Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disease caused by abnormal expression of glycosylphosphatidylinositol (GPI) on the cell membrane due to mutations in the phosphatidylinositol glycan class A(PIGA) gene. It is commonly characterized by intravascular hemolysis, repeated thrombosis, and bone marrow failure, as well as multiple systemic involvement symptoms such as renal dysfunction, pulmonary hypertension, swallowing difficulties, chest pain, abdominal pain, and erectile dysfunction. Due to the rarity of PNH and its strong heterogeneity in clinical manifestations, multidisciplinary collaboration is often required for diagnosis and treatment. Peking Union Medical College Hospital, relying on the rare disease diagnosis and treatment platform, has invited multidisciplinary clinical experts to form a unified opinion on the diagnosis and treatment of PNH, and formulated the Expert Consensus of Multidisciplinary Diagnosis and Treatment for Paroxysmal Nocturnal Hemoglobinuria (2024), with the hope of promoting the standardization of PNH diagnosis and treatment.

Objective To investigate the clinical significance of combined cerebrospinal fluid(CSF)and routine blood parameter analysis in differentiating between multiple cerebral glioma(MCG)and primary central nervous system lymphoma(PCNSL).Methods We Rretrospectively analyzed the clinical data,CSF and routine blood indicators levels of 62 MCG patients and 56 PCNSL patients admitted to Beijing Tiantan Hospital,Capital Medical University from November 2017 to March 2023.Additionally,we assessed the diagnostic value of individual meaningful indicators as well as their combinations in distinguishing between MCG and PCNSL.Results The levels of CSF total cell count,CSF white cell count,CSF:pro,lactate,routine bloodperipheral neutrophil count,and neu-trophil percentage were significantly higher in the MCG group than in the PCNSL group(P<0.05);while the levels of CSF:Glu,CSF:cl,routine blood lymphocyte count,eosinophil,lymphocyte percentage,and eosinophil percent-age were significantly higher in the PCNSL group than in the MCG group(P<0.05).The AUCs of CSF cell count,CSF white cell count,CSF:pro,lactate,routine blood neutrophil count,neutrophil percentage for differentiating MCG from PCNSL were 0.900,0.899,0.797,0.867,0.828 and 0.772 respectively;sensitivities were 72.4%,77.6%,63.8%,67.2%,72.4%,82.8%,77.6%and 81%,with sensitivities of 97.1%,100%,88.2%,91.2%,88.2%,64.7%,100%and 94.1%,respectively.In addition,the combined detection of CSF total cell count,CSF white cell count,CSF:pro,routine blood neutrophil count and neutrophil percentage in CSF had an AUC of 0.919 for differentiating MCG from PCNSL,with a sensitivity and specificity of 77.6%and 100%,respectively.Conclusions Combined detection of CSF indicators including CSF total cell count,CSF white cell count,CSF:pro,along with routine blood markers such as neutrophil count and neutrophil percentage,holds significant clinical utility for differ-entiating between MCG and PCNSL.

Objective To explore the application of nurse-performed point-of-care ultrasound in abdominal distension of ICU patients with enteral nutrition.Methods Purposive sampling method was used to select 108 patients with enteral nutrition abdominal distension admitted to the ICU of a tertiary A general hospital in Hefei City from January to December 2022,and they were divided into an experimental group and a control group according to random number table method.The experimental group used bedside ultrasound to evaluate the stomach,intestine and abdominal cavity of patients with abdominal distension,and implemented targeted treatment measures according to the evaluation results.The control group was given corresponding treatment measures according to the abdominal sight,touch,tapping,listening and traditional syringe withdrawal method.Intra-abdominal pressure,abdominal circumference,feeding compliance rate and feeding interruption rate,ICU stay time and mechanical ventilation time were compared at the 1st,3rd and 5th day.Results 11 cases dropped out of the study due to transfer,automatic discharge,death,etc.,and 97 cases were included 51 cases in the experimental group and 46 cases in the control group.Repeated measurement ANOVA showed that intra-abdominal pressure and abdominal circumference time in the 2 groups had interaction with each other(F=41.724,P＜0.001;F=17.762,P＜0.001).Generalised estimating equations showed that there was only a between-group effect for the rates of feeding compliance and feeding disruption in 2 groups(Wald y2=18.033,P＜0.001;Wald x2=6.567,P＜0.001).Simple effect analysis showed that on the 3rd and 5th day after intervention.The experimental group had lower abdominal depression and the feeding interruption rate was lower than the control group(P＜0.05).On the 5th day after interven-tion,the abdominal circumference of the experimental group was lower than that of the control group,the feeding compliance rate was higher than that of control group(P＜0.05).After intervention,in the experimental group,the mechanical ventilation time was shorter than that of the control group(P＜0.05).There was no significant difference in ICU stay time between the 2 groups(P=0.095).Conclusion The application of nurse-performed point-of-care ultrasound in the management of abdominal distension in patients with enteral nutrition in ICU is feasible and scientific,which is helpful for the management of patients with enteral nutrition abdominal distension in ICU,reducing internal abdominal pressure,shortening mechanical ventilation time,and avoiding the occurrence of feeding intolerance.

