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2015 Vol. 6, No. 4

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Original Contributions
Influence of Different Staple Food Compositions on Blood Glucose and Lipid in Patients with Type 2 Diabetes Mellitus
Jia-yu ZHANG, Fang MA, Peng-ju LIU, Shu-li HE, Jing-hui FANG
2015, 6(4): 241-245. doi: 10.3969/j.issn.1674-9081.2015.04.001
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  Objective  To compare the effect of staple food containing edible medicinal foods versus wheat fiber on blood glucose control in patients with type 2 diabetes mellitus.  Methods  We recruited 120 patients with type 2 diabetes mellitus into this study, and randomly divided them into 2 groups (80 participants in the study group and 40 in the control group). The staple food in the study group was steamed bread with wheat flour and flour of several kinds of edible medicinal foods, and in the control was steamed bread with wheat flour and wheat fiber. The study lasted for 13 weeks. The changes of anthropometry, biochemical tests, blood glucose and insulin levels before and after the dietary intervention were compared between the two groups.  Results  Compared with the control group, patients in the study group showed more remarkable improvement in diastolic blood pressure(-0.05 mm Hg vs. 0 mm Hg, P=0.021), triglyceride level (-0.10 mmol/L vs. 0.27 mmol/L, P=0.040), fasting and 2-hour postprandial blood insulin levels (-1.30 mU/L vs. 0.62 mU/L, P=0.001; -14.82 mU/L vs. -3.93 mU/L, P=0.020).The patients in the control group had a larger reduction in waistcircumference compared with the study group(-5.00 cm vs. -4.00 cm, P=0.001). There was no significant inter-group difference in changes of body weight, hip circumference, systolic blood pressure, or glucose tolerance (P > 0.05).  Conclusions  Compared with wheat fiber, staple food containing wheat flour and edible medicinal foods can reduce triglyceride and insulin levels more significantly in patients of type 2 diabetes mellitus, while staple food supplemented with wheat fiber has a more obvious effect on waist circumference.
Nutrition-related Risk Factors for Gestational Diabetes Mellitus: a Case-control Study
Chun-wei LI, Kang YU, Liang-kun MA, Rong-rong LI, Xiao-chun WANG
2015, 6(4): 246-250. doi: 10.3969/j.issn.1674-9081.2015.04.002
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  Objective  To identify nutrition-related risk factors for gestational diabetes mellitus (GDM), so as to provide guidance for improvement of maternal nutrition and health management.  Methods  Subjects were selected with multi-stage continuous proportionate sampling from the women who visited Department of Obstetrics of Peking Union Medical College Hospital and received glucose tolerance test in 24-28 gestational weeks during the period from December 2014 to May 2015. A total of 150 confirmed GDM cases were enrolled, and 150 non-GDM gravida were selected into control group. General condition and dietary status of the GDM group and the control group were investigated using a food frequency questionnaire (FFQ). Nutrition-related risk factors for GDM were identified using Logistic regression analysis.  Results  Univariate analysis showed that GDM was significantly associated with family history of type 2 diabetes mellitus, preconception body mass index (BMI), history of GDM, fruits intake, proportion of refined grains, daily meat intake, frequency of high fat diet consumption, daily salt intake, daily oil intake, daily nuts intake, frequency of eating out, consumption of sugary drinks, and physical activity (P < 0.05). Multivariate Logistic regression analysis indicated that preconception BMI (OR=1.628, 95% CI:1.079-2.456), family history of type 2 diabetes mellitus (OR=1.761, 95% CI:1.001-3.069), history of GDM (OR=7.855, 95% CI:1.982-31.125), fruits intake (OR=1.457, 95% CI:1.148-1.849), refined grains(OR=1.350, 95% CI:1.008-1.808), high fat diet (OR=1.398, 95% CI:1.066-1.833), and physical inactivity (OR=1.257, 95% CI:1.111-1.422) were related to GDM(P < 0.05).  Conclusions  High preconception BMI, family history of type 2 diabetes mellitus, history of GDM, over intake of fruits, high proportion of refined grains, frequent intake of high fat diet, and physical inactivity may increase the risk of GDM.
