Introduction: Electrolyte imbalance is common in central nervous system infections. Arginine vasopressin deficiency (AVP-D), Cerebral Salt Wasting (CSW), and Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) are important etiologies that can cause opposing extremes of serum sodium, posing diagnostic and therapeutic challenges. We report a rare case of transient central AVP-D followed by CSW secondary to tuberculous meningitis (TBM). Case: An 18-year-old female presented with a 1-month history of fever, reduced responsiveness, and visual hallucinations. Her Glasgow Coma Scale was E4V1M4 with neck stiffness and upper motor neuron signs. Initial investigations revealed severe hyponatremia (119 mmol/L) and communicating hydrocephalus with third ventricle ballooning on brain imaging. Coupled with a positive tuberculosis contact, anti-tuberculous therapy was initiated for probable TBM alongside 3% saline correction prior to insertion of external ventricular drain (EVD). Her condition deteriorated on day 5, requiring intubation for aspiration pneumonia. Repeated imaging showed worsening hydrocephalus, necessitating EVD revision. She subsequently developed polyuria (urine output [UO] 150–300 mLs/hour), with biochemical findings consistent with AVP-D (serum sodium 154 mmol/L; urine osmolality 96 mOsm/kg; urine sodium <20 mmol/L). Intravenous desmopressin 1 mcg was administered, and UO reduced to 30 mLs/hour. However, polyuria recurred on Day 9, accompanied by tachycardia, hypotension, and a rapid decline in serum sodium to 120 mmol/L. Diagnosis of CSW was established (urine sodium 204 mmol/L; urine osmolality 470 mOsm/kg). Oral fludrocortisone was initiated and titrated to 0.4 mg daily to maintain serum sodium >130 mmol/L. Due to persistent hydrocephalus, right ventriculoperitoneal shunt was inserted on Day 22, after which her UO gradually decreased, allowing tapering of fludrocortisone. She remains on fludrocortisone 0.1 mg daily with ongoing rehabilitation. Conclusion TBM can be complicated by SIADH, AVP-D, or CSW. Concurrent AVP-D and CSW have not been reported. This case highlights the dynamic electrolyte disturbances in TBM which may lead to diagnostic confusion and therapeutic error. Early recognition and tailored therapy, alongside definitive management to reduce intracranial pressure, are essential for optimal outcomes.
Hypernatremia ; Hyponatremia ; Tuberculosis, Meningeal

This study analyzed the burden and trends in enteric infections in China from 1990 to 2021 from a One Health perspec-tive.Data on mortality associated with enteric infections were extracted from the 2021 Global Burden of Disease(GBD)database.The analysis focused on assessing the mortality rates of enteric infectious diseases attributed to various etiologies and risk factors,along with the age and sex distribution,from 1990 to 2021.Average annual percentage change(AAPC)was used to assess the total changes in disease burden.The age-standardized mortality rate of intestinal infections in China decreased from 9.642/100 000 in 1990 to 0.439/100 000 in 2021,with an AAPC of-57.103%(95%CI:-57.118%to-57.088%).In 2021,Rotavirus,Norovirus,and Crypto-sporidium were the top three etiologies contributing to disease burden,with mortality rates of 1.020/100 000,0.040/100 000 and 0.079/100 000,respectively.A significant variation in etiology distribution was observed across age groups:Rotavirus,Shigella,and Crypto-sporidium dominated among children under 5 years of age,whereas Cryptosporidium,Norovirus,and Clostridioides difficile were more prevalent in older populations.Risk factor analysis indicated that unsafe water sources and poor sanitation accounted for 73.394%of all enteric disease-related deaths.In conclusion,the burden of enteric infections in China markedly declined from 1990 to 2021,and sig-nificant variations in the etiological spectrum and disease burden were observed across age groups.The persistent effects of unsafe wa-ter sources and poor sanitation underscore the need for targeted interventions to further decrease the burden of these diseases.Our find-ings highlight the success of public health interventions in decreasing the burden of enteric infections in China,while emphasizing the need for targeted measures to address disparities in high-risk populations and improve environmental sanitation.

