Objective To explore the relationship between homocysteine (Hcy)expression and diabetic ret-inopathy(DR)in patients with type 2 diabetes mellitus (T2DM).Methods 79 patients with T2DM were selected and divided into proliferative DR group (n =26),background stage of DR group (n =25)and without DR group(n =28)according to the degree of retinopathy.28 cases of healthy physical examination were involved as control group. Blood glucose levels,Hcy and clinical significance were detected and compared among the groups.Results The FPG and Hcy levels in the control group,without retinopathy group,background stage of DR group and proliferative DR group showed an increasing trend,there were significant differences among groups (F =448.53,174.25,all P <0.01).The FPG level of the control group was (4.86 ±0.42)mmol/L,which was significantly lower than the back-ground stage of DR group[(8.73 ±0.48)mmol/L,t =31.59,P <0.01 ]and the proliferative DR group[(10.9 ± 0.95)mmol/L,t =30.59,P <0.01].The FPG level of proliferative diabetic retinopathy DR group was also signifi-cantly higher than without retinopathy group(t =17.72,P <0.01).The Hcy level of the control group was (7.93 ± 0.70)μmol/L,which was significantly lower than the background stage of DR group[(9.45 ±0.83)μmol/L,t =7.69,P <0.01]and the proliferative DR group[(13.55 ±1.56)μmol/L,t =11.0,P <0.01].The Hcy level of the proliferative DR group was also significantly higher than without retinopathy group(t =12.52,P <0.01).Conclusion Hcy may involved in the process of T2DMwith DR,it may be used as an important reference index for the degree of retinopathy.

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 We examined the Grp78, ERK1/2 and phospho-ERK1/2 expressions in hepatocellular carcinoma(HCC) tissue samples in vitro, we interfered the expression of Grp78 in SMMC-7721 cells to explore whether Grp78 is involved in ERK1/2 signal pathway. Methods The Grp78, ERK1/2 and phospho-ERK1/2 expressions were detected by immunohistochemistry and confirmed by Western blotting in 47 HCC tissue samples. The Grp78 expression in SMMC-7721 cells was interfered by plasmid transfection and siRNA, ERK1/2 phosphorylation and expression were determined by Western blotting. Results The Grp78 expression was significantly correlated with ERK1/2 and phospho-ERK1/2 in HCC tissue samples. Overexpression of Grp78 promoted ERK1/2 phosphorylation in SMMC-7721 cells and the increased ERK1/2 phosphorylation was inhibited by Grp78 knockdown. Conclusion Grp78 is involved in the regulation of ERK1/2 signal pathway and might be a potential target for the comprehensive therapy of HCC.

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 To investigate the application of resistive exercise combined with Buerger exercise in lower extremity vascular disease of type 2 diabetes mellitus .Methods According to the order of admission ,120 type 2 diabetes mellitus patients with lower extremity vascular disease were randomly divided into resistance exercise group ,Buerger exercise group and combined exercise group ,with 40 cases in each group .The resistance exercise group was given resistance exercise ,the Buerger exercise group was given Buerger exercise ,and the combined exercise group was given resistance exercise combined with Buerger movement .The changes of self -inductance ,ABI and DAWV of the three groups were observed .Results The clinical symptoms of the three groups were significantly reduced ( the resistance exercise group:markedly effective in 10 cases,effective in 14 cases;the Burger exercise group:markedly effective in 15 cases,effective in 17 cases;the combined exercise group: markedly effective in 22 cases,effective in 13 cases),the effective rate of the combined exercise group was higher than that of the resistance exercise group and Buerger exercise group ( the resistance exercise group:60.0％;the Burger exercise group:80.0％;the combined exercise group:87.5％,χ2 =11.333,P <0.05).The ABI of the three groups were higher than those before treatment,and the ABI ratio of the combined exercise group [(0.933 ±0.113)]was higher than that of the resistance exercise group[(0.866 ±0.112)] and the Buerger exercise group[(0.888 ±0.111)](t=1.796,2.663,all P<0.05 ) .The DAWV of the three groups increased compared with those before treatment , and the DAWV of the combined exercise group[(7.023 ±0.535)cm/s]was higher than that of the resistance exercise group [(6.633 ± 0.552)cm/s] and the Buerger exercise group [(6.772 ±0.435) cm/s] (t =2.302,3.209,all P <0.05). Conclusion Resistant exercise combined with Buerger exercise is helpful to improve the blood flow velocity and blood flow in the lower extremity vessel of patients with diabetic lower limb vascular disease , and can improve the self-sensitization symptoms of peripheral neuropathy in patients .

Objective: To understand the current situation of academic burnout among primary and middle school students and to explore its associated factors, so as to provide a scientific guidance and preventing and amelioration academic burnout among primary and middle school students. Methods: Between September and October 2023, a total of 10 474 primary and middle school students residing in Wuxi City participated in a questionnaire survey and physical examination conducted through stratified cluster random sampling. Latent profile analysis was used to classify academic burnout among primary and middle school students. Furthermore, differences in the types of academic burnout among children and adolescents with varying characteristics were examined using the Chi square test. Additionally, multinomial Logistic regression analysis was utilized to identify the associated factors for academic burnout. Results: The academic burnout of primary and middle school students was divided into 4 categories:no/light academic burnout group(43.6%),physical and mental exhaustion group (32.9%), low achievement group(15.0%), high physical and mental exhaustion/high academic burnout group(8.5%). Middle and high school students, boys, not living with parents, smoking, daily screen time ≥2 hours, suffering from campus bullying, sometimes/often subjected to cyber attacks, abused by parents were more likely to have high physical and mental exhaustion/high academic alienation among primary and middle school students ( OR=1.70, 1.42, 1.56, 1.56, 2.31, 1.48, 2.94, 3.03, 5.94, 2.08, P <0.01). Conclusions The phenomenon of academic burnout among primary and middle school students is prominent. And targeted intervention measures shoould be actively taken to prevent and reduce the occurrence of academic burnout among primary and middle school students.