Objectives To systemically review and investigate the efficacy of intensive glucose control in Type 2 diabetes mellitus. Methods Database searches of MEDLINE, EMBASE, Cochrane Controlled Trials Register, VIP Database, CNKI, and CBM disc (from the date of establishment of the databases to June 2009) were conducted. Additional studies were retrieved via references of articles and direct contact with the authors to retrieve relevant data. Prospective, randomized controlled trials of intensive glucose control compared with standard therapy in diabetic patients were selected. We accessed the quality of included trials and extracted the relevant data. Statistical analysis was performed using The Cochrane Collaboration’s software RevMan 5.0. Results Eight trials with a total of 37 004 participants were included. The Meta-analysis showed: intensive glucose therapy was associated with a significant 9% reduction in the odds of cardiovascular events [OR=0.91, 95%CI (0.85, 0.98), P=0.007], and a 26% reduction in the microvascular events [OR=0.74, 95%CI (0.60, 0.91), P=0.005]. For the peripheral vascular events, no statistical difference was found between intensive therapy and standard therapy [OR=0.94, 95%CI (0.83, 1.07), P=0.35]. No statistical difference could be found in total mortality [OR=1.00, 95%CI (0.92, 1.08), P=0.98] and cardiovascular mortality [OR=1.03, 95%CI (0.83, 1.28), P=0.77]. Intensive therapy could increase more than 1.1-fold odds of hypoglycemia compared with standard-therapy [OR=2.12, 95%CI (1.24, 3.60), P=0.006]. Conclusions Findings from this meta-analysis suggest that intensive glucose control significantly reduces the risk of cardiovascular events and microvascular events, and increases the risk of hypoglycemia, while no prominent difference is found in mortality.
Ciliary body tumor is a rare intraocular tumor. Due to its unique anatomical location, its correct diagnosis and reasonable treatment are very difficult problems. In terms of diagnosis and differential diagnosis, ophthalmologists need to fully utilize the role of slit lamp microscope and transillumination experiment to capture secondary changes in the anterior segment caused by hidden ciliary body tumors, such as monocular localized cataract, lens indentation, and pigment dissemination, etc. Ophthalmological imaging methods, especially ultrasound biomicroscopy, can achieve the purpose of early detection and early diagnosis. According to the size, location and morphological characteristics of the tumor, a reasonable treatment plan is formulated. Since ciliary body tumors are mostly benign, the recurrence rate of local resection is low, which can satisfy the pathological diagnosis and preserve part of the patient's vision. Therefore, eye-preserving treatment should be advocated. However, enucleation remains the treatment of choice for tumors that are too large to be treated with local excision or radiation, eyes with refractory glaucoma, and tumors that do not respond to radiation therapy.
Objective To study the clinical significance of gasdermin-D（GSDMD) and caspase-1 expressions in the invasive ductal breast carcinoma. Methods Seventy-seven female patients with invasive ductal carcinoma of breast performed radical resection in the 904th Hospital of Joint Logistic Support Force of PLA from January 2015 to June 2016 were selected as the research object. The expressions of GSDMD and caspase-1 protein in cancer tissues and 20 adjacent tissues were detected by immunohistochemistry, and their correlation with clinicopathological features was analyzed. Kaplan-Meier analysis was used to draw the survival curve, and log-rank test was used for univariate survival analysis, and Cox proportional hazards regression analysis of prognostic factors in patients with breast invasive ductal carcinoma. Results The proportion of high expression of GSDMD and caspase-1 protein in adjacent tissues were significantly higher than those in breast cancer tissues (P<0.05). Univariate analysis results showed that the survival time of patients with invasive ductal carcinoma of breast were correlated with lymphatic metastasis, TNM staging, and the expression status of progesterone receptor, GSDMD, caspase-1 and Ki-67 (P<0.05). Multivariate analysis results showed that the low expression of GSDMD protein [HR=4.096, 95%CI (1.102, 15.216), P<0.05] and low expression of caspase-1 protein [HR=3.945, 95%CI (1.062, 14.652), P<0.05] were the independent risk factor that affect the survival rate of patients with invasive ductal carcinoma of breast. Conclusion The low expression of GSDMD and caspase-1 protein in invasive ductal carcinoma of breast are independent risk factors for postoperative survival.
