Objective To investigate the characteristics of executive function impairment in patients with chronic insomnia disorder and its correlation with Objective sleep structure parameters. Methods A total of 92 patients who met the DSM-5 diagnostic criteria for chronic insomnia disorder were enrolled as chronic insomnia disorder group， and 45 healthy controls were enrolled as healthy control group. All subjects underwent assessments for anxiety and depression， overnight polysomnography， and executive function， and the two groups were compared in terms of sleep parameters （including sleep latency， sleep efficiency， total sleep time， sleep stages， and the proportion of each stage） and executive function （Stroop Color-Word Test， digit span test， and trail making test）， as well as the correlation between these parameters. Results Compared with the healthy control group， the chronic insomnia disorder group had significant increases in Stroop Card C completion time， Stroop interference effect， trail making test-B completion time， and trail making test B-A time difference and significant reductions in the score of digit span backward task and the total score of digit span test （P<0.05）. The correlation analysis showed that total sleep time， sleep efficiency， NREM stage 3 duration， and the proportion of NREM stage 3 were negatively correlated with Stroop Card C completion time， Stroop interference effect， trail making test-B completion time， and trail making test B-A time difference and were positively correlated with the score of digit span backward task and the total score of digit span test （P<0.05）. Conversely， NREM stage 1 duration and the proportion of NREM stage 1 were positively correlated with Stroop Card C completion time， Stroop interference effect， trail making test-B completion time， and trail making test B-A time difference and were negatively correlated with the score of digit span backward task （P<0.05）. Conclusion Patients with chronic insomnia disorder exhibit executive function impairment in multiple dimensions including inhibitory control， working memory， and cognitive flexibility， which are associated with the reductions in sleep efficiency and deep sleep.

OBJECTIVE To establish a full-cycle management model for type 2 diabetes mellitus （T2DM） patients led by clinical pharmacists. METHODS Based on literature research， a basic framework and items of full-cycle management model led by clinical pharmacists were initially formulated. The Delphi method was adopted to conduct questionnaire inquiries among 26 experts to determine the specific implementation items of the model. The analytic hierarchy process （AHP） method was used to determine the weight values of items at all levels， and the reliability and validity of the model items were analyzed. RESULTS The recovery rates of the two rounds of expert consultation questionnaires were 86.67% and 100%， respectively， and the expert authority coefficient was 0.88. Kendall’s concordance coefficients of the tertiary-level items were 0.064 and 0.084， respectively， and the P values from the χ 2 tests were all less than 0.05； the consistent ratios of the judgment matrices for all levels of AHP model were all less than 0.1. The established full-cycle management led by clinical pharmacists comprised three primary-level items （pharmacy service pathway for T2DM patients during hospitalization， pharmacy management pathway for hypoglycemia in T2DM inpatients， and the pharmacy follow-up pathway for T2DM discharged patients， with weights of 0.098， 0.568 and 0.334， respectively）， twelve secondary-level items （e.g. pharmaceutical care during hospitalization for 1 to 2 days， admission assessment and education， with weights ranging from 0.143 to 0.333） and thirty-seven tertiary-level items （e.g. assessment of medication compliance， verification of the medication plan for discharge， with weights ranging from 0.068 to 0.750）. Cronbach’s α coefficients for primary-level items and the overall questionnaire were 0.762， 0.879， 0.928 and 0.951， respectively. The item-level and scale-level content validity indexes were 0.967 and 0.808， respectively. CONCLUSIONS A full-cycle management model for T2DM patients led by clinical pharmacists has been constructed successfully， demonstrating high scientificity and reliability.

