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.

ObjectiveTo establish and validate a new prediction model for the risk of death in patients with acute-on-chronic liver failure （ACLF） based on sarcopenia and other clinical indicators， and to improve the accuracy of prognostic assessment for ACLF patients. MethodsA total of 380 patients with ACLF who were admitted to Beijing YouAn Hospital， Capital Medical University， from January 2019 to January 2022 were enrolled， and they were divided into training group with 228 patients and testing group with 152 patients in a ratio of 6∶4 using the stratified random sampling method. For the training group， CT images were used to measure the cross-sectional area of the skeletal muscle at the third lumbar vertebra （L3）， and L3 skeletal muscle index （L3-SMI） was calculated. Sarcopenia was diagnosed based on the previously established L3-SMI reference values for healthy adults in northern China. Univariate and multivariable Cox regression analyses were used to establish a sarcopenia-ACLF model which integrated sarcopenia and clinical risk factors， and a nomogram was developed for presentation. The area under the ROC curve （AUC） was used to assess the predictive performance of the model， the calibration curve was used to assess the degree of calibration， and a decision curve analysis was used to investigate the clinical application value of the model. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison between groups. The DeLong test was used for comparison of AUC between different models. ResultsThe multivariate Cox regression analysis showed that sarcopenia （hazard ratio ［HR］=1.962， 95% confidence interval ［CI］： 1.185‍ ‍—‍ ‍3.250， P=0.009）， total bilirubin （HR=1.003， 95%CI： 1.002‍ ‍—‍ ‍1.005， P<0.001）， international normalized ratio （HR=1.997， 95%CI： 1.674‍ ‍—‍ ‍2.382， P<0.001）， and lactic acid （HR=1.382， 95%CI： 1.170‍ ‍—‍ ‍1.632， P<0.001） were included in the sarcopenia-ACLF model. In the training cohort， the sarcopenia-ACLF model had a larger AUC than MELD-Na score in predicting 90-day mortality in patients with ACLF （0.80 vs 0.73， Z=1.97， P=0.049）. In the test cohort， the sarcopenia-ACLF model had a significantly larger AUC than MELD score （0.79 vs 0.69， Z=2.70， P=0.007） and MELD-Na score （0.79 vs 0.68， Z=2.92， P=0.004）. The calibration curve showed that the model had good calibration ability， with a relatively good consistency between the predicted risk of mortality and the observed results. The DCA results showed that within a reasonable range of threshold probabilities， the sarcopenia-ACLF model showed a greater net benefit than MELD and MELD-Na scores in both the training cohort and the test cohort. ConclusionThe sarcopenia-ACLF model developed in this study provides a more accurate tool for predicting the risk of 90-day mortality in ACLF patients， which provides support for clinical decision-making and helps to optimize treatment strategies.

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 find the relationship between phthalates(PAEs)metabolite concentrations and body mass index(BMI)in infertile patients.Methods From December 2018 to January 2021,120 infertile pa-tients were selected from the Reproductive Medicine Centre of the 988th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army and the Reproductive Medicine Centre of the Henan Provincial People's Hospital,while 60 patients with no history of infertility and normal weight were selected from the Medical Check-up Centre as the normal group.According to BMI index,the infertility patients were divided into the control group(BMI＜28 kg/m2),obesity group(obesity,BMI≥28 kg/m2).The obesity group was divided into BHI(BMI≥32 kg/m2)and BH2(BMI≥28 kg/m2,＜32 kg/m2).The basic information of each group was collected.Serum level of PAEs metabolites diethyl phthalate(DEP),dibutyl phthalate(DBP)and di-isooctyl phthalate(DEHP)was detected using liquid chromatography/mass spectrometry(HPLC).The rela-tionship between PAEs metabolite concentration and body mass index(BMI)were analyzed by Spearman's analysis.Results The serum level of DEP,DBP and DEHP was significantly higher in obese group than in the control group(P＜0.05).The serum level of DEP,DBP and DEHP was significantly higher in the control group than in the normal group(P＜0.05);The metabolites level of PAEs was higher in patients with BHI than in the patients with BH2(P＜0.05).Spearman's analysis showed that the BMI of the patients in the obese group of infertility was positively correlated with DEP,DBP and DEHP content(P＜0.05).Conclusions Obesity and PAEs metabolite concentration in infertility patients are related,the higher the degree of obesity,the higher the content of related metabolites.

