AIM: To examine differences in etiology, risk factors, gender, and acute-phase manifestations of retinal artery occlusion(RAO)patients in different age groups, highlighting age-related heterogeneity.

METHODS:This retrospective comparative cohort study enrolled patients with RAO. Patients were divided into <50 y group and ≥50 y group. Etiological classification was based on modified TOAST criteria. Comparisons assessed the prevalence of risk factors, etiological distribution, sex ratio, and, in cases of acute central retinal artery occlusion(CRAO), fundus characteristics and visual outcomes.

RESULTS:This study included a total of 145 RAO patients,which were divided into two groups based on age: <50 y group(15 females and 13 males)with the mean age of 36.64±9.72 y, and ≥50 y group(38 females and 79 males)with the mean age of 63.50±9.54 y. Hypertension(46.4% vs 85.5%)and diabetes(3.6% vs 27.4%)were less prevalent in <50 y group(both P<0.001). The <50 y group was characterized predominantly by stroke of other determined etiology(SOE, 35.7% vs 2.6%, P<0.001), whereas the ≥50 y group was dominated by small artery occlusion(SAO, 35.9%)and large artery atherosclerosis(LAA, 31.6%), the incidence rates were significantly higher in the ≥50 y group than in the <50 y group(both P<0.001). Females were more frequently represented in <50 y group(53.6% vs 32.5%, P=0.039). Multivariable analysis demonstrated that LAA was independently linked to older age and SOE to younger age. Boxcarring occurred exclusively in ≥50 y patients\〖39.5%(17/43)vs 0, P=0.011\〗.

CONCLUSION:The RAO patients<50 y predominantly present with non-atherosclerotic causes and a higher proportion of females, whereas patients≥50 y are mainly affected by atherosclerosis driven etiologies and show signs of reduced vascular compensatory capacity. These findings indicate that age-related differences in RAO should be taken into account when determining etiologic evaluation and management strategies.

Digital simulation and three-dimensional (3D) printing technology-assisted treatment of mandibular fractures in children has good clinical application value. During the surgery, attention should be paid to the fixation of dentition defects, jawbone development, and the protection of permanent tooth germs. This article reports a case of a 7-year-old male patient with a mandibular chin fracture, treated with digital simulation of fracture reduction and 3D printing of mandible model, along with implantable occlusal splint, then underwent open reduction and internal fixation surgery. After 3 and 6 months, the 3D printed splint and internal fixation titanium plate were removed. The mandibular fracture healed well, without affecting jawbone development, and the tooth germs remained undamaged, the occlusal relationship recovered well. The case suggests the use of computer digital simulation and 3D printing technology facilitates precise reduction of mandibular fractures and reduces the impact on the jawbone and tooth germs, which provids valuable clinical reference.

Digital simulation and three-dimensional (3D) printing technology-assisted treatment of mandibular fractures in children has good clinical application value. During the surgery, attention should be paid to the fixation of dentition defects, jawbone development, and the protection of permanent tooth germs. This article reports a case of a 7-year-old male patient with a mandibular chin fracture, treated with digital simulation of fracture reduction and 3D printing of mandible model, along with implantable occlusal splint, then underwent open reduction and internal fixation surgery. After 3 and 6 months, the 3D printed splint and internal fixation titanium plate were removed. The mandibular fracture healed well, without affecting jawbone development, and the tooth germs remained undamaged, the occlusal relationship recovered well. The case suggests the use of computer digital simulation and 3D printing technology facilitates precise reduction of mandibular fractures and reduces the impact on the jawbone and tooth germs, which provids valuable clinical reference.

Objective To design a multifunctional sputum suction device and verify its effectiveness.Methods A total of 50 patients using the multifunctional sputum suction device in a tertiary A hospital in Guangzhou from July to December 2022 were selected as the test group,from January to June 2022,while 49 patients using the traditional sputum suction device were taken as the control group.We compared the first suction preparation time,perfect rate of goods preparation,satisfaction of medical staff between the 2 groups.Results Compared with the control group,the time of preparation for the first sputum suction in the test group was shorter(t=-120.113,P＜0.001),and the times of preparation in the test group were more than these in the control group(x2=8.002,P=0.005).The satisfaction degree of nursing staff to the tidiness,practicability,convenience and timeliness of the sputum suction device was higher than that of the control group,and the difference was statistically significant(Z=-6.825,Z=-5.172,Z=-6.806,Z=-7.215,all P＜0.001).Conclusion The multifunctional sputum suction device can reduce the time spent in preparing the items before suction,improve the rate of item preparation and the satisfaction of nursing staff.

