Acute lung injury(ALI)is a common critical illness caused by intrapulmonary or extra-pulmonary factors,which is accompanied by ex-tremely high morbidity and mortality.Its pathogen-esis is extremely complex and difficult to treat.Src homology 2 domain-containing protein tyrosine phosphatase(Shp2),a key cellular signal transduc-tion molecule,plays a pivotal role in the pathophys-iological processes of diverse diseases.Notably,in the context of pathogen infection,Shp2 regulates the functionality of cellular immunity,lung epitheli-al cells,and vascular endothelial cells.This review article highlights the significant role of Shp2 in the onset and progression of ALI,emphasizing its regu-lation of inflammatory response,apoptosis,and ox-idative stress.Shp2 could emerge as a novel thera-peutic target for ALI,offering valuable insights for the development of innovative drug candidates to treat this debilitating condition.

Acute lung injury(ALI)is a common critical illness caused by intrapulmonary or extra-pulmonary factors,which is accompanied by ex-tremely high morbidity and mortality.Its pathogen-esis is extremely complex and difficult to treat.Src homology 2 domain-containing protein tyrosine phosphatase(Shp2),a key cellular signal transduc-tion molecule,plays a pivotal role in the pathophys-iological processes of diverse diseases.Notably,in the context of pathogen infection,Shp2 regulates the functionality of cellular immunity,lung epitheli-al cells,and vascular endothelial cells.This review article highlights the significant role of Shp2 in the onset and progression of ALI,emphasizing its regu-lation of inflammatory response,apoptosis,and ox-idative stress.Shp2 could emerge as a novel thera-peutic target for ALI,offering valuable insights for the development of innovative drug candidates to treat this debilitating condition.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective To systematically retrieve and integrate the best evidence of enteral and parenteral nutrition support in adult patients with severe bums.Methods 2 nursing master students who had studied evidence-based nursing systematically searched the clinical decisions,recommended practices,guidelines,expert consensuses,systematic reviews,evidence summaries and other evidences on enteral and parenteral nutrition support for adult patients with severe bums in domestic and foreign guideline networks,relevant institutional websites and databases.The retrieval time was from the establishment of the databases to April 2023.2 researchers who had obtained master's degrees and undergone systematic evidence-based training in Fudan University used the appraisal of guidelines for research and evaluation n and JBI critical appraisal tools to evaluate the methodological quality,and extracted and summarized the evidence according to the theme.Results A total of 28 articles were included,including l clinical decision,9 guidelines,3 expert consensuses,9 systematic reviews,and 6 evidence summaries.A total of 20 pieces of evidence were summarized from 6 aspects:nutritional risk screening and assessment,energy requirement calculation,timing and route of nutritional support,nutrient intake,nutritional support monitoring and effect evaluation.Conclusion The best evidence of enteral and parenteral nutrition support for adult patients with severe burns summarized in this study is more comprehensive and scientific.It is suggested that in clinical application,targeted screening should be carried out according to the promotion and hindering factors of evidence,so as to scientifically carry out nutritional support for adult patients with severe burns.

Objective:To evaluate the feasibility and safety of laparoscopic surgery of hiatal hernia with gastric volvulus.Methods:A retrospective study was conducted to analyze the clinical data of 29 cases of hiatal hernia with gastric volvulus undergoing laparoscopic mesh repair and fundoplication at Beijing Chao-Yang Hospital from Jun 2021 to Dec 2022. Fundoplication was performed according to esophageal motility. The general data, operation times, intraoperative blood loss, percentage of intrathoracic stomach, hernia and gastric volvulus classification, conversion to open surgery, post-operative hospital stay and complications, symptom improvement rate, post-operative satisfaction were analyzed.Results:Chronic obstruction symptoms were the most common complaint among the 29 patients. All the operations were done laparoscopicaly with no conversion case,19(65%) cases with type Ⅲ hiatal hernia, 20(70%)　cases with organoaxial gastric volvulus, average operating time was (110.2±33.3)min, average blood loss was (12.6±7.0)ml, percentage of intrathoracic stomach 75.9%±15.8%, length of hernia defect was (6.6±1.2)cm, width of hernia defect was (5.0±1.1)cm .Average post-operative hospital stay was (6.4±1.7) days, perioperative complications were pneumonia(7%) ,atelectasis(7%) and gastric motility disorder(3%). All the patients were followed up for 15 to 32 months, without report of patch infection, long-term chronic pain, intestinal obstruction and hernia recurrence. Postoperative symptom improvement rate was 90%,postoperative satisfaction rate was 90%.Conclusion:Laparoscopic surgery of hiatal hernia with gastric volvulus is a safe, feasible and effective method with satisfactory results.

