Sixty-two patients with type 2 diabetes were treated with acarbose combined intensive insulin therapy( combined intensive group)or intensive insulin therapy alone (simple intensive group).As the blood glucose control reached the target,the mean amplitude of glycaemic excursion (MAGE),the absolute difference between the mean of daily differences ( MODD ),and standard deviation of blood glucose (SDBG) in combined intensive group were lower than those in simple intensive group [ ( 3.76 ± 1.47 vs 6.52 ± 1.57 ) mmol/L,( 0.57 ±0.49 vs 1.10 ±0.69 )mmol/L,( 1.44±0.60 vs 2.42±0.92 ) mmol/L,all P＜0.01 ].Daily mean blood glucose (MBG) of the former group was better than that of the latter group [ (7.08±0.69 vs 8.27 ± 1.31 ) mmol/L,P＜0.01 ].By the end of treatment,HbA1c [ 6.77％ ± 0.57％ vs 7.21％ ±0.83％,P＜0.05 ],incidence of hypoglycemia( 29％ vs 48％,P＜0.01 ),and body mass index[ (24.14±2.7 vs 27.63±3.41 ) kg/m2,P＜0.01 ] in combined intensive group were statistically improved more than those in the simple intensive group.

Objective To study the effects of berberine (BBR) on the gene mRNA expression of fat-specific protein 27 (FSP27) and PR domain containing 16 (PRDM16) signal pathway in visceral white adipose tissues (VWAT) from type 2 dia? betic (T2DM) Chinese hamsters, and explore the related mechanisms. Methods The obese insulin-resistant (OIR) hamster model was induced by high-fat diet, and T2DM hamster model was created by OIR hamster model injected with low-dose streptozotocin. The control group was fed with standard laboratory chow. After the induction, the hamsters were randomly di?vided into control, OIR, obese T2DM and BBR-treated T2DM groups. After nine-week BBR treatment, real-time quantita?tive PCR was used to measure the gene mRNA expression changes of VWAT FSP27 and PRDM16 signal pathway and their target genes from different groups. Results Compared with control group, the gene mRNA expressions of PRDM16, CtBP-1, CtBP-2, C/EBPβ, PPARγ, PGC1α, PGC-1β and brown adipose tissue-specific genes such as UCP-1, Cidea, Elovl3, PPARα, and Acox, Cpt1 and Acadm were decreased and that of FSP27 and white adipose tissue-specific genes including Resistin, MEST and Serpina3k were increased in VWAT in OIR and obese T2DM groups. BBR treatment down-regulated FSP27 expression, enhanced PRDM16 signal pathway, and induced the gene mRNA expression of brown adipose tissue-spe?cific genes in VWAT of obese T2DM group to develop browning gene phenotype of VWAT, and then improved fat-induced insulin resistance. Conclusion The decreased FSP27 expression and increased PRDM16 expression are involved in the molecular mechanisms of browning of visceral white adipose tissues induced by BBR, and which contributes to improve ab?normal lipids metabolism and fat-induced insulin resistance in VWAT by enhancing consumption of energy as heat to re?store VWAT function.

Surgical robots, as a new means for surgeons, have been gradually applied in orthopedics. Initially, the development of orthopedic robots was stagnant for a long time because of limited techniques available, clumsy equipment, high costs, and low market demands. The recent decade has witnessed rapid growth of artificial intelligence in all walks of life, increasing investment in research and development, reducing manufacture costs and expanding demands for precise and individualized medical treatment so that a wide variety of novel and ingenious robotic systems have been proposed, prototyped, and commercialized in most of the major procedures in orthopedic surgery, including knee and hip replacements, cruciate ligaments surgery, spine surgery, corrective osteotomy, bone tumor surgery, and trauma surgery. This review depicts the history of development and future prospects in application of surgical robots in the field of orthopedics.

