Objective To summarize the diagnostic ideas, clinical characteristics and treatment methods of the rupture of pseudoaneurysm in the pararenal artery, so as to provide reference for the management of such condition.Methods The diagnosis and treatment process of a patient with massive retroperitoneal hemorrhage due to rupture of pseudoaneurysm in the left pararenal artery admitted to the Affiliated Hospital of Yan'an University were reported, and relevant literature was retrieved to summarize the etiology, pathogenesis, diagnosis and treatment of this disease.Results The patient was a 49-year-old male who presented with sudden onset of lumbar and abdominal pain.After admission, enhanced computed tomography (CT) scan indicated a cystic lesion in the left kidney, along with fluffy high-density and fluidic density shadows around the kidney.There was extensive extravasation of contrast agent in the lower polar artery of the left kidney, with rupture shadows, retention of contrast agent, and the extent of extravasation expanding in the venous phase and delayed phase, suggesting that the renal artery or pararenal artery had ruptured and bled.After consultation by the Department of Intervention, an urgent superselective left renal artery embolization procedure was performed.During the operation, angiography showed the “jetting sign” in the arterial phase, and the stenosis at the neck of the tumor.In the delayed phase, the contrast agent was retained accompanied with the “chimney sign”, which was consistent with the characteristics of a pseudoaneurysm.The final diagnosis was rupture and bleeding of a pseudoaneurysm of the left pararenal artery, along with the formation of a hematoma, as well as accumulation of blood and fluid in the abdominal and pelvic cavities.The patient recovered well after surgery.After a follow-up of 6 months, CT scan showed that the hematoma was basically absorbed and there were no obvious abdominal pain or other discomforts.Conclusion Rupture of pseudoaneurysm in the pararenal artery is rare in clinical practice.Treatment should be tailored to the anatomical features and the patients' condition.Multidisciplinary collaboration, precise imaging evaluation, and the application of interventional techniques can achieve efficient diagnosis and treatment, and protect the renal function to the greatest extent.

OBJECTIVE To compare the effect of traditional swab sampling method on etiological surveillance of in-fectious diseases for large-scale object surfaces in hospitals and validate the samples processing method based on pre-wet anti-static fabric and modified polyethylene glycol(PEG)precipitation enrichment technology so as to im-prove the capability of early warning of infectious diseases and optimize the environmental surveillance program in the hospitals.METHODS The on-site surveillance was carried out for 8 times in 3 public hospitals(Shenzhen Longgang People's Hospital,the Second People's Hospital of Longgang and Longgang Maternal and Child Health Hospital)from May 2024 to Mar.2025.Totally 23 types of respiratory tract pathogens(18 types of viruses,5 type of pathogenic bacteria)and 6 types of gastrointestinal tract pathogens were simultaneously detected by means of fluorescent quantitative polymerase chain reaction(PCR);the actual isolation rates,etiological spectrum and cycle threshold(Ct)value were compared.The acrylic plate added with standards of different loads of H1NI influ-enza viruses was used as model for laboratory evaluation.The minimum detection limit,sensitivity and repeatabili-ty were observed and compared between the methods.RESULTS The minimum detection limit of both methods was 6.0 × 104 copies/ml,however,the positive rate of nucleic acid testing of the pre-wet fabric method was 100.00％(3/3),higher than 33.33％(1/3)of the swab method;when the low viral load was 6.0× 105 copies/ml,the average concentration of viral nucleic acid of the pre-wet fabric method(X-Ct=36.59)was higher,with the re-peatability(CV=0.99％,＜3.14％)better.The results of the on-site surveillances showed that the total isolation rates of pathogens of the pre-wet fabric method ranged between 42.84％and 64.27％,higher than between 10.71％and 21.43％of the swab method,with the isolated pathogens more abundant,the Ct value lower(P＜0.05).CONCLUSION The pre-wet fabric sampling enrichment method integrated with anti-static fabric sampling and PEG enrichment technology shows higher sensitivity and stability in the etiological surveillance of large-scale object surfaces,raising the isolation rate.

