Objective To test the effectiveness of an integrated intervention to improve control and management of type 2 diabetic patients.Methods The study was designed as a randomized and multi-center clinic trial for 24 weeks.150 overweight patients from 2 companies and one hospital in Shanghai were recruited.The principal objective of the project was to compare the effectiveness of a structured diabetes management program consisting of 200 kcal breakfast as a meal replacement with low glycemic index (GI),scheduled blood glucose monitoring(6 times per week),low GI diet consulting,monitoring and medical check up and nutritional education (diet consulting,health education on nutrition and healthy lifestyle) in overweight individuals with type 2 diabetes.Results At 12th week,the level of fasting blood glucose(FBG) in both groups decreased by 16.5% and 10.6%,and at 24th week,the FBG also decreased by 25.0% in intervention group,but in control group FGB increased 2.8% (P＜0.01).Meanwhile,there were 8.2% and 11.1% reductions in HbA1C respectively at 12th week and at 24th week in intervention group,while the values were increased slightly in control group(P＜0.01).Compared with control group,waist circumference,hip circumference,and blood pressure were significantly reduced after treatment for 24 weeks in intervention group (P＜0.01).Conclusions Integrated intervention is an effective approach in managing FBG,HbA1C blood pressure,and weight control in overweight diabetic patients.

Background:The occurrence of gastric cancer is a gradual process with multiple factors and multiple steps. In addition to cytological and structural abnormalities,there are abnormal molecular expressions,which involve the activation of many oncogenes and the inactivation of tumor suppressor genes. Aims:To explore the expressions and significance of Ki-67,p53 and P504s in normal gastric mucosa,atrophic gastritis with intestinal metaplasia,low-grade intraepithelial neoplasia,high-grade intraepithelial neoplasia and early gastric cancer. Methods:A total of 44 cases of normal gastric mucosa,44 cases of atrophic gastritis with intestinal metaplasia,41 cases of low-grade intraepithelial neoplasia,38 cases of high-grade intraepithelial neoplasia and 35 cases of early gastric cancer from Jan. 2015 to Dec. 2016 at the Affiliated Drum Tower Hospital of Nanjing University Medical School were collected. Expressions of Ki-67,p53 and P504s were detected by immunohistochemical staining. Results:Compared with normal gastric mucosal tissue,the positivity rates of expression of Ki-67,p53 and P504s in atrophic gastritis with intestinal metaplasia,low-grade intraepithelial neoplasia,high-grade intraepithelial neoplasia and early gastric cancer were obviously increased (P＜0.05). With the increasing of severity of the lesion,the positivity rate gradually increased. Conclusions:The expressions of Ki-67,p53 and P504s are closely related to the occurrence and development of gastric cancer,and are involved in the early process of gastric cancer. The detections of these molecular markers are helpful for determining the severity and trend of the lesion,and beneficial for improving the detection rates of gastric precancerous lesion and early gastric cancer.

OBJECTIVE: To evaluate the effect of low-temperature coblation on subglottic hemangioma under endoscopy. METHOD: Clinical data of 5 patients whom were diagnosed as subglottic hemangioma treated with low-temperature coblation under endoscopy were retrospectively studied. Two cases of the patients were treated after tracheotomy. RESULT: Hemangioma vanished completely in the 5 patients. All patients were followed-up from 3-6 months,no recurrence was found, and the 2 cases were extubated successfully. CONCLUSION Endoscopic surgery u sing low-temperature coblation for subglottic hemangioma after tracheotomy can relief the airway obstruction quickly, shorten the nature course of hemangioma and the period of wearing trachea,also no complication such as subglottic stenosis which is thought to be a safe and effective therapy for large size hemangioma. While for small size hemangioma, endoscopic surgery using low-temperature coblation under good total anesthesia without tracheotomy combined is effective, less injure, and suitable. Endoscopic surgery using low-temperature coblation for subglottic hemangioma has following advantages such as simplicity, minimal invasion and so on. It is a viable surgical method for the treatment of subglottic hemangioma.
Catheter Ablation ; methods ; Female ; Glottis ; Hemangioma ; surgery ; Humans ; Hypothermia, Induced ; Infant ; Laryngeal Neoplasms ; surgery ; Male ; Retrospective Studies

