Objective To explore the interactive effect of vitamin D and triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C)on the time to achieve glycemic control in hospitalized patients with type 2 diabetes mellitus(T2DM).Methods A retrospective cohort study was conducted on 82 T2DM patients admitted to Henan Hongli Hospital from March 2021 to December 2023.Patients were categorized into two groups based on the time it took for their blood glucose to reach target levels during their hospitalization:the≤7 d group and the>7 d group.The baseline data,vitamin D levels,and TG/HDL-C ratios of both groups were compared.The relationship between vitamin D,TG/HDL-C levels,and the time it took for blood glucose to reach target levels was analyzed.Further-more,the TG/HDL-C levels of patients with varying vitamin D levels were compared,and the relative risk(RR)and receiver operating characteristic(ROC)curve were used to analyze the interactive effect and predictive value of vitamin D and TG/HDL-C levels on the time it took for hospitalized T2DM patients to achieve target blood glucose levels.Results The hospitalization duration of the group with a duration of>7 days was longer than that of the group with a duration of≤7 days.The fasting blood glucose,glycosylated hemoglobin,and TG/HDL-c levels were higher in the former group,while the vitamin D level was lower.The proportion of patients with vitamin D deficiency and severe deficiency was higher in the former group compared to the latter group(P<0.05).Pearson correlation analysis revealed that vitamin D level was negatively correlated with the time to achieve glycemic control(r=-0.733,P<0.001),while TG/HDL-C level was positively correlated with the time to achieve glycemic control(r=0.830,P<0.001).After adjustment,logistic regression analysis indicated that vitamin D(95%CI:0.482～0.694)and TG/HDL-C level(95%CI:1.053～1.392)remained independent factors influencing the time to achieve glycemic control in hospitalized T2DM patients(P<0.05).Patients with insufficient,deficient,and severely defi-cient vitamin D had higher TG/HDL-C levels compared to those with sufficient vitamin D(P<0.05).The relative risk(RR)of patients with vitamin D deficiency and elevated TG/HDL-C coexisting resulting in a hospitalization duration of>7 days for T2DM patients was 15.867,indicating a synergistic effect.The area under the receiver operating characteristic(AUC)curve for predicting the time to achieve glycemic control in hospitalized T2DM patients using a combination of vitamin D and TG/HDL-C was 0.929,which was greater than that of vitamin D and TG/HDL-C alone(Z=3.849,3.526,P<0.05).Conclusion The vitamin D and TG/HDL-C levels in hospitalized T2DM patients are closely related to the time of reaching glycemic targets.The simultaneous exposure of both factors can affect the time of achieving glycemic targets,and the combined prediction of vitamin D and TG/HDL-C has good reference value for predicting the time of achieving glycemic targets in hospitalized T2DM patients.

Objective To construct a relationship model of emotional intelligence,psychological capital and professional identity by using structural equation model in probationer nursing students,explore the mechanism of interaction among them,and investigate the corresponding intervention measures in combination with the present situation of their emotional intelligence and psychological capital in order to improve their professional identity.Methods An anonymous survey was conducted on 308 probationer nursing students,with questionnaires including General Information Questionnaire,Wong and Law Emotional Intelligence Scale (WLEIS),and Psychological Capital Questionnaire (PCQ)and Professional Identity Questionnaire for Nurse Students (PIQNS).AMOS25.0 software was used to establish a structural equation model fitting the relationship of emotional intelligence,psychological capital and professional identity.Results There were positive correlations between each other among emotional intelligence,psychological capital and professional identity in the students (r=0.681～0.755,P<0.01).The structural equation model showed that the total effect of emotional intelligence on professional identity was 0.633,of which the direct effect was 0.380,the mediating effect was 0.253.Significant mediating effect was observed in emotional intelligence on professional identity,with the direct effect accounting for 60.03％ and the mediating effect for 39.97％,indicating a mediating role of psychological capital.Conclusion For probationer nursing students,their psychological capital and emotional intelligence have a positive predictive effect on professional identity,and psychological capital is the intermediary variable in the relationship between the emotional intelligence and professional identity.It suggested that nursing educators and hospital administrators should pay full attention to psychological state of nursing students during practice,and at the same time,should also attach importance to the positive incentive effect of psychological capital and take corresponding intervention measures,and actively guide psychological adjustment in order to improve their professional identity and stabilize nursing team.

Objective:To investigate the efficacy of negative pressure wound therapy (NPWT) combined with a retrograde sural neurovascular flap for the repair of foot and ankle wounds.Methods:Eighty-eight patients with foot and ankle wounds who received treatment in Shandong Wendeng Osteopathic Hospital from July 2019 to January 2020 were included in this study. They were randomly assigned to undergo either NPWT combined with retrograde sural neurovascular flap repair (observation group, n = 44) or retrograde sural neurovascular flap repair alone (control group, n = 44). Clinical efficacy, flap survival, wound healing, and postoperative ankle function scores were compared between the two groups. Results:Total response rate was significantly higher in the observation group than in the control group [97.73% (43/44) vs. 81.82% (36/44), χ2 = 6.07, P = 0.014]. Flap survival rate was significantly higher in the observation group than in the control group [100.00% (44/44) vs. 86.36% (38/44), χ2 = 4.47, P = 0.034]. Wound healing rate was significantly higher in the observation group than in the control group [97.73% (43/44) vs. 79.55% (35/44), χ2 = 7.22, P = 0.007]. Half a year after surgery, pain score, gait score, foot and ankle swelling score, range of motion of the tibiotalar joint, range of motion of the ankle joint were (1.81 ± 0.45) points, (1.40 ± 0.41) points, (1.98 ± 0.38) points, (0.41 ± 0.35) points, and (0.84 ± 0.51) points, respectively in the observation group, which were significantly lower than those in the control group ( t = 2.63, 2.62, 2.15, 2.09, 2.02, all P < 0.05). Conclusion:NPWT combined with a retrograde sural neurovascular flap greatly increases flap survival rate and wound healing rate and improves the ankle function of patients with foot and ankle wounds.

As the most basic and widely used invasive nursing activity, intravenous therapy plays an extremely important role in clinical treatment, and its theoretical system and practical techniques have developed rapidly. This study carries out a comprehensive comparative analysis of domestic and foreign intravenous therapy concepts, practice standards, specialist nurse training, vascular access tools, infusion-related technologies, and Pharmacy Intravenous Admixture Services. The purpose of this study is to grasp the international development and innovation level in the field of intravenous therapy and the current gap in China, so as to provide a complete reference for the professional construction of intravenous therapy and nursing in China.

Objective:To observe the expression and significance of Jagged1 in fibrovascular membranes of proliferative diabetic retinopathy (PDR).Methods:Sixty preretinal fibrovascular membrane specimens collected from fifty-seven patients (60 eyes) with PDR during vitrectomy in The Affiliated Hospital of Qingdao University from July 2014 to July 2015 were set as the PDR group.The patients were divided into the injection group (30 cases, 32 eyes) and non-injection group (27 cases, 28 eyes) according to whether they received anti-vascular endothelial factor drug intravitreally before surgery.Ranibizumab injections were administered to the patients in the injection group intravitreally 2-7 days before surgery.Eighteen macular epiretinal membrane specimens obtained from 18 non-diabetic patients were served as the control group.Hematoxylin-eosin staining was applied to observe the structural festures of specimers. The immunohistochemical staining was used to detect the expression levels of Jagged1, Delta-like 4(Dll4) and Notch1 in the injection and non-injection groups, and the real-time fluorescent quantitative polymerase chain reaction was performed to detect the relative expression levels of Jagged1, Dll4 and Notch1 mRNA in the three groups.Pearson linear correlation analysis was used to evaluate the relationships between the expression of Jagged1 mRNA and both Dll4 mRNA or Notch1 mRNA in the PDR fibrovascular membranes.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of The Affiliated Hospital of Qingdao University (No.QYFYWZLL25645). Written informed consent was obtained from each patient.Results:The neovascularization was found in fibrovascular membranes of PDR with a light microscope, and the lumen of the new blood vessels in the injection group was narrow, but relatively dilated in the non-injection group.There was no neovascularization found in the macular epiretinal membranes.The immunohistochemical staining revealed that there was the positive expression of Jagged1, Dll4 and Notch1 proteins in all PDR membranes, mainly located in the vascular endothelium during neovascularization.The absorbance values of Jagged1, Dll4 and Notch1 proteins were 6.25±1.82, 6.87±1.89 and 5.12±2.14 respectively in the non-injection group, which were all higher than 1.46±0.37, 1.55±0.24 and 1.32±0.53 respectively in the injection group, showing statistically significant differences ( t=5.168, P=0.014; t=6.012, P=0.008; t=3.453, P=0.030). There were statistically significant differences in Jagged1, Dll4 and Notch1 mRNA relative expression levels among the three groups ( F=77.337, 62.305, 51.869; all at P<0.01). The relative expression levels of Jagged1, Dll4 and Notch1 mRNA in the fibrovascular membranes with PDR were significantly higher than those of control macular epiretinal membranes, and the relative expression levels of Jagged1, Dll4 and Notch1 mRNA of the injection group were significantly lower than those of the non-injection group (all at P<0.05). The expression level of Jagged1 mRNA was positively correlated with expression levels of both Dll4 and Notch1 mRNA ( r=0.925, 0.950; both at P<0.05). Conclusions:There is a high expression of Jagged1 in the vascular endothelium of fibrovascular membranes with PDR and the Jagged1 expression is positively correlated with the expression of Dll4 and Notch1.The effect of Jagged1 on the neovascularization in PDR may be related to Dll4 and Notch1.

【Objective】 Through bioinformatics methods to analyze the differences in the gene expression profiles of peripheral blood mononuclear cells （PBMCs） between middle-aged and elderly women and normal people， so as to explore the diagnosis and treatment targets of OA. 【Methods】 We downloaded the GSE48556 data set from GEO databases. We utilized the R language to screen out the differentially expressed genes （DEGs） between OA and NC. By gene set enrichment analysis （GSEA）， we obtained the target gene subset. The GO and KEGG pathways of the target gene subset were analyzed by DAVID. We applied STRING and Cytoscape software to construct PPI network. The module analysis was performed by the Mcode and centiscape plug-in， and the key genes were screened out by Cytohubba. 【Results】 By GSEA analysis and P.adjust <0.05 & |log2FC| >0.2， a total of 292 target genes were screened， consisting of 81 upregulated genes and 211 downregulated genes. The GO enrichment analysis of all target genes mainly focused on the biological functions， such as “regulation of NIK/NF-κB”， “monocytes”， “proliferation”， “regulation of apoptosis signaling pathway”， “TNF-mediated signaling pathway”， “regulation of Wnt signaling pathway”， “regulation of MAP kinase activity”， and “regulation of autophagy”. KEGG was mainly enriched in four pathways： cytotoxicity of natural killer cell mediation， TNF signaling pathway， MAPK signaling pathway， and apoptosis. We employed PPI network and related plug-ins to screen out eight core genes highly related to OA inflammation and apoptosis， namely， MAPK1， IL10， PTGS2， IL18， GSK3B， NFKBIA， TNFRSF1A， and EGR1. 【Conclusion】 Bioinformatics analysis revealed that the differences in PBMCs gene expressions between OA and NC were concentrated in the biological events of apoptosis and inflammation， making blood expression profile an effective breakthrough for monitoring OA target markers.

Objective:To construct a Nomogram model in predicting recurrence-free survival (RFS) and overall survival (OS) at six months, one year and two years after hepatocellular carcinoma (HCC) resection by using inflammatory markers combined with other routine clinical indicators.Methods:The data of 314 patients with HCC who underwent first time hepatectomy at Beijing Chaoyang Emergency Rescue Center and Air Force Characteristic Medical Center from January 2013 to January 2018 were analyzed. HCC patients who underwent hepatectomy at the First Medical Center of PLA General Hospital from January 2011 to January 2016 ( n=106) were used as the external validation group. Univariate and multivariate Cox proportional risk model was used to analyze independent risk factors of recurrence and death in HCC patients. A Nomogram model was constructed based on independent risk factors. Validation of the efficacy of the Nomogram model was done based on external data. Results:In the experimental group, 174 patients relapsed. The median RFS was 26 months. The 6 months, 1 year and 2 years RFS were 26.8%, 43.9%, and 68.8%, respectively. A total of 142 patients had died. The median survival time was 30 months. The 6 months, 1 year and 2 years OS were 5.9%, 23.6% and 63.1%, respectively. In the external validation group, 63 patients had developed recurrence, with a median RFS time of 28 months. The 6 months, 1 year and 2 years RFS were 26.4%, 45.3%, 54.7%, respectively. The median survival time was 31 months. The 6 months, 1 year and 2 years OS were 7.5%, 25.5%, 46.6%, respectively. Tumor size (>6.0 cm, HR: 1.447), vascular invasion ( HR: 1.408), TBil (>0.94 mg/dl, HR: 1.949), NLR (>2.54, HR: 2.843), AGR (≤0.88, HR: 2.447) were independent risk factors of HCC recurrence ( P<0.05). Tumor size (>6.0 cm, HR: 2.207), vascular invasion ( HR: 1.529), and NLR (>2.54, HR: 2.708) were independent risk factors of death for HCC patients ( P<0.05). The C-indexes of half-year, one-year and two-year RFS were 0.764 (95% CI: 0.677-0.854), 0.710 (95% CI: 0.615-0.824) and 0.673 (95% CI: 0.601-0.786), respectively. The C-indexes of half-year OS, one-year OS and two-year OS were 0.729 (95% CI: 0.648-0.841), 0.708 (95% CI: 0.608-0.813) and 0.664 (95% CI: 0.618-0.771), respectively. Conclusion:In this study, the construction of a Nomogram model in predicting prognosis of HCC patients was helpful to guide clinicians in improving preoperative treatment plans and in providing ideas for individualized treatment of patients.

