Associations between isomers and alternatives of per- and polyfluoroalkyl substances and fasting blood glucose / 环境与职业医学

Background Previous research indicated that isomers and alternatives of per- and polyfluoroalkyl substances (PFAS) probably disturb glucose metabolism; however, current epidemiological evidence on the associations of PFAS with fasting blood glucose is inconsistent. Besides, studies on the joint association of multiple components of PFAS and fasting blood glucose as well as the key component are scarce. Objective To evaluate the associations of PFAS isomers and alternatives with fasting blood glucose and their joint effects, as well as identify the key component among population without glucose metabolism problems. Methods We selected 923 adults without glucose metabolism problems or missing data from the Isomers of C8 Health Project in China (2015—2016). Serum PFAS isomers and alternatives and fasting blood glucose were measured using ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) and automatic biochemical analyzer. We applied multiple linear regression to explore the associations of 16 pollutants which were detected among over 80% participants with fasting blood glucose. Meanwhile, we utilized qgcomp and Bayesian kernel machine regression (BKMR) models to explore the joint effects of PFAS isomers and alternatives mixture on target outcome indicators and identify the key component. Results The average age among the 923 participants in this study was (62.4±13.8) years old, including 472 men (51.1%) and 451 women (48.9%). Among selected PFAS isomers and alternatives, the highest serum concentration was ∑3+4+5m-PFOS (perfluoro-3/4/5-methylheptanesulfonate) with a median concentration of 10.20 ng·mL−1. The concentrations of linear perfluorooctane sulfonate (n-PFOS, 9.61 ng·mL−1), perfluorooctanoic acid (PFOA, 4.55 ng·mL−1), linear perfluorohexane sulfonic acid (n-PFHxS, 2.48 ng·mL−1), 6:2 chlorinated polyfluorinated ethersulfonic acid (6:2 Cl-PFESA, 1.90 ng·mL−1), perfluoro-6-methylheptanesulfonate (iso-PFOS, 1.85 ng·mL−1), perfluorobutanoic acid (PFBA, 1.81 ng·mL−1), perfluorinated n-nonanoic acid (PFNA, 1.39 ng·mL−1), and perfluoro-1-methylheptanesulfonate (1m-PFOS, 1.27 ng·mL−1) were higher than 1.00 ng·mL−1. After being adjusted for selected confounders, PFAS isomers and alternatives were positively associated with fasting blood glucose. With 1 ln unit concentration increment of 6:2 Cl-PFESA and PFNA, the estimated changes of fasting blood glucose were 0.18 (95%CI: 0.13, 0.23) mmol·L−1 and 0.24 (95%CI: 0.18, 0.30) mmol·L−1, respectively. The multi-pollutant models indicated a joint association of PFAS isomers and alternatives mixture with fasting blood glucose. The BKMR models reveals that as the quantiles of mixture elevated from the 50th to the 75th percentile, the values of fasting blood glucose increased 0.25 (95%CI: 0.21, 0.30) mmol·L−1, and the posterior inclusion probability of PFNA was 0.92, implying that PFNA was the key component. Conclusion PFAS isomers and alternatives are positively associated with fasting blood glucose. PFNA is the key component of the joint association.

Summary of best evidence and practice recommendations for nonpharmacological interventions of urinary incontinence in elderly women / 中华健康管理学杂志

Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.

Three cases of congenital adrenal hypoplasia with hypogonadotropic hypogonadism due to novel NR0B1 mutation / 中华内分泌代谢杂志

Objective:To advance the understanding of X-linked adrenal hypoplasia congenita(XL-AHC)through genetic analysis.Methods:Genomic DNA was extracted from peripheral blood of three patients with XL-AHC and their family members as well. Pathogenic genes were screened with whole exome sequencing followed by Sanger sequencing and pedigree verification.Results:All three probands were diagnosed as primary adrenal insufficiency at early age and developed hypogonadotropic hypogonadism in adolescence. The proband 1 was hemizygous for c. 420delG(p.R141Gfs*123)mutation in exon 1 of NR0B1 gene. His mother was a heterozygous mutation carrier while his brother did not carry the mutation, which was consistent with the X-linked recessive inheritance. A hemizygous mutation c. 212_213delAA(p.K71Rfs*41)of NR0B1 gene was detected in both proband 2 and proband 3. These two novel mutations were not reported in HGMD database.Conclusions:In this study, two novel NR0B1 mutations, c. 420delG and c. 212_213delAA were identified in 3 patients with XL-AHC. For men with early onset of adrenocortical hypofunction, XL-AHC should be considered. Early genetic screening of NR0B1 gene is helpful for early diagnosis.

