Objective To characterize the clinic features of fulminant type 1 diabetes mellitus (IT1DM).Methods It was a retrospective study analyzing the clinical and laboratory data of patients diagnosed as FT1DM and type 1 diabetes in the Department of Endocrinology in China-Japan Friendship Hospital from January 2011 to November 2015.Results A total of 125 newly diagnosed type 1 diabetic patients were included in the study,14 of them (11.2％) met with the criteria of FT1DM.The age at onset was (35.8 ± 8.3) years.The time from onset to ketosis was 2 (0-7) days.The plasma glucose levels were extremely high[(33.79 ± 14.13)mmol/L],while glycosylated hemoglobin A1c[HbA1c,(6.9 ±0.7) ％] and serum glycosylated albumin [(21.8 ± 4.5)％] levels were only slightly above the normal range.Moreover,the C-peptide levels were extremely low and the situation kept after one month to two years' follow-up.Four (28％) patients were glutamic acid decarboxylase antibody (GADA) positive at the onset with two turned negative.One patient was GADA negative at the onset and turned positive after one month.The levels of serum transaminases increased with enlargement of liver in one of the patients after insulin therapy,who was diagnosed as glycogenic hepatopathy.Conclusions FT1 DM is an extremely rapidly progressing type of diabetes and life threatening disease.Causations have to be taken in medical practice.

Objective To observe the clinical efficacy of puncturing Tianshu (ST 25) alone in treating intractable constipation in the elderly.Method Totally 193 senile subjects with intractable constipation were randomized into group A of 57 cases, group B of 73 cases, and group C of 63 cases. Group A was intervened by acupuncture at Tianshu (ST 25), group B was by Lactulose oral solution, and group C was by retention enema. The clinical efficacies and effect-lasting time of the three groups were compared. Result The total effective rate was 89.3% in group A, versus 88.6% in group B and 92.1% in group C, and the between-group differences were statistically insignificant (P>0.05). Of the markedly effective and improved cases, the effect-lasting time in group A was significantly different from that in group B and C (P<0.01).Conclusion Acupuncture at Tianshu (ST 25) alone is an effective method in treating senile intractable constipation.

BACKGROUND:Mental material has shadow intervention effects on multi-slice helical CT (MDCT).Mental wall thickness and lumens inner diameter in stent structure can significantly affect longitudinal axis imaging quality of MDCT target vessel stent.However.there are few studies involved in this aspect.OBJECTIVE:To analyze the effect of various coronary stent materials and structures on patency images of target vessel by MDCT evaluation,and to provide clinical evidences for improving stent technique.DESIGN,TIME AND SETTING:The comparison observation was conducted at the Shenzhou Hospital,Shenyang Medical College.and Shengjing Hospital,China Medical University from January 2006 to December 2008.PARTICIPANTS:A total of 139 patients with coronary heart disease who were treated with stent implantation were divided into material and construct groups (227 stents were implanted).There were 92 stainless steel stents,135 nick-eltitanium alloy stents,85 thin mental wall stents (<140μm).142 thick mental wall stents (≥140μm).71 small diameter stents (<3 mm),and 156 big diameter stents (≥3mm).METHODS:During following up,patients were checked using 64-slice helical CT and routine coronary arteriongraphy to compare patency images of target vessels in the two groups.MAIN OUTCOME MEASURES:MDCT was scored by four-mark standard to evaluate sensitivity,specificity,accuracy,positive and negative predictive values of MDCT.RESULTS:A total of 227 stents were implanted into 139 patients.CT images of stainless steel stent group were poorer than nickel-titanium alloy group,and the indicators including image score,sensitivity,specificity,positive and negative predictive values of the stainless steel stent group were significantly less than nickel-titanium alloy group (P<0.05).CT images of thick-wall stent were poorer than thin-wall stent,while the indicators including image score,sensitivity,specificity,positive and negative predictive values of the thick-wall stent were significantly less than thin-wall stent (P<0.05).CT images of small-diameter stent were poorer than large-diameter stent,while the indicators including image score,sensitivity,specificity,positive and negative predictive values of the small-diameter stent were significantly less than large-diameter stent (P<0.05).CONCLUSION:Materials,wall thickness and diameter of coronary stent may influence images of target vessels via MDCT evaluation.

OBJECTIVETo explore the relationship between temperature and non-accidental mortality in Guangzhou, Changsha and Kunming;to evaluate the temperature-related risk of mortality; and thereby to provide scientific evidence for enacting the policy to tackle climate changes.

METHODDaily meteorology data and mortality data were collected in 2006-2009 in Guangzhou, Changsha and Kunming. Distributed lag non-linear model (DLNM) was established and applied in a case-crossover design, which controlled the secular trend of time, to estimate the specified effects of temperature on non-accidental mortality at conditions of lag 0-2, lag 0-18 and lag 0-27 days, respectively.

