Volume 100 ·  Issue 06 ·  2020

The liver has the function of synthesis and degradation, and is responsible for the regulation of metabolic pathways such as carbohydrates, proteins, lipids, trace elements and vitamins. Disorders in these metabolic pathways and specific enzyme defects can cause primary or secondary abnormalities in the liver. In recent years, due to factors such as lifestyle changes and genetic susceptibility of the population, the number of people with alcoholism, obesity and metabolic syndrome has increased rapidly, and the number of liver disease patients with clinical non-viral hepatitis has continued to increase rapidly. Non-viral hepatitis liver disease has multiple abnormalities such as lipid metabolism disorder, glucose metabolism and increased ethanol metabolic load, which is obviously different from viral hepatitis in many dimensions such as pathogenic factors, incidence, diagnostic indicators, prevention and treatment measures, etc. Because its pathogenic factors are mainly metabolic factors, it is called metabolic liver disease. This paper reviews the literature of recent studies and puts forward the preliminary definition and classification, calls for the establishment of special diagnosis and treatment teams or units, and strengthens clinical and related basic research work.

Insulin is the first choice for blood sugar control during pregnancy. Almost all pre-pregnancy diabetes, most gestational dominant diabetes, and about 20% of gestational diabetes need insulin to control blood sugar during pregnancy. Compared with non-pregnancy, postprandial blood glucose during pregnancy is higher and fluctuates more, and blood glucose levels change constantly with the progression of gestational age and changes in placental function. The use of insulin during pregnancy should be combined with the characteristics of blood glucose at different gestational weeks, and a reasonable dosage form and treatment plan should be selected. The efficacy and safety of insulin analogs including insulin aspart, insulin lispro, insulin glulain, insulin detemir, insulin glargine and insulin degluck in pregnancy are described.

Artificial intelligence decision-making system can help us better formulate clinical protocols and improve decision-making efficiency. A mature system needs data, core algorithms and good interface support. Based on the breast cancer database of the Chinese Society of Clinical Oncology, based on domestic core algorithms, and based on the guidelines, we created an artificial intelligence decision-making system with independent intellectual property rights, and used phase I to IV clinical studies to verify the compliance rate of this system with the guidelines and the degree of help to doctors at different levels. The promotion of this system will further improve the standardized diagnosis and treatment of breast cancer, and at the same time provide experience for the establishment and application of other intelligent decision-making systems.

In the past 20 years, China's medical insurance system has advanced by leaps and bounds, and great achievements have been made. In order to further improve the medical insurance system of our country, this paper analyzes the present situation of the system and reveals its existing problems at the present stage. This paper puts forward the idea of perfecting the construction of medical insurance system by developing commercial insurance, discusses and discusses the opportunities and predicaments of commercial insurance in the field of medical insurance at present, and suggests that the reform should be carried out from three aspects: legislative path, autonomous path and connecting path, so as to give full play to the complementary role of commercial insurance in perfecting China's medical insurance system.

To investigate related factors for microalbuminuria in adult type 1 diabetes (T1D) patients of short disease duration (less than 5 years), and provide evidence for prevention of early diabetic kidney disease in this population.

All adult patients enrolled in the Guangdong T1D translational medicine study between 2011 and 2017 with a disease duration of less than 5 years were included in this analysis. At enrollment, patients′ demographic and clinical data were documented, and blood and urine samples were collected for the measurements of blood lipids, glycated hemoglobin A1c and urine albuminuria. Insulin resistance was evaluated by estimated glucose disposal rate (eGDR). Patients were categorized into groups based on urine albumin creatitine ratio (UACR): normoalbuminuric group (UACR<30 mg/g) and microalbuminuric group (UACR≥30 mg/g). Stepwise multivariate linear regression analysis was used to analyze risk factors for microalbuminuria in adult T1D patients of short disease duration.

A total of 384 patients were included in this analysis, and 51.3% (197/384) of which was female. The onset age of patients was (24.6±12.5) years, with a disease duration of 2.1(0.6, 3.5) years, body mass index of (19.8±3.2) kg/m², waist hip ratio of 0.85±0.21, and glycated hemoglobin A1c of (9.8±3.3)% at enrollment. Microalbuminuria occurred in 62 patients (16.1%). Multivariate linear analysis showed that higher glycated hemoglobin A1c, higher systolic blood pressure and more severe insulin resistance were related factors for microalbuminuria (t=2.322, 2.868 and -2.373, respectively, all P<0.05).

