Objective: Scutellarin in Shuganning injection has potential allergenicity and is prone to causing anaphylactoid reactions. There is an urgent need to establish a simple and rapid chromatographic quantitative method to achieve the limit control of scutellarin in Shuganning injection.
Methods: For scutellarin, HPLC method was used in the quantitative analysis using a Shim-pack GIS C₁₈ (2.1 mm×150 mm, 5 μm) column. The mobile phase was a blend of 0.1% trifluoroacetic acid in water and acetonitrile, and gradient elution progress was applied for the whole process. The flow rate was 0.3 mL·min^-1 and the column temperature was maintained at 37 ℃. The detecting wavelength was 320 nm.
Results: The linear regression equation was y=51 456x-27 352, the correlation coefficient r=0.999 8, namely the calibration curve was linear in the range of 1.02-102.00 μg·mL^-1; the average recovery was 103.76%; the detection and quantification limit for determining scutellarin was 0.16 μg·mL^-1 and 0.57 μg·mL^-1, respectively; the injection sample was stable at room temperature for 48 h.
Conclusion: This method is easy to operate, reproducible and has high accuracy, thus can be used for quality control of Shuganning injection.

BackgroundPatients with schizophrenia experience low quality of life， and internalized stigma is considered an important indicator for quality of life， while the mediating role of self-esteem and severity of negative symptoms in the relationship between internalized stigma and quality of life remains underexplored. ObjectiveTo examine the mediating role of self-esteem and severity of negative symptoms in the relationship between internalized stigma and quality of life， so as to provide references for improving their quality of life. MethodsA total of 342 patients with schizophrenia who were hospitalized in 6 hospitals in Xiangyang City， Siping City and Changchun City from April to September 2023 were included， and all of whom met the diagnostic criteria for schizophrenia according to the International Classification of Diseases， tenth edition （ICD-10）. Internalized Stigma of Mental Illness Scale （ISMI）， Schizophrenia Quality of Life Scale （SQLS）， Self-Esteem Scale （SES） and negative symptom subscale of Positive and Negative Symptom Scale （PANSS） were administered to all patients. Spearman correlation analysis was adopted to determine correlations between the different scales. A structural equation modeling was constructed using Amos 28.0， and Bootstrap method was employed to verify the mediating effect of self-esteem and negative symptom severity in the association between internalized stigma and quality of life. ResultsA total of 309 patients （90.35%） completed questionnaires in this study. The ISMI score of schizophrenia patients was positively correlated with both SQLS score and the PANSS negative symptom subscale score （r=0.612， 0.492， P<0.01）， while was negatively correlated with SES score （r=-0.513， P<0.01）. The SQLS score was negatively associated with the SES score （r=-0.555， P<0.01） and positively associated with PANSS negative symptom subscale score （r=0.672， P<0.01）. The SES score was negatively correlated with PANSS negative symptom subscale score （r=-0.433， P<0.01）.The total effect value of internalized stigma on quality of life was 0.746 （95% CI： 0.680~0.806）. Self-esteem and severity of negative symptoms independently mediated the relationship between internalized stigma and quality of life， and the indirect effect values were 0.151 （95% CI： 0.062~0.254） and 0.126 （95% CI： 0.047~0.205）， accounting for 20.24% and 16.89% of the total effect， respectively. In addition， a chained mediation effect of self-esteem and quality of life was also demonstrated， the indirect effect value was 0.102 （95% CI： 0.049~0.165）， accounting for 13.67% of the total effect）. ConclusionInternalized stigma in patients with schizophrenia patients can not only directly affect the quality of life， but also indirectly affect the quality of life of patients through either separate or chained mediation of self-esteem and the severity of negative symptoms. ［Funded by Hubei Provincial Undergraduate Innovation and Entrepreneurship Project （number， S202410519027）］

Objective:To develop an economical,simple,and accessible method for early identification of high-risk pregnant women with gestational diabetes mellitus(GDM),this study developed and evaluated multiple machine learning models,identified the optimal prediction model,and constructed a clinical decision support sys-tem(CDSS)based on this model.Methods:A total of 464 pregnant women who visited the Second Affiliated Hospital of Dalian Medical University from January 1,2023 to December 30,2024 were included,of which 386 were used to establish a prediction model(231 in the training set and 155 in the testing set),and the remaining 78 were used as a validation.Adopting the methods of double-point sequence correlation and chi-square test,four machine learning models were constructed after selecting feature variables:Logistic Regression,Random Forest,Support Vector Machine,and eXtreme Gradient Boosting(XGBoost).Preliminary judgment of the maximum weight mod-el,further comparison of the discriminative ability,calibration ability,and clinical practicality of each model to evalu-ate and select the optimal model,develop its CDSS,and verify the accuracy of the model.Results:①Correlation analysis identified predictors of GDM:age,pre-pregnancy body mass index(BMI),systolic/diastolic blood pres-sure,white blood cell count,hemoglobin,lymphocyte ratio,fasting plasma glucose,uric acid,direct bilirubin,chronic hypertension complicating pregnancy,and assisted reproductive technology conception.②XGBoost dominated the ensemble model and demonstrated the best performance in discrimination(AUC 0.931,95%CI 0.910-0.967),cali-bration,and clinical utility among the four models.③The CDSS achieved an accuracy of 78.2%,sensitivity of 64.7%,and specificity of 82.0%in the XGBoost model.Conclusions:The XGBoost model has the highest ability to predict GDM in the early stage.Developing its CDSS not only facilitates doctors to quickly assess GDM risk,but also is suitable for promotion to remote areas,where high-risk population screening can be achieved through re-mote data.

