Objective To evaluate the effects of femoral artery wall thickness, stillness and ankle brachium index(ABI) on clinical manifestation of peripheral vascular disease(PVD) in type 2 diabetes mellitus. Methods According to the presence of lower limb and reduced ABI (ABI<0.9), 151 patients with type 2 diabetes were divided into group of patients with and without PVD symptoms, and group of patients with and without reduced ABI. Intima-media thickness of femoral artery (FA-IMT) and stiffness of femoral artery (FA-β) were measured by ultrasound. FA-IMA and FA-β of femoral arteries were compared between group of patients with and without PVD symptoms as well as between group of patients with and without reduced ABI. Correlation between FA-IMT and FA-β was analyzed. Factors affecting symptoms of lower limb and ABI were evaluated by multiple logistic regression analysis. Results FA-IMT and FA-β in group of PVD symptoms were higher than those in group without PVD symptoms. Similarly, patients with reduced ABI had greater FA-IMT and FA-β than those without. However,there was no correlation between FA-IMT and FA-β in group of PVD symptoms. Multiple logistic regression analysis indicated that the presence of PVD symptoms was associated closely with increased FA-β, whereas reduced ABI was associated closely with FA-IMT. Conclusions The stiffening of arterial wall has a significant impact on PVD manifestations,particularly on the leg symptoms in patients with type 2 diabetes.

Objective To explore the possible mechanism by which thioredoxin-interacting protein (TXNIP) par?ticipated in early brain injury (EBI) of subarachnoid hemorrhage (SAH) via examination of the expression of TXNIP and its downstream apoptotic factors before and after intervention. Methods Subarachnoid Hemorrhage (SAH) was performed by endovascular perforation. Total 97 adult male SD rats were randomly divided into 6 groups:sham-operation (17), SAH (32), control siRNA (12), TXNIP siRNA (12), resveratrol control (12) and resveratrol injection (12). Western blot was used to examine the expression of TXNIP, p-ASK-1, Caspase-3 before and after intervention. Laser scanning confocal microscopy (LSCM) was used to detect the expression of TXNIP in neurons. The co-localization of TXNIP with apoptotic cells was examined by using fluorescent TUNEL. Mortality, behavior score and cerebral edema were also evaluated. Re?sults Mortality, behavior scores and brain edema were improved after TXNIP siRNA and resveratrol injection(P<0.05). LSCM showed that TXNIP was widely expressed in brain and mainly located in cytoplasm of neurons in SAH rats. Fluo?rescent TUNEL revealed the co-localization of TXNIP with apoptotic cells. The expression level of TXNIP was signifi?cantly higher in SAH group than in sham operation (P<0.05, n=3). The expression level of TXNIP gradually increased at 12h and still remained at high level at 72h (P<0.05). This increase was simultaneously accompanied by the increase in downstream apoptosis factors, p-ASK-1 and Caspase-3. Inhibition of TXNIP by siRNA or resveratrol significantly re?duced the expression of TXNIP, p-ASK-1 and Caspase-3 (P<0.05, n=3). Conclusion TXNIP gradually increases in ear?ly period after SAH and aggravates brain damage through activation of ASK-1 apoptosis signaling pathway, whereas inhi?bition of TXNIP may attenuate EBI through reduction of p-ASK-1 and Caspase-3 after SAH.

Objective To study the effect of stilbene on blood glucose of rats with type 2 diabetes. Methods 50 male Wistar rats wererandomly divided into model group (n=40) and control group (n=10). The model group was given fat emulsion 40 days continuously with 20ml/kg, po, and streptozotocin with 120 mg/kg on the 41st day, 100 mg/kg on the 42nd day, i.p. After the modeling, the model group was dividedinto 4 groups with 10 in each. They were given stilbene with 500 ml/kg, 200 ml/kg, 100 ml/kg and metformin with 100 mg/kg, ip, respectively.The level of blood glucose, blood lipid and glycogen content were determined. Results After the modeling, the blood glucoseand TG, TC, LDL-C, HDL-C increased by 140.89%, 25.77%, 275.52%, 105.54% and 31.25% respectively (P<0.01); after stilbene was given,the level of blood glucose and lipid decreased significantly (P<0.05), the liver glycogen content increased significantly by 8.06%~16.17% compared to the control group. Conclusion Stilbene can decrease the concentration of blood glucose and lipid, and increase the liverglycogen content of rats with type 2 diabetes.

