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Objective To explore efficacy and safety of simulated artificial pancreas in modulating stress hyperglycemia in critically ill patients. Methods A prospective randomized controlled study was performed. Seventy-two critically ill patients with stress hyperglycemia, aged 18-85 years, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score over 15, two consecutive random blood glucose 11.1 mmol/L or higher, glycated hemoglobin (HbA1C) below 0.065, unable to eat food for 3 days after inclusion, or only accepting parenteral nutrition, admitted to intensive care unit (ICU) in Shanghai Punan Hospital of Pudong New District from January 1st, 2015 to June 30th, 2017 were enrolled. The patients were divided into three groups according to the random number table method, high-intensity group and low-intensity group were injected Novolin R (high-intensity group 2/3 dosage, low-intensity group 1/3 dosage) to modulate stress hyperglycemia by simulated artificial pancreas. Simulated artificial pancreas consisted of Guardian real time glucose monitoring system (GRT system), close-circle control algorithm and micro-pump;subcutaneous injection of Humulin 70/30 was applied to modulate stress hyperglycemia in humulin group. Real-time glucose levels of interstitial fluid in abdominal wall, equivalent to blood glucose levels, 10 minutes each time, were monitored by using of GRT system for all patients in three groups. Fasting serum levels of stress hormones including epinephrine and cortisol and insulin resistance index (IRI) were recorded within 24 hours after inclusion. Mean blood glucose, blood glucose variation coefficient, blood glucose target-reaching rate, blood glucose target-reaching time, hypoglycemia rate and 6-month mortality were measured. Twenty healthy adults from health administration department of the hospital were recruited as healthy control group. Results A total of 60 eligible critically ill patients were included in this study, each group with 20 patients. There was no significant difference in gender, age, APACHE Ⅱ scores among three groups. The levels of serum epinephrine, cortisol and IRI within 24 hours after inclusion in the three groups were significantly higher than those in healthy control group. The mean blood glucose levels of humulin group, low-intensity group, high-intensity group were decreased (mmol/L: 10.2±3.2, 8.4±2.6, 8.1±2.2), the blood glucose target-reaching rate were increased [40.2% (3 295/8 196), 71.1% (5 393/7 585), 80.4% (6 286/7 818)], the blood glucose target-reaching time were shortened (hours: 49.1±5.8, 24.6±4.6, 17.5±4.2), the hypoglycemia rates were increased respectively [1.3% (108/8 196), 2.8% (211/7 585), 4.0% (313/7 818)], with statistically significant differences (all 1 = 0.000). There was no significant difference in blood glucose variation coefficient and 6-month mortality among three groups [blood glucose variation coefficient: (29.4±3.7)%, (28.5±5.3)%, (26.1±4.6)%, 6-month mortality: 55.0%, 45.0%, 40.0%, all 1 > 0.05]. Conclusions Simulated artificial pancreas could effectively and safely modulate stress hyperglycemia in critically ill patients, high-intensity modulation could bring about better efficacy in the regulation of hyperglycemia. High-frequency blood glucose monitoring by using GRT system could promptly identify hypoglycemia and help it to be corrected.
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Objective To compare the difference in recurrence rates between the endovenous laser therapy(EVLT) combined with percutaneous continuous circumsature (PCCS) and simplex EVLT following the treatment of great saphanous vein incompetence through the introduction of propensity score matching (PSM).Methods T the baseline data of 170 patients diagnosed with great saphanous vein incompetence who were treated in Punan Hospital in Pudong New District of Shanghai from 2009 to 2014 were retrospectively analyzed,of which underwent EVLT were 87 cases as EVLT group and EVLT combined with PCCS were 83 cases as EVLT +PCCS group.The groups covariate were balanced based on the PSM function of SPSS software using 1 ∶ 1 nearest neighbor matching method.The recurrence rates of the two groups were estimated by Kaplan-Meier method and the differences between the two groups were evaluated by Log-rank test.Results Sixty-seven pairs of patients were successfully matched.No significant difference between the two matched groups in the basic clinical features.Before PSM,the 1,2,and 3 year cummulative recurrence rates were 3.5％,5.4％ and 7.3％ in the EVLT group,and 0.9％,4.7％ and 4.7％ in the EVLT+PCCS group,respectively,there were no statistically significant differences between the two groups by Log-rank test (P =0.491).After PSM,the 1,2,and 3 year cummulative recurrence rates were 5.2％,5.2％ and 7.1％ in the EVLT group,and 0％,1.0％ and 1.0％ in the EVLT+PCCS group,there were statistically significant differences between the two groups (P =0.031).Conclusion The PSM methods can effectively balanced the covariates of groups in non-randomised study.EVLT combined with PCCS can effectively reduce the recurrence rate after the treatment of great saphanous vein incompetence.
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Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1-3N0 gastric cancer.Methods One hundred and twenty patients with stage pT1-3N0 gastric tumors were included,and 2 106 lymph nodes were harvested and examined in all the specimens.There were 9-28 lymph nodes with average 18 lymph nodes from each patient.All the lymph nodes were negative by HE staining.The CK20 expression of lymph nodes was tested by immunohistochemistry.The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed.Results The positive expression rate of CK20 was 9.07%(191/2 106)in lymph nodes and 26.67%(32/120)in patients with pT1-3N0 gastric cancer by immunohistochemistry.Eleven cases were with micriometastasis,21 cases were isolated tumor cells(ITC).The average postoperative follow-up was 66.35(range 24-121)months.Five-year disease free survival rates were 87.4%,78.3%,and 40.9% for the lymph node negative,ITC,and micrometastasis groups,respectively.Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group(P=0.000)and ITC group(P=0.046).However,there was no significant difference between the lymph node negative group and ITC group(P=0.253).Multivariate analysis identified tumor diameter(P=0.011),depth of tumor invasion(P=0.043),and lymphatic vessel invasion(P=0.002)were related with CK20 positive expression.There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates.Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi),the restage rate was 9.17%.While the lymph node negative(88 patients)and ITC(21 patients)were recorded pN0(i-)and pN0(i+),respectively,and were not recommended restage(stage pN0).Conclusion Patients with stage pT1-3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate,for whom adjuvant therapies may be justified and effective.
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Objective To study the safety, reasonableness and feasibility of D 3 lymphadenectomy(LC) for advanced right colon cancer(ARCC). Methods 97 cases of ARCC were divided randomly into two groups: D 2.LC group (55cases) and D 3 LC group (42cases). The climical data between D 3 LC and D 2LC were compared. Results Comparing to D 2 LC,D 3 had higher operative invasive degree, but the incidence of postoperative complications did not increase, the ratio of the curable resection and the three-year and five-year survival rate after operation were significantly higher (88.1% and 73.8% vs 72.8% and 52.7%) (all P