Study on genetic etiology of three cases of Kallmann syndrome using whole-exome sequencing / 中华内分泌代谢杂志

Objective:Kallmann syndrome(KS) is a complex genetic disease characterized by congenital hypogonadotropic hypogonadism and anosmia. More than 20 genes have been reported to be associated with KS. Herein, we explore potential genetic aberration in 3 KS patients using the whole-exome sequencing. The potentially pathogenic variants filtered were validated by Sanger sequencing.Methods:Genomic DNA was extracted from the peripheral blood of 3 patients with KS and their family members. Sanger sequencing and pedigree verification were performed on the pathogenic variants identified using whole-exome sequencing. The function of the mutation sites were analyzed with bioinformatics software.Results:The proband 1 was a 25 years old male, characterized by lower gonadotropin gonad hypofunction, early grey hair and bilateral sensorineural hearing loss. A heterozygous mutation c. 475C>T(p.R159W) of SOX10 gene was detected in the proband 1. His mother, sister and cousin who had KS phenotype were also found carrying this mutation, showing an autosomal dominant inheritance. The proband 2 was a 15-year-old male with hypogonadotropic hypogonadism and unilateral renal agenesis. The proband was hemizygous for c. 844delC(p.R282Vfs*28) of ANOS1 gene, his mother was heterozygous for the mutation, which was consistent with the X-linked recessive inheritance. The proband 3 was a 21 years old female, characterized by hypogonadotropic hypogonadism and anosmia. A heterozygous missense mutation c. 149G>A(p.R50Q) was detected in FGF17 gene. The mutation p. R50Q was predicted to be pathogenic by the SIFT and PolyPhen2 programs, and has not been reported in HGDM database yet, which considered to be a novel mutation.Conclusion:KS is a clinically and genetically heterogeneous disease. In this study, ANOS1 c. 844delC, SOX10 c. 475C>T and FGF17 c. 149G>A mutations were found in 3 patients with KS by whole exome sequencing, which would expand the genotypic and phenotype spectrum of KS.

Effect of liaison nurse-led relocation program on the relocation stress in family members of neurosurgery patients after ICU transfer / 中国实用护理杂志

Objective:To investigate the effect of liaison nurse-led relocation program on the relocation stress in family members of neurosurgery patients after ICU transfer.Methods:A total of 90 neurosurgery patients and family members were randomly divided into study group (45 cases) and control group (45 cases) . Participants in the control group received routine nursing, while the study group carried out liaison nurse-led relocation program. Family relocation stress scale and family caregiver task inventory-Chinses version was used to assessed relocation stress, care ability of the families before and after intervention.Results:After intervention, the scores of separation anxiety, environmental changes, nursing model changes, the safety of transfer, self-efficacy of care ability and total relocation stress scores were 15.20±2.42, 7.14±1.63, 7.68±2.12, 7.10±1.73, 8.25±1.94 and 49.69±6.96 in the study group, those scores were 16.93±4.19, 9.42±2.31, 10.53±2.64, 8.06±2.12, 10.39±1.62 and 42.56±4.68 in the control group. The scores of separation anxiety, environmental changes, nursing model changes, the safety of transfer, self-efficacy of care ability and total relocation stress scores were lower in the study group compared to the control group ( t value was 2.400-5.678, P<0.05). After intervention, the scores of FCTI such as care role, strain and provide assistance, handle personal emotions, assess family and community resources and adjust life to meet care needs and total scores were 4.16±0.66, 5.28±0.73, 3.51±0.65, 3.99±0.83, 4.52±1.07 and 21.46±1.73 in the study group, those scores were 7.63±1.30, 6.82±1.08, 4.94±0.94, 5.08±1.09, 7.17±1.51 and 31.65±3.09 in the control group. The scores of care role, strain and provide assistance, handle personal emotions, assess family and community resources and total FCTI scores significantly decreased in the study group compared to the control group ( t value was 5.343-19.268, P<0.05). Conclusion:The liaison nurse-led relocation program can effectively prevent the level of relocation stress and improve the care ability of family members of neurosurgery patients after ICU transfer.

