?AIM: To study the changes of choroidal thickness and hemodynamic parameters in patients with diabetic retinopathy and their influencing factors.?METHODS: From January 2013 to January 2015, 100 patients (100 eyes) with type 2 diabetes were divided into 3 groups:34 patients without diabetic retinopathy ( NDR) , 36 patients with non proliferative diabetic retinopathy ( NPDR) group, and 30 patients with proliferative diabetic retinopathy (PDR). According to the results of OCT, the patients with diabetic retinopathy were divided into 2 groups: diabetic macular edema ( DME ) group ( 28 cases) , and 38 cases without diabetic macular edema. During the same period in our hospital 35 subjects for physical examination were selected as the control group. The hemodynamic parameters of the posterior ciliary artery in different groups of patients at different distance from the center of the macular were compared, analyzing influencing factors.?RESULTS:With the aggravation of diabetic retinopathy, the choroidal thickness in different distance from the center of the macular decreased. The choroidal thickness of NPDR and PDR group were thinner than that of the control group (P<0. 05). The choroidal thickness of NDR group was not different from the control group (P>0. 05). There was no significant difference in the choroidal thickness between the DME patients and non DME patients (P>0. 05). Pearson correlation analysis showed that there was no significant correlation between choroidal thickness of patients with diabetic retinopathy and diabetic duration, fasting blood glucose, HbA1c, eye axis length, systolic blood pressure and diastolic blood pressure (P>0. 05), but there was a correlation with BCVA (logMAR) (P<0. 01). EDV and PSV in NDR group and NPDR group were significantly lower than those in control group, RI was higher than that in control group. PSV and EDV in PDR group were significantly lower than those in other three groups, RI was higher than the other three groups, and the difference was statistically significant ( P<0. 05).?CONCLUSION:With the severity of retinopathy in type 2 diabetic patients, the choroidal thickness decreased, and the thickness of the choroid is beneficial in the comprehensive analysis of 2 diabetic retinopathy.

Objective:To explore the willingness to use mobile healthcare in patients with gout and explore its influencing factors, and provide theoretical guidance for optimizing the gout mobile healthcare platform and improving patients' willingness to use it.Methods:This study was a cross-sectional study. Totally 234 patients with gout who attended the outpatient service in Shandong Provincial Gout Clinic Medical Center from November 2019 to January 2020 were selected by convenient sampling, and investigated with a self-designed general information questionnaire and questionnaire of gout patients' willingness to use mobile healthcare and its influencing factors. Univariate analysis and multiple linear regression analysis were used to analyze the influencing factors of gout patients' willingness to use mobile healthcare.Results:A total of 53.85% (126/234) of patients with gout mainly used gout WeChat official account as a form of mobile healthcare, and the commonly used functions were diet guidance (64.96%, 152/234) , disease knowledge (60.26%, 141/234) , exercise guidance (54.27%, 127/234) ; 47.01% (110/234) of patients were not satisfied with mobile healthcare. The gout patients' willingness score to use mobile healthcare was (10.91±3.28) . Univariate analysis showed that there were statistically significant differences in the willingness scores of patients with different personal monthly income, education level, and whether have comorbid diseases ( F/t=12.511, 6.343, -2.229; P< 0.05) . Regression analysis showed that the influencing factors of gout patients' willingness to use mobile healthcare included perceived susceptibility, perceived severity, perceived benefits, perceived barriers, information quality and system quality (adjust R2=0.446, P<0.01) . Conclusions:The willingness of gout patients to use mobile healthcare services is at a moderately high level, and there are differences between different individuals. The willingness to use mobile healthcare is affected by patients' health beliefs and the quality of mobile healthcare information systems.

