Fulminant type 1 diabetes (FT1 D) has been identified as a new subtype of idiopathic diabetes.FT1D is characterized by abrupt and complete destruction of pancreatic β cells,with diabetic ketosis or diabetic ketoacidosis occurring within a week after the onset of hyperglycemic symptoms.At the time of initial presentation,plasma glucose level is increased,with near normal HbA1C.Serum pancreatic enzyme is elevated in the majority of patients with FT1D.Flu-like symptoms or gastrointestinal symptoms precede disease onset in most of patients.However,the pathogenesis of this disease remains unclear.Factors such as viral infection,autoimmune,and pregnancy based on the background of genes may account for FT1D.We herewith report two cases of FT1 D,and review its clinical features,diagnosis,and treatment.

Objective: To investigate the expression of co-stimulatory molecule CD86 and inducible costimulator(ICOS) in the intestinal mucosa of Crohn disease (CD) and to exlpore its pathologic significance. Methods: Expression of co-stimulator CD86 and ICOS was examined by immunohistoehemistry on paraffin embedded tissue from patients with CD (30 cases) and normal controls (20 cases). The subsets of lamina propria mononuclear cells (LPMC) were also analysed via immunostaining for CD4, CD8 and CD20. Results: Increased amount of CD86 or ICOS positive LPMC was observed in the lesional area of CD when compared with the essentially normal area of CD and normal controls (q = 9. 23 ,P ＜0. 01 and q =5. 46 ,P＜0. 01). In addition, the expression of CD86 or ICOS was higher in intestinal epithelium of CD than that in normal controls (H = 24. 93, P＜0. 01 and H = 4. 66, P＜0. 01 ) , whereas no significant difference was seen between the diseased and the essentially normal area of CD. The amount of CD4 or CD8 positive lymphocytes in lamina propria, epithelium and small vascular walls was also significantly increased in CD than that in normal controls (P＜0. 05 or P＜0. 01). Conclusion: Increased amount of CD86 or ICOS positive LPMC and enterocytes in CD suggests that co-stimulatory molecules may play a role in the pathogenesis of CD. The enterocytes may act as non-specific antigen presenting cells in the process of cellular immunity activation in CD.

Objective To investigate the application of radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy in the diagnosis of peripheral pulmonary lesions (PPLs),assess its safety and diagnostic value,and explore the influencing factors.Methods Clinical data of 140 patients who underwent R-EBUS transbronchial biopsy (TBB) and brush biopsy in our department of respiratory endoscopy from January 2015 to March 2017 were collected and retrospectively analyzed in the study.Eighty-three cases were diagnosed as PPLs.The detection rate,ability to locate the peripheral lesions,and influencing factors of EBUS were analyzed.The incidence rate of complications was observed to assess its safety.Results Of the 83 PPLs patients,they were 55 males and 28 females,and at a mean age of 59.81 ± 11.85 years.The total success rate of EBUS-guided bronchoscopic diagnosis was 59.04％ (49/83),and the diagnostic rate was 50.94％ (27/53) for malignant lesions,and 73.33％ (22/30) for benign diseases.The rate of EBUS-TBB (56.92％,37/65) was significantly higher than that of brush biopsy (30.12％,25/83,Chi square =10.76,P =0.001).EBUS-guided diagnostic methods had an accuracy of 60.00％ (45/75),while the EBUS-guided bronchoscopy had a rate of 50.0％ (4/8),but no significant difference was seen between the 2 methods (Chi square =0.03,P =0.87).The sizes of the lesions ranged from 10.0 to 52.4 mm,and the diagnostic yield for PPLs ≤20 mm in diameter (36.84％,7/19) was lower than that for those ＞20 mm (65.62％,42/64,Chi square =5.02,P =0.003).There was no significant difference (Chi square =10.05,P =0.07)in the diagnostic yield for different sites,with that of right upper lobe of 46.15％ (12/26),right middle lobe 100.00％ (8/8),right lower lobe 53.85％ (7/13),left upper lobe 37.50％ (3/8),left lingula lobe 63.64％ (7/11),left lower lobe 70.59％ (12/17).But the detection rate was obviously lower in the upper lobe (22/45,48.89％) than the middle/lower lobe (27/38,71.05％,Chi square =5.02,P =0.003).Of all the 83 patients,74 ones (89.16％) were successfully identified using radial probe EBUS,but the lesions were not found in 9 patients.When the radial probe position was within the target lesion,the diagnostic yield was 81.58％ (31/38),notably higher than that when the probe was positioned adjacent to the lesion (50.00％,18/36,Chi square =8.24,P =0.004).Mild bleeding was observed when performing biopsy under bronchoscope,and no pneumothorax,or other serious complications were observed.Conclusion Radial EBUS is a safe and feasible nethod to accurately identify PPLs and improve its diagnostic rate.EBUS-guided bronchoscopy has higher positive detection rate for PPLs,and is cost saving.The relationship of the probe and the site of lesion is the main factor influencing the diagnostic rate.

