Objective:To investigate the effect of high-dose vitamin D combined with insulin on serum homocysteine (HCY), glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus.Methods:From June 2020 to May 2023, 120 patients with gestational diabetes mellitus in Yan'an People's Hospital were selected as the research object, and they were randomly divided into observation group and control group with 60 cases in each group. The control group was treated with insulin aspart, while the observation group was treated with insulin aspart and large dose of vitamin D. The levels of serum HCY, glucose metabolism, serum 25-hydroxyvitamin D3 and blood lipid metabolism were compared between the two groups before and after treatment. The pregnancy outcomes of the two groups were compared and analyzed through follow-up.Independent sample t-test is used for comparison between two groups of econometric data that conform to normal distribution, while paired t-test is used for comparison within groups. The comparison between the groups was performed by χ2 test. Results:After treatment, fasting blood glucose ((4.67±0.52) mmol/L vs (5.46±0.68) mmol/L), 2-hour postprandial blood glucose ((6.67±0.56) mmol/L vs (8.42±0.78) mmol/L) and homeostasis model insulin resistance index (2.45±0.45 vs 3.87±0.34) in the observation group were significantly lower than those in the control group, and homeostasis model assessment of islets in pre diabetes patients β cell function index (HOMA-β) in the observation group was significantly higher than that in the control group (87.15±10.45 vs 75.92±10.06). The differences were statistically significant (t values were 7.15, 14.12, 19.50, and 6.00; all P<0.001). After treatment, the serum HCY level ((8.72±1.27) μmol/L vs (10.18±1.65) μmol/L), in the observation group was lower than that in the control group and the serum 25-OH-D3 level ((15.05±2.41) μg/L vs (11.25±2.37) μg/L) in the observation group was higher than that in the control group. The differences were statistically significant ( t=5.43, 8.71, P<0.001). After treatment, the serum triglyceride, total cholesterol and low density lipoprotein cholesterol (LDL-C) in the observation group were compared with those in the control group. LDL-C levels were lower than those in the control group ((2.15±0.15) mmol/L vs (3.23±0.18) mmol/L, (5.23±0.14) mmol/L vs (6.34±0.17) mmol/L, (1.53±0.21) mmol/L and (2.21±0.22) mmol/L), serum high density lipoprotein cholesterol (HDL-C), HDL-C levels were significantly higher than those in the control group ((1.18±0.11) mmol/L vs (0.98±0.12) mmol/L), and the differences were statistically significant (t-values were 35.70, 39.04, 17.32, and 9.52, respectively, all P<0.001). The incidence of adverse pregnancy outcome in the observation group was lower than that in the control group (10% (6/60) vs 40% (24/60)), and the difference was statistically significant ( χ2=14.28, P<0.001). Conclusion:High-dose vitamin D combined with insulin therapy can not only effectively improve glucose and lipid metabolism, but also reduce the HCY level and improve the adverse pregnancy outcome in patients with gestational diabetes mellitus.

Artemisinins/therapeutic use* ; Antiviral Agents/therapeutic use*

Objective:Comparing the diagnostic performance of pulmonary infection pathogens between metagenomic next-generation sequencing (mNGS) testing and traditional assay in patients with AIDS to provide references for the diagnosis and treatment of the disease.Methods:From July 2019 to January 2021, the regular clinical assays as well as mNGS testing were performed for patients and those discharged with a diagnosis of AIDS and pulmonary infection were retrospectively reviewed in the department of infectious diseases of Beijing You An Hospital. The cases with discharge diagnosis of AIDS for whom mNGS testing was performed on samples from respiratory system were analyzed. Diagnostic performance of pathogens was compared between mNGS testing and traditional etiologyic diagnostic method. Diagnosis concordance analysis and diagnostic comparison study between mNGS and traditional etiology diagnosis method in terms of pathogens were also performed.Results:Fifty-five cases discharged with AIDS and pulmonary infection were enrolled.. For 29 cases for whom mNGS testing was performed on samples from respiratory system, the sensitivity of mNGS for diagnosing infection was higher than that of traditional etiology diagnosis method (89.7% vs. 37.9%, P<0.001) but with poor consistency (Kappa=0.249, P=0.170). A superior positivity rate in mNGS than that in traditional etiology diagnosis method for diagnosing bacterial (90.9% vs. 9.1%, P<0.001) Pneumocystis jirovecii (mNGS only), and nontuberculous mycobacteria (mNGS only). Conclusions:mNGS could yield a higher sensitivity for pulmonary pathogen identification in AIDS patients, especially for bacterial, Pneumocystis jirovecii and nontuberculous mycobacteria compared to traditional etiologic diagnostic method.

