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Sarcopenia and hip fractures are musculoskeletal system diseases, which cause great harm to the health of geriatric population.As sarcopenia is receiving more and more attention in recent years, its relationship with hip fractures has been increasingly noted.The paper summarized the epidemiological evidences on the relationship between sarcopenia and hip fracture and investigated the possible etiologic mechanism by which sarcopenia triggers hip fractures.
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Objective:To investigate the effect and mechanism of Acyl-CoA: lysocardiolipin acyltransferase 1 (ALCAT1) on hepatocyte steatosis and oxidative stress in fatty liver cell model.Methods:A fatty liver cell model was established and induced by free fatty acids (FFA). The expression of ALCAT1 in fatty liver cell model was detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting. The empty siRNA plasmid and ALCAT1 siRNA plasmid were constructed. For the fatty liver cell model group, human normal hepatocytes (L-02 cells) were transfected with empty siRNA plasmid for 24 hours, and then cultured with FFA for 24 hours. For the ALCAT1 interfering group, L-02 cells were transfected with ALCAT1 siRNA plasmid for 24 hours, and then cultured with FFA for 24 hours. And L-02 cells cultured in common medium were used as as blank control group. Lipid droplet deposition and mitochondrial morphology were observed under transmission electron microscopy. The expression levels of autophagy-associated proteins (microtubule-associated protein 1 light chain 3 (LC3)-Ⅱ and Beclin1) and key proteins of autophagy signal pathway (mammalian target of rapamycin (mTOR) and serine/threonine kinase (AKT)) were measured by Western blotting. The expression levels of oxidative stress products (malondialdehyde, 4-hydroxynonenal (4-HNE) and reactive oxygen species (ROS)) and inflammatory factors (interleukin-6(IL-6) and tumor necrosis factor (TNF)-α) were detected by enzyme-linked immunosorbent assay (ELISA) kits. Independent sample t test was used for statistical analysis. Results:The mRNA and protein expression levels of ALCAT1 of the fatty liver cell model group were both higher than that of negative control group (9.26±0.83 vs. 1.02±0.12, 0.35±0.02 vs. 0.17±0.01), and the differences were statistically significant ( t=9.82 and 6.83, both P<0.05). The results of electron microscopy indicated that the deposition of lipid droplets of the fatty liver cell model group and ALCAT1 interfering group were both higher than that of blank control group (17.67±3.52 and 7.67±0.33 vs. 4.33±0.33), the quantity of lipid droplets deposition of ALCAT1 interfering group was lower than that of fatty liver cell model group (7.67±0.33 vs. 17.67±3.52), and the differences were statistically significant ( t=3.76, 7.07 and 2.82, all P<0.05). The degree of mitochondria swelling of fatty liver cell model group was higher than that of blank control group and the degree of mitochondria swelling of ALCAT1 interfering group was lower than that of fatty liver cell model group. The results of Western blotting showed that the expression level of LC3-Ⅱof the fatty liver cell model group was higher than that of the blank control group (0.43±0.01 vs. 0.28±0.02), and the difference was statistically significant ( t=7.32, P<0.05). However there was no significant difference in the expression level of Beclin1 between fatty live cell model group and blank control group (0.93±0.05 vs. 0.98±0.05, P>0.05). The expression levels of LC3-Ⅱ and Beclin1 of the ALCAT1 interfering group were both higher than those of the fatty liver cell model group and blank control group (0.95±0.04 vs. 0.42±0.01 and 0.28±0.02, 2.07±0.06 vs. 0.93±0.05 and 0.98±0.05), and the differences were statistically significant ( t=13.30, 15.63, 14.05 and 13.02, all P<0.05). The expression levels of mTOR of the fatty liver cell model group and ALCAT1 interfering group were both lower than that of the blank control group (1.44±0.02 and 0.74±0.01 vs. 1.93±0.10), the expression level of mTOR of the ALCAT1 interfering group was lower than that of the fatty liver cell model group (0.74±0.01 vs. 1.44±0.02), and the differences were statistically significant ( t=4.83, 12.04 and 32.14, all P<0.05). The expression levels of phosphorylated AKT of the fatty liver cell model group and ALCAT1 interfering group were both lower than that of the blank control group (0.14±0.01 and 0.07±0.01 vs. 0.28±0.01), while the expression level of phosphorylated AKT of the ALCAT1 interfering group was lower than that of the fatty liver cell model group (0.07±0.01 vs. 0.14±0.01), and the differences were statistically significant ( t=8.59, 14.10 and 5.96, all P<0.05). The results of ELISA indicated that the expression levels of ROS, malondialdehyde, 4-HNE, IL-6 and TNF-α of the fatty liver cell model group and the ALCAT1 interfering group were all higher than those of the blank control group ((11.44±0.30) and (5.84±0.36) g/L vs. (1.72±0.38) g/L; (19.94±2.47) and (11.95±1.55) μmol/L vs. (1.47±0.18) μmol/L; (5.00±0.43) and (2.99±0.37) ng/L vs. (1.46±0.23) ng/L; (203.40±5.16) and (92.07±11.98) ng/L vs. (23.32±3.33) ng/L; (123.70±8.38) and (67.42±4.88) ng/L vs. (47.18±4.57) ng/L), and the differences were all statistically significant ( t=19.86, 7.86, 7.45, 6.74, 7.22, 3.49, 29.34, 5.53, 8.02 and 3.03, all P<0.05). While the