探讨利拉鲁肽联合米格列醇治疗肥胖2型糖尿病患者的疗效.选取2017年6月～2018年5月该院收治的肥胖T2DM患者100例,采用随机数字表法将所有患者分为对照组(50例)和观察组(50例).两组患者均给予糖尿病(Diabetes mellitus,DM)饮食、适量运动及接受DM教育,在此基础上对照组患者给予利拉鲁肽治疗,观察组在对照组基础上加用米格列醇治疗.比较两组临床疗效及不良反应发生情况,同时比较两组治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、血清胆固醇(TC)及三酸甘油脂(TG),体重指数(BMI),胰岛功能指标及血清生长激素释放肽(Ghrelin)和视黄醇结合蛋白(RBP4)水平.与对照组(80％)比较,观察组总有效率(96％)显著升高(P＜o.05).治疗期间观察组和对照组不良反应发生率(8.00％vs12.00％)比较差异无统计学意义(P＞0.05).治疗12周后,观察组BMI、FPG、2hPPG、HbA1c、TC及TG水平均显著低于对照组,观察组INS、CP水平均显著高于对照组,观察组血清Ghrelin水平显著高于对照组,RBP4水平均显著低于对照组(P＜0.05).利拉鲁肽联合米格列醇可有效降低肥胖型T2DM患者体质量、血糖及血脂,改善胰岛素功能,提高血清Ghrelin水平,降低RBP4水平,且安全性可靠.

目的 统计学分析肾动脉与脾动脉阻力指数(RI)以及两者的差值△RI与糖尿病肾病(DN)的相关性,探讨3个参数评估DN的可行性与可靠性.方法 257例DN患者纳入本次研究,测量每位患者的左肾肾动脉RI及脾动脉RI,并计算两者的差值△RI;同时测量颈动脉内膜厚度,收集心率、收缩压及舒张压,计算糖尿病肾病组患者的肾小球滤过率(eGFR).采用Spearman检验计算相关系数,多元线性回归方程分析肾动脉RI、脾动脉RI及△RI的独立预测因子.结果 Spearman检验显示肾动脉RI值和脾动脉RI值与年龄、脉压、颈动脉内膜厚度呈正相关(均P<0.01);与心率、eGFR呈负相关.△RI只与eGFR呈负相关.多元线性回归结果显示:肾动脉RI值与年龄、脉压和eGFR独立相关;脾动脉RI值与年龄、心率及脉压独立相关;△RI与eGFR独立相关,而与颈动脉内膜厚度、年龄、心率和脉压无相关性.结论 肾动脉RI与肾动脉与脾动脉RI差值△RI都可以反映老年人糖尿病肾病损害情况,其中△RI因不与肾外因素相关,可靠性更高.

炎症性肠病(inflammatory bowel disease,IBD)是一种胃肠道慢性炎症性疾病,由多种遗传、免疫和环境因素共同作用引起,是人体免疫系统对消化道常见细菌过度反应的结果.约25％的IBD患者在儿童时期出现,其不仅出现成人IBD中常见的症状,如腹痛、体重减轻和腹泻,而且还有生长衰竭和青春期延迟的高风险[1].其中极早发炎症性肠病(very early onset IBD,VEO-IBD)被定义为发病年龄6岁以下的IBD.

Objective:To explore the effect of feeding via the transpyloric route on the gastrointestinal function in very low birth weight (VLBW) infants and find the best early enteral nutrition protocol.Methods:Sixty VLBW infants were randomly devided into transpyloric feeding group(TP group) (n =30) and intragastric feeding group(IG group) (n =30).The frequency of apnoea,weight gain,the time of birth weight regain,feed intolerance,time of reaching full enteral feeding,the incidence of extrauterus-growth retardation (EUGR),motilin,gastrin,the length of hospital stay,necrotizing enterocolitis and duodenal perforation were observed in two groups.Results:The intolerance and time of reaching full enteral feeding were reduced significantly during transpyloric feeding compared with intragastric feeding (P ＜ 0.05).The number of episodes of apnoea was decreased significantly during transpyloric feeding compared with intragastric feeding (P ＜ 0.01).Conclusion:Transpyloric feeding can be used in VLBW infants.