Nasopharyngeal carcinoma （NPC） is a malignant tumor originating from the mucosal epithelium of the nasopharynx. In recent years， its incidence and mortality rates have shown a continuous upward trend， and there is still a lack of therapeutic regimens with both favorable efficacy and safety in clinical practice. Mitogen-activated protein kinase （MAPK） signaling pathway plays a key regulatory role in biological processes such as cell proliferation， differentiation， apoptosis and invasion. It is widely involved in the occurrence and progression of NPC， and serves as an important target in the research field of anti-NPC therapy. This article systematically elaborates on the mechanism of action of the MAPK signaling pathway in NPC， and reviews the research status regarding the anti-NPC effect of active components of traditional Chinese medicine （TCM） and TCM compound prescriptions by regulating this signaling pathway. The results show that TCM active components， including flavonoids （luteolin， maackiain， baicalein， etc.）， alkaloids （picrasidine Ⅰ， tetrandrine， etc.）， terpenoids （bakuchiol， cantharidic acid）， as well as traditional Chinese medicine compound formulas （such as Biyan jiedu capsules and Yiqi jiedu formula） can exert effects including inducing autophagy and apoptosis of NPC cells， promoting pyroptosis， reversing drug resistance， blocking epithelial-mesenchymal transition， weakening cell stemness and arresting cell cycle progression by regulating the MAPK signaling pathway， thereby inhibiting the occurrence and development of NPC through multiple pathways.

Currently, the quality control of traditional Chinese medicine (TCM) encounters substantial technical challenges, necessitating the urgent development of innovative evaluation methods for key quality attributes. This study proposes the construction of a quality assurance system centered on key quality attributes, with systems biology and chemical biology serving as its core components: utilizing multi-omics technologies to systematically analyze the core functional modules of TCM, integrating pharmacological approaches to precisely identify key bioactive components; applying chemical biology to elucidate the interaction mechanisms between components and their targets, while screening for quality markers associated with specific functions and clinical indications; establishing an integrated quality control system based on quality markers and biological potency to ensure comprehensive quality management from raw herb materials through to finished products. Additionally, it emphasizes the formulation of compatibility rules grounded in TCM theory, integrates clinical practice and multi-dimensional value assessments, and establishes a novel quality evaluation model with distinct TCM characteristics.This offers a comprehensive and systematic approach to ensuring the safety and efficacy of TCM while facilitating the high-quality development of the TCM industry.

Background: Adrenocortical hormones, particularly 11-oxygenated androgens, are pivotal in female reproductive health and fertility. Standardized detection kits and population-specific reference intervals are lacking in China, hindering related clinical applications. Methods: A HPLC-tandem mass spectrometry (HPLC-MS/MS) pipeline was developed, rigorously validated, and applied to simultaneously quantify corticosterone, cortisone, cortisol, 18-OH cortisol, androstenedione (A4), 11β-hydroxyandrostenedione (11-OH A4), dehydroepiandrosterone, and dehydroepiandrosterone sulfate in serum samples from 455 reproductive-aged women (18–45 yrs) in Guangxi, China. Age-dependent concentration trends were analyzed, and reference intervals stratified by age (2.5th to 97.5th percentiles) were established. Correlations with body-composition metrics, ethnicity, and the menstrual cycle were investigated. Results: The HPLC-MS/MS method demonstrated high precision (intra- and inter-assay CVs < 15%), accuracy, and sensitivity. All eight hormones exhibited significant age-related declines (P < 0.001 for seven hormones; P = 0.001 for 11-OH A4). Notably, 11-OH A4 levels were significantly lower in the 35–45-yr (3.05 nmol/L) and 25–34-yr (3.09 nmol/L) age groups than in the 18–24-yr (3.57 nmol/L) age group, whereas no significant difference was observed between the 35–45-yr and 25–34-yr age groups. Weak negative correlations were observed between the body mass index and corticosterone and cortisone levels, whereas ethnicity and the menstrual cycle showed no significant associations with hormone levels. Conclusions We developed an HPLC-MS/MS-based method for simultaneously quantifying eight adrenocortical hormones, including 11-OH A4, and defined age-specific reference intervals for reproductive-aged Chinese women. These findings advance the clinical utility of adrenocortical hormones in diagnosing and managing reproductive disorders.

