The management of hyperglycemia in the intensive care unit(ICU)patients has been concerned in recent years.Epidemiological data show that the occurrence of severe hyperglycemia is associated with increased mortality and morbidity in ICU patients.Several large scale trials about intensive glycemic control in the critically ill patients were carried out,but reached disparate conclusions.Based on the latest clinical research evidences,the optimal target range of blood glucose Level in ICU patients seems to be 7.8-10 mmol/L.However,the target should be individualized in clinical practice.Both hyperglycemia and hypoglycemia should be carefully avoided.

Action for Health in Diabetes( Look AHEAD) trial showed that an intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adult patients with type 2 diabetes. However, the intensive lifestyle intervention improved the control levels of the risk factors for cardiovascular disease, attenuated the obesity-associated comorbidities, and improved the quality of life in these patients.

Standards of Medical Care in Diabetes released by American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies,the Standards of Medical Care in Diabetes is annually updated by ADA. The statement of ADA on diagnosis,assessment and management in diabetes are recommended for clinicians,patients and researchers. The latest edition of Standards of Medical Care in Diabetes was published as supplement form on Diabetes Care in January 2017. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.

Glycated hemoglobin A1c ( HbA1c) is worldwide used as the gold standard for long term glycemic control in patients with diabetes.Recently,it has been recommended as one of the diagnostic criteria of diabetes mellitus.To improve the accuracy and comparability of HbA1c testing,expedite the standardization of HbA1c assay and make a reasonable interpretation of the HbA1c results in clinical practice are inevitably faced by clinical laboratorians together with physicians.

Objective To compare the efficacy and safety of insulin aspart (IAsp) versus regular human insulin (RHI) used in basal bolus (BB) or continuous subcutaneous insulin infusion (CSII) regimen in patients with diabetes mellitus in Chinese population.Methods We searched MEDLINE (via OVID),the Cochrane Library,Embase,PubMed,CBM,China National Knowledge Infrastructure (CNKI),and Wanfang databases from the beginning of the databases to November,2015.The randomized controlled trials comparing IAsp and RHI in DM were searched.The meta-analysis in newly diagnosed DM and treated DM was performed by RevMan 5.3.Results A total of 40 trials were included in this study,with 1087 newly diagnosed and 2395 treated DM patients.In both groups,IAsp was better in lowering 2 hours postprandial plasma glucose (2 hPG) after breakfast,lunch and dinner (For newly diagnosed population MD=-1.22,-1.70,-1.44;95%CI:-1.79~-0.64,-2.77~-0.63,-2.12~-0.75;for treated population MD=-1.19,-1.14,-1.03;95%CI:-1.39~-0.98,-1.27~-1.02,-1.25~-0.81) and fasting plasma glucose (For newly diagnosed population MD=-0.55,95%CI:-0.97~-0.12;for treated population MD=-0.24,95%CI:-0.44~-0.03) when compared with RHI.IAsp could shorten the time to achieve blood glucose target(For newly diagnosed population MD=-1.58,95%CI:-1.74~-1.42;for treated population MD=-1.73,95%CI:-2.10~-1.36) and reduce the risk of hypoglycaemia compared with RHI (For newly diagnosed population RR=0.33,95%CI:0.19~0.56;for treated population RR=0.44,95%CI:0.32~0.61) (P<0.05).Moreover,the total daily insulin dose was lower in IAsp therapy than in RHI therapy when using CSII regimen.Conclusion In Chinese DM patients,IAsp shows advantages in controlling 2 hPG,shortening the time to achieve blood glucose target and lowering the risk of hypoglycaemia when compared with RHI.

Objective To evaluate cerebrospinal fluid adenosine deaminase(CSF-ADA)activity in the diagnosis of tuberculous meningitis(TMB), and to observe its dynamic changes. Methods A total of 160 patients were included and were divided into two groups: 76 cases of TBM and 84 cases of non-TBM.Among the cases of non-TBM, there were 36 cases of bacterial meningitis, 30 cases of viral meningitis and 18 cases of cryptocoocal meningitis. All the patients were measured with their CSF-ADA activity by Enzymecoupled assay(Trinder method)and 47 patients of TBM were measured again after 2 weeks' and 6 weeks'antitubercular therapy. Results were expressed as(-x)± s. Mann-Whitney U test and paired-samples t test were used. Results CSF-ADA activity in TBM group was(12.9 ±6.4)U/L, while that in the non-TBM group was(6.0 ± 4.1)U/L, the difference was of statistical significance(U = 7.860, P ＜ 0.05). With the cutoff value of 9 U/L, the sensitivity and specificity to differentiate TBM from non-TBM was 84.21% and 83. 33%, respectively. CSF-ADA activity decreased in TBM patients after antitubercular treatment.Conclusions CSF-ADA activity can be an effective laboratory marker for early differential diagnosis of TMB with the cut-off value of 9 U/L. Dynamic changes of CSF-ADA activity may be a indicator for the effect of antitubercular treatment.

