Objective To explore the influencing factors of type 2 diabetes mellitus(T2DM)merging with diabetic peripheral neuropathy(DPN),and to construct and verify a prediction model based on random forest algorithm.Methods 512 T2DM patients who were hospitalized in our hospital from January 2019 to December 2021 were divided into simple T2DM group(n=292)and T2DM combined with DPN group(DPN,n=220)based on whether or not DPN was present.The general data and biochemical indicators of the two groups were compared.Logistic regression analysis was conducted to identify the influencing factors of DPN in T2DM patients.A random forest model was constructed.Results Compared with the T2DM group,the DPN group showed an increase in weight loss rate,incidence of diabetic retinopathy(DR),WBC and HbA1c(P<0.05),with decrease in DM duration≥10 years,TG and HDL-C(P<0.05).Logistic regression analysis showed that age≥60 years,HbA1c,TG,HDL-C,rate of weight loss,DR were influencing factor for T2DM combined with DPN.The random forest model showed that when the number of trees was 387,the error rate was the lowest.The importance ranking of the influencing factors of T2DM combined with DPN were the rate of weight loss,TG,DR,HDL-C,HbA1c and age≥60 years.Conclusions Age≥60 years,HbA1c,TG,HDL-C,rate of weight loss and DR are influencing factors for T2DM combined with DPN,that can be used for early clinical diagnosis and treatment.

Objective:To explore the association between dopamine-β-hydroxylase (DβH), norepinephrine transporter (NET) gene polymorphisms and panic disorder(PD).Methods:The structured clinical interview for the diagnostic and statistical manual of mental disorders fourth edition (DSM-Ⅳ) axis Ⅰ disorders was administered by trained clinical psychiatrist, 139 patients with PD(PD group) and 196 healthy controls(control group) were enrolled in the study.Single nucleotide polymorphism(SNP) genotyping was performed using an improved multiplex ligation detection reaction technique.SPSS 16.0 and PLINK softwares were used to compare the allele frequency and genotype distribution.Results:(1)Compared with control group, PD group carried more G allele(76.3% vs 68.4%) and fewer A allele(23.7% vs 31.6%) in NET rs5569, and the difference was significant(χ 2=4.986, OR=0.67, 95% CI: 0.47-0.95, P<0.05). However, the correlation was no longer significant after adjusting for Bonferroni’s multiple testing( P>0.05). (2)The additive model of NET rs5569 showed a association with PD ( OR=0.68, 95% CI: 0.48-0.96, P<0.05). And the recessive model of DβH rs1611114 showed a association with PD( OR=0.42, 95% CI: 0.18-0.96, P<0.05). However, these correlations were no longer significant after adjusting for Bonferroni's multiple testing( P>0.05). (3)No matter allele or genotype, there were no significant differences in DβH (rs129882, rs1611114, rs1611115) and NET (rs2242446, rs28386840) gene polymorphisms between panic disorder group and control group(all P>0.05). Conclusion:The present study indicates that there is no significant association of DβH and NET gene polymorphisms with PD.

Objective:To explore whether brain-derived neurotrophic factor (BDNF) promoter methylation status is associated with panic disorder(PD), and then assess the effect of the BDNF gene methylation status on the severity of clinical symptoms in PD.Methods:The methylation levels of the BDNF gene were compared between 111 patients with PD and 130 matched healthy controls using MethylTarget approach.In addition, the panic disorder severity scale(PDSS), Hamilton anxiety rating scale(HAM-A), and Hamilton depression rating scale(HAM-D) were respectively assessed to all subjects.Results:(1)The result showed that 7 CpG regions from the promoter regions of the BDNF gene were sequenced.However, there was no statistically significant differences between cases and controls in terms of BDNF DNA methylation status ( OR=1.087, 95% CI=0.849-1.391, P>0.05). (2)Spearman correlation analysis revealed that the hypermethylation of BDNF gene was significantly associated with the severity of the depressive symptoms in PD patients (all P<0.05). The methylation levels of BDNF gene was not significantly related to the severity of anxiety and panic in PD patients(all P>0.05). Conclusion:No association between BDNF promoter methylation status and panic disorder is found in Chinese Han population, but BDNF promoter methylation status may be related to the severity of depressive symptoms in patient with panic disorder.

