A short-time economic evaluation of various modalities of glutamine dipeptide-enriched parenteral nutrition support in patients undergoing elective surgery for gastrointestinal tumors using decision-tree model / 中华临床营养杂志

Objective To assess the short-time economics of various glutamine dipeptide-enriched parenteral nutrition (PN) for patients undergoing elective surgery for gastrointestinal tumors, with an attempt to provide evidence for decision makers on clinical nutrition support.Methods A prospective cohort study was designed.From payer/disburser''s perspective, a cost-effectiveness decision-tree model was developed to assess the clinical outcomes and short-time economic effects of glutamine dipeptide-enriched PN that used in different time points (early postoperative or perioperative).Cost-effectiveness analysis, cost-utility analysis, and incremental cost-effectiveness analysis were adopted in the decision-tree model.One-way sensitivity analysis was performed to determine the robustness of the results.Results Totally 107 patients were included.There was no significant difference between the perioperative alanine(Ala) glutamine(Gln) nutrition support (group A) and early postoperative Ala-Gln nutrition support (group B) in the ratio of 5％ weight declines on the 8th day after surgery and infection-related postoperative complications (72.1％ vs.78.1％, χ2=0.509, P=0.498 and 2.32％ vs.4.69％, χ2=0.060, P=0.806).The levels of prealbumin (PA) and albumin(Alb) and the level of total lymphocyte count(TLC) also the time of recovering gastrointestinal function, length of stay nutritional discharge index(LOSNDI), and direct costs were significantly different [PA:(208.19±56.92)mg/L vs.(187.97±62.05)mg/L, t=2.283,P=0.039;Alb:(33.82±3.91)×109 vs.(31.96±4.57)×109, t=2.184, P=0.036;TLC:(1.19±0.55)×109 vs.(0.89±0.66)×109, t=2.461, P=0.015;the time of recovering gastrointestinal function(3.06±0.28)d vs.(3.39 ± 0.34)d, t=-3.675, P=0.000;LOSNDI:(16.84±2.92)d vs.(18.52 ±3.47)d, t=-2.613, P=0.011;direct costs:￥(17 029.05±317.28) vs.￥(15 610.64±292.56), t=23.764, P=0.000].When LOSNDI and quality-adjusted life years (QALYs) were estimated as indicators of effectiveness, the incremental cost-effectiveness ratios and incremental cost-utility ratios of group A were ￥844.3 and ￥70 920.5, respectively.Net monetary benefit of group B was more than that of group A.One-way sensitivity analysis showed that parameters had no significant effect on the model.Conclusion When using local per capita gross domestic product as threshold, early postoperative Ala-Gln PN was more economical than perioperative Ala-Gln PN strategy evaluation.

Impact of pre-setted adaptive statistical iterative reconstruction Veo on radiation dose and image quality of chest CT scanning: Chest model and clinical study / 中国医学影像技术

Objective To explore the impact of pre-setted generation adaptive statistical iterative reconstruction Veo (ASiR-V) on chest CT radiation dose and image quality.Methods The chest model and 120 patients (divided into 6 groups,each n=20) were scanned by GE Revolution CT under the condition of pre-setted ASiR-V weights for 0,20％,40％,60％,80％ and 100％ respectively.The tube voltage was 120 kV,the tube current was automated mAs (Smart mA10-500) technology,the noise index was 11.The dose-length product of each chest model group and patients group were record,the effective dose (ED) of each group was calculated and compared.The image quality among groups through combining the objective CT and standard deviation (SD) values of different organizations (lung tissue,the soft tissue near by spine,the aorta and vertebral body) in chest model and the image subjective rating of patients were compared,and the subjective score of patients' images was also compared among groups.Results With the increase of pre-setted ASiR-V,the ED of chest model and patients reduced as a logarithmic fitting,there are no obvious changes of the CT value and image noise SD value of different organizations in model.The subjective score of mediastinal and pulmonary window was begin to decline at 40％ weighted ASiR-V.The subjective score of mediastinal and pulmonary window descend obviously at 60％ weighted ASiR-V compare to 40％ (P＜0.05).ED of pre-setted 40％ weighted ASiR-V reduced to 57.21％ compared to that of 0 weighted ASiR-V.Conclusion The pre-setted ASiR-V can reduce the radiation dose,and does not affect the objective image quality at the same time.The pre-setted 40 ％ weighted ASiR-V has the highest clinical application value due to the radiation dose can be obviously reduced with ensuring the image quality,which can meet the demand of diagnosis.

