Objective:To establish a practical patient-based internal quality control method for valproic acid drug concentration monitoring.Methods:Observational Study. A PBRTQC model based on the exponentially weighted moving average (EWMA) method was established using Python. All results of a total of 28, 757 valproic acid concentration data from February 1, 2023 to January 31, 2024 were collected and split into training set and validation set at a ratio of 80% and 20% respectively. The truncation limit (TL) was optimized by using the winsorized mean method and the trimmed mean method. Different weighting coefficients λ were set. Different TL and different λ were combined with the EWMA algorithm into different patient-based real-time quality control (PBRTQC) models. The optimized models were verified by introducing simulated constant errors (CE) and proportional errors (PE) respectively. The false positive alarm rate (FAR) was used to evaluate specificity, and the average number of patients before error detection (ANPed) was used to evaluate sensitivity. According to the daily test volume and quality target requirements, we comprehensively judged whether the performance evaluation indicators of FAR and ANPed meet the laboratory requirements. Bias detection curve was used for determination of the best model.Results:The parameters of the best PBRTQC model for valproic acid drug concentration monitoring are: trimmed mean method with 1.5 standard deviations (i.e., truncating data outside 1.5 standard deviations of the data mean), λ=0.01. The performance verification result shows that ANPed of CE and PE of this model are both less than 100. The comparison between the EQA results and the EWMA results show that the EWMA method results are comparable to the EQA results.Conclusion:A PBRTQC model for the valproic acid drug concentration monitoring project based on the EWMA method has been successfully established. It is comparable with both IQC and EQA results, which means PBRTQC may be used as a supplement to the quality control of daily quality control products.

The defocus curve, which quantifies visual performance under various defocus states to accurately evaluate the eye's ability to achieve clear vision across a continuous range of distances, is a vital tool for assessing visual quality. With the aging population and improved quality of life driving a significant increase in the demand for presbyopia correction, the application of the defocus curve has continually expanded in ophthalmic clinical practice, particularly in the perioperative period of presbyopia-correcting corneal refractive surgery and refractive cataract surgery, where it aids in personalized surgical planning and proves valuable for patient education and postoperative visual quality assessment. This article systematically reviews the examination methodology, influencing factors, analytical approaches, and recent clinical advancements of defocus curves, focusing on the potential impact of variables such as pupil diameter, contrast sensitivity, and chart selection on results; it further discusses current limitations including lack of standardization and insufficient assessment of dynamic visual performance, and proposes future research directions based on the latest literature. The aim is to provide valuable insights for researchers and clinicians, promote the standardized and normative application of defocus curves, and ultimately enhance the overall efficacy of presbyopia correction and patients' quality of visual life.

Objective To investigate the early prediction efficacy of adiponectin(ADPN)for gestational diabetes mellitus(GDM),and to explore new indicators for the early diagnosis of GDM and risk models for early prediction.Methods A cohort of 486 pregnant women in early pregnancy(7-12 weeks)was selected from July to November 2023 at Beijing Tongren Hospital,Capital Medical University.According to the diagnostic criteria of GDM recommended by the International Association for the study of Diabetes and Pregnancy Study Group(IADPSG)in 2010,mid-pregnancy pregnancies were divided into GDM group(150 cases)and non-GDM group(336 case).ADPN,insulin(IR),fasting glucose(GLU),and glycated albumin(GA)were collected in early pregnancy,and the homeostatic model assessment of adiponectin(HOMA-AD),homeostatic model assessment of insulin resistance index(HOMA-IR)and hepatic steatosis index(HSI)were calculated.The differences in ADPN,HOMA-AD,and HOMA-IR between the two groups were analyzed and compared,and the value of each type of index in predicting GDM was analyzed with the receiver operating characteristics(ROC)curve,and the predictive risk model was established by combining the relevant indexes.Results There was a statistically significant difference between the GDM and non-GDM groups in ADPN in early pregnancy(P＜0.05).The results of the ROC curve analysis showed that the area under the curve(AUC)of ADPN for early prediction of GDM positivity was 0.723,with a cutoff value 13.38 mg/L.There was a statistically significant difference between the GDM and non-GDM groups in HOMA-AD(P=0.000).The AUC of HOMA-AD for early prediction of GDM was 0.815,with the cutoff value 3.024.Combining GLU,HOMA-AD,HOMA-IR,and HSI in a Logistic regression model improved predictive performance across several metrics,with the final test set of AUC=0.829,accuracy=0.740,sensitivity=0.913,negative predictive value=0.833.Conclusion ADPN levels were reduced in the GDM group compared to the non-GDM group,and the diagnostic efficacy of a single ADPN was poor when it was used for early prediction of the onset of GDM.The HOMA-AD level of the GDM group was lower than that of the non-GDM group,and HOMA-AD was negatively correlated with the disease,which was more effective than ADPN,HOMA-IR,and HIS in the early prediction of GDM.HOMA-AD could be used in combination with these indexes to establish a diagnostic and predictive model to improve the effectiveness of the prediction.