This study analyzed the burden and trends in enteric infections in China from 1990 to 2021 from a One Health perspec-tive.Data on mortality associated with enteric infections were extracted from the 2021 Global Burden of Disease(GBD)database.The analysis focused on assessing the mortality rates of enteric infectious diseases attributed to various etiologies and risk factors,along with the age and sex distribution,from 1990 to 2021.Average annual percentage change(AAPC)was used to assess the total changes in disease burden.The age-standardized mortality rate of intestinal infections in China decreased from 9.642/100 000 in 1990 to 0.439/100 000 in 2021,with an AAPC of-57.103%(95%CI:-57.118%to-57.088%).In 2021,Rotavirus,Norovirus,and Crypto-sporidium were the top three etiologies contributing to disease burden,with mortality rates of 1.020/100 000,0.040/100 000 and 0.079/100 000,respectively.A significant variation in etiology distribution was observed across age groups:Rotavirus,Shigella,and Crypto-sporidium dominated among children under 5 years of age,whereas Cryptosporidium,Norovirus,and Clostridioides difficile were more prevalent in older populations.Risk factor analysis indicated that unsafe water sources and poor sanitation accounted for 73.394%of all enteric disease-related deaths.In conclusion,the burden of enteric infections in China markedly declined from 1990 to 2021,and sig-nificant variations in the etiological spectrum and disease burden were observed across age groups.The persistent effects of unsafe wa-ter sources and poor sanitation underscore the need for targeted interventions to further decrease the burden of these diseases.Our find-ings highlight the success of public health interventions in decreasing the burden of enteric infections in China,while emphasizing the need for targeted measures to address disparities in high-risk populations and improve environmental sanitation.

Objective:To explore the mechanism of long non-coding RNA nuclear-enriched transcript 1(LncRNA NEAT1)on improving myocardial injury in rats with myocardial infarction(MI)mechanism through miR-136/extracellular signal-regulated kinase 1/2(ERK1/2)axis.Methods:Using the random number table method,120 male SD rats were divided into 6 groups(n=20):sham group,myocardial infarction group(MI group),control interference group(sh-NC group),NEAT1 interference group(sh-NEAT1 group),NEAT1 interference+miR-136 control inhibition group(sh-NEAT1+antagomiR-NC group)and NEAT1 interference+miR-136 suppression group(sh-NEAT1+antagomiR-136 group).Seven days before MI operation,100 μl of corresponding adenovirus vector was injected into the myocardium.Rats in each group were ligated the left anterior descending vessel to establish MI model.In sham group,only the left chest was opened and the heart was exposed without ligation.H9C2 cardiomyocyte were divided into:control group,vehicle group,sh-NC group,sh-NEAT1 group,sh-NEAT1+antagomiR-NC group and sh-NEAT1+antagomiR-136 group.Car-diomyocyte were transfected with corresponding NEAT1 interference vector and negative control,miR-136 inhibitor and negative con-trol.StarBase prediction and dual luciferase report experiment verify the targeted regulation of LncRNA NEAT1 on miR-136;myocar-dial infarct size was measured by TTC staining,and myocardial histopathological changes were observed by HE staining;Echocardiog-raphy was used to detect rat cardiac function;detection of apoptosis in rat myocardial tissue and H9C2 cells by flow cytometry.ELISA method was used to detect serum oxidative stress,corresponding indexes of myocardial enzymes and the contents of inflammatory fac-tors in myocardial tissue and H9C2 cells.CCK8 and EdU staining were used to detect the proliferation ability of H9C2 cells.RT-qPCR was used to detect the expressions of miR-136,SIRT1 mRNA in myocardial tissue and H9C2 cells.Western blot was used to detect the expressions of ERK1/2,p-ERK1/2,B-cell lymphoma-2(Bcl-2),Bcl2-related X protein(Bax)protein in rat myocardial tissue and H9C2 cells.Results:The expression of LncRNA NEAT1 was up-regulated in injured myocardial tissues and cells,and the expression of miR-136 was down-regulated(P<0.05).At the same time,NEAT1 targets and regulates the level of miR-136.Inhibition of NEAT1 expression could increase left ventricular ejection fraction(LVEF),left ventricular fraction shortening(LVFS),Bcl-2 level,and de-crease the activities of creatine kinase(CK),lactate dehydrogenase(LDH),and aspartame Acid transaminase(AST),superoxide dismutase(SOD),reduce Bax,troponin Ⅰ(cTnⅠ),malondialdehyde(MDA),TNF-α,IL-1β,IL-6,ERK1/2/p-ERK1/2 levels(P<0.05),promote the proliferation of myocardial cells,inhibit cell apoptosis,reduce the area of myocardial infarction,inhibit oxida-tive stress and inflammation,and improve myocardial damage Inhibiting miR-136 can save the above effects.Conclusion:The expres-sion of LncRNA NEAT1 is up-regulated and the expression of miR-136 is down-regulated in injured myocardial tissue and cells.Inhibi-tion of LncRNA NEAT1 expression inhibits apoptosis,oxidative stress and inflammation through miR-136/ERK1/2 axis,thus improving myocardial injury.