Microalbuminuria was not rare in adult T1D patients of short disease duration. Inadequate glycemic control and insulin resistance were independent related factors for microalbuminuria in this population.

To establish the electrochemiluminescence (ECL) method for insulin autoantibody (IAA) detection in China and preliminarily evaluate its application value.

Proinsulin was labeled with Sulfo-tag and biotin, and then incubated with IAA in serum. The Meso Scale Discovery (MSD) streptavidin plate was used to capture the labeled antigen-antibody complex, which was subsequently detected by MSD electrochemiluminescence machine. IAA index ≥ 0.005 was used as a positive threshold. After optimizing the detection conditions, the correlation and consistency of ECL method and microplate radioimmunoassay were compared. Patients with type 1 diabetes mellitus (T1DM, n=55) and first-degree relatives (n=216) from the Department of Metabolism and Endocrinology of the Second Xiangya Hospital of Central South University from 2016 to 2018, and healthy volunteers (n=413) were selected as subjects, and their serum samples were tested to evaluate the clinical application value of ECL.

The optimized conditions included as follows: (1) The optimal concentration of biotin-proinsulin and Sulfo-tag-proinsulin was 800 ng/ml. (2) Serum acidification was achieved by incubating for 45 min. (3) Adding 35 μl diluted antigen, followed by adding 15 μl Tris-HCl to the reaction system, and then incubated with acidified serum overnight to obtain a higher signal-to-noise ratio (S/N). Twenty-two samples were repeatedly detected by ECL method at intervals of 3 months. There was no significant difference in IAA index ( P=0.095) and the positive or negative results was completely consistent. The agreement rate between ECL method and microplate radioimmunoassay for IAA was 93.7% (119/127) (Kappa value: 0.858), and the index showed a significant positive correlation (correlation coefficient r=0.749, P<0.001). The area under the curve (AUC) of ECL assay was 0.764 (95%CI: 0.669 to 0.858). The positive rate of IAA in T1DM patients by ECL method was 52.73% (29/55), which was significantly higher than 0.76% (2/263) in healthy controls. The positive rate of IAA in T1DM first-degree relatives group was 0.93% (2/216), and there was no significant difference compared with healthy control group (P=0.854).

ECL method of IAA has the features of high sensitivity and specificity, simple operation and no radioactive contamination, indicating its appreciable clinical application value.

To investigate the effect and specific mechanism of heat shock protein 47 (HSP47) on streptozotocin (STZ)-induced diabetic cardiomyopathy (DCM).

A mouse model of type 1 diabetic cardiomyopathy was established by intraperitoneal injection of STZ. After 8 weeks of successful modeling, HSP47 was overexpressed by tail vein injection, and the heart of the mouse was harvested after 6 weeks. Hematoxylin-eosin (HE) staining and Sirius red (PSR) staining were used to detect the cross-sectional area of myocardial cells and myocardial fibrosis, respectively. Immunofluorescence staining with α-smooth muscle actin (α-SMA) and collagen Ⅰ was used to detect the degree of fibrosis activation. The expression level of fibrosis-related proteins was determined by Western blot.

The expression level of HSP47 in the myocardium of the diabetic group up-regulated (2.014±0.264 vs 1.004±0.064, P<0.001). The area of myocardial cells in the diabetic group was increased compared with the control group [(235.3±20.7) μm ² vs (172.8±13.6) μm ², P<0.001] and the cross-sectional area of myocardial cells in the HSP47 overexpression-diabetes group was further increased [(302.2±41.0) μm ² vs (235.3±20.7) μm ², P=0.009], while the mRNA levels of mouse cardiac hypertrophic markers atrial natriuretic peptide (ANP), type B brain natriuretic peptide (BNP), myosin heavy chain β (β-MHC) further upregulated (all P<0.001). Compared with the control group, the myocardial fibrosis content in the diabetic group increased [(7.333±1.127)% vs (4.837±0.775)%, P=0.002] and the left ventricular fibrosis content of the HSP47 overexpressing diabetic group further increased [(9.175±1.008)% vs (7.333±1.127)%, P=0.025] and the mRNA levels of fibrosis index collagenⅠ, collagen Ⅲ, connective tissue growth factor (CTGF) and transforming growth factor β (TGFβ) further up-regulated (all P<0.001). Immunofluorescence results showed that compared with the control group, the expression of collagenⅠ up-regulated in the endothelial stroma of the diabetic group and the content of collagenⅠ in the HSP47 over-expressing diabetic group was higher (P<0.001). Western blot results indicated that the phosphorylation level of Smad3 and the protein levels of α-SMA and TGFβ in HSP47 overexpressing diabetic group increased, compared with those of diabetic group (all P<0.001).

