Objective: To explore the relationship of family function with sleep and externalizing problem behaviors of preschool children, so as to provide a guidance for externalizing problem prevention and intervention among preschool children. Methods: From October 2023 to January 2024, a convenience sampling method was used to select 5 138 preschool children from kindergartens in 8 districts of Wuhan City, Hubei Province. Parents completed the survey for Family Adaptability and Cohesion Scale, children s sleep habits and Child Behavior Checklist (CBCL). Spearman correlation analysis was used to examine the correlation of family function with scores of sleep quality and externalizing problem behaviors among preschool children. A mediation model analysis and bootstrap test were conducted to further investigate the mediating role of sleep quality between family function and externalizing problem behaviors. Mplus 8.7 software was used for latent profile analysis of family function. Results: The reported rates of poor sleep quality and externalizing problem behaviors among preschool children were 11.8% ( n =607), 20.0% ( n =1 026). The relevant analysis results showed that family function was negatively correlated with sleep quality and externalizing problem behaviors ( r = -0.20, -0.23), and sleep quality was positively correlated with externalizing problem behaviors ( r =0.27) ( P <0.01). The mediation effect test showed that family function negatively predicted externalizing problem behaviors ( β =-0.079) and sleep quality ( β = -0.075), while sleep quality positively predicted externalizing problem behaviors ( β =0.215) ( P <0.01). The latent profile analysis results showed that family function could be classified into 4 categories: high family function group (23.01%), upper middle family function group (44.65%), moderate family function group (26.24%) and low family function group (6.11%). Compared to high family function, the other three categories significantly positively predicted externalizing problem behaviors, and the mediating effects of sleep quality on different categories of family function were statistically significant [upper middle family function: mediation effect value was 0.022 (95% CI =0.004-0.041) and direct effect value was 0.329 (95% CI =0.263-0.396); middle family function: mediation effect value was 0.087 (95% CI =0.063-0.115) and direct effect value was 0.491 (95% CI =0.416-0.565); low family function: mediation effect value was 0.144 (95% CI =0.107-0.185) and direct effect 0.621 (95% CI =0.503-0.740)] ( P < 0.05 ). Conclusion Family function negatively predicts the externalizing problem behaviors of preschool children, and sleep quality plays a partial mediating role.

AIM: To investigate the expression of serum growth differentiation factor 11(GDF11)and thrombospondin 1(TSP1)in patients with diabetic retinopathy(DR), and discuss their relationship with microvascular injury.METHODS: Totally 102 DR patients were served as DR group and assigned into non proliferative DR group(NPDR group)and proliferative DR group(PDR group)based on the severity of DR lesions. Meantime, 100 patients with simple diabetes were served as control group. Serum indicators of microvascular injury including vascular endothelial growth factor(VEGF), endothelial cells(ECs), endothelial progenitor cells(EPCs), and levels of GDF11 and TSP1 were measured in each group. Pearson method was used to discuss the correlation between GDF11, TSP1 and microvascular injury indicators. Logistic regression was used to discuss the factors that affected the occurrence of DR. Receiver operating characteristic(ROC)curve was applied to analyze the evaluation value of serum GDF11 and TSP1 for the DR conditions.RESULTS: For the control group, DR group had lower EPCs and GDF11, and higher VEGF, ECs, and TSP1 levels(all P<0.05). The PDR group had lower GDF11 and higher TSP1 than the NPDR group(all P<0.05). Serum GDF11 was negatively related to VEGF and ECs(r=-0.486, -0.511, all P<0.001), and positively related to EPCs(r=0.475, P<0.001). TSP1 was positively related to VEGF and ECs(r=0.579, 0.594, all P<0.001), and negatively related to EPCs(r=-0.505, P<0.001). Moreover, GDF11 and TSP1 were negatively correlated(r=-0.443, P<0.001). The course of T2DM, VEGF, and TSP1 were risk factors for DR, while GDF11 was a protective factor(all P<0.05). The AUC of GDF11, TSP1, and combined diagnosis for PDR conditions was 0.819, 0.822, and 0.915, respectively. The combined diagnosis was better than single diagnosis(Zcombination-GDF11=2.070, P=0.039, Zcombination-TSP1=2.274, P=0.023).CONCLUSION: GDF11 and TSP1 are closely associated with microvascular injury in DR patients and are related to the progression of DR disease, and the combined detection of their serum levels is of clinical value in the assessment of DR disease.

