Objective To retrieve,evaluate and summarize the best evidence for blood glucose monitoring and management in patients with diabetes of the exocrine pancreas(DEP),and to provide evidence-based basis for clinical practice.Methods According to the"6S"evidence model,relevant evidence on blood glucose management in patients with DEP was searched from computer decision support systems,guideline networks,professional association websites and databases from top to bottom,covering clinical decision-making,clinical practice guidelines,evidence summaries,systematic reviews,expert consensuses,and randomized controlled trials.The search scope was from the establishment of the databases to June 30,2024.Totally 2 researchers independently evaluated the quality of the included literature,and extracted data and summarized evidence that met the criteria.Results A total of 10 articles were included,including 3 guidelines,1 expert consensus,2 systematic reviews,l clinical decision,1 RCT,and 2 cohort studies.Finally,26 pieces of best evidence were formed from 5 aspects,including blood glucose management team construction and goals,blood glucose monitoring methods,glucose control medication management,lifestyle health education and treatment of hypoglycemia.Conclusion This study summarizes the best evidence for blood glucose monitoring and management in DEP patients,which can provide resource preparation for clinical translation and a basis for medical staff to carry out blood glucose management in DEP patients.

Objective:To investigate the association between dopamine D2 receptor ( DRD2) promoter methylation levels and melancholic depression (MD), and its correlation with psychosocial factors and depression severity. Method:A total of 30 patients with melancholic depression (MD group) and 30 with non-melancholic depression (NMD group) were recruited from the First Affiliated Hospital of Xinjiang Medical University between October 2023 and October 2024, along with 30 healthy controls. Participants were assessed by the Hamilton depression rating scale (HAMD-24), dimensional anhedonia rating scale (DARS), childhood trauma questionnaire (CTQ), life event scale (LES), and social support rating scale (SSRS). DRD2 methylation levels in peripheral blood were measured by MassArray technology. Data were analyzed in SPSS 29.0 software using ANOVA, non-parametric tests, and t-tests to compare methylation levels among groups, and Logistic regression, Pearson correlation, and multiple linear regression to examine associations between DRD2 methylation and psychosocial factors and depression severity. Results:(1) There were statistically significant differences among the three groups in years of education ( F=9.873, P=0.007), HAMD-24 total scores ( H=76.669, P<0.001), DARS total scores ( H=60.617, P<0.001), SSRS total scores ( F=3.592, P=0.032), LES negative stimulus scores ( H=43.461, P<0.001), and CTQ total scores ( H=10.751, P=0.005). The MD group had a longer course of illness ( Z=-1.980, P=0.048), more episodes ( Z=-2.027, P=0.043), and a higher rate of suicide attempts in the past year ( χ2= 9.643, P=0.002) compared with the NMD group. The MD group had higher HAMD-24 total scores (31.00 (28.00, 32.25)) than the NMD group (23.00 (21.00, 25.00)), and lower DARS total scores (17.00 (9.75, 22.00)) compared with the NMD group(36.50 (33.75, 43.00)) (both P<0.05). (2) No statistically significant difference was found in DRD2 gene methylation levels among the three groups ( F=0.081, all P>0.05). Logistic regression showed that DRD2 gene methylation level was not an influencing factor for the onset of MD ( P>0.05). (3)The correlation analysis and multiple linear regression analysis showed that childhood trauma (CTQ total score) was negatively correlated with DRD2 gene methylation levels in MD patients ( r=-0.416, P=0.025) and MDD patients. DRD2 gene methylation level was not correlated with depression severity ( r=0.136, P>0.05) or anhedonia severity (both P>0.05). Social support (SSRS total score) was positively correlated with DARS total scores in MD patients( r=0.427, P=0.019), and years of education had a positive association with DARS total scores in MDD patients ( B=1.527, P=0.030), suggesting that both are negatively correlated with the degree of anhedonia. Conclusion:DRD2 methylation may be influenced by early-life trauma, but its role in the pathogenesis of MD and its association with depression severity require further investigation.

