Diabetic peripheral neuropathy(DPN)is a common and devastating complication of diabetes,for which effective therapies are currently lacking.Disturbed energy status plays a crucial role in DPN pathogenesis.However,the integrated profile of energy metabolism,especially the central carbohy-drate metabolism,remains unclear in DPN.Here,we developed a metabolomics approach by targeting 56 metabolites using high-performance ion chromatography-tandem mass spectrometry(HPIC-MS/MS)to illustrate the integrative characteristics of central carbohydrate metabolism in patients with DPN and streptozotocin-induced DPN rats.Furthermore,JinMaiTong(JMT),a traditional Chinese medicine(TCM)formula,was found to be effective for DPN,improving the peripheral neurological function and alleviating the neuropathology of DPN rats even after demyelination and axonal degeneration.JMT ameliorated DPN by regulating the aberrant energy balance and mitochondrial functions,including excessive glycolysis restoration,tricarboxylic acid cycle improvement,and increased adenosine triphosphate(ATP)generation.Bioenergetic profile was aberrant in cultured rat Schwann cells under high-glucose conditions,which was remarkably corrected by JMT treatment.In-vivo and in-vitro studies revealed that these effects of JMT were mainly attributed to the activation of adenosine monophosphate(AMP)-activated protein kinase(AMPK)and downstream peroxisome proliferator-activated receptor gamma coactivator 1-alpha(PGC-1α).Our results expand the thera-peutic framework for DPN and suggest the integrative modulation of energy metabolism using TCMs,such as JMT,as an effective strategy for its treatment.

We report a case of functional parathyroid cyst treated by ultrasound-guided anhydrous ethanol sclerotherapy and microwave ablation. The 63-year-old female patient was diagnosed to have functional parathyroid cyst with hypercalcemia, high PTH and cystic space-occupying lesions in the neck by ultrasound, radionuclide scanning and PTH measurement of the cystic fluid. The patient refused to receive cyst resection, and anhydrous ethanol sclerotherapy with microwave ablation was performed under ultrasound guidance. The procedure was completed smoothly without any complications either during or after the operation. Follow-up examination of the patient at 18 months after the operation showed a significant reduction of the mass and normal blood calcium and iPTH levels, demonstrating a clinical cure of the patient. Ablative treatment of functional parathyroid cyst has not been documented so far. This approach provides a minimally invasive treatment modality for such cases where surgical resection is not an option, but its efficacy and safety need to be evaluated in more cases with longer follow-up time.
Female ; Humans ; Middle Aged ; Microwaves/therapeutic use* ; Plastic Surgery Procedures ; Cysts ; Ethanol/therapeutic use* ; Ultrasonography, Interventional

Objective:To explore the application effect of structural formula based continuous nursing in colorectal cancer patients with ostomy.Methods:Using the convenient sampling method, a total of 128 patients with colorectal cancer stoma who were admitted to Liuzhou Worker's Hospital from July 2019 to September 2021 were selected as the research objects. According to the random number table method, they were divided into the observation group and the control group, with 64 cases in each group. Patients in the observation group received structural continuous nursing, while patients in the control group received traditional continuous care. Exercise of Self-Care Agency Scale (ESCA) and the Medical Outcomes 36-items Short Form Health Survey (SF-36) scores were compared between the two groups.Results:After 3 months of intervention, ESCA and SF-36 scores in the observation group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Structural formula based continuous nursing can improve the self-care ability and quality of life of colorectal cancer patients with ostomy.