expression levels of ROS, 4-HNE, IL-6 and TNF-α of the ALCAT1 interfering group were all lower than those of the fatty liver cell model group ((5.84±0.36) g/L vs. (11.44±0.30) g/L, (2.99±0.37) ng/L vs. (5.00±0.43) ng/L, (92.07±11.98) ng/L vs. (203.40±5.16) ng/L and (67.42±4.88) ng/L vs. (123.70±8.38) ng/L), and all the differences were statistically significant ( t=11.99, 3.51, 8.54 and 5.81, all P<0.05). There was no statistically significant difference in the expression of malondialdehyde between ALCAT1 interfering group and fatty liver cell model group ((11.95±1.55) μmol/L vs. (19.94±2.47) μmol/L, P>0.05). Conclusions:The expression of ALCAT1 is up-regulated in fatty liver cell model. Knockdown of ALCAT1 can inhibit the expression of mTOR pathway proteins, activate autophagy, alleviate hepatocyte steatosis, oxidative stress and inflammatory response.
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Objective:To analyze the predictive value of P504S for pathological upgrading of gastric low-grade intraepithelial neoplasia (LGIN) after endoscopic submucosal dissection (ESD).Methods:Data of 117 patients (119 lesions) who underwent ESD for LGIN at Huadong Hospital from January 2015 to March 2019 were analyzed retrospectively. Biopsy and ESD specimens were collected. According to pathology, specimens were divided into the LGIN group (postoperative pathology of non-upgrade) and the upgrade group (postoperative pathology of upgrade). The positive rates of P504S were compared between biopsy and postoperative specimens of the LGIN group, and between biopsy and postoperative specimens of the upgrade group. The consistency of the expression of P504S was examined between the biopsy specimens and the postoperative specimens in the LGIN group and the upgrade group. Receiver operator characteristic (ROC) curve of the prediction of pathological upgrading was drawn by the results of P504S in biopsy, and the cutoff value of immunohistochemical staining score was calculated.Results:The positive rate of P504S in the biopsy specimens of the LGIN group (46.8%, 36/77) was lower than that in the biopsy specimens of the upgrade group (73.2%, 30/41) with significant difference ( P=0.006). The positive rate of P504S in the postoperative specimens of the LGIN group (51.9%, 40/77) was lower than that in the postoperative specimens of the upgrade group (82.9%, 34/41) with significant difference ( P=0.001). In the LGIN group, the positive rate of P504S in biopsy specimens (46.8%, 36/77) was lower than that in postoperative specimens (51.9%, 40/77) without significant difference ( P=0.289). The expression of P504S was consistent between biopsy specimens and postoperative specimens with good consistency( K=0.793, P<0.001). In the upgrade group, the positive rate of P504S in biopsy specimens (73.2%, 30/41) was lower than that in the postoperative specimens (82.9%, 34/41) without significant difference ( P=0.219). The expression of P504S was consistent between biopsy and postoperative specimens, and the consistency was general ( K=0.579, P<0.001). ROC curve was drawn for the prediction of pathological upgrading by the results of P504S in biopsy, and the cutoff value of immunohistochemical staining score was 100. The sensitivity and specificity of pathological upgrading for positive result were 0.659 and 0.740, respectively. Conclusion:P504S staining of the postoperative specimens facilitates identification of the degree of gastric mucosal neoplasia. When the cutoff value of staining score is 100, the staining of P504S in biopsy tissue plays a role in predicting the pathological upgrading.
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Objective To investigate and analyze serological and hepatic morphological changes in aged rats with non-alcoholic fatty liver disease(NAFLD)by establishing NAFLD model with SD rats at different months of age.Methods Male SD rats were randomly divided into four groups according to age:the aged model group (18-months-old),the aged control group (18-months-old),the young model group (2-months-old) and the young control group (2-months-old),with 12 rats in each group.Rats in the model groups and the control groups were fed a 45％ high-fat diet and a normal diet,respectively,for eight weeks.Serum biochemical indexes and the insulin index were measured.Hepatic histological changes were evaluated under a light microscope following HE staining and Oil red staining.Results The body and liver weights of the rats increased with age,and the average rate of weight growth and liver wet weight of the model groups were higher than those of their corresponding control groups (P ＜ 0.01).Levels of serum alanine aminotransferase (ALT),triglycerides(TG),cholesterol(CHOL),glucose(GLU),fasting insulin(FINS)and homeostatic model assessment of insulin resistance(HOMA-IR)in the aged model group were higher than those in the corresponding control group and of the young model group(P ＜0.05).Under the light microscope,hepatic cells stained with HE and Oil red showed diffuse swelling and were full of lipid vacuoles in the model groups.In the aged model group,hepatic cells were characterized by macrovesicular steatosis with focal necrosis.Conclusions Clear hyperlipemia,hyperglycemia and hyperinsulinemia can be seen in a NAFLD model induced by short-term high-fat feeding.Insulin resistance and decreased insulin sensitivity are more significant in aged rats with NAFLD.
