Objective:To explore the implementation effect of type 2 diabetes mellitus (T2DM) management pathway in a primary hospital, and analyze its influencing factors.Methods:Henan Provincial People's Hospital instructed Zhengzhou Beixia Street Community Health Service Center to implement the conventional T2DM management model from January to December 2019, and to implement the T2DM management pathway from January to December 2020. The implementation effect of the T2DM management pathway was observed. A total of 220 cases of T2DM patients after the implementation were set as the good group and the poor group according to the effect of the pathway management. Logistic regression was used to analyze the influencing factors of the implementation effect of T2DM management pathway.Results:Before the implementation, hospitalization time, hospitalization expenses, incidence of adverse nursing events, patient satisfaction, and good compliance rate of medication, diet, exercise, and blood glucose self-monitoring were (15.39±2.14) d, (4 256.87±536.14) yuan, 12.27% (27/220) , 81.82% (180/220) , 60.45% (133/220) , 69.55% (153/220) , 56.36% (124/220) , 54.55% (120/220) , respectively, and after the implementation were (12.20±2.82) d, (3 158.62±425.16) yuan, 6.36% (14/220) , 91.36% (201/220) , 72.27% (159/220) , 81.82% (180/220) , 73.18% (161 /220) , 78.18% (172/220) , respectively. After the implementation, the hospitalization time of the patients was shorter than that before the implementation, and the hospitalization expenses and the incidence of adverse nursing events were lower than those before the implementation, and the good compliance rate of medication, diet, exercise and blood glucose self-monitoring and patient satisfaction were higher than those before implementation, and the differences were statistical ( P<0.05) . Logistic regression showed that smoking, the course of T2DM, and the irregular pathway management were all factors that affected the implementation effect of the T2DM management pathway ( P<0.05) . Conclusions:The implementation of T2DM pathway management in primary hospitals can achieve obvious effects. Smoking, the course of T2DM, and irregular pathway management are all factors that affect its implementation effect.

A sensitive, fast and comprehensive method for the quality assessment of Semen Ziziphi Spinosae (SZS) standard decoction with characterization of its chemical components was developed and validated. UPLC-Q/TOF-MS/MS system was used to identify thirty-six chemical components of SZS standard de-coction which included nucleosides, phenolic acids, alkaloids, and flavonoids. Furthermore, a UPLC-PDA method was validated to simultaneously determine adenosine, protocatechuic acid, magnoflorine, ca-techin, protocatechin, vicenin II, spinosin, kaempferol-3-rutinoside, and 6'''-feruloylspinosin which re-present four species of characteristic compounds. The qualitative method had been validated according to Chinese Pharmacopoeia (2015 edition) in terms of lineary, repeatability, recovery and stability for all analytes, with the results showing good precision, accuracy and stability. In conclusion, the method using UPLC combined with MS and PDA provided a novel way for the standardization and identification of SZS standard decoction, and also offered a basis for qualitative analysis and quality assessment of the pre-parations for SZS standard decoction.

Objective ToevaluatethevalueofMRDKIandDWIindiagnosingendometrialcarcinomaandevaluatingitspathologicalgrade. Methods TheDKIandDWIdataof48patientswithendometrialcarcinomaand27patientswithnormalendometrium wereanalyzed retrospectively.Thevaluesofmeankurtosis (MK),meandiffusion (MD)andADCinendometrialcarcinomaandnormalendometrium were measuredrespectively.Thesimilaritiesanddifferencesoftheparametersbetweentheendometrialnormalgroup(G0)andtheendometrialcarcinoma group (G1,G2,G3)werecomparedandanalyzed.TheROCcurvewasemployedtoevaluatethediagnosticefficacyandthresholdof eachparameter.P earson correlation wasappliedtoanalyzethecorrelationbetweeneachparametervalueandpathologicalgrade.Results The MK valuesincreasedgradually,meanwhiletheMDandADCvaluesdecreasedgraduallyinG0,G1,G2andG3groups.ExceptforMDand ADCvaluesbetweenG0andG1groups,othervalueswerestatisticallysignificantdifferent(P<0.05)betweendifferentgroups.In differentiatingoftheG0/(G1+G2+G3),G0/G1,G1/G2,G2/G3,theMKvalueshadthehighestdiagnosticefficacy(AUC=09.2,07.6,09.0,0.96, P<0 .05 ).M oreover ,in the correlation of pathological grading ,M K>M D>A D C (r=0 .850 ,0 .781 ,0 .709 ,P<0 .05 ).Conclusion Both DKIandDWIcandiagnoseandevaluatepathologicalgradeofendometrialcarcinoma.ComparedwithDWI,DKIembracesmoreperfectmathematical modelandmoresensitiveparameters,andcanbeusedasaneffectivemethodtoevaluatethepathophysiologicalfeaturesofendometrialcarcinoma.

