Voice biomarkers， as an emerging smart medical technology， are now being used in applications such as assisting in the diagnosis and treatment of diseases， facilitating accurate and personalized medical services for patients. However， it also raises many ethical issues， including informed consent， privacy protection， accuracy and reliability， data security， legal risks， and other issues. This paper systematically sorted out the ethical issues in the applications of voice biomarkers in the medical field， summarized these issues， such as informed consent， privacy protection， accuracy and reliability， data security， and legal risks， as well as explored the corresponding coping strategies. These countermeasures encompassed utilizing new media platforms to raise public awareness of voice biomarkers， strengthening supervision and management to promote the privacy protection of voice biomarkers， reducing algorithm biases to promote the general benefits of voice biomarkers to the public， establishing multidisciplinary teams to protect the data security of voice biomarkers， and encouraging medical professionals and researchers to participate in policy research， with a view to providing references for promoting and regulating the applications of voice biomarkers in the medical field.

Objective: To investigate the association between emotional intelligence and sleep problems at the symptom level among junior and senior high school students, so as to provide new insights for interventions targeting junior and senior high school students sleep disorders. Methods: From November 2023 to May 2024, a stratified cluster random sampling method was employed to select 3 531 first year junior high school and first year senior high school students from 6 schools in Guangyuan City and Liangshan Yi Autonomous Prefecture in Sichuan Province, as well as Lhasa City in Tibet Autonomous Region. The Insomnia Severity Index Scale and the Wong and Law Emotional Intelligence Scale(WLEIS) were used to assess sleep problems and emotional intelligence. A network analysis was performed to explore the relationship between emotional intelligence and sleep disorders, and a gender based network comparison analysis was conducted. Results: The reported rate of sleep problems among junior and senior high school students was 47.3%, with severe sleep problems of 2.2%. Difficulty maintaining sleep, worry about sleep, and emotional application were the core symptoms in the network (node strength values: 1.11, 0.98, and 0.82, respectively). Dissatisfaction with sleep and emotional application served as bridge symptoms connecting emotional intelligence and sleep problems (bridge strength values: 1.77 and 1.59, respectively). The edge weights of the emotional intelligence and sleep problems network differed significantly between genders (maximum difference in edge weight values was 0.13， P <0.05). Conclusions Emotional application ability and dissatisfaction with sleep are the key nodes in the network connecting emotional intelligence and sleep problems. Targeted efforts to enhance emotional application ability may effectively reduce the risk of sleep problems among junior and senior high school students.

Objective To investigate the influence of intravenous esketamine infusion on anesthetic effect and awakening quality in elderly patients undergoing laparoscopic surgery for prostate cancer.Methods One hundred and twenty patients with laparoscopic radical prostatectomy were selected and divided into the esketamine group(group E)and control group(group C)by the random number table method,60 ca-ses in each group.The group E used esketamine for anesthesia induction and maintenance,while the group C received the same amount of physiological saline at the same time during operation process as control.The es-ketamine pumping infusion or normal saline in the two groups was stopped at 30 min before operation end.In addition,the types and doses of other drugs used during the induction and maintenance phase of anesthesia were identical between the two groups.The use total amounts of anesthetic drugs during perioperative period were recorded.The heart rate(HR)and mean arterial pressure(MAP)were recorded before operation(T1),instantly before tracheal intubation(T2),at 1 min after tracheal intubation(T3),1 h during surgery(T4),end of skin suture(T5),and 5 min after extubation(T6)in the two groups respectively;the anesthetic recovery time after extubation was recorded.The Riker sedation and restlessness score was used to conduct the agita-tion evaluation,the incidence rates of agitation and bucking and the resuscitation room stay time were recor-ded.The pain VAS score was used to conduct the pain evaluation in the patients.The incidence rates of ad-verse events such as respiratory depression,shiverring,nausea,vomiting,drowsiness after extubation were re-corded.Results The perioperative doses of resutanil and propofol in the group E were significantly lower than those in the group C,and the difference was statistically significant(P＜0.05).HR and MAP at T2 in the group E were higher than those in the group C,while HR and MAP at T3 in the group E were lower than those in the group C.The recovery time after extubation in the group E was longer than that in the group C,the agitation incidence rate,acute bucking incidence rate and VAS score were lower,the stay time in the recov-ery room was shorter.The incidence rate of drowsiness in the group E was significantly higher than that in the group C(P＜0.05).The incidence rates of other adverse events had no statistical differnece(P＞0.05).Con-clusion Esketamine is safe and effective in the elderly patients with laparoscopic prostate cancer surgery,which is conducive to stabilize the hemodynamic parameters and reduce the incidence rate of agitation and buc-king.

