Objective:To identify the risk factors for poor prognosis following interventional treatment in the patients with postherpetic neuralgia (PHN) and construct a predictive model.Methods:The medical records from patients with PHN undergoing interventional therapy at the First Affiliated Hospital of Soochow University from March 2020 to August 2023 were retrospectively collected, including basic characteristics, past medical and surgical history, symptoms, medication therapy, clinical pain score, neutrophil/lymphocyte ratio (NLR) before interventional treatment and interventional treatment methods. Logistic regression analysis was used to identify the risk factors associated with poor prognosis following interventional treatment in PHN patients, and a nomogram predictive model for poor prognosis was constructed. The discrimination and calibration of the nomogram predictive model were evaluated using the C-index and Hosmer-Lemeshow test. Calibration curves and clinical decision curves were drawn to further verify the accuracy of the predictive model.Results:The results of the multivariate logistic regression analysis show that increasing age, prolonged disease duration, elevated NLR, use of immunosuppressants and use of pulsed radiofrequency were independent risk factors for poor prognosis following intervention treatment in PHN patients ( P<0.05). The nomogram predictive model for poor prognosis following PHN interventional treatment constructed based on these factors had a C-index of 0.844. Calibration curves showed good consistency between predicted probability of poor prognosis and actual incidence of poor prognosis. Clinical decision curves indicated that the predictive model provided good accuracy and net benefit. Conclusions:Increasing age, prolonged disease course, elevated NLR, use of immunosuppressants and use of pulsed radiofrequency are independent risk factors for poor prognosis following interventional treatment in the patients with PHN. The nomogram predictive model based on these factors can effectively predict the occurrence of poor prognosis in PHN patients undergoing interventional treatment.

Objective:To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes.Methods:This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis.Results:Pearson correlation analysis showed that LSM was negatively correlated with TIR( r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR; r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM( β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM( β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD( OR=1.96, 95% CI 1.07-3.62, P=0.027), advanced liver fibrosis( OR=3.82, 95% CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD( OR=1.22, 95% CI 1.04-1.43, P=0.005) and advanced liver fibrosis( OR=1.26, 95% CI 1.03-1.54, P=0.025). Conclusions:TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.

OBJECTIVE To investigate the effect of a new variety of Sambucus williamsii Hance Yandan on the healing in rats with fractures. METHODS SD rats were randomly allocated to sham surgery group， model group， Zhonghua dieda pill group （0.54 g/kg）， wild S. williamsii group （5.4 g/kg， using raw drug dosage）， and high-， medium-， and low-dose groups of Yandan （10.8， 5.4， 2.7 g/kg， using raw drug dosage）， with 12 rats in each group. Except for the sham surgery group， the remaining groups were prepared with a femoral fracture model. Starting from the second day after surgery， each group was intubated with the corresponding drugs and distilled water once daily for 8 consecutive weeks. At 2， 4， and 8 weeks after administration， the levels of calcium， phosphorus， alkaline phosphatase （ALP）， and osteocalcin （OCN） in rat serum were detected. Micro-CT scanning was used to evaluate the morphology and bone microstructural parameters of the fractured femur [bone mineral density （BMD）， bone volume/tissue volume （BV/TV）， trabecular number （Tb.N）， trabecular separation （Tb.Sp）， trabecular thickness （Tb.Th）]， and hematoxylin-eosin staining was adopted to observe the morphological changes at the bone fracture site. RESULTS Compared with the model group， the levels of calcium in rat serum were significantly decreased （except at 4 weeks after administration）， and the levels of phosphorus， ALP， and OCN were significantly increased （P＜0.05） at 2， 4， and 8 weeks after administration in the high- dose group of Yandan； bone callus formation， connection of fracture ends， gradual blurring or disappearance of the fracture line， and opening of the marrow cavity were observed in the bone repair process， and a large amount of granulation tissue， fibroblasts， chondrocytes， new trabeculae， and new bone plates were visible at the fracture site of bone tissue； after 8 weeks of administration， BMD， BV/TV， Tb.N， and Tb.Th were significantly increased， and Tb.Sp was significantly decreased （P＜0.05）. Most of the above indicators in the wild S. williamsii Hance group showed no significant changes. CONCLUSIONS Yandan has the effect of promoting fracture healing in rats， and its effect is superior to that of wild S. williamsii.