OBJECTIVE: To investigate the effect of nasal instillation of vitamin D3 on patients with allergic rhinitis symptoms including nasal itching, sneezing, clear nasal discharge, and nasal congestion. METHOD: Thirty subjects with allergic rhinitis proved by skin prick test (SPT) and 30 subjects with deviated septum alone were recrui ted and administrated with 300 000 IU of vitamin D3 by nasal instillation weekly. Seven days after the intervention, the four major symptoms including nasal itching, sneezing, clear nasal discharge, and nasal congestion were evaluated by score. RESULT: After intranasal instillation of vitamin D3, the symptoms in allergic rhinitis group in cluding nasal itching, sneezing, nasal discharge and nasal congestion, and serum 25-hydroxyvitamin D level has statistical differences (P < 0.05). CONCLUSION Vitamin D3 could be well absorbed through nasal mucosa. It demonstrated to have significantly effect on serum 25-hydroxyvitamin D to improve the symptoms for patients with allergic rhinitis. Vitamin D3 may be a kind of adjuvant therapy for prevention and treatment of allergic rhinitis.
Administration, Intranasal ; Adult ; Cholecalciferol ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Rhinitis, Allergic ; drug therapy ; Young Adult

Objective:This study aims to analyze the counts (per kilogram of body weight) or percentages of transplanted lymphocyte subgroups in children with non-infectious pulmonary complications (NIPC) and air-leak syndrome (ALS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and explore its significance in the progression of lung complications after transplantation.Methods:The patients with NIPC and ALS after allo-HSCT from January 2013 to December 2019 in Hebei Yanda Ludaopei Hospital were retrospectively studied and the influencing factors in the progress of NIPC after HSCT were statistically analyzed.Results:Of the 2026 children who received HSCT treatment, 59 patients (34 males and 25 females) developed NIPC, the probability was 2.9% (59/2 026), and the probability of combined ALS was 1.4% (28/206). The differences in the comparison between NIPC progressed to ALS group (ALS group) and failed to progress to ALS group (non-ALS group) in the patient′s age( P=0.028), disease condition before transplantation( P=0.022), NIPC onset time( P=0.004) were significant. The P values of the percentage of NKT-like cells in the bone marrow ( P=0.008) or peripheral stem cells ( P=0.003) accounted for the lymphocytes. CD4+CD25+dim cells in bone marrow ( P=0.029) or peripheral stem cells ( P=0.036) accounted for the CD4+lymphocytes and the ratio of CD4/CD8 in bone marrow( P=0.004) or peripheral stem cells ( P=0.020) were less than 0.05, which meant the differences in patients′ refusion cells were significant. In the binary logistic regression model, the percentage of bone marrow NKT-like cells to lymphocytes, the ratio of bone marrow CD4+/CD8+and the percentage of peripheral stem NK cells to lymphocytes were important risk factors for the progression of NIPC to ALS. The rest factors were excluded from the model (AUC=0.918, P<0.05). Conclusion:During allo-HSCT transplantation, a high proportion of NKT-like cell and NK cell levels, and a high CD4+/CD8+ratio in the infusion of donors with high immune tolerance have an important correlation with the progression of the NIPC.

