Kleine-Levin syndrome (KLS) is a rare, recurrent-remitting sleep disorder characterized by periodic hypersomnia, hyperphagia, and hypersexuality, accompanied by cognitive dysfunction, perceptual disturbances, mood changes, or psychiatric abnormalities. Patients typically experience recurrent episodes, with hypersomnic periods lasting from several days to weeks. Most KLS patients exhibit normal functions during the intermission period, while early-onset KLS cases in adolescents are rare, often presenting with frequent episodes and complex symptoms, which can easily lead to misdiagnosis. Therefore, this case report analyzed the detailed medical history, laboratory findings, differential diagnosis, and treatment of a teenage patient with KLS, along with a review of the literature. This case aims to provide a deeper understanding of the complex symptoms and diagnostic challenges associated with early-onset KLS in adolescents.

Kleine-Levin syndrome (KLS) is a rare, recurrent-remitting sleep disorder characterized by periodic hypersomnia, hyperphagia, and hypersexuality, accompanied by cognitive dysfunction, perceptual disturbances, mood changes, or psychiatric abnormalities. Patients typically experience recurrent episodes, with hypersomnic periods lasting from several days to weeks. Most KLS patients exhibit normal functions during the intermission period, while early-onset KLS cases in adolescents are rare, often presenting with frequent episodes and complex symptoms, which can easily lead to misdiagnosis. Therefore, this case report analyzed the detailed medical history, laboratory findings, differential diagnosis, and treatment of a teenage patient with KLS, along with a review of the literature. This case aims to provide a deeper understanding of the complex symptoms and diagnostic challenges associated with early-onset KLS in adolescents.

Objective To investigate the predictive value of a nomogram model constructed based on imaging combined with prostate-specific antigen(PSA)and its related parameters for biopsy in patients with PSA levels of 4-10 ng/mL.Methods The serological and imaging data of 191 patients who were detected for PSA and related indicators and underwent the first biopsy of prostate by transrectal ultrasound at Zhongshan City People's Hospital and/or Yunfu Hospital of TCM from January 2018 to December 2023 were analyzed retrospectively.Multivariate Logistic regression identified independent risk factors for prostate cancer,and a nomogram model was developed for patients with PSA levels of 4-10 ng/mL.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)curves,calibration curves,and decision curves.Results The multivariate Logistic regression analysis showed that free PSA,prostate volume,transition zone volume,PSA density,and the prostate imaging-reporting and data system(PI-RADS v2.1)score were independent risk factors for prostate cancer.The model incorporating these significant variables demonstrated the best performance,with an area under the curve(AUC)of 0.750(95%CI:0.678-0.821),sensitivity of 72.7%,specificity of 77.2%,and accuracy of 74.9%.The calibration curve indicated good agreement between the predicted probability and the actual probability of prostate cancer;and the decision curve analysis further confirmed that the model had high clinical utility.Conclusion The constructed nomogram prediction model can effectively estimate the preoperative risk of prostate cancer in patients with PSA levels of 4-10 ng/mL,providing clinicians with an intuitive tool to adjust treatment plans based on the assessed risk,thereby optimizing patient outcomes.

Objective To investigate the predictive value of a nomogram model constructed based on imaging combined with prostate-specific antigen(PSA)and its related parameters for biopsy in patients with PSA levels of 4-10 ng/mL.Methods The serological and imaging data of 191 patients who were detected for PSA and related indicators and underwent the first biopsy of prostate by transrectal ultrasound at Zhongshan City People's Hospital and/or Yunfu Hospital of TCM from January 2018 to December 2023 were analyzed retrospectively.Multivariate Logistic regression identified independent risk factors for prostate cancer,and a nomogram model was developed for patients with PSA levels of 4-10 ng/mL.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)curves,calibration curves,and decision curves.Results The multivariate Logistic regression analysis showed that free PSA,prostate volume,transition zone volume,PSA density,and the prostate imaging-reporting and data system(PI-RADS v2.1)score were independent risk factors for prostate cancer.The model incorporating these significant variables demonstrated the best performance,with an area under the curve(AUC)of 0.750(95%CI:0.678-0.821),sensitivity of 72.7%,specificity of 77.2%,and accuracy of 74.9%.The calibration curve indicated good agreement between the predicted probability and the actual probability of prostate cancer;and the decision curve analysis further confirmed that the model had high clinical utility.Conclusion The constructed nomogram prediction model can effectively estimate the preoperative risk of prostate cancer in patients with PSA levels of 4-10 ng/mL,providing clinicians with an intuitive tool to adjust treatment plans based on the assessed risk,thereby optimizing patient outcomes.