Objective:To investigate the relationship between time in range(TIR) of glucose and sarcopenia in elderly patients with type 2 diabetes mellitus.Methods:A total of 673 patients with type 2 diabetes aged 65 years and above who were admitted to Henan Provincial People′s Hospital from March 2018 to July 2020 were selected. All patients completed questionnaire, physical and laboratory examination. Sensor-based flash continuous glucose monitoring(CGM) systems was used to monitor glucose levels, and the TIR was computed. Dual energy X-ray was used to assess total muscle mass and appendicular skeletal muscle mass index(ASMI) was calculated, the muscle strength was assessed with testing handgrip strength, and physical function was assessed by testing gait speed. Sarcopenia was diagnosed and graded according to the 2019 Asian Working Group on Sarcopenia(AWGSOP) standard. Patients with less than 3 days of CGM were excluded and a total of 658 subjects were included in the analysis.Results:The total prevalence of sarcopenia was 28.72%. Compared with non-sarcopenia group, TIR levels in the sarcopenia and severe sarcopenia groups were significantly decreased [55.0%(36.5%, 68.0%), 49.0%(31.0%, 70.5%) vs 66.0%(44.8%, 79.0%), both P<0.01]. The level of ASMI increased in line with TIR quartiles and topped in the fourth quartile group( P<0.05). Pearson correlation analysis showed that TIR was significantly positively correlated with ASMI, gait speed, and handgrip strength in male patients( P<0.05 or P<0.001), and TIR was significantly positively associated with ASMI and gait speed in female patients( P<0.05 or P<0.01). After logistic regression adjusted for gender, age, body mass index, blood pressure, disease duration, HbA 1C, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein-choresterol, high density lipoprotein-choresterol, estimated glomerular filtration rate, protein intake, exercise intensity, smoking and alcohol consumption, an increase in TIR levels was associated with a decrease in the prevalence of severe sarcopenia( OR=0.923, 95% CI 0.878-0.970, P=0.002). The lowest quartile TIR significantly increased the risk of sarcopenia compared with the highest quartile TIR( OR=3.733, 95% CI 1.129-12.342, P=0.031). Conclusion:Decline in TIR is significantly associated with an increased risk of sarcopenia in older patients with type 2 diabetes.

Objective:To investigate the association of time in range(TIR) with the severity of coronary artery disease and acute coronary syndrome in patients with type 2 diabetes mellitus.Methods:A total of 216 patients with type 2 diabetes mellitus and coronary heart disease were recruited and undergone anthropometric and biochemical measurements, continuous glucose monitoring, and calculation of SYNTAX score. TIR was defined as the percentage of time within the glucose range of 3.9-10.0 mmol/L during 24 h. Spearman correlation analysis and multivariate linear regression analysis were used to evaluate the correlation factors of SYNTAX score. Multivariate logistic regression analysis was used to analyze the association of TIR with the severity of coronary artery disease and acute coronary syndrome. Results:Compared with patients with mild coronary artery disease, TIR in patients with moderate to severe coronary artery disease was lower[(69.4±17.3)% vs (60.8±17.8)%, t=3.0, P=0.003], and HbA 1C of patients with moderate to severe coronary artery disease was higher [(9.6±1.7)% vs (8.8±1.6)%, t=3.3, P=0.001]. SYNTAX score was negatively correlated with TIR ( r=-0.251, P<0.01) and positively correlated with HbA 1C ( r=0.249, P<0.01). Moreover, compared with HbA 1C (standardized coefficients=0.181, P=0.007), TIR (standardized coefficients=-0.192, P=0.004) had a greater influence on SYNTAX score. Multivariate linear regression analysis showed that TIR, HbA 1C, duration of diabetes and smoking were independently correlated with SYNTAX score. Multivariate logistic regression analysis revealed that compared with TIR Q1, Q3 and Q4 were independent protective factors for moderate to severe coronary artery disease (respectively, OR=0.61 and 0.59, 95% CI 0.39-0.96 and 0.38-0.94, P=0.014 and 0.009) and acute coronary syndrome (respectively, OR=0.51 and 0.39, 95% CI 0.32-0.95 and 0.26-0.75, P=0.022 and 0.008). Conclusion:TIR was significantly and independently correlated with the severity of coronary artery disease and acute coronary syndrome in type 2 diabetes mellitus after controlling confounding factors. When TIR level was decreased, the severity of coronary artery disease was aggravated, and SYNTAX score and the risk of acute coronary syndrome was increased.

Craniopharyngioma is the most common benign intracranial tumor in children. The major post-operative complication is dysfunction of pituitary, which can result in many complicate clinical manifestations with hormonal deficiencies. Normochromic anemia has been reported as a common hematologic abnormality. However, pancytopenia is rarely reported so far. Here we describe a 21-year-old inpatient with the main complaint of nasal bleeding, who accepted craniopharyngioma surgery 9 years ago. Laboratory tests showed pancytopenia secondary to panhypopituitarism. This paper aims to increasing the awareness of this disease and accumulating clinical experiences for the clinicians.

