Corresponding author:PAN Cong-qing,E-mail:cq.pan@163.com Objective The prevalence of diabetic foot was 2.3% for out-patients and 8.6% (208/2428) for in-patients with amputation rate of 17.3% in our hospital from May 1997 to Dec 2000, more often seen on right than left extremity and in patients over 50 years old than in the younger.

OBJECTIVETo explore the relationship between microsomal triglyceride transfer protein (MTP) gene variation and diabetic dyslipidemia among Chinese.

METHODSUsing PCR restriction fragment length polymorphism (PCR-RFLP) analysis and gene sequencing, we studied the influence of a common MTP gene polymorphism in the promoter region on the apoB-containing lipoproteins in 44 Chinese type 2 diabetic subjects and 32 non-diabetic volunteers.

RESULTSA common functional G/T polymorphism in 493 bp upstream from the transcriptional start point was detected among native Chinese. There were 41 carriers (53.9%) of the MTP-493 G/G genotype, 28 (36.8%) of the MTP-493 G/T genotype and 7 (9.3%) of the MTP-493 T/T genotype. The allele frequency of MTP-493 T in the diabetic group was 0.30. The MTP-493 T/T diabetic group had significantly higher TG (P < 0.05), VLDL-CH (P < 0.05) and smaller LDL particle size (P < 0.001) than the MTP-493 common genotype group.

CONCLUSIONGenetic variation in the MTP promoter is likely to be highly involved in the production of dyslipidemia in type 2 diabetic subjects.

Carrier Proteins ; genetics ; Diabetes Mellitus, Type 2 ; genetics ; Genotype ; Humans ; Hyperlipidemias ; etiology ; genetics ; Polymorphism, Genetic ; Promoter Regions, Genetic

Objective:To explore the journey map of patients with chronic constipation during fecal microbiota transplantation.Methods:This study adopted phenomenological methods. From October to December 2023, purposive sampling was used to select chronic constipation follow-up patients who underwent fecal microbiota transplantation at the Intestinal Microecology Center of Shanghai Tenth People's Hospital as respondents for semi-structured interviews. Colaizzi 7-step analysis method and NVivo 11.0 software were used for data analysis.Results:A total of 15 interviewees were interviewed. During fecal microbiota transplantation, the journey map of constipation patients included stages, mood changes, touchpoints, themes, emotional experiences and opportunities. The patient's experience and needs were summarized into three themes and ten sub-themes, including pre-transplant adaptation disorders to new environments (unfamiliarity and confusion-admission coordination disorders, anxiety and expectations-diverse complex emotions, puzzle and helplessness-asymmetric doctor and patient information), effectiveness-related psychological and social experiences in transplantation (attention and expectations-longing for positive efficacy, perception of benefits and risk avoidance, shame and inferiority-treatment stigmatization experience, questioning and despair-unrealized expectations, treatment resistance-sensitive economic burden), post-transplant transition dilemmas (inaccessible medical services-lack of continuous treatment and nursing, disease recurrence troubles) .Conclusions:This study visualizes the experiences and needs of constipation patients during microbiota transplantation through a patient journey map and identifies multidimensional issues and needs of patients. Clinical medical and nursing staff should pay attention to the needs of patients at different stages of the treatment process when formulating intervention programs to improve the quality of fecal microbiota transplantation nursing.

Objective To investigate the diagnosis, treatment and prevention method for bile duct injury caused by laparoscopic cholecystectomy (LC). Methods Clinical data of 16 patients with iatrogenic bile duct injury caused by LC in Meizhou People's Hospital of Guangdong Province between January 2007 and January 2013 were retrospectively analyzed. Among them, 7 were males and 9 were females, aged 28-75 years old with a median age of 47 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The types of bile duct injury were classified according to the Strasberg bile duct injury classification. Treatments and postoperative clinical manifestations were analyzed, and clinical efficacy was observed. Results Among 16 patients, 9 were converted to open surgery during the surgery, and 7 underwent open surgery within 2 weeks after LC. There were 2 cases of type A bile duct injury, 7 of type D, 2 of type E1, 3 of type E2 and 2 of type E4. Two cases underwent bile duct repair alone, 1 underwent bile duct repair and stage Ⅱ endoscopic retrograde cholangiopancreatography (ERCP) balloon dilatation, 4 underwent bile duct repair + T tube drainage, 3 underwent bile duct anastomosis + T tube drainage, and 7 underwent Roux-en-Y anastomosis. One case died from multiple organ failure in the perioperative period. Recurrent mild biliary tract infection was observed in 1 case after surgery, biliary tract stenosis in 1 case and obstructive jaundice in 1 case, and all the other patients recovered. Conclusions For the bile duct injury caused by LC, surgeons should not only be familiar with the early diagnosis method, clinical classification and surgical treatment principles for iatrogenic bile duct injury, but also possess the capacity of coping with emergenices. During the surgery, surgeons should carefully identify the relationship among cystic duct, common bile duct and gallbladder ampulla, and perform precisely. Early diagnosis and appropriate treatment also play an important role.

Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making,and to provide a basis for developing decision support strategies.Methods From April to December 2023,through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing'an District,Shanghai.semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate.Data were analyzed via Braun's style of thematic analysis.Results 4 themes and 10 sub-themes were identified.Theme 1:negative emotional dilemmas(urgent decision-making leads to anxiety,fear,and unknown stroke trajectory increases the sense of uncertainty).Theme 2:supportive environment dilemmas(lack of information support delays decision-making;lack of family support increases decision-making stress;insufficient economic support increases the burden of decision-making).Theme 3:the dilemma of weighing the pros and cons(difficult trade-offs between risk and reward,tough decisions between reality and ethics,conflicting choices of life and dignity).Theme 4:preference management dilemmas(practical difficulties in adhering to patient preferences,impediments to decision-making due to unknown patient preferences).Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas.Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers,as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.