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【Objective】 To investigate the practice and benefit of national standardized management of type 2 diabetes in Yulin City. 【Methods】 We recruited the adult type 2 diabetes patients who sought medical help at our hospital from May 2020 to October 2022 as subjects. We collected their basic information (sex and age); measured height, weight, waist and hip circumference, and blood pressure; calculated body mass index (BMI); and detected blood glucose, c-peptide, HbA1c, biomarkers, urinary microalbumin, sensory nerve conduction velocity of lower limbs, ABI, and subcutaneous and visceral fat at the time of MMC recruited and the end of six months. T test and Mann-Whitney U rank sum test were used for measurement data and χ2 test or Fisher’s exact probability method for counting data to analyze the data. 【Results】 After 6 months, the levels of fasting blood glucose, postprandial blood glucose, HbA1c, and visceral and subcutaneous fat in all the patients decreased, but the level of fasting c-peptide increased compared with the baseline (all P<0.05). Secondly, compared with the baseline, the control rate of HbA1c (35.21% vs. 13.71% ) and the comprehensive control rate (13.97% vs. 7.26% ) were both significantly increased at six months (P<0.05). Thirdly, after 6 months, the levels of fasting blood glucose, postprandial blood glucose, HbA1c, TG, TC, and UA were decreased more, while the fasting c-peptide and postprandial c-peptide were increased more in the patients of the HbA1c standard group (HbA1c<7% ) than those of the non-standard group. 【Conclusion】 The multiple benefits of blood glucose, blood lipid, uric acid and islet function can be achieved by taking type 2 diabetes patients into MMC. Meanwhile, the rates of HbA1c control and comprehensively reaching the standard are significantly increased. Therefore, MMC can explore a new way for the management of type 2 diabetic patients in this area.
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Objective:To construct and validate a nomogram predictive model for readmission risk within 1 year of children with type 1 diabetes.Methods:A total of 395 children with type 1 diabetes who were hospitalized in four hospitals in Xi′an City from February 2019 to February 2021 were selected as the research subjects. The children were divided into training set ( n = 219) and verification set ( n = 175) in 5∶4 ratios. A nomogram prediction model for readmission risk within 1 year of children with type 1 diabetes was constructed based on the training set data, and internal validation was carried out. The external validation was carried out based on validation set data. Results:A total of 85 (21.5%) children were readmitted within 1 year. Mean glycohemoglobin A1c ≥ 7.5%, co-infection, complications of diabetes, and family history of diabetes were risk factors for readmission within 1 year of children with type 1 diabetes ( OR values were 4.010 - 5.510, P<0.05), and age of onset >7 years old was a protective factor ( OR = 0.070, P<0.05). The internal verification of nomogram model showed that the area under ROC curve was 0.778 (95% CI 0.703- 0.853), and the observed curve in calibration curve was basically consistent with the predicted curve. The external verification showed that the area under ROC curve was 0.748 (95% CI 0.642- 0.854), and the observed curve in calibration curve was basically consistent with the predicted curve. Conclusions:The nomogram predictive model for readmission risk within 1 year of children with type 1 diabetes is scientific and practical, and has certain clinical value in guiding targeted prevention and intervention of readmission of children with type 1 diabetes within one year.
