糖尿病对骨代谢影响的基础研究进展

近年来,一系列临床研究及动物实验结果表明,糖尿病与骨质疏松症的发生及发展进程密切相关,糖尿病可通过不同的分子机制对骨代谢产生不良影响。相关的机制研究表明糖尿病通过脂肪因子、晚期糖基化终末产物、骨硬化蛋白、胰岛素、胰岛素生长因子-1、促炎因子、骨髓脂肪组织及胰高血糖素样肽1等因素直接或间接地参与和诱导了骨质疏松症的形成和发展。本研究就糖尿病对骨代谢影响的基础研究,糖尿病性骨质疏松症的分子机制进行综述。     

先天性胫骨假关节的文献计量学分析CSCD

Objective To quantify the 100 most frequently cited papers in CPT for predicting research hotspots for benefitting future clinical outcomes. Methods Web of Science database was searched for publications related to CPT original research from January 1, 1900 to December 31, 2022. And Cited Reference Search tool was employed for retrieving articles to determine the most cited item. Then a knowledge map was generated for number ofcitations, publication year, publication periodical, author unit, publication country and key words. Results Top 100 selected articles were cited from 11 to 196 times and publication period started from 1928 to 2016. Clinical research was the major type (n =93) and only 7 studies belonged to basic research. The largest contribution came from the United States (n =37), followed by Republic of Korea (n =9), Germany (n =6) and Italy (n=6). The frequently appearing keywords were divided into 2 groups of “Neurofibroma” and “Clinical characteristic of pseudarthrosis”. And term “NF1” was the latest hot spot in the most cited article. Conclusion Current researches on CPT focuse upon clinical treatment. Basic research on the pathogenesis of CPT is still relatively lacking. In the future, investment in basic research on CPT should be strengthened to provide a more comprehensive treatment for CPT. © 2022, Journal of Clinical Pediatric Surgery. All rights reserved.     

儿童脑瘫性髋关节疾病的外科治疗与结果评价CSCD

儿童脑瘫性髋关节疾病通常需要手术治疗,手术方式包括预防性、重建性和补救性手术三种。手术的目的是防止股骨头向外侧移位,重建半脱位及脱位髋关节的稳定,消除不可重建髋关节脱位导致的持续性疼痛,进而改善患儿行走功能,方便不具站立及行走能力患儿的会阴部护理。本文通过系统复习新近相关文献,重点阐述儿童脑瘫性髋关节疾病各种手术方式的适应证、操作要点以及临床与X线评价结果、远期随访结果。     

Electrolyte analysis of pleural effusion for discrimination between seawater and freshwater drowning in decomposed bodies

ObjectiveThe diagnosis of drowning is an important issue in forensic investigations. Moreover, discriminating between seawater and freshwater drowning is crucial to identify where the drowning occurred. The present study aimed to investigate electrolyte concentrations in pleural fluid in decomposed bodies in late postmortem intervals and derive cut-off values for the diagnosis of seawater and freshwater drowning.Study designData were collected from 44 seawater drowning cases, 60 freshwater drowning cases, and 30 non-drowning cases with pleural effusion which served as controls. The levels of sodium ion (Na⁺), potassium ion (K⁺), and chloride ion (Cl⁻) of pleural fluid were measured, and two indices were calculated: summation of Na⁺ and K⁺ levels (SUM _Na + K), and summation of Na⁺, K⁺, and Cl⁻ levels (SUM _{Na + K + Cl}). The means of the three ion concentrations and two indices significantly differed between the three groups (p < 0.0001).ResultsThe receiver operating characteristic analysis revealed that the sensitivity and specificity were both 1.000 for SUM _{Na + K + Cl} of 288.3 mEq/L between the seawater and control groups. The Na⁺ value of 109.0 mEq/L also had a high sensitivity of 0.977 and a specificity of 0.933 in the seawater and control groups. The sensitivity and specificity were 0.967 and 1.000, respectively, for SUM _Na + K of 123.2 mEq/L between the freshwater and control groups.ConclusionThe electrolyte concentrations in pleural effusion may be useful for the diagnosis of drowning in decomposed bodies with a longer postmortem interval.     

