Objective To analyze the clinical and therapeutic characteristics of Epstein-Barr virus (EBV)-negative posttransplant lymphoproliferative disease (PTLD) with diffuse large B-cell lymphoma (DLBCL) in the context of specific cases and literature. Methods A case of EBV-negative DLBCL (GCB type) after kidney transplantation is reported. The patient was a 45-year-old male who underwent living-related kidney transplantation in 2016 and has been receiving triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil and methylprednisolone since then. In 2024, the patient presented with intermittent fever, night sweats and gastrointestinal symptoms. The diagnosis was confirmed by endoscopic pathology, immunohistochemical staining and positron emission tomography/computed tomography. The R-CDOP regimen (rituximab + cyclophosphamide + liposomal doxorubicin + vincristine + dexamethasone) was used for treatment. Results The patient was diagnosed with EBV-negative DLBCL (GCB type, Ann Arbor stage Ⅳ B). After 4 cycles of R-CDOP chemotherapy, the efficacy assessment was partial remission, and the transplant kidney function remained stable. Conclusions For EBV-negative PTLD after kidney transplantation, it is necessary to break through the "virus-dependent" diagnostic thinking. In clinical practice, the focus should be on protecting the transplant kidney, and individualized treatment plans should be developed for patients.

Objective　To analyze and investigate a hospital-acquired outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a hospital's neurosurgical intensive care unit (NSICU), and to implement rectification based on the investigation results, providing valuable insights and recommendations for controlling similar outbreaks caused by multi-drug-resistant strains. Methods The field epidemiological investigation was conducted to investigate five cases of clustered CRKP pulmonary infection in the NICU in Shandong in 2021. Hygienic monitoring of the environment was undertaken. The main occurrence stages were analyzed, effective control measures were taken, and the effectiveness of the control measures was evaluated. Results The study identified an outbreak of CRKP infections that occurred in the neurosurgical intensive care unit, with the beds of infection cases and spatial positions being centrally distributed. Hygienic monitoring was performed on environmental surfaces, as well as the hands and nasal cavities of medical and cleaning staff. In the first sampling, 3 samples from the patient bed units tested positive for CRKP, while no CRKP was detected on other surfaces, or in samples from the hands and nasal passages of the medical staff and air specimens. The CRKP strains found on surfaces had antibiotic resistance profiles consistent with the patient strains. No further related cases occurred after comprehensive control measures were implemented. Conclusions The comprehensive control measures, including enhanced ward disinfection and isolation, strict management of hand hygiene among medical staff, and personnel training, can effectively control the outbreak of CRKP hospital-acquired infections in NSICU.

Objective: To analyze the issuance of Chinese adolescents mental health promotion policies and policy objects, and to explore the use of different object policy tools and the effectiveness of the policy, so as to provide reference for the improvement of the subsequent policy. Methods: Adolescents mental health promotion policies published and policy documents that included adolescents in mental health promotion policies and regulations in China from 2014 to the present were obtained, with the search period of July to August 2024. Policy content and effectiveness were analyzed by using content cross tabulation analysis and Policy Modeling Consistency Index Model (PMC index model). It coded with Nvivo 20 software to understand the types of tools that policy depends on. Results: A total of 41 documents were included. The number of adolescent mental health promotion policy texts rose by year, most of which were issued independently, accounting for 70% of the total number of texts issued; 30% were jointly issued, with the Ministry of Education and the National Health Commission as the core subjects. Supply type policy tools accounted for 47.45 % of the total, while environment type and demand type policy tools accounted for 29.68% and 22.87% respectively; the use of policy tools by different policy targets varies, with families and social organizations using more supply type and demand type policy tools, while the education system and healthcare institutions were more inclined to supply type policy tools, and the government departments were more inclined to supply type policy tools and environment type policy tools. In terms of policy effectiveness, there was a common problem of a lack of incentives and constraints, and the PMC values of two long term planning mental health policies were high (7.76, 7.56), and both reached the excellent level. Conclusions China has paid more attention to adolescents mental health, and the basic guarantees have been established and overall policy effectiveness is good, but the use of policy tools is uneven. There is a need to improve the operational content of medium and long term policies and to strengthen synergies between implementing departments.

