A semi-supervised material quantitative intelligent imaging algorithm for spectral CT based on prior information perception learning / 南方医科大学学报

OBJECTIVE@#To propose a semi-supervised material quantitative intelligent imaging algorithm based on prior information perception learning (SLMD-Net) to improve the quality and precision of spectral CT imaging.@*METHODS@#The algorithm includes a supervised and a self- supervised submodule. In the supervised submodule, the mapping relationship between low and high signal-to-noise ratio (SNR) data was constructed through mean square error loss function learning based on a small labeled dataset. In the self- supervised sub-module, an image recovery model was utilized to construct the loss function incorporating the prior information from a large unlabeled low SNR basic material image dataset, and the total variation (TV) model was used to to characterize the prior information of the images. The two submodules were combined to form the SLMD-Net method, and pre-clinical simulation data were used to validate the feasibility and effectiveness of the algorithm.@*RESULTS@#Compared with the traditional model-driven quantitative imaging methods (FBP-DI, PWLS-PCG, and E3DTV), data-driven supervised-learning-based quantitative imaging methods (SUMD-Net and BFCNN), a material quantitative imaging method based on unsupervised learning (UNTV-Net) and semi-supervised learning-based cycle consistent generative adversarial network (Semi-CycleGAN), the proposed SLMD-Net method had better performance in both visual and quantitative assessments. For quantitative imaging of water and bone materials, the SLMD-Net method had the highest PSNR index (31.82 and 29.06), the highest FSIM index (0.95 and 0.90), and the lowest RMSE index (0.03 and 0.02), respectively) and achieved significantly higher image quality scores than the other 7 material decomposition methods (P < 0.05). The material quantitative imaging performance of SLMD-Net was close to that of the supervised network SUMD-Net trained with labeled data with a doubled size.@*CONCLUSIONS@#A small labeled dataset and a large unlabeled low SNR material image dataset can be fully used to suppress noise amplification and artifacts in basic material decomposition in spectral CT and reduce the dependence on labeled data-driven network, which considers more realistic scenario in clinics.

Effect of needle-free jet injection of insulin glargine on glycaemic fluctuation in type 2 diabetic patients with uncontrolled glycemia / 中华内分泌代谢杂志

Objective:To investigate the effects of insulin glargine administration by jet injection versus conventional insulin pen on glucose profile using professional mode flash glucose monitoring(FGM) system in type 2 diabetic patients with poor glucose control.Methods:In this randomized, controlled, crossover study, 40 patients with T2DM who treated with insulin glargine were enrolled. The patients were randomly divided into group A(jet injector-conventional pen, n=20) and group B(conventional pen-jet injector, n=20). Each patient wore FreeStyle Libre sensor from day 4 to day 17. The specialist nurse instructed patients how to master the injection techniques. Professional FGM system was applied to assess glucose profile. Results:The fasting blood glucose(FBG) of the enrolled patients was(9.37±1.84) mmol/L. In contrast to conventional insulin pen, treatment with the jet injector significantly decreased the 24h MBG [(9.06±2.13 vs 9.98±2.67) mmol/L, P=0.001], MaxBG [(16.69±3.01 vs 17.95±3.48) mmol/L, P=0.001], AUC>10 mmol/L [95.93(21.12, 129.02) vs 142.66( 27.88, 198.46), P=0.002], TAR(31.10±21.89 vs 39.49±25.93, P=0.003), MAGE and SDBG. It was observed that patients using jet injector had significant increased TIR(65.94±20.47 vs 58.32±25.00, P=0.001). There were no difference in the risk of hypoglycaemia between two groups. Conclusion:Insulin jet injector was more effective than the insulin pen on glycaemic control and glucose fluctuation without increasing the risk of hypoglycemia in type 2 diabetic patients with uncontrolled glycemia.