Objective:To study the ability of the Retinal Health Assessment (RHA) system to obtain fundus images in patients with different types and degrees of cataracts.Methods:A cross-sectional study was performed.Forty-five eyes of 41 patients with cataract were enrolled in First People's Hospital, Shanghai Jiaotong University from December 2016 to January 2017.Lens opacity grading and RHA fundus imaging were performed after pupil dilation.Forty-five eyes were divided into 4 groups according to the degree of lens opacity: cortical cataract group 18 eyes, nucleus cataract group 21 eyes, posterior subcapsular cataract group 2 eyes, hybrid cataract group 4 eyes.Fundus images were obtained by FullSpectrum mode of RHA2020, and the clearness of fundus images was evaluated.Scores of fundus images clarity were compared between the cortical cataract group and nucleus cataract group.This study was approved by the Ethics Committee of First People's Hospital, Shanghai Jiaotong University.Written informed consent was obtained from each patient prior to any medical examination.Results:In all 45 eyes, the phacoscotasmus classification ranged from mildest (C0N2P0, 1 eye) to very serious (C2N5P2 and C4N2P4, 2 eyes). The grade Ⅳ nuclear opacity, grade Ⅲ cortical opacity, and grade Ⅲ posterior subcapsular opacity reduced the quality of RHA images significantly, especially for images with red and green light.In cortical cataract group, images showed peripapillary vessels and retinal vessels at 580 nm and 590 nm, while retinal and choroidal vessels, as well as choroidal pigmentation, were visible at 810 nm.The clarity scores at 580, 590 and 810 nm were 2.0 (1.0, 3.0), 2.0 (2.0, 3.0) and 2.0 (2.0, 3.0), which were lower than that with red and green light (620 nm + 550 nm) (3.0[2.0, 3.0]), with statistically significant differences (all at P<0.05). In nucleus cataract group, the quality of fundus images from the eyes with grade Ⅲ nucleus cataracts was good, the image quality decreased when the nucleus opacity was grade Ⅳ, retinal vessels were occasionally observed at 580 nm and 590 nm.Additionally, retinal and choroidal vessels and choroidal pigment were visible at 810 nm and 850 nm.The clarity scores at 580, 590, 810 and 850 nm were 1.0 (1.0, 3.0), 2.0 (1.0, 3.0) and 2.0 (1.0, 3.0), which were lower than that with red and green light (620 nm + 550 nm) (3.0[1.5, 3.0]), with statistically significant differences (all at P<0.05). In posterior subcapsular cataract group, the retinal vessels were visible at 580 nm, meanwhile retinal and choroidal vessels and choroidal pigment could be observed at 810 nm and 850 nm.In hybrid cataract group, running lines of retinal vessels could be seen at 850 nm, while the central reflection was absent.Focal choroidal vessels were observed. Conclusions:Except for severe cases, RHA system can produce good quality fundus images in cataract eyes at 580, 590, 810 and 850 nm, facilitating the evaluation of fundus disease before surgery and prediction of visual outcomes after surgery.

Objective:To investigate the application value of molecular detection in the differential diagnosis of ovarian adult granulosa cell tumors (AGCT) by analyzing FOXL2, AKT1 and DICER1 mutations in these tumors.Methods:A total of 48 cases of ovarian sex cord-stromal tumor (SCST) were selected from July 2012 to June 2019 in Beijing Obstetrics and Gynecology Hospital, including 21 adult granulosa cell tumors (AGCT), 15 fibromas/fibrothecomas, 8 Sertoli-Leydig cell tumors (SLCT) and 4 other types of ovarian SCST. Genomic DNA was extracted from the formalin-fixed paraffin-embedded tissue sections. Polymerase chain reaction amplification for FOXL2, AKT1 and DICER1 genes was performed, followed by sequencing using capillary electrophoresis. Fisher exact test was used to compare the prevalence difference of FOXL2, AKT1 and DICER1 mutations among the groups. P<0.05 was considered significant. Results:Eighteen of the 21 (85.7%) AGCT harbored FOXL2 mutation. Compared with other SCST (13.0%, 3 of 23; including fibromas/fibrothecomas and SLCT), FOXL2 mutation was significantly higher in AGCT ( P<0.001). In addition, FOXL2 mutation was also detected in one fibrothecoma, two SLCT and two gynandroblastomas. DICER1 mutation was identified in four of eight SLCT, and these cases were moderately to poorly differentiated. FOXL2 mutation was found in one SLCT with DICER1 mutation. There was no DICER1 mutation in other ovarian SCST. No AKT1 mutation was detected in all the patients. Conclusions:FOXL2 mutation is a highly specific biomarker for adult AGCT and may be helpful to resolve problematic cases. Diagnosis should also be taken into consideration of the clinical and histological features as FOXL2 mutation is also found in other SCST. The detection of DICER1 mutation is helpful for the differential diagnosis of ovarian SLCT. Synchronous DICER1 and FOXL2 mutation in the SLCT has been observed, and its significance needs to be further studied.