OBJECTIVES: Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. However, the patterns, temporal trends, and all-cause mortality associated with NCD multimorbidity over time have not been well described in the United States. METHODS: All adult participants were sourced from nationally representative data from the National Health and Nutrition Examination Survey. In total, 55,081 participants were included in trend analysis, and 38,977 participants were included in Cox regression. RESULTS: The 5 NCDs with the largest increases over the study period were diabetes, osteoporosis, obesity, liver conditions, and cancer. The estimated prevalence of multimorbidity increased with age, especially for middle-aged participants with 5 or more NCDs; in general, the prevalence of NCD multimorbidity was higher among females than males. Participants with 5 or more NCDs were at 4.49 times the risk of all-cause mortality of participants without any diseases. Significant interactions were found between multimorbidity and age group (p for interaction <0.001), race/ethnicity (p for interaction<0.001), and educational attainment (p for interaction=0.010). CONCLUSIONS The prevalence of multiple NCDs significantly increased from 1999 to 2018. Those with 5 or more NCDs had the highest risk of all-cause mortality, especially among the young population. The data reported by this study could serve as a reference for additional NCD research.

Objective To systematically evaluate and sequentially analyze the clinical efficacy and safety of Baogong Zhixue Granules for the treatment of abnormal uterine bleeding due to ovulation disorder.Methods The randomized controlled trials(RCTs)of Baogong Zhixue Granules for the treatment of abnormal uterine bleeding due to ovulation disorder were retrieved from the databases of CNKI,Wanfang Data,VIP,China Biology Medicine,PubMed,Embase,and Cochrane Library from the establishment of the databases to January 5th,2023.Literature screening and data extraction were conducted according to Cochrane Handbook for Systematic Reviews of Interventions,and Meta-analysis was performed by RevMan 5.4.Results Totally 15 articles were included,involving 1 425 patients.Meta-analysis results showed that Baogong Zhixue Granules could effectively improve the clinical efficacy of abnormal uterine bleeding due to ovulatory disorder(RR=1.17,95%CI[1.13,1.23],P<0.000 01),shorten hemostasis time[bleeding control time(MD=-6.35,95%CI[-8.89,-3.81],P<0.000 01),complete hemostasis time(MD=-12.56,95%CI[-16.22,-8.89],P<0.000 01)],reduce endometrial thickness(MD=-1.26,95%CI[-1.71,-0.80],P<0.000 01),reduce hemoglobin loss(MD=13.35,95%CI[11.41,15.29],P<0.000 01),improve the score of uterine bleeding(MD=-2.22,95%CI[-2.43,-2.01],P<0.000 01),and reduce the recurrence of disease(RR=0.37,95%CI[0.19,0.72],P=0.004).There was no statistical significance between the test group and the control group in terms of adverse reactions(P=0.82).The trial sequential analysis of the total efficiency was carried out,and the cumulative included research passed the traditional threshold and trail sequential analysis threshold.Conclusion Baogong Zhixue Granules have a certain clinical efficacy in the treatment of abnormal uterine bleeding due to ovulation disorder,but there may be publication bias in the study,and higher quality clinical RCTs need to be carried out.

Objective:To investigate the outcomes of periacetabular osteotomy (PAO) through modified Smith-Petersen or Bikini approach with an auxiliary posterolateral incision for developmental dysplasia of hip (DDH).Methods:85 patients (97 hips) who underwent PAO through modified Smith-Petersen or Bikini approach with auxiliary posterolateral incision for DDH in the 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army or the Second Xiangya Hospital of Central South University from January 2016 to January 2021 were retrospectively analyzed. There were 70 females and 15 males, with an average age of 28.6±8.4 years (12-49). According to the Hartofilakidis classification, all patients were classified as type Ⅰ. There were 77 hips classified as Grade 0 and 20 hips classified as Grade 1 according to the T?nnis classification. The X-ray evaluation including the lateral central edge angle (LCEA), t?nnis angle (TNS) and anterior central edge angle (ACEA), visual analogue score (VAS) and modified Harries hip score (mHHS) were recorded preoperatively and during each postoperative follow-up. The cumulative sum (CUSUM) method was used to fit the learning curves of operation time.Results:All patients were followed-up with an average of 52.7±18.9 months (21 to 84). The average operative time and intraoperative blood loss were 95.9±28.2 min (65 to 215) and 414.7±97.0 ml (250 to 900), respectively. The learning curve of operation time was 10 cases. The average LCEA 32.39° (30.29°, 34.92°), TNS 3.14° (1.56°, 5.67°) and ACEA 31.55° (29.07°, 33.88°) were all significantly improved compared to preoperative values ( Z=-30.764, P<0.001; Z=30.595, P<0.001; Z=-38.134, P<0.001). The average VAS was reduced from 5.18±0.88 points preoperatively to 1.27±0.93 points postoperatively with significant difference ( t=51.231, P<0.001). The average mHHS was increased from 73.12±9.17 to 92.02±4.05 postoperatively with significant difference ( t=-26.902, P<0.001). No patients received total hip arthroplasty during the follow-up period. Conclusion:Bernese PAO through modified Smith-Petersen or Bikini approach with a small auxiliary posterolateral incision was not only a safe and effective method for the treatment of DDH but also shortened the learning curve and reduced difficulty of the surgery.

