ObjectiveTo investigate the main risk factors for liver cirrhosis in chronic hepatitis B （CHB） patients with high metabolic risk， to establish a noninvasive predictive model， and to compare the diagnostic efficiency of this model and other models including fibrosis-4 （FIB-4）， aspartate aminotransferase-to-platelet ratio index （APRI）， gamma-glutamyl transpeptidase-to-platelet ratio （GPR）， and Forns index. MethodsA total of 527 CHB patients with high metabolic risks who were admitted to The Second Affiliated Hospital of Guangxi Medical University from September 1， 2017 to October 31， 2022 were enrolled as subjects， and they were randomly divided into modeling group with 368 patients and validation group with 159 patients at a ratio of 7∶3. The LASSO regression analysis and the multivariate Logistic regression analysis were performed for the modeling group to identify independent risk factors， and a nomogram model was established. The receiver operating characteristic （ROC） curve， the calibration curve， and the decision curve analysis were used to validate the nomogram prediction model in the modeling group and the validation group and assess its discriminatory ability， calibration， and clinical practicability. The Delong test was used to compare the area under the ROC curve （AUC） of the nomogram prediction model and other models. ResultsThe multivariate Logistic regression analysis showed that prealbumin （odds ratio ［OR］ = 0.993， 95% confidence interval ［CI］： 0.988 — 0.999， P= 0.019）， thrombin time （OR=1.182， 95% CI： 1.006 — 1.385， P=0.047）， log₁₀ total bilirubin （TBil） （OR=1.710， 95%CI： 1.239 — 2.419， P=0.001）， and log₁₀ alpha-fetoprotein （AFP） （OR=1.327， 95%CI： 1.052 — 1.683， P=0.018） were independent influencing factors for liver cirrhosis in CHB patients with high metabolic risks. A nomogram model for risk prediction was established based on the multivariate analysis， which had an AUC of 0.837 （95%CI： 0.788 — 0.888）， a specificity of 73.5%， and a sensitivity of 84.7%， as well as a significantly higher diagnostic efficiency than the models of FIB-4 （0.739）， APRI （0.802）， GPR （0.800）， and Forns index （0.709） （Z=2.815， 2.271， 1.989， and 2.722， P=0.005， 0.017， 0.045， and 0.006）. ConclusionThe nomogram model established based on prealbumin， thrombin time， log₁₀ TBil， and log₁₀ AFP has a certain clinical application value.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

Objective To investigate the protective effect of lipoic acid-niacin(N2L)on blue light-induced retinal in-jury in mice by regulating the nuclear factor-E2-related factor 2(Nrf2)signaling pathway.Methods Forty-eight male C57BL/6 mice were selected and randomly divided into a wild-type group(+)and an Nrf2 knockout group(-).Each group was further randomly subdivided into four parallel subgroups,with six mice in each.These subgroups were designat-ed as Con+,BL+,N2L+,NS+,Con-,BL-,N2L-,and NS-for corresponding treatments.Electroretinography(ERG)was performed to assess retinal function.TUNEL staining was used to detect photoreceptor cell apoptosis in the mouse retinal tissue.Western blot analysis was conducted to measure the expression levels of heme oxygenase-1(HO-1),B-cell lymphoma-2(Bcl-2),and Bcl-2-associated X proteins(Bax)in the mouse retinal tissue.Results Compared with those in the Con+group,the amplitudes of the ERG b-wave and the second peak(OS2)of mouse oscillatory potentials(OPs)in BL+,NS+,BL-,N2L-,and NS-groups were decreased significantly under medium-and high-intensity stim-ulating light(all P＜0.05).The cell apoptosis rate and the expression level of Bax proteins in BL+,NS+,BL-,N2L-,and NS-groups were significantly higher than those in the Con+group(all P＜0.05).Compared with those in the BL+group,the amplitudes of the ERG b-wave and OS2 of OPs were increased significantly under medium-and high-intensity stimulating light in N2L+and Con-groups(all P＜0.05).N2L+and Con-groups had a significantly lower cell apopto-sis rate than the BL+group(P＜0.05).BL-and NS-groups had a significantly higher cell apoptosis rate and significant-ly lower Bax levels than the BL+group(all P＜0.05).Compared with those in the N2L+group,the amplitudes of the ERG b-wave and OS2 of OPs were reduced significantly under medium-and high-intensity stimulating light in NS+,BL-,N2L-,and NS-groups(all P＜0.05).The cell apoptosis rate and Bax levels in NS+,BL-,N2L-,and NS-groups were significantly higher than those in the N2L+group(all P＜0.05).The Bax level in the Con-group was significantly lower than that in the N2L+group(P＜0.05).Compared with those in the NS+group,the amplitudes of the ERG b-wave and OS2 of OPs were increased significantly under medium-and high-intensity stimulating light in the Con-group(all P＜0.05).The cell apoptosis rate and Bax levels in the Con-group were significantly lower than those in the NS+group(P＜0.05).Compared with those in the Con-group,the amplitudes of the ERG b-wave and OS2 of OPs were decreased significantly under medium-and high-intensity stimulating light in BL-,N2L-,and NS-groups(all P＜0.05).BL-,N2L-,and NS-groups had a significantly higher cell apoptosis rate and Bax levels than the Con-group(all P＜0.05).HO-1 and Bcl-2 levels in BL+,N2L+,and NS+groups were significantly higher than those in the Con+group(all P＜0.05).Compared with those in the BL+group,HO-1 and Bcl-2 levels were increased significantly in the N2L+group and decreased significantly in Con-,BL-,N2L-,and NS-groups(all P＜0.05).HO-1 and Bcl-2 levels in NS+,Con-,BL-,N2L-,and NS-groups were significantly lower than those in the N2L+group(all P＜0.05).Con-,BL-,N2L-,and NS-groups showed significantly lower HO-1 and Bcl-2 levels than the NS+group(all P＜0.05).The N2L-group had significantly higher HO-1 and Bcl-2 levels than the Con-group(both P＜0.05).Conclusion N2L may antag-onize blue light-induced retinal damage in mice by activating the Nrf2 signaling pathway.

