Hypokalemia,a common clinical electrolyte disorder,can affect multiple systems and can be life-threatening in severe cases.Identifying the cause of hypokalemia is crucial for its prevention and treatment.However,the etiology of hypokalemia is complex and often requires detailed differential diagnosis.This article reports a rare clinical case of hypokalemia caused by long-term excessive consumption of strong tea and discusses its pathogenesis.The aim is to raise clinical awareness and understanding of the etiology of such cases of hypokalemia and reduce misdiagnosis and missed diagnosis.

Gyrovirus galga1(GyVg1)and gyrovirus homsa1(GyH1)are two newly discovered cir-coviruses that can cause symptoms related to transmissible viral proventriculitis of chickens.These viruses have been reported in various regions worldwide.This research aims to establish a duplex real-time PCR assay capable of identifying and detecting GyVg1 and GyH1.Specific primers and probes were designed based on the conserved regions of GyVg1 and GyH1 respectively using all genome sequence data currently available in GenBank.After optimizing reaction conditions,the du-plex real-time PCR detection method was established and further validated by comparing it with a conventional PCR assay and sequencing results from an analysis of 256 clinical samples collected in 2023 across eight regions of Nanning,Guangxi.The results showed that GyVg1 and GyH1 could be identified in 1 h by the duplex real-time PCR assay and two pairs of primer probes can amplify effectively but there is no any cross reaction with other pathogens.Besides,the detection limit was determined to be 7.5 copies/μL.The correlation coefficient of standard curves exceeded 0.99,and CV for intra-and inter-assay was less than 0.45％.Based on clinical performance,when the quanti-ty of template was greater than or equal to 100 copies,the agreements between the duplex real-time PCR assay and the conventional PCR assay were 94.3％(GyVg1)and 100％(GyH1).In con-clusion,the newly developed duplex real-time PCR assays exhibited good specificity,sensitivity and repeatability,which could contribute to the rapid detection and differentiation of GyVg1 and GyH1.

Objective:To explore effects and mechanism of Hydroxylsafflower Yellow A(HSYA)on expression of NLRP3 in glial cells after cerebral ischemic injury.Methods:A middle cerebral artery occlusion/reperfusion(MCAO/R)model was established in male SD rats.After successfully modeling for 24 h,Longa scoring and corner test were used to evaluate degree of neurological dys-function.Western blot and immunofluorescence were used to detect expressions of JAK2/STAT3 molecules and NLRP3,ELISA was used to measure IL-1β,IL-6 and TNF-α levels.A glucose-oxygen deprivation/reperfusion(OGD/R)model was established in microg-lia,and JAK2 and STAT3 inhibitor AG490 was used to further verify action of HSYA on NLRP3.Results:Compared with sham group,neurological dysfunction aggravated in MCAO/R group(P<0.01),HSYA treatment improved neurological function(P<0.01).Expres-sions of p-JAK2,p-STAT3 and NLRP3 in MCAO/R group were higher than those in the sham group(P<0.01);and HSYA treatment reduced expressions of p-JAK2,p-STAT3 and NLRP3(P<0.01).Levels of inflammatory factors IL-1β,IL-6 and TNF-α were higher in MCAO/R group than sham group(P<0.01),and HSYA inhibited expressions of IL-1β,IL-6 and TNF-α(P<0.01 or P<0.05).In vi-tro experiments showed expressions of p-JAK2,p-STAT3 and NLRP3 in OGD/R group were significantly higher than normal control group(P<0.01),after adding AG490,phosphorylation of JAK2 and STAT3 decreased,NLRP3 expression was inhibited(P<0.01).Inflammatory cytokines IL-1β,IL-6 and TNF-α levels were higher in OGD/R group than normal control group(P<0.01),and HSYA inhibited expressions of IL-1β,IL-6 and TNF-α(P<0.01 or P<0.05).Conclusion:HSYA alleviates brain damage,probably by regu-lating JAK2/STAT3 signaling pathway and inhibiting NLRP3 expression in microglia after cerebral ischemia and hypoxia.

Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder caused by a combination of genetic and environmental factors.The epigenetic transcriptional modifications after RNA transcription can affect gene expression and glucose homeostasis.N6-methyladenine(m6A),as an RNA methylation modification,plays an important role in the pathogenesis of T2DM.This article reviews the research progress of m6A methylation in T2DM.

Objective To observe the association between afterschool physical exercise and sleep quality among preschool children,and to explore the proper afterschool physical exercise model for better sleep quality.Methods A cross-sectional study was conducted.From Apr to Jun 2024,a total of 1 430 children from three public kindergartens in Minhang district were enrolled to participate in the survey.Parents were invited to complete the basic sociodemographic information,afterschool physical exercise information and the Children's Sleep Habits Questionnaire.One-way ANOVA and linear mixed effects models were used to explore the relationship between afterschool exercise and sleep quality.Results A total of 1 430 questionnaires were sent out and 1 384 were recovered with a recovery rate of 96.78%.Among them 1 366 were valid,with an effective rate of 95.52%.The average age of the children was(5.19±0.87)years old with gender ration of 1.07∶1(male:female).The prevalence of poor sleep quality was 80.60%(regarding a CSHQ total score>41 as cutoff).A one-way ANOVA indicated that time on afterschool physical exercise was significantly associated with sleep duration,Night waking,and sleep onset delay(P<0.05).After adjusting for age,gender,the only child or not,main caregiver,and parental education and occupation,linear mixed effects models showed that engaging in afterschool physical activity for at least 180 mins per week has a statistically significant predictive effect on sleep duration scores(β=-0.50,z=-4.52,95%CI:-0.72,-0.28,P<0.001),night waking scores(β=-0.16,z=-2.34,95%CI:-0.29,-0.02,P=0.020),and sleep onset delay scores(β=-0.14,z=-2.35,95%CI:-0.26,-0.02,P=0.019).Conclusion Afterschool exercise was significantly associated with sleep quality among preschool children in Minhang district of Shanghai.The time≥180 min on afterschool exercise per week in preschool children was significantly positively associated with maintaining sleep duration,reducing night wakings and shortening the latency to fall asleep.The habit of afterschool exercise and the time on afterschool exercise should be emphasized by parents and the society to improve sleep quality among preschool children.

Purpose To explore the clinical value of real-time three-dimensional automatic left atrial quantification technology in evaluating left atrial volume and function in heart failure with preserved ejection fraction(HFpEF).Materials and Methods A total of 65 patients diagnosed as HFpEF at the Fourth Affiliated Hospital of Harbin Medical University from December 2021 to October 2023 were prospectively enrolled.The control group included 65 healthy subjects who underwent ultrasound examination during the same period and were matched with the HFpEF group in terms of age and gender.According to the New York Heart Association(NYHA)cardiac function classification,patients with NYHA grade Ⅰ+Ⅱ were classified into the HFpEF group A,and those with grade Ⅲ+Ⅳ into the HFpEF group B.Relevant clinical data,conventional ultrasound parameters and three-dimensional ultrasound parameters were recorded in both the HFpEF group and the control group.Left atrial volume parameters,longitudinal strain parameters and circumferential strain parameters were analyzed.The area under the receiver operating characteristic curve was used to compare the diagnostic efficacy of left atrial functional parameters for HFpEF.Results Compared with the control group,the HFpEF group exhibited significant abnormalities in cardiac structure and function.Specifically,left ventricular posterior wall thickness,interventricular septal thickness at end-diastole,and mean E/e′ were significantly increased(t=-5.127,-5.886,-16.670,all P<0.05),while the absolute value of left ventricular global longitudinal strain(LVGLS)and septal and lateral mitral annular e′ were significantly decreased(t=-17.092,40.279,45.412,all P<0.05).All left atrial volume parameters were significantly increased,whereas left atrial functional and strain parameters were significantly decreased(t=-13.632-6.912,all P<0.05).Compared with HFpEF group A,HFpEF group B showed lower left atrial total emptying fraction,left atrial expansion index,left atrial contraction strain and absolute value of LVGLS(t=2.062,3.545,-2.189,-2.586),as well as a higher left atrial minimum volume(t=-2.187),respectively(all P<0.05).Left atrial reservoir strain was negatively correlated with N-terminal pro-B-type natriuretic peptide and mean E/e′(r=-0.395,-0.626,both P<0.05),and positively correlated with the absolute value of LVGLS(r=0.602,P<0.05).The LASr and LAEI had high predictive value for HFpEF,with area under the curve of 0.898 and 0.817,cut-off values of 20.5%and 112%,sensitivities of 96.9%and 83.1%,specificities of 75.4%and 78.5%,and Youden indices of 0.723 and 0.616,respectively.Conclusion Real-time three-dimensional automatic left atrial quantification technology enables early and sensitive detection of left atrial dysfunction in HFpEF.Among the parameters derived,LASr(a strain parameter)and LAEI(a functional parameter)exhibit high diagnostic efficacy for HFpEF.