Objective To explore the epidemiological characteristics,risk factors,and pathogen distribution of stroke associated pneumonia in middle-aged and elderly patients.Methods A total of 822 middle-aged and elderly stroke patients treated in Second People's Hospital of Lishui from January 2020 to September 2023 were retrospectively selected,and they were divided into incidence group(n=217)and non-incidence group(n=605)based on the occurrence of stroke associated pneumonia.Clinical data,pathogen culture and drug sensitivity test results of two groups of patients were collected.Results There were significant differences in age,length of stay,smoking history,diabetes mellitus,hypertension,disturbance of consciousness,dysphagia,National Institutes of Health stroke scale(NIHSS)score at admission,hypoproteinemia,and gastric tube indwelling or not between two groups(P<0.05).Logistic regression analysis showed that age>65 years,length of stay≥15 days,smoking history,diabetes mellitus,disturbance of consciousness,dysphagia,NIHSS score≥13 points at admission,and indwelling gastric tube were risk factors for stroke associated pneumonia(P<0.05).A total of 251 pathogenic bacterial strains were cultured in the sputum of 217 patients,including 168 Gram negative bacteria,72 Gram positive bacteria,and 11 fungi.The main pathogens were 68 strains of Klebsiella pneumoniae(27.1%),50 strains of Pseudomonas aeruginosa(19.9%),41 strains of Staphylococcus aureus(16.3%),and 25 strains of Acinetobacter baumannii(10.0%).Klebsiella pneumoniae had a higher resistance rate to ampicillin and gentamicin,while Pseudomonas aeruginosa,Staphylococcus aureus,and Acinetobacter baumannii had a higher resistance rate to ampicillin and amoxicillin.Conclusion The occurrence of stroke associated pneumonia in middle-aged and elderly patients is related to age,comorbidities,disturbance of consciousness,dysphagia,indwelling gastric tubes,etc.,and there are many types of infectious pathogens.In clinical practice,it is necessary to strengthen the identification of high-risk factors and select appropriate antibiotics for treatment based on drug sensitivity tests.

Objective:To investigate the effect of hyperuricemia treatment on vascular endothelial function and blood pressure in patients with acute cerebral infarction.Methods:A total of 138 cases from the same center were enrolled in the study. 92 cases of acute cerebral infarction patients combined with hyperuricemia were selected. They were randomly divided into the experimental group (46 cases) and control group (46 cases). 46 cases of acute cerebral infarction patients with normal uric acid were selected in the same period. Patients in the experimental group received oral allopurinol for 3 months to treat hyperuricemia. Serum uric acid, blood lipid, and hs-CRP were tested before and after treatment in these populations. Blood pressure and body mass index (BMI) were also detected, and vascular endothelial function was evaluated using ultrasound non-invasive blood flow mediated vasodilation function (FMD). Comparison and statistical analysis were carried out in groups.Results:Uric acid [(479.7±49.0) μmol/L vs. (381.2±76.7) μmol/L]、hs-CRP[(8.1±6.7) mg/L vs. (5.1±4.6) mg/L]、systolic blood pressure [(124.7±26.3) mmHg vs. (97.4±13.5) mmHg] decreased significantly in the experimental group after 3 months of treatment with allopurinol ( P<0.05), and blood flow mediated vasodilation function [(7.6±3.5) vs. (11.2±3.9)]significantly increased ( P<0.05). The decrease of serum uric acid was positively correlated with the increase of FMD in the experimental group ( r=0.463, P<0.01). Multiple Regression analysis showed that serum uric acid was an independent predictor of FMD( β=-0.229, P=0.035). Conclusions:The treatment of hyperuricemia in patients with acute cerebral infarction can significantly improve the vascular endothelial function of patients, improve inflammation state and lower blood pressure. It is further confirmed that a higher uric acid level is related to worse endothelial function which may contribute to atherosclerosis.

