Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

BACKGROUND： Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine （TCM）; meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression （PSD）. OBJECTIVE： To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation. DESIGN： Contrast observation. SETTING： Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group. PARTICIPANTS： A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years. METHODS： （1） All the enrolled subjects were diagnosed for syndrome differentiation by senior TCM physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis, kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale （NDS; 45 points in total; the higher the scores were, the severer the deficit was）, Fugl-Meyer assessment, （FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was）, modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of daily life （ADL） was], symptom checklist-90 （SCL-90; including total scores, positive scores, mean and average scores of positive items）, Hamilton depression rating scale （HAMD） and Hamilton anxiety rating scale （HAMA, the higher the scores were, the severer the degree was）. （2） Patients were divided into one symptom type, two symptom types and ≥ 3 symptom types; meanwhile, they were also divided into deficiency symptom, excess symptom and deficiency-excess symptom. Scores among various groups were compared simultaneously. MAIN OUTCOME MEASURES： Comparison of nervous function and mental psychology of PSD patients with various symptoms. RESULTS： （1） Differences of various symptoms： Among 177 patients, there were 43 subjects in the types of sputum-stasis stagnation, 64 in qi stagnation and blood stasis, 21 in kidney-essence deficiency, 33 in deficiency of the spleen and stomach, and 16 in phlegm-fire disturbing the heart. In the comparison of the scores of nervous function and psychological tests among different syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency were obviously lower than those of the total samples and PSD patients of deficiency of the spleen and stomach and phlegm-fire disturbing the heart, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items in the former three groups were all obviously higher than those in the latter three groups （P 〈 0.05 - 0.01）. （2） Different number of syndrome types： In the comparison of the scores of nervous function and psychological tests among the PSD patients with different number of syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients with one or two syndrome types were obviously higher than those of the total samples and the PSD patients with three or more syndrome types, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items were all obviously lower in the former two than in the latter two （P 〈 0.05 - 0.01）. （3） There were no obvious differences in the scores of most items of nervous function and psychological tests among the PSD patients of deficiency syndrome, excess syndrome and the deficiency-excess syndrome （P 〉 0.05）. CONCLUSION： The damages of nervous function and mental psychology are more serious in PSD patients with the syndrome types of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency, as well as those with several （three or more） syndrome types, and the conditions may be improved by the treatment based on TCM syndrome differentiation.

Urrets-Zavalia syndrome in different methods of keratoplasty

INTRODUCTIONUrrets-Zavalia was first described as a syndrome consisting of a fixed,dilated pupil with iris atrophy following penetrating keratoplasty（PKP）in 1963 and back then it was thought that this syndrome was only related to keratoconus patients.Other findings that were not essential for the diagnosis were posterior synechiae,ectropion uvea,pigment dispersion,anterior subcapsular lens opacities and secondary glaucoma syndrome.

Remarkably different results between two studies from North America on genomic mutations and sensitivity to DNA demethylating agents for myelodysplastic syndromes

Sekeres et al. （1） conducted a multicenter randomized, controlled trial to compare whether azacitidine-based combinations with lenalidomide or vorinostat produce superior overall response rates to azacitidine in the treatment of myelodysplastic syndromes （MDS）. In that trial, 224 patients with higher-risk MDS and 53 with chronic myelomonocytic leukemia （CMML） were enrolled and randomly assigned to the ＂azacitidine＂ group, ＂azacitidine plus lenalidomide＂ group or ＂azacitidine plus vorinostat＂ group. The researchers found that patients with MDS treated with azacitidine-based combinations had similar response rate to azacitidine monotherapy. Using genomic mutation analysis, they found that the overall response rate to azacitidine-based treatment was higher for patients with mutations in DNMT3A and lower for those with mutations in SRSF2. Whereas in another study, Welch et al. enrolled 26 patients with MDS and 90 with acute myeloid leukemia （AML） who were treated with decitabine, and they found that patients with TP53 mutations had a higher response rate, but not those with DNMT3A mutations （2）. We propose that this big discrepancy in the conclusions between the two studies might have been caused by the presence of many co-interacting factors, e.g. study aims, DNA demethylating agents, treatment protocols, and patient sources.

