Objective:To analyze the clinical characteristics, RAN-binding protein 2 ( RANBP2) gene variations, and prognosis in Chinese acute necrotizing encephalopathy (ANE) patients. Methods:A retrospective analysis of ANE cases registered in the Peking Union Medical College Hospital Encephalitis Registry System from 2022 to 2024, involving patients from Peking Union Medical College Hospital and other hospitals, was conducted. A descriptive study was performed on the clinical characteristics, treatments and prognosis, cerebrospinal fluid examination results, and imaging findings of these patients based on adjusted ANE diagnostic criteria. Whole-exome sequencing technology was used to detect gene mutations in these patients.Results:A total of 18 ANE cases were included, ranged in age from 2 to 72 [20(5, 43)] years. The male-to-female ratio was 4∶5. All patients were found with precipitating infections including COVID-19, influenza A virus and Mycoplasma pneumoniae infections. All patients presented with fever, with varying degrees of consciousness disturbance observed in 16 cases, and seizures in 10 cases. All patients underwent lumbar puncture, with normal or mildly elevated white cell counts [3(2, 13)×10 6/L] and mildly to moderately elevated protein levels [1.90(0.92, 4.65) g/L]. A total of 6 patients were found with extremely elevated interleukin-6 level [950(164, 2 000) pg/ml] in cerebrospinal fluid. Bilateral symmetric thalamic lesions were typical imaging features of ANE, while involvement of other areas such as cortical and subcortical white matter, brainstem, and cerebellum was also observed. A total of 14 patients performed genetic tests while 4 patients were identified with RANBP2 gene mutations (c.1754C>T in 3 cases, c.1966A>G in 1 case). All patients received immunotherapy, and 7 patients died at discharge while other patients presented with neurological sequelae of varying degrees. Conclusions:ANE is a rare and severe parainfectious encephalopathy that can occur in both children and adults. Clinically, it is characterized by rapidly progressing encephalopathy following systematic infection, with bilateral symmetric thalamic lesions. The detection of RANBP2 gene mutations could help make the diagnosis.

Objective:To analyze the clinical characteristics, RAN-binding protein 2 ( RANBP2) gene variations, and prognosis in Chinese acute necrotizing encephalopathy (ANE) patients. Methods:A retrospective analysis of ANE cases registered in the Peking Union Medical College Hospital Encephalitis Registry System from 2022 to 2024, involving patients from Peking Union Medical College Hospital and other hospitals, was conducted. A descriptive study was performed on the clinical characteristics, treatments and prognosis, cerebrospinal fluid examination results, and imaging findings of these patients based on adjusted ANE diagnostic criteria. Whole-exome sequencing technology was used to detect gene mutations in these patients.Results:A total of 18 ANE cases were included, ranged in age from 2 to 72 [20(5, 43)] years. The male-to-female ratio was 4∶5. All patients were found with precipitating infections including COVID-19, influenza A virus and Mycoplasma pneumoniae infections. All patients presented with fever, with varying degrees of consciousness disturbance observed in 16 cases, and seizures in 10 cases. All patients underwent lumbar puncture, with normal or mildly elevated white cell counts [3(2, 13)×10 6/L] and mildly to moderately elevated protein levels [1.90(0.92, 4.65) g/L]. A total of 6 patients were found with extremely elevated interleukin-6 level [950(164, 2 000) pg/ml] in cerebrospinal fluid. Bilateral symmetric thalamic lesions were typical imaging features of ANE, while involvement of other areas such as cortical and subcortical white matter, brainstem, and cerebellum was also observed. A total of 14 patients performed genetic tests while 4 patients were identified with RANBP2 gene mutations (c.1754C>T in 3 cases, c.1966A>G in 1 case). All patients received immunotherapy, and 7 patients died at discharge while other patients presented with neurological sequelae of varying degrees. Conclusions:ANE is a rare and severe parainfectious encephalopathy that can occur in both children and adults. Clinically, it is characterized by rapidly progressing encephalopathy following systematic infection, with bilateral symmetric thalamic lesions. The detection of RANBP2 gene mutations could help make the diagnosis.