Objective:To investigate the effects of dexamethasone-assisted ademetionine and ursodeoxycholic acid on pregnancy outcome and serum thyroid peroxidase antibody (TPOAb) and interleukin-12 (IL-12) expressions in patients with intrahepatic cholestasis (ICP) during pregnancy.Methods:A prospective randomized controlled study of 80 patients with ICP in Pingyang Hospital Affiliated of Wenzhou Medical University from April 2017 to April 2020 was selected. The patients were divided into the observation group and the control group using random number table, with 40 cases in each group. On the basis of conventional treatment, the control group was given ademetionine and ursodeoxycholic acid, and the observation group was given dexamethasone-assisted ademetionine and ursodeoxycholic acid. All patients were treated for 1 week. The efficacy, time of disappearance of symptoms, maternal and infant outcomes and liver function indexes aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bile acid (TBA), immune function indexes immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin G (IgG), serum TPOAb and IL-12 levels before and after treatment were compared between the two groups.Results:After treatment, the total effective rate in the observation group was higher than that in the control group: 95.0% (38/40) vs. 80.0%(32/40), the difference was statistically significant ( χ2 = 4.114, P<0.05). The disappearance time of jaundice and itching were shorter than those in the control group ( P<0.05). After treatment, the levels of serum AST, ALT, TBA, TPOAb, and IL-12 in the two groups were lower than before treatment, and the levels of above index in the observation group were lower than those in the control group: (57.49 ± 11.45) U/L vs. (83.70 ± 13.57) U/L, (87.61 ± 29.03) U/L vs. (126.24 ± 33.28) U/L, (13.24 ± 5.48) μmol/L vs. (21.39 ± 7.20) μmol/L, (9.18 ± 2.41) kU/L vs. (12.97 ± 2.73) kU/L, (11.37 ± 2.05) ng/L vs. (18.26 ± 2.54) ng/L; the levels of serum IgM, IgA and IgG in two groups were higher than before treatment, the levels of above index in the observation group were higher than those in the control group: (1.40 ± 0.09) g/L vs. (1.28 ± 0.11) g/L, (1.96 ± 0.14) g/L vs. (1.82 ± 0.12) g/L, (11.53 ± 2.80) g/L vs. (9.37 ± 2.59) g/L, the differences were statistically significant ( P<0.05). The incidence of cesarean section, premature delivery, postpartum hemorrhage, neonatal asphyxia, and intrauterine distress in the observation group were lower than those in the control group. Conclusions:Dexamethasone-assisted ademetionine and ursodeoxycholic acid treatment of ICP patients can improve liver function and immune function, reduce serum TPOAb and IL-12 levels, alleviate clinical symptoms and improve maternal and infant outcomes.

