OBJECTIVE: To investigate the mechanism of self-efficacy between self-management ability and self-management behavior and its differences among patients with different disease courses through mediation tests. METHODS: In the study, 489 patients with type 2 diabetes who attended the endocrinology departments of four hospitals in Shanxi Province and Inner Mongolia Autonomous Region from July to September 2022 were enrolled as the study population. They were investigated by General Information Questionnaire, Diabetes Self-Management Scale, Chinese version of Diabetes Empowerment Simplified Scale, and Diabetes Self-Efficacy Scale. Mediation analyses were performed using the linear regression model, Sobel test, and Bootstrap test in the software Stata version 15.0 and divided the patients into different disease course groups for subgroup analysis according to whether the disease course was > 5 years. RESULTS: In this study, the score of self-management behavior in the patients with type 2 diabetes was 6.16±1.41, the score of self-management ability was 3.99±0.74, and the score of self-efficacy was 7.05±1.90. The results of the study showed that self-efficacy was positively correlated with self-management ability (r=0.33) as well as self-management behavior (r=0.47) in the patients with type 2 diabetes (P < 0.01). The mediating effect of self-efficacy accounted for 38.28% of the total effect of self-management ability on self-management behaviors and was higher in the behaviors of blood glucose monitoring (43.45%) and diet control (52.63%). The mediating effect of self-efficacy accounted for approximately 40.99% of the total effect for the patients with disease course ≤ 5 years, while for the patients with disease course > 5 years, the mediating effect accounted for 39.20% of the total effect. CONCLUSION Self-efficacy enhanced the effect of self-management ability on the behavior of the patients with type 2 diabetes, and this positive effect was more significant for the patients with shorter disease course. Targeted health education should be carried out to enhance patients' self-efficacy and self-management ability according to their disease characteristics, to stimulate their inner action, to promote the development of their self-management behaviors, and to form a more stable and long-term mechanism for disease management.
Humans ; Diabetes Mellitus, Type 2/therapy* ; Self Efficacy ; Self-Management ; Blood Glucose Self-Monitoring ; Blood Glucose ; Self Care

Objective:To compare the efficacy and safety of biologics versus methotrexate in the treatment of severe pediatric plaque psoriasis.Methods:A retrospective matched case-control study was carried out. Twenty children with severe plaque psoriasis from Beijing Children′s Hospital, Capital Medical University from June 2016 to November 2021 were included in this study, and the patients treated with biologics (adalimumab or secukinumab) were matched with those treated with methotrexate at a ratio of 1∶1 according to the psoriasis area and severity index (PASI) score and age. PASI, physician′s global assessment (PGA) , and body surface area (BSA) scores were assessed at weeks 4, 8 and 12 after the start of treatment, and adverse drug reactions were recorded. Statistical analysis was mainly carried out by using Mann-Whitney U test, Fisher′s exact test and generalized estimating equations. Results:At weeks 4 and 8, the proportions of patients achieving PASI75 and PASI90 were significantly higher in the biologics group (PASI75: 7/10, 10/10, PASI90: 5/10, 9/10, respectively) than in the methotrexate group (PASI75: 1/10, 5/10, PASI90: 0, 1/10, respectively; all P < 0.05) , while there was no significant difference between the biologics group and methotrexate group at week 12 (PASI75: 10/10 vs. 8/10, PASI90: 9/10 vs. 4/10, both P > 0.05) . There were no significant differences in the PASI, BSA or PGA scores between the two groups at baseline (all P > 0.05) , while the biologics group showed significantly decreased PASI and BSA scores at weeks 4, 8 and 12, and significantly decreased PGA score at week 8 compared with the methotrexate group (PASI: Z = 2.50, 3.56, 2.63, respectively; BSA: Z = 2.87, 3.57, 2.40, respectively; PGA: Z = 2.81; all P<0.05) . Analysis of changes over time showed that the PASI, PGA and BSA scores in the biologics group significantly decreased at weeks 4, 8 and 12 compared with those at baseline (all P<0.01) ; the PASI and PGA scores significantly decreased at weeks 8 and 12 compared with the corresponding scores at week 4 (all P<0.05) ; however, there were no significant differences in the PASI, PGA or BSA scores between week 12 and 8 (all P>0.05) . In the methotrexate group, the PASI, PGA and BSA scores at weeks 4, 8 and 12 were all significantly lower than the corresponding scores at the previous adjacent time points (all P<0.05) . There was no significant difference in the incidence of adverse reactions between the two groups ( P = 0.650) , and no serious adverse reactions occurred in either group. The main adverse reaction was infection in the biologics group, while infection and elevation of transaminase levels were common in the methotrexate group. Conclusion:Biologics and methotrexate were both effective and safe for the treatment of severe pediatricplaque psoriasis, and biologics facilitated rapider achievement of PASI75 and PASI90 compared with methotrexate.