Objective To study the changes in serum adiponectin level in children with severe sepsis,and to explore its clinical significance.Methods A prospective study was conducted,and 39 cases of critically ill children with severe sepsis and 47 cases of sepsis were enrolled into the Pediatric Intensive Care Unit(PICU),Children's Hospital of Nanjing Medical University from July 2012 to July 2014.Thirty cases of critically ill children without sepsis were enrolled as a control group.The plasma adiponectin,procalcitonin(PCT),and C-reactive protein(CRP)were determined with enzyme linked immunosorbent assay(ELISA)within 24 hours after PICU admission.The pediatric critical illness score(PCIS)was recorded.Results Among severe sepsis group,sepsis group and control group,there was no statistical significance in body temperature,heart rate,body mass index,PCIS,white blood cell count,platelet count,bilirubin,creatinine,pH value and activated partial thromboplastin time(APTT)(all P>0.05).Plasma adiponectin in the severe sepsis group[(0.102±0.041)mg/L] significantly decreased compared with that in the sepsis group[(0.125±0.046)mg/L] and the control group[(0.147±0.047)mg/L](F=8.456,P=0.000).The level of CRP in the severe sepsis group[(60.68±59.43)mg/L] significantly increased compared with that in the sepsis group[(52.76±26.67)mg/L] and the control group[(33.89±6.87)mg/L](F=17.416,P=0.000).There was a statistical significance in PCT level in the severe sepsis group,the sepsis group and the control group(x2=27.269,P=0.000).Further comparison showed that there was a significant difference in PCT level between the severe sepsis group and the sepsis group(Z=-4.679,P=0.000),which was also statistically significant between the severe sepsis group and the control group(Z=-4.244,P=0.000);there was no significant difference between the sepsis group and the control group(Z=-0.340,P=0.733).Negative correlation was found between plasma adiponectin and CRP(r=-0.219,P=0.042),PCT(r=-0.303,P=0.005).The correlation between plasma adiponectin and PCIS was positively correlated(r=0.332,P=0.002).Conclusions Plasma adiponectin decreased in severe sepsis children and was significantly associated with the severity of the disease.Detection of plasma adiponectin levels in children with sepsis has an important clinical significance in evaluating the severity of sepsis.Plasma adiponectin is negatively correlated with CRP and PCT,and plays a role in diagnosis of infection.

目的:探讨乳腺癌超声及超声造影表现特征与生物学预后因子之间的相关性.方法:对239例乳腺癌患者术前行超声及超声造影检查,术后免疫组化法观察肿瘤组织ER、PR、HER2以及Ki-67的表达情况,采用Spearman等级相关和二元Logistic回归方法分析上述指标阳性表达与超声及超声造影表现的相关性.结果:肿块边缘、钙化、周边回声晕、肿块形态及超声造影增强方式与ER、PR、HER2及Ki-67的相关性无统计学意义(P＞0.05).乳腺癌后方回声衰减是ER阳性表达的预测因素;乳腺癌直径≥2 cm是HER2、Ki-67表达阳性的预测因素.乳腺癌超声造影表现为早增强、慢消退是HER2表达阳性的预测因素.结论:乳腺癌超声及超声造影表现与乳腺癌预后因子之间存在一定相关性.

Objective To evaluate the efficacy of the combined therapy of ReDuNing injection and acyclo-vir on children with infectious mononueleosis(IM). Methods From October 2012 to July 2015 in the emergency ward of Children′s Hospital of Nanjing Medical University ,167 cases diagnosised with infectious mononucleosis were enrolled in this study. Ninety-five cases received acyclovir treatment were recruited in the conventional treat-ment group,72 cases received the combined thrapy of ReDuNing injection and acyclovir of children were recruited in the observation group. The clinical symptoms ,clinical manifestation and blood routine ,liver and kidney func-tion,myocardial enzymes,temperature recovery time,reduce lymph node,liver function recovery time and hospi-talization time of patients were recorded and compared between the two groups. Results No significant differences were observed in the clinical course and general fever,pharyngitis,lymphadenopathy,hepatosplenomegaly,rash and eyelid edema in children of the observation group (ReDuNing + Acyclovir) and routine treatment group (Acyclovir). No significant differences were found in blood routine ,blood biochemical indexes of liver ,kidney function and myocardial enzymes in patients of the two groups before and after treatment. The white blood cells , ALT and LDH were significantly reduced in patients of the two groups after treatment(P<0.05). However,LDH was still high in patients of the two groups before discharge ,with the level of(355.63 ± 116.89)U/L and(347.79 ± 106.74)U/L,respectively. The pyretolysis time(2.97 ± 2.56)d,lymph node reduced time(9.08 ± 1.54)d,liver function recovery time(8.67 ± 2.35)d,white blood cell recovery time(6.76 ± 2.96)d,hospitalization time (11.10 ± 3)d in the observation group were significantly shortened than those in the conventional treatment group ((4.38 ± 2.70)d,(10.48 ± 3.62)d,(11.50 ± 3.71)d,(9.15 ± 3.24)d,12.32 ± 3.62)d,respectively)(P<0.05, respectively). Conclusions The fever,lymphadenopathy,leukocytosis,liver damage and LDH were relieved and reduced at different degrees in patients of both the observation group and the routine treatment group after treat-ments. Reduning combined with acyclovir treatments lead to better clinical efficacy in children ,with shortening the duration of fever,Lymph node reduction time,and white blood cell recovery time. In particularly,the combined therapy can shorten the recovery time of patients with liver function damage ,which is a safe clinical application and can be used as one of the effective treatment measures for children with infectious mononucleosis.

