Acute Gelsemium poisoning is a systemic disease primarily affecting the central nervous system and respiratory symptoms caused by the ingestion of a substantial amount of Gelsemium within a short period. It manifests as sudden onset and rapid progression, primarily caused by accidental ingestion due to misidentification, and posing significant health risks. The compilation of the Technical Plan for Emergency Health Response to Acute Gelsemium Poisoning describes in detail the specialized practice and technical requirements in the process of handling acute Gelsemium poisoning, including accident investigation and management, laboratory testing and identification, in-hospital treatment, and health monitoring. The guidelines clarify key procedures and requirements such as personal protection, investigation elements, etiology determination, medical rescue, and health education. The key to acute Gelsemium poisoning investigation lies in promptly identifying the toxin through exposure history, clinical manifestations, and sample testing. Because there is no specific antidote for Gelsemium poisoning, immediate removal from exposure, rapid elimination of the toxin, and respiratory monitoring are critical on-site rescue measures. Visual identification of food or herbal materials, followed by laboratory testing to determine Gelsemium alkaloids in samples is a rapid effective screening method. These guidelines offer a scientific, objective, and practical framework to support effective emergency responses to acute Gelsemium poisoning incidences.

Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.

Objectives:This study aims to investigate the incidence,characteristics and clinical outcomes of vagal response(VR)during pulmonary vein isolation(PVI).Methods:A total of 702 patients with nonvalvular atrial fibrillation(AF)who received the first PVI radiofrequency ablation in Central China Fuwai Hospital from January 2022 to December 2023 were consecutively enrolled.PVI was initiated from right superior pulmonary vein(RSPV),followed by other pulmonary veins(PVs).The VR was defined as atrioventricular block(AVB),asystole or a 50%increase in the RR interval.Results:Among 702 patients with AF,380 patients(54.1%)were paroxysmal AF and 322 patients(45.9%)were persistent AF.77 patients(11.0%)developed 81 VR episodes,which were more common in paroxysmal group than in persistent AF group(19.5%vs.0.9%,P<0.001).VR manifestations included 51 sinus arrest(63.0%),26 sinus bradycardia(32.1%),and 4 atrioventricular block(AVB,4.9%).Most VR episodes were observed in the left superior ganglionated plexi(67[82.7%]).Paroxysmal AF(OR=18.667,95%CI:6.638-52.491,P<0.001),body mass index(BMI)≥28.0 kg/m2(OR=2.361,95%CI:1.376-4.051,P=0.002)and left ventricular ejection fraction(LVEF)≥62.0%(OR=1.964,95%CI:1.119-3.447,P=0.019)were independent risk factors of VR.During a mean of(13.0±7.1)months follow up,among paroxysmal AF patients,6 patients(8.1%)with VR and 33 patients(10.8%)without VR experienced AF recurrence(P=0.496).Kaplan-Meier curves estimated that the AF-free survival rate was similar between VR group and non-VR group among paroxysmal AF patients(log-rank P=0.735).Conclusions:The most common sites of VR when initiating PVI from right RSPV occur in left superior ganglionated plexi.Paroxysmal AF,BMI≥28.0 kg/m2 and LVEF≥62.0%are independent risk factors of VR.VR does not affect AF-free survival.

With the development of medical technology towards precision and individualization, the protection of gastric function and the postoperative quality of life of patients are increasingly receiving the attention and emphasis of surgeons. In the context of the booming development of function-preserving gastrectomy, the combined approach using both laparoscopy and endoscopy also presents a trend of diversity and innovation. The laparoscopic and endoscopic cooperative surgery not only addresses for the limitations of each method, but also plays a role in locating the tumor precisely, narrowing the scope of gastrectomy, preserving the anatomical structure and function of the stomach, maintaining the continuity of the gastric wall, precise lymphadenectomy, and preserving the vagus nerve in function-preserving gastrectomy. In this paper, the author expounds on the above advantages and scope of application of dual-scope cooperative surgery and recognizes the significance of dual-scope cooperative surgery in future development.

