ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and dyslipidemia in patients with type 2 diabetes mellitus,and to analyze the risk factors.Methods A total of 200 patients with type 2 diabetes mellitus including 99 with NAFLD and 101 without NAFLD were recruited.Height,weight,waist circumference,hip circumference,liver enzymes,blood lipids,fasting and postprandial blood glucose,insulin,C-peptide,and HbA1C levels were detected.Body mass index ( BMI),waist-hip ratio( WHR),and improved insulin and C-peptide index(HOMA-C-peptide) were calculated and compared between two groups.ResultsCompared with non-NAFLD group,weight,BMI,waist circumference,hip circumference,alanine aminotransferase ( ALT),aspartate aminotransferase,triglyceride ( TG ),total cholesterol ( TC ),low density lipoprotein-cholesterol(LDL-C) were significantly higher in NAFLD group( all P＜0.01 ),while age,duration,and high density lipoprotein-cholesterol were lower( all P＜0.05 ).The incidence of combined hyperlipidemia,especially hypertriglyceridemia,was significantly higher in NAFLD group( P＜0.01 ).Fasting and postprandial 1 h blood glucose [ ( 2.07 ±0.36 vs 1.83 ±0.43 ) mmol/L,( 14.04 ± 3.96 vs 12.59 ± 3.90 ) mmol/L ],fasting and postprandial 1 h Cpeptide [ (2.79± 1.15 vs 2.08±1.29 ) ng/ml,( 1.33 ±0.45 vs 1.12±0.54) ng/ml ],HbA1C [ (2.09±0.33 vs 1.96±0.28) ％ ],and HOMA-C-peptide index were significantly increased in NAFLD group ( P ＜ 0.05 or P ＜ 0.01 ).Logistic analysis showed that TG,BMI,and ALT were the major risk factors of NAFLD in type 2 diabetes mellitus( P＜0.05 or P＜0.01 ).ConclusionTriglyceridemia,obesity,and raised ALT level were significantly associated with an increased risk of NAFLD in patients with type 2 diabetes mellitus.

Objective To search MRI features of patients with HIV-negative cryptococcus meningoencephalitis (CM)and evaluate the value in judging the prognosis of CM.Methods The findings of cranial MRI and prognosis were retrospectively analyzed in 19 cases with India-ink capsule staining-proved HIV-negative CM in our department.The prognosis was evaluated by Glasgow Outcome Scale:score 1=death,score 2=persistent vegetative state,score 3=severe disability,score 4=moderate disability,score 5=good recovery. The patients with score 1-3 were classified as the group of poor prognosis,while those with score 4,5 as good prognosis.Results Abnormal manifestations on cranial MRI were observed in 84.2%(1 6/1 9)cases,meninges enhanced in 84.2% (1 6/1 9),brain edema in 31.6%(6/1 9),brain parenchyma lesion in 47.4% (9/1 9 ),vasculitis in 5.2% (1/1 9 ).The mean duration of follow-up was 3.5 years,The prognosis of 5/9(44.4%)cases with brain parenchyma lesion confirmed by cranial MR was poor.Conclusion The MRI manifestation of HIV-negative CM is diverse,and brain parenchyma lesion confirmed by cranial MRI may associated with poor prognosis.

Objective To investigate the incidence of serum monoclonal immunoglobulins (McIg) in B-cell chronic lymphoproliferative disorders (B-CLPD) and the clinical significance of McIg in B-CLPD and its possible sources.Methods A total of 1 147 patients with B-CLPD treated from May 2006 to May 2015 were enrolled into this retrospective study.The incidence of McIg and the relationship between McIg and prognostic factors in patients with B-CLPD were analyzed.Results Out of 1 147 B-CLPD patients,there were 164 patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia (LPL/WM),and among them,McIg was detected in 140 cases (85.4 ％).In the remaining 983 patients with B-CLPD,monoclonal Ig was detected in 50 (5.1％) patients.Most of McIg in 2 groups were IgM paraprotein.The levels of IgM paraprotein of the LPL/WM group,non-LPL./WM group and McIg-negative patients were (48.88±33.42) g/L,(27.9±15.23) g/L and (2.75±1.21) g/L,respectively,the difference was statistical significance (P=0.000);the level of IgM paraprotein in LPL/WM group was significantly higher than that in non-LPL/WM group (P=0.000).The level of paraprotein decreased significantly when the patients got complete response after therapy (P=0.001,0.048,respectively).The incidence of serum McIg was higher in the group with complex karyotype (P =0.016) andwith high level of β2-microglobulin (β2-MG) (P =0.001).In the 47 non-LPL/WM patients with positive McIg,serum McIg in 38 (80.9 ％) patients were expressed in a pattern consistent with the distribution of tumor cells (P ＜ 0.005).Most of the light chain subtype of the McIg were consistent with the light chain subtype of the membrane immunoglobulin on the tumor cells.Conclusions Some non-LPL/WM B-CLPD patients also have serum McIg,and it could have certain relevance with the prognosis of B-CLPD.Moreover,the McIg may be secreted by tumor cells or those derived from the same progenitor cells with tumor cells.

