Association between atherosclerotic cardiovascular diseases risk and renal outcome in patients with type 2 diabetes mellitus

AimsChronic kidney disease (CKD) and diabetes mellitus increase atherosclerotic cardiovascular diseases (ASCVD) risk. However, the association between renal outcome of diabetic kidney disease (DKD) and ASCVD risk is unclear.MethodsThis retrospective study enrolled 218 type 2 diabetic patients with biopsy-proven DKD, and without known cardiovascular diseases. Baseline characteristics were obtained and the 10-year ASCVD risk score was calculated using the Pooled Cohort Equation (PCE). Renal outcome was defined as progression to end-stage renal disease (ESRD). The association between ASCVD risk and renal function and outcome was analyzed with logistic regression and Cox analysis.ResultsAmong all patients, the median 10-year ASCVD risk score was 14.1%. The median of ASCVD risk score in CKD stage 1, 2, 3, and 4 was 10.9%, 12.3%, 16.5%, and 14.8%, respectively (p = 0.268). Compared with patients with lower ASCVD risk (＜14.1%), those with higher ASCVD risk had lower eGFR, higher systolic blood pressure, and more severe renal interstitial inflammation. High ASCVD risk (>14.1%) was an independent indicator of renal dysfunction in multivariable-adjusted logistic analysis (OR, 3.997; 95%CI, 1.385–11.530; p = 0.010), though failed to be an independent risk factor for ESRD in patients with DKD in univariate and multivariate Cox analysis.ConclusionsDKD patients even in CKD stage 1 had comparable ASCVD risk score to patients in CKD stage 2, 3, and 4. Higher ASCVD risk indicated severe renal insufficiency, while no prognostic value of ASVCD risk for renal outcome was observed, which implied macroangiopathy and microangiopathy in patients with DKD were related, but relatively independent.     

完全腹腔镜根治性膀胱切除加体内改良回肠通道术的学习效果分析

目的分析术者对完全腹腔镜根治性膀胱切除(LRC)+改良回肠通道术(MIC)的学习效果。方法回顾性分析首都医科大学附属北京朝阳医院2014年4月至2019年10月42例接受完全LRC+MIC患者的临床资料。男34例,女8例;年龄(63.4±9.1)岁。其中术者1行34例手术,术者2行8例。将术者1的34例按时间顺序分为3组,第1~12例为A组,第13~23例为B组,第24~34例为C组;术者2实施的8例为D组。4组中有腹部手术史者分别为0、1、4、3例,差异有统计学意义(P<0.05);4组年龄、体质指数、美国麻醉医师协会评分等差异均无统计学意义(P>0.05)。改良术式的重要步骤包括光源透射下离断肠系膜、输出袢固定的条件下行输尿管-输出袢反流性对端吻合、缝合后腹膜缺口。比较各组患者手术时间、构建回肠通道时间、出血量、并发症发生比例、淋巴结清扫数量、切缘阳性比例等重要手术指标。结果各组手术均顺利完成,均无中转开放手术。A~C组手术时间分别为330.0(320.0,360.0)、300.0(250.0,308.0)、270.0(216.0,324.0)min,差异有统计学意义(P=0.010);3组构建回肠通道时间分别为136.5(131.3,147.5)、92.0(79.0,119.0)、79.0(72.0,115.0)min,差异有统计学意义(P<0.001)。手术时间和构建回肠通道时间组间两两比较,A、B组,A、C组差异均有统计学意义(P<0.05),B、C组差异无统计学意义(P>0.05)。3组出血量[200.0(125.0,300.0)、100.0(100.0,150.0)、200.0(100.0,400.0)ml]、并发症发生比例[4/12、4/11、3/11]、淋巴结清扫数量[(19.0±10.7)、(16.0±9.8)、(23.3±8.5)枚]、切缘阳性比例(1/12、1/11、2/11)的比较,差异均无统计学意义(P>0.05)。D组手术时间420.0(350.0,450.0)min,与A组比较差异有统计学意义(P<0.05)。D组出血量200.0(112.5,350.0)ml,并发症发生比例2/8,淋巴结清扫数量(13.8±7.1)个,切缘阳性比例1/8,与A组比较差异均无统计学意义(P>0.05)。结论完全LRC+MIC学习效果明显,随着手术例数的增加,手术时间及构建回肠通道时间显著下降;该术式具有较好的可重复性和安全性。     

Podocyte EGFR Inhibits Autophagy Through Upregulation of Rubicon in Type 2 Diabetic Nephropathy

