A case of acute cholestatic jaundice after hormone treatment of Graves disease with upper respiratory tract infection / 中国综合临床

Cholestatic jaundice is rare in patients with Graves' disease and is generally considered to be a complication of Graves' disease or an adverse reaction to methimazole. We report a case of acute cholestatic jaundice caused by Graves' disease complicated with upper respiratory tract infection in Jinan Central Hospital. After timely treatment with glucocorticoid, the jaundice quickly subsided and the liver function gradually returned to normal. We believe that Graves' disease combined with upper respiratory tract infection can lead to cholestatic jaundice, the pathogenesis of which may be immune dysfunction, and glucocorticoid therapy is beneficial to the regression of jaundice.

Correlation between serum bile acid and glucose and lipid metabolism in type 2 diabetes patients with metabolic fatty liver disease / 中国综合临床

Objective:To analyze the correlation between serum bile acid and glycolipid metabolism in patients with type 2 diabetic mellitus (T2DM) and metabolically associated fatty liver disease (MAFLD).Methods:A total of 387 T2DM patients hospitalized in Jinan Central Hospital in Shandong Province from July 2020 to November 2021 were selected, including 140 T2DM patients (T2DM group) and 247 T2DM patients with MAFLD (T2DM with MAFLD group). Clinical data were collected of all patients for retrospective analysis and compare the differences in clinical datas in the T2DM group and the T2DM with MAFLD group. Analyze the influencing factors of T2DM with MAFLD. The serum total bile acid (S-TBA) of the T2DM with MAFLD group was divided into T1, T2 and T3 groups by the method of trisection. Triglyceride glucose index (TyG) and hemoglobin glycation index (HGI) were divided into low TyG group, high TyG group and low HGI group, high HGI group by their median values. The incidence of hyperlipidemia, degree of insulin resistance and glycosylated hemoglobin variation was compared among the three groups. To analyze the influencing factors of TyG and HGI. The measurement data conforming to the normal distribution were compared between two groups by independent sample t-test, the comparison between multiple groups by ANOVA, the comparison between two groups of measurement data not conforming to the normal distribution by Mann Whitney U test, and the comparison between multiple groups by Kruskal Wallis H test, χ 2 test was used for comparison of count data between groups. The influencing factors of T2DM with MAFLD and high HGI were analyzed by multivariate binary Logistic regression. The influencing factors of TyG were analyzed using multiple stepwise linear regression. Results:There was no significant difference between the S-TBA of T2DM group and T2DM with MAFLD group ( P>0.05). TyG ( OR=1.788, 95% CI: 1.223-2.614), superoxide dismutase (SOD) ( OR=1.019, 95% CI: 1.009-1.030) and VFA (visceral fat area) ( OR=1.021, 95% CI: 1.013-1.028) were risk factors for the occurrence of T2DM with MAFLD ( P values are 0.003, 0.001 and 0.001, respectively). The incidence of high TyG in T3 group (61.0% (50/82)) as higher than that in T1 group (40.0% (32/80)), the incidence of high HGI in T3 group (61.0% (50/82)) was higher than that in T2 group (41.2% (35/85)), the morbidity of hypercholesterolemia in T3 group (15.9% (13/82)) was higher than that in T2 group (4.7% (4/85)), the differences were statistically significant (χ 2 values were 7.13, 6.55, 5.67; the P values were 0.008, 0.011, 0.017). S-TBA, hepatic steatosis index (HSI) and VFA were independent influencing factors of TyG (the P values were 0.003, <0.001, <0.001). S-TBA ( OR=0.940, 95% CI:0.887-0.997) and fasting C peptide ( OR=0.454, 95% CI:0.219-0.940) were protective factors for the occurrence of high HGI (the P values were 0.039, 0.034). Conclusion:S-TBA was positively correlated with the degree of insulin resistance and incidence of hypercholesterolemia in patients with T2DM and MAFLD, negatively correlated with the degree of glycated hemoglobin variation.

