Thirty-three patients with new-onset type 1 diabetes from Zhongshan Hospital, Fudan University were recruited from 2013 to 2014. Relevant clinical data were collected for the statistical analysis. Among the 33 patients with type 1 diabetes, there were 7 with fulminant type 1 diabetes (FT1DM), 12 acute onset type 1 diabetes (AT1DM), and 14 with slowly progressive type 1 diabetes (SPIDDM). The fasting and stimulated C-peptide levels were significantly lower while glycated albumin (GA)/HbA1C and mean amplitude of glucose excursions (MAGE) levels were significantly higher in FT1DM group compared with other two groups(all P<0.05). Pearson correlation analysis in all patients with type 1 diabetes revealed that GA/HbA1C was correlated with fasting C-peptide, MAGE, and difference of the peak blood glucose to the lowest blood glucose (ΔBG) levels (all P<0.05). Stepwise multivariate analysis showed that GA/HbA1C was independently correlated with MAGE and ΔBG (P<0.05). Logistic regression model indicated that GA, HbA1C, and GA/HbA1C were independently correlated with FT1DM.

Objective:To evaluate the value of blood urea nitrogen (BUN)/creatinine (Cr) ratio for guiding the access route of double balloon enteroscopy (DBE) for small intestinal bleeding.Methods:The clinical information was collected from 105 patients who underwent DBE for suspected small intestinal bleeding at Air Force Medical Center from January 2015 to October 2019. Patients were divided into the elevated BUN/Cr group ( n=52) and the normal BUN/Cr group ( n=53), with a cut-off value of 81. Comparison was made for the detection rate of lesions between the oral route and anal route separately in the two groups using Chi-square test. Results:Among the 105 patients with suspected small intestinal bleeding, definite causes of bleeding were identified in 79 patients by DBE, and the overall lesion detection rate was 75.24% (79/105). In the elevated BUN/Cr group, the overall lesion detection rate was 76.92% (40/52), among which 79.49% (31/39) was through oral and 47.37% (9/19) through anal enteroscopy. In the normal BUN/Cr group, the overall lesion detection rate was 73.58% (39/53), and 63.64% (21/33) was transoral and 51.43% (18/35) transanal. The lesion detection rate of transoral enteroscopy in the elevated group was significantly higher than that in the normal group ( χ2=6.576, P=0.010). There was no significant difference in the lesion detection rate of transanal enteroscopy between the two groups ( χ2=2.230, P=0.135). Conclusion:For patients with active small intestinal bleeding (active bleeding within 48 hours), the BUN/Cr ratio higher than 81 may indicate that DBE should be performed firstly via oral route.

Objective:To investigate the efficacy of double balloon enteroscopy (DBE) in the treatment of bleeding from small intestinal vascular lesion and risk factors of bleeding recurrence .Methods:From April 2013 to May 2020, at Air Force Medical Center, the clinical data of 65 patients with confirmed or suspected bleeding from small intestinal vascular lesion were retrospectively analyzed. The patients were divided into DBE treatment group (patients of Yano classification 1a and 1b received argon plasma coagulation, and patients of Yano classification 2 and 3 accepted combination of titanium clip and submucosal injection of lauromacrogol sclerosing agent) and non-DBE treatment group (traditional treatments such as stopping anticoagulant or antiplatelet drugs, blood transfusion, and iron supplementation). The bleeding recurrence of patients with single small intestinal vascular lesion between DBE treatment group and non-DBE treatment group, and patients with single or mulitiple vascular lesion of DBE treatment group were compared. Univariate analysis was used to analyze the clinical data of patients with or without recurrent bleeding. Multivariate logistic regression model was used to analyze the independent risk factors and protective factors of recurrent bleeding in small intestinal vascular lesion. Independent sample t test, chi-square test and Fisher exact probability method were used for statistical analysis. Results:Forty-four (25 of single vascular lesion and 19 of multiple vascular lesion) patients were diagnosed with small intestinal vascular lesions and received DBE treatment (DBE treatment group). Twenty-one patients with single vascular lesion accepted traditional treatment (non-DBE treatment group). The recurrent rate of bleeding in patients with single vascular lesion of DBE treatment group was lower than that in patients with single vascular lesion of non-DBE treatment group and patients with multiple vascular lesion of DBE treatment group (24.0%, 6/25 vs. 71.4%, 15/21 and 12/19), and the differences were statistically significant ( χ2=10.348 and 6.848, P=0.001 and 0.009). The results of univariate analysis showed that the proportion of blood transfusion, hypertension, complicated with valvular heart disease and DBE treatment in patients with rebleeding or not rebleeding from small intestinal vascular lesion was different with statistically significant (69.7%(23/33) vs. 37.5%(12/32), 51.5%(17/33) vs. 18.8%(6/32), 42.4%(14/33) vs. 12.5%(4/32) and 54.5%(18/33) vs. 81.2%(26/32), χ2=6.777, 7.628, 7.265, and 5.298, all P<0.05). The results of multivariate logistic regression analysis indicated that blood transfusion during the course of disease (odds ratien ( OR)=3.736, 95% confidence interval ( CI) 1.082 to 12.898, P=0.037) and complication with valvular heart disease ( OR=4.916, 95% CI 1.107 to 21.829, P=0.036) were independent risk factors of bleeding recurrence in patients with small intestinal vascular lesions. DBE treatment was the protective factor of bleeding recurrence in patients with small intestinal vascular lesion ( OR=0.214, 95% CI 0.057 to 0.808, P=0.023). Conclusions:DBE is effective in the treatment of small intestinal vascular lesion bleeding, especially for single vascular lesion. Blood transfusion during disease course and complication with valvular heart disease are independent risk factors for bleeding recurrence in patients with small intestinal vascular lesion.