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Objective:To investigate the clinical features of ocular involvement and the application of Rose criteria in patients with relapsing polychondritis (RP).Methods:The data from RP patients with ocular involvement were collected and analyzed. Patients included must have at least one major criteria of Michet criteria and the application Rose criteria was also investigated. Demographic data of these patients was presented as percentages. The difference between types of disease onset was tested by Mann-Whitney U and comparison among groups was tested by False Discovery Rate. Results:A total of 192 patients were enrolled 98 males and 94 females. The mean age of disease onset was (42±14) (0.5-79) years old, the median disease duration (DD) was 13(0.5, 600) months. The median RP disease activity index (RPDAI) was 39(9-74) and the median RP organ damage index (RPODI) was 2.5(0.1, 108). The median RP damage index (RPDAM) was 3(1-6). The statistical significant difference was identified in median DD between groups of nose and pinna ( Z=10.775, P<0.01), nose and OEH ( Z=9.277, P<0.01), in RPODI between groups of nose and pinna ( Z=7.999, P=0.031), nose and and extra-cranial organs ( Z=8.115, P=0.030) and eye and airway involvement of RPDAM could be seen between groups ( Z=7.683, P=0.037) respectively. Ocular involvement(50.0%), auricular chondritis(21.4%) and airway chondritis(13.5%) were the top three most common symptoms at disease onset. The ocular involvement(100%), airway chondritis (75.0%) and inner ear involvement(69.3%) were the top three most frequent affected organs. All parts of eye could be involved in RP ocular damage. Single-organ involvement was 59.9%; and multi-organ involvement could be seen in 40.1% patients. Diagnostic strength was enhanced by application of Rose criteria in 171 cases fulfilled Michet criteria and 21(10.9%) cases partially fulfilled Michet criteria fulfilled Rose criteria. Active screening for organ (especially inner ear and airway) involvement would improve the rate of early diagnosis. The pinna and airway involvement suggested nose and middle-ear might be involved. Conclusion:Ocular involvement in RP can involve all parts of the eye ball. Examining the inner ear and airway may help to confirm the diagnosis. It is worthy to apply this to clinical practice.
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Objective@#To explore the association between middle school students health literacy and bully victimization and associated sex difference, and to provide guidance for bully prevention in adolescents.@*Methods@#During November 2017 to January 2018, 18 900 junior and senior high school students were enrolled from Hefei of Anhui Province, Shenyang of Liaoning Province, Yangjiang of Guangdong Province and Chongqing by multistage cluster sampling. A self rated questionnaires were used to collect demographic information, health literacy, and bully victimization. Group differences by different characteristics and the association between health literacy and bully victimization were analyzed.@*Results@#The detection rates of campus and cyber bullying victimization were 15.8% (2 992/18 900) and 9.1% (1 723/18 900). Boys, junior high school students, students with poor family financial status and few close friends had a detection rate of 28.0%, 18.8%, 23.3%, and 33.6% of school bullying, which are higher than those of the control group ( χ 2=225.64, 148.07, 141.13, 143.49, P <0.01); boys, students with poor household income and few close friends, the detection rates of cyber bullying were 10.9%, 14.4%, and 20.1%, respectively, are higher than the control group ( χ 2=62.96, 112.82, 88.49, P <0.01). Multivariate Logistic regression analysis indicated that students with low overall and dimensions scores of health literacy were more likely to suffer from campus and cyber bullying, except for the dimension of physical activity. In addition, at all levels of health literacy, males are more likely to be bullied than females ( P <0.05).@*Conclusion@#Health literacy of middle school students is related to bully victimization, which is sex specific. Intervention programs of bullying should focus on health literacy enhancement.
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Objective@#To explore the application effects of enhanced computed tomography (CT) and three-dimensional reconstruction technology in the reconstruction of pediatric post-burn scars with expanded flaps.@*Methods@#From May 2016 to March 2019, 19 children with hypertrophic scars after thermal injuries were admitted to our unit, including 10 boys and 9 girls, aged from 4 years and 5 months to 15 years and 11 months. The area of scars ranged from 5 cm×4 cm to 23 cm×9 cm. One or more skin and soft tissue expanders with suitable volume and shape were implanted into the normal skin area around scar of children. Three to six months later, enhanced CT and three-dimensional reconstruction were performed before the second stage operation to obtain three-dimensional images of the vascular branches in the donor site for expanded flaps to be cut, so as to determine the course and distribution of the vascular branches and guide the design of expanded flaps. According to the design scheme, the resection of scar, removal of expanders, and excision and transfer of flaps were performed to repair the wounds after scar resection. The area of flaps ranged from 6 cm×4 cm to 25 cm×10 cm. The donor site was closed directly. The number of flaps was counted. The anatomical structure, vascular distribution, and adverse reactions during enhanced CT and three-dimensional reconstruction of site for expanded flaps to be cut, the survival of expanded flaps and the follow-up after the second-stage operation were observed.@*Results@#A total of 48 expanded flaps were designed and excised in 19 children. The anatomical structure of the site for expanded flaps to be cut and the adjacent spatial position relationship were visually observed through the three-dimensional reconstruction after enhanced CT, and no adverse reactions were observed. Arterial branch blood supply or venous return was observed in 29 sites for expanded flaps to be cut. All the expanded flaps survived well without blood supply disorder after the second stage operation. The children were followed up for 6 months to 1 year and 6 months after the second stage operation. The appearance of the flaps was natural, and the color and thickness of the flaps were similar to those of the surrounding normal skin, except for one child with obvious linear scar.@*Conclusions@#Enhanced CT and three-dimensional reconstruction can assist the vascular assessment of the expended flaps, which is helpful for rational design of the flap excision and transfer protocol to improve the survival rate of flaps. Thus, it has certain clinical application value in the reconstruction of post-burn scar in children with expanded flaps.
