Objective To systematically review the prevalence, clinical characteristics, and prognosis of fulminant type 1 diabetes mellitus (F1DM) in China. Methods The CNKI, WanFang Data, CBM and PubMed databases were searched to collect Chinese F1MD case reports from January 1, 2000 to March 30, 2022. Data analysis was performed using Stata 16.0 software and RevMan 5.3 software. Results A total of 874 cases were included in 233 papers, involving 410 males (46.91%) and 464 females (53.09%). The age of onset was 29.32±1.09 years and the course of disease was 3.74±0.63 days. The BMI was 21.18±0.52 kg/m2, HbA1c was 6.58%±0.08%, the level of fasting C-peptide was 0.04±0.010 ng/mL, level of C-peptide 2 h after meal was 0.09±0.020 ng/mL, the level of blood glucose at the doctor’s office was 34.72±2.89 mmol/L, and the level of arterial blood gas pH was 7.09±0.015. Among them, 734 patients had diabetic ketoacidosis (84.55%), 496 patients had infection of the upper respiratory or digestive tract before onset (56.75%), 4 patients died (0.46%), 78 patients were GADA positive, 11 patients were ICA positive, 13 patients were IAA positive, and 109 were pregnant patients (90 fetal deaths, 82.57%). Conclusion Chinese F1DM is a special but common subtype of diabetes. Its characteristics include a relatively young age of onset, devastating islet damage, and rapid progression, and it is often accompanied by severe metabolic disorders, complications, and grim prognosis. Clinicians should pay more attention to F1DM.
ObjectiveTo enhance the cognition about the clinical characteristics of diffuse panbronchiolitis (DPB). MethodsThe data of patients with DPB searched out on the computer from January 1996 to September 2013 were retrospectively studied. ResultsThe 91 patients had a male to female ratio of 2︰1, and the mean age at onset was (40.5± 18.4) years old. The median course of disease was 7 years. The main clinical profiles included chronic cough, sputum production, exertional dyspnea, and crackles. A history of sinusitis occurred in 90.1% (82/91) of the patients. Positive rate of cold hemoagglutinin and HLA-B54 were 46.1% (30/65) and 42.1% (8/19), respectively. All patients' CT scans showed bilateral, diffuse, small centrilobular nodules. Lung function assessment showed an obstructive ventilation disfunction in 60.0% (51/85) of the patients and a mixed obstructive-restrictive pattern in 36.5% (31/85) of the patients. Thirty-four patients underwent lung biopsy. A total of 65.9% (60/91) of the patients had been misdiagnosed, and 98.8% (84/85) of the patients achieved significant improvement after the macrolide therapy. ConclusionDPB is not rare in China, but tends to be misdiagnosed or underdiagnosed. Macrolides can improve the prognosis of DPB.
ObjectiveTo analyze the clinical application and safety of Shenmai injection.MethodsWe collected clinical data of 30 012 patients using Shenmai injection from 26 hospitals nationwide from September, 2009 to June, 2013. The SPSS 15.0 software was used to analyze demographic characteristics, diagnostic information, and clinical application of the injection.ResultsAmong all patients, 14 270 were females (47.55%), 8 218 were aged 45-60 (27.38%), and 10 452 were aged 61-75 (34.83%). The primary use of Shenmai injection was as an adjuvant treatment of chemotherapy for cancer patients, and the top 3 cancers were lung cancer (1 533, 5.11%), breast cancer (1 509, 5.03%) and gastric cancer (847, 2.82%). The second important use of Shenmai injection was the treatment of coronary heart disease (5 703, 19.00%), of which the most common single dose was 50 mL (14 406, 48.00%), followed by 100 mL (10 804, 36.00%) and 200 mL (600, 2.00%). The solvents were used in 18 902 patients (62.98%), and the 5% glucose injection was used most frequently (84.64%). The adverse effects (AEs) rate was 0.15%, and 57.78% AEs occurred within 24 hours of infusion. The most common AEs were damage of the cardiovascular system, followed by damaging of blood system and respiratory system.ConclusionsShenmai injection has a wide range of applications and can be used in treatment of numerous diseases in the real-world, and the AEs have been linked to off-label uses.
