The disorder of group 3 innate lymphoid cells(ILC3)subgroup,such as the predominance of NCR-ILC3 but the deple-tion of NCR+ILC3,is unfavorable to damaged intestinal barrier repair,which leads to the prolongations and obstinacy of ulcerative colitis(UC).Our previous studies had shown that luteolin promoted NCRILC3 differentitating into NCR+ILC3 to improving the de-pletion of NCR+ILC3 in UC mice,while the mechanism is unclear.This article aimed to explore the underlying mechanism of luteolin enhancing the proportion NCR+ILC3.UC mice model was established with 2％DSS and Notch signaling was blocked,then luteolin was used to intervene.The results showed that the effect of luteolin on ameliorating disease symptoms in UC mice,including inhibit-ing the weight loss,reducing the pathological damage of colon mucosa,etc.,was diminished with blocking Notch signaling pathway.In addition,luteolin increased the proportion of NCR+ILC3,NCR+MNK3 and IL-22+ILC3,decreased intestinal permeability,pro-moted mucin secretion,and promoted ZO-1 and Occludin expression,the above effect of luteolin was neutralized by Notch inhibitor LY-411575.Luteolin activated the abnormally blocked Notch signaling pathway in UC mice.And molecular docking predicted the af-finity of luteolin for RBPJ to be-7.5 kcal·mol-1 in mouse,respectively;the affinity of luteolin for Notchl and RBPJ was respectively scored to be-6.4 kcal·mol-1 and-7.7 kcal·mol-1 homo sapiens.These results proved that luteolin is positive for enhancing the propor-tion of NCR+ILC3 via Notch signaling,and it provides a basis for targeting NCR+ILC3 for restoring intestinal barrier function to alle-viating ulcerative colitis.

Objective:To explore the values of transcranial Doppler (TCD) characterized spectra oscillatory wave and nail wave in determining brain death in patients accepted decompressive craniectomy (DC).Methods:One hundred and eighty-nine patients with brain death caused by neurological severe diseases admitted to Department of Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University from January 1, 2021 to December 31, 2023 were enrolled: 51 patients accepted DC (skull incomplete group) and 138 patients did not accept DC (skull intact group). TCD, electroencephalogram (EEG) and evoked potential (EP) were performed in all patients from the skull incomplete group and in 47 patients from the skull intact group. Differences in clinical data and detectable rate of TCD characterized spectra between the 2 groups were compared. Consistency of TCD results with EEG and EP results between the skull incomplete group and skull intact group was analyzed at time interval from brain death by clinical judgment to TCD<48 h or time interval from brain death by clinical judgment to TCD≥48 h. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for consistency of TCD results with EEG and EP results in patients from the skull incomplete group.Results:No significant difference in age, gender, time interval from brain injury to brain death by clinical judgment, time interval from brain death by clinical judgment to TCD, or systolic blood pressure during TCD was noted between the skull incomplete group and skull intact group ( P>0.05). Detectable rate of TCD characterized spectra in skull incomplete group (92.16%) was significantly higher than that in the skull intact group (73.91%, χ2=7.428, P=0.006). Consistency of TCD results with EEG and EP results in the skull incomplete group and skull intact group was both 100% at time interval from brain death by clinical judgment to TCD≥48 h. Multivariate Logistic regression analysis showed that time interval from brain death by clinical judgment to TCD≥48 h was an independent influencing factor for consistency of TCD results with EEG and EP results in the skull incomplete group ( OR=7.313, 95% CI: 1.612-15.973, P=0.004). Conclusion:Oscillatory wave and nail wave in TCD observed at time interval from brain death by clinical judgment to TCD≥48 h are the characteristic performances for brain death in patients accepted DC.