Objective Construction and Practice of a Whole-Process Digitalized Hemodialysis Management System.Methods ① Integrate device data through the Internet of Things(IoT)to enable automatic collection of dialysis parameters and real-time validation of quality control rules.② Build an"intelligent error prevention system"based on Data Analysis,realizing the transformation from patient management to digital quality control management in hemodialysis treatment.③ Implement a closed-loop management system for the entire patient dialysis process.Results The system reduced clinicians' time spent manu-ally filling and verifying documentation by 75％,and increased the adequacy compliance rate for maintenance dialysis patients to 100％per quarter and other goals.Conclusion Traditional hemodialysis management relies on manual records,leading to issues such as fragmented data,delayed quality control,material waste,and high risks of hospital-acquired infections.The entire process,from patient appointment to post-dialysis summary management lacks coordination,and manual calculation of key indica-tors is prone to errors,with insufficient timeliness in quality surveillance warnings.The construction of an information system can break down operational silos and enable"data-driven decision-making",and provides a replicable model for the digital manage-ment of hemodialysis.

Objective To investigate the analgesic effect of ultrasound-guided quadratus lumborum block combined with patient-controlled intravenous analgesia after lower abdominal surgery.Methods A total of 134 patients who underwent lower abdominal surgery in General Hospital of Central Theater Command from April 2021 to April 2024 were prospectively selected and randomly divided into the observation group and the control group,with 67 patients in each group.Patients in the observation group received ultrasound-guided quadratus lumborum block combined with patient-controlled intravenous analgesia.Patients in the control group underwent only patient-controlled intravenous analgesia.The number of analgesic pump compressions and the cumulative sufentanil consumption 4 hours,6 hours,12 hours,and 24 hours after surgery,the visual analogue score(VAS)of pain at rest and exercise,and the incidence of adverse reactions during postoperative analgesia were compared between the two groups.Results Compared with the control group,the number of analgesic pump compressions and the cumulative sufentanil consumption of patients were fewer/less at 6 hours,12 hours and 24 hours after surgery in the observation group(P<0.05).The VAS scores of patients at exercise 4 hours,6 hours,12 hours and 24 hours after surgery in the observation group were significantly lower than those in the control group(P<0.05).The incidence of nausea,vomiting and vertigo in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Compared with patient-controlled intravenous analgesia,ultrasound-guided quadratus lumborum block combined with patient-controlled intravenous analgesia can significantly reduce the number of analgesia pump compressions and the cumulative sufentanil consumption in postoperative analgesia of lower abdominal surgery,and has a better effect in relieving exercise pain,it can also reduce the occurrence of adverse reactions such as nausea and vomiting.

Objective To explore the biosynthesis of Dipsacus asper Wall.ex Henry triterpenoid saponin,and the UGT gene in Dipsacus asper Wall.ex Henry has been analyzed by the identification of whole genome,genome and prokaryotic expression.Methods The laboratory self-tested sequenced protein sequence files of the Dipsacus asper Wall.ex Henry genome were used.To validate the conserved domains of the sequence of the Dipsacus asper Wall.ex Henry UGT gene,BLASTP and hmmsearch were utilized.Prot-Param,SOMPA,MAGA7.0,Tbtools and other tools were used to investigate the protein physicochemical properties,protein structure,and covariance analysis of the Dipsacus asper Wall.ex Henry UGT gene family,and using the joint analysis of transcriptomic data and metabolomics data,two glycosyltransferases that might be related to triterpene saponin biosynthesis were screened,and expression vectors were constructed for prokaryotic expression.Results 44 Dipsacus asper Wall.ex Henry UGT genes were identified from the Dipsacus asper Wall.ex Henry genome.The length of Dipsacus asper Wall.ex Henry UGT proteins ranged from 49 to 1083 amino acids,with an average molecular weight of 24.86 kDa and an isoelectric point of 4.31-8.59.Dipsacus asper Wall.ex Henry UGT gene family was distributed on eight chromosomes.The phylogenetic tree constructed from the sequences of Dipsacus asper Wall.ex Henry,Arabidopsis thaliana and identified UGTs showed that glycosyltransferase gene families in Dipsacus asper Wall.ex Henry were mainly in the UGT73,UGT81,UGT85,and UGT80 families.Cis-acting element analysis showed that light-responsive elements were the most prevalent elements in the promoter regions of UGT gene family members.Two glycosyltransferases potentially related to triterpene saponin biosynthesis were screened using combined transcriptomics and metabolomics analysis,and were successfully expressed in prokaryotic form.Conclusion In this study,two candidate genes related to the biosynthesis of Dipsacus asper Wall.ex Henry triterpenoid saponins were jointly screened for prokaryotic expression using multi-omics,and were subjected to prokaryotic expression for further validation of the function of the genes.