Objective:To explore the clinical characteristics, treatment and prognosis of splenic marginal zone lymphoma.Methods:The clinical data of 51 patients with splenic marginal zone lymphoma who underwent surgical treatment at Department of Hepatobiliary in Peking University People's Hosipital from Dec 2009 to Oct 2022 were retrospectively analyzed.Results:The patients 's average age was 60.5±11.8 years old, and the ratio of male to female rate was about 1:1. As of the last follow-up date of Feb 28, 2023, 8 patients died of the primary lymphoma and 14 patients suffered from disease progression. The 5-year progression free survival rate was 68%, and the overall survival rate was 79%. Univariate analysis showed that age ≥65 years old, decreased preoperative albumin, increased bilirubin level, and increased lactate dehydrogenase bode ill for overall survival time, but none of them were independent risk factors; Age ≥65 years old and diffuse large B cell transformation were independent risk factors.Conclusions:Surgery combined with comprehensive treatment which contained rituximab is currently the main treatment method. Splenectomy remains an important treatment and diagnostic method for patients with obvious symptoms or persistent unrelieved blood count abnormalities and unexplained splenomegaly. Advanced age, elevated bilirubin and lactate dehydrogenase, decreased albumin, and diffuse large B cell transformation, it may indicate poor prognosis.

Objective:To evaluate the efficacy of Janus kinase (JAK) inhibitors in the treatment of 5 children with severe alopecia areata, especially those with complicated nail damage.Methods:A total of 5 children with severe alopecia areata were enrolled and treated with oral JAK inhibitors (tofacitinib or baricitinib). The improvement of hair loss was assessed by using the severity of alopecia tool (SALT) at 12, 24, 36, and 48 weeks after the start of treatment. For 3 children with complicated nail damage, the improvement of diseased nails and toenails was evaluated by using the modified nail psoriasis severity index after treatment. During the treatment, adverse reactions were monitored.Results:The 5 children with severe alopecia areata were aged 2 - 11 years, with the disease duration ranging from 5 to 120 months, and the treatment with JAK inhibitors lasted 24 - 48 weeks. After 12-week treatment, 2 children achieved a 50% improvement in SALT (SALT50) ; after 24-week treatment, 3 achieved SALT95, and 1 achieved SALT75 and then withdrew baricitinib for personal reasons; after 36-week treatment, 3 achieved SALT99, and then received half-dose treatment; after 48-week treatment, 1, 1, 1 and 1 patient achieved SALT99, SALT83, SALT31, and SALT0, respectively, and 2 of them experienced gradually aggravated hair loss 1 - 2 months after the start of half-dose treatment. Among the 3 children with complicated nail damage, the improvement rates of nail severity index scores were 67.5%, 45.4%, and 25% respectively, and the improvement rates of toenail severity index scores were 42.5%, 71.4%, and 5% respectively after 12-week treatment; after 48-week treatment, the improvement rate of nail severity index scores were 100%, 100%, and 50% respectively, and the improvement rate of toenail severity index scores were 96.2%, 100%, 50% respectively. During the treatment, the uric acid level increased in 2 children, and one of them was accompanied by increased serum levels of low-density lipoprotein cholesterol and high-density lipoprotein cholesterol; 1 suffered from respiratory tract infections twice during the treatment, and was recovered after symptomatic treatment; there were no adverse reactions leading to drug withdrawal.Conclusion:JAK inhibitors can be used as a treatment option for severe alopecia areata in children.

