Objective: To investigate the self-care activities and their influencing factors among young and middle-aged patients with type 2 diabetes mellitus ( T2DM ), so as to provide the basis for the care management of T2DM. Methods: T2DM patients at ages of 18 to 59 years that were admitted to Department of Endocrinology, Hangzhou First People's Hospital Affiliated to Medical School of Zhejiang University were selected using the convenient sampling method from January to August 2021, and the demographic data were collected using questionnaires, including gender, age and educational levels. The self-care level was measured using the Summary of Diabetes Self-Care Activities ( SDSCA ) was used to assess self-management behaviors, and the social support level was evaluated using the Social Support Rating Scale ( SSRS ), while the coping modes were assessed using the Medical Coping Modes Questionnaire ( MCMQ ). Factors affecting the self-care activities were identified among young and middle-aged patients with T2DM using multivariable linear regression analysis. Results: The 342 respondents included 185 men ( 54.07% ) and 157 women (45.93% ), and had a mean age of ( 43.76±3.82 ) years. The total score of self-care activities was ( 94.22±18.74 ), and the overall scoring rate was 72.48%, including 63 cases with high scores ( 18.42% ), 208 cases with moderate scores ( 60.82% ) and 71 cases with low scores ( 20.76% ). Multivariable linear regression analysis identified gender ( women, β'=0.213 ), educational level ( high school/technical secondary school, β'=0.187; diploma and above, β'=0.411 ), household monthly income per capita (5 000 Yuan and higher, β'=0.390), course of disease ( >5 years, β'=0.340 ), history of receiving health education targeting diabetes ( β'=0.411 ), coping mode ( avoidance, β'=0.195; confronce, β'=0.367 ) and social support level ( general, β'=0.206; high, β'=0.383 ) as factors affecting self-care activities among young and middle-aged patients with T2DM. Conclusions The overall self-care activities at a moderate level among young and middle-aged patients with T2DM, which are associated with gender, educational level, economic income, course of disease, health education targeting diabetes, coping mode and social support level.

Objective To explore the relationship of content of plasma endothelin(ET)-1 with the change of pulmonary function in patients with chronic obstructive pulmonary disease(COPD).Method Thirty cases of the normal people were as group A ,34 cases of the patients with COPD with acute exacerbation before treatment were as group B and the patients with remission period after treatment were as group C,the plasma ET-1,arterial blood gas and pulmonary function parameters were determined from the patients before and after treatment.Results The plasma ET-1 in group B and group C were significantly higher than that in group A,the content of the plasma ET-1 had negatively correlated with PaO2,and that had positively correlated with PaCO2,P＜0.01.The pulmonary function parameters (VC,FEV1/FVC,MVV,V50 V25)in group B were significantly lower than those in group A and group C[(55.3±24.5)%,(54.8±19.3)%,(54.2±16.2)%,(54,8±9,9)%,(58.7±14.5)%;(114.8±24.1)%,(84.9±21.6)%,(86.4±17.2)%,(78.5±14.8)%,(90.3±15.4)% and (110.1±19.4)%,(85.8±15.5)%,(85.9±16.7)%,(74.5±13.4)%,(89.4±18.6)%,respectively],P＜0.01.Conclusion Pathophysiological effects of patients with COPD can be commonly adjusted by the plasma ET-1,oxygen and carbon dioxide retention,which affect pulmonary function.

Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.