Effects of Inulin and Chicory on Glucose Control and Lipid Profiles in Patients with Type 2 Diabetes
Peng-ju LIU, Fang MA, Ming LI, Jie LU
2015, 6(4): 251-254. doi: 10.3969/j.issn.1674-9081.2015.04.003
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  Objective  To investigate the effects of inulin and chicory on glucose control and lipid profiles in patients with type 2 diabetes.  Methods  Seventy-five patients with type 2 diabetes were assigned to inulin group (n=25), chicory group (n=25), and control group (n=25) with matching gender and body mass index. The three groups were all given diabetes diets, in addition, 15 g inulin and 120 g chicory daily were added in the inulin group and the chicory group, respectively. All the patients' fasting blood glucose (FBG), homeostasis model assessment of insulin resistance index (HOMA-IR), glycated hemoglobin (HbA1c), lipid profiles, aminotransferase, and creatinine were observed at baseline, 4 weeks, and 8 weeks, and the changes of all those parameters were compared.  Results  The numbers of patients finishing this study in the inulin, chicory, and control groups were 23, 22, and 23, respectively. At baseline, none of the parameters showed significant difference among the three groups (P > 0.05). At 4 weeks, the changes of FBG, HbA1c, HOMA-IR, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c) in the inulin group showed a decreasing trend compared with the control group; and the differences in changes of FBG, HbA1c, HOMA-IR, TC, and LDL-c were significant at 8 weeks (P < 0.05), while the changes of other parameters showed no significant difference(P > 0.05). The changes of all the parameters showed no significant difference between the chicory group and the control group at 4 weeks and 8 weeks (P > 0.05).  Conclusions  Inulin is conducive to blood glucose control and lipid profiles in type 2 diabetes, and does not affect liver and renal functions. In contrast, chicory has no significant effect on glucose control or lipid profiles in type 2 diabetes.
Nutrition Management of Celiac Disease Improves Outcome of Patients
Rong-rong LI, Kang YU
2015, 6(4): 255-259. doi: 10.3969/j.issn.1674-9081.2015.04.004
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  Objective  To investigate effect of comprehensive nutrition management on outcome of patients with celiac disease.  Methods  We retrospectively reviewed 17 consecutive patients with celiac disease diagnosed from January 2000 to December 2014 in Peking Union Medical College Hospital. Clinical features of these patients were summarized. Nutrition management was implemented, involving gluten-free diet. Of these 17 patients, 8 cases were followed up to assess their compliance and responses to nutrition management.  Results  The mean age of the recruited patients was (39.65±19.14) years. The male/female ratio was 9/8. All the patients were featured with chronic diarrhea of various severity, with 6(35.29%) patients having steatorrhea (positive sudan Ⅲ staining) and 7(41.18%) patients showing positive occult blood in feces. Besides, low D-xylose absorption (< 1.2 g/5 h) was observed in 12(70.59%) patients. The mean body mass index (BMI) at presentation was (16.57±3.05)kg/m2. Twelve (70.59%) patients had malnutrition (BMI < 18.5 kg/m2), including 6(35.29%) patients who had severe malnutrition (BMI < 15 kg/m2). Hypoalbuminemia was present in 14(82.35%) patients. Anemia was the most common extra-intestinal manifestation, found in 11(64.71%) patients. Deficiency of iron, folate and vitamin B12 were confirmed in 6 (35.29%), 3 (17.65%), and 5 (29.41%) patients, respectively. Comprehensive nutrition management was administered to all the patients. Eight patients were followed up, with mean follow-up duration of (10.38±8.28) months (3-25 months). Of the 8 patients, 7 were well compliant to nutrition management (Likert scale scores 1-2) and had significant improvement of diarrhea and abdominal distention, with body weight increasing from (44.83±9.77)kg before management to (47.17±9.30)kg (P=0.681) and serum albumin elevating from (27.50±7.92)g/L at presentation to (34.20±3.27)g/L (P=0.102).  Conclusion  Patient education and comprehensive nutrition management with application of strict gluten-free diet, close follow-up, disease monitor, and guidance of dietary modification play a significant role in improving outcome and life quality of patients with celiac disease.
