Objective To investigate the relationship between pancreatic beta cell function and liver function in hepatitis B cirrhosis with different glucose metabolism status.Methods A total of 247 patients with hepatitis B cirrhosis were included and divided into 3 groups according to measurement of fasting blood glucose (FBG),and 2h blood glucose in 75g oral glucose tolerance test(2hPG),normal glucose metabolic status group(group A,n =47),glucose tolerance impairment group(group B,n =103) and diabetes mellitus group(group C,n =97).Data of fasting and 2h postprandial blood glucose,C-peptide,insulin and glycosylated hemoglobin (HbA1c),pancreatic beta cell function index(HBCI),insulin sensitivity index (ISI),hepatitis B virus load were collected and analyzed.Results Abnormal glucose metabolism was observed in 81％ patients with hepatitis B cirrhosis,while hepatogenic diabetes accounted for 39.3％.2 hPG[(6.29 ± 3.78) mmol/L,(10.56 ± 4.26) mmol/L,(17.34 ± 5.9) mmol/L],FBG [(4.72 ±2.15)mmot/L,(5.68 ±2.81) mmol/L,(9.82 ±5.1) mmol/L],HbA1c [(4.5 ± 1.2)％ (10.56 ±4.26) ％ (9.5 ± 3.0) ％],HBV-DNA [(3.78 ± 0.52),(4.82 ± 0.61),(6.02 ± 0.63)] were compared in group A,group B and C.2hPG,FBG,HbA1c and HBV viral loads in group A were significantly lower than group B and group C (F =93.23,41.35,84.93,237.2,P ＜ 0.05).Fasting insulin [(15.65 ± 4.17) mU/L,(26.53 ± 7.22) mU/L,(30.18 ± 3.23) mU/L],postprandial insulin [(45.28 ± 10.22) mU/L,(106.8 ± 20.74) mU/L,(141.68 ±20.25) mU/L],postprandial C peptide [(5.96 ± 4.82) mU/L,(9.86 ± 5.46) mU/L,(9.54 ± 6.42) mU/L] and ISI [(-5.96 ± 0.61),(-4.92 ± 0.42),(-5.03 ± 0.51)] were compared in group C,group B and A,those values in group C were lower than group A and B,the defferences were stastistically significant (P ＜ 0.05).HBCI in three groups were (5.66 ± 0.64),(5.32 ± 1.01),(4.30 ± 1.53),respectively,the defferences were stastistically significant(F =27.55,P ＜0.05).Patients in group C with Child-Pugh C score was much more than group A and B,the defference was stastistically significant (x2 =48.6,P ＜ 0.01).Conclusion Hyperinsulinemia,increased insulin resistance and decreased insulin secretion exist in hepatitis B cirrhosis patients,and they are closely related to liver function.

Objective To explore the value of CD+4T lymphocyte count in laboratory diagnosis of AIDS complicated with pulmonary tuberculosis.Methods Forty-three patients with acute tuberculosis were selected as the subjects.Among them,14 patients had typical tuberculosis(X-ray or chest CT),29 cases were atypical tuberculosis(X-ray or chest CT).43 patients were examined by CD+4T lymphocyte count,sputum smear tuberculosis acid-fast bacilli test and T-SPOT.TB(interferon-γ release test),and the results of various methods were compared.Results The The number of CD+4T lymphocytes in patients with typical pulmonary tuberculosis was (151.26±59.47)/μL,and that in atypical pulmonary tuberculosis was (69.11±19.65)/μL,the difference was statistically significant(t=5.124,P<0.05);and with the reduction of CD+4T lymphocytes,AIDS patients showed more atypical pulmonary tuberculosis.The positive detection rates of CD+4T lymphocyte count,T-SPOT.TB and sputum smear were 86.05%,16.28% and 51.16% respectively.The positive rate of combined detection of three methods(90.70%) was significantly higher,the differences were statistically significant(x2=5.123,6.023,7.125,all P<0.05).Conclusion CD+4T lymphocyte count is of great value in the laboratory diagnosis of AIDS complicated with tuberculosis,and it is worthy to be widely carried out in clinical practice.

