National Medical Journal of China
Volume 100 · Issue 38 · 2020
Natl Med J China
Glycosylated hemoglobin is an important index to evaluate the level of blood glucose control in diabetic patients, but it has certain limitations. With the development of continuous glucose monitoring (CGM) technology, the related indexes of CGM are gradually applied in scientific research and clinical practice. Among them, the time of glucose within the target range (TIR) as an important index has attracted special attention in academic circles, which can complement with glycosylated hemoglobin. According to the 2019 TIR International Consensus, the recommended target value for TIR is>70% for most diabetic patients. However, TIR still lacks evidence-based medical evidence in many aspects, and further research on the relationship between TIR and diabetic complications and its significance in reflecting blood glucose control is still needed to establish its important position in the evaluation system of blood glucose control.
Chemotherapy is a common treatment for tumors. Chemotherapy drugs can abnormally increase the proliferation and spread of tumor cells, and they are gradually recognized by doctors. This paper analyzes the correlation between chemotherapy and tumor metastasis, discusses the possible mechanism of action and coping methods, hopes to preserve the curative effect of chemotherapy drugs while reducing the probability of metastasis, and reminds doctors to pay attention to the consequences of poor tumor metastasis caused by chemotherapy drugs.
As a common chronic airway disease, bronchial asthma (hereinafter referred to as asthma) not only seriously affects the physical and mental health of patients, but also brings a heavy mental and economic burden to families and society. Affected by the accelerated industrialization and urbanization, environmental pollution and changes in climate and ecological environment, the incidence and prevalence of asthma is increasing. It is estimated that there are about 300 million asthma patients worldwide[
Writing Team Leader
To investigate the appropriate cut-off point of time in range (TIR) for evaluating glucose control in type 2 diabetes mellitus (T2DM) patients, and analyze the prevalence of abnormal carotid intima-media thickness (CIMT) and diabetic retinopathy (DR) in different TIR categories.
A total of 2 161 subjects with T2DM (1 183 males) were enrolled from hospitalized patients at the Department of Endocrinology and Metabolism of the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from January 2005 to February 2012. The age of the enrolled participants was (60.4±11.9) years. Each patient underwent continuous glucose monitoring (CGM) for three consecutive days, then TIR (3.9-10.0 mmol/L), time above range (TAR) and time below range (TBR) were calculated. Fundus photography and carotid artery Doppler ultrasound were performed to diagnose DR and abnormal CIMT (defined as CIMT≥1.0 mm), respectively. Multivariate logistic regression models were used to examine the independent association of different TIR groups with CIMT and DR.
All subjects were divided into 4 groups according to TIR:≤40%, 41%-70%, 71%-85% and>85%. Significant linear trends in age, diabetes duration, body mass index (BMI), total cholesterol, glycated hemoglobin A1c (HbA1c), TAR and mean glucose (MG) existed among the 4 groups (all Ptrend<0.05). However, there was only a weak correlation between TIR and TBR (<3.9 mmol/L) (r=0.087, P<0.001), and no significant association was observed between TBR (<3 mmol/L) and the TIR categories (Ptrend=0.378). The overall prevalence of abnormal CIMT and DR was 12.1% and 23.8%, respectively. The prevalence of abnormal CIMT in the 4 groups with ascending levels of TIR was 16.9% (59/349), 12.9% (96/746), 11.2% (57/510) and 9.0% (50/556) (Ptrend<0.001), respectively. And the prevalence of DR was 30.7% (107/349), 29.4% (219/746), 20.8% (106/510) and 14.9% (83/556), respectively (Ptrend<0.001). In the binary logistic regression model by adjusting confounding factors, compared with TIR≤ 40%, the risk of abnormal CIMT was reduced by 33.8% (OR=0.662, 95%CI: 0.456-0.963, P=0.031), 40.8% (OR=0.592, 95%CI: 0.390-0.899, P=0.014), and 45.0% (OR=0.550, 95%CI: 0.358-0.846, P=0.006) in the other three groups, respectively. And the risk of DR was reduced by 2.9% (OR=0.971, 95%CI: 0.725-1.301, P=0.844), 33.4%(OR=0.666, 95%CI: 0.479-0.924, P=0.015) and 53.3% (OR=0.467, 95%CI: 0.331-0.657, P<0.001), respectively.
Using 40%, 70% and 85% as cut-off point of TIR helps stratify the risk of diabetic complications, and assess the glucose control (Poor: TIR≤40%; Unsatisfactory: TIR≤70%; Satisfactory: TIR>70%; Optimal: TIR>85%) in patients with T2DM.
