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Gestational diabetes mellitus combined with fulminant type 1 diabetes mellitus, four cases of double diabetes: A case report

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World Journal of Clinical Cases 2024年第4期12卷 787-794页

作者： Hui Li Yun Chai Wei-Hong Guo Yu-Meng Huang Xiao-Na Zhang Wen-Li Feng Qing He Jin Cui Ming Liu Department of Endocrinology and Metabolism Tianjin Medical University General HospitalTianjin 300052China

BACKGROUND Fulminant type 1 diabetes mellitus(FT1DM)that occurs during pregnancy or the perinatal period is known as pregnancy-related FT1DM(PF),always without history of abnormal glucose metabolism.Here,we present four patients who developed FT1DM during treatment but were first diagnosed with gestational diabetes mellitus(GDM).CASE SUMMARY The clinical data of four patients with GDM combined with FT1DM admitted to our hospital between July 2018 and April 2021 were collected,and the patients and their infants were followed up.All patients were diagnosed with GDM during the second trimester and were treated.The blood glucose level elevated suddenly during the third trimester and then were diagnosed with FT1DM.Two patients had an insulin allergy,and two had symptoms of upper respiratory tract infection before onset.One patient developed ketoacidosis,and three developed ketosis.Two patients had cesarean section deliveries,and two had vaginal deliveries.The growth and development of the infants were normal.C-peptide levels were lower than those at onset,suggesting progressive impairment of islet function.The frequencies of the DRB109:01,DQB103:03,DQA103:02,DPA101:03,DPA102:02,DPB105:01,DRB401:03,G 01:01,and G 01:04 human leukocyte antigen(HLA)-G alleles were high in the present study.CONCLUSION In comparison with pregnancy-associated FT1DM(PF),patients with GDM combined with FT1DM had an older age of onset,higher body mass index,slower onset,fewer prodromal symptoms,and less acidosis.The pathogenesis may be due to various factors affecting the already fragileβ-cells of GDM patients with genetically susceptible class II HLA genotypes.We speculate that GDM combined with FT1DM during pregnancy,referred to as“double diabetes,”is a subtype of PF with its own unique characteristics that should be investigated further.

关键词： Fulminant type 1 diabetes mellitus Gestational diabetes mellitus Pregnancy-related fulminant type 1 diabetes mellitus Double diabetes Case report

Clinical outcome and prognostic factors of T4N0M0 colon cancer after R0 resection:A retrospective study

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1869-1877页

作者： Bang Liu Zhao-Xiong Zhang Xin-Yang Nie Wei-Lin Sun Yong-Jia Yan Wei-Hua Fu Department of General Surgery Tianjin Medical University General HospitalTianjin Medical UniversityTianjin 300052China

BACKGROUND Paradoxically,patients with T4N0M0(stage II,no lymph node metastasis)colon cancer have a worse prognosis than those with T2N1-2M0(stage III).However,no previous report has addressed this issue.AIM To screen prognostic risk factors for T4N0M0 colon cancer and construct a prognostic nomogram model for these patients.METHODS Two hundred patients with T4N0M0 colon cancer were treated at Tianjin Medical University General Hospital between January 2017 and December 2021,of which 112 patients were assigned to the training cohort,and the remaining 88 patients were assigned to the validation cohort.Differences between the training and validation groups were analyzed.The training cohort was subjected to multi-variate analysis to select prognostic risk factors for T4N0M0 colon cancer,followed by the construction of a nomogram model.RESULTS The 3-year overall survival(OS)rates were 86.2%and 74.4%for the training and validation cohorts,respectively.Enterostomy(P=0.000),T stage(P=0.001),right hemicolon(P=0.025),irregular review(P=0.040),and carbohydrate antigen 199(CA199)(P=0.011)were independent risk factors of OS in patients with T4N0M0 colon cancer.A nomogram model with good concordance and accuracy was constructed.CONCLUSION Enterostomy,T stage,right hemicolon,irregular review,and CA199 were independent risk factors for OS in patients with T4N0M0 colon cancer.The nomogram model exhibited good agreement and accuracy.