Objective:To understand the molecular epidemic characteristics and genes of human astrovirus (HAstV) in infantile diarrhea patients in Jilin province from 2017 to 2020.Methods:Fecal samples of hospitalized infants with diarrhea under 5 years of age from January 2017 to December 2020 were collected. The nucleic acids of fecal samples were amplified by reverse transcription-polymerase chain reaction (RT-PCR), the positive amplification products were sequenced, and the phylogenetic tree was constructed.Results:A total of 2 019 fecal samples were collected, of which 71 were positive for HAstV, with a positive rate of 3.5%. Among the cases with positive samples of HAstV, 42 had mixed infection with other viruses causing diarrhea, accounting for 59.2% of the total number of positive cases, half of which were mixed infection with rotavirus and HAstV. From 2017 to 2020, the positive rates of HAstV were 4.69%, 1.98%, 5.93% and 0.43% per year, respectively. There were two epidemic peaks every year and one epidemic peak year every two years. The positive rate of 36-47 months old was the highest, followed by 0-2 months old. A total of 55 sequences were obtained in this study. Phylogenetic tree analysis showed that they all belonged to classical HAstV, including 42 HAstV-1a subtypes, 8 HAstV-1b subtypes and 5 HAstV-5 subtypes.Conclusions:HAstV is one of the important pathogens of diarrhea in children under 5 years of age in Jilin province. The epidemic law has obvious seasonal and age differences. The dominant strain is HAstV-1a.

Objective:To explore the effect of behavioral training of creative art therapy(CAT) on interpersonal communication in teenagers.Methods:Eighty teenagers were randomly divided into study group( n=40) and control group( n=40).The study group was received the behavioral training of CAT (12 times, each activity lasts for 120 min), and the control group did not take part in the behavioral training of CAT.The two groups were measured with self-esteem scale(SES), shyness scale(SS) and social anxiety scale for children(SASC) before and after behavior training.SPSS 17.0 software was used for statistical analysis, and t-test variance analysis and Mann-Whitney U test were used to compare the differences between groups or within groups. Results:Before and after behavioral training, changes in the SES total score (7.00(5.00, 9.75) vs 1.00(0, 2.00)), the SS total score (7.00(6.00, 12.75) vs 2.00(1.00, 3.00)), the SASC total score (5.00(2.00, 8.75) vs 0(0, 1.00)) and two factor scores (3.00(0.25, 5.00) vs 1.00(0, 1.00), 2.00(1.00, 4.00) vs 0(0, 1.00))in the study group were obviously higher than those in the control group( Z=-7.347, -7.338, -5.841, -4.122 and -5.393, all P<0.05).The score differences of the SASC total score ((7.19±3.82) vs (3.21±3.04)) and two factor scores ((4.00±2.23) vs (1.68±2.05), 3.00 (1.00, 5.00) vs 2.00 (0, 2.00)) of girls were significantly higher than those of boys in the study group ( t=-3.611, -3.398, Z=-2.111, P=0.001, 0.002, 0.035). Conclusion:Behavioral training of CAT can improve teenagers' self-esteem, relieve their shyness and social anxiety, as well as promote their interpersonal communication.

Objective:To investigate the effect of art behavior intervention of yoga training on patients with insomnia comorbid depressive disorder.Methods:Totally 66 patients with insomnia comorbid depressive disorder were randomly divided into the study group( n=36) and the control group( n=30). All patients in two groups were given pharmacotherapy, while the patients in the study group were received art behavior intervention of yoga training for 20 times.Using self-made general information questionnaire to collect the patients' demographic and clinical characteristics.Polysomnography(PSG) was performed to measure objective sleep parameters.The Pittsburgh sleep quality index(PSQI), Hamilton depression scale(HAMD) and Hamilton anxiety scale(HAMA) were used to measure subjective sleep quality, depressive symptoms and anxiety symptoms at baseline and at the end of the interventions. Results:The score differences of pre-and post-intervention in the two group of PSQI total score((11.00±2.72) vs(9.00±2.22)), habitual sleep efficiency((2.02±0.81) vs (1.53±0.77)), daytime dysfunction((1.75±0.90) vs(0.96±0.85)), HAMD total score((12.19±6.25) vs(8.03±5.67)) and HAMA total score(13.00(8.25, 16.75) vs 7.00(5.00, 9.25))in the study group were obviously higher than those in the control group( t=3.220, 2.516, 3.595, 2.806, Z=-3.616, all P<0.05). Conclusion:Art behavior intervention of yoga training can improve sleep quality, depression and anxiety symptoms in patients with insomnia comorbid depressive disorder, which will be applied and popularized in clinical practice.

