Dent disease is a rare X-linked recessive renal tubular disease characterized by low molecular weight proteinuria，hypercalcemia and nephrocalcinosis. It is also a major cause of tubular proteinuria in children. According to different causative genes，Dent disease can be divided into three types：type 1 is caused by mutations in the CLCN5 gene，accounting for about 60%-70%；type 2 is caused by mutations in the OCRL gene，accounting for about 15%-20%；type 3 has a similar clinical phenotype but no known pathogenic gene mutations. CLCN5 encodes the voltage-dependent 2Cl -/1H +exchange channel CIC-5，which is involved in proximal renal tubule endocytosis. Its mutations can cause a variety of proximal tubular dysfunction symptoms，mainly including low molecular weight proteinuria. The use of gene detection technology has resulted in an increase in reports on Dent disease year after year. At present，the specific mechanism underlying Dent disease remains unknown. This article reviews the research progress of CLCN5，hoping to provide new insight for the mechanism research of CLCN5 and the specific treatment of Dent disease type 1.

Objective To investigate the effect of ankle pump exercises,based on hemodynamic mechanisms,on the prevention of venous thrombosis in stroke patients.Methods A total of 110 stroke patients,admitted to a tertiary A hospital in Jiangsu Province between June 2023 and June 2024,were selected using a convenience sampling method.The patients were divided into an experimental group and a control group,with 55 patients in each group.The experimental group received ankle pump exercise nursing interventions based on hemodynamic mechanisms,while the control group received routine nursing interventions.The incidence of lower extremity deep vein thrombosis,Pittsburgh Rehabilitation Participation Scale scores,subjective perceived fatigue,and exercise self-efficacy scores were compared between 2 groups on the 7th day of hospitalization.Results No dropouts occurred in either group.The incidence of deep vein thrombosis was significantly lower in the experimental group than it in the control group(P=0.004).The Pittsburgh Rehabilitation Participation scores on day 1,3,5,and 7 were higher in the experimental group compared to them in the control group(P＜0.001).A significant time-dependent trend was observed in Pittsburgh Rehabilitation Participation scores(P=0.034).Subjective fatigue was significantly lower in the experimental group at various time points(P＜0.001).Both groups showed an increase in exercise self-efficacy over time(P=0.016),with the experimental group demonstrating higher exercise self-efficacy than the control group on the day before discharge(P=0.003).Conclusion Ankle pump exercises,based on hemodynamic mechanisms,can effectively reduce the incidence of deep vein thrombosis in stroke patients,enhance rehabilitation participation and exercise self-efficacy,without increasing subjective fatigue.

The National Essential Medicines System could protect public health and ensure access to essential medications.Although the current selection methods for China's National Essential Medicines Lists(NEMLs)are becoming more scientific and standardized,there are still problems such as much emphasis on expert experience and the lack of transparency of decision-making basis.To address these issues,it proposes an evidence-based decision-making pathway for NEMLs selection guided by clinical value.This approach ensures a strong integration of evidence and decision-making,offering valuable insights for improving the adjustment procedures and selection criteria of the NEMLs in China.

The National Essential Medicines System could protect public health and ensure access to essential medications.Although the current selection methods for China's National Essential Medicines Lists(NEMLs)are becoming more scientific and standardized,there are still problems such as much emphasis on expert experience and the lack of transparency of decision-making basis.To address these issues,it proposes an evidence-based decision-making pathway for NEMLs selection guided by clinical value.This approach ensures a strong integration of evidence and decision-making,offering valuable insights for improving the adjustment procedures and selection criteria of the NEMLs in China.

