Objective To investigate whether insulin glargine can increase compliance and improve hyperglycemia or not in solitary senile patients with type 2 diabetes.Methods Thirty-two solitary senile patients with type 2 diabetes were given insulin glargine once daily besides the previous oral hypoglycaemic agents.Results FBG decreased(2.6? 1.5)mmol/L and(0.3?0.1)mmol/L in observing and control group respectively(t=1.691,P

[Objective]To investigate Y-shaped osteotomy and the internal fixation with geese-head steel plates for treatment of congenital coxa vara.[Method]Lesser subtrochanteric and greater laterotrochanteric osteotomy were performed for 7 cases(9 hips)of congenital coxa vara with the Y-shaped osteotomy line.The distal femoral section met the lateral greater trochanteric section,fixed with geese-head steel plates.[Result]The cases were followed up for 1~5 years(averaged 3.6 years).According to Shi Yingqi's evaluation,4 hips were excellent,4 good and 1 fair.[Conclusion]The Y-shaped osteotomy and internal fixation with geese-head steel plates can improve the abnormal structure of upper femur,increase the real length of the affected limb.Therefore,it is an ideal effective method for treatment of congenital coxa vara.

Objective To study the clinical features,differential diagnosis and treatment of caesarean scar pregnancy (CSP) with sonographic mass.Methods A retrospective analysis was performed on 39 patients of CSP with sonographic mass undergoing treatment in Peking Union Medical College Hospital from 2005 to 2012.14 cases with misdiagnosis of gestational trophoblastic neoplasm,among 4 cases were administered by chemotherapy with methotrexate (MTX),cisplatin,fluorouracil (5-FU) and dactinomycin.According to treatment methods,39 cases were divided into five groups: 3 cases in methotrexate,16 cases in dilation and curettage,15 cases in excision of CSP lesion via laparoscopy,6 cases in excision of CSP lesion via laparotomy,and 4 cases in transabdominal hysterectomy (TAH).Results (1)Clinical characteristics: the mean age was (33 ± 5) years old.Five patients had undergone two prior caesarean sections.The median interval from the last caesarean delivery to CSP was 4 years.Thirty-five cases presented vaginal bleeding or abnormal serum β-hCG level from 5 cases with medical abortion,9 cases with artificial abortion and 21 cases with dilation and curettage.The sonography showed cystic-solid or solid mass with mixed echoes in the lower segment of anterior uterine wall,surrounded by peritrophoblastic vasculature.(2) Treatment outcome: diagnosis of gestational trophoblastic neoplasm was suspected or made in 20 patients,four of whom were even treated by chemotherapy.MTX therapy was given to 3 patients,2 of whom were cured.Dilation and curettages were given to 16 patients,11 of whom were cured.8 patients underwent curettage with sonographic guidance after uterine artery embolism,and 8 patients with laparoscopic or hysteroscopic guidance.All of 15 patients underwent excision of CSP lesion via laparoscopy were cured.4 patients were treated by TAH.(3) Time of in hospital and operation:in laparoscopy group,the average hospitalization days were (3.5 ± 1.6) days,the average operation duration was (54 ± 16)minutes.In laparotomy group,the average hospitalization days were (9.7 ± 5.8) days,and the average surgical duration was (87 ± 15) minutes.It reached significant difference (P ＜ 0.05).Conclusions CSP with sonographic mass was the consequence of continued growth of residual pregnancy mass after incomplete abortion or curettage of CSP with gestation sac.The similar sonographic image might lead to misdiagnosis.Individual therapy was recommended.Excision of CSP lesion via laparoscopy might be the primary option for its advantages in differential diagnosis,caesarean scar defect repair and successful ratio.

