Objective:To study the risk factors for combined bacterial/fungal infections in patients with severe fever with thrombocytopenia syndrome (SFTS) and to develop a novel and validated prediction model.Methods:The basic data and the results of the first laboratory examination after admission were retrospectively collected from patients diagnosed with SFTS who were hospitalized in the First Affiliated Hospital, Nanjing Medical University from January 2018 to December 2022. The patients were categorized into co-infected and non-co-infected groups according to whether they had co-infections with bacterial/fungal infections or not.Independent risk factors were screened by multivariate logistic regression analyses. A novel prediction model was constructed, and the predictive value of the model was assessed using receiver operating characteristic curve. Non-parametric tests and chi-square test were used for statistical analysis.Results:A total of 294 patients were included, and 62 cases were in the combined infection group including 39 cases of simple respiratory tract infections, 11 cases of simple bloodstream infections, four cases of simple urinary tract infections, four cases of respiratory tract combined with bloodstream infection, and four cases of respiratory tract combined with urinary tract infection. Acinetobacter baumannii was mostly found in bacterial infections, with a total of 19 strains, followed by Escherichia coli and Pseudomonas aeruginosa, both with seven strains. Aspergillus were mostly common in fungi, with a total of 16 strains which were all collected from patients with pulmonary infections. Compared with the non-co-infected group, patients in the co-infected group had longer hospital stays, with statistically significant differences ( Z=-6.18, P<0.001). The patients also had higher frequencies of bleeding symptoms, neurological symptoms, severe illness, and death, with statistically significant differences ( χ2=23.91, 16.37, 15.51 and 15.58, respectively, all P<0.001). The aspartate transaminase-to-platelet ratio index (APRI) was also higher in patients with coinfection, with a statistically significant difference ( Z=-4.64, P<0.001). Multivariate binary logistic regression showed that severe illness (odds ratio ( OR)=2.567, 95% confidence interval ( CI) 1.344 to 4.904, P=0.004), blood glucose level higher than 7.782 mmol/L ( OR=4.766, 95% CI 2.493 to 9.109, P<0.001), procalcitonin level higher than 0.228 μg/L ( OR=2.487, 95% CI 1.289 to 4.799, P=0.007), and APRI value higher than 6.268 ( OR=3.032, 95% CI 1.404 to 6.548, P=0.005) were the independent risk factors for co-infections in SFTS patients. Disease severity, blood glucose, procalcitonin, and APRI were combined to construct a novel predictive model: Infect-risk score=-3.331+ 0.654×severity (severe=1, non-severe=0)+ 0.160×blood glucose+ 0.066×procalcitonin+ 0.013×APRI. The AUC for this score was 0.764 (95% CI 0.698 to 0.830, P<0.001), with Youden index of 0.416, sensitivity of 0.839, and specificity of 0.578. Conclusions:Severe illness, blood glucose levels higher than 7.782 mmol/L, procalcitonin levels above 0.228 μg/L, and APRI values above 6.268 are independent risk factors for bacterial/fungal coinfection in SFTS patients. The constructed Infect-risk score model has good predictive value for bacterial/fungal coinfection in SFTS patients.

The reverse phase nystagmus is not uncommon in clinical practice.Inadequate understanding brings great confusion to clinical diagnosis and treatment,which leads to misdiagnosis frequently and also increases the eco-nomic burden on patients.The purpose of this paper is to summarize and analyze the mechanism,characteristics and clinical significance of reverse phase nystagmus,to help clinicians better understand the significance of inversion nys-tagmus in benign paroxysmal positional vertigo,in order to achieve accurate and efficient diagnosis and treatment of these patients.

The reverse phase nystagmus is not uncommon in clinical practice.Inadequate understanding brings great confusion to clinical diagnosis and treatment,which leads to misdiagnosis frequently and also increases the eco-nomic burden on patients.The purpose of this paper is to summarize and analyze the mechanism,characteristics and clinical significance of reverse phase nystagmus,to help clinicians better understand the significance of inversion nys-tagmus in benign paroxysmal positional vertigo,in order to achieve accurate and efficient diagnosis and treatment of these patients.

