格列美脲对比其他磺脲类降糖药治疗2型糖尿病的系统评价

摘 要 目的:系统评价格列美脲对比其他磺脲类治疗2型糖尿病的疗效和安全性。方法：计算机检索Cochrane、PubMed、Embase、Medline、中国知网、万方、维普数据库,纳入格列美脲对比其他磺脲类降糖药治疗2型糖尿病的随机对照试验（RCT）,按Cochrane系统评价的方法评价纳入研究的质量,对纳入研究进行偏倚风险分析,并对同质性结果采用RevMan 5.2软件进行Meta分析。结果：共纳入28个RCT,5 677例患者。经改良Jadad量表评分,8篇为高质量文献,其余为低质量文献。Meta分析结果显示：改善糖化血红蛋白（HbA1c）方面,格列美脲与格列本脲、格列吡嗪、格列齐特相比,差异无统计学意义（P＞0.05）;与格列喹酮相比[MD＝-0.55,95%CI（-0.95,-0.15）],差异有统计学意义（P＜0.01）。改善空腹血糖（FPG）方面,格列美脲与格列吡嗪、格列齐特相比,差异无统计学意义（P＞0.05）;与格列本脲[MD＝-0.14,95%CI（-0.28,-0.01）]、格列喹酮[MD＝-0.74,95%CI（-1.01,-0.48）]相比,差异均有统计学意义（P＜0.05或0.01）。改善餐后2 h血糖（2hPG）方面,格列美脲与格列本脲、格列吡嗪、格列齐特相比,差异无统计学意义（P＞0.05）;与格列喹酮相比[MD＝-1.23,95%CI（-1.71,-0.75）],差异有统计学意义（P＜0.01）。低血糖反应发生率方面,格列美脲与格列吡嗪、格列喹酮相比,差异无统计学意义（P＞0.05）;与格列本脲相比[OR＝0.52,95%CI（0.41,0.68）],差异有统计学意义（P＜0.01）。结论：基于当前临床证据,格列美脲在改善HbA1c、FPG、2hPG方面不低于甚至优于其他磺脲类药物,低血糖反应发生率不高于甚至低于其他磺脲类药物。因受纳入研究数量和质量限制,尚需开展高质量大样本RCT,为临床应用提供更多循证依据。     

GC-MS法分析蛇床子的脂溶性成分

〗摘 要 目的： 研究蛇床子的脂溶性成分。方法: 用索氏提取法提取蛇床子的脂溶性成分,甲酯化处理后,采用气相色谱 质谱联用技术首次对其脂溶性成分进行分析和鉴定。结果: 从蛇床子中鉴定了39个化合物,占蛇床子脂溶性成分的85.33%,蛇床子主要的脂溶性成分为植物醇(15.98%)、棕榈酸(12.73%)、9,12,15 十八碳三烯酸(11.02%)、油酸(6.33%)和9,12 十八碳二烯酸(4.77%)。结论:植物醇、棕榈酸、9,12,15 十八碳三烯酸和油酸是蛇床子的活性成分。     

六味开胃消食颗粒质量标准的建立

摘 要 目的： 建立六味开胃消食颗粒的质量标准。方法: 采用TLC法对六味开胃消食颗粒中的枳壳、木香、白术和山楂等药材进行了薄层色谱鉴别;采用HPLC法测定君药枳壳药材中柚皮苷与新橙皮苷的含量,色谱柱为Sinochrom ODS BP（250 mm×4.6 mm,5 μm）,流动相：乙腈-0.1%磷酸（21∶79）;流速：1.0 ml·min^-1;检测波长：283 nm;柱温：30℃。结果: 薄层色谱法可鉴别出该制剂中的枳壳、木香、白术和山楂。柚皮苷在89.600～1.792×10³ μg范围内有良好的线性关系（r=0.999 8）,新橙皮苷在1.060×10²～2.120×10³ μg范围内有良好的线性关系（r=0.999 9）,柚皮苷平均回收率为98.67%,RSD为0.57%（n=6）,新橙皮苷平均回收率为98.07%,RSD为1.19%（n=6）。结论: 该方法准确、灵敏、重复性好,能有效的控制六味开胃消食颗粒的质量。     

