Climate change is altering the Earth's water cycle system. The resulting three extreme weather events—heatwaves, droughts, and extreme precipitation—impacts urban and rural water security through multi-layered mechanisms. A primary structural disparity exists between urban and rural systems: while urban areas benefit from comprehensive and standardized pipe networks that ensure terminal water quality, rural areas often suffer from "last mile" vulnerability due to inadequate infrastructure and outdated purification facilities. Extreme weather can directly alter the microbial community structure, concentrations of chemical pollutants and physicochemical properties of source water. These alterations interfere with the efficiency of water treatment processes and ultimately compromise the integrity of distribution systems. Because distribution networks often lack real-time monitoring and adaptive response capabilities, they have emerged as the most vulnerable link in the "water source-water treatment-distribution system" chain. Based on a systematic analysis of these chain-wide impacts, this paper proposed a series of control strategies, including security frameworks based on multi-model coupling and water source protection measures, improvement of water treatment technologies, optimization of distribution systems, and development of new water quality monitoring methods. These strategies aim to enhance the climate adaptability of urban and rural drinking water systems through multi-dimensional intervention, providing a theoretical basis for constructing climate-resilient water infrastructure.

OBJECTIVE: To explore the clinical characteristics and genetic etiology of a child with Neurofibromatosis-Noonan syndrome (NFNS). METHODS: A child with NFNS who was treated at the Department of Endocrinology of Hangzhou Children's Hospital in January 2024 was selected as the study subject. Clinical data of the child was collected by retrospective analysis. Peripheral venous blood samples (2 mL each) were collected from the child and his parents. Genomic DNA was extracted, and trio-whole exome sequencing (Trio-WES) of the family was carried out. Sanger sequencing was used to perform family verification on the candidate variants. The identified variants were classified for pathogenicity according to the Standards and Guidelines for the Interpretation of Sequence Variants established by the American College of Medical Genetics and Genomics (ACMG) (hereafter referred to as the "ACMG guidelines"). This study has been approved by the Medical Ethics Committee of Hangzhou Children's Hospital (Ethics No. 2021-06). RESULTS: The child was a 7-year and 4-month-old male. He has short stature, numerous café-au-lait spots on the neck and trunk, and special facial features such as a full forehead, wide interpupillary distance, a low nasal bridge, and low-set ears. The results of Trio-WES showed that the he had harbored the NF1 gene c.3773G>T (p.W1258L) mutation, which was verified by Sanger sequencing to be de novo in origin. The NF1 gene was associated with NFNS, which has an autosomal dominant inheritance. According to the ACMG guidelines, this variant was judged to be a likely pathogenic variant (PS2+PM2+PP3+PP2). No pathogenic variant in genes associated with Noonan syndrome, such as PTPN11, SOS1, RAF1, RIT1, and KRAS, was found. CONCLUSION The child with NFNS has clinical features such as short stature, special facial features, and café-au-lait spots. The c.3773G>T (p.W1258L) variation in the NF1 gene may be the genetic etiology of the NFNS child in this study. The results of this study has enriched the variation spectrum of the NF1 gene.
Child ; Humans ; Male ; Exome Sequencing ; Mutation ; Neurofibromatosis 1/genetics* ; Neurofibromin 1/genetics* ; Noonan Syndrome/genetics*

Objective:To explore the values of electroencephalogram (EEG) combined with glial fibrillary acidic protein (GFAP) in the early diagnosis and prognosis evaluation of viral encephalitis (VE).Methods:A total of 63 patients with VE admitted to the Hangzhou Seventh People′s Hospital from January 2016 to December 2019 were selected as the observation group. In addition, 80 healthy people suspected of central nervous system disease in the same period were selected as the control group. The data of gender, age, body mass and body mass index (BMI) were recorded, the Niolet V32 digital EEG instrument of American Nigolli Company was used for EEG inspection, and the level of serum GFAP was detected by enzyme-linked immunosorbent assay (ELISA). The general data, abnormal EEG results and the level of serum GFAP of the control group and the observation group were compared. The diagnostic values of EEG and its combination with serum GFAP in VE were analyzed by four grid table; and the diagnostic value of serum GFAP for VE was evaluated by drawing receiver operating characteristic (ROC) curve.Results:There was no significant difference in sex, age, body mass and BMI between the two groups ( P>0.05). The results of EEG diagnosis for VE showed that 11 of 63 cases were missed and 10 of 80 cases in the control group were misdiagnosed, and the sensitivity, specificity and accuracy of EEG diagnosis for VE were 82.54%, 87.50% and 85.31%, respectively. Compared with that of the control group, the level of serum GFAP of the observation group was higher: (460.19 ± 126.53) ng/L vs. (217.36 ± 53.17) ng/L, t =15.525, P<0.05. ROC curve showed that area under curve (AUC) of serum GFAP for VE diagnosis was 0.907 and cutoff value was 238.37 ng/L. The sensitivity, specificity and accuracy of EEG combined with serum GFAP in diagnosing VE were 93.65%, 83.75% and 88.11%, respectively, and the sensitivity and accuracy of EEG combined with serum GFAP were higher than those of EEG and GFAP alone. The results of 12-month follow-up showed that 20 of 63 VE patients had sequel (poor prognosis group), 43 patients had good prognosis (good prognosis group), and the incidence of adverse prognosis was 31.75%(20/63). There were significant differences in EEG and GFAP between the good prognosis group and poor prognosis group ( P<0.05). Conclusions:The sensitivity and accuracy of EEG combined with serum GFAP in the diagnosis of VE are good, which may be used for the early diagnosis and prognosis evaluation of VE.

