Pyoderma gangrenosum(PG)is a rare autoinflammatory disease,characterized mainly by painful and necrotic skin ulcers.The etiology of PG is unknown,and its treatment is quite challenging.This article reports a case of recurrent pyoderma gangrenosum successfully treated with adalimumab combined with tofacitinib,along with a review of relevant literature.The patient,a 54-year-old male,presented with scrotal ulcers accompanied by pain for 20 days,worsening and involving the groin area for 5 days,and fever for 1 day.Dermatological examination revealed two painful ulcers on the scrotum with raised edges,clear boundaries,and a small amount of purulent discharge on the surface;the right groin area and the medial left thigh showed irregular infiltrative erythematous plaques,with scattered clustered pustules on them,central necrosis appearing purplish-brown,surrounded by a red halo with clear boundaries.Based on the patient's past medical history,clinical manifestations,and auxiliary examinations,the diagnosis was consistent with pyoderma gangrenosum.After treatment with adalimumab combined with tofacitinib,the patient's symptoms were significantly improved,and the ulcers healed.At the 6-month follow-up,the skin lesions had not recurred.For refractory PG that is ineffective to conventional treatments,adalimumab combined with tofacitinib is an effective and safe treatment option,providing a new combination therapy regimen for PG.

Objective:To compare the clinical efficacy of direct versus double-balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO).Methods:Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group ( n=36) and the double-balloon occlusion technique group ( n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results:The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) ( χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) ( χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion:Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.

Over the past decade, the research on major depressive disorder (MDD) has made steady progress globally. The prevalence of MDD is high with a noticeable trend toward younger and professional. Additionally, MDD is grappling with heavy burdens. Genome-wide association studies have shed light on the heritability of MDD, while imaging studies have identified diverse biological subtypes. Furthermore, multi-omics studies have uncovered potential biomarkers for the condition. The emergence of novel therapeutic agents and advancements in brain stimulation techniques have introduced innovative strategies for the management of MDD. Digital therapeutics are rapidly advancing, holding the promise of delivering personalized and full-course care for MDD patients. This article provides a comprehensive overview of the key research progress and hot spots in the epidemiology, etiology, and clinical therapeutics of MDD over the past decade. It aims to assist clinicians in understanding the current state of research and the future directions within this domain.

The global prevalence of mental disorders has been increasing in recent years, while conventional drugs are limited by sole mechanism, slow-acting, and insufficient efficacy. As an emerging treatment choice, anesthetic therapeutics has demonstrated unique advantages in managing mental disorders, including rapid-acting and significant efficacy. This study reviews current research progress in general anesthetic drugs, psychedelics and anesthetic techniques for the innovative application of mental disorders, and outlines future development directions. The emergence of anesthetic therapeutics has provided new direction for the treatment of mental disorders, though multidisciplinary research is still warranted to investigate long-term safety and underlying mechanisms in the future.

This study aims to determine the therapeutic effect and then elucidate the molecular mechanism of Dietary Yangrong Decoction(DYRT)on blood deficiency syndrome based on net-work pharmacology and study its active compounds.The molecular mechanism of DYRT in the treatment of blood deficiency syndrome was predicted by network pharmacology.The blood defi-ciency of rats was established using cyclophosphamide and acetophenohydrazine jointly,which was divided into a blank control group,a model group,a Men's Yangrong Decoction group(MYRT)(positive control group),a medicinal group and food-based Yangrong Decoction group.The active components were analyzed by liquid chromatography-mass spectrometry(HPLC-MS),the periph-eral hemogram was detected by an automatic biochemical analyzer,the levels of hematopoietic regulatory factors in serum were determined by ELISA,and the relative expression of EPO in kid-ney and PI3K,AKT,GM-CSF in bone marrow were measured by RT-PCR.The results showed that DYRT had 57 active ingredients and 128 potential targets for the treatment of spleen deficien-cy syndrome.1 835 items were obtained by GO enrichment analysis,and 20 pathways were ob-tained by KEGG enrichment analysis;DYRT and MYRT were identified by HPLC-MS to contain 12 same blood active compounds.Animal experiments showed that,compared with the model group,the number of red blood cells,the number of platelets and the content of hemoglobin in the DYRT group were significantly increased,and the number of white blood cells was significantly decreased(P＜0.05).The contents of EPO,IL-3,IL-6 and GM-CSF in serum were significantly in-creased,and the content of TNF-α was significantly decreased(P＜0.05).The relative expression levels of EPO in kidney and PI3K,AKT and GM-CSF mRNA in bone marrow were significantly increased(P＜0.05).Compared with the MYRT group,the number of white blood cells in the DYRT group was significantly reduced,the content of GM-CSF in serum was significantly in-creased,and the content of EPO and GM-CSF mRNA was significantly increased(P＜0.05).In conclusion,DYRT contains the same active compounds as MYRT,which can regulate hematopoi-etic factors,thereby activating the PI3K/AKT pathway to restore hematopoietic function and im-prove the blood deficiency state of the body.

