Objective:To investigate the correlation between the clinical features and endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) in patients with cirrhosis.Methods:A total of 148 patients with cirrhosis and portal hypertension who underwent EUS-PPG measurement at the Third Xiangya Hospital of Central South University from March 15, 2022 to June 20, 2023 were selected. The clinical data of patients collected before EUS-PPG measurement were analyzed. Variations in the EUS-PPG across different clinical data subgroups were analyzed. Multivariate linear regression analysis was used to explore the independent factors influencing EUS-PPG.Results:The EUS-PPG was significantly elevated in patients exhibiting red signs (16.62±5.33 mmHg VS 13.44±5.34 mmHg, t=3.616, P<0.001), gastroesophageal varices (15.78±5.30 mmHg VS 9.70±4.77 mmHg, t=4.247, P<0.001), hepatic encephalopathy (20.83±7.52 mmHg VS 14.92±5.35 mmHg, t=2.606, P=0.010), thrombocytopenia (15.66±5.39 mmHg VS 13.29±5.83 mmHg, t=2.136, P=0.034), hypoproteinemia (16.13±5.86 mmHg VS 14.12±5.03 mmHg, t=2.230, P=0.027), and an increased international normalized ratio (16.25±6.00 mmHg VS 14.40±5.11 mmHg, t=2.022, P=0.045). Conversely, the EUS-PPG was significantly reduced in patients with a history of splenectomy and devascularization (13.17±5.88 mmHg VS 15.73±5.34 mmHg, t=-2.379, P=0.019). The EUS-PPG in patients with varying degrees of ascites (no VS slight VS moderate or severe: 13.40±5.48 mmHg VS 15.90±5.49 mmHg VS 16.69±5.17 mmHg, F=5.188, P=0.007) and different Child-Pugh classifications (A VS B VS C: 14.07±5.05 mmHg VS 15.69±5.74 mmHg VS 17.64±5.99 mmHg, F=3.066, P=0.049) increased gradually. Multivariable linear regression analysis showed that red signs ( β=2.44, t=2.732, P=0.007), gastroesophageal varices ( β=4.45, t=2.990, P=0.003), ascites ( β=1.75, t=2.368, P=0.019), and hepatic encephalopathy ( β=5.82, t=2.644, P=0.009) were independent factors for the elevated EUS-PPG. Conclusion:There is a significant correlation between EUS-PPG and the clinical features related to the severity of cirrhotic portal hypertension, which indicates the feasibility of EUS-PPG in evaluating cirrhotic portal hypertension.

Objective:To investigate the effects of case-based learning combined with clinical anatomy in neurosurgery internships.Methods:We included students in grades 2014 and 2015 (test group, n=58) and those in grade 2013 (control group, n=48) doing internships in The first Affiliated Hospital of Shantou University Medical College. The test group adopted case-based learning combined with clinical anatomy in the form of neurosurgery intern learning groups. The group learning consisting of four sessions was held twice a week for a total of four times. The traditional teaching method was used in the control group. All the students filled in the Self-Directed Learning Readiness Scale before and after neurosurgery internships. The test group filled in the Satisfaction Survey on case-based learning combined with clinical anatomy after neurosurgery internships. SPSS 20.0 was used to perform t test. Results:Before neurosurgery internships, there was no difference in self-directed learning ability between the test group and control group ( t=0.25, P=0.807). After the internships, the total score of self-directed learning ability was significantly improved in both the test group ( t=-6.49, P<0.001) and the control group ( t=-4.68, P<0.001). The test group showed improvements in six learning factors, while the control group had no significant changes in love of learning and learning motivation. Compared with the control group, the test group showed a significantly higher total score of self-directed learning ability ( t=2.17, P=0.032) and significantly higher scores of efficient learning ( t=3.81, P=0.001) and learning motivation ( t=4.20, P=0.001). The students in the test group were generally satisfied with the new method combining case-based learning and clinical anatomy. Conclusion:The new method combining case-based learning and clinical anatomy has positive effects on students' self-directed learning ability, especially on learning efficiency and motivation, with a high degree of satisfaction from the students.

