The prevalence of microalbuminuria and its relationships with the components of metabolic syndrome in the general population of China

BackgroundFew studies have examined the relationships between the prevalence of microalbuminuria and the metabolic risk factors in the general population of China. We performed a population based study to investigate the prevalence of microalbuminuria and its relationships with the components of the metabolic syndrome in Hangzhou, China.MethodsThe subjects of this cross-sectional study were the individuals from 19 to 87y. The metabolic syndrome was defined based on the criteria of the Chinese Diabetes Society (CDS). Microalbuminuria was defined as a urine albumin–creatinine ratio of 30 to 300 mg/g.ResultsA total of 2985 subjects (average age of 44 y) were analyzed. Among them, the prevalence of the metabolic syndrome and microalbuminuria was 12.6% and 8.8%, respectively. Microalbuminuria prevalence rate was significantly higher in the population > 60 y than < 60 y. The prevalence of MAU in the group with metabolic abnormalities was significantly higher than the control group, and the prevalence rate of MAU in the metabolic syndrome group reached up to 20.3%. There was a significantly positive correlation between the prevalence of microalbuminuria and the corresponding components of the metabolic syndrome (P < 0.001).ConclusionsMicroalbuminuria was highly prevalent in the middle-aged and elderly Chinese population in the city of Hangzhou. There is an increasing likelihood of having microalbuminuria if subjects have the metabolic syndrome. Early screening strategies for prevention and treatment of MAU are strongly suggested, especially in the population > 60 y and the ones with metabolic abnormalities.     

Monitoring coagulation and the clinical effects of recombinant factor VIIa

Accurately monitoring hemostasis in patients with coagulation disorders is vital in order to allow physicians to optimize anticoagulant therapy and deliver effective patient management. Traditional assays, based on the measurement of the time to first evidence of clot formation, fail to describe the kinetics of clot production that ultimately define the quality of the final clot. This review describes the technologies that have been developed to accurately describe and monitor the kinetics of clot formation. Using clinical examples, the utility of these technologies is assessed and conclusions drawn about the most useful diagnostic measures for monitoring hemostasis.     

Does follicular flushing increase oocyte number in poor responders? An update of a systematic review

Research questionDoes flushing of the follicles at ovum retrieval increase the number of retrieved oocytes in poor-response IVF patients?DesignAn update of an electronic literature search was performed to identify randomized controlled trials (RCT) investigating follicular flushing versus no flushing in women with a poor response to IVF treatment. No exclusion criteria for type of needle, stimulation or protocol were applied. A meta-analysis was conducted using the software RevMan 5.4.ResultsSix RCT were identified that had the primary objective of testing for an increase in mean number of cumulus–oocyte complexes or/and metaphase II oocytes between flushing and no flushing. A double-lumen needle was used in five trials, one study investigated a pseudo-double-lumen needle, and a conventional single-lumen needle was used in all the control groups. The main risk of bias in all the included studies is a lack of blinding of the physicians performing the puncture and incomplete data in four trials. A heterogeneity of direction and size of effect of follicular flushing on mean oocyte number retrieved was detected (I² = 80, P = 0.0001), which precludes a synthesis of the data. Two studies showed a decrease or tendency towards a decrease in oocyte numbers, one study showed similar oocyte numbers, and one study showed a strong tendency towards increased oocyte numbers with flushing. A similar picture was seen for metaphase II oocytes (I² = 73, P = 0.002).ConclusionsIt is uncertain whether follicular flushing in poor-response IVF patients affects the number of retrieved oocytes. Larger pragmatic trials are warranted to clarify the effect of flushing on oocyte numbers and clinical outcomes in poor responders and monofollicular patients.     

间充质干细胞外泌体在骨关节炎治疗修复中的研究进展

骨关节炎(OA)是种以关节软骨退变为特征的疾病,其缺乏干预性药物,对于晚期OA患者往往通过关节置换术以维持生活质量。外泌体(exosomes)是一种由不同细胞分泌的细胞外囊泡,可以传递DNA、微小RNA(microRNA,miRNA)、mRNA、蛋白质等多种信息,并以此通过多种方式进行细胞间信号传递和功能调节。间充质干...     

