Objective: To understand the changing trends and related factors of knowledge, attitude and practice (KAP) regarding the three major infectious diseases (acquired immunodeficiency syndrome, tuberculosis, hepatitis B) among freshmen in Jiangsu from 2019 to 2022, so as to provide a reference basis for the health education of infectious diseases in schools. Methods: From 2019 to 2022, a total of 33 944 freshmen from 20 universities in Jiangsu Province were randomly selected for four consecutive years to investigate their KAP levels online through self designed questionnaires on three major infectious diseases. The multiple linear regression model was used to analyze the changing trends of students KAP levels of the three major infectious diseases, and to explore the influencing factors of KAP. Results: From 2019 to 2022, the knowledge scores(18.0±3.1,18.4±3.2,18.7±3.2,18.8±3.2), related to the three major infectious diseases showed an upward trend ( F=436.50, P <0.01), and the positive attitude reporting rates were 81.77%, 81.46%, 82.68% and 81.74%, respectively. The reporting rates of positive practice were 80.11%, 79.25%, 79.08 % and 79.04%, respectively. Multiple linear regression showed that school type, parental education level, mother s occupation, average income per person in family and living arrangements during high school all had an impact on the knowledge ( β = -1.510 -0.559), attitudes ( β =-0.043-0.065) and practice ( β =-0.028-0.027) of the three major infectious diseases ( P < 0.05 ). The family residence areas only affected the reporting rate of positive attitude scores ( β =0.002-0.065), and whether only children or not affected the reporting rate of positive practice scores ( β =0.009)( P <0.05). The knowledge score showed an upward trend ( β= 0.297, P <0.01), the positive attitude reporting rate showed no statistically significant change ( β=0.001, P =0.22), and the positive practice reporting rate showed a downward trend ( β=-0.005, P <0.01). Conclusions Freshman in Jiangsu Province from 2019 to 2022 have shown a separation in KAP scores regarding the three major infectious diseases. Targeted measures should be taken to improve their health practice level.

Inflammatory bowel disease（IBD）is a type of disease characterized by chronic intestinal inflammation，mainly including Crohn's disease，ulcerative colitis，and undifferentiated IBD. Its pathogenesis is very complex and involves multiple factors. In recent years，studies have shown that heat shock proteins（HSPs）and cell apoptosis play important roles in the occurrence and progression of IBD. HSPs not only participate in cellular stress response，but also play a crucial role in regulating cell apoptosis. The specific mechanism of the interaction between HSPs and apoptosis in IBD is currently unclear. This article reviews the relationship and mechanism between HSPs and apoptosis in the occurrence and development of IBD，explores the roles of HSPs and apoptosis in IBD，and proposes potential treatment strategies to provide more effective treatment options for IBD patients in the future.

Objective To observe the clinical efficacy of filiform-heated needle stimulation on myofascial trigger points(MTrPs)based on the"pivot mechanism"theory in treating neck-shoulder myofascial pain syndrome(MPS).Methods Sixty-four patients diagnosed with neck-shoulder MPS from the Acupuncture Department(inpatient and outpatient)of Guangzhou University of Chinese Medicine Dongguan Hospital between January 2023 and September 2023 were selected and randomly divided into a control group and an observation group using a random number table,with 32 cases per group.The control group received oral administration of Celecoxib Capsules,while the observation group received additional filiform-heated needle therapy.The treatment duration was 2 weeks and 1 course per week.Clinical efficacy was evaluated after 2 weeks,with observing the changes in the Short-Form McGill Pain Questionnaire(SF-MPQ)scores,Neck Disability Index(NDI)scores.The cervical range of motion(ROM)was compared between the two groups.Results(1)After treatment,the SF-MPQ scores of the two groups of patients were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the SF-MPQ scores,and the difference was statistically significant(P＜0.05).(2)After treatment,the NDI scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the NDI scores,and the difference was statistically significant(P＜0.05).(3)After treatment,the cervical joint mobility of patients in the two groups was significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving cervical joint mobility,with a statistically significant difference(P＜0.05).(4)The total effective rate was 96.88%(31/32)in the observation group and 84.38%(27/32)in the control group.The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).Conclusion Filiform-heated needle stimulation on MTrPs based on the"pivot mechanism"theory significantly alleviates pain,improves soft tissue injury,and enhances neck-shoulder mobility in patients with neck-shoulder MPS,demonstrating remarkable clinical efficacy.

