BackgroundThe focus of this survey is on survey data for adults aged 20 and above, covering nine survey cycles from 2001 to 2018. Additionally, the present study explored the correlation between vitamin D concentrations and both cardiovascular disease (CVD) and all-cause mortality.ObjectiveThe objectives of this study were to evaluate the trend of changes in the serum 25(OH)D concentration changes in US adults during the survey period, the prevalence of vitamin D deficiency, and the current status of vitamin D dietary intake and supplementation.MethodsIn-home health interviews were performed using meticulously designed questionnaires that gathered information on demographic details, socioeconomic conditions, dietary patterns, and overall health status. Health assessments were conducted in specially designed mobile centers.1ResultsSurvey data from 2001 to 2018 revealed a rise in serum 25(OH)D levels, from a weighted mean (95% CI) of 65.6 (63.8–67.4) nmol/L during 2001–2002 to 73.5 (70.4–76.5) nmol/L during 2017–2018, among US adults, while overall vitamin D deficiency rates remained stable (p = 0.152). Notably, in adults aged 20–39, 25(OH)D levels decreased (p = 0.002 for trend), and 25(OH)D deficiency increased (p = 0.003 for trend), especially among those with low incomes (deficiency >30%). Upon multivariable adjustment, an L-shaped relationship was found between serum 25(OH)D concentrations and both CVD and all-cause mortality (p < 0.001 for nonlinearity), as corroborated by sensitivity analyses.ConclusionFrom 2001 to 2018, US adults experienced a significant increase in their serum 25(OH) D concentration. However, subgroups of individuals, including young adults and individuals with lower socioeconomic status, exhibited a heightened risk of 25(OH)D deficiency. Furthermore, an L-shaped relationship was found between 25(OH)D concentration and both all-cause and CVD mortality among US adults.

目的:为了验证基于基层医疗机构和疾病预防控制机构紧密结合、有效衔接的医防融合模式,对糖尿病患者知识、行为和自我效能的影响.方法:在社区招募糖尿病患者800人,随机分为干预和对照组.在国家基本公共卫生服务项目常规随访的基础上,对干预组还采取利用网络新媒体促进健康知识传播干预为主,传统健康教育讲座为辅的方式,进行个性化健康教育等健康干预,包括施行饮食处方和运动处方的健康教育,多种形式的针对个体或者群体的教育,健康咨询和健康指导,以及8次健康讲座,干预持续3个月.干预前后对患者进行糖尿病知识,行为和自我效能的进行问卷调查.结果:总共有724人完成研究,使用倍差法消除常规管理的影响和调整混杂因素之后,干预对糖尿病的知识得分没有影响(P>0.05),行为得分增加0.68分(P<0.05),自我效能得分增加17.6分(P<0.05).结论:基于基层医疗机构和疾病预防控制机构紧密结合、有效衔接的医防融合模式虽然不能改善糖尿病知识,但能显著提升糖尿病患者行为和自我效能,有利于提升糖尿病患者的自我管理能力,可以做更多的试点推广,以验证远期效果和分析成本效益.

Introduction:The efficacy of dapagliflozin remains controversial for patients with type 2 diabetes and non-alcoholic fatty liver disease. We conduct this meta-analysis to explore the influence of dapagliflozin versus placebo on the treatment efficacy of type 2 diabetes complicated with non-alcoholic fatty liver disease.Methods:We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2021 for randomized controlled trials (RCTs) assessing the efficacy of dapagliflozin versus placebo for type 2 diabetes complicated with non-alcoholic fatty liver disease. This meta-analysis is performed using the random-effect model.Results:Four RCTs are included in the meta-analysis. Overall, compared with patients with type 2 diabetes and non-alcoholic fatty liver disease, dapagliflozin treatment is associated with significantly reduced alanine aminotransferase (ALT, standard mean difference [SMD]=-1.27; 95% confidence interval [CI]span style="font-family: 'Times New Roman'">=-1.60 to -0.95; P<0.00001), aspartate-aminotransferase (AST, SMD=-1.37; 95% CI=-2.08 to -0.65; P=0.0002), fasting glucose (SMD=-0.78; 95% CI=-1.28 to -0.27; P=0.003) and HbA1c (SMD=-0.77; 95% CI=-1.21 to -0.34; P=0.0005), but demonstrated no obvious influence on homeostatic Model Assessment of Insulin Resistance (HOMA-IR, SMD=-0.36; 95% CI=-0.86 to 0.14; P=0.16).Conclusions:Dapagliflozin benefits to improve hepatic function and glucose control in patients with type 2 diabetes and non-alcoholic fatty liver disease, as evidenced by the reduction in ALT, AST, fasting glucose and HbA1c.

