The development and benefits of metformin in various diseases / 医学前沿

Metformin has been used for the treatment of type II diabetes mellitus for decades due to its safety, low cost, and outstanding hypoglycemic effect clinically. The mechanisms underlying these benefits are complex and still not fully understood. Inhibition of mitochondrial respiratory-chain complex I is the most described downstream mechanism of metformin, leading to reduced ATP production and activation of AMP-activated protein kinase (AMPK). Meanwhile, many novel targets of metformin have been gradually discovered. In recent years, multiple pre-clinical and clinical studies are committed to extend the indications of metformin in addition to diabetes. Herein, we summarized the benefits of metformin in four types of diseases, including metabolic associated diseases, cancer, aging and age-related diseases, neurological disorders. We comprehensively discussed the pharmacokinetic properties and the mechanisms of action, treatment strategies, the clinical application, the potential risk of metformin in various diseases. This review provides a brief summary of the benefits and concerns of metformin, aiming to interest scientists to consider and explore the common and specific mechanisms and guiding for the further research. Although there have been countless studies of metformin, longitudinal research in each field is still much warranted.

Effects of feeding patterns on sleep of infants aged 0-5 months / 中华围产医学杂志

Objective:To investigate the sleep of infants aged 0 to 5 months and explore its association with feeding patterns.Methods:A cross-sectional survey on infant sleep was conducted from February to August 2019 using "Brief Infant Sleep Questionnaire" posted on a WeChat public account, which mainly included two dimensions of sleep duration and habits. In addition, information on maternal and infant characteristics as well as feeding patterns was also collected. Multiple linear regression and multinomial logistic regression were used to analyze the association between sleep and feeding patterns.Results:This study included 28 444 singleton infants aged 0 to 5 months and their mothers from 31 provincial-level administrative regions in mainland China. The median sleep duration of infants at night and during the day was 9 h and 6 h, respectively. These infants sharing the bed with their parents accounted for 53.5% (15 221/28 444). Of all infants, 46.0% (13 092/28 444) slept on their backs; 84.7% (24 078/28 444) woke up two times or more at night; 58.3% (16 597/28 444) stayed awake 2 h or more at night; 89.7% (25 523/28 444) had a sleep latency of 1 h or more. Falling asleep while being fed was the most common way to fall asleep (40.2%, 11 426/28 444). The numbers of infants who were exclusively breastfed, exclusively formula-fed and mixed-fed were 7 164 (25.2%), 4 097 (14.4%) and 17 183 (60.4%), respectively. Compared with exclusively breastfed infants, exclusively formula-fed infants slept for shorter periods at night (a β=－0.14, 95% CI:－0.22 to－0.06, P<0.05), while mixed-fed infants slept longer (a β=0.08, 95% CI: 0.02-0.13, P<0.05). Exclusively formula-fed infants had less overall sleep time than recommended ( aOR=1.10, 95% CI: 1.00-1.21, P<0.05). Exclusively formula-fed and mixed-fed infants were less likely to sleep in cribs in separate rooms ( aOR=0.50, 95% CI: 0.44-0.56; aOR=0.35, 95% CI: 0.32-0.38; both P<0.05). Exclusively formula-fed infants were less likely to share the bed with their parents ( aOR=0.91, 95% CI: 0.83-0.99, P<0.05), but the likelihood in mixed-fed infants was high ( aOR=1.19, 95% CI: 1.11-1.27, P<0.05). Mixed-fed infants were more likely to sleep on their backs ( aOR=1.12, 95% CI: 1.06-1.18, P<0.05). Exclusively formula-fed infants were more likely to stay awake for four hours or more at night ( aOR=1.12, 95% CI: 1.01-1.25, P<0.05). Conclusions:Exclusively breastfeeding was the best feeding pattern for infant sleep quantity. But much attention should be paid to sleeping habits including sleeping place and sleeping position associated with exclusively breastfeeding to improve infant sleep and feeding.

