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Objective To investigate the clinical features of hypopituitarism with nonalcoholic fatty liver disease (NAFLD) in children after sellar tumor surgery and the association between hypopitarism and NAFLD in children. Methods A retrospective analysis was performed for the clinical data of children with hypopituitarism and NAFLD after sellar tumor surgery who were followed up regularly in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2017 to December 2021, and their clinical features were analyzed. Results There were 32 children with regular follow-up and complete clinical data after sellar tumor surgery, and 10 children (31.25%) developed NAFLD, among whom there were 5 boys and 5 girls. Among these 10 children, 9 had craniopharyngioma and underwent surgical treatment, and 1 had germinoma and underwent local radiotherapy. The 10 children had a median age of 8.4(6.29.8) years at the diagnosis of hypopituitarism and a median age of 11.9(8.7-12.6) years at the diagnosis of NAFLD. The median number of years from the diagnosis of hypopituitarism to the diagnosis of NAFLD was 2.0(1.4-4.0) years. At the diagnosis of NAFLD, all 10 children had obesity, and body mass index (BMI) was increased by 7.26±4.25 kg/m 2 on average since the diagnosis of hypopituitarism; the 10 children had a mean fasting blood glucose level of 4.67±0.55 mmol/L, a mean fasting insulin level of 25.40±5.93 μIU/ml, and a mean HOMA-IR index of 5.26±1.29. Among these 10 children, 9 had hypertriglyceridemia, and 1 had elevated triglyceride, with a mean level of 3.08±1.09 mmol/L; 6 children had hypercholesterolemia, with a mean level of 5.67±1.25 mmol/L; 8 children had high-density lipoprotein cholesterolemia, with a mean level of 3.97±1.27 mmol/L. After the diagnosis of NAFLD, 2 children were treated with recombinant human growth hormone and metformin and achieved reductions in BMI, HOMA-IR, and triglyceride after treatment, and total cholesterol and low-density lipoprotein cholesterol were reduced to the normal range. Conclusion Children may experience weight gain, hypopituitarism, insulin resistance, and dyslipidemia after sellar tumor surgery, which may lead to the onset of NAFLD. Weight management and active pituitary hormone replacement therapy are recommended for such children, as well as routine screening and management of fatty liver disease.
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Objective To discuss the Etiological Distribution of COPD patients and explore the potential influencing factors of COPD infection. Methods From January 2018 to January 2021, 134 patients with concurrent pulmonary infection and 131 patients without any infection were selected from all 295 patients with COPD treated in our hospital. A total of 265 patients (30 patients with accidental pulmonary infection and other organ system infection, which did not meet the inclusion and exclusion criteria of this study, were excluded). The study collected the basic information of subjects and the information of potential factors affecting pulmonary infection. SPSS statistical software package was used to analyze the research data. Firstly, the etiology of patients with COPD infection (134 cases) was further analyzed to explore the distribution characteristics of etiology. At the same time, the related conditions of COPD patients with infection (134 cases) and patients without any infection (131 cases) were compared and analyzed to explore the related factors affecting COPD patients with pulmonary infection. Results A total of 149 bacterial strains were detected in this study. Gram-negative bacteria accounted for a higher proportion of lung infection (97/149 , 65.10%), gram-positive bacteria 50 strains (50/149 , 33.56%), and other (fungi, etc.) 2 strains (2/149 , 1.34%). Gram-negative bacteria included acinetobacter baumannii (53/149 , 35.57%), Klebsiella pneumoniae (25/149 , 16.78%), Pseudomonas aeruginosa (16/149 , 10.74%) and Escherichia coli (3/149 , 2.01%). Gram-positive bacteria included staphylococcus aureus (24/149,16.11%), Staphylococcus superficial (13/149 , 8.72%), Staphylococcus haemolyticus (9/149 , 6.04%), and streptococcus pneumoniae (4/149,2.68%). Compared with chronic obstructive pulmonary disease (134 cases) and without any infection (131 cases), it was suggested that the proportion of patients aged >60 years, smoking history, type 2 diabetes mellitus, mechanical ventilation and antibiotics use time was >15 days (P60 years, smoking history, type 2 diabetes mellitus, and >15 OR duration of antimicrobial use were all risk factors, and all of them had P<0.05. Conclusion Gram negative bacteria are the main pathogens of lung infection in COPD patients. The risk of lung infection is higher in patients with high age, smoking history, type 2 diabetes and long time use of antibiotics, which is worthy of clinical attention.
