OBJECTIVE To provide references for the accurate identification and management of immune-related cutaneous adverse events （irCAEs） caused by durvalumab， and ensuring safe clinical drug use. METHODS Clinical pharmacists participated in the diagnosis and treatment process of a patient with gallbladder cancer who developed irCAEs caused by durvalumab. The clinical pharmacists systematically reviewed the patient’s past medical history and medication history， and assisted physicians in assessing the association between adverse drug reactions and administered drugs. Meanwhile， the clinical pharmacists conducted a graded assessment of the adverse reaction， proposed recommendations such as discontinuing durvalumab and adjusting the administration regimen of glucocorticoids， assisted physicians in restarting immunotherapy， and carried out medication education and other pharmaceutical care. RESULTS The occurrence of irCAEs in this patient was “highly likely” related to durvalumab and was classified as severe. The physicians adopted the clinical pharmacist’s opinion， and after symptomatic treatment， the patient’s skin symptoms improved， and discharged with medication. After the completion of glucocorticoid therapy for the patient， the physician restarted immunotherapy with tislelizumab， and no related adverse reactions occurred again in the patient. CONCLUSIONS Durvalumab can cause irCAEs such as severe skin maculopapular rash. In clinical practice， it is crucial to promptly identify and discontinue suspicious drugs， immediately implement effective symptomatic treatment measures， and actively resume immunotherapy to ensure the continuity and safety of the patient’s treatment.

Objective: To investigate the role of butyric acid-producing bacteria in long bone homeostasis in mice with periodontitis under a high-fat/high-sugar diet and to provide new insights for the prevention and treatment of periodontitis and related bone metabolic diseases. Methods: This study has been approved by the Animal Welfare and Ethics Committee of the Experimental Animal Center. Initially, 14 mice were randomly divided into the CON group (the control group) and the LIG group (the periodontitis group). Mice in the LIG group had experimental periodontitis induced by ligating the second maxillary molars bilaterally and were fed a high-fat and high-sugar diet. After 8 weeks, samples were collected. Micro-computed tomography (Micro-CT) was used to analyze alveolar bone resorption and various parameters of the proximal tibia trabecular bone, including bone mineral density (BMD), bone volume per tissue volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp). After decalcification, hematoxylin and eosin (HE) staining was performed on maxillary bone sections to assess periodontal tissue inflammation and connective tissue destruction. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect related genes in the distal femur and proximal tibia bone tissues, including osteocalcin (OCN), osteogenic transcription factor (Osterix), osteoprotegerin (OPG), tartrate resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), receptor activator of nuclear factor kappa-B (RANK), and receptor activator of nuclear factor kappa-B ligand (RANK-L). Subsequently, the other 28 mice were randomly divided into the CON group (the control group), LIG group (the periodontitis group), CON + butyric acid-producing bacteria (BP) group, and LIG + BP group. The breeding, sampling, and sample detection methods remained the same. Finally, the other 28 mice were randomly divided into the CON group (the control group), LIG group (the periodontitis group), CON + sodium butyrate (SB) group, and LIG + SB group. The breeding, sampling, and sample detection methods remained the same. Results: ①Periodontitis modeling was successful. Compared with the CON group, the LIG group exhibited significant alveolar bone resorption of the maxillary second molar, aggravated periodontal tissue inflammation, and connective tissue destruction. ②Periodontitis exacerbated long bone resorption in mice fed a high-fat high-sugar diet. Compared with the CON group, the LIG group had significantly lower BMD, BV/TV, Tb.N, and Tb.Th (P<0.05), and significantly higher Tb.Sp (P<0.05). HE staining of the proximal tibia showed that the trabeculae in the LIG group were sparse and disordered, with some areas showing fractures or dissolution. The expression of osteoblast markers (OCN, Osterix, OPG) was significantly lower in the LIG group (P<0.05), while the expression of the osteoclast