Objective To review systematically whether there is enough existing evidence that methylcobalamin is effective and safe in the treatment of the patients with diabetic peripheral neuropathy.Methods A Cochrane systematic review of all relevant randomized or quasi-randomized controlled trials of methycobalamin for diabetic peripheral neuropathy was performed. Clinical trials were searched from Cochrane Controlled Trials Register (Issue 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1980 to January 2004), the Chinese Biological Medicine Database (1978 to January 2004), the Chinese Science and Technology Journal Full-text Database (1989 to January 2004) and references of all included trials. The selection of studies, data extraction and assessment of methodological quality were performed independently by two reviewers. The following outcomes were assessed: effectiveness of clinical signs and symptoms, sensory nerve and motor nerve conduction velocities and serious adverse events of methylcobalamin. Results Thirty randomized clinical trials including 1 949 patients met the inclusion criteria. The quality of the most included trials was of low level. The "funnel plot" of the comparison of thirteen studies of methylcobalamin with other B Vitamins studies showed symmetry, which indicated less possible publication bias and the result was partly reliable, but it could not indicate the whole publication biases. The results of meta-analysis indicated that methylcobalamin showed significantly positive effects on the improvement of the signs and symptoms of peripheral neuropathy, and the effects were better than the other vitamin B agents. The increase of some nerves conduction velocities by methylcobalamin was better than by the other vitamin B. No serious adverse events were observed during the treatment period.Conclusions Methylcobalamin appears to be a safe and effective treatment on diabetic peripheral neuropathy. However, the evidence is not b because of the low quality of most trials. Rigorously designed, randomized, double-blinded, placebo-controlled trials of methylcobalamin for diabetic peripheral neuropathy are needed to further assess the effect.
Objective To systematically evaluate the effectiveness and safety of Puerarin on diabetic peripheral neuropathy. Methods A systematic review and evaluation of all available relevant randomized or quasi-randomized controlled trials of Puerarin for diabetic peripheral neuropathy from Cochrane Controlled Trials Register (150 issue of 2003), Medline (1966-2003. 2), EMbase (1984-2001. 12. 4), and the Chinese Biological Medicine Database (1978-2003. 2) were performed. The selection of studies, data extraction, and assessment of methodological quality were performed independently by two reviewers. The following outcomes were assessed: effectiveness of clinical symptoms, sensory nerve and motor nerve conduction velocities, and severe adverse events of Puerarin. Results Ten randomized controlled clinical trials including 726 patients met the inclusion criteria. At the end of the treatment, compared to general treatment or vitamin B, Puerarin showed significant positive effects on the total effect rate of therapy and increased peripheral nerve conduction velocity. No severe adverse events were observed during the treatment period. However, most included trials show some degree of study design or analysis defect. Conclusions Our analysis suggests that Puerarin appears to be an effective and safe treatment for diabetic peripheral neuropathy. However, due to the low quality trials included in this review, more rigorously designed, randomized, double-blind, placebo-controlled trials of Puerarin for diabetic peripheral neuropathy are needed to further assess its usefulness in diabetes peripheral neuropathy patients.
