to matched controls. The mortality rate of rats treated with povidone-iodine was significantly less than those treated with noxythiolin (P<0·01).     

Valsartan Decreases Platelet Activity and Arterial Thrombotic Events in Elderly Patients with Hypertension

Background:Angiotensin type 1 receptor (AT1R) antagonists are extensively used for blood pressure control in elderly patients with hypertension.This study aimed to investigate the inhibitory effects of...     

Oral theophylline in chronic heart failure

Theophylline choline 600 mg was given as a single oral dose to nine patients in chronic left ventricular failure due to myocardial dysfunction. Cardiac output, left ventricular filling pressure (LVFP) and right atrial pressure (RAP) were measured with a pulmonary artery thermodilution catheter for the following 3 hr. Continuous recordings of cardiac rhythm were made throughout the study. Mean cardiac index increased from 1·75 (±0·14 s.e. mean) to 2·04 (±0·11) 1/min/m² (P<0·02), mean LVFP fell from 27 (±2·4) to 22 (±1·5) mmHg (P<0·01), mean RAP fell from 5 (±1·3) to 3 (±2·0) mmHg (P<0·05) and mean systemic arterial pressure rose from 80 (±3) to 86 (±3·5) mmHg (P<0·05). There were no significant changes in heart rate or systemic vascular resistance; thus the increase in cardiac output was probably due to a positive inotropic effect. Side effects were seen in two patients, both of whom proved to have toxic plasma theophylline concentrations.     

Effects of Saikokaryukotsuboreito on Spermatogenesis and Fertility in Aging Male Mice

Background:

Aspermia caused by exogenous testosterone limit its usage in late-onset hypogonadism (LOH) patients desiring fertility. Saikokaryukotsuboreito (SKRBT) is reported to improve serum testosterone and relieve LOH-related symptoms. However, it is unclear whether SKRBT affects fertility. We aimed to examine the effects of SKRBT on spermatogenesis and fertility in aging male mice.

Methods:

Thirty aging male mice were randomly assigned to three groups. Mice were orally administered with phosphate-buffer solution or SKRBT (300 mg/kg, daily) or received testosterone by subcutaneous injections (10 mg/kg, every 3 days). Thirty days later, each male mouse was mated with two female mice. All animals were sacrificed at the end of 90 days. Intratesticular testosterone (ITT) levels, quality of sperm, expression of synaptonemal complex protein 3 (SYCP3), and fertility were assayed.

Results:

In the SKRBT-treated group, ITT, quality of sperm, and expression of SYCP3 were all improved compared with the control group (ITT: 85.50 ± 12.31 ng/g vs. 74.10 ± 11.45 ng/g, P = 0.027; sperm number: [14.94 ± 4.63] × 10⁶ cells/ml vs. [8.79 ± 4.38] × 10⁶ cells/ml, P = 0.002; sperm motility: 43.16 ± 9.93% vs. 33.51 ± 6.98%, P = 0.015; the number of SYCP3-positive cells/tubule: 77.50 ± 11.01 ng/ml vs. 49.30 ± 8.73 ng/ml, P < 0.001; the expression of SYCP3 protein: 1.23 ± 0.09 vs. 0.84 ± 0.10, P < 0.001), but fertility was not significantly changed (P > 0.05, respectively). In the testosterone-treated group, ITT, quality of sperm, and expression of SYCP3 were markedly lower than the control group (ITT: 59.00 ± 8.67, P = 0.005; sperm number: [4.34 ± 2.45] × 10⁶ cells/ml, P = 0.018; sperm motility: 19.53 ± 7.69%, P = 0.001; the number of SYCP3-positive cells/tubule: 30.00 ± 11.28, P < 0.001; the percentage of SYCP3-positive tubules/section 71.98 ± 8.88%, P = 0.001; the expression of SYCP3 protein: 0.71 ± 0.09, P < 0.001), and fertility was also suppressed (P < 0.05, respectively).

Conclusion:

SKRBT had no adverse effect on fertility potential in aging male mice.     

