Individuals with type 1 diabetes or advanced type 2 diabetes suffer insufficient insulin secretion, leading to symptoms of hyperglycemia. To maintain the normal blood glucose levels, those people with diabetes must administer insulin multiple times a day. However, insulin requirements are influenced by several factors such as diet, exercise, and illness, combined with the narrow therapeutic index, making accurate insulin dosage challenging. Excessive insulin administration can even pose life-threatening risks. In addition, frequent daily insulin injections place considerable physiological and psychological burdens on patients. To tackle these challenges, researchers have embarked on the development of closed-loop insulin delivery systems. These systems adjust insulin dosages in real-time changes based on the patient’s blood glucose levels, therefore enhancing both the safety and effectiveness of insulin therapy. This review categorizes closed-loop insulin delivery systems into two types: electronic-based and material-based systems, based on their compositional attributes. The exploration of both types covers their components, developmental history, clinical applications, current pros and cons, and future directions. The relative strengths and limitations of these two categories of closed-loop insulin delivery systems are also compared and discussed.

Objective:To explore the risk factors of hypomagnesemia in elderly patients with sepsis and the influence of hypomagnesemia on the prognosis of elderly patients with sepsis.Methods:In this retrospective study, 249 elderly patients with sepsis or septic shock were recruited between January 2018 and January 2021 from the Department of Geriatrics and the Department of Emergency Medicine, General Hospital of Tianjin Medical University, and relevant clinical data were collected.The Logistic regression analysis model was used to identify the relationship between risk factors and hypomagnesemia in patients with sepsis.The prognosis criteria such as hospitalization time in intensive care unit(ICU), 28-day mortality rate, mechanical ventilation time, double infection rate, shock reversal time, etc., were compared between the hypomagnesemia group and the normal magnesium group.Results:Among the 249 elderly patients with sepsis, 187 had normal blood magnesium, 43 had low blood magnesium and 19 had high blood magnesium, accounting for 75.10%, 17.27% and 7.63%, respectively.Compared with the normal blood magnesium group, elderly sepsis patients with hypomagnesemia had a longer hospitalization time in ICU[(16.21±3.68)d vs.(13.86±3.58)d, t=-4.845, P=0.036], and a significantly prolonged mechanical ventilation time[11(3, 18)d vs.3(1, 6)d, Z=-1.782, P=0.033]. There was no significant difference in mortality and double infection rate between the two groups(both P>0.05). The sequential organ failure assessment(SOFA)score of elderly sepsis patients in the low magnesium group was significantly higher than that in the normal magnesium group[(5.69±1.28)scores vs.(3.09±0.68)scores, t=-0.322, P=0.008], but there was no significant difference in acute physiology and chronic health evaluation(APACHE) Ⅱ score between the two groups( P>0.05). Multivariate Logistic regression analysis showed that high SOFA score( OR=1.111, 95% CI: 1.025-1.758, P=0.001)was an independent risk factor for hypomagnesemia. Conclusions:A high SOFA score is an independent risk factor for hypomagnesemia in elderly sepsis patients, and the clinical prognosis of elderly sepsis patients with hypomagnesemia is poor.

Pancreatic metastasis of small cell lung cancer is very rare in clinic. The purpose of this article is to improve the knowledge of clinical and radiologists about this disease by reporting one case.

Objective:To explore an effective treatment method for mycobacterial infection of multiple abscesses in the face and breast after autologous fat injection.Methods:Six patients with non-tuberculous mycobacterial infection after autologous fat injection in the face and chest were treated from June to September in 2018. All patients underwent preoperative ultrasound localization. The small incision was opened for debridement and the necrotic granular tissues were completely scraped. Vacuum aspiration therapy in the sinus was used to promote wound growth, in line with the standard anti-tuberculosis drug treatment.Results:All six patients in this group were being followed up for 10-14 months. The average follow-up time was 12 months. All the infected patients were recovered, and the appearance of the infected site was satisfied by the patients.Conclusions:Small incision debridement with vacuum aspiration therapy combined with a variety of anti-tuberculosis drugs can effectively treat non-tuberculous mycobacterial infection after autologous fat injection, and achieve good results.

