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Objective To observe the clinical efficacy of liraglutide combined with metformin in the treatment of newly diagnosed type2 diabetes mellitus (T2DM) accompanying non-alcoholic fatty liver disease (NAFLD).Methods 40 newly diagnosed patients with type 2 diabetes combined with fatty liver were randomly divided into observation group and control group.On the basis of lifestyle intervention,the observation group was given metformin 500 mg,oral,3 times/d,Liraglutide Injection 1.8 mg,subcutaneous injection,1 times/d,and the control group was given metformin 500 mg,orally,3 times/d.The treatment process lasted for 12 weeks.Waist circumference,body mass index (BMI),fasting plasma glucose (FPG),2 hour postprandial glucose (2 h PG),glycosylated hemoglobin A1 c (HbA1 c),alanine aminotransferase (ALT),aspartate transaminase (AST),glutamyl transpeptidase (GGT),total cholesterol (TC),triglyceride (TG),Transforming growth factor beta (TGF-β) and the degree of fatty liver were compared before and after treatment,and the adverse events were recorded.Results Compared with the control group,the degree of WC,BMI,FPG,2 h PG,HbA1c,TG,TGF-beta and fatty liver were significantly improved in the observation group (P ＜ 0.05).There was no significant difference in adverse reactions between the two groups (P ＞ 0.05).Conclusions Liraglutide combined with metformin is a new kind of safe and effective treatment for T2DM accompanying NAFLD.
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Objectives To observe the clinical curative effect of Wuzhuyu acupoint on the treatment of gastrointestinal dysfunction in severe patients. Methods A total of 60 patients with gastrointestinal dysfunction were randomly divided into treatment group and control group, 30 patients in each group. The control group was treated with routine western medicine, and the treatment group was given the acupoint application of Wuzhuyu on the basis of routine treatment. The treatment last 7 days. The clinical efficacy was evaluated by observing bowel sounds recovery time, exhaust time and defecating time, enteral nutrition tolerability, gastrointestinal dysfunction score and acute physiology and chronic health evaluation (APACHE Ⅱ). Results The treatment group showd significantly shorter bowel sound recovery time and anal exhaust time than the control group (t value were 8.811, 5.538, 8.908, all P value <0.01). The enteral tolerance rate was 80.0％ (24/30), and the control group tolerance rate was 53.3％ (16/30). The tolerance rate of treatment group was significantly higher than that of control group (χ2=4.720, P=0.030). The Gastrointestinal dysfunction score and APACHE Ⅱ score in treatment group were significantly lower than control group (t value were 3.873,2.805,all P value <0.01). Conclusions The acupoint application of Wuzhuyu can promote the recovery of gastrointestinal function, increase the tolerance of enteral nutrition, and reduce the severity of the patient's condition and improve the prognosis of patients.
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Objective To analyze the improvement of clinical symptoms,relapse and neurological functional recovery and the prognostic factors of anti-N-methyl-D-aspatate receptor (NMDAR) encephalitis.Methods Follow-up was conducted for 51 hospitalized patients with anti-NMDAR encephalitis at the Department of Neurology,Xuanwu Hospital,Capital Medical University from June 2012 to April 2015.The neurological functional recovery was evaluated through modified Ranking Scale (mRS),and the prognostic factors were analyzed.Results Among the 51 patients with anti-NMDAR encephalitis,89％ (45/51) were completely recovered or remained mild neurological dysfunction (mRS score ≤ 2).The prognosis of main clinical symptoms was as follows:78％ (35/44) of the mental and behavior disorders were fully recovered,94％ (32/34) of the seizures were controlled and 65％ (21/31) of the cognitive deficiency were completely recovered;25％ (13/51) of the patients relapsed.Comparison of clinical data of initial on-set among complete recovery patients group (mRS score =0),partial recovery patients group (mRS score =1 or 2) and poor prognosis patients group (mRS score ≥ 3) showed that initial clinical manifestation with memory deficiency (17,9,6 cases respectively;x2 =6.664,P=0.036),involuntary movements(19,4,5 cases respectively;x2 =7.976,P =0.019) and central hypoventilation (5,0,2 cases respectively;x2 =6.124,P =0.047) had statistically significant difference.Conclusions The majority of anti-NMDAR patients have favorable prognosis,but some of the patients may remain various degrees of neurological deficiency,including mental and behavior disorders,cognitive deficiency and seizures.Initial clinical manifestation with memory deficiency,involuntary movements and central hypoventilation may indicate a poorer prognosis.
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Objective To analyze the clinical characteristics of leucine-rich glioma-inactivated protein 1 antibody-associated encephalitis.Methods Fourteen patients diagnosed as leucine-rich gliomainactivated protein 1 antibody-associated encephalitis in Capital Medical University Xuanwu Hospital from January 2012 to January 2015 were recruited.The clinical manifestation,brain magnetic resonance imaging,cerebrospinal fluid findings and biochemical examination of these patients were analyzed.Results The case series of 14 patients had an average age of (48.93 ± 15.60) years (range 27-67 years) with a male to female ratio of 2.5∶ 1.All patients presented with short-term memory loss.Nine patients experienced dementia.Additionally,among the 14 patients,12 experienced seizures,8 experienced faciobrachial dystonic seizures,10 had psychiatric symptoms,and 8 showed sleep dysfunction.Two patients were transferred into intensive care unit because of deteriorating symptoms and were provided operated mechanical ventilation.Thirteen of 14 patients exhibited abnormalities in their brain magnetic resonance imaging,with lesions in temporal lobe and hippocampus.Six patients had abnormal cerebrospinal fluid findings,8 patients showed hyponatremia (serum Na+ ＜ 135 mmol/L),while 5 patients co-existed with other autoantibodies.Screening for malignant tumors revealed normal findings.During 2 years follow-up,3 patients relapsed.Conclusions Leucine-rich glioma-inactivated protein 1 antibody-associated encephalitis is an autoimmune encephalitis characterized by short-term memory loss,faciobrachial dystonic seizures and hyponatremia.Lesions in brain MRI always involve in temporal lobe and hippocampus.This disease can relapse and is seldom associated with tumor.
