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Objective:To analyze the rash characteristics and diagnosis and treatment process of measles infection in patients with diabetes mellitus and psoriasis, to reduce the clinical diagnosis and treatment delay of such patients.Methods:The clinical data of a patient with diabetes combined with psoriasis and measles infection who was diagnosed and treated in The First Hospital of Yulin in April 2015 were analyzed.Results:The patient was admitted to hospital due to polydipsia and polyuria for 3 years and fever for 3 days. Hypoglycemic and anti-inflammatory treatment after admission was not good. On the third day after hospitalization, rash on the trunk and the extremities was seen. The patient had a history of measles infection. Based on clinical practice, Measles morbillivirus infection was not excluded, and Measles morbillivirus infection was confirmed by pathogen inspection. Measles reinfection was considered to be caused by variation of Measles morbillivirus. The atypical rash formed because of the patient's need for long-term treatment with Acitretin capsule and capotriol for psoriasis. After adjusting the antibiotic treatment, hypoglycemia and antiviral therapy were given, the body temperature was normal and the rash gradually subsided.Conclusion:For patients with type 2 diabetes mellitus and psoriasis, if they have a fever, they should be considered comprehensively to guard against re-infection caused by measles virus mutation. Timely etiological diagnosis is performed to avoid missed diagnosis and delayed treatment.
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Objectives:To investigate the relationship between visceral adipose index and glomerular filtration rate in patients with type 2 diabetes mellitus.Methods:A total of 1 036 patients with type 2 diabetes mellitus who received treatment in The Second Affiliated Hospital of Xi'an Jiaotong University from May 2017 to May 2018 were included in this study. The visceral adipose index was detected using a bioresistance assay. These patients were divided into four groups using the quartile method: Visceral adipose index < 8.10 (q1 group, n = 246), 9.60 > visceral adipose index ≥ 8.10 (q2 group, n = 64), 11.10 > visceral adipose index ≥ 9.60 (q3 group, n = 423), visceral adipose index ≥ 11.10 (q4 group, n = 233). One-way analysis of variance was performed to compare the differences among groups. Partial correlation and multiple regression were used to analyze the correlation between body mass index, waist circumference, waist-to-height ratio, waist-to-hip ratio, body fat content, visceral adipose index, and urinary microalbumin and glomerular filtration rate. Results:With the increase in the visceral adipose index, the glomerular filtration rate gradually decreased. The glomerular filtration rate in the q1, q2, q3, q4 groups was (112.19 ± 31.74) mL·min -1·1.73 m -2, (106.14 ± 28.26) mL·min -1·1.73 m -2, (104.73 ± 23.63) mL·min -1·1.73 m -2, (103.40 ± 27.51) mL·min -1·1.73 m -2, respectively. In the female group, with the increase in visceral adipose index, the glomerular filtration rate decreased gradually. After controlling for age, sex, diabetes, and hypertension, the visceral adipose index was significantly correlated with the glomerular filtration rate ( r = -0.10, P < 0.001). Multiple regression analysis showed that visceral adipose index and waist-to-height ratio were closely related to glomerular filtration rate ( F = 6.00, P < 0.001). Conclusion:With the increase of visceral adipose index, body mass index, waist circumference, waist-to-height ratio, waist-to-hip ratio, body fat content, and urinary microalbumin increased gradually. When the visceral adipose index is greater than 9.60, the glomerular filtration rate is significantly decreased. Therefore, it is suggested to adopt various methods to evaluate obesity in clinical work, and visceral fat index should be paid more attention, especially when the visceral fat index is greater than 9.60.
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Objective To ummarized the clinical characteristics of lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,so to improve the physician's treatment ability by summary the clinical feature of lactic acidosis combined with hypoglycemic coma,diabetic ketosis and hyperkalemia.Methods Analyzed the clinical characteristics and disease development of one case with lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,and reviewed literature.Results The patient had hypoglycemia and acidosis at the same time due to taking phenformin and glibenclamide.After 2 days,the patient was better through correcting acidosis,intravenous fluid therapy,lowering blood potassium and controlling blood glucose.Conclusion Because acidosis caused the potassium transfer from intracellular to extracellular,the latter leads to hyperpotassemia,lactic acidosis caused by phenformin should be treated with intravenous fluid therapy,correcting acidosis.
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Objective:To explore the predictive value of serum thyroglobulin autoantibody (TgAb) for recurrence / metastasisin of thyroglobulin (TG)-negative and TgAb-positive patients with differentiated thyroid carcinoma(DTC) after thyroid ablation.Methods:The clinical data of 57 patients with DTC,undergoing complete resection of thyroid tissue,TG negative and TgAb positive,who were reviewed in Liaocheng People's Hospital during April 2013 to April 2015,were selected and divided into recurrence/metastasis group (n=20) and no recurrence/metastasis group (n=37).The TG and TgAb levels in the two groups were detected and compared by the electrochemical luminescence method,the sensitivity,specificity,positive predictive value and negative predictive value of TgAb in the diagnosis of DTC recurrence / metastasis were analyzed;the independent risk factors of DTC recurrence / metastasis were analyzed by Logistic regression.Results:The TgAb levels(72～3850 IU/mL) in the recurrence/metastasis group was higher than that(18～3638 IU/mL) in the no recurrence/metastasis group,the difference was statistically significant (P＜0.05).The sensitivity,specificity,positive predictive value,negative preictive value of TgAb in the diagnosis of recurrence/metastasis of DTC were 85.71％,83.33％,75.00％,90.91％,respectively.Logistic Regression analysis showed that the 100≤ TgAb ＜204 IU/mL,204≤ TgAb≤ 1000IU/mL,and ＞ 1000IU/rnL levels of TgAb were the independent risk factors of rucurrence/metastasis ofDTC (OR=1.267,2.853,6.791,P＜0.05).Conclusion:TgAb can be used as evaluation of an important index of the recurrence/metastasis of patients with DTC when serum thyroglobulin (TG) was negative and TgAb was positive after thyroid ablation.The higher the TgAb levels,the more probability of the recurrence/metastasis.
