The effect of dexmedetomidine combined with sevoflurane anesthesia on postoperative cognitive function and hemodynamics in elderly patients with humeral fractures during the operation / 中国医师进修杂志

Objective:To study the effect of dexmedetomidine (Dex) combined with sevoflurane anesthesia on postoperative cognitive function and hemodynamics in elderly patients with humeral fractures during the operation.Methods:A total of 120 elderly patients with humeral fractures diagnosed and treated in Chaoyang Central Hospital from January 2018 to June 2020 were selected and divided into the control group (59 cases) and the study group (61 cases) according to the non-randomized clinical concurrent controlled study and patients′ voluntary principle. Sevoflurane inhalation was given to patients to maintain general anesthesia in two groups, while Dex anesthesia was given to the study group. Cognitive function, hemodynamics, stress response and pain were compared between the two groups before and after the operation, and anesthesia related complications were observed and recorded.Results:The mean arterial pressure (MAP) in the study group at 10 min after endotracheal intubation (T 1), operation time (T 2), 30 min after the beginning of the operation (T 3) were lower than those in the control group, the heart rate (HR) in the study group at T 2, T 3 and the immediate time after the operation (T 4) were lower than those in the control group, the differences were statistically significant ( P<0.05). The levels of norepinephrine (NE) and cortisol (Cor) in the study group were lower than those in the control group after the surgery: (0.92 ± 0.19) mmol/L vs. (1.10 ± 0.28) mmol/L, (213.69 ± 20.83) μg/L vs. (258.43 ± 28.27) μg/L, the differences were statistically significant ( P<0.05). The scores of Montreal Cognitive Assessmentin the study group on 3, 7 d after the operation were higher than those in the control group: (23.42 ± 1.37) points vs. (21.39 ± 1.53) points, (25.83 ± 0.95) points vs. (25.14 ± 0.99) points, the differences were statistically significant ( P<0.05). The incidence of anesthesia related complications in the study group was lower than that in the control group: 8.2%(5/61) vs. 22.0%(13/59), χ2 = 4.50, P<0.05. Conclusions:The application of Dex combined with sevoflurane in the anesthesia of elderly patients with humeral fractures is beneficial to maintain hemodynamic stability, reduce stress response and pain degree, and promote the recovery of cognitive function.

Effect of amitriptyline on lipid deposition and biochemical metabolism in a cell model of nonalcoholic fatty liver disease / 临床肝胆病杂志

ObjectiveTo investigate the effect of amitriptyline on lipid deposition and biochemical metabolism in a cell model of nonalcoholic fatty liver disease (NAFLD) by regulating the acid sphingomyelinase (ASM)/ceramide (CE) pathway. MethodsHepG2 and L02 cells were cultured in vitro to establish a cell model of NAFLD. MTT colorimetry was used to measure cell proliferation rate, and oil red O staining was used to observe the change of lipid droplets in cells. In the experiment, the cells were divided into normal control group, model group, Ami group, TNFα group, and Ami+TNFα group. An automatic biochemical analyzer was used to measure the levels of triglyceride (TG) and total cholesterol (TC) in cells and the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in supernatant; ELISA was used to measure the levels of CE and ASM in cells; Western blot was used to measure the protein expression ASM in cells, and RT-PCR was used to measure the mRNA expression of ASM in cells. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Turkey test was used for further comparison between two groups. ResultsCompared with the normal control group, the NAFLD model group had significant increases in the protein and mRNA expression of ASM and the levels of CE, TG, TC, ALT, and AST (all P＜0.05). Compared with the model group, the Ami group had significant reductions in the protein and mRNA expression of ASM and the levels of CE, TG, TC, ALT, and AST (all P＜0.05), and the TNFα group had significant increases in the protein and mRNA expression of ASM and the levels of CE, TG, ALT, and AST (all P＜0.05). Compared with the TNFα group, the Ami+TNFα group had significant reductions in the protein and mRNA expression of ASM and the levels of CE, TG, TC, ALT, and AST (all P＜0.05). ConclusionThe ASM/CE pathway promotes lipid accumulation and may lead to hepatocyte steatosis, and amitriptyline can alleviate lipid deposition in NAFLD hepatocytes by inhibiting the ASM/CE pathway.