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Objective@#To investigate and analyze serological and hepatic morphological changes in aged rats with non-alcoholic fatty liver disease(NAFLD)by establishing NAFLD model with SD rats at different months of age.@*Methods@#Male SD rats were randomly divided into four groups according to age: the aged model group(18-months-old), the aged control group(18-months-old), the young model group(2-months-old)and the young control group(2-months-old), with 12 rats in each group.Rats in the model groups and the control groups were fed a 45% high-fat diet and a normal diet, respectively, for eight weeks.Serum biochemical indexes and the insulin index were measured.Hepatic histological changes were evaluated under a light microscope following HE staining and Oil red staining.@*Results@#The body and liver weights of the rats increased with age, and the average rate of weight growth and liver wet weight of the model groups were higher than those of their corresponding control groups(P<0.01). Levels of serum alanine aminotransferase(ALT), triglycerides(TG), cholesterol(CHOL), glucose(GLU), fasting insulin(FINS)and homeostatic model assessment of insulin resistance(HOMA-IR)in the aged model group were higher than those in the corresponding control group and of the young model group(P<0.05). Under the light microscope, hepatic cells stained with HE and Oil red showed diffuse swelling and were full of lipid vacuoles in the model groups.In the aged model group, hepatic cells were characterized by macrovesicular steatosis with focal necrosis.@*Conclusions@#Clear hyperlipemia, hyperglycemia and hyperinsulinemia can be seen in a NAFLD model induced by short-term high-fat feeding.Insulin resistance and decreased insulin sensitivity are more significant in aged rats with NAFLD.
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Objective To evaluate the value of near focus narrow-band imaging ( NF-NBI ) in differentiating hyperplastic polyp ( HP ) and sessile serrated adenomas/polyp ( SSA/P ) . Methods Data of 65 cases of pathologically confirmed HP or SSA/P with clear NF-NBI images in Huadong Hospital Affiliated to Fudan University from October 2017 to September 2018 were retrospectively analyzed. Three senior doctors observed the images of NF-NBI, including expanded crypt opening ( ECO ) and thick & branched vessel ( TBV) . The results were compared with pathological results in order to analyze differential diagnostic value of ECO and TBV for HP and SSA/P. Results Among 65 lesions, 44 were SSA/P and 21 were HP. The sensitivity, specificity, and accuracy of ECO, TBV, and ECO combined with TBV for differential diagnosis between HP and SSA/P were 80. 3％( 106/132 ) , 85. 7％( 54/63 ) and 82. 1％( 160/195 ); 38. 6％( 51/132) , 82. 5％( 52/63 ) , and 52. 8％( 103/195 ); and 84. 8％( 112/132 ) , 73. 0％( 46/63 ) , and 81. 0％(158/195), respectively. Conclusion ECO under NF-NBI has a high sensitivity for diagnosis of SSA/P . ECO combined with TBV is helpful for differential diagnosis between HP and SSA/P .
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Objective To evaluate the effectiveness and associated factors of prevention of motherto-child human immunodeficiency virus (HIV) transmission in Hubei Province,and to provide a reference for prevention of mother-to-child transmission of HIV.Methods In this prospective cohort study,HIV-positive pregnant women who were in some counties and cities of Hubei Province from January 2004 to December 2016 were enrolled.Prevention of mother-to-child transmission of HIV was conducted for these HIV-positive pregnant women and their infants,and their clinical data were collected.Descriptive analysis and x2 test were used to analyze the general characteristics of HIV-positive pregnant women and their infants.Logistic regression analysis was adopted to explore the associated factors of mother-to-child HIV transmission.Results In total,536 HIV-positive pregnant women (628 pregnancies) were found,among which,334 pregnant women and 345 infants were enrolled in this study.Twenty-four infants were HIV-positive,which was 6.96％ in all infants (95％CI:4.27％-9.64％).The rates of mother-to-child HIV transmission without prevention,formula feeding only,infant medication plus formula feeding,mother and infant medication plus formula feeding were 35.71％ (95％CI:21.61％-51.93％),8.82％ (95％CI:2.08％-15.57％),7.41％ (95％CI:0.92％-24.22％),and0.48％ (95％CI:0.01％-2.64％),respectively.No antiretroviral medications during delivery (OR =14.484,95 ％CI:1.740-120.577,P=0.013),breastfeeding (OR=6.542,95％CI:2.416-17.713,P=0.000),and CD4-T lymphocyte count＜200 cells/μL during delivery (OR=3.060,95％CI:1.076-8.703,P=0.036) were independent risk factors of mother-to-child HIV transmission.Conclusions The rate of mother-to-child HIV transmission without prevention is high in Hubei Province,which can be significantly reduced by comprehensive interventions (mother and infant medication plus formula feeding).Thus,we should diagnose HIV-positive pregnant women as early as possible,and should give pregnant woman antiretroviral therapy plus infant medication and formula feeding to further reduce the rate of mother-to-child HIV transmission.