Objective:To observe the long-term effect of repairing soft tissue defect of the digital palmar with medial plantar artery perforators flap.Methods:From January, 2012 to February, 2015, 15 cases of digital palmar soft tissue defect were selected clinically, including 8 cases with phalangeal fracture, 5 cases with flexor tendon injury, and 9 cases with digital artery and nerve injury. The soft tissue defect area was 7.0 cm×2.5 cm-2.4 cm×3.0 cm. The medial pedis perforators flap with deep branch of medial plantar artery as pedicle and terminal cutaneous branch of saphenous nerve was cut out. The artery of the flap was anastomosed with the digital artery or common digital artery, 1 accompanying vein or superficial vein was selected to anastomose with the dorsal digital vein, and the cutaneous nerve was anastomosed with the digital nerve or common digital nerve. The perforating point, number, source of perforating vessels and the length of vessel pedicle were observed during the operation, and the color, shape, stability and TPD of the flap were observed through long-term followed-up. The good and excellent rate of the affected finger was evaluated and whether there was obvious scar, abnormal sensation and abnormal walking gait in the donor area.Results:All flaps survived and the wounds healed in one stage. All 15 patients were followed-up for 36-72 months, with an average of 48.5 months. The color and thickness of the flap were similar to that of the normal digital palmar, and the flap was wear-resistant, stable and strong in holding. The TPD was 9-12 mm. Twelve patients had transverse finger striations at the interphalangeal joint. According to the Trial Standard of the Function Evaluation of the Upper Limb of the Hand Surgery Society of Chinese Medical Association, 10 cases were excellent, 4 cases were good, 1 case was acceptable, and the good and excellent rate was 93.3%. There was no painful scar or abnormal sensation in the donor area. The ankle and foot function was good, and the gait was normal.Conclusion:The thickness, color and texture of the medial pedis perforator flap are similar to that of the palmar skin, and it is an ideal choice for repairing the palmar skin defect.

Objective To investigate the effect of CYP2D6 gene polymorphism on risperidone (RISP) metabolism in schizophrenic patients. Methods CYP2D6 allele polymorphisms including*10,*4,*41 and *2 was detected by real-time fluorescent PCR in 120 schizophrenic patients who have taken risperidone continually. Alleles without SNP mutations were classified as wild-type (WT). At the same time, serum risperidone and 9-hydroxyrisperidone concentration of all patients were detected by mass spectrometric analysis. Some samples were selected for DNA sequencing of CYP2D6*10, which is the most common CYP2D6 allele in Oriental population. The 120 patients were divided into three groups according to their allele variants. Group 1 was defined as carriers of two functional alleles, group 2 was defined as carriers of one defective allele, group 3 was defined as carriers of two defective alleles. Genotype distributions, alleles frequencies, RISP, 9-oh-RISP, RISP+9-OH-RISP, 9-oh-RISP/RISP among three groups were calculated.Results Group 1 amount to 23 cases including 13 cases of WT/WT, 7 cases of*2/*2, 3 cases of WT/*2. Group 2 amount to 51 cases, including 38 cases of WT/*10, 8 cases of *2/*10, 1 case of *2/*41, 4 cases of WT/*41. Group 3 amount to 46 cases, including 44 cases of *10/*10, 2 cases of *10/*41. The*4 allele was not detected. The allele frequency of WT, *2, *10 and *41 was 29.6％, 10.8％, 56.7％ and 2.9％, respectively. The 9-hydroxyrisperidone/risperidone-ratio of three groups were 15.24±5.77, 11.06±4.56 and 2.39 ± 1.06, respectively. There was a significant difference in 9-hydroxyrisperidone/risperidone-ratio between Group 3 and the first two groups (P<0.001). Conclusions The frequency of *10 allele was the highest among the subjects. The frequency of WT and*2 allele was over 95％in the population. Individuals carrying one defective allele of CYP2D6 will decrease the rate of risperidone metabolism slightly, while individuals carrying two defective alleles of CYP2D6 may decrease the rate of risperidone metabolism significantly.

Laparoscopic cholecystectomy (LC) is a standard procedure for symptomatic cholelithiasis.Single incision laparoscopic cholecystectomy (SILC) as one kind of LC has been paid more attention nowadays.This article aims to review the therapeutic effect,complications and limitations of SILC.