Objective To explore the effects of empowerment education model on glycemic control and self-management behavior of community patients with diabetes. Method A total of 120 diabetics from 2 different communities were set as the observation group and control group. The control group was treated by routine medications and health education and the observation group was intervened with empowerment education model. After intervention for 6 months, the patients′blood glucose index and the diabetes self-management behavior were assessed and compared by scale of the diabetes self-care activities (SDSCA) between the two groups. Result By the end of the study, the glycemic index and SDSCA score in the former group were both significantly decreased than those in the control group (P<0.05), indicating the patients in the experiment group had better glycemic control and self-management behaviors compared with those in the control group. Conclusions Empowerment education model can arouse the internal motivation of patients to change their behaviors from passive to active acceptance in the health education. Empowerment education model can enhance diabetes patients′self-management conduct and the glycemic level.

Objective:To investigate the changes and clinical significance of serum immunoregulatory cytokines in patients with rheumatoid arthritis (RA) complicated with osteoporosis (OP).Methods:The clinical data of 420 patients with RA admitted to Mianyang Central Hospital from January 2019 to December 2019 were analyzed. According to their bone mineral density, they were divided into OP group (220 cases) and non OP group (200 cases). The immunoregulatory cytokines and bone metabolism indexes of the two groups were compared, and the correlation between them was analyzed.Results:The age, course of disease, glucocorticoid use history, fracture history, swelling joint number and tenderness joint number of OP group were significantly higher than those of non OP group ( P<0.05). In OP group, the serum levels of interleukin (IL)-6, IL-17, tumor necrosis factor-α (TNF-α) and C-terminal peptide cross-linking (CTX) of type Ⅰ collagen were significantly higher than those in control group ( P<0.05), while the IL-10 and transforming growth factor-β1 (TGF-β1) were significantly higher than that of non OP group ( P<0.05). The serum level of CTX in patients with RA complicated with OP was positively corrected with IL-6, IL-17, TNF-α ( r=0.913, 0.915, 0.921, P<0.001), and negatively correlated with IL-10 and TGF-β1 ( r=-0.921, -0.920, P<0.001). Conclusions:RA patients complicated with OP have higher age, longer course of disease, history of fracture, history of glucocorticoid use, more joint swelling and pain, higher IL-6, IL-17, TNF-α levels, lower IL-10 and TGF-β1 levels. Immunoregulatory cytokines may regulate the proliferation and differentiation of osteoclasts and osteoblasts, and play an important role in RA complicated with OP.

Objective:To analyze the effect of the multipoint tiny incision with continuous buried suture method in double eyelidplasty for patients with mild or moderate dermatolysis.Methods:Totally, 1 161 patients from May 2008 to February 2019 underwent the double-eyelid surgical procedure with the multipoint tiny incision with continuous buried suture method. 1 148 patients were female and 13 patients were male, ranging from 25 to 50 years old. All the patients had normal single-eyelid or inborn narrow double-eyelid without blepharoptosis and they were performed double eyelidplasty for the first time. During the operation, moderate orbicularis oculi muscle and orbital septum fat were cut down from the four or five tiny incisions which were all 2 mm long. Skin levator fixation was performed through continuous buring suture between subcutaneous and the levator aponeurosis. Postoperative follow-up time points were 3 months, 1 year and 5 years.Results:There were 10 patients that showed slight asymmetry, 8 patients' eyes showed shallow creases and 5 patients' double eyelids narrowed. These 23 patients were operated for the second time. Besides that, all the creases were symmetry, parallel and natural. Notched scars did not occur, and patients' satisfaction was achieved in the rest of the cases.Conclusions:Our double eyelid procedure creates natural and beautiful double eyelids without depressed scars. The blepharoplasty of multipoint tiny incision with continuous buried suture method can produce a desired aesthetic effect and it lasts for a long time.

