Differing clinical phenotype for higher alanine-aminotransferase (ALT) compared with high-risk NAFLD fibrosis score in type 2 diabetes mellitus

Aims

The impact of non-alcoholic fatty liver disease (NAFLD) presence and severity on the diabetes phenotype remains unclear. Our study aimed to explore and contrast the phenotypes associated with higher ALT and high-risk NAFLD fibrosis score (NFS) in type 2 diabetes.

Spatial and temporal differences of HMGB1 expression in the pancreas of rats with acute pancreatitis

We aimed to investigate the spatial and temporal differences in expression between HMGB1 and early-stage inflammatory cytokines (IL-1, IL-6 and TNF-α) in pancreas tissue in rats with acute pancreatitis. SD rats (BW 350 ± 30 g, n = 48) were randomly divided into the experimental group (n = 36) which were injected with 5% sodium taurocholate into the bilipancreatic duct retrogradely to produce acute necrotic pancreatitis (ANP) rat models, and the sham-operated (SO) group (n = 12) injected with equal dose of saline. The rats were sacrificed at different time points at 0 h, 3 h, 6 h, 12 h, and 24 h post modeling, respectively. The peripheral blood amylase and different inflammatory factors in ANP rats at different time points were detected by ELISA, and the expression of HMGB1 in the pancreatic tissue was detected by immunohistochemistry, Western blot and Q-PCR methods. Results showed that the serum amylase in the ANP model rats was significantly higher than the sham-operated group (P < 0.05). The early inflammatory factors (IL-1, TNF-α and IL-6) increased quickly at 3 h after the model induction, reached the peak level at 6 h (higher than SO group, P < 0.05), then decreased at 12 h, and at 24 h the levels were lower than those at 12 h (P < 0.05). The HMGB1 level in the pancreatitis tissue did not change significantly at 3 h and 6 h (P > 0.05), however, it increased remarkably at 12 h, and maintained up to 24 h (P > 0.05). As a late inflammatory factor, the expression of HMGB1 in acute pancreatitis was obviously later than the early inflammatory factors IL-1, TNF-α and IL-6. HMGB1 may play a key role in maintaining the development of the acute pancreatitis.     

81例肋骨骨折切开复位内固定手术疗效分析

目的：探讨肋骨骨折切开复位内固定手术治疗的疗效。方法观察2012年4月至2014年4月行肋骨骨折切开复位内固定手术治疗的81例患者作为手术组,选择同期行保守治疗的37例肋骨骨折患者作为保守组比较,观察2组患者入院后疼痛评分变化趋势及相关临床指标的变化。结果手术组81例手术均顺利,术后恢复良好。术后疼痛评分、呼吸频率明显降低( P=0.000),氧饱和度明显升高(P=0.002),咳痰困难、呼吸困难及活动困难的比例明显降低(P<0.05)。手术组疼痛评分在入院第4天之后即手术高峰时段之后明显下降,而保守组疼痛评分总体下降缓慢。2组平均住院时间差异无统计学意义(P=0.084)。结论对于有明确手术指征的肋骨骨折行切开复位内固定手术治疗,其疗效迅速、显著;病程第4天为手术的最佳时机。     

早期胃癌规范化诊治流程及预后因素

胃癌依然是世界范围内最常见的癌症之一。近些年,在日本,早期胃癌(early gastric cancer,EGC)约占胃癌治疗患者的57%,而在中国,该比例却不足10%。包括内镜粘膜下剥离术(endoscopic submucosal dissection,ESD)和内镜下粘膜切除术(endoscopic mucosal resection,EMR)在内的微创手术,对于EGC患者而言是治愈性的治疗,而且患者会获得很好的预后。对于EGC而言,规范化诊治流程非常重要。首先,内镜、超声内镜及组织学检查是筛选微创手术患者的关键步骤。第二,仔细评估微创手术标本可以为将来可能的外科干预提供重要信息,这些信息包括脉管瘤栓、肿瘤体积、组织学类型、浸润深度。此外,淋巴细胞浸润情况,淋巴管侵犯、HER2/neu、Mucin-4、VEGF C、VEGF D过表达是EGC的预后因素。     