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Objective To explore the clinical characteristics of the lesions of spinal cord and optic nerve as the onset of neuromyelitis optica (NMO).Methods A total of fifty-one patients with myelitis or optic neuritis (ON) as the onset of NMO who hospitalized in our Neurology Department during October 2010 to October 2012 were enrolled in the study.Clinical presentations and MRI findings of the spinal cord and brain were studied.Results (1) A total of 26 cases (51.0％) presented with myelitis as the index event,in which 30.8％ (8/26) were the longitudinally extensive transverse myelitis (LETM) and 69.2％ (18/ 26) were non-LETM (short segmental myelitis or non-transverse myelitis).Patients with non-LETM as the onset were found to have better prognosis than those with LETM (full recovery ratio was 13/18 vs 2/8,P ＜ 0.05),while shorter recurrence interval of myelitis and higher recurrence frequency of events were shown in patients with non-LETM (11.1 vs 18.6 months,3 times per year vs once per year,with all P ＜ 0.05).(2) A total of 25 cases (49.0％) presented with ON as the index event with 24.0％ (6/25) of unilateral ON and 76.0％ (19/25) of bilateral ON.Patients with bilateral ON had more severe visual impairment and shorter first remission period than those with unilateral ON (P ＜ 0.05).Conclusion Non-LETM and bilateral ON are the most common index demyelinating events in NMO cases.
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Objective To analyze the clinical manifestations and the features of brain MRI and cerebrospinal fluid (CSF) findings in adult Chinese patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.Methods We reviewed the clinical manifestations,brain MRI and CSF examinations of 29 patients who were diagnosed as anti-NMDAR encephalitis.Results The major clinical features of anti-NMDAR encephalitis patients included psychiatric symptoms (86％,25/29),seizures (83％,24/29),decreased consciousness (55％,16/29),involuntary movements (55％,16/29),central hypoventilation (34％,10/29),and hypersalivation (17％,5/29).Some patients also experienced autonomic instability,hemiplegia and aphasia.Underlying ovarian teratoma was identified in 14％ of affected patients(4/29).Brain MRI was found abnormal in up to 62％ patients (18/29),located in the temporal lobes,hippocampus,thalamus,brain stem,cingulate gyrus,frontal and parietal cortex,corpus callosum,internal capsule,basal ganglia and periventricular area.CSF findings were abnormal in 83％ of patients with anti-NMDAR encephalitis.Oligoclonal banding in CSF was positive in 95％ patients (19/20).The recurrence rate during 3 years was 31％ (9/29).Conclusions Anti-NMDAR encephalitis is a treatable disease,yet with high recurrence rate.Its predominant clinical features are psychiatric symptoms and seizures,while involuntary movements,central hypoventilation and hypersalivation are its characteristic manifestations.Lesions in MRI are widespread,not only restricted to limbic lobe.
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The pancreatic tissues from patients with islet cell hyperplasia,insulinoma,and pancreatic adenocarcinoma,as well as normal pancreatic tissues were embedded with paraffin,serial sections were cut and mounted on glass slides.Immunohistochemical staining was carried out with N-myc down-stream regulated gene 2 (Ndrg2) monoclonal antibody by means of ABC method,and Western blotting was carried out to detect the expression and distribution of Ndrg2.The results showed that Ndrg2 positive immunoreactivity was mainly localized in the cytoplasm of islet cell,being similar to the localization of insulin positive immunoreactivity.The number and volume of pancreatic islets were increased in the patients with islet cell hyperplasia,and Ndrg2 expression was also increased.Western blotting results showed that the expression of Ndrg2 in the pancreas of patients with islet cell hyperplasia was increased compared with normal group.The above results suggest that Ndrg2 may play an important role in performing physiological function of islet cells.
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Objective To evaluate the application value of non-invasive hemodynamic monitoring by thoracic electrical bioimpedance (TEB) in elderly non-cardiac surgery patients after general anaesthesia.Methods Fifty-six elderly non-cardiac surgery patients after general anaesthesia were divided into control group and TEB group with 28 patients in each group by random digits table. All patients received standardized care including central venous pressure (VAP). Besides these monitoring, hemodynamic monitoring by TEB was used to evaluate the hemodynamic state of patients in TEB group. Diuretics, inotropic agents, vasoactive drugs or intravenous fluid therapy were used according to monitoring guidance. The heart rate (HR), mean arterial pressure (MAP), VAP, urine output (UO) were recorded in different time. The length of mechanical ventilation and ICU stay were also recorded. The difference in HR, MAP, VAP, UO, the length of mechanical ventilation and ICU stay between two groups were analyzed. Results The differences between two groups had no significance in HR, MAP, VAP, UO at the same time (P ＞ 0.05 ). The length of mechanical ventilation of TEB group [ (19.5±15.9)h] was shorter as compared to that of control group [ (25.5 ± 16.5) h ], but the difference was not significant (P =0.173). The ICU stay of TEB group [(2.8 ± 1.0) d ] was shorter as compared to that of control group[(3.6±1.6)d] and the difference was significant (P=0.032). Conclusion Non-invasive hemodynamic monitoring by TEB can monitor the changes of hemodynamics and direct treatment in elderly non-cardiac surgery patients after general anaesthesia.