OBJECTIVE: The investigation of the correlation between ecological factors and the genetic characteristics or metabolites of plants offers valuable insights into the regional causes of genetic and metabolic diversity. Here, Gastrodia elata, a medicinal plant, is employed as a model to explore the environmental factors that influence its genetic characteristics and metabolic accumulations. METHODS: A total of 23 G. elata populations from six cultispecies and 11 cultivated regions were selected based on the predictions of the global geographic information system. The genetic characteristics of these populations were evaluated using highly polymorphic simple sequence repeat markers. Additionally, the metabolic accumulations and antioxidant capacity of mature tubers were measured employing colorimetry and high performance liquid chromatography (HPLC). Ecological data of each region were obtained from the WorldClim-global climate database and harmonized world soil database. To assess the influence of ecological factors on the genetic characteristics and metabolic profiles of G. elata, Pearson's correlation analysis was conducted. RESULTS: Genetic variation among G. elata populations exceeded that within populations. Genetic diverisity, distance and structure manifested regional and species-specific patterns. Metabolic profiling and antioxidant capacity exhibited regional variations. Notably, the Lueyang region demonstrated that a content range of total polysaccharide, total protein, and phenolic glycosides was 9.34%-189.67% higher than the average. Similarly, in the Hubei region, total phenolic content, p-hydroxybenzyl alcohol content, and antioxidant indicators were observed to be higher than the average levels, by 106.57%, 136.47% and 12.50%-91.14%, respectively. Furthermore, ecological factors had a significant comprehensive impact on G. elata genetic characteristics (r > 0.256 and P < 0.05). Multivariate metabolite accumulations in G. elata were influenced by dominant ecological factors. Temperature notably impacted the accumulation of total protein (|r| > 0.528 and P < 0.05). Moisture, encompassing precipitation and soil content, significantly affected the production of phenolic glycosides (|r| > 0.503 and P < 0.05). CONCLUSION The genetic characteristics of G. elata manifested regional and species-specific patterns, with the metabolic accumulations and antioxidant capacity of mature tubers exhibited regional variations. Specifically, multivariate ecological factors comprehensively influenced genetic characteristics. Temperature and moisture played pivotal roles in regulating the accumulations of proteins and phenolic glycosides, respectively. These findings underscore the significant impact of ecological factors on the shaping of G. elata, highlighting their crucial role in enhancing the quality of Chinese medicinal materials.

Objective:A nationwide multi-center and large sample survey was conducted to compare the validity of the Mini International Neuropsychiatric Interview (Hypo-) Manic Episode with Mixed Features-DSM-5 Module (MINI-M) questionnaire and the Clinically Useful Depression Outcome Scale Supplemented with Questions for the DSM-5 Mixed Features Specifier (CUDOS-M) depression subscale in identifying mixed features in patients experiencing (hypo-) manic episodes.Methods:Using a convenience sampling method, 366 patients with bipolar disorder experiencing acute (hypo-) manic episodes who met the inclusion and exclusion criteria were recruited. The diagnosis of "with mixed features" was based on the DSM-5 criteria for mixed features. The predictive validity of the MINI-M questionnaire and the CUDOS-M depression subscale to screen mixed features was analyzed using the receiver operating characteristic (ROC) curve. Additionally, the difference in area under the ROC curve (AUC) between the two instruments was compared.Results:The AUC for the MINI-M questionnaire and the CUDOS-M depression subscale in screening mixed features were 0.79 (95 %CI=0.75-0.84) and 0.81 (95 %CI=0.77-0.86), respectively. There was no statistically significant difference in AUC between the two measurements ( Z=-1.19, P>0.05). Among patients with acute (hypo-) manic episodes, 45.9% (168/366) presented with mixed features according to the DSM-5 criteria, while the corresponding figures were 43.7% (160/366) using the MINI-M questionnaire (total score≥3) and 42.1% (154/366) using the CUDOS-M depression subscale (total score≥20). Screening results were comparable among the three measures. Conclusion:Mixed features are common among patients experiencing acute (hypo-) manic episodes. The MINI-M questionnaire and the CUDOS-M depression subscale demonstrate equivalent validity in identifying mixed features.