Study on the effect of ultrasound intermediate frequency acupoint drug guiding technology on the recovery of gastrointestinal function in patients undergoing lumbar spine surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound intermediate frequency acupoint targeted drug guiding technology on the recovery of gastrointestinal function and serum gastrin levels in elderly patients after lumbar spine surgery under general anesthesia.Methods:This study used prospective research methods.A total of 90 elderly patients undergoing lumbar spine surgery after general anesthesia in the orthopaedic ward of Beijing Geriatrics Hospital from June 2019 to June 2021 were randomly divided into blank control group, drug control group, and drug-guided treatment group, with 30 cases each group. After the operation, no intervention was given to the blank control group, the drug control group received oral mosapride citrate tablets, the drug-guided treatment group used the D patch to guide the medicine at the two acupoints of Zusanli and Zhongwan with ultrasound medium frequency guided medicine instrument for 1 week each. The serum gastrin levels of the patients in each group were detected 1 d before operation, 3 d after operation, and 1 week after operation, and the time of first exhaust and first defecation after operation were recorded.Results:The results showed that the level of serum gastrin preoperativein the three groups was not significantly different ( P>0.05). On the third day after operation, the levelof serum gastrin in the drug guide treatment group, drug control group and blank control group were lower than those at 1 d before operation: (66.51 ± 5.34) ng/L vs. (69.36 ± 6.50) ng/L, (58.34 ± 5.71) ng/L vs. (68.75 ± 5.13) ng/L, (55.76 ± 6.23) ng/L vs. (70.20 ± 6.71) ng/L, the differences were statistically significant ( P<0.05), and showed a decreasing trend in turn. Among them, the level of serum gastrin in the drug guide treatment group was higher than that in the drug control group and blank control group, the difference was statistically significant ( P<0.05). One week after operation, the level of serum gastrin in the three groups increased compared with the third day after operation ( P<0.05), and the drug guiding treatment group was higher than the drug control group and the blank control group: (72.38 ± 6.78) ng/L vs. (67.15 ± 6.27) ng/L, (63.52 ± 5.38) ng/L, the differences were statistically significant ( P<0.05). The time of first exhaust and defecation after the operation of the three groups of patients, the drug-guided treatment group was significantly shorter than the drug control group and the blank control group: (15.25 ± 3.10) h vs. (20.38 ± 4.21) h and (28.52 ± 3.69) h, (24.14 ± 3.53) h vs. (36.15 ± 3.54) h and (49.51 ± 4.37) h, the differences were statistically significant ( P<0.05). Conclusions:Ultrasound intermediate frequency acupoint drug guiding technology can increase the patient′s serum gastrin level and promote the recovery of gastrointestinal function in elderly patients with lumbar spine surgery after general anesthesia.

A semi-supervised network-based tissue-aware contrast enhancement method for CT images / 南方医科大学学报

OBJECTIVE@#To propose a tissue- aware contrast enhancement network (T- ACEnet) for CT image enhancement and validate its accuracy in CT image organ segmentation tasks.@*METHODS@#The original CT images were mapped to generate low dynamic grayscale images with lung and soft tissue window contrasts, and the supervised sub-network learned to recognize the optimal window width and level setting of the lung and abdominal soft tissues via the lung mask. The self-supervised sub-network then used the extreme value suppression loss function to preserve more organ edge structure information. The images generated by the T-ACEnet were fed into the segmentation network to segment multiple abdominal organs.@*RESULTS@#The images obtained by T-ACEnet were capable of providing more window setting information in a single image, which allowed the physicians to conduct preliminary screening of the lesions. Compared with the suboptimal methods, T-ACE images achieved improvements by 0.51, 0.26, 0.10, and 14.14 in SSIM, QABF, VIFF, and PSNR metrics, respectively, with a reduced MSE by an order of magnitude. When T-ACE images were used as input for segmentation networks, the organ segmentation accuracy could be effectively improved without changing the model as compared with the original CT images. All the 5 segmentation quantitative indices were improved, with the maximum improvement of 4.16%.@*CONCLUSION@#The T-ACEnet can perceptually improve the contrast of organ tissues and provide more comprehensive and continuous diagnostic information, and the T-ACE images generated using this method can significantly improve the performance of organ segmentation tasks.

