Metabolic Syndrome and Perioperative Complications during Scheduled Surgeries with Spinal Anesthesia

Background: Metabolic syndrome (MS) is a constellation of factors associated with increased risk of developing cardiovascular diseases and Diabetes Mellitus. Despite of the many studies related to MS, little is known about its impact on scenarios such as surgical anesthesia. Objective: To examine the correlation between demographic and metabolic variables with the occurrence of perioperative complications in patients with MS undergoing scheduled surgeries using a spinal anesthesia technique in the surgery department at the University Clinic San Juan de Dios in Cartagena de Indias, Colombia. Methods: Observational, analytical, cross-sectional, single-center study of 150 subjects with MS and 150 control subjects. Perioperative complications, socio-demographic, hemodynamic and respiratory variables were registered. Groups were compared using t test, Fisher’s exact test or Chi-square, as appropriate. We applied a logistic multiple regression model, adjusted by backward stepwise at 0.25 and forward at 0.05, to find possible incompatible associations. p value < 0.05 was considered significant. Results: There were significant differences between groups in age, American Society of Anesthesiologists physical status classification, frequency of diseases associated to MS and perioperative complications. There were no cases of mortality among patients. There was statistically significant difference between the two groups for intraoperative hypotension and hypertension with p values of <0.0001 and 0.034. Among postoperative complications there was statistically significant difference in pain (13.3% vs 5.3% in patients without MS) and nausea and/or postoperative vomiting (8% vs 2% in patients without MS) with a p value of 0.027 and 0.015 (by Fisher) respectively. Conclusions: Metabolic abnormalities in MS are a risk factor for developing complications in the perioperative period of patients scheduled for surgeries using the subarachnoid anesthesia technique. Accordingly, it is appropriate to implement health intervention strategies by the surgical team, aiming at their prevention and management.

Application of the back-error propagation artificial neural network(BPANN) on genetic variants in the PPAR-γ and RXR-α gene and risk of metabolic syndrome in a Chinese Han population

This study was aimed to explore the associations between the combined effects of several polymorphisms in the PPAR-γ and RXR-α gene and environmental factors with the risk of metabolic syndrome by back-error propaga- tion artificial neural network （BPANN）. We established the model based on data gathered from metabolic syndrome patients （n = 1012） and normal controls （n = 1069） by BPANN. Mean impact value （MIV） for each input variable was calculated and the sequence of factors was sorted according to their absolute MIVs. Generalized multifactor dimensionality reduction （GMDR） confirmed a joint effect of PPAR-9＂ and RXR-a based on the results from BPANN. By BPANN analysis, the sequences according to the importance of metabolic syndrome risk fac- tors were in the order of body mass index （BMI）, serum adiponectin, rs4240711, gender, rs4842194, family history of type 2 diabetes, rs2920502, physical activity, alcohol drinking, rs3856806, family history of hypertension, rs1045570, rs6537944, age, rs17817276, family history of hyperlipidemia, smoking, rs1801282 and rs3132291. However, no polymorphism was statistically significant in multiple logistic regression analysis. After controlling for environmental factors, A1, A2, B1 and B2 （rs4240711, rs4842194, rs2920502 and rs3856806） models were the best models （cross-validation consistency 10/10, P = 0.0107） with the GMDR method. In conclusion, the interaction of the PPAR-γ and RXR-α gene could play a role in susceptibility to metabolic syndrome. A more realistic model is obtained by using BPANN to screen out determinants of diseases of multiple etiologies like metabolic syndrome.