OBJECTIVE:To explore the effects of entecavir combined with chemotherapy on positive HBV in tumor patients with normal liver function. METHODS:106 patients were selected and divided into observation group (44 cases) and control group (62 cases) according to therapy plan. Control group received routine chemotherapy according to tumor condition;observa-tion group was given Entecavir tablets orally 0.5 mg,qd,before 1 week of chemotherapy,for consecutive 1 week. HBV reactiva-tion rate,recurrence rate of severe hepatitis,mortality rate,serum level of ALT before and after treatment and the incidence of ADR were compared between 2 groups. RESULTS:4 patients of observation group and 2 of control group withdrew from the study. HBV reactivation rate,recurrence rate of severe hepatitis and mortality were 7.5%,0,0 in observation group and 56.7%, 50.0%,13.3% in control group,with statistical significance between 2 groups(P<0.05). Before chemotherapy,there was no sta-tistical significance in serum levels of ALT between 2 groups(P>0.05);after chemotherapy,the serum levels of ALT in 2 groups were increased significantly,and the control group was significantly higher than the observation group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Entecavir can effectively prevent HBV reactivation and decrease the recurrence rate of severe hepatitis and mortality rate in tumor patients dur-ing chemotherapy, and doesn’t increase the risk of ADR.

Objective To evaluate the clinical efficacy of compound matrine injection combined with fentanyl transdermal patch in the treatment of elderly patients with advanced gastric cancer.Methods A total of 100 elderly patients with advanced gastric cancer were enrolled in this study.All patients were randomly divided into the observation group (n =50) given compound matrine injection plus Fentanyl transdermal patch and the control group given fentanyl transdermal patch alone(n=50).The analgesic efficacy,quality of life and adverse reaction were evaluated and compared between the two groups.Results The analgesic efficacy was significantly higher in the observation group[76％(38/50)]than in the control group[(44％),(x2=4.46,P＜0.05)].Before treatment,the life quality scores were similar between two groups.After treatment,the life quality score of the two groups was significantly improved as compared with pre-treatment.In addition,life quality score was significantly higher in the observation group than in control group(t=8.61,P＜0.05).After treatment,only mild adverse events were observed in two groups,with no significant difference in adverse events between the two groups(x2 =0.00,P＞0.05).Conclusions Compound matrine injection plus Fentanyl transdermal patch are safe and effective in the treatment of carcinoma pain in elderly patients with advanced gastric cancer.

Objective:To systematically assess the efficacy and safety of acupuncture therapy for essential hypertension.Methods:A computerized literature search of the Chinese National Knowledge Infrastructure(CNKI),Chongqing VIP Database(CQVIP),Wanfang Academic Journal Full-text Database(Wanfang),China Biology Medicine Disc(CBM),PubMed,Excerpta Medica Database(EMBASE),and Cochrane Library was conducted to retrieve randomized controlled clinical trials on acupuncture as the main intervention for the treatment of essential hypertension published from the inception of the database to 30 January 2021.The risk-of-bias assessment was carried out for each included study according to the Cochrane Handbook.Data analysis was performed using Review Manager 5.4.1 and Stata 15.0.Results:After the screening,46 randomized controlled trials involving a total of 3 859 subjects were included.Primary outcomes included changes in the diastolic blood pressure after intervention[eight studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group[mean difference(MD)=1.45,95%confidence interval(CI)(0.48,2.43),P=0.004,fixed effects model;I2=39%]and changes in the systolic blood pressure after intervention{11 studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group[MD=8.60,95%CI(7.12,10.07),P<0.00001,fixed effects model;I2=26%]}.The secondary outcome was antihypertensive efficacy,12 studies of acupuncture monotherapy group[risk ratio(RR)=1.20,95%CI(1.12,1.28),P<0.00001,fixed effects model;I2=36%]and 15 studies of acupuncture combined with antihypertensive drug group[RR=1.27,95%CI(1.20,1.34),P<0.00001,fixed effects model;I2=6%]showed better results than the antihypertensive drug monotherapy group in antihypertensive efficacy.In terms of the adverse events,four studies showed that the acupuncture monotherapy group had fewer adverse events than the antihypertensive drug monotherapy group[RR=0.10,95%CI(0.04,0.25),P<0.00001,fixed effects model;I2=0%].Conclusion:Acupuncture combined with antihypertensive drugs is superior to antihypertensive drugs alone in reducing blood pressure,and acupuncture therapy is effective and safe for the treatment of essential hypertension with fewer side effects.However,there is still a lack of high-quality multicenter randomized double-blinded controlled trials in this field.Rigorous large-sample clinical trials are needed to validate these findings.