Adolescent ; Adult ; Aged ; Blood Coagulation Disorders ; Blood Coagulation Factors ; Case-Control Studies ; Child ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Vitamin K ; Vitamin K Deficiency ; Young Adult

Objective To evaluate the value of laparoscopic surgery in the diagnosis of suspected gestational trophoblastic neoplasia (GTN) cases with uterine mass.Methods The clinical characteristics of patients underwent laparoscopic surgery for a suspected diagnosis of GTN with uterine mass in Peking Union Medical College Hospital from November 2009 to November 2014 were retrospectively reviewed and analyzed.GTN and other pregnant-related disease were definitely diagnosed by pathological findings.The prognoses of the GTN cases were also investigated.Results Sixty-two patients with a suspected diagnosis of GTN with uterine mass were studied.Among them,17 cases were definitely diagnosed as GTN,including 8 choriocarcinoma,5 invasive mole and 4 placental site trophoblastic tumor(PSTT).The other 45 cases were diagnosed as benign pregnancy-related diseases,including 29 cornual pregnancy,6 cesarean scar pregnancy,5 placenta accreta,4 intramural uterine pregnancy and 1 exaggerated placental site.There were no significantly differences between the two groups in average age,preoperative value or tendency of β-hCG,and location or size of lesions (P＞0.05).More GTN patients showed a history of hydatidiform mole [5/17 vs 4％ (2/45),P＞0.05],and more patients with benign pregnancy-related disease showed a history of cesarean section [38％ (17/45) vs 1/17,P＞0.05].No serious perioperative complication was found in these patients received laparoscopic surgery.All GTN patients achieved complete remission by chemotherapy later.Except for 1 case loss,no recurrence was found in 11 low-risk stage Ⅰ cases with an average follow-up period of 11-66 months,1 high-risk stage Ⅰ case with a follow-up period of 61 months and 4 cases PSTT with a follow-up period of 13-66 months.Conclusions There were some atypical GTN cases with uterine mass,which were difficult to be differentiated from benign pregnancy-related diseases according to the clinical characteristics.Laparoscopic surgery with a pathologic diagnosis could be an essential way with efficiency and safety.

Objective To discuss the effects of prophylactic chemotherapy on the outcomes and prognosis of invasive mole patients.Methods One hundred and fifteen invasive mole (IM) patients older than 40 years were registered in Peking Union Medical Collage Hospital.Eleven of them were treated with prophylactic chemotherapy before diagnosed as IM prophylactic chemotherapy group,while the other 104 cases received therapeutic chemotherapy after diagnosed as IM (non-prophylactic chemotherapy group).The general clinical data (including age,clinical stage,risk factor score),treatment,outcomes and relapse of patients were retrospectively compared between two groups.Results (1) The age of prophylactic chemotherapy group and non-prophylactic chemotherapy group were (47±5) versus (46±4) years old.Ratio of clinical stage Ⅰ-Ⅱ were 3/11 versus 29.8％ (31/104),clinical stage Ⅲ-Ⅳ were 8/11 versus 70.2％ (73/104).Ratio of risk factor score 0-6 were 11/11 versus 84.6％ (88/104),risk factor score ＞6 were 0 versus 15.4％(16/104).There were no significant statistical differences between two groups in age,clinical stage or risk factor score (all P＞0.05).(2) Treatment:the total chemotherapy courses between prophylactic chemotherapy group and non-prophylactic chemotherapy group (median 7 versus 5) were significantly different (Z=3.071,P=0.002).There were no significant statistical differences between two groups in the chemotherapy courses until negative conversion of β-hCG,consolidation chemotherapy courses,total therapeutic chemotherapy courses or ratio of hysterectomy (all P＞0.05).(3) Outcomes and relapse:between the prophylactic chemotherapy group and the non-prophylactic chemotherapy group,the complete remission rate were 11/11 versus 98.1％(102/104),the relapse rate were 0 versus 1.0％(1/102).There were no significant difference between the two groups in outcomes or relapse rate (P＞0.05).Conclusions Prophylactic chemotherapy does not substantially benefit the IM patients older than 40 years.Prophylactic chemotherapy may not significantly improve patients' prognosis,in which increased sample size is required in further study.

