BackgroundAdverse childhood experiences （ACEs） are strong predictors of psychopathology across the lifespan， exerting extensive adverse effects on physical and mental health during early development. While ACEs increase the risk of childhood psychopathology， sleep quality and impair cognitive function， the early neurobiological mechanisms mediating ACE-induced cognitive impairment remain unclear. ObjectiveTo explore the association between ACEs exposure and the risk of psychopathology， sleep disorders， and cognitive function， and to examine the mediating role of the putamen volume in the relationship between ACEs and cognitive function from a neurodevelopment perspective. MethodsData were obtained from the Adolescent Brain Cognitive Development （ABCD） study， comprising 10 572 children aged 9 to 10. Participants were categorized into five groups based on the cumulative score of ACEs reported by their parents and the children themselves： no-exposure group （0 types of ACEs）， the one-exposure group， the two-exposure group， the three-exposure group， and the high-risk exposure group （≥ 4 types of ACEs）. Logistic regression analysis was employed to evaluate the association between ACEs and psychopathological symptoms ［T score of the Child Behavior Checklist （CBCL） ≥ 65］. Multiple linear regression analysis was ultilized to analyze the correlations between ACEs and the scores of the Sleep Disturbance Scale for Children （SDSC）， the NIH Toolbox Cognition Battery （NIHTB-CB）， as well as the multiple structures in the cerebral cortex and subcortex. The Bootstrap method was applied to test the mediating effect of the putamen volume between ACEs and neurocognitive function. ResultsAfter adjusting for confounders， ACEs cumulative score was correlated with children's psychopathological symptoms in a dose-response manner. Compared with the no-exposed group， the high-risk exposure group had a 2.08-fold （OR=2.080， 95% CI： 1.401–3.088） increased risk of internalizing problems and a 3.13-fold （OR=3.132， 95% CI： 1.703–5.760） increased risk of externalizing problems， and the risk of conduct problems was 4.68 times that of the no-exposed group （OR=4.681， 95% CI： 2.528–8.669）. ACEs cumulative score positively predicted the total score of SDSC （β=0.080， 95% CI： 0.059–0.102）， with relatively stronger predictive effects on sleep-wake transition disorder （β=0.086， 95% CI： 0.063–0.109） and sleep onset and maintenance disorder （β=0.066， 95% CI： 0.043–0.089）. In terms of neurocognition and brain structure， ACEs cumulative score negatively predicted the overall cognitive composite score （β=-0.025， 95% CI： -0.050–-0.001）， the crystallized cognitive composite score （β=-0.035， 95% CI： -0.060–-0.010）， the volume of the left putamen nucleus （β=-0.025， 95% CI： -0.046– 0.003）， and the volume of the right putamen nucleus （β=-0.023， 95% CI： -0.044– 0.003）. The total putamen volume played a partial mediating role between ACEs and the overall cognitive composite score， the effect value was -0.002 （95% CI： -0.004–-0.001）， accounting for 7.49% of the total effect. ConclusionACEs exposure may increase the risk of psychopathological and sleep disturbances in children and may impair neurocognitive function. Reduced putamen volume may serve a potential neurobiological pathway underlying the impact of ACEs on childhood cognition. ［Funded by National Natural Science Foundation of China-Young Scientists Program （number， 82401763）； Sichuan University West China Hospital Full-time Postdoctoral Research and Development Fund Project （number， 2023HXBH084）］

A 15-year-old boy developed abdominal pain and melena two weeks after COVID-19 infection, which was followed by gross hematuria and proteinuria. Laboratory studies revealed significantly elevated inflammatory markers. Endoscopic examinations showed multiple jejunal and ileal ulcers. Renal biopsy suggested mesangial proliferative glomerulonephritis with crescent formation, necrosis of capillary loops, and mesangial IgA deposits. IgA vasculitis without purpura was considered as a possible diagnosis, and the treatment with prednisone led to remission of both gastrointestinal and renal diseases.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

A 15-year-old boy developed abdominal pain and melena two weeks after COVID-19 infection, which was followed by gross hematuria and proteinuria. Laboratory studies revealed significantly elevated inflammatory markers. Endoscopic examinations showed multiple jejunal and ileal ulcers. Renal biopsy suggested mesangial proliferative glomerulonephritis with crescent formation, necrosis of capillary loops, and mesangial IgA deposits. IgA vasculitis without purpura was considered as a possible diagnosis, and the treatment with prednisone led to remission of both gastrointestinal and renal diseases.

A 65-year-old male patient was admitted for recurrent lymph node enlargement for 5 years and elevated creatinine for 6 months. This patient was diagnosed with angioimmunoblastic T-cell lymphoma 5 years ago and underwent multiple lines of anti-tumor therapy, including cytotoxic chemotherapy; epigenetic modifying drugs such as chidamide and azacitidine; the immunomodulator lenalidomide; and targeted therapy such as rituximab, a CD20-targeting antibody, and brentuximab vedotin, which targets CD30. Although the tumor was considered stable, multiple virus activation (including BK virus, JC virus, and cytomegalovirus) accompanied by the corresponding organ damage (polyomavirus nephropathy, cytomegalovirus retinitis, and progressive multifocal leukoencephalopathy) occurred during anti-tumor treatment. Anti-tumor therapy was suspended and ganciclovir was used. The serum viral load decreased and organ functions were stabilized. The purpose of this report was to raise clinicians′ awareness of opportunistic virus reactivation during anti-tumor treatment.