Empirical Study on Qi-yin Deficiency Syndrome of Type 2 Diabetes Based on Structural Equation Model / 中国中医药信息杂志

Objective To verify the relationship between qi-yin deficiency syndrome and the etiology and diagnostic information on type 2 diabetes mellitus.Methods Data of 185 cases of qi-yin deficiency syndrome of type 2 diabetes and 351 cases of other syndromes at TCM Hospital of Hongqiao District in Tianjin and Metabolic Disease Hospital of Tianjin Medical University were randomly collected. Etiology and diagnostic information of qi-yin deficiency syndrome were screened by the likelihood radio of forward step method by using Logistic regression analysis. On this basis, the relationship between qi-yin deficiency syndrome and the etiology and diagnostic information was verified by using maximum likelihood estimation method of the structural equation model.Results The goodness of fit index of the model (GFI) was 0.909; root mean square residual (RMR) of that was 0.071; comparative fit index (CFI) of that was 0.942, which suggested that the fitting effect of the model was good. The reasonable interpretation of the relationship between qi-yin deficiency syndrome and the etiology and diagnostic information was given. Conclusion From the aspect of single syndrome factors, the relationship between qi-yin deficiency syndrome and the etiology and diagnostic information on type 2 diabetes mellitus is verified.

The impact of non-alcoholic fatty liver disease on islet function in type 2 diabetes / 中华内科杂志

Objective To analyze the influence of hepatosteatosis on pancreatic β-cell function in type 2 diabetes mellitus (T2DM).Methods A total of 213 subjects with T2DM from Metabolic Disease Hospital,Tianjin Medical University from January 2013 to December 2013 were included in the study.Non-alcoholic fatty liver disease (NAFLD) was diagnosed with abdominal ultrasonography.Patients were divided into two groups:T2DM with NAFLD and T2DM without NAFLD.ALT,AST,γ-glutamyltransferase,serum lipid,glycosylated hemoglobin A1 c (HbA1c),fructosamine,fasting glucose,insulin and 2 hours plasma glucose,insulin after 75g glucoseload were detected.The insulin resistance and β-cell function were assessed by HOMA-IR and HOMA-β.Results Among the 213 T2DM subjects,51％ (108 cases) were with NAFLD.The HOMA-IR [4.76 (2.83,7.21) vs 2.79 (1.76,4.37),P ＜ 0.05] and HOMA-β [49.18 (37.78,85.09) vs 29.50 (18.09,45.54),P ＜ 0.05] were significantly higher in T2DM with NAFLD than those in T2DM alone.Within subjects with T2DM and NAFLD,the HOMA-IR [6.28 (2.87,8.17) vs 2.95 (2.07,3.66) P ＜ 0.05] and HOMA-β [59.18 (37.78,85.09) vs 30.59 (28.56,34.49),P ＜ 0.05] levels were higher in subjects with normal liver function than those with abnormal liver function.Conclusions T2DM patients with NAFLD have severer insulin resistance than those without NAFLD.The β-cell function of those patients was compensatory increased,which was decreased in subjects with abnormal liver function.

Cephalometric study on mandibular positions of functional anterior crossbite before and after treatment / 实用口腔医学杂志

Objective:To analysis the relationship of cephalometric measurements from intercuspal position(before and after treat-ment)and retruded contact position(before treatment).Methods:18 cases with Class III malocclusion were treated using MBT straight wire appliance technique,all the incisal relationships could be edge-to-edge when the mandible was retruded,X-ray films of intercus-pal position and retruded contact position before treatment and intercuspal position after treatment were taken.The cephalometric meas-urements were statistically analysed by ANOVA.Results:After 25 months treatment the anterior crossbite were corrected in all cases. The molar relationship were class Ⅰ.The measurements of SNB,ANB,MP-FH,MP-SN,U1-SN,L1-MP,Y-axis angle and ANS-Me were significantly changed.Conclusion:After the treatment of Class III malocclusion by MBT straight wire appliance,the sagittal and vertical mandibular location can be between intercuspal position and retruded contact position of pretreatment,and it is more close to the retruded contact position.

Detection of cortical architecture of rat brain using high-resolution 7.0 T manganese-enhanced MRI in vivo / 中华放射学杂志