Objective:To investigate the effects of wheat-grain moxibustion at the Guanyuan point on testosterone(T)synthe-sis and the hypothalamic-pituitary-gonadal(HPG)axis in naturally aged mice.Methods:We fed 40 twelve-month-old SPF male C57BL/6J mice with a normal diet for 3 months,randomized them into a moxibustion and an aged group of an equal number,and se-lected 7 four-month-old ones as young controls.We treated the animals of the moxibustion group by wheat-grain moxibustion at the Guanyuan point,once 5 moxibustion sticks,qd,5 times a week,and fed those of the aged group normally,all for 12 weeks.After treatment,we obtained the testicular index of the mice,observed the histomorphology of the testis tissue by HE staining,measured the contents of T in the testis,gonadotropin-releasing hormone(GnRH)in the hypothalamus and total T(tT),free T(fT),luteinizing hormone(LH)and follicle-stimulating hormone(FSH)in the serum by ELISA,and determined the expressions of silence information regulator-1(SIRT1),P53,glutathione peroxidase(GPX4)and cholesterol side-chain?cleavage enzym e(CYP11A1)in the testis by Western blot.Results:Compared with the young controls,the mice in the aged group showed obviously losing and dull hair,energy declination,loose structure of the spermatogenic tubule with different degrees of cell loss and rupture,reduced testicular index,and ev-ident aging phenotype.In comparison with the aged mice,the animals of the moxibustion group were fairly energetic and exhibited dis-tinct structure of the spermatogenic tubules,orderly arranged and highly differentiated cells at all levels,significantly increased T lev-el,up-regulated expressions of SIRT1,GPX4 and CYP11 A1,and down-regulated expression of P53 in testis tissue,and elevated levels of GnRH,FSH,LH,tT and fT in the HPG axis.Conclusion:Wheat-grain moxibustion at the Guanyuan point protects testosterone synthesis in the testis tissue of naturally aged mice,promotes negative feedback regulation of the HPG axis,and improves low testoster-one.

Objective:To investigate the effect of KRAS,NRAS and BRAF gene mutations on the efficacy of pre-operative short-course radiotherapy combined with chemotherapy and postoperative liver metastasis in patients with stage Ⅱ～Ⅲ mid-low rectal cancer.Methods:The clinical data of 149 patients with stage Ⅱ～Ⅲ low rectal cancer admitted to Dongnan Hospital of Xiamen University from January 2017 to June 2020 were retrospectively analyzed.All patients received neoadjuvant therapy with preoperative short-course radiotherapy combined with chemotherapy and radical surgery,and were followed up until June 30,2023.The mutations of KRAS,NRAS and BRAF genes were de-tected by pathological tissue before surgery.The effect of neoadjuvant therapy was evaluated according to tumor re-gression grade(TRG).The risk factors of postoperative liver metastasis were analyzed by Logistic multivariate analysis.Results:There were 44 cases of KRAS,10 cases of NRAS and 12 cases of BRAF gene mutation in 149 patients with stage Ⅱ～Ⅲ low rectal cancer,and the mutation rates were 29.53%,6.71%and 8.05%.The incidence of positive vas-cular invasion in patients with KRAS gene mutation was higher than negative(P＜0.05).In NRAS mutation patients,the incidence of positive lymph node metastasis was higher than negative(P＜0.05),and the incidence of maximum tumor diameter≥5 cm was higher than that of maximum tumor diameter＜5 cm(P＜0.05).The clinical stage of BRAF muta-tion was higher in stage Ⅲ than in stage Ⅱ(P＜0.05),and the incidence of positive lymph node metastasis was higher than negative(P＜0.05).During the follow-up period,liver metastasis occurred in 42 patients,and the liver metastasis rate was 28.18%.The KRAS,NRAS and BRAF gene mutations in the effective group were 25.81%,2.15%and 3.23%,lower than those in the ineffective group(35.71%,14.29%and 17.07%,P＜0.05).Multiple factors found clinical stage Ⅲ(OR=10.620,95%CI:2.645～22.575),lymph node metastasis was positive(OR=8.774,95%CI:1.878～19.645),neoadju-vant therapy failed(OR=3.373,95%CI:1.014～11.218),KRAS gene mutation(OR=6.245,95%CI:1.876～20.789),BRAF gene mutation(OR=9.497,95%CI:1.754～19.335)were independent risk factors for postoperative liver metastasis of stage Ⅱ～Ⅲ mid-low rectal cancer.Conclusion:Mutations in the KRAS and BRAF genes of middle are associated with poorer efficacy of neoadjuvant therapy in patients with stage Ⅱ～Ⅲ mid-low rectal cancer and are also indepen-dent risk factors for postoperative liver metastasis.