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4K laparoscopy brings opportunities and challenges to the development of rectal surgery. 4K laparoscopy can truly provide the structure of abdominal and pelvic fascia, so that surgeons can see more subtle anatomical structure. The clear and real picture under 4K laparoscopic system can reduce visual fatigue of surgeons, which make the operation easier and safer. Radical resection of right colon cancer includes complete mesocolic excision and D 3 lymphadenectomy. Through 4K laparoscopic system, surgeons can easily observe the fascia structure of right mesocolon and its mesenteric bed, distinguish the vascular anatomical relationship at the mesenteric root, which make D 3 lymphadenectomy safer with dissection of lymph nodes completely. The authors comprehensively analyze the related research progress at home and abroad, and systematically elaborate the region of dissection and significance of 4K laparoscopic right hemicolectomy for right colon cancer.
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Digestive tract reconstruction with side-to-side esophagojejunostomy is one of the most commonly used digestive tract reconstruction methods after laparoscopic total gastrectomy. It does not need an auxiliary incision. The linear stapler is used to directly enter the abdominal cavity through the Trocar to perform side-to-side anastomosis of esophagojejunostomy. The common hole can be closed by hand suture or linear stapler. 4K laparoscopy can present a clearer and more realistic view to the operators, so as to realize side-to-side esophagojejunostomy more accurately, to reduce the postoperative anastomo-tic related complications and improve the safety of the operation. This article will elaborate the technical key points and difficulties of esophagojejunostomy in 4K laparoscopic total gastrectomy, as well as the prevention and treatment of anastomotic related complications.
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Laparoscopic radical surgery for rectal can-cer involves total mesorectal excision (TME), D 3 lymphadenectomy, and pelvic autonomic nerve preservation, the goal of which is trying to achieve completely radical cure for cancer and urogenital function preservation. In the actual operation procedure, the understanding of fascial anatomy in abdominal and pelvic cavity will help us to improve the quality of TME surgery for rectal cancer and to preserve the pelvic autonomic nerves. When entering the pelvic cavity, the identification of fascia propria of mesorectum, visceral fascia, pre-hypogastric nerve fascia, presacral fascia, ligament structures around the rectum and the Denonvilliers′ fascia in front of the rectum will help us to protect the pelvic autonomic nerves and avoid surgical injury. So the authors focus on how to identify the pelvic fascia structure clearly in laparoscopic radical resection for rectal cancer, furthermore, to master the concepts of fascia anatomy to realize TME for rectal cancer and to achieve pelvic autonomic nerve preservation.
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Objective:To investigate the effect of automated nested multiplex PCR system in the detection of children with severe community-acquired pneumonia(CAP), and identify the pathogenic infection of the children with severe CAP in Foshan.Methods:Children with severe CAP, who were admitted to the PICU at Foshan First People′s Hospital from January 2016 to December 2018, were enrolled in the analysis.Nasopharyngeal secretions were collected.And automated nested multiplex PCR was used to detect adenovirus, coronavirus (HKUl type, NL63 type, 229E type, 0C43 type), human metapneumovirus, influenza A virus (H1 subtype, H1-2009 subtype, H3 subtype), influenza B virus, parainfluenza virus (type 1, type 2, type 3, type 4), respiratory syncytial virus, Bacillus pertussis, Chlamydia pneumoniae and Mycoplasma pneumonia.Results:Among the 290 specimens detected by the automated nested multiplex PCR, 246(84.83%) were positive.There were 166 positive samples for a single pathogen, 60 positive samples for two pathogens, 17 positive samples for three pathogens, and three positive samples for four pathogens.Among the virus-positive cases, respiratory syncytial virus was the most common pathogen in children younger than 6 months(62.39%, 73/117). The most common pathogen was human rhinovirus/enterovirus(43.48%, 20/46) from seven months to one year old.Adenovirus(37.50%, 18/48) was the most common pathogen among children aged one to three years old.Rhinovirus/enterovirus(35.00%, 7/20) was the most common pathogen among children aged three to six years old.The most common pathogen in children over six years old was influenza virus(46.67%, 7/15). The adenovirus detection rate was highest in May, the syncytial virus detection rate was highest in August, and the influenza virus detection rate was highest in July.Mycoplasma pneumoniae and pertussis were distributed throughout the year.Conclusion:The automated nested multiplex PCR system can detect multiple pathogens efficiently, quickly and accurately; the common pathogens of severe CAP are diverse in different age groups; the epidemic season of common pathogens is unique in different regions due to different climates.
