显微镜下多血管炎患者继发弥漫性肺泡出血和肺间质病的临床特征及预后分析（英文）

目的 评估继发于显微镜下多血管炎（microscopic polyangiitis,MPA）的弥漫性肺泡出血和/或肺间质病患者的临床特征以及预后相关因素。方法 回顾性分析2002年至2012年于北京协和医院内科住院的MPA患者,根据肺受累类型不同分为单纯肺间质病组、单纯弥漫性肺泡出血组、弥漫肺泡出血合并肺间质病组和无肺受累组。比较各组患者人口学资料、全身症状、脏器受累情况、实验室检查、治疗与预后。采用Logistic回归和Cox分析患者早期与晚期死亡的危险因素。结果 共181例MPA患者纳入研究,其中单纯肺间质病组96例、单纯弥漫性肺泡出血组19例、弥漫肺泡出血合并肺间质病组18例、无肺受累组48例。随访时间的中位数为67个月（范围：1～199个月）。单纯弥漫性肺泡出血组肾脏受累最严重（血肌酐中位值：449μmol/L,显著高于单纯肺间质病组（123μmol/L,Nemenyi=-35.215,P=0.045）和弥漫肺泡出血合并肺间质病组（359μmol/L,Nemenyi=-43.609,P=0.007）。单纯肺间质病组患者年龄大于单纯弥漫性肺泡出血组（中位年龄：69比57岁;Nem...     

Association Between Lipid Profiles and Left Ventricular Hypertrophy: New Evidence from a Retrospective Study

ObjectiveTo explore the association between lipid profiles and left ventricular hypertrophy in a Chinese general population.MethodsWe conducted a retrospective observational study to investigate the relationship between lipid markers [including triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL-cholesterol, apolipoprotein A-I, apolipoprotein B, lipoprotein[a], and composite lipid profiles] and left ventricular hypertrophy. A total of 309,400 participants of two populations (one from Beijing and another from nationwide) who underwent physical examinations at different health management centers between 2009 and 2018 in China were included in the cross-sectional study. 7,475 participants who had multiple physical examinations and initially did not have left ventricular hypertrophy constituted a longitudinal cohort to analyze the association between lipid markers and the new-onset of left ventricular hypertrophy. Left ventricular hypertrophy was measured by echocardiography and defined as an end-diastolic thickness of the interventricular septum or left ventricle posterior wall > 11 mm. The Logistic regression model was used in the cross-sectional study. Cox model and Cox model with restricted cubic splines were used in the longitudinal cohort.ResultsIn the cross-sectional study, for participants in the highest tertile of each lipid marker compared to the respective lowest, triglycerides [odds ratio (OR): 1.250, 95%CI: 1.060 to 1.474], HDL-cholesterol (OR: 0.780, 95%CI: 0.662 to 0.918), and lipoprotein(a) (OR: 1.311, 95%CI: 1.115 to 1.541) had an association with left ventricular hypertrophy. In the longitudinal cohort, for participants in the highest tertile of each lipid marker at the baseline compared to the respective lowest, triglycerides [hazard ratio (HR): 3.277, 95%CI: 1.720 to 6.244], HDL-cholesterol (HR: 0.516, 95%CI: 0.283 to 0.940), non-HDL-cholesterol (HR: 2.309, 95%CI: 1.296 to 4.112), apolipoprotein B (HR: 2.244, 95%CI: 1.251 to 4.032) showed an association with new-onset left ventricular hypertrophy. In the Cox model with forward stepwise selection, triglycerides were the only lipid markers entered into the final model.ConclusionLipids levels, especially triglycerides, are associated with left ventricular hypertrophy. Controlling triglycerides level potentiate to be a strategy in harnessing cardiac remodeling but deserve to be further investigated.     

Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty

ObjectiveTotal knee arthroplasty is one of the most common orthopedic surgeries. Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons. In this study, we evaluated the risk factors for severe complications after primary total knee arthroplasty.MethodsWe retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital. Postoperative complication > grade IE was defined as severe complication according to Clavien-Dindo classification system. Binary logistic regression was used to identify the predictive risk factors for severe complications.ResultsThe complication rate after primary total knee arthroplasty was 6.8% and severe complication rate was 2.5%. Male (OR = 2.178, 95%CI: 1.324-3.585, P = 0.002), individuals above 75 years old (OR = 1.936, 95%CI: 1.155-3.244, P = 0.012), arrhythmia (OR = 2.913, 95%CI: 1.350-6.285, P = 0.006) and cerebrovascular disease (OR = 2.804, 95%CI: 1.432-5.489, P = 0.003) were predictive risk factors for severe complications after primary total knee arthroplasty.ConclusionAdvanced age, male, arrhythmia, and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty. Special attention should be paid to patients with risk factors.     

CDKAL1基因rs7756992位点A>G多态性与2型糖尿病易感性的meta分析

目的 系统评价CDKAL1基因rs7756992位点A＞G多态性与2型糖尿病(T2DM)易感性的关系.方法 制定原始文献的纳入、排除标准及检索策略,通过检索学术期刊全文数据库(CNKI)、万方数据库及EMBASE、PubMed、ScienceDirect等数据库,收集有关CDKAL1基因rs7756992位点A＞G多态性与T2DM易感性的病例对照研究,以病例组与对照组CDKAL1基因rs7756992位点各种基因模型的比值比(OR)及其95％置信区间(CI)为效应指标进行meta分析,并根据研究人群种族不同进行亚组分析.结果 本研究共纳入15篇文献,T2DM组和对照组病例数分别为24 315例和35 132例.Meta分析显示,CDKAL1基因rs7756992位点A＞G多态性与T2DM易感性有关联[等位基因模式(G vs A):OR=1.171,95％CI 1.122～1.223,P＜0.001;共显性模式(GG vs AA):OR=1.380,95％CI1.258～1.515,P＜0.001;共显性模式(AG vs AA):OR=1.131,95％CI 1.089～1.176,P＜0.001;显性模式(AG+GGvs AA):OR=1.168,95％CI 1.101～1.240,P＜0.001;隐性模式(CG vs AA+AG):OR=1.343,95％CI 1.282～1.405,P＜0.001].亚组分析显示,亚洲人群和白种人群中携带CDKAL1基因rs7756992位点G等位基因的人群发生T2DM的风险增加(P＜0.05);而非洲人群中携带CDKAL1基因rs7756992位点G等位基因与A等位基因的人群发生T2DM风险的差异无统计学意义.结论 在亚洲人群及白种人群中CDKAL1基因rs7756992位点A＞G等位基因的突变可能是T2DM发病的危险因素之一.     

Penehyclidine Hydrochloride Premedication Is Not Associated with Increased Incidence of Post-Operative Cognitive Dysfunction or Delirium: A Systemic Review and Meta-Analysis

ObjectivePost-operative cognitive dysfunction (POCD) and post-operative delirium (POD) are two common post-operative cerebral complications. The current meta-analysis was to systematically review the effects of penehyclidine hydrochloride (PHC) on POCD and POD in surgical patients.MethodsElectronic databases were searched to identify all randomized controlled trials comparing PHC with atropine/scopolamine/placebo on POCD and POD in surgical patients. Primary outcomes of interest included the incidences of POCD and POD; the secondary outcomes of interest included peri-operative mini-mental state examination (MMSE) scores. Two authors independently extracted peri-operative data, including patients’ baseline characteristics, surgical variables, and outcome data. For dichotomous data (POCD and POD occurrence), treatment effects were calculated as odds ratio (OR) and 95% confidential interval (CI). Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity. For continuous variables (MMSE scores), treatment effects were calculated as weighted mean difference (WMD) and 95% CI. Statistical significance was defined as P<0.05.ResultsOur search yielded 33 studies including 4017 patients. Meta-analysis showed that, the incidence of POCD in PHC group was comparable to that in saline group (OR = 0.97; 95% CI: 0.58-1.64; P = 0.92), scopolamine group (011 = 0.78; 95% CI: 0.48-1.27; P= 0.32) and atropine group (OR = 1.20; 95% CI: 0.86-1.67; P = 0.29). The incidence of POD in PHC group was comparable to that in saline group (OR = 1.53; 95% CI: 0.81-2.90; P = 0.19) and scopolamine group (OR = 0.53; 95% CI: 0.06-4.56; P = 0.56), but higher than that in atropine group (OR = 4.49; 95% CI: 1.34-15.01; P = 0.01).ConclusionsPHC premedication was not associated with increased incidences of POCD or POD as compared to either scopolamine or placebo.     