ObjectiveTo analyze the clinical and epidemiological characteristics of hospitalized avian influenza A (H7N9) virus infections in Hunan province from 2013 to 2017, and provide evidences for control, diagnosis and treatment of this disease.MethodsNinety-one hospitalized patients were confirmed with H7N9 infection in Hunan. Excluding 2 patients less than 18 years old and 10 with missing data, 79 patients with H7N9 infection were analyzed.ResultsMost confirmed cases were affected in the second and fifth epidemic wave and number of patients in the fifth wave was more than the sum in prior 4 waves. Epidemiological characteristics, clinical symptoms and case fatality did not change significantly. Administration of antiviral drugs was more active in the fifth wave [from illness onset to antiviral drug: (6.3±2.4)d vs. (7.6±2.4)d, P=0.047]. Multiple logistic regression analysis showed that shock (OR=4.683, 95%CI 1.136–19.301, P=0.033) was the independent risk factor of H7N9 infections. There were no significant differences in case fatality among group oseltamivir, group oseltamivir+peramivir, and group peramivir.ConclusionsPatients with avian influenza A (H7N9) increased in the fifth wave but clinical characteristics changed little. Antiviral treatment should be more active. Shock is an independent risk factor of H7N9 infections. Oseltamivir-peramivir biotherapy can not reduce case fatality compared with oseltamivir or peramivir monotherapy.
Objective To analyze the BEST1 gene mutations and clinical features in patients with multifocal vitelliform retinopathy (MVR). Methods This is a retrospective case series study. Five MVR families with MVR, including 9 patients and 10 healthy family members were recruited. Clinical evaluations were performed in all MVR patients and their family members, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), refraction, slit-lamp examination, 90 D preset lens examination, gonioscopy, color fundus photography, optical coherence tomography (OCT), fundus autofluorescence (AF), ultrasound biomicroscopy (UBM) and axial length measurement. Electro-oculogram (EOG) was performed in 12 eyes and visual field were performed in 13 eyes. Peripheral blood samples were collected in all subjects to extract genomic DNA. Coding exons and flanking intronic regions of BEST1 were amplified by polymerase chain reaction and analyzed by Sanger sequencing. Results Among the 5 MVR families, 3 probands from three families had family history, including 1 family had autosomal dominant inheritance pattern. Two patients from 2 families were sporadic cases. Screening of BEST1 gene identified four mutations, including three missense mutations (c.140G>T, p.R47L; c.232A>T, p.I78F; c.698C>T, p.P233L) and 1 deletion mutation (c.910_912del, p.D304del). Two mutations (p.R47L and p.I78F) were novel. The BCVA of affected eyes ranged from hand motion to 1.0. The mean IOP was (30.39±11.86) mmHg (1 mmHg=0.133 kPa). The mean refractive diopter was (-0.33±1.68) D. Twelve eyes had angle-closure glaucoma (ACG) and 4 eyes had angle closure (AC). EOG Arden ratio was below 1.55 in all patients. The mean anterior chamber depth was (2.17±0.29) mm. Visual field showed defects varied from paracentral scotoma to diffuse defects. The mean axial length was (21.87±0.63) mm. All MVR patients had multifocal vitelliform lesions in the posterior poles of retina. ACG eyes demonstrated pale optic disc with increased cup-to-disc ratio. OCT showed retinal edema, extensive serous retinal detachment and subretinal hyper-reflective deposits which had high autofluorescence in AF. The genetic testing and clinical examination were normal in 10 family members. Conclusions MVR patients harbored heterozygous mutation in the BEST1 gene. Two novel mutations (p.R47L and p.I78F) were identified. These patients had clinical features of multifocal vitelliform retinopathy and abnormal EOG. Most patients suffered from AC/ACG.
ObjectiveTo investigate the clinical heterogeneity and auto-immunologic state in patients with diabetic ketosis (DK) or diabetic ketoacidosis (DKA). MethodsDiabetic patients who presented with DK/DKA were recruited from West China Hospital of Sichuan University from January 1, 2000, to December 31, 2008. We analyzed the clinical classification, biochemical profiles, and auto-immunologic state of the patients. ResultsAmong them, 257 (15.0%) patients had type 1 diabetes, while 883 (51.6%) with type 2 diabetes, and 515 (30.1%) could be typed as "atypical diabetes" or "untying diabetes". The average age of hospitalized patients with type 1 diabetes was (31.1±13.5) years, which was significantly lower than that of the type 2 diabetes patients [(58.1±13.2) years] (P＜0.001). The most common contributing factor for DK/DKA was infection, followed by noncompliance with therapy. Glutamic acid decarboxylase antibody positive rate was 4.37% in patients with "atypical diabetes", which was similar with type 2 diabetes group (2.69%, P=0.79), but lower than that of the patients with type 1 diabetes (13.79%, P＜0.001). ConclusionsWe conclude that DK or DKA can occur not only in type 1 diabetic patients but also in patients with type 2 diabetes under infection or stress condition. DK/DKA patients have a high clinical heterogeneity. The auto-immunologic state and β-cell function have significant implications for the diagnosis and classification of diabetes.
