OBJECTIVE To investigate the influence of CYP2C19 gene polymorphism on platelet function and inflammatory cytokines in elderly patients with ischemic stroke， and to analyze potential factors associated with poor prognosis. METHODS A retrospective study was conducted on elderly patients with ischemic stroke admitted to our hospital from June 2024 to June 2025， wh o underwent CYP2C19 genotype testing and received antiplatelet therapy with clopidogrel. The levels of platelet function indicators and inflammatory cytokines before and after treatment were compared among patients with different metabolic phenotypes. Based on the prognosis at 6 months post-treatment， patients were divided into poor prognosis group and good prognosis group. Univariate analysis was performed on general data， metabolic phenotype， the levels of platelet function indicators and inflammatory cytokines. Variables with P ＜0.05 and the levels of inflammatory cytokines before treatment were included in a multivariate Logistic regression analysis to identify independent risk factors for poor prognosis. Multiple linear regression was used to further analyze the relationship between metabolic phenotypes and inflammatory cytokines. RESULTS A total of 448 elderly patients with ischemic stroke were included； among them， 162 cases were normal metabolic phenotype， 218 were intermediate metabolic phenotype， and 68 were poor metabolic phenotype. No rapid or ultrarapid metabolic phenotypes were observed. After treatment， platelet aggregation rate， the levels of P-selectin and platelet activated complex-1 （PAC-1）， high-sensitivity C-reactive Protein （hs-CRP）， interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α） in the normal metabolic phenotype group， intermediate metabolic phenotype group， and poor metabolic phenotype group （except for platelet aggregation rate， and the levels of P-selectin and PAC-1 in the poor metabolic phenotype group） were significantly lower than those before treatment in the same group. Moreover， the above indicators in the normal metabolic phenotype group were significantly lower than those in the intermediate and poor metabolic phenotype groups at the corresponding time， and the levels of platelet function indicators in the intermediate metabolic phenotype group were significantly lower than those in the poor metabol ic phenotype group at the corresponding time （ P ＜0.05）. Univariate and multivariate Logistic regression analyses showed that combined with hypertension， combined with diabetes mellitus， and intermediate or poor metabolic genotypes were independent risk factors for poor prognosis in elderly patients with ischemic stroke （ P ＜0.05）. Multiple linear regression analysis showed that serum levels of hs-CRP， IL-1β， IL-6 and TNF-α before treatment were significantly higher in patients with intermediate and poor metabolic genotypes compared to those with normal metabolic genotype （ P ＜0.05）， with a greater magnitude of increase in inflammatory cytokines observed in the patients with poor metabolic genotype. CONCLUSIONS The elderly ischemic stroke patients with CYP2C19 intermediate and poor metabolic genotypes have poor inhibition effect on platelet and higher levels of inflammatory cytokines than normal metabolic genotype； CYP2C19 gene polymorphism， and in combination with hypertension and diabetes， can be used as independent predictors of poor prognosis.

Objective:To explore the potential profile categories of self-disgust in young and middle-aged breast cancer patients, and analyze the influencing factors of different categories.Methods:A convenience sampling method was used, and 270 young and middle-aged breast cancer patients admitted to the thyroid and breast cancer ward and oncology ward of Fenyang Hospital in Shanxi Province from September 2023 to April 2024 were the study subjects. The survey was conducted transect surveys using the general information questionnaire, Questionnaire for the Assessment of Self-Disgust, Social Constraints Scale, the Chronic Illness Rejection and Discrimination Scale. Potential categories of self-disgust in young and middle-aged breast cancer patients were explored using latent profile analysis, and unordered multinomial Logistic regression was employed to investigate their influencing factors.Results:A total of 234 young and middle-aged female breast cancer patients were included, with the age of (45.61±10.90) years old. Latent profile analysis revealed three potential categories of self-hatred in these patients: low disgust group (45.30%, 106/234), medium disgust group (41.45%, 97/234), and generalized high disgust group (13.25%, 31/234). Compared to the low disgust group, patients with more comorbidities and poorer self-care ability were more likely to belong to the generalized high disgust group ( OR=0.244, 8.775, both P<0.05). Patients with a longer duration of illness and higher scores on the social constraints scale and chronic illness rejection and discrimination scale were more likely to fall into the medium disgust group and the generalized high disgust group ( OR values were 0.156 - 1.317, all P<0.05). Conclusions:The level of self-disgust in young and middle-aged breast cancer patients is significantly heterogeneous. Nursing staff should formulate personalized intervention strategies according to this classification characteristic, which can be cut from the perspective of reducing patients' social restriction and chronic illness rejection and discrimination to improve patients' acceptance of the disease and self-acceptance level, and then reduce their self-disgust.