Risk Factors and Clinical Outcomes of Pan-drug Resistant Acinetobacter baumannii Bacteremia
Yun LONG, Qing-hua GUO, Da-wei LIU, Xiao-jiang ZHANG, Lian-yan SONG, Huai-wu HE
2015, 6(4): 260-266. doi: 10.3969/j.issn.1674-9081.2015.04.005
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  Objective  To determine the risk factors and outcomes of pan-drug resistant Acinetobacter baumannii(PDRAB) bacteremia by comparing clinical data of PDRAB patients with those of non-pan-drug resistant Acinetobacter baumannii (NPDRAB) bacteremia.  Methods  This retrospective cohort study included patients with Acinetobacter baumannii bacteremia diagnosed and treated in Peking Union Medical College Hospital during January 1, 2010 and December 31, 2012. Clinical data and laboratory test results of the patients were collected with unified forms. The primary clinical outcome was in-hospital death within 14 days after sample collection for blood culture of Acinetobacter baumannii.  Results  A total of 52 patients with Acinetobacter baumannii bacteremia were included, with the mean age of 54±20 years and including 30 (57.7%) males. The mean acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sepsis-related organ failure assessment (SOFA) score were 21±9 and 10±5, respectively. The median length of hospital stay before Acinetobacter baumannii bacteremia was 12 days (7-20 days). Among these patients, only 6 cases were sensitive to carbapenem. Thirty-three cases were infected by NPDRAB and 19 by PDRAB. Compared with NPDRAB patients, PDRAB patients had a higher rate of receiving mechanical ventilation (94.7% vs. 63.6%, P=0.031) and a longer hospital stay (median:17 days vs. 10 days, P=0.025) before Acinetobacter baumannii infection. The 14-day mortality rate in patients with Acinetobacter baumannii bacteremia was 67.3% (35/52). In multivariate analysis, septic acute kidney injury[odds ratio (OR) 7.9, 95% confidence interval (CI) 1.113-55.448, P=0.039], inappropriate anti-microbial therapy (OR 9.4, 95% CI 1.020-87.334, P=0.048), and procalcitonin level (OR 1.3, 95% CI 1.332-1.088, P=0.005) were independent risk factors of 14-day mortality in Acinetobacter baumannii bacteremia patients.  Conclusions  Acinetobacter baumannii has multi-drug resistance and is even not susceptible to all currently available systemic antimicrobials. Acinetobacter baumannii infection is associated with high mortality rate. Mechanical ventilation and long hospital stay before occurrence of bacteremia are risk factors for PDRAB bacteremia. However, PDRAB infection itself is not a predictor of poor prognosis. Inappropriate antimicrobial therapy, septic acute kidney injury, and procalcitonin level are independent risk factors of 14-day mortality in Acinetobacter baumannii bacteremia.
