Objective To summarize the clinical characteristics and outcomes of corona virus disease 2019(COVID-19)in patients with adrenal insufficiency(AI),and analyze the risk factors of outcomes.Methods The clinical data of COVID-19 patients with AI in Peking Union Medical College Hospital in December 2022 were ana-lyzed retrospectively and the patients were followed up to collect outcomes of their diseases.Results Among 28 COVID-19 patients with AI,20 cases(71.4%)received basal corticosteroid replacement.Among the 18 patients with community-acquired COVID-19,11 cases(61.1%)increased the corticosteroid dosage proactively at home.The most common symptoms of COVID-19 were fever(96.4%),gastrointestinal symptoms(82.1%)and con-sciousness disturbance(78.6%).Occurrence of severe consciousness disturbance was associated with older age and lower basal corticosteroid replacement dose(P＜0.05). Adrenal crisis(AC)occurred in 20 patients(71.4%),which was associated with lower basal corticosteroid replacement dose,hypochloremia,lower eosinophil,lower platelet,and longer activated partial thromboplastin time(APTT)(P＜0.05). 2 patients died during hospitalization.26.3%(5/19)of surviving patient's recovered consciousness longer than 48 hours.Delayed recovery of conscious-ness was associated with lower systolic pressure,higher blood creatinine,and higher fibrinogen(P＜0.05).Long COVID-19 symptoms such as fatigue and poor appetite occurred in 48.0%(12/25)of patients.Among patients with increased corticosteroid dosage,50.0%(12/24)had their dose reduced to baseline within 3 weeks.Conclusions COVID-19 patients with AI have a high frequency of consciousness disturbance and AC.AI patients are lack of awareness of adjusting corticosteroid dosage proactively in case of infection stress,thus education of"sick day rules"for AI patients should be strengthened in clinical practice.

Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis. Most studies have shown that sarcopenia is associated with overt hepatic encephalopathy (OHE), leading to an increased risk of events such as reduced quality of life, poor clinical prognosis, and even death in patients with liver cirrhosis, but there are few studies on the association between sarcopenia and minimal hepatic encephalopathy (MHE). This article reviews the research advances in sarcopenia and hepatic encephalopathy to provide a reliable basis for clinical treatment, and it is pointed out that the nutritional status of patients can be improved to prevent MHE and even reduce the onset of OHE, thereby improving patient prognosis, increasing quality of life, and reducing the risk of death.

【Objective】 To explore the effects of perceived risk of COVID-19 of college students on their anxiety and depression, as well as the roles of attention to negative information and perceived social support, so as to provide theoretical basis for colleges and universities to formulate corresponding intervention measures. 【Methods】 By the convenience sampling method, totally 1 404 college students from Shaanxi and Henan provinces were investigated online by using General Information Questionnaire, Perceived Risk of COVID-19 Pandemic Scale, Attention to Negative Information Scale, Patient Health Questionnaire, Generalized Anxiety Disorder and Perceived Social Support Scale. SPSS 20.0 was used for data analysis, Pearson correlation method was used to explore the correlation between variables. The mediating effect of attention to negative information and the moderating effect of perceived social support were analyzed by PROCESS. 【Results】 The scores of anxiety and depression of the 1 404 college students included in the study were 4.03±4.48 and 6.21±5.41, respectively. The detection rate of anxiety symptom was 29.9%, and that of depression symptom was 44.4%. The risk perception of COVID-19 epidemic of the college students was positively correlated with attention to negative information (r=0.373, P<0.001), anxiety (r=0.227, P<0.001), and depression (r=0.226, P<0.001). Anxiety (r=0.553, P<0.001) and depression (r=0.497, P<0.001) were positively correlated with attention to negative information, while perceived social support was negatively correlated with the risk perception of the COVID-19 (r=-0.154, P<0.001), attention to negative information (r=-0.259, P<0.001), anxiety (r=-0.321, P<0.001) and depression (r=-0.278, P<0.001). The risk perception of COVID-19 affected the anxiety and depression of the students mainly through the mediating effect of attention to negative information. The total effect of risk perception of COVID-19 and anxiety was 0.227, and the mediating effect accounted for 80.18% of the total effect. The total effect of risk perception of COVID-19 and depression was 0.228, and the mediating effect accounted for 90.35% of the total effect. Perceived social support played a moderating role in the last half of this mediating model. 【Conclusion】 Risk perception of COVID-19 indirectly affects the occurrence of anxiety and depression in college students through attention to negative information, and perceived social support plays a moderating role in this mediating model. The findings suggest that when a risk event occurs, colleges and universities should pay attention to guiding students to adjust their attentional bias to external information, and give students enough care and support to improve their mental health.