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Digestive tract reconstruction with side-to-side esophagojejunostomy is one of the most commonly used digestive tract reconstruction methods after laparoscopic total gastrectomy. It does not need an auxiliary incision. The linear stapler is used to directly enter the abdominal cavity through the Trocar to perform side-to-side anastomosis of esophagojejunostomy. The common hole can be closed by hand suture or linear stapler. 4K laparoscopy can present a clearer and more realistic view to the operators, so as to realize side-to-side esophagojejunostomy more accurately, to reduce the postoperative anastomo-tic related complications and improve the safety of the operation. This article will elaborate the technical key points and difficulties of esophagojejunostomy in 4K laparoscopic total gastrectomy, as well as the prevention and treatment of anastomotic related complications.
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Objective To investigate and analyze the similarities of allergens in children of the same family with susceptibility to the same genetic background and environmental factors. Methods From January 2013 to December 2017,a total of 142 pairs of children with allergic diseases aged 0-15 years and their siblings ( 284 cases) were collected from the outpatient or hospitalized treatment of Pediatrics and otolaryngology department of the First People′s Hospital of Foshan City,the Third Affiliated Hospital of Sun Yat-sen University. The elder group was brother or sister (142 cases),and the younger group was brother or sister ( 142 cases ) . The serum allergen sIgE was tested by Allergy Screen allergen detection system (developed by Germany MEDIWISS Company) and the similarity of allergens was analyzed. Results A total of 142 siblings ( 284 cases ) had systemic symptoms of allergic diseases in varying degrees, including respiratory symptoms ( cough ( 47 cases in the old group,32 cases in the young group), χ2 ＝3. 946, P＝0. 047),nasal obstruction ( 41 cases in the old group,19 cases in the young group, χ2 ＝ 10. 227, P ＝0. 001),runny nose (46 cases in the old group,26 cases in the young group,χ2＝7. 442,P＝0. 006), gastrointestinal symptoms (abdominal pain (11cases in the old group,7 cases in the young group,χ2＝4. 63, P＝0. 031),skin symptoms(urticaria (18 cases in the old group,8 cases in the young group,χ2＝4. 234,P＝0. 037)) and so on,the difference was statistically significant. Some children have multiple organ system symptoms at the same time. There was no significant difference between the old group and the young group in the early use of antibiotics,mode of production and feeding mode within 6 months (all P＞0. 05). Among the two groups,house dust mite and cockroach (r＝0. 831,P＜0. 05),dog hair and house dust ( r＝0. 717,P＜0. 05),cypress,elm,willow,birch,oak,maple,walnut,sycamore,poplar and Dianqing,branching,yanqu, and heiqu ( r ＝ 0. 683, P＜ 0. 05 ) . Conclusion With the same genetic background and the same environmental factors,the allergens in siblings are similar.
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Single-port and reduced-port laparoscopic radical gastrectomy as the innovative surgery for gastric cancer are gradually accepted nowadays,and more attentions are also paid to single-port and reduced-port laparoscopic radical gastrectomy due to its better cosmetic effect,less pain,lower incidence rate of surgical site infection and more advantages in enhanced recovery after surgery.However,in the early stage,the development of single-port and reduced-port laparoscopic radical gastrectomy were facing challenges and obstacles on account of limited surgical skills,the lack of special laparoscopic instruments,laparoscope and multi-port Trocar.In recent years,the dilemma and difficult situations were gradually resolved following by surgical techniques innovation,laparoscopic instruments and facilities improvement.It is believed that single-port and reduced-port laparoscopic radical gastrectomy will have a good prospect and breakthrough in the field of gastric cancer treatment in the future.