Objective:To investigate the relationship between thyroid hormone sensitivity indicators and the risk of mild cognitive impairment (MCI) in patients with type 2 diabetes mellitus (T2DM) who have normal thyroid function.Methods:A retrospective study design was used to gather data from 100 patients with T2DM who had normal thyroid function and were treated at Shangluo Central Hospital between June 2022 and January 2024. The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were used for evaluation. Patients with an MMSE score of ≤ 26 or a MoCA score of ≤ 26 were included in the MCI group ( n = 22), whereas those with an MMSE score of > 26 and a MoCA score of > 26 were included in the non-MCI group ( n = 78). Multivariate logistic regression analysis was performed to identify factors influencing MCI in patients with T2DM. Additionally, receiver operating characteristic curve analysis was conducted to assess the predictive value of thyroid hormone sensitivity indicators for MCI in this patient population. Results:In the MCI group, 68.18% of patients had an education level of high school or below. The level of glycosylated hemoglobin in this group was (8.45 ± 1.95)%, insulin resistance index was (3.34 ± 0.25), the level of triglycerides was (2.59 ± 0.19) mmol/L, the level of uric acid was (354.76 ± 46.16) μmol/L, thyroid-stimulating hormone index was (3.09 ± 0.26), and thyroid feedback quantile-based index was [0.2 (0.0, 0.5)]. All of these values were significantly higher than those in the non-MCI group: [43.59%, (7.63 ± 1.61)%, (3.05 ± 0.17), (2.09 ± 0.15) mmol/L, (311.74 ± 67.15) μmol/L, (2.87 ± 0.13), 0.2 (-0.1, 0.4), χ2 = 4.15, t = 2.01, 6.32, 12.99, 3.47, 5.47, Z = -2.54, all P < 0.05]. In the MCI group, the level of free triiodothyronine was (4.32 ± 0.21) pmol/L, and thyrotroph T4 resistance index (TT4RI) was (34.54 ± 4.30), both of which were significantly lower than those in the non-MCI group [(4.61 ± 0.36) pmol/L, (37.15 ± 5.55), t = 2.58, 2.04, both P < 0.05]. There were no significant differences in gender, age, body mass index, alcohol consumption, smoking, history of cerebral infarction, hypertension, duration of diabetes, use of only metformin, fasting blood glucose, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, alanine aminotransferase, aspartate aminotransferase, free thyroxine, and thyroid-stimulating hormone between the two groups (all P > 0.05). Logistic regression analysis indicated that education level, triglyceride, uric acid, free triiodothyronine, thyroid-stimulating hormone index, and TT4RI were risk factors for MCI (all P < 0.05). The predictive value of the combined thyroid hormone sensitivity indicators for MCI in patients with T2DM was high, with an area under the receiver operating characteristic curve of 0.778 [95% CI(0.676, 0.880), P < 0.001], a sensitivity of 0.538, a specificity of 0.909, and a maximum Youden index of 0.447. Conclusions:In patients with T2DM who have normal thyroid function, the thyroid hormone sensitivity indicators (TT4RI and thyroid feedback quantile-based index) exhibited a negative correlation with MCI, whereas TSHI demonstrated a positive correlation with MCI. The combined use of these thyroid hormone sensitivity indicators is valuable for predicting MCI and offers significant guidance for the early intervention of cognitive impairment in patients with T2DM.