The prefrontal cortex (PFC) plays a pivotal role in orchestrating higher-order emotional and cognitive processes, a function that depends on the precise modulation of synaptic activity. Although pharmacological studies have demonstrated that dopamine signaling through dopamine D1 receptor (DRD1) in the PFC is essential for these functions, the cell-type-specific and molecular mechanisms underlying the neuromodulatory effects remain elusive. Using cell-type-specific knockout mice and patch-clamp recordings, we investigated the regulatory role of DRD1 on neurons and astrocytes in synaptic transmission and plasticity. Furthermore, we explored the mechanisms by which DRD1 on astrocytes regulate synaptic transmission and plasticity at the cellular level, as well as emotional and cognitive functions at the behavioral level, through two-photon imaging, microdialysis, high-performance liquid chromatography, transcriptome sequencing, and behavioral testing. We found that conditional knockout of the Drd1 in astrocytes (CKO^AST) increased glutamatergic synaptic transmission and long-term potentiation (LTP) in the medial prefrontal cortex (mPFC), whereas Drd1 deletion in pyramidal neurons did not affect synaptic transmission. The elevated level of d-serine in the mPFC of CKO^AST mice increased glutamatergic transmission and LTP through NMDA receptors. In addition, CKO^AST mice exhibited abnormal emotional and cognitive function. Notably, these behavioral changes in CKO^AST mice could be reversed through the administration of d-serine degrease to the mPFC. These results highlight the critical role of the astrocytic DRD1 in modulating mPFC synaptic transmission and plasticity, as well as higher brain functions through d-serine, and may shed light on the treatment of mental disorders.

OBJECTIVE To compare the effect of traditional swab sampling method on etiological surveillance of in-fectious diseases for large-scale object surfaces in hospitals and validate the samples processing method based on pre-wet anti-static fabric and modified polyethylene glycol(PEG)precipitation enrichment technology so as to im-prove the capability of early warning of infectious diseases and optimize the environmental surveillance program in the hospitals.METHODS The on-site surveillance was carried out for 8 times in 3 public hospitals(Shenzhen Longgang People's Hospital,the Second People's Hospital of Longgang and Longgang Maternal and Child Health Hospital)from May 2024 to Mar.2025.Totally 23 types of respiratory tract pathogens(18 types of viruses,5 type of pathogenic bacteria)and 6 types of gastrointestinal tract pathogens were simultaneously detected by means of fluorescent quantitative polymerase chain reaction(PCR);the actual isolation rates,etiological spectrum and cycle threshold(Ct)value were compared.The acrylic plate added with standards of different loads of H1NI influ-enza viruses was used as model for laboratory evaluation.The minimum detection limit,sensitivity and repeatabili-ty were observed and compared between the methods.RESULTS The minimum detection limit of both methods was 6.0 × 104 copies/ml,however,the positive rate of nucleic acid testing of the pre-wet fabric method was 100.00％(3/3),higher than 33.33％(1/3)of the swab method;when the low viral load was 6.0× 105 copies/ml,the average concentration of viral nucleic acid of the pre-wet fabric method(X-Ct=36.59)was higher,with the re-peatability(CV=0.99％,＜3.14％)better.The results of the on-site surveillances showed that the total isolation rates of pathogens of the pre-wet fabric method ranged between 42.84％and 64.27％,higher than between 10.71％and 21.43％of the swab method,with the isolated pathogens more abundant,the Ct value lower(P＜0.05).CONCLUSION The pre-wet fabric sampling enrichment method integrated with anti-static fabric sampling and PEG enrichment technology shows higher sensitivity and stability in the etiological surveillance of large-scale object surfaces,raising the isolation rate.

Objective To investigate the effect of respiratory training based on core stability training on feedforward control in pa-tients with chronic nonspecific low back pain(CNLBP). Methods A total of 60 patients with CNLBP in Jiaxing Second Hospital from January,2022 to March,2023 were ran-domly divided into control group(n=30)and experimental group(n=30).Both groups received health educa-tion,physical factor therapy and core stability training,while the experimental group received respiratory training in addition,for four weeks.Visual Analogue Scale(VAS)score,Japanese Orthopaedic Association low back pain(JOA)score and Oswestry Dysfunction Index(ODI)were compared between two groups before and after treat-ment,while surface electromyography was used to detect the root mean square(RMS)and integrated electromy-ography(iEMG)of transversus abdominis,multifidus and triceps(movement muscles),and the activation se-quence and relative activation time of transversus abdominis,multifidus and triceps were calculated. Results After treatment,the scores of VAS,JOA and ODI improved significantly in both groups(|t|>8.515,P<0.001),and the scores were better in the experimental group than in the control group(|t|>2.089,P<0.05).RMS and iEMG of transversus abdominis and multifidus improved significantly after treatment in both groups(|t|>18.831,P<0.001),and were significantly better in the experimental group(|t|>3.481,P<0.05).The transversus abdominis and multifidus in both groups were activated before the movement muscles,and the relative activation time of transversus abdominis and multifidus increased in negative(|t|>48.115,P<0.001),the experimental group being better(|t|>3.229,P<0.05). Conclusion Combination of core stability training and respiratory training is beneficial in reducing the pain of patients with CNLBP,reducing the lumbar dysfunction,improving the order of muscle activation,and strengthening feed-forward control.

Objective:The study retrospectively analyzed the etiology, clinical manifestations, emergency treatment and etiological treatment of a large sample of cases with hypercalcemic crisis.Methods:The clincial data of patients with hypercalcaemia cirisis who were administered in First Medical Center of Chinese PLA General Hospital from January 2009 to July 2022 were analyzed, inculding the general data, clinical manifestations, etiology, photographic examination, emergency treatment, etiological treatment, serological examination before and after treatment, pathological immunohistochemical findings and prognosis.Results:A total of 143 hypercalcaemia crisis patients(84 males and 59 females) with a mean age of 53.51±16.60 were enrolled. The most common disease was hyperparathyroidism(62/143), followed by solid malignancy(57/143) and multiple myeloma(12/143). Patients presented with digestive system symptoms at 76.91%, followed by neurological symptoms at 63.60%, urinary system symptoms at 58.76%, musculoskeletal symptoms at 55.23%, and cardiovascular system symptoms at 32.91%. After emergency calcium-lowering treatment, the remission rate of hypercalcemic crisis in 143 patients was 100%(143/143), and after etiological treatment, the remission rate of hypercalcemia was 85.31%(122/143).Conclusion:Early identification, emergency treatment and etiology treatment of hypercalcaemia crisis are essential. Effective treament with comprehensive calcium reduction can quickly relieve clinical symptoms and create opportunities for treatment for the cause. Targeted etiological interventions can lead to the correction or long-term remission of hypercalcemia.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore the characteristics of the association between the triglyceride glucose (TyG) index and nonfatal cardio-cerebrovascular disease risk in a community population.Method:This was a prospective cohort study. From December 2011 to April 2012, the first investigation was conducted among subjects with more than 40-year old who were from Shijingshan district and Pingguoyuan community in Beijing. The second investigation was conducted from April to October 2015. All the subjects were divided into three groups according to the tertile of the TyG index at baseline. The multivariate Cox proportional risk regression model was established to explore the correlation between the TyG index and nonfatal cardio-cerebrovascular disease risk and the Kaplan-Meier survival curve of the TyG index group was drawn. Subgroup analyses were performed according to age, gender, body mass index, type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia to determine the correlation characteristics between the TyG index and nonfatal cardio-cerebrovascular disease among subgroups.Results:A total of 9 577 subjects were finally included to analyze. The mean follow-up time of this study was (34.14±3.84) months. During the follow-up, 363 subjects (3.8%) occurred nonfatal cardio-cerebrovascular disease. The multivariate Cox regression analysis results showed that the hazard ratio ( HR) of nonfatal cardio-cerebrovascular disease in the high TyG index group was 1.54 (95% CI 1.19-1.98), 1.60 (95% CI 1.23-2.10), and 1.57 (95% CI 1.20-2.05) in the three models, compared with the low TyG index group. The Kaplan-Meier analysis showed that the risk of nonfatal cardio-cerebrovascular disease increased from the low-TyG index group to the high-TyG index group ( P=0.015). In the six subgroups analysis, only gender was shown to have a significant interaction effect with the TyG index and nonfatal cardio-cerebrovascular disease risk. In the female population, the risk of nonfatal cardio-cerebrovascular disease is significantly increased with the increase in the TyG index level ( P<0.001). Conclusions:A high TyG index is independently related to the increased risk of nonfatal cardio-cerebrovascular disease in the Beijing community population. Gender has a significant interaction with the TyG index and nonfatal cardio-cerebrovascular disease risk. Therefore, the TyG index may be a useful marker to predict the nonfatal cardio-cerebrovascular disease risk of a community population.

