Objective To investigate whether the combination of glipizide-XL with glucophage was more rational in insulin resistance and insulin secretion in patients with type 2 diabetes mellitus(T2DM).Methods The changes of insulin resistance and insulin secretion were evaluated from variations of IAI(insulin sensitivity index),IR(insulin resistance index.),IS(insulin secretion index)and HBCI(B-ce1l function index)in cases treated with glipigide-XL and glucophage or either for 18 weeks.Results IAI\IR standing for insulin resistance were higher significantly,and IS & HBCI standing for insulin secretion were lower significantly in patients with T2DM than in normal group(P

BACKGROUND:Previous studies have found that electroacupuncture can delay articular cartilage degeneration mediated by JAK-STAT signaling pathway through upregulating the expression level of transforming growth factor β1 as well as mRNA expression levels of STAT3, Smad3 and LepR. In the meanwhile, electroacupuncture can inhibit the mRNA expression of p38 and Fas mRNA mediated by MAPK signaling pathways, further inhibiting the apoptosis of chondrocytes. OBJECTIVE: To explore the effect of electroacupuncture on the degeneration of articular cartilage in rats with knee osteoarthritis based on Ras-Raf-MEK1/2-ERK1/2 signaling pathway. METHODS:120 male healthy Sprague-Dawley rats aged 2 months olds were selected and randomly divided into normal, model, 15-minite electroacupuncture and 30-minute electroacupuncture groups (n=30 per group). The rats in the latter three groups received the intra-articular injection of 4% papain bilaterally, and the remaining rats received no intervention. At 2 weeks after modeling, the latter two groups were respectively given 15- and 30-minute electroacupuncture, five times weekly for consecutive 12 weeks. The morphology of the cartilage was observed by hematoxylin-eosin staining, the expression level of interleukin-1β in the synovium was detected by ELISA assay, and the protein expression levels of Ras, Raf, MEK1/2, ERK1/2, C-MYC, C-FOS, and C-JUN were detected by western blot analysis. RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed that: in the model group, the cartilage surface was rough, the cartilage layer became thinner, and the cartilage structure was damaged with incomplete tidal line; in the 15- and 30-minute electroacupuncture groups, the cartilage structure was complete with clear layers and complete tidal line. ELISA showed that the expression level of interleukin-1β in the model group was significantly higher than that in the normal group (P< 0.01), and the level in the 15- and 30-minute electroacupuncture groups was significantly lower than that in the model group (P < 0.05). Western blot assay found that compared with the normal group, the protein expression levels of Ras, Raf, MEK1/2, ERK1/2, C-MYC, C-FOS, and C-JUN were increased in the model group. However, all above protein levels except ERK1/2 in the 15- and 30-minute electroacupuncture groups were significantly lower than those in the model group (P < 0.01,P < 0.05). To conclude, electroacupuncture inhibits the degeneration of articular cartilage in osteoarthritisvia Ras-Raf-MEK1/2-ERK1/2 signaling pathway and downregulating the expression level of interleukin-1β.