Association of Metabolic Syndrome with Inflammation in Chinese Adults with Different Kidney Function

Chronic kidney disease （CKD） has become a worldwide public health problem, and currently, it affects approximately 10% of adults in the United States[I]. Meanwhile, it also has emerged as an important social challenge in China[2]. CKD has been reported to be a major risk factor for cardiovascular diseases, premature death, and end-stage renal diseaseTM. Thus, it is necessary to determine the risk factors for CKD.

Differentially Expressed Serum Protein Profiling in Esophageal Squamous Cell Carcinoma Patients with Different Chinese Medicine Syndromes

Objective:Esophageal carcinoma is the eighth most common malignant tumor and ranked the sixth cause of death in the worldwide careinoma.To find out effective serum markers for early diagnosis and targeted treatment is important to improve esophageal carcinoma survival rate.The aim of this study was to screen differ-entially expressed serum protein profiling in esophageal squamous cell careinoma(ESCC)patients with differ-ent Chinese medicine syndrome and establish ESCC syndrome diagnosis model,to explore the signifcance of ESCC serum differential protein in traditional Chinese medicine(TCM)syndrome diagnosis and provide exper-imental and theoretical basis for the diagnosis,clinical treatment of ESCC.Methods:Serum specimens of 80 ES-CC patients with different syndrome and 20 healthy people were selected according to distribution of their sex and age.Magnetic beads based weak cation exchange combined w ith matrix-assist ed laser desorption/ionization time-of-flight mass spectrometry prot eomic technology and Autoflex Analysis and ClinProTools software were applied to screen differentially expressed serum protein profiling.Then establishing each syndrome group diag-nosis model and verifying with new samples to evaluate the diagnosis value of each syndrome group diagnosis model.Results:18 significantly differential expression protein peaks were screened between the whole ESCC patients sera and the healthy control group.Compared with normal control group,among which,ten were signif-cant down-regulation with m/z values of4210,4267,4054,4248,2106,4091,2991,5337,3952,822,and eight were significant up-regulation with m/z values of 2900,2883,1467,1617,2862,2600,895,811.There were 16,12,11,15 differentially expressed protein peaks in phlegm and qi stagnat ion syndrome(Group P),fluid insufficiency and heat agglomeration syndrome(Group F),blood stasis syndrome(Group B),qi and yang deficiency syndrome(Group Q),respectively.Protein with m/z of4210,4091,4054 and 5337 presen-ted obviously low expression in all syndrome groups,while protein with m/z of2883,1617 presented obvious-y high expression.Protein with m/z of 4644 is an obvious and significative biomarker in the comparison of dif-ferent syndrome of ESCC.Establishing ESCC each syndrome serum different ial protein profiling diagnosis mod-el showed that the specificity and veracity in four syndrome groups were all≥80.00%.Conclusion:Our study achieved differentially expressed protein profiling in ESCC patients with different TCM syndromes,established relatively high sensitivity and specificity of different syndrome of ESCC serum differential protein profiling diag-nosis model,which implied the screened syndrome related serum differential expression protein in TCM syn-drome differentiation and diagnosis had great clinical meaning,could be the assistant diagnosis biomarker of ESCC.

Metabolic syndrome and its individual components among people with type 2 diabetes: Prevalence, gender differences and its association with ischemic heart disease

Background: Metabolic syndrome (MS) is common among people with type 2 diabetes. The purpose of this study was to assess the proportion of MS and its individual components among type 2 diabetic adults, to stratify these by gender and to determine their association with ischemic heart disease (IHD). Method: A cross-sectional multicentre study was conducted in public and private sector clinics in Karachi, Pakistan. A pretested structured questionnaire and medical records were used to collect information from 889 people with type 2 diabetes after informed consent. Chi-square test and odds ratios with 95% CI were used to assess the association of MS, its components and IHD. Adjusted odds ratios were used to evaluate the differences of MS and its components by gender. Results: In all, 70% of the participants had MS. The likelihood of having IHD among those with MS was higher (OR = 3.21;95%CI = 2.22 - 4.65). Of the individual MS components, obesity conferred the strongest association with IHD (OR = 2.57;95%CI = 1.91 - 3.43). Multivariate analysis showed an increased proportion of MS among women (AOR = 1.63;95%CI = 1.18 - 2.24). Of the individual MS components, women had a higher prevalence of obesity (AOR = 4.70;95%CI = 3.30 - 6.70). Conclusion: A very high burden of MS among type 2 diabetics has been identified in this study. Dedicated interventions are needed to prevent/delay the onset of MS and the associated morbidity and mortality.

