The clinical data of 2 pediatric patients with atypical hemolytic uremic syndrome (aHUS) who were admitted to the Department of Nephrology at the Children′s Hospital of Nanjing Medical University on July 2018 to June 2023 were retrospectively analyzed.Both patients had combined CFH and CD46 gene mutations.One patient, a 2-year-old boy, presented jaundice and darkened urine following mumps.The other patient, a 7-month-old girl and the younger sister of the boy, developed fever, cough, vomiting, and thrombocytopenia without any apparent cause.Laboratory tests revealed hemolytic anemia, thrombocytopenia, and acute kidney injury in both patients.The genetic test results revealed mutations in both CFH (c.3572C>T, p.Ser1191Leu) and CD46 genes (c.293C>T, p.Thr98Ile) in both patients.The patients′ mother is a heterozygous carrier of the CFH gene mutation, while their father is a heterozygous carrier of the CD46 gene mutation.Both parents exhibit normal phenotypes and are currently receiving regular infusions of Eculizumab.The pediatric aHUS caused by combined CFH and CD46 gene mutations is reported in this study for the first time in China.The clinical features of these patients are summarized and analyzed.

Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2(Lp-PLA2)and homocysteine(Hcy)combined with white matter hyperintensities(WMH)for cognitive impairment in patients with cerebral small vessel disease(CSVD).Methods A total of 240 patients with CSVD were selected.According to the Montreal Cognitive Assessment(MoCA)scale,all subjects were divided into the non-cognitive impairment group(MoCA≥26 points,120 cases)and the cognitive impairment group(MoCA＜26 points,120 cases).Paraventricular white matter high signal(PWMHs)and deep white matter high signal(DWMHs)were scored by Fazekas scale.The sum of the two parts was the total score,and the severity of DWMHs was graded by the score.The basic information,serum Lp-PLA2,Hcy level and severity of WMH were compared between the two groups.Logistic regression was applied to analyze influencing factors of cognitive impairment in CSVD patients.The predictive value of serum level of Lp-PLA2 and Hcy and WMH for cognitive impairment in CSVD patients was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the non-cognitive impairment group,patients of the cognitive impairment group were older,had higher serum levels of Lp-PLA2 and Hcy,and had more severe of WMH(P＜0.05).Results of Logistic regression analysis showed that serum Lp-PLA2,Hcy levels and severity of WMH were influencing factors for cognitive impairment of patients with CSVD(P＜0.05).The results of ROC curve analysis showed that the area under the curve of serum Lp-PLA2,Hcy level combined with severity of WMH predicting cognitive impairment in patents with CSVD was 0.812,the sensitivity was 81.7%and the specificity was 71.7%(P＜0.05).Conclusion Patients with cognitive impairment caused by CSVD have higher serum levels of Lp-PLA2 and Hcy,and more severe WMH.The combination of the three has a relatively high predictive value for cognitive impairment in patents with CSVD.

Objective:To construct a shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach and to explore its effectiveness.Methods:The first draft of the shoulder and neck functional exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach was constructed through literature review, and two rounds of expert consultation were conducted with 20 experts to determine the final draft of the program with the results of the pretest. A total of 98 patients who underwent endoscopic thyroidectomy by a gasless unilateral axillary approach in the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from September 2023 to January 2024 were selected for the study using the convenience sampling method. Patients from September to December 2023 were set up as control group and patients from October 2023 to January 2024 were set up as experimental group, with 49 patients in each group. Control group implemented routine nursing, and experimental group received the shoulder and neck functional exercise program developed in this study on the basis of control group. Constant-Murley Score score, occurrence of numbness in the chest wall access area, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire scores in cancer patients were compared between the two groups at one week, one month, and three months post-intervention.Results:In the two rounds of expert consultation, the effective questionnaire recovery rates were 85.00% (17/20) and 94.12% (16/17), and the coefficient of the expert familiarity was 0.938, the coefficient of basis of judgment was 0.891, and the coefficient of authority was 0.915. The coefficients of variation for the importance ratings of the entries in the second round of consultation were 0.096 to 0.190 and Kendall's harmony coefficient was 0.155 ( P<0.01). The shoulder and neck function exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach included three first-level items, five second-level items, and 13 third-level items. At one week post-intervention, the difference in occurrence of numbness in the chest wall access area was statistically significant in both groups ( P<0.05). At one month post-intervention, the differences in shoulder function scores, occurrence of numbness in the chest wall access area, and quality of life scores between the two groups were statistically significant (all P<0.05). At three months post-intervention, the differences in shoulder function scores and quality of life scores between the two groups were statistically significant (all P<0.05) . Conclusions:The shoulder and neck function exercise program for patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach has certain scientific validity and feasibility, which can improve the shoulder and neck function of patients undergoing endoscopic thyroidectomy by axillary approach, reduce the numbness in the chest wall access area, and improve the quality of life of the patients in the postoperative period.