Objective To approach the predictive value of continuous monitoring end-tidal carbon dioxide partial pressure (PETCO2) on the outcome of in-hospital cardiopulmonary resuscitation (CPR), and explored the indicators of termination of resuscitation. Methods A secondary analysis of a multicenter observational study data was conducted. The screening aim was adult non-traumatic in-hospital CPR patients whose PETCO2were recorded within 30 minutes of CPR. Clinical information was reviewed. The mean PETCO2in restoration of spontaneous circulation (ROSC) and non-ROSC patients was recorded. The outcome of CPR was continuously assessed by PETCO2≤ 10 mmHg (1 mmHg = 0.133 kPa) for 1, 3, 5, 8, 10 minutes. Receiver operating characteristic (ROC) curve was plotted, and the predictive value of PETCO2≤ 10 mmHg for different duration on the outcome of CPR was evaluated. Results A total of 467 recovery patients, including 419 patients with complete recovery were screened. Patients who were out-of-hospital resuscitation, non-adults, traumatic injury, had no PETCO2value, PETCO2value failed to explained the clinical conditions, or patients had not monitored PETCO2within 30 minutes of resuscitation were excluded, and finally 120 adult patients with non-traumatic in-hospital resuscitation were enrolled in the analysis. The mean PETCO2in 50 patients with ROSC was significantly higher than that of 70 non-ROSC patients [mmHg: 17 (11, 27) vs. 9 (6, 16), P < 0.01]. ROC curve analysis showed that the area under ROC curve (AUC) of PETCO2during the resuscitation for predicting recovery outcome was 0.712 [95% confidence interval (95%CI) = 0.689-0.735]; when the cut-off was 10.5 mmHg, the sensitivity was 57.8%, and the specificity was 78.0%, the positive predictive value (PPV) was 84.6%, and negative predictive value (NPV) was 46.9%. The duration of PETCO2≤ 10 mmHg was used for further analysis, which showed that with PETCO2≤10 mmHg in duration, the prediction of the sensitivity of the patients failed to recover decreased from 58.2% to 28.2%, but specificity increased from 39.4% to 100%; PPV increased from 40% to 100%, and NPV decreased from 57.5% to 34.2%. Conclusion For adult non-traumatic in-hospital CPR patients, continuous 10 minutes PETCO2≤10 mmHg may be an indicate of termination of CPR.

OBJECTIVE: To investigate the clinical and genetic characteristics of a patient with STISS syndrome due to variant of PSMD12 gene. METHODS: Clinical data and result of genetic testing of a patient who was admitted to Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine on October 4, 2020 were analyzed, together with a review of relevant literature. RESULTS: The patient was found to harbor a heterozygous c.601C>T (p.Arg201*) nonsense variant of the PSMD12 gene, which was unreported previously. Clinically, the height of the patient has differed significantly from reported in the literature. An extremely rare case of STISS syndrome due to variant of the PSMD12 gene has been diagnosed. CONCLUSION Whether the severely short stature is part of the clinical spectrum for PSMD12 gene variants needs to be further explored, and the efficacy and safety of growth hormone therapy has yet to be determined.
Child ; Humans ; China ; Dwarfism ; Genetic Testing ; Heterozygote ; Syndrome

Objective:To investigate the value of early tight junction protein Claudin-5 levels in predicting the severity of acute pancreatitis (AP).Methods:A prospective observational study was conducted, including patients diagnosed with AP and admitted to the Northern Jiangsu People's Hospital from December 1, 2021 to November 30, 2022. Eligible healthy volunteers were randomly selected to serve as healthy controls during the same period. Patients were classified into mild acute pancreatitis (MAP) group, moderate-severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group based on the 2012 Atlanta classification criteria. Patients with SAP were then divided into three subgroups of 1, 3, and 7 days based on the duration of hospitalization. Baseline data, such as gender, age, underlying disease, and probable etiology, was collected from all enrolled individuals. The enzyme-linked immunosorbent assay (ELISA) was employed to detect serum Claudin-5 levels in each cohort of enrollees. Data on additional serologic indicators, including hematocrit (HCT), albumin (Alb), serum Ca 2+, C-reactive protein (CRP), and procalcitonin (PCT) levels, were obtained via the in-hospital test query system in each group of patients with AP. The modified Marshall score (mMarshall), modified CT severity index (mCTSI) score, bedside severity index of severity in acute pancreatitis (BISAP) score, and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) were recorded for each group of patients with AP. Differences in the above indicators between groups were analyzed and compared. Spearman's correlation method was employed to examine the relationship between Claudin-5 levels and each influential factor. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of each influencing factor on SAP. Ridge regression was used to screen for independent risk factors for SAP. Results:A total of 109 patients with AP were enrolled, comprising 66 in the MAP group, 15 in the MSAP group, and 28 in the SAP group. Additionally, 27 healthy volunteers were enrolled as the healthy control group. No statistically significant differences were observed in gender and age among the enrolled groups, and no statistically significant differences were identified among the three groups of patients with AP in terms of underlying disease and etiologic composition. As the disease progressed, serum Claudin-5 levels exhibited a notable increase across all AP patient groups, and they were all significantly higher than those in the healthy control group [ng/L: 888.58 (574.52, 1 141.59), 3 749.02 (2 784.93, 5 789.92), 4 667.81 (3 935.21, 7 315.66) vs. 291.13 (250.19, 314.75), all P < 0.05]. Subgroup analyses showed that as the disease duration prolonged, patients in the SAP group exhibited a notable decline in Claudin-5 levels at 3 days post-admission, compared with those at 1 day post-admission [ng/L: 2 052.59 (1 089.43, 4 006.47) vs. 4 667.81 (3 935.21, 7 315.66), P < 0.05]. Spearman correlation analysis showed that serum Claudin-5 levels in patients with AP were significantly positively correlated with CRP, PCT, HCT, and mMarshall, mCTSI, and BISAP scores ( r values were 0.570, 0.525, 0.323, 0.774, 0.670, 0.652, all P < 0.001), and significantly negatively correlated with Alb ( r = -0.394, P < 0.001). A significant trend was observed in patients with AP, with an increase of HCT levels and a decrease of Alb levels as the disease progressed (both P < 0.05). An improvement of aforementioned phenomena was observed in patients with SAP following treatment, indirectly indicating that serum Claudin-5 level was a positive indicator of vascular leakage. ROC curve analysis showed that serum Claudin-5 levels in patients with AP exhibited the highest accuracy for early prediction of SAP, with the area under the ROC curve (AUC) of 0.948. When serum Claudin-5 levels ≥2 997 ng/L, the sensitivity for early screening for SAP was 100% and the specificity was 88.89%. Multifactorial ridge regression analysis showed that serum Claudin-5 level, PCT and APACHEⅡscore could be used as independent risk factors for early prediction of SAP (all P < 0.05). Conclusion:Serum Claudin-5 levels facilitate early prediction of SAP and are strongly associated with inflammatory response and vascular leakage.