Objective To systematically evaluate the efficacy of Xixian Tongshuan Capsules/Pills in the treatment of acute ischemic stroke(AIS).Methods Literature about Xixian Tongshuan Preparation combined with conventional Western medicine for the treatment of AIS was retrieved from CNKI,SinoMed,VIP,Wanfang Data,PubMed,Medline,Embase,Cochrane Library and Web of Science from establishment of the databases to February 28,2023.Meta-analysis was conducted for the studies that could be quantitatively analyzed.The effective rate and response indicators were combined.Results A total of 7 articles were included for Meta-analysis.Results showed that there was statistical difference in the effective rate(RR=0.34,95%CI[0.23,0.51],P<0.01),NIHSS score(MD=-2.90,95%CI[-3.74,-2.06],P<0.01),BI score(MD=-10.08,95%CI[-13.47,-6.68],P<0.01),FIB(MD=-1.18,95%CI[-1.59,-0.77],P<0.01)of Xixian Tongshuan Preparation combined with conventional Western medicine for the treatment of AIS.There was no statistical difference in IL-6(MD=-15.4,95%CI[-33.3,2.49],P=0.09).There was no statistical difference in the effects of different dosage forms and treatment courses on the effective rate and NIHSS score.Conclusion The combination of Xixian Tongshuan Capsules/Pills could better improve the NIHSS and BI scores of patients with AIS,recovery the neurological function,and reduce the risk of blood hypercoagulability by reducing FIB content,with good safety.

Objective To investigate the correlation between lipid-related index and diabetic kidney disease(DKD)by observing the expression levels of lipid-related index in different stages of DKD.Methods A total of 265 patients with type 2 diabetes mellitus(T2DM)were divided into the T2DM group(n=106)and the DKD group(n=159).According to estimated glomerular filtration rate(eGFR)level,the DKD group was sub-divided into the DKD-G2 group(n=59),the DKD-G3 group(n=59)and the DKD-G4 group(n=41).Data of triglycerides(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A(Apo A),Apo B and urinary albumin/urinary creatinine ratio(UACR)were collected.Gomerular filtration rate(eGFR),triglyceride-glucose index(TyG),visceral adiposity index(VAI)and atherogenic index of plasma(AIP)were calculated.The differences of TyG,VAI and AIP between different groups and their correlation with eGFR and UACR were analyzed.Multiple linear regression analysis of DKD renal injury factors was conducted.Receiver operating characteristic(ROC)curves were drawn to evaluate the predictive efficiency of TyG,VAI,and AIP.Results The levels of TyG,VAI and AIP were significantly higher in the DKD group compared to the T2DM group,and these indices exhibited an increasing trend with disease progression(P＜0.05).Furthermore,there was a negative correlation between TyG,VAI,AIP and eGFR(r=-0.396,-0.425,-0.519,P＜0.01),and a positive correlation between UACR and eGFR(r=0.482,0.479 and 0.583,P＜0.01)in DKD patients.Multiple linear regression results showed that VAI and AIP were independent risk factors for eGFR,and TG,HDL-C,LDL-C,Apo B and VAI were influencing factors of UACR(P＜0.05).The ROC curve analysis revealed that the areas under the curves for TyG,VAI and AIP were 0.902(0.866-0.937),0.969(0.953-0.986)and 0.958(0.937-0.979)respectively.Conclusion The levels of TyG,VAI and AIP are correlated with the progression of DKD,and have predictive value for the occurrence and development of DKD.These biomarkers can be used as a biological indicator to evaluate the occurrence and development of DKD.

This article reviews the demand, development process, aid types, effects, and existing problems of decision aids for colorectal cancer. The aim is to provide reference for the development of convenient and efficient decision aids for colorectal cancer diagnosis and treatment in China, and to improve the quality of treatment decisions for colorectal cancer patients.

Objective:To determine the motion detection uncertainty of the real-time CybeRay ? imaging system and patient intrafractional motion with thermoplastic mask-based immobilization. Methods:Real-time CybeRay ? imaging system was used for irradiation and treatment for head phantom and patients with brain tumors. All patients were immobilized with thermoplastic masks. Real-time imaging was delivered using kilovoltage projection images during radiotherapy. The detected patient motion data was collected from 5 head phantom measurements and 27 treatment fractions of 9 brain tumor patients admitted to Kaifeng Cancer Hospital. The accuracy and uncertainty of the motion monitoring system were determined. Results:The mean and standard deviation (SD) of the detected motion in the X, Y, and Z directions for phantom were (-0.02±0.41) mm, (-0.05±0.22) mm and (0.01±0.35) mm, respectively. The detected motion in the X, Y and Z directions for patents were (-0.13±0.48) mm, (-0.05±0.48) mm and (0.11±0.36) mm, respectively. After removing the motion detection uncertainty, the actual intrafractional motion of patients were (-0.11±0.25) mm, (0±0.43) mm and (0.10±0.08) mm in three directions, respectively. Conclusions:The uncertainty of real-time imaging-based motion monitoring system of CybeRay ? is less than 0.5 mm. It is feasible to apply thermoplastic masks for brain tumor patients in clinical practice, which can provide steady immobilization and limit the SD of patient intrafractional motion within 0.5 mm. Real-time imaging-based motion monitoring system of CybeRay ? is accurate for patient motion monitoring during frameless stereotactic radiosurgery/radiotherapy.

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.