BackgroundPersistent cognitive impairment is prevalent among patients with stable schizophrenia. While serum total bile acid （TBA） level in acute-phase patients are known to be associated with cognitive dysfunction， the relationship between serum TBA and multi-dimensional cognitive functions in stable phase patients remains unclear. ObjectiveTo investigate the correlation between serum TBA level and cognitive function in patients with stable schizophrenia， and to evaluate its predictive value for cognitive impairment， thereby providing a serological biomarker for the timely identification and objective assessment of cognitive dysfunction. MethodsA cross-sectional study was conducted on 137 inpatients with stable schizophrenia at The Fourth People's Hospital of Yancheng from March to December 2024. All participants met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. Cognitive function was evaluated using the Chinese Brief Cognitive Test （C-BCT）， patients were categorized into four groups： normal cognition （n=28）， mild impairment （n=28）， moderate impairment （n=47）， and severe impairment （n=34）. Fasting venous blood samples were collected， and serum TBA level was quantified using an enzymatic cycle assay. Spearman correlation analysis was ultilized to determine the relationship between serum TBA level， overall cognitive function， and specific cognitive domains. Binary Logistic regression model was used （adjusting for covariates such as age， gender， and disease duration） to analyze the impact of serum TBA level on overall and individual cognitive functions. The predictive value of serum TBA level for overall cognitive impairment was evaluated using receiver operating characteristic （ROC） curve. ResultsSerum TBA levels differed significantly among the four groups （H=18.677， P<0.01）. Specifically， serum TBA levels in both the moderate and severe cognitive impairment groups were significantly higher than those in the normal cognitive group （adjusted P<0.01）. Serum TBA level was positively correlated with the severity grading of overall cognitive impairment （r_s=0.354， P<0.05）， and negatively correlated with T-scores on the trail making test （r_s=-0.328， P<0.05）， continuous performance test （r_s=-0.247， P<0.05）， digit span （r_s=-0.265， P<0.05）， and symbol coding （r_s=-0.221， P<0.05）. Binary Logistic regression analysis identified serum TBA level as an independent risk factor for overall cognitive impairment （OR=1.322， 95% CI： 1.021 - 1.713， P=0.034）， with a particularly robust predictive ability for impaired information processing speed （OR=1.325， 95% CI： 1.057 - 1.661， P=0.015）. The area under ROC curve （AUC） for serum TBA level in predicting overall cognitive impairment was 0.738， with a sensitivity of 60.61% and a specificity of 78.64%. ConclusionIn patients with stable schizophrenia， elevated serum TBA levels are associated with worse overall cognitive function， as well as deficits in information processing speed， attention， working memory， and executive function. Serum TBA serves as an independent risk factor and exhibits moderate predictive value for overall cognitive impairmen，particularly in the domain of information processing speed. ［Funded by Yancheng Municipal Health Commission Medical Research Project （number， YK2024141）］

ObjectiveTo investigate the effects of jujuboside A （JuA） on the learning and memory abilities and histopathological changes in the rat model of vascular cognitive impairment （VCI） and explore the potential mechanisms by which JuA treats VCI. MethodsA total of 50 male SPF-grade SD rats were randomized into a sham operation group （n=10）， a blank control group （n=10）， and a modeling group （n=30）. The rats in the modeling group underwent bilateral carotid artery ligation （2-VO） for the modeling of VCI. After stabilization， the VCI rats were randomized into model， JuA （20 mg·kg^-¹）， and donepezil （0.45 mg·kg^-¹） groups. After 4 weeks of gavage， the novel object recognition and Morris water maze tests were conducted to evaluate the learning and memory abilities of rats. Nissl staining was employed to evaluate the morphology and number of hippocampal neurons. Real-time PCR was employed to measure the mRNA levels of glycogen synthase kinase-3β （GSK-3β）， cAMP response element-binding protein （CREB）， B cell lymphoma-2 （Bcl-2）， phosphatidylinositol 3-kinase （PI3K）， and protein kinase B （Akt） in the hippocampal tissue. Western blot was employed to quantify the protein levels of GSK-3β， p-GSK-3β， p-CREB， Bcl-2， PI3K， p-PI3K， Akt， and p-Akt in the hippocampal tissue. ResultCompared with the sham operation group， the model group exhibited declines in the learning and memory abilities （P<0.01）， neuronal damage and decreased neurons in the hippocampal CA1 region （P<0.01）， up-regulation in the mRNA level of GSK-3β （P<0.01）， and down-regulation in the mRNA levels of PI3K， Akt， CREB， and Bcl-2， as well as the protein levels of p-PI3K， p-Akt， p-GSK-3β， p-CREB， and Bcl-2 （P<0.01）. In comparison to the model group， both the JuA and donepezil groups demonstrated improvements in the learning and memory abilities （P<0.05， P<0.01）， with reduced neuronal damage and increased neurons （P<0.05， P<0.01）. In addition， the two groups showed down-regulation in the mRNA level of GSK-3β （P<0.01） and up-regulation in the mRNA levels of PI3K， Akt， CREB， and Bcl-2 and the protein levels of p-PI3K， p-Akt， p-GSK-3β， p-CREB， and Bcl-2 （P<0.05， P<0.01）. There were no statistically significant differences between the blank control and sham operation groups in terms of the learning and memory abilities， neuron count， and mRNA and protein levels of PI3K/Akt/GSK-3β pathway-related factors. ConclusionJuA can ameliorate the cognitive impairment in the rat model of VCI by activating the PI3K/Akt signaling pathway， reducing the apoptosis of hippocampal neurons， and alleviating the hippocampal neuronal damage.

