Objective To explore the changes in neural activity in patients with type 2 diabetes mellitus(T2DM)and their corre-lation with executive function,and to analyze the neural mechanisms underlying the decline in executive function in T2DM patients.Methods Thirty-one T2DM patients(T2DM group)and thirty-two healthy controls(HC)(HC group)matched for body mass index(BMI)underwent resting-state functional magnetic resonance imaging(rs-fMRI)scans and N-back task tests were included.Differ-ences in the amplitude of low-frequency fluctuation(ALFF),regional homogeneity(ReHo),and seed-based functional connectivity(FC)between the two groups were compared,and partial correlation analyses were performed between the difference results and N-back task performance.Results The T2DM group showed prolonged reaction time(RT)in the 1-back and 2-back tasks.T2DM patients exhibited increased ALFF in the bilateral caudate nucleus,left medial superior frontal gyrus,and right postcentral gyrus,as well as elevated ReHo in the right putamen.FC analysis revealed significant alterations in FC between the caudate nucleus,putamen,and multiple brain regions in T2DM patients,with some of these FC changes significantly correlated with RT and accuracy(ACC)in the N-back task.Conclusion The decline in executive function in T2DM patients may be associated with abnormal neural activity in brain regions such as the striatum,salience network,and frontoparietal control network.FC further decreases under increased cognitive load.These findings provide evidence for the study of the neural mechanisms of executive function impairment in T2DM patients.

This article reports a case of a patient with Crohn's disease who had 1 to 2 loose stools per day,occasionally with a small amount of bloody stool.Despite treatment with multiple drugs in the past,the disease was still poorly controlled.The patient was switched to upadacitinib extended-release tablets 45 mg once daily for oral administration.The patient's hemoglobin level decreased continuously,with the lowest value of 68 g·L-1.After evaluation,it was determined that the decrease in hemoglobin was very likely related to upadacitinib extended-release tablets.The upadacitinib was discontinued,and vedolizumab was used for continued treatment.Symptomatic treatment was also given,and the patient's hemoglobin level gradually recovered.This article analyzes the clinical characteristics of upadacitinib-induced hemoglobin reduction in this case and the treatment plan optimization process,to provide a reference for safe clinical medication.

Objective To analyze the disability level and long-term care needs assessment policies issued by 49 pilot cities in China's long-term care insurance system,providing insights for further improvement of the system.Methods Policy documents related to long-term care insurance,published between June 2016 and December 2024 on official platforms of local governments,the Ministry of Human Resources and Social Security,the National Healthcare Security Administration,and the National Public Service Platform for Standards Information,were retrieved.A comparative analysis was used to summarize and compare the content of these policy texts.Results Currently,there are 49 pilot cities implementing the long-term care insurance system in China.47 cities have issued disability level assessment standards,with 38 cities adopting the trial standards issued by the National Healthcare Security Administration.In 42 pilot cities,the disability level assessment includes indicators such as activities of daily living,cognitive function,and sensory and communication abilities.22 cities have issued policies related to care needs assessment.In most cities,the care needs assessment partially or fully includes indicators from the disability level assessment.Conclusion There is no national uniformity in disability level assessment standards,and the care needs assessment framework needs further improvement.It is recommended to standardize disability level assessment criteria,clearly delineate the boundaries and content of disability level and care needs assessments,and enhance the development of the care needs assessment system.

Objective To investigate the correlation of serum leucine-rich alpha-2 glycoprotein-1(LRG1)and Thiol levels with autoimmune antibodies and renal injury in patients with systemic lupus erythematosus nephritis(SLEN).Methods 80 SLEN patients(SLEN group)and 80 simple SLE patients(non-SLEN group)admitted to the Department of Nephrology at Qingdao Eighth People's Hospital and the Department of Rheumatology and Immunology at Affiliated Hospital of Qingdao University from January 2021 to December 2023 were selected.An enzyme-linked immunosorbent assay(ELISA)was used to detect serum LRG1 levels,while a colorimetric assay was used to detect serum Thiol levels.Pearson/Spearman correlation analysis was used to investigate the correlation between serum LRG1 and Thiol levels,autoimmune antibodies,and renal function indicators in SLEN patients.The diagnostic value of serum LRG1 and Thiol levels in SLEN was analyzed using receiver characteristic curves.Results The serum LRG1(26.00±8.76 μg/ml)and Scr(98.03±49.71μmol/L)in the SLEN group were higher than those in the non-SLEN group(16.71±5.51μg/ml,73.85±33.51μmol/L),and Thiol(80.69±36.90μmol/L)was lower than those in the non-SLEN group(131.49±45.34μmol/L),the differences were statistically significant(t=8.026,3.608,7.772,all P<0.001).Pearson/Spearman correlation analysis showed that serum LRG1 in SLEN patients was positively correlated with anti-double-stranded deoxyribonucleic acid(dsDNA)antibody,anti-complement 1q(C1q)antibody,anti-Smith antibody,serum creatinine(Scr),24-hour urine protein(r=0.226～0.637,all P<0.05),and negatively correlated with estimated glomerular filtration rate(eGFR)(r=-0.633,P<0.05).Serum Thiol was negatively correlated with anti-dsDNA antibodies,anti C1q antibodies,anti-Smith antibodies,Scr and 24-hour urine protein(r=-0.612～-0.256,all P<0.05),and positively correlated with eGFR(r=0.614,P<0.05).The AUC(95%CI)of serum LRG1 combined with Thiol levels for diagnosing of SLEN was 0.907(0.851～0.947),which was higher than that of serum LRG1 and Thiol alone at 0.802(0.731～0.860)and 0.808(0.738～0.866),and the differences were statistically significant(Z=3.450,3.749,all P<0.05).Conclusion Elevated serum LRG1 levels and decreased Thiol levels in SLEN patients were closely related to positive expression of autoimmune antibodies and renal dysfunction.Combined detection of serum LRG1 and Thiols can provide reference for the diagnosis of SLEN.