Objective:To investigate the association between dopamine D2 receptor ( DRD2) promoter methylation levels and melancholic depression (MD), and its correlation with psychosocial factors and depression severity. Method:A total of 30 patients with melancholic depression (MD group) and 30 with non-melancholic depression (NMD group) were recruited from the First Affiliated Hospital of Xinjiang Medical University between October 2023 and October 2024, along with 30 healthy controls. Participants were assessed by the Hamilton depression rating scale (HAMD-24), dimensional anhedonia rating scale (DARS), childhood trauma questionnaire (CTQ), life event scale (LES), and social support rating scale (SSRS). DRD2 methylation levels in peripheral blood were measured by MassArray technology. Data were analyzed in SPSS 29.0 software using ANOVA, non-parametric tests, and t-tests to compare methylation levels among groups, and Logistic regression, Pearson correlation, and multiple linear regression to examine associations between DRD2 methylation and psychosocial factors and depression severity. Results:(1) There were statistically significant differences among the three groups in years of education ( F=9.873, P=0.007), HAMD-24 total scores ( H=76.669, P<0.001), DARS total scores ( H=60.617, P<0.001), SSRS total scores ( F=3.592, P=0.032), LES negative stimulus scores ( H=43.461, P<0.001), and CTQ total scores ( H=10.751, P=0.005). The MD group had a longer course of illness ( Z=-1.980, P=0.048), more episodes ( Z=-2.027, P=0.043), and a higher rate of suicide attempts in the past year ( χ2= 9.643, P=0.002) compared with the NMD group. The MD group had higher HAMD-24 total scores (31.00 (28.00, 32.25)) than the NMD group (23.00 (21.00, 25.00)), and lower DARS total scores (17.00 (9.75, 22.00)) compared with the NMD group(36.50 (33.75, 43.00)) (both P<0.05). (2) No statistically significant difference was found in DRD2 gene methylation levels among the three groups ( F=0.081, all P>0.05). Logistic regression showed that DRD2 gene methylation level was not an influencing factor for the onset of MD ( P>0.05). (3)The correlation analysis and multiple linear regression analysis showed that childhood trauma (CTQ total score) was negatively correlated with DRD2 gene methylation levels in MD patients ( r=-0.416, P=0.025) and MDD patients. DRD2 gene methylation level was not correlated with depression severity ( r=0.136, P>0.05) or anhedonia severity (both P>0.05). Social support (SSRS total score) was positively correlated with DARS total scores in MD patients( r=0.427, P=0.019), and years of education had a positive association with DARS total scores in MDD patients ( B=1.527, P=0.030), suggesting that both are negatively correlated with the degree of anhedonia. Conclusion:DRD2 methylation may be influenced by early-life trauma, but its role in the pathogenesis of MD and its association with depression severity require further investigation.

Objective To retrieve,evaluate and summarize the best evidence for blood glucose monitoring and management in patients with diabetes of the exocrine pancreas(DEP),and to provide evidence-based basis for clinical practice.Methods According to the"6S"evidence model,relevant evidence on blood glucose management in patients with DEP was searched from computer decision support systems,guideline networks,professional association websites and databases from top to bottom,covering clinical decision-making,clinical practice guidelines,evidence summaries,systematic reviews,expert consensuses,and randomized controlled trials.The search scope was from the establishment of the databases to June 30,2024.Totally 2 researchers independently evaluated the quality of the included literature,and extracted data and summarized evidence that met the criteria.Results A total of 10 articles were included,including 3 guidelines,1 expert consensus,2 systematic reviews,l clinical decision,1 RCT,and 2 cohort studies.Finally,26 pieces of best evidence were formed from 5 aspects,including blood glucose management team construction and goals,blood glucose monitoring methods,glucose control medication management,lifestyle health education and treatment of hypoglycemia.Conclusion This study summarizes the best evidence for blood glucose monitoring and management in DEP patients,which can provide resource preparation for clinical translation and a basis for medical staff to carry out blood glucose management in DEP patients.

BACKGROUND:Animal models of diabetic encephalopathy that have been studied mainly include streptozotocin-induced model,high-sugar and high-fat diet-induced model and spontaneous animal model.Establishing a simple,easy,short-cycle,safe and effective model of diabetic encephalopathy can help to explore the subsequent pathogenesis and screen therapeutic drugs. OBJECTIVE:To further explore and evaluate the method of building diabetic encephalopathy rat models. METHODS:Twenty Sprague-Dawley rats were randomly divided into control(n=10)and model(n=10)groups.Rats in the model group were given a single injection of 45 mg/kg streptozotocin in the left lower abdominal cavity,and those in the control group were given the same amount of citrate buffer.During the experiment,the body mass,feed intake,water intake and blood glucose were measured.After 8 weeks,the glucose tolerance and oxidative stress levels were measured,and the pathological changes of brain tissue and the expression of apoptotic proteins were compared between groups. RESULTS AND CONCLUSION:Compared with the control group,the food intake,water intake,encephalization quotient,blood glucose and area under the blood glucose curve were significantly increased in the model group,while the body mass decreased significantly(P<0.01).Histopathological examination of the brain showed that compared with the control group,the number of surviving nerve cells was significantly reduced in the model group(P<0.01),with more significant pathological damage of nerve cells.Compared with the control group,the activities of serum superoxide dismutase,catalase and glutathione in the model group were significantly decreased(P<0.01),and the content of oxidative malondialdehyde was significantly increased(P<0.05).The expression levels of apoptosis-related proteins Bax and Caspase-3 in brain tissue increased in the model group compared with the control group,while the expression of Bcl-2 decreased(P<0.01).In conclusion,an 8-week injection of 45 mg/kg streptozotocin can cause obvious pathological damage to the brain tissue of diabetic rats,to successfully establish the rat model of diabetic encephalopathy.

