Objective To explore the association of serum Irisin with diabetic nephropathy(DN) in patients with type 2 dia‐betes mellitus(T2DM) .Methods Totally 40 cases of patients with newly diagnosed T2DM(SDM group) ,41 cases of patients with early diabetic nephropathy(EDN group) ,and 42 cases of patients with clinical diabetic nephropathy(CDN group) were selected ,an‐other 40 healthy individuals with normal glucose tolerance were selected as the controls(NC group) .Serum Irisin was measured by using ELISA method .Results (1) The serum Irisin levels of four groups from high to low were:NC group(320 .48 ± 107 .03)ng/mL ,SDM group(291 .53 ± 101 .01)ng/mL ,EDN group(278 .54 ± 93 .48)ng/mL ,CDN group(209 .12 ± 88 .53)ng/mL ,and the difference was statistically significant(P<0 .05) .(2)The correlation analysis showed that Irisin level was negatively correlated with insulin resistance index (HOMA‐IR) ,fasting insulin (FINS) ,FPG ,HbA1c ,Scr ,BUN ,TNF‐αand UAlb/Cr(r= -0 .592 ,-0 .610 ,-0 .614 ,-0 .638 ,-0 .538 ,-0 .552 ,-0 .589 ,-0 .561 ,P<0 .05) ,and positively correlated with superoxide dismutase (SOD) and HDL(r=0 .578 ,0 .556 ,P<0 .05) .(3)The regression analysis showed that UAlb/Cr and HOMA‐IR were the independent influen‐cing factors of Irisin .Conclusion The level of serum Irisin in DN patients is decreased ,and the level of Irisin may be correlated with the severity of DN .

Objective To investigate the effects of Metformin on serum proprotein convertase subtilisin/kexin type 9(PCSK9)level in patients with type 2 diabetes(T2DM). Methods 48 healthy people with normal glucose tolerance were selected as the controls (NGT group). 93 newly diagnosed T2DM were randomized to Metformin treated group (Met,n= 47 )and Glipizide treated group (Gli,n=46).Serum PCSK9 was measured by ELISA in all participants. After treatment,the changes of serum PCSK9 were observed in Met group and Gli group. Results Serum PCSK9 levels in Met group and Gli group were higher than NGT group(P<0. 01). PCSK9 level was positively correlated with FPG,HbA1 c, HOMA-IR,FIns,TC,LDL-C,TG,hsC-RP,TNF-αand BMI (r= 0. 578,0. 638,0. 556,0. 610,0. 578, 0. 592,0. 589,0. 638,0. 561,0. 552;P<0. 05 or P<0. 01),and negatively correlated with HDL-C(r=-0. 614,P<0. 01). The levels of PCSK9 significantly decreased after treatment with Metformin(P<0. 05). PCSK9 levels had no significant differences before and after treatment with Glipizide. Multiple regression analysis showed that TNF-αand HOMA-IR were independent related factors of PCSK9. Conclusion T2DM patients have high levels of serum PCSK9 which can be decreased by Metformin.

Objective To explore the effect and mechanism of curcumin on rat cerebral ischemia reperfusion injury.Methods The rat model of cerebral ischemia reperfusion injury was constructed by the suture-occluded method.The effects of curcumin on cerebral infarction range,cerebral water content,neurological symptoms,cerebral histopathological morphology and expressions of PI3K,AKT,p-AKT,m-TOR,MDA,CAT,GPX,SOD,Bcl-2,Bax,Caspase-3 and Cleavage-Caspase-3 were evaluated.Results Cur-cumin had the protective effect on cerebral ischemia reperfusion injury,could alleviate the neurological symptoms,decreased the cer-ebral tissue pathological morphological changes and cerebral water content,in addition,which could alleviate the expressions of MDA,Bax,Cleavage-Caspase-3,IL-6,MCP-1 and TNF-αand increased the expressions of PI3K,p-AKT,mTOR,Bcl-2,Caspase-3, CAT,GPX and SOD.Conclusion The curcumin pretreatment has the significantly protective effect on cerebral ischemia-reperfusion injury,which may be associated with activating PI3K/AKT/mTOR signal pathway,while suppressing inflammation,apoptosis and oxidative stress.

