In October 2024, a 36-year-old female patient with botulinum toxin type A intoxication for 15d was admitted to the Department of Neurology of Northern Jiangsu People’s Hospital. Although type A botulinum antitoxin (BAT) therapy remained effective, the patient developed a serum sickness-like reaction (SSLR) on day 4 of treatment after receiving eight consecutive desensitizing intramuscular injections of BAT. After stopping the injection of the drug and giving intravenous dexamethasone, the patient’s symptoms improved. On the 6th day after stopping the injection of botulinum antitoxin type A, the patient was followed up in the outpatient clinic and the skin symptoms had almost disappeared. This article analyzed the patient’s medical records and explored the association between BAT and SSLR, suggesting that medical personnel should be alert to the risk of adverse reactions when applying antitoxin therapy, and that they should identify and intervene in a timely manner in order to ensure the safety of the medication and therapeutic efficacy of the patients.

Objective:To investigate the clinicohistologic and molecular pathological characteristics of invasive stratified mucin-producing carcinoma(ISMC).Methods:The clinicopathological data,immunohistochemistry,alcian blue/periodic acid-Schiff(AB/PAS)staining,molecular detection and PD-L1 expressions of 11 cases of ISMC and 4 cases of stratified mucin-producing intraepithelial lesion(SMILE)in the pathological database of Anqing Medical Center of Anhui Medical University/Anqing Municipal Hospital and the first Affiliated hospital of Wannan Medical School/Yijishan Hostital between January of 2018 and March of 2024 were retrospectively analyzed.Results:ISMC patients often presented with irregular vaginal bleeding.Morphologically,the cells containing mucus in the cytoplasm were arranged in stratified layers,surrounded by a palisade,and the tumor cells might be signet ring-shaped or have clear cytoplasm.ISMC might occur in both pure and mixed forms.ISMC had highly invasive biological characteristics.CK7,p16,p40 and(or)p63 were expressed focally or positively in the form of palisades around the cancer nests.AB-PAS staining was positive.HPV test results:HPV16/18 was positive in ISMC(1/4);HPV16/18 was positive before surgery(4/6);no HPV was detected in SMILE;all ISMC cases expressed PD-L1.Eight ISMC patients were successfully followed up for 4-39 months(average 20.50 months),and four SMILE patients for 1-25 months(average 8.25 months).All followed-up patients survived;however,one ISMC patient developed multi-organ metastases post-surgery.Conclusion:ISMC has unique morphological characteristics and immunophenotypes,indicated by high invasiveness and poor prognosis.All ISMC are PD-L1 positive,suggesting that these patients may benefit from PD-L1 immunotherapy.

Objective This study aims to introduce and explore the application of the medical service price online audit system,which enables pre-positioning,informatization,intelligence,and refinement of price management,ensuring the safety of medical insurance funds and protecting the legitimate rights and interests of patients.Methods Taking a tertiary hospital in Guangdong Province as an example,the application practice of the medical institution's online audit system for price management is thoroughly introduced.Results Through the real-time monitoring of charge data by the online audit system,full-process man-agement is carried out,including pre-warning,mid-intervention,and post-analysis of medical billing behavior,in order to stand-ardize clinical diagnosis and treatment practices.Conclusion By utilizing information technology and continuously improving in-telligent audit rules,the standardization of hospital charge management can be promoted,internal control construction can be strengthened,and the hospital's refinement development can be facilitated.

