Objective:To compare the efficacy and safety of insulin degludec and insulin glargine U100 in patients with type 2 diabetes mellitus.Methods:This study was a retrospective cohort study. The subjects were patients with type 2 diabetes mellitus who were hospitalized in 13 3A-level general hospitals in Shandong Province from September 2018 to December 2021. According to the type of basal insulin used, the patients were divided into insulin degludec group and insulin glargine U100 group. The basic information and laboratory test results in patients in the 2 groups were collected, the differences of fasting blood glucose level and incidence of hypoglycemia between the 2 groups were compared. The patients with complete blood glucose monitoring data in the 2 groups were selected and their blood glucose fluctuations were compared.Results:A total of 1 152 patients were entered in the study, including 552 patients in the insulin degludec group and 600 patients in the insulin glargine U100 group. The difference in the basic conditions in patients in the 2 groups was not statistically significant (all P>0.05). After treatment, the fasting blood glucose levels in patients in the 2 groups were lower than those before treatment, with statistically significant differences [10.2 (8.8, 12.5) mmol/L vs. 7.5 (6.6, 8.7) mmol/L, Z=-19.443, P<0.001; 10.0 (8.6, 11.7) mmol/L vs. 7.8 (6.6, 9.0) mmol/L, Z=-15.449, P<0.001], but the difference in fasting blood glucose levels between the 2 groups after treatment was not statistically significant ( Z=-1.427, P>0.05). The incidence of hypoglycemia in the insulin degludec group was lower than that in the insulin glargine U100 group [1.09% (6/552) vs. 2.83% (17/600), Z=4.481, P=0.032]. The intraday blood glucose standard deviation, maximum blood glucose fluctuation range, postprandial blood glucose fluctuation range, and average blood glucose fluctuation range in patients with complete blood glucose monitoring data in the insulin degludec group were significantly lower than those in the insulin glargine U100 group [(1.7±0.6) mmol/L vs. (2.4±1.0) mmol/L, (4.5±1.6) mmol/L vs. (6.7±2.9) mmol/L, (1.8±1.0) mmol/L vs. (3.3±1.2) mmol/L, (2.9±1.3) mmol/L vs. (4.6±2.1) mmol/L; all P<0.001]. Conclusion:The efficacy of insulin degludec in the treatment of type 2 diabetes mellitus is equivalent to that of insulin glargine U100, but the risk of hypoglycemia and blood glucose fluctuation is lower.

Objective:To compare the efficacy and safety of insulin degludec and insulin glargine U100 in patients with type 2 diabetes mellitus.Methods:This study was a retrospective cohort study. The subjects were patients with type 2 diabetes mellitus who were hospitalized in 13 3A-level general hospitals in Shandong Province from September 2018 to December 2021. According to the type of basal insulin used, the patients were divided into insulin degludec group and insulin glargine U100 group. The basic information and laboratory test results in patients in the 2 groups were collected, the differences of fasting blood glucose level and incidence of hypoglycemia between the 2 groups were compared. The patients with complete blood glucose monitoring data in the 2 groups were selected and their blood glucose fluctuations were compared.Results:A total of 1 152 patients were entered in the study, including 552 patients in the insulin degludec group and 600 patients in the insulin glargine U100 group. The difference in the basic conditions in patients in the 2 groups was not statistically significant (all P>0.05). After treatment, the fasting blood glucose levels in patients in the 2 groups were lower than those before treatment, with statistically significant differences [10.2 (8.8, 12.5) mmol/L vs. 7.5 (6.6, 8.7) mmol/L, Z=-19.443, P<0.001; 10.0 (8.6, 11.7) mmol/L vs. 7.8 (6.6, 9.0) mmol/L, Z=-15.449, P<0.001], but the difference in fasting blood glucose levels between the 2 groups after treatment was not statistically significant ( Z=-1.427, P>0.05). The incidence of hypoglycemia in the insulin degludec group was lower than that in the insulin glargine U100 group [1.09% (6/552) vs. 2.83% (17/600), Z=4.481, P=0.032]. The intraday blood glucose standard deviation, maximum blood glucose fluctuation range, postprandial blood glucose fluctuation range, and average blood glucose fluctuation range in patients with complete blood glucose monitoring data in the insulin degludec group were significantly lower than those in the insulin glargine U100 group [(1.7±0.6) mmol/L vs. (2.4±1.0) mmol/L, (4.5±1.6) mmol/L vs. (6.7±2.9) mmol/L, (1.8±1.0) mmol/L vs. (3.3±1.2) mmol/L, (2.9±1.3) mmol/L vs. (4.6±2.1) mmol/L; all P<0.001]. Conclusion:The efficacy of insulin degludec in the treatment of type 2 diabetes mellitus is equivalent to that of insulin glargine U100, but the risk of hypoglycemia and blood glucose fluctuation is lower.

