Visceral adipose tissue is more strongly associated with insulin resistance than subcutaneous adipose tissue in Chinese subjects with pre-diabetes

Aims: To investigate the value of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in a cohort of a community’s residents who were diagnosed as pre-diabetes, and to evaluate the association of VAT and SAT with insulin resistance.

Methods: This study was based on cross-sectional analysis of data from 107 adults. VAT and SAT were assessed by computed tomography. Insulin resistance was defined by homeostasis model assessment of insulin resistance >2.69. The relationship of VAT and SAT with insulin resistance were examined by linear regression. Logistic regression was used to analyze the association of VAT and SAT with insulin resistance.

Results: A total of 87 subjects had VAT ≥100?cm². Thirty-six out of 107 (33.6%) subjects were detected to have insulin resistance, 71 were normal (66.4%), and all had insulin resistance with VAT ≥100?cm². VAT (r?=?0.378, p?r?=?0.357, p?p?=?.003), but that of SAT was lost.

Conclusion: Pre-diabetic subjects with insulin resistance had elevated levels of VAT. VAT was more strongly associated with insulin resistance than SAT in Chinese subjects with pre-diabetes.     

The role of urine IgG in the progression of IgA nephropathy with a high proportion of global glomerulosclerosis

International Urology and Nephrology - IgA nephropathy (IgAN), the most common glomerulonephritis in the world, is an important cause of end-stage renal disease (ESRD). It is necessary to explore...     

兰州汉族青少年骨强度指数特点及其影响因素分析

目的调查分析兰州汉族青少年跟骨骨强度指数(bone strength index,SI)变化规律,探讨其影响因素。方法采用超声骨密度仪和生物电阻抗分析仪测量662例(男345例,女317例)兰州汉族青少年SI及体重、体质量指数(body mass index,BMI)、去脂体重、脂肪量4项体成分指标,采用Pearson相关分析法和多元逐步回归法探讨SI的影响因素。结果总体来看,随年龄增加,兰州汉族青少年SI以及身高、体重、BMI、去脂体重、脂肪量5项指标均呈上升趋势。但是,不同性别以及不同年龄段各指标的增长速度存在差异,一般在17岁组或18岁组达到峰值,其中14岁左右为骨发育速度高峰。SI仅在总体上和13岁组存在性别差异且女性大于男性。SI与性别、年龄、身高、体重、BMI、去脂体重、脂肪量均呈正相关关系。而性别、年龄和BMI是SI的主要影响因素。结论兰州汉族青少年SI在不同性别和不同年龄段间变化规律不同,主要的影响因素为性别、年龄及BMI。     

产后妇女漏尿症状及影响因素分析

目的 调查产后妇女发生漏尿症状的现状并分析其影响因素,为预防和积极干预提供参考。方法 采用便利抽样法,收集717例产后42~60 d复查的妇女的一般资料,测量产后盆底功能及评估产后漏尿情况。结果 717例产后妇女中,出现漏尿症状130例,发生率为18.13%。单因素分析结果显示,年龄、阴道分娩次数、分娩方式、妊娠期漏尿、生殖裂孔长度、Ⅰ类肌力、Ⅱ类肌力以及POP-Q分期与妇女产后出现漏尿症状有关（P＜0.05,P<0.01）;Logistic回归分析显示,年龄、顺产、产钳助产、Ⅰ类肌力和妊娠期漏尿是产后妇女发生漏尿症状的影响因素（P<0.05,P<0.01）。结论 产后42~60 d妇女的漏尿患病率处于较高水平,年龄增大、顺产及产钳助产、I类肌力减弱和妊娠期漏尿可增加产后出现漏尿症状的概率,临床医护人员应早期给予积极干预,以降低产后漏尿的发生率。     

