ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.

AIM: To compare the agreement between the ARK Biometer Combo and OA 2000 in patients wearing orthokeratology lenses.METHODS: A prospective study. A total of 148 patients(148 eyes)who were wearing orthokeratology lenses and returned for follow-up at the Shanghai Eye Disease Prevention and Treatment Center from August to September 2024 were included. Biometric measurements were performed using both the ARK Biometer Combo and OA 2000. Parameters including axial length(AL), corneal central thickness(CCT), anterior chamber depth(ACD), lens thickness(LT), corneal curvature(Kf and Ks), astigmatism(AST), white-to-white corneal diameter(WTW)and pupil diameter(PD)were obtained. Differences in measurement parameters between the two biometers were compared, and agreement was assessed.RESULTS: There were no statistically significant differences in the measurements of Kf, Ks and AST between the two biometers(P>0.05). Statistically significant differences were found in the measurements of AL, CCT, ACD, LT, WTW and PD(t=2.559, P=0.012; t=16.771, P<0.0001; t=4.749, P<0.0001; t=-15.212, P<0.0001; t=-14.915, P<0.0001; t=-2.402, P=0.018). ICC ranged from 0.615 to 0.999. Bland-Altman analysis showed that the maximum absolute values of the 95% limits of agreement(LoA)of AL, CCT, ACD, LT, Kf, Ks, AST, WTW and PD were 0.07 mm, 35.07 μm, 0.07 mm, 0.12 mm, 0.66 D, 1.14 D, 1.00 D, 0.76 mm, and 0.98 mm, respectively.CONCLUSION: In orthokeratology patients, the ARK Biometer Combo and OA 2000 showed good agreement in measuring AL, CCT, ACD, Kf and LT, and can be used interchangeably.

Objective:To compare the clinical and laboratory characteristics and survival between Chinese and Western patients with myelodysplastic neoplasms (MDS) .Methods:Clinical and laboratory data were collected from 1,464 primary adult patients diagnosed with MDS at the Institute of Hematology & Blood Diseases Hospital from August 2016 to June 2024. Collected data were retrospectively analyzed and compared with 2,191 patients from the International Working Group for the Prognosis of Myelodysplastic Syndromes (IWG-PM) .Results:Chinese patients were significantly younger (median age: 56 years vs. 72 years, P<0.001) and experienced more severe hematopenia ( P<0.001) compared with patients from the IWG-PM. Further, Chinese patients exhibited a higher percentage of isolated del (20q), +8, and complex karyotypes as well as a lower percentage of normal karyotypes, del (5q), and -Y ( P<0.001). Higher U2AF1, NRAS, and NPM1 mutation rates and lower ASXL1, SF3B1, and RUNX1 mutation rates were observed in Chinese patients than in participants from the IWG-PM ( P<0.05). No significant difference in overall survival (OS) was found between the two groups (median OS: 48 [95% CI: 40 - 56]months, vs. 45[95% CI: 40 - 49] months; P=0.449). Among participants aged ≤45 years, Chinese patients demonstrated more trisomy 8 ( P=0.070) and U2AF1 mutation ( P<0.001) and higher 4-year OS rate compared with those from the IWG-PM (75.5% vs. 62.1%, P=0.001). Among participants aged ≥70 years, Chinese patients exhibited more complex karyotypes but fewer del (5q) as well as more NPM1 but less SF3B1 and TET2 compared with those from the IWG-PM ( P<0.05). Chinese patients demonstrated shorter survival (median OS: 20 [95% CI: 13 - 27] months vs. 37 [95% CI: 32 - 42] months, P<0.001) . Conclusion:Chinese and Western MDS patients differ in age of onset, clinical features, and cytogenetic or molecular genetic abnormalities, with significant differences persisting in age-matched groups. Although the OS is similar, disparities exist in survival for younger and older patients between the two populations.

Objective:To explore the risk fall death associated with compound hot extremes.Methods:This study collected data on fall deaths in Guangdong, Hunan, and Zhejiang Provinces from 2013 to 2018 and matched their exposure to meteorological data. Based on a time-stratified case-crossover design, a conditional logistic regression model embedded with a cross-basis function of the distributed lag nonlinear model was applied to estimate the risk of fall to death due to compound hot extremes.Results:Compared with regular days, compound hot extremes significantly increased the risk of death from falls ( OR=1.19, 95% CI: 1.09-1.30), and women ( OR=1.27, 95% CI: 1.11-1.45) and the elderly age 65 and above ( OR=1.24, 95% CI: 1.12-1.39) were more sensitive to compound hot extremes. The maximum duration of compound hot extremes was 7 days, and the maximum intensity was 6.2 ℃, and the duration and intensity were proportional to the risk of death from falls. The risk of death from falls increased by 12% ( OR=1.12, 95% CI: 1.06-1.18) each day, increasing in duration after linearization. The risk of death from falls increased by 16% ( OR=1.16, 95% CI: 1.10-1.22) for each 1 ℃ increase in linearized intensity. Conclusion:Compound hot extremes increase the risk of death cases from falls.

Objective To investigate the effects of glycerol ingestion on pure tone audiometry(PTA),distor-tion products otoacoustic emission(DPOAE),and electrocochleography(ECochG)in patients with Ménière disease(MD).Methods Glycerol test was conducted in 50 patients with MD.PTA was performed in four series:before glycerol intake,1,2 and 3 hours after intake.DPOAE and ECochG were performed before glycerol intake and 2 hours after intake.All results were analyzed to assess the effect of glycerol on cochlear function of patients with MD.Results ① 55％of MD patients tested positive in PTA glycerol test,and the positive rate increased gradually after 1-3 hours of glycerin ingestion(P＜0.05).For the 33 positive ears,the pure tone threshold decreased the most between 1-2 hours and reached the lowest thresholds at 3 hours.Thresholds at 0.5 kHz,1 kHz,2 kHz dropped the most.② The positive rate of DPOAE glycerol test was 56.67％,with 34 positive ears showing a sig-nificant increase in amplitude between 0.75-2 kHz of f2.③ The positive rate of ECochG glycerin test was 13.64％.The decrease of-SP/AP ratio was not statistically significant before and after ingestion of glycerin(P＞0.05).Conclusion Ingestion of glycerin could alter to varying degrees of the results of PTA,DPOAE and ECo-chG,and influence the cochlear function to some extent.

Objective:To identify the prognostic value of the Revised 15-item Myelodysplastic Syndrome-specific frailty scale (FS-15) in Chinese patients with myelodysplastic syndromes (MDS) .Methods:This retrospective study analyzed 812 patients with newly diagnosed MDS admitted to the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College from August 2016 to June 2023. Patients were assessed using the FS-15 and subsequently categorized into frail and non-frail groups. Clinical and laboratory characteristics, as well as overall survival (OS), were compared between these groups.Results:① The median patient age was 55 years ( IQR 45–64), with a median follow-up of 22.5 months (95% CI: 20.2–24.9) and a median OS of 43.3 months (95% CI: 36.8–49.8). The median FS-15 score was 0.42, with a cutoff value of 0.44. Male patients demonstrated higher median FS-15 scores than female patients (0.42 vs 0.38, P=0.006). In both the Revised International Prognostic Scoring System (IPSS-R; P=0.001) and Molecular International Prognostic Scoring System (IPSS-M; P=0.014) stratifications, FS-15 scores were significantly higher in the very high-risk group compared with the very low-risk group. ② The median OS was 54.7 months (95% CI: 47.5–NA) and 31.5 months (95% CI: 22.9–41.0) in the nonfrail ( n=452) and frail groups ( n=360), respectively ( P<0.001). The 3-year OS rates were (63.2 ± 3.2) % and (46.4 ± 3.6) % for the non-frail and frail groups, with 5-year OS rates of (49.9 ± 4.7) % and (32.0 ± 4.3) %, respectively ( P<0.001). ③Subgroup analysis revealed that nonfrail patients demonstrated significantly higher 3-year OS rates than frail patients in both the IPSS-M low-risk and very high-risk groups (all P<0.05). Similarly, nonfrail patients demonstrated superior 3-year OS rates compared with frail patients in the IPSS-R very low-risk, low-risk, and high-risk groups (all P<0.05). ④Among patients receiving hypomethylating agent therapy, the overall response rate was significantly higher in the non-frail group than in the frail group (86.7% vs 64.6%, P=0.007). Moreover, the frail group experienced higher rates of treatment-related adverse events, including febrile neutropenia (67.1% vs 47.4%, P=0.016) and liver function abnormalities (30.0% vs 14.5%, P=0.023), compared with the non-frail group. Conclusion:The FS-15 frailty score is a feasible and effective tool for assessing frailty in patients newly diagnosed with MDS in China and serves as a valuable prognostic indicator.

Objective:To investigate the clinical, laboratory, and prognostic features of myelodysplastic neoplasm (MDS) patients harboring acute myeloid leukemia (AML) -like mutations.Methods:We retrospectively analyzed clinical, molecular, and outcome data from 1 464 adults with primary MDS diagnosed at the Institute of Hematology and Blood Diseases Hospital from August 2016 to June 2024.Results:AML-like mutations were detected in 64 patients (4.4% ). Compared with patients without AML-like mutations, those with AML-like mutations were younger [median 50 ( IQR 39–60) vs 56 (45, 65) years; P=0.001], more often female (51.6% vs 35.4% ; P=0.009), had higher bone marrow blast percentage [6.5% (3.0%, 10.5% ) vs 2.5% (1.0%, 7.0% ) ; P<0.001], a higher rate of normal karyotype (75.0% vs 48.1% ; P<0.001), and lower hemoglobin levels [73 (67, 82) g/L vs 80 (66, 98) g/L; P=0.006]. The AML-like group had a higher number of gene mutations than the non-AML-like group [3 ( IQR 2–4) vs 2 (1, 3) ; P<0.001). It was enriched for mutations in NPM1, DNMT3A, WT1, PTPN11, NRAS, BCOR, FLT3, CEBPA, and MYC (all P<0.05) and had lower rates of U2AF1, ASXL1, and TP53 mutations (all P<0.05). Overall survival (OS) did not differ between groups ( P=0.730) ; however, the AML-like group had significantly shorter leukemia-free survival (LFS) [19 months (95% CI: 13–25) vs 46 months (95% CI: 38–54) ; P=0.012] and a higher 2-year cumulative incidence of AML transformation [ (41.7±9.1) % vs (10.4±1.1) % ; P<0.001]. Within the AML-like group, OS, LFS, and cumulative incidence of AML transformation did not differ between patients with low blasts and those with excess blasts (IB). Multivariable Cox regression identified age ≥60 years and PTPN11 mutations as independent adverse prognostic factors for OS, while DNMT3A, PTPN11, and FLT3 mutations independently predicted leukemic transformation. Conclusions:MDS patients harboring AML-like mutations exhibit distinct clinical and molecular features and a higher risk of progression to AML.

Objective:To investigate the genetic causes of fetuses with abnormal nasal bone development in early pregnancy.Methods:A retrospective study was conducted which involved 422 cases of singleton pregnancies with nasal bone development abnormalities indicated by ultrasound screening at 11 to 13 weeks and 6 days of gestation, who underwent chorionic villus sampling for prenatal diagnosis at the Prenatal Diagnosis and Genetic Center, Maternity & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2015 to May 2023. All cases underwent chromosomal karyotype analysis and single nucleotide polymorphism array (SNP-array) analysis. Based on whether other abnormal ultrasound indicators were present, the cases were divided into isolated (175 cases) and non-isolated groups (247 cases). The results of invasive prenatal diagnosis, distribution of chromosomal abnormalities, detection of copy number variation (CNV) in fetuses with nasal bone development abnormalities, the relationship between maternal age, number of abnormal ultrasound indicators and chromosomal abnormalities, and pregnancy outcomes were analyzed. Statistical analysis was performed using the Chi-square test (continuity correction Chi-square test or Fisher's exact test). Results:(1) Among the 422 cases, 262 cases (62.1%) showed no abnormalities with both detection techniques; 160 cases had abnormalities, including 145 cases (34.4%) had consistent abnormal results and types of abnormalies with the two techniques; two cases (0.5%) had chromosomal translocations detected by karyotype analysis but not by SNP-array analysis; 13 cases (3.1%) had no abnormalities detected by karyotype analysis but had abnormal SNP-array results. This study's overall detection rate of chromosomal abnormalities was 37.9% (160/422), with an additional detection rate of 4.7% (13/275) using SNP-array technology. (2) Among the 160 cases of chromosomal abnormalities, there were 140 cases of aneuploidy, 18 cases of CNV, and two cases of chromosomal translocation. The overall detection rate of chromosomal abnormalities and the detection of aneuploidy, and pathogenic CNV in the non-isolated group was higher than that in the isolated group [74.3% (130/175) vs. 12.1% (30/247), χ2=168.02; 68.0% (119/175) vs. 8.5% (21/247), χ2=163.56; 5.7% (10/175) vs. 0.8% (2/247), χ2=4.74; all P<0.05]. Eighteen cases of CNV were detected using SNP-array technology, including eight cases in the isolated group and ten cases in the non-isolated group. (3) The age of the 422 pregnant women was (33.1±5.4) years. In both isolated and non-isolated groups, the detection rate of chromosomal abnormalities was higher in women of advanced age (expected delivery age ≥35 years) than those not [isolated group: 20.0% (17/85) vs. 8.6% (14/162), χ2=6.55; non-isolated group: 82.1% (69/84) vs. 65.9% (60/91), χ2=5.92; both P=0.010]; regardless of maternal age, the detection rate of chromosomal abnormalities in the non-isolated group was significantly higher than that in the isolated group ( χ2 were 65.28 and 92.42, respectively, both P<0.001). (4) In the non-isolated group, the detection rates of chromosomal abnormalities were 69.0% (78/113) and 83.9% (52/62) when nasal bone abnormalities were combined with one or more other abnormal ultrasound indicators, respectively. When combined with increased nuchal translucency, the detection rate of fetal chromosomal abnormalities was 73.2% (71/97), higher than the detection rate when combined with other single indicators (7/16) ( χ2=5.57, P=0.020). (5) Among the 262 cases with negative karyotype analysis and SNP-array results, 241 cases (92.0%) resulted in live births, with a gestational age at delivery of 39 weeks (32-41 weeks); 12 cases (4.6%) resulted in induced labor, five cases (1.9%) resulted in miscarriage, and four cases (1.5%) were lost to follow-up. The live birth rate in the isolated group was higher than that in the non-isolated group [86.9% (213/245) vs. 20.2% (35/173), χ2=187.00, P<0.001]. Conclusions:Fetuses with nasal bone developmental abnormalities in early pregnancy have a higher detection rate of chromosomal abnormalities and CNV. Invasive prenatal diagnosis is recommended for cases of nasal bone developmental abnormalities in early pregnancy, whether isolated or non-isolated. When combined with other abnormal indicators, the genetic etiology of the fetus is more complex, and detailed genetic counseling should be provided to the patient.

OBJECTIVE To investigate the characteristics of influenza A and influenza B viruses infections in the children aged between 0 and 14 years old after COVID-19 was downgraded to category B management of infectious diseases.METHODS From Jan.2023 to Feb.2024,a total of 2349 children aged between 0 and 14 years old who were treated in Beijing Hospital of Traditional Chinese Medicine,Capital Medical University due to influenza-like symptoms of infection and received nucleic acid testing for influenza A and influenza B viruses were recruited as the research subjects.The gender and age of the children as well as the seasons were observed by chi-square test.RESULTS Totally 2349 children were included in the study,and the total positive rate of influenza was 49.85％(1171/2349);the positive rate of influenza A virus was 36.36％(854/2349),the positive rate of influenza B virus was 13.92％(327/2349),and the positive rate of the mixed infections of influenza A virus and influenza B virus was 0.43％(10/2349).The positive rate of influenza A of the girls was the highest(44.17％)(x2=8.980,P=0.011)among the children aged less than 5 years old;the positive rate of influenza B of the boys was the highest(17.19％)(x2=8.378,P=0.015)among the children aged between 5 and 10 years old.There was significant difference in the positive rate of influenza A virus among the seasons in 2023 to 2024(x2=268.12,P＜0.001);the prevalence rate was 60.93％in spring,44.40％in autumn,22.01％in winter.There was significant difference in the positive rate of influenza B virus among the seasons in 2023 to 2024(x2=373.16,P＜0.001),and the preva-lence rate was 25.44％in winter.CONCLUSIONS The influenza viruses are prevalent in spring,autumn and winter from 2023 to 2024,and the influenza A is dominant.The positive rate of influenza viruses shows an upward trend among the children aged between 0 and 14 years old after the COVID-19 is downgraded to category B management of infectious diseases,with the peak of prevalence lagging behind.

Objective:To explore the application of three-level task-driven teaching based on motivational regulation strategy in training nurse interns in the Department of Clinical Psychology.Methods:This study included 80 nurse interns in the Department of Clinical Psychology at Zhejiang Provincial People's Hospital between June 2021 and May 2024 as research subjects. They were divided into a control group ( n=40) and an experimental group ( n=40). The control group received traditional teaching, while the experimental group received three-level task-driven teaching based on motivational regulation strategy, covering basic knowledge mastery, practical operation improvement, and comprehensive ability enhancement. Through scenario guidance and simulation exercises, the intrinsic motivation of nurse interns was stimulated. The assessment scores, self-learning ability, teaching quality, and recognition of teaching were compared between the two groups of nurse interns. Results:After teaching, the experimental group scored higher than the control group on theoretical assessment [(86.05±5.86) vs. (74.35±4.72)] and operational skill assessment [(88.18±5.67) vs. (82.65±6.09)] ( P<0.001). The total score and scores of various dimensions of teaching quality were higher in the experimental group compared to those in the control group ( P<0.001). After teaching, the total score and scores of various dimensions of self-learning ability of both groups were higher than those before teaching, and the scores were higher in the experimental group than in the control group ( P<0.05). Conclusions:The three-level task-driven teaching based on motivational regulation strategy can significantly improve the assessment scores, self-learning abilities, and teaching quality of nurse interns in the Department of Clinical Psychology. Additionally, this method can enhance their recognition of nursing internship teaching. This teaching method is worth promoting.