Objective To investigate the relationship between serum leptin concentration and type 2 diabetes mellitus (DM) with cerebral infarction (CI). Methods Serum leptin concentrations were measured by enzyme-linked immunosorbent in 128 DM patients (65 male, 63 female and 62 lean, 66 obese and 63 complicated CI. Serum leptin concentration, triglyceride, total cholesterol, blood glucose, blood pressure, and body mass index (BMI) in CI were analyzed by correlation analysis. Results (1)The fast serum leptin concentrations in the obese individual were higher than that in the lean ( P

Objective To investigate the relationship between the resting heart rate (RHR) and target organ damage (TOD) in elderly patients with metabolic syndrome(MS). Methods 264 elderly patients with MS were divided into four groups according to the level of RHR: RHR1 group, RHR<65 beats/minute (bpm) (46 cases) ;RHR2 group, 65≤RHR<75 bpm (77 cases);RHR3 group, 75 bpm≤RHR<85 bpm (89 cases);RHR4 group, RHR≥85 bpm (52 cases).Electrocardiography, echocardiography, carotid uhrasonography, crcatinine clearance rate (Ccr) and quantitative assay of 24 hours' albuminuria were performed. Results (1) Compared with RHR1, RHR2 and RHR3 groups, RHR4 group showed higher levels of carotid intima-medial thickness (IMT), carotid arterial diameter (CAD), left ventricular mass index (LVMI) and albuminuria(P< 0.05 or P<0.01), and lower levels of left ventricular ejection fraction (LVEF) and Ccr (all P< 0.01). (2) The IMT, CAD, LVMI and albuminuria were positively correlated with RHR (r=0.33, 0.23, 0.61, 0.58, respectively, all P<0.01). However, the LVEF and Ccr were negatively correlated with RHR (r=-0.59, -0.51, all P<0.01). (3) Logistic multivariate analysis showed that RHR and pulse pressure (PP) had effects on myocardial hypertrophy, coronary heart disease, heart failure, cerebral stroke and renal dysfunction(P<0.05 or P<0.01). Except heart failure, PP played a more important role than RHR. Coneinsions RHR may be an independent risk factors for TOD in elderly patients with MS,and RHR regulation is important for the development of MS in the elderly.

Objective To investigate and compare the effects of etomidate or propofol on spatial cognitive,exploring,learning and memory abilities and hippocampus tissue in rapid development period of rats.Methods Thirty-nine SD rats with anage from 17 to 18 days were randomly divided into group C(10 ml/kg of normal saline),group E(5 mg/kg of etomidate),group P(50 mg/kg of propofol)(n=13).They were all single injected intraperitoneally.The tests of cognitive function were performed in Open Field Test(OFT),Hole Board Test and Ymaze Test at 3 hours postanesthesia awake.HE staining method was uesed to observe the morphology of hippocampus neuron tissue and immunohistochemistry(IHC) method was uesed to detect the expression of aspartic acid specificity cysteine protease (caspase-3) in hippocampal neurons.Results In the OFT,there was no significant difference between group C((3.70 ± 1.06)s,(39.10 ± 11.89)s)and group E,P((4.40 ±2.01)s and (4.60 ± 1.96) s,(37.90 ± 11.88) s and (36.30 ± 15.68) s) about the retention time in central check and the locomotion (P ＞ 0.05).In the Hole Board Test,the rats of groups E and P(12.00 ± 3.13,10.00 ± 2.79) about the times of rats stretch into the hole were significant different comparing with group C(16.30 ±4.62) (P＜0.05).In the Ymaze Test,compared with group C,the group E in the right number and total reaction time were no significant differences (P ＞ 0.05).The right number of group P (9.80 ± 2.39) were obviously decreased as compared with group C(13.30 ±2.00)(P ＜ 0.01),and there also had significant difference between group E and group C (P ＜0.05).In addition,the total reation time between group P ((82.30 ± 10.20) s) and group C ((67.70 ± 12.18) s) was significant difference(P ＜ 0.05).In HE staining,there were obvious changes in group E and P.In IHC,the expression of caspase-3 between groups C,E and P,there were no significant differences (P ＞ 0.05).Conclusion Single intraperitoneal injection of etomidate can make a transient effects for the rapid development period of rats ' ability of exploration,but have no obvious influence of the spatial cognition and learning and memory abilities.And etomidate lead less influence on newborn rat behavior and hippocampal tissue than propofol.

Objective To examine the correlation of imbalance of urinary exosome Th1/Th2 with diabetic nephropathy (DN).Methods A total of 120 patients with type 2 diabetes mellitus (DM) and 30 healthy volunteers as control were enrolled in the study.According to urinary albumin/creatinine ratio (UACR),type 2 diabetes mellitus patients were divided into 3 groups:diabetes mellitus without nepbropathy group (DM,n=40,UACR＜30 mg/gCr),microalbuminuria group (DN 1,n=50,UACR-30～300 mg/gCr) and clinicoalbuminuria group (DN 2,n=30,UACR＞300 mg/gCr).Urine exosome-interferon-gamma (IFN-γ) and exosome-interleukin 4 (IL-4) levels were determined by enzyme-linked immunosorbent assay (ELISA).Multiple stepwise linear regression was used to analyze the correlation of exosome-IFN-γ/IL-4 with glycated hemoglobin (HbA1c),cholesterol (CH),UACR,Scr and BUN.Results Th1/Th2 ratio in DM,DN1,DN2 groups was significantly higher than that in healthy group (0.8089±0.2458,0.8993 ±0.3515,0.8571±0.2470 vs 0.6198±0.1769,all P＜0.01).Correlation analysis showed that urinary exosomeIFN-γ/IL-4 ratio was positively correlated with UACR (r=0.213,P=0.015) and BUN (r=0.292,P=0.001).Multiple stepwise linear regression analysis showed that BUN was independent determinants for exosome-IFN-γ/IL-4 (β=0.246,P=0.006).Conclusion The imbalance of urinary exosomeTh1/Th2 is correlated with DN,which may play an important role in the pathogenesis of DN.

Since the outbreak of COVID-19 pandemic, a large number of elective or limited operations, including tumor treatment, have been postponed. With the deepening of the understanding of the virus and the change of the prevention policy, the impact of the pandemic is gradually shrinking, and a large number of operations delayed by the pandemic will be rescheduled. However, there is no consensus on the best time to perform surgery for patients infected with SARS-CoV-2, and the consensus on thoracic surgery is more limited. This article reviews the research progress in the timing of surgical operations, especially thoracic surgery, after SARS-CoV-2 infection.

Humans ; Uric Acid ; Cross-Sectional Studies ; Spondylarthritis/diagnostic imaging* ; C-Reactive Protein ; Spondylitis, Ankylosing

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance" strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinary personalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in 10%patients' blood samples at acute period and 50%of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifying cytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance" strategy effectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favored the balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short period of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased probiotics such as and , so nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore,we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.
Betacoronavirus ; isolation & purification ; China ; epidemiology ; Coronavirus Infections ; diagnosis ; epidemiology ; therapy ; virology ; Disease Management ; Early Diagnosis ; Feces ; virology ; Humans ; Pandemics ; Pneumonia, Viral ; diagnosis ; epidemiology ; therapy ; virology ; Sputum ; virology

The current epidemic situation of corona virus disease-19 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 inZhejiang Province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance"strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinarypersonalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in10% patients'blood samples at acute periodand 50% of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifyingcytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance"strategyeffectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviraleffects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favoredthe balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis should be prescribed rationally and was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbialdysbiosis with decreasedprobiotics such as and . Nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the SARS-CoV-2 infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience above and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.