Objective:To investigate the clinical and genetic characteristics of a family with cataplexy and epilepsy caused by KCNA1 gene mutations. Methods:The clinical data of a family with KCNA1 gene mutations leading to cataplexy and epilepsy who hospitalized in the Department of Pediatric Neurology at Anhui Children's Hospital in August 2022 were collected，and their clinical manifestations，imaging，electroencephalogram，gene testing results and treatment were analyzed. A total of 68 pathogenic or potentially pathogenic variants of the KCNA1 gene were identified by searching the database of CNKI，Wanfang Data Knowledge Service Platform, ClinVar, dbSNP and PubMed using the keyword‘KCNA1’between the establishment and August 2023. Results:The proband was a 9 years and 8 months old boy who initially presented with cataplexy induced by strenuous exercise or fatigue，followed by focal epilepsy. The whole exome sequencing detected heterozygous variation of exon 2 c.1006G>A（p.Gly336Arg）of KCNA1 gene，which was a missense mutation and was not reported in the country or abroad. Both the mother and brother of the proband detected heterozygous mutations at the same locus，and both had cataplexy induced by strenuous exercise or fatigue，but the type of seizure was generalized tonic-clonic seizure. The proband's grandmother，aunt，and brother all had seizures or cataplexy. Affected patients receiving different or the same anti-seizure drugs（sodium valproate，lamotrigine，phenytion sodium and carbamazepine）had varying degrees of relief，and those treated with sodium channel blockers had varying degrees of relief. A total of 68 mutation sites of KCNA1 gene were retrieved from domestic and foreign literature，mainly missense mutations，and most patients showed episodic ataxia type 1（EA1），and there was genetic heterogeneity between the genotype and phenotype of the variable patients. Conclusion:We have reported a heterozygous mutation in the KCNA1 gene c.1006G>A（p.Gly336Arg），which is a missense mutation and is easy to misdiagnose in patients with cataplexy and epilepsy as the main phenotypes. Patients with the KCNA1 mutation have different degrees of efficacy on sodium channel blockers.

Objective:To investigate the clinical and genetic characteristics of a family with cataplexy and epilepsy caused by KCNA1 gene mutations. Methods:The clinical data of a family with KCNA1 gene mutations leading to cataplexy and epilepsy who hospitalized in the Department of Pediatric Neurology at Anhui Children's Hospital in August 2022 were collected，and their clinical manifestations，imaging，electroencephalogram，gene testing results and treatment were analyzed. A total of 68 pathogenic or potentially pathogenic variants of the KCNA1 gene were identified by searching the database of CNKI，Wanfang Data Knowledge Service Platform, ClinVar, dbSNP and PubMed using the keyword‘KCNA1’between the establishment and August 2023. Results:The proband was a 9 years and 8 months old boy who initially presented with cataplexy induced by strenuous exercise or fatigue，followed by focal epilepsy. The whole exome sequencing detected heterozygous variation of exon 2 c.1006G>A（p.Gly336Arg）of KCNA1 gene，which was a missense mutation and was not reported in the country or abroad. Both the mother and brother of the proband detected heterozygous mutations at the same locus，and both had cataplexy induced by strenuous exercise or fatigue，but the type of seizure was generalized tonic-clonic seizure. The proband's grandmother，aunt，and brother all had seizures or cataplexy. Affected patients receiving different or the same anti-seizure drugs（sodium valproate，lamotrigine，phenytion sodium and carbamazepine）had varying degrees of relief，and those treated with sodium channel blockers had varying degrees of relief. A total of 68 mutation sites of KCNA1 gene were retrieved from domestic and foreign literature，mainly missense mutations，and most patients showed episodic ataxia type 1（EA1），and there was genetic heterogeneity between the genotype and phenotype of the variable patients. Conclusion:We have reported a heterozygous mutation in the KCNA1 gene c.1006G>A（p.Gly336Arg），which is a missense mutation and is easy to misdiagnose in patients with cataplexy and epilepsy as the main phenotypes. Patients with the KCNA1 mutation have different degrees of efficacy on sodium channel blockers.