RESULTAn obvious seasonal periodicity was found in non-accidental mortality in Guangzhou, Changsha and Kunming during 2006-2009. The mortality number was comparatively high in the winters, and some high temperature days in summer; but was comparatively low in springs and autumn. An L-shaped relationship was found between temperature and mortality in Guangzhou and Kunming and a U-shaped relationship was found in Changsha. When daily mean temperature exceeded 28.2 °C, 24.5°C and 23.2°C, as average temperature increase 1°C, non-accidental mortality increased 4.56% (95%CI:2.74%-6.63%), 5.66% (95%CI:0.22%-12.65%) , -3.94% (95%CI:-32.77%-39.01%) , respectively; when daily mean temperature below 24.8°C, 20.0°C and 17.3°C, as average temperature decrease 1°C, the corresponding increase in non-accidental mortality were 3.28% (95%CI:2.41%-4.10%) (lag 0-18 days), 1.35% (95%CI:0.31%-1.77%) (lag 0-2 days) and 2.42% (95%CI:1.08%-3.27%) (lag 0-27 days) , respectively. The effects of hot weather were acute and short term; while the effects of cold weather had a several days delay, but a longer persistence.

CONCLUSIONSExtreme cold and hot temperature could increase the risk of non-accidental mortality in Guangzhou, Changsha and Kunming. The effects of cold weather had a several days delay, but a longer persistence.

Objective To evaluate the clinical efficacy of early enteral nutrition combined with additional parenteral nutrition (EEN + PN) versus TPN (total parenteral nutrition) in patients after conventional pancreaticoduodenectomy (PD).Methods From January 2009 to January 2013, 340 consecutive patients who underwent conventional PD with Child's reconstruction at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled into this single-center retrospective comparative study.There were 87 patients in the EEN + PN group and 253 patients in the TPN group.The preoperative baseline characteristics,histopathological types, intraoperative parameters and postoperative outcomes were recorded and compared between the two groups.Results There were no significant differences in the preoperative general characteristics data, pathological patterns, and intraoperative details.There were significantly higher rates in delayed gastric emptying (DGE), morbidity (15.9％ vs 6.7％, P ＜ 0.05), and pneumonia (10.3％ vs 3.6％, P ＜ 0.05);significantly prolonged nasogastric tube removal time (5.6 ± 0.2 days vs 3.9 ± 0.1 days, P＜0.05), and increase in hospitalization expenses (65 397.0 ± 861.2) Yuan vs (50 663.9 ± 239.2) Yuan, P ＜ 0.05) in the EEN + PN group when compared with the TPN group.Conclusions EEN + PN after conventional PD was associated with increased rates of DGE and pneumonia, prolonged nasogastric tube removal time, longer EN duration and increase in hospitalization expenses.Hence, EEN should only be performed prudently and selectively.

Objective To investigate the high mobility group box chromosomal protein-1 (HMGB1) levels in patients with acute pancreatitis (AP); and to study the relationship between the serum level of HMGB1 and the severity of AP. Methods The patients' serum HMGB1 concentrations were determined right after admission, 24, 48 hour after admission. The levels of HMGB1 were measured by ELASA kit and its relationship with the severity of AP was analyzed. 20 healthy adults were treated as the control group. Results At the time of admission, and 24, 48 hours after admission, the serum HMGB1 levels in AP patients were (8.05 + 1.60 ), ( 8.04 ± 1.39 ), ( 8.25 ± 1.56) ng/ml, respectively, which were significantly higher than that in the healthy control [ ( 2.20 + 0.57 ) ng/ml, P ＜ 0. 01]. There were 35 patients with severe acute pancreatitis (SAP) and 27 patients with mild acute pancreatitis (MAP). The HMBG1 levels in patients with SAP were (7.99 + 1.69) ,(8.12 ± 1.40), (8.13 ± 1.34) ng/ml, and they were (8.12 + 1.52), (7.92 +1.40), (8.39 ± 1.81 )ng/ml in patients with MAP, and the difference between the two groups was not statistically significant. Conclusions The serum HMGB1 level in AP patients was significantly higher than that in healthy controls, but it was not related with the severity of AP.

Objective To observe the effect of heat needle treatment on the inflammatory reaction in the damaged tissues of rats with the third lumbar transverse process syndrome. Methods Ninety Sprague-Dawley rats were randomly divided into 6 groups, namely normal group, model group, drug group, heat needle group, conventional acupuncture group and warming acup-moxibustion group, 15 rats in each group. The rat model of the third lumbar syndrome was established by embedding gelatin sponge. Two weeks later, the rats in various groups were given corresponding treatment respectively. Before treatment and on the 7th, 14th and 28th day of treatment, the blood samples were collected from jugular vein, and then the serum inflammatory cytokines of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA). On the 28th day of treatment, all of the rats were sacrificed, the expression levels of TNF-α, IL-1βand IL-6 mRNA in the muscle tissue were detected by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR), and the pathological changes in local muscle tissue were observed by HE staining method. Results The serum contents of the inflammatory cytokines of TNF-α, IL-1β and IL-6 in the model group and treatment groups after modeling were significantly higher than those in the normal group (P < 0.05). After treatment, the contents of TNF-α, IL-1β and IL-6 in various treatment groups were decreased significantly as compared with those in the model group, and the decrease was most obvious in the heat needle group. The expression levels of TNF-α, IL-1β and IL-6 mRNA in muscle tissues of drug group, heat needle group, conventional acupuncture group and warming acup-moxibustion group were lower than those of the model group (P < 0.05), and the heat needle group had the lowest levels. HE staining results showed that heat needle group had milder inflammatory reaction and better muscle fiber structure than the model group. Conclusion Heat needle treatment can improve the local inflammatory response and promote the repair of tissue damage through decreasing the expression levels of inflammatory cytokines of TNF-α, IL-1βand IL-6.