Objective To explore the value of synchrotron radiation micro-CT(SR-pCT)and automatic marker watershed image segmentation for quantifying three-dimensional local bone tissue and blood vessels in mouse models of breast cancer tibia metastasis.Methods Mouse models with breast cancer bone metastasis in tibia were established and underwent oral Vatalanib,injection of Bevacizumab,combination of Vatalanib or Bevacizumab,or injection of placebo,respectively.On the 8th day(time point T1)and the 22nd day(time point T2)after injection of tumor cells,the tibia bone was scanned using combined vascular contrast injection and SR-pCT,and high-resolution simultaneous imaging of local bone tissue and vascular network were achieved.Then bone tissue and vessels on images were segmented using automatic marker watershed image-segmentation method,global threshold method and region growing method,respectively,and the quality of segmentations were assessed with Dice similarity coefficient(DSC).The anatomical quantitative parameters of tibia with breast cancer metastasis were obtained,including the fraction of bone volume in total volume(BV/TV),fraction of vessel volume in total volume(VV/TV),the mean thickness of bone(B.Th)and the mean thickness of vessel(V.Th).The anatomical quantitative parameters were compared among different treatments at the same time point,also between different time points under the same treatment.Results DSC for segmentation of local tibia bone tissue and vascular structures based on automatic marker watershed image segmentation method were all greater than 0.95,higher than that of other methods(all P＜0.05).No significant difference of anatomical quantitative parameters was found under different treatments at T1(all P＞0.05),and V.Th under the combined treatment were lower than that under other treatments at T2(all P＜0.05).Compared with T1,BV/TV and B.Th at T2 increased while VV/TV at T2 decreased in tibia metastasis under combination treatment(all P＜0.05),BV/TV,B.Th and V.Th at T2 increased under Vatalanib or Bevacizumab treatment(all P＜0.05),and BV/TV and B.Th at T2 increased under placebo(both P＜0.05).Conclusion The combination of SR-pCT and automatic marker watershed method could be used to initially quantify three-dimensional structures of local bone tissue and blood vessels in mouse models of breast cancer tibia metastasis.