Objective We aimed to evaluate the efficacy and safety of Shengxuebao Mixture in the treatment of cancer-related anemia(CRA)presenting with syndrome of deficiency of liver and kidney combined with syndrome of deficiency of both qi and blood.Methods A randomized,double-blind,placebo-controlled,multicenter clinical trial was conducted.Eligible patients with malignant tumors meeting the inclusion and exclusion criteria were enrolled from 26 hospitals,including Dongzhimen Hospital,Beijing University of Chinese Medicine,Xiaogan Central Hospital,and Yangzhou Hospital of Traditional Chinese Medicine,from June 1,2022,to September 30,2024.Patients were allocated 1:1 to either the experimental group receiving Shengxuebao Mixture or the control group receiving its simulator(placebo)using a block randomization method under double-blind conditions.Both groups received 15 mL orally three times daily for 28 consecutive days.The primary efficacy indicators included the hemoglobin(Hb)improvement rate(RHb)and the traditional Chinese medicine(TCM)syndrome improvement rate(RTCM)at week 4 of treatment.The secondary efficacy indicators encompassed Hb and red blood cell(RBC)count,Karnofsky Performance Status(KPS)score,TCM syndrome score,individual TCM symptom scores,and changes in each of these indicators compared to the baseline period at weeks 2,4,and 6 of treatment.Safety evaluations were conducted at week 4 of treatment.Results A total of 239 patients were enrolled,with 225 cases included in the Full Analysis Set(FAS)(109 in the experimental group vs.116 control group),163 in the Per Protocol Set(PPS)(77 vs.86),and 225 in the Safety Set(SS)(109 vs.116).Baseline characteristics between groups showed no significant differences.Significant differences were observed between the experimental and control groups in RHb at week 4(FAS:49.51%vs.35.24%,P<0.05;PPS:53.25%vs.36.05%,P<0.05)and RTCM at week 4(FAS:61.54%vs.39.62%,P<0.01;PPS:64.94%vs.40.70%,P<0.01).At weeks 2,4,and 6,the experimental group showed greater improvements in Hb and RBC counts than the control group.Additionally,the TCM syndrome scores were lower in the experimental group than in the control group at these time points.Except for week 2 in PPS,the KPS improvement was better in the experimental group than in the control group(P<0.05).The experimental group also demonstrated a greater reduction in scores for individual TCM symptoms such as spiritlessness and weakness,poor appetite and reduced food intake at weeks 4 and 6 compared to the control group(P<0.05,P<0.01).Furthermore,the reduction in vertigo score was more pronounced in the experimental group at week 6(P<0.01).For the score of pale and lusterless complexion,only in the PPS was the reduction from baseline more significant in the experimental group than in the control group at weeks 4 and 6(P<0.05).No significant differences were observed between the experimental and control groups in the incidence of all adverse events or drug-related adverse reactions.Conclusion Shengxuebao Mixture demonstrates significant efficacy in patients with CRA presenting syndrome of deficiency of liver and kidney combined with syndrome of deficiency of both qi and blood,effectively increasing Hb levels,ameliorating TCM syndromes,alleviating clinical symptoms,and enhancing functional status,with no significant difference in adverse drug reactions compared to the placebo.