Objective To investigate the effects of sodium-glucose cotransporter 2 inhibitor combined with Lepidium seed on cardiac,digestive,and pulmonary function in patients with heart failure complicated by pulmonary infection.Methods A total of 168 patients with heart failure and lung infection admitted to Zigui County Hospital of Traditional Chinese Medicine from August 2017 to March 2019 were selected as the research objects.They were divided into observation group and control group according to different treatment methods(84 patients per group).The control group received sodium-glucose cotransporter 2 inhibitor combined with ceftazidime,while the observation group was treated with Lepidium seed on the basis of control group for 30 days.Nutritional status[prealbumin(PA),albumin(ALB),red blood cell count(RBC),body mass index(BMI)],immune function[cytoplasmic domains(CD3,CD4,CD8),immunoglobulins(IgG,IgM)],inflammatory cytokines[interleukins(IL-8,IL-10,IL-17),tumor necrosis factor-α(TNF-α)],intestinal flora(Enterococcus,Escherichia coli,Lactobacillus,Bifidobacterium,Saccharomycetes,Digestion),and cardiopulmonary function[arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),heart rate(HR),maximum oxygen consumption(VO2max),maximum exercise load(Wmax),maximum oxygen pulse,anaerobic threshold(AT),forced expiratory volume in one second/forced lung volume ratio(FEV1/FVC),FEV1 and maximal voluntary ventilation(MVV)]were compared between the two groups before and after treatment.Results After treatment,PA,ALB,RBC,BMI,CD3,CD4,CD8,IgG and IgM,Lactobacillus,Bifidobacterium,PaO2,VO2max,Wmax,maximum oxygen pulse,AT,FEV1/FVC,FEV1,MVV all increased significantly compared to before treatment.IL-8,IL-17,TNF-α,Enterococcus,Escherichia coli,PaCO2,and heart rate were significantly reduced compared to before treatment.The levels of PA,ALB,RBC,BMI,CD3,IgG,IgM,IL-10,Bifidobacterium,Lactobacillus,PaO2,VO2max,Wmax,maximum oxygen pulse,AT,FEV1/FVC,FEV1,and MVV in the observation group were significantly higher than those in the control group after treatment[PA(mg/L):259.69±20.73 vs.217.69±20.73,ALB(g/L):41.46±4.58 vs.36.56±3.73,RBC(×1012/L):4.52±0.24 vs.4.21±0.31,BMI(kg/m2):22.37±2.73 vs.19.66±2.24,CD3:0.63±0.08 vs.0.56±0.08,IgG(g/L):21.85±3.68 vs.15.72±4.36,IgM(g/L):4.68±1.68 vs.3.73±1.67,IL-10(ng/L):65.28±7.23 vs.50.23±6.14,Bifidobacterium(CFU/kg):83.5±8.6 vs.78.5±8.3,Lactobacillus(CFU/kg):62.1±6.5 vs.53.5±6.0,PaO2(mmHg,1 mmHg≈0.133 kPa):98.36±1.75 vs.91.95±2.95,VO2max(L/min):1.71±0.35 vs.1.22±0.39,Wmax(W):127.49±19.54 vs.97.49±15.37,maximum oxygen pulse(L/time):11.27±2.42 vs.9.46±2.79,AT:(50.49±7.48)%vs.(41.35±6.67)%,FEV1/FVC:(75.68±5.86)%vs.(65.48±8.54)%,FEV1:(82.44±5.73)%vs.(73.57±7.75)%,MVV(L/min):74.86±10.64 vs.64.63±9.68,all P<0.05].CD4,CD8,IL-8,IL-17,TNF-α.Enterococcus,Escherichia coli,PaCO2,and heart rate levels were significantly lower than those in the control group[CD4:0.32±0.06 vs.0.39±0.05,CD8:0.28±0.06 vs.0.34±0.05,IL-8(ng/L):16.64±2.63 vs.26.35±4.13,IL-17(ng/L):112.38±30.16 vs.207.75±42.23,TNF-α(ng/L):45.27±10.23 vs.61.26±14.29,Enterococcus(CFU/kg):63.6±5.6 vs.69.5±6.8,Escherichia coli(CFU/kg):65.8±6.4 vs.70.5±7.0,PaCO2(mmHg):41.84±4.45 vs.56.18±5.37,heart rate(bpm):75.96±11.57 vs.91.57±12.68,all P<0.05].Conclusions Treatment with Lepidium seed combined with sodium-glucose cotransporter 2 inhibitor improved cardiopulmonary function,reduced inflammation,enhanced nutrition,and normalized gut flora in heart failure patients with lung infections.Our findings support integrating this combination into clinical guidelines for optimized management of these critically ill patients.