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Objective Waist-to-height ratio (WHtR), a measurement of the distribution of body fat, correlated with abdominal obesity indicating that it might be a better predictor of cardiovascular risk and metabolic disease.We, therefore, evaluated optimal WHtR cutoff points according to the risk of framingham risk score ( FRS ) and metabolic syndrome ( MS ) in Chinese .Methods The subjects were from China National Diabetes and Metabolic Disorders Survey during 2007 -2008.Receiver operating characteristic analysis was used to examine the optimal cutoff values of WHtR according to the risk of FRS and MS . Results A total of 27820 women and 18419 men were included in the evaluation .The average age was (45.0 ±13.7 ) years.The proportions of FRS ≥10% and MS increased with WHtR both in men and women.The cutoff points of WHtR for the risk of FRS ≥10%and MS were 0.51, 0.52 in men, and 0.52, 0.53 in women, respectively.When FRS ≥10% and MS were taken into consideration with a certain weights, the pooled cutoffs of WHtR were 0.51 in men, and 0.53 in women, respectively.By using the similar method, the optimized cutoff points were 0.52, 0.51, 0.50 for men and 0.51, 0.53, 0.54 for women in age group 20-39, 40-59 and ≥60 years, respectively.Conclusions The optimal cutoffs of WHtR are 0.51 in men, and 0.53 in women for FRS≥10% in combination with MS indicating that this WHtR cutoff points might be used as indexes to evaluate obesity and risk of obesity -related diseases .
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The data of 6 patients with tertiary hyperparathyroidism were retrospectively analyzed.The first symptom in 3 patients was bone ache,1 with lower extremity weakness,1 with swelling of lower limbs,and 1 with increase serum alkaline phosphatase.5 patients had past history of renal failure,1 case suffered from severe intestinal malabsorption,and 4 of them had renal transplantation.X-ray showed subperiosteal bone resorption,bone demineralization,or cellulose osteitis.5 subjects presented with osteoporosis,and 1 of them had fractures.Left atrioventricular membrane calcification and gluteal calcification were found in each of 2 cases.4 patients suffered from hypercalcaemia,2 patients with normal serum calcium,4 with hypophosphataemia,and 6 with high levels of PTH.Pathological results showed adenoma in parathyroid gland in 4 patients and enlarged parathyroid glands in 2 patients.Serum calcium and PTH levels returned to normal after operation and calcium supplement.
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Sixty-four patients with Graves' diseases were divided into methimazole group ( n =30 ) and propylthiouracil group( n =34 ).20 healthy volunteers were used as the control group.The levels of interleukin (IL) -2,IL-6,and TSH receptor antibody (TRAb) were determined by ELISA after serum samples were eollected before treatment and after treatment for 3 and 6 months.The results showed that the general data of two groups were not significantly different before treatment.IL-2 and IL-6 levels at 6 months after treatment were significantly different from the baseline (P＜ 0.05 ),IL-2 being gradually increased while IL-6 decreased with time.The level of IL-6 in methimazole group was lower than that in propylthiouracil group after treatment for 6 months ( P＜ 0.05 ).There was no significant difference in TRAb levels between two groups before treatment while differences became significant at 3 and 6 months of treatment ( all P＜ 0.01 ),being gradually decreased with time. IL-2/IL-6 ratio became significantly greater at 3 and 6 months of treatment compared with that before treatment in the same treatment group( P＜0.05 ) and the ratio in methimazole group was higher than that in propylthiouracil group by 6 months of treatment ( P＜0.05 ).IL-6level was positively correlated with FT3 and FT4 levels,and IL-2 level was negatively correlated with FT3,FT4,and TRAb levels in GD patients before treatment.The correlations of IL-2 and IL-6 with FT3 and FT4 disappeared by 3 and 6 months of treatment.IL-2 and IL-6 levels were related with TRAb level before and after treatment in methimazole group. These results suggest that the immunosuppressive effect of methimazole is more evident than that of propylthiouracil in patients with Graves' disease.
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Objctive:To investigate the immunohistochemical and morphological characteristics of the papillary thyroid microcarcinoma(PTM) ,and differential diagnosis of the related disease.Methods:The morphological characteristics of 223 patients with PTM were observed under light microscope.Seventy-four cases of PTM and 32 cases of proliferative lesion of thyroid were observed under light microscope with stains of hematoxylin and eosin and immunohistochemical staining.The antibody included CK19,MC,Galectin-3 and CD56.Results:Eighty-six cases were follicular-patterned and 31 cases nuclear features were untypical in 223 cases of PTM.The positive expression rates of CK19、MC、 Galectin-3、CD56 were 100.0%,98.6%,98.6% and 4.1% in 74 cases of PTM,and were 37.5%,12.5%,18.8%,68.8% in proliferative lesion of thyroid,respectively.Conclusion:Some cases of PTM show a follicular-patterned and the nuclear features.It is untypical compared with classical papillary thyroid carcinoma.It can be differentiated from proliferative lesion with absence of envelope,obviously various and unusually proliferated follicular cells,sclerotic stroma,neoplastic follicles among the collagen and normal follicles.The wide and intensive expression of CK19,Galectin-3,and the negative expression of CD56 are extremely useful in the diagnosis of PTM,four-marker panel with CK19,Galectin-3,MC and CD56 can improve the specificity and accuracy of the differential diagnosis of PTM.