OBJECTIVES: Recent evidence suggests that the gut may be a primary site of metformin action. However, studies on the effects of metformin on gut microbiota remain limited, and its impact on gut microbial metabolites such as short-/medium-chain fatty acids is unclear. This study aims to investigate the effects of metformin on gut microbiota, short-/medium-chain fatty acids, and associated metabolic benefits in high-fat diet rats. METHODS: Twenty-four Sprague-Dawley rats were randomly divided into 3 groups: 1) Normal diet group (ND group), fed standard chow; 2) high-fat diet group (HFD group), fed a high-fat diet; 3) high-fat diet + metformin treatment group (HFD+Met group), fed a high-fat diet for 8 weeks, followed by daily intragastric administration of metformin solution (150 mg/kg body weight) starting in week 9. At the end of the experiment, all rats were sacrificed, and serum, liver, and colonic contents were collected for assessment of glucose and lipid metabolism, liver pathology, gut microbiota composition, and the concentrations of short-/medium-chain fatty acids. RESULTS: Metformin significantly improved HFD-induced glucose and lipid metabolic disorders and liver injury. Compared with the HFD group, the HFD+Met group showed reduced abundance of Blautia, Romboutsia, Bilophila, and Bacteroides, while Lactobacillus abundance significantly increased (all P<0.05). Colonic contents of butyric acid, 2-methyl butyric acid, valeric acid, octanoic acid, and lauric acid were significantly elevated (all P<0.05), whereas acetic acid, isoheptanoic acid, and nonanoic acid levels were significantly decreased (all P<0.05). Spearman correlation analysis revealed that Lactobacillus abundance was negatively correlated with body weight gain and insulin resistance, while butyrate and valerate levels were negatively correlated with insulin resistance and liver injury (all P<0.05). CONCLUSIONS Metformin significantly increases the abundance of beneficial bacteria such as Lactobacillus and promotes the production of short-/medium-chain fatty acids including butyric, valeric, and lauric acid in the colonic contents of HFD rats, suggesting that metformin may regulate host metabolism through modulation of the gut microbiota.
Animals ; Metformin/pharmacology* ; Rats, Sprague-Dawley ; Diet, High-Fat/adverse effects* ; Rats ; Gastrointestinal Microbiome/drug effects* ; Male ; Fatty Acids, Volatile/metabolism* ; Fatty Acids/metabolism*

Objective To investigate the expression level and diagnostic value of serum cysteine protease inhibitor S(CST4)in patients with gastric cancer.Methods Clinical data of 115 patients with suspected gastric cancer who complained of gastric discomfort were retrospectively analyzed,and they were divided into benign disease group(n=50),precancerous disease group(n=26)and gas-tric cancer group(n=39).The levels of serum CST4,carcinoembryonic antigen(CEA),carbohy-drate antigen 19-9(CA19-9)and carbohydrate antigen 72-4(CA72-4)were analyzed in the three groups.The positive rates of CST4 among the three groups were compared.Binary Logistic regression analysis was used to screen for independent risk factors for gastric cancer occurrence.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of CST4 in gastric cancer.Results The positive rate of CST4 was 6.00％(3/50)in the benign gastric disease group,30.77％(8/26)in the gastric precancerous lesion group,and 66.67％(26/39)in the gastric canc-er group.The positive rate of CST4 in the gastric cancer group was higher than that in the gastric pre-cancerous lesion group and the benign gastric disease group(P＜0.05).The results of binary Logistic regression analysis showed that advanced age,high levels of serum CST4 and high levels of CEA were independent risk factors for gastric cancer occurrence(P＜0.05).The area under the curve(AUC)for CST4 alone in diagnosing gastric cancer was 0.847(95％CI,0.760 to 0.934),with an optimal cut-off value of 94.6 U/mL,the Youden index of 0.638,sensitivity of 71.8％,and specificity of 92.0％.The AUC for the combined diagnosis of gastric cancer using CST4,age and CEA was 0.959(95％CI,0.919 to 0.992),with sensitivity of 94.9％and specificity of 86.0％.Conclusion As a novel se-rum marker,CST4 has high predictive value in the auxiliary diagnosis of gastric cancer.

