Peripheral arterial disease is one of the common complications of diabetes. At present, the pathogenesis of diabetic peripheral arterial diseases is not completely clear, and there is a lack of effective treatment methods and drugs. Adipokines have profound impact on the occurrence and development of diabetes mellitus and its complications, and are directly or indirectly involved in the progression of diabetic peripheral arterial diseases. Different adipokines may inhibit or promote the occurrence of vascular diseases with the mechanisms that are complex and controversial. Adipokines are expected to be a new target for the treatment of diabetic peripheral arterial disease, which is worthy of further study. This article mainly reviews the relationship between some common adipokines and new adipokines and diabetic vascular disease, aiming to provide new methods for the clinical treatment of diabetic peripheral arterial disease.

Ischemia-reperfusion (I / R) is a complex hemodynamic process that can cause tissue damage through oxidative stress, mitochondrial dysfunction, and inflammatory reactions. It is an important factor leading to poor prognosis in patients, and the exploration of effective prevention and treatment measures is of significant clinical significance. As an endogenous hormone with strong antioxidant and anti-inflammatory properties, Melatonin plays an important role in reducing cell death and improving tissue I / R injury. Therefore, this article reviews the relationship between Melatonin and organ I/R injury in order to provide a theoretical basis for the clinical application of melatonin to alleviate organ I/R injury.

The aim of this study was to evaluate the roles of interleukin (IL)-17A in risk stratification and prognosis of patients with sepsis-associated acute kidney injury (SAKI). Methods: We enrolled 146 sepsis patients (84 non-SAKI and 62 SAKI patients) admitted to the emergency department from November 2020 to November 2021. Patients with SAKI were differentiated based on the severity of acute kidney injury. All clinical parameters were evaluated upon admission before administering antibiotic treatment. Inflammatory cytokines were assessed using flow cytometry and the Pylon 3D automated immunoassay system (ET Healthcare). In addition, a receiver operating characteristic (ROC) curve was utilized to determine the prognostic values of IL-17A in SAKI. Results: The levels of creatinine, IL-2, IL-4, IL-6, IL-17A, tumor necrosis factor alpha, C-reactive protein, and procalcitonin (PCT) were significantly higher in the SAKI group than in the non-SAKI group (p < 0.05). The level of IL-17A revealed significant differences among stages 1, 2, and 3 in SAKI patients (p < 0.05). The mean levels of PCT, IL-4, and IL-17A were significantly higher in the non-survival group than in the survival group in SAKI patients (p < 0.05). In addition, the area under the ROC curve of IL-17A was 0.811. Moreover, the IL-17A cutoff for differentiating survivors from non-survivors was 4.7 pg/mL, of which the sensitivity and specificity were 77.4% and 71.0%, respectively. Conclusion: Elevated levels of IL-17A could predict that SAKI patients are significantly prone to worsening kidney injury with higher mortality. The usefulness of IL-17A in treating SAKI requires further research.

This paper reviewed the research on moral injury among foreign medical staff in the background of the COVID -19 pandemic. It was found that foreign medical staff bore multiple moral pressures and impacts in the face of the epidemic, including the collision between medical practice and utilitarian policy, the inability to meet personal needs, the rapid transformation of medical mode, and a variety of comprehensive factors. Therefore, the moral injury of foreign medical staff is particularly prominent. In order to avoid and reduce the occurrence of moral injury, it is necessary to strengthen the cultivation of moral resilience, provide psychological and social support, and carry out personalized treatment for medical staff.

Objective To investigate the value of flexi-rigid thoracoscopy in pleural effusion of unknown causes and the correlation with CEA, TK1 and ADA. Methods The clinical data and results of CEA, TK1 and ADA of 25 patients were retrospective analyzed in our department from 2015 January to November 2015. These patients accepted the examination of flexi-rigid thoracoscopy with pleural effusion of unknown causes. Results In the 25 patients with pleural effusion of unknown causes, definite diagnosis was made in 22 cases (88.00 %), of which 9 cases were malignant pleural effusion (36.00 %), 11 cases were tuberculous pleural effusion (44.00 %), 2 cases were inflammatory pleural effusion (8.00 %), 3 cases were undetermined (12.00 %). The positive rate of TK1 and CEA in malignant group was significantly higher than that in the tuberculosis group and inflammatory group, the positive rate of ADA in the tuberculosis group was significantly higher than that in the malignant group and inflammatory group. Conclusion Flexi-rigid medical thoracoscopy examination is an effective and safe method for diagnosis of unexplained pleural effusion with high exact diagnosis rate, less trauma and less complication. Combination with CEA, TK1 and ADA are helpful to improve diagnostic rate of pleural effusion of unknown causes.