Exploratory metabolomics of metabolic syndrome: A status report

Metabolic syndrome(MetS) is as a cluster of cardio-metabolic factors that greatly increase the risk of chronic diseases such as type II diabetes mellitus and atherosclerotic cardiovascular disease. In the United States, obesity, physical inactivity, aging, and genetics(to a minor extent) have arisen as risk factors for developing MetS. Although 35% of American adults suffer from MetS, its pathogenesis largely remains unknown. Worse, there is a lack of screening and optimum therapy for this disease. Researchers have consequently turned towards metabolomics to identify biomarkers to better understand MetS. The purpose of this review is to characterize various metabolites and their potential connections to MetS. Numerous studies have also characterized MetS as a disease of increased inflammation, and therefore this review also explores how metabolites play a role in various inflammatory pathways. Our review explores a broad range of metabolites including biogenic amines, branched chain amino acids, aromatic amines, phosphatidylcholines, as well as a variety of other molecules. We will explore their biochemical pathways and their potential role in serving as biomarkers.

Effects of Chinese herbal medicine Yiqi Huaju Qingli Formula in metabolic syndrome patients with microalbuminuria:a randomized placebo-controlled trial

BACKGROUND： Microalbuminuria （MAU） is a key component of metabolic syndrome （MetS） and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to control high blood pressure, hyperglycemia and dyslipidemia, some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients. OBJECTIVE： To investigate the efficacy of Yiqi Huaju Qingli Herb Formula, a compound traditional Chinese herbal medicine, in MetS patients with MAU when it is combined with routine Western medicine treatment. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： Sixty patients with MetS were randomized into the Chinese herbal formula group （CHF, Yiqi Huaju Qingli formula treatment in combination with Western medicine） and control group （placebo in combination with Western medicine）. All treatments were administered for 12 weeks. MAIN OUTCOME MEASURES： Urinary microalbumin （MA）, urinary albumin-to-creatinine ratio （UACR）, 24-hour total urine protein （24-hTP）, body mass index （BMI）, waist circumference （WC）, waist-to-hip ratio （WHR）, fasting plasma glucose （FPG）, 2-hour postprandial plasma glucose （2-hPPG）, glycosylated hemoglobin （HbAlc）, homeostasis model assessment for insulin resistance （HOMA-IR）, blood lipid profile and blood pressure were observed. RESULTS： Compared with the control group, CHF treatment significantly decreased BMI （P〈0.05）, WC （P〈0.01） and WHR （P〈0.01）. Both groups had significant decreases in FPG, 2-hPPG, HbAlc, HOMA-IR, MA, and UACR, with CHF treatment showing better effects on these parameters compared with the control treatment （P〈0.05）. Both treatments significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triacylglycerol （TAG）, and a greater reduction in TAG was observed with CHF treatment （P〈0.05）. The level of high-density lipoprotein cholesterol did not change in the control group after treatment （P〉0.05）, whereas it significantly increased with CHF treatment （P〈0.01）. Compared with before the treatment, significant decreases in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were observed in both groups （P〈0.01）. However, there was no significant difference between the two groups （P〉0.05）. CONCLUSION： Combined treatment ofYiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU, which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER： This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.

Metabolic syndrome is directly associated with gamma glutamyl transpeptidase elevation in Japanese women

AIM:This study aimed to determine whether metabolic syndrome is directly or indirectly,through fatty liver,associated with elevated gamma-glutamyl transpeptidase (GGT) levels in Japanese women. METHODS:From 4 366 women who received their annual health check-up,4 211 women were selected for analysis. All 4 211 women were negative for both hepatitis B surface antigen and antibody to hepatitis C virus.Clinical and biochemical variables were examined by using univariate and multivariate analysis. RESULTS:A raised GGT level (>68 IU/L) was seen in 258 (6.1%) of the 4 211 women.In univariate analysis,all variables examined (age,body mass index,blood pressure, hemoglobin concentration,fasting blood glucose, glycosylated hemoglobin Alc,cholesterol,triglyceride,and uric acid) were associated with the elevated GGT level, whereas in multivariate analysis,four variables (age≧50 yr, hemoglobin≧14 g/dL,triglyceride≧150 mg/dL,and presence of diabetes) were significantly and independently associated with raised GGT level.Clinical variables predicting the presence of ultrasonographic evidence of fatty liver were also examined by multivariate analysis;four variables were associated with the presence of fatty liver:BMI≧25 kg/m^2, hemoglobin≧14 g/dL,triglyceride≧150 mg/dL,and uric acid ≧ 7 mg/dL.There was no significant association between the raised GGT level and the presence of fatty liver. Hypertriglyceridemia was significantly and independently associated with both the raised GGT level and the presence of fatty liver. CONCLUSION:Metabolic syndrome seemed to be directly, not indirectly through fatty liver,associated with the raised GGT level in Japanese women.

