ObjectiveThis paper aims to investigate the effects and mechanism of Mimenghua prescription in modulating the mitogen-activated protein kinase kinase （MEK）/rat sarcoma viral oncogene homolog （Ras）/rapidly accelerated fibrosarcoma kinase （Raf）/extracellular signal-regulated kinase （ERK） signaling pathway to inhibit inflammatory responses in a dry eye animal model. MethodsA total of 60 C57BL/6J mice （eight weeks old， half male and half female） were used in the experiment. Ten mice were randomly selected as the blank control group， while the remaining 50 were exposed to a controlled dry system and received instillation of 0.2% benzalkonium chloride （BAC） into the eyes for four weeks to establish a dry eye mouse model. After successful modeling， the mice were randomly divided into five groups： Model group， sodium hyaluronate group， and Mimenghua prescription groups with low dose （4.83 g·kg^-1）， medium dose （9.67 g·kg^-1）， and high dose （19.34 g·kg^-1）. The mice in the model group received an equal volume of normal saline via gavage for four weeks. The mice in the sodium hyaluronate group received instillation of sodium hyaluronate eye drops twice daily for 14 consecutive days. The tear secretion volume， tear film break-up time （TBUT）， and corneal fluorescein staining were evaluated once every two weeks. After four weeks of administration， mice were euthanized， and their lacrimal gland tissues and corneas were harvested. Hematoxylin-eosin （HE） staining was used to assess histopathological morphology. Western blot was performed to detect the protein expression levels of MEK， Ras， Raf， and ERK. Enzyme-linked immunosorbent assay （ELISA） was used to measure the contents and expressions of MEK， Ras， Raf， ERK， and interleukin （IL）-1β in lacrimal gland and corneal tissues of the mice in each group. Quantitative real-time polymerase chain reaction （Real-time PCR） was employed to determine mRNA expression levels of MEK， Ras， Raf， and ERK. ResultsThe Mimenghua prescription groups and the sodium hyaluronate group exhibited significantly increased tear secretion volume （P<0.05） and prolonged TBUT （P<0.05） after treatment. Ocular surface damage of mice was visibly recovered. Western blot results indicated that protein expression levels of MEK， Ras， Raf， and ERK in the lacrimal gland and corneal tissues were significantly downregulated in the sodium hyaluronate group and Mimenghua prescription group with high dose （P<0.05）. ELISA results showed that IL-1β levels were highest in the model group but significantly reduced in the sodium hyaluronate group and Mimenghua prescription groups （P<0.05）. Both ELISA and Real-time PCR results demonstrated that the expression levels of MEK， Ras， Raf， and ERK in the lacrimal glands and corneal tissues were significantly elevated in the model group （P<0.05）， but markedly downregulated in the sodium hyaluronate group and Mimenghua prescription groups （P<0.05）， suggesting that Mimenghua prescription can decrease the expressions of MEK， Ras， Raf， and ERK in the lacrimal glands and corneal tissues. ConclusionMimenghua prescription can reduce inflammatory responses， increase tear secretion， prolong TBUT， and promote corneal recovery by inhibiting the MEK， Ras， Raf， and ERK signaling pathways in lacrimal gland and corneal tissues.

Objective:To investigate the value of serum IgG4 detection in diagnosis,treatment,evaluation and outcome of IgG4-associated diseases(IgG4-RD).Methods:By integrating the clinical data of patients,retrospectively and systematically analyze the results of common laboratory examinations,imaging examinations,pathological examinations,etc.26 patients who were diagnosed with IgG4-RD in Huaian First Hospital Affiliated to Nanjing Medical University from March 2013 to October 2023.Results:The median age of onset was 65(31～90)years old,and the male to female ratio was 3.33∶1.The first three symptoms were abdominal discomfort,skin scleral yellow stain and fever.Patients mainly involved multiple organs,the most commonly involved organs were lung,pancreas,liver,kidney,bile duct.Compared with the control group,NLR,PLR,ESR,CRP,TBIL,DBIL,ALT,AST,GGT,IgG,IgA and IgM were all abnormally elevated in the first hematological,biochemical and immune tests of the patients,the difference was statisti-cally significant,while C3 and C4 were all decreased,but there was no statistical difference.The first IgG4 level of IgG4-RD patients was correlated with the length of hospitalization,the length of return visit,and the dynamic changes of IgG4 level after return visit.Conclusion:Serum IgG4 detection plays an important role in the diagnosis and treatment of IgG4-RD.In patients with abnormally high level of IgG4,those who are sensitive to high-dose glucocorticoid therapy have a faster decline in IgG4 levels and a longer duration of symptom remission.