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Objective:To discuss the clinic features and diagnosis of one case of hepatic angiomyolipoma (HAML) , and to analyze and summarize its diagnosis and treatment methods.Methods:The clinical materials of one case of HAML patient who was misdiagnosised as hepatocellcular carcinoma were analyzed retrospectively, and the related literatures were reviewed.Results:A middle-aged female patient visited our outpatient service because of low back discomfort.The upper abdominal CT and MRI suggested that a space occupying lesion located at the left lobe of liver inner lower segment, considering a high possibility of hepatocellular carcinoma.The patient underwent the left lobe of inner lower segmentectomy.The postoperative histopathological examination and immunohistochemical staining showed the tumour was HAML, After operation, the patient recovered well and the follow-up examination after hepatectomy found no tumor recurrence.Conclusion:HAML has no specific clinical characteristics or imaging features.The diagnosis of HAML mostly depend on the histopathological examination and hepatectomy is the effective treatment.
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Objective:To evaluate the cognitive level of nursing professionalism quantitatively and analyze its influencing factors, so as to provide research evidences for improving nursing professionalism. Method:A question-naire survey was conducted among 741 nurses from 7 public class A tertiary hospitals in Guangdong and Hubei Province. Descriptive statistics and multiple stepwise linear regressions were adopted using total score and scores of five dimensions of nursing professionalism scale as dependent variables. Results: Total score of professionalism cognitive level was (83. 41 ± 8. 75). The five dimensions of participation in professional organization, public health philosophy, peer review philosophy, professional sense of mission and autonomy were(16. 04 ± 2. 64), (17. 25 ± 2. 89), (16. 93 ± 2. 45), (17. 82 ± 3. 13), (15. 38 ± 2. 58), separately. There were mainly 5 factors influencing nursing professionalism cognitive level, namely gender, admission volunteer, first academic qualifications, employ-ment type, and whether receiving nursing award in past 3 years. Conclusion:Cognitive level of nursing profession-alism of sample nurses in 7 class A tertiary hospitals is similar to that of American nurse, but lower than that of Ko-rean - American nurses. And it is related to basic demographic characteristics, education background, practice status, enthusiasm of participating in the professional activities.
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To discover the nephroprotective substances from Huangkui capsule.The components of Huangkui capsule were isolated by preparative liquid chromatography, and the active components were screened by LC/MS and identified. The adriamycine-injured HK-2 cells were treated with various active components with different concentrations, and the malonaldehyde (MDA) content, adenosine triphosphate (ATP) level and mitochondrial oxygen consumption rate were measured to verify the protective activity of the compounds.Four active components in Huangkui capsule were identified to exert nephroprotective effects. Fifteen flavanoids from these four components were tentatively identified by LC/MS, and hyperin, myricetin, quercetin, rutin and isoquercetin were confirmed. Hyperin, myricetin quercetin and rutin showed dose-dependent protective effects on injured HK-2 cells. Espacially, hyperin significantly reduced MDA content, quercetin and rutin significantly increased ATP level, and myricetin significantly increased mitochondrial oxygen consumption rate.Hyperin, myricetin, querctein and rutin might be the potential nephroprotective compounds in Huangkui capsule, their effects may be related to the inhibition of lipid peroxidation and the alleviation of mitochondrial damage.