Objective To analyze the prevention condition of skin tears of inpatients in level-III hospitals, so as to provide basis for making prevention strategies.Methods 14 level-III hospitals were involved in the cross-section survey. Within the same time period, using the same research tools, methods and procedure, 964 trained nurses inspected patients from head to toes, who were selected by convenience sampling, with hospital stay ≥24 h, with age≥18 years old, and with signature on the informed consent documents, and also investigated implementation of prevention measures. Results A total of 18 806 effective cases were obtained, with 238 locations of skin tears in 199 patients found. Incidence of hospital-acquired skin tears was 1. 06%. Implementation rate of risk assessment and nutrients and water supplement was 3. 92% and 10. 35%. Implementation rate of prevention of falling and falling down from bed was 51. 58% and 47. 20%. Usage of assistant tools and emollients accounted for 28. 23% and 2. 69%. Adopting suitable moving techniques and wearing long sleeves, trousers or long stockings accounted for 8.07% and 6.95%. Differences of incidence rate, risk assessment and implementation of prevention measures of skin tears among teaching hospitals, comprehensive hospitals and specialty hospitals were statistically meaningful ( P < 0. 05 for all ) . Conclusions Risk assessment and prevention of skin tears in these 14 level-III hospitals were not satisfactory. Prevention measures vary from different types of the hospitals. In future, nurses should be trained to strengthen awareness of risk assessment and prevention, and implementation rate and consistency of preventive measures should be improved.

OBJECTIVE：To shar e the experienc e of pharmaceutical care in Wuhan Jinyintan Hospital （herein after refers to “our hospital ”）under the condition of novel coronavirus pneumonia （COVID-19）epidemic，and to provide reference for other hospitals to deal with public health emergencies. METHODS ：The situation of pharmaceutical care in our hospital under the condition of COVID- 19 epidemic was summarized and shared ，including the epidemic prevention and control management （regional division ，disinfection management ，pharmacy personnel training ），supply of drugs and disinfection products ，the monitoring and education of rational drug use by information technology. RESULTS ：The pharmacy department of our hospital divided the activity scope into clean area ，potential pollution risk area ，semi pollution area ，and implement different disinfection management. All pharmacists received training ，involving personal health protection ，prevention and control knowledge of COVID-19，health status monitoring ，etc. For supply and guarantee of drugs and disinfectants ，the epidemic drug list of our hospital was formulated ，drugs and disinfectants were purchased accurately and stored in a standardized way. 24 h response telephone was set up in the clinical pharmacy room to receive consultation from clinicians on drug use at any time. The drugs mentioned in the COVID- 19 diagnosis scheme were compared in terms of the mechanism of action and the medication of special populations to form a tablet ，so as to help clinical rational choice treatment drug. CONCLUSIONS ：The pharmaceutical care in the designated hospital of COVID- 19 is a professional and complicated work ，involving a wide range of aspects. Pharmacy department must respond actively and adjust the strategy in time so as to play an important role in improving the ability of medical treatment.

[摘 要] 目的：探讨幽门螺杆菌（Helicobacter pylori, Hp）感染对胃癌细胞共济失调毛细血管扩张突变（ataxia-telangiectasia mutated，ATM）基因表达的影响及其临床意义。方法：从TCGA数据库中获取胃癌相关RNAseq数据，比较ATM基因的表达差异，分析ATM表达与患者临床病理参数的相关性及预后价值，用Kaplan-Meier法进行生存分析，LinkedOmics数据库分析ATM相关基因，用R语言进行GO、KEGG富集分析。选用2019年3月至2019年12月贵州医科大学附属医院12例手术切除的胃癌及癌旁组织标本，以及胃癌细胞系AGS和BGC823，用感染复数40∶1的Hp GZ7菌感染细胞，用免疫组织化学染色法检测胃癌组织中ATM蛋白的表达，qPCR法检测胃癌组织和细胞中ATM mRNA的表达。结果：TCGA数据显示胃癌和Hp感染胃癌组织中ATM miRNA表达水平均显著高于癌旁组织（均P<0.01）；胃癌组织中ATM miRNA表达与患者的T分期、AJCC分期等病理参数呈正相关（均P<0.05），ATM高表达时生存率显著降低（P<0.05）。实验检测显示，胃癌组织标本中ATM蛋白的表达水平明显高于癌旁组织（P<0.01）；Hp感染胃癌细胞中ATM miRNA表达水平显著高于未感染胃癌细胞（P<0.01）。胃癌中ATM基因与NPAT等12 461个基因呈正相关（P<0.05），与MIF等7 764个基因呈负相关（P<0.05）。GO、KEGG富集分析显示，ATM富集到DNA修复复合体、癌症中的转录失调等信号通路。结论：ATM基因在胃癌组织中高表达，患者生存率随表达水平的增高而降低，其与患者的T分期、AJCC分期等病理参数相关，且Hp感染引起ATM表达水平升高可能是Hp引起胃癌的原因之一。

OBJECTIVETo study the accuracy of pulse contour cardiac output (PCCO) during blood volume change.