Alzheimer′s disease is a serious neurodegenerative disorder. Approximately 80% to 90% of patients are accompanied by behavioral and psychological symptoms of dementia (BPSD), which manifest as a series of behavioral, psychological and mental abnormalities. These abnormalities can accelerate the cognitive deterioration and premature death of patients, and thus are regarded as important clinical symptoms. However, the pathogenesis of BPSD is still unknown, and treatment methods are limited. The pathogenesis of BPSD from the perspective of neuroimaging and pathophysiology, and possible treatment measures were analyzed in this article, in order to provide references for the early diagnosis and treatment of BPSD.

OBJECTIVE: To determine the carrier rate for thalassemia mutations in the ethnic Miao population of Qianxinan Prefecture. METHODS: Ethnic Miao people suspected for thalassemia trait at the People's Hospital of Qianxinan Prefecture, Guizhou Province between November 2020 to September 2024 were selected as the study subjects. Gap-PCR technology combined with high-throughput sequencing was used to screen a total of 666 individuals. ArcMap v10.8.2 was used to create a spatial distribution map of thalassemia based on the screening results. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: 2016-01). RESULTS: In total 254 positive cases were detected, with an overall positive rate of 38.14%. Among these, 173 cases were α-thalassemia (25.98%), 77 cases were β-thalassemia (11.56%), and 4 cases were αβ compound thalassemia (0.60%). The most common genotypes for α-thalassemia were αα/--^SEA (positive rate = 10.06%, accounting for 38.73%), αα/-α^3.7 (positive rate = 8.86%, accounting for 34.10%), and α^CSα/αα (positive rate = 4.95%, accounting for 19.08%). The most common genotypes for β-thalassemia were β^41/42(-TTCT)/β^A (positive rate = 5.11%, accounting for 44.16%) and β^{17 (A>T)}/β^A(positive rate = 4.20%, accounting for 36.36%), with these two genotypes accounting for as much as 80.52%. The spatial distribution map indicated that the highest overall detection rate of thalassemia and α-thalassemia in the Miao population of Qianxinan Prefecture was in Xingyi City. The highest detection rate of β-thalassemia was in Zhenfeng County, and the highest detection rate of αβ compound thalassemia was in Wangmo County. CONCLUSION The detection rate of thalassemia among the ethnic Miaos from Qianxinan Prefecture is relatively high, which primarily consisted of α-thalassemia. Regular monitoring and educational outreach should be conducted.
Humans ; China/ethnology* ; Female ; Male ; Genetic Testing ; Adult ; alpha-Thalassemia/genetics* ; Thalassemia/ethnology* ; Ethnicity/genetics* ; Genotype ; beta-Thalassemia/ethnology* ; Adolescent ; Mutation ; Middle Aged ; Child ; Asian People/genetics* ; Young Adult

Objective To observe the efficacy,safety,and compliance of lamotrigine combined with magnesium valproate in treating children with depressive episodes of bipolar disorder,and to explore the effects on thyroid hormone levels,brain-derived neurotrophic factor(BDNF),C-reactive protein(CRP),interleukin-1(IL-1),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and plasma concentration of valproate.Methods The children with bipolar disorder diagnosed from January 2023 to February 2025 were selected,and divided into the observation group and control group.The control group was treated with magnesium valproate tablets,and the observation group was added lamotrigine in addition to the treatment given to the control group.Both groups were treated continuously for 8 weeks.The clinical efficacy,the Hamilton Depression Scale-24(HAMD-24)score,Clinical Global Impression(CGI)assessment,thyroid hormone levels,BDNF,CRP,IL-1,IL-10 and TNF-α,daily average dose of magnesium valproate(D),blood concentration of valproate(C),C/D ratio,mean dosing interval(h),incidence of adverse reactions,and medication adherence and satisfaction scores in both groups was observed.Results A total of 100 children were included,50 in each group.After treatment,the total effective rate of the observation group was 98.00％which was significantly higher than that of the control group(84.00％)(P＜0.05).The serum free triiodothyronine(FT3),free thyroxine(FT4),BDNF and IL-10 in both groups increased compared to the previous(P＜0.05),while HAMD-24 score,CGI score,thyroid-stimulating hormone(TSH),CRP,IL-1 and TNF-α decreased(P＜0.05),and all indicators in the observation group were better than those in the control group(P＜0.05).Both groups had no serious or new adverse drug reactions,and the incidence of total adverse reactions,the difference in the incidence of total adverse reactions was not statistically significant(P＞0.05).There was no statistically significant difference in valproic acid blood concentrations between the two groups of children(P＞0.05).The medication compliance score and satisfaction score of the observation group were significantly higher than those of the control group(P＜0.05).Conclusion Combination of lamotrigine with magnesium valproate in children with depressive episodes of bipolar disorder improves treatment effective and clinical symptoms,promotes a rise in thyroid hormone and BDNF as well as improves inflammatory factors and increases medication adherence and satisfaction in children with a better safety profile.

