Objective To explore the normal range of serum glycated albumin (GA) during the second trimester in non-gestational diabetes mellitus (GDM) population and the value of serum GA in the blood glucose monitoring during pregnancy.Methods The GA was measured in 101 healthy gravida during the second trimester and 80 gravida with GDM and diabetes mellitus who were in treatment at Peking University First Hospital between August 2011 and December 2011,in order to analyze the normal range of GA and the relationship between GA and the level of blood glucose.Results (1) The normal range of GA during the second trimester was 10.9％-15.3％,which was negatively correlated with body mass index (P＜0.01).(2) Significant correlations were observed between GA and the level of hemoglobin A1c (HbA1c),preprandial,postprandial and mean plasma glucose in gravida with GDM and diabetes mellitus (r:0.361,0.252,0.338,0.310 ; all P ＜ 0.05).(3) When the level of GA was 13.97％,the sensitivity and specificity index for glucose control were 78.0％ and 74.4％.Conclusions GA could evaluate the severity of disease in gravida with GDM and diabetes mellitus.10.9％-15.3％ could be suggested as normal range of GA for the gravida at the second trimester.

Objective Explore the risk factors and prevention of HAP after surgical excision of Esophageal carcinoma in elderly Patients.Methods Two hundred and eight elderly patients with HAP after Surgical excision of Esophageal carcinoma from 2009 to 2012 were analyzed.Logistic regression analysis was used to find the related risk factors.Results The incidence of HAP was 25.9％.In several factors Logistic regression analysis,smoking,low lung function,postoperative non-epidural analgesia,injure of recurrent laryngeal nerve and fistula of anastomotic were the risk factors.Conclusions The preoperative evaluation,Intensive monitoring during the postoperative period and reducing the complication after operation can decrease the incidence of HAP.

Objective To study the relationship of gestational diabetes mellitus(GDM) and ~family history of diabetes (FHD), clinical characteristics and maternal and infant outcomes of GDM and gestational impaired glucose tolerance (GIGT). Methods A prospective case-control study was performed in 244 women with GDM/ GIGT, including 93 patients with family history of diabetes and 151 without FHD, and 244 normal OGTT cases as control from Feb. 2004 to Aug. 2004 in Dept of OB &GYN of Peking University First Hospital. Univariate analysis was used to estimate the odds ~ratios with 95% CI. Results (1)FHD was a risk factor of GDM/GIGT, OR=2.9.The co-effect of parents DM on transmission was excessive. (2)Maternal≥30 years old with FHD were greater than those without FHD (75.3% vs 62.9%). More intakes of fruits and carbohydrate per day and more weight gain during pregnancy in pregnant women with FHD were lower than those in patients without FHD. (3) The prevalence of GDM was indifferent ~between patients with and without FHD. 50 g OGCT plasma glucose (PG), fasting PG and 3 h PG in 75 g OGTT of patients with FHD were higher than those of patients without FHD. The number of pregnant women treated by insulin was significantly different between patients with and without FHD. (4) No difference was found between family and non-family history of diabetes in the prevalences of pre-eclampsia, FGR, polyhydramnios, preterm labor, LGA and SGA. Conclusions (1) FHD is a risk of GDM/GIGT, and exposure to a diabetic intrauterine environment is a mechanism responsible for this excessive maternal inheritance. (2)~Besides family history of diabetes, more intake of fruits or carbohydrate and larger gain of body weigh during pregnancy may result in GDM/GIGT.

Objective To investigate the characteristics of insulin requirements during pregnancy in women with pre-gestational diabetes mellitus. Methods A retrospective study was conducted on 116 pregnant women with pre-gestational diabetes admitted to the Department of Obstetrics & Gynaecology, First Hospital, Peking University from 1981 to 2003. Ninty-five among the 116 cases required insulin during pregnancy among which 82 cases were enrolled in the observational group. Results Eighteen women in the observational group had OGTT performed during pregnancy whose values were above the diagnostic criteria of non-pregnant diabetes. The insulin requirements increased with the gestational age with the peak dose at 32~36 weeks followed by slight decrease till delivery. Among all the women who used animal insulin, the average BMI of those whose dose

Objective To investigate the value of endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) for the diagnosis and therapy of gastric ectopic pancreas.Methods A total of 86 patients who were suspicion diagnose with gastric ectopic pancreas received ESD or STER in hospital,and the therapeutic effect and safety were followed-up.Results Fifty-four gastric ectopic pancreas patients were definitely diagnosed by postoperative pathology.Of the 54 patients,43 cases were located at the gastric antrum,7 cases were located at gastric fundus and gastric corpus juncture,4 cases were located at gastric corpus.Forty-five cases received ESD,9 cases received STER,rate of completely resection was 88.9％ (48/54),6 cases had a little tissue residual after resection.One case (1.9％,1/54) happened postoperative delay-bleeding,intraoperative and postoperative perforation was not found.During 1-32 months followed up,recurrence was not found.Conclusion ESD could excise the whole lesion to offer an accurate pathology diagnose,meanwhile good for treatment,ESD is an effective and relatively safe method for gastric ectopic pancreas,STER may be a new approach for gastric ectopic pancreas.

