2019年 · 第132卷第01期

出版日期 2019-01-05电子版￥0.00元

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Editorial

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亚裔和非亚裔2型糖尿病患者的治疗反应：有什么相似或不同吗？

Xiao-Ling Cai, Li-Nong Ji

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000012

摘要

Original Article

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自体骨髓单个核细胞移植治疗难治性糖尿病周围神经病变的疗效观察

Hong Mao, Wei Wei, Xiu-Li Fu, Jing-Jian Dong, Xiao-Yu Lyu, Ting Jia, Yang Tang, Shi Zhao

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000009

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中国心内科人群住院心源性猝死预测模型的建立：一项回顾性研究

Lu-Xiang Shang, Xian-Hui Zhou, Jiang-Hua Zhang, Wen-Hui Zhang, ZuKe-La TuEr-Hong, Yang Zhao, Wen-Kui Lyu, Yao-Dong Li, Bao-Peng Tang

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000010

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阻塞性睡眠呼吸暂停低通气综合征患者骨保护素/核因子受体激活因子-κ B配体失衡与氧化应激

Xiao-Rong Ma, Yong Wang, Yong-Chang Sun

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000046

摘要

Background: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with a higher prevalence of osteoporosis. However, the underlying mechanisms linking OSAHS with bone loss are still unclear. The aim of this study was to investigate the changes of receptor activator of nuclear factor-κB ligand (RANKL, an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG, the decoy receptor for RANKL), oxidative stress and bone metabolism markers in OSAHS, in order to understand the potential mechanisms underlying bone loss in OSAHS patients. Methods: Forty-eight male patients with OSAHS, confirmed by polysomnography (PSG) study, were enrolled. Twenty male subjects who were confirmed as not having OSAHS served as the controls. The subjects’ bone mineral density (BMD) was assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA). Blood samples were collected from all subjects for measurement of RANKL, OPG, the bone formation marker bone-specific alkaline phosphatase (BAP), the bone resorption marker tartrate-resistant acid phosphatase 5b (TRAP-5b), and total antioxidant capacity (TAOC). Results: The BMD and the T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group (P < 0.05). The serum level of BAP was significantly decreased in the OSAHS group (15.62 ± 5.20 μg/L) as compared to the control group (18.83 ± 5.50 μg/L, t= －2.235, P < 0.05), while the levels of TRAP-5b did not differ between the two groups (t= －1.447, P > 0.05). The serum level of OPG and the OPG/RANKL ratio were lower in the OSAHS group compared to the control group (both P < 0.05). TAOC level was also decreased significantly in the OSAHS group (P < 0.05). Correlation analysis showed that the TAOC level was positively correlated with BAP in the OSAHS group (r= 0.248, P = 0.04), but there were no correlations between TAOC and the BMD or the T-scores. The correlations between the level of OPG (or the OPG/RANKL ratio) and BMD or TAOC did not reach significance. Conclusion: In OSAHS patients, lower levels of TAOC were associated with decreased bone formation, suggesting a role of oxidative stress in bone loss, while the role of OPG/RANKL imbalance in bone metabolism in OSAHS needs further evaluation .

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生物标志物增强中国ST段抬高型心肌梗死患者KAMIR风险评分的长期预测能力

Jian-Jun Wang, Yan Fan, Yan Zhu, Jian-Dong Zhang, Su-Mei Zhang, Zhao-Fei Wan, Hong-Ling Su, Na Jiang

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000015

摘要

Background: The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines. But it has inherent defects. The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes. Methods: A total of 1093 consecutive STEMI patients were included and followed up 48.2 months. Homocysteine, hypersensitive C-reactive protein (hs-CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected. The KAMIR score and the GRACE score were calculated. The performance between the KAMIR and the GRACE was compared. The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve. Results: The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death: AUC = 0.802 vs. 0.721, P < 0.001; major adverse cardiovascular events (MACE): AUC = 0.683 vs. 0.656, P < 0.001). It showed that the biomarkers could independently predict death [homocysteine: HR= 1.019 (1.015–1.024), P < 0.001; hs-CRP: HR= 1.052 (1.000–1.104), P= 0.018; NT-pro BNP: HR= 1.142 (1.004–1.280), P= 0.021] and MACE [homocysteine: HR= 1.019 (1.015–1.024), P < 0.001; hs-CRP: HR= 1.012 (1.003–1.021), P= 0.020; NT-pro BNP: HR= 1.136 (1.104–1.168), P= 0.006]. When they were used in combination with the KAMIR, the area under the ROC curve (AUC) significantly increased for death [homocysteine: AUC = 0.802 vs. 0.890, Z = 5.982, P < 0.001; hs-CRP: AUC = 0.802 vs. 0.873, Z= 3.721, P < 0.001; NT-pro BNP: AUC= 0.802 vs. 0.871, Z = 2.187, P= 0.047; homocysteine, hs-CRP and NT-pro BNP: AUC = 0.802 vs. 0.940, Z = 6.177, P < 0.001] and MACE [homocysteine: AUC = 0.683 vs. 0.771, Z= 6.818, P < 0.001; hs-CRP: AUC= 0.683 vs. 0.712, Z= 2.022, P= 0.031; NT-pro BNP: AUC= 0.683 vs. 0.720, Z= 2.974, P= 0.003; homocysteine, hs-CRP and NT-pro BNP: AUC= 0.683 vs. 0.789, Z= 6.900, P < 0.001]. Conclusion: The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients. A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.

