Objective · To explore the relationship of adipose chemerin and its receptor chemerinR gene expression to obesity and type 2 diabetes mellitus. Methods · Twenty-four patients undergoing elective abdominal surgery were enrolled, and were divided into normal glucose regulation-normal weight group (NGR-NW), normal glucose regulation-overweight/obesity group (NGR-OW/OB), and type 2 diabetic overweight/obesity group (T2DMOW/OB) according to the body mass index (BMI). The levels of chemerin and chemerinR mRNA were detected by reverse transcription PCR (RT-PCR).Results · Compare to the NGR-NW group, the chemerin mRNA levels of abdominal subcutaneous and omental fat were significantly increased in the NGR-OW/OB and T2DM-OW/OB group (P<0.05). Correlation analysis showed that the chemerin mRNA levels of abdominal omental fat were positively correlated with BMI, fasting insulin (FINS), triglyceride and serum chemerin (r=0.577, r=0.561, r=0.472, r=0.623, P<0.05 for all). The chemerin mRNA levels of abdominal subcutaneous fat showed significant positive correlation with BMI, FINS and serum chemerin (r=0.692, r=0.513, r=0.497, P<0.05 for all). Conclusion · The chemerin mRNA levels of abdominal subcutaneous and omental fat were positively correlated with BMI, FINS and serum chemerin, suggesting that the chemerin gene may play a crucial role in the pathophysiological mechanism of obesity and type 2 diabetes.

Insulin is secreted in a pulsatile fashion, consisting of ultradian oscillation and rapid pulses. Several aspects of these characteristic features, generating mechanism, and clinical significance are reviewed in this article.

Objective To assess the impact of intervention with Insulin therapy management unit program in the poorly controlled type 2 diabetic patients in a community of Shanghai.Methods There were 55 patients with type 2 diabetes with poorly controlled hyperglycemia (HbA1C ≥ 8％) enrolled in this study.They were divided at random into 2 groups:intensive care group and standard care group.The subjects in intensive care group were provided with a glucose meter and required to monitor their blood glucose levels at least 2 or 3 times per day.Community health provider acquired information of blood glucose level,episodes of hypoglycemia,and dosage of insulin every week by cell phone.Standard care patients received diabetes care from the same provider in outpatient clinic every month.Results By the end of 6 months of intervention,the intensive care group showed a significant difference in HbA1C as compared to the standard care group (7.40％ ±0.91％ vs 8.65 ％ ± 1.28％,P＜0.01).The frequency of self-monitoring of blood glucose (SMBG) was 4 times per month in both groups at baseline.After intervention,the frequency of SMBG in intensive care group was greatly increased compared to standard care group (50times per month vs 5 times per month,P＜0.01).The frequency of self-reported hypoglycemia in intensive care group was increased compared to standard care group (3 times per month vs once per month,P＜0.01).The average daily dose of insulin in intensive care group was increased 6 units by the end of the present study(P＞0.05).Conclusion After 6 months of intervention,the glycemic control was obviously improved in type 2 diabetic patients treated with insulin and the daily dose of insulin was not increased significantly.TheInsulin therapy management unit is effective and safe.

This paper introduces the nursing care of two children with type 1 diabetes during continuous glucose monitoring. In addition to psychological care,diet instruction and insulin therapy,the nurses actively communicated with the children and their parents,introduced the principle and advantages of continuous glucose monitoring system (CGMS) to promote the children and parents to cooperate with the medical staff. Moreover,the insert site of CGMS was changed from inferior abdomen to up-per lateral buttock according to the physiological character of children. As a result,the CGMS was completed successfully in the 2 eases,which provided reliable reference for the regulation of treatment plan.

Objective To investigate the incidence of cholelithiasis after laparoscopic Roux-en-Y gastric bypass(LRYGB) for treatment of type 2 diabetes mellitus with obesity.Methods The clinical data of 89 obese patients with type 2 diabetes mellitus who underwent LRYGB at the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from March 2011 to March 2013 were retrospectively analyzed.Sixty-six patients without postoperative gallstone and sludge were divided into the nornal group and 23 with postoperative gallstone or sludge into the gallstone group.The waistline,hipline,body weight,body mass index (BMI),excess weight loss (EWL),fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin (HbAlc),homeostasis model assessment-insulin resistance (HOMA-IR),total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-c),low-density lipoprotein cholesterol (LDL-c),serum total bile acid at postoperative month 6,12,24 were analyzed.The patients were followed up by inpatient,outpatient examination and telephone interview till April 2015.Measurement data with normal distribution were presented as x ± s,comparison between groups and repeated measures data were analyzed using the t test and repeated measures ANOVA,respectively.Count data were analyzed by the chi-square test.Results All the 89 patients underwent successful LRYGB and were fol lowed up for 31 months (range,24-48 months).The EWL,HbAlc and serum total bile acid at postoperativemonth 6,12,24 were 113％±43％,117％±64％,119％±84％ and 6.1％±0.8％,6.2％± 1.1％,6.4％± 1.0％ and (4.6 ± 3.8) μmol/L,(4.5 ± 3.6) μmol/L,(4.6 ± 3.8) μmol/L in the normal group and 157 ％ ± 96％,152％±102％,151％±93％ and 5.9％±0.8％,5.8％±0.6％,5.9％±0.8％ and (23.9 ±9.0) μmol/L,(11.8 ± 7.3) μmol/L,(10.5 ± 9.6) μmol/L in the gallstone group,respectively,showing significant differences in changing trend between the 2 groups (F =6.896,5.226,5.351,P ＜ 0.05).There were significant differences in the EWL at postoperative month 6,12,24 between the 2 groups (t =2.814,2.628,2.099,P ＜ 0.05).There were significant differences in the HbAlc at postoperative month 12 and serum total bile acid at postoperative month 6,24 between the 2 groups (t =2.018,-1.378,-1.990,P ＜ 0.05).Conclusion There is incidence risk of cholelithiasis after LRYGB in obese patients with type 2 diabetes mellitus.The rapid decreasing of weight is associated with cholelithiasis in which patients have higher level of serum bile acid.