Effects of different doses of dexmedetomidine on heart rate variability in patients with non-ST-segment elevation myocardial infarction / 中国医师进修杂志

Objective:To investigate the effects of different doses of dexmedetomidine (Dex) on heart rate variability (HRV) in patients with non-ST-segment elevation myocardial infarction (NSTEMI).Methods:The clinical data of 144 patients with NSTEMI from January 2017 to October 2020 in the 942 Hospital of Chinese PLA were analyzed retrospectively. Among them, 36 cases were treated with Dex 0.05 to 0.15 μg/(kg·h) (Dex1 group), 36 cases with Dex 0.20 to 0.40 μg/(kg·h) (Dex2 group), 36 cases with Dex 0.50 to 0.70 μg/(kg·h) (Dex3 group), and 36 cases without Dex (control group). The changes of HRV time domain indexes, frequency domain indexes and prognosis index before and after treatment were compared among 4 groups, the time domain indexes include normal R-R interval standard deviation (SDNN), mean value of adjacent normal R-R interval standard deviation (SDANNindex), root mean square of adjacent normal R-R interval standard deviation (SDNNindex), square root of adjacent normal R-R interval difference (rMSSD) and percentage of adjacent normal R-R interval difference>50 ms to R-R interval number (PNN50); the frequency domain indexes include total power (TP), low frequency power (LF), high frequency power (HF), ultra-low frequency power (VLF) and LF/HF; the prognostic indexes include ICU stay time, vasoactive drug use time, 28-day mortality and incidence of complication.Results:There was no significant difference in HRV indexes among 4 groups before treatment ( P>0.05); after treatment, except for LF/HF in Dex2 group and Dex3 group was significantly lower than that in control group and Dex1 group, other HRV indexes were significantly higher than those in control group and Dex1 group, and there were statistical differences ( P<0.05). There was no significant difference in 28-day mortality among 4 groups; the ICU stay time and vasoactive drug use time in Dex2 group were significantly shorter than those in control group, Dex1 group and Dex3 group: (7.14 ± 1.25) d vs. (9.08 ± 1.68), (9.53 ± 1.98) and (9.81 ± 1.95) d, (122.67 ± 29.5) h vs. (176.15 ± 23.26), (181.72 ± 23.40) and (180.42 ± 22.90) h, the incidence of complication was significantly lower than that in control group, Dex1 group and Dex3 group: 16.67% (6/36) vs. 72.22% (26/36), 47.22% (17/36) and 61.67% (22/36), and there were statistical differences ( P<0.05); there were no statistical difference in ICU stay time, vasoactive drug use time and incidence of complication among control group, Dex1 group and Dex3 group ( P>0.05). Conclusions:Dex 0.20 to 0.40 μg/(kg·h) is well tolerated, and has less adverse reactions. It can effectively increase HRV, regulate the balance of sympathetic-vagal nerve tension, stabilize cardiovascular response and improve prognosis in patients with NSTEMI.

Sparse-view helical CT reconstruction based on tensor total generalized variation minimization / 南方医科大学学报

OBJECTIVE@#We propose a sparse-view helical CT iterative reconstruction algorithm based on projection of convex set tensor total generalized variation minimization (TTGV-POCS) to reduce the X-ray dose of helical CT scanning.@*METHODS@#The three-dimensional volume data of helical CT reconstruction was viewed as the third-order tensor. The tensor generalized total variation (TTGV) was used to describe the structural sparsity of the three-dimensional image. The POCS iterative reconstruction framework was adopted to achieve a robust result of sparse-view helical CT reconstruction. The TTGV-POCS algorithm fully used the structural sparsity of first-order and second-order derivation and the correlation between the slices of helical CT image data to effectively suppress artifacts and noise in the image of sparse-view reconstruction and better preserve image edge information.@*RESULTS@#The experimental results of XCAT phantom and patient scan data showed that the TTGVPOCS algorithm had better performance in reducing noise, removing artifacts and maintaining edges than the existing reconstruction algorithms. Comparison of the sparse-view reconstruction results of XCAT phantom data with 144 exposure views showed that the TTGV-POCS algorithm proposed herein increased the PSNR quantitative index by 9.17%-15.24% compared with the experimental comparison algorithm; the FSIM quantitative index was increased by 1.27%-9.30%.@*CONCLUSIONS@#The TTGV-POCS algorithm can effectively improve the image quality of helical CT sparse-view reconstruction and reduce the radiation dose of helical CT examination to improve the clinical imaging diagnosis.

