ObjectiveTo explore the mechanism by which Tangbikang granules improve diabetic peripheral neuropathy based on ferroptosis mediated by the adenosine monophosphate-activated protein kinase/nuclear factor erythroid 2-related factor 2 （AMPK/Nrf2） signaling pathway. MethodsA diabetes model was established using spontaneous male Zucker diabetic fatty （ZDF） rats. After successful modeling， the rats were divided into a normal group， a model group， high-， medium-， and low-dose Tangbikang granules groups， and a metformin hydrochloride group. The high-， medium-， and low-dose Tangbikang granules groups were administered by gavage at doses of 2.5， 1.25， 0.625 g·kg^-1， respectively. The metformin hydrochloride group received 0.135 g·kg^-1 by gavage， while the remaining groups received an equal volume of deionized water. Administration continued for 12 weeks. Blood glucose levels were measured after administration， and at 4， 8， 12 weeks. Following the 12-week intervention， the thermal pain threshold and the sciatic nerve conduction velocity （SNCV） were measured. The levels of malondialdehyde （MDA）， superoxide dismutase （SOD）， and adenosine triphosphate （ATP） in the sciatic nerve were measured using enzyme-linked immunosorbent assay （ELISA）. Morphological changes in the sciatic nerve were observed using hematoxylin and eosin （HE） staining， and the ultrastructural changes were examined using transmission electron microscopy. The levels of glutathione peroxidase 4 （GPx4） were detected using immunofluorescence （IF） assay. The protein expression levels of p-AMPK， Nrf2， GPx4， and acyl-CoA synthetase long-chain family member 4 （ACSL4） were detected using Western blot. ResultsCompared with the normal group， the model group had significantly higher blood glucose levels after administration and at weeks 4， 8 and 12 （P<0.01）. The thermal pain threshold was significantly prolonged （P<0.01）， and the SNCV was significantly slowed down （P<0.01）. The SOD and ATP levels significantly decreased （P<0.01）， while the MDA levels significantly increased （P<0.01）. Pathologically， the sciatic nerve fibers in the model group showed a dispersed structure， disordered and sparse arrangement， axonal atrophy， irregular myelin sheath halo， increased and swollen Schwann cell nuclei， obvious endoneurial fibrosis， and collagen hyperplasia. Immunofluorescence assay revealed fragmented red fluorescence and significantly reduced expression of GPx4 （P<0.01）. Western blot analysis showed significantly decreased protein expression levels of p-AMPK， Nrf2， and GPx4 （P<0.01）， and significantly increased expression of ACSL4 （P<0.01） in the model group. Compared with the model group， fasting blood glucose level decreased significantly in the high-dose Tangbikang granules group at weeks 4 and 12 （P<0.05）. The thermal pain threshold was significantly shortened in the high- and medium-dose Tangbikang granules groups （P<0.01）. The SNCV was significantly accelerated in the high- and medium-dose Tangbikang granules groups （P<0.01）. The SOD levels were significantly elevated in the high-dose Tangbikang granules group （P<0.01）. The MDA levels significantly decreased in all Tangbikang granules groups （P<0.01）. Both the metformin hydrochloride group and the high-dose Tangbikang granules group exhibited relatively orderly and densely arranged sciatic nerve fibers with more regular myelin sheath halos. The GPx4 expression significantly increased in both the metformin hydrochloride group and all Tangbikang granules groups （P<0.01）. The protein expression levels of p-AMPK， Nrf2， and GPx4 were significantly increased （P<0.01）， while ACSL4 protein expression significantly decreased （P<0.01）. ConclusionTangbikang granules may improve peripheral neuropathy by suppressing ferroptosis through the regulation of the AMPK/Nrf2 signaling pathway.