Deep phenotyping is a precise and comprehensive approach used for the precise analysis and comprehensive assessment of multi-system phenotypes of the patients. The approach uses symptoms, signs, various medical examination and laboratory results, and other relevant medical information. In the clinical diagnosis and medical research of rare bone diseases, deep phenotyping plays a pivotal role. The realization of precision medicine primarily comprises three key dimensions: deep phenotyping, stratified medicine, and targeted therapy. The deep phenotyping is the basis for the latter two. Deep phenotyping not only facilitates fine subtyping of diseases, but also allows for the in-depth understanding of genetic data. The use of deep phenotyping requires stand- ardized terminology and specific procedures. Moreover, deep phenotyping shows substantial potential using the application of artificial intelligence technology particularly when combining with multi-omics techniques.

Blau syndrome is a rare genetic disorder characterized by the a mix of granulomatous arthritis, uveitis, and dermatitis. Patients typically manifest multisystem involvement, including ocular, skin, and skeletal abnormalities. Blau syndrome is extremely rare, with a global incidence of less than one in a million among children. In this multidisciplinary consultation, we present a case of a 21-year-old young female patient having multisystemic involvement since early childhood. She was presented with multiple joint swelling, skin lesions, increased eye discharge, and accompanied by hypertension and arterial abnormalities, and received a diagnosis of uveitis. The patient had been receiving steroid treatment since the age of 6 and has tried various medications, with some improvement in joint swelling and ocular symptoms. Through this rare disease multidisciplinary consultation, we aim to provide guidance in the molecular diagnosis of the patient, multisystem assessment, and the selection and formulation of treatment plans. Additionally, we hope that by reporting this case, clinical physicians can gain a better understanding of the diagnosis and comprehensive treatment strategies for Blau syndrome, thereby improving the management and treatment of rare diseases.

OBJECTIVE To clarify whether the thera-peutic effect of escitalopram on depression patients is cor-related with traditional Chinese medicine syndrome types,and to provide a basis for more accurate drug applica-tion.METHODS A total of 235 depression patients were recruited and classified according to traditional Chinese medicine syndrome differentiation into 5 types:liver and qi stagnation(45),liver stagnation and fire transformation(43),liver qi stagnation and spleen deficiency(79),heart and spleen deficiency(20),and liver and kidney deficiency(38).All patients were treated with escitalopram(10 mg·d-1)for eight weeks.The Montgomery Depression Rating Scale(MADRS)and the 17 Hamilton Depression Rating Scale(HAMD-17)were used to score before treatment and 2,4,and 8 weeks after treatment,respectively.RESULTS Compared with before treatment,the MADRS and HAMD-17 scores and remission rates of each syn-drome type significantly improved with increasing medica-tion duration.The MADRS score relief rate of liver and kidney deficiency type was the most significant(69.3%),significantly higher than the other four syndrome types(47.5%-52.6%,P<0.05);The remission rate of HAMD-17 score was significantly higher than that of heart and spleen deficiency(50.7%vs.28.5%,P＜0.05).The remis-sion rate of HAMD-17 score in liver and qi stagnation type(52.2%)was significantly higher than that in liver stagnation and spleen deficiency type(37.0%,P＜0.01)and heart spleen deficiency type(28.5%,P＜0.05).CON-CLUSION Escitalopram may have a more significant therapeutic effect on patients with liver and kidney defi-ciency and liver stagnation depression.This study pro-vides a new approach for the more effective and accu-rate application of traditional Chinese medicine syndrome differentiation in the selection of clinical antidepressants.

