Objective: To investigate the effect of interleukin-25 (IL-25) on ovalbumin (OVA) induced atopic dermatitis of mice, and the significance of regulating IL-25. Methods: In this study, 90 healthy male 6-week-old specific pathogen free (SPF) BALB/c mice were divided into 6 groups (15 in each group): ① subcutaneous injection of phosphate buffered saline (PBS) group (normal control group); ② subcutaneous injection of mouse IL-25 group (IL-25 group); ③ subcutaneous injection of anti-mouse IL-25 monoclonal antibody (anti-IL-25 group), each group received subcutaneous injection once a day for 1 week, 2 weeks apart, repeated daily subcutaneous injections for 1 week, 2 weeks apart, and repeated daily subcutaneous injections for 1 week, for a total of 7 weeks; ④ OVA treated group (model group); ⑤ OVA treated and IL-25 subcutaneous injection group (IL-25 treated dermatitis group); ⑥ OVA treated and anti-mouse IL-25 monoclonal antibody injection group (anti-IL-25 treated dermatitis group). The ⑤ and ⑥ groups in the process of treatment with OVA, IL-25 or anti-IL-25 antibody were given in the same way as the ② and ③ groups. Scratching behavior and skin performance of the mice were recorded during the seven-week-treatment. Twenty four hours after the final treatment, blood was taken from the mouse heart, and the serum was separated to detect the total IgE, IL-4, IL-5, IL-13, etc. The skin samples of the treatment sites were used for hematoxylin-eosin (HE) staining, immunohistochemistry, real-time PCR and Western blot detections. A single factor (ANOVA) analysis of variance was used to compare the differences in various indicators between the groups. Results: The frequency of scratches in the IL-25 treated dermatitis group was higher than that in the model group, and the scratching behavior of the anti-IL-25 treated dermatitis group was significantly lower than that in the model group. The appearance of atopic dermatitis, thickening of the epidermis and the degree of dermal inflammation in the IL-25 treated dermatitis group were more serious than those in the model group and the anti-IL-25 treated dermatitis group. The levels of serum IgE, IL-4, IL-5, and IL-13 in the IL-25 treated dermatitis group were significantly higher than that in the model group and the anti-IL-25 treated dermatitis group. There were significantly more CD4⁺ T cells in the dermis of IL-25 treated dermatitis group than that in the anti-IL-25 treated dermatitis group. The expression levels of filaggrin and defensin β2 proteins in the IL-25 treated dermatitis group were significantly lower than those in the model group and the anti-IL-25 treated dermatitis group. Conclusion: In the OVA induced atopic dermatitis mice model, IL-25 can significantly promote the damage of the epidermal barrier function and aggravate the OVA-induced dermatitis. Antagonizing IL-25 can alleviate OVA induced dermatitis to a certain extent.

Objective: To detect the cystic fibrosis transmembrane transduction regulator (CFTR) gene mutations and congenital bilateral absence of vas deferens (CBAVD) susceptibility gene mutations in patients with CBAVD, and to explore their association with the risk of CBAVD. Methods: Whole-exome sequencing and Sanger sequencing validation were conducted on the pathogenic genes CFTR, adhesion G protein-coupled receptor G2 (ADGRG2), sodium channel epithelial 1 subunit beta (SCNN1B), carbonic anhydrase 12 (CA12), and solute carrier family 9 member A3 (SLC9A3) in thirteen cases of isolated CBAVD patients. The polymorphic loci, intron and flanking sequences of CFTR gene were amplified by polymerase chain reaction (PCR) followed by Sanger sequencing. Bioinformatics methods were employed for conservative analysis and deleterious prediction of novel susceptibility gene mutations in CBAVD. Genetic analysis was performed on the pedigree of one out of thirteen patients with CBAVD to evaluate the risk of inheritance in offspring. Results: Exome sequencing revealed CFTR gene exon mutations in only six of the thirteen CBAVD patients, with six missense mutations c.2684G>A(p.Ser895Asn), c.4056G>C(p.Gln1352His), c.2812G>(p.Val938Leu), c.3068T>G(p.Ile1023Arg), c.374T>C(p.Ile125Thr), c.1666A>G(p.Ile556Val)), and one nonsense mutation (c.1657C>T(p.Arg553Ter). Among these six patients, two also had the CFTR homozygous p.V470 site, additionally, mutations in CFTR gene exon regions were not detected in the remaining seven patients. Within the thirteen CBAVD patients, three carried the homozygous p.V470 polymorphic site, four carried the 5T allele, two carried the TG13 allele, and ten carried the c.-966T>G site. Four CBAVD patients simultaneously carried 2-3 of the aforementioned CFTR gene mutation sites. Susceptibility gene mutations in CBAVD among the thirteen patients included one ADGRG2 missense mutation c.2312A>G(p.Asn771Ser), two SLC9A3 missense mutations c.2395T>C(p.Cys799Arg), c.493G>A(p.Val165Ile), one SCNN1B missense mutation c.1514G>A(p.Arg505His), and one CA12 missense mutation c.1061C>T (p.Ala354Val). Notably, the SLC9A3 gene c.493G>A (p.Val165Ile) mutation site was first identified in CBAVD patients. The five mutations exhibited an extremely low population mutation frequency in the gnomAD database, classifying them as rare mutations. Predictions from Mutation Taster and Polyphen-2 software indicated that the harmfulness level of the SLC9A3 gene c.493G>A (p.Val165Ile) site and the SCNN1B gene c.1514G>A (p.Arg505His) site were disease causing and probably damaging. The genetic analysis of one pedigree revealed that the c.1657C>T (p.Arg553Ter) mutation in the proband was a de novo mutation, as neither the proband's father nor mother carried this mutation. The proband and his spouse conceived a daughter through assisted reproductive technology, and the daughter inherited the proband's pathogenic mutation c.1657C>T (p.Arg553Ter). Conclusion: CFTR gene mutations remain the leading cause of CBAVD in Chinese patients; however, the distribution and frequency of mutations differ from data reported in other domestic and international studies, highlighting the need to expand the CFTR mutation spectrum in Chinese CBAVD patients. The susceptibility genes ADGRG2, SLC9A3, SCNN1B, and CA12 may explain some cases of CBAVD without CFTR mutations. Given the lack of specific clinical manifestations in CBAVD patients, it is recommended that clinicians conduct further physical examinations and consider scrotal or transrectal ultrasound before making a defi-nitive diagnosis. It is advisable to employ CFTR gene mutation testing in preconception genetic screening to reduce the risk of CBAVD and cystic fibrosis in offspring.

Objective: To delve into the intricate relationship between common genetic variations across the entire genome and the risk of non-syndromic cleft lip with or without cleft palate (NSCL/P). Methods: Utilizing summary statistics data from genome-wide association studies (GWAS), a thorough investigation to evaluate the impact of common variations on the genome were undertook. This involved assessing single nucleotide polymorphism (SNP) heritability across the entire genome, as well as within specific genomic regions. To ensure the robustness of our analysis, stringent quality control measures were applied to the GWAS summary statistics data. Criteria for inclusion encompassed the absence of missing values, a minor allele frequency ≥1%, P-values falling within the range of 0 to 1, and clear SNP strand orientation. SNP meeting these stringent criteria were then meticulously included in our analysis. The SNP heritability of NSCL/P was calculated using linkage disequilibrium score regression. Additionally, hierarchical linkage disequilibrium score regression to partition SNP heritability within coding regions, promoters, introns, enhancers, and super enhancers were employed, and the enrichment levels within different genomic regions using LDSC (v1.0.1) software were further elucidated. Results: Our study drew upon GWAS summary statistics data obtained from 806 NSCL/P trios, comprising a total of 2 418 individuals from the Chinese population. Following rigorous quality control procedures, 490 593 out of 492 993 SNP were deemed suitable for inclusion in SNP heritability calculations. The observed SNP heritability of NSCL/P was 0.55 (95%CI: 0.28-0.82). Adjusting for the elevated disease pre-valence within our sample, the SNP heritability scaled down to 0.37 (95%CI: 0.19-0.55) based on the prevalence observed in the general Chinese population. Notably, our enrichment analysis unveiled significant enrichment of SNP heritability within enhancer regions (15.70, P=0.04) and super enhancer regions (3.18, P=0.03). Conclusion: Our study sheds light on the intricate interplay between common genetic variations and the risk of NSCL/P in the Chinese population. By elucidating the SNP heritability landscape across different genomic regions, we contribute valuable insights into the genetic basis of NSCL/P. The significant enrichment of SNP heritability within enhancer and super enhancer regions underscores the potential role of these regulatory elements in shaping the genetic susceptibility to NSCL/P. This paves the way for further research aimed at uncovering novel genetic pathogenic factors underlying NSCL/P pathogenesis.