Long-term Outcomes of Laparoscopic Surgery for Stage Ⅲ Colon Cancer
Lai XU, Yi XIAO, Guo-le LIN, Bin WU, Bei-zhan NIU, Xi-yu SUN, Hui-zhong QIU
2015, 6(4): 267-270. doi: 10.3969/j.issn.1674-9081.2015.04.006
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  Objective  To investigate the clinical efficacy and long-term outcomes of laparoscopic radical resection for stage Ⅲ colon cancer.  Methods  A total of 169 stage Ⅲ colon cancer patients treated with laparoscopic surgery (n=75) or open surgery (n=94) between January 2007 and December 2012 in Department of General Surgery, Peking Union Medical College Hospital were included. The clinicopathologic features, as well as long-term outcomes including 5-year local recurrence rate, overall survival, and disease-free survival, were compared between the two groups.  Results  Compared with the open surgery group, the laparoscopic surgery group had significantly longer operation time[(171.3±43.2) minutes vs. (132.7±60.4) minutes, P < 0.001], significantly less blood loss[(86.3±61.7)ml vs. (109.8±74.6)ml, P=0.030], and significantly more invaded lymph nodes detected (23.3±12.2 vs. 19.3±9.6, P=0.022). No significant difference was found between the laparoscopic surgery group and open surgery group in cumulative local recurrence rate (6.7% vs. 8.5%, P=0.876), 5-year overall survival (73.6% vs. 58.8%, P=0.317), and 5-year disease-free survival (61.6% vs. 56.3%, P=0.544).  Conclusion  Laparoscopic colectomy is safe and effective for stage Ⅲ colon cancer, comparable with the conventional open colectomy in terms of long-term oncological outcomes.
Feasibility of New Artificial Biologic Patch as Aortic Valve Replacement
Jian-zhou LIU, Xing-rong LIU, Chao-ji ZHANG, Guo-tao MA, Xiao-feng LI, Qi MIAO
2015, 6(4): 271-274. doi: 10.3969/j.issn.1674-9081.2015.04.007
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  Objective  To study the feasibility of artificial biologic patch made of collagen membranes loaded with collagen-binding base fibroblast growth factor (bFGF) as aortic valve replacement.  Methods  Ten healthy mongrel dogs were randomly divided into control group and experiment group (both n=5). Abdominal aorta replacement using artificial biologic patch made of collagen membranes loaded with collagen-binding bFGF (experiment group) or soaked with phosphate buffered saline (control group) was performed under general anesthesia and abdominal aorta blockage. Three months after the surgery, echocardiography was performed to evaluate the function of the artificial valve. Six months after the surgery, the condition of the artificial valve transplanted in the abdominal aorta was observed.  Results  No significant difference was found between the experiment group and the control group in function of the artificial valve evaluated by echocardiography 3 months after the surgery. The artificial valves entirely degraded 6 months after implanted into the abdominal aorta in both groups.  Conclusion  The degradation of artificial biologic patch made of collagen membrane loaded with collagen-binding bFGF in vivo is so fast that it is not a good alternative for replacement of the aortic valve.
Transfusion-free Medicine and Surgery(2nd ed.) (2014)
2015, 6(4): 266-266.
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2015, 6(4): 275-277. doi: 10.3969/j.issn.1674-9081.2015.04.008
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2015, 6(4): 278-280. doi: 10.3969/j.issn.1674-9081.2015.04.009
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Red Blood Cell Transfusion Condition of In-patients of Peking Union Medical College Hospital in 2010 and 2013
Chan MENG, Xue-jun ZENG, Jia GAN, Wei-gang FANG, Jia-lin CHEN, Lian-jun BAI
2015, 6(4): 281-285. doi: 10.3969/j.issn.1674-9081.2015.04.010
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  Objective  To study the general condition and changes of red blood cell transfusion in Peking Union Medical College Hospital in the years of 2010 and 2013.  Methods  Random sampling was conducted among the in-patients who received red blood cell transfusion during hospitalization at Peking Union Medical College Hospital in 2010 and 2013. The clinical information including gender, age, wards where transfusion was performed, and the hemoglobin values before the first red blood cell transfusion were compared between the 2 years.  Results  Totally, 174 cases in 2010 and 500 cases in 2013 were enrolled. The mean hemoglobin value before red blood cell transfusion in non-surgical and surgical wards were (67.71±11.31)g/L and (78.68±15.64)g/L respectively in 2010, which were (63.75±12.41)g/L and (81.53±17.09)g/L respectively in 2013. Hemoglobin detection rates in in-patients before red blood cell transfusion in non-surgical wards in 2010 and 2013 were both 100%; in surgical wards, the hemoglobin detection rate was 68.6% in 2013, significantlyhigher than that in 2010 (47.7%, P < 0.001).  Conclusions  In both non-surgical and surgical wards of Peking Union Medical College Hospital, the hemoglobin threshold for initiating red blood cell transfusion were in accordance with the recommendations of international and China guidelines, indicating that in our hospital, indication of red blood cell transfusion is strictly followed and transfusion administration is rational with continuous improvement.
