Objective:To explore the incidence of delirium in patients of advanced age hospitalized in internal medicine departments and analyze its influencing factors.Methods:A retrospective analysis was conducted on the medical records of 586 patients of advanced age hospitalized in internal medicine departments at the Beijing University of Chinese Medicine Third Affiliated Hospital from May 2023 to May 2024. Patients were divided into a delirium group and a non-delirium group based on whether delirium occurred. Univariate analysis and binary Logistic regression analysis were used to explore the factors influencing delirium in patients of advanced age hospitalized in internal medicine departments.Results:Among 586 patients of advanced age hospitalized in internal medicine departments, the incidence of delirium was 21.2% (124/586). Binary Logistic regression analysis showed that age, activities of daily living (Barthel Index), folate deficiency, sleep disorders, and indwelling catheters were factors influencing delirium in patients of advanced age hospitalized in internal medicine departments ( P<0.05) . Conclusions:The incidence of delirium is high among patients of advanced age hospitalized in internal medicine departments. Healthcare professionals should pay particular attention to elderly patients with advanced age, limited activities of daily living, folate deficiency, sleep disorders, and indwelling catheters, and should implement targeted preventive strategies as early as possible.

Objective To evaluate the diagnostic value of positive serum specific antibodies to Mycoplasma pneumoniae(MP)in children with Mycoplasma pneumoniae pneumonia(MPP).Methods PubMed,Cochrane Library,Embase,Sinomed,CNKI,Wanfang and VIP databases were searched for studies on the detection of MPP based on antibodies from the establishment of the database to March 31,2023.After literature screening and data extraction,STATA 16.0 software was used for Meta-analysis.Results A total of 9 literatures and 2 148 clinical samples were included.The combined sensitivities[M(95%CI)]of particle agglutination assay(PA)and enzyme-linked immunosorbent assay(ELISA)were 50%(31～69)and 88%(85～90),and the combined specificities[M(95%CI)]were 88%(76～95)and 88%(62～97).The combined diagnostic odds ratio(DOR)[M(95%CI)]were 5.61(3.30～9.53)and 43.82(12.78～150.19),and the summary receiver operating characteristic curve(SROC)area under the curve(AUC)were 0.80 and 0.88,respectively.Conclusion Serum MP specific antibody detection can be used for diagnosis and screening of children MPP,but needs to be combined with clinical symptoms improve the accuracy of the diagnosis.

Depression is a common chronic mental illness.Animal models of depression are widely used to study the pathogenesis of depression as well as in the development of new antidepressant drugs.The consistency and reliability of animal models of depression to simulate human depressive symptoms directly affect the study result.However,at present,no animal models have been found that are completely consistent with the onset of human depression,which hinders the in-depth study of depression.By using scientific and reasonable modeling and evaluation method,the pathological state of depression can still be simulated to a large extent,providing a basis for further in-depth research of the pathogenesis of depression and the development of effective antidepressant drugs.This paper aims to provide a reference for researchers by reviewing several commonly used animal models and behavioral tests of depression.

Objective To investigate the effects of early pulmonary rehabilitation training on lung function recovery,complication rates,and quality of life in patients who undergo thoracoscopic surgery.Methods A ran-domized controlled trial was conducted involving 132 patients who underwent thoracoscopic surgery between June 2020 and June 2023.Participants were randomly allocated to either an early pulmonary rehabilitation program(n=72)or a conventional rehabilitation program(n=60).The early intervention group commenced a staged rehabilitation protocol—including respiratory training and physical exercise—within 24 to 72 hours following surgery,whereas the conventional group received standard postoperative nursing care only.Outcomes measured included postoperative pulmonary function(FEV1,FVC),incidence of postoperative complications,length of hospi-tal stay,and quality of life scores(maximum score:40).These outcomes were compared between the two groups.Results On postoperative days 3 and 7,the early group showed significantly higher FEV1 values compared to the conventional group[(1.6±0.17)L vs.(1.3±0.21)L;(1.9±0.20)L vs.(1.6±0.11)L,respectively],as well as improved FVC measurements[(2.5±0.20)L vs.(2.1±0.14)L;(2.9±0.25)L vs.(2.3±0.23)L(all P＜0.05)].The early intervention group also demonstrated a significantly lower overall complication rate(14.3％vs.33.3％,x2=6.79,P=0.009),including reduced incidences of atelectasis(6.9％vs.20.0％,P=0.031)and pulmonary infection(4.2％vs.13.3％,P=0.044).Additionally,patients in the early group had a shorter average hospital stay[(8.4±1.2)days vs.(10.9±2.3)days,P=0.018]and reported higher quality of life scores[(35.6±3.7)vs.(30.8±4.5),P=0.032].No significant difference was observed between the two groups in terms of the overall incidence of adverse events(23.6％vs.31.7％,x2=1.07,P=0.301).Conclusions Early pulmonary rehabilitation significantly facilitates the recovery of lung function,reduces the incidence of postoperative complica-tions,enhances quality of life,and demonstrates a favorable safety profile among patients undergoing thoracoscopic surgery.Therefore,this intervention should be more broadly implemented in clinical practice to optimize postop-erative recovery outcomes.