Objective:To investigate the difference in efficacy of thoracic endovascular aortic repair (TEVAR) for high-risk uncomplicated Stanford B aortic dissection in acute versus subacute phase.Methods:The clinical and follow-up data of of 126 patients with high-risk, uncomplicated Stanford B aortic dissection treated with TEVAR at the Affiliated Hospital of Chengde Medical College from Jan 2014 to Oct 2020 were retrospectively analyzed.Results:One hundred and twenty-six patients were divided according to the time from onset to surgery into an acute phase group ( n=65, 1-14 days) and a subacute phase group ( n=61, 15-90 days). The average hospital stay of patients in the subacute phase group was significantly shorter than that of patients in the acute phase group ( P<0.05). One year post-operatively, abdominal aortic false lumen thrombosis in patients of the acute phase group was better than that in the subacute phase group ( P<0.05). The in hospital overall incidence of adverse events (total complications+death) was lower in the subacute phase group than in the acute phase group ( P<0.05). The difference in the long-term overall incidence of adverse events between the two groups was not statistically significant ( P>0.05). Conclusions:The TEVAR procedure for high-risk, uncomplicated Stanford B aortic dissection performed during the subacute phase had a lower postoperative in hospital incidence of adverse events.

Objective To investigate the early prediction efficacy of adiponectin(ADPN)for gestational diabetes mellitus(GDM),and to explore new indicators for the early diagnosis of GDM and risk models for early prediction.Methods A cohort of 486 pregnant women in early pregnancy(7-12 weeks)was selected from July to November 2023 at Beijing Tongren Hospital,Capital Medical University.According to the diagnostic criteria of GDM recommended by the International Association for the study of Diabetes and Pregnancy Study Group(IADPSG)in 2010,mid-pregnancy pregnancies were divided into GDM group(150 cases)and non-GDM group(336 case).ADPN,insulin(IR),fasting glucose(GLU),and glycated albumin(GA)were collected in early pregnancy,and the homeostatic model assessment of adiponectin(HOMA-AD),homeostatic model assessment of insulin resistance index(HOMA-IR)and hepatic steatosis index(HSI)were calculated.The differences in ADPN,HOMA-AD,and HOMA-IR between the two groups were analyzed and compared,and the value of each type of index in predicting GDM was analyzed with the receiver operating characteristics(ROC)curve,and the predictive risk model was established by combining the relevant indexes.Results There was a statistically significant difference between the GDM and non-GDM groups in ADPN in early pregnancy(P＜0.05).The results of the ROC curve analysis showed that the area under the curve(AUC)of ADPN for early prediction of GDM positivity was 0.723,with a cutoff value 13.38 mg/L.There was a statistically significant difference between the GDM and non-GDM groups in HOMA-AD(P=0.000).The AUC of HOMA-AD for early prediction of GDM was 0.815,with the cutoff value 3.024.Combining GLU,HOMA-AD,HOMA-IR,and HSI in a Logistic regression model improved predictive performance across several metrics,with the final test set of AUC=0.829,accuracy=0.740,sensitivity=0.913,negative predictive value=0.833.Conclusion ADPN levels were reduced in the GDM group compared to the non-GDM group,and the diagnostic efficacy of a single ADPN was poor when it was used for early prediction of the onset of GDM.The HOMA-AD level of the GDM group was lower than that of the non-GDM group,and HOMA-AD was negatively correlated with the disease,which was more effective than ADPN,HOMA-IR,and HIS in the early prediction of GDM.HOMA-AD could be used in combination with these indexes to establish a diagnostic and predictive model to improve the effectiveness of the prediction.