Reexamination of the diagnosis of fatty liver disease under the background of disease spectrum progression / 临床肝胆病杂志

Recent studies have shown that metabolic syndrome (MetS), e.g., obesity, diabetes mellitus, insulin resistance, and nonalcoholic fatty liver disease (NAFLD), and drinking coexist in a considerable number of individuals, suggesting the overlap of alcoholic liver disease (ALD) and NAFLD promotes the development and progression of fatty liver disease and aggravates the adverse outcome of fatty liver disease in a synergistic and interactive way. The evolution of the disease spectrum of fatty liver disease challenges the exclusive diagnosis system which divides fatty liver disease into ALD and NAFLD. This article summarizes the research advances in recent years and introduce the latest international consensus on the renaming of NAFLD, aiming to pay attention to the influence of drinking and MetS on NAFLD, put forward our insights into the diagnosis of fatty liver disease, and thus provide a new basis for reexamination the diagnosis and individualized treatment of fatty liver disease.

Hepatic macrophage-targeted therapy for fatty liver disease: Opportunities and challenges / 临床肝胆病杂志

Hepatic macrophages are an important cell component in the natural immune system. In the physiological environment, they can recognize and eliminate necrotic or apoptotic cell fragments, pathogens, and presenting antigens and participate in adaptive immunity and immune surveillance, while in the pathological state, activated macrophages can produce and release a large number of inflammatory factors and cytokines and recruit other immune cells to participate in local anti-infection or tissue repair, and therefore, they are the key factor in the pathogenesis and progression of fatty liver disease. As an important component of hepatic immune cells, hepatic macrophages have attracted great attention due to its role in the pathogenesis of the disease and the hepatic macrophage-targeted therapy. This article reviews the challenges and opportunities in hepatic macrophage-targeted therapy for fatty liver disease.

Advances in epidemiology and serum markers for the noninvasive diagnosis of nonalcoholic fatty liver disease / 中华肝脏病杂志

The global prevalence rate of nonalcoholic fatty liver disease (NAFLD) has increased year by year, and it has become the number one cause for chronic liver disease in China. In addition, the trend of NAFLD has become more pronounced and evident in female gender and younger age group. The long-term persistence of fatty liver disease may cause serious consequences. There are no accepted diagnostic criteria for diagnosing noninvasive diagnosis of NAFLD. Alpha-ketoglutarate is a newly discovered serological marker of high diagnostic value and considered the most valuable potential biomarker along with cytokeratine-18 (CK-18).

Development and verification of reference nucleic acid materials of H9N2 influenza viruses by real-time RT-PCR / 生物工程学报

The HA gene of H9N2 influenza virus (A/chicken/Hunan/04.14 (H9N2)) was amplified and sequenced. The RNA was synthesized by in vitro transcription. The RNA transcription solutions were diluted to 10⁹ copies/μL using the RNA storage solution. The aliquoted RNA solutions were used to evaluate the homogeneity and stability. The results were determined by the average value obtained from four independent laboratories. Furthermore, the fluorescence quantitative RT-PCR method was also developed to verify the detection accuracy of clinical samples. The detection limit of this method is approximately 10 copies. Taken together, the RNA transcription solution established in our study can used as positive standard reference for rapid detection of H9N2 influenza virus.

Role of 5-hydroxytryptamine in the pathogenesis and treatment of nonalcoholic fatty liver disease / 临床肝胆病杂志

The prevalence rate of nonalcoholic fatty liver disease (NAFLD) has been increasing year by year.However,since the complex pathogenesis of NAFLD has not been fully clarified,there still lacks a gold standard for the diagnosis and treatment of NAFLD.5-Hydroxytryptamine (5-HT) can affect the development and progression of NAFLD via several links and thus change the course of NAFLD.This article introduces the association between 5-HT and NAFLD,the role of 5-HT in the pathogenesis of NAFLD,and its future application in treatment.