早期肠内营养支持治疗对重症脑出血患者免疫功能和预后指标的影响

目的:探讨早期肠内营养(early enteral nutrition,EEN)治疗对重症脑出血患者免疫功能和预后指标的影响.方法:随机将173例重症脑出血伴吞咽障碍患者分为对照组(n=77)和EEN组(n=96),入院后12~48 h分别给普通鼻饲饮食和予肠内营养(EN).两组患者于入院第2和第14天后采用美国国立卫生院神经功能缺损量表(National Institutes of Health Stroke Scale,NIHSS)进行功能评分,并观察两组患者营养指标及免疫球蛋白(IgA、IgG、IgM),淋巴细胞计数(LYM)和细胞因子CD4+、CD8+、CD4+/CD8+值,并且比较两组患者预后并发症的发生情况.结果:入院14 d后,EEN组患者NIHSS评分显著低于对照组(P<0.05);两组患者入院后第2天各项营养指标无显著差异,第14天对照组TP、Alb、PA和Hb指标较第2天显著降低(P<0.05),EEN组患者的TP、Alb、PA和Hb均明显高于对照组,差异具有统计学意义(P<0.05);EEN组患者IgA、IgM、CD4+显著升高,LYM和CD4+/CD8+升高,IgG接近术前水平,CD8+降低;EN组患者并发症低于对照组组,但无统计学差异(P>0.05).结论:早期肠内营养支持治疗可以改善重症脑出血患者的神经功能、免疫功能、身体营养状态.     

早期康复护理对高血压脑出血颅内血肿清除术患者的并发症及生活能力的影响

目的：探讨早期康复护理措施对高血压脑出血颅内血肿清除术患者的应用效果。方法：回顾性分析我院2010年3月~2014年3月收治的120例高血压脑出血颅内血肿术患者临床资料,其中,自2010年3月~2012年3月收治的60例患者采用了常规护理措施,记为对照组;自2012年4月至2014年3月收治的60例患者则采取了早期康复护理措施,记为观察组。比较两组患者的护理效果。结果：护理干预后,观察组患者的MBI、ESS及GCS评分均较对照组患者出现了明显改善,组间差异具有统计学意义,观察组患者术后并发症的发生率明显低于对照组患者,组间差异具有统计学意义。结论：早期康复护理措施对高血压脑出血颅内血肿清除术患者具有十分重要的意义,可有效改善患者的神经功能,促进患者日常生活能力的改善,从而改善患者的生活质量,促进患者的预后恢复,值得临床参考。     

Osteoinductive factor is a novel biomarker for the diagnosis of early diabetic nephropathy

Background: Microalbuminuria is the earliest clinical sign of diabetic nephropathy (DN). However, earlier markers as a diagnostic tool for DN was required for the invalid of microalbuminuria in some cases. Osteoinductive factor (OIF) was known to be an essential component of the normal vascular matrix. We aimed to research the relationship between DN and OIF, and discussed the availability of the serological markers for earlier stage of DN. Method: One hundred twenty Chinese subjects, who included patients with type 2 diabetes mellitus (T2DM), DN with microalbuminuria, and DN with macroalbuminuria, as well as healthy controls, were enrolled in this study. Serum OIF levels were examined by ELISA and other clinical biochemical parameters were tested based on standard methods. Results: Our results indicated that, serum OIF levels were significantly increased in DN subjects compared with healthy and T2DM subjects (P < 0.05 respectively). However, no significant changes in serum OIF levels were found between T2DM and healthy subjects. Furthermore, serum OIF had negative correlation with estimated glomerular filtration rate (eGFR) and positive correlation with blood urea nitrogen(BUN) and creatinine. ROC curve analysis showed that serum OIF level was a good sensitive and specificity marker for microalbuminuria and early renal damage with sensitivity of 86.7% and specificity of 95%, as well as for macroalbuminuria and damage progress with sensitivity of 90% and specificity of 95%. Conclusion: OIF may be an indicator of the earlier-stage DN in subjects with T2DM. Understanding the exact mechanism of up-regulated OIF in subjects with DN requires further study.