Multiple system atrophy （MSA） is a rare degenerative disease of the nervous system and has diverse and atypical clinical manifestations， and it overlaps with other diseases in α-synuclein spectrum disease. There are great challenges in the diagnosis and early differential diagnosis of the disease， and missed diagnosis and misdiagnosis occur from time to time， thereby delaying the treatment of the disease.Videonystagmography （VNG） is currently the main noninvasive test used to assess vestibular function and can provide different eye movement parameters. Studies have shown the presence of abnormal eye movements in patients with MSA. From the perspective of vision-eye movement， this article reviews the current status of research on eye movements in patients with MSA and reveals the internal connection between them， in order to provide an important reference for the early diagnosis of MSA.
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Objective:to investigate age-related changes in high-sensitivity cardiac troponin T(hs-cTnT)levels among middle-aged and elderly individuals, and to establish reference values for the 99th percentile upper reference limit(99th URL)of hs-cTnT within this demographic.Methods:This research is designed as a cross-sectional study.Hs-cTnT test results were collected from outpatients at Beijing Hospital between January 2018 and December 2023.The final sample included 5, 677 outpatients aged 45 to 85 years(65±10), all of whom were free from cardiovascular diseases and other chronic heart-related conditions.Multiple linear regression was utilized to assess the impact of gender and age group on hs-cTnT concentrations within the middle-aged and elderly populations.Furthermore, a generalized additive model for location, scale, and shape(GAMLSS)was employed to generate percentile curves of hs-cTnT by gender in this cohort, with the aim of determining the 99th URLs for both middle-aged and elderly individuals.Results:Multiple linear regression analyses indicated that both gender and age significantly influenced hs-cTnT levels in middle-aged and elderly populations( β60-69 years=1.399, β≥70 years=5.306, βgender=-2.650, all Pvalues<0.001).The hs-cTnT data for both males and females conformed to Box-Cox-Cole-Green(BCCG)distributions, with percentile curves fitted at the 25th, 50th, 75th, and 99th percentiles according to gender.The percentile values of hs-cTnT in both males and females demonstrated a progressive increase with advancing age.Notably, males exhibited higher 99th percentile values than females across all age groups. Conclusions:The GAMLSS approach is employed to establish continuous reference intervals for hs-cTnT in the middle-aged and elderly population.This effort aims to provide a theoretical foundation for reference values specific to this demographic in China and to offer guidance for clinical diagnosis and treatment.

Objective To investigate the effects of obesity-related indexes on cardiovascular autonomic nervous function in type 2 diabetes mellitus(T2DM)patients.Methods A total of 421 T2DM patients treated in the Department of Endocrinology of Gansu Provincial People's Hospital were enrolled in this study from October 2020 to October 2023.All the patients were divided into simple T2DM group with VFA<100 cm2(n=193)and obese group with VFA≥100 cm2(OB,n=228)according to visceral fat area(VFA).BMI,waist-to-height ratio(WHtR),waist-to-hip ratio(WHR),lipid accumulation index(LAP),visceral fat index(VAI),Chinese visceral fat index(CVAI),tapeness index(CI),body shape index(ABSI),and body roundness index(BRI)were calculated.Time domain parameters of heart rate variability(HRV)in 24 h holter electrocardiogram were recorded,including the global standard deviation(SDNN)of normal sinus RR interval,standard deviation of mean value of sinus RR interval(SDANN),root mean square difference(RMSSD)of normal continuous sinus RR interval.The percentage of adjacent RR interval difference>50 ms in total interval(PNN50),the HRV triangle index,the standard deviation of the difference of the entire adjacent NN interval length(SDSD).Results Compared with T2DM group,the OB group showed an increase in age,weight,BMI,WC,hip circumference(HC),neck circumference(NC),SBP,HbA1c,TG,SUA,CI,WHtR,WHR,VFA,SFA,VAI,LAP,CVAI,and BRI(P<0.05 or P<0.01),while a decrease in HDL-C(P<0.05).The SDNN,SDANN,SDSD,RMSSD,HRV trigonometric index,and PNN50 were lower in OB group than in T2DM group(P<0.05 or P<0.01).Spearman correlation analysis showed that SDNN and HRV trigonometric index was negatively correlated with age,DM duration,HR,SBP,PWV,WHtR,TG,SUA,VAI,LAP,BRI,VFA,LAP,and CVAI(P<0.05 or P<0.01).Logistic regression analysis shows that age,VFA,and LAP are influencing factors for cardiac autonomic dysfunction.The analysis of the working characteristic curve of the subjects showed that the area under the curve of VFA,age,and LAP in predicting cardiovascular autonomic dysfunction was 0.680,0.614,and 0.577,with sensitivity of 87.5%,41.7%,and 61.8%,and specificity of 47.3%,73.6%,and 55.6%respectively.Conclusions BMI,HC,NC,WC,TG,SFA,CI,WHtR,WHR,LAP,BRI,VAI,CVAI and VFA are closely related to cardiovascular autonomic nervous function in T2DM patients.As VFA,Ageand LAP increase,the risk of cardiovascular autonomic dysfunction increases.

