Objective:To assess the attitudes toward and factors influencing starting insulin use among community-based patients with type 2 diabetes (T2D).Methods:A cross- sectional study. This secondary analysis used baseline data from patients with T2D recruited through convenience sampling from a community-based peer support intervention study implemented in nine community health service centers in Shanghai since 2017. Attitudes toward insulin use were assessed using the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ); the higher the score, the more negative the attitude toward starting insulin use. Multiple linear regression was used to analyze the factors influencing attitudes toward starting insulin use.Results:A total of 336 patients with T2D were included in the survey. The patients had a mean age of (67.7±7.9) years, mean disease duration of (13.62±7.73) years, relatively low levels of depression [Patient Health Questionnaire 8 (PHQ-8): 2 (0, 5)] and diabetes distress [Diabetes Distress Scale 4 (DDS-4): 1.97±0.95], and suboptimal target achieving rates of risk factors including body mass index, blood pressure, blood glucose, and lipid levels. The total score on the Ch-ASIQ among all patients was 1.84±0.55. Multivariate analyses showed that refusing insulin use was positively significantly associated with higher scores on the Ch-ASIQ and the three sub-dimensions of "Factors promoting self-efficacy," "Fear of pain or needles," and "Time and family support" [ β (95% CI): 0.515 (0.355-0.674), 0.728 (0.470-0.986), 0.273 (0.030-0.515), 0.909 (0.606-1.213), all P<0.05]. In addition, disease duration [ β (95% CI):-0.011 (-0.019 to -0.004)] was independently negatively associated with the Ch-ASIQ score. In comparison, age [ β (95% CI): 0.011 (0.003-0.018)], DDS-4 [0.129 (0.069-0.190)], and PHQ-8 [0.015 (0.000-0.029)] were independently positively associated with the Ch-ASIQ score (all P<0.05). There were slight differences in the factors influencing the four sub-dimensions of the Ch-ASIQ scale. Conclusions:Community-based patients with T2D had moderate negative attitudes toward starting insulin treatment. Refusing insulin use, shorter diabetes duration, older age, higher diabetes distress, and higher levels of depression were associated with higher negative attitudes towards starting insulin use.

ObjectiveNeuroinflammation plays a crucial role in both the onset and progression of ischemic stroke, exerting a significant impact on the recovery of the central nervous system. Excessive neuroinflammation can lead to secondary neuronal damage, further exacerbating brain injury and impairing functional recovery. As a result, effectively modulating and reducing neuroinflammation in the brain has become a key therapeutic strategy for improving outcomes in ischemic stroke patients. Among various approaches, targeting immune regulation to control inflammation has gained increasing attention. This study aims to investigate the role of in vitro induced regulatory T cells (Treg cells) in suppressing neuroinflammation after ischemic stroke, as well as their potential therapeutic effects. By exploring the mechanisms through which Tregs exert their immunomodulatory functions, this research is expected to provide new insights into stroke treatment strategies. MethodsNaive CD4⁺ T cells were isolated from mouse spleens using a negative selection method to ensure high purity, and then they were induced in vitro to differentiate into Treg cells by adding specific cytokines. The anti-inflammatory effects and therapeutic potential of Treg cells transplantation in a mouse model of ischemic stroke was evaluated. In the middle cerebral artery occlusion (MCAO) model, after Treg cells transplantation, their ability to successfully migrate to the infarcted brain region and their impact on neuroinflammation levels were examined. To further investigate the role of Treg cells in stroke recovery, the changes in cytokine expression and their effects on immune cell interactions was analyzed. Additionally, infarct size and behavioral scores were measured to assess the neuroprotective effects of Treg cells. By integrating multiple indicators, the comprehensive evaluation of potential benefits of Treg cells in the treatment of ischemic stroke was performed. ResultsTreg cells significantly regulated the expression levels of both pro-inflammatory and anti-inflammatory cytokines in vitro and in vivo, effectively balancing the immune response and suppressing excessive inflammation. Additionally, Treg cells inhibited the activation and activity of inflammatory cells, thereby reducing neuroinflammation. In the MCAO mouse model, Treg cells were observed to accumulate in the infarcted brain region, where they significantly reduced the infarct size, demonstrating their neuroprotective effects. Furthermore, Treg cell therapy notably improved behavioral scores, suggesting its role in promoting functional recovery, and increased the survival rate of ischemic stroke mice, highlighting its potential as a promising therapeutic strategy for stroke treatment. ConclusionIn vitro induced Treg cells can effectively suppress neuroinflammation caused by ischemic stroke, demonstrating promising clinical application potential. By regulating the balance between pro-inflammatory and anti-inflammatory cytokines, Treg cells can inhibit immune responses in the nervous system, thereby reducing neuronal damage. Additionally, they can modulate the immune microenvironment, suppress the activation of inflammatory cells, and promote tissue repair. The therapeutic effects of Treg cells also include enhancing post-stroke recovery, improving behavioral outcomes, and increasing the survival rate of ischemic stroke mice. With their ability to suppress neuroinflammation, Treg cell therapy provides a novel and effective strategy for the treatment of ischemic stroke, offering broad application prospects in clinical immunotherapy and regenerative medicine.

