Hypomyelinating leukodystrophies (HLDs) are a group of neurodegenerative diseases characterized by decreased myelination in the central nervous system, with diverse clinical manifestations like psychomotor retardation and dyskinesia.Some HLDs patients have epilepsy, microcephaly and other clinical manifestations.At present, there is no specific treatment of HLDs, and the prognosis is usually poor.At present, with the wide application of gene screening in clinical practice, many pathogenic genes related to HLDs have been found.It is particularly important to clarify the pathogenesis and clinical phenotypic changes of HLDs.

Objective To analyze the clinical characteristics of thyroid dysfunction induced by camrelizumab in the treatment of classical Hodgkin lymphoma(cHL)and explore the influencing factors.Methods The medical records of cHL patients treated with camrelizumab from January 1st,2017 to December 31st,2020,were collected.The clinical characteristics of thyroid dysfunction induced by camrelizumab were analyzed,and the influencing factors of adverse drug reactions(ADRs)were discussed.Results A total of 47 patients were included,12 patients(25.53%)experiencing thyroid dysfunction after receiv-ing camrelizumab.Among them,3 patients had hypothyroidism,7 had subclinical hypothyroidism,and 2 had subclinical hyperthy-roidism.The severity of ADRs was between grade 1 and 2(mild to moderate).None of the patients with thyroid dysfunction dis-continued camrelizumab.Thyroid dysfunction occurred between 1 and 22 months after camrelizumab treatment,with a median time of 6 months.2 patients with hypothyroidism treated with levothyroxine,the thyroid function returned to normal in 1 patient and was improved in the other.1 patient with subclinical hypothyroidism was treated with levothyroxine with the thyroid function continued to be abnormal.The rest of the 9 patients with thyroid dysfunction received no intervention,and 4 of them returned to normal,and others remained with no obvious change or loss in follow-up.Thyroid dysfunction was associated with baseline thyroid stimulating hormone level(P=0.03).The level of thyroglobulin antibodies and thyroid peroxidase antibodies was increased in 2 patients a-mong 3 patients with moderate thyroid dysfunction.Conclusion The incidence of thyroid dysfunction induced by camrelizum-ab in cHL was high.Camrelizumab-induced thyroid dysfunction was related to TSH baseline level(P=0.03).The severity was between grade 1 and 2,which was related to the level of TgAb and TPOAb.The subtype of thyroid dysfunction was mainly sub-clinical hypothyroidism with a long period.Patients could continue camrelizumab treatment,and the thyroid function of patients with grade 2 hypothyroidism was improved after the treatment with levothyroxine.

Objective To explore the relevant factors of new-onset conduction disturbance(NOCD)after transcatheter aortic valve replacement(TAVR),such as anatomical structure,device type,surgical strategies,etc.,discover relevant predictive factors,and establish a predictive model to assess the risk of conduction blockages.Methods From January 2016 to March 2022,clinical data of symptomatic patients with severe aortic valve stenosis or severe regurgitation who underwent TAVR at Xiangya Second Hospital of Central South University were collected through the hospital information system and imaging database.ECG,echocardiography,CTA,surgical materials,etc.,were extracted and analyzed by specialists.SPSS software was used for statistical analysis,and a multi-factor regression prediction model for NOCDwas built.Results A total of 184 patients were included,the occurrence rate of NOCD after TAVR was 31.0%,pure regurgitation patients'NOCD occurrence rate was 63.6%(7/11).The NOCD group had a larger aortic angles[(57.7±10.3)°vs.(52.0±9.0)°,P＜0.001],larger Oversizing[(129±28)%vs.(120±21)%,P=0.018],deeper implantation depth[(7.2±5.1)mm vs.(4.8±4.2)mm,P=0.001],and higher pure regurgitation patients'proportion[12.3%vs.3.1%,P=0.037]than the non-NOCD group.Multifactorial Logistic regression analysis indicated that an aorta angle＞54.5°(OR 3.78,95%CI 1.86-7.63,P＜0.001)or implantation depth＞5.7 mm(OR 3.39,95%CI 1.68-6.85,P＜0.001)are independent risk factors for new onset conduction disturbances after TAVR,and a predictive model was established with aortic angle,implantation depth,and Oversizing ratio as variables.The receiver operating characteristics curve showed area under ROC curve 0.709,95%CI 0.623-0.795,predicting NOCD after TAVR.Conclusions A retrospective analysis carried out at a single center discovered that the aortic angle in the NOCD group was larger than that in the non-NOCD group,the Oversizing ratio was higher,the implantation location was deeper,and there was a higher proportion of patients with pure regurgitation lesions.An aortic angle greater than 54.5°or an implantation depth more than 5.7 mm were identified as independent risk factors for NOCD after TAVR.