Objective To explore the correlation of nerve function and prognosis with serum uric acid(UA),homocysteine(Hcy)and low-density lipoprotein cholesterol(LDL-C)in patients with acute cerebral infarction(ACI)after alteplase intravenous thrombolysis.Methods A total of 220 ACI patients undergoing thrombolysis in Changsha First Hospital ICU between January 2020 and December 2022 were enrolled,and according to mRS score at 3 months after thrombolysis,they were divided into poor prognosis group(mRS score＞2,91 cases)and good prognosis group(mRS score ≤2,129 cases).The serum levels of UA,Hcy and LDL-C were compared between the two groups.The correlation between the three indexes and score of National Institutes of Health Stroke Scale(NIHSS),and their predictive value for poor prognosis were analyzed.Results At 1 and 3 d after thrombolysis,the serum levels of UA,Hcy and LDL-C and NIHSS score were sig-nificantly decreased in both groups,and the serum levels of UA and Hcy and NIHSS score at 3 d after thrombolysis were significantly lower than those at 1 d(P＜0.05).The poor prognosis group had obviously higher serum levels of UA,Hcy and LDL-C and NIHSS score at 1 and 3 d after thrombolysis than the good prognosis group(P＜0.05,P＜0.01).Pearson correlation analysis showed that the serum levels of UA,Hcy and LDL-C were positively correlated with NIHSS score at 1 and 3 d after thrombolysis(P＜0.01).ROC curve analysis indicated that the AUC values of UA,Hcy and LDL-C at 1 d after thrombolysis for predicting poor prognosis were 0.707(95％CI:0.639-0.776),0.800(95％CI:0.739-0.860)and 0.624(95％CI:0.550-0.698),respectively,while the values of them at 3 d after thrombolysis were 0.655(95％CI:0.583-0.726),0.730(95％CI:0.664-0.795)and 0.573(95％CI:0.497-0.649),respectively.Conclusion In ACI patients after thrombolysis,the serum levels of UA,Hcy and LDL-C are increased in those with poor prognosis,and are associated with the severity of nerve injury.The levels at 1 d after throm-bolysis have good predictive value for poor prognosis.

Objective:To enhance understanding of mental retardation autosomal dominant 35 (MRD35) by analyzing the clinical and genetic characteristics of the disease.Methods:Clinical and genetic data of 1 case of MRD35 in Beijing Children′s Hospital in July 2018 were reported, and literature review was conducted.Results:The male proband, 1 year and 3 months old, was admitted with the clinical manifestations including mental retardation, low-grade fever, a large forehead, flat nose, open mouth, and hypomyotonia. The brain magnetic resonance imaging showed enlarged lateral ventricles, cavum septum, cavum verge and cavum velum interpositum cyst. The whole exome sequencing test showed that the proband carried a missense mutation c.1258 G>A, (p.E420K) in the PPP2R5D gene, and the mutation was de novo confirmed by Sanger sequencing. There were ten literatures reported, including a total number of 31 cases. Counting on this case, totally 32 cases were included. Among the 32 patients, 32 cases (100.0%) had mental retardation, 26 cases (81.3%) with motor retardation, 26 cases (81.3%) with macrocephaly, 8 cases (25.0%) with epilepsy. Facial dysmorphic features, ocular abnormalities, skeletal abnormalities, and cardiac malformations were also reported. All reported individuals had missense mutations of PPP2R5D gene and were autosomal dominantly inherited. Conclusions:The main clinical manifestations of MRD35 include growth retardation/mental retardation, severe speech impairment, macrocephaly, hypomyotonia, seizures and dysmorphic facial features. A novel missense mutation in the PPP2R5D gene is the cause of MRD35.