Objective:To investigate the preventive efficacy of pirfenidone in esophageal stent-related restenosis and the related underlying mechanisms.Methods:Twenty-four rats underwent esophageal stent placement were included in this study. The rats were randomly assigned to three groups, with 8 rats in each group. The three groups were set to receive placebo, 150 mg/kg pirfenidone and 300 mg/kg pirfenidone daily by oral administration for 28 days, respectively. Twenty-eight days after stent placement, the stented esophagi were harvested for histological examinations. The number of epithelial layers, the thickness of submucosal fibrosis, the percentage of granulation tissue area, the degree of inflammatory cell infiltration, the degree of collagen deposition, and the α-SMA staining scores were evaluated. One-way ANOVA was performed for the statistical comparison of the number of epithelial layers, the degree of inflammatory cell infiltration, the degree of collagen deposition and the α-SMA staining scores among these three groups. The Kruskal-Wallis H test was used for comparison of the thickness of submucosal fibrosis and the percentage of granulation tissue area among the three groups. Results:Gross pathological findings showed that both pirfenidone groups had significantly less luminal fibrotic tissue formation and restenosis than placebo group. The percentage of granulation tissue areas in placebo group, 150 mg/kg and 300 mg/kg pirfenidone groups were 57.23%±25.68%, 21.80%±6.65% and 12.18%±6.37%, respectively. Both pirfenidone groups showed significantly less granulation tissue areas than placebo group ( P<0.01). The degree of inflammatory cell infiltration, the degree of collagen deposition and the α-SMA staining scores were 3.28±0.55, 3.38±0.63 and 2.75±0.38 in placebo group, 2.30±0.46, 2.36±0.58 and 2.00±0.42 in 150 mg/kg pirfenidone group, and 1.86±0.38, 1.91±0.41 and 1.57±0.28 in 300 mg/kg pirfenidone group, respectively. Both pirfenidone groups showed significantly less inflammatory cell infiltration, collagen deposition and α-SMA staining scores than placebo group ( P<0.01). Conclusion:Pirfenidone can suppress esophageal stent-related restenosis in rats by significantly inhibiting inflammation, myofibroblast activation and proliferation, and fibrotic tissue formation.

BACKGROUND:Little data have been available concerning the mechanism of drag resistance and anti-apoptosis in leukemic cells of leukemia children.The majority of studies focus on normal bone marrow mesenchymal stem cells (MSCs) and established stroma cells,but not interaction of MSCs and leukemic cells in leukemia children.OBJECTIVE:To explore the effect of MSCs in leukemia children on the proliferation and apoptosis of leukemic cell strain K562/AO_2.DESIGN,TIME AND SETTING:In vitro cytology experiment was performed at the laboratory of Department of Pediatrics,First Affiliated Hospital of Guangzhou Medical College from December 2007 to August 2008.MATERIALS:MSCs were provided by 30 leukemia children admitted to First Affiliated Hospital of Guangzhou Medical College,including 22 acute lymphoblastic leukemia and 8 acute myeloblastic leukemia.Written informed content was obtained from all families.K562/AO_2 was provided by Tianjin Institute of Hematopathy.METHODS:MSCs were isolated and cultured by Ficoll density gradient method.They were cultured in two conditions:the co-culture of MSCs and K562/AO_2 and K562/AO_2 suspension alone.In co-culture group,1×10~8 /L K562/AO_2 cells at log phase were added to confluent MSCs,and free floating K562/AO_2 cells were discarded after 24 hours.MAIN OUTCOME MEASURES:Effect of MSCs on the growth of K562/AO_2 cells was observed;effect of addamycln on K562/AO_2 cell apoptosis was detected by AnnexinV-FITC method.Cell cycle was determined by flow cytomtry,mdrl gene of K562/AO_2 cell was detected by Taqman-MGB probe real-time PCR.RESULTS:Compared with K562/AO_2 alone,the K562/AO_2 cell co-cultured with MSCs grew slower and the log phase of growth was not significant;the rate of apoptosis in earlier period was significantly decreased (P ＜ 0.05);co-cultured K562/AO_2 G_0-G_1 phase increased,but S phase decreased.No changes in mdr1 gene in cells were found between two culture conditions (P ＞ 0.05).CONCLUSION:In vitro cytology has demonstrated that leukemia children MSCs induce drug resistance of K562/AO_2 cells by changing K562/AO2 cell cycle through adhesion to avoid pro-apoptotic effect of drugs but not related with mdr1 gene.