BACKGROUND: Despite the progress in perinatal-neonatal medicine, complications of extremely preterm infants continue to constitute the major adverse outcomes in neonatal intensive care unit. Human umbilical cord Wharton’s Jellyderived mesenchymal stem cells (HUMSCs) may offer new hope for the treatment of intractable neonatal disorders. This study will explore the functional differences of HUMSCs between extremely preterm and term infants. METHODS: UMSCs from 5 extremely preterm infants(weeks of gestation: 22+5 w,24+4 w,25+3 w,26 w,28 w) and 2 term infants(39 w,39+2 w) were isolated, and mesenchymal markers, pluripotent genes, proliferation rate were analyzed.HUVECs were injured by treated with LPS and repaired by co-cultured with HUMSCs of different gestational ages. RESULTS: All HUMSCs showed fibroblast-like adherence to plastic and positively expressed surface marker of CD105,CD73 and CD90, but did not expressed CD45,CD34,CD14,CD79a and HLA-DR; HUMSCs in extremely preterm exhibited significant increase in proliferation as evidenced by CCK8, pluripotency markers OCT-4 tested by RT-PCR also showed increase. Above all, in LPS induced co-cultured inflame systerm, HUMSCs in extremely preterm were more capable to promote wound healing and tube formation in HUVEC cultures, they promoted TGFb1 expression and inhibited IL6 expression. CONCLUSIONS Our results suggest that HUMSCs from extremely preterm infants may be more suitable as candidates in cell therapy for the preterm infants.

Novel coronavirus Omicron variant infection can cause severe illness and even death in certain populations. Omicron variant infection may lead to systemic inflammatory response, coagulation disorder, multi-organ dysfunction and other pathophysiological changes, which are different from other Novel coronavirus variants to a certain extent, so therapeutic strategies should not be the same. The National Medical Center for Major Public Health Events invited experts in fields of infectious diseases, respiratory medicine, intensive care, pediatrics and fever clinic to develop this quick guideline based on the current best evidence and extensive clinical practices. This quick guideline aims to standardize the diagnosis and treatment of novel coronavirus Omicron infection, and to improve the disease management abilities of clinicians.

Objective:To investigate the factors affecting phenotypes in the patients of methylmalonic acidemia combined with homocysteinemia cblC type with MMACHC c. 609G>A homologous variant. Methods:A retrospective study on the clinical manifestations, complications, treatment, and outcome in 164patients of cblC type with MMACHC c. 609G>A homologous variant was conducted.The patients were diagnosed by biochemical and genetic analysisfrom January 1998 to December 2020. Results:Among the 164 patients, 2 cases were prenatally diagnosed and began treatment after birth. They are 3 and 12 years old with normal physical and mental development. Twenty-one cases were diagnosed by newborn screening. Among them, 15 cases had with normal development. They were treated fromthe age of two weeks at the asymptomatic period. Six cases began treatment aged 1 to 3 months after onset. Their development was delayed. One hundred and forty-one cases were clinically diagnosed. Their onset age ranges from a few minutes after birth to 6 years old. 110 cases had early-onset (78.0%). 31 cases had late-onset (22.0%). Five of them died. 24 patients lost to follow-up. Of the 141 clinically diagnosed patients, 130 (92.2%) with psychomotor retardation, 69 (48.9%) with epilepsy, 39 (27.7%) with anemia, 30 (21.3%) had visual impairment, 27 (19.1%) had hydrocephalus, 26 (18.4%) had feeding difficulties, 7 (5.0%) with liver damage, and 5 (3.5%) with metabolic syndrome. The frequency of hydrocephalus and seizures was significantly higher in the early-onset group. The urinary methylmalonic acid increased significantly in the patients with epilepsy. During the long-term follow-up, the level of plasma total homocysteine in the seizure-uncontrolled group was significantly higher than that in the seizure-controlled group, the difference had a statistical significance ( P<0.05). Conclusion:Most of the patients with MMACHC c. 609G>A homozygous variant had early-onset disease, with a high mortality and disability rate. If not treated in time, it will lead to neurological damage, resulting in epilepsy, mental retardation, hydrocephalus, and multiple organ damage. Pre-symptomatic diagnosis and treatment are crucial to prevent irreversible neurological damage. Neonatal screening and prenatal diagnosis are important to improve the outcome of the patients.

