ObjectiveTo establish three standardized rehabilitation unit models covering acute, critical and comprehensive recovery stages for traumatic brain injury (TBI) that fit the whole-course characteristics, clarify their multidisciplinary collaborative framework, standardized procedures, and information management system, and verify the clinical effectiveness of this staged rehabilitation unit on long-term functional prognosis and in-hospital complications of TBI patients. MethodsThis study was conducted at two stages: model construction and efficacy verification. At the first stage, TBI rehabilitation units for acute, critical and recovery stages were established in the Department of Neurosurgery, Intensive Care Unit and Department of Rehabilitation Medicine, respectively, with unified multidisciplinary team configuration, standardized assessment and treatment protocols, collaborative workflows, and a dedicated information management system. At the second stage, 324 TBI patients admitted to the newly built rehabilitation units from July, 2023 to July, 2025 were enrolled as the observation group, and 167 TBI patients receiving traditional management from January, 2018 to December, 2022 were retrospectively selected as the control group. The primary outcomes were 1-year post-injury Glasgow Outcome Scale (GOS) and Disability Rating Scale (DRS) scores. Secondary outcomes included the incidence of in-hospital complications and the mean indwelling time of tracheal intubation, gastric tube and urinary catheter. ResultsThe 1-year GOS score was significantly higher (t = -7.836, P < 0.001), and the DRS score was significantly lower (t = -6.742, P < 0.001) in the observation group than in the control group. The overall incidence of complications was significantly lower in the observation group than in the control group (χ² = 18.762, P < 0.001). The incidences of pulmonary infection, urinary tract infection, pressure ulcer, lower extremity venous thrombosis and joint contracture deformity were all significantly reduced (χ² > 4.328, P < 0.05). The indwelling time of tracheal intubation, gastric tube and urinary catheter was significantly shorter in the observation group than in the control group (t > 10.276, P < 0.001). ConclusionThe acute-critical-comprehensive three-stage standardized TBI rehabilitation unit could significantly improve the long-term functional outcomes of TBI patients, reduce the incidence of complications, and shorten the indwelling time of invasive tubes through multidisciplinary collaboration, whole-course standardized management and information-based quality control. This model conforms to the pathological and functional laws of TBI, realizes seamless whole-course connection from acute treatment to recovery rehabilitation, and has good clinical feasibility and promotion value. It can provide evidence-based evidence and practical reference for the homogenized and standardized development of TBI rehabilitation in China.

OBJECTIVE: To explore the co-morbid influencing factors of postmenopausal osteoporosis(PMOP) and dyslipidemia, and to provide evidence-based basis for clinical co-morbidity management. METHODS: Based on the 2017 to 2018 Beijing community cross-sectional survey data, PMOP patients were included and divided into the dyslipidemia group and the uncomplicated dyslipidemia group according to whether they were comorbid with dyslipidemia. Demographic characteristics, living habits and disease history were collected through questionnaires, and bone mineral density and bone metabolism biomarkers (osteocalcin, blood calcium, serum typeⅠprocollagen N-terminal prepeptide, etc.) were detected on site. Co-morbidity risk factors were analyzed using binary logistic regression. RESULTS: Three hundred and twenty patients with PMOP were included, including the comorbid group (75 patients) and the uncomplicated group (245 patients). The results showed that history of cardiovascular disease [OR=1.801, 95%CI(1.003, 3.236), P=0.049], history of cerebrovascular disease [OR=2.923, 95%CI(1.460, 5.854), P=0.002], frying and cooking methods[OR=5.388, 95%CI(1.632, 17.793), P=0.006], OST results[OR=0.910, 95%CI(0.843, 0.983), P=0.016], and blood Ca results [OR=60.249, 95%CI(1.862, 1 949.926), P=0.021] were the influencing factors of PMOP complicated with dyslipidemia. CONCLUSION Focus should be placed on the influencing factors of PMOP and dyslipidemia co-morbidities, with emphasis on multidimensional assessment, combining lifestyle interventions with bone metabolism marker monitoring to optimize co-morbidity management.
Humans ; Dyslipidemias/epidemiology* ; Female ; Middle Aged ; Osteoporosis, Postmenopausal/metabolism* ; Aged ; Cross-Sectional Studies ; Risk Factors ; Bone Density

This study explores whether the current external quality assessment (EQA) level and acceptable bias for basic semen analysis in China are clinically useful. We collected data of semen EQA from Andrology laboratories in the Hunan Province (China) in 2022 and searched for data in the published literature from January 2000 to December 2023 in China. On the basis of these data, we analyzed the coefficients of variation and acceptable biases of different quality control materials for basic semen analysis through robust statistics. We compared these findings with quality specifications based on biological variation from optimal, desirable, and minimum levels of bias to seek a unified and more suitable semen EQA bias evaluation standard for China's national conditions. Different sources of semen quality control material exhibited considerable variation in acceptable biases among laboratories, ranging from 8.2% to 56.9%. A total of 50.0% of the laboratories met the minimum quality specifications for progressive motility (PR), whereas 100.0% and 75.0% of laboratories met only the minimum quality specifications for sperm concentration and total motility (nonprogressive [NP] + PR), respectively. The Z value for sperm concentration and PR+NP was equivalent to the desirable performance specification, whereas the Z value for PR was equivalent only to the minimum performance specification. This study highlights the feasibility of operating external quality assessment schemes for basic semen analysis using quality specifications based on biological variation. These specifications should be unified among external quality control (EQC) centers based on biological variation.
Semen Analysis/standards* ; Humans ; China ; Male ; Quality Control ; Sperm Motility ; Sperm Count/standards*

OBJECTIVES: To explore the predictive factors for hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants and to construct a nomogram prediction model for hsPDA occurrence in this population. METHODS: A retrospective analysis was conducted on the clinical data of preterm infants with gestational age <32 weeks diagnosed with patent ductus arteriosus (PDA) who were delivered at Nanjing Women and Children's Healthcare Hospital from January 2020 to December 2022. The subjects were divided into an hsPDA group (52 cases) and a non-hsPDA group (176 cases) based on the presence of hsPDA. Univariate analysis and multivariate logistic regression analysis were performed to screen predictive variables regarding the general information of the infants at birth, maternal pregnancy and delivery conditions, and relevant indicators during hospitalization. A nomogram prediction model for hsPDA occurrence was constructed using R software in preterm infants. Internal validation was performed using the Bootstrap method. Finally, the predictive model was evaluated for calibration, discrimination ability, and clinical utility. RESULTS: Multivariate regression analysis showed that the ratio of the left atrium to aorta diameter (LA/AO), mode of delivery (vaginal), and duration of mechanical ventilation were independent predictive factors for hsPDA in preterm infants (P<0.05). Based on the results of univariate analysis and multivariate logistic regression analysis, variables used to construct the nomogram prediction model for hsPDA risk included: LA/AO ratio, mode of delivery (vaginal), duration of mechanical ventilation, 5-minute Apgar score, and the presence of neonatal respiratory distress syndrome requiring surfactant therapy. The area under the receiver operating characteristic curve for this model was 0.876 (95%CI: 0.824-0.927), and the calibrated curve was close to the ideal reference line, indicating good calibration. The Hosmer-Lemeshow test demonstrated that the model fit well, and the clinical decision curve was above the extreme curves. CONCLUSIONS The nomogram prediction model, constructed using five variables (LA/AO ratio, vaginal delivery, duration of mechanical ventilation, 5-minute Apgar score, and the presence of neonatal respiratory distress syndrome requiring surfactant therapy), has reference significance for predicting the occurrence of hsPDA in preterm infants and provides valuable guidance for the early clinical identification of hsPDA.
Humans ; Ductus Arteriosus, Patent/etiology* ; Nomograms ; Female ; Infant, Newborn ; Infant, Premature ; Retrospective Studies ; Male ; Hemodynamics ; Logistic Models ; Pregnancy

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Ergopeptines or their derivatives are widely used for treating neurodegenerative and cerebrovascular diseases. The nonribosomal peptide synthetase-d-lysergyl peptide synthetase A (LPSA) determines ergopeptine formation but the detailed mechanism remains to be elucidated. Here, we characterized two LPSAs from Claviceps purpurea Cp-1 strain through heterologous expression in Aspergillus nidulans feeding with d-lysergic acid. We proved that Cp-LPSA1 catalyzed the formation of ergocornine, α-ergocryptine, and β-ergocryptine, precisely controlled by the substrate specificity of its three modules. Cp-LPSA2 was initially inactive but could be restored to catalyze α-ergosine formation. Using this platform, we validated that P1-LPSA1 and P1-LPSA2 from the reported C. purpurea P1 strain catalyzed ergotamine and α-ergocryptine formation, respectively. Typically, the non-ribosomal peptide codes implicated in every module of the LPSAs were defined and elucidated, in which certain key residues could play a switched role for substrate specificity and product interconversion. By constructing chimeric LPSAs through module assembly, the production of the desired ergopeptines was achieved. Notably, 1.46 mg/L of α-ergocryptine and 1.09 mg/L of ergotamine were produced respectively by mixed-culture of C. paspali No. 24 (fermentation supernatant) and the recombinants of A. nidulans. Our findings provide insights into the biosynthetic mechanism of ergopeptines and lay a foundation for directed ergopeptine biosynthesis.