Predictive value of combined measurement of D-dimer, fibrinogen, and peripheral blood leukocyte count for severity of acute pancreatitis / 临床肝胆病杂志

Objective To explore the predictive value of combined measurement of D-dimer (D-D),fibrinogen (FIB),and peripheral blood leukocyte count (PBLC) for the severity of acute pancreatitis (AP).Methods We collected the clinical data of 134 hospitalized patients who were diagnosed with AP in the General Hospital of Ningxia Medical University from January 2014 to January 2016.These patients were divided into mild acute pancreatitis (MAP) group (n =72) and severe acute pancreatitis (SAP) group (n =62).Also,these patients were divided into hyperlipidemic acute pancreatitis (HAP) group (n =43) and biliogenic acute pancreatitis (BAP) group (n =91).The initial measurements of D-D,FIB,and PBLC for the patients who were admitted to the hospital within 24 hours of onset and received no treatment before admission were collected.The t test was used for comparison of normally distributed continuous data,while the Mann-Whitney U test was used for non-normally distributed continuous data.The chi-square test was used for comparison of categorical data.In addition,the Spearman correlation test and Pearson correlation test were used for correlation analyses.The receiver operating characteristic (ROC) curve was used to analyze the predictive values of D-D,FIB,and PBLC for the severity of AP.Results Compared with the MAP group,the SAP group had significantly increased D-D and FIB levels in peripheral blood (Z =-3.171,P =0.002;t =-2.339,P =0.021).Compared with the HAP group,the BAP group had a significantly higher D-D level (Z =-4.178,P ＜ 0.001),an insignificantly higher FIB level (P ＞ 0.05),and a significantly lower PBLC (t =2.466,P =0.015).The areas under the ROC curve (AUCs) of D-D,FIB,and PBLC were 0.659,0.611,and 0.591,respectively,and D-D had a higher value than FIB and PBLC in predicting the severity of SAP.The AUC of a combination of D-D,FIB,and PBLC was 0.712.Plasma D-D and FIB levels were positively correlated with the severity of AP (r =0.275 and 0.192,P =0.001 and 0.026).Conclusions D-D,FIB,and PBLC are important for early judgment of the severity of AP,and a combination of the three markers has greater significance.

Role of ceramide in development and progression of nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is a clinicopathological syndrome caused by liver damage factors except alcohol and has the major feature of diffuse macrovesicular hepatocyte steatosis.Thetwo-hit hypothesis can partly explain the pathogenesis of NAFLD.Recent studies have found that ceramide is a key molecular messenger involved in the development and progression of NAFLD,and as a sphingolipid,it is closely associated with the two-hit hypothesis.This article reviews the role of ceramide in NAFLD.

The effect of nonalcoholic fatty liver disease on the severity of acute pancreatitis / 实用医学杂志

Objective To investigate the relationship between nonalcoholic fatty liver disease and the severity of acute pancreatitis,the data of patients with acute pancreatitis was collected to provide clinic basis for the diagnosis and treatment,severity assessment,prognostic judgement,and prevention of acute pancreatitis. Methods SPSS22.0 was used to analyze all data.Mann-Whitney U test(in case of non-normal distribution)was used to compare data between two groups.Chi-square test was used to counting data.Risk factors were analyzed by using logistic regression analysis. Results The severity of acute pancreatitis in patients with nonalcoholic fatty liver disease had a statistically significance with that of patients without nonalcoholic fatty liver disease(χ2=3.968, P = 0.046);nonalcoholic fatty liver disease(95% CI:4.132 ~ 22.575,OR = 9.658,P < 0.01)had a correlation with the severity of acute pancreatitis.Conclusion Nonalcoholic fatty liver disease was associated with the severity of acute pancreatitis.Nonalcoholic fatty liver disease was the risk factors for the severity of acute pancreatitis.