Objective:To use cone-beam computed tomography(CBCT)to conduct microscopic root canal therapy of micro-calcification and to analyze the influencing and prognostic factors of occurring endodontic inter appointment emergencies(EIAE)during root canal treatment.Methods:A total of 80 patients with root canal calcification who admitted to Suzhou Stomatological Hospital from February 2020 to February 2023 were selected,all of whom underwent CBCT examination and microscopic root canal therapy of micro-calcification.Based on the results of CBCT examination,the incidence of EIAE during root canal treatment and the prognosis post one year(missed filling,under filling,displacement of root canal)were analyzed by using statistical method.Multiple logistic regression analysis was used to analyze the influencing factors of occurring EIAE.Results:80 patients had a total of 100 calcified root canals,and the EIAEs incidence was 8.75%.The results of logistic regression analysis showed that gender,pre-treatment pain,pre-treatment fistula,apical shadow and vitality of dental pulp were all factors affecting the occurrence of EIAEs(OR=2.217,1.249,1.405,1.320,1.835,P＜0.05),respectively.The vitality of dental pulp,pre-treatment fistula,preoperative presence or absence of apical shadow,filling length of root canal,filling density and crown leakage were all factors affecting the prognosis of micro root canal treatment(OR=1.256,1.425,1.237,1.225,1.280,1.267,P＜0.05),respectively.Conclusion:In the microscopic root canal therapy,CBCT imaging can have a more detailed understanding of the morphology of calcified root canal and can clarify the direction of the root canal,which can help the individual characteristics of the affected teeth,and can contribute to formulate treatment plans,and strengthen the evaluation and analysis of prognosis,and improve the treatment effect.

Objective:To investigate the clinical application value of photodynamic therapy(PDT)mediated by diode laser,which combined with disinfection in root canal in patients with combined periodontal-endodontic lesions.Methods:A total of 100 patients with combined periodontal-endodontic lesions who admitted to the Suzhou Stomatological Hospital from November 2021 to December 2023 were selected,and they were randomly divided into the observation group and control group,with 50 cases in each group.The control group underwent disinfection treatment in root canal,and the observation group underwent PDT treatment based on the treatment of control group.The clinical efficacy,the bacteria count in root canal,the expression levels of inflammatory factors of gingival crevicular fluid,which included interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),as well as periodontal related indexes such as periodontal pocket depth(PD),gingival sulcus bleeding index(SBI)and periodontal attachment loss(AL),were compared between the two groups.Results:After treatment,the effect of 28 cases(56%)was significant,and that of 20 cases(40%)was effective,and 2 cases(4%)were ineffective,and the total effective rate was 96.00%in the observation group.The effect of 20 cases(40%)was significant,and that of 21 cases(42%)was effective,and 9 cases(18%)were ineffective,and the total effective rate was 82.00%in the control group.The total effective rate of the observation group was significantly higher that of the control group,with a statistically significant difference(x2=4.639,P＜0.05).Compared with the control group,the bacteria count in root canal of observation group significantly decreased,and the IL-6 and TNF-α of observation group significantly decreased,and the differences were significant(t=6.524,5.268,4.394,P<0.05).There was no significant difference in IFN-γ levels between the two groups(P＞0.05).After treatment,the PD,SBI and AL indicators in both groups significantly reduced,and the above indicators of observation group were more lower than these of control group,and the differences were significant(t=5.401,6.309,7.006,P＜0.001),respectively.Conclusion:PDT combined with disinfection in root canal can significantly improve clinical efficacy in treating combined periodontal-endodontic lesions,and can reduce bacterial count in root canal and the levels of inflammatory factors of gingival crevicular fluid,and improve the indicators of periodontal health.

Objective:A nationwide multi-center and large sample survey was conducted to compare the validity of the Mini International Neuropsychiatric Interview (Hypo-) Manic Episode with Mixed Features-DSM-5 Module (MINI-M) questionnaire and the Clinically Useful Depression Outcome Scale Supplemented with Questions for the DSM-5 Mixed Features Specifier (CUDOS-M) depression subscale in identifying mixed features in patients experiencing (hypo-) manic episodes.Methods:Using a convenience sampling method, 366 patients with bipolar disorder experiencing acute (hypo-) manic episodes who met the inclusion and exclusion criteria were recruited. The diagnosis of "with mixed features" was based on the DSM-5 criteria for mixed features. The predictive validity of the MINI-M questionnaire and the CUDOS-M depression subscale to screen mixed features was analyzed using the receiver operating characteristic (ROC) curve. Additionally, the difference in area under the ROC curve (AUC) between the two instruments was compared.Results:The AUC for the MINI-M questionnaire and the CUDOS-M depression subscale in screening mixed features were 0.79 (95 %CI=0.75-0.84) and 0.81 (95 %CI=0.77-0.86), respectively. There was no statistically significant difference in AUC between the two measurements ( Z=-1.19, P>0.05). Among patients with acute (hypo-) manic episodes, 45.9% (168/366) presented with mixed features according to the DSM-5 criteria, while the corresponding figures were 43.7% (160/366) using the MINI-M questionnaire (total score≥3) and 42.1% (154/366) using the CUDOS-M depression subscale (total score≥20). Screening results were comparable among the three measures. Conclusion:Mixed features are common among patients experiencing acute (hypo-) manic episodes. The MINI-M questionnaire and the CUDOS-M depression subscale demonstrate equivalent validity in identifying mixed features.