Symptomatic improvement after catheter ablation of supraventricular tachycardia measured by the arrhythmia-specific questionnaire U22

Introduction

The main indication for ablation of supraventricular tachycardia is symptomatic relief. Generic measures of quality of life are not suitable for direct evaluation of arrhythmia-related symptoms, and a specific tool is needed. The questionnaire U22 quantifies symptoms associated with arrhythmic events. It uses discrete 0–10 scales for quantification of influence of arrhythmia on well-being, intensity of discomfort, type of dominant symptom, and a time aspect that summarizes duration and frequency of spells. We evaluated U22 in a well defined group of patients with paroxysmal supraventricular tachycardia, undergoing an intervention with a distinct end-point and a high success rate.

Methods

Symptoms in patients with accessory pathway and atrioventricular nodal re-entrant tachycardia scheduled for ablation were measured with U22 and SF-36 on admission. The evaluation was repeated after 6 months.

Results

Altogether 58 patients successfully ablated in 2006–2008 completed the four forms (U22 and SF-36 at base-line and follow-up, 210 ± 35 days after ablation). The score for well-being (0–10; 10 being best) increased from 5.9 ± 2.6 to 7.9 ± 1.9 (P < 0.0005). The score for arrhythmia as cause for impairment in well-being (0–10; 10 being highest) decreased from 7.5 ± 2.8 to 2.0 ± 3.1 (P < 0.0005). The time aspect score (0–10) decreased from 4.7 ± 1.5 to 1.4 ± 1.8 (P < 0.0005). The two SF-36 summary measures PCS and MCS increased from 46.9 ± 9.4 to 48.4 ± 10.7 and from 44.9 ± 12.5 to 49.1 ± 9.9 (P = 0.04 and 0.002).

Conclusion

After successful ablation of accessory pathway and atrioventricular nodal re-entrant tachycardia, the U22 protocol detected a relevant increase in arrhythmia-related well-being. Modest improvement in general well-being was detected by the SF-36 protocol.     

Effects of bisoprolol and cilazapril on the central retinal artery blood flow in patients with essential hypertension—preliminary results

Background

A growing body of evidence suggests that effective blood pressure reduction may inhibit the progression of microvascular damage in patients with essential arterial hypertension. However, the potential influence of anti-hypertensive drugs on ocular circulation has not been studied sufficiently.

Purpose

The aim of our study was to evaluate the effects of anti-hypertensive therapy on blood flow in the central retinal artery in patients with systemic arterial hypertension.

Material and methods

Twenty patients with essential arterial hypertension, aged 32–46 years, were examined with Doppler ultrasonography (10 MHz ultrasound probe). Blood flow velocities, pulsatility, and vascular resistance were determined before and 3 hours after systemic application of either bisoprolol 5 mg or cilazapril 2.5 mg.

Results

Administered bisoprolol significantly decreased maximum (9.8 ± 0.5 cm/s versus 8.5 ± 0.6 cm/s; P < 0.05) and minimum (2.75 ± 0.19 cm/s versus 1.75 ± 0.27 cm/s; P < 0.02) velocity, increased the Pourcellot''s index (0.71 to 0.79; P < 0.05) in central retinal artery. There were no statistically significant changes in central retinal artery blood flow after administration of cilazapril.

Conclusion

Systemic application of beta-blockers may unfavourably disturb the ocular blood flow.     

Continuous infusion of papaveretum for relief of postoperative pain

Postoperative analgesia, once established initially by the titration method, is sustained with a flexible regime of papaveretum, infused continuously with a portable syringe pump. The initial analgesic requirement (IAR) for titrating the pain threshold level, was between 4 and 10 mg of papaveretum and the maintenance dose between 1 and 1·66 mg/hr for the first 24 hr and between 0·83 and 1 mg/hr for the second 24 hr. There was no significant association between IAR and the maintenance dose (P<0·2) nor was there any correlation between the maintenance dose, body weight, age, sex or nature of operations. The results in 70 patients are encouraging.     