Objective:To investigate the effectiveness of detecting MC B/P in PB by FCM for EBV+PTLD screening.Methods:481 patients with fever and large lymph nodes after allogenic hematopoietic stem cell transplantation (ALLO-SCT) in Ludaopi Hospital from 2018 to 2019 were retrospectively analyzed. The results of post-transplantation days, viral load (EBV, CMV) and MCB/P were detected. To evaluate the value of MC B/P in the diagnosis of PTLD by the sensitivity, specificity, positive predictive value and negative predictive. Logistic regression was used to analyze the clinical influencing factors of EBV-associated PTLD. The median fellow-up time was 449 days (range: 184 days to 700 days).Results:The diagnosis of PTLD was established in 51 patients. 55 patients who detecting MC B/P by FCM were positive. There were significant differences between the PTLD negative and positive groups in lymph node enlargement, age, EBV, CMV, monoclonal B cells, and monoclonal plasma cells ( P<0.05). Monoclonal plasma, monoclonal B and days after transplantation are important relationship with the diagnosis of PTLD, which have good diagnostic value for EBV-associated PTLD. Conclusion:FCM screening peripheral blood MC B/P has good diagnostic performance for EBV-associated PTLD. Monoclonal B, monoclonal plasma and the number of days of PTLD after transplantation were correlated with EBV-associated PTLD.

Objective:To survey the teaching ability of general practitioners(GPs) in community health centers of Shanghai, and its influencing factors.Methods:A questionnaire survey on the teaching ability of general practice trainers was conducted from January to February 2017. The participants of the survey were GPs with teaching experiences from community health centers in Shanghai selected by a stratified and proportional cluster sampling method. The questionnaire included two aspects: the general information and teaching ability of the participants. The influencing factors of teaching ability were analyzed by univariate and multivariate regression analysis.Results:A total of 1 138 GPs from 116 selected community health centers participated in the questionnaire survey, among whom 63.6% (724/1 138) worked in community teaching bases and 78.5% (893/1 138) had received training for trainers. The total score of teaching ability was 38.00 (30.00, 40.00). The score of the item"interesting in teaching"was (3.46±0.80), 75%—80% of the other questions answered "yes". The score of"application of multi-teaching methods"was (3.78±0.72). Multivariate analyses showed that working for 5—9 and 10—19 years [ OR=7.14 (2.47—11.81), P=0.003; OR=5.32 (1.30—9.33), P=0.009], working in community teaching bases [ OR=13.23 (9.88—16.57), P<0.001] and receiving training for trainers [ OR=17.76 (13.80—21.71), P<0.001] were influencing factors of teaching ability. Conclusion:The main problems related to teaching ability in community GPs are lack of teaching interest and the poor application of multi-teaching methods, the relevant training is necessary for them in the future.

Objective:To predict the short-term postoperative recurrence status of patients with refractory temporal lobe epilepsy (TLE) by analyzing preoperative 18F-FDG PET images and patients′ clinical characteristics based on deep residual neural network (ResNet). Methods:Retrospective analysis was conducted on preoperative 18F-FDG PET images and clinical data of 220 patients with refractory TLE (132 males and 88 females, age 23.0(20.0, 30.2) years)) in the First Affiliated Hospital of Jinan University between January 2014 and June 2020. ResNet was used to perform high-throughput feature extraction on preprocessed PET images and clinical features, and to perform a postoperative recurrence prediction task for differentiating patients with TLE. The predictive performance of ResNet model was evaluated by ROC curve analysis, and the AUC was compared with that of classical Cox proportional risk model using Delong test. Results:Based on PET images combined with clinical feature training, AUCs of the ResNet in predicting 12-, 24-, and 36-month postoperative recurrence were 0.895±0.073, 0.861±0.058 and 0.754±0.111, respectively, which were 0.717±0.093, 0.697±0.081 and 0.645±0.087 for Cox proportional hazards model respectively ( z values: -3.00, -2.98, -1.09, P values: 0.011, 0.018, 0.310). The ResNet showed best predictive effect for recurrence events within 12 months after surgery. Conclusion:The ResNet model is expected to be used in clinical practice for postoperative follow-up of patients with TLE, helping for risk stratification and individualized management of postoperative patients.

