Immunoglobulin A (IgA) nephropathy is a globally prevalent type of primary glomerulonephritis, characterized by complex symptoms and diverse clinical manifestations. The internationally recognized " multiple hit hypothesis" explains the systemic immune disease features of IgA nephropathy. However, current treatment strategies primarily focus on local pathological changes, inadequately addressing its complex systemic mechanisms. The " qi cycle in round" theory, an integral concept of the academic thought of HUANG Yuanyu, a prominent medical expert from the Qing Dynasty, offers a concise and insightful framework for understanding complex pathologies. For example, this theory provides valuable insights for elucidating the pathogenesis of IgA nephropathy and guiding its clinical management by simplifying intricate systemic processes. This study applies the " qi cycle in round" theory to postulate that patients with IgA nephropathy experience disrupted qi flow owing to spleen-stomach qi deficiency and dampness-heat accumulation. These imbalances manifest as internal symptoms, such as diarrhea; external vulnerability to illness; upper body symptoms, like sore throat; and lower body symptoms, such as hematuria and proteinuria. Pathologically, the condition is characterized by immune complex deposition. This article also emphasizes strategies that prioritize tonifying spleen-stomach qi to enhance the pivotal functions of transportation and transformation. Regulating qi and relieving stagnation are emphasized to harmonize ascending and descending dynamics. Additionally, eliminating turbidity and unblocking collaterals are highlighted to promote qi transformation. These approaches aim to restore the harmonious operation of organ qi dynamics and harmonious qi transformation functions. This study aims to provide a reference for syndrome differentiation and IgA nephropathy treatment using traditional Chinese medicine based on the " qi cycle in round" theory.

ObjectiveTo investigate the epidemiological feature of Mpox infection and genetic characteristics of Mpox viruses (MPXVs), so as to understand the etiological evolution of the pathogen. MethodsThe cases infected with MPXVs were originated from Changning District, Shanghai from July 20 to August 24 in 2023. Epidemiological investigations were conducted, and throat swabs, anal swabs, or vesicle fluid were collected for MPXVs nucleic acid testing. High-throughput sequencing was performed using Miniseq of the Illumina sequencing platform, and thereafter the sequences were concatenated and analyzed using the online analysis tool Nextclade. An evolutionary tree was constructed using the MEGA 11 software. ResultsAll 8 cases were male, with an average age of (35.76±7.00) years. Among them, 6 cases were identified through active hospital visits, and 2 cases were discovered during contact tracing for Mpox cases. Within the 21 days preceding the disease onset, all cases had male-male sexual behaviors, and the incubation period ranged from 6 to 10 days. 3 cases had a history of sexually transmitted diseases (STDs). MPXVs nucleic acid testing indicated that the detection rate of MPXVs was found to be 25.00% for throat swabs, 87.50% for anal swabs, and 100.00% for vesicle fluid, with statistically significant differences (χ²=11.052, P=0.004). Sequencing analyses using the online tool Nextclade indicated that all 8 MPXVs belonged to the West African clade Ⅱb, 4 MPXVs were classified as C.1 sub-lineages, and 4 MPXVs were identified as C.1.1 sub-lineages. Phylogenetic analysis using MEGA 11 indicated that 5 MPXVs were classified as Lineage C.1.1, closely related to the prevalent strains in Portugal and other European regions. ConclusionThe MPXVs sequences from Changning District are clssified into clade Ⅱb, lineage C.1.1. The detection rates of vesicle fluid and anal swabs for MPXVs are significantly higher than that of throat swabs.

