摘要:目的: 觀察格列美脲對2型糖尿病患者心血管的保護作用并探討其可能的機制。 方法 :112例T2DM患者隨機分為格列美脲組(格列美脲+二甲雙胍)和對照組(格列本脲+二甲雙胍),觀察治療前后兩者空腹及餐后兩小時血糖(FBG,2hPBG)、糖化血紅蛋白(HbA1c)、空腹胰島素(FINS)、HOMA模型胰島素抵抗指數(HOMAIR)、甘油三脂(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDLC)、低密度脂蛋白膽固醇(LDLC)、同型半胱氨酸(HCY)、血漿脂聯素的變化。 結果 :兩組患者的TC、LDLC、TG、FBG、2hPBG都較治療前降低,連續服用6個月以上格列美脲的T2DM患者其血漿HCY、HOMAIR、血糖水平明顯下降,血漿脂聯素水平明顯升高,與對照組相比差異有統計學意義(〖WTBX〗P lt;005)。 結論 :格列美脲能降低多項心血管危險因子水平,對血脂、HCY和動脈粥樣硬化都有良性調節作用,其作用基礎可能與改善胰島素抵抗,增加血漿脂聯素相關。Abstract: Objective: To observe the protective effects and to explore mechanisms of glimepiride on cardiovascular system of Type 2 Diabetes Mellitus. Methods : 112 patients with type 2 diabetes mellitus were randomly divided into treatment group (glimepiride combined with metformin) and control group (glibenclamide combined with metformin). The fasting blood glucose (FBG), 2hPBG, hemoglobin A1c (HbA1c), FINS, HOMAIR, blood lipid (TC, TG, LDLC and HDLC), HCY (homocysteine) and adiponectin were detected before and after treatment. Results : In all cases, the level of TC、LDLC、TG、FBG、2hPBG were decreased after treated with glimepiride or glibenclamide combined with metformin for 6 monthes. Moreover, the level of HCY, HOMAIR and blood glucose were decreased and the level of adiponectin was increased significantly than that of in control group (Plt;005). Conclusion : Glimepiride showed the effective on decreasing the risk factor of cardiovascular system disease with regulation of blood lipid, HCY, and improve the atherosclerosis. The effective of glimepiride on cardiovascular system was relation to improved the insulin resistance and increase the adiponectin.
ObjectiveTo summarize the research progress of ultrasmall superparamagnetic iron oxide (USPIO) enhanced magnetic resonance imaging (MRI) in normal-sized lymph node metastasis of colorectal cancer.MethodThe relevant literatures published recently at domestic and abroad about USPIO enhanced MRI in normal-sized lymph node metastasis of colorectal cancer were collected and reviewed.ResultsUSPIO, a kind of lymph node targeted magnetic resonance contrast agent, could be used to evaluate lymph node metastasis of malignant tumors. USPIO enhanced MRI could detect normal-sized lymph node metastasis in colorectal cancer effectively compared with normal MRI. It provided a higher diagnostic performance than normal enhanced MRI. In addition, USPIO enhanced MRI could also distinguish inflammatory and metastatic lymph nodes better that were difficult to be distinguished by normal enhanced MRI.ConclusionUSPIO enhanced MRI shows a certain potential for clinical application in detecting normal-sized lymph node metastasis of colorectal cancer, but it has not been widely used in China.
摘要:目的: 探討非體外循環冠狀動脈旁路移植術(offpump coronary artery bypass grafting,OPCABG)患者的圍術期管理。 方法 : 回顧分析2005 年7 月至2008 年6 月的200 例擇期非體外循環下冠狀動脈旁路移植術患者200例,誘導用咪唑安定005～01 mg/kg,依托咪酯03 mg/kg,芬太尼5～15 μg／kg,羅庫溴銨05～10 mg／kg,麻醉維持采用持續泵注異丙酚1～4 mg/kg·h,,間斷輔以05%～20%異氟烷吸入,術中隨手術操作時出現的血流動力學變化,用血管活性藥物調整。 結果 : 麻醉效果滿意,術中血壓心率基本滿意。本組患者蘇醒時間,拔管時間和ICU停留時間為(178±42) min、(105±40)h、(18±63)h。術畢180例患者在12 h內拔管。180例預后良好,無麻醉并發癥。 結論 :非體外循環下冠狀動脈旁路移植術麻醉管理的關鍵是合理的應用麻醉藥和血管活性藥來維持血流動力學平穩。Abstract: Objective: To summarize the technique and evaluate the effect of anesthesia for offpump coronary artery bypass surgery (OPCAB). Methods :From July of 2005 through June of 2008,two hundred consecutive patients undergoing OPCAB were retrospectively studied. Anesthesia was induced with midazolam 00501mg/kg, or etomidate 03mg/kg and fentanyl 515μg/kg. Anesthesia was maintained with isoflurane 05%20% and oxygen, combined with propofol 14mg/(kg·h). Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately. Results :Intraoperative hemodynamics deviation was tolerated with the support of inotropics. The mean of patients of consciousness recovery time, tracheal extubation time and stay in ICU time were 178±42 min,105±40 hours and 18±63 hours. The patients were discharged in 80±12 days. Racheal intubation were remained 12 hours in 180 patients after operation, 180 patients had good recovery without any anesthesia complications. Conclusion : Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.
