This paper reported a patient with early-onset Alzheimer's disease （AD） who had previously responded poorly to anti-dementia medications while showed improvement in cognitive functioning after treatment with occupational therapy and computerized cognitive remediation therapy （CCRT） for 50 minutes three times per week. This case report provided an in-depth evaluation of occupational therapy combined with CCRT for early-onset AD in an effort to inform cognitive rehabilitation of patients with AD. ［Funded by Chengdu Medical Scientific Research Project （number， 2023635）］

Neurofibromatosis type 1 (NF1) presents with a diverse range of symptoms that can affect the skin, bones, eyes, central nervous system, and other organs. This article reports the diagnosis and treatment process of a patient with NF1 complicated by bilateral severe-to-profound sensorineural hearing loss. Genetic testing revealed a heterozygous variant of NF1 NM_ 000267.3: c.4054_ 4058del(p.Ser1352LeufsTer20, supporting the diagnosis of NF1. After thorough evaluation, a right cochlear implantation was performed, yielding satisfactory postoperative results. This case suggests that NF1 patients may exhibit phenotypic heterogeneity and atypicality, providing a reference for clinicians in the diagnosis and treatment of such patients.

Objective:To investigate the current status of the technological pedagogical content knowledge (TPACK) levels of youth teachers in a military medical university, and to provide a practical basis for improving youth teachers' ability to teach with technologies.Methods:Youth teachers (with less than 3 years of teaching experience) in a military medical university were selected by convenience sampling for a survey on TPACK abilities using a modified TPACK questionnaire. The questionnaire was distributed through the internet, and 119 valid responses were returned. SPSS 20.0 software was used to perform the independent samples t-test and one-way analysis of variance.Results:The youth teachers scored highest in technological knowledge [TK; (3.68±0.74)] and lowest in TPACK (3.17±0.74). There were no significant differences in TPACK abilities between youth teachers in different majors. Youth teachers of different educational attainments showed significant differences in the levels of technological knowledge (TK; F=12.99, P<0.001), content knowledge (CK; F=13.64, P<0.001), technological pedagogical knowledge (TPK; F=4.38, P=0.015), technological content knowledge (TCK; F=3.83, P=0.025), and TPACK ( F=3.63, P=0.029)—the TK, CK, TPK, and TCK levels of teachers with doctoral degrees were significantly higher than those with bachelor's and master's degrees. Conclusions:Efforts should be made to design a TPACK ability development system throughout the growth cycle of youth teachers, build teaching practice communities, and improve the system guarantees.

Chimeric antigen receptor (CAR)-T cell therapy has achieved remarkable success in the treatment of hematological malignancies. Based on the immunomodulatory capability of CAR-T cells, efforts have turned toward exploring their potential in treating autoimmune diseases. Bibliometric analysis of 210 records from 128 academic journals published by 372 institutions in 40 countries/regions indicates a growing number of publications on CAR-T therapy for autoimmune diseases, covering a range of subtypes such as systemic lupus erythematosus, multiple sclerosis, among others. CAR-T therapy holds promise in mitigating several shortcomings, including the indiscriminate suppression of the immune system by traditional immunosuppressants, and non-sustaining therapeutic levels of monoclonal antibodies due to inherent pharmacokinetic constraints. By persisting and proliferating in vivo, CAR-T cells can offer a tailored and precise therapeutics. This paper reviewed preclinical experiments and clinical trials involving CAR-T and CAR-related therapies in various autoimmune diseases, incorporating innovations well-studied in the field of hematological tumors, aiming to explore a safe and effective therapeutic option for relapsed/refractory autoimmune diseases.

Background::China is one of the countries with the largest burden of gastrointestinal and liver diseases (GILD) in the world. The GILD constitutes various causes of mortality and disability. The study aimed to investigate the trend of GILD in China using the Global Burden of Diseases Study 2019 (GBD 2019) data resources from 1990 to 2019.Methods::The data on the age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) for GILD in China from 1990 to 2019 were collected from the GBD 2019 data resources. Furthermore, the ranking of the main causes of deaths and DALYs, as well as the trends of ASMR, DALYs, years of life lost (YLLs), and years of life lost due to disability (YLDs) per 1,000,000 in GILD were reported.Results::The ASMR and DALYs for stomach cancer, liver cancer, and esophageal cancer, which ranked top three among the GILDs from 1990 to 2019, were gradually decreasing. Significant decreases in the ASMR and DALYs were found in diarrheal diseases and acute hepatitis (A, E, and C). However, noteworthy increases were found in those of colon and rectum cancer (CRC) and pancreatic cancer. Trend of DALYs, mortality, and YLLs rates for most of GILD were decreasing from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trend. The DALYs, mortality and YLLs of most GILD diseases showed decreasing trends from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trends.Conclusions::The result of the GBD 2019 showed that the rates of most GILDs decreased in China; however, gastrointestinal and liver cancer, such as stomach cancer still held the top ranking. Furthermore, the shift from infectious diseases to non-communicable causes among GILD burden is occurring.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To explore the value of the Kyoto classification score in differentiating undifferentiated gastric cancer from differentiated gastric cancer,and establish a predictive scoring system for differentiating undifferentiated gastric cancer under endoscope.Methods 183 gastric cancer patients were retrospectively analyzed.According to pathology,95 patients were included in the differentiated group and 88 were included in the undifferentiated group.The age,gender and Kyoto classification score of patients in the two groups were compared,and the factors associated with undifferentiated gastric cancer were screened by binary Logistic regression analysis.The predictive scoring system for undifferentiated gastric cancer was established based on the obtained odds ratio(O(R))values,and the receiver operator characteristic curve(ROC curve)was drawn.Results Compared with differentiated group,the total scores of Kyoto classification,atrophy,intestinal metaplasia and diffuse redness were lower in undifferentiated group(P<0.01).Under the age of 55(P<0.05),female(P<0.05),and C1 atrophy or no atrophy(P<0.01)were independently associated with undifferentiated gastric cancer.The area under the curve(AUC)of predictive scoring system for undifferentiated gastric cancer was 0.881(95％CI:0.828～0.934),and the sensitivity and specificity were 80.70％and 90.50％at the optimal cut-off value.Conclusion There are differences in Kyoto classification scores between undifferentiated and differentiated gastric cancer patients.The predictive scoring system of undifferentiated gastric cancer established by us has certain value in distinguishing undifferentiated gastric cancer under endoscope.