【Objective】 To evaluate the efficacy and safety of human coagulation factor Ⅷ developed by Shenzhen Weiguang Biological products Co, Ltd in the treatment of patients with hemophilia A. 【Methods】 A prospective, multi-center, open, single-group clinical study was conducted. A total of 65 subjects with hemophilia A were enrolled, and human coagulation factor Ⅷ(FⅧ) was injected according to the patients’ bleeding severity. The improvement score of bleeding symptoms and signs after the first infusion of the first bleeding event and the transfusion efficiency of FⅧ activity at 10 min and 1 hour after infusion were taken as the main efficacy indexes. The improvement scores of bleeding symptoms and signs after the first infusion and the increase of FⅧ activity at 10 min and 1 hour after infusion were the secondary efficacy indexes. 【Results】 The 65 subjects were enrolled in safety analysis set (SS) and full analysis set (FAS), and 58 of them were enrolled in protocol analysis set (PPS). Ten minutes and one hour after the first infusion, the level of factor Ⅷ activity in the subjects increased significantly, and the FⅧ activity increased by 100% or more in more than 79% of the subjects. The average infusion efficiency of FⅧ activity in all subjects was more than 100%. In 70% of the subjects, the pain was relieved rapidly and /or the bleeding symptoms were significantly improved 8 hours after each bleeding infusion, and the improvement rate of bleeding symptoms and signs reached 100% 72 hours after infusion. 【Conclusion】 After infusion of human coagulation factor Ⅷ, the activity level of factor Ⅷ in patients with hemophilia A significantly increased. The infusion efficiency can reach a optimal level, and the bleeding symptoms can be significantly improved.

【Objective】 To evaluate the clinical efficacy and safety of one kind of human prothrombin complex concentrate in treatment of patients with hemophilia B. 【Methods】 The clinical data of 36 patients with hemophilia B treated with human prothrombin complex concentrate produced by Shenzhen Weiguang Biological Products Co. Ltd. from May 2018 to April 2019 were retrospectively analyzed, and its clinical efficacy and safety were analyzed. 【Results】 A total of 35 subjects entered the full analysis set (FAS)and safety set (SS), 33 subjects entered the per protocol Set (PPS). Thirty minutes after the first infusion of FAS subjects, the activity of coagulation factor Ⅸ increased from (3.93±0.975) IU/dL to (25.61±9.337) IU/dL, and the infusion efficiency was (96.43±22.007)%. The increased value of coagulation factor Ⅱ activity was (73.25±14.874) IU/dL. The activity of coagulation factor Ⅶ was (42.79±16.847) IU/dL. The increased value of coagulation factor Ⅹ activity was (65.29±17.042) IU/dL. The increased value of coagulation factor Ⅸ activity was (21.68±9.434%) IU/dL. Twenty-four hours after the first infusion of FAS subjects, the improvement of bleeding symptoms and signs was excellent in 21 cases (60%), improved in 14 cases (40.0%), and the effective rate was 100%. The incidence of adverse reactions was 2.9%(1/35), and there was no antibody to human coagulation factor Ⅸ and new virus infection. 【Conclusion】 Infusion of human prothrombin complex concentrate produced by Shenzhen Weiguang Biological Products Co. Ltd. in the treatment of hemophilia B has significant clinical efficacy and good safety.

Objective:To investigate the correlation between CD133 expression and clinicopathological features in triple negative breast cancer (TNBC) patients, and the impact of CD133 on prognosis in these patients.Methods:Data of 70 patients who received surgical treatment in our center from Jan. 2008 to Dec. 2012 were collected. Immunohistochemistry was used to examine the expression of CD133. Patients were divided into two groups according to CD133 expression. Univariate analysis, Cox and Logistic regression multivariate analysis were used in order to investigate the correlation between CD133 expression and clinicopathological features. Kaplan-Meier curve and Log-rank analysis were used to evaluate DFS (disease-free survival) and OS (overall survival) .Results:CD133 was expressed in cytomembrane and cytoplasm with expression rate of 95.71% (67/70) . Of which, 64.29% (45/70) of patients were low CD133 expression and 35.71% (25/70) were high expression. High CD133 expression was significantly correlated with younger age (≤50) ( P=0.007) and larger tumor size (>2 cm) ( P=0.020) . Tumor size ( P=0.035) , axillary status ( P=0.001) , Ki67 ( P=0.005) and CD133 expression ( P=0.014) were independent predictors of recurrence and metastasis in TNBC patients. Axillary status was independent predictor of death event ( P=0.008) . Increased CD133 was associated with poor prognosis. Compared with high expression, patients with low CD133 expression had better DFS ( P=0.002) and OS ( P=0.088) , while OS did not reach significant difference. Conclusion:CD133 expression was correlated with age and tumor size in TNBC patients. High expression was associated with recurrence, metastasis and poor prognosis. Thus, CD133 may be a potential biomarker in predicting prognosis in TNBC.