Renal epidermal growth factor receptor (EGFR) signaling is activated in models of diabetic nephropathy (DN), and inhibition of the EGFR signaling pathway protects against the development of DN. We have now determined that in cultured podocytes, high glucose led to increases in activation of EGFR signaling but decreases in autophagy activity as indicated by decreased beclin-1 and inhibition of LC3B autophagosome formation as well as increased rubicon (an autophagy inhibitor) and SQSTM1 (autophagy substrate). Either genetic (small interfering [si]EGFR) or pharmacologic (AG1478) inhibition of EGFR signaling attenuated the decreased autophagy activity. In addition, rubicon siRNA knockdown prevented high glucose–induced inhibition of autophagy in podocytes. We further examined whether selective EGFR deletion in podocytes affected the progression of DN in type 2 diabetes. Selective podocyte EGFR deletion had no effect on body weight or fasting blood sugars in either db/db mice or nos3^−/−; db/db mice, a model of accelerated type 2 DN. However selective podocyte EGFR deletion led to relative podocyte preservation and marked reduction in albuminuria and glomerulosclerosis, renal proinflammatory cytokine/chemokine expression, and decreased profibrotic and fibrotic components in nos3^−/−; db/db mice. Podocyte EGFR deletion led to decreased podocyte expression of rubicon, in association with increased podocyte autophagy activity. Therefore, activation of EGFR signaling in podocytes contributes to progression of DN at least in part by increasing rubicon expression, leading to subsequent autophagy inhibition and podocyte injury.     

竹节参鲨烯环氧酶基因的克隆及生物信息学分析

目的 克隆竹节参Panax japonicus鲨烯环氧酶基因（squalene epoxidase,PjSE）的全长cDNA序列,进行生物信息学分析和原核表达。方法 设计特异性引物,从竹节参中克隆得到PjSE序列;以PjSE基因序列作为输入数据,利用多序列同源比对等生物信息学分析工具进行序列分析;构建重组原核表达载体pCold-PjSE,转化至大肠杆菌BL21(DE3)中进行蛋白诱导表达;采用实时荧光定量PCR技术分析该基因在竹节参不同组织中的相对表达量。结果 PjSE基因开放阅读框长度为1884 bp,编码627个氨基酸,PjSE蛋白相对分子质量为68 639.49,初步预测其具有跨膜结构域,可能定位在叶绿体上;聚丙烯凝胶电泳结果显示诱导表达蛋白的相对分子质量大小与预期结果一致;该基因在竹节参叶中表达量最高,须根次之,根中表达量最低。结论 PjSE基因的克隆、生信分析及原核表达研究,不仅有助于丰富竹节参中该类功能蛋白的种类和数量,完善竹节参皂苷类成分的生物合成途径,也为后期开展竹节参皂苷的异源合成提供了可供选择的关键基因元件。     

定痛和血汤联合低分子肝素治疗老年髋部骨折术后血栓前状态临床研究

目的：观察在常规术后治疗措施基础上采用定痛和血汤联合低分子肝素治疗老年髋部骨折术后血 栓前状态的效果。方法：回顾性分析86 例血瘀型老年髋部骨折术后血栓前状态患者的临床资料,根据术后治 疗方法分为对照组和观察组各43 例。2 组均予常规术后治疗措施与低分子量肝素钠注射液皮下注射,观察组 加予定痛和血汤加减治疗。2 组均以5 d 为1 个疗程,连续治疗2 个疗程。比较2 组术后10 d 肺栓塞、下肢深 静脉血栓（DVT）、皮下瘀斑的发生率,评定髋部疼痛视觉模拟评分法（VAS） 评分,记录术后48 h 内的切口 总引流量,检测血栓前状态指标［血管性血友病因子（vWF）、D-二聚体（D-D）、P-选择素］。结果：观察组 术后48 h 切口总引流量少于对照组（P＜0.05）。2 组术后疼痛VAS 评分随着时间的延长逐渐降低。2 组术 后5 d、10 d 的VAS 评分均较术后1 d 降低（P＜0.05）;2 组术后10 d 的VAS 评分均较术后5 d 降低（P＜ 0.05）。观察组术后5 d、10 d 的VAS 评分均低于对照组（P＜0.05）。术后10 d,2 组vWF、D-D、P-选择素 水平均较术后1 d 下降（P＜0.05）,观察组vWF、D-D、P-选择素水平均低于对照组（P＜0.05）。2 组肺栓 塞发生率、下肢DVT 发生率、皮下瘀斑发生率比较,差异均无统计学意义（P＞0.05）。结论：在常规术后治 疗措施基础上采用定痛和血汤联合低分子量肝素治疗,能有效纠正老年髋部骨折术后患者的血栓前状态,预防 下肢DVT 形成,减轻术后痛感,在预防术后出血倾向方面具有优势。     

