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Objective:To investigate the status of hypoglycemia fear, diabetes distress, self-regulatory fatigue and self-management in type 2 diabetes patients. The chain mediating effects of self-regulated fatigue and psychological distress on hypoglycemic fear and self-management were investigated.Methods:The Hypoglycemia Fear Survey-Worry Subscale (CHFSII-WS), Diabetes Distress Scale (DDS), Self-Regulatory Fatigue Scale (SRF-S) and Summary of Diabetes Self-Care Activities (SDSCA) were used to investigate the type 2 diabetes patients from the department of Endocrinology of the First Affiliated Hospital in Jinzhou Medical University. And constructed the structural equation model.Results:The scores of fear of hypoglycemia in type 2 diabetes patients were positively correlated with psychological pain and self-regulating fatigue ( r=0.739, 0.625, P<0.05), but negatively correlated with self-management level ( r=-0.602, P<0.05). The psychological pain score was positively correlated with the self-regulating fatigue score ( r=0.669, P<0.05) and negatively correlated with the self-management level score ( r=-0.609, P<0.05). The score of self-regulation fatigue was negatively correlated with the score of self-management ( r=-0.596, P<0.05). Pathway analysis showed that hypoglycemia fear could directly affect self-management behavior, indirectly predict self-management level through self-regulation fatigue and psychological pain respectively, and negatively affect self-management behavior through chain mediation of self-regulation fatigue and psychological pain ( χ2/ df=3.079, GFI=0.920, CFI=0.961, NFI=0.943, IFI=0.961, RMSEA=0.078). Conclusions:The Self-regulated fatigue and psychological distress acts as the chain mediators of hypoglycemic fear and self-management in patients with type 2 diabetes.
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Objective To evaluate an effective and feasible quantitative evaluation table of traditional Chinese medicine (TCM) syndrome differentiation, and to observe the effect of combination of TCM syndrome differentiation and standard bundle therapy in patients with septic shock. Methods A prospective randomized controlled trial was conducted. The septic shock patients with acute deficiency syndrome admitted to department of critical care medicine of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1st, 2016 to December 31st, 2017 were enrolled. The patients were randomly divided into control group and Shenfu group. The patients in both groups received early application of standardized bundle therapy; those in Shenfu group received 60 mL Shenfu injection infusion in addition for 7 days. The TCM syndrome score was evaluated by classification and scoring method of TCM symptoms. The circulation and tissue perfusion, severity of disease, organ function, inflammation response, adjuvant treatment and 28-day mortality were compared between the two groups. Results A total of 50 patients with septic shock were enrolled in the analysis, 25 in control group and 25 in Shenfu group. The markedly effective rate of TCM symptoms score in Shenfu group was significantly higher than that in control group [60.0% (15/25) vs. 16.0% (4/25), P < 0.01]. There was no significant difference in all parameters before treatment between the two groups. After treatment, the observation indexes of both groups were improved. Compared with control group, the mean arterial pressure (MAP) in Shenfu group increased more significantly [mmHg (1 mmHg = 0.133 kPa): 13.0 (2.5, 28.5) vs. 6.0 (0, 13.5)], the lactate (Lac) and procalcitonin (PCT) decreased more significantly [Lac (mmol/L): 0.8 (0.1, 3.7) vs. 0.5 (-0.6, 1.7), PCT (μg/L): 2.0 (0.7, 32.3) vs. 0 (-1.8, 3.8)], activated partial thromboplastin time (APTT) was shortened more significantly [s: 8.5 (0, 12.9) vs. 0 (-7.2, 10.0)], and interleukins (IL-2 receptor and IL-6) levels decreased more significantly [IL-2 receptor (ng/L):1 031.0 (533.0, 1 840.0) vs. 525.5 (186.0, 1 166.8), IL-6 (ng/L): 153.1 (21.4, 406.8) vs. 35.1 (16.3, 110.1)] with significant differences (all P < 0.05). There was no significant difference in the use time of vasoactive drugs, duration of mechanical ventilation, severity of the disease or 28-day mortality between the two groups. However, the use time of vasoactive drugs in Shenfu group was shorter than that in control group (days: 5.48±4.81 vs. 8.28±7.83), and the 28-day mortality was decreased [8.0% (2/25) vs. 20.0% (5/25)]. Conclusions TCM syndrome score is helpful to evaluate the effect of TCM syndrome differentiation and treatment, and it is effective and feasible in clinical application. Septic shock patients treated with TCM syndrome differentiation and treatment combined with standard bundle therapy were significantly improved in circulation, tissue perfusion, coagulation function and inflammation reaction.