Objective: This prospective study evaluated the feasibility of chemical exchange saturation transfer (CEST) MRI for assessing disease activity in thyroid-associated ophthalmopathy (TAO). Materials and Methods: A total of 88 patients with active TAO, 76 with inactive TAO, and 30 healthy controls were enrolled. CEST MRI-derived magnetization transfer ratio (MTR) and MTR asymmetry (MTRasym) at 1 ppm, 2 ppm, and 3.5 ppm were calculated. Clinical data, MTR, and MTRasym values for the extraocular muscles (one representative muscle per eye, yielding two measurements per participant) were compared among the groups. Spearman’s correlation was used to examine associations between imaging parameters and the clinical activity score (CAS) in patients with TAO. Logistic regression analysis was used to identify independent associations between imaging parameters and disease activity in patients with TAO (active vs. inactive). Receiver operating characteristic (ROC) analysis was conducted to evaluate the diagnostic performance for discriminating active from inactive TAO. Results: Patients with active TAO showed lower MTR values (P < 0.001) and higher MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) (all P < 0.001) compared with those with inactive TAO. MTR was negatively correlated with CAS (r = -0.402; P < 0.001), while MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) were positively correlated with CAS (r = 0.369, 0.350, and 0.349, respectively;all P < 0.001). MTR and MTRasym (1 ppm) were independently associated with TAO activity. The areas under the ROC curve (AUCs) for MTR and MTRasym (1 ppm) in discriminating active from inactive TAO were 0.772 and 0.730, respectively. Combining MTR with MTRasym (1 ppm) significantly improved diagnostic performance compared with either parameter alone, achieving an AUC of 0.805 (P = 0.029 and 0.001). Conclusion MTR and MTRasym (1 ppm) were independently associated with TAO activity. Their combination further enhanced diagnostic performance in distinguishing active from inactive TAO, suggesting their potential as quantitative imaging biomarkers to guide treatment in patients with TAO.

Objective To explore the effect and mechanism of Slc1a2 overexpression on cognitive dysfunction in sleep-deprived mice.Methods A total of 130 mice were divided into five groups:normal sleep(NS),NS+ov-Slc1a2,sleep deprivation(SD),SD+ov-NC,and SD+ov-Slc1a2,with 26 mice in each group.The SD mice model was established using an automatic system based on a rotating rod,and overexpress Slc1a2 adenovirus was injected into the prefrontal cortex(PFC).Immunofluorescence and Western blotting were used to detect the expression of Slc1a2 in the mouse PFC.Electrophysiological tests were used to evaluate non-rapid eye movement(NREM)sleep time,rapid eye movement(REM)sleep time,and wakefulness time in mice.Real-time quantitative PCR was used to detect the expression of glutamate(Glu)and gamma-aminobutyric acid(GABA)metabolic enzymes in the mouse PFC.Whole-cell patch-clamp recording was used to detect the frequency and amplitude of miniature excitatory postsynaptic currents(mEPSC)in mouse PFC.Immunofluorescence was used to detect the proportion of GABA-positive cells in the mouse PFC.The C11-BODIPY fluorescent probe was used to detect lipid reac-tive oxygen species(ROS)levels in mouse PFC.Commercial kits were used to detect Fe2+and malondialdehyde(MDA)levels in the mouse PFC.Cognitive function in mice was evaluated using the open field,novel object recognition,and Y-maze tests.Results Compared with the NS group,the NREM sleep time,REM sleep time,central area stay time,recognition index,and novel wall selection index increased significantly,while wakefulness time decreased significantly in the NS+ov-Slc1a2 group(all P＜0.05).The percentage of Slc1a2+GFAP+cells,expression of Slc1a2 protein,expression of Glul,Slc6a1,and Abat mRNA,frequency and amplitude of mEPSC,and proportion of GABA-positive cells in the PFC increased significantly,whereas lipid ROS,Fe2+,and MDA levels decreased significantly(all P＜0.05).Compared with the NS group,the NREM sleep time,REM sleep time,central area stay time,recognition index,and novel wall selection index of the SD group and the SD+ov-NC group were significantly decreased,whereas wakefulness time was significantly increased(all P＜0.05).The percentage of Slc1a2+GFAP+cells,expression of Slc1a2 protein,expression of Glul,Slc6a1,and Abat mRNA,frequency and amplitude of mEPSC,and proportion of GABA-positive cells in the mouse PFC decreased significantly,whereas lipid ROS,Fe2+,and MDA levels increased significantly(all P＜0.05).Compared with the SD and SD+ov-NC groups,the NREM sleep time,REM sleep time,central area stay time,recognition index,and novel wall selection index of the SD+ov-Slc1a2 group increased significantly,whereas the wakeful-ness time decreased significantly(all P＜0.05).The percentage of Slc1a2+GFAP+cells,the expression of Slc1a2 protein,the expression of Glul,Slc6a1,and Abat mRNA,the frequency and amplitude of mEPSC,and the proportion of GABA-positive cells in the mouse PFC increased significantly,whereas lipid ROS,Fe2+,and MDA levels decreased significantly(all P＜0.05).Conclusion Ectopic overexpres-sion of Slc1a2 in the PFC can improve sleep disorders in SD mice,reduce the damage caused by SD to excitatory synaptic transmission and GABAergic neuron function in the PFC,and alleviate cognitive impairment and anxiety-like behavior in these mice.Its mechanism may be related to the improvement of Glu/GABA metabolic imbalance in the PFC and inhibition of ferroptosis.