OBJECTIVE: To investigate the effect of vitamin D3 on polarization of monocyte macrophages induced by serum from patients with ankylosing spondylitis (AS). METHODS: Twenty AS naïve patients and 20 healthy controls from Wenzhou People's Hospital during January 2016 and December 2017 were enrolled. The macrophages were differentiated from THP1 cells induced by phorbol 12-myristate 13-acetate (PMA), and then co-cultured with the serum from healthy subjects (control group) or AS patients. Vitamin D3 was added in the medium mixed with serum from AS patients. Flow cytometry was used to analyze the ratio of CD68 and CD206 positive cells, and RT-PCR was performed to detect the mRNA expression of inducible nitric oxide synthase(iNOS) and arginase-1(Arg-1). RESULTS: THP1 cells could be polarized into mononuclear-macrophages with the induction of PMA. The proportion of CD206 positive cells in AS-serum group was lower than that in the control group (=9.434, <0.05), while the proportion of CD68 positive cells was higher than that in the control group (=43.920, <0.05). The proportion of CD206 positive cells in vitamin D3 group was higher than that in AS-serum group (=8.895, <0.05), while the proportion of CD68 positive cells was lower than that in AS-serum group (=9.089, <0.05). mRNA expression of Arg-1 in AS-serum group was lower than that in the control group (=8.899, <0.05), while mRNA expression of iNOS was higher than that in the control group (=3.656, <0.05). mRNA expression of Arg-1 in vitamin D3 group was higher than that in AS-serum group (=6.219, <0.05), while mRNA expression of iNOS was lower than that in AS-serum group (=5.876, <0.05). CONCLUSIONS Vitamin D3 can regulate the polarization of mononuclear macrophages for immunoregulation in patients with AS.
Adjuvants, Immunologic ; pharmacology ; Cell Differentiation ; drug effects ; Cholecalciferol ; pharmacology ; Humans ; Monocytes ; drug effects ; Spondylitis, Ankylosing ; blood ; physiopathology

Objective To investigate the effects of tripterygium glycosides combined with methotrexate in treatment of rheumatoid arthritis (RA) curative effect and peripheral blood of patients with IL-6, effects of IL-10 and TNF- alpha. Methods 80 patients with RA from February 2014 to August 2016 in our hospital were retrospectively analyzed. According to the different treatment methods by for the observation group, the control group (40 cases). To compare and analyze the curative effect before and after short-term treatment and treatment of patients in the 2 groups were the main clinical symptoms and signs of change and ESR, RF, CRP, IL-6, TNF- alpha, IL-10 index. Results The total effective rate of observation group (92.50％) was significantly higher than the control group (77.50％), the difference was statistically significant (P<0.05), 2 groups of patients before treatment of main clinical symptoms and signs, there was no significant difference, after treatment, clinical symptoms and signs of 2 groups of patients were compared with those before treatment was statistically significant to alleviate the differences (P<0.05), and the observation group of main clinical symptoms and signs were lower than the control group and the remission (down), the difference was statistically significant (P<0.05).Before ESR, the treatment of 2 patients with RF, CRP, TNF- IL-6, alpha, IL-10 index level, no statistical significance, the 2 groups after treatment in patients with ESR, RF, CRP, IL-6, TNF- alpha, IL-10 index level than before treatment with significant difference (P<0.05), and the observation group ESR, RF, CRP, TNF- alpha, IL-6 average index of water compared with the control group decreased significantly, IL-10 index increased significantly than the control group. The difference was statistically significant (P<0.05). Conclusion Tripterygium glycosides combined with methotrexate in treatment of rheumatoid arthritis And it can effectively inhibit the expression of peripheral serum L-6 and TNF- alpha, promote the expression of IL-10 and alleviate the inflammatory reaction

Objective To discuss MSCT signs of colon multiple diverticulum in order to improve the accuracy of diagnosis.Meth-ods MSCT signs and clinical data of 30 cases with colon multiple diverticulum of were analyzed retrospectively.Imaging character-istics of colon multiple diverticulum were summarized and comparated with the results of colonoscopic appearance.Results There were 30 cases of colon multiple diverticulum confirmed by colonoscopy,including 1 6 cases in the ascending colon,6 cases the de-scending colon,5 cases the sigmoid colon,1 case transverse colon,2 cases the whole colon,5 cases with diverticulitis.Multiple pro-jecting processes were showed in 1 9 cases(63.3%,1 9/30),lesion diameter were 3.0-10.0 mm,gas or liquid filled in the lesion in 1 1 cases,small bezoar filled in 8 cases and the surrounding fat gaps were fuzzy in 5 cases.There was no any MSCT abnormal sign in 1 1 cases.Conclusion The typical MSCT signs of colon multiple diverticulum are multiple projecting processes,which size is smaller than 1 cm and filled with gas,liquid or small bezoar.The sign of surrounding fat gap fuzzy often means diverticulitis.