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

Objective:To construct a management scheme of physical restraints in geriatric medical and nursing institutions by evidence-based and expert meeting methods so as to guide clinical nursing practice.Methods:Physical restraint related guidelines, systematic evaluation, evidence summary and other data were searched to conduct literature quality evaluation and evidence collection and a management scheme of physical restraints in geriatric medical and nursing institutions was initially constructed. The expert meeting method was adopted to finally establish a management scheme for physical restraints in geriatric medical and nursing institutions.Results:A total of 10 literatures were included, including 6 guidelines, 3 systematic evaluations and 1 evidence summary. The management scheme of physical restraints in geriatric medical and nursing institutions was constructed, including assessment, planning, implementation, evaluation and training.Conclusions:This study constructs a physical restraint management scheme for geriatric medical and nursing institutions based on evidence, and will conduct clinical transformation and application research on this scheme in the future to verify the applicability and clinical effect of the scheme, so as to standardize the use of physical restraints in geriatric medical and nursing institutions and improve the service quality of geriatric medical and nursing institutions.

Objective: To investigate the biological characteristics of high hyperdiploid and triploid/tetraploid acute myeloid leukemia (HH/TT-AML) and its relationship with prognosis. Methods: The clinical data of 28 patients with newly diagnosed HH/TT-AML during March 2006 and June 2017 were retrospectively analyzed, and the factors influencing prognosis were analyzed by the Kaplan-Meier method. Results: The karyotypes of HH/TT-AML patients were mainly 49 chromosomes, accounting for 39.3% (11/28), followed by 50-55 chromosomes, accounting for 32.1% (9/28). The karyotypes of high hyperdiploid acute myeloid leukemia (HH-AML) patients were more likely to be +8 (77.3%, 17/22) or +21 (54.5%, 12/22). The survival analysis showed that the overall survival rate of HH/TT-AML patients with -5/5q-, -7/7q-, -17/der(17p) or der(3q) was significantly lower than that without these abnormalities (4.1 months vs 10.1 months,P＜0.05). There was no significant difference in the overall survival rate between triploid/tetraploid acute myeloid leukemia (TT-AML) patients and HH-AML patients (8.4 months vs 7.2 months,P＞0.05). The overall survival rate of the patients with allogeneic hematopoietic stem cell transplantation was significantly longer than that with chemotherapy alone (25.4 months vs 4.1 months,P＜0.01). Conclusion HH/TT AML patients are highly heterogeneous. The identification of poor prognosis-related chromosome abnormalities is helpful for the stratification of prognosis. The overall survival time of these patients is short. Early allogeneic hematopoietic stem cell transplantation after remission by combination chemotherapy can significantly improve the prognosis of these patients.

Objective To analyze the research status and existing problems on physical restraints in China, and to discuss the future research focus and direction, so as to provide reference for clinical research and practice in this field. Methods We search literatures using "body restraint OR restraint belts OR physical constraint" as the subject or key words from the database of CNKI, Wanfang database and VIP, using "physical restraint OR restraint" as the main title or key words from the database of PubMed and Web of Science database from the beginning to August 19, 2019. NoteExpress and Excel software were used to analyze the annual distribution, geographical distribution, fund support, journal distribution, literature type, research object and research content of the included literatures from 2009 to 2019. Results A total of 492 valid literatures have been retrieved. The annual distribution has been increasing year by year. According to the first author, literatures have a wide geographical distribution. The top three are Jiangsu, Hubei and Guangdong province. There are 31 literatures which have received 17 funds. Peking University Chinese core journals and Chinese scientific and technological papers have counted 155 literatures, accounting for 31.50%. The design and application of constraint tools is the most common content of research, for 264. 122 literatures have been conducted on patients in intensive care unit. Conclusions The research on physical restraints is developing rapidly in China, but the quality of the literatures needs to be improved. It is suggested use the published guidelines and evidence-based researches abroad for reference, combining Chinese national conditions and the characteristics of medical institutions and patients, develop management programs and guidelines to minimize physical restraints and promote patient safety.

Diabetic peripheral neuropathy (DPN) is a neurodegenerative disease induced by chronic hyperglycemia.Its pathophysiologic processes including neurons loss,nerve demyelination,axonal degeneration,and disorders in nerve repair and regeneration may be associated with mitochondrial dysfunction.Ultrastructural abnormalities of mitochondria,mitochondrial proteomic changes,dysfunctions of mitochondrial electron transport chain and mitochondria have been implicated as the etiological factors of DPN.These abnormal conditions may be relevant to adenosine monophosphate-activated protein kinase/peroxisome proliferator-activated receptor-γ coactivator 1α signaling axis disorder.Therefore,therapies targeting this pathway may help to protect nerves and delay the progression of DPN.

