Objective To investigate the association of neuregulin 4(NRG4)and meteorin-like protein(Metrnl)with insulin resistance in patients with metabolic syndrome(MS).Methods From September to November 2023,totally 60 MS patients in Anhui No.2 Provincial People's Hospital were selected as MS group,and 60 physical examination healthy people were selected as control group.The changes of human mor-phological indicators,biochemical indicators,blood routine,NRG4,Metrnl,insulin resistance index(HOMA-IR)and other indicators in the two groups were observed,and the correlation between NRG4,Metrnl and HO-MA-IR and each index was analyzed,and the diagnostic value of NRG4 and Metrnl for MS was evaluated.Re-sults Compared with the control group,the levels of white blood cell count(WBC),alanine aminotransferase(ALT),uric acid(UA),triglyceride(TG),total cholesterol(TC),fasting insulin(FINS),HOMA-IR,body weight,body mass index(BMI),waist circumference,hip circumference,waist-hip ratio(WHR),and body fat ratio were significantly increased in MS group(P<0.05),however,high density lipoprotein cholesterol(HDL-C),NRG4,and Metrnl were significantly decreased(P<0.05).Spearman correlation analysis showed that serum NRG4 was positively correlated with Metrnl and HDL-C(P<0.05),and negatively correlated with TG,FINS,HOMA-IR,body weight,waist circumference,hip circumference,WHR,and ALT(P<0.05).Serum Metrnl was positively correlated with NRG4 and HDL-C(P<0.05),and negatively correlated with TG and hip circumference(P<0.05).Binary Logistic regression analysis showed that NRG4 and Metrnl were protective factors for MS(P<0.05).The receiver operating characteristic curve analysis showed that the sensitivity of NRG4,Metrnl,and their combination for diagnosing MS was 67%,41%,and 67%,respec-tively,the specificity was 71%,95%,and 86%,respectively,and the area under the curve was 0.713,0.635,and 0.787,respectively.Conclusion The levels of serum NRG4 and Metrnl are decreased in MS patients,and NRG4 is associated with insulin resistance.The combination of NRG4 and Metrnl has a certain diagnostic val-ue for MS.

Objective To investigate the correlation between thyroid function,neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR)and diabetic ketoacidosis(DKA).Methods A total of 272 diabetic patients admitted to the Department of Endocrinology,Anhui No.2 Provincial People's Hospital were enrolled in this study from January 2021 to March 2024 and divided into DKA group(n=74),diabetic ketosis group(DK group,n=100)and simple DM group(n=98)according to their disease conditions.Serum free triiodothyronine(FT3),free tetraiodothyronine(FT4),thyroid stimulating hormone(TSH),FPG,HbA1c,anion gap(AG),white blood cells(WBC),neutrophils(N),platelets(PLT)and lymphocytes(L)were detected in each group,and NLR and PLR were calculated.The influence factors of DKA were analyzed by logistic regression,and the diagnostic value of FT3,NLR and PLR in DKA was evaluated by receiver operating characteristic(ROC)curve.Results Hospitalization days,FPG,HbA1c,incidence of LT3S,AG,WBC,N,PLT,NLR,PLR were higher in DKA group than in DM and DK groups(P<0.05),Age,FT3,FT4,TSH,L were lower in DKA group than in DM and DK groups(P<0.05).Logistic regression analysis showed that FT3,AG,NLR and PLR were the influencing factors for DKA.ROC curve showed that the area under the curve of FT3,NLR,PLR and combined detection to predict DKA were 0.961,0.938,0.810 and 0.980,the sensitivity was 87.8%,90.5%,75.7%and 98.6%,the specificity was 95.5%,92.9%,76.3%,92.4%,and the combined detection was superior to the single detection.Conclusions FT3,NLR,PLR have a certain diagnostic value for DKA,and the combined detection of the three has a high diagnostic value,which can provide a reference for clinical diagnosis of DKA.

Objective:To compile the post quality standard scale for wound, ostomy and continence nurses in China and to test the reliability and validity of the scale.Methods:The first draft of the scale was formed through literature review, semi-structured interview and Delphi expert letter consultation. Using the purposive sampling method, a total of 796 wound, ostomy and continence nurses from 31 provinces, municipalities and autonomous regions of China were selected from April to May 2019 to test the reliability and validity of the scale. A total of 796 questionnaires were sent out and 693 were effectively received, with effective recovery of 87.1%.Results:The post quality standard scale for wound, ostomy and continence nurses included 3 first-level items and 77 second-level items. Three common factors were extracted from exploratory factor analysis and the cumulative variance contribution rate was 72.466%. The correlation coefficient between the first-level items was 0.709-0.898 and the correlation coefficient between the first-level item and the total scale was 0.859-0.937. The Cronbach's α coefficient of the total amount table was 0.992 and the half-fold reliability coefficient was 0.917 ( P<0.01) . Conclusions:The post quality standard scale for wound, ostomy and continence nurses has good reliability and validity, which can be used to evaluate the post quality of wound, ostomy and continence nurses.