Objective:To investigate the value of serum IgG4 detection in diagnosis,treatment,evaluation and outcome of IgG4-associated diseases(IgG4-RD).Methods:By integrating the clinical data of patients,retrospectively and systematically analyze the results of common laboratory examinations,imaging examinations,pathological examinations,etc.26 patients who were diagnosed with IgG4-RD in Huaian First Hospital Affiliated to Nanjing Medical University from March 2013 to October 2023.Results:The median age of onset was 65(31～90)years old,and the male to female ratio was 3.33∶1.The first three symptoms were abdominal discomfort,skin scleral yellow stain and fever.Patients mainly involved multiple organs,the most commonly involved organs were lung,pancreas,liver,kidney,bile duct.Compared with the control group,NLR,PLR,ESR,CRP,TBIL,DBIL,ALT,AST,GGT,IgG,IgA and IgM were all abnormally elevated in the first hematological,biochemical and immune tests of the patients,the difference was statisti-cally significant,while C3 and C4 were all decreased,but there was no statistical difference.The first IgG4 level of IgG4-RD patients was correlated with the length of hospitalization,the length of return visit,and the dynamic changes of IgG4 level after return visit.Conclusion:Serum IgG4 detection plays an important role in the diagnosis and treatment of IgG4-RD.In patients with abnormally high level of IgG4,those who are sensitive to high-dose glucocorticoid therapy have a faster decline in IgG4 levels and a longer duration of symptom remission.

ObjectiveTo investigate the short-term knee function recovery of patients undergoing total knee arthroplasty (TKA) after discharge and analyze its related factors. MethodsFrom December, 2022 to April, 2023, 140 adult patients who underwent TKA in Nanjing Drum Tower Hospital and being about to be discharged were selected as the survey subjects using convenient sampling. Potential influencing factors were selected based on a literature review. They were investigated with general information questionnaire, Rehabilitation Exercise Compliance Scale, Self-Efficacy Scale for Rehabilitation Exercise (SER), Visual Analog Scale for pain (VAS), and joint range of motion measurements before discharge, and were investigated with the Hospital for Special Surgery Knee Score (HSS) one month after discharge. ResultsA total of 130 patients finished follow-up. One month after discharge, the HSS score ranged from 40 to 82, with an average of (70.89±6.26). Multiple linear regression analysis revealed that Body Mass Index (B = -0.423, 95%CI -0.622 to -0.224, P < 0.001), pre-discharge VAS (B = -1.016, 95%CI -1.198 to -0.113, P = 0.028), rehabilitation exercise compliance (B = 0.267, 95%CI 0.121 to 0.413, P < 0.001), SER (B = 0.478, 95%CI 0.315 to 0.642, P < 0.001), and knee joint flexion contracture angle (B = -0.251, 95%CI -0.414 to -0.088, P = 0.003) could influence HSS score one month after discharge (R² = 0.615, F =17.106, P < 0.001). ConclusionPatients after TKA have recovered well in short time after discharge, however, there is still significant room for improvement. Clinical healthcare providers should design and implement appropriate interventions based on related factors to improve the function.

