RESUMO
BACKGROUND: Vascular health has been associated with cognition but related evidence is limited in Chinese. The objective of this study was to examine the association of vascular aging assessed by arterial stiffness and blood pressure with cognitive function in an unselected Chinese population. METHODS: In the Tianning Cohort (N = 5158), indicators of arterial stiffness and blood pressure including carotid-femoral pulse wave velocity (cfPWV), ankle-brachial index (ABI), pulse pressure (PP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured. Cognitive function was assessed using the Mini Mental State Examination (MMSE) questionnaire. We applied Poisson regression and logistic regression to examine the associations of vascular aging and blood pressure with cognitive function. RESULTS: 76 (1.47%) participants had impaired cognitive function diagnosed by a MMSE score of less than 24 points. Participants with a higher level of PP were more likely to have a decreased score of MMSE (ß=-0.0121, P < 0.001 for log-transformed pulse pressure) and a higher risk of having impaired cognitive function (OR = 5.95, 95%CI: 2.02-17.79, P < 0.001 for log-transformed PP). Per standard deviation increment in SBP was significantly associated with lower MMSE score (ß=-0.0020, P < 0.001) and impaired cognitive function (OR = 1.69, 95%CI: 1.38-2.06, P < 0.001). No significant associations were found regarding other parameters. CONCLUSIONS: Blood pressure and hypertension were associated with cognitive function in Chinese adults. PP may be a potential predictor for impaired cognitive function.
Assuntos
Pressão Sanguínea , Cognição , Rigidez Vascular , Humanos , Feminino , Masculino , China/epidemiologia , Pessoa de Meia-Idade , Rigidez Vascular/fisiologia , Idoso , Cognição/fisiologia , Pressão Sanguínea/fisiologia , Envelhecimento/fisiologia , Índice Tornozelo-Braço , Adulto , Análise de Onda de Pulso , Estudos de Coortes , População do Leste AsiáticoRESUMO
BACKGROUND: Situs inversus totalis (SIT) is a rare congenital anomaly characterized by a complete transposition of all the viscera. SIT cases were usually reported because of the presence of tumors, leading to false association between them. Therefore, any research that advances our understanding on SIT is highly required. This study firstly describes a very rare case of SIT with "jumping" metastasis to pancreas of gallbladder carcinoma. CASE PRESENTATION: A 69-year-old female patient presented at our hospital with complaints of one month of epigastric pain was studied. She had not sought for treatment prior the visit. Imaging examinations of this patient revealed SIT and a variation of the common hepatic artery with concomitant tumors of gallbladder and pancreas. However, there was no evidence of distant metastases beyond the abdominal cavity. She underwent a combination of radical cholecystectomy, total pancreatectomy, splenectomy and hepatic artery-splenic artery reconstruction. Histological analyses revealed metastasis of the gallbladder carcinoma in to the pancreas. Although the patient opted against chemotherapy, she survived without tumor for 16 months following the surgery. A review of the current literature on association with SIT and tumor occurrence was presented. CONCLUSIONS: It is a great surgical challenge for the resection of multicenter hepatobiliary and pancreatic tumors in such rare SIT anatomical abnormalities with vascular variants. A reliable surgical plan based on detailed preoperative imaging and intraoperative anatomical exploration is crucial to achieving radical resection.
