Objective Objective To analyze the potential spatial factors affecting the genetic differentiation of Oncomelania hupensis robertsoni in Yunnan Province. Methods A total of 13 administrative villages were selected from schistosomiasis-endemic areas of Yunnan Province as O. hupensis snail sampling sites. At least 200 snails were collected in each site, and the spatial variable data of each site were recorded, including longitude, latitude and altitude. Thirty active and Schistosoma japonicum uninfected O. hupensis snails were selected from each sampling site by means of the crawling method and the cercarial shedding method. Genomic DNA was extracted from O. hupensis snails. Following PCR amplification, purification of PCR amplification products and sequencing, the gene sequences of O. hupensis snail samples were spliced and edited using the DNAstar software and the NCBI database to yield the complete mitochondrial sequences of O. hupensis snails at each sampling site, and the mitochondrial genetic distance matrix of O. hupensis robertsoni was calculated at each sampling site. The geographical coordinates of each sampling site were marked using the software ArcGIS 10.2, and the straight-line geographical distance between each sampling site was calculated. The altitude difference, longitude difference and latitude difference between each sampling site were calculated using the Excel software, and the correlation between the mitochondrial genetic distance matrix of O. hupensis robertsoni and each spatial variable matrix was examined by using the Mantel test at 13 sampling sites in Yunnan Province. Results Among the 13 O. hupensis snail sampling sites in Yunnan Province, the largest mitochondrial genetic distance of O. hupensis robertsoni snail populations was seen between Anding Village, Nanjian Yi Autonomous County and Caizhuang Village, Midu County (26.244 2), and the largest geographical distance was seen between Dongyuan Village, Gucheng District and Cangling Village, Chuxiong County (272.64 km). The highest altitude difference was seen between Anding Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1 086.10 m), and the largest longitude difference was found between Qiandian Village, Eryuan County and Cangling Village, Chuxiong County (1.86°), while the largest latitude difference was measured between Leqiu Village, Nanjian Yi Autonomous County and Dongyuan Village, Gucheng District (1.81°). In addition, the mitochondrial genetic distance of O. hupensis robertsoni snail populations was positively correlated with altitude at 13 snail sampling sites in Yunnan Province (r = 0.542 8, P < 0.001), and showed no significant correlations with geographical distance (r = 0.093 4, P > 0.05), longitude (r = −0.199 5, P > 0.05) or latitude (r = 0.205 7, P > 0.05). Conclusion Altitude may be a potential spatial factor affecting the genetic differentiation of O. hupensis robertsoni in Yunnan Province.

Objective: To investigate the correlation between peripheral blood CD4 T lymphocyte subsets and delayed graft function (DGF) and short-term prognosis in kidney transplant recipients, so as to help optimize preoperative assessment for kidney transplantation and provide insights into the immune mechanisms of DGF. Methods: A retrospective analysis was conducted on the clinical data of 103 kidney transplant recipients at the First Affiliated Hospital of Soochow University during Jun.2022 and Oct.2023. A total of 61 recipients were finally included in this study, and were categorized into two groups based on postoperative renal function recovery：the DGF group (n=20) and the immediate graft function (IGF) group (n=41).Flow cytometry was used to detect the proportions and absolute counts of various CD4 T lymphocyte subsets in the peripheral blood on postoperative day 7.The clinical data and peripheral blood lymphocyte subsets between the two groups were compared.For the subsets that exhibited significant differences, the correlation between their proportions and absolute counts and serum creatinine (Scr) levels on postoperative day 7 was further analyzed in the DGF group.Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to evaluate the predictive performance of the most strongly correlated CD4 T lymphocyte subset in terms of proportion and absolute count for short-term renal function. Results: There were no statistically significant differences in the proportions and absolute counts of Th1, Th2, Th17, and regulatory T cells (Treg) between the DGF and IGF groups (P>0.05).The proportions and absolute counts of follicular helper T cells (Tfh) and PD-1 Tfh cells were significantly higher in the DGF group than in the IGF group (P＜0.000 1). The Scr levels at 1 month and 1 year postoperatively were significantly higher in the DGF group than in the IGF group (P＜0.01), while the estimated glomerular filtration rate (eGFR) was significantly lower in the DGF group compared with the IGF group (P＜0.01, P=0.02).Spearman correlation analysis showed that the proportions and absolute counts of Tfh and PD-1 Tfh cell subsets were positively correlated with the Scr level on post-operative day 7 in the DGF group (P＜0.05).The ROC curve demonstrated that the AUC for the proportion of PD-1 Tfh cells in predicting Scr and eGFR at 1 month after surgery was 0.73(95%CI:0.61-0.86) and 0.75 (95%CI:0.62-0.88), respectively.Additionally, the AUC for predicting Scr and eGFR at 1 year was 0.72(95%CI:0.59-0.86) and 0.70(95%CI:0.58-0.83), respectively. Conclusion: The increase in the proportions and absolute counts of Tfh and PD-1 Tfh cells is associated with postoperative DGF of renal transplant recipients, and the proportion of PD-1 Tfh cells may help predict the short-term renal function of recipients.

Systemic lupus erythematosus (SLE) is a highly heterogeneous systemic autoimmune disease characterized by multi-organ involvement, recurrent flares, and chronic progression. With advances in diagnostics and therapeutics, SLE management is shifting from disease control toward long-term remission and organ protection. Incorporating recent global evidence and characteristics of the Chinese population, the National Clinical Research Center for Dermatologic and Immunologic Diseases and the Chinese SLE Treatment and Research Group (CSTAR) have developed the Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus (2025 edition). Centered on a treat-to-target strategy, the guidelines prioritize clinical remission and low disease activity as primary goals, optimizing the use of glucocorticoids, immunosuppressants, biologics, and novel therapies. Key updates include individualized management recommendations for lupus nephritis, multi-organ involvement, and antiphospholipid syndrome, alongside first-ever evidence-based recommendations on vaccination in SLE patients. By integrating large-scale domestic cohort studies and real-world data, this edition provides more precise and actionable guidance, offering significant value for standardizing and improving SLE diagnosis, treatment, and long-term management in China.

Objective:To investigate the clinical characteristics and prognostic significance of germline mutations in patients with myelodysplastic neoplasms (MDS) .Methods:Clinical data from 407 patients with MDS [male, 252; female, 155; median age, 64 (range, 19-85) years] diagnosed at the First Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed. The clinical features and prognostic effects of germline mutations were evaluated.Results:The prevalence of germline mutations in patients with MDS was 5.9% (24/407), peaking at 20.0% in the group aged 21-30 years. The spectrum of germline mutations comprised DDX41 (9 cases, 2.2%), TP53 (3 cases, 0.7%), and single cases of RUNX1, TET2, MPL, CBL, ATRX, CEBPA, ETV6, IDH1, KDM5C, SBDS, GNAS, and CTC1. Patients with germline mutations exhibited significantly lower peripheral WBC counts than those without (1.87×10 9/L vs 2.50×10 9/L, P=0.018), but showed comparable median overall survival (21.3 months vs 21.1 months, P=0.97). Patients with DDX41 germline mutations, compared with those with other germline mutations, had a significantly older median age (65 vs 54 years, P=0.010), lower WBC counts (1.51×10 9/L vs 2.31×10 9/L, P=0.040), increased mean corpuscular volume (111.80 fl vs 97.25 fl, P=0.003), and a higher prevalence of normal karyotypes (100.0% vs 53.3%, P=0.022). The most frequently co-occurring somatic mutations in DDX41 germline mutation carriers were ASXL1, TET2, and RUNX1. Conclusion:In this study, the detection rate of germline mutations in MDS patients was 5.9% (24/407), peaking at 20% in the group aged 21-30 years. DDX41 and TP53 were the most prevalent germline mutations. DDX41 mutation carriers displayed distinct clinical characteristics; however, germline mutations overall showed no significant prognostic effect.

This study investigated the association between a proximal promoter polymorphism of IFNGR1 (interferon-γ receptor α chain, IFNGR-α) and breast cancer susceptibility, as well as the prognostic value of its expression variation in breast cancer patients. A case-control study was conducted at the Sixth Medical Center of PLA General Hospital from June 2020 to June 2022. The study included 182 pathologically confirmed breast cancer patients as the breast cancer group, 177 non-tumor patients with benign breast lesions as the benign breast lesions group, and 229 healthy individuals as the normal control group. 2-3 ml EDTA anticoagulant whole blood samples were collected from all participants, and genomic DNA was extracted and stored for further analysis. Basic patient information was retrieved from the hospital′s electronic medical records by patients′ ID number. The proximal promoter sequence of IFNGR1 was obtained from NCBI, and sequencing primers were designed using Primer Premier 6.0. Sanger sequencing was employed to analyze the IFNGR1 promoter sequence in the three groups, and the results were compared with the Eukaryotic Promoter Database (EPD) sequence using Bioedit software. Statistical analysis was performed on single nucleotide polymorphisms (SNPs) in the IFNGR1 promoter. The TCGA database was utilized to assess the relationship between IFNGR1 expression levels and breast cancer patient survival. The findings revealed that the -56 TG genotype of the IFNGR1 promoter was significantly associated with increased breast cancer risk ( Z=2.73, P<0.05). Notably, IFNGR1 expression was lower in breast cancer group compared to normal control group ( P<0.05). Analysis of the TCGA database indicated that patients with high IFNGR1 expression had longer survival times than those with low expression ( HR=0.87, 95% CI:0.77-0.98, P<0.05). In summary, the IFNGR1 -56 TG genotype is associated with an increased risk of breast cancer, and there is a positive correlation between IFNGR1 expression levels and the survival of breast cancer patients.

OBJECTIVE To explore the expression level of miR-196a in cervical cells infected with high-risk human papillomavirus(HPV)16 and 18.METHODS The Gene Expression Omnibus(GEO)was used to screen for dif-ferentially expressed miRNAs between HPV 16 or 18-positive cervical cancer cells and normal cervical cells.On-line biological software https://kmplot.com/analysis/was utilized to analyze the relationship between the most differentially expressed miRNA and the overall survival of cervical cancer patients.Cervical swab samples positive for HPV 16 or HPV 18,detected by real-time fluorescent quantitative polymerase chain reaction(qPCR)genoty-ping,were collected as the study subjects.Cervical swab samples from the same period of physical examination population that were negative for HPV 16 or HPV 18 by qPCR genotyping served as negative controls.The qRT-PCR method was employed to detect the level of miR-196a in cervical cells,with data processed via the 2-△△Ctmethod.RESULTS Differential analysis of the GSE86100 data revealed that miR-196a expression de-creased in HPV 16 or HPV 18-positive cervical cells(log2FC=-6.60,P＜0.001),while miR-3188 expression significantly increased(log2FC=6.22,P＜0.001).Using online analysis tools https://kmplot.com/analysis,it was found that cervical cancer patients with high miR-196a expression had a shorter overall survival compared to those with low m iR-196a expression(HR=1.87,95％CI:1.17-3.00,P=0.008).H owever,there was no cor-relation between miR-3188 and the overall survival of cervical cancer patients(HR=1.47,95％CI:0.92-2.37,P=0.110).The results of specific qRT-PCR testing showed that the expression levels of miR-196a in cervical cells positive for HPV 16 and HPV 18 were 0.93±0.09 and 0.51±0.07,respectively,which were lower than those in the normal control group(1.89±0.13)(P＜0.05),consistent with the sequencing analysis results CONCLUSIONS Infection of cervical cells with HPV 16 or HPV 18 can lead to decreased expression of miR-196a,and the expres-sion level of miR-196a is negatively correlated with the overall survival of cervical cancer patients.

Objective:To investigate the efficacy and safety of doxycycline in children with macrolide-resistant mycoplasma pneumoniae pneumonia（MRMPP）.Methods:A retrospective analysis was conducted on the data from 92 children with severe MRMPP admitted to the Intensive Care Unit of Hunan Children's Hospital from January 2020 to November 2023.Depending on antibiotic treatment strategies for mycoplasma pneumoniae，patients were divided into three groups：Doxycycline group（those treated with doxycycline，12 cases）；Azithromycin group（those treated with azithromycin，53 cases）；and Switch group（those switched from azithromycin to doxycycline，27 cases）.Clinical outcomes and adverse reactions were compared among the three groups.Results:Significant statistical differences were found among the three groups in terms of age（ F=49.365， P<0.001）and weight（ H=40.595， P<0.001），with the Doxycycline group presenting the highest average age and median weight，followed by the Switch group，and then the Azithromycin group.After antibiotic treatment，children in the Doxycycline group，when compared to the Switch group and the Azithromycin group，showed a shorter fever resolution time[3.0（2.0，3.8）days vs.5.0（4.0，5.0）days vs.6.0（5.0，7.0）days， H=25.243， P<0.001]，a higher defervescence rate at 48 hours and 72 hours (41.7% vs.0 vs.0 at 48 hours，and 75.0% vs.0% vs.5.7% at 72 hours，both P<0.001]，a shorter mechanical ventilation duration[83.0（70.0，93.0）hours vs.135.0（129.0，172.0）hours vs.152.0（139.0，164.5）hours， H=9.980， P=0.007]，a shorter ICU stay[7.0（6.0，8.0）days vs.10.0（8.0，13.0）days vs.11.0（9.0，13.0）days， H=21.887， P<0.001]，and a lower proportion of Methylprednisolone usage [8.3% vs.57.1% vs.54.7%， P=0.008].There was no significant statistical difference in extrapulmonary complications and co-pathogens（both P>0.05）.Gastrointestinal reactions occurred in all children treated with doxycycline and azithromycin，with rates of 10.3%（4/39）and 13.8%（11/80）,respectively，showing no statistical significance（ P=0.771）.Among the 67（72.8%）cases with available follow-up data，the incidence of bronchiolitis obliterans was 8.3%（1/12）in the Doxycycline group，13.6%（3/22）in the Switch group，and 15.2%（5/33）in the Azithromycin group，with no statistical significance（ P>0.05）.Among the 34 cases using doxycycline with follow-up data available，none had tooth discoloration or enamel hypoplasia related to the medication. Conclusion:Doxycycline in the treatment of severe MRMPP in children could rapidly improve clinical symptoms，shorten the course of the disease，reduce the likelihood of methylprednisolone use，and is relatively safe for short-term use.

Objectives:To quantitatively evaluate the relationship between triglyceride-glucose index and stroke risk by a dose-response meta-analysis.Methods:Prospective cohort studies on the association between triglyceride-glucose(TyG)index and stroke risk were searched by computer in China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform,VIP,China Biomedical Literature Database,PubMed,Embase and Web of Science.The retrieval time was from the self-established database to November 7,2024.Two researchers used the Newcastle-Ottawa Scale(NOS)to evaluate literature quality and then extract relevant data for the included literatures.Stata 17.0 software was used for statistical analysis.Results:A total of 17 prospective literatures were included,involving 449 210 subjects,including 28 506 patients with stroke.The results of meta-analysis showed that the TyG index was positively correlated with the risk of stroke(HR=1.60,95%CI:1.45-1.76,P<0.05).The results of dose-response meta-analysis showed that there was a positive correlation between the TyG index and the risk of stroke,and every 1 unit increase of the TyG index,the risk of stroke increased by 20.2%.According to Egger's test,the P value is 0.962,and the P value of Begg's test is 0.967,indicating that there was no publication bias in the literature included in this study.Conclusions:There is a linear dose-response relationship between TyG index and stroke risk,and higher TyG index can increase the risk of stroke.

Objective:To evaluate the efficacy of early bronchoalveolar lavage using electronic bronchoscopy in pediatric drowning cases.Methods:A retrospective analysis of clinical data from 81 pediatric drowning cases treated in the intensive care unit of Hunan Children's Hospital from January 2017 to September 2023 was conducted.Among these,43 cases underwent bronchoalveolar lavage with electronic bronchoscopy within 24 hours of drowning,constituting the treatment group,while 38 cases either did not receive treatment within 24 hours or underwent the procedure after 24 hours,forming the control group.We compared the two groups regarding pre-admission observations,admission observations,and disease progression or prognosis indicators to assess the clinical efficacy of early bronchoalveolar lavage with electronic bronchoscopy in pediatric drowning cases.Results:Compared to the control group,children in the treatment group exhibited a significant reduction in invasive ventilation time [(73.33±13.33) h vs.(94.82±15.77) h] and a significant decrease in pediatric intensive care unit stay [105.00 (94.00,121.00) h vs.123.5 (109.75,149.00) h],with both differences being statistically significant( P<0.05).No significant differences in white blood cell count and neutrophil percentage were observed between the treatment group and control group at admission and on the first day( P>0.05).However,by the third day,there was a significant improvement in white blood cell count in both groups,with statistical significance( P<0.05).There was a significant decrease in C-reactive protein and procalcitonin levels between the treatment group and control group on the 1st and 3rd days,with the differences being significant( P<0.05).Six hours after electronic bronchoalveolar lavage,the P/F ratio in the treatment group was lower than that in the control group (177.09±41.27 vs. 233.50±48.23),but it increased more significantly at 24 hours (286.00±34.32 vs.256.34±44.22),with a significant difference between two groups.The positive rate of lavage fluid culture in the treatment group was significantly higher than that in the control group,and the difference was statistically significant( P<0.05).There was no significant difference in the number of organ function damage between two groups( P>0.05).However,regarding prognosis,the treatment group showed significantly better outcomes than the control group( P<0.05). Conclusion:For pediatric patients with wilderness drowning,early electronic bronchoscopy with alveolar lavage may shorten the duration of invasive mechanical ventilation and pediatric intensive care unit stay,improving prognosis,and is worth promoting.

Objective:To deeply understand newly employed nurses' cognition and experience of reflective practice (RP) and explore its application in clinical settings, providing a scientific basis for constructing an RP training system.Methods:A descriptive phenomenological research method was used, with purposive sampling to select newly employed nurses from the Affiliated Hospital of Yangzhou University between October and December 2023. Semi-structured interviews were conducted, and traditional content analysis was used to analyze the data.Results:Fourteen newly employed nurses were interviewed, including 3 males and 11 females, aged 22-25 (22.92 ± 0.92) years old. A total of 190 000 words of interview data were transcribed. Four themes and eight sub-themes were extracted: understanding of RP, attitudes toward RP, differences in RP abilities, and challenges in the clinical application of RP.Conclusions:Newly employed nurses have some understanding of RP, but there are issues such as insufficient learning pathways, negative attitudes toward RP, differences in RP abilities, and challenges in clinical application. RP learning should be incorporated into the training of newly employed nurses to promote the improvement of their RP abilities.