Enhancing the treatment of metabolic syndrome with integrative medicine

Metabolic syndrome, with the main clinical manifestations of obesity, dyslipidemia, elevated blood pressure, and elevated blood glucose levels, has become an increasingly prevalant global public health concern. Metabolic syndrome is a convergence of multiple risk factors related to cardiovascular disease. When the concept of metabolic syndrome was initially proposed, some researchers thought the concept was unnecessary, since there were already measures in place to describe the separate cardiovascular risk factors such as dyslipidemia, hypertension and diabetes. However, a large number of epidemiological investigations confirmed that even if blood glucose or blood pressure did not reach the cutoff point of the diseases,

Metabolic syndrome after liver transplantation: Preventable illness or common consequence?

The metabolic syndrome is common after liver transplant being present in approximately half of recipients. It has been associated with adverse outcomes such as progression of hepatitis C and major vascular events. As the United States population ages and the rate of obesity increases, prevention of the metabolic syndrome in the post-transplant population deserves special consideration. Currently, the metabolic syndrome after transplant appears at least two times more common than observed rates in the general population. Specific guidelines for patients after transplant does not exist, therefore prevention rests upon knowledge of risk factors and the presence of modifiable elements. The current article will focus on risk factors for the development of the metabolic syndrome after transplant, will highlight potentially modifiable factors and propose potential areas for intervention. As in the non-transplant population, behavioral choices might have a major role. Opportunities exist in this regard for health prevention studies incorporating lifestyle changes. Other factors such as the need for immunosuppression, and the changing characteristics of wait listed patients are not modifiable, but are important to know in order to identify persons at higher risk. Although immunosuppression after transplant is unavoidable, the contribution of different agents to the development of components of the metabolic syndrome is also discussed. Ultimately, an increased risk of the metabolic syndrome after transplant is likely unavoidable, however, there are many opportunities to reduce the prevalence.

Metabolic syndrome and non-alcoholic fatty liver disease in liver surgery: The new scourges?

The aim of this topic highlight is to review relevant evidence regarding the influence of the metabolic syndrome(MS) and its associated liver manifestation, non-alcoholic fatty liver disease(NAFLD), on the development of liver cancer as well as their impact on the results of major liver surgery. MS and NAFLD, whose incidences are significantly increasing in Western countries, are leading to a changing profile of the patients undergoing liver surgery. A MEDLINE search was performed for relevant articles using the key words "metabolic syndrome", "liver resection", "liver transplantation", "non alcoholic fatty liver disease", "non-alcoholic steatohepatitis" and "liver cancer". On one hand, the MS favors the development of primary liver malignancies(hepatocellular carcinoma and cholangiocarcinoma)either through NAFLD liver parenchymal alterations(steatosis, steatohepatitis, fibrosis) or in the absence of significant underlying liver parenchyma changes. Also, the existence of NAFLD may have a specific impact on colorectal liver metastases recurrence. On the other hand, the postoperative period following partial liver resection and liver transplantation is at increased risk of both postoperative complications and mortality. These deleterious effects seem to be related to the existence of liver specific complications but also higher cardio-vascular sensitivity in a setting of MS/NAFLD. Finally, the long-term prognosis after curative surgery joins that of patients operated on with other types of underlying liver diseases. An increased rate of patients with MS/NAFLD referred to hepatobiliary units has to be expected. The higher operative risk observed in this subset of patients will require specific improvements in their perioperative management.