Objective:To explore the correlation between the methylation of the FOS gene and the occurrence of osteoporosis (OP) in patients with gestational diabetes mellitus (GDM) .Methods:From Aug. 2017 to Aug. 2022, 120 patients with gestational diabetes mellitus (GDM) were collected in Affiliated Hospital of Jining Medical College as the research subjects. According to the bone density values, the research subjects were divided into the OP group (15 cases) and the non-OP group (105 cases) . The methylation status of the FOS gene was detected in the two groups of patients, and levels of blood calcium (Ca) , phosphorus (P) , β-collagen special sequence ( β-CTX) , procollagen I n-terminal propeptide (PINP) , osteocalcin (OC) , and bone alkaline phosphatase (AKP) were measured to analyze the correlation between FOS gene methylation and osteoporosis (OP) . Results:The frequency of FOS methylation in the OP group patients [66.67% (10/15) ] was significantly higher than that in the non-OP group patients [28.57% (30/105) ] ( χ2=8.57, P=0.003) . Compared to the non-OP group, patients in the OP group showed significant decreases in AKP and OC levels (AKP: 19.05±3.65 vs. 12.98±3.09, t=6.13, P<0.001) (OC: 12.76±1.74 vs. 9.12±1.49, t=7.70, P<0.001) , with no statistically significant differences in Ca, P, β-CTX, or PINP between the two groups ( P>0.05) . Among OP group patients, those who were FOS methylation positive showed significantly lower bone density, AKP, and OC levels compared to FOS methylation negative patients (bone density: 0.38±0.05 vs. 0.31±0.06, t=2.24, P=0.043) (AKP: 16.20±1.68 vs. 11.47±2.34, t=4.00, P=0.001) (OC: 10.27±1.55 vs. 8.58±1.14, t=2.41, P=0.032) . In Logistic multivariate analysis, FOS methylation was found to be a risk factor for osteoporosis in GDM pregnant women ( OR=1.17, 95% CI=0.04-4.26, P=0.027) , while bone density ( OR=0.71, 95% CI=0.42-2.10, P=0.012) , AKP ( OR=0.53, 95% CI=0.24-1.90, P=0.008) , and OC ( OR=0.90, 95% CI=0.17-5.18, P=0.021) were identified as protective factors for GDM patients against osteoporosis. Conclusion:The methylation of the FOS gene is significantly associated with the occurrence of OP in pregnant women with GDM, and it can increase the risk of OP in pregnant women with GDM.

Objective:To explore the rehabilitation effects of individual computer story-version magnanimous therapy (ICSMT) on patients with end-stage renal disease undergoing maintenance hemodialysis (MHD).Methods:A total of 120 patients with end-stage renal disease receiving MHD treatment at the Department of Nephrology Hemodialysis Center of Huadu District People's Hospital of Guangzhou from August 2022 to April 2024 were selected as the study subjects.They were randomly divided into control group ( n=60, receiving routine clinical treatment) and ICSMT group ( n=60, receiving routine clinical treatment combined with ICSMT for psychological intervention) by random number table method.The patients in the two groups were evaluated by the self-rating anxiety scale (SAS), self-rating depression scale (SDS), enterprising and magnanimous questionnaire (EMQ), the short-form-36 health survey (SF-36), and activity of daily living scale (ADL) before intervention and at 4-week post-intervention.Blood pressure, blood urea nitrogen (BUN), hemoglobin (Hb), and serum albumin (ALB) levels were also measured before the intervention and at the 4-week post-intervention.The clinical global impression scale (CGI) was used to evaluate clinical efficacy before the intervention, at the 2-week post-intervention, and at the 4-week post-intervention.Statistics analysis was performed using SPSS 29.0.1.0(171). Independent-samples t-test, paired t-test, Mann-Whitney U test and Wilcoxon signed-rank test were used for statistical analysis. Results:After 4 weeks of intervention, the SAS and SDS in the ICSMT group (49.0 (48.0, 50.0), 50.0 (49.0, 51.0)) were significantly lower than those in the control group (51.0 (50.0, 52.0), 52.0 (51.0, 53.0)) (both P<0.001). The enterprising subscore of the EMQ in the ICSMT group (35.0 (32.0, 37.0)) was significantly higher than that in the control group (31.0 (29.0, 34.0)) ( P<0.001). Furthermore, the differences of enterprising and magnanimous subscores between the two groups before and after intervention in the ICSMT group (2.0 (1.0, 4.0), 1.0 (-1.0, 2.0))were significantly higher than those in the control group (-1.0 (-1.0, 0), -1.0 (-1.2, 0)) (both P<0.05). Systolic and diastolic blood pressure values in the ICSMT group (130 (126, 134) mmHg, 85 (80, 88) mmHg)were significantly lower than those in the control group (145 (138, 152) mmHg, 93 (88, 99) mmHg)(1 mmHg=0.133 kPa) after 4 weeks of intervention(both P<0.05). After 4 weeks of intervention, the level of BUN in the ICSMT group (5.5 (3.7, 8.4) mmol/L) was significantly lower than that in the control group (9.1 (6.8, 11.4) mmol/L), while the level of Hb and ALB in the ICSMT group ((115.0±10.0)g/L, (38.3±3.2)g/L)were significantly higher than those in the control group ((104.0±12.0)g/L, (37.1±2.9)g/L) (all P<0.05). After 4 weeks of intervention, the physical functioning, role-physical, general health, vitality, social functioning, role-emotional, and mental health subscores of SF-36 in ICSMT group were all significantly higher than those in the control group (all P<0.05). After 4 weeks of intervention, the score of ADL in the ICSMT group (15.42±1.58)was significantly lower than that in the control group (16.78±2.06) ( t=-4.08, P<0.05). At the 2-week post-intervention and the 4-week post-intervention, the severity of illness (SI) and global improvement (GI) in the ICSMT group were significantly lower than those in the control group, while the efficacy index (EI) in the ICSMT group was significantly higher than that in the control group (all P<0.05). Conclusion:ICSMT can effectively promote the physical, psychological, and social functional rehabilitation of end-stage renal disease patients undergoing MHD, significantly improving their quality of life.