【摘要】 目的 通过检测临床确诊为慢性乙型肝炎患者血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、甲状腺激素T3、T4及促甲状腺素（TSH）含量，进一步探讨慢性乙型肝炎患者肝损情况与甲状腺分泌功能的关系。 方法 收集2009年1-4月79例确诊为慢性乙型肝炎患者（病例组）血清标本，分别检测其ALT、AST、甲状腺激素T3、T4及TSH含量。以同期健康体检者30例作为对照组。比较两组的差异及各指标间的相关性。 结果 病例组AST为（87±113） U/L、ALT为（135±241） U/L、AST/ALT为0.97±0.57、TSH为（1.63±1.29） mU/L、T3为（1.61±0.52）ng/mL、T4为（10.7±2.9） μg/dL，对照组分别为（23±5） U/L、 （18±5） U/L、1.31±0.26、（2.13±0.90） mU/L、（1.19±0.16） ng/mL和（8.6±0.9） μg/dL，两组各指标比较均有统计学差异（Plt;0.01）。所有指标均正常的共有6例（7.6%），有73例（92.4%）存在不同程度的指标异常；在68例AST/ALT比值降低的慢性乙型肝炎患者（93.2%）中，伴有单纯T4升高的有11例（16.2%），单纯T3升高的有4例（5.9%），T3、T4同时升高的有11例（16.2%），T3、T4同时升高且TSH降低的有2例（2.9%），1例T4升高且TSH降低（1.5%），1例仅TSH升高（1.5%）；在4例AST/ALT比值正常的慢性乙型肝炎患者（5.5%）中，有1例T3、T4同时升高且TSH降低，1例T3和T4同时升高，1例单纯T4升高，1例单纯TSH降低；有1例仅AST/ALT比值升高而其他项正常。 结论 慢性乙型肝炎患者除AST/ALT比值异常外，还同时伴有不同程度的甲状腺激素指标异常，其原因可能与慢性乙型肝炎应用干扰素治疗时甲状腺功能受损有关。【Abstract】 Objective To explore the relationship between liver damage and the secretion function of thyroid by detecting the serum alanine aminotransferase (ALT), aspartate aminotransferase(AST), T3, T4, and thyroid stimulating hormone (TSH) in patients with chronic hepatitis B. Methods The serum samples of 79 patients with chronic hepatitis B from January to April 2009 were collected, and the ALT, AST, T3, T4, and TSH concentrations were detected. Another 30 healthy subjects were selected as the control. The detected indexes were compared between the two groups. Results In the case group, the concentration of AST was (87±113)U/L, ALT was (135±241)U/L,AST/ALT was 0.97±0.57, TSH was (1.63±1.29) mU/L, T3 was (1.61±0.52) ng/mL, and T4 was (10.7±2.9) μg/dL; while in the control group, the concentrations of the items were (23±5) U/L, (18±5)U/L, 1.31±0.26, (2.13±0.90) mU/L, (1.19±0.16) ng/mL, and (8.6±0.9) μg/d L, respectively. The differences between the two groups were significant (Plt;0.01). Among the 79 case, 6 (7.6%) had a totally normal result, and 73(92.4%) had an abnormal result. There were 68 patients who had a low ratio of AST/ALT, among whom 11 (16.2%) had a simple T4 elevation, 4(5.9%) had a simple T3 elevation,11(16.2%) had an elevation of both T3 and T4, 2 (2.9%) had an elevation of both T3 and T4 and a depression of TSH, 1(1.5%) had an elevation of T4 and a depression of TSH, and 1 (1.5%) had a simple TSH elevation. There were 4 cases who had a normal ratio of AST/ALT, among whom 1 had an elevation of both T3 and T4 and a depression of TSH, 1 had an elevation of both T3 and T4, 1 had a simple T4 elevation, and 1 had a simple TSH depression. There was 1 case who had only an elevation of AST/ALT. Conclusion Most of the patients with chronic hepatitis B have an abnormal result of thyroid hormone together with the abnormal ratio of AST and ALT. The reason mainly lies in the damage of thyroid function by the usage of interferon for the therapy of chronic hepatitis B.
