Objective To explore the mediating effect of empowerment ability between type D personality and self-management behavior of patients with diabetes mellitus(DM).Methods A total of 738 patients with type 2 diabetes mellitus(T2DM)hospitalized in the Department of Endocrinology of three tertiary hospitals in Hainan Province from December 2022 to May 2023 were selected and divided into Type D personality(Type D,n=104)group and T2DM group(n=634).The general data,biochemical indexes,scores of negative emotion(NA),social inhibition(SI),empowerment ability,and scale of DM self-management activities(SDSCA)were compared between the two groups,and the correlation between type D personality,empowerment ability and self-management ability was analyzed.The mediating effect model was used to analyze the mediating effect of empowerment ability on the four self-management behaviors of patients with type D personality,and the chain mediating effect model was used to analyze the relationship between type D personality,empowerment ability,self-management behaviors and HbA1c.Results Compared with the T2DM group,HbA1c,proportion of rural residence,proportion of complications≥3,proportion of education level of junior high school or above,proportion of monthly income<3000 yuan,and NA and SI scores were significantly higher in the Type D group(P<0.05).The empowerment ability and scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance were lower in the Type D group than in the T2DM group(P<0.05).Spearman correlation analysis showed that the empowerment ability score was positively correlated with the scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).NA and SI scores were negatively correlated with empowerment ability score,healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).The results of model analysis with empowerment ability as the mediating variable showed that type D personality had direct,indirect and total effects on regular exercise,blood glucose monitoring,medication compliance and SDSCA total score(P<0.05),and indirect and total effects on regular diet score(P<0.05).The mediating effect of empowerment ability was significant(Bootstrap CI did not include 0).The chain mediating effect analysis showed that type D personality could indirectly affect HbA1c through empowerment ability,healthy diet(γ=0.389,95%CI 0.206～0.591),and medication compliance(γ=0.149,95%CI 0.040～0.265),and the effect proportion was 39.4%and 14.1%,respectively.Conclusions Type D personality can indirectly influence self-management behavior through the mediating effect of empowerment,and simultaneously affecting HbA1c through the chain effect of empowerment,diet,and medication behavior.

Objective:To investigate the correlations among diabetes-related distress, self-management behavior, empowerment, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2DM) .Methods:A convenience sampling method was used to recruit a total of 1 927 hospitalized patients with T2DM from the Endocrinology Departments of five tertiary general hospitals in Hainan, Jiangsu, and Henan Provinces between December 2022 and December 2023. General demographic and clinical data were collected. The Problem Areas in Diabetes 5 (PAID-5), the Summary of Diabetes Self Care Activities (SDSCA), and the Diabetes Empowerment Scale-Short Form (DES-SF) were used to evaluate patients' psychological distress, self-management behaviors, and empowerment levels. Pearson correlation analysis was performed to examine the relationships among diabetes-related distress, empowerment, self-management behaviors, and HbA1c levels.Results:Pearson correlation analysis showed that diabetes-related distress was negatively correlated with empowerment ( r=-0.119, P<0.001) and the total score of self-management behavior ( r=-0.106, P<0.001), and positively correlated with HbA1c levels ( r=0.103, P<0.001). Empowerment was positively correlated with self-management behavior ( r=0.538, P<0.001) and negatively correlated with HbA1c levels ( r=-0.170, P<0.001). Self-management behavior was negatively correlated with HbA1c levels ( r=-0.165, P<0.001) . Conclusions:Diabetes-related distress, empowerment, and self-management behavior are all associated with glycemic control. Future research and interventions should focus on enhancing patients' self-management abilities, strengthening empowerment, and providing psychological support in order to improve glycemic outcomes and offer a more comprehensive and effective management approach for patients with T2DM.

