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Correlation of blood glucose and homocysteine with type 2 diabetic fundus lesions

Clinical Medicine of China.2013;29(9):950-952. doi:10.3760/cma.j.issn.1008-6315.2013.09.019

Objective To investigate the correlation of homoeysteine (Hcy) and blood glucose level with type 2 diabetic fundus lesions.Methods Sixty patients with type 2 diabetic fundus lesions were selected and grouped as the diabetic fundus lesions group from February of 2011 to October of 2012,and 40 patients with type 2 diabetes were recruited as the diabetes group,40 healthy volunteer were recruited as the control group.Glycosylated hemoglobin Alc(HbAlc),fasting blood glucose(FBG),homocysteine(Hcy) and total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) of the three groupwere measured and compared.Results Compared with the control group,Hcy in the diabetic fundus lesions group and the diabetic group were significantly higher than the control group ((17.6 ± 4.7) μmol/L,(13.3 ± 2.9) μmol/L vs.(7.3 ± 1.8) μmol/L),and as well as HbA1 c ((11.3 ±2.7)％,(9.2±1.4)％ vs.(4.0±1.1)％),FBG ((11.5 ±3.4) μmol/L,(10.1 ±2.1) μmol/Lvs.(4.2 ±1.7) μmol/L)and TC((6.7 ±1.1) mmol/L,(5.1 ±1.0) mmol/L vs.(4.4±0.8) mmol/L) (F=5.091,5.107,6.017,5.813,P =0.043,0.036,0.032,0.040 respectively).The Hcy,TC,TG,FBG and HbAlc of type 2 diabetic fundus lesions with I stage were the lowest,and the stage of type 2 diabetic fundus lesions was relevant with the level of Hcy,TC,TG,FBG and HbAlc,which were different significantly (F =5.418,5.524,4.971,5.713 respectively,P =0.038,0.041,0.042,0.040 respectively).Conclusion The serum Hcy and blood glucose are risk factors to type 2 diabetic nephropathy.Lowering Hcy concentration and reducing the glucose may be a new way to prevent the occurrence of type 2 diabetic nephropathy.

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Clinical evaluation of early enteral nutrition in the treatment of advanced esophageal cancer

Chaoqun LIU ; Xin LI ; Jiang PU ; Shanfeng FU ; Xiaohui WANG ; Lihong CUI ; Tao SUN

Clinical Medicine of China.2013;29(9):953-956. doi:10.3760/cma.j.issn.1008-6315.2013.09.020

Objective To investigate the impact of early enteral nutrition on the nutritional status and complications of patients with advanced esophageal carcinomas.Methods Sixty-five patients with advanced esophageal carcinomas were randomly divided into the enteral nutrition group group (n =33) and the control group (n =32).The two groups were given enteral nutrition support and normal nasogastric feeding diet respectively in 24-72 h after hospitalization.The two groups were tested with nutrition indicators:body Mass Index (BMI)/brachial triceps skinfold thickness/upper arm circumference measurement,fasting blood glucose/serum total protein/albumin/cholesterol/triglyceride and the liver function (alanine aminotransferase (ALT)/aspartate aminotransferase(AST)/total bilirubin (TBiL)),and were observed the incidences of complications with liver/intestinal and infection diseases.Results After one month's treatment,compared with the control group,there was significant statistical difference between the two group in patients' nutritional status (BMI index:(22.1 ±4.5) kg/m2 vs.(19.2±4.3) kg/m2; skinfold thickness:(6.2 ±0.4) mm vs.(5.1 ±0.4)mm ; upper arm circumference:(22.8 ± 3.0) cm vs.(20.4 ± 3.2) cm ; serum total protein:(49.2 ± 10.1) g/L vs.(45.1 ± 9.9) g/L; Albumin:(35.5 ± 5.8) g/L vs.(30.6 ± 6.1) g/L; Cholesterol:(5.0 ± 0.6) mmol/L)vs.(4.3 ± 0.7) mmol/L)),the liver function(ALT:(36.0 ± 4.7) U/L vs.(61.5 ± 9.9) U/L; AST:(29.6 ±6.7) U/Lvs.(88.9±10.6) U/L;TBiL:(17.7±3.8) μmol/Lvs.(31.6 ±9.4) μmol/L) (t=2.624,2.036,2.220,2.256,4.155,2.207,2.349,2.476,2.280 respectively,P ＜ 0.05 for all),and the incidence of diarrhea (12％ (4/33) vs.34％ (11/32)) and infection (15％ (5/33) vs.41％ (13/32)) (x2 =2.501,2.193 respectively;P ＜0.05).No statistical difference was observed between the two groups on the levels of serum glucose and triglycerides,and the incidences of complications like bloating/constipation/reflux (P ＞ 0.05).Conclusion The early enteral nutrition could improve the nutritional status of patients with advanced esophageal carcinomas effectively,and reduce the incidence of liver injury,diarrhea and infection.