Objective:To compare the value of 3 methods (threshold method, visual method and CT method) based on 18F-FDG PET-CT for qualitative diagnosis of solitary pulmonary nodules (SPN). Methods:The clinical characteristics, pathological results, CT signs and maximum standardized uptake value (SUV max) of 226 SPN patients who underwent 18F-FDG PET-CT and met lung imaging reporting and data system (Lung-RADS1.1) grading criteria grade 2-4 in Shanxi Province Cancer Hospital from January 2015 to January 2019 were retrospectively analyzed, and the diagnostic efficacy of threshold method (according to SUV max), visual method [according to the degree of fluorodeoxyglucose (FDG) uptake in the mediastinum or liver blood pool] and CT method (according to Lung-RADS1.1 grading criteria) for SPN were compared by using receiver operating characteristic (ROC) curve. The highest diagnostic accuracy of CT method and the highest diagnostic accuracy of threshold method and visual method were combined as PET-CT comprehensive diagnosis method, and the diagnostic efficiency of which was compared with the other methods. Results:Among the 226 patients with SPN, 174 cases were malignant and 52 cases were benign in pathology. ROC curve analysis showed that the area under the curve (AUC) of CT method 2 (defined Lung-RADS1.1 grade 4A and below as benign, grade 4B and above as malignant) in CT methods for qualitative diagnosis of SPN was 0.622, the sensitivity was 87.93%, and the accuracy was 76.11%, the diagnostic efficiency was higher than method 2. The AUC of the threshold method 1 (defined solid nodules that SUV max≥2.5 and ground-glass nodules that SUV max≥1.14 as malignant, the others as benign) in threshold methods for qualitative diagnosis of SPN was 0.675, the sensitivity was 85.06%, and the accuracy was 76.99%, the diagnostic efficiency was higher than other methods in the threshold methods and visual methods. The AUC of PET-CT comprehensive diagnosis method (combination of CT method 2 and threshold method 1) for qualitative diagnosis of SPN was 0.652, the sensitivity was 97.70%, and the accuracy was 82.74%, the diagnostic efficiency was higher than other methods. Conclusions:There is no significant difference among threshold method, visual method and CT method based on 18F-FDG PET-CT in qualitative diagnosis of SPN. The diagnostic efficiency of combining CT method with threshold method is significantly improved.

Objective:This study explores the diagnostic efficiency of a modified semi-structured clinical interview (MSCI) based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) for bipolar disorder (BD) by comparing MSCI with a traditionally structured interview and a self-reported diagnostic scale.Methods:MSCI, Structured Clinical Interview for DSM Axis Ⅰ Disorders-Patient Edition (SCID-Ⅰ/P), and 32-item hypomania checklist (HCL-32) were simultaneously administered in 445 outpatients with major depressive disorder ( n=100) or BD ( n=345). All patients were followed up for at least half a year and at least three times to confirm the diagnosis based on the clinical data, follow-up evaluation, and treatment efficacy. The sensitivity and specificity of the three diagnostic strategies were compared using the chi-square test. Results:The sensitivity of MSCI was significantly higher than that of SCID-Ⅰ/P (0.67 vs. 0.32, χ 2=82.10, P<0.001) but was similar to that of HCL-32 (0.67 vs. 0.70, χ 2=2.22, P=0.136). MSCI presented significantly lower specificity than SCID-Ⅰ/P (0.96 vs.1.0, χ 2=4.08, P=0.043) but significantly higher specificity than HCL-32 (0.96 vs.0.67, χ 2=27.89, P<0.001). For the diagnosis of bipolar Ⅰ disorder, no significant difference was found between the sensitivity of MSCI (1.0) and SCID-Ⅰ/P (0.73) (χ 2=3.47, P=0.062) and between the sensitivity of MSCI and HCL-32 (0.73) (χ 2=3.47, P=0.062). For bipolar Ⅱ disorder, the sensitivity of MSCI (0.90) was significantly higher than that of SCID-Ⅰ/P (0.41) (χ 2=92.49, P<0.001) and that of HCL-32 (0.66) (χ 2=22.51, P<0.001). For BD with mixed features, the sensitivity of MSCI (0.37) was significantly higher than that of SCID-Ⅰ/P (0.19) (χ 2=10.85, P<0.001) but lower than that of HCL-32 (0.80) (χ 2=49.40, P<0.001). For other specified bipolar and related disorders, the sensitivity of MSCI (0.41) did not significantly differ from that of SCID-Ⅰ/P (0.18) (χ 2=2.73, P=0.100) but was significantly lower than that of HCL-32 (0.70) (χ 2=4.53, P=0.033). Conclusion:Compared to SCID-Ⅰ/P and HCL-32, MSCI has better diagnostic efficiency for BD.