Objective:To analyze the relevant studies on fertility concerns intervention programs for breast cancer survivors of childbearing age, and identify the specific content, outcome indicators and intervention effects of intervention, in order to provide reference for clinical staff to implement relevant intervention.Methods:According to the research method of scope review, the studies on the fertility concerns with breast cancer patients of childbearing age in China National Knowledge Infrastructure, WanFang, VIP, China Biomedical Literature Database, CINAHL, PubMed, Cochrane Library, Web of Science etc. were searched. The search period was from database establishment to May 9, 2024. The included literature was classified and analyzed.Results:A total of 12 articles were included, 9 were randomized controlled trials, 2 were self-controlled before and after studies, and 1 was a prospective cohort study. Fertility concerns intervention programs included group fertility counseling centered on couples, fertility support based on a multidisciplinary team collaboration model, and fertility management based on "Internet + reproductive health". The duration of intervention was usually 4 or 24 weeks. The intervention had different effects on the level of fertility concerns, psychological state and marital status.Conclusions:At present, the intervention programs for fertility concerns of breast cancer survivors of childbearing age reflect the importance, professionalism, immediacy and interactivity, but China is in the initial stage, and there are still shortcomings in multidisciplinary teams, fertility referral system, and Internet platform construction. Future research should build a breast cancer fertility intervention program suitable for our country, and promote its application through the Internet.

Objective:To analyze the clinical characteristics and nutritional treatment of malnutrition in infants with botulism.Methods:A retrospective analysis was conducted on 25 infant botulism patients admitted to Beijing Children's Hospital Affiliated to Capital Medical University，from May 1，2019 to October 31，2024.The nutritional risk and malnutrition incidence were assessed，nutritional therapy methods，formulations，tolerance status, energy intake rate, secondary infections and prognosis were analyzed.Results:A total of 25 pediatric patients were included, 19 males and 6 females, with a median age of 5(4,6) months. Twenty-five cases (100%) showed reduced food intake, with a weight of 7.3 (7.0, 9.0) kg upon admission. Twenty-four cases (96%) were assessed as high-risk for nutrition screening, and one case was diagnosed with malnutrition. Twenty-four cases (96%) received nasogastric tube feeding, with an early enteral nutrition implementation rate of 84% (21 cases) and intermittent infusion in 25 cases (100%). Fourteen cases used whole protein formula milk,eight cases used hydrolyzed protein formula milk and three cases were given 5% sugar solution. Nine cases were treated with intravenous nutrition, with a duration of 9 (5, 12) days. Five cases (20%) developed enteral feeding intolerance, and all five cases had secondary infections and were treated with parenteral nutrition. All 25 patients had good prognosis. At discharge, 17 cases (68%) were fed orally, and eight cases (32%) were fed through nasogastric tubes, with a median weight of 7.5 (7.0, 9.0) kg. Fifteen patients (60%) had weight gain, and the nutritional screening assessment was all low-risk.Conclusion:Infants with botulism are mostly in a state of high nutritional risk when they are admitted to hospital. Early enteral nutrition through a gastric tube has a high implementation rate. Some children may experience feeding intolerance,combined with timely use of parenteral nutrition replacement and symptomatic treatment can improve prognosis.