Establishment of a deep feature-based classification model for distinguishing benign and malignant breast tumors on full-filed digital mammography / 南方医科大学学报

OBJECTIVE@#To develop a deep features-based model to classify benign and malignant breast lesions on full- filed digital mammography.@*METHODS@#The data of full-filed digital mammography in both craniocaudal view and mediolateral oblique view from 106 patients with breast neoplasms were analyzed. Twenty-three handcrafted features (HCF) were extracted from the images of the breast tumors and a suitable feature set of HCF was selected using -test. The deep features (DF) were extracted from the 3 pre-trained deep learning models, namely AlexNet, VGG16 and GoogLeNet. With abundant breast tumor information from the craniocaudal view and mediolateral oblique view, we combined the two extracted features (DF and HCF) as the two-view features. A multi-classifier model was finally constructed based on the combined HCF and DF sets. The classification ability of different deep learning networks was evaluated.@*RESULTS@#Quantitative evaluation results showed that the proposed HCF+DF model outperformed HCF model, and AlexNet produced the best performances among the 3 deep learning models.@*CONCLUSIONS@#The proposed model that combines DF and HCF sets of breast tumors can effectively distinguish benign and malignant breast lesions on full-filed digital mammography.

Key technologies in digital breast tomosynthesis system:theory, design, and optimization / 南方医科大学学报

OBJECTIVE@#To develop a digital breast tomosynthesis (DBT) imaging system with optimizes imaging chain.@*METHODS@#Based on 3D tomography and DBT imaging scanning, we analyzed the methods for projection data correction, geometric correction, projection enhancement, filter modulation, and image reconstruction, and established a hardware testing platform. In the experiment, the standard ACR phantom and high-resolution phantom were used to evaluate the system stability and noise level. The patient projection data of commercial equipment was used to test the effect of the imaging algorithm.@*RESULTS@#In the high-resolution phantom study, the line pairs were clear without confusing artifacts in the images reconstructed with the geometric correction parameters. In ACR phantom study, the calcified foci, cysts, and fibrous structures were more clearly defined in the reconstructed images after filtering and modulation. The patient data study showed a high contrast between tissues, and the lesions were more clearly displayed in the reconstructed image.@*CONCLUSIONS@#This DBT imaging system can be used for mammary tomography with an image quality comparable to that of commercial DBT systems to facilitate imaging diagnosis of breast diseases.

A radiomic approach to differential diagnosis of renal cell carcinoma in patients with hydronephrosis and renal calculi / 南方医科大学学报

To explore the application of radiomic analysis in differential diagnosis of renal cell carcinoma in patients with hydronephrosis and renal calculi using supervised machine learning methods.The abdominal CT scan data were retrospectively analyzed for 66 patients with pathologically confirmed hydronephrosis and renal calculi, among whom 35 patients had renal cell carcinoma. In each case 18 non-texture features and 344 texture features were extracted from the region of interest (ROI). Infinite feature selection (InfFS)-based forward feature selection method coupled with support vector machine (SVM) classifier was used to select the optimal feature subset. SVM was trained and performed the prediction using the selected feature subset to classify whether hydronephrosis with renal calculi was associated with renal cell carcinoma.A total of 12 texture features were selected as the optimal features. The area under curve (AUC), accuracy, sensitivity, specificity, false positive rate and false negative rate of the SVM- InfFS model for predicting accompanying renal tumors in patients with hydronephrosis and calculi were 0.907, 81.0%, 70.0%, 90.9%, 9.1%, and 30.0%, respectively. The diagnostic accuracy, sensitivity, specificity, false positive and false negative rates by the clinicians provided with these classification results were 90.5%, 80.0%, 100%, 0.00%, and 20.0%, respectively.The computer-aided classification model based on supervised machine learning can effectively extract the diagnostic information and improve the diagnostic rate of renal cell carcinoma associated with hydronephrosis and renal calculi.

Effect of flash glucose monitoring on ambulatory glucose profile in patients with type 2 diabetes mellitus / 中国医师进修杂志

