Identification of U-shaped curve relation between proneurotensin and risk of coronary artery disease (CAD) in patients with premature CAD

Background and aimsNeurotensin (NT) is a gut hormone with broad effects on the cardiovascular system. Recent data suggested that circulating proneurotensin (pro-NT)—the stable precursor fragment of NT—could independently predict cardiovascular artery disease (CAD) development. However, serum pro-NT levels in patients with premature cardiovascular artery disease (PCAD) are still unknown. This study aims to determine serum pro-NT levels in patients with PCAD and investigate its relationship with PCAD risk.Methods and resultsA total of 490 subjects, including 364 with PCAD and 126 without PCAD (NPCAD), and 182 controls were enrolled in the study. Data of baseline clinical parameters and biochemical variables were collected. Serum pro-NT levels were measured by ELISA.Serum pro-NT levels were higher in patients with PCAD than in controls (59.42 ± 66.66 vs. 38.07 ± 48.48 pg/mL, P < 0.05), especially in patients with BMI<25 kg/m². Serum pro-NT levels were independently related to PCAD (β = 0.349, P < 0.001), and the association revealed a U-shaped curve characteristic between pro-NT tertiles and CAD risk in patients with premature CAD and controls. Subjects with low and high tertiles of pro-NT levels had 1.79-fold and 2.23-fold higher risks of PCAD, respectively, than subjects with median pro-NT levels (P < 0.05). After adjusting for age, gender, and BMI in Model 1 and other confounders in Model 2 and Model 3, the U-shaped relationship remained significant.ConclusionSerum pro-NT levels were significantly increased in patients with PCAD. The association between pro-NT levels and PCAD risk presents a U-shaped curve characteristic, which demonstrated that subjects with lower and higher pro-NT levels both were more likely to have PCAD.     

我国60岁及以上老年人血红蛋白与心率增快的关联研究

目的探讨我国老年人血红蛋白水平与心率增快的关联性。方法研究对象来源于2018年中国慢性病及危险因素监测中≥60岁的老年人。根据WHO关于贫血严重程度的定义和非贫血者血红蛋白浓度的三分位数, 将男性和女性研究对象分别分为5组。考虑群内相关性后用多因素logistic回归分析血红蛋白分组与心率增快风险的关联, 用限制性立方样条探讨两者间的剂量反应关系。结果最终纳入≥60岁老年人71 409名。血红蛋白浓度为(142.6±17.7)g/L, 心率为(78.5±12.2)次/min。调整混杂因素后, 与男性血红蛋白130～147 g/L组相比, <110、110～129、148～158、≥159 g/L组心率增快的优势比(OR值)分别为1.39(95%CI:1.17～1.64)、1.10(95%CI:0.99～1.21)、1.16(95%CI:1.09～1.23)、1.42(95%CI:1.33～1.51)。与女性血红蛋白120～133 g/L组相比, <110、110～119、134～142、≥143 g/L组心率增快的OR值分别为1.17(95%CI:1.02～1.33)、1....     

Changes in serum uric acid and the risk of cardiovascular disease and all-cause mortality in the general population

Background and aimLongitudinal evidence on change in serum (SUA) with risk of cardiovascular disease (CVD) and all-cause mortality is limited, as many prior studies focused on baseline SUA. Further, the optimal threshold range of SUA change is unclear.Methods and resultsA total of 63,127 participants without history of CVD were enrolled. Change in SUA was determined by the difference of SUA levels between 2006 and 2010, which divided by baseline SUA was percent change in SUA. Multivariable Cox proportional hazards models were used to calculated the hazard ratios (HRs) and 95% confidence intervals (CIs). Our analysis also included restricted cubic spline model and three-piecewise Cox proportion hazards model to address the non-linearity between percent change in SUA and outcomes. During a median follow-up of 7.04 years, 3341 CVD and 3238 deaths occurred. We did not observed a significant association between changes in SUA and CVD. However, changes in SUA at extreme were associated with higher risk of all-cause mortality, the HRs (95% CIs) were 1.15 (1.02–1.29) and 1.20 (1.06–1.35) in the first and fifth quintile group, compared with the third quintile group. We further found a U-shaped association between percent change in SUA and all-cause mortality, and the optimal range was within 20%.ConclusionsChanges in SUA at extreme were risk factors for all-cause mortality, but not for CVD in the general population. The findings are relevant for role of SUA in the management of CVD risk and may contribute to improve identification of patients at higher risk.     

一种新型新生儿头部固定枕的设计与临床应用

目的探讨自制＂U＂形枕在预防新生儿头颅畸形、辅助治疗新生儿常见疾病中的作用。方法自制新生儿＂U＂形枕,选取住院的新生儿颅内出血、新生儿硬肿症、新生儿缺血缺氧性脑病及急性脱水热患儿各10例,分别根据疾病选择合适的＂U＂形枕,同时选择相同疾病患儿各10例,不应用＂U＂形枕,相同住院时间对比头颅外形。结果治愈出院时头颅外形美观、端正,没有任何一例患儿因枕头而发生体位性水肿现象,受到家属高度赞誉,出院满意度调查达100%,并且对不同的新生儿科疾病起到了辅助治疗的作用。结论针对病种对症选枕,既有辅助治疗的作用,又保持了患儿头颅的美观外形,既提高了患儿家属的满意度,又经济实用、人性化,具有直接的社会效益与经济效益。     

Anatomic Reduction and Next-Generation Fixation Constructs for Arthroscopic Repair of Crescent,L-Shaped,and U-Shaped Rotator Cuff Tears

Emerging techniques and instrumentation have allowed orthopaedic surgeons to achieve rotator cuff repair through an all-arthroscopic technique. The most critical steps in rotator cuff repair consist of proper identification of the cuff tear pattern and anatomic restoration of the torn tendon footprint. With anatomic reduction of the rotator cuff tendons, a sound fixation construct can help restore rotator cuff contact pressure and kinematics, allowing for decreased repair tension and optimal healing potential. We provide surgical methods to recognize tear patterns and present a repair construct that will restore the anatomic footprint of the torn rotator cuff tendon. The key, initial maneuver to restore the anatomic footprint of the cuff includes placement of a suture anchor at the anterolateral corner for L-shaped tears and at the posterolateral corner for reverse L–shaped and U-shaped tears. After insertion of the medial-row anchors, the tendon stitches should be planned by use of a grasper to hold the tendon in a reduced position and guide location of the stitch. The lateral row with suture bridge can be visualized, and the final repair construct should produce an anatomic restoration of the rotator cuff footprint.     