Objective To investigate the effect of paeoniflorin on aerobic glycolysis of macrophages induced by resiquimod.Methods THP-1 cells were treated with phorbol ester(PM A)to differentiate into macrophages.The cells were divided into control group,model group and low,medium,high dose experimental group.The cells in the control group were cultured normally;in the model group,2 μg·mL-1 resiquimod was used to stimulate macrophages for 24 h to induce aerobic glycolysis.The low,medium and high dose experimental groups were treated with 1,10 and 100 μmol·L-1 paeoniflorin for 24 h on the basis of the model group.Cell activity was detected by cell counting kit-8(CCK-8)method.Lactate and glucose determination kit were used to detect lactate secretion and glucose consumption of cells in each group.The protein and mRNA expression levels of(PKM2)and(LDHA)were detected by Western blot and real-time fluorescence quantitative polynucleotide chain reaction(q-PCR)respectively.Immunofluorescence method was used to compare the fluorescence intensity of PKM2 in each group.Results After 24 h stimulation of THP-1 cells with 2 μg·mL-1 resiquimod,the glucose contents in cell culture supernatants of control group,model group and low,medium and high dose experimental groups were(14.70±0.44),(9.83±0.43),(10.68±0.29),(11.79±0.33)and(13.63±0.74)mmol·L-1;the lactate secreted by cells were(6.17±0.48),(11.94±0.55),(9.08±0.55),(7.79±0.66)and(6.50±0.55)mmol·L-1;the protein expression levels of PKM2 in cells were 1.00±0.00,1.33±0.18,1.02±0.17,0.74±0.17 and 0.73±0.18;the protein expression levels of LDHA were 1.00±0.00,1.20±0.09,0.90±0.14,0.76±0.12 and 0.78±0.17;the PKM2 mRNA levels were 1.00±0.09,2.11±0.23,1.98±0.31,1.38±0.25 and 0.93±0.32;the LDHA mRNA levels were 1.00±0.13,1.85±0.25,1.44±0.21,0.91±0.24 and 0.96±0.14;the average fluorescence intensities of PKM2 were 136.41±33.63,217.94±5.33,210.27±1.03,204.14±3.27 and 186.79±14.03.Compared with control group,the above indicators in model group showed statistically significant differences(P＜0.05,P＜0.01);compared with model group,the differences in the above indicators in medium and high dose experimental group were all statistically significant(P＜0.05,P＜0.01).Conclusion Paeoniflorin can inhibit the aerobic glycolysis of macrophages induced by resiquimod.

