RNA-based gene therapy has been widely used for various diseases, and extensive studies have proved that suitable delivery routes greatly help the development of RNA therapeutics. Identifying a safe and effective delivery system is key to realizing RNA therapeutics' clinical translation. Inhalation is a non-invasive pulmonary delivery modality that can enhance the retention of therapeutic agents in the lungs with negligible toxicity, thereby improving patient compliance. Inhaled RNA therapeutics are increasingly becoming an area of focus for researchers; however, only several clinical trials have explored inhaled delivery of RNA for pulmonary diseases. This review presents an overview of recent advances in inhaled delivery systems for RNA therapeutics, including viral and nonviral systems, highlighting state of the art regarding inhalation in the messenger RNA (mRNA) field. We also summarize the applications of mRNA inhalants in infectious and other lung diseases. Simultaneously, the research progresses on small interfering RNAs (siRNAs), antisense oligonucleotides (ASOs), and different types of RNA are also discussed to provide new strategies for developing RNA inhalation therapy. Finally, we clarify the challenges inhaled RNA-based therapeutics face before their widespread adoption and provide insights to help advance this exciting field to the bedside.

ObjectivesTo summarize the clinical and pathological features of patients with congenital liver fibrosis （CHF）， and to investigate the differences in clinical and pathological features between patients in different age groups. MethodsA retrospective analysis was performed for the clinicopathological data of 26 patients with pathologically confirmed CHF in China-Japan Friendship Hospital from August 2005 to June 2023， and the patients were stratified by age to investigate the clinical and pathological features of patients in different age groups. ResultsAmong the 26 patients， there were 12 male patients and 14 female patients， with an age of onset of 4 — 61 years. There were 19 patients with portal hypertension type （73.08%）， 2 patients with cholangitis type （7.69%）， 4 patients with mixed type （15.38%）， and 1 patient with occult type （3.85%）. Of all 26 patients， 4 had unknown clinical symptoms， and among the 22 patients with clear clinical symptoms， 10 （45.45%） attended the hospital due to upper gastrointestinal bleeding caused by portal hypertension. Pathological manifestations included roughly normal liver parenchyma separated by fibrous septa in the portal area， with the presence of abnormal reactive bile duct hyperplasia. Denser fibrous septa and a lack of portal veins with the corresponding caliber were observed in 4 pediatric patients with disease onset before the age of 10 years， with a significant reduction or even disappearance of compensatory thin-walled blood vessels. ConclusionPortal hypertension-type CHF is the most common type in clinical practice. Patients with an early age of onset have certain histopathological features of the liver， with the presence of serious complications associated with portal hypertension. Therefore， liver biopsy should be performed for patients suspected of CHF in clinical practice， and genetic testing should be performed when necessary. Early identification and diagnosis are of great importance for improving the prognosis of patients.

Strengthening the cultivation of innovation ability is the new requirement put forward by the state for higher educa-tion.High-quality curriculum design is the primary means of achieving high-quality talent cultivation.By constructing the"disease case library"and"problem graph"of immune system and related diseases,and adopting the teaching method of"combining large and small cases and integrating online and offline",this study not only consolidates students'basic knowledge,but also builds a bridge for students from theory to practice,from knowledge accumulation to creation and application.It further exercises students'ability to dis-cover,analyze and solve problems,and enhances students'innovation awareness and ability.

Strengthening the cultivation of innovation ability is the new requirement put forward by the state for higher educa-tion.High-quality curriculum design is the primary means of achieving high-quality talent cultivation.By constructing the"disease case library"and"problem graph"of immune system and related diseases,and adopting the teaching method of"combining large and small cases and integrating online and offline",this study not only consolidates students'basic knowledge,but also builds a bridge for students from theory to practice,from knowledge accumulation to creation and application.It further exercises students'ability to dis-cover,analyze and solve problems,and enhances students'innovation awareness and ability.