Objective:To investigate the characteristics of short-term prognostic factors in very elderly patients with acute coronary syndrome (ACS).Methods:A total of 2 912 ACS patients admitted to Shengjing Hospital of China Medical University from January 1, 2010 to October 31, 2014 and treated with percutaneous coronary intervention (PCI) were enrolled and divided into two groups according to age: very elderly group (≥75 years, 480 cases) and control group (< 75 years, 2 432 cases). The clinical data and coronary artery lesions of the included patients were detected. Major cardiovascular adverse events (MACE) occurred within 30 d after discharge were followed up and recorded. The short-term prognostic factors in very elderly patients with ACS were analyzed by Logistic regression.Results:Compared with control group, the percentage of hypertension, global registry of acute coronary events (GRACE) score, high density lipoprotein cholesterol, N-terminal pro-brain natriuretic peptide, the left main lesion ratio and Gensini score in very elderly group were higher, while the percentage of men, number of smoking, hyperlipidemia proportion, red blood cell count, white blood cell count, blood platelet count, albumin, and long term oral administration of aspirin, clopidogrel, statins, angiotensin receptor inhibitor after discharge were lower, and the differences were statistically significant ( P<0.01 or<0.05). During the follow-up period, the all-cause mortality in very elderly group was higher than that in control group: 2.5%(12/480) vs. 0.9% (21/2 432), and the difference was statistically significant ( P<0.01). Multivariate analysis showed that oral angiotensin converting enzyme inhibitor was a protective factor for elderly ACS patients after discharge ( OR = 0.046, 95% CI 0.006 to 0.383, P = 0.004). The receiver operating characteristic curve analysis showed that Gensini score ≥ 87.75 scores was a threshold value for all-cause mortality. The all-cause mortality ratio in high Gensini score (≥ 87.75 scores) group was higher than that in low Gensini score (<87.75 scores) group: 6.6% (9/137) vs. 0.9% (3/343), and the difference was statistically significant ( P<0.01). Conclusions:Very elderly patients with ACS have their own characteristics from both clinical history and prognostic factors. Patients with Gensini score of ≥ 87.75 scores should be closely observed, and drug treatment during hospitalization should be intensified if necessary. Follow-up should be strengthened for such patients, and oral drug treatment should be continued after discharge.

This article was aimed to study the stability of hesperidin in alkaline solution, in order to provide experi-ment evidences for quality control of extraction and purification as well as formulation development. RP-HPLC was applied to determinate content changes of hesperidin in alkaline solution by changing the temperature, pH and heat-ing time. The results showed that hesperidin was degraded in alkaline solution by heating. The content of hesperidin decreased along with the increasing of heating temperature and heating time. The hesperidin appeared to be more stable in a weak base. It was concluded that for the purpose of ensuring of the stability of hesperidin in alkaline so-lution, it should be kept at low temperature (below 50℃), weak base conditions and shorten the heating time during the preparation process.

ObjectiveTo investigate the family history of other cancers in Chinese han women with familial or sporadic breast cancer.Methodswe analyzed the clinical date of 4 847 primary breast cancer patients cancer patients were treated at the Breast Cancer,Peking University Cancer Hospital between October 2003 and February 2011,among them,465 were familial and4 382 were sporadic breast cancer patients.The differences of family history of cancers other than breast or ovarian cancers were compared between the patients with familial breast cancer and sporadic breast cancer.Results The proportion of cancers other than breast or ovarian cancers in familial breast cancer patients was significantly higher than that in sporadic breast cancer patients(29.7％ vs 20.8％,odds ratio 1.61,P＜ 0.001).Furthermore,the proportion in pancreatic cancer,prostate cancer,and renal cancer in familial breast cancer patients was significantly higher than that of sporadic breast cancer patients ( pancreatic cancer:2.2％ vs 0.8％,P =0.002 ; prostate cancer:1.5％ vs 0.3％,P ＜ 0.001 ; renal cancer:1.1％ vs 0.4％,P =0.03,respectively).And the relative risks of pancreatic cancer,prostate cancer,and renal cancer in the familial breast cancer patients were 2.90-fold,6.07-fold,and 2.97-fold higher than that of sporadic breast cancerpatients,respectively.ConclusionsOur results suggest that the relative risk of cancer other than breast or ovarian in familial breast cancer patients is significantly higher than that in sporadic breast cancer patients,especially pancreatic cancer,prostate cancer,and renal cancer.