关键词： T4N0M0 colon cancer Prognosis Multivariate analysis Nomogram Colon cancer

Single-cell RNA sequencing reveals abnormal transcriptome signature of erythroid progenitors in pure red cell aplasia

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Genes & Diseases 2024年第1期11卷 49-52页

作者： Yumei Liu Haiyue Niu Jie Ren Zhiqin Wang Li Yan Limin Xing Zonghong Shao Rong Fu Zhigang Cai Huaquan Wang Department of Hematology Tianjin Medical University General HospitalTianjin 300052China School of Basic Medical Sciences Tianjin Medical UniversityTianjin 300070China

Pure red cell aplasia(PRCA)is a bone marrow failure syndrome characterized by severe anemia,reticulocytopenia,selective reduction,and even the absence of bone marrow erythroid precursors,while leukocyte and platelet counts are normal.1 Acquired PRCA can be divided into primary and secondary.Both are mediated by immune responses.Reduction in the quantity and dysfunction of committed erythroid progenitors(EPs),including burst forming uniterythroid(BFU-E)and colony forming unit-erythroid(CFU-E),may be the source of reduced erythropoiesis and needs to be elucidated.

关键词： progenitor anemia leukocyte

Cryptococcus splenic abscess in primary biliary cholangitis: a case report

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World Journal of Emergency Medicine 2024年第4期15卷 319-321页

作者： Yuxin Dong Qing Tang Lijun Wang Songtao Shou Department of Emergency Medicine Tianjin Medical University General HospitalTianjin 300052China

Chronic liver diseases,including primary biliary cholangitis(PBC),are recognized as immunosuppressive conditions due to the impaired functionality of hepatic sinusoidal Kupffer cells.[1]PBC is specifically characterized by cholangitis and progressive liver pathology,which may eventually lead to cirrhosis.The compromised liver function and reduced efficacy of Kupffer cells in patients with PBC weaken their cell-mediated immune responses,increasing their susceptibility to opportunistic pathogens such as Cryptococcus.[2]Cryptococcosis is an infectious disease caused by pathogenic encapsulated yeasts of the genus Cryptococcus,which is distributed worldwide and exhibits diverse clinical presentations.[3]Most case reports on cryptococcal infections are associated with HIV infection or other conditions that compromise the immune system.[4]Case reports related to primary biliary cholangitis are rare.Therefore,this case report underscores a rare cryptococcal infection in a patient with primary biliary cholangitis,emphasizing the need to consider opportunistic infections in those with compromised liver function and immune dysregulation.

关键词： cholangitis impaired diseases

初诊Ⅳ期肺癌患者中性粒细胞/淋巴细胞比值与营养不良风险的相关性分析

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中国肺癌杂志 2024年第3期27卷 193-198页

作者：肖平潘海马晴宋丽平钟殿胜天津医科大学总医院肿瘤内科天津300052

背景与目的恶性肿瘤患者往往伴随营养不良,与预后密切相关。中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)作为体内炎症的指标,能够预测多种疾病的营养不良风险,然而其与肺癌患者营养不良的关系尚不明确。本研究旨在... 详细信息

背景与目的恶性肿瘤患者往往伴随营养不良,与预后密切相关。中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)作为体内炎症的指标,能够预测多种疾病的营养不良风险,然而其与肺癌患者营养不良的关系尚不明确。本研究旨在分析NLR与初诊Ⅳ期肺癌患者营养不良风险的关系,并进一步确定NLR的截断值以更好地预测患者营养不良的风险。方法回顾性分析2019年5月至2021年2月天津医科大学总医院肿瘤内科收治的209例初诊Ⅳ期肺癌患者,应用营养风险筛查2002 (nutritional risk screening 2002,NRS 2002)量表对其营养状况进行评估,同时收录患者人口学信息、病理、卡氏体能状态(Karnofsky performance status,KPS)评分、体重指数、合并疾病及临床生化指标的资料。分析NLR与营养不良风险的关系,并采用受试者工作特征(receiver operating characteristic,ROC)曲线来确定预测营养不良风险的最佳NLR临界值。应用多因素Logistic回归进一步评估NLR与营养不良风险之间的关系。结果初诊Ⅳ期肺癌患者存在营养不良风险的比率为36.36%(76/209)。对NLR与NRS 2002营养不良风险评分进行分析发现,NLR与营养不良风险评分呈正相关(r=0.765,P3.94组的患者更容易发生营养不良(69.49%vs 23.33%,P<0.001),并且NLR为初诊Ⅳ期肺癌患者营养不良风险的独立危险因素。结论 NLR在初诊Ⅳ期肺癌患者中与营养不良风险有关,NLR可作为Ⅳ期肺癌患者营养风险筛查的指标之一。

关键词：营养肺肿瘤中性粒细胞与淋巴细胞比值

艾曲泊帕治疗原发免疫性血小板减少症疗效及安全性的真实世界单中心数据分析

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中华血液学杂志 2024年第3期45卷 271-276页