2015, 6(4): 285-285.
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Effect of Comprehensive and Whole Process Blood Management on Allogeneic Transfusion in Orthopedic Surgical Patients
Si-yi CAI, Jian-xiong SHEN, Xi-sheng WENG, Bao-zhong ZHANG, Bo YANG, Bin FENG, Gui-xing QIU
2015, 6(4): 286-290. doi: 10.3969/j.issn.1674-9081.2015.04.011
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  Objective  To retrospectively analyze the effect of comprehensive and whole process blood management on allogeneic transfusion in patients undergoing orthopedic surgery.  Methods  A total of 7082 patients (3320 in 2013, 3762 in 2014) who underwent orthopedic surgery in the period from January 2013 to December 2014 in Department of Orthopedics, Peking Union Medical College Hospital were retrospectively analyzed, among which 2178 cases in 2013 and 2322 cases in 2014 were considered at high hemorrhage risk. Since January 2014, the Department has implemented individualized comprehensive blood management measures covering the whole perioperative period, involving perioperative autologous blood transfusion technology, treatment improvement during surgery and perioperative period, drug intervention, and strict following of blood transfusion principles. We compared the overall conditions of allogeneic blood transfusion in 2014 with those in 2013, assessing the impact of those new management measures on allogeneic blood transfusion in patients who underwent orthopaedic surgery.  Results  The differences in gender, age, types and distribution of high hemorrhage risk surgeries were not statistically significant between the two years. However, both the overall number of orthopedic surgeries and the number of surgeries with high hemorrhage risk were larger in 2014 than in 2013. The total volume of allogeneic blood transfusion in 2014 was 106 950 ml (713 cases), lower than the volume in 2013 (121 600 ml, 760 cases). Similarly, the total amount of transfused concentrated red blood cells in 2014 (2543 U) was less than that in 2013(2804 U). The expense on allogeneic transfusion was 680 720 RMB in 2014, accounting for 0.97% of the total medical expenses (70 287 242.03 RMB) of the patients receiving allogeneic blood transfusion and 0.35% of the overall medical expenses (196 100 485 RMB), which were all lower than the corresponding figures in 2013(1.04% and 0.42%, respectively). Moreover, the average length of hospital stay in 2014 was lower than that in 2013 (12.46 d vs. 12.90 d), as well as the incidence rate of complications (2.02% vs. 5.03%).  Conclusion  In addition to ensuring safe healthcare and efficient medical service, comprehensive and whole process blood management could reduce the volume of allogeneic blood transfusion in patients undergoing orthopedic surgeries.