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Objective To investigate clinical and imaging characteristics of patients with relapsing polychondritis (RP) with insidious airway involvement.Methods Data collected prospectively and consecutively for patients with the diagnosis of RP and their disease activity evaluation was analyzed.The t-test and Mann-Whitney U test were used for statistical analysis between the two groups forquantitative datain normal distri-bution and non-normal distribution respectively,while Chi-square test was use for qualitative data analysis.Results Two hundred and sixteen patients with complete data from Dec 1,2007 to Jul 31,2016 were enrolled with a M:F ratio of 1:1.Mean age of disease onset was (44±16)(8～86) years.The median disease duration was 12 (0.3～480) month.The median relapsing polychondritis disease activity index (RPDAI) was 35 (8～67),the median RPODI was 2.4 (0.1～84).The top three initial presentation were auricular chondritis (28.7％),airway chondritis (24.1％) and ocular involvement (22.2％) respectively.RPODI was significantly higher in auricular chondritis (4.4) (Z=-2.084,P＜0.05) and lower in nose chondritis (0.6) (Z=-2.425,P＜0.05).Up to 81.5％ of the patients were found with airway damage and 52.3％ of them were asymptomatic.Airway damage was mostly located in trachea (79.0％ 139/176) and common features on CT scan werecharacterized by airway wail thickening (72.7％,128/176).Airway narrowing was mostly seen in symptomatic patients while calcification was seen more in asymptomatic patients.Insidious hearing-loss and nose chondritis were found not related to airway damage while obvious auricular chondritis (x2=15.580,P＜0.01),ocular involvement (x2=8.105,P＜0.01) were found to be more in patients with asymptomatic airway damage.All diagnosis before RP was organ-driven.Conclusion Airway involvement in RP is one of the three most common disease initial presentation-sand half of them are asymptomatic.RPODI is a reasonable marker for disease evaluation.Routine follow-up of airway damage (wall thickness,calcification and lumen narrowing) is essential for early RP recognition.
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Objective To analyze the clinical features of chronic rhino-sinusitis (CRS) in patients with immunoglobulin G4-related disease (IgG4-RD).Methods A retrospective analysis of the data from March 2013 to July 2015 in our Department of Rheumatology was conducted in patients who were diagnosed as IgG4-RD and were follow-up for over half a year.The clinical features and the results of laboratory tests were compared between of the case group and the control group.The t test,Mann-Whitney U test and Fisher'Exact Test (n ＜40) were used to analyze the data.Results Twenty-four cases in 44 cases of IgG4-RD were complicated with CRS (54％).The mean age was (49±13) years old,with the ratio of male:female was 2∶1;With the longer disease duration [4.0 (1.0,6.3) year vs 0.5 (0.2,4.3) year,U=-2.182,P=0.041],the more the number of organs involved [4.0 (3.8,5.3) vs 3.0 (1.0,4.0),U=-2.827,P=0.005],the higher the ratio of ocular involvement (89％ vs 42％,P=0.013).The higher the percentage of eosinophils in peripheral blood [8.5％(4.0,13.8) vs 3.3％(0.8,8.5),P=0.043],the more common the allergic manifestations (61％ vs 20％,P=0.026),the higher the operation times [1.5(1.0,3.0) vs1.0(0,10),U=2.096,P=0.048] before making the definitive diagnosis than the control group A.The level of ESR/CRP (56％ vs 0,P=0.004) and the number of IgG4 positive plasma cells [57.5(50.0,66.3)/HP vs 10.0(1.8,20.0)/HP,U=4.358,P＜0.01] and the percentage of IgG4/IgG positive plasma cell (40％ vs 10％,P＜0.01) in the nasal mucosal tissues of the IgG4-related chronic rhino-sinusitis were higher than patients with ordinary CRS (the control group B),but there was no difference in the severity of sinusitis manifestations between patients with IgG4-related chronic rhino-sinusitis and the regular CRS.Conclusion IgG4-related chronic rhino-sinusitis is different from regular CRS,and is closely associated with IgG4-related ocular lesion.IgG4-related chronic rhino-sinusitis has some clinical features which are different from other phenotypes of IgG4-related diseases.