Objective To investigate the etiological and antibiotic resistance profile in the old patients with bloodstream infection (BSI).Methods Microbiological and clinical data were collected and reviewed retrospectively for the patients with confirmed bloodstream infection and at least 65 years of age who were treated as inpatients in Tongling People′s Hospital from January to December 2015.Results A total of 107 strains of pathogen were isolated from the blood samples of 107 patients with bloodstream infections, of which community-acquired BSI accounted for 57.9 % (62/107), and hospital-acquired BSI 42.1 % (45/107). Gram negative bacilli accounted for 67.7 % in the pathogens of community-acquired BSI and gram positive cocci accounted for 55.5 % in the pathogens of hospital-acquired BSI. More male BSI patients were secondary to respiratory tract infection than female patients (P<0.001), while more female BSI patients were secondary to urinary tract infection than male patients (P<0.001). Of the 107 isolates, gram negative bacilli, gram positive cocci and fungi accounted for 55.1 % (59/107), 42.1 % (45/107) and 2.8 % (3/107), respectively. The top six pathogens were E. coli (30.9 %), coagulase negativeStaphylococcus (CNS) (20.6 %), S. aureus (10.3 %),K. pneumoniae (6.5 %),Enterococcusspp. (6.5 %) and Acinetobacter spp. (4.7 %). About 51.5 % of the E. coli isolates and 28.6 % of the K. pneumoniae isolates produced extended-spectrum β-lactamases (ESBLs).E. coli isolates showed low resistance rate (< 10 %) to amikacin,cefoxitin and piperacillin-tazobactam. No E. coli isolate was found resistant to carbapenem. About 14.3 % to 28.6 % of K. pneumoniae isolates were resistant to carbapenems. No tigecycline-resistant K. pneumoniae was found. The prevalence of MRSA and MRCNS was 36.4 % and 72.7 %, respectively. No staphylococcal isolates were found resistant to vancomycin, teicoplanin or linezolid. One strain of E. faecium was identified as resistant to vancomycin (VRE).Conclusions This surveillance data indicate that gram negative bacilli play an important role in the BSI of old patients. E. coli and CNS are the most common pathogens. We should pay more attention to the effect of gender and site of infection on the BSI in old patients.

Objective To investigate the clinical characteristics of 40 patients with ocular toxocariasis (OT) on the first attendance.Methods A total of 40 consecutive patients who were clinically and serologically diagnosed with OT were retrospectively reviewed.Results The mean age of patients was (12.12±10.42) years.There were 29 males and 11 females.29 cases presented with decreased vision,4 children with leukocoria,2 cases with strabismus and 5 cases was found abnormal during regular eye examination.Initially 8 eyes (20％) were misdiagnosed as retinoblastoma (1 eye),Coat' s disease (1 eye),cataract (2 eyes),iridocyclitis (2 eyes) and retinal detachment (2 eyes).23 eyes had retinal detachment,19 eyes had cataract.OT was the initial diagnosis for 15 patients (37.5％).The best corrected visual acuity (BCVA) were NLP to 0.7.Ultrasound biomicroscopy (UBM) were performed in 29 eyes,and identified peripheral granulomas in 23 eyes and adjacent tractional retinal detachment in 12 eyes.We also identified 17 cases (68.0％) with elevated IgE level among 25 patients with positive serological antibody test.Conclusions Tractional retinal detachment,vitreous opacities and cataract are the common clinical findings at the first attendance of OT patients.The adjunctive test of serum total IgE level may be helpful for the diagnosis.The application of UBM and specific IgG detection in serum and intraocular fluid,can also improve the diagnosis.