Objective To analyze the clinical characteristics and nursing strategies of elderly patients with type 2 diabetes mellitus complicated with acute myocardial infarction(AMI).Methods A total of 138 elderly patients with type 2 diabetes mellitus combined with AMI admitted to Jiangsu Province Hospital from January 2019 to December 2021 were included in observation group,and 346 patients with AMI without diabetes mellitus were enrolled in control group.The clinical data,complications,coronary angiography results and prognosis of two groups were collected and analyzed.Results The proportion of smoking,hypertension and typical chest pain in observation group were significantly lower than those in control group,while the proportion of hyperlipidemia and Killip grade≥Ⅲ were significantly higher than those in control group(P<0.05).The proportion of patients with three branch lesions or left main trunk lesions in observation group were significantly higher than those in control group(P<0.05).The incidences of arrhythmia,acute heart failure and pulmonary infection in observation group were significantly higher than those in control group(P<0.05).There was no significant difference in the incidence of cardiogenic shock and cardiac death during hospitalization between two groups(P>0.05).Conclusion Elderly patients with type 2 diabetes mellitus complicated with AMI have atypical clinical symptoms and more complications.Early identification and active control of cardiovascular risk factors by medical staff can reduce the mortality of patients and improve the long-term prognosis.

Coronary artery bypass grafting (CABG) is one of the most effective revascularization treatments for coronary heart disease. Secondary prevention strategies, which rely on antiplatelet and lipid-lowering drugs, are crucial after CABG to ensure the durability of revascularization treatment effects and prevent adverse cardiovascular and cerebrovascular events in the medium to long term. Previous research conducted by Professor Zhao Qiang's team from Ruijin Hospital of Shanghai Jiao Tong University, known as the DACAB study, indicated that dual antiplatelet therapy (DAPT, specifically ticagrelor+aspirin) after CABG can enhance venous graft patency. However, it remains uncertain whether DAPT can further improve the medium to long-term clinical outcomes of CABG patients. Recently, the team reported the medium to long-term follow-up results of the DACAB study, termed the DACAB-FE study, finding that DAPT administered after CABG can reduce the incidence of major cardiovascular events over five years and improve patients' medium to long-term clinical outcomes. This article will interpret the methodological highlights and significant clinical implications of the DACAB-FE study.

Objective To explore the relationship between haptoglobin gene polymorphism and disease se-verity and susceptibility in senile vascular dementia patients.Methods A total of 80 patients with senile vas-cular dementia admitted to the hospital from February 2018 to February 2023 were selected as the vascular de-mentia group,and 80 stroke patients with non-vascular dementia admitted to the hospital during the same pe-riod were selected as the control group.The genotype distribution and allele frequency of haptoglobin gene were measured using polymerase chain reaction with sequence-specific primers,and their relationship with the severity and susceptibility of vascular dementia patients was analyzed.Results The proportion of history of hyperlipidemia and diabetes mellitus and the levels of total cholesterol and triglyceride in vascular dementia group were higher than those in control group,the differences were statistically significant(P＜0.05).The distribution of genotypes was in Hardy-Weinberg equilibrium(P＞0.05).The frequency of haptoglobin 2-2 genotype and haptoglobin 2 allele in vascular dementia group were higher than those in control group,and the differences were statistically significant(P＜0.05).There were significant differences in the scores of mini-mental state examination and hachinski ischaemic score among patients with vascular dementia with different haptoglobin genotypes(P＜0.05).Multivariate Logistic regression analysis showed that the carrier of hapto-globin 2-2 genotype and the carrier of haptoglobin 2 allele were independent risk factors for vascular dementia(P＜0.05).Conclusion Haptoglobin 2-2 genotype and haptoglobin 2 allele distribution frequency are associ-ated with the occurrence of vascular dementia after stroke,and those with high frequency of haptoglobin 2-2 genotype and haptoglobin 2 allele distribution suffer a severe disease,which can provide reference for early i-dentification and assessment of vascular dementia.

Objective:To explore the clinical phenotype and genetic characteristics of a child with Hypotrichosis 14.Methods:A child who had presented at the Henan Provincial People′s Hospital on May 4, 2020 due to hair thinning was selected as the study subject. Clinical data of the child was collected. Peripheral venous blood samples were collected from the child and her parents. Genomic DNA was extracted and subjected to whole exome sequencing. Candidate variants were validated by Sanger sequencing and bioinformatic analysis.Results:The child, a 5-year-old female, had presented with thin, soft lanugo-like hair which was easy to fall off. The child was found to harbor compound heterozygous missense variants of the LSS gene, namely c. 1609G>A (p.V537M) in exon 17 and c. 802T>G (p.F268V) in exon 8, which were respectively inherited from her father and mother. Both variant sites were highly conserved, though based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were rated as variants of unknown significance (PM2_Supporting+ PP3+ PP4). Conclusion:The c. 1609G>A (p.V537M) and c. 802T>G (p.F268V) compound heterozygous variants of the LSS gene probably underlay the clinical phenotype in this patient.

[Objective] In view of the crucial role of indole propionic acid in the treatment of tumor immune checkpoint blockade and further revealing its mechanism, our study intended to design and synthesize 1-[¹⁸F]-fluoroethyl-indole propionic acid (1-[¹⁸F]-IPA), and evaluate it as a tumor PET imaging agent. [Methods] The precursor 1-(2-p-toluenesulfonic acid oxygen ethyl)-methyl indole propionate underwent nucleophilic substitution reaction with ¹⁸F^-. The crude product was separated and purified by high-performance liquid chromatography and the intermediates were collected. Finally, 1-[¹⁸F]-IPA was obtained by hydrolysis. The clarity of the product was measured by visual inspection, the pH value was determined by precision test paper, and the radiochemical purity and stability were determined by high-performance liquid chromatography. In order to determine the biodistribution of 1-[¹⁸F]-IPA in normal mice, ICR mice were intravenously injected with 1-[¹⁸F]-IPA (0.2 mL, 7 MBq), and sacrificed at 5, 15, 25, 45, 75 and 120 min and dissected. Micro-PET imaging was performed and analyzed in BxPC-3 tumor-bearing nude mice. Student t test was used to compare the biodistribution of tissues and organs at different time points. [Results] The total preparation time of 1-[¹⁸F]-IPA was 35-40 min, the radiochemical yield was (45±5)%, and the radiochemical purity was more than 95%. The product solution was clear without particles, and the pH value was 6.5, which had good stability in vitro and in vivo. The results of biodistribution in healthy ICR mice showed that except for the brain, 1-[¹⁸F]-IPA had a certain uptake in all major organs, with the most obvious uptake in the liver, gallbladder and kidneys. The radioactivity in the gallbladder gradually increased with time and reached (39.86±6.56)%ID/g at 120 min, but bone uptake did not change significantly with time. Micro-PET/CT showed that there was radioactive uptake at the tumor 30 min after injection of 1-[¹⁸F]-IPA in Dutch BxPC-3 nude mice, but it was not obvious. At this time, SUVmax was about 55.18±14.62. Consistent with the results of biodistribution, the brain uptake was low at each time point. [Conclusion] In summary, 1-[¹⁸F]-IPA with short preparation time and high yield is expected to be a tool to probe tryptophan indole metabolism pathway and further reveal tumor immune resistance.

Objective To analyze and verify the factors influencing the prediction model of suicidal ideation of burn patients in hospital based on international scale.Methods The clinical data of 194 burn patients treated in hospi-tal were retrospectively analyzed.General data questionnaire,ISI,HAMD,HAMA,ASDS and BSHS-B were used to evaluate the influencing factors of suicidal ideation.According to the presence or absence of suicidal ideation,the patients were divided into the suicidal ideation group and the non-suicidal ideation group.The baseline data be-tween the groups were compared,univariate screening of meaningful variables was conducted,and multivariate Lo-gistic regression modeling was further conducted.ROC analysis evaluated model differentiation,and internal verifi-cation was conducted.Results According to the baseline data analysis results,there were no statistically signifi-cant differences in age,BMI,years of education,smoking history,estimated percentage of burned area,head and neck burns,hip and perineal burns,and pain scores in the suicidal ideation group(21/194)compared with the non-suicidal ideation group(173/194).Gender(P=0.047),presence or absence of trunk burn(P=0.022),severity of burn(moderate burn:P=0.002;severe burn:P=0.458;extremely severe burn:P=0.169),ISI score(P=0.001),HAMD score(P=0.001),HAMA score(P＜0.001),ASDS score(P=0.003),BSHS-B score(P=0.011)had statistical significance.Multivariate Logistic regression analysis showed that the severity of burn(moderate burn:OR=0.103,P=0.009;severe burn:OR=0.351,P=0.223;extremely severe burn:OR=0.103,P=0.095)and HAMA score(OR=1.136,P=0.007)were independent influencing factors for burn patients with suicidal ideation.The Logistic regression prediction model was established by two independent influ-encing factors.ROC analysis results showed that the model had good differentiation(AUC=0.880,95％CI:0.808-0.952,P＜0.001)and the internal verification accuracy was 79.38％.Conclusion The prediction model built on the basis of two independent influencing factors,burn severity and HAMA score,has a good predic-tion accuracy,which is helpful for clinicians to intervene as soon as possible for burn patients with suicidal ideation in hospital,in order to reduce the incidence and enrich clinical psychological research.