Objective: To determine the pharmacokinetics of ephedrine hydrochloride in rats after intragastric administration of Shegan mixtures. Methods:Shegan mixtures (1. 0 ml/100 g) were administered to each rat by gavage. Blood samples were collected after the administration. Plasma concentration of ephedrine hydrochloride was determined by LC-MS/MS. The pharmacokinetic parame-ters of ephedrine hydrochloride were obtained using the pharmacokinetic software. Urine and fecal samples were collected in 24 hours after the administration using metabolic cage to determine the recovery of ephedrine hydrochloride. Results: The pharmacokinetic pa-rameters of ephedrine hydrochloride were as follows:Tmax of (1. 30 ± 0. 23)h,T1/2 of (21. 17 ± 1. 35)h, Cmax of (278. 86 ± 46. 41)ng ·ml-1,AUC0~∞ of (1221.98 ±412.64)ng·ml-1 and Vc/F of (1.70 ±0.15)L. Totally 85.66% ephedrine hydrochloride could be recovered from urine in 24 hours after the administration;however, it was not detected in the fecal samples. Conclusion: Most of e-phedrine hydrochloride is excreted through kidney in 24h,therefore, Shegan mixtures can't cause the accumulation of ephedrine hydro-chloride in rats.

Objective To investigate the effect of paroxetine in the adjuvant treatment of maintenance hemodialysis(MHD)com-plicating depression.Methods 60 patients with MHD complicating depression were randomly divided into the control group and the observation group,30 cases in each group.The control group received the routine therapeutical scheme(hemodialysis,complication treatment and correcting the renal anemia,etc).On the basis of the routine therapy the observation group was given oral paroxetine 10 mg/d,once daily for continuous 8 weeks.The depression level was assessed by the Hamilton depression scale(HAMD).The clinical symptoms,levels of Hb,ALB,Kt/V,iPTH,SF and HAMD scores were statistically analyzed and compared between the two groups.Results The clinical symptoms,levels of Hb,ALB,Kt/V after 8-week treatment in the two groups were significantly im-proved compared with pretherapy(P<0.05);the level of iPTH,SF and the HAMD scores in the two groups were decreased com-pared with pretherapy(P<0.05).The effective rate of depression was 86.67% in the observation group and 23.33% in the control group,the difference between the two groups had statistical significance(P<0.05).Conclusion Paroxetine in the assisted treat-ment of MHD complicating depression symptom can improve the quality of life in MHD patients.

