Objective To assess the validity of using fasting plasma glucose （FPG） and HbA1c for the screening of diabetes. Methods 1118 subjects （489 men, 629 women） in Beijing area underwent an oral glucose tolerance test （OGTT） for screening diabetes. HbA1c was examined at the same time. They have never undergone OGTT and controlled plasma glucose levels by any methods. Their average age was 48±12 years. Results Using 1999 WHO criteria, 510 had normal glucose tolerance （NGT）, 35 had impaired fasting glucose（IFG）, 155 had impaired glucose tolerance （IGT）, 52 had IGT and IFG, 366 had diabetes. Using a receiver operating characteristic curve （ROC curve）, the optimal cut-point of FPG related to diabetes diagnosed by OGTT was 6.2mmol/L that was associated with a sensitivity and specificity of 85.0% and 90.4% respectively. Area under the curve was 0.943 （95% CI 0.9270.959）, a positive likelihood ratio （LR） was 8.9, and a negative LR was 0.2. The optimal cut-point of HbA1c related to diabetes diagnosed by OGTT was 6.2%, which was associated with a sensitivity and specificity of 86.6% and 77.5% respectively. Area under the curve was 0.896 （95% CI 0.8760.916）, a positive LR was 3.9, and a negative LR was 0.2. The cut-point of FPG related to IGT diagnosed by OGTT was 5.1 mmol/L, which was associated with a sensitivity and specificity of 65.2% and 68.3% respectively. Area under the curve was 0.729 （95% CI 0.6890.769）, a positive LR was 2.1, and a negative LR was 0.5. The cut-point of HbA1c related to IGT diagnosed by OGTT was 5.7%, which was associated with a sensitivity and specificity of 63.3% and 56.5% respectively. Area under the curve was 0.634 （95% CI 0.5910.677）, a positive LR was 1.5, and a negative LR was 0.7. Conclusions When FPG<7.0 mmol/L and ≥6.2 mmol/L or HbA1c≥6.2%, OGTT was necessary to confirm the diagnosis of diabetes. FPG or HbA1c was not reliable to identify IGT.

Objective To evaluate the clustered characteristics of the components of metabolic syndrome. Methods 483 subjects (242 men, 241 women, aged 53±12 years ) in Beijing area underwent a 75g oral glucose tolerance test (OGTT) for screening of diabetes.203 subjects were diagnosed as diabetes through OGTT.Factor analysis was performed using the variables of insulin/blood glucose, total cholesterol (CHO), LDL-C, HDL-C, triglycerides (TG), systolic blood pressure, diastolic blood pressure, BMI, waist-to-hip ratio and waist circumference. Results Five factors, including obesity, insulin resistance/hyperglycemia, CHO/LDL-C, dyslipidemia (elevated TG and decreased HDL) and hypertension, could explain 72.2% of total variance.The most important component was obesity, which could explain 29.8% of total variance.The obesity factor was associated with dyslipidemia factor through C-reactive protein (CRP).Dyslipidemia factor also associated with insulin resistance/hyperglycemia factor.Hypertension factor and CHO/LDL-C factor were isolated from other factors. Conclusions Obesity factor is the most important component of metabolic syndrome.The pathophysiologic mechanism of metabolic syndrome is complex.Insulin resistance alone could not explain all features of the metabolic syndrome.Its pathophysiology maybe include the factors of obesity, insulin resistance and inflammatory reaction.

Objective: To explore the pathophysiologic and clinical features and investigate the roles of insulin resistance and insulin secretion in the pathogenesis of type 2 diabetes mellitus. Methods:A total of 888 first-degree relatives without glucose intolerance history underwent an oral glucose test (OGTT) and their level of HbA1c, insulin concentration and lipid levels were determined. The homeostasis model assessment was used to estimate insulin resistance (HOMA IR ) and ?-cell function (HOMA-?). The ratio of incremental glucose (?G30) and insulin (?I30) response was used to evaluate the early insulin secretion.?I30/?G30/HOMA IR was used to evaluate the glucose disposition index (DI). Results: In the subjects, 167 were diagnosed with diabetes, 180 with impaired glucose tolerance or/and impaired fasting glucose (impared glucose regulation), 457 with normal glucose tolerance and normal HbA1c, and 84 with normal glucose tolerance and high HbA1c. From normal glucose tolerance through impared glucose regulation to diabetes mellitus, the HOMA IR , body mass index (BMI), waist/hip ratio (WHR) and serum triglyceride (TG) progressively increased, HOMA-? cell 、?I30/?G30 、 DI and high density liproprotein (HDL) progressively decreased. Subjects with normal glucose tolerance were divided into three tertile subgroups (1/3, 2/3 and 3/3 groups) with different area under the curve of OGTT glucose, after being adjusted by sex, age, BMI, the 3/3 group was found having higher HOMA IR , and lower HOMA-?, ?I30/?G30/, and DI than the 1/3 group. Conclusion: Both insulin resistance and impaired ? cell function are important pathophysiologic changes contributing to the onset and development of type 2 diabetes. These changes and lipid profile have occurred before a patient is diagnosed with abnormal glucose tolerance.

