As a new hypoglycemic drug,Dapagliflozin has attracted much attention because of its unique hypoglycemic mechanism. It has been used in many studies on type 2 diabetes mellitus,but the application of type 1 diabetes mellitus(T1DM)in the eastern population is rare. This article uses Dapagliflozin through a case of obese T1DM to provide new ideas for the treatment of T1DM.

【Objective】 To explore the technical methods and clinical efficacy of transvaginal or transrectal repair in the treatment of iatrogenic bladder fistula. 【Methods】 The clinical data of 7 cases of iatrogenic bladder fistula patients treated during 2016 and 2019 were retrospectively analyzed, including 6 cases of vesicovaginal fistula (VVF) and 1 case of vesicorectal fistula (VRF). The operation was conducted 3 to 10 months after the diagnosis of urinary fistula, and the vagina or rectum was fully cleaned before operation. Modified Latzko technique was employed to separate the gap between the bladder wall and vaginal or rectal wall along the fistula, the fistula scar was sharply removed, and the fistula, bladder wall, vaginal or intestinal wall, and vaginal or intestinal mucosa were sutured in layers. The urinary catheter was indwelled for 4 weeks. 【Results】 All 7 cases were successfully repaired at one procedure. No urine leakage was found after the urinary catheter was removed. There was no recurrence after 6 to 12 months of follow-up. 【Conclusion】 Selective application of the modified Latzko technique to repair iatrogenic urinary fistula through the natural lumen is an advantageous treatment scheme, which simplifies the operation and reduces trauma.

Objective:To develop a risk prediction lineogram of neooperative atrial fibrillation in patients with esophageal cancer.Methods:The clinical data of 1 509 patients undergoing esophageal cancer surgery admitted to the department of esophageal surgery of our hospital from December 2019 to April 2022 were gathered, and they were divided into two layers according to whether they had new atrial fibrillation after surgery. In each layer, they were randomly divided into training set and test set in a ratio of 7∶3. In the training population, the multi-factor logistic regression method was used to establish the prediction model, and the line graph of the prediction model was drawn. The ROC curve and calibration curve were drawn to assess the differentiation ability and calibration ability of the prediction model. The test set population is used to validate the prediction model. Results:A total of 1 509 patients with esophageal cancer were included in the study, and the incidence of new atrial fibrillation after surgery was 247 patients(16.4%). A total of 1 039 patients(68.9%) were enrolled in the training set. The multivariate logistic regression model indicated that age, gender, BMI, pulmonary infection, the use of invasive ventilator, and the need for additional drainage of fluid accumulation were the influencing factors for new postoperative atrial fibrillation. The AUC of the training set prediction model under ROC curve was 0.775(95% CI: 0.737-0.812, P<0.001), indicating that the model has high predictive discrimination ability. Calibration curve and Hosmer- Lemeshow test results P=0.796, indicating that the model has good consistency of prediction ability. There were 470 subjects(31.1%) in the test set. The results showed that the AUC of the prediction model under the ROC curve was 0.773(95% CI: 0.719-0.826, P<0.001), indicating that the prediction model still has a high discriminative ability in the test set population. Conclusion:Patients with age, gender, BMI, pulmonary infection, the use of invasive ventilator, and the need for additional drainage of effusion are at higher risk of new atrial fibrillation after surgery. The timely prediction, prevention and management of POAF are crucial to improve the prognostic quality of postoperative patients with esophageal cancer by constructing clinical prediction models.

Objective:To investigate the effect of exposure to histological chorioamnionitis(HCA) on premature infants with respiratory distress syndrome(RDS)complicated with bronchopulmonary dysplasia(BPD).Methods:The clinical data of premature infants with gestational age<32 weeks and survival>14 days who were born in the department of obstetrics and admitted into NICU at Qingdao Women and Children′s Hospital from January 2018 to December 2020 were collected.According to placental pathology, they were divided into positive HCA + positive RDS group(observation group)and negative HCA + positive RDS group(control group). T-test, rank sum test and χ2 test were used to analyze the occurrence and clinical characteristics of BPD between the two groups.For premature infants with positive HCA who were diagnosed as BPD, Spearman rank correlation was used to analyze the correlation between HCA stage and BPD severity. Results:There were a total of 162 premature infants with RDS.The average gestational age at birth was 29.29(28.29, 30.43) weeks, and the average birth weight was 1.32(1.13, 1.55)kg; the incidence of BPD was 69.8%(113/162), and the mortality rate of BPD was 2.7%(3/113). There were 114 cases in the observation group and 48 cases in the control group.The incidence of BPD in the observation group was 76.3%(87/114), which was higher than that in the control group(54.2%, 26/48), and the difference was statistically significant( P<0.05). Further study of 87 premature infants with positive HCA who were diagnosed as BPD showed that, the correlation between the stage of HCA and the severity of BPD had not been confirmed( rs=0.062, P=0.571). Serum C-reactive protein before the mother used antibiotics and procalcitonin on the first day after birth in the observation group were higher than those in the control group, and the differences were statistically significant( P<0.05). Among 113 premature infants with RDS who were diagnosed as BPD, the time of antibiotic use, length of stay in intensive care unit and hospitalization cost in positive HCA group were higher than those in negative HCA group, and the differences were statistically significant( P<0.05). Conclusion:HCA exposure will increase the risk of BPD in premature infants with RDS.In addition, HCA also increases the intake period of antibiotics, length of stay and cost of intensive care unit in premature infants with BPD.

