Objective To observe the clinical efficacy of Shuangye San(the prescription mainly composed of Mori Folium and Nelumbinis Folium)in the treatment of type 2 diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD)of spleen deficiency and phlegm stasis type.Methods A total of 80 patients with T2DM complicated with NAFLD of spleen deficiency and phlegm stasis type were randomly divided into a treatment group and a control group,with 40 cases in each group.The control group was treated with conventional western medicine for lowering blood glucose and lipid,protecting liver and lowering enzymes.The treatment group was treated with the granules of Shuangye San orally on the basis of treatment for the control group.The course of treatment lasted for three months.The changes of traditional Chinese medicine(TCM)syndrome scores,homeostasis model assessment of insulin resistance(HOMA-IR),fasting insulin(FINS),fasting blood glucose(FBG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1C),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),liver function indicators and B-ultrasound grading of fatty liver in the two groups were observed before and after treatment.After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1)After three months of treatment,the total effective rate of the treatment group was 85.00％(34/40),and that of the control group was 70.00％(28/40).The intergroup comparison(tested by chi-square test)showed that the efficacy of the treatment group was significantly superior to that of the control group(P＜0.01).(2)After treatment,the scores of TCM symptoms of obese physique,heaviness and weakness in the limbs,shortness of breath and unwilling to talk,tightness and stabbing pain in the chest,abdominal distension and poor appetite in the two groups were decreased compared with those before treatment(P＜0.05),and the decrease of TCM syndrome scores in the treatment group was significantly superior to that in the control group(P＜0.05).(3)After treatment,the levels of glucose and lipid metabolism indicators of FINS,HOMA-IR,FBG,2hPG,HbA1C,TC,TG and LDL-C in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the level of HDL-C was significantly increased compared with that before treatment(P＜0.05).The decrease of FINS,HOMA-IR,FBG,2hPG,HbA1C,TC,TG and LDL-C levels and the increase of HDL-C levels in the treatment group were significantly superior to those in the control group(P＜0.05).(4)After treatment,the levels of liver function indicators of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and gamma-glutamyl transpeptidase(GGT)in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of liver function indicators in the treatment group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the B-ultrasound grading of fatty liver of the two groups was significantly improved compared with that before treatment(P＜0.05),and the improvement of fatty liver B-ultrasound grading in the treatment group was significantly superior to that in the control group,and the difference was statistically significant(P＜0.05).(6)During the treatment,there were no adverse reactions such as impairment of liver and kidney function and abnormalities in routine blood,urine and stool test in the two groups.Conclusion Shuangye San exerts certain effect in the treatment of T2DM complicated with NAFLD of spleen deficiency and phlegm stasis type.It can alleviate the clinical symptoms of patients,correct the disorder of glucose and lipid metabolism,and improve liver function and fatty liver B-ultrasound grading.

Objective To construct a three-dimensional statistical shape model of the pelvis and analyze the individual variation and gender differences of the three-dimensional shape of the pelvis.Methods We collected CT data from 201 Chinese individuals and used deep learning to automatically reconstruct three-dimensional models of the pelvis.Through three-dimensional model registration,dense correspondence mesh mapping,and the use of statistical shape modelling(SSM)and principal component(PC)analysis method,we extracted models of variations(MoV)of pelvic shape changes and statistically compared the shape MoV between males and females.Results We analysed the top 10 principal components of shape variations,which accounted for 86.1％of the total variability.Among them,PC01,PC02,and PC04 showed significant differences between genders(P＜0.001),accounting for a total variability of 60.1％.PC08 and PC 10 demonstrated pelvic asymmetry,accounting for a total variability of 3.8％.Conclusion We constructed a three-dimensional statistical shape model of the pelvis in Chinese individuals,revealing the morphological variation and sex differences of Chinese pelvis.

BACKGROUND: Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up. METHODS: The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student's t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC). RESULTS: A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001). CONCLUSIONS The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease/therapy* ; Coronary Restenosis ; Follow-Up Studies ; Fractional Flow Reserve, Myocardial ; Humans ; Pharmaceutical Preparations ; Predictive Value of Tests ; Retrospective Studies ; Treatment Outcome

