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.

There is no defined legislation on paternity testing in present China,thus the testing status quo is in a mess to some extent.Together with other unfavorable factors including the unstable marital status in modern society,increasing extramarital sexual behaviors and illegitimate children,and the ever-heated testing competition among testing institutes driven by the economic interests and so forth,the paternity testing is on a sharp rise these years,which leads to a increasing chaos in paternity testing field.Social ethical crisis is partially responsible for the current problem,thus related ethical issues to paternity testing are discussed in this article.

Objective To study the role of TLR2 and TLR4 signal transduction in RAW264.7 monocyte-macrophages stimulated by Aspergillus fumigatus conidia,and to investigate the expression of TLR2 signal transduction after silencing gene of TLR4.Methods Macrophages were randomly divided into normal group ( N group),normal+stimulated with Aspergillus fumigatus conidia ( N +Af group ),normal + transfected with TLR4-siRNA [ TLR4 (RNAi) group ],normal+transfected with TLR4-siRNA +stimulated with Aspergillus fumigatus conidia[ TLR4(RNAi) +Af group].RT-PCR and Western blot were used to assay expression levels of TLR2,TLR4,MyD88 mRNA and pro-inflammatory cytokines TNF-α protein when macrophages were stimulated 12 h by Aspergillus fumigatus conidia after tranfected 24 h with TLR4-siRNA by technology of RNAi.Results ( 1 ) Compared with N group,the expression of TLR2,TLR4,MyD88 mRNA and TNF-αprotein in N+Af group significantly increased before silencing gene of TLR4.(2) Silencing efficiency of macrophates was up to 83％ after transfected with TLR4-siRNA.(3)The expression of TLR2,MyD88 mRNA in TLR4 (RNAi) group significantly decreased contrast with normal group.Meanwhile the expression of TLR2,MyD88 mRNA and TNF-α protein also obviously reduced in TLR4(RNAi) +Af group when compared with N +Af group.Compared with TLR4 (RNAi) group,the expression of MyD88 mRNA in TLR4 (RNAi) +Af group significantly increased.However,the expression of TLR2 mRNA and TNF-α protein have no significant change after silencing gene of TLR4.Conclusion Signaling pathway of TLR2 and TLR4 in macrophages was activated by given stimulus of Aspergillusfumigatus conidia and exerted the effect of anti-Aspergillus fumigatus spores stimulation through the release of pro-inflammatory cytokines TNF-α.Meanwhile,silencing gene of TLR4 down-regulate the effect of TLR2 signal transduction in RAW264.7 cells to anti-Aspergillus fumigatus conidia stimulation,and it found that TLR4 played an more important role by contrast with TLR2.

Objective: To analyze the effectiveness of a quality improvement program for facilitating breastfeeding and improving clinical outcomes for very low birth weight infants (VLBWI). Methods: VLBWI admitted to the Neonatal Intensive Care Unit of Shaoxing Women and Children's Hospital before the implementation of the quality improvement program from February 2016 to January 2017 were retrospectively selected as control group (n=84), while those admitted after the implementation from August 2017 to July 2018 were enrolled as intervention group (n=75). Primary outcomes included breastfeeding rates by biological mothers and duration of achieving full enteral feeding and the secondary outcomes included duration of peripherally inserted central venous catheters (PICC) and parenteral nutrition, PICC associated infections, average body weight growth rates during hospitalization, preterm-associated complications and mortality between the two groups were compared. Two independent sample t test, rank-sum test and Chi-square test or Fisher's exact test were used as statistical methods. Results: Compared with the control group, the intervention group had significantly increased breastfeeding rate [82.7% (62/75) vs 36.9% (31/84), χ²=34.183, P<0.001] and a shorter time to achieve full enteral feeding [M(P₂₅-P₇₅): 13(10-16) vs 17(14-23) d, Z=-4.542, P<0.001]. Moreover, the PICC indwelling time and parenteral nutrition duration were both significantly shortened after the implementation of quality improvement program [M(P₂₅-P₇₅): 10(7-13) vs 14(11-20) d, 12(9-15) vs 16(13-22) d, Z=-4.902 and -4.677; both P<0.001], but no statistical differences were found in any other secondary outcomes. Conclusions The quality improvement program is a feasible and practical approach to effectively improve breastfeeding rates in VLBWI and shorten the time required to achieve full enteral feeding.

