2022年 · 第135卷第09期

出版日期 2022-05-05电子版￥0.00元

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Review Article

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代谢功能障碍相关脂肪性肝病的治疗进展

Yiwen Shi, Jiangao Fan

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000002091

摘要

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靶向elabela/apelin-apelin受体轴治疗高血压的新方法

Jiawei Song, Jianqiong Tang, Zhenzhou Zhang, Ying Liu, Jiuchang Zhong

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001766

摘要

Hypertension is the leading risk factor for global mortality and morbidity and those with hypertension are more likely to develop severe symptoms in cardiovascular and cerebrovascular system, which is closely related to abnormal renin-angiotensin system and elabela/apelin-apelin receptor (APJ) axis. The elabela/apelin-APJ axis exerts essential roles in regulating blood pressure levels, vascular tone, and cardiovascular dysfunction in hypertension by counterbalancing the action of the angiotensin II/angiotensin II type 1 receptor axis and enhancing the endothelial nitric oxide (NO) synthase/NO signaling. Furthermore, the elabela/apelin-APJ axis demonstrates beneficial effects in cardiovascular physiology and pathophysiology, including angiogenesis, cellular proliferation, fibrosis, apoptosis, oxidative stress, and cardiovascular remodeling and dysfunction during hypertension. More importantly, effects of the elabela/apelin-APJ axis on vascular tone may depend upon blood vessel type or various pathological conditions. Intriguingly, the broad distribution of elabela/apelin and alternative isoforms implicates its distinct functions in diverse cardiac and vascular cells and tissue types. Finally, both loss-of-function and gain-of-function approaches have defined critical roles of the elabela/apelin-APJ axis in reducing the development and severity of hypertensive diseases. Thus, targeting the elabela/apelin-APJ axis has emerged as a pre-warning biomarker and a novel therapeutic approach against progression of hypertension, and an increased understanding of cardiovascular actions of the elabela/apelin-APJ axis will help to develop effective interventions for hypertension. In this review, we focus on the physiology and biochemistry, diverse actions, and underlying mechanisms of the elabela/apelin-APJ axis, highlighting its role in hypertension and hypertensive cardiovascular injury and dysfunction, with a view to provide a prospective strategy for hypertensive disease therapy.

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动态血压监测在高血压管理中的应用

Yibang Cheng, Yan Li, Jiguang Wang

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000002028

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Viewpoint

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神经生物学中的组蛋白巴豆酰化：生存还是毁灭？

Cechuan Deng, Jia-Hua Qu, InKyeom Kim, Xiaoqiang Tang

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001945

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临床实践中的心力衰竭分类：是时候重新定义了吗？

Kai Hu, Georg Ertl, Stefan Frantz, Peter Nordbeck

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001823

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Commentary

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关注心力衰竭中的HFpEF

Chunhui He, Rongchong Huang

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001841

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Original Article

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环丙酚的安全性和有效性vs.异丙酚用于重症监护室机械通气患者镇静：一项多中心、开放标签、随机、2期试验

Yongjun Liu, Xiangyou Yu, Duming Zhu, Jun Zeng, Qinhan Lin, Bin Zang, Chuanxi Chen, Ning Liu, Xiao Liu, Wei Gao 等

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001912

摘要

Background: Ciprofol (HSK3486; Haisco Pharmaceutical Group Co., Ltd., Chengdu, China), developed as a novel 2,6-disubstituted phenol derivative showed similar tolerability and efficacy characteristics as propofol when applicated as continuous intravenous infusion for 12 h maintenance sedation in a previous phase 1 trial. The phase 2 trial was designed to investigate the safety, efficacy, and pharmacokinetic characteristics of ciprofol for sedation of patients undergoing mechanical ventilation. Methods: In this multicenter, open label, randomized, propofol positive-controlled, phase 2 trial, 39 Chinese intensive care unit patients receiving mechanical ventilation were enrolled and randomly assigned to a ciprofol or propofol group in a 2:1 ratio. The ciprofol infusion was started with a loading infusion of 0.1-0.2 mg/kg for 0.5-5.0 min, followed by an initial maintenance infusion rate of 0.30 mg·kg-1·h-1, which could be adjusted to an infusion rate of 0.06 to 0.80 mg·kg-1·h-1, whereas for propofol the loading infusion dose was 0.5-1.0 mg/kg for 0.5-5.0 min, followed by an initial maintenance infusion rate of 1.50 mg·kg-1·h-1, which could be adjusted to 0.30-4.00 mg·kg-1·h-1 to achieve -2 to +1 Richmond Agitation-Sedation Scale sedation within 6-24 h of drug administration. Results: Of the 39 enrolled patients, 36 completed the trial. The median (min, max) of the average time to sedation compliance values for ciprofol and propofol were 60.0 (52.6, 60.0) min and 60.0 (55.2, 60.0) min, with median difference of 0.00 (95% confidence interval: 0.00, 0.00). In total, 29 (74.4%) patients comprising 18 (69.2%) in the ciprofol and 11 (84.6%) in the propofol group experienced 86 treatment emergent adverse events (TEAEs), the majority being of severity grade 1 or 2. Drug- and sedation-related TEAEs were hypotension (7.7% vs. 23.1%, P = 0.310) and sinus bradycardia (3.8% vs. 7.7%, P = 1.000) in the ciprofol and propofol groups, respectively. The plasma concentration-time curves for ciprofol and propofol were similar. Conclusions: ciprofol is comparable to propofol with good tolerance and efficacy for sedation of Chinese intensive care unit patients undergoing mechanical ventilation in the present study setting. Trial registration: ClinicalTrials.gov, NCT04147416.