Objective:To observe the changes of skeletal muscle indexes in elderly patients with type 2 diabetes complicated with sarcopenia treated with sitagliptin and acarbose.Methods:A total of 60 patients over 60 years old with type 2 diabetes complicated with sarcopenia in Dalian Municipal Central Hospital from January 2019 to January 2020 were selected and divided into two groups by random number table method.One group received sitagliptin and metformin,and the other group received acarbose and metformin. The changes of skeletal muscle indexes, glucagon-like peptides-1 (GLP-1), insulin resistance index (HOMA-IR) and inflammatory indexes were compared between the two groups at baseline and 36 weeks after treatment.Results:After treatment, the skeletal muscle index (SMI) of sitagliptin group was increased (5.94 ± 1.52 vs. 5.99 ± 1.52), and the difference was statistically significant ( P<0.05). Muscle strength and SMI decreased in acarbosse group (18.75 ± 4.64 vs. 17.72 ± 4.44, 6.09 ± 1.74 vs. 6.00 ± 1.71), with statistical significance ( P<0.05). GLP-1 increased in sitagliptin group, 0 min: (10.65 ± 1.68) pmol/L vs. (12.41 ± 1.88) pmol/L; 60 min: (22.79 ± 2.85) pmol/L vs. (25.51 ± 2.79) pmol/L; 120 min: (24.26 ± 2.94) pmol/L vs. (29.49 ± 2.91) pmol/L; 180 min: (11.68 ± 1.84) pmol/L vs. (12.88 ± 1.83) pmol/L. There were significant differences ( P<0.05). HOMA-IR and CRP decreased: 4.73 ± 3.04 vs. 3.16 ± 2.41, (2.39 ± 0.50) mg/L vs. (2.33 ± 0.43) mg/L, and the differences were statistically significant ( P<0.05). HOMA-IR in acarbose group decreased after treatment (5.80 ± 3.94 vs. 4.00 ± 1.63), and the difference was statistically significant ( P<0.05). Comparison between the two groups after treatment, the decreased value of muscle strength in sitagliptin group was less than that in acarbose group, and the difference was statistically significant ( P<0.05). GLP-1 and overall GLP-1 area under the curve in sitagliptin group were higher than those in acarbose group (67.64 ± 6.81 vs. 58.98 ± 6.72), with statistical significance ( P<0.05). HOMA-IR and CRP in sitagliptin group were lower than those in acarborose group: 3.16 ± 2.42 vs. 4.00 ± 1.63, (2.33 ± 0.43) mg/L vs. (2.41 ± 0.70) mg/L, with statistical significances ( P<0.05). Conclusions:Sitagliptin therapy improves muscle mass and protects muscle strength in elderly patients with type 2 diabetes mellitus and sarcopenia.

Objective:To study the correlation between serum uric acid (SUA) and vascular calcification in middle-aged and elderly men.Methods:Using the Yiduyun electronic medical record retrieval system, a cross-sectional study was conducted on the clinical data of 2 786 male patients aged ≥40 years who underwent lung CT examinations in Dalian Central Hospital, Dalian University of Technology from January 2010 to October 2022. According to the degree of pulmonary CT vascular calcification, they were divided into vascular calcification group (1 296 cases)and non vascular calcification group (1 490 cases). The clinical data were collected and the correlation between SUA and vascular calcification were analyzed.Results:The levels os SUA in the vascular calcification group was higher than that in the non vascular calcification group: 311.50(270.25, 359.00) μmol/L vs. 284.00(251.00, 318.00) μmol/L, there was statistical difference ( F = 14.16, P<0.01). The constituent ratio of hyperuricemia in vascular calcification group was higher than that in non vascular calcification group : 25.62%(332/1 296) vs. 11.68%(174/1 490), there was statistical difference ( χ2 = 20.15, P<0.01). Spearman correlation analysis found a positive correlation between SUA level and vascular calcification in middle-aged and elderly men ( r = 0.489, P<0.01). Binary Logistic regression analysis results showed that SUA, body mass index (BMI), diastolic blood pressure(DBP), fasting plasma glucose(FPG) were positively correlated with vascular calcification ( P<0.01); after adjusting the influence of BMI, DBP and FPG on male vascular calcification, SUA was still a risk factor for vascular calcification. Conclusions:In the middle-aged and elderly male population, with the increase of blood uric acid, vascular calcification increase, and the elevated blood uric acid level is an independent risk factor for vascular calcification.