Dead-in-bed syndrome (DBS) is a rare but devastating sudden death condition that mainly affects young patients with type 1 diabetes.Its mechanism is quite complicated and may involve multiple factors.Acute onset of recurrent and severe nocturnal hypoglycemia,abnormal cardiac repolarization,genetic factors,and obstructive sleep apnea may all contribute to ventricular arrhythmias and even sudden death.The future research plans include elucidating and understanding the underlying mechanisms and triggers for DBS,developing a risk stratification system,using real-time continuous glucose monitoring system to detect severe nocturnal hypoglycemia,and initiating appropriate therapeutic interventions to uhimately prevent the tragedy.

There are multimechanism and multipathogens in the course of the progress and the metastasis of hepatocarcinoma Growth factors play an important role in the process. In this review, the relationship between growth factors and hepatocarcinoma are summarized.[

Acute suppurative thyroiditis (AST) is a rare non-specific infectious disease of thyroid gland.The signs and symptoms of AST may mimic those of a variety of noninfectious inflammatory conditions or other anterior neck infectious diseases.AST is a progressive disease and is also potentially life threatening if devoid of prompt diagnosis and proper treatment.Herein,we report a case in order to call attention to the diagnosis and treatment of AST.

Glycosylation of proteins, one of the most prevalent and complex post-translational modifications occurring in nature, plays a crucial role in regulating protein net charge, conformation, binding properties and, ultimately, biological function.Traditional structural techniques are not amenable for glycoproteins due to the inherent heterogeneity of oligosaccharides.With the advances in analytical technique, mass spectrometry displays an increasingly crucial role in elucidating the structure of glycoproteins.Mass spectrometry-based proteomic technique can dissect the chemical composition and site information of low-abundance glycosylation at the peptide level.Instead, native mass spectrometry (nMS) can analyze intact glycoproteins while maintaining the information for glycan heterogeneity, and the insights into the regulatory effects of glycosylation on protein higher order structures and interactions with other proteins or ligands.As a representative structural mass spectrometry tool, ion mobility-based nMS strategy is powered by its conformer-resolving capability and by the feasibility of conformer manipulation through collision-induced unfolding.Consequently, native IM-MS analysis can provide rich information of dynamic protein conformations, allowing for the rapid identification and differentiation of protein isoforms in an unprecedented manner.In this review, we briefly introduced two emerging native IM-MS analytical modes, dynamic conformer-resolving mode and glycoform-resolving mode.Besides, we also discussed the recent progress of conformational and topological characterization of intact glycoproteins with three typical model systems based on two above-mentioned emerging modes of native IM-MS.

Objective: To investigate the urban and rural differences in adverse outcomes of pulmonary tuberculosis (PTB) in patients with pulmonary tuberculosis-diabetes mellitus comorbidity (PTB-DM), so as to provide insights into improving the prevention and treatment measures for PTB-DM. Methods: Patients with PTB-DM who were admitted and discharged from 14 designated tuberculosis hospitals in Hangzhou City from 2018 to 2022 were selected. Basic information, and history of diagnosis and treatment were collected through hospital information systems. The adverse outcomes of PTB were defined as endpoints, and the proportions of adverse outcomes of PTB in urban and rural patients with PTB-DM were analyzed. Factors affecting the adverse outcomes of PTB were identified using a multivariable Cox proportional hazards regression model. Results: A total of 823 patients with PTB-DM were enrolled, including 354 (43.01%) urban and 469 (56.99%) rural patients. There were 112 (13.61%) patients with adverse outcomes of PTB. The proportions of adverse outcomes of PTB in urban and rural patients were 14.41% and 13.01%, respectively, with no statistically significant difference (P>0.05). Multivariable Cox proportional hazards regression analysis identified first diagnosed in county-level hospitals or above (HR=2.107, 95%CI: 1.181-3.758) and drug resistance (HR=3.303, 95%CI: 1.653-6.600) as the risk factors for adverse outcomes of PTB in urban patients with PTB-DM, while the treatment/observed management throughout the process (HR=0.470, 95%CI: 0.274-0.803) and fixed-dose combinations throughout the process (HR=0.331, 95%CI: 0.151-0.729) as the protective factors for adverse outcomes in rural patients with PTB-DM. Conclusions There are differences in influencing factors for adverse outcomes of PTB in urban and rural patients with PTB-DM. The adverse outcomes of PTB are associated with first diagnosed hospitals and drug resistance in urban patients, and are associated with the treatment/observed management and fixed-dose combinations throughout the process in rural patients.

Objective:To study the changing characteristics and impact factors of helical tomotherapy (HT)for longitudinal dose fall-off outside the target, in order to guide the plan junction or pretreatment target and implementation efficiency in clinical.Methods:Eight patients with head and neck tumors admitted to the Department of Oncology Radiotherapy of the First Affiliated Hospital of Zhengzhou University in December 2019 were retrospectively selected as the research objects. The planning target area and dose drop structure were outlined in the head and neck images with a thickness of 1 mm obtained by Siemens SOMATOM Definition AS positioning computerized tomography (CT). Different field widths (FW, 5.0 cm/2.5 cm/1.0 cm) and pitches (0.430/0.287/0.215) were assembled for planning with the same modulation factor (1.8), finest does calculation grid (0.195 cm ×0.195 cm) and other planning parameters were consistent. The plans were designed by different parameters, and the result was analyzed by univariate analysis.Results:The that different pitch curves coincided under the same field width by comparative analyzing, so pitchs had no effect on dose drop. The different field width curves were independent of each other, indicating that the field width had an effect on dose drop in the head and foot direction. The relationship between the longitudinal dose drop speed outside the target and the change of the field width was inversely correlated: the larger field widths meant the slower dose fall-off and the larger penumbra, while the smaller field widths meant the faster fall-off and the smaller penumbra. When the dose fall-off to 50% of the prescribed dose, the distance from the target was approximately equal to half the field widths, and the pitchs had not affect the rate of dose-drop, while the dose at different distances from the target boundary could be calculated by the fitting formulas. The field widths and pitchs had little effect on the CI and HI index of the target, relatively, the target area was best when the field width was 2.5 cm. The total beam-on time gradually decreased with the increase of the field widths and pitches.Conclusions:When segment target therapy needs to consider planning junction, execution efficiency, and controlling longitudinal dose fall-off and considered the execution, the optimal planned parameters such as field widths and pitches could be selected or the target at the junction regions could be adducted according to the longitudinal dose drop formula, so as to achieve the ideal dose distribution.

Objective To evaluate the effect of serratus plane block (SPB) combined with general anesthesia and SPB with patient-controlled nerve analgesia (PCNA) after surgery on the early postoperative quality of recovery in the patients undergoing radical mastectomy.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ female patients,aged 18-64 yr,weighing 45-70 kg,scheduled for elective unilateral modified radical mastectomy under general anesthesia,were assigned into 3 groups (n=20 each) using a computer software:SPB and general anesthesia plus patient-controlled intravenous analgesia (PCIA) group (SG+PCIA group),SPB and general anesthesia plus SPB with PCNA group (SG+PCNA group),and general anesthesia plus PCIA group (G+PCIA group).Ultrasound-guided ipsilateral SPB was performed before anesthesia induction.Analgesia was maintained with propofol-remifentanilsevoflurane,rocuronium or vecuronium was intermittently injected to maintain muscle relaxation.PCIA solution contained tramadol 800 mg and flurbiprofen axetil 100 mg in 54 ml of normal saline,and the PCA pump was set up to deliver a 2 ml bolus dose,with a 15 min lockout interval and background infusion at a rate of 0.5 ml/h after a loading dose of 5 ml.The location of the indwelling catheter was confirmed again using ultrasound at the end of surgery,PCNA solution contained 1％ ropivacaine 500 mg in 250 ml of normal saline,and the PCA pump was set up to deliver a 5 ml bolus dose,with a 45 min lockout interval and background infusion at a rate of 5 ml/h after a loading dose of 5 ml.The PCA pumps were used until 48 h after surgery.The automatic key was pressed when pain scores (numerical rating scale [NRS] scores) ≥ 4 at rest or during activity (at 45° ipsilateral upper extremity-up tilt).Quality of Recovery-40 (QoR-40) score was used to assess the early postoperative quality of recovery at 24 and 48 h after surgery.NRS scores at rest or during activity were recorded at 6,8,12,24 and 48 h after surgery.The total pressing times of PCA and occurrence of adverse reactions such as respiratory depression,pruritus,infection at the puncture site or pneumothorax were also recorded.Results Compared with group G+PCIA,the postoperative QoR40 scores were significantly increased,NRS scores at rest or during activity were decreased at each time point after surgery,and the total pressing times of PCA were reduced in SG+PCIA and SG+PCNA groups,the incidence of nausea and vomiting was significantly decreased in group SG+PCIA,and the incidence of nausea and vomiting and dizziness was significantly decreased in group SG+PCNA (P＜0.05 or 0.01).Compared with group SG+PCIA,the postoperative QoR-40 scores were significantly increased at 24 h after surgery,and NRS scores at rest or during activity were decreased after surgery in group SG+PCNA (P＜ 0.05 or 0.01).Conclusion SPB combined with general anesthesia and SPB with PCNA after surgery can raise the early postoperative quality of recovery in the patients undergoing modified radical mastectomy.

