Objective To investigate the status of diabetes distress in patients with middle-andhigh risk of diabetic foot and explore the impact of self-perceived burden and social support on diabetes distress.Methods Totally 205 patients with middle-and-high risk of diabetic foot were investigated with Diabetes Distress Scale,Self-perceived Burden Scale and Social Support Scale.Results The total average score of diabetes distress was (2.59±0.57),the diabetes distress level was correlated with self-perceived burden,dimensions of social support (r=0.481～0.653) and were influenced by gender,vocation,objective support,use of support.Conclusions Diabetes distress is widespread in patients with middleand-high risk of diabetic foot and was influenced by many factors,these provide the basis for taking effective interventions to reduce diabetes distress.

Orbital metastases rarely occur in the patients with cancer,especially from a primary pancreat-ic carcinoma.In patients presenting ophthalmologic symptoms such as local pain and periorbital edema,it is im-portant to consider orbital metastatic disease.And it is also crucial to determine the site of the primary tumor for better treatments.The mechanism underlying the orbital metastasis from pancreatic carcinoma remains to be clari-fied.In this report,we describe the clinical characteristics of a case with orbital and hepatic metastases from pri-mary pancreatic carcinoma,providing a reference for clinical diagnosis.Computed tomography of the abdomen and left orbit,in combination with intraorbital biopsy,suggesting a primary pancreatic malignancy with metastatic dis-ease.Surgical pathology and histopathological examination results confirmed the diagnosis.After single agent gem-citabine chemotherapy,the patient′s symptoms relieved.

Objective To observe clinical efficacy of external bath of modified Huangqi Guizhi Wuwu Decoction in relieving peripheral neurotoxicity induced by oxaliplatin.Methods Sixty patients were randomly divided into control group and treatment group (30 cases in each group). Both groups received intramuscular injection of mecobalamine (0.5 mg/d, three times a week). At the same time, the treatment group received external bath of modifiedHuangqi Guizhi Wuwu Decoction. All the courses of treatment lasted for 14 days. Clinical efficacy and adverse reactions of the two groups were observed.Results The total effective rate of treatment group was 73.3% (22/30), which was superior to that of 40.0% (12/30) in the control group, with statistical significance (P<0.05), without any adverse reaction.Conclusion External bath of modifiedHuangqi Guizhi Wuwu Decoction is effective as supportive care for alleviating chronic peripheral neurotoxicity induced by oxaliplatin.

Objective To investigate the effect of the revision of Chinese Versions of Reading the Mind in the Eyes Test(RME) on the diagnosis of mild cognitive impairment (MCI) and mild Alzheimer's dementia (AD).Methods We compared performance on the cognitive test battery between 96 patients with MCI and 55 patients with AD and 95 control individuals.Neuropsychological tests, encompassing RME-T, Mini Mental State Examination (MMSE) and Auditory Verbal Learning Test (AVLT), were conducted on 96 patients with MCI, 55 patients with AD and 95 healthy control individuals.Completion rate of RME-T in the normal group and the total scores and each item score of RME-T were analyzed, and the feature between RME-T and RME-S (RME-short) was compared.Results The total score of RME-T was (23.7±4.7) in normal group, (19.9 ± 4.9) in MCI group,and (19.9±7.5) in AD group.There were significant differences in the total score of RME-T among the three groups (t=13.9, P＜0.01).The differences in the total score of RME-T between normal group and AD group, between normal group and MCI group were also significant (both P＜0.01).RME-S was composed of 20 items after rejecting 16 items of RME T whose project completion rate was lower than 50％ in the normal group and in which there was no significant difference among normal, MCI and AD groups.The correlations between the total score of RME-T and 3 item scores of RME-T were not significant (P＞0.05).However, the total score of RME-S was highly correlated with each item score of RME-S (P＜0.01).The total score of RME-T and RME S were highly correlated with each total score of the cognitive test battery (P＜0.01).With the normal and MCI groups, normal and AD groups as the subjects, the receiver operating characteristic (ROC) curve analysis found that AUC(RME-S) was＞ AUC(RME-T) in normal and AD groups (P＜0.01), whereas, AUC(RME-S) was＜AUC(RME-T) in normal and MCI groups (P＞0.05).Conclusions RME has good reliability and validity, and RME-S is better than RME-T in internal consistency, which is more suitable for identifying mild cognitive impairment and Alzheimer's disease in Chinese population, and it is worthy of further popularization and application.

