Objective To explore the relationship between homocysteine (Hcy)expression and diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM).Methods 100 cases with T2DM were selected,they were divided into observation group(diabetic early nephropathy,n =50)and matched group(simple diabetes,n =50),50 healthy people were involved as control group.Hcy,BUN and Cre were detected and compared among groups. Results Hcy level in 3 groups showed a increased trend,there were significant differences among groups (F =145.007,P <0.01).Hcy level of the control group was (8.19 ±0.92)μmol/L,which was significantly lower than that in the observation group and matched group[(9.63 ±1.15)μmol/L (P <0.01)and (11.94 ±1.24)mmol/L (P <0.01)].There were no significant differences of levels of BUN and Cre among the groups (F =0.66,P >0.05),the comparison between groups also had no statistical significance (P =0.936,0.097,all P >0.05 ). Conclusion Hcy may participate in the process of early type 2 diabetic nephropathy,can be used as important reference index of diagnosis of early diabetic nephropathy.

OBJECTIVE To investigate the management criteria for selecting and applying of prosthesis and implants.METHODS Through a standard system and appropriate measures,the strict management to the purchase and entire application of prosthesis and implants was encouraged.RESULTS The systemic management ensured the hospital to use prosthesis and implants safely on patients and prevent from improper or illegal use,thus to safeguard the interests of both the patients and the hospital,avoiding unnecessary harms to patients′ body and spirit,therefore to minimize the conflicts between hospitals and patients.During the implementation of the management,further improvement and investigation were required.CONCLUSIONS Maintaining the mutual inferests between patients and hospital,avoiding unnecessary harms to patients′can minmize the medical conflicts and persistent improvements.

Objective Maple syrup urine disease (MSUD) is a rare metabolic disorder caused by deficiency of the activity of branched-chain 2-keto acid dehydrogenase complex.The complex contains E1α,E1β and E2 subunits which are encoded by BCKDHA,BCKDHB or DBT genes respectively.Mutation in any gene will cause MSUD.The aim of this study was to analyze the gene mutations of four cases with MSUD and carry out prenatal diagnosis for these four families for MSUD.Methods From 2005 to 2010,four neonates (two males and two females) were diagnosed as MSUD at 2,5,10and 26 days of life.The coding regions of BCKDHA gene and BCKDHB gene in the above four cases were amplified by polymerase chain reaction and analyzed by direct DNA sequencing.During the second pregnancy of the same mother,the amniotic fluid was drawn out at 16-20 weeks for gene mutation analysis after the amniocytes were cultured.Results Mutation analysis revealed six mutations in four patients,including four novel mutations (c.308T＞C,c.562G＞T,c.1279C＞G and c.1280-1291de112) and two previously reported mutations.Five mutations (c.308T＞C,c.562G ＞T,c.868G＞A,c.1279C＞G and c.1280-1291de112) were detected on BCKDHA gene in three patients.While one mutation (c.853C＞T) was found on BCKDHB gene in one patient.Only one mutation was found in the amniocytes of each patient's mother at their second pregnancies suggesting a MSUD heterozygous fetus.Conclusions Analysis of BCKDHA and BCKDHB allowed preliminary understand of gene mutations in the four MSUD families,and made prenatal diagnosis possible,which helped in consultation in the second pregnancy.

Objectives To calculate the rate of pathological underestimation for core needle biopsy (CNB)- diagnosed intraductal papillary tumors, to analyze the clinical and imaging data of patients and to dis-cuss factors for underestimation. Methods A retrospective analysis of patients undergoing core needle biopsy and subsequent surgical excision was performed. 1359 female patients undergoing CNB from Jan. 2010 to Feb. 2013 in Comprehensive Breast Health Center of Ruijin hospital were analyzed. Clinical, radiological and histo-logical variables were assessed using the Chi-square test, Fisher’s exact test and a binary logistic regression model in order to predict pathological underestimation for tumors. Results There were 50 patients with CNB-di-agnosed intraductal papillary tumors. The overall underestimation rate was about 44%(22/50). CNB-diagnosed atypical papillary lesions (OR=15.164, 95% CI 1.49-170.443) and BI-RADS 5 by MRI (OR=26.766, 95% CI 2.409-297.440)were significantly related to underestimation in these patients. Conclusions Considering the high underestimation rate in CNB-diagnosed intraductal papillary tumors, routine surgical excision should be per-formed to avoid potential malignancy, especially for patients with high risk factors. MRI is helpful in these pa-tients to predict underestimation.