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Impact of palliative radiotherapy to the prognosis of patients with stage Ⅳ non-small cell lung cancer

Yunfeng YUAN ; Xiaozhong ZHU ; Jun TIAN

Clinical Medicine of China.2013;29(9):971-974. doi:10.3760/cma.j.issn.1008-6315.2013.09.026

Objective To investigate the impact of palliative radiotherapy to the prognosis of patients with stage Ⅳ non-small cell lung cancer (NSCLC).Methods Two hundred and forty-four cases of stage Ⅳ NSCLC were collected from our hospital.The study group (n =129) received the treatment of primary tumor and metastases palliative radiotherapy after chemotherapy.The control group (n =115) received only chemotherapy.Followed-up and compared 1-year and 2-year survival rate of the patients,and explored the factors affecting palliative radiotherapy.Results The 129 patients in the study group were followed up for 2 years,and 16 patients survived and 110 patients died.Three patients were lost to follow-up.The median survival time was 8 months.1-year and 2-year survival rates was 29.46％ (38/129) and 12.40％ (16/129) respectively.In the control group,7 patients survived,and 106 patients died.Two patients were lost to follow up.The median survival time was 6 months.1-year and 2-year survival rates was 11.30％ (13/115) and 6.09％ (7/115)respectively.Survival rates between the two groups were significantly different (x2 =8.451,P =0.014)Univariate regression analysis found that factors affecting the prognosis of stage Ⅳ NSCLC were KPS score (x2 =5.057,P =0.031),occurrence of brain metastases (x2 =4.781,P =0.029),number of organs of metastasis (x2 =6.341,P =0.010),and the primary stove radiotherapy dose (x2 =5.893,P =0.015) ; Cox regression model analysis showed that the number of organs of metastasis (HR =1.719,95％ CI 为 1.172-3.126,P =0.008),the primary focal radiotherapy dose (HR =1.560,95％ CI 为 1.082-2.761,P =0.022) were independent prognostic factors.Conclusion Palliative radiotherapy plays a role of prolonging survival time in the treatment of Ⅳ NSCLC.In palliative radiotherapy,we should pay attention to the control of the primary tumor and metastases radiotherapy dose,therefore prolonging the survival time of patients.

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Clinical analysis of alone or combined with antibiotics on community acquired pneumonia in pediatric patients

Li LIAO ; Xiang WEN ; Qin LI ; Wei WANG

Clinical Medicine of China.2013;29(9):994-997. doi:10.3760/cma.j.issn.1008-6315.2013.09.036

Objective To compare the clinical analysis of alone or combined with antibiotics on community acquired pneumonia (CAP) in pediatric patients,and provide reference for clinical rational use of antibiotics.Methods The clinical data of 274 cases of CAP children treated by single antibiotic therapy and 271 cases of CAP children treated by bivalent antibiotic therapy were retrospectively analyzed,and the drug efficacy and adverse reactions were compared between the two groups.Results There were no statistical differences on the sex,age distribution and severity between the two groups (all P ＞ 0.05) ; The sputum submission rate in two groups were over 90％,and there were no significant differences on the positive rate and detection rate of multi-resistant bacteria (P ＞ 0.05) ; Treatment efficiency in the two groups of children were 97.45％ (267/274) and 98.15％ (266/271),the difference was not statistically significant (x2 =0.32,P ＞0.05) ; Average hospital inpatient days were (8.76 ± 1.75) d and (8.66 ± 1.62) d in the two groups,the difference was not statistically significant (x2 =0.71,P ＞ 0.05).Adverse reactions in the two groups of children mainly were drug fever,rash,nausea,bloating,hemolytic anemia.Cases of drug fever (50) and hemolytic anemia(32) in single antimicrobial group were significantly less than those in the combined with antibiotic group (51,72,x2 =4.804 and x2 =5.381,all P ＜0.05).Conclusion The effects of alone or combined with antibiotics on community acquired pneumonia in pediatric patients are same,so alone antibiotics is recommended for treating mild CAP to get better efficacy.