Objective: To analyze the clinical diagnosis, treatment, and prognosis of the patients with pyridoxine-dependent epilepsy (PDE) characterized by infantile epileptic spasm syndrome (IESS). Methods: A total of 75 PDE patients with ALDH7A1 variants were diagnosed at the Department of Pediatrics of Peking University First Hospital and Peking University People's Hospital from July 2012 to June 2024, and five PDE patients with the phenotype of IESS were selected. The clinical manifestations, treatment, blood biochemistry, metabolic screening, electroencephalogram (EEG), brain magnetic resonance imaging (MRI), and gene testing results of the five PDE patients were analyzed. Results: Among the five patients diagnosed with PDE, three were female and two were male, and the phenotype was consistent with IESS. The age at the last follow-up was from one year and 3 months to 11 years and 9 months. All the five cases were delivered at term. Two cases had anoxia and asphyxia at birth, and three cases had normal birth history. The onset age of seizure ranged from one day to 4 months after birth. One case presented with epileptic spasms (ES), and three cases presented with focal seizure and ES. The other patient was started with ES, followed by multiple seizure types, including focal seizure and generalized tonic-clonic seizure, and developed epileptic status which caused secondary brain injury. The interictal EEG results showed hypsarrhythmia in three cases, generalized and multifocal discharges in one cases, and multifocal discharges in one case. No abnormalities were found in brain MRI in three cases, and secondary cerebral atrophy and hydrocephalus were observed in two cases during the course of the disease. Gene analysis confirmed that the five patients carried compound heterozygous variants of ALDH7A1, and two of them carried exon deletion variants. High dose pyridoxine treatment started at the end of 2 days, 4 years, 3 years, 4 days. and 2 months after the onset of the disease. Up to the last follow-up, seizures of four cases were controlled, followed by normal EEG. One patient with brain atrophy had uncontrolled seizures and EEG remained abnormal. The neurodevelopment of the three patients were severely delayed, and two were mildly delayed. Conclusion: IESS could be a rare phenotype of PDE. High doses of pyridoxine can control or reduce the frequency of seizures. Delayed diagnosis and treatment, secondary brain injury, and the genotype, especially deletions variants, were associated with poor prognosis.

Objective: To evaluate the level of first morning voided (FMV) urinary luteinizing hormone (LH) in girls with breast development, and to determine the value of FMV urine LH in the evaluation of central precocious puberty (CPP). Methods: From September 2018 to April 2021, among the patients who were admitted to the Department of Pediatrics of Peking University Third Hospital for "precocious puberty" and underwent gonadotropin-releasing hormone (GnRH) stimulation test, a total of 108 girls were enrolled. According to CPP diagnostic criteria, they were divided into CPP group (n=45) and non-CPP group (n=63). The clinical characteristics and hormone levels of the two groups were compared. Receiver operating characteristic (ROC) curve was used to analyze the cut-off value of FMV urinary LH in the diagnosis of CPP in girls. Further analyses were done to evaluate the value of FMV urinary LH in the diagnosis of CPP using correlation analysis between urinary LH level and common clinical cha-racteristics. Results: ROC curve analysis showed that FMV urine LH level was significant for the diagnosis of CPP. The cut-off value of FMV urine LH was 0.69 IU/L (specificity 56.9%, sensitivity 85.0%, area under curve 0.804, P < 0.001). The basic clinical characteristics without GnRH stimulation test were analyzed by binary Logistic regression analysis, indicating that the level of FMV urine LH, uterine volume, ovarian volume and advanced T-bone age had predictive significance for CPP diagnosis in girls (OR values were 2.125, 1.961, 1.564 and 2.672, respectively). The prediction model was established and the area under the ROC curve was 0.904, P < 0.001. The level of FMV urine LH was positively correlated with the levels of serum LH, FSH and estrogen before GnRH stimulation test, the peak value of blood LH after GnRH stimulation test, T bone age and uterine volume, with r values of 0.462, 0.373, 0.242, 0.360, 0.373 and 0.263, respectively, and P values were < 0.001, < 0.001, 0.013, < 0.001, < 0.001 and 0.007, respectively. Conclusion: FMV urine LH can provide a good indication for the diagnosis of CPP. Combining with bone age advanced level and pelvic ultrasound measurement, the predictive value of FMV urine LH can be further improved for the diagnosis of CPP in girls.

Objective: To evaluate the nutritional status of vitamin A (VitA) in breast milk and its influencing factors among lactating women in the Weihai, Yueyang, and Baotou of China. Methods: From May to July 2014, 403 lactating mothers at (42±7) d postpartum were recruited from three Chinese cities, Weihai in Shandong Province, Yueyang in Hunan Province, and Baotou in Inner Mongolia. Basic information of lactating women and newborns and fish intake information of the lactating women in the last month were collected. The concentration of retinol in breast milk was collected and measured using high-performance liquid chromatography to determine the levels of VitA. According to the breast milk retinol concentration, the nutritional status of breast milk VitA among the lactating women was divi-ded into deficiency (< 1.05 μmol/L) and sufficient (≥1.05 μmol/L). The multivariate quantile regression was used to calculate the adjusted breast milk retinol concentrations. The Kruskal-Wallis H test and the Mann-Whitney U test were used to test the difference of breast milk retinol concentration according to the characteristics of the lactating women. The Logistic regression was used to analyze the effect of characteristics of lactating women on breast milk VitA deficiency. Results: The M (P₂₅, P₇₅) of breast milk retinol concentration among the Chinese lactating women was 1.15 (0.83, 1.49) μmol/L. Multivariate analysis showed that the adjusted breast milk retinol concentration was related to the regions, maternal age, ethnicity, education levels, body mass index (BMI), parity, gestational age, delivery modes, breastfeeding practice, fish intake and birth weight of the infants. The prevalence of VitA deficiency in breast milk among all the lactating women was 41.9%. In Weihai, Yueyang, and Baotou, the prevalence rates were 34.8%, 39.6%, and 51.5%, respectively. Compared with the women in Weihai, the adjusted OR for breast milk VitA deficiency among the women in Baotou was 1.75 (95%CI: 1.05-2.92). Compared with the women having college and above education, the adjusted OR for breast milk VitA deficiency among those having junior high school and below education were 2.16 (95%CI: 1.10-4.24). Compared with women with low fish intake, the adjusted OR for breast milk VitA deficiency among those with high fish intake were 0.55 (95%CI: 0.36-0.84). Conclusion: The prevalence of breast milk VitA deficiency among the Chinese lactating women was 41.9%, suggesting that breast milk VitA deficiency in lactating women and inadequate VitA intake for infants were common in China. The women in Baotou, low educational status and low fish intake increased the risk of breast milk VitA deficiency, suggesting that attention should be paid to the nutritional status of lactating women in underdeveloped regions such as inland region, and education for health should be enhanced and food containing VitA such as fish intake should be increased.

