ObjectiveThis study employed the scoping review method to systematically retrieve and analyze the basic information and clinical research evidence of expensive Chinese patent medicines （CPMs）， aiming to provide a basis for future related research and clinical applications. MethodsEight Chinese and English databases were systematically searched for the clinical research evidence on expensive CPMs. ResultsEleven expensive CPMs （Angong Niuhuang Wan， Jufang Zhibao Wan， Suhexiang Wan， Pien Tze Huang， Niuhuang Qingxin Wan， Qinggong Shoutao Wan， Compound Realgar Natural Indigo Tablets， Xihuang Wan， Dingkun Wan， Babao Wan， and Guilingji Capsules） were selected. A total of 365 related studies were included in this review， comprising 331 clinical studies （of which 291 were randomized controlled trials）， 30 systematic reviews and Meta-analyses， 3 expert consensus， and 1 rapid health technology assessment. Among the 11 CPMs， 2（Angong Niuhuang Wan and Jufang Zhibao Wan） had a daily price over 500 yuan. The famous and precious Chinese medicinal materials involved included Moschus （frequency of 7）， Bovisc Alculus （7）， and Borneol （5）. The dosage forms included pills， capsules， oral liquid， tablets， and lozenges. The diseases treated by these CPMs mainly included malignant tumors， cerebrovascular diseases， gynecological diseases， and hepatobiliary system diseases. The sample sizes of the clinical studies were mainly concentrated within the range of 51-100 cases， and the main control form was CPM + basic Western medicine treatment vs. basic Western medicine treatment. The 331 clinical studies reported a total of 44 adverse events occurred， of which 36 were determined to be adverse reactions. ConclusionThe scarcity of raw materials leads to the high prices of expensive CPMs. The difficulty of conducting clinical research and the critical and severe cases treated lead to a lack of clinical research evidence with large sample sizes. The uneven distribution of existing studies， incomplete information on medicine package， and non-standard clinical research designs remain to be addressed in the future.

Kounis syndrome is an acute coronary syndrome triggered by an allergic reaction, which is clinically rare and frequently subject to misdiagnosis or missed diagnosis. This article presents a case report of a 70-year-old male patient who developed a rash, pruritus, and chest pain following colon polyp resection. Coronary angiography revealed occlusion of the left anterior descending artery, and blood flow was restored after stent implantation. However, the patient experienced recurrent symptoms accompanied by loss of consciousness. Drug skin tests confirmed positive reactions to chlorhexidine and fondaparinux sodium, leading to a diagnosis of type Ⅱ Kounis syndrome. By avoiding allergenic drugs and combining antihistamines with symptomatic treatment to correct myocardial ischemia, the patient′s clinical symptoms significantly improved, and he eventually recovered and was discharged from the hospital. This case underscores the importance of maintaining vigilance for this syndrome in patients with allergies accompanied by chest pain and promptly identifying and avoiding allergens.

Here, we report a previously unrecognized syndromic neurodevelopmental disorder associated with biallelic loss-of-function variants in the RBM42 gene. The patient is a 2-year-old female with severe central nervous system (CNS) abnormalities, hypotonia, hearing loss, congenital heart defects, and dysmorphic facial features. Familial whole-exome sequencing (WES) reveals that the patient has two compound heterozygous variants, c.304C>T (p.R102*) and c.1312G>A (p.A438T), in the RBM42 gene which encodes an integral component of splicing complex in the RNA-binding motif protein family. The p.A438T variant is in the RRM domain which impairs RBM42 protein stability in vivo. Additionally, p.A438T disrupts the interaction of RBM42 with hnRNP K, which is the causative gene for Au-Kline syndrome with overlapping disease characteristics seen in the index patient. The human R102* or A438T mutant protein failed to fully rescue the growth defects of RBM42 ortholog knockout ΔFgRbp1 in Fusarium while it was rescued by the wild-type (WT) human RBM42. A mouse model carrying Rbm42 compound heterozygous variants, c.280C>T (p.Q94*) and c.1306_1308delinsACA (p.A436T), demonstrated gross fetal developmental defects and most of the double mutant animals died by E13.5. RNA-seq data confirmed that Rbm42 was involved in neurological and myocardial functions with an essential role in alternative splicing (AS). Overall, we present clinical, genetic, and functional data to demonstrate that defects in RBM42 constitute the underlying etiology of a new neurodevelopmental disease which links the dysregulation of global AS to abnormal embryonic development.
Female ; Animals ; Mice ; Humans ; Child, Preschool ; Intellectual Disability/genetics* ; Heart Defects, Congenital/genetics* ; Facies ; Cleft Palate ; Muscle Hypotonia

Objective:To investigate the hard and soft tissue changing trend and contributing factors of skeletal class Ⅱ hyperdivergent patients before and after orthodontic camouflage treatment by analyzing the cephalogram and the three dimensional(3D)facial scan data.Methods:Eighteen skeletal class Ⅱhyperdivergent adult female patients who finished camouflage orthodontic treatment were selected.Skele-tal and dental measurements were carried out with the cephalometric analysis before and after the treat-ment.3D facial data before and after orthodontic treatment were acquired and the anatomical landmarks were set after the repositioning and superimposition process.Hard tissue measurement included 17 mea-surement indicators(sella-nasion-subspinale angle,sella-nasion-supramental angle,subspinale-nasion-supramental angle,facial angle,angle of convexity,Frankfort horizontal plane-mandibular plane angle(FH-MP),Y axis angle,sella-nasion plane-mandibular plane angle(MP-SN),pogonion-nasion-supra-mental distance,upper incisor-nasion-subspinale distance,upper incisor to sella-nasion,lower incisor-nasion-supramental distance,lower incisor-nasion-supramental angle,upper incisor to lower incisor,up-per incisor to sella-nasion,lower incisor-mandibular plane angle,and Z angle),and the changes before and after treatment were measured for 11 of them.Twenty soft tissue landmarks(left/right cheekbone,left/right chelion,left/right crista philtra,soft tissue gnathion,left/right gonion,glabella,labrale infe-rius,labrale superius,soft tissue menton,left/right mid-mandibular border,soft tissue pogonion,stomi-on superius,sublabial,subnasale,and supralabial)and 9 soft tissue indicators(lower lip height,facial convexity,lower vermilion height,mandibular contour,nasolabial angle,philtral length,philtral width,upper lip height,and upper vermilion height)were measured and recorded for treatment changes.Linear-regression analysis and correlation analysis were carried out for analyzing the relationship between hard and soft tissue changes before and after the treatment.Results:Significant differences were noticed for 18 out of the 20 cephalometric measurements and facial measurements before and after the treatment(P＜0.05),which mainly represented the sagittal retraction of lip area after the treatment.Significant vertical displacements were revealed for soft tissue menton after treatment[(1.88±2.61)mm,P＜0.05].Significant sagittal displacements were revealed for left/right cheilion[(-2.95±1.9)mm,(-2.90±1.92)mm],labrale inferius[(-4.94±1.95)mm],labrale superius[(-3.25±1.44)mm],sublabial[(-3.10±3.5)mm],and subnasale[(-1.23±1.06)mm]after treatment(P＜0.05).An average of 4.10°±2.57° increasement was noticed for Z angle after treatment.High correla-tion(r＞0.7)was noticed for the displacement of menton after treatment with FH-MP,with the rate of-0.183:1,and MP-SN,with the rate of-0.157:1.Moderate correlations(0.7≥r＞0.4)were no-ticed for the other measurements with correlations(P＜0.05).Conclusion:A certain extent of facial improvements could be achieved with orthodontic camouflage treatment for skeletal class Ⅱ hyperdiver-gent patients,which were mostly represented by the improvement of sagittal relationship of nose,lips,and chin.Certain correlations were noticed for the hard and soft tissue changes.

Objective To analyze the mutation of common driver genes in patients with non-small cell lung cancer(NSCLC)in eastern Henan Province.Methods A retrospective analysis was performed on 661 patients with NSCLC admitted to the First People's Hospital of Shangqiu city from March 2022 to July 2023.Five kinds of gene mutation detection kits(fluorescent PCR)were used for gene detection in all enrolled patients.The relationship between the clinical features and the status of each driver gene was analyzed by statistical methods.Results In the 661 patients with NSCLC,the mutation rates of EGFR,KRAS,ALK,ROS1,PIK3CA,BRAF,HER2,RET,MET14 and NRAS were 47.35%,9.68%,5.45%,1.82%,2.87%,1.82%,1.21%,0.91%,0.61%and 0%.Mutations in EGFR,ROS1 and HER2 were more likely to occur in women(P<0.05),while KRAS mutations were more common in men(P<0.05).The mutation rates of EGFR,KRAS and ALK in adenocarcinoma was significantly higher than that in squamous cell carcinoma and NSCLC.NOS(P<0.05),and the mutation rate of PIK3CA in NSCLC.NOS was the highest.The mutation rate of KRAS gene in stage Ⅰ+Ⅱ was significantly higher than that in stage Ⅲ+Ⅳ(P<0.05),and there was no significant correlation between other genes and clinical stage.Compared with smokers,the mutation rate of total driver gene was significantly higher in non-smokers(P<0.05).EGFR,ALK,PIK3CA,ROS1,BRAF and HER2 were more common in non-smokers(P<0.05),while KRAS gene was more common in smokers(P<0.05).The mutation rate of 10 driver genes in sediment cell block samples was 78.67%,and the detection rate was significantly higher than that in other types of samples(P<0.05).Conclusion Com-mon driver genes such as EGFR,KRAS and ALK are correlated with gender,pathological type,clinical stage and smoking.Qualified samples of sediment cells have obvious advantages for gene detection and could be widely pro-moted in patients.ARMS-PCR combined detection of 10 genes could be used as the preferred gene detection method for newly diagnosed and treated NSCLC patients.

Objective By observing the effects of"three methods and three points"tuina technique on the expression of interleukin-17F(IL-17F),interleukin-17 receptor C(IL-17RC),activator 1 of nuclear transcription factor-κB(Act1),tumour necrosis factor receptor-associated factor 6(TRAF6)and M1 microglial cell expression in the spinal dorsal horn of rats with mild chronic compressive injury(minor CCI)model,we explored the immediate analgesic mechanism of tuina on peripheral neuropathic pain(pNP).Methods Thirty-six SD rats were divided into the sham group,the model group and the tuina group according to the random number method,twelve rats in each group,and the minor CCI model was replicated by ligating the right sciatic nerve.The rats in the tuina group were subjected to pointing,plucking and kneading at the BL37,BL57 and GB34 points on the affected side using a tuina simulator,while the sham group and the model group were only grasped and restrained,and were intervened for one time.The mechanical pain test and cold plate test were used to evaluate the response of rats to mechanical stimulation and cold stimulation after immediate intervention.The protein expression of IL-17F and TRAF6 in the spinal dorsal horn of rats in each group was detected by Western blotting.The mRNA expression of IL-17F,IL-17RC,Act1 and TRAF6 in the spinal dorsal horn of rats in each group was detected by real-time PCR.The average fluorescence intensity of M1 microglia in the spinal dorsal horn of rats in each group was detected by immunofluorescence.Results Behavioral results showed that before intervention,compared with the sham group,paw mechanical withdraw threshold(PMWT)decreased and cold sensitivity threshold(CST)increased in the model group and the tuina group;after tuina intervention,PMWT in the tuina group was increased,and CST was decreased compared with the model group;after intervention,PMWT in the tuina group was increased,while CST was decreased(P＜0.05).RT-PCR results showed that compared with the sham group,mRNA expression levels of IL-17F,IL-17RC,TRAF6 and Act1 in the spinal dorsal horn of the model group were increased;compared with model group,the mRNA expression levels of above indexes in the tuina group were decreased(P＜0.05).Western boltting results showed that compared with the sham group,the expression levels of IL-17F and TRAF6 protein in the spinal dorsal horn of the model group were increased;compared with the model group,the expression levels of IL-17F and TRAF6 protein in the tuina group decreased(P＜O.05).Immunofluorescence results showed that the mean fluorescence intensity of CD40 in the spinal dorsal horn of model group was enhanced compared with the sham group;compared with the model group,the mean fluorescence intensity of CD40 in the tuina group was decreased(P＜0.05).Conclusion The"three methods and three points"tuina technique can produce immediate analgesia by inhibiting the expression of IL-17F,IL-17RC,Act1,TRAF6 and the activation of M1 microglia in the dorsal horn of the spinal cord after one intervention.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective To investigate the mental health status and its influencing factors among elderly hypertensive patients from Rural Areas of Chuxiong and Honghe Prefecture in Yunnan.Methods Multi-stage random sampling method was adopted to select elderly hypertensive patients from rural Yi ethnic areas in Yunnan.Questionnaires were used to collect their basic information and mental health status.Multivariate logistic regression was performed to explore the influencing factors of mental health among the elderly hypertensives.Results 21.82%(209/958)of elderly people with hypertension have poor mental health status in Chuxiong and Honghe Prefecture,Yunnan.Age of 80-89 years(OR = 2.395,P<0.05)and over 90 years(OR = 3.293,P<0.05),as well as physical disability(OR = 2.037,P<0.05),were risk factors for poor mental health.Compared with those who rated their economic situation as very difficult,rating as somewhat difficult(OR = 0.490,P<0.05),moderate(OR = 0.632,P<0.05)and relatively affluent(OR = 0.344,P<0.05),having a spouse(OR = 0.655,P<0.05),received full concern from the offspring(OR = 0.411,P<0.05)and maintain good relationships with offspring(OR = 0.339,P<0.05)were protective factors.Conclusions The mental health status of elderly people with hypertension is relatively poor in rural areas of Chuxiong and Honghe Prefecture in Yunnan Province.Special attention should be paid to the mental health of older and physically disabled elderly hypertensives.Economic and mental support from children was crucially important in improving the mental health of elderly hypertensive patients in rural areas of Chuxiong and Honghe Prefecture in Yunnan Province.