Objective To identify factors associated with gastrointestinal heat retention in preschool children,and to provide a foundational understanding for future clinical investigations. Methods A case-control study was performed,which involved children from kindergartens in the Longgang District of Shenzhen City,Guangdong Province,from May to July 2021. Using the Children's Gastrointestinal Heat Retention Diagnostic Self-assessment Scale,subjects were allocated into a case group (children diagnosed with gastrointestinal heat retention) and a control group (children without this condition). An online survey was used to collect data on dietary behaviors,caregivers' feeding behaviors,early antibiotic use,daily routines,and birth conditions. SPSS 27.0 software was used to facilitate precise sociodemographic matching and paired logistic regression analysis to explore the association between gastrointestinal heat retention and the above factors. Results From the analysis of 51,252 matched cases,the study found that several factors contributed to an increased risk of gastrointestinal heat retention. These factors included reduced food intake compared to peers,reports of picky eating by caregivers,distractions during meals,pronounced dietary preferences,disinterest in food,meal durations ≥ 25 min,reluctance to sample new foods,consistent refusal of specific food types for over one month,irregular meal locations,coercive feeding practices,use of micronutrient supplements,allowing children too much freedom in food choice,persuading children to eat,infrequent encouragement to experiment with new foods,early antibiotic introduction,inadequate sleep,and premature birth (P<0.05). In contrast,exclusive breastfeeding in the first six months,engagement in moderate to massive physical activity,and regular napping patterns were associated with a reduced risk of gastrointestinal heat retention (P<0.05). Conclusion The suboptimal dietary habits,improper feeding practices,insufficient physical activity,inadequate sleep,and premature antibiotic exposure may be significant risk factors for gastrointestinal heat retention. Future research dedicated to unraveling the cause of gastrointestinal heat retention should prioritize these elements.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

ObjectiveMyelodysplastic syndromes （MDS） is a group of clonal hematopoietic stem cell disorders，and this study aims to investigate the expression of hypoxia-inducible factor-1α（HIF-1α） in the bone marrow cells of patients with MDS and its correlation with the clinical features of MDS，the therapeutic efficacy of arsenic-containing Chineseherbal compound，and the survival prognosis. MethodAccording to the inclusion and exclusion criteria，27 MDS patients treated with arsenic-containing Chinese herbal compound in the Department of Hematology，Xiyuan Hospital，China Academy of Chinese Medical Sciences from January 2022 to September 2022 were included，and their bone marrow samples were collected by myelotomy. HIF-1α expression level in bone marrow cells was detected by real-time polymerase chain reaction （PCR） to analyze its correlation with clinical features，and logistic and Cox regression was used to analyze the risk factors affecting the efficacy and prognostic survival of MDS patients. ResultThe HIF-1α mRNA expression level was lower in bone marrow cells of MDS patients than in healthy subjects. HIF-1α was positively correlated with the degree of myelodysplasia（r=0.384，P<0.05） and bone marrow granulocytic system%（G%）（r=0.560，P<0.01）. Logistic regression showed that HIF-1α was a risk factor for the prognosis in the follow-up of the efficacy of treatment（P<0.05）and Cox regression showed that HIF-1α was an independent factor affecting the survival prognosis of MDS patients ［odds ratio（OR）=398.968，95% confidence interval（CI）（1.281，116 858.743），P<0.05］. ConclusionThe level of HIF-1α expression in bone marrow cells of MDS patients was closely related to the degree of clinical myelodysplasia and G%，and HIF-1α was a risk factor for the efficacy for and survival prognosis of MDS patients.

Objective To compare the clinical efficacy of a new low notch plate system(Carmen synchronous adaptive cervical fusion system)and Zero-p in the treatment of single level cervical spondylotic radiculopathy(CSR).Methods Retrospective analysis was made on 48 patients with single level cervical spondylosis of nerve root type admitted from January 2015 to January 2020,including 26 patients with new low notch steel plate system(observation group)and 22 patients with Zero-P(control group).The operation duration,intraoperative blood loss,incidence of postoperative dysphagia,preoperative and postoperative JOA scores,cervical dysfunction index(NDI)Visual analog score of pain(VAS)and Cobb angle and intervertebral space height of postoperative imaging.Results There was no significant difference between the two groups in terms of operation time,intraoperative blood loss and the incidence of postoperative dysphagia(P＞0.05).All patients were followed up for 12-15 months,with an average of(12.6±0.7)months.There was no significant difference in JOA score,NDI index and VAS score of pain between the two groups before and 3 and 12 months after operation(P＞0.05).Conclusion The clinical efficacy of the new low notch plate system in the treatment of single segment cervical spondylotic radiculopathy is equivalent to Zero-P,and it is a reliable new type of anterior cervical internal fixation system.