Objective: To understand the growth and development of Uygur primary and secondary school students aged 7-18 years in Xinjiang from 1985 to 2019, and to provide theoretical basis for formulating health promotion strategies. Methods: In the study, 18 591 Xinjiang Uygur primary and secondary school students aged 7-18 years with complete body height, body mass and body mass index (BMI) data by the Chinese National Surveillance on Students' Constitution and Health in 1985, 2000, 2010 and 2019 were selected as the research objects. The growth rate of each age group in each adjacent two survey years and per decade were calculated, and a t-test on the mean of each index to analyze was used to analyze the difference between the years. Results: During the period 1985-2019, except for the height of girls aged 17-18 years, the height and mass of Uyghur boys and girls in all the age groups increased significantly (P all < 0.01), and the growth range of height for boys and girls was 2.06-9.89 cm and -0.03 to 6.86 cm, respectively; the growth range of mass was 2.39-10.2 kg and 2.57-8.05 kg, respectively; the BMI for most age groups increased from 2000 to 2019, whose range was -0.94 to 0.86 kg/m² and 0.08-1.34 kg/m² for boys and girls, respectively. The growth range was greater for boys than for girls. Height and mass of boys and girls increased at the fastest rate in the first 15 years; the height of most age groups, mass and BMI of a few age groups decreased in the middle 10 years; overall turned to a positive growth trend in the last 9 years except for the mass of boys, and height of girls increased at the highest rate in all periods. Advancement of maximum increase/growth age (MIA) in height was greater than that in mass and BMI for girls; MIA in height did not change significantly in boys, but MIA in mass and BMI was significantly earlier. Conclusion: The overall body shape indexes of Uyghur primary and secondary school students aged 7-18 years in Xinjiang during the 34 years showed an increasing trend with gender differences. The overall status of growth was in the early stage of a secular growth trend, requiring focused attention to the mass status of both sexes to prevent the emergence of abnormal nutritional status.

Objective: To discuss the influencing factors of mental resilience in adolescents with depression, and to analyze the interaction between them by using path analysis, in order to determine the reasonable prevention and treatment measures for clinical practice and provide reference for the study of mental resilience in adolescents with depression. Methods: This survey adopted cross-sectional study and convenience sampling method. General information questionnaire, Connor-Davidson resilience scale (CD-RISC), family assessment device (FAD) and social support rating scale (SSRS) were used to investigate the general information, mental resilience level, family function and social support level of 162 adolescents with depression in Jiaozuo Fourth People ' s Hospital. Multiple linear regression was used to analyze the influencing factors of mental resilience in adolescents with depression. Structural equation model was established by Amos 22.0 software to analyze the influencing factors. Results: (1) The total score of CD-RISC and the scores of toughness, strength and optimism in adolescents with depression were lower than the domestic norm (P < 0.05). (2) The results of multiple linear regression showed that weight, childhood trauma experience, family structure, family function, parental rearing style, parental marital status, social support and depression degree were the influencing factors of psychological resilience of adolescents with depression (P < 0.05). (3) The model showed that weight, childhood trauma experience, family structure, family function and social support had direct effects on the mental resilience of adolescents with depression, and also had indirect effects on the mental resilience of adolescents with depression through the degree of depression (P < 0.05). Conclusion: In this study, we found that weight, childhood trauma experience, social support, depression degree and other factors have an effect on the psychological resilience of adolescents with depression. We suggest that school administrators increase the class time and course content of physical education courses, improve the mental health service system, strengthen mental health services for key groups, and formulate corresponding topics for timely counseling. At the same time, encourage them to actively participate in social practice activities, enhance self-confidence, and thus help to improve the level of psychological resilience of adolescents with depression.

Objective: To describe the epidemiological distribution of hemorrhoids in a physical examination population in China, which could provide evidence for precision prevention and early intervention of hemorrhoids. Methods: Chinese subjects over 18 years of age who underwent a physical examination in a nationwide chain of physical examination centers in 2018 were studied in a cross-sectional design, which collected information by a questionnaire and physical examination results from each subject. The epidemiological distribution of hemorrhoids was described using Logistic models. The gender-, age-, and region-detection rates of hemorrhoids were standardized to the Sixth National Population Census of the People's Republic of China (2010). Results: A total of 2 940 295 adult subjects were included in the study, of whom the average age was (41.7±14.0) years, and 52.6% were females. The standardized detection rate of hemorrhoids was higher for females (43.7%) than that for males (17.7%; P < 0.001) in this study. In the females, the age distribution of hemorrhoids was inverted U-shaped, with the highest standardized detection rate of hemorrhoids in the age group of 30-39 years (63.5%). In the males, the standardized detection rate of hemorrhoids increased along with age, with the highest percentage of 17.2% in the age group of 50-59 years, and the standardized detection rate of hemorrhoids in the age group of 60 and above decreased slightly (P < 0.001 for trend test). The participants with hypertension had a higher standardized detection rate of hemorrhoids than those with normal blood pressure in both males and females (P < 0.001). The standardized detection rate of hemorrhoids showed a positive correlation with body mass index (P < 0.001 for trend test in males). Conclusion: The detection rate of hemorrhoids varied to gender, age, obesity, and hypertension status, which could help to identify the risk factors and the high-risk sub-groups, and hence to strengthen health education and early detection accordingly, which could eventually reduce the incidence of hemorrhoids and improve the quality of life and health in the Chinese population. This study was conducted in a physical examination population, and the conclusions of this study should be extrapolated with caution.

Objective: To assess the impact of exposure to particulate matter with aerodynamic diameter ≤2.5 μm (PM_2.5) on non-accidental mortality under different apparent temperature levels and to further explore the modification effect of apparent temperature. Methods: This study used time-series design. Tianjin and Ningbo from China, Bangkok and Chiang Mai from Thailand were selected as the research sites, and the apparent temperature was applied as the exposure index. Through the quantitative estimation of the threshold temperature, the corresponding pollutant concentration was divided into high and low levels, and the generalized Poisson additive model was used to evaluate the association between PM_2.5 exposure and non-accidental death of residents at different temperature levels. Results: The ave-rage concentrations of PM_2.5 in Tianjin, Ningbo, Bangkok, and Chiang Mai during the study period were (73.6±35.6), (48.0±32.1), (33.5±28.4) and (32.6±28.6) μg/m³, respectively; the average daily non-accidental death counts were 148, 57, 28, and 8. The analysis of the generalized Poisson additive model showed that the daily non-accidental death counts increased by 0.43% (95%CI: 0.33%-0.54%) per 10 μg/m³ increase of PM_2.5 in lag 0 day in Tianjin of China; 0.27% (95%CI: 0.08%-0.46%) per 10 μg/m³ increase of PM_2.5 in lag 2 days in Ningbo of China. The effect was magnified in high temperature levels in Tianjin and in low temperatures in Ningbo and Bangkok. The mortality effect of PM_2.5 in various temperature levels stayed still in co-pollutant regression models. Conclusion: Exposure to fine particulate matter had an adverse effect on non-accidental mortality, which reminded us to give further attention to the pollution control. The findings also indicated that apparent temperature might modify mortality effects of PM_2.5 and the modification effect varied in different regions. Protective policies due to regional differences should be made and more scientific and social attention on mutual effect of air pollution and climate change needs to be appealed.

Objective: To assess the reliability, and validity of the Chinese version of a short-form of Health Literacy Dental scale (HeLD-14) in 3-6 years old preschool children's parents. Methods: The study population consisted of those eligible 3-6 years old preschool children's parents in Yanqing District, Beijing, China in 2021. A total of 1 479 preschool children's parents were surveyed by questionnaire to understand the general situation of parents and oral health literacy related content. SPSS 21.0 and Mplus 7.4 were used for statistical analysis. Through Cronbach's α coefficient, confirmatory factor analysis, Pearson correlation calculation, Student's t test and other methods, the internal consistency reliability, structure validity, calibration validity and discrimination validity of the scale were evaluated. Results: The Cronbach's α coefficient of Chinese version HeLD-14 scale was 0.958, and Cronbach's α coefficient of different constructs ranged from 0.778 to 0.963. The confirmatory factor analysis showed that the factor loadings of each item of the Chinese version HeLD-14 scale were between 0.719 and 0.977 (P < 0.001), root-mean-square error of approximation (RMSEA)=0.04, comparative fix index (CFI)=0.992, Tucker-Lewis index (TLI)=0.988, and the model had good goodness of fit. The total score of the Chinese version HeLD-14 scale and the scores of the dimension of concerning, understanding, supporting, financial burden, medical treatment, communication, and application were all positively correlated with general self-efficacy, and the correlation coefficients were 0.439, 0.406, 0.370, 0.344, 0.346, 0.367, 0.373, 0.390, respectively (P all < 0.05). For parents in the high group with the top 27% HeLD-14 score, the average HeLD-14 score was 69.27±1.06, which was higher than the low group with the bottom 27% HeLD-14 score, 41.29±11.09 (t=48.13, P < 0.01). Conclusion: The Chinese version HeLD-14 scale has good reliability and validity in the 3-6 years old preschool children's parents, and can be used as a tool to assess the oral health literacy of parents of preschool children.

