Objective:To investigate the potential utility of the lymphocyte to monocyte ratio (LMR) and its modified index, albumin-LMR product, as predictive biomarkers for disease activity and presence of lupus nephritis in systemic lupus erythematosus (SLE).Methods:A total of 264 patients with newly diagnosed SLE who were treated at Henan Provincial People′s Hospital between December 2016 and September 2022 were included in this study. Their clinical data were subsequently collected for analysis. Patients were classified into non-active disease group (SLEDAI<5, n=55) and active disease group(SLEDAI≥5, n=209) based on the SLE SLEDAI. The Mann-Whitney U test was employed to compare the differences in clinical parameter levels, LMR and albumin-LMR product between the two groups. Additionally, the active disease group was further stratified into mild(SLEDAI 5~9, n=86), moderate(SLEDAI 10~14, n=96) and severe (SLEDAI≥15, n=27) subgroups to assess differences in LMR and albumin-LMR product. Further more patients were stratified into two groups based on renal involvement: those without lupus nephritis(non-LN) and those with lupus nephritis (LN). For non-parametric comparisons, the Mann-Whitney U test was used for intergroup comparisons between two groups, while the Kruskal-Wallis H test was applied for comparisons among three groups. If the Kruskal-Wallis H test revealed statistically significant differences ( P<0.05), pairwise comparisons were performed using the Mann-Whitney U test, and the significance level was adjusted using the Bonferroni method to account for multiple testing.Correlations between LMR, albumin-LMR product, and disease activity indicators were analyzed using Spearman′s correlation. The diagnostic value of LMR and albumin-LMR product for SLE activity was evaluated using the receiver operating characteristic (ROC) curves. Results:Both LMR and albumin-LMR product were significantly lower in active disease group compared to the non-active group {LMR:3.56 (2.15, 5.00) vs. 5.68 (3.89, 7.00); albumin-LMR product [93.21 (59.50, 143.98)g/L] vs. [187.89 (137.67, 260.90)]g/L, Z=-5.68, -7.05, P<0.001 for all}. Further subgroup analysis revealed that LMR and albumin-LMR product levels in severe, moderate, and mild active disease were also significantly decreased compared to the non-active disease group {LMR:3.83(1.78, 5.09)、3.09(2.06, 4.90)、3.65(2.45, 5.03) vs. 5.68(3.89, 7.00); albumin-LMR product: [95.69(66.57, 121.61)]g/L、[79.82(49.02, 126.91)]g/L、[104.73(69.21, 169.01)]g/L vs. [187.89(137.67, 260.90)]g/L, H=34.27, 58.29, P<0.001 for all}. A significant disparity in the levels of LMR and albumin-LMR product was detected between the non-LN and LN, with statistical significance ( Z=-3.44, P=0.001 and Z=-7.06, P<0.001). Correlation analysis indicated that LMR negatively correlated with SLEDAI( r=-0.31), urea( r=-0.29), creatinine ( r=-0.28) and 24-hour urinary protein level ( r=-0.27), all P<0.001, with no significant correlation to complement C3 or C4. Albumin-LMR product showed stronger negative correlations with SLEDAI ( r=-0.44), urea ( r=-0.40), creatinine ( r=-0.37), and 24-hour urinary protein ( r=-0.55), all P<0.001, and a positive correlation with complement C3 ( r=0.18, P=0.004). The areas under the ROC curves for LMR and LMR combined with complement C3 were 0.749 and 0.795, respectively, while for albumin-LMR product and its combination with complement C3, they were 0.809 and 0.833, indicating superior diagnostic efficacy for the modified albumin-LMR product. Conclusion:LMR and albumin-LMR product levels are significantly associated with SLE disease activity and may serve as potential biomarkers for assessing SLE activity and the degree of lupus nephritis.

This article reported a case of a newborn with congenital absence of the penis. The prenatal examinations were unremarkable. Physical examination of the newborn revealed abnormal external genitalia, with well-developed scrotum and fully descended testicle in normal size, but without the penis. Postnatal ultrasound showed no obvious signals of uterus and ovaries in pelvis and had normal bilateral testicles and urinary system. The diagnosis was congenital absence of the penis.

Epilepsy is a chronic neurological disorder characterized by abnormal brain network function. The localization of the epileptogenic zone and feature analysis of the epileptic networks are key issues in clinical diagnosis and treatment as well as in research of disease mechanisms. In recent years, electroencephalography-functional magnetic resonance imaging (EEG-fMRI), by integrating the high temporal resolution of EEG and high spatial resolution of fMRI, has provided an important tool for localizing epileptogenic zones and researching epileptic networks. This article reviews the recent advance in EEG-fMRI in epilepsy, with a focus on its role in localizing the origin of epileptic seizures, exploring the epileptic networks of different modalities, analyzing the characteristics of epileptic networks, and studying the pathogenesis of epilepsy combined with cognitive impairment, in order to analyze pathophysiological mechanisms of epilepsy and provide new perspectives for clinical diagnosis and treatment.

