Objective To investigate the risk factors for severe hypoglycemia in the treatment of type 2 diabetes mellitus (T2DM) and to provide scientific rationales for the prevention of hypoglycemia in treating diabetes.Methods Clinical data of 49 T2DM patients with severe hypoglycemia (hypoglycemic group) and 98 T2DM patients without hypoglycemia as control group were retrospectively analyzed.Severe hypoglycemia was defined as that patient requiring assistance for intaking carbohydrate to alleviate hypoglycemia and plasma glucose concentration was less than 3.9 mmol/L.Clinical and biochemical indexes were analyzed by the single-factor analysis.Logistic regression model was established by multi factors regression analysis,and the receiver operating characteristic (ROC) curve was used to assess the performance of the logistic regression model.Results The mean serum glucose level was (2.3±0.7) mmol/L during hypoglycemia in hypoglycemia group.The mean age was higher in hypoglycemia group than in control group [(76.2±6,5) years vs.(69.8±11.5) years,P=0.001].The mean glycosylated hemoglobin Alc (HbAlc) level was lower in hypoglycemia group than in control group [(6.4±0.8)％ vs.(9.1± 2.5)％,P＜0.001].Endogenous creatinine clearance rate (Ccr) was lower in hypoglycemia group than in control group [(46.8±21.0) ml/min vs.(74.2 ± 24.5) ml/min,P＜0.001].Logistic regression analysis indicated that female and HbA1c level were the independent risk factors for severe hypoglycemia (OR=11.83,0.91 and 0.18,95％CI:1.82 76.93,0.86-0.97 and 0.08-0.44,respectiely] ; T2DM therapies with insulin and insulin secretagogues increased the risk of hypoglycemia (OR＝12.31 and 5.36,95％CI:1.70-88.88 and 1.08-26.56); however,duration of diabetes,body mass index (BMI),and urinary microalbumin (UMA) had no correlation with severe hypoglycemia (all P＞0.05).The area under the ROC curve was 96.5％ by the logistic regression model.Conclusions Gender,Ccr,HbA1c,insulin and insulin secretagogues are the main risk factors for severe hypoglycemia in T2DM patients.Preventive interventions of hypoglycemia should be taken earlier for the patients with the high risk factors.

Objective To study the effect of Fas gene transfection on bladder cancer cells. Methods Fas cDNA were transduced into bladder cancer cells EJ by DOTAP liposomal transfection regeant. Northern blot,in situ hybrization and flow cytometric evaluation were used to confirm the Fas mRNA and protein expression. The apoptosis and proliferation of EJ cells pre and posttransfection induced by cisplatin were analysed by flow cytometry、DNA ladder and MTT methods. Results Transfection of Fas gene can significantly upregulate the expression of Fas in human bladder cancer EJ cells. Apoptosis and decrease of proliferation were easily induced by cisplatin in the transfected EJ cells. Conclusions Fas system might involve in the development and progression of urogenital malignant tumors. Transfection of Fas gene by lipofectin can significantly upregulate the Fas expression in target cell. The synergistic cytotoxic effect obtainted in EJ cells suggested that combined use of Fas gene transfection and cisplatin may help in the treatment of cisplatin resistant bladder cancer.

Objective To investigate the change of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the skin of diabetic rats, and to explore the potential role of MMP-9/TIMP-1. Methods Diabetic rats were induced with streptozotocin (STZ). Then all rats were maintained for 6 weeks. Routine pathological examination and immnnohistochemistry were made to reveal the histological and cytological appearances. RT-PCR and Western blotting were used to detect the expression of mRNA and protein of MMP-9 and TIMP-1 in the skin. Results Six weeks after STZ treatment, examination of HE-stained skin sections from normal and diabetic animals revealed that the epidermis and dermis layers were thinner in diabetic rats than those in control rats. The skin of diabetic rats showed features of atrophy such as disorganization of connective tissue fiber bundles and enlarged space between collagen fiber bundles. In contrast, thick bundles of connective tissue were observed in the dermis of normal rat skin. In normal skin, cells had a bipolar, spindle-shaped appearance in the thick collagen bundles, while in the skin of diabetic animals the interstitial cells had a rounded, shrunken and crenated appearance. The relative values of expression of MMP-9 in diabetic group were higher than those in normal group with significant difference, however, the relative values of expression of TIMP-I in diabetic group were lower than those in control group. Conclusion The changes in cutaneous histology and cytology appear earlier than skin wound. These "underlying disorders" may be associated with the imbalance of MMP-9/TIMP-1.