MRI appearance of pancreatic neuroendocrine neoplasms correlation with pathological grade:comparative study / 中华放射学杂志

Objective To analyze MR imaging appearance of pancreatic neuroendocrine neoplasms (pNEN) and to investigate the practical value of MR imaging appearance in predicting pathological grade of pNEN. Methods All data of 35 patients with pathologically proven pNEN were retrospectively reviewed. MR examinations of the abdomen were performed on all these patients before operation and the data of clinical, pathological and MR imaging were intact. Both plain scan and contrast-enhanced MR scan were performed on each patient. Histopathological grade of pNEN was defined as: G1, G2, and G3 according to World Health Organization classification of tumours of the digestive system guidelines(2010). Image analysis included tumor location, number, size, shape, lesion margins, signal intensity, enhancement pattern, main pancreatic duct dilatation, extrapancreatic spread, and metastases of lymph node and liver. The comparison of quantitative index between G1 and G2 group was performed with t test. Categorical variables were tested using Fisher exact test. Results Thirty five lesions were found in 35 patients, with 14 lesions in G1, 19 lesions in G2, and 2 lesions in G3.Thirty three lesions appeared as a solid mass, and 2 lesions appeared as a cystic lesion. Significant gender-based difference was found between G1 group and G2 group (P0.05). Of the 35 lesions, 27 lesions were round in shape, while other 8 lesions were irregular. There were 18 lesions with clear margin, and the margins in other 17 lesions were blurred. Main pancreatic duct dilatation was found in 3 cases(1 in G2, 2 in G3). Significant differences in tumor diameter, shape, margin, signal intensity on precontrast images, extrapancreatic spread and metastases were found between G1 group and G2 group(P<0.05). No significant difference was found in main pancreatic duct dilatation or signal intensity on all enhancement phases between G1 group and G2 group. The 2 lesions in G3 group appeared mild contrast enhancement with degrees lower than the pancreas in all enhancement phases. Conclusion MR imaging features such as tumor diameter, shape, margin, signal intensity on precontrast images, extrapancreatic spread and metastases may preoperatively predict the pathological graden of pNEN.

The relationship between psychiatric symptoms and burden of caregivers in senile dementia patients / 中华老年医学杂志

Objective To investigate the occurrence and severity of behavioral and psychological symptoms of dementia(BPSD)in elderly dementia patients,and to explore the relationship of the degree of dementia and the severity of BPSD with the burden of caregivers in pension agency.Methods Using a convenient sampling method,the Clinical Dementia Rating (CDR) scale,neuropsychiatric scale (NPI)and Zarit caregiver burden scale(ZBI)were used to evaluate 145 patients with Alzheimer's disease and caregiver burden in Hangzhou.Results The incidence rate of BPSD was 51.8 ％ (72 cases),with a higher incidence rate of delusions of 22.3％ (31 cases),a higher severity of sleep disorder/nocturnal behavior [NPI symptom score (5.95 ± 4.60) points].The symptom making a greatest burden on the caregivers was delusion [ZBI score (32.81 ± 17.66) points].There were positively correlations of the burden of caregivers with the degree of dementia and the severity of BPSD (r=0.434,0.710,all P＜0.01)in patients with senile dementia.Conclusions The incidence rate of BPSD in dementia patients is higher,and the occurrence of BPSD is associated with the severity of mini mental state examination(MMSE)and dementia,which increases the burden of caregivers.More attention should be paid to BPSD in patients with senile dementia.And the social support system serving patients with senile dementia and their caregivers should be further improved.