Objective:To analyze the clinical phenotype and genetic characteristics of probands in 3 pedigrees of complex hereditary spastic paraplegia type 5 (HSP5) who developed symptoms during childhood, and the genetic diagnostic methods of HSP5 to improve the diagnosis and differential diagnosis of this disease.Methods:The clinical data of 3 HSP5 families admitted to Henan Provincial People′s Hospital from June 2020 to January 2023 were collected. Whole exome sequencing (WES) was performed on the patients to analyze phenotype-related single nucleotide variation (SNV) and small fragment insertion/deletion (INDEL) variation. At the same time, the sequencing data were used to analyze the dynamic mutation regions of specific genes.Results:The probands in the 3 families had complex HSP: the proband in family 1 showed weakness of both lower limbs, urgency of urination and ataxia; the proband in family 2 showed slightly lower intelligence, weakness of both lower limbs, dysarthria, and brain magnetic resonance imaging showed white matter lesions; the proband in family 3 showed muscle weakness, spasm, frequent urination and ataxia of both lower limbs. The sequencing results showed that the CYP7B1 gene c.1171G>T (paternal) and c.1249C>T (maternal) compound heterozygous mutations were found in proband 1 and his younger brother. The CYP7B1 gene c.334C>T (paternal) and c.259+2T>C (maternal) compound heterozygous mutations were found in proband 2 and her younger sister. The CYP7B1 gene c.334C>T (paternal) and c.1082G>A (maternal) compound heterozygous mutations were found in proband 3. And c.1171G>T was a new variant that had not been reported before. Dynamic mutation analysis showed that the numbers of CAG repeats of ATXN1/2/3/6/7/8/12, DRPLA, TBP genes were within the normal range. According to the clinical manifestations and genetic examination results of the children in the 3 pedigrees, the diagnosis of HSP5 was clear. Conclusions:The 3 families in the study all had complex HSP5 caused by compound heterozygous mutations of the CYP7B1 gene. WES can analyze SNV, INDEL and dynamic mutations simultaneously to make the maximum clear diagnosis and can be used as an effective detection method for HSP5.

Objective To investigate the satisfaction degree among medical interns with the effect of infectious diseases online teaching.Methods A questionnaire survey was conducted among 172 interns from a 5-year clinical medicine program who were doing internship with infectious diseases in the Third Affiliated Hospital of Sun Yat-Sen University in the spring and fall semesters of 2022.The survey aimed to investigate the advantages and disadvantages of online teaching for medical interns com-pared with traditional offline teaching.Results In terms of the advantages,online internship online teaching saved commuting time among 95.4％(164/172)of the students,enhanced self-management ability among 41.9％(72/172)of the students,en-riched teaching elements among 71.5％(123/172),promoted reviewing and consolidation of clinical knowledge among 38.4％(66/172)of the students.As regarding the disadvantages,online internship decreased clinical situational experience among 83.7％(144/172)students,reduced teaching-student interactions among 76.2％(131/172)of the students,decreased learn-ing efficiency among 51.7％(89/172)of the students and lowered quality of learning among 59.3％(102/172)of the students due to frequent network inefficiency.For prospection,37.8％(65/172)of the students expressed their wish to resume the tradi-tional offline teaching model continue and 57.6％(99/172)of them suggested that the combination of online and offline teaching mode should be adopt.Conclusion The inevitability and possibility of online internship of infectious diseases are gradually in-creasing.Compared with offline internships in infectious disease,students welcome a hybrid model of internships that combines online and offline models.