To analyze the disease burden and trends of motor neuron disease(MND) in China and globally from 1990 to 2021, providing evidence for the formulation of relevant health strategies inChina.

ObjectiveTo evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease（COPD） patients， and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease（COPD） patients. MethodsStudy subjects were recruited from chronic obstructive pulmonary patients aged ≥40 in Pudong New Area. Propensity score matching method was used to determine the intervention group and the control group. The control group received regular health education and follow-up management， and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat， mobile phone short message service（SMS）and telephone. Finally， a total of2 589 subjects were included in the analysis， including 1 300 in the intervention group and 1 289 in the control group. General demographic data， past medical history and family history of COPD， COPD related knowledge and practice survey， COPD related symptom assessment， acute onset， health service utilization and medical expenses before and after intervention were collected through questionnaire survey. The differences of acute attack， health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect. ResultsIn terms of acute attacks， after intervention， the incidence of acute attacks in the intervention group was lower than that before intervention（χ²=52.901， P<0.001）， and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention （P<0.001）. WeChat had the best effect， decreasing the incidence by 14.4%， followed by mobile phone SMS SMS decreasing by 12.3%. In terms of utilization of health services， the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention （χ²=7.129， P=0.008）， and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention （χ²=4.675， P<0.001）. In terms of medical expenses， there was no significant difference between control group and intervention group with different intervention methods before intervention （P>0.05）. After intervention， the difference between the control group and the intervention group with different intervention methods was statistically significant （H=11.864， P<0.05）. The results of multiple comparisons showed that compared with the control group， the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group， and the difference was statistically significant （P<0.05）. ConclusionMeteorological risk forecasting service can reduce the acute onset of COPD， reduce the rate of consultation and medical expenses due to acute onset， and provide scientific basis for the basic COPD health management model.

Objective:To explore the clinical effect of magnetic resonance imaging (MRI) or ultrasound-guided high intensity focused ultrasound (HIFU) ablation in the treatment of uterine fibroids.Methods:The clinical data of 124 patients with uterine fibroids who received HIFU ablation in the Department of Obstetrics and Gynecology of Xi'an People's Hospital were retrospectively analyzed from April 2020 to February 2023. The patients were divided into an MRI group (58 cases treated with magnetic resonance guided HIFU ablation) and an ultrasound group (66 cases treated with ultrasound guided HIFU ablation) according to different guidance methods. The treatment effects (total effective rate, fibroid ablation volume, fibroid ablation rate), surgical conditions (total energy consumption, total time consumption, energy efficiency factor, irradiation time), incidence of adverse events, ovarian function (follicle stimulating hormone (FSH), inhibin) at 3 months before and after surgery were compared between the two groups. B. Antral follicle count (AFC) and recurrence at 6 and 12 months after surgery. The t-test is used for comparing between groups of metric data that conform to normal distribution, and the chi square test is used for comparing between groups of count data.Results:The total energy consumption, total time consumption and irradiation time in MRI group were longer than those in ultrasound group( (571.68±184.31) kJ vs (494.82±155.03) kJ, (186.21±36.19) min vs (121.63±31.09) min, (26.12±7.93) min vs (22.07±7.46) min), there were have statistical differences( t values were 2.52, 10.69, and 2.93, respectively; P values were 0.013, <0.001, and 0.004, respectively). At 3 months after surgery, the level of FSH in the two groups was risen than that before surgery(MRI group (10.27±1.72) U/L vs (8.67±1.63) U/L, ultrasound group (10.13±1.66) U/L vs (8.46±1.57) U/L), the level of INHB and the number of AFC were declined (MRI group (40.46±5.31) ng/L vs (47.19±4.24) ng/L, (4.22±1.21) vs (6.72±1.48); ultrasound group (39.07±5.12) ng/L vs (48.20±4.77) ng/L, (4.11±1.09) vs (6.63±1.41)) there were have statistical differences ( t values were 5.14, 5.94, 7.54, 9.96, 10.60, and 11.48, respectively; all P<0.001). Conclusion:Both methods of guided HIFU ablation for uterine fibroids can effectively ablate fibroids and improve ovarian function, with safety. Ultrasound guidance has a shorter treatment time and less energy consumption compared to MRI guidance.