Objective To investigate the effect of flash glucose monitoring (FGM) on ambulatory glucose profile of only oral antidiabetic drugs treated patients with type 2 diabetes mellitus. Methods Twenty-eight type 2 diabetic mellitus patients with only oral antidiabetic drugs treatment from August 2017 to January 2018 were enrolled. All the patients were exposed to FGM for 14 d without changing the original treatment and encouraged to manage self-behavior by adjusting diet and activity based on the blood glucose data obtained from the real-time scanning. The changes in glucose profile during the FGM period were observed, including estimated glycated hemoglobin (HbA1c), standard deviation of blood glucose, variable coefficient of blood glucose, mean amplitude of glycemic excursions, time in range (blood glucose 3.9 to 10.0 mmol/L), area under the curve hyperglycemia (blood glucose> 10.0 mmol/L) and area under the curve hypoglycemia (blood glucose<3.9 mmol/L). The blood glucose levels on second day and thirteenth day were used as baseline and end point respectively. Results All of the 28 patients did not change their anti-diabetic drug therapy and there were no adverse events occurred. The estimated HbA1c was significantly lower than the baseline HbA1c: (6.90 ± 1.48)% vs. (7.57 ± 1.35)%, and there was statistical difference (P = 0.004). The standard deviation of blood glucose, variable coefficient of blood glucose, mean amplitude of glycemic excursions, area under the curve hyperglycemia and area under the curve hypoglycemia at end were significantly lower than those at baseline: (2.07 ± 0.86) mmol/L vs. (2.44 ± 0.86) mmol/L, 0.26 ± 0.11 vs. 0.30 ± 0.11, (5.32 ± 2.75) mmol/L vs. (6.76 ± 3.06) mmol/L, 265 (0, 1 310) vs. 351 (107, 2 177) and 0 (0, 0) vs. 0 (0, 19), the time in range at end was significantly higher than that at baseline: (1 069 ± 386) min vs. (921 ± 449) min, and there were statistical differences (P＜0.05 or＜0.01). The rate of scanning was (12.92 ± 4.87) times/d. Conclusions FGM could be applied by type 2 diabetic mellitus patients to make self-glycemic management without changing therapy, reduce the estimated HbA1c,and hypoglycemia, and improve the glucose fluctuations, which may result from real-time scanning to find abnormal glycemia and adjust daily behavior.

A survey on the present status of diagnosis and treatment of Graves' disease in Jiangsu province / 中华内分泌代谢杂志

Objective To investigate the management of Graves' disease in Jiangsu province. Methods According to the 2011 management of GD survey from American Thyroid Association and the 2013 survey from European Thyroid Association, a questionnaire was designed for this survey to acquire the diagnosis, treatment, and follow-up of Graves' disease among endocrinologists from 35 tertiary hospitals in Jiangsu province. Results A total of 476 valid questionnaires were collected. For patients with symptoms of hyperthyroidism, a large majority of respondents monitored serum FT3 , FT4 , TSH, thyroid peroxidase antibody, thyroglobulin antibody, TSH receptor antibody, and finding of thyroid ultrasound, accounted for 95. 6％, 95. 0％, 95. 4％, 95. 8％, 90. 3％, 90. 5％, and 93. 9％physicians, respectively. 91.2％ of physicians preferred anti-thyroid drugs as the first-line treatment, and 92. 6％ of them gave priority to the use of methimazole. For the duration of anti-thyroid drugs therapy, 41.2％of endocrinologists chose 24 months, while 20％ chose 18 months. When patients have moderate and active ophthalmopathy, most respondents with medium or senior professional titles preferred anti-thyroid drugs, while most resident physicians chose radioactive iodine plus corticosteroids. When pregnancy was confirmed in the patients of Graves' disease, 88％ of respondents preferred propylthiouracil during the first trimester of pregnancy, and 58. 4％ of them would continue propylthiouracil into the second trimester. Conclusions The mastering of basic perception of Graves' disease knowledge is satisfactory among the endocrinologists. But by comparing to the American and European survey results and related guidelines, there are still some differences in diagnosis and treatment. Therefore, physicians should notice those differences and make improvement on standardized treatment for patients to raise the response ratio while reducing the recurrent events.

The efficacy and dispersion analysis of high viscosity cement in the treatment of osteoporotic vertebral compression fractures with different degrees of osteoporosis / 中国基层医药