METHODSHemorrhagic shock model was made in twenty dogs followed by volume resuscitation. Two PiCCO catheters were placed into each model to monitor the cardiac output (CO). One of catheters was used to calibrate CO by transpulmonary thermodilution technique (COTP) (calibration group), and the other one was used to calibrate PCCO (none-calibration group). In the hemorrhage phase, calibration was carried out each time when the blood volume dropped by 5 percents in the calibration group until the hemorrhage volume reached to 40 percent of the basic blood volume. Continuous monitor was done in the none-calibration group.Volume resuscitation phase started after re-calibration in the two groups. Calibration was carried out each time when the blood equivalent rose by 5 percents in calibration group until the percentage of blood equivalent volume returned back to 100. Continuous monitor was done in none-calibration group. COTP, PCCO, mean arterial pressure (MAP), systemic circulation resistance (SVR), global enddiastolic volume (GEDV) were recorded respectively in each time point.

RESULTS(1) At the baseline, COTP in calibration group showed no statistic difference compared with PCCO in none-calibration group (P >0.05). (2) In the hemorrhage phase, COTP and GEDV in calibration group decreased gradually, and reached to the minimum value (1.06 ± 0.57) L/min, (238 ± 93) ml respectively at TH8. SVR in calibration group increased gradually, and reached to the maximum value (5 074 ± 2 342) dyn · s · cm⁻⁵ at TH6. However, PCCO and SVR in none-calibration group decreased in a fluctuating manner, and reached to the minimum value (2.42 ± 1.37) L/min, (2 285 ± 1 033) dyn · s · cm⁻⁵ respectively at TH8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TH1-8, t values were respectively -5.218, -5.495, -4.639, -6.588, -6.029, -5.510, -5.763 and -5.755, all P < 0.01). From TH1 to TH8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TH1 and TH4, t values were respectively 2.866 and 2.429, both P < 0.05, at TH2 - TH3 and TH5 - TH8, t values were respectively 3.073, 3.590, 6.847, 8.425, 6.910 and 8.799, all P < 0.01). There was no statistic difference in MAP between the two groups (P > 0.05). (3) In the volume resuscitation phase, COTP and GEDV in the calibration group increased gradually. GEDV reached to the maximum value ((394±133) ml) at TR7, and COTP reached to the maximum value (3.15 ± 1.42) L/min at TR8. SVR in the calibration group decreased gradually, and reached to the minimum value (3 284 ± 1 271) dyn · s · cm⁻⁵ at TR8. However, PCCO and SVR in the none-calibration group increased in a fluctuating manner. SVR reached to the maximum value (8 589 ± 4 771) dyn · s · cm⁻⁵ at TR7, and PCCO reached to the maximum value (1.35 ± 0.70) L/min at TR8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TR1-8, t values were respectively 8.195, 8.703, 7.903, 8.266, 9.600, 8.340, 8.938, 8.332, all P < 0.01). From TR1 to TR8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TR1, t value was -2.810, P < 0.05, at TR2-8, t values were respectively -6.026, -6.026, -5.375, -6.008, -5.406, -5.613 and -5.609, all P < 0.05). There was no statistic difference in MAP between the two groups (P > 0.05).

CONCLUSIONPCCO could not reflect the real CO in case of rapid blood volume change, which resulting in the misjudgment of patient's condition. In clinical practice, more frequent calibrations should be done to maintain the accuracy of PCCO in rapid blood volume change cases.

Animals ; Blood Volume ; Calibration ; Cardiac Output ; Disease Models, Animal ; Dogs ; Humans ; Monitoring, Physiologic ; Shock, Hemorrhagic ; diagnosis ; Thermodilution