Objective:To explore the occurrence of alexithymia in patients with functional constipation (FC) and its influence on the symptoms, anorectal function and treatment efficacy.Methods:From July 4, 2022 to September 30, 2023, a total of 118 FC patients who visited the outpatient Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University and underwent high-resolution anorectal manometry (HR-ARM) were selected. According to twenty-item Toronto alexithymia scale, a total score of <51 was classified as without alexithymia, and a total score of ≥51 was classified as with alexithymia. The combination of osmotic laxatives and probiotic agents was used for the treatment for 4 weeks. The efficacy of the medication was compared before and after treatment in FC patients with and without alexithymia, as well as the scores of patient assessment of constipation-symptom (PAC-SYM), patient assessment of constipation-quality of life (PAC-QoL), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and HR-ARM results.Independent sample t-test, Mann-Whitney U test and chi-square test were used for statistical analysis. Multivariate logistic regression analysis was performed to analyze the related factors affecting the efficacy of FC treatment. Results:Among the 118 FC patients, 43.2% (51/118) of FC patients had alexithymia, and 56.8% (67/118) of FC patients had no alexithymia. Among them, 43 patients without alexithymia and 32 patients with alexithymia completed the evaluation of treatment efficacy, respectively. There was no statistically significant difference in the frequency of spontaneous defecation before and after treatment in patients with alexithymia ( P>0.05). The frequency of complete spontaneous defecation after treatment was higher than that before treatment in FC patients without alexithymia (5.0 (3.0, 7.0) vs. 3.0 (2.0, 3.0)), and the increased times of total spontaneous defecation after treatment compared to before treatment in patients with alexithymia was less than that in patients without alexithymia (0.0 (0.0, 0.0) vs. -2.0 (-3.0, 0.0)), and the differences were statistically significant ( Z=-4.49 and -3.79, both P < 0.001). The scores of PAC-SYM, PAC-QoL, SAS and SDS in FC patients without alexithymia after treatment were all lower than those before treatment (2.0 (0.0, 8.0) vs. 14.0 (11.0, 16.0), 9.0 (1.1, 16.0) vs. 22.0 (18.0, 40.0), 26.0 (25.0, 30.0) vs. 29.0 (25.0, 34.0), 28.0 (26.0, 30.0) vs. 30.0 (29.0, 35.0)), and the differences were statistically significant ( Z=-5.24, -5.08, -3.60, and -5.21, all P<0.001). Among all the scores, only the PAC-SYM score after treatment was lower than that before treatment in FC patients with alexithymia (14.0 (9.5, 19.0) vs. 17.0 (12.5, 21.0)), and the difference was statistically significant ( Z=-2.66, P=0.008). The effective rate of FC patients without alexithymia was higher than that of patients with alexithymia (72.1%, 31/43 vs. 18.8%, 6/32), and the difference was significant ( χ2=22.09, P<0.001). The reduction of PAC-SYM, PAC-QoL, SAS and SDS scores in FC patients with alexithymia after treatment were all lower than those of FC patients without alexithymia (0.0 (0.0, 2.8) vs. 9.0 (2.0, 14.0), 0.0 (0.0, 0.8) vs. 15.0 (2.0, 19.0), 0.0 (-1.0, 1.0) vs. 0.0 (0.0, 4.0), 0.0 (0.0, 1.0) vs. 3.0 (1.0, 5.0)), and the differences were statistically significant ( Z=-4.24, -4.31, -2.59, and -4.60, all P<0.05). The results of multivariate logistic regression analysis showed that alexithymia was an independent risk factor of ineffective medication treatment of constipation in FC patients ( OR=8.930, 95% confidence interval 2.011 to 39.658, P=0.004). Conclusions:There is a high incidence of alexithymia in FC patients. Alexithymia affects the perception of symptoms and the efficacy of medication treatment of constipation in FC patients.

Objective:To explore the occurrence of alexithymia in patients with functional constipation (FC) and its influence on the symptoms, anorectal function and treatment efficacy.Methods:From July 4, 2022 to September 30, 2023, a total of 118 FC patients who visited the outpatient Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University and underwent high-resolution anorectal manometry (HR-ARM) were selected. According to twenty-item Toronto alexithymia scale, a total score of <51 was classified as without alexithymia, and a total score of ≥51 was classified as with alexithymia. The combination of osmotic laxatives and probiotic agents was used for the treatment for 4 weeks. The efficacy of the medication was compared before and after treatment in FC patients with and without alexithymia, as well as the scores of patient assessment of constipation-symptom (PAC-SYM), patient assessment of constipation-quality of life (PAC-QoL), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and HR-ARM results.Independent sample t-test, Mann-Whitney U test and chi-square test were used for statistical analysis. Multivariate logistic regression analysis was performed to analyze the related factors affecting the efficacy of FC treatment. Results:Among the 118 FC patients, 43.2% (51/118) of FC patients had alexithymia, and 56.8% (67/118) of FC patients had no alexithymia. Among them, 43 patients without alexithymia and 32 patients with alexithymia completed the evaluation of treatment efficacy, respectively. There was no statistically significant difference in the frequency of spontaneous defecation before and after treatment in patients with alexithymia ( P>0.05). The frequency of complete spontaneous defecation after treatment was higher than that before treatment in FC patients without alexithymia (5.0 (3.0, 7.0) vs. 3.0 (2.0, 3.0)), and the increased times of total spontaneous defecation after treatment compared to before treatment in patients with alexithymia was less than that in patients without alexithymia (0.0 (0.0, 0.0) vs. -2.0 (-3.0, 0.0)), and the differences were statistically significant ( Z=-4.49 and -3.79, both P < 0.001). The scores of PAC-SYM, PAC-QoL, SAS and SDS in FC patients without alexithymia after treatment were all lower than those before treatment (2.0 (0.0, 8.0) vs. 14.0 (11.0, 16.0), 9.0 (1.1, 16.0) vs. 22.0 (18.0, 40.0), 26.0 (25.0, 30.0) vs. 29.0 (25.0, 34.0), 28.0 (26.0, 30.0) vs. 30.0 (29.0, 35.0)), and the differences were statistically significant ( Z=-5.24, -5.08, -3.60, and -5.21, all P<0.001). Among all the scores, only the PAC-SYM score after treatment was lower than that before treatment in FC patients with alexithymia (14.0 (9.5, 19.0) vs. 17.0 (12.5, 21.0)), and the difference was statistically significant ( Z=-2.66, P=0.008). The effective rate of FC patients without alexithymia was higher than that of patients with alexithymia (72.1%, 31/43 vs. 18.8%, 6/32), and the difference was significant ( χ2=22.09, P<0.001). The reduction of PAC-SYM, PAC-QoL, SAS and SDS scores in FC patients with alexithymia after treatment were all lower than those of FC patients without alexithymia (0.0 (0.0, 2.8) vs. 9.0 (2.0, 14.0), 0.0 (0.0, 0.8) vs. 15.0 (2.0, 19.0), 0.0 (-1.0, 1.0) vs. 0.0 (0.0, 4.0), 0.0 (0.0, 1.0) vs. 3.0 (1.0, 5.0)), and the differences were statistically significant ( Z=-4.24, -4.31, -2.59, and -4.60, all P<0.05). The results of multivariate logistic regression analysis showed that alexithymia was an independent risk factor of ineffective medication treatment of constipation in FC patients ( OR=8.930, 95% confidence interval 2.011 to 39.658, P=0.004). Conclusions:There is a high incidence of alexithymia in FC patients. Alexithymia affects the perception of symptoms and the efficacy of medication treatment of constipation in FC patients.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by repeated abdominal pain and changes in defecation habits, which seriously affects the quality of life of patients. The occurrence and development of IBS are affected by many factors. As an inherent component of the gastrointestinal tract, eosinophils play a role in maintaining the local homeostasis of intestine. The activation of intestinal eosinophils plays a direct or indirect role in the occurrence and development of IBS. This article reviewed the progress of research on the potential role of eosinophils in IBS.

China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.

Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.

Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.