Objective To investigate the relationship between insomnia,gastrointestinal symptoms,and glycosylated hemoglobin(HbA1c)levels in individuals diagnosed with type 2 diabetes mellitus(T2DM),as well as the related influencing factors.Methods A total of 910 T2DM patients treated in our multicenter from January 2022 to December 2022 were enrolled in this study.General information(gender,age,smoking and drinking history,exercise,course of disease,treatment and complications),HbA1c,Athens Insomnia Scale(AIS)scores and Gastrointestinal Symptoms Rating Scale(GSRS)scores of patients were collected.The differences of sleep and gastrointestinal symptoms between groups were analyzed,and the correlation between the differences and HbA1c was analyzed.Furthermore,the risk factors for non-standard HbA1c were analyzed.Results The AIS score and GSRS score in the HbA1c control group were less than those in the non-standard group(P＜0.01).Insomnia was reported by 37.0％of T2DM patients,and the HbA1c level in the insomnia group was significantly higher than that in the non-insomnia group(10.00％±2.38％vs.8.26％±1.73％,P＜0.01).Gastrointestinal symptoms were present in 57.5％of T2DM patients,and the HbA1c levels in the group with gastrointestinal symptoms were significantly higher than those in the group without gastrointestinal symptoms(9.26％±2.23％vs.8.43％±1.98％,P＜0.01).Furthermore,26.3％of T2DM patients experienced both insomnia and gastrointestinal symptoms.Remarkably,the HbA1c levels in the group with both insomnia and gastrointestinal symptoms were significantly higher than those in the group without either condition(10.18％±2.44％vs.8.45％±1.86％,P＜0.01).Correlation analysis demonstrated a significant association between sleep quality,gastrointestinal function,and HbA1c levels(P＜0.01).The logistic regression analysis result revealed that age,GSRS score,AIS score,and the presence of insomnia combined with gastrointestinal symptoms were independent risk factors for predicting HbA1c≥6.5％(P＜0.01).Having both insomnia and gastrointestinal symptoms concurrently was the strongest risk factor for substandard HbA1c control,and the risk of blood sugar control may increase about 5 times when both appear together.Conclusion Insomnia and gastrointestinal symptoms are common comorbidities in T2DM patients,showing a cross-interfering relationship,and they appear together with poor blood sugar control,interact causally,and amplify each other.

Objective To investigate the effect of intravertebral labor analgesia nursing intervened by anesthesia nurse on labor analgesia and delivery outcome.Methods Two hundreds cases of parturients who received intravertebral labor analgesia in The First Affiliated Hospital of Kunming Medical University from July to December 2022 were selected as research objects and randomly divided into observation group and control group by drawing lots,with 100 cases in each group.The control group was given routine nursing by midwives,and the observation group was given anesthesia nursing by an anesthesia nurse.The degree of labor pain,the outcome of labor,the incidence of anesthesia-related complications,and the satisfaction of labor analgesia nursing were compared between the two groups.Results The degree of labor pain in the observation group was significantly lower than that in the control group(P<0.05).The duration of labor in the observation group was longer than that in the control group(P<0.05).The incidence of anesthesia-related complications in the observation group was significantly lower than that in the control group(P<0.05).The satisfaction of parturient analgesic care in the observation group was higher than that in the control group(P<0.05).Conclusion Labor analgesia care intervened by anesthesia nurses can effectively reduce labor pain,shorten the labor process,reduce the incidence of anesthesia-related complications,improve the satisfaction of labor analgesia nursing,and provide a safe,comfortable,and effective labor process for women,which is worthy of clinical promotion.

This paper discussed the clinical ideas and methods of treating diabetes by improving symptoms. Diabetes-related symptoms can affect the control of blood glucose and other metabolic indicators to varying degrees， and affect the quality of life of patients. In the clinical diagnosis and treatment of diabetes， “equal emphasis on both indicators” is suggested， meaning that quality of life indicators is as important as metabolic indicators. The patient's symptoms should be paied attention to， and the diagnosis and treatment should start from “symptom differentiation”， and emphasize the “key symptoms”. When there are many symptoms， it is advised to adopt the combined treatment mode of “syndrome cluster”， and take the principle of “treating both the root and accompanying symptoms in mild cases with multiple symptoms， and prescribing multiple formulas daily”. At the same time， the model of co-management of three disciplines of diabetes consisting of diabetes specialists， traditional Chinese medicine doctors， and health managers can help the management of diabetes symptoms.