To investigate the efficacy of sodium zirconium cyclosilicate on emergency correction of hyperkalemia in chronic kidney disease patients.
Patients with chronic kidney disease who were admitted to the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from May to June 2020 were selected. Those who had hyperkalemia and took sodium zirconium cyclosilicate powder were finally included. The patient′s clinical data and laboratory results were collected.
A total of 24 results were included from 21 patients. The age of patients was (48.9±13.5) years old. Fourteen patients were male, and 7 patients were female. After 2 hours of administration, the venous potassium level decreased from (5.85±0.52) mmol/L to (5.15±0.43) mmol/L (P<0.001, n=21), with an average decline of (0.71±0.43) mmol/L. Meanwhile, the arterial potassium level decreased from (5.50±0.40) mmol/L to (4.88±0.33) mmol/L (P<0.001, n=10), with an average decline of (0.62±0.29) mmol/L. Based on the initial venous potassium level, the patients were further divided into three groups. The average potassium decrease in<5.5 mmol/L group (4 patients), 5.5-<6.0 mmol/L group (11 patients) and ≥6.0 mmol/L group (6 patients) was (0.46±0.26) mmol/L, (0.62±0.38) mmol/L and (1.04±0.45) mmol/L, respectively. There was statistically significant difference of potassium reduction among the three groups (P=0.045). Moreover, the extent of potassium reduction was positively correlated with baseline venous potassium level (r=0.603, P=0.004, n=21). The study did not reveal any treatment-related adverse event.
Sodium zirconium cyclosilicate powder can rapidly and effectively reduce the serum potassium level in chronic kidney disease patients with hyperkalemia.
To investigate the clinical characteristics, treatment and prognosis of gastric cancer complicated with immediate double primary cancer.
The clinical data of patients who met the diagnostic criteria of gastric cancer with immediate double primary cancer from January 2016 to June 2019 were analyzed retrospectively.
There were 29 cases of gastric cancer with immediate double primary carcinoma, accounting for 1.7% of the 1 741 patients with gastric cancer in the same period. Of these, 17 (58.6%) were more than 70 years of age. 25 cases (86.2%) were male. The postoperative pathological staging was mainly for early gastric cancer (63.2%). Colorectal cancer accounted for 8 cases (27.6%), followed by esophageal cancer in 7 cases (24.1%). The others included 6 cases of lung cancer (20.7%), 2 cases of pancreatic cancer (6.9%), 2 cases of prostate cancer (6.9%), 1 case of non-Hodgkin′s lymphoma (3.4%), 1 case of ampullary tumor (3.4%), 1 case of bile duct carcinoma (3.4%) and 1 case of laryngeal carcinoma (3.4%). The prognosis of the surgical treatment group was significantly better than that of the non-surgical treatment group (median survival time: 21.0 months vs 13.0 months, P=0.014).
Gastric cancer complicated with immediate double primary cancer mostly occurs in elderly men and early gastric cancer patients. In the complicated tumor, colorectal cancer is the main cause, so we should pay attention to the screening of digestive system. Radical surgery should be performed as far as possible for each primary tumor.
To summarize and compare clinicopathological features of Caroli disease and Caroli syndrome.
A total of 21 patients diagnosed with Caroli disease or Caroli syndrome in Beijing Friendship Hospital, Capital Medical University, from January 2015 to December 2018 were included. Through the clinical manifestations and comparative analysis of the differences between different clinical types, the liver pathological features of these patients were described.
Of all patients included, 8 were male and 13 were female, and the medium age was 13.5 year old. The initial symptom was fever in 6 cases (28.6%), gastrointestinal bleeding in 6 cases (28.6%) and hepatosplenomegaly in 9 cases (42.8%). Caroli disease accounted for 6 cases (28.6%) and Caroli syndrome 15 cases (71.4%). The total bilirubin [6.7 (4.7, 15.0) vs 16.0(10.9, 33.0)μmol/L] and direct bilirubin [1.3(0.9,6.4)vs 3.5(2.7, 16.2)μmol/L] were significantly lower in Caroli disease group in comparison to those in Caroli syndrome group(bothP<0.05). The hemoglobin [117.0 (106.0, 126.2) vs 85.0 (74.0, 103.0) g/L] and platelet count [286.0 (149.8, 467.5)×109/L vs 76.1(55.0,123.0)×109/L] in Caroli disease group were significantly higher than those in Caroli syndrome group (both P<0.05). There were 10 patients (47.6%) who underwent liver transplantation. Child-Pugh-Turcotte Score (liver function reserve) were significantly higher than that in the non-liver transplantation group[8.0(8.0, 10.2)vs 5.0 (5.0, 6.0), P<0.05].