A Nested Case-Control Study to Explore the Association between Immunoglobulin G N-glycans and Ischemic Stroke

ObjectiveThis study prospectively investigates the association between immunoglobulin G (IgG) N-glycan traits and ischemic stroke (IS) risk.MethodsA nested case-control study was conducted in the China suboptimal health cohort study, which recruited 4,313 individuals in 2013–2014. Cases were identified as patients diagnosed with IS, and controls were 1:1 matched by age and sex with cases. IgG N-glycans in baseline plasma samples were analyzed.ResultsA total of 99 IS cases and 99 controls were included, and 24 directly measured glycan peaks (GPs) were separated from IgG N-glycans. In directly measured GPs, GP4, GP9, GP21, GP22, GP23, and GP24 were associated with the risk of IS in men after adjusting for age, waist and hip circumference, obesity, diabetes, hypertension, and dyslipidemia. Derived glycan traits representing decreased galactosylation and sialylation were associated with IS in men (FBG2S2/(FBG2 + FBG2S1 + FBG2S2): odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.87–0.97; G1ⁿ: OR = 0.74, 95% CI: 0.63–0.87; G0ⁿ: OR = 1.12, 95% CI: 1.03–1.22). However, these associations were not found among women.ConclusionThis study validated that altered IgG N-glycan traits were associated with incident IS in men, suggesting that sex discrepancies might exist in these associations.     

ABO血型与幽门螺杆菌感染风险的meta分析

目的 通过meta分析探讨ABO血型系统与幽门螺杆菌感染发生的关系.方法 以PubMed、EMBASE、CNKI等作为文献来源数据库,并追溯相关参考文献和引文,进行全面、系统的文献检索.收集ABO血型系统与幽门螺杆菌感染关系的文献研究,根据纳入和排除标准,由2名研究者独立筛选文献、提取数据并进行文献质量评价,采用Review Manager 5.0、Stata 11.0软件进行meta分析、敏感性分析及发表偏倚的评估.以比值比(OR)作为评估ABO血型与幽门螺杆菌感染关系的指标,采用Egger法及漏斗图评价发表偏倚.结果 本研究共纳入文献31篇.敏感性分析的结果显示Lin等的研究明显影响了系统分析的结果,剔除该研究后,重新合并OR值.Meta分析结果表明:ABO血型与幽门螺杆菌感染发生无关(血型A:OR=0.98,95％CI 0.84～1.15,P=0.82;血型B:OR=0.93,95％CI 0.84～1.03,P=0.15;血型O:OR=1.10,95％CI0.93～1.29,P=0.26;血型AB:OR=0.84,95％CI 0.67～1.06,P=0.14).Egger法计算结果显示不存在发表偏倚,而漏斗图则显示存在潜在发表偏倚.亚组分析结果也显示ABO血型与幽门螺杆菌感染发生无关.结论 ABO血型与幽门螺杆菌感染的发生无关.     

Effect of Body Mass Index on the Associations between Parity and Metabolic Syndrome and its Components among Northern Chinese Women

Objectives The aims of this study were to assess the associations between parity and metabolic syndrome(Met S) and its components and to evaluate the effects of body mass index(BMI) on these associations.Methods A total of 5,674 women were enrolled from Jidong and Kailuan communities(Tangshan,Hebei) in Northern China. All participants completed standardized questionnaires, physical examination,and biochemical measurements. Logistic regression analysis was used to test the associations.Results Compared with women with parity of one, nulliparous women had decreased odds ratios(ORs); those with parity of two had odds of abdominal obesity [OR = 1.45, 95% confidence interval(CI)1.17–1.81, P 0.001], high blood pressure(OR = 1.26, 95% CI: 1.03–1.54, P = 0.025), elevated fasting glucose levels(OR = 1.36, 95% CI: 1.03–1.79, P = 0.029), and Met S(OR = 1.39, 95% CI: 1.13–1.73, P =0.002); and those with parity of three or more had increased odds of elevated triglyceride levels(OR =1.42, 95% CI: 1.04–1.94, P = 0.027) and Met S(OR = 1.50, 95% CI: 1.10–2.05, P = 0.011) after complete adjustment for confounders. Furthermore, BMI and age subgroups partially modified the associations between parity and Met S and its components.Conclusions Parity is positively associated with Met S and select components in women. BMI is an important modifier involved in the associations between parity and MetS.     