Objective:To evaluate the predictive value of simplified geriatric assessment (sGA) in elderly Chinese patients diagnosed with diffuse large B-cell lymphoma (DLBCL) .Methods:It retrospectively analyzed the relationships of sGA with the clinical characteristics, outcome, and prognosis of 219 patients aged ≥60 years who were newly diagnosed with DLBCL at six hospitals in Jiangsu province between January 2018 and December 2022.Results:The median age of 219 patients was 68 years (60-87 years). According to the sGA system criteria, 101 (46.1%), 103 (47.0%), and 15 (6.8%) elderly patients with DLBCL were categorized as fit, unfit, and frail, respectively. The most common adverse reactions after chemotherapy were hematologic, and the incidence of grade >2 hematologic adverse reactions was similar among the three groups (47.5% vs 41.7% vs 46.7%, respectively; χ2=0.712, P=0.700). Compared with the fit and unfit groups, the frail group showed tendencies toward for higher proportions of grade >2 gastrointestinal, pulmonary, and infectious adverse reactions ( P>0.05 for all). The fit, unfit, and frail groups had respective remission rates of 74.3%, 46.6%, and 20.0% ( χ2=25.249, P<0.001) ; disease progression rates of 5.9%, 11.7%, and 26.7% ( χ2=6.763, P<0.05) ; 2-year overall survival rates of 92.1% (95% CI 86.6% to 97.9%), 77.6% (95% CI 69.5% to 86.6%), and 70.1% (95% CI 49.4% to 99.6%) ( P<0.05) ; and 2-year progression-free survival rates of 76.8% (95% CI 67.0% to 84.8%), 69.7% (95% CI 61.8% to 82.0%), and 65.7% (95% CI 53.3% to 100%) ( P=0.399) . Conclusion:sGA can effectively predict treatment adverse effects and efficacy, disease progression, and long-term survival in elderly DLBCL.

Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.

Food safety problems caused by foodborne pathogenic bacteria pose a serious threat to public health,creating an urgent need to develop testing methods and techniques with excellent performance and are simple to use and of affordable cost.Traditional testing methods,such as isolation and culture,morphological observation,biochemical identification,and serological tests,have many limitations,including complex procedures,reliance on specialized technical equipment and personnel,and long turnaround time,rendering them inadequate for meeting current and future testing demands.Therefore,it is particularly important to develop simple,rapid,and highly sensitive methods for analyzing pathogenic bacteria.The fusion of nucleic acid aptamers and nanozymes brings new ideas for the rapid testing of pathogenic bacteria.On one hand,aptamers offer specific recognition capability for target bacteria and can be combined with various nucleic acid signal amplification techniques.On the other hand,the enzyme-like catalytic activity and signal amplification effect of many nanomaterials provide a basis for highly sensitive testing.This review highlights the application potential of nanozyme?aptamer coupling systems in the field of microbial analysis by briefly summarizing the latest research progress in the use of nanozymes combined with aptamers for the detection of foodborne pathogenic bacteria.First of all,two main approaches to conjugating nanozymes with aptamers are introduced.Then,the testing mechanisms and typical applications of nanozyme?aptamer coupling systems for foodborne pathogenic bacteria are discussed.Finally,future development trends and existing challenges are disucssed from four perspectives,including specificity,high sensitivity,high throughput,and intelligent detection.This review aims to provide a useful reference for the fusion of nanozymes and aptamers and for the development of on-site rapid testing techniques for foodborne pathogens,and to encourage broader academic interest to further advance this promising research field.