Objective To investigate the therapeutic efficacy of granulocyte colony-stimulating factor in combination with tadalafil in patients with thin endometrium undergoing artificial cycle frozen-thawed embryo transfer(FET).Methods A prospective randomized clinical trial was conducted involving sixty patients with thin endo-metrium who underwent artificial cycle FET at the Reproductive Center of Qinhuangdao First Hospital between January 2021 and October 2023.The patients were randomly assigned to two groups:the control group(n=30)received tadalafil,while the study group(n=30)received granulocyte colony-stimulating factor in addition to tadalafil.Endometrial ultrasound characteristics,uterine artery blood flow parameters,and pregnancy outcomes were compared between the two groups before and after treatment.Results Before treatment,no significant differ-ences were observed between the research group and the control group in terms of endometrial thickness or endome-trial volume(P>0.05).Ultrasound assessments were repeated after 8 and 14 days of treatment.Compared with baseline measurements,both endometrial thickness and volume exhibited significant increases in both groups(all P<0.05).By day 14 post-treatment,the research group demonstrated significantly greater endometrial thickness and volume compared to the control group(P<0.05).With regard to endometrial patterns,no significant differences were noted between the two groups prior to treatment(P>0.05).After 14 days of treatment,the proportion of patients exhibiting a Type A endometrial pattern in the research group was significantly higher than that in the control group(P<0.05).Prior to treatment,no statistically significant differences were observed between the two groups in terms of pulsatility index(PI),resistance index(RI),systolic/diastolic ratio(S/D),vascularization index(VI),flow index(FI),or Vascularization Flow Index(VFI)(all P>0.05).Following 14 days of treatment,both groups showed significant increases in VI,FI,and VFI compared to baseline values(all P<0.05),along with significant reductions in PI,RI,and S/D(all P<0.05).At 14 days post-treatment,the S/D ratio in the research group was significantly lower compared to the control group,while the VFI was significantly higher(P<0.05).However,statistical analysis showed no significant differences between the two groups in terms of embryo implanta-tion rate,clinical pregnancy rate,early miscarriage rate,and live birth rate(P>0.05).Conclusion For patients with thin endometrium undergoing FET,the combination of granulocyte colony-stimulating factor and tadalafil is more effective than tadalafil alone in improving endometrial receptivity and uterine blood perfusion.

Objective:To explore the impact of "basic nursing" course with signature pedagogy on undergraduate nursing students' critical thinking, professional identity, and professionalism.Methods:A signature pedagogy method for the "basic nursing" course was established using narrative as a theoretical lesson and scenario-simulation as a laboratory lesson. Ninety sophomore nursing students in the 2020 undergraduate nursing program were selected as the participants of a controlled pre-post study. The students were evaluated using the Critical Thinking Inventory, the Professional Identity Questionnaire, and the Professionalism Inventory before and after the course. Semi-structured interviews were conducted at the end of the course to gain an in-depth understanding of their learning experience. Data analysis was conducted using SPSS 26.0 and Nvivo 11.0 Colaizzi's seven-step method was used for analysis of qualitative research.Results:A total of 87 nursing students participated in the course and 83 were included in the quantitative analysis. The total scores of critical thinking skills (286.83±17.44), professional identity (58.95±6.43), and professionalism (67.08±11.21) were significantly higher after the course than before the course ( P<0.001). Qualitative study identified the four themes of promoting effective learning, developing critical thinking and empathy, building professional attitudes, and expecting curriculum optimization. Conclusions:The "basic nursing" course based on signature pedagogy for undergraduate nursing students helps to enhance their critical thinking, foster a sense of professional identity, and develop professionalism.

