Objective: Sites for subcutaneous insulin injections include the upper arms, abdomen, buttocks and outer sides of the thigh. No similar study has explored the feasibility of using the inner side of the thigh for insulin injection, since the 4mm pen needles were introduced for clinical use. This study aimed to determine whether the inner side of the thigh is suitable for insulin injection.Research design and methods: Seventy-five patients with diabetes under insulin therapy from the Inpatient Department of Endocrinology were recruited for this non-blinded, non-randomized observational study. Subcutaneous adipose layer thicknesses of the upper, middle and lower area of the inner and outer thighs of 35 patients were measured by ultrasound, distance from the skin surface to the femoral deep vessels in 20 patients was measured, and insulin was injected at the upper inner and outer sides of the thigh in 20 patients. Pain perception, bleeding or bruising, leakage at the injection sites, blood glucose changes after insulin injection, and preferred ratings of the patients were measured.Clinical trial registration: ClinicalTrials.gov NCT02307968.Results: Subcutaneous adipose layer thicknesses at both the upper inner and outer thighs were more than 4mm and the minimum distance was 10 mm. Among the 100 injections at the upper inner thigh, only three incidents of perceived pain occurred. No bleeding or bruising and leakage were observed from the inner or outer sides. Furthermore, the difference in blood glucose control between insulin injections at the inner side and outer sides was not statistically significant. Patient ratings for injections at the inner side were similar to injections at the outer side. The key limitation of this study was the small sample size of adult patients as well as the non-randomized controlled design of this study.Conclusion: The upper inner thigh might be a new option for insulin injection rotation.

BackgroundRecent reports have characterized virological and clinical features of the novel reassortant avian-origin influenza A (H7N9) virus. However, cardiovascular involvement during H7N9 infection is still unclear. In this study, we evaluate cardiac injury among H7N9-infected patients.Materials and MethodsA total of 40 patients who were laboratory-confirmed with H7N9 infection were retrospectively included and grouped by Acute Physiology and Chronic Health Evaluation II (APACHE II) score into four subgroups I(0-10), II(11-20), III(21-30) and IV(31-71). Cardiovascular complications and markers of cardiac injury including creatinine kinase (CK), CK iso-enzyme (CK-MB), cardiac troponin I (cTNI) and brain natriuretic peptide (BNP) were assessed. Electrocardiogram (ECG) and echocardiography (ECHO) were also performed.ResultsHalf of patients manifested with cardiovascular complications, with hypotension (475%) and heart failure (400%) the most prevalent. CK, CK-MB and cTNI showed marked increase with H7N9 virus infection but significantly decreased after H7N9 viral tests turned negative. More than half of patients presented with an abnormal ECG, but most of them are benign changes. ECHO examination showed different degree of impairment of cardiac function. Pulmonary artery systolic pressure was increased in all groups. Cardiac damage was more evident in patients with higher APACHE II score.ConclusionsH7N9 virus exerts a transient impairment on the cardiovascular system. Patients with a higher APACHE II score are more susceptible to cardiac damage.

OBJECTIVE:To evaluate the application of contrast-enhanced ultrasonography (CEUS) in diagnosis of inflammatory pseudotumor of liver (IPL).METHODS:The contrast-enhanced untrasonography was performed in 32 cases of IPL and the results were retrospectively analyzed.RESULT:Among total 32 cases, 21 had absent contrast enhancement (type I); 6 had rimlike or stringlike enhancement during arterial phase and presented hypoechoic lesions during the late phase (type II); 2 had diffuse and homogeneous enhancement during early arterial phase,persisting hyperechoic during the late phase (type III); 3 had enhancement during arterial phases and washed out more quickly than liver parenchymal (type IV).CONCLUSION:The perfusion pattern of IPL with CEUS varies, the predominant type is no contrast enhancement; type IV may be confused with atypical hepatic carcinoma, in that case the needle biopsy is necessary.

Objective To evaluate the safety, feasibility and clinical value of real-time navigation system with CT/MR and sonographic images for percutaneous ablation of hepatic malignancies poorly defined on conventional ultrasonography. Methods Fifteen patients with 22 hepatic malignant lesions underwent percutaneous ablation guided by virtual navigation system with ultrasonography. Treatment response was assessed by the contrast CT/MR followed up one month after procedures. Results Complete tumor necrosis was achieved in 20 lesions, but 2 lesions showed residual tumor in the ablation zone. No treatment associated complications were found. Conclusions The application of virtual navigation system is of clinical value in localization of lesions, guidance of biopsy and assessment of the interventional therapy in patient with hepatic malignancies, particularly for those with poorly identified lesions by conventional ultrasonography.

Objective To study the clinical features and postoperative complications for gastric carcinoma in the patients older than 65 years. Methods From January 2005 to January 2007, 65 elderly gastric carcinoma cases underwent surgical resection, the age related preoperative and postoperative complications were analyzed. Result The incidence of preoperative complications in elderly gastriccarc inoma patients is 83%, compared with younger group of 59%; Preoperatively, 52% elderly cases presented with two or more complications. The incidence of hypertension was the highest (40%), the radical curative rate for the elderly group was 86% as compared with younger group of 93%. The postoperative complications in elderly group was 37%. In elderly cases, postoperative complications were common in those suffering from preoperative complications such as hypertension, diabetes, respiratory diseases, anaemia, hypoalbuminemia. Conclusion The age itself is not a single influential factors indicating postoperative complications. There was no significant difference in the morbidity and mortality between elderly and younger gastric carcinoma cases undergoing a surgery.

OBJECTIVE:To investigate the effects of vascular endothelial growth factor (VEGF) antisense oligodeoxynucleotide (ASODN) on the mRNA and protein expression of VEGF, Flt-1, and kinase insert domain containing receptor (KDR) and VEGF excretion in human gallbladder carcinoma cells.METHODS:Human gallbladder carcinoma cells of the line GBC-SD were cultured and transfected with VEGF ASODN and sense oligodeoxynucleotide (SODN) mediated by Oligofectamine. The toxicity of SODN and Oligofectamine to the GBC-SD cells was examined by MTT method. RT-PCR was used to detect the mRNA and expression of VEGF, Flt-1, and KDR, and ELISA was used to detect the protein expression of VEGF.RESULTS:MTT method showed that SODN and Oligofectamine were not toxic to the GBC-SD cells. The mRNA expression levels of VEGF, Flt-1, and KDR of the ASODN and ASODN + Oligofectamine groups were all significantly lower than those of the control group (all P < 0.05), and were the lowest 72 hours after transfection, and then gradually increased. ELISA showed that there were not significant differences in the VEGF protein concentration in the supernatant of the GBC-SD cells among the SODN, SODN + Oligofectamine, and control groups (all P < 0.05), however, the VEGF protein concentration in the supernatant of the GBC-SD cells of the ASDN and ASDN + Oligofectamine groups were significantly lower than that of the control group (both P < 0.05).CONCLUSION:VEGF ASODN inhibits the mRNA and protein expression of VEGF, Flt-1, and KDR and VEGF excretion in human gallbladder carcinoma cells. Oligofectamine strengthens the effect of ASODN.