Introduction: Current education on diabetes self-management is time-consuming as it is conducted face-to-face. This study aimed to evaluate the effectiveness of diabetes education via mobile application on hemoglobin A1c (HbA1c). Methodology: This was a double-blinded randomized controlled study conducted in the Department of Endocrinology, Hospital Pulau Pinang and Hospital Raja Permaisuri Bainun. Participants were stratified randomized according to HbA1c to intervention group (using T-Manis) and control group. The primary objective was to assess the difference in HbA1c between the groups. Secondary objectives were to assess the difference in body weight, hospitalization related to diabetes, diabetes knowledge between groups and usability and satisfaction of T-Manis. Laboratory investigations and questionnaires were conducted at baseline, 4 months and 8 months. Results: A total of 112 participants were randomized into two groups each with 56 participants. Mean age was 51 years with similar diabetes duration of 16 years in both groups. Participants comprised of 61.6% females with ethnic distribution of 49.1% Malay, 30.4% Chinese, 19.6% Indian and 0.9% Siamese. Baseline HbA1c levels were comparable between intervention and control groups (10.04% versus 9.91%; mean difference 0.13%; 95% CI −0.56 to 0.81; p = 0.718). At 4 months, HbA1c of the intervention group demonstrated a significant reduction compared to the control group (8.93% versus 9.80%; mean difference −0.86; 95% CI −1.59 to −0.14; p = 0.02). Sustained reduction of HbA1c in the intervention group was observed at 8 months (mean difference −1.01; 95% CI −1.85 to −0.16; p = 0.02). Baseline body weight was 77 kg, with no betweengroup differences in body weight, hospitalization related to diabetes and diabetes knowledge scores, although diabetes knowledge scores improved at 4 months in the intervention group. 89.3% of participants reported satisfaction with T-Manis Conclusion The T-Manis mobile application aided in significantly improving glycemic control with high user satisfaction, supporting its feasibility as an adjunct to standard diabetes care.
Diabetes Mellitus, Type 2 ; Glycemic Control ; Mobile Applications ; Pangolins

Objective:To explore the characteristics of social skills and problem behaviors of children and adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), as well as the association with core symptoms.Methods:A total of 409 patients aged 5-18 years old with ASD or ADHD in the outpatient department of Nanjing Brain Hospital from 2023 to 2024, and 344 children and adolescents with typical development(TD) were recruited.All participants were matched in a ratio of 1∶1∶1 (ASD∶ADHD∶TD) according to gender and age, and 97 participants were included in each group for analysis.The Chinese version of the social skills improvement system rating scales(SSIS-RS-C) was used to evaluate social skills and problem behaviors, and autistic child behavior checklist(ABC), childhood autism rating scale(CARS), the Chinese version of the social communication questionnaire(SCQ) and the Chinese version of Swanson, Nolan, and Pelham, version Ⅳ scale-parent form(SNAP-Ⅳ) were used to evaluate the core symptoms of ASD and ADHD, respectively. SPSS 26.0 software was used to perform variance, Chi-square test, Spearman correlation analysis and multivariate Logistic regression analysis.Results:The social skills score of ASD group was lower than ADHD group ((61.53±24.26) vs (80.89±15.19), P<0.05), while the problem behavior score of ASD group was higher than ADHD group ((38.82±11.92) vs (34.00±12.45), P<0.05). In ASD group, the scores of ABC, CARS and SCQ were negatively correlated with the score of social skills ( r=-0.26--0.55, P<0.05). In ADHD group, the total score and each subscale of SNAP-Ⅳ were positively correlated with the score of problem behavior ( r=0.25-0.65, P<0.05). Multivariate Logistic regression analysis showed that empathy was a negative influencing factor of ASD ( B=-0.246, OR=0.782, P<0.05), and hyperactivity/inattention was a positive influencing factor of ASD ( B=0.589, OR=1.802, P<0.01), while only hyperactivity/inattention was a positive influencing factor of ADHD( B=0.779, OR=2.180, P<0.01). Conclusion:Children and adolescents with ASD and ADHD both have defects in social skills and problem behaviors, and these defects are associated with the core characteristics of their respective diseases.