Objective:To investigate the diagnosis, treatment and prognosis of ovarian yolk sac tumor (OYST).Methods:The clinicopathological data and follow-up data of 12 patients with OYST admitted to the Affiliated Hospital of Qingdao University from January 2013 to December 2020 were retrospectively analyzed, and the diagnosis, treatment and prognosis of OYST patients were summarized.Results:(1) The age of 12 patients with OYST ranged from 11 to 37 years, with a median age of 20 years. At the first visit, all 12 patients had pelvic masses. Reasons for seeing a doctor: 6 cases of abdominal distension and abdominal pain, 4 cases of mass in the lower abdomen, 1 case of vaginal bleeding, and 1 case of appendicitis. International Federation of Obstetrics and Gynecology (FIGO) 2014 staging: 4 cases in stage Ⅰa, 2 cases in stage Ⅰc, 1 case in stage Ⅱc, 4 cases in stage Ⅲc, and 1 case in stage Ⅳb. (2) All 12 patients were examined by color Doppler ultrasound before operation, among which 10 cases showed unilateral adnexal masses and 2 cases bilateral adnexal masses. The median maximum diameter of tumor was 16.5 cm (range: 6.0-28.0 cm). The preoperative levels of alpha fetoprotein (AFP) in 12 patients (all >1 210 μg/L) were significantly higher than normal (<25 μg/L). Among the 11 patients with cancer antigen 125 (CA 125) detection results, 9 patients showed elevated serum CA 125 levels. (3) Among the 12 patients, 8 young infertile patients who needed to preserve their reproductive function underwent appendectomy, 3 infertile patients underwent staged surgery for ovarian malignant germ cell tumor, and only one bilateral lesion and infertile patient underwent unsatisfactory staged surgery for ovarian malignant germ cell tumor. Of the 12 patients, 11 patients were given combined chemotherapy regimen of bleomycin, cisplatin, and etoposide (BEP) after operation. One patient without chemotherapy developed metastasis 3 months after operation, and was given BEP chemotherapy, and her condition was controlled. (4) The deadline for follow-up was December 31st, 2022, and the median follow-up time was 60 months (range: 25-115 months). All the 12 patients survived without tumor during the follow-up period, and the median disease-free survival time was 84.5 months (range: 25-115 months). Conclusions:OYST mostly occurs in children and young women. Color Doppler ultrasound examination and serum AFP and CA 125 detection have diagnostic value for OYST. Surgical treatment after diagnosis of OYST includes surgery to preserve reproductive function and timely and standardized chemotherapy after operation. The prognosis of patients is good regardless of stage.

With rapid development of information technology,blended teaching model has gradually become mainstream teaching model in most colleges and universities.How to evaluate students'learning effect and analyze factors that affect students'per-formance is a key research direction of this teaching model.Taking blended teaching of Medical Immunology course in Xinxiang Medical University as an example,this paper introduces implementation process and evaluation system of blended teaching,analyzes main factors affecting students'performance and learning effect,and focuses on discussing influence of formative evaluation and"flipped classroom"on students'academic performance.

Objective:To understand the current situation of knowledge, attitude and practice of nasointestinal tube nursing among emergency department nurses and analyze its influencing factors.Methods:A total of 470 emergency department nurses from 35 hospitals with nasoenteric tube technology in Beijing were selected as the survey objects by the convenient sampling method from December 2023 to January 2024. The general data questionnaire and Knowledge, Attitude and Practice Questionnaire on Nasointestinal Tube Nursing among Emergency Department Nurses were used to investigate. Multiple linear regression analysis was used to analyze influencing factors on the knowledge, attitude and practice level of nurses in nasointestinal tube nursing.Results:A total of 470 questionnaires were sent out and 470 were effectively collected, with the effective recovery rate of 100.0%. The scores of knowledge, attitude and practice dimensions and total score of emergency department nurses in nasointestinal tube nursing were (25.14±6.80), (44.55±6.94), (79.33±11.73) and (149.03±18.35), respectively. The results of multiple linear regression analysis showed that the education level of emergency department nurses, whether they were teachers, whether they had systematically cared for nasointestinal tubes and whether they had encountered nasointestinal tube blockage were the influencing factors of knowledge dimension ( P<0.05), the professional title of nurses was the influencing factor of attitude dimension ( P<0.05), and hospital level, whether they systematically studied and whether they could independently complete nasointestinal tube placement were the influencing factors of practice dimension ( P<0.05) . Conclusions:The nasointestinal tube nursing level of nurses in the emergency department still needs to be improved and is affected by various factors. Nursing managers should strengthen the training and guidance of nasointestinal tube nursing, train clinical nutrition specialized nurses, formulate targeted training plans and carry out quality supervision combining various methods to comprehensively promote the improvement of nurses' nasointestinal tube nursing level.