Background Improper settings of outdoor smoking points in public places may increase the risk of secondhand smoke exposure among the population. Conducting research on air pollution in and around smoking spots and related influencing factors can provide valuable insights for optimizing the setting of outdoor smoking points. Objective To investigate the influence of the number of smokers at outdoor smoking points and the distance on the diffusion characteristics of surrounding air pollutants, in order to optimize the setting of outdoor smoking points. Methods Surrounding the exhibition halls in the China International Import Expo (CIIE), two outdoor smoking points were randomly selected, one on the first floor (ground level) and the other on the second floor (16 m above ground), respectively. At 0, 3, 6, and 9 m from the smoking points in the same direction, validated portable air pollutant monitors were used to measure the real-time fine particulate matter (PM_2.5) and carbon dioxide (CO₂) concentrations for consecutive 5 d during the exhibition, as well as the environmental meteorological factors at 0 m with weather meters including wind speed, wind direction, and air pressure. An open outdoor atmospheric background sampling point was selected on each of the two floors to carry out parallel sampling. Simultaneously, the number of smokers at each smoking point were double recorded per minute. The relationships between the number of smokers, distance from the smoking points, and ambient PM_2.5 and CO₂ concentrations were evaluated by generalized additive regression models for time-series data after adjustment of confounders such as temperature, relative humidity, and wind speed. Results The median numbers of smokers at smoking points on the first and second floors were 6 [interquartile range (IQR): 3, 9] and 9 (IQR: 6, 13), respectively. Windless (wind speed <0.6 m·s⁻¹) occupied most of the time (85.9%) at both locations. The average concentration of ambient PM_2.5 at the smoking points (0 m) [mean ± standard deviation, (106±114) μg·m⁻³] was 4.2 times higher than that of the atmospheric background [(25±7) μg·m⁻³], the PM_2.5 concentration showed a gradient decline with the increase of distance from the smoking points, and the average PM_2.5 concentration at 9 m points [(35±22) μg·m⁻³] was close to the background level (1.4 times higher). The maximum concentration of CO₂ [(628±23) μmol·mol⁻¹] was observed at 0 m, and its average value was 1.3 times higher than that of the atmospheric background [(481±40) μmol·mol⁻¹], and there was no gradient decrease in CO₂ concentration with increasing distance at 0, 3, 6, and 9 m points. The regression analyses showed that, taking smoking point as the reference, every 3 m increase in distance was associated with a decrease of ambient PM_2.5 by 24.6 [95% confidence interval (95%CI): 23.5, 25.8] μg·m⁻³ (23.2%) and CO₂ by 54.1 (95%CI: 53.1, 55.1) μmol·mol⁻¹ (8.6%). Every one extra smoker at the smoking point was associated with an average increase of PM_2.5 and CO₂ by 2.0 (95%CI: 1.7, 2.8) μg·m⁻³ and 1.0 (95%CI: 0.7，1.2) μmol·mol⁻¹, respectively. The sensitivity analysis indicated that, under windless conditions, the concentrations of PM_2.5 and CO₂ at the smoking points were even higher but the decreasing and dispersion characteristics remained consistent. Conclusion Outdoor smoking points could significantly increase the PM_2.5 concentrations in the surrounding air and the risks of secondhand smoke exposure, despite of the noticeable decreasing trend with increasing distance. Considering the inevitable poor dispersion conditions such as windless and light wind, outdoor smoking points are recommended to be set at least 9 m or farther away from non-smoking areas.

Objective This study compared the effects of intraoperative intercostal nerve block(ICNB)and preoperative ultrasound-guided paravertebral block(US-PVB)on postoperative complications in patients undergoing thoracoscopic lung surgery.Methods Data from 240 patients who underwent video-assisted thoracoscopic lung surgery under general anesthesia between January 2019 and December 2020 was retrospectively collected.These patients either received intraoperative intercostal nerve block(ICNB)(202 cases)or pre-operative ultrasound-guided paravertebral block(US-PVB)(38 cases).The incidence rates of overall postoperative complications,postoperative pulmonary complications,postoperative cardiac complications,postoperative cerebral complications,other postoperative complications,remedial analgesia requirement in the PACU,intraoperative fentanyl consumption,postoperative oral morphine equivalent(OME),perioperative OME,duration of postoperative drainage tube,postoperative ICU stay,and postoperative hospital stay were compared between the ICNB group and the US-PVB group.Univariate and multivariate regression were used to analyze the effects of different analgesia methods on postoperative complicationsResults There was no statistically significant difference in postoperative overall complications between the ICNB group and the US-PVB group(P＞0.05).In the univariate analysis,no significant difference was found in the overall postoperative complications between the ICNB group(16.3％)and the US-PVB group(13.2％)(OR=0.642,95％CI 0.239-1.786;P=0.404.Multivariate analysis also did not reveal any differences between the two groups(OR=0.843,95％CI 0.299-2.377;P=0746).For the analysis of secondary outcomes,according to multivariate analysis,there was no significant difference between the two groups in postoperative pulmonary complications,postoperative cardiac complications,other postoperative complications,remedial analgesia requirement in the PACU,intraoperative fentanyl consumption,postoperative OME,perioperative OME,duration of postoperative drainage tube,postoperative ICU stay or postoperative hospital stay(P＞0.05).Conclusion In this study,we found no difference in postoperative complications between intraoperative ICNB and preoperative US-PVB.