Objective:To analyze the monitoring results of plague foci in Guizhou Province, to master the epidemic dynamics of the plague and to formulate the prevention and control measures.Methods:The plague monitoring data from 2018 to 2020 in Guizhou Province were collected from China Disease Prevention and Control Information System Plague Prevention and Control Information Management System to analyze the plague epidemic situation. The murine animals capture methods used were cage clip method, 5 m cage clip method and day-by-day rodent capture method. Bacterial culture and hemagglutination were used in laboratory.Results:A total of 2 273 murine animals were captured indoors with cage clip method, and the Rattus norvegicus was the dominant species, accounting for 47.29% (1 075/2 273), Rattus flavipectus and Mus musculus were common species, accounting for 43.55% (990/2 273) and 5.10% (116/2 273). A total of 1 460 murine animals were captured outdoors with 5 m cage clip method, and the Rattus rattus sladoni was the dominant species, accounting for 35.48% (518/1 460), Rattus flavipectus and Eothenomys miletus were common species, accounting for 16.03% (234/1 460) and 8.70% (127/1 460). A total of 5 742 murine animals (including 3 733 animals captured with cage clip method and 5 m cage clip method, 2 009 animals captured with day-by-day rodent capture method) were examined and 1 176 with flea, the flea infestation rate of murine animals was 20.48%, Xenopsylla cheopi was the dominant flea species [56.63% (3 020/5 333)] and the index was 0.53. Laboratory test results were all negative. Conclusions:The plague foci of Guizhou Province is at a quiescent stage, but the reignition cannot be ruled out. The monitoring of plague should be strengthened, the quality of the monitoring should be improved, and health education and publicity should be carried out to prevent the occurrence of human plague outbreaks.

Objective:To analyze the clinical features, genetic characteristics, treatment and follow-up results of patients with hydrocephalus caused by methylmalonic acidemia combined with homocysteinuria, and to discuss the optimal strategies for assessing and treating such patients.Methods:From January 1998 to December 2020, 76 patients with hydrocephalus due to methylmalonic acidemia combined with homocysteinuria in the Department of Pediatrics in 11 hospitals including Peking University First Hospital were diagnosed by biochemical, genetic analysis and brain imaging examination. The patients were divided into operation-group and non-operation-group according to whether they underwent ventriculoperitoneal shunt. The clinical features, laboratory examinations, genotype, and follow-up data were retrospectively analyzed. Data were compared between the two groups using rank sum test, and categorical data were compared using χ 2 test. Results:Among the 76 patients (51 male, 25 female), 5 were detected by newborn screening, while 71 were diagnosed after clinical onset, 68 cases (96%) had early-onset, 3 cases (4%) had late-onset. The most common clinical manifestations of 74 cases with complete data were psychomotor retardation in 74 cases (100%), visual impairment in 74 cases (100%), epilepsy in 44 cases (59%), anemia in 31 cases (42%), hypotonia or hypertonia in 21 cases (28%), feeding difficulties in 19 cases (26%) and disturbance of consciousness in 17 cases (23%). Genetic analysis was performed in 76 cases, all of whom had MMACHC gene variations, including 30 homozygous variations of MMACHC c.609G>A. The most common variations were c.609G>A (94, 62.7%), followed by c.658_660del (18, 12.0%), c.567dupT (9, 6.0%) and c.217C>T (8, 5.3%). Therapy including cobalamin intramuscular injection, L-carnitine and betaine were initiated immediately after diagnosis. A ventriculoperitoneal shunt operation was performed in 41 cases (operation group), and 31 patients improved after metabolic intervention (non-operation group). There was no significant difference in the age of onset, the age of diagnosis, the blood total homocysteine, methionine, and urinary methylmalonic acid concentration between the two groups (all P>0.05). The symptoms of psychomotor development, epilepsy, and visual impairments improved gradually after a long-term follow-up in the operation group. Conclusions:Hydrocephalus is a severe complication of methylmalonic acidemia combined with homocysteinuria. The most common clinical manifestations are psychomotor retardation, visual impairment, and epilepsy. It usually occurs in early-onset patients. Early diagnosis and etiological treatment are very important. Hydrocephalus may improve after metabolic intervention in some patients. For patients with severe ventricular dilatation, prompt surgical intervention can improve the prognosis.