Objective:To establish a practical patient-based internal quality control method for valproic acid drug concentration monitoring.Methods:Observational Study. A PBRTQC model based on the exponentially weighted moving average (EWMA) method was established using Python. All results of a total of 28, 757 valproic acid concentration data from February 1, 2023 to January 31, 2024 were collected and split into training set and validation set at a ratio of 80% and 20% respectively. The truncation limit (TL) was optimized by using the winsorized mean method and the trimmed mean method. Different weighting coefficients λ were set. Different TL and different λ were combined with the EWMA algorithm into different patient-based real-time quality control (PBRTQC) models. The optimized models were verified by introducing simulated constant errors (CE) and proportional errors (PE) respectively. The false positive alarm rate (FAR) was used to evaluate specificity, and the average number of patients before error detection (ANPed) was used to evaluate sensitivity. According to the daily test volume and quality target requirements, we comprehensively judged whether the performance evaluation indicators of FAR and ANPed meet the laboratory requirements. Bias detection curve was used for determination of the best model.Results:The parameters of the best PBRTQC model for valproic acid drug concentration monitoring are: trimmed mean method with 1.5 standard deviations (i.e., truncating data outside 1.5 standard deviations of the data mean), λ=0.01. The performance verification result shows that ANPed of CE and PE of this model are both less than 100. The comparison between the EQA results and the EWMA results show that the EWMA method results are comparable to the EQA results.Conclusion:A PBRTQC model for the valproic acid drug concentration monitoring project based on the EWMA method has been successfully established. It is comparable with both IQC and EQA results, which means PBRTQC may be used as a supplement to the quality control of daily quality control products.

Objective:To investigate the difference in efficacy of thoracic endovascular aortic repair (TEVAR) for high-risk uncomplicated Stanford B aortic dissection in acute versus subacute phase.Methods:The clinical and follow-up data of of 126 patients with high-risk, uncomplicated Stanford B aortic dissection treated with TEVAR at the Affiliated Hospital of Chengde Medical College from Jan 2014 to Oct 2020 were retrospectively analyzed.Results:One hundred and twenty-six patients were divided according to the time from onset to surgery into an acute phase group ( n=65, 1-14 days) and a subacute phase group ( n=61, 15-90 days). The average hospital stay of patients in the subacute phase group was significantly shorter than that of patients in the acute phase group ( P<0.05). One year post-operatively, abdominal aortic false lumen thrombosis in patients of the acute phase group was better than that in the subacute phase group ( P<0.05). The in hospital overall incidence of adverse events (total complications+death) was lower in the subacute phase group than in the acute phase group ( P<0.05). The difference in the long-term overall incidence of adverse events between the two groups was not statistically significant ( P>0.05). Conclusions:The TEVAR procedure for high-risk, uncomplicated Stanford B aortic dissection performed during the subacute phase had a lower postoperative in hospital incidence of adverse events.

Objective To investigate the effect of Yigong San(YGS)on learning and memory abilities of rats with lipopolysaccharide(LPS)-induced cognitive decline and explore its possible mechanism in light of intestinal microbiota.Methods Forty SD rats were randomly divided into control group,model group,donepezil(1.3 mg/kg)group,and high-dose(5.25 g/kg)and low-dose(2.63 g/kg)YGS treatment groups.After 24 days of treatment with the corresponding drugs or water by gavage,the rats in the latter 4 groups received an intraperitoneal injection of LPS(0.5 mg/kg)to establish models of Alzheimer's disease(AD).Water maze test and HE staining were used to evaluate the changes in learning and memory abilities and pathomorphology of the hippocampus.The changes in gut microbial species of the rats were analyzed with 16S rRNA sequencing,and the levels of IL-6,TNF-α,and IL-1β in the brain tissue and serum were detected using ELISA.Results Compared with the AD model group,the YGS-treated rats showed significantly shortened escape latency on day 5 after modeling,reduced neuronal degeneration and necrosis in the hippocampus,lowered pathological score of cell damage,and decreased levels IL-6,TNF-α and IL-1β in the brain tissue and serum.The YGS-treated rats showed also obvious reduction of Alpha diversity indicators(ACE and Chao1)of intestinal microbiota with significantly increased abundance of Prevotellaceae species at the family level and decreased abundance of Desulfovibrionaceae,which were involved in such metabolic signaling pathways as cell community prokaryotes,membrane transport,and energy metabolism.Conclusion YGS improves learning and memory abilities and hippocampal pathomorphology in AD rat models possibly by regulating the abundance of intestinal microbial species such as Prevotellaceae to affect the metabolic pathways for signal transduction,cofactors,and vitamin metabolism.

