Objective:To explore the role of process management for continuous periheral insulin infusion (CPII) for controlling hyperglycemia during enteral nutrition (EN) for critically ill patients.Methods:A total of 75 patients who received continuous EN treatment in the emergency intensive care unit (EICU) of Qinghai Red Cross Hospital from January 2023 to January 2024 were selected in this historical controlled trial study. Patients who were admitted before the implementation of process management for CPII were included in the historical control group ( n=35), and those who were admitted after the implementation were included in the observation group ( n=40). Both groups were treated with continuous EN infusion combined with micropump-based insulin therapy, with the target blood glucose being<10 mmol/L. The blood glucose values at 4 hours and 8 hours after treatment, the time to reach the target blood glucose and the dosage of insulin, the total amount of insulin at 24 hours, the amount of calories administered when reaching the target blood glucose, the frequency of blood glucose measurement, the incidence of hypoglycemia and hypokalemia, the amount of potassium supplemented for hypokalemia, the length of EICU stay, and the incidence of nosocomial infection were compared between these two groups. Results:The blood glucose levels of the observation group at 4 hours and 8 hours after CPII were significantly lower than those of the control group (both P<0.001), and the time for the observation group to reach the target blood glucose level was significantly shorter than that for the control group ( P<0.001). The total amount of insulin in the observation group when reaching the target blood glucose and the total amount of insulin used within 24 hours were significantly smaller than those in the control group (both P<0.05). The amount of calories administered to the observation group when reaching the target blood glucose level was significantly higher than that of the control group ( P=0.002). The number of blood glucose measurements within 24 hours after insulin initiation in the observation group was significantly larger than that in the control group ( P=0.042), but there was no statistically significant difference in the total number of monitoring during EICU stay ( P=0.561). The incidence rates of hypoglycemia and hypokalemia and the amount of potassium supplemented for hypokalemia in the observation group were significantly lower than those in the control group (all P<0.05). There was no statistically significant difference in the length of EICU stay and the incidence of nosocomial infection between the two groups (both P>0.05). Conclusions:Process management for CPII in critically ill patients promotes rapid glycemic control during enteral nutrition (EN), reduces hypoglycemia, hypokalemia, and nosocomial infections, and improves overall blood glucose stability. It is vital for controlling stress hyperglycemia during EN in critical illness, with excellent safety.

Objective:To evaluate the clinical efficacy of Buyang Huanwu Decoction combined with medium-frequency pulsed electrical stimulation in the treatment of diabetic peripheral neuropathic pain (DPNP).Methods:A randomized controlled trial study was conducted. A total of 86 patients with DPNP in the endocrinology department of Xi'an Hospital of Traditional Chinese Medicine from September 2020 to September 2023 were selected as the observation objects and divided into 2 groups through the random number table method, with 43 cases in each group. The control group was combined with medium-frequency pulsed electrical stimulation on the basis of conventional Western medical treatment, while the observation group was supplemented with Buyang Huanwu Decoction on the basis of the control group. Both groups were treated for 12 weeks. TCM syndrome scores were conducted before and after the treatment respectively. The Toronto Clinical Scoring System (TCSS) was used to grade the severity of neuropathy. The motor nerve conduction velocity (MCV) and sensory nerve conduction velocity (SCV) of the median nerve and common peroneal nerve were detected by electromyography evoked potential tester. Adverse reactions during the treatment were recorded to evaluate the clinical efficacy.Results:The total effective rate was 93.02% (40/43) in the observation group and 74.42% (32/43) in the control group, with statistical significance between the two groups ( χ2=5.46, P=0.019). After treatment, the scores of shortness of breath and fatigue, end-limb pain, listlessness, dull tongue and the total score in the observation group were lower than those in the control group ( t values were 3.06, 3.42, 3.09, 3.57 and 3.98 respectively, P<0.05); the scores of neurological symptoms, neural reflexes and sensory function examinations were lower than those in the control group ( t values were 4.54, 6.28 and 5.16 respectively, P<0.01). After treatment in the observation group, MCV of the median nerve [(47.96±5.98) m/s vs. (42.02±5.74) m/s, t=4.70] and SCV [(54.90±6.29) m/s vs. (48.04±6.16) m/s, t=5.11] were higher than those in the control group. The MCV of the common perbular nerve [(41.76±6.27) m/s vs. (37.04±6.18) m/s, t=3.52] and SCV [(50.35±6.41) m/s vs. (46.14±6.13) m/s, t=3.12] were higher than those in the control group ( P<0.01 or P<0.05). During the treatment period, the incidence of adverse reactions was 11.63% (5/43) in the observation group and 9.30% (4/43) in the control group, without statistical significance between the two groups ( χ2=0.12, P=0.725). Conclusion:Buyang Huanwu Decoction combined with medium-frequency pulsed electrical stimulation can effectively improve the degree of neuropathy in patients with DPNP, increase nerve conduction velocity, alleviate TCM syndromes, enhance clinical efficacy and has good safety.