Objective:To analyze and validate the reliability and validity of the social skills improvement system-rating scales Chinese version (parent version) (SSIS-RS-C) in middle school students.Method:A total of 1 486 parents of middle school students were recruited according to the cluster sampling method.The social responsiveness scale and strengths and difficulties questionnaire were used as criterion validity tools.A retest was conducted one month later.SPSS 27.0 was used for descriptive statistics, item analysis, internal consistency test, test-retest reliability test and criterion validity test. AMOS 24.0 was used to perform confirmatory factor analysis .Results:Item analysis indicated significant positive correlations between each item and the subscales ( r=0.293-0.782, all P<0.01), with significant differences in scores between high and low groups ( t=10.079-37.038, all P<0.01).Confirmatory factor analysis supported a seven-factor structure for the social skills subscale(communication, cooperation, assertion, responsibility, empathy, engagement and self control) and a five-factor structure for the problem behavior subscale (externalizing, bullying, hyperactivity/inattention, internalizing and autism spectrum) of the SSIS-RS-C.There was a positive correlation between the social skills subscale and prosocial behavior ( r=0.637, P<0.001), and between the problem behavior subscale and social impairments and difficult behaviors ( r=0.765, 0.688, both P<0.001).The Cronbach's α coefficients for the total scale, social skills subscale and problem behavior subscale were 0.934, 0.972 and 0.963, respectively.The test-retest correlation coefficients for the total score and the two subscales were 0.665, 0.871 and 0.598, respectively (all P<0.001). Conclusion:The SSIS-RS-C demonstrated good reliability and validity in the Chinese adolescent population.

The global aging population has intensified the incidence of degenerative bone diseases and the therapeutic demand for traumatic bone injuries, thereby making bone regenerative medicine a research focus. There is a close connection and interaction between the skeletal system and the nervous system, and innervation plays an indispensable regulatory role in the process of bone regeneration: the sympathetic nervous system exerts a negative regulatory effect during bone regeneration, while the parasympathetic nervous system plays a positive regulatory role in this process. Nerve fibers within bones are distributed alongside blood vessels, with their density decreasing from the periosteum to the cancellous bone. Nerve signals regulate bone regeneration either by directly acting on target cell receptors or indirectly modulating the metabolism of the local microenvironment (such as the levels of inflammatory factors and the supply of nutrients). A variety of neuropeptides (e.g., calcitonin gene-related peptide, substance P, neuropeptide Y, vasoactive intestinal peptide, etc.) play a crucial role in bone tissue, constructing a "neuro-osseous" regulatory axis, which in turn regulates the osteoblast-osteoclast balance, angiogenesis, and the homeostasis of the local microenvironment. This review focuses on the neural regulatory mechanisms in bone regeneration, with an emphasis on sorting out the functions of key neuropeptides and related neurotransmitters. Neuropeptides are the core mediators of neuro-osseous interaction; however, the interaction network among neuropeptides remains to be further clarified, which requires the application of advanced in vitro models such as three-dimensional bioprinted bone models and organoid technology, as well as cutting-edge techniques like single-cell sequencing for analysis. In the future, the integration of neural regulation strategies with traditional bone regeneration technologies, along with the expansion into interdisciplinary fields such as neuro-vascular and neuro-muscular fields, is expected to provide new directions for the treatment of bone defects and large maxillofacial tissue defects, and promote the transformation of regenerative medicine from prosthetic treatment to functional and neurotized tissue regeneration.

Objective To conduct a rapid health technology assessment(rHTA)of the efficacy,safety,and cost-effectiveness of tirzepatide for the treatment of type 2 diabetes mellitus(T2DM),and to provide evidence for clinical medication.Methods PubMed,Web of Science,Embase,Cochrane Library,WanFang Data,CNKI databases,and health technology assessment(HTA)websites were searched to collect systematic reviews/Meta-analysis,pharmacoecomic literature and HTA reports of tirzepatide in the treatment of T2DM from inception to February 28,2025.Two researchers independently conducted literature screening,data extraction,and quality assessment,and then summarized and analyzed the results.Results A total of 13 articles were included,comprising 2 HTA reports,8 systematic reviews/Meta-analyses,and 3 pharmacoeconomic studies.In terms of efficacy,tirzepatide outperformed placebo or other antidiabetic drugs in reducing glycated hemoglobin(HbA1c),increasing the rate of HbA1c＜7％,lowering blood glucose,and reducing weight.The antihyperglycemic and weight-loss effects of tirzepatide were dose-dependent,and it also had certain advantages in reducing the risk of cardiovascular events and renal composite endpoint events.Regarding safety,the incidence of gastrointestinal adverse events in the tirzepatide group was higher than that in the placebo group and the insulin group,mainly manifested as diarrhea,nausea,and vomiting.However,it did not increase the risk of serious gastrointestinal adverse events,nor did it increase the risk of hypoglycemia and pancreatitis.In terms of cost-effectiveness,tirzepatide had cost-utility and cost-effectiveness advantages compared with semaglutide and other antidiabetic drugs.Conclusion Compared with other antidiabetic drugs,tirzepatide has better efficacy,safety,and cost-effectiveness in the treatment of T2DM.