Objective:To investigate the quality of life (QoL) and its related influencing factors of patients undergoing laparoscopic hiatal hernia repair (LHHR).Methods:The retrospec-tive cohort study was conducted. The clinical data of 215 patients undergoing LHHR in Beijing Chaoyang Hospital of Capital Medical University from August 2020 to April 2022 were collected. There were 90 males and 125 females, aged (62±14)years. All patients underwent symptom scoring and quality of life assessment 6 months after LHHR. Measurement data with normal distribution were represented as Mean± SD, and comparison before and after operation within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M(range). Stepwise linear regression analysis was used for influencing factors analysis. Optimal model was selected based on Akaike information criterion. Results:(1) Treatment. Of 215 patients, 162 cases underwent LHHR+gastric fundus folding surgery (Dor surgery), and 53 cases underwent LHHR+reconstruction of HIS angle. The score of visual analogue scale (VAS) of heartburn symptoms in 215 patients 6 months after surgery was 0(range, 0-4), with the score of VAS of acid reflux symptoms was 0(range, 0-9), the score of VAS of belching symptoms was 0(range, 0-9), the score of VAS of chest pain symptoms was 0(range, 0-9), the score of VAS of early satiety symptoms was 0(range, 0-9), respectively. (2) Assessment of QoL before and after surgery. The score of MOS item short from health survey (SF-36) of physiological function in 215 patients before and after LHHR was 80±24 and 87±18, with the score of SF-36 of physiological functionality before and after LHHR was 49±45 and 68±38, the score of SF-36 of body pain before and after LHHR was 65±23 and 74±19, the score of SF-36 of general health condition before and after LHHR was 46±7 and 51±9, the score of SF-36 of vigour before and after LHHR was 67±19 and 75±17, the score of SF-36 of social function before and after LHHR was 71±24 and 81±18, the score of SF-36 of emotional function before and after LHHR was 60±45 and 77±33, the score of SF-36 of emotional health before and after LHHR was 68±19 and 76±17, the score of SF-36 of health change before and after LHHR was 33±19 and 57±28. There were significant differences in the above indicators before and after surgery ( t=-7.82, -8.73, -8.20, -10.08, -9.75, -8.83, -8.00, -9.88, -12.95, P<0.05). (3) Factors influencing physical compo-nent summary (PCS) and mental component summary (MCS) 6 months after LHHR. Results of multi-variate analysis showed that gender, age, mental disease, cerebral infarction, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery were independent factors influencing PCS 6 months after LHHR ( P<0.05), and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery were independent factors influencing MCS 6 months after LHHR ( P<0.05). Conclusions:LHHR can improve patients′ QoL. Gender, age, mental disease, cerebral infarc-tion, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery are independent factors influencing PCS 6 months after LHHR, and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery are independent factors influencing MCS 6 months after LHHR.

Objective:To investigate the quality of life (QoL) and its related influencing factors of patients undergoing laparoscopic hiatal hernia repair (LHHR).Methods:The retrospec-tive cohort study was conducted. The clinical data of 215 patients undergoing LHHR in Beijing Chaoyang Hospital of Capital Medical University from August 2020 to April 2022 were collected. There were 90 males and 125 females, aged (62±14)years. All patients underwent symptom scoring and quality of life assessment 6 months after LHHR. Measurement data with normal distribution were represented as Mean± SD, and comparison before and after operation within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M(range). Stepwise linear regression analysis was used for influencing factors analysis. Optimal model was selected based on Akaike information criterion. Results:(1) Treatment. Of 215 patients, 162 cases underwent LHHR+gastric fundus folding surgery (Dor surgery), and 53 cases underwent LHHR+reconstruction of HIS angle. The score of visual analogue scale (VAS) of heartburn symptoms in 215 patients 6 months after surgery was 0(range, 0-4), with the score of VAS of acid reflux symptoms was 0(range, 0-9), the score of VAS of belching symptoms was 0(range, 0-9), the score of VAS of chest pain symptoms was 0(range, 0-9), the score of VAS of early satiety symptoms was 0(range, 0-9), respectively. (2) Assessment of QoL before and after surgery. The score of MOS item short from health survey (SF-36) of physiological function in 215 patients before and after LHHR was 80±24 and 87±18, with the score of SF-36 of physiological functionality before and after LHHR was 49±45 and 68±38, the score of SF-36 of body pain before and after LHHR was 65±23 and 74±19, the score of SF-36 of general health condition before and after LHHR was 46±7 and 51±9, the score of SF-36 of vigour before and after LHHR was 67±19 and 75±17, the score of SF-36 of social function before and after LHHR was 71±24 and 81±18, the score of SF-36 of emotional function before and after LHHR was 60±45 and 77±33, the score of SF-36 of emotional health before and after LHHR was 68±19 and 76±17, the score of SF-36 of health change before and after LHHR was 33±19 and 57±28. There were significant differences in the above indicators before and after surgery ( t=-7.82, -8.73, -8.20, -10.08, -9.75, -8.83, -8.00, -9.88, -12.95, P<0.05). (3) Factors influencing physical compo-nent summary (PCS) and mental component summary (MCS) 6 months after LHHR. Results of multi-variate analysis showed that gender, age, mental disease, cerebral infarction, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery were independent factors influencing PCS 6 months after LHHR ( P<0.05), and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery were independent factors influencing MCS 6 months after LHHR ( P<0.05). Conclusions:LHHR can improve patients′ QoL. Gender, age, mental disease, cerebral infarc-tion, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery are independent factors influencing PCS 6 months after LHHR, and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery are independent factors influencing MCS 6 months after LHHR.