Cautions on the laboratory indicators of COVID‐19 patients on and during admission

BackgroundDifferent disease severities of COVID‐19 patients could be reflected on clinical laboratory findings.MethodsIn this single‐centered retrospective study, demographic, clinical, and laboratory indicators on and during admission were compared among 74 participants with mild, moderate, critical severe, or severe classification. Risk factors associated with disease severity were analyzed by multivariate analyses. The AUC and 95% CI of the ROC curve were calculated.ResultsThe most common manifestations of these patients were fever and cough. Critical severe or severe group owned the longest length of stay (23 (19,31), p < 0.001). After multivariate logistic regression, independent influence factors on admission for severity of disease were CK‐MB (OR 0.674; 95% CI 0.489–0.928; p = 0.016), LDH (OR 1.111 or 1.107; 95% CI 1.026–1.204 or 1.022–1.199; p = 0.009 or 0.013), normal T‐BIL (OR 4.58 × 10⁻⁸; 95% CI 3.05 × 10⁻⁹–6.88 × 10⁻⁷; p < 0.001), LYM% (OR 0.008; 95% CI 0–0.602; p = 0.029), and normal ESR (OR 0.016; 95% CI 0–0.498; p = 0.019). Factors during hospitalization were normal T‐BIL (OR 8.56 × 10⁻⁹; 95% CI 8.30 × 10⁻¹⁰–8.83 × 10⁻⁸; p < 0.001), LYM (OR 0.068; 95% CI 0.005–0.934; p = 0.044), albumin (OR 0.565; 95% CI 0.327–0.977; p = 0.041), and normal NEU% (OR 0.013; 95% CI 0.000–0.967; p = 0.048). Combined indicators of AUC were 0.860 (LYM, LDH, and normal ESR on admission, p < 0.001) and 0.750 (CK‐MB, LDH, and normal T‐BIL during hospitalization, p = 0.020) when predicting for severe or critical severe patients.ConclusionTo pay close attention to the progression of COVID‐19 and take measures promptly, we should be cautious of the laboratory indicators when patients on admission especially CK‐MB, LDH, LYM%, T‐BIL as well as ESR; and T‐BIL, LYM, albumin, NEU% with the process of disease.     

Influence of ADRB1, ADRB2, and COMT Genetic Polymorphisms on Postoperative Outcomes of Patients Undergoing Cardiac Valve Surgery

PurposeThe aim of this study is to prospectively investigate the influence of ADRB and COMT gene polymorphisms on postoperative outcomes of patients undergoing cardiac surgery.MethodsThis prospective cohort study included 223 patients undergoing elective cardiac valve surgery using cardiopulmonary bypass. Demographic information, intraoperative data, postoperative data, and blood samples were collected. Patients were genotyped for single-nucleotide polymorphisms (SNPs) of ADRB1 rs1801253, ADRB2 rs1042713, and COMT rs4680. Major adverse cardiovascular and cerebrovascular events (MACCEs) were used as the primary outcome to evaluate the postoperative prognosis of patients. Secondary outcomes included the duration of mechanical ventilatory support, intensive care unit stay, postoperative hospital stay, and postoperative need of inotropic or vasoactive agents.FindingsThe overall incidence of MACCEs was 15.2%. Among 3 SNP loci, only different genotyped carriers of ADRB2 rs1042713 had statistically significant differences in the incidence of MACCEs (P = 0.005), especially for acute kidney injury (P = 0.023). The proportions of postoperative norepinephrine demand of patients carrying the AA genotype of ADRB2 rs1042713 (P = 0.016) and the AG genotype of COMT rs4680 (P = 0.018) were low. The duration of mechanical ventilatory support (P = 0.034) and postoperative hospital stay (P = 0.045) of patients carrying the AG genotype of COMT rs4680 was shortest. After multiple logistic regression analysis, we found that the G allele carriers of ADRB2 rs1042713 had a higher risk of MACCEs (AG vs AA genotype: odds ratio [OR] = 4.348; 95% CI, 1.529–12.359, P = 0.006; GG vs AA genotype: OR = 3.722; 95% CI, 1.060–13.071; P = 0.040), in particular with acute kidney injury (AG vs AA genotype: OR = 5.273; 95% CI, 1.093–25.451; P = 0.038; GG vs AA genotype: OR = 7.533; 95% CI, 1.275–44.522; P = 0.026). There was no SNP-SNP interaction found among the 3 SNPs with multifactor dimensionality reduction analysis.ImplicationThe ADRB2 rs1042713 polymorphism might be related to prognosis of patients undergoing cardiac surgery. Patients carrying the G allele of ADRB2 rs1042713 had a higher risk of developing MACCEs, especially acute kidney injury. chictr.org.com identifier: ChiCTR1800015105.     