Objective To relatively prolong the length of C7 nerve through microanatomical study and carry out direct anastomosis between the end of avulsed nerve and contralateral C7. Methods Fifteen cadaveric specimens and 30 sides of the adult brachial plexus was dissected. The C7 nerve was confirmed and measured by using electric vernier caliper. Parameters as follow: the length of C7 nerve from root to trunk; the length of C7 nerve from root to division(anterior and posterior division); transverse and longitudinal diameter of C7 nerve in root site, combination site between trunk and division, end site of anterior and posterior division. After dissected the nerve adventitia of binding site between division and cord and cut the distal end of anterior and posterior division, the length of C7 nerve from root to division (anterior and posterior division)was measured again. Results The measured result of the length C7 nerve: the length of C7 from root to trunk: (45.87 ± 10.43)mm; Before micro-dissected, the length of C7 from root to anterior division: (61.14 ±13.44)mm; the length of C7 from root to posterior division: (54.63 ± 11.35)mm after micro-dissected, the length of C7 from root to anterior division: (74.67±12.86)mm; the length of C7 from root to posterior division:(68.73± 11.86)mm; the prolonged length of anterior division: (13.15± 4.26)mm; the prolonged length of posterior division: (14.21 ± 6.98)mm. Conclusion Through dessecting the adventitia of binding site of division (anterior and posterior division) and cord of C7 nerve. The length of C7 nerve can be relatively prolonged.

Objective To explore clinical value of intraoperative extra strong electrical stimulation in the treatment of birth brachial plexus palsy. MethodsFrom July 2008 to September 2011,intraoperative extra strong electrical stimulation was applied in 9 cases of incomplete birth brachial plexus palsy after neurolysis.The latency and amplitude of compound muscle action potentials before and after electrical stimulation were recorded and the extent of improvement was compare.ResultsThe latency was improved in 7 cases with 8.02％ in average,amplitude in 8 cases with 185.97％ in average.The related nerve recover partial motor function in 8 cases in 2 weeks after operation.ConclusionIntraoperative extra strong electrical stimulation is a effective assistant technique to promote motor functional recovery of birth brachial plexus palsy.

AIM:To investigate the imbalance between the expression of metalloproteinases (MMPs) and that of tissue inhibitors of metalloproteinase (TIMPs) during wound healing in diabetic rats. METHODS: Diabetic rats were induced with streptozotocin. All rats were maintained for 6 weeks. A full-thickness excisional wound was created on the back of each rat. Every group was randomly divided into 3 subgroups of 7 rats: 3 d group, 7 d group, 14 d group and animals were killed at 3rd, 7th and 14th day. Routine pathological examination, Masson′s trichrome staining and immunohistochemistry were made to calculate the score of epidermal and dermal regeneration, granulation tissue thickness, angiogenesis, matrix density, and infiltrated cells at different time points. RT-PCR and Western blotting were used to detect the expression of mRNA and protein of MMP-9 and TIMP-1 in the skin at those time points. RESULTS: Six weeks after streptozotocin treatment, Three days after injury, the wound healing rate of normal rats was faster than that of diabetic rats. From 3rd to 14th day, there were a lot of fibroblast and macrophage in normal skin, while few such cells were observed in diabetic skin. The other histological scores in normal skin were higher than those in diabetic rats at 7th and 14th day. Both MMP-9 and TIMP-1 had minimally detectable levels before wounding but exhibited rapid, significantly large increases within 3 d after wounding. Subsequently, they showed a rapid decline by 14 d. The relative values of expression of MMP-9 mRNA and protein in diabetic group were higher than those in normal group at different time points. However, the values of TIMP-1 mRNA and protein in diabetic group were significantly lower than those in control group. Significant difference was observed between two groups with the ratio of MMP-9/TIMP-1, higher in diabetic group than that in normal group. CONCLUSION: Abnormal reepithelialization, angiogenesis, inflammatory cell infiltration, collagen fibers generation, granulation tissue deposition, seem to be the basic histopathology that delays wound healing. The imbalance between MMPs and TIMPs in diabetic skin tissue before and after injury may be one of the important reasons of these alterations of histopathology.