Van Wyk-Grumbach syndrome: A case report and literature review / 中南大学学报(医学版)

Van Wyk-Grumbach syndrome (VWGS) is a rare complication of prolonged untreated juvenile hypothyroidism characterized by precocious puberty and enlarged multicystic ovaries. A 13-year-old girl visited our outpatient clinic due to menstrual irregularities. She had precocious puberty, pituitary hyperplasia and multiple cystic ovaries in addition to clinical signs of severe congenital hypothyroidism. After the initiation of L-thyroxine therapy, the symptoms were alleviated in a short time. This rare syndrome is easy to be misdiagnosed as pituitary and ovarian tumor. High degree of suspicion and timely diagnosis can prevent unnecessary surgical procedures because the symptoms can be reversed with thyroid hormone supplementation.

Analysis of the Features of Facial Complexions in 129 Children with Bronchial Asthma / 世界科学技术-中医药现代化

This study aimed to investigate the clinical significance of facial color features' evaluation in the dignosis and the treatment of bronchial asthma (BA) in children,providing an objective basis and therapeutic evaluation for its clinical studies.Parameters of the fratures of facial complexions of 129 children with BA were detected using.TCM-Ⅰ Smart type of life information analysis system.Then the parameters of the features of facial complexions in the children was analyzed and explored.It was found that red faces were common in asthma children during the acute stage,while withered faces were presented in the children with BA during the remission stage,lacking bright cheeks in the children of both the two stages.The H values and the S values of the features of facial complexions in the children with BA were significantly higher than those of the healthy children (P ＜ 0.05),while the V values of the children with BA were significantly lower than those of the healthy children (P ＜ 0.05).Besides,the H values and the V values of the features of facial complexions in the children with BA during the acute period were significantly lower than those in the remission stage (P ＜ 0.05).In conclusion,it was demonstrated that the characteristics of facial complexions may provide an objective basis for the prognosis of bronchial asthma in children.

MRI features and pathological grading of hepatic neuroendocrine neoplasm / 中华肝胆外科杂志

Objective To compare the MRI features of hepatic neuroendocrine tumors (NET G1,G2) and neuroendocrine carcinomas (NEC G3),as well as to improve the accuracy in hierarchical diagnosis.Methods Twenty patients with histopathologically proven NET and nineteen patients with histopathologically proven NEC were retrospectively analyzed.The morphological and MR signal features were compared.Results The morphological features of vascular invasion (P ＜ 0.05) and lymphadenectasis or necrosis (P ＜ 0.05),as well as the MR signal features on portal phase (P ＜ 0.05) and delayed phase (P ＜0.05) were different between the NET group and the NEC group;contrast to noise ratios (CNR) were also different between the two groups (x2 =5.14,P ＜ 0.05),CNR of the NEC group on both arterial phase (Z =121.75,P ＜ 0.05) and portal phase (Z =139.31,P ＜ 0.05) were significantly lower than the NET group;ROC analysis of CNR demonstrated an area under the curve of 0.729 (P ＜ 0.05) on portal phase,when the optimal cut-off value of-61.38 was used,a sensitivity of 90.0％ and a specificity of 63.2％ can be achieved.Conclusions MRI plays an important role in the hierarchical diagnosis of hepatic neuroendocrine neoplasms.The signs of vascular invasion,lymphadenectasis or necrosis as well as the MR signal features during dynamic enhanced scanning are of great value in differentiating NETs from NECs.

Clinical observation of lafutidine treated in curing peptic ulcer / 中国综合临床

Objective To observe the clinical efficacy and safety of application of lafutidine treated in curing peptic ulcer.Methods Eighty-four patients with peptic ulcer were randomly assigned to receive either lafutidine(10 mg) twice daily in 42 patients of cured group or lansoprazole (30 mg) once daily for 4 weeks in 42 patients of control group.Ulcer healing rate and clinical performance were examined after treatment.Results The first,third and seventh day of peptic ulcer healing rate were 38.09％ (16/42), 71.42％ (30/42) and 90.47％ (38/42) in the lansoprazole group and 23.81％ (10/42), 76.19％ (32/42) and 85.71％ (36/42) in the lafutidine group.There were no siginificant difference between two groups (P =0.157,0.620, 0.736).Gastroscope examination showed the complete healing rate, average healing rate and general clinical effectiveness were 61.90％(26/42) ,30.95％(13/42) and 97.61％(41/42) in the lansoprazole group,while the number for lafutidine group were 57.14％ (24/42), 28.57％ (12/42) and 95.23％ (40/42).There were no siginificant difference between two groups (P =0.657, 0.811, 1.000).No severe side-effect was occurred in both groups.Conclusion Use Lafutidine to cure peptic ulcer can promote healing effectively, improve patients' clinical symptoms which is similar to lansoprazole.

