糖尿病性心肌病的发病机理探析

目的：探讨糖尿病性心肌病（DC）的发病机制。方法：查阅研读近年的大量文献，将所获信息整理分类，得出结论。结果：糖尿病性心肌病（DC）是以持续高血糖、RAS的作用、Ca^2＋转运异常等因素共同作用，使存心肌细胞代谢障碍，导致心脏结构和功能障碍，心肌细胞凋亡，心肌间质纤雏化，引起左心室舒张收缩功能不全，心室肥厚重构，功能渐丧而致心力衰竭。结论：从以上各方面探讨了DC的发病机制，希望能为DC早期防治提供理论依据。     

96例肝硬化继发肾功能损害患者血清胱抑素C检测结果分析

目的:探讨血清胱抑素C检测在诊断肝硬化继发肾功能损害患者的临床意义。方法:回顾性分析2011年01月-2013年08月我院收治的96例肝硬化继发肾功能损害患者(观察组)CysC、Urea及Cr检测结果,并与我院同期50例健康体检者(对照组)检测结果作对比分析。结果:观察组血清Cvs C及Urea水平明显高于对照组,差异有统计学意义(P0.05),而血清Cr在两组之间差异无统计学意义(P0.05);观察组CysC、Urea及Cr阳性率比较,Cys C阳性率明显高于Urea及Cr阳性率(P0.O5)。结论:肝硬化患者早期肾损害时,CysC已有变化,检测Cys C可有效判断肝硬化患者早期肾功能损害情况。     

孕母甲状腺功能异常对子代的影响

妊娠期母体甲状腺激素会发生一系列变化,而子代的生长发育,尤其是甲状腺的发育,对母体甲状腺功能状态有很大的依赖性.孕母甲状腺功能异常若未及时发现和控制,会引起子代各种严重的不良后果,包括流产、早产、死胎、死产、先天性畸形、甲状腺功能亢进症或甲状腺功能减退症、神经系统发育落后等,甚至影响子代远期的生长发育,因此应及早检出并控制孕妇及子代的甲状腺功能异常,以提高子代存活率及生活质量.     

产科多器官功能障碍综合征临床诊治进展

多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)指因机体对严重疾病或创伤产生长时间逐渐恶化的炎症反应,导致多个器官发生功能障碍,     

Postpartum thyroid dysfunction in women with autoimmune thyroiditis

Introduction: Autoimmune thyroiditis (AIT) is a predisposing factor for developing postpartum thyroid dysfunction (PPTD).

Aim: To study the characteristics of PPTD in women with AIT.

Methods: Thirty-eight women with pre-existing AIT were included in the study. Thyroid-stimulating hormone, free triiodthyronine, free thyroxine, thyroid peroxidase antibodies, thyroglobulin antibodies were measured and ultrasound evaluation of the thyroid gland was performed in the first trimester of pregnancy and during the first year following delivery.

Results: Thyroid dysfunction was recognized in 68.4% of the patients – 28.9% presented with hypothyroidism and 39.5 % with thyrotoxicosis. The immunological and morphological parameters did not differ between euthyroid women and those with thyroid dysfunction. At the end of the postpartum period restoration of euthyroid state (being on the treatment before pregnancy) was observed in 15.4% of patients with PPTD, while 84.6% required increase of the levothyroxine dose. The analysis found a significantly lower volume of the thyroid gland, shorter duration of the disease, a lower dose of levothyroxine before and during gestation in patients with impaired thyroid function at the end of the postpartum period.

Conclusion: The risk of PPTD in women with AIT predating pregnancy is higher among women with preserved thyroid functional capacity motivating a thorough assessment of thyroid hormone levels and close follow-up of those women during the postpartum period.     

Association between metabolic syndrome and left ventricular geometric change including diastolic dysfunction

BackgroundWe investigated the association between individual components of metabolic syndrome (MetS) and left ventricular (LV) geometric changes, including diastolic dysfunction, in a large cohort of healthy individuals.MethodsOverall, 148 461 adults who underwent echocardiography during a health‐screening program were enrolled. Geographic characteristics on echocardiography and several markers of LV relaxation function were identified according to individual MetS components. Univariate linear regression analysis and a multivariate regression model adjusted for factors known to influence LV relaxation function were conducted.ResultsThe prevalence of LV diastolic dysfunction (LVDD) was higher in the MetS group than in the non‐MetS group (0.56% vs. 0.27%, p < .001). In univariate and multivariate analyses, E/A ratio, e′ velocity, and left atrial volume index were significantly associated with each component of MetS and covariates (all p ≤ .001). In the age‐ and sex‐adjusted model, MetS was significantly associated with LVDD (odds ratio [95% confidence interval], 1.350 [1.103, 1.652]). However, subjects with more MetS components did not have a significantly higher risk of LVDD. As the analysis was stratified by sex, the multivariate regression model showed that MetS was significantly associated with LVDD only in men (1.3 [1.00, 1.68]) with higher risk in more MetS component (p for trend < .001). In particular, triglyceride (TG) and waist circumference (WC) among MetS components were significantly associated with LVDD in men.ConclusionsMetS was associated with the risk of LVDD, especially in men, with a dose‐dependent association between an increasing number of components of MetS and LVDD. TG and WC were independent risk factors for LVDD in men.     

The overall benefits of empagliflozin treatment in adult siblings with glycogen storage disease type Ib: one year experience

IntroductionRecently published case reports suggest the benefit of empagliflozin use in subjects with glycogen storage disease Ib (GSD Ib).MethodsWe present the clinical and laboratory data of 2 adult brothers with GSD Ib treated with empagliflozin for 12 months.ResultsThere was no severe infection during administration of empagliflozin. The improvement of clinical symptoms of inflammatory bowel disease and arthritis along with reduction in serum CRP levels and urinary albumin excretion was noted. Neutrophil count increased, allowing for reduction or temporary withdrawal of G-CSF treatment.ConclusionsEmpagliflozin may be a new safe treatment in GSD Ib patients with an advanced stage of the disease.     

Radiotherapy plus cetuximab for locally advanced squamous cell head and neck cancer in patients with cisplatin-ineligible renal dysfunction: A retrospective study

Clinical trials have not fully demonstrated the efficacy and safety of radiotherapy plus cetuximab for locally advanced squamous cell head and neck cancer (LA-SCCHN) in patients with cisplatin-ineligible renal dysfunction. Patients who received radiotherapy plus cetuximab for LA-SCCHN at Chiba University Hospital (Chiba, Japan) between July 2013 and October 2018 were retrospectively reviewed. Background characteristics and locoregional control and overall survival rates were compared between patients with and without renal dysfunction. Survival was examined using Kaplan-Meier analysis and an adjusted Cox proportional hazards model. Kaplan-Meier analysis demonstrated that overall survival was shorter in patients with creatinine clearance of <45 ml/min (P=0.041; log-rank test). However, there was no difference in the locoregional control rate (P=0.477; log-rank test). Adjusted Cox analysis revealed that the risk of death was increased by 2.52-fold (hazard ratio, 2.52; 95% confidence interval, 1.01-6.30; P=0.048) if creatinine clearance was <45 ml/min. Moderate to severe renal dysfunction did not affect the locoregional control rate in patients with LA-SCCHN treated with radiotherapy plus cetuximab but was an adverse prognostic factor.