Objective To improve the image quality of the electrical impedance tomography (EIT) by introducing the prior information into the regularization matrix.Methods The linear combination of the conductivity was established by background conductivity of dynamic variation,the covariance matrix was used here to remove the correlation between the background conductivity,and this prior information was introduced to construct the regularization matrix.Resnlts Compared with the traditional regularization matrix,the one involving in the prior information on the dynamic background gained more stable and better images.Conclusion Trials prove the efficacy of the regularization matrix on EIT imaging in 1 respiratory cycles (or heart beat),and following related researches may find theoretical references and support for feasibility.

Objective To study the maternal and fetal outcome in pregnancy with overt diabetes. Methods Retrospective study was made on 88 pregnancies with overt diabetes from 1981 to 2001 in department of Obstetrics & Gynaecology, first teaching hospital, Beijing university to study the maternal and fetal outcome in pregnancy with overt diabetes and its relationship with the level of blood glucose. One case with artificial abortion and 2 cases with metaphase induced labor were rejeceted from the 88 cases, we devided the other 85 cases into two groups. Group A with well controlled glucose had 42 cases; group B without well controlled glucose had 43 cases. Results In this study, we found 5 cases of fetal death in group B, 3 of them were perinatal death. Nine cases of newborn malformation were all found in those people without well controlled glucose in early pregnancy, the incidence of newborn malformation was 10.2%. The rate of asphyxia of newborn in group B (24.4%) is significant higher than in group A (4.8%) ( P =0.011). The rate of pregnancy induced hypertension in group B (44.2%) is significantly higher than that in group A (21.4%) ( P = 0.026). The rate of premature labor in group B (30.2%) is significantly higher than that in group A (9.2%) ( P =0.017). Conclusions Maternal blood glucose with ideal control throughout pregnancy may reduce the maternal complications and perinatal morbidity and mortality in pregnancy with overt diabetes.

Objective To evaluate the value of glycosylated hemoglobin (HbAlc) level in glucose monitoring,insulin therapy and neonatal birth weight prognosis in gestational diabetes mellitus (GDM) patients.Methods Data of 1074 women who were diagnosed as GDM and delivered at Peking University First Hospital between January 1,2005 and August 31,2011 were collected and retrospective analysis was conducted.The relationship of HbAlc level with plasma glucose level of oral glucose tolerance test (OGTT),insulin administration and neonatal birth weight were investigated with Pearson correlation analysis,Logistic regression analysis or receiver operating characteristic (ROC) curve.Results OGTT was done on 1074 women with (31.8± 4.0) years old during the second and third trimester and diagnosed GDM at (27.6 ± 3.4) weeks of gestational age.Among them,glucose level of fasting and 1 and 2 hours after OGTT were (5.2 ± 0.7),(10.9± 1.4) and (9.4±1.5) mmol/L.The levels of HbAlcwere (5.57±0.48)％ at the fist time of HbAlc testing at (31.8±4.3) weeks of gestational age.(1)The average value of HbAlc in 726 women determined at one month after OGTT was (5.54±0.47)％,and increased from (5.34±0.41)％ in women with one abnormal item in OGTT to (5.47±0.41)％ and (5.71±0.46)％ in women with two or three abnormal items inOGTT (t=3.025 and 6.399,all P＜0.01).(2) HbAlc level in women received insulin therapy was higher than those who did not [(5.78±0.58) ％ vs (5.42±0.37) ％,t=9.431,P＜0.01].The sensitivity and specificity were 57.8％ and 75.5％ respectively in predicting insulin requirement in women with GDM at the cut-off value of 5.67％ for HbAlc (Logistics analysis:OR＝6.847,95％CI:4.588-10.218,P＜0.01).(3) Maternal HbAlc levelat the third trimester was higher in large for gestational age(LGA) group than that in non-LGA group [(5.75±0.52)％ vs (5.54±0.42)％,t=6.845,P＜0.01].The sensitivity and specificity were 44.8％ and 73.8％ respectively in predicting LGA at the cut-off value of 5.75％ for HbAlc (Logistics analysis:OR=2.187,95％CI:2.097-3.783,P＜0.01).(4) Maternal HbAlc level at the third trimester was higher in macrosomia group than that in non-macrosomia group [(5.88±0.53)％ vs (5.57±0.45)％,t=5.990,P＜0.01].The sensitivity and specificity were 50.4％ and 79.8％ respectively in predicting macrosomia at the cut-off value of 5.85％ for HbAlc (Logistics analysis:OR=3.299,95％CI:2.237-4.865,P＜0.01).Conclusions HbAlc level at the time of GDM diagnosis could imply the severity of disease and might predict insulin requirement.While maternal HbAlc level at the third trimester may predict the occurrence of LGA and macrosomia.

