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:In this study, we aimed to compare the short-term safety of two digestive tract reconstruction techniques, laparoscopic total abdominal overlap anastomosis and laparoscopic-assisted end-to-side anastomosis, following radical resection of Siewert Type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 139 patients who had undergone radical surgery for Siewert Type II esophagogastric junction adenocarcinoma. These included 89 patients treated at the First Affiliated Hospital of Air Force Medical University from November 2021 to July 2023, 36 patients treated at the First Affiliated Hospital of Xi'an Jiaotong University from December 2020 to June 2021, and 14 patients treated at the Yuncheng Central Hospital in Shanxi Province from September 2021 to November 2022. The group consisted of 107 men (77.0%) and 32 women (23.0%) of mean age 62.5±9.3 years. Forty-eight patients underwent laparoscopic total abdominal overlap anastomosis (overlap group), and 91 laparoscopic-assisted end-to-side anastomosis (end-to-side group). Clinical data, surgical information, pathological findings, postoperative recovery, and related complications were compared between the two groups.Results:There were no significant differences in general clinical data between the overlap and end-to-side anastomosis groups (all P>0.05), indicating comparability. There was no significant difference in operation time (267.2±60.1 minutes vs. 262.8±70.6 minutes, t=0.370, P=0.712). However, the intraoperative blood loss in the overlap group (100 [50, 100] mL) was significantly lower compared to the end-to-side group (100[50, 175] mL, Z=2.776, P=0.005). Compared to the end-to-side group, longer distances between the tumor and distal resection margin proximal(1.7±1.0 cm vs. 1.3±0.9 cm, t=2.487, P=0.014) and the tumor and distal resection margin (9.5±2.9 cm vs. 7.9±3.5 cm, t=2.667, P=0.009) were achieved in the overlap group. Compared with the end-to-side group, the overlap group achieved significantly earlier postoperative ambulation (1.0 [1.0, 2.0] days vs. 2.0 [1.0, 3.0] days, Z=3.117, P=0.002), earlier time to first drink (4.7±2.6 days vs. 6.2±3.0 days, t=2.851, P=0.005), and earlier time to first meal (6.0±2.7 days vs. 7.1±3.0 days, t=2.170, P=0.032). However, the hospitalization costs were higher in the overlap group (113, 105.5±37, 766.3) yuan vs. (97, 250.2±27, 746.9) yuan; this difference is significant ( t=2.818, P=0.006). There were no significant differences between the two groups in postoperative hospital stay, total number of lymph nodes cleared, or time to first postoperative flatus (all P>0.05). The incidence of surgery-related complications was 22.9%(11/48) in the overlap group and 19.8% (18/91) in the end-to-side group; this difference is not significant (χ2=0.187, P=0.831). Further comparison of complications using the Clavien-Dindo classification also showed no significant differences ( Z=0.406, P=0.685). Conclusions:Both laparoscopic total abdominal overlap anastomosis and laparoscopic-assisted end-to-side anastomosis are feasible for radical surgery for Siewert Type II esophagogastric junction adenocarcinoma. Laparoscopic total abdominal overlap anastomosis achieves longer proximal and distal resection margins and better postoperative recovery; however, end-to-side anastomosis is more cost-effective.

Objective To investigate the presence of pepsin and trypsin in the middle ear effusion of children with acute suppurative otitis media(ASOM).Methods Middle ear effusion samples were collected from 71 children with ASOM at Children's Hospital of Xuzhou.According to the characteristics of the middle ear effusions,the effu-sion was divided into serous and mucous types.The pH testing,Western Blotting(WB),and enzyme-linked immu-nosorbent assay(ELISA)were performed.Results ① There were 49.29％(35/71)of ASOM patients had a posi-tive RSI score(＞13).② The positive rate of pepsin in ASOM children was 49.29％(35/71),and the positive rate of trypsin was 42.25％(30/71).In addition,the positive rate of pepsin in RSI-positive children was 100％(35/35),and the positive rate of trypsin was 60％(21/35).There was no significant difference in the positive rate of pepsin and trypsin between serous and mucous middle ear effusion(P＞0.05).③ The pepsin concentration was 47.80(39.80,69.30)ng/ml and the trypsin concentration was 291.87±20.45 ng/ml in middle ear effusion of chil-dren with ASOM who had a positive WB test,and the trypsin concentration was significantly higher than pepsin(P＜0.05).There was no significant difference between the pepsin and the trypsin concentrations in serous and mu-cous middle ear effusion(P＞0.05).④ The pH value of mucous middle ear effusion was 7.39±0.28,and the pH value of serous middle ear effusion was 7.36±0.26.There was no significant difference between the pH value in se-rous and mucous middle ear effusion(P＞0.05).Conclusion The detection rates of pepsin and trypsin in middle ear effusion of children with ASOM were high which has important diagnostic value for children with ASOM combined with LPRD.