Objective To discuss the application of multi-parameters of coronary CT angiography(CTA)in diagnosing coronary heart disease(CHD)and predicting major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI).Methods A total of 350 patients with CHD,who received PCI at the Affiliated Beijing Rehabilitation Hospital of Capital Medical University of China from January 2021 to January 2024,were enrolled in this study as observation group.Other 180 patients with suspected CHD,who underwent coronary CTA and coronary angiography(CAG)to exclude coronary artery lesion in the same period as in the observation group,were collected and used as control group.According to whether MACE occurred or not within 6 months after PCI,the patients of observation group were further divided into MACE group and non-MACE group.The CTA parameters,including total plaque volume(TPV),plaque burden(PB),remodeling index(RI),fat attenuation index(FAI)around coronary artery,spot calcification and napkin-ring sign,were compared between the observation group and the control group as well as between MACE group and non-MACE group.Logistic regression analysis was used to analyze the independent factors influencing the occurrence of MACE after PCI.Area under receiver operating characteristic curve(AUC)was adopted to assess the value of each parameter in predicting the occurrence of MACE within 6 months after PCI.Results The TPV,PB,RI,FAI,and the detection rate of spot calcification and napkin-ring sign in the observation group were significantly higher than those in the control group(P＜0.05).Of the 350 patients in the observation group,54(15.43％)developed MACE within 6 months after PCI,including cardiac death(n=5,1.43％),non-fatal myocardial infarction(n=22,6.29％),target vessel reconstruction due to in-stent restenosis(n=15,4.29％),and hospitalization due to heart failure(n=12,3.43％),all the 54 patients were classified in MACE group.The non-MACE group had 296 patients.The TPV,PB,RI,FAI,and the detection rate of napkin-ring sign in MACE group were higher than those in non-MACE group(P＜0.05).Logistic multivariate analysis showed that TPV,PB and FAI were the independent factors influencing the occurrence of MACE in CHD patients after PCI(P＜0.05).ROC curve analysis indicated that in predicting the occurrence of MACE within 6 months after PCI the sensitivity of TPV,PB and FAI were 65.40％,76.90％and 76.90％respectively,and the specificity of TPV,PB and FAI were 63.80％,72.50％and 73.80％respectively.The sensitivity and specificity of the combined detection were 96.20％and 71.80％respectively,with an AUC of 0.896.Conclusion Multi-parameters of coronary CT A have important application value in diagnosing CHD and in predicting the occurrence of MACE after PCI.The combined detection of TPV,PB and FAI can provide important reference for making clinical decision.

Objective To explore the characteristics of coagulation and immune function and their clinical significance in children with severe adenovirus pneumonia(SAP).Methods A total of 122 children with SAP and 120 children with non-severe adenovirus pneumonia(NSAP)were enrolled and assigned to severe group and non-severe group.The severe group was further subdivided into good prognosis subgroup(n=105)and poor prognosis subgroup(n=17)according to prognosis.Addition-ally,120 healthy children undergoing physical examination during the same period were included as control group.Coagulation function indicators,including prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and thrombin time(TT)were measured.Levels of immunoglobulin A(IgA),immunoglobulin G(IgG),and immunoglobulin M(IgM)were determined using the nephelometric immunoassay.Multivariate Cox regression analysis was conducted to explore the influencing factors of poor prognosis.Results Compared with the control group,children in both the non-severe and severe groups exhibited increased levels of white blood cells(WBC),neutrophils(N),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),procalci-tonin(PCT),FIB,and IgG,as well as decreased levels of B lymphocytes,natural killer(NK)cells,PT,APTT,IgA,and IgM(P＜0.05).Compared with the non-severe group,children in the severe group showed increased levels of WBC,N,CRP,ESR,IL-6,PCT,FIB,and IgG,as well as decreased levels of B lymphocytes,NK cells,PT,APTT,IgA,and IgM(P＜0.05).Compared with the good prognosis subgroup,the poor prognosis subgroup exhibited increased levels of CRP,IL-6,PCT,and IgG,as well as decreased levels of APTT,IgM,and IgA(P＜0.05).The results of multivariate Cox regression analysis showed that PCT,APTT,and IgM were influencing factors of poor prognosis in children with SAP(P＜0.05).Conclusion Children with SAP have decreased levels of PT,APTT,IgA,and IgM,as well as increased levels of FIB and IgG.Coagulation and im-mune function indicators are correlated with the prognosis of SAP.