Objective To analyze the current practices of the telemedicine collaboration network in Jiangxi Province and provide references for enhancing the efficiency of telemedicine services and strengthening the overall telemedicine system.Meth-ods The research team investigates the progress of the telemedicine service system in Jiangxi Province,using the construction status of the telemedicine collaboration network at Jiangxi Provincial People's Hospital as a case study.The study identifies prob-lems and challenges encountered during the establishment and proposes development strategies.Results Jiangxi has adopted a"holistic approach,"implementing a series of measures including enhanced top-level design,pilot exploration,the establishment of a provincial platform,formulation of supportive policies,and intensified training to promote telemedicine vigorously.In Decem-ber 2015,Jiangxi Provincial People's Hospital established the first provincial teleconsultation center,innovatively advancing the medical consortium construction through the"telemedicine collaboration network"model.By 2024,the hospital completed 20,417 telemedicine service instances and conducted 182 remote surgical demonstrations.Additionally,since its inception,the remote electrocardiogram service has accumulated 1,138,295 instances,effectively enhancing the quality and efficiency of medi-cal services,facilitating tiered diagnosis and treatment,and alleviating access difficulties for grassroots populations.Conclusion Leveraging the National Intelligent Social Governance Pilot Base(Health and Wellness),the study promotes the integration of next-generation information technologies such as big data,artificial intelligence,and cloud computing into the traditional health-care sector.This aims to provide high-quality,efficient,and convenient medical services to the public,achieving comprehensive coverage of the telemedicine collaboration network across provincial,municipal,county,and township levels.In the next steps,the focus will be on strengthening quality control,improving supportive policies,and scientifically managing operations to foster the sustainable development of telemedicine health services,ensuring a"one-stop service and one-stop oversight"system across the province.

Objective:To explore the results of four types of Urea cycle disorders (UCDs) in newborns from the Xuzhou region, assess the efficacy of newborn screening by tandem mass spectrometry (MS/MS), and analyze their genetic characteristics.Methods:A retrospective analysis was performed using tandem mass spectrometry to screen for inherited metabolic disorders in 691 712 newborns at the Maternal and Child Health Care Hospital of Xuzhou from November 2015 to December 2023. Ten children (cases 1-10) were diagnosed with Ornithine transcarbamylase deficiency (OTCD), Carbamoylphosphate synthase 1 deficiency (CPS1D), Arginase deficiency (ARGD), and Argininosuccinate synthase deficiency (ASSD) based on MS/MS and genetic testing. This study was approved by the Medical Ethics Committee of Xuzhou Maternity and Child Health Care Hospital (Ethics No.XZFY2024-051K-01J).Results:A total of 691 712 neonates were screened for UCDs using MS/MS, which identified 1 237, 1 237, 510, and 1 009 initial positive cases for OTCD, CPS1D, ASSD, and ARGD, respectively. After genetic testing, 1 case of OTCD, 1 case of CPS1D, 1 case of ASSD, and 7 cases of ARGD were confirmed. The overall positive predictive value for these four UCDs was 0.362%. Among the 10 diagnosed UCD cases, four novel variants were identified, which included OTC: c. 1024C>A (p.L342M) and ASS1: c. 826A>G (p.M276V), c.695C>T (p.P232L) and c. 694C>T (p.P232S). Bioinformatic analysis has rated these as variants of uncertain clinical significance or likely pathogenic based on guidelines from the American College of Medical Genetics and Genomics (ACMG). Conclusion:The incidence of four UCDs in neonates from the Xuzhou area is relatively low, and there is a correlation between genetic variants and clinical phenotypes. For novel variants with uncertain clinical significance or suspected pathogenicity, their pathogenicity should be clarified in conjunction with clinical and biochemical indicators. The four novel pathogenic variants of UCDs identified in this study have enriched the mutational spectrum of UCDs-associated genes in the Xuzhou region.