Subject(s)
Abelmoschus , Chemistry , Adenosine Triphosphate , Metabolism , Cell Line, Transformed , Chromatography, Liquid , Doxorubicin , Drugs, Chinese Herbal , Epithelial Cells , Flavonoids , Pharmacology , Kidney Diseases , Drug Therapy , Kidney Tubules, Proximal , Lipid Peroxidation , Malondialdehyde , Metabolism , Mass Spectrometry , Mitochondria , Oxygen Consumption , Protective Agents , Chemistry , Pharmacology , Quercetin , Pharmacology , Rutin , PharmacologyABSTRACT
Objective The variation of serum thyroid hormones within the euthyroid range may be associated with insulin sensitivity.The study was to investigate whether the variation of thyroid hormones within the euthyroid range could influence insulin sensitivity in elderly patients with type 2 diabetes mellitus (T2DM). Methods 200 elderly inpatients and outpatients with type 2 diabetes were collected from September 2013 to May 2014 in our hospital for T2DM group.150 normal controls with normal glucose metabolism were taken as the control group.Blood samples were collected after 75g oral glucose tolerance test(OGTT) on all the re-search objects.Questionaire survey, physical examination and related metabolic index test were also done on them .Chemilumines-cence method were applied to detect their insulin, thyroid stimulating hormone(TSH), FT3 and FT4. Results FT3 levels were significantly lower in T2DM group than in control group[(4.05 ±0.27 )pmol/L vs (4.61 ±0.5)pmol/L), P<0.05].TSH levels were significantly higher in T2DM group than in control group[(2.75 ±1.07) IU/mL vs (2.28 ±0.89) IU/mL, P<0.05], while there was no significant difference as to FT4 levels between these two groups.All subjects were divided into three groups according to the tertiles of FT3 level, Matsuda index of high FT3 level group were significantly higher in comparison to middle and low FT3 level groups, while there was no significant difference as to HOMA-IR in the three groups.FT3 levels were negatively correlated with HO-MA-IR and positively correlated with Matsuda index .After stepwise regression analysis, there was significant positive association be-tween FT3 and Matsuda index. Conclusion Thyroid hormone especially FT3 is significantly associated with insulin resistance .FT3 may participate in the development of type 2 diabetes, which pro-vides a new treatment for T2DM.
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[Summary] The effects of lipid components on insulin secretion in patients with type 2 diabetes(T2DM) and control subjects were explored. The results demonstrated that in control group, disposal index( DI)0 was positively correlated with high density cholesterol(HDL-C), while DI30 was negatively correlated with total cholesterol(TC), triglycerides( TG) and low density cholesterol ( LDL-C), and DI120 was also negatively correlated with TC and LDL-C. In T2DM group, DI0 was negatively correlated with TC and LDL-C, DI30 was negatively correlated with TC, TG, LDL-C and TG/ HDL-C, DI120 was negatively correlated with TC, TG, LDL-C and TG/ HDL-C.
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Objective To explore the clinical value of serum procalcitonin (PCT)-based antibiotic therapy in the second-classedexacerbations of chronic obstructive pulmonary disease (AECOPD). Methods 240 patients diagnosised as AECOPD were randomized to the PCT group and the control group. Serum PCT levels of patients from the PCT group were measured 1 h after hospitalized and the third, fifth, eighth day respectively. When PCT < 0.1 μg / L, patients will stop taking antibiotics and initiated while PCT≥0.1 μg / L. Antibiotic treatment in the control group was based on guidelines of COPD diagnosis and treatment. Results Duration of antibiotic therapy and hospitalization were respectively 5.6 ± 1.4 and 8.2 ± 1.1 days in the PCT group, 9.2 ± 2.2 and 11.4 ± 2.5 days in the control group (both P < 0.05). Mean costs of hospitalization expensesand antibiotic therapy were 5700 ± 201 and 1650 ± 189) yuan in the PCT group, 6210 ± 220 and 2350 ± 210 yuan in the control group (both P < 0.05). The clinical effective rate, times of exacerbation, one-year ΔFEV1, the 1-year hospitalization rate and time to next exacerbation all showed no significant differences between the two groups. Conclusion PCT-guided antibiotic treatment reduces antibiotic use inthe second-classed acute exacerbations patients.
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Objective To investigate the efficacy of high-dose ambroxol in elderly patients with aspiration pneumonias. Methods Totally 62 patients aged 65 years and over with aspiration pneumonia were enrolled into 2 groups:conventional-dose group intravenously given ambroxol 60 mg/d (n=30) and high-dose group received 270 mg/d (n=32).The times of remission and fever disappearance,rate of adverse effects,average duration of hospitalization,rates of mortality and recurrence within 2 months were observed. Results There were no significant differences in clinical charecteristics between the two groups.The times of remission and fever disappear ance and average duration of hospitalization were lower in high-dose group than in conventional-dose group [(3.2±0.6)d,(54.2±19.5)h,(12.7±4.1) d vs.(3.8±1.1)d,(66.5±18.4)h,(13.5±3.1)d,t=2.11,2.36,2.04,all P＜0.05].No differences were found in rates of mortality and recurrence within 2 months between the two groups (6.3％,3.1％ vs.10.0％,13.3％,x2=0.01,0.87,both P＞0.05).Adverse effects did not appear in the two dose groups. Conclusions High-dose ambroxol is efficient and safe for aspiration pneumonia in elderly patients.
