OBJECTIVE: To investigate the association between long-term glycemic control and cerebral infarction risk in patients with diabetes through a large-scale cohort study. METHODS: This prospective, community-based cohort study included 12,054 patients with diabetes. From 2006 to 2012, 38,272 fasting blood glucose (FBG) measurements were obtained from these participants. FBG trajectory patterns were generated using latent mixture modelling. Cox proportional hazards models were applied to assess the subsequent risk of cerebral infarction associated with different FBG trajectory patterns. RESULTS: At baseline, the mean age of the participants was 55.2 years. Four distinct FBG trajectories were identified based on FBG concentrations and their changes over the 6-year follow-up period. After a median follow-up of 6.9 years, 786 cerebral infarction events were recorded. Different trajectory patterns were associated with significantly varied outcome risks (Log-Rank P < 0.001). Compared with the low-stability group, Hazard Ratio ( HR) adjusted for potential confounders were 1.37 for the moderate-increasing group, 1.23 for the elevated-decreasing group, and 2.08 for the elevated-stable group. CONCLUSION Sustained high FBG levels were found to play a critical role in the development of ischemic stroke among patients with diabetes. Controlling FBG levels may reduce the risk of cerebral infarction.
Humans ; Cerebral Infarction/blood* ; Middle Aged ; Male ; Female ; Blood Glucose/analysis* ; Fasting/blood* ; Aged ; Prospective Studies ; Risk Factors ; Diabetes Mellitus/blood* ; Adult ; Proportional Hazards Models

As a member of the Citrus genus of the Rutaceae family, Citrus changshan-huyou(CSHY) is mainly produced in Quzhou city, Zhejiang province. Modern research shows that different medicinal parts of CSHY(immature fruit, mature fruit peel, flower buds, leaves, seeds, etc.) are abundant in flavonoids, terpenes, coumarins, phenolic acids, and volatile oils. Their pharmacological activities include respiratory system protection, liver protection, anti-inflammation, anti-hyperlipidemia, anti-hyperglycemia, and antioxidation. Based on the summarization of 374 chemical components in different medicinal parts of CSHY identified in the past 20 years, this study reviewed their pharmacological actions and mechanisms and further analyzed the current status of quality control of different medicinal parts of CSHY, aiming to provide reference for the resource development and exploitation and the quality control research of different medicinal parts of CSHY.
Citrus/chemistry* ; Drugs, Chinese Herbal/pharmacology* ; Humans ; Plants, Medicinal/chemistry* ; Quality Control ; Animals

AIM To establish an HPLC method for the simultaneous content determination of 5-hydroxymethylfurfural,chlorogenic acid,caffeic acid,strychnine,paeoniflorin,ferulic acid,paeoniflorin Ⅰ,epimedium glycoside,psoralen,isopsoralen and glycyrrhetinic acid in Bunao Soft Capsules.METHODS The analysis was performed on a 35 ℃ thermostatic Waters Symmetry C18 column(250 mm×4.6 mm,5 μm),with the mobile phase comprising of acetonitrile-0.1％phosphoric acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelengths were set at 230,280 nm.RESULTS Eleven constituents showed good linear relationships within their own ranges(r＞0.999 0),whose average recoveries were 98.47％-103.30％with RSDs of 1.13％-2.80％.CONCLUSION This simple and reliable method can be used for the quality control of Bunao Soft Capsules.