Tamarindus indica Linn. tamarinds,belonging to the family Caesalpiniaceae,is a kind of large subtropical ever?green tree. Every part of tamarind has rich nutritional value and broad usage in traditional medicine since ancient times. Recent studies suggest extraction of leaves,flesh,seeds,and velamina of T. indica Linn. have numerous biological activities such as anti-microbial, anti-inflammatory,detoxification,analgesic,antidiabetic and anti-hyperlipidemiactions. A great interest has been seen in various sec?ondary metabolites isolated and identified from chemical components of T. indica Linn. In this review article,we summarize recent achievement in chemical components and biological activities of T. indica Linn.,aiming to provide a useful reference for further study and exploitation of T. indica Linn..

Objective: To explore the establishment and application of three-dimensional model of deep inferior epigastric artery perforator flap based on computed tomography angiography (CTA). Methods: Six patients with breast absence after modified radical mastectomy because of breast cancer, 5 patients with congenital absence of vagina, and 6 patients with Paget′s disease of penis and scrotum were hospitalized in our unit from January 2012 to April 2017. The size of wounds after excision of the lesion or that of flaps needed for reconstruction ranged from 17 cm×5 cm to 25 cm×9 cm. Abdominal CTA was performed before the surgery, and data of CTA were sent to CT workstation to make three-dimensional model of deep inferior epigastric artery perforator flap according to shape and size of wound. The number, course, and location of deep inferior epigastric artery, vein, and their perforators, and the superficial inferior epigastric vein were observed in the above-mentioned three-dimensional model. The rectangular plane coordinate system with the umbilicus as the origin was established to locate and observe course and type of the largest deep inferior epigastric artery perforator in left and right side. Deep inferior epigastric artery perforator flaps were designed and deep inferior epigastric artery perforators etc. were marked according to three-dimensional models of the flaps before the surgery. The condition observed in three-dimensional model of the flap was compared with the clinical condition in the surgery of free transverse bilateral deep inferior epigastric artery perforator flap transplantation for breast reconstruction and longitudinal pedicled thinned unilateral deep inferior epigastric artery perforator flap transplantation for vagina reconstruction and wound repair of Paget′s disease of penis or scrotum. The size of flap ranged from 17 cm×6 cm to 25 cm×10 cm. Results: Seventeen three-dimensional models of deep inferior epigastric artery perforator flaps were established, including 6 bilateral models and 11 unilateral models. Seventy-two reliable deep inferior epigastric artery perforators were observed in the three-dimensional model with 3.2±0.7 in the right and 3.1±0.8 in the left. The locations of the largest deep inferior epigastric artery perforators in the right and left were [(-3.2±1.4) cm, (-1.0±0.7) cm] and [(4.0±1.2) cm, (-1.2±1.1) cm] respectively. Fourteen largest deep inferior epigastric artery perforators coursed directly and nine coursed tortuously in the rectus muscle. Twenty-three superficial inferior epigastric veins were detected in the three-dimensional models of the flaps. The number, location, and course of deep inferior epigastric artery and vein and superficial inferior epigastric vein observed in the three-dimensional model of deep inferior epigastric artery perforator flap were in accordance with the condition observed in the surgery. Seventy reliable deep inferior epigastric artery perforators were detected in the surgery, and the other 2 perforators were unclear due to bleeding. Course of these perforators were in accordance with the condition observed in the three-dimensional model. Deep inferior epigastric artery perforator flaps of all patients survived well with no complication except that 1 patient suffered from delayed healing of wound in perineum. During follow-up of 1 to 12 months, all flaps survived with good shape and texture. Conclusions The three-dimensional model of deep inferior epigastric artery perforator flap based on CTA can be established easily and can provide information of number, location, and course of deep inferior epigastric artery, vein, and their perforators, and superficial inferior epigastric vein to guide preoperative design and intraoperative dissection of the flap effectively.