Objective:To evaluate the efficacy and safety of nebulized inhalation of recombinant human interferon (IFN) α1b injection in the treatment of respiratory syncytial virus (RSV) associated lower respiratory tract infections (pneumonia and bronchiolitis) in children.Methods:A randomized, double-blind, parallel, placebo-controlled add-on design was used.Children with pneumonia or bronchiolitis aged 2 months to 5 years who tested positive for RSV antigen within 72 hours of onset from 30 clinical trial sites including Beijing Children′s Hospital, Capital Medical University between February 2021 and December 2022 were included in this study and randomly divided into 2 groups at a ratio of 1∶1 based on a stratified-block method.Both groups received basic treatments such as cough control, asthma relieving, expectorant treatment, fever reduction, oxygen therapy, etc.The experimental group received additional nebulized inhalation of IFN α1b injection at a dose of 2.0 μg/(kg·time), twice a day.The control group received nebulized inhalation of placebo twice a day.Clinical efficacy was evaluated based on indicators such as the duration of clinical symptoms and signs, and the Kaplan-Meier method was used to calculate the median and 95% CI of the duration of clinical symptoms and signs.The Log-rank test was used to compared data between groups.Safety was assessed through the incidence of adverse reactions and laboratory tests, and the Chi-square test was used to analyze the difference between groups. Results:There were 123 children in the experimental group and 122 children in the control group.The median durations of all the 5 clinical symptoms and signs [including shortness of breath, wheezing, dyspnea (visible retractions), decreased transcutaneous oxygen saturation, and abnormal mental state] in the experimental group after treatment were slightly shortened than those in the control group [2.7 d(95% CI: 1.9-3.0 d)] vs.[2.9 d(95% CI: 2.6-3.6 d), P=0.027].The improvement in dyspnea (retractions) was especially pronounced in the experimental group, with a relief rate of 50.0% (0, 100%) on the first day of administration[compared with 0 (0, 50.0%) in the control group ( Z=2.002, P=0.025)].The median duration of dyspnea in the experimental group was nearly 1 day shorter than that in the control group [1.0 d(95% CI: 0.7-1.7 d) vs.1.8 d(95% CI: 1.0-2.5 d), P=0.046].There were no significant difference in hospital stay [6.0(5.0, 8.0) d vs.6.5(5.0, 8.0) d, Z=0.675, P=0.500], oxygen therapy duration [32.0(14.0, 96.3) h vs.39.0 (24.0, 83.2) h, Z=0.094, P=0.925], the recovery rate from clinical symptoms during treatment [(105/106, 99.1%) vs.(96/101, 95.0%)], and recurrence rate [(0/106, 0) vs.(2/101, 2.0%)] between the 2 groups (all P>0.05).However, the above-mentioned four indicators in the experimental group showed a trend of clinical benefits.The quantitative virus detection results showed that the RSV viral load in both groups decreased after treatment compared to before treatment.After 2 days of treatment, the decline rate of RSV viral load from the baseline was 0.90 lg copies/(mL·d) in the experimental group and 0.25 lg copies/(mL·d)in the control group, with a statistically significant difference ( P<0.05).Furthermore, there was no statistically significant difference in the incidence of adverse reactions between the 2 groups ( P>0.05).Importantly, no drug-related serious adverse reactions occurred in both groups. Conclusions:The nebulized inhalation therapy of IFN α1b demonstrates efficacy and safety in treating pediatric RSV associated lower respiratory tract infections.It particularly offers outstanding clinical therapeutic value for severe children.