OBJECTIVE To investigate the effects of the split formulas of Biyuan Heji(BYHJ)on paranasal sinus mucosal in-flammation in rats with acute rhinosinusitis(ARS)based on the pathogenesis of"wind-cold transforming into lung-heat".METHODS Unilateral nasal cavity occlusion combined with nasal dripping of Staphylococcus aureus were performed to establish a rat model of ARS.SD rats were randomly divided into blank,model,BYHJ(wind-cold removal+lung-heat removal),lung-heat removal,wind-cold removal,and positive drug groups,with 6 rats in each group.The rats were treated with the corresponding drugs for 7 d and then the samples were collected.HE staining was used to observe the pathological changes of rat paranasal sinus mucosa tissues,ELISA was employed to determine the levels of interleukin-1β(IL-1β),IL-6,IL-8,IL-9,IL-10,and IL-12 in serum,immunohistochemis-try(IHC)was adopted to measure the protein expression of tumor necrosis factor-α(TNF-α)and intercellular adhesion molecule(ICAM-1)in paranasal sinus mucosa tissues,and Western blot was used to detect the protein expression of phosphorylated p38 mito-gen-activated protein kinase(p38 MAPK),nuclear transcription factor-κB p50(NF-κB p50),and NF-κB p65 in paranasal sinus mucosa tissues.RESULTS The acute sinusitis rat inflammation model was successfully established.Compared with the model group,the water drinking,diet eating,and body weight of rats in the BYHJ group,wind-cold removal,lung-heat removal,and positive drug groups were significantly improved,the aggregation of inflammatory cells in the paranasal sinus mucosal tissue was reduced,and the levels of IL-1β,IL-6,IL-8,IL-9,and IL-12 in the serum were significantly reduced(P<0.01),IL-10 content significantly in-creased(P<0.01),the protein expression of TNF-α,ICAM-1,p38 MAPK,NF-κB p50,and NF-κB p65 in the paranasal sinus mucosa was significantly decreased(P<0.01).The comparison between various traditional Chinese medicine groups showed that the decrease of IL-1β,IL-6,IL-8,IL-9,IL-12,TNF-α,ICAM-1,p38 MAPK,NF-κB p50,and NF-κB p65 and the increase of IL-10 in the BYHJ group were better than those in the split formula groups(P<0.01),and the lung-heat removal group was better than the wind-cold removal group(P<0.01).CONCLUSION BYHJ and its split formulas can effectively inhibit the inflammatory response in rats with ARS.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To analyze the current preparation and usage situation of first-aid drugs in the rescue vehicles in children's medical institutions, and provide references for optimizing the list of emergency drugs.Methods:First-aid drug lists in the rescue vehicles of 12 children's medical institutions from 11 provinces and municipalities in China were collected through questionnaire surveys, and the drugs as well as their quantities were compared. The existing problems in the use of first-aid drugs in the 12 medical institutions were investigated by on-site interviews. The usage information of first-aid drugs in the rescue vehicles of the General Surgery and Cardiology Department of Shanxi Children's Hospital from May 2022 to April 2023 was collected through the hospital information center, and usage frequency and dosage per patient of the drugs were calculated. Descriptive statistical analysis was conducted on the collected data.Results:The first-aid drug lists in 12 hospitals were various, including 7 to 22 kinds of drugs and involving a total of 23 drugs. These mainly included vasoactive drugs, cardiotonic drugs, antiarrhythmic drugs, antiangina and anti-ischemic drugs for the heart, antispasmodic drugs, diuretics, dehydrating drugs, sedative-hypnotic drugs, and glucocorticoids, all of which were injections. The drugs that were included in all the lists of 12 hospitals were epinephrine, dopamine, dexamethasone, furosemide, and atropine. The drug lists of different rescue vehicles throughout the hospital were the same in 4 hospitals, while the lists varied among departments based on their specific clinical needs in the other 8 hospitals. None of the 12 hospitals had a first-aid drug usage manual. The on-site interview results showed that, the existing problems about drug preparation and use in rescue vehicles mainly involved the following 6 aspects: drug types, quantities, labels, storage, procurement, and usage. In Shanxi Children's Hospital, the types and quantities of first-aid drugs in rescue vehicles of General Surgery Department and Cardiology Department were the same. There were 6 and 9 kinds of drugs were used in the 2 departments during rescue operations, respectively. The drugs that were never used in either department included promethazine, lidocaine, diazepam, phenobarbital, raceanisodamine, sodium bicarbonate, atropine, glucose, and calcium gluconate.Conclusions:The phenomenon of unreasonable kinds and quantities of first-aid drugs in the rescue vehicles existed in the children's medical institutions, and the drugs provided did not fully match the actual clinical needs. There was an urgent need for preparation guidelines and usage manuals of first-aid drugs that were suitable for children's medical institutions to enhance the scientificity of drug supply and the correctness of usage.