Objective: To investigate the prevalence of dental caries of 4-year-old children in Miyun District of Beijing by international caries detection and assessment system (ICDAS), to detect the caries activity Cariostat value and to analyze the correlation between the Cariostat value and dental caries. Methods: Totally 815 children aged 4 years in 7 kindergartens in Miyun District of Beijing were recruited. The clinical examination of all children was conducted by one examiner using ICDAS. The oral de-birs and plaques were collected by one doctor who recorded the Cariostat scores. The results of clinical examination were compared between genders. At the same time, the prevalence of dental caries, the mean d_3-6ft/d_3-6fs and d_1-6ft/d_1-6fs among high Cariostat scores group (2.0-3.0), medium Cariostat scores group (1.5) and low Cariostat scores group (0-1.0) were compared. The distributions of incipient caries in different Cariostat scores groups were compared among children with incipient caries only. Results: All the children had incipient caries, and 78.3% of the children had cavitated caries with ICDAS score of 3 or above. The mean d_1-2t scores were 9.76±3.65, the mean d_3-6ft scores was 4.64±4.43 and the mean d_1-6ft scores were 14.41±3.42. The incipient caries with ICDAS score of 1-2 were widely distributed, accounting for 67.7% of the total numbers of caries. There was no significant diffe-rence in caries prevalence and caries experience between genders (P>0.05). The proportion of children with high Cariostat scores in boys (43.6%) was higher than that in girls (33%) and the difference was statistically significant (P<0.05). With the increase of Cariostat scores, the prevalence of cavitated caries, the mean d_3-6ft/d_3-6fs and d_1-6ft/d_1-6fs scores in children was on the increase and the difference among the three groups was statistically significant (P<0.05). For children with incipient caries only, the distribution of incipient caries in different Cariostat scores groups was no significant difference (P>0.05). Conclusion: ICDAS can detect early enamel demineralization of deciduous teeth in children. The prevalence of dental caries among 815 4-year-old children in Miyun District of Beijing is more serious, and incipient caries is widely distributed in children. Cariostat value reflects the status of cavi-tated caries and has no correlation with the distribution of incipient caries. Therefore, the combined application of ICDAS and Cariostat caries activity detection method is helpful for the detection of incipient caries and screening of caries high-risk children, which has great significance for the comprehensive ma-nagement of caries in children and the formulation of early preventive measures.

Objective: To study the distribution characteristics of natural killer (NK) cells and their subsets in normal peripheral blood in China, and to explore their normal value and significance. Methods: In this study, peripheral blood was collected from 200 healthy adults. Their age range was 18-87 years. All the subjects were divided into 6 age groups: 18-30, 31-40, 41-50, 51-60, 61-70, and 71-87 years. With CD16, CD56, CD4, CD19, as surface markers, fluid cytology detection techniques were used to detect NK cells and the relative and absolute counts. SPSS 27.0 was used for systematic analysis of the data, and the measurement data were expressed as mean±standard deviations. A t test, variance analysis or rank sum test were performed to compare the differences between the age groups and the sex groups. The significance level was set at α=0.05, and P < 0.05 was considered statistically significant. Results: The range of NK B cells in the 200 healthy adult subjects was (0.46±0.24)×10⁶/L, that of CD3^-CD56⁺NK cells was (13.14±7.56)×10⁶/L, that of CD56^dimCD16⁺NK cells was (5.23±3.12)×10⁶/L, that of CD56^brightNK cells was (85.61±7.40)×10⁶/L, and that of NK T cells was (4.16±3.34)×10⁶/L. There were no statistically significant differences in CD3^-CD56⁺NK cells and NK T cells with respect to age (P= 0.417, P=0.217). However, there was a decreasing trend in the number of NK B cells and CD56^dimCD16⁺NK cells with increasing age (r=0.234, P < 0.001; r=0.099, P < 0.001), particularly after the age of 50. Conversely, CD56^brightNK cells showed an increasing trend with age (r=0.143, P < 0.001). Conclusion: The detection of NK cells and their subsets has significant reference value for the diagnosis, treatment, and prognosis of autoimmune diseases, infectious diseases, and tumors. This study provides a preliminary reference range for clinical detection of NK cell subsets, but further research with a larger sample size and multi-center trials are needed to confirm these findings.

Objective: To assess the diagnostic value of anti-salivary gland protein-1 (SP1) antibody combined with anti-parotid secretory protein (PSP) antibody for Sjögren's syndrome (SS). Methods: A total of 60 patients with primary SS (pSS) who were treated in the outpatient and inpatient department of Department of Rheumatology and Immunology of the Second Hospital of Hebei Medical University from January 2020 to December 2022 were collected. Thirty patients with other autoimmune diseases accompanied by dry mouth and/or dry eyes were collected as disease control group. Thirty healthy subjects from the physical examination center were collected for healthy control group, serum samples were obtained from all of them. Their general features and clinical information including clinical manifestations, laboratory examinations and other examinations were recorded. The 2016 American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) classification criteria were adopted as the diagnostic standard of pSS. Immunoglobulin G (IgG) subtype of anti-SP1 antibody and anti-PSP antibody were detected by chemiluminescence immunoassay. The receiver operating characteristic (ROC) curve was used to evaluate the accuracy of anti-SP1 antibody and anti-PSP antibody in diagnosing pSS.The cli-nical characteristics of anti-SP1 antibody and anti-PSP antibody positive patients and negative patients in pSS group were further compared. Independent samples t test, Mann-Whitney U test, variance analysis, Kruskal-Wallis test, Chi-square test or Fisher's exact test and Spearman correlation analysis were used for statistical analysis. Results: There was no significant difference in age (F=1.406, P=0.495) and gender (χ²=2.105, P=0.349) among pSS group, disease control group and healthy control group. The expression levels of anti-SP1 antibody (H=16.73, P < 0.001) and anti-PSP antibody (H=26.09, P < 0.001) were statistically different among the three groups. An intergroup comparison of anti-SP1 antibody expression levels showed that there was a statistically significant difference between pSS and healthy control group (P < 0.001), but no statistically significant difference between the other groups. Comparison of anti-PSP antibody expression levels between the groups showed that there were statistically significant differences between pSS and healthy control group (P < 0.001), and between disease control group and healthy control group (P=0.009), while no statistically significant differences between the other groups. The positive rate of anti-SP1 antibody in pSS group was significantly higher than that in disease control group and healthy control group (58.33% vs. 40.00% vs. 13.33%, P < 0.001). The positive rate of anti-PSP antibody in pSS group was significantly higher than that in disease control group and healthy control group (75.00% vs. 56.17% vs. 16.67%, P < 0.001). The area under the curve for anti-SP1 antibody was 0.688 (P < 0.001). The sensitivity and specificity of anti-SP1 antibody were 58.33% (35/60) and 70.00% (42/60) respectively, the positive predictive value was 66.04% (35/53) and the negative predictive value was 54.55% (42/77) of anti-SP1 antibody.The area under the curve of anti-PSP antibody was 0.720 (P < 0.001), with a sensitivity was 75.00% (45/60), and specificity was 63.33% (38/60).The positive predictive value and negative predictive value of anti-PSP antibody were 67.16% (45/67) and 71.70% (38/53) respectively. All the 13 pSS patients were negative for anti-Sjögren's syndrome A (SSA, including SSA52 and SSA60) antibody and anti- Sjögren's syndrome B (SSB) antibody. Among them, 11 patients were positive for both anti-SP1 antibody and anti-PSP antibody, 1 patient was positive for anti-SP1 antibody and 1 patient was positive for anti-PSP antibody. The clinical features of anti-SP1 antibody and anti-PSP antibody positive and negative groups were compared in pSS patients. The duration of disease in anti-SP1 antibody positive group was shorter (Z=-2.277, P=0.023) when compared with the negative patients. The patients with positive anti-PSP antibody were younger than those in the negative group (t=2.598, P < 0.05), the positive rate of rheumatoid factor (P=0.002) and the serum level of IgG (t=3.806, P=0.003) in anti-PSP antibody positive group were higher than in the negative group. Analysis of the correlation between anti-SP1 antibody and anti-PSP antibody in the pSS patients showed that there was significant correlation between them (r=0.801, P < 0.001). Conclusion: Both anti-SP1 antibody and anti-PSP antibody are valuable in the diagnosis of SS, and anti-SP1 antibody is helpful for the early diagnosis of pSS. The combined detection of anti-SP1 antibody and anti-PSP antibody is helpful for the early diagnosis of pSS patients with negative anti-SSA antibody and anti-SSB antibody.

Objective: To explore the application of ¹⁸F-flurodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in rheumatic diseases, to compare these different imaging features, and to describe the current PET/CT imaging status in clinical practice. Methods: A total of 486 cases in our department from January 2012 to December 2018 were enrolled in this study, and ¹⁸F-FDG PET/CT examination was performed in all the patients. The clinical use of ¹⁸F-FDG PET/CT was retrospectively analyzed to discuss the clinical application and its imaging characteristics of rheumatic diseases. Categorical data were used to ascertain prevalence statistics, whereas continuous data were used to delineate means and standard deviations. Independent sample t test, Chi square test and Mann-Whitney U test were used for statistical analysis. A P-value of < 0.05 was considered significant. Results: (1) From 2012 to 2018, totally 486 patients in the Department of Rheumatology and Immunology underwent ¹⁸F-FDG PET/CT examination, accounting for 5.30% of the total number of PET/CT examinations in the whole hospital. In this study, 304 of the 486 patient were female (62.55%), 182 of them were male (37.45%), the average age of the patients was (53.21±18.81) years, and the proportion of the patients aged 45-65 (227/486, 46.71%) was the highest group. (2) Three leading purposes of the PET/CT examination in our department were to exclude cancers (55.56%), assist in diagnosis (24.60%) and evaluate the disease activity (19.84%). (3) Of the 486 patients who underwent ¹⁸F-FDG PET/CT, 327 cases might indicate a differential diagnosis of rheumatic disease, of which, 292 cases were highly suggestive of diagnosis, including 61 cases of myositis, 60 cases of vasculitis, 37 cases of adult still's disease, 32 cases of IgG4 related diseases, 30 cases of rheumatoid arthritis, 22 cases of Sjögren's syndrome, 22 cases of systemic lupus erythematosus, and 9 cases of rheumatic polymyalgia; the remaining 35 cases only prompted the possibility of autoimmune disease. Of the 486 patients, 74 cases suggested the diagnosis of cancers, 25 cases indicated the diagnosis of infectious diseases, while 60 cases could not show any diagnostic values. Ten patients with rheumatic disease were followed up with a post-treatment repeat PET/CT, and the findings in remission showed reduced ¹⁸F-FDG metabolic activity as well as a reduction in the extent of metabolic hypertrophic lesions. Conclusion: There are some typical sign of ¹⁸F-FDG PET/CT for diffuse connective tissue diseases, therefore ¹⁸F-FDG PET/CT has auxi-liary effect on the classification diagnosis of rheumatic diseases, especially for the exclusion of cancers.

Objective: To investigate the mechanism of immunomodulatory effects of umbilical cord mesenchymal stem cells (UC-MSCs) modified by miR-125b-5p on systemic lupus erythematosus (SLE). Methods: The expression level of miR-125b-5p was detected by real-time fluorescence quantitative PCR in UC-MSCs and peripheral blood mononuclear cells (PBMCs) from SLE patients and health checkers. Annexin V-FITC/PI apoptosis detection kit was used to detect the effect of miR-125b-5p on apoptosis of UC-MSCs. MRL/lpr mice in each group were injected with UC-MSCs via tail vein, and T-lymphocyte subsets in the spleen of the MRL/lpr mice were detected by flow cytometry after 5 weeks. The expression levels of interleukin (IL)-4 and IL-17A in serum of MRL/lpr mice were detected by ELISA. Hematoxylin-eosin staining was used to observe the pathological manifestations of the lungs and kidneys of the MRL/lpr mice. Results: miR-125b-5p was significantly down-regulated in PBMCs of SLE patients compared with healthy controls (P < 0.01). Compared with the UC-MSCs group, the expression of miR- 125b-5p in UC-MSCs modified by miR-125b-5p group was increased (P < 0.01). The survival rate of UC-MSCs was significantly increased by miR-125b-5p (P < 0.01). Compared with the untreated group of MRL/lpr mice, the expression level of IL-4 in serum was increased (P < 0.05); the expression level of IL-17A was decreased (P < 0.05); the proportion of Th17 cells in the spleen of MRL/lpr mice was decreased (P < 0.05); the inflammatory cells infiltration and micro-thrombosis of lungs and kidneys of MRL/lpr mice were significantly reduced in the UC-MSCs modified by miR-125b-5p treatment group. Conclusion: UC-MSCs modified by miR-125b-5p have immunomodulatory effects on systemic lupus erythematosus.

Objective: To evaluate knee biomechanics of patients about 12 months after anterior cruciate ligament (ACL) reconstruction during cutting and determine the abnormal biomechanical characteristics. Methods: Sixteen males about 12 months after ACL reconstruction were recruited for this study. Three-dimensional kinematic and kinetic data were collected during cutting movement. Knee joint angles and moments were calculated. Paired t-tests were used to compare the differences in knee biomechanics between the surgical leg and nonsurgical leg. Results: The peak posterior ground reaction force (surgical leg: 0.380±0.071; nonsurgical leg: 0.427±0.069, P = 0.003) and vertical ground reaction force (surgical leg: 1.996±0.202, nonsurgical leg: 2.110±0.182, P = 0.001) were significantly smaller in the surgical leg than in the nonsurgical leg. When compared with the uninjured leg, the surgical leg demonstrated a smaller knee flexion angle (surgical leg: 38.3°± 7.4°; nonsurgical leg: 42.8°± 7.9°, P < 0.001) and larger external rotation angle (surgical leg: 10.3°± 2.4°; nonsurgical leg: 7.7°± 2.1°, P = 0.008). The surgical leg also demonstrated a smaller peak knee extension moment (surgical leg: 0.092 ± 0.031; nonsurgical leg: 0.133 ± 0.024, P < 0.001) and peak knee external rotation moment (surgical leg: 0.005 ± 0.004; nonsurgical leg: 0.008 ± 0.004, P = 0.015) when compared with the nonsurgical leg. Conclusion: The individuals with ACL reconstruction mainly showed asymmetrical movements in the sagittal and horizontal planes. The surgical leg demonstrated a smaller peak knee flexion angle, knee extension moment, and knee external rotation moment, with greater knee external rotation angle.