Objective:To explore the role of process management for continuous periheral insulin infusion (CPII) for controlling hyperglycemia during enteral nutrition (EN) for critically ill patients.Methods:A total of 75 patients who received continuous EN treatment in the emergency intensive care unit (EICU) of Qinghai Red Cross Hospital from January 2023 to January 2024 were selected in this historical controlled trial study. Patients who were admitted before the implementation of process management for CPII were included in the historical control group ( n=35), and those who were admitted after the implementation were included in the observation group ( n=40). Both groups were treated with continuous EN infusion combined with micropump-based insulin therapy, with the target blood glucose being<10 mmol/L. The blood glucose values at 4 hours and 8 hours after treatment, the time to reach the target blood glucose and the dosage of insulin, the total amount of insulin at 24 hours, the amount of calories administered when reaching the target blood glucose, the frequency of blood glucose measurement, the incidence of hypoglycemia and hypokalemia, the amount of potassium supplemented for hypokalemia, the length of EICU stay, and the incidence of nosocomial infection were compared between these two groups. Results:The blood glucose levels of the observation group at 4 hours and 8 hours after CPII were significantly lower than those of the control group (both P<0.001), and the time for the observation group to reach the target blood glucose level was significantly shorter than that for the control group ( P<0.001). The total amount of insulin in the observation group when reaching the target blood glucose and the total amount of insulin used within 24 hours were significantly smaller than those in the control group (both P<0.05). The amount of calories administered to the observation group when reaching the target blood glucose level was significantly higher than that of the control group ( P=0.002). The number of blood glucose measurements within 24 hours after insulin initiation in the observation group was significantly larger than that in the control group ( P=0.042), but there was no statistically significant difference in the total number of monitoring during EICU stay ( P=0.561). The incidence rates of hypoglycemia and hypokalemia and the amount of potassium supplemented for hypokalemia in the observation group were significantly lower than those in the control group (all P<0.05). There was no statistically significant difference in the length of EICU stay and the incidence of nosocomial infection between the two groups (both P>0.05). Conclusions:Process management for CPII in critically ill patients promotes rapid glycemic control during enteral nutrition (EN), reduces hypoglycemia, hypokalemia, and nosocomial infections, and improves overall blood glucose stability. It is vital for controlling stress hyperglycemia during EN in critical illness, with excellent safety.

Objective:To study the clustered regularly interspaced short palindromic repeats (CRISPR) genotype of Yersinia pestis and its regional distribution characteristics in natural plague focus of Tibet Autonomous Region. Methods:A total of 125 representative Yersinia pestis strains isolated from natural plague focus in Tibet Autonomous Region at different times, regions, hosts and vectors were selected as experimental strains, and the phenol chloroform mixed extraction method was used to extract Yersinia pestis DNA. Three pairs of CRISPR primers (for YPa, YPb, YPc locus) were used to amplify the DNA of the experimental strains, and the CRISPR genotype of Yersinia pestis was determined by sequencing. Results:All 125 strains of Yersinia pestis had three CRISPR locus: YPa, YPb, and YPc. A total of 18 spacer were found, including 8 in YPa loci, 6 in YPb loci, and 4 in YPc loci. Two new types of spacers had been discovered, namely b52 and c14. CRISPR typing revealed 10 genotypes, including G1, G7, G7-b4''', G7-b52, G7-c2 -, G8, G22, G22-a4 -, G22-b4''', and G22-c14, of which 6 were newly discovered genotypes. Among the 125 experimental strains, G7 was the main genotype, accounting for 65.6% (82/125), which was distributed in 6 prefecture level citys and 1 region of Tibet Autonomous Region. Next were G22 and G7-c2 - genetypes, accounting for 14.4% (18/125) and 11.2% (14/125), respectively. G22 gene type was distributed in Nagqu, Changdu, Lhasa citys, and Ngari Prefecture, while G7-c2 - genetype was distributed in Shigatse and Shannan cities. Conclusion:The CRISPR locus of Yersinia pestis in natural plague focus of Tibet Autonomous Region is highly polymorphic, and the Yersinia pestis strains with different genotypes have obvious regional distribution characteristics.

Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinoma(G1 EAC)and the recurrence rate after treatment.Methods Sixty patients(aged 20-42 years)with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups(n=30)to receive oral MA treatment at the daily dose of 160 mg(control)or MA plus oral metformin(850 mg,twice a day)for at least 6 months.The treatment could extend to 12 months until a complete response(CR)was achieved,and follow-up hysteroscopy and curettage were performed every 3 months.For all the patients who achieved CR,endometrial expressions of IGFBP-rP1,p-Akt and p-AMPK were detected immunohistochemically.Results A total of 58 patients completed the treatment.After 9 months of treatment,23(76.7%)patients in the combined treatment group and 20(71.4%)in the control group achieved CR;two patients in the control group achieved CR after converting to the combined treatment.The recurrence rate did not differ significantly between the control group and combined treatment group(30.0%vs 22.7%,P>0.05).Ten(35.7%)patients in the control group experienced significant weight gain of 5.7±6.1 kg,while none of the patients receiving the combined treatment exhibited significant body weight changes.Compared with the control group,the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression.Conclusion Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC,and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.

Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinoma(G1 EAC)and the recurrence rate after treatment.Methods Sixty patients(aged 20-42 years)with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups(n=30)to receive oral MA treatment at the daily dose of 160 mg(control)or MA plus oral metformin(850 mg,twice a day)for at least 6 months.The treatment could extend to 12 months until a complete response(CR)was achieved,and follow-up hysteroscopy and curettage were performed every 3 months.For all the patients who achieved CR,endometrial expressions of IGFBP-rP1,p-Akt and p-AMPK were detected immunohistochemically.Results A total of 58 patients completed the treatment.After 9 months of treatment,23(76.7%)patients in the combined treatment group and 20(71.4%)in the control group achieved CR;two patients in the control group achieved CR after converting to the combined treatment.The recurrence rate did not differ significantly between the control group and combined treatment group(30.0%vs 22.7%,P>0.05).Ten(35.7%)patients in the control group experienced significant weight gain of 5.7±6.1 kg,while none of the patients receiving the combined treatment exhibited significant body weight changes.Compared with the control group,the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression.Conclusion Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC,and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.

Abstract: Objective To understand the phenotypic and genetic characteristics of Yersinia pestis strains isolated from Himalayan marmot natural focus area and domestic rat plague focus area in southern China, and provide reference for mastering the pathogenic characteristics of Yersinia pestis of two plague foci. Methods A total of 412 of Yersinia pestis strains isolated from Himalayan marmot plague focus and domestic rat plague focus of southern China were subjected to to sorbitol fermentation assays, virulence factor, different region (DFR) typing, and clustered regularly interspaced palindromic repeats (CRISPR) typing. Results The biochemical types of Y. pestis from the two plague foci showed distinct regional distribution features. Five biochemical phenotypes were identified in Yersinia pestis isolated from Himalayan marmot natural focus area, while only one biochemical phenotype was identified in strains isolated from the domestic rat plague focus of Southern China. Most of the Yersinia pestis isolated from the two plague foci were capable of producing the virulence factors of Fl and PstI. Among the strains from Himalayan marmot focus, 70.53% (201/285) were VW-positive, 75.09% (214/285) were Pgm-positive, 20.00% (57/285) of the strains were Pgm-negative, and 5.26% (15/285) were Pgm mixed-type strains. Among strains from domestic rat plague focus of southern China, 37.80% (48/127) were VW-positive, 29.13% (37/127) were Pgm-positive, 58.27% (74/127) were Pgm-negative, and 12.60% (16/127) were Pgm mixed-type strains. DFR typing revealed 22 genotypes of Y. pestis from the Himalayan marmot plague focus, with the main genotypes being type 5, 7, 8, 10, 19, 32 and 49. All strains from domestic rat plague focus area in southern China belonged to type 9. CRISPR typing revealed that all strains from the Himalayan marmot natural focus were classified into 7 CRISPR gene clusters and 14 CRISPR genotypes, with the main genotypes being G7, G22, G26-a1'and G22-A1'. All strains from domestic rat plague focus area in southern China belonged to CRISPR genotype G30, with the gene cluster being Ca8. Conclusions The phenotypes and genotypes of the Yersinia pestis of Himalayan marmot plague focus are diverse, with an obvious characteristics of geographical distribution. The phenotype and genotype of the Yersinia pestis of domestic rat plague focus of Southern China are single. DFR and CRISPR genotyping methods with phenotypic characteristics can effectively identify the Yersinia pestis isolated from the two plague foci, thereby meeting the needs of identification and traceability research.

