Objective To assess the economic efficiency of glycated haemoglobin(HbA1C)determination in screening the undiagnosed diabetes among hospitalised patients. Methods Exclusive criteria were made based on the information of the electronic patient history,including age<18 years,hospitalization for diabetes treatment, and having received a transfusion within half a year. Pathology samples from participants were collected for blood routine analysis and HbA1C screening test. Screening the undiagnosed diabetes was based on the level of HbA1C. Results In this study ,1012 patients were enrolled ,78 patients with diabetes ,and 934 patients haven′t been diagnosed before. Among the 934 patients ,HbA1C level of 51 patients was over 6.5%(48 mmol/mol). These 51 patients (5.46%) were determined to have previously unknown diabetes. The prevalence of undiagnosed diabetes was 5.46% during the study period. The cost of HbA1C test was ￥1098 per new diagnosis of diabetes. Conclusions HbA1C is a simple ,inexpensive screening test for diabetes ,which can significantly improve the diagnostic efficiency,and the early detection of diabetes can slow the progression of complication and reduce the medical care expenditures.

Objective To investigate the clinical efficacy of modified YV-plasty for refractory bladder neck contracture (BNC) caused by transurethral resection of prostate (TURP).Methods From June 2013 to March 2016,11 patients with BNCs secondary to TURP were included in this study.Their mean age was 63.7 years (range,56-73 years).All patients presented voiding difficulty and failed after 2 or more prior endoscopic treatments.Modified YV-reconstruction of bladder neck was performed,by incising the anterior wall of bladder neck in a T-shaped manner,and creating two well-vascularized and tension-free flaps,which offer the possibility to reconstruct a wide bladder neck.Results After a mean follow-up of 14.6 months (ranging 3-24 months),successful outcome was achieved in 9 patients without incontinence secondary by surgery.Recurrent voiding difficulty developed in 2 patients,which was cured after a following endoscopic treatment.Conclusion A wider bladder neck can be obtained through modified YV-reconstruction of bladder neck,while avoiding external urethral sphincter injury.It is an available option for refractory bladder neck contracture.

Objective To investigate the effect of ischemia/reperfusion(I/R) on tumor metastasis in a experimental mouse model of hematogenous metastasis after I/R; we also quantitated expression of matrix metalloproteinases-9 (MMP-9) during I/R.Methods An experimental mouse model of metastasis after partial hepatic I/R was designed to determine the effects of I/R on tumor metastasis to liver.Tumor loads were valued 7 days after operation.In addition,tissue analysis for alanine transaminase,aspartate transaminase (AST) and matrix metalloproteinases and 8 h reperfusion were performed.Results After 2 h hepatic reperfusion,ALT and AST in I 45 min group were higher than the sham group and I 30 min group (P ＜0.05).ALT and AST in the sham group were both a little higher than the normal.ALT and AST in the I 45 min group and I 30 min group at 8 h were both higher than those at 2 h reperfusion(P ＜0.05).The tumor load (valued by Hepatic replacement area) and the expression of MMP-9 in ischemic lobe in I 45 min group were greater than that after 30 min group and sham group.(P =0.013,P =0.007).There was no statistical difference on tumor load between the right lobe of sham operated mice and the right lobe (non-ischemic lobe) of mice subjected to I/R(P =0.089).Mouse survival were compared among the groups.Mice in Sham group lived longer than I 30 min group (P =0.041).And there were no statistical significance between I 45 min group and I 30 min group (P =0.055).MMP-9 expression in I 45 min group was higher than I 30 min group(P ＜ 0.001).Conclusion Hepatic I/R promotes liver hematogenic metastasis of hepatocellular carcinoma in mice through induction of MMP-9 expression.

Objective To explore the occurence,clinical characteristics and treatment of Mycoplasma pneumonia complicated with embolism in children.Methods Twenty-three cases with Mycoplasma pneumonia complicated with embolization were retrospectively analyzed from January 1990 to December 2012.Results The ages of cases were from 4 years old to 13 years old,and fifteen cases were male,eight cases were female.Nineteen cases with single-shot embolism included four cases of lower limb venous thrombosis,one case of internal carotid artery thrombosis,nine cases of cerebral infarction,two cases of cardiac infarction,two cases of splenic infarction,one case of pulmonary infarction; and the other four cases were multiple embolism,two cases combined pulmonary embolism and lower limb deep vein thrombosis,one case combined cardiac embolism and pulmonary embolism,one case combined internal carotid artery and the brain embolism.In addition,eight cases had temporary anti-cardiolipin antibody IgM,two cases combined protein C decrease,one case merge protein S decrease,and one case was lack of AT-Ⅲ.At last,two children died,the rest all recovered well after thrombolysis and anticoagulation therapy.Conclusion Mycoplasma pneumoniae has hypercoagulative state and potentialized to thrombosis,especially for children with high risk factors of thrombosis.Early diagnosis and anticoagulation and thrombolysis treatment actively is the key to better prognosis.