Objective:To investigate the risk factors of cerebral venous sinus thrombosis (CVST) during puerperal period.Methods:This study was a restrospective analysis, A total of 33 puerperal CVST patients admitted to Beijing Tiantan Hospital, Capital Medical University from January 2016 to November 2022 were selected as the observation group, and 61 puerperal healthy women who underwent postpartum follow-up at the same period in the hospital were selected as the control group. The age, body mass index (BMI), smoking history, hypertension history, diabetes history, drug use history and mode of delivery or abortion of the two groups of women were compared and collected, as well as the level of laboratory indicators. The risk factors of CVST in puerperal period were analyzed. The measurement data of normal distribution were represented by two independent samples t test for comparison between groups. The measurement data of non-normal distribution were expressed as M ( Q1, Q3), and the Wilcoxon rank sum test was used for comparison between groups. The count data is expressed as number (%), and the comparison between groups is performed using χ 2 test or Fisher exact probability method. Logistic regression model was established to analyze the risk factors of CVST in puerperal period. Results:BMI, serum LDH, α-HBDH, fasting blood glucose, HCY levels, WBC, NEU, NLR, RDW and MPV in observation group were higher than those in control group [(30.21±4.25) kg/m 2 vs (21.94±3.02) kg/m 2]. 195.15(183.10,240.98) U/L vs 165.75(154.55,184.62) U/L, 166.60(143.10,188.60) U/L vs 124.10(116.30,137.90) U/L, (4.88 ± 0.98) vs (4.25±0.41), 8.35 (7.10, 12.16) μmol/L vs 6.60 (5.30, 7.58) μmol/L, 9.26 (6.56, 11.76) × 10 9/L vs 7.25 (6.23, 8.00) × 10 9/L, and 7.18 (4.66, 8.79) × 10 9/L vs 3.93 (3.25, 4.52) × 10 9/L, 4.13 (2.27,6.55) vs 1.63 (1.16,1.97), 42.80(38.95,47.45) fL vs 40.70(38.95,42.60) fL, (9.52±0.99) fL vs 8.96±0.88 fL], LY and PDW were lower than control group [1.58(1.11,1,96)×10 9/L vs 2.50(2.04,2.91)×10 9/L, 15.60(11.65,16.20) fL vs 16.00(15.80,16.30) fL]. The differences were statistically significant ( t=4.58, P<0.001; Z=4.54, P<0.001; Z=5.56, P<0.001; t=3.38, P=0.002; Z=4.18, P<0.001; Z=3.39, P=0.001; Z=4.92, P<0.001; Z=4.92, P<0.001; Z=4.54, P<0.001; Z=5.56, P<0.001; Z=4.18, P<0.001; Z=4.92, P<0.001; Z=5.87, P<0.001; Z=2.18, P=0.029; t=2.82, P=0.006; Z=4.78, P<0.001; Z=2.52, P=0.012). Multivariate Logistic regression analysis showed that NEU, HCY and α-HBDH were risk factors for puerparal CVST (odds ratios were 3.07, 1.53 and 1.07, respectively, 95% confidence interval: 1.65~5.71, 1.09~2.15, 1.02~1.12, P values were <0.001, 0.014, 0.007, respectively). Conclusions:α-HBDH, HCY and NEU are independent risk factors for puerperal CVST.

Since its establishment for 60 years, Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine has grown into a famous regional burn center in China under the leading of the pioneers and through the efforts of several generations. The department has distinctive disciplinary features in burn care, nutritional support, scar prevention and treatments, standard management of chronic wound, and skin tissue engineering research, making positive contribution to the development of burn medicine in China.

