ABSTRACT
Objective:To observe the changes of skeletal muscle indexes in elderly patients with type 2 diabetes complicated with sarcopenia treated with sitagliptin and acarbose.Methods:A total of 60 patients over 60 years old with type 2 diabetes complicated with sarcopenia in Dalian Municipal Central Hospital from January 2019 to January 2020 were selected and divided into two groups by random number table method.One group received sitagliptin and metformin,and the other group received acarbose and metformin. The changes of skeletal muscle indexes, glucagon-like peptides-1 (GLP-1), insulin resistance index (HOMA-IR) and inflammatory indexes were compared between the two groups at baseline and 36 weeks after treatment.Results:After treatment, the skeletal muscle index (SMI) of sitagliptin group was increased (5.94 ± 1.52 vs. 5.99 ± 1.52), and the difference was statistically significant ( P<0.05). Muscle strength and SMI decreased in acarbosse group (18.75 ± 4.64 vs. 17.72 ± 4.44, 6.09 ± 1.74 vs. 6.00 ± 1.71), with statistical significance ( P<0.05). GLP-1 increased in sitagliptin group, 0 min: (10.65 ± 1.68) pmol/L vs. (12.41 ± 1.88) pmol/L; 60 min: (22.79 ± 2.85) pmol/L vs. (25.51 ± 2.79) pmol/L; 120 min: (24.26 ± 2.94) pmol/L vs. (29.49 ± 2.91) pmol/L; 180 min: (11.68 ± 1.84) pmol/L vs. (12.88 ± 1.83) pmol/L. There were significant differences ( P<0.05). HOMA-IR and CRP decreased: 4.73 ± 3.04 vs. 3.16 ± 2.41, (2.39 ± 0.50) mg/L vs. (2.33 ± 0.43) mg/L, and the differences were statistically significant ( P<0.05). HOMA-IR in acarbose group decreased after treatment (5.80 ± 3.94 vs. 4.00 ± 1.63), and the difference was statistically significant ( P<0.05). Comparison between the two groups after treatment, the decreased value of muscle strength in sitagliptin group was less than that in acarbose group, and the difference was statistically significant ( P<0.05). GLP-1 and overall GLP-1 area under the curve in sitagliptin group were higher than those in acarbose group (67.64 ± 6.81 vs. 58.98 ± 6.72), with statistical significance ( P<0.05). HOMA-IR and CRP in sitagliptin group were lower than those in acarborose group: 3.16 ± 2.42 vs. 4.00 ± 1.63, (2.33 ± 0.43) mg/L vs. (2.41 ± 0.70) mg/L, with statistical significances ( P<0.05). Conclusions:Sitagliptin therapy improves muscle mass and protects muscle strength in elderly patients with type 2 diabetes mellitus and sarcopenia.
ABSTRACT
【Objective】 To study and analyze the serological and viral charactereristics of hepatitis B virus(HBV) infection in voluntary blood donors in Qingdao. 【Methods】 315 520 blood samples of voluntary blood donors were screened by ELISA combined with nucleic acid testing (NAT). All HBsAg-/HBV DNA+ samples were subjected to high-precision viral load detection and five serological markers of HBV. The sequence of HBV S gene was detected by PCR direct sequencing, and virus genotypes and amino acid mutations were analyzed. 【Results】 A total of 604(0.20%)HBV ELISA or NAT reactive samples were detected: HBsAg+ /HBV DNA- in 307(0.10%) cases, HBsAg-/HBV DNA+ in 138(0.04%) and HBsAg+ /HBV DNA+ in 157(0.05%). Among the 138 HBsAg-/HBV DNA+ donors, 118(85.5%) carried anti-HBc, and 45 (32.61%) carried sole anti-HBc and 5 (3.62%) carried both HBsAg and anti-HBc. In viral load detection, 64 were quantitatively negative and 74 were quantitatively positive, of which 42 were HBV DNA 20 IU/mL. 13 HBsAg-/HBV DNA+ samples were successfully amplified and sequenced, and 5 were genotype B, presenting a total of 17 amino acid mutations without any deletion or insertion, and 8 were genotype C, presenting a total of 41 amino acid mutations and 2 amino acid deletions. 【Conclusion】 NAT, in combination of ELISA, provides additional safety in detecting potentially infectious HBV during the window period and occult HBV infection (OBI). The viral load was low in OBI infected donors, and anti-HBc+ was the main manifestation.The dominating HBV genotypes are genotype B and C, suggesting HBsAg amino acid mutations may be related to the formation of OBI.
