A 57-year-old female patient with small cell lung cancer was treated with serplulimab (100 mg by intravenous infusion on the first day, 21 days as a cycle). After the 10th cycle of treatment, the patient suddenly presented drowsiness, shortness of breath, dry mouth, nausea, vomiting, fatigue and other symptoms. Laboratory tests showed fasting blood glucose 38.9 mmol/L, glycosylated hemoglobin 7.9%, serum C peptide 0.2 μg/L, pH value 7.05, anion gap 31 mmol/L, anti-islet cell antibody 36 kU/L, anti-glutamic acid decarboxylase antibody 131 kU/L, urine ketone body (+++). The patient was diagnosed with fulminant type 1 diabetic ketoacidosis, which was considered to be related to serplulimab. The drug was stopped, and insulin, rehydration, correction of acid-base imbalance, and other treatments were given. After 3 days, the patient′s consciousness returned to normal. After 12 days, her breathing was stable, dry mouth, nausea, vomiting and other symptoms were relieved. Laboratory tests showed random blood glucose 13.6 mmol/L, pH value 7.44, anion gap 6 mmol/L, and urine ketone body negative. After 26 days, her random blood glucose was controlled at 10.0-12.0 mmol/L.

A 57-year-old female patient with small cell lung cancer was treated with serplulimab (100 mg by intravenous infusion on the first day, 21 days as a cycle). After the 10th cycle of treatment, the patient suddenly presented drowsiness, shortness of breath, dry mouth, nausea, vomiting, fatigue and other symptoms. Laboratory tests showed fasting blood glucose 38.9 mmol/L, glycosylated hemoglobin 7.9%, serum C peptide 0.2 μg/L, pH value 7.05, anion gap 31 mmol/L, anti-islet cell antibody 36 kU/L, anti-glutamic acid decarboxylase antibody 131 kU/L, urine ketone body (+++). The patient was diagnosed with fulminant type 1 diabetic ketoacidosis, which was considered to be related to serplulimab. The drug was stopped, and insulin, rehydration, correction of acid-base imbalance, and other treatments were given. After 3 days, the patient′s consciousness returned to normal. After 12 days, her breathing was stable, dry mouth, nausea, vomiting and other symptoms were relieved. Laboratory tests showed random blood glucose 13.6 mmol/L, pH value 7.44, anion gap 6 mmol/L, and urine ketone body negative. After 26 days, her random blood glucose was controlled at 10.0-12.0 mmol/L.

Objective:To analyze the relationship between serum betaine homocysteine methyltransferase (BHMT) level and visceral fat area (VAF) in patients with type 2 diabetes mellitus (T2DM) and its predictive value for diabetic nephropathy (DN) .Methods:A retrospective study was conducted to select 170 patients with T2DM admitted to the hospital from Apr. 2021 to Apr. 2023 as the study subjects. According to the occurrence of DN, the patients were divided into two groups: DN group and non-DN group. All patients were tested for serum BHMT and VAF, and the relationship between them was analyzed by bivariate correlation. The baseline data of patients were collected, and the correlation between serum BHMT and VAF levels and DN in patients with T2DM was analyzed by binary Logistic regression. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of serum BHMT and VAF levels for DN in patients with T2DM.Results:DN occurred in 34 of 170 patients with T2DM, with an incidence of 20.00%. The proportion of patients with DN combined with hypertension [61.76% (21/34) ] was higher than that of non-DN group [41.91% (57/136) ]. The levels of glycosylated hemoglobin (HbA1c), homocysteine (Hcy) and VAF were (8.97±1.53) %, (15.87± 5.09) μmol/L, (113.62±18.74) cm 2 respectively, higher than those in non-DN group [ (8.16± 1.27) %, (11.65±4.81) μmol/L, (92.61±14.17) cm 2]. The level of BHMT was (57.74± 9.18) pg/ml, lower than that in non-DN group [ (78.74±11.53) pg/ml] ( P<0.05). The levels of serum creatinine (Scr), blood urea nitrogen (BUN) and urinary albumin excretion rates (UAER) in DN group were (71.74±9.81) μmol/L, (8.18±1.27) mmol/L, (106.61±28.61) mg/24 h respectively, higher than those in non-DN group [ (57.11±10.06) μmol/L, (5.29±1.02) mmol/L, (14.65± 2.52) mg/24 h] ( P<0.05). BHMT was negatively correlated with VAF, Scr, BUN and UAER ( r<0, P<0.05). Binary Logistic regression analysis showed that high levels of HbA1c, Hcy and VAF were risk factors for DN in patients with T2DM ( OR>1, P<0.05). High level of BHMT was a protective factor for DN in patients withT2DM ( OR<1, P<0.05). The results of ROC curve showed that the AUC of BHMT, VAF levels and combined prediction of DN in patients with T2DM were all>0.70, which had certain predictive value, and the combined detection had the highest. Conclusion:Serum BHMT level is negatively correlated with VAF in patients with T2DM, and serum BHMT and VAF levels are closely related to the occurrence of DN in patients with T2DM, both of which can effectively predict the risk of DN in patients.

