Objective To evaluate the prognostic nutritional index(PNI)in patients with newly diagnosed type 2 diabetes mellites(T2DM)complicated with diabetic peripheral neuropathy(DPN).Methods A total of 300 patients with newly diagnosed T2DM from the Wenzhou People's Hospital during January 2017 to March 2023 were enrolled in this study.The patients were divided into uncomplicated DPN(n=214)and complicated DPN(n=86).The general data,biochemical indicators,PNI and other clinical indicators of the two groups were compared.According to PNI thirds,patients were divided into three groups:low,medium and high,comparing the proportion of DPN among the three groups;Logistic regression calculated the risk of DPN in different groups;Drawing receiver operating characteristic curve to analyze PNI and other indicators to predict the value of DPN.Results Compared with the non-DPN group,patients had lower PNI in the DPN group(P＜0.05);lower PNI was associated with higher risk of DPN(P＜0.001).Area under the curve of PNI was 0.882(95％CI:0.841-0.923,P＜0.001),and better predictive value of PNI for DPN than the systemic immune inflammation index,the neutrophil/lymphocyte ratio.Conclusion PNI is closely associated with the occurrence of DPN in newly diagnosed T2DM complicated,and PNI may be used as an important indicator for screening patients with T2DM complicated with DPN.

Objective:To investigate the epidemiological and genetic characteristics of hand, foot and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6) in Xi′an city from 2021 to 2023.Methods:Collected clinical cases of HFMD, epidemiological information and samples were obtained. The specimens were tested by the real-time RT-PCR for enterovirus A71(EVA71), CVA16, CVA6 and CVA10, respectively. The VP1 regions of CVA6 were amplified and sequenced, MEGA X was used for phylogenetic analysis.Results:From 2021 to 2023, a total of 1 393 HFMD samples were collected, 1 106 (79.40%, 1 106/1 393) of which were positive for enteroviruses. The proportions of EVA71, CVA16, CVA6 and CVA10 were 0.45% (5/1 106), 16.64% (184/1 106), 72.42% (801/1 106) and 2.17% (24/1 106). A total of 801 HFMD cases tested positive for CAV6, including 783 mild cases and 18 severe cases, mainly in children aged ≤5 years (86.02%, 689/801), with a male/female ratio of 1.49∶1. The composition ratio of CVA6 infection differed with year(χ 2=332.62, P<0.01), and the highest composition ratio of CVA6 was in 2023 (91.01%, 638/701). The nucleotide and amino acid similarities in the VP1 region of Xi′an strains of CVA6 were 92.4%-99.8% and 98.3%-100.0%, respectively. Compared with the CVA6 prototype strain(Gdula), the nucleotide and amino acid similarities in the VP1 region of Xi′an strains were 82.2%-84.0% and 95.4%-96.0%, respectively, and there were 18 amino acid mutations in different degrees. Based on the phylogenetic analysis of VP1 region sequences, the CVA6 strains in Xi′an city from 2021 to 2023 belonged to D3a subtype, and could be divided into two clusters with 18 strains in cluster 1 while two strain in cluster 2. Conclusions:The sub-genotype D3a of CVA6 is the predominant virus causing HFMD in Xi′an city from 2021 to 2023, and there are two transmission chains. The monitoring and prevention of CVA6 should be strengthened.

Objective:To investigate the prevalence,related factors,and career implications of occupational burnout among resident physicians during standardized training in Inner Mongolia.Methods:This cross-sectional study used convenience sampling to enroll 2 891 resident physicians,assessing them with a self-developed general information questionnaire,socio-psychological scales,and a universal burnout inventory.Latent profile analysis clas-sified participants based on burnout dimensions,while logistic regression models examined the factors influencing burnout and their relationship with career choices.Results:Resident physicians were divided into low(59.0％),moderate(28.9％),and high(12.1％)burnout subgroups.Logistic regression showed that,compared to the low burnout group,significant risk factors included professional master's students(OR=0.44),working＞70 hours weekly(OR=0.63),＞4 night shifts monthly(OR=0.66),anxiety(mild OR=0.49;moderate OR=0.26;se-vere OR=0.14),depression(mild OR=0.38;moderate OR=0.24;severe OR=0.11),insomnia(mild OR=0.51;moderate OR=0.44;severe OR=0.38),low social support(OR=0.23),and low happiness index(OR=0.42).Male residents(OR=1.25)were less likely to experience burnout.High burnout residents were 5.11 times more likely to quit the medical profession.Conclusion:Training intensity and socio-psychological factors signifi-cantly contribute resident physicians' burnout levels,with severe burnout increase career attrition.

