Objective: To investigate the influencing factors for delay in healthcare-seeking, definitive diagnosis and identification in patients with pulmonary tuberculosis (PTB) in Minhang District, Shanghai Municipality, so as to provide the basis for effectively reducing delay in PTB patients. Methods: Data of PTB patients in Minhang District from 2017 to 2022 were collected from the Infectious Disease Reporting Information System of Chinese Disease Prevention and Control Information System. The prevalence rates of delay in healthcare-seeking, definitive diagnosis and identification were analyzed, and factors affecting delay in healthcare-seeking, definitive diagnosis and identification were identified using multivariable logistic regression models. Results: A total of 4 214 PTB patients were reported in Minhang District from 2017 to 2022, including 2 802 males and 1 412 females, with a male-to-female ratio of 1.98∶1. The majority of patients were aged 25 to <45 years (1 664 cases, 39.49%). The prevalence rates of delay in healthcare-seeking, definitive diagnosis and identification were 36.81%, 30.21% and 38.09%, respectively. Delay in healthcare-seeking was associated with the year (2018, OR=0.708; 2019, OR=0.549; 2020, OR=0.670; 2021, OR=0.682), gender (female, OR=1.199), occupation (worker, OR=1.379; housekeeping service/housework/unemployed, OR=1.481), case identification route (symptom-based consultation, OR=11.159), and level of the first-diagnosed hospital (city-level, OR=1.528). Delay in definitive diagnosis was associated with age (45 to <65 years, OR=1.476), occupation (commercial service, OR=0.687; housekeeping service/housework/unemployed, OR=0.672), household registration (non-local, OR=0.820), case identification route (symptom-based consultation, OR=0.616), pathogen test result (negative/not tested, OR=1.903), and the level of the first-diagnosed hospital (city-level, OR=0.311). Delay in identification was associated with the year (2018, OR=0.785; 2019, OR=0.647; 2020, OR=0.790; 2021, OR=0.710), occupation (commercial service, OR=0.687), household registration (non-local, OR=0.848) and level of the first-diagnosed hospital (city-level, OR=0.560) Conclusions Year, gender, occupation, case identification route and level of the first-diagnosed hospital are influencing factors for delay in healthcare-seeking in PTB patients. Age, occupation, household registration, case identification route, pathogen test result and level of the first-diagnosed hospital are influencing factors for delay in definitive diagnosis. Year, occupation, household registration and level of the first-diagnosed hospital are influencing factors for delay in identification.

It is believed that patients with cirrhotic ascites exhibit a pathological mechanism characterized by the decline of healthy qi and the accumulation of pathogenic factors. Clinically， treatment should be based on the theory of tonification and purging， with a staged approach distinguishing between the active phase and the remission phase. The balance between tonification and purging should be adjusted according to the progression of pathogenic and healthy actors. In the acute phase， purging should take precedence over tonification， using purging as a means of tonification to facilitate the flow of water and qi through the triple energizer. The severity of water retention， dampness， blood stasis， and heat should be carefully assessed to ensure thorough elimination of pathogenic factors while avoiding harm to healthy qi. Medication adjustments should be made once the pathogenic factors are significantly weakened. In the remission phase， an integrated approach combining both tonification and purging should be adopted， incorporating purging within tonification to clear residual pathogens and prevent recurrence. Concurrently， proactive treatment of the underlying disease is essential to achieve complete recovery and prevent the recurrence of ascites.