Objective To investigate the relationship between tubal sterilization and endometrial hyperplasia and endometrial cancer. Methods The clinical data of 4 987 peoples with diagnostic curettage in Datong, Shanxi Province from January 2008 to January 2017 were retrospectively analyzed. According to the pathological type, 2 891 cases were in abnormal endometrium group (simple hyperplasia, complex hyperplasia, and atypical hyperplasia, endometrial cancer) (experimental group) and 2 096 cases were in normal endometrium group (proliferative endometrium, secretory endometrium, atrophic endometrium) (control group). The relationship between tubal sterilization and endometrial hyperplasia and endometrial cancer was analyzed. Results The proportion of age, education level, sterilization, duration of sterilization and menopausal years were significantly different between the two groups (χ2values were 36.47, 15.05, 33.11, 34.50, 5.19, all P< 0.05). There was no significant difference in the other variables (all P> 0.05). Multivariate Logistic regression analysis showed that age ≥60 years (OR= 5.64, 95 % CI 1.42-16.08, P=0.012), sterilization (OR= 4.76, 95 % CI 1.31-12.69, P = 0.015), duration of sterilization ≥10 years (OR= 15.58, 95 % CI 2.05-118.54, P= 0.008) were high risk factors for endometrial abnormalities. Conclusions Tubal sterilization is a risk factor for the development of endometrial hyperplasia and endometrial cancer.The postoperative patients should be strengthened anti-cancer census.

Objective To investigate the protective role of Gingko Biloba extract (EGB 761) in intestinal mucosal barrier of intestinal inflammation model mouse.Methods Thirty mice were randomly divided into the control group,model group and EGB 761 group;the animal model was established;the general condition,body mass change,fecal occult blood and colon histopatho1ogical changes were observed,the expressions of occludin-1 proteins in colon tissue were detected by immunofluorescence.Results The body mass in the model group appeared to decrease,drinking water and eating food were significantly decreased compared with that in the control group.However after the EGB 761 intervention,the body mass of the model mice was significantly risen again;little inflammatory cells infiltration could be seen in the EGB 761 group,the inflammatory degree was significantly alleviated compared with the model group.The fluorescence distribution of the claudin-1,occludin and zo-1 in colonic tissues of the model group was more disperse compared with the normal group,the fluorescence intensity was weakened with rough edge;after EGB 761 intervention,the fluorescence in the EGB7 61 group was distributed along with the cellular membrane,the intensity was slightly weakened compared with the normal control group,but was still stronger than that in the model group.Conclusion EGB 761 can improve the inflammatory reaction in mouse colonic tissue,its mechanism may be related with its strengthening the protective effect of intestinal mucosal barrier.

Objective To investigate the correlation between hemoglobin level and health status of the elderly living in communities in Beijing.Methods A random cluster sampling method was used to select residents living in communities of Beijing city,and a cross-sectional study was carried out by questionnaires,scene testing and blood sample collection.WHO-formulated criteria were applied for diagnosing anemia.The health indicators in questionnaires included visual impairment,physical disability,decreased health,self-care,fatigue,anorexia,independent walking distance,exercise frequency,intelligence status and computing power.Results Complete information was obtained in a total of 1 948 elderly people,including 790 cases of male and 1 158 cases of female,with an average age of(73.9±6.1)years and a median age of 74 years(65-100).The mean level of hemoglobin in the 1 948 people was(135.65 ± 14.48) g/L,with (142.56 ± 15.56) g/L in male and (130.95 ± 11.53) g/L in female.Hemoglobin level was significantly lower in female than in men (t =54.739,P＜ 0.01).Hemoglobin level was decreased with aging,and negatively associated with appetite,physical strength,walk assistance,visual acuity and physical ability(r=-0.055,-0.067,-0.071,-0.114,-0.095;P =0.022,0.005,0.004,0.000,0.000),while positively associated with health status,activities in daily life,athletic ability,exercise frequency and intelligence (r =0.073,0.126,0.122,0.066,0.124;P =0.002,0.000,0.000,0.006,0.000).Conclusions The hemoglobin level of the elderly decreases with aging and is associated with health status and quality of life in the elderly,which should be taken care seriously.

"Treatment after discovery" is the most effective way to prevent and treat AIDS by far.Although Yunnan Province has made remarkable achievements in the three wars of AIDS prevention and control,it faced realistic obstacles of slow updating of knowledge,shortage of full-time medical staff,unstable team and poor trans-provincial treatment system in the implementation of "treatment after discovery".This paper analyzed these obstacles from the perspective of bioethics,reflected the ideological roots of the unfulfilment to the HIV / AIDS population's dignity identify and human rights protection,and further put forward countermeasures and suggestions.