Sex Differences in Clinical and Angiographic Characteristics in Acute Coronary Syndrome Patients in Dakar, Senegal

Background: Coronary artery disease (CAD) is in relentless progression, along with the adoption of western lifestyle in sub-Saharan Africa. In Senegal, the incidence of acute coronary syndrome (ACS) rose from 5% to 12% in Dakar during the last 20 years. That increase was observed in both women and men, and according to current data, the former paid the heaviest price in terms of mortality compared to men. In this study, we aim to retrospectively assess the clinical characteristics and angiographic profile of ACS in women compared to men in two tertiary care centers in Dakar. Methods: In this study, we retrospectively analyzed and compared data between men and women among 133 patients who underwent coronary angiogram for ACS in 2 tertiary centers from February 2019 to January 2020. Results: A total of 133 patients were included in our study of whom 97 (72.9%) were men. The mean age was 58 ± 13.6 years. Women were older than men (61.4 ± 14.3 years vs 56.6 ± 13.5 years (p = 0.07). Hypertension, sedentary lifestyle and obesity were significantly more frequent in women (69.4%, 52.7% and 19.4%) when compared to men (38.8%, 25.7% and 6.19%) respectively, (p = 0.001;0.002 and 0.03). Smoking was less frequent in women (2.8%) than in men (44.3%), (p Conclusion: In our study, women with ACS were older, had more cardiovascular risk factors but less angiographic extent of disease than men.

Serum Uric Acid Level Has Stronger Correlations with Metabolic Syndrome-Related Markers in Women than in Men in a Japanese Health Check-Up Population

Background A serum uric acid (UA) level of 7.0 mg/dL has been used as the criterion for hyperuricemia in Japan regardless of gender, despite higher serum UA levels in men than in women. Serum UA has been identified as a predictive biomarker for metabolic syndrome (MetS);however, the gender differences in the association between UA levels and MetS-related conditions in a Japanese population have not been completely assessed. Objective To examine gender and age differences in the associations between serum UA levels and other biomarkers within a health-screened Japanese population and to evaluate the usefulness of serum UA as a predictor of MetS between the two genders. Methods A cross-sectional study of healthy individuals in Japan (16,391 men;16,656 women) was conducted. Associations between UA and several biomarkers were analyzed for each gender type and for age- and serum UA level-stratified groups. Logistic regression was used to analyze the association of age and serum UA levels with MetS-related conditions. Receiver operating characteristic (ROC) curve analysis was performed to identify the UA cut-off value for predicting the risk of the MetS-related conditions. Results Serum UA levels in women had stronger correlations with MetS-related biomarkers than in men. After adjusting for age, the odds ratios for a 1-mg/dL serum UA increase for diabetes mellitus and dyslipidemia in women were 1.13 (95% confidence interval, 1.04 - 1.23) and 1.30 (1.25 - 1.34), respectively. In ROC analysis, women had significantly higher area under the curve (AUC) values for MetS prediction than men. Conclusion An elevated serum UA level has a higher predictive ability for the risk of MetS-related conditions in Japanese women than in men. The optimal serum UA cut-off value for MetS in women was suggested to be approximately 5 mg/dL, remarkably lower than that in men.

Knee osteoarthritis treated with acupuncture based on syndrome differentiation:a randomized controlled trial