Objective:To explore the correlation between the methylation of the FOS gene and the occurrence of osteoporosis (OP) in patients with gestational diabetes mellitus (GDM) .Methods:From Aug. 2017 to Aug. 2022, 120 patients with gestational diabetes mellitus (GDM) were collected in Affiliated Hospital of Jining Medical College as the research subjects. According to the bone density values, the research subjects were divided into the OP group (15 cases) and the non-OP group (105 cases) . The methylation status of the FOS gene was detected in the two groups of patients, and levels of blood calcium (Ca) , phosphorus (P) , β-collagen special sequence ( β-CTX) , procollagen I n-terminal propeptide (PINP) , osteocalcin (OC) , and bone alkaline phosphatase (AKP) were measured to analyze the correlation between FOS gene methylation and osteoporosis (OP) . Results:The frequency of FOS methylation in the OP group patients [66.67% (10/15) ] was significantly higher than that in the non-OP group patients [28.57% (30/105) ] ( χ2=8.57, P=0.003) . Compared to the non-OP group, patients in the OP group showed significant decreases in AKP and OC levels (AKP: 19.05±3.65 vs. 12.98±3.09, t=6.13, P<0.001) (OC: 12.76±1.74 vs. 9.12±1.49, t=7.70, P<0.001) , with no statistically significant differences in Ca, P, β-CTX, or PINP between the two groups ( P>0.05) . Among OP group patients, those who were FOS methylation positive showed significantly lower bone density, AKP, and OC levels compared to FOS methylation negative patients (bone density: 0.38±0.05 vs. 0.31±0.06, t=2.24, P=0.043) (AKP: 16.20±1.68 vs. 11.47±2.34, t=4.00, P=0.001) (OC: 10.27±1.55 vs. 8.58±1.14, t=2.41, P=0.032) . In Logistic multivariate analysis, FOS methylation was found to be a risk factor for osteoporosis in GDM pregnant women ( OR=1.17, 95% CI=0.04-4.26, P=0.027) , while bone density ( OR=0.71, 95% CI=0.42-2.10, P=0.012) , AKP ( OR=0.53, 95% CI=0.24-1.90, P=0.008) , and OC ( OR=0.90, 95% CI=0.17-5.18, P=0.021) were identified as protective factors for GDM patients against osteoporosis. Conclusion:The methylation of the FOS gene is significantly associated with the occurrence of OP in pregnant women with GDM, and it can increase the risk of OP in pregnant women with GDM.

Objective:To analyze the effects of Mulligan technique combined with isokinetic exercise training (IET) on isokinetic muscle strength and neuromuscular control ability in patients with knee osteoarthritis (KOA).Methods:A retrospective case-control study was conducted. A total of 49 patients with KOA who underwent IET at Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to January 2022 were included in the control group. An additional 49 patients with KOA who received Mulligan technique and IET at the same hospital from June 2022 to June 2023 were included in the observation group. Both groups were treated for 8 successive weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Lysholm score, proprioception metrics [including average track error (ATE) and test time execution (TTE)], isokinetic muscle strength [peak torque (PT) and average power (AP) for flexors and extensors at 60°/s, 90°/s, and 120°/s)]were compared between the two groups before and after 4 and 8 weeks of intervention. Additionally, Visual Analog Scale score was compared between the two groups at baseline and after 8 weeks of intervention.Results:There was no statistically significant difference in WOMAC score, Lysholm score, or PT and AP levels for flexor and extensor muscles at 60°/s, 120°/s, and 180°/s between the two groups before intervention (all P > 0.05). After 4 and 8 weeks of intervention, the levels of PT and AP for both flexors and extensors at 60°/s, 120°/s, and 180°/s, as well as the Lysholm scores, were significantly higher in the observation group compared with the control group [PT level: t = -0.10, -3.03, -3.85, -0.35, -3.62, -3.95, -0.27, -5.51, -6.52, -1.13, -2.74, -3.68, -0.09, -2.91, -5.79, -0.13, -4.66, -6.05; AP level: t = -0.23, -4.77, -6.15, 0.01, -3.10, -3.75, -0.13, -3.73, -3.44, 0.16, -2.09, -4.05, -0.17, -3.71, -3.51, -0.27, -3.26, -3.69; Lysholm score: t = -7.17, -6.44; all P < 0.05]. After 4 and 8 weeks of intervention, the WOMAC score, ATE, and TTE in the observation group were significantly lower than those in the control group [WOMAC score: t = 3.68, 0.64; ATE level: t = 3.88, 4.13; TTE level: t = 4.86, 4.60; all P < 0.05]. After 8 weeks of intervention, both groups had lower Visual Analog Scale scores compared with their scores before the intervention (U control group = -8.75, U observation group = -8.63), with the observation group showing significantly lower scores than the control group ( U = -5.95, P < 0.001). Conclusions:The Mulligan technique combined with IET can effectively alleviate knee joint pain in patients with KOA, promote the recovery of knee joint function, enhance proprioceptive recovery, and improve neuromuscular control abilities.