Objective To investigate the clinical value of hysteroscopy in helping identify the etiology of intrauterine fluid collection in postmenopausal women.Methods One hundred and thirtyfour postmenopausal women with intrauterine fluid collection,detected via transvaginal sonography,were admitted in the department of gynecology and obstetrics at Beijing ChaoYang Hospital from May 2014 to October 2016.All clinical data were retrospectively analyzed.All patients underwent hysteroscopy and biopsy of the endometrium.The results of hysteroscopy were analyzed against biopsy results.Results Hysteroscopy revealed that 116 of the 134 cases had uterine fluid(86.6％).Based on hysteroscopy results,44 (37.9 ％) had endometritis,10 (8.6 ％) had atrophic endometritis,5 (4.3 ％) had endometrial carcinoma,and 7(6.0 ％)had endometrial polyps,but the case numbers and rates for these conditions from microscopic examination were39 (33.6％),15 (12.9％),6 (5.2％),and 7 (6.0 ％),respectively.When microscopic examination was used as the gold standard,the sensitivities and specificities of hysteroscopy in the diagnosis of endometritis,atrophic endometritis,endometrial cancer and endometrial polyps were 82.0 ％ and 85.7 ％,66.7 ％ and 97.1％,80.0 ％ and 98.2 ％,and 100.0％ and 97.3％,respectively.The diagnostic coincidence rates were 84.6％,93.2％,94.4％ and 97.4％,respectively.Conclusions Postmenopausal women with intrauterine fluid collection shown on transvaginal sonography should receive hysteroscopy for early detection of endometrial lesions.

Objective To explore the CT and MRI imaging and clinicopathological features of extranodal NK/T cell lymphoma (NK/TCL). Methods Sixty-six patients with NK/TCL diagnosed from 2002 June to 2016 April in Beijing Tongren Hospital with intact CT and/or MRI imaging results were enrolled in this study. All the patients had tailed clinical information and follow-up. The imaging and clinicopathological features were analyzed retrospectively and their prognostic value on overall survival was analyzed. Results There were 49 males and 17 females with median age of 42 years. The median follow-up time was 18 months. The cases showed surrounding invasions including 10 cases (15.2 %) in soft palate, 5 cases (7.6 %) in hard palate, 2 cases(3.0 %) in tonsil, 8 cases(12.1 %) in upper lip, 13 cases(19.7 %) in maxillofacial soft tissue, 9 cases (13.6 %) in eyelid, 10 cases (15.2 %) in orbital, 3 cases (4.5 %) in maxilla, 6 cases (9.1 %) in pterygopalatine fossa,6 cases(9.1 %)in infratemporal fossa,3 cases(4.5 %)in skull base, 3 cases(4.5 %) in eyeball and 2 cases (3.0 %) in brain tissue. Kaplan-Meier survival analysis found that the 2-year overall survival rates of the patients with the involvement of hard palate, upper lip, maxillofacial soft tissue, eyelid, orbital, maxillary, eyeball and brain organizer were lower than those of the patients without the involvement of these sites(χ2values were 4.470,4.041,4.456,13.933,8.986,4.000,44.121,6.527,16.822,respectively, all P< 0.05). Further multivariate Cox regression analysis showed that maxilla and brain involvement were independent adverse factors (RR=34.717, 95 % CI 3.404-354.035, P=0.003; RR=37.545, 95 % CI 3.188-442.187, P= 0.004). Conclusions MRI and CT examinations are of great value in diagnosis and prognostic assessment of NK/TCL. Clinicians can make correct and timely diagnosis by comprehensive clinical, radiological and pathological features and can make a detailed clinical assessment to give patients appropriate treatment,thus improving the outcome of the NK/TCL patients.