Early symptoms of Caroli disease/Caroli syndrome are atypical and prone to misdiagnosis and misdiagnosis. The diagnosis is usually based on pathology and may be supplemented by laboratory examination and imaging analysis.
To observe the analgesic effect, complication and patient satisfaction of Acute Pain Service (APS) after thoracic surgery.
The clinical data were collected from 264 patients who underwent different thoracic surgery from January 2017 until December 2019 retrospectively. They were divided into thoracotomy group (group O) and thoracoscopy surgery group (group T). There were 90 cases in group O and 174 cases in group T. According to the use of APS, the group O is divided into the no-APS group (group O1) and the APS group (group O2), the group T is divided into the no-APS group (group T1) and the APS group (group T2). The effect of postoperative analgesia, the incidence of nausea and vomiting and the satisfaction of patients were compared between group O1 and group O2, group T1 and group T2, respectively.
In the resting state, the Numeric Rating Scales (NRS) scores of the group O2 at 0 h (0.92±0.50 vs 1.59±0.62), 4 h (0.92±0.50 vs 2.06±1.03), 8 h (0.92±0.50 vs 2.18±1.13), 12 h (0.92±0.50 vs 2.47±1.42), 24 h (1.00±0.71 vs 2.53±1.42), and 48 h (1.00±0.71 vs 2.35±1.80) after leaving the Anesthesia Recovery Room (PACU) were significantly lower than those of the group O1 (all P<0.05), and in the active state, the NRS scores of the group O2 at 0 h (P=0.023), 4 h (P=0.001), 8 h (P=0.000), 12 h (P=0.001), 24 h (P=0.000), 48 h (P=0.000), and 72 h (P=0.019) after leaving the PACU were significantly lower than those of the group O1 (all P<0.05). In the resting state, the NRS scores of the group T2 at 4 h (P=0.029), 8 h (P=0.008), 12 h (P=0.006), and 24 h (P=0.013) after leaving the PACU were significantly lower than those of the group T1 (all P<0.05). In the active state, the NRS scores of the group T2 at 4 h (P=0.019), 8 h (P=0.000), 12 h (P=0.001), 24 h (P=0.002), and 48 h (P=0.002) after leaving the PACU were significantly lower than those of the group T1 (all P<0.05).
APS can significantly reduce the NRS scores after thoracotomy and thoracoscopic surgery compared to ordinary analgesia model.
To investigate the effect of Na+/K+-ATPase inhibitor ouabain on the proliferation and division of liver cancer HepG2 cells, and to explore the anticancer mechanism.
HepG2 cells were exposed with different concentrations of ouabain (0.1, 1, 10 μmol/L) for 24 h, the proliferation ability was appraised using CCK-8, and the HepG2 cells was as a control group. The status of chromosome separation was detected with cell immunofluorescence (ICC) coupled to confocal microscope. The expression levels of AURKA, mTOR, p-mTOR, ERK and p-ERK protein were analyzed using western blot.
After treating with 0.1, 1 and 10 μmol/L of ouabain for 24 h, the inhibitory rate of cells were (23.5±4.57)%, (49.80±5.32)%, and (72.10±5.62)%, respectively. Ouabain could significantly inhibit the proliferation of HepG2, and presented in a dose-dependent manner(F=32.8, P<0.05). The ICC results showed that the chromosome separation disorders occurred in HepG2 cells treated with 1 μmol/L for 24 h, and the spindle diameter of HepG2 cells with ouabain treatment was decreased significantly compared with the control group(t=9.58, P<0.05). The results of western blot showed that the expression levels of AURKA, p-mTOR and p-ERK expressions in HepG2 cells treated with 1 μmol/L of ouabain were significantly decreased compared with the control group(F=16.26, 8.32, 33.59, P<0.05). Ouabain inhibited the growth of hepatocellular carcinoma cells in nude mice(F=370.20, P<0.05).
Ouabain can induce chromosome division disorder and inhibit the proliferation in liver cancer HepG2 cells by inhibiting AURKA signaling pathway.