两种药物促排卵过程中PCOS患者AMH变化

目的：探讨来曲唑（LE）和尿促性腺激素（HMG）治疗多囊卵巢综合征（PCOS）患者在促排卵过程中抗苗勒氏管激素（AMH）的变化。方法：选择PCOS患者50例，随机分为2组，分别给予来曲唑2．5mg／d口服，共5d；或低剂量递增法肌注hMG；对照组50例；阴道超声计数小卵泡数和优势卵泡数，测定月经第3天、第8天以及hCG日（对照组LH峰日）血AMH、E2。结果：在促排卵过程中，hMG组AMH水平逐渐降低，与E2升高间成负相关（r＝0．65）；LE组AMH水平略有下降但无显著性；对照组AMH值无明显变化。结论：LE治疗过程中PCOS患者AMH变化及卵泡生长更接近自然月经周期。     

单核细胞计数与高密度脂蛋白胆固醇比值评价老年急性心肌梗死患者冠状动脉介入术后ST段回落不良的观察

目的探讨单核细胞计数与高密度脂蛋白胆固醇比值(MHR)评价老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后ST段回落不良的临床意义。方法回顾性病例对照研究,收集2015年12月至2018年12月我院收治的接受直接PCI治疗的老年STEMI患者274例的临床资料,按术后心电图ST段回落情况分为ST段回落不良组79例和良好组195例,比较两组患者临床资料,采用Logistic回归分析MHR与ST段回落不良的关系,并绘制受试者工作特征(ROC)曲线分析MHR预测STEMI患者ST段回落不良临床价值。结果与ST段回落良好组患者比较,ST段回落不良组患者前壁心肌梗死、Killip分级≥2级比例高,胸痛到球囊扩张时间长,入院时肌酸激酶同工酶、N末端脑钠肽前体、超敏C反应蛋白、血糖、血尿酸、纤维蛋白原、三酰甘油、单核细胞计数高,高密度脂蛋白胆固醇、淋巴细胞计数较低(均P<0.05)。ST段回落不良组患者MHR为0.75±0.22,高于ST段回落良好组患者的0.48±0.19(t=9.831,P=0.001)。多元Logistic回归分析,MHR是老年STEMI患者PCI后ST段回落不良的独立危险因素(OR=1.950,95%CI:1.646~5.430,P=0.003)。ROC曲线显示,MHR预测STEMI患者ST段回落不良的曲线下面积为0.867,敏感度为79.72%,特异度为79.61%,最佳诊断值为0.64。结论MHR可能是老年STEMI患者PCI术后ST段回落不良独立危险因素,有良好的预测价值。     

胸腔镜联合腹腔镜食管癌切除术的临床效果分析

目的分析胸腹腔镜联合下行食管癌切除术的临床效果。方法选取2013年5月~2014年5月我院收治的食管癌患者96例,根据术式将患者分为联合组(57例)和传统组(39例),传统组患者给予传统食管癌根治手术,联合组患者进行胸腔镜联合腹腔镜下食管癌切除术,所有患者手术前后均给予针对性护理干预。结果传统组患者手术时间,术中出血量,淋巴结清扫个数,术后引流量,住院时间及VAS评分均高于联合组,且差异具有统计学意义(P0.05)。结论传统手术和胸腔镜联合腹腔镜下食管癌切除术并配合针对性护理均可治疗食管癌,但胸腔镜联合腹腔镜下食管癌切除术效果更优,本研究也为食管癌的治疗和护理提供一定依据。     

