Objective To quantitatively analyze the volumetric characteristics of each subregion of the basal ganglia in patients with hepatolenticular degeneration （also known as Wilson disease ，WD） using brain magnetic resonance imaging （MRI） and brain segmentation technology， to explore the specific imaging findings of choreiform symptoms， and to assess the clinical value of caudate nucleus atrophy as an imaging indicator for this symptom. Methods A retrospective analysis was performed for 40 WD patients with choreiform symptoms and 40 patients without choreiform symptoms from June 2023 to June 2025， and clinical indicators were compared between the two groups. In addition， the two groups were compared in terms of the volume of the basal ganglia after estimated total intracranial volume （eTIV） correction， and the correlation between the volume of differential brain regions and the chorea subscale score of Unified Wilson's Disease Rating Scale （UWDRS） was explored. Results There were no significant differences in baseline data between the two groups. UWDRS scores showed that the choreiform group had a higher neurological function score （P=0.005）， a significantly higher chorea subscale score （P<0.01）， and a lower hepatic function score （P<0.01）. The choreiform group had a significantly smaller caudate nucleus volume than the non-choreiform group （P<0.001）， suggesting severe subregional atrophy， and in contrast， the choreiform group had a significant increase in thalamus volume （P=0.002）. Caudate nucleus volume ratio was significantly negatively correlated with chorea subscale score in the choreiform group （P<0.001）. Conclusion Caudate nucleus atrophy is a specific imaging finding of choreiform symptoms in WD patients， and a quantitative analysis of caudate nucleus volume is expected to become an objective imaging indicator for assessing the severity of choreiform symptoms and monitoring disease progression in WD.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Objective To systematically evaluate and integrate real experience and feelings of self-determination in home-based exercise rehabilitation of stroke patients.Methods We searched databases including PubMed,Embase,Web of Science,Cochrane Library,CINAHL,CNKI,Wanfang,VIP,Sinomed.The literature of qualitative research on self-determination experience in home-based exercise rehabilitation of stroke patients from the establishment of the database to February 2024 was retrieved.The literature was evaluated using the Australian JBI Quality Evaluation Criteria for Qualitative Research in Evidence-based Health Care Centers(2016),and the results were consolidated using an aggregative integration approach.Results A total of 23 theme were extracted,and 10 new categories were formed after induction and integration,which were finally merged into 3 integrated results,including multiple dilemmas in rehabilitation self-determination,motivation transformation during self-determination,strategies to achieve self-determination.Conclusion During the process of home-based exercise rehabilitation for stroke patients,medical personnel should pay attention to patients'determination dilemma,motivation changes and related strategies they adopt.Targeted decision-making programs should be developed for stroke patients,aiming for the scientific and precise advancement of exercise rehabilitation.

Objective:To analyze the epidemiological and clinical characteristics of pertussis cases identified through active surveillance.Methods:Active surveillance for pertussis was conducted in three sentinel hospitals in Yiwu, Zhejiang Province, and Yongcheng, Henan Province. The study population included cases that met the surveillance case definition and sought medical care at outpatient/emergency departments or were hospitalized between June 1, 2021, and May 31, 2022. Samples were collected for bacterial culture and PCR detection. Case information and clinical data were collected. Differences in rates were assessed using the chi-square test or Fisher's exact probability test, and the differences in cough time were compared using the Mann-Whitney U test. Results:Among 1 423 cases of pertussis surveillance, the positive rate of pertussis was 28.11% (400/1 423), with a median age of 5 years (interquartile range: 2, 8). The positive rate in Yongcheng, Henan Province, and Yiwu, Zhejiang Province were 39.27% (216/550) and 21.08% (184/873), respectively; the positive rate of pertussis was highest in July 2021, and the highest positive rate of pertussis was among those aged 10-14. The positive rate of pertussis in hospitalized cases was higher than in outpatient/emergency cases (26.68%) ( χ2=4.16, P=0.041). Among the 400 laboratory test-positive cases, the highest proportion of atypical symptom cases was in adults aged 20-59 (43.33%, 13/30). The specificity rates of apnea and worsening nocturnal cough in monitored cases under 3 months of age were 100.00% and 73.81%, respectively. Among monitored cases aged 3 months to 9 years, the proportions of symptoms including worsening nighttime cough (63.00%) and night sweats (4.59%) in test-positive cases were significantly higher than those in the test-negative group (47.77% and 0.56%, respectively), with statistically significant differences (both P<0.05). The specificity rates of worsened nighttime coughing and night sweats were 52.23% and 99.44%, respectively. Conclusions:The active surveillance results for pertussis showed that the 10-14 age group exhibited the highest positivity rate. Active surveillance enhanced the detection rate of pertussis. Among laboratory-confirmed cases, the proportion of atypical symptoms was the highest in adults, suggesting that laboratory testing should be combined to diagnose programs of pertussis. For infants under 3 months, worsening nighttime cough and apnea increase the diagnostic specificity, while for individuals aged 3 to 9 years old, worsening nighttime cough and night sweats increase the diagnostic specificity.