不同严重程度急性缺血性卒中患者静脉溶栓预后的影响因素分析

目的观察不同严重程度急性缺血性卒中(AIS)患者静脉溶栓远期预后和出血转化的影响因素。方法回顾性分析2009年6月至2013年12月在浙江大学医学院附属第二医院神经内科因AIS接受静脉溶栓治疗患者的资料, 根据美国国立卫生研究院卒中量表(NIHSS)将患者分为轻度(≤8分)、中度(9~15分)、重度(≥16分)三组, 分别观察影响患者溶栓后的预后(3月时改良Rankin评分≤2分定义为预后良好)及发生出血转化的因素。结果共365例患者纳入分析:轻度134例、中度121例、重度110例。轻度AIS患者中, 年龄[ OR=0.937, 95%可信区间( CI): 0.898~0.978; P=0.003]、基线NIHSS( OR=0.732, 95% CI: 0.564~0.950; P=0.019)、发病至治疗时间在270 min内( OR=4.109, 95% CI: 1.441~11.719; P=0.008) 是预后良好的独立影响因素; 而基线血糖( OR=1.326, 95% CI: 1.009~1.743; P=0.043) 是发生脑实质出血型出血转化的独立影响因素。中度AIS患者中, 年龄( OR=0.954, 95% CI: 0.924~0.984; P=0.003)、基线NIHSS( OR=0.760, 95% CI: 0.619~0.933; P=0.009) 是预后良好的独立影响因素; 而心房颤动( OR=3.307, 95% CI: 1.140~9.596; P=0.028)、收缩压( OR=0.967, 95% CI: 0.943~0.991; P=0.008) 是发生出血性梗死型出血转化的独立影响因素, 心房颤动( OR=36.972, 95% CI: 1.770~772.462; P=0.02) 是发生脑实质出血型出血转化的独立影响因素。重度AIS患者中, 基线NIHSS( OR=0.808, 95% CI: 0.677~0.963; P=0.018) 是预后良好的独立影响因素, 未发现发生溶栓后出血转化的独立影响因素。 结论对于不同严重程度的AIS患者, 影响静脉溶栓后远期预后及发生出血转化的影响因素不尽相同; 发病至治疗时间在270 min内是轻度AIS患者静脉溶栓后3个月预后良好的独立影响因素; 心房颤动是中度AIS患者静脉溶栓后发生出血转化的独立影响因素。     

Influence of Built Environment in Hygienic City in China on Self-rated Health of Residents

Objective To assess the subjective perception of residents on the built environment in hygienic cities and its relation to the self-rated health(SRH) status of residents, providing a basis for a better promotion on construction of health-supportive environments.Methods The online survey was adopted with the respondents recruited from residents living in Chaoyang District of Beijing in January 2021. With SRH level as the dependent variable, two-category logistic regression analysis was conducted ...     

抑癌扶正平衡Ⅱ号方对乳腺癌小鼠移植瘤生长转移的实验研究

[目的]观察抑癌扶正平衡Ⅱ号方对乳腺癌小鼠移植瘤生长及肺转移的抑制作用,并探索其抗肿瘤效应与硫酸乙酰肝素蛋白聚糖的相关性。[方法]建立4T1乳腺癌小鼠模型,随机分为空白组、模型组、低分子肝素组、抑癌扶正平衡Ⅱ号方高、中、低剂量组,连续给药14 d后处死取材。测定移植瘤瘤质量和计数肺转移结节个数,并计算瘤质量抑制率及肺转移抑制率。ELISA法检测各组小鼠移植瘤、转移瘤、血清中硫酸乙酰肝素蛋白聚糖（HSPG）的表达。[结果]中药各组瘤质量、肺转移结节数随中药剂量增高而下降（P<0.05）;高剂量中药组瘤质量抑制率及肺转移抑制率均优于低分子肝素组（P<0.05）。中药各组移植瘤、转移瘤、血清中HSPG的表达随中药剂量增高而上升（P<0.05）;高剂量中药组移植瘤、转移瘤、血清中HSPG的表达高于低分子肝素组（P<0.05）。[结论]抑癌扶正平衡Ⅱ号方可显著抑制乳腺癌小鼠移植瘤的增殖和肺转移,其作用机制可能与增高硫酸乙酰肝素蛋白聚糖的表达有关。     