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Objective To examine the prevalence ofHelicobacter pylori in Shanghai and relevant risk factors, evaluate the resistance proifle ofH. pylori isolates to antibiotics used in ifrst-line therapy in two hospitals in Shanghai.MethodsH. pylori were isolated from the biopsy samples of gastric mucosa collected from September 2013 to January 2015. Antimicrobial susceptibility test was performed by E-test method for 131H. pylori strains to 4 antibiotics, clarithromycin, metronidazole, amoxicillin and tetracycline. Results A total of 955 patients receiving gastroscopy were enrolled. And 248 (26.0%)H. pylori strains were isolated from the biopsy samples of gastric mucosa. Overall, 14.5%, 64.1%, 0 and 0.8% of the strains were resistant to clarithromycin, metronidazole, amoxicillin and tetracycline, respectively. Resistance to two drugs was found in 10.7%(14/131) of the strains, and majority (92.8%, 13/14) of which were resistant to clarithromycin and metronidazole.Conclusions The prevalence ofH. pylori in gastric mucosa is rather lower compared with the data reported previously. It is associated with the sex, age and clinical outcome of patients, however, antibiotic resistance profile is not related to these factors.H. pylori eradication therapy should be individualized according to the results of susceptibility test in Shanghai.
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Objective To explore the operational methods and effect of craniopharyngioma resection via fronto-basal interhemisheric approach. Methods The clinical data of 31 patients who had underwent craniopharyngioma resection via fronto- basal interhemisheric approach were analyzed retrospectively. Results The saddle area structures of all the 31 patients were revealed well. The tumor total resection was in 19 cases (61.3%), and the tumor subtotal resection was in 12 cases (38.7%). The vision and field of vision after surgery were improved. Six cases (19.4% ) presented electrolyte disturbance, and 15 cases (48.4%) presented diabetes insipidus. Conclusions The fronto-basal interhemisheric approach can clearly expose the anatomical structures in midline and saddle area. This approach is safe and effective for craniopharyngioma resection.
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Objective To evaluate the effect of colonoscopy with a transparent hood on the adenoma detection rate.Methods A prospective randomized controlled trial was performed.A total of 376 patients,who underwent colonoscopy for screening colorectal polyps,were randomly allocated to 2 groups:transparent hood group (TH group,n =190) and conventional colonoscopy group (CC group,n =186).Only one endoscopist performed all the colonoscopy examinations,recorded the withdrawal time,bowel preparation status,the number,shape,location,size of adenoma when withdrawing the endoscope.All the adenoma were removed under the colonoscopy.The pathological results were recorded,and the data and relative factors were analysed.Results A total of 317 adenomas were detected in 175 patients:172 adenomas in 99 patients of TH group,145 adenomas in 76 patients of CC group.Total ADR was 46.54％.ADR of TH group was 52.11％ and ADR of CC group was 40.86％ (P =0.029).A total of 40 adenomas were found behind the fold,32 in TH group and 8 in CC group(P ＜ 0.01).In cecum and transverse colon,there were more adenomas in TH group than in CC group.In cecum,there were 23 adenomas found in TH group,6 adenomas in CC group(P ＜0.05).In transverse colon,there were 46 adenomas in TH group,25 adenomas in CC group (P ＜ 0.05).In descending colon and rectum,there were more adenomas in CC group than in TH group.In descending colon,there were 16 adenomas TH group,and 30 adenomas in CC group.In rectum,there were 14 adenomas in TH group,24 adenomas in CC group(P ＜0.05).There was no significant difference in size or shape of adenomas found between two groups.Conclusion Colonoscopy with transparent hood for screening can increase the adenoma detection rate,especially the adenoma behind the fold.