Negative Association of Domestic Activity and Active Commuting with Metabolic Syndrome in a Chinese Population Aged 35-64 Years

Objective To understand the associations of physical activity domains with metabolic syndrome among a middle-aged Chinese population. Methods In all, 3326 professional adults aged 35-64 years from Beijing and Zhejiang province were recruited with a cluster random sampling method. The Global Physical Activity Questionnaire was modified, and the recommended Asia-Pacific cut-offs of waist circumstance were introduced into the criteria for metabolic syndrome from the Adult Treatment Panel III. A binary logistic regression model was applied to examine the association of all physical activity domains with the risk of the syndrome. Results Participants who engaged in domestic activity for 〉1176 MET-min/week had a 41.6% less chance of having metabolic syndrome [odds ratio （OR）, 0.584; 95% confidence interval （CI）, 0.480-0.710] than those without this activity. In adjusted models, adults who actively commuted for 〉33 MET-rain/week but 〈52g MET-min/week had a 25% less chance of having the syndrome （OR, 0.750; 95% CI, 0.582-0.966） than those who did not. No interaction was detected between the two domains of activity and the syndrome. Conclusion This study highlighted the independently negative association of traffic and house activity with the prevalence of the syndrome in this sample with a generally low level of moderate activity.

CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

Objective:To investigate the rol e of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 t imes on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females ) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unil ateral shadow in 16 (19.52%). The lung CT findings were sub pleural focal con solidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large a rea consolidation in 9 (10.97%), ground glass blurry shadow in 31 (37.80%), a lveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51% ). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesi ons tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub pleural focal consolidation, flaky cloudy shadow, large area consolidation, grou nd glass blurry shadow, and often accompanied with signs of broncho inflat ion. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid pr ogressions or changes on the size, amount, and distribution of the lesions likel y to be found in dynamic observation of chest X ray and CT scanning, i.e., ma rkedly dynamic changes found within 24 to 48 hrs. Lesions with these characteris tics may be recognized as pulmonary changes possibly induced by SARS. Complicati ons were found in 6 patients (7.31%), including tuberculosis of lung and brain a ccompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SAR S, by which more accurate assessment of the abnormal changes of lung and occurre nce of complications in SARS patients can be made.

Functional and metabolic complications of androgen deprivation therapy

Prostate cancer is the most common non-cutaneous cancer in men worldwide.Several different treatment strategies are available including minimally invasive procedures for localized tumors such as radical prostatectomy,radiotherapy,and androgen deprivation therapy,among others.All these strategies can be given as mono-therapy or as combination therapy.For this review,we will focus on the side effects of androgen deprivation therapy,independent of the other treatment modalities.Some of the most common affections are loss of bone mineral density,weight gain and obesity,myocardial infarction and sudden death,metabolic syndrome and insulin resistance,dyslipidemia,loss of libido and erectile dysfunction,fatigue,cognitive decline,vasomotor flushing,to mention a few.All these alterations can have an impact on quality of life and even lead to more serious complications such as fractures and cardiovascular complications.We present recommendations for prevention,early recognition and treatment.The different modalities for androgen deprivation therapy have particular side-effects profiles and indications should be made in an individualized manner.Androgen deprivation therapy is a useful tool for some patients with prostate cancer but every effort should be made to avoid related complications.The use of guidelines and educational programs for both,patients and urologists,are extremely useful strategies.