HSP47 ameliorates STZ-induced diabetic myocardial fibrosis by activating the TGFβ/Smad3 signaling pathway.

To study the efficacy and safety of Balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH).

Patients who were diagnosed CTEPH in China-Japan Friendship Hospital from Feb 2018 to Sep 2019 were evaluated. The ineligibility for pulmonary endarterectomy (PEA) and the indication for BPA were decided on the basis of a consensus among the multidisciplinary team for all CTEPH patients. 6-min walk distance (6MWD), the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary artery pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were collected and analyzed before the first and the last BPA session.

A total of 67 BPA sessions were performed for 302 subsegmental pulmonary arteries in 25 inoperable CTEPH patients. 10 males (40.0%) and 15 females (60.0%), with the age of (57.8±7.1) years old. The median interval between CTEPH diagnosis and first BPA was 20.0 (9.0, 48.5) months. 18 patients were received more than 2 BPA sessions, the median follow-up time was 5.0 (3.5, 8.3) months. 6MWD, CI and the mixed venous oxygen saturation were significant improved after BPA [(425±74) vs (345±109) m, (1.99±0.45) vs (1.62±0.35) L·min^-1·m^-2, (68.1%±6.5%) vs (61.2%±6.3%)](all P<0.05). The plasma level of NT-proBNP, mPAP and PVR were significantly decreased after BPA [259 (93, 739) vs 806 (148, 2 159) ng/L, (40.6±8.3) vs (47.3±10.7) mmHg (1 mmHg=0.133 kPa), (11.9±4.9) vs (17.2±6.5) WU (1 WU=80 dyn·s·cm^-5)](all P<0.05). Hemoptysis occurred in 5 sessions (7.5%) and reperfusion pulmonary edema (RPE) occurred in 2 sessions (1.5%), 1 patient needed non-invasive mechanical ventilation because of RPE, 1 patient died from right heart failure caused by hemoptysis during perioperative period.

BPA can significantly improve the exercise tolerance and hemodynamic parameters for inoperable CTEPH patients, the risks of BPA are acceptable. BPA is an effective and relatively safe treatment for inoperable CTEPH patients.

To analyze the clinical features and prognosis of lung cancer patients with metastasis-induced acute pancreatitis (MIAP), and to provide clues for early diagnosis.

The characteristics and prognosis of 8 patients with MIAP in lung cancer admitted to Peking Union Medical College Hospital from January 2002 to September 2019 were retrospectively analyzed and were compared with non-tumor-induced AP.

Sevencases(7/8) were Mild AP, one (1/8) was Severe AP. Four patients (4/8) presented with AP as the reporting sign and lung cancer was not diagnosed until (112±36) days after the onset of AP. Clinical manifestations included abdominal pain (8/8), weight loss (4/8), nausea and vomiting (2/8), and jaundice (1/8). Stages of lung cancer were all Ⅳ.Histopathology proved that seven cases (7/8) were small cell lung cancer, and one case (1/8) was poorly differentiated adenocarcinoma. The median survival time was 11 months. Compared with non-tumor-induced AP, lung cancer patients with MIAP were older[(62±9) vs (48±15), P=0.018], the incidence of primary pancreatic duct dilatation (37.5% vs 3.1%, P=0.004) and abdominal lymphadenopathy (37.5% vs 6.3%, P=0.017) were higher; the level of hemoglobin [105.3±15.6) g/L vs (147.9±24.8) g/L, P<0.001] and hematocrit [(31.4±5.3) vs (42.5±6.1), P<0.001] were lower.

Patientswith MIAP in lung cancer had poor outcome and unspecific symptoms. Old age, anemia, main pancreatic duct dilatation and abdominal lymphadenopathy are diagnostic clues that merit clinical attention.

To compare and analyze the curative effect of three surgical methods in the treatment of small intestine atresia, and to provide evidence for individualized surgical treatment of children with small intestine atresia.

The clinical diagnosis and treatment of 168 children with small intestine Ⅱ, Ⅲ, Ⅳ type atresia in our hospital from January 2008 to September 2017 were retrospectively analyzed and they were divided into different types according to the operation. The three groups were end-to-end anastomosis group (EEA, n=58), end oblique anastomosis group (EOA, n=68), and proximal end-end anastomosis group (PEA, n=42). The EEA group and the EOA group were further divided into group a (EEA-a/EOA-a) with a proximal intestinal tube diameter greater than 4.0 times the distal end and a group b ((EEA-b/EOA-b) with a diameter less than or equal to 4.0 times the distal intestinal tube diameter. The gender, gestational age, birth weight, type of atresia, and postoperative defecation time, postoperative feeding time, postoperative hospital stay and postoperative follow-up complications were compared.