Objective:To investigate the impacts of the radiosensitivity of cell lines on a microdosimetric kinetic model (MKM) used in carbon-ion radiotherapy.Methods:The saturation-corrected specific energy ( ) of monoenergetic carbon ions was calculated using the Kiefer-Chatterjee (K-C) track structure model. Correction curve f(LET) was derived from experimental data on relative biological effectiveness (RBE) (RBE DSB-LET) defined based on the double-strand DNA break of the Chinese hamster ovary (CHO) and Fibroblast cell lines irradiated using carbon ions with varying linear energy transfer (LET) values. Then, based on the MKM, the D10-LET curves, as well as α and β databases, of the CHO and Fibroblast cell lines with varying radiosensitivity were determined. Results:Compared to the clinically applied MKM, the predicted D10 after correction while accounting for cell line radiosensitivity agreed better with experimental D10 values of the CHO and Fibroblast cell lines. Specifically, compared to experimental values in the literature, the D10 values calculated in the study and determined using the MKM showed mean squared errors (MSEs) of 0.04 and 0.71, for the CHO cell line and 0.35 and 0.55, respectively, for the Fibroblast cell line. For monoenergetic carbon ions with varying LET values, the calculated α and β values generally increased with cellular radiosensitivity. Conclusions:Incorporating cellular radiosensitivity into the MKM framework serves as a more specific method for RBE assessment while also providing a reference for advancing MKM applications and achieving the fine-scale calculations of RBE in carbon-ion radiotherapy.

Objective:To analyze the clinical features, imaging features and diagnosis and treatment process of a female pelvic epithelioid inflammatory myofibroblastic sarcoma (EIMS) with peritoneal metastasis, so as to improve the clinical understanding and diagnostic ability of the disease and avoid misdiagnosis and missed diagnosis.Methods:The clinical data of a female patient with pelvic EIMS combined with peritoneal metastasis in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:The triad examination of the patient involved an irregular solid mass in the pelvic cavity about 8.0 cm×9.0 cm in size. Laboratory examination revealed human epididymal protein 4(HE4)154.00 pmol/L. The ultrasonography showed multiple low-echo masses in deep pelvic cavity with unclear boundary and uneven internal echo, and color doppler flow imaging (CDFI) showed abundant internal blood flow signals. Enhanced CT showed uneven and obvious enhancement of the lesion. Pathological examination showed the infiltration of inflammatory cells in the mucous interstitial background. The tumor cells were round and epithelioid, with large nuclei, deep staining and obvious nucleolus. Immunohistochemistry showed anaplastic lymphoma kinase (ALK) positive, and molecular pathology fluorescence in situ hybridization showed ALK gene amplification (positive). Combined with pathological, immunohistochemical and genetic tests, EIMS was diagnosed. Conclusions:EIMS should be considered when there are single or multiple solid or cystic nodules or masses in the pelvic cavity with obvious enhancement, invasive growth and peritoneal implantation metastasis, and the correct diagnosis can be made according to the pathological findings, immunohistochemistry and genetic test results.

OBJECTIVE To investigate the effect of dopamine receptor 3(D3R)on fear memory induced by intense electric shocks and the possible neurobiological mechanism.METHODS ① To prevent pain threshold differences from influencing the effect of intense electric shocks,wild-type(WT)and D3R knockout mice(D3R-/-)were used in the Hargreaves test to evaluate their basal pain threshold,with the paw withdrawal latency(PWL)as the observation index.② WT and D3R-/-mice were divided into control groups and model groups,respectively.On the training day(the first day,D 1),the model groups received inescapable electric shocks(1.5 mA,10 s,10 s interval,15 cycle)while the control groups did not.Contextual fear tests were conducted on D2,D7,D10,D14,and D16 after training,with the percentage of freezing time(FT)as the observation index to evaluate fear memory acquisition induced by contextual cues.On D17,after the model groups showed no more fear responses to contex-tual cues,they were re-stimulated with low-intensity current(0.5 mA,10 s,10 s interval,15 cycle)to evoke fear memory.The two control groups did not receive any shocks.Contextual fear tests were conducted on day 18,and the FT%of each group was observed to evaluate fear memory retrieval induced by contextual cues.③ Another cohort of WT and D3R-/-mice was used to further investigate the underlying neural mechanism,with the same grouping and treatment as in ②.Real-time dynamic changes in calcium signals of dopamine(DA)neurons in the ventral tegmental area(VTA)of WT and D3R-/-mice were detected using fiber photometry during electric shocks.The fluorescence area under the curve(AUC)was used as the indicator to quantify the excitability of DA neurons.RESULTS ① In the Hargreaves test,there was no significant difference in PWL between D3R-/-mice and WT mice,indi-cating the two genotype mice had no significant differences in the basal pain threshold.② Compared with the WT control group,the percentage of FT of the WT model group significantly increased on D2,D7,D10,and D14(P<0.05).Compared with the D3R-/-control group,the percentage of FT of the D3R-/-model group significantly increased only on D2 and D7(P<0.01).Meanwhile,the percentage of the FT of D3R-/-model group was significantly lower than in the WT control group on D2,D7,D10,and D14(P<0.05,P<0.01).During memory recall(D18),the percentage of FT of the WT model and D3R-/-model groups significantly increased compared to their respective control groups(P<0.01,P<0.05),while the percentage of FT of D3R-/-model mice was significantly lower than that of WT model mice(P<0.01).③ In the fiber photometry test,during the shock period,the calcium signals of DA neurons in the VTA of WT model and D3R-/-model mice rapidly increased within the first 2 s,and then gradually decreased between 2 to 10 s.The AUC within the 2 to 10 s interval was significantly lower in D3R-/-model mice compared to WT model mice(P<0.05),indicating that the excitability of DA neurons in the VTA of D3R-/-model mice was significantly lower than that of WT-model mice.CONCLUSION D3R knockout inhibits the acquisition and recall of long-term fear memory in mice,and its neurobiological mechanism may be related to the decreased excitability of DA neurons during electric shock.