Objective To compare the efficacy differences between acupuncture and western medicine in treating osteoarthritis of knee joints.Methods One hundred and twenty cases were randomly divided into an acupuncture group and a western medication group with 60 cases in each group.In the acupuncture group,acupuncture was applied mainly at Nèixīyǎn（内膝眼 EX-LE 4）,Dúbí（犊鼻 ST 35）,Yīnlíngquán（阴陵泉 SP 9） and Yánglíngquán（阳陵泉 GB 34） plus other acupoints selected according to syndrome differentiation.In the medication group,Glucosamine Hydrochloride capsules were orally given 3 times daily with 2 capsules each time.Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）,Medical Outcomes Study 36-Item Short Form Health Survey（SF-36,Chinese version） were used to assess therapeutic effects before treatment,after 4 weeks treatment and 9 weeks after treatment,respectively.Results After 4 weeks of treatment,the total effective rates were 86.7%（52/60） and 88.3%（53/60） in the acupuncture group and the western medication group,respectively,without significant difference（P〈0.05）.In 9 weeks after treatment,the total effective rates were 83.3%（50/60） and 61.7%（37/60） in the acupuncture group and the western medication group,respectively,with significant difference between the two groups（P〈0.05）.According to WOMAC and SF-36,the scores were all improved in both groups（P〈0.05,P〈0.01）,with significant difference in follow-up visit of 9 weeks after treatment between the two groups（P〈0.05,P〈0.01）,but not after 4 weeks of treatments（both P〈0.05）.Conclusion Short-term of therapeutic effects of acupuncture and oral administration of Glucosamine Hydrochloride on osteoarthritis of knee joints are similar,but long-term efficacy in the acupuncture group is better than that in the western medication group.

Treatment of 33 Cases of Nerve Tinnitus by Acupuncture on Syndrome Differentiation

Summary： Thirty-three cases of nerve tinnitus were treated mainly by needling acupoints Baihui（GV 20）, Tinggong（SI 19）, Tinghui（GB 2）, Yifeng（TE 17） and Zhongzhu（TE 3）. In the presence of kidney deficiency, Shenshu（BL 23） and Mingmen（GV 4） were added; in the presence of liver-gallbladder fire preponderance, Taichong（LR 3） and Qiuxu（GB 40） were added; in the presence of exogenous wind heat, Waiguan（TE 5） and Hegu（LI 4） were added. After 6-course treatments, 6 cases were cured, 22 cases improved and 2 cases failed, with the total effective rate of 93.9%.

Gender-based differences in cardiac diseases

It has been observed that the incidence of heart failure and Brugada syndrome are higher in men, while women are more likely to have QT interval prolongation and develop torsades de pointes （TdP）. Over the past decade, new studies have improved our understanding of the mechanisms of abnormal repolarization and the relationship between gender differences in cardiac repolarization and presentation of clinical syndromes. Nevertheless, the causes of gender-based differences in cardiac disease are still not completely clear. This review paper briefly summarized what is currently known about gender differences in heart failure, Brugada syndrome and long QT syndrome from molecular mechanisms to clinical presentations.

Clinical Study of Tuina on Tension-type Headache with Syndrome Differentiation

The 6 point behavioral rating scale and Stead＇s grading method of diagnostic scale were applied to evaluate objectively the therapeutic effects of Tuina on 150 patients with tension-type headache in the experimental and controlled groups in this study. The results indicated that abdominal Tuina method of invigorating blood circulation and regulating qi had better effect than the routine Tuina method in treating tension-type headache. Meantime, it is considered that eliminating the immoderate defensive response caused by the process of headache-muscular contraction headache is the academic basis of the marked effect.

Acupuncture Treatment of Irritable Bowel Syndrome Based on Differentiation of Symptoms and Signs

According to differentiation of traditional Chinese medicine, Irritable Bowel Syndrome was classified into two types, disharmony of the liver and spleen and deficiency of the heart and spleen, which were treated with acupuncture respectivdy. As a result, of 31 cases, 25 cases had marked effectiveness, 5 cases had effectiveness and 1 case had ineffectiveness.

