Objective To predict the radiation impact of discharging wastewater containing uranium within the specified limit generated during the normal operation of a new production line at a nuclear fuel plant on the receiving water body and its downstream, and to provide a reference for the management of radioactive liquid effluent discharge from nuclear facilities. Methods Based on the technical guidelines for environmental impact assessment, literature on radiation environmental impact assessment, and data collected from on-site investigations, appropriate hydrological parameters and prediction models were selected to analyze and predict the variation pattern of radioactive nuclide uranium along the receiving water body and the radiation exposure of nearby residents. Results The maximum increase in uranium concentration in the receiving water body and its downstream caused by the discharge of uranium-containing wastewater was 1.14 μg/L. The maximum predicted concentration was 2.75 μg/L after adding the background data of the water body. The resulting maximum individual annual effective dose for the public was 1.49 × 10⁻⁴ mSv/a. Conclusion The maximum predicted uranium concentration in the receiving water body and its downstream is lower than the uranium concentration limit of 30 μg/L specified in the Standards for Drinking Water Quality (GB 5749-2022). The maximum individual annual effective dose for the public is much lower than the control value of 0.2 mSv/a specified in the Radiation Protection Regulations for Uranium Processing and Fuel and Fuel Manufacturing Facilities (EJ 1056-2018). The radiation impact is acceptable.

This study was aimed at comprehensively understanding the epidemic status of acute hemorrhagic conjunctivitis(AHC)and influencing factors related outbreak in Fujian Province,to provide valuable insights for AHC prevention and control in this region.We conducted a descriptive statistical analysis of epidemiological data for AHC cases.Additionally,clinical samples collected from a 2023 outbreak were subjected to pathogen detection,determination of full-length nucleotide sequences within the VP1 region,genotype identification,and comprehensive analysis.The peak incidence of AHC in 2023 was observed in September and accounted for a substantial proportion(86.39%,5 205/6 025)of the total cases throughout the year.The three areas with the highest incidence rates were Sanming(118.57/100 000),Longyan(53.83/100 000)and Zhangzhou(16.02/100 000).From 2011 to 2022,the inci-dence of AHC in Longyan City was the highest for consecutive 12 years.During the peak AHC outbreak period in Fujian Province in 2023,all 62 conjunctival swabs collected were identified as CVA24v,and 60 complete VP1 sequences were obtained through se-quencing.The nucleotide sequence identity among these 60 sequences ranged from 98.7%to 100%,whereas the amino acid identity ranged from 98.4%to 100%.The highest nucleotide sequence identity was observed for the 2023 strain isolated from Zhongshan,Guangdong Province(rang:99.0%～100%).The 2023 strains in Fujian Province belonged to the GIV genotype,and L16I represented a potential unique amino acid variation within the sequence.CVA24v was the causative agent responsible for this AHC epidemic,and its GIV genotype is currently the dominant type in China.Future efforts should prioritize AHC prevention and control measures cen-tered in key cities.Monitoring and early warning of AHC in the whole province should be strengthened before September each year,and the variation of pathogen nucleic should also be tracked in time.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective To evaluate the effects of the method of blood-cooling and blood stasis-resolving on heart function and prognosis in patients with sepsis-induced myocardial dysfunction(SIMD).Methods Sixty patients with SIMD admitted to the department of critical care medicine of Affiliated Hospital of Nanjing University of Chinese Medicine from June 2022 to October 2024 were enrolled as study subjects.The patients were divided into treatment group and control group according to random number table,with 30 patients in each group.All patients received conventional treatments,the patients in the treatment group were given Taohe Chengqi decoction(Persicae Semen 12 g,Chinese rhubarb 12 g,Cinnamon twig 6 g,Licorice root 6 g and Sodium Sulfate 6 g),the decoction was concentrated to 200 mL and taken in 2 divided doses in the morning and evening,one dose daily;and the patients in the control group were given the same amount of warm water.The total course of treatment lasts for 7 days.The differences in indicators of cardiac function[brain natriuretic peptide(BNP),cardiac troponin I(cTnI),MB isoenzyme of creatine kinase(CK-MB),aspartate aminotransferase(AST)]and echocardiographic parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),mitral orifice early/late diastolic blood flow velocity ratio(E/A ratio),E/mitral and tricuspid valve ostia and the peak early diastolic velocity(E/e')]at admission,at 1st and 7th day after treatment,and prognosis indexes[mechanical ventilation time,intensive care unit(ICU)length of stay,total hospital stay,28-day survival rate]were compared between two groups.Draw the Kaplan-Meier survival curve and compare the difference in the 28-day cumulative survival rate between the two groups of patients.Results After 7 days therapy,LVEF of the treatment group was significantly higher than that the control(0.524±0.132 vs.0.458±0.118,P<0.05)and E/e'ratio of the treatment group was significantly lower than the control group[11.17(9.57,12.04)vs.11.82(11.28,13.72),P<0.05].There were no significant differences in the 28-day mortality and total hospital stay time between the two groups,but mechanical ventilation time[days:7.00(0.00,11.00)vs.12.50(3.50,21.75),P<0.05]and stay time of ICU[days:14.50(7.75,25.00)vs.21.00(14.25,31.50),P<0.05]in the treatment group were shorter than those in the control group.The Kaplan-Meier survival showed that the cumulative 28-day survival rate was similar between two groups(Log-Rank:χ2=1.448,P=0.229).Conclusion The method of blood-cooling and blood stasis-resolving could decrease mechanical ventilation time and length of stay in ICU of SIMD patients and could increase LVEF in the treatment group.

A 13-year-old boy was admitted to the hospital due to 1 month after trauma in a traffic accident on September 29，2017. After admission，due to a large amount of pleural effusion through the chest tube，thoracoscopic exploration and fiberboard dissection were performed，and the postoperative pleural effusion was not significantly reduced. The creatinine of pleural effusion was 913 μmol/L，CT showed that left hydronephrosis and perirenal encapsulated effusion were closely related to the ureter，so ureteral injury and urinothorax were considered. Retrograde ureterography revealed a defect of left ureter，approximately 6 cm in length，and left nephrectomy + left kidney rupture repair + renal autotransplantation was performed. 7 years later，the patient recovered well and the renal blood supply was good，no left hydronephrosis was found by MRU. Early diagnosis of ureteral injury is challenging，especially when accompanied by urinothorax. When life is stable，early diagnosis and treatment can reduce the loss of renal function after combined trauma. Renal autotransplantation is safe and effective for the treatment of long segmental ureteral defects.

For centuries, people have been searching for ways to reconstruct the mutilated thumb and fingers. Among the hundreds of operation methods that have appeared, the method of toe transplantation to reconstruct the thumb and fingers, which appeared in the second half of the 19 th century, had the best effect. However, due to the limitation of technical level at that time, only the pedicled toe could be transplanted to reconstruct the thumb and fingers. During the treatment period, the patient was in an inappropriate position where the hand and foot were fixed together for a long time, and the nerve was not repaired, so the thumb and fingers reconstructed after surgery had poor feeling. Therefore, it has not been widely used. It was not until 1966 when Yang Dongyue succussed in reconstructing the thumb using a free toe transplant with blood vessel anastomosis that toe transplantation gradually became the mainstream method of thumb and finger reconstruction. The appearance and function of the thumb and finger reconstructed by toe transplantation are still very different from that of the normal thumb and finger. Moreover, when multiple thumbs and fingers are defective, the transplantation of multiple toes for repair will cause great damages to the foot, so it is not suitable to reconstruct more than three thumb and fingers using toes in the same period. In 2007, Wang Zengtao proposed the concept of "full-finger reconstruction of thumb and fingers" and a series of new operation methods: new fingers were designed and assembled by means of using a variety of tissue combination assembly, which changed the traditional method of toe transplantation to reconstruct thumb and fingers, and the method of replacing thumb and fingers by toes was changed to manufacturing new thumb and fingers so that the toes could be retained and the thumb and fingers could be reconstructed with approximately normal shape and function. In recent years, the concept and series of new operation methods of thumb and finger reconstruction have been popularized at home and abroad. This paper focuses on the development of full-finger reconstruction of thumb and fingers.

Objective To assess the correlation between the body mass index(BMI)and short-term prognosis in the patients with acute myocardial infarction complicating cardiogenic shock(AMI-CS).Methods A total of 262 patients with diagnosed AMI-CS hospitalized in this hospital from January 2013 to February 2022 were selected as the study subjects,and a total of 255 patients with AMI-CS were included after excluding the patients with incomplete clinical data,no coronary angiography,loss to follow-up and low BMI(<18.5 kg/m2).Among them,those with BMI of 18.5-<24.0 kg/m2 were included in the normal BMI group(n=150),and those with BMI of≥24.0 kg/m2 were included in the overweight or obese group(n=105).The baseline data,auxiliary examinations and treatment measures of the patients were collected,and the patients who did not die at the time of discharge were followed up by telephone on 30 d after AMI onset,and the survival status of the patients,whether having major adverse cardiovascular events(MACE)occurrence and the occurrence time were obtained.The correlation between BMI and endpoint events was assessed by the COX regression model.Results The proportion of complicating atrial fibrillation,BNP and urea levels in the overweight or obesity group were lower than those in the normal BMI group,the BMI and Hb levels were higher than those in the normal BMI group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the results of cardiovascular examination between the two groups(P>0.05).The use rate of β-receptor blockers in the overweight or obese group was higher than that in the normal BMI group,and the difference was statistically significant(P<0.05).On 30 d of follow-up,the all-cause mortality rate in the overweight or obese group was 39.0%,which was lower than 44.0%in the normal BMI group,but the difference was not statistically significant(P=0.430);there was no statistically signifi-cant difference in the incidence rate of each MACE event and the total incidence rate of MACE between the two groups(P>0.05).The BMI normal group served as the control,the risk of death and the occurrence risk of MACE events in the overweight or obese group had no significant increase(P>0.05).The short-term prognosis had no significant interaction between BMI and the patients in different subgroups(P>0.05).Con-clusion The short-term prognosis has no significant difference between the overweight/obese AMI-CS pa-tients and normal BMI AMI-Cs patients.

Objective To investigate the organ protective role and the underlying mechanism of nafamostat mesylate(NM)in a renal ischemia-reperfusion injury(RIRI)model.Methods A total of 21 healthy male Sprague-Dawley(SD)rats were randomly assigned to 3 groups(n=7 in each group),including the sham operation group(Sham group),the RIRI group,and the NM intervention group(NM group).The RIRI and NM groups underwent ischemia-reperfusion injury(IRI)modeling.The NM group was given an intraperitoneal injection of NM at 0.75 mg/kg before modeling.Venous blood and renal tissue samples were then collected from the rats 24 hours after modeling.The levels of serum creatinine,cystatin C,and serum inflammatory factors were determined using the serum samples.Hematoxylin-eosin(HE)staining and TUNEL stainings were performed on the renal tissues to evaluate the damage of the renal tissues.The localization and expression of HMGB1 were analyzed by immunofluorescence and Western blotting,respectively.Single-cell RNA sequencing of the nuclei was performed to obtain the single-cell transcriptome of the kidneys from the rats in the RIRI and the NM groups and to acquire the RIRI cell profile.The cells were annotated according to the cell marker genes to explore the cell type composition in the disease model and the functional status of immune cells between the groups.Results 1)Compared with those of the Sham group,the levels of cystatin C,creatinine,and inflammatory factors in the RIRI and NM groups were significantly increased,and the expression levels in the NM group were lower than those in the RIRI group(P＜0.05).Compared with those of the RIRI group,the tubular injury score and apoptosis rate in the NM group were significantly decreased(P＜0.05),but those of both the NM and RIRI groups were higher than those of the sham group.Compared with that in the RIRI group,the expression of HMGB1 in the NM group was significantly decreased(P＜0.05),but the expression levels in both the RIRI and NM groups were higher than that in the sham group.Immunofluorescence showed that there was increased cytoplasmic expression of HMGB1 in both the NM and RIRI groups,with the increase being more prominent in the RIRI group.2)A total of 13 major cell populations were identified through the single-nucleus sequencing results.The proportion of tubular cells in the NM group was higher,with the HMGB1 gene being highly expressed in the damaged proximal convoluted tubular cells.The proportion of the polarized Macro3 cell subpopulation in the macrophages in the NM group was lower compared to that in the RIRI group.Conclusion NM may play a protective role in a rat model of RIRI,and its underlying mechanisms may be related to the regulation of the functional abnormalities of HMGB1-mediated macrophages.

The catalytic activity of 3-mercaptopyruvate (3MP) sulfurtransferase (MPST) converts 3MP to hydrogen sulfide (H₂S). However, the regulatory mechanisms governing MPST and its impact on the brain remain largely unexplored. Our study reveals the neuroprotective role of endothelial MPST-generated H₂S, regulated by protein phosphatase 2A (PP2A). Bioinformatics analysis and RNA sequencing demonstrated that endothelial PP2A is associated with neurodegenerative disease pathways. Cerebral ischemic mice exhibited significant inactivation of endothelial PP2A, evidenced by the reduction of PP2Acα in the brain endothelium. Mice with endothelium-specific null PP2A (PP2A^EC-cKO) exhibited neuronal loss, cognitive dysfunction, and long-term potentiation deficits. Postnatal inactivation of endothelial PP2A also contributes to cognitive dysfunction and neuronal loss. However, regaining endothelial PP2A activity by overexpressing Ppp2ca rescued neuronal dysfunction. Mechanistically, PP2A deficiency is intricately linked to the MPST-H₂S signaling pathway. A robust reduction in endothelial MPST-dependent H₂S production followed PP2A deficiency. Exogenous H₂S treatment and AAV-mediated overexpression of MPST in brain endothelial cells significantly mitigated neuronal dysfunction in PP2A^EC-cKO mice. Furthermore, PP2A deficiency promotes an increase in calcium influx and calpain2 phosphorylation, subsequently leading to MPST degradation. The PP2A activator (FTY720) and MPST activator (3MP sodium) both remarkably restored endothelial MPST-dependent H₂S production, subsequently rescuing ischemia-induced neurological deficits. In conclusion, our study demonstrates that endothelial PP2A deficiency leads to MPST degradation by activating calpain2, thus damaging neuronal function.

Ischemic stroke is the leading cause of disability and mortality worldwide. The blood‒brain barrier (BBB) is the first line of defense after ischemic stroke. Disruption of the BBB induced by brain microvascular endothelial cells (BMECs) dysfunction is a key event that triggers secondary damage to the central nervous system, where blood-borne fluids and immune cells penetrate the brain parenchyma, causing cerebral edema and inflammatory response and further aggravating brain damage. Here, we develop a novel artificial mesenchymal stem cell (MSC) extracellular vesicles by integrating MSC membrane proteins into liposomal bilayers, which encapsulated miR-132-3p with protective effects on BMECs. The artificial extracellular vesicles (MSCo/miR-132-3p) had low immunogenicity to reduce non-specific clearance by the mononuclear phagocytosis system (MPS) and could target ischemia-injured BMECs. After internalization into the damaged BMECs, MSCo/miR-132-3p escaped the lysosomes via the H_II phase transition of 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE) and decreased cellular reactive oxygen species (ROS) and apoptosis levels by regulating the RASA1/RAS/PI3K/AKT signaling pathway. In the transient middle cerebral artery occlusion (tMCAO) models, MSCo/miR-132-3p targeted impaired brain regions (approximately 9 times the accumulation of plain liposomes at 12 h), reduced cerebral vascular disruption, protected BBB integrity, and decreased infarct volume (from 44.95% to 6.99%).