Objective To systematically evaluate the effectiveness of diabetes self-management education through telemedicine on glycosylated hemoglobin (HbA1c). Methods Randomized clinical trials (RCTs) that assessed the effectiveness of remote diabetes self-management education in patients with diabetes were systematically reviewed using multiple electronic databases. The searching time was from database establishment to May 2015. These articles were analyzed after evaluation of their quality. Results Eight RCTs were included involving 2 047 patients.The results of Meta-analysis showed the effectiveness of remote DMSE on reduction of HbA1c of patients with type 2 diabetes was more significant than that of the control group [WMD=-0.50,95%CI (-0.88,-0.12),P < 0.05],while failing to support the effectiveness of remote DMSE on patients with type 1 diabetes [WMD=0.62, 95%CI(-0.19,1.43), P>0.05]. Conclusions Remote DMSE is effective to improve the glycemic control in patients with type 2 diabetes,while the effect on patients with type 1 diabetes is still not certain. Large-scale and multi-centered RCTs are needed to confirm its effectiveness.

Objective: To investigate the willingness to receive a COVID-19 vaccination and its influencing factors among individuals that missed the second dose of the inactivated COVID-19 vaccine in Zhejiang Province, so as to provide the evidence for improving the strategy for COVID-19 vaccination. Methods: Individuals that did not receive the second dose of the inactivated COVID-19 vaccine after 56 days of getting the first dose (missed individuals) from March and May, 2021, were randomly sampled from Zhejiang Provincial SaaS Vaccination Information System. Their basic information, status of getting the inactivated COVID-19 vaccine and willingness to receive the second dose of the inactivated COVID-19 vaccine were collected through telephone interviews. The factors affecting the willingness to receive the second dose of the inactivated COVID-19 vaccine were identified among the missed individuals using a multivariable logistic regression model. Results: Totally 562 individuals were investigated, and there were 292 (51.96%) valid respondents. There were 54 actual missed individuals, with a mean age of (40.91±16.75) years, which included 39 men (72.22%) and 15 women (27.78%). Of all missed individuals, 23 had an educational level of junior high school and below (42.59%). The mean duration from the time of investigation to the time of getting the first dose of the inactivated COVID-19 vaccine was (137±28) days. A half of the missed individuals were willing to receive the second dose of the inactivated COVID-19 vaccine. Multivariable logistic regression analysis showed high willingness to receive the second dose of the inactivated COVID-19 vaccine among the missed individuals with requirements of vaccination in the workplace (OR=5.393, 95%CI: 1.112-26.152) and low willingness among the missed individuals that felt physical discomfort after receiving the first dose (OR=0.168, 95%CI: 0.035-0.806). Conclusions The willingness to receive the second dose of the inactivated COVID-19 vaccine was low among the missed individuals, and high willingness is seen among the missed individuals with requirements of vaccination in the workplace and without physical discomfort after receiving the first dose of the inactivated COVID-19 vaccine.

ObjectiveTo explore the correlation between butylphthalide and plasma brain-type creatine kinase isoenzyme (CK-BB),endothelin (ET),calcitonin gene related peptide (CGRP) in patients with acute cerebral infarction (ACI).MethodsSixty patients with ACI were divided into treatment group and control group with 30 cases each by random digits table method.Both groups received normal treatment continuously for 7 days,and butylphthalide of 200 mg was added to treatment group for 3 times per day.The levels of plasma CK-BB,ET and CGRP of two groups before and after treatment were measured and compared.ResultsThe levels of plasma CK-BB,ET of two groups both decreased significantly after treatment,but CGRP rose obviously.It showed significant differences before and after treatment of both groups (P ＜0.01 or ＜ 0.05).The levels of plasma CK-BB,ET of treatment group after treatment were lower than those of control group in the same period [(216.48±36.95) U/L vs.(333.07±54.03) U/L,(83.33±26.48)ng/L vs.(98.46±31.46) ng/L,P ＜ 0.05 ].The level of plasma CGRP of treatment group after treatment was significantly higher than that of control group in the same period [ (44.16±13.28 ) ng/L vs.(36.42±12.31 )ng/L,P ＜ 0.05 ].ConclusionButylphthalide can reduce the plasma enzyme activity,balance ET and CGRP,extend the cerebral arteries to antagonize ET,improve cerebral ischemia and cerebral hypoxia,which can protect brain cells and endothelial cells.

To study the in situ intestinal absorption kinetics of flrubiprofen in rats, the absorption of flurbiprofen in small intestine (duodenum, jejunum and ileum) and colon of rats was investigated using in situ single-pass perfusion method and the drug content was measured by HPLC. The effects of drug concentration on the intestinal absorption were investigated. The K(a) and P(app) values of flurbiprofen in the small intestine and colon had no significant difference (P > 0.05). Drug concentration (4.0, 10.0 and 16.0 mg x L(-1)) had no significant influence on the K(a) values (P > 0.05). However, when concentration was 4.0 mg x L(-1) and 10.0 mg x L(-1), significant effect on the P(app) values (P < 0.05) was found, but significant effect on the P(app) values was not shown between 10.0 mg x L(-1) and 16.0 mg x L(-1) (P > 0.05). The K(a) and P(app) values of flurbiprofen on the perfusion flow rate had significant difference (P < 0.05). Flurbiprofen could be absorbed at all segments of the intestine in rats and had no special absorption window. The absorption of flurbiprofen complies with the facilitated diffusion in the general intestinal segments, and accompany with the cytopsistransport mechanism probably. The perfusion flow rate had significant effect on the K(a) and P(app).

