The effect of blood glucose levels on programmed death-1 in patients with severe sepsis and type 2 diabetes mellitus / 中华急诊医学杂志

Objective To investigate the effect of blood glucose levels on peripheral blood T lymphocyte programmed death-1 factor (PD-1) and the prognosis of 28-day in patients with severe sepsis and type 2 diabetes mellitus (T2DM).Methods A total of 106 severe sepsis patients with T2DM and 50 healthy subjects as controls were included in this prospective study.According to the blood glucose levels at admission,patients were divided into three groups:the blood glucose ＜ 6.1 mmol/L group,the blood glucose 6.1 to 11.1 mmol/L group,and the blood glucose ＞ 11.1mmol/L group.The patients were followed up for trace the 28-day outcomes,and the levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were detected.The Kaplan-Meier survival curves were used to compare the risk of 28-day death in patients with different blood glucose levels.Results The levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were higher in patients with severe sepsis and T2DM than those in healthy subjects.The mortality of blood glucose ＜ 6.1 mmol/L group (56.52％) was higher than that of blood glucose 6.1 to 11.1 mmol/L group (24.3％) and the blood glucose ＞ 11.1 mmol/L group (28.3％) (P ＜ 0.05),Kaplan-Meier survival curve showed that the 28-day mortality risk of patients with blood glucose ＜ 6.1 mmol/L was higher than that of patients with blood glucose 6.1 to 11.1 mmol/L group and blood glucose ＞ 11.1 mmol/L group (The Log-rank test values were 6.523 and 5.794,the P values were 0.011 and 0.016).The level of PD-1 + CD8 + T lymphocytes in the blood glucose ＜ 6.1 mmol/L group was higher than that in the blood glucose 6.1 to 11.1 mmol/L group and the blood glucose ＞ 11.1 mmol/L group (P =0.013).Conclusions The patients with severe sepsis and T2DM getting blood glucose level ＜ 6.1 mmol/L at admission may be suffered from severe immunosuppression,and more attention should be paid to the risk of 28-days mortality in these patients..

Study on real-time monitoring and assessment of near-infrared in the dehydration treatment of traumatic brain injury / 生物医学工程学杂志

We used near-infrared spectroscopy technology to monitor and assess the treatment effect of dehydrating agent in injured rat brain in real time style. We employed the brain edema model in rats resulting from Feeney' s freefall damage, then treated with different doses of mannitol, and collected reduced scattering coefficient (p',) and intracranial pressure (ICP) values after the injury and during the treatment. The results showed that brain edema happened 1 h after the injury in rats' brain tissue, peaked around 72 h after injury, and then began to decrease gradually. The reduced scattering coefficient and ICP values of the treatment group injected with mannitol all decreased after administration. Compared with the effect of low-dose mannitol treatment, that of high-dose mannitol treatment was much better. The duration of the plateau was longer and most experiments results declined significantly. From this we conclude that the reduced scattering coefficient and ICP are consistent with the trend changes, and the reduced scattering coefficient could be used as an indicator for monitoring cerebral edema.

Analysis of type 2 diabetic nephropathy markers / 中国医师进修杂志

Objective To investigate the type 2 diabetic patients with glomerular filtration rate and urinary albumin value as renal finction evaluation.Methods A total of 1217 patients with type 2 diabetic nephropathy from August 1,2010 to June 31,2012 were selected.Evaluated glomerular filtration rate (eGFR) was calculated according to the currently recommended simplified modification of diet in renal disease study (MDRD) formula.According to the K/DOQI guidelines for chronic kidney disease,patients were divided into three groups:group A [eGFR ≥90 ml/ (min ·1.73 m2)] of 891 cases,group B [60 ml/(min· 1.73 m2) ≤eGFR ＜ 90 ml/(min· 1.73 m2)] of 256 cases,group C[eGFR ＜ 60 ml/(min· 1.73 m2)]of 70 cases,respectively.Eight-hour urinary albumin excretion rate (UAER) was compared between and among the groups; according to 8-hour UAER,patients were divided into three groups:group a (8-hour UAER ＜20 μg/min) of 946 cases,group b (20 μg/min≤8-hour UAER ＜200 μg/min) of 193 cases,group c(8-hour UAER ≥ 200 μ g/min) of 78 cases.eGFR was calculated and compared between and among the groups.Results Eight-hour UAER was (32.71 + 79.62),(57.56 + 130.59),(107.50 + 222.64) μ g/min in group A,B,C,and the difference among three groups was statistically significant (P＜0.05).eGFR was (110.78 ±32.75),(108.26 ±45.78),(94.96 ±32.30) ml/ (min ·1.73 m2) in group a,b,c,and the difference between group a and group c,or between group b and group c was statistically significant (P ＜0.05),but the difference between group a and group b was not statistically significant (P ＞0.05).Conclusion When evaluating the function of type 2 diabetic nephropathy,two indicators should be considered:glomerular filtration rate and urinary albumin.

Relationship between urinary albumin excretion rate and cardiac structure and function in type 2 diabetes mellitus / 中国医师进修杂志

Objective To study the relationship between urinary albumin excretion rate(UAER)and cardiac structure and function in type 2 diabetes mellitus(T2DM).Methods Five hundred and twenty patients with T2DM were divided into three groups by 8 h UAER:normoalbuminuria group(424 cases),microalbuminuria group(75 cases)and macroalbuminuria group(21 cases).At the same time,50 healthy people were selected as control group.The cardiac structure and function in four groups were evaluated by echocardiographic measurements.Results Left atrial dimensio[(34.39±3.46)mm],left ventricular posterior wall thickness[(10.34±1.05)mm],relative wall thickness(0.46±0.05),interventricular septal thickness[(10.49±1.07)mm],left ventricular mass[(167.37±32.12)g],left ventricular mass index[(87.62±12.16)g/m2]in macroalbuminuria group were significantly higher than those in control group[(32.59±2.71)mm,(9.30±0.77)mm,0.42±0.04,(9.75±0.81)mm,(147.33±27.23)g,(80.14±13.81)g/m2](P＜0.05),mean while the ratio of E/A(0.82±0.19)in macroalbuminuria group was significantly lower than that in control group(1.21±0.16)(P＜0.05).Conclusions In T2DM patients with albuminuria,the cardiac structure and function have changed.With the increase of UAER,the impairments are more prominent.And it may predict diabetes cardiomyopathy.

Study on the severity of diabetic retinopathy and its relationship with serum bilirubin / 中国医师进修杂志

Objective To investigate the relationship between the severity of diabetic retinopathy and serum bilirubin level. Methods From August 1 2008 to December 31 2009, hospitalized patients of 1062 cases with type 2 diabetes were divided into three groups according to fundus examination: no diabetic retinopathy (NDR) group (457 cases), non-proliferative diabetic retinopathy (NPDR) group (484 cases)and proliferative diabetic retinopathy (PDR) group ( 121 cases). The difference in serum bilirubin level was compared. Results Total bilirubin in PDR, NPDR and NDR group were (9.96 ± 3.84), ( 11.41 ± 3.82),( 13.38 ± 3.98) μ mol/L respectively. There was significant difference among three groups (P ＜ 0.01 ). Logistic multivariate regression analysis showed that a drop in serum total bilirubin level was an independent risk factor of diabetic retinopathy. Conclusions Bilirubin level and the severity of diabetic retinopathy have some relationship. The antioxidant bilirubin and anti-inflammatory effect should be paid attention to.