Effect of hydrogen sulfide on airway inflammation induced by ozone in mice / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate the effect of hydrogen sulfide ( H2 S) on airway inflammation induced by ozone (O3) exposure and its mechanisms.METHODS:C57BL/6 mice (n=32) were randomly divided into control group, O3 group, NaHS+O3 group and NaHS group.The mice in O3 group and O3 +NaHS group were exposed to 2.14 mg/m3 O3 for 3 h on days 1, 3 and 5, while the mice in control group and NaHS group were exposed to filtered air .NaHS (14μmol/kg) was administered intraperitoneally to the mice in NaHS group and O 3 +NaHS group 30 min before each exposure .After the last exposure for 24 h, the airway responsiveness was determined , and bronchoalveolar lavage fluid ( BALF) was collected for counting inflammatory cells and measuring total protein concentration .The lung tissues were collected for observing the morphological changes with HE staining .The levels of interleukin-6 ( IL-6 ) , interleukin-8 ( IL-8 ) , malondialdehyde ( MDA) and NF-κB p65 protein in the lungs were determined .RESULTS: Compared with control group , the airway re-sponsiveness, inflammatory cells, protein concentration, inflammation score, levels of IL-6, IL-8, MDA and NF-κB p65 in O3 group increased significantly , but these in NaHS+O3 group decreased compared with O 3 group.CONCLUSION: The present findings suggest that H 2 S attenuates O3 induced airway inflammation by inhibiting NF-κB expression and preventing lipid peroxidation .

Secular trends of premarital medical examination in China during 1996 and 2013 / 北京大学学报(医学版)

Objective:To describe the secular trends of premarital medical examination ( PME ) in China during 1996 and 2013 and to assess the impacts of national health policies on the PME rate. Methods:The information on marriage and PME for districts and counties in 31 provinces of China was annually collected by the Office for National Maternal & Child Health Statistics of China, and the infor-mation on the health policies was from official governmental websites. According to the main health poli-cies, the calendar years were categorized into 3 periods:1996 to 2003 was mandatory PME period;2004 to 2008 was encouraged voluntary PME period; and 2009 to 2013 was free-paid voluntary PME period. Results: During the 18-year period, 284 242 719 people were registered for a marriage in which 107 198 795 were examined, giving the PME rate of 37. 7%. During the mandatory PME period, the rate ranged 52 . 7% -67 . 7% with an average of 60 . 9% ( urban 71 . 5%, and rural 51 . 7%) . In 2004 , the first year when the PME became voluntary, the rate was abruptly dropped to 2. 6%, and thereafter gradually increased to 11 . 5% in 2008 . As the policies of the free-paid voluntary PME were subsequently issued, the rate was quickly increased to 52. 3% (urban 49. 8%, and rural 54. 6%) in 2013. The in-creasing trend was consistently observed both in urban and rural areas, and across East, Middle, West, and Northeast economical regions. However, the rates differed greatly among provinces. In 2013, 5 pro-vinces had rates of >90% ( Guangxi 97 . 5%, Fujian 96 . 0%, Ningxia 95 . 4%, Zhejiang 93 . 4% and Anhui 90. 1%), whereas some provinces were stuck at a low rate, including developed and underdeve-loped provinces/cities. The PME rate in 2013 was 27. 4% for Shanghai, 25. 5% for Guangdong, 12. 4%for Chongqing, 5. 8% for Beijing and 4. 6% for Tianjin. Underdeveloped provinces were Guizhou (6. 4%) and Qinghai (1. 8%). Conclusion:As various national policies to promote voluntary PME were issued, the PME rate was significantly increased after a sharp decline, though it varied greatly by provinces. For provinces with high PME rate, PME-related health benefits need to be evaluated;for provinces with low rate, it is of important practical significance to explore a cost-effective health service model that is likely incorporated with pre-pregnancy examination.