Objective:In this study, we aimed to compare the short-term safety of two digestive tract reconstruction techniques, laparoscopic total abdominal overlap anastomosis and laparoscopic-assisted end-to-side anastomosis, following radical resection of Siewert Type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 139 patients who had undergone radical surgery for Siewert Type II esophagogastric junction adenocarcinoma. These included 89 patients treated at the First Affiliated Hospital of Air Force Medical University from November 2021 to July 2023, 36 patients treated at the First Affiliated Hospital of Xi'an Jiaotong University from December 2020 to June 2021, and 14 patients treated at the Yuncheng Central Hospital in Shanxi Province from September 2021 to November 2022. The group consisted of 107 men (77.0%) and 32 women (23.0%) of mean age 62.5±9.3 years. Forty-eight patients underwent laparoscopic total abdominal overlap anastomosis (overlap group), and 91 laparoscopic-assisted end-to-side anastomosis (end-to-side group). Clinical data, surgical information, pathological findings, postoperative recovery, and related complications were compared between the two groups.Results:There were no significant differences in general clinical data between the overlap and end-to-side anastomosis groups (all P>0.05), indicating comparability. There was no significant difference in operation time (267.2±60.1 minutes vs. 262.8±70.6 minutes, t=0.370, P=0.712). However, the intraoperative blood loss in the overlap group (100 [50, 100] mL) was significantly lower compared to the end-to-side group (100[50, 175] mL, Z=2.776, P=0.005). Compared to the end-to-side group, longer distances between the tumor and distal resection margin proximal(1.7±1.0 cm vs. 1.3±0.9 cm, t=2.487, P=0.014) and the tumor and distal resection margin (9.5±2.9 cm vs. 7.9±3.5 cm, t=2.667, P=0.009) were achieved in the overlap group. Compared with the end-to-side group, the overlap group achieved significantly earlier postoperative ambulation (1.0 [1.0, 2.0] days vs. 2.0 [1.0, 3.0] days, Z=3.117, P=0.002), earlier time to first drink (4.7±2.6 days vs. 6.2±3.0 days, t=2.851, P=0.005), and earlier time to first meal (6.0±2.7 days vs. 7.1±3.0 days, t=2.170, P=0.032). However, the hospitalization costs were higher in the overlap group (113, 105.5±37, 766.3) yuan vs. (97, 250.2±27, 746.9) yuan; this difference is significant ( t=2.818, P=0.006). There were no significant differences between the two groups in postoperative hospital stay, total number of lymph nodes cleared, or time to first postoperative flatus (all P>0.05). The incidence of surgery-related complications was 22.9%(11/48) in the overlap group and 19.8% (18/91) in the end-to-side group; this difference is not significant (χ2=0.187, P=0.831). Further comparison of complications using the Clavien-Dindo classification also showed no significant differences ( Z=0.406, P=0.685). Conclusions:Both laparoscopic total abdominal overlap anastomosis and laparoscopic-assisted end-to-side anastomosis are feasible for radical surgery for Siewert Type II esophagogastric junction adenocarcinoma. Laparoscopic total abdominal overlap anastomosis achieves longer proximal and distal resection margins and better postoperative recovery; however, end-to-side anastomosis is more cost-effective.