Objective: This study aims to elucidate the role of aryl hydrocarbon receptor nuclear transporter 2 (ARNT2) in cervical cancer (CC) and explore the potential mechanism by which ARNT2 promotes the progression of CC through the protein phosphatase 2A (PP2A)/Akt signaling pathway. Methods: Bioinformatics tools were used to analyze the expression level of ARNT2 in cancer and its correlation with cancer prognosis. Western Blot and immunohistochemistry staining were used to detect the expression of ARNT2 protein in CC tissues and cells. ARNT2 was knocked down in SiHa and HeLa cells, respectively. Cell Counting Kit-8 assay and colony formation assay were used to detect changes in cell proliferation. Transwell assay and plate scratch assay were used to detect changes in cell migration and invasion. Western Blot assay was used to detect changes in the expression of PP2A/Akt signaling pathway after ARNT2 expression was downregulated. Finally, a CC xenograft tumor model was constructed to evaluate the effect of ARNT2 on SiHa cell tumorigenesis in vivo. Results: ARNT2 is highly expressed in tumor tissues and cell lines. ARNT2 knockdown can significantly inhibit the proliferation, invasion and migration of SiHa and HeLa cells in vitro and in xenograft models. Further studies have shown that ARNT2 may promote tumor formation by regulating the PP2A/Akt pathway. Conclusion ARNT2 promotes the malignant biological behavior of CC cells through the PP2A/Akt signaling pathway, confirming its potential as a prognostic marker for CC.

Objective:To study the risk factors for combined bacterial/fungal infections in patients with severe fever with thrombocytopenia syndrome (SFTS) and to develop a novel and validated prediction model.Methods:The basic data and the results of the first laboratory examination after admission were retrospectively collected from patients diagnosed with SFTS who were hospitalized in the First Affiliated Hospital, Nanjing Medical University from January 2018 to December 2022. The patients were categorized into co-infected and non-co-infected groups according to whether they had co-infections with bacterial/fungal infections or not.Independent risk factors were screened by multivariate logistic regression analyses. A novel prediction model was constructed, and the predictive value of the model was assessed using receiver operating characteristic curve. Non-parametric tests and chi-square test were used for statistical analysis.Results:A total of 294 patients were included, and 62 cases were in the combined infection group including 39 cases of simple respiratory tract infections, 11 cases of simple bloodstream infections, four cases of simple urinary tract infections, four cases of respiratory tract combined with bloodstream infection, and four cases of respiratory tract combined with urinary tract infection. Acinetobacter baumannii was mostly found in bacterial infections, with a total of 19 strains, followed by Escherichia coli and Pseudomonas aeruginosa, both with seven strains. Aspergillus were mostly common in fungi, with a total of 16 strains which were all collected from patients with pulmonary infections. Compared with the non-co-infected group, patients in the co-infected group had longer hospital stays, with statistically significant differences ( Z=-6.18, P<0.001). The patients also had higher frequencies of bleeding symptoms, neurological symptoms, severe illness, and death, with statistically significant differences ( χ2=23.91, 16.37, 15.51 and 15.58, respectively, all P<0.001). The aspartate transaminase-to-platelet ratio index (APRI) was also higher in patients with coinfection, with a statistically significant difference ( Z=-4.64, P<0.001). Multivariate binary logistic regression showed that severe illness (odds ratio ( OR)=2.567, 95% confidence interval ( CI) 1.344 to 4.904, P=0.004), blood glucose level higher than 7.782 mmol/L ( OR=4.766, 95% CI 2.493 to 9.109, P<0.001), procalcitonin level higher than 0.228 μg/L ( OR=2.487, 95% CI 1.289 to 4.799, P=0.007), and APRI value higher than 6.268 ( OR=3.032, 95% CI 1.404 to 6.548, P=0.005) were the independent risk factors for co-infections in SFTS patients. Disease severity, blood glucose, procalcitonin, and APRI were combined to construct a novel predictive model: Infect-risk score=-3.331+ 0.654×severity (severe=1, non-severe=0)+ 0.160×blood glucose+ 0.066×procalcitonin+ 0.013×APRI. The AUC for this score was 0.764 (95% CI 0.698 to 0.830, P<0.001), with Youden index of 0.416, sensitivity of 0.839, and specificity of 0.578. Conclusions:Severe illness, blood glucose levels higher than 7.782 mmol/L, procalcitonin levels above 0.228 μg/L, and APRI values above 6.268 are independent risk factors for bacterial/fungal coinfection in SFTS patients. The constructed Infect-risk score model has good predictive value for bacterial/fungal coinfection in SFTS patients.