Objective To investigate the relationship between the expression levels of mir-155/Th17 and mir-23b-3p/Tfh in peripheral blood and the prognostic value of secondary atopic dermatitis(AD)in AIDS patients.Methods In this study,80 AIDS patients were treated in our hospital from February 2021 to December 2023.The subjects were divided into AD group and non-AD group according to whether they had secondary AD.The levels of mir-155,Th17,mir-23b-3p and Tfh in peripheral blood of AD group and non-AD group were compared.Spearman method was used to analyze the relationship between levels of mir-155,Th17,mir-23b-3p and Tfh in peripheral blood and secondary AD in AIDS patients.At the same time,according to the prognosis of patients,the subjects were divided into good prognosis group and poor prognosis group,and the risk factors affecting the prognosis of patients were screened by Logistic regression analysis.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of peripheral blood mir-155,Th17,mir-23b-3p and Tfh levels on the prognosis of AIDS patients.Results Compared with non-AD group,the levels of miR-155,Th17 and Tfh in peripheral blood of AD group were higher(P＜0.05),and the levels of miR-23b-3p were lower(P＜0.05).The level of miR-155,Th17 and Tfh in peripheral blood were positively correlated with secondary AD of AIDS(r=0.487,0.492,0.495,P＜0.05),and the level of miR-23b-3p in peripheral blood was negatively correlated with secondary AD of AIDS(r=-0.503,P＜0.05).The levels of HIV load(high dose),lymphoma,PLT,NLR,CRP,miR-155,Th17 and Tfh in the poor prognosis group were higher than those in the good prognosis group(P＜0.05),while the levels of albumin and miR-23b-3p in the poor prognosis group were lower than those in the good prognosis group(P＜0.05).Logistic regression analysis showed that lymphoma,PLT,NLR,low albumin,CRP,miR-155,Th17,Tfh and low miR-23b-3p were all risk factors for poor prognosis of AIDS patients(P＜0.05).ROC curve results showed that the AUC(95％CI)and sensitivity of combined detection of peripheral blood miR-155,Th17,Tfh and miR-23b-3p in predicting poor prognosis of AIDS patients were 0.883(0.805～0.992)and 96.70％,respectively.All of them were higher than the above peripheral blood indexes alone(P＜0.05).Conclusion The abnormal expression of miR-155,Th17,Tfh,and miR-23b-3p in peripheral blood is closely related to secondary AD in AIDS patients,and is a risk factor affecting the poor prognosis of AIDS patients.The combined detection of these indicators has a high predictive value for the poor prognosis of AIDS patients.

Objective:To analyze the conventional ultrasound（CUS）and contrast-enhanced ultrasound（CEUS）features of hepatic lymphoma，and to investigate the value of CEUS in the diagnosis of hepatic lymphoma.Methods:The images of 39 patients（39 lesions）with hepatic lymphoma pathologically confirmed by surgery and puncture from March 2012 to July 2024 at Zhongshan Hospital，Fudan University were retrospectively analyzed. Evaluations of CUS included the echogenicity，morphology，color Doppler flow imaging（CDFI）situation，evaluations of CEUS included enhancement type，enhancement degree compared to the peripheral normal liver parenchyma and time to enhancement.Results:In the 39 lesions，hypoechoic lesions were detected in 31（79.49%，31/39）patients on CUS. CDFI detected linear or branched color flow signals inside the lesions in 21（53.85%，21/39）lesions，and peripheral color flow signals around the lesions in 3 lesions，while arterial flow signals were detected in 16 of them，with a resistance index of 0.50～0.77（0.67 ± 0.02）. In addition，signs of non-compacted normal blood vessels passing through the lesions were detected in 5 lesions. After injection of contrast medium，39 lesions showed different degrees of enhancement，mainly showed entirety homogeneous enhancement，during the arterial phase of CEUS，34（87.18%，34/39）lesions showed fast enhancement，and when the enhancement reached the peak，26（66.67%，26/39）lesions revealed hyper-enhancement，showing “fast progression”. There were 38（97.44%，38/39）lesions in the portal and delayed phases showed “fast forward”.Conclusions:CUS and CEUS can provide some value in the diagnosis and differential diagnosis of hepatic lymphoma.

Objective:To explore the differences between clinical-pathological-ultrasound features in hepatocellular carcinoma（HCC）with negative and positive des-gamma-carboxy prothrombin（DCP）.Methods:A retrospective analysis was conducted on 649 patients with pathologically confirmed HCC at Zhongshan Hospital，Fudan University from April 2020 to May 2024. Patients were stratified into DCP-negative（177 cases，<40 mAU/ml）and DCP-positive（472 cases，≥40 mAU/ml）groups. Clinical data，pathological features，and ultrasound findings were collected. Conventional ultrasound and contrast-enhanced ultrasound（CEUS）imaging characteristics were analyzed and compared between the two groups，and the correlation between ultrasound features and pathological characteristics were analyzed.Results:The DCP-negative group exhibited a lower incidence of microvascular invasion（10.17% vs. 34.75%， P<0.001）and smaller median tumor diameter（23 mm vs. 40 mm， P<0.001）. Heterogeneous internal echogenicity was less frequent in DCP-negative tumors［48.59%（86/177） vs. 74.58%（352/472）， P<0.001］. CEUS revealed higher rates of arterial-phase iso-enhancement（6.78% vs. 1.69%）and absence of washout（13.56% vs. 4.45%）in DCP-negative HCC（both P<0.001）. CEUS LI-RADS classification showed fewer LR-5 lesions［50.85%（90/177） vs. 59.53%（281/472）］in DCP-negative group（ P<0.001）. Conclusions:HCC with different DCP states has different clinical-pathological-ultrasound features. DCP-negative HCCs are more likely to show atypical enhancement patterns characteristic of HCC.