OBJECTIVE: To explore the genetic basis of a patient suspected for Loeys-Dietz syndrome (LDS). METHODS: A adult male patient with aneurysmal dilation of the aortic root identified during the treatment for chronic myeloid leukemia at Anzhen Hospital of Capital Medical University in 2021 was selected as the study subject. Clinical data of the patient were retrospectively collected. Peripheral blood samples were collected from the patient and his family members and subjected to whole-exome sequencing (WES). Candidate variant was verified by bioinformatic analysis, with a focus on the genes associated with hereditary aortic aneurysms. Candidate variant was validated by Sanger sequencing. The online SpliceAI software was used for the prediction of protein function. The results, combined with information from public databases, were used to classify the pathogenicity of the candidate variant according to the guidelines from the American College of Medical Genetics and Genomics (ACMG). This study was approved by the Ethics Committee of Beijing Anzhen Hospital (Ethics No. 2023163X). RESULTS: Imaging analysis revealed that the patient had aneurysmal dilation of the aortic root. Based on his clinical features and past history, a provisional diagnosis of LDS was established. WES revealed that the patient had harbored a heterozygous splice site variant c.206+2T>G in the SMAD3 gene (NM_005902). The variant was not reported in public databases and was predicted to be pathogenic by SpliceAI. Sanger sequencing showed that the variant was also present in the proband's mother, sister, nephew, and daughter, but not in his father. Based on the guidelines from the ACMG, the variant was classified as likely pathogenic (PVS1+PM2_Supporting). CONCLUSION The heterozygous splice site variant c.206+2T>G of the SMAD3 gene probably underlay the disease in this patient. Above discovery has enriched the mutational spectrum of LDS, which may facilitate delineation of the genotype-phenotype correlation and provide a basis for further risk stratification and personalized treatment of LDS.
Adult ; Humans ; Male ; Exome Sequencing ; Loeys-Dietz Syndrome/genetics* ; Mutation ; Pedigree ; Smad3 Protein/genetics*

OBJECTIVE To understand the prevalence of pathogens causing genital tract infections among the infer-tile patients so as to provide bases for clinical diagnosis,treatment and prevention.METHODS A total of 54,562 infertile patients who were treated in Reproductive Medicine Center of Tang Du Hospital of Air Force Medical University from Jul.2023 to Jan.2025 were enrolled in the study.The cervical swab samples were collect-ed from the female patients,and the urine samples were collected from the male patients.Chlamydia trachomatis(CT),Ureaplasma urealyticum(UU),Mycoplasma genitalium(MG)and Neisseria gonorrhoeae(NG)were tested by real-time fluorescent nucleic acid isothermal amplification for RNA.The statistical analysis was per-formed based on the gender,age and type of infection.RESULTS The total positive rates of UU,MG,CT and NG were 38.36％,2.85％,0.99％and 0.04％,respectively.The patients with CT plus MG infection were dominant a-mong the patients with mixed infections.The positive rates of UU and CT of the female patients were higher than those of the male patients(P＜0.001),while the positive rate of NG of the female patients was lower than that of the male patients(P=0.028).The patients aged more than 25 years old were susceptible to UU,with the positive rate highest among the patients aged between 35 and 40 years old.The patients aged less than 25 years old were dominant among the patients with MG and CT infections,and NG infection was more common among the patients aged between 25 and 35 years old.The positive rate of MG was higher among the patients aged less than 25 years old than among other age groups of patients(P＜0.005);the positive rate of MG was higher among the patients aged between 35 and 40 years old than among the patients aged between 30 and 35 years old(P＜0.005).The positive rate of CT was higher among the patients aged less than 25 years old than among all the age groups except for the 25 to 30 age group;the positive rate of CT of the patients aged no less than 40 years old was lower than that of the patients aged between 25 and 35 years old(P＜0.005).CONCLUSIONS UU is most common among the pathogens causing genital tract infections among the infertile patients.There are a variety of types of mixed infections.The female patients are more likely to have UU and CT infections,while the male patients are more likely to have NG infection.MG and CT infections shows a low-age trend.It is necessary to focus on the joint screening of multiple pathogens during the clinical diagnosis and treatment and strengthen the prevention and intervention to the susceptible population.

