Objective To study the risk values of glycosylated hemoglobin ( HbA1c) screening patients with diabetes mellitus(DM) and pre-diabetes(PreD) in different age and sex.Methods HbA1c results from10 840 in Taizhou Hospital in 2012 were retrospectively collected , and CHAID analysis of decision tree was used in preliminary hierarchy .Age was further divided into five groups according to the preliminary results , then one-way ANOVA and linear regression were utilized to determine the differences between age groups and the prediction intervals (PI) of HbA1c,respectively.The upper limit value of 95%PI of HbA1c was set as diabetes risk values ( DRVs).By comparison of the sensitivity of DM patients screening by DRVs in 1 889 cases whose HbA1c were between 6.0%to 6.5%and the upper limit value of traditional HbA1c reference intervals to verify the screening value ofDRVs .Then the DRVs of HbA1c were utilized to screen DM in the population whose HbA 1c is were 6.0%-6.5% in 2008,and followed their re-examination records toverify the screening value of the DRVs toin PreD patients. Results (1) On the basis of the initially root of decisiontree by age , the populationwas divided into 9 groups ( P =0.000, F =231.462).By calculatingthe 95% confidence interval(CI) of each group and merging reasonably,it was finally divided into 5 groups:20-30years,31-40years,41-50years,51-60years and >60years (F=434.342, P=0.000).(2)Using the method of linear regression , the 95% PI of HbA1c of the 5 groups showed as following:20-30 years, males 4.6%-5.9%, females 4.6%-5.9%.31-40 years, males 4.8%-6.0%, females 4.7%-6.0%.41-50 years, males 4.9%-6.2%, females 4.8%-6.1%.51-60 years, males 5.0%-6.3%, females 4.9%-6.2%.>60 years, males 5.1%-6.4%, females 5.0%-6.3%.The traditional HbA1c reference interval was4.8%-6.3%.(3) The screening sensitivity of DM by the upper limit value of traditional HbA1c reference interval and DRVs in group which HbA1c was between 6.0%-6.5% were 34.5%and 48.1%,respectively.(4) Reviewing of the group with HbA1c between 6.0%-6.5% and not diagnosed as DM in 2008, 49 hadnegative DM screening results by using the upper limit value of traditional HbA1c reference interval but were positive in our setting DRVs , and 13 have developed to DM now , which accounted for 26.5%.Conclusion HbA1c DRVs need to be set hierarchically between different age and sex groups as a supplement to the traditional reference interval , which has a great significance for the diagnosis and treatment of DM and also forthe screening and intervention of PreD patients.

Objective To investigate the pathologic features of ganglioglioma/gangliocytoma.Methods 19 cases of gangliogliomas and gangliocytomas were studied by HE stain, immunohistochemistry and ultrastructural observation.Results (1) The tumor cells presented widespread, derangement distribution, and conglobation in some regions. (2) The tumor cells were similar with ganglion cell, showing multipolar in feature, and had large, irregular nucleoli. The nucleoli were clear. Some tumor cells were bi-nucleated. (3) Neurogliocytomas were Ⅱ～Ⅲ grades according to the standard published by WHO. (4) Immunoreactions showed GFAP (-), S-100 (+) and Synaptophyein (+) in neoplastic cells. (5) Ultrastructure observation showed cytolysosome, ribosome and rough endoplasmic reticulum in the cytoplasm of the neoplastic cells. Abundant mitochondria and dense neuroendocrine granules were also found in these cells.Conclusions Ganglioglioma/gangliocytoma is a rare tumor of central nervous system. Its diagnosis mainly depends on histopathology, special markers of immunohistochemistry and ultrastructural features. The property of neoplasma is related to the component of neurogliocytoma.

Objective To investigate the clinical and pathological features of meningeal carcinoma.Methods The clinical,cerebrospinal fluid(CSF)and immunocytochemistry data of 142 patients with meningeal carcinoma were analysis retrospectively.Results Clinical manifestation:headache were found in 123 cases(86.62%),and dizziness were found in 19 cases(13.38%).26 cases(18.31%)had fever and 10 cases(7.04%)had poor vision.CSF and immunocytochemistry:in all cases,EMA,CK were positive and CD14,GFAP were negative in all meningeal carcinomatosis.99 cases(69.72%)showed low molecule CK(+)and high molecule CK(-).These were adenocarcinoma.33 cases(23.24%)showed high molecule CK(+)and low molecule CK(-).These were squamous cell carcinoma.10 cases(7.04%)showed both high and low molecule CK(+).These were adenocarcinoma and squamous cell carcinoma.In 67 cases(47.18%),primary cancer were found in lungs.Tumors were found in gastrointestinal tract in 23 cases(16.20%),and in breast in 9 cases(6.34%).Other primary cancers were found in endomertrium(1 case),in ovarium(1 case)and in liver(1 case).In 37 cases(26.06%),primary cancer couldn't been found.Among the 105 cases which primary cancer were found,15 cases were drawn out.In other 90 cases,82(91.11%)died from 3 to 14 months after diagnosis.In the cases no primary cancer were found,6 cases were drawn out.In other 31 cases,28(90.32%)died from 2 to 13 months after diagnosis although primary tumor was not found.Conclusions The headache and dizziness are the main symptom.The immunocytochemistry are important in the diagnosis of the meningeal carcinoma.The prognosis of the cases with meningeal carcinoma is serious whatever found or not found primary cancer.