Objective:To investigate the correlation between histologic chorioamnionitis(HCA) and periventricular leukomalacia(PVL) in preterm infants less than 34 weeks old.Methods:A total of 287 preterm infants born in Qingdao Women′s and Children′s Hospital from January 2018 to December 2018, whose mothers underwent placental pathological examination and preterm infants transferred to the neonatal intensive care unit for treatment, and whose gestational age was less than 34 weeks old, were selected as the study objects. According to the results of placental pathological examination, the infants were divided into two groups: the positive HCA group(167 cases)and the negative HCA group(120 cases). The incidence of PVL was compared between the two groups. According to the results of placental pathological examination and the stage standard of HCA, the preterm infants who had been diagnosed with PVL(41 cases) were divided into three groups: the non-HCA group, the early HCA group and the middle/late HCA group.The severity of PVL, clinical data, complications were compared in each groups, and the conditions that following up to 6 months were adjusted.Results:PVL was 19.16%(32/167) in the positive HCA group and was 7.50%(9/120) in the negative HCA group.There was significant difference in the incidence of PVL between the two groups( P<0.05). Among the preterm infants with PVL, 21.95%(9/41) was in non-HCA group, 31.71%(13/41) was in the early HCA group, and 46.34%(19/41) was in the middle/late HCA group.The severity of PVL, 1 min Apgar score, white blood cell count at 24 h after birth, the incidence of bronchopulmonary dysplasia, the number of hospital stay, the use of antibiotics, the mental development index(MDI) and psychomotor development index(PDI) at the adjusted gestational age to 6 months were significant differences among the three groups( P<0.05). Moreover, the degree of HCA inflammation was positively correlated with the severity of PVL( r s=0.374, P=0.016). Conclusion:There is a correlation between HCA and PVL in premature less than 34 weeks old.With the increasing of HCA inflammation, the incidence and severity of PVL increase. With the progression of the severity of inflammation, the white blood cell count at 24 h after birth, the incidence of bronchopulmonary dysplasia, the use of antibiotics and the time of hospital stay increase, the MDI and PDI scores at the adjusted gestational age to 6 months decrease.

Objective:To investigate the best neutralization ratio of protamine and heparin during off-pump coronary artery bypass grafting(OPCABG) by analyzing the advantages and disadvantages of heparin residue after OPCABG.Methods:From July 2018 to January 2019, 112 patients undergoing elective OPCABG were included in this study. The patients’ whole blood was drawn at 2 time points, including before entering operating room and entering intensive care unit, to receive thrombelastography(TEG) and heparinase-modified thromboelastography(hmTEG) . Conventional coagulation indexes such as activated coagulation time(ACT) were also detected. All the patients were divided into 3 groups, the non-heparin residue group(30 cases), heparin residue group 1(42 cases) and heparin residue group 2(40 cases) according to the laboratory results of TEG, hmTEG and ACT. We observed the dosage of each group of protamine and heparin, as well as the ratio of heparin and protamine. The changes of R time in TEG and ACT between 3 groups were analyzed and compared. Postoperative chest tube drainage at postoperative 12 h and 48 h, cTnI peak value, incidence of perioperative myocardial infarction(MI), incidence of reoperation and poor wound healing, amount of blood loss and transfusion, and acute renal injury were compared between the 3 groups.Results:No significant trio-group differences existed in basic clinical characteristics(all P>0.05). Postoperative R(CKH)time was similar in the 3 groups( P>0.05). Comparing with heparin residue group 1 and heparin residue group 2, the ACT after protamine neutralizing heparin and postoperative R time were decreased, the dosage of protamine, ratio of heparin and protamine, cTnI peak value were increased in the non-heparin residue group( P<0.05). Comparing with heparin residue group 2, the dosage of heparin, postoperative chest tube drainage at postoperative 12h and 48h, amount of blood transfusion and transfusion probability were significantly decreased in non-heparin residue group( P<0.05), but compared with group 1 of heparin residue, there was no significant difference in the above indexes( P>0.05). The perioperative myocardial infarction, incidence of reoperation and poor wound healing, postoperative acute renal injury and time of in ICU stay showed no significant differences between the 3 groups( P>0.05). Conclusion:Moderate heparin residue after OPCAB suggests that it has myocardial protective effect, and does not significantly increase the risk of bleeding. A large number of heparin residues can affect the coagulation function and lead to bleeding tendency, increase the amount of blood loss and transfusion. It is reasonable to make ACT after protamine neutralize heparin higher than the level of ACT before operation, and not higher than 20% of the level before operation.