Objective To observe the clinical efficacy of"hegu needling"combined with"joint needling"in the treatment of chronic lumbar muscle strain.Methods A total of 64 patients with chronic lumbar muscle strain were randomly divided into observation group and control group,32 cases in each group.The control group was treated with routine acupuncture,and the observation group was treated with"hegu needling"combined with"joint needling"on the basis of the control group.One week for a course of treatment,a total of two courses of treatment.After two weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes of Visual Analogue Scale(VAS)of pain score and simplified Oswestry Dysfunction Index questionnaire(simplified ODI)score were observed before and after treatment.The changes of spinal mobility were compared before and after treatment between the two groups.Results(1)The total effective rate was 93.75%(30/32)in the observation group and 78.13%(25/32)in the control group.The curative effect of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,the simplified ODI score and spinal activity score of the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the simplified ODI score and spinal activity score,the differences were statistically significant(P＜0.05).(3)After two weeks of treatment,the VAS scores of the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the VAS score,the difference was statistically significant(P＜0.05).After one month of treatment,there was no significant difference in VAS score of the observation group when compared with that after two weeks of treatment(P＞0.05).Conclusion"Hegu needling"combined with"joint needling"in the treatment of chronic lumbar muscle strain can significantly improve the patients'pain symptoms,enhance the patient's waist function,and improve the patients'spinal mobility.

Objective:To study the distribution of drug resistance genes and virulence genes in multidrug-resistant Salmonella typhimurium strains.Methods:A total of 96 strains of Salmonella typhimurium were collected，and drug sensitivity tests were performed to evaluate the drug resistance and multidrug-resistance of Salmonella typhimurium.Multidrug-resistant Salmonella typhimurium strains were selected to conducted whole genome sequencing，and the distribution of drug resistance genes and virulence genes in the strain were analyzed.Results:Salmonella typhimurium strains had the highest resistance rates to ampicillin and ampicillin/sulbactam，with 89.58% and 76.04%，respectively.Followed by trimethoprim/sulfamethoxazole，ceftriaxone，and aztreonam，with 47.92%，38.54% and 33.33%，respectively，and low resistance rates to ciprofloxacin and levofloxacin，with 8.33% and 4.17%，respectively.Ninety-six strains were all sensitive to carbapenem antibiotics and piperacillin/tazobactam.Fifty-seven strains（59.38%）of Salmonella typhimurium showed multidrug-resistance.Resistance genes were detected in all 57 multidrug-resistant Salmonella typhimurium strains,with higher carrier rates of 98.25%,77.19%,and 59.65% for aac(6')-Iaa,aadA22,and blaTEM-1B,respectively.The multidrug-resistant Salmonella typhimurium strains had the highest carrier rates for invA，sipA，sseL，and sopB.Conclusion:Multidrug-resistant Salmonella typhimurium strains have a high incidence and a high carrier rate for multiple drug resistance genes and virulence genes.The monitoring and prevention of Salmonella typhimurium should be strengthened in the clinic in order to reduce the spreading epidemic of multidrug-resistant strains.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Levothyroxine anaphylaxis is a rare yet severe adverse reaction to exogenous levothyroxine. While levothyroxine desensitization is commonly employed, its direct application in patients with severe shock poses considerable risks. Omalizumab may offer a potential adjunctive approach to induce tolerance to levothyroxine. We reported a case of a 30-year-old female with a history of thyroid papillary carcinoma who developed anaphylactic shock following oral administration of 50 μg levothyroxine daily after surgery. High serum level of immunoglobulin E (IgE 99.2 kU/L) and positive intradermal tests to all brands of levothyroxine available in China confirm a type Ⅰ hypersensitivity reaction. Several reports have proven the role of omalizumab in desensitization protocol in IgE-mediated diseases; therefore, she was pretreated with three courses of omalizumab (150 mg intradermal injection every four weeks). She then successfully completed oral levothyroxine desensitization and tolerated treatment dose of levothyroxine without experiencing allergic symptoms along with normalization of thyroid function. Further research is warranted to assess its potential as a standard treatment in difficult-to-treat levothyroxine hypersensitivity.