浅析国医大师邓铁涛治疗高血压病经验

分析探讨邓铁涛教授治疗高血压病的临床经验,认为邓铁涛教授治疗高血压病在病因病机分析 上,以阴阳为纲领,辨证论治则多运用五脏相关理论,遣方用药重视益气除痰,同时,灵活应用针刺、浴足等 外治方法,重视通过日常调护以期达到防治高血压病的目标。     

铜绿假单胞菌注射液治疗甲状腺乳头状癌颈侧区淋巴结清扫术后淋巴漏的临床观察

背景与目的 淋巴漏为颈部淋巴结清扫术后常见并发症,传统治疗方法作用相对有限,而铜绿假单胞菌注射液处理创面可较好促进局部炎症反应以闭合漏点,因此本研究分析铜绿假单胞菌注射液对甲状腺乳头状癌（PTC）颈侧区淋巴结清扫术后淋巴漏患者引流量的影响及安全性,以明确铜绿假单胞菌注射液的应用价值。方法 回顾性分析2019年1月—2020年1月郑州大学第一附属医院甲状腺外科行颈侧区淋巴结清扫术后出现淋巴漏的69例PTC患者资料,依据淋巴漏治疗方式不同将其分为对照组（37例,术中常规双侧留置负压引流）、观察组（32例,在对照组治疗的基础上,术后第4、6天,通过引流管注入2支铜绿假单胞菌注射液）,比较两组术后引流量、体温变化,记录其引流时间及不良反应发生率。结果 两组术后第1、2、3天引流量比较差异无统计学意义（均P>0.05）,观察组术后第4、5、6天引流量低于对照组［（310.79±32.16）mL vs.（338.64±34.55）mL、（157.82±16.43）mL vs.（325.43±33.96）mL、（87.34±8.59）mL vs.（333.68±34.59）mL,均P<0.05］;观察组术后第6、7 天体温高于对照组［（37.78±3.77）℃ vs.（35.96±3.60）℃、（37.65±3.72）℃ vs.（35.79±3.68）℃,均P<0.05］,其他时点两组体温差异均无统计学意义（均P>0.05）;观察组引流时间明显短于对照组［（6.17±0.63）d vs.（7.28±0.75）d,P<0.01］;观察组部分患者术后2周内出现局部发热、寒战不良反应,予以物理降温后均恢复正常,观察组术后不良反应发生率高与对照组（12.50% vs. 8.11%）,但差异无统计学意义（P>0.05）。结论 铜绿假单胞菌注射液治疗PTC患者颈侧区淋巴结清扫术后淋巴漏患者临床效果较好,可降低引流量,缩短引流时间,部分患者可能有体温升高、发热等现象,经对症处理后均可缓解,不影响治疗。     

Specific cerebellar reductions in children with chromosome 22q11.2 deletion syndrome

Children with chromosome 22q11.2 deletion syndrome commonly are found to have morphological brain changes, cognitive impairments, and elevated rates of psychopathology. One of the most commonly and consistently reported brain changes is reduced cerebellar volume. Here, we demonstrate that, in addition to the global cerebellum reductions previously reported, volumetric reductions of the anterior lobule and the vermal region of the neo-cerebellum in the mid-sagittal plane best differentiate children with the deletion from typically developing children. These results suggest that the morphological changes of specific portions of the cerebellum may be an important underlying substrate of cognitive impairments and increased incidence of psychopathology in this group.     

张锡纯脉法初探

张锡纯是我国清末民初的一位熟读经典、医术精湛、衷中参西、于临床多有发挥的著名医家.其在脉学方面多有自己的独到见解. 1 部候取精用弘,切合临床张氏在其<医学衷中参西录>中明确指出"脉虽分部位,而其大致不分部位".观其临证脉法,多三部齐奉,共论病因病机.左右部脉象也不为主血主气所拘泥.其在治徐益林医案中有论"其左脉弦细者,气虚也,弦细兼硬者,肝血虚津液短也.其右脉濡者,湿痰留饮也.濡而兼沉者,中焦气化亦有不足也".此医案中只讨论了弦细兼硬及濡而兼沉的脉象主证,然后综合诊断为"气血两亏,并有停饮之证".由此可见气血两亏是由左部脉象得知,与右部脉象无关.