Objective: To investigate the prevalence of metabolic disorder among the high school students in Guangzhou. Methods: A cross-sectional study among 4 620 high school students selected with stratified cluster sampling was conducted in Guangzhou. Height, weight, blood pressure, fasting plasma glucose (FPG) and serum lipid of TC, TG were measured. Household socioeconomic status, medical history, physical activities as well as personal diet and study habits were acquired with structured questionnaire. Results: The prevalence of central obesity was 11.5%. The overall prevalence of IFG and DM was 6.9%. The overall prevalence of both hypercholesteremia and hypertriglyceridemia was 13.4%. The prevalence of hypertension was 11.6%. With multivariable logistic regression, the results showed that: fast eating was associated with increased risk of central obesity (OR=1.79, 95%CI=1.47-2.18) and hypercholesteremia/hypertriglyceridemia (OR=1.27，95%CI=1.04-1.54). While students who ate slow had low risk of central obesity (OR=0.47, 95%CI=0.33-0.68), hypercholesteremia/hypertriglyceridemia(OR=0.71, 95%CI=0.54-0.94) and hypertension (OR=0.65, 95%CI=0.49-0.88). Students with sugar-sweetened beverages once a day or more had higher risk of central obesity (OR=1.60, 95%CI=1.08-2.38) while students without sugar-sweetened beverages consumption had low risk of IFG/DM (OR=0.57, 95%CI= 0.43-0.77) than those who consumed 1-2 times/week. Students without eating out habit had lower risk of hypercholesteremia /hypertriglyceridemia than those with eating out for 1-2 times/week (OR=0.78, 95%CI=0.62-0.98), and students who had lunch out of home or canteen had higher risk of hypercholesteremia /hypertriglyceridemia than those who ate at canteen (OR=1.38，95%CI=1.06-1.81). Conclusion The prevalence of metabolic disorder among high school students in Guangzhou is at a relatively high level. High eating speed, heavy sugared beverages intake and frequently eating out habits are associated with risk of metabolic disorder.

OBJECTIVETo analyze the genotype and phenotype correlation in the hemoglobin E (HbE) carriers, and to investigate the effect of HbE on hematological parameters.

METHODSThe capillary electrophoresis was used to screen total 14 141 samples and blood cell analysis was further processed to the HbE carrying samples. Gap-PCR and reverse dot blot hybridization method were used for the detection of Chinese common mutation of α and β thalassemia.

RESULTSThere is a statistical difference in hematological phenotype index (HGB, MCV, MCH, HbE, HbA(2)) between samples of HbE heterozygous (53 samples), HbE homozygous (2 samples), HbE composite α thalassemia (α-thal, 7 samples) and HbE composite β thalassemia (β-thal, 8 samples). Among the four groups, HbE heterozygous \[HGB (122.7 ± 19.99) g/L, MCV (78.65 ± 5.03) fl\] and HbE composite α-thal \[HGB (113.6 ± 22.68) g/L, MCV (73.50 ± 7.73) fl\] had slight effect on hematological parameters, but HbE composite β-thal \[HGB (76.4 ± 12.30) g/L\], MCV (59.23 ± 5.28) fl\] had the heaviest effect on hematological parameters.