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2型糖尿病患者范围时间与尿白蛋白排泄率的负相关：一项住院患者的回顾性研究

Sanbao Chai, Shanshan Wu, Sixu Xin, Ning Yuan, Jianbin Sun, Xiaomei Zhang, Linong Ji

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001914

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妊娠早期妊娠体重增加过多和妊娠中期妊娠体重增加不足会增加妊娠期糖尿病的风险

Aiqi Yin, Fuying Tian, Xiaoxia Wu, Yixuan Chen, Kan Liu, Jianing Tong, Xiaonian Guan, Huafan Zhang, Linlin Wu, Jianmin Niu

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001972

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中国重症患者的质量指标和结果：2015-2019年全国重症医学临床质量控制指标调查结果

Xi Rui, Fen Dong, Xudong Ma, Longxiang Su, Guangliang Shan, Yanhong Guo, Yun Long, Dawei Liu, Xiang Zhou

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001933

摘要

Background: It is crucial to improve the quality of care provided to ICU patient, therefore a national survey of the medical quality of intensive care units (ICUs) was conducted to analyze adherence to quality metrics and outcomes among critically ill patients in China from 2015 to 2019. Methods: This was an ICU-level study based on a 15-indicator online survey conducted in China. Considering that ICU care quality may vary between secondary and tertiary hospitals, direct standardization was adopted to compare the rates of ICU quality indicators among provinces/regions. Multivariate analysis was performed to identify potential factors for in-hospital mortality and factors related to ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs). Results: From the survey, the proportions of structural indicators were 1.83% for the number of ICU inpatients relative to the total number of inpatients, 1.44% for ICU bed occupancy relative to the total inpatient bed occupancy, and 51.08% for inpatients with Acute Physiology and Chronic Health Evaluation II scores ≥15. The proportions of procedural indicators were 74.37% and 76.60% for 3-hour and 6-hour surviving sepsis campaign bundle compliance, respectively, 62.93% for microbiology detection, 58.24% for deep vein thrombosis prophylaxis, 1.49% for unplanned endotracheal extubations, 1.99% for extubated inpatients reintubated within 48 hours, 6.38% for unplanned transfer to the ICU, and 1.20% for 48-hour ICU readmission. The proportions of outcome indicators were 1.28‰ for VAP, 3.06‰ for CRBSI, 3.65‰ for CAUTI, and 10.19% for in-hospital mortality. Although the indicators varied greatly across provinces and regions, the treatment level of ICUs in China has been stable and improved based on various quality control indicators in the past 5 years. The overall mortality rate has dropped from 10.19% to approximately 8%. Conclusions: The quality indicators of medical care in China’s ICUs are heterogeneous, which is reflected in geographic disparities and grades of hospitals. This study is of great significance for improving the homogeneity of ICUs in China.

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Clusterin作为血清生物标志物候选物对慢性阻塞性肺疾病肺成纤维细胞活化的贡献

Qiang Zhang, Yuanyi Yue, Rui Zheng

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000002065

摘要

Background: Fibrosis in the peripheral airways contributes to airflow limitation in patients with chronic obstructive pulmonary disease (COPD). However, the key proteins involved in its development are still poorly understood. Thus, we aimed to identify the differentially expressed proteins (DEPs) between smoker patients with and without COPD and elucidate the molecular mechanisms involved by investigating the effects of the identified biomarker candidate on lung fibroblasts. Methods: The potential DEPs were identified by isobaric tags for relative and absolute quantitation (iTRAQ)-based proteomic analysis. The messenger RNA and protein levels of clusterin (CLU) in COPD patients and 12% cigarette smoke extract (CSE)-treated human bronchial epithelial cells were determined at the indicated time points. Furthermore, an in vitro COPD model was established via the administration of 8% CSE to normal human lung fibroblasts (NHLFs) at indicated time points. The effects of CSE treatment and CLU silencing on proliferation and activation of lung fibroblasts were analyzed. Results: A total of 144 DEPs were identified between COPD patients and normal smokers. The iTRAQ-based proteomics and bioinformatics analyses identified CLU as a serum biomarker candidate. We also discovered that CLU levels were significantly increased (P < 0.0001) in Global Initiative for Obstructive Lung Disease II, III, and IV patients and correlated (P < 0.0001) with forced expiratory volume in 1 s (R=-0.7705), residual volume (RV) (R = 0.6281), RV/total lung capacity (R = 0.5454), and computerized tomography emphysema (R = 0.7878). Similarly, CLU levels were significantly increased in CSE-treated cells at indicated time points (P < 0.0001). The CSE treatment significantly inhibited the proliferation, promoted the inflammatory response, differentiation of NHLFs, and collagen matrix deposition, and induced the apoptosis of NHLFs; however, these effects were partially reversed by CLU silencing. Conclusion: Our findings suggest that CLU may play significant roles during airway fibrosis in COPD by regulating lung fibroblast activation.

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高频振荡联合多模态成像方法对癫痫手术的预后价值

Xiaoming Yan, Fangzhao Yin, Cuiping Xu, Tao Yu, Xiaonan Li, Wei Wang, Xi Zhang, Kai Ma, Guojun Zhang

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001909

摘要

Clinical Observation

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重症监护病房自发性脑出血患者感染的患病率及危险因素

Shengjie Feng, Miaoxian Yang, Shuixiang Deng, Feng Zhao, Peng Jin, Mi Tian, Ye Gong

中华医学杂志英文版2022年 135卷 09期

DOI: 10.1097/CM9.0000000000001703