This case reported a 17-year-old female patient who presented to the hospital with "poor mood and irritability for more than 5 months". The patient was diagnosed with hepatolenticular degeneration at the age of five. According to the International Classification of Diseases， tenth edition （ICD-10）， she was diagnosed with hepatolenticular and depressive episodes of bipolar disorder. The condition improved after administration of a combination of a mood stabilizer and an antidepressant. There are few reports of hepatolenticular degeneration combined with depressive episodes of bipolar disorder， and it is controversial whether the diagnosis should be considered a psychiatric disorder due to a physical illness or a co-morbidity. In addition， somatic conditions are often overlooked in the treatment of patients with psychiatric disorders. This case analyzed the diagnosis and medication by integrating the patient's psychiatric symptoms and somatic conditions， suggesting that psychiatrists should pay attention to both psychiatric symptoms and the patient's previous history of somatic diseases in their clinical work for rational diagnosis and treatment.

Aim To explore the impacts of high mobility group box 1 (HMGB1) on the phenotypes, endocy-tosis and extracellular signal-regulated kinase (ERK)/ Jun N-terminal protein kinase (JNK)/P38 mitogen-ac-tivated protein kinase (MAPK) signaling pathway in indoxyl sulfate (IS) -induced dendritic cells (DCs). Methods After treatment with 30, 300 and 600 (xmol · L

ObjectiveTo identify and clarify the key issues faced by tertiary hospitals in responding to public health emergencies. MethodsA literature review index system was constructed， and key issues were identified using hierarchical analysis. ResultsAfter a systematic literature review， 20 types of problems faced by tertiary hospitals in responding to public health emergencies were identified. Three key issues were ultimately identified by prioritizing the issues that needed to be addressed. ConclusionThe key issues of tertiary hospitals in responding to public health emergencies are concentrated in the areas of emergency response capabilities and competencies of medical staff， the number of emergency response personnel， and the standardization and specificity of training and drills. Tertiary hospitals should focus on these issues in developing public health emergency response systems to improve the effectiveness of their emergency response.

ObjectiveTo identify the key issues in emergency response to public health emergencies in the Yangtze River Delta region， and to provide a basis for the formulation of relevant policies. MethodLiterature on emergency response to public health emergencies in the Yangtze River Delta region was systematically reviewed and collected， and 18 main problems were identified after collecting and organizing the problems. A questionnaire survey and cluster analysis were used to identify the key issues. ResultsThe study of 18 major problems revealed that "insufficient reserve of emergency medical supplies"， "insufficient financial investment to meet the needs of emergency response"， "lack of a sound mechanism for the deployment of supplies， resulting in the untimely deployment of materials"， were the key issues of emergency response to public health emergencies in the Yangtze River Delta region. ConclusionFuture development of the emergency response system in the Yangtze River Delta region should focus on accelerating the integration process of the Yangtze River Delta， establishing and improving information systems， optimizing the material storage and deployment network， prioritizing the fund investment and utilization mechanism， and improving the effectiveness of public health emergency response.

This study was aimed at understanding the molecular characteristics of Plasmodium ovale curtisi and Plasmodi-um ovale wallikeri imported cases in Chongqing,to provide data to support monitoring and control efforts.In a retrospective analysis,26 Plasmodium ovale archival blood samples were characterized with respect to five molecular markers(Cox1,Cytb,Tra,Dhfr,and K13)from 2013 to 2023.PCR amplification of partial fragments of the Cox1,Cytb,and Tra genes of Plas-modium ovale was performed to distinguish the two subspecies.The drug-resistance Dhfr and K13 genes of Plasmodium ovale were amplified with PCR assays followed by DNA sequencing,and the sequences were aligned.The differentiation of 26 cases of Plasmodium ovale(14 cases of curtisi subspecies and 12 cases of wallikeri subspecies)according to ssrRNA was consistent with the classification results of Cox1,Cytb,and TRA genes.Thirteen single nucleotide dimorphism sites were identified in Cox 1,including the 145 and 153 loci,with only variations in amino acids M176I and I288V at loci 528 and 862,and N337H mutation in one sample.Twelve base substitutions were found among Cytb gene subspecies,with only the M248I mutation in amino acid 248.A total of 49 nucleotide dimorphism sites in Tra gene,resulting in 18 amino acid mutations,were identified be-tween the two subspecies.In the curtisi type sample,the poc1 type had more PINTINPINTIN and TITPIS amino acid units than the poc2 type.The mutation rate of the Dhfr gene was rel-atively high:25％of the samples showed S58R mutations.The K13 gene subspecies was not homozygous,and one sample was heterozygous.This study confirmed the dimorphism and mutation sites between Plasmodium ovale curtisi and wallikeri sub-species in Cox1,Cytb,Tra,Dhfr,and K13 gene fragments of imported Plasmodium ovale in Chongqing,thus enriching knowledge regarding gene polymorphisms in Plasmodium ovale curtisi and wallikeri imported cases.