ABSTRACT
【Objective】 To compare the detection performance of Cobas s201, a minipool(MP) nucleic acid test(NAT) system, and Panther, a individual donation(ID) NAT system, in blood donor screening. 【Methods】 NAT was conducted on 126 359 blood samples, and initially reactive (IR) samples were either discriminated or resolved by ID testing.The non-discriminated reactive (NDR) samples implicated in Panther sysytem were subjected to ID-NAT by Cobas s201. Some non-repeatable reactivet(NRR) and repeatable reactive (RR) samples implicated in Cobas s201 system were subjected to ID-NAT by Panther. 【Results】 61 MP-IR cases were implicated in a total of 85 128 samples that detected by Cobas 201, and 29(0.34‰) were RR after resolved by ID testing. 74(1.79‰)IR samples were implicated in 41 231 samples that detected by Panther, and 22 (29.73%) were DR-HBV after discriminatory test. Among the NDR 28 samples detected by Panther multiplex system, 7 were positive by Cobas s201 single sample (PP1) whereas non-reactive in simulated MPs of six by Cobas 201.In 28 RR samples resolved by Cobas 201, 24 positive and 4 negative samples were retested by Panther. Among the 11 samples presenting inconsistent retest results by Panther and Cobas 201, 10 were anti-HBc positive, carrying low viral load HBV. 【Conclusion】 The NAT-yield by Panther was significantly higher than that by Cobas s201. Some samples with negative discriminatory results were OBI, and it is necessary to further track and verify the unidentified samples. Cobas s201 is more suitable for a wide array of MP-NAT testing while Panther sample loading, which is flexible and easy to operate, is more suitable for ID-NAT with medium sample size.
ABSTRACT
Objective To summarize the CT imaging features of peritoneal metastasis of gastric cancer (GC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 78 GC patients with peritoneal metastasis who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to September 2016 were collected.All the patients underwent plain and enhanced scans of CT,and imaging data were converted to the multiplanar reformation (MPR) and maximum intensity projection (MIP).Observation indicators:(1) CT imaging features of primary lesion of GC;(2) CT diagnostic accurary and imaging features of GC with peritoneal metastasis;(3) CT imaging features of lymph nodes and other abdominal organ metastasis;(4) treatment and follow-up.Patients selected treatment plan according to results of laboratory and imaging examinations and patient's will.Follow-up using outpatient examination,telephone interview and correspondence was performed to detect the treatment method and patients' prognosis up to December 2016.The survival time was from post-treatment to death or end of follow-up.Measurement data with skewed distribution were described as M (range).Results (1) CT imaging features of primary lesion of GC:primary tumor location of 78 patients:tumor located in the antrum,leather bottle stomach,gastric cardia,lesser curvature,gastric antrum and body and greater curvature were detected in 40,11,9,9,5 and 4 patients,respectively.All the 78 patients were in T4 stage,including 43 with T4a stage and 35 with T4b stage.(2) CT diagnostic accurary and imaging features of GC with peritoneal metastasis:of 78 patients,57 were found with peritoneal metastasis by CT examinations before chemotherapy,15 with peritoneal metastasis by exploratory laparotomy or open surgery and 6 with peritoneal metastasis by follow-up CT re-examinations after gastrectomy.Seventy-two patients were diagnosed as GC with peritoneal metastasis by CT scans,and final diagnosis,missed diagnosis and overdiagnosis were detected in 78,9 and 3 patients,respectively.The precision,sensitivity,specificity,positive and negative predictive values of CT diagnosis were respectively 98.7％,88.5％,99.6％,95.8％ and 98.9％.Location and manifestation of 78 GC with peritoneal metastasis patients:① Peritoneal effusions:71 patients were accompanied with peritoneal effusions,including 21 with the slight peritoneal effusions and 50 with moderate and massive peritoneal effusions.② Greater omentum thickening:greater omnentum of 59 patients showed sheet,flocculent and nodular thickening,with a mass and cake-like change.