marker TRAP showed an increasing trend (P>0.05). The ratio of RANK-L/OPG was significantly higher in the LIG group compared with the CON group (P<0.05). ③ Supplementation with butyric acid-producing bacteria alleviates periodontitis-induced disruption of long bone homeostasis in mice fed a high-fat/high-sugar diet. Compared with the LIG group, BMD and Tb.Th were significantly higher in the LIG + BP group. HE staining of the proximal tibia showed that bone resorption was mitigated in the LIG + BP group compared with the LIG group. The expression of OCN and Osterix was significantly higher in the LIG + BP group, while the expression of osteoclast-specific genes (OSCAR, RANK, RANK-L) was significantly lower (P<0.05). ④ Supplementation with butyrate alleviates periodontitis-induced disruption of long bone homeostasis in mice fed a high-fat/high-sugar diet. Compared with the LIG group, BV/TV and Tb.N were significantly higher in the LIG + SB group, and Tb.Sp was significantly lower (P<0.05). HE staining of the proximal tibia showed that bone resorption was mitigated in the LIG + SB group compared with the LIG group. The expression of Osterix, OPG, OSCAR, TRAP, and RANK was significantly lower in the LIG + SB group compared with the LIG group (P<0.05). Conclusion Periodontitis disrupts the long bone homeostasis of mice fed a high-fat high-sugar diet, aggravating long bone resorption. Supplementation with butyric acid-producing bacteria or butyrate can effectively alleviate the disruption of long bone homeostasis caused by periodontitis.

Objective: To investigate the effects of Zuogui Jiangtang Yishen Formula (左归降糖益肾方, ZGJTYSF) in regulating the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)/caspase-1/gasdermin D (GSDMD) signaling axis on pyroptosis in rats with diabetic kidney disease (DKD). Methods: Fifty male specific pathogen-free (SPF) grade Goto-Kakizaki (GK) rats (12 weeks old) were fed a high-fat diet for one month to establish an early DKD model. Model establishment was confirmed when fasting blood glucose (FBG) ≥ 11.1 mmol/L and urinary albumin-to-creatinine ratio (uACR) ≥ 30 mg/g. The successfully modeled early DKD rats were randomly divided by random number table into five groups (n = 10 per group): model group; dapagliflozin group (1.0 mg/kg, by gavage, served as positive control); and low-, medium-, and high-dose of ZGJTYSF groups (4.9, 9.9, and 19.9 g/kg, respectively, by gavage). Age-matched male SPF Wistar rats (n = 10) served as control group. Rats in control and model groups were gavaged with equivalent volumes of distilled water. Treatment lasted 12 weeks. Changes in uACR, FBG, and renal function were observed in all groups. Hematoxylin-eosin (HE), periodic acid-Schiff (PAS), and Masson staining were used to observe renal histopathological changes. Immunohistochemistry was performed to detect the localization and expression of caspase-1, GSDMD, and NLRP3 in rat renal tissues. Terminal deoxynucleotidyl transferase deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) was utilized to detect pyroptosis in renal tissues. Quantitative real-time polymerase chain reaction (qPCR) and Western blot were applied to detect mRNA and protein expression levels of NLRP3, caspase-1, GSDMD, interleukin (IL)-1β, and IL-18. Results: Compared with model group, all doses of ZGJTYSF showed reductions in FBG, with medium- and high-dose of ZGJTYSF groups demonstrating significant decreases at week 8 and 12 (P < 0.05). For uACR, all doses of ZGJTYSF groups exhibited a decreasing trend, with high-dose of ZGJTYSF group being significantly lower than low- and medium-dose of ZGJTYSF groups at week 12 (P < 0.05) and showing no significant difference from dapagliflozin group (P > 0.05). No significant differences in renal function parameters (serum creatinine, blood urea nitrogen, and uric acid) were observed among groups (P > 0.05). Histopathological examination revealed milder glomerular and tubular lesions in both ZGJTYSF groups and dapagliflozin group, with renal pathological changes in high-dose of ZGJTYSF group resembling those in dapagliflozin group. Immunohistochemistry demonstrated significantly reduced expression of caspase-1, GSDMD, and NLRP3 in renal tissues of dapagliflozin group and high-dose of ZGJTYSF group compared with model group (P < 0.05 or P < 0.01), while the differences in low- and medium-dose of ZGJTYSF groups were not statistically significant (P > 0.05). TUNEL assay showed significantly fewer TUNEL-positive cells in renal tissues of dapagliflozin and high-dose of ZGJTYSF groups (P < 0.01), indicating a marked reduction in pyroptotic cells. Molecular analysis revealed that compared with model group, both dapagliflozin and high-dose of ZGJTYSF groups showed significantly downregulated mRNA and protein expression levels of NLRP3, caspase-1, GSDMD, IL-1β, and IL-18 in renal tissues (P < 0.01), while low- and medium-dose of ZGJTYSF groups showed downward trends without statistical significance (P > 0.05). Conclusion ZGJTYSF may inhibit renal pyroptosis by regulating the NLRP3/caspase-1/GSDMD signaling axis, thereby preventing and treating early renal injury in DKD and delaying the onset and progression of DKD.