Objective:To explore the expression of serum inflammatory factors in patients with thyroid tumor and their correlation with thyroid hormones.Methods:A total of 92 patients with thyroid tumors (48 cases of thyroid cancer and 44 cases of thyroid adenoma) admitted to Department of Endocrinology in Linyi Central Hospital in Shandong Province from Jan. 2020 to Oct. 2021 were enrolled. 50 healthy volunteers who received physical examination in the hospital during the same period were enrolled in the control group. The serum inflammatory factors [tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6) , interleukin-17 (IL-17) ] and thyroid hormone expression levels [thyroid stimulating hormone (TSH) , free thyroxin T4 (FT4) , free triiodothyronine (FT3) ] of the three groups were detected. Analysis of variance was used for multi-group comparison, independent sample t test was performed for comparison between groups, Spearman correlation analysis and Logistic regression analysis were made for the risk factors of thyroid cancer. The expression of serum inflammation and thyroid hormones in patients with different stages of thyroid cancer was observed. Results:Serum TNF-α, IL-17, IL-6 from high to low were in the thyroid cancer group (74.61±7.94 ng/L, 68.65±7.05 ng/L, 20.52±2.84 ng/L) , thyroid adenoma group (26.97±3.42 ng/L, 46.31±5.31 ng/L, 13.61±1.58 ng/L) , control group (18.82±2.63 ng/L, 34.52±4.02 ng/L, 8.97±1.06 ng/L) ( F=1596.271, 468.602, 423.351, all P<0.001) ; Serum TSH levels from high to low were in the thyroid cancer group (8.64±1.34 mU/L) , the thyroid adenoma group (5.21±1.02 mU/L) , the control group (3.94±0.85 mU/L) ( F=242.182, P=0.000) . There was no significant difference in serum FT4 or FT3 levels among the three groups ( P=0.753, 0.634) . Correlation analysis indicated that serum TNF-α, IL-17, and IL-6 were positively correlated with the expression level of serum TSH ( r=0.936, 0.726, 759, all P<0.05) . The expression level of TNF- α, IL-17, IL-6 and TSH was significantly higher in patients of stage III and IV than that in patients of stage I and II ( t=2.541, 4.394, 6.390, 4.962, P=0.015, P<0.001, P<0.001, P<0.001) . Multivariate Logistic regression analysis suggested serum TNF-α, IL-17, IL-6 and TSH were all risk factors for thyroid cancer. Conclusions:Serum inflammatory factors and some thyroid hormones (TSH) are generally highly expressed in patients with thyroid tumors, the expression levels of serum inflammatory factors are correlated with the expression of TSH. There are statistically significant differences in the expression levels of serum inflammatory factors and TSH between patients with thyroid cancer of different stages, serum inflammatory factors and TSH are also involved in the occurrence and development of thyroid cancer, and are risk factors for thyroid cancer.

