Dialectical behavior therapy （DBT） is one of the empirically supported therapeutic approaches for borderline personality disorder （BPD）. By integrating behaviorism， dialectical philosophy， biosocial theory and Zen principles， DBT aims to enhance patients' emotional regulation， interpersonal effectiveness and distress tolerance， thereby alleviating BPD symptoms. This article systematically reviews the theoretical foundations of DBT and its research progress in BPD treatment， to Delve into the intervention effects of DBT， as well as the adjuvant role of pharmacotherapy and physiotherapy in enhancing DBT for BPD， and analyzes the challenges faced in DBT research and clinical application. The findings are expected to provide new insights for the localization and theoretical research of DBT in China.

Objective: To explore the associations between caregivers nutrition literacy and pediatric nonalcoholic fatty liver disease (NAFLD), so as to provide scientific evidence for the key contents of family intervention measures. Methods: In September 2022, a study involving 1 609 thirdgrade students and their caregivers from six schools in Yinzhou, Haishu, and Zhenhai Districts of Ningbo City, Zhejiang Province, was conducted. Venous blood samples were collected to measure lipid profiles and investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) among the children. Family Food Environment Questionnaire was used to assess the nutrition literacy levels of the caregivers. Generalized linear regression analysis was employed to explore the correlation between caregivers nutrition literacy levels and the prevalence of NAFLD in children. Results: Among the surveyed students, 191 were in the NAFLD group, whereas 1 418 were in the nonNAFLD group. The median nutrition literacy score of caregivers in the NAFLD group and nonNAFLD group all were 11.00 (9.00,12.00), which was not significantly different (Z=-0.40, P=0.71). The generalized linear regression results revealed that the level of nutrition literacy of caregivers had no significant effect on childrens Triglyceride-glucose (TyG) index and Triglyceride-glucose-Waisttoheight ratio (TyG-WHtR) [β(95%CI) were 0.001(-0.005-0.006) and 0.000(-0.014-0.014), P>0.05]. Conclusions The nutrition literacy level of caregivers has no significant correlation with the direct incidence of NAFLD in children. As for family intervention measures, it is necessary not only to improve the nutrition literacy level of caregivers but also to effectively apply nutritional knowledge in practice to optimize health management.

Objective To evaluate the protective effects of the traditional Chinese medicine formula Shenxiankang on renal injury and fibrosis,and to explore its potential mechanisms of action.Methods Chronic kidney disease(CKD)model was established in mice using unilateral ureteral obstruction(UUO).The mice were randomly divided into four groups:sham,UUO,and Shenxiankang(SXK)Low/High dose groups(1500,4500 mg/(kg·d)),each comprising eight mice.The each SXK groups received daily oral administration of Shenxiankang,and the remaining mice were gavaged equivalent volumes of saline for 7 d.After the experiment,renal tissues were collected for assessment of renal injury and fibrosis using HE and Masson staining.The expression levels of fibrosis markers and proteins involved in the epithelial membrane protein 3(Emp3)and Tgf-β/Smad3 signaling pathway were determined by Real-time PCR,immunohistochemistry,and Western Blot.In cell-based experiments,the effects of Shenxiankang on the Emp3/Tgf-β/Smad3 pathway and its interaction with TGF-beta receptor R2(Tgfβ2)were further analyzed using an Emp3 knockdown and Co-IP assays.Results Shenxiankang significantly reduced immune cell infiltration and tubular atrophy in the UUO model group and decreased the expression of kidney injury markers kidney injury molecule 1(Kim1)and Lipocalin 2(Lcn2),confirming its efficacy in alleviating renal injury.Masson staining and analysis of fibrosis markers Fibronectin(Fn)and α-smooth muscle actin(α-SMA)indicated that Shenxiankang effectively suppressed fibrosis induced by UUO.Mechanistic studies revealed that Shenxiankang exerted its effects by selectively downregulating the abnormal activation of the Emp3/Tgf-β/Smad3 signaling pathway,a finding further supported by cellular experiments showing that Shenxiankang modulates Tgf-β/Smad3 signaling through Emp3 regulation.Moreover,the Co-IP experiment result indicate that Shenxiankang exerts its effects by regulating the interaction between Emp3 and Tgfβ2.Conclusions Shenxiankang exhibits significant protective effects in a mouse model of chronic kidney disease,effectively reducing renal injury and fibrosis.These effects are likely mediated through the downregulation of the Emp3/Tgf-β/Smad3 signaling pathway,suggesting Shenxiankang's potential therapeutic value in renal protection.