Objective:To evaluate the effect of ultrasound-guided internal branch of superior laryngeal nerve(ibSLN) block on the quality of anesthesia recovery in the patients undergoing intracranial tumor surgery.Methods:The data from patients of either gender, aged 18-65 yr, with a body mass index of 18-28 kg/m 2, who underwent intracranial tumor surgery from December 2022 to October 2023, were retrospectively collected. Patients were divided into control group (group C) and ultrasound-guided ibSLN block group (group U). Bilateral ibSLN block was performed with 0.375% ropivacaine hydrochloride 2 ml.The tracheal extubation time, emergence time, development of cardiovascular events within 15 min after extubation, emergence agitation, Ramsay sedation score, Steward recovery score, visual analogue scale scores at 10 min after extubation and development of postoperative sore throat and hoarseness in postanesthesia care unit were recorded. Results:Compared with group C, the incidence of emergence agitation, Ramsay sedation score, visual analogue scale scores and sore throat were significantly decreased, the incidence of hoarseness was increased ( P<0.05), and no significant change was found in the extubation time, emergence time and Steward recovery score in group U( P>0.05). No hypertension, hypotension, tachachycardia and bradycardia were found in two groups. Conclusions:Ultrasound-guided ibSLN block can improve the quality of anesthesia recovery in the patients undergoing intracranial tumor surgery.

The education concepts of four famous traditional Chinese medicine（TCM） doctors（XIAO Longyou， SHI Jinmo， KONG Bohua and WANG Fengchun） in Beijing during the Republic of China were compared， the commonalities in their education concepts of TCM were sorted out， and the root system of the cultivation and growth of talents in TCM， as well as the direction and way of further development were searched， so as to improve the quality of the inheritance and development of TCM. Based on the systematic review of text and opinion method（SrTO） developed by the centre for evidence-based health care at the Joanna Briggs Institute（JBI） in Australia， this study was conducted to collate and analyze the relevant information， including 14 books， 115 journal papers and 7 documents. Related theory construction and practice of early tutor and academic education have been summarized from college， continuing and tutor education， academic research， examination， and so on. And then the connections and commonalities between the different forms of education in the period were summarized to form a SrTO-based narrative， opinion， text assessment and review instrument（NOTARI） summary table. The findings revealed that these four esteemed TCM doctors and educators， through their substantial influence on TCM education in Beijing， emphasized the importance of classics in teaching and clinical practice， underscored the cultivation of virtue， preserved the traditional teaching model， and championed the establishment of TCM schools. They also put forward novel requisites for the compilation of curricula， teaching materials， and books. Moreover， they advocated for a unified perspective on TCM and western medicine， fostering talent capable of bridging the gap between the two. They encouraged the standardization of TCM teaching examination system， and actively participated in scientific research and book writing. The four TCM doctors transcended the traditional boundaries of TCM practice， fostering a new TCM model of education-clinical-research， and profoundly influencing the contemporary TCM colleges and teacher education.