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Narrow leaf 1 (NAL1) plays an important role in plant branching, while little is known about the roles of this gene in petunias. In this study, PhNAL1b was cloned from Petunia×hybrida cv. Mitchell Diploid, with a total length of 1 767 bp, encoding a protein composed of 588 amino acid residues and containing the peptidase S64 domain. The PhNAL1b promoter region contained several elements involved in the responses to auxin, jasmonic acid, abscisic acid, and light. The expression analysis showed that PhNAL1b had the highest expression level in roots and the lowest expression level in flowers, and its transcription could be inhibited by decapitation and cytokinin. The subcellular localization analysis showed that PhNAL1b was located in the nucleus and was a nuclear protein. Virus-induced gene silencing was employed to downregulate the expression of PhNAL1b, which resulted in significant increases in branch number and plant height. The results indicated that PhNAL1b played an important role in regulating the branching of petunias. This study lays a foundation for revealing the mechanism of NAL1 in regulating branch development and provides genetic resources for plant architecture improvement.
Petunia/growth & development* ; Plant Proteins/metabolism* ; Diploidy ; Gene Expression Regulation, Plant ; Cloning, Molecular ; Promoter Regions, Genetic

Objective To explore the effects of combined exposure to bisphenol A (BPA) and high-fat diet on liver lipid metabolism and hepatocyte senescence in mice, and to elucidate the potential mechanisms of the onset and development of non-alcoholic fatty liver disease (NAFLD). Methods Specific pathogen free C57BL/6J mice were randomly divided into six groups, with 10 mice with equal numbers of each sex in each group. The mice in the control group and the simple BPA group were fed with regular diet, while others four groups of mice were fed with high-fat diet. At the same time, the mice in the simple BPA group were intragastric administered with BPA at a dose of 50 μg/kg body weight, while the mice in the low-, medium- and high-dose BPA+high-fat groups were intragastric administered with BPA at doses of 5, 50 and 500 μg/kg body weight respectively. The mice in the control group and the high-fat group were intragastric administered with the same volume of corn oil once per day for 90 consecutive days. Liver tissues were subjected to hematoxylin-eosin (HE) and Oil Red O staining. Liver coefficients and lipid-stained area ratios were calculated. Serum level of total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and the activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined using an automatic biochemical analyzer. The hepatic tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-10 levels were quantified by enzyme-linked immunosorbent assay. The relative expression of cholesterol regulatory element binding protein 1 (SREBP1), CCAAT enhancer binding protein α, P16, and phosphorylated histone H2AX (γ-H2AX) in liver tissues was detected using Western blotting. The interaction effect of the combined exposure to BPA and high-fat diet was observed based on the result of mice in the control group, the simple high-fat group, the simple BPA group, and the medium-dose BPA group+high-fat group (the combined exposure group) using a 2×2 factorial design. The results of mice in the simple high-fat group and the low-, medium-, and high-dose BPA+high-fat groups were used to observe the effect of BPA exposure dose under high-fat diet conditions. Results i) The interactive effect of combined exposure to BPA and high fat. The HE and Oil Red O staining results indicated that the combined exposure to BPA and high-fat diet successfully established NAFLD in mice. The interactive effect of combined exposure to BPA and high-fat diet on serum ALT