Objective:To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes.Methods:The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results:A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs ( OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions:The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

Objective:To investigate the clinical features, pathogen composition, and prognosis of septic shock in pediatric intensive care units (PICU) in China.Methods:A multicenter retrospective cohort study. A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021. The clinical features, pathogen composition, and outcomes were collected. Patients were categorized into malignant tumor and non-malignant tumor groups, as well as survival and mortality groups. T test, Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups. Multiple Logistic regression was used to identify risk factors for mortality. Results:A total of 1 247 children with septic shock were included, with 748 males (59.9%) and the age of 3.1 (0.9, 8.8) years. The in-patient mortality rate was 23.2% (289 cases). The overall pathogen positive rate was 68.2% (851 cases), with 1 229 pathogens identified. Bacterial accounted for 61.4% (754 strains) and virus for 24.8% (305 strains). Among all bacterium, Gram negative bacteria constituted 64.2% (484 strains), with Pseudomonas aeruginosa and Enterobacter being the most common; Gram positive bacteria comprised 35.8% (270 strains), primarily Streptococcus and Staphylococcus species. Influenza virus (86 strains (28.2%)), Epstein-Barr virus (53 strains (17.4%)), and respiratory syncytial virus (46 strains (17.1%)) were the top three viruses. Children with malignant tumors were older and had higher pediatric risk of mortality (PRISM) Ⅲ score, paediatric sequential organ failure assessment (pSOFA) score (7.9 (4.3, 11.8) vs. 2.3 (0.8, 7.5) years old, 22 (16, 26) vs. 16 (10, 24) points, 10 (5, 14) vs. 8 (4, 12) points, Z=11.32, 0.87, 4.00, all P<0.05), and higher pathogen positive rate, and in-hospital mortality (77.7% (240/309) vs. 65.1% (611/938), 29.7% (92/309) vs. 21.0% (197/938), χ2=16.84, 10.04, both P<0.05) compared to the non-tumor group. In the death group, the score of PRISM Ⅲ, pSOFA (16 (22, 29) vs. 14 (10, 20) points, 8 (12, 15) vs. 6 (3, 9) points, Z=4.92, 11.88, both P<0.05) were all higher, and presence of neoplastic disease, positive rate of pathogen and proportion of invasive mechanical ventilation in death group were also all higher than those in survival group (29.7% (87/289) vs. 23.2% (222/958), 77.8% (225/289) vs. 65.4% (626/958), 73.7% (213/289) vs. 50.6% (485/958), χ2=5.72, 16.03, 49.98, all P<0.05). Multiple Logistic regression showed that PRISM Ⅲ, pSOFA, and malignant tumor were the independent risk factors for mortality ( OR=1.04, 1.09, 0.67, 95% CI 1.01-1.05, 1.04-1.12, 0.47-0.94, all P<0.05). Conclusions:Bacterial infection are predominant in pediatric septic shock, but viral infection are also significant. Children with malignancies are more severe and resource consumptive. The overall mortality rate for pediatric septic shock remains high, and mortality are associated with malignant tumor, PRISM Ⅲ and pSOFA scores.

Chlorogenic acid is a bioactive phenolic acid compound found in a variety of medicinal materials and foods.As a secondary metabolic product in plant cells,chlorogenic acid has many pharmacological effects,such as antibacterial effect,immune regulation,anti-inflammatory,antiviral,anti-aging,anti-cardiovascular dis-ease,anti-cancer,regulation of blood glucose and lipids and so on.In recent years,the widespread use of antibi-otics and the emergence of multiple drug-resistant bacteria pose great challenges to clinical antimicrobial ther-apy and global health safety.The exploration and development of new antibacterial drugs has attracted world-wide attention.In this paper,the recent research on the antibacterial effect of chlorogenic acid and the mecha-nism of immune system regulation are reviewed,aiming to provide a new strategy for the development of new antibacterial drugs and the selection of clinical infectious diseases drugs.

Repetitive transcranial magnetic stimulation (rTMS) has become an essential method in psychiatric disorders. However, many problems occurred in clinical application. This article interpreted the Association Standard T/CMEAS 011-2023'Operating Specifications for Repetitive Transcranial Magnetic Stimulation in Clinical Applications on Psychiatric Disorders′ released by the Chinese Medicine Education Association. The main content included a range of applications, normative references, terms and definitions, site specifications, equipment specifications, ability specifications of rTMS operators and rTMS process specifications.This article provided suggestions for clinical applications of rTMS on psychiatric disorders.

Repetitive transcranial magnetic stimulation (rTMS) has become an essential method in psychiatric disorders. However, many problems occurred in clinical application. This article interpreted the Association Standard T/CMEAS 011-2023'Operating Specifications for Repetitive Transcranial Magnetic Stimulation in Clinical Applications on Psychiatric Disorders′ released by the Chinese Medicine Education Association. The main content included a range of applications, normative references, terms and definitions, site specifications, equipment specifications, ability specifications of rTMS operators and rTMS process specifications.This article provided suggestions for clinical applications of rTMS on psychiatric disorders.