Objective To explore the mediating effect of empowerment ability between type D personality and self-management behavior of patients with diabetes mellitus(DM).Methods A total of 738 patients with type 2 diabetes mellitus(T2DM)hospitalized in the Department of Endocrinology of three tertiary hospitals in Hainan Province from December 2022 to May 2023 were selected and divided into Type D personality(Type D,n=104)group and T2DM group(n=634).The general data,biochemical indexes,scores of negative emotion(NA),social inhibition(SI),empowerment ability,and scale of DM self-management activities(SDSCA)were compared between the two groups,and the correlation between type D personality,empowerment ability and self-management ability was analyzed.The mediating effect model was used to analyze the mediating effect of empowerment ability on the four self-management behaviors of patients with type D personality,and the chain mediating effect model was used to analyze the relationship between type D personality,empowerment ability,self-management behaviors and HbA1c.Results Compared with the T2DM group,HbA1c,proportion of rural residence,proportion of complications≥3,proportion of education level of junior high school or above,proportion of monthly income<3000 yuan,and NA and SI scores were significantly higher in the Type D group(P<0.05).The empowerment ability and scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance were lower in the Type D group than in the T2DM group(P<0.05).Spearman correlation analysis showed that the empowerment ability score was positively correlated with the scores of healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).NA and SI scores were negatively correlated with empowerment ability score,healthy diet,regular exercise,blood glucose monitoring and medication compliance(P<0.05).The results of model analysis with empowerment ability as the mediating variable showed that type D personality had direct,indirect and total effects on regular exercise,blood glucose monitoring,medication compliance and SDSCA total score(P<0.05),and indirect and total effects on regular diet score(P<0.05).The mediating effect of empowerment ability was significant(Bootstrap CI did not include 0).The chain mediating effect analysis showed that type D personality could indirectly affect HbA1c through empowerment ability,healthy diet(γ=0.389,95%CI 0.206～0.591),and medication compliance(γ=0.149,95%CI 0.040～0.265),and the effect proportion was 39.4%and 14.1%,respectively.Conclusions Type D personality can indirectly influence self-management behavior through the mediating effect of empowerment,and simultaneously affecting HbA1c through the chain effect of empowerment,diet,and medication behavior.

Objective:To investigate the correlations among diabetes-related distress, self-management behavior, empowerment, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2DM) .Methods:A convenience sampling method was used to recruit a total of 1 927 hospitalized patients with T2DM from the Endocrinology Departments of five tertiary general hospitals in Hainan, Jiangsu, and Henan Provinces between December 2022 and December 2023. General demographic and clinical data were collected. The Problem Areas in Diabetes 5 (PAID-5), the Summary of Diabetes Self Care Activities (SDSCA), and the Diabetes Empowerment Scale-Short Form (DES-SF) were used to evaluate patients' psychological distress, self-management behaviors, and empowerment levels. Pearson correlation analysis was performed to examine the relationships among diabetes-related distress, empowerment, self-management behaviors, and HbA1c levels.Results:Pearson correlation analysis showed that diabetes-related distress was negatively correlated with empowerment ( r=-0.119, P<0.001) and the total score of self-management behavior ( r=-0.106, P<0.001), and positively correlated with HbA1c levels ( r=0.103, P<0.001). Empowerment was positively correlated with self-management behavior ( r=0.538, P<0.001) and negatively correlated with HbA1c levels ( r=-0.170, P<0.001). Self-management behavior was negatively correlated with HbA1c levels ( r=-0.165, P<0.001) . Conclusions:Diabetes-related distress, empowerment, and self-management behavior are all associated with glycemic control. Future research and interventions should focus on enhancing patients' self-management abilities, strengthening empowerment, and providing psychological support in order to improve glycemic outcomes and offer a more comprehensive and effective management approach for patients with T2DM.

Objective:To explore the relationship between normal serum creatinine(Scr) level and diabetic kidney disease(DKD) in patients with type 2 diabetes mellitus(T2DM).Methods:This was a prospective cohort study. Patients with yet not DKD who were regularly followed up at six centers of Li′s United Clinic in Taiwan, China from January 1, 2002 to December 31, 2018 were selected. At baseline, clinic information and lab tests were collected. According to whether the patients developed DKD during the follow-up period, they were divided into DKD group and non-DKD(NDKD) group. The exposure factor was the Scr(μmol/L) value, and it was used as a categorical variable. According to the quartiles of Scr, they were divided into 4 groups: Q1 group(Scr<57.68 μmol/L), Q2 group(57.68 μmol/L≤Scr<68.51 μmol/L), Q3 group(68.51 μmol/L≤Scr<80.44 μmol/L) and Q4 group(Scr≥80.44 μmol/L). The Cox regression model was used to explore the relationship between Scr level and the incidence of DKD. Receiver operating characteristic(ROC) curve was used to analyze the predictive effect of normal level Scr on DKD. Results:A total of 2 202 T2DM patients without DKD at baseline were included. After a follow-up period of(5.2±2.17) years, there were 966 patients in the DKD group and 1 236 patients in the NDKD group. Compared with the NDKD group, the DKD group had older age, longer duration of diabetes, higher BMI, SBP, DBP, LDL-C, Scr, and UACR(all P<0.05). Cox regression analysis results showed that compared with the Q1 group as the reference, the risk of developing DKD in the Q2, Q3, and Q4 groups after adjusting for confounding factors was 1.394, 1.688, and 2.821 times higher, respectively(all P<0.05). ROC curve analysis results showed that the area under the curve(AUC) for predicting DKD occurrence using normal serum creatinine level was 0.70(95% CI 0.678-0.722), with an optimal cutoff value of 74.27 μmol/L, sensitivity of 0.54, and specificity of 0.76. The cumulative risk plot showed that after adjusting for confounding factors, patients in the Q4 group had a higher cumulative risk of developing DKD compared to the Q1, Q2, and Q3 groups(all P<0.05). Conclusion:Scr is an independent risk factor for developing DKD in patients with T2DM. The higher the Scr level, the greater the risk, especially when Scr is greater than 74.27 μmol/L.

Objective To investigate the intervention effect and mechanism of LUO's Neiyi Prescription on the proliferation and angiogenesis of eutopic endometrium in rats with endometriosis(EMs)based on hypoxia-inducible factor 1A(HIF1A)/enhancer of zeste homolog 2(EZH2)/anthrax toxin receptor 2(ANTXR2)signaling pathway.Methods SD rats were randomly divided into sham operation group,model group,Danazol group(4.2 g·kg-1),low-dose LUO's Neiyi Prescription group and high-dose LUO's Neiyi Prescription group(15.74,31.48 g·kg-1),eight rats in each group.The rat model of EMs with qi stagnation and blood stasis syndrome was constructed by autologous endometrial transplantation combined with multi-factor intervention.Intragastric administration was given once a day for 28 consecutive days.The pathological changes of endometrial tissue were observed by HE staining.The expression levels of proliferating cell protein 67(Ki67)and platelet endothelial cell adhesion molecule 1(CD31)in endometrial tissue were detected by immunohistochemistry.The mRNA and protein expression levels of HIF1A,EZH2 and ANTXR2 in endometrial tissues were detected by qRT-PCR and Western Blot.The expression levels of YAP1,CD44 and β-catenin in endometrial tissues were detected by Western Blot.Results Compared with the sham operation group,the epithelial cells of the eutopic endometrium of the model group were thickened,the interstitial cells were arranged disorderly,and the inflammatory cells increased.The expression levels of Ki67 and CD31 in endometrial tissues were significantly increased(P＜0.01),the mRNA and protein expression levels of HIF1A and ANTXR2 were significantly increased(P＜0.01),while the mRNA and protein expression levels of EZH2 were significantly decreased(P＜0.01),and the protein expression levels of YAP1,CD44 and β-catenin were significantly increased(P＜0.01).Compared with the model group,the epithelial layer of the eutopic endometrial tissue of the rats in each administration group became thinner,the interstitial disorder and inflammatory infiltration were improved,and the levels of Ki67 and CD31 in the eutopic endometrial tissue were significantly decreased(P＜0.01).The mRNA and protein expression levels of HIF1A and ANTXR2 in the endometrium of rats in the Danazol group and the high-dose LUO's Neiyi Prescription group were significantly decreased(P＜0.05,P＜0.01),and the mRNA and protein expression levels of EZH2 were significantly increased(P＜0.05,P＜0.01).The protein expression levels of YAP1,CD44 and β-catenin in endometrial tissue of rats in each administration group were significantly decreased(P＜0.05,P＜0.01).Conclusion LUO's Neiyi Prescription can play a role in the treatment of EMs by inhibiting the proliferation and angiogenesis of eutopic endometrial cells,and its mechanism may be related to the inhibition of HIF1A/EZH2/ANTXR2 signaling pathway.

Objective: This study used cardiac magnetic resonance imaging (MRI) to compare the characteristics of left ventricular remodeling in patients with primary aldosteronism (PA) with those of patients with essential hypertension (EH) and healthy controls (HCs). Materials and Methods: This prospective study enrolled 35 patients with PA, in addition to 35 age- and sex-matched patients with EH, and 35 age- and sex-matched HCs, all of whom underwent comprehensive clinical and cardiac MRI examinations. The analysis of variance was used to detect the differences in the characteristics of left ventricular remodeling among the three groups. Univariable and multivariable linear regression analyses were used to determine the relationships between left ventricular remodeling and the physiological variables. Results: The left ventricular end-diastolic volume index (EDVi) (mean ± standard deviation [SD]: 85.1 ± 13.0 mL/m2 for PA, 75.9 ± 14.3 mL/m2 for EH, and 77.3 ± 12.8 mL/m2 for HC; p = 0.010), left ventricular end-systolic volume index (ESVi) (mean ± SD: 35.2 ± 9.8 mL/m2 for PA, 30.7 ± 8.1 mL/m2 for EH, and 29.5 ± 7.0 mL/m2 for HC; p = 0.013), left ventricular mass index (mean ± SD: 65.8 ± 16.5 g/m2 for PA, 56.9 ± 12.1 g/m2 for EH, and 44.1 ± 8.9 g/m2 for HC; p < 0.001), and native T1 (mean ± SD: 1224 ± 39 ms for PA, 1201 ± 47 ms for EH, and 1200 ± 44 ms for HC; p = 0.041) values were higher in the PA group compared to the EH and HC groups. Multivariable linear regression demonstrated that log (plasma aldosteroneto-renin ratio) was independently correlated with EDVi and ESVi. Plasma aldosterone was independently correlated with native T1. Conclusion Patients with PA showed a greater degree of ventricular hypertrophy and enlargement, as well as myocardial fibrosis, compared to those with EH. Cardiac MRI T1 mapping can detect left ventricular myocardial fibrosis in patients with PA.

Objective: This study used cardiac magnetic resonance imaging (MRI) to compare the characteristics of left ventricular remodeling in patients with primary aldosteronism (PA) with those of patients with essential hypertension (EH) and healthy controls (HCs). Materials and Methods: This prospective study enrolled 35 patients with PA, in addition to 35 age- and sex-matched patients with EH, and 35 age- and sex-matched HCs, all of whom underwent comprehensive clinical and cardiac MRI examinations. The analysis of variance was used to detect the differences in the characteristics of left ventricular remodeling among the three groups. Univariable and multivariable linear regression analyses were used to determine the relationships between left ventricular remodeling and the physiological variables. Results: The left ventricular end-diastolic volume index (EDVi) (mean ± standard deviation [SD]: 85.1 ± 13.0 mL/m2 for PA, 75.9 ± 14.3 mL/m2 for EH, and 77.3 ± 12.8 mL/m2 for HC; p = 0.010), left ventricular end-systolic volume index (ESVi) (mean ± SD: 35.2 ± 9.8 mL/m2 for PA, 30.7 ± 8.1 mL/m2 for EH, and 29.5 ± 7.0 mL/m2 for HC; p = 0.013), left ventricular mass index (mean ± SD: 65.8 ± 16.5 g/m2 for PA, 56.9 ± 12.1 g/m2 for EH, and 44.1 ± 8.9 g/m2 for HC; p < 0.001), and native T1 (mean ± SD: 1224 ± 39 ms for PA, 1201 ± 47 ms for EH, and 1200 ± 44 ms for HC; p = 0.041) values were higher in the PA group compared to the EH and HC groups. Multivariable linear regression demonstrated that log (plasma aldosteroneto-renin ratio) was independently correlated with EDVi and ESVi. Plasma aldosterone was independently correlated with native T1. Conclusion Patients with PA showed a greater degree of ventricular hypertrophy and enlargement, as well as myocardial fibrosis, compared to those with EH. Cardiac MRI T1 mapping can detect left ventricular myocardial fibrosis in patients with PA.