Objective To investigate the relationship between vitamin D receptor(VDR)gene TaqI rs731236 and BsmI rs1544410 polymorphisms and benign paroxysmal positional vertigo(BPPV),the relationship and clinical significance of BPPV.Methods A total of 263 patients with confirmed BPPV admitted to Dongguan People's Hospital from January 2021 to October 2023 were retrospectively selected,and another 100 healthy subjects in the same period were selected as controls.Single nucleotide polymorphisms(SNPs)at the locus of TaqI rs731236 and BsmI rs1544410 gene locus of the were detected by fluorescence quantitative PCR.Single nucleotide polymorphisms(SNP)at TaqI rs731236 and BsmI rs1544410 were detected by fluorescence quantitative PCR.The genetic balance of TaqI and BsmI genes was tested by Hardy-Weinberg balance.Genotype and allele distribution were compared between the two groups.The correlation between TaqI and BsmI genotype and clinical features of BPPV was analyzed.The risk factors of BPPV were analyzed by Logistic regression.Results Compared with the clinical data of the two groups,the levels of diabetes(22.05%),hypertension(28.90%),blood uric acid(345.38±36.69μmol/L),cholesterol(4.98±0.68mmol/L)and low density lipoprotein(3.48±0.67mmol/L)in BPPV group were significantly higher than those in control group(11.00%,15.00%,328.76±32.24μmol/L,4.36±0.57mmol/L,3.07±0.62mmol/L),and the serum 25(OH)D level(62.78±8.69nmol/L)was significantly lower than that in control group(97.65±9.54nmol/L),and the differences were statistically significant(t/χ2=3.982～33.233,all P<0.05).Hardy-Weinberg test showed that the genotype distribution of the SNP locus of TaqI and BsmI genes conforms s to the law of genetic equilibrium and is representative of the population(χ2=1.406～2.851,all P>0.05).The frequencies of AG genotype(53.99%)and A allele(57.41%)at TaqI rs731236 in BPPV group were significantly higher than those in control group(44.00%,48.00%),while the frequencies of GG genotype(15.59%)at TaqI rs731236 in BPPV group were significantly lower than those in control group(30.00%),the frequencies of CC genotype(32.32%)and C allele(54.56%)at BsmI rs1544410 locus in BPPV group were significantly higher than those in control group(18.00%,38.00%),while the frequencies of TT genotype(23.19%)and T allele(45.44%)at BsmI rs1544410 locus were significantly lower than those in control group(42.00%,62.00%),and the differences were statistically significant(χ2=9.589,5.185;14.603,15.900,all P<0.05).BPPV patients carrying AG and AA genotypes at TaqI rs731236 and CT and CC genotypes at BsmI rs1544410 had higher blood uric acid and cholesterol levels and lower serum 25(OH)D levels,and the differences were statistically significant(t=4.256～12.742,all P<0.05).The AG genotype and A allele at TaqI rs731236,CC genotype and C allele at BsmI rs1544410 were one of the independent risk factors for BPPV(Wald χ2=8.651,7.269;5.010,6.793,all P<0.05).Conclusion Carrier of AG genotype and A allele at TaqⅠ rs731236 and CC genotype and C allele at BsmI rs1544410 are closely associated with blood uric acid,cholesterol and serum 25(OH)D levels,and insrease the risk of BPPV.The polymorphism of VDR gene is an independent risk factor for BPPV.