Association between Mean Ocular Perfusion Pressure and Diabetic Retinopathy in a Northeastern Chinese Population

Objective To evaluate the association between diabetic retinopathy(DR) and mean ocular perfusion pressure(MOPP) in patients with type 2 diabetes mellitus(T2 DM).Methods Patients from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT), a communitybased prospective cohort study conducted in northeast China, were included in this study. The presence and severity of DR were determined by grading fundus photographs according to the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale. Systolic and diastolic blood pressure(SBP and DBP) were recorded using an electronic sphygmomanometer. Intraocular pressure(IOP) was measured using an iCare rebound tonometer. MOPP was calculated using the formula MOPP = 2/3 [DBP + 1/3(SBP-DBP)]-IOP.Results In total, 1,857 patients who had gradable fundus photography and MOPP data were enrolled in this study. Male patients had a higher MOPP than female patients(52.25 ± 8.75 vs. 50.96 ± 8.74 mmHg, P = 0.002). Overall, both male and female patients with any type of DR, non-proliferative DR(NPDR), or non-sight-threatening DR(non-STDR) had significantly higher MOPP relative to patients without DR. Increased MOPP(per 1 mmHg) was in turn associated with the presence of any type of DR[odds ratio(OR) = 1.03, 95% confidence interval(CI) : 1.02–1.04], NPDR(OR = 1.03 95% CI: 1.02–1.04),and non-STDR(OR = 1.03, 95% CI: 1.01–1.04) after adjusting for confounders. Increased MOPP(per 1 mmHg) was also associated with an increased likelihood of macular edema(OR = 1.02, 95% CI:1.01–1.04).Conclusions The results suggest that increased MOPP was associated with DR and macular edema in northeastern Chinese patients with T2 DM.     

Prevalence and Associated Factors of Diabetes Mellitus in a Very Elderly Chinese Population: A Cross-sectional Study

Objectives This paper aimed to investigate the prevalence of diabetes mellitus(DM) and explore the associated risk factors in a very elderly southwest Chinese population.Methods From September 2015 to June 2016, a cross-sectional survey was conducted to obtain a representative sample of 1,326 participants over 80 years old living in Chengdu. The presence of DM was based on fasting plasma glucose(FPG) and 2-h plasma glucose(2-h PG) levels during an oral glucose tolerance test(OGTT). A logistic regression model was used to calculate the odds ratios(ORs) and 95%confidence intervals(CIs) of the potential associated factors.Results The participants' mean age was 83.5 ± 3.1 years. The overall prevalence of DM was 27.4%. The prevalence was higher in males(30.2%) than females(24.7%)(P = 0.02). The prevalence of DM increased with body mass index(BMI) and decreased with aging. The multivariate analysis suggested that male sex(OR = 1.433; 95% CI, 1.116–1.843), hypertension(OR = 1.439; 95% CI, 1.079–1.936), overweight or obesity(OR = 1.371; 95% CI, 1.023–1.834), high heart rate(≥ 75 beats/min; OR = 1.362; 95% CI,1.063–1.746), and abdominal obesity(OR = 1.615; 95% CI, 1.216–2.149) were all significantly positively correlated with DM. However, age was negatively correlated with DM(OR = 0.952; 95% CI,0.916–0.989).Conclusions The prevalence of DM and newly diagnosed DM in a very elderly southwest Chinese population was high. OGTT screening should be performed regularly in people aged ≥ 80 years to ensure timely diagnosis of DM.     