ObjectiveTo analyze the clinical characteristics of coronavirus disease 2019 (COVID-19), identify the high-risk factors which promoted the disease progression into severe or critical cases, and provide clinical guidance.MethodsNinety-six cases of clinically diagnosed coronavirus disease 2019 were collected and analyzed from General Hospital of the Yangtse River Shipping from January 20 to February 14, 2020. According to clinical classification, those cases were divided into two groups: mild group, including common and mild cases, and severe group including severe and critical cases.ResultsThere were more than half of patients ages>60 years old and severe or critical illness (61.5%, 56.3%), and obese patients accounts for 45.8%, the complication of hypertension accounts for 52.1%. The average time from onset to hospitalization was (6.1±2.6) days, and the average hospitalization days were (15.7±6.3) days. Compared with the mild group, the number of male patients in the severe group was more (57.4% vs. 35.7%, P<0.05), the numbers of elderly patients were larger (77.8% vs. 40.5%, P<0.01), and more obese peoples (55.6% vs. 33.3%, P<0.05). Cough symptom was more common in clinical presentation in the severe group (81.5% vs. 61.9%, P< 0.05). Patients with the complication of hypertension or diabetes occupied a higher proportion in the severe group, which were 64.8% vs. 35.7% and 35.2% vs. 14.3% (P< 0.05), respectively. And the rate of hypoxemia in admission of the severe group was significantly higher (79.6% vs. 9.5%, P< 0.01).ConclusionsThe cases of ages>60 years old and severe or critical illness in coronavirus disease 2019 occupy a higher proportion, and the complication of hypertension accounts for high proportion. Men, ages>60 years old, obese, coughing symptoms, with hypertension and / or diabetes, hypoxemia upon admission are high risk factors for progression into severe and critical cases.
ObjectiveTo explore the clinical characteristic, operation time, and methods of elderly calculous cholecystitis. MethodsThe data of 386 cases of elderly calculous cholecystitis in our hospital from January 2008 to April 2014 were retrospectivly analyzed. ResultsIn 386 patients, 234 cases were chronic cholecystitis, 152 cases were acute calculous cholecystitis; there were preoperative complications in 174 cases (45.08%); 234 cases of chronic calculous cholecystitis patients underwent elective operation, 35 cases in 152 cases of acute phase underwent operation at 72 h, the remaining 117 cases underwent operation in within 2 weeks of onset. Laparoscopic cholecystectomy (LC) were in 283 cases, including transfer laparotomy operation in 8 cases; underwent conventional open cholecystectomy in 103 cases. Postoperative complications occurred in 49 cases, the complication rate was 12.69%, including incision infection, pulmonary infection, acute urinary retention, urinary tract infection, biliary fistula and so on. Three hundreds and eighty-four cases were cured, 2 cases died, for cholecystolithiasis complicated with severe acute cholangitis, died from multi organ failure in 3 days after operation. ConclusionsThe clinical characteristics of elderly calculous cholecystitis is unique. To strictly grasp the operation indication, selection of operation time, take individual operation method with the disease, and strengthen treatment of perioperative period are the key to improve the cure rate and the operation success rate of elderly cholecystitis.
