Objective To compare the efficacy and the side-effect of three different ways in treating the patients with malignant pleural effusion. Methods 98 patients histologically proved malignant pleural effusion were randomly divided into three groups, bleomycin group(BLM), bleomycin with mycobacterium group( BLM + UTL) and blemycin with intertleukino2 ( BLM +IL). 31 patients were treated with bleomycin intrapleural injection in BLM group,32 patients were treated with bleomycin and Utilin's(mycobacterium) intrapleural injection in BLM + ULL group and 35 patients were treated with bleomycin and intertleukin-2 intrapleural injection in BLM + IL group. The therapeutic efficacy, change of performance and side effects were compared among the three groups after one period of treatment. The changes of CEA and TNF in the pleural effusion were examined before and after treatment. Results The therapeutic efficacy and performance improvement were higher in BLM+UTL and BLM+IL group than that of BLM group(P＜0. 05) ,the pleural CEA of post-treatment in three groups were lower than that of pre-treatment(P＜0.01) ,the CEA after treatment in BLM+UTL group and BLM+IL group was lower than that of BLM group(P＜0. 01,respectively). The pleural TNF of post-treatment in BLM+UTL and BLM+IL groups was higher than that of pre-treatment(P＜0. 01 ) in BLM group. The pleural TNF of post-treatment in BLM+UTL and BLM+IL group was higher than that of BLM group ( P＜0. 01 ). Conclusion Intrapleural injection of mycobacterium with bleomycin or interlekin-2 with bleomycin has better efficacy than using bleomycin only in treating malignant pleural effusion.

Objective To analyze the impact factors for early renal damage in type 2 diabetic patients by the classification tree model.Methods A total of 601 patients with type 2 diabetes were enrolled.According to glomerular filtration rates and urine albumin quantification,the patients were divided into type 2 diabetes group (418 cases) and early diabetic renal damage group (183 cases).The clinical data of the patients were recorded to analyze the main influential factors for the microalbuminuria of type 2 diabetic patients using the Exhaustive CHAID classification tree algorithm.Results Six important explanatory variables were screened out by the classification tree model from the 34 candidate variables related to early renal damage,including fibrinogen,history of hypertension,retinopathy,Cys C levels,SBP and peripheral neuropathy.Elevated fibrinogen was the main factor.Conclusion The classification tree model can analyze the major influential factors of early renal damage in type 2 diabetic patients effectively,and it can help develop the prevention and treatment methods.

Background Endophthalmitis is a serious,sight-threatening condition.Identifying the causative microorganisms is very important for available treatment of endophthalmitis.Objective This survey was to analyze the spectrum of organisms causing culture-proven endophthalmitis and their sensitivities to commonly antimicrobial agents.Methods Medical data of patients with culture-proven endophthalmitis at Zhongshan Ophthalmic Center from January 2003 through December 2010 were respectively reviewed.The outcomes included intravitreal isolates and antibiotic sensitivities were analyzed.Results Four hundred and sixty-nine strains of organisms were isolated from 447 eyes of 447 patients with infective endophthalmitis,including 22 eyes of polymicrobial infection.In the organisms,gram-positive organisms were 241 (51.4％),fungi were 125 (26.7％) and gram-negative organisms were 103 (22.0％).The most common organisms were Staphylococcus epidermidis in 29.4％,Aspergillus in 7.7％ and Pseudomonas aeruginosa in 5.3％.In this group of infective patients,the most common clinic settings were posttraumatic endophthalmitis (72.7％),and then were postoperative endophthalmitis (10.5％),endogenous endophthalmitis (9.8％) and keratitis (6.9％).Most gram-positive organism and gram-negative organism were sensitive to levofloxacin and cefoperazone.The susceptibility rate of gram-positive organism to chloromycetin was increased in 2007-2010 years compared with 2003-2006 years (x2=5.398,P＜0.05).The susceptibility rate to ciprofloxacin of gram-negative organisms declined (x2 =5.398,P ＜ 0.05),but that to rifampicin increased in the duration of 2007-2010 compared with 2003-2006 (x2 =4.500,P ＜ 0.05).Conclusions Gram-positive organisms are the most commonly causative organisms of endophthalmitis.Most bacterial organisms are sensitive to levofloxacin and cefoperazone.Local data of culturing and susceptibility test offers a guideline for the treatment of infectious endophthalmitis.