Objective To systemically review the effectiveness and safety of human recombinant activated protein C (rhAPC) for severe sepsis. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, VIP, CNKI and CBM were electronically searched for comprehensively collecting randomized controlled trials (RCTs) on the effectiveness and safety of human recombinant activated protein C (rhAPC) for severe sepsis from inception to July 2012. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results Totally, five RCTs involving 6 307 patients were included. The results of meta-analysis showed that, no significant difference was found in 28-day mortality (RR=1.00, 95%CI 0.84 to 1.19, P=1.00) and 90-day mortality (RR=1.00, 95%CI 0.87 to 1.14, P=0.96) between the rhAPC group and the placebo group. The results of subgroup analysis showed that, the two groups were similar in the 28-day mortality of patients with different Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (APACHE II scorelt;25: RR=1.06, 95%CI 0.93 to 1.21, P=0.37; APACHE II score≥25: RR=0.93, 95%CI 0.69 to 1.24, P=0.60), and in the 28-day mortality by protein C deficiency class (APC deficiencylt;80%: RR=0.96, 95%CI 0.56 to 1.65, P=0.89; APC deficiencygt;80%: RR=0.61, 95%CI 0.34 to 1.08, P=0.09). Besides, bleeding risk in the rhAPC group was 1.62 fold more than that in the placebo group (RR=1.62, 95%CI 1.17 to 2.23, P=0.004). No significant difference was found in the incidence of adverse reaction (RR=1.04, 95%CI 0.92 to 1.18, P=0.53). Conclusion Current evidence suggests that, rhAPC could not improve the prognosis of patients with severe sepsis, but it significantly increases bleeding risk.
Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C3F8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. MethodsA retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference (P＞0.05). PPV combined with ILM peeling and C3F8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. ResultsAfter initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation (P＞0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month (P=0.783, 0.358), but the difference was statistically significant at 3 months (P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation (P=0.687, 0.950). ConclusionPPV combined with ILM peeling and C3F8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
In order to improve the motion fluency and coordination of lower extremity exoskeleton robots and wearers, a pace recognition method of exoskeleton wearer is proposed base on inertial sensors. Firstly, the triaxial acceleration and triaxial angular velocity signals at the thigh and calf were collected by inertial sensors. Then the signal segment of 0.5 seconds before the current time was extracted by the time window method. And the Fourier transform coefficients in the frequency domain signal were used as eigenvalues. Then the support vector machine (SVM) and hidden Markov model (HMM) were combined as a classification model, which was trained and tested for pace recognition. Finally, the pace change rule and the human-machine interaction force were combined in this model and the current pace was predicted by the model. The experimental results showed that the pace intention of the lower extremity exoskeleton wearer could be effectively identified by the method proposed in this article. And the recognition rate of the seven pace patterns could reach 92.14%. It provides a new way for the smooth control of the exoskeleton.
ObjectiveTo study the nursing methods for patients after transcatheter aortic valve implantation (TAVI). MethodsFrom April 2012 to August 2013, 25 patients undergoing TAVI before returning to the coronary care unit (CCU) were included in this study. We reviewed the clinical nursing methods and summarized the clinical nursing experiences. ResultsAmong the 25 patients, there were 1 case complicated with retroperitoneal hematoma, 1 case with hemorrhage of upper digestive tract, 1 case with severe hemorrhage of femoral artery incision site, 1 case with mild hemorrhage of femoral artery puncture site, 1 case with catheter-related infections of right external jugular vein, and 2 cases with hemorrhage related to the loosening of radial artery invasive blood pressure monitoring. All the complications were controlled by reasonable treatments and all the patients were transferred out from CCU with stable vital signs. The mean time of CCU stay was 29 hours ranging from 14 hours to 243 hours. ConclusionDue to special characteristics of patients after TAVI, we should observe carefully, follow the nursing operation rules strictly, discover complications timely, give treatment correctly, and finally ensure the safety of patients during the high risk period.