Objective To explore the effects of spleen-fortifying and kidney-replenishing therapy on man-ifestation and quality of life in patients with systemic lupus erythematosus disease ( SLE) . Methods 50 SLE patients were randomly divided into treatment group and control group. Both groups were given pred-nisone tablets combined with hydroxychloroquine sulfate while the treatment group also took the Spleen-fortifying and Kidney-replenishing Decoction ( Jianpi Yishen Tang ) . Changes of clinical manifestations and laboratory parameters before and after treatment were used to evaluate the efficacy and effects on the quality of life. Results Total effective rate of 88. 0% with 4 cases of clinical response, 10 cases of re-markable effect, 8 cases of effect and 3 cases of non-respond in the treatment group, was significantly higher than 72. 0% of the control group (clinical response 2 cases, remarkable effect 6 cases, effect 10 cases and non-response 7 cases) (P<0. 05). There was no significant difference between the two groups in SLEDAI scores. The treatment group was significantly superior to the control group (P<0. 01) in im-proving patients’ quality of life and scores of SDS and SAS. TCM symptom scores in the treatment group were significantly lower than those in the control group (P<0. 05). IgG, CRP and other laboratory pa-rameters in the treatment group were also significantly lower than that of the control group ( P<0 . 05 ) . Levels of IgM, C4, WBC, and RBC in the treatment group were significantly higher than those in the control group ( P<0 . 05 ) . Conclusion Spleen-fortifying and kidney-replenishing therapy could signifi-cantly attenuate clinical manifestations, disease activity, TCM symptom scores and relieve anxiety and depression in SLE patients. The efficiency and safety had been proved to improve the quality of patents’ life.

Objective: To explore the relationship between depressive symptoms, negative life events and resilience among primary and secondary school teachers, so as to provide a reference for mental health promotion in school teachers. Methods: During November to December 2022, a questionnaire survey was conducted using convenient cluster sampling method to select 11 332 in service teachers from 38 schools in 8 provinces (cities) including Beijing, Guangdong, Anhui, Hubei, Sichuan, Xinjiang, Liaoning, and Heilongjiang. The Patient Health Questionnaire-9 items, a self developed 21-item Adverse Life Events questionnaire, and a 10-item Conner-Davidson Resilience Scale were used to assess depressive symptoms, experiences of negative life events, and resilience levels of the teachers, respectively. The relationship between depressive symptoms, negative life events and psychological resilience were analyzed by multiple linear regression and stratified regression. Results: The detection rate of depressive symptoms among primary and secondary school teachers was 14.0%. Negative life events of primary and secondary school teachers were positively correlated with depressive symptoms ( r =0.35), while psychological resilience was negatively correlated with depressive symptoms ( r =-0.45) ( P <0.05). After adjusting for possible covariates including gender and marital status, negative life events were positively correlated with depressive symptoms ( β=0.22, P <0.01). Resilience played a moderating role in the association of negative life events with depressive symptoms among primary and secondary school teachers ( B=-0.15, P <0.01). Conclusions Negative life events experiences are associated with higher level of depressive symptoms among school teachers. However, resilience might mitigate the negative effects of negative life events on depressive symptoms, playing a protective role in teachers mental health.

Objective:To construct a simple, precise and personalized comprehensive nomogram for prediction the risk of multidrug-resistant tuberculosis (MDR-TB) and to evaluate its prediction value among individuals with previous tuberculosis history (PTBH).Methods:A matched case-control study (1∶2 ratios) was performed in 1 881 patients with PTBH treated in 12 designated tuberculosis hospitals in Hangzhou City between January 1, 2005 and December 31, 2019, and there were 1 719 patients in training set, and 162 in validation set. A multivariable Cox regression analysis was used to evaluate independent predictors for the incident of MDR-TB in individuals with PTBH. A comprehensive nomogram was developed based on the multivariable Cox model. The accuracy of the prediction was assessed using concordance index (C-index), calibration curve and area under the receiver operator characteristic (ROC) curve.Results:The nomogram constructed based on the multivariable Cox regression model incorporated 10 independent predictors of the risk of MDR-TB. A history of direct contact (grade 1, 0-100.0 points) ranked on the top of all risk factors, followed by duration of positive sputum culture (grade 2, 0-84.5 points), unfavorable treatment outcome (grade 3, 0-52.0 points), human immunodeficiency virus infection (grade 4, 0-48.5 points), retreated tuberculosis history (grade 5, 0-40.0 points), non-standardized treatment regimens of retreated tuberculosis (grade 6, 0-32.5 points), duration of pulmonary cavities (grade 7, 0-31.0 points), passive mode of tuberculosis case finding (grade 8, 0-25.0 points), age<60 years (grade 9, 0-17.5 points), and standard frequencies of chest X-ray examination (grade 10, 0-14.0 points). The C-indexes of this nomogram for the training and validation sets were 0.833 (95% confidence interval ( CI) 0.807-0.859) and 0.871 (95% CI 0.773-0.969), respectively, indicating that the nomogram had good fitting effect. The calibration curves for the risk of incident MDR-TB showed an optimal agreement between nomogram prediction and actual observation in the training and validation sets, respectively.The areas under ROC curve of the 1-year, 5-year, and 10-year MDR-TB risk probability of the training set were 0.904, 0.921, and 0.908, respectively, and those of the validation set were 0.954, 0.970, and 0.919, respectively. Conclusion:Through this nomogram model, clinicians could precisely predict the risk of incident MDR-TB among individuals with PTBH in the clinical practice.