Objective To study the role of manganese-enhanced MRI(MEMRI) in the depiction of cortical architecture of rat brain after systemic administration of Mn~(2+) through caudal vein and compare the effects of normal or opened blood-brain barrier on the manganese-enhanced MRI. Methods Fifteen SD rats were randomly divided into three groups according to ranked list of random. Blood-brain barrier was opened in short time by the injection of 30% mannitol via the right internal carotid artery, in group A, then 100 mmol/L MnCl_2 physiologic saline solution was delivered through vena caudalis, and MRI was performed 12 hours later. In group B, 100 mmol/L MnCl_2 physiologic saline solutions was administrated through vena caudalis, following normal saline injection into the right internal carotid artery, and MRI was performed 12 hours later. The group C served as normal control group. All images were acquired with a 7.0 T microMR scanner. Signal-to-noise ratios (SNR) in regions of interest were measured by Paravision 4.0 and the differences of three groups were compared by using one-way ANOVA. The differences of SNR on both sides of hemispheres were compared by using paired t test. Results MEMRI could show the gray matter and white matter of rat brain and the anatomy borders between somatosensory cortex and motor cortex clearly. Periventricular structures such as hippocampus, dentate gyms, habenula united, and olfactory bulb could also be showed clearly. Symmetrical enhancement on both sides of the cortex and banded structures was shown clearly in group B. The SNR increased and the differences were significant in right cerebral cortex, both sides of cerebellar cortex, hippocampus and pituitary, among three groups (right cerebral cortex 35.2±7.0,30.1±2.4,26.6±2.8,F =4.36,P=0.038;left cerebellar cortex 27.1±5.2,29.4±3.8,19.4±4.5, F=6.66, P=0.011;right cerebellar cortex 27.8±3.8,28.5±4.2,20.4±4.8, F=5.84, P=0.017; left hippocampus 34.5±4.9,38.1±5.3,24.5±3.6, F=11.38, P=0.002; right hippocampus 35.3±5.5, 37.6±4.7,25.6±3.0,F=9.93,P=0.003;pituitary 39.5±3.8,52.6±9.1,26.2±4.2,F=22.80, P=0.001) after systemic administration of Mn~(2+). Asymmetric enhancement on two sides of cortex was shown in group A. The mannitol-infused side was enhanced obviously but displayed blurring banded structures. However,the SNR differences of both sides of hemispheres in group A and B were not significant (P >0.05). Conclusions After systemic administration of MnCl_2 through vena caudalis, MEMRI could map the laminar architectures and the anatomy border of functional zone of somatosensory cortex specifically. High concentration of mannitol could open blood brain barrier(BBB) effectively and have distinct impacts on the architectures displayed in MEMRI. Opening or maintaining BBB in MEMRI had respective characteristics, and it should be selected according to practical needs.

Three-dimensional perfusion imaging in acute cerebral infarction / 中国医学影像技术

Objective To assess the value of whole cerebral perfusion weighted map (PWM) and whole cerebral perfusion blood volume (PBV) integrating in scan protocol about CT perfusion (CTP) combined with CT angiography (CTA) in acute cerebral infarction. Methods Twenty-three patients with acute cerebral infarction proved clinically underwent CTP examination combined with CTA. The color-coded images of PWM and PBV were attained using workstation, and the raw data of contract CTA images and subtractive images between contract CTA and non-contract CTA were processed. The diagnostic sensitivity and the value of CTP and PWM, PBV integrating CTP in acute cerebral infraction were evaluated. Results Seven of 9 patients with negative results on CTP images had positive expressions on PWM and PBV images. The sensitivity of CTP was 60.87% and the sensitivity of PWM and PBV integrating CTP was 91.30%. Conclusion The scan protocol of PWM, PBV integrating CTP not only increases detection rate of acute cerebral infraction, but also has ability to predict the clinical prognosis of patients with cerebral infraction.

Correlation between N-terminal Pro-brain Natriuretic Peptide and Cardiac Diastolic and Systolic Function / 中国康复理论与实践

@#Objective To study the correlation between N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac diastolic and systolic function. Methods 60 New Zealand male rabbits were randomly assigned to two groups. The abdominal aorta 1 cm just above right renal artery were constricted in operated group. The clinical manifestation of heart failure was observed, and cardiac structure and function were investigated with echocardiography. Concentration of serum NT-proBNP was determined regularly. Results The concentration of NT-proBNP was correlated with Sm（r=－0.635,P=0.000）, Em（r=－0.693,P=0.000）, E/Em（r=0.688,P=0.000）, E/Vp（r=0.707, P=0.000）, and EF（r=－0.395,P=0.001）. Conclusion Concentration of serum NT-proBNP could prognose the diastolic and long axis systolic function of left ventricle.

Changes of Systolic and Diastolic Function after Constriction of Abdominal Aorta (above Renal Artery) in New-Zealand Rabbit / 中国康复理论与实践

@#Objective To establish an animal model of heart failure with preserved ejection fraction(EF)resulting from hypertension.Methods35 male New-Zealand rabbits were randomly assigned to 2 groups:constriction was performed at the abdominal aorta 1 cm just above right renal artery in operated group(n=25),and the sham-operated animals were taken as control group(n=10).The clinical manifestations of heart failure were followed up carefully.Systolic and diastolic function,and systemic hemodynamics were investigated with echocardiography and left ventricle catheter.ResultsIn operated group,marked ventricular hypertrophy was observed 2 weeks after operation.4 weeks after operation,the clinical manifestations of heart failure presented,and IVRT and LVEDP increased,and-dp/dt max decreased.Tissue doppler image indicated that e/a ratio of annulus of mitral valve decreased(P<0.05).However,EF and +dp/dt max were preserved.ConclusionThe operated animals presented the clinical manifestation of heart failure,and diastolic function of left ventricle injured,however,ejection fraction was preserved,which corresponded with the character of heart failure with preserved ejection fraction resulting from hypertension.