Objective To investigate the function and necessity of ICU to supervise and cure the patients after comprehensive correction of facial skeletal contouring. Methods 178 patients were examined carefully and perfectly before operation to obviate taboo. After comprehensive correction of facial skeletal contouring operation, all the patients were transferred into ICU in order to be supervised and cured comprehensively. Results 26 (14. 61 %) patients had hypoxemia ( SPO2 ≤90 %),11(6. 18 %)kaliopenia (K+≤3. 5 mmol/L) and 18 (10. 11 %) hypertension. 21 patients appeared arhythmia. Among these 21 arhythmia patients, 15 (8.43 %) patients had pyknocardia (HR≥100/min), 3 (1. 69 %) atrial premature beat, 1 (0.56 %) fibrillation atrial, 2 (1. 12 %) premature ventricular contraction, 1 (0. 56 %) Ⅱ degree atrioventricular block. 8 patients had respiratory tract obstruction. 2 (1. 12 %) had hemorrhea of mandible and 1 transfused 600 ml blood. 17 (9. 55 %) patients had restlessness. 65 patients had nausea and vomitting. All patients in ICU having postoperative complications had been deal with corresponding management. There were no respiratory failure,hemorrhagic shock, cardiac arrest after operation in 178 patients. Conclusions ICU can offer timely, continuous, and systemic supervision and cure to patients after comprehensive correction of facial skeletal contouring,and reduce the postoperative emergency rate.

OBJECTIVETo analyze the clinical features and TGFBI gene mutation in a Chinese family affected with Reis-Bucklers corneal dystrophy.

METHODSGenomic DNA was extracted from 53 members including 9 patients from the family. The 17 exons and splice region of introns of the TGFBI gene were amplified by PCR and directly sequenced. All family members were subjected to ophthalmologic examination.

RESULTSA heterozygous mutation (R124L) was found in exon 4 of the TGFBI gene among all patients from the family. The same mutation was not found among unaffected family members. The inheritance pattern of the family was identified as autosomal dominant, and the Reis-Bucklers corneal dystrophy in the family was diagnosed as the geographic type.

CONCLUSIONThe R124L mutation of the TGFBI gene probably underlies the pathogenesis of Reis-Bucklers corneal dystrophy in this Chinese family. Molecular genetic approach is useful for the proper diagnosis of this type of corneal dystrophy.

Corneal Dystrophies, Hereditary ; etiology ; genetics ; Female ; Humans ; Male ; Mutation ; Sequence Analysis, DNA ; Transforming Growth Factor beta1 ; genetics

Objective:To observe the effects of acupuncture and moxibustion on interleukin(IL)-9/IL-9 receptor(IL-9R)in the colon tissue of rats with ulcerative colitis(UC)and investigate the protective mechanism of acupuncture and moxibustion on the intestinal mucosal barrier in UC rats. Methods:Male Sprague-Dawley rats were randomly divided into a normal control(NC)group and a modeling group.UC models were prepared by giving 4%dextran sulfate sodium(DSS)water for 7 d.After the successful construction of the UC rat model,the modeling group was randomly divided into a UC group,a herb-insulated moxibustion(HM)group,and an electroacupuncture(EA)group.HM and EA interventions at bilateral Tianshu(ST25)were performed once a day for 7 d.Hematoxylin-eosin(HE)staining was used to observe the histopathological changes in the colon.The serum concentrations of IL-9,IL-6,IL-1β,and hemoglobin-H(HbH)were determined by enzyme-linked immunosorbent assay.The protein expression levels of IL-9,IL-9R,claudin-2,zonula occludens-1(ZO-1),and occludin in the colon tissue were measured by Western blotting or immuno-histochemistry.Immunofluorescence was used to detect the co-expression of PU.1 and CD4 with the IL-9 protein. Results:Compared with the NC group,the colon tissue of UC rats was severely damaged and ulcerated with congestion and edema,and the colonic histopathological score increased significantly(P<0.01).The serum HbH concentration decreased significantly(P<0.01),while the serum concentrations of IL-9,IL-6,and IL-1β increased(P<0.01).The protein expression of colonic ZO-1 and occludin decreased significantly(P<0.01),while the protein expression of colonic IL-9 and IL-9R increased(P<0.05).The positive co-expression levels of IL-9/PU.1 and IL-9/CD4 increased in the colon tissue(P<0.05).Compared with the UC group,the colonic mucosal structures were gradually repaired in both HM group and EA group,and healed ulcers could be observed,the colonic histopathological score decreased significantly(P<0.05).The serum concentration of HbH increased(P<0.01),while the serum concentrations of IL-9,IL-6,and IL-1β decreased(P<0.05).The protein expression levels of ZO-1 and occludin increased(P<0.05),while the protein expression levels of IL-9 and IL-9R decreased(P<0.01).The positive co-expression levels of IL-9/PU.1 and IL-9/CD4 decreased in the colon tissue(P<0.05). Conclusion:Both HM and EA can inhibit the protein expression levels of IL-9 and IL-9R in the UC colon by regulating the transcription factor PU.1,promote the repair of intestinal mucosal barrier,and down-regulate protein contents of proinflammatory factors IL-9,IL-6,and IL-1β in the serum,which may be one of the key mechanisms of acupuncture and moxibustion in reducing the inflammation of UC colonic mucosa and protecting the intestinal mucosal barrier.