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 .

OBJECTIVETo study the genetic polymorphisms and mutations of 20 frequently used autosomal microsatellites among ethnic Hans from Henan.

METHODSPeripheral blood samples of 2604 individuals were collected. DNA was amplified and genotyped using a PowerPlex(TM) 21 system. The frequencies, forensic parameters and mutation rates of the 20 short tandem repeat (STR) loci were analyzed.

RESULTSA total of 323 alleles were found in this population and the allelic frequencies have ranged from 0.0003 to 0.5144. Except for D3S1358, TH01 and TPOX, mutations have been found in all of the remaining 17 STR loci, which totaled 47, with mutation rates ranging from 0 to 3.46 × 10.

CONCLUSIONThe 20 STR loci selected by the PowerPlex(TM) 21 system are highly polymorphic among ethnic Hans from Henan, and may be of great value in forensic and human population studies. As no similar study has been carried out previously, above results may be of great value for individual discrimination and paternal testing.

Adolescent ; Adult ; Alleles ; Asian Continental Ancestry Group ; ethnology ; genetics ; Child ; Child, Preschool ; China ; ethnology ; Female ; Genotype ; Humans ; Male ; Microsatellite Repeats ; Mutation ; Pedigree ; Polymorphism, Genetic ; Young Adult

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 investigate the application value of enhanced recovery after surgery (ERAS) in perioperative period of laparoscopic sleeve gastrectomy (LSG).Method:The retrospective cohort study was conducted. The clinical data of 1 181 patients undergoing LSG in the Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from January 2021 to December 2023 were collected. There were 242 males and 939 females, aged (31±8)years. Of 1 181 patients, 598 cases receiving routine perioperative care were divided into the control group, and 583 cases receiving perioperative care with ERAS were divided into the ERAS group. Measurement data with normal distribution were represented as Mean± SD, and the independent sample t test was used for comparison between the groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and the Mann-Whitney rank sum test was used for comparison between the groups. Count data were expressed as absolute numbers or percentages, and the chi-square test or Fisher exact probability were used for comparison between the groups. Repeated measurement data were analyzed using the repeated ANOVA, with baseline scores as covariates. Simple effects analysis was conducted in case of interaction, and multiple comparisons were adjusted using the Bonferroni method. Results:(1) Postoperative outcomes. The numerical rating scale (NRS) scores for pain at immediate return to the ward and on the third postoperative mornings changed from 5.35±0.93 to 2.57±0.83 in the control group, versus changed from 3.15±0.93 to 0.70±0.65 in the ERAS group, showing significant difference between the two groups ( Ftime=66.58, Fgroup=1 765.85, Finteraction=6.90, P<0.05). After adjusting NRS scores for pain at immediate return to the ward as the baseline, results of simple effects analysis showed that on the third postoperative mornings, the NRS scores in the ERAS group were lower by 1.89, 1.53, and 1.76 respectively compared to the control group ( P<0.05). Cases with nausea at immediate return to the ward and on the third postoperative mornings changed from 497 to 97 in the control group, versus changed from 198 to 11 in the ERAS group, showing signifi-cant difference between the two groups ( χ2=294.45, 398.76,209.39, 73.00, P<0.05). Cases with vomiting at immediate return to the ward and on the third postoperative mornings changed from 243 to 41 in the control group, versus changed from 51 to 2 in the ERAS group, showing significant difference between the two groups ( χ2=160.54, 149.37, 71.76, 35.69, P<0.05). The duration of postoperative hospital stay was (3.22±0.65)days in the control group, versus (2.17±0.49)days in the ERAS group, showing a significant difference between the two groups ( t=-11.89, P<0.05). (2) Complications. The incidence of cases with dehydration within postoperative 30 days was 0.50%(3/598) in the control group, versus 0.69%(4/583) in the ERAS group, showing no significant difference between the two groups ( P>0.05). None of patient in the control group and the ERAS group experienced bleeding, gastric leakage, intra-abdominal infection, and no patient had unplanned secondary surgery within postoperative 30 days. Conclusions:ERAS in perioperative period of LSG are safe and feasible. Compared to routine care, ERAS can significantly reduce postoperative pain, decrease the incidence of postoperative nausea and vomiting, shorten the postoperative hospital stay, and do not increase the rate of postoperative complications or unplanned secondary surgeries within postoperative 30 days.