ObjectiveTo investigate the clinical characteristics and prognosis of cerebral hemorrhage in young and elderly patients, to provide evidences for individual clinical diagnosis and treatment, and lay a foundation for building a predictive model of prognosis in cerebral hemorrhage.MethodsPatients with spontaneous cerebral hemorrhage in the Third People’s Hospital of Chengdu were recruited prospectively and continuously from January 2014 to January 2019. They were divided into the youth group (≤50 years old) and the elderly group (>50 years old), and their risk factors, disease characteristics, etiology, and prognosis were analyzed.ResultsA total of 757 patients were recruited. There were 160 cases (21.1%) in the youth group, including 120 males and 40 females, aged from 17 to 50 years, with an average age of (42.06±7.62) years old; 597 cases (78.9%) in the elderly group, including 361 males and 236 females, aged from 51 to 96 years, with an average age of (69.34±10.56) years old. The incidences of hypertension (74.2% vs. 51.2%), diabetes (15.1% vs. 4.4%), coronary heart disease (12.1% vs. 1.3%), and the level of blood glucose at admission [7.1 (5.8, 8.4) vs. 6.3 (5.3, 8.1) mmol/L] in the elderly group were higher than those in the youth group (P<0.05), respectively. However, the proportions of males (60.5% vs. 75.0%), smoking (24.5% vs. 36.9%), and the diastolic blood pressure at admission [(92.37±18.50) vs. (100.95±25.25) mm Hg (1 mm Hg=0.133 kPa)] in the elderly group were lower than those in the youth group (P<0.05), respectively. There was no significant difference between the two groups in systolic blood pressure at admission, Glasgow Coma Score, National Institutes of Health Stroke Scale score, initial hematoma volume, hematoma enlargement, brain hernia, location of hemorrhage, midline shift, hydrocephalus, combined subarachnoid hemorrhage, or intraventricular extension (P>0.05). Hypertension was the most common etiology in the two groups. There was a significant difference in the etiology of cerebral hemorrhage between the two groups (P<0.05), the difference was mainly reflected in cerebral amyloid angiopathy, cavernous hemangioma, and arteriovenous malformation. The fatality rate during hospitalization (9.4% vs. 20.9%), 3 months after discharge (10.3% vs. 26.3%), and at 1 year follow-up (19.0% vs. 37.6%) in the youth group was lower than that in the elderly group (P<0.05), respectively. The disability rate 3 months after discharge and at 1 year follow-up in the youth group was lower than that in the elderly group (32.1% vs. 44.2%, 16.9% vs. 34.4%; P<0.05), respectively.ConclusionsThe education of healthy lifestyles should be strengthened to reduce the adverse effects of smoking in young patients. Young patients should choose antihypertensives that can control diastolic blood pressure better. There are more structural abnormalities in young patients, so routine vascular examination is reasonable. It is necessary to focus on whether the original underlying diseases are stable in elderly patients. Cerebral amyloid angiopathy is an important cause of cerebral hemorrhage in elderly patients, and is a risk factor of recurrence. Anticoagulation or antiplatelet therapy should be cautious.
ObjectiveTo investigate the clinical characteristics of tracheobronchial stenosis due to tracheobronchial tuberculosis (TBTB).MethodsWe recruited all patients diagnosed as TBTB within one year from four centers of Guangdong province, southern China. The prevalence, risk factors and bronchoscopy characteristics of tracheobronchial stenosis were analyzed. The location and pathological type of stenosis were also compared between different genders.ResultsA total of 345 patients were diagnosed with TBTB, 206 cases (59.7%) of which were concomitant with varying degrees of tracheobronchial stenosis. The stenosis was mainly located at upper lobe (50.0%) and gave priority to unilateral infiltration. The proportion of left and right-side stenosis were 53.9% and 44.2%, respectively. Forty-nine cases (23.8%) with tracheobronchia stenosis developed severe airway narrowing, the proportion of which was similar between left and right-side lung (49% vs. 51%). Severe stenosis in the left-side lung mainly involved in upper lobe (37.5%), main bronchus (37.5%) and the right-side mainly involved in upper lobe (44.0%), middle lobe or intermediate bronchus (40.0%). Among the TBTB patients, females, those with age ≥18 years, non-smokers, and those with symptom duration ≥4 weeks were more likely to be with tracheobronchial stenosis (P<0.05). The differences in gender between the patients with airway stenosis were as follows: the median age of female tracheobronchial stenosis patients was smaller than that of male patients (31 years vs. 43 years, P<0.05); stenosis were more likely involved in left side and main bronchus in female patients; ulceration necrosis of stenosis was more frequently seen in the female patients (P<0.05).ConclusionsTracheobronchial stenosis due to tracheobronchial tuberculosis is more frequently seen in young and middle-aged female patients. There are different stenosis location and lesion types between different genders.