Objective:To explore the effect of vitamin D supplement on chronic musculoskeletal pain (CMP) in patients with ankylosing spondylitis (AS) through a cohort study and provide evidence for optimizing vitamin D supplement strategies in AS management.Methods:Based on the large-scale prospective cohort of the UK Biobank, a total of 1 497 middle-aged and older patients diagnosed with AS were included. Patients were categorized into three groups according to their baseline vitamin supplements usage: non-vitamin supplement group ( n=978), vitamin D supplement group ( n=65), and other vitamin supplements group ( n=454). The occurrence of CMP was obtained by baseline pain survey and follow-up data from 2019—2020 and 2022—2023. A generalized linear mixed model (GLMM) was used to analyze the association between vitamin D supplement and CMP occurrence, with odds ratio ( OR) and its 95% confidence intervals ( CI) calculated. To verify robustness of the study findings, propensity score matching was employed to match participants in the vitamin D supplementation group with those in the non-vitamin supplement group and the other vitamin supplements group for sensitivity analysis. Results:After adjusting for confounding factors such as demographic characteristics, lifestyle, and co-morbidities, GLMM analysis did not find significant association between vitamin D supplement and the risk of CMP occurrence in AS patients [ OR(95% CI)=0.85(0.48, 1.48), P=0.555]. However, GLMM analysis indicated that male AS patients had a lower likelihood of developing CMP compared to female patients [ OR(95% CI)=0.69(0.56, 0.86), P<0.001]. Additionally, current smoking [ OR(95% CI)=1.46(1.06, 2.03), P=0.022] and poorer overall health status-categorized as general [ OR(95% CI)=2.32(1.85, 2.90)] or poor [ OR(95% CI)=2.31(1.68, 3.18), P<0.001] were associated with an increased risk of CMP occurrence. In the sensitivity analysis, no significant association was observed between vitamin D supplement and CMP. Conclusion:Vitamin D supplement does not reduce the risk of CMP occurrence in middle-aged and old AS patients. However, female, smoking, and poor overall health status are identified as risk factors for CMP in AS patients. Future research should focus on large-scale real-world studies, particularly in younger AS populations, to further investigate the relationship between vitamin D supplement and CMP, thereby providing more targeted intervention strategies.

Plant-derived bioactive peptides have become a research hotspot in the fields of food and medicine due to their high source safety,easy absorption and utilization by the human body,and potential edible and medicinal value.Bioactive peptides can be classified into antihypertensive,hypoglycemic,hypolipidemic,anticancer,antioxidant,antimicrobial,and anti-inflammatory peptides according to their functions.Among these,antihypertensive,hypoglycemic,and hypolipidemic peptides are collectively referred to as cardiovascular active peptides,which can be used for the treatment and prevention of cardiovascular diseases and have an important role in the development of modem biomedicine.This review focused on the preparation methods,separation,purification,and identification techniques of bioactive peptides,as well as their mechanisms of action and applications in regulating cardiovascular diseases,aiming to provide a reference for further development and application of plant-derived cardiovascular peptides.

Objective To explore the relationship of microRNA(miR)-155,miR-92a and miR-126 with in-stent restenosis(ISR)after percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD).Methods A total of 118 elderly CHD patients receiving PCI in our hospital from January 2021 to June 2023 were enrolled,and according to whether ISR occurred by coronary angiography(CAG)at 1 year after surgery,they were divided into a stenosis group(45 cases)and a non-stenosis group(73 cases).Their baseline data,number of stent,stent diameter,medication,coronary artery lesion score,and serum expression levels of miR-155,miR-92a and miR-126 were compared between the two groups.The correlation of expression levels of the three miRNAs and clinical indicators was analyzed.Multivariate logistic regression analysis was performed to identify the risk factors of ISR in elderly CHD patients.ROC curve was adopted to analyze the diagnostic value of the three miRNAs for ISR in the elderly patients.Results Signifi-cantly higher BMI,SBP and DBP,and larger proportions of stent count ≥3 and stent diameter＜3 mm were observed in the stenosis group than the non-stenosis group(P＜0.05,P＜0.01).The expression levels of miR-155 and miR-126 were obviously lower,while that of miR-92a was nota-bly higher in the stenosis group than the non-stenosis group(P＜0.01).Pearson correlation analy-sis showed that miR-155 and miR-126 were negatively correlated with BMI,SBP,DBP,and stent count,and positively correlated with stent diameter(P＜0.01);miR-92a was positively correlated with BMI,SBP,DBP,and stent count,and negatively with stent diameter(P＜0.01).Multivariate logistic regression analysis suggested that stent count,stent diameter and miR-92a were risk fac-tors for ISR in elderly CHD patients after PCI,and miR-155 and miR-126 were protective factors(P＜0.05,P＜0.01).ROC curve analysis revealed that the AUC value of miR-155,miR-92a,and miR-126 alone and combined together was 0.742,0.778,0.751 and 0.853,respectively,with a sen-sitivity of 86.67％,71.11％,73.33％and 93.33％respectively,and the combined detection showed better diagnostic value for ISR than the single detection(P＜0.01).Conclusion Down-regulation of miR-155 and miR-126 and up-regulation of miR-92a may be involved in the occurrence of ISR in elderly CHD patients after PCI.Monitoring the three miRNAs is beneficial to auxiliary clinical prediction for ISR after PCI.