Objective:To explore the impact of pain, functional disability, self-efficacy and social support on health-related quality of life (HRQOL) in gout patients.Methods:From November 2019 to January 2020, a total of 218 patients with gout were investigated using the general information questionnaire, Visual Analogue Scale, Health Assessment Questionnaire Disability Index, General Self-Efficacy Scale, Perceived Social Support Scale, and Gout Impact Scale. The structural equation model was established by AMOS 24.0 for parth analysis, and the mechanism of pain dysfuction, self-efficacy and social support affecting the quality of life in gout patients was tested.Results:The total score of Gout Impact Scale, pain, functional disability, self-efficacy and social support respectively was 59.94±18.39, 6.00±2.76, 0.25 0, 0.88, 23.39±6.40 and 62.92±8.24. Pain directly influenced HRQOL ( β=-0.293, P<0.01), and indirectly influenced HRQOL ( β=-0.039, P<0.05). Functional disability directly influenced HRQOL ( β=-0.244, P<0.01). Self-efficacy directly influenced HRQOL ( β=0.182, P<0.01), and indirectly influenced HRQOL ( β=0.202, P<0.01) through pain and functional disability. Social support indirectly influenced HRQOL ( β=0.278, P<0.01) through pain, functional disability and self-efficacy. Conclusions:HRQOL of patients among gout is affected by several factors, mainly affected by pain, functional disability and self-efficacy; and there are interactions among them. Targeted interventions should be strengthened to relieve pain, prevent or slow down the progress of physical disability, enhance self-efficacy and social support to improve HRQOL.

Objective To summarize the condition of delayed elimination occurred on a patient with acute B lymphocytic leukemia after the forth time of high-dose methotrexate (MTX) chemotherapy and to analyze its reasons.Methods Reviewed the patient's relevant data during the four times of high-dose chemotherapy,including the therapeutic regimen,the results of therapeutic drug monitoring,and other relevant laboratory reports etc.What's more,consulted some related literature,further analyzed the reason of delayed elimination appeared on the patient after repeated chemotherapy of MTX in different views.Results The patient hadn't suffered the MTX relevant adverse reactions after the rescue drug therapy by calcium folinate etc.The blood concentration of MTX decreased to 0.10 μmol · L-1 after 216 hours of administration.It was suggested that the pH of the patient's urine was the possible reason influencing the elimination of MTX,but the foods,the cycles of chemotherapy and the disease stage also couldn't be excluded.Conclusion The blood drug concentration in the different cycles of MTX therapy for the patient were not same,and its specific mechanism needs an in-depth study.If the delayed elimination of MTX occurred,the rescue should be strengthened to ensure the safety and effectiveness of patients.

OBJECTIVETo investigate the association of urinary albumin excretion rate (UAER) and hyperuricemia with macrovascular atherosclerosis in type 2 diabetic patients.

METHODSNinety-seven type 2 diabetic patients were divided into two groups according to the UAER, namely group A with UAER between 20 and 200 microg/min (n=63) and group B with UAER > or = 200 microg/min (n=34); the patients were also classified into hyperuricemia group (group C, n=59) and normal blood uric acid (BUA) group (group D, n=38). The disease course, BUA, fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoproteins (HDL), UAER and arteria carotis intima-media thickness (IMT) were determined in these patients. The relationship of UAER and hyperuricemia with carotid arterial IMT was analyzed statistically.

RESULTSThe levels of TG, TC, LDL and HDL showed no significant differences between the 4 groups (P>0.05). The disease course, BUA, UAER, and FBG levels and IMT in groups A and C were significantly higher than those in groups C and D (P<0.05), but no such differences were found between groups A and C or between groups B and D (P>0.05). Arotid arterial IMT was independently correlated to the disease course, BUA and UAER (r=0.201, 0.1999, 0.211, respectively, P<0.05), and a significant positive correlation was noted between BUA and UAER (r=0.221, P<0.05).

CONCLUSIONMacrovascular atherosclerosis in type 2 diabetic patients is significantly correlated to the disease course, BUA and UAER levels, which can be used to evaluate and predict macrovascular atherosclerosis in type 2 diabetic patients.