Alzheimer′s disease is a serious neurodegenerative disorder. Approximately 80% to 90% of patients are accompanied by behavioral and psychological symptoms of dementia (BPSD), which manifest as a series of behavioral, psychological and mental abnormalities. These abnormalities can accelerate the cognitive deterioration and premature death of patients, and thus are regarded as important clinical symptoms. However, the pathogenesis of BPSD is still unknown, and treatment methods are limited. The pathogenesis of BPSD from the perspective of neuroimaging and pathophysiology, and possible treatment measures were analyzed in this article, in order to provide references for the early diagnosis and treatment of BPSD.

Objective To observe the efficacy,safety,and compliance of lamotrigine combined with magnesium valproate in treating children with depressive episodes of bipolar disorder,and to explore the effects on thyroid hormone levels,brain-derived neurotrophic factor(BDNF),C-reactive protein(CRP),interleukin-1(IL-1),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and plasma concentration of valproate.Methods The children with bipolar disorder diagnosed from January 2023 to February 2025 were selected,and divided into the observation group and control group.The control group was treated with magnesium valproate tablets,and the observation group was added lamotrigine in addition to the treatment given to the control group.Both groups were treated continuously for 8 weeks.The clinical efficacy,the Hamilton Depression Scale-24(HAMD-24)score,Clinical Global Impression(CGI)assessment,thyroid hormone levels,BDNF,CRP,IL-1,IL-10 and TNF-α,daily average dose of magnesium valproate(D),blood concentration of valproate(C),C/D ratio,mean dosing interval(h),incidence of adverse reactions,and medication adherence and satisfaction scores in both groups was observed.Results A total of 100 children were included,50 in each group.After treatment,the total effective rate of the observation group was 98.00％which was significantly higher than that of the control group(84.00％)(P＜0.05).The serum free triiodothyronine(FT3),free thyroxine(FT4),BDNF and IL-10 in both groups increased compared to the previous(P＜0.05),while HAMD-24 score,CGI score,thyroid-stimulating hormone(TSH),CRP,IL-1 and TNF-α decreased(P＜0.05),and all indicators in the observation group were better than those in the control group(P＜0.05).Both groups had no serious or new adverse drug reactions,and the incidence of total adverse reactions,the difference in the incidence of total adverse reactions was not statistically significant(P＞0.05).There was no statistically significant difference in valproic acid blood concentrations between the two groups of children(P＞0.05).The medication compliance score and satisfaction score of the observation group were significantly higher than those of the control group(P＜0.05).Conclusion Combination of lamotrigine with magnesium valproate in children with depressive episodes of bipolar disorder improves treatment effective and clinical symptoms,promotes a rise in thyroid hormone and BDNF as well as improves inflammatory factors and increases medication adherence and satisfaction in children with a better safety profile.