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia,which long-term loss of control can lead to complications of blood vessels of heart,renal and other multi-system,and even threaten the patient's life.Monitoring for blood glucose is crucial for adjusting treatment and preventing complications.Traditional invasive glucose monitoring technology requires frequent blood collection,which not only leads to significant pain in patients,but also poses the risk of infection at the puncture site,coupled with the reduced compliance brought about by cumbersome operation,which seriously restricts the effectiveness and continuity of blood glucose management.The non-invasive monitoring technique for blood glucose can enhance frequency of monitoring,and comfort level through optical method,biosensing method,etc.,which has key values in optimizing glycemic control,reducing risk of complications,and decreasing medical cost.It is becoming a hot point of research.This review summarized a noninvasive monitoring technique system included sample analysis method,optical method and physiological process-based method,which analyzed principles,advantages,and limitations of its development of each detection method.The review also concluded the challenges of noninvasive monitoring technique for blood glucose in some aspects included overcoming individual differences,enhancing precision of measurement,and improving accuracy and stability.In addition,it proposed some developing directions of noninvasive monitoring technique in future,such as continuous monitoring equipment with low cost,establishment of standardized database,and individual validation,so as to promote implementation of noninvasive monitoring technique for blood glucose,and realize accurate management for diabetes mellitus.