Objective To investigate the clinical and laboratory characteristics of patients with chronic lymphocytic leukemia (CLL). Methods 503 patients with CLL admitted from October 1998 to February 2015 were retrospectively analyzed. Baseline characteristics were compared using Chi-square test and Kaplan-Meier methodology was undertaken for survival analyses. Results The median age was 58 years (26-86 years):335 cases were male and 168 cases were female. 204 cases (40.5%) were at the clinical stage of Binet A, followed by Binet B (148 cases, 30.1%) and Binet C (151 cases, 29.3%). 108 cases (21.1%) had anemia at diagnosis, while 113 cases (26.5 %) had an elevated level of lactate dehydrogenase and the expression of CD38 was detected among 100 cases (29.1 %). Clonal abnormalities were observed using fluorescence in situ hybridization (FISH) analysis. Those involving 13q deletion were the most frequent (156 cases, 47.3 %), followed by IgH translocation (22.4 %), trisomy 12 (21.2 %) and 17p deletion (14.5 %). The mutational status of immunoglobulin heavy chain variable region was determined among 230 cases, 165 cases (71.7%) of which were found to be with mutated status. The most frequently encountered gene was V4-34 (28 cases, 12.4 %). The median progression-free survival (PFS) was 89.0 months (95 %CI 75.0-103.0 months), while the median overall survival was 129.0 months (95 %CI 106.9-151.1 months). Conclusion Compared with patients in the western world, CLL patients in this study are younger at diagnosis and have longer overall survival, which, to some extent, could reflects the characteristics of CLL patients in China.

Objective: To summarize and investigate the characteristics, prognosis and treatments of chronic lymphocytic leukemia (CLL) patients with trisomy 12 by using FISH (CEP12). Methods: Clinical data of 330 CLL patients were analyzed retrospectively by using FISH (CEP12) to detect trisomy 12 from May 2003 to April 2015. The clinical data and laboratory characteristics of CEP12 positive patients (70 cases) were compared with those CEP12 negative patients (260 cases). Results: Compared with CEP12 negative CLL patients, the proportion of hepatomegaly (13.6% vs 4.0%, P=0.011) and LDH>247 U/L (43.3% vs 18.5%, χ²=15.892, P<0.001) in CEP12 positive CLL patients were much higher, respectively. There were no significant differences between age, sex, clinical stage, β₂-microglobulin level, IGHV mutation ratio and splenomegaly/lymphadenopathy in these two subgroups. However, compared with CEP12 negative patients, CEP12 positive patients had higher ratio of FMC7 (23.8% vs 12.7%, χ²=4.730, P=0.030), and lower ratio of CD23 (95.2% vs 99.6%, P=0.033). The overall response rates (ORR) in Fludarabine (without Rituximab), Rituximab (with or without Fludarabine) and the traditional chemotherapy group (chlorambucil, CHOP or CHOP-like) were 77.5% (31/40), 84.8% (56/66) and 45.4% (50/110), respectively. The ORR of the traditional chemotherapy group was lower than that of the Fludarabine group and Rituximab group. For CEP12 positive patients, the ORR was inferior to CEP12 negative patients when only using Fludarabine (P<0.05). However, when using Rituximab, the difference could be eliminated, and the ORR was even a little higher in CEP12 negative patients (91.7% vs 81.0%, P=0.306). Compared with CEP12 negative patients, there were no significant differences in progression-free survival (PFS) (χ²=0.410, P=0.478) and overall survival (OS) (χ²=0.052, P=0.180) for CEP12 positive patients whom the median time from diagnosis to start treatment and OS time was 22.6 (95%CI 15.4-31.7) and 118.5 (95%CI 74.5-162.4) month while the 5-year PFS and OS were (52.9±7.6)% and (74.8±6.6)%. Conclusions CEP12 positive CLL patients are more common in hepatomegaly and higher level of LDH. The traditional chemotherapy treatment had the lowest efficacy, and the curative effect of single use of fludarabine is not as good as that of CEP12 negative patients, however, when using Ritaximab, the efficacy could be comparable.