Objective To explore the influence of peer support on blood glucose management of type 2 diabetic patients.Methods From April 2017 to December 2017,the study subjects were selected according to the inclusion criteria from all type 2 diabetes patients who admitted in the Fourth People′s Hosipital of Ningbo.The patients in bed 1-9 were assigned into observation group,and patients in bed 10-20 were assigned into control group.All beds were assigned randomly from a random number generator.Standard diabetes education was provided to both two groups,while peer support was added to the experimental group.The average hospitalization costs and length of hospital stay were compared between the two groups using t-test.Results The average hospitalization cost of the observation group was(6218.48 ±1432.75)yuan,which of the control group was(6913.32 ±1426.34)yuan,the average hospitalization time of the observation group was(6.49 ±1.91)d,which of the control group was(7.41 ±1.99)d,the differences between the two groups were significant(t=-4.480,-4.347,all P<0.01).Conclusion Application of peer support to the glucose management in patients with type 2 diabetes can effectively enhance education effect and reduce hospitalization cost and length of hospital stay.

Objective To apply the Plan -Do -Check -Act ( PDCA ) cycle in glucose management in inpatients with diabetes , in order to decrease the incidence of hypoglycemia and related complications .Methods 517 inpatients with diabetes were divided into 4 groups according to the quarter ,the monthly incidence rates of hypo-glycemia were collected.The association of monthly incidence of hypoglycemia with age (≥65 years),longer diabetic history (≥5 years),lower C-peptide (<0.370nmol/L),receiving combined regimen (basal insulin plus 3 doses of pre-prandial short-acting insulin ) were analyzed .PDCA cycle was applied for hypoglycemia detection and etiolo-gy control in order to achieve quality improvement via effective glucose control measures .Theχ2 test was used to ana-lyze the incidence of the hypoglycemia in each group .The hypoglycemic incidence based on different characteristics , were also compared with the overall hypoglycemic incidences of all patients .Results The incidence of hypoglycemia was significantly reduced with the application of PDCA cycle in inpatients with diabetes ,from 44.09％ in the first quarter to 13.04％ in the fourth quarter (χ2 =32.815,P<0.001).The annual hypoglycemic incidence rate was 26.89％.The patients with low C-peptide or receiving combined regimen had significantly higher incidence rate of hypoglycemia (53.57％and 31.88％) as compared to general inpatients with diabetes (χ2 =35.721,7.105,all P<0.05).Conclusion The application of PDCA cycle can effectively decrease the incidence of hypoglycemia ,and it can be a great asset for management of inpatients with diabetes .

Objective To study the application of walking combined with Buerger exercise in the treatment of grade 0 diabetic foot.Methods Eighty patients with grade 0 diabetic foot were randomly divided into observation group and control group.The control group was trained by walking exercise .The observation group was trained by walking combined with Buerger exercise through 12 months of training.The changes of self-sensory symptoms,ABI and DAWV were observed.Results The self-sensory symptoms of the two groups were significantly decreased (observation group: markedly effective 15 cases,effective 19 cases;control group: markedly effective 5 cases,effective 23 cases).The effective rate of the observation group was higher than that of the control group (85% vs.70%,χ2 =7.831,P <0.05).The ABI ratio of the two groups were higher than those before treatment ,and the ABI ratio of the observation group was higher than that of the control group [(0.889 ±0.113) vs.(0.842 ±0.124),t =1.772 P <0.05].The ratio of DAWV in the observation group was higher than that in the control group [(6.772 ±0.435)cm/s vs.(6.543 ±0.552)cm/s,t =2.061,P <0.05].Conclusion Walking combined with Buerger exercise can improve the blood flow velocity and blood flow of the collateral circulation of the lower limbs of patients with grade 0 diabetic foot,and improve the self-sensory symptoms of peripheral neuropathy .

