objective To investigate the ability of insulin sensitivity index HOMA2-%S and secretion function index HOMA2-%B calculated by HOMA2,the new homeostasis model assessment,in clinical application. Methods Eighty female volunteers with polycystic ovary syndrome in Chongqing area [50 subjects with normal glucose tolerance(NGT group)and 30 subjects with impaired glucose regulation(IGR group)]were involved in this study.Thev underwent a 75 g oral glucose tolerance test(OGTF)and the Botnia clamp test. From the data of faming blood samples in OGTF,insulin sensitivity index HOMAI-ISI,secretion function index HOMAl-β and disposal index DI-HOMA1 were calculated by the old homeostasis model assessment(HOMA I),meanwhile insulin sensitivity index HOMA2-%S,secretion function index HOMA2-%B and disposal index(DI-HOMA2) were caleulated by the new homeostasis model assessment (HOMA2).Correlation coefficients between insulin sensitivity index and GIR (the glucose infusion rate at steady state of Botnia clamp test),and between insulin secretion function index and AIR(the acute insulin response in Botnia clamp test),were studied.Results The Pearson's linear correlation coefficient between HOMA2-%S and GIR(r=0.503),HOMA1-ISI and HOMA2-%S (r= 0.990).HOMA2-%B and AIR(r=0.382),HOMA1-B and HOMA2-%B(r=0.976) were all statistically significant(a11 P<0.01).The glucose disposal indexes calculated from the HOMA2 and HOMA1 of 1GR group were significantly lower than those from the NGT group(t=2.825,P<0.Ol;t=2.222,P<0.05). Conclusion The HOMA2 is a better model in evaluating the insulin sensitivity and secretion function and is recommended to be widely used in clinical evaluation.

Objective To explore the clinical characteristics and treatment of paroxysmal supraventricular tachycardia (PSVT) in children. Methods The clinical data of 67 children with PSVT were analyzed retrospectively, and the therapeutic effects of different treatments were compared. Results The clinical manifestations of infants were paleness, shortness of breath, irritability and sweating, and children showed chest tightness, palpitations, abdominal discomfort and fatigue. The curative effect of electric cardioversion, transesophageal atrial pacing, physical therapy, and drug therapy was statistically different (P<0.05), The different cardioversion rates of them were observed for the treatment of paroxysmal supraventricular tachycardia. The cardioversion rate of transesophageal atrial pacing, was the highest, and the rate of physical therapy was the lowest. There was no significant difference in the cardioversion rate between propafenone, digoxin and amiodarone. Conclusion The clinical manifestations of PSVT in infants are atypical and easily to be ignored. There are many methods for treatment of PSVT. The vagus nerve can be stimulated first, and, if no response, either drugs or electric cardioversion and transesophageal atrial pacing can be used. The cardioversion rate of transesophageal atrial pacing is higher. The drug effectiveness for the treatment of PSVT depends on many factors, and our choice of medication varies from person to person.

OBJECTIVETo investigate the effectiveness of microbubble-enhanced ultrasound (MEUS) for detecting perforators preoperatively in supraclavicular flap surgery.

METHODSFrom May 2009 to October 2013, there were 20 patients (26 flaps were involved) who planned to undergo supraclavicular artery based flap surgeries to recover the large-area defects in head and neck. The MEUS together with regular color Doppler ultrasound ( CDUS) were conducted preoperatively to determine the anatomical features of perforators branching from supraclavicular arteries (SCA). The perforator with wider caliber, faster flow speed, longer pedicles and closer pivot point was selected and the flap was designed according to the observed results.

RESULTSThere were 37 perforators of SCA detected by CDUS, whose calibers were ranging from 0.5 to 0.8 mm [Mean: (0.6 ± 0.1) mm]. There were 48 perforators of SCA detected by MEUS. Compared to CDUS, the caliber obtained from MEUS for same vessel is significantly increased [(0.7 ± 0.3) mm vs (0.6 ± 0.1) mm, P < 0.05]. According to the results of MEUS and three-dimensional reconstructive techniques, in at least 65.4% (17/26) of the flaps, thoracic branch of SCA (TBSA) has large caliber and good flow velocity which can be regarded as the predominant vessel and used as the pedicle of flap. The results of the operations confirmed the existences of all the marked vessels. 25 flaps were obtained according to the preoperative plans and one case used perforators of internal mammary artery as free flaps since the perforator of SCA was found improper. The contrast-related complication occurred in one patient which was manifested by gastrointestinal adverse effect like nausea and anorexia. The patient recovered 1 day later without treatment. All the patients have been followed up for 3 to 16 months (Mean: 8 months) with well-survived flaps.