Objective Construction and Practice of a Whole-Process Digitalized Hemodialysis Management System.Methods ① Integrate device data through the Internet of Things(IoT)to enable automatic collection of dialysis parameters and real-time validation of quality control rules.② Build an"intelligent error prevention system"based on Data Analysis,realizing the transformation from patient management to digital quality control management in hemodialysis treatment.③ Implement a closed-loop management system for the entire patient dialysis process.Results The system reduced clinicians' time spent manu-ally filling and verifying documentation by 75％,and increased the adequacy compliance rate for maintenance dialysis patients to 100％per quarter and other goals.Conclusion Traditional hemodialysis management relies on manual records,leading to issues such as fragmented data,delayed quality control,material waste,and high risks of hospital-acquired infections.The entire process,from patient appointment to post-dialysis summary management lacks coordination,and manual calculation of key indica-tors is prone to errors,with insufficient timeliness in quality surveillance warnings.The construction of an information system can break down operational silos and enable"data-driven decision-making",and provides a replicable model for the digital manage-ment of hemodialysis.

Background and Aims:Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy in China,with cervical lymph node metastasis being a frequent and critical clinical feature that directly affects patient prognosis and recurrence risk.In recent years,with the rapid increase in the prevalence of overweight and obesity in China,the role of body mass index(BMI)in various tumors has attracted growing attention.This study aimed to investigate the association between overweight and cervical LNM in PTC,analyze sex-specific differences and influencing factors,and provide evidence for precise clinical management.Methods:A retrospective analysis was conducted on the clinicopathologic data of 1 445 patients with classical PTC treated at Xiangya Hospital of Central South University between August 2021 and June 2022.Patients were divided into groups based on the presence or absence of lymph node metastasis.Restricted cubic spline analysis explored the nonlinear relationship between BMI and lymph node metastasis risk.Univariate and multivariate Logistic regression analyses were applied to identify independent risk factors.Furthermore,sex-stratified analysis was performed among overweight patients(BMI≥24 kg/m2)to determine sex-specific risk factors for lymph node metastasis.Results:Among all patients,716(49.6%)had lymph node metastasis.Univariate analysis showed that BMI,sex,age,tumor diameter,multifocality,and extrathyroidal extension were significantly associated with cervical lymph node metastasis in PTC patients(all P<0.05).A nonlinear positive correlation was observed between BMI and lymph node metastasis risk,which was more pronounced in male patients.Additionally,BMI was positively correlated with triglyceride levels and negatively correlated with high-density lipoprotein cholesterol.Sex-stratified analysis revealed that in overweight male patients,younger age(OR=0.954),larger tumor diameter(OR=1.085),and multifocality(OR=2.776)were independent risk factors for LNM;in overweight female patients,younger age(OR=0.943)and larger tumor diameter(OR=1.074)were the main influencing factors.Conclusion:Overweight is closely associated with cervical lymph node metastasis in PTC,and the high-risk factors for LNM differ between male and female overweight patients.Young age,larger tumor size,and multifocality in overweight males,and young age and larger tumors in overweight females indicate a higher risk of metastasis.It is recommended that high-risk populations receive enhanced preoperative evaluation and individualized lymph node dissection strategies to achieve precise treatment and improved risk control.

Background and Aims:Secondary hyperparathyroidism(SHPT)is a common and difficult-to-treat complication of chronic kidney disease(CKD),significantly impairing patients'quality of life and prognosis.For patients who respond poorly to medical therapy,surgical intervention remains an effective treatment option.This study aimed to evaluate the clinical efficacy and safety of total parathyroidectomy with forearm autotransplantation(tPTX+AT)in the treatment of CKD-related SHPT.Methods:A retrospective analysis was conducted on 40 patients with CKD complicated by SHPT who underwent tPTX+AT in Gaozhou People's Hospital between January 2020 and June 2023.Changes in intact parathyroid hormone(iPTH),serum phosphorus,calcium,alkaline phosphatase(ALP),and bone mineral density(BMD)were recorded preoperatively and at multiple postoperative time points.Postoperative symptom relief,complications,and follow-up outcomes were also analyzed.Results:A total of 158 parathyroid glands were removed during surgery.Among the patients,38 had four glands successfully excised,while two had only three glands removed.After operation,levels of iPTH,phosphorus,calcium,and ALP decreased significantly compared to preoperative values(all P<0.05),and BMD increased significantly at 3 months(P<0.05).Symptoms such as bone pain,pruritus,and restless leg syndrome improved markedly by 3 months postoperatively(all P<0.05).Hypocalcemia occurred in 34 cases(85.0%);one patient experienced transient recurrent laryngeal nerve injury and one had superior laryngeal nerve injury,both of which resolved after treatment.The two patients who had only three glands removed exhibited persistent SHPT postoperatively,with iPTH levels of 457 pg/mL and 609 pg/mL,respectively.Although their symptoms improved partially,the condition was medically controlled without the need for reoperation.Conclusion:tPTX+AT can effectively correct mineral metabolism disorders and improve BMD and clinical symptoms in SHPT patients.The procedure achieves a high rate of complete gland resection and stable autograft function.Although postoperative hypocalcemia is common,overall complications are manageable.This surgical approach is safe and effective for the treatment of refractory SHPT.