Objective:To explore the genetic basis of a patient suspected for Loeys-Dietz syndrome (LDS).Methods:An adult male patient with aneurysmal dilation of the aortic root identified during the treatment for chronic myeloid leukemia at Anzhen Hospital of Capital Medical University in 2021 was enrolled as the study subject. Clinical data of the patient were retrospectively collected. Peripheral blood samples were collected from the patient and his family members and subjected to whole-exome sequencing (WES). Candidate variant was verified by bioinformatic analysis, with a focus on the genes associated with hereditary aortic aneurysms. Candidate variant was validated by Sanger sequencing. The online SpliceAI software was used for the prediction of protein function. The results, combined with information from public databases, were used to classify the pathogenicity of the candidate variant according to the guidelines from the American College of Medical Genetics and Genomics (ACMG). This study was approved by the Ethics Committee of Beijing Anzhen Hospital (Ethics No. 2023163X).Results:Imaging analysis revealed that the patient had aneurysmal dilation of the aortic root. Based on his clinical features and past history, a provisional diagnosis of LDS was established. WES revealed that the patient had harbored a heterozygous splice site variant c. 206+ 2T>G in the SMAD3 gene (NM_005902). The variant was not reported in public databases and was predicted to be pathogenic by SpliceAI. Sanger sequencing showed that the variant was also present in the patients mother, sister, nephew, and daughter, but not in his father. Based on the guidelines from the ACMG, the variant was classified as likely pathogenic (PVS1+ PM2_Supporting). Conclusion:The heterozygous splice site variant c. 206+ 2T>G of the SMAD3 gene probably underlay the disease of this patient. The discovery has enriched the mutational spectrum of LDS, which may facilitate delineation of the genotype-phenotype correlation and provide a basis for further risk stratification and personalized treatment of LDS.

BACKGROUND:Currently,there have been studies on three-dimensional digitalization and visualization systems for adult acupoints,but there are not many reports on the visualization of pediatric acupoints based on real pediatric digital sectional anatomical datasets. OBJECTIVE:To design and develop a digital three-dimensional visualization system for children's neck acupoints,to provide a basis for acupuncture and moxibustion,meridian and acupoint science teaching,clinical practice,acupuncture manipulation practice,and acupuncture safety research,and to provide a basis for the development of children's acupoint simulation system. METHODS:Based on a real cross-sectional anatomical dataset of pre-school boys,a three-dimensional digital virtual anatomical model of the neck region of children and internal multi-organ three-dimensional reconstruction were completed using PhotoShop 2021 and Digihuman Reconstruction System software.A database of 11 acupoints was compiled,including Fengfu and Fengchi,using the Unity database language.A three-dimensional model of children's neck anatomy,acupoint database,and writing acupuncture operation codes were integrated in Unity3D software.A three-dimensional digital visualization system for children's neck acupoints was successfully created,which integrated simulation acupoint positioning,three-dimensional acupoint anatomy,acupuncture training,clinical teaching,and acupuncture safety research. RESULTS AND CONCLUSION:(1)This study was based on real child specimens.Manual layer by layer segmentation of cross-sectional images was used to ensure the accuracy of the three-dimensional model to the greatest extent possible.The 3D software Digihuman Reconstruction System was utilized to extract and save independent segmentation data.PhotoShop 2021 software was collaborated with to complete dozens of three-dimensional reconstruction anatomical models of the outer skin of the neck and its internal bone structure,cervical spinal cord,blood vessels and nerves,muscles,and ligaments in children.The basic morphology and overall contour integrity verification of each independent structure were completed in MeshLab software.The 3-material research 13.0 software was applied for final fine tuning and anatomical position confirmation,successfully simulating and restoring the true anatomical morphology of the neck of preschool children.(2)Based on and referring to the national standards of the People's Republic of China,a database of commonly used acupoints in children's neck region was collected and organized,including their names,meridians,positioning,local anatomy,needle insertion levels,acupuncture methods,acupuncture accidents and prevention,acupoint indications,and two-dimensional anatomical sectional images.(3)Unity3D software was employed to integrate the three-dimensional model of children's neck,acupuncture simulation operation,and acupoint database,and a three-dimensional digital children's neck acupoint acupuncture visualization system was successfully constructed.The system displayed information on children's neck acupoints,two-dimensional and three-dimensional anatomical structures,and achieved two-dimensional and three-dimensional acupuncture simulation functions and acupuncture safety research functions for children's neck acupoints.Based on the ultra-thin sectional anatomical dataset of real child specimens,the first three-dimensional digital and visualization system for acupoints in the neck region of children had been constructed.Compared with previous acupoint acupuncture systems,it is more in line with the anatomical and morphological development characteristics of Asian children and has high application value in the fields of acupuncture safety research,clinical teaching,and acupuncture simulation training.