Advances in the treatment of nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD)has become a major liver disease in the world and its prevalence rate continues to in-crease. As a component of metabolic syndrome,it has become a risk factor for many serious cerebrovascular and cardiovascular diseases. Due to the complex pathogenesis of NAFLD or the combined/ mutual effect of pathogenic factors,there are still no widely accepted effective therapies. In recent years,more and more studies have revealed new pathogeneses of NAFLD and the prospects of corresponding treatment. This article introduces the recent advances in the treatment of NAFLD,including lifestyle intervention,drug therapy,integrated traditional Chinese and Western medicine therapy,and bariatric surgery. In the aspect of drug therapy,this article introduces the drugs commonly used in clinical practice and new drugs in phase Ⅱ and Ⅲ clinical trials and their therapeutic effects.

Current status of nonalcoholic fatty liver disease and related risk factors: an analysis of an enterprise in Xi′an / 临床肝胆病杂志

ObjectiveTo investigate the current status of nonalcoholic fatty liver disease (NAFLD) in an enterprise in Xi′an, China, and to provide a scientific basis for further studies on NAFLD in Shanxi. MethodsA total of 415 employees who underwent health examination in The First Affiliated Hospital of Xi′an Medical University from June to July, 2014 were enrolled. All the patients underwent physical examination, abdominal ultrasound, and serological examination, and completed related questionnaires. The t-test was applied for comparison of continuous data, and the Pearson correlation analysis was applied for correlation analysis. ResultsOf all the 415 patients, 86 (20.7%) had NAFLD, consisting of 70 patients (16.9%) with mild NAFLD and 16 patients (3.8%) with moderate NAFLD. The population with an age of 50-58 years had the highest prevalence rate (30.8%, 16/52). Of all the 86 patients with NAFLD, 57 (66.3%) had obesity, and 76 (88.4%) had abdominal obesity. The employees with moderate NAFLD had a significantly higher alanine aminotransferase (ALT) level, a significantly higher aspartate aminotransferase (AST) level, a significantly larger abdominal circumference, and a significantly higher body mass index (BMI) than those with mild NAFLD (t=-4.140, -3.512, -4.405, and -5.051, respectively, all P＜0.05). In the employees with NAFLD, BMI and abdominal circumference were correlated with AST level (r=0.283 and 0.271, both P＜0.05) and ALT level (r=0.325 and 0.316, both P＜0.05). Most employees in this enterprise had a bad eating habit, a sedentary lifestyle, and a lack of physical exercise. ConclusionThis enterprise has a high prevalence rate of NAFLD. BMI and abdominal circumference of patients with NAFLD have certain clinical values in predicting the degree of fat deposition in the liver, and are correlated with AST and ALT levels.

Research advances in differential diagnosis of benign and malignant ascites / 临床肝胆病杂志

Differential diagnosis of benign and malignant ascites is of a great value in determining etiology, evaluating prognosis, and determining therapy regimens. There are many diagnostic methods for ascites, but up to now, no method can achieve high sensitivity and specificity and meet the requirements of clinical economics and feasibility at the same time. Therefore, searching for an ideal method for differential diagnosis of ascites has become an important topic of current research. This article describes the clinical value of diagnostic methods, such as molecular biological detection, cytological examination, combined determination of tumor markers, and routine tests, in the differential diagnosis of benign and malignant ascites, analyzes the diagnostic efficiency of related biomarkers, and points out that combined determination of various parameters has an increased value in the differential diagnosis of benign and malignant ascites.

