Objective To explore the clinical characteristics and treatment of methylmalonic acidemia(MMA) in order to improve our understanding of it.Methods We analyzed the clinical manifestations,laboratory examinations and treatments of 26 cases of methylmalonic acidemia in children.Results Twenty-four cases were involved in nervous system.Nine patients were involved in renal system.Eight cases of hematological involved.Liver enzyme elevated in 2 cases as well as the cardiac system were involved in 3 cases.One case was with pneumonia onset.The laboratory findings showed metabolic acidosis in 12 cases,hyperhomocysteinemia in 8 cases and remarkable elevation of urinary methylmalonic acid concentration in all cases.Some abnormalities in globus pallidus and cerebral white matter as well as diffuse cerebral atrophy were noted by the brain CT and MRI in 15 cases.Sixteen children have received therapy of vitamin B12,and supplementation of L-carnitine with restricted-protein diet.The follow-up for a period ranging from 3 months to 1.5 years( mean 8.5 months) of 15 cases with medical therapy showed a favorable outcome of nervous system improvement in 12 cases,however,2 patients died from severe metabolic acidosis.8 patients with renal involvement were normal in urine routine and renal function.Conclusion Methylmalonic acidemia has different clinical features,so early urine organic acids analysis by GC/MS method is essential Long-term and reasonable treatment after diagnosis is an effective way to improve the prognosis.

Aging ; Arteriosclerosis ; pathology ; Blood Vessels ; pathology ; Cellular Senescence ; Humans ; Medicine, Chinese Traditional

Objective To investigate the effect of recombinant human erythropoietin (rhEPO) on the expression of glutamine synthetase (GS) of cultured rat retinal Müller cells in high glucose environment in vitro.Methods Mtüller cells were isolated from retinas of 10 Sprague-Dawley rats at postnatal day three to five by trypsin digestion,and were randomly divided into six groups,including normal control group,high glucose group,high glucose +5 U/ml rhEPO group,high glucose+ 10 U/ml rhEPO group,high glucose+ 20 U/ml rhEPO group,high glucose+40 U/ml rhEPO groups.After 48 hours,the apoptosis of retinal Müller cells were assayed by terminal transferase-mediated DNA end labelling assay,and the expression levels of GS protein were detected with semi-quantitative immunocytochemistry.Results Compared with the normal control group,the cell viability and GS protein were reduced while the cell death increased in Müller cells cultured in high glucose,the difference was statistically significant (t =27.4,P ＜ 0.01).Compared with the high glucose group,rhEPO treatment reduced the apoptotic Müller cells (t=857.2,2 374.6,2 473.2,2 537.7; P＜0.01),induced the expression of GS proteins (t=3.2,18.0,22.5,26.4; P＜0.05).Conclusions rhEPO can protect Müller cells from apoptosis under high glucose condition.The mechanism may be related to its function to up-regulate the GS protein expression,promote glutamic acid cycle,and reduce the excitotoxicity effects of high concentration of glutamate.

Objective:To discuss the important role of clinical pharmacists in the prevention of medication errors and rational drug use through medication reconciliation in endocrinology department. Methods: The medication reconciliation was given to the diabetic patients over 70 years old newly admitted in the endocrinology department from January to April 2016, and the consistency and appro-priateness of medication orders were verified and the results were collected and analyzed by the pharmacists. Results: Totally 84 pa-tients were enrolled into the research with the average age of (76. 3 ± 5. 0) and the average number of combined diseases of (3. 5 ± 1. 2). The average medications taken by the patients before the admission were (6. 7 ± 2. 9), and 22. 6% of the patients took tradi-tional Chinese medicines and 4. 76% of the patients took health products. The patients whose medications for 24h needed intervention accounted for 27. 38%, the medications orders needed intervention accounted for 3. 67%, and the intervention success rate of clinical pharmacist was 100%. Conclusion:To the patients over 70 years old with type 2 diabetes and multiple diseases treated with a variety of medications, medication reconciliation in 24 hours can effectively prevent the medication errors and promote the rational drug use.

Aging is one of dangerous elements in cancer, diabetes, cardiovascular diseases, and neurodegenerative diseases. Qi deficiency and blood stasis is an important syndrome pattern in aging. The treatment methods of nourishing qi and resolving blood stasis is an important way to delay aging. Based on the theory that nourishing qi and resolving blood stasis can delay aging, many scholars have conducted lots of clinical and experimental researches nowadays. This article mainly analyzeds the theory and origin of nourishing qi and resolving blood stasis delaying aging, the current situation of clinical and experimentai researches on age-related diseases. The purpose of this article is providing a basis for anti-aging researches on Chinese herbal medicines that have the efficienoy of nourishing qi and resolving blood stasis, and further revealing aging mechanism.

