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ObjectiveTo investigate the association between urinary thallium （TL） and nonalcoholic fatty liver disease （NAFLD）. MethodsRelated data were collected from the registered participants aged ≥18 years in National Health and Nutrition Examination Survey from 2017 to 2020， with th exclusion of the individuals with a lack of liver transient elastography data and urinary TL indicators and those with hepatitis B， hepatitis C or significant alcohol consumption. A total of individuals were divided into NAFLD group and non-NAFLD group. Urinary TL level was quantitatively measured using high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry and online solid-phase extraction combined with isotope dilution. The two groups were compared in terms of age， sex， race， marital status， education， family income poverty impact ratio （FMPIR）， body mass index （BMI）， smoking， alcohol consumption， diabetes mellitus （DM）， hypertension （HTN）， hyperlipidemia （HL）， and urinary TL level. The independent-samples t test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Descriptive analysis， multivariable Logistic regression， restricted cubic spline regression analysis， subgroup analysis， and interaction analysis were conducted to investigate the risk association between urinary TL and NAFLD. ResultsA total of 2 511 individuals were included， with 1 612 （64.20%） in the NAFLD group and 899 （35.80%） in the non-NAFLD group， and the NAFLD group had a significantly higher urinary TL level than the non-NAFLD group ［0.18 （0.11 — 0.26）μg/L vs 0.16 （0.09 — 0.25）μg/L， Z=-2.76， P=0.01］. After adjustment for the covariates of age， sex， race， education， marital status， FMPIR， BMI， smoking， alcohol consumption， DM， HTN， and HL， the urinary TL Q4 group had a significant increase in the risk of NAFLD （odds ratio ［OR］=1.90， 95% confidence interval ［CI］： 1.48 — 2.44， P<0.01）. There was a positive dose-response relationship （P<0.01） and a non-linear relationship （P<0.01） between urinary TL and the risk of NAFLD. A significant interaction was observed between urinary TL and smoking/BMI （P<0.05）. For individuals taking ≥100 cigarettes in their lifetime， the risk of NAFLD was increased by 50% for every quartile increase in urinary TL （OR=1.50， 95%CI： 1.24 — 1.80）， and for individuals taking<100 cigarettes in their lifetime， the risk of NAFLD was increased by 20% for every quartile increase in urinary TL （OR=1.20， 95%CI： 1.03 — 1.40）； for individuals with a BMI of ≥30 kg/m2， the risk of NAFLD was increased by 30% for every quartile increase in urinary TL （OR=1.30， 95%CI： 1.05 — 1.70）， with a statistical significance （P<0.05）. ConclusionUrinary TL level is significantly associated with the risk of NAFLD.
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Polygonum multiflorum （PM）， a commonly used Chinese herbal medicine in clinical practice， has been associated with frequent reports of liver injury in recent years， and the medication safety of PM has attracted more and more attention in China and globally. This article reviews the recent research advances in the signaling pathways and mechanisms of PM in causing drug-induced liver injury （DILI） and aims to provide new ideas for the proper and rational use of PM in clinical practice. The results show that PM is involved in the regulation of various signaling pathways， and it leads to the death of hepatocytes by destroying mitochondrial function， exacerbating bile acid accumulation， and inducing immune response， oxidative stress， and endoplasmic reticulum stress， thereby inducing the development and progression of DILI through multiple targets， pathways， and levels.