Objective To explore the clinical manifestations,imaging findings,pathological classification and treatment of congenital cystic adenomatoid malformation (CCAM)of the lung.Methods The clinical features,imaging findings,pathology information,diagnosis,treatment method and its prognosis of children with CCAMconfirmed by ope-ration and pathology were retrospectively analyzed in Yuying Children′s Hospital Affiliated to Wenzhou Medical Univer-sity from August 2006 to August 201 4.Results Eleven patients were boys and 4 patients were girls.One case had a-symptomatic clinical features,1 2 cases had pulmonary infection,1 case had recurrent chest pain,and 1 case had de-pressed deformity in sternum inferior segment.Chest CT scanning indicated that 9 cases had multiple gas cysts at unila-teral side of lung,among which 1 case was of funnel chest and pulmonary sequestration,1 case of huge cyst containing air and fluid at inferior lobe of left lung,and 4 cases of high density lung shadow;CT examination indicated that 1 case had recurrent chest pain and eventration of diaphragm of the right side combined with pulmonary sequestration.All ca-ses were treated by surgical resection,of whom 1 case was given cystectomy and sequestrectomy,diaphragmatic plication respectively,1 case complicated with funnel chest disease underwent lesion pulmonary lobectomy,sequestrectomy and minimally invasive corrective surgery in pectus excavatum (Nuss surgery),and the remaining 1 2 cases received lesion pulmonary lobectomy.All of 1 5 cases recovered well without complications.Pathological classification type of CCAMin-cluded 1 1 cases of type Ⅰ,3 cases of type Ⅱ and 1 case of type Ⅲ,among which 2 cases had pulmonary sequestration. Conclusions CCAMis a rare disease which can be discovered along with pulmonary infection.Multiple gas cysts are the most common imaging findings and the preoperative diagnosis of CCAM is mostly based on chest CT examination. Type Ⅰ and type Ⅱ are the most common pathological classification.The surgical resection should be given early surgi-cal resection and the prognosis is usually good.

Objective To investigate the changes of hypoxia-inducible factor(HIF)-1α and hexokinase-Ⅱ(HK-Ⅱ)expression in human esophageal squamous cell carcinoma and its effect in glycolysis.Methods TE13 cells and Eca109 cells were cultured under hypoxic condition(1 ％O2)for different hypoxic time(6,12,24 and 48 hours).Cells cultured under normal oxygen condition(20％O2)were set as control.The changes of HIF-1α and HK-Ⅱ expressions at protein level were detected by Western blot.HIF-1α genes were specifically silenced with RNA interference technology(RNAi),and then the changes of HIF-1α and HK-Ⅱ expression were determined by realtime PCR and Western blot.Under normal oxygen and hypoxic condition,the changes of lactic acid concentration in cell culture medium were detected by spectrophotometric method.Results Under hypoxic condition,the expression of HIF-1α and HK-Ⅱ gradually increased as hypoxic time extended(P＜0.05),reached a peak at 12h and then gradually decreased as time extended.Compared with that under normal oxygen condition,the expression of HK-Ⅱ in TE13 cells and Eca109 cells significantly increased under hypoxic condition(P＜0.05),which was more significant after 12 hours hypoxia.The result of realtime PCR indicated that under normal oxygen condition the expression of HIF-1α at RNA level in TE13/shRNA cells and Eca109/shRNA cells significantly decreased compared with TE13 cells and Eca109 cells without interference(P＜0.05).The expression of HK-Ⅱ at RNA level was consistent with the result of HIF-1α.Under normal and hypoxia condition,the expression of HK-Ⅱ at protein level in TE13/shRNA cells and Eca109/shRNA cells significantly decreased compared with TE13 cells and Eca109 cells without interference,and the difference was statistic significant(P＜0.05).The lactic acid secretion of TE13 cells and Eca109 cells under hypoxia condition(14.707 ± 3.594 and 15.062 ±3.901)was higher than that under normal oxygen condition(6.070±1.839 and 6.891±1.592,P＜0.05).The lactic acid secretion of TE13/shRNA cells and Eca109/shRNA cells significantly decreased compared with TE13 cells and Eca109 cells without interference,and the difference was statistic significant(P＜0.05).Conclusion The expressions of HIF-1α and HK-Ⅱ in human esophageal squamous cell carcinoma significantly increased under hypoxia conditions.The expression of HK-Ⅱ is closely correlated with lactic acid concentration and HIF-1α expression.HIF-1α may affect cell glycolysis through HK-Ⅱ.