Metabolic syndrome in the development and progression of prostate cancer

Prostate cancer(PCa)is the most common noncutaneous malignancy and second leading cause of cancerspecific mortality for men in the United States.There is a wide spectrum of aggressiveness ranging from biologically significant to indolent disease,which has led to an interest in the identification of risk factors for its development and progression.Emerging evidence has suggested an association between metabolic syndrome(MetS)and PCa.MetS represents a cluster of metabolic derangements that confer an increased risk of cardiovascular disease and type 2 diabetes mellitus.Its individual components include obesity,dyslipidemias,high blood pressure,and high fasting glucose levels.Met S has become pervasive and is currently associated with a high socioeconomic cost in both industrialized and developing countries throughout the world.The relationship between MetS and PCa is complex and yet to be fully defined.A better understanding of this relationship will facilitate the development of novel therapeutic targets for the prevention of PCa and improvement of outcomes among diagnosed men in the future.In this review,we evaluate the current evidence on the role of MetS in the development and progression of PCa.We also discuss the clinical implications on the manage-ment of PCa and consider the future direction of this subject.

Metabolic Syndrome: Consensus and Controversy: State of the Art

Metabolic syndrome is an epidemic that affects more and more people, increasing the probability of suffering metabolic and cardiovascular diseases in the short, medium or long term depending on the severity. The purpose of this article is to review the metabolic syndrome, assessing consensus, controversy and prevalence. The methodology was the preparation of a literature review on various health care databases, which were from 43 articles published from 2010 to 2015, in the general population. SM rate ranges from 0% to 90% depending on genders, ages and regions. There is still lack of consensus on cutoffs of diagnostic criteria. Thus, it is concluded that the prevalence of metabolic syndrome is being increased, urging the need for early diagnosis and treatment to promote the health of the global population.

Clinical outcomes and complications of single anastomosis duodenal-ileal bypass with sleeve gastrectomy:A 2-year follow-up study in Bogotá,Colombia

BACKGROUND The global prevalence of obesity has increased over the past 40 years,and bariatric surgery has proven to be the most effective therapy for long-term weight loss.Its principles are based on modifying the brain-gut axis by altering the gastrointestinal anatomy and affecting the function of gastrointestinal hormones,thereby modifying satiety signals.Single anastomosis duodeno-ileal bypass with sleeve gastrectomy(SADI-S)combines both techniques and has become an alternative to gastric bypass and biliopancreatic diversion procedures for treating severe obesity and associated metabolic diseases in selected patients.AIM To describe the outcomes and complications of SADI-S.METHODS We retrospectively analyzed the data of patients who underwent SADI-S laparoscopically at the Clínica Reina Sofía in Bogotá,Colombia.This study assessed the therapeutic effectiveness of SADI-S in terms of short-term preoperative clinical characteristics,postoperative complications,comorbidities,nutritional deficiencies,and intraoperative complications during a 2-year follow-up.RESULTS Sixty-one patients with a mean body mass index(BMI)of 50±7.1 kg/m2 underwent laparoscopic SADI-S.The mean operative time and hospital stays were 143.8±42 min and 2.3±0.8 d,respectively.The mean follow-up period was 18 mo,and the mean BMI decreased to 28.5±12.2 kg/m2.The excess BMI loss was 41.8%±13.5%,and the weight loss percentage was 81.1%±17.0%.Resolution of obesity-related comorbidities,including type 2 diabetes mellitus,hypertension,dyslipidemia,and obstructive sleep apnea,was achieved and defined as complete or partial remission.No intraoperative complications were observed.Short-term complications were observed in four(6.8%)patients.However,larger studies with longer follow-up periods are required to draw definitive conclusions.CONCLUSION SADI-S has a low intraoperative and postoperative complication rate and is effective for weight loss and improving obesity-related comorbidities,including hypertension,type 2 diabetes mellitus,dyslipidemia,and sleep apnea syndrome.