【Objective】 To explore the relationship between chronic comorbidity and the physical and mental health of relatives of elderly people during the nursing home confinement, and to analyze the mediating effects of perceived stress and intolerance of uncertainty in this context. 【Methods】 A total of 568 family members of elderly people in nine elderly institutions in Shaanxi Province were selected. The survey included the short version of the Perceived Stress Scale, Intolerance of Uncertainty Scale, and The World Health Organization-5 Well-being Index. The data were analyzed with Stata for correlation and mediation effects. 【Results】 ① The comorbidities of chronic diseases was positively correlated with the perceived stress (r=0.16, P<0.001) and intolerance of uncertainty (r=0.11, P=0.006) of the family members, but negatively correlated with the physical and mental health of the family members (r=-0.13, P=0.002). ② The mediating effect of perceived stress between chronic disease co-morbidity and physical and mental health of family members in older adults was -0.023, accounting for 18.8% of the total effect; the mediating effect of intolerance of uncertainty between chronic disease co-morbidity and physical and mental health of family members in older adults was -0.041, accounting for 33.5% of the total effect. 【Conclusion】 During closed management in a nursing facility, the physical and mental health of family members of older adults with chronic co-morbidities is poorer than that of family members of non-chronic co-morbidities. And it can lead to a decline in physical and mental health of family members through increased perceived stress and intolerance of uncertainty.

Objective To investigate the value of Stroop test, a neuropsychological test, in the diagnosis of minimal hepatic encephalopathy (MHE). Methods A total of 96 patients with liver cirrhosis who were hospitalized in Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, from August 2020 to March 2021 were enrolled, and the number connection test-A (NCT-A), digit symbol test (DST), animal naming test (ANT), and Stroop test were performed for all patients. Test results were recorded and related clinical data were collected. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was used to investigate the value of Stroop test in the diagnosis of MHE, and the Pearson correlation coefficient was used to analyze the correlation of the results of Stroop test with those of NCT-A, DST, and ANT. Results For the 96 patients with liver cirrhosis, the prevalence rate of MHE was 30.21% (29/96). The Off+On time of Stroop test had a cut-off value of 212.49 s in the diagnosis of MHE, with an area under the ROC curve of 0.845, a sensitivity of 93.10%, and a specificity of 64.20%. The Pearson correlation analysis showed that the On+Off time and On time of Stroop test were moderately correlated with NCT-A( r =0.580 and 0.590, both P < 0.01), the Off time of Stroop test was strongly correlated with NCT-A( r =0.620, P < 0.01), and the On+Off time, On time, and Off time of Stroop test were strongly correlated with DST( r =-0.650, -0.650, and -0.630, all P < 0.01). Conclusion In the diagnosis of MHE, Stroop test is a highly sensitive method with easy-to-read results and a high diagnostic value and does not require professional equipment.

Organophosphorus flame retardants (OPFRs) pollution and its impacts on human health are of global concern. The review briefly reviewed the current state-of-knowledge on exposure assessment and epidemiological evidence of OPFRs-related health effects. Specifically, this paper provided an overview and comparison of the levels of respiratory and gastrointestinal exposure to OPFRs and their body burden in different populations worldwide; summarized potential adverse effects of long-term low-level OPFRs exposure on children's neurodevelopment, adults' reproductive system, and thyroid function. Available epidemiological studies have revealed that the OPFRs exposure level of Chinese population is low, and rice consumption may be a potential source of exposure to OPFRs; OPFRs such as tris (1-chloro-2-propyl) phosphate (TCIPP) and tris (2-chloroethyl) phosphate (TCEP) have both neurotoxicity and reproductive toxicity, and possibly affect the thyroid function in adults and increase the risk of wheezing and eczema in children. Finally, the future research focus on population exposure and health effects of OPFRs was prospected.