Objective To analyze the risk factors of retinopathy and nephropathy in hospitalized patients with type 2 diabetics. Methods 24 h-urinary albumin was measured in 2 338 patients with type 2 diabetic hospitalized from July, 2002 to Sep, 2008 in our hospital. All the subjects were divided into normalbuminuria group (NA) and diabetic nephropathy group (DN), the latter consisted of microalbuminuria group (MAU) and macroalbuminuria group (CAU). All the patients were divided into normal retina group (NR) and diabetic retinopathy group (DR), the latter consisted of background diabetic retinopathy group (BDR) and proliferative diabetic retinopathy group (PDR) according to fundus photography. Results (1) The percentages of DR and DN of this cohort were 28.8% and 28.7%, respectively.The percentage of DR and DN had no statistical difference between male and female (27.8% vs 30.0%;29.6% vs 27.6%, P>0.05). (2) The percentage of DR was 23.1%, 37.7% and 56.6% in NA, MAU and CAU group, respectively. There was significant difference among different albuminuria group (P<0.01). (3) The percentage of DN was 23.1%, 41.1% and 59.3% in NR, BDR and PDR group, respectively. There was significant difference among different DR group (P<0.01). (4) Combined with DN, diabetes duration, systolic pressure, hemoglobin A1C, triglyceride were independently associated with DR by Logistic regression analysis. Meanwhile, combined with DR, systolic pressure, hemoglobin A1C, and triglyceride were all independently associated with DN. Conclusions The onset and progression of microvascular complications in type 2 diabetic patiens are correlated with hemoglobin A1C and systolic pressure. Diabetic retinopathy is closely correlated with diabetic nephropathy.

Objective To investigate the preoperative magnetic resonance imaging (MRI)examination of the distribution of neurovascular bundles (NVB) around the prostatic capsule,and its clinical value in the nerve-sparing laparoscopic radical prostatectomy (NS-LRP).Methods The clinical data of 42 patients with clinically localized prostate cancer who were admitted from January 2008 to January 2017 were retrospectively analyzed.Age ranged from 58 to 74 years,with an average of 68 years.Preoperative serum PSA range from 0.94 to 12.28 ng/dl,with an average of 7.01 ng/dl.Preoperative Gleason score range from 6 to 8,with an average of 6.Clinical stage:T1-T2 37 cases,T3 5 cases.The average preoperative International Erectile Function Index questionnaire-5 (IIEF-5) 21,of which 23 cases had normal erectile function (IIEF-5 ＞ 22).All the 42 patients underwent MRI examination before operation.According to the distribution of NVB around the prostatic capsule,they were divided into 3 groups:17 cases in group A,and no NVB was evident in all cases.In group B,8 cases were visible but not obvious.In group C,17 cases were evident NVB.There was no significant difference in age,preoperative serum PSA and Gleason score between the three groups (P ＞ 0.05).The preoperative IIEF-5 in group A,B,and C were 19.5,22.8,and 21.5,respectively,with no statistically significant difference (P ＞ 0.05).All 42 cases received NS-LRP under general anesthesia.The differences in IIEF-5 before and after surgery were compared between the three groups.Results In this study,42 cases were successfully completed.42 patients were followed up for 12 to 36 months,with an average of 14.1 months.In group A,B,and C,postoperative IIEF-5 was 8.0,14.1,and 15.5,respectively,which was statistically significant compared with preoperative values (P ＜ 0.05).The decrease of IIEF-5 afteroperation in group A was significantly different from that of group Band C (P ＜0.05).Conclusions Compared with patients with visible NVB on MRI examination,patients have no visible NVB observed on MRI with erectile function-related nerves around the prostatic capsule may be walking on both sides of the prostatic capsule and spreading over the entire anterior ventral surface of the prostate.To maxium-preserve NVB and postoperative erectile function to the utmost,NS-LRP surgery should be more accurately dissected on both sides and ventral side of the prostatic capsule.

