Table of Content

05 August 2017, Volume 32 Issue 8

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Epidemiological investigation in recent 20 years and status analysis of diabetic foot in Africa

Zulfiqarali G.Abbas1， Liu Rongmei2a， Zhang Lili2b， Xu Zhangrong3

2017, 32(8):  645-648.  doi:10.3969/j.issn.1004-583X.2017.08.001

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The incidence of  type two diabetes (T2DM) is great increasingly year by year. Diabetic foot as one of the most important complications of diabetes， which incidence is about 40%~60%， can lead to the serious public health problems. And the situations of diabetic foot in Africa is much worse than other developing and developed countries. So Dr ZG. Abbas established the first foot clinic in Tanzania and the project of Step By Step has been developed in global regions from the origin of Tanzania and India， which has made great contributions for human beings.

Nonalcoholic fatty liver disease  and diabetes mellitus

Brandon Orr-Walker1， Tan Lixin2， Xu Zhangrong3

2017, 32(8):  649-653.  doi:10.3969/j.issn.1004-583X.2017.08.002

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Nonalcoholic fatty liver disease（NAFLD）  is a spectrum of disorders  ranging from simple steatosis (nonalcoholic fatty liver，NAFL)  to nonalcoholic steatohepatitis (NASH)， cirrhosis and cancer. As  a spectrum of severity， NAFLD is not a single metabolic disorder. This article begins with the definition of NAFLD， describes the assessment and quantification of hepatic steatosis， the epidemiology and pathogenesis of NAFLD， and the endocrine and metabolic disorders associated with NAFLD. Diet and intestinal flora can promote the occurrence and development of NAFLD. Based on epidemiology， dietary habits and obesity and other related factors， diabetes and NAFLD are closely related.Furthermore， the two have formed a vicious circle. To some extent， diet and drug intervention can alleviate the incidence and development of NAFLD and diabetes mellitus.

Update in diabetes medications

Ted Wu1， Liu Shan2， Xu Zhangrong3

2017, 32(8):  654-657.  doi:10.3969/j.issn.1004-583X.2017.08.003

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The safety of glucose lowering medications is an important issue. New medications must undertake rigorous study in clinical trials to assess the cardiovascular and renal safety before being used in clinical practice. Recently, a clinical trial showed empagliflozin had protective effect on cardiovascular and kidney. The outcomes indicated a wide clincal application for SGLT2 inhibitor. At the same time, liraglutide showed a protective effect on cardiovascular and  weight loss.

Improving outcomes in pregnancy through technology

Marg McGill1， Xing Yuwei2， Xu Zhangrong3

2017, 32(8):  658-660.  doi:10.3969/j.issn.1004-583X.2017.08.004

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Achieving tight glycaemic targets throughout the pregnancy is essential for a healthy baby and a healthy mother   and intelligent use of technology is fundamental to this success. To treat GDM or preexisting diabetes， we can use the following technology to meet glucose targets，such as blood glucose monitoring，HbA1c，CGM，Flash Libre and subcutaneous insulin pumps. We can also use the Pea Pod to measure neonatal body composition within 48 hours after birth to help determine the success of treatment during pregnancy.

Necessity to recognize early gestational diabetes mellitus

Jencia Wong1， Xing Yuwei2， Xu Zhangrong3

2017, 32(8):  661-664.  doi:10.3969/j.issn.1004-583X.2017.08.005

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There is a linear association between glucose in early  gestational diabetes mellitus (GDM) and outcomes. But we can  not  use the same criteria in early pregnancy，because glucose thresholds based on relationships in later pregnancy；very little data are available on glucose in normal pregnancy；glucose varies over trimesters in normal pregnancy. Despite uncertainty over currently recommended diagnostic criteria for early GDM，several studies showed  that glucose levels in early pregnancy predicted pregnancy complications. Some evidences supported for poor pregnancy outcomes even in treatment. Maybe this is associated with fetal glucose steal phenomenon，fetal hyperinsulinemia，potentially attenuate maternal glucose level. As there is limited evidence that intervention improves pregnancy outcomes，   it is time to recognize early GDM.