Comparison of efficacy and safety of insulin aspart injection Rishulin and NovoRapid for treatment of diabetes: a multicenter, randomized, open-labeled, controlled trial / 中华内科杂志

Objective:To compare the efficacy and safety of Tonghua Dongbao′s insulin aspart injection (Rishulin) and NovoRapid (Novo Nordisk) in the treatment of diabetes.Methods:A 26-week, randomized, open-label, parallel-group, positive control drug and non-inferiority trial was conducted in 23 centers in China. A total of 563 diabetes with poor blood glucose control treated with insulin for at least 3 months before were included. The subjects were randomized(stratified block random method) into those receiving Rishulin or NovoRapid at a ratio of 3∶1. Both groups were combined with basal insulin (Lantus). The primary endpoint was the change in glycosylated hemoglobin (HbA1c) from baseline to the end of 24 weeks of treatment.Results:For full analysis set, after 24 weeks of treatment, HbA1c level of Ruishulin group decreased from (8.66±1.28)% to (7.77±1.09)% ( P<0.001), and that of NovoRapid group decreased from (8.47±1.28) % to (7.65±0.97) % ( P<0.001). Treatment difference in HbA1c (NovoRapid group-Ruishulin group) was -0.061% (95% CI -0.320-0.199). HbA1c<7.0% target reacing rates were 24.26% and 21.21% ( P=0.456), and HbA1c<6.5% target reacing rates were 9.65% and 6.82% ( P=0.310) in Ruishulin group and NovoRapid group, repectively. The standard 2 hours postprandial blood glucose (2hPG) in Ruishulin group decreased from (16.23±5.22) mmol/L to (12.65±4.57) mmol/L ( P<0.001), and 2hPG in NovoRapid group decreased from (16.13±5.37) mmol/L to (11.91)±4.21) mmol/L ( P<0.001). The fingertips blood glucose at 7-point of both groups exhibited varying degrees of reduction compared with those at baseline, repectively. Positive ratios of specific antibodies were 31.68% in Ruishulin group and 36.36% in NovoRapid group ( P=0.320). Ratios of negative to positive were 7.43% and 10.61% ( P=0.360), and ratios of positive to negative were 10.40% and 7.58% ( P=0.360) in Ruishulin group and NovoRapid group, respectively. The incidence of hypoglycemia was 60.05% and 55.40% ( P=0.371), and the incidence of adverse events was 76.60% and 77.70% ( P=0.818) in Ruishulin group and NovoRapid group, respectively. Conclusions:Rishulin is not inferior to NovoRapid, and has shown good efficacy and safety. It can be an ideal choice for clinicians in patients with poor blood glucose control with insulin.

A new strategy for diabetes management: time in target range of glucose / 中国综合临床

In our country, the prevalence of type 1 and type 2 diabetes is increasing year by year, while the glucose management of diabetic patients is indeed not satisfactory.Glycosylated hemoglobin, as an indicator of blood glucose management, has certain limitations.So, it is particularly important to explore other valuable evaluation indicators.Some studies found that, time-in-target-range of glucose is highly correlated with average blood glucose and has a linear negative correlation with glycosylated hemoglobin.Time in range(TIR) will be a key indicator for evaluating blood glucose compliance.In addition to blood glucose assessment, monitoring TIR can also reduce the frequency and duration of hypoglycemia in type 1 diabetes patients, improving the quality of life in type 1 diabetes patients.Besides that, TIR can also be used to assess the occurrence of microvascular and macrovascular complications in type 2 diabetes patients.Therefore, TIR is important for glucose management type 1 and type 2 diabetes patients.

A case of myocardial injury caused by allergy / 中国综合临床

Objective Urticaria,itchy skin,chest tightness,abdominal pain and anaphylactic shock are the common clinical manifestations of allergic reactions.In addition,the relevant literature indicates that allergies can cause coronary vasospasm or rupture of atherosclerotic plaque, leading to acute coronary syndrome,which is named Kounis syndrome.Here we report a case of a child admitted to the emergency departments with myocardial injury and ST depression on electrocardiography while a severe allergic reaction.The patient was discharged from the hospital after receiving anti?allergic and nutritional myocardial medication.I hope that we can learn more about Kounis syndrome through this case.