Objective To investigate the influencing factors of quality of life ( QOL) in patients with type 2 diabetes mellitus ( T2DM ) after gastric bypass, and provide theoretical basis for developing holistic nursing measures and improving the mental health level and the life quality of patients.Methods Four different questionnaires including the general situation questionnaire, diabetes-specific quality of life scale ( DSQL) , self-rating anxiety scale ( SAS) , and social support rating scale ( SSRS) were used to investigate diabetic patients hospitalized in our hospital between May 2011 and May 2015 according to the convenience sampling medthod. The investigation was conducted in the follow-up of 1 year before and 1 year after surgery. Surveying data was analyzed by descriptive statistics, t-test, analysis of variance and multiple stepwise regression analysis through SPSS 18.0 software. Results The QOL of participants significantly improved one year after the surgery. The score of DSQL decreased from ( 75. 98 ± 14. 48 ) to ( 52. 12 ± 10. 35 ) , and there was significant difference compared with data before surgery ( P<0. 05 ) . The proportion of patients who continued to take oral hypoglycemic agents decreased to 5. 9%. Influencing factors that affect the QOL were: the course of disease, age, body mass index (BMI), anxiety, drug treatment and social support (P<0.05).Conclusions In the premise of strict operative indications, the QOL of postoperative patients will be promoted by strengthening the psychological guidance, social support and emphasizing the importance of regular follow-up.

Objective:To explore the risk factors of osteosarcopenia in maintenance hemodialysis patients, construct a diagnostic nomogram model and verify the effect.Methods:Usingthe convenient sampling method, a total of 697 patients who underwent regular hemodialysis in six hospitals in Shanghai from July 2020 to April 2021 were selected as the modeling set, and 132 patients who underwent regular hemodialysis in Tongji Hospital in Shanghai in November 2020 were selected as the validation set. General information, laboratory indicators, human parameters, physical functions, nutritional status, physical activity, cognitive function, and depression were collected. Logistic regression was used to analyze the risk factors of osteosarcopenia in maintenance hemodialysis patients and to construct a nomogram model. The effect of the model was evaluated by the area under the receiver operating characteristic curve, calibration curve, and decision curve.Results:A total of 697 maintenance hemodialysis patients were included in the modeling set, including 171 patients with osteosarcopenia, with an incidence rate of 24.53% (171/697). The results of the binomial logistic regression analysis showed that age, body mass index, physical activity intensity, and Charlson Comorbidity Index (CCI) were the influencing factors for the occurrence of osteosarcopenia in maintenance hemodialysis patients ( P<0.05). The area under the receiver operating characteristic curve in the modeling set, ten-fold cross-validation, and validation set were 0.835, 0.827, and 0.851, respectively. The calibration curves of the modeling and validation sets fitted well. The decision curve showed that the clinical utility of the nomogram was good. Conclusions:Maintenance hemodialysis patients are prone to osteosarcopenia. Old age, low body mass index, high Charlson Comorbidity Index, and low-intensity physical activity are risk factors for osteosarcopenia in maintenance hemodialysis patients. A nomogramdiagnostic model based on the above-mentioned influencing factors can help medical staff identify high-risk populations early and develop prevention and treatment measures.

Objective:The aim of this study was to evaluate the safety and efficacy of prostatistic urethral lift (PUL) in treating benign prostate hyperplasia(BPH) through systematic review and Meta-analysis.Methods:A systematic literature search on CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane Library and Chinese Clinical Trial Registry to identify the relevant studies and data before September 2021. Information was extracted from each eligible article. All statistical analyses of this Meta-analyses were performed with Review Manager 5.3 and Stata 15.0 software to conduct a Meta-analysis of the symptom improvement of BPH patients before and 3 months and 12 months after PUL. The main evaluation indicators included: International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q max), post-void residual (PVR), and Quality of Life Scale (QOL), Sexual Health Inventory for Men (SHIM). The complication rate of PUL was systematically evaluated. Results:A total of 12 clinical studies were included, and 850 patients accepted the PUL. The results showed that IPSS decreased significantly at both 3 and 24 months after PUL surgery ( MD = -11.77, 95% CI -12.47—-11.07, P<0.05; MD = -9.71, 95% CI-10.76—-8.66, P<0.05), Q max (ml/s) increased to a certain degree ( MD = 3.87, 95% CI 3.37—4.37, P<0.05; MD = 3.68, 95% CI 2.97—4.40, P<0.05), QOL decreased significantly ( MD=-2.57, 95% CI -2.76—-2.38, P<0.05; MD = -2.14, 95% CI -2.38—-2.91, P<0.05), SHIM score was unaffected ( P>0.05), compared with preoperative baseline data. PUL could be performed under local anesthesia, the main perioperative complications reported in the included studies were dysuria (17%±6%), hematuria (14%±5%) and pelvic pain (8%±6%), all of which were transient. Conclusions:PUL in the treatment of BPH has significant short-term and long-term efficacy with low surgical risk and complication rate, and can preserve normal ejaculation function. It is a safe and effective minimally invasive surgery, which can be used for BPH patients with intolerance to general anesthesia surgery or normal sexual function demand.