activity and the relative expression of P16 in the liver tissue of female mice, as well as the serum ALT and AST activities and the relative expression of SREBP1 in the liver tissue of male mice was significant (all P<0.05). Specifically, the serum ALT activity of male mice in the combined exposure group was higher than that in the simple high-fat group (P<0.05), while the ALT activity in the serum of female mice in the combined exposure group was lower than that in the simple BPA group (P<0.05). The relative expression of SREBP1 protein in the liver tissue of male mice in the combined exposure group was higher than that in the control group, the simple high-fat group, and the simple BPA group (all P<0.05). For the other indicators, there were no significant differences in the interactive effect of combined exposure to BPA and high-fat diet (all P>0.05). ii) Dose effects of BPA exposure. The HE and Oil Red O staining result showed that the degree of vacuolar steatosis in the liver of female and male mice of medium- and high-dose BPA + high-fat groups was aggravated, and the range of inflammatory cell infiltration was expanded when compared with same-sex mice in the simple high-fat group. The serum ALT activity and the fat stained area ratio, as well as the relative expression of P16 in liver tissue of female mice in high-dose BPA + high-fat group increased (all P<0.05), while the level of IL-10 in liver tissue decreased (P<0.05), compared with the female mice in simple high-fat group. The serum ALT activity, the TNF-α level in liver tissue, and the relative expression of SREBP1, P16 and γ-H2AX proteins in liver tissue of male mice in high-dose BPA + high-fat group increased (all P<0.05), while the IL-6 level in liver tissue decreased (P<0.05), compared with the male mice in simple high-fat group. For the female or male mice in the low- and medium-dose BPA + high-fat groups, only some of the above indicators showed significant changes (all P<0.05). Conclusion The combined exposure to BPA and high-fat diet has a synergistic effect on the onset and development of NAFLD. The mechanism may be related to inducing cellular senescence and modulation of lipid synthesis pathways, thereby affecting liver steatosis. The exposure dose of BPA may affect the synergistic effect.

Objective : To investigate the role of AdipoRon, an adiponectin receptor agonist, in treatment of carbon tetrachloride(CCl4) induced liver fibrosis mice model and the mechanisms. Methods : Forty mice were randomly divided into control group, model group, L-AdipoRon group and H-AdipoRon group, with 10 mice in each group. Hepatic fibrosis was induced by intraperitoneal injection of CCl4solution. The mice in L-and H-AdipoRon groups were given 100 mg/kg and 200 mg/kg AdipoRon by gavage, respectively. The activities of serum aspartate aminotransferase(AST) and alanine aminotransferase(ALT) were detected by biochemical method. Liver histopathological changes and fibrosis were detected by HE staining, Masson staining and Sirius scarlet stain. The protein expression levels of Collagen I, α-smooth muscle actin(α-SMA), matrix metalloproteinase 1(MMP-1) and matrix metalloproteinase inhibitor 1(TIMP-1) in mice liver were detected by Western blot. Lipid deposition in liver were detected by oil red O staining. The percentage(%) of CD68+ iNOS+ positive M1-type macrophages in the liver were detected by immunofluorescence. The expression levels of fatty acid synthetase(Fasn), stearoyl-CoA desaturase 1(Scd1), fatty acid transporter(Cd36), peroxissome proliferator activated receptor-α(Pparα) and carnitine palmitoyl transferase 1α(Cpt1α) in mice liver tissues, as well as M1 macrophage-related genes interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) and M2 macrophage-related genes arginase 1(Arg1), Chil3 chitinase-like 3(Ym-1) were detected by RT-qPCR assay. Results : Compared with model group, in low-dose AdipoRon group and high-dose AdipoRon group, serum ALT and AST activities significantly decreased(P<0.05); liver tissues structure were damaged, liver cells degeneration and inflammatory cells infiltration were improved; collagen fiber deposition was also significantly reduced; the relative expression levels of Collagen I, α-SMA and TIMP-1 proteins were significantly down-regulated(P<0.05), while the relative expression levels of MMP-1 protein were significantly up-regulated(P<0.05); the lipid droplets deposition in livers were significantly reduced. The relative Fasn, Scd1 and Cd36 mRNA expression levels in liver tissues