Background and objective Post-operation management of minimally invasive thoracic surgery is simi-lar to that of open surgery, especially on the drainage tube of the chest. hTe aim of this study is to compare the advantages of us-ing 16 F versus 28 F chest tubes in video-assisted thoracoscopic surgery (VATS) lobectomy of lung cancer.Methods Data from 163 patients (February-May 2014) who underwent VATS lobectomy of lung cancer with insertion of one chest drain (16 F or 28 F) were analyzed. hTe following post-operative data were evaluated: primary healing of tube incision, CXR abnormalities (pneumothorax, lfuid, atelectasis, subcutaneous emphysema, and hematoma), drainage time, new drain insertion, and wound healing at the site of insertion.Results A total of 75 patients received 28 F chest tubes, and 88 patients received 16 F chest tubes. Both groups were similar in age, gender, comorbidities, and pathological evaluation of resection specimens. Atfer adjust-ment, no statistically signiifcant difference was found between the two groups in relation to tube-related complications includ-ing residual pneumothoraces (4.00%vs 4.44%;P=0.999), subcutaneous emphysema (8.00%vs 6.67%;P=0.789), retained hemothorax (0vs41%,P=0.253), and drainage time [(28.4±16.12) hvs(22.1±11.8) h;P=0.120)] hTe average total drainage volume and rrhythmia rates of the 16 F group [(365±106) mL, 14.67%)] was less than that of the 28 F group [(665±217) mL, 4.5%;P=0.030,P=0.047]. hTe rates of primary healing at the site of insertion in the 16 F group (95.45%) was higher than that in the 28 F group (77.73%,P=0.039). A signiifcant difference was found on the post-operative length of stay of the two groups [(4.23±0.05) dvs(4.57±0.16) d,P=0.078].Conclusion hTe use of 16 F chest tube for VATS lobectomy of patients with lung cancer did not affect the clinically relevant outcomes tested. However, 16 F chest tube facilitated faster wound healing at the site of insertion.

Objective:To analyze and compare the association between different obesity-related indices and vitamin D deficiency in middle-aged and elderly population dwelled in Lanzhou city.Methods:From May, 2011 to September, 2012, middle-aged and elderly individuals with complete baseline data were included via randomly cluster sampling from 3 communities in Lanzhou. The subjects were divided into 4 subgroups by vitamin D levels and various obesity-related indices were compared across subgroups with the same gender. The relationship between the obesity-related indices and the severity of vitamin D deficiency was analyzed using Spearman correlation analysis, and the effects of different obesity-related indices on the severity of vitamin D deficiency was analyzed using multivariate logistic regression analysis.Results:A total of 9 437 residents were included. The overall prevalence of vitamin D deficiency was 97.7%. Compared with the group with lower vitamin D level, participants in the group with higher vitamin D level showed evidently lower body mass index (BMI), waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI) and triglyceride/ high density lipoprotein cholesterol (TG/HDL-C) ratio in the total population and females, while only WC, LAP, VAI and TG/HDL-C in the males (all P<0.05). Spearman correlation analysis showed that BMI, WC, LAP, VAI and TG/HDL-C were positively correlated with the severity of vitamin D deficiency in the total population and the females, while only LAP, VAI and TG/HDL-C in the males (all P<0.05) . Multivariate logistic regression analysis showed that higher levels of these obesity related indices were correlated with more severe vitamin D deficiency in the total population and the females, while only higher LAP, VAI and TG/HDL-C in the males (all P<0.05). The effects of higher LAP was the most prominant in the total population ,the females and the males. Conclusion:Various obesity phenotypes are closely related to vitamin D deficiency in middle-aged and elderly women, while only visceral obesity and abnormal lipid metabolism are related to vitamin D deficiency in middle-aged and elderly men, with LAP being the most important influencing factor.