Objective:To explore the characteristics of social skills and problem behaviors of children and adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), as well as the association with core symptoms.Methods:A total of 409 patients aged 5-18 years old with ASD or ADHD in the outpatient department of Nanjing Brain Hospital from 2023 to 2024, and 344 children and adolescents with typical development(TD) were recruited.All participants were matched in a ratio of 1∶1∶1 (ASD∶ADHD∶TD) according to gender and age, and 97 participants were included in each group for analysis.The Chinese version of the social skills improvement system rating scales(SSIS-RS-C) was used to evaluate social skills and problem behaviors, and autistic child behavior checklist(ABC), childhood autism rating scale(CARS), the Chinese version of the social communication questionnaire(SCQ) and the Chinese version of Swanson, Nolan, and Pelham, version Ⅳ scale-parent form(SNAP-Ⅳ) were used to evaluate the core symptoms of ASD and ADHD, respectively. SPSS 26.0 software was used to perform variance, Chi-square test, Spearman correlation analysis and multivariate Logistic regression analysis.Results:The social skills score of ASD group was lower than ADHD group ((61.53±24.26) vs (80.89±15.19), P<0.05), while the problem behavior score of ASD group was higher than ADHD group ((38.82±11.92) vs (34.00±12.45), P<0.05). In ASD group, the scores of ABC, CARS and SCQ were negatively correlated with the score of social skills ( r=-0.26--0.55, P<0.05). In ADHD group, the total score and each subscale of SNAP-Ⅳ were positively correlated with the score of problem behavior ( r=0.25-0.65, P<0.05). Multivariate Logistic regression analysis showed that empathy was a negative influencing factor of ASD ( B=-0.246, OR=0.782, P<0.05), and hyperactivity/inattention was a positive influencing factor of ASD ( B=0.589, OR=1.802, P<0.01), while only hyperactivity/inattention was a positive influencing factor of ADHD( B=0.779, OR=2.180, P<0.01). Conclusion:Children and adolescents with ASD and ADHD both have defects in social skills and problem behaviors, and these defects are associated with the core characteristics of their respective diseases.

Objective:To analyze and validate the reliability and validity of the social skills improvement system-rating scales Chinese version (parent version) (SSIS-RS-C) in middle school students.Method:A total of 1 486 parents of middle school students were recruited according to the cluster sampling method.The social responsiveness scale and strengths and difficulties questionnaire were used as criterion validity tools.A retest was conducted one month later.SPSS 27.0 was used for descriptive statistics, item analysis, internal consistency test, test-retest reliability test and criterion validity test. AMOS 24.0 was used to perform confirmatory factor analysis .Results:Item analysis indicated significant positive correlations between each item and the subscales ( r=0.293-0.782, all P<0.01), with significant differences in scores between high and low groups ( t=10.079-37.038, all P<0.01).Confirmatory factor analysis supported a seven-factor structure for the social skills subscale(communication, cooperation, assertion, responsibility, empathy, engagement and self control) and a five-factor structure for the problem behavior subscale (externalizing, bullying, hyperactivity/inattention, internalizing and autism spectrum) of the SSIS-RS-C.There was a positive correlation between the social skills subscale and prosocial behavior ( r=0.637, P<0.001), and between the problem behavior subscale and social impairments and difficult behaviors ( r=0.765, 0.688, both P<0.001).The Cronbach's α coefficients for the total scale, social skills subscale and problem behavior subscale were 0.934, 0.972 and 0.963, respectively.The test-retest correlation coefficients for the total score and the two subscales were 0.665, 0.871 and 0.598, respectively (all P<0.001). Conclusion:The SSIS-RS-C demonstrated good reliability and validity in the Chinese adolescent population.