Objective To know the correlation of anxiety and pains of out-patients who had accept-ed operation and the effect of nursing intervention. Methods Divided 173 out-patients with operation in-to the intervention group(83 cases) and the control group(90 cases) randomly. Routine nursing cares was used in the control group, preoperative health education was used in the intervention group in addition. Us-ing the Me-Gill and SF-MPQ to evaluate pains between the 2 groups. Using the S-AI and the T-AI to evaluate the emotional condition between the 2 groups. Results The indexes which can indicated the pains and emotional condition in the intervention group after the health education were significant better than those of in the control group and themselves before the nursing intervention. Conclusions Preoperative pains and emotional condition should be evaluated among out-patients, and then carry out certain counter nursing measures to release patients' pain and negative emotion.

Objective To compare the laboratory and clinical results between unstimulated in vitro maturation (IVM) and IVM converted from in vitro fertilization (IVF) in polycystic ovarian syndrome (PCOS) and non-PCOS patients.Methods We divided 591 IVM cycles in the First Affiliated Hospital of Wenzhou Medical Univesity from Jan.2008 to Dec.2013 into 4 groups:group A1B1,PCOS patients underwent unstimulated IVM protocol,240 cycles; group A1B2,PCOS patients underwent IVM converted from conventional stimulated IVF protocol,153 cycles; group A2B1,non-PCOS patients underwent unstimutlated IVM protocol,103 cycles; group A2B2,non-PCOS patient underwent IVM converted from conventional stimulated IVF protocol,95 cycles.Multiple linear regression method and binary logistic regression method were used to assess the influence of PCOS and protocols for IVM on laboratory and clinical outcomes.Results The mean number of oocytes retrieved was positively related with PCOS [partial regression coefficient (B)=3.37,P＜0.01].The maturation rate of oocytes was positively related with hCG-prime prior to oocyte aspiration (B=0.05,P=0.010).High-quality embryo rate was positively related with PCOS and IVM converted from IVF (B=0.08,P=0.010; B=0.09,P=0.001),as well as implantation rate related with them (B=0.07,P=0.010; B=0.10,P＜0.01).PCOS and IVM converted from IVF improved hCG positive (hCG＞10 U/L) rate (OR=1.636,95％CI:1.113-2.204,P＜0.05; OR=1.861,95％CI:1.307-2.649,P＜0.05) and the clinical pregnancy rate (OR=1.507,95％CI:1.041-2.240,P＜0.05; OR=1.881,95％CI:1.312-2.696,P＜0.05).IVM converted from IVF protocol decreased the spontaneous abortion rate (OR=0.490,95％CI:0.245-0.978,P＜0.05).Multiple gestation rate and ectopic pregnancy rate were not affected by PCOS condition and protocol used (P＞0.05).Conclusions PCOS and IVM converted from IVF protocol improved the high-quality embryo rate,implantation rate,hCG positive rate and clinical pregnancy rate.IVM converted from IVF protocol reduced the spontaneous abortion rate.PCOS patients may be more suitable for the IVM treatment.No matter PCOS or non-PCOS patients,IVM converted from IVF protocol had better pregnancy outcome than that of unstimulated cycle.

Objective To analysis the incidence and management of monozygotic twin (MZT) conceived by assisted reproductive techniques (ART). Methods A retrospective analysis of clinical pregnancies and MZT that resulted from ART was performed in Reproductive Medical Center,the First Affiliated Hospital,Wenzhou Medical University between January 2011 and January 2014. Results A total of 5 908 pregnancies were diagnosed: 2 012 twins, 157 high-order multiple pregnancy (HOMP), including 4 quadruplets. Overall, 51 MZT pregnancies were identified of them including 32 cases HOMP and 19 cases MZT. The incidence of MZT resulting from cleavage-stage embryo transfer was similar to blastocyst transfer (P=0.960). The percent of MZT resulting from in vitro fertilization [0.93% (28/3 022)], frozen-thawed embryo transfer [0.87% (13/1 502)] and intracytoplamic sperm injection [0.72% (10/1 384)] did not show statistical significance (P=0.794). The expectantly managed MZT was associated with a significantly greater likelihood of miscarriage [6/19 vs 5.11% (101/1 976)], and low birth weight infant [73.91% (17/23) vs 42.89% (1 453/3 388), P<0.01], when compared with dizygotic twin (DZT) did not undergo selective embryo reduction(SER). In monozygotic (MZ)-triplets with SER to 2 fetuses or to 1 fetus, there was no cases of preterm birth or low birth weight infant observed in MZ-triplets with SER to 1 fetus;when compared with MZ-triplets with SER to 2 fetuses, the low birth weight infant [56.00% (14/25), P=0.021] has statistical significance. The likelihood of the survival of two babies was lower in MZ-triplets with SER to 2 fetuses when compared with non-MZ triplets with SER to 2 fetuses [42.86%(9/21)vs 75.21%(91/121), P=0.003]. Conclusions The incidence of MZT pregnancies following ART is high. It plays a significant role in the occurrence of HOMP. MZT pregnancies are at an increased risk of adverse outcomes , it should transform to a single embryo thansfer (SET) program to reduce them incideuce. Reduction of MZT contained in multiple pregnancies appears to be a safe option.