There was no significant difference in gender, gestational age and birth weight between the groups (P>0.05). The PEA group was better than EEA-a group and EOA-a group in postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications (P<0.05). The postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications of the EOA-a group were better than those of the EEA-a group (P<0.05). There was no statistically significant difference in postoperative defecation time, postoperative feeding time, and complications between the EEA-b group and the EOA-b group (P>0.05), but the postoperative hospital stay in the EEA-b group was longer than that in the EOA-b group (P<0.05).

PEA is recommended for children with a proximal intestinal canal diameter greater than 4.0 times greater than the distal end because of the rapid recovery and fewer complications; EOA is recommended for children with a proximal intestinal canal diameter of 4.0 or less because of its advantage of shorter hospital stay than EEA surgery. Congenital intestinal atresia has a better effect according to the specific conditions of the child.

To investgate the effect of properative transitional zone index (TZI) on the outcome of transurethral resection of prostate (TURP).

A retrospective analysis was performed on 206 patients with TURP who were admitted to our hospital from January 2016 to September 2018. All patients underwent transrectal ultrasound (TRUS) to determine the total prostate volume (TPV) and the transition zone volume (TZV). Patients were divided into two groups according to TZI (TZV/TPV) (group A: TZI<0.5, group B: TZI≥0.5). We collected data 6-months after surgery including international prostate symptom score (IPSS), quality of life score (QOL), maximum flow rate (Qmax), and postvoiding residue (PVR) to compare the difference of the postoperative outcome of two groups, while the IPSS was subdivided into voiding (IPSS-v) and storage(IPSS-s) symptoms, and the changes of IPSS, IPSS-v, IPSS-s, QOL, Qmax and PVR before and after surgery were analyzed. The treatment efficacy was determined as the changes of IPSS (post/preoperative IPSS: %IPSS), QOL (preoperative QOL-postoperative QOL: ΔQOL) and Qmax(preoperative Qmax-postoperative Qmax: ΔQmax). Pearson linear correlation analysis was employed to estimate the correlation of TZI and %IPSS, ΔQOL and ΔQmax, respectively.

A total of 126 patients were in Group A, and 80 patients were in group B. 1. The preoperative clinical data of the two groups were compared. There were no significant differences regarding age, IPSS, IPSS-v, IPSS-s, QOL, Qmax, and PVR between two groups (all P>0.05). However, the TPV of patients in group B (74.57±29.25) ml was significantly larger than that in group A (46.25±24.56) ml, P<0.001. While the postoperative follow-up outcomes of the two groups were compared, we found that IPSS-s (P=0.079), QOL (P=0.710), and PVR (P=0.651) were not statistically different between the two groups, but the postoperative IPSS, IPSS-v, and Qmax (8.50±5.75 vs 6.38±4.36, 4.03±3.75 vs 2.63±2.5, and (16.54±4.43) ml/s vs (18.94±4.84) ml/s, all P<0.05) were significantly different between the two groups. 2. Postoperative IPSS, IPSS-v, IPSS-s, QOL, Qmax and PVR were significantly different from those before surgery in two groups, respectively. 3. Pearson linear correlation analysis showed a significant positive correlation between TZI and ΔQmax ( r=0.32, P<0.01), a weaker negative correlation between TZI and %IPSS (r=-0.22, P<0.01), and no correlation between TZI and ΔQOL ( r=0.08, P=0.238).

There may be a correlation between the outcome of TURP and TZI, and the outcome of TURP may be better in patients with TZI ≥ 0.5.

To compare the curative effect of mesenchymal stem cells derived from human Wharton′s Jelly(WJ-MSC) or adipose(AD-MSC) culture supernatant on endothelial cells angiogenesis.

WJ-MSC and AD-MSC were isolated, identified, and the culture supernatant of stem cells was collected.The WJ-MSC or AD-MSC supernatant co-cultured with the endothelial cells. The expression levels of pro-angiogenic and anti-angiogenic genes of endothelial cells were assessed using qRT-PCR analysis, and the effects of stem cell culture supernatant on angiogenesis were evaluated by performing a tube formation assay in vitro.