Objective:To investigate the effects of transaxillary endoscopic and traditional open radical thyroidectomy on the levels of inflammatory factors in patients with thyroid cancer.Methods:The clinical data of 102 thyroid cancer patients underwent radical thyroidectomy from October 2019 to October 2021 in Xinjiang Medical University Hospital of Chinese Medicine were retrospectively analyzed. Among them, 50 cases underwent transaxillary approach endoscopic radical thyroidectomy (study group), and 52 cases underwent open radical thyroidectomy (control group). The operation related indexes were compared between two groups, including operation time, intraoperative blood loss, postoperative drainage, lymph node clearance and hospital stay; the pain scores 1, 3 and 7 d after operation were recorded; the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), galectin-3 (Gal-3) and tumor necrosis factor-α (TNF-α) before operation and 1 d after operation were measured by enzyme-linked immunosorbent assay; the postoperative complications were recorded, including hoarseness, limb numbness, cough after drinking water and hypocalcemia; and the cosmetic satisfaction was followed up 3 months after discharge, and the recurrence was observed by CT 6 months after discharge.Results:The operation time in study group was significantly longer than that in control group: (88.69 ± 15.16) min vs. (61.47 ± 15.48) min, while the intraoperative blood loss, postoperative drainage and hospital stay were significantly lower in control group: (51.21 ± 10.06) ml vs. (85.46 ± 11.37) ml, (98.29 ± 30.61) ml vs. (117.47 ± 30.25) ml and (5.35 ± 0.54) d vs. (7.72 ± 0.61) d, and there were statistical differences ( P<0.01); there was no statistical difference in lymph node clearance between two groups ( P>0.05). The pain score 1 and 3 d after operation in study group was significantly lower than that in control group: (5.13 ± 1.07) scores vs. (7.87 ± 1.46) scores and (4.22 ± 1.35) scores vs. (6.42 ± 1.28) scores, and there were statistical differences ( P<0.05); there was no statistical difference in pain score 7 d after operation between two groups ( P>0.05). There were no statistical differences in IL-6, IL-10, TNF-α and Gal-3 between two groups ( P>0.05); the IL-6, IL-10, TNF-α and Gal-3 1 d after operation in study group were significantly lower than those in control group: (26.27 ± 3.14) ng/L vs. (29.22 ± 4.52) ng/L, (7.54 ± 2.31) ng/L vs. (10.92 ± 2.54) ng/L, (14.98 ± 3.76) μg/L vs. (23.65 ± 2.46) μg/L and (3.54 ± 0.48) μg/L vs. (4.48 ± 0.63) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of total complications between two groups ( χ2 = 1.73, P>0.05). The total satisfaction rate in study group was significantly higher than that in control group: 94.0% (47/50) vs. 78.8% (41/52), and there was statistical difference ( χ2 = 4.94, P<0.05). The patients were followed up for 6 months after discharge, and there was no recurrence. Conclusions:The transaxillary approach endoscopic radical thyroidectomy can reduce intraoperative blood loss, length of stay, postoperative drainage, postoperative pain, and to some extent inhibit inflammatory response. It can improve the postoperative cosmetic satisfaction, reduce the incidence of postoperative complications, and does not increase the recurrence rate

Objective    To explore the clinical value of soluble suppression of tumorigenesis-2 (sST2) in replacement of N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) in cardiac function evaluation in renal failure patients after cardiac surgery. Methods    Sixty patients with renal insufficiency after cardiac surgery from January 2019 to June 2019 were divided into a test group, including 34 males and 26 females, with an average age of 49-78 (63.3±4.5) years. Another 60 patients with normal renal function were divided into a control group, including 37 males and 23 females, with an average age of 53-77 (61.7±3.8) years. The perioperative left ventricular ejection fraction, cardiac troponin T, creatine kinase-MB, sST2 and NT-proBNP were compared. Results    In patients of the test group, the NT-proBNP level increased significantly during perioperative period, and the change range was different from other cardiac function indexes. The change of sST2 in perioperative period was similar to other cardiac function indexes, which could reflect the change degree of cardiac function after operation. Conclusion    sST2 is more important to reflect the change degree of cardiac function in patients with renal dysfunction after cardiac surgery than NT-proBNP.