Objective We tried to explore the relationship between work engagement and organizational citizenship behavior among nurses in tertiary hospitals in order to provide evidence for implementing targeted interventions to promote nurses' organizational citizenship behavior and job performance from a perspective of positive psychology.Methods Totally 511 nurses from four tertiary hospitals of Jinan city were enrolled using multistage sampling.Data were collected with Utrecht Work Engagement Scale (UWES-9) and Chinese Organizational Citizenship Behavior Scale.Data analysis included descriptive analysis,Pearson correlation analysis and stepwise multiple regression analysis.Results The average scores of work engagement and organizational citizenship behavior were (3.82 ± 1.08) and (5.89 ± 0.66),respectively.Work engagement accounted for 25.4％ of the variance in identification with the company,14.6％ of the variance in altruism and 18.7％ of the variance in conscientiousness.Conclusions Work engagement is a significant predictor of organizational citizenship behavior.Nurse managers are suggested to take actions in aspects of professional practice environment,resources allocation and staff training so as to enhance nurses' work engagement and subsequent their organizational citizenship behavior.

Objective To compare the outcomes of in-vitro maturation (IVM) and in-vitro fertilization (IVF) after early follicular phase gonadotropin-releasing hormone agonist (GnRH-a)down-regulation in infertile patients with polycystic ovary syndrome (PCOS).Methods From July 2010 to December 2012,72 infertile patients with PCOS undergoing assisted reproductive technology treatment in the Affiliated First Hospital of Wenzhou Medical University were enrolled in this study.The patients were divided into 2 groups,which were patients with early follieular phase down-regulation IVM (36 cases) at IVM group and early follicular phase down-regulation long protocol IVF (36 cases) at IVF group.The laboratory parameters and clinical outcomes were compared between two groups.Results (1) Lab parameters:a total of 442 oocytes were retrieved in group IVM,and 560 were in group IVF.The rate of mature oocytes of 83.8％ (469/560) and high-quality embryos of 70.9％ (212/299) at group IVF were significantly higher than that of group IVM [54.1％ (239/442) and 50.7％ (73/144),retrospectively,P ＜0.01].In group IVM,the average duration of gonadotropin (Gn) was (2.8 ± 1.5) days and the average dosage of Gn was (285 ± 169) U,which were significantly lower than (11.0 ± 1.0) days and (1499 ±165) U in group IVF (P ＜0.01).The mean number of oocytes retrieved 12.8 ± 2.5,fertilization rate of 64.8％ (155/239),and implantation rate of 31％ (23/74) in group IVM and 15.6 ±3.1,65.5％ (307/469),31％ (23/74) in group IVF,which did not reach statistical difference (P ＞0.05).(2) Clinical outcomes:the clinical pregnancy rate (17/31,55％) of IVF group was not significantly higher than that 44％ (14/32) at IVM group (P ＞ 0.05).The abortion rate was 1/17 at Group IVF and 1/14 in group IVM,which did not show statistical difference.Women at IVM group has no ovarian hyper-stimulation syndrome (OHSS) cycle,group IVF has 31％ (11/36) cycles presented moderate and severe OHSS.Conclusions Infertile patients with PCOS undergoing IVM and IVF treatment after early follicular phase GnRH-a down-regulation can get satisfactory laboratory and clinical outcome.In addition to short treatment cycle,IVM can also avoid the occurrence of OHSS completely,but it has a rising trend in the abortion rate.IVF has a high incidence of OHSS,meanwhile,it increases the dosage of gonadotropins.

Objective To develop a sensitive and simple LC/MS method for determination of methomyl in blood samples.Methods Methomyl was extracted from blood by liquid-liquid extraction with ethyl acetate, and then analyzed on a Zorbax SB-C18 (2.1mm×50mm, 5μm) column. The mobile phase consisted of acetonitrile-0.1% formic acid with gradient elution, at a lfow rate of 0.5 mL/min, at 40℃. LC-MS was performed in ESI source with MRM mode for quantiifcation.ResultsThe linear range of the concentration were 0.05~2.0μg/mL for methomyl (r>0.995). The relative recoveries of methomyl were in the range of 90%~108%. The RSDs of intra-days and inter-day were both less than 15%.Conclusion The method is a simple, quick, sensitive and could be used for determination of methomyl in blood samples.