Objective To investigate the clinical effect of biapenem and levofloxacin in the treatment of pulmonary infection caused by extensive drug resistant bacillus.Methods 182 patients with pulmonary infection caused by extensive drug resistant bacillus from the department of respiratory in our hospital were selected and divided into two groups, 91 cases in the control group were given cefoperazone sodium and sulbactam sodium +levofloxacin treatment, 91 cases in the experiment group received biapenem +levofloxacin treatment, serum levels of white blood cell count(WBC), high sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),serum amyloid A(SAA), recovery time of clinical symptoms, signs and laboratory examination, the clinical effect, bacteriological effect and incidence of adverse reactions were compared after treatment.Results The effective rate in the control group(74.72%)was lower than the experiment group(86.81%), with significant difference (P<0.05); compared with the control group, the bacterial clearance rate was higher, bacterial unclearance rate, partial clearance rate, replacement rate were higher in the experiment group after treatment, serum levels of WBC,hs-CRP,PCT,SAA were lower after treatment, recovery time of body temperature, pulmonary signs, abnormal shadow of chest X-ray, WBC, hs-CRP were shorter, with significant difference ( P<0.05 ); there was no significant difference in the incidence of adverse reactions between the two groups.Conclusion The clinical effect of biapenem and levofloxacin in the treatment of pulmonary infection caused by extensive drug resistant bacillus was exactly, can effectively remove bacteria, control infection, shorten the treatment time, and the safety was high.

Contraindications ; Humans ; Laryngeal Neoplasms ; classification ; pathology ; surgery ; Laryngectomy ; methods ; Neoplasm Staging

OBJECTIVETo evaluate the colorectal cancer incidence among compliers and non-compliers in the population of colorectal cancer screening area, and to provide scientific basis for health economic evaluation of cancer screening.

METHODSBy screening different years build queue, to retrospectively compare the data of colorectal cancer screening from January 1, 2008 to December 31, 2013 and the data of cancer registration, and to analyze the colorectal cancer incidence rates among screening compliers and non-compliers, and to compare the average intervals between the end of screening and clinical cancer diagnosis using SPSS 19 statistical software. Mantel-Haenszel test was performed with a statistical significance level of α = 0.05.

RESULTSThe non-compliance rate was 38.24% among males and 28.49% among females (P < 0.001). The non-compliance rate was highest in the 40-44 and 70-74 years age groups and lowest in the 50-59 years age group. The compliers of the screening were followed up for 476,049 person-years, and there were 51 cases of colorectal cancer, with an incidence rate of 10.71/100,000. The non-compliers of the screening were followed up for 259 183 person-years, and there were 66 cases of colorectal cancer, with an incidence rate of 25.46/100,000, which was 1.38 times higher than that of the compliance group (χ2 = 21.699, P < 0.001). The incidence rate of colorectal cancer among subjects who were positive in initial screening but refused to receive an electronic colonoscopy was as high as 164.40/100,000, and the average delay time was 20.8 ± 16.8 months.

CONCLUSIONSThe colorectal cancer screening adherence among women is better than among men, and that of 50-54 years and 55-59 years age groups is better than in other age groups. The subsequent incidence rate of colorectal cancer in the non-compliance group is significantly higher than that of the compliance population.

Adult ; Age Factors ; Aged ; China ; epidemiology ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms ; diagnosis ; epidemiology ; Early Detection of Cancer ; Female ; Humans ; Incidence ; Male ; Mass Screening ; statistics & numerical data ; Middle Aged ; Patient Compliance ; statistics & numerical data ; Retrospective Studies ; Sex Factors

Objective To compare the setup errors of two position fixation, head-neck-shoulders immobilization system and trunk immobilization system in radiotherapy for esophageal cancer, and to provide technical guidance for the fixed modes and determination of plan target volume (PTV) in the intensity modulated radiation therapy (IMRT) of esophageal cancer. Methods 97 thoracic esophageal cancer patients treated with radiotherapy were collected and divided into two groups: head-neck-shoulders group (51 patients immobilized with head-neck-shoulders immobilization system) and trunk group (the other 46 patients immobilized with trunk immobilization system). Before the weekly radiotherapy, all the patients received cone-beam CT (CBCT) scan to get the setup errors of X axis (left and right), Y axis (head and foot) and Z axis (front and back) on line. Results In the head-neck-shoulders group, the errors in X, Y and Z direction were (0.333 ±0.400) cm, (0.333 ±0.291) cm and (0.238 ±0.256) cm, respectively. In trunk group, the errors were (0.327±0.255) cm, (0.582±0.501) cm and (0.189±0.154) cm, respectively. There were statistically significant differences in the setup errors in Y axis and Z axis between the head-neck-shoulders group and the trunk group (P< 0.05). Conclusions In the radiotherapy for thoracic esophageal carcinoma, there is no difference in the X axis setup error between head-neck-shoulders system and trunk immobilization system. The Y axis setup error of head-neck-shoulders group is less than that of the trunk group. The Z axis setup error of trunk group is less than the head-neck-shoulders group.