ω-3多不饱和脂肪酸对严重烧伤患者心肌功能的影响

目的 观察ω-3多不饱和脂肪酸(ω-3 PUFA)对严重烧伤患者心肌功能的影响。 方法 将2013年1月至2014年12月安徽医科大学第一附属医院烧伤科收治且符合纳入标准的24例危重患者随机分为两组。对照组12例为常规治疗的基础上使用20%中长链脂肪乳治疗,治疗组12例为常规治疗基础上使用ω-3 PUFA,均持续使用7 d。留取治疗前及治疗后1、4、7 d静脉血,并检测TNF-α、IL-6、cTnI、NF-κBp65值。对统计资料进行析因方差分析。 结果 治疗后,治疗组与对照组血标本中TNF-α、IL-6、cTnI、NF-κBp65值水平均较治疗前均降低,且治疗后,治疗组TNF-α、IL-6、cTnI、NF-κBp65值水平均明显低于对照组,差异有统计学意义(P <0.01)。 结论 ω-3 PUFA可改善严重烧伤患者心肌功能。     

Synthesis and phototoxicity of isomeric 7,9-diglutathione pyrrole adducts: Formation of reactive oxygen species and induction of lipid peroxidation

Pyrrolizidine alkaloids (PAs) are hepatotoxic, genotoxic, and carcinogenic in experimental animals. Because of their widespread distribution in the world, PA-containing plants are probably the most common poisonous plants affecting livestock, wildlife, and humans. Upon metabolism, PAs generate reactive dehydro-PAs and other pyrrolic metabolites that lead to toxicity. Dehydro-PAs are known to react with glutathione (GSH) to form 7-GSH-(+/−)-6,7-dihydro-7-hydroxy-1-hydroxymethyl-5H-pyrrolizine (7-GS-DHP) in vivo and in vitro and 7,9-diGS-DHP in vitro. To date, the phototoxicity of GS-DHP adducts has not been well studied. In this study, we synthesized 7-GS-DHP, a tentatively assigned 9-GS-DHP, and two enantiomeric 7,9-diGS-DHP adducts by reaction of dehydromonocrotaline with GSH. The two 7,9-diGS-DHPs were separated by high performance liquid chromatography (HPLC) and their structures were characterized by ¹H nuclear magnetic resonance (NMR) and ¹H–¹H correlation spectroscopy (COSY) NMR spectral analysis. Photoirradiation of 7-GS-DHP, 9-GS-DHP, and the two 7,9-diGS-DHPs as well as dehydromonocrotaline, dehydroheliotrine, and the 7-R enantiomer of DHP (DHR), by UVA light at 0 J/cm², 14 J/cm², and 35 J/cm² in the presence of a lipid, methyl linoleate, all resulted in lipid peroxidation in a light dose-responsive manner. The levels of lipid peroxidation induced by the two isomeric 7,9-diGS-DHPs were significantly higher than that by 7-GS-DHP and 9-GS-DHP. When 7,9-diGS-DHP was irradiated in the presence of sodium azide (NaN₃), the level of lipid peroxidation decreased; lipid peroxidation was enhanced when methanol was replaced by deuterated methanol. These results suggest that singlet oxygen is a product induced by the irradiation of 7,9-diGS-DHP. When irradiated in the presence of superoxide dismutase (SOD), the level of lipid peroxidation decreased, indicating that lipid peroxidation is also mediated by superoxide. These results indicate that lipid peroxidation is mediated by reactive oxygen species (ROS). These results suggest that 7,9-diGS-DHPs are phototoxic, generating lipid peroxidation mediated by ROS.     

Is it safe and effective to correct congenital scoliosis associated with multiple intraspinal anomalies without preliminary neurosurgical intervention?