OBJECTIVE: To explore the results of four types of Urea cycle disorders (UCDs) in newborns from the Xuzhou region, assess the efficacy of newborn screening by tandem mass spectrometry (MS/MS), and analyze their genetic characteristics. METHODS: A retrospective analysis was performed using tandem mass spectrometry to screen for inherited metabolic disorders in 691 712 newborns at the Maternal and Child Health Care Hospital of Xuzhou from November 2015 to December 2023. Ten children (cases 1-10) were diagnosed with Ornithine transcarbamylase deficiency (OTCD), Carbamoylphosphate synthase 1 deficiency (CPS1D), Arginase deficiency (ARGD), and Argininosuccinate synthase deficiency (ASSD) based on MS/MS and genetic testing. This study was approved by the Medical Ethics Committee of Xuzhou Maternity and Child Health Care Hospital (Ethics No.XZFY2024-051K-01J). RESULTS: A total of 691 712 neonates were screened for UCDs using MS/MS, which identified 1 237, 1 237, 510, and 1 009 initial positive cases for OTCD, CPS1D, ASSD, and ARGD, respectively. After genetic testing, 1 case of OTCD, 1 case of CPS1D, 1 case of ASSD, and 7 cases of ARGD were confirmed. The overall positive predictive value for these four UCDs was 0.362%. Among the 10 diagnosed UCD cases, four novel variants were identified, which included OTC: c.1024C>A (p.L342M) and ASS1: c.826A>G (p.M276V), c.695C>T (p.P232L) and c.694C>T (p.P232S). Bioinformatic analysis has rated these as variants of uncertain clinical significance or likely pathogenic based on guidelines from the American College of Medical Genetics and Genomics (ACMG). CONCLUSION The incidence of four UCDs in neonates from the Xuzhou area is relatively low, and there is a correlation between genetic variants and clinical phenotypes. For novel variants with uncertain clinical significance or suspected pathogenicity, their pathogenicity should be clarified in conjunction with clinical and biochemical indicators. The four novel pathogenic variants of UCDs identified in this study have enriched the mutational spectrum of UCDs-associated genes in the Xuzhou region.
Humans ; Infant, Newborn ; Tandem Mass Spectrometry/methods* ; Urea Cycle Disorders, Inborn/diagnosis* ; Neonatal Screening/methods* ; Genetic Testing/methods* ; Female ; Retrospective Studies ; Male ; Ornithine Carbamoyltransferase Deficiency Disease/diagnosis* ; Mutation ; Carbamoyl-Phosphate Synthase (Ammonia)/genetics* ; Ornithine Carbamoyltransferase/genetics*

Objective To analyze the current practices of the telemedicine collaboration network in Jiangxi Province and provide references for enhancing the efficiency of telemedicine services and strengthening the overall telemedicine system.Meth-ods The research team investigates the progress of the telemedicine service system in Jiangxi Province,using the construction status of the telemedicine collaboration network at Jiangxi Provincial People's Hospital as a case study.The study identifies prob-lems and challenges encountered during the establishment and proposes development strategies.Results Jiangxi has adopted a"holistic approach,"implementing a series of measures including enhanced top-level design,pilot exploration,the establishment of a provincial platform,formulation of supportive policies,and intensified training to promote telemedicine vigorously.In Decem-ber 2015,Jiangxi Provincial People's Hospital established the first provincial teleconsultation center,innovatively advancing the medical consortium construction through the"telemedicine collaboration network"model.By 2024,the hospital completed 20,417 telemedicine service instances and conducted 182 remote surgical demonstrations.Additionally,since its inception,the remote electrocardiogram service has accumulated 1,138,295 instances,effectively enhancing the quality and efficiency of medi-cal services,facilitating tiered diagnosis and treatment,and alleviating access difficulties for grassroots populations.Conclusion Leveraging the National Intelligent Social Governance Pilot Base(Health and Wellness),the study promotes the integration of next-generation information technologies such as big data,artificial intelligence,and cloud computing into the traditional health-care sector.This aims to provide high-quality,efficient,and convenient medical services to the public,achieving comprehensive coverage of the telemedicine collaboration network across provincial,municipal,county,and township levels.In the next steps,the focus will be on strengthening quality control,improving supportive policies,and scientifically managing operations to foster the sustainable development of telemedicine health services,ensuring a"one-stop service and one-stop oversight"system across the province.