Mitochondrial diseases are a group of hereditary disorders characterized by impaired oxidative phosphorylation in the mitochondrial respiratory chain caused by defects in either mitochondrial DNA or nuclear DNA， and such diseases have complex and diverse clinical manifestations and often involve multiple organs and systems， with the main manifestation of lesions in the nervous system and muscles due to their high energy demands. At present， there is still a lack of effective therapies for most mitochondrial diseases， and therefore， multidisciplinary management is essential in clinical practice， integrating various therapeutic approaches to provide personalized treatment regimens for patients with mitochondrial diseases. The primary treatment principle involves the timely correction of pathological and physiological abnormalities through pharmacological interventions， dietary modifications， and exercise management， along with the prompt treatment of system-specific impairments and the prevention of potential complications.
Diagnosis

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Transcription factor EB(TFEB)is a member of the microphthalmia associated transcription factor family.It plays an important role in lipid metabolism and other biological processes by regulating the expression of auto-phagy and lysosomal related genes.The activity and cellular localization of TFEB can be regulated by posttranslational modifications of proteins.This paper discusses the mechanism of autophagy regulation by TFEB posttranslational modifica-tion,aiming to help understand the pathogenesis of related diseases caused by abnormal autophagy,and provides new ideas and feasible intervention targets for the prevention and treatment of corresponding diseases.

Objectives:To investigate the association between social determinants of health(SDOH)and incident stroke and analyze the main risk factors for stroke among resident with different SDOH levels. Methods:From 2012 to 2015,30 036 residents(≥35 years old)from 30 districts in 14 provincial-level administrative divisions in China were enrolled this study based on stratified multi-stage-random-sampling method.The prevalence of cardiovascular diseases and related risk factors were investigated,and stroke events were followed up in 2018 to 2019.Principal component analysis was performed to establish SDOH scores based on 9 indicators related to socioeconomic and healthcare resources,participants were divided into low SDOH group(n=8 343)when it was≥-2.01 to<-1.14,middle SDOH group(n=7 257)when it was≥-1.14 to<0.10,and high SDOH group(n=8 457)when it was≥0.10 to≤5.79.Multivariate Cox regression was applied to estimate the association of SDOH levels with incident stroke.The random survival forest method was used to analyze the major risk factors in different SDOH levels. Results:A total of 24 057 participants were finally included,669(2.8%)participants developed stroke during a mean of(4.7±0.8)years follow-up.The incidence densities of stroke in the low,medium,and high SDOH groups were 468.39,628.85,and 700.39/100 000 person-years,respectively(Pdifference<0.05,Ptrend=0.01).Compared with individuals with low SDOH level group,fully HR for incident stroke among those with medium and high were 1.91(95%CI:1.54-2.36)and 1.59(95%CI:1.30-1.95),respectively(Ptrend<0.001).Advanced age is the primary risk factor for stroke in the population,especially in districts with high SDOH level.In districts with medium SDOH level,diabetes is an important risk factor for stroke.High blood pressure and alcohol consumption are important modifiable risk factors in low SDOH level districts. Conclusions:Present study shows that higher levels of SDOH are associated with increased risk of stroke.The main risk factors for stroke differ among participants with different SDOH level districts.Targeted interventions should be implemented to improve the prevention and treatment of stroke in populations with different levels of SDOH.