Objective:To investigate the utility of cardiac magnetic resonance (CMR) multiparametric imaging in the etiological and differential diagnoses of troponin increase with non-obstructive coronary arteries (TINOCA).Methods:A retrospective analysis was conducted on patients diagnosed with TINOCA and confirmed by coronary angiography in Dongguan Kanghua Hospital from January 2018 to June 2023. CMR examinations were performed within 7 days of onset. The examination sequences included "black blood" single-shot balanced turbo field echo with breath-hold, balanced turbo field echo with breath-hold, T 2-weighted short tau inversion recovery black blood, modified gradient and spin echo black blood with SENSE, dynamic balanced turbo field echo, and phase-sensitive inversion recovery [late gadolinium enhancement (LGE)]. Based on the imaging findings, patients were categorized into 4 groups: myocardial infarction with non-obstructive coronary arteries (MINOCA) group, acute myocarditis group, Takotsubo syndrome group, and CMR negative group. The observed indices included left ventricular function, myocardial edema, first perfusion, and LGE of contrast enhancement. The differences in these parameters among the aforementioned disease groups were statistically compared. The categorical data were analyzed between groups using the chi-square test or Fisher′s exact probability method. The data in line with normal distribution were statistically described by xˉ±s. The independent-sample t test was used to compare the means of the 2 samples. The data with skewed distribution were described by M ( Q1, Q3). The Mann-Whitney U test was used for intergroup analysis. Results:A total of 33 patients were enrolled in this study, the 4 groups comprised 14(42.4%), 12(36.4%), 0, and 7(21.2%) patients, respectively. The positive rate of CMR diagnosis was 78.8%. The onset age in the MINOCA group significantly differed from that in the acute myocarditis group ( Z=3.32, P=0.001). No significant differences were observed in left ventricular function, number of myocardial edema segments, and T 2 value of the diseased myocardium between the 2 groups ( P>0.05), but the number of abnormal first perfusion was significantly distinct ( P<0.001). Significant differences were observed in the quality and volume of LGE between the 2 groups ( P<0.05 for all). Conclusion:CMR multiparameteric imaging technology plays a unique role in the etiological diagnosis of TINOCA, accurately distinguishing TINOCA caused by MINOCA, acute myocarditis, and other cardiac causes.

Objective:To explore the efficacy and safety of dual targeted therapy（DTT）in the treatment of refractory inflammatory bowel disease（IBD）in children.Methods:The diagnosis and treatment processes of refractory IBD children treated with DTT in the Department of Gastroenterology,Beijing Children's Hospital Affiliated to Capital Medical University from April 2022 to May 2024 were analyzed retrospectively,and their clinical characteristics were summarized.Results:A total of ten children with refractory IBD were included,including five males and five females,with a median onset age of 12.58 (5.25,13.33) years old,and seven cases of Crohn's disease (CD) and three cases of ulcerative colitis (UC),with a median disease course of 1.25 (0.91,4.00) years，were treated with DTT for a median time of 6.08 (6.00,13.40)months.Two (2/7) cases of CD patients were partially effective with infliximab(IFX) treatment,while five (5/7) cases were partially effective with a combination of IFX and azathioprine treatment.These patients received DTT with UST in addition to continuous using of IFX.When the seven CD patients were treated with DTT for four weeks,12 weeks and 24 weeks,and the clinical remission rates were 42.9%(3/7),71.4%(5/7) and 100%(7/7)，respectively.The pediatric Crohn's disease activity index gradually decreased,which were significantly lower than those before treatment( P<0.05).Fecal calprotectin,C-reactive protein,erythrocyte sedimentation rate,and blood white blood cells all gradually decreased,which were lower than those before treatment,while hemoglobin and serum albumin were higher than those before treatment.Three children with UC were all resistant to glucocorticoids.One case was partially effective with adalimumab treatment,one case was partially effective with IFX combined with immunosuppressive agents,and one case was partially effective with vedolizumab.All the three UC patients received DTT treatment with UST in addition to continuous using of the original biological preparation.When the three UC patients were treated with DTT for four weeks and 12 weeks,one case showed clinical remission,one case showed clinical response,and one case showed no clinical response.After 24 weeks of DTT treatment,two cases achieved clinical remission and one case had no clinical response.Re-examination of colonoscopy showed that one case of clinical remission had mucosal healing and one case had mild disease activity.However,there was a slight improvement in disease activity under endoscopy compared with that before DTT in patient who had no clinical response.During DTT treatment,no adverse events occurred in all patients. Conclusion:DTT is effective and relatively safe for children with refractory IBD,and can be one of the attempts for children with IBD when they are partially effective with one biological agent.