Objective:To use inductively coupled plasma mass spectrometry(ICP-MS)to screen biomarkers of element omics of thyroid cancer,and to establish a risk assessment model of element omics of thyroid cancer,so as to provide a basis for the diagnosis and treatment of thyroid cancer.Methods:A total of 200 patients with thyroid cancer who admitted to Beijing Tongren Hospital from February to November 2020 were selected as the thyroid cancer group,and 50 healthy volunteers who underwent physical examinations at hospital during the same period were selected as the healthy control group.The total amount of 28 trace elements,including iodine(I),calcium(Ca),iron(Fe),nickel(Ni),copper(Cu),zinc(Zn),selenium(Se),antimony(Sb),etc.,in their serum were determined by ICP-MS.The content of trace element,thyroid function,free triiodothyronine(FT3),free tetraiodothyronine(FT4),triiodothyronine(T3),tetraiodothyronine(T4),and thyroid volume of ultrasound examination of were analyzed,and then,a risk assessment model of elemental omics of thyroid diseases was established.Results:There were statistically significant differences in the contents of eight trace elements,including I,Ca,Fe,Ni,Cu,Zn,Se and Sb between the thyroid cancer group and the healthy control group(U=2.601,1.972,2.607,2.611,2.603,2.605,2.601,2.605,P<0.05),respectively.The I,Cr and Mn levels of female patients with thyroid cancer appeared increase,while there were significant differences in I,Mn,Fe,Ni,Cu,Zn,Se and Sb contents of male patients between the thyroid cancer group and the health control group(U=2.601,2.608,2.603,2.602,1.973,2.603,2.601,2.602,P<0.05),respectively.In thyroid cancer group,the FT3,FT4,T3,T4 correlated with I content(r=06209,0.5116,0.557,0.5923,P<0.05),respectively.There were correlations in the concentrations between Fe and Zn,between Cr and Mn,between Ca and Zn,between Se and Fe,and between Zn and Se in the thyroid cancer group(r=0.5523,0.5528,0.7158,0.5699,0.6371,0.5420,P<0.05),respectively.High concentrations of I and Mn were risk factors for thyroid cancer.The specificity and sensitivity of the risk assessment model of elemental omics of thyroid cancer were all larger than 95%.Conclusion:In patients with thyroid cancer,both of the serum Ca of female patients and serum Fe of male patients play important role besides cobalt(Co),Ni,Cu,Zn,Se and Sb play role,which can provide basis for the diagnosis and treatment of thyroid cancer.The risk assessment model based on elemental omics of thyroid cancer has favorable diagnostic performance.

Objective:To summarize the best evidence of transitional care for adolescents with systemic lupus erythematosus, and provide reference for clinical implementation of transitional care.Methods:According to the "6S" evidence pyramid model, the guide websites, related association websites and databases at home and abroad were searched from the establishment of the databases to November 7, 2023. The quality of literature was evaluated independently by two researchers. The evidence was graded according to the evidence grading and recommendation grading system of the Joanna Briggs Institute Evidence-Based Health Care Center.Results:A total of 20 articles were included, including one clinical decision, one guideline, 16 expert consensus and two systematic evaluations. A total of 27 best pieces of evidence were extracted from five aspects, including transition principles, formation of transition teams, initiation of transition, individualized care during the transition period and transferring to the adult health care system.Conclusions:This study summarizes the best evidence on transitional care for adolescent patients with systemic lupus erythematosus. Medical staff can refer to the evidence and combine hospital policies, patients' own conditions and the wishes of patients and parents to develop personalized transitional care plans to help patients transition smoothly and improve their outcomes after transfer.