Objective:To monitor the epidemiological characteristics of viral etiology in children with influenza-like illness and to guide the prevention and management of acute respiratory tract infections in childhood.Methods:Nasopharyngeal swabs were collected from the outpatient children seeking medical care in Children′s Hospital of Fudan University, Shanghai for influenza-like illness between January 2015 and December 2018. Multiplex real-time polymerase chain reaction was performed to detect respiratory syncytial virus (RSV), influenza virus (Flu), adenovirus (ADV), parainfluenza virus (PIV, type Ⅰ to type Ⅳ) and enterovirus (EV), and the epidemiological data were analyzed. Chi-square test was used for statistical analysis.Results:A total of 2 271 patients with influenza-like illness were enrolled, age range from two months to 182 months old, 1 280 cases(56.4%) were positive for the target respiratory viruses tested on respiratory samples. The detection rates of FluA, FluB, PIV, EV, ADV, RSV were 15.1%(343/2 271), 12.5%(284/2 271), 8.4%(191/2 271), 7.8%(177/2 271), 5.1%(116/2 271) and 6.7%(152/2 271), respectively.The detection rates of influenza virus were statistically different among the age groups ( χ2=39.33, P<0.05), which showed an increasing trend with the increasing ages. The detection rate of RSV was 9.7%(35/361) in infant group from zero to 12 months old, which was higher than other age groups. Usually, FluA had two epidemic peaks during the winter and summer seasons, the epidemics of FluB and RSV peaked during the winter season, and EV and PIV were more prevalent in the summer season. Conclusions:Influenza virus remains the most common viral pathogen responsible for childhood influenza-like illness in Shanghai.Influenza virus has high incidence in winter.Widely influenza vaccination is highly recommended for the effective prevention the influenza outbreaks.Continuous monitoring the epidemic trend of viral respiratory infections is imperative for the prevention and control of diseases.

Objective:To explore the risk factors for adverse cardiac events within 30 postoperative days in the aged patients with hip fracture.Methods:We retrospectively evaluated the clinical data of 1, 004 aged patients who had been admitted to Department of Orthopaedics, The 7th Medical Center, PLA General Hospital for hip fractures from January 2012 to December 2016. According to whether cardiac complications occurred within 30 days after operation, they were divided into 2 groups: a group with adverse cardiac events and a group free from adverse cardiac events. The 2 groups were compared in terms of age, gender, concomitant disease, timing of surgery, type of surgery and anesthesia mode. Multivariate Logistic regression analysis was used to determine the independent risk factors of adverse cardiac events 30 days after operation. In addition, the 2 groups were also compared in 30-day mortality, 1-year mortality, and total mortality postoperation.Results:Adverse cardiac events occurred in 45 patients (4.5%) within 30 days after operation. The multivariate Logistic regression analysis showed that advanced age ( OR=1.085, 95% CI: 1.033-1.139), chronic renal insufficiency ( OR=5.296, 95% CI: 2.172-12.910), cardiac insufficiency ( OR=2.938, 95% CI: 1.283-6.729), delayed operation ( OR=3.682, 95% CI: 1.110-12.220) were independent risk factors for cardiac adverse events 30 days after operation. The 30-day mortality, 1-year mortality, and total mortality postoperation were respectively 17.8% (8/45), 26.7% (12/45) and 46.7% (21/45) for the group with adverse cardiac events, and respectively 3.6% (35/959), 9.1% (87/959) and 28.5%(273/959) for the group free from adverse cardiac events, showing significant differences between the2 groups (all P<0.05). Conclusions:Advanced age, cardiac insufficiency, chronic renal insufficiency and delayed surgery may be independent risk factors for adverse cardiac events within 30 days after surgery in the elderly patients with hip fracture who show a significantly higher mortality than those free from adverse cardiac events.