Passive smoking: Absorption by non-smokers of carbon monoxide from room-air polluted by tobacco smoke

Twenty subjects spent a mean of 78 min seated in an unventilated smoke-filled room of approximately 43 m³ (15 × 12 × 8 ft). The smoke was produced by burning and smoking eighty cigarettes and two cigars. The average ambient carbon monoxide (CO) concentration was 38 ppm. Blood samples taken before and after the exposure showed an increase in carboxyhaemoglobin (COHb) in all subjects without exception (P<0·001). The COHb of the twelve non-smokers increased from a mean of 1·6% to 2·6% (P<0·001), while the six cigarette smokers, all inhalers, besides having significantly higher initial levels (P<0·001) also showed a greater increase from a mean of 5·9% to 9·6% (P<0·001). The two cigar smokers, one an inhaler, the other a non-inhaler, showed respective COHb changes similar to the cigarette smokers and non-smokers. The mean increase of 1% COHb among the non-smokers was similar to the mean increase for the smokers of 0·7% for each cigarette smoked, suggesting that the amount of CO which the non-smokers absorbed by passive smoking was about the same as would be expected if they had actively smoked and inhaled one cigarette.     

抗核抗体阳性类风湿关节炎的临床和实验室检查特点

目的:分析抗核抗体(anti-nuclear antibodies, ANA)阳性类风湿关节炎(rheumatoid arthritis,RA)患者的临床及实验室检查特征。方法:选择2013年1月—2018年12月于北京大学第三医院风湿免疫科住院的428例RA患者的临床及实验室检查资料,回顾性分析ANA阳性RA患者的临床和实验室检查指标的特点。统计学方法符合正态分布的定量资料采用t检验,非正态分布的定量资料采用Wilcoxon秩和检验。定性资料采用χ²检验,1≤理论频数<5采用校正四格表χ²检验,理论频数<1采用确切概率法。结果:收集到ANA阳性患者共231例(54%),ANA阳性组中女性占比明显多于ANA阴性组(82.7% vs. 63.5%, χ²=20.355,P<0.01);ANA阳性组出现跖趾关节受累(22.1%)低于ANA阴性组(33.0%, χ²=6.414,P<0.05),ANA阳性组中合并继发性干燥综合征(secondary Sj?gren’s syndrome, sSS)的比例显著高于ANA阴性组(19.5% vs. 4.1%, χ²=23.300,P<0.01);ANA阳性组合并类风湿因子(rheumatoid factor, RF)阳性(77.1% vs. 53.8%, χ²=25.743,P<0.01)及抗环瓜氨酸多肽(cyclic citrullinated peptide,CCP)抗体阳性(74.9% vs. 59.4%, χ²=11.694,P<0.01)的比例均显著高于阴性组。ANA阳性组免疫球蛋白G(immunoglobulin G,IgG)水平[(15.1±5.1) g/L vs. (13.8±5.3) g/L, t=2.359, P<0.05]及免疫球蛋白M(immunoglobulin M,IgM)水平[1.25(0.92) g/L vs.1.05(0.65) g/L, Z=-3.449, P<0.01]高于阴性组,而血红蛋白(hemoglobin, Hb)水平[(109.64±17.98) vs. (114.47±18.48) g/L,t=-2.734, P<0.01]、血小板(platelet, PLT)水平[(266.4×10⁹±104.6×10⁹) vs. (295.9×10⁹±100.1×10⁹) /L,t=-2.970, P<0.01]低于阴性组。结论:ANA阳性RA患者合并sSS的比例显著高于ANA阴性者,前者IgG水平更高,而Hb及PLT水平则更低。     

Radiological Characteristics and Anatomical Risk Factors in the Evaluation of Hallux Valgus in Chinese Adults

Background:There are no unified theories as to the anatomical changes that occur with hallux valgus,we investigated the radiological characteristics and anatomical risk factors for hallux valgus deform...     

Cytomegalovirus Pneumonia in Patients with Rheumatic Diseases After Immunosuppressive Therapy: A Single Center Study in China

Background:

Rheumatic diseases involve multiple organs that are affected by immunological mechanisms. Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection. Cytomegalovirus (CMV) is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients. This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.

Methods:

Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated. GraphPad Prism version 5.013 (San Diego, CA, USA) was used to conduct statistical analysis. The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test. Significance between qualitative data was analyzed using Pearson''s Chi-squared test. The cut-off thresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic (ROC) curve analysis.

Results:

One hundred and forty-two patients had positive CMV viral load tests. Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic. The symptomatic group received higher doses of prednisolone (PSL) and more frequently immunosuppressants than the asymptomatic group (P < 0.01). The symptomatic group had lower lymphocyte counts, especially CD⁴⁺ T-cells, than the asymptomatic group (P < 0.01). By ROC curve analysis, when CD⁴⁺ T-cell count was <0.39 × 10⁹/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection. The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients (P < 0.01; threshold viral loads: 1.75 × 10⁴ copies/ml). Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts (P < 0.01), including CD4⁺ and CD⁸⁺ T-cells (P < 0.01).

Conclusions:

When CD⁴⁺ T-cell count is <0.39 × 10⁹/L, patients are at high risk for pulmonary CMV infection. Patients are prone to be symptomatic with CMV-DNA load >1.75 × 10⁴ copies/ml. Lymphopenia (especially CD⁴⁺ T-cells), presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.     

Changes in the Bispectral Index in Response to Loss of Consciousness and No Somatic Movement to Nociceptive Stimuli in Elderly Patients

Background:

Bispectral index (BIS) is considered very useful to guide anesthesia care in elderly patients, but its use is controversial for the evaluation of the adequacy of analgesia. This study compared the BIS changes in response to loss of consciousness (LOC) and loss of somatic response (LOS) to nociceptive stimuli between elderly and young patients receiving intravenous target-controlled infusion (TCI) of propofol and remifentanil.

Methods:

This study was performed on 52 elderly patients (aged 65–78 years) and 52 young patients (aged 25–58 years), American Society of Anesthesiologists physical status I or II. Anesthesia was induced with propofol administered by TCI. A standardized noxious electrical stimulus (transcutaneous electrical nerve stimulation, [TENS]) was applied (50 Hz, 80 mA, 0.25 ms pulses for 4 s) to the ulnar nerve at increasing remifentanil predicted effective-site concentration (Ce) until patients lost somatic response to TENS. Changes in awake, prestimulus, poststimulus BIS, heart rate, mean arterial pressure, pulse oxygen saturation, predicted plasma concentration, Ce of propofol, and remifentanil at both LOC and LOS clinical points were investigated.

Results:

BIS_LOC in elderly group was higher than that in young patient group (65.4 ± 9.7 vs. 57.6 ± 12.3) (t = 21.58, P < 0.0001) after TCI propofol, and the propofol Ce at LOC was 1.6 ± 0.3 μg/ml in elderly patients, which was significantly lower than that in young patients (2.3 ± 0.5 μg/ml) (t = 7.474, P < 0.0001). As nociceptive stimulation induced BIS to increase, the mean of BIS maximum values after TENS was significantly higher than that before TENS in both age groups (t = 8.902 and t = 8.019, P < 0.0001). With increasing Ce of remifentanil until patients lost somatic response to TENS, BIS_LOS was the same as the BIS_LOC in elderly patients (65.6 ± 10.7 vs. 65.4 ± 9.7), and there were no marked differences between elderly and young patient groups in BIS_awake, BIS_LOS, and Ce of remifentanil required for LOS.

Conclusion:

In elderly patients, BIS can be used as an indicator for hypnotic-analgesic balance and be helpful to guide the optimal administration of propofol and remifentanil individually.

Trial Registration:

CTRI Reg. No: ChiCTR-OOC-14005629; http://www.chictr.org.cn/showproj.aspx?proj=9875.     

Effect of hypocalcaemia on glucose tolerance, insulin release and free fatty acid levels in human subjects

Eight patients with hypocalcaemia who presented with frank or latent tetany due to parathyroid insufficiency or nutritional osteomalacia were studied. Their serum calcium ranged from 6·85 to 7·7 mg/100 ml (mean 7·33±0·36 mg/100 ml). In six of them, serum calcium after treatment varied from 8·4 to 9·2 mg/100 ml. In ten healthy normal subjects the serum calcium levels were 9·0-10·2 mg/100 ml (9·50±0·47 mg/100 ml). The blood glucose levels during a 3 hr oral GTT were significantly elevated during hypocalcaemia and returned to normal levels after treatment. Serum insulin levels were low at 60 and 120 min after the administration of glucose in hypocalcaemia but returned to normal once the serum calcium levels were above 8·4 mg/100 ml. The FFA levels were high during the low calcium state and reached normal levels after treatment. The above studies suggest that an optimal level of serum calcium is essential for glucose-induced insulin release.     