Objective:To analyze problems found in the implementation of the appointment registration system at public hospitals in China under the new situation, and provide a reference for the improvement and development of the system.Methods:Documents on appointment registration system published before December 31, 2020 were collected through the databases of CNKI, Wanfang, VIP and other official websites such as the National Health Commission. The Smith-Model was used as the main analysis framework in a systematical sorting and analysis of the implementation of the appointment registration system of public hospitals, in such means as qualitative interviews with relevant managers, doctors and residents and PEST analysis method.Results:The appointment registration system of public hospitals was highly idealized in its design, but there existed policy deficiencies in system standards, implementation effectiveness and supporting systems; and there were various problems in policy cognition, acceptance and implementation with its implementation agencies and target groups. Environmental factors such as politics, laws, economy, social culture and technology also posed negative effects on the implementation of policies.Conclusions:There were still some problems in the implementation of the appointment registration system in public hospitals, such as imperfect system standards, different implementation efforts in different regions, imperfect incentive and economic compensation mechanisms, and it was difficult to change residents' traditional ideas.Targeted strategies and measures should be taken regarding the policy makers, health administrative departments, business institutions, patients and environmental factors to ensure the continuous and effective implementation of the system in the future.

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 influence of different discontinuation time of aspirin and clopidogrel before off-pump coronary artery bypass grafting (OPCABG) on postoperative bleeding and blood products transfusion requirement. Methods: Three hundred and fifty-three coronary artery disease patients who underwent OPCABG from January 2017 to January 2018 at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University were retrospectively analysed. There were 268 males and 85 females, aged (66.0±9.1)years. All patients were divided into three groups: (1) guideline-recommended group: patients who discontinued clopidogrel for >5 days without discontinuing aspirin before surgery; (2) without discontinuing group: patients who discontinued clopidogrel for ≤5 days without discontinuing aspirin before surgery; (3) discontinuing group: patients who discontinued clopidogrel for >5 days with discontinuing aspirin before surgery. Postoperative bleeding recorded as chest tube drainage (CTD) volume and blood products transfusion requirement and perioperative complications were recorded. CTD volumes within 12 hours after surgery between groups were compared by Mann-Whitney U tests, CTD volumes after 12 hours postoperatively were compared by repeated measures analysis of variance and blood products transfusion and complications incidence were compared by χ² test or Fisher′s precise test. Results: The 12 hours CTD volumes of guideline-recommended group, without discontinuing group, discontinuing group after surgery were 280(153) ml (M(Q_R)), 291(229) ml, 225(161) ml, respectively. There were no significant differences in postoperative 12 hours CTD volumes (P=0.865), red blood cells transfusion incidence (χ²=2.626, P=0.149) and fresh frozen plasma (FFP) transfusion incidence (χ²=1.258, P=0.324) between guideline-recommended group and without discontinuing group. However, the 12 hours CTD volumes were significantly higher in guideline-recommended group patients compared with disconutinuing group patients (U=5 247, P=0.002). No significant differences were observed in red blood cells (χ²=0.182, P=0.757) and FFP (χ²=0.083, P=0.839) transfusion rate between these two groups. Repeated measures analysis of variance indicated that when patients began to take antiplatelet drugs (aspirin and clopidogrel) after 12 hours postoperatively, the change of CTD volumes beyond 12 hours after surgery didn′t differ either between guideline-recommended group and without discontinuing group (F=0.019, P=0.941) or between guideline-recommended group and discontinuing group (F=2.447,P=0.113). Besides, the incidence of perioperative arrhythmia was significantly higher in guideline-recommended group patients compared with without discontinuing group patients (4.8% vs. 0, χ²=5.073, P=0.038). Conclusions OPCABG patients who discontinued aspirin before surgery had lower postoperative 12 hours CTD volumes but similar blood products transfusion rate and CTD volumes beyond 12 hours postoperatively compared with patients adhering to the current guideline-recommended protocol. And for patients who discontinued clopidogrel for ≤5 days, postoperative CTD volumes and blood products transfusion requirement were similar but the incidence of perioperative arrhythmia was significantly lower compared with guideline-treated patients.