血府逐瘀方治疗原发性高血压有效性与安全性的系统评价与Meta分析

[目的]评估血府逐瘀方（包括汤剂、胶囊、丸剂、片剂、颗粒剂）治疗原发性高血压的当前临床证据。[方法]系统检索Cochrane图书馆、PubMed、EMBASE、中国知网（CNKI）、中国科技期刊数据库（重庆维普）、万方数据库、中国生物医学文献服务系统（CBM）7个电子数据库,检索日期截至2018年12月,纳入血府逐瘀方单用或联合降压药与降压药对照的随机临床试验,评估文献的方法学质量,提取有效数据并根据Cochrane系统评价方法进行系统评价,结局指标包括降压疗效、收缩压及舒张压水平、中医证候疗效和不良反应。[结果]降压疗效Meta分析显示,OR=3.32,95% CI[2.00,5.50],P<0.000 01,差异比较有统计学意义。收缩压水平Meta分析显示,MD=-5.64,95% CI[-8.10,-3.17],P<0.000 01,两组差异有统计学意义。舒张压Meta分析显示,MD=-3.42,95% CI[-4.61,-2.24],P<0.000 01,两组差异有统计学意义。中医证候疗效Meta分析显示,OR=3.57,95% CI[2.09,6.11],P<0.000 01,差异有统计学意义。不良反应Meta分析显示,OR=1.34,95% CI[0.44,4.09],P=0.6,差异无统计学意义。[结论]血府逐瘀方联合降压药在降低血压水平、提高疗效和改善中医证候方面优于单纯降压药治疗,不增加不良反应,但由于目前纳入的文献质量参差不齐,干预措施不完全一致,仍需要进一步深入研究。     

Clustering of Risk Behaviors and their Social Determinants among Primary School Learners in Beijing,China: A Cross-sectional Study

Background:

Studies in developed countries reveal that poor lifestyle choices triggering diseases typically cluster among children. However, there is insufficient evidence on the clustering of risk behaviors among children in developing countries. This study aimed to determine the clustering of risk behaviors and their social determinants among 4^th-and 5^th -grade learners in Beijing, China.

Methods:

The sample comprised of 967 learners from six primary schools enrolled migrant and resident learners by two-stage stratified cluster sampling. Prevalence denoted the risk behaviors and their clustering. A log-linear model was used to explore the clustering patterns. Ordinal logistic regression determined the influence of demographic characteristics, school environment, and family context on behavioral clustering.

Results:

The prevalence of none, one, two, and three or more risk factors was 61.2%, 20.0%, 10.8%, and 8.1% for infectious diseases and 46.0%, 30.6%, 15.4%, and 8.0% for chronic diseases, respectively. Some behaviors appeared dependent and were more likely to be observed together. The three most influential factors for infectious diseases were school type (odds ratio [OR] =4.47, 95% confidence interval [CI] 3.00–6.66), school located in an inner suburb (OR = 0.27, 95% CI 0.18–0.38), and gender (OR = 0.56, 95% CI 0.42–0.74). Regarding risk behaviors for chronic diseases, clustering was not associated with household registration status and number of appliances, but was significantly associated with school type (OR = 5.36, 95% CI 3.72–7.73), school located in an inner suburb (OR = 0.59, 95% CI 0.43–0.81), and gender (OR = 0.61, 95% CI 0.47–0.78). School environment variables were the most significant contributor to the number of risk behaviors.

Conclusions:

The characteristics of schools enrolling migrants and residents influenced the number of risk behaviors. Therefore, improved school conditions and integrated behavioral interventions are particularly recommended for health promotion.     

Mediation Effects of Placental Inflammatory Transcriptional Biomarkers on the Sex-Dependent Associations between Maternal Phthalate Exposure and Infant Allergic Rhinitis: A Population-Based Cohort Study

ObjectivePrenatal phthalate exposure has been associated with placental inflammatory factors and infant allergic rhinitis (AR). However, the results are inconclusive. We designed a population-based cohort study to examine the effects of placental inflammatory biomarkers on the sex-dependent associations between maternal phthalate exposure and infant AR.MethodsA total of 2,348 pregnant women from Ma'anshan, Anhui Province, China, who were screened before antenatal visits and met the inclusion criteria, were included in the present study. We assessed AR in their offspring aged 36 months with a questionnaire. Quantitative PCR was performed to measure placental inflammatory factor mRNAs. The independent samples t-test and multivariable logistic regression were used to determine the associations between infant AR and maternal phthalates.ResultsChildhood AR may be related to education and family monthly income (P = 0.01). The phthalate metabolites, mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-hydroxyl) phthalate (MEHHP), in pregnant women were associated with a significantly increased risk for infant AR in males [P < 0.05; odds ratio (OR): 1.285; 95% confidence interval (CI): 1.037–1.591, and OR: 1.232, 95% CI: 1.008–1.507, respectively], but not females. Additionally, irritably-increased expression levels of HO-1 and IL-4 were associated with AR in male infants (OR: 1.175; 95% CI: 1.038–1.329 and OR: 1.181; 95% CI: 1.056–1.322, respectively). The association between maternal urinary MEHHP and placental HO-1 was marginally significant according to mediation analysis.ConclusionThe associations of maternal MEHHP and MEOHP levels with fetal AR in males were significant. Placental HO-1 was a fractional mediator in the associations between MEHHP and AR. Thus, the placenta should be further investigated as a potential mediator of maternal exposure-induced disease risk in children.     

复方阿胶浆防治癌症化疗后骨髓抑制疗效和安全性的系统评价

[目的]系统评价复方阿胶浆联合化疗防治癌症化疗后骨髓抑制的有效性和安全性。[方法]计算机检索CNKI、WanFang、SinoMed、PubMed、EMbase、The Cochrane Library,搜集关于复方阿胶浆联合常规化疗治疗癌症/肿瘤患者的随机对照试验,检索时限从建库至2017年3月。由2位作者独立筛选文献、提取资料,采用RevMan 5.3软件进行Meta分析。[结果]共纳入17个RCT,包含7个结局指标,1 139例患者。Meta分析结果显示,与单纯化疗组相比,联用复方阿胶浆组在改善外周血象白细胞[MD=-0.71,95% CI（-1.14,-0.28）,P=0.001;OR=0.24,95% CI（0.13,0.48）,P<0.0001]、血红蛋白[MD=-10.34,95% CI（-15.10,-5.58）,P<0.001;OR=0.28,95% CI（0.14,0.54）,P=0.000 2]、血小板[MD=-20.94,95% CI（-35.63,-6.25）,P=0.005]、红细胞[MD=-0.46,95% CI（-0.69,-0.23）,P<0.000 1]及生活质量[OR=3.84,95% CI（2.07,7.11）,P<0.000 1]方面差异有统计学意义;对降低血小板所致骨髓毒性[OR=0.58,95% CI（0.27,1.21）,P=0.15]、保护中性粒细胞[MD=-0.10,95% CI（-0.66,0.47）,P=0.73]及不良反应等方面差异均无统计学意义。[结论]当前证据提示复方阿胶浆联合化疗能够改善癌症化疗后外周血象和生活质量,且安全性较好。但由于纳入文献质量不高,尚需严格设计的高质量临床研究进一步验证。     

急性缺血性卒中患者静脉溶栓后24小时血压变异与血流再灌注的相关性研究

目的明确急性缺血性卒中患者静脉溶栓后24 h血压变异对脑组织再灌注以及3个月后神经功能结局的影响。方法连续收集2009年6月至2014年9月期间在浙江大学医学院附属第二医院行多模式MRI检查或CT灌注扫描, 接受静脉溶栓治疗的急性缺血性卒中患者的临床、影像、溶栓后24 h内动态血压监测资料, 评估溶栓后24 h再灌注情况及3个月改良Rankin评分。记录血压均值和变异指标, 后者包括标准差(sd)、连续变异度(sv)、上升变异(sv-rise)和下降变异(sv-drop)。采用二元logistic回归分析血压变异指标对再灌注及神经功能结局的影响。结果最终纳入188例患者, 其中114例(60.6%)达到再灌注, 74例(39.4%)未达到再灌注。二元logistic回归分析提示, 静脉溶栓后24 h内收缩压连续变异(SBPsv), 尤其是上升变异(SBPsv-rise)较大者不易达到再灌注(sv: OR=0.421, 95% CI:0.187~0.950, P=0.037;sv-rise: OR=0.311, 95% CI:0.137~0.704, P=0.005)。同时, 静脉溶栓后24 h SBPsv-rise高者不易达到早期神经功能恢复( OR=0.372, 95% CI:0.166~0.832, P=0.016);SBPsv、SBPsv-rise和SBPsv-drop是溶栓治疗3个月后患者神经功能不良结局的独立危险因素(sv: OR=6.381, 95% CI:2.132~19.096, P=0.001;sv-rise: OR=5.615, 95% CI:2.152~14.654, P < 0.001;sv-drop: OR=3.009, 95% CI: 1.263~7.169, P=0.013)。 结论急性缺血性卒中患者早期收缩压变异越大越不利于脑组织再灌注和早期神经功能恢复, 并与静脉溶栓治疗后3个月患者神经功能不良结局有关。     