Objective To investigate the risk factors for cardiovascular disease(CVD)in patients with rheumatoid arthritis(RA).Methods Clinical data of 225 patients with RA admitted to the Second Affiliated Hospital of Zhengzhou University from January 2023 to September 2024 were collected,and the patients were divided into CVD group(n=50)and non-CVD group(n=175)according to whether they were complicated by CVD.Univariate and multivariate Logistic regression was used to analyze the risk factors of CVD in RA patients.Results Univariate Logistic regression analysis showed that age,hematocrit,red cell volume distribution width(RDW),erythrocyte sedimentation rate,neutrophil to high density lipoprotein ratio(NHR)and platelet to lymphocyte ratio(PLR)were all influencing factors for CVD in RA patients(P＜0.05).Multivariate Logistic regression analysis showed that age,RDW,NHR and PLR were all risk factors for CVD in RA patients(P＜0.05).The results of receiver operating characteristic curve analysis showed that the area under the curve(AUC)of age,RDW,NHR and PLR diagnosed CVD in RA patients were 0.844,0.797,0.572 and 0.713,respectively.The combined diagnosis AUC of four indexes was 0.898.Conclusion The risk of CVD in RA patients is influenced by many factors,and the combination of age,RDW,NHR,and PLR can improve early diagnosis of CVD in RA patients.

A 76-year-old male patient with lung cancer developed thrombocytopenia due to chemotherapy.Three days after taking the Shengxuexiaoban capsules orally,he experienced abdominal pain and bloody stool and was admitted to the hospital.The blood test showed white blood cell count of 11.54×109·L-1,neutrophil percentage of 82.4％,platelet count of 93×109·L-1,and C-reactive protein level of 23.50 mg·L-1.Fecal occult blood test positive,and pathology indicatesd ischemic-like changes in the rectal mucosa.The patient was diagnosed with ischemic bowel disease.After treatment with fluid replacement and anti-infection,the patient's abdominal pain disappeared and his stool turned yellow.The Naranjo's Assessment Scale was used to evaluate the association between adverse effects of ischemic bowel disease and Shengxuexiaoban capsules,and the result was very likely related.This article analysed the clinical characteristics and drug treatment process of ischemic bowel disease caused by Shengxuexiaoban capsule through this case,aiming to provide references for the safe use of drugs in the clinically.

Objective:To evaluate the effect of esketamine on caspase-11-mediated non-canonical pathway pyroptosis in sepsis-induced acute lung injury in rats.Methods:Eighteen SPF healthy Sprague-Dawley rats, aged 8-12 weeks, weighing 280-320 g, were divided into 3 groups ( n=6 each) using a random number table method: sham operation group (Sham group), cecal ligation and puncture (CLP) group and CLP+ esketamine group (CLP+ ES group). Sepsis was induced by CLP in anesthetized animals. Esketamine 10 mg/kg was injected via the tail vein immediately after development of the model, and the equal volume of normal saline was injected via the tail vein in the other two groups. At 24 h after development of the model, the rats were sacrificed under anesthesia, and the lung tissues and blood samples were taken. The wet to dry lung weight ratio (W/D ratio) was calculated, and the pathological changes were observed and the lung injury was scored. The expression of caspase-11, gasdermin D-N (GSDMD-N), phosphorylated phosphatidylinositol 3-kinase (p-PI3K) and phosphorylated protein kinase B (p-AKT) was detected by Western blot. The expression of caspase-11 and GSDMD-N mRNA was detected by quantitative real-time polymerase chain reaction. The serum concentration of interleukin-1β (IL-1β) was determined by enzyme-linked immunosorbent assay. Results:Compared with Sham group, the lung injury score and W/D ratio were significantly increased, the expression of caspase-11 and GSDMD-N protein and mRNA was up-regulated, the expression of p-PI3K and p-AKT was down-regulated, and the concentration of IL-1β was increased in CLP group ( P<0.05). Compared with CLP group, the lung injury score and W/D ratio were significantly decreased, the expression of caspase-11 and GSDMD-N protein and mRNA was down-regulated, the expression of p-PI3K and p-AKT was up-regulated, and the concentration of IL-1β was decreased in CLP+ ES group ( P<0.05). Conclusions:The mechanism by which esketamine alleviates sepsis-induced acute lung injury may be related to the inhibition of caspase-11-mediated non-canonical pathway pyroptosis in rats.