Objective To study the role of vascular resection in the radical resection of hilar cholangiocarcinoma. Methods One hundred and forty-two cases of hilar cholangiocarcinoma (HC) data during July 2009 and December 2014 were analyzed retrospectively .After sufficient preoperative management including relieving jaundice , three dimensional assessments were evaluated and then surgical planning was designed. Results One hundred and forty-two cases underwent surgery after adequate preoperative preparation and evaluation, of whom 16 patients had vascular resection. Portal vein resection was performed in 11 cases, in which the portal vein wedge excision was performed in 4 cases, the portal vein anastomosis in 6 cases, and right anterior portal vein resection and reconstruction was performed in 1 case. Because of tumor invasion in the right hepatic artery, 4 patients underwent right hepatic artery resection and saphenous vein reconstruction, and 1 patient underwent right hepatic artery anastomosis. Postoperative complications were as follows:bile leakage in 1 case, no abdominal bleeding and abdominal infection, and no vascular thrombosis-related complications, and the overall complication rate was 1/16. There was no perioperative death . The follow-up results was as follows: 1 patient died 3 months after surgery, 1 died of liver metastasis after 9 months, 2 cases were lost to follow up, and the rest patients were still followed up. Conclusions Vascular resection for hilar cholangiocarcinoma helps to improve tumor resection rate and prognosis in large medical centers. With the use of three dimensional assessment, preoperative management and reasonable surgical strategy can reduce postoperative complications and ensure safety for hilar cholangiocarcinoma resection.

Objective To explore and evaluate the method and feasibility of applying the contrast agent fluorescein sodium to enhance the efficiency of Cerenkov radiation energy transfer (CRET).Methods Fluorescein sodium was employed as the energy transfer receptor of 18 F-FDG Cerenkov radiation (CR) to achieve stronger signal.18F-FDG was mixed with fluorescein sodium of different concentrations:0.05,0.10,0.20,1.00,2.00,4.00,8.00 mmol/L.Optical signal strength was quantified by ROI analysis.The influence of fluorescein sodium concentration on CRET efficiency and the optimal concentration that could achieve most optical signal augmentation were studied.The optimal concentration of fluorescein sodium was mixed with 1.85-11.10 MBq 18F-FDG for CLI.Linear regression was performed to investigate the range of 18F-FDG dose with most optical signal augmentation and the influence of 18F-FDG dose on CRET efficiency.A tumorbearing nude mouse was imaged after intravenous injection of 18F-FDG and then imaged again after injection of fluorescein sodium post 18 F-FDG injection.These two sets of images were compared to evaluate the CRET efficiency in vivo.Results In vitro study showed that 1.00 mmol/L fluorescein sodium was the optimal concentration for 18F-FDG dose ranging from 1.85 MBq to 11.10 MBq.The signal from 18F-FDG mixed with fluorescein sodium was 3.7 times stronger than that from 18F-FDG alone.Experiment in vivo suggested that 18F-FDG mixed with fluorescein sodium could effectively enhance the signal strength by CRET.Conclusion 18F-FDG mixed with fluorescein sodium may improve the efficiency of CRET,therefore,can enhance the signal strength,reduce the exposure time and achieve better signal to noise ratio.