A Comparative Study of Anti-Gastric Cancer Activity Between Aqueous Extract and Ethanol Extract of Folium Cordylines Fruticosae

The active components in Folium Cordylines Fruticosae were extracted by heat reflux method. The solvents used were distilled water and ethanol. The effects of two types of extracts on gastric cancer cells were compared; dry extract yields were calculated, as well as the inhibition rates of gastric cancer MGC-803 cell proliferation and the colony cell counts. The micro-Kjeldahl method was used to measure the cell protein contents and to make a comprehensive comparison. The results showed that the MGC-803 cell inhibition rates of three different concentrations (32.5, 75 and 150 mg/ml) of ethanol extracts increased with the increase of concentration, which was 48.9% at a concentration of 150 mg/ml; aqueous extract of Folium Cordylines Fruticosae had very low inhibitory activity at a low concentration (32.5 mg/ml), which was remained at about 20%. After being affected by two types of extracts, cells had uneven sizes, with very low brightness, while the normal cells presented a uniform full form, with high definition.     

急性Stanford B型主动脉夹层真腔次全闭塞治疗 ——单中心病例系列报道

【摘要】 目的 总结急性Standford B型主动脉夹层（AD）真腔次全闭塞患者的治疗经验。方法 回顾性分析2016年1月至2019年12月湖南省人民医院采用胸主动脉腔内修复术治疗的39例急性B型AD真腔次全闭塞患者临床资料。所有患者均接受主动脉覆膜支架腔内隔绝术,术中根据近端破口位置决定是否同时行左颈动脉或左锁骨下动脉重建修复（含支架开窗、烟囱支架）,远端受累分支血管根据AD真腔开通后具体情况选择保守、支架成形术或血液透析治疗。结果 39例患者共植入主动脉覆膜支架51枚（植入1枚27例, 2枚12例）,同时植入腹主动脉裸支架3枚,肠系膜上动脉支架8枚,髂动脉支架12枚,颈动脉原位开窗或烟囱支架9枚,锁骨下动脉开窗或烟囱支架枚17枚。介入治疗技术成功率为100%。围手术期并发症为肾功能不全15例（38.5%）;5例一侧肾动脉完全假腔供血遂接受覆膜支架开通;中重度肠道缺血表现8例（20.5%）,其中6例接受二次腔内治疗。围手术期死亡率为7.7%（3/39）,死因主要为重度肾功能不全和酸中毒多脏器衰竭。术后随访6～25个月,支架段假腔完全血栓化率为80.6%（25/31）,其中支架段主动脉完全重塑率为68%（17/25）。结论 B型AD真腔次全闭塞一经确诊,建议尽快手术。腔内开通过程需要多种技巧,部分患者两段式支架应用有利于真腔开通,降低假腔压力,促进血管重塑。     

介入治疗肝癌患者主要照顾者负担水平现状调查及影响因素

【摘要】 目的 了解行介入治疗肝癌患者主要照顾者负担水平的现状并分析其影响因素。方法 选取2018年1至8月住院行介入治疗的肝癌患者的140例主要照顾者作为研究对象,采用照顾者负荷能量表（CBI）对照顾者进行问卷调查。同时,以CBI评分为因变量,以患者及照顾者一般资料为自变量进行单因素分析,将有统计学意义的因素再进行logistic回归分析,分析患者主要照顾者负担水平的现状及影响因素。结果 患者主要照顾者CBI评分为（65.3±17.5）分,82位（58.5%）处于重度负荷水平,52位（37.1%）处于中度负担。单因素分析显示患者因素（疾病是否发生转移）、照顾者因素（性别、工作状况、与患者的关系良好程度、是否能胜任护理工作、性格特征、教育程度、健康状况）、经济因素（医疗费用压力）均为主要照顾者CBI评分的影响因素。Logistic回归分析显示患者疾病有无转移、照顾者性别、照顾者与患者的关系良好程度、医疗费用压力为照顾者负担水平的主要影响因素（P＜0.05）。结论 行介入治疗肝癌患者主要照顾者负担水平较高,医护人员应高度重视对该人群负担水平的评估,及时采取针对性的整体干预措施,预防和降低肝癌行介入治疗患者主要照顾者高负担的发生及发展。     

Microglia-associated neuroinflammation is a potential therapeutic target for ischemic stroke

Microglia-associated neuroinflammation plays an important role in the pathophysiology of ischemic stroke. Microglial activation and polarization, and the inflammatory response mediated by these cells play important roles in the development, progression and outcome of brain injury after ischemic stroke. Currently, there is no effective strategy for treating ischemic stroke in clinical practice. Therefore, it is clinically important to study the role and regulation of microglia in stroke. In this review, we discuss the involvement of microglia in the neuroinflammatory process in ischemic stroke, with the aim of providing a better understanding of the relationship between ischemic stroke and microglia.