ObjectiveTo explore the relationship between sleep quality and glucose level,diabetic complications in elderly type 2 diabetes mellitus.Methods A total of 130 hospitalized elderly type 2 diabetes in our hospital were included in the study. Questionnaires and other related clinical data were collected within one week after admission.Patients were divided into two groups:poor-sleeper group and good-sleeper group according to Pittsburgh Sleep Quality Index(PSQI).ResultsSixty percent (78/130) of these patients were poor sleepers. The following parameters differed in the two groups:the duration of diabetes [ (7.9 ± 1.8 ) years vs ( 7.2 ± 1.5 ) years,t =2.318 ],systolic blood pressure [ ( 148 ± 30 ) mm Hg ( 1 mm Hg =0.133 kPa) vs ( 138 ± 23 ) mm Hg,t =2.037 ],fasting plasma glucose (FPG) [ ( 10.7 ± 2.2) mmol/Lvs ( 9.8±1.9)mmol/L,t =2.410],hemoglobin A1c (HbA1c) [(8.6 ±2.2)％ vs (7.8±2.1 ) ％,t =2.068],high-sensitive C-reactive protein (hs-CRP) [ (5.27 ± 2.34) mg/L vs (4.44 ± 1.76)mg/L,t =2.179 ],ratio of diabetic complications ( 61％ vs 32％,x2 ＝ 4.257 ),percentage of depression ( 20％ vs 8％,x2 =3.722 ),score of life quality [ ( 98 ± 19 ) scores vs ( 89 ± 13 ) scores,t ＝ 2.980 ],and proportion of patients treated with insulin (32％ vs 12％,x2 =4.489). All the above parameters were significantly higher in poor-sleeper group than the good-sleeper group (all P value＜ 0.05 ). Multiple correlation analysis showed that the factors affecting sleep quality were FPG,HbA1c,duration of diabetes,diabetic complications,depression,life quality and insulin application (r =0.213,0.257,0.223,0.335,0.422,0.3451,0.231,respectively ; all P value ＜ 0.05 ).By multivariate logistic regression analysis,the followings were found:FPG (β =1.29,P ＜ 0.05 ) and PSQI (β =1.07,P ＜ 0.05 ) were found to be correlated with HbA1c.With increasing of PSQI,FPG,HbA1c,diabetic complications and life quality were changed significantly( all P value ＜ 0.05 ).The indcpcndcnt risk factors of diabetic complications were duration of diabetes ( OR ＝ 1.32,95％ CI 1.01-2.01 ),HbA1c ( OR =2.01,95％ CI 1.63-2.67 ),hs-CRP( OR =1.12,95％ CI 1.08-1.21 ) and PSQI ( OR =1.71,95％ CI 1.58-2.02).ConclusionsElderly type 2 diabetes mellitus are usually poor sleepers. Sleep quality probably affects blood glucoseregulation, and is closely correlated with the occurrence of complications.In addition,poor sleep quality results in poor life quality.

Ninty-eight patients with newly diagnosed type 2 diabetes mellitus were divided into atherosclerosis(AS) group and non-AS group.Fasting plasma cystatin C level( CysC ) was determined.The results showed that there existed a significant correlation between CysC level and the number of carotid arteries plaque ( r =0.432,P＜0.01 ).CysC was an independent risk factor( OR =2.21,95％ CI 1.88-3.02 ) of carotid artery intimamedia thickening in patients with type 2 diabetes.

Objective To explore the predictive value of cholinesterase (ChE) in the prognosis of gerontal patients with systemic inflammatory response syndrome. Methods The clinical data of 124 elderly patients with systemic inflammatory response syndrome collected from September 2009 through September 2010 were retrospectively analyzed. All patients were divided into death group and survival group according to the outcome of patients. The cholinesterase ( ChE), albumin, D-Dime, lactic acid and C-reactive protein (CRP) were detected, and the APACHE Ⅱ and GCS scores were documented in the first 24 hours in the ICU. Results There were no significant differences in age, gender, APACHE Ⅱ score and GCS score of patients between death group and survival group ( all P ＞ 0. 05 ), but there were significant differences in lactic acid, D-Dime, albumin, CRP and ChE between two groups ( theP values were 0.011,0.011, 0. 007,0. 008, 0. 000, respectively) . The results of multiple factors regression analysis showed that age, gender,lactic acid, D-Dime, albumin, CRP, APACHE Ⅱ score, and GCS score were not the independent risk factors of prognosis of gerontal patients with SIRS ( the P = 0. 401, 0. 165, 0. 446, 0. 841,0. 615, 0. 120,0. 502, 0. 184, respectively) except ChE ( P = 0. 000) . The receiver operating characteristic curve (ROC) of ChE in the gerontal patients with SIRS showed the area under curve (AUC) = 0.797, SE =0.04, P=0. 000, and the ChE = 103.00 U/L could be a diagnosis point with sensitivity = 0.793, 1-specificity = 0. 258. The correlation analysis showed that the APACHE Ⅱ score, CRP, and albumin were poorly correlated with ChE ( Kendall coefficients were 0. 061, 0. 231, and -0. 090, and theP = 0. 161,0. 000, and 0. 069, respectively ) . Conclusions ChE maybe played a important role in the gerontal patients with SIRS, and could be a predictive index for the prognosis of gerontal patients with systemic inflammatory response syndrome.