Objective To study the mechanism of brain death-induced heart damage by observing the change patterns of morphological damage to the heart and related inflammatory factors after brain death and provide the experimental basis for heart transplantation by brain-dead donor.Methods The 30 rabbits were equally divided into two groups by the random digital table method:sham-operation group and brain death group.The rabbit brain death model was established in the brain death group,and the sham-operation group was given slow intracranial pressure.The rest treatments in the two groups were the same.At 2nd,6th and 8th h after operation,blood pressure,heart rate and respiratory rate were recorded.The damage of heart tissues was observed by HE staining.The plasma concentrations of IL-1,IL-6 and IL-8 were tested by ELISA.The expression of some inflammatory factors in heart issues was detected by RT-PCR and immunohistochemistry.Results At 8 h after brain death,there was no signifiant difference in blood pressure and heart rate between two groups (P＞0.05).The damage of heart issues in the brain death group was more serious than in the shamoperation group.With the prolongation of brain death,the plasma concentrations of IL-6 and IL-8 increased significantly in the brain death group (P＜0.05),but the concentration of IL-1β showed no siginificant difference between the two groups at 2 h after brain death (P＜0.05).Besides,the expression of HSP27 and HSP70 mRNA as well as the protein expression of ICAM and NF-κB was significantly increased in the brain death group as compared with that in the sham-operation group (P＜0.05).Conclusion With the prolongation of brain death time,the inflammatory factors in the heart tissues and plasma interleukin were increased,suggesting the inflammatory reaction occurs in donor heart under the condition of brain death,which influences the quality of donor in the heart transplantation.

Objective To investigate the feasibility of multiple model parameters of intravoxel incoherent motion (IVIM) in differential diagnosis of cervical carcinoma and its pathological types.Methods IVIM images of 33 patients with cervical cancer (cervical cancer group) and 30 patients with normal cervix (normal group) were retrospectively analyzed.The monoexponential model parameters (ADC-stand),biexponential model parameters (ADC-slow,ADC-fast,f) and stretched-exponential model values (distributed diffusion coefficient [DDC],α) were measured,respectively.Then the parameters were compared among the two groups,as well as among different pathological types and different pathological grades of cervical cancer.The thresholds and diagnostic efficiency of the parameter values were evaluated with ROC curve.Results ADC-stand,ADC-slow,f,DDC and α values of cervical cancer group were lower than those of normal group (all P＜0.05).The area under the ROC curve of ADC-stand,ADC-slow,DDC,f and a values in diagnosis of cervical cancer was 0.93,0.94,0.96,0.94 and 0.93 (all P＜0.05),and the diagnostic thresholds were 1.03 × 10-3 mm2/s,0.99 × 10-3mm2/s,30.50％,1.21 × 10-3 mm2/s and 0.699,respectively.ADC-stand,ADC-slow and DDC values in cervical squamous cell carcinoma patients were lower than those of cervical adenocarcinoma patients (all P＜0.05).The area under the ROC curve of ADC-stand,ADC-slow and DDC values in differential diagnosis of cervical squamous cell carcinoma and cervical adenocarcinoma was 0.98,0.91 and 0.98 (all P＜0.05),the diagnostic thresholds were 1.11 × 10-3 mm2/s,0.81×10-3 mm2/s and 0.98 × 10-3 mm2/s,respectively.There was no significant difference of the parameters among high,moderate,low differentiation of cervical squamous cell carcinoma.Conclusion Multiple model parameters of IVIM can quantitatively reflect the histological features of cervical cancer.