Objective To explore the effect and mechanism of miR-581 on the autophagy of ovarian cancer SKOV3 cells. Methods miR-581 mimics and miR-581 NC were transfected into SKOV3 cells, and the transfection efficiency was detected by qRT-PCR. After successful transfection, Western blot was used to detect autophagy-related proteins expression in SKOV3 cells. TargetScanHuman database predicted miR-581 target genes, and Western blot verified the role of miR-581 and target genes. Results Overexpression of miR-581 significantly inhibited the expression of autophagy-related proteins LC3 Ⅱ and Beclin1 (P < 0.01); miR-581 negatively regulated FOXO1 expression (P < 0.01) and FOXO1 promoted autophagy of SKOV3 cells (P < 0.01). Conclusion miR-581 affects the autophagy of ovarian cancer SKOV3 cells by regulating the expression of FOXO1.

Objective:To investigate the genotypes of clustered regularly interspaced short palindromic repeats (CRISPR) of Yersinia pestis ( Y. pestis) and it's regional distribution in the plague natural foci of Qinghai-Tibet Plateau. Methods:In this study, 1 004 strains of Y. pestis isolated from different hosts and vectors in different regions from 1954 to 2011 were selected as experimental objects, which preserved in Qinghai Institute for Endemic Disease Prevention and Control, and DNA of Y. pestis was extracted by traditional phenol-chloroform method. Three CRISPR loci (YPa, YPb and YPc) were amplified by PCR and sequenced, respectively, and the CRISPR sequences were compared with the CRISPRDictionary database recently reported in the literature to identify CRISPR spacer. For the spacer discovered for the first time at each CRISPR locus, Blast sequence alignment was performed in the National Center for Biotechnology Information (NCBI) database to speculate the source of gene sequence. Genotyping of Y. pestis from Qinghai-Tibet Plateau was performed based on the polymorphism of CRISPR spacer array. Results:A total of 53 spacers were found in 1 004 strains of Y. pestis, of which 6 spacers were newly discovered, namely a105, a106, a107, b51, b52 and c14. The 1 004 strains of Y. pestis were divided into 10 groups with 44 different CRISPR genotypes, and 15 new genotypes were found. The dominant genotypes of Y. pestis were G26-a1', G7, G22, G24-a1', G22-a1', G9 and G26-a1'a60 in Himalayan Marmot plague natural foci, and G37-a6' in Qinghai Microtinae plague natural foci. Conclusion:The CRISPR genotypes of Y. pestis in the plague natural foci of Qinghai-Tibet Plateau are high diverse and have significant regional distribution characteristics.

Objective:To understand whether there are drug resistant and disinfectant resistant Yersinia pestis strains in China, and to provide accurate information for clinical treatment of plague. Methods:A total of 2 753 Yersinia pestis strains isolated from 10 natural plague foci in China from 1943 to 2016 were collected. According to National Center for Biotechnology Information (NCBI) released sequences of aminoglycoside streptomycin resistant genes strA, strB, β-lactam antibiotics resistant genes TEM, SHV and CTX-M, sulfamilamide resistant genes sul1, sul2 and sul3, and disinfectant resistant gene qacE△1-sul1, a pair of primers of each gene was designed for above-mentioned genes. Genomic DNA of 2 753 strains of Yersinia pestis was extracted, and the 9 target genes of all DNA samples were amplified by PCR. Results:Negative and positive controls of PCR detection were established. No corresponding target bands of aminoglycoside streptomycin resistant genes strA, strB, β-lactam antibiotics resistant genes TEM, SHV and CTX-M, sulfamilamide resistant genes sul1, sul2 and sul3, and disinfectant resistant gene qacE△1-sul1 were found in the DNA samples of 2 753 strains of Yersinia pestis.Conclusion:The above-mentioned genes of drug resistance and disinfectant resistance have not been detected in Yersinia pestis of China, but the monitoring of drug resistance of Yersinia pestis still needs to be carried out continuously.