Objective·To explore the effects of hypertension and dyslipidemia on cognitive function in the elderly.Methods·A dynamic population cohort was established by using prospective cohort study methods.In 2019,a complete cohort was selected from residents aged 65 and above who voluntarily participated in a free physical examination program in a community in Shanghai,serving as the baseline cohort.In 2022,512 community-dwelling elderly aged 67 to 93 were randomly selected from the same community as the follow-up cohort for the study.The collected date included residents' health records,various physical examination measurements,and Mini-mental State Examination(MMSE)scale scores.Results·Of the 512 cases that were followed up,the valid sample size was reduced to 495 after data cleaning.According to the baseline and follow-up cognitive assessments and changes,the cases were categorized into three cognitive groups:the improvement group,the normal group,and the decline group.The prevalence of hypertension in the decline group was 43.14%higher than that in the improvement group and 24.39%higher than that in the normal group(66.67%in the decline group vs 23.53%in the improvement group,P=0.011;66.67%in the decline group vs 42.28%in the normal group,P=0.040).Total cholesterol(TC)in the improvement group was lower than that in the normal group[improvement group(4.38±1.04)mmol/L vs normal group(5.11±1.12)mmol/L,P=0.009].Additionally,TC in the decline group in 2022 was higher than that in 2019[paired difference(0.46±0.87)mmol/L,95%CI 0.08?0.84,P=0.021].LDL-Ch in the improvement group was lower than that in the normal group[improved group(2.51±0.92)mmol/L vs normal group(3.07±1.00)mmol/L,P=0.024],and their HDL-Ch in 2022 was higher than that in 2019[paired difference(0.16±0.20)mmol/L,95%CI 0.06?0.26,P=0.005].The results of multinomial Logistic regression showed:TC in the improved group was lower than that in the normal group[β=4.12,OR=61.64,95%CI 1.52?2494.07,P=0.029]and the decline group[β=5.88,OR=357.35,95%CI 4.54?28149.75,P=0.008];the TAG[β=1.85,OR=6.34,95%CI 1.05?38.43,P=0.045],LDL-Ch[β=5.61,OR=274.06,95%CI 3.65?20567.57,P=0.011],and hypertension[β=1.90,OR=6.69,95%CI 1.53?29.16,P=0.011]in the decline group were higher than those in the improvement group;the age of the decline group was greater than that of the normal group[β=0.08,OR=1.08,95%CI 1.00?1.16,P=0.041],and the education level was lower than that of the normal group[β=1.22,OR=3.39,95%CI 1.28?8.94,P=0.014].Conclusion·Low TC and LDL-Ch and high HDL-Ch are beneficial to cognitive improvement.Conversely,hypertension,high TC,high TAG,high LDL-Ch,low education level,and advanced ages are risk factors for cognitive decline.

A male child, aged 5 years and 3 months, was admitted to the Oncology Department with a history of pain in both hip joints, headache, and diplopia lasting for 40 days. Physical examination did not reveal definitive signs or obvious abnormalities in the nervous system. Imaging studies showed only abnormalities in the craniocerebrum and spinal cord. Routine cerebrospinal fluid (CSF) analysis revealed elevation in the total number of white blood cells, mainly mononuclear cells. Biochemical analysis of CSF showed normal glucose and chloride levels, and increased protein concentrations. The possibility of central nervous system (CNS) infection was initially considered. Subsequently, antibacterial and antiviral therapy was administered; however, this treatment was ineffective. Further examination of CSF through immunophenotyping revealed mature B-cell lymphoma with CNS involvement; there were no neoplastic lesions detected elsewhere in the body. Thus, the patient was diagnosed with primary central nervous system lymphoma (PCNSL). Complete remission was achieved after chemotherapy with the CNCL-2017-mature B-cell lymphoma regimen. Thus far, all chemotherapy cycles have been completed, the patient remains in complete remission, and the follow-up is ongoing. Clinicians should pay close attention to PCNSL in children.