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Background:Colonoscopy is considered as a standard method for detecting various kinds of colorectal polyps. However,conventional colonoscopy( CC)still has the chance to miss some lesions. Literatures have already reported that transparent hood assisted colonoscopy( THAC)can improve the detection of colorectal polyps. However,the effect of black hood assisted colonoscopy( BHAC)on detection of colorectal polyps is still unclear. Aims:To evaluate the effect of BHAC on detection of colorectal polyps. Methods:A total of 1 076 patients underwent CC and BHAC from Sept. 2014 to April 2015 at Huadong Hospital Affiliated to Fudan University were enrolled in this prospective randomized controlled study. Baseline characteristics,cecal intubation time,withdrawal time,number of polyps,detection rate of polyps,location, size,morphology and pathological diagnosis of polyps between two groups were compared. Results:Compared with CC group,cecal intubation time was significantly shorter in BHAC group than in CC group[(6. 31 ± 3. 51)min vs.(7. 05 ± 4. 15)min,P=0. 002]. No significant differences in withdrawal time and rate of cecal intubation were found between two groups(P>0. 05). Detection rate of polyps was significantly higher in BHAC group than in CC group(65. 4% vs. 48. 7%,P=0. 004). No significant differences in size,morphology of polyps were found between two groups(P>0. 05). Conclusions:Compared with CC,BHAC could significantly improve the detection of colorectal polyps,and shorten cecal intubation time.
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Objective To improve the knowledge of intestinal Behcet's disease.Methods From October 2012 to January 2014,36 patients with intestinal Behcet's disease were collected.The general information of the patients,manifestation of Behcet's disease,digestive symptoms,lab findings,imaging findings,endoscopic examination results,treatment and prognosis of Behcet's disease were analyzed.Chi square test and Fisher exact probability test were performed for count data analysis.Single factor and multi factors of efficacy were analyzed by Logistic regression analysis.Results Among 36 patients with Behcet's disease (male 19 and female 17),the mean onset age was 26.5 years old and the average course of disease was (8.2±6.8) years.Symptoms of digestive system of 91.7％ (33/36) patients showed up later than system manifestations of Behcet's disease appeared.All 36 patients had oral ulcer.The rates of genital ulcers,skin diseases,inflammation and joint disease were 63.9％ (23/36),58.3％ (21/36),25.0％ (9/36) and 25.0％ (9/36),respectively.The main symptoms of digestive system were abdominal pain,diarrhea,bloating and hemafecia,of which abdominal pain was the predominant symptom and the incidence rate was 75.0％ (27/36).Gastrointestinal bleeding,intestinal perforation,intestinal obstruction and arteriovenous fistula were the common complications of Behcet's disease and the incidence rates were 36.1％ (13/36),2.8％ (1/36),2.8％ (1/36) and 2.8％ (1/36),respectively.Among patients with ocular lesions,male patients were more than female patients (male six and female three),and the difference was statistically significant (x2 =0.111,P＜0.05).Erythrocyte sedimentation rate increased in 55.6％ (20/36) patients.C-reactive protein was positive in 27.8％ (10/36) patients.Nine patients received computed tomography (CT) examination,there were five cases with thickened bowel wall and one case with proliferative lesions at ileocecal valve.Ileocecum was the predilection site,and accounted for 36.1％ of the disease (13/36).Endoscopic appearance was mainly ulcers.Pathological examination indicated non-specific acute and chronic gastrointestinal mucosal inflammation and the formation of inflammatory granulation tissue.Twerty-two patients received sulfasalazine (SASP) treatment and 24 patients accepted glucocorticoid therapy.After Behcet's disease recurrence,five patients received combined immunosuppressive therapy,five patients received immunosuppressive therapy and tumor necrosis factor (TNF) antagonist treatment,and nine patients received TNF antagonist treatment.All the patients treated together with proton pump inhibitor (PPI).Twelve patients without glucocorticoid treatment took thalidomide and immunosuppressive therapy.The efficacy was good in patients with immunosuppressive therapy or TNF antagonist treatment and the recurrence rate was low (r=3.984,P ＜ 0.05).Conclusions Most patients with intestinal Behcet' s disease are young adults.Symptoms of digestive system show up later than system manifestations of Behcet's disease appeared.Ileocecum is the predilection site of digestive system.The common endoscopic appearance is ulcers.Corticosteroids and sulfasalazine are the main therapy,which could be much more effective when combined with tumor necrosis factor antagonists or immunosuppressive therapy.
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Objective To evaluate the methods and effects of modified surgical treatment for Amold-Chiari Ⅰ malformation complicated with syringomyelia.Methods Twelve patients with ArnoldChiari Ⅰ malformation complicated with syringomyelia,underwent a modified surgical treatment,effects were observed.Results During the first follow-up,sensation and motion function were significantly improved in 10 cases,unchanged in 2 cases.During the second follow-up,2 cases previously unchanged were improved,while the other were with no change.During the first follow-up,lesion showed on MRI disappeared in 5 cases,reduced in 4 cases,no significant change in 3 cases,no case extend,3 cases with hydrocephalus ventricle was significantly reduced.The second follow-up,MRI showed that there was no change compared with the first follow-up.Conclusion The remove of the pia mater of tonsillar hernia + reconstruction the cisterna magna have good effect on surgical therapies for Arnold-Chiari I malformation complicated with syringomyelia.
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Objective To investigate the relative percentage of normal cognitive function (NCF),age associated memory impairment (AAMI),mild cognitive impairment (MCI) and Alzheimer's disease (AD) in the elderly,and the correlation between cognitive function and ApoE genotypes.Methods A total of 2666 elderly people aged ≥65 years (2132 males and 534 females)were divided into 3 groups according age:65-74-year age group (925 cases),75-84 year age group (1054 cases) and 85-100-year age group (687 cases).ApoE genotypes were determined in the controls and patients with AAMI and MCI.The degrees of fundus arteriosclerosis were detected in all subjects except for patients with AD.Results There were 867 cases with NCF,860 cases with AAMI and 782 cases with MCI.The incidence of AAMI was higher in 65-74-year age group than in the other two groups (42.0％ vs.31.1,20.96).The incidences of MCI and AD were higher in 85-100-year age group than in the other groups (42.5％,13.3％).The major degrees of fundus arteriosclerosis were Ⅰ+,Ⅰ-Ⅱ°,Ⅱ in subjects with AAMI (34.7％,x2=10.02,P＜0.01) and were Ⅱ °/ Ⅱ + / Ⅲ° in subjects with MCI (34.9 ％,x2 =23.39,P＜0.001).The APOEε4 allele frequency was significantly higher in patients with MCI than in the controls (x2=8.31,P＜0.05).However,no significant differences in APOEε4 allele frequency were found between patients with AAMI and the controls.Conclusions The incidence of AAMI is highest in 65-74-year age group,while the incidences of MCI and AD are highest in 85-100-year age group.Compared to patients with AAMI,the more serious fundus arteriosclerosis and higher allele frequency of APOEε4 appear in patients with MCI.
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Objective To investigate the health-related quality of life (HRQoL) and its influencing factors in patients with gastric remnant cancer (GRC).Methods A total of 130 patients received gastrectomy more than 10 years ago because of early gastric cancer.According to the gastric remnant canceration after the surgery,patients were divided into GRC group (80 cases) and gastric remnant group (50 cases).Both the patients of these two groups accepted questionnaires of cancer patients' quality of life questionnaire (QLQ) C30 and gastric cancer specific questionnaire QLQ-STO22,the HRQoL were evaluated.The comparison between two groups with normal distribution of data was aralyzed by t test.Wilcoxon rank sum test was applied for the comparison between two groups with non-normal distribution of data.Optimal scaling regression analysis was used for screening HRQoL related clinical influencing factors.Results All the research objectives finished the questionnaires survey.Compared with health control group,the scores of GRC group were lower,which included quality of life evaluation,physical function,role function,emotional function,cognitive function and social function,and the differences were statistically significant (t =-6.678,-7.111,-10.605,-5.748,-4.765 and-21.170,all P＜0.01).The scores of fatigue,pain,diarrhea,nausea and vomiting,loss of appetite,economic difficulties,dysphagia,abdominal pain,reflux symptoms,diet restricted,anxiety,physical appearance and hair loss were higher,and the differences were significant (t=6.925,4.218,4.728 and Z=-5.236,-7.890,-7.698,-10.058,-3.612,-6.914,-9.711,9.940,-7.987 and-4.966,all P＜0.01).Compared with gastric remnant group,the scores of GRC group were lower,which included quality of life evaluation,physical function,role function,emotional function,cognitive function and social function,and the differences were statistically significant (t=-5.861,-5.821,-7.077,-7.999,-2.808and-5.710,all P＜0.01).However the scores of fatigue,pain,diarrhea,nausea and vomiting,loss of appetite,economic difficulties,dysphagia,diet restricted,anxiety,physical appearance and hair loss were higher,and the differences were significant (t=9.363,6.842 and Z=-2.654,-6.256,-3.266,-4.132,-2.854,-7.996,-4.258 and-2.005,all P＜0.01).Compared with health control group,the score of social function of gastric remnant group was lower and the difference was significant (t =-9.820,P＜ 0.01); the scores of diarrhea,nausea and vomiting,economic difficulties,dysphagia,reflux symptoms,diet restricted,physical appearance and hair loss were higher,the differences were statistical significant (t=3.020 and Z=-1.981,-3.775,-6.505,-6.098,-8.032,-3.369 and-3.147,all P＜0.05) ; the symptom scores of fatigue and pain were lower,the differences were significant (t=-2.890 and-2.439,all P＜0.05).HRQoL of patients was positively correlated with education degree,marital status,family income and the disease course of gastric remnant.Conclusions HRQoL of GRC patients decreased to certain degree.Education degree,marital status,family income and the disease course of gastric remnant were the influential factors of HRQoL in GRC patients.
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Objective To review the clinical features of drug-induced liver injury (DILI) in elderly Chinese patients.Methods A literature search was conducted with the key wordsdrug-induced liver injury ordrug-induced liver disease andelderly; four Chinese medical databases were used:including Chinese Biomedical Literature Database (CBM),Chinese Science and Technology Periodical Database (VIP),Wanfang Database and China National Knowledge Infrastructure (CNKI),from when the bases established to December 2011.Data from retrieved literatures of retrospective controlled studies of DILI were analyzed by SPSS 14.0 software.Results Five studies met the inclusion criteria,including 275 elderly patients (aged group) and 602 non-elderly patients (non-aged group) with DILL There was no significant difference in gender between the two groups (P ＞ 0.05).Clinical manifestations of jaundice,fatigue,anorexia,and skin itching were more commonly seen in the aged group (P ＜ 0.01).Cholestatic hepatic injury occurred more frequently in the aged group than in the non-aged group [24.9％ (61/245) vs.18.8％ (102/245),P ＜ 0.05],while hepatocellular type occurred more frequently in the non-aged group [64.3％ (350/544) vs.55.1％ (135/245),P ＜ 0.05].More DILI were induced by Chinese herb medicine and cardiovascular drugs in the aged group than in the non-aged group [47.0％ (79/168) vs.35.9％ (93/254) and 8.3％ (14/168) vs 1.2％ (3/259) respectively,P ＜ 0.05].As for the prognosis,there was no significant difference in clinical cure and improvement rate between the two groups [84.4％ (141/167) vs.81.5％ (291/357),P ＞0.05].Conclusion The elderly are more sensitive to the drugs and have a high risk of DILI.Prevention and timely diagnosis and treatment of DILI are particularly important for elderly patients.
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Objective To investigate the role of renin angiotensin system (RAS) in pathogenesis of nonalcoholic fatty liver disease (NAFLD).Methods Twenty-four Wistar rats were evenly divided into control group and model group.The rats of control group were fed with normal diet,and model group were with high-fat diet.Rats were killed at the eighth week and serum liver function,blood lipid,glucose and insulin were tested.The liver tissues were stained with HE and Picro acid-Sirius red for pathological observation.The liver tissue concentration of angiotensin Ⅱ was determined by ELISA method and the expression of TGF-β1 in liver tissue was examined by immunohistochemistry.Results After eight weeks high fat feeding,weight,liver index,liver function,blood lipids and serum insulin of model group were significantly higher than those of control group (weight:(463.50±22.72) g vs.(404.29±10.32) g; liver index:(3.75±0.21) g vs.(2.66±0.15) g; ALT:(79.8±8.6) U/L vs.(58.8±11.6) U/L; AST:(200.01±51.72) U/L vs.(150.30±37.27) U/L; total cholesterol:(3.67±0.48) mmol/L vs.(1.50±0.23) mmol/L; triglycerides:(2.06±0.40) mmol/L vs.(0.71±0.34) mmol/L; insulin:(17.37±2.89) pmol/L vs.(11.08±2.12) pmol/L),and all the differences were statistically significant (P＜0.01).The histopathological results of model group indicated liver steatosis,inflammatory reaction in part of lobule and portal area and significant fibrosis in part of liver tissue.The liver tissue angiotonin Ⅱ concentration of model group [(32.80 ± 2.81)pg/ml] was higher than that of control group [(22.83 ± 1.75) pg/ml,t =9.559,P＜0.01].The immunohistochemistry results showed that the expression of TGF-β1 of model group was obviously higher than that of control group (Z=-2.540,P =0.011 ).Spearman correlation analysis revealed that the increasing degree of angiotensin Ⅱ concentration was positively correlated with liver steatosis scores (r=0.644,P=0.002) and the expression of TGF-β1 (r=0.470,P=0.037).Conclusion The concentration of angiotensin Ⅱ and TGF-β1 increased in the livers of model rats,which indicated that RAS may participate in the pathogenesis and progress of NAFLD.