Objective To investigate the protective effect of lipoic acid-niacin(N2L)on blue light-induced retinal in-jury in mice by regulating the nuclear factor-E2-related factor 2(Nrf2)signaling pathway.Methods Forty-eight male C57BL/6 mice were selected and randomly divided into a wild-type group(+)and an Nrf2 knockout group(-).Each group was further randomly subdivided into four parallel subgroups,with six mice in each.These subgroups were designat-ed as Con+,BL+,N2L+,NS+,Con-,BL-,N2L-,and NS-for corresponding treatments.Electroretinography(ERG)was performed to assess retinal function.TUNEL staining was used to detect photoreceptor cell apoptosis in the mouse retinal tissue.Western blot analysis was conducted to measure the expression levels of heme oxygenase-1(HO-1),B-cell lymphoma-2(Bcl-2),and Bcl-2-associated X proteins(Bax)in the mouse retinal tissue.Results Compared with those in the Con+group,the amplitudes of the ERG b-wave and the second peak(OS2)of mouse oscillatory potentials(OPs)in BL+,NS+,BL-,N2L-,and NS-groups were decreased significantly under medium-and high-intensity stim-ulating light(all P＜0.05).The cell apoptosis rate and the expression level of Bax proteins in BL+,NS+,BL-,N2L-,and NS-groups were significantly higher than those in the Con+group(all P＜0.05).Compared with those in the BL+group,the amplitudes of the ERG b-wave and OS2 of OPs were increased significantly under medium-and high-intensity stimulating light in N2L+and Con-groups(all P＜0.05).N2L+and Con-groups had a significantly lower cell apopto-sis rate than the BL+group(P＜0.05).BL-and NS-groups had a significantly higher cell apoptosis rate and significant-ly lower Bax levels than the BL+group(all P＜0.05).Compared with those in the N2L+group,the amplitudes of the ERG b-wave and OS2 of OPs were reduced significantly under medium-and high-intensity stimulating light in NS+,BL-,N2L-,and NS-groups(all P＜0.05).The cell apoptosis rate and Bax levels in NS+,BL-,N2L-,and NS-groups were significantly higher than those in the N2L+group(all P＜0.05).The Bax level in the Con-group was significantly lower than that in the N2L+group(P＜0.05).Compared with those in the NS+group,the amplitudes of the ERG b-wave and OS2 of OPs were increased significantly under medium-and high-intensity stimulating light in the Con-group(all P＜0.05).The cell apoptosis rate and Bax levels in the Con-group were significantly lower than those in the NS+group(P＜0.05).Compared with those in the Con-group,the amplitudes of the ERG b-wave and OS2 of OPs were decreased significantly under medium-and high-intensity stimulating light in BL-,N2L-,and NS-groups(all P＜0.05).BL-,N2L-,and NS-groups had a significantly higher cell apoptosis rate and Bax levels than the Con-group(all P＜0.05).HO-1 and Bcl-2 levels in BL+,N2L+,and NS+groups were significantly higher than those in the Con+group(all P＜0.05).Compared with those in the BL+group,HO-1 and Bcl-2 levels were increased significantly in the N2L+group and decreased significantly in Con-,BL-,N2L-,and NS-groups(all P＜0.05).HO-1 and Bcl-2 levels in NS+,Con-,BL-,N2L-,and NS-groups were significantly lower than those in the N2L+group(all P＜0.05).Con-,BL-,N2L-,and NS-groups showed significantly lower HO-1 and Bcl-2 levels than the NS+group(all P＜0.05).The N2L-group had significantly higher HO-1 and Bcl-2 levels than the Con-group(both P＜0.05).Conclusion N2L may antag-onize blue light-induced retinal damage in mice by activating the Nrf2 signaling pathway.