were significantly down-regulated(P<0.05), and the relative Pparα and Cpt1α mRNA expression levels were significantly up-regulated(P<0.05); the percentage(%) of CD68+ iNOS+ positive M1-type macrophages significantly decreased(P<0.05); the relative IL-6 and TNF-α mRNA expression levels significantly decreased(P<0.05), the relative Arg1 and Ym-1 mRNA expression levels were significantly up-regulated(P<0.05). In addition, the improvement effects of high-dose AdipoRon group were better than those of low-dose AdipoRon group(P<0.05). Conclusion AdipoRon can improve the disorder of lipid metabolisms, inhibit the M1 type macrophages polarization, and improve the liver fibrosis in CCl4-induced liver fibrosis mice model.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Objective To explore the correlation between platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR)and carotid atherosclerotic(CAS)plaque in patients with type 2 diabetes(T2DM),and the predictive value of PLR and NLR for T2DM complicated with CAS plaque.Methods A total of 369 T2DM patients admitted to the Department of Endocrinology,the Third Affiliated Hospital of Xinxiang Medical University from September 2019 to November 2021 were se-lected as research subjects.The clinical data such as gender,age,course of disease,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),personal history,and history of past illness of patients were collected by searching the electronic medical record system.Neutrophil(NC)count,lymphocyte count(LC)and platelet(PLT)count were detected by fully automated blood routine analyzer,and PLR,NLR were calculated;the levels of fasting blood glucose(FBG),total cholesterol(TC),triglycerides(TG),high-density lipoprotein-cholesterol(HDL-C)and low-density lipoprotein-cholesterol(LDL-C)were detected by biochemical analyzer;the level of glycosylated hemoglobin(HbA1c)were detected by high-performance liquid chromatography.The T2DM patients were divided into T2DM uncomplicated with CAS plaque group(n=94)and T2DM complicated with GAS plaque group(n=275)based on whether they complicated with CAS plaque or not;the general clinical data,blood indicators,and PLR,NLR of patients were compared between the two groups.The T2DM patients were divided into non plaque group(group A,n=94),1 plaque group(group B,n=79),2 plaque group(group C,n=89),and 3 or more plaques group(group D,n=107)based on the number of CAS plaques;the indicators with statistical differences between T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group of patients were compared among the four groups.According to the PLR quartile,the patients were divided into P1 group(PLR≤94.87,n=93),P2 group(94.87＜PLR≤117.30,n=91),P3 group(117.30＜PLR ≤ 148.53,n=93),and P4 group(PLR＞148.53,n=92),and the detection rate of CAS plaques of patients was compared among the four groups;according to the NLR quartile,the patients were divided into N1 group(NLR≤1.59,n=92),N2 group(1.59＜NLR≤1.93,n=92),N3 group(1.93＜NLR≤2.50,n=93),and N4 group(NLR＞2.50,n=92),and the detection rate of CAS plaque of patients was compared among the four groups.The risk factors of T2DM complicated with CAS plaque was analysed by multivariate logistic regression analysis,and the predictive efficacy of PLR and NLR for T2DM complicated with CAS plaque were evaluated by receiver operating characteristic(ROC)curve.Results The age,course of T2DM,proportion of patients combined with hyper-tension,SBP,PLR,and NLR of patients in the T2DM complicated with CAS plaque group were significantly higher than those in the T2DM uncomplicated with CAS plaque group,while LC and TG levels were significantly lower than those in the T2DM uncomplicated with CAS plaque group(P＜0.05);there was no significant difference in gender,proportion of patients com-bined with hyperlipidemia,proportion of smoking history,proportion of drinking history,and the levels of DBP,BMI,NC,PLT,TC,HDL-C,LDL-C,FBG,HbA1c between the T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,SBP,PLR,and NLR of patients in group B,group C,and group D were significantly higher than that in group A,while LC level was significantly lower than that in group A(P＜0.05).The TG level of patients in group D was significantly lower than those in group A(P＜0.05);there was no statistically significant difference in TG level of patients among group A,group B,and group C(P＞0.05).The age,proportion of patients combined with hypertension,and course of T2DM of patients in group C and group D were significantly higher than those in group B,while the SBP