Objective:This work aims to assess the distribution of peripheral blood monocyte subsets, the expression level of the functional markers in rheumatoid arthritis (RA) patients, and analyze the correlation between the above indexes and the onset of RA.Methods:Peripheral blood mononuclear cells were collected and isolated from 62 RA patients, 52 healthy control (HC) and 12 disease control group′s patients via density centrifugation. The enrolled patients were attended or underwent physical examination in East Hospital, Tongji University from June 2020 to December 2021. Monocytes could be classified into classical (CM), intermediate (IM) and non-classical (NCM). Then, the flow cytometry was performed to examine the distribution of monocyte subsets and the measure the expression level of human leukocyte antigen DR (HLA-DR), intracellular tumor necrosis factor α (TNF-α) in peripheral blood monocytes. The statistical methods in this study mainly include: Kruskal-Wallis H test, Chi-Square test, Mann-Whitney U test, Wilcoxon matched-pairs signed ranks test, Spearman correlation coefficient test and Logistic regression analysis. The diagnostic value of IM proportion in RA was analyzed by ROC curve. Results:The monocytes number and monocytes proportion in white blood cells were much higher in RA [0.40 (0.40, 0.50), 7.60% (5.97%, 8.53%)] and disease control [0.40 (0.40, 0.68), 8.20% (5.85%, 10.28%)] compared with HC [0.30 (0.30, 0.40), 5.80% (5.03%, 6.38%)] ( H=24.733, P<0.001; H=27.469, P<0.001). A statistic-significant difference was detected among the proportion of CM[85.49%(76.91%,89.21%),88.94%(86.36%,91.72%),90.26%(80.25%, 92.56%)],IM[11.65%(8.47%,17.89%),7.89%(5.36%,10.75%), 5.56%(4.17%, 8.27%)], NCM[2.22%(1.39%, 3.74%), 2.49%(1.74%, 4.66%), 5.13%(3.39%, 9.85%)] in RA group, HC group and disease control group ( H=11.389, P=0.003; H=20.815, P<0.001; H=10.640, P=0.005). The proportion of CM was lower in RA and the IM proportion was increased in RA( P=0.003; P=0.003). The intracellular TNF-α level of monocytes in all three groups revealed the trend that IM>NCM>CM. The intracellular TNF-α in IM of RA was positively associated with serum TNF-α ( r=0.376, P=0.041). The HLA-DR expression in IM subsets were higher than CM and NCM subsets in all RA,HC and disease control groups. The expression of HLA-DR of IM in RA group and disease control was higher than HC group [8 611.50 (6201.3, 9890.8), 10 295.0 (7 899.0, 13632.0), 6 278.00(4 057.8, 9522.0), H=10.495, P=0.005]. There were no correlations between the proportion of peripheral blood IM and clinical characteristics CRP ( r=0.119, P=0.359), RF ( r=0.204, P=0.112) and ESR ( r=0.153, P=0.236). Logistic regression analysis showed that the proportion of IM ( OR=1.169, 95% CI 1.003-1.363, P=0.046), CRP ( OR=1.277, 95% CI 1.000-1.631, P=0.050), RF ( OR=1.179, 95% CI 1.080-1.287, P<0.001) are positively correlated with RA onset. The area under ROC curve for diagnosis of RA with IM proportion was 0.687, and the 95% confidence interval was 0.590-0.784, P<0.001. Conclusions:The distribution of monocyte subsets in peripheral blood of RA patients is abnormal. The increase in the proportion of IM, the enhanced antigen-presenting ability, and the increased level of TNF-α secretion in RA patients may play an important role in the pathogenesis of RA.

Objective:To explore the significance of lateral lymph node dissection for low rectal cancer.Methods:Retrieval the Cochrane Library,PubMed,EMBASE,CBM,VIP,CNKI,WANFANG DATA,the time is from January 2000 to October 2015.Bring into the comparative studies about lateral lymph node dissection for low rectal cancer.Processing data using the revman 5.2 to reaserch the significance of lateral lymph node dissection for low rectal cancer.Results:9 clinical comparative studies were included in this study.The observation group was the lateral lymph node dissection group and the control group was the traditional operation group.Results showed that the length of incision of the observation group was longer [MD=-42.48,95％CI (32.92,-52.04),P＜0.00001],The amount of bleeding in observation group was more[MD=-18.72,95％Cl(5.60,31.83),P＜0.005],The local recurrence rate in the observation group was Iower[OR=-0.52,95％CI (0.38,0.71),P＜0.0001],The 3 year survival rate and the 5 year survival rate in the observation group were higher than those in the control group,the difference was statistically significant,Their combined OR and 95％CI were [OR=2.65,95％ CI (1.76,3.99),P＜0.00001] and [OR=3.57,95％ CI (2.05,6.22),P＜0.00001].Conclusion:Lateral lymph node dissection increasing operation time、hemorrhage volume and postoperative complication risk,but could increase the survival rate of the patients.