ObjectiveTo explore a rapid and accurate method for evaluating the quality of Prunus mandshurica (Maxim.) Koehne (P. mandshurica, Ku Xing Ren) during rancidity using machine vision and learning.MethodsSensory evaluation and chemometrics were used to classify P. mandshurica quality grades after rancidity. Chemical indicators of the P. mandshurica quality change were determined to verify the obtained grades and support the subsequent modeling. The International Commission on Illumination color space was used to extract the color features of the P. mandshurica. Discrimination and prediction models based on color features combined with multiple machine learning algorithms were established using 10-fold cross-validation and external test set validation.ResultsThe P. mandshurica rancidity samples were allocated to three quality grades. The Bayes net model based on powder color successfully identified the P. mandshurica at different grades with an accuracy of 88.89% and 100% using two validations, and the naive Bayes model based on section color achieved the same accuracy with an receiver operating characteristic area of 0.979. The instance-based k-nearest neighbors model based on powder color performed best in predicting the amygdalin content [R2 = 0.9801, mean absolute error (MAE) = 0.2071, root mean squared error (RMSE) = 0.4170], followed by the random committee model in predicting the acid value (R2 = 0.9580, MAE = 1.5121, RMSE = 1.9099) and the random forest model in predicting the peroxide value (R2 = 0.8857, MAE = 0.0027, RMSE = 0.0035).ConclusionThis study demonstrates that color digitization analysis is a potential method for rapidly evaluating the quality of P. mandshurica across the rancidity process, providing a new reference for the quality assessment of traditional Chinese medicines.

Objective To understand the current status and influencing factors of patient perception for humanistic care in China hospitals,and to provide a basis for developing nursing humanistic care measures and improving the quality of nursing humanistic care services.Methods A total of 30,099 outpatients and inpatients from 107 hospitals in 30 provinces(autonomous regions and municipalities)from July to August 2022 as survey subjects.A general information questionnaire and the Relational Caring Questionnaire-Patient Form were used for a cross-sectional survey,and a single-factor analysis was used to analyze the influencing factors of patient relationship care.Results Finally,29 108 valid questionnaires were collected,and the effective questionnaire recovery rate was 96.7％.The patient evaluation of relationship care was(65.72±8.61)points.Single-factor analysis showed that gender,age,marital status,children's situation,education level,occupation,place of residence,average family income,medical insurance type,visiting department,and location of the visiting hospital,and whether or not surgery were influencing factors of patient relationship care(P＜0.05).Conclusion The evaluation score of caregiver-patient relationship care among Chinese hospital patients is above average,but there is still room for improvement in western and rural regions,seriously ill and outpatient patients,low-income and low-medical insurance reimbursement populations,and non-surgical patients.Medical institutions at all levels should optimize and improve nursing humanistic care services based on influencing factors,and further enhance patients'perception of nursing humanistic care.

Objective:To investigate corneal transparency alteration in patients with type 2 diabetes and its influencing factors.Methods:A case-control study was conducted.A total of 52 patients with type 2 diabetes mellitus (DM) (104 eyes) and 23 age-matched healthy controls (46 eyes) were enrolled as DM group and normal control group in the Second Affiliated Hospital of Anhui Medical University from October 1, 2020 to October 30, 2021.Patients with DM were further divided into non-diabetic retinopathy (non-DR) and DR groups according to their fundus conditions.Corneal densitometry (CD) was evaluated using the Pentacam.According to its built-in program, the cornea was divided into anterior, intermediate, and posterior layers and subdivided into 0-2 mm, >2-6 mm, >6-10 mm, and >10-12 mm annular regions with the corneal apex as the center of the circle.Pentacam automatically calculated the CD value of each corneal layer and region as well as the total CD value.The influencing factors of total CD value in diabetes group were analyzed by a multivariate linear regression analysis model.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (No.YX2023-129[F1]).Written informed consent was obtained from each subject before any medical examination.Results:The total CD value of diabetes group was 20.24±3.10, which was significantly higher than 18.79±3.31 of normal control group ( t=-2.583, P=0.011).The CD values of the anterior layer, intermediate layer, 0-2 mm, and >2-6 mm regions were significantly higher in diabetes group than in normal control group (all at P<0.05).The CD values in the anterior layer were higher in non-DR and DR groups than in normal control group, and the CD values and total CD values in the middle and posterior layers were higher in non-DR group than in normal control group and DR group, and the differences were statistically significant (all at P<0.05).The CD values in the 0-2 mm and >2-6 mm regions were significantly higher in non-DR group than in normal control group, and the CD value in the >6-10 mm annular region was significantly higher in non-DR group than in DR group and normal control group (all at P<0.05).Multivariate linear regression analysis showed that age and glycosylated hemoglobin (HbA1c) level were the main influencing factors for the increase in CD values in diabetic patients ( β=0.266, P<0.001; β=0.423, P=0.003). Conclusions:The decrease of corneal transparency precedes the appearance of DR in patients with diabetes.Poor control of HbA1c level in diabetic patients may cause the decline of corneal transparency.

Objective To explore the correlation between changes in cerebral blood flow and auditory cognitive function in patients with amnestic mild cognitive impairment(aMCI).Methods The aMCI patients who visited the Memory Clinic of Beijing Friendship Hospital from July 2022 to September 2023 were selected as the research subjects,and gender and age matched healthy controls were included in the comparative study.All subjects underwent ASL scans using 3.0 T MRI and underwent a Chinese"repeat-recall"verbal cognitive function test(RRT)as an assessment of auditory cognitive abilities,and the correlation between cerebral blood flow(CBF)changes and auditory cognitive function was finally analyzed.Results A total of 26 patients with aMCI and 32 normal healthy were included.Regardless of the high and low context and signal to noise ratio(SNR),the auditory cognitive ability of the aMCI group significantly decreased compared to the control group(P<0.01).The standardized CBF value of the left inferior parietal lobule in the aMCI group was significantly reduced compared to the control group(0.921±0.234 vs 1.247±0.076,P<0.001).Correlation analysis showed that the standardized CBF value of the left inferior parietal lobule in the aMCI group was correlated with auditory cognitive ability under low contextual conditions of-5 dB signal-to-noise ratio(r=0.857,P<0.001).Conclusion CBF in the left inferior parietal lobe in patients with aMCI may have some relevance for auditory cognitive impairment.

Objective To investigate the value of serum high mobility group B1(HMGB1)and vascular endothelial growth factor A(VEGFA)levels in diagnosing the diabetic retinopathy(DR)and predicting the prognosis of patients.Methods A total of 202 patients with type 2 diabetes mellitus(T2DM)admitted to the hospital from January 2021 to January 2022 were selected and divided into DR group(143 cases)and T2DM group(59 cases)based on whether DR occurred or not.According to the degree of lesions,DR groups were di-vided into proliferative DR(PDR)group(76 cases)and non PDR(NPDR)group(67 cases).The DR group was followed up for 1 year,and was divided into poor prognosis group(43 cases)and good prognosis group(143 cases)according to the occurrence of visual disability.46 healthy volunteers who underwent the physical examination during the same period were selected as the control group.Serum HMGB1 and VEGFA levels were measured by enzyme-linked immunosorbent assay.Pearson correlation was used to analyze the correla-tion between serum HMGB1 and VEGFA levels in patients with DR.Multivariate Logistic regression was used to analyze the factors affecting the occurrence of DR and the prognosis of patients with DR,and receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum HMGB1 and VEGFA levels for DR and the predictive value for poor prognosis in patients with DR.Results Serum HMGB1 and VEGFA levels increased sequentially in the control group,the T2DM group,the NPDR group,and the PDR group(P＜0.05).Pearson correlation analysis showed that there was a positive correlation between serum HMGB1 and VEGFA levels in DR patients(r=0.730,P＜0.001).After 1-year follow-up,the incidence of poor prognosis in 143 DR patients was 30.07％(43/143).Multivariate Logistic regression analysis showed that prolonged duration of T2DM,elevated glycosylated hemoglobin(HbA1c)level,elevated HMGB1 level,and elevated VEGFA level were independent risk factors affecting the occurrence of DR and poor prognosis of patients with DR(P＜0.05).ROC curve analysis showed that the area under the curve of the combined detec-tion of serum HMGB1 and VEGFA levels for diagnosing DR and predicting poor prognosis in patients with DR were 0.871 and 0.867,respectively,which were larger than 0.784,0.800 and 0.772,0.780 of the diagnosis and prediction of serum HMGB1 and VEGFA levels alone(P＜0.05).Conclusion Elevated serum HMGB1 and VEGFA levels in DR patients are closely associated with the occurrence of DR and poor prognosis in DR patients,and the combination of serum HMGB1 and VEGFA levels has high value for the diagnosis of DR and the prediction of poor prognosis in DR patients.