of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in SBP of patients between group C and group B(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,and SBP of patients in group D were significantly higher than those in group C(P＜0.05).There was no statistically significant difference in the levels of LC,TG,and PLR of patients among group B,group C,and group D(P＞0.05).The NLR of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in NLR of patients between group C and group B(P＞0.05),and there was no statistically significant difference in NLR of patients between group D and group C(P＞0.05).The detection rate of CAS plaques of patients in P1 group,P2 group,P3 group,and P4 group showed a significant increase trend(x2=30.610,P=0.000);and the detection rate of CAS plaques of patients in N1 group,N2 group,N3 group,and N4 group showed a significant increase trend(x2=35.170,P=0.000).Multivariate logistic regression analysis showed that age,PLR,and NLR were independent risk factors for T2DM complicated with CAS plaque(odds ratio=1.107,1.017,1.940;P＜0.05).The opti-mal cutoff value of PLR in predicting T2DM complicated with CAS plaque was 119.95,with an area under the curve of 0.680,a sensitivity of 54.7％,and a specificity of 76.3％;the optimal cutoff value of NLR in predicting T2DM complicated with CAS plaque was 1.97,with an area under the curve of 0.698,a sensitivity of 56.5％,and a specificity of 79.6％.Conclusion PLR and NLR are associated with T2DM complicated with CAS plaque,which are independent risk factors for T2DM compli-cated with CAS plaque,and have certain predictive value for T2DM complicated with CAS plaque.

Objective:To explore the application effect of theory of inventive problem solving(TRIZ)in the management of loaner instruments in central sterile supply department(CSSD).Methods:TRIZ management team was set up to analyze problems in cleaning,disinfection and sterilization of loaner instruments.The invention principles of TRIZ were compared to determine targeted solutions to the corresponding problems.A total of 1,000 pieces of loaner instruments received by The Third Affiliated Hospital of Air Force Medical University were selected from January and December 2023 were selected,the 500 pieces received from January to June were managed by routine standard management mode,and the 500 pieces received from July to December were managed by the TRIZ management mode.The qualification rates of instruments cleaning,disinfection,packaging and sterilization,the incidence of adverse events,the satisfaction scores of clinical departments and assessment results of newly hired nurses of CSSD were compared between the two management modes.Results:The qualification rates of instruments cleaning,disinfection,packaging and sterilization of TRIZ management mode were 98.00%(490/500),97.20%(486/500),96.40%(482/500)and 96.00%(480/500),respectively,which were higher than those of routine standard management mode,the difference was statistically significant(x2=12.029,11.685,8.859,8.322,P<0.05).The incidence of adverse events of TRIZ management mode was 0%,the routine standard management mode was 1.20%,the difference was statistically significant(x2=6.036,P<0.05).The average scores of CSSD newly hired nurses in of theoretical knowledge,treatment process,cleaning,disinfection and sterilization and packaging of TRIZ management mode were(89.20±6.69)points,(88.47±3.48)points,(92.47±5.37)points and(92.00±5.83)points,respectively,which were higher than those of routine standard management mode,the difference was statistically significant(t=3.993,4.402,3.926,3.332,P<0.05).The satisfaction scores of clinical department personnel with instruments quality,distribution,handover,information traceability,service attitude and overall satisfaction of TRIZ management mode were(18.65±0.81)points,(18.85±1.04)points,(18.95±1.05)points,(18.40±0.75)points,(18.35±0.93)points and(93.20±1.91)points,respectively,which were higher than those of the routine standard management mode,the difference was statistically significant(t=3.599,5.889,4.851,4.865,2.075,8.723,P<0.05).Conclusion:The application of TRIZ in the management of loaner instruments in CSSD can significantly improve theoretical knowledge and practical skills of newly hired nurses in CSSD,thereby improving the qualification rates of instruments cleaning,disinfection,packaging and sterilization of loaner instruments,reducing the occurrence of instrument-related adverse events and improving satisfaction of department personnel with instruments use.