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Objective To investigate the clinical and audiological characteristics of non-elder patients with relapsing polychondritis (RP).Methods Clinical and audiological data of patients with RP under 60 years old were collected consecutively and analyzed.The t-test and Mann-Whitney U test were used for statistical analysis between the two groups in quantitative data in normal distribution and non-normal distribution respectively,while Chi-square test was use for qualitative data analysis.Results One hundred and seventy four patients with complete data who fulfilled the Michet criteria were enrolled with a M∶F=1∶1.1.The mean age of disease onset was (39±13) (8-60) years;the median time of disease duration was 12 (1-480) months;the median relapsing polychondritis disease activity index (RPDAI) was 38(10-77) and the median RPODI was 2.4(0.1-56).Auricular chondritis (32.8％,57/174),ocular involvement (24.7％,43/174) and airway chonchritis (21.3％,37/174) were the top three onset-pattern.All parts of external,middle and inner ear were involved in RP.Inner-ear damage was the most common (95.4％,166/174) with insidious cochlea and vestibule equally distributed.Auricular chondritis was predominant in external ear involvement (55.2％,96/174);ET dysfunction was included in eardrum abnormalities of neglected middle-ear involvement (29.9％,52/174).Positive HL by active detection was 71.8％(125/174) with 14.3(25/174) HL fulfilled world health organization (WHO)-2006 criteria,including 52.0％(13/25) disabling HL.Sensorineural hearing loss (SNHL) was predominant in RP after 21 years old while 60.0％(6/10) was seen in childhood RP with non-SNHL.At least two parts of ear involvement were seen in almost all patients with heavy overlap.Conclusion All parts of ear are involved in non-elder RP with age related clinical characteristics.Active detection is a key to find insidious middle-and inner-ear involvement for early RP recognition.RPODI is a potential marker for RP evaluation.
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Objective To investigate the clinical characteristics of granulomatosis with polyangiitis (GPA) patients with scleritis.Methods The completed clinical data of 102 GPA patients from March 2012 to July 2016 in Capital Medical University, Tong Ren Hospital were collected. Altogether 43 GPA patients with scleritis were enrolled, and the clinical data were analyzed respectively. The t test, Mann-Whitney U test and x2testwere used to analyze the data. Results The most common ocular manifestation in GPA was scleritis. The incidence of renal damage(37.2% vs 11.9%,x2=9.148,P=0.002),disease activity(BVAS/GPA score 8.9 vs 5.1,Z=7.847, P=0.000),DEI score (7 vs 4,Z=5.919, P=0.000),inflammation index(56 mm/1 h vs 36 mm/1 h, Z=2.456, P=0.016; CRP 51 mg/L vs 8 mg/L, Z=3.748, P=0.000), neutrophil percent (70% vs 61%, t=3.993, P=0.000),complement 3(1.2 g/L vs 1.0 g/L, t=2.652, P=0.009),plasma fibrinogen(3.5 g/L vs 3.3 g/L, t=3.947, P=0.000), D-dimmer (0.5 mg/L FEU vs 0.3 mg/L FEU, Z=2.371, P=0.018) and ANCA positive rate (90.7% vs 57.6%,x2=13.369,P=0.000)were higher in patients with scleritis,as well as a poor prognosis(2009-FFS 0.4 vs 0.1, Z=2.600, P=0.009). However, a lower rate of subglottic involvement was detected in scleritis group (4.7% vs 20.3%, x2=5.169, P=0.023). There were no significant differences between GPA patients with scleritis and episcleritis in clinical feature, disease activity, inflammatory index and prognosis. Aggressive immunosuppres-sive treatment was appropriate for GPA with scleritis. Tumor necrosis factor (TNF)-аinhibitor was an effective treatment. Conclusion GPA with scleritis usually suffered from higher disease activity index,broader DEI,as well as poorer prognosis. Aggressive treatment should be initiated in order to achieve disease remission. Subglottic involvement is less common in patients with scleritis. The phenotype of scleritis is not associated with disease severity.