Background and purpose: Phosphatase and tensin homologue deleted on chromosome 10 (PTEN) gene is a kind of tumor suppressors, which has been reported to be underexpressed in endometrial carcinoma (EC) tissues by several reports. However, the biological effects and possible mechanisms of PTEN on EC have been known less. In this study, we tried to investigate the effects and possible mechanisms of PTEN on the invasion and migration of endometrial carcinoma cells and to provide a potential target for endometrial carcinoma therapy. Methods:The recombinant plasmid pIRES2-ZsGreen1-PTEN was rebuilt by gene recombination technology;The plasmid was transferred into HEC-1B cells and the cells transfected with pIRES2-ZsGreen1 plasmid were used as control;The expression of PTEN was observed by fluorescence microscope and Western blot assay;Cell migration and invasion was determined by the wound healing assay, transwell migration and invasion assays respectively;The Western blot analysis was performed to detect the expression of ATP-dependent tyrosine kinase (AKT), phosphorylated-AKT (p-AKT) and matrix metalloproteinase-2 (MMP-2). Results:The agarose gel electrophoresis showed a stripe of 1.2 kb which was same to PTEN cDNA;The sequence analysis showed the PCR products owned the same sequence with the coding region of PTEN cDNA in GenBank, suggesting the recombinant plasmid was constructed successfully;The green light of cells observed by fluorescence microscope and the Western blot analysis showed the expression of PTEN was upregulated in the cells transfected with the recombinant plasmid, suggesting the plasmid expressed successfully in HEC-1B cells;The wound healing assay as well as transwell migration assay showed ectopic expression of PTEN suppressed cell migration;The invasive capacity of HEC-1B cells was significantly decreased upon transfection with PTEN plasmid compared to control and untreated groups;Moreover, compared with the control groups, the expression of p-AKT and MMP-2 was downregulated, while there was no significant alteration of the expression of AKT. Conclusion:PTEN could suppress cell migratory and invasive ability of endometrial carcinoma cells by suppressing the phosphorylation of AKT followed by the decrease of MMP-2.

Objective To investigate the preventive and therapeutic effects of different doses of penehyclidine hydrochloride preoperative medication on the catheter -related bladder discomfort during general anesthesia recovery period.Methods 160 adult patients who underwent general anesthesia for elective surgery were randomly dividided into four groups.40 patients in each group received intravenous injection 30min before surgery with penehyclidine hydrochloride 0.005mg/kg (group A),0.010mg/kg (group B),0.015mg/kg (group C),or normal saline (group D).All patients were catheterized with a 12 Fr Foley's catheter and the balloon was inflated with 8mL normal saline after anesthesia induction .The bladder discomfort was assessed during recovery in the post -anesthesia care unit .The severity of bladder discomfort was graded as mild , moderate and severe .Results The incidence of moderate and severe bladder discomfort in group B and group C (group B:20.0％,5.0％;group C:12.8％,2.5％) were significant lower compared with group A and group D ( group A:38.5％,12.8％;group D:46.0％ 15.4％) (χ2 =7.834, 6.764,8.163,14.172,8.362,6.943,15.413,17.512,all P<0.05).There was no significant difference between group B and group C , group A and group D .Conclusion Hydrochloride penehyclidine preoperative administration with 0.010mg/kg or 0.015mg/kg can effectively control the incidence of catheter discomfort during general anesthesia recovery period and 0.010mg/kg is appropriate for the elderly .

Objective To be good for the different working age midwives to carry out the same evaluation of the pregnant woman,we build and use the Episiotomy Evaluation Form for reducing the rate of episiotomy with ensuring the safety of mother and baby.Methods Consult relevant literature,combine clinical practice,discuss,report to the hospital ethics committee many times and at last it was made after approval.The details included:perineal lesions,perineum elasticity,perineal length,maternal coordination,gestational age,age,fetal distress degree,amniotic fluid situation,the weight of fetus estimated,the second time of labor and so on,to score by 0,1,3,5,20.A total of 600 patients with low risk of natural childbirth were randomly divided into observation group and control group according to method of random number table with 300 cases each.The observation group was graded according to the perineal incision evaluation and we operated according to its use method.The control group was judged according to the experience of midwife and subjective cognition.At last compared the effects on the mother and baby.Results The rates of lateral episiotomy and Ⅰ degree laceration were 15.00％ (45/300) and 63.00％ (189/300) in the observation group and 48.33％ (145/300) and 21.67％ (65/300) in the control group,respectively.The difference between the two groups was statistically significant (x2=16.238,21.507,P ＜ 0.05).There was no statistical difference in the perineal intact rate,median perineal incision rate,perineal Ⅱ degree laceration rate,severe perineal laceration,second stage of labor,postpartum hemorrhage 2 hours,neonatal asphyxia rate,incidence of neonatal birth injury (brachial plexus injury,clavicle fracture,etc.) and pelvic floor muscle strength of 42 days after delivery between the two groups (P ＞ 0.05).Conclusions By using the episiotomy evaluation form,we can improve the accuracy and homogeneity of the midwife's assessment about the episiotomy which is benefit to reduce rate of episiotomy.It is worth promoting in clinical practice but we should ensure the safety of maternal and child.