Objective To investigate the current status of taste disorders in type 2 diabetes mellitus(T2DM)and to explore whether the taste disorders persists after 3 months of novel corona virus(COVID-19)infection.Methods 95 T2DM out patients(23 without COVID-19 infection history,72 infected with COVID-19 3～4 months ago)visiting the Endocrine Department of the Strategic Support Force Medical Center from February 20 to March 10,2023 were collected.Taste test box was used to test the taste function.General information,biochemical indicators,taste disorders,etc.were compared between the two groups.Results The average age of T2DM patients in this group was(58.3±9.6)years old,61 patients were male(64.2%),the median duration of DM was 11 years,and the median HbA1c was 7.3%.In taste testing,the proportion of sour,sweet,bitter,salty taste perception disorders was 60.0%,45.3%,57.9%,41.1%,84.2%.The average number of days from infection to enrollment into COVID-19 group was 102.4 days.The proportion of acid,sweet,bitter and salty sensory disorders was 61.1%,44.4%,55.6%and 41.7%in COVID-19 group and 56.5%,47.8%,65.2%and 39.1%in non-COVID-19 group.The prevalence of taste disorders in COVID-19 group was higher than that in non-COVID-19 group(86.1%vs 78.3%).Conclusions Taste disorders are common in T2DM patients.Compared with uninfected T2DM patients,there is no significant difference in the prevalence of taste disorders 3 months after COVID-19 infection.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and still has the highest mortality rate. The occurrence and development of non-small cell lung cancer are related to multi gene regulation. Circular RNA is a non coding RNA formed by reverse splicing, which is widely expressed in many types of biological cells. Circular RNA lacks 5' and 3' terminals, and compared to linear RNA, circular RNA has better stability towards exonuclease and ribonuclease. With the development of high-throughput sequencing and bioinformatics technology, the correlation between more and more circular RNAs and tumors is gradually being recognized. This article provides a review on the role of circular RNA in the occurrence, development, diagnosis, and treatment of non-small cell lung cancer, aiming to provide new ideas for further research on its mechanism.

Objective:To evaluate the long-term constancy of image uniformity and noise of cone-beam computed tomography (CBCT) for the on-board imager (OBI) system of a Varian linac.Methods:Monthly quality assurance (QA) tests were carried out for the OBI system of a Clinac iX linac, and CBCT images of Catphan 504 phantom were obtained with six scanning protocols. The 6 protocols were high-quality head (HQH), low-dose head (LDH), pelvis spot light (PSL), standard-dose head (SDH), low-dose thorax (LDT) and pelvis, respectively. The 144 series of CBCT images acquired from Nanjing First Hospital, Nanjing Medical University between January 2020 and December 2021 were analyzed, and the data of image uniformity and noise were obtained by delineating regions of interest (ROI) in the images of CTP486 module. Image uniformity was expressed by the absolute value of the maximum difference between the average CT value of the ROI in the 3, 6, 9 and 12 o'clock directions and the central ROI. Image noise was expressed by the standard deviation of CT value of large circular ROI. The smaller the values of image uniformity and noise, the better the image quality. Statistical description was applied to obtain data of the maximum, minimum, mean and standard deviation for the above mentioned two parameters. Y was defined as the difference between the average CT value of ROI in each direction and the average CT value of central ROI, which was used to represent the monthly changes of image quality.Results:The image uniformity and noise of CBCT images of the OBI system were generally stable during 2 years. For the 6 protocols of HQH, LDH, PSL, SDH, LDT and pevlis, the image uniformity was (21.5±1.0), (21.4±2.2), (21.3±0.9), (18.3±1.3), (3.4±1.9) and (7.2±1.9) HU, respectively. The image noise was (19.2±0.2), (41.0±0.3), (14.2±0.3), (38.2±0.2), (16.0±0.9) and (13.5±0.9) HU, respectively. The average image uniformity of LDT was the smallest, and the average image noise of pelvis was the smallest. Under the 6 scanning protocols, the average CT values of central ROI involved in image uniformity were (32.3±2.7), (24.0±3.3), (19.3±2.4), (11.1±2.5), (67.2±2.1), (-24.6±1.7) HU, respectively. The average CT values were stable. The standard deviation of Y was < 3 HU, suggesting that the stability of image quality was favorable every month.Conclusions:The image uniformity and noise of CBCT images for the OBI system are generally stable in 2 years. Among the 6 scanning protocols, LDT yields the best image uniformity, and pelvis has the lowest image noise.