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上海市区不同生长标准对婴儿影响的比较：一项整群随机对照试验

Jun-Li Wang, Jing-Qiu Ma, Ming-Yu Xu, Feng Li, Fang Ren, Yan-Fei Guo, Xiao-Yang Sheng

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000004

摘要

Background: The Shanghai growth standards are higher than World Health Organization (WHO) growth standards, which may influence the feeding practices of the caregivers and increase the risk of overweight in these infants. This study aimed to compare the effects of different growth standards on childhood obesity in Shanghai metropolitan area. Methods: This was a cluster-randomized controlled trial conducted in 2 downtown areas with 19 community health service centers in Shanghai from November 2013 to December 2015. Randomization was done at the level of the community. Infants (health newborns) were assessed and monitored by the Shanghai growth standards (S-group) and the 2006 WHO growth standards (W-group), respectively. Measurements were taken at 1.0, 2.0, 4.0, 6.0, 9.0 and 12.0 months of age during follow-up period. Based on the values of length and weight measurements, according to the group’s growth standards, doctors provided the caregivers with corresponding clinical consultation. Changes in weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and weight-for length z-score (WLZ) between 2 groups were assessed using mixed regression models. Overweight was compared between 2 group at all follow-up measurements. Results: A total of 6509 infants (52.1% were boys) were in the W-group, and 8510 infants (51.4% were boys) were in the S-group. The overweight ratios between two groups were distinct at 9 months of age (3.4% in W-group and 4.3% in S-group) and 12 months of age (2.2% in W-group and 3.8% in S-group), and the differences were statistically significant (P= 0.020 and P< 0.001, respectively). Compared to W-group, the increase in WAZ (coefficient= 0.04, P= 0.004) and WLZ (coefficient= 0.09, P < 0.001) were significantly greater, and the LAZ was lower (coefficient = －0.04, P = 0.047) in S-group (W-group values were used as reference in mixed regression models). Conclusion: Compared to the Shanghai growth standards, the adoption of WHO 2006 growth standards would reduce the risk of infant overweight in Shanghai metropolitan area up to 1 year of age. Trial registration number: ChiCTR1800015371, http://www.chictr.org.cn/Chinese Clinical Trial Registry.

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在大鼠缺血/再灌注损伤皮瓣模型中发现坏死性下垂

Hao Liu, Ming-Zi Zhang, Yi-Fang Liu, Xin-Hang Dong, Yan Hao, You-Bin Wang

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000005

摘要

Background: Necroptosis is a new form of cell death that has been identified as a third pathway causing cell death. In this study, necrostatin-1 (Nec-1) was used to determine whether necroptosis exists in a rat ischaemia/reperfusion injury flap model. Methods: In this study, twenty male Sprague-Dawley rats were divided randomly into two groups: a control group (CTL group) and a Nec-1 group. Each abdominal skin flap underwent 3 h of ischaemia and then reperfusion. Fifteen minutes before and after reperfusion, phosphate buffer saline (PBS) was administered intraperitoneally to the CTL group, while Nec-1 was administered intraperitoneally to the Nec-1 group. Twenty-four hours after reperfusion, the whole flap was divided equally into 54 sections. Flap blood perfusion was measured. One sample was taken randomly from each row. Morphological changes, apoptosis, receptor-interacting protein-1 (RIP-1) expression and caspase-3 activity were observed and detected. The measurements between the two groups were compared with the independent t-test, and a P value of <0.05 was considered statistically significant. Results: Compared to flaps in the CTL group, flaps in the Nec-1 group showed longer survival rates, better blood perfusion and less inflammatory infiltration. The total flap area considered to have survived was 70.88 ± 10.28% in the CTL group, whereas 80.56 ± 5.40% of the area was found to be living in the Nec-1 group (Nec-1 vs. CTL, t= –2.624, P < 0.05). For some rows, there were significant differences in cell apoptosis between the two groups, the apoptosis index (AI) in rows "9 cm", "7 cm", "6 cm" and "5 cm" was significantly lower in the Nec-1 group than that in the CTL group (Nec-1 vs. CTL, P < 0.05). RIP-1 expression was much lower in the Nec-1 group than that in the CTL group in rows "5 cm" to "9 cm" (Nec-1 vs. CTL, P < 0.05). No significant differences in caspase-3 activity were found. Conclusion: According to the results, necroptosis was present in a rat abdominal ischaemia/reperfusion injury flap model.