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Objective:To investigate the independent predictors of colorectal polyps complicating colorectal laterally spreading tumors (CLST) and the independent risk factors for malignancy in CLST coexisting with colorectal polyps.Methods:Clinical data of 260 patients with CLST who underwent endoscopy and received treatment in the Second Affiliated Hospital of Dalian Medical University from January 2016 to December 2021 were retrospectively collected. Patients were divided into the coexisting group ( n=135) and the non-coexisting group ( n=125) according to the presence or absence of polyps. Differences in clinicopathological characteristics between the two groups were compared and binary logistic regression was used to analyse the predictors of coexistence. Then the coexisting group was further divided into coexisting malignant group ( n=38) and coexisting non-malignant group ( n=97) according to the infiltration depth of CLST, and binary logistic regression was used to analyse the risk factors for malignancy in CLST coexisting with colorectal polyps. Results:Male ( P=0.002, OR=2.355, 95% CI:1.354-4.099), villous tubular adenoma ( P=0.022, OR=3.873, 95% CI: 1.214-12.355) and polyps history ( P=0.001, OR=2.738, 95% CI: 1.527-4.909) were independent predictors for colorectal polyps coexisting with CLST. Area under the curve (AUC) of the predictive model was 0.725 ( P<0.001, 95% CI: 0.664-0.786). Polyp diameter≥10 mm ( P=0.007, OR=6.266, 95% CI:1.634-24.034), CLST diameter≥20 mm ( P<0.001, OR=11.879, 95% CI:4.078-34.601), granular-mixed type CLST ( P=0.003, OR=8.584, 95% CI: 2.126-34.660), flat-elevated type CLST ( P=0.021, OR=4.399, 95% CI: 1.250-15.482) and pseudo-depressed type CLST ( P<0.001, OR=31.426, 95% CI: 4.975-198.509) were independent risk factors for malignancy in CLST coexisting with polyps. AUC of the predictive model was 0.854 ( P<0.001, 95% CI: 0.775-0.933). Conclusion:Male CLST patients with polyps history and a pathological type of villous tubular adenoma are more likely to develop coexistence. In patients with CLST which is granular-mixed type, flat-elevated type and pseudo-depressed type coexisting with colorectal polyps, the larger the diameter of the polyp and the diameter of the CLST, the more likely it is to be malignant.
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Objective:To analyze the clinical and pathological characteristics of colorectal laterally spreading tumor (CLST) and provide reference for clinical diagnosis and treatment of CLST.Methods:From January 1, 2016 to June 30, 2021, the clinical data of patients with CLST who underwent endoscopic resection at the Second Affiliated Hospital of Dalian Medical University were retrospectively collected. The clinical and pathological characteristics of CLST were analyzed in terms of lesion location (right colon, left colon, rectum) and morphological type (granular-homogeneous type, granular-mixed type, flat-elevated type, and pseudo-depressed type). One-way analysis of variance, Pearson′s chi-square test and Fisher′s exact test were used for statistical analysis.Results:A total of 266 patients with CLST and 296 CLST lesions were included. The most common maximum diameters of the lesions were 10 to 29 mm, accounting for 85.1% (252/296). The main morphological type was granular type, accounting for 81.4% (241/296), and the main pathological type was adenoma, accounting for 79.7% (236/296), and the most common histological type was low-grade intraepithelial neoplasia (LGIN), accounting for 81.1% (240/296). The maximum diameter of CLST lesion of rectum was larger than that of the right colon and the left colon ((24.20±16.97), (18.38±8.24) and (18.59±7.95) mm, respectively), and the difference was statistically significant ( F=6.62, P<0.001). The detection rate of granular-homogeneous type CLST in rectum was lower than that in the right colon and the left colon (22.0%, 11/50, 53.5%, 69/129 and 58.9%, 69/117, respectively), while the detection rate of granular-mixed type CLST in rectum was higher than that in the right colon and the left colon (50.0%, 25/50; 29.4%, 38/129 and 24.8%, 29/117, respectively), and the differences were statistically significant ( χ2=20.06 and 10.67, both P<0.01). The incidence of adenoma in CLST in the right colon was lower than that in the left colon and rectum (68.2%, 88/129; 87.2%, 102/117 and 92.0%, 46/50, respectively), while the incidence of serrated adenoma in CLST in the right colon was higher than that in the left colon and rectum (30.2%, 39/129; 12.8%, 15/117 and 4.0%, 2/50, respectively), and the differences were statistically significant ( χ2=19.25 and 20.85, both P<0.001). The CLST in left colon was mostly treated by endoscopic submucosa dissection (94.9%, 111/117), while the CLST in rectum was mostly treated by endoscopic mucosal resection (20.0%, 10/50), and the difference was statistically significant ( χ2=8.77, P=0.012). The maximum diameter of the pseudo-depressed type CLST was larger than that of the granular-homogeneous type, granular-mixed type and flat-elevated type ((24.18±14.07), (15.96±5.70), (23.49±13.80) and (21.21±8.02) mm), and the difference was statistically significant ( F=13.40, P<0.001). The incidence of adenoma in flat-elevated type CLST was higher than that of the granular-homogeneous type, granular-mixed type and pseudo-depressed type (92.1%, 35/38; 71.1%, 106/149; 86.9%, 80/92 and 15/17, respectively), and the difference was statistically significant ( χ2=14.13, P=0.003). The incidence of serrated adenoma in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (28.9%, 