Prevalence and associated risk factors for obesity and nonalcoholic fatty liver disease in adolescents in Xi′an, Shaanxi province, China / 临床肝胆病杂志

ObjectiveTo provide a scientific basis for the prevention and early intervention of obesity and nonalcoholic fatty liver disease (NAFLD) in adolescents. MethodsAnthropometric measurements, liver function test, and abdominal ultrasonography were performed in adolescents who received physical examination in our hospital from March to April, 2012. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. The further multivariate analysis was performed by logistic regression analysis. ResultsA total of 4141 adolescents, including 2061 girls and 2080 boys, were enrolled in the study with an average age of 18.62±0.66 years. Boys had significantly higher overweight and obesity rates than girls (χ2=49.5, P＜0.01; χ2=20.4, P＜0.01). The overall incidence of NAFLD in subjects was 8.1% (335/4141), while the incidence of NAFLD in boys was significantly higher than that in girls (13.4% vs 2.8%, χ2=156.4, P＜0.01). The detection rate of NAFLD was the highest in obese subjects, followed by subjects with high body mass index (BMI) and subjects with normal BMI. Moreover, obese boys had a significantly higher detection rate of NAFLD than obese girls (71.6% vs 29.0%, χ2=56.5, P＜0.01). Among both boys and girls, BMI, body mass, alanine aminotransferase level, and aspartate aminotransferase level were significantly higher in the NAFLD group than in the non-NAFLD group (all P＜0.05). Logistic regression analysis revealed that body mass and BMI were likely to be independent risk factors for NAFLD. ConclusionThe prevalence of obesity and NAFLD in adolescents in Xi′an is not optimistic. For obese adolescents, healthy lifestyle, body mass control, and BMI reduction are important approaches for prevention of NAFLD.

Study on the diagnosis of common diseases of the upper gastrointestinal tract by the instant gastrointestinal ultrasound contrast agent / 实用医学杂志

Objective To investigate the diagnostic value of the instant gastrointestinal ultrasound contrast agent in the digestive diseases. Methods Five hundred and seventy-nine patients received the examination of the color Doppler after they drinked the ultrasonic contrast agent. Then the results were analyzed by consistency analysis. Results There was high consistency between the two examinations in the normal control, gastritis, peptic ulcer, gastric cancer and gastric leiomyoma. The Kappa value was 0.768, 0.913, 0.925, 0.939 and 1.000, respectively. But the consistency in the gastric polyp was low , the Kappa value was 0.368. Conclusion The color Doppler through the instant gastrointestinal ultrasound contrast agent has high diagnostic value in the common diseases of the digestive system.

Genetic polymorphism of cytochrome P450 2C19 in Xinjiang Uigur population versus Han population / 中国组织工程研究

BACKGROUND: Previous studies demonstrated that,metabolic phenotype of cytochrome P450 2C19 has genetic polymorphism,which presents with extensive or poor metabolisms and has great differences in races and individuals.OBJECTIVE: To study the genotype distribution of cytochrome P450 2C19 in Xinjiang Uigur population.METHODS: In total 144 unrelated Uigur and 156 unrelated Han subjects were genotyped for cytochrome P450 2C19 by polymerase chain reaction-restriction fragment length polymorphism.The differences of gene phenotype and gene frequency were compared between Uigur and Han populations.RESULTS AND CONCLUSION: The frequency of extensive metabolism wt/wt,wt/m and wt/m1+wt/m2 of Uigur was notably higher than that of Han population(P<0.05),but the frequency of poor metabolism m1/m1 was obviously lower than that of Han population(P<0.05).There were significant differences between Uigur and Han populations in allele frequency wt,m1 and m2(P<0.05),especially m1,which was 58-fold of m2(P<0.01).The results revealed that,distribution frequency m1/m1 of poor metabolism of Uigur is obviously lower than that in Han population,and m1 frequency is higher than that of Han population,accordingly,m1 is the main gene mutation of cytochrome P450 2C19 in Uigur population.