After adding WJ-MSC and AD-MSC culture supernatant, the expression levels of pro-angiogenic genes in endothelial cells were upregulated, and the expression levels of anti-angiogenic genes were downregulated significantly in both experimental groups compared to the control group (P<0.01), and tube formation of endothelial cells was also significantly increased in both experimental groups as determined by the increase of the tube length ((43.2±9.2) mm vs (94.3±13.2)mm, (86.1±7.2)mm, P<0.01).

The results showed that AD-MSC culture supernatant can promote endothelial cells angiogenesis and its curative effect is similar to that of WJ-MSC.

In this study, we used the Weighted gene co-expression network analysis (WGCNA) analysis to find the gene module that are specifically expressed in Medulloblastoma and screened the marker genes that may diagnose and treat Medulloblastoma.

WGCNA was used to identify the gene modules that are specifically associated with suvival in Medulloblastoma. Cytoscape software was used to construct Co-expression Network. Survival analysis of hub genes using Kaplan Meier (KM) analysis method.

Based on the predicted co-expression network, we found that green module significantly associated with survival traits. Green module genes were analyzed and we identified the hub gene UBE2G1 by cytoscape software which have the most correlation with survival trait.

Our results indicate that UBE2G1 may be served as a candidate diagnostic biomarker and a promising therapeutic target for Medulloblastoma.

22q11.2 microdeletion syndrome is the most common chromosomal microdeletion syndrome in humans and includes a variety of diseases named after clinical features. Digeorge syndrome is one of them, which is typical of absence or dysplasia of the thymus, abnormal development of cardiac large vessels, and hypoparathyroidism. Complete Digeorge syndrome with absent thymus is rare, difficult to diagnose and treat and poor prognosis. This paper reports the clinical, imaging data, genetic test results and diagnostic process of a confirmed child with complete Digeorge syndrome, and analyzes the difficulties, doubts and breakthroughs in the diagnosis process, so as to provide experience for the follow-up diagnosis and clinical management of this disease.

This paper reports a case of quinolone-related Achilles tendinitis. The patient had swollen and painful heels. MRI showed inflammatory edema of Achilles tendon. The condition improved after physiotherapy after stopping quinolone drugs. This disease is prone to the elderly, patients with rheumatoid arthritis, athletes, patients with long-term use of hormones and patients with renal insufficiency. The pathogenesis is related to high concentration of quinolone tissue, oxidative stress of Achilles tendon and degradation of tendon cell matrix.

This case is a patient with Behcet's syndrome with pulmonary vascular involvement, pulmonary aneurysm-like lesions and pulmonary thromboembolism. The patient started with symptoms of pulmonary embolism, and during the course of anticoagulant therapy, hemoptysis symptoms still occurred without overdose of drugs. Behcet's syndrome was diagnosed after comprehensive screening, and pulmonary aneurysm was detected after 40 days of follow-up. It is suggested that hemoptysis occurs in patients with pulmonary embolism during anticoagulation. If overdose of anticoagulants is excluded, the possibility of systemic disease should be considered and carefully examined. Patients with clinical suspicion of pulmonary vasculitis need to maintain dynamic detection during the course of the disease to avoid missed diagnosis, although vascular involvement is not found at the initial diagnosis.

Childhood bronchial asthma (asthma for short) is a heterogeneous disease, including clinical phenotype, endophenotype biological targets and therapeutic response difference. The high risk factors of asthma in children are complex and difficult to identify, and the age span varies significantly. Most of them include improper inhalation techniques or poor treatment compliance, and asthma itself leads to refractory problems. In particular, the clinical phenotype of asthma in children under 5 years of age is variable and different from adolescent and adult asthma. Therefore, the diagnosis of childhood asthma should be combined with age characteristics, emphasizing the first exclusion of other diseases that cause wheezing. The targeted therapy strategy is based on the heterogeneous characteristics of childhood asthma, first removing or avoiding triggers and causes, based on the Global Asthma Management Initiative (GINA) protocol; For children with refractory asthma, individualized targeted therapy with biological agents can be selected, and treatment response can be observed and evaluated.

At present, freeze-thaw embryo transfer (FET) has become an important part of human assisted reproduction. The important factor affecting the outcome of FET is the failure of embryo implantation. Among the reasons leading to the failure of FET implantation, endometrial receptivity (ER) accounts for about 2/3. Therefore, improving ER, especially thin ER, to improve clinical pregnancy rate and live birth rate has become a research hotspot. This article reviews the progress of intrauterine perfusion in improving ER during frozen-thaw embryo transfer at home and abroad, in order to provide reference for future scientific research and clinical treatment.