Objective To explore key genes and mechanisms of depression aggravating Crohn disease. Methods In March 2023, the Public Health Genomics and Precision Health Knowledge Base and Gene Expression Omnibus database were used to identify the overlapping differentially expressed genes between Crohn disease and depression and the key genes were screened by Metascape, STRING, Cytoscape, and protein interaction network analysis. The Gene Expression Omnibus database was used to analyze the correlations between key genes and clinical pathologies such as Crohn Disease Endoscopic Index of Severity and intestinal microvilli length. Results There were 137 overlapping differentially expressed genes between Crohn disease and depression, and 25 key genes were further screened out. Among them, CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A genes were significantly correlated with multiple clinical parameters. The functions of PROK2 and PROK2-related genes were mainly enriched in neutrophil and granulocyte migration, neutrophil and granulocyte chemotaxis, etc. Conclusions There are 25 key genes, especially CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A, that possibly contribute to the establishment and deterioration of Crohn disease caused by depressive disorder. Among these genes, PROK2 showes the possibility of regulating immune cell (neutrophils and CD8+ T cells) infiltration.
Abstract： Objective To summarize early clinical result of total cavopulmonary connection, and analyze the risk factors contributing to prolonged postoperative recovery. Methods Between February 2009 and August 2010, 58 patients with functional univentricular complex congenital heart disease received total cavopulmonary connection in Beijing Fu Wai Hospital. All of them were diagnosed by echocardiogram and angiography including 26 patients with single ventricle, 10 patients with tricuspid atresia, 4 patients with pulmonary artery atresia, 5 patients with double outlet rightventricle, 1 patient with transposition of great arteries, and 12 patients with corrected transposition of the great arteries.Fifty seven patients underwent extracardiac conduit total cavopulmonary connection, and only one patient underwent total cavopulmonary connection with an intracardiac lateral tunnel. According to their postoperative pleural drainage volume and duration, these 58 patients were divided into a large pleural drainage volume group (17 patients with 10 males and 7 females, mean age of 8.61±6.73 years）that included patients with large volume and long duration of pleural drainage, and a little pleural drainage volume group (41 patients with 15 males and 26 females, mean age of 7.21±4.24 years) . A univariable analysis was conducted to compare the risk factors that effected recovery result between the two groups. Results There was no death in hospital period. The average length of hospital stay was 12.30±9.80 d . Average drainage time (18.00±5.50 d versus 5.00±2.20 d , t= -1.967, P ＜ 0.05）, drainage volume (12.30±2.60 ml/(kg·d) versus 2.80±1.70 ml/(kg·d), t=-3.221, P ＜ 0.05), and hospital stay (20.10±7.20 d versus 7.20±1.10 d, t=-2.003, P ＜ 0.05） of the large pleural drainage volume group were significantly larger or longer than those of the little pleural drainage volume group. Univariate analysis showed that preoperative pulmonary pressure measured by catheter in the large pleural drainage volume group was significantly higher than that in the little pleural drainage volume group (17.42±5.34 mm Hg versus 13.91±5.22 mm Hg，t=-2.073，P ＜ 0.05). Conclusions The mortality and major morbidities after total cavopulmonary connection are low in the current era. Preoperative high pulmonary pressure is a risk factor for large amount of pleural drainage and prolonged recovery.
Electroencephalogram (EEG) serves as an effective indicator of detecting fatigue driving. Utilizing the open accessible Shanghai Jiao Tong University Emotion Electroencephalography Dataset (SEED-VIG), driving states are divided into three categories including awake, tired and drowsy for investigation. Given the characteristics of mutual influence and interdependence among EEG channels, as well as the consistency of the graph convolutional neural network (GCNN) structure, we designed an adjacency matrix based on the Pearson correlation coefficients of EEG signals among channels and their positional relationships. Subsequently, we developed a GCNN for recognition. The experimental results show that the average classification accuracy of driving state categories for 20 subjects, from the SEED-VIG dataset under the smooth feature of differential entropy (DE) linear dynamic system is 91.66%. Moreover, the highest classification accuracy can reach 98.87%, and the average Kappa coefficient is 0.83. This work demonstrates the reliability of this method and provides a guideline for the research field of safe driving brain computer interface.