Objective: To construct and validate a nomogram for prediction of in-hospital postoperative heart failure (PHF) in elderly patients with hip fracture. Methods: This was a retrospective cohort study. The patients aged ≥65 years undergoing hip fracture surgery in Peking University Third Hospital from July 2015 to December 2023 were enrolled. The patients admitted from July 2015 to December 2021 were divided into a development cohort, and the others admitted from January 2022 to December 2023 in to a validation cohort. The patients ' clinical data were collected from the electronic medical record system. Univariate and multivariate Logistic regression were employed to screen the predictors for PHF in the patients. The R software was used to construct a nomogram. Internal and external validation were performed by the Bootstrap method. The discriminatory ability of the model was determined by the area under the receiver operating characteristic curve (AUC). The calibration was evaluated by the calibration plot and Hosmer-Lemeshow goodness-of-fit test. Decision curve analysis (DCA) was performed to assess the clinical utility. Results: In the study, 944 patients were eventually enrolled in the development cohort, and 469 were in the validation cohort. A total of 54 (5.7%) patients developed PHF in the deve-lopment cohort, and 18 (3.8%) patients had PHF in the validation cohort. Compared with those from non-PHF group, the patients from PHF group were older, had higher prevalence of heart disease, hypertension and pulmonary disease, had poorer American Society of Anesthesiologists (ASA) classification (Ⅲ-Ⅳ), presented with lower preoperative hemoglobin level, lower left ventricular ejection fraction, higher preoperative serum creatinine, received hip arthroplasty and general anesthesia more frequently. Multivariate Logistic regression analysis showed that age (OR=1.071, 95%CI: 1.019-1.127, P=0.008), history of heart disease (OR=5.360, 95%CI: 2.808-10.234, P < 0.001), preoperative hemoglobin level (OR=0.979, 95%CI: 0.960-0.999, P=0.041), preoperative serum creatinine (OR=1.007, 95%CI: 1.001-1.013, P=0.015), hip arthroplasty (OR=2.513, 95%CI: 1.259-5.019, P=0.009), and general anesthesia (OR=2.024, 95%CI: 1.053-3.890, P=0.034) were the independent predictors for PHF in elderly patients with hip fracture. Four preoperative predictors were incorporated to construct a preoperative nomogram for PHF in the patients. The AUC values of the nomogram in internal and external validation were 0.818 (95%CI: 0.768-0.868) and 0.873 (95%CI: 0.805-0.929), indicating its good accuracy. The calibration plots and Hosmer-Lemeshow goodness-of-fit test (internal validation: χ²=9.958, P=0.354; external validation: χ²=5.477, P=0.791) showed its satisfactory calibration. Clinical usefulness of the nomogram was confirmed by decision curve analysis. Conclusion: An easy-to-use nomogram for prediction of in-hospital PHF in elderly patients with hip fracture is well developed. This preoperative risk assessment tool can effectively identify patients at high risk of PHF and may be useful for perioperative management optimization.

Objective: To evaluate the efficacy of modified femoral neck osteotomy (mFNO) in the surgical treatment of patients with ankylosing spondylitis (AS) and severe spinal kyphosis combined with hip flexion contracture. Methods: A retrospective analysis was conducted on 61 AS patients (103 hips) with spinal kyphosis and hip flexion contracture who underwent pedicle subtraction osteotomy (PSO) and total hip arthroplasty (THA) from January 1, 2019 to November 15, 2023. Data on mFNO operation time, blood loss, preoperative and postoperative values of the angle of the trunk and lower limb (ATL), hip passive range of motion (ROM), visual analogue scale (VAS), and incidence of in-hospital complications were recorded. Statistical analysis was performed using paired-samples t test. P < 0.05 was considered statistically significant. Results: The study ultimately included 10 cases, 9 males and 1 female, with an average age of (41.30±9.03) years. These patients underwent surgery for a total of 52 times, including 19 hips both receiving mFNO and THA, and 14 times PSO. The average operation time for nine bilateral mFNO was (133.11±34.81) min, with blood loss of (433.33±187.10) mL. A unilateral mFNO took 60 min with 200 mL of blood loss. The preoperative ATL of 19 hips was 40.37°±13.66°, and the postoperative ATL value was 88.47°±12.46° (P < 0.05). The preoperative VAS score was 0, while the postoperative VAS score was 5.95±1.51 (P < 0.05). The preoperative hip extension ROM was 37.37°±18.13°, while the postoperative hip extension ROM was -4.95°±21.24° (P < 0.05). Hip flexion ROM improved from 37.37°±18.13° to 50.79°±20.36° after FNO (P < 0.05). There were three cases of in-hospital complications (3/52, 5.67%): One case of postoperative atelectasis following PSO (1/52, 1.92%), one greater trochanter fracture identified during THA (1/52, 1.92%), and one early dislocation post-THA (1/52, 1.92%). Conclusion: mFNO significantly improves the ATL in AS patients with severe spinal kyphosis combined with hip flexion contracture, facilitating PSO and THA surgeries.

Objective: To compare the effects of unilateral thoracic paravertebal block with lidocaine on hemodynamic and the level of consciousness during double lumen endotracheal intubation. Methods: From June to october 2021, a total of 40 patients American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, aged 19-65 years, scheduled for elective thoracic sugeries in Peking University International Hospital block with under general anesthesia requiring orotracheal intubation were recruited and divided into two groups: The double-lumen endobronchial intubation (group C) and double-lumen endobronchial intubation after thoracic paravertebal block with lidocaine (group P). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy, respectively. Invasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction, immediately after intubation and 5 min after intubation with 1-minute interval and the intubation time was also noted. Rate-pressure product (RPP) were calculated. Results: After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. As comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BP, HR and RPP. Diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1-minute in group C compared with the baseline values. Systolic blood pressure (SBP) was not significant change and DBP increased significantly immediately after intubation in group P.HR of both groups after intubation were significantly higher than their baseline values and lasted for 4 min in group C, HR increased significantly immediately after intubation in group P. SBP, DBP, MAP, HR and RPP after intubation in group P were significantly lower than those of group C during the observation period. The value of BIS was similar between the two groups. Compared with group C, the incidence of SBP greater than 30% and RPP greater than 22 000 was significantly lower in group P in the observation period, and no patient in group P developed RPP greater than 22 000. At the end of the incidence of SBP less than 30% of the basal value and HR less than 30% of the baseline, no severe bradycardia occurred in both groups. Conclusion: During double-lumen endobronchial intubation, unilateral thoracic paravertebal block with lidocaine can provide less hemodynamic response and level of conscionsness.

Objective: To analyze the risk factors for postoperative pathological upgrade of prostate cancer patients with single core positive biopsy, and to attempt to build a mathematical model for predicting postoperative pathological upgrade in these cancer patients with single core positive biopsy. Methods: A retrospective analysis was conducted on 1 349 patients diagnosed with prostate cancer and undergoing radical prostatectomy at Peking University First Hospital from January 2015 to August 2020. The patients' age, body mass index, clinical stage, prostate imaging reporting and data system (PI-RADS) scores, prostate volume in magnetic resonance imaging (MRI), Gleason score of biopsy, serum prostate specific antigen (PSA) before biopsy and operation, surgical method and pathological stage were inclu-ded in the analysis. The variables with P < 0.1 in univariate analysis were included to construct multi-variate Logistic regression and the nomogram was drawn. The model was evaluated using the receiver operating curve. Results: A total of 71 patients were included in this research, with 34 patients in the upgraded group and 37 patients in the non-upgraded group. There were no significant differences in the patients' age (P=0.585), body mass index (P=0.165), operation method (P=0.08), prostate volume in MRI (P=0.067), clinical stage (P=0.678), PI-RADS score (P=0.203), difference of PSA density (P=0.063), Gleason score in biopsy (P=0.068), PSA before puncture (P=0.359) and operation (P= 0.739) between the two groups. However, there were significant differences in the proportion of tumor tissue (P=0.007), postoperative pathological stage (P < 0.001) and postoperative Gleason score (P < 0.001) between the two groups. The preoperative variables with a P value of less than 0.1 (prostate volume in MRI, difference of PSA density, proportion of tumor tissue and Gleason score in biopsy) in univariate analysis were included in the Logistic regression, and the nomogram was drawn. Only the prostate volume in MRI had a P value of less than 0.05. The area under the curve of the model was 0.773. Conclusion: In patients with single core positive biopsy, if the prostate volume is small or the proportion of tumor in positive core is small, clinicians should be alert to the possibility of postoperative pathology upgrading, preoperative risk stratification should be carefully considered for patients with possible pathological upgrading. This model can be used to predict the pathological upgrade of patients with single core positive biopsy.