Adult ; Aged ; Albuminuria ; complications ; Atherosclerosis ; complications ; pathology ; Carotid Arteries ; pathology ; Diabetes Mellitus, Type 2 ; complications ; pathology ; Female ; Humans ; Hyperuricemia ; complications ; Male ; Middle Aged ; Retrospective Studies

Objective In order to investigate etiology and molecular-epidemiological characteristics of enterovirus associated encephalitis (EAE) in Zhejiang,2008-2012.Method Cerebrospinal fluid and stool specimens were collected from suspected EAE patients,who were admitted to our hospitals.RD and Hep-2 cell lines were used to isolate enterovirus (EV).Serotypes of these EV isolates were identified through neutralization test by using serotype specific anti-sera.VP 1 genes of these isolates were sequenced,compared and used for the construction of phylogenetic tree.Results 127 (20.6％) human enterovirus (HEV) strains were isolated from 616 samples,which were collected from 610 patients.Serotypes of these EV isolates,including 60 coxsackievirus (CV),and 67 Echovirus (E) appeared to be CVA9,CVB1,CVB3-5,E3,E4,E6,E9,El4,E25 and E30,respectively.Predominant EV serotypes on EAE from 2008 to 2012 were seen as CVB3,CVB5,E6,E30 and E30,respectively.The full length of VP1 genes from different EV isolates was between 834 and 918 nucleotides.The VP1 gene similarities between these isolates and the reference strains were from 76.7％ to 85.0％ (nucleotides level) and 91.1％ to 97.9％ (amino acids level).The VP1 genes from E6 serotype isolates appeared most diverged,reaching 20.4％ (nucleotides level) attd 4.8％ (amino acids level).Based on the generated phylogenetic tree,all the EV isolates were fallen on the same branch of HEV-B,and the isolates in the same serotype formed one sub-branch,suggesting there existed geographical and temporal effects.E6 isolates diverged into two branchlets.Conclusion EVs from HEV-B were the etiologic agents for EAE in Zhejiang province from 2008 to 2012.All these EV isolates showed 12 serotypes,with predominant isolates varied every year.E30 was determined as the most dominant serotype while serotype E6 diverged into two sub-genetypes.

OBJECTIVETo explore the intervention effect of the auricular stimulator in the cavum concha for diabetes.

METHODSForty-five cases were treated with auricular simulator in the cavum concha for 30 min, once daily for consecutive 3 months. The changes of the fasting plasma glucose (FBG), blood glucose load after 2-hour 75 g oral glucose tolerance test (P2 BG)and glycosylated hemoglobin (HbA1c) were compared before and after treatment.

RESULTSThe level of the HbA1c was obviously decreased (P < 0.05, P < 0.01), and there were also statistically significant differences in FBG and P2 BG after the treatment (P < 0.05, P < 0.01).

CONCLUSIONWith the auricular stimulator, the stimulation in the cavum concha is benefit for the improvement of HbA1c of the diabetes.

Acupuncture, Ear ; Adult ; Aged ; Diabetes Mellitus ; metabolism ; therapy ; Female ; Glucose ; metabolism ; Glycated Hemoglobin A ; metabolism ; Humans ; Male ; Middle Aged

OBJECTIVETo observe the incidence of heparin-induced thrombocytopenia (HIT) in patients received unfractionated heparin (UFH) treatment, and explore the feasibility of monitoring HIT by platelet counts, as well as the significance of HIT-antibody test in HIT diagnosis.

METHODS145 patients received UFH treatment in Vascular Surgery Department were studied. Before and after the UFH treatment, platelet counts, HIT-antibody ELISA test and heparin-induced platelet aggregation (HIPA) were tested.

RESULTSAmong the 145 patients, thrombocytopenia occurred in 40 (27.6%) cases, HIT-antibody ELISA test positive in 59 (40.7%) cases, HIPA test positive in 26 (17.9%) cases. The HIT was diagnosed in 24 (16.5%) cases, and heparin-induced thrombocytopenia and thrombosis (HITTS) occurred in 5 (3.4% in all cases, and 20.8% in HIT patients). In HIT patients, 15 patients (62.5%) were thrombocytopenia, HIT-antibody positive and HIPA test positive. Platelet counts in all of the 24 patients recovered to normal or level before UFH treatment in 3-6 days after heparin withdrawal therapy.

CONCLUSIONHIT can be early diagnosed by monitoring platelet counts, HIT-antibody ELISA test and HIPA test. Withdrawal of heparin therapy in time and use of alternative anticoagulant, HITTS rate might be expected to decline further.

Adult ; Aged ; Anticoagulants ; adverse effects ; Enzyme-Linked Immunosorbent Assay ; Female ; Heparin ; adverse effects ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; Platelet Count ; Thrombocytopenia ; chemically induced ; diagnosis

OBJECTIVETo explore the indications of arthroscope for the treatment of knee osteoarthritis and investigate the correlation between knee osteoarthritis imaging and effects of arthroscope.