Objective:To explore any effect of blood flow restriction during exercise on knee proprioception and motor coordination after anterior cruciate ligament (ACL) reconstruction.Methods:Thirty patients recovering from ACL reconstruction were randomly divided into an experimental group and a control group, each of 15. Both groups were given routine rehabilitation training, while the experimental group was additionally provided with 45 minutes of training with blood flow restriction, 3 times a week for 8 weeks. The blood flow restriction training involved constant pressure in the groin while the patient performed knee flexion and extension resistance training, squats, alternate knee flexion and extension and ergometer cycling. Before and after the intervention, both groups′ knee function, proprioception and lower limb motor coordination were evaluated using the Lysholm knee scale, the Humac isokinetic measurement system and surface electromyography.Results:Before the experiment there were no significant differences between the two groups in any of the measurements. After the intervention, both groups′ average Lysholm score had improved significantly, and errors in reproducing a knee angle had decreased significantly. Significantly better improvement was observed in the observation group than in the control group. That group′s average coordinated contraction rate on the affected side in extension and flexion was also significantly better than the control group′s ave-rage. Indeed, there were no significant differences in the contraction rates between the healthy and affected sides.Conclusions:Training with restricted blood flow can significantly improve knee function, proprioception and motor coordination after anterior cruciate ligament reconstruction.

Objective:To observe any effects of contralateral repeated transcranial magnetic stimulation (rTMS) of the swallowing motor cortex on the swallowing and brainstem auditory evoked potentials (BAEPs) of stroke survivors with dysphagia.Methods:A total of 83 stroke survivors with dysphagia were randomly divided into an ipsilesional stimulation group ( n=22), a contralesional stimulation group ( n=21), a bilateral stimulation group ( n=20), and a control group ( n=20). In addition to their conventional dysphagia training, those in the three stimulation groups received 3Hz rTMS while the control group was given fake stimulation. The treatment was administered daily for 20 minutes, 6 days a week, for 5 consecutive weeks. Before and after the treatment, swallowing function was assessed videofluoroscopically and using the Dysphagia Outcome and Severity Scale (DOSS). The oral and pharyngeal stages of swallowing were evaluated using the videofluoroscopic dysphagia scale (VDS). Brain stem conduction was assessed using BAEPs. Results:After treatment the average DOSS scores of all 4 groups were significantly better than before the treatment. The average DOSS scores of the contralesional and bilateral sti-mulation groups were then significantly better than those of the other two groups. The sub-item and total VDS scores of all 4 groups had decreased significantly, but the average score of the bilateral stimulation group was significantly lower than the control group′s average. Ipsilesional stimulation significantly improved the VDS sub-item scores for the triggering of pharyngeal swallowing, laryngeal elevation, and pharyngeal transit time compared with the control group. In the contralesional stimulation group the average total score and the VDS sub-item scores for apraxia, premature bolus loss, oral transit times, the triggering of pharyngeal swallowing, vallecular residue, laryngeal elevation, coating on the pharyngeal wall, and pharyngeal transit time were significantly lower than those of the control group, on average. After the treatment the latencies of BAEP waves I, III and V and the I-III, III-V and I-V interpeak intervals had decreased significantly in all four groups, but the average latencies and intervals of the bilateral and contralesional groups were significantly shorter than those of the control group. The latencies and intervals of the bilateral stimulation group were then significantly shorter than those in the ipsilesional stimulation group on average. The average latency of wave V in the bilateral stimulation group (6.53±0.73ms) was significantly shorter than that in the contralesional stimulation group after the treatment.Conclusion:Bilateral rTMS over the swallowing motor cortex combined with conventional dysphagia training can significantly improve the swallowing of dysphagic stroke survivors.