Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

Objective:To investigate the clinical diagnosis, treatment, and genetic variations of neonates with congenital hyperinsulinism (CHI).Methods:The clinical data of CHI newborns admitted to the Provincial Hospital Affiliated to Shandong First Medical University from September 2018 to April 2022 were retrospectively analyzed.Results:Four cases of CHI were included, three of whom were full-term infants and all were macrosomic, while one was a premature infant. One infant was born to a mother with gestational diabetes mellitus, and 1 had a family history of hypoglycemia. All the 4 patients presented with weak response, 3 with drowsiness, 1 with hypotonia and 1 with convulsions. Cranial MRI indicated abnormal signals in the occipital lobe cortex in 1 case. Gene sequencing revealed homozygous variation c.799C>G in KCNJ11 gene for 1 case, and heterozygous variations c.4477C>T, c.3540C>G, c.683G>A and c.4536C>A in ABCC8 gene for 3 cases respectively and all these variations were identified as pathogenic mutations. Notably, the c.799C>G variant in KCNJ11 gene as well as the c.3540C>G and c.4536C>A variants in ABCC8 gene were reported for the first time. Among infants with ABCC8 gene variations, two showed no response to diazoxide treatment while one patient with KCNJ11 gene variation responded effectively. The parents of the patient with hypoglycemic brain injury gave up treatment. Three other cases were discharged from hospital after improvement and followed up to 1 year old. 2 patients had stable blood glucose after ceasing medication, and 1 patient still required intermittent oral glucose to maintain normal blood glucose level.Conclusions:CHI can lead to hypoglycemic brain injury. Clinically, infants large for gestational age or with a family history of diabetes and hypoglycemia should be monitored for blood glucose early after birth, to identify CHI as early as possible and actively treat it. Different gene variants have different therapeutic responses.

Objective To construct,implement and evaluate the effectiveness of the virtual simulation technology-based prenatal health education course.Methods The curriculum included 4 parts:"warm delivery room and easy delivery","medicated analgesic delivery","non-medicated analgesic delivery"and"early maternal and infant health care".From May to September 2022,100 primiparas in an obstetrics and gynecology hospital in Zhejiang Province were investigated by convenient sampling method.Random number table method was used to divide the participants into an experimental group and a control group,with 50 participants per group.The control group received conventional health education,while the experimental group received an augmented virtual reality technology-based prenatal health education course during the late stages of pregnancy on this basis.We conducted a post-intervention comparative analysis of antenatal anxiety levels,fear of childbirth,and birth outcomes between the 2 groups.Furthermore,a post-intervention satisfaction survey was administered to the experimental group.Results After intervention,the antenatal anxiety of the experimental group was lower than that of the control group(x2=4.943,P=0.026),and the decrease in fear of childbirth scores was higher than that of the control group(t=3.200,P=0.002).The experimental group was highly satisfied with all of the 4 dimensions of the course,and the overall evaluation was(31.8±3.23)points.However,there were no significant differences in vaginal delivery rate,postpartum bleeding volume,postpartum hemorrhage incidence,perineal injury degree and duration of each labor stage between the 2 groups(P＞0.05).Conclusion The virtual reality technology-based prenatal health education course was effective in improving the antenatal anxiety and fear of childbirth of primipara,and the use satisfaction is high.

The debate over the governor of spirit is an age-old yet ever-renewing topic in Traditional Chinese Medicine(TCM).The theory primarily revolves around three viewpoints:the heart governs the spirit,the brain governs the spirit,and the heart and brain have a joint role governing the spirit.This article,proceeding from the debate on the dominance of the divine spirit,aims to establish a novel perspective that integrates second-generation cognitive science with the TCM theory of the divine spirit based on their shared concerns regarding cognitive issues.Consciousness is the holistic living organism,and according to the cognitive concepts of second-generation cognitive science,consciousness is an interactive process between the body and the environment.Incorporating the embodied characteristics of the second-generation cognitive science,which emphasizes a return to the human body,behavior,and environment,and its holistic research paradigm into the exploration of the TCM theory of the divine spirit can provide a novel interpretive perspective for the debate on the dominance of the divine spirit.Additionally,conducting an in-depth analysis of the commonalities and differences between second-generation cognitive science and the TCM theory of the divine spirit offers theoretical principles and new research pathways for further developing the TCM theory of the divine spirit.This study has remarkable value in promoting the modernization of the TCM theory of the divine spirit.

Objective: To investigate whether acupoint penetration acupuncture (APA) could regulate chondrocyte autophagy and apoptosis via the PI3K/Akt-mTOR signaling pathway to reduce cartilage degeneration in knee osteoarthritis (KOA) rats. Methods: KOA was induced in rats via intra-articular injection of sodium iodoacetate resolution. Forty male Sprague-Dawley rats were randomly assigned to blank control, model, APA, electro-acupuncture (EA), and sham model groups (n = 8) and those in the APA and EA groups received their respective therapies. Following completion of the treatment course, histological examinations of cartilage and muscle were conducted. Levels of apoptosis- and autophagy-related factors, including Bax, Bcl-2, mTOR, ULK-1, and Beclin-1 protein, and mRNAs were assessed. Additionally, β-endorphin (β-EP) concentrations in the brain and serum were measured. Results: Histological analysis revealed that APA alleviated cartilage and muscle damage compared with the model group. APA inhibited cartilage degeneration by modulating the expression of apoptosis- and autophagy-related proteins and mRNA, thus preventing chondrocyte apoptosis. In the APA group, Bax and mTOR protein levels were significantly lower than those in the model group (both P = .024). Conversely, the Bcl-2 expression level was significantly higher than that in the EA group (P = .035). Additionally, ULK-1 expression was significantly lower than that in the EA group (P = .045). The mRNA level of Bax was significantly higher than that in the blank control group (P < .001). However, Beclin-1 levels were significantly higher than those in both the model and EA groups (both P < .001). ELISA results showed a significant decrease in the concentration of β-EP in the brains of the rats in the APA group compared with those in the model group (P = .032). Conclusions APA reduced osteoarthritis-related pain and alleviated cartilage damage by upregulating chondrocyte autophagy and down-regulating apoptosis via signaling pathways involving PI3K/Akt-mTOR in KOA rats.

Purpose To investigate the value of a radiomics model based on dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the differential diagnosis of granulomatous mastitis and breast cancer.Materials and Methods The MRI data of 82 patients with granulomatous mastitis or breast cancer confirmed by pathology in Xiyuan Hospital of China Academy of Chinese Medical Sciences from February 2019 to January 2022 were retrospectively collected.Based on the first phase of DCE-MRI,the regions of interest(ROI)were delineated layer by layer by semi-automatic segmentation method and manual segmentation method,respectively.99 ROI were randomly assigned to 69 in training groups and 30 in test groups.The consistency difference between the two methods was compared.The original data extracted by the semi-automatic segmentation method were screened by correlation analysis and multi-factor Logistic regression.Six kinds of classifiers(Logistic regression,support vector machine,naive Bayes,decision tree,random forest,K nearest neighbor)were used to construct prediction models,and the differences in diagnostic efficiency,accuracy,sensitivity and specificity of each model were evaluated.Results A total of 99 lesions(n=37 cases with granulomatous mastitis and n=62 cases with breast cancer)were segmented from 82 patients.The radiomics data extracted by the two ROI segmentation methods had poor consistency between groups[Intraclass correlation coefficient=0.68(0.51,0.78)].Among the six prediction models constructed from the data extracted by the semi-automatic segmentation method,the diagnostic performance of the Logistic regression model and the support vector machine model was significantly better than those of other models,and the Logistic regression model had the best diagnostic performance and stability(training group:area under the curve 0.928,accuracy rate 0.855,sensitivity 0.837,specificity 0.885;test group:area under the curve 0.933,accuracy 0.833,sensitivity 0.895,specificity 0.727,respectively).Conclusion Radiomics based on DCE-MRI can provide high value for the differential diagnosis of granulomatous mastitis and breast cancer.The semi-automatic segmentation method is more recommended for the segmentation method of ROI.The prediction model constructed by Logistic regression and support vector machine shows better diagnostic efficiency and stability.

Objective:To determine incidence of seasonal influenza virus infection in the community and to analyze the factors influencing seasonal influenza virus infection.Methods:This study recruited residents aged 6-59 years to build a cohort in 15 villages/streets in Macheng city in November 2019. Meanwhile, a cross-sectional baseline survey was conducted immediately to collect sera, information on demographics and child protection knowledge, behaviors, as well as attitudes using a questionnaire from the participants enrolled in the cohort (i.e., before the influenza epidemic season). In July 2020, a cross-sectional follow-up survey was conducted to collect sera once again (i.e., after the influenza season). Paired sera from the two cross-sectional surveys were tested for influenza virus-specific antibodies by hemagglutination inhibition (HI) test or micro-neutralization (MN) test using a circulating representative strain of each subtype/lineage of influenza virus as the test antigen. The infections with influenza virus subtype/lineage was confirmed if there was a four-fold or more increase in titers of antibodies against circulating representative strain of the subtype/lineage of influenza virus. Factors influencing infection with influenza A (H3N2) and B/Victoria viruses were analyzed using univariable and multivariable logistic regression.Results:In November 2019, 800 study participants were enrolled in the cohort, including 340 children aged 6-17 years and 460 adults aged 18-59 years; 605 study participants (including 224 children and 381 adults) were followed up in July 2020 and their paired sera were obtained before and after the influenza season. 25.3% (153/605) of the participants were confirmed to be infected with at least one subtype/lineage of seasonal influenza virus by HI and MN tests. The overall incidence of influenza viruses of all subtypes/lineages in children was 44.2% (95% CI: 37.6%-50.8%) which was significantly higher than the incidence of 14.1% in adults (95% CI: 10.7%-17.7%). Children had the highest incidence of influenza A (H3N2) virus infection, followed by B/Victoria. MN or HI antibody titers in A (H3N2)[ OR=0.88 (95% CI: 0.84-0.93)] and B/Victoria[ OR=0.97 (95% CI: 0.95-0.99)] before the influenza season were significantly associated with whether children were infected with that subtype/lineage of influenza virus. Conclusions:The residents aged 6-59 years in Macheng city had a substantial incidence of seasonal influenza virus infection during the influenza season from winter 2019 to spring 2020. Notably, almost half of children aged 6-17 years have been infected with seasonal influenza virus. Higher titers of HI/MN antibodies against seasonal influenza virus before the influenza season would be likely to reduce the risk of infection with influenza A (H3N2) and B/Victoria.

Objective:To investigate the neuropsychological and imaging features of patients with posterior cortical atrophy (PCA).Methods:Patients of PCA, dementia with Lewy bodies (DLB), typical Alzheimer′s disease (t-AD) who were diagnosed in the Department of Neurology, Huashan Hospital, Fudan University from September 27, 2019, to September 24, 2021 were enrolled, and the normal controls who visited the Outpatient and Physical Examination Centers of Huashan Hospital, Fudan University and Rizhao People′s Hospital at the same time were enrolled, too. Neuropsychological assessments, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT data of the 4-group subjects were collected. Variance analysis was used to compare the differences in neuropsychological performance among the 4 groups, and the imaging features of PCA patients were summarized.Results:Eleven PCA patients, 17 DLB patients, 31 t-AD patients, and 11 normal controls were included in the study. The cognitive function of patients in the PCA group [Mini-Mental State Examination (MMSE) score 13.52±1.81; Montreal Cognitive Assessment (MoCA) score 7.06±1.72] was significantly impaired compared to the normal control group (MMSE score 27.85±1.75, t=-6.561, P<0.001; MoCA score 23.60±1.59, t=-7.968, P<0.001]. However, there was no statistically significant difference compared to the DLB group and the t-AD group. Patients in the PCA group exhibited more severe impairments in attention, executive function, and language compared to the DLB group (Trail Making Test A score: 298.86±16.16 vs 110.07±18.62, t=9.980, P<0.001; Trail Making Test B score: 305.51±18.89 vs 230.34±23.59, t=2.865, P=0.024; Boston Naming Test score: 8.67±1.53 vs 15.66±1.56, t=-2.682, P=0.013) and the t-AD group (148.91±12.77, t=7.071, P<0.001; 200.78±19.34, t=3.789, P=0.004; 15.15±1.05, t=-2.544, P=0.016). Scores for visuospatial function [PCA group: 1(0, 1), normal control group: 3(3, 3), Z=-4.023, P<0.001] and visual perception [PCA group: 0(0, 1), normal control group: 35(34, 36), Z=-3.704, P<0.001] were significantly lower in the PCA group compared to the normal control group. The cranial MRI findings of PCA patients showed atrophy of the parietal and occipital lobes, with less obvious atrophy of the medial temporal lobe, which can be distinguished from t-AD. 18F-fluorodeoxyglucose PET/CT of the PCA patients showed a relative reduced glucose metabolism in the bilateral parietal lobe, occipital lobe and posterior cingulate gyrus, while the 18F-florbetapir PET/CT showed deposition of amyloid protein in the bilateral frontal lobe, parietal lobe, temporal lobe, and cingulate gyrus. Conclusions:PCA patients exhibit neuropsychological characteristics of visuospatial dysfunction, along with impairments in various cognitive domains such as memory, attention, and executive functions. The typical MRI feature is parietal occipital lobe atrophy, and the PET/CT findings are consistent with metabolic changes in AD.

Objective:To explore the remodeling of brain function 2 years after anterior cruciate ligament reconstruction (ACLR) and its relationship with functioning and behavior.Methods:Forty-eight volunteers who had received ACLR from the same surgeon were divided into a coping and a non-coping group, each of 17. Another 14 health volunteers formed the control group. Resting-state functional magnetic resonance imaging was used to record blood oxygen level-dependent signals from the members of all three groups in the 0.01 to 0.08Hz band. One-way analysis of variance was applied to the differences in low frequency amplitude (ALFF) observed.Results:The results of multiple comparisons with Gaussian random field theory correction showed that the differences in bilateral putamen ALFF values among the three groups were statistically significant. The signals from the right cerebellar area 8 and the bilateral putamen were significantly stronger among the non-coping group on average. Pearson correlation analysis showed that the ALFF values from the right cerebellar 8 region were positively and significantly more correlated with the symmetry of a subject′s Y balance function test results in the coping group compared with the non-coping group.Conclusions:Subcortical brain function remodeling occurs in ACLR patients returning to exercise after surgery, and a Y-balance function test can indirectly reflect such remodeling. That can provide a basis for designing programs for rehabilitating advanced brain functions.

Fulminant myocarditis occurs suddenly and progresses rapidly, often leading to severe heart failure, hypotension, or cardiogenic shock. Widespread myocardial calcification secondary to fulminant myocarditis is clinically rare, with sporadic reports both domestically and internationally. This article reports a case of a young female patient who presented with acute onset and rapidly deteriorating condition, with imaging indicating myocardial calcification by the second day of hospitalization, highlighting the unusual speed of progression.