Objective:To analyze the factors associated with prolonged hospital stay in patients with mycoplasma pneumoniae pneumonia (MPP) and construct an early identification model.Methods:A case-control study was conducted on 503 newly diagnosed pediatric patients with MPP who received treatment at Suzhou Municipal Hospital from April to December 2023. Clinical data were collected. Patients were divided into an observation group ( n = 240, hospital stay > 8 days) and a control group ( n = 263, hospital stay ≤ 8 days). Logistic regression analysis was used to identify the independent factors that affect hospital stay in the observation group. A Nomogram model was constructed. Results:The incidence of lobar pneumonia in the observation group was significantly higher than that in the control group [62.5% (150/240) vs. 22.4% (59/263), χ2 = 82.94, P < 0.001]. The mean age of the observation group was significantly higher than that in the control group [5.0 (3.0, 7.0) years vs. 4.0 (2.0, 6.0) years, Z = 2.40, P = 0.016]. The hypersensitive C-reactive protein level in the observation group was significantly higher than that in the control group [10.5 (4.8, 22.0) mg/L vs. 6.1 (1.8, 14.2) mg/L, Z = 5.16, P < 0.001]. The ferritin level in the observation group was significantly higher than that in the control group [225.3 (180.9, 271.3) μg/L vs. 177.7 (138.0, 222.0) μg/L, Z = 6.31, P < 0.001]. The albumin level in the observation group was significantly lower than that in the control group [43.7 (41.0, 46.2) g/L vs. 44.4 (42.3, 46.5) g/L, Z = 2.45, P = 0.014]. The total protein level in the observation group was significantly lower than that in the control group [70.0 (66.8, 73.0) g/L vs. 71.5 (67.8, 74.6) g/L, Z = 2.45, P = 0.014]. The lactate dehydrogenase level in the observation group was significantly higher than that in the control group [337.5 (301.5, 391.8) U/L vs. 291.0 (258.0, 332.3) U/L, Z = 3.28, P = 0.001]. The creatine kinase level in the observation group was significantly lower than that in the control group [77.5 (55.3, 115.8) U/L vs. 89.0 (65.0, 126.0) U/L, Z = 2.75, P = 0.006]. The fibrinogen level in the observation group was significantly higher than that in the control group [4.3 (3.4, 4.8) g/L vs. 3.8 (3.0, 4.6) g/L, Z = 4.17, P < 0.001]. After performing univariate binary logistic regression using the glm method to screen variables, multivariate binary logistic regression was conducted. The results showed that the presence of lobar pneumonia, higher levels of hypersensitive C-reactive protein, ferritin, and lactate dehydrogenase were independent risk factors for prolonged hospital stays in children with MPP [ OR (95% CI): 3.803 (2.029,7.129), 0.986 (0.974,0.998), 0.994 (0.990,0.998), 0.989 (0.985,0.993), P < 0.001, 0.027, 0.002, < 0.001]. Conclusions:Based on the fundamental clinical laboratory indicators, an early prediction model was constructed for predicting prolonged hospital stay in children with MPP. This model provides a scientific basis for the early assessment of MPP in children and is suitable for broader application.

AIM To establish an HPLC method for the simultaneous content determination of 5-hydroxymethylfurfural,chlorogenic acid,caffeic acid,strychnine,paeoniflorin,ferulic acid,paeoniflorin Ⅰ,epimedium glycoside,psoralen,isopsoralen and glycyrrhetinic acid in Bunao Soft Capsules.METHODS The analysis was performed on a 35 ℃ thermostatic Waters Symmetry C18 column(250 mm×4.6 mm,5 μm),with the mobile phase comprising of acetonitrile-0.1％phosphoric acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelengths were set at 230,280 nm.RESULTS Eleven constituents showed good linear relationships within their own ranges(r＞0.999 0),whose average recoveries were 98.47％-103.30％with RSDs of 1.13％-2.80％.CONCLUSION This simple and reliable method can be used for the quality control of Bunao Soft Capsules.

Objective:To analyze the factors associated with prolonged hospital stay in patients with mycoplasma pneumoniae pneumonia (MPP) and construct an early identification model.Methods:A case-control study was conducted on 503 newly diagnosed pediatric patients with MPP who received treatment at Suzhou Municipal Hospital from April to December 2023. Clinical data were collected. Patients were divided into an observation group ( n = 240, hospital stay > 8 days) and a control group ( n = 263, hospital stay ≤ 8 days). Logistic regression analysis was used to identify the independent factors that affect hospital stay in the observation group. A Nomogram model was constructed. Results:The incidence of lobar pneumonia in the observation group was significantly higher than that in the control group [62.5% (150/240) vs. 22.4% (59/263), χ2 = 82.94, P < 0.001]. The mean age of the observation group was significantly higher than that in the control group [5.0 (3.0, 7.0) years vs. 4.0 (2.0, 6.0) years, Z = 2.40, P = 0.016]. The hypersensitive C-reactive protein level in the observation group was significantly higher than that in the control group [10.5 (4.8, 22.0) mg/L vs. 6.1 (1.8, 14.2) mg/L, Z = 5.16, P < 0.001]. The ferritin level in the observation group was significantly higher than that in the control group [225.3 (180.9, 271.3) μg/L vs. 177.7 (138.0, 222.0) μg/L, Z = 6.31, P < 0.001]. The albumin level in the observation group was significantly lower than that in the control group [43.7 (41.0, 46.2) g/L vs. 44.4 (42.3, 46.5) g/L, Z = 2.45, P = 0.014]. The total protein level in the observation group was significantly lower than that in the control group [70.0 (66.8, 73.0) g/L vs. 71.5 (67.8, 74.6) g/L, Z = 2.45, P = 0.014]. The lactate dehydrogenase level in the observation group was significantly higher than that in the control group [337.5 (301.5, 391.8) U/L vs. 291.0 (258.0, 332.3) U/L, Z = 3.28, P = 0.001]. The creatine kinase level in the observation group was significantly lower than that in the control group [77.5 (55.3, 115.8) U/L vs. 89.0 (65.0, 126.0) U/L, Z = 2.75, P = 0.006]. The fibrinogen level in the observation group was significantly higher than that in the control group [4.3 (3.4, 4.8) g/L vs. 3.8 (3.0, 4.6) g/L, Z = 4.17, P < 0.001]. After performing univariate binary logistic regression using the glm method to screen variables, multivariate binary logistic regression was conducted. The results showed that the presence of lobar pneumonia, higher levels of hypersensitive C-reactive protein, ferritin, and lactate dehydrogenase were independent risk factors for prolonged hospital stays in children with MPP [ OR (95% CI): 3.803 (2.029,7.129), 0.986 (0.974,0.998), 0.994 (0.990,0.998), 0.989 (0.985,0.993), P < 0.001, 0.027, 0.002, < 0.001]. Conclusions:Based on the fundamental clinical laboratory indicators, an early prediction model was constructed for predicting prolonged hospital stay in children with MPP. This model provides a scientific basis for the early assessment of MPP in children and is suitable for broader application.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

