As a pharmaceutical excipient with low caloric value, low hygroscopicity, and high stability, mannitol is widely used in various dosage forms, such as solid, lyophilized and inhalation preparations, etc. It has different crystal structures (α, β and δ) and cocrystal, and the changes in the crystal structure will affect formulation properties of pharmaceutical formulations. This paper reviews structural features, physicochemical properties, and preparation methods of mannitol polymorphs and cocrystal formation, with emphasis on polymorphic transformation pathways, monitoring methods and the effect of polymorphic transformation on properties and application in pharmaceutical formulations, including tabletability, disintegration and dissolution properties. By systematically summarizing the crystallographic study of mannitol, this study attempts to provide new ideas for the development of novel pharmaceutical excipients and applications in pharmaceutical formulations.

As a pharmaceutical excipient with low caloric value, low hygroscopicity, and high stability, mannitol is widely used in various dosage forms, such as solid, lyophilized and inhalation preparations, etc. It has different crystal structures (α, β and δ) and cocrystal, and the changes in the crystal structure will affect formulation properties of pharmaceutical formulations. This paper reviews structural features, physicochemical properties, and preparation methods of mannitol polymorphs and cocrystal formation, with emphasis on polymorphic transformation pathways, monitoring methods and the effect of polymorphic transformation on properties and application in pharmaceutical formulations, including tabletability, disintegration and dissolution properties. By systematically summarizing the crystallographic study of mannitol, this study attempts to provide new ideas for the development of novel pharmaceutical excipients and applications in pharmaceutical formulations.

Objective To investigate the quality of life status in patients with type 2 diabetes mellitus and its influencing factors,understand their demands for continuous nursing services,analyze the correlation,and provide a reference for formulating and implementing continuous nursing plans for diabetes in the later stage.Methods From May to December 2024,a cross-sectional survey was conducted among 294 patients with type 2 diabetes mellitus in this hospital by using the Self-Rating Anxiety Scale(SAS),the Diabetes Pa-tient-Specific Quality of Life Scale(DSQL),and the Questionnaire on the Need for Continuous Care.Results The SAS score of patients with type 2 diabetes was 45.76±7.45,DSQL score was 54.68±10.99,and the score of continuous care needs was 32.98±5.79.The quality of life of patients with type 2 diabetes mellitus is mainly influenced by factors such as age,family type,educational level,average monthly family in-come,duration of diabetes,blood glucose control,dietary compliance,intensity of physical exercise,and diabet-ic complications.The quality of life of patients with type 2 diabetes mellitus was positively correlated with need for continuous care(P<0.05).Conclusion The quality of life of patients with type 2 diabetes mellitus is influenced by multiple factors and is related to the need for continuous care.Professional continuous care plans can be formulated and implemented based on the needs of patients with type 2 diabetes mellitus.

Objective:To investigate the effect of dihydroartemisinin (DHA) and gasdermin E(GSDME) on the proliferation, metastasis and pyroptosis of laryngeal cancer cells as well as its related mechanisms.Methods:Human laryngeal squamous cell cancer Hep-2 cells were taken and divided into 4 groups: the blank group (untreated Hep-2 cells), DHA group (Hep-2 cells treated with 50 μmol/L DHA), GSDME-siRNA group (Hep-2 cells transfected with GSDME-siRNA), and DHA+GSDME-siRNA group (Hep-2 cells treated with 50 μmol/L DHA and transfected with GSDME-siRNA). Methyl thiazolyl tetrazolium (MTT) method was used to detect the effect of DHA on the proliferation ability of Hep-2 cells, and the cell proliferation inhibition rate and half inhibitory concentration ( IC50) were calculated. Flow cytometry was used to detect the pyroptosis rate, Transwell assay was used to detect cell invasion ability and Western blot was used to detect the relative expression levels of GSDME, caspase-3, hexokinase Ⅱ (HK-Ⅱ), cyclophilin D, and voltage-dependent anion channel (VDAC) proteins. Results:The cell proliferation inhibition rates of Hep-2 cells treated with 10, 20, 40, 80, 160 μmol/L DHA for 48 h were higher than those treated with the corresponding concentration for 24 h (all P < 0.05). The IC50 values of Hep-2 cells treated by DHA for 24 h and 48 h were 57.20 μmol/L and 43.50 μmol/L, respectively, and thus 50 μmol/L DHA was selected for subsequent experiments. The pyroptosis rate was (6.5±0.8)%, (22.7±2.5)%, (3.1±0.6)% and (7.0±1.0)%, respectively in the blank group, DHA group, GSDME-siRNA group, and DHA+GSDME-siRNA group, and the difference was statistically significant ( F = 221.20, P < 0.05). The number of invasive cells was (153±14), (95±10), (205±16), and (148±16), respectively in the blank group, DHA group, GSDME-siRNA group, and DHA+GSDME-siRNA group, and the difference was statistically significant ( F = 56.89, P < 0.05). The results of Western blot showed that the relative expression levels of GSDME and caspase-3 in DHA group were higher than those in the blank group (both P < 0.05); the relative expression levels of GSDME and caspase-3 in GSDME-siRNA group were lower than those in DHA group (both P < 0.05); the relative expression levels of GSDME and caspase-3 in DHA+GSDME-siRNA group were higher than those in GSDME-siRNA group (both P < 0.05); the relative expression levels of HK-Ⅱ, cyclophilin D, and VDAC in DHA group were lower than those in the blank group (all P < 0.05); the relative expression levels of HK-Ⅱ, cyclophilin D, and VDAC in GSDME-siRNA group were higher than those in DHA group (all P < 0.05); the relative expression levels of HK-Ⅱ, cyclophilin D, and VDAC in DHA+GSDME-siRNA group were lower than those in GSDME-siRNA group (all P < 0.05). Conclusions:Dihydroartemisinin can increase the pyroptosis of laryngeal cancer cells and reduce cell proliferation and metastasis ability. The mechanism may be related to the inhibition of mitochondrial HK-Ⅱ expression.