Objective To understand the growth pattern of infants of mothers with maternal glucose metabolism during pregnancy.Methods Totally,7600 infants,born from singleton pregnant women from January 1st,2007 to December 31st,2009 in Peking University First Hospital and were followed up at 6-12 weeks after birth,were included.Altogether,645 mothers were complicated with hyperglycemia and 6955 with normal glucose metabolism during pregnancy.All infants were divided into four groups based on maternal glucose metabolism and their birth weight:Group N1 (n =6432) was consisted of non-macrosomia infants with normal maternal glucose metabolism; Group N2 (n =523) included macrosomia infants with normal maternal glucose metabolism; Group A1 (n =588) were non-macrosomia infants with abnormal maternal glucose metabolism; Group A2 (n =57) were macrosomia infants with abnormal maternal glucose metabolism.Birth weight,body weight at the day of follow-up and average daily weight gain were compared among these four groups.T-test,single variance analysis and LSD was applied in statistics,and the time at follow-up was used as co variance to find out the early growth pattern of infants.Results The birth weight of infants in normal and abnormal glucose metabolism group showed no statistical difference [(3367.0±420.3) g vs (3368.2±475.1) g,t=-0.061,P＞0.05],but body weight at the day of follow-up and the daily weight gain in the former group were lower than in the latter [body weight at follow-up:(5459.3±625.2) g vs (5393.9±647.2) g;daily weight gain:(44.0±9.5) g vs (42.9±9.5) g,t=2.464 and 2.874,all P＜0.05].The birth weight of infants in Group N1,A1,N2 and A2 was (3300.6±359.2) g,(3282.1±397.0) g,(4183.8±203.8) g and (4256.8±248.8) g,respectively;the body weight at the day of follow-up was (5400.5±590.7) g,(5325.8±618.8) g,(6182.7±584.7) g and (6096.5±502.4) g;daily weight gain was (44.1±9.4) g,(43.2±9.4) g,(42.4±10.9) g and (39.6±10.0) g,respectively (F=1140.471,313.376 and 10.830,all P＜0.001).While using co-variance to compare among the four groups,statistically more daily weight gain was shown in Group N1 than in A1,A2 and N2,in Group N2 than in Group A2,in Group A1 than in A2 (all P＜ 0.05).Conclusions The growth speed may slow down in early infantile period for offsprings of mother with hyperglycemia during pregnancy.

Objective (1) To investigate the glucose and lipid metabolism 6-12 weeks after delivery in women with hyperglycemia during pregnancy. (2) To find out factors associated with the prognosis of women with hyperglycemia during pregnancy. (3) To investigate the feasibility of the diagnostic criteria set by the International Association of Diabetes and Pregnancy Study Group according to the follow-up data of women with hyperglycemia in pregnancy. Methods Clinical data of 262 women with hyperglycemia during pregnancy delivered in our hospital from January 1, 2007 to December 31, 2009 were collected. All patients underwent oral glucose tolerance test (OGTT) at 6-12weeks after delivery. They were divided into two groups according to the postnatal status of glucose and lipid metabolism. Multivariate Logistic regression model was used to analyze the factors affected glucose and lipid metabolism after 6-12 weeks of delivery. Results (1) Among the 262 women, 92(35.1%) were reported with abnormal glucose metabolism at 6-12 weeks of delivery, including one (0. 4 % ) woman with impaired fasting glucose, 81 (30. 9 % ) with impaired glucose tolerance, 4( 1.5 % )with impaired fasting glucose+impaired glucose tolerance and 6 (2. 3%) with diabetes mellitus.glucose levels in OGTT (OGTT 2hPG and the OGTT 3hPG) were risk factors for postpartum 0. 181-0. 918)]. (3) All markers of lipid metabolism were detected in 250 women with hyperglycemia during pregnancy at 6-12 weeks after delivery, the rate of abnormal postnatal lipid metabolism was 63.2%(158/250). In the abnormal group (n= 174), the most common abnormal marker was hypercholesterolemia (n = 126, 50. 4 % ), followed by high levels of low-density lipoprotein-cholesterol (n = 102, 40. 8 %), hypertriglyceridemia (n= 60, 24. 0 %) and low levels of high-density lipoproteincholesterol (n= 11, 4. 4 %). (4) Logistic regression model showed that elevated OGTT 2hPG was the risk factor for postpartum abnormal glucose metabolism [OR= 1. 364 (95%CI: 1. 063-1. 751)], while 0. 169-0. 851)]. Conclusions Women with hyperglycemia during pregnancy are more likely to present with abnormal glucose and lipid metabolism which commonly coexisted with insulin resistance.The risk factors for the postpartum abnormal glucose metabolism in mothers with hyperglycemia during pregnancy include early diagnosis, OGTT 2hPG and OGTT 3hPG, while the protective factor is breastfeeding. The risk factor for the postpartum dyslipidaemia in mothers with hyperglycemia during pregnancy is OGTT 2hPG, while the protective factor is high-density lipoprotein-cholesterol level in pregnancy.