Objective To investigate the level and correlation between Thioredoxin (Trx) and Thioredoxin interacting protein (Txnip) in aqueous humor of cortical cataract patients with type 2 diabetes.Methods The Txnip and Trx levels were determined by Elisa in aqueous humor of 60 cataract patients with type 2 diabetes,which were divided into group A (control group,HbA1c ＜5.5％),group B (5.5％ ≤HbA1c ＜6.5％) and group C (HbA1c＞6.5％),and each group contains 20 patients.Results The level of Txnip in group B was higher than that in group A,while that in group C was the highest,there were statistical differences (all P ＜ 0.05).Compared with group A,the level of Trx in group B was increased,while that in group C was the lowest,there were statistical differences (all P ＜ 0.05).The level of Trx was positive correlated with Txnip in group A (r =0.810,P =0.000),but negative correlated with Txnip in group C (r =-0.809,P =0.000) and degree of cataract in group C (r =-0.727,P =0.001).Logistic regression analysis revealed that Txnip and HbAl c were risk factors of cortical cataract.Conclusion Trx and Txnip may play an important role in the development of diabetic cataract.

Objective To examine the impact of diabetic foot patients′ negative emotion on the caregiver′quality of life. Methods Totally 100 pairs of diabetic foot patients and their caregivers were investigated using convenience sampling method. Results The incidence of anxiety, depression of hospitalized patients with diabetic foot was 41.5% (23/200), 44.0% (88/200) respectively. Pearson correlation analysis showed that anxiety score were negatively correlated with caregivers′ quality of life except for mental health dimension, physical pain dimension and the total score of physical health, mental health and the MOS item Short from Health Survey (SF-36) (r=-0.471--0.117, P<0.05), and depression score were negatively correlated with caregivers′ quality of life except for physical pain dimension and the total score of physical health, mental health and SF-36(r=-0.519--0.220, P<0.05). Multiple regression analysis indicated that caregivers educational level, provided support, social support , relationship with patients, self-evaluation of health, live together time with patient, patient care burden, caregivers gender, depression score, patient age, diabetic foot Wagner grade were the influence factors of the caregiver′ quality of life. Conclusions Diabetic foot patients′ negative emotion has an important impact on caregiver′quality of life, we can improve the quality of life of patients and their caregivers by reducing the negative mood of patients with diabetic foot.

Objective To investigate the effects of noise from the subway cars on the preferred listening volumes using different kinds of earphones.Methods A total of 75 subjects with normal hearing were investigated to listen the same song wearing 4 kinds of earphones: insert earphones, intra-concha earphones, supra-concha earphones, and circumaural earphones, in the semi-anechoic background and inside the Line 7 subway-cars of the Beijing subway (the mean of LAeq,1s is 80.3 dB A and then selected personally preferred listening volumes.The effects of noise in the subway cars and earphone types on the preferred listening volumes were then analyzed.Results Inside subway-cars, the preferred listening levels using insert earphones, intra-concha earphones, supra-concha earphones, circumaural earphones were 76.6±4.7, 84.3±5.0, 82.3±4.2, and 80.8±4.2 dB A, respectively.The levels were respectively 65.5±6.8, 71.9±7.1, 69.5±7.5, 67.9±7.3 dB A for those in the semi-anechoic background.The preferred listening levels increase more than 10 dB averagely when stepped into noisy subway-cars background from silent background.According to the threshold levels stipulated in the WHO, to avoid hearing impairment, the daily noise exposure duration should not exceed 134 mins when exposed to subway-cars noise and the duration should not exceed 315, 54, 85, and 120 mins respectively when wearing those 4 kinds of earphones in subway-cars.Conclusion The noise and earphones types have great effects on the preferred listening volumes.The noise exposure levels in the ear canal wearing earphones with good sound insulation and listening at highly increased volume may be lower than that without earphones.