Objective:To evaluate the efficacy of self-made Xiaogan Tiaopi Kaiwei Decoction combined with conventional western medicine therapy in the treatment of infantile anorexia of spleen-stomach weakness.Methods:Randomized controlled trial. A total of 100 children with anorexia of spleen-stomach weakness ,who were treated in the First Clinical Medical College of Shaanxi University of Chinese Medicine between April 2020 and September 2021, were selected as the observation subjects in a prospective cohort study, and they were divided into two groups by the random number table method, with 50 in each group. The control group was given routine treatment, and the Traditional Chinese Medicine (TCM) group was given self-made Xiaogan Tiaopi Kaiwei Decoction on the basis of the control group. The TCM syndromes were scored before and after treatment. The levels of trace elements such as iron, zinc and calcium were detected by atomic spectrometer, the absorptivity of D-xylose was measured by colorimetry. The adverse events during treatment were recorded. After 6 months of follow-up, the height, weight and BMI were measured and recorded, and the clinical efficacy was assessed.Results:The total response rate was 96.0% (48/50) in the TCM group and that in the control group was 84.0% (42/50) ( χ2=4.00, P=0.046). The scores of decreased appetite, anorexia, sallow complexion, abdominal fullness and distention and shortness of breath and laziness to speak and total score in the TCM group after treatment were significantly lower than those in the control group ( t=12.47, 13.42, 14.19, 16.39, 9.15, 17.72, P<0.01). The levels of blood trace elements such as iron [(414.58 ± 57.52) mg/L vs. (350.85 ± 53.33) mg/L, t=5.75 ], zinc [(8.26 ± 1.55) mg/L vs. (7.64 ± 1.37) mg/L, t=2.12 ] and calcium [(77.26 ± 15.30) mg/L vs. (71.05±14.26) mg/L, t=2.10] and urine D-xylose absorption rate [(31.76±5.28) % vs. (27.97 ± 4.61) %, t=3.82 ] in the TCM group were significantly higher than those in the control group ( P<0.01 or P<0.05). During treatment, there was no serious adverse reaction in the TCM group and 1 case of nausea in the control group. There was no statistical significance in the incidence rate of adverse reactions between the two groups ( χ2=1.01, P=0.315). After follow-up, the weight in the TCM group was significantly higher than that of the control group ( t=2.17, P=0.032). Conclusion:Self-made Xiaogan Tiaopi Kaiwei Decoction combined with conventional western medicine therapy can relieve the clinical symptoms, promote the absorption of trace elements and improvement of spleen-stomach function, and enhance the long-term efficacy in the treatment of children with anorexia of spleen-stomach weakness, and it has no adverse reactions.