Objective To investigate the changes of serum stromal cell‐derived factor‐1α (SDF‐1α) in patients with diabetic peripheral neuropathy (DPN) and the influence of mouse never growth factor (MNGF) on the levels of serum SDF‐1α. Methods 180 patients with type 2 diabetes (T2DM ) were divided into T2DM with DPN (DPN group ,n=92) and T2DM without DPN (T2DM group ,n=88). 90 healthy people were select as normal control (NC group). DPN group was divided into 47 cases of MNGF treatment (A) subgroup and 45 cases of basic treatment (B) subgroup. The levels of serum SDF‐1αwere measured using ELISA method. The relationships between the levels of serum SDF‐1αand SOD ,TGF‐β1 , hsC‐RP ,and GAP‐43 were analyzed. After treatment ,the levels of serum SDF‐1α in A and B subgroups were compared. Results Compared with NC group [(0.91 ± 0.37)μg/L] ,the levels of serum SDF‐1αin T2DM and DPN group were higher [(2.58 ± 0.58) μg/L and(1.71 ± 0.43)μg/L ,respectively ,P<0.05 or P<0.01]. The levels of SDF‐1αwere positively correlated with FPG ,HbA1 c ,TGF‐β1 and hsC‐RP ,and negatively correlated with SOD in T2DM group. The levels of SDF‐1αwere positively correlated with TG and TGF‐β1 ,and negatively correlated with course of disease ,FPG ,HbA1 c ,SOD ,hsC‐RP ,GAP‐43 , MMCV ,PMCV ,MSCV and PSCV in DPN group. SDF‐1α levels were significantly increased after treatment with MNGF in subgroup A [(1.75 ± 0.39) vs (2.09 ± 0.45)μg/L ,P<0.05]. There were no significant difference of SDF‐1αlevels after treatment in subgroup B [(1.67 ± 0.48) vs (1.71 ± 0.51)μg/L , P>0.05] .Multiple stepwise regression analysis showed that HbA1c ,hsC‐RP and PSCV were the independent factors related with the levels of SDF‐1αin DPN patients. Conclusion The levels of serum SDF‐1αin DPN patients are lower than in T2DM patients without DPN. MNGF may increase the level of serum SDF‐1α.

Objective To explore the level of angiopoietin‐like protein 4 (ANGPTL4) in patients with early chronic kidney disease (CKD ) in diabetes and the influence of pioglitazone on the level. Methods 92healthypeoplewithnormalglucosetolerancewereselectedasthecontrols(NCgroup).89 newly diagnosed T2DM were selected (T2DM group ). 90 cases of CKD group were divided into pioglitazone (PGZ) and glimepiride (GLI) treated subgroups ,45 cases in each subgroup. After treatment , serum ANGPTL4 levels were observed in CKD group. Results There were significant differences in serum ANGPTL4 levels among NC ,T2DM and CKD groups [(34.8 ± 4.75) vs (31.1 ± 3.65) vs (27.1 ± 3.52)ng/ml ,P<0.05 or P<0.01]. ANGPTL4 level was positively correlated with SOD ,TG (r=0.635 , 0.526 ,P< 0.05 or P< 0.01) ,and negatively correlated with BMI ,FPG ,HbA1c ,hsC‐RP ,UAlb/Cr , VEGF ,FIns ,HOMA‐IR (r= -0.502 ,-0.624 ,-0.542 ,-0.520 ,-0.538 ,-0.566 ,-0.576 ,-0.509 ,P< 0.05 or P < 0.01 ). In PGZ subgroup after treatment ,ANGPTL4 levels were significantly increased and UAlb/Cr significantly decreased [(31.51 ± 3.87 ) vs (27.60 ± 3.58 )ng/ml ,P < 0.05 ;(88.50 ± 8.90 ) vs (116.20 ± 10.30 )mg/24 h ,P < 0.01 ]. In GLI subgroup after treatment ,there were no significant difference in FPG and HbA1 c as compared with PGZ subgroup but ANGPTL4 levels have no significant differences after treatment ,and UAlb/Cr decreased [(27.20 ± 3.54 ) vs (26.60 ± 3.48 )ng/ml ,P > 0.05 ;(99.70 ± 12.80 ) vs (122.40 ± 13.10 )mg/24 h ,P < 0.05]. HbA1 c ,FIns ,UAlb/Cr were the independent related factors influencing ANGPTL4 of CKD patients. Conclusion Serum ANGPTL4 has a lower level in CKD patients. PGZ is effective in treating CKD. This role is associated with the increase of serum ANGPTL4.