43/149; 10.9%, 10/92; 5.3%, 2/38 and 1/17, respectively), and the difference was statistically significant ( χ2=19.98, P<0.001). The incidence of adenocarcinoma in the pseudo-depressed type CLST was higher than that of the granular-homogeneous type, granular-mixed type and flat-elevated type (1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38, respectively), and the difference was statistically significant (Fisher′s exact test, P=0.049). The incidence of LGIN in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (90.6%, 135/149; 76.1%, 70/92; 65.8%, 25/38 and 10/17, respectively), while the incidences of high-grade intraepithelial neoplasia and carcinoma in the pseudo-depressed type CLST were higher than those of the granular-homogeneous type, granular-mixed type and flat-elevated type (6/17; 9.4%, 14/149; 21.7%, 20/92; 31.6%, 12/38 and 1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38), and the differences were statistically significant( χ2=21.58 and 16.81 and Fisher′s exact test, all P<0.05). Conclusions:The clinicopathological characteristics of CLST have certain specificity. The maximum diameter and malignant potential of the rectal CLST are both larger and higher than those of the colonic CLST. Although the granular-mixed type CLST is the granular type, it shows a larger maximum diameter and a higher degree of malignancy.
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Background: Previous studies have found that patients with gastrointestinal diseases have a higher incidence of headache, while migraine patients are often accompanied by gastrointestinal symptoms. Understanding the relationship between diseases can provide new ideas for the study of its mechanism. Aims: To explore the co-occurrence and related risk factors of gastroesophageal reflux disease (GERD), functional dyspepsia (FD), irritable bowel syndrome (IBS) and migraine without aura (MWoA). Methods: A total of 2 696 adult rural residents in Shaanxi Province were investigated by random stratified sampling. MWoA, GERD, FD and IBS were diagnosed based on ICHD-IIIβ, Montreal classification and Rome , respectively. The prevalence of the single disease and overlapping prevalence of MWoA were calculated. The prevalence rates of GERD, FD and IBS between MWoA group and non-MWoA group were compared, and the disease-related risk factors were analyzed. Results: In this study, a total of 2 423 valid questionnaires were collected. The prevalence rates of GERD, FD and IBS were 12.5%, 15.6% and 6.9%, respectively, and the prevalence rate of MWoA was 8.8%. The prevalence rates of GERD (30.5% vs. 10.7%), FD (37.1% vs. 13.5%) and IBS (27.2% vs. 4.9%) in MWoA group were all higher than those in non-MWoA group (P all < 0.001). Multivariate analysis showed that female, hypertension, chronic motor system diseases were positively correlated with GERD, FD, IBS and MWoA. Conclusions: There is a certain association between GERD, FD, IBS and MWoA.
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Objective To observe the therapeutic effect of Shenluo'an Decoction(SD) for the treatment of obese patients with early diabetic nephropathy and to explore the possible mechanism.Methods A total of 68 obese patients with early diabetic nephropathy were randomly assigned into control group and treatment group,34 cases in each group.Both groups were given conventional western medicine treatment including lifestyle regulation,dietary control,and medicine for lowering blood pressure,blood glucose and blood lipids.Additionally,the control group was given oral use of Irbesartan,and the treatment group was given oral use of SD combined with Irbesartan.Before and after treatment,we observed the traditional Chinese medical syndrome scores,body mass index(BMI),blood levels of cystatin C (Cys C),β2-microglobumin(β2-MG),homocysteine (Hcy) and fasting blood glucose (FBG),and urine parameters of urinary monocyte chemoattractant protein-1 / urinary creatinine (UMCP-1/UCR),urinary factor of regulated on activation in normal T cell expressed and secreted / urinary creatinine (URANTES/UCR),urinary albumin-to-creatinine ratio (UACR) and urinary albumin excretion ratio (UAER) before treatment and after treatment for 16 weeks.After treatment,the clinical efficacy and safety were also evaluated.Results (1) During the treatment,5 cases were dropped out,and a total of 63 cases (32 from the treatment group and 31 from the control group) completed the experiment.(2) The total effective rate of the treatment group(90.6％) was significantly higher than that of the control group(67.7％),the difference being significant(P ＜ 0.05).(3)BMI of the two groups after treatment was significantly lower than that before treatment (P ＜ 0.05).(4) After treatment,the traditional Chinese medical syndrome scores,blood parameters (Cys C,β2-MG,Hcy,FBG) and urine parameters (UMCP-1/UCR,URANTES/UCR,UACR,UAER) in the treatment group were decreased as compared with those before treatment and those in the control group after treatment(P ＜0.05).(5) A positive correlation was present among the parameters of UMCP-1/UCR,URANTES/UCR,UACR and UAER.(6) No abnormal changes took place in the blood and stool routine examination,hepatic function,or electrocardiography of the 63 cases.Conclusion SD combined with western medicine exerts certain therapeutic effect for obese patients with early diabetic nephropathy,and is effective on relieving clinical symptoms anddecreasing BMI,Cys C,β2-MG,UACR,UAER,UMCP-1 and URANTES.Its mechanism is probably related with the inhibition of chronic renal inflammation.