Adult ; Aged ; Burns ; complications ; Female ; Glutathione ; therapeutic use ; Humans ; Liver ; physiopathology ; Liver Failure ; drug therapy ; physiopathology ; Male ; Middle Aged

OBJECTIVETo compare the difference between muscle-tension-balance acupuncture and conventional acupuncture in the impacts on motor function and living ability of patients with drop foot and strephenopodia after stroke.

METHODSSeventy cases were randomly divided into a muscle-tension-balance acupuncture group (group A) and a conventional acupuncture group (group B), 35 cases in each one. In group A, firstly the acupuncture of weakening technique was applied to Sanyinjiao (SP 6) and Taixi (KI 3) on the musculus extensor side; secondly, the strengthening technique was adopted at Jiexi (ST 41), Shenmai (BL 62) and Yanglingquan (GB 34) on musculus flexor side. In group B, the conventional needling technique was applied to Zusanli (ST 36), Sanyinjiao (SP 6), Xuanzhong (GB 39), etc. The treatment was given once every day in either group, 10 treatments made one session and 3 sessions of treatment were required. The score of Fugl-Meyer motor function of the lower limb on the affected side and Barthel index score were assessed before and after treatment in two groups.

RESULTSAfter treated for 3 sessions, Fugle-Meyer motor function score and Barthel index score of the patients all increased in two groups (all P < 0.01). The results in group A were better than those in group B (both P < 0.05). The improvements were apparent in the 2nd session of treatment in group A (both P < 0.01), which were superior to those in group B (both P < 0.05).

CONCLUSIONEither acupuncture therapy can improve the motor function and living ability of patients with drop foot and strephenopodia after stroke. The muscle-tension-balance acupuncture achieves the efficacy quickly and its efficacy is much better.

Activities of Daily Living ; Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Female ; Gait Disorders, Neurologic ; etiology ; physiopathology ; therapy ; Humans ; Male ; Middle Aged ; Motor Activity ; Stroke ; complications

Objective: To analyze the relationship between serum uric acid (SUA) level and clinical indicators in maintenance hemodialysis (MHD) patients, and explore its influence on all-cause mortality and cardiovascular mortality. Methods: This study was a retrospective cohort study. Patients who received MHD from the blood purification center of the Third Affiliated Hospital of Sun Yat-sen University from January 1, 2011 to December 30, 2015 were enrolled in the queue. They were divided into 3 groups according to the first and third quantile of the SUA level quartiles, and the baseline data of clinical and laboratory examinations were compared. The correlation between SUA level and clinical indicators was analyzed by Pearson correlation coefficient. Kaplan-Meier method and Cox proportional hazard regression model were used to examine the association between SUA and all-cause mortality and cardiovascular mortality in MHD patients. Results: A total of 201 patients were enrolled in the study. The age of the patients was (56.9±16.7) years and the baseline SUA level was (531.1±137.9) μmol/L. Patients were divided into 3 groups with the first quantile (442 μmol/L) and the third quantile (620 μmol/L) of the SUA quartiles as the boundary points: group 1 (SUA<442 μmol/L, n=52), group 2 (SUA 442-620 μmol/L, n=101) and group 3 (SUA>620 μmol/L, n=48). The results showed that the patients in group 1 were older and had more proportion of patients with diabetes mellitus and cardiovascular diseases than those in group 3 (all P<0.05). Compared to group 3, the serum albumin, serum phosphorus and serum creatinine were lower in group 1, while the hypersensitive C-reactive protein was higher (all P<0.05). Pearson correlation analysis showed that SUA level was positively correlated with albumin (r=0.135, P=0.047), blood phosphorus (r=0.269, P<0.001) and serum creatinine (r=0.333, P<0.001), and negatively correlated with hypersensitive C-reactive protein (r=-0.216, P=0.002). After a median follow-up of 49.8 months, 66(32.8%) all-cause deaths and 32(15.9%) cardiovascular deaths were recorded. Kaplan-Meier method showed that with the decrease of SUA, all-cause mortality (Log-rank χ²=18.27, P<0.001) and cardiovascular mortality (Log-rank χ²=15.04, P=0.001) increased. After adjusting for age, gender, comorbidity and other factors using the Cox proportional hazards model, the all-cause mortality and cardiovascular mortality decreased by 20.1% (HR=0.799, 95% CI 0.651-0.980, P=0.031) and 29.6% (HR=0.704, 95% CI 0.524-0.946, P=0.020) for each 100 μmol/L increase in baseline SUA. Compared to group 1, all-cause mortality (HR=0.332, 95%CI 0.142-0.774, P=0.011) and cardiovascular mortality (HR=0.140, 95%CI 0.030-0.657, P=0.013) were lower in the group 3. Conclusion Low SUA level increases the risk of all-cause mortality and cardiovascular mortality in MHD patients.

Objective To analyze the predictive value of apolipoprotein B (ApoB) in the risk of progression to renal replacement therapy (RRT) in diabetic kidney disease (DKD) patients with chronic kidney disease (CKD) stage 3-5. Methods The data of DKD patients with CKD stage 3-5 who were hospitalized and followed up with detailed clinical data from January 2011 to November 2014 in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected. Estimated glomerular filtration rate (eGFR) was calculated according to the CKD-EPI formula. After 2 years of follow-up, the patients were divided into RRT group and non-RRT group according to whether they had entered renal replacement therapy. Cox regression analysis was used to analyze the influencing factors of DKD progression to RRT. The predicted value of ApoB in the risk of progression to renal replacement therapy (RRT) of DKD patients within 2 years of follow-up was analyzed by plotting the receiver operating characteristic curve (ROC). By establishing multiple Cox models, the effect of ApoB elevation on the progression of DKD patients to RRT was analyzed after adjusting for the influencing factors gradually. Results A total of 258 cases were included in this study, including 156 males and 102 females. They were (66.13±11.88) years old (27-91 years old). CKD 3-5 patients were 181 cases, 50 cases and 27 cases respectively. There were 165 cases in the non-RRT group and 93 cases in the RRT group. There were statistically significant difference in hemoglobin, hematocrit, blood phosphorus, ApoB, serum creatinine, urea nitrogen, serum cystatin C, eGFR and in the proportion of using angiotensin converting enzyme inhibitor, diuretic, β blockers between the two groups (all P＜0.05). Multivariate Cox regression analysis showed that ApoB was an independent predictor of progression to RRT in patients with DKD within 2 years (HR=2.203, 95% CI 1.352-3.589, P=0.002). The area under the ROC curve of ApoB for DKD progression to RRT within 2 years of follow-up was 0.641 (C-index=0.749, P＜0.01). After adjusting for confounding factors, Cox regression analysis showed that for every 1 mmol/L increase in ApoB, the risk of RRT increased by 1.038 times in DKD patients with CKD stage 3-5 (HR=2.038, 95% CI 1.312-3.168, P=0.002). Conclusions ApoB is an independent predictor of progression to RRT with CKD stage 3-5 diabetic kidney disease (DKD). For every 1 mmol/L increase in ApoB, the risk of progression to RRT in patients with CKD 3-5 DKD increases by 1.038 times.

Objective To establish a rat model of nonalcoholic steatohepatitis (NASH),and to investigate the preventative and therapeutic effects of compound ginkgo extract against NASH.Methods A total of 60 male Sprague-Dawley rats were fed with high-fat feed and 10％ fructose water for 24 weeks to establish the rat model of NASH.The general behaviors of the rats were observed,and the body weight was recorded.Blood samples from the inferior vena cava and the liver were collected after the last administration to measure serum total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C),and low-density lipoprotein cholesterol (LDL-C),as well as liver function parameters.The liver index was calculated,HE staining was performed to observe liver histopathological changes,and the total lipase activity and the levels of TC,TG,and free fatty acid (FFA) in liver tissue were measured.Results After 24 weeks,compared with the normal group,the model group had a significantly faster increase in body weight,significant increases in serum levels of TC (2.20±0.52 mmol/L),TG (0.87±0.22 mmol/L),LDL-C (1.22±0.50 mmol/L),alanine aminotransferase (ALT) (129.4±44.7 U/L),and aspartate aminotransferase (AST) (209.3±42.8 U/L),liver index (3.62％±0.28％),and the levels of TC (4.42±1.39 mmol/mg.prot),TG (0.85±0.11 mmol/mg.prot),and FFA (644.78±36.65 μmol/L) in liver tissue,and significant reductions in serum HDL-C level (0.58±0.11 mmol/L) and the activity of lipoprotein lipase (LPL) (9.95±1.64 U/mg.prot)and hepatic lipase (HL) (9.91±1.03 U/mg.prot) (all P ＜ 0.01).In addition,the pathological results showed severe hepatocyte steatosis,varying degrees of inflammatory cell infiltration,exudation in the portal area,and necrosis of liver cells in the model group.After the intervention with compound ginkgo extract,there were significant reductions in serum levels ofTC (1.78±0.21 mmol/L),TG (0.58±0.07 mmol/L),LDL-C (0.84±0.19mmol/L),and ALT (84.1±17.1 U/L),AST (155.4±20.9 U/L),liver index (2.71 ％±0.15％),and the levels of TC (2.24±1.02 mmol/mg.prot),TG (0.46±0.11 mmol/mg.prot),and FFA (580.56±50.63 μmol/L) in liver tissue,as well as significant increases in serum HDL-C level (0.68±0.10 mmol/L) and the activities of LPL (15.54±2.21U/mg.prot) and HL (11.92± 1.87 U/mg.prot) (P ＜ 0.05 or P ＜ 0.01).At the same time,it significantly reduced hepatomegaly in rats and improved fatty degeneration and degree of inflammation in liver cells.Conclusion Compound ginkgo extract can prevent and treat NASH by correcting dyslipidemia,improving liver function and fatty degeneration in hepatocytes,and reducing the degree of inflammation,and its mechanism of action may be associated with increasing total lipase activity,reducing FFA in the liver,increasing the decomposition of TG,and reducing the synthesis of TG.

BACKGROUNDDiabetes management could be improved by diabetes education, through influencing attitudes towards diabetes, knowledge and behaviors of patients. The purpose of this study was to characterize the impact of diabetes education on glycemic control, and to assess the attitude, knowledge and self-care behavior in patients with type 2 diabetes in China.

METHODSThis questionnaire-based survey was conducted in 50 medical centers across China from April to July of 2010. The patients with type 2 diabetes were eligible for the study. The information of glycemic control and diabetes education was collected. The diabetes attitude scale-3 formulae, a questionnaire of diabetes knowledge and Summary of Diabetes Self-care Activities scale were used to assess attitude, knowledge and the self-care of patients, respectively.

RESULTSAmong the 5961 eligible respondents (3233 males; mean age (59.50 ± 12.48) years; mean hemoglobin A1c (HbA1c) (8.27 ± 2.23)%), most patients (79.8%) considered themselves educated on diabetes. Compared with patients without diabetes education, their educated counterparts showed significant lower value of HbA1c, after controlling for age, gender, body mass index and duration of diabetes (P < 0.01). The patients who received diabetes education also performed significant higher scores on attitude, knowledge and self-care than their uneducated counterparts. Patients with lower income or education level tended to have higher glucose levels, and showed lower percentage of patients received diabetic education.

CONCLUSIONSChinese patients with diabetes education achieved better glycemic control than un-educated patients. Our study indicates effort is required to provide professional education to patients, with emphasis on lower income and lower education level populations.

Aged ; Blood Glucose ; metabolism ; China ; Cross-Sectional Studies ; Data Collection ; Diabetes Mellitus, Type 2 ; blood ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Self Care ; Surveys and Questionnaires

Objective:To investigate the correlation between triglyceride-glucose (TyG) index and high on-treatment platelet reactivity (HTPR) during clopidogrel treatment in patients with ischemic stroke.Methods:Patients with ischemic stroke who received maintenance dose of clopidogrel (75 mg/d) in the Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine from January 2017 to March 2021 were retrospectively included. The highest quartile (Q4) of the TyG index was defined as insulin resistance. Platelet reactivity was assessed by thromboelastogram and clopidogrel HTPR was defined as the clot strength induced by adenosine diphosphate (MA ADP) >47 mm. Multivariate regression model was used to analyze the independent correlation between TyG index and platelet reactivity. Results:A total of 83 patients were included. The TyG index showed a linear correlation with MA ADP. The patients were divided into 4 groups according to the quartile of TyG index. The incidence of clopidogrel HTPR increased significantly with the increase of the quartile of the TyG index ( Ptrend=0.017). Multivariate analysis showed that there was a significant independent correlation between insulin resistance and clopidogrel HTPR (odds ratio 4.597, 95% confidence interval 1.285-16.446; P=0.019). Conclusions:In patients with ischemic stroke treated with clopidogrel, the incidence of clopidogrel HTPR gradually increases with the increase of the quartile of the TyG index. The insulin resistance assessed by the TyG index is independently associated with clopidogrel HTPR.