Purpose To investigate the application value of cardiac magnetic resonance tissue tracking imaging in assessing early heart failure(HF)in plateau environment.Materials and Methods Thirty male SD rats were randomly divided into 10 in the control group and 20 in the experimental group.The rats in the experimental group were transported to the Qinghai Plateau laboratory(average altitude 4 250 metre)for eight weeks of exposure,and then divided into the plateau hypoxia group and the plateau HF group,and the HF group was treated with 5 mg/ml Isoprenaline 10 mg/(kg·d)subcutaneously for 14 consecutive days to establish a HF rat model.The rats were then transported back to the plains(average elevation 500 metre)for 7T cardiac magnetic resonance movie sequence scanning.Cardiac function parameters and myocardial strain parameters were obtained using CVI 42 software.Myocardial pathological changes were detected using HE staining and Masson trichrome staining.Serum levels of malondialdehyde and glutathione peroxidase were detected by enzyme-linked immunosorbent assay.Western blot and PCR were used to detect the expression of nuclear factor-E2-related factor 2(NRF2)and heme oxygenase 1(HO-1)in myocardial tissues.Results Left ventricular ejection fraction was reduced in the HF group compared with the control group[(67.06±4.66)%vs.(61.91±2.11)%;F=4.149,P=0.037],and overall left ventricular circumferential strain was significantly reduced in the HF group compared with the control group[(-24.60±0.81)%vs.(-20.16±1.86)%;F=12.241,P=0.001],and pathologic staining showed necrosis as well as interstitial fibrosis in cardiomyocytes.Enzyme-linked immunosorbent assay results showed decreased glutathione peroxidase levels in the HF group[(1 079.94±70.58)U vs.(311.99±39.47)U;F=209.294,P=0.001]and increased malondialdehyde in the HF group compared with those in the control group[(7.24±2.48)μmol/L vs.(53.28±4.51)μmol/L;F=156.39,P=0.010).Western blot results showed significantly lower NRF2 and HO-1 expression in myocardial tissues of the HF group compared with those in the control group(1.00±0.00 vs.0.52±0.13;F=26.607,P=0.001).PCR results showed significantly lower NRF2 and HO-1 mRNA expression in myocardial tissues of the HF group compared with those in the control group(1.19±0.16 vs.0.31±0.07;F=84.784,P=0.010).Conclusion Magnetic resonance tissue tracking imaging can be used for early assessment of HF caused by plateau environment.

Purpose To quantitatively evaluate myocardial three-dimensional strains using cardiac magnetic resonance feature tracking,investigate whether ferroptosis contributes to myocardial injury in experimental autoimmune myocarditis(EAM),and explore the relationship between strains and ferroptosis biomarkers.Materials and Methods EAM was induced in Lewis rats via subcutaneous injections with porcine cardiac myosin emulsified in same amount of complete Freund's adjuvant.Both EAM(n=15)and control(n=15)rats underwent 7T cardiac magnetic resonance and were euthanatized at day 21.Cardiac magnetic resonance assessments included left ventricular function and strains.The cardiac damage and ferroptosis-related markers were measured with histopathology,serology,Western blot and polymerase chain reaction.Results The left ventricular ejection fraction declined in the rats post-immunization with porcine cardiac myosin at day 21(t=7.86,P<0.001).Global,basal,middle and apical strains encompassing radial strain,circumferential strain and longitudinal strain were significantly lower in the EAM group compared to the control group(t=2.61-10.45,P<0.05).Cardiac and inflammatory biomarkers,including lactate dehydrogenase,cardiac troponin I and interferon γ indicated myocardial injury in EAM group compared to the control group(t=16.54,21.20,16.06,all P<0.001).Prussian blue staining revealed iron overload in EAM group.Compared to the control group,malondialdehyde and reactive oxygen significantly increased in EAM group(t=15.75,3.47,both P<0.01),and superoxide dismutase were significantly decreased(t=14.21,P<0.001).Western blot and histopathology showed that the protein expression of ferritin heavy chain was significantly higher in the EAM group compared to the control group(t=5.15,P<0.01).The solute carrier family 7 member 11/glutathione/glutathione peroxidase 4 axis was down regulated at serum,mRNA and protein expression levels in EAM group(t=7.73-30.14,all P<0.001).Global circumferential and longitudinal strains were significantly associated with ferroptosis biomarkers(r=-0.854-0.829,all P<0.05).Conclusion Cardiac magnetic resonance feature tracking has the potential to quantitatively evaluate myocardial damage of EAM which involves ferroptosis.The strains are related with ferroptosis biomarkers.