Relationship between the acid-suppression efficacy of proton pump inhibitors and CYP2C19 genetic polymorphism in patients with peptic ulcer / 西安交通大学学报·英文版

Objective: To investigate acid-suppression efficacy of proton pump inhibitors (PPIs) in relation to CYP2C19 genetic polymorphism on patients with peptic ulcer. Methods: By an open, randomized and control trial, fifty nine patients with active peptic ulcer were randomly assigned to receive one of three PPIs on a single dose (20 mg of each drug): omeprazole group (n = 19), rabeprazole group (n = 20) and esomeprazole group (n = 20). Intragastric pH was recorded 1 hour before and 24 hours after administration. CYP2C19 genotype was tested in all patients. Results: The EMs/PMs ratio of each group was 16/3,17/3 and 17/3, respectively. The total time that intragastric pH>4, time percent pH>4 and median pH in PMs patients were significantly higher than those in EMs patients of omeprazole group (P < 0.05). But all these differences were not found in rabeprazole group and esomeprazole group. The pH of nocturnal acid breakthrough (NAB) in both rabeprazole group and esomeprazole group was higher than that of omeprazole group, while there was no significant difference between rabeprazole group and esomeprazole group. Conclusion: The acid-suppression efficacy of omeprazole is highly dependent on CYP2C19 genetic polymorphism, while CYP2C19 genetic polymorphism may have a little influence on the acid-suppression efficacy of rabeprazole and esomeprazole. The acid-suppression action of rabeprazole and esomeprazole is superior to omeprazole, especially on night acid secretion.

Relationship between the acid-suppression efficacy of proton pump inhibitors and CYP2C19 genetic polymorphism in patients with peptic ulcer / 药物分析学报

Obiective To investigate acid-suppression efficacy of proton pump inhibitors(PPls) in relation to CYP2C19 genetic polymorphism on patients with peptic ulcer. Methods By an open, randomized and control trial, fifty nine patients with active peptic ulcer were randomly assigned to receive one of three PPIs on a single dose (20 mg of each drug): omeprazole group (n=19), rabeprazole group (n=20) and esomeprazole group (n=20). lntragastric pH was recorded 1 hour before and 24 hours after administration. CYP2C19 genotype was tested in all patients. Resuits The EMs/PMs ratio of each group was 16/3,17/3 and 17/3, respectively. The total time that intragastric pH＞4, time percent pH＞4 and median pH in PMs patients were significantly higher than those in EMs patients of omeprazole group (P＜0.05). But all these differences were not found in rabeprazole group and esomeprazole group. The pH of nocturnal acid breakthrough (NAB) in both rabeprazole group and esomeprazole group was higher than that of omeprazole group, while there was no significant difference between rabeprazole group and esomeprazole group. Gonclusion The acid-suppression efficacy of omeprazole is highly dependent on CYP2C19 genetic polymorphism, while CYP2C19 genetic polymorphism may have a little influence on the acid-suppression efficacy of rabeprazole and esomeprazole. The acid-suppression action of rabeprazole and esomeprazole is superior to omeprazole, especially on night acid secretion.

Simultaneous Determination of Plasma Rabeprazole and It's Metabolites by RP-HPLC / 中国药房

OBJECTIVE:To establish RP-HPLC method for the simultaneous determination content of rabeprazole(RAB)and its two metabolites thioether-rabeprazole(TE)and demethylated thioether-rabeprazole(DMTE)in human plasma.METHODS:The plasma samples were extracted with ethyl acetate;The Diamonsil C 18 reversed-phase column was used as analytical column,the mobile phase was consisted of methanol-water-glacial acetic acid-triethylamine(40∶60∶0.4∶0.1)with a flow rate at1.0ml/min,the ultraviolet detection wavelength was288nm.RESULTS:Good separation of chromatographic peaks of RAB,TE and DMTE were manifested.The mean recovery of which were110.40%,87.28%and98.21%respectively.CONCLUSION:The method was sensitive and accurate,and it meets the requirements for the study of pharmacokinetic of rabeprazole.

The acid-suppressing effects of esomeprazole between extensive metabollizers and poor metabolizers in relation to CYP2C19 genetic polymorphism / 西安交通大学学报(医学版)

0.05). Conclusion We di d not find the difference between the two CYP2C19 phenotypes in relation to the acid-suppressing effect of esomeprazole.