Objective To summarize and analyze the main clinical characteristics,feature and composition changes of gut microbiota in elderly patients with severe pneumonia,and to further explore the potential correlation between the gut characteristics and the etiology of severe pneumonia in elderly patients.Methods Patients with severe pneu-monia admitted to the respiratory intensive care unit of a tertiary teaching hospital in Changsha were selected as the research subjects.Patients aged ≥65 years were assigned to the elderly severe pneumonia group,while those aged＜65 years were assigned to the non-elderly severe pneumonia group.Based on clinical characteristics and pathogen detection of lower respiratory secretion,the elderly severe pneumonia group was further divided into a pulmonary bacterial infection group and a pulmonary fungal infection group.The pulmonary bacterial infection group was sub-divided into Gram-positive bacteria group and Gram-negative bacteria group based on Gram-staining results.Clinical data of patients were collected,and fecal specimens within 24 hours after admission were obtained for 16S rRNA se-quencing.Differences in gut microbiota characteristics between two groups of patients were compared,and the cor-relation between clinical characteristics of patients in the elderly severe pneumonia group and the abundance of dif-ferential microbiota was analyzed.Subsequently,the gut microbiota characteristics of elderly patients in severe pneumonia group infected by different pathogens were analyzed.Results Gut microbiota analysis showed no signifi-cant statistical differences in α-and β-diversity indicices between patients in the elderly and non-elderly severe pneu-monia groups(both P＞0.05).Linear discriminant analysis effect size(LEFSe)analysis indicated that,compared with patients in the non-elderly severe pneumonia group,the relative abundance of opportunistic pathogens,inclu-ding Pseudomonadales,Moraxellaceae,and Acinetobacter,was significantly higher in patients in the elderly severe pneumonia group(all P＜0.05).Some differential gut microbiota in two groups of patients were correlated with clinical indicators in patients in the elderly severe pneumonia group(all P＜0.05).β-diversity analysis(principal co-ordinate analysis)combined with Anosim analysis revealed that in patients in elderly severe pneumonia group,there was significant differences in gut colony structures between patients in the bacterial and fungal infection groups(R=0.149,P=0.02).Compared with the fungal infection group,patients in bacterial infection group showed a signifi-cantly reduced abundance of probiotics,including Verrucomicrobiales and Collinsella,and opportunistic pathogens such as Akkermansia(all P＜0.05).Conclusion Elderly patients with severe pneumonia have a dysregulated gut microbiota with significantly increased abundance of pathogenic bacteria compared with non-elderly patients.Differ-ential gut microbiota of two groups of patients are correlated with some infection-related and organ function indica-tors in elderly patients with severe pneumonia.Compared with elderly patients with severe fungal pneumonia,those with severe bacterial pneumonia have significant differences in gut colony structures and a notably reduction in probi-otics abundance.