OBJECTIVE：To study inhibitory activity of different extracts of Dracocephalum moldavica to clinical pathogenic bacteria，and to excavate its possible antibacterial mechanism. METHODS ：After extraction by 65％ ethanol and extraction by petroleum ether ，dichloromethane，ethyl acetate ，n-butanol，the different polar fractions of D. moldavica were obtained . Taking Klebsiella pneumoniae ，Staphylococcus aureus and other clinical multiple resistant pathogens as objects，the diameter of inhibition zone of different extraction fractions was measured by paper diffusion method ，and the antibacterial active fraction was screened. The minimal inhibitory concentration （MIC）of antibacterial active fraction to common clinical pathogens was determined by agar dilution method ；the growth curve of MRSA was drawn by turbidimetric method. The differentially expressed protein between antibacterial active fraction group and control group was screened by PEAK ® Q 8.5 software，and the gene ontology （GO）analysis and KEGG signaling pathway enrichment analysis were carried out by Blast 2 GO and KOBAS 3.0 online software. RESULTS ： Petroleum ether ，dichloromethane，ethyl acetate and n-butanol fraction of D. moldavica had no significant inhibitory effect on Gram-negative bacteria. The ethyl acetate fraction of D. moldavica had antibacterial activity in varying degrees against several kinds of Gram-positive bacteria as Staphylococcus aureus ，S. epidermidis；the diameter of inhibition zone was 10-16 mm，which was the active fraction. MICs of ethyl acetate fraction to S. aureus ，S. epidermidis and S. hominis were all 0.781 3 mg/mL；MIC to S. saprophyticus was 0.390 7 mg/mL；MICs to S. saprophyticus and standard strain of S. aureus were both 1.562 5 mg/mL. The 1， 2 times MIC of ethyl acetate could inhibit the growth of MRSA ，and the inhibitory activity increased with the increase of dose. A total of 300 differentially expressed proteins were screened （P＜0.01），of which 239 were up-regulated and 61 were down-regulated. The differentially expressed proteins were （No.81260478，No.816- mainly concentrated in cell sites such as cells ，cellular com- 60048） ponent，etc.，and in metabolic process such as cell process ， biological process and molecular functions such as catalytic activity，protein binding ，etc. They were mainly concentratedwang.zhanli@hotmail.com in microbial metabolism in different environments ，fructose and mannose metabolism signaling pathway （P＜0.05）. CONCLUSIONS ：The ethyl acetate fraction of D. Moldavica is the antibacterial active fraction ，and its activity may be related to the microbial metabolism and cell glycometablism.

Objective To investigate the characteristics of metabolic foci on 18F-fluorodeoxyglucose (FDG) PET/CT scan in pediatric patients with epilepsy.Methods Twenty-three pediatric patients (15 males,8 females,age range:0.5-13.3 years) with epilepsy were retrospectively reviewed from March 2014 to December 2016.All patients underwent 18F-FDG PET/CT and metabolic foci were found.The visual method and semi-quantitative analysis were used to analyze images.Fourteen of them underwent surgery and were followed up for 3-24 months.Results Glucose hypermetabolism were observed most frequently in the frontal and parietal lobes,with or without surrounding/remote hypometabolism.On the day of PET/CT imaging,8 patients had no seizures,14 patients had seizures,and 1 patient was uncertain.The sites of resection were consistent with the regions of hypermetabolism in 9 patients,among whom the pathological results showed 8 cortical malformations and 1 Rasmussen's syndrome.Follow-up results for the above 9 patients showed that there was 7 Engel class Ⅰ patients and 2 Engel class Ⅲ patients.Conclusion The hypermetabolism may mostly appear in the frontal and parietal lobes of pediatric patients with epilepsy,and malformations of cortical development seem to be the most common pathology results.