心肌标志物在脓毒症心肌损伤中的临床作用

脓毒症引起的多器官功能衰竭是导致危重病患者的主要死因。心肌损伤在脓毒症中为器官功能障碍的常见表现。本文综述了心肌标志物肌钙蛋白和B型钠尿肽在脓毒症心肌损伤中的产生原理和临床应用,从而为脓毒症心肌损伤的早期诊断、病情监测、疗效观察和预后判断等诸方面提供了依据。     

Smac与缺血性神经元凋亡

Smac Diablo(第二个线粒体源的caspase激活物低等电点的IAP直接结合蛋白)是一种重要的促凋亡因子,在缺血性损伤引起的神经元凋亡中发挥着重要作用。本文对其研究现状和与神经元凋亡的关系做一简单论述。     

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China

ObjectiveSeveral COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.MethodsA retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of the associations between comorbidities (cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.ResultsOverall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30–6.32), type 2 diabetes (T2DM) (3.57, 2.32–5.49), cardiovascular disease (CVD) (3.78, 1.81–7.89), fatty liver disease (7.53, 1.96–28.96), hyperlipidemia (2.15, 1.26–3.67), other lung diseases (6.00, 3.01–11.96), and electrolyte imbalance (10.40, 3.00–26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89–12.75), CVD (8.47, 6.03–11.89), and electrolyte imbalance (19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46–29.64) within two weeks.ConclusionBesides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.     

苦碟子注射液治疗缺血性中风急性期上市后再评价

目的:评价苦碟子注射液对缺血性中风急性期患者影响的有效性和安全性。方法:采用实用性随机对照试验,通过中央随机系统,将700例缺血性中风患者随机分为试验组346例、对照组354例。试验组给予苦碟子注射液的基础上加用西医内科基础治疗和中医康复技术,对照组给予西医内科基础治疗加用现代康复技术,疗程为10～21 d,在第7,14,21天3个时间点上观察患者的神经功能缺损(NIHSS评分)和肢体运动功能(FMI评分)。同时观察2组不良事件发生率及治疗前后实验室检查指标。结果:应用广义估计方程模型,发现随着治疗时间的延长,2组NIHSS评分及FMI评分均呈改善趋势,且治疗第14天和第21天NIHSS和FMI评分试验组较对照组相比,具有显著统计学差异(P<0.05)。试验组未发生与苦碟子注射液相关的不良事件。结论:苦碟子注射液对缺血性中风患者的神经功能缺损及肢体运动功能有一定的改善作用。苦碟子注射液在治疗缺血性中风早期康复方面是安全有效的。     

First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advancedEGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label,randomized study

BackgroundIcotinib has been previously shown to be non-inferior to gefitinib in non-selected advanced non-small-cell lung cancer patients when given as second- or further-line treatment. In this open-label, randomized, phase 3 CONVINCE trial, we assessed the efficacy and safety of first-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance in lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutation.Patients and methodsEligible participants were adults with stage IIIB/IV lung adenocarcinoma and exon 19/21EGFR mutations. Participants were randomly allocated (1 : 1) to receive oral icotinib or 3-week cycle of cisplatin plus pemetrexed for up to four cycles; non-progressive patients after four cycles were maintained with pemetrexed until disease progression or intolerable toxicity. The primary end point was progression-free survival (PFS) assessed by independent response evaluation committee. Other end points included overall survival (OS) and safety.ResultsBetween January 2013 and August 2014, 296 patients were randomized, and 285 patients were treated (148 to icotinib, 137 to chemotherapy). Independent response evaluation committee-assessed PFS was significantly longer in the icotinib group (11.2 versus 7.9 months; hazard ratio, 0.61, 95% confidence interval 0.43–0.87;P = 0.006). No significant difference for OS was observed between treatments in the overall population or inEGFR-mutated subgroups (exon 19 Del/21 L858R). The most common grade 3 or 4 adverse events (AEs) in the icotinib group were rash (14.8%) and diarrhea (7.4%), compared with nausea (45.9%), vomiting (29.2%), and neutropenia (10.9%) in the chemotherapy group. AEs (79.1% versus 94.2%;P < 0.001) and treatment-related AEs (54.1% versus 90.5%;P < 0.001) were significantly fewer in the icotinib group than in the chemotherapy group.ConclusionsFirst-line icotinib significantly improves PFS of advanced lung adenocarcinoma patients withEGFR mutation with a tolerable and manageable safety profile. Icotinib should be considered as a first-line treatment for this patient population.