Objective: To design a record sheet of the core control measures for multi-drug resistant bacteria in ICU and apply it to clinical practice. Methods: Through consulting the guidelines and literature, we designed the ICU core control measures to execute the record sheet and applied the record sheet to patients with multiple resistant bacteria infection. The implementation rate of the core control measures of medical personnel before and after the use of the record sheet(the awareness rate of medical personnel, the awareness rate of nursing staff, the compliance rate of hand hygiene, the implementation rate of isolation medical orders, the implementation rate of isolation marks, the implementation rate of single room isolation or bedside isolation, and the exclusive implementation rate of items), qualified rate of surface disinfection of articles, qualified rate of use of antimicrobial agents and incidence of multi-drug resistant bacteria infection were compared. Results: After implementing the record sheet using the ICU multi-drug resistant bacteria core control measures, the implementation rate of medical personnel's core control measures, the conformity rate of surface disinfection of articles and the acceptance rate of antimicrobial drug use were all improved, the difference was statistically significant (χ²=2.85-432.18, P<0.05 or 0.01); incidence of multi-drug resistant bacteria infection from 15.7%(112/713) to 6.8%(51/748), the difference is statistically significant (χ²=28.22, P<0.05) . Conclusions The implementation of ICU multi-drug resistant core control measures can improve the rate of implementation of multi-drug resistant core control measures, reduce the incidence of multi-drug resistant infections, and standardize the operation of medical personnel against multiple drug resistant bacteria. The application of ICU multi-drug-resistant core control measures to the management of nosocomial infections in patients with multiple drug-resistant bacteria will help improve the quality of care and ensure the safety of patients.

Objective: To investigate the effect of enteral nutrition feeding procedure in ICU in severe patients in order to reduce complications and promote rehabilitation of patients. Methods: A total of 184 severe patients admitted to ICU from January to October 2018 were selected as the subjects of the study. 90 patients admitted to the family from January to May were the control group, and 94 patients admitted to the family from June to October were the observation group. The control group adopted routine nutritional support and nursing, and the observation group carried out intensive enteral nutrition feeding process. The nutritional status, immunity, gastrointestinal dysfunction, complications of nosocomial infection and outcome of patients in two groups were compared between the two groups. Results: The nutritional indicators of hemoglobin, serum total protein and serum albumin after a week of treatment were (119.73 ± 9.96), (58.88 ± 2.65), (29.09 ± 1.42) g/L, immunization indicators IgA, IgG, IgM were (2.56±0.10), (2.98±0.36), (1.65±0.15) g/L in the observation group. The control groups were (108.02±9.21), (51.90±2.74), (27.80±1.59), (2.09±0.18), (2.01±0.24), (1.41±0.13)g/L, the difference between the two groups was statistically significant (t=5.81-22.48, P<0.01). The incidence of gastrointestinal dysfunction (gastric retention, diarrhea) in the observation group were 11.70%(11/94), 8.51%(8/94), the incidence of nosocomial infections (ventilator associated pneumonia, catheter related blood stream infection, catheter-associated urinary tract infections) were 6.12‰(5/817), 1.53‰(1/650), 0, the outcome indicators of patients (nutritional standard time, ICU hospitalization time, and mortality rate) were (6.12±1.03) d, (10.98±2.03) d, 13.82%(13/94), all were lower than the control group′s 23.33%(21/90), 20.00%(18/90), 13.06‰(11/842), 11.28‰(8/709), 2.88 ‰(2/694), (7.98 ± 1.54) d, (12.21 ± 1.87) d, 26.67%(24/90), the difference between the two groups was statistically significant (χ²=4.33-8.22, t=6.19, 2.26, P<0.05). Conclusions The procedure of enteral nutrition feeding in patients with severe illness can effectively reduce enteral nutrition complications and enable patients to obtain effective nutrition early.

Objective To study the clinical efficacy of Bushen Huoxue decoction in the treatment of varicocele infertility and its influence on epididymis function and sperm vitality. Methods A total of 98 patients with varicocele infertility who were treated in our hospital from August 2016 to July 2018 were selected. The patients were randomly divided into control group of 49 cases and study group of 49 cases. The patients in the control group were treated with Maizhiling plus Wuzi Yanzong pill; the patients in the study group were treated with Bushen Huoxue decoction. After 12 weeks of treatment, the clinical efficacy of the patients was evaluated. The semen quality (including semen volume, sperm density, sperm motility, forward-moving sperm), sex hormones, and seminal plasma neutral α-glucosidase in the two groups were compared before and after treatment. After the end of treatment, the patients were followed up for 3 months to observe the pregnancy of the patients' spouse. Results After treatment, the total effective rate of the study group was87.76％, and the total effective rate of the control group was 69.39％. The semen quality, sex hormone and neutral α-glucosidase levels in the study group were better than those in the control group (P<0.05). Conclusion Bushen Huoxue decoction has a significant clinical effect in treating varicocele infertility. It can improve the semen quality, improve testosterone level and seminal plasma neutral α-glucosidase level, and improve the fertility of patients with varicocele.It is worthy of clinical promotion.