OBJECTIVE To investigate the effects of the split formulas of Biyuan Heji(BYHJ)on paranasal sinus mucosal in-flammation in rats with acute rhinosinusitis(ARS)based on the pathogenesis of"wind-cold transforming into lung-heat".METHODS Unilateral nasal cavity occlusion combined with nasal dripping of Staphylococcus aureus were performed to establish a rat model of ARS.SD rats were randomly divided into blank,model,BYHJ(wind-cold removal+lung-heat removal),lung-heat removal,wind-cold removal,and positive drug groups,with 6 rats in each group.The rats were treated with the corresponding drugs for 7 d and then the samples were collected.HE staining was used to observe the pathological changes of rat paranasal sinus mucosa tissues,ELISA was employed to determine the levels of interleukin-1β(IL-1β),IL-6,IL-8,IL-9,IL-10,and IL-12 in serum,immunohistochemis-try(IHC)was adopted to measure the protein expression of tumor necrosis factor-α(TNF-α)and intercellular adhesion molecule(ICAM-1)in paranasal sinus mucosa tissues,and Western blot was used to detect the protein expression of phosphorylated p38 mito-gen-activated protein kinase(p38 MAPK),nuclear transcription factor-κB p50(NF-κB p50),and NF-κB p65 in paranasal sinus mucosa tissues.RESULTS The acute sinusitis rat inflammation model was successfully established.Compared with the model group,the water drinking,diet eating,and body weight of rats in the BYHJ group,wind-cold removal,lung-heat removal,and positive drug groups were significantly improved,the aggregation of inflammatory cells in the paranasal sinus mucosal tissue was reduced,and the levels of IL-1β,IL-6,IL-8,IL-9,and IL-12 in the serum were significantly reduced(P<0.01),IL-10 content significantly in-creased(P<0.01),the protein expression of TNF-α,ICAM-1,p38 MAPK,NF-κB p50,and NF-κB p65 in the paranasal sinus mucosa was significantly decreased(P<0.01).The comparison between various traditional Chinese medicine groups showed that the decrease of IL-1β,IL-6,IL-8,IL-9,IL-12,TNF-α,ICAM-1,p38 MAPK,NF-κB p50,and NF-κB p65 and the increase of IL-10 in the BYHJ group were better than those in the split formula groups(P<0.01),and the lung-heat removal group was better than the wind-cold removal group(P<0.01).CONCLUSION BYHJ and its split formulas can effectively inhibit the inflammatory response in rats with ARS.

This article reported a case of a newborn with congenital absence of the penis. The prenatal examinations were unremarkable. Physical examination of the newborn revealed abnormal external genitalia, with well-developed scrotum and fully descended testicle in normal size, but without the penis. Postnatal ultrasound showed no obvious signals of uterus and ovaries in pelvis and had normal bilateral testicles and urinary system. The diagnosis was congenital absence of the penis.

Objective:To analyze the current preparation and usage situation of first-aid drugs in the rescue vehicles in children's medical institutions, and provide references for optimizing the list of emergency drugs.Methods:First-aid drug lists in the rescue vehicles of 12 children's medical institutions from 11 provinces and municipalities in China were collected through questionnaire surveys, and the drugs as well as their quantities were compared. The existing problems in the use of first-aid drugs in the 12 medical institutions were investigated by on-site interviews. The usage information of first-aid drugs in the rescue vehicles of the General Surgery and Cardiology Department of Shanxi Children's Hospital from May 2022 to April 2023 was collected through the hospital information center, and usage frequency and dosage per patient of the drugs were calculated. Descriptive statistical analysis was conducted on the collected data.Results:The first-aid drug lists in 12 hospitals were various, including 7 to 22 kinds of drugs and involving a total of 23 drugs. These mainly included vasoactive drugs, cardiotonic drugs, antiarrhythmic drugs, antiangina and anti-ischemic drugs for the heart, antispasmodic drugs, diuretics, dehydrating drugs, sedative-hypnotic drugs, and glucocorticoids, all of which were injections. The drugs that were included in all the lists of 12 hospitals were epinephrine, dopamine, dexamethasone, furosemide, and atropine. The drug lists of different rescue vehicles throughout the hospital were the same in 4 hospitals, while the lists varied among departments based on their specific clinical needs in the other 8 hospitals. None of the 12 hospitals had a first-aid drug usage manual. The on-site interview results showed that, the existing problems about drug preparation and use in rescue vehicles mainly involved the following 6 aspects: drug types, quantities, labels, storage, procurement, and usage. In Shanxi Children's Hospital, the types and quantities of first-aid drugs in rescue vehicles of General Surgery Department and Cardiology Department were the same. There were 6 and 9 kinds of drugs were used in the 2 departments during rescue operations, respectively. The drugs that were never used in either department included promethazine, lidocaine, diazepam, phenobarbital, raceanisodamine, sodium bicarbonate, atropine, glucose, and calcium gluconate.Conclusions:The phenomenon of unreasonable kinds and quantities of first-aid drugs in the rescue vehicles existed in the children's medical institutions, and the drugs provided did not fully match the actual clinical needs. There was an urgent need for preparation guidelines and usage manuals of first-aid drugs that were suitable for children's medical institutions to enhance the scientificity of drug supply and the correctness of usage.