Haploidentical hematopoietic stem cell transplantation for hematologic malignancies  is equivalent to HLA matched sibling transplantation

Gao Xinbao， Wen Shupeng， Xing Lina， Niu Zhiyun， Wang Ying， Wang Fuxu， Zhang Xuejun

2017, 32(8):  665-671.  doi:10.3969/j.issn.1004-583X.2017.08.006

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Objective  To compare the clinical efficacy for treatment of malignant hematological disease in haploidentical hematopoietic stem cell transplantation (HaploSCT) and human leukocyte antigen identical sibling hematopoietic stem cell transplantation (human leukocyte antigen matched sibling donor transplantation， MSDT).  Methods   Fiftyeight patients with hematologic malignancies undergoing related haploidentical (n=33) and HLAidentical sibling (n=25) in our hospital were enrolled for a retrospective analysis.  The clinical efficacy and related risk factors of post transplantation overall survival（OS）  were analyzed.  The therapeutic effects of the two treatments and the risk factors related to overall survival (OS)  were evaluated.Results  ①Haploidentical and identical sibling cohorts were successfully engrafted. ②The cumulative incidences of grades Ⅱ to  Ⅳ acute graftversushost disease (aGVHD) and grades Ⅲ  to Ⅳ  aGVHD in the mismatched and matched cohorts were 33.3% versus 24%(P=0.261) and 18.2% versus 8%(P=0.611)， respectively. ③Oneyear leukemiafree survival (LFS) and twoyear OS in mismatched and matched cohorts were 77% vs 61% (P=0.211) and 72% vs 61% (P=0.118)， respectively. ④Multivariate analysis showed that only relapse after alloHSCT (P=0.033) were risk factors for OS.Conclusion  For patients with hematological malignancies lacking matched sibling donor，HLAhaploidentical donors were an alternative stem cell source.

Clinical characteristics of cardiac rupture after acute myocardial infarction

Dong Songwu， Zhang Jing， Jiang Rongyan， Wu Qiao

2017, 32(8):  672-675.  doi:10.3969/j.issn.1004-583X.2017.08.007

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Objective  To analyze the clinical features and risk factors of cardiac rupture (CR) complications in patients with acute myocardial infarction (AMI)， and to identify the risk factors for early identification of cardiac rupture and to reduce the incidence of complications. Methods  The clinical data of 1 110 cases of AMI admitted to the hospital from September 2014 to November 2016 were reviewed， and 37  cases combined with CR assigned into study group， and 111 cases from 1∶3  pairmatched randomly in non CR AMI patients were control group. Clinical information was compared between two groups and the relevant risk factors for predicting CR were studied by logistic regression analysis. Results  The two groups showed statistical significances in the age of patients (72.92±7.84) years old vs (66.25±10.05) years old (P<0.05)， the proportion of women (51.35% vs 26.13%，P<0.05)， the treatment time 7 (5，48) h vs 5 (3，12) h(P<0.05)， heart rate (85.30±23.02) beats/min vs  (76.53±16.41) beats/min(P<0.05)， TG 0.99(0.86，1.36) mmol/L vs 1.35(1.00，1.95) mmol/L(P<0.05)， reperfusion ratio 5 cases (13.51%) vs 43 cases(38.74%)(P<0.05) and using angiotensinconverting enzyme inhibitor(ACEI) and beta blockers ratio 10 cases （27.03%） vs 52 cases（46.85%）(P<0.05). Logistic multifactor regression analysis suggested that the age and not using of ACEI and beta blockers were independent risk factors. The mean time of incidence of CR after AMI was (4.65±3.37) days， and 41.67% of AMI had abnormal incentives before the onset of CR. Conclusion  Advanced age， women， treatment time delay， high admission heart rate， low TG， without infusion therapy and not using of ACEI and beta blockers were high risks for CR. Advanced age and not using of ACEI and beta blockers were independent risk factors.Early reperfusion of infarct related artery completely， early using of ACEI and beta blockers， avoiding mood swings and ambulation could reduce the incidence of CR after AMI.