Genome-wide analysis of differential DNA methylation in Silver-Russell syndrome

Silver-Russell Syndrome(SRS) is clinically heterogeneous disorder characterized by low birth weight, postnatal growth restriction, and variable dysmorphic features. Current evidence strongly implicates imprinted genes as an important etiology of SRS. Although almost half of the patients showed DNA hypomethylation at the H19/IGF2 imprinted domain, and approximately7%–10% of SRS patients have maternal uniparental disomy of chromosome 7(UPD(7) mat); the rest of the SRS patients shows unknown etiology. In this study, we investigate whether there are further DNA methylation defects in SRS patients. We measured DNA methylation in seven SRS patients and five controls at more than 485,000 CpG sites using DNA methylation microarrays. We analyzed methylation changes genome-wide and identified the differentially methylated regions(DMRs) using bisulfite sequencing and digital PCR. Our analysis identifies epimutations at the previously characterized domains of H19/IGF2,providing proof of principle that our methodology can detect the changes in DNA methylation at imprinted loci. In addition,our results showed a novel SRS associated imprinted gene OSBPL5 located on chromosome 11p14 with the probe cg25963939,which is hypomethylated in 4/7 patients(P=0.023, β=.0.243). We also report DMRs in other genes including TGFβ3, HSF1,GAP43, NOTCH4 and MYH14. These DMRs were found to be associated with SRS using GO pathway analysis. In this study,we identified the probe cg25963939, located at the 5′UTR of imprinted gene OSBPL5, as a novel DMR that is associated with SRS. This finding provides new insights into the mechanism of SRS etiology and aid the further stratification of SRS patients by molecular phenotypes.

Changes in Cold and Hot Syndromes and Gastrointestinal Bacterial Community Structure in Mice by Intervention with Food of Different Nature

Objective:To reveal the effect of foods with different natures on cold or hot syndrome and gastrointestinal bacterial community structure in mice.Methods:Forty-five 6-week-old male ICR Kunming mice of clean grade were divided into 5 groups,9 per group,including the control(CK),hot nature herb medicine(HM),Hong Qu glutinous rice wine(RW),tea rice wine(TW),and cold nature herb medicine(CM)groups.Distilled water or corresponding herbs were administered to mice(0.01 mL/g body weight)in the 5 groups by gastric infusion respectively,once daily for 28 d.Appearance,behavior,and serum biochemical indicators,including 5-hydroxytryptamine(5-HT),thyroid stimulating hormone(TSH),noradrenaline(NE),cyclic adenosine monophosphate(cAMP)and cyclic guanosine monophosphate(cGMP),the hot nature index,as well as the gastrointestinal bacterial community structure were analyzed in all groups after treatment.Results:After supplementation for 28 d,CM and TW mice showed different degrees of cold syndrome,and HM and RW mice showed different degrees of hot syndrome.Compared with the HM and RW mice,the TSH,NE,cAMP levels and hot nature indices in the CM and TW mice were significantly decreased and 5-HT and cGMP levels were significantly increased(P<0.05).There was no obvious change in appearance or behavior in CK mice.Results of clustering analysis showed that the gastrointestinal bacterial community structures were highly similar in TW and CM mice as well as in RW and HM mice,and that they were from the same branch,respectively,when the distance was 0.02.The key microbes associated with cold syndrome were Lachnospiraceae uncultured,Lactococcus,etc.,and the key microbes associated with hot syndrome were S24-7 norank,Ruminococcaceae uncultured,etc.Conclusion:The interventions with different nature foods could change cold or hot syndrome in mice,leading to changes in gastrointestinal bacterial community structure.

Characteristics of Traditional Chinese Medicine Syndrome in Patients with Coronary Heart Disease at Different Disease Stages

Coronary atherosclerotic heart disease(CHD)has a high incidence,disability rate,and mortality rate,which severely affect people’s health,work,and life.Based on its clinical manifestations,traditional Chinese medicine(TCM)has classified CHD as“chest impediment”and“heart pain”for the treatment.The course of CHD is protracted,and the pathogenesis is complex and changeable.Moreover,different disease stages have different syndrome characteristics.Thus,this article aimed to summarize the classification and distribution characteristics of the TCM syndrome in various stages of CHD,such as before and after percutaneous coronary intervention therapy,disease progression,age,and complications,to provide references for the TCM clinical diagnosis and treatment of CHD.