Objective:To investigate the pathogenic mechanism and clinical characteristics of the novel splicing variant of ATP-binding cassette subfamily B member 4 (ABCB4) and provide a basis for subsequent genetic diagnosis.Methods:The clinical data of a 5-year-old child with cholestatic liver disease admitted to the Beijing Children′s Hospital of Capital Medical University was retrospectively analyzed. The pathogenic variations were detected by whole exome sequencing and verified by Sanger sequencing, and bioinformatics was used to predict the pathogenicity of the mutation sites. Possible pathogenic variations were verified in vitro by Minigene assay. The clinical outcome was followed after discharge from hospital.Results:The 5-year-old boy had developed cholestasis at the age of 11 months. His physical examination showed obvious enlargement of the liver and spleen. Cholestatic cirrhosis was diagnosed by liver function tests, abdominal ultrasonography, liver biopsy and pathology. The results of genetic analysis showed that the patient was a complex heterozygote of the ABCB4 gene, with a pathogenic mutation c.2860G>A and a novel mutation c.2065-8T>G, derived from the mother and father respectively. The conservative prediction of the c.2065-8T>G site showed that this region was highly conserved and may affect splicing. Minigene assay results confirmed that the c.2065-8T>G mutation resulted in a 7 bp retention of intron 16 in the mature mRNA. In the absence of nonsense-mediated mRNA decay, the amino acid frameshift forms a truncated protein, which is represented by p.Glu689ValfsTer19. The patient was diagnosed as progressive familial intrahepatic cholestasis type 3 (PFIC3) and treated with ursodeoxycholic acid (UDCA). His clinical symptoms improved during 18 months of follow-up.Conclusions:The c.2065-8T>G variant is confirmed to affect the splicing process and exhibits complex heterozygosity with c.2860G>A, which is identified as the cause of the disease. PFIC3 children with this variant showed cholestatic liver disease as the main manifestation with a slow progression and was sensitive to treatment with UDCA.

It is the current confusion encountered by integrated Chinese and Western medicine that how to find the breakthrough direction of integrating Chinese and Western medicine， from crossover to integration to innovation， and open up a new horizon of integrated Chinese and Western medicine. The progress of Chinese medicine lay in expanding the scope of diagnosis and treatment with the help of modern diagnostic and therapeutic equipments and developing “micro” identification， while the progress of Western medicine lay in looking at “macro” and developing systemic medicine and integrated medicine， both of which are in the direction of each other. The “state-target identification and treatment” may become an important way to build a modern diagnosis and treatment system of integrated Chinese and Western medicine， and the thinking mode of “from target to state” is a further refinement and development on the basis of the theoretical system of “state-target identification and treatment”， which provided a clearer solution for the current stage of the integrated Chinese and Western medicine model， and pointed out the important development direction for the future integrated Chinese and Western medicine. From the perspective of strategic level and diagnosis and treatment practice， it integrated the “target-state” thinking mode into the modern diagnosis and treatment model of the integrated Chinese and Western medicine， i.e.， “Western medicine as the basis and treating with Chinese medicine； Chinese medicine as the basis and treating with Western medicine”. On the one hand， Western medicine should strengthen the reference to the traditional theories and holism of Chinese medicine， and advocate a higher level of education on the integrated Chinese and Western medicine under the guidance of the traditional theories of Chinese medicine. On the other hand， the “from target to state” mode of thinking should be applied to guide the establishment of diagnostic and treatment strategies and clinical selection of medicines in clinical practice， so as to locate the target and adjust the body state in a gradual and orderly manner， and to provide practical methods for the modern clinical work of the integrated Chinese and Western medicines. Chinese and Western medicine systems can learn from each other， combine organically， give full play to their respective strengths， and form an internal law， so as to make breakthroughs and innovations in the integrated Chinese and Western medicine model.