Objective:To understand the ethical misconduct of Chinese medical researchers and its influencing factors, so as to provide a reference for regulating such misconduct in clinical research.Methods:From September to November 2021, a stratified random sampling method was adopted to select medical researchers from the China Clinical Trial Registration Platform as interview objects, and semi-structured interviews were made on ethical misconduct and its influencing factors in clinical trials. The interview data were analyzed using NVivo11 software.Results:A total of 28 interviewees were included, 57%( n=16) of whom holding that medical researchers accept research ethics passively in most cases. The influencing factors of ethical misconduct of medical researchers are summarized into 7 secondary nodes and 43 tertiary nodes, including 248 reference points. The environmental factors included poor ethical supervision, great research pressure information asymmetry between subjects and researchers, and insufficient ethical atmosphere, including 54, 40, 38, and 29 reference points respectively. The self-factors included lack of ethical knowledge, weak ethical awareness, and individual characteristics of researchers, including 48, 21 and 18 reference points respectively. Conclusions:The attitude and behavior of clinical research ethics of Chinese medical researchers are generally in the transitional stage from passive acceptance to positive compliance, and there are many factors influencing ethical misconduct. In order to further standardize the ethical behavior of medical researchers, the authors suggest relevant authorities to improve ethical review and supervision, establish systematic ethical training, improve the scientific research environment, and actively carry out clinical trials and science popularization.

Objective:To analyze the long-term prognosis and prognostic factors of allergic bronchopulmonary aspergillosis(ABPA) in children suffering from cystic fibrosis (CF).Methods:An observational study was performed.All children who were admitted to the Department of Respiratory, Beijing Children′s Hospital, Capital Medical University from August 2014 to June 2018, with more than 2 years of followed up for the diagnosis of CF accompanied by ABPA were involved.Results:Three children met the inclusion criteria, with 2 boys and 1 girl, and their diagnostic age were 14, 8 and 9 years old, respectively.The follow-up duration ranged from 2 to 6 years.All the 3 cases were treated with systemic corticosteroids and antifungal agent.In case 1, the initial dose of prednisone was 0.75 mg/(kg·d), and the course of treatment was more than 5 years.The corticosteroid-dependent patient suffered from expectoration and chest pain, and radiographic findings indicated exacerbation, while his lung function was normal.Treating with initial dose of prednisone 2 mg/(kg·d) for 9 months, case 2 had normal serum immunoglobulin E(IgE) concentration, but his pulmonary artery was infiltrated by lesions, thus leasing to lobectomy.In case 3, the initial dose of prednisone was 0.6 mg/(kg·d), and the course of treatment was 18 months.And she developed persistent hypoxemia, and decreased pulmonary function, so lung transplantation was necessary 2 years after diagnosis.Conclusions:Systemic glucocorticoid combined with antifungal therapy is the main treatment for CF with ABPA, but there are individual differences in the efficacy.The level of serum total IgE is not always consistent with lung function and chest images.The overall prognosis is poor, and it is infeasible to evaluate the prognosis by single factor.

Deciphering the metabolites of multiple components in herbal medicine has far-reaching significance for revealing pharmacodynamic ingredients.However,most chemical components of herbal medicine are secondary metabolites with low content whose in vivo metabolites are close to trace amounts,making it difficult to achieve comprehensive detection and identification.In this paper,an efficient strategy was proposed:herb-derived metabolites were predicted according to the structural characteristics and metabolic reactions of chemical constituents in Corydalis Rhizoma and chemical structure screening tables for metabolites were conducted.The fragmentation patterns were summarized from represen-tative standards combining with specific cleavage behaviors to deduce structures of metabolites.Ion abundance plays an important role in compound identification,and high ion abundance can improve identification accuracy.The types of metabolites in different biological samples were very similar,but their ion abundance might be different.Therefore,for trace metabolites in biological samples,we used the following two methods to process:metabolites of high dose herbal extract were analyzed to char-acterize those of clinical dose herbal extracts in the same biological samples;cross-mapping of different biological samples was applied to identify trace metabolites based on the fact that a metabolite has different ion abundance in different biological samples.Compared with not using this strategy,44 more metabolites of clinical dose herbal extract were detected.This study improved the depth,breadth,and accuracy of current methods for herb-derived metabolites characterization.

Hospice care is a health care involving end-of-life quality of millions of people. Compared with the growing demand for hospice services, the domestic service supply is seriously insufficient, making it urgent to explore the development path to meet the diversified health service needs of the public. Based on the analysis of the current situation of hospice development in the mainland and Taiwan of China, the " five-in-one" hospice development path consisting of top-level design, legislative protection, personnel training, social support, and publicity and education was proposed, which was expected to provide a basis for promoting the development of hospice practice in Chinese mainland. The aim is to provide a reference for promoting the development of hospice practice in Chinese mainland.