Jiāwèi Wǔbèizǐsǎn(Supplemented Galla Chinensis Powder) application on the navel for different syndromes of profuse sweating after tumor chemotherapy

Objective To observe the clinical efficacy of Jiāwèi Wǔbèizǐ sǎn（加味五倍子散,Supplemented Galla Chinensis Powder） application on the different syndromes of profuse sweating after tumor chemotherapy.Methods One hundred and sixty patients with profuse sweating after tumor chemotherapy were randomly divided into a control group（n=80） and a treatment group（n=80）.Placebo application was carried out in the control group,and traditional Chinese medicine application was conducted in the treatment group.Treatment for 7 days was considered as 1 course of treatment.Results In treatment group,48 patients were cured,improvement was found in25 cases,and ineffectiveness was seen in 7 cases.For the patients with lungwei insecurity syndrome,19 cases were cured,improvement was found in10 cases,and ineffectiveness was seen in 1 case;for the patients with deficiency of both qi and yin,27 cases were cured,improvement was found in 9 cases,and ineffectiveness was seen in 2 cases;for the patients with vigorous fire due to yin deficiency,3 cases were cured,improvement was found in5 cases,and ineffectiveness was seen in 4 cases.According to statistical analysis,the total efficacy of treatment group was superior to that of control group（P0.05）.The efficacy on lung-wei insecurity and deficiency of both qi and yin of treatment group was superior to that of control group（both P0.05）,but there was no obvious difference between treatment group and control group in the efficacy on vigorous fire due to yin deficiency（P0.05）.Conclusion Supplemented Galla Chinensis Powder application on the navel can effectively improve the profuse sweating syndrome of patients in the types of lung-wei insecurity and deficiency of both qi and yin after tumor chemotherapy,but the efficacy is not so good for the patients in the type of vigorous fire due to yin deficiency.

特发性肺纤维化肺内相关共病异病同证基因组生物信息学分析

目的通过基因组生物信息学分析探讨特发性肺纤维化(IPF)肺内相关共病(肺动脉高压、阻塞性睡眠呼吸暂停综合征、慢性阻塞性肺疾病、肺癌)异病同证生物学基础。方法下载GSE110147、GSE113439、GSE135917、GSE106986和GSE118370数据集,筛选各病例组与对照组的差异基因,运用Cytoscape3.10.0软件进行拓扑分析以筛选核心基因,运用OmicShare平台对核心基因进行GO和KEGG通路富集分析。结果共筛选出IPF肺内相关共病核心基因23个。GO富集分析显示,核心基因生物过程主要富集于细胞进程、代谢进程、生物调控/生物进程调控、发育进程、底物定位进程、刺激反应、免疫系统进程、信号转导,细胞组分主要富集于细胞解剖实体、含蛋白复合物,分子功能主要富集于结合途径、酶催化活性、结构分子活性、分子适配器活性、分子功能调节因子、转录调控因子活性;KEGG通路富集分析显示,核心基因主要富集于真核生物核糖体的生物合成、糖尿病并发症AGE-RAGE信号通路、Th17细胞分化、JAK-STAT信号通路、RNA聚合酶、中性粒细胞胞外诱捕网形成等信号通路。结论运用基因组生物信息学分析探讨IPF肺内相关共病核心基因及信号通路,可在一定程度上揭示IPF肺内相关共病异病同证作用机制。