Objective To explore the therapeutic effect of precise disconnection of pargastric varices guided by endoscopic ultrasound in the treatment of esophagogastric variceal bleeding.Method A retrospective analysis was conducted on 20 patients with cirrhosis esophagogastric variceal bleeding treated with endoscopic ultrasound-guided precise disconnection of pargastric varices from January 1,2024 to December 31,2024.The efficacy was analyzed.Result All 20 patients successfully completed the precise disconnection of pargastric varices under the guidance of endoscopic ultrasound.The injection of tissue gel combined with the placement of spring coils(14 cases)and the injection of tissue gel alone(4 cases)successfully blocked the pargastric varices.All patients did not experience perforation,esophageal and cardia stenosis,massive bleeding,septicemia,or ectopic embolization.One patient who received tissue gel alone had slight bleeding from the pargastric varices after surgery and improved after 3 days of treatment to reduce portal vein pressure.Another one patient who received tissue gel alone had a low-grade fever and normal body temperature after 3 days of anti-infection treatment.Conclusion Precise disconnection of pargastric varices under the guidance of endoscopic ultrasound has a good therapeutic effect on esophagogastric variceal bleeding,with fewer complications such as ectopic embolization,massive bleeding,infection,and perforation.However,close follow-up observation is still needed to address the issue of pargastric varices.

Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2(Lp-PLA2)and homocysteine(Hcy)combined with white matter hyperintensities(WMH)for cognitive impairment in patients with cerebral small vessel disease(CSVD).Methods A total of 240 patients with CSVD were selected.According to the Montreal Cognitive Assessment(MoCA)scale,all subjects were divided into the non-cognitive impairment group(MoCA≥26 points,120 cases)and the cognitive impairment group(MoCA＜26 points,120 cases).Paraventricular white matter high signal(PWMHs)and deep white matter high signal(DWMHs)were scored by Fazekas scale.The sum of the two parts was the total score,and the severity of DWMHs was graded by the score.The basic information,serum Lp-PLA2,Hcy level and severity of WMH were compared between the two groups.Logistic regression was applied to analyze influencing factors of cognitive impairment in CSVD patients.The predictive value of serum level of Lp-PLA2 and Hcy and WMH for cognitive impairment in CSVD patients was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the non-cognitive impairment group,patients of the cognitive impairment group were older,had higher serum levels of Lp-PLA2 and Hcy,and had more severe of WMH(P＜0.05).Results of Logistic regression analysis showed that serum Lp-PLA2,Hcy levels and severity of WMH were influencing factors for cognitive impairment of patients with CSVD(P＜0.05).The results of ROC curve analysis showed that the area under the curve of serum Lp-PLA2,Hcy level combined with severity of WMH predicting cognitive impairment in patents with CSVD was 0.812,the sensitivity was 81.7%and the specificity was 71.7%(P＜0.05).Conclusion Patients with cognitive impairment caused by CSVD have higher serum levels of Lp-PLA2 and Hcy,and more severe WMH.The combination of the three has a relatively high predictive value for cognitive impairment in patents with CSVD.

Objective:To analyze the clinical characteristics of the Chikungunya fever outbreak in Shunde District, Foshan City, Guangdong Province in July 2025 and the risk factors associated with delayed viral RNA clearance.Methods:A total of 562 patients with Chikungunya fever admitted to three designated hospitals in Shunde District from July 10 to 30, 2025 were enrolled. Demographic data, clinical manifestations, and laboratory findings were collected. Patients were categorized into four age groups including minors (<18 years), young adults (18 to 39 years), middle-aged adults (40 to 64 years) and elderly adults (≥65 years). The differences of clinical characteristics among these age groups were analyzed. Intergroup comparisons were performed using chi-square test, one-way analysis of variance, or Kruskal-Wallis H test. Pairwise comparisons between groups were conducted using the Bonferroni or Games-Howell or Dunn method. Binary logistic regression was employed to analyze risk factors associated with delayed viral RNA clearance (>7 days). Results:The mean age of the 562 enrolled Chikungunya fever patients was (44.8±21.3) years. Fever, arthralgia and rash were the three core symptoms, with incidence rates of 87.5% (492/562), 88.4%(497/562) and 69.6%(391/562), respectively. At discharge, only 54.1%(304/562) of patients achieved complete symptom resolution, while 26.5%(149/562) still had arthralgia and 36.1%(203/562) had residual rash. Significant differences were observed among age groups in the incidence of fever ( χ2=9.43, P=0.024), peak body temperature ( F=6.54, P<0.001), incidence of arthralgia ( χ2=26.89, P<0.001), duration of arthralgia ( F=12.68, P=0.001), incidence of rash ( χ2=68.99, P<0.001), rate of residual rash at discharge ( χ2=32.37, P<0.001), lymphocyte count ( F=12.94, P<0.001), platelet count ( F=14.95, P<0.001), and C-reactive protein levels (CRP) ( H=94.18, P<0.001). Further pairwise comparisons revealed that compared to the middle-aged and elderly groups, the minor group had a higher incidence of fever and a lower incidence of arthralgia, and the duration of arthralgia was shorter than the elderly group (all P<0.008 3). Compared with the other three groups, the elderly group had lower incidence and residual rate of rash, and lower platelet counts (all P<0.008 3), and higher levels of CRP (all P<0.05). The elderly group had lower lymphocyte counts compared to the minor and young adult groups (both P<0.05). Significant differences were found among age groups in the time to viral RNA clearance ( F=5.77, P=0.003) and length of hospital stay ( F=11.64, P<0.001), with the elderly group having significantly longer duration for both compared to the other three groups (all P<0.05). Multivariate analysis showed that advanced age (odds ratio ( OR)=1.049, 95% confidence interval ( CI) 1.015 to 1.083), longer duration of fever ( OR=1.529, 95% CI 1.086 to 2.155) and longer duration of arthralgia ( OR=1.927, 95% CI 1.318 to 2.817) were independent risk factors for delayed viral RNA clearance (all P<0.05). Conclusions:Patients with Chikungunya fever in Shunde District primarily present with fever, arthralgia and rash. The incidence and characteristics of these three core symptoms show age-related variations. Elderly patients and those with longer durations of fever or arthralgia are more likely to experience delayed viral clearance.