Objective: To evaluate the expression of cytokeratin (CK)7, CK8/18, CK19 and p40 in esophageal squamous cell carcinoma (ESCC) and its significances. Methods: One hundred and ninety cases of surgically resected ESCCs and 154 normal esophageal tissues as control were collected at the First Affiliated Hospital of Zhengzhou University in 2012.Of the 190 ESCC cases including 116 male and 74 female, aged 28-82 (60.3±8.6) years, 88 cases <60 years old and 102 cases ≥60 years old. Tissue sections were immunostained for CK7, CK8/18, CK19 and p40, and the expression was evaluated and correlated with the clinicopathologic findings and outcome. Results: CK19 and p40 were expressed in 190 cases of ESCCs; with 147 cases (77.4%) and 151 cases (79.5%) showing high p40 and CK19 expression, respectively; while 43 cases (22.6%) and 39 cases (20.5%) showed low p40 and CK19 expression, respectively. The low expression groups showed more lymph node metastases and higher pTNM stages compared to the high expression groups. The high CK19 expression group showed better prognosis than the low expression group (P<0.01); p40 expression was not correlated with prognosis(P>0.05). In contrast, CK7 and CK8/18 expression was only seen in 29 cases (15.3%) and 59 cases (31.1%) of ESCCs, respectively, and their expression correlated significantly with the degree of tumor differentiation and lymph node metastasis (P<0.05). The prognosis in the CK7 negative group was better than that in the CK7 positive group. Similar results were found in CK8/18 expression. Multivariate analysis revealed that pTNM stages, low CK19 expression and CK8/18 expression were independent prognostic factors. Conclusions Low p40 expression and the expression of CK7 and CK8/18 cannot exclude poorly-differentiated ESCCs.CK7 and CK8/18 expression and low CK19 and p40 expression in the ESCCs are associated with lymph node metastasis and poor prognosis. Decreased expression of CK19 and positive expression of CK8/18 in ESCCs are independent prognostic markers.

Objective To analyze the clinical characteristics and genotype of a patient with congenital systemic lip-odystrophy(CGL)type 1 associated with exudative xanthoma caused by AGPAT2 gene mutation,and to provide ev-idence for clinical and genetic diagnosis of the disease.Methods Clinical data of the patient such as medical histo-ry,physical examination and laboratory examination were collected.Peripheral venous blood was collected for whole exome sequencing analysis and Sanger sequencing verification,and treatment was provided to patients according to the changes of condition.Results The clinical manifestations of the patient were subcutaneous fat reduction,fatty liver,spleen enlargement,kidney enlargement,high blood sugar and lipids,severe insulin resistance,scattered yellow rash on limbs,which was confirmed as xanthoma.The results of whole exon sequencing showed that the AGPAT2 gene of the patient had a heterozygous nonsense mutation of c.202C＞T:p.R68?and c.646A＞T:p.K216?,and the former was the pathogenic mutation site.Follow-up therapy covers improvement of lifestyle,low-fat diet and regular exercise.The rashes subsided after active lipid-lowering therapy.Conclusions Apart from typical lipody-strophy,the patient was accompanied by exanthemous xanthoma.No CGL1 patient with exanthemous xanthoma has been reported in the domestic literature database up to now,and the genetic test results showed that there was a c.202C＞T heterozygous mutation of AGPAT2 gene.This gene site has not been reported in the literature,and its functional verification needs to be further studied.

A rapid and sensitive method for analyzing trace β-blockers in complex biological samples,which involved magnetic solid-phase extraction(MSPE)coupled with Fourier transform ion cyclotron reso-nance mass spectrometry(FTICR-MS),was developed.Novel nanosilver-functionalized magnetic nano-particles with an interlayer of poly(3,4-dihydroxyphenylalanine)(polyDOPA@Ag-MNPs)were synthesized and used as MSPE adsorbents to extract trace β-blockers from biological samples.After extraction,the analytes loaded on the polyDOPA@Ag-MNPs were desorbed using an organic solvent and analyzed by FTICR-MS.The method was rapid and sensitive,with a total detection procedure of less than 10 min as well as limits of detection and quantification in the ranges of 3.5-6.8 pg/mL and 11.7-22.8 pg/mL,respectively.The accuracy of the method was also desirable,with recoveries ranging from 80.9％to 91.0％following the detection of analytes in human blood samples.All the experimental results demonstrated that the developed MSPE-FTICR-MS method was suitable for the rapid and sensitive analysis of trace β-blockers in complex biological samples.