Objective:To evaluate the effect of an opioid-sparing anesthesia strategy primarily using quadratus lumborum block combined with esketamine on early postoperative recovery in patients undergoing laparoscopic radical resection of colon cancer.Methods:This study was a randomized controlled trial. From January 2023 to July 2024, 72 patients of either sex, aged 45-65 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective laparoscopic radical resection of colon cancer with general anesthesia at Yichang Central People′s Hospital, were divided into 2 groups ( n=36 each) using a random number table method: control group (group C) and opioid-sparing anesthesia strategy group (group D). Anesthesia was induced with sufentanil and propofol and maintained with propofol and remifentanil in group C. In group D, ultrasound-guided quadratus lumborum block was performed before the start of anesthesia, and anesthesia was induced with esketamine, propofol and lidocaine and maintained with esketamine, propofol, low-dose remifentanil, lidocaine and magnesium sulfate. Patient-controlled intravenous analgesia was carried out at the end of surgery until 48 h postoperatively, using dezocine for rescue analgesia. The Quality of Recovery-15 scores were assessed and recorded at 1 day before operation and 1, 3 and 7 days after operation. Ramsay sedation scores were recorded at 2, 6, 12, 24 and 48 h after surgery. The effective pressing times of patient-controlled analgesia and requirement for rescue analgesia were recorded within 24 h after surgery and during the 24-48 h postoperative period. The intraoperative consumption of opioid, emergence time, duration of postanesthesia care unit stay, time to first flatus, first ambulation time and length of postoperative hospital stay were also recorded. The postoperative complications were recorded during hospital stay and assessed with the Clavien-Dindo classification. Results:Compared with group C, the Quality of Recovery-15 scores were significantly increased at each time point after operation, Ramsay sedation scores were increased at 2, 6 and 12 h after operation, the effective pressing times of patient-controlled analgesia and rate of rescue analgesia were decreased in each postoperative period, the intraoperative consumption of remifentanil was reduced, the time to first flatus, first ambulation time and length of postoperative hospital stay were shortened, the incidence of nausea and vomiting was decreased ( P<0.05), and no significant change was found in the emergence time or duration of postanesthesia care unit stay in group D ( P>0.05). Conclusions:The opioid-sparing anesthesia strategy primarily using quadratus lumborum block combined with esketamine can raise the quality of early postoperative recovery in the patients undergoing laparoscopic radical resection of colon cancer.

Objective To systematically evaluate of the effect of autoimmune diseases(AIDs)on early spontaneous abortion(ESA).Methods Several databases such as Ovid and Web of Science were searched from January 2000 to May 2024 for retrospective analysis.Furthermore,subgroup analysis was conducted in terms of AIDs,continent and assisted reproduction.Results Total of 73 eligible studies were included in this study.There was a statistically significant difference in the risk of ESA between the population with AIDs and the population with normal pregnancy(OR=1.832,95％CI:1.619-2.073).When subgroup studies of AIDs were performed,the increased risk of ESA in patients with some AIDs was statistically significant:e.g.,thyroid autoimmunity,antiphospholipid syndrome,systemic lupus erythematosus,desiccation syndrome,antinuclear antibody positivity and rheumatoid arthritis.While the impact of some AIDs on ESA was still uncertain,e.g.inflammatory bowel disease,ulcerative colitis,Crohn's disease,autoimmune skin diseases,neuromyelitis optica spectrum disorders.In addition,patients with antiphospholipid syndrome who had underwent assisted reproductive technologies were at higher risk of ESA.Furthermore,compared to other continents,there is a difference in the risk of ESA in patients with AIDs in Africa.Conclusion AIDs are associated with the risk of ESA.