The identification of the components absorbed in serum of platycosides in total saponins fraction of Platycodonis Radix is great significance, but there are still great challenges. In this study, 8 types of 44 primordial components from Platycodon saponins were firstly identified using the ultra-performance liquid chromatography-linear ion trap electrostatic field orbitrap high resolution mass spectrometry (UPLC-LTQ-Orbitrap-MS) equipped with the software of Compound Discoverer 3.2 and Trace finder 2.1. Then, the platycosides and their deglycosylated metabolites were used as the template molecules to construct the intestinal microbiota mediated method to identify the primary components and the prototypes in serum. As results, 57 components originating from 44 prototypes of platycosides were identified from drug-containing plasma. Those compounds consist of 12 prototypes of platycosides and 45 metabolites, while the prototypes in serum are also deglycosylated metabolites of other platycosides. The results showed that the intestinal microbiota mediated method could be applied to identify the metabolites of platycosides in total saponins fraction of Platycodonis Radix; and reveal the potential existing forms of prototypes of platycosides in plasma; In addition, it could clearly illustrate the one to many and many to one network of the prototypes and metabolites of platycosides. All animal protocols were approved by the Animal Ethics Committee of Jiangxi University of Traditional Chinese Medicine (No.JZLLSC-202100322).

Objectives:This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence navigation in laparoscopic lateral pelvic lymph node dissection (LLND) and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes (LPLNs).Methods:The clinical and pathological characteristics, surgical outcomes, lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed. The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement (MRI showed the maximum short axes of the LPLNs were ≥5 mm and <10 mm at first visit).Results:All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND. Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND. The lateral pelvic sentinel lymph nodes (SLNs) were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%. Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations. Among the 14 patients in whom lateral pelvic SLNs were detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs. The specificity, sensitivity, negative predictive value, and accuracy was 85.7%, 100%, 100%, and 100%, respectively.Conclusions:This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy. This technique may replace preventive LLND for locally advanced lower rectal cancer.

Objective To observe the efficacy and safety of Morinda officinalis oligosaccharides in the continuation treatment of mild and moderate depression.Methods An open,single-arm,multi-center design was adopted in our study.Adult patients with mild and moderate depression who had received acute treatment of Morinda officinalis oligosaccharides were enrolled and continue to receive Morinda officinalis oligosaccharides capsules for 24 weeks,the dose remained unchanged during continuation treatment.The remission rate,recurrence rate,recurrence time,and the change from baseline to endpoint of Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Clinical Global Impression-Severity(CGI-S)and Arizona Sexual Experience Scale(ASEX)were evaluated.The incidence of treatment-related adverse events was reported.Results The scores of HAMD-17 at baseline and after treatment were 6.60±1.87 and 5.85±4.18,scores of HAMA were 6.36±3.02 and 4.93±3.09,scores of CGI-S were 1.49±0.56 and 1.29±0.81,scores of ASEX were 15.92±4.72 and 15.57±5.26,with significant difference(P＜0.05).After continuation treatment,the remission rate was 54.59％(202 cases/370 cases),and the recurrence rate was 6.49％(24 cases/370 cases),the recurrence time was(64.67±42.47)days.The incidence of treatment-related adverse events was 15.35％(64 cases/417 cases).Conclusion Morinda officinalis oligosaccharides capsules can be effectively used for the continuation treatment of mild and moderate depression,and are well tolerated and safe.