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Objective@#To investigate the relationship between neck circumference and metabolic syndrome (MS) in ≥ 40 years old community residents.@*Methods@#A total of 5 017 Dalian community residents who participated in "the risk evaluation of cancers in Chinese diabetic individuals: a longitudinal study" from July to December 2014 were selected, with 1 256 male cases and 3 761 female cases, aged ≥ 40 years old. The basic information was selected by questionnaire. The neck circumference, waist circumference (WC), body height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), 2 h-postprandial plasma glucose (2 h PG), glycosylated hemoglobin (HbA1c) and blood fat were measured; the body mass index (BMI) was calculated.@*Results@#The age, neck circumference, WC, FPG, 2 h PG, SBP, DBP, incidence of obesity, incidence of hypertension and incidence of type 2 diabetes mellitus in male were significantly higher than those in female: (63.5 ± 8.4) years vs. (60.8 ± 8.0) years, (38.6 ± 3.0) cm vs. (34.4 ± 2.6) cm, (92.3 ± 9.1) cm vs. (87.3 ± 9.6) cm, 5.59 (5.20, 6.42) mmol/L vs. 5.43 (5.09, 5.99) mmol/L, 7.67 (6.06, 11.08) mmol/L vs. 7.20 (5.97, 9.64) mmol/L, (135.3 ± 18.8) mmHg (1 mmHg = 0.133 kPa) vs. (129.8 ± 19.5) mmHg, (79.8 ± 10.7) mmHg vs. (74.8 ± 10.0) mmHg, 53.0% (666/1 256) vs. 48.9% (1 841/3 761), 49.9% (627/1 256) vs. 40.6% (1 528/3 761) and 29.8% (374/1 256) vs. 22.5% (846/3 761); the total cholesterol, triacylglycerol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and incidence of central obesity in male were significantly lower than those in female: (5.04 ± 0.94) mmol/L vs. (5.58 ± 1.03) mmol/L, 1.35 (0.97, 1.95) mmol/L vs. 1.45 (1.06, 2.04) mmol/L, (1.18 ± 0.27) mmol/L vs. (1.32 ± 0.29) mmol/L, (2.99 ± 0.78) mmol/L vs. (3.27 ± 0.85) mmol/L and 63.7% (800/1 256) vs. 79.7% (2 998/3 761), and there were statistical differences (P<0.01 or <0.05). There were no statistical differences in BMI, HbA1c and incidence of MS between male and female (P>0.05). After adjustment for age, smoking, drinking, menopausal status (female), BMI and WC, Logistic regression analysis result showed that increased neck circumference in male increased the risk of type 2 diabetes mellitus (OR = 1.075, 95% CI 1.012 to 1.142, P = 0.019); increased neck circumference in female increased the risks of type 2 diabetes mellitus (OR = 1.143, 95% CI 1.096 to 1.192, P = 0.000), hypertension (OR = 1.112, 95% CI 1.071 to 1.156, P = 0.000), hypertriacylglyceremia (OR = 1.099, 95% CI 1.060 to 1.139, P = 0.000), low HDL-C (OR = 1.104, 95% CI 1.064 to 1.144, P = 0.000) and MS (OR = 1.167, 95% CI 1.120 to 1.217, P = 0.000). Taking neck circumference as detection variable and MS as outcome variable, the receiver operating characteristic curve was analyzed. In male, the area under curve was 0.733, the optimal cut-off value of neck circumference was 37.9 cm, with a sensitivity of 77.9%, and a specificity of 55.9%. In female, the area under curve was 0.720, the optimal cut-off value of neck circumference 33.3 cm, with a sensitivity of 76.7%, and a specificity of 56.0%.@*Conclusions@#Neck circumference is associated with MS in ≥ 40 years old community residents. Male neck circumference >37.9 cm and female neck circumference>33.3 cm are the optimal cut-off value for forecasting MS.