Objective:To investigate the level of self-management and daily physical activity in patients with type 2 diabetes mellitus (T2DM) of Zang and Han nationalities in Tibetan, China, and to compare the difference in daily management between T2DM patients of Zang and Han nationalities, to develop reasonable and effective chronic disease management strategies for long-term out-of-hospital management of T2DM patients of Zang nationalities.Methods:A total of 265 T2DM patients with glycosylated hemoglobin (HbA1c) ≥ 7% who were admitted to the Endocrinology Ward of the Hospital of Chengdu Office of People's Government of Tibet Autonomous Region from November 2020 to April 2021 and who were from different regions of Tibet were included in this study according to inclusion and exclusion criteria. The general data of all included patients were collected. Glucose and lipid metabolism-related indicators were determined. The Generalized Diabetes Self-Management Efficacy Scale and International Physical Activity Questionnaires (IPAQ) were used to evaluate patients' levels of self-management and daily physical activity.Results:The hemoglobin level in T2DM patients of Zang nationality was (154.09 ± 24.11) g/L, which was significantly higher than that in T2DM patients of Han nationality ( P < 0.05). The total cholesterol, fasting blood glucose, and low-density lipoprotein in T2DM patients of Zang nationality were (4.63 ± 1.41) mmol/L, (7.94 ± 2.19) mmol/L, and (2.75 ± 1.11) mmol/L, respectively, which significantly higher compared with T2DM patients of Han nationality (all P < 0.05). Compared with T2DM patients of Han nationality, T2DM patients of Zang nationality had lower self-management scores (81.40 ± 15.44) points, diet control scores (17.26 ± 4.97) points, physical exercise scores (11.67 ± 4.42) points, prevention and treatment of high and low blood sugar score (12.21 ± 5.72) points. The differences were statistically significant (all P < 0.05). Moderate-intensity physical activity was a significant difference between T2DM patients of Zang and Han nationalities ( P < 0.05). Conclusion:Compared with T2DM patients of Han nationality, T2DM patients of Zang nationality have lower overall self-management levels, including diet control, physical exercise, prevention and management of high and low blood glucose, and moderate-intensity physical activity. Targeted individualized education should be carried out according to the Tibetan cultural characteristics, to further develop an intervention method and an out-of-hospital management strategy for chronic disease, which are suitable for T2DM patients of Zang nationality.

Objective:To investigate the effects of insulin glargine administration by jet injection versus conventional insulin pen on glucose profile using professional mode flash glucose monitoring(FGM) system in type 2 diabetic patients with poor glucose control.Methods:In this randomized, controlled, crossover study, 40 patients with T2DM who treated with insulin glargine were enrolled. The patients were randomly divided into group A(jet injector-conventional pen, n=20) and group B(conventional pen-jet injector, n=20). Each patient wore FreeStyle Libre sensor from day 4 to day 17. The specialist nurse instructed patients how to master the injection techniques. Professional FGM system was applied to assess glucose profile. Results:The fasting blood glucose(FBG) of the enrolled patients was(9.37±1.84) mmol/L. In contrast to conventional insulin pen, treatment with the jet injector significantly decreased the 24h MBG [(9.06±2.13 vs 9.98±2.67) mmol/L, P=0.001], MaxBG [(16.69±3.01 vs 17.95±3.48) mmol/L, P=0.001], AUC>10 mmol/L [95.93(21.12, 129.02) vs 142.66( 27.88, 198.46), P=0.002], TAR(31.10±21.89 vs 39.49±25.93, P=0.003), MAGE and SDBG. It was observed that patients using jet injector had significant increased TIR(65.94±20.47 vs 58.32±25.00, P=0.001). There were no difference in the risk of hypoglycaemia between two groups. Conclusion:Insulin jet injector was more effective than the insulin pen on glycaemic control and glucose fluctuation without increasing the risk of hypoglycemia in type 2 diabetic patients with uncontrolled glycemia.