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Objective@#To study the association between the AKAP12 promoter methylation and recurrence of hepatocellular carcinoma.@*Methods@#A total of 142 primary liver cancer patients underwent surgery in department of Hepatobiliary surgery in Peking University Cancer Hospital from 2003 to 2009 were selected as subjects in the survey; with the inclusion criteria as hepatocellular carcinoma, no cancer cells were observed in the surgical margin(SM) samples. All patients had neither lymph nor distant metastasis at the time of surgery, and receiving complete follow-up data for at least 3 years. By the end of May 2014, a total of 75 patients had relapsed of whom 71 died and there were no lost. All samples were acquired from the frozen surgical tissues. Genomic DNA was extracted using phenol/chloroform method and performed bisulfite modification following with polymerase chain reaction (PCR). AKAP12 methylation in hepatoma and the corresponding SM samples from 142 patients was determined by denature high-performance liquid chromatography (DHPLC) and bisulfite clone sequencing. Kaplan-Meier and Cox proportion hazard regression model were used to identify the factors related to the survival time.@*Results@#In 142 cases, 125 patients (88.0%) were male and 17 (12.0%) cases were female. The median age was 52.5 years, ranging from 34 years to 76 years. AKAP12 methylation-positive rate was significantly higher in hepatomas than SMs (54.9% vs. 10.2%, P<0.001). Patients with AKAP12 methylation-positive had less risk of the recurrence (HR=0.62, 95%CI: 0.39-0.99); with tumor diameter more than 5 cm (HR=1.53, 95%CI: 1.00-2.50),portal vein invasion(HR=4.53, 95% CI:2.69-7.64) increased the recurrence risk. Moreover, portal vein invasion had a higher risk of death (HR=2.98, 95% CI: 1.73-4.98).@*Conclusion@#There was significant association between AKAP12 DNA methylation and low risk of recurrence and long progression-free survival of hepatocellular carcinoma patients.
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Introduction to the content design, selection and implementation method of the simulation exercise test method for work quality of clinical laboratories,and a comparison with traditional control method.It is held that the method is advantageous in artificial impact factors as necessary and whole-process tracing,and it tests not only the outcomes,but also all steps in the workflow,and can avoid man-made interference.
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Objective To explore the mRNA expressions of NLRP1 (NOD-like receptor 1 ) and NLRP3 inflammasomescomponents and related pro-inflammation cytokines in peripheral blood mononuclear cells (PBMCs).Methods A total of 21 septic patients,20 non-infectious SIRS patients and 20 health subjects were enrolled in this study.The mRNA expressions of inflammasomes components and related proinflammation cytokines were measured by using RT-PCR,and serum levels of IL-1β and IL-18 were measured using ELISA.One-way ANOVA was usedd to compare the data of all three groups,and SNK-q was employed to compare thedata among different groups.Spearman correlation analysis was used to analyze the correlation between these biomarkers and the severity of septic patients.Results ①The mRNA expression of NLRP1 in PBMCs of septic patients in early stage and non-infectious SIRS patients was down-regulated in comparison with healthy subjects (P ＜0.01 ).The expression of NLRP3 in septic patients was not differentfrom that in healthy subjects ( P ＞ 0.05 ),but NLRP3 mRNA expression in non-infectious SIRS patients was significantly higher than that in septic patients and in healthy subjects ( P ＜ 0.01 ).ASC ( apoptosis associated speck like protein containing a CARD) and caspase-1 mRNA expressions in septic patients and non-infectious SIRS patients were higher than those in healthy subjects ( P ＜ 0.01 ).There was no difference in level of IL-1β found among all groups.IL-18 mRNA expression in septic patients and non-infectious SIRS patients was higher than that in healthy subjects ( P ＜ 0.01 ),and that in non-infectious SIRS patients was highest.②)Serum protein level of IL-1β in septic patients was lower than that in healthy subjects (P ＜0.05 ),and serum level of IL-18 in septic patients was significantly higher than that in non-infectious SIRS patients and in healthy subjects ( P ＜ 0.01 ).③NLRP1 was negatively related to SOFA ( sepsis-related organ failure assessment) score (r =-0.44,P ＜ 0.05 ) and negatively related to APACHE Ⅱ score as well ( r =- 0.52,P ＜ 0.05 ).Conclusions NLRP1 mRNA expression was down regulated in patients with early sepsis and its expression was negatively correlated to the severity of septic patients,indicating the lower NLRP1 mRNA expression the severer illness.
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A new solid-phase BA-ELISA-spot assay is described for detection and enumera-tion of antigen specific antibody secreting cells.Spleen cells from immunized mice areincubated in plstic wells precoated with specific an tigen.After removal of the cells,immobilized antibodies at the point of release from single cell are demonstrated bymeans of an immunenzyme procedure in which.enzyme-substrate(HRP-TMB)reactionsare performed.Blue spots are thus produced and counted with naked eye.