Objective:To investigate the clinicopathological characteristics and differential diagnosis of DICER1-mutant primary intracranial sarcoma.Methods:Five cases of DICER1-mutant primary intracranial sarcoma at Sanbo Brain Hospital, Capital Medical University, Beijing, China during May 2013 to November 2024 were collected. The clinical and imaging data were retrieved. Histological evaluation, immunohistochemical staining and next generation sequencing were performed. Additionally, a literature review was conducted.Results:All five DICER1-mutant primary intracranial sarcomas were located in the supratentorial region, with one case involving the basal ganglia. There were two males and three females. The median age at diagnosis was 25 (14.0, 30.5) years. Morphologically, they were characterized by high-grade spindle cell sarcoma, with brisk mitotic activity and cytoplasmic eosinophilic globules. Myxoid degeneration, necrosis, and invasion into surrounding brain tissue were observed in some cases. The tumor cells showed diffuse staining of vimentin and variable expression of myogenic marker (desmin), with or without focal MyoD1 and/or Myogenin expression. Four tumors exhibited diffuse, strong expression of TLE1 and p53, while only three tumors showed loss of ATRX (nuclear) expression. Two cases showed mosaic loss of H3K27me3 expression in neoplastic cells. The Ki-67 proliferation index was high (40%-80%). Various neuronal markers, such as synaptophysin, NF, SOX2 and MAP2, were expressed in all tumor samples. Genetically, all tumors samples harbored biallelic abnormalities of DICER1. One was a hotspot missense mutation in the RNase Ⅲb domain within exon 25 on one allele (p.E1813 or p.D1810), while the other allele had mutations including a germline mutation in one case, a somatic mutation in two cases, and a copy number deletion in two cases. In addition, these sarcomas showed alterations in TP53 (4/5), ATRX (3/5), and the genes of the mitogen-activated protein kinase pathway (3/5). Finally, all five cases were diagnosed as DICER1-mutant primary intracranial sarcoma. All patients underwent craniotomy that led to complete tumor resection. Three patients received adjuvant radiotherapy and chemotherapy, with progression-free survival time of 28, 48, and 50 months, respectively. Patient 2 succumbed to the tumor after 3 months post-surgery due to rapid progression and tumor dissemination. Patient 5 was lost to follow-up 3 months after the surgery.Conclusions:DICER1-mutant primary intracranial sarcoma is a newly defined tumor entity in the fifth edition of the World Health Organization Classification of Central Nervous System Tumors, and commonly occurs in children and young adults. High-grade malignant spindle cells are their typical morphological feature. Eosinophilic cytoplasmic globules and myogenic differentiation can help establish the diagnosis. This study suggests that DICER1-mutant primary intracranial sarcomas exhibit immunophenotypic neuronal differentiation. Rendering the diagnosis of DICER1-mutant primary intracranial sarcoma largely relies on detecting DICER1 pathogenic alterations or DNA methylation profiling.

