Objective:To investigate the influencing factors of adult dental fluorosis in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.Methods:A case-control study was conducted in January 2024 to select adult fluorosis patients (case group) and healthy individuals (control group) from the drinking water-borne endemic fluorosis areas in Helinger County, Hohhot City, Inner Mongolia Autonomous Region as the survey subjects. Urine samples were collected to determine urinary fluoride concentration. A questionnaire survey was conducted. SPSS 25.0 software was used for χ 2 test and multivariate logistic regression analysis. Restricted cubic spline (RCS) was used to analyze the association between urinary fluoride concentration and the risk of dental fluorosis in adults. Results:A total of 161 individuals were included in the survey, including 100 in the case group and 61 in the control group. The results of univariate analysis showed that there were statistically significant differences in the distribution of gender, smoking, and urinary fluoride concentration between the case group and the control group (χ 2 = 7.54, 5.02, 9.69, P < 0.05). The results of multivariate logistic regression analysis indicated that gender ( OR = 0.36, 95% CI: 0.18 - 0.73, P = 0.005) and urinary fluoride concentration ( OR = 3.08, 95% CI: 1.46 - 6.67, P = 0.003) were the influencing factors of adult fluorosis. RCS analysis showed a significant linear dose-response relationship between the risk of dental fluorosis and urinary fluoride concentration ( Poverall trend = 0.001, Pnonlinear = 0.071). When the urinary fluoride concentration was greater than 1.57 mg/L, the risk of dental fluorosis increased with the increase of urinary fluoride concentration. Conclusion:Gender and urinary fluoride concentration are the risk factors of dental fluorosis in adults in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.

Objective:To investigate the influencing factors of adult dental fluorosis in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.Methods:A case-control study was conducted in January 2024 to select adult fluorosis patients (case group) and healthy individuals (control group) from the drinking water-borne endemic fluorosis areas in Helinger County, Hohhot City, Inner Mongolia Autonomous Region as the survey subjects. Urine samples were collected to determine urinary fluoride concentration. A questionnaire survey was conducted. SPSS 25.0 software was used for χ 2 test and multivariate logistic regression analysis. Restricted cubic spline (RCS) was used to analyze the association between urinary fluoride concentration and the risk of dental fluorosis in adults. Results:A total of 161 individuals were included in the survey, including 100 in the case group and 61 in the control group. The results of univariate analysis showed that there were statistically significant differences in the distribution of gender, smoking, and urinary fluoride concentration between the case group and the control group (χ 2 = 7.54, 5.02, 9.69, P < 0.05). The results of multivariate logistic regression analysis indicated that gender ( OR = 0.36, 95% CI: 0.18 - 0.73, P = 0.005) and urinary fluoride concentration ( OR = 3.08, 95% CI: 1.46 - 6.67, P = 0.003) were the influencing factors of adult fluorosis. RCS analysis showed a significant linear dose-response relationship between the risk of dental fluorosis and urinary fluoride concentration ( Poverall trend = 0.001, Pnonlinear = 0.071). When the urinary fluoride concentration was greater than 1.57 mg/L, the risk of dental fluorosis increased with the increase of urinary fluoride concentration. Conclusion:Gender and urinary fluoride concentration are the risk factors of dental fluorosis in adults in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.

Objective:To investigate the distribution characteristics and analyze the clinical significance of dermatophagoides pteronyssinus allergen components in children with allergic rhinitis and asthma in Shenzhen.Methods:This study was a cross-sectional study. The clinical data of children with allergic rhinitis and asthma induced by dust mites admitted to the allergy clinic of Shenzhen Children′s Hospital from 2021 to 2024 were collected and the serum sIgE levels of dermatophagoides pteronyssinus, dermatophagoides farinae (Der p, Der f) and dermatophagoides pteronyssinus components (Der p 1, Der p 2, Der p 10, Der p 23) were detected by magnetic bead chemiluminescence method. The correlation between dermatophagoides pteronyssinus allergen components and clinical data of children was analyzed. According to the diagnosis, the children were divided into allergic rhinitis (AR) group and AR with asthma (ARAS) group. According to the age, the children were divided into preschool age (5 years ≤age<7 years), school age (7 years ≤age<10 years) and adolescence (10 years ≤age≤15 years). The expression differences of dermatophagoides pteronyssinus components among AR group and ARAS group and different age groups were compared.Results:A total of 314 children with allergic rhinitis and asthma caused by dust mites were included in the study, of whom 112 were male and 202 were female. There were 188 cases of AR and 126 cases of ARAS, aged 5-15 years, with a median age of 7.54 years and an average age of (8.02±2.24) years. BMI was 13.89-31.76 kg/m 2,the median BMI was 15.87 kg/m2 and average BMI was (16.55±3.05) kg/m2. There was not statistically significant difference in gender, age, BMI, blood eosinophils, blood basophils, FeNO, FVC and FEV1 between the AR group and the ARAS group ( P>0.05). There was significant difference in FEV1/FVC and small airway function indexes MMEF, MEF75%, MEF50% and MEF25% between the AR group and the ARAS group ( P<0.05). In the 314 children, the dermatophagoides pteronyssinus allergen components sensitization rates were in the order of Der p 1 (97.1%), Der p 2 (89.8%), Der p 23 (55.1%), Der p 10 (8.6%), and the difference in the positive rate was statistically significant (χ 2=658.31, P<0.001). There was not significant difference in Der p 1, Der p 2 and Der p 10 among children of different ages ( P>0.05). There was significant difference in Der p 23 among children of different ages (χ 2=7.29, P=0.03). A correlation analysis showed that Der p, Der f, Der p 1 and Der p 2 had a high positive correlation ( P<0.001). Eosinophils are positively correlated with Der p, Der f, Der p 1, Der p 2, Der p 10 and Der p 23 ( P<0.001). FeNO is positively correlated with Der p, Der f, and Der p 23 ( P<0.05). Small airway function indicators MMEF, MEF50% and MEF25% are negatively correlated with Der p, Der f and Der p 1 ( P<0.05). The sIgE levels of Der p, Der f, Der p 1, Der p 2 and Der p 10 in the AR group were significantly lower than those in the ARAS group ( P<0.05). In the ARAS group, 120 cases (95.24%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 71 cases (56.35%) showed positive results for at least 3 dermatophagoides pteronyssinus components. In the AR group, 171 cases (90.96%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 94 cases (50.00%) showed positive results for at least 3 dermatophagoides pteronyssinus components. Conclusion:Der p 1, Der p 2 and Der p 23 may be the main dermatophagoides pteronyssinus allergen components that induce allergic rhinitis and asthma in Shenzhen City. The elevation of sIgE levels in the dermatophagoides pteronyssinus components can aggravate the severity of lower airway eosinophilic inflammation and airway obstruction. Attention should be paid to the detection of dermatophagoides pteronyssinus components in children with poor response to dust mite-allergen specific immunotherapy.

Objective:To investigate the distribution characteristics and analyze the clinical significance of dermatophagoides pteronyssinus allergen components in children with allergic rhinitis and asthma in Shenzhen.Methods:This study was a cross-sectional study. The clinical data of children with allergic rhinitis and asthma induced by dust mites admitted to the allergy clinic of Shenzhen Children′s Hospital from 2021 to 2024 were collected and the serum sIgE levels of dermatophagoides pteronyssinus, dermatophagoides farinae (Der p, Der f) and dermatophagoides pteronyssinus components (Der p 1, Der p 2, Der p 10, Der p 23) were detected by magnetic bead chemiluminescence method. The correlation between dermatophagoides pteronyssinus allergen components and clinical data of children was analyzed. According to the diagnosis, the children were divided into allergic rhinitis (AR) group and AR with asthma (ARAS) group. According to the age, the children were divided into preschool age (5 years ≤age<7 years), school age (7 years ≤age<10 years) and adolescence (10 years ≤age≤15 years). The expression differences of dermatophagoides pteronyssinus components among AR group and ARAS group and different age groups were compared.Results:A total of 314 children with allergic rhinitis and asthma caused by dust mites were included in the study, of whom 112 were male and 202 were female. There were 188 cases of AR and 126 cases of ARAS, aged 5-15 years, with a median age of 7.54 years and an average age of (8.02±2.24) years. BMI was 13.89-31.76 kg/m 2,the median BMI was 15.87 kg/m2 and average BMI was (16.55±3.05) kg/m2. There was not statistically significant difference in gender, age, BMI, blood eosinophils, blood basophils, FeNO, FVC and FEV1 between the AR group and the ARAS group ( P>0.05). There was significant difference in FEV1/FVC and small airway function indexes MMEF, MEF75%, MEF50% and MEF25% between the AR group and the ARAS group ( P<0.05). In the 314 children, the dermatophagoides pteronyssinus allergen components sensitization rates were in the order of Der p 1 (97.1%), Der p 2 (89.8%), Der p 23 (55.1%), Der p 10 (8.6%), and the difference in the positive rate was statistically significant (χ 2=658.31, P<0.001). There was not significant difference in Der p 1, Der p 2 and Der p 10 among children of different ages ( P>0.05). There was significant difference in Der p 23 among children of different ages (χ 2=7.29, P=0.03). A correlation analysis showed that Der p, Der f, Der p 1 and Der p 2 had a high positive correlation ( P<0.001). Eosinophils are positively correlated with Der p, Der f, Der p 1, Der p 2, Der p 10 and Der p 23 ( P<0.001). FeNO is positively correlated with Der p, Der f, and Der p 23 ( P<0.05). Small airway function indicators MMEF, MEF50% and MEF25% are negatively correlated with Der p, Der f and Der p 1 ( P<0.05). The sIgE levels of Der p, Der f, Der p 1, Der p 2 and Der p 10 in the AR group were significantly lower than those in the ARAS group ( P<0.05). In the ARAS group, 120 cases (95.24%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 71 cases (56.35%) showed positive results for at least 3 dermatophagoides pteronyssinus components. In the AR group, 171 cases (90.96%) showed positive results for at least 2 dermatophagoides pteronyssinus components, while 94 cases (50.00%) showed positive results for at least 3 dermatophagoides pteronyssinus components. Conclusion:Der p 1, Der p 2 and Der p 23 may be the main dermatophagoides pteronyssinus allergen components that induce allergic rhinitis and asthma in Shenzhen City. The elevation of sIgE levels in the dermatophagoides pteronyssinus components can aggravate the severity of lower airway eosinophilic inflammation and airway obstruction. Attention should be paid to the detection of dermatophagoides pteronyssinus components in children with poor response to dust mite-allergen specific immunotherapy.

Objective:To investigate the application of "micro ward" teaching based on the concept of dedicated education units (DEU) in the standardized training of neurosurgery residents.Methods:The 22 neurosurgery residents enrolled in 2021 for standardized training were assigned to the control group with traditional teaching method. The 24 neurosurgery residents enrolled in 2022 were assigned to the observation group with the "micro ward" teaching method based on the DEU concept. The theoretical knowledge and operational skill scores, clinical thinking ability, and teaching satisfaction were compared between the two groups of students before and after the training. SPSS 21.0 was used to perform chi-square test, Z test and t test. Results:The observation group had higher scores in terms of surgical skills [(190.63±4.35) vs. (86.79±4.82)] and case analysis [(190.54±5.06) vs. (86.13±5.35)] than the control group ( P<0.05). The scores were higher in the observation group than in the control group in terms of broadening thinking, overall thinking, curiosity, and cognitive maturity after training ( P<0.05). The observation group had a significantly higher proportion of students who were satisfied with standardized neurosurgery training teachers, teaching methods, and teaching results than the control group ( P<0.05). Conclusion:The application of "micro ward" teaching based on the concept of DEU in the standardized training of neurosurgery residents can effectively improve the clinical practice ability and professional quality of trainees, cultivate their specialized clinical thinking, enhance their independent learning ability, and improve the training quality. Therefore, this teaching method is worth promoting.

Objective:To explore the risk factors of linezolid-induced thrombocytopenia (LIT) and evaluate their predictive value.Methods:Medical records of hospital acquired pneumonia (HAP) patients who admitted in Suzhou Municipal Hospital from July 2019 to October 2021 and received linezolid were collected and retrospectively analyzed. Clinical data including general information, comorbidities, linezolid application, laboratory test results, and trough concentration of linezolid was extracted. Patients were divided into LIT group and non-LIT group according to the occurrence of LIT. Clinical characteristics were compared between the 2 groups; risk factors of LIT in patients with HAP were analyzed using a binary logistic regression model, and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated; the predictive value of the risk factors for LIT were evaluated using receiver operating characteristic (ROC) curve. Results:A total of 74 patients were included in the study, including 55 males and 19 females, aged 82 (73, 88) years. LIT occurred in 25 patients (33.8%). Compared with the non-LIT group, the age and trough concentration of linezolid in patients in the LIT group were higher [88 (81, 92) years vs. 79(70, 86) years, P=0.001; (19.6±10.3) mg/L vs. (9.8±6.4) mg/L, P<0.001], and the baseline platelet count and baseline creatinine clearance rate were lower [181(162, 212) ×10 9/L vs. 229 (169, 289) ×10 9/L, P=0.025; 31(19, 44) ml/(min·1.73 m 2) vs. 46 (27, 65) ml/(min·1.73 m 2), P=0.018]. Binary logistic regression analysis showed that the lower baseline creatinine clearance rate ( OR=0.974, 95 %CI: 0.951-0.998, P=0.035) and higher trough concentration of linezolid ( OR=1.156, 95 %CI: 1.059-1.261, P=0.001) were independent risk factors for LIT in HAP patients. ROC curve analysis showed that the threshold of the age, trough concentration of linezolid, baseline platelet count, and baseline creatinine clearance rate were 87 years (sensitivity 56.0%, specificity 83.7%), 15.4 mg/L (sensitivity 64.0%, specificity 87.8%), 189×10 9/L (sensitivity 67.3%, specificity 68.0%), and 45 ml/(min·1.73 m 2) (sensitivity 53.1%, specificity 80.0%), respectively. Patients were respectively divided into 2 groups according to the thresholds and the incidences of LIT were compared. The results showed that the incidences of LIT in patients with age and trough concentration of linezolid exceeding the thresholds and in patients with baseline plate count and baseline creatinine clearance rate lower than or equal to the thresholds were significantly higher than those in the other patients (all P<0.01). Conclusions:Baseline creatinine clearance rate, trough concentration of linezolid, age, and plate count are risk factors for LIT in HAP patients and their thresholds are 45 ml/(min·1.73 m 2), 15.4 mg/L, 87 years, and 189×10 9/L, respectively. These risk factors have good predictive value for the occurrence of LIT.

OBJECTIVE: To analyze the clinical features and variants of ABCD1 gene in a Chinese pedigree affected with X-linked adrenoleukodystrophy. METHODS: Clinical data of the proband were collected and analyzed. Potential variant of the ABCD1 gene were analyzed by PCR and Sanger sequencing of the proband, his parents and 100 unrelated healthy individuals. RESULTS: The prominent features of the proband included cerebellar and brainstem lesions, along with increased serum level of very-long chain fatty acids. He was found to harbor a hemizygous c.1509delG (p.L504Sfs*54) variant of the ABCD1 gene, for which his mother was heterozygous. The same variant was not detected in his father and 100 healthy controls. CONCLUSION X-linked adrenoleukodystrophy has a variety of clinical manifestations. Discovery of the c.1509delG (p.L504Sfs*54), as a novel pathogenic variant of the ABCD1 gene, has enabled diagnosis and genetic counseling for this pedigree.
Adrenoleukodystrophy/genetics* ; Asians/genetics* ; China ; Female ; Genetic Testing ; Humans ; Male ; Mutation ; Pedigree

OBJECTIVE To analyze the risk factors of substandard drug blood concentration of meropenem in patients with hospital acquired pneumonia （HAP）. METHODS Totally 130 HAP patients who were admitted to the intensive care unit of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2021 and received steady -state blood concentration test of meropenem were selected as the study subjects . The patient ’s age ，sex，body mass and other medical history were recorded . The steady-state blood trough concentration of meropenem was determined and its target was determined . Univariate and multivariate Logistic regression analysis were used to screen the risk factors for the substandard steady -state blood trough concentration of meropenem. The receiver operating characteristic （ROC）curve was drawn to screen the warning value of the risk factors and evaluate the predictive value of the risk factors . RESULTS The steady -state blood trough concentrations of 85 cases were ≥2 mg/L， and those of 45 cases were ＜2 mg/L. Multivariate Logistic regression analysis showed that age ，negative balance and brain injury were independent risk factors for the substandard steady-state blood trough concentration of meropenem （P＜ 0.05）.ROC curve showed that when the patient was 58 years old，the area under the ROC curve was the largest （0.744）， the sensitivity was 0.882，the specificity was 0.556，and the Youden index was 0.438；when the negative balance was 520.5 mL/24 h，the area under the ROC curve reached the maximum （0.827），the sensitivity was 0.722，the specificity was 0.905，and th e Youden index was 0.628. The creatinine clearance rate in the brain injury group was significantly higher than that in the non -brain injury group ，and the steady -state blood trough concentration of meropenem in the brain injury group was significantly lower than that in the non -brain injury group （P＜0.001）. CONCLUSIONS When the HAP patient ’s age is less than 58 years old ，the brain injury and the negative balance is more than 520.5 mL/24 h，the risk of substandard steady -state blood trough concentration of meropenem will increase .