Objective    To explore the relationship between glycated hemoglobin (HbA1c) level and blood glucose fluctuations after coronary artery bypass grafting (CABG) and adverse events in non-diabetic patients, thus providing theoretical support for intensive preoperative blood glucose management in patients undergoing CABG surgery. Methods    A total of 304 patients undergoing CABG with or without valvular surgery from October 2013 to December 2017 were enrolled in this prospective, single-center, observational cohort study. We classified them into two different groups which were a low-level group and a high-level group according to the HbA1c level. There were 102 males and 37 females, aged 36–85 (61.5±9.5) years in the low-level group, and 118 males and 47 females aged 34–85 (63.1±9.4) years in the high-level group. The main results were different in hospital mortality and perioperative complications including in-hospital death, myocardial infarction, sternal incision infection, new stroke, new-onset renal failure and multiple organ failure. To assess the effects of confounding factors, multivariate logistic regression analysis was used. Results     Postoperative blood glucose fluctuation was more pronounced in the high-level group than that in the low-level group before admission [0.8 (0.6, 1.2) mmol/L vs. 1.0 (0.8, 1.8) mmol/L, P<0.01]. This study also suggested that the  incidence of major adverse events was significantly lower in the low-level group compared with the high-level group (P=0.001). Multivariate logistic regression analyses to correct the influence of other confounding factors showed that HbA1c (OR=2.773, P=0.002) and postoperative blood glucose fluctuations (OR=3.091, P<0.001) could still predict the occurrence of postoperative adverse events. Conclusion    HbA1c on admission can effectively predict blood glucose fluctuations in 24 hours after surgery. Secondly, HbA1c on admission and postoperative blood glucose fluctuations can further predict postoperative adverse events. It is suggested that we control the patient's preoperative HbA1c at a low level, which is beneficial to control postoperative blood glucose fluctuation and postoperative adverse events.

Objective To evaluate the diagnostic accuracy of CMS50F for screening in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Sixty-four volunteers with suspected OSAHS underwent simultaneous noc?turnal polysomnography (PSG), micromovement sensitive mattress sleep monitoring system(MSMSMS)and CMS50F. The ap?nea-hypopnea index (AHI) detected by PSG and MSMSMS was used as the diagnostic standard for OSAHS. The reliability of CMS50F for monitoring sleep was assessed. Results There was no statistic difference in CMS50F-ODI3 and PSG-AHI be?tween normal, mild and moderate OSAHS groups(P>0.05). The CMS50F-ODI3 was smaller than the PSG-AHI in severe OSAHS patients(P < 0.05). There was a positive correlation between CMS50F-ODI3 and PSG-AHI(r=0.855, P < 0.05). PSG-AHI≥5 events per hour was used as the threshold value to diagnose OSAHS, the sensitivity and specificity of CMS50F were 94.5%and 88.9%. There were no significant differences in CMS50F-ODI3 and MSMSMS-AHI between normal, mild and moderate OSAHS patients(P>0.05). The value of CMS50F-ODI3 was smaller than MSMSMS-AHI in severe OSAHS patients (P < 0.05). There was also a significant correlation between CMS50F- ODI3 and MSMSMS-AHI (r=0.867,P <0.05). MSMSMS-AHI≥5 events per hour was used as the threshold value to diagnose OSAHS, the sensitivity and specificity of CMS50F were 94.5%and 88.9%. Conclusion CMS50F can be used as a portable and reliable device for screening of pa?tients suspected OSAHS.

OBJECTIVETo compare the differences in the clinical efficacy on post-stroke speech disorder between scalp electric acupuncture (EA) under anatomic orientation combined with rehabilitation training and simple rehabilitation training.

METHODSSixty patients of post-stroke speech apraxia were randomized into an observation group and a control group, 30 cases in each one. In the observation group, under anatomic orientation, the scalp EA was adopted to the dominant hemisphere Broca area on the left cerebrum. Additionally, the speech rehabilitation training was combined. In the control group, the speech rehabilitation training was simply,used. The treatment lasted for 4 weeks totally. The speech movement program module in the psychological language assessment and treatment system of Chinese aphasia was used for the evident of efficacy assessment. The scores of counting, singing scale, repeating phonetic alphabet, repeating monosyllable and repeating disyllable were observed in the patients of the two groups. The assessment was done separately on the day of grouping and 4 weeks after treatment.

RESULTSIn 4 weeks of treatment, the scores of counting, singing scale, repeating phonetic alphabet, repeating monosyllable and repeating disyllable were all improved as compared with those before treatment in the two groups (all P<0. 001). The results in the observation group were better than those in the control group (all P< 0. 05). The total effective rate was 100. 0% (30/30) in the observation group, superior apparently to 53. 3% (16/30) in the control group (P<0. 001).

CONCLUSIONThe scalp EA under anatomic orientation combined with' speech rehabilitation training obviously improves speech apraxia in stroke patients so that the speech disorder cani be relieved. The efficacy is better than that in simple rehabilitation training.

Acupuncture Points ; Adolescent ; Adult ; Aged ; Apraxias ; etiology ; physiopathology ; rehabilitation ; therapy ; Electroacupuncture ; Female ; Humans ; Language ; Male ; Middle Aged ; Speech Disorders ; physiopathology ; rehabilitation ; therapy ; Speech Therapy ; Stroke ; complications ; Young Adult