Objective:To investigate the detection of bone marrow tumor cells in small cell lung cancer (SCLC) patients and their relationship with clinical features, treatment response and prognosis.Methods:A total of 113patients with newly diagnosed SCLC from January 2018 to October 2022 at Beijing Chest Hospital were prospectively enrolled. Before treatment, bone marrow was aspirated and separately submitted for tumor cells detection by liquid-based cytology and disseminated tumor cells (DTCs) detection by the substrction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH) platform. The correlation between the detection results of the two methods with patients' clinical features and treatment response was evaluated by Chi-square. Kaplan-Meier method was applied to create survival curves and the Cox regression model was used for multivariate analysis.Results:The positive rate of bone marrow liquid-based cytology in SCLC was 15.93% (18/113). The liver and bone metastases rates were significantly higher (55.56% vs 11.58% for liver metastasis, P＜0.001; 77.78% vs 16.84% for bone metastasis, P＜0.001) and thrombocytopenia was more common (16.67% vs 2.11%, P=0.033) in patients with tumor cells detected in liquid-based cytology than those without detected tumor cells. As for SE-iFISH, DTCs were detected in 92.92% of patients (105/113), the liver and bone metastasis rates were significantly higher (37.93% vs 11.90% for liver metastasis, P=0.002; 44.83% vs 20.23 % for bone metastasis, P=0.010), and the incidence of thrombocytopenia was significantly increased (13.79% vs 1.19%, P=0.020) in patients with DTCs≥111 per 3 ml than those with DTCs＜111 per 3 ml. The positive rates of bone marrow liquid-based cytology in the disease control group and the disease progression group were 12.00% (12/100) and 46.15% (6/13), respectively, and the difference was statistically significant ( P=0.002). However, the result of SE-iFISH revealed the DTCs quantities of the above two groups were 29 (8,110) and 64 (15,257) per 3 ml, and there was no statistical difference between the two groups ( P=0.329). Univariate analysis depicted that the median progression-free survival (PFS) and median overall survival (OS) of liquid-based cytology positive patients were significantly shorter than those of tumor cell negative patients (6.33 months vs 9.27 months for PFS, P=0.019; 8.03 months vs 19.50 months for OS, P=0.019, P=0.033). The median PFS and median OS in patients with DTCs≥111 per 3 ml decreased significantly than those with DTCs＜111 per 3 ml (6.83 months vs 9.50 months for PFS, P=0.004; 11.2 months vs 20.60 months for OS, P=0.019). Multivariate analysis showed that disease stage ( HR=2.806, 95% CI:1.499-5.251, P=0.001) and DTCs quantity detected by SE-iFISH ( HR=1.841, 95% CI:1.095-3.095, P=0.021) were independent factors of PFS, while disease stage was the independent factor of OS ( HR=2.538, 95% CI:1.169-5.512, P=0.019). Conclusions:Both bone marrow liquid-based cytology and SE-iFISH are clinically feasible. The positive detection of liquid-based cytology or DTCs≥111 per 3 ml was correlated with distant metastasis, and DTCs≥111 per 3 ml was an independent prognostic factor of decreased PFS in SCLC.

Objective:To construct the quality evaluation scale of specification of management for humanistic caring in outpatients and test its reliability and validity.Methods:Referring to the group standards in Specification of Management for Humanistic Caring in Outpatients released by the China Association for Life Care,as well as relevant guidelines and literature,a pool of items for the quality evaluation scale of specification of management for humanistic caring in outpatients was formed.After expert consultation and expert argumentation,a quality evaluation scale of specification of management for humanistic caring in outpatients was constructed.From January to February 2024,243 hospital managers from 5 hospitals in Zhengzhou were selected as survey subjects to conduct item analysis,and reliability and validity testing on the scale.Results:Two rounds of expert inquiry and two rounds of expert argumentation were conducted,with questionnaire response rates of 92.00%and 100.00%,respectively,and expert authority coefficients of 0.952.In the second round of the expert inquiry scale,the mean importance score of the first-level indicators was 4.80 to 5.00,the full score ratio was 88.00%to 100.00%,the coefficient of variation was 0.04 to 0.17,and Kendall's coefficient of concordance was 0.857(P＜0.001);the mean importance score of the second-level indicators was 4.60 to 5.00,the full score ratio was 80.00%to 100.00%,the coefficient of variation was 0.00 to 0.21,and Kendall's coefficient of concordance was 0.775(P＜0.001);the mean importance score of the third-level indicators was 4.60 to 5.00,the full score ratio was 76.00%to 100.00%,the coefficient of variation was 0.00 to 0.21,and Kendall's coefficient of concordance was 0.830(P＜0.001).Finally,a quality evaluation scale of specification of management for humanistic caring in outpatients was formed,including 5 first-level indicators,25 second-level indicators,and 58 third-level indicators.Exploratory factor analysis produced 5 common factors with a cumulative variance contribution rate of 74.628%.The Pearson correlation coefficients between the five-factor scores ranged from 0.648 to 0.798,and the correlation coefficients between the factor scores and the total score of the scale ranged from 0.784 to 0.938.The scale-level content validity index(S-CVI)of the scale was 0.945,the item-content validity index(I-CVI)was 0.725 to 1.000,the Cronbach's alpha coefficient of the total scale was 0.973,and the retest reliability coefficient was 0.934.Conclusion:The constructed quality evaluation scale of specification of management for humanistic caring in outpatients has good scientific validity and reliability,and can be used as an evaluation tool for specification of management for humanistic caring in outpatients.