Objective:To evaluate the efficacy of Q-switched 755 nm alexandrite laser combined with tranexamic acid in the treatment of facial melasma.Methods:According to the inclusion and exclusion criteria, the subjects were selected from female patients with melasma who visited the Department of Dermatology of Zhejiang Rongjun Hospital from June to December 2020, the patients were divided into group A, B and C according to the random number table. The study was conducted by half face self contrast method. Group A, lesions on the left side of the face were irradiated by Q-switched 755 nm alexandrite laser with the mode of 5 mm spot, 1.6 J/cm 2 energy, 70 ns pulse width(mode A) with an interval of two weeks for 6 sessions. Meanwhile, tranexamic acid serum was applied topically on the lesions twice a day for six months. Lesions on the right side of the face, as control side, tranexamic acid serum was used in the same way as above described. Group B, lesions on the left side of the face were irradiated by Q-switched 755 nm alexandrite laser for 6 sessions with the mode of 3 mm spot, 5.0 J/cm 2 energy, 150 μs pulse width(mode B) with an interval of two weeks for 6 sessions. Meanwhile, tranexamic acid serum was applied topically on the lesions twice a day for six months. The treatment of right side of face as control side was the same as group A. The treatment method and postoperative treatment of the left face in group C were the same as those in group A left face. The treatment method and postoperative treatment of the right side face were the same as those of the left side face of group B. The treatment effect was evaluated 12 weeks after the end of laser treatment. (1) Assessment of Melasma Area and Severity Index (MASI), the score ranges from 0 to 48, with higher scores indicating more severe lesions. (2) Physician Global Assessment(PGA), the score ranged from 0 to 6, and the higher the score, the more melasma remained. (3) The patient satisfaction rate was the percentage of the total number of patients with very satisfied and satisfied cases. Measurement data to (Mean±SD), the MASI score and PGA score were compared by paired sample t-test, patient satisfaction is using chi-square test, P<0.05 was considered statistically significant. Results:A total of 90 patients were enrolled, and they were divided into A, B and C groups according to the ratio of 1∶1∶1, with 30 patients in each group. The age of patients in group A, B and C were (33.0±5.8) years, (32.3±7.2) years and (32.9±6.5) years, respectively ( P>0.05), the disease duration was (3.5±2.3) years, (3.3±1.9) years, (3.5±1.5) years, respectively ( P>0.05). Assessing the efficacy of 12 weeks after the last laser treatment: (1) MASI. The scores of both sides of the face in group A after treatment were lower than those before treatment ( P< 0.01 or <0.05), and the scores of the left side after treatment (9.67±4.10) were significantly lower than those of the right side (18.13±7.67) ( P<0.01). The scores of both sides of the face in group B after treatment were significantly lower than those before treatment ( P<0.01 or 0.05), and the scores of the left side (9.97±3.74) were significantly lower than those of the right side (18.01±7.17) after treatment ( P<0.01). The scores of both sides of the face in group C after treatment were significantly lower than those before treatment ( P<0.01), and the scores of the left side of the face after treatment (9.92±4.11) were higher than those of the right side (7.95±3.27) ( P<0.05), the effect of laser treatment in mode B was better than that in mode A. (2) PGA. The score of the left side of the face in group A was (1.63±1.32), lower than the right side of the face (2.97±1.50) ( P<0.01). The left side score of group B was (1.27 ± 1.02), which was lower than that of the right side (2.87±1.46) ( P<0.01). The left side score of group C was (1.97±1.16), higher than that of the right side (1.27±1.02) ( P<0.05). It shows that the therapeutic effect of mode B laser is better than that of mode A laser. (3) Patient satisfaction rate. The left side satisfaction rate of group A was 67% (20/30), higher than that of right side 37% (11/30) ( P<0.05). In group B, the satisfaction rate of the left side was 73% (22/30), higher than that of the right side 47% (14/30) ( P<0.05). The satisfaction rate of the left side in group C was 53% (16/30), which was lower than that of the right side 80%(24/30), indicating that the satisfaction rate of the mode B laser treatment side was higher than that of the mode A ( P<0.05). Conclusions:The treatment of Q-switched 755 nm alexandrite laser combined with topical tranexamic acid can significantly improve facial melasma, and the treatment mode with 3 mm spot, 5.0 J/cm 2 energy density, 150 μs pulse width parameters is recommended.