GBA1 gene mutation is an important genetic risk factor for Parkinson’s disease (PD). This paper reports a case of a 43-year-old male PD patient carrying a rare heterozygous Thr408Met mutation in the GBA1 gene identified through whole-exome sequencing, leading to a diagnosis of GBA1-associated PD. The patient’s motor symptoms were primarily characterized by bradykinesia and rigidity, without significant cognitive decline. Treatment with low-dose levodopa combined with a dopamine agonist resulted in significant symptomatic improvement.

OBJECTIVE To resolve account discrepancies caused by drug price adjustment in medical institution pharmacy management and reduce the time required for price adjustment. METHODS The problems existing in the drug price adjustment models of domestic medical institutions were investigated， and a drug price adjustment system was developed based on price- invoice synchronization mechanism. The system optimized the drug price adjustment process through batch number matching and real-time monitoring functionalities. The account consistency rate and price adjustment time were evaluated before and after system implementation. RESULTS A drug price adjustment system was successfully developed， featuring an innovative “synchronized entry and exit” mode， batch number matching， real-time monitoring， intelligent automation， and electronic traceability. After implementation， the account consistency rate for Western medicines increased from 86.89% （86.66%， 89.63%） to 100% （100%， 100%） （P＝0.005）， while Chinese patent medicines and herbal medicines maintained a 100% （100%， 100%） account consistency rate. Concurrently， the drug price adjustment time significantly decreased from 6.00 （5.00， 7.00）d to 2.50 （1.50， 3.00） d （P＜ 0.001）. CONCLUSIONS The developed system significantly improves account consistency， shortens price adjustment time， and demonstrates notable innovation and practical utility.

OBJECTIVE: To propose a new protocol for personalized mandibular reconstruction assisted by three-dimensional (3D) retrieval model based on fully connected neural network (FCNN) and a database of mandibles, and to verify clinical feasibility of the protocol. METHODS: A database of mandibles of 300 normal northern Chinese Han people was established. On the basis of cephalometry, the mandible landmarks with good stability were further screened. Mandibular landmarks were selected and geometric features of the mandible were extracted. A 3D retrieval algorithm was developed, which could retrieve the mandible most similar to a given mandible from the database. A FCNN was built to train the algorithm to improve accuracy of the 3D retrieval model. Using Geomagic Control 2014 software, matching accuracy of the 3D retrieval model was based on aforementioned mandible database and algorithm. From December 2019 to March 2021, a total of 5 patients underwent personalized mandibular reconstruction assisted by a 3D retrieval model based on mandible database and FCNN in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. The most similar mandible was retrieved from mandible database through 3D retrieval algorithm. It was used to restore the premorbid morphology of defect area and guide mandibular reconstruction. For the 5 patients, mandible was reconstructed with iliac flap. Virtual surgical plan was transformed using individual surgical guides. RESULTS: Through screening, mandibular landmarks with high reproducibility and stability were identified and composed of mandibular landmarker protocols. After training, the average deviation between most similar mandible retrieved from the 300-case mandible database through 3D retrieval model based on FCNN and given mandible was (1.77±0.44) mm. And the root-mean-square deviation between the most similar mandible retrieved from the database and given mandible was (2.58±0.86) mm. The mandibular reconstruction surgery was successful in all the 5 patients. Their facial symmetry and occlusion were restored. All the patients were satisfied with postoperative appearance. The mean deviation between postoperative mandible and preoperative design was (0.98±0.17) mm. The area with a deviation ≤1 mm accounted for 61.34%±14. 13%, ≤2 mm accounted for 83.82%±7.35%, and ≤3 mm accounted for 93.94%± 2.87%. CONCLUSION The personalized mandibular reconstruction assisted by 3D retrieval model based on the 300-case mandible database and FCNN is feasible clinically.
Humans ; Neural Networks, Computer ; Mandibular Reconstruction/methods* ; Mandible/diagnostic imaging* ; Imaging, Three-Dimensional/methods* ; Adult ; Databases, Factual ; Female ; Male ; Algorithms ; Middle Aged ; Cephalometry

Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Schizophrenia (SZ) stands as a severe psychiatric disorder. This study applied diffusion tensor imaging (DTI) data in conjunction with graph neural networks to distinguish SZ patients from normal controls (NCs) and showcases the superior performance of a graph neural network integrating combined fractional anisotropy and fiber number brain network features, achieving an accuracy of 73.79% in distinguishing SZ patients from NCs. Beyond mere discrimination, our study delved deeper into the advantages of utilizing white matter brain network features for identifying SZ patients through interpretable model analysis and gene expression analysis. These analyses uncovered intricate interrelationships between brain imaging markers and genetic biomarkers, providing novel insights into the neuropathological basis of SZ. In summary, our findings underscore the potential of graph neural networks applied to multimodal DTI data for enhancing SZ detection through an integrated analysis of neuroimaging and genetic features.
Humans ; Schizophrenia/pathology* ; Diffusion Tensor Imaging/methods* ; Male ; Female ; Adult ; Brain/metabolism* ; Young Adult ; Middle Aged ; White Matter/pathology* ; Gene Expression ; Nerve Net/diagnostic imaging* ; Graph Neural Networks

Objective To investigate the capacity of low-intensity pulsed ultrasound(LIPUS)for promoting osteogenic differentiation of senescent bone marrow mesenchymal stem cell(BMMSC)in mice,also the potential mechanism of involving myocardin-related transcription factor-A(MRTF-A)during this process.Methods Five aged mice received LIPUS irradiation on the left femur for eight weeks.Micro CT and HE staining were employed to evaluate bone status of bilateral femur.Bone marrow cells were isolated from mouse long bones,BMMSC were cultured,and the cells were divided into H2O2+LIPUS group,H2O2 group and control group.Mouse BMMSC were subjected to H2O2 for 3 days,followed by reactive oxygen species fluorescence staining and senescence-associated β-galactosidase staining to assess cellular senescence.Immunofluorescence and phalloidin staining were performed to examine MRTF-A distribution and cytoskeletal status.Based on H2O2-induced senescence model,MRTF-A nuclear translocation inhibitor CCG-100602 was applied,and the cells were further divided into H2O2+CCG-100602+LIPUS group,H2O2+CCG-100602 group,H2O2+LIPUS group and H2O2 group.Immunofluorescence staining was used to assess MRTF-A distribution.Alkaline phosphatase(ALP)and alizarin red staining were conducted to evaluate osteogenic differentiation capacity.Results LIPUS resulted in increased trabecular bone in the left femur of aged mice compared to the right femur,with increased bone volume to total volume and trabecular number and decreased trabecular spacing(both P＜0.05).Compared with H2O2 group,H2O2+LIPUS group showed increased nuclear expression of MRTF-A and increased intracellular rigid actin filament density.The nuclear expression of MRTF-A in H2O2+CCG-100602+LIPUS group was significantly lower than that in H2O2+LIPUS group.Compared with the H2O2+CCG-100602+LIPUS group and H2O2 group,the ALP and alizarin red staining positive areas in H2O2+LIPUS group were significantly larger.Conclusion LIPUS could improve osteoporosis in aged mice.Nuclear translocation of MRTF-A was a key regulator to LIPUS for promoting osteogenic differentiation of senescent BMMSC.