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Objective To investigate the roles of Arsenic Trioxide to the lupus nephritis in MRL/ lpr mice and the effect on the expression of TGF-pl in the renal tubule. Methods 45 MRL/lpr mice were chosen for such experiment, then separated in 3 different groups, including arsenic trioxide ( ATO) group, cyclophosphamide (CYC) group and sodium chloride (NS) group. Urine of these mice was kept after the treatment to detect the urine protein levels. The pathological changes and the expression of IgG were observed , and the complement 3 of the nephridial tissue as well as the TGF-pl were detected by immunohisto-chemistry. Result The levels of urine protein in ATO group and CTX group were lower than NS group after the treatment ( P <0.05). The expression of IgG along the glomerular mesangium and capillary loop in ATO and CTX groups was less than NS group ( P <0.05). The expression of C3 had no significant difference within three groups ( P > 0.05). The glomcrulus spherulous cells and the integral of activity in ATO group and CTX group were less than that in NS group ( P <0.05). TGF-β1 wildly presented in the epithelial cells endochylema of the nephric tubule, but it was rarely seen in glomcrulus in NS group. The expression in the nephric tubule of ATO group was less than NS group (20.28 ± 1. 90 vs 68. 23 ± 2. 87, P < 0.01) , and the expression in the nephric tubule in CTX group was less than that in NS group (23. 26 ± 1.71 vs 68. 23 ±2. 87, P <0. 01). Conclusion TGF-pl may take part in the immunopathogenesis of lupus nephritis in MRI/lpr mice. ATO can relieve the inflammation of nephric tubule by down regulation the expression of TGF-β1. ATO can also relieve the tissue damage of kidney in lupus nephritis through reducing the inflammation of glomcrulus and interstitial substance,as well as the expression of the immunocomplex.
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Objective To discuss the diagnostic value of the examination of serum NAG, AFU, PAB, LAP, ASTm, GLDH,ADA and AFP in patients suffering from liver diseases.Methods Serum of 274 hepatitis cases and 30 healthy cases are examined with auto biochemical analyzer and analyzed statistically.Results The mean values of LAP, ASTm, GLDH, ADA and AFU in acute hepatitis patients are higher than health′s significantly, AUC of AFU,LAP and ASTm are 0.842,0.816 and 0.782 separately, positive rate of AFU,LAP and ASTm are 84.2%,95% and 80% separately; The mean values of ADA、AFU and NAG in liver cirrhosis patients are higher than health′s significantly while the mean value of PAB is lower significantly, AUC of ADA is 0.689, positive rate of ADA is 89.5%; The mean values of ADA and NAG in severe hepatitis patients are higher than health′s significantly while the mean values of PAB and AFU are lower significantly, AUC of PAB and AFU all is 0.861, positive rate of PAB and AFU is 100% and 52.1%; The mean values of LAP,AFP,NAG,ADA and AFU in liver cancer patients are higher than health′s significantly while the mean value of PAB is lower significantly, AUC of LAP and AFU is 0.697 and 0.653 separately, positive rate of LAP and AFU are 74% and 79.5% separately.Conclusions AFU、LAP and ASTm are valuable markers for diagnosing of acute hepatitis, ADA is a valuable marker for diagnosing of liver cirrhosis, PAB and AFU are valuable markers for diagnosing of severe hepatitis, LAP and AFP are valuable markers for diagnosing of liver cancer.
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Objective: Insulin glargine is a new long-acting basal insulin analogue.Glimepiride is an anti-diabetic drug with action independent of the pancreas.In this study,the efficacy and safety of glargine plus glimepiride in the treatment of elderly diabetic patients were evaluated.Methods: Sixty-five elderly diabetic patients were randomly assigned to receive Neutral protamine hagedorn insulin(NPH) plus glimepiride(n=19),and glargine plus glimepiride(n=21).The dose of insulin was adjusted according to the fasting blood glucose(FBG) level,with the target FBG