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Clinical value of uterine artery embolization on the treatment of 112 cases cesarean scar pregnancy

Haibin HE ; Yan HU ; Bengui JIANG

Clinical Medicine of China.2013;29(9):997-1000. doi:10.3760/cma.j.issn.1008-6315.2013.09.037

Objective To investigate the clinical value of uterine artery embolization on the treatment of cesarean scar pregnancy(CSP).Methods Clinical data of 112 cases of CSP patient underwent uterine artery embolization in Ningbo Women and Children's Hospital from January to December 2012 were enrolled for retrospectively analysis.Results All 112 patients underwent transvaginal ultrasound examination before admitted to hospital and among them 101 cases were diagnosed as CSP and 11 cases were suspected of CSP.Ninety-four cases were checked by magnetic resonance imaging (MRI) to measure the muscular thickness of uterine scar and the size of pregnant bursa.All patients received bilateral uterine artery embolization successfully,50-100 mg Methotrexat (MTX) were injected into uterine artery during this procedure.After uterine artery embolization,95 cases received curettage under ultrasound guidance,while 17 cases received curettage under hysteroscopy.All patients recovered as schedule.During the follow-up,no serious complication was found.Conclusion The use of uterine artery embolization in the treatment of CSP is safe and effective,and it can preserve patients' fertile ability.It is worthy recommended in the clinical application.

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Early analgesic effect of lliac fascia compartment block in patient with surgery of the whole knee replacement

Chuan WU ; Feifei LIU ; Xiuli WANG

Clinical Medicine of China.2013;29(10):1019-1021. doi:10.3760/cma.j.issn.1008-6315.2013.10.004

Objective To investigate the effect of lliac fascia compartment block on early analgesia of patients during performed the whole knee replacement.Methods Forty patients undergoing single whole knee replacement were randomly divided into group A and B,20 cases in each group.Before anesthesia,patients in group A underwentthree in one femoral nerve block guided by nerve stimulator with 20 ml of 0.5％ ropivacaine.Patients in group B underwent lliac fascia compartment block with 25 ml of 0.5％ ropivacaine.Visual analogue score (VAS) during rest and movement were recorded at 0 (T0),0.5 (T1),1 (T2),2 (T3),4 (T4),6 (T5),and 8 h (T6) after a patient fully awoke from surgery.Results In group B,Resting VAS scoresofpatientswere(4.5±0.7),(4.5 ±0.6),(4.2 ±0.8),(4.4 ±0.5),(4.3 ±0.7),(4.4 ±0.6),(5.2 ±0.6) at T0-T6 time point,and moving VAS were(4.7 ±0.6),(4.4 ±0.7),(4.4 ±0.5),(4.3 ±0.6),(4.4±0.6),(5.0 ±0.7),(5.1 ±0.6),all higher than that of group A((1.5 ±0.6),(1.7 ±0.6),(1.7 ± 0.6),(1.7 ±0.6),(1.9 ±0.6),(2.0 ±0.6),(2.2 ± 0.5) and(1.6 ±0.6),(2.0 ±0.6),(1.8 ±0.6),(1.7 ± 0.6),(2.0 ± 0.6),(2.3 ± 0.6),(2.5 ± 0.7),and there was significant difference (resting VAS∶ F (between group) =17.672,P ＜ 0.05,F(within group) =5.062,P ＜ 0.001,F(interaction) =1.443,P =0.143) ; Moving VAS:F (between group) =8.183,P ＜ 0.001,F (within group) =7.742,P ＜ 0.001,F (interaction) =0.85,P =0.424).Conclusion Iliac fascia compartment block had proved with early analgesic effect in patients with total knee replacement.Iliac fascia block is simple,safe,and can be performed without nerve stimulator.Therefore iliac fascia block has a certain clinical application.

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Clinical effect of alpha lipoic acid on early diabetic nephropathy

Wenjuan JIANG ; Lianhua ZHOU ; Jinan ZHANG

Clinical Medicine of China.2013;29(10):1040-1042. doi:10.3760/cma.j.issn.1008-6315.2013.10.010