Inflammatory bowel disease (IBD) is a group of chronic non-specific intestinal inflammatory diseases with unknown etiology. Irritable bowel syndrome (IBS)-like symptoms may occur in IBD in remission, which has a negative impact on the quality of life and prognosis of the disease. This article reviewed the progress of research on epidemiology, pathological mechanism, diagnosis and treatment of IBD in remission overlapping IBS-like symptoms both at home and abroad, in order to provide references for the diagnosis and treatment of IBD in remission and the management of chronic disease.

Post-traumatic stress disorder (PTSD) is a psychiatric disease that seriously affects brain function. Currently, selective serotonin reuptake inhibitors (SSRIs) are used to treat PTSD clinically but have decreased efficiency and increased side effects. In this study, nasal cannabidiol inclusion complex temperature-sensitive hydrogels (CBD TSGs) were prepared and evaluated to treat PTSD. Mice model of PTSD was established with conditional fear box. CBD TSGs could significantly improve the spontaneous behavior, exploratory spirit and alleviate tension in open field box, relieve anxiety and tension in elevated plus maze, and reduce the freezing time. Hematoxylin and eosin and c-FOS immunohistochemistry slides showed that the main injured brain areas in PTSD were the prefrontal cortex, amygdala, and hippocampus CA1. CBD TSGs could reduce the level of tumor necrosis factor-

The blood-brain barrier (BBB) constitutes a major obstacle to effective delivery of drugs to the brain. Recent technological advances have led to improvements in brain-targeted drug delivery. In this review, we summarize existing technologies for efficient drug delivery across the BBB. We discuss the mecha-nisms of current BBB-based drug delivery strategies and introduce prospects for application in brain-targeted delivery of traditional Chinese medicine. We highlight the use of physical techniques for brain-targeted drug delivery, including electroporation, ultrasound, magnetophoresis, microneedles, microwaves, and laser. The characteristics of these techniques and relevant studies employing these approaches are discussed. In general, microneedles, lasers, ultrasound, electroporation, magnetophoresis, and microwaves are effective for drug delivery across the BBB. Notably, the synergistic effects of multiple approaches are superior to the additive effects of each technique in isolation. Our review provides guidance for the practical application of brain-targeted drug delivery techniques in an efficient and safe manner.

OBJECTIVE：To study the prepar ation technology of gastric floating tablets of Schisandra chinensis total lignans （SCTL），and evaluate the quality of prepared tablets. METHODS ：Based on single factor test ，the orthogonal experiment was conducted to optimize the formulation of SCTL gastric floating tablets with the contents of hydroxypropylmethylcellulose （HPMC） K15M，NaHCO3 and microcrystalline cellulose as the factors ，using starting time ，holding time and cumulative release rate of gastric floating tablets as evaluation indexes. The properties ，weight difference ，floatability and accumulative release rate of the prepared SCTL gastric floating tablets were determined. The gastric floating tablets were qualitatively identified by TLC ，and the contents of schisandrin A and total lignans were determined by HPLC and UV spectrophotometry. RESULTS ：The optimal formulation of SCTL gastric floating tablets was made up of 23％ SCTL extract ，20％ HPMC K 15M，40％ microcrystalline cellulose，15％ sodium bicarbonate ，1％ octadecyl alcohol and 1％ polyvinylpyrrolidone. The results of detection of this preparation were in line with the related provisions of “0101 tablet”stated in 2015 edition of Chinese Pharmacopoeia （part Ⅳ）. TLC indicated that the chromatogram of the test sample showed the main spots of same color as the corresponding positions of the chromatogram of schizandrol A control ，Schisandra chinensis reference substance and raw material ，while the negative control has no interference. Content determination results shows that the average content of schizandrol A and total lignans in SCTL gastric floating tablets is 3.187，19.617 mg. It was preliminarily formulated that the content limitation of schizandrol A in one tablet should not be less than 2.50 mg，and the content of total lignans （calculated by schizandrol A ）should not be less than 15.50 mg. CONCLUSIONS：The preparation technology of SCTL gastric floating tablets is stable ，feasible and controllable in quality.