Objective:This study investigates the difference in the detection rate and symptomatology between ICD-10 and DSM-5 diagnostic criteria for bipolar disorder with mixed states.Methods:Based on the Phase Ⅰ (2012) and Phase Ⅱ (2021) databases of National Bipolar Mania Pathway Survey (BIPAS), patients with bipolar disorder were included. General demographic data, clinical characteristics, symptomatic phenotypes, and mixed characteristics were retrieved. The detection rates and symptomatic performances of patients with or without mixed states in Phase Ⅰ and Ⅱ were compared using the chi-square test.Results:For patients with mixed states, the detection rate during Phase Ⅱ (2021) using DSM-5 (18.79%, 199/1 059) criteria was significantly higher than that during Phase Ⅰ (2012) using ICD-10 (6.78%, 199/2 934; χ 2=125.05, P<0.001). Whether using ICD-10 or DSM-5 criteria, patients with mixed states had a significantly higher frequency of multiple symptomatic manifestations. Conclusion:The DSM-5 diagnostic criteria generate a high detection rate for bipolar disorder with mixed states. The clinical phenotypes of bipolar disorder with mixed states vary significantly using different diagnostic tools.

Objective:This study explores the diagnostic efficiency of a modified semi-structured clinical interview (MSCI) based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) for bipolar disorder (BD) by comparing MSCI with a traditionally structured interview and a self-reported diagnostic scale.Methods:MSCI, Structured Clinical Interview for DSM Axis Ⅰ Disorders-Patient Edition (SCID-Ⅰ/P), and 32-item hypomania checklist (HCL-32) were simultaneously administered in 445 outpatients with major depressive disorder ( n=100) or BD ( n=345). All patients were followed up for at least half a year and at least three times to confirm the diagnosis based on the clinical data, follow-up evaluation, and treatment efficacy. The sensitivity and specificity of the three diagnostic strategies were compared using the chi-square test. Results:The sensitivity of MSCI was significantly higher than that of SCID-Ⅰ/P (0.67 vs. 0.32, χ 2=82.10, P<0.001) but was similar to that of HCL-32 (0.67 vs. 0.70, χ 2=2.22, P=0.136). MSCI presented significantly lower specificity than SCID-Ⅰ/P (0.96 vs.1.0, χ 2=4.08, P=0.043) but significantly higher specificity than HCL-32 (0.96 vs.0.67, χ 2=27.89, P<0.001). For the diagnosis of bipolar Ⅰ disorder, no significant difference was found between the sensitivity of MSCI (1.0) and SCID-Ⅰ/P (0.73) (χ 2=3.47, P=0.062) and between the sensitivity of MSCI and HCL-32 (0.73) (χ 2=3.47, P=0.062). For bipolar Ⅱ disorder, the sensitivity of MSCI (0.90) was significantly higher than that of SCID-Ⅰ/P (0.41) (χ 2=92.49, P<0.001) and that of HCL-32 (0.66) (χ 2=22.51, P<0.001). For BD with mixed features, the sensitivity of MSCI (0.37) was significantly higher than that of SCID-Ⅰ/P (0.19) (χ 2=10.85, P<0.001) but lower than that of HCL-32 (0.80) (χ 2=49.40, P<0.001). For other specified bipolar and related disorders, the sensitivity of MSCI (0.41) did not significantly differ from that of SCID-Ⅰ/P (0.18) (χ 2=2.73, P=0.100) but was significantly lower than that of HCL-32 (0.70) (χ 2=4.53, P=0.033). Conclusion:Compared to SCID-Ⅰ/P and HCL-32, MSCI has better diagnostic efficiency for BD.

Objective:This study investigates the difference in the detection rate and symptomatology between ICD-10 and DSM-5 diagnostic criteria for bipolar disorder with mixed states.Methods:Based on the Phase Ⅰ (2012) and Phase Ⅱ (2021) databases of National Bipolar Mania Pathway Survey (BIPAS), patients with bipolar disorder were included. General demographic data, clinical characteristics, symptomatic phenotypes, and mixed characteristics were retrieved. The detection rates and symptomatic performances of patients with or without mixed states in Phase Ⅰ and Ⅱ were compared using the chi-square test.Results:For patients with mixed states, the detection rate during Phase Ⅱ (2021) using DSM-5 (18.79%, 199/1 059) criteria was significantly higher than that during Phase Ⅰ (2012) using ICD-10 (6.78%, 199/2 934; χ 2=125.05, P<0.001). Whether using ICD-10 or DSM-5 criteria, patients with mixed states had a significantly higher frequency of multiple symptomatic manifestations. Conclusion:The DSM-5 diagnostic criteria generate a high detection rate for bipolar disorder with mixed states. The clinical phenotypes of bipolar disorder with mixed states vary significantly using different diagnostic tools.