Objective:To assess the sound localization ability of patients with unilateral sudden hearing loss during the early period of treatment, to explore its changing characteristics and to analyze influencing factors.Methods:A total of 22 patients with unilateral sudden sensorineural hearing loss, with onset within 3 days, who were hospitalized at Shandong Provincial ENT Hospital between January and April 2024, were collected in this study. The cohort included 13 males and 9 females, with a mean age of 36.5 years. Among them, 10 suffered in the right ear and 12 in the left ear. Additionally, 15 healthy individuals (8 males and 7 females, mean age 29.2 years) were selected as controls. Pure tone audiometry and sound localization tests were reviewed on the first day, third day, fifth day of admission; the third week after onset, and the pure tone average and the root-mean-square error(RMSE) were used as indicators, respectively. The improvement of the ability of sound localization and pure tone average were assessed by correlation analyses using SPSS, version 27.0, and multiple regression analysis was employed to explore effects that might influence sound localization ability.Results:The pure tone threshold and sound localization ability on the third week of onset were improved compared with those on the initial three instances(the first, third, and fifth days of admission). 9 of the 22 patients (40.91%, 9/22) presented normal sound localization ability whereas their hearing loss had not recurred yet. The Spearman correlation analysis revealed a significant positive correlation between the improvement of sound localization ability and hearing improvement ( r=0.57, P<0.001). Meanwhile, multiple regression analysis showed that hearing threshold was a significant factor for sound localization when there was audible frequency. Vice versa, at this circumstance, ages and vertigo were significant factors. Conclusions:For most of the patients with unilateral sudden hearing loss, ability of sound localization improves with the decrease of hearing threshold. Notably, some patients can restore normal levels of sound localization for white noise, even in the presence of hearing loss at certain frequencies, by relying on binaural acoustic cues provided by residual hearing.

Objective:This study aims to provide insights into the clinical features of anti-melanoma differentiation-associated protein-5(MDA5)-positive dermatomyositis (MDA5-DM) patients with fatal outcomes, leveraging pathogenic microbiota metagenomic analysis, to guide the clinical assessment and treatment choices.Methods:From January 2020 to August 2023, deceased patients diagnosed with MDA5-DM were identified at the Department of Rheumatology and Immunology, the Second Affiliated Hospital of Xi ′an Jiaotong University. Clinical data were retrospectively collected and analyzed using Mann Whitney U test and Fisher ′s exact test to summarize risk factors and treatment assessment for MDA5-DM patients with fatal outcomes. Results:①The proportion of male patients was higher than females among MDA5-DM patients with fatal outcomes, which differed from the incidence pattern, possibly associated with smoking and gender proportions (6/11 vs. 0/7, P=0.037). ②94%(17/18) patients presented initially with elevated ferritin levels [(1 350±942)ng/ml] and CRP [(47±36)mg/L]. ③All patients (18/18) exhibited early involvement of the upper lung lobes, including multiple nodules in 9/18, ground-glass opacities in 5/18, and solitary nodules in 4/18. ④Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid was negative in 4/16 cases, with cytomegalovirus and pneumocystis jirovecii being the most commonly detected pathogens in 5/16 cases each. ⑤89%(16/18) of patients continued to have lymphocyte counts persistently <0.5×10 9/L irrespective of treatment. Conclusion:Smoking may have adverse effects on male MDA5 patients. Early involvement of the upper lobe of the lungs is more common in MDA5 antibody positive deaths, and persistent lymphocyte depletion is an important factor in poor response. Enhancing mNGS analysis of bronchoalveolar lavage fluid and vigilance towards cytomegalovirusand Pneumocystis jirovecii could provide valuable clinical guidance.