Objective:To explore the results of four types of Urea cycle disorders (UCDs) in newborns from the Xuzhou region, assess the efficacy of newborn screening by tandem mass spectrometry (MS/MS), and analyze their genetic characteristics.Methods:A retrospective analysis was performed using tandem mass spectrometry to screen for inherited metabolic disorders in 691 712 newborns at the Maternal and Child Health Care Hospital of Xuzhou from November 2015 to December 2023. Ten children (cases 1-10) were diagnosed with Ornithine transcarbamylase deficiency (OTCD), Carbamoylphosphate synthase 1 deficiency (CPS1D), Arginase deficiency (ARGD), and Argininosuccinate synthase deficiency (ASSD) based on MS/MS and genetic testing. This study was approved by the Medical Ethics Committee of Xuzhou Maternity and Child Health Care Hospital (Ethics No.XZFY2024-051K-01J).Results:A total of 691 712 neonates were screened for UCDs using MS/MS, which identified 1 237, 1 237, 510, and 1 009 initial positive cases for OTCD, CPS1D, ASSD, and ARGD, respectively. After genetic testing, 1 case of OTCD, 1 case of CPS1D, 1 case of ASSD, and 7 cases of ARGD were confirmed. The overall positive predictive value for these four UCDs was 0.362%. Among the 10 diagnosed UCD cases, four novel variants were identified, which included OTC: c. 1024C>A (p.L342M) and ASS1: c. 826A>G (p.M276V), c.695C>T (p.P232L) and c. 694C>T (p.P232S). Bioinformatic analysis has rated these as variants of uncertain clinical significance or likely pathogenic based on guidelines from the American College of Medical Genetics and Genomics (ACMG). Conclusion:The incidence of four UCDs in neonates from the Xuzhou area is relatively low, and there is a correlation between genetic variants and clinical phenotypes. For novel variants with uncertain clinical significance or suspected pathogenicity, their pathogenicity should be clarified in conjunction with clinical and biochemical indicators. The four novel pathogenic variants of UCDs identified in this study have enriched the mutational spectrum of UCDs-associated genes in the Xuzhou region.

Objective·To study early expression levels of serum heparin-binding protein(HBP)and its potential value in early alarming for prognosis and occurrence of sepsis in patients with severe bums.Methods·Retrospective analysis was performed on medical records of 52 severely burned patients admitted to the Department of Bum and Plastic,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine during January 2021 to May 2023.General data of patients on gender,age,total bum area,body mass index(BMI),and whether endotracheal intubation or incision was performed were collected.The level of HBP,serum procalcitonin(PCT),serum C-reactive protein(CRP)and the count of white blood cells within 48 h of admission were collected.The scores of acute physiological and chronic health assessment evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)within 48 h of admission were collected.Patients were divided into death group and survival group according to the status at discharge.According to whether sepsis occurred during hospitalization,the patients were divided into sepsis group and non-sepsis group.According to whether shock occurred,the septic patients were divided into sepsis without shock group and septic shock group.Risk factors for death,sepsis,and septic shock in severely burned patients were analyzed by using Logistic regression models.Receiver operator characteristic(ROC)curve analysis was established to study risk factors,which may alarm the occurrence of poor prognosis,sepsis,and septic shock.Results·Compared with the survival group,patients in the death group were older,and the difference was statistically significant(P=0.036).Differences in burn area and whether tracheal intubation or tracheotomy was performed were statistically significant in patients with or without sepsis(P=0.011,P=0.001).Compared with the survival group,the serum HBP levels were higher in the death group,and the difference was statistically significant(P=0.002).Compared with the non-sepsis group,patients in the sepsis group had higher levels of serum HBP,APACHE Ⅱ scores,and SOFA scores,and the differences were statistically significant(all P＜0.05).The differences in other indicators were not statistically significant.Compared with the sepsis without shock group,the septic shock group had higher HBP levels,with a statistically significant difference(P=0.008).Logistic regression analysis showed that HBP was an independent risk factor for death in patients with severe burns during hospitalization and also an independent risk factor for the occurrence of septic shock in patients with sepsis after severe burns.ROC curve analysis showed that the area under the curve(AUC)for HBP in predicting patient mortality during hospitalization was 0.798;when HBP ≥147.03 ng/mL,its sensitivity and specificity were 88.33％and 70.00％,respectively.The AUC for HBP in predicting the occurrence of septic shock in patients with sepsis after severe burns was 0.789;when HBP ≥147.03 ng/mL,its sensitivity and specificity were 90.00％and 63.20％,respectively.Conclusion·The level of serum HBP within 48 h of admission might be used as an early alarming index for prognosis in patients with severe burns and for the occurrence of septic shock in patients with sepsis following severe burns.

