Objective To detect the content of plasma ctDNA and the mutation rate of BRAF V600E in plasma of patients with thyroid carcinoma ,and to explore its clinical significance. Methods Plasma ctDNA was extracted from 16 patients with thyroid carcinoma and 59 patients with benign thyroid nodules by using the blood genomic DNA Extraction Kit. The ctDNA content was detected by fluorescence quantitative PCR ,and the mutation of circulating BRAF V600E was detected by PCR and sequencing. Then the clinical significance was analyzed by combined detection analysis. Results The content of ctDNA in thyroid cancer group was significantly higher than that in benign nodule group (P < 0.01). BRAF V600E mutation detection showed that the mutation rate was 43.75%,but benign nodules had no mutation. Parallel combined detection improved the sensitivity and the specific-ity of the combined detection was higher. Conclusion Combined detection of ctDNA and BRAF V600E in plasma is helpful for differential diagnosis of benign and malignant thyroid nodules.

Objective To investigate the effect of erythropoietin(EPO)on the expression of aquaporin - 2 (AQP2)in the kidney of young SD rats after release of bilateral ureter obstruction(BUO - R). Methods Thirty - two young SD rats were equally divided into 4 groups randomly(BUO group,BUO - R group,BUO - R ﹢ EPO group and Sham group,8 rats in each group). The BUO model was built through bilateral ureteral ligation. EPO(500 U/ kg)was given to BUO - R ﹢ EPO rats at 2 h after release of BUO,and then repeated 6 h,12 h,24 h and 36 h thereafter and the same volume of 9 g/ L saline was simultaneously given to BUO - R rats. The Sham group was prepared in parallel by laparotomy and free dissection of bilateral ureters but not ligated. Both side kidneys were harvested 48 h(72 h for Sham group)after release of BUO to examine the effect of EPO on the expression of AQP2 in inner medulla by immunohisto-chemistry,Real - time PCR and Western blot. The urine samples were collected by using metabolic cage before death. Results The osmotic pressure of BUO - R ﹢ EPO group was higher than that of BUO - R group,but lower than that of Sham group(P ﹤ 0. 05). Immunohistochemistry showed that the collecting duct wall thinned and lumen enlarged. After the pictures were analysized by using Image - Pro Plus software,it showed that the expression of AQP2 in collecting duct in BUO group was significantly down - regulated compared with that in Sham group,whereas,it was slightly weaker in BUO - R group and BUO - R ﹢ EPO group than Sham group(P ﹤ 0. 05). These results were further confirmed by a-dopting Western blot,and the relative quantity of AQP2 in BUO group was also the lowest of the four groups(P ﹤0. 05). Real - time PCR showed that the level of AQP2 mRNA in Sham group was(24. 30 ± 1. 03)folds of BUO group,(10. 60 ± 1. 05)folds of BUO - R group and(5. 70 ± 1. 01)folds of BUO - R ﹢ EPO group,respectively. Conclusion EPO could promote not only the recovery of AQP2 mRNA and protein expression but also the recovery of AQP2 function in young BUO - R rats.

Restless legs syndrome is a common motor-sensory disease of the nervous system. The main manifestations are an urge to move the legs, usually accompanied by or thought to be caused by uncomfortable and unpleasant sensations in the legs. These symptoms may begin or worsen during periods of rest or inactivity such as lying down or sitting and be partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues. This article will systematically review the pathogenesis, clinical manifestations, diagnostic criteria, differential diagnosis and treatment of restless legs syndrome.