Objective: To evaluate the effectiveness and safety of the use of noninvasive high-frequency oscillation ventilation (nHFOV) in very low birth weight infants. Method: A total of 36 cases received nHFOV between January 2016 and October 2016 in Children′s Hospital, Zhejiang University School of Medicine, including 24 males and 12 females, with the gestational age of (27.5±2.5) weeks and birth weight of(980±318)g. The data of the ventilator settings, side effects, and changes of the respiratory function before and after nHFOV were collected and analyzed retrospectively. Nonparametric tests or t tests or χ² tests were used. Result: Thirty-two (89%) out of the 36 cases successfully avoided intubation or re-intubation after using of nHFOV. nHFOV was used as the rescue treatment after failure of other noninvasive ventilation in 17 cases, and as the prophylactical treatment preventing re-intubation after extubation in the remaining 19 cases. There were significant decreases in the incidences of apnea and desaturation(SpO₂<0.85), the level of PaCO₂, and the FiO₂ 24 h after the initiation of the nHFOV as the rescue therapy((1.2±1.1)vs.(6.3±2.1)episodes , (1.1±1.2) vs.(4.3±1.5) episodes, (43±8) vs.(56±10) mmHg, 0.30±0.07 vs. 0.39±0.11, respectively; 1 mmHg=0.133 kPa, t=7.562, 8.913, 4.179, 3.437 respectively, all P<0.01). No significant changes were found in FiO₂ and PaCO₂ levels 24 h after initiation of nHFOV as the prophylactical therapy after extubation (0.42±0.12 vs.0.40±0.10, (49±8)vs.(48±7)mmHg, t=0.872 and 0.501 respectively, both P>0.05), except for the significant decreases in the mean airway pressure ((7.9±2.6)vs.(9.6±1.6)cmH₂O, 1 cmH₂0=0.098 kPa, t=2.198, P=0.041). There were 4 cases suffered from nasal septum injury, while no other nHFOV related complications were noted. Conclusion nHFOV can be applied in preterm infants as a rescue treatment after the failure of other noninvasive ventilation, or prophylactically used in patients who have high risk of re-intubation.

Regulating phase Ⅰ and Ⅱ enzyme,drug transporters and constitutive androstane receptor (CAR) play an important role in dug metabolism and keeping balance on the levels of glucose,lipids and hormone in serum.As a hub of material metabolism within body,CAR can affect the efficacy of various drugs and be involved in many common metabolic diseases.Studying its polymorphism is referential for explaining the individual difference genetically and predicting the occurrence and development of diseases.This review focuses on the correlation between the CAR polymorphism and metabolic,which provides evidence for predicting the development of disease and choosing clinical drug dosage.

Neuromyelitis optica spectrum disorder (NMOSD) is a kind of immune mediated inflammatory demyelinating disease of the central nervous system manifesting with optic neuritis and acute transverse myelitis,which takes a relapsing or progression course.The exact etiology and pathogenesis are not clear.There are a lot of researches on immune pathogenesis;in addition,the pathogenesis also involves genetic,environmental,oxidative stress and other factors.

Objective To compare the differences of electrical activity in calf muscle of children with growing pains from normal children when standing and heel raising. Methods 32 children with growing pains and foot pronation were as growing pains group, and 32 normal children as control group. All the children were measure with surface electromyography (sEMG) of tibialis anterior, peroneus longus, medial gastrocnemius and tibialis posterior when standing and heel raising. Results The root mean square (RMS) of peroneus longus increased significantly in growing pains group when standing (P<0.01). The RMS decreased significantly in medial gastrocnemius (P<0.05) and increased significantly in tibialis posterior (P<0.01) when heel raising. Conclusion The characteristics of electrical activity in calf muscle is difference from the normal in the growing pains children with foot pronation during standing and heel raising.

Objective To explore the parallel validity of Alberta infant motor scale (AIMS) and Peabody developmental motor scale-2 (PDMS-2) in assessing motor function of high risk infants. Methods 60 high risk infants, aged from 1 month to 9 months, were assessed by both the AIMS and PDMS-2. The total scores of AIMS and the total original scores of PDMS-2 gross motor scale (GMS) were compared by the Spearman's analysis. The AIMS's percentage and PDMS-2 gross motor quotient (GMQ) were compared with qualitative analysis by Kappa value. The examination time of the two scales was also compared. Results The correlation coefficient of the total scores of AIMS and the original scores of GMS was 0.91 (P<0.001). The correlation coefficient of AIMS's percentage and GMQ was 0.6. The mean time of AIMS was (10.47±3.63) min, and that of PDMS-2 was (26.5±7.77) min for examination (t=28.895, P<0.001). Conclusion AIMS and PDMS-2 are in a high level of consistency when assessing the motor function of 1-month-old to 9-month-old high risk infants.