Effect of simvastatin on the expression of farnesoid X receptor in diabetic animal models of altered glucose homeostasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Statin therapy has affected glucose homoeostasis of type 2 diabetes patients, which could be related with bile acids metabolism. Whether bile acid metabolism and the expression of farnesoid X receptor (FXR), liver X receptor-α (LXR-α) and sterol regulatory element-binding protein (Srebp)-1c is regulated by hyperglycemia, or whether simvastatin therapy led to higher glucose is related with down-regulated expression of FXR in diabetic rats remained unclear.</p><p><b>METHODS</b>Forty male Wistar rats were randomly divided into four groups: normal control rats, insulin resistance rats, diabetic model rats, and the late simvastatin induced diabetic rats. Normal control rats were fed with standard diet, others were fed with high-fat diet. Diabetic model rats were induced by a single intraperitoneal injection of streptozotocin (STZ). The late simvastatin induced diabetic rats started simvastatin administration after STZ induced diabetic model rats. Characteristics of fasting blood glucose (FPG), lipid files and total bile acids (TBAs) were measured and the oral glucose tolerance test (OGTT) was performed after overnight fasting at the eighth weekend. RNA and protein levels of FXR, LXR-α and Srebp-1c were tested by Western blotting and reverse transcription polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>The insulin resistance rats showed higher glucose, lipid files and lower expression of FXR compared with normal control rats (P > 0.05). The diabetic model rats showed significantly higher glucose, lipid files, TBA and lower expression of FXR compared with insulin resistance rats (P < 0.05). The late simvastatin induced diabetic rats displayed higher glucose and TBA and lower expression of FXR compared with diabetic model rats (P < 0.05).</p><p><b>CONCLUSIONS</b>Changes in bile acid homeostasis, including the alterations of bile acid levels and bile acid receptors, are either a cause or a consequence of the metabolic disturbances observed during diabetic models. Statin therapy induced hyperglycemia may be related with FXR, SHP, LXR-α and Srebp-1 pathways.</p>

Repair of severely burned hand and wrist with abdominal thin skin flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the experience of repairing of severely burned hand and wrist with abdominal thin skin flaps in insertion pattern.</p><p><b>METHODS</b>Twelve burn patients with the dorsum of the hands and wrist being severely injured were enrolled in this report. The donor sites of the flaps were selected on the upper abdomen in 4 cases and on the lower abdomen in 8 cases. The division of the flap pedicles was done on the 10th - 13th postoperative days.</p><p><b>RESULTS</b>All the flaps survived except that there were two necrotic areas sized 2 cm x 2 cm and 1 cm x 1 cm, respectively, on the distal ends of the flaps in two cases. The hand function and contour recovered satisfactorily after the operation.</p><p><b>CONCLUSION</b>It could be an ideal choice for the repair of severely burned hand and wrist with abdominal thin skin flaps.</p>

Common Pathogens in Burn Wards and Their Drug Resistance / 中华医院感染学杂志

OBJECTIVE To know the pathogens distribution and resistance situation in the burn wards.METHODS A retrospective analysis was conducted to 627 pathogen isolates and sensitivity results,which submitted by burn department from May 2005 to May 2008.RESULTS Gram-negative(G-) bacilli occupied for 33.8%,Gram-positive(G+) cocci occupied for 48.8% and fungi occupied for 17.4%.Acinetobacter baumannii occupied for 8.6%,Pseudomonas aeruginosa occupied for 6.0%,Staphylococcus aureus occupied for 77.5%,in which the isolation rate of meticillin-resistant S.aureus(MRSA) was 94.9%.The drug sensitivity tests showed that various detectable bacteria possessed multi-drug resistance;G+ bacteria were sensitive to vancomycin,G-were sensitive to imipenem,but only A.baumannii was sensitive to cefoperazone/sulbactam.CONCLUSIONS The bacterial infection in the burn department in our hospital mainly is due to G+ cocci,then is G-bacilli,from which the A.baumannii detection rate is increasing.Clinicians should enhence to detect the sensitivity of bacteria and use antibiotics reasonably.