Objective To observe the effects of telmisartan treatment on the abdominal fat deposit in metabolic syndrome (MS) combined with essential hypertension (EH).Methods Sixty patients of MS combined with EH were divided into two groups according to random number table method,with 30 cases in each group.The patients in experimental group were given telmisartan orally 40 mg once a day,and in control group were given valsartan 80 mg once a day,until average ambulatory blood pressure monitoring blood pressure was ＜ 140/90 mmHg (1 mmHg =0.133 kPa) in 24 weeks.The visceral fat area (VFA) and subdermal fat area (SFA) was measured by multislice CT,at the same time the body mass index (BMI),blood pressure,blood glucose,homeostasis model assessment of insulin resistance (HOMA-IR) and glyeosylated hemoglobin (HbA1c) of the subjects was measured.Results The blood pressure,BMI,blood glucose,HbA1c,and blood lipids between two groups before treatment had no statistical significance (P ＞0.05).VFA in experimental group after treatment was lower than that before treatment [(127.8 ± 16.6) cm2 vs.(150.5 ± 15.4) cm2] (P ＜ 0.05).But there was no statistical significance of VAF in control group before and after treatment (P ＞0.05).The SFA in experimental group and control group had no statistical significance before and after the treatment (P ＞ 0.05).The HOMA-IR in experimental group after treatment was reduced compared with that before treatment (1.9 ± 0.3 vs.4.2 ± 0.9),and adiponectin was increased [(5.77 ±0.71) mg/L vs.(3.16 ±0.72) mg/L] (P ＜0.05).Conclusion Compared with valsartan,telmisartan can significantly reduce the visceral fat deposition in MS combined with EH patients and improve insulin resistance.

Objective To assess the use of bipolar radiofrequency device Habib 4X in hepatic malignant tumor resection. Methods Clinical data of 75 patients with hepatic malignant tumor undergoing hepatectomy with the use of Habib 4X in Department of Gastrointestinal Oncology, Cancer Center of Guangzhou Medical University from February 2009 to June 2013 were retrospectively analyzed. There were 55 males and 20 females with a mean age of (53±12) years old. Forty-nine cases were with primary liver cancer and 26 cases were with secondary liver cancer. The informed consents of all patients were obtained and the ethics committee approval was received. Patients received endotracheal general anesthesia. Hepatectomy was performed after tumor ablation was employed with Habib 4X device 2-3 cm away from the tumor. The intraoperative bleeding, blood transfusion, operation duration, changes of postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), length of postoperative hospital stay and complications were observed. Patients were followed up after being discharged from hospital and tumor recurrence and mortality were observed. Results All the 75 patients underwent hepatectomy successfully. The mean intraoperative bleeding was (318±89)ml, the rate of blood transfusion was 7%(5/75), the median of operation duration was 104 (17-191) min, the length of postoperative hospital stay was (11±4)d. ALT, AST, TB rose to a top level 1 d after operation, then went down progressively and liver function backed to normal 9 d after operation. Two cases suffered from bile ifstula and were cured after enhancing drainage. The 1-, 3-year recurrence rates were 6%(3/49), 10%(5/49) respectively in patients with primary liver cancer and were 23%(6/26), 27%(7/26) respectively in patients with secondary liver cancer. The mortality were 4%(2/49), 27%(7/26) respectively in patients with primary liver cancer and secondary liver cancer during the follow-up. Two cases with primary liver cancer died of postoperative hepatic encephalopathy and 7 cases with secondary liver cancer died of tumor widespread metastasis. Conclusions Habib 4X is safe and effective for hepatic malignant tumor resection. It may reduce the postoperative tumor recurrence rate.

Delicacy management is an important issue to the hospital logistics mode innovation,which is the only way to realize a scientific hospital logistics management.This article proposes the practical ways to push on the hospital logistics delicacy management from many respects,such as working regulation,consumption measurement,contract supervision,cost accounting,structure control and convergence supporting.