Objective:To explore the effect of standardized pain assessment and peer education on self-efficacy, quality of life and pain control of cancer pain patients.Methods:From January 2019 to January 2020, convenience sampling was used to select 162 inpatient cancer patients admitted to Henan Cancer Hospital as the research object. Patients were divided into observation group ( n=82) and control group ( n=80) based on the odd and even numbers of the patient's ward end number. Patients in control group received regular health education and traditional pain assessment. Observation group carried out standardized pain assessment and peer education. We compared self-efficacy, quality of life, pain control of two groups of patients before and after intervention. Results:Before intervention, there was no statistically significant difference between the two groups of patients in terms of dimension scores and total scores of self-efficacy, quality of life ( P>0.05) . After intervention, dimension scores and total scores of self-efficacy and quality of life of cancer pain patients' pain between two groups were higher than those before intervention, and the differences were statistically significant ( P<0.01) . Dimension scores and total scores of self-efficacy and quality of life of cancer pain patients in observation group were higher than those in control group with statistical differences ( P<0.01) . The overall pain control effect of cancer pain patients in observation group was better than that in control group, and the difference was statistically significant ( Z=-3.721, P<0.01) . Conclusions:Standardized pain assessment and peer education applied to the pain management of cancer pain patients can effectively improve the pain control effect and self-efficacy as well as the quality of life.

Objective:To explore the effect of hyperbaric oxygen (HBO) therapy on serum VEGF and IGF-1 in patients with elder diabetic retinopathy.Methods:A total of 114 patients with elder diabetic retinopathy admitted in Linyi Central Hospital from the May of 2016 to the May of 2018 were selected and randomly divided into observation group and control group according to the random number table method, with 57 patients in each group. The control group received routine treatments, i. e. calcium dobesilate, while the observation group received HBO combined with the routine treatment as the control group. After 3 courses of treatment, the changes of serum high-sensitivity C-reactive protein (hs-CRP), vascular endothelial growth factor (VEGF), and type-1 insulin like growth factor (IGF-1) of each group were compared before and after the treatment. The effects of retinopathy severity after treatment in each group on the levels of serum hs-CRP, VEGF, and IGF-1 were also observed.Results:The therapeutic efficacy rate of the observation group (78.39%) was significantly higher than that of the control group (56.77%), with statistical difference ( χ2=4.524, P<0.05). After 3 courses of the treatment, the expression levels of hs-CRP, VEGF, and IGF-1 of the two groups were significantly lower than those before the treatment. Furthermore, the expression levels of hs-CRP, VEGF and IGF-1 in the observation group were significantly lower than those in the control group, with statistical difference( P<0.01). Among the patients with Grade I and II retinopathy, the serum hs-CRP, VEGF, and IGF-1 in the observation group were significantly lower than those in the control group, and the differences were statistically significant ( P<0.05). Among the patients with Grade III and IV retinopathy, there was no statistical difference comparing those values between the two groups ( P>0.05). Conclusion:In the treatment of elder diabetic retinopathy, HBO assisting calcium dobesilate is more effective than singly using calcium dobesilate, and decreases serum hs-CRP, VEGF and IGF-1 levels.

Objective:To observe the mechanism of hyperbaric oxygen combined with lipoic acid in treating diabetic foot patients, and analyze its preventive effect on amputation as the adverse outcome.Methods:A total of 84 patients with diabetic foot admitted to the Department of Endocrinology of Linyi Central Hospital from June 2016 to June 2019 were selected as research objects and randomly divided into control group ( n=42) and observation group ( n=42). The patients in the control group received intravenous infusion of lipoic acid (0.6 g/250 ml, 1 time/d) on the basis of conventional treatment, while the patients in the observation group received hyperbaric oxygen therapy on the basis of the treatment in the control group. The levels of hypoxia inducible factor-1 (HIF-1α), endothelin-1 (ET-1), nitric oxide (NO) and vascular endothelial growth factor (VEGF) in serum before and after treatment were compared between the two groups. The occurrence of amputation as the adverse outcome was also recorded. Results:After treatment, the levels of HIF-1α, ET-1, NO, and VEGF in both groups decreased, and the levels of HIF-1α, ET-1, and VEGF in the observation group were significantly lower than those of the control group ( P<0.05). The incidence of amputation as the adverse outcome in the observation group (9.52%) was lower than that of the control group (21.43%). Analysis of the receiver operating characteristic (ROC) curve showed that the threshold value of HIF-1α, ET-1/NO ratio, and VEGF for predicting amputation as the adverse outcome were 317.5 pg/ml, 1.977, and 29.0125 pg/ml, respectively. The specificity of HIF-1α for predicting amputation occurrence was 85.9%, which was better than those of ET-1/NO ratio (80.3%) and VEGF (76.4%). Conclusion:Hyperbaric oxygen combined with lipoic acid can significantly reduce the levels of HIF-1α, ET-1, NO, and VEGF in patients with diabetic foot. HIF-1α has a relatively high accuracy in predicting the occurrence of amputation, which can help to reduce or prevent the occurrence of amputation as the adverse outcome.