Assuntos
Neoplasias da Vesícula Biliar , Situs Inversus , Idoso , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Artéria Hepática/diagnóstico por imagem , Humanos , Estudos Multicêntricos como Assunto , Pancreatectomia , Situs Inversus/complicações , Situs Inversus/diagnóstico por imagem , Situs Inversus/cirurgia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Corin protein and its coding gene variants have been associated with hypertensive disorders of pregnancy (HDP), but the underlying mechanisms are unclear. As a mediator linking fixed genome with the dynamic environment, DNA methylation at the CORIN gene may link corin with HDP but not has been studied. This study aimed to examine whether CORIN promoter methylation and HDP in Chinese pregnant women. METHODS: Based on a cohort of Chinese pregnant women, we designed a nested case-control study including 196 cases with HDP and 200 healthy controls. DNA methylation levels in the CORIN promoter were quantified by pyrosequencing using peripheral blood before 20 gestational weeks. The association between DNA methylation in CORIN promoter and HDP was systemically examined by single CpG association analysis, followed by gene-based analysis. Multiple testing was controlled by the false discovery rate (FDR) method. RESULTS: The single CpG association analysis found that, among the 5 CpG sites assayed, hypermethylation at one CpG site (Chr4:47839945) was significantly associated with HDP (OR = 1.94, raw P = 0.020), but the significance did not survive for multiple testing correction (FDR-P = 0.100). The gene-based association analysis found that DNA methylation of the 5 CpG sites was jointly associated with HDP (raw P = 0.003). In addition to HDP, CORIN promoter methylation was also significantly associated with dynamic blood pressure during pregnancy (raw P < 0.05). DISCUSSION: Hypermethylation in CORIN promoter at early pregnancy was associated with the risk of HDP during late pregnancy in Chinese women. However, further evidence is required to establish the causality between CORIN promoter methylation and HDP.
Assuntos
Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Gravidez , Feminino , Humanos , Estudos de Casos e Controles , Pré-Eclâmpsia/genética , Pressão Sanguínea , Metilação de DNA , Serina Endopeptidases/genética , Serina Endopeptidases/metabolismoRESUMO
How to reduce grade C postoperative pancreatic fistula (POPF) incidence after pancreaticoduodenectomy (PD) is the pursuit of pancreatic surgeons. This study introduced an innovative pancreaticojejunostomy (PJ) technique with a complete set of perioperative management. All 144 patients in this single-center retrospective cohort study underwent the same PJ technique and perioperative management. The primary endpoint was grade C POPF incidence. The secondary endpoints were grade B POPF rate, drain fluid amylase level, complications, hospital stay duration, and mortality. Risk factors for clinically-relevant POPF (CR-POPF) were assessed by logistic regression analysis. No patient (0.0%) experienced grade C POPF, while 44 (30.6%) developed grade B. No in-hospital death was recorded. Multivariate analysis found relatively high body mass index, laparoscopic surgery, and soft or moderate pancreatic texture independent risk factors for CR-POPF. Our novel PJ anastomosis with modified perioperative management helped avoid grade C POPF. However, grade B POPF incidence was relatively high to some extent because of the enhanced management itself.
Assuntos
Pancreaticoduodenectomia , Pancreaticojejunostomia , Humanos , Pancreaticojejunostomia/efeitos adversos , Pancreaticojejunostomia/métodos , Pancreaticoduodenectomia/métodos , Estudos Retrospectivos , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Fístula Pancreática/prevenção & controle , Pâncreas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologiaRESUMO
Pelvic fractures with retroperitoneal hematoma are frequent injuries, and there are multiple treatment options for patients. In this case, a 35-year-old female patient suffered an unstable pelvic fracture due to a car crash, accompanied by the formation of a huge retroperitoneal hematoma. The vital signs of patient were not stable. The patient immediately underwent active anti-shock therapies such as multi-channel infusion, blood transfusion, blood volume supplementation, and blood pressure elevation. However, the vital signs of patient remained unstable, the abdominal circumference increased, hemoglobin decreased rapidly, and the plasma protamine paracoagulation (3P) test was positive. So, tracheal intubation and mechanical ventilation were performed. Experts from various departments were invited to form an emergency multidisciplinary team (MDT), and exploratory laparotomy was selected. Intraoperative exploration revealed the formation of a huge retroperitoneal hematoma, and there was no bleeding or abdominal organ rupture. So, five large gauzes were developed and packed into the extra peritoneal space to stanch bleeding. Following successful hemostasis, the pelvic external fixator was positioned. Re-surgery was performed 78 hours after surgery to remove all gauzes. At 2.5 months postoperatively, the pelvic external fixator was also removed. Ultimately, the patient achieved good surgical results. Pelvic gauze packing combined with an external fixator is a rapid and effective treatment strategy for critical and huge retroperitoneal hematomas caused by unstable pelvic fractures. To our knowledge, this has not been previously reported.