Objective:To explore the risk factors of linezolid-induced thrombocytopenia (LIT) and evaluate their predictive value.Methods:Medical records of hospital acquired pneumonia (HAP) patients who admitted in Suzhou Municipal Hospital from July 2019 to October 2021 and received linezolid were collected and retrospectively analyzed. Clinical data including general information, comorbidities, linezolid application, laboratory test results, and trough concentration of linezolid was extracted. Patients were divided into LIT group and non-LIT group according to the occurrence of LIT. Clinical characteristics were compared between the 2 groups; risk factors of LIT in patients with HAP were analyzed using a binary logistic regression model, and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated; the predictive value of the risk factors for LIT were evaluated using receiver operating characteristic (ROC) curve. Results:A total of 74 patients were included in the study, including 55 males and 19 females, aged 82 (73, 88) years. LIT occurred in 25 patients (33.8%). Compared with the non-LIT group, the age and trough concentration of linezolid in patients in the LIT group were higher [88 (81, 92) years vs. 79(70, 86) years, P=0.001; (19.6±10.3) mg/L vs. (9.8±6.4) mg/L, P<0.001], and the baseline platelet count and baseline creatinine clearance rate were lower [181(162, 212) ×10 9/L vs. 229 (169, 289) ×10 9/L, P=0.025; 31(19, 44) ml/(min·1.73 m 2) vs. 46 (27, 65) ml/(min·1.73 m 2), P=0.018]. Binary logistic regression analysis showed that the lower baseline creatinine clearance rate ( OR=0.974, 95 %CI: 0.951-0.998, P=0.035) and higher trough concentration of linezolid ( OR=1.156, 95 %CI: 1.059-1.261, P=0.001) were independent risk factors for LIT in HAP patients. ROC curve analysis showed that the threshold of the age, trough concentration of linezolid, baseline platelet count, and baseline creatinine clearance rate were 87 years (sensitivity 56.0%, specificity 83.7%), 15.4 mg/L (sensitivity 64.0%, specificity 87.8%), 189×10 9/L (sensitivity 67.3%, specificity 68.0%), and 45 ml/(min·1.73 m 2) (sensitivity 53.1%, specificity 80.0%), respectively. Patients were respectively divided into 2 groups according to the thresholds and the incidences of LIT were compared. The results showed that the incidences of LIT in patients with age and trough concentration of linezolid exceeding the thresholds and in patients with baseline plate count and baseline creatinine clearance rate lower than or equal to the thresholds were significantly higher than those in the other patients (all P<0.01). Conclusions:Baseline creatinine clearance rate, trough concentration of linezolid, age, and plate count are risk factors for LIT in HAP patients and their thresholds are 45 ml/(min·1.73 m 2), 15.4 mg/L, 87 years, and 189×10 9/L, respectively. These risk factors have good predictive value for the occurrence of LIT.

Objective:To investigate the cause of missed diagnosis by transthoracic echocardiography (TTE) based on the characteristics of partial anomalous pulmonary venous connection (PAPVC), and to improve the ultrasonic diagnostic accuracy of PAPVC in children.Methods:The TTE results of 252 children under 12 years old who were confirmed with PAPVC at Guangdong Provincial People′s Hospital from January 2011 to June 2019 were reviewed retrospectively.The types of PAPVC and the associated atrial septal defects (ASD) as well as the confirmed and missed cases by TTE were analyzed.Results:PAPVC was right-sided in 238 patients (94.4%), left-sided in 8 patients (3.2%), and bilateral in 6 patients (2.4%). There were 177 cases (70.2%) whose pulmonary veins were abnorma-lly connected to the right atrium(RA), 37 cases (14.7%) to the junction of the RA and the superior vena cava (SVC), 27 cases (10.7%) to the distal SVC, and 6 cases (2.4%) to the inferior vena cava.Besides, pulmonary veins of 5 cases (2.0%) flew back to the RA through the coronary sinus.One hundred and ninety PAPVC cases were combined with sinus venous defects (SVD) and 53 cases combined with secondum ASD.Two hundred and twenty-one cases were accurately diagnosed while 31 cases were underestimated by TTE.The omission diagnostic rates of right superior pulmonary veins connecting to the distal SVC, 1 or 2 right pulmonary veins connecting to the RA or the junction of the RA and SVC, and left-sided PAPVC were 8 out of 18 (44.4%), 22 out of 215 (10.2%) and 1 out of 8 (12.5%), respectively.Among 54 cases with right superior pulmonary veins anomalously connected to the RA or the junction of the RA and SVC, 88.9% of them (48/54 cases) were combined with superior SVD.Among 161 cases with the right inferior pulmonary veins or 2 right pulmonary veins connected to the RA, 78.2% of them (126/161 cases) were combined with inferior SVD.There were statistically significant differences in ASD types between the 2 right-sided PAPVC groups.Conclusions:SVD is often associated with 1 or 2 right pulmonary veins connected to the RA or the junction of the RA and SVC.The cases with right superior pulmonary veins connected to the distal SVC are prone to be underestimated by TTE.Whether there is abnormal blood flowing into SVC should be noticed during superior sternal fossa examinations.Each pulmonary vein should be examined in detail in the TTE test and accurate diagnosis of PAPVC can be made in most cases.