Objective:To evaluate the efficacy and safety of endoscopic stricturotomy (EST) under balloon-assisted enteroscopy (BAE) in treatment of benign jejuno-ileal stenosis.Methods:From December 2015 to August 2021, at the Air Force Medical Center, 41 patients who were diagnosed with benign jejuno-ileal stenosis underwent BAE deep small bowel EST and/or surgery due to ineffective or ineffective drug treatment were retrospectively analyzed. Twenty-one patients were treated with EST (EST group) and 20 patients were treated with surgery (surgery group). The etiology and follow-up time were analyzed, the general conditions (male proportion and age), the immediate technical success rate (the percentage of the stenosis that the enteroscope could pass through after EST in the total number of treated stenoses), the incidence of complications (including perforation, bleeding, etc.), the symptom remission rates at 3-month, 6-month, and 1-year after treatment (the percentage of patients with complete or partial remission in the total number of patients), cumulative symptom-free survival rate (no obstruction-related symptoms after EST or surgery till the last follow-up) and cumulative surgery-free survival rate of two groups were compared. Chi-square test, independent t-test, Fisher′s exact probability method and Kaplan-Meier analysis were used for statistical analysis. Results:The main etiology of stricture of EST group and surgery group was Crohn′s disease (71.4%, 15/21 and 60.0%, 12/20, respectively), and the median follow-up time was 12 months (6 to 46 months) and 45 months (14 to 73 months), respectively. There were no significant differences in male proportion, age, immediate technical success rate and incidence of complication between EST group and surgery group (57.1%, 12/21 vs. 65.0%, 13/20; (45.2±17.4) years old vs. (43.1±20.3) years old; 95.3%, 41/43 vs. 100.0%, 30/30; 26.9%, 7/26 vs. 10.0%, 2/20, all P>0.05). In the EST group, 9.5% (2/21) of the patients received surgery because of perforation during EST, 76.2% (16/21) of the patients did not need surgery after EST, and the median symptom-free survival time of patients without symptoms in EST group was 13.3 months. There was no significant difference in the symptom remission rate at 3-month after treatment between EST group and the surgery group (17/19 vs. 100.0%, 20/20, P>0.05). The symptom remission rate at 6-month and 1-year of EST group were lower than those of the surgery group (15/19 vs. 100.0%, 20/20; 8/11 vs. 100.0%, 20/20), and the differences were statistically significant (both were Fisher′s exact probability method, P=0.047 and 0.037). The cumulative symptom-free survival rates at 3-month, 6-month and 1-year of EST group and surgery group were 66.0% vs. 90.0%, 61.0% vs. 85.0% and 54.0% vs. 80.0%, respectively.The results of Kaplan-Meier analysis indicated that there was no significant difference in the symptom-free survival curve between two groups ( P>0.05). The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in EST group were 90.0%, 81.0% and 73.0%, respectively. The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in surgery group were all 100.0%. Conclusion:EST under BAE is technically feasible, and safe in the treatment of benign jejuno-ileal stenosis, and can effectively relieve clinical obstruction symptoms and avoid or delay surgery in the short term.

Objective:To evaluate the efficacy and safety of combination of sufficient argon plasma coagulation(APC) cauterization and clipping in the treatment of colonic diverticular bleeding.Methods:From June 2018 to April 2022, the clinical data of patients were retrospectively analyzed, who visited Department of Gastroenterology of Air Force Medical Center due to overt gastrointestinal bleeding, and were confirmed or suspected to have colonic diverticular bleeding and received combination of sufficient APC cauterization and clipping treatment. The deadline for follow-up was September 30, 2022. During the follow-up after endoscopic treatment, the re-bleeding rate, hemoglobin level difference between the last follow-up and before treatment, wound healing under colonoscopy as well as the intraoperative and postoperative complications of patients were statistically analyzed. Descriptive analysis was used for statistical analysis.Results:A total of 15 patients were enrolled, including 13 males and 2 females, aged (60.8±14.8) years old. The course of the disease was 1 day to 13 years. A total of 145 colonic diverticula of 15 patients were treated under endoscopy. The median follow-up time was 14.5 months (5.3 to 49.5 months) months. Among the 15 patients, 12 patients received endoscopic therapy once and no bleeding occurred till the end of follow-up. Three patients suspected with diverticular bleeding received a second endoscopic treatment because of bleeding at the 12 days, 3 months and 8 months after the first treatment, respectively.No rebleeding occurred after the second endoscopic therapy till the end of follow-up. The re-bleeding rate of the first treatment was 3/15 and the re-bleeding rate of re-treatment was 0. At the end of follow-up, the hemoglobin concentration increased (35.9±26.3) g/L compared with that before the treatment. Two patients had perforation during operation and were closed with multiple titanium clips. There was no abdominal pain or other symptoms after operation. And the patients were discharged 3 and 4 days after treatment, respectively. Two patients suffered short-term postoperative wound bleeding and successful hemostasis was achieved after endoscopic treatment. One patient developed postoperative infection and the symptoms disappeared after anti-infection treatment.Conclusions:Combination of sufficient APC cauterization and titanium clipping is safe and effective in the treatment of colonic diverticular bleeding. For patients with dominant diverticular hemorrhage, or patients with recurrent gastrointestinal bleeding, if other etiology are excluded and colonic diverticular bleeding is highly suspected, the combination of sufficient APC cauterization and titanium clipping under endoscopy is feasible.