Objective To investigate the clinical features of acute mesenteric ischemia (AMI) in the elderly and provide evidence for early prevention,diagnosis and treatment of AMI for elderly patients.Methods A retrospective analysis was performed in 104 patients with AMI in our hospital,who were divided into two groups:the elderly group (aged≥60 years) and the non-elderly group (aged ＜ 60 years).Clinical manifestations,misdiagnosis rate,laboratory data,underlying diseases,treatment and prognosis were compared between the two groups.Results Acute superior mesenteric artery thromboembolus (ASMATE) was the main cause of AMI in the elderly group and acute mesenteric venous thrombosis (ASMVT) was the main cause of AMI in the non-elderly group.Elderly patients were more prone to misdiagnosis as compared with the non-elderly group (P =0.007).Abdominal pain (100.0％) was the most common clinical manifestation of AMI patients,followed by vomiting (58.7％).Nausea and vomiting were strongly associated with AMI in the elderly (P＜0.05).In laboratory data,serum creatinine,lactate dehydrogenase and uric acid were higher and the D-Dimer level was lower in elderly patients than in non-elderly patients (P＜0.05).Hypertension,atrial fibrillation,arteriosclerosis,ischemic heart disease,cerebral infarction and chronic renal insufficiency were more common in the elderly with AMI (all P＜0.05),while history of alcohol intake was higher in the non-elderly group (P=0.042).Hypertension,arteriosclerosis and cerebral infarction were independent relevant factors for elderly-onset AMI (P =0.000,OR =4.057;P =0.001,OR=4.585;P=0.007,OR=4.269).The number of patients with colon necrosis was higher in the elderly group than in the non-elderly group (P=0.038),and the prognosis was worse in the elderly group than in the non-elderly group (P=0.001).Conclusions ASMATE is the main cause of AMI in elderly patients.Nausea and vomiting are the main clinical manifestations,together with impaired renal function.Hypertension,arteriosclerosis and cerebral infarction are the independent relevant factors for elderly-onset AMI.Elderly patients are more prone to misdiagnosis,show more severity and have worse prognosis.

Abnormalities, Multiple ; Child, Preschool ; Face ; abnormalities ; Hematologic Diseases ; Humans ; Male ; Vestibular Diseases

OBJECTIVE To identify the possible risk factors for the development of surgical site infection (SSI). METHODS A total of 218 consecutive patients who received open cholecystectomy due to gallbladder disease and stone of common bile duct during from the Jun to Dec in 2007 were included in the study. The potential risk factors including clinical features,biochemical data,operative types and incision types were analyzed by univariate analysis. RESULTS The overall incidence of SSI was 5.04%.The incidence of SSI in cholecystectomy alone group was lower than in cholecystectomy with exploration of common bile duct group (10.9% vs 3.1%,P=0.022).The incidence of SSI in emergency group was higher than that in selective operation group (12.5% vs 3.8%,P=0.037). The incidence of SSI among patients with white blood cell count more than 10.0?109 befove surgery was higher (12.2% vs 3.0%,P=0.025). The incidence was 1.5%,6.1% and 26.3%,respectively,for patients with Ⅱ,Ⅲ and Ⅳ types incision (P=0.000). CONCLUSIONS These findings indicate that risk factors for the development of SSI after open cholecystectomy include operation manner,operation type,incision type and preoperative leucocyte count.

Objective To analyze the clinical manifestation, diagnosis and treatment of acute mesenteric vascular obliteration (AMVO). Methods 112 cases of AMVO were analyzed, including 20 cases admitted to our hospital from 1992 to 2004 and 92 cases reported by other hospitals. Results Abdominal pain, abdominal distension, nausea and vomiting, decrease or disappearance of bowel sound, elevation of white blood cell count were more frequent manifestations.Cardiovascular disease, portal vein stasis or hypercoagulation state were common findings in patients' history. The average misdiagnosis rate of AMVO in these 112 patients was 61.5%, with a misdiagnosis rate of 45.0% in 20 cases of our hospital. The average mortality rate of all these patients was 41.9%, with a mortality rate of 30.0% for 20 cases of our hospital. Conclusion The early clinical manifestation of AMVO lacks specificity, the misdiagnosis ratio and mortality rate are very high. Angiography should be done early to confirm the diagnosis and improve the therapeutic effect in the patients suspicions of having this ailment.

Objective To observe the effects of irbesartan and amlodipine on insulin sensitivity in obese hypertensive patients. Methods 157 moderate hypertensive patients were divided into two greups,which received irbesartan or amlodipine for 16 weeks. The changes of blood pressure,heart rate and weight were observed. Insulin re-sistance was computed using the homeostasis model assessment (HOMA-IR). Results There was no difference in antihypertensive efficacy between the two groups(P>0.05). After 16 weeks of treatment ,the insulin resistance index decreased by 8.7±2.4 vs 6.1±2.6 (P<0.01) and body mass index decreased(28.1±3.8) kg/m2 vs (27.2± 3.2 ) kg/m2 (P<0.05 ) and mean heart rate raised by (73.1 ±10.0 ) kg/m2 vs ( 79.1±11.4) kg/m2 ( P < 0.01 ) in irbesartan group while no such changes were found in amlodipine treated group. Conclusions In obese hypertensive patients,irbsartan and amlodipine exert similar antihypertensive effect, but irbesartan may help to improve some obe-sity-related metabolize disorder,so the obese hypertensive patients may benefit more from irbsartan than from amlo-dipine.