Objective To investigate the clinical application of alpha lipoic acid on early diabetic nephropathy(DN).Methods Seventy patients with early diabetic nephropathy were randomly divided into two groups.Patients in control group were treated with regular glycemic control methods,while patients in treatment group were received alpha lipoic acid 300 mg static drop treatment for two weeks beside regular treatment.High sensitivity C reaction protein,microalbuminuria and urine creatinine were measured before and after the treatment.Microalbuminuria and urine creatinine were re-measured three months later.Results At the end of two weeks treatment,the levels of high sensitivity C reaction protein in the treatment group decreased from (3.92 ± 4.56) mg/L to (2.24 ± 2.49) mg/L,and there was significant difference (t =2.803,P ＜ 0.05).Microalbuminuria decreased from (127.18 ± 76.91) mg/L to (84.50 ± 122.87) mg/L,and there was significant difference (t =2.501,P ＜ 0.05).The ratio of microalbuminuria and urine creatinine in treatment group decreased from(28.95 ± 30.49) mg/mmol to(13.76 ± 20.83) mg/mmol,and there was significant difference (t =3.616,P ＜ 0.05).While there was no significant difference in the control group before and after regular waglycemic control.At three months after treatment,there were no significant difference regarding of microalbuminuria,the ratio of microalbuminuria and urine creatinine between treatment and control groups (P ＞ 0.05).Conclusion Alpha lipoic acid might be with ability of decreasing the levels of microalbuminuria of diabetic nephropathy in the short term,but further study is needed to verify whether alpha lipoic acid can decrease the level of microalbuminuria in the long term.

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Study on intestinal mucosal barrier dysfunction induced by postthoracotomyand and protection of alanyl-glutamine dipeptide in aged patients

Hongwei SHANG ; Shengbin SUN ; Xiuli MA

Clinical Medicine of China.2013;29(10):1064-1067. doi:10.3760/cma.j.issn.1008-6315.2013.10.019

Objective To investigate the changes of intestinal mucosal barrier function and protection of alanyl-glutamine(Alm-Gln) dipeptide during early stage of postthoracotomy in aged patients.Methods A prospective,randomized and controlled trial was conducted and 20 aged patients who underwent non-digestive thoracotomy were randomized into two groups,experimental group (intravenous administration of Aln-Gln dipeptide,0.5 g/(kg · d),for 4 days,n =10) and control group(equal amount saline as placebo,for 4 days,n =10).The indices of boby temperatures,heart rates,respiration and white blood cell count of all patients were daily recorded during administration.Serum concentrations of glutamine (Gln),D-lactate,diamine oxidase (DAO) and tumor necrosis factor-α(TNF-α) were measured before and after operation.Results There were no statistically significant differences in the patients' general information between experimental group and control group including age,gender and body weight.Plasma Gln concentration in postoperative 5 days was higher than that of pre-operation of experiment group ((478.32 ± 47.42) μmol/L vs.(372.67 ± 29.14) μmol/L,P =0.021).The plasma Gln level of control group at 5th day after operation was higher than that in pre-operation ((431.12 ± 42.27) μmol/L vs.(386.29 ± 19.73) μmol/L,P =0.017).The plasma level of Gln in experimental group was significantly higher than that in control group after operation((478.32±47.42) μmol/L vs.(386.29 ± 19.73) μmol/L,P =0.012).There were no significantly differences between the two groups in terms of the plasma level of DAO and D-lactate before operation (P ＞ 0.05).Meanwhile the levels of DAO and D-lactate in both group at 5th day after operation were significantly higher than that at before operation(DAO:(2.53 ±0.47) U/ml vs.(1.66±0.32) U/ml,P =0.003;D-lactate:(6.82 ±1.91) mg/L vs.(4.92 ±1.57) mg/L,P =0.024),and the levels of them in experimental group were significantly lower than that in control group(DAO:(1.10 ± 0.23) U/ml vs.(2.53 ± 0.47) U/ml,P =0.013 ; D-lactate:(4.87 ± 1.33) mg/L vs.(6.82 ± 1.91) mg/L,P =0.019).The concentration of TNF-α was significant increase in both two groups at first day after operation,but decreased at the third day.The concentration of TNF-α in experimental group at 5th day after operation was lower than that in control group ((6.89 ± 5.21) pg/L vs.(13.04 ± 4.46) pg,/L,P =0.003).The morbidity of systemic inflammatory response syndrome (SIRS) was significantly decreased in experimental group and the rate of SIRS was also lower than that in the control group(P ＜ 0.01).Conclusion Intestinal mucosal barrier function was damaged after thoracotomy in aged patients.Administration of Aln-Gln dipeptide could increase the level of serum Gln,protect the intestinal barrier and attenuate the systemic inflammatory response.Aln-Gln dipeptide can be used to help aged patients recover rapidly.