To investigate the clinical symptoms and endoscopic features of rectal benign lymphoid polyps, a retrospective analysis was conducted on 15 consecutive cases (16 lesions) who underwent endoscopic resection at the First Affiliated Hospital of Shandong First Medical University between April 2015 and June 2023, with postoperative pathological confirmation of rectal benign lymphoid polyps. The results showed that among the 15 patients, 6 were male and 9 were female, with a mean age of 52.6 years. Colonoscopy was performed in 8 patients due to clinical symptoms, among whom 7 presented with abdominal pain. All 16 lesions were submucosal, including 14 solitary and 1 multiple. The lesions were located in the lower rectum ( n=10) and mid-rectum ( n=6), with a mean long diameter of 0.5 cm. Fourteen lesions exhibited regular shape as flat circles or hemispheres. The surface mucosa appeared normal or gray-white in 11 lesions, and varying degrees of capillary dilation were observed in 8 lesions, among which 2 exhibited prominent capillaries resembling a "wheel-shaped" pattern. Endoscopic ultrasonography (EUS) was performed in 10 lesions prior to endoscopic resection: 4 originated from the third layer, 3 from the second layer, and 3 from both the second and third layers. Five lesions appeared as homogeneous hypoechoic masses, 3 were hyperechoic, and 2 showed mixed echogenicity. Therefore, the clinical symptoms of rectal benign lymphoid polyps are non-specific. Endoscopically, the presence of "wheel-shaped" pattern of dilated capillaries may serve as a diagnostic clue. When EUS demonstrates hyperechoic or mixed echogenicity, it could aid in the differential diagnosis from rectal neuroendocrine neoplasms.

Objective:To explore the relationship between sperm DNA integrity, semen parameters, seminal plasma neutral α-glucosidase activity and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. Methods:The clinical data of 300 male infertile patients who underwent routine semen analysis in the Second Affiliated Hospital of Air Force Medical University from October 2023 to April 2024 and whose spouses received IVF/ICSI treatment were retrospectively analyzed. The results of sperm DNA integrity [sperm DNA fragmentation index (DFI)], semen parameters (sperm percentage, sperm density, sperm motility, normal morphology sperm rate) and seminal plasma neutral α-glucosidase activity at admission were recorded. According to their spouses′ IVF/ICSI outcomes, the 300 patients were divided into the successful pregnancy group (those with successful intrauterine pregnancy detected by ultrasound 30 days after transplantation) and the unsuccessful pregnancy group (those without successful intrauterine pregnancy detected by ultrasound 30 days after transplantation). The differences in sperm DNA integrity, semen parameters and seminal plasma neutral α-glucosidase activity at admission between the two groups were compared. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of sperm DNA integrity, semen parameters and seminal plasma neutral α-glucosidase activity in male infertile patients at admission for their spouses′ IVF/ICSI outcomes.Results:According to the IVF/ICSI outcomes of the spouses of male infertile patients, 169 cases (56.3%) had successful intrauterine pregnancy detected by ultrasound 30 days after transplantation; 131 cases (43.7%) had unsuccessful intrauterine pregnancy. At admission, there was no statistically significant difference in clinical data between the two groups (all P>0.05). The DFI and sperm density in the successful pregnancy group were lower than those in the unsuccessful pregnancy group, while the sperm percentage, sperm motility, normal morphology sperm rate and seminal plasma neutral α-glucosidase activity were higher than those in the unsuccessful pregnancy group (all P<0.05). The area under the ROC curve (AUC) values of single indicators including DFI, sperm percentage, sperm density, sperm motility, normal morphology sperm rate, and seminal plasma neutral α-glucosidase level in predicting the IVF/ICSI outcomes of spouses of male infertile patients were 0.719, 0.718, 0.812, 0.779, 0.769, and 0.736, respectively; the sensitivities were 70.42%, 77.46%, 69.01%, 70.42%, 69.01%, and 77.46%, respectively; the specificities were 66.38%, 55.02%, 81.22%, 73.80%, 77.29%, and 62.88%, respectively; the Youden indexes were 0.368, 0.325, 0.502, 0.442, 0.463, and 0.404, respectively; all differences were statistically significant (all P<0.05). Conclusions:Sperm DNA integrity, semen parameters and seminal plasma neutral α-glucosidase activity can assist in predicting IVF/ICSI outcomes, providing an important reference for the treatment outcomes of male infertile patients.