Peripheral Artery Disease and Risk of Fibrosis Deterioration in Nonalcoholic Fatty Liver Disease: A Prospective Investigation

Objective Liver fibrosis is an important predictor of mortality in nonalcoholic fatty liver disease(NAFLD). Peripheral artery disease(PAD) and liver fibrosis share many common metabolic dysfunctions.We aimed to explore the association between PAD and risk of fibrosis deterioration in NAFLD patients.Methods The study recruited 1,610 NAFLD patients aged ≥ 40 years from a well-defined community at baseline in 2010 and followed up between August 2014 and May 2015. Fibrosis deterioration was defined as the NAFLD fibrosis score(NFS) status increased to a higher category at the follow-up visit.PAD was defined as an ankle-brachial index of 0.90 or 1.40.Results During an average of 4.3 years' follow-up, 618 patients progressed to a higher NFS category.PAD was associated with 92% increased risk of fibrosis deterioration [multivariable-adjusted odds ratio(OR): 1.92, 95% confidence interval(CI): 1.24, 2.98]. When stratified by baseline NFS status, the OR for progression from low to intermediate or high NFS was 1.74(95% CI: 1.02, 3.00), and progression from intermediate to high NFS was 2.24(95% CI: 1.05, 4.80). There was a significant interaction between PAD and insulin resistance(IR) on fibrosis deterioration(P for interaction = 0.03). As compared with non-PAD and non-IR, the coexistence of PAD and IR was associated with a 3.85-fold(95% CI: 2.06, 7.18) increased risk of fibrosis deterioration.Conclusion PAD is associated with an increased risk of fibrosis deterioration in NAFLD patients,especially in those with IR. The coexistence of PAD and IR may impose an interactive effect on the risk of fibrosis deterioration.     

Risk Factors for Anesthesia-Related Airway Patient Safety Incidents: A Single-Center Retrospective Case-Control Analysis from 2009 to 2022

ObjectiveAirway-related patient safety incident (PSI) has always been the top concern of anesthesiologists because this type of incidents could severely threaten patient safety if not treated immediately and properly. This study intends to reveal the composition, prognosis, and to identify risk factors for airway related incidents reported by anesthesiologists.MethodsAll airway related PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and May 2022 were collected from the PSI reporting system. Patients with airway incidents reported were matched 1:1 with controls based on sex and type of surgery. Univariable and multivariable analysis were performed to find risk factors associated with airway incident occurrence, and to evaluate influence of airway PSIs on patient prognosis.ResultsAmong 1,038 PSIs voluntarily reported by anesthesiologists during the study period, 281 cases (27.1 %) were airway-related incidents, with an overall reporting incidence of 4.74 per 10,000 among 592,884 anesthesia care episodes. Only ASA physical status was found to be significant independent predictor of these airway PSIs (P = 0.020). Patients with airway PSIs reported had longer extubation time (0.72 ± 1.56 d vs. 0.16 ± 0.77 d, 95%CI: 0.29 to 0.82, P < 0.001), longer ICU length of stay (LOS) (1.63 ± 5.71 d vs. 0.19 ± 0.84 d, 95%CI: 0.57 to 2.32, P = 0.001), longer post operative LOS (10.56 ± 13.09 d vs. 7.59 ± 10.76 d, 95%CI: 0.41 to 5.53, P = 0.023), and longer total in-hospital LOS (14.99 ± 15.18 dra. 11.62 ± 11.88 d, 95%CI: 0.46 to 6.27, P = 0.024).ConclusionsThis single-center retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within thirteen years. Airway incidents might influence patient prognosis by elongating extubation time and LOS. Airway PSI data were worth analyzing to improve patient safety.