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Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease (CCVD) in maintenance hemodialysis (MHD) patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 3rd Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1st, 2009 to Dec 31st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of (53.2 ± 16.4) years old, and 138 of them were male (56.8%). The multivariate Cox proportional model revealed that age (HR=1.040, 95%CI:1.015-1.065, P=0.002), Erythropoietin (EPO) dose (HR=0.914, 95%CI: 0.846-0.987, P=0.022) and history of cardiovascular and cerebrovascular disease (HR=4.045, 95%CI: 2.074-7.890, P<0.001) were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time-dependent serum phosphorus level (HR=1.722, 95%CI: 1.034-2.866, P=0.037) was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovascular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.
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<p><b>OBJECTIVE</b>The platelet membrane glycoprotein (GP) Ia/IIa plays a major part as a primary collagen receptor in platelet function. Previous studies indicated that variations of GPIa/IIa density and function are associated with the 807 C/T polymorphism of GPIa gene in American and Spanish Caucasian populations. This study investigated the correlation between acute coronary syndrome (ACS) and 807 C/T dimorphism of GPIa gene in Chinese of Han ethnicity.</p><p><b>METHODS</b>A case-control study was carried out, including 75 patients with either acute myocardial infarction (AMI) or unstable angina pectoris (UAP), and 65 controls with no history of coronary heart disease, thrombogenic and hemorrhagenic diseases. Genotypes of GPIa were checked by polymerase chain reaction-sequence specific primers (PCR-SSP) technique.</p><p><b>RESULTS</b>The frequencies of both homozygotes and heterozygotes for T807 allele (TT+TC) were significantly higher in patients with AMI than in controls (62.16% vs 33.85%, P<0.01; odds ratio 3.21). The prevalence of (TT+TC) genotypes was also markedly higher in patients with UAP than in controls (65.79% vs 33.85%, P < 0.005; odds ratio 3.76). There was significant difference in the distribution of (TT+TC) genotypes not only between all patients and controls (64.00% vs 33.85%, P<0.005; odds ratio 3.47) but also between the two subgroups aged <60 years (70.00% vs 38.24%, P<0.005; odds ratio 3.77). However, there was no significant difference in the distribution of (TT+TC) genotypes between patients with AMI and with UAP. Platelet GPIa T807 allele remained significantly associated with AMI and UAP by multiple logistic regression (odds ratio 4.94).</p><p><b>CONCLUSION</b>This study suggests a strong association between presence of GPIa T807 allele and ACS. T807 allele can be a marker of genetic susceptibility to ACS.</p>
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Aged , Female , Humans , Male , Middle Aged , Alleles , Angina, Unstable , Genetics , Asian People , Case-Control Studies , China , Gene Frequency , Genetic Predisposition to Disease , Genotype , Integrin alpha2 , Genetics , Myocardial Infarction , Genetics , Odds Ratio , Polymorphism, GeneticABSTRACT
<p><b>OBJECTIVE</b>To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.</p><p><b>METHODS</b>In the present study, eighteen patients with acute myocardial infarction (AMI) received 1.5 or 2.0 million U nonspecific urokinase (UK), or 70 approximately 80 mg fibrin-specific recombinant tissue plasminogen activator (rt-PA) and did not use heparin until 8 hours after intravenous injection of the above agents. Eight patients with AMI and without thrombolytic therapy were enrolled as controls. Coagulant and thrombolytic activity markers included thrombin-antithrombin III complex (TAT), D-dimer, fibrinogen (Fg), FMPV/Amax. All markers were determined before, immediately, 1, 2, 4 and 8 hours after the administration of thrombolytic agents respectively.