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.

Schizophrenia is a chronic and debilitating mental disorder.Around 20%to 40%of patients do not respond well to normal antipsychotic medication,and are ultimately diagnosed with treatment-resistant schizophrenia(TRS),representing the most severe and challenging form of schizophrenia.Currently,clozapine is the standard treatment for TRS.Early identification and standardized treatment can be beneficial to patients with TRS by controlling acute-phase symptoms as soon as possible,reducing suicidal rate and improving their quality of life.Under the guidance of the Steering Committee,this consensus was formed after multiple discussions by 30 psychiatric experts and anonymous Delphi surveys including 17 consensus opinions on treatment-resistant schizophrenia,which cover risk factors and prevention,diagnosis and evaluation,standardized clozapine treatment and management of adverse reactions,treatment regimens for clozapine resistance and intolerance,and psychosocial intervention,etc.The consensus-making process also incorporated evidence-based medicine to help standardize and guide diagnosis and treatment for adults with TRS in China.

Psoriasis, a chronic, immune-mediated inflammatory disease characterized by hyperproliferation of keratinocytes, is difficult to cure and prone to relapse, often leading to systemic damage. Triptolide (TPL) can modulate cutaneous immune responses and inflammation, yet its therapeutic window is narrow with significant toxicity. To enhance skin targeting and retention of TPL while reducing systemic absorption and toxicity, a TPL/hyaluronic acid/phospholipid polymeric micelle (TPL/HA-DOPE) was constructed via HA's targeting of the CD44 receptor on skin cells. The prepared TPL/HA-DOPE exhibited a uniform spherical morphology with particle size of (130.4±1.23) nm, drug loading capacity of (19.74±0.084) %, and encapsulation efficiency of (85.53±1.34) %. Transdermal permeation studies in vitro and in vivo demonstrated that TPL/HA-DOPE not only enhanced uptake in HaCaT cells but also exhibited excellent skin retention. In a murine model of psoriasis, the TPL/HA-DOPE gel at the dose of 50 μg/(kg•d) showed the most significant improvement in erythema, scaling, and epidermal thickening. Histological analysis confirmed that TPL/HA-DOPE markedly reduced stratum corneum thickness, epidermal hyperplasia, and inflammatory cell infiltration. Ki67 immunostaining proved that its anti-inflammatory mechanism might be achieved by reducing the number of Ki67-positive cells and lowering the levels of inflammatory factors IL-6 and TNF-α. The above results demonstrate that HA-DOPE as a drug delivery carrier for the treatment of psoriasis-like skin diseases has high value of scientific research and good prospects for clinical application.

OBJECTIVE To investigate the effectiveness of different bacterial cleaning methods and their effects on the general condition,nasal mucosal and systemic inflammation of mice.METHODS A total of 44 mice were randomly divided into six groups:4-antibiotic per os group(4ABX po)with 7 mice,5-antibiotic oral gavage group(5ABX og)with 8 mice,5-antibiotic intranasal group(5ABX in)with 8 mice,and each of their control groups with 7 mice.Body weight,water intake,and peripheral blood routine test of mice were measured.Bacterial culture of nasal lavage fluid(NLF)was performed;mRNA level of inflammatory mediators and histopathological analysis were conducted with mouse nasal mucosa.RESULTS Bacteria were cultured from all control groups,while Bacteria were cultured from all control groups,while one mouse in the 4ABX po group,three mice in the 5ABX og group,and two mice in the 5ABX in group showed no bacterial growth.The number of goblet cells in the nasal mucosa significantly increased in the 5ABX og group compared with its control group(P<0.05).The 5ABX in group exhibited significantly higher counts of peripheral blood lymphocytes and hemoglobin levels,as well as greater nasal mucosal thickness compared with its control group,with a notable decrease in goblet cells(P<0.05).No statistical differences were observed in body weight or the mRNA expression of nasal mucosal inflammatory mediators.CONCLUSION Different combinations of antibiotics and administration routes have varying effects on nasal bacteria,systemic and nasal mucosal inflammation in mice.Therefore,choosing appropriate protocols is crucial for the progression of subsequent research.