Diabetes mellitus(DM)is an endocrine metabolic disease mainly characterized by chronic hyperglycemia,which seriously threatens the health and quality of life of human beings,and with the improvement of living standard and unhealthy lifestyle in China,the incidence of DM continues to rise and tends to be younger,so it is urgent to carry out in-depth research on hypoglycemic treatment.DM is pathologically based on absolute or relative insulin deficiency,and there is no radical cure for it,and Western medicine mostly adopts insulin injection or oral hypoglycemic drugs for symptomatic treatment,which is effective but prone to toxic side effects in long-term use.Chinese medicine has the advantages of multi-path and multi-target in treating DM,and plays a role in lowering blood sugar by promoting insulin secretion,improving insulin resistance,regulating glucolipid metabolism and anti-oxidative stress,etc.Its efficacy is remarkable and the rate of toxic side effects is low.In recent years,there have been more studies on the mechanism of action of traditional Chinese medicine and compound prescriptions on animal models of DM.By reviewing the relevant literature in recent years,the author has systematically sorted out the mechanism of hypoglycemic action of single Chinese medicine,traditional Chinese medicine compound prescriptions,effective components of traditional Chinese medicine and their related experimental designs,from promoting insulin secretion,inhibiting gluconeogenesis,promoting glycogen synthesis,improving insulin resistance,inhibiting glycosidase activity,alleviating oxidative stress damage,inhibiting inflammatory response and regulating intestinal stress.The study and experimental design of the hypoglycemic mechanism of Chinese medicine were summarized in terms of promoting insulin secretion,inhibiting gluconeogenesis,promoting glycogen synthesis,improving insulin resistance,inhibiting glucosidase activity,alleviating oxidative stress damage,inhibiting inflammatory response and regulating intestinal flora,etc.,with a view to providing reference for the wider clinical application of Chinese medicine in hypoglycemia and its in-depth pharmacodynamic study.

Objectives:To investigate the efficacy and safety of anlotinib combined with niraparib in treating patients with platinum-resistant ovarian cancer.Methods:Thirty-five patients with pathological confirmed platinum-resistant ovarian cancer who experienced progression after receiving at least two lines of standard treatment were eligible. All of them were treated with anlotinib combined with niraparib between September 2019 and October 2021. The primary endpoint was progression-free survival (PFS). The second endpoints included overall survival, objective response rate (ORR), disease control rate (DCR) and safety. Survival analysis was performed using the Kaplan-Meier method and Log-rank test, and influence factor analysis was performed using Cox proportional risk regression models.Results:The best overall response showed that partial response was observed in 14 patients, stable disease was noted within 13 patients, and progressive disease was found in 8 patients. Therefore, the ORR and DCR of these 35 patients were 40.0% (95% CI:22.9%-57.1%) and 77.1% (95% CI:62.9%-91.4%), respectively. The median follow-up duration was 18.9 months (6.9-32.2). The median PFS was 6.5 months (95% CI:5.35-7.66). Multivariate Cox regression analysis for PFS indicated that age, Eastern Cooperative Oncology Group performance status (ECOG PS) score, International Federation of Gynecology and Obstetrics (FIGO) stage, and BRCA mutation status were independent factors influencing PFS ( P＜0.05). Additionally, the PFS in patients with BRCA mutation who have never received PARP inhibitor treatment was significantly longer than that in patients without BRCA mutation who have been exposed to prior PARPi treatment (15.0 vs 6.0 month, P=0.029). The most common treatment-related adverse reactions were fatigue (85.7%), hematologic toxic (85.7%) and hypertension (74.3%). There were no treatment-related deaths. Conclusion:Anlotinib combined with niraparib shows a promising efficacy and tolerable safety in platinum-resistant ROC patients.

Objectives:To investigate the efficacy and safety of anlotinib combined with niraparib in treating patients with platinum-resistant ovarian cancer.Methods:Thirty-five patients with pathological confirmed platinum-resistant ovarian cancer who experienced progression after receiving at least two lines of standard treatment were eligible. All of them were treated with anlotinib combined with niraparib between September 2019 and October 2021. The primary endpoint was progression-free survival (PFS). The second endpoints included overall survival, objective response rate (ORR), disease control rate (DCR) and safety. Survival analysis was performed using the Kaplan-Meier method and Log-rank test, and influence factor analysis was performed using Cox proportional risk regression models.Results:The best overall response showed that partial response was observed in 14 patients, stable disease was noted within 13 patients, and progressive disease was found in 8 patients. Therefore, the ORR and DCR of these 35 patients were 40.0% (95% CI:22.9%-57.1%) and 77.1% (95% CI:62.9%-91.4%), respectively. The median follow-up duration was 18.9 months (6.9-32.2). The median PFS was 6.5 months (95% CI:5.35-7.66). Multivariate Cox regression analysis for PFS indicated that age, Eastern Cooperative Oncology Group performance status (ECOG PS) score, International Federation of Gynecology and Obstetrics (FIGO) stage, and BRCA mutation status were independent factors influencing PFS ( P＜0.05). Additionally, the PFS in patients with BRCA mutation who have never received PARP inhibitor treatment was significantly longer than that in patients without BRCA mutation who have been exposed to prior PARPi treatment (15.0 vs 6.0 month, P=0.029). The most common treatment-related adverse reactions were fatigue (85.7%), hematologic toxic (85.7%) and hypertension (74.3%). There were no treatment-related deaths. Conclusion:Anlotinib combined with niraparib shows a promising efficacy and tolerable safety in platinum-resistant ROC patients.