Objective To explore the distribution law of TCM syndromes in children with severe mycoplasma pneumoniae pneumonia(SMPP)based on factor analysis and clustering analysis;To provide references for accurately identifying this disease.Methods General data,symptoms,signs and tongue and pulse were retrospectively collected from 408 children with SMPP who were hospitalized in the Department of Traditional Chinese Medicine of Beijing Children's Hospital,Capital Medical University between September 2019 and November 2023.The relevant clinical information was extracted and entered into the Excel 2019 database,and SPSS 27.0 was used to perform factor analysis.The sample of 408 cases was subjected to K-means clustering analysis,and finally,the distribution of TCM syndromes was derived.Results Factor analysis screened five common factors with eigenvalue>1,and its cumulative contribution rate was 63.063%;clustering analysis co-classified four types of syndromes,among which phlegm-heat-closure lung syndrome,toxic-heat-closure lung syndrome,lung-spleen-qi deficiency syndrome and healthy qi deficiency and pathogens attachment syndrome accounted for 39.22%,32.35%,15.20%and 12.75%,respectively.Conclusion Pediatric SMPP is characterized by toxic heat,qi deficiency,phlegm-heat,damp-heat and yin deficiency,and the disease is located in lungs,spleen and heart;TCM syndromes are characterized by phlegm-heat-closure lung,toxic-heat-closure lung,healthy qi deficiency and pathogens attachment and lung-spleen-qi deficiency,with phlegm-heat-closure lung syndrome and toxic-heat-closure lung syndrome being the most common syndromes.

Objective To explore the imaging manifestations of Rosai-Dorfman disease(RDD)in children.Methods A total of 12 children with RDD confirmed by pathology were retrospectively enrolled,including 8 cases underwent non-contrast CT(NCCT)+contrast enhanced CT(CECT),2 cases underwent NCCT+CECT+non-contrast MR(NCMR)+contrast enhanced MR(CEMR),1 case underwent NCCT+NCMR and CEMR,while 1 case underwent NCCT and X-ray examinations.Imaging manifestations of RDD in children were observed.Results Among 12 cases,intranodal type RDD was found in 7 case,extranodal type RDD in 3 cases,and mixed type(with both lymph nodes and extranodal sites affected)RDD were noticed in 2 cases.In 7 cases of intranodal type RDD,NCCT and CECT showed multiple lymph node enlargements in both sides of the neck,with uniform isodensity on NCCT and mild-moderate progressive enhancement in 5 cases,while with low-density necrotic area and ring-shaped enhancement in 2 cases.Among 3 cases of extranodal RDD,the lesion in 1 case involved nasal cavity and posterior group of ethmoid sinuses on CT and MRI,which developed circular soft tissue mass centered on nasal septum with moderate heterogeneous enhancement,also compressed the adjacent bone with destruction.In another case of extranodal RDD,CT showed that the lesion involved left ilium and bilateral parietal bones,with bone destruction accompanied by obvious periosteal reaction and soft tissue mass,which was mildly enhanced.In the rest 1 case of extranodal RDD,CT and X-ray film showed that the lesion involved the upper segment of right femur and left parietal bone,with osteolytic destruction accompanied by layered periosteal reaction.The lesions in both 2 cases of mixed type RDD involved brain(1 case involved left parieto-occipital lobe,1 case involved bilateral temporal lobes,left frontal lobe and bilateral occipital lobes),presented as isodensity on CT and equal or slightly low signal intensity on T 1WI,equal-high mixed signal intensity on T2WI,some shaped like brain gyral with mild edema of surrounding tissue,and nodular or mass-like significant enhancement.RDD involvements of bilateral lung,mediastinum and hilar lymph nodes were also observed in the above 2 cases,chest CT showed multiple nodular or small patchy uniform high-density shadows in bilateral lungs,as well as enlarged mediastinum and hilar lymph nodes.Conclusion Imaging manifestations of pediatric RDD had certain specificity,being helpful to diagnosis.

Objective To investigate the geographical distribution patterns and influencing factors of suitable habitats for the desert medicinal plant Cynomorium songaricum Rupr under current climatic conditions;To provide a basis for its resource conservation and sustainable utilization.Methods The MaxEnt model was used to analyze potential suitable habitats for Cynomorium songaricum Rupr.Geographical Detector model was used to identify key environmental factors affecting habitat suitability.Surface cover data were overlaid to assess the distribution of sandy and Gobi regions within suitable habitats,enabling a quantitative evaluation of actual potential suitable areas.Results Model predictions indicated a total suitable habitat area of approximately 2.98×106 km2,representing 30.99%of China's mainland area.Highly suitable habitats are concentrated in desert and Gobi regions of Gansu,Xinjiang,Inner Mongolia,Qinghai and Ningxia.Among climatic factors,precipitation of the coldest quarter(bio19),solar radiation in August(srad8),and mean temperature of the coldest quarter(bio11)significantly influence Cynomorium songaricum Rupr distribution.The interaction between temperature and solar radiation intensity exhibited the highest explanatory power for habitat distribution patterns(q=0.82).Overlay analysis with surface cover data estimated the actual potential suitable area at approximately 9.70×105 km2,with sandy regions comprising 5.73×105 km2 and Gobi regions 3.98×105 km2.Conclusion By integrating multi-source data and modeling approaches,this study delineates the potential suitable habitats for Cynomorium songaricum Rupr across China and evaluates the spatial distribution characteristics and influencing factors of suitable habitats in Cynomorium songaricum Rupr.These findings offer a foundation for conserving wild Cynomorium songaricum Rupr resources,optimizing ecological planting regions,and promoting sustainable industry development.

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*