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Objective To determine the impact of uric acid changes on kidney function in middle-aged and elderly women with normal renal function.Methods Serum uric acid and estimated glomerular filtration rate(eGFR) were studied by prospective cohort analysis in 1152 middle-aged and elderly Dalian women with serum uric acid45 years old.Results The analysis of variance (ANOVA) of clinical indices between baseline and follow-up data showed that an eGFR was decreased after three years in both middle-aged and elderly women even with normal serum uric acid.Compared with those in the lowest guartile subgroup, a significant drop of eGFR to less than 90 ml·min-1·(1.73 m2)-1 was seen in those with the highest guartile of baseline serum uric acid group (OR=1.707, 95%CI 1.192-2.443, P=0.003).Furthermore, there were positive correlations between changes in the levels of serum uric acid and eGFR, and linear regression analysis showed that, as the change level of serum uric acid increased, the change level of eGFR declined(β=1.562, 95%CI 1.050-2.075, P<0.01], and the changing degree of uric acid increase is independent risk factors refor eGFR reductions.Conclusion Reduction in eGFR level is inversely related to serum uric acid in perimenopausal and postmenopausal women.However, our study showed that, women with serum uric acid level ranging from normal, slight increase, and relatively high levels, the increasing degrees of uric acid are independent risk factors responsible for the changing degree of eGFR reduction.
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Objective To evaluate protective effects of dexmedetomidine combined with lung-protective ventilation on lungs in patients undergoing thoracic surgery.Methods Eighty patients with normal pulmonary function,aged 40-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,with body mass index of 20-25 kg/m2,scheduled for elective right lobectomy for lung cancer performed via a thoracoscope,were divided into 4 groups (n =20 each) using a random number table:conventional ventilation group (group C),dexmedetomidine combined with conventional ventilation group (group DC),lung-protective ventilation group (group P) and dexmedetomidine combined with lung-protective ventilation group (group DP).In DC and DP groups,dexmedetomidine was intravenously infused as a loading dose of 0.5 μg/kg (over 10 min) starting from 10 min before anesthesia induction,followed by an infusion of 0.6 μg · kg 1 · h-1 until the end of surgery.In C and DC groups,the tidal volume was set at 9 ml/kg,positive end-expiratory pressure 0 cmH2O,fraction of inspired oxygen 100％,respiratory rate 10-12 breaths/min,inspiratory/expiratory ratio 1 ∶ 2,and end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg during both two-lung ventilation (TLV) and one-lung ventilation (OLV).In P and DP groups,the tidal volume was set at 6 ml/kg,positive end-expiratory pressure 5 cmH2O,fraction of inspired oxygen 70％,respiratory rate 14-16 breaths/min,i nspiratory/expiratory ratio 1 ∶ 2,and end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg during TLV and OLV.Airway peak pressure (Ppe~),airway plateau pressure (Pp~t),dynamic lung compliance and airway resistance (Raw) were monitored and recorded immediately before OLV (T1),at 30 min,1 h and 2 h of OLV (T2-4) and at 15 min after restoration of TLV (T5).Arterial blood samples were collected at 10 min before induction of anesthesia (T0) and T1-5 for blood gas analysis,and oxygenation index was calculated.At T0,T1,T3,T4 and 2 and 24 h after surgery (T6,7),blood samples were taken from the right internal jugular vein for determination of the concentrations of serum tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and high-mobility group box 1 protein (HMGB1) by enzyme-linked immunosorbent assay.Results Compared with group C,Raw was significantly decreased at T2-4 in group DC,Ppeak,Pplat and Raw were significantly decreased at T2-4 in P and DP groups,oxygenation index was significantly increased at T5 in DC and P groups,oxygenation index was significantly inereased at T2-5 in group DP,the concentrations of serum TNF-α and IL-6 were significantly decreased at T3,4 and T6,7 in P,DC and DP groups,and the concentrations of serum HMGB1 were significantly decreased at T6,7 in DC and DP groups (P＜0.05).Compared with group DC,Ppeak,Pplat and Raw were significantly decreased at T2-4,oxygenation index was increased at T3-5,and the concentrations of serum TNF-α and IL-6 were decreased at T3,4 and T6,7 in group DP (P＜0.05).Compared with group P,Raw was signifieantly decreased at T2-4,oxygenation index was increased at T2-5,and the concentrations of serum TNF-α and IL-6 were decreased at T3,4 and T6,7,and the concentrations of serum HMGB1 were decreased at T6,7 in group DP (P＜0.05).There was no significant difference in dynamic lung compliance at each time point among the four groups (P＞0.05).Conclusion The combination of dexmedetomidine and lung-proteetive ventilation provides protective effects on lungs and exterts better efficacy than either alone,and the mechanism may be related to inhibiting systemic inflammatory responses of patients undergoing thoracic surgery.