Multiple myeloma(MM)remains an incurable disease,with most patients experiencing multiple relapses before ultimately progressing to refractory stage.Extramedullary infiltration is a common manifestation of relapse.However,distinguishing synchronous multifocal extramedullary infiltration from secondary malignancies poses significant diagnostic challenges.This study presents a case of relapsed refractory MM with multifocal extramedullary infiltration,diagnosed as coexistence of multiple myeloma extramedullary infiltration and pulmonary adenocarcinoma through multidisciplinary team(MDT)collaboration.Such coexistence is exceedingly rare in clinical practice and introduces substantial complexity in diagnosis and treatment planning.Through a comprehensive case report and literature review,this paper explores the diagnostic and therapeutic approaches to managing multifocal extramedullary infiltration coexisting with secondary malignancies in MM,highlighting the pivotal role of MDT in achieving precise diagnosis and optimizing patient outcomes.

Objective:To investigate the prevalence,related factors,and career implications of occupational burnout among resident physicians during standardized training in Inner Mongolia.Methods:This cross-sectional study used convenience sampling to enroll 2 891 resident physicians,assessing them with a self-developed general information questionnaire,socio-psychological scales,and a universal burnout inventory.Latent profile analysis clas-sified participants based on burnout dimensions,while logistic regression models examined the factors influencing burnout and their relationship with career choices.Results:Resident physicians were divided into low(59.0％),moderate(28.9％),and high(12.1％)burnout subgroups.Logistic regression showed that,compared to the low burnout group,significant risk factors included professional master's students(OR=0.44),working＞70 hours weekly(OR=0.63),＞4 night shifts monthly(OR=0.66),anxiety(mild OR=0.49;moderate OR=0.26;se-vere OR=0.14),depression(mild OR=0.38;moderate OR=0.24;severe OR=0.11),insomnia(mild OR=0.51;moderate OR=0.44;severe OR=0.38),low social support(OR=0.23),and low happiness index(OR=0.42).Male residents(OR=1.25)were less likely to experience burnout.High burnout residents were 5.11 times more likely to quit the medical profession.Conclusion:Training intensity and socio-psychological factors signifi-cantly contribute resident physicians' burnout levels,with severe burnout increase career attrition.

Objective To evaluate the prognostic nutritional index(PNI)in patients with newly diagnosed type 2 diabetes mellites(T2DM)complicated with diabetic peripheral neuropathy(DPN).Methods A total of 300 patients with newly diagnosed T2DM from the Wenzhou People's Hospital during January 2017 to March 2023 were enrolled in this study.The patients were divided into uncomplicated DPN(n=214)and complicated DPN(n=86).The general data,biochemical indicators,PNI and other clinical indicators of the two groups were compared.According to PNI thirds,patients were divided into three groups:low,medium and high,comparing the proportion of DPN among the three groups;Logistic regression calculated the risk of DPN in different groups;Drawing receiver operating characteristic curve to analyze PNI and other indicators to predict the value of DPN.Results Compared with the non-DPN group,patients had lower PNI in the DPN group(P＜0.05);lower PNI was associated with higher risk of DPN(P＜0.001).Area under the curve of PNI was 0.882(95％CI:0.841-0.923,P＜0.001),and better predictive value of PNI for DPN than the systemic immune inflammation index,the neutrophil/lymphocyte ratio.Conclusion PNI is closely associated with the occurrence of DPN in newly diagnosed T2DM complicated,and PNI may be used as an important indicator for screening patients with T2DM complicated with DPN.

Multiple myeloma(MM)remains an incurable disease,with most patients experiencing multiple relapses before ultimately progressing to refractory stage.Extramedullary infiltration is a common manifestation of relapse.However,distinguishing synchronous multifocal extramedullary infiltration from secondary malignancies poses significant diagnostic challenges.This study presents a case of relapsed refractory MM with multifocal extramedullary infiltration,diagnosed as coexistence of multiple myeloma extramedullary infiltration and pulmonary adenocarcinoma through multidisciplinary team(MDT)collaboration.Such coexistence is exceedingly rare in clinical practice and introduces substantial complexity in diagnosis and treatment planning.Through a comprehensive case report and literature review,this paper explores the diagnostic and therapeutic approaches to managing multifocal extramedullary infiltration coexisting with secondary malignancies in MM,highlighting the pivotal role of MDT in achieving precise diagnosis and optimizing patient outcomes.