Objective:To construct a nomogram model for spontaneous respiratory arrest prediction in nerocritical patients within 72 hours after brain injury for early identification of potential brain death organ donors.Methods:From October 2017 to May 2019, 127 hospitalized neurocritical patients (including traumatic brain injury and spontaneous cerebral hemorrhage) were prospectively enrolled and the parameters related to brain injury were dynamically recorded. Among them, the data from October 1, 2017 to May 31, 2018 were used for constructing the training set and the data from June 1, 2018 to January 31, 2019 for constructing the validation set. The occurrence of spontaneous respiratory arrest within 72 h after brain injury was regarded as the time interest point and grouping factor. The factors associated with spontaneous respiratory arrest were screened by univariate and multivariate analyses. Then the Nomogarm prediction model was developed and tested in the validation set.Results:Sixty-five patients entered the training set and another 62 cases were enrolled into the validation set. In training set, univariate and multivariate analyses indicated that midline shift ( OR=4.56, 95%CI: 1.87~19.21), absent of ambient cistern ( OR=4.83, 95%CI: 1.35~16.34), cough reflex ( OR=3.82, 95%CI: 1.15~12.42), intraventricular hemorrhage ( OR=3.16, 95%CI: 1.53~14.52) and serum Na + <125 mmol/L ( OR=3.06, 95%CI: 1.53~13.44) were associated with spontaneous respiratory within 72 h. In both sets, the predicted C index of spontaneous respiratory arrest rate within 72 h was 0.81 (95%CI: 0.76~0.85) and 0.80 (95%CI 0.75~0.83) respectively. Further statistical analysis implied that 140, 160 and 170 points were the dangerous dividing points and these three points were 30.1%, 65.6% and 93.4% associated with spontaneous respiratory arrest within 72 h respectively. Conclusions:Nomogram model based upon assessment parameters of brain injury may predict the time of spontaneous respiratory arrest in neurocritical patients. It can be used for early identification of potential brain death organ donors. The results require further external data validation.

Objective:To understand the current status of knowledge, attitude and practice of exercise rehabilitation nursing of clinical nurses in ClassⅢ Grade A hospitals in China.Methods:The convenient sampling method was adopted to conduct an online survey of 9 091 nurses from 31 Class Ⅲ Grade A hospitals in 31 provinces, municipalities and autonomous regions by using a self-designed questionnaire on Nurses' Knowledge, Attitude and Practice of Exercise Rehabilitation from May to July 2019. There were 34 items in the questionnaire, which mainly included the basic information of the survey objects, the knowledge and skills of sports rehabilitation nursing that nurses needed to master, the willingness of nurses to provide sports rehabilitation guidance and the current status of clinical implementation. A total of 9 091 questionnaires were distributed in this study, and the effective response rate was 100%.Results:Among the 9 091 nurses, 3 728 nurses (41.0%, 3 728/9 091) and 3 749 nurses (41.2%, 3 749/9 091) respectively indicated that they had not received relevant courses or skills training in school. 8 565 nurses (94.2%, 8 565/9 091) thought it was important to provide sports rehabilitation guidance, but they lacked the corresponding guidance ability, motivation and energy. In practice, 8 493 nurses (93.4%, 8 493/9 091) would provide suggestions and guidance related to sports rehabilitation to patients, mainly based on departmental nursing routine, relevant training, personal experience and literature.Conclusions:Clinical nurses in ClassⅢ Grade A hospitals in China have a positive attitude to participate in the exercise rehabilitation guidance of patients, but the level of knowledge and skills is low, and the behavior of rehabilitation guidance needs to be standardized. In the future, it should be further strengthened in terms of professional training, personnel training and related guidelines and standard construction.

Objective To identify the relative factors for "incongruent phenomenon" of brain electrical activity and cerebral blood flow during brain death determination for potential organ donors,and intensify the understanding and cognition of this phenomenon.Methods The clinical data of 127 potential donors accepted donation after brain death (DBD),admitted to our hospital from June 2018 to May 2019,were collected prospectively.All patients preferred brain electrical activity and cerebral blood flow assessments as the confirmatory tests of brain death determination.For patients with "incongruent phenomenon",further test of median nerve short latency evoked potential or brain electrical activity and cerebral blood flow assessments after waiting for 24 h were performed to confirm brain death determination again.Fifteen parameters,such as gender,age,time of spontaneous respiration arrest,blood pressure,operative types,neurological examination,neuroimaging index,and serum Na+ level,were selected;univariate and multivariate Logistic regression analyses were used to identify these risk factors related to "incongruent phenomenon".Results Among the 127 patients,22 patients (17.3％) appeared "incongruent phenomenon";17 (77.2％) had electrical silence earlier than cerebral blood flow arrest,and 5 (22.7％) had cerebral blood flow arrest earlier than electrical silence.Multivariate Logistic analysis showed that age ≤ 14 years (OR=6.250,95CI:1.201-32.220,P=0.028),systolic blood pressure ≥ 140 mmHg (OR=7.430,95CI:1.621-33.992,P=0.010),primary brain-stem injury (OR=15.890,95CI:3.042-82.930,P=0.006),spontaneous respiratory arrest time ≤72 h (OR=1 1.964,95CI:3.045-82.932,P=0.006),and unilateral/bilateral decompressive craniectomy (OR=16.281,95CI:1.590-89.785,P=0.001)were independent risk factors for "incongruent phenomenon".Conclusion "Incongruent phenomenon" is common in confirmatory test of brain death determination in China;patients with age≤14 years,systolic blood pressure ≥ 140 mmHg,primary brain-stem injury,spontaneous respiratory arrest time ≤ 72 h,and decompressive craniectomy (unilateral/bilateral) are more likely to have "incongruent phenomenon".