Objective To evaluate the clinical effect of supraclavicular fossa puncture in coracoid approach brachial plexus block under ultrasonic guidance.Methods Sixty patients scheduled for distal upper extremity surgery, male 33 and female 27, BMI 18.5-28.0 kg/m2, aged 18-60 years old, falling into ASA physical statusⅠ-Ⅲ, were randomly divided into groups A and B, 30 cases in each.Coracoid approach brachial plexus block was carried out under ultrasonic guidance.The puncturing point was located in infraclavicula (group A) or supraclavicular fossa (group B), and 0.5％ropivacaine 20 ml was injected around axillary artery for each patient.The procedure time and the number of needle adjustment were recorded as primary outcome, and the onset time, sensory block score at 15 min after injection, the success rate of block and the incidence of complications were noted also.Results Compared with group A, the procedure time was shorter in group B (P<0.05).There was no significant difference in the number of needle adjustment, onset time, sensory block score at 15 min, the success rate of block and incidence of complications between the two groups.Conclusion Puncturing through supraclavicular fossa can shorten the procedure time of coracoid approach brachial plexus block guided by ultrasound.It is effective and safe, and does not increase the complications.

Objective:To investigate the cognitive impairment after intensive care unit (ICU) discharge and provide theoretical basis for prevention and intervention.Methods:Studies about cognitive impairment after ICU discharge were retrieved in PubMed, Embase, Cochrane Library, Web of Science, Wanfang data, CNKI and SinoMed from their foundation to December 2019. The literature screening and data extraction were performed by two researchers independently, and the quality of different types of researches was evaluated using Cochrane Handbook 5.1.0, Newcastle-Ottawa scale (NOS) and agency for healthcare research and quality criteria (AHRQ). The Meta-analysis was performed by Stata 13.0 software. Sensitivity analysis was used to determine the reliability of the combined effect values. Funnel plot and Egger test were used to analyze publication bias. The non-parametric clipping was used to evaluate the impact of publication bias on the results.Results:A total of 35 studies were enrolled, including 27 prospective cohort studies, 4 retrospective cohort studies, 2 randomized controlled trial (RCT) studies, 1 case-control study, and 1 cross-sectional study. Three literatures were published in Chinese and 32 were in English, which covered 13 countries, and a total of 102 504 ICU survivors were followed up successfully. Literature quality evaluation results showed that the NOS scores of 31 cohort studies were between 6 and 9, of which the case-control study scored 9. The quality grade of 2 RCT studies were both B. According to the AHRQ criteria, 1 cross-sectional study's design was scientifically rigorous and of high quality. Thirty-five studies reported that the overall incidence of cognitive impairment after ICU discharge ranged from 2.47% to 66.07%. For the multiple follow-ups studies, the first survey data was selected for Meta-analysis, and the results showed that the pooled incidence was 38.44% [95% confidence interval (95% CI) was 29.32-47.55]. Each study was removed for sensitivity analysis and the pooled results did not change much, which indicated that the results were reliable. The sub-group analysis was performed on different evaluation methods for cognitive impairment after ICU discharge, different types of ICU patients, and different follow-up time. The results showed that the pooled incidence of studies using neuropsychological test to evaluate cognitive impairment after ICU discharge was 31.42% (95% CI was 21.82-41.02), the pooled incidence of studies using questionnaires or scales was 38.75% (95% CI was 29.54-47.96), and the difference between the two groups was statistically significant ( P < 0.01). The pooled incidence of cognitive impairment after ICU discharge in general ICU patients was 43.42% (95% CI was 30.88-55.95), acute respiratory distress syndrome (ARDS) patients' pooled incidence was 34.40% (95% CI was 23.02-45.79), and the pooled incidence of elderly ICU patients was 12.93% (95% CI was 8.48-17.37), the difference among the three groups was statistically significant ( P < 0.01). The incidences of cognitive impairment < 1 year, 1 to 4 years, ≥ 5 years after ICU discharge were 43.30% (95% CI was 29.47-57.13), 34.21% (95% CI was 26.70-41.72), and 20.22% (95% CI was 4.89-35.55), respectively, and the differences among the three groups were statistically significant ( P < 0.01). The funnel plot showed that the distribution of all studies was asymmetric, and the Egger test result also suggested that there might be publication bias ( P < 0.05). The non-parametric clipping was used to estimate the impact of publication bias on the results, and the result showed that the difference in the incidence of cognitive impairment after ICU discharge before and after non-parametric clipping was large, suggesting that publication bias might influence the stability of the research results. Conclusions:The incidence of cognitive impairment after ICU discharge is relatively high and persistent for a long time, but diagnostic criteria of cognitive impairment and follow-up time are quite different. It is necessary to develop consistent evaluation criteria and rigorous designed research in the further.