Objective To analyze risk factors of acute kidney injury （AKI） after cardiac surgery in adults and develop a clinical score system to predict postoperative AKI. Methods Clinical data of 3 500 consecutive patients undergoing cardiac surgery from June 2010 to April 2011 in Beijing Anzhen Hospital of Capital Medical University were retrospectively analyzed. According to whether they had postoperative AKI，all these patients were divided into AKI group and non-AKI group. AKI group was consisted of 1 407 patients （40.2%） with a mean age of 58±12 years，including 1 004 male patients （71.4%）. The non-AKI group was consisted of 2 093 patients （59.8%） with a mean age of 55±13 years，including 1 259 male patients （60.2%）. Predictive score system of postoperative AKI was established by univariate analysis between the AKI and non-AKI group and multivariate logistic regression and then verified. Results The predictive score system was as followed：male gender （2 points），every 5 years older than 60 years （1 point），diabetes mellitus （2 points），preoperative use of angiotensin converting enzyme inhibitor or angiotensin AT1 receptor blocker （1 point），every 10 ml / （min·1.73 m2） of preoperative estimated glomerular filtration rate （eGFR） under 90 ml / （min·1.73m2） （1 point），preoperative NYHA class Ⅳ （3 points），cardiopulmonary bypass time＞120 minutes （2 points），intraoperative hypotension duration＞60 minutes （2 points），postoperative hypotension duration＞60 minutes （3 points），postoperative peak dosage of intravenous furosemide＞100 mg/day （3 points），postoperative peak dosage of intravenous furosemide 60-100 mg/day （2 points），and postoperative mechanical ventilation time＞24 hours （2 points）. The predictive score system presented a good discrimination ability with the area under the receiver operating characteristic（ROC）curve of 0.738 with 95% CI 0.707 to 0.768，while it also presented a good calibration with Hosmer-Lemeshow statistic （P=0.305）. Conclusion A clinical predictive score system for AKI after cardiac surgery in adults is established，which may help clinicians implement early preventive interventions.
Objectives We aimed to assess the methodological qual ity of RCT on acupuncture for migraine prophylaxis. Methods With the searching terms including acupuncture, migraine, prophylaxis and prevent, etc, the database of the Cochrane Library (Issue 4, 2007), MEDLINE (1966-2007), EMBase (1966-2007), CBM (1978-2007) and CMCC (1994-2007) were searched from their date of start publ ication. Chinese medical journals and relevant academic conference proceedings were hand searched as well. Several items in included trials were assessed, including methodology, diagnostic criteria, inclusion/exclusion criteria, acupuncture/control interventions, outcome measures and follow-up, etc. Result Among the 12 included trials, 9 trials overseas were high-qual ity and 3 in China were low-quality. Frequency or days of migraine attacks and SF-36/SF-12 were often evaluated as outcome measures in western countries, while headache index was used in China. Among the 12 trials, 9 reported the follow-up outcomes and 8 mentioned adverse events. Conclusion There was no high qual ity trial on acupuncture for migraine prophylaxis in China. The outcome measures in trials published in China by now can not evaluate the outcomes of acupuncture for migraine prophylaxis accurately. To study designs, advantages of trials oversea can be used for reference. To Chinese cl inical physicians, prophylactic therapy and abortive therapy of migraine should be distinguished in order to design high-qual ity study on acupuncture for migraine prophylaxis.
Abstract： Objective To analyze the mid-term outcomes after correction of type Ⅰ and type Ⅱ persistent truncus arteriosus in all patients operated in our institution over the past 5 years. Methods Between May 2006 and October 2010, 17 patients, mean age 4.7（ 0.7-19.0）years, underwent repair of truncus arteriosus（ type Ⅰ in 13 and type Ⅱ in 4） in Fu Wai Cardiovascular Hospital. Some other concomitant cardiovascular malformations included truncal valve regurgitation, partial anomalous pulmonary venous connection, mitral regurgitation and atrial septal defect. Their average pulmonary vascular resistance was （4.4±2.2） Wood units detected by cardiac catheterization before operation. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in all 17 patients （aortic homografts in 3, pulmonary homografts in 2, and bovine jugular vein in 12 patients）. Survivors were followed up for assessment of residual heart lesions. Results The early mortality was 5.8% （1/17）. The mean cardiopulmonary bypass time was （165±52） min, mean aortic cross-clamping time was （114±29） min, and mean postoperative ventilation time was （106±148） h. Two patients had pleural effusion after surgery, 2 patients underwent tracheostomy, and other patients recovered uneventfully. The surviving 16 patients were followed up for 0.6-5.0 years. All patients were alive with their original conduit during follow-up. No patient required re-operation for conduit dysfunction after correction. Conclusion Truncus arteriosus remains a challenging congenital heart disease. For patients with type Ⅰ and type Ⅱ persistent truncus arteriosus who have missed their best age for correction, cardiac catheterization should be routinely examined, and the operation should be performed if the pulmonary vascular resistance is under 8 Wood units before operation. Although the short- and mid-term results of surgery are good, more observations are needed to assess its long-term effect.