Objective:To investigate the high-risk factors affecting the prognosis of patients with pT 1-2N 1M 0 after mastectomy, establish a nomogram prediction model, perform risk stratification, and screen the radiotherapy benefit populations. Methods:Clinical data of 936 patients with pT 1-2N 1M 0 breast cancer undergoing mastectomy in the Fourth Hospital of Hebei Medical University from January 2010 to December 2016 were retrospectively analyzed and 908 cases had complete follow-up data. They were divided into the radiotherapy (RT) group ( n=583) and non radiotherapy (NRT) group ( n=325) according to the radiotherapy. After propensity score matching (PSM) was performed 1 vs. 1, 298 cases were assigned into the RT group and 298 in the NRT group. Overall survival (OS) and disease-free survival (DFS) were compared between two groups using log-rank test. Nomogram prediction model was established, the survival differences were compared among different risk groups, and the radiotherapy benefit populations were screened. Results:Univariate analysis showed that the 5- and 8-year OS and DFS in the RT group were significantly better than those in the NRT group (both P<0.001). Multivariate analysis showed that age, tumor quadrant, number of lymph node metastases, T staging, and Ki-67 level were the independent prognostic factors for OS. Age, tumor quadrant, and T staging were the independent prognostic factors for DFS. The OS nomogram analysis showed that the OS of patients in the high-risk group was significantly improved by post-mastectomy radiotherapy (PMRT) ( P=0.001), while PMRT did not show an advantage in the low- and medium-risk groups ( P=0.057, P=0.099). The DFS nomogram analysis showed that DFS was significantly improved by PMRT in patients in the medium- and high-risk groups ( P=0.036, P=0.001), whereas the benefits from PMRT were not significant in the low-risk group ( P=0.475). Conclusions:For patients with pT 1-2N 1M 0 breast cancer after mastectomy, age ≤ 40 years, tumor located in the inner quadrant or central area, T 2 staging, 2-3 lymph node metastases, Ki-67>30% are the high-risk factors affecting clinical prognosis. The nomogram prediction model can screen the populations that can benefit from PMRT, providing reference for clinical decision-making.

Objective: To learn about the characteristics of physical activity(PA) and physical fitness, and to provide basis for the health and development of the Tibetan students. Methods: The cluster stratified random sampling was used, and 8 945 Tibetan students in Tibet were selected in May to June, 2019, and were administrated with questionnaire. Independent samples t test, one way ANOVA and Pearson correlation analysis were used. Results: There were significant differences of PA, and physical fitness by gender, grade and living area among Tibetan adolescents ( P <0.05). The PA score of boys(2.79±0.58) was higher than that of girls( 2.51 ±0.56), while the physical fitness level of girls(62.40±25.55) was higher than that of boys(59.26±26.55). The PA score( 2.59 ±0.55) of rural Tibetan children and youth was lower than those of urban areas, while the physical fitness level(61.53±26.53) was only lower than that of county area; the PA score(2.60±0.58) of Tibetan children and youth was the lowest for grade 7 and 9, while physical fitness level(57.62±24.33) was the lowest for grade 5 and 6. PA was not significantly correlated with physical fitness of Tibetan adolescents( r =-0.01， P >0.05). Conclusion Lack of physical activity and poor physical fitness are observed in Tibetan adolescents. It is suggested that schools, families and society should cooperate in various aspects and actively take measures to improve the physical health level of Tibetan children and adolescents.