痰湿型多囊卵巢综合征患者游离睾酮指数水平与临床特征的差异及相关性分析

目的 探讨痰湿证与非痰湿证多囊卵巢综合征(polycystic ovarian syndrome, PCOS)患者游离睾酮指数(free testosterone index, FAI)与不同临床特征的差异及相关性。方法 基于临床科研信息一体化平台收集病例资料,回顾性纳入2019年9月~2021年1月黑龙江中医药大学第一附属医院收治的1041例PCOS患者。按中医诊断标准分为痰湿组(n=658)和非痰湿组(n=383),记录各项指标并统计分析各项指标与FAI的相关性,以分析不同中医证型FAI的影响因素。结果 痰湿组PCOS患者FAI、体重、腰围、臀围、腰臀比(waist-to-hip ratio, WHR)、空腹血糖(fasting plasma glucose, FPG)、30min葡萄糖、空腹胰岛素(fasting insulin, FINS)、30min胰岛素、胰岛素抵抗指数(insulin resistance of homeostasis model assessment, HOMA-IR)、甘油三酯(triglyceride, TG)、总胆固醇(total cholesterol, TC)、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol, LDL-C)、载脂蛋白B(apolipoprotein B, ApoB)、ApoB/ApoA等临床指标值高于非痰湿组(P<0.05)。在痰湿组PCOS患者中,FAI与卵泡生成素(follicle-producing hormone, FSH)、泌乳素(prolactin, PRL)、性激素结合球蛋白(sex hormone-binding globulin, SHBG)、高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol, HDL-C)、载脂蛋白A(apolipoprotein A, ApoA)呈负相关,与收缩压、舒张压、体重、体重指数(body mass index, BMI)、腰围、臀围、WHR、睾酮(testosterone, T)、雄烯二酮(androstenedione, AND)、60min葡萄糖、120min葡萄糖、FINS、30min胰岛素、60min胰岛素、120min胰岛素、180min胰岛素、HOMA-IR指数、TG、ApoB/ApoA呈正相关(P<0.05)。在非痰湿组PCOS患者中,FAI与PRL、SHBG呈负相关,与舒张压、体重、BMI、腰围、T、硫酸脱氢表雄酮(dehydroepiandrosterone sulfate, DHEAS)、AND、60min葡萄糖、120min葡萄糖、FINS、60min胰岛素、120min胰岛素、180min胰岛素、ApoB、HOMA-IR指数呈正相关(P<0.05)。结论 痰湿组与非痰湿组PCOS患者的FAI等研究指标水平存在显著差异,痰湿组PCOS患者的FAI水平高于非痰湿组。痰湿组PCOS患者FAI水平与肥胖、糖脂代谢水平等具有明显的相关性,其因果关系需进一步探究。

不同角度俯卧位通气在急性呼吸窘迫综合征患者中的应用效果

目的评估不同角度俯卧位通气在急性呼吸窘迫综合征(ARDS)患者中的应用效果。方法本研究为一项前瞻性、随机、对照临床试验,纳入2021年7月至2023年6月广东省第二中医院重症医学科(ICU)收治的ARDS患者共96例,随机分为A组(0°俯卧位通气)、B组(30°俯卧位通气)、C组(45°俯卧位通气),每组32例。A组男19例,女13例;年龄(50.25±11.31)岁;体重指数(BMI)(23.42±3.16)kg/m^(2)。B组男17例,女15例;年龄(51.93±12.48)岁;BMI(22.72±4.15)kg/m^(2)。C组男20例,女12例;年龄(52.39±12.82)岁;BMI(24.76±4.31)kg/m^(2)。观察时间为5 d。A组患者每天持续0°俯卧位通气16 h,每2 h将其托起一次防止压力性损伤。B组:维持0°俯卧位2 h后,使用30°翻身垫将患者身体向左倾斜30°,维持2 h;然后向右倾斜30°,同样维持2 h;最后恢复至0°俯卧位,如此循环,直至完成16 h俯卧位通气。C组:维持0°俯卧位2 h后,使用45°翻身垫将患者身体向左倾斜45°,维持2 h;然后向右倾斜45°,同样维持2 h;最后恢复至0°俯卧位,如此循环,直至完成16 h俯卧位通气。比较3组氧合指标[氧合指数(PaO_(2)/FiO_(2))、动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)]、Murray肺损伤评分(MLIS)、急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)评分、多器官功能障碍综合征(MODS)评分的变化,观察压力性损伤发生率。采用单因素方差分析、LSD法、配对t检验、χ^(2)检验。结果俯卧位通气5 d后,3组PaO_(2)/FiO_(2)、SaO_(2)、PaO_(2)、PaCO_(2)均较通气前改善,且A组、B组改善幅度均优于C组(均P<0.05);俯卧位通气前和通气5 d后,3组HR、MAP、CVP差异均无统计学意义(均P>0.05);俯卧位通气5 d后,3组MLIS、APACHEⅡ、MODS评分均较通气前降低,且A组、B组均低于C组[(1.72±0.37)分比(1.54±0.16)分比(1.89±0.26)分、(11.02±2.69)分比(11.01±2.01)分比(12.87±2.06)分、(5.64±0.37)分比(5.34±0.67)分比(6.19±0.43)分](均P<0.05);B组和C组压力性损伤发生率低于A组[15.63%(5/32)比18.75%(6/32)比40.63%(13/32)](P<0.05)。结论不同角度俯卧位通气均可以改善ARDS患者氧合和减轻病情,其中30°俯卧位通气改善最明显,并且可以降低压力性损伤发生率。