Rapid induction of protective tolerance to potential terrorist agents: a systematic review of low- and ultra-low dose research

OBJECTIVE: To systematically review the literature on the ability of low-dose (LD) and ultra-low-dose (ULD) toxin exposure to prevent and treat biological and chemical threats. METHODS: Laboratory research articles on protection or treatment from LD or ULD exposure for the 13 high-risk chemical and biological warfare threats were collected and systematically evaluated for quantity and scientific quality using pre-defined methodological criteria. RESULTS: Over 2600 articles were screened. Only five studies met the inclusion criteria examining stimulation and protective effects of LD- or ULD-exposures to the 13 pre-identified biological and chemical agents. The quality evaluation (QE) of these studies was above average with a mean QE score of 70.6% of maximum. Two articles of fair to good quality reported both protective and treatment efficacy from exposure of animals or humans to LD- and ULD-exposures to toxins of risk in biochemical warfare. CONCLUSION: There is little research on agents of biological and chemical warfare investigating the possible use of LD- and ULD-toxins for protection and treatment. The existing literature is generally of good quality and indicates that rapid induction of protective tolerance is a feasible but under-investigated approach to bioterrorist or biowarfare defense. In our opinion, further research into the role of induced protection with LD- and ULD-toxic agents is needed.     

U形截骨术和下颌骨超长弧形截骨术矫正下颌角肥大伴长颏畸形的疗效对比分析

目的:探讨不同术式矫正下颌角肥大伴长颏畸形的应用效果。方法:选取笔者科室2017年1月-2019年1月收治的26例下颌骨肥大伴长颏畸形患者,分别采用U形截骨术和下颌骨超长弧形截骨术两种术式进行矫正,比较两组患者的疗效、术后并发症及满意度情况。结果:U形截骨术组总有效率为90.00%,下颌骨超长弧形截骨术组总有效率为100.00%,下颌骨超长弧形截骨术组总有效率高于U形截骨术组,两组比较差异有统计学意义(P<0.05)。采用U形截骨术后,其中5例患者出现下唇麻木或肿胀,1例有轻微皮肤软组织下垂;采用下颌骨超长弧形截骨术后,其中8例患者口唇有不同程度的麻木或肿胀,1例出现下颌部局部轻度血肿。所有患者均未出现严重并发症,两组患者术后并发症发生情况比较,无统计学差异(P>0.05)。术后6个月对所有患者进行随访,U形截骨术组患者满意度为80.00%,下颌骨超长弧形截骨术组患者满意度为100.00%,下颌骨超长弧形截骨术组满意度高于U形截骨术组,两组比较差异有统计学意义(P<0.05)。结论:相较于传统下颌角截骨术,U形截骨术以及下颌骨超长弧形截骨术均可进一步改善矫正效果,满足患者术前要求。其中,下颌骨超长弧形截骨术具有更佳的矫正效果,并能提高患者对矫正术后的满意度及预后质量。     

运用黄金区域法减少抗菌素不良反应和降低病菌耐药性

目的 用药剂量在什么范围内对治疗适合？药物不良反应及病菌耐药性与剂量有关系吗？本文研究这三个问题及其关系,并寻求解决的统一之道.方法 考察剂量与用药效果的关系,以黄金区域为中段,把经验范围分成三段是研究设计的关键.结果 超大容量样本调查表明,两种药分别按公斤体重剂量由小到大给药,不良反应率都南高变低、然后再升高,呈U形规律,U形的底部出现在黄金区域上.通过黄金区域内外合理成本与不合理成本的分析,表明耐药性与用药剂量的关系也符合U形规律.结论 抗菌素被滥用、不良反应和耐药性是当今医药界的三大顽疾.用黄金区域法规定用药剂量是探讨当前解决三个难题的一个特殊突破口.     

跟骨外侧U形切口入路治疗跟骨骨折

目的探讨跟骨外侧U形切口入路治疗跟骨骨折的临床疗效。方法采用跟骨外侧U形切口暴露治疗30例累及跟距关节、跟骰关节的单侧闭合跟骨骨折患者,术前术后测量Bhler角和Gissane角,按Maryland足部评分系统评价疗效。结果 Bhler角:术前-6°~20°(6.35°±10.34°),术后3个月20°~36°(28.32°±5.29°);Gissane角:术前71°~110°(89.76°±11.32°),术后3个月112°~140°(122.45°±7.89°);两项与术前比较差异均有统计学意义(P0.01)。30例均获随访,时间9~23(14.23±2.23)个月。患者骨折均愈合,时间为8~11(9.2±1.5)周。关节面复位满意,跟骨高度恢复正常。无创伤性关节炎发生,无内固定物折断等相关并发症。术后34~80(46.2±8.98)周取出钢板。按Maryland足部评分系统评价疗效:优15例,良12例,中3例,优良率为90%。结论跟骨外侧U形切口能很好暴露骨折部位,利于恢复跟骨解剖形态,对累及跟距关节、跟骰关节的跟骨骨折疗效较好。