Objective To investigate the effects of Bushen Zhuanggu decoction on total N-terminal propeptide of type Ⅰprocollagen(t-PINP)and β-C-terminal telopeptide of type Ⅰ collagen(β-CTX)in patients with knee osteoarthritis(KOA).Methods A total of 120 patients with liver-kidney deficiency KOA treated in Linping District Hospital of Traditional Chinese Medicine from June 2021 to April 2024 were selected and divided into study group and control group according to random number table method,with 60 cases in each group.The patients of control group was given oral treatment with etocoxib and omeprazole,and patients of study group was given oral treatment of Bushen Zhuanggu decoction on the basis of control group.Both groups were treated for one month.The clinical efficacy,TCM syndrome scores,serum t-PINP and β-CTX leves,t-PINP/β-CTX,Western Ontario and Mcmaster Universities osteoarthritis index(WOMAC)scores and adverse reactions during treatment were compared between two groups.Results The total effective rate in study group was significantly higher than that in control group(x2=4.5 13,P=0.034).After treatment,the TCM syndrome scores,serum t-PINP and β-CTX levels and WOMAC scores in two groups were significantly lower than before treatment,and t-PINP/β-CTX were significantly higher than before treatment(P＜0.05).The TCM syndrome scores,serum t-PINP and β-CTX levels and WOMAC scores in study group were significantly lower than those in control group,and t-PINP/β-CTX was significantly higher than that in control group(P＜0.05).There was no significant difference in incidence of adverse reactions between two groups(x2=0.686,P=0.408).Conclusion Bushen Zhuanggu decoction can improve the clinical efficacy of KOA patients with liver-kidney deficiency,relieve clinical symptoms and pain,increase t-PINP/β-CTX,and reduce the incidence of adverse reactions.

Objective To observe the clinical efficacy and safety of vericiguat tablets combined with sacubitril valsartan sodium(Sac/Val)tablets in the treatment of patients with heart failure with reduced ejection fraction(HFrEF).Methods The HFrEF patients were divided into control group and treatment group according to the cohort method.The control group was treated with Sac/Val tablets 200 mg per time,bid,orally.On the basis of control group,the treatment group was treated with vericiguat tablets 2.5 mg per time,qd,taken with meal.Two groups were treated for 3 months.The clinical efficacy,left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDD)and end-systolic diameter(LVESD),levels of high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),nitric oxide(NO),N-terminal pro-brain natriuretic peptide(NT-proBNP),blood urea nitrogen(BUN)and serum creatinine(SCr),and safety were compared between the two groups.During follow-up,the heart failure rehospitalization rates and major adverse cardiovascular events were compared between the two groups.Results Treatment group was enrolled 53 patients,control group was enrolled 53 patients.After treatment,the total effective rates of treatment and control groups were 94.34％(50 cases/53 cases)and 81.13％(43 cases/53 cases)with statistical significant difference(P＜0.05).After treatment,the LVEF of treatment and control groups were(48.02±5.20)％and(43.02±4.33)％,the LVEDDs were(52.85±6.30)and(55.63±6.88)mm,the LVESDs were(41.64±6.40)and(44.22±5.85)mm,the levels of hs-CRP were(10.22±2.63)and(14.60±2.98)mg L-1,the levels of IL-6 were(14.48±2.40)and(17.36±2.52)pg·mL-1,the levels of NO were(102.60±20.16)and(92.16±16.33)μmol·L-1,the levels of NT-proBNP were(898.74±102.20)and(1315.60±182.64)ng·L-1,the levels of BUN were(12.02±2.28)and(13.45±2.33)mmol·L-1,the levels of SCr were(82.22±5.89)and(85.64±6.03)μmol·L-1,the heart failure rehospitalization rates were 5.66％and 13.21％,respectively;the differences were statistical significant between two groups(all P＜0.05).The adverse drug reactions of treatment group were hyperkalemia,hypotension,renal dysfunction,dizziness and headache,while those in control group were renal dysfunction,hyperkalemia,and hypotension.The major adverse cardiovascular events of treatment group were angina pectoris and acute myocardial infarction,while those in control group were angina pectoris,acute myocardial infarction and atrial fibrillation.The incidences of total adverse drug reactions in treatment and control groups were 13.21％and 7.55％,the incidences of major adverse cardiovascular events were 5.66％and 13.21％,respectively,without statistically significant differences(all P＞0.05).Conclusion Vericiguat tablets combined with Sac/Val tablets have a definitive clinical efficacy in the treatment of HFrEF patients,which can improve cardiac and endothelial function,reduce inflammatory response and readmission times,without increasing the incidences of adverse drug reactions.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.