Perioperative Blood Transfusion Management in Vascular Surgery
Zhi-li LIU, Chang-wei LIU, Xiao-jun SONG, Yu CHEN, Leng NI, Rong ZENG, Jiang SHAO, Yong-jun LI
2015, 6(4): 291-295. doi: 10.3969/j.issn.1674-9081.2015.04.012
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  Objective  To analyze the status quo and tendency of blood transfusion in vascular surgery and summarize the experiences of rational blood transfusion management in order to provide clinical guidance.  Methods  Hospitalized patients who underwent vascular surgery at Peking Union Medical College Hospital from January 1, 2011 to December 31, 2014 were enrolled. The records of blood transfusion, surgical procedures, transfusion case number, transfusion components, transfusion volume, and mean transfusion volume were retrospectively analyzed.  Results  Altogether 3989 surgical patients were included. Four hundred and six patients (10.18%) received blood transfusion in perioperative period, including 229 patients receiving allogeneic blood transfusion, 80 patients receiving autologous blood transfusion, and 97 patients receiving both. The rate of blood component transfusion was 100%. 43.60% of the patients received autologous blood transfusion, accounting for 20.60% of the total blood transfusion amount. According to the records from 2011 to 2014, with the increase of quantity and difficulty of vascular surgery (compared with 2011, the growth rate of vascular surgeries in 2012, 2013, and 2014 were 6.66%, 9.28%, and 25.13%, respectively), the total and the mean transfusion volume increased too (compared with 2011, the total blood transfusion volume in 2012, 2013, and 2014 increased by 3.07%, 12.91%, and 21.72%, and the mean transfusion volume in 2012, 2013, and 2014 increased by 10.43%, 18.56%, and 27.81%, respectively), especially the transfusion of fresh frozen plasma (FFP) (compared with 2011, the total and mean transfusion volume of FFP in 2014 increased by 96.77% and 9.83%, respectively). However, the rate of allogeneic red blood cell transfusion declined year by year (9.19%, 7.52%, 6.67%, 6.31%), along with a fluctuating increase of salvaged autologous blood usage at the 4 years(4.32%, 4.22%, 4.65%, 4.53%).  Conclusion  Rational perioperative blood transfusion management with the using of blood component transfusion and autologous blood transfusion could effectively reduce the transfusion of allogeneic red blood cells and ensure perioperative patient safety, in the context of increasing quantity and difficulty of vascular surgery.
2015, 6(4): 295-295.
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Retrospective Analysis for Causes of Perinatal Blood Transfusion
Yi-feng ZHONG, Jian-qiu YANG, Tao WANG, Jing HU, Jun-tao LIU, Jin-song GAO
2015, 6(4): 296-299. doi: 10.3969/j.issn.1674-9081.2015.04.013
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  Objective  To analyze the clinical factors related to perinatal blood transfusion, thus to assist clinicians in reducing perinatal hemorrhage.  Methods  We retrospectively analyzed clinical records of 80 parturients who delivered and received perinatal transfusion at Peking Union Medical College Hospital in the period from January 2013 to December 2014, focusing on the correlation of blood transfusion with major pregnancy complications, calculating the rate and volume of blood transfusion, to elucidate the major risk factors contributing to postpartum hemorrhage and perinatal transfusion.  Results  The mean age of parturients receiving blood transfusion was (29.8±4.8) years, and the mean gestational weeks at delivery was (35.6±4.3) weeks. The total blood transfusion volume was 503 U, including 293 U red blood cell suspension, 151 U plasma, and 59 U platelet. The blood transfusion rate was over 20% in the following conditions:HELLP syndrome (61.1%), pernicious placenta previa (57.1%), placenta accrete (57.1%), pregnancy acute fatty liver (57.1%), placental abruption (50.0%), hematologic diseases (41.2%), uterine inertia (40.7%) and severe preeclampsia (24.2%). The average blood transfusion volume was over 8 U in precipitate labor (15.0 U), pernicious placenta previa(14.0 U), placenta accrete (13.7 U), placental abruption (13.2 U), and acute fatty liver (9.6 U).  Conclusions  Various pregnancy comorbidities and complications can lead to severe postpartum hemorrhage, even hemorrhage refractory to conventional measurements. Standard diagnosis and treatment of high-risk parturients, preventive procedure, timely detection of hemorrhage, and improved skills to control bleeding are the key to reducing postpartum hemorrhage, saving blood products, and to successful rescue in these emergencies.
The Importance of Immunonutrition(2013)
2015, 6(4): 299-299.
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2015, 6(4): 300-304. doi: 10.3969/j.issn.1674-9081.2015.04.014
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2015, 6(4): 304-304.
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2015, 6(4): 305-309. doi: 10.3969/j.issn.1674-9081.2015.04.015
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2015, 6(4): 310-314. doi: 10.3969/j.issn.1674-9081.2015.04.016
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2015, 6(4): 314-314.
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2015, 6(4): 315-317. doi: 10.3969/j.issn.1674-9081.2015.04.017
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2015, 6(4): 318-320. doi: 10.3969/j.issn.1674-9081.2015.04.018
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