Objective To understand the serum gonadal hormone level of female patients with panic disorder(PD),and to analyze its relationship with the disease severity.Methods The chemiluminescence method was adopted to detect serum gonadal hormone level in 57 female patients with panic disorder and 74 healthy subjects,the panic disorder severity scale (PDSS),Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were simultaneously used to conduct the investigation.Results The serum pituitary prolactin (PRL) level in the female patients with PD had lower level was higher than that in the control group,the difference was statistically significant (P＜0.05);the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were lower than those in the control group(P＜0.05).The difference of the serum testosterone,estradiol and progesterone levels between the female patients with panic disorder and control group was not statistically significant (P＞0.05).The correlation analysis found that serum T level in the female patients with PD was negatively correlated with the disease severity of panic disorder,HAMD total score,retardation factor and sleep disorder factor (P＜0.05).Serum LH and FSH were positively correlated with the anxiety somatic factor of HAMA (P＜0.05).Serum FSH level was positively correlated with anxiety somatization and the sleep disorder factor of HAMD (P＜0.05).Conclusion The disorder of gonadal hormone levels may exist in the female patients with PD,and the serum T level is correlated with the PD severity and depressive symptoms.

Objective To explore the mediating effects of security on the severity of panic disorder and life events.Methods Security Questionnaire(SQ),life event scale(LES)were used to investigate 97 cases of patients with panic disorder and 108 cases of normal control group. The severity of panic disorder was assessed by panic disorder severity scale(PDSS).And the correlation and hierarchical regression analy-sis were used.Results ①The panic disorder patients' positive life stimulation(7.95±6.00)were less than that the normal control group's(18.06± 13.60),negative life stimulation and total life events stimulation ((36.64±29.98),(44.59±31.24))were higher than that of the normal control group(respectively(10.19± 7.89),(28.25±14.51)),the differences were statistically significant(all P<0.05).Panic disorder patients' interpersonal security certainty in control and total score(respectively(18.89 ± 8.66),(17.88 ± 7.58), (36.76±13.47))were lower than that the normal control group(respectively(26.64±9.33),(24.34±8.33), (50.98±15.31)),the differences were statistically significant(all P<0.01).②Severity of panic disorder and positive life events were negatively related to positive events,the total score of security,interpersonal securi-ty,certainty in control(r=-0.262--0.392);severity of panic disorder were positively related to the negative life stimulation and total life event(r=0.346,0.280)(all P<0.01).③Security played a partial mediating role between the negative life events and the severity of panic disorder(beta value decreased from 0.346 to 0.253).Conclusion The patients with panic disorder have more negative life events,lower security.And negative life events and lower security are related to the severity of panic disorder.And security plays a partial mediating effect between the negative life events and the severity of panic disorder.