Objective·To establish a research framework for serotonylation of proteins and to provide a methodological basis for the identification of serotonylated proteins.Methods·The Cancer Genome Atlas(TCGA)and Genotype-Tissue Expression(GTEx)databases were used to analyze the expression of the transglutaminase 2(TGM2)gene,which encodes the key enzyme for serotonylation,and the solute carrier family 6(SLC6A4)gene,which encodes the serotonin transporter(SERT),in normal and pan-cancer tissues.5-Propargyltryptamide(5-PT),a serotonin derivative,was synthesized stepwise from serotonin hydrochloride,and its structure was characterized by the Fourier transform infrared spectroscopy(FT-IR),proton nuclear magnetic resonance(1H-NMR),carbon nuclear magnetic resonance(13C-NMR),and time-of-flight mass spectrometry(TOF-MS).The intracellular uptake of 5-PT in the human pancreatic cancer cell line AsPC-1 and mouse immune cells,including CD4+T cells,CD8+T cells,and bone marrow-derived macrophages(BMDMs),was detected by using flow cytometry.Click chemistry,co-immunoprecipitation,and mass spectrometry analysis techniques were employed to identify serotonylated proteins,and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis was performed.Results·Bioinformatics analysis indicated that TGM2 and SLC6A4 were widely expressed in various normal tissues and across pan-cancer tissues.The flow cytometry results showed that the synthesized 5-PT can be taken up into the human pancreatic cancer cell line AsPC-1 and mouse immune cells,including CD4+T cells,CD8+T cells,and BMDMs,via the SERT.Mass spectrometry analysis data showed that a significant amount of serotonylated proteins were enriched in various cells treated with 5-PT.KEGG enrichment analysis revealed that these proteins were involved in important pathways related to glycolysis and amino acid synthesis.Conclusion·By using the synthesized 5-PT,multiple serotonylated proteins are enriched in various cell types.A research system for identifying serotonylated proteins has been successfully established,providing a relatively simple and efficient method for studying protein serotonylation.

ObjectiveTo observe the clinical efficacy and safety of Tangning Tongluo tablets in the treatment of nonproliferative diabetic retinopathy （DR）. MethodsFourteen research centers participated in this study， which spanned a time interval from September 2021 to May 2023. A total of 240 patients with nonproliferative DR were included and randomly assigned into an observation group （120 cases） and a control group （120 cases）. The observation group was treated with Tangning Tongluo tablets， and the control group with calcium dobesilate capsules. Both groups were treated for 24 consecutive weeks. The vision， DR progression rate， retinal microhemangioma， hemorrhage area， exudation area， glycosylated hemoglobin （HbA1c） level， and TCM syndrome score were assessed before and after treatment， and the safety was observed. ResultsThe vision changed in both groups after treatment （P<0.05）， and the observation group showed higher best corrected visual acuity （BCVA） than the control group （P<0.05）. The DR progression was slow with similar rates in the two groups. The fundus hemorrhage area and exudation area did not change significantly after treatment in both groups， while the observation group outperformed the control group in reducing the fundus hemorrhage area and exudation area. There was no significant difference in the number of microhemangiomas between the two groups before treatment. After treatment， the number of microhemangiomas decreased in both the observation group （Z=-1.437， P<0.05） and the control group （Z=-2.238， P<0.05）， and it showed no significant difference between the two groups. As the treatment time prolonged， the number of microhemangiomas gradually decreased in both groups. There was no significant difference in the HbA1c level between the two groups before treatment. After treatment， the decline in the HbA1c level showed no significant difference between the two groups. The TCM syndrome score did not have a statistically significant difference between the two groups before treatment. After treatment， neither the TCM syndrome score nor the response rate had significant difference between the two groups. With the extension of the treatment time， both groups showed amelioration of TCM syndrome compared with the baseline. ConclusionTangning Tongluo tablets are safe and effective in the treatment of nonproliferative DR， being capable of improving vision and reducing hemorrhage and exudation in the fundus.