Objective To investigate the distribution of circadian typology of patients with type 2 diabetes mellitus (T2DM) and to analyze its consequent impact on glycemic control. Methods From January 2016 to June 2016, a total of 283 T2DM patients were interviewed in this study. Self designed questionnaire, Morningness-Eveningness Questionnaire (MEQ), Pittsburg Sleep Quality Index (PSQI) and Center for Epidemiological Survey-Depression Scale (CES-D) were used to collect information on diabetes history, circadian typology, sleep quality and depression. HbA1c and other biochemical indicators were determined. The glycemic control target was<7%. The 283 T2DM patients were divided into three groups:morning type group, evening type group and neither type group according to MEQ score. Results Of the 283 subjects, 97 (34.3%) were classified as morning type, 42 (14.8%) as evening type, and 144 (50.9%) as neither. Participants with evening type were younger, shorter diabetes duration, more depressive symptoms, higher perceived sleep debt, higher FBG and higher HbA1c than those with morning type. The binary Logistic regression analysis showed that HbAlc≥7%was associated with higher FBG, higher PSQI score, higher sleep debt, lower HDL-C, and lower MEQ scores (OR=0.189-2.904, all P<0.05). Conclusions Evening type was associated with higher HbA1c and poorer glycemic control in T2DM patients compared with morning type and may be one of the risk factors affecting glycemic control.

Objective To investigate the influence of fear of hypoglycemia on the compliance of diabetes patients.Methods A total of 201 diabetes inpatients with hypoglycemia in four first-class hospital of grade three in Ji'nan were selected by convenience sampling method and investigated by General Information Questionnaire,Chinese version of Hypoglycemia Fear Survey Ⅱ-Worry Scale and Diabetes Treatment Compliance Scale.And carrid on the correlation analysis and the multiple linear regression analysis.Results The scores of fear of hypoglycemia was 3-33 points,the median score was 12 points(interquartile range,10-15 points).The score of treatment compliance was 23-55(35.90±5.84)points.Spearman correlation analysis showed that fear of hypoglycemia score were negative correlated with treatment compliance score,drug,diet,exercise dimensions(r=-0.467-0.288),and it was positively correlated with self monitoring dimension(r=0.259),the difference was statistically significant(P＜0.01),it was not associated with periodic inspection dimension.Multiple linear regression analysis showed that the economic income,occupation,whether to participate in health education of diabetes mellitus,glycosylated hemoglobin,fear of hypoglycemia were the influence factors of treatment compliance.Conclusions Diabetes patients'fear of hypoglycemia can influence treatment compliance.medical staff should pay attention to and take effective measures to reduce their fear of hypoglycemia and improve treatment compliance.

Objective To observe the expressions of serum insulin-like growth factor (IGF)- Ⅰ ,Ⅱ and IGF binding protein (IGFBP) 3, 5 and to explore the clinical significances in patients with clear cell carcinoma of kidney. Methods Enzyme-linked immunosorbent assay (ELISA) methods were adopted to examine serum expressions of IGF-Ⅰ , Ⅱ and IGFBP 3, 5 in 40 cases with clear cell carcinoma of kidney (renal carcinoma group) and 16 cases with hydronephrosis (control group) from May 2007 to December 2009. Results IGF- Ⅰ , Ⅱ and IGFBP 3,5 in renal carcinoma showed higher expressions before operation (985. 7 μg/L, 1154.0 μg/L,46.6 μg/L and 9.6 μg/L, respectively)than after operation (431.4 μg/L, 632.6 μg/L, 26.7 μg/L, and 6.7 μg/L, respectively, all P＜0. 05 ～0.01). There were no significant differences in those indexes between pre- and post- operation in control group (P＞ 0. 05). Conclusions There are high expressions of serum IGF-Ⅰ , Ⅱ and IGFBP 3, 5 in renal carcinoma patients, and IGF- Ⅱ has clinical significance in diagnosis.