Objective:To investigate the molecular epidemiological characteristics of HIV-1 infection among men who have sex with men (MSM) in Jiaxing city, and provide methods and ideas for the prevention and control of HIV-1 infection.Methods:This study retrospectively collected the blood samples from all newly reported cases of HIV-1 infection among MSM without antiviral treatment from 2020 to 2022. HIV-1 pol genes in the blood samples were amplified and sequenced. MEGA v6.0 software was used to analyze nucleic acid sequences. A phylogenetic tree was constructed to analyze HIV-1 subtypes. The calibrated population resistance program (CPR) was used to detect drug-resistant mutations. After calculating the genetic distance between gene sequences, molecular transmission networks were constructed using Cytoscape v3.6.0 software. Results:A total of nine genetic subtypes were identified, with CRF07_BC (43.3%) and CRF01_AE (36.9%) accounting for the most. The recombinant forms that were not clustered with the reference subtype accounted for 5.0%. Drug-resistant mutations were identified in 21 cases (7.0%), and the mutation rates among strains of CRF07_BC and CRF01_AE subtypes were 8.2% and 7.8%, respectively. The detection rates of drug-resistant mutations to protease inhibitors, nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors were 1.7%, 0.7% and 4.7%, respectively. The optimal genetic distance threshold of the molecular network was 0.018. At this genetic distance, the molecular network access rate was 43.3%, and 38 molecular clusters (ranging from 2 to 26 nodes per cluster) were included. Cases with ≥6 homosexual partners and a degree value of ≥4 were more likely to access the active molecular cluster. The population of high-risk transmission cases with TNS>0.75 were mainly nonlocal residents and commercial service providers. The recombinant forms showed high similarity in sequences with the strains from other provinces.Conclusions:The distribution of HIV-1 subtypes in MSM in Jiaxing city was complex. Given the increasing detection rate of recombinant forms, the high transmission rate of drug-resistant mutations, and the active molecular clusters and high-risk transmission clusters mainly detected in nonlocal residents and commercial service providers, strengthened surveillance and intervention are needed.

Objective　To analyze the use of drugs andinfluencing factors of objective sleep disturbance among chronic insomnia patientsand to provide some normalization reference for clinical drug use. Methods　357 patients with definite chronic insomnia were selected. All patients were assessed with the Symptom Checklist （SCL-90），Hamilton Anxiety Scale （HAMA），Hamilton Depression Scale （HAMD），Pittsburgh sleep quality index （PSQI），Epworth sleepiness scale （ESS）. Polysomnography was used to evaluate objective sleep quality. Results　（1）The use of sedative and hypnotic drugs and other drugs that may affect sleep in the past 1 month before the first visit to the Sleep Center of our hospital was 53.50% for no drugs，46.5% for drugs and 18.21% for BzRAs among them. （2） The ESS scores of pharmacologic-therapy group was significantly lower than those in no-drugs group （Z=-2.463，P=0.014）. The total time sleep（Z=-3.521，P<0.001），Sleep efficiency（Z=-3.164，P=0.002），R%（Z=-3.044，P=0.003）were both significantly lower than those in no-drugs group. （3）The multivariate logistic regression results showed male （OR=1.938，95%CI 1.071～3.505，P=0.029），highly educated（OR=2.222，95%CI 1.196～4.130，P=0.012），anxiety state（OR=2.029，95%CI 1.018～4.043，P=0.044） and medication history（OR=1.974，95%CI 1.091～3.573，P=0.025） were the factors influencing SL>30 min. Age is the common factors for WASO>30 min（OR=1.052，95%CI 1.023～1.082，P<0.001），WASO>60 min（OR=1.068，95%CI 1.046～1.091，P<0.001） and SL>30 min and/or WASO>60 min （OR=1.068，95%CI 1.046～1.091，P<0.001）. Conclusion　Some patients have a high percentage of sleep-related medications before their first visit in our center，Most used was benzodiazepine receptor agonists. Gender，education，anxiety state and medication historywere the factors influencingsleep latency. Age is the common factors for difficulty maintaining sleep.

Objective　To explore the therapeutic effects of comorbid different insomnia symptoms on continuous positive airway pressure （CPAP） in patients with obstructive sleep apnea （OSA）. Methods　A total of 202 patients with CPAP in the Department of Neurology of Tangdu Hospital of Air Force military Medical University from 2011 to 2016 were collected. Age，sex，height，weight and past history were collected，as well as the results of Epworth sleepiness scale，polysomnography of diagnostic night and CPAP titration night. The differences of the above indexes between the group of difficulty maintaining sleep and other insomnia groups were analyzed. Results　There were 101 patients co-morbid insomnia and sleep apnea （48.95±11.75 years old）. There were 101 patients with OSA only （48.39±11.23 years old）. Compared with other insomnia groups，there were significant differences in proportion of Stage No rapid eye movement 2（NREM 3），proportion of Stage NREM 3，Apnea-hypopnea index（AHI），mean pulse oxygen saturation and oxygen desaturation index in the group of difficulty maintaining sleep after treatment. Conclusion　Therapeutic efficacy of patients with comorbid OSA and different insomnia symptoms on CPAP treatment are different. Individualized therapy for insomnia symptoms combined with OSA therapy is benefit for the rehabilitation of these patients.