OBJECTIVETo explore the effect of Danshensu on the lipid metabolism of hyperlipidemic rats.

METHODSixty clean male SD rats were selected. Twelve of them were selected in the basic control group and fed with common foods, and the remaining rats were fed with the high-fat feeds. After the successful modeling, they were randomly divided into the high-fat control group and low dose (10 mg x kg(-1) x d(-1)), medium dose (20 mg x kg(-1) x d(-1)) and high dose (40 mg x kg(-1) x d(-1)) Danshensu (dissolved in saline) groups. Both of the two groups were abdominally injected with the same volume of normal saline once a day for consecutively 30 days. The serum TG, TC, HDL-C and liver ACC1, FAS, HMGR, CPT-I mRNA expressions were detected.

RESULT AND CONCLUSIONDanshensu could inhibit the LDL-C level, timely clear redundant cholesterol and effectively regulate the lipid metablism of hyperlipidemic rats by reducing the TC content, decrease the fatty acid by reducing the FAS mRNA expression, and reduce the synthesis levels of endogenous cholesterol by inhibit the HMGR mRNA expression.

Animals ; Hyperlipidemias ; drug therapy ; metabolism ; Lactates ; pharmacology ; Lipid Metabolism ; drug effects ; Male ; Rats ; Rats, Sprague-Dawley

To compare the clinical features and prognosis in patients with cytomegalovirus pneumonia from other pneumonia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 118 patients with pulmonary complications after allo-HSCT from March 2016 to June 2019 were analyzed retrospectively, who were divided into cytomegalovirus (CMV) pneumonia group ( n=34) and the non-CMV pneumonia group ( n=84). Compared with non-CMV pneumonia group, CMV pneumonia group presented earlier median onset time (1.8 vs.6.0 months, P=0.015) after allo-HSCT, more dyspnea (41.2% vs. 19.0%, P=0.012), hypoxemia (38.2% vs. 13.1%, P=0.006), and interstitial pneumonia (82.4% vs. 23.8%, P<0.01).The incidence of CMV-viremia and serum viral load in CMV pneumonia group were significantly higher than those in non-CMV pneumonia group. Consistently, and the development of mixed infection in CMV pneumonia group was higher than that of non-CMV pneumonia group (41.2% vs. 16.7%, P=0.013). The median follow-up time was 12.8 (0.4-46.5) months. The 1-year attributable mortality in CMV pneumonia group was significantly higher than that in non-CMV pneumonia group (26.5% vs. 10.7%, P=0.004), while the 1-year overall survival rate was significantly lower than that in non-CMV pneumonia group (61.8% vs. 85.7%, P=0.001). Reduced-intensity conditioning (RIC)( P=0.036), high flow ventilation ( P=0.033) and negative CMV-viremia ( P=0.009) were unfavorable prognostic factors of patients with CMV pneumonia. Compared with those with non-CMV pneumonia, patients with CMV pneumonia had more characteristic clinical manifestations and imaging features. However, due to the higher incidence of mixed infections, the causes of pneumonia need to be identified by bronchoscopic alveolar lavage. In conclusion, patients with CMV pneumonia have worse clinical outcome. RIC, high flow ventilation and negative CMV-viremia are adverse prognostic factors for CMV pneumonia.