Objective:To investigate the epidemiological and genetic characteristics of hand, foot and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6) in Xi′an city from 2021 to 2023.Methods:Collected clinical cases of HFMD, epidemiological information and samples were obtained. The specimens were tested by the real-time RT-PCR for enterovirus A71(EVA71), CVA16, CVA6 and CVA10, respectively. The VP1 regions of CVA6 were amplified and sequenced, MEGA X was used for phylogenetic analysis.Results:From 2021 to 2023, a total of 1 393 HFMD samples were collected, 1 106 (79.40%, 1 106/1 393) of which were positive for enteroviruses. The proportions of EVA71, CVA16, CVA6 and CVA10 were 0.45% (5/1 106), 16.64% (184/1 106), 72.42% (801/1 106) and 2.17% (24/1 106). A total of 801 HFMD cases tested positive for CAV6, including 783 mild cases and 18 severe cases, mainly in children aged ≤5 years (86.02%, 689/801), with a male/female ratio of 1.49∶1. The composition ratio of CVA6 infection differed with year(χ 2=332.62, P<0.01), and the highest composition ratio of CVA6 was in 2023 (91.01%, 638/701). The nucleotide and amino acid similarities in the VP1 region of Xi′an strains of CVA6 were 92.4%-99.8% and 98.3%-100.0%, respectively. Compared with the CVA6 prototype strain(Gdula), the nucleotide and amino acid similarities in the VP1 region of Xi′an strains were 82.2%-84.0% and 95.4%-96.0%, respectively, and there were 18 amino acid mutations in different degrees. Based on the phylogenetic analysis of VP1 region sequences, the CVA6 strains in Xi′an city from 2021 to 2023 belonged to D3a subtype, and could be divided into two clusters with 18 strains in cluster 1 while two strain in cluster 2. Conclusions:The sub-genotype D3a of CVA6 is the predominant virus causing HFMD in Xi′an city from 2021 to 2023, and there are two transmission chains. The monitoring and prevention of CVA6 should be strengthened.

Objective To establish a high-precision and high-specificity quantitative nuclear magnetic resonance phosphorus spectrometry method(31P-qNMR)for detecting the phosphorus content in calcium hydrogen phosphate chewable tablets.Methods Hexamethyl phosphoramide was used as an internal standard,phosphorus spectrum data of calcium hydrogen phosphate chewable tablets solution was collected.The linear relationship of calcium hydrogen phosphate within the concentration range of 1.0 to 9.0 mg/ml was studied,and sample recovery rate and repeatability experiments were conducted.Results Calcium hydrogen phosphate and the internal standard demonstrated a good linear relationship within the concentration range of 1.0 to 9.0 mg/ml,with a regression equation A=0.004 3+0.183 6C.The recovery rates for low,medium,and high concentrations were 98.0%,98.1%,and 98.4%,respectively,with relative standard deviations(RSD)of 0.31%,0.68%,and 0.62%,respectively(n=9).The average content of calcium hydrogen phosphate in the chewable tablets was determined to be 98.1%.Conclusion This study successfully established a high-precision and highly specific method for quantifying the content of calcium hydrogen phosphate in chewable tablets,which did not require a self-reference substance,was simple in sample preparation,and had a fast detection speed.The method could provide a new technical support for the quality control of phosphorus-containing drugs.

Multiple myeloma is a malignant proliferative disease of plasma cells,and some patients may develop systemic amyloidosis.Cardiac amyloidosis is a common cause of death in these patients.Secondary adrenal insufficiency is caused by dysfunction of the hypothalamus and/or the pituitary gland,and multiple myeloma cases combined with secondary adrenal cortical dysfunction have been rarely reported in China.The patient,55-year-old,male,was admitted to the Emergency Department of Shenzhen Luohu People's Hospital on June 5,2018 due to"repeated chest tightness and fatigue for 7 months,and fainting for 1 hour".Later,he was transferred to Department of Hematology and was diagnosed as having multiple myeloma(λ light chain type)with systemic amyloidosis through bone marrow puncture and other examinations.The first course regimen of chemotherapy was bortezomib,cyclophosphamide,and dexamethasone.After the course,the patient was infected with a mixture of bacteria and fungi in the lung and had improvement after treatment.Then the regimen was adjusted to bortezomib and dexamethasone from the second course.After the fourth course,the patient achieved complete remission of multiple myeloma.After the fifth course,the patient experienced severe pulmonary-mixed infection again,which was improved after treatment.Thereafter,the patient presented with refractory hypotension,and decreased levels of cortisol and adrenocorticotropic hormone(ACTH),which was diagnosed as secondary adrenal cortical dysfunction.Hydrocortisone replacement therapy was administered.After 9 courses of chemotherapy,the patient received maintenance treatment with ixazomib.Multiple myeloma was evaluated as a stringent complete response.Cardiac amyloidosis was evaluated as a very good partial response,and secondary adrenal cortical dysfunction was treated with hydrocortisone maintenance therapy and with the cortisol level in the normal range.