Objective:To conduct a symptom network analysis in patients with systemic lupus erythematosus (SLE) and identify core symptoms, in order to provide a foundation for the development of precision-based symptom management interventions.Methods:A convenience sampling method was used to recruit 420 SLE patients who received treatment at Shengjing Hospital of China Medical University between November 2022 and July 2023. The SLE Specific Symptom Checklist was administered to these patients. A contemporaneous symptom network was constructed using a Gaussian graphical model, and centrality measures including closeness centrality, betweenness centrality, and expected influence coefficient were calculated to determine the core symptoms within the network.Results:The most commonly reported symptoms among the 420 patients were fatigue (65.7%, 276/420), hair loss (59.8%, 251/420), photosensitivity (56.9%, 239/420), memory impairment (54.5%, 229/420), and facial swelling (52.1%, 219/420). In the symptom network analysis, the most central symptom was photosensitivity (closeness centrality=1.58; betweenness centrality=2.56; expected influence coefficient=1.06), followed by skin fragility (closeness centrality=1.00; betweenness centrality=0.43; expected influence coefficient=1.78), gastrointestinal discomfort (closeness centrality=1.30; betweenness centrality=1.14; expected influence coefficient=0.77), fatigue (closeness centrality=0.50; betweenness centrality=0.70; expected influence coefficient=1.61), and mood changes (closeness centrality=0.65; betweenness centrality=1.14; expected influence coefficient=0.89) .Conclusions:Among the various symptoms experienced by SLE patients, photosensitivity, skin fragility, gastrointestinal discomfort, fatigue, and mood changes emerged as core symptoms that influence and activate other symptoms in the network. Healthcare professionals should tailor symptom management strategies based on patients' self-reported symptom profiles, prioritize intervention targets, and work to reduce the overall symptom burden in individuals with SLE.

Objective To compare the dosimetric disparities among static intensity-modulated radiotherapy(IMRT),volumetric modulated arc therapy(VMAT),and tomotherapy(TOMO)techniques in cervical cancer radiotherapy for providing data support for clinical decision-making scheme of radiotherapy.Methods The clinical data of 19 cervical cancer patients,treated at the Affiliated Cancer Hospital and Institute of Guangzhou Medical University from February to May in 2024,were analyzed.Three plans were devised for each case using IMRT,VMAT,and TOMO techniques,followed by dosimetric evaluation in terms of various metrics such as dose volume parameters of the target areas as well as organs-at-risk(OAR),conformity index(CI),homogeneity index(HI),and delivery time.Results All 3 plans met the clinical prescription requirements for the target areas.Compared with static IMRT and VMAT,TOMO had significantly lower Dmean and Dmaxof PCTV and PGTVnd.For OAR,TOMO demonstrated significant advantages over IMRT and VMAT in the Dmean of the bladder,the Dmean,Dmax,V30,V40of the rectum,the Dmean,Dmax,V20,V30of left and right femoral heads,and the Dmean,V20,V50of the pelvis(P<0.05).In addition,the TOMO group showed significantly higher CI for both PCTV and PGTVnd as compared with IMRT and VMAT groups,and lower PGTVnd HI than IMRT group(all P<0.05).Although there was trivial difference among 3 groups in term of PCTV HI,TOMO group performed slightly better than the other two groups.Notably,VMAT technique had the shortest treatment time.Conclusion In various treatment modalities for cervical cancer,TOMO is superior to IMRT and VMAT in terms of target dose coverage,OAR dose distribution,CI,and HI.However,VMAT has the highest efficiency.