Risk factors of metabolic syndrome in different gender patients with type 2 diabetes mellitus

Luo Jiakai， Li Zhihong， Yin Fei， Yuan Xiaochao， Wang Xin

2017, 32(8):  676-680.  doi:10.3969/j.issn.1004-583X.2017.08.008

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Objective  To explore risk factors of metabolic syndrome（MS） in different gender patients  with type 2 diabetes mellitus（T2DM）. Methods  Totally 3 251  T2DM patients were chosen to carry on a retrospective casecontrol study， general information and laboratory examination among different gender patients with MS and without MS were compared， and the risk factors of MS in different gender T2DM patients were analyzed by using binary logistic regression analysis. Results  ①High density lipoprotein cholesterol(HDLC) was a protective factor of MS in male T2DM patients; age， family history of diabetes， smoking history，body mass index(BMI)，systolic blood pressure(SBP)，diastolic blood pressure(DBP)， triglyceride(TG)，serum uric acid(SUA) and renal complication were risk factors of MS in male T2DM patients. ②HDLC was a protective factor of MS in female T2DM patients; age，BMI，SBP，TG and HbAlc were risk factors of MS in female T2DM patients. Conclusion  The high risk factors should be focused on screening for MS of different gender T2DM patients.

Clinical features and chromosomal  karyotype analysis of 15 cases of Turner syndrome

Sun Yan， Liu Jingfang， Tang Xulei， Cheng Jianguo， Yang Xiaomei

2017, 32(8):  681-685.  doi:10.3969/j.issn.1004-583X.2017.08.009

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Objective  To collect and analyze the clinical data of patients with Turner syndrome(TS)， and to strengthen the understanding of clinical features and chromosomal abnormalities in patients with TS. Methods  A total of 15 patients with TS  were  included and the results of laboratory tests and imaging findings were collected. Results  There were 4 kinds of chromosome karyotypes in these patients， 9 cases were 45，X0，1 case was 46， XX/45， X0， 4 case was 46， X，i(Xq) and 1 case was 46， X，inv(Xq). The primary diagnosis age of 10 patients was ≤18 years old.  The height 8 patients was  less than the third percentage of height in girls of the same age， 2 of them less than the tenth percentage.Breast and vulva with different degrees of dysplasia were found in 15 patients and their  pubic hairs and armpit hairs were absent. The abnormal development of uterine and ovarium were 12 and 10 cases， respectively. Totally 12 cases of patients showed decrease in estradiol， but their  follicle stimulating hormone and luteinizing hormone were relatively high. Totally  8 cases of patients associated with Hashimoto thyroiditis，in which the complications of subclinical hyperthyroidism， Graves' hyperthyroidism， subclinical hypothyroidism and hypothyroidism were  2，1，3，1 cases， respectively. Totally 5 cases of patients showed abnormality in liver function; 1 case of them had type 2 diabetes mellitus. There was 1 case of them had combined atrial septal defect of congenital heart disease and 1 associated with the disease of horseshoe kidney. Conclusion  The patients with TS have many different kinds of chromosome karyotypes and clinical signs， but they all have the characteristics of growth retardation and gonadal dysgenesis.

Role of  ubiquitinspecific proteases 46  gene in blood of patients with systemic lupus erythematosus

Zhang Wei1， Wei Qun2a， Guo Huifang3， Zheng Guimin2b， Zhang Lianzhi1， Peng yuanyuan1， Liu Shuxia1

2017, 32(8):  686-690.  doi:10.3969/j.issn.1004-583X.2017.08.010

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Objective  To investigate the role of  ubiquitinspecific proteases 46 (Usp46) in the blood of systemic lupus erythematosus (SLE) patients and healthy population. Methods  Real  time polymerase chain reaction analysis was used to determine the Usp46 expression in the blood of 73 patients with SLE and 75 healthy controls.Results  The mRNA expression level of Usp46 was significantly increased， about 4.22（1.30，17.02）  folds， in samples from SLE patients compared to healthy population (Z=-6.98，P＜0.01). In addition， there was significantly positive correlation between the expression level of Usp46 and ESR， IgG， IgM and ALT (P＜0.05). Conclusion  The mRNA expression level of Usp46 was significantly higher in SLE patients than in healthy population， which indicates that Usp46 may participate in the development of SLE process.

