A young male patient was diagnosed with aplastic anemia accompanied by paroxysmal nocturnal hemoglobinuria(PNH),and achieved only partial remission after immunosuppressive therapy.Over the past year,his anemia worsened,leading to transfusion dependence,which was considered to be caused by active he-molysis of PNH.Despite switching to eculizumab treatment,his anemia continued to deteriorate.A detailed medical history revealed chronic periodontal infection,with periodontal pain,purulent discharge,and fever in the past month.Multidisciplinary discussion suggested that chronic odontogenic infection activating the comple-ment system was the primary cause of aggravated PNH hemolysis,and the acute infection affected the efficacy of eculizumab.Based on multidisciplinary consultation,a treatment plan was formulated,including intravenous antibiotics combined with periodontal irrigation and tooth extraction to control odontogenic infection,while con-tinuing regular eculizumab infusion.The patient's symptoms improved,hemoglobin levels rose rapidly,and he was no longer transfusion-dependent.This case provides an empirical reference for addressing difficulties en-countered in the treatment of rare diseases with new drugs through multidisciplinary collaborative diagnosis and treatment.

Objective To investigate the correlation between serum uric acid(SUA)levels and incident chronic kidney disease(CKD)in middle-aged and elderly Chinese population and gender differences.Methods Based on the longitudinal survey data of China Health and Retirement Longitudinal Study from 2011 to 2015,the CKD-Epidemiology Collaboration cystatin C formula was used to estimate the glomerular filtration rate(eGFR),and 4 119 participants with normal renal function(eGFR≥60 mL·min-1·1.72 m-2)at baseline were included.Incident CKD was defined as eGFR<60 mL·min-1·1.72 m-2 at the follow-up in 2015.Logistic regression analysis was used to analysis the association of SUA levels at baseline and incident CKD among different genders.Restricted cubic spline analysis was used to analyze the dose-response relationship.Results After 4-year follow-up,127 participants developed incident CKD,including 57 males and 70 females.Multivariate Logistic regression analysis showed that elevated SUA levels were independently associated with the risk of incident CKD(OR=1.532,P<0.001).For each 1 mg/dL increase in SUA,the risk of incident CKD increased by 33.6%in males(OR=1.336,P=0.012)and 77.5%in females(OR=1.755,P<0.001).Restricted cubic spline analysis showed a linear positive correlation between SUA levels and incident CKD in both males and females.Participants were divided into four groups according to SUA quartiles(Q1-Q4).Multivariate Logistic regression analysis indicated a significant increase in the risk of incident CKD in Q3 group(3.75 mg/dL4.43 mg/dL)compared with Q1 group in females(Q3 group:OR=2.571,P=0.045;Q4 group:OR=3.666,P=0.005).Conclusion SUA is an independent risk factor for incident CKD in the middle-aged and elderly population.In females,serum uric acid levels exceeding 3.75 mg/dL are associated with an increased risk of incident CKD.

This study established the HPLC fingerprints, characteristic chromatograms, and a multi-component content determination method for Bidens bipinnata and B. biternata. The chemical pattern recognition analysis was then employed to clarify the characteristic indexes of quality differences between the two original plants of Bidentis Herba, providing a reference for establishing the quality standards of Bidentis Herba. HPLC was launched on an Agilent Poroshell 120 EC-C_(18) chromatographic column(4.6 mm×250 mm, 4 μm) by gradient elution with a mobile phase of 0.1% aqueous phosphoric acid-acetonitrile at a flow rate of 0.7 mL·min~(-1), detection wavelength of 270 nm, column temperature of 25 ℃, and an injection volume of 5 μL. The similarity between the fingerprints of 18 batches of Bidentis Herba samples and the common pattern(R) ranged from 0.572 to 0.933. A total of 23 chromatographic peaks were calibrated. Through comparison with the reference substances, six components(neochlorogenic acid, chlorogenic acid, isochlorogenic acid A, isochlorogenic acid B, rutin, and hyperoside) were identified and subjected to quantitative analysis. The characteristic fingerprints of B. bipinnata and B. biternata were calibrated with 20 and 17 characteristic peaks, respectively. Among them, peaks 8, 9, 22, and 23 were the characteristic peaks of B. bipinnata, and peak 7 was the characteristic peak of B. biternata, which can be used to distinguish the two original plants of Bidentis Herba. The relative standard deviation of the content of the above-mentioned six components ranged from 36% to 123%. The cluster analysis, principal component analysis, and orthogonal partial least squares-discriminant analysis(OPLS-DA) classified the 18 batches of Bidentis Herba samples into two categories. Additionally, through the analysis of variable importance in projection(VIP) under OPLS-DA, three characteristic indexes, rutin, isochlorogenic acid A, and isochlorogenic acid B, were identified. The analytical method established in this study can comprehensively evaluate the consistency of Bidentis Herba samples derived from different original plants, specifically identify the differential components between them, and effectively distinguish the two original plants of Bidentis Herba, providing a basis for the differentiation between different original plants and the quality control of Bidentis Herba.
Chromatography, High Pressure Liquid/methods* ; Drugs, Chinese Herbal/chemistry* ; Quality Control ; Bidens/chemistry*

This comprehensive review synthesizes the latest advancements in understanding inflammatory disorders affecting cerebral small vessels, a distinct yet understudied category within cerebral small vessel diseases (SVD). Unlike classical SVD, these inflammatory conditions exhibit unique clinical presentations, imaging patterns, and pathophysiological mechanisms, posing significant diagnostic and therapeutic challenges. Highlighting their heterogeneity, this review spans primary angiitis of the central nervous system, cerebral amyloid angiopathy-related inflammation, systemic vasculitis, secondary vasculitis, and vasculitis in autoinflammatory diseases. Key discussions focus on emerging insights into immune-mediated processes, neuroimaging characteristics, and histopathological distinctions. Furthermore, this review underscores the importance of standardized diagnostic frameworks, individualized immunomodulation approaches, and novel targeted therapies to address unmet clinical demands.
Humans ; Cerebral Small Vessel Diseases/pathology* ; Inflammation/pathology* ; Cerebral Amyloid Angiopathy/pathology* ; Vasculitis, Central Nervous System/pathology* ; Vasculitis/pathology*

OBJECTIVE: This study aimed to explore the association between body mass index (BMI) and mortality based on the 10-year population-based multicenter prospective study. METHODS: A general population-based multicenter prospective study was conducted at four sites in rural China between 2013 and 2023. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to assess the association between BMI and mortality. Stratified analyses were performed based on the individual characteristics of the participants. RESULTS: Overall, 19,107 participants with a sum of 163,095 person-years were included and 1,910 participants died. The underweight (< 18.5 kg/m ²) presented an increase in all-cause mortality (adjusted hazards ratio [ aHR] = 2.00, 95% confidence interval [ CI]: 1.66-2.41), while overweight (≥ 24.0 to < 28.0 kg/m ²) and obesity (≥ 28.0 kg/m ²) presented a decrease with an aHR of 0.61 (95% CI: 0.52-0.73) and 0.51 (95% CI: 0.37-0.70), respectively. Overweight ( aHR = 0.76, 95% CI: 0.67-0.86) and mild obesity ( aHR = 0.72, 95% CI: 0.59-0.87) had a positive impact on mortality in people older than 60 years. All-cause mortality decreased rapidly until reaching a BMI of 25.7 kg/m ² ( aHR = 0.95, 95% CI: 0.92-0.98) and increased slightly above that value, indicating a U-shaped association. The beneficial impact of being overweight on mortality was robust in most subgroups and sensitivity analyses. CONCLUSION This study provides additional evidence that overweight and mild obesity may be inversely related to the risk of death in individuals older than 60 years. Therefore, it is essential to consider age differences when formulating health and weight management strategies.
Humans ; Body Mass Index ; China/epidemiology* ; Male ; Female ; Middle Aged ; Prospective Studies ; Rural Population/statistics & numerical data* ; Aged ; Follow-Up Studies ; Adult ; Mortality ; Cause of Death ; Obesity/mortality* ; Overweight/mortality*

Objective:To explore the application value of renin-angiotensin-aldosterone system (RAAS) indexes in the clinical diagnosis of essential hypertension.Methods:Eighty-eight patients with essential hypertension treated in the 962nd Hospital of the PLA Joint Logistics Support Force from April 2023 to May 2024 were enrolled as the observation group, and 80 normotensive healthy subjects undergoing physical examination in the same hospital during the same period were selected as the control group. RAAS-related indexes [angiotensin Ⅱ (ATⅡ), plasma renin activity (PRA), and aldosterone (ALD)] were detected in both groups. The levels of ATⅡ, PRA, ALD, and the ratio of plasma ALD to PRA (ARR) were compared between the two groups and among subgroups with different hypertension severities in the observation group. The diagnostic efficacy of each index for essential hypertension was analyzed by receiver operating characteristic (ROC) curve.Results:The levels of ALD, ATⅡ, and ARR in the observation group were significantly higher than those in the control group, while the PRA level was significantly lower (all P<0.05). Among the three subgroups in the observation group, the levels of ATⅡ, ALD, and ARR showed a significant increasing trend in grade 1, grade 2, and grade 3 hypertension subgroups, while the PRA level showed a significant decreasing trend (all P<0.05). ROC curve analysis showed that the areas under the curve (AUC) of plasma PRA, ATⅡ, ALD, and ARR for the diagnosis of essential hypertension were 0.814, 0.703, 0.687, and 0.879, respectively. The combined detection of the four indexes had an AUC of 0.918, with the highest sensitivity and accuracy. Conclusions:Changes in RAAS indexes are closely related to the occurrence and severity of essential hypertension. PRA and ARR are effective indexes for the diagnosis of essential hypertension. The combined detection of the four indexes can achieve more ideal diagnostic efficacy and improve the diagnostic satisfaction of patients.

Objective:To investigate the influening factors for postoperative paroxysmal sympathetic hyperactivity (PSH) and prolonged disorders of consciousness (pDoC) in patients with severe traumatic brain injury (sTBI).Methods:A retrospective cross-sectional study was performed; 204 patients with sTBI accepted surgery in Department of Neurosurgery, Second Affiliated Hospital of Fuyang Normal University from January 2018 to April 2024 were enrolled. These patients were divided into PSH group and non-PSH group based on postoperative PSH occurrence. These patients were also divided into pDoC group and non-pDoC group depending on whether duration of postoperative pDoC exceeded 28 days. Differences in clinical data between the PSH group and non-PSH group, as well as between the pDoC group and non-pDoC group, were compared respectively. Multivariate Logistic regression analysis was used to determine the independent influencing factors for PSH or pDoC. Receiver operating characteristic curve was used to investigate the predictive value of these influencing factors in PSH or pDoC in patients with sTBI.Results:(1) Of these 204 patients with sTBI, 28 patients (13.7 %) experienced PSH and 176 patients (86.3 %) were without PSH; compared with the non-PSH group, the PSH group had younger age, lower Glasgow Coma Scale (GCS) score on admission, higher proportions of patients with brain herniation, basilar skull fracture and traumatic intraventricular hemorrhage, higher proportion of patients accepted decompressive craniectomy, higher blood glucose level and neutrophil-to-lymphocyte ratio (NLR), and higher proportion of patients with postoperative hydrocephalus, with significant differences ( P<0.05). Of these 204 patients with sTBI, 77 patients (37.7 %) suffered from pDoC, and 127 (62.3 %) were without pDoC; compared with the non-pDoC group, the pDoC group had older age, lower GCS score on admission, higher proportions of patients with brain herniation, basilar skull fracture and traumatic intraventricular hemorrhage, higher proportion of patients accepted decompressive craniectomy, and higher proportions of patients with postoperative hydrocephalus or postoperative PSH, with significant differences ( P<0.05). (2) Multivariate Logistic regression analysis showed that age, skull base fracture, traumatic intraventricular hemorrhage, blood glucose level, NLR, and postoperative hydrocephalus were independent influencing factors for PSH ( P<0.05); PSH, age, GCS score on admission, and postoperative hydrocephalus were independent influencing factors for pDoC ( P<0.05). (3) Areas under the curve (AUC) of age, skull base fracture, traumatic intraventricular hemorrhage, blood glucose level, NLR and postoperative hydrocephalus in predicting PSH were 0.750, 0.718, 0.760, 0.756, 0.790 and 0.679, respectively; AUC of age, GCS score on admission, postoperative hydrocephalus, postoperative PSH and their combinations in predicting pDoC were 0.598, 0.833, 0.691, 0.630 and 0.925, respectively. Conclusion:The sTBI patients with younger age, skull base fracture, traumatic intraventricular hemorrhage, high blood glucose level and NLR, or hydrocephalus are prone to have postoperative PSH; the sTBI patients with older age, low GCS score on admission, postoperative hydrocephalus or postoperative PSH are prone to have postoperative pDoC.

A young male patient was diagnosed with aplastic anemia accompanied by paroxysmal nocturnal hemoglobinuria(PNH),and achieved only partial remission after immunosuppressive therapy.Over the past year,his anemia worsened,leading to transfusion dependence,which was considered to be caused by active he-molysis of PNH.Despite switching to eculizumab treatment,his anemia continued to deteriorate.A detailed medical history revealed chronic periodontal infection,with periodontal pain,purulent discharge,and fever in the past month.Multidisciplinary discussion suggested that chronic odontogenic infection activating the comple-ment system was the primary cause of aggravated PNH hemolysis,and the acute infection affected the efficacy of eculizumab.Based on multidisciplinary consultation,a treatment plan was formulated,including intravenous antibiotics combined with periodontal irrigation and tooth extraction to control odontogenic infection,while con-tinuing regular eculizumab infusion.The patient's symptoms improved,hemoglobin levels rose rapidly,and he was no longer transfusion-dependent.This case provides an empirical reference for addressing difficulties en-countered in the treatment of rare diseases with new drugs through multidisciplinary collaborative diagnosis and treatment.

Objective To investigate the correlation between serum uric acid(SUA)levels and incident chronic kidney disease(CKD)in middle-aged and elderly Chinese population and gender differences.Methods Based on the longitudinal survey data of China Health and Retirement Longitudinal Study from 2011 to 2015,the CKD-Epidemiology Collaboration cystatin C formula was used to estimate the glomerular filtration rate(eGFR),and 4 119 participants with normal renal function(eGFR≥60 mL·min-1·1.72 m-2)at baseline were included.Incident CKD was defined as eGFR<60 mL·min-1·1.72 m-2 at the follow-up in 2015.Logistic regression analysis was used to analysis the association of SUA levels at baseline and incident CKD among different genders.Restricted cubic spline analysis was used to analyze the dose-response relationship.Results After 4-year follow-up,127 participants developed incident CKD,including 57 males and 70 females.Multivariate Logistic regression analysis showed that elevated SUA levels were independently associated with the risk of incident CKD(OR=1.532,P<0.001).For each 1 mg/dL increase in SUA,the risk of incident CKD increased by 33.6%in males(OR=1.336,P=0.012)and 77.5%in females(OR=1.755,P<0.001).Restricted cubic spline analysis showed a linear positive correlation between SUA levels and incident CKD in both males and females.Participants were divided into four groups according to SUA quartiles(Q1-Q4).Multivariate Logistic regression analysis indicated a significant increase in the risk of incident CKD in Q3 group(3.75 mg/dL4.43 mg/dL)compared with Q1 group in females(Q3 group:OR=2.571,P=0.045;Q4 group:OR=3.666,P=0.005).Conclusion SUA is an independent risk factor for incident CKD in the middle-aged and elderly population.In females,serum uric acid levels exceeding 3.75 mg/dL are associated with an increased risk of incident CKD.

Objective:To explore the application value of renin-angiotensin-aldosterone system (RAAS) indexes in the clinical diagnosis of essential hypertension.Methods:Eighty-eight patients with essential hypertension treated in the 962nd Hospital of the PLA Joint Logistics Support Force from April 2023 to May 2024 were enrolled as the observation group, and 80 normotensive healthy subjects undergoing physical examination in the same hospital during the same period were selected as the control group. RAAS-related indexes [angiotensin Ⅱ (ATⅡ), plasma renin activity (PRA), and aldosterone (ALD)] were detected in both groups. The levels of ATⅡ, PRA, ALD, and the ratio of plasma ALD to PRA (ARR) were compared between the two groups and among subgroups with different hypertension severities in the observation group. The diagnostic efficacy of each index for essential hypertension was analyzed by receiver operating characteristic (ROC) curve.Results:The levels of ALD, ATⅡ, and ARR in the observation group were significantly higher than those in the control group, while the PRA level was significantly lower (all P<0.05). Among the three subgroups in the observation group, the levels of ATⅡ, ALD, and ARR showed a significant increasing trend in grade 1, grade 2, and grade 3 hypertension subgroups, while the PRA level showed a significant decreasing trend (all P<0.05). ROC curve analysis showed that the areas under the curve (AUC) of plasma PRA, ATⅡ, ALD, and ARR for the diagnosis of essential hypertension were 0.814, 0.703, 0.687, and 0.879, respectively. The combined detection of the four indexes had an AUC of 0.918, with the highest sensitivity and accuracy. Conclusions:Changes in RAAS indexes are closely related to the occurrence and severity of essential hypertension. PRA and ARR are effective indexes for the diagnosis of essential hypertension. The combined detection of the four indexes can achieve more ideal diagnostic efficacy and improve the diagnostic satisfaction of patients.