Objective To explore the imaging features of brucellar spondylitis (BS).Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (≥1:100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed.X-ray,CT scan and MRI examination was performed in 49,28 and 42 cases,respectively,of which 19 cases underwent both CT scan and MRI examination.The imaging manifestations of the spine were analyzed.The x2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination.Results Of the 49 patients,34 patients (69.4％) had involvement of the lumbar vertebra.Forty-five patients (91.8％) had contiguous involvement at adjacent 2 vertebral bodies.There were 10 cases (20.4％) with bony spur or bone bridge,3 cases (6.1％) with spondylolisthesis and 3 cases (6.1％)with slightly kyphosis deformity.There were 8 cases (28.6％) showing bone destruction of more than half of the vertebral body and 6 cases (21.4％) with sequestra on CT.There were 14 cases (33.3％) with psoas abscesses,of which 2 (4.8％) had migrating abscess.Epidural abscesses with dural sac compression were found in 17 cases (40.5％) and 3 cases (7.1％) showed nerve roots compression.There were statistically significant differences in the detection of vertebral bone destruction,bone marrow edema,hyperosteogeny,intervertebral disc changes,abscess formation and sequestrum between CT and MRI (P＜0.05).Conclusion BS has characteristic imaging features.The presence of bone destruction,sequestrum,and migrating abscess should warrant the possibility of BS.

ObjectiveTo explore the effects of applying multidisciplinary team based action study method in quality control of blood samples before test in order to improve the quality of inpatients' blood samples before test. MethodsA multidisciplinary team which was mainly led by the Nursing Department, professionally guided by the department of Clinical Laboratory and assisted by the Service Center as well as the Information Center was established. We analyzed the quality of the blood samples before examination in August 2017 in a Class Ⅲ Grade A hospital, and used the action study method of planning, action, observation and reflection as the axis to intervene. After 3 cycles, the number of unqualified blood samples of inpatients from August 2017 to August 2018 were compared. ResultsThe unqualified rate of blood samples had an overall downward trend during the period from August 2017 to August 2018,and there was statistical difference before and after intervention(P＜0.01). ConclusionsMultidisciplinary team collaboration provides guarantee for the improvement of blood samples quality before examination, and the application of action study method regulate the quality of blood samples in each procedure before examination and effectively reduce the unqualified rate of the blood samples.

Objective To investigate the effect of depression on morning blood pressure surge ( MBPS) in maintenance hemodialysis( MHD) patients with hypertension. Methods 67 MHD patients with hypertension were included in this study.All clinical data were collected,and ambulatory blood pressure mo-nitor was used to monitor patient''''''''s blood pressure in 24 hours.Self-rating depression scale(SDS) was used to survey 67 MHD patients,and multivariable logistic regression was conducted to determine independent risk factors for morning hypertension in MHD patients with hypertension. Results There were 14 depression pa-tients in non-morning hypertension group ( 35. 0％) , 18 depression patients in morning hypertension group (66.7％),and the difference was significant(χ2=6.479,P=0.011).In addition correlation analysis showed that age(r=0.027,P=0.044),24 h systolic pressure(r=0.284,P=0.020),24 h diastolic pressure(r=0.278,P=0.023),fasting blood-glucose (r=0.293,P=0.039),low-density lipoprotein cholesterol (r=0.345,P=0.016),and the standard score of SDS(r=0. 276,P=0.024)were significantly correlated with MBPS .Furthermore,multivariable logistic regression showed that the standard score of SDS(OR=1.101,95％CI=1.018-1.191,P=0.016) ,24 h diastolic pressure ( OR=1.070,95％CI=1.007-1.136,P=0.028) and fast-ing blood-glucose (OR=2.127,95％CI=1.118-4.049,P=0.022)were independent risk factors for morning hypertension in MHD patients with hypertension ( OR=1. 101, 95％CI:1. 018-1. 191, P=0. 016 ) . Conclu-sion Depression,24 h diastolic pressure and fasting blood-glucose can increase the risk of morning blood pressure surge in patients with MHD hypertension.

Objective To observe the value of CT spectral imaging in assessment of synovial hemosiderin deposition (SHD) in the knee joint in patients with hemophilic arthropathy (HA).Methods Twenty-five HA patients (40 assessable knees) underwent CT spectral imaging and MR scanning.According to the MRI international prophylaxis study group (IPSG) score of SHD,the knees were divided into mild group and severe group.CT value,iron (water) concentration (FeC),water (iron) concentration (WC),effective atomic number (Eff-Z) and average spectral curve slope (aSCS) of SHD area were measured and calculated,respectively.Meanwhile,the adjacent semi-membrane muscles in the same slice were taken as controls.The spectral parameters of CT were compared with One-Way ANOVA,and ROC curves were plotted to obtain the spectral parameters and the optical diagnostic threshold of SHD.Results CT value,FeC,and aSCS of SHD area were statistically significant among three groups (F=148.08,307.88,7.80,364.62 and 261.50,P＜0.01),and the differences of parameters between any two groups except WC were statistically significant (all P＜0.05).The area under ROC curve of SHD evaluated with aSCS was the largest,and the thresholds for the diagnosis of severe and mild SHD of aSCS was 1.84 and 0.42,respectively.Conclusion Multiple parameter analysis of CT spectral imaging is of great value for assessment of the severity of SHD in the knee joint in HA patients,therefore having important clinical significance.