CONCLUSIONSThe perforators of SCA demonstrated significant variations and preoperative mapping was vital for the success of surgery. MEUS is a valuable imaging modality for the preoperative assessment of the vascular supply for supraclavicular artery based flap.

Arteries ; diagnostic imaging ; Humans ; Mammary Arteries ; Microbubbles ; Neck ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; Ultrasonography ; methods

Age Factors ; Cardiopulmonary Bypass ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; P-Selectin ; blood ; Platelet Glycoprotein GPIb-IX Complex ; analysis

Objective To investigate the changes of serum leptin levels and the influential factors in maintenance peritoneal dialysis patients.Methods Seventy-six peritoneal dialysis patients were chosen at the time before,and 3 months,6 months,12 months,18 months and 24 months after they began the peritoneal dialysis therapy,to examine body mass index (BMI),triceps skinfold thickness (TSF),abdominal circumference,homeostasis model assessment of insulin resistance (HOMA-IR),the plasma lipid profile,and leptin in the same situation.Results For 24 months,these patients showed higher serum leptin level than the values before commencing peritoneal dialysis treatment (P ＜ 0.01).The level of leptin was positively correlated with the BMI(r =0.412,P ＜ 0.01),TSF(r =0.308,P ＜ 0.01),abdominal circumference(r =0.284,P ＜ 0.01),HOMA-IR(r =0.184,P ＜ 0.01) and TG(r =0.288,P ＜ 0.01),negatively corelated with the high-density lipoprotein cholesterol(HDL-C)(r =-0.285,P ＜ 0.01).Multiple logistic regression analysis showed that BMI (β =0.339,P ＜ 0.01),TGβ =0.157,P ＜ 0.01) and HDL (β =-0.126,P ＜ 0.05)were significant predictive factors for the changes of serum leptin levels.Conclusion Leptin maybe involve in the occurrence and the development of cardiovascular events like other metabolic parameters in peritoneal dialysis therapy.

Objective To analyze risk factors of multiple drug-resistant infections in neonatal intensive care unit (NICU). Methods The clinical data from 284 hospitalized pediatric patients were retrospectively analyzed from June 2011 to July 2015 . The differences between 59 cases with multiple drug-resistant infections and 225 cases with non-multiple drug-resistant infections were compared and analyzed by logistic regression. Results All of 284 cases were single birth. Fifty-nine cases ( 13 . 13 ± 9 . 03 days old) had multiple drug-resistant infections, in which 42 were males and 17 were females. Two hundred and twenty-ifve cases ( 14 . 21 ± 8 . 34 days old) had non-multiple drug-resistant infections, in which 175 cases of males and 50 cases of females. Single factor analysis showed that 8 factors, including gestational age, birth weight, days in hospital, Apgar score at birth, mechanical ventilation, parenteral nutrition, and the categories and duration of use of antimicrobial agents, were the risk factors of multiple drug-resistant infections (P?

Objective To explore effect of daily clearance and improvement mode application in man-agement of clinical nursing responsible group. Methods 200 patients from hand and foot surgery department of our hospital between January to June, 2007 were included into the control group, and 200 patients who were in hospital between July to December, 2007 were included into the experimental group. Then quality of care and satisfaction of patients were compared respectively between the two groups to study application effect of daffy clearance and improvement mode. Results After six months application of daily clearance and improvement mode, significant difference was seen in the two groups. Condusions Application of daffy clearance and improvement mode in management of clinical nursing responsible group is an effective method in nursing supervision.

Objective To analyze the risk factors for healthcare-associated pneumonia (HAP) in patients with orthopedic injury,provide the basis for making prevention and control measures.Methods HAP occurred in patients with orthopedic injury and admitted to the department of orthopedics of a hospital from June 2011 to May 2015 were investigated retrospectively,risk factors were analyzed by univariate and multivariate logistic regression methods.Results A total of 2 578 patients with orthopedic injury were investigated,92 patients developed HAI,incidence of HAP was 3.57％.107 strains of pathogens were detected,the major were Klebsiella pneumoniae (n =22,20.56％),Escherichia coli (n =14,13.08％),and Acinetobacter baumannii (n =13,12.15％).Risk factors for HAP in patients with orthopedic injury were length of hospital stay≥15 days,smoking history≥3 years,bedridden ≥7 days,associated with underlying diseases,complications,indwelling catheter≥7 days,surgical operation,mechanical ventilation,admitted to intensive care unit,open injury,blood sugar≥11 mmol/L,plasma albumin＜30 g/ L,hemoglobin concentration＜90 g/L,and use of glucocorticoid≥4 days (all P＜0.05).Multivariate logistic regression analysis showed that smoking,bedridden,surgery,mechanical ventilation,glucocorticoid use,and anaemia were independent risk factors for HAP in patients with orthopedic injury.Conclusion The occurrence of HAP in patients with orthopedic injury is related with multiple factors,the major are surgical operation,mechanical ventilation,glucocorticoid use,long term smoking,bedridden,and anaemia.

Objective To investigate the early diagnostic value of cornel confocal microscopy for the screening of small neuropathy in elderly patients with type 2 diabetic mellitus.Methods In the prospective study,96 elderly patients with diabetes as study group and 46 patients with non-diabetes as the control group were continuously collected from our hospital endocrinology and ophthalmology out patients during May 2014 to February 2016.The 96 cases of type 2 diabetes were subdivided into 47 patients with diabetic peripheral neuropathy (DPN)and 47 patients with nowdiabetic peripheral neuropathy(non DPN).Results The diabetes course was shorter in non-DPN group than in DPN group(P=0.000).The levels of glycosylated hemoglobin and urine albumin were lower in the nonDPN than in the DPN(P =0.072,0.007,respectively).The corneal nerve fiber density was lower in the DPN group than in NDPN group (P =0.000).Corneal nerve fiber density was higher in control group than in DPN and NDPN group.The differences in number of corneal nerve fibers showed no statistical significance between DPN and NDPN group (x2 =2.391,P =0.314).But the number of corneal nerve fibers was significant less in DPN and NDPN group than in control group(x2 =16.014,P =0.000).The negative correlation was found between the course of disease and corneal fibrous density by using single factor linear regression analysis.The number of corneal nerve fibers was lower in smoking group than in non-smoking group(P=0.003).The multiple linear regression analysis showed that duration of diabetes was a risk factor for diabetic neuropathy.Conclusions In some elderly diabetic patients with non-neuropathy,corneal nerve fiber density and number have been significantly decreased before nerve conductive velocity is reduced.Therefore,corneal confocal microscopy can be used to detect and diagnose small diabetic neuropathy in elderly patients with diabetes mellitus.

Objective To analyze the risk factors of multiple drug resistant bacterial infections in patients with chronic obstructive pulmonary disease (COPD), and provide guidance for disease control and prevention. Methods Clinical data of 814 COPD patients were retrospectively analyzed from June 2011 to May 2015, including patient's age, gender, smoking history, age of onset, severity, aggravated frequency, duration of exacerbations, diabetes mellitus, complications, use frequency and use duration of glucocorticoid, use frequency of antimicrobial agents and use duration of each time, types of antimicrobial drugs used, combined with antibacterial drugs, plasma albumin concentration, blood glucose, bacteria culture detection of multi drug resistant bacteria infection. The risk factors of multi drug resistant bacteria infection were analyzed. Results A total of 857 pathogenic bacteria were isolated from 814 COPD patients with pulmonary infection. Multiple drug resistant bacteria infection were detected in 170 cases, and 175 strains (20.42%) were detected. The detection rate of multi drug resistant/PAN resistant pseudomonas aeruginosa (MDR/PDR-PA) was 55.38% (36/65). There were significant differences in patients with multi drug resistant bacteria infection between different clinical pathological characteristics. Logistic regression analysis showed that the acute exacerbation duration (days), long time use of antimicrobial drugs, and high frequency of corticosteroids and antibiotics use were independent risk factor of multi drug resistant bacteria infection in COPD patients. Conclusion Prevention and treatment of multiple drug resistant bacteria infection in COPD patients should pay attention to the combination of community and hospital, and take effective measures to prevent and control the risk factors.