Effect of glucagon like peptide-1 on proliferation and differentiation of endothelial progenitor cells and its mechanism / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect and mechanism of glucagon like peptide 1(GLP-1)on the proliferation and differentiation of endothelial progenitor cells(EPCs)derived from the peripheral blood.@*METHODS@#Mononuclear cells were isolated from human peripheral blood by density gradient centrifugation. After 7 days of culture,attached cells were stimulated with different cultures of 0.2% BSA,and GLP-1(1,10,and 20 nmol/L). Laser scanning confocal microscope was used to determine the EPCs from human peripheral blood.The activity of EPCs was observed under reverse microscope. MTT was used to determine the proliferation of EPCs. The expression of KDR,Flt-1,VE-cadherin,and eNOS mRNA was detected by RT-PCR.The concentration of serum VEGF was detected by ELISA. The expression of VEGF protein was detected by immunohistochemical SP method. The EPCs cultured in GLP-1 were intervened by VEGFmAb.@*RESULTS@#EPCs was proliferated more in the GLP-1 group(1,10,and 20 nmol/L) than in the control group (P<0.05 or P<0.01). The expression of KDR,FLT-1,VE-cadherin,eNOS mRNA and VEGF protein was higher than that in the control group(P<0.05 or P<0.01). VEGFmAb(100 ng/mL)down-regulated the expression of KDR,Flt-1,VE-cadherin,and eNOS mRNA.@*CONCLUSION@#GLP-1 can promote the proliferation and differentiation of EPCs derived from the peripheral blood by up-regulating VEGF autocrine.

Establishment of cell line stably expressing INSIG2 and its effects on fat metabolism / 基础医学与临床

Objective To establish the cell line stably expressing INSIG2 and observe its effecet on fat metabolism after overexpression of INSIG2.Methods The eukaryotic expression plasmid pcDNA3.1(+)-INSIG2 was constructed,which was transfected into 3T3-L1 cells.The expression of INSIG2 and related genes were detected by RT-PCR and immunohistochemistry,the contents of FFA in cell culture medium and adipocyte differentiation were detected by ELISA and Oil Red "O"staining respectively.Results After pcDNA3.1(+)-INSIG2 was transfected into the 3T3-L1 cells,the expression of INSIG1 mRNA and FAS mRNA were down-regulated,the content of FFA in the cell culture medium was decreased and adipocyte differentiation was drepressed.Conclusion The cell line stably expressing INSIG2 was successfully established,the transfected INSIG2 may have a drepressant effect on fat metabolism.

The influence of short-term intensive insulin therapy on ?-cell function in newly diagnosed type 2 diabetes / 中国糖尿病杂志

Objective To observe the influence of short-term continuous subcutaneous insulin infusion(CSII)on ?-cell function in newly diagnosed type 2 diabetes(T2DM).Methods A total of 32 inpatients with newly diagnosed T2DM who had a 14-day course of CSII were randomly assigned to two groups of OGTT and arginine stimulating test(AST).Before and after 3 days and 14 days CSII treatments,OGTT and AST were performed respectively.The changes of the values of plasma glucose,HOMA-IR,HOMA-? and △C30/△G30,△C120/△G120 or arginine-induced acute C-peptide reaction(ACRARG)in two groups were compared.Results In OGTT,the values of plasma glucose and HOMA-IR were decreased,HOMA-? and △C120/△G120 were increased significantly after CSII therapy,both in day 3 and day 14;and △C30/△G30 were unchanged after 3 days but increased markedly after 14 days.However,in ACRARG,the above mentioned parameters almost remained unchanged after CSII treatment in 3 days or 14 days.Conclusions In newly diagnosed T2DM with elevated fasting glucose levels,intensive insulin therapy can partly improve ?-cell function showed by OGTT,not by AST.