Objective:To investigate the clinicopathological characteristics and differential diagnosis of DICER1-mutant primary intracranial sarcoma.Methods:Five cases of DICER1-mutant primary intracranial sarcoma at Sanbo Brain Hospital, Capital Medical University, Beijing, China during May 2013 to November 2024 were collected. The clinical and imaging data were retrieved. Histological evaluation, immunohistochemical staining and next generation sequencing were performed. Additionally, a literature review was conducted.Results:All five DICER1-mutant primary intracranial sarcomas were located in the supratentorial region, with one case involving the basal ganglia. There were two males and three females. The median age at diagnosis was 25 (14.0, 30.5) years. Morphologically, they were characterized by high-grade spindle cell sarcoma, with brisk mitotic activity and cytoplasmic eosinophilic globules. Myxoid degeneration, necrosis, and invasion into surrounding brain tissue were observed in some cases. The tumor cells showed diffuse staining of vimentin and variable expression of myogenic marker (desmin), with or without focal MyoD1 and/or Myogenin expression. Four tumors exhibited diffuse, strong expression of TLE1 and p53, while only three tumors showed loss of ATRX (nuclear) expression. Two cases showed mosaic loss of H3K27me3 expression in neoplastic cells. The Ki-67 proliferation index was high (40%-80%). Various neuronal markers, such as synaptophysin, NF, SOX2 and MAP2, were expressed in all tumor samples. Genetically, all tumors samples harbored biallelic abnormalities of DICER1. One was a hotspot missense mutation in the RNase Ⅲb domain within exon 25 on one allele (p.E1813 or p.D1810), while the other allele had mutations including a germline mutation in one case, a somatic mutation in two cases, and a copy number deletion in two cases. In addition, these sarcomas showed alterations in TP53 (4/5), ATRX (3/5), and the genes of the mitogen-activated protein kinase pathway (3/5). Finally, all five cases were diagnosed as DICER1-mutant primary intracranial sarcoma. All patients underwent craniotomy that led to complete tumor resection. Three patients received adjuvant radiotherapy and chemotherapy, with progression-free survival time of 28, 48, and 50 months, respectively. Patient 2 succumbed to the tumor after 3 months post-surgery due to rapid progression and tumor dissemination. Patient 5 was lost to follow-up 3 months after the surgery.Conclusions:DICER1-mutant primary intracranial sarcoma is a newly defined tumor entity in the fifth edition of the World Health Organization Classification of Central Nervous System Tumors, and commonly occurs in children and young adults. High-grade malignant spindle cells are their typical morphological feature. Eosinophilic cytoplasmic globules and myogenic differentiation can help establish the diagnosis. This study suggests that DICER1-mutant primary intracranial sarcomas exhibit immunophenotypic neuronal differentiation. Rendering the diagnosis of DICER1-mutant primary intracranial sarcoma largely relies on detecting DICER1 pathogenic alterations or DNA methylation profiling.

Objective To investigate the therapeutic efficacy of artesunate(AS)on polycystic ovary syndrome(PCOS)in mice and explore the potential mechanism primarily.Methods Twenty-five female C57BL/6J mice were randomly divided into Control group,model group(PCOS group),low-and high-dose AS groups(AS15 and AS30 groups)and metformin group(Met group).In addition to the Control group,the mouse model of PCOS was established by subcutaneous injection of dehydroepiandrosterone(DHEA,60 mg/kg)following by a high-fat diet for 21 d.After modeling,AS of 15 and 30 mg/kg was intraperitoneally injected into the mice of the AS 15 and AS30 groups,respectively,and 200 mg/kg Met was given to those of the Met group by gavage,once per day,for 6 weeks.ELISA was used to detect serum testosterone(T),fasting insulin(FINS),luteinizing hormone(LH)and follicle-stimulating hormone(FSH),and the LH/FSH ratio was calculated.The levels of fasting blood glucose(FBG),triglyceride(TG)and total cholesterol(TC)were detected by automatic biochemical analyzer,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.The estrous cycle was observed,and HE staining was performed for pathological changes in the ovary and uterus.Immunofluorescence assay was employed to measure the expression of p-eIF2α,ATF4 and CHOP in the ovarian tissue.After steroidogenic human granulosa-like tumor cell line KGN were exposed to 100 μmol/L DHEA to simulate the hyperandrogen environment of PCOS,and then treated with 5 and 10 μg/mL AS for 24 h,the protein levels of endoplasmic reticulum stress signaling pathway was detected by Western blotting.Results Compared with the Control group,the PCOS mice had disturbed estrous cycle,polycystic changes in the ovaries,and significantly increased serum T level and LH/FSH ratio(P＜0.05),and obviously elevated HOMA-IR,TC and TG levels in terms of metabolism(P＜0.01).The expression levels of p-eIF2α,ATF4 and CHOP were notably up-regulated in the ovarian granulosa cells of PCOS mice and KGN cells after DHEA exposure(P＜0.05).Additionally,AS treatment attenuated the pathological changes of ovary and uterine expression,decreased the serum T level and the LH/FSH ratio(P＜0.05),and reduced HOMA-IR,TC and TG levels(P＜0.05)when compared with the PCOS mice.Moreover,the expression levels of p-eIF2α,ATF4 and CHOP were significantly down-regulated after AS treatment in both ovarian granulosa cells of PCOS mice and KGN cells(P＜0.05).Conclusion AS significantly improves glycolipid metabolic disorder and reproductive dysfunction in PCOS mice,which may be associated with its suppressing endoplasmic reticulum stress by inhibiting the PERK/eIF2α/ATF4/CHOP pathway.