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Objective To compare the cellular immune function during postoperative analgesia with dezocine and fentanyl in the patients with gynecologic malignant tumors.Methods Fifty patients scheduled for elective surgery for gynecologic malignant tumors, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , were equally and randomly divided into either dezocine group (group D) or fentanyl group (group F) using a random number table.Total intravenous anesthesia was used for all the patients, and the intraoperatively administered anesthetics was the same.The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained dezocine 0.8 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group D.PCIA solution contained fentanyl 0.01 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group F.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h after a loading dose of 2 ml in the two groups.Tramadol 100 mg was given intravenously as rescue analgesic to maintain visual analogue scale score ≤ 4.Before surgery (T0), at the end of surgery, and at 24 and 48 h after surgery (T2,3) , venous blood samples were collected for detection of T lymphocyte subsets CD3+, CD4+ , CD8+ and natural killer (NK) cell levels (by flow cytometry).CD4+/CD8+ ratio was calculated.The requirement for rescue analgesics and occurrence of adverse reactions such as nausea, vomiting, hypotension and respiratory expression were recorded after surgery.Results No patients required tramadol as rescue analgesic in either group.Compared with the value at T0, the levels of CD3+ , CD4+ and NK cells and CD4+/CD8+ ratio were significantly decreased at T1,2, and the CD8+level was increased at T1 in group D, and the levels of CD3+ cells at T1,2, CD4+ cells at T1 and NK cells at T1-3 were decreased (P＜0.05) , and no significant change was found in CD8+ cell level and CD4+/CD8+ ratio in group F (P＞0.05).Compared with group F, the levels of CD3+ and NK cell were significantly increased at T3 (P＜0.05) , and no significant change was found in the incidence of adverse reactions after surgery in group D (P＞0.05).Conclusion The inhibitory degree of the cellular immune function is reduced when postoperative analgesia is performed with dezocine as compared with that when fentanyl is used in the patients with gynecologic malignant tumors.
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Objective To evaluate the efficiency of dexmedetomidine combined with flurbipro-fen axetil preventing agitation and reducing extubation reaction after general anesthesia. Methods Eighty patients,ASA Ⅰ or Ⅱ,scheduled for selective oral and maxillofacial surgery were randomly divided into four groups,20 patients in each group.30 mins before end of the operation, patients intravenously received flurbiprofen axetil 50 mg (group F),dexmedetomidine 0.5 μg/kg (group D),dexmedetomidine 0.25 μg/kg plus flurbiprofen axetil 50 mg (group DF),normal saline (group C),respectively.MAP,HR were recorded before extubation (T0 ),extubation (T1 ),5 mins after extubation (T2 ).The recovery time,extubation time,Riker sedation-agitation score(RSAS)be-fore extubation and Ramsay sedation score 5 min after extubation were observed.Results Compared with T0 ,MAP,HR at T1 ,T2 in group C and group F were significantly increased (P <0.05 or P <0.01),MAP,HR at T1 ,T2 in group D and group DF were significantly lower than those in group C (P <0.01 ).The recovery time,extubation time in group D were significantly longer than those in group C,group F and group DF(P <0.05).Ramsay scores in group D was significantly higher than other groups(P <0.05).The incidence of agitation in group D and group DF were significantly lower than those in group C(P <0.05 or P <0.01).Conclusion Dexmedetomidine 0.25 μg/kg plus flurbi-profen axetil 50 mg can effectively prevent agitation and reduce extubation cardiovascular reaction dur-ing recovery period,without the disadvantage of prolonging the recovery and extubation time.