Twin reversed arterial perfusion sequence, a severe and unique complication of monochorionic multiple pregnancy, is characterized by vascular anastomosis and abnormal or absent cardiac development in the twins. This article reviewed its pathogenesis, prenatal ultrasound diagnosis, and management. The pump twin’s chances for survival can be maximized by proper management. The optimal timing of the interventions remains a debate, although the latest studies encourage early intervention, i.e., in the first trimester. The most preferred approach is to interrupt the vascular supply to the acardius, such as through ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels.

Twin reversed arterial perfusion sequence, a severe and unique complication of monochorionic multiple pregnancy, is characterized by vascular anastomosis and abnormal or absent cardiac development in the twins. This article reviewed its pathogenesis, prenatal ultrasound diagnosis, and management. The pump twin’s chances for survival can be maximized by proper management. The optimal timing of the interventions remains a debate, although the latest studies encourage early intervention, i.e., in the first trimester. The most preferred approach is to interrupt the vascular supply to the acardius, such as through ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels.

Objective: To investigate the relationship between neutrophil to lymphocyte ratio (NLR) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus. Methods: The clinical data of 117 patients with type 2 diabetes mellitus from January 2016 to June 2017 in Anhui No.2 Provincial People′s Hospital were analyzed retrospectively. According to the eGFR level, the patients were divided into 3 groups: eGFR ≥ 90 ml/(min·1.73 m²) in 68 cases (DM0 group), eGFR 60 to 89 ml/(min·1.73 m²) in 33 cases (DM1 group), and eGFR<60 ml/(min·1.73 m²) in 16 cases (DM2 group). In addition, 30 healthy people in the same period were selected as control group (NC group), eGFR ≥ 90 ml/(min·1.73 m²). The systolic blood pressure, diastolic blood pressure, blood routine, glycosylated hemoglobin (HbA₁c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), urea nitrogen, creatinine and uric acid were recorded; and the NLR was calculated. The influencing factors of eGFR in patients with type 2 diabetic mellitus were analyzed, and the relationship between NLR and eGFR was evaluated. Results: Compared with that in NC group and DM0 group, the eGFR in DM1 group and DM2 group was significantly lower: (75.12 ± 8.14) and (46.31 ± 13.25) ml/(min·1.73 m²) vs. (114.17 ± 12.21) and (113.21 ± 12.04) ml/(min·1.73 m²), the NLR was significantly higher: 2.50 ± 1.16 and 2.75 ± 1.39 vs. 1.53 ± 0.22 and 1.83 ± 0.65, and there were statistical differences (P<0.05). Compared with that in DM1 group, the eGFR in DM2 group was significantly lower, the NLR was significantly higher, and there were statistical differences (P<0.05). There were no statistical differences in NLR and eGFR between DM0 group and NC group (P>0.05). Correlation analysis result showed that NLR, age, course of disease, systolic blood pressure, TC, HDL-C, urea nitrogen, creatinine and uric acid were negatively correlated with eGFR (r=-0.415, -0.555, -0.491, -0.432, -0.259, -0.237, -0.584, -0.840 and -0.261; P < 0.05); gender, diastolic pressure, HbA₁c, TG and LDL-C were not correlated with eGFR (P > 0.05). Multiple linear regression analysis result showed that NLR, age, TC, creatinine and systolic blood pressure were independent risk factors of eGFR in patients with type 2 diabetes mellitus (P<0.01 or < 0.05). Conclusions There is a close relationship between the increase of NLR and the decrease of eGFR in patients with type 2 diabetes mellitus. Monitoring NLR is helpful to understand the changes of eGFR in patients with type 2 diabetes mellitus.