Objective:To build an internet hospital cost-benefit evaluation index system based on a large public tertiary hospital, for references for improving the operation and management of internet hospitals.Methods:From May to October 2024, this study identified the elements of cost-benefit through on-site investigation, literature analysis and expert discussion, and built an initial evaluation index system of cost-benefit of internet hospitals; Delphi method and Pareto chart method were used to determine indicators and their weights; This evaluation index system was used to quantitatively evaluate an internet hospital since its operation for two years (from May 2022 to April 2024).Results:Five profit entities and 26 cost-benefit components had been identified; The expert authority coefficient of the two rounds of Delphi method was 0.73, and the Kendall coefficient was 0.80 ( P<0.001). The costs and benefits of an internet hospital since its operation for two years were 14.06 million yuan and 134.95 million yuan, respectively, with a benefit cost ratio of 9.60. Conclusions:The cost-benefit evaluation index system of internet hospitals built in this study was suitable for these relying on physical hospitals. This system was scientific and practical, and could provide references for cost-benefit evaluation of other Internet hospitals.

Objective To investigate the effects of early pulmonary rehabilitation training on lung function recovery,complication rates,and quality of life in patients who undergo thoracoscopic surgery.Methods A ran-domized controlled trial was conducted involving 132 patients who underwent thoracoscopic surgery between June 2020 and June 2023.Participants were randomly allocated to either an early pulmonary rehabilitation program(n=72)or a conventional rehabilitation program(n=60).The early intervention group commenced a staged rehabilitation protocol—including respiratory training and physical exercise—within 24 to 72 hours following surgery,whereas the conventional group received standard postoperative nursing care only.Outcomes measured included postoperative pulmonary function(FEV1,FVC),incidence of postoperative complications,length of hospi-tal stay,and quality of life scores(maximum score:40).These outcomes were compared between the two groups.Results On postoperative days 3 and 7,the early group showed significantly higher FEV1 values compared to the conventional group[(1.6±0.17)L vs.(1.3±0.21)L;(1.9±0.20)L vs.(1.6±0.11)L,respectively],as well as improved FVC measurements[(2.5±0.20)L vs.(2.1±0.14)L;(2.9±0.25)L vs.(2.3±0.23)L(all P＜0.05)].The early intervention group also demonstrated a significantly lower overall complication rate(14.3％vs.33.3％,x2=6.79,P=0.009),including reduced incidences of atelectasis(6.9％vs.20.0％,P=0.031)and pulmonary infection(4.2％vs.13.3％,P=0.044).Additionally,patients in the early group had a shorter average hospital stay[(8.4±1.2)days vs.(10.9±2.3)days,P=0.018]and reported higher quality of life scores[(35.6±3.7)vs.(30.8±4.5),P=0.032].No significant difference was observed between the two groups in terms of the overall incidence of adverse events(23.6％vs.31.7％,x2=1.07,P=0.301).Conclusions Early pulmonary rehabilitation significantly facilitates the recovery of lung function,reduces the incidence of postoperative complica-tions,enhances quality of life,and demonstrates a favorable safety profile among patients undergoing thoracoscopic surgery.Therefore,this intervention should be more broadly implemented in clinical practice to optimize postop-erative recovery outcomes.

Objective To evaluate the diagnostic value of positive serum specific antibodies to Mycoplasma pneumoniae(MP)in children with Mycoplasma pneumoniae pneumonia(MPP).Methods PubMed,Cochrane Library,Embase,Sinomed,CNKI,Wanfang and VIP databases were searched for studies on the detection of MPP based on antibodies from the establishment of the database to March 31,2023.After literature screening and data extraction,STATA 16.0 software was used for Meta-analysis.Results A total of 9 literatures and 2 148 clinical samples were included.The combined sensitivities[M(95%CI)]of particle agglutination assay(PA)and enzyme-linked immunosorbent assay(ELISA)were 50%(31～69)and 88%(85～90),and the combined specificities[M(95%CI)]were 88%(76～95)and 88%(62～97).The combined diagnostic odds ratio(DOR)[M(95%CI)]were 5.61(3.30～9.53)and 43.82(12.78～150.19),and the summary receiver operating characteristic curve(SROC)area under the curve(AUC)were 0.80 and 0.88,respectively.Conclusion Serum MP specific antibody detection can be used for diagnosis and screening of children MPP,but needs to be combined with clinical symptoms improve the accuracy of the diagnosis.