Objective To analyze the correlations between platelet-related parameters and the incidence of anxiety and depression in the patients undergoing peritoneal dialysis(PD),and evaluate the efficacy of the pa-rameters in the diagnosis of anxiety and depression in PD patients.Methods A total of 245 patients undergoing PD in the First Affiliated Hospital of Hebei North University from September 2022 to February 2023 were enrolled.The gener-alized anxiety scale(GAD-7)and the patient health questionnaire(PHQ-9)were used to evaluate the anxiety and depression of the patients,respectively.The personal information and biochemical indicators of the patients were col-lected,and the platelet count(PLT),mean platelet volume(MPV),and platelet distribution width(PDW)were measured.Logistic regression was adopted to analyze the relationships of platelet-related parameters with anxiety and depression in PD patients.Results Among the 245 patients undergoing PD,the incidences of anxiety and depression were 15.9% and 38.0% ,respectively.There were differences in the dialysis period(Z=-2.358,P =0.018;Z =-3.079,P=0.002),MPV(Z=-4.953,P<0.001;Z=-7.878,P<0.001),and PDW(Z =-4.587,P<0.001;Z=-7.367,P<0.001)between the anxiety group and the non-anxiety group as well as between the de-pression group and the non-depression group.The correlation analysis showed that MPV(r =0.358,P<0.001;r =0.489,P<0.001)and PDW(r =0.340,P<0.001;r =0.447,P<0.001)were positively correlated with anxiety and depression in the patients undergoing PD.The Logistic regression model showed that MPV(P =0.022,P =0.011),PDW(P =0.041,P =0.018),and dialysis period(P =0.011,P =0.030)were independent risk factors for the anxiety and depressive state in PD patients.The areas under the receiver operating characteristic curve of MPV in the diagnosis of anxiety and depression in PD patients were 0.750 and 0.800,respectively,and those of PDW were 0.732 and 0.780,respectively.Conclusion MPV and PDW have high efficacy in the diagnosis of anxiety and depression associated with PD and can be used as objective indicators to evaluate the anxiety and depression in the patients undergoing PD.

This paper aims to conduct an in-depth analysis of the current situation of wind and flood prevention safety management in hospitals and propose effective management optimization strategies,providing reliable basis for scientific preven-tion and defense against typhoons and flood disasters in hospitals.To achieve the established goals,the daily safety management work of the hospital can be steadily promoted through the implementation of a series of measures.Specific measures include opti-mizing early warning response plans,emphasizing leadership by cadres and strengthening their awareness,organizing safety man-agement training and practical exercises throughout the hospital,ensuring emergency material reserves,establishing flood preven-tion facilities,accurately identifying and strengthening the weak links and key areas of wind and flood prevention in the hospital,and continuously optimizing monitoring,etc.When facing natural disasters such as typhoons and floods,hospitals and relevant departments need to formulate effective strategies in a timely manner,conduct advance response deployment,and ensure that all established measures can be effectively implemented.Through scientific and reasonable countermeasures,the safety of employees and patients can be guaranteed,and the normal operation of the hospital during disasters can be ensured to maintain the stability of the society.

Objective:To explore the implementation status and influencing factors of enhanced recovery after surgery (ERAS) in perioperative management of patients undergoing total hip arthroplasty.Methods:This study was a cross-sectional study. From May to December 2022, purposive sampling was used to select 186 orthopedic nurses from 9 ERAS pilot hospitals in Beijing as the research subject. A self-designed questionnaire was used to investigate the implementation status of ERAS. Pearson correlation was used to analyze the correlation between Nurse ERAS Implementation Status Questionnaire scores and ERAS Behavioral Intention Questionnaire scores. Multiple linear regression was used to analyze the influencing factors of ERAS in perioperative nursing of patients undergoing total hip arthroplasty.Results:A total of 186 questionnaires were distributed and 186 valid questionnaires were collected, with an effective response rate of 100.00% (186/186). The total score of the Nurse ERAS Implementation Status Questionnaire was (116.49±20.71), and the standardized scores for each dimension from high to low were follow-up management (80.22±20.44), intraoperative period (78.98±15.17), preoperative period (74.72±14.09), and postoperative period (69.77±15.94). The total score of the ERAS Behavioral Intention Questionnaire was (77.39±15.08), and the standardized scores of each dimension from high to low were subjective norm (79.93±19.01), behavioral intention (77.69±19.61), behavioral attitude (74.19±15.77), and perceived behavioral control (64.41±14.69). The nurse's professional title, familiarity with ERAS, ERAS training, and subjective norm were the influencing factors of the specific implementation status score of ERAS ( P<0.05), explaining 40.9% of the total variance. Conclusions:Nurses should strengthen training on ERAS, increase their familiarity with knowledge, and adopt various incentive measures to further enhance the implementation of ERAS programs in clinical practice.