Objective:To explore the effect of formative evaluation based on Rain Classroom on clinical skills teaching.Method:s A total of 70 students in clinical medicine from Grade 2016 were enrolled and divided into experimental group ( n=35) and control group ( n=35). The experimental group adopted Rain Classroom combined with formative evaluation, while the control group used conventional teaching method and evaluation. Test scores of the two groups were compared and students' satisfaction was collected via questionnaire. T-test was performed using SPSS 17.0. Result:The total score of clinical skills test in the experimental group was (84.11±7.76), which was significantly higher than that in the control group (74.37±12.58), and the difference was statistically significant ( P<0.05). According to the questionnaire survey, the experimental group was significantly better than the control group in terms of enhancing learning interest, improving knowledge comprehension, clinical skills, clinical thinking and analytical ability, as well as better satisfaction towards teaching ( P<0.05). Conclusion:Formative evaluation based on Rain Classroom is helpful to improve the teaching effect on clinical skills and comprehensive abilities of students, so as to promote their overall development.

Objective: To observe the analgesic and sedative effect of epidural dexmedetomidine injection in patients undergoing transurethral resection of prostate (TURP) and its effect on postoperative cognitive function. Methods: A total of 60 patients undergoing TURP under combined spinal-epidural anesthesia (CSEA) were randomly divided into dexmedetomidine group and normal saline group. Patients in the dexmedetomidine group were given 0.1 μg/kg of dexmedetomidine injection after epidural anesthesia, and 0.9 μg/kg of dexmedetomidine was added into epidural analgesia pump after operation; patients in the normal saline group were given the same dose of normal saline. The vital signs, visual analogue scale (VAS) and Ramsay sedation score of patients in the two groups at different time points[before intervention (T₀), after intervention for 15 min (T₁), after intervention for 30 min (T₂), after intervention for 45 min (T₃), after intervention for 60 min (T₄), after surgery for 12 h (T₅), after surgery for 36 h (T₆)] were recorded. The mini mental state examination (MMSE) of patients in the two groups 1 d before operation and 3 d after operation were recorded. Results: Compared with normal saline group, the VAS scores of patients in dexmedetomidine group were significantly lower at T₁-T₆ (P < 0.05), and the Ramsay scores were significantly higher (P < 0.05). There was no significant difference of MMSE total score [25.00(23.50, 27.50) scores] in the patients of dexmedetomidine group 3 d after operation but the memory ability score [4.00(3.00, 5.00) scores] was significantly decreased (P < 0.05), and the language ability score [9.00(8.00, 9.00) scores] was significantly increased (P < 0.05). There was no significant difference in MMSE score between the two groups in comparison with that 1 d before operation. Conclusions Epidural dexmedetomidine injection (1 μg/kg) enhancesd the analgesic effect of ropivacaine and producesd sedative effect. Although there was is no significant effect on the overall cognitive function, it might have some effect on memory function.

Contrast induced nephropathy (CIN) is acute renal injury following administration of contrast media during angiographic or other medical procedures, which represents as the third cause of hospital-acquired renal failure. CIN is associated with prolonged hospital stay, increased health-care costs, and undesirable clinical outcome. The risk of CIN includes advanced age and diabetes mellitus. With the rapid development of iconography and the wide application of interventional techniques, the patients with CIN are increasing. The preventive measures of CIN include hydration, using appropriate contrast media, stopping nephrotoxic drugs, ischemic preconditioning, renal replacement therapy, and using appropriate drugs. In this paper, the current status and early prevention progress of CIN will be reviewed from three aspects of the high-risk factors, pathogenesis and prevention, aiming to provide guidance for the early prevention of CIN and explore new research directions.

Contrast induced nephropathy (CIN) is acute renal injury following administration of contrast media during angiographic or other medical procedures, which represents as the third cause of hospital-acquired renal failure. CIN is associated with prolonged hospital stay, increased health-care costs, and undesirable clinical outcome. The risk of CIN includes advanced age and diabetes mellitus. With the rapid development of iconography and the wide application of interventional techniques, the patients with CIN are increasing. The preventive measures of CIN include hydration, using appropriate contrast media, stopping nephrotoxic drugs, ischemic preconditioning, renal replacement therapy, and using appropriate drugs. In this paper, the current status and early prevention progress of CIN will be reviewed from three aspects of the high-risk factors, pathogenesis and prevention, aiming to provide guidance for the early prevention of CIN and explore new research directions.
Acute Kidney Injury ; Angiography ; Contrast Media ; Humans ; Ischemic Preconditioning ; Kidney Diseases ; Renal Replacement Therapy ; Risk Factors