③ Peritoneal thickening:54 patients had peritoneal thickening,with the main of nodulelike and thick lines-like thickening;thickening occurred mainly in around the liver,peritoneal cavity and pelvic floor;11 patients were found with obvious left anterior renal fascia thickening.④ Mesenteric thickening:46 patients were found with mesenteric thickening and edema,showing increased fat density with multi-node shadow.⑤ Lesser omentum and hepatogastric ligament:18 patients were found with increased fat density of lesser omental bursa,showing striped and nodular shadow.⑥ Transverse mesocolon:increased local fat density with striped-and nodular-like changes were seen in 15 patients after coronal and sagittal planes reconstruction,including 5 with local wall thickening of transverse colon.⑦ Ovary:8 patients had ovarian metastases,including 6 with bilateral metastases and 2 with unilateral metastasis;diameter of metastatic tumor was 3-12 cm.⑧ Intestinal canal:6 patients had local intestinal wall thickening,including 3 in small intestine and 3 in transverse colon,thickening tissues were mainly located in the mesentery,showing obvious intestinal wall enhancement.⑨ Liver capsule node:2 patients showed multi-node abnormal enhanced lesions under liver capsule.(3) CT imaging features of lymph nodes and other abdominal organ metastasis:78 patients were accompanied with lymph nodes enlargement,including 41 in N2 stage and 37 in N3 stage;liver metastases were detected in 13 patients;5 had adrenal metastases,including 3 with bilateral metastases and 2 with unilateral metastasis;4 had lower GC invading the pancreatic head and body;2 had upper GC invading the liver and spleen;1 had leather bottle stomach invading the pancreatic head and neck,and inducing to obstruction of biliary tract.(4) Treatment and follow-up:of 78 patients,62 underwent systemic chemotherapy,6 underwent systemic chemotherapy and intraperitoneal hyperthermic perfusion chemotherapy,5 underwent systemic chemotherapy and local radiotherapy and 5 underwent palliative operations due to gastrointestinal tract obstruction or bleeding.Of 78 patients,69 were followed up for 15 months (range,3-21 months),and 9 lost to follow-up.The median survival time of 69 follow-up patients was 12 months (range,3-19 months).Conclusions CT imaging features of peritoneal metastasis of GC show specific sites of metastasis and performance.Combining with CT axial images and images of coronal and sagittal planes reconstruction,adjusting appropriate window width and level would be benefit to observe primary lesions of GC and peritoneal metastasis.
ABSTRACT
Objective To analyze the blood screening results after adjustment of critical value 40 to 50 U/L and to observe the effect of reducing blood scrap rate and to discuss the correlation between ALT and HBV,HCV infection.Methods We screened 2656 blood donors (ALT >40 U/L)by serological and nucleic acid amplification testing(NAT)in Qingdao blood center from 2013 to 2014,and conducted the correlation analysis by chi square test.Results 1 771 cases (66.68%)were ALT 40-50 U/L,including 6 cases of HBsAg ELISA (+),2 cases NAT (+),4 cases NAT(-).In the 8 cases of anti-HCV ELISA (+)samples,4 cases NAT (+),3 cases NAT (-),1 case with positive TP without NAT result.In 885 blood donors with ALT>50 U/L,5 cases were HBsAg-reactive,7 cases were anti-HCV-reactive,and 873 cases were negative.Related statistics showed that there was no signifi-cant difference between ALT and HBV infection (P 0.05).Conclusion The proportion of blood donors with ALT 40-50 U/L is much higher than that with ALT >50 U/L do-nors.Adjustment of the critical value greatly reduces blood scrap rate.Elevated ALT is associated with the infection of HBV but not with HCV.
ABSTRACT
[Summary] The experience of diagnosis and treatment in a case of hypothyroidism with severe ascites and extremely elevated blood CA125 levle was summarized,the mechanism for severe ascites and extremely elevated blood CA125 were discussed,and the diagnosis clues and the main points of differential diagnosis were proposed.
ABSTRACT
0.05),but there was significant difference between group A and group C,the rate of hypoglycemia of group A was less than group C(P