Objective To observe the effect of dexmedetomidine in cerebral aneurysm embolization in pa-tients with hypertension. Methods Sixty patients with hypertension undergoing emergency cerebral aneurysm em-bolization were randomly divided into two groups:research group(dexmedetomidine given group) and control group. SBP,DBP,HR,plasma norepinephrine(NE):baseline value(T0),before intubation(T1),after intubation (T2),after extubation(T3). Extubation time and anesthetic-related complications were also recorded. Results The hemodynamic parameters and plasma norepinephrine concentration in the research group were more stable than those in the control group at different time point during perioperative period. There was no difference between two groups about extubation time. The incidence of anesthetic-related complications in research group was lower than control group(P < 0.05). Conclusions Dexmedetomidine can reduce the stress response of intubation ,extuba-tion and perioperative hemodynamic fluctuations in cerebral aneurysm embolization in patients with hypertension. It can also reduce the consumption of prorofol and the incidences of adverse effects.

Objective To investigate the clinical value of 18 F?FDG PET/CT in staging multiple myeloma ( MM) and evaluating the glucose metabolic activity of MM. Methods A total of 25 MM patients ( 13 males, 12 females, age:39-67 years) from May 2010 to April 2015 were enrolled in this retrospective study. The SUVmax of each patient was recorded. D?S plus staging according to 18 F?FDG PET/CT was com?pared with the traditional D?S staging. The SUVmax and the percentage of plasmacytes of bone marrow of phase Ⅲ and non?phase Ⅲ ( phaseⅠand Ⅱ) according to D?S plus staging were compared. Two?sample t test and Wilcoxon rank sum test were used to analyze the data. Results In 25 MM patients, the range of SUVmax of lesions was 1.8-12?0 and the mean value was 5.15±2.74. According to D?S staging, the numbers of patients with phase Ⅰ,Ⅱ andⅢwere 7, 4 and 14, respectively. While the numbers were 3, 1 and 21 by D?S plus staging. Based on the D?S plus staging system, stages of 7 patients ( 28%, 7/25 ) were changed. According to the D?S plus staging system, the SUVmax between phaseⅢand non?phaseⅢpatients was significantly different (5.75±2.54 vs 3.00±0?70; t=2.12, P<0.05), while the percentage of plasma?cytes of bone marrow between the 2 groups had no significant difference ( 17. 50%( 4. 25%-41. 75%) vs 11?15%(10.25%-36.57%);z=0.05, P>0.05). Conclusion 18F?FDG PET/CT is of clinical importance for MM staging and metabolic activity assessment of MM.

PURPOSE: Secondary hyperparathyroidism (SHPT) develops in patients with chronic renal failure. This study aimed to compare analgesic efficacy in SHPT patients who undergo subtotal parathyroidectomy after superficial versus deep cervical plexus block. METHODS: Sixty chronic renal failure patients with SPHT scheduled for subtotal parathyroidectomy were randomized to receive general anesthesia (group GA), general anesthesia plus bilateral superficial and deep cervical plexus block (group BD), or general anesthesia plus bilateral superficial cervical plexus block (group BS) (n = 20). Bilateral superficial cervical plexus block or combined superficial and deep cervical plexus block with 0.5% ropivacaine was administered. Postoperative pain was assessed using visual analogue scale (VAS). RESULTS: VAS score at 1 hour, 4 hours, and 8 hours after operation was 3.71 +/- 0.60, 2.72 +/- 0.54, 2.17 +/- 0.75 in BS group; 4.00 +/- 0.28, 2.89 +/- 0.21, and 2.46 +/- 1.01 in BD group, significantly lower than in GA group (6.50 +/- 0.50, 5.02 +/- 0.54, and 4.86 +/- 0.51, respectively). The dosage of tramadol was 109.0 +/- 35.2 mg in BS group and 93.0 +/- 24.52 mg in BD group, significantly lower than in GA group (300.0 +/- 27.13 mg). The incidence of complications in GA group (90%) was significantly higher than in BS group (30%) and BD group (15%). Serum glucose and norepinephrine levels were significantly higher at 1 hour, 4 hours, and 8 hours after operation, but returned to baseline levels at 24 hours after operation. CONCLUSION: Superficial cervical plexus block or combined superficial and deep cervical plexus block effectively reduces postoperative pain, stress response, and complications in SHPT patients who undergo subtotal parathyroidectomy.
Anesthesia, General ; Blood Glucose ; Cervical Plexus* ; Humans ; Hyperparathyroidism, Secondary* ; Incidence ; Kidney Failure, Chronic* ; Norepinephrine ; Pain, Postoperative ; Parathyroidectomy ; Tramadol