AIM To explore the protective effects of Huoxue Kangnao Granules (Astragali Radix,Morindae officinalis Radix,Puerariae lobatae Radix,etc.) on cerebral ischemia-reperfusion injury in rats.METHODS The rat model for middle cerebral artery occlusion (MCAO) was established,SD rats were randomly divided into sham operation group,model group,positive control group,Huoxue Kangnao Granules low-,middle-and highdose groups.Nerve function score was tested.Volume of cerebral infarction was calculated by TTC staining.SOD,MDA,6-keto-PGF1α,TXB2,IL-1 β and TNF-α were detected by ELISA.The expression levels of MMP-9 and ICAM-1 were detected by RT-PCR.To observe the influence of Huoxue Kangnao Granules on platelet aggregative function,clotting time was analyzed by automatic blood coagulation analyzer,plasma T-PA and PAI activities were determined by ELISA,and hemorheology indices were detected by automatic biochemical analyzer.RESULTS Huoxue Kangnao Granules could significantly decrease cerebral infarction volume,improve nerve function,reduce MDA content,increase SOD activity;increase 6-keto-PGF1 α level,reduce TXB2 content;decrease TNF-α and IL-1β expressions;inhibit MMP-9 and ICAM-1 expressions;extend KPTT and PT;elevate t-PA activity,inhibit PAI activity;decrease whole blood viscosity,enhance erythrocyte deformation ability.Each dosage group of Huoxue Kangnao Granules had a positive correlation between dose and response.CONCLUSION Huoxue Kangnao Granules can protect cerebral ischemia-reperfusion injury in rats,whose mechanisms may be related to anti-free radical injury,anti-thrombus,anti-cerebral vasospasm,improving cerebrovascular permeability,anti-inflammatory,anti-coagulation and improving abnormal changes of hemorheology.

Objective To evaluate the lymphoscintigraphic imaging characteristics for the patients with lower limb lymphedema and to establish a novel grading system for the injury to lower limb lymphatic system. Methods One hundred and sixty six consecutive patients (332 lower limbs) with lower limb lymphedema after surgical and(or) radiotherapy treatment for gynecological cancer were recruited into this retrospective study. The lymphoscintigraphy studies were performed after subcutaneous injection of 111～185 MBq (0. 1～0. 15 ml) of 99Tcm-DX into the webbed space between the first and second toes of both feet. Based on the integrity of lymphatic vessel and the extension of dermal diffusion on lymphoscintigram,the lymphatic injury to the lower limb was graded as 0, 1,2 and 3 respectively. The lymphedema of the limb was staged as 0, Ⅰ , Ⅱ a, Ⅱ b, Ⅲ by the standard of Consensus Document of the International Society of Lymphology (ISL). Chi square test was carried out to validate the established grading system for the assessment of the injury to the lower limb lymphatic system. Results The lymphoscintigraphic imaging characteristics included lymphatic blockage, dermal backflow, no visualization of lymphatic or lymph node, lymphocele and lymph fistula in the lower limb, pelvis and abdomen. There were 65 (19.6%), 71 (21.4%),131 (39.5%), 62 (18.7%) and 3 (0.9%) limbs staged as 0, Ⅰ , Ⅱa, Ⅱb, and Ⅲ for lymphedema while 36(10.8%), 79(23.8%), 116(34.9%) and 101 (30.4%) limbs graded as 0, 1, 2, and 3 for lymphatic injury. There was a statistically significant correlation between the grading methods (χ2 =313.483, P <0.001). The patients who underwent radiotherapy had a higher incidence rate of grade 2 and 3 (70.5%, 158/224) than those who underwent surgery (53.6%, 59/108) (χ2 = 9.662, P = 0.022).The patients with erysipelas had a higher incidence rate of grade 3(73.1%, 38/52) than those without erysipelas (43.9%, 50/114) (χ2= 12.238, P<0.001). The incidence rate of grade 3 increased with the duration of lymphedema after treatment: 36.6% (34/93) for less than 1.5 years, 72.3% (34/47) for between 1.5 to 5 years, and 76.9% (20/26) for more than 5 years (χ2 = 23.123, P<0.001). The grade of lymphatic injury showed no significant difference among 3 types of gynecological cancers (χ2 = 4.000, P =0.676), or between the patients with and without chemotherapy (χ2 =0.411, P=0.938). Conclusions Lymphoscintigraphy is a reliable modality to diagnose lower limb lymphedema after treatment for gynecological cancer. The injury grading system could provide objective assessment of the lymphatic damage.