Objective To evaluate the effect of early-phase insulin secretion and insulin resistance in the pathogenesis of type 2 diabetes, and to analysis the risk factors of glucose tolerance deterioration. Methods Oral glucose tolerance test (OGTT) was performed in subjects over 30 years old coming from 78 families with type 2 diabetes. A total of 118 subjects with normal glucose tolerance (NGT) [fasting plasma glucose (FPG)<6.1 mmol/L and 2h postprandial glucose (2hPG)<7.8 mmol/L] were enrolled. Another OGTT was performed in them to define the glucose tolerance status at the end of the 4-7 years follow-up. AINS30/APG30, the ratio of the increment of insulin to that of plasma glucose at 30 min after the glucose load, was used to assess the early phase insulin secretion. HOMA-IR and HOMA-β were calculated to assess the insulin resistance and β-cell function respectively. Results After 4-7 years follow-up, 66 of 118 subjects still remained NGT, while 52 became either diabetic (n=11)or pre-diabetic (n=41). Using the median of HOMA-IR and AINS30/APG30 as the cutoff points, all subjects were divided into four groups: subjects with good early phase insulin secretion and no insulin resistance, subjects with good early insulin secretion but relative insulin resistance, subjects with impaired early phase insulin secretion but no insulin resistance, subjects with impaired early phase insulin secretion and also relative insulin resistance. The incidences of abnormal glucose tolerance among these four groups were 23.1%, 36.4%, 45.5% and 73.1% respectively. There was a statistical difference between the former three groups and the last one (P<0.05). Log/st/c regression analysis showed that only the early phase insulin secretion was the risk factor of glucose tolerance deterioration, while age, gender, insulin resistance or β-cell function were not. Conclusion Impaired early phase insulin secretion is a major risk factor for the disturbance of glucose metabolism in the population with NGT.

Objective To investigate the application of dual volume reconstruction translucent imaging in performing stent- assisted coil embolization for intracranial aneurysm embolization treatment. Methods During the period from Nov. 2011 to Sep. 2012, a total of 30 patients with intracranial aneurysm were admitted to authors’ hospital. Stent-assisted coil embolization was carried out in all patients. The number of all the stent point-marks visualized on routine 2D-DSA, on rotational angiography (3D-RA) and on dual volume reconstruction translucent images were determined, and the results were compared between each other of the three imaging methods. Results A total of 34 stents (206 stent point-marks in total) were implanted in the 30 patients. Of the 206 stent point-marks, 2D-DSA, 3D-RA and dual volume reconstruction translucent image could clearly display 146 (70.8%), 123 (59.7%) and 190 (92.2%), respectively. Statistically significant difference in the displaying rate of the stent point-marks existed between each other among the three imaging methods (P < 0.05). Conclusion Dual volume reconstruction translucent imaging can distinctly display the location of the stent marks, which is of great value in guiding the performance of intracranial stent implantation surgery.

Objective To study the diagnosis and treatment of blunt pancreatic injury (BPI). Methods A retrospective analysis was made on the clinical data of 58 cases of BPI admitted and treated in our hospital during 23 years. Results The positive diagnosis rate was 51.1%(23/45) for single BUS examination ,but 70.0%(21/30) for two and more BUS examimations. The positive diagnosis rate was 65.0%(26/40) for single CT scanning, but 91.3%(21/23) for two and more CT scannings. Twenty-five cases(25/37,67.6%) with BPI were determined preoperatively, and 12 cases(12/37,32.4%)during (operation).Thirty-seven cases underwent operatiom, included grade I in 10cases、grade II 13cases、grade III 9cases、 grade IV 4cases and gradeV 1case. Twenty-one cases received nonoperative treatment, included 11 grade in I,7 grade II and 3 grade III. In the entire group, 6 cases died(10.4%).The mortality in the operation group was 16.2%(6/37).There were no deaths in the nonoperative group. The main cause of death was multiorgan failure(5/6,83.3%). There were 11(19.0%)cases of pancreatic pseudocyst after treatment in the entire group, included 3(3/37,8.1%) in operation group and 8(8/21,38.1%) in nonoperation group. Conclusions The diagnosis of BPI should combine the clinical findings with repeated BUS and CT scanning. Nonoperative treatment is a good choice for BPI without main pancreatic duct injury. Operative treatment is suitable for serious BPI and those with other intra-abdominal organ jnjury.

The etiology of deep vein thrombosis (DVT) is still not elucidated nowadays. Based on the accordance between DVT incidence and the anemophilous pollen concentration in the air, we proposed the hypothesis that allergic reaction induced by anemophilous pollen may cause "idiopathic" DVT, and proinflammatory factors may play an important role in the thrombosis process.

cerebral infarction as compare with patients at Grade 1-2 in both vascular locations, whereas the risk was not significantly increased in patients at Grade 3-4 in only one vascular location. Conclusions The simple method of assessing the degree of arterial atherosclerosis can be used to evaluate carotid artery and lower-extremity artery atherosclerosis in patients with type 2 diabetes. Patients with plaques or stenosis in both vascular locations were with a significantly increased risk of coronary heart disease or cerebral infarction if they were evaluated concurrently.

[Summary] Data from 1 589 consecutive inpatients with type 2 diabetes mellitus from January 2012 to March 2015 were collected. The patients were divided into five groups according to the quintile of HbA1C . The association between serum uric acid ( SUA) and HbA1C was tested using a general linear model after adjusting for age, body mass index ( BMI) , systolic blood pressure, and creatinine. Linear regression analysis was used to analyze the association between SUA and HbA1C in patients with HbA1C<9. 0% and HbA1C≥9. 0%, respectively. The results showed that BMI, waist circumference, triglycerides, and the incidence of fatty liver were elevated with increased serum uric acid level. SUA was negatively associated with HbA1C level in inpatients with type 2 diabetes. However, SUA should be measured after glycemic control in men with HbA1C≥7. 0% and women with HbA1C≥9. 0%.

A 46-year-old female patient was diagnosed as mixed phenotype acute leukemia with chief complaints of intermittent gingival swelling and bleeding for 1 week. The induction chemotherapy was not effective. During the second course chemotherapy, the patient had sudden convulsion and coma. She was transferred to the intensive care unit with worsened condition after transient improvement. Her final diagnosis was secondary adrenocortical insufficiency, adrenal crisis, intractable hyponatremia and cerebral edema.