Objective:To explore the correlation between the oxygenation index and the monitored parameters of lung injury view in ventilator,so as to provide a basis for monitoring the change of oxygenation index by the parameters of lung injury view.Methods:A total of 28 patients who received mechanical ventilation treatment and admitted to respiratory department of the First Affiliated Hospital with Nanjing Medical University from May 14 to September 30,2024 were selected.The monitored parameters of lung injury views of them during mechanical ventilation treatment with invasive ventilators were collected,including platform pressure(Pplat),driving pressure(ΔP),mechanical energy(Emech),ratio of tidal volume to ideal body weight(TVe/IBW),etc..Then,the data of oxygenation index were obtained.Finally,135 valid data were screened out.The 84 pieces of data with oxygenation index≤300mmHg were included in low oxygen group,and 51 data with oxygenation index>300mmHg were included in normal group.The correlations between oxygenation index and Pplat,ΔP,Emech,TVe/IBW were conducted by pairwise analysis.Results:In the low oxygen group,the oxygenation index was[(196.302±74.522)mmHg]significantly negative correlation with Emech[(12.686±5.401)J/min](ρ=-0.425,P<0.05),but not was significant correlation with Pplat,ΔP,and TVe/IBW(P>0.05).In the normal group,there were not significant correlations between the oxygenation index and Pplat,ΔP,Emech and TVe/IBW(P>0.05).There was a significant negative correlation between Emech and rank of oxygenation index(β=-0.389,P<0.05)in the low oxygen group.Conclusion:The visualization function of the Emech of the monitored parameters in lung injury view of ventilator can provide help for monitoring the changes of oxygenation index of patients in the low oxygen group,and can improve the oxygenation of patients by optimizing mechanical energy.However,it is necessary to balance the contradiction between ventilation intensity and protection for lung.

The transformation of medical models and the growing demand for healthcare necessitate the establishment of one-stop multimorbidity management clinics within general practice departments of general hospitals to enhance clinical management of patients with multiple chronic conditions. This study employed SWOT analysis to evaluate the internal conditions (strengths and weaknesses) and external conditions (opportunities and threats) associated with establishing such clinics. The analysis revealed that the strengths of general practice departments in general hospitals for establishing a multimorbidity clinic include abundant medical resources, the comprehensive nature of general practice functions, and multidisciplinary collaboration. Opportunities are presented by public health needs, supportive government policies, and technological advancements. However, weaknesses include shortages of qualified human resources, the high complexity of patient management, increased medical costs, limitations in insurance reimbursement, and difficulties in performance evaluation. Threats encompass an underdeveloped general practitioner system, patients′ traditional healthcare-seeking habits, medico-legal and ethical challenges, and a lack of directly transferable experience. Based on this analysis, the paper proposes strategies and measures for developing multimorbidity clinics within general practice departments of general hospitals in China, aiming to provide a theoretical foundation for their promotion and development.

Objective:To develop a training program for general practitioners (GPs) on carotid plaque screening using portable intelligent point-of-care ultrasonography (POCUS).Methods:A draft training program for GPs on carotid plaque screening using POCUS was initially formulated through focus group discussions involving experts in ultrasonography and general practice. Two rounds of Delphi consultation were conducted with 15 ultrasound experts from 6 secondary and tertiary public hospitals in Shanghai in February and April 2023. The analytic hierarchy process (AHP) was applied to assign weights to the indicators in the final program.Results:The final program consisted of 4 first-level indicators, 10 second-level indicators, and 47 third-level indicators. Among the first-level indicators,"training objects" had the lowest weight (7.69%), while the other three indicators were equally weighted (30.77% each). The top 3 third-level indicators by combined weight were "mastering key diagnostic points of carotid plaque"(10.26%),"mastering carotid plaque screening using portable POCUS"(6.84%), and "primary care hands-on training sessions"(6.39%).Conclusion:A structured training program for GPs has been successfully developed for carotid plaque screening using portable intelligent POCUS, comprising 4 first-level, 10 second-level, and 47 third-level indicators.

Objective To explore the environmental factors affecting the growth of Lonicera japonica Thunb.;To predict the suitable areas of L.japonica in China under current and future climate conditions.Methods Totally 2 553 pieces of L.japonica distribution information and 19 environmental factors were collected.MaxEnt model was used to screen the main environmental factors affecting the growth of L.japonica.Combined with ArcGIS 10.8 software,this article simulated the suitable area of L.japonica in our country under current and future climate conditions.Results The main environmental factors affecting the distribution of L.japonica were the lowest temperature in the coldest month,the average daily temperature range,the precipitation in the wettest quarter and the annual temperature range.Under the current climate conditions,the suitable area of L.japonica in China was about 318.29×104 km2,which was mainly distributed in central and southern China.Under the future climate scenario,the total suitable area would decrease.Conclusion This study predicted distribution of L.japonica resources and ecological suitability areas can provide theoretical basis for its wild cultivation,rational cultivation,and resource protection.