Objective To investigate the values of pneumonia severity index ( PSI) , CURB-65,plasma procalcitonin ( PCT) , C-reactive protein ( CRP) measurements for evaluation the severity of healthcare-associated pneumonia ( HCAP) .Methods A retrospective observational study was conducted on 92 hospitalized patients with HCAP admitted between June 2010 and December 2011. They were divided into different groups according to different severity assessment criteria. The variance and correlation of PCT,CRP,WBC and percent of neutrophil ( Neu% ) levels were compared among different groups. ROC curvewas established to analyze PSI, CURB-65, PCT and CRP levels for predicting the motality of HCAP patients.Results In the severe HCAP group, PSI and CURB-65 scoring and serum PCT, CRP, WBC, Neu% levels were significantly higher than those in the non-severe HCAP group( P lt; 0. 05) . In the high-risk HCAP group, PCT, CRP, WBC and Neu% levels were significantly higher than those in the low-risk HCAP group according to the PSI and CURB-65 scoring criteria( P lt;0. 05) .WBC and Neu% levels were also significantly higher than those in the moderate-risk group. PSI and CURB-65 scoring were positively correlated with PCT and CRP levels. PSI scoring gt;120 points or CURB-65 scoring gt;2 points on admission were predictors of mortality. Conclusions PSI and CURB-65 scoring are correlated with severity of HCAP. Combining serum PCT and CRP levels can improve the predictive accuracy of the severity of HCAP.
ObjectiveTo observe vertebral three-dimensional motion characteristics of adjacent segments in patients with symptomatic L4 isthmic spondylolisthesis (IS). MethodsFourteen symptomatic L4 IS patients who underwent surgery treatment (trial group) and 15 asymptomatic volunteers without back pain and other lesions of spine (control group) were recruited. There was no significant difference in gender, age, body mass index, and bone mineral density between the two groups (P>0.05). The three-dimensional reconstruction model of lumbar spine was acquired from the thin slice CT of the lumbar spine of the subjects by combining dual-X-ray fluoroscopy imaging system with spiral CT examination. The model was matched to the double oblique X-ray fluoroscopy images captured by dual-X-ray fluoroscopy imaging system at different active positions of the lumbar spine to reproduce the three-dimensional instantaneous of lumbar spondylolisthesis at different state of motion. The motion and relative displacement of adjacent segments (L3, 4 and L5, S1) of spondylolisthesis were measured quantitatively by establishing a three-dimensional coordinate system at the geometric center of the vertebral body. The results were compared with those of the control group. ResultsWhen L3, 4 in the control group were flexed flexion-extension, left-right twisting, and left-right bending, and when L5, S1 in the control group were flexed left-right twisting and left-right bending, the activity along the main axis of motion (main axis of motion) tended to increase compared with that along the corresponding coupled axis of motion (secondary axis of motion); however, this trend disappeared in the trial group, and the main and secondary movements were disordered. Because of the coronal orientation of the facet joints of L5, S1, the degree of motion along the main axis of motion decreased during flexion and extension, but this trend disappeared in the trial group. Compared with the control group, L3, 4 in the trial group exhibited displacement instability in flexion-extension, left-right twisting, and left-right bending (P<0.05); there was no significant difference in the relative displacement of L5, S1 intervertebral bodies along x, y, and z axes between the trial group and the control group in flexion-extension, left-right twisting, and left-right bending curvature (P>0.05). ConclusionPatients with symptomatic L4 IS have disorders of primary and secondary movement patterns in adjacent segments, while IS showed significantly displacement instability in L3, 4 and significantly decreased motion in L5, S1.
The coronary artery disease is a frequent severe disease of cardiovascular system in recent years. Meanwhile, lung cancer, with its high morbidity and mortality, is the most frequent malignant tumor of respiratory system in the world. Clinical studies have shown that the incidence of coronary artery disease and lung cancer is high throughout the year, and comorbidities are becoming more common, especially in elderly patients. The incidence of lung cancer and coronary heart disease may be related. This article summarizes the common risk factors (smoking and environmental pollution, fibrinogen, estrogen, and age), and treatment (surgical treatment, neoadjuvant therapy, and targeted therapy) progress of the two diseases, providing a theoretical basis for clinical prevention and treatment.