Objective:To investigate the clinical efficacy of different surgical approaches for repairing eyelid coloboma.Methods:Patients with the divided nevus of eyelid treated at Hypospadias Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2005 to January 2022 were included. The surgeries were categorized into 4 types. (1) Direct excision and suture. (2) Local skin grafts: covering the defect with split- or full-thickness skin grafts according to the size of the defect on the upper and lower eyelids. (3) Combined skin grafts with orbicularis oculi myocutaneous flap: grafting skin flaps for defects on the upper eyelid and near the lower eyelid, and temporal area skin flaps based on the same side orbicularis oculi muscle pedicle for lower eyelid defects. (4) Temporal area expanded flap based on the orbicularis oculi muscle combined with skin grafts: the surgery was divided into two stages, the first stage involves the placement of an expander in the temporal area of the affected side, and the second stage involves the removal of the expander, excision of eyelid lesion tissue and formation of an island-shaped skin flap with the orbital part of the orbicularis oculi muscle pedicle as the pedicle, which was rotated 180° to cover the lower eyelid defect. Defects near the upper and lower eyelid margins were still covered with skin grafts. Follow-up was conducted through outpatient visits, telephone calls, and WeChat messaging to assess facial appearance postoperatively. SPSS 22.0 statistical software was used for analysis, and the measurement data were expressed as Mean±SD, the count data were expressed as percentage, and the comparison of preoperative and postoperative was calculated by aesthetic and functional status of facial soft-tissue deformities (A&F scores) within the group was performed by paired t-test, the difference was considered statistically significant at P<0.05. Results:A total of 34 patients were included; average age was 17.7±15.3 years. The size of the lesions varied from the smallest nevus measuring 0.3 cm × 0.2 cm and the largest measuring 14.0 cm × 14.0 cm. Direct excision with suturing was performed in 6 cases, among which 2 cases received simultaneous double eyelid surgery, the postoperative A&F score (4.54 ± 1.32) was higher than the preoperative (3.28 ± 0.98) score, the difference was not statistically significant ( P>0.05). The skin graft was performed in 10 cases, the postoperative A&F score (5.13 ± 1.59) was higher than the preoperative (2.25 ± 1.59), the difference was not statistically significant ( P>0.05). The skin graft combined with using orbicularis oculi muscle skin flap was performed in 7 cases, the postoperative A&F score of our patients (5.54 ±1.46) was significantly higher than the preoperative (2.18 ±1.61 ), the difference was statistically significant ( P<0.05). The skin graft combined with the expanded temporal area flap based on the orbicularis oculi muscle was performed in 11 cases, the A&F score of our patients after repair (4.95 ±0.60) was improved compared with the preoperative (2.18±1.48) score, and the difference was not statistically significant ( P>0.05). Twenty-eight patients were followed up for 8 to 81 months while 6 cases lost due to change of contact information, among whom three developed secondary ectropion of the lower eyelid, three experienced recurrence of nevi in the incision and grafting area, two exhibited significant pigmentation in the grafting area, and one developed secondary ptosis of the upper eyelid, while the rest of the patients were satisfied with the repair results. Conclusion:Surgical excision is the only effective treatment for eyelid cleft nevi with different clinical presentations. Covering defects on the upper and lower eyelids with different tissue transplantation method can disperse the entire nevus, resulting in more stable long-term repair effects and a more natural appearance. The combination of an orbicularis muscle flap and a free skin graft provides more stable result in the plastic surgery of medium to large eyelid split nevi. Free skin grafting of the upper and lower lids near the margins, and flap grafting of the lower lids are more consistent with the physiological state of the upper and lower lids, and the combination of different tissue grafting method can make the appearance of the face more reasonable.

Indocyanine green ( ICG ) is a water-soluble biological fluorescent contrast agent with infrared absorption and emission characteristics. Indocyanine green angiography ( ICGA ) takes advantage of this biological property. After ICG is injected into the vascular system, the blood flow dynamic map is captured by high-speed photography or real-time photography, which can realize the visualization of vascular structure and tissue blood supply. Currently, ICGA is the only technique for intraoperative quantitative evaluation of flap blood perfusion, and it is widely used in plastic surgery and microsurgery. According to the relevant literature reports at home and abroad in recent years, this review introduced the working principle and method of ICGA and its research progress in evaluating the blood perfusion of pedicled skin flaps. It is considered that this technique still has some limitations in methodology and accuracy of result, and it is still necessary to combine the clinical experience of doctors in the evaluation of tissue perfusion of pedicled skin flaps.