Objectives:This study aims to investigate the incidence,characteristics and clinical outcomes of vagal response(VR)during pulmonary vein isolation(PVI).Methods:A total of 702 patients with nonvalvular atrial fibrillation(AF)who received the first PVI radiofrequency ablation in Central China Fuwai Hospital from January 2022 to December 2023 were consecutively enrolled.PVI was initiated from right superior pulmonary vein(RSPV),followed by other pulmonary veins(PVs).The VR was defined as atrioventricular block(AVB),asystole or a 50%increase in the RR interval.Results:Among 702 patients with AF,380 patients(54.1%)were paroxysmal AF and 322 patients(45.9%)were persistent AF.77 patients(11.0%)developed 81 VR episodes,which were more common in paroxysmal group than in persistent AF group(19.5%vs.0.9%,P<0.001).VR manifestations included 51 sinus arrest(63.0%),26 sinus bradycardia(32.1%),and 4 atrioventricular block(AVB,4.9%).Most VR episodes were observed in the left superior ganglionated plexi(67[82.7%]).Paroxysmal AF(OR=18.667,95%CI:6.638-52.491,P<0.001),body mass index(BMI)≥28.0 kg/m2(OR=2.361,95%CI:1.376-4.051,P=0.002)and left ventricular ejection fraction(LVEF)≥62.0%(OR=1.964,95%CI:1.119-3.447,P=0.019)were independent risk factors of VR.During a mean of(13.0±7.1)months follow up,among paroxysmal AF patients,6 patients(8.1%)with VR and 33 patients(10.8%)without VR experienced AF recurrence(P=0.496).Kaplan-Meier curves estimated that the AF-free survival rate was similar between VR group and non-VR group among paroxysmal AF patients(log-rank P=0.735).Conclusions:The most common sites of VR when initiating PVI from right RSPV occur in left superior ganglionated plexi.Paroxysmal AF,BMI≥28.0 kg/m2 and LVEF≥62.0%are independent risk factors of VR.VR does not affect AF-free survival.

With the development of medical technology towards precision and individualization, the protection of gastric function and the postoperative quality of life of patients are increasingly receiving the attention and emphasis of surgeons. In the context of the booming development of function-preserving gastrectomy, the combined approach using both laparoscopy and endoscopy also presents a trend of diversity and innovation. The laparoscopic and endoscopic cooperative surgery not only addresses for the limitations of each method, but also plays a role in locating the tumor precisely, narrowing the scope of gastrectomy, preserving the anatomical structure and function of the stomach, maintaining the continuity of the gastric wall, precise lymphadenectomy, and preserving the vagus nerve in function-preserving gastrectomy. In this paper, the author expounds on the above advantages and scope of application of dual-scope cooperative surgery and recognizes the significance of dual-scope cooperative surgery in future development.

Objective To investigate the relationship between vitamin D receptor(VDR)gene TaqI rs731236 and BsmI rs1544410 polymorphisms and benign paroxysmal positional vertigo(BPPV),the relationship and clinical significance of BPPV.Methods A total of 263 patients with confirmed BPPV admitted to Dongguan People's Hospital from January 2021 to October 2023 were retrospectively selected,and another 100 healthy subjects in the same period were selected as controls.Single nucleotide polymorphisms(SNPs)at the locus of TaqI rs731236 and BsmI rs1544410 gene locus of the were detected by fluorescence quantitative PCR.Single nucleotide polymorphisms(SNP)at TaqI rs731236 and BsmI rs1544410 were detected by fluorescence quantitative PCR.The genetic balance of TaqI and BsmI genes was tested by Hardy-Weinberg balance.Genotype and allele distribution were compared between the two groups.The correlation between TaqI and BsmI genotype and clinical features of BPPV was analyzed.The risk factors of BPPV were analyzed by Logistic regression.Results Compared with the clinical data of the two groups,the levels of diabetes(22.05%),hypertension(28.90%),blood uric acid(345.38±36.69μmol/L),cholesterol(4.98±0.68mmol/L)and low density lipoprotein(3.48±0.67mmol/L)in BPPV group were significantly higher than those in control group(11.00%,15.00%,328.76±32.24μmol/L,4.36±0.57mmol/L,3.07±0.62mmol/L),and the serum 25(OH)D level(62.78±8.69nmol/L)was significantly lower than that in control group(97.65±9.54nmol/L),and the differences were statistically significant(t/χ2=3.982～33.233,all P<0.05).Hardy-Weinberg test showed that the genotype distribution of the SNP locus of TaqI and BsmI genes conforms s to the law of genetic equilibrium and is representative of the population(χ2=1.406～2.851,all P>0.05).The frequencies of AG genotype(53.99%)and A allele(57.41%)at TaqI rs731236 in BPPV group were significantly higher than those in control group(44.00%,48.00%),while the frequencies of GG genotype(15.59%)at TaqI rs731236 in BPPV group were significantly lower than those in control group(30.00%),the frequencies of CC genotype(32.32%)and C allele(54.56%)at BsmI rs1544410 locus in BPPV group were significantly higher than those in control group(18.00%,38.00%),while the frequencies of TT genotype(23.19%)and T allele(45.44%)at BsmI rs1544410 locus were significantly lower than those in control group(42.00%,62.00%),and the differences were statistically significant(χ2=9.589,5.185;14.603,15.900,all P<0.05).BPPV patients carrying AG and AA genotypes at TaqI rs731236 and CT and CC genotypes at BsmI rs1544410 had higher blood uric acid and cholesterol levels and lower serum 25(OH)D levels,and the differences were statistically significant(t=4.256～12.742,all P<0.05).The AG genotype and A allele at TaqI rs731236,CC genotype and C allele at BsmI rs1544410 were one of the independent risk factors for BPPV(Wald χ2=8.651,7.269;5.010,6.793,all P<0.05).Conclusion Carrier of AG genotype and A allele at TaqⅠ rs731236 and CC genotype and C allele at BsmI rs1544410 are closely associated with blood uric acid,cholesterol and serum 25(OH)D levels,and insrease the risk of BPPV.The polymorphism of VDR gene is an independent risk factor for BPPV.

Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.

Objectives:The present study evaluated the impact of ablation pain during pulmonary vein isolation(PVI)on catheter-tissue contact at different regions. Methods:Forty consecutive patients with atrial fibrillation(AF)referred to Central China Fuwai Hospital for catheter radiofrequency ablation from February to May 2023 were enrolled.The pulmonary veins on each side were divided into 8 regions.The catheter-tissue contact force(CF)and the number of ablation contact stability(>50%catheter attach time CF≥10 g)of each ablation lesion were analyzed.Pain scores during the ablation were assessed using the Faces Pain Scale-Revised and the maximum score was taken for each ablation region.Based on the pain scores,in each region,20 cases with higher pain scores were categorized into the pain group and 20 cases with lower pain scores were categorized into the normal group.The CF characteristics of each region and the relationship with ablation induced pain were analyzed. Results:A total of 3 832 lesions were recorded in 40 patients with AF,with a mean CF of(12.2±7.8)g.Among them,the CF in the pain group was significantly lower than that in the normal group([11.1±5.1]g vs.[13.4±4.8]g,P<0.05).The top region of the right pulmonary vein was the region with the largest CF(16.5±5.8)g,and the upper part of the left anterior wall(at the ridge between the left atrial appendage)was the region with the smallest CF(7.5±3.7)g.At the bottom of right pulmonary vein,right lower posterior wall,left pulmonary vein,and left posterior wall,as well as the middle region of left posterior wall,and upper region of left posterior wall,the CF was significantly smaller in the pain group than that in the normal group(all P<0.05).Of the 3 832 lesions,2 193(57.2%)were stable lesions,and the proportion of stable lesions in the pain group was significantly lower than that in the normal group(55.2%vs.59.5%,P<0.05).In the right pulmonary vein bottom,right lower posterior wall,left lower anterior wall,left pulmonary vein bottom,and left lower posterior wall,the proportion of stable lesions was significantly lower in the pain group than in the normal group(all P<0.05).In addition,the ratio of stable lesions in left pulmonary vein regions was lower than in the right(54.2%vs.60.5%,P<0.05).In the upper part of the left anterior wall(at the ridge between the left atrial appendage),only 88(39.3%)of the 224 lesions in 40 patients were stable lesions. Conclusions:Pain during ablation significantly affects the stability of the catheter to tissue.Monitoring real-time CF during PVI may have important implications for improving ablation efficacy,especially in regions with more intense pain.