METHODSFrom 2005.8 to 2008.4, 86 patients with knee osteoarthritis underwent arthroscope examination and treatment. Among the patients, 44 patients were male, and 42 patients were female, ranging in age from 46 to 67 years, averaged 56.3 years. Arthrodial cartilage of knee was graded by ICRS MR, and by Kellgern Laqrence X-ray. All the patients were followed up, and the duration ranged from 12 to 30 months. The Lysholm score was evaluated at the follow-up time.

RESULTSAmong 86 knees in 86 cases, cartilage injury degree of knees was graded as follows: grade 4 in 30 cases, grade 3 in 22 cases, grade 2 in 20 cases, grade 1 in 12 cases, grade 0 in 2 cases, mean grade (2.77 +/- 1.138). Postoperative Lysholm score ranged from 59 to 100, averaged (95.17 +/- 7.556), Kendall's correlation coefficient was -0.089, P = 0.317. There was no correlations between cartilage injury degree and Lysholm score. X-ray of knees was graded as follows: grade 4 in 0 cases, grade 3 in 24 cases, grade 2 in 38 cases, grade 1 in 17 cases, grade 0 in 7 cases, mean grade was (2.13 +/- 0.67), the Kendall's correlation coefficient was -0.851 with negative correlations (P = 0.036) between postoperative Lysholm score and K/L grade.

CONCLUSIONThere is no correlation between the grade of knee cartilage injury confirmed by MRI (1.5T) and effects of arthroscopy, and the grade is not a gold standard as an operation indication in arthroscope procedure. The K/L grade in X-ray had important effects.

Aged ; Arthroscopes ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnostic imaging ; pathology ; Radiography

OBJECTIVETo clarify the differential expression of the genes related to the lipid metabolism in the early stage of atherosclerosis in the young LDLR-/- mice of different ages.

METHODSA RT-PCR assay was used to analyse the gene expression patterns in the livers of LDLR-/- mice and wild type (WT) mice from 14 to 90 days. The characteristics of early lipid deposition in intima were evaluated using biochemical and pathological techniques.

RESULTSIn LDLR-/- mice, when compared to WT mice, the mRNA level of the apolipoprotein A IV (apoA IV), fatty acid translocase (Fat/CD36) and carnitine palmitoyl transferase I (CPT I) changed prominently at the age of 14-days (P < 0.05). At 30 days, the mRNA level of apolipoprotein A I (apoA I) was up regulated, but apolipoprotein F (apoF), CD36 and CPT I were down regulated (P < 0.05). At 60 days, the mRNA levels of apoA I, CPT I and liver X receptor alpha (LXRalpha) were up regulated, but apoA IV was down regulated (P < 0.05). At 90 days, the level of the apoA I was higher, but the expression of the apoA IV, apoF and acyl-coenzymeA oxidase 1 (ACOX1) were down regulated (P < 0.05), whereas the expression of apolipoprotein A V (apoA V), apolipoprotein E (apoE), peroxidase proliferator-activated receptor alpha (PPARalpha) and angiopoietin-like protein 3 (angptl 3) had no significant changes (P > 0.05). The serum levels of TC (P < 0.05), TG (P < 0.05) and LDLC (P < 0.05) in LDLR-/- mice were significantly higher than those in wild type mice with the same age.

CONCLUSIONSThe mRNA levels of the apoA I, apoA IV, apoF, FAT/CD36, CPT I, ACOX1 and LXRalpha of the LDLR-/- mice were significantly changed compared to the WT mice. The genes may be of some relevance to the complicated lipid metabolism network, and have effect in the early stage of atherogenesis.

Animals ; Apolipoprotein A-I ; genetics ; metabolism ; Apolipoproteins A ; genetics ; metabolism ; Apolipoproteins E ; genetics ; metabolism ; Gene Expression ; Lipid Metabolism ; Liver ; metabolism ; Liver X Receptors ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Orphan Nuclear Receptors ; genetics ; metabolism ; RNA, Messenger ; metabolism ; Receptors, LDL ; deficiency