The aim of the study was to determine if multiple intraspinal anomalies increase the risk of scoliosis correction compared to the normal intraspinal condition or 1 or 2 intraspinal anomalies in congenital scoliosis (CS) and whether correction for multiple intraspinal anomalies need to be performed with preliminary neurosurgical intervention before scoliosis correction.A total of 318 consecutive CS patients who underwent corrective surgery without preliminary neurosurgical intervention at a single institution from 2008 to 2016 were retrospectively reviewed, with a minimum of 2 years of follow-up. The patients were divided into 3 groups according to different intraspinal conditions. In the normal group (N group; n = 196), patients did not have intraspinal anomalies. In the abnormal group (A group; n = 93), patients had 1 or 2 intraspinal anomalies. In the multiple anomaly group (M group; n = 29), patients had 3 or more intraspinal anomalies including syringomyelia, split cord malformation [SCM], tethered cord, low conus, intraspinal mass, Chiari malformation or/and arachnoid cyst. The occurrence of complications as well as perioperative and radiographic data were analyzed.The incidence rate of multiple intraspinal anomalies in CS patients was 9.1% (29/318). No significant difference was observed in the perioperative outcomes or radiographic parameters at the final follow-up. There were no significant differences among the 3 groups in the total, major or neurological complication rates (all P > .05). Two patients (1 in the N group and 1 in the A group) experienced transient neurological complications, whereas no patient experienced permanent neurological deficits during surgery or follow-up.To our knowledge, the current study reported the largest cohort of intraspinal anomalies in patients with CS that has been reported in the literature. The results of our study demonstrated that patients with congenital scoliosis associated with intraspinal anomalies, even multiple intraspinal anomalies that coexist with more complex intraspinal pathologies, may safely and effectively achieve scoliosis correction without preliminary neurological intervention. More complex intraspinal pathologies do not seem to increase the risk of neurosurgical complications during corrective surgery.     

Effect of electroacupuncture treatment on functional constipation in adults: A protocol for systematic review

Background:Electroacupuncture has been widely used to treat functional constipation. But its efficiency has not been scientifically and methodically evaluated. The objective of this study is to evaluate the efficiency and safety of the electroacupuncture treatment for functional constipation in adults.Methods:This protocol of systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). We will conduct the literature searching in the following electronic databases: the Cochrane Library, MEDLINE, EMBASE, Web of Science, Springer, the Chinese Science Citation Database (CSCD), China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), Wanfang, and the Chinese Scientific Journal Database (VIP). The time limit for retrieving studies is from establishment to July 2020 for each database. All published randomized controlled trials (RTCs) related to this review will be included. Review Manager (V.5.3.5) will be implemented for the assessment of bias risk and data analyses. The selection of the studies, data abstraction, and validations will be performed independently by 2 researchers.Results:This review will assess the clinical efficacy and safety, as well as the acupoints characteristics of electroacupuncture on functional constipation (FC) in adults.Conclusion:This review will summarize the current evidence of electroacupuncture on FC outcomes and provide guidance for clinicians and patients to select electroacupuncture for FC in adults.Trail registration number:This protocol of systematic review has been registered on PROSPERO website (No. CRD42019146715).     

The efficacy and safety of gemcitabine-based induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation: A meta-analysis

Objectives:To assess the efficacy and toxicity of gemcitabine-based induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locally advanced nasopharyngeal carcinoma (LA-NPC).Methods:Both observational studies (OBS) and randomized controlled trials (RCT) were included in the meta-analysis. Systematic online searches were conducted in Web of Sciences, PubMed, Embase, meeting proceedings and ClinicalTrials.gov from the inception to May 25, 2020. The primary endpoint of interest was overall survival.Results:five OBSs and 2 RCTs including 1680 patients were incorporated in the analysis. The evidence from the RCTs showed that adding gemcitabine-based induction chemotherapy to CCRT significantly improved progression free survival (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.40–0.88; P = .010; chi square P = .25; I² = 24%) and overall survival (HR: 0.47; 95% CI: 0.28–0.80; P = 0.005; chi square P = .49, I² = 0%) and was related to a higher risk of hematological toxicities. Furthermore, based on the data of OBSs, overall survival (HR: 0.52; 95% CI: 0.31–0.88; P = .02; chi square P = .37, I² = 6%) was significantly improved in patients treated with gemcitabine-based induction chemotherapy compared to those treated with taxane-based induction chemotherapy. However, the progression free survival (HR: 0.67; 95% CI: 0.45–1.01; P = .06; chi square P = .74; I² = 0%) showed no significant difference.Conclusions:For LA-NPC patients, adding gemcitabine-based induction chemotherapy to CCRT significantly improved overall survival and progression free survival with a higher risk of hematological toxicities when compared to CCRT alone. Also, gemcitabine-based regimen could be used as an alternative induction chemotherapy regimen to taxane-based regimen in the treatment of LA-NPC.     