Abstract Purpose Xiaoyao Huaxian Formula (XYHXF) shows promise in treating liver fibrosis (LF), but the mechanism is unknown. We sought to elucidate this using network pharmacology, docking and animal experiments.Methods The overlapping targets were determined between those of the main active ingredients of XYHXF using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and the Traditional Chinese Medicine Integrated Database and LF-related targets from the Therapeutic Target Database, Online Mendelian Inheritance in Man, and DisGeNET. Protein-protein interaction (PPI) network was generated with Cytoscape 3.7.2. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed using R language. Docking was conducted with AutoDockTools for the key targets and active ingredients of XYHXF. An LF rat model was established with subcutaneously injected carbon tetrachloride followed by ethanol gavage and feeding a high-fat, low-protein diet, and an oral dose of 2.72 g/kg of XYHXF was tested in this model. Liver function was assessed with serum ALT and AST measurements, HE and Masson staining, and western blot of TGF-β, α-SMA, PI3K, p-PI3K, AKT, and p-AKT proteins in liver.Results Overall, 143 active ingredients of XYHXF with 520 potential targets and 2,070 targets of LF were retrieved. The 220 overlapping targets included STAT3, MAPK3, MAPK1, AKT1, and SRC. GO and KEGG analysis revealed overlapping targets that included the response to lipopolysaccharide, response to molecule of bacterial origin, reactive oxygen species metabolic process, and PI3K-Akt signaling pathway. Docking demonstrated potential binding between quercetin/luteolin and AKT1. In rats, compared to the LF group, the XYHXF group had significantly attenuated liver injury and fibrosis, reductions in ALT, AST, α-SMA, and TGF-β; and down-regulation of p-PI3K/PI3K and p-AKT/AKT ratios.Conclusion XYHXF may act on inflammatory processes via multiple active ingredients and treat LF by regulating PI3K-Akt signaling.

肝豆状核变性又称威尔逊病,是由ATP7B基因突变导致铜代谢障碍的常染色体隐性遗传病,2018年5月被收录进《国家首批罕见病目录》,全球患病率为1︰50000～1︰30000,由于外显率的差异,遗传患病率可能比临床高3～4倍 [1].在我国肝豆状核变性以儿童和青少年多见,分为肝型、脑型、其他类型及混合型,由于临床表现多样化,误诊率较高.现回顾笔者收治的肝豆状核变性肝脑混合型患者1例的诊治经过,探讨其临床特点和治疗方法.

目的 比较不同中西医结合方法治疗糖尿病神经源性膀胱(DNB)的疗效.方法 选取重庆市南岸区中西医结合医院2019年10月至2020年10月收治的DNB患者150例,采用随机数字表法分为3组,各50例.A组给予甲钴胺治疗,B组给予甲钴胺+补中益气汤加减治疗,C组给予甲钴胺+补中益气汤加减+针灸理疗治疗.比较治疗周期结束后各组膀胱残余尿、下尿路症状量表(BLUTS-SF)评分.结果 B组1例患者脱失,C组1例患者因不配合退出试验.治疗后,3组膀胱残余尿、BLUTS-SF评分均较治疗前明显降低(P<0.05);A、B、C组复合达标率分别为10.00％、57.14％、77.55％,A组

糖尿病与膀胱癌均是当今世界主要的公共卫生问题,对人类的健康产生着巨大的影响.目前糖尿病合并肿瘤患者越来越多,并且已经有大量研究表明糖尿病与膀胱癌之间可能存在着一定的相关性.糖尿病不仅与膀胱癌有许多共同的患病危险因素,还可能导致膀胱癌的发病率增加,并对其预后产生不同程度的影响;但另外一些研究的结果却持有不同的观点.除此之外,某些降糖药物与膀胱癌之间也存在一定的相关性.本文就糖尿病及降糖药物与膀胱癌的关系、糖尿病对膀胱癌预后的影响等方面进行综述.

尽管头孢类抗菌药物安全性较高，但时常也有粒细胞降低的情况发生。现将本院收治的1例头孢噻肟钠致粒细胞缺乏伴高热患者报道如下。

AIM:To study the effect of hydrogen sulfide (H2S) on severe acute pancreatitis (SAP) in a rat model.METHODS:Sprague-Dawley (SD) rats were administered an intraperitoneal injection of saline containing 20% L-Arg (250 mg/100 g) hourly for over 2 h to induce SAP. The rats were treated with DL-propargylglycine (PAG, 50 mg/kg) or different dosages of NaHS (5 mg/kg, 10 mg/kg, 20 mg/kg or 100 mg/kg). PAG or NaHS was administered 1 h before induction of pancreatitis. Rats were sacrificed 24 h after the last L-Arg injection. Blood and pancreas tissues were collected.RESULTS:The H2S and cystathionine-γ-lyase mRNA levels in SAP rats were significantly lower than those in the control group, and treatment with PAG further reduced the H2S level. Nevertheless, H2S was significantly increased after NaHS administration compared with the SAP group, and the degree of upregulation was associated with the NaHS dosage. NaHS reduced the levels of plasma amylase, interleukin-6 and myeloperoxidase in pancreatic tissue. NaHS suppressed the degradation of IκBα and the activity of nuclear factor-κB, as well as the phosphorylation of PI3K/AKT.CONCLUSION:H2S plays an anti-inflammatory role in SAP in vivo.