Objective To investigate the effect of ankle pump exercises,based on hemodynamic mechanisms,on the prevention of venous thrombosis in stroke patients.Methods A total of 110 stroke patients,admitted to a tertiary A hospital in Jiangsu Province between June 2023 and June 2024,were selected using a convenience sampling method.The patients were divided into an experimental group and a control group,with 55 patients in each group.The experimental group received ankle pump exercise nursing interventions based on hemodynamic mechanisms,while the control group received routine nursing interventions.The incidence of lower extremity deep vein thrombosis,Pittsburgh Rehabilitation Participation Scale scores,subjective perceived fatigue,and exercise self-efficacy scores were compared between 2 groups on the 7th day of hospitalization.Results No dropouts occurred in either group.The incidence of deep vein thrombosis was significantly lower in the experimental group than it in the control group(P=0.004).The Pittsburgh Rehabilitation Participation scores on day 1,3,5,and 7 were higher in the experimental group compared to them in the control group(P＜0.001).A significant time-dependent trend was observed in Pittsburgh Rehabilitation Participation scores(P=0.034).Subjective fatigue was significantly lower in the experimental group at various time points(P＜0.001).Both groups showed an increase in exercise self-efficacy over time(P=0.016),with the experimental group demonstrating higher exercise self-efficacy than the control group on the day before discharge(P=0.003).Conclusion Ankle pump exercises,based on hemodynamic mechanisms,can effectively reduce the incidence of deep vein thrombosis in stroke patients,enhance rehabilitation participation and exercise self-efficacy,without increasing subjective fatigue.

Objective:To explore the barriers and facilitators of exercise rehabilitation in patients with atrial fibrillation (AF) after radiofrequency ablation.Methods:From March to August 2022, 285 patients with atrial fibrillation who underwent radiofrequency ablation within three months were recruited from the "Cloud Ward" of the Department of Cardiovascular of the First Affiliated Hospital with Nanjing Medical University by convenience sampling. The Cardiac Rehabilitation Barriers Scale (CRBS) and the Self-efficacy for Exercise Scale (SEE) were used to evaluate the barriers and self-efficacy of patients participating in exercise rehabilitation, respectively. Among them, 22 patients were subjected to semi-structured interviews to extract themes.Results:Among 285 patients with atrial fibrillation, 202 (70.88%) participated in exercise rehabilitation programs. Work/time conflicts, lack of cardiac rehabilitation knowledge, and health/physical function limitations affected the participation of patients in exercise rehabilitation ( P<0.05). Qualitative research extracted three themes that affected the patient's exercise rehabilitation, including capability, opportunity, and motivation. Conclusions:The participation of atrial fibrillation patients in exercise rehabilitation is influenced by multiple factors such as family responsibility, capability, motivation, and opportunity. Medical and nursing staff should comprehensively consider the above factors, develop targeted interventions from all aspects and multiple angles, so as to effectively improve the participation of patients in exercise rehabilitation.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective To explore the specific plasma exosomal protein expression in Coronary Heart Disease(CHD)with phlegm-turbidity syndrome(PTS),so as to provide biological reference for the diagnosis of CHD with PTS.Methods A total of 20 CHD patients with PTS and 20 healthy subjects at the same period were included.Plasma exosomes were extracted from all subjects using the qEV size exclusion method.First,10 CHD cases with PTS and 10 healthy subjects were randomly selected,and differentially expressed proteins between the two groups were screened using label free non-targeted protein quantification analysis.Then,MRM targeting protein labeling technique was applied to verify the differentially expressed proteins in the remaining subjects.Results Compared with healthy controls,214 differentially expressed plasma exosomal proteins(61 up-regulated and 153 down-regulated)were found in CHD patients with PTS,mainly related to cholesterol metabolism,complement and coagulation cascade,and immune effects.ANXA6,C4BPB,F8,CFB,APOE,C9,and CLU proteins were further validated by MRM targeting protein.Conclusion CHD patients with PTS had differences in plasma exosomal protein expression from healthy controls,and the differential proteins are mainly related to cholesterol metabolism,complement,and the coagulation cascade.