This study was aimed at examining the influence of meteorological factors on scrub typhus in Xiamen.Scrub ty-phus monitoring data and meteorological factors were collected in Xiamen from 2005 to 2023.Spearman correlation analysis and nonlinear regression were used to analyze the correlation between scrub typhus incidence and meteorological factors.The inci-dence of scrub typhus first increased and subsequently decreased in Xiamen from 2005 to 2023.The highest incidence was be-tween 2014 and 2016,and the peak incidence was from June to October.The monthly incidence of scrub typhus positively cor-related with daily minimum temperature(r=0.637,P＜0.001,daily average temperature(r=0.627,P＜0.001),daily maxi-mum temperature(r=0.612,P＜0.001),sunshine duration(r=0.405,P＜0.001),average relative humidity(r=0.346,P＜0.001),and daily rainfall(r=0.207,P=0.002),and negatively correlated with average atmospheric pressure(r=-0.549,P＜0.001),whereas no correlation was observed with the average wind speed in Xiamen.The regression equation of scrub ty-phus monthly incidence and meteorological parameters was y=-433.869-11.503x1+0.381x1 2+9.150x2-0.197x2 2+3.936 x3-0.132x3 2+0.881x4+0.035x4 2-1.048x5+0.009x5 2+0.186x6-0.023x6 2+0.421x7+6.210×10-5x8-1.051 × 10-10x8 2 in Xiamen,and the R2 was 0.473,thus indicating good model fit.Scrub typhus incidence correlated with the daily minimum av-erage temperature,average temperature,daily maximum tem-perature,sunshine duration,daily rainfall,relative humidity,and average atmospheric pressure in Xiamen.Various meteoro-logical factors had differing effects on scrub typhus.

Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.

Pulmonary fibrosis (PF) is a pathological change caused by repeated injuries and repair dysfunction of the alveolar epithelium. Our previous study revealed that the residues Asn3 and Asn4 of peptide DR8 (DHNNPQIR-NH₂) could be modified to improve stability and antifibrotic activity, and the unnatural hydrophobic amino acids α-(4-pentenyl)-Ala and d-Ala were considered in this study. DR3penA (DHα-(4-pentenyl)-ANPQIR-NH₂) was verified to have a longer half-life in serum and to significantly inhibit oxidative damage, epithelial-mesenchymal transition (EMT) and fibrogenesis in vitro and in vivo. Moreover, DR3penA has a dosage advantage over pirfenidone through the conversion of drug bioavailability under different routes of administration. A mechanistic study revealed that DR3penA increased the expression of aquaporin 5 (AQP5) by inhibiting the upregulation of miR-23b-5p and the mitogen-activated protein kinase (MAPK) pathway, indicating that DR3penA may alleviate PF by regulating MAPK/miR-23b-5p/AQP5. Safety evaluation showed that DR3penA is a peptide drug without obvious toxicity or acute side effects and has significantly improved safety compared to DR8. Thus, our findings suggest that DR3penA, as a novel and low-toxic peptide, has the potential to be a leading compound for PF therapy, which provides a foundation for the development of peptide drugs for fibrosis-related diseases.

Humans ; Receptors, Chimeric Antigen ; Hematopoietic Stem Cell Transplantation ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma ; Immunotherapy, Adoptive ; Antigens, CD19

Objective: To comprehensively assess the current status of extrauterine growth restriction (EUGR) in very preterm infants (VPI) and its associated factors in Chinese neonatal intensive care units (NICU). Methods: In this cohort study, 6 179 preterm infants born at <32 weeks' gestation were included, who were admitted to 57 hospitals in the China Neonatal Network in 2019 and hospitalized for ≥7 days. EUGR was evaluated by a cross-sectional definition (weight at discharge<10^th percentile for postmenstrual age), a longitudinal definition (decline in weight Z score>1 from birth to discharge), and weight growth velocity. The comparison between infants with and without EUGR was conducted by t-test, Mann-Whitney U test or χ² test as appropriate. Multivariable Logistic regression models were used to evaluate associations between EUGR with different definitions and maternal and neonatal factors, clinical practices, and neonatal morbidities. Results: A total of 6 179 VPI were enrolled in the study, with a gestational age of (29.8±1.5) weeks and birth weight of (1 365±304) g; 56.2% (3 474) of them were male. Among them, 48.4% (2 992 VPI) were cross-sectional EUGR and 74.9% (4 628 VPI) were longitudinal EUGR. Z score of weight was (0.13±0.78) at birth and decrease to (-1.35±0.99) at discharge. The weight growth velocity was 10.13 (8.42, 11.66) g/(kg·d). Multivariate Logistic regression analysis showed that among the influential factors that could be intervened after birth, late attainment of full enteral feeds (OR_adjust=1.01, 95%CI 1.01-1.02, P<0.001; OR_adjust=1.01, 95%CI 1.01-1.02, P<0.001), necrotizing enterocolitis≥Ⅱstage (OR_adjust=2.64, 95%CI 1.60-4.35, P<0.001; OR_adjust=1.62, 95%CI 1.10-2.40, P<0.001) and patent ductus arteriosus (OR_adjust=1.94, 95%CI 1.50-2.51, P<0.001; OR_adjust=1.63, 95%CI 1.29-2.06, P<0.001) were all associated with increased risks of both cross-sectional and longitudinal EUGR. In addition, late initiation of enteral feeds (OR_adjust=1.06, 95%CI 1.02-1.09, P=0.020) and respiratory distress syndrome (OR_adjust=1.45, 95%CI 1.24-1.69, P<0.001) were all associated with cross-sectional EUGR. Breast milk feeding (OR_adjust=1.33, 95%CI 1.05-1.68, P<0.001) was associated with a higher risk of longitudinal EUGR. Conclusions: The incidence of EUGR in VPI in China is high. Some modifiable risk factors provide priorities to improve postnatal growth for VPI. Nutritional management of VPI and the efforts to decrease the incidence of complications are still the focus of clinical management in China.
Female ; Humans ; Infant, Newborn ; Male ; Cohort Studies ; East Asian People ; Infant, Premature ; Infant, Premature, Diseases ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal