血糖控制未达标对2型糖尿病合并脑白质病变患者的影响

目的 探讨血糖控制未达标对伴2型糖尿病（T2DM）的脑白质病变（WMC）患者病变程度及认知功能的影响.方法 对167例伴T2DM的脑白质病变患者,以HbA1C＞ 7.0％为界限,超过此值的为血糖控制未达标组即观察组,低于此值的为血糖控制达标组即对照组.结果 根据Fazekas量表对2组患者程度进行影像学评分,观察组WMC评分4～6分的患者多于对照组,差异有统计学意义（P＜0.05）.根据蒙特利尔认知评价量表（MoCA）对2组患者的MoCA总分及各认知域得分进行比较,观察组患者MoCA总分及视空间与执行能力、注意、延迟回忆评分显著低于对照组,差异有统计学意义（P＜0.05）.结论 血糖控制未达标的人群中WMC程度较重,且认知功能损害也较严重.     

糖尿病足患者合并认知功能障碍的相关危险因素分析

目的 分析2型糖尿病足患者合并轻度认知功能障碍(mild cognitive impairment,MCI)的相关危险因素.方法 采用MoCA量表,比较2型糖尿病足患者与非糖尿病足患者(对照组)的认知功能及糖尿病足Wagner各分级间认知功能各项评分的差异.依据MoCA量表评分将糖尿病足患者分为MCI组和认知功能正常(normal cognitire,NC)组,对两组的自然情况、生物学因素及实验室检查情况进行比较,并分析MCI的相关危险因素.结果 2型糖尿病足患者与对照组MoCA总分值比较差异无统计学意义,但在注意力、延迟回忆亚测试中,2型糖尿病足组较对照组下降明显,差异有统计学意义(P＜0.05).F4、F5级糖尿病足患者注意力、延迟回忆评分及MoCA总分与阳级患者比较,差异均有统计学意义(P＜0.05).MCI组和NC组比较,年龄、BMI、有无糖尿病视网膜病变、FBG、PBG、HbA1c、TC、LDL-C方面差异均有统计学意义(P＜0.05).MoCA评分与患者年龄、糖尿病视网膜病变、糖尿病足严重程度、FBG、PBG、HbA1c、TC和LDL-C呈负相关;糖尿病视网膜病变、HbA1c和糖尿病足严重程度是2型糖尿病足患者合并MCI的独立危险因素.结论 2型糖尿病足患者认知功能障碍与多种因素相关,控制其危险因素有助于预防认知功能障碍.     

中年2型糖尿病患者病程和HbA1c水平与认知功能相关性研究

目的:探讨2型糖尿病中年患者病程和HbA1c水平与认知功能的相关性。方法:采用横断面研究设计,选择45～65岁2型糖尿病患者168例,分别按照病程和HbA1c水平分组,使用蒙特利尔认知评估量表(MoCA)、连线测试(TMT)两种量表评估患者认知功能。结果:病程<5年51例,5～10年48例,10年以上69例。除注意力外,不同病程分组MoCA各维度得分和总分差异均有统计学意义(P<0.05),病程越长得分越低。除注意力、定向力外,不同HbA1c水平分组MoCA各维度得分和总分差异均有统计学意义(P<0.05),HbA1c水平越高得分越低。不同病程组TMT A和B均有差异(P<0.05);不同HbA1c水平分组TMT A有差异(P<0.05),而TMT B尚未见差异(P>0.05)。结论:2型糖尿病中年患者病程和HbA1c水平与认知功能密切相关。应做好2型糖尿病中年患者认知功能筛查,早期干预。     

糖化血红蛋白达标与否对2型糖尿病患者认知功能的影响研究

目的 探讨糖化血红蛋白（HbA1c）是否达标对2型糖尿病（T2DM）患者认知损伤的影响。方法 选择2013年4月-2014年9月唐山工人医院内分泌科住院的T2DM患者255例,男119例、女136例。分为HbA1c＜7.0%组（A组）、HbA1c7.0%~9.0%组（B组）和HbA1c＞9.0%组（C组）,采用可重复的成套神经心理状态测验（RBANS）量表评估患者的认知功能,比较组间RBANS评分,分析T2DM患者认知评分的影响因素。结果 T2DM患者RBANS总分与年龄（r=-0.20）、受教育程度（r=0.35）、病程（r=-0.13）及HbA1c（r=-0.19）相关（P＜0.05）;多元回归分析显示,受教育程度（t=6.16）、HbA1c（t=-4.61）是T2DM患者RBANS总分的影响因素（P＜0.05）。校正性别、年龄、受教育程度等因素后,3组患者的即刻记忆（F=14.1）、延迟记忆（F=17.2）和RBANS总分（F=15.9）比较,差异均有统计学意义（P＜0.05）,B、C组RBANS总分均低于A组,差异有统计学意义（P＜0.05）。结论 HbA1c未达标的T2DM患者认知功能损伤较严重,控制HbA1c在达标范围内对预防T2DM患者认知损伤有潜在价值。     

动脉自旋标记技术对2型糖尿病患者脑血流量改变的初步研究

目的 探究2型糖尿病(T2DM)患者脑血流量(CBF)的改变及其与认知功能及嗅觉功能减退的相关性。方法 对83例T2DM患者与62例健康对照(HC)进行认知功能评估及嗅觉识别测验(CSIT),并采集所有被试头部三维伪连续动脉自旋标记(3D-pcASL)图像,经后处理获得大脑灰质的CBF值。比较T2DM组与HC组之间CBF值差异,并分析其与认知功能及嗅觉识别测验的相关性。结果 T2DM患者在CSIT、蒙特利尔认知评估量表(MoCA)、数字广度测验(DST)、词语流畅性测验(VFT)测试结果低于HC组(P<0.05),T2DM患者双侧额中回CBF高于HC组(P<0.001),T2DM患者在双侧直回及双侧嗅皮质CBF则低于HC组(P<0.001)。结论 T2DM患者的认知功能及嗅觉功能减退,双侧额中回、直回及嗅皮质存在灌注异常,揭示了这些脑区的CBF改变可能是T2DM认知障碍及嗅觉功能减退的原因之一。     

孤立性侧脑室后角旁白质疏松对认知功能的影响及其神经心理特征

目的 探讨孤立性侧脑室后角旁白质疏松对认知功能的影响及其神经心理特征.方法 纳入30例孤立性侧脑室后角旁白质疏松(后角组)、32例大脑半球多部位白质疏松(混合组)以及33例颅脑MRI证实无脑实质结构性改变的受试者(对照组),采用简易精神状态量表(mini-mental state examination scale,MMSE)和蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA,北京版),评价受试者总体认知功能,韦氏成人智力量表中数字广度测验分项目评估注意能力,临床记忆量表评估记忆能力,对比分析侧脑室后角旁白质疏松所致认知损害特征.结果 与对照组比较,后角组MMSE和MoCA总分较低(P＜0.01),定向力、短时记忆、延迟记忆、指向记忆和语言测试单项评分也明显降低(P ＜0.05,P＜0.01),而其他认知方面单项评分差异无统计学意义(P＞0.05);混合组MMSE和MoCA总分较低(P＜0.01),定向力、记忆力、注意能力、视觉空间与执行、语言测试和抽象认知单项评分也明显降低(P ＜0.05,P＜0.01).结论 孤立性侧脑室后角旁白质疏松导致以定向力、记忆力和语言能力减退为特征的认知功能损害.     

老年2型糖尿病患者视网膜病变与认知功能的研究

目的研究老年2型糖尿病患者视网膜病变与认知功能。方法选取123例老年2型糖尿病患者,根据眼底筛查结果有无糖尿病视网膜病变分为四组:无明显视网膜病变(NonDR组),轻-中度非增殖性DR(mild NPDR组),重度非增殖性DR(severe NPDR组)和增生性DR(PDR组)。应用简易智力状况检查法(MMSE)和蒙特利尔认知评估量表(MoCA)进行认知功能的测定。结果各组组间MMSE与MoCA评分有差异,且随着糖尿病视网膜病变病情的进展,MMSE与MoCA评分的平均得分均显著降低(P0.05)。结论随老年2型糖尿病患者视网膜病变的进展,认知功能水平下降。     

睡眠呼吸暂停综合征患者脑白质病变与认知功能的相关性

目的 探讨睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者脑白质病变与认知功能损害特点及不同部位白质病变与认知功能障碍的关系.方法 选取70例OSAS患者(轻度组26例,中重度组44例)及体检健康者30例(对照组),采用年龄相关白质改变评分量表(WMLs)进行脑白质病变测定,采用蒙特利尔评估量表北京版(MoCA)进行认知功能评定;分析3组之间脑白质病变和认知功能情况,同时对其结果 进行相关性分析.结果 中重度组左右基底节区白质病变、总体脑白质病变及认知功能异常、视空间与执行、记忆、注意力异常的发生频率均明显高于对照组及轻度组(均P＜0.05);记忆功能与基底节区及WML总分呈负相关(P＜0.05);MoCA总分与WML总分呈负相关(P＜0.05);而注意、视空间与执行功能与白质病变无明显相关性(P＞0.05).结论 OSAS患者存在特定的脑白质病变与认知功能损害,其中以视空间与执行、记忆和注意能力损害突出,而记忆功能损害与基底节区病变程度相关.     

血浆同型半胱氨酸水平与血管性认知损害及海马体积的相关性研究

目的 探讨高同型半胱氨酸(Hcy)血症与海马体积及血管性认知功能损害的相关性.方法 采用病例对照研究,纳入脑梗死患者194例,所入选患者均测定血浆Hcy浓度,用脑磁共振三维测量方法测量海马体积,采用蒙特利尔认知评估量表(MoCA)进行认知测定,根据血浆Hcy水平分为正常Hcy组(血浆Hcy＜15 μmol/L,49例);Hcy轻度升高组(血浆Hcy 16～30μmol/L,78例);Hcy中重度升高组(血浆Hcy 31～100μmol/L,52例);Hcy重度升高组(Hcy＞ 100μmol/L,15例).结果 血浆Hcy不同水平组间认知功能MoCA总分差异有统计学意义(P＜0.05),血浆Hcy不同水平组间左、右侧海马体积差异有统计学意义(P＜0.05),血浆Hcy水平与认知功能MoCA总分呈负相关(r=-0.504,P＜0.05),血浆Hcy水平与左、右侧海马体积均呈负相关(r=-0.472,P＜0.05;r=-0.647,P＜0.05).左、右侧海马体积均与认知功能MoCA总分呈正相关(r=0.569,P＜0.05;r=0.671,P＜0.05).结论 高Hcy血症可能与脑梗死患者的海马体积缩小及认知损害相关.     

老年2型糖尿病患者认知功能障碍的临床特点及危险因素分析

目的：探讨老年2型糖尿病(T2DM)患者认知功能障碍的临床特点及危险因素。方法：选取南方医科大学附属东莞人民医院2021年1月-2022年6月收治的253例T2DM患者为研究对象,由经过培训的社区医师根据蒙特利尔认知评估量表(MoCA)对患者进行评估,将患者分为认知功能障碍组(CI)与认知功能正常组(N组)。分析两组患者的一般资料与实验室检查结果,探讨影响T2DM患者认知功能障碍的危险因素。结果：两组患者性别、吸烟率、饮酒率、体重指数(BMI)、空腹血糖、血肌酐、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平比较,差异无统计学意义(P>0.05);CI组年龄高于N组,糖尿病(DM)病程长于N组,受教育年限短于N组,收缩压(SBP)、糖化血红蛋白(HbA1c)、同型半胱氨酸(HCY)水平高于N组,差异有统计学意义(P<0.05)。两组命名、注意力、语言、抽象、定向力单项评分比较,差异无统计学意义(P>0.05);CI组视空间与执行能力、延迟记忆、计算力单项评分及总分均低于N组,差异有统计学意义(P<0.05)。经分析,...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.