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一种新型多孔钽植入物在兔腰椎前路融合模型中的应用；体外和体内实验

Ming Lu, Song Xu, Zi-Xiong Lei, Dong Lu, Wei Cao, Marko Huttula, Chang-He Hou, Shao-Hua Du, Wei Chen, Shuang-Wu Dai 等

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000030

摘要

Background Some porous materials have been developed to enhance biologic fusion of the implants to bone in spine fusion surgeries. However, there are several inherent limitations. In this study, a novel biomedical porous tantalum was applied to in vitro and in vivo experiments to test its biocompatibility and osteocompatibility. Methods Bone marrow-derived mesenchymal stem cells (BMSCs) were cultured on porous tantalum implant. Scanning electron microscope (SEM) and Cell Counting Kit-8 assay were used to evaluate the cell toxicity and biocompatibility. Twenty-four rabbits were performed discectomy only (control group), discectomy with autologous bone implanted (autograft group), and discectomy with porous tantalum implanted (tantalum group) at 3 levels: L3–L4, L4–L5, and L5–L6 in random order. All the 24 rabbits were randomly sacrificed at the different post-operative times (2, 4, 6, and 12 months; n = 6 at each time point). Histologic examination and micro-computed tomography scans were done to evaluate the fusion process. Comparison of fusion index scores between groups was analyzed using one-way analysis of variance. Other comparisons of numerical variables between groups were made by Student t test. Results All rabbits survived and recovered without any symptoms of nerve injury. Radiographic fusion index scores at 12 months post-operatively between autograft and tantalum groups showed no significant difference (2.89 ± 0.32 vs. 2.83 ± 0.38, F = 244.60, P = 0.709). Cell Counting Kit-8 assay showed no significant difference of absorbance values between the leaching liquor group and control group (1.25 ± 0.06 vs. 1.23 ± 0.04, t = –0.644, P = 0.545), which indicated the BMSC proliferation without toxicity. SEM images showed that these cells had irregular shapes with long spindles adhered to the surface of tantalum implant. No implant degradation, wear debris, or osteolysis was observed. Histologic results showed solid fusion in the porous tantalum and autologous bone implanted intervertebral spaces. Conclusion This novel porous tantalum implant showed a good biocompatibility and osteocompatibility, which could be a valid biomaterial for interbody fusion cages.

Study Protocol

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超声造影一站式评估疑似肾血管性高血压患者肾动脉狭窄和肾微血管灌注的基本原理和研究设计

Jun-Hong Ren, Na Ma, Si-Yu Wang, You-Jing Sun, Yue-Wei Zhang, Fa-Jin Guo, Yong-Jun Li, Tian-Hui Li, Hu Ai, Wen-Duo Zhang 等

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000002

摘要

Review Article

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使用三维表面成像设备测量过滤、离心或沉降处理技术后的面部美容脂肪移植物保留率

Guan-Hui-Er Wang, Jian-Fang Zhao, Hong-Yu Xue, Dong Li

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000016

摘要

Objective: How to increase the long-term retention rate of autologous fat grafting has been widely discussed. This study aimed to evaluate long-term fat graft retention rates for the most widely used fat processing methods in the area of facial esthetic surgery, including centrifugation, filtration, and sedimentation, using three-dimensional (3D) imaging. Data Sources: PubMed, Embase, Wiley/Cochrane Library, and Web of Science databases were comprehensively searched from inception to July 2018 according to the guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology. Study Selection: Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, follow-up devices, fat grafting techniques, and clinical outcomes. Patient cohorts were pooled, and fat graft retention rates were calculated. Complications were summarized according to different clinical characteristics. Results: Of 77 articles, 10 clinical studies met the inclusion criteria and reported quantified measurement outcomes with 3D imaging which provide precise volumetric data with approximately 2% standard deviation compared to real volumes. Data of 515 patients were included. Fat grafting retention varied from 21% to 82%. We found filtration and centrifugation techniques could result in better retention outcomes. However, retention varied within each processing technique, with no significant difference among the 3 techniques. Twenty-two complications were reported among 515 patients, including donor-site hematoma (1 case), mild postoperative erythema (2 cases), mild volumetric asymmetries (2 cases), chronic edema (2 cases), overcorrection (2 cases), skin irregularity (6 cases), and headache or dysesthesia (7 cases). Conclusions: Filtration and centrifugation techniques may result in better fat grafting retention outcomes than gravity sedimentation; however, more accurate statistical evidence is needed. Controversies continue to exist with respect to the performance of the different fat-processing techniques in fat graft retention.