Genetic and Metabolic Determinants of Plasminogen Activator Inhibitor 1 (PAI-1) in Tunisian Type 2 Diabetes Patients

Background: PAI-1 (plasminogen activator inhibitor-1) is a powerful regulator of fibrinolysis and plasma level is high in type 2 diabetes and cardio-vascular disease, which is determined by genetic polymorphisms in PAI-1 gene and environmental factors. The aim of the study was to examine the determinants of plasma PAI-1 Ag level among type 2 diabetes patients. Methods: 491 Tunisian type 2 diabetes patients had clinical evaluation (weight, high, BMI, Waist Circumference), laboratory investigations including FBG Hb1Ac, cholesterol, triglyceride;HDL-cholesterol was done;plasma PAI-1 antigen level was done with ELISA;&minus;675 4G/5G and &minus;844 G/A polymorphisms of PAI-1 gene was done by PCR-ASA and PCR-RFLP respectively. Results: The mean age for our patients was 58.3 ± 10.5 years;sex-ratio = 0.92;mean PAI-1 level was 34.6 ± 21.3 ng/ml. We didn’t find correlation between PAI-1 level and BMI, but we have found significant correlation between PAI-1 and waist circumference (p = 0.032), most enhanced in men (P = 0.002), T2D patients who have FBG > 11 mmol/l had PAI-1 Ag level higher than those who have FBG P = 0.034), but no difference found between T2D with high Hb1Ac > 8% and those with Hb1Ac < 8%, significant correlation was seen between PAI-1 level and LDL-cholesterol (P = 0.05), high correlation between PAI-1 Ag level and &minus;675 4G/5G polymorphism genotype was seen, 4G/4G carriers had the highest PAI-1 level, 4G/5G had intermediary level and 5G/5G had the lowest level (P &minus;844G/A polymorphism genotypes. Using multiple variable linear regression analysis, the independent factor associated with plasma PAI-1 level was &minus;675 4G/5G polymorphism (regression coefficient β = 4.6, P Conclusion: the present study identifies &minus;675 4G/5G not &minus;844 G/A polymorphism of PAI gene as the principal determinant of plasma PAI-1 level in Tunisian T2D patients, the android fat distribution, dyslipidemia and hyperglycemia play a modest role in this variation.

OCULO-CEREBRO-RENAL SYNDROME (LOWE'S SYNDROME)

Oculo-cerebro-renal syndrome (Lowe's syndrome) is characterized by mental and motor retardation, cataract, glaucoma and renal abnormalities. It is an X-linked recessive metabolic disease. Two brothers suffering from Lowe's syndrome are reported. Their mother with lenticular opacities and peculiar facial appearance is in concordance with the obligate carrier. The ocular changes and heridity are discussed.

序贯性血液净化机治疗中毒所致的多器官功能障碍的临床效果及安全性评估

目的:研究序贯性血液净化机治疗中毒所致的多器官功能障碍的临床效果及安全性。方法:选取2020年5月至2022年2月新疆医科大学第一附属医院收治的110例中毒所致多器官功能障碍综合征(MODS)患者,采用随机数表法将其分为序贯性血液净化组和单种血液净化组,每组55例。对比两组患者在不同血液净化治疗下营养代谢指标、肠道屏障功能指标、急性生理与慢性健康量表(APACHEⅡ)评分、MODS早期预测评分系统及重症监护室(ICU)住院时间,同时记录不同血液净化治疗期间的并发症发生率。结果:两组治疗7d后,序贯性血液净化组患者的血红蛋白(Hb)、白蛋白(ALB)、胱抑素A(PAB)以及总胆固醇(TC)高于单种血液净化组,谷丙转氨酶(ALT)和甘油三酯(TG)均低于单种血液净化组,差异有统计学意义(t=4.454、4.474、13.22、2.035、51.358、2.195,P<0.05)。两组治疗7d后,钾离子(K+)及钠离子(Na+)差异无统计学意义(P>0.05)。序贯性血液净化组治疗7d后谷氨酸水平及谷氨酰胺水平高于单种血液净化组,尿乳果糖/甘露醇(L/M)比值低于单种血液净化组,差异有统计学意义(t=32.83、3.435、4.132,P<0.05)。序贯性血液净化组治疗7d后APACHEⅡ评分、MODS评分低于单种血液净化组,ICU住院时间短于单种血液净化组,差异有统计学意义(t=4.438、4.481、7.421,P<0.05),血液净化治疗并发症发生率低于单种血液净化组,差异有统计学意义(χ^(2)=5.238,P<0.05)。结论:序贯性血液净化治疗相比于单种血液净化治疗,在中毒所致的多器官功能障碍综合征治疗中可更好的促进调节机体营养代谢指标,改善肠道屏障功能,康复效果更好,并发症发生率较低,同时缩短了ICU住院时间。