Objective To investigate the correlation between the expression of lectin galactoside binding soluble-3 binding protein(LGALS3BP),GTP enzyme activating protein SH3 functional region binding protein 1(G3BP1)and Wnt/β-catenin pathway genes in endometrial cancer(EC)tissues and its clinical prognostic significance.Methods 138 patients with EC treated in Cangzhou Central Hospital from February 2016 to February 2019 were selected.qRT-PCR was used to detect the expression of LGALS3BP mRNA,G3BP1 mRNA and Wnt/β-catenin pathway genes Wnt5a mRNA,β-catenin mRNA and matrix metalloproteinase-9(MMP-9)mRNA in cancer and adjacent tissues.The expression of LGALS3BP protein and G3BP1 protein in cancer and adjacent tissues was detected by immunohistochemistry.Pearson correlation analysis was used to analyze the correlation between LGALS3BP mRNA,G3BP1 mRNA and Wnt/β-catenin pathway genes.Kaplan-Meier curve was used to analyze the effect of LGALS3BP mRNA and G3BP1 mRNA on the survival and prognosis of EC patients.COX regression model was used to analyze the factors affecting the prognosis of EC patients.Results The expression of LGALS3BP mRNA(3.01±0.34),G3BP1 mRNA(2.87±0.33),Wnt5a mRNA(2.29±0.26),β-catenin mRNA(3.25±0.41)and MMP-9 mRNA(2.68±0.36)in EC cancer tissues were higher than those in adjacent tissues(1.10±0.23,1.06±0.24,0.84±0.17,0.88±0.26,0.69±0.17),and the differences were statistically significant(t=52.109～58.719,all P<0.001).The expression of LGALS3BP mRNA and G3BP1 mRNA in EC was positively correlated with the expression of Wnt5a mRNA,β-catenin mRNA and MMP-9 mRNA(r=0.675～0.781,all P<0.001).The expression of LGALS3BP protein(3.54±0.47 vs 0.51±0.16)and G3BP1 protein(2.84±0.44 vs 0.42±0.13)in EC cancer tissues were higher than that in adjacent tissues,and the differences were statistically significant(t=71.692,61.962,all P<0.001).The expression of LGALS3BP mRNA and G3BP1 mRNA in cancer tissues of EC patients with FIGO stage Ⅲ and lymph node metastasis were higher than that of FIGO stage Ⅰ～Ⅱ and no lymph node metastasis,and the differences were statistically significant(t=40.279～557.671,all P<0.001).The 5-year survival rate of LGALS3BP mRNA high expression group was 58.82%(40/68),which was lower than that of low expression group 94.29%(66/70),and the difference was statistically significant(Log-rank χ2=24.970,P<0.001).The 5-year survival rate of G3BP1 mRNA high expression group was 62.12%(41/66),which was lower than that of low expression group 90.28%(65/72),and the difference was statistically significant(Log-rank χ2=15.960,P<0.001).FIGO stage Ⅲ,lymph node metastasis,high expression of LGALS3BP mRNA and high expression of G3BP1 mRNA were risk factors for poor prognosis of EC patients(Wald χ2=7.847～12.054,all P<0.001).Conclusion The expression of LGALS3BP and G3BP1 mRNA is elevated in EC,both of which are associated with Wnt/β-catenin pathway genes,promoting the malignant progression of EC tumors,and are new tumor markers for evaluating the prognosis of EC patients.

Objective:To analyze the disease burden of respiratory syncytial virus (RSV)- associated lower respiratory tract infection (LRTI) in Chinese children under one year of age from 1990 to 2021.Methods:Using the Global Burden of Disease (GBD) 2021 database ( https://vizhub.healthdata.org/gbd-results/), we calculated deaths, mortality, age-standardized mortality rates (ASMR), disability- adjusted life years (DALYs), DALY rates, and age-standardized DALY rates (ASDR) to assess the disease burden of RSV-associated LRTI in Chinese children under one year of age. Joinpoint regression modeling was employed to analyze temporal trends in disease burden in China from 1990 to 2021, with stratification by time, age, and sex. Comparisons were made with global and high socio-demographic index (SDI) regions. Results:In 2021, there were 324 deaths (95% UI: 179-539) from RSV-LRTI in Chinese infants under one year of age, with a mortality rate of 2.82 per 100 000 (95% UI: 1.55-4.69), ASMR of 0.10 per 100 000 (95% UI: 0.06-0.16), DALYs of 29 131.28 years (95% UI: 16 050.27-48 398.30), DALY rate of 253.56 per 100 000 (95% UI: 139.70-421.26), and ASDR of 6.70 per 100 000 (95% UI: 3.72-11.12). All metrics were lower than global levels but significantly higher than high-SDI regions. From 1990 to 2021, substantial reductions were observed in