The role of E255K/V-inclusive mutations in a Philadelphia-positive acute lymphoblastic leukemia with mutation evolution during sequential TKIs therapies: A case report

Rationale:Until recently, the survival rate in patients with Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) was approximately 30%. Tyrosine kinase inhibitors (TKIs), which are a new class of drugs that target BCR-ABL fusion protein, have shown to be effective in treating Ph+ ALL in adults. However, the resistance mechanisms that promote the disease recurrence have altered the initial success of these revolutionary agents.Patient concerns:A 71-year-old Chinese female patient who suffered from severe shoulder and back pain for 1 week.Diagnosis:The patient was diagnosed with Ph+ ALL (B–cell) because of the following items. Complete blood count showed extremely abnormal white blood cell count (26.26×10⁹/l), hemoglobin concentration (65 g/l) and platelet count (14×10⁹/l). And because that Bone marrow aspirate showed 72.5% lymphoblasts and 59.30% lymphoblasts were confirmed by flow cytometry (FCM). At mean time, Real-time fluorescent quantitative PCR analysis confirmed that the P190 BCR/ABL fusion gene expression was 5.9%. Karyotype analysis indicated the following: 45, XX, −7, t (922) (q34; q11) [cp3].Interventions:The patient was treated with chemotherapy and different TKIs including imatinib, dasatinib, ponatinib, and bosutinib.Outcomes:The patient achieved complete remissions with different TKIs after diagnose but relapsed afterward and died of infection.Lessons:Multidrug-resistant mutations within the BCR-ABL1 kinase domain are an emerging clinical problem for patients receiving sequential TKIs therapy. Acquisition of E255K/V-inclusive mutations is usually associated with ponatinib resistance, thus it is necessary to screen out new real pan-inhibitor compounds for all BCR/ABL mutations and figure out the potential efficacy of asciminib-based drug combinations in the future.     

Analysis of related risk factors of lung metastasis after laparoscopic radical hysterectomy of cervical cancer

To explore the risk factors of lung metastasis in patients after laparoscopic radical hysterectomy (LRH) of cervical cancer (CC).The clinical data of CC patients with clinical stage of IA₁–IIA₂ diagnosed in our hospital from April 2007 to October 2015 were collected. According to the situation of metastasis, the patients were divided into lung metastasis (n = 73) and non-lung metastasis group (n = 2076). The clinical data were compared between 2 groups, and logistic stepwise regression model was used to analyze the risk factors of lung metastasis in patients with CC after LRH.The incidence of lung metastasis after LRH of CC was 3.39%, and 67.13% of patients with lung metastases had no obvious clinical symptoms. 15.06% patients had lung metastasis in the first year, 38.35% in the second year, 43.83% in the third year and later. The postoperative lung metastasis of CC was related to tumor diameter (P < .001), pathological type (P < .001), interstitial invasion depth (P < .001), pelvic lymph node metastasis (PLNM, P < .001), vascular tumor thrombus (P = .011), tumor uterine invasion (P = .002), and abnormal preoperative tumor markers (P = .015). However, it was not related to age, clinical stage, tumor growth pattern, tumor differentiation, and para-aortic lymph node metastasis (P > .05). Logistic regression analysis revealed non-squamous cell carcinoma (P = .022), tumor diameter ≥4 cm (P = .008), interstitial invasion depth >2/3 (P = .003), PLNM (P = .007), and tumor uterine invasion (P = .037) is an independent risk factor for lung metastasis after LRH of CC.Non-squamous cell carcinoma, tumor diameter ≥4 cm, tumor interstitial invasion depth >2/3, PLNM, and tumor uterine invasion are independent risk factors for lung metastasis after LRH of CC.