Objective:To explore the effect of mental model based on relaxation training and 5E rehabilitation model on the perioperative rehabilitation of patients with osteosarcoma, in order to provide the reference for rehabilitation nursing of patients with osteosarcoma.Methods:A total of 142 osteosarcoma patients were selected from January 2018 to December 2019 in the Affiliated Union Hospital of Tongji Medical College of Huazhong University of Science and Technology. According to the random method of digital table, the patients were divided into observation group and control group, 71 cases respectively. The control group took routine nursing, and the observation group patients took the mental model based on relaxation training and 5E rehabilitation mode. The quality of life, the levels of depression and anxiety before and after intervention were evaluated by Karuafsky Functional State Score, Generalized Anxiety Scale (GAD-7) and Health Questionnaire Depression Symptom Group Scale (PHQ-9). The recovery of the affected limb was evaluated by the Musculoskeletal Tumor Society (MSTS).The adverse reactions were observed.Results:There was no significant difference in the quality of life between the two groups before nursing ( P>0.05). After nursing, the quality of life score was (91.10±12.38) points in the observation group and (82.20±12.51) points in the control group. The difference was statistically significant ( t value was 10.441, P<0.001). There was no significant difference in GAD-7 and PHQ-9 scores between the two groups before nursing ( P>0.05). After nursing, the GAD-7 and QPH-9 score were (5.21±3.12), (4.41±3.43) points in the observation group and (6.82±3.34) , (6.43±3.13) points in the control group. The differences were statistically significant ( t values were 9.531, 10.592, P<0.001). The excellent and good recovery rate of the affected limb in the observation group was 71.9%(51/71) in the observation group and 54.9%(39/71) in the control group, the difference was statistically significant ( χ2 value was 10.468, P<0.001). The incidence of adverse reactions was 5.6%(4/71) in the observation group and 12.7%(9/71) in the control group, the difference was statistically significant ( χ2 value was 12.543, P<0.001). Conclusions:The mental model based on relaxation training combined with 5E rehabilitation model can improve the postoperative rehabilitation effect of patients with osteosarcoma limb salvage treatment, so that patients can establish confidence, actively cooperate with treatment and participate in postoperative rehabilitation training. Through intervention, patients can actively adjust their mentality, lay the foundation for further adjuvant treatment, improve the quality of life of patients, and ultimately improve the prognosis.

Objective: To evaluate the efficacy and long-term outcome of a combined protocol for multiple myeloma (MM) , including induction therapy, autologous hematopoietic stem cell transplantation (ASCT) and consolidation and maintenance therapy. Methods: Clinical records of 144 patients with MM from January 1, 2005 to February 1, 2016 were retrospectively analyzed. Results: The overall response rate (ORR) after ASCT was 100.0%, in which the complete remission (CR) was 64.1% and the best treatment response rate of superior to PR was 89.4%. During a median follow-up of 47 months, patients with an overall survival (OS) and progression free survival (PFS) was 120.9 and 56.9 months respectively. 5y-OS (73.7±4.7) %, 7y-OS (60.5±6.3) %; 3y-PFS (69.2±4.2) %, 5y-PFS (47.8±5.3) %. The median OS and PFS between the first line transplantation group and salvage transplantation group were 120.9 months vs 50.1 months and 60.2 months vs 16.7 months (all P=0.000). In 127 patients with R-ISS staging, the median survival of Ⅰ, Ⅱ, Ⅲ stage was 120.9 months (n=43) , 88.4 months (n=64) , 35.6 months (n=20) , respectively (P=0.000). For subgroup analysis of survival in early and late ASCT, the median OS of patients with R-ISS stage Ⅲ (35.6 months vs 15.8 months, P=0.031) and the median PFS of two groups (phase Ⅰ: 72.1 months vs 18.9 months, P=0.000; Ⅱ: 53.4 months vs 16.7 months, P=0.012; Ⅲ: 28.5 months vs 5.9 months, P=0.001) were different. Multivariate analysis showed that only R-ISS and the degree of remission before transplantation had impact on OS (HR=8.486, 95% CI 2.549-28.255, P=0.003) and PFS (HR=2.412, 95% CI 1.364-4.266, P=0.002) , respectively. Conclusion The combined protocol containing ASCT is effective for MM patients, improving remission rate and remission depth, prolonging PFS and OS. First line transplantation could significantly prolong the OS and PFS as compared with salvage transplantation. R-ISS and pre-transplantation remission depth are prognostic factors for survival.