Objective: The current study aimed to evaluate the predictive performances of anatomic staging system (AS) and prognostic staging system (PS) proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual in patients with pure mucinous breast cancer (PMBC). Methods: Clinicopathologic features and follow-up information were collected from a total of 3628 patients with PMBC. Breast cancer-specific survival (BCSS) were compared among patients in different stage groups. Likelihood ratio (LR) χ², Akaike information criterion (AIC) and Harrell′s concordance index (C-index) were used to evaluate the predictive performances of AS and PS in PMBC. Results: In PMBC, BCSS was associated with tumor size (P=0.002), lymph node status (P=0.002), grade(P=0.003), PR status(P=0.017)and the receipt of radiation. Compared to AS, 1326 patients (37.54%) underwent stage change after applying PS, with 6.50% upstaged and 37.04% downstaged. There were significant differences in BCSS among patients of different stages under the AS and PS (P<0.001). However, PS was not superior to AS in predicting prognosis (AS vs PS, LR χ²: 16.41 vs 17.5; AIC: 357.44 vs 358.35; C-index, 0.72 vs 0.73, P=0.667). Conclusions Both of AS and PS proposed in the 8th edition American Joint Committee on Cancer (AJCC) staging manual were predictive factors in patients with PMBC. Compared with AS, the PS did not show superiority in prognosis prediction among patients with PMBC.

Objective:To understand the status quo of autonomous learning ability of nurses in ClassⅢ Grade A psychiatric hospitals and analyze its influencing factors, so as to provide a basis for further improvement of nurse specialist education.Methods:Using the convenient sampling method, a questionnaire survey was conducted among 910 nurses in 5 ClassⅢ Grade A psychiatric hospitals in Zhejiang province from July to October 2019. The survey methods included General Information Questionnaire and Self-Learning Ability of Nursing Staff Evaluation Scale. Multiple linear regression analysis was carried out on the influencing factors of autonomous learning ability of nurses. A total of 910 questionnaires were issued and 904 valid questionnaires were recovered.Results:The total score of Self-Learning Ability of Nursing Staff Evaluation Scale of 904 nurses was (118.43±19.14) , the score of self-motivation belief dimension was (49.49±8.32) and score of the self-evaluation dimension was (14.05±2.39) . There were statistically significant differences in scores of autonomous learning ability of nurses among different genders, working departments, initial and final education background, employment method and current post ( P<0.05) . The results of multiple linear regression analysis showed that gender, initial education, current post and work department were the main factors affecting the autonomous learning ability of nurses, which jointly explained 40.1% of the total variation of the autonomous learning ability of nurses in psychiatric hospitals ( R2=0.401, F=15.685, P<0.001) . Conclusions:The self-learning ability of nurses in psychiatric hospitals is at a general level. Nursing managers should pay attention to the group of nurses with low self-learning ability, and carry out multi-level, multi-form and multi-channel on-the-job training methods for nurses with different educational backgrounds and posts to promote the improvement of self-learning ability and overall quality of nurses.

Objective: To evaluate the choice of surgical treatment of ductal carcinoma in situ (DCIS) and its impact on long-term outcomes. Methods: A retrospective analysis of the clinicopathological features and treatment protocol of DCIS patients who underwent surgical treatment in Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine from January 2009 to August 2016 was done. The factors which could affect surgical treatment were analyzed by χ² test and Logistic regression. Survival analysis were performed between different surgical approaches. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival and overall survival. Results: A total of 526 patients were enrolled in this study, 405 cases (77.0%) underwent mastectomy, 121 cases (23.0%) underwent breast-conserving surgery, of which 88 cases received radiotherapy after breast-conserving surgery. It was shown by univariate and multivariate analysis that age>50 years (OR=0.631, 95% CI: 0.413 to 0.965, P=0.034), first symptom of nipple discharge (OR=0.316, 95% CI: 0.120 to 0.834, P=0.020), excision biopsy (OR=1.831, 95% CI: 1.182 to 2.835, P=0.007) and tumor size >3 cm (OR=0.422, 95% CI: 0.206 to 0.864, P=0.018) were significantly correlated with choice of surgical treatment for breast lesions. Axillary lymph node dissection was performed for 118 cases (22.4%), with sentinel lymph node biopsy for 327 cases (62.2%), and none for 81 cases (15.4%). There was significant statistical difference in the choice of axillary lymph node management in patients of different age (χ²=8.124, P=0.017), biopsy type (χ²=35.567, P=0.000), breast operation type (χ²=149.118, P=0.000) and tumor size (χ²=13.394, P=0.010). The 5-year disease free survival rates was 95.7%, 89.6% and 100%, respectively, for mastectomy group, breast-conserving surgery group and breast-conserving surgery plus radiotherapy group. And the 5-year overall survival rates for three groups were 99.0%, 100% and 100%. The differences were not statistically significant (P=0.427, 0.777). Conclusions For DCIS patients, age, first symptom and tumor size are independent predictors of breast surgery. The choice of axillary lymph node surgery is influenced by age, biopsy, operation type, and tumor size. Different surgical treatment options has no significant effect on disease-free survival and overall survival in DCIS patients.