新型3D打印导板辅助颈椎前路双侧椎弓根置钉的安全及可行性

文题释义：3D 打印手术导板：该导板依据手术需要,通过计算机辅助设计、3D打印制备出的一种具有术中准确定位点、置钉的位置、方向和深度,精确建立孔道、截面、空间距离、相互成角关系及其他复杂空间结构等功能的辅助手术器械,具有获取途径方便、使用方法简单、价格低廉等优点。 颈椎前路椎弓根置钉：是一种区别于传统颈椎后路椎弓根螺钉置钉技术的新型置钉技术,该技术可通过单独前方入路实现颈椎三柱损伤或多节段病变的坚强固定,无需再行后路固定,可有效减少手术创伤和并发症。 背景：下颈椎前路椎弓根螺钉固定技术可通过前方入路实现颈椎坚强固定,具有较大的应用前景。但该技术操作难度大、风险高,目前尚未得到广泛应用。 目的：改良设计一种用于下颈椎双侧前路椎弓根螺钉置钉的3D打印导板,探讨其辅助颈椎前路椎弓根螺钉置钉的可行性及安全性。 方法：选取6具正常成人颈椎标本,男女各3具,行薄层CT扫描后将影像数据以DICOM格式导入Mimics 17.0软件,三维重建后模拟设计出C₃-C₇双侧颈椎前路椎弓根螺钉钉道导孔,再以颈椎椎体前面、椎体上面前1/2及双侧钩突关节面前1/2骨性结构为标志,反向增厚设计生成导孔基座,形成颈椎前路椎弓根螺钉置钉导板。经3D打印得到导板实体后,在导板辅助下行C₃-C₇双侧颈椎前路椎弓根螺钉置钉。将置钉后的颈椎标本再次行CT扫描,通过CT断面影像评价置钉准确性。同时利用Mimics17.0软件比较实际钉道与模拟钉道在横断面的内、外偏移角度(α1、α2)差异及其在矢状面的上、下偏移角度(β1、β2)差异。 结果与结论：①双侧共计60枚颈椎前路椎弓根螺钉均顺利置入,其中57枚完全位于椎弓根皮质内,判定为0级,准确率95.0%;另外3枚破出椎弓根皮质,其中1级2枚(3.3%),2级1枚(1.7%);②真实钉道与模拟钉道相比,其横断面内、外偏移角分别为(0.867±0.787)°、(0.783±0.792)°,差异无显著性意义(P > 0.05);矢状面上、下偏移角分别为(1.362±1.380)°、(1.314±1.300)°,差异无显著性意义(P > 0.05)。③提示在设计得到的3D打印导板辅助下可顺利完成下颈椎双侧前路椎弓根螺钉置钉,且具有良好的置钉安全性。 ORCID: 0000-0003-0124-7585(肖强)中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Controlled release of stromal cell-derived factor-1α from silk fibroin-coated coils accelerates intra-aneurysmal organization and occlusion of neck remnant by recruiting endothelial progenitor cells

This study is to test the efficacy of stromal cell-derived factor-1α (SDF-1α)-coated coils together with endothelial progenitor cells (EPCs) transplantation in occluding aneurysms. Bone marrow-derived EPC surface markers were analyzed using flow cytometry. The migratory function of EPCs in response to SDF-1α was evaluated using a modified Boyden chamber assay. Capillary-like tube formation was assessed using Matrigel gel. Coil morphologies before and after coating with SDF-1α were observed under a scanning electron microscope. The level of SDF-1α in supernatants was measured by ELISA. Sprague-Dawley rats were randomly allocated into five groups. Histological analysis was performed on days 14 and 28 after coil implantation. The bone marrow-EPCs could express CD133, CD34, and VEGFR-2 and form tubule-like structures in vitro. Migratory ability of EPCs in the presence of SDF-1α-coated coils was similar to that in the presence of 5 ng/ml SDF-1α gradient. Sustained release of SDF-1α was achieved using silk fibroin as a carrier. In SDF-1α-coated coils + EPCs transplantation group, a well-organized fibrous tissue bridging the orifice of aneurysms was shown on days 14 and 28. On day 28, tissue organization was greater in the SDF-1α-coated coils group than in the unmodified coils group. Immunofluorescence showed α-smooth muscle actin-positive cells in organized tissue in sacs. Combined treatment with SDF-1α-coated coils and EPCs transplantation is a safe and effective treatment for rat aneurysms. This may provide a new strategy for endovascular therapy following aneurysmal subarachnoid hemorrhage.