Objective:To evaluate the effect of an opioid-sparing anesthesia strategy primarily using quadratus lumborum block combined with esketamine on early postoperative recovery in patients undergoing laparoscopic radical resection of colon cancer.Methods:This study was a randomized controlled trial. From January 2023 to July 2024, 72 patients of either sex, aged 45-65 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective laparoscopic radical resection of colon cancer with general anesthesia at Yichang Central People′s Hospital, were divided into 2 groups ( n=36 each) using a random number table method: control group (group C) and opioid-sparing anesthesia strategy group (group D). Anesthesia was induced with sufentanil and propofol and maintained with propofol and remifentanil in group C. In group D, ultrasound-guided quadratus lumborum block was performed before the start of anesthesia, and anesthesia was induced with esketamine, propofol and lidocaine and maintained with esketamine, propofol, low-dose remifentanil, lidocaine and magnesium sulfate. Patient-controlled intravenous analgesia was carried out at the end of surgery until 48 h postoperatively, using dezocine for rescue analgesia. The Quality of Recovery-15 scores were assessed and recorded at 1 day before operation and 1, 3 and 7 days after operation. Ramsay sedation scores were recorded at 2, 6, 12, 24 and 48 h after surgery. The effective pressing times of patient-controlled analgesia and requirement for rescue analgesia were recorded within 24 h after surgery and during the 24-48 h postoperative period. The intraoperative consumption of opioid, emergence time, duration of postanesthesia care unit stay, time to first flatus, first ambulation time and length of postoperative hospital stay were also recorded. The postoperative complications were recorded during hospital stay and assessed with the Clavien-Dindo classification. Results:Compared with group C, the Quality of Recovery-15 scores were significantly increased at each time point after operation, Ramsay sedation scores were increased at 2, 6 and 12 h after operation, the effective pressing times of patient-controlled analgesia and rate of rescue analgesia were decreased in each postoperative period, the intraoperative consumption of remifentanil was reduced, the time to first flatus, first ambulation time and length of postoperative hospital stay were shortened, the incidence of nausea and vomiting was decreased ( P<0.05), and no significant change was found in the emergence time or duration of postanesthesia care unit stay in group D ( P>0.05). Conclusions:The opioid-sparing anesthesia strategy primarily using quadratus lumborum block combined with esketamine can raise the quality of early postoperative recovery in the patients undergoing laparoscopic radical resection of colon cancer.

Objective:To evaluate the efficacy and safety of nebulized inhalation of recombinant human interferon (IFN) α1b injection in the treatment of respiratory syncytial virus (RSV) associated lower respiratory tract infections (pneumonia and bronchiolitis) in children.Methods:A randomized, double-blind, parallel, placebo-controlled add-on design was used.Children with pneumonia or bronchiolitis aged 2 months to 5 years who tested positive for RSV antigen within 72 hours of onset from 30 clinical trial sites including Beijing Children′s Hospital, Capital Medical University between February 2021 and December 2022 were included in this study and randomly divided into 2 groups at a ratio of 1∶1 based on a stratified-block method.Both groups received basic treatments such as cough control, asthma relieving, expectorant treatment, fever reduction, oxygen therapy, etc.The experimental group received additional nebulized inhalation of IFN α1b injection at a dose of 2.0 μg/(kg·time), twice a day.The control group received nebulized inhalation of placebo twice a day.Clinical efficacy was evaluated based on indicators such as the duration of clinical symptoms and signs, and the Kaplan-Meier method was used to calculate the median and 95% CI of the duration of clinical symptoms and signs.The Log-rank test was used to compared data between groups.Safety was assessed through the incidence of adverse reactions and laboratory tests, and the Chi-square test was used to analyze the difference between groups. Results:There were 123 children in the experimental group and 122 children in the control group.The median durations of all the 5 clinical symptoms and signs [including shortness of breath, wheezing, dyspnea (visible retractions), decreased transcutaneous oxygen saturation, and abnormal mental state] in the experimental group after treatment were slightly shortened than those in the control group [2.7 d(95% CI: 1.9-3.0 d)] vs.[2.9 d(95% CI: 2.6-3.6 d), P=0.027].The improvement in dyspnea (retractions) was especially pronounced in the experimental group, with a relief rate of 50.0% (0, 100%) on the first day of administration[compared with 0 (0, 50.0%) in the control group ( Z=2.002, P=0.025)].The median duration of dyspnea in the experimental group was nearly 1 day shorter than that in the control group [1.0 d(95% CI: 0.7-1.7 d) vs.1.8 d(95% CI: 1.0-2.5 d), P=0.046].There were no significant difference in hospital stay [6.0(5.0, 8.0) d vs.6.5(5.0, 8.0) d, Z=0.675, P=0.500], oxygen therapy duration [32.0(14.0, 96.3) h vs.39.0 (24.0, 83.2) h, Z=0.094, P=0.925], the recovery rate from clinical symptoms during treatment [(105/106, 99.1%) vs.(96/101, 95.0%)], and recurrence rate [(0/106, 0) vs.(2/101, 2.0%)] between the 2 groups (all P>0.05).However, the above-mentioned four indicators in the experimental group showed a trend of clinical benefits.The quantitative virus detection results showed that the RSV viral load in both groups decreased after treatment compared to before treatment.After 2 days of treatment, the decline rate of RSV viral load from the baseline was 0.90 lg copies/(mL·d) in the experimental group and 0.25 lg copies/(mL·d)in the control group, with a statistically significant difference ( P<0.05).Furthermore, there was no statistically significant difference in the incidence of adverse reactions between the 2 groups ( P>0.05).Importantly, no drug-related serious adverse reactions occurred in both groups. Conclusions:The nebulized inhalation therapy of IFN α1b demonstrates efficacy and safety in treating pediatric RSV associated lower respiratory tract infections.It particularly offers outstanding clinical therapeutic value for severe children.