OBJECTIVETo explore the level of serum uric acid (UA) in children with obstructive sleep apnea/hypopnea syndrome (OSAHS).

METHODBetween Sep. 2008 and Mar. 2010, 138 children with OSAHS were enrolled in study group. Sixty-five children with accessory auricle or ptosis of upper lid were enrolled into the control group. Furthermore, according to apnea/hypopnea index (AHI) or obstructive apnea index (OAI) the study group was further divided into three subgroups (mild, moderate and severe group). At last, the study group and control group were divided into two groups according to the body mass index (BMI), separately. The fasting serum UA level was compared among the different groups. Then the correlation between the serum UA level and AHI, BMI, oxygen desaturation index, least arterial oxygen saturation (LSaO(2)) and the percentage of total sleep time with arterial oxygen saturation < 0.92 was also analyzed in OSAHS children with or without overweight and obesity respectively.

RESULTThe difference of serum UA level between the study group and control group (z = -0.443), and the difference among the three groups (χ(2) = 1.241) was not significant(P > 0.05). The serum UA level in overweight and obese children [study group, 273.0 (238.3 - 357.3); control group, 298.0 (253.0 - 336.0)] was significantly higher than that in children with normal BMI [study group, 246.5(215.8 - 300.0); control group, 266.0 (224.0 - 303.3)] (z = -2.084, -2.214, P < 0.05). That serum UA level did not correlate with the above index of OSAHS was observed in children with or without overweight and obesity in study group (P > 0.05).

CONCLUSIONFindings of higher serum UA level were not observed in children with OSAHS. There was no correlation between serum UA level and the above indices of OSAHS. The serum UA level in overweight and obese children was significantly higher than that in children with normal BMI.

Case-Control Studies ; Child ; Child, Preschool ; Humans ; Sleep Apnea, Obstructive ; blood ; Uric Acid ; blood

Objective To explore the reasons of multiple operations in children with airway foreign body through analyzing the clinical data of children who received two or more operations. Methods From 2003 to 2009, all children with airway foreign body who received two or more operations in hospital were enrolled. The clinical manifestations, image before and after operation and intraoperative conditions were retrospectively analyzed, in order to find the reasons of multiple operations. Results All children fully recovered, no serious complications or death. The reasons of two or more operations were multiple: 21 cases (42.8%) were related to the factor of apparatus, 20(40.8%) cases were related to the quality,surrounding conditions and location of the foreign body and experience and surgical skills of operator,4(8. 2% ) cases were due to incarceration of foreign body , another 4(8. 2% ) cases were due to unstable intraoperative oxygen saturation. Conclusions Both subjective and objective factors ( quality, surrounding conditions or location of foreign body, et al) were related to multiple operations. To reduce the chance of multiple operations, careful preoperative assessment and preparation are necessary.

Objective To explore the correlation between periodic limb movement index (PLMI) and the apnea-hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and lowest oxygen saturation (LSaO_2) in sixty-four children with sleep-disordered breathing(SDB).Methods Between March 2008 and May 2009, sixty-four children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center.OSAHS was diagnosed according to the general criterion.Sixty-four children were divided into two groups.Thirty children were diagnosed as OSAHS and 34 children were diagnosed as primary snoring (PS, 32 children) or upper airway resistance syndrome (UARS, 2 children).The difference of PLMI and periodic limb movement index during sleep associated with arousals (PLMl-arousal) were compared between the two groups.Besides this, the correlation between PLMI, periodic limb movement index during sleep associated with arousals and AHI, AI, HI and LSaO_2 were also analyzed in all SDB children.Furthermore, all SDB children were divided into two groups according to PLMI (< 5 events/h vs ≥5 events/h).AHI, AI, HI, LSaO_2 and sleep structure were compared between the two groups.Results ①The difference of PLMI and PLMI-arousal between the children with OSAHS and children with other SDB types(PS and UARS) were not significant (z value, - 1.279, - 1.490; P value, 0.201,0.136, respectively).② The increased sleep stage I was significant as being compared between the two groups (<5 events/h vs ≥5 events/h, t = -2.16, P <0.05).However, other sleep stages and sleep efficiency were not significantly different (P value, all > 0.05).③ The difference of HI, AI, AHI, arousals index (ArI) and LSaO_2 were not significant between the two groups(<5 events/h vs ≥5 events/h, P value, all > 0.05).④ PLMI and PLMI-arousal were not correlated with AHI, HI, AI, AHI and LSaO_2 (Spearman rank correlation analysis).Conclusions PLMS may be independent of SDB and PLMS had a little influce on sleep structure.