Objective To observe the efficacy and difference of dispersion of osteoporotic vertebral fractures with high-viscosity cement in the treatment of vertebral compression fractures with different degrees of osteoporosis.Methods From October 2013 to October 2016,a total of 65 patients with clinically diagnosed thoracolumbar osteoporotic fractures in Beijing Geriatrics Hospital were selected,and they were divided into three groups according to Genant semiquantitative method:24cases of] degree group (vertebral compression ≤ 25％),23cases of Ⅱ degree group(vertebral compression of ＞ 25％-40％),18 cases of Ⅲ degree group(vertebral compression ＞ 40％).All patients underwent vertebroplasty and received high viscosity bone cement.CT scan was performed after operation,then the volume of vertebral bone cement dispersion and diffusion coefficient were calculated,the differences among different groups were compared.The visual analogue scale(VAS) of all patients were recorded before operation,1 day after operation and 6 months after operation.The differences of preoperative and postoperative VAS scores were compared to evaluate the therapeutic effect of high viscosity cement on PVP.Results There were no statistically significant differences among the three groups in the time of single vertebral body operation and the amount of cement injected(all P ＞0.05).However,the volume and the diffusion coefficient of the cement in the Ⅲ degree group [(8.25 ± 1.38)mL and (2.15 ± 0.21)] were significantly different from those in the Ⅱ degree group[(9.32 ±1.85) mL and (2.42 ± 0.27)] (t =2.43,3.51,all P ＜ 0.05) and the Ⅰ degree group [(9.38 ± 1.92) mL and (2.44 ± 0.23)] (t =2.12,2.29,all P ＜ 0.05).There were no statistically significant differences in the volume and the dispersion coefficient of cement between the Ⅰ degree group and Ⅱ degree group(t =0.11,0.29,all P ＞0.05).The postoperative VAS score decreased significantly,and the differences were statistically significant among preoperation,postoperative 1 day and postoperative 6 months (t =28.21,27.01,all P ＜ 0.01).Conclusion The VAS score of patients with OVCF decreases significantly after PVP treatment with high viscosity cement.The pain symptoms of patients with OVCF are significantly relieved in both short-term and long-term,and PVP with high viscosity cement has a very low incidence rate of bone cement leakage.The different degree of preoperative vertebral compression doesn't affect the amount of bone cement injection and operation time,but partly impact the dispersion of high viscosity cement,shown as the dispersion volume and diffusion coefficient of bone cement can decline with the increase of the degree of vertebral compression,especially for heavily compressed vertebral fractures,the dispersion of bone cement is clearly diminished.

Design and optimization of a cone-beam CT system for extremity imaging / 南方医科大学学报

OBJECTIVE@#To establish a cone beam computed tomography (ECBCT) system for high-resolution imaging of the extremities.@*METHODS@#Based on three-dimensional X-Ray CT imaging and high-resolution flat plate detector technique, we constructed a physical model and a geometric model for ECBCT imaging, optimized the geometric calibration and image reconstruction methods, and established the scanner system. In the experiments, the pencil vase phantom, image quality (IQ) phantom and a swine feet were scanned using this imaging system to evaluate its effectiveness and stability.@*RESULTS@#On the reconstructed image of the pencil vase phantom, the edges were well preserved with geometric calibrated parameters and no aliasing artifacts were observed. The reconstructed images of the IQ phantom showed a uniform distribution of the CT number, and the noise power spectra were stable in multiple scanning under the same condition. The reconstructed images of the swine feet had clearly displayed the bones with a good resolution.@*CONCLUSIONS@#The ECBCT system can be used for highresolution imaging of the extremities to provide important imaging information to assist in the diagnosis of bone diseases.

Clinical efficacy of decitabine combined with half dose CAG regimen in treatment of patients with relapsed/refractory acute myeloid leukemia / 白血病·淋巴瘤

Objective To observe the clinical efficacy of decitabine combined with half dose CAG regimen in patients with relapsed/refractory acute myeloid leukemia (AML).Methods Clinical data of 8 patients with relapsed/refractory AML who took the therapeutic regimen with decitabine combined with half dose CAG regimen in the Third People's Hospital of Datong from January 2015 to January 2017 were collected.The clinical efficacy and adverse effects were observed.Results After one course treatment by decitabine combined with half dose CAG regimen,3 patients achieved complete remission,and 2 patients achieved partial remission.The major adverse reactions were myelosuppression and infection,8 patients appeared grade Ⅲ-Ⅳ myelosuppression,5 patients appeared infection,2 patients appeared grade Ⅰ abnormality of liver and no treatment-related death occurred.Conclusion Decitabine combined with half dose CAG regimen is effective for relapsed/refractory AML,and this regimen is worthy of further study.

Effect of moderate exercise for 30 min at 30 min versus 60 min after dinner on glycemic control in patients with type 2 diabetes: a randomized, crossover, self-controlled study / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the effectiveness of moderate exercise for 30 min at 30 min and 60 min after dinner on glycemic control in patients with type 2 diabetes.</p><p><b>METHODS</b>This randomized, crossover, self-controlled pilot study was conducted in 15 inactive patients with type 2 diabetes without serious complications or use of exogenous insulin. The participants completed two randomly ordered exercise protocols (brisk walking for 30 min at 30 min or 60 min after dinner on the exercise day) spaced 1 week apart. All the exercise was performed while maintaining a heart rate reserve of 40%. The interstitial glucose level was monitored using a continuous glucose monitor (CGM) for all the participants, who maintained a standardized diet with routine medications. The 2-h postprandial mean glucose, peak glucose, and glucose area under the curve (AUC) were measured. The mean amplitude of glycemic excursions (MAGE) and other plasma glucose fluctuation parameters in 12 h after dinner, including the mean blood glucose (MBG) and the coefficient variation (CV) of glucose, were also calculated. The incidence of nocturnal hypoglycemia was recorded in all the participants.</p><p><b>RESULTS</b>The participants had a mean age of 46±11 years with a mean BMI of 25.8±3.1 kg/m and a mean HbA1c of 7.7%. No significant differences were found between postprandial 30 min exercise group and postprandial 60 min exercise group in terms of 2-h postprandial mean glucose, peak glucose, glucose AUC, or in MBG, CV and MAGE during the 12-h period after dinner. No nocturnal hypoglycemia occurred in the participants after exercise at 30 or 60 min after dinner. However, significant reductions in the 2-h postprandial glucose levels were detected after exercise at 60 min after dinner as compared to exercise at 30 min.</p><p><b>CONCLUSIONS</b>The timing (30 min 60 min after dinner) of moderate exercises for 30 min does not produce significant difference in the improvement of postprandial hyperglycemia in type 2 diabetic patients, and both exercise protocols are safe without a potential risk of hypoglycemia. Nevertheless, exercise at 60 min after dinner can be more effective to lower 2-h postprandial glucose, while exercise at 30 min after dinner might be safer for patients with a high risk of hypoglycemia.</p>

A case of Kazakh adolescent Niemann-Pick disease type C / 中华神经科杂志

The clinical data and genetic results of a case of Xinjiang Kazakh adolescent Niemann-Pick disease type C (NPC) with neurological lesions as the first and main clinical manifestations were analyzed, and the literatures at home and abroad were reviewed and summarized. The main clinical manifestations of the patient were unstable walking, frequent falls, slow progression of the disease, difficulty in independent walking, and involuntary movements of the limbs and face, inability to concentrate and dysarthria. Skull MRI revealed abnormal signals in the posterior horn of bilateral lateral ventricles. Abdominal ultrasound splenomegaly was found. Niemann-Pick cells and navy tissue cells were seen in the bone marrow smear. The result of the patient gene sequencing showed that the exon 23 in NPC1 gene had a homozygous mutation c.3493G>A (p.V1165M), which was a missense mutation;the patient′s father and mother performed Sanger generation sequencing verification and were found that they all carried the disease-causing mutation. NPC is a rare autosomal recessive lysosomal storage disease with no specific clinical symptoms. For adolescents with ataxia, dystonia, or psychiatric symptoms, there is a high degree of suspicion of NPC when there is isolated splenomegaly and no liver disease.

The relationship between rs9521733 polymorphism of COL4A2 gene and lacunar stroke in Xinjiang Han populations / 中华神经科杂志

Objective To investigate the association of COL4A2 gene polymorphism rs9521733 with lacunar stroke in Xinjiang Han populations.Methods A total of 406 Han lacunar stroke patients and 425 controls enrolled from the First Hospital of Xinjiang Medical University and the 7th Division Hospital of Xinjiang Production and Construction Corps between March 2016 and September 2017 were recruited in the study.Clinical data were collected from all subjects.The improved multiple ligase detection reaction method was used to analyze the genotypes of rs9521733 in the COL4A2 gene.SPSS 17.0 was used for data analysis.Results There was no statistically significant difference in genotype and allele frequency of rs9521733 between case group and control group.Stratification analyses showed that the CC genotype of rs9521733 was associated with a significant increase in risk of lacunar stroke in the group of age ≥≥60 years (adjusted OR =1.950,95％ CI 1.222-3.112,P =0.005).Conclusion The rs9521733 of the COL4A2 gene might be associated with a higher risk of lacunar stroke in the group of age ≥60 years.