Objective:To investigate the effect of highly active antiretroviral therapy(HAART) on thyroid function in adult patients with acquired immunodeficiency syndrome(AIDS).Methods:A cross-sectional retrospective study was conducted on 1 276 AIDS patients hospitalized in the Department of Infection, Guangzhou Eighth People′s Hospital from June 2017 to May 2020. General data, the first laboratory examination on admission, thyroid function, and related antibodies were collected and analyzed. A total of 176 patients were included in the study and divided into HAART group( n=83) and no-HAART group( n=93) according to whether they received HAART treatment. Results:Among 176 AIDS patients, the rate of thyroid dysfunction was 53.98%. It was significantly lower in the HAART group, compared with no-HAART group(40.96% vs 65.59%), with a statistically significant difference ( P=0.001). The course of AIDS, body mass index, CD4 + T lymphocyte count, free triiodothyronine, and serum creatinine in HAART group were significantly higher than those in no-HAART group, and aspartate aminotransferase was significantly lower than those in no-HAART group, with statistical significance(all P<0.05). There was no significant difference in age, sex, smoking history, free thyroxine, thyroid stimulating hormone, thyroid peroxidase antibody, thyroglobulin antibodies, and alanine aminotransferase between HAART group and no-HAART group(all P>0.05). The prevalence of low T 3 syndrome in HAART group was significantly lower than that in no-HAART group(14.46% vs 39.78%), and the difference was statistically significant( P<0.001). There was no significant difference in the prevalence of hyperthyroidism, hypothyroidism, and isolated low T 4 between HAART group and No-HAART group(all P>0.05). Multivariate logistics regression analysis showed that HAART was an independent protective factor for thyroid dysfunction and isolated low T 4 in AIDS patients. Conclusions:Thyroid dysfunction is a common endocrine disorder in AIDS patients that requires attention from infectious disease specialists. HAART therapy serves as a protective factor against thyroid dysfunction. Thyroid dysfunction mainly manifests as low T3 syndrome and requires continuous monitoring of thyroid function changes.

A 31-year-old man sought medical evaluation for a 2-year history of edema and proteinuria, with prior pathology suggesting atypical membranous nephropathy (MN). Despite treatment with a combination of steroids, calcineurin inhibitors, and four courses of rituximab (1 g, intravenous injection), the patient′s nephrotic syndrome showed no relief (24 h urine protein peaked at 31.18 g/d), indicating refractory nephrotic syndrome. Later in the disease course, a sudden surge of creatinine level (322.5 μmol/L) prompted a renal biopsy, which revealed concurrent acute interstitial nephritis. Further treatment involving steroids, cyclophosphamide, and a fifth rituximab infusion (1 g, intravenous injection) resulted in improvement in renal function (serum creatinine: 322.5?147 μmol/L), but the MN failed to achieve partial relief. Subsequent treatment with the novel humanized CD20 monoclonal antibody obinutuzumab (1 g, intravenous injection) was initiated. In the latest follow-up, anti-phospholipase-A2-receptor antibody (PLA2R) antibody were negative, B cells were eliminated, serum albumin was 36 g/L, urine protein-to-creatinine ratio was 4 810 mg/g, and serum creatinine was 162 μmol/L. This case underscores the potential efficacy of obinutuzumab in refractory MN. For advanced MN cases, prompt identification of the cause of acute kidney injury is crucial, emphasizing the need for targeted interventions to potentially stall renal function decline.

A 67-year-old female patient with lymph node metastasis from lung adenocarcinoma received the treatment of chemotherapy, immunotherapy, and targeted therapy (cisplatin, pemetrexed, pembrolizumab, and lenvatinib) at the same time. After the end of the third cycle of treatment, the patient developed elevated blood pressure (160/100 mmHg), blood creatinine increase (from 90 μmol/L to 160 μmol/L), anemia (hemoglobin 90 g/L), and metabolic acidosis (total carbon dioxide 18 mmol/L). Renal histopathological examination showed tubulointerstitial damage. Excluding kidney injury caused by other drugs, it was considered to be the immune adverse reaction caused by pembrolizumab. The drug was discontinued and hormone, antihypertensive, and symptomatic treatments were given. After 5 months, the patient′s blood pressure was 110-120/70-80 mmHg, serum creatinine decreased to 130 μmol/L, hemoglobin was 117 g/L, and total carbon dioxide was 26 mmol/L.

Primary biliary cirrhosis/cholangitis is an autoimmune disease. Renal tubular acidosis is a common form in PBC cases, but Fanconi syndrome is rarely reported. The paper reported a 66-year-old female patient with fatigue, renal insufficiency and elevated bile duct enzymes. The patient presented with type 2 proximal renal tubular acidosis and complete Fanconi syndrome. Laboratory examinations showed high-titer-positive anti-mitochondrial antibodies, elevated serum IgM, and type 3 cryoglobulinemia. Renal biopsy revealed interstitial nephritis, and electron micrographs showed abnormal mitochondria in proximal tubular epithelial cells. The patient's renal function ameliorated, and acid-base imbalance and electrolyte disturbances were corrected after high-dose glucocorticoid treatment.