Objective:To investigate the potential utility of the lymphocyte to monocyte ratio (LMR) and its modified index, albumin-LMR product, as predictive biomarkers for disease activity and presence of lupus nephritis in systemic lupus erythematosus (SLE).Methods:A total of 264 patients with newly diagnosed SLE who were treated at Henan Provincial People′s Hospital between December 2016 and September 2022 were included in this study. Their clinical data were subsequently collected for analysis. Patients were classified into non-active disease group (SLEDAI<5, n=55) and active disease group(SLEDAI≥5, n=209) based on the SLE SLEDAI. The Mann-Whitney U test was employed to compare the differences in clinical parameter levels, LMR and albumin-LMR product between the two groups. Additionally, the active disease group was further stratified into mild(SLEDAI 5~9, n=86), moderate(SLEDAI 10~14, n=96) and severe (SLEDAI≥15, n=27) subgroups to assess differences in LMR and albumin-LMR product. Further more patients were stratified into two groups based on renal involvement: those without lupus nephritis(non-LN) and those with lupus nephritis (LN). For non-parametric comparisons, the Mann-Whitney U test was used for intergroup comparisons between two groups, while the Kruskal-Wallis H test was applied for comparisons among three groups. If the Kruskal-Wallis H test revealed statistically significant differences ( P<0.05), pairwise comparisons were performed using the Mann-Whitney U test, and the significance level was adjusted using the Bonferroni method to account for multiple testing.Correlations between LMR, albumin-LMR product, and disease activity indicators were analyzed using Spearman′s correlation. The diagnostic value of LMR and albumin-LMR product for SLE activity was evaluated using the receiver operating characteristic (ROC) curves. Results:Both LMR and albumin-LMR product were significantly lower in active disease group compared to the non-active group {LMR:3.56 (2.15, 5.00) vs. 5.68 (3.89, 7.00); albumin-LMR product [93.21 (59.50, 143.98)g/L] vs. [187.89 (137.67, 260.90)]g/L, Z=-5.68, -7.05, P<0.001 for all}. Further subgroup analysis revealed that LMR and albumin-LMR product levels in severe, moderate, and mild active disease were also significantly decreased compared to the non-active disease group {LMR:3.83(1.78, 5.09)、3.09(2.06, 4.90)、3.65(2.45, 5.03) vs. 5.68(3.89, 7.00); albumin-LMR product: [95.69(66.57, 121.61)]g/L、[79.82(49.02, 126.91)]g/L、[104.73(69.21, 169.01)]g/L vs. [187.89(137.67, 260.90)]g/L, H=34.27, 58.29, P<0.001 for all}. A significant disparity in the levels of LMR and albumin-LMR product was detected between the non-LN and LN, with statistical significance ( Z=-3.44, P=0.001 and Z=-7.06, P<0.001). Correlation analysis indicated that LMR negatively correlated with SLEDAI( r=-0.31), urea( r=-0.29), creatinine ( r=-0.28) and 24-hour urinary protein level ( r=-0.27), all P<0.001, with no significant correlation to complement C3 or C4. Albumin-LMR product showed stronger negative correlations with SLEDAI ( r=-0.44), urea ( r=-0.40), creatinine ( r=-0.37), and 24-hour urinary protein ( r=-0.55), all P<0.001, and a positive correlation with complement C3 ( r=0.18, P=0.004). The areas under the ROC curves for LMR and LMR combined with complement C3 were 0.749 and 0.795, respectively, while for albumin-LMR product and its combination with complement C3, they were 0.809 and 0.833, indicating superior diagnostic efficacy for the modified albumin-LMR product. Conclusion:LMR and albumin-LMR product levels are significantly associated with SLE disease activity and may serve as potential biomarkers for assessing SLE activity and the degree of lupus nephritis.