Objective: To analyze the clinical characteristics of acute and chronic gastrointestinal bleeding in patients with end-stage renal disease (ESRD) after kidney transplantation, to improve the understanding of the causes, diagnosis, treatment and prevention of this complication, and to improve the management of patients with gastrointestinal bleeding after kidney transplantation. Methods: The clinical, imaging and pathological data of patients with gastrointestinal bleeding after kidney transplantation in the Department of Urology of The First Affiliated Hospital of Anhui Medical University from August, 2015 to December, 2020 were collected. The etiology, early clinical manifestations, abnormal laboratory tests and examinations, treatment procedures, late prevention and treatment measures and outcomes of gastrointestinal bleeding were retrospectively studied, and the relevant literature was summarized and reviewed. Results: A total of 17 patients were included in this study. Nine patients had chronic small amount of bleeding, hemoglobin gradually decreased, melena and fecal occult blood positive in the early stage, and the general condition was good, vital signs were stable, and were cured by drug treatment. Gastroscopy showed small ulcers with active bleeding foci in 2 cases, and the bleeding was stopped by titanium clips, and the prognosis was good. Gastroscopy showed that the anterior wall longitudinal ulcer at the junction of gastric antrum body was not effective in 1 case, and the small branch of right gastroepithelial artery was embolized, and the patient recovered and discharged after 2 weeks. Gastroscopy showed deep pit ulcer at the lesser curvature of gastric antrum in 1 patient, who underwent distal gastroduodenal artery embolization and had a good prognosis. Gastroscopy showed huge multiple ulcers in the stomach and duodenal bulb in 2 patients, who underwent subtotal gastrectomy and partial duodenectomy, duodenal stump exclusion and remnant gastrojejunostomy. One patient recovered and was discharged, and the other patient died of rebleeding on the 12th day after surgery. Two cases of diverticulum underwent surgical resection of diverticulum, and the prognosis was good. Conclusion: The onset of gastrointestinal hemorrhage in kidney transplant patients is insidious, and the condition is acute or slow, which can cause different degrees of damage to the patient and the transplanted kidney. Active prevention, early diagnosis, timely drug treatment, if the effect is not good, decisive endoscopic titanium clip hemostasis, transvascular interventional embolization, and even surgical treatment can minimize the harm of gastrointestinal bleeding.

Objective: To evaluate the efficacy of cyclophosphamide (CYP) at different doses in replicating the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS) in an animal model, thereby providing an experimental basis for understanding the pathophysiology of IC/BPS and assessing treatment strategies. Methods: Twenty-eight female Sprague-Dawley rats aged seven weeks were divided into four groups: Group a (25 mg/kg CYP), group b (75 mg/kg CYP), group c (125 mg/kg CYP), and group d (a control group). The rats were injected intraperitoneally with either CYP or saline solution. Evaluations included urine spot tests, von Frey filament pain threshold tests, urodynamic examinations, and histological assessments. Results: The study found that the 25 mg/kg CYP dosage significantly outperformed higher doses in simulating bladder dysfunction and inflammatory responses while minimizing the impact on the rats' physiological functions. Specifically, urine spot area, group a showed a significant reduction in urine spot area compared with the control group (P < 0.05), while groups b and c did not show significant differences. Pain threshold: The von Frey filament test indicated increased visceral pain in group a, aligning closely with IC/BPS patient symptoms, without a significant increase in urination frequency. Urodynamic assessments: Group a exhibited decreased bladder compliance and reduced maximum bladder capacity (P < 0.05), with no significant differences in baseline bladder pressure and maximum detrusor pressure across all groups. Histological analysis: Hematoxylin-eosin (HE) staining revealed that bladder tissue in group a had moderate inflammatory reactions, whereas groups b and c showed severe inflammation and tissue damage, correlating with the higher doses of CYP. Furthermore, the urine spot tests and von frey filament tests provided quantitative data supporting the model's reliability, urine spot count, group a had an average urine spot count of (15±3) spots, significantly higher than the control group's (5±2) spots (P < 0.01). Nociceptive score: Group a nociceptive score increased to 0.5±0.1, indicating heightened pain sensitivity compared with the control group 0.10±0.05 (P < 0.01). Conclusion: The 25 mg/kg CYP demonstrated significant advantages in simulating the key features of non-ulcerative IC/BPS, summarizing the main aspects of the human condition, including persistent visceral pain and mild inflammatory reactions in bladder tissue. These findings offer substantial experimental support for drug development and treatment research in IC/BPS and provide new insights into the complex patho-physiology of the disease.

Objective: To investigate the etiological distribution of hydronephrosis caused by upper urinary tract obstruction in adult patients and to improve the diagnostic accuracy for this condition. Methods: The clinical information of adult patients with newly diagnosed hydronephrosis in Upper Urinary Tract Repair Outpatient Clinic of Peking University First Hospital from May 2020 to May 2021 were prospectively and continuously collected. Patients with ureteral calculi or upper urinary tract tumor were excluded. A total of 767 patients were involved. The underlying causes of upper urinary tract obstruction were identified by senior urological surgeons according to symptoms, medical history, physical examination, and a range of diagnostic imaging techniques including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), retrograde pyelography, antegrade pyelography, radionuclide renogram and ureteroscopy. Results: Among the 767 patients, 359(46.8%) were male and 408(53.2%) were female. The median age of these patients was 37 years (range, 14-84 years). Hydronephrosis was observed at left-sided in 357 cases(46.6%), right-sided in 251 cases(32.7%), and bilateral in 159 cases(20.7%). The causes of hydronephrosis were classified as follows: (1) Non-iatrogenic factors were found in 464 cases (60.5%). These included urinary malformations in 355 cases(76.5%), infection in 29 cases(6.3%), pelvic lipomatosis and/or cystitis glandularis in 23 cases(5.0%), ureteral endometriosis in 18 cases(3.9%), retroperitoneal fibrosis in 15 cases(3.2%), trauma in 7 cases(1.5%) and other non-iatrogenic factors in 12 cases(2.6%). Some of these patients had multiple non-iatrogenic causes. Among the 355 cases with urinary system malformations, 252 cases (71.0%) had ureteropelvic junction obstruction. (2) Iatrogenic ureteral injuries accounted for 210 cases (27.4%), including 112 cases(53.3%) of urological surgical injuries, 51 cases(24.3%) of radiotherapy for malignant tumor related injuries, 34 cases(16.2%) of gynecological and obstetrical surgical injuries, and 13 cases(6.2%) of general surgical injuries. (3) The cause of hydronephrosis remained unknown in 93 cases(12.1%). Conclusion: Hydronephrosis in adults due to upper urinary tract obstruction has a diverse range of causes, with urinary malformations and iatrogenic ureteral injuries being significant contributors. Urological surgeon involved in upper urinary tract reconstruction should be familiar with these potential causes to facilitate accurate diagnosis and effective treatment.

To investigate the initial experience of coated metal ureteral stent (CMUS) for treatment of pelvic lipomatosis induced hydronephrosis (PLH). The clinical and follow-up data of 8 patients who were diagnosed as PLH treated with CMUS in Peking University People's Hospital from August 2018 to February 2021 were retrospectively analyzed. Inclusion criteria included: Imaging evidence of excessive adipose tissue around the bladder in the pelvic cavity, bladder elevation in an "inverted pear shape", and bladder wall thickening; Cystoscopy indicated follicular hyperplasia of bladder mucosa and biopsy pathology indicated glandular cystitis; Unilateral or bilateral hydronephrosis and ureteromegaly. Exclusion criteria included: Ureteral atresia; Recurrent obstruction of the bladder outlet. Preoperative baseline data included age, gender, serum creatinine, pelvis width and ureteric stent symptoms questionnaire (USSQ) score. Intraoperative data included the location and length of ureteral stenosis observed by retrograde urography. Postoperative follow-up data included serum creatinine, pelvis width, and USSQ score. In the study, 8 patients (11 sides) with PLH were all male, with an average age of (38.7±8.6) years. Unilateral hydronephrosis was found in 5 cases and bilateral hydronephrosis in 3 cases. Preoperative mean serum creatinine was (90.0±10.3) μmol/L, and the mean renal pelvis width was (3.0±1.5) cm. The lower ureteral stricture was found in all cases, and the mean stricture length was (1.9±0.9) cm. Before operation, 3 patients had ureteral Double-J stents, with USSQ scores of 97.0, 68.0 and 100.0, respectively. Five patients underwent retrograde CMUS stenting, and 3 patients retrograde and antegrade. At the last follow-up, the average serum creatinine was (82.0±11.1) μmol/L and the mean renal pelvis width was (1.9±0.5) cm, which were significantly lower than those before operation (t=3.12, P=0.02; t=3.23, P=0.02). In the 3 patients with Double-J stent before surgery, the USSQ scores were 87.0, 62.0 and 89.0, respectively, which were significantly improved after CMUS stenting. The average follow-up time was (10.0±6.3) months. During the follow-up, 1 patient developed CMUS related symptoms, and no stent-associated infection and stent encrustation were found. In one case, the stent migrated to the bladder 3 months after operation, and the hydronephrosis disappeared after 3 months follow-up. CMUS stenting for treatment of PLH has certain efficacy and safety, which can explore a new therapeutic method for the long-term treatment of PLH.