Objective:To explore the changes in the functional connectivity (FC) of hippocampal subregions in nicotine addicts after repetitive transcranial magnetic stimulation (rTMS) using resting-state FC.Methods:This study was a cross-sectional study. The clinical and imaging data from 20 male nicotine addicts at Zhejiang Hospital between 2022 and 2024 were analyzed prospectively. All participants received rTMS treatment and were assessed with nicotine-related clinical scales and resting-state FC analysis before and after treatment. The clinical scale evaluations included the Fagerstr?m test for nicotine dependence (FTND), smoking severity index, Minnesota nicotine withdrawal scale (MNWS), short tobacco craving questionnaire (sTCQ), and visual analog scale (VAS). Paired t-tests and Wilcoxon signed-rank tests were used to compare the differences in clinical scale scores before and after treatment. Ten subregions of the bilateral hippocampus (including the hippocampus, dentate gyrus, entorhinal cortex, hippocampus-amygdala transition area, and subiculum) were used as seed points, and paired t-tests were conducted to compare the FC differences in these subregions before and after treatment. Pearson and Spearman correlation analyses were used to assess the correlation between changes in resting-state FC in the rTMS group and clinical scale scores. Results:Compared to pre-treatment, the scores on the FTND, smoking severity index, MNWS, sTCQ, and VAS all significantly decreased after rTMS treatment in nicotine addicts (all P<0.05). Compared to pre-treatment, post-treatment FC was reduced between the left dentate gyrus subregion and the bilateral supplementary motor area and left middle cingulate gyrus, while it increased between the left entorhinal cortex subregion and the right middle and superior temporal gyri, and between the left hippocampus-amygdala transition area subregion and the bilateral calcarine cortex and cuneus (Gaussian random field correction, voxel-level P<0.01, cluster-level P<0.05). Negative correlations were observed between the FC difference in the left hippocampus-amygdala transition area subregion and the right calcarine cortex and the difference in sTCQ-impulse score before and after treatment ( r=-0.447, P=0.048). Negative correlations were observed between the FC difference in the left hippocampus-amygdala transition area subregion and the right cuneus and the difference in the sTCQ-expectation score ( r=-0.559, P=0.010). Negative correlations were observed between the FC difference in the left hippocampus-amygdala transition area subregion and the left calcarine cortex and the differences in sTCQ-emotion and sTCQ-expectation scores ( r=-0.516, P=0.020; r=-0.466, P=0.038, respectively). Negative correlations were observed between the FC difference in the left hippocampus-amygdala transition area subregion and the left cuneus and the differences in sTCQ-emotion and sTCQ-expectation scores ( r=-0.459, P=0.042; r=-0.501, P=0.024, respectively). Conclusion:Changes in FC in certain hippocampal regions are observed in nicotine addicts following rTMS treatment, suggesting that hippocampal subregions may serve as potential biomarkers for nicotine addiction withdrawal to some extent.

MR angiography(MRA)is an important imaging method for non-invasive evaluation on the structure and hemodynamics of portal venous system.With the emergence of new MR sequences and iterations of contrast agents,the applications of portal MRA in children became more and more feasible.The technical research progresses and challenges of portal MRA in children were reviewed in this article.

This study was performed to explore the impact of glutamine(Gln)on the anti-tumor immune response of CD8+ T cells and its mechanism.TCGA database was used to analysis the relationship between tumor Gln metabolism and the quantity and functionality of infiltrating CD8+ T cells.CRISPR/Cas9 was employed to knock down GLS expression in mouse MC38 cells,and a mouse tumor model was established.Flow cytometry was conducted to assess tumor proliferation,apoptosis,and the quantity and functionality of tumor-infiltrating immune cells.Lymphocytes isolated from health individuals were treated with Gln-deficient media,complete media or media supplemented with GSH,RSL3 in vitro.Then the apoptosis,the expression levels of GPX4,Lipid-ROS,and effector function protein of CD8+ T cells were detected by flow cytometry.Furthermore,RNA-seq was performed to analyze the differential gene expression on the Gln-depleted CD8+ T cells.Data showed that tumor Gln metabolism was inversely associated with the quantity and functionality of tumor-infiltrating CD8+ T cells.Low expression of GLS in MC38 cells could inhibit C57BL/6 tumor growth,decrease Ki-67 expression,promote casepase-3 expression,increase the amount of tumor-infiltrating immune cells,suppress PD-1,TIM-3,and LAG-3 expression,and enhance CD137,CD107a,IFN-γ and TNF-α expression in tumor-infiltrating CD8+ T cells.RNA-seq results indicated an upregulation of ferroptosis genes TFRC,HMOX1,CYBB and SLC7A11 in CD8+ T cells following glutamine deficiency.Gln deficiency led to lower CD137,CD107a,IFN-γ,GSH,GPX4 expression,increased Lipid-ROS level,and caused cell death in CD8+ T cells.Supplementation of GSH upregulated GPX4 expression,downregulated Lipid-ROS level,and increased IFN-γ secretion in CD8+ T cells.In conclusion,Gln deficiency inhibits the effector function of CD8+ T cells by inducing ferroptosis,and promotes tumor growth.

This study aims to enhance the activation level and efficiency of second-generation chimeric antigen receptor-T(CAR-T)cells in killing tumor cells by modifying the lymphocyte-specific protein tyrosine kinase(LCK)structure of second-generation CAR,so as to lay the foundation for the preparation of novel second-generation CAR-T cells.Using genetic engineering techniques,lentiviral vectors for CD137-LCK2 CAR and CD137-PYAP2 CAR targeting human epidermal growth factor receptor 2(HER2)were constructed,and CD137-LCK2 and CD137-PYAP2 CAR-T cells were prepared by lentiviral packaging and infection of activated T cells.The differences between them in terms of CAR expression level,activating molecule CD 137 expression,phenotypic distribution,cytokines secretion,and killing effect on HER2-expressing tumor cells were detected and compared using flow cytometry,enzyme-linked immunosorbent assay,and cytotoxicity assay,respectively.Compared with the second-generation CD137 CAR-T cells,the structurally modified CD137-LCK2 and CD137-PYAP2 CAR-T cells targeting HER2 can increase the expression of activating molecule CD 137,increase the secretion of cytokine IFN-γ,and enhance the killing ability of target antigens;at the same time,these cells can be maintained in the memory state and can rapidly activate proliferation and differentiation after stimulation by antigen.In conclusion,CD137-LCK2 and CD137-PYAP2 CAR-T cells targeting HER2 are expected to activate and exert anti-tumor effects more effectively than second-generation CD 137 CAR-T cells.