Objective:To establish a preoperative forecasting model for the nature of duodenal papillary tumors and to discuss its main predictors.Methods:A case-control study was conducted;the case group included patients with malignant duodenal papillary tumors and the control group included patients with benign duodenal papillary tumors.All the patients were from Changhai Hospital. Data of patients,including the demographic characteristics,clinical symptoms during onset,laboratory findings,and radiological data, were collected by face-to-face interviews or by reviewing the medical history.Chi-square,t-test or ANOVA were employed to performed univariate analysis.All factors with P values less than or equal to 0.25 in the univariate analysis were used as independent variables for multivariate analysis,and a Logistic regression forecasting model for the nature of duodenal papillary tumors was established.Results: Totally 199 patients with pathologically-confirmed duodenal papillary tumors were included in the present study,with 166 in the case group and 33 in the control group.Multivariate analysis showed that hemoglobin(Hb),total bilirubin(Tbil),direct bilirubin(Dbil), aspartate transferase(AST),alkaline phosphatase(AKP),gamma glutamyl transpeptidase(GGT),and carcinoembryonic antigen(CEA) were independent predictors for nature of duodenal papillary tumors,with their odds ratios(95% confidence interval)being 0.981 (0.959,1.003),0.867(0.794,0.948),1.207(1.075,1.355),1.028(1.008,1.048),0.996(0.992,1.000),1.002(1.000,1.004),and 0.974(0.953,0.994),respectively.Conclusion:The Logistic regression model,which takes into consideration of Hb,Tbil,Dbil,AST, AKP,GGT,and CEA,can be used to predict the nature of duodenal papillary tumors,and its clinical value need to be further studied.

OBJECTIVE To investigate the relationship of nosocomial infection with use of antimicrobial agents.METHODS A retrospective study of 171 cases admitted from Nov 2004 to Apr 2005 in a general hospital.RESULTS Sixteen thrush cases all were found to have prior use of antimicrobial agents with average time about(12.5?8.10) days.Twenty six out of 57 surgical cases had wound infection,all used antimicrobial agents preoperatively.Inadequate use of antimicrobial agents manifested as prolonged use or over frequent drug change or improper combined use of drugs etc.CONCLUSIONS Protracted use of antimicrobial agents may be related with development of thrush.Rational use of antimicrobial agents is to be emphysized.

Objective To investigate the clinical value of serum glycyl-proline dipeptidyl aminopeptidase(GPDA)combined with carcino-embryonic antigen (CEA),carbohydrate antigen724 (CA724),carbohydrate antigen242 (CA242) in the early diagnosis of gastric cancer.Methods Collected in Changan hospital in patients with gastric cancer and atrophic gastritis patients and healthy subjects 60 cases,by TBA-120FR biochemical analyzer glycyl-proline dipeptidyl aminopeptidase (GPDA),chemiluminescence analyzer to detect the levels of serum CEA,CA724 and CA242,analysis of single detection and joint detection and the differences between the positive rate and sensitivity.Results The detection of GPDA in gastric cancer group was significantly lower than that in atrophic gastritis group and healthy control group,the difference was statistically significant (F=69.532,P=0.000).The results of CEA,CA724 and CA242 in gastric cancer group were higher than those in atrophic gastritis group and healthy control group,the difference was statistically significant (CEA:F=59.926,P=0.001;CA724:F=51.056,P =0.001;CA242:F =72.613,P =0.000).Serum GPDA,CEA,CA724 and CA242 single detection positive rate were 70 ％,45 ％,61.7 ％ and 50 ％.Tumor markers CEA,CA724,CA242 positive rate of three joint detection was 75％.Serum GPDA and tumor markers of CEA,the positive rate of CA724 and CA242 combined detection of four was 86.7％.The positive rate of three and higher than that of single detection,the difference was statistically significant (F=49.635,P=0.003).Serum GPDA,CEA,CA724 and CA242 single detection sensitivity was 70.2 ％,50.2 ％,67.3 ％ and 53.2％.Tumor markers CEA,CA724,CA242 three joint detection sensitivity was 85.6％.Serum GPDA and tumor markers CEA,CA724 and CA242 four joint detection sensitivity was 90.3％.The sensitivity was higher than the three items and the individual tests,and the difference was statistically significant (F=52.016,P =0.001).Conclusion GPDA joint CEA,CA724 and CA242 tumor markers detection can improve the positive rate and sensitivity in early diagnosis of gastric cancer,but it will not reduce the diagnostic specificity,the clinical diagnosis of early gastric cancer has important significance and value.