目的观察厄贝沙坦对2型糖尿病（type 2 diabetes mellitus，T2DM）合并高血压患者胰岛素抵抗（insulin resistance，IR）及胰岛B细胞功能的影响。方法将94例初发T2DM合并高血压患者随机分为两组（n=47）：厄贝沙坦组、苯磺酸氨氯地平组，分别给予厄贝沙坦和苯磺酸氨氯地平治疗12周。比较治疗前后两组患者体质量指数（body mass index，BMI）、腰围（waist circumference，WC）、血压（bloodpressure，BP）、空腹血糖（fasting blood glucose，FBG）、空腹胰岛素（fasting plasma insulin，FINS）、糖化血红蛋白（glycosylated hemoglobin，HbAlC）、甘油三酯（triglyeride，TG）、总胆固醇（totalcholesterol，TC）、低密度脂蛋白胆固醇（low—density lipoprotein cholesterol，LDL—C），并采用稳态模式评估法计算胰岛素抵抗指数（HOMA—HOMA-insulin resistance index，HOMA，IR）、胰岛素分泌指数（HOMA—pcellSecretionindex，HOMA—p）及治疗前后的变化。结果治疗12周后，两组患者治疗后的BP、FBG、HbAlC均较治疗前降低（均P〈0．05），两组患者治疗后的胰岛素分泌指数均较治疗前升高（均P〈0．05），两组治疗前后WC、BMI、TG、TC、LDL—C、HDL．C差异均无统计学意义（均P〉0．05）。厄贝沙坦组治疗后胰岛素抵抗指数较治疗前下降[3．79（2．51～4．99）掷4．58（3．38—5．94），P〈0．05]，氨氯地平组治疗前后胰岛素抵抗指数差异无统计学意义[3．90（2．52—5．26）1）83．90（2．52～5．26），P〉0．05]。结论厄贝沙坦在降低血压的同时，可能改善T2DM患者的胰岛素抵抗。

Objective To explore the role and mechanism of H2 S in severe acute pancreatitis .Methods SD rats were randomly assigned into several experimental groups :contorl group(n=6) ,SAP group(n=10) ,PAG+SAP group(n=10) ,5 mg/kg NaHS+SAP group(n=10) ,10 mg/kg NaHS+SAP group(n=10) ,20 mg/kg NaHS+SAP group(n=10) ,100 mg/kg NaHS+SAP group (n=10) ,wortmannin(W)+ SAP group(n= 10) ,5 mg/kg NaHS + W+ SAP group(n=10) and 100 mg/kg NaHS+ W+ SAP group(n=10) .These rats were intra-peritoneal injected L-Arginine to get SAP model ,and sacrificed ar 24 h hour after the first in-jection .Plasma IL-6 and MPO activity in pancreas were determined by ELISA .Expression of p-AKT and IκBαin pancreas were de-tected by Western blot ,and NF-κB activity was assessed with EMSA .Results SAP and PAG+ SAP resulted in a significant in-creasing in plasma IL-6 ,MPO activity and expression of p-AKT in pancreas ,when compared with the control group(P<0 .05) ,and NF-κB activity also increased ,and NF-κB activity in PAG+SAP group was more significant (P<0 .05);however ,IκBαexpression in SAP and PAG+SAP down-regulated obviously ,when compared with the control group(P<0 .05) ,and the expression in PAG+SAP group was significantly lower(P<0 .05) .Different dosage of NaHS reduced that the level of plasma IL-6 ,MPO activity ,ex-pression of p-AKT and NF-κB activity in pancreas changed in different degrees ,yet IκBαexpression in these groups increased gradu-ally .When compared with the SAP group ,5 mg/kg NaHS+SAP and 100 mg/kg NaHS+SAP ,plasma IL-6 ,MPO activity and ex-pression of p-AKT in pancreas significantly depressed after given wortmannin ,besides NF-κB activity also down-regualated;never-theless IκBαexpression up-regulated .Conclusion H2 S in precondition induced the development of an anti-inflammatory activity in SAP ,and in proportion with the concentration of H2 S in blood in a degree .H2 S regulated the degree of SAP injury via PI3K/AKT-NF-κB pathway .

AIM:To evaluate the role of prophylactic antibiotics in the management of acute necrotizing pancreatitis.METHODS:A computerized literature search of Medline,PubMed,Spring,Ovid,Elsevier,Embase,CNKI,and VIP databases was conducted to identify relevant articles published from January 1994 to October 2011.According to the inclusion criteria,5 studies were selected.The data were analyzed using RevMan 5.1 software.RESULTS:Our meta-analysis suggests that prophylactic antibiotic treatment did not significantly reduce morbility (RR=0.75,95%CI 0.43-1.28,P=0.29) or the incidence of infected pancreatic necrosis (RR=0.81,95%CI 0.55-1.19,P=0.29),nonpancreatic infection (RR=0.79,95%CI 0.59-1.06,P=0.12),or surgical intervention (RR=0.78,95%CI 0.45-1.36,P=0.37).CONCLUSION:Prophylactic antibiotic treatment does not reduce the occurrence of infected pancreatic necrosis,nonpancreatic infection,surgical intervention or morbility in patients with acute necrotizing pancreatitis.