deaths, mortality rates, DALYs, and DALY rates of RSV-LRTI among children under one year of age in China, globally, and in high-SDI regions. China achieved ASMR and ASDR reductions of－95.91% (95% CI:－97.75% to－92.96%) and－96.70% (95% CI:－98.19% to－94.33%), comparable to high-SDI regions but exceeding global averages. Joinpoint analysis showed average annual percentage changes (AAPC) in ASMR of－9.80% (95% CI:－10.45% to－9.14%) for China,－5.38% (95% CI:－5.83% to－4.91%) globally, and－7.13% (95% CI:－9.07% to－5.14%) for high-SDI regions (all P<0.001). The AAPC for ASDR were－10.41% (95% CI:－11.01% to－9.79%),－5.40% (95% CI:－5.82% to－4.97%), and－7.09% (95% CI:－9.70% to－4.41%) for China, the global average, and high-SDI regions, respectively, with the most pronounced decline occurring between 2019 and 2021 (ASMR decreased by 53.33%, 45.81%, and 61.31%, while ASDR declined by 52.50%, 44.54%, and 58.88% in China, globally, and in high-SDI regions, respectively). In 2021, both China and high-SDI regions exhibited declining mortality and DALY rates for RSV-LRTI with increasing age among children under one year, while neonates younger than 28 days consistently demonstrated the highest burden metrics. The rate of decline was comparable between China and high-SDI regions, with both exceeding the global average. Furthermore, from 1990 to 2021, male infants under one year of age in China, globally, and in high-SDI regions consistently showed higher overall trends in deaths, mortality rates, DALY, and DALY rates for RSV-LRTI compared to female infants. Conclusions:Although China's RSV-LRTI disease burden in infants under one year remains lower than global levels but higher than high-SDI regions, the country achieved reduction rates comparable to high-SDI regions, exceeding global averages. RSV-LRTI continue to pose significant health threats to neonates and male infants, necessitating age-specific and sex-specific prevention strategies.

Objective To investigate the effects of obesity-related indexes on cardiovascular autonomic nervous function in type 2 diabetes mellitus(T2DM)patients.Methods A total of 421 T2DM patients treated in the Department of Endocrinology of Gansu Provincial People's Hospital were enrolled in this study from October 2020 to October 2023.All the patients were divided into simple T2DM group with VFA<100 cm2(n=193)and obese group with VFA≥100 cm2(OB,n=228)according to visceral fat area(VFA).BMI,waist-to-height ratio(WHtR),waist-to-hip ratio(WHR),lipid accumulation index(LAP),visceral fat index(VAI),Chinese visceral fat index(CVAI),tapeness index(CI),body shape index(ABSI),and body roundness index(BRI)were calculated.Time domain parameters of heart rate variability(HRV)in 24 h holter electrocardiogram were recorded,including the global standard deviation(SDNN)of normal sinus RR interval,standard deviation of mean value of sinus RR interval(SDANN),root mean square difference(RMSSD)of normal continuous sinus RR interval.The percentage of adjacent RR interval difference>50 ms in total interval(PNN50),the HRV triangle index,the standard deviation of the difference of the entire adjacent NN interval length(SDSD).Results Compared with T2DM group,the OB group showed an increase in age,weight,BMI,WC,hip circumference(HC),neck circumference(NC),SBP,HbA1c,TG,SUA,CI,WHtR,WHR,VFA,SFA,VAI,LAP,CVAI,and BRI(P<0.05 or P<0.01),while a decrease in HDL-C(P<0.05).The SDNN,SDANN,SDSD,RMSSD,HRV trigonometric index,and PNN50 were lower in OB group than in T2DM group(P<0.05 or P<0.01).Spearman correlation analysis showed that SDNN and HRV trigonometric index was negatively correlated with age,DM duration,HR,SBP,PWV,WHtR,TG,SUA,VAI,LAP,BRI,VFA,LAP,and CVAI(P<0.05 or P<0.01).Logistic regression analysis shows that age,VFA,and LAP are influencing factors for cardiac autonomic dysfunction.The analysis of the working characteristic curve of the subjects showed that the area under the curve of VFA,age,and LAP in predicting cardiovascular autonomic dysfunction was 0.680,0.614,and 0.577,with sensitivity of 87.5%,41.7%,and 61.8%,and specificity of 47.3%,73.6%,and 55.6%respectively.Conclusions BMI,HC,NC,WC,TG,SFA,CI,WHtR,WHR,LAP,BRI,VAI,CVAI and VFA are closely related to cardiovascular autonomic nervous function in T2DM patients.As VFA,Ageand LAP increase,the risk of cardiovascular autonomic dysfunction increases.