CONCLUSIONCo-existence of HbE heterozygous and other type thalassemias showed variation in their hematological phenotype, so patients should be informed of genetics in prenatal diagnosis.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Genotype ; Hemoglobin E ; genetics ; Heterozygote ; Humans ; Infant ; Male ; Middle Aged ; Phenotype ; Thalassemia ; blood ; genetics ; Young Adult

Objective: To evaluate the effects on reduction of peripherally inserted central catheter-related venous thrombosis by hand grip exercise. Methods: A detailed search was performed to identify literature about the impact of handgrip exercise on peripherally inserted central catheter-related venous thrombosis, using the Cochrane Library and the databases of PubMed, CINAHL, Embase, CNKI, WanFang and CBM. The meta-analysis or descriptive review were performed after two authors in-dependently searching databases,extracting data and assessing quality of included studies. Results: Seven RCTs were included in a total of 789 patients. Meta-analysis showed the effectiveness of handgrip exercise on reduction of peripherally inserted central catheter-related venous thrombosis (RR=0.27, 95% CI 0.17-0.42, P<0.01); and improving vein maximum velocity (WMD=6.53, 95%CI 3.34-9.73, P<0.01) and time-mean flow velocity (WMD=6.05, 95%CI 3.24-8.87, P<0.01). Conclusions Handgrip exercise can improve axillary vein blood flow parameters and reduce peripherally inserted central catheter-related venous thrombosis. Due to a small number of included studies and heterogeneity of indicators, multi-centered, high-quality RCTs with large sample size are needed in the future to assess the effect of handgrip exercise in PICC patients.

Objective:To analyze the epidemiological and clinical characteristics of hospitalized patients with dengue fever in Guangdong Province in 2019, so as to provide reference for clinical diagnosis and treatment of dengue fever.Methods:The general data, laboratory examination data, clinical manifestations and prognosis data of 480 inpatients with dengue fever admitted to Eight People′s Hospital Affiliated to Guangzhou Medical University between January 4 and October 31, 2019 were analyzed retrospectively. The clinical and onset characteristics of patients with dengue fever were described.Results:Among 480 dengue patients, 442(92.1%) were dengue fever, 38(7.9%) were severe dengue, and 136(28.3%) had underlying diseases. The peak age of onset was mainly in young adults aged 20 to 49 years old, accounting for 66.0%(317/480) in total. The seasonal peak was mainly in August to October. There were 399(83.1%) local cases and 61(12.7%) imported cases. The most common clinical manifestations were fever (98.1%, 471/480), chills (72.9%, 350/480), headache (58.5%, 281/480) and bone/joint/muscle pain (67.1%, 322/480), followed by digestive tract symptoms and respiratory tract symptoms. Among 446 serum samples, 358 (80.3%) were dengue virus (DENV)-1, 54 (12.1%) were DENV-2, 34 (7.6%) were DENV-3. The main laboratory tests of the patients were leucopenia (65.8%, 316/480), low hematocrit (30.2%, 145/480), thrombocytopenia (48.3%, 232/480), neutropenia (44.8%, 215/480), elevated alanine aminotransferase (ALT) (37.7%, 181/480) and aspartate aminotransferase (AST) (59.4%, 285/480). Treatment mainly adopted symptomatic support treatment and active prevention of complications. The length of stay was (5.8±3.1) days (range 1.0-38.0 days). A total of 461(96.0%) patients were cured or improved.Conclusions:In 2019, the majority of dengue fever patients in Guangdong Province are young adults aged 20 to 49 years old, and the proportion of severe patients is high, with DENV-1 infection as the main type. After symptomatic support treatment and active prevention of complications, most of the dengue fever patients have a good prognosis.