Objective: To establish a method for simultaneous and rapid detecting of the polymorphisms in Cytochrome P450 2C9 (CYP2C9), CYP2C19, CYP4F2, Vitamin K epoxide reductase (VKORC1) and ATP-binding cassette subfamily B member1 (ABCB1) gene, which were associated with warfarin and clopidogrel, based on liquid phase chip technology. Methods: Method establishment. The eight gene sequences near targeted sites related to warfarin and clopidogrel were found in Genbank, and the specific primers and probes were designed. Through multiple PCR amplification, followed by allele specific primer extension (ASPE), and MagPlex-Tag microspheres hybridization, the suspension array Luminex 200 system step-by-step, the genotypes were determined by fluorescence signal. The reaction system was optimized and its methodological evaluation was performed. 260 patients with antithrombotic therapy from Dongguan houjie hospital were recruited in this study form June 2017 to December 2018. The eight genotypes of the 260 patients were detected by the established method, and the results were compared with the sequencing results. Results: The results of 260 samples showed that allelic median fluorescence intensity (MFI) ratios of homozygotes (mutant/wild-type) were all greater than 0.9 or less than 0.1, and all the allelic MFI ratios of heterozygotes were between 0.3 and 0.6. The within run and between run coefficients of variance for allelic MFI ratios were lower than 6.4% and 10.9%, respectively. The minimum DNA template requirements was 0.75ng. The genotypes of 260 patients determined by the established method were completely concordant with the sequencing results. Conclusion A method was established successfully for rapid detecting the genotypes which associated with warfarin and clopidogrel based on liquid phase chip technology.

Objective By analyzing unusual movements of brain death organ donors before organ donation,to avoid misunderstanding and ensure the implementation of organ donation successfully.Methods Relevant clinical data of potential brain death organ donors admitted to the First Affiliated Hospital of Sun yat-sen University were prospectively collected between January 2016 and December 2017.The related parameters of neurological examination,neuroimaging examination and laboratory examination after brain death determination were dynamically recorded.The occurrence of limb,head and respiratory-like movement after brain death was defined as unusual movements,and the factors associated with unusual movements were screened by univariate and multivariate analysis.Results According to the inclusion criteria,164 patients were enrolled into this study.Twenty-two (13.4％) had unusual movements and duration was less than 72 h.Among them,21 (12.8％) had limbs unusual movements,6 (3.7％) had respiratory-like movement,5 (3％) owned both,and 4 (2.4％) had head rotation accompanied with limbs unusual movements.Univariate and multivariate analysis showed that axillary temperature ≤36 ℃,serum sodium ≤125 mmol/L,primary brain stem injury,spontaneous respiratory arrest time ≤72 h and age ≤ 18 years were associated with unusual movements.Conclusion During the clinical practice of brain death determination in China,the incidence of unusual movements is relatively low,and related to some factors,but it is extremely easy to cause misunderstanding.Correct cognition and interpretation are contributed to the successful implementation of organ donation.