Objective:To investigate the clinical efficacy of different surgical approaches for repairing eyelid coloboma.Methods:Patients with the divided nevus of eyelid treated at Hypospadias Plastic Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2005 to January 2022 were included. The surgeries were categorized into 4 types. (1) Direct excision and suture. (2) Local skin grafts: covering the defect with split- or full-thickness skin grafts according to the size of the defect on the upper and lower eyelids. (3) Combined skin grafts with orbicularis oculi myocutaneous flap: grafting skin flaps for defects on the upper eyelid and near the lower eyelid, and temporal area skin flaps based on the same side orbicularis oculi muscle pedicle for lower eyelid defects. (4) Temporal area expanded flap based on the orbicularis oculi muscle combined with skin grafts: the surgery was divided into two stages, the first stage involves the placement of an expander in the temporal area of the affected side, and the second stage involves the removal of the expander, excision of eyelid lesion tissue and formation of an island-shaped skin flap with the orbital part of the orbicularis oculi muscle pedicle as the pedicle, which was rotated 180° to cover the lower eyelid defect. Defects near the upper and lower eyelid margins were still covered with skin grafts. Follow-up was conducted through outpatient visits, telephone calls, and WeChat messaging to assess facial appearance postoperatively. SPSS 22.0 statistical software was used for analysis, and the measurement data were expressed as Mean±SD, the count data were expressed as percentage, and the comparison of preoperative and postoperative was calculated by aesthetic and functional status of facial soft-tissue deformities (A&F scores) within the group was performed by paired t-test, the difference was considered statistically significant at P<0.05. Results:A total of 34 patients were included; average age was 17.7±15.3 years. The size of the lesions varied from the smallest nevus measuring 0.3 cm × 0.2 cm and the largest measuring 14.0 cm × 14.0 cm. Direct excision with suturing was performed in 6 cases, among which 2 cases received simultaneous double eyelid surgery, the postoperative A&F score (4.54 ± 1.32) was higher than the preoperative (3.28 ± 0.98) score, the difference was not statistically significant ( P>0.05). The skin graft was performed in 10 cases, the postoperative A&F score (5.13 ± 1.59) was higher than the preoperative (2.25 ± 1.59), the difference was not statistically significant ( P>0.05). The skin graft combined with using orbicularis oculi muscle skin flap was performed in 7 cases, the postoperative A&F score of our patients (5.54 ±1.46) was significantly higher than the preoperative (2.18 ±1.61 ), the difference was statistically significant ( P<0.05). The skin graft combined with the expanded temporal area flap based on the orbicularis oculi muscle was performed in 11 cases, the A&F score of our patients after repair (4.95 ±0.60) was improved compared with the preoperative (2.18±1.48) score, and the difference was not statistically significant ( P>0.05). Twenty-eight patients were followed up for 8 to 81 months while 6 cases lost due to change of contact information, among whom three developed secondary ectropion of the lower eyelid, three experienced recurrence of nevi in the incision and grafting area, two exhibited significant pigmentation in the grafting area, and one developed secondary ptosis of the upper eyelid, while the rest of the patients were satisfied with the repair results. Conclusion:Surgical excision is the only effective treatment for eyelid cleft nevi with different clinical presentations. Covering defects on the upper and lower eyelids with different tissue transplantation method can disperse the entire nevus, resulting in more stable long-term repair effects and a more natural appearance. The combination of an orbicularis muscle flap and a free skin graft provides more stable result in the plastic surgery of medium to large eyelid split nevi. Free skin grafting of the upper and lower lids near the margins, and flap grafting of the lower lids are more consistent with the physiological state of the upper and lower lids, and the combination of different tissue grafting method can make the appearance of the face more reasonable.

Indocyanine green ( ICG ) is a water-soluble biological fluorescent contrast agent with infrared absorption and emission characteristics. Indocyanine green angiography ( ICGA ) takes advantage of this biological property. After ICG is injected into the vascular system, the blood flow dynamic map is captured by high-speed photography or real-time photography, which can realize the visualization of vascular structure and tissue blood supply. Currently, ICGA is the only technique for intraoperative quantitative evaluation of flap blood perfusion, and it is widely used in plastic surgery and microsurgery. According to the relevant literature reports at home and abroad in recent years, this review introduced the working principle and method of ICGA and its research progress in evaluating the blood perfusion of pedicled skin flaps. It is considered that this technique still has some limitations in methodology and accuracy of result, and it is still necessary to combine the clinical experience of doctors in the evaluation of tissue perfusion of pedicled skin flaps.