Humans ; Male ; Middle Aged ; Tracheal Stenosis

[Summary] A 19-year-old male patient with central diabetes insipidus complained of polydipsia and polyuria and was found to be accompanied by cervical vertebra lesions.The diagnosis of Langerhans cell histiocytosis was confirmed by laboratory and pathological results.Therefore,it should be alert to consider the possibility of Langerhans cell histiocytosis in a patient with central diabetes insipidus coexisting with the signs of multisystem lesions such as bone disease.

Objective To analyze the reproducibility of keratometry and astigmatism measured by the VERION Digital Guidance System and the comparability of VERION with iTrace,Lenstar LS900 and manual keratometer.Methods The keratometry of 62 cataract patients were measured using four different devices.The steep keratometry (Ks),flat keratometry (Kf),astigmatic magnitude,astigmatic axis,cylinder at 0-degree meridian (vector component,J0) and cylinder at 45-degree meridian (vector component,J45) from each machine were recorded and analyzed.The three repeated measurements and the results of VERION system with other three devices were compared to analyze the reproducibility and comparability of VERION system.Results Reproducibility:Intraclass correlation coefficients and Cronbach's alpha values were higher than 0.9 for Ks,Kf,astigmatic magnitude,astigmatic axis,J0 and J45 measured by the VERION system (all P ＜ 0.001).Comparability:The results of Ks and magnitude of astigmatism of VERION were larger than the iTrace (all P ＜ 0.05) in the paired-samples t test.There was no statistical difference for the rest of parameters (all P ＞ 0.05).The Bland-Altman graphs revealed the 95％ limits of agreement (LOA) of J0,J45 and the astigmatic axis between VERION and iTrace were (-0.31-0.35) D,(-0.25-0.31) D and-13.5 °-12.3 °,respectively;There was no statistical differences for all parameters except for J45 in the paired-samples t test between the VERION and Lenstar LS900 (all P ＞ 0.05).The Bland-Altman graphs revealed the 95％ LOA of J0,J45 and the astigmatic axis were (-0.25-0.31)D,(-0.27-0.36) D and-13.5°-11.0°,respectively;There were statistical differences for the results of Kf and magnitude of astigmatism between the VERION and manual keratometer (all P ＜ 0.05).The Bland-Altman graphs revealed the 95％ LOA of J0,J45 and the astigmatic axis between VERION and manual keratometer were (-0.38-0.35) D,(-0.41-0.42) D,-12.6°-16.4°,respectively.Conclusion The VERION system is a reliable system for the measurement of keratometry and astigmatism.The keratometry and astigmatic magnitude of the VERION system have a good agreement with the iTrace,Lenstar LS900 and manual keratometer.However,the astigmatic axis measurements are significantly different among the four devices.

Objective To research and evaluate measuring Toric intraocular lens (Toric IOL) alignment by iTrace aberration without mydriasis.Methods Forty-five eyes of 35 patients underwent phacoemulsification in Tianjin Medical University Eye Hospital from June 2015 to February 2016 were enrolled.Follow-up and iTrace aberration examination were performed at postoperative 1 week.The internal optics aberration astigmatism axis was transformed into postoperative Toric IOL alignment.The result and the Toric IOL alignment measured by tradition slitlamp method were compared by linear correlation and difference.Results At postoperative 1 week,the uncorrected distant visual acuity and corrected distant visual acuity were (0.19 ± 0.12)LogMAR and (0.10 ±0.09) LogMAR.The UCVA was 20/40 or better in 42 eyes (93.3％).The mean IOL misalignment measured by slitlamp was (3.13 ± 2.86) degrees (ranged 0-9 degrees) and by the iTrace aberration was (4.44 ± 3.42) degrees(ranged 0-13 degrees),there was statistical significant difference (t =-2.321,P =0.025).The mean difference in the error of the Toric intraocular lens alignment measured by iTrace aberration and the slitlamp was (3.67 ± 3.59) degrees (ranged 0-14 degrees).The results showed that there was less than 5 degrees of difference between the two methods in 32 eyes (71.1％),locate 5 to 10 degrees in 9 eyes (20％),more than 10 degrees in 4 eyes (8.9％).The correlation between the 2 methods showed significant linear relationship (r =0.926,P ＜ 0.01).Conclusion Using iTrace aberration can accurately measure Toric intraocular lens alignment without mydriasis,the result has some reference value.