Objective: To delineate the variants spectrum of phenytalanine hydroxylase (PAH) gene among 78 unrelated patients with phenylketonuria (PKU) from Jiangxi province. Methods: The 13 exons and flanking intronic regions of the PAH gene were subjected to PCR amplification and sequencing. Results: A total of 143 variants were detected among the 156 alleles, which included 54 types of variants, which yielded a detection rate of 91.7%. Common variants have included R243Q (26/143, 18.2%), R408Q (10/143, 7.0%), EX6-96A>G (8/143, 5.6%), IVS4-1G>A (7/143, 4.9%), R241C (7/143, 4.9%) and V399V (7/143, 4.9%). In addition, 6 novel variants were detected, which included IVS4-3T>G, Q172H, C284Y, V291L, V329del, and L430R. The variants consisted of missense, splicing, nonsense and deletion variants, which have mainly located in exons 7 (45, 31.5%), 12 (17, 11.9%), 11 (16, 11.2%) and 6 (14, 9.8%). Conclusion Variants of the PAH gene identified in Jiangxi province mainly involve exons 7, 12, 11 and 6, with the most common variants being R243Q and R408Q. Six novel variants were identified.

OBJECTIVE: To assess the value of chromosomal microarray analysis (CMA) for the prenatal diagnosis of a fetus with structural anomaly detected by ultrasonography. METHODS: The fetus and its parents were subjected to chromosomal karyotyping and CMA analysis. RESULTS: The fetus was found to carry a 46,XN,t(8;11)(q21.2;q13) translocation which was inherited from its mother. CMA has found no copy number variations (CNVs) in both parents but a de novo 2.00 Mb microdeletion in the fetus at 8q13.3. CONCLUSION CMA is capable of detecting microdeletions and microduplications in fetuses with translocations detected by karyotyping analysis.
Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Human, Pair 8 ; DNA Copy Number Variations ; Female ; Fetus ; Humans ; Karyotyping ; Microarray Analysis ; Pregnancy ; Prenatal Diagnosis

Objective To observe and analyze the influence of mastoscopic axillary lymph node dissection on the inflammatory stress and immune stress of patients with breast cancer.Methods Sixty patients with breast cancer were selected and randomly divided into control group(open surgery group)and observation group(mastoscopy-assisted treatment group),30 cases in each group.The inflammatory stress and immune stress indexes of two groups before the surgery and 12,48 and 72 hours after the surgery were detected and compared.Results The inflammatory stress and immune stress indexes 12,48 and 72 hours after the surgery in observation group were significantly better than those in control group(P<0.05).Conclusion The influence of mastoscopic axillary lymph node dissection on the inflammatory stress and immune stress of patients with breast cancer is better than open surgery.

Objective To observe and analyze the influence of mastoscopic axillary lymph node dissection on the inflammatory stress and immune stress of patients with breast cancer.Methods Sixty patients with breast cancer were selected and randomly divided into control group(open surgery group)and observation group(mastoscopy-assisted treatment group),30 cases in each group.The inflammatory stress and immune stress indexes of two groups before the surgery and 12,48 and 72 hours after the surgery were detected and compared.Results The inflammatory stress and immune stress indexes 12,48 and 72 hours after the surgery in observation group were significantly better than those in control group(P<0.05).Conclusion The influence of mastoscopic axillary lymph node dissection on the inflammatory stress and immune stress of patients with breast cancer is better than open surgery.