Objective To systematically evaluate of the effect of autoimmune diseases(AIDs)on early spontaneous abortion(ESA).Methods Several databases such as Ovid and Web of Science were searched from January 2000 to May 2024 for retrospective analysis.Furthermore,subgroup analysis was conducted in terms of AIDs,continent and assisted reproduction.Results Total of 73 eligible studies were included in this study.There was a statistically significant difference in the risk of ESA between the population with AIDs and the population with normal pregnancy(OR=1.832,95％CI:1.619-2.073).When subgroup studies of AIDs were performed,the increased risk of ESA in patients with some AIDs was statistically significant:e.g.,thyroid autoimmunity,antiphospholipid syndrome,systemic lupus erythematosus,desiccation syndrome,antinuclear antibody positivity and rheumatoid arthritis.While the impact of some AIDs on ESA was still uncertain,e.g.inflammatory bowel disease,ulcerative colitis,Crohn's disease,autoimmune skin diseases,neuromyelitis optica spectrum disorders.In addition,patients with antiphospholipid syndrome who had underwent assisted reproductive technologies were at higher risk of ESA.Furthermore,compared to other continents,there is a difference in the risk of ESA in patients with AIDs in Africa.Conclusion AIDs are associated with the risk of ESA.

This study aimed at conducting retrospective analysis of the clinical symptoms and genetic mutations in 20 children with Gitelman syndrome treated at the Affiliated Children′s Hospital of Nanjing Medical University from August 2015 to November 2022 and also explored the molecular mechanism of the pathogenic high-frequency mutation D486N in the Chinese population.

ObjectiveTo analyze the epidemic characteristics of measles and rubella in Pudong New Area of Shanghai from 2013 to 2022， and to provide data support for the elimination of measles and rubella. MethodsEnzyme linked immunosorbent assay was used to detect IgM antibodies in serum samples. The sequence of 630 nucleotides at the C-terminal of N gene of measles virus was amplified by reverse transcription-polymerase chain reaction and the phylogenic tree was constructed. ResultsA total of 1 529 suspected cases of measles were detected from 2013 to 2022， among which the positive rate of measles IgM antibody was 33.55% （513/1 529）. The highest positive rate （20.73%） was from March to May ， and the positive rate of rubella IgM antibody was 6.80% （104/1 529）. The positive rate of both IgM was higher in males than that in females （P<0.05）. The IgM against measles was mainly detected in 0‒ years old （63.16%， 96/152） and 20‒ years old （45.61%， 161/353）. The IgM against rubella was mainly detected in 10‒20 years old （27.27%， 18/66）. The IgM antibody could be detected more easily from 4 to 28 days after eruption， and the IgM antibody positive rate of measles/rubella from 2020 to 2022 was significantly lower than previous years （2013‒2019）. There were 2 D8 genotype strains， and the rest were H1a gene subtypes. ConclusionThe positive rate of IgM antibodies against measles/rubella in Pudong New Area of Shanghai decreased significantly. People aged 0‒ years and 20‒ years old are more susceptible to measles， and rubella is concentrated in 10‒ years old. It is necessary to strengthen the vaccination of school-age children， in order to achieve the goal of eliminating measles. The age group with high risk of exposure should be checked for vaccination status to ensure the enhanced immunization， and the surveillance of imported measles cases should be strengthened.