Objective: To investigate the trends in incidence and mortality of prostate cancer in Huangpu District, Shanghai Municipality from 2002 to 2019, so as to provide insights into the prevention and treatment of prostate cancer. Methods: The incidence and mortality of prostate cancer among men in Huangpu District from 2002 to 2019 were collected from the Shanghai Cancer Registry System. The crude incidence, crude mortality, truncated age-standardized incidence (aged 35 to 64 years) and cumulative incidence (aged 0 to 74 years) of prostate cancer were calculated. The Chinese Fifth National Population Census in 2000 and the Segi's world standard population in 1960 were used to calculate Chinese-standardized rate and world-standardized rate. The trends in incidence and mortality of prostate cancer were evaluated using annual percent change (APC) and average annual percent change (AAPC). Results: A total of 2 672 cases of prostate cancer were reported in Huangpu District from 2002 to 2019, and the crude incidence was 33.35/105, the Chinese-standardized incidence was 14.93/105 and the world-standardized incidence was 12.37/105 (AAPC=7.675%, 4.886% and 4.983%, all P<0.05). The incidence of prostate cancer among males at ages of 60 to <70 years and 70 to <80 years appeared increasing trends (AAPC=4.554% and 5.045%, both P<0.05). A total of 1 214 deaths of prostate cancer were reported, and the crude mortality was 15.15/105, the Chinese-standardized mortality was 6.01/105 and the world-standardized mortality was 4.61/105 (AAPC=5.500%, 2.057% and 1.784%, all P<0.05). The mortality of prostate cancer among males at ages of 80 years and above appeared an increasing trend (AAPC=4.220%, P<0.05). Conclusions The incidence and mortality of prostate cancer appeared increasing trends in Huangpu District from 2002 to 2019, and the incidence among males at ages of 60 years and above also increased. The screening for prostate cancer among males at ages of 60 years and above should be strengthened.

Objective:To study the predictive value of the amplitude-integrated electroencephalography (aEEG) within 6 hours and 3 days after birth and magnetic resonance imaging(MRI) on the adverse neurobehavioral development of asphyxiated preterm infants at the correction age of 6 months.Methods:From December 2017 to June 2019, 50 asphyxiated preterm infants who were delivered at the obstetrical department transferred to the division of neonatology in the Third Affiliated Hospital of Anhui Medical University were monitored by aEEG within 6 hours after birth, then once a day for at least 4 h. MRI was administered at 40 weeks of corrected age, neuromotor developmental function of the infants was assessed by the Geisel developmental diagnostic scale at 6 months of corrected age, then the infants were divided into good prognosis group and poor prognosis group according to the assessment results. SPSS 19.0 software was used for statistical analysis.The software of SPSS 19.0 was used to analyze the data.Independent sample t-test and χ 2 test were used to analyze the difference between the two groups.The relationship between aEEG grading and MRI, and their predictive value for adverse neurobehavioral development were analyzed at 6 months of corrected age. Results:The degree of white matter damage( H=24.896) and intracranical hemorrhage( H=29.245) of premature infants with different aEEG clinical grades were different (both P<0.01) on MRI. The sensitivity of aEEG within 6 hours and 3 days after birth on predicting poor prognosis was 96.2% and 97.8%, the specificity was 56.2% and 62.5%, the negative predictive value was 98.2% and 99.0%, the positive predictive value was 37.8% and 52.3%, the correct index was 52.4% and 60.3%, respectively. The aEEG was combined with MRI, the sensitivity (90.0%, 97.0%), specificity (89.0%, 99.0%), negative predictive value (99.2%, 99.5%), positive predictive value (80.6%, 88.5%), and correct index (79%, 96%) were all improved. Conclusion:The combination of aEEG grading and MRI can improve the prognostic value on neurodevelopmental prognosis, and provide a better evaluation basis for clinical follow-up and intervention of asphyxiated premature infants with brain injury.

Objective To Screen serum protein markers related to CRF and establish a diagnosis model,exploring and discussing its significance in serodiagnosis by comparing differences of serum protein spectrum expression between patients with chronic renal failure (CRF) and control group.Methods The trial included 62 CRF patients and 28 control ones.Serum samples were tested by surface enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS).The data were analyzed to screen serum proteomic biomarkers.By bioinformatics analysis,decision classification tree models were to be established and tested.Results A total of 19 effective protein peaks were significantly different between CRF and normal control (P＜0.001) at m/z range of 1 500 to 30 000,among which 18 showed low expression and 1 showed high expression in CRF.CRF and normal control were obviously different in the clustering;By bioinformatics analysis,a CRF-normal controls of the diagnostic decision tree model was developed,which was 87.8% in with prediction accuracy rate of 87.8% sensitivity of 87.1% and a specificity of 89.3%.Condusion Diagnostic decision tree model provides a more accurate prediction and solid experimental evidence for early clinical diagnosis.