Objective:To explore the potential profile categories of self-disgust in young and middle-aged breast cancer patients, and analyze the influencing factors of different categories.Methods:A convenience sampling method was used, and 270 young and middle-aged breast cancer patients admitted to the thyroid and breast cancer ward and oncology ward of Fenyang Hospital in Shanxi Province from September 2023 to April 2024 were the study subjects. The survey was conducted transect surveys using the general information questionnaire, Questionnaire for the Assessment of Self-Disgust, Social Constraints Scale, the Chronic Illness Rejection and Discrimination Scale. Potential categories of self-disgust in young and middle-aged breast cancer patients were explored using latent profile analysis, and unordered multinomial Logistic regression was employed to investigate their influencing factors.Results:A total of 234 young and middle-aged female breast cancer patients were included, with the age of (45.61±10.90) years old. Latent profile analysis revealed three potential categories of self-hatred in these patients: low disgust group (45.30%, 106/234), medium disgust group (41.45%, 97/234), and generalized high disgust group (13.25%, 31/234). Compared to the low disgust group, patients with more comorbidities and poorer self-care ability were more likely to belong to the generalized high disgust group ( OR=0.244, 8.775, both P<0.05). Patients with a longer duration of illness and higher scores on the social constraints scale and chronic illness rejection and discrimination scale were more likely to fall into the medium disgust group and the generalized high disgust group ( OR values were 0.156 - 1.317, all P<0.05). Conclusions:The level of self-disgust in young and middle-aged breast cancer patients is significantly heterogeneous. Nursing staff should formulate personalized intervention strategies according to this classification characteristic, which can be cut from the perspective of reducing patients' social restriction and chronic illness rejection and discrimination to improve patients' acceptance of the disease and self-acceptance level, and then reduce their self-disgust.

OBJECTIVE To evaluate the cost-effectiveness of finerenone combined with standard treatment regimen in the treatment of diabetic nephropathy (DN).METHODS From the perspective of healthcare service providers,a Markov model was established to simulate the dynamic changes of each stage in DN patients who received finerenone combined with the standard treatment regimen or the standard treatment regimen alone based on the phase Ⅲ clinical trial study of finerenone for DN.Markov model was used to perform the cost-effectiveness of long-term effects and the costs of the two therapies with a simulation cycle of 4 months,a simulation period of 15 years and an annual discount rate of 5％.At the same time,one-way sensitivity analysis and probability sensitivity analysis were performed,and the stability of the results was validated.RESULTS Accumulative cost of the standard treatment regimen was 579329.54 yuan,and the accumulative utility was 8.0524 quality-adjusted life year (QALYs);the accumulative cost of finerenone combined with the standard treatment regimen was 332520.61 yuan,and the accumulative utility was 8.1874 QALYs.Finerenone combined with the standard treatment regimen was more cost-effective.The results of one-way sensitivity analysis showed that dialysis status utility value,DN stage 3 utility value and DN stage 4 utility value had a great influence on the incremental cost-effectiveness ratio,but did not affect the robustness of the model.The results of probability sensitivity analysis showed that finerenone combined with the standard treatment regimen was more cost-effective with 100％ probability.CONCLUSIONS For DN patients,finerenone combined with the standard treatment regimen is more cost-effective as an absolute advantage option.

Objective:To explore the categories of health behavior autonomy of elderly breast cancer patients and their influencing factors, so as to provide reference for developing targeted strategies.Methods:A convenience sampling method was used to select 300 elderly breast cancer patients from Fenyang Hospital in Shanxi Province from December 2023 to May 2024, and a cross-sectional survey was conducted using general information questionnaire, Functional Indicator of Autonomy (FIA), Simplified Bidirectional Social Support Scale (SBSS), and Fried Frailty Scale (FFS) to explore the potential categories of autonomy by using latent profile analysis, and multicategorical Logistic regression was used to analyze the effects of each factor on their different categories.Results:Validly recovered questionnaires were 256, and the female elderly breast cancer patients aged (65.54 ± 5.34) years. The autonomy of health behaviors of breast cancer patients was divided into three groups: "low autonomy group" (35.56%, 91/256), "medium autonomy group" (48.82%, 125/256), "high autonomy group" (15.62%, 40/256) in 3 potential profiles. Logistic regression analysis showed that patients′knowledge of the disease, debilitation, comorbidities, and bi-directional social support were influential factors in patients′autonomy in health behaviors ( OR values were 0.283-4.310, all P<0.05). Conclusions:There is significant heterogeneity in the level of health behavior autonomy among elderly breast cancer patients. Healthcare professionals should focus on the characteristics of different patients′autonomy and give personalized guidance and nursing interventions to improve the autonomy of patients′health management, in order to provide a basis for intervention to improve the health behaviors of elderly breast cancer.