Association between short-term outcomes and collateral circulation status in patients with acute ischemic stroke receiving thrombolysis therapy: a systematic review and meta-analysis / 中华全科医师杂志

Objective To evaluate the association between short-term outcomes and collateral circulation status in patients with acute ischemic stroke receiving thrombolysis therapy.Methods Full-text articles published from January 2000 to November 2016 in Cochrane Library,Medline,Embase and Web of Science electronic database were retrieved and their quality was assessed.The association between short-term outcomes and collateral circulation status were analyzed by random-effects models.Results Twenty three studies involving 2 849 patients were included in quantitative synthesis.The results showed that good collateral circulations had a beneficial effect on favorable outcomes at 3 or 6 months (RR =2.26,95％ CI:1.85-2.77,P =0.00),and were also associated with a lower rate of symptomatic intracranial hemorrhage (RR =0.56,95％ CI:0.47-0.67,P ＜ 0.01) and a lower rate of mortality (RR =0.30,95％ CI:0.22-0.40,P ＜ 0.01).Conclusion The baseline collateral cimulation status is associated with the short-term outcomes in patients with acute ischemic stroke receiving thrombolysis therapy.

Cross-sectional study of current situation of glucose metabolism with in-hospital type l diabetic patients / 中国医师进修杂志

Objective To analyze the present situation of glucose metabolism and the characteristics of blood glucose fluctuation in in-hospital type l diabetic patients (T1DM). Methods One hundred and forty-three hospitalized cases of T1DM patients from November 2012 to November 2016 were retrospectively analyzed.The percentage of adult-onset T1DM patients was 76.22%(109/143)and none adult-onset was 23.78%(34/143). The following data were collected: general information, the indexes of glucose metabolism and islet function.Seventy-two-hour continuous glucose monitoring(CGM) was carried on 40 patients as a subgroup.Results The average age was(40.29 ± 16.79)years.The onset age of diabetes was(33.57 ± 17.18)years.The disease duration was 4.0(1.0,10.0)years.The body mass index(BMI)was(20.68 ± 2.95)kg/m2.The fasting blood glucose(FBG)was(12.02 ± 5.40)mmol/L.The HbA1c was(9.80 ± 2.65)%.The fasting C-peptide was 0.08(0.01,0.38)nmol/L.The 2-hour postprandial C-peptide (C-P 2 h) was 0.12(0.01, 0.70) nmol/L. The anti-glutamic acid decarboxylase antibody was 12.08(8.16,20.56)μg/L.The islet-cell antibody was 4.85(2.66,12.07)μg/L.By using multivariate linear regression analysis, HbA1c were negatively related to the duration and BMI of T1DM. CGM: the mean blood glucose was (10.34 ± 2.97) mmol/L. The standard deviation of blood glucose was (2.89 ± 1.07) mmol/L. The mean amplitude glycemic excursions was (7.10 ± 3.09) mmol/L. The incidence of hypoglycemia was 10.00% (≤ 2.8 mmol/L) and 32.50% (≤ 3.9 mmol/L). Conclusions Adult-onset T1DM patients account for more than two-thirds. In-hospital T1DM patients have poor control of blood glucose, and they show the clinical characteristics of high blood glucose fluctuation and more hypoglycemia.

Correlation between Plasma Concentration of Nateglinide and Clinical Efficacy in Newly Diagnosed Type 2 Diabetes / 中国药师

Objective:To study the correlation between plasma concentration and clinical efficacy in newly diagnosed type 2 diabe-tes treated with nateglinide. Methods:On the basis of diet control and exercise, 73 cases of newly diagnosed type 2 diabetes received nateglinde therapy for 2 months. Adverse events were routinely monitored during the therapy. Fasting blood glucose(FBG), 2h post-prandial blood glucose(2h-PG), fasting C-peptide(F-CP), 2h C-peptide(P-CP) and glycosylated hemoglobin (HbA1c) were ob-served before and after the treatment. LC-MS was used to determine the plasma concentration of nateglinide on the last day of treat-ment. Results:FBG, 2h-PG, HbAlc and P-CP after the treatment had significant changes when compared with those before the treat-ment (P0. 05). The difference in HbA1c and P-CP before and after the treatment both showed a significantly positive correlation with plasma concentration of nateglinide (P<0. 05). Conclusion:Nateglinide displays good clinical efficacy and safety in newly diagnosed type 2 diabetes, and its plasma concentration can be used to evaluate the pancreatic islets function and glucose-lowing effects.