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Objective To observe the influence of Shenkang injection with Irbesartan on urinary albumin excretion rate(UAER)in 24 hours,serum lipid and blood rheology in early diabetic nephropathy.Methods One hundred and fifty normotensive early diabetic nephmpathy were randomly divided into control group,Shenkang injection group and Shenkang injection with Irbesartan group.Three groups were treated with diabetic education,dietary regimen,suitable physical activity and oral anti-hyperglycemic agents till their fasting blood glucose(FBG)was less than 7.0 mmol/L and postprandial blood glucose(PBG)was less than 10.0 mmol/L.The control group was treated with oral anti-hyperglycemic agents or/and insulin.Shenkang injection group was additionally treated with Shenkang solution.Shenkang solution was mixed by Shenkang injection 100 ml,5% glucose 250 ml and insulin 2-3 U.Shenkang solution was intravenously guttaed once a day.Shenkang injection with Irbesartan group was additionally treated with Irbesartan 0.15 g,once a day,taken orally.A course was taken for 3 weeks.The levels of UAER,serum lipid and blood rheology were detected immediately and 9 weeks after treatment.Results In the Shenkang injection group,compared with those before treatment,them were significant difference in UAER (87.44 ±10.06)μg/min vs.(116.55 ± 33.42)μg/min),serum lipid( (4.22 ± 0.70)mmol/L vs.(4.88 ± 0.69 )mmol/L)and blood rheology( (5.77 ±0.53)mPa·s vs.(7.38 ± 0.41)mPa·s)(P ＜ 0.05).In the Shenkang injection with Irbesartan group,compared to those before treatment,there were also significant difference in UAER ( (61.90 ±28.02)μg/min vs.(123.37 ± 29.98)μg/min),serum lipid( (4.00 ± 0.14)mmol/L vs.(4.90 ± 0.12)mmol/L)and blood rheology( (5.11 ±0.41)mPa·s vs.(7.27 ± 0.44)mpa·s)(P ＜ 0.05).Whearas in the control group,no significant difference were found compared with those before treatment.Furthermore,the improvements in the Shenkang injection with Irbesartan group were better than those in the Shenkang injection group(P ＜ 0.05).Conclusions Shenkang injection can reduce UAER,decrease serum lipid and improve renal blood rheology.Iteffectively prevents diabetic nephropathy in earlier period and maybe have synergy with Irbesartan.
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Objective To investigate the protective effects and mechanism of Pentoxifylline(PTX) on rats with renal interstitial fibrosis following unilateral ureteral obstruction(UUO).Methods The rats were randomly divided into 5 groups: Sham operation group(group A),UUO group(group B),Enalapril group(group C),PTX group(group D) and PTX plus Enalapril group(group E).On the 3th,7th and 14th day after operation,5 rats of each group were sacrificed by exsanguinations,respectively.The concentration of hydroxyproline was measured,and the ratio of collagen and renal weight was tested.The expressions of transforming growth factor-?1(TGF-?1),tissue inhibitor of metalloproteinase-1(TIMP-1),vascular endothelial growth factor(VEGF),bone morphogenetic protein-7(BMP-7),NF-?B and CD34 were measured by immunohistochemistry.The peritubular capillary index(PCI) was regarded as the expression of CD34.Results The ratio of collagen and renal weight in the rats of group B was higher than that of other 4 groups(P