Objective To explore the association between monoamine oxidase A (MAOA) variable number tandem repeat (VNTR) polymorphism and panic disorder,and then to compare panic disorder(PD) severity patient with different MAOA VNTR genotypes.Methods The structured clinical interview for the diagnostic and statistical manual of mental disorders fourth edition (DSM-Ⅳ) Axis I Disorders (SCID-1) was administered by a trained clinical psychiatrist,135 patients with PD and 195 healthy controls were recruited.MAOA-VNTR polymorphism were measured by fluorescent tags amplification product length polymorphism technology,Chi-square test was used to compare the distribution difference between each genotype and the allele frequency distribution.Results ①Whether male or female,there was no statistically significant difference between case group and healthy control group in the genotype and allele frequencies of MAOA-VN-TR polymorphism (x2=1.574,1.894,3.588;all P＜0.05).② There was no statistically significant difference between genotypes and panic disorder severity in the male with panic disorder ((14.46± 3.53),(14.15 ± 4.02);t=-0.247,P＞0.05).③)However,there was significant difference between genotypes and panic disorder severity in the female with panic disorder((13.15±3.47),(16.57±4.34),(15.27±4.91);F=4.222,P＜ 0.05).MAOA VNTR-L/L carriers experienced more serious panic (16.57 ± 4.34) than the patient with MAOA VNTR-H/H (13.15±3.47) (P＜0.01) by LSD multiple test.Conclusion No association between MAOA-VNTR polymorphism and panic disorder is found in Chinese Han population,but low activity homozygous genotype may be related to the severity of panic disorder in female patient with panic disorder.

SUMMARY Thehumanembryonicstemcells(hESCs)serveasaself-renewable,genetically-healthy, pluripotent and single source of all body cells,tissues and organs.Therefore,it is considered as the good standard for all human stem cells by US,Europe and international authorities.In this study,the standard and healthy human mesenchymal progenitors,ligament tissues,cardiomyocytes,keratinocytes,primary neurons,fibroblasts,and salivary serous cells were differentiated from hESCs.The human cellular health-safety of NaF,retinoic acid,5-fluorouracil,dexamethasone,penicillin G,adriamycin,lead ace-tate PbAc,bisphenol A-biglycidyl methacrylate (Bis-GMA)were evaluated selectively on the standar-dized platforms of hESCs,hESCs-derived cardiomyocytes,keratinocytes,primary neurons,and fibro-blasts.The evaluations were compared with those on the currently most adopted cellular platforms.Parti-cularly,the sensitivity difference of PM2.5 toxicity on standardized and healthy hESCs derived fibroblasts, currently adopted immortalized human bronchial epithelial cells Beas-2B and human umbilical vein endo-thelial cells (HUVECs)were evaluated.The results showed that the standardized hESCs cellular plat-forms provided more sensitivity and accuracy for human cellular health-safety evaluation.

Objective To assess the prevalence and severity of burnout in medical staffs,and investigate associated demographic,perceived social support and job burnout.Methods Totally 618 medical staffs form Sichuan province people's hospital were selected by the systematic sampling method,and were tested by general state questionnaire,job burnout questionnaire and perceived social support scale.Results ①The prevalence of job burnout was 75.6％,including mild job burnout (36.1％),moderate (32.2％),severe (7.3％).②The scores of emotional exhaustion in the female medical staffs(20.50±8.35) was higher than the male medical staffs (19.07±7.76,P＜0.05).Divorced medical staffs had higher scores(18.28±7.13) than that of single and married medical staffs (15.05±5.00) in low personal accomplishment (P＜ 0.01).The medical personnel of different ages were statistically significant difference in total job burnout scores,emotional exhaustion and depersonalisation (F=4.475,3.061,3.942,all P＜0.05).The medical personnel of different post,professional title and working years were statistically significant difference in total job burnout scores and emotional exhaustion (F=6.920,13.968; 3.506,3.391;3.190,3.300,all P＜ 0.05).The medical personnel of different educational attainment were statistically significant difference in total job burnout scores,emotional exhaustion and low personal accomplishment(F=6.218,2.837,2.850,all P＜0.05).)Correlation analysis found that emotional exhaustion,depersonalisation,low personal accomplishment and total job burnout respectively with family support,friend support,and other support and total social support was significantly negative correlation (r=-0.126～-0.403,P＜0.01).④Regression analysis showed that education,family and friends support were protective factors for total job burnout(OR=-0.248,95％ CI =0.625-0.975 ; OR=-0.084,95％ CI =0.862-0.980 ; OR=-0.091,95％ CI =0.860-0.968 ; all P＜0.05).Conclusion The prevalence of job burnout is high in medical staffs.The medical staffs of different sex,age,title,jobs,education,working years,marital status are showed the differences job burnout scores,which is closely related to the perceived social support.