Objective: To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis. Methods: The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results: Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×10⁴ yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×10⁴ yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P<0.05). (3) Postoperative complications: 1 of 30 patients in the observation group had postoperative biliary leakage, with a postoperative complication rate of 3.3%, and was cured after symptomatic support treatment. Six of 22 patients in the control group had postoperative complication, with a postoperative complication rate of 27.3%, including 2 of biliary leakage, 1 of hemorrhage, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, and they were cured after symptomatic support treatment. There was a significant difference between the two groups (χ²=4.358, P<0.05). (4) Postoperative pain scores: from postoperative 6 hours to 48 hours, the postoperative pain score changed from 2.4±0.7 to 1.9±0.9 in the observation group, and from 4.1±0.7 to 2.9±0.9 in the control group, respectively, showing a significant difference in the changing trend between the two groups (F=78.053, P<0.05). (5) Changes in hepatic function and blood routine during perioperative period: from preoperation to postoperative 3 days, levels of alamine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), total bilirubin (TBil), and count of white blood cells in the observation group changed from (77±20)U/L to (53±12)U/L, from (85±22)U/L to (61±17)U/L, from (166±39)U/L to (55±24)U/L, from (40±13)μmol/L to (29±12)μmol/L, from (7.0±2.0)×10⁹/L to (6.8±1.9)×10⁹/L, and changed from (79±23)U/L to (62±14)U/L, from (88±24)U/L to (64±17)U/L, from (179±34)U/L to (74±29)U/L, from (45±13)μmol/L to (35±12)μmol/L, from (7.9±2.4)×10⁹/L to (7.5±1.9)×10⁹/L in the control group, respectively. The levels of ALT, AST, GGT, TBiL, and count of WBC showed increasing at postoperative 1 day, and decreasing at postoperative 3 days. There was no significant difference in the changing trend between the two groups (F=0.058, 0.471, 3.021, 1.593, 2.172, P>0.05). Conclusion ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.

Objective To evaluate the value in the diagnosis of focal nodular hyperplasia( FNH) by combining micro-flow imaging ( MFI) and color Doppler flow imaging ( CDFI) . Methods A total of 32 patients with 32 FNH lesions were enrolled in this study . Each patient underwent CDFI ,MFI ,and contrast-enhanced ultrasonography ( CEUS ) examinations . The differences in the grade and characteristic distribution of blood flow in FNH were compared between CDFI and MFI . The results were further compared with CEUS . Results There was a significant difference between MFI and CDFI in detecting the blood flow in FNH . Twenty-six cases (81 .3％ ) were detected with blood flow of grade Ⅱ and Ⅲ by MFI , however , 18 cases ( 56 .3％ ) were detected of grade Ⅱ and Ⅲ by CDFI ( P = 0 .000) . A total of 12 (37 .5％ ) lesions were correctly showed spoke-wheel arterial flow peculiar by CDFI ,whereas the number increased to 23(71 .9％ ) in combination with MFI( P = 0 .013) . Conclusions In combination with MFI , CDFI can reveal more blood flow and detect more sensitively in FNH ,which helps to diagnose FNH . To a certain degree ,it can be applied to reduce the use of CEUS .

Objective To evaluate the imaging features of hepatic epithelioid angiomyolipoma (EAML) on contrast-enhanced ultrasound (CEUS). Methods The imaging features of pathologically proved hepatic EAML lesions in 17 patients who had undergone baseline ultrasound and CEUS examinations were evaluated retrospectively. Results All of the cases were single lesion.70.6% (12/17) of the lesions were hypoechoic on ultrasound and 82.4% (14/17) of the lesions were heterogeneous.Flow signals were detected in 88.2% (15/17) of the lesions and 82.4% (14/17) of the lesions showed ringlike or arc arterials peripherally on color Doppler flow imaging (CDFI).The value of RI was 0.38-0.56.On CEUS,all lesions exhibited remarkable hyperenhancement in the arterial phase. 29.4% (5/17) of the lesions showed branched enhancement,70.6% (12/17) of the lesions showed diffusely entire enhancement.Strong ring-like enhancement peripherally was detected in 29.4% (5/17) of the lesions.88.2% (15/17) of the lesions were detected homogeneously enhancement during the peak period on CEUS. Washout of contrast agent and hypoechogenicity to surrounding liver tissue during portal or late phase were observed in 41.2% (7/17) and 64.7% (11/17) of the cases retrospectively.Conclusions The combination of real-time CEUS and baseline US can improve the correct diagnosis of hepatic EAML.

Objective To explore the characteristics of contrast-enhanced ultrasonagraphy(CEUS) of sarcomatoid hepatocellular carcinoma ( SHC ) . Methods Fifteen lesions identified pathologically from 15 patients were included in this study . Among them ,9 lesions had completely sarcomatoid change and 6 lesions had partially sarcomatoid change . Totally 8 lesions were in the small size group with maximum diameter＜ 50 mm and 7 lesions in the big size group with maximum diameter ≥ 50 mm . The CEUS performance was observed and analyzed . Results In the arterial phase of CEUS ,9 lesions in the group with completely sarcomatoid change showed rim hyperenhancement and 6 lesions in the group with partially sarcomatoid change showed whole hyperenhancement , the difference between the two groups was statistically significant ( P ＜ 0 .001 ) . However ,the difference of CEUS performance between small size group and big size group was not statistically significant ( P ＝ 0 .608 ) , all the lesions showed hypoechogenecity in portal and(or) late phase of CEUS . Conclusions The difference of performance on CEUS is not related to the size of SHC ,but to the degree of sarcomatoid change within the tumor . SHC with completely sarcomatoid change shows rim hyperenhancement and SHC with partially sarcomatoid change shows entire hyperenhancement in arterial phase on CEUS .