Objective:To explore the efficacy and safety of low-dose rituximab in the treatment of idiopathic membranous nephropathy (IMN).Methods:The medical record data of IMN patients treated with low-dose rituximab (375 mg/m 2 by IV infusion, administration once, and then decided whether to add drugs according to the patient′s situation) were searched from the electronic medical record system of Beijing Friendship Hospital, Capital Medical University from January 1, 2020 to June 30, 2023. The patients′ gender, age, 24-hour urinary protein quantitation, plasma albumin, serum creatinine, and the number of CD19 + B cells in peripheral blood before and 1, 3, and 6 months after rituximab application were collected. The efficacy (complete remission, partial remission, and no remission) and the occurrence of adverse reactions were retrospectively analyzed. Results:A total of 32 patients were enrolled in the study, including 24 males and 8 females, with mean age of (59±14) years. The 24-hour urinary protein of patients at 1, 3, and 6 months after the application of rituximab showed a decreasing trend, but the difference was not statistically significant ( P>0.05); after medication, plasma albumin showed an upward trend when compared with that before medication [(23.85±5.65)g/L], with values of (28.06±5.91), (30.56±6.87), and (32.47±7.69) g/L, respectively, and the differences were statistically significant ( P<0.05); the serum creatinine levels were within the reference range before and after medication, and the difference was not statistically significant ( P>0.05); the number of CD19 + B cells in peripheral blood significantly decreased after medication, and the difference was statistically significant ( P<0.05). The effective rate at 6 months after treatment was 65.62% (21/32), including complete remission rate of 9.38% (3/32), partial remission rate of 56.25% (18/32), and no remission rate of 34.38% (11/32). Eight patients experienced mild adverse reactions, all of which were improved after symptomatic treatments. Conclusion:Low-dose rituximab has good efficacy and safety in the treatment of IMN.

Objective:To explore the efficacy and safety of low-dose rituximab in the treatment of idiopathic membranous nephropathy (IMN).Methods:The medical record data of IMN patients treated with low-dose rituximab (375 mg/m 2 by IV infusion, administration once, and then decided whether to add drugs according to the patient′s situation) were searched from the electronic medical record system of Beijing Friendship Hospital, Capital Medical University from January 1, 2020 to June 30, 2023. The patients′ gender, age, 24-hour urinary protein quantitation, plasma albumin, serum creatinine, and the number of CD19 + B cells in peripheral blood before and 1, 3, and 6 months after rituximab application were collected. The efficacy (complete remission, partial remission, and no remission) and the occurrence of adverse reactions were retrospectively analyzed. Results:A total of 32 patients were enrolled in the study, including 24 males and 8 females, with mean age of (59±14) years. The 24-hour urinary protein of patients at 1, 3, and 6 months after the application of rituximab showed a decreasing trend, but the difference was not statistically significant ( P>0.05); after medication, plasma albumin showed an upward trend when compared with that before medication [(23.85±5.65)g/L], with values of (28.06±5.91), (30.56±6.87), and (32.47±7.69) g/L, respectively, and the differences were statistically significant ( P<0.05); the serum creatinine levels were within the reference range before and after medication, and the difference was not statistically significant ( P>0.05); the number of CD19 + B cells in peripheral blood significantly decreased after medication, and the difference was statistically significant ( P<0.05). The effective rate at 6 months after treatment was 65.62% (21/32), including complete remission rate of 9.38% (3/32), partial remission rate of 56.25% (18/32), and no remission rate of 34.38% (11/32). Eight patients experienced mild adverse reactions, all of which were improved after symptomatic treatments. Conclusion:Low-dose rituximab has good efficacy and safety in the treatment of IMN.