目的:使用三维超声评估乳腺癌的肿瘤体积倍增时间(tumour volume doubling time,TVDT),分析TVDT与病理学指标的相关性.方法:69例至少有2次三维超声检查(间隔至少3个月)的乳腺癌病人纳入研究.根据公式计算出TVDT,并与病理学指标进行统计学分析.结果:本组TVDT平均天数为(185±126)d(66～521 d,中位天数164 d).乳腺癌患者不同年龄、月经状态、病理类型、淋巴结转移情况、组织学分级、诺丁汉预后指数(Nottingham prognostic index,NPI)及HER-2的患者TVDT差异无统计学意义(P＞0.05).不同乳腺癌家族史、ER、PR、Ki-67及乳腺癌分子亚型的乳腺癌患者TVDT差异有统计学意义(P＜0.05).乳腺癌分子亚型中ER阳性组TVDT为(234±156)d,HER-2过表达组为(184±71)d,三阴性组为(127±48)d.结论:乳腺癌TVDT与乳腺癌预后分子病理学标志物ER、PR、Ki-67及分子亚型有关,其中三阴性乳腺癌生长最快.

Objectives To observe the performance of renal cell carcinoma with contrast-cnhanced ultrasound(CEUS) ,and to assess clinical application value of CEUS.Methods 106 RCC patients underwent conventional ultrasonography and CEUS were analyzed retrospectively.The visualization rate of pseudocapsule of the tumors were compared between the two methods.Results Final diagnosis results were as follows:renal cell carcinomas 98, Multilocular cystic renal cell carcinomas 3, papillary renal cell carcinomas 5.Pseudocapsule was detected in 29 cases (27.3％) with conventional ultrasound and in 80 cases (75.4％) with CEUS, which was a significant difference (P ＜ 0.01).The pseudocapsule in 26 cases was not visible with either conventional or CEUS.Conclusions CEUS is more effective in the detection of pseudocapsule than conventional ultrasound and may be vital useful in diagnosis of renal cell carcinoma.

目的:观察降钙素原(procalcitonin,PCT)在小儿重症感染中的变化,评价其诊断价值及与病情危重程度的关系.方法:观察PCT在小儿全身细菌感染、局部细菌感染、病毒感染及无感染患儿中的变化情况.依据小儿危重病评分法,观察病情危重程度和PCT的相关性.结果:PCT作为细菌感染指标,在比较全身和局部细菌感染时有统计学意义.PCT在全身性细菌感染组中,与病情危重程度存在相关性.但在局部细菌感染组、病毒感染及无感染组中差异未见显著性.结论:PCT可有效地区分全身或局部细菌感染.而且PCT在全身性细菌感染性疾病中与病情危重程度存在相关性.

目的 探讨微波热消融治疗H22小鼠肝癌细胞移植荷瘤小鼠后活化的淋巴细胞,过继免疫给另一组同源荷瘤小鼠,体外观察其抗肿瘤效应.方法 成年健康C57BL/6J近交系荷瘤小鼠90只,雌雄不限,7～8周龄,体质量20～25g.取60只,随机分治疗组(n=20)、假照组(n=20)和正常对照组(n=20);在H22小鼠肝癌细胞移植术后7d,治疗组接受微波热消融治疗,假照组不启用微波热消融,正常对照组不做任何处理;治疗后10d,分离2组荷瘤小鼠和正常对照组荷瘤小鼠脾淋巴细胞.另选30只C57BL/6J荷瘤小鼠,随机分为过继免疫治疗组(n=10)、过继免疫假照组(n=10)和过继免疫对照组(n=10),前2组用H22小鼠肝癌细胞移植造模.7d后,3组分别经鼠尾静脉注射之前提取的淋巴细胞.输注7d后将肿瘤病灶制成单细胞悬液,测定肿瘤局部淋巴细胞的功能变化.结果 与假照组和正常对照组比较,治疗组对H22小鼠肝癌细胞杀伤活性明显增加,差异有显著统计学意义(P＜0.01).淋巴细胞过继免疫治疗后7d,与过继免疫假照组和过继免疫对照组比较,过继免疫治疗组分泌的淋巴细胞数量明显增多,差异有显著统计学意义(P＜0.01).结论 微波热消融治疗H2小鼠肝癌细胞移植后,活化的淋巴细胞在同种来源肿瘤发挥特异性的抗肿瘤效应.