Objective:To systematically and comprehensively retrieve studies on urethra care for patients with urinary catheter at home and abroad, so as to provide a reference for removing low-value care measures in the future.Methods:Arksey and O'?Malley scoping review method was used to systematically search the China National Knowledge Infrastructure, China Biology Medicine disc, WanFang Data, VIP, PubMed, Cochrane Library, CINAHL, Embase, and Web of Science. The search period was from database establishment to January 1, 2024. Literature was screened based on inclusion and exclusion criteria, and catheter care site, disinfection/cleaner type, frequency, institutional norms, and determinants were independently extracted by two researchers, where determinants were framed based on the theoretical domains framework.Results:A total of 21 papers were included. Urethra low-value care measures were reflected in the selection of nursing solutions that differed significantly from guideline recommendations and were inconsistently standardized across hospitals. Thirteen strategies were proposed to remove urethra low-value care measures. Factors that influenced the removal of low-value care behaviors included knowledge, reinforcement, environment and resources, social influences, personal roles and identities, outcome beliefs and memories, and attention and decision-making processes.Conclusions:Future researchers should further refine the evidence on urethra care and develop contextualized care for complex, multilevel healthcare settings to achieve continuous improvement and high quality care at low cost.

Objective To construct a decision aid scheme for surgical methods of thyroid cancer patients and explore its application effect.Methods A retrospective analysis was conducted on 692 patients with thyroid cancer who were treated in the department of breast and thyroid surgery in the First Affiliated Hospital of Army Medical University from January 1 to December 31,2022,patients who underwent surgery from January 1 to June 30,2022 were selected as the control group(n=346),while patients who underwent surgery from July 1 to December 31,2022 were selected as the observation group(n=346).Patients in the control group chose surgical methods after conventional education,while patients in the observation group chose the surgical methods through the decision aid scheme.The decision conflict and decision-making at admission and 1 day before surgery of patients in the two groups were assessed.The psychological state at admission,1 day before surgery,and 1 month after surgery of patients in the two groups were evaluated.The decision satisfaction of patients in the two groups were assessed 1,3,and 6 months after surgery.Results There was no significant difference in the decision conflict score,decision making score or anxiety and depression scores at admission of patients between the two groups(P>0.05).One day before surgery,the decision conflict score of patients in the observation group was significantly lower than that in the control group(t=21.099,P<0.001),and the decision-making score was significantly higher than that in the control group(t=8.806,P<0.001).The anxiety and depression scores of patients in the two groups decreased over time,among which the anxiety and depression scores 1 day before surgery and 1 month after surgery of patients in the observation group were lower than those in the control group(P<0.05).The decision satisfaction scores 1,3 and 6 months after surgery of patients in the observation group were higher than those in the control group(P<0.05).Conclusion The implementation of decision aid scheme can effectively reduce decision conflicts of patients with thyroid cancer regarding the choice of surgical methods,relieve negative emotions,and enhance decision satisfaction.