Objective:To investigate the imaging follow-up value of discectomy and Modic changes caused by endolate fracture.Methods:Forty-six patients with end-plate fractures admitted to Changxing People′s Hospital during January to December 2016 were selected as subjects and followed up for 1 year. All patients underwent MRI examination to analyze the changes of Modic, disc degeneration and lumbar function recovery before and after follow-up.Results:A total of 230 lumbar intervertebral discs in 46 patients in this group had Modic changes. After 1 year′s follow-up, Modic changes occurred in 185 lumbar intervertebral discs in 46 patients. Modic changes occurred in L 5-S 1 [38.92%(72/185)] and L 4 - L 5 [40.0%(74/185)] segments. After 1 year′s follow-up, the rate of intervertebral disc 3-4 grade was higher than that before discharge [70.43%(162/230) vs. 60.43%(139/230)], the rate of intervertebral disc 6-8 grade was lower than that before discharge[8.70%(20/230) vs. 15.22%(35/230)], and the differences were statistically significant ( χ2 = 5.085, 4.646, P<0.05). After 1 year′s follow-up, the lumbar spine function score was significantly higher than that before discharge [(23.47 ± 2.86) scores vs. (9.15 ± 1.32) scores], and the difference was statistically significant ( P<0.05). Conclusions:Diffusion-weighted MR imaging has the characteristics of convenient operation, good repeatability and high accuracy. It is suitable for diagnosis and follow-up of disc degeneration and Modic change caused by endplate fracture. It is worthy of clinical promotion.

Objective: By modeling ischemic foot ulcers in experimental rabbits, the mechanism of healing in animal models was investigated. Methods: Sixty healthy male clean grade New Zealand rabbits were 3 months. The weight range was 2.1-2.5 kg. Randomly draw auording to the number, the experimental rabbits were randomly divided into 4 groups, namely, no ischemia-no ulcer-no intervention group (group A), no ischemia-no ulcer-no intervention group (group B), no ischemia-no ulcer-no intervention group (group C) and no ischemia-ulcer-intervention group (group D), with 15 rabbits in each group. Ischemic foot ulcers experimental rabbit building complete after 24 h, will naturally exposed ischemic foot ulcers in the low frequency electromagnetic field on experimental rabbit 7 d feeding experiment, the experimental rabbits ischemia crus muscle and the ulcer base were collected, and plasma by enzyme-linked immunosorbent assay (ELISA) verification tests in experimental rabbit plasma hypoxia-inducible factor 1 alpha subunit (HIF-1α), matrix metalloproteinases 9 (MMP-9) and soluble leukocyte differentiation antigen 40 ligand 1 (sCD40L1) expression level, while detecting ulcer healing area change, hematoxylin-eosin staining was used to detect and analyzed the pathological changes of ulcerated skin. Measurement data were expressed as mean±standard deviation (Mean±SD), one-way analysis of variance was used for comparison between groups, and LSD method was used for pairwise comparison. Results: The concentration of MMP-9 and sCD40L1 in group D were (40.510±10.155) ng/ml and (44.580±19.138) ng/ml, respectively. Concentrations in group C were (93.210±17.838) ng/ml and (318.500±52.680) ng/ml, respectively. Group D was significantly lower than group C, and the difference was statistically significant (P< 0.000 1). The concentrations of HIF-1α in group D was (249.700±71.824) ng/ml, and that in group C was (124.830±20.110) ng/ml. The concentration in group D was significantly higher than that in group C, and the difference was statistically significant (P< 0.000 1). The concentrations of HIF-1α, MMP-9 and sCD40L1 in group B were (181.590±31.927), (78.950±16.652) and (173.670±43.048) ng/ml, respectively. The concentrations of group A were (35.420±9.916), (32.700±6.449) and (47.440±11.831) ng/ml, respectively. The concentration in group B was significantly higher than that in group A, the difference was statistically significant(P<0.000 1). The concentration of HIF-1α in group D was (249.700±71.824) ng/ml, and the concentration of group A was (35.420±9.916) ng/ml. The concentration of group D was significantly higher than that of group A, and the difference was statistically significant (P=0.000 1). The concentration of the MMP-9 in the group D was compared with the concentration of group A, and the difference was not statistically significant (P=0.207). The concentration of sCD40L1 in group D was (44.580±19.138) ng/ml, and that in group A was (47.440±11.831) ng/ml. The difference between group D and group A was not statistically significant(P=0.858). The healing area of ulcer was (1.855±0.394) cm² in group D and (0.653±0.269) cm² in group C. Group D was significantly higher than group C, and the difference was statistically significant (P<0.000 1). Hematoxylin-eosin staining results of ulcer skin showed that the epithelial of ischemic foot ulcer was significantly atrophied, hyperkeratinized, and the acinous cell layer was atrophied with a small amount of obvious inflammatory cell infiltration and hyperplasia of small vessels. After intervention, the symptoms were relieved. Conclusion Low frequency electromagnetic fields can promote the expression of HIF-1α in experimental rabbits, inhibit the expression of MMP-9 and sCD40L1, and promote the healing of ischemic foot ulcer.