Objective:To explore the rehabilitation effects of individual computer story-version magnanimous therapy (ICSMT) on patients with end-stage renal disease undergoing maintenance hemodialysis (MHD).Methods:A total of 120 patients with end-stage renal disease receiving MHD treatment at the Department of Nephrology Hemodialysis Center of Huadu District People's Hospital of Guangzhou from August 2022 to April 2024 were selected as the study subjects.They were randomly divided into control group ( n=60, receiving routine clinical treatment) and ICSMT group ( n=60, receiving routine clinical treatment combined with ICSMT for psychological intervention) by random number table method.The patients in the two groups were evaluated by the self-rating anxiety scale (SAS), self-rating depression scale (SDS), enterprising and magnanimous questionnaire (EMQ), the short-form-36 health survey (SF-36), and activity of daily living scale (ADL) before intervention and at 4-week post-intervention.Blood pressure, blood urea nitrogen (BUN), hemoglobin (Hb), and serum albumin (ALB) levels were also measured before the intervention and at the 4-week post-intervention.The clinical global impression scale (CGI) was used to evaluate clinical efficacy before the intervention, at the 2-week post-intervention, and at the 4-week post-intervention.Statistics analysis was performed using SPSS 29.0.1.0(171). Independent-samples t-test, paired t-test, Mann-Whitney U test and Wilcoxon signed-rank test were used for statistical analysis. Results:After 4 weeks of intervention, the SAS and SDS in the ICSMT group (49.0 (48.0, 50.0), 50.0 (49.0, 51.0)) were significantly lower than those in the control group (51.0 (50.0, 52.0), 52.0 (51.0, 53.0)) (both P<0.001). The enterprising subscore of the EMQ in the ICSMT group (35.0 (32.0, 37.0)) was significantly higher than that in the control group (31.0 (29.0, 34.0)) ( P<0.001). Furthermore, the differences of enterprising and magnanimous subscores between the two groups before and after intervention in the ICSMT group (2.0 (1.0, 4.0), 1.0 (-1.0, 2.0))were significantly higher than those in the control group (-1.0 (-1.0, 0), -1.0 (-1.2, 0)) (both P<0.05). Systolic and diastolic blood pressure values in the ICSMT group (130 (126, 134) mmHg, 85 (80, 88) mmHg)were significantly lower than those in the control group (145 (138, 152) mmHg, 93 (88, 99) mmHg)(1 mmHg=0.133 kPa) after 4 weeks of intervention(both P<0.05). After 4 weeks of intervention, the level of BUN in the ICSMT group (5.5 (3.7, 8.4) mmol/L) was significantly lower than that in the control group (9.1 (6.8, 11.4) mmol/L), while the level of Hb and ALB in the ICSMT group ((115.0±10.0)g/L, (38.3±3.2)g/L)were significantly higher than those in the control group ((104.0±12.0)g/L, (37.1±2.9)g/L) (all P<0.05). After 4 weeks of intervention, the physical functioning, role-physical, general health, vitality, social functioning, role-emotional, and mental health subscores of SF-36 in ICSMT group were all significantly higher than those in the control group (all P<0.05). After 4 weeks of intervention, the score of ADL in the ICSMT group (15.42±1.58)was significantly lower than that in the control group (16.78±2.06) ( t=-4.08, P<0.05). At the 2-week post-intervention and the 4-week post-intervention, the severity of illness (SI) and global improvement (GI) in the ICSMT group were significantly lower than those in the control group, while the efficacy index (EI) in the ICSMT group was significantly higher than that in the control group (all P<0.05). Conclusion:ICSMT can effectively promote the physical, psychological, and social functional rehabilitation of end-stage renal disease patients undergoing MHD, significantly improving their quality of life.

Objective:To evaluate the role of necroptosis in paclitaxel-induced cognitive dysfunction in mice.Methods:Thirty SPF healthy male C57BL/6N mice, aged 6-8 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) using a random number table method: vehicle control group (Veh group), paclitaxel group (PTX group), and paclitaxel+ a specific inhibitor of necroptosis Necrostatin-1 group (P+ N group). In PTX group and P+ N group, paclitaxel 10 mg/kg (diluted to 5 mg/ml in anhydrous ethanol and castor oil [1∶1], and further diluted to 1 mg/ml in 0.9% normal saline before use) was intraperitoneally injected daily for 7 consecutive days to induce cognitive dysfunction. P+ N group received an intraperitoneal injection of Necrostatin-1 6.5 mg/kg (diluted to 10 mg/ml in dimethyl sulfoxide, and further diluted to 1 mg/ml in 0.9% normal saline before use) at 2 h before paclitaxel administration every other day, 4 times in total. Veh group received the equal volume of solvent at the matched time points as previously described in P+ N group. After establishment of the model, spontaneous locomotor activity was assessed using the open field test, followed by the novel object recognition test and the Morris water maze to evaluate the cognitive function. The animals were sacrificed after the end of the Morris water maze test, and the hippocampal tissues were collected for determination of the expression of necroptosis-related proteins receptor-interacting serine/threonine-protein kinase 1 (RIPK1), RIPK3, mixed lineage kinase domain-like protein (MLKL), and phospho-MLKL (p-MLKL) (by Western blot analysis) and contents of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) (double immunofluorescence staining) and for observation of the localization of programmed necrosis cells (using enzyme-linked immunosorbent assay). Results:There were no significant differences in the total distance traveled and mean movement speed in the open field test or swimming speed in the Morris water maze test among the three groups ( P>0.05). Compared to Veh group, the time spent in the central zone in the open field and time spent in the original platform quadrant were significantly shortened, the discrimination index was decreased, the escape latency was prolonged, the number of crossing the original platform was reduced, the expression of RIPK1, RIPK3, MLKL and p-MLKL was up-regulated, the contents of TNF-α and IL-1β were increased, and the number of RIPK1-positive neurons was increased in PTX group ( P<0.05). Compared to PTX group, the time spent in the central zone in the open field test and time spent in the original platform quadrant were significantly prolonged, the discrimination index was increased, the escape latency was shortened, the number of crossing the original platform was increased, the expression of RIPK1, RIPK3, MLKL and p-MLKL was down-regulated, the contents of TNF-α and IL-1β were decreased, and the number of RIPK1-positive neurons was decreased in P+ N group ( P<0.05). Conclusions:Necroptosis in hippocampal neurons can lead to neuroinflammation, thus contributeing to paclitaxel-induced cognitive dysfunction in mice.

Objective:To conduct a latent profile analysis of general self-efficacy among postpartum nurses with two children and explore the influencing factors of different profiles.Methods:A stratified sampling approach was used to recruit 298 clinical nurses with two children who had resumed work from 12 public healthcare facilities in Mianyang during May and December 2023. Data were collected using a demographic questionnaire, Work-Family Conflict Scale, Nursing Stress Scale, Family Stress Scale, and General Self-Efficacy Scale. Latent profile analysis was performed via Mplus 8.3. Pearson correlation and logistic regression analyses were used to examine associations between self-efficacy, work-family conflict, nursing stress, family stress, and profile membership.Results:Data collection yielded 298 questionnaires, with 281 valid responses (94.3% response rate). Three latent profiles of general self-efficacy were identified: low efficacy group (43.8%), moderate efficacy group (42.7%), and high efficacy group (13.5%). Work position, hospital level, time since return to work, nursing stress, and family stress were significant predictors of profile membership ( P< 0.05) . Conclusions:General self-efficacy among nurses with two children post-childbirth is heterogeneous. Nursing administrators should deliver tailored interventions based on latent profile characteristics and develop individualized self-efficacy enhancement programs from both individual and organizational perspectives to improve adaptability and competency during post-return work transition.