Objective Construction of a predicting model of uncertainty in illness based on Mishel's theories of uncertainty in illness in a sample of the postoperative patients with digestive system tumors undergoing chemotherapy.Methods By convenient sampling method,MUIS-A,MSAS,SSRS were used to evaluate 484 postoperative patients with digestive system cancer during chemotherapy period,and then AMOS 17.0 software was used to perform analysis.Results The score of uncertainty in illness of postoperative patients with the digestive system cancer undergoing chemotherapy was in the medium level (89.86+11.84) points; Structure provider (social support,economic income) could not only reduce the uncertainty directly,but also had an indirect effect on the uncertainty by stimuli frame (symptoms pattern,event familiarity).Conclusions Structure equation model can be applied to the uncertainty in illness model construction,so as to help medical staff manage uncertainty in illness pertinently.

Objective To investigate the empathy of clinical nurses and analyze the influencing fac-tors.Methods Totally 465 clinical nurses were investigated with demographic data and interpersonal Reactivity Index-C (IRI-C).Results Mean score of the empathy of clinical nurses was (53.77±8.99)points with a medium level.Age,working years,whether or not to engage in management work were the main predictors of empathy.There were no significant differences in nurses with different genders,marital status,professional titles,education degree,hospital grades.Conclusions The length of the working years is one of the important factors of nursing unit.Common clinical nurses should be involved in the nursing manage-ment.Clinical nurses should pay attention to the study and discussion about empathy knowledge in order to improve their level of empathy.

Objective To study the epidemiological tendency and influencing factors for major chronic diseases in the elderly in Changsha,and to provide the scientific basis for the prevention and control strategies for the aged people.Methods Multi-stage randomized cluster sampling method was used in selecting 3135 persons aged 65 and over in Changsha.Using unified questionnaire and face to face asking method to investigate the prevalence of chronic diseases and its influencing factors.Results 95.7％ of questionnaires were valid (3000/3135).The total prevalence rate of chronic disease was 86.33％ in patients aged from 65-96 (74.83±6.63) years,with 85.49％ (1332) in males,and 87.23％ (1258) infemales(x2=1.93,P=0.164).Most of them had 1-3 kinds of chronic diseases,in 1 patient with 13 kinds of chronic diseases at the most.The most common chronic diseases among the elderly were hypertension,heart diseases,osteoarthritis,diabetes mellitus,benign prostatic hyperplasia,and fatty liver.Multivariate logistic regression suggested that age,marital status,smoking,quality of sleep were common influencing factors for hypertension,heart diseases and diabetes mellitus.Conclusions The prevalence of chronic diseases is high and the influencing factors are ubiquitous among the elderly in Changsha community.Community health education should be carried out to improve the effect of prevention and control of chronic diseases.

Objective To explore the relationship of empathy ability and leadership among nurse managers.Methods 184 nurse managers completed the Interpersonal Reactivity Index-Chinese Version (IRI-C)scale and Leadership Questionnaire for Nursing Manager for empathy and leadership.Results The average score of the empathy is 57.72±8.59,the average score of leadership is 102.38±14.38.The relationship between empathy and leadership is positive and the coefficient of correlation is r =0.21,(P＜0.05).Conclusion The empathy and leadership ability of the nurse managers surveyed are found to be at intermediate level; empathy ability and leadership have positive interactions; and improved empathy ability of nurse managers can strengthen their leadership.

Objective:To investigate the application of the decision-oriented context-input-process-product (CIPP) model combined with integrated teaching in standardized training of medical oncology.Methods:A total of 98 standardized training residents who participated in standardized training in Department of Oncology, Jiangsu Cancer Hospital, were enrolled as subjects, and they were divided into control group and observation group using a simple random number table, with 49 residents in each group. The residents in the control group received routine teaching, and those in the observation group received CIPP model combined with integrated teaching. The two groups were compared in terms of department examination score and assessment of subjective learning effect, and the observation group was assessed in terms of critical thinking ability before and after training. SPSS 22.0 was used for the t-test. Results:Compared with the control group, the observation group had significant increases in theoretical examination score ( t=2.95, P=0.004), practical operation score ( t=17.04, P<0.001), and total score ( t=3.55, P=0.001). After training, the observation group had significant increases in the scores of each dimension of critical thinking ability and the total score of critical thinking ability ( t=2.89, 3.55, 3.37, 3.20, 3.13, 2.67, 3.06, 3.13; P=0.005, 0.001, 0.001, 0.002, 0.002, 0.009, 0.003, 0.002). The observation group had significantly higher assessment scores of subjective learning effect than the control group ( t=3.46, 3.56, 2.83, 2.85, 2.57, 3.07; P=0.001, 0.001, 0.006, 0.005, 0.012, 0.003). Conclusion:The CIPP model combined with integrated teaching can improve the department examination score and critical thinking ability of standardized training residents in medical oncology, with good assessment results of subjective learning effect.