目的 检测胎粪吸入综合征(MAS)患儿血清前白蛋白(PA)、白细胞介素-8(IL-8)的变化,以了解MAS早期炎症反应.方法 对2010年8月至2013年10月在南京医科大学附属儿童医院新生儿医疗中心住院的35例MAS患儿行血清PA、IL-8检测,并与对照组分析比较,PA测定采用免疫比浊法,IL-8测定用ELISA法.结果 MAS患儿PA水平(96.74±9.14) mg/L低于对照组(107.31±15.59) mg/L,IL-8水平(19.29±4.28) pg/mL高于对照组(11.28±1.67)pg/mL,差异均具有统计学意义(t值分别为3.41和9.76,均P＜0.01).结论 MAS患儿早期有明显炎症反应,PA、IL-8可以作为MAS患儿早期炎症反应的敏感监测指标.

目的：探讨遗传型甲状腺髓样癌（hereditary medullary thyroid carcinoma，HMTC）和散发型甲状腺髓样癌（sporadic medullary thyroid carcinoma，SMTC）超声图像的异同。方法：回顾分析48例甲状腺髓样癌患者，其中37例SMTC，11例HMTC，比较二者的声像图特征及相关生化检测。结果：SMTC和HMTC在声像图上有所异同，二者除外大部分病灶位于甲状腺中上部2／3处，纵横比≤1，边界清楚，周边无声晕，呈实性为主的低回声、内见粗大钙化伴后方声影，或簇状密集分布的粗、微钙化，周边及内部血流丰富等共同征象外，HMTC有别于SMTC的声像图表现主要是：（1）HMTC常累及双侧，病灶长径大。（2）HMTC病灶内更易出现粗大钙化灶。（3）HMTC常见增生的甲状旁腺。术前降钙素水平HMTC组要明显低于SMTC组。HMTC组尿儿茶酚胺及甲状旁腺激素水平异常的比例要明显高于SMTC组。结论：SMTC和HMTC 在声像图上的异同及相关生化检测有助于二者的鉴别诊断。

<正>1病例资料患儿,孙某某,男,4岁6个月,江苏泗洪人,因"误服百草枯8h"于2012年5月28日入院。2012年5月27日20:00,患儿误服百草枯约7mL,20min后在当地卫生院洗胃,并予维生素C及法莫替丁等治疗;28日4:55,收入本院PICU。病程中患儿无抽搐、呕血、

Objective:To investigate the incidence of aspirin and clopidogrel resistance in patients with coronary artery disease received percutaneous coronary intervention(PCI),and provide evidence for the individualized anti-platelet treatment.Methods:Two hundreds patients with defined coronary artery disease who have received PCI were recruited in this study.Platelet aggregations(PLAA and PLADP) 1 mmol/L arachidonic acid(AA) and 5 μmol/L adenosine diphosphate(ADP) were determined using the light transmission aggregometer(LTA).Aspirin and clopidogrel resistance were defined as PLAA >20% and PLADP >40%,respectively.Results:None of the patients was resistant to aspirin in the recruited subjects;the mean PLAA of the recruited patients was(2.63 ± 2.40)%.Forty four patients(22.0%) were resistant to clopidogrel,and the mean PLADP of the non-responders was(47.16 ± 5.82)%;by contrast,156 patients(78.0%) were sensitive to clopidogrel,and the mean PLADP of the responders was(25.62 ± 8.71)%.Conclusion:Aspirin resistance is rare,while clopidogrel resistance is much common in patients with coronary artery disease,which suggests that individualized anti-platelet treatment should be initiated targeting patients with clopidogrel resistance.