</p><p><b>RESULTS</b>Molecular marker of thrombin generation--TAT showed an activated coagulant state immediately after thrombolytic therapy. Level of TAT showed no significant changes between every two observed phases in controls. However, level of TAT increased significantly from 4.95 +/- 1.75 microg/L ( 4.63 +/- 1.37 microg/L) to 14.71 +/- 3.31 microg/L (14.25 +/- 2.53 microg/L) before and immediately after administration of thrombolytic agents UK (or rt-PA). There was significant difference between level of serum TAT of patients with and without thrombolytic therapy (P < 0.05). Patients achieving clinical reperfusion had lower TAT level than those failing in thrombolytic therapy, and higher FMPV/Amax level than controls. D-dimer, a surrogate of thrombolytic activity increased markedly and Fg significantly declined after thrombolytic therapy (P < 0.05).</p><p><b>CONCLUSIONS</b>Thrombin generation occurred in plasma in response to excess fibrinolysis induced by thrombolytic therapy. Both urokinase and rt-PA had procoagulant action. This transient activation of the coagulant system might contribute to early reocclusion. These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents. These results also suggested that TAT might be useful in predicting clinical outcomes of patients treated with thrombolytic therapy for AMI.</p>
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Aged , Female , Humans , Male , Middle Aged , Antithrombin III , Biomarkers , Blood , Fibrin Fibrinogen Degradation Products , Metabolism , Fibrinogen , Metabolism , Fibrinolytic Agents , Therapeutic Uses , Myocardial Infarction , Blood , Drug Therapy , Peptide Hydrolases , Blood , Recombinant Proteins , Therapeutic Uses , Thrombolytic Therapy , Tissue Plasminogen Activator , Therapeutic Uses , Urokinase-Type Plasminogen Activator , Therapeutic UsesABSTRACT
AIM: To explore the serum levels of certain adhesion mole cules and its significance in acute coronary syndrome(ACS). METHODS: The subjects included 40 patients with acute myocardial infarction(AMI) and 40 patients with unstable angina pectoris (UAP). Among the 80 patients, 60 patients accepted a follow- up 4 months. At the same time we selected 40 controls from people who atte nded a routine health check in the university. Serum levels of E-selectin,sICAM -1,sVCAM-1 were measured by ELISA. RESULTS: Serum level s of E-selectin ,sICAM-1,sVCAM-1 were significantly higher in the ACS group(AMI or UAP) than in the control group. Four months later, the levels of E-selectin,sICAM-1 bec ame sig nificantly lower in the follow-up group than in the ACS group, while sVCAM- 1 showed no significant difference. CONCLUSION: Serum levels of E-se lectin ,sICAM-1 may have certain diagnostic value for ACS, and can be a useful marker reflecting th e stability of the disease.
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6 score group using Wagner's QRS scoring system. CONCLUSIONS: Serum levels of certain inflammatory markers have some diagnostic value for ACS. The high levels of serum SAA, IL-6 and sCRP are not mainly caused by myocardial death, but by the inflammation in the multifocal unstable plague. [
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Objective To explore the effects of HMGCoA agents and ACE inhibitor on serum inflammatory markers in patients with acute coronary syndrome (ACS). Methods The 60 patients with ACS were randomly divided into two groups, one treated with lipid lowered by HMGCoA agents and the other treated with HMGCoA agents added with ACE inhibitor. After 4 months, serum levels of some inflammatory markers were measured by means of ELISA. Results Serum levels of certain inflammatory markers were significantly higher in the ACS group than in the control group and became significantly lower 4 months later in the follow-up group. There were no differences in all the inflammatory markers between the two groups receiving different therapies 4 months later. Conclusion Serum levels of some inflammatory markers may have certain diagnostic value for ACS and may reflect the stability of the disease. HMGCoA agents seem to have no effect on inflammatory responses in a short period.