Objective:To explore the effect of hyperbaric oxygen (HBO) therapy on serum VEGF and IGF-1 in patients with elder diabetic retinopathy.Methods:A total of 114 patients with elder diabetic retinopathy admitted in Linyi Central Hospital from the May of 2016 to the May of 2018 were selected and randomly divided into observation group and control group according to the random number table method, with 57 patients in each group. The control group received routine treatments, i. e. calcium dobesilate, while the observation group received HBO combined with the routine treatment as the control group. After 3 courses of treatment, the changes of serum high-sensitivity C-reactive protein (hs-CRP), vascular endothelial growth factor (VEGF), and type-1 insulin like growth factor (IGF-1) of each group were compared before and after the treatment. The effects of retinopathy severity after treatment in each group on the levels of serum hs-CRP, VEGF, and IGF-1 were also observed.Results:The therapeutic efficacy rate of the observation group (78.39%) was significantly higher than that of the control group (56.77%), with statistical difference ( χ2=4.524, P<0.05). After 3 courses of the treatment, the expression levels of hs-CRP, VEGF, and IGF-1 of the two groups were significantly lower than those before the treatment. Furthermore, the expression levels of hs-CRP, VEGF and IGF-1 in the observation group were significantly lower than those in the control group, with statistical difference( P<0.01). Among the patients with Grade I and II retinopathy, the serum hs-CRP, VEGF, and IGF-1 in the observation group were significantly lower than those in the control group, and the differences were statistically significant ( P<0.05). Among the patients with Grade III and IV retinopathy, there was no statistical difference comparing those values between the two groups ( P>0.05). Conclusion:In the treatment of elder diabetic retinopathy, HBO assisting calcium dobesilate is more effective than singly using calcium dobesilate, and decreases serum hs-CRP, VEGF and IGF-1 levels.

Objective:To observe the mechanism of hyperbaric oxygen combined with lipoic acid in treating diabetic foot patients, and analyze its preventive effect on amputation as the adverse outcome.Methods:A total of 84 patients with diabetic foot admitted to the Department of Endocrinology of Linyi Central Hospital from June 2016 to June 2019 were selected as research objects and randomly divided into control group ( n=42) and observation group ( n=42). The patients in the control group received intravenous infusion of lipoic acid (0.6 g/250 ml, 1 time/d) on the basis of conventional treatment, while the patients in the observation group received hyperbaric oxygen therapy on the basis of the treatment in the control group. The levels of hypoxia inducible factor-1 (HIF-1α), endothelin-1 (ET-1), nitric oxide (NO) and vascular endothelial growth factor (VEGF) in serum before and after treatment were compared between the two groups. The occurrence of amputation as the adverse outcome was also recorded. Results:After treatment, the levels of HIF-1α, ET-1, NO, and VEGF in both groups decreased, and the levels of HIF-1α, ET-1, and VEGF in the observation group were significantly lower than those of the control group ( P<0.05). The incidence of amputation as the adverse outcome in the observation group (9.52%) was lower than that of the control group (21.43%). Analysis of the receiver operating characteristic (ROC) curve showed that the threshold value of HIF-1α, ET-1/NO ratio, and VEGF for predicting amputation as the adverse outcome were 317.5 pg/ml, 1.977, and 29.0125 pg/ml, respectively. The specificity of HIF-1α for predicting amputation occurrence was 85.9%, which was better than those of ET-1/NO ratio (80.3%) and VEGF (76.4%). Conclusion:Hyperbaric oxygen combined with lipoic acid can significantly reduce the levels of HIF-1α, ET-1, NO, and VEGF in patients with diabetic foot. HIF-1α has a relatively high accuracy in predicting the occurrence of amputation, which can help to reduce or prevent the occurrence of amputation as the adverse outcome.