Objective:To measure and analyze the corneal biological parameters of Tibetan junior middle school students who have lived in Mozhugongka County of Lhasa city for a long time.Methods:A cross-sectional study was performed.The basic information including gender, age and grade of 1 784 Tibetan junior high school students who have lived in Mozhugongka County of Lhasa city for a long time was collected, and the corneal biological parameters were measured in May, 2020.The available data of 690 students were obtained in this study.Unilateral eye of each subject was randomly selected for statistical analysis using computer random number method.Three hundred and forty-five right eyes and 345 left eyes from 366 males and 324 females were included.There were 461 eyes from students aged 12 to 15 years, and 229 eyes from students aged 16 to 20 years.Sirius 3D corneal topography and anterior segment analysis system were used to measure the thinnest corneal thickness (TCT), central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal corneal angle, simulated K1 and simulated K2, thinnest point position.Histogram and Q-Q chart were used to assess the distribution of continuous variables except the thinnest point position of cornea.The differences in biological parameters were compared between males and females, 12-15 years group and 16-20 years group as well as right eyes and left eyes.The literature of corneal biological parameters from other ethnic group was reviewed and compared with the Tibetan subjects.This study complied with the Declaration of Helsinki and was approved by an Ethics Committee of Tibet Hospital (No.QZYY2019-IRBPJ-21).Results:The ACD of the right eye of the students was (3.31±0.27)mm, which was significantly greater than (3.26±0.26)mm of the left eye ( t=0.745, P=0.012). Mean TCT, CCT, iridocorneal angle, simulated K1 and simulated K2 were (504.99±30.73)μm, (509.10±35.82)μm, (47.45±5.70)°, (43.15±1.89)D, and (44.16±2.29)D of the right eye, and thoes of the left eyes were (503.34±29.22)μm, (508.36±28.75)μm, (47.86±5.88)°, (43.06±1.40)D and (44.16±1.53)D, respectively, with no significant differences between the right and left eyes (all at P>0.05). The ACD and iridocorneal angle were significantly greater, and the simulated K1 and simulated K2 were significantly smaller in males compared with females (all at P<0.05). There were no significant differences in TCT and CCT between males and females (both at P>0.05). The corneal biological parameters were not signficantly different between different age groups (all at P>0.05). The thinnest point of cornea distributed mainly at inferior temporal quadrant zone for the right eyes, and superior temporal quadrant zone for the left eyes. Conclusions:Corneal biological parameters of Tibetan junior high school students in high altitude areas might be different from those of other ethnic students.Ophthalmologists should pay attention to this population in diagnosis and treatment of corneal diseases and refractive error.

This article summarized the clinical experience of Professor WANG Meng-yong in treating lupus nephritis from the symptoms and essence. Professor WANG Meng-yong believes that treatment for lupus nephritis should attach importance to clinical features of setting deficiency of liver, spleen and kidney as the essence and toxin and blood stasisas symptoms, in which the essence is deficient and the symptoms are excess and combination of external and internal pathogenesis. He flexibly uses methods of nourishing liver and kidney, tonifying spleen, and stomach, clearing heat and cooling blood, activating blood and promoting diuresis to alleviate water retention, which have obvious efficacy, effectively avoid adverse reactions and reduce the risk of recurrence, and improve patient prognosis.

OBJECTIVETo explore the clinical value of detecting adenosine triphosphate (ATP) level in CD4T lymphocytes (Immuknow ATP) of patients on early stage after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSThe base-line ATP value in CD4T lymphocytes in cases of hematological malignancies and the ATP level in CD4T lymphocytes of acute leukemia patients before allo-HSCT were detected. Allo-HSCT recipients were devided into 3 groups with different level of immunereactivity according to ATP concentraiton in month 3 (day 90±5) after allo-HSCT. The clinical characteristics of patients in 3 groups were analyzed.

RESULTSThe mass concentration of Immuknow ATP in 15 cases of hematological malignancies before allo-HSCT ranged from 56.21-435.71 ng/ml, with a mean of 203.98±112.72 ng/ml. The ATP level in 46 cases after allo-HSCT ranged from 1.69-333.09 ng/ml, with a median of 41.96 ng/ml. Both 91.26 ng/ml (mean-SD) and 316.70 ng/ml (mean+SD) were used as cutoff, and 36 allo-HSCT recipients (78.3%) were assigned to low immunereactivity group, 8 recipients (17.4%) to middle group and 2 recipients (4.3%) to high group. The incidence of infection in low immunereactivity group was significantly higher than that in middle immunereactivity group (86.1% vs 50.0%)(P=0.022), and also significantly higher than that in high immunereactivity group (86.1% vs 0%)(P=0.002). There were no statistical differences in the incidences of severe infection among 3 groups. The incidence of grade II or higher acute graft versus host disease (aGVHD) in high immunereactivity group was superior to that in low immunereactivity group statistically (100% vs 13.9%)(P=0.002). Immune-mediated organ injury occurred more frequently in high immunereactivity group as compared with low and middle immunereactivity groups (100% vs 0% and vs 0%)(P=0.000; P=0.002). There were no significant differences in relapse rates of leukemia among 3 groups. The percentage of patients with increased trough blood concentration of cyclosporine A(CsA) was not significantly different among 3 groups (P=0.720).