Objective: To predict and screen potential biomarkers of systemic lupus eythematosus(SLE) based on machine learning algorithms and structural biology, and to reveal their mechanisms of action and to provide new targets for disease diagnosis and treatment. Methods: Four machine learning algorithms, random forest(RF), eXtreme gradient boosting(XGBoost), support vector machine(SVM), least absolute shrinkage and selection operator(LASSO), were used to analyze the gene expression data of SLE patients in GEO(datasets: GSE121239 and GSE11907) to analyze the gene expression data of SLE patients and screen key markers. Peripheral blood single nucleated cells(PBMCs) from SLE patients were collected and RT-qPCR was used to detect differential gene expression levels. Subsequently, GSEA enrichment analysis was used to identify biomarker-related pathways. CIBERSORT immune infiltration analysis and protein interactions network were applied to calculate the sample immune cell infiltration abundance. Single-cell data were analyzed for gene expression specificity in immune cells. Interaction relationships in combination with AlphaFold3(AF3) were predicted. Results: Multiple algorithms were screened together to identify the unique marker gene HERC5 , and expression analysis of multiple datasets showed that HERC5 was highly expressed in SLE compared to the normal group (P < 0. 05) , and RT⁃qPCR verified the same trend (P = 0. 006 2) . Functional enrichment analysis identified the major pathway promoted by HERC5 in SLE as the interferon receptor signalling pathway (P < 0. 05) . Immune infiltration analysis showed that HERC5 was closely associated with immune cells (Neutrophils : r = 0. 39 , P < 0. 05 ; Memory B cells : r = 0. 33 , P < 0. 05 ; Activated dendritic cell : r = 0. 52 , P < 0. 05) . Most HERC5 ⁃related interacting proteins were associated with SLE ,and potential transcription factors of HERC5 and its related genes were also significantly associated with immune responses. Conclusion The HERC5 gene is an important biomarker for SLE , which upregulates the interferon pathway to promote SLE progression and provides a new target for SLE diagnosis and treatment.

Objective To establish two osteoarthritis models of destabilization of the medial meniscus(DMM)and chronic ankle instability(CAI)in mice,and compare the effects of knee osteoarthritis with varus deformity on ipsilateral ankle cartilage degeneration.Methods Thirty 6-week-old C57BL/6J male mice were randomly divided into a control group and two surgical groups(DMM group and CAI group),respectively.The progression of ankle joint degeneration was quantitatively evaluated through behavioral observation,imaging techniques and histopathology analysis in each group of mice over a 12-week period.Results A decline in gait stability and balance was observed in two surgical groups.Compared to the control group,the time required to cross the balance beam was increased by 23.20％,and the number of slips was increased by 43.26％at 12th week postoperatively in the DMM group.The bone volume fraction and bone mineral density of ankle joints also increased.Meanwhile,wear and tear of the ankle cartilage were found,with the formation of osteophytes,and OARSI score was increased by 88.89％.These changes in ankle joint were more pronounced in the CAI group.Conclusions This mouse model-based study revealed a coupling relationship between the knee and ankle motion.Knee osteoarthritis with varus deformity could lead to a significant ankle joint degeneration,while the damage was less severe than that observed in CAI.

Objective To explore the clinical effect of totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunos-tomy for gastric cancer.Methods Ninety cases of gastric cancer patients were seleted,of which 45 cases undergoing Roux-en-Y esophagoje-junostomy for digestive tract reconstruction were set as the control group,while 45 cases undergoing hand-sewn esophagojejunostomy for digestive tract reconstruction were set as the observation group.Patients in the control group underwent laparoscopic-assisted total gastrectomy combined with Roux-en-Y esophagojejunostomy to reconstruct digestive tract,while patients in the observation group underwent totally laparoscopic total gastrectomy combined with hand-sewn esophagojejunostomy to reconstruct digestive tract.The perioperative indicators and complications of patients in the two groups were compared.Results The surgical time,time of esophagojejunostomy,and time to get out of bed after surgery of patients in the observation group were significantly shorter than those in the control group(P<0.05),the pain score 24 hours after surgery was significantly lower than that in the control group(P<0.05).There was no statistically significant difference between the two groups in terms of the incidence of complications or Clavien-Dindo grading(P>0.05).Conclusion Hand-sewn esophagojejunostomy for digestive tract reconstruction has a good clinical effect in gastric cancer during totally laparoscopic total gastrectomy.It can shorten the surgical time and time of esophagojejunostomy,reduce postoperative pain,and accelerate postoperative recovery,whose safety is comparable to Roux-en-Y esophagojejunostomy.