Objective To screen the risk factors for hypoglycemia in adult intensive care unit(ICU)patients,construct a risk prediction model,and validate its predictive effect.Methods A retrospective study was conducted on adult critically ill patients admitted to the general ICU of Hospital of Chengdu University of Traditional Chinese Medicine from December 2023 to September 2024.Patients admitted from December 2023 to June 2024 served as the modeling group,and those from July to September 2024 as the validation group.A total of 928 patients were included,with 650 in the modeling group and 278 in the validation group.After literature review and expert consultation,27 potential risk factors for hypoglycemia in ICU patients were initially screened,and data were collected including general information[gender,age,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,nutrition risk in critically ill(NUTRIC)score,mechanical ventilation status,hemodialysis status,enteral nutrition status],disease data(sepsis,liver disease history,kidney disease history,diabetes history,hypoglycemia history),blood glucose-related indicators[mean blood glucose,blood glucose coefficient of variation,insulin dosage,intravenous insulin titration use,inotropic drug use,insulin secretagogues(Sulfonylureas and Glinides),and combined use of hypoglycemic drugs(two or more)],and laboratory indicators[serum creatinine(SCr),blood urea nitrogen(BUN),serum albumin(Alb),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),glomerular filtration rate(GFR)].The patients were divided into a hypoglycemia group and a non-hypoglycemia group based on the occurrence of hypoglycemia.Univariate analysis and binary Logistic regression analysis were used to identify influencing factors of hypoglycemia in adult ICU patients,and a nomogram prediction model was constructed.The area under the receiver operator characteristic curve(AUC)and calibration curves were employed to evaluate the discrimination and calibration of the model.Results The modeling cohort included 552 non-hypoglycemic patients and 98 hypoglycemic patients,with an ICU hypoglycemia incidence rate of 15.1％.Compared with the hypoglycemia group,the non-hypoglycemia group showed significantly lower proportions of patients with renal disease history,diabetes history,hypoglycemia history,undergoing hemodialysis,using intravenous insulin titration,and combined use of hypoglycemic drugs,as well as lower blood glucose coefficient of variation,lower APACHEⅡ scores,and significantly elevated GFR(all P<0.05).Binary Logistic regression analysis was performed using the 9 variables with statistically significant differences in univariate analysis as independent variables and hypoglycemia occurrence as the dependent variable.The results indicated that a history of diabetes,a history of hypoglycemia,APACHEⅡ score,GFR,blood glucose coefficient of variation,and combined use of hypoglycemic drugs were independent risk factors for hypoglycemia in ICU patients[odds ratios(OR)were 1.761,2.095,1.048,0.990,1.029,and 1.975,respectively,and 95％confidence intervals(95％CI)were 1.052-2.949,1.220-3.600,1.022-1.074,0.982-0.997,1.013-1.046,and 1.145-3.408,respectively.The corresponding Pvalues were 0.031,0.007,0.000,0.009,<0.001,0.014].A nomogram prediction model for hypoglycemia in ICU patients was constructed using six independent predictors selected through binary logistic regression analysis.The ROC curve AUC for the modeling group was 0.884(95％CI 0.826-0.941,P=0.250),with a maximum Youden index of 0.713,sensitivity of 92.1％,and specificity of 79.2％.The validation cohort included 38 patients with hypoglycemia and 240 patients without hypoglycemia.Compared with the hypoglycemia group,the non-hypoglycemia group showed significantly lower proportions of patients with a history of diabetes,a history of hypoglycemia,and combined use of hypoglycemic drugs,as well as lower APACHEⅡ scores and lower blood glucose coefficient of variation,with significantly increased GFR(all P<0.05).The ROC curve AUC for the validation cohort was 0.803(95％CI was 0.757-0.849,P=0.138),indicating high discriminatory ability.The predicted probability at the diagnostic cutoff point was P=0.138.The model's diagnostic threshold for predicted probability was P=0.138,while the optimal cut-off value based on the Youden index was 0.513,yielding a sensitivity of 76.5％and specificity of 74.8％,indicating predictive value for hypoglycemia in adult ICU patients.The mean absolute error(MAE)results for the modeling group and validation group were<0.05.The calibration curves of both the modeling and validation groups showed close alignment with the ideal curve,indicating excellent calibration performance of the model.Conclusion The constructed hypoglycemia risk prediction model for adult ICU patients has good predictive performance,which can quickly identify high-risk populations of hypoglycemia in ICU and provide reference for clinical preventive nursing.

The identification and optimization of mutations in nanobodies are crucial for enhancing their thera-peutic potential in disease prevention and control.However,this process is often complex and time-consuming,which limit its widespread application in practice.In this study,we developed a work-flow,named Evolutionary-Nanobody(EvoNB),to predict key mutation sites of nanobodies by combining protein language models(PLMs)and molecular dynamic(MD)simulations.By fine-tuning the ESM2 model on a large-scale nanobody dataset,the ability of EvoNB to capture specific sequence features of nanobodies was significantly enhanced.The fine-tuned EvoNB model demonstrated higher predictive accuracy in the conserved framework and highly variable complementarity-determining regions of nanobodies.Additionally,we selected four widely representative nanobody-antigen complexes to verify the predicted effects of mutations.MD simulations analyzed the energy changes caused by these mu-tations to predict their impact on binding affinity to the targets.The results showed that multiple mu-tations screened by EvoNB significantly enhanced the binding affinity between nanobody and its target,further validating the potential of this workflow for designing and optimizing nanobody mutations.Additionally,sequence-based predictions are generally less dependent on structural absence,allowing them to be more easily integrated with tools for structural predictions,such as AlphaFold 3.Through mutation prediction and systematic analysis of key sites,we can quickly predict the most promising variants for experimental validation without relying on traditional evolutionary or selection processes.The EvoNB workflow provides an effective tool for the rapid optimization of nanobodies and facilitates the application of PLMs in the biomedical field.

Cerebral blood flow directly affects the metabolism of substances and neural activity in the brain, and is closely associated with the occurrence and development of cerebral small vessel disease (CSVD). Multiple studies have revealed that various imaging biomarkers in patients with CSVD, such as lacunar infarction, enlarged perivascular spaces, cerebral microbleeds, cerebral atrophy, and white matter hyperintensities, are closely associated with cerebral autoregulation (CA) function. Therefore, understanding the regulatory mechanism of CA in patients with CSVD is of great significance for delaying the further development of CSVD, improving cerebral ischemia and cognitive impairment. This article reviews the correlation and mechanism between CA and CSVD.