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Objective To investigate the epidemiological characteristics of non-toxic goiter and non-toxic thyroid nodules in the regions with different iodine intakes and the factors influencing the occurrence, development and outcome of goiter and thyroid nodules. Methods 3 385 subjects, who had taken part in the previous survey in 1999 with the ultrasonic examination of thyroid, were composed of individuals in Panshan with chronic mild iodine deficiency,in Zhangwu with more than adequate iodine "after iodine supplementation and in Huanghua with excessive iodine. These 3 groups of subjects were followed up in 2004. Results (1) The cumulative incidences of diffuse goiter in Panshan ,Zhangwu and Huanghua were 7.1% ,4.4% and 6.9% ,respectively ,being the lowest in Zhangwu (P<0.01) and those of nodular goiter were 5.0% ,2. 4% and 0.8%, respectively, being the highest in Panshan (P<0.01). (2) The incidences of single nodule were 4.0% ,5.7% and 5.6%, respectively, and those of multiple nodules 0.4%, 1.2% and 1.0%, respectively. (3)The result of logistic analysis showed that iodine deficiency,iodine excess and positive thyroid autoantibodies (TAA) were the independent risk factors for the occurrence of goiter. (4)In Zhangwu ,the incidence of non-toxic goiter in the group with positive TAA was higher than that in the group with negative TAA(P<0.01) ,while there were no such differences in Panshan and Huanghua. (5)In these three regions, the rates of positive TAA in the individuals with diffuse non-toxic goiter were higher than those in the healthy subjects (P<0.05). And in Huanghua,the rate of positive TAA in subjects with non-toxic nodular goiter was also higher than that in the healthy individuals (P<0.05). Conclusion Iodine deficiency and iodine excess may both induce the raising incidence of goiter. Nodular goiter is prevalent in iodine deficient district and diffuse goiter is the predominant form in places with iodine excess. Thyroid autoimmunity is associated with occurrence and maintenance of goiter, and this phenomenon is more obvious in the community with previous iodine deficiency followed then by treatment with more than adequate iodine.
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Objective To clarify the effect of iodine intake on serum thyroglobulin (Tg). Methods A 5-year prospective study was conducted in the 3 different iodine intake areas in China [Panshan (miht deficiency) ,Zhangwu (more than adequate) and Huanghua (excess)]. A total of 3 099 people with normal serum levels of Tg in 1999 were followed and 2 448 of these participants were feasible to be observed in 2004 and included in the present study. The serum levels of Tg, thyraglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and TSH, thyroid volume, family and personal histories of thyroid diseases were measured and inquried. The general linear model (GLM) was used to explore the determinants of Tg. Results Among the study population at baseline, serum Tg were significantly different in three areas [7.5 (4.4-13. 1) μg/L at Panshan, 6.8 (3.6-11.2)μg/L at Huanghua, 5.9 (3.2-10.7) μg/L at Zhangwu, P<0.01]. They were associated with age, sex and the rate of positive TgAb, abnormal thyroid volume, abnormal TSH and positive personal history of thyroid diseases, in order to control the effects of confounding factors, the data from 1856 subjects with thyroid-related indexes all in normal range and without personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. The serum Tg among three areas were significantly different in both 1999 and 2004, they were all increased in 5 years with significant augment (△ Tg) among the three areas[3.1 (-0.2-8.0) μg/L at Panshan, 3.5 (0.5-9.0)μg/L at Huanghua vs 2. 5(0.3-6.1) μg/L at Zhangwu,P<0.01]. The GLM analysis revealed that age, Tg and TSH levels at baseline were the determinants of △Tg in addition to iodine intake. Conclusion Iodine intake is a dominant determinant of serum Tg. Age and TSH should also be considered while indicating iodine intake by serum Tg.
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OBJECTIVE To strengthen the hospital infection control to realize the potency feeling among malignant tumor patients under the conduct of psychological nurses and other medical staff.METHODS The related hospital infection control system and the psychological countermeasure of nursing were formulated,we used two groups of comparisons methods around implements,counting and analyzing the effect of the hospital infection control among malignant tumor patients.RESULTS The psychologically healthy instruction enabled the patient positively to coordinate the treatment,the ratio of hospital infection from the original 21.33% dropped to 15.41%,and make the certain dynamic function to the self-realization of the patients' potency feeling.CONCLUSIONS The hospital infection control is an essential and important link to the nursing of the malignant tumor patients;the psychologically healthy instruction is an effective way to promote the self-realization of patients potency feelings.
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With the development of our understanding of the physiology,pathophysiology and pharmacology of pain,preemptive analgesia has been widely introduced into clinical treatment.This review focuses on the mechanism and application of preemptive analgesia in acute pain therapy.
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0.05),but there was significant difference between group A and group C,the rate of hypoglycemia of group A was less than group C(P