Objective To explore the possibility and safety of ~(32)P-colloidal chromic phosphate interstitial injection.Methods Ten Beagle dogs were randomly divided into 5 groups (n ＝ 2) according to different doses (185 and 370 MBq) ,different sites (gluteus maximus and liver) and cold colloid as a control group.At different time-points after surgery,the weights of dogs were measured,and the blood and blood biochemical inspections were examined.ECT imaging was performed and histomorphology was observed dynamically.The radioactive counts of body surface for 90 days,blood for 12 weeks and urine and feces for 30 days were measured continuously.Measured data were expressed by mean ±standard error ((x) ±s) and SPSS 13.0 software was used for statistical analysis.Results ECT imaging demonstrated that the whole liver imaging was obtained although the radioactive distribution was uneven in liver groups,and the radioactivity concentrated continuously in the area of injection,but no liver imaging in muscle groups.Dogs in group 4 lost weight progressively and reduced by 2.7 kg till 45 d after operation.While the mean weight increments in the other groups were 3.0,1.6,0.8 and 3.1 kg in order.In group 4,PLT and RBC reduced obviously.Dogs died at 23 or 45 d.AST and ALT were elevated sharply before death.In the other groups,blood and blood biochemistry inspection showed there were no significant statistical differences.The highest radioactive counts after operation were obtained from the injection spot,while the urinary bladder and the spleen were followed.The peak of blood cpm in liver groups presented at 5 min.Peak values were 0.5 × 10~7/min and 1.0 × 10~7/min,respectively.The blood cpm in the muscle groups was always maintained at 3 × l0~5/min.Histology study showed the hyperemia dropsy changes in muscle groups and 185 MBq liver group in 4 weeks,while after 8 weeks the organizational structure restored normally.There were partial liver cells necrosis in 4 weeks,and the massive liver cells balloon type changes in 6 weeks,as well as obvious hyperemia dropsy and the hepatic lobe structure unclear in 370 MBq liver group.For the radioactive counts of urine and excrement,the peak appeared at 13 and 12 d respectively,and the peak values were (42.0 ±3.3) × 10~4 and (29.6 ±4.5) ×10~4 /min in muscle groups,respectively ;while the peak appeared at 5 and 9 d,respectively and the peak values were (49.0 ± 10.2) × 10~4 and (28.5 ± 7.1) × 10~4 /min in liver groups,respectively.Cumulative excretion ratios in urine and excrement were 36.58% and 10.62% in muscle groups,respectively and 23.48% and 8.76% in liver groups till 30 d,respectively.The liver absorbed doses were 30.6 and 55.6 Gy in liver groups,while those were 2.3 and 6.5 Gy in muscle groups.The maximus absorbed doses of gluteus were 53.4 and 98.1 Gy in muscle groups.Conclusions When ~(32)P- colloidal chromic phosphate of 794.39 MBq/m~2 was injected into the liver of Beagle,the liver absorbed dose was 56 Gy,which could be lethal dose for its strong liver toxicity and systemic side effects.Injection of 463.98-772.93 MBq/m~2 in muscle of Beagle could be safe.~(32) P-colloidal chromic phosphate interstitial injection is secure to treat the solid tumors with poor and middle blood supply which could be reached by puncture.

Objective:To design a tracheotomy cannula cuff filling device for hyperbaric oxygen therapy, which is convenient for clinical operation, improves work efficiency and reduces the incidence of aspiration pneumonia.Methods:This study was a randomized controlled trial. From July 2020 to June 2022, 90 patients with tracheotomy who were treated with hyperbaric oxygen in the First Hospital of Jiaxing were selected as the research objects. According to the random number table method, the patients were divided into the experimental group and the control group, with 45 cases in each group. In the experimental group, the cuff pressure was maintained by the tracheotomy cannula cuff filling device, and in the control group, the traditional water injection method was used to maintain the cuff pressure. The operation time, infection index and incidence of aspiration pneumonia were compared between the two groups.Results:The operation time in the experimental group was (6.33 ± 1.31) s lower than that in the control group (40.96 ± 3.70) s, and the difference was statistically significant ( t=-59.11, P<0.05). Body temperature, C-reactive protein and procalcitonin after treatment in the experimental group were (36.91 ± 0.83) ℃, (34.59 ± 16.25) mg/L, (1.57 ± 0.82) μg/L, respectively, lower than those in the control group (37.42 ± 0.72) ℃, (44.18 ± 18.10) mg/L, (2.45 ± 0.92) μg/L, the differences were statistically significant ( t=-3.09, -2.64, -4.73, all P<0.05). The difference of white blood cell count post-treatment between the two groups was not statistically significant ( P>0.05). The incidence of aspiration pneumonia in the experimental group was 11.11%(5/45) lower than 31.11%(14/45) in the control group, and the difference was statistically significant ( χ2=5.17, P<0.05). Conclusions:The application of tracheotomy cannula cuff filling device can simplify the operation process, reduce the incidence of infection and aspiration pneumonia, and optimize the clinical work.