With the continuous progress of research methodology in the real world and the growing maturity of artificial intelligence technology， a method for conducting “quantitative” research to guide clinical practice based on traditional Chinese medicine （TCM） diagnosis and treatment data was gradually developed. However， there is still a need for further improvements in the overall design of studies and the transformation of findings into clinical practice. Based on this， we put forward a comprehensive overall design concept and application approach for real-world study and artificial intelligence research based on clinical diagnosis and treatment data of TCM. This approach consists of five steps： Constructing a research-based database with a large sample size and high data quality； Mining and classification of core prescriptions； Conducting cohort studies to evaluate the effectiveness of core prescriptions； Utilizing case-control studies to clarify the dominant population； Establishing predictive models to achieve precision medicine. Additionally， it is imperative for researchers to establish a standardized system for collecting TCM variables and processing data， optimize the determination and measurement methods of confounding factors， further improve and promote methodologies， and strengthen the training of interdisciplinary talents. By following this research method， we anticipate that the clinical translation of research findings will be facilitated， leading to advancements in TCM precision medicine. Real-world study and artificial intelligence research share similar research foundations， and clinical applications complement each other. In the future， the two will merge together.

Objective:To analyze clinicopathological features of thyroid nodules and to assess preoperative diagnostic methods for the nature of nodules.Methods:The clinical and pathological data of 2 132 patients [456 males and 1 676 females with a mean age of (48.7±11.4) year] with thyroid nodules who underwent surgical treatment in our hospital from January 2017 to December 2019 were retrospectively analyzed. Among all patients, 433 nodules had complete fine needle aspiration biopsy cytology (FNAC) and ultrasound results were selected for further assessment. According to preoperative high-resolution ultrasound images, the nodules were classified by Kwak thyroid imaging and reporting data systems (Kwak TI-RADS) and American College of Radiology TI-RADS (ACR TI-RADS). ROC curve was used to assess the diagnostic efficacy of the two ultrasound modes and FNAC.Results:In 2 132 patients with thyroid nodules, 743 were benign and 1 389 were malignant. In all malignant cases 1 119 were females, accounting for 80.56%. In newly diagnosed benign nodules, 67.97% (505/743) were found by examination, and 32.03% (238/743) were self-found. In malignant nodules, 48.67% (676/1 389) were detected by examination, 51.33% (713/1 389) were self-found. The malignant rate of nodule diameter≤1 cm was the lowest in 1 118 patients with complete thyroid ultrasound data. In 628, 722 and 782 patients who underwent surgical treatment in 2017, 2018 and 2019, the proportion of malignant nodules was 56.37% (354/628), 66.48% (480/722) and 70.97% (555/782); the proportion of benign nodules was 43.63% (274/628), 33.52% (242/722) and 29.03% (227/782), respectively. Among all malignant nodules, papillary carcinoma accounted for 95.18% (1 322/1 389), followed by follicular carcinoma 4.32% (60/1 389), myeloid carcinoma 0.43% (60/1 389) and undifferentiated carcinoma 0.07%(1/1 389). Among all benign nodules, the proportion of nodular goiter was the highest (95.56%, 710/743). The proportion of patients undergoing preoperative FNAC in 2017, 2018 and 2019 was 57.96% (364/628), 63.43% (458/722) and 69.44% (543/782), respectively;the coincidence rate of preoperative FNAC and postoperative pathological diagnosis was 46.15% (168/364), 52.18% (239/458) and 62.06% (337/543), respectively. Among 433 nodules with both FNAC and ultrasound data, the areas under the ROC curve(AUC)of FNA, ACR TI-RADS and Kawk TI-RADS were 0.91, 0.74 and 0.59, respectively ( P<0.05). The sensitivity of ACR TI-RADS and Kawk TI-RADS was 84.34%, 37.35% ( P<0.05) and specificity was 56.29% and 79.14% ( P=0.075). Conclusions:The study reveals that from 2017 to 2019, both the number of cases and malignant rate of thyroid nodules shows a rising trend, meanwhile the application rate of preoperative FNAC and its coincidence rate with postoperative pathology shows an increasing trend. FNAC, ACR Ti-RADS and Kawk TI-RADS have certain diagnostic efficacy in differentiating benign and malignant thyroid nodules, and the diagnostic value of FNAC is the highest followed by ACR TI-RADS and Kawk TI-RADS.