Objective:To observe and analyze the influence of deoxycholic acid (DCA) on intestinal microbiota and bile acid metabolism during the process of enteritis induced by DCA in mice.Methods:Twenty C57BL/6J mice were randomly and equally divided into DCA group and control group. The mice in DCA group were developed by feeding the feed with 0.2% DCA and the mice in control group were developed with routine feed for 24 weeks. The degree of intestinal tissue inflammation was evaluated by HE staining and scored, the change of intestinal microbiota was analyzed by pyrosequencing, bile acid levels of all grades in faeces were detected by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS) , the expressions of bile acid-related genes were detected by quantitive real-time PCR.Results:The intestinal histology scores in DCA group was significantly higher than that of the control group (both P<0.05) . The diversity of fecal microbiota in the DCA group was significantly reduced, the percentage of Firmicutes at the phylum level and the percentage of Clostridium XIVa at the genus level were significantly decreased (both P<0.05) . The total bile acid, secondary bile acid, unconjugated bile acid and tauro-α-muricholic acid (T-α-MCA) of mice faeces in DCA group were significant higher than those in control group (all P<0.05) . The expression of biliary acid transporter gene organic solute transporter β ( Ost- β) , farnesoid X receptor ( FXR) and fibroblast growth factor 15 ( FGF15) in DCA group decreased significantly (all P<0.05) , while the expressions of liver bile synthesis rate-limiting enzymes Cyp7a1, Cyp7b1 and Cyp27a1 increased obviously (all P<0.05) . Conclusions:DCA can induce the progress of enteritis, which may be related to its destruction of intestinal microbiota in mice and the promotion of liver bile acid synthesis through FXR-FGF15 signaling pathway.

Objective:To observe and analyze the influence of deoxycholic acid (DCA) on intestinal microbiota and bile acid metabolism during the process of enteritis induced by DCA in mice.Methods:Twenty C57BL/6J mice were randomly and equally divided into DCA group and control group. The mice in DCA group were developed by feeding the feed with 0.2% DCA and the mice in control group were developed with routine feed for 24 weeks. The degree of intestinal tissue inflammation was evaluated by HE staining and scored, the change of intestinal microbiota was analyzed by pyrosequencing, bile acid levels of all grades in faeces were detected by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS) , the expressions of bile acid-related genes were detected by quantitive real-time PCR.Results:The intestinal histology scores in DCA group was significantly higher than that of the control group (both P<0.05) . The diversity of fecal microbiota in the DCA group was significantly reduced, the percentage of Firmicutes at the phylum level and the percentage of Clostridium XIVa at the genus level were significantly decreased (both P<0.05) . The total bile acid, secondary bile acid, unconjugated bile acid and tauro-α-muricholic acid (T-α-MCA) of mice faeces in DCA group were significant higher than those in control group (all P<0.05) . The expression of biliary acid transporter gene organic solute transporter β ( Ost- β) , farnesoid X receptor ( FXR) and fibroblast growth factor 15 ( FGF15) in DCA group decreased significantly (all P<0.05) , while the expressions of liver bile synthesis rate-limiting enzymes Cyp7a1, Cyp7b1 and Cyp27a1 increased obviously (all P<0.05) . Conclusions:DCA can induce the progress of enteritis, which may be related to its destruction of intestinal microbiota in mice and the promotion of liver bile acid synthesis through FXR-FGF15 signaling pathway.