Objective:To investigate the detection of bone marrow tumor cells in small cell lung cancer (SCLC) patients and their relationship with clinical features, treatment response and prognosis.Methods:A total of 113patients with newly diagnosed SCLC from January 2018 to October 2022 at Beijing Chest Hospital were prospectively enrolled. Before treatment, bone marrow was aspirated and separately submitted for tumor cells detection by liquid-based cytology and disseminated tumor cells (DTCs) detection by the substrction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH) platform. The correlation between the detection results of the two methods with patients' clinical features and treatment response was evaluated by Chi-square. Kaplan-Meier method was applied to create survival curves and the Cox regression model was used for multivariate analysis.Results:The positive rate of bone marrow liquid-based cytology in SCLC was 15.93% (18/113). The liver and bone metastases rates were significantly higher (55.56% vs 11.58% for liver metastasis, P＜0.001; 77.78% vs 16.84% for bone metastasis, P＜0.001) and thrombocytopenia was more common (16.67% vs 2.11%, P=0.033) in patients with tumor cells detected in liquid-based cytology than those without detected tumor cells. As for SE-iFISH, DTCs were detected in 92.92% of patients (105/113), the liver and bone metastasis rates were significantly higher (37.93% vs 11.90% for liver metastasis, P=0.002; 44.83% vs 20.23 % for bone metastasis, P=0.010), and the incidence of thrombocytopenia was significantly increased (13.79% vs 1.19%, P=0.020) in patients with DTCs≥111 per 3 ml than those with DTCs＜111 per 3 ml. The positive rates of bone marrow liquid-based cytology in the disease control group and the disease progression group were 12.00% (12/100) and 46.15% (6/13), respectively, and the difference was statistically significant ( P=0.002). However, the result of SE-iFISH revealed the DTCs quantities of the above two groups were 29 (8,110) and 64 (15,257) per 3 ml, and there was no statistical difference between the two groups ( P=0.329). Univariate analysis depicted that the median progression-free survival (PFS) and median overall survival (OS) of liquid-based cytology positive patients were significantly shorter than those of tumor cell negative patients (6.33 months vs 9.27 months for PFS, P=0.019; 8.03 months vs 19.50 months for OS, P=0.019, P=0.033). The median PFS and median OS in patients with DTCs≥111 per 3 ml decreased significantly than those with DTCs＜111 per 3 ml (6.83 months vs 9.50 months for PFS, P=0.004; 11.2 months vs 20.60 months for OS, P=0.019). Multivariate analysis showed that disease stage ( HR=2.806, 95% CI:1.499-5.251, P=0.001) and DTCs quantity detected by SE-iFISH ( HR=1.841, 95% CI:1.095-3.095, P=0.021) were independent factors of PFS, while disease stage was the independent factor of OS ( HR=2.538, 95% CI:1.169-5.512, P=0.019). Conclusions:Both bone marrow liquid-based cytology and SE-iFISH are clinically feasible. The positive detection of liquid-based cytology or DTCs≥111 per 3 ml was correlated with distant metastasis, and DTCs≥111 per 3 ml was an independent prognostic factor of decreased PFS in SCLC.