Objective To analyze the effects of dexmedetomidine(Dex) on levels of inflammatory cytokines in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods From April 2015 to April 2017,94 patients with acute exacerbations of COPD who received mechanical ventilation in Wenling Hospital Affiliated to Wenzhou Medical College were randomly divided into two groups according to the digital table,with 47 cases in each group. Group A was given Dex,and group B was given midazolam. The levels of TNF - α,IL - 1, hs - CRP between the two groups were compared. Results There were no statistically significant differences in TNF - α,IL - 1,hs - CRP between the two group before treatment (all P > 0. 05). One day after treatment,the levels of TNF - α,IL -1,hs - CRP in group A were (92. 99 ± 15. 25)ng/ L,(68. 63 ± 14. 53)ng/ L,(15. 44 ± 4. 92)mg/ L, respectively,which in group B were (150. 63 ± 20. 78)ng/ L,(91. 13 ± 12. 58)ng/ L,(19. 35 ± 5. 17)mg/ L,respec-tively,there were statistically significant differences between the two groups(t = 2. 736,2. 503,2. 421,P = 0. 008, 0. 012,0. 015). Three days after treatment,the levels of TNF - α,IL - 1,hs - CRP in group A were (73. 37 ± 11. 01)ng/ L,(51. 52 ± 9. 16) ng/ L, (14. 82 ± 3. 29) mg/ L, respectively, which in group B were (123. 80 ± 19. 62)ng/ L,(73. 46 ± 17. 36) ng/ L, (18. 77 ± 4. 02 ) mg/ L, respectively, there were statistically significant differences between the two groups(t = 2. 184,2. 354,2. 098,P = 0. 031,0. 022,0. 039). Five days after treatment, the levels of TNF - α,IL - 1,hs - CRP in group A were (63. 54 ± 13. 06)ng/ L,(34. 04 ± 8. 13) ng/ L,(13. 84 ± 4. 13)mg/ L,respectively,which in group B were (76. 63 ±17. 39)ng/ L,(50. 66 ± 9. 17)ng/ L,(14. 27 ± 3. 95)mg/ L, respectively,there were statistically significant differences between the two groups( t = 1. 906,2. 082,1. 834,P =0. 067,0. 041,0. 081). Compared with group B,the ICU time in group A was significantly decreased[(9. 27 ± 1. 63) d vs. (7. 16 ± 1. 21)d,t = 2. 215,P = 0. 031](t = 2. 215,P = 0. 031). There was no statistically significant difference in the incidence rate of multiple organ dysfunction syndrome between the two groups at 5 days after treatment (χ2 =2. 286,P = 0. 132). Conclusion Dex can effectively inhibit inflammation cytokines of the mechanical ventilation COPD patients in acute exacerbation,and can reduce the ICU time.

Objective To study the clinical effect of the treatment of cognitive dysfunction of acute cerebral infarction with ganglion glycosides.Methods 83 acute cerebral infarction patients with cognitive dysfunction were selected.83 patients were randomly divided into two groups:the conventional group (41 cases) and the intervention group (42 cases).The conventional group was given conventional control infection,anti platelet aggregation and control hemorrhage of digestive tract and routine rehabilitation training for the main therapy.The intervention group was given conventional treatment plus ganglioside 100mg + 0.9％ sodium chloride 250mL,1 time a day,treatment for 21 days.Observation index:(1) total effective rate;before and after treatment,the difference of MMSE score and Barthel index.Results The total effective rate of the intervention group was higher than that of the conventional group,there was statistically significant difference (95.24％ vs.75.61％,x2 =8.245,P ＜ 0.01);Before treatment,the MMSE score,Barthel index in the two groups had no significant differences (t =0.372,0.313;P =0.711,0.756).After treatment,the MMSE score,Barthel index of the intervention group improved more significantly compared with the conventional group,the differences were statistically significant(t =7.997,25.530,all P ＜ 0.01).Conclusion The clinical effect of ganglion glycosides in the treatment of acute cerebral infarction with cognitive impairment is accurate,it can effectively reduce the patients'cognitive dysfunction,improve the ability of daily life,it is worthy of promoting.