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Objective To investigate the diagnostic accuracy of 13C urea breath test (13C-UBT)in the diagnosis of Helicobacter pylori (Hp) infection in patients with gastric remnant.Methods A total of 94 gastric remnant patients (gastric remnant group) and 100 non-gastric remnant patients (control group) received 13C-UBT.According to the course of the disease,the gastric remnant group were divided into group 1 (29 cases,≤5 years),group 2 (33 cases,6 to 10 years) and group 3 (32cases,＞10 years).Before surgery,the diagnosis of Hp infection was according to 13C-UBT and gastric mucosa tissue staining.After surgery,the diagnosis was according to gastric mucosa tissue staining.The applying value of 13C-UBT in gastric remnant patients was evaluated.The consistency of results between 13C-UBT and gastric mucosa tissue staining were evaluated by the Kappa test.Results In gastric remnant group,the Hp infection rate after surgery (37.2％) was obviously lower than that before operation (79.8％;x2 =35.058,P＜0.01) and that of control group (77.0％).After surgery,the Hp infection rate of patients with Billroth Ⅱ gastrectomy (24.4％) was lower than that of patients with Billroth Ⅰ gastrectomy (47.2％ ; x2 =5.133,P=0.023).Before surgery,the Hp infection rate of gastric remnant subgroups were similar (P＞0.05).With the extension of the postoperative course,the Hp infection rate gradually decreased in gastric remnant subgroups (group 1:58.6％,group 2:36.4％,group 3:18.8％; x2=7.839,P=0.021).Setting the cut-off point at 2.0‰ in the gastric remnant group and 3.5‰ in the control group,the accuracy rate of diagnosis was the highest (92.6％ and 96.0％).There was good consistency between the results of 13C-UBT and gastric mucosa tissue staining (Kappa =0.84,P＜0.01).Conclusion With suitable operation and standard,13C-UBT may be a easy,safe and effective assay applied in the gastric remnant patients.
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Objective To evaluate changes of regional cerebral metabolism by proton MR spectroscopy (~1H-MRS) in patients with minimal hepatic encephalopathy (MHE) and to correlate these changes with the neuropsychological test. Methods Fifty-four patients with cirrhosis including nine patients with hepatic encephalopathy (HE),23 patients with MHE,22 patients without HE and 13 controls underwent neuropsychological tests and ~1H-MRS scanning. The volumes of interest included occipital gray matter and left parietal white matter regions. Ratio of spectral peak areas of N-acetylaspartate (NAA),choline (Cho),myo-inositol (mI),and glutamine/glutamate (Glx) relative to creatine (Cr) were acquired. Statistical analysis was conducted using independent t test and one-way analysis of variance. The results of different groups were compared by using the nonparametric Mann-Whitney U test with Bonferroni correction. Correlations among the ~1H-MRS ratios, the grade of HE, neuropsychological test and ammonia data were calculated with Spearman correlation test. Results The ratios of NAA/Cr,Cho/Cr,mI/Cr,Glx/Cr of the occipital gray matter and left parietal white matter regions in patients with cirrhosis are 1.55±0.12,0.48±0.10,0.42±0.14,2.52±0.48 and 1.73±0.17,0.75±0.16,0.42±0.16,2.75±0.59respectively,and they are 1.53±0.10,0.48±0.09,0.51±0.11,2.20±0.39 and 1.69±0.15,0.82±0.14,0.53±0.12,2.40±0.40 in patients without HE,1.58±0.13,0.48±0.08,0.38±0.13,2.62±0.39 and 1.78±0.18,0.74±0.14,0.38±0.15,2.84±0.58 in patients with MHE,1.54±0.12,0.50±0.13,0.29±0.07,3.04±0.31 and 1.70±0.19,0.62±0.16,0.29±0.07,3.37±0.38 inpatients with HE.Compared with controls, decreased mI/Cr and Cho/Cr ratios and elevated Glx/Cr ratios were found in patients with cirrhosis (t=3.196,9.394,-6.527,P＜0.01,occipital gray matter. t=5.592,9.717,-6.681,P＜0.01,left parietal white matter＝ and in subgroup of patients without HE, with MHE and HE (F=5.097,25.896,20.204,P＜0.01,occipital gray matter.F=16.435,28.660,21.283,P＜0.01,left parietal white matter).Significant difference in these metabolic alterations was also found among the different groups of cirrhosis especially the ratios of Glx/Cr in occipital gray matter and left parietal white matter (P＜0.0084).The ratios of mI/Cr also significantly altered between patients without HE and with MHE (P＜0.0084).There was a significant negative correlation between the ratios of Cho/Cr,mI/Cr and the grade of HE (P＜0.01＝ and a significant positive correlation between the ratios of Glx/Cr and the grade of HE (r=0.709,P＜0.01,occipital gray matter; r=0.720,P＜0.01,left parietal white matter＝.NCT-A and DST of controls is (49±8) s and 39±6.They are (134±37),(83±26),(64±22) second and 15±2,25±9,35±8 in patients with HE,MHE and without HE respectively.The metabolic alterations of Cho/Cr,mI/Cr,Glx/Cr correlated significantly with neurepsychological tests in all subjects (P＜0.01＝.There was a significant positive and a negative correlation between the ratios of Glx/Cr and the data of NCT-A and DST respectively (r=0.570,-0.642,occipital gray matter; r=0.541,-0.632,left parietal white matter).The metabolic alterations of Glx/Cr had no correlation with ammonia data as well as other metabolic alterations.Conclusions ~1H-MRS study shows cerebral metabolic alterations of gray and white matter in patients with cirrhosis,especially the reduction in mI/Cr ratio and increase in Glx/Cr ratio. These changes correlate well with the neuropsychological tests and may be useful in predicting the presence of MHE.