Objective To develop a risk management system for complications associated with peripheral venous indwelling needles and to evaluate its application effect in order to reduce the risk of related complications.Methods We designed a comprehensive risk management system for peripheral intravenous indwelling needle complications,integrating specialized evidence-based guidelines with clinical practice insights,including 5 modules:intelligent assessment and decision support,intelligent inspection reminders,educational modules,collaborative case management procedures,and a knowledge base.Patients admitted to the neurology and internal classification metabolism departments of a tertiary hospital in Jilin Province were conveniently selected as the research subjects.Patients were assigned to a control group(from May to July 2022,before the implementation of the system)and an experimental group(from September to December 2022,after the implementation of the system).The incidence of complications,duration of indwelling needle,compliance rate of core indicators for nursing quality and number of nursing consultations were compared between the groups.Additionally,a self-administered questionnaire was used to assess clinical nurses'evaluations of the system.Results A total of 189 patients were included in the experimental group and 177 patients in the control group.The incidence of complications associated with peripheral intravenous indwelling needles was lower than that in the control group.The duration of indwelling peripheral intravenous needles was longer than that in the control group.The quality compliance rate of peripheral venous indwelling needle care in the experimental group was higher than that in the control group,and the number of consultation cases in the experimental group was higher than that in the control group.Comparisons between the 2 groups showed statistically significant differences for all indicators(P＜0.05).The nurses'recognition rates for the system's user-friendliness,professional guidance,and patient benefit were 77.78％,81.74％,and 82.13％,respectively.Conclusion The application of a peripheral vein indwelling needle complication risk management system can reduce the incidence of complications,prolong the duration of indwelling,and improve nursing quality.Nurses have a high recognition of this system.

Objective To investigate the clinical value of metagenomic next-generation sequencing(mNGS)in the detection of pathogenic microorganisms in pediatric infectious diseases and to analyze the clinical characteristics of relevant cases.Methods A retrospective analysis was conducted on 30 pediatric patients who underwent mNGS pathogen detection in Hangzhou Red Cross Hospital from January 2023 to January 2024,along with 30 patients who did not undergo mNGS testing as the control group.Clinical information,including age,gender,hospital stay,symptoms and signs,routine blood tests,C-reactive protein(CRP),imaging findings,mNGS pathogen detection results,and patient outcomes,was collected.The differences between mNGS and conventional microbiological testing(CMT)results were compared,and the impact of mNGS testing on infection treatment and hospitalization duration was analyzed.Results Among the 30 patients who underwent mNGS testing,21 were male and 9 were female;with an age range of 1 year 5 months to 12 years 9 months,mean age:(7.15±3.13)years.The mNGS test identified 9 viruses,10 Gram-positive bacteria,5 Gram-negative bacteria,3 fungi,and 5 specific pathogens.Based on the test results,12 patients had their anti-infective treatment plans adjusted,with an average hospital stay of(10.63±3.15)days.In the control group,7 patients had their treatment plans adjusted,with an average hospital stay of(12.64±2.79)days.The average hospital stay was significantly shorter in the mNGS group compared to the control group(P<0.05).Conclusions The clinical symptoms and signs of pediatric infectious diseases often lack specificity,and CMT methods are suboptimal.mNGS exhibits high sensitivity for pathogen detection and demonstrates significant value in etiological diagnosis and therapeutic guidance when CMT fails to identify pathogens.However,interpretation of mNGS results requires integration with clinical presentations and other auxiliary diagnostic findings.