Relationship of residual renal function and endothelial dysfunction  in peritoneal dialysis patients

Si Bolin， Shen Ruifang， Luo Yanping， Yu Su

2017, 32(8):  691-694.  doi:10.3969/j.issn.1004-583X.2017.08.011

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Objective  To elucidate factors of endothelial dysfunction for  patients with peritoneal dialysis.Methods  Fortyfive peritoneal dialysis patients in a single center were recruited. Demographic and clinical data were recorded. Residual glomerular filtration rate (GFR) was measured. Endothelial  function was assessed by brachial artery endotheliumdependent vasodilation(FMD). Renal urea and creatinine clearance were used to assess residual kidney function.Results  According to residual GFR，peritoneal dialysis patients were divided into two groups: group A   (residual GFR<1 ml/min）， group B（residual GFR>1 ml/min）. Blood pressure， hemoglobin， serum albumin， total cholesterol， triglyceride， serum P， PTH and weekly KT/V had no significant difference between group A  and group B(P>0.05). The FMD in group B was significantly higher than that in group A(P<0.05). Correlation analysis revealed that residual GFR was positively correlated with FMD， whereas PD duration was inversely correlated with FMD. In multivariate linear regression analysis， residual GFR was found to be an independent determinant of FMD（β=0.36，P=0.01）.Conclusion  This study showed that the residual renal function was independently associated with endothelial dysfunction in patients with peritoneal dialysis.

 

Analysis and prevention of deep venous catheter related bloodstream infection in 107 patients with malignant tumor

Cheng Xiaojian1a， Yang Xue1b， Hao Wanrong2， Liu Junqing3

2017, 32(8):  695-698.  doi:10.3969/j.issn.1004-583X.2017.08.012

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Objective  To analyze deep venous catheterrelated bloodstream infection in patients with malignant tumor for reference in prevention and treatment of the disease. Methods  Retrospective analysis was made in 107 cases of patients with malignant tumor in the hospital from January 2014 to December 2016， including the incidence of deep venous catheterrelated bloodstream infection. Results  In 107 patients  of  deep venous catheter related bloodstream infection，gram positive bacteria were cultured in 46 cases (42.98%)， gram negative bacteria 38 cases (35.51%) and fungi 23 cases (21.51%). The highest infection rate was found in 730 days after catheter indwelling， up to 43.90%. The ways of catheter maintenance of peripherally inserted central catheters (PICC) infection  also showed significant difference. The constituent ratios of two PICC infections from individual clinics or/ external hospitals maintenance and self maintenances were respectively 48.7% and 28.3%. Conclusion  Malignant tumor patients with deep venous catheterrelated bloodstream infection were mainly gram positive bacteria. The highest infection rate was found in 730 days after catheter indwelling. Prevention should be strengthened. Improper maintenance will result in a significant increase in the rate of infection.

Relationship between functional dyspepsia with depression and serum interleukin 6 level