作者：董喜凤李亚兰李念斌林纬楠王婷王化泉李丽娟瞿文邢莉民刘鸿吴玉红王国锦宋嘉关晶王晓明邵宗鸿付蓉天津医科大学总医院血液科天津300052 天津市骨髓衰竭及癌性造血克隆防治重点实验室天津300052

目的观察艾曲泊帕治疗原发免疫性血小板减少症(ITP)的疗效及安全性,并分析相关影响因素。方法对自2018年1月至2022年3月在天津医科大学总医院血液科应用艾曲泊帕的198例ITP患者进行回顾性分析。结果198例ITP患者,男70例、女128例,中位年... 详细信息

目的观察艾曲泊帕治疗原发免疫性血小板减少症(ITP)的疗效及安全性,并分析相关影响因素。方法对自2018年1月至2022年3月在天津医科大学总医院血液科应用艾曲泊帕的198例ITP患者进行回顾性分析。结果198例ITP患者,男70例、女128例,中位年龄45(7~88)岁,新诊断ITP 130例(65.7%),持续性ITP 25例(12.6%),慢性ITP 43例(21.7%)。基线出血评分:4分以下患者占84.3%,4分及以上患者占15.7%。艾曲泊帕6周内有效率(初始有效率)为78.8%,其中完全反应(CR)率为49.1%,CR1率为14.6%,CR2率为15.2%;中位起效时间7(7,14)d。艾曲泊帕25、50、75 mg剂量组初始反应率分别为74.1%、85.9%和60.0%(P=0.031),50 mg剂量组初始反应率高于25 mg和75 mg剂量组。在治疗过程中,有70.7%的患者维持初始剂量,8.6%的患者调整到50 mg剂量组,6.1%的患者调整到75 mg剂量组,2例患者调整到100 mg剂量组。且调整剂量后25、50、75 mg各个剂量组的持续有效率分别为83.6%、85.3%和85.7%,差异无统计学意义;调整后,100 mg剂量组共4例,持续有效率为100.0%。艾曲泊帕治疗6周后,ITP患者出血评分总体降低,4分以上病例数降低为0,4分患者比例降低,1~2分患者比例变化不显著。艾曲泊帕治疗中,肝功能异常发生率为7.7%,经药物治疗均能好转,未见有合并血栓病例发生。ITP类型与巨核细胞数量分别是艾曲泊帕疗效的影响因素。新诊断的、持续性、慢性ITP患者对艾曲泊帕的初始有效率分别为85.3%、56%和76.2%(P=0.003);巨核细胞数量减少、正常和增多的ITP患者对艾曲泊帕的初始有效率分别为61.8%、87.1%和84.3%(P=0.009)。结论艾曲泊帕作为二线及以上治疗对成人ITP起效时间较快且具有良好的安全性。艾曲泊帕50 mg、25 mg剂量组相比较,50 mg剂量组初始有效率显著增高。新诊断类型的ITP、巨核细胞数量正常或增多的ITP患者对艾曲泊帕初始反应率更高。

关键词：艾曲泊帕原发免疫性血小板减少症有效性安全性

Skull and vertebral bone marrow in central nervous system inflammation

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Fundamental Research 2024年第2期4卷 246-250页

作者： Honglei Ren Qiang Liu Department of Neurology Tianjin Neurological InstituteTianjin Institute of ImmunologyState Key Laboratory of Experimental HematologyInternational Joint Laboratory of Ocular DiseasesMinistry of EducationHaihe Laboratory of Cell EcosystemTianjin Medical University General HospitalTianjin 300052China

Emerging evidence has highlighted the capacity of hematogenous cells in skull and vertebral bone marrow to enter the meningeal borders via ossified vascular channels and maintain immune homeostasis in the central nervous system(CNS).CNS-adjacent skull and vertebral bone marrow comprises hematopoietic niches that can sense CNS injury and supply specialized immune cells to fine-tune inflammatory responses.Here,we review recent advances in our understanding of skull and vertebral bone marrow-derived immune cells in homeostasis and inflammatory CNS diseases.Further,we discuss the implications for future development of therapies to mitigate CNS inflammation and its detrimental sequelae in neurological disorders.

关键词： Central nervous system Bone marrow Hematopoiesis Immune cells Neuroinflammation Stroke Multiple sclerosis

Graves病诊治与骨转换标志物的相关性研究

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中华内分泌代谢杂志 2024年第4期40卷 312-319页

作者：柴锦燕苏孟雪张瑞国郑薇贾强谭建门剑龙刘伟任静孟召伟天津医科大学总医院核医学科 300052 天津医科大学总医院精准医学科 300052

目的探讨Graves病(GD)患者相关指标与骨转换标志物(BTMs)的关系及其治疗前后变化的预测价值。方法回顾性研究458例GD患者和109名健康体检者(对照组)。比较2组的甲状腺激素[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TS... 详细信息

目的探讨Graves病(GD)患者相关指标与骨转换标志物(BTMs)的关系及其治疗前后变化的预测价值。方法回顾性研究458例GD患者和109名健康体检者(对照组)。比较2组的甲状腺激素[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)]和BTMs[骨钙素、Ⅰ型前胶原N-末端肽(PⅠNP)、Ⅰ型胶原C-末端肽(CTX)]水平。采用单、多因素分析探讨GD患者14项相关指标与BTMs的相关性。所有GD患者均接受抗甲状腺药物(ATD治疗组)或放射性碘治疗(RAI治疗组)。绘制受试者工作特征(ROC)曲线,分析治疗后FT3、FT4水平/治疗前FT3、FT4水平(FT3-P/FT3-A,FT4-P/FT4-A)的变化对BTMs是否恢复正常的预测价值。结果GD组FT3、FT4、骨钙素、PⅠNP、CTX水平均显著高于对照组(P0.05)。结论GD患者的BTMs异常升高。ATD治疗6个月后FT3下降超过46.5%,FT4下降超过40.5%;RAI治疗组治疗6个月后FT3下降超过64.5%,FT4下降超过40.5%是GD骨形成指标骨钙素恢复的独立预测因子。

关键词：甲状腺功能亢进症骨转换标志物骨钙素 Ⅰ型前胶原N-末端肽 Ⅰ型胶原C-末端肽

2021年天津市医疗机构健康管理(体检)服务能力现况调查

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中华健康管理学杂志 2024年第3期18卷 191-198页

作者：王司宇宋崑高鹰刘莉王崇金张卿天津医科大学总医院健康管理中心天津300052

目的:调查分析2021年天津市医疗机构健康管理(体检)服务能力现况。方法:本研究为横断面研究,采用普查法通过问卷调查获取天津市86家医疗机构2021年健康管理(体检)服务能力情况,问卷内容包括机构基本情况、人力资源及设备、体检项目开展... 详细信息

目的:调查分析2021年天津市医疗机构健康管理(体检)服务能力现况。方法:本研究为横断面研究,采用普查法通过问卷调查获取天津市86家医疗机构2021年健康管理(体检)服务能力情况,问卷内容包括机构基本情况、人力资源及设备、体检项目开展、年体检量、信息化程度及质量控制指标完成情况等,共发放问卷86份,收回有效问卷86份(100%)。采用Mann-Whitney U检验、χ^(2)检验比较公立与社会办医机构健康管理(体检)各项指标差异,分析天津市医疗机构健康管理(体检)服务能力现况。结果:纳入分析的86家医疗机构中,公立性质53家(61.6%),社会办医性质33家(38.4%)。在基本情况方面,公立机构所属综合医院、医疗机构级别为三级的比例以及健康管理(体检)业务开展时间均显著高于社会办医机构[62.3%比30.3%、62.3%比0、11(7,5)年比7(5,10)年],独立设置比例、体检区域总面积均显著低于社会办医机构[33.3%比98.1%、1011(600,1000)m^(2)比2000(1395,2782)m^(2)](均P<0.05);在从业人员方面,2021年天津市健康管理(体检)从业人员共2964人,年龄43(35,56)岁,公立机构男性、兼职、护理、中级职称、主检医师、健康管理师比例以及从事健康管理时间均显著高于社会办医机构[20.6%比17.5%、20.7%比8.1%、33.8%比23.4%、40.7%比27.3%、7.1%比3.9%、13.8%比4.7%、6(3,11)年比5(3,8)年](均P<0.05);在业务开展方面,公立机构中医治未病管理、心理健康管理、高血压风险管理、健康管理签约服务、肺结节管理、健康管理干预方案、健康风险评估、健康教育项目开展率均显著高于社会办医机构(24.5%比0、28.3%比0、35.8%比15.2%、39.6%比15.2%、41.5%比12.1%、50.9%比18.2%、66.0%比36.4%、83.0%比42.4%),年健康体检人次、团体及个人体检人次均显著低于社会办医机构[18625(11844,27998)人次比38384(10832,46927)人次、14818(8803,23915)人次比28663(4982,41927)人次、2179(1221,3588)人次比5784(1461,12156)人次](均P<0.05)。在6项健康体检质量控制指标中,两种类型机构的腰臀围测量完成率均较低(均<40%)。结论:相比公立机构,天津市社会办医机构健康管理(体检)人才梯队建设和服务开展水平仍有待提升。

关键词：健康管理体格检查质量控制现况调查