<正>患儿女,17岁,无明显诱因出现发热、头痛、恶心、呕吐,自测体温最高39.8℃,当地医院给予退烧止吐对症处理,无明显疗效。CT示右侧肾上腺占位性病变。我院常规超声:右肾上腺区见实性低回声团,约51mm×38mm,边界清晰,形态规则,包膜完整;CDFI示肿物周边可见血流信号(图1)。CEUS:瘤体

Objective To study the correlation between contrast-enhanced ultrasound (CEUS) features and Nottingham prognostic index (NPI) in patients with breast carcinoma. Methods The ultrasound features and microvascular imaging manifestation of 91 breast carcinomas confirmed by pathology were retrospectively analyzed.NPI was typically stratified into 3 major groups:NPI ＜ 3.4 ( n =19 ), NPI:3.4-5.4 ( n =52 ) and NPI ＞5.4(n =21 ). Results With the increase of NPI, the rate of heterogeneous enhancement, perfusion defects, edge enhancement higher than center enhancement, and unclear border increased.The difference among the 3 groups had statistical significance (P ＜ 0.05 ).There was no significant difference in enhancement order among the 3 groups ( P ＞ 0.05 ).The lesions of the 3 groups were mainly “high enhancement” and there was no significant difference among the 3 groups ( P ＞ 0.05 ).With the increase of NPI, the rate of early enhancement and late regression increased.The difference among the 3 groups had statistical significance ( P ＜ 0.05 ).With the increase of NPI, the rate of enlarged and twisted vessels as well as peripheral vessel burr increased.There was significant difference among the 3 groups ( P ＜ 0.05 ).Conclusion CEUS festures and microvescular architecture pattern of breast carcinoma are related to NPI, which is useful in predicating the prognosis of breast carcinoma.

目的:探讨经直肠超声造影(CEUS)和磁共振成像(MRI诊断前列腺癌(PCa)有关问题,评价二者的诊断价值.方法:选取有完整相关临床资料的患者48例,对患者行前列腺超声造影及MRI检查,并与病理检查结果进行比较.结果:48例患者经病理检查证实为PCa 30例.经直肠CEUS诊断符合率为77.08％,敏感性为80.00％,与MRI的符合率(79.16％)、敏感性(76.67％)比较,差异无统计学意义(P＞0.05),但其特异性(72.22％)低于MRI的特异性(83.33％),差异有统计学意义(P＜0.05).二者联合诊断的符合率为89.58％,敏感性为90.oo％,特异性为88.89％,与单独一种诊断比较,差异均有统计学意义(P＜0.05).结论:经直肠CEUS及MRI对PCa的诊断各有优势,经直肠CEUS联合MRI可提高PCa的检出率.

Objective:To understand whether human bocavirus(HBoV) is one of the pathogens leading to the children's respiratory infections in Nanjing.Methods:The patients hospitalized for respiratory tract infections(RTIs) were enrolled in the present study.Nasopharyngeal aspirates(NPAs) were collected from November 2009 to June 2010.HBoV NP1 gene in the samples was determined by polymerase chain reaction(PCR).The amplified positive NP1 fragments were sequenced and alignment with other HBoVs by DNAStar.Phylogenetic trees were drawn with MEGA software.The clinic findings of the children with HBoV infection were collected and analyzed.Results:Of all the 100 NPAs,five positive ones were founded.Among the five positive samples,the sequence homogeneity of the amplified NP1 gene fragment were 99.7%～100.0% at the nucleotide level.As compared with HBoVs from other countries,the homogeneity were 99.4%～100.0%.Among the five patients,the diagnoses were bronchopneumonia,bronchiolitis and bronchitis.Clinic findings included fever,cough,wheezing,etc.The patients were all recovered with conventional therapy.Conclusion:HBoV was one of the pathogens leading to the children's respiratory tract infection in Nanjing.

目的:分析各种含囊性成分的肾脏肿瘤的综合影像学特点,提高诊断和鉴别水平.方法:回顾性分析了29例经病理证实的含囊性成分的肾脏肿瘤的B超、CT和MR表现,观察病灶的部位、形态、密度、回声及信号特点.结果:29例患者中有肾癌囊性变15例(14例为透明细胞癌、1例为乳头状肾癌),表现为病灶内部密度和回声不均匀,增强后不均匀明显强化,6例(40％)病灶周围可见有包膜；囊性肾癌5例(均为透明细胞癌),3例(60％)有明显壁结节,增强后结节明显强化,2例(40％)为多房性,增强后分隔有强化；囊性肾瘤4例,均为多房性,房间隔较薄而均匀,增强后间隔有强化；囊肿伴感染5例,均表现为圆形病灶,形态规则,壁厚而均匀,增强后囊壁轻度强化.各项检查诊断准确率依次为:B超检查(52.6％,10/19),CT检查(62.5％,15/24),MR检查(54.5％,6/11);3项检查诊断准确率之间进行两两比较,均无显著差别(P＞0.05).结论:对含囊性成分的肾脏肿瘤影像学诊断和鉴别较为困难.综合B超、CT和MR的影像学表现,有助于对其术前诊断与鉴别.