Serum zinc levels in corticosteroid-treated asthmatic patients

Serum zinc levels have been measured in twenty-four asthmatic patients, of whom sixteen were on long term corticosteroid therapy. They were carefully screened to exclude any concomitant disease. The non-steroid-treated asthmatics had normal serum zinc levels which ranged from 89 to 138 μg/ml. The corticosteroid-treated patients had a mean serum zinc level of 64 ± 9 μg/100 ml; this was significantly lower than normal (P = < 0·001).     

柴胡桂枝汤通过sirt1-p53信号通路产生抗抑郁作用

目的探讨柴胡桂枝汤的抗抑郁效应和作用机制。方法设两组成年雄性C57BL/6J小鼠：柴胡桂枝汤组（CGD，n=12）接受连续7 d的柴胡桂枝汤灌胃给药，药物浓度为17 g·kg^-1·d^-1；溶剂对照组（Vehicle，n=14）接受连续7 d的药物溶剂灌胃给药。采用强迫游泳实验（FST）、高架十字迷宫实验（EPM）、新环境压抑进食实验（NSF）以及旷场实验（OFT），检测两组小鼠的抑郁样行为、焦虑样行为和运动能力。进一步使用慢性社会挫败应激模型（CSDS）和社会交互实验（SI）明确柴胡桂枝汤在动物抑郁模型中的抗抑郁作用；造模和对照小鼠连续接受柴胡桂枝汤或溶剂7 d灌胃处理，具体分组为：造模鼠+柴胡桂枝汤组（CSDS+ CGD，17 g·kg^-1·d^-1，n=8）、造模鼠+溶剂组（CSDS+vehicle，n=11）、对照鼠+柴胡桂枝汤组（Con+CGD，17 g·kg^-1·d^-1，n=8）、对照鼠溶剂组（Con+vehicle，n=6）。此外，采用蛋白质免疫印迹（Western blot）、实时荧光定量聚合酶链反应（qRT-PCR）检测柴胡桂枝汤给药组及溶剂对照组小鼠海马组织中的sirt1、p53、乙酰化p53蛋白水平和海马神经元突触可塑性相关基因synapsin I（Syn1）、Rab4B、SNAP25和Tubulin beta4b的表达。结果柴胡桂枝汤组小鼠在FST中的不动时间显著性减少（P < 0.05）；两组动物在EPM、NSF和OFT实验中无显著性差异；在SI行为实验中，CSDS+vehicle组小鼠与其他3组相比，在交互区的停留时间有显著性差异（P < 0.05）。与溶剂对照组相比，柴胡桂枝汤组小鼠海马区sirt1蛋白水平上升，乙酰化p53蛋白水平下降（P < 0.05），突触可塑性相关蛋白Syn1 mRNA表达上调（P < 0.05），Rab（P=0.813），SNAP（P=0.820），Tubb（P=0.864）的mRNA表达没有显著性差异。结论柴胡桂枝汤在FST和CSDS动物模型中都具有抗抑郁样作用；可能通过sirt1-p53通路及突触可塑性机制发挥其抗抑郁效应。     

Ranibizumab Plus Combined Surgery for Treatment of Neovascular Glaucoma with Vitreous Hemorrhage

Background:Neovascular glaucoma (NVG) is a refractory glaucoma.The management of NVG is very difficult,and it is more difficult when combined with vitreous hemorrhage.The aim of this study was to inves...     

Nerve Growth Factor for the Treatment of Spinocerebellar Ataxia Type 3: An Open-label Study

Background:Spinocerebellar ataxia type 3 (SCA3) is the most common subtype of SCA worldwide,and runs a slowly progressive and unremitting disease course.There is currently no curable treatment availabl...