Objective: To identify pathogenic variants in 5 sporadic patients and two Chinese pedigrees affected with 17-hydroxylase deficiency (17-OHD). Methods: Peripheral blood samples were collected with informed consent. Variants of CYP17A1 gene were screened by PCR and Sanger sequencing. Suspected mutations were validated in other members of the pedigrees. Results: Gene sequencing has identified a homozygous c. 985_987delTACinsAA (Y329Kfs) mutation in exon 6 of the CYP17A1 gene in 4 patients and the sister of case 3. Case 1 was found to harbor compound heterozygous mutations c. 1459_1467del9 (p.D487_F489del) and c. 1244-3C>A. The parents and brother of cases 2 and 5 were heterozygous carriers of a c. 985_987delTACinsAA(Y329Kfs) mutation. Conclusion Mutations of the CYP17A1 gene probably underlie the pathogenesis of 17-OHD, for which c. 985_987delTACinsAA(Y329Kfs) is the most common. The c. 1244-3C>A is a novel mutation. Above results have facilitated genetic counseling for the affected families.

OBJECTIVE: To explore the genotype-phenotype correlation among 18 patients with 21-hydroxylase deficiency (21-OHD). METHODS: PCR-Sanger sequencing was used to analyze the 10 exons and flanking regions of the CYP21A2 gene among the 18 patients and 20 healthy controls. RESULTS: Seventeen patients had variants of the CYP21A2 gene. Eight patients (44.4%, 8/18) carried homozygous variants including p.Ile 173Asn (62.5%, 5/8), p.Pro31Leu (25.0%, 2/8), and IVS2-13A/C>G (12.5%, 1/8), respectively. Six patients (33.3%, 6/18) carried compound heterozygous variant, among which IVS2-13 A>G+p.Ile 173Asn were most common (50.0%). 94.4% (34/36) of the variant were pathogenic, with the most common variants being p.Ile173Asn (41.7%), IVS2-13A/C>G (19.4%), and p.Ile173Asn (7.5%). No variant was identified among the 20 healthy controls. CONCLUSION The majority of 21-OHD patients carried CYP21A2 gene variants in homozygous or compound heterozygous forms, among which the p.Ile173Asn was the most common one. There is a strong correlation between the genotypes and clinical phenotypes.
Adrenal Hyperplasia, Congenital ; genetics ; Genotype ; Humans ; Mutation ; Phenotype ; Steroid 21-Hydroxylase ; genetics

OBJECTIVE: To identify pathogenic variants in 5 sporadic patients and two Chinese pedigrees affected with 17-hydroxylase deficiency (17-OHD). METHODS: Peripheral blood samples were collected with informed consent. Variants of CYP17A1 gene were screened by PCR and Sanger sequencing. Suspected mutations were validated in other members of the pedigrees. RESULTS: Gene sequencing has identified a homozygous c.985_987delTACinsAA (Y329Kfs) mutation in exon 6 of the CYP17A1 gene in 4 patients and the sister of case 3. Case 1 was found to harbor compound heterozygous mutations c.1459_1467del9 (p.D487_F489del) and c.1244-3C>A. The parents and brother of cases 2 and 5 were heterozygous carriers of a c.985_987delTACinsAA(Y329Kfs) mutation. CONCLUSION Mutations of the CYP17A1 gene probably underlie the pathogenesis of 17-OHD, for which c.985_987delTACinsAA(Y329Kfs) is the most common. The c.1244-3C>A is a novel mutation. Above results have facilitated genetic counseling for the affected families.
Adrenal Hyperplasia, Congenital ; genetics ; Exons ; Female ; Humans ; Male ; Mutation ; Pedigree ; Steroid 17-alpha-Hydroxylase ; genetics

Objective To explore the relationship between visfatin and mild cognitive impairment(MCI)in patients with type 2 diabetes mellitus(T2DM).Methods A perspective study involving 75 hospitalized T2DM patients were divided into groups with(MCI,n=35)and without (NMCI,n =40)mild cognitive impairment.Another 30 non-diabetic patients were chosen as normal control(NC).Fasting plasma levels of glucose (FPG),insulin (FINS),lipid,glycosylated hemoglobin (HbAlc),HOMA-IR and visfatin were measured and calculated.Results The serum visfatin level was higher in MCI(28.81±3.32)μg/L than in NMCI(20.69±3.40)μg/L and NC(19.06±2.35)μg/L (F=96.491,P＜ 0.01).Visfatin was negatively correlated with Montreal Cognitive Assessment (MoCA) total score (MoCA-TS) (r =-0.646,P ＜ 0.01),but positively correlated with course of disease,waist hip ratio,FPG,HbAlc,FINS,HOMA-IR and triglyceride (r=0.282,0.276,0.318,0.496,0.339,0.433,0.309,P＜0.05 or P＜0.01).MoCA-TS was negatively correlated with course of disease,HbAlc,HOMA-IR,triglyceride,total cholesterol,low density lipoprotein cholesterol (r =-0.582,-0.365,-0.234,-0.330,0.277,-0.238,P＜0.05 or P＜0.01),but positively correlated with high density lipoprotein cholesterol(r=0.290,P＜0.05).Higher values of visfatin(OR =3.246,P＜0.01),HbAlc(OR=2.308,P＜0.01)and course of disease(OR=1.634,P＜0.05)were the risk factors for MCI.Conclusions The elevated visfatin level might be a risk factor for MCI in T2DM patients.