Background: and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods: This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results: Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.

Objective:To investigate the efficacy of fludarabine and cyclophosphamide combined with rituximab (FCR) in previously untreated patients with chronic lymphocytic leukemia (CLL) .Methods:The clinical data of 43 enrolled patients from May 2004 to December 2017 were analyzed the efficacy and survival results.Results:A total of 43 patients with 31 males and 12 females, and the median age was 58 years old (range 36 to72) before treatment. There were 8 patients with symptom B. The median number of peripheral blood lymphocyte was 26 (3-550) ×10 9/L. IGHV unmutated was detected in 62.1% (18/29) patients, P53 deletion in 14% (6/43) patients, RB1 deletion in 18.6% (8/43) patients, Trisomy 12 in 25.6% (11/33) patients, ATM deletion in 16.7% (7/42) patients, respectively. The median number of treatment courses administered was 4 (range 2-6) . Twenty patients obtained CR (46.5%) , 18 patients obtained PR, 4 patients were SD, 1 patient was PD. The overall response rate (ORR) was 88.37%. Seven patients obtained MRD negative. After the median follow-up time of 51 (6-167) months, median PFS was 67 (29-105) months, median OS was not reach, 5-year PFS was (62.1±8.6) %, 10-year PFS was (31±14.3) %, 5-year OS was (70.5±8.3) %, and 10-year OS was (51.3±13.8) %. Less than 4 courses predicted adverse OS ( P<0.05) . P53 deletion and less than 4 courses were associated with poor PFS ( P<0.001) , and the prognostic value still remained after multivariate analysis[ HR=7.65 (95% CI 1.74-33.60) , P=0.007; HR=3.75 (95% CI 1.19-11.80) , P=0.025]. Eighteen patients (41.9%) appeared grade 2-3 infection after chemotherapy, and 19 patients (44.2%) appeared grade 3-4 hematological adverse reactions. One patient (2.3%) was developed tumor lysis syndrome. All adverse reactions were controlled or recovered spontaneously. Conclusion:Previously untreated CLL patients treated with FCR had a high response rate and good survival rate, which is an important treatment choice for fit patients.

Objective To summarize and investigate the characteristics of nodal marginal zone lymphoma (NMZL). Method The clinical data and laboratory characteristics of of NMZL patients admitted in our hospital between January 2002 and September 2013 were analyzed retrospectively. Results Twenty-four patients were enrolled in the study. The median age was 54.4 (28-70) years,and the male/female ratio was 1:1. Most of the patients (95%) had bone marrow involvement,40.9% (9/22) had elevated lactate dehydrogenase level,8.3% (2/24) had the positive expression of hepatitis C virus antibody,33.3% (6/18) had positive autoimmune antibodies,and 33.3% (8/24) had monoclonal immunoglobulins in the serum. All of the patients expressed CD19 and CD20 cell markers,whereas none of them expressed CD10 cell marker. The positive rate of CD5 marker was 10% (1/10),the positive rate of CD23 marker was 50% (5/10),whereas no patient had the expressions of both CD5 and CD23 at the same time. The total overall remission rate was 81.25%,and the total complete remission rate was 56.2%. The separate overall remission and complete remission rate had increasing trends in rituximab subgroup than subgroups without using rituximab(P=0.136,P=0.262).Conclusion NMZL has a low incidence and can be seen in both males and females. It often invades bone marrow. Rituximab may increase the response rate and even improve the progression free survival.