BACKGROUNDThere are no unified theories as to the anatomical changes that occur with hallux valgus, we investigated the radiological characteristics and anatomical risk factors for hallux valgus deformity in Chinese adults.

METHODSWe reviewed 141 patients with hallux valgus (206 feet; 15 males, 126 females; mean age, 58.5 years). These patients attended Peking University People's Hospital from April 2008 to March 2014. All feet had intact radiological data, obtained using the Centricity RIS/PACS system. We measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), proximal articular set angle (PASA), distal articular set angle, hallux interphalangeal angle, metatarsocuneiform angle, size of the medial eminence of the distal first metatarsal, tibial sesamoid position, and joint congruity of the first metatarsophalangeal joint (MTPJ).

RESULTSWe found positive correlations between the HVA and IMA (r = 0.279, P < 0.01) and HVA and PASA (r = 0.358, P < 0.01), but not for IMA and PASA (P > 0.05). Feet were divided into three groups based on HVA severity. IMA (P < 0.05) and PASA (P < 0.05) in the mild group were significantly lower than that in the moderate and severe groups, with no significant difference determined for IMA or PASA between the moderate and severe groups (P > 0.05). Feet were then grouped based on the shape of the first metatarsal head. Using this grouping, HVA was significant higher in the rounded shape (19.92°) than in a flat shape (17.66°). The size of the medial eminence of the distal first metatarsal was positively correlated with HVA (r = 0.185, P < 0.01). The medial eminence in the moderate and severe groups was significantly larger than that in the mild group; moderate and severe groups were not significantly different.

CONCLUSIONSPASA enlargement is an adaptive change during early hallux valgus formation, and decompensation leads to subdislocation in the first MTPJ. A rounded first metatarsal head would thus predispose a foot to hallux valgus. Furthermore, bone proliferation at the medial eminence may also lead to early hallux valgus development.

Adult ; Aged ; Female ; Hallux Valgus ; diagnostic imaging ; pathology ; Humans ; Male ; Middle Aged ; Radiography ; Risk Factors

OBJECTIVE:To prepare rifampicin(RFP)nano-structured lipid carriers(RFP-NLCs)to improve its water-solubili-ty,and evaluate its quality. METHODS:Using liquid-solid lipid materials oleate and glyceryl monostearate as lipid materials,soy lecithin as emulsifier,poloxamer 188 as nonionic surfactant,melting-ultrasonic emulsification was used to prepare RFP-NLCs. Us-ing the comprehensive scores of particle size and encapsulation efficiency as indexes,the amount of lipid materials,proportion of liquid lipid materials,dosage,and mass ratio of soy lecithin-poloxamer 188 as factors,orthogonal test was adopted to optimize the formulation. The morphology,particle size,polydispersity index(PDI),Zeta potential,encapsulation efficiency,drug loading and in vitro release degree of prepared lipid carriers with optimal formulation were evaluated. RESULTS:In the optimal formulation, the amount of lipid materials was 150 mg,proportion of liquid lipid materials was 30%,amount of RFP was 10 mg,and mass ra-tio of soy lecithin-poloxamer 188 was 1:3. Prepared RFP-NLCs had rounded appearance,particle size was (124.07 ± 3.25) nm, PDI was 0.104±0.010,Zeta potential was(-31.07±2.94)mV,encapsulation efficiency was(80.90±2.59)%,and drug loading was(4.81±0.68)%(n=3). Compared with RFP raw materials,in vitro release degree of RFP-NLCs significantly slowed down, and the cumulative release degree within 12 h was 63.2%,which was in line with Weibull equation. CONCLUSIONS:Screened formulation can successfully prepare RFP-NLCs;the prepared RFP-NLCs have small particle size and high encapsulation efficien-cy,and the in vitro drug release shows certain sustained-release characteristics.