Objective:To investigate the clinical effect of homemade adjustable mirabilite vest in patients with severe acute pancreatitis and supply reference for clinical nursing.Methods:This was a randomized controlled study. One hundred patients with acute severe pancreatitis admitted to Putuo Hospital, Shanghai University of Traditional Chinese Medicine from January 2021 to June 2022 were selected, and were divided into the pocket group and the vest group according to the order of admission with 50 cases in each group. The pocket group used traditional mirabilite bag for external application, the vest group used adjustable mirabilite vest for external application. The other treatment measures were the same for both two group. The comfort degree, itching severity and average length of hospital stay of these two groups were compared.Results:The basic data of the two groups were homogeneous. The difference were not statistically significant( P>0.05). After intervention, the comfort degree of the pocket group was (65.90 ± 7.95) points while the comfort degree of the vest group was (77.04 ± 5.96) points. The difference was statistically significant ( t = 7.93, P<0.01). The degree of pruritus was (12.72 ± 3.95) points in the pocket group and (8.00 ± 1.20) points in the vest group.The difference was statistically significant ( t = 8.08, P<0.05). The mean length of hospital stay in the pocket group was (15.86 ± 5.83) days and (11.02 ± 3.38) days in the vest group. The difference was statistically significant ( t = 5.08, P<0.01). Conclusions:When using topical mirabilite for patients with acute severe pancreatitis, the use of adjustable mirabilite vest can significantly improve patients′ comfort, reduce itching, and reduce the number of hospital days, which has the value of promotion and use.

Objective:To investigate the clinical effect of using free bilateral anterolateral thigh flaps(ALTF) in series to repair large area soft tissue defects of forearm.Methods:The clinical data of 11 patients with large soft tissue defects of forearm admitted in the Department of Plastic(Repair and Reconstruction) Surgery, Lishui Hospital of Zhejiang University from March 2014 to December 2021 were retrospectively analyzed, including 8 males and 3 females. Aged 36 to 68 years old, with an average of 48 years old. VSD treatment was performed after debridement, and until fresh removed 3 to 5 days after the operation. Until the wound was fresh. The wound was repaired with free bilateral ALTF in series until fresh. The size of the forearm wound was 18 cm×15 cm-28 cm×13 cm. The cut area of a single flap was 10 cm×8 cm-20 cm×13 cm. The series of bilateral flaps: One of the flaps was used as the proximal flap, and its vascular pedicle was anastomosed with the arteries and veins of the recipient area. The other flap was used as the distal flap, and the arteries and veins between the 2 ALTFs on both sides were anastomosed. The vascular pedicle beyond the distal flap was ligated or anastomosed to the distal end of the ulnar artery or the distal end of the radial artery. The flap and the surrounding skin of the recipient area were sutured immediately. The donor sites of the flap was closed directly. Periodic and regular outpatient follow-up was performed after operation and the clinical efficacy was analyzed.Results:All the flaps successfully survived after the surgery. The postoperative follow-up lasted for 6-18 months, 12 months in average. The flaps survived well with good soft texture, without swelling, the capillary reaction time was normal, without surface ulceration, in rosy colour and restored protective sensations. The hand function of the affected limb recovered well. The wound at donor sites healed well without complications. At the last follow-up, the hand function of the affected limb was evaluated by the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the result was 7 in excellent and 4 in good. The patients were satisfied with the flap and the therapeutic effect.Conclusion:The free bilateral ALTF in series can be used to repair a wound surface with large area, and the donor site can be closed at the same time. It is an effective method to repair large soft tissue defect of forearm.

Objective To explore the high-quality development path of tertiary public hospitals and provide scientific reference for deepening the reform of public hospitals.Methods Based on SPO theory,it constructed an analytical framework for the high-quality development of tertiary public hospitals,collected data of a quarterly monitoring in-dex for the performance assessment and high-quality development of tertiary public hospitals in a certain province in 2023,and analysed 73 tertiary public hospitals participating in the performance assessment as the object of analy-sis,and adopted the fuzzy-set Qualitative Comparative Analysis to explore different condition sets of high-quality de-velopment of tertiary public hospitals and reveal the path of high-quality development of public hospitals.Results High-quality development is the result of multi-factor interaction.Four configurations were identified to promote the high-quality development of tertiary public hospitals:service quality-technology-driven path,service quality-driven path,comprehensive service-driven path,and service quality-benefit-driven path.Quality safety and functional orientation were found to be the core elements in promoting high-quality development of public hospitals.Conclusion Hospitals at all levels should strengthen the guidance of party building,combine with the actual functional positioning,take quality and safety as the core,and optimize the combination conditions of technical level,personnel structure,service process,and cost control.It is essential to clarify the development strategy of hospitals,implement the dynamic concept,and realize the high-quality development of public hospitals.