OBJECTIVEWe designed a multi-center, double-blind, randomized, parallel, with metformin controlled clinical trial to evaluate the efficacy and safety of low dose rosiglitazone combined with sulphonylurea therapy in type 2 diabetic patients who were inadequately controlled with sulphonylurea alone.

METHODSPatients were treated with 4 mg rosiglitazone once daily plus sulphonylurea (test group) or 0.5 g metformin twice daily plus sulphonylurea (control group) for 12 weeks. The mean levels of HbA(1c), fasting and postprandial plasma glucose were recorded and compared between the two groups.

RESULTSThe mean levels of HbA(1c) decreased by 1.09% and 0.95% in the test group (n = 102) and control group (n = 96) respectively. Fasting and postprandial plasma glucose levels in the test group decreased by 25.0% and 35.6%, and in the control group, decreased by 17.7% and 23.8% as compared with the baseline (both P < 0.01). No liver damage was found.

CONCLUSIONCombination treatment of rosiglitazone and sulphonylurea can effectively improve glycemic control in type 2 diabetic patients inadequately controlled with sulphonylurea alone.

Adult ; Aged ; Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; drug therapy ; Double-Blind Method ; Drug Therapy, Combination ; Humans ; Hypoglycemic Agents ; administration & dosage ; Metformin ; administration & dosage ; Middle Aged ; Sulfonylurea Compounds ; administration & dosage ; Thiazoles ; administration & dosage ; Thiazolidinediones

Objective To assess right ventricular systolic function using real-time three-dimensional right ventricular quantitative analysis (RT-3DRVQ) in patients with coronary artery disease (CAD) complicating left heart failure. Methods Sixty-eight patients diagnosed with CAD and left heart failure were selected as the case group.Among them,38 individuals were associated with pulmonary hypertension (PH) and 30 were without. Another 30 healthy people were recruited as control group. Conventional echocardiographic parameters,as well free wall and septum longitudinal strains of right ventricle were evaluated in all subjects. Results Patients with left heart failure had significant lower strain values than control group( P <0.001).In case group,three-dimensional derived right ventricular free wall longitudinal strain (3D-FWLS) had strongly correlation with right ventricular ejection fraction ( r = -0.877, P <0.001). The patients with PH had also significantly reduced 3D-FWLS values compared with patients without PH ( P < 0.01),and the area under the curve was 0.726 using ROC method to predict patients with PH.Conclusions RT-3DRVQ could be recognized as a good technology to evaluate right ventricular systolic function,which would provide valuable information for clinical decision-making.

Objective: To explore the effects of exercise rehabilitation on the depression and anxiety state and quality of life in patients with chronic heart failure. Methods: 400 cases of chronic heart failure patients were selected as the research objects.They were randomly divided into control group(n=200)and exercise rehabilitation group(n=200) by random number table.Two groups were given symptomatic treatment and routine care on a regular basis, and exercise rehabilitation group again on this foundation to give rehabilitation therapy for 3 weeks.Self-rating anxiety scale(SAS) and Self-rating depression scale(SDS)were used to score the anxiety and depression of the two groups before and after rehabilitation.The SF-36 was used to assess the quality of life of patients.Rehabilitation satisfaction questionnaire was used to investigate the satisfaction degree of rehabilitation. Results: There was no significant difference in SAS and SDS scores between the two groups before intervention (P>0.05). After intervention, the SAS and SDS scores of the two groups were significantly lower than those before intervention (P<0.05). SAS and SDS scores in exercise rehabilitation group ((27.47±4.82)vs(45.63±5.61))were significantly lower than those in control group ((43.17±4.81) vs (59.61±4.18))(P<0.05). Before intervention, there was no significant difference in the scores of SF-36 scale between the two groups (P>0.05). After intervention, the scores of SF-36 scale were significantly increased in the two groups, and the difference was statistically significant compared with that before intervention (P<0.05). All the factors of SF-36 in exercise rehabilitation group were significantly higher than those in control group (mental health: (72.06±7.48)vs(64.34±7.01), emotional function: (81.06±7.01)vs(76.05±6.92), social function: (81.14±7.83)vs(71.26±7.65), overall health: (70.14±8.05)vs(61.26±7.95), energy: (74.56±7.81)vs(69.46±7.40), the body pain: (68.51±7.36)vs(60.26±7.51), physical limitations: (64.99±7.31)vs(59.62±7.53 ), physiological function: (69.71±7.63)vs(63.84±7.04), all P<0.05). The satisfaction of the exercise rehabilitation group (92.5%)was significantly higher than that of the control group(75.0%) (P<0.05). Conclusion Exercise rehabilitation training can not only improve the anxiety and depression of patients with chronic heart failure, but also effectively improve the quality of life of patients.Exercise rehabilitation training has a high degree of recognition, and is worthy of extensive application in clinical practice.

Objective:To detect the changes of left ventricular myocardial work parameters, and evaluate the left ventricular systolic function in patients with hyperglycemia during pregnancy by left ventricular pressure-strain loop (PSL).Methods:From June 2021 to March 2022, 97 pregnant women who were admitted to the Second Affiliated Hospital of Harbin Medical University and clinically diagnosed as gestational hyperglycemia were prospectively and randomly selected. According to the blood glucose level, the patients were divided into gestational dominant diabetes mellitus (ODM) group(39 cases) and gestational diabetes mellitus (GDM) group(58 cases). Meanwhile, another 62 healthy pregnant women were selected as control group. The basic clinical data of the pregnant women were collected, and the conventional two-dimensional parameters of the heart were collected. The global longitudinal strain (GLS) was analyzed by two-dimensional speckle tracking technique. Then the cuff blood pressure was used as the left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. The global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) of each group were calculated and compared. The correlation between myocardial performance parameters and GLS, glycated hemoglobin(HbA 1c) were analyzed, and the independent factors affecting left ventricular systolic function were obtained by Logistic regression analysis. Twenty cases were randomly selected from the study subjects, and the intraclass correlation coefficients(ICC) of within the observers and between observers were calculated for repeatability test. Results:①Conventional ultrasound parameters: There were no significant differences among the three groups (all P>0.05). ②GLS and left ventricular myocardial performance parameters: GWI, GWE, GCW and GLS in GDM and ODM groups were significantly lower than those in control group (all P<0.001), GWW was significantly higher than control group ( P<0.001); GWI, GWE, GCW and GLS in ODM group were lower than those in GDM group (all P<0.001), while GWW was higher than control group ( P<0.001). ③GWE, GWI and GCW were negatively correlated with GLS ( r=-0.525, -0.408, -0.435; all P<0.05), GWW was positively correlated with GLS ( r=0.348, P<0.05). GWE, GWI and GCW were negatively correlated with HbA 1c ( r=-0.325, -0.262, -0.250; all P<0.05), while GWW was positively correlated with HbA 1c ( r=0.175, P<0.05). ④GWE, 1 h oral glucose tolerance test and HbA 1c were the influencing factors of left ventricular systolic function in patients with hyperglycemia during pregnancy. ⑤The predictive values of GWI, GWE, GCW, GWW and GLS for cardiac function in patients with gestational hyperglycemia were high, and the predictive value of GWE was the highest (AUC: 0.87, the best truncation value: 94.5%, specificity: 0.76, sensitivity: 0.82) and better than GLS. ⑥The repeatability of myocardial work parameters was better in both groups. Conclusions:Myocardial work parameters obtained by PSL are early and sensitive parameters for evaluating left ventricular systolic function impairment in patients with hyperglycemia during pregnancy which can provide reliable and objective quantitative indicators for early clinical intervention and improvement of prognosis.

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.