Liu Hongna1，2， Su Shaohui1，2， Hu Yiting2， Wang Yuzhen2

2017, 32(8):  699-702.  doi:10.3969/j.issn.1004-583X.2017.08.013

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Objective  To explore the possible mechanism and clinical significance of serum interleukin 6 (IL6) level and the digestive symptoms in patients caused by the mental factors. Methods  Totally 48 functional dyspepsia (FD) patients with Hamilton Depression Scale (HAMD) for mildtomoderate depression (HAMD 8 points≤scores≤35 points) were selected as the case group. Meanwhile， 40 FD patients with no depression symptom (HAMD scores＜8 points) in the same period were selected as the control group. The serum IL6 in two groups were measured and the indigestion symptom was scored in the case group. Results  The serum level of IL6 in case group was significantly higher than that of control group (P＜0.05). The HAMD scores and the indigestion symptom scores in case group were significantly higher than those of control group (P＜0.05). The serum level of IL6 and HAMD scores were positively correlated (P＜0.01). The serum level of IL6 and the indigestion symptom scores were positively correlated (P＜0.01). The indigestion symptom scores and HAMD scores were positively correlated  in case group(P＜0.01). Conclusion  The mental factors play important role in the pathogenesis of FD. The more depressed patients are， the higher their serum IL6 are， and the more severe their dyspeptic symptoms are.

Expression and significance of neutrophil surface adhesion molecules CD11b from cytomegalovirus infection in children

Yang Lina

2017, 32(8):  703-706.  doi:10.3969/j.issn.1004-583X.2017.08.014

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Objective  To study diagnosis and clinical significance of neutrophil surface adhesion molecules including CD11b from cytomegalovirus (CMV) infection pneumonia in children. Methods  Blood samples were collected from 113 children of CMV infection pneumonia including male 80 and female 40 cases between November 2014 and October 2016. Healthy male 21 cases and female 12 cases served as healthy control group from outpatients in the same period. Children of CMV infection pneumonia were divided into high active CMV infection group， CMV infection group and the negative control group， and healthy group as normal control group according to CMVpp65 antigen detection. Neutrophil surface adhesion molecule CD11b was analyzed by flow cytometry and compared respectively. ROC curve of CD11b in children of CMV infection pneumonia was made. Results  The expression ratio of CD11b in high active CMV infection group was significantly different as compared with negative control group and control group (P<0.05); optimal cutoff value of CD11b in high active CMV infection group was 40.11%， the sensitivity was 100%， the specificity in high active CMV infection group was 63.19%， and the area under the ROC was 0.612. The optimal cutoff value of CD11b in CMV infection group was 63.87%， the sensitivity of CD11b was 92.87%， the specificity of CD11b was 98.34%， and the area under of ROC of CD11b was 0.991. Conclusion  The neutrophils CD11b expression in children of CMV infection pneumonia is down regulation. CD11b expression can be used as a laboratory diagnosis basis of children’s CMV infection.

Association between XRCC1 polymorphisms and pancreatic cancer risk: a metaanalysis

Su Guoming1， Huang Binyang1， Han Yuxin1， Xiang Junbei1， Song Qiling2，

2017, 32(8):  707-712.  doi:10.3969/j.issn.1004-583X.2017.08.015

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Objective  To systematically evaluate the association between XRCC1 single nucleotide polymorphisms and pancreatic cancer risk. Methods  An electronic search of PubMed， Embase， the Cochrane Library， Web of Science， CBM， Wanfang Data and CNKI  database were conducted. Studies were identified with the criteria for inclusion and exclusion for metaanalysis. Publication bias was examined and sensitivity analysis was also performed. Results  A total of eight  casecontrol  studies were included in the metaanalysis. The combined results showed that there was no significant association between XRCC1 Arg399Gln (rs25487 G>A) mutant and Arg194Trp (rs1799782 C>T)  mutant and pancreatic cancer risk. There was significant association between XRCC1 Arg280His (rs25489 G>A) mutant and pancreatic cancer risk (A vs G: OR=0.743，95%CI=0.5760.958，P=0.022; GA vs GG: OR=0.701，95%CI=0.5250.936，P=0.016; AA+GA vs GG: OR=0.710，95%CI=0.5370.939，P=0.016). Egger linear regression test revealed that there was no publication bias (P＞0.05). Sensitivity analysis showed that the results were robust to the removal of each individual trial from the metaanalysis.Conclusion  This study showed that XRCC1 Arg399Gln (rs25487 G>A)  mutant  and Arg194Trp (rs1799782 C>T)mutant had no significant correlation with the risk of pancreatic cancer. XRCC1 Arg280His (rs25489 G>A) mutant might be associated with the risk of pancreatic cancer.