This paper reports a rare case of DiGeorge syndrome with cortical thickening and polyarticular pain. In this case, the patient was short in stature and poor in intellectual development since childhood, and had abnormal appearance such as wide eye distance, wide base of nose bridge, and small auricles on both sides. At the age of 27, due to tetany of both hands and multiple symmetric joint pain, the examination found hypocalcemia, and the diagnosis was consistent with hypoparathyroidism. The difficulty in diagnosis lies in the etiology of hypoparathyroidism. According to the clinical characteristics of the patient, the etiology was identified, and molecular biology techniques were applied, and finally the diagnosis of DiGeorge syndrome was confirmed. According to previous literature reports, combined with the patient's treatment response, cortical bone thickening may be a rare manifestation of DiGeorge syndrome, while multiple joint pain symptoms are considered to be related to hypocalcemia.
This article reports the diagnosis and treatment of a middle-aged male patient with chronic diarrhea and weight loss. There are many doubts in the auxiliary examination of this patient. The elevation of serum amylase first considered pancreatic disease. After excluding chronic pancreatitis and pancreatic tumors one by one, it was found that this patient had macroamylasemia. Taking diffuse lesions of small intestine and macroamylasemia combined with elevated immunoglobulin A as the breakthrough point, after comprehensive analysis and investigation, serum celiac disease antibody and small intestinal mucosal biopsy were improved, and celiac disease was finally diagnosed. Celiac disease is rare in Asian people, and the disease can lead to widespread deficiency of nutritional elements. It is very important to know its serological, endoscopic and pathological characteristics, diagnose it in time and guide the diet to remove gelatin.
With the popularization of laparoscopic surgery, laparoscopic skills training has become an important part of surgeons' surgical training. Various training methods and courses have emerged, and a large number of studies have proved that this is an effective teaching method, which has been widely used in general surgery, urology, gynecology and other fields. This paper will summarize and analyze the significance, methods and influencing factors of laparoscopic skills training.
Since the pandemic of novel coronavirus, although various countries or regions have taken non-pharmaceutical intervention measures, from a global perspective, the epidemic of novel coronavirus has not been contained, and even some countries where the epidemic has been initially controlled have experienced a local rebound of the epidemic. People place the hope of controlling the epidemic on the research and development and application of novel coronavirus vaccine. This study starts from seven different vaccine research and development routes: inactivated vaccine, live attenuated vaccine, viral vector vaccine (replicating and non-replicating), virus-like particle vaccine, subunit vaccine, DNA vaccine and RNA vaccine, and introduces the advantages and limitations of vaccine research and development mechanism, similar vaccine situation, production speed and technological maturity, so as to systematically sort out and summarize the characteristics of vaccines developed by different technologies, so as to provide reference for vaccine research and development and use.
Compared with the general population, patients with type 1 diabetes (T1DM) have an increased risk of developing celiac disease. According to previous literature reports, 1% to 16% of T1DM patients are complicated with celiac disease, but these patients often have no typical clinical manifestations of celiac disease such as diarrhea and abdominal distension, but are diagnosed by screening for serum antibodies and endoscopy. At present, it is inconclusive whether patients with T1DM complicated with subclinical celiac disease need to be treated with a de-gelatin diet (GFD). This study evaluated the effects of GFD on hypoglycemic episodes and height, weight, glycosylated hemoglobin (HbA1c), insulin dosage, bone metabolism and other indicators in patients with T1DM complicated with subclinical celiac disease through a prospective randomized controlled trial (RCT). The study screened for celiac disease in 320 patients with T1DM. The diagnostic criteria for celiac disease were positive for anti-tissue glutaminase antibody immunoglobulin A (tTG-IgA) and duodenal biopsy consistent with celiac histopathological changes, or normal biopsy pathology but tTG-IgA>200 U/ml. Subclinical celiac disease was defined as meeting the above diagnostic criteria for celiac disease and without chronic diarrhea, recurrent diarrhea, severe anemia (hemoglobin<80 g/L). The study finally included 30 subclinical celiac patients who were randomly divided into GFD and non-GFD groups. The patients in the two groups were evaluated at the 6th month of dietary intervention. The differences in the number of hypoglycemic episodes (2.3 vs. 3.4, P =0.5) and the mean onset time (124.1 min vs. 356.9 min, P =0.1) between the GFD and non-GFD groups were not statistically significant; However, the number of hypoglycemic episodes in the 6th month of GFD group was significantly reduced compared with baseline (2.3 vs. 3.5, P =0.03); HbA1c decreased by 0.73% in the GFD group and increased by 0.99% in the non-GFD group; There were no significant differences in height, weight, insulin dosage and bone metabolism indexes between the two groups. This study suggests that GFD may be beneficial to blood glucose control and reduce the occurrence of hypoglycemic events in patients with T1DM complicated with celiac disease. The definite role of GFD still needs to be further verified by RCT on a larger scale and longer follow-up time.
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