白细胞介素38在代谢综合征中的最新研究进展

代谢综合征是指肥胖、高血压、高血糖、血脂异常等多种心血管疾病的危险因素在一个个体中同时存在的临床症候群。近年来慢性亚临床炎症学说备受关注,低水平的炎症状态也是导致代谢综合征的关键因素。白细胞或免疫细胞产生的细胞因子影响局部或全身炎症,这也成为了代谢综合征发病机理的重要环节。白细胞介素38作为白细胞介素1家族的最新成员,在多种炎症性疾病中显示出抗炎功能。本文旨在总结白细胞介素38在代谢综合征中的作用和最新进展研究。

SARS的胸部X线平片分析

目的研究SARS患者X线胸部平片的征象及其演变规律,以指导治疗及评价预后。方法应用移动式X光机和计算机摄影(computedradiography,CR)进行床旁投照,高分辨率肖像型专业显示器进行图像显示和分析。搜集70例资料完整的SARS患者,分析其X线胸部平片的征象、演变规律,以及与临床的相关性。采用SPSSWIN(10.0版)软件进行资料的统计学分析。结果SARS患者的X线胸部平片检查显示病变以双肺较高或高密度的片状阴影为主,可伴有肺间质改变,主要分布于双肺中下肺野。病变大小均超过全肺面积的30%,以30%～49%之间者居多(31例),病变范围越大,持续时间越长,患者的病死率越高。上述重症表现可持续多天,部分(19例)伴有弥漫性肺间质改变。肺间质改变评为3分者,其病死率显著高于评分不足3分者(p<0.01)和呈轻度弥漫性间质改变评为2分者(p<0.05)。有重度弥漫性肺间质改变,肺浸润阴影大于全肺面积50%是引起SARS患者病死的重要危险因素。SARS的合并症主要包括细菌性或霉菌性感染,成人呼吸窘迫综合症,气胸、纵隔气肿和皮下气肿等。康复期肺内病变范围缩小,伴随的肺内间质改变减轻,甚至消失。结论SARS具有一定的影像特征,X线胸部平片可用于SARS的预后评估及疗效判断。

成年男性腰椎骨密度与代谢综合征的相关性

目的观察成年男性腰椎骨密度(BMD)与代谢综合征(MS)的相关性。方法回顾性分析13490名成年男性低剂量胸部CT联合定量CT,测量其腰椎BMD,判断有无MS及其程度,分析成年男性腰椎BMD值与有无MS或MS程度的相关性,以及腰椎BMD值与MS相关因素的关系。以腰椎BMD值为因变量,将年龄、低密度脂蛋白胆固醇(LDL-C)、血尿酸(BUA)、血红蛋白(Hb)及有无MS纳入多元线性回归分析,观察其对腰椎BMD值的影响。结果13490名成年男性中,MS 3900例(MS组)、非MS 9590名(非MS组),组间BMD差异有统计学意义(P=0.001)。腰椎BMD值与有无MS(r_(s)=-0.025,P=0.004)及MS程度(r_(s)=-0.038,P<0.001)均呈负相关,与腹型肥胖、高甘油三酯及低HDL-C均呈正相关(r_(s)=0.024、0.061、0.036,P均<0.001),与高血压及高血糖均呈负相关(r_(s)=-0.135、-0.104,P均<0.05)。矫正年龄因素后,成年男性腰椎BMD值与有无MS及LDL-C均呈负相关(P均<0.05),与BUA及Hb均呈正相关(P均<0.001)。结论成年男性腰椎BMD值与MS相关。