Objective:To combine the SPARK learning model with five-step questioning method, construct a new teaching regimen, and evaluate its effectiveness in the resident training in the department of thyroid and breast surgery, and to provide theoretical basis and practical reference for optimizing the training model of specialist physicians.Methods:A total of 104 clinicians in the department of thyroid and breast surgery who participated in standardized training from December 2022 to December 2024 were selected as research subjects. Based on the time of teaching reform (January 2024), 52 clinicians who participated in standardized training from December 2022 to December 2023 were included in the control group; they received the routine teaching method mainly based on the linear teaching process of "theory teaching, clinical demonstration, skill training, and case discussion", which emphasized knowledge transmission and skill imitation. The 52 clinicians who participated in standardized training from January to December 2024 were assigned to the experimental group; they received SPARK learning model combined with the five-step question teaching method. Teaching evaluation included assessment of basic theory, clinical skills, and clinical thinking as well as satisfaction with teaching. The t test and chi-square test were performed using SPSS 26.0. Results:The basic theory assessment and clinical skill assessment scores were significantly higher in the experimental group than in the control group. The scores of all thinking ability dimensions were significantly higher in the experimental group than in the control group [diagnostic decision-making: (21.85±1.15) vs. (18.35±3.42); treatment plan: (24.62±1.52) vs. (20.28±4.13); complication management: (14.82±0.73) vs. (12.17±2.53); evidence-based medicine application: (15.18±0.92) vs. (12.48±2.85); multidisciplinary collaboration: (14.95±0.83) vs. (12.73±3.08); and cost benefit analysis: (8.25±0.42) vs. (6.82±1.53)]. The satisfaction scores were significantly higher in the experimental group than in the control group.Conclusions:Through the organic combination of systematic knowledge construction and critical thinking training, the teaching method integrating SPARK learning model and five-step questioning method can significantly enhance the specialized core competence of residents in the department of thyroid and breast surgery and their decision-making ability to cope with complex clinical scenarios.

Objective:To investigate the current practice of nasogastric tube care and the training needs among nurses in the emergency departments of tertiary hospitals in Beijing, to provide a basis for further standardizing nasogastric tube care practices.Methods:A convenience sampling method was used to select head nurses and nurses from the emergency departments of 47 tertiary hospitals in Beijing in June 2024. A self-designed questionnaire on the current practice of nasogastric tube care and training needs was administered to the participants.Results:A total of 47 emergency departments from tertiary hospitals in Beijing were surveyed, of which only 25 departments implemented nasogastric tube techniques. In the key practices of nasogastric tube care, nine hospitals met the overall implementation standards, while 16 hospitals had substandard implementation. The key practices with poor standardization included the frequency of changing the nasogastric tube dressing, blind insertion (spiral nasogastric tube) through the pylorus, the recommended temperature for enteral nutrition liquids, and the timing for flushing the nasogastric tube. There were statistically significant differences ( P<0.05) in the presence of specialized nasogastric tube care teams and the use of case discussions or workshops for department training between hospitals with good and poor implementation. Moreover, 89.5% (496/554) of the nurses indicated a need for training related to nasogastric tube maintenance, and 91.9% (509/554) expressed willingness to participate in technical training or seminars. Statistically significant differences ( P<0.05) were found between emergency specialized nurses and non-specialized nurses in terms of preferred training frequency, duration, format, and content (sharing of the latest research and advancements) . Conclusions:Nasogastric tube techniques have not been widely implemented in the emergency departments of tertiary hospitals in Beijing. The standardization of nasogastric tube care needs further improvement, and there is a significant demand for training among emergency nurses, indicating an urgent need for specialized nasogastric tube training programs.

Immunotherapy following transplantation has long been a central focus in both anti-rejection strategies and the induction of immune tolerance. Regulatory B cells (Bregs) can directly suppress the immune system via the interaction between programmed cell death protein 1 (PD-1) and its ligand programmed death ligand 1 (PD-L1). Additionally, Bregs exert indirect immunosuppressive effects through the secretion of cytokines such as interleukin-10 (IL-10), transforming growth factor-β (TGF-β), and granzyme B (GrB), among which IL-10 plays a particularly critical role. This review summarizes recent progress in the classification, functional characteristics, and activation mechanisms of Bregs, as well as their potential applications in transplantation immunotherapy, aiming to provide a theoretical foundation for Breg-targeted strategies in transplant immune modulation.