Objective:To explore the relationship between the morphology of the carotid siphon, its related risk factors, and cerebral blood flow perfusion in patients with arteriosclerotic cerebral small vessel disease (aCSVD), and provide imaging evidence for the etiology of aCSVD.Methods:A total of 130 aCSVD patients hospitalized in the Department of Neurology of the First People′s Hospital of Hefei from March 2022 to June 2024, all of whom underwent multimodal imaging assessments, were enrolled. The baseline data were collected, and the morphology of the carotid siphon was visually evaluated using post-processing of head and neck computed tomography angiography (CTA), which was categorized into U-type ( n=63), C-type ( n=32), and V-type ( n=35). Calcification degree was semi-quantitatively assessed based on transverse CTA images. Cerebral perfusion was measured using magnetic resonance arterial spin labeling. The relationship between different siphon segment morphologies, calcification degrees, their risk factors, and cerebral blood flow perfusion was analyzed using analysis of variance and multinomial Logistic regression. Results:Univariate analysis of the 3 siphon types showed significant differences in low-density lipoprotein cholesterol [U-type (2.44±0.84) mmol/L,V-type (2.21±0.57) mmol/L, C-type (2.89±1.07) mmol/L, F=5.578, P=0.005], calcification degree [Among the 63 cases in the U-type group, 19 cases (30.15%) had mild calcification, 20 cases (31.75%) had moderate calcification, and 24 cases (38.10%) had severe calcification; among the 35 cases in the V-type group, 20 cases (57.14%) had mild calcification, 10 cases (28.57%) had moderate calcification, and 5 cases (14.29%) had severe calcification; among the 32 cases in the C-type group, 12 cases (37.50%) had mild calcification, 14 cases (43.75%) had moderate calcification, and 6 cases (18.75%) had severe calcification; χ2=13.092, P=0.011], and total aCSVD load [modified aCSVD load score: U-type 4.00(1.00, 4.00),V-type 3.00(1.00, 4.00),C-type 2.00(2.00, 4.00), H=9.997, P=0.007]. Multivariate Logistic regression revealed that patients with U-shaped siphons had a significantly higher overall aCSVD load than those with C-shaped siphons, with a regression coefficient of 0.728, and a statistically significant difference ( OR=2.070 ,95% CI 1.026-4.178, P=0.042). Additionally, total brain and white matter cerebral blood flow were decreased in patients with U-type siphons compared to those with C-type and V-type, primarily involving bilateral superior frontal gyri, left orbital frontal gyrus, and left straight gyrus regions (false discovery rate correction, P<0.05). Conclusions:The imaging manifestations of aCSVD are closely related to the shape of the internal carotid artery siphon.The U type siphon is more likely to lead to hemodynamic changes, resulting in decreased global and regional cerebral blood flow, and demonstrating a higher overall burden of aCSVD, which has certain clinical reference value for assessing the etiology of aCSVD.