Objective To study the predictive value of continuous amplitude-integrated electroencephalogram (aEEG) monitoring for the neurodevelopment outcome in infants with hypoxic-ischemic encephalopathy (HIE) receiving hypothermia treatment.Method From April 2014 to May 2016,neonates admitted to our NICU with HIE receiving hypothermia treatment were continuously monitored using aEEG for 96 h,and assigned into moderately and severely abnormal groups according to aEEG results.The aEEG results before hypothermia treatment,within 24 h,48 h,72 h and 96 h after hypothermia treatment were recorded.The Bayley Scales of Infant Development Ⅱ examination was performed at 6 months of age.The sensitivity,specificity,positive and negative predictive values and Youden's index of aEEG for poor outcome at these timepoints was compared.Result A total of 30 neonates were enrolled.Among them 13 were moderately abnormal and 17 were severely abnormal.The gender,gestational age,birth weight and delivery method between two groups were similar (P ＞ 0.05).The 1 min Apgar score,arterial pH,base excess (BE) were significantly lower in the severely abnormal group (P ＜ 0.05).The neurodevelopment assessment at 6 months of age showed unfavorable outcomes in 16 cases,while the remaining 14 cases had generally good outcomes.The sensitivity and specificity of aEEG before hypothermia treatment for the prediction of poor outcome was 81.3％ and 71.4％ respectively.The sensitivity and negative predictive values of aEEG within 24 and 48 after hypothermia treatment for poor outcome was 100％.The Youden's index of aEEG within 72 h after hypothermia treatment for abnormal outcome was the highest 0.661.Conclusion The aEEG before hypothermia treatment alone is not a reliable indicator of poor outcomes in HIE neonates.The aEEG within 72 h after hypothermia is better.Continuous aEEG monitoring during hypothermia in HIE infants is very important because it provides reliable prediction of outcome.

Objective To analyze the monitoring results on plague from 2013 to 2017 in Guizhou Province,to master the epidemic dynamics of the plague and to provide a basis for developing countermeasures.Methods Using a retrospective analysis method,plague monitoring data from 9 monitoring sites in Xingyi City,Anlong County,Ceheng County,Xingren County,Pan County,Liuzhi Special Zone,Si'nan County,Dejiang County and Yanhe County in Guizhou Province from 2013-2017 were collected and analyzed.Results In 2013-2017,there were no plague F1 antigen and F1 antibody.A total of 3 575 murine animals were captured indoors,with Rattus norvegicus as the dominant species,accounting for 49.99％ (1 787/3 575).Rattus norvegicus and Mus musculus were common species,accounting for 35.64％ (1 274/3 575) and 11.36％ (406/3 575),respectively;the density of indoor rat was 3.48％(3 575/102 641),there was no significant difference in rat density between different years (x2 =3.655,P ＞ 0.05).A total of 1 674 murine animals were captured outdoors,and the Rattus norvegicus was the dominant species,accounting for 34.29％ (574/1 674).S.serrata and Rattus norvegicus were common species,accounting for 18.28％ (306/1 674) and 13.20％ (221/1 674),respectively;the density of outdoor rat was 1.67％ (1 674/100 180),there was no significant difference in rat density between different years (x2 =6.241,P ＞ 0.05).A total of 9 541 murine animals were examed and 2 270 rats with flea were detected,the flea infestation rate of rat was 23.79％,the rat body flea index was 1.019 4,Xenopsylla cheopi was the dominant flea species and the index was 0.557 3.Conclusions The plague natural focus of Guizhou is at a quiescent stage.The plague monitoring work should be strengthened,health education should be done well,and plague epidemics should be stricdy prevented.

Temporal lobe epilepsy (TLE) is the most common clinical type of epilepsy,which is generally available for drug therapy.Surgical operation will be considered when patients developing into refractory epilepsy.Currently,treatment response evaluation is based on the observation of seizure remission in a certain period,and the real-time and objective evaluation is unavailable.With the improvement of MRI technology and image analysis methods,the multimodal MRI has been widely used to assess the effectiveness of TLE treatment.The progresses of multi-modal MRI and its new technique in assessment of epilepsy remission and cognitive function in TLE patients were reviewed in this article.