Cerebrovascular diseases pose a serious threat to human health.According to the latest epidemiological data,stroke is one of the leading causes of death and disability among adults worldwide.Acute ischemic stroke(AIS),which is caused by local circulatory disorders in the brain,accounts for over 80%of all strokes and is the most common type of stroke.Due to extensive damage to the cerebral cortex or direct involvement of the autonomic nerve centers and pathways caused by AIS,the balance between the sympathetic and parasympathetic nervous systems is disturbed(with a predominance of sympathetic activation).Therefore,the organs targeted by the downstream pathways of the sympathetic and parasympathetic nervous systems are affected by the neurotransmitters they secrete,resulting in a range of systemic complications(such as cardiac complications,stroke-related infections,gastrointestinal complications,acute kidney injury,metabolic changes,and sexual dysfunction).These systemic pathological changes,in turn,affect the progression of AIS,thereby exacerbating brain damage or directly leading to patient death.Treatments targeting imbalances in the autonomic nervous system may play a role in reducing complications and improving the prognosis of AIS.This article reviews the systemic effects of autonomic dysfunction following AIS and its mechanisms,providing insights for the treatment of AIS and intervention of systemic complications.

Objective:To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS) in the perioperative period of congenital choledochal cysts in children.Methods:This is a multicenter prospective randomized controlled study. The clinical data of 273 pediatric congenital choledochal cysts(CCC) patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform. Among them, 123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode, and 150 cases in conventional group were managed according to traditional mode. The length of hospital stay,time to first farting, time to complete feeding, the incidence of complications, cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results:Compared with the conventional group, median time to start farting (2.0 d vs. 3.0 d, P<0.001), median time to complete feeding (5.0 d vs. 7.0 d, P<0.001), median postoperative hospitalization time (6.0 d vs. 9.0 d, P<0.001),the median total length of stay(13.0 d vs. 15.0 d, P<0.001) were shorter,the median hospitalization cost (37,000 yuan vs.43,000 yuan P<0.001) was lower, and stress indexes recovered quickly. The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups. Conclusion:It is safe and feasible to implement ERAS for children with CCC in the perioperative period, which can reduce stress response, speed up recovery,and save medical costs.

Reflex epilepsy is a type of partial or generalized seizure induced by specific or nonspecific stimulation in individuals without a prior history of seizures. Mahjong epilepsy is a special form of complex reflex epilepsy induced by playing or watching mahjong, with a low incidence rate and complex pathogenesis. Due to the lack of comprehensive understanding, clinical studies of mahjong epilepsy are still mainly based on case reports. Now, we will analyze and summarize the etiology, pathogenesis, clinical diagnosis, electroencephalogram, treatment, and prognosis of mahjong epilepsy to raise awareness of mahjong epilepsy among clinical medical workers.