CONCLUSIONDetection of ATP level in CD4T lymphocytes on early stage after allo-HSCT possesses clinical significance for predicting infection, severity at aGVHD and immune-mediated organ injury.

OBJECTIVETo analyze the result of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for treatment of patients with T cell Lymphoblastic lymphoma(T-LBL).

METHODSThe engraftment, graft versus host disease (GVHD), infection, relapse and survival of 10 T-LBL patients received allo-HSCT was observed. The clinical outcome of allo-HSCT for T-LBL patients was analyzed.

RESULTSThe median age of patients was 25 years old, 10 (6 males and 4 females) T-LBL patients received allo-HSCT including 3 from HLA-matched unrelated donors, 3 from HLA-matched sibling donors, 2 from HLA haploidentical sibling donors, and 2 from haploidentical related donors. The clinical staging showed that 1 case was in stage III and 8 cases were in stage IV. The bone marrow was involved in 7 patients. All the 10 patients achieved engraftment, and the median times of neutrophil and platelet engraftment were 11 (10-19) days and 12(7-19) days, respectively. Acute GVHD occurred in 5 patients and chronic GVHD occured in 1 patient. After the median follow-up of 26 months (11-51 months), 3 patients died, out of them 1 died from relapse after transplantation, 1 from infection and 1 from GVHD. The relapse, overall survival, and disease-free survival rate were 10%, 70%, 70%,respectively. And the estimated overall survival rate was 66.7%.

CONCLUSIONT-LBL has high rate of relapse and poor prognosis. The allo-HSCT can improve the survival of patients with T-LBL, and is an effective method for treatment of T-LBL patients.

OBJECTIVETo investigate the prevalence of chronic kidney disease (CKD) in subjects with different glucose metabolism status.

METHODSBetween January, 2015 and October, 2015, a total of 934 subjects without a previous diagnosis of diabetes visiting the Department of Endocrinology or Health Examination Center underwent oral glucose tolerance test (OGTT), which identified 266 subjects with normal glucose tolerance (NGT group), 243 pre-diabetic subjects, and 425 patients with diabetes mellitus group. The baseline characteristics and laboratory test data of the subjects were collected. The diagnosis of CKD was established for an eGFR <60 mL/min/1.73 m(2) or a ACR≥30 mg/g, and the prevalence of CKD were compared among the 3 groups. Logistic regression model was used to analyze the OR value of the risk factors of CKD.

RESULTSThe prevalences of CKD in NGT, pre-diabetic and diabetic groups were 10.2%, 26.3% and 32.5%, respectively. Pairwise comparisons showed that the prevalence of CKD was significantly higher in pre-diabetic group (P<0.001, OR=3.17, 95% CI 1.94-5.17) and diabetic group (P<0.001, OR=4.27, 95% CI 2.72-6.65) than in NGT group, and was comparable between the pre-diabetic and diabetic groups (P=0.115, OR=1.35, 95% CI 0.95-1.91). Logistic regression analysis, after adjustment for age, gender, blood pressure, hypertension, blood lipids and uric acid, showed that pre-diabetes (OR=2.03, P=0.044) and diabetes mellitus (OR=2.22, P=0.016) were independently associated with CKD.

CONCLUSIONGlucose metabolism status has a significant independent impact on the incidence of CKD, suggesting the importance of early detection of pre-diabetes and timely interventions in pre-diabetic subjects in prevention CKD.

Diabetes Mellitus ; epidemiology ; Glucose ; metabolism ; Glucose Tolerance Test ; Humans ; Incidence ; Prediabetic State ; epidemiology ; Prevalence ; Renal Insufficiency, Chronic ; epidemiology ; Risk Factors

When to design clinical trials in the treatment of depression, we should follow some general rules of ordinary clinical trials, and also have to consider the characteristics of depression and test drugs, as well as the influence of these characteristics.Due to the questionable efficacy of active drug in the treatment of depression,placebo control could apply a potent evidence to clarify the absolute efficacy of test drugs.In this ar-ticle, the present situation of placebo control in these studies was intro-duced, we interpreted the general considerations on placebo control of these studies from ethnics and safety aspects, and analysed the factors which may contribute to the drug-placebo difference, and finally provid-ed suggestions about how to design these studies with placebo control, which may help sponsors and drug research units to obtain a systematic understanding of placebo control in these studies.

Neuropathic pain is one of the global medical difficulties , and it requires a multidisciplinary participation , but the core method still is the drug.To develop safe and effective drugs intended for the treatment of neuropathic pain is very important for clinical treatment.This article introduces considerations for the clinical trial designs of developing drugs intended for the treatment of neuropathic pain , offering helps for pharma-ceutical enteprises and clinical investigators.