Objective:To conduct a symptom network analysis in patients with systemic lupus erythematosus (SLE) and identify core symptoms, in order to provide a foundation for the development of precision-based symptom management interventions.Methods:A convenience sampling method was used to recruit 420 SLE patients who received treatment at Shengjing Hospital of China Medical University between November 2022 and July 2023. The SLE Specific Symptom Checklist was administered to these patients. A contemporaneous symptom network was constructed using a Gaussian graphical model, and centrality measures including closeness centrality, betweenness centrality, and expected influence coefficient were calculated to determine the core symptoms within the network.Results:The most commonly reported symptoms among the 420 patients were fatigue (65.7%, 276/420), hair loss (59.8%, 251/420), photosensitivity (56.9%, 239/420), memory impairment (54.5%, 229/420), and facial swelling (52.1%, 219/420). In the symptom network analysis, the most central symptom was photosensitivity (closeness centrality=1.58; betweenness centrality=2.56; expected influence coefficient=1.06), followed by skin fragility (closeness centrality=1.00; betweenness centrality=0.43; expected influence coefficient=1.78), gastrointestinal discomfort (closeness centrality=1.30; betweenness centrality=1.14; expected influence coefficient=0.77), fatigue (closeness centrality=0.50; betweenness centrality=0.70; expected influence coefficient=1.61), and mood changes (closeness centrality=0.65; betweenness centrality=1.14; expected influence coefficient=0.89) .Conclusions:Among the various symptoms experienced by SLE patients, photosensitivity, skin fragility, gastrointestinal discomfort, fatigue, and mood changes emerged as core symptoms that influence and activate other symptoms in the network. Healthcare professionals should tailor symptom management strategies based on patients' self-reported symptom profiles, prioritize intervention targets, and work to reduce the overall symptom burden in individuals with SLE.

Objective·To establish a research framework for serotonylation of proteins and to provide a methodological basis for the identification of serotonylated proteins.Methods·The Cancer Genome Atlas(TCGA)and Genotype-Tissue Expression(GTEx)databases were used to analyze the expression of the transglutaminase 2(TGM2)gene,which encodes the key enzyme for serotonylation,and the solute carrier family 6(SLC6A4)gene,which encodes the serotonin transporter(SERT),in normal and pan-cancer tissues.5-Propargyltryptamide(5-PT),a serotonin derivative,was synthesized stepwise from serotonin hydrochloride,and its structure was characterized by the Fourier transform infrared spectroscopy(FT-IR),proton nuclear magnetic resonance(1H-NMR),carbon nuclear magnetic resonance(13C-NMR),and time-of-flight mass spectrometry(TOF-MS).The intracellular uptake of 5-PT in the human pancreatic cancer cell line AsPC-1 and mouse immune cells,including CD4+T cells,CD8+T cells,and bone marrow-derived macrophages(BMDMs),was detected by using flow cytometry.Click chemistry,co-immunoprecipitation,and mass spectrometry analysis techniques were employed to identify serotonylated proteins,and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis was performed.Results·Bioinformatics analysis indicated that TGM2 and SLC6A4 were widely expressed in various normal tissues and across pan-cancer tissues.The flow cytometry results showed that the synthesized 5-PT can be taken up into the human pancreatic cancer cell line AsPC-1 and mouse immune cells,including CD4+T cells,CD8+T cells,and BMDMs,via the SERT.Mass spectrometry analysis data showed that a significant amount of serotonylated proteins were enriched in various cells treated with 5-PT.KEGG enrichment analysis revealed that these proteins were involved in important pathways related to glycolysis and amino acid synthesis.Conclusion·By using the synthesized 5-PT,multiple serotonylated proteins are enriched in various cell types.A research system for identifying serotonylated proteins has been successfully established,providing a relatively simple and efficient method for studying protein serotonylation.

Objective To determine the pathogenicity of a novel mutation(c.109_111del)in DKC1 gene of an adult patient,and to analyze the clinical phenotype,immunophenotype and telomere length,so as to provide clues for early clinical identification and diagnosis.Methods The clinical data and peripheral blood samples of the patient were collected for genetic testing and family analysis.The lymphocyte subsets of the patient were detected by Flow cytometry,and the telomere length of the patient and healthy controls were detected by Flow-FISH.Results The main clinical manifestations of the patient were mucocutaneous triad,bone marrow failure and infection.The telomere length of lymphocytes in the patient was significantly shorter than that of healthy controls of the same age,and the absolute value and percentage of lymphocyte subsets were abnormal.Conclusion The clinical manifestations of DC patients are diverse.Flow-FISH detection of telomere length is helpful for early diagnosis of DC patients.