Objective:To analyze the clinical features of postnatal cytomegalovirus (pCMV) infection in very preterm infants or very low birth weight infants.Methods:This was a case-control study. A total of 50 very preterm or very low birth weight infants who were hospitalized and diagnosed with pCMV infection in the Neonatal Intensive Care Unit of Children′s Hospital, Zhejiang University School of Medicine from January 2019 to June 2024, were enrolled as the pCMV group. Meanwhile, through propensity score matching, each infant in the pCMV group was paired with a very preterm or very low birth weight infant without cytomegalovirus infection during the same period, constituting the control group, also consisting of 50 cases. Subsequently, the pCMV group was divided into a treated subgroup and an untreated subgroup according to antiviral treatment. Clinical data of all enrolled infants, including clinical features, laboratory test results, and clinical outcomes were collected. Differences in relevant parameters were analyzed using with χ2 test or continuity-corrected χ2 test or Fisher′s exact test, independent-samples t test, Mann-Whitney U test as appropriate. Logistic regression was employed to analyze the risk factors, and Spearman correlation analysis was applied for non-normal distribution data or ordinal data. Results:There were no significant differences between the pCMV group and the control group in terms of gestational age, birth weight, proportion of male infants, Apgar score at the 1 st minute and 5 th minute and days of breastfeeding during the first 3 weeks of life (all P>0.05). Compared with the control group, the duration of hospital stay and invasive mechanical ventilation were both longer in the pCMV group (both P<0.05). The risks of bronchopulmonary dysplasia, retinopathy of prematurity, and hearing impairment were all higher in the pCMV group when compared with the control group(all P<0.05). The body weight and body length of the infants in the pCMV group were both lower than those of in the control group at the corrected gestational age of 36 weeks (both P<0.05). pCMV infections were associated with the increased incidence of both necrotizing enterocolitis ( OR=11.50, 95% CI 1.94-68.30, P=0.007) and severe intraventricular hemorrhage ( OR=6.82, 95% CI 1.19-38.97, P=0.031) in very preterm infants or very low birth weight infants. In the treated group, the platelet count was significantly improved after 6-8 weeks of antiviral treatment compared with that before treatment ((245±19)×10 9/L vs. (119±14)×10 9/L, t=5.37, P<0.001). Conclusions:Very preterm infants or very low birth weight infants with postnatal cytomegalovirus infection have longer hospital stay and duration of invasive mechanical ventilation, and are highly susceptible to bronchopulmonary dysplasia, retinopathy of prematurity, hearing impairment, and growth restriction. Antiviral treatment can effectively ameliorate thrombocytopenia in these infants.

Objective:To develop an artificial intelligence（AI）-based sequential ultrasound-magnetic resonance imaging（US-MRI）diagnostic strategy to optimize the imaging workflow for ovarian masses.Methods:A total of 1 120 patients with pathologically confirmed ovarian masses who underwent both preoperative pelvic ultrasound and MRI between January 2021 and December 2023 at Women's Hospital，Zhejiang University School of Medicine were retrospectively included. Patients were randomly divided into the training（ n=672）and internal test set（ n=448）at a ratio of 6∶4. An external test set（ n=128）was established at the Forth Affiliated Hospital of School of Medicine. Deep learning was used for automated segmentation of MRI lesions，followed by radiomic feature extraction and machine learning classification to construct both a US-MRI multimodal model and sequential US-MRI strategy. Diagnostic performance and potential healthcare cost-saving effects were evaluated across strategies. Results:In the internal test set（ n=448），the AI-based sequential US-MRI strategy achieved a F1 score of 0.863 and a diagnostic accuracy of 82.14%，with no significant difference compared to the US-MRI multi-modal model（ P>0.05）. The sequential strategy identified 82 cases（18.30%，82/448）of patients as low-risk true negatives during initial ultrasound screening，suggesting a potential to reduce the need for MRI examinations in future clinical practice. In the external test set（ n=128），the strategy achieved an F1 score of 0.800 and a confirmed diagnosis rate of 85.94%，with a theoretical reduction of 26.56%（34 cases）in MRI utilization while maintaining a diagnostic accuracy rate higher than that of the multi-modal model（82.18%）. Conclusions:The AI-based US-MRI sequential diagnostic strategy demonstrates favorable diagnostic accuracy while offering the potential to optimize MRI utilization. This approach may enhance the efficiency of imaging resource allocation and reduce healthcare burden in the management of ovarian masses.

Objective To analyze residents' awareness,usage,and influencing factors regarding smart shared Tradition-al Chinese Medicine(TCM)pharmacies in Nanchang City.Methods Descriptive analysis,one-way ANOVA,chi-square tests,and hierarchical regression analysis were employed to determine the awareness,usage,and influencing factors of shared TCM pharmacies.Results The survey revealed that the primary channel for disseminating information about smart shared TCM phar-macies is the internet.The functions of TCM decoction and delivery services were widely recognized among respondents.Conven-ience was a key advantage considered by users.Most respondents had not used smart shared TCM pharmacy services,while over half primarily utilized TCM decoction,delivery,and prescription review services.Willingness to pay for decoction and delivery services was moderate,and drug quality emerged as a critical issue for the development of smart shared TCM pharmacies.Statisti-cally significant differences in awareness were observed across age,education level,residential area,household registration type,occupation,and household income(P＜0.05).Age,occupation,residential area,and household registration significantly influ-enced usage frequency(P＜0.05).The primary drivers of usage behavior were the functional value of smart shared TCM phar-macies rather than demographic characteristics.Conclusion It is recommended that the government,hospitals,and enterprises collaborate to establish a service framework for smart shared TCM pharmacies that ensures"visible quality,reliable delivery,and affordable pricing".