Objective To compare the pathological results between preoperative gastroscopy samples and postoperative samples of endoscopic resection from patients with gastric intraepithelial neoplasia, and further investigate the risk factors of pathological upgrading. Methods A retrospective analysis was performed on the data of 371 patients with gastric intraepithelial neoplasia confirmed by biopsy and undergoing endoscopic resection from January 2012 to December 2014 in Nanjing Drum Tower Hospital. The preoperative and postoperative pathological results were compared, and the risk factors for pathological upgrading after operation were analyzed. Results Among 371 patients, 173 and 198 cases were diagnosed as low-grade intraepithelial neoplasia ( LGIN ) and high-grade intraepithelial neoplasia ( HGIN ) , respectively, by preoperative endoscopic biopsy. By postoperative pathology of endoscopic resection, 113 ( 65. 3％) of 173 LGIN cases kept the diagnosis, while 46 ( 26. 6％) of 173 cases were upgraded to HGIN, and 10 ( 5. 8％) of 173 cases were finally upgraded to gastric cancer. The upgrade rate was 32. 4％(56/173). In the HGIN group, 107 ( 54. 0％) of 198 HGIN patients had the same diagnosis after endoscopic resection, 78 ( 39. 4％) of 198 cases were upgraded to cancer. Multivariate regression analysis showed that diameter of larger than 2 cm (P=0. 008), proximal stomach location (P=0. 011), mucosal surface redness ( P=0. 000 ) , and surface depression or ulcer ( P=0. 003 ) were independent factors of pathological upgrading for postoperative samples. Conclusion Preoperative biopsy for the diagnosis of gastric intraepithelial neoplasia has a certain misdiagnosis rate. More attentions should be paid on the lesion which is larger than 2 cm in diameter, located in the proximal stomach, or mucosa with red surface, depression or ulcer. Postoperative pathological examination can help to clarify the nature of the lesion.

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with N-acetylglutamate synthase deficiency. METHODS: Trio whole exome sequencing (WES) was carried out for the pedigree. Pathogenicity of the identified variant was predicted based on the latest recommendation of the American College of Medical Genetics and Genomics (ACMG). Prenatal diagnosis was provided for subsequent pregnancy through Sanger sequencing. RESULTS: Trio WES showed that the proband has carried compound heterozygous c.68delG and c.796G>C variants of NAGS gene, for which the mother and father were respectively heterozygous carriers. Neither variant was reported previously. Based on the ACMG guidelines, the c.68delG variant was classified as "likely pathogenic" (PVS1+PM2), while the c.796G>C variant was classified as with "uncertain significance" (PM2+BP4). Sanger sequencing validated the above findings, and only detected the heterozygous c.796G>C variant in the amniotic fluid sample. The fetus was followed up till 6 month after birth with no obvious abnormality. CONCLUSION The compound heterozygous c.68delG and c.796G>C variants of the NAGS gene probably underlay the disorder in this pedigree, and the resulth asenabled genetic counseling and prenatal diagnosis for this pedigree.
Amino-Acid N-Acetyltransferase/genetics* ; China ; Female ; Genetic Testing ; Humans ; Male ; Mutation/genetics* ; Pedigree ; Pregnancy ; Prenatal Diagnosis ; Urea Cycle Disorders, Inborn/genetics* ; Whole Exome Sequencing

OBJECTIVE: To investigate the clinical features and prognosis of sudden hearing loss in children, so that to guide clinical diagnosis and treatment. METHOD: A retrospective review of medical records of 12 hospitalized children (21 ears) suffering from sudden hearing loss was conducted. RESULT: The study comprised 8 males and 4 females with a mean age of 6.28 years old, among which 25% had a unilateral hearing loss and 75% exhibited bilateral hearing loss. The mean onset time was 5.42 days. Four children had tinnitus and 3 patients showed dizziness. For the possible etiology. 2 cases had mumps. 6 cases had definite upper respiratory infections history, one experienced trauma, and another one took ototoxic drugs. Five patients were proved to come down with the large vestibular aqua duct syndrome by the CT scan. Among the 21 ears. 7 ears were diagnosed severe hearing loss and 14 ears were diagnosed profound hearing loss. After the treatment of 7 days, 6 ears were cured, one car showed effective change. and 14 cars came out to be ineffective, with the total effective rate of 33.3%. After the 14 days' treatment, there was no improvement for 5 patients. CONCLUSION CT scan should he performed on all of the children with hearing loss to exclude the inner ear malformation. Most of the children with sudden hearing loss underwent some clear etiology, showing more severe hearing loss and had a poorer prognosis.
Child ; Child, Preschool ; Female ; Hearing Loss, Sudden ; diagnosis ; Hearing Tests ; Humans ; Male ; Retrospective Studies