Comparison of four metal fixation implants for femoral intertrochanteric fractures in old patients / 中国组织工程研究

BACKGROUND:The selection of metal implant for old patients with femoral intertrochanteric fracture should focus on patient’s age, osteoporotic degree, perioperative status and type of fracture. Individual therapeutic program should be made. OBJECTIVE:To compare the therapeutic effects of four types of metal implant fixation for femoral intertrochanteric fracture in old patients. METHODS:180 old patients with femoral intertrochanteric fractures treated from September 2009 to September 2012 were analyzed. Four kinds of metal implants were used for repair of fracture. There were 45 patients in the dynamic hip screw group, proximal femoral nail anti-rotation group, Gamma nail group and anatomical dynamic hip lock nickelclad group, separately. Operation time, blood loss, hospital time, Harris score after operation, fracture healing time and complications in different groups were compared. RESULTS AND CONCLUSION:Operation time and hospital time were shorter, and blood loss was fewer in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the dynamic hip screw group and Gamma nail group (P0.05). The incidence of complications was significantly lower in the anatomical dynamic hip lock nickelclad group and proximal femoral nail anti-rotation group compared with the Gamma nail group and dynamic hip screw group (P<0.05). Results suggested that anatomical dynamic hip lock nickelclad and proximal femoral nail anti-rotation are reliable in treatment of intertrochanteric fracture in old patients, show less postoperative complications, and are ideal choices for implant fixation of femoral intertrochanteric fracture in old patients.

Analysis on the treatment of crush syndrome complicated in earthquake injury / 中华急诊医学杂志

Objective To explore the risk factors and treatment of crush syndrome comlicated in earth-quake injury. Method The demographics and epidemiological characteristics, clinical treatment and the outcome of 35 cases with crush syndrome were reviewed and analyzed.The 35 patients were among 325 victims of "5·12" Wenchuan earthquake, who were admitted in Sichuan Provincial People's Hospital, Chengdu. Results Of 35 pa-tients with crush syndrome, 7 cases injured at forearm, 25 cases injured at cruse, and 3 cases injured at palm,and 3 cases were complicated with acute renal failure. The time from the occurrence of injury to transporting patients into the hospital was 6～92 hours, with mean time 49.3 hours. All the 35 patients had their wound cut open for de-compression,and 6 cases were cured, 2 had dysfunction, and 27 underwent amputation. Young patients under 14 years old had higher rate (25.8%) of crush syndrome than elder patients of 14～59 years old with rate of 8.0%.And patients admitted into hospital later (over 48 hour after injury) had higher incidence of crush syndrome (31.0 %) than those admitted earlier within 48 hours after injury (3.5 %). Conchusions Attaching great impor-tance to crush syndrome after earthquake injury, early diagnosis and treatment, and timely and complete surgical decompression are key points to the successful treatment and prevention of crush syndrome complicated in earth-quake injury. Because the longer interval between injury and rescue, delayed diagnosis and treatment, and the younger age of patients are all the risk factors of crush syndrome.

Clinical Features and Strategy of Diagnosis and Treatment of the Abdominal Trauma in Elder People / 中国普外基础与临床杂志

Objective To investigate the clinical features and strategy of diagnosis and treatment of the abdominal trauma in eld er people. Methods Clinical data of 68 elderly patients w ith abdominal trauma were analyzed retrospectively.Results Diagnosis in 35 of 68 cases were confir med within 12 hours after trauma (51.5%). Fifty-eight cases in this group were treated surgically and 10 cases with non-surgical treament.The re were 7 death, the overall mortality was 10.3% . The cause of death was septic shock and multiple organ systemic failure. Conclusion The elder patient with abdominal tra uma has its speciality in clinical and pathophysiological characteristics and is less tolerant to trauma, which easily leads to misdiagnosis or maldiagnosis. T he principle of treatment is to choose positive surgery, to streng then the peri operative management, to protect the function of each important organ, and to pr event the occurrence of multiple organ dysfunction syndrome.