As a physical treatment technique, modified electro-convulsive therapy (MECT) is used to treat mental and certain neurological disorders by causing seizures with short, suitable electrical currents applied to the brain while the patient is under general anesthesia and muscle relaxants. MECT is recognized for its therapeutic efficacy and clinical safety, rendering it one of the most prevalent interventions in psychiatric care. To enhance clinical outcomes and minimize adverse effects, this consensus document delineates the indications, therapeutic parameters, therapeutic procedures, potential adverse effects, and associated management strategies for MECT. These guidelines are informed by the latest clinical research and expert consensus, integrating evidence-based medicine methodologies. The objective is to furnish clinicians with precise operational guidelines and to advance the standardization of MECT practices in clinical settings.

Respiratory syncytial virus (RSV) is an enveloped, negative-sense, single-stranded RNA virus of the Orthopneumovirus  genus of the Pneumoviridae family in the order Mononegavirales. RSV can cause acute upper and lower respiratory tract infections, sometimes with extrapulmonary complications. The disease burden of RSV infection is enormous, mainly affecting infants and older adults aged 75 years or above. Currently, treatment options for RSV are largely supportive. Prevention strategies remain a critical focus, with efforts centered on vaccine development and the use of prophylactic monoclonal antibodies. To date, three RSV vaccines have been approved for active immunization among individuals aged 60 years and above. For children who are not eligible for these vaccines, passive immunization is recommended. A newly approved prophylactic monoclonal antibody, Nirsevimab, which offers enhanced neutralizing activity and an extended half-life, provides exceptional protection for high-risk infants and young children. This review provides a comprehensive and detailed exploration of RSV's virology, immunology, pathogenesis, epidemiology, clinical manifestations, treatment options, and prevention strategies.
Humans ; Respiratory Syncytial Virus Infections/prevention & control* ; Respiratory Syncytial Viruses/pathogenicity* ; Respiratory Syncytial Virus, Human/pathogenicity* ; Antiviral Agents/therapeutic use*

AIM: To investigate the preventive effect and optimal drug dose of lipoic acid-niacin(N2L)against blue light-induced retinal damage in SD rats, and to explore its possible protective mechanism.METHODS: A total of 36 specific pathogen free-grade male SD rats of 150-200 g were selected and randomly divided into normal control group, blue light injury group, N2L low-dose group(1.0 mg/kg), N2L medium-dose group(2.5 mg/kg), N2L high-dose group(5.0 mg/kg), and physiological saline group, with 6 rats in each group. The normal control group was reared in a 12 h dark and light cycle, and the rest of the groups received 9 h of daily light exposure, 3 h of blue light irradiation with a wavelength of 455 nm and an intensity of 3000±50 lx, and 12 h of darkness to establish the injury model, and were exposed to light exposure for 14 d. For 14 consecutive durations, a 1 mL dose of the corresponding drug was injected intraperitoneally. The rats were reared for another 5 d with a regular 12 h light-dark cycle and were examined by electroretinography. Specimens were prepared by over anesthesia, HE staining, and the thickness of the outer nuclear layer was observed under a optical microscope; superoxide dismutases(SOD)activity was detected by CheKineTM SOD Activity Assay Kit; and the retinal Caspase-3, quinone oxidoreductase 1(NQO1), glutathione S transferase(GST), Bcl-2, and Bax protein expression in rat retina were detected by Western blot.RESULTS: The amplitude of b-wave in dark-vision ERG 3.0 and 10.0(cd·s)/m2 stimulated light, b-wave in bright-vision ERG 3.0(cd·s)/m2 stimulated light, and the amplitude of the 2nd wave peak of oscillatory potential were significantly lower in blue light injury group than that in the normal control group(all P<0.01), while the amplitude was significantly higher in the N2L medium-dose group than in the blue light injury group(all P<0.05), and was not statistically different from that of the normal control group; the thickness of the retina in the blue light injury group was decreased in the ONL compared with that of the normal control group(P<0.001), while in the N2L medium dose group, it was thicker than that of the blue light injury group(P<0.001), and there was no statistically significant difference from the normal control group; SOD activity was significantly higher in the N2L medium-dose group than in the remaining 5 groups(P<0.05); the expression of Caspase-3, Bax, and NQO1 in the blue light injury group was higher than that of the normal control group(all P<0.01), and expression of Bax and Caspase-3 was significantly lower in the N2L medium-dose group compared with the blue light injury group(all P<0.001), whereas GST, NQO1 and Bcl-2 were significantly increased(all P<0.01).CONCLUSION:A concentration of 2.5 mg/kg N2L can effectively antagonize the damaging effect of blue light on the retina of SD rats, and it is expected to be a preventive and curative drug for it.

Objective To investigate the correlation between the proportion of peripheral blood follicular T helper cells(Tfh cells)and intracellular interleukin-21(IL-21)content with blue light retinal injury.Methods Brown Norway(BN)rats were randomly divided into 4 groups and were exposed to blue light for 3 hours a day to establish retinal light damage model.According to the duration of illumination,the rats was divided into 0 days(control group),3 days(3 d group),7 days(7 d group)and 14 days(14 d group).The proportion of Tfh cells and content of IL-21 in Tfh cells in peripheral blood of each group was detected by flow cytometry and ELISA sepa-rately after illumination.Electroretinogram(ERG)was used to evaluate retinal function.The changes of fundus in rats were observed by fundus photography.The thickness of outer nuclear layer of retina was analyzed by HE staining.Results After retinal blue light injury,with the extension of illumination time,the proportion of Tfh cells in peripheral blood and intracellular IL-21 content both increased(P<0.05).ERG showed that retinal function decreased after light damage and aggravated with the extension of illumination time,the latency and ampli-tudes of A-wave and B-wave increased and decreased respectively(P<0.05).The retinal fundus of rats showed depigmentation in 3 d,and the retinal vessels became thinner and exudate with the extension of illumination time.HE staining showed that the outer nuclear layer of retina(ONL)became thinner(P<0.05).Correlation analy-sis indicated that the proportion of Tfh cells in peripheral blood and the intracellular IL-21 content could jointly reflect the degree of injury(P<0.000 1),and the proportion of Tfh cells in peripheral blood was negatively corre-lated with ONL thickness and the amplitude of a and b waves,positively correlated with the peak time of a and b waves,(P<0.0001).Conclusion The proportion of Tfh cells in peripheral blood and the intracellular IL-21 content were increased after blue light damage to retina,and were significantly increased with the extension of light time with a certain correlation.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

OBJECTIVE: To explore the genetic etiology of a patient with epilepsy and provide genetic counseling. METHODS: A patient who had visited the Center for Reproductive Medicine of Shandong University on November 11, 2020 was selected as the study subject, and her clinic information was collected. Candidate variant was identified through whole exome sequencing (WES), and Sanger sequencing was used for validation. Possible transcriptional changes caused by the variant was detected by reverse transcription-PCR and Sanger sequencing. RESULTS: The patient was a 35-year-old female with no fever at the onset, loss of consciousness and abnormal firing in the temporal lobe, manifesting predominantly as convulsions and fainting. WES revealed that she had harbored a heterozygous c.2841+5G>A variant of the SCN9A gene, which was verified by Sanger sequencing. cDNA sequencing confirmed that 154 bases were inserted between exons 16 and 17 of the SCN9A gene, which probably produced a truncated protein and affected the normal function of the SCN9A protein. Based on the guidelines from the American College of Medical Genetics and Genomics, the c.2841+5G>A variant was classified as likely pathogenic (PVS1_Strong+PM2_Supporting). CONCLUSION The c.2841+5G>A variant of the SCN9A gene probably underlay the epilepsy in this patient. Above finding has enriched the variant spectrum of the SCN9A gene and provided a basis for the prenatal diagnosis and preimplantation genetic testing for this patient.
Humans ; Female ; Pregnancy ; Adult ; Epilepsy/genetics* ; Seizures ; Exons ; DNA, Complementary ; Genetic Counseling ; NAV1.7 Voltage-Gated Sodium Channel