Objective:To observe the correlation between homocysteine (Hcy) and serum uric acid (SUA) and retinopathy in type 2 diabetes mellitus (T2DM), preliminary study on its predictive value.Methods:A retrospective study. From January 2020 to March 2021, a total of 324 T2DM patients hospitalized in Department of Endocrinology, Cangzhou Central Hospital of Hebei Province were included. Fasting blood glucose (FBG), glycated hemoglobin (HbA1C), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), serum creatinine (Scr), blood urea nitrogen (BUN), Hcy, SUA, peripheral blood endothelial progenitor cells (EPC), circulating endothelial cells (CEC) were counted and homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. According to the absence or presence of diabetic retinopathy (DR), the patients were divided into non DR (NDR) group and DR group with 100 and 214 cases, respectively. Clinical data and laboratory biochemical indexes of the two groups were compared and observed. The logistic regression was used to analyze the independent risk factors for DR in T2DM patients. Smooth curve fitting was used to analyze the curve relationship between Hcy, SUA and DR, and ROC area (AUC) of Hcy, SUA; their combined prediction of DR in T2DM patients was calculated by receiver operating characteristic curve (ROC curve), and the predictive value of Hcy and SUA for DR in T2DM patients was evaluated.Results:Diabetic course ( t=5.380), systolic blood pressure ( t=2.935), hypertension ( χ2=10.248), diabetic nephropathy ( χ2=9.515), diabetic peripheral neuropathy ( χ2=24.501), FBG ( t=3.945), HbA1C ( t=3.336) and TG in DR Group ( t=2.898), LDL-C ( t=3.986), Scr ( t=2.139), SUA ( t=7.138), HOMA-IR ( t=3.237), BUN ( t=3.609), Hcy ( t=2.363) and CEC ( t=19.396) were significantly higher than those in NDR group. The difference was statistically significant ( P<0.05). EPC ( t=9.563) and CPC ( t=7.684) levels were significantly lower than those of NDR group, and the difference was statistically significant ( P<0.05). Logistic regression analysis showed that diabetes course, SBP, hypertension, FBG, HbA1C, LDL-C, SUA, Hcy, EPC, CPC and CEC were all independent risk factors for developing DR in T2DM patients ( P<0.05). The smooth curve fitting analysis showed that Hcy and SUA were positively correlated with the occurrence of DR. After adjusting for confounding factors, when Hcy≥15 μmol/L, the risk of DR Increased by 14% for every 1 μmol/L increase in Hcy [odds ratio ( OR)=0.92, 95% confidence interval ( CI) 0.88-0.98, P<0.05]. When Hcy <15 μmol/L, there was no significant difference ( OR=0.96, 95% CI 0.92-1.08, P>0.05). When SUA≥304 μmol/L, the risk of DR increased by 17%, every 20 μmol/L SUA increased ( OR=0.80, 95% CI 0.68-0.94, P<0.05). When SUA <304 μmol/L, the difference was not statistically significant ( OR=0.83, 95% CI 0.72-0.95, P>0.05). ROC curve analysis results showed that the AUC values of Hcy, SUA and Hcy combined with SUA in predicting the occurrence of DR in T2DM patients were 0.775 (95% CI 0.713-0.837, P<0.001), 0.757 (95% CI 0.680-0.834, P<0.001) and 0.827 (95% CI 0.786-0.868, P<0.001). Hcy combined with SUA showed better predictive efficiency. Conclusions:The abnormal increase of Hcy and SUA levels in T2DM patients are closely related to the occurrence of DR, they are independent risk factors for the occurrence of DR. Hcy combined with SUA has high predictive value for the occurrence of DR.