Viewpoint

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中药治疗2型糖尿病

Guo-Ming Pang, Fang-Xu Li, Yong Yan, Yin Zhang, Li-Li Kong, Pu Zhu, Kai-Feng Wang, Fang Zhang, Bin Liu, Cheng Lu

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000006

摘要

Correspondence

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头孢曲松致免疫性溶血性贫血伴人工耳蜗植入术后大前庭导水管综合征1例

Yu Wang, Tao Pan, Fu-Rong Ma, Ji-Jun Wang, Ke Zhang, Wei-Wei Pan, Jing-Hui Zhang, Zhan-Miao Yi, Ying-Qiu Ying

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000017

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结节性硬化症并发肾血管平滑肌脂肪瘤恶性肿瘤TSC2突变

Yu-Jing Huang, Zong-Pei Jiang, Yu-Ping Chen, Jin-Quan Wu, Jia-Li Huang, Yan-Qiang Chen, Meng-Jun Liang

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000026

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黄芪对雌激素缺乏大鼠听觉功能的保护作用

Xu-Jun Hu

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000024

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系统性红斑狼疮致蛛网膜下腔出血伴多发性颅内动脉动脉瘤

Yun Zhang, Shu-Fen Liu, Xue-Jun Zeng

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000022

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需要用喹硫平监测

Pugazhenthan Thangaraju, Sajitha Venkatesan, Vineet Kumar Chadha

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000025

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中的杂合突变GJA1中国进行性严重变异型红斑狼疮家系的基因研究

Bi-Rong Guo, Hai-Bin Cai, Wen-Kai Zong, Cong-Sheng Li, Li-Zhong Liu, Song Qiao, Qi-Ming Zhu, Ming Li

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000011

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真菌性主动脉瘤破裂的外科治疗肺炎克雷伯菌

Sang Dong Kim, Jeong Kye Hwang, In Sung Moon, Sun Cheol Park

中华医学杂志英文版2019年 132卷 01期

DOI: 10.1097/CM9.0000000000000021

摘要

致编辑：一名63岁男性患者因弥漫性腹痛1天和计算机断层扫描（CT）显示腹主动脉瘤破裂（rAAA）而从当地诊所转诊。他否认有任何高血压、糖尿病、肝炎或肺炎病史。患者血压为100/70 mmHg，脉搏率为105次/分钟，体温为37.1℃。腹部轻度肿胀，伴有弥漫性疼痛和压痛。中腹部可触及5cm × 5cm大小的搏动性肿块。实验室检查结果包括白细胞（WBC）计数为10,600/μ L，血红蛋白（Hb）为92 g/L，血细胞比容为26.7%，血清肌酐（Cr）为0.9 mg/dl，C反应蛋白（CRP）为10.24 mg/L。在初始胸片上，没有病理性肺部病变。腹部CT显示5 cm × 5 cm破裂的肾下腹主动脉假性动脉瘤，呈局灶性强化隆起轮廓[图1A和图1B].决定接受紧急手术。在全身麻醉下，我们通过中线皮肤切口接近腹膜后rAAA和血肿。在夹闭肾下主动脉和双侧髂动脉后，我们在动脉瘤周围区域和动脉瘤壁发现了大量的感染性物质[图1C].我们对动脉瘤周围组织、血栓和动脉瘤壁中的各种微生物进行了培养试验。随后，我们对动脉瘤周围组织和动脉瘤囊进行了仔细的广泛局部清创术和切除，同时进行了大量冲洗[图1D].我们用带网膜瓣的分叉聚四氟乙烯(PTFE)移植物完成了主动脉双髂动脉介入术[图1E].根据我们的rAAA管理方案，我们使用第三代头孢菌素作为术前和术后预防性抗生素，直到确定致病微生物和对抗生素的敏感性。我们在术后前5天加用甲硝唑。动脉瘤周围组织、血栓和动脉瘤壁的培养试验显示肺炎克雷伯菌对除氨苄青霉素外的大多数抗生素均敏感。主动脉壁组织革兰氏染色（Brown-Brenn染色）结果为阴性[图1F].此外，血清学和组织试验沙门氏菌都是阴性的。我们继续每天静脉注射第三代头孢菌素，持续4周。术后3周，我们进行了血清学培养试验，结果为阴性。术后4周，患者出院，无并发症，口服第三代头孢菌素2周。随后的临床过程平安无事。术后6个月CT示PTFE通畅，无感染复发[图1G和图1H].