Objective:To understand the clinical characteristics of patients with Corona virus Disease 2019 (COVID-19) so as to further provide practical references for clinical practice through collecting and analyzing the clinical data of COVID-19 patients admitted to Beijing Yuoan Hospital.Methods:The clinical data were summarized and analyzed for COVID-19 classified as severe patients and critically ill patients between January 28, 2020 and February 12, 2020 in Beijing Youan Hospital, including their age, gender, course of disease, epidemiological history, previous history, clinical symptoms, laboratory tests, CT findings of lungs, treatment and clinical outcomes. Statistical processing was performed using SPSS software (version 22.0).Results:Nineteen patients were included in this study and divided into two groups by investigators, i. e. ten of the patients had severe type and 9 had the critically ill type of the disease. The average age of the patients was 75 years (range from 58 to 94 years), including 10 males and 9 females. Their course of diseases varied from 1 day to 14 days with a median of 5 days. Among these patients, 4 patients resided in Wuhan, 13 patients had been in close contact with confirmed patients (including family gatherings, during meals, living in the same room, etc.), and 2 patients had no relevant epidemiological history. Fourteen patients suffered from underlying chronic diseases (including 11 cases with hypertension, 4 cases with coronary heart disease, 4 cases with cardiac insufficiency, 3 cases of chronic obstructive pulmonary disease, 2 cases of previous anterior myocardial infarction, 3 cases of arrhythmia, 1 case of heart valve disorders, 2 cases of diabetes mellitus, 2 cases of chronic renal disease, etc.), and 4 patients had 3 or more underlying diseases at the same time. The first symptoms at onset of illness were fever in 18 cases, cough in 13 cases, and dyspnea in 8 cases. Seventeen patients had absolute lymphocyte count (ALC) lower than the normal range. Eleven patients experienced different degrees of hepatic injury, 10 patients had renal injury, 7 patients had abnormal myocardial enzymes to a varying degree. C-reactive protein was increased in 18 patients.12 patients received hormone therapy, 4 patients were treated with gamma globulin, 3 patients used non-invasive ventilator mechanical ventilation, and 7 patients used an invasive ventilator to assist ventilation. Moreover, 1 patient received continuous renal replacement therapy (CRRT), and 1 patient was treated with extracorporeal membrane oxygenation (ECMO). As of February 17, 2020, 10 patients had recovered or been discharged upon treatment, 4 patients were still in the intensive care unit (ICU), and 5 patients had died.Conclusions:The elderly and individuals who had underlying diseases were considered as independent predictors for developing severe and critical disease, and were at higher risk of increased mortality. The decrease of ALC and the increase of C-reactive protein levels in the patients, and the abnormality of liver function, renal function and myocardial enzyme spectrum to different degrees suggest the correlation with severe cases. Steroids and ventilator are effective in the treatment of severe cases.

Malignancy is one of the most important complications of acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) infection and destruction of host CD4-positive T lymphocytes. Lymphoma ranks first in AIDS-related malignancies. The clinical features of lymphoma patients infected with HIV are different from non-HIV infected patients. The host immune condition in anti-lymphoma chemotherapy also needs to be considered. This paper reviews the clinical characteristics of AIDS-related lymphoma and the attention in anti-lymphoma therapy according to the latest international research findings and related guidelines.

Objective To compare the effectiveness and safety of endoscopic submucosal dissection ( ESD) with endoscopic piecemeal mucosal resection ( EPMR) for early esophageal cancer and precancerous lesions with length more than 5 cm. Methods A retrospective analysis was performed on data of 85 patients diagnosed as early esophageal cancer and precancerous lesions with length more than 5 cm in Fujian Medical Association of Early Esophageal Carcinoma from January 2012 to July 2017. The patients were divided into ESD group (52 cases) and EPMR group (33 cases), and the effectiveness and safety between the two groups were compared. Results There was no significant difference on the complete resection rate between the two groups[86. 5％ (45/52) VS 87. 9％ (29/33), P>0. 05]. The operative time (58. 53±30. 50 min VS 32. 06±9. 12 min), postoperative fasting time (4. 18±1. 30 d VS 3. 67±0. 96 d), postoperative hospital-stay time (7. 45±2. 44 d VS 6. 54±1. 73 d), and postoperative antibiotics using time (3. 48±2. 33 d VS 1. 96±2. 20 d) in ESD group were higher than those in EPMR group (all P<0. 05). There were no significant difference in the rate of intraoperative complication and short-term postoperative complication, such as fever, chest pain, and postoperative bleeding, between the two groups ( all P>0. 05 ) . But the postoperative stricture rate of ESD group was higher than that of EPMR group[23. 1％ (12/52) VS 6. 1％(2/33), P<0. 05]. During the follow-up of 3-63 months, 5 cases recurred in ESD group and 1 case in EPMR group, with no significant difference ( P>0. 05). Conclusion ESD and EPMR have equivalent efficacy and safety on the treatment of early esophageal cancer and precancerous lesion. EPMR has a shorter operative time, lower rate of post-operative stricture, and is easier to master.