Objective:To establish a polymerase chain reaction(PCR)method to accurately discriminate the crude materials and aqueous extract of Zaocys dhumnades,Elaphe carinata,Elaphe meollendorff and Ptyas korros.Methods:Specific primers were designed using mitochondrial Cytb gene(CO1)as a target gene,and annealing temperature,number of cycles and the type of DNA polymerases were optimized.The mixed samples were detected by this method.Results:By this multiplex allele-specific PCR identification method,135,182,246 and 197 bp of specific fragments were amplified from DNA templates of Zaocys dhumnades,Elaphe carinata,Elaphe meollendorffi and Ptyas korros,respectively,following the conditions:cycle number of 35,annealing temperature of 62 ℃.The adulterants and the blank control showed no bands.The method could simultaneously and accurately identify the snake-derived components in the mixed samples.Conclusion:The method can be used to identify the samples of Zaocys dhumnades,Elaphe carinata,Elaphe meollendorffi and Ptyas korros simultaneously,accurately and rapidly,and is suitable for the identification of standard decoctiond and formula granules samples.

Objective To investigate the short-term mortality of transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer, and explore the possible causes of death and countermeasures. Methods All patients who underwent TACE at the Department of Interventional Radiology, First Affiliated Hospital of Soochow University from January 2015 to December 2020 were studied, but those with metastatic liver cancer or receiving combined treatment were excluded. The clinical and imaging data of all patients were collected before and 30 days after TACE, and the clinical characteristics of the patients with short-term postoperative death were analyzed. Death within 30 days after TACE was defined as short-term death. Results A total of 1466 TACE in 741 patients with primary liver cancer were included. Ten patients (10/741, 1.35%) died within 30 days after TACE, with a mortality rate of 0.68% for all TACE. The mortality rate of d-TACE and c-TACE was 1.62% (3/185) and 0.55 % (7/1281), respectively. The mortality rates of patients at China Liver Cancer Staging Ⅰ, Ⅱ, and Ⅲ stages were 0.45% (2/448), 0.33% (2/599), and 1.43% (6/419), respectively. The mean diameter of the largest lesion in death cases was 10.1±0.8 cm. The possible causes of death were liver failure (4 cases), rupture bleeding (3 cases), myelotoxicity (1 case), pulmonary embolism (1 case), and heart failure (1 case). Conclusion The mortality rate after TACE in patients with primary liver cancer is low, with occasional short-term postoperative deaths. The death cases are characterized by a large tumor volume, and the most common causes of short-term death are liver failure and rupture bleeding.

Objective To investigate the etiological characteristics of infection after percutaneous biliary drainage or stent implantation in patients with malignant biliary obstruction (MBO). Methods Clinical data were collected from MBO patients who underwent interventional therapy in Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, from January 2016 to December 2020 and had or were suspected of biliary tract infection, with samples submitted for bile culture and/or simultaneous blood culture. Analysis was performed for the aspects of positive rate of culture, flora distribution, consistency between blood culture and bile culture, and drug resistance rate of major pathogenic bacteria. Results A total of 219 patients were enrolled, among whom 105(47.95%) were positive for bile culture, and the composition ratios of Gram-negative bacteria, Gram-positive bacteria, and fungi were 64.89%, 28.24%, and 6.87%, respectively. A total of 69 patients had samples submitted for blood culture during the same period of time, among whom 33(47.82%) had positive results. Positive results of both bile culture and blood culture were observed in 25 patients, and consistency analysis showed that the patients with complete consistency, partial consistency, and complete inconsistency accounted for 36%(9/25), 20%(5/25), and 44%(11/25), respectively. Common Gram-negative bacteria were Escherichia coli , Klebsiella pneumoniae , and Enterobacter cloacae , with a relatively low level of drug resistance to antibiotics including cefoperazone/sulbactam, amikacin, and imipenem. Common Gram-positive bacteria were Enterococcus faecium and Enterococcus faecalis , with a relatively low level(< 15%) of drug resistance to antibiotics including vancomycin, linezolid, and teicoplanin. Conclusion Common pathogens of infection after percutaneous biliary drainage or stent implantation in MBO patients include Escherichia coli , Klebsiella pneumoniae , Enterococcus, and Enterobacter cloacae . There is a relatively low level of consistency between blood culture and bile culture, and thus samples should be submitted for both tests.