The objective was to report a relatively rare case of fulminant type 1 diabetes (FT1DM) complicated with acute pancreatitis (AP), to summarize the characteristics as well as experience of diagnosis and treatment, and to explore its pathogenesis. Clinical data of a case of FT1DM complicated with AP in the Department of Endocrinology of our hospital were analyzed retrospectively. A 66-year-old male presented with acute fever and abdominal pain, accompanying with the significantly elevated pancreatic enzymes, and his abdominal CT scan showed exudation around the pancreas. The clinical manifestations mentioned above were consistent with the diagnosis of AP. Five days after onset, the patient developed clinical symptoms, such as obvious thirst, polyuria, polyasthenia and fatigue. Meanwhile, his plasma glucose increased significantly and the diabetic ketoacidosis (DKA) occurred. The patient's fasting and postprandial 2 hours C peptide decreased significantly (all 0.02 μg/L), glycated hemoglobin level was not high (6%), and his islet-related autoantibodies were undetectable. Thus, the patient could be diagnosed with FT1DM. After the treatment of fasting, fluid replacement, anti-infection, somatostatin, anticoagulation and intravenous insulin sequential subcutaneous insulin pump, the patient gained the alleviation of pancreatitis, restoration of oral intake, and relatively stable blood glucose levels. Summarizing the characte-ristics of this case and reviewing the literature, FT1DM complicated with AP was relatively rare in FT1DM. Its common characteristics were described below: (1) Most cases started with AP and the blood glucose elevated within 1 week, or some cases had the simultaneously onset of AP and FT1DM. (2) The clinical course of AP was short and relieved no more than 1 week; Pancreatic imaging could completely return to normal within 1 to 4 weeks after onset. (3) The etiology of AP most was idiopathic; The elevation of pancreatic enzyme level was slight and the recovery was rapidly compared with AP of other etiologies. FT1DM could be complicated with AP, which was different from the physiological manifestations of pancreatic disease in general FT1DM patients. Virus infection mignt be the common cause of AP and FT1DM, and AP might be the early clinical manifestation of some FT1DM. The FT1DM patients developed with abdominal pain was easy to be missed, misdiagnosed and delayed, which should receive more attention in clinic.

Rheumatoid arthritis (RA) is a common chronic autoimmune inflammatory disease, characterized by persistent polyarthritis. Patients with RA may exhibit varying degrees of B lymphocyte activation, clinically manifested as enlarged lymph nodes. Disease-modifying anti-rheumatic drugs and glucocorticoid are often used to treat RA. Biological agents targeting tumor necrosis factor alpha, interleukin-6(IL-6), and B lymphocytes are often used to treat rheumatoid arthritis. Castleman disease (CD) is a rare benign lymphoproliferative disorder. Histopathological examination is the most important method to diagnose this disease. Based on the different lymph node involvement areas CD can be divided into unicentric CD(UCD) and multicentric CD(MCD). Surgical removal of lymph nodes is a common treatment method for UCD. MCD often requires chemotherapeutic drugs combined with glucocorticoid therapy. For the most recent years, biological agents targeting IL-6 and B lymphocytes have shown good curative effects on CD. In the past, patients with rheumatic immune disease accompanied by Castleman like histopathology in lymph nodes were commonly referred to as rheumatic immune disease combined with CD. In 2021, experts unanimously agreed that autoimmune diseases with Castleman like lymphadenopathy should be diagnosed as rheumatic autoimmune diseases with Castleman like histopathology in lymph nodes. This report introduces a 65-year-old female patient with rheumatoid arthritis who was admitted to the hospital due to joint swelling and pain. Physical and chemical examinations after admission showed that rheumatoid arthritis was in an active phase. Chest CT revealed multiple enlarged lymph nodes in the right armpit. Then it was removed by surgery. The histopathological report showed that the lymphatic sinus disappeared, the lymphoid tissue proliferated, the lymphoid follicles increased, and the size was inconsistent. The small lymphocytes around the germinal centers of some follicles were concentric circles, and the follicular interstitial blood vessels proliferated. She was diagnosed with rheumatoid arthritis with Castleman like histopathology in lymph nodes and was treated with methotrexate and hydroxychloroquine sulfate combined with glucocorticoids. The patient was followed up for 2 years. In the first year after sur-gery, the patient' s condition remained stable and there was no growth of lymph nodes in the right axilla. The patient passed away due to severe infection in the second year after the surgery.

With the continuous development and maturity of anti-tumor immunotherapy technology, immune checkpoint inhibitors as one of the main methods of immunotherapy were increasingly widely used in clinical tumor cases, bringing new hope for many advanced cancer patients with poor response to traditional treatment, but at the same time, reported on adverse reactions of various organs related to this were also increasing, and the immune damage caused by them was harmful to patients, especially immune checkpoint inhibitor-associated pneumonia, immune checkpoint inhibitor-associated myocarditis and immune checkpoint inhibitor-associated encephalitis, which could even seriously endangered the lives of patients. Therefore, it was necessary for clinicians to fully understand and master the mechanism, clinical characteristics, laboratory and imaging examination characteristics, diagnostic criteria and differential diagnosis conditions, and treatment principles of adverse reactions that may be caused by immune checkpoint inhibitors, so as to find a more optimized anti-tumor treatment regimen and actively prepared for the treatment of possible immune-related adverse reactions. In this paper, we reported a case of immune checkpoint inhibitor-associated severe pneumonia, referred to the relevant guidelines, introduced its clinical features, laboratory and imaging findings, difficulties encountered in the diagnosis and treatment process, briefly analyzed the causes, and reviewed the possibility of immune-related pneumonia should be considered when respiratory symptoms occurred in patients receiving immunotherapy; the increased ratio of blood neutrophil count to lymphocyte count, and the increased ratio of eosinophil count to lymphocyte count could be used as indicators to indicate immune-related adverse reactions in patients; bronchoalveolar lavage fluid examination and bronchoscopy and lung biopsy were helpful for the diagnosis; when immune checkpoint inhibitor-associated severe pneumonia occurred, in addition to symptomatic and sup-portive treatment, adequate glucocorticoid-based immunosuppressive therapy should be given in time, and combined with cytokines monoclonal antibodies and other biological agents, immunoglobulin co-therapy, but the current indications for the use of biological agents were not fully clear, and the use of high-dose immunosuppressive drugs might cause the risk of severe infection. Therefore, according to the relevant literature and the findings in the process of clinical diagnosis and treatment, this paper proposed that the serum levels of IL-6, TNF-α, CRP and other inflammatory mediators in patients may be used as a quantitative indication to initiate biological agent therapy and accumulate experience for better solving similar problems in the future.

Air embolism is a rare but dreaded complication of medical or surgical procedures with significant mortality. An abnormal air-to-blood pressure gradient and communication between the vein and atmosphere can lead to the venous air embolism. Here, we presented a rare case of venous air embolism just after the removal of the central venous catheters. A 59-year-old female was admitted to Peking University International Hospital suffering from neuromyelitis optica spectrum disorder. After 5 rounds of immunosorbent therapy, her hemodialysis catheter was removed. Five hours later, she suddenly experienced shortness of breath, dizziness, weakness of the lower extremities, transient loss of consciousness and seizures. Ultrasound showed a small amount of gas in the right internal jugular vein and brain CT showed scattered air accumulation in part of venous blood ducts and bilateral cavernous sinuses, which was diagnosed as air embolism. High-flow oxygen inhalation, compression of the right neck extubation site, head down and feet up left decubitus position, intravenous fluid therapy were used. The patient gradually improved and returned to normal activities after one week. To sum up, air embolism is a rare, but serious and life-threatening complication after central catheters removal. Clinicians need to be alerted and take appropriate preventive measures.