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Causes of failure of manually rotating fetal head technology and its delivery outcomes

Bo XU

Clinical Medicine of China.2013;29(10):1101-1103. doi:10.3760/cma.j.issn.1008-6315.2013.10.030

Objective To investigate the causes of failure of manually rotating fetal head technology and its delivery outcomes.Methods One hundred and Ninety-eight cases with persistent occipito transverse position or persistent occipitoposterior position admitted to our hospital form January 2008 to December 2010 were enrolled as our subjects.According to the result of manually rotating fetal head technology,these patients were divided into the success group (126 cases) and the failure group (72 cases).The information related to delivery was recorded.Results The proportion of fetal weight ≥ 3500 g in the failure group was 76.4％ (55/72),higher than that of the success group(31.7％ (40/126)),and there has statistic significant difference (x2 =30.177,P =0.001).The proportion of uterine inertia in the failure group(58.3％ (42/72)) was higher than that of the success group(38.1％ (48/126)),and there has statistic significant difference (x2 =7.569,P =0.006).The proportion of critical or low-grade narrow birth canal in the failure group(38.9％ (28/72)) was significantly higher than that of the success group (23.8％ (30/126)),and there has statistic significant difference (x2 =5.030,P =0.002).The proportion of the improper time for manually rotating fetal head (opening of cervix was less than 6 cm,and fetal head was above ischial spine and opening of cervix was 8-10 cm,fetal head reach to more than 2 cm lower of ischial spine) in the failure group was 61.1％ (44/72),which was significantly higher than that of the success group (38.9 ％ (49/126)),and there has statistic significant difference (x2 =9.084,P =0.003).The proportion of maternal and neonatal complications (postpartum hemorrhage,puerperal morbidity,fetal distress,neonatal asphyxia) in the failure group were significantly higher than those of the success group (x2 =9.586,P =0.002 ; x2 =9.334,P =0.002 ; x2 =5.910,P =0.015 ; x2 =5.240,P =0.022).The proportion of cesarean section in the failure group(72.2％ (52/72)) was significantly higher than that of the success group(34.1％ (43/126)),and there has statistic significant difference(x2 =26.641,P =0.001).Conclusion The manually rotating fetal head technology can transform from dystocia to normal delivery and decrease the rate of cesarean section.It is necessary to prevent and deal with the failure causes of manually rotating fetal head technology.And it must be cautious to perform the follow-up correction and trial production after the failure of previous correction.

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Clinical effect of levothyroxine tablets on subclinical hypothyroidism in pregnancy

Xilian LI

Clinical Medicine of China.2013;29(10):1104-1107. doi:10.3760/cma.j.issn.1008-6315.2013.10.031

Objective To investigate the effect of levothyroxine tablets on subclinical hypothyroidism in pregnancy.Methods One hundred and twenty patients with the subclinical hypothyroidism in hospital were divided into four groups,subclinical hypothyroidism + TPOAb (+) treatment group (39 cases),subclinical hypothyroidism + TPOAb(+) untreated group (15 cases),subclinical hypothyroidism + TPOAb (-) treatment group(26 cases) and subclinical hypothyroidism + TPOAb (-) untreated group (40 cases).Patients in the treatment groups were administrated with levothyroxine tablets.Results The levels of thyroid stimulating hormone(TSH) in subclinical hypothyroidism and TPOAb(+) treatment group were significantly lower(16-20 weeks and 28-32 weeks) at after treatment,which was also lower than that in B group(t =5.671,6.661,P ＜ 0.001).Compared with the untreated group,there was a significant difference in terms of average gestational age,fetal weight ((39.3 ± 1.6) weeks vs.(37.9 ± 1.4) weeks ; (3524 ± 562) g vs.(3101 ± 351) g,t =4.561,7.834,P ＜ 0.001) between A and B groups.In B group,premature birth,gestational hypertension,incidence of placental abruption were significantly higher than that in A group (26.67％ and 2.56％,x2 =7.490,P ＜ 0.001 ; 5.13％ and 40.00％,x2 =10.438,P ＜ 0.001 ; 0 and 13.33％,x2 =5.400,P =0.020).In C group after 16 weeks of treatment,TSH levels at (16-20) weeks and (28-32) weeks were significantly decreased.Compared with the D group,the differences were statistically significant (t =4.980 and 5.432,both P ＜ 0.001).There was no significant difference in C group and D group in terms of pregnancy outcome (P ＞ 0.05).Conclusion Patients with gestational subclinical hypothyroidism such as mergers TPOAb(+) should be treated in time.Prompt treatment can significantly reduce the incidence of adverse pregnancy outcomes,but if patient with TPOAb(-),It is recommended not to conduct any treatment.

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