Objective To compare the clinical effects of coronary artery bypass grafting (CABG) via the left anterior small thoracotomy (LAST) versus lower-end sternal splitting (LESS) approach in the treatment of coronary heart disease. Methods The patients who underwent LAST CABG in Tianjin Chest Hospital from October 2015 to December 2020 were allocated to an observation group (LAST group), and the patients who underwent LESS CABG at the same period were allocated to a LESS group. Propensity score matching method was applied with a ratio of 1∶1. The baseline data, perioperative data and grafts data were compared between the two groups after matching. Results Before matching, there were 110 patients in the LAST group, and 206 patients in the LESS group. After matching, there were 110 patients in each group. In the LAST group, there were 83 males and 27 females with an average age of 60.6±8.3 years. In the LESS group, there were 80 males and 30 females with an average age of 61.0±9.6 years. There was no statistical difference in baseline data between the two groups after matching (P>0.05). The hospital stay time (t=2.255, P=0.025) and ventilator using time (t=−2.229, P=0.027) in the LAST group were significantly shorter than those in the LESS group. There were no statistical differences between the two groups in the postoperative hospital stay time, ICU stay time, postoperative left ventricular ejection fraction, postoperative left ventricular end-diastolic diameter, average number of grafts, secondary intubation, secondary thoracotomy, postoperative wound infection, sternal complications, postoperative atrial fibrillation, postoperative pulmonary infection or main adverse cardiovascular and cerebrovascular events (P>0.05). There was no statistical difference in the distribution of target vessels in the anterior descending branch, diagonal branch or posterior descending branch between the two groups (P>0.05). The grafts of the LAST group were significantly more than those of the LESS group in the area of obtuse marginal branch and posterior ventricular branch, and the grafts of the LESS group were significantly more than those of the LAST group in the area of right coronary artery (P<0.05). Postoperative computerized tomography angiography indicated that 1 patient in the LAST group had obtuse marginal branch vein bridge vessel occlusion, and the bridge vessels in the other patients were unobstructed. Conclusion Minimally invasive CABG via both LAST and LESS approaches is safe and effective. LAST approach can achieve complete revascularization for multi-vessel lesions, and it is safe and reliable, with the advantages of less trauma and aesthetic appearance. However, it requires a certain learning curve of surgical techniques and certain surgical indications.
Objective To assess the effects of lung transplantation (LT) in the treatment of end-stage pulmonary arterial hypertension (PAH) and evaluated its impact on quality of life (QoL). Methods A total of 54 patients with end-stage PAH admitted to the LT center of Wuxi People’s Hospital between January 2007 and June 2019 were retrospectively analyzed. The patients were divided into surgical and non-surgical groups. Clinical data were compared between the groups. The clinical data such as symptoms, signs, biochemistry, survival rate and quality of life were compared between the two groups. The effects of lung transplantation on survival and quality of life were analyzed. The quality of life was scored by SF-36 scale. Results A total of 54 patients with end-stage pulmonary arterial hypertension who met the indications for lung transplantation were enrolled. Among them, 36 patients underwent lung transplantation and 18 patients did not undergo surgery. There were no statistical differences in gender, course of disease, disease type, symptoms between the two groups. The uric acid of the non-operation group was significantly higher than that of the lung transplantation group (P=0.014). The systolic pulmonary artery pressure (SPAP) of the non-operation group was significantly lower than that of the lung transplantation group (P=0.046). Kaplan-Meier survival curve showed that the survival rate of the operation group was higher than that of the non-operation group (P=0.0087). The quality of life assessment showed that after lung transplantation, the physical component summary and mental component summary scores of operation group were higher than those before operation (P<0.01), and also higher than non-operation group in the same period (P<0.05). Preoperative low systemic circulation blood pressure, poor cardiac function, high NT-proBNP and high uric acid may be the risk factors for early death of patients with pulmonary arterial hypertension after lung transplantation. Conclusions Lung transplantation can effectively improve survival and also QoL for patients with end-stage PH. Early detection of risk factors and preoperative assessment can help improve the perioperative survival.