This article reports a case of a patient with Crohn's disease who had 1 to 2 loose stools per day,occasionally with a small amount of bloody stool.Despite treatment with multiple drugs in the past,the disease was still poorly controlled.The patient was switched to upadacitinib extended-release tablets 45 mg once daily for oral administration.The patient's hemoglobin level decreased continuously,with the lowest value of 68 g·L-1.After evaluation,it was determined that the decrease in hemoglobin was very likely related to upadacitinib extended-release tablets.The upadacitinib was discontinued,and vedolizumab was used for continued treatment.Symptomatic treatment was also given,and the patient's hemoglobin level gradually recovered.This article analyzes the clinical characteristics of upadacitinib-induced hemoglobin reduction in this case and the treatment plan optimization process,to provide a reference for safe clinical medication.

Objective:To investigate the relationship between lipid levels and cognitive impairment in the elderly Chinese population using prospective cohort data.Methods:Based on the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) cohort, this study included 24 380 individuals aged ≥60 years who participated in the cognitive function follow-up survey from 2018 to 2019. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with cognitive impairment defined according to different educational levels: MMSE ≤17 for illiterate individuals, MMSE ≤20 for those with primary education and MMSE ≤24 for those with secondary education or above. Multivariable linear regression and logistic regression models were employed to examine the associations between six baseline lipid indicators and cognitive scores, as well as cognitive impairment. Additionally, restricted cubic splines were used to explore the exposure-dose relationship between lipid levels and cognitive function.Results:The study population had a median follow-up time of 11.6 years, with a baseline age of (59.7±6.8) years. Among the participants, 9 510 (39.0%) were males, and the mean MMSE score was 24.7±6.8. A total of 3 887 individuals (15.9%) were identified as cognitively impaired. The results of multivariable linear regression and logistic regression indicated that total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) levels were not only significantly positively associated with cognitive scores but also significantly associated with a lower risk of cognitive impairment. Each 1 mmol/L increase in these lipid levels corresponded to β values (95% CI) of 0.267 (0.173-0.361), 0.385(0.271-0.499) and 0.331(0.231-0.431), respectively. Each 1 mmol/L increase in these lipid levels corresponded to odds ratio ( OR) (95% CI) values of 0.915 (0.876-0.956), 0.875 (0.830-0.923) and 0.886 (0.848-0.927), respectively. The dose-response curve demonstrated that the negative association was primarily observed within the guideline-recommended optimal lipid level range. Specifically, when LDL-C was less than 3.4 mmol/L and non-HDL-C was less than 4.1 mmol/L, the corresponding OR (95% CI) values were 0.859 (0.796-0.926) and 0.876 (0.818-0.939). Conclusion:Lipid levels exhibit a certain linear negative association with cognitive impairment in elderly Chinese adults, with LDL-C and non-HDL-C demonstrating a stronger effect, particularly within the guideline-recommended optimal range.

Objective To analyze the clinical and cardiac magnetic resonance(CMR)characteristics of patients with Fabry disease(FD)and evaluate the application value of CMR in the early diagnosis of cardiac involvement in FD.Methods This retrospective study involved nine patients with FD confirmed by renal biopsy pathology and genetic testing at our hospital between January 2021 and October 2024.Their clinical baseline data,laboratory test reuslts,and CMR images were collected.CMR images were analyzed using CVI42 software to generate functional,morphological,and structural parameters.Results In this study,78％of the patients were male,and a high proportion(67％)had a family history of FD.Electrocardiographic abnormalities were observed in eight patients(89％),while 33％reported acroparesthesia and 22％exhibited cornea verticillata,a characteristic ocular manifestation of FD.Left ventricular hypertrophy was present in four patients,with one case also showing right ventricular hypertrophy.Late gadolinium enhancement(LGE)was positive in one patient,presenting as intermural enhancement.The mean left ventricular ejection fraction(LVEF)was within the normal range.T1 mapping demonstrated that both global and segmental native T1 values in the left ventricular myocardium were below 1 200 ms.Conclusion Multimodal CMR imaging provides crucial imaging evidence for the diagnosis of FD,with native T1 mapping showing significant clinical potential for disease staging.