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 explore the clinical value in the diagnosis of allergic rhinitis (AR) by analyzing levels of 12 cytokines in plasma and nasal local eosinophil in patients with AR and non-allergic rhinitis (NAR), and to construct a diagnostic model based on logistic regression, providing a novel method for rapid and precise diagnosis of AR.Methods:A retrospective cross-sectional study was conducted on patients with AR symptoms who underwent plasma cytokine testing at Beijing Tongren Hospital from January 1 to December 31, 2024. Patients were grouped based on serological test results into AR Group ( n=395) and NAR Group ( n=185), including 205 children (<18 years) and 375 adults (≥18 years). Plasma levels of 12 cytokines, including interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12P70, IL-17A, tumor necrosis factor (TNF)-α, interferon (IFN)-α, and IFN-γ, were measured using multiplex microsphere flow cytometric immunofluorescence. Nasal eosinophil levels were assessed through nasal secretion cell testing. Clinical characteristics of AR and NAR patient population were analyzed using Mann-Whitney U test, and the correlations between cytokine levels and nasal eosinophils was analyzed using Spearman′s test. Logistic regression was used to screen predictors and to construct an AR diagnosis model, whose predictive ability and efficacy were demonstrated through receiver operating characteristic (ROC) curves and nomograms. Results:Significant differences were observed in total IgE (tIgE) and Phadiatop (Phad) between AR and NAR patients in both children ( U=?7.799, P<0.001; U=?8.296, P<0.001) and adults ( U=?12.630, P<0.001; U=?13.810, P<0.001). Nasal eosinophil levels were higher in AR patients ( Z=?4.592, P<0.001) compared with that in NAR patients. In children, significant differences were found in IL-4, IL-5, and IL-10 levels between AR and NAR patients ( P<0.05), while in adults, only IL-10 levels differed significantly ( P<0.05). Nasal local eosinophil levels were weakly positively correlated with plasma IL-5 ( ρ=0.166, P<0.001) and IFN-γ ( ρ=0.132, P=0.002). Based on logistic regression, the adult AR diagnosis model included age, local eosinophil levels, and IL-10, with an AUC of 0.709, sensitivity of 73.9%, and specificity of 57.4%, outperforming single-indicator diagnosis. High and moderate eosinophil levels were risk factors for AR(compared with low levels: moderate level OR=3.072, P<0.001; compared with high level OR=15.136, P<0.001), while age and IL-10 levels were protective factors (age OR=0.572, P=0.002; IL-10 OR=0.535, P=0.003). Conclusions:AR patients exhibit an immune response characterized by increased T helper 2 cell (Th2) cytokines (IL-4, IL-5) and decreased IL-10, with significantly higher nasal local eosinophils levels than NAR patients. The logistic regression model based on age, local eosinophil level, and IL-10 provides a new tool for the precise diagnosis of AR.

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.

A case report of adult skeletal class Ⅲ patient with high angle open bite is presented in this article.The patient underwent extraction of bilateral mandibular first molars and straightening the third molars,open bite was resolved,normal over bite,over jet and good occlusion were established.

Schizophrenia is a chronic and debilitating mental disorder.Around 20%to 40%of patients do not respond well to normal antipsychotic medication,and are ultimately diagnosed with treatment-resistant schizophrenia(TRS),representing the most severe and challenging form of schizophrenia.Currently,clozapine is the standard treatment for TRS.Early identification and standardized treatment can be beneficial to patients with TRS by controlling acute-phase symptoms as soon as possible,reducing suicidal rate and improving their quality of life.Under the guidance of the Steering Committee,this consensus was formed after multiple discussions by 30 psychiatric experts and anonymous Delphi surveys including 17 consensus opinions on treatment-resistant schizophrenia,which cover risk factors and prevention,diagnosis and evaluation,standardized clozapine treatment and management of adverse reactions,treatment regimens for clozapine resistance and intolerance,and psychosocial intervention,etc.The consensus-making process also incorporated evidence-based medicine to help standardize and guide diagnosis and treatment for adults with TRS in China.

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.