Objective To explore the diagnostic value of pulse transit time(PTT) in children with sleep disordered breathing(SDB).Methods Forty eight randomly selected snorers(2-13 years)with SDB were examined by PSG and PTT in the same time. Data obtained were analyzed by different technicians respectively. Statistics and analysis of the data were performed. Results Apnea hypopnea index (AHI),obstructive apnea index(OAI), the lowest oxygen and micro-arousal index were obtained by PSG and PTT.The results was described as M [25 percentile; 75 percentile]:4.9[1.3; 10.1], 4.6 [1.5; 11.8]; 1.2[0.7;4.9], 1.3[0.6;5.0]; 0.93[0.85;0.95], 0.93[0.84;0.95]; 14.5[12.6;16.4], 26.0[17.4;30.6]. The difference of AHI, OAI, and the lowest oxygen were not significant (P＞0.05), while the PTT arousal index detection rate was higher than PSG(Z=-5.19, P＜0.01). There was no significant difference in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) and determination of degree of patient's condition (P＞0.05). PTT could identify upper airway resistance syndrome in children without OASHS. Conclusions Both methods can be used to diagnose SDB. However, PTT is easy to useand suitable for the diagnosis of SDB in children, especially for UARS.

Objective To analyze the similarities and differences of the clinical manifestations between the children with upper airway resistance syndrome (UARS) and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to explore the clinical features and characteristics of sleep respiratory parameters. Methods Using the double-blind method, all children were diagnosed as UARS or OSAHS through the polysomnography test and the results of all children were analyzed by a sleep technician and an otolaryngologist. Another ENT doctor recorded their clinical and physical examination in detail. Results Polysomnography showed that the apnea-hypopnea index (AHI) and the lowest oxygen in 253 children with OSAHS were 3.60 [ 2. 00 ;7. 55 ] times/h and 0. 90 [ 0. 85 ;0. 91 ], and were 0. 90 [ 0. 50; 1.10 ] times/h and 0. 95 [ 0. 92 ;0. 96 ] in 102 children with UARS, the difference of the two groups by rank test was statistically significant. The proportion of UARS and OSAHS was more common during preschool period than during school-age period. The chief complaint in two groups was sleep snoring, and the main symptoms were sleep restless, attention deficit/hyperactivity and breath with mouth open. The incidence rate of above symptoms were as follows, 94. 1% ,72. 5% ,62. 7% and 37. 3% in children with UARS, 92. 9% ,78. 7% ,57. 7% and 45. 5% in children with OSAHS. The difference was not significant by chi-square test (P >0. 05). Tonsil and adenoid hypertrophy were also observed in the two groups, the difference was not significant ( x2 = 0. 27, P =0. 87). However, the children with OSAHS were more apt to have the sleep apnea than with UARS, the difference was statistically significant (x2 =34.07,P<0.001). Conclusions The clinical manifestations of two groups are similar, the difference between UARS and OSAHS can not be determined by the patient's clinical performance. Sleep apnea can be more easily observed in children with OSAHS than that in UARS, the final diagnosis is based on polysomnography.

OBJECTIVETo summarize the reasons for bile duct injury (BDI) after laparoscopic cholecystectomy (LC), and to determine the effect of multiple treatment after BDI.

METHODSA retrospective cohort study was performed. The medical records of 110 patients diagnosed with BDI after LC from October 1993 to November 2007, in ten large hospitals in Guangdong of China, were reviewed.

RESULTSAmong 110 patients with BDI, 58 cases (52.7%) were local patients, whereas 52 cases (47.3%) were transferred from outside hospitals. Reasons for BDI following LC were: (1) Lack of experience of the LC operator (48.2%); (2) LC performed during acute cholecystitis (20.0%); (3) The structure of Calot triangle was unclear (15.5%); (4) Variable anatomical position (11.8%); (5) Intra-operation bleeding (4.5%). The commonest sites of injury were the choledochus and common hepatic duct (76.4%). Following BDI, endoscopic stenting or operative repair was performed in 106 patients. The overall success rate was 95.3% (101/106), with a mortality rate was 0.9% (1/106). Cholangitis occurred in 3.8% (4/106) cases. Choledocho-enterostomy operation was performed in almost 60.0% (63/106) cases, and the success rate was 93.7% (59/63). Endoscopic stenting or operative repair was performed immediately following BDI in 23.6% (25/106) patients, the success rate was 100%; and within 30 days in 63.2% (67/106) patients. Eighty-eight out of 106 patients who underwent repair were successful following the first operative procedure.

CONCLUSIONSFactors such as an un-experienced operator and unclear anatomical position were causes of BDI following LC. Early operative repair should be regarded as the treatment of choice, in patients diagnosed with BDI. Early refer to an experienced hepatobiliary operator ensures a high success rate.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Ducts ; injuries ; surgery ; Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Humans ; Iatrogenic Disease ; Intraoperative Complications ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies