Pulmonary electrical impedance tomography (EIT), a noninvasive, continuous, dynamic, and radiation-free bedside imaging technique for monitoring pulmonary ventilation, is now widely utilized in the diagnosis and management of critically ill patients. Beyond ventilation monitoring, hypertonic saline contrast-enhanced EIT for bedside pulmonary perfusion assessment has recently garnered significant attention. This article describes the application of hypertonic saline contrast-enhanced EIT to evaluate pulmonary perfusion in two patients following pulmonary endarterectomy, providing a reference for its perioperative application in such patients.

Based on the viewpoint of "sweat pore-qi and liquid-kidney collaterals"， it is believed that children's nephrotic syndrome is caused by the core mechanism of sweat pore constraint and closure， qi and liquid imbalance， and kidney collaterals impairment， and it is proposed that the treatment principle is to nourish the sweat pore， regulate qi and fluid， and supplement the kidney and unblock the collaterals. In clinic， guided by sequential therapy and according to the different disease mechanism characteristics of the four stages， including early stage of the disease， hormone induction stage， hormone reduction stage， hormone maintenance stage， the staged dynamic identification and treatment was applied. For early stage of the disease with edema due to yang deficiency， modified Zhenwu Decoction （真武汤） was applied to warm yang and drain water； for hormone induction stage with yin deficiency resulting in effulgent fire， modified Zhibai Dihuang Pill （知柏地黄丸） plus Erzhi Pill （二至丸） was used to enrich yin and reduce fire； for hormone reduction stage with qi and yin deficiency， modified Shenqi Dihuang Decoction （参芪地黄汤） was used to boost qi and nourish yin； for hormone maintenance stage， modified Shenqi Pill （肾气丸） was used to supplement yin and yang. Meanwhile， the treatment also attaches importance to the combination of vine-based or worm medicinals to dredge collaterals， so as to providing ideas for clinical treatment.

AIM: To analyze the clinical outcomes of cyclosporine combined with lacrimal plug in the treatment of dry eye in patients with primary Sjögren's syndrome.METHODS: The clinical data of 60 patients(120 eyes)who were admitted to the ophthalmology department and rheumatology and immunology department of Baoding No.1 Central Hospital and were diagonosed with siogren's syndrome dry eye after multidisciplinary consultation from June 2022 to September 2023 were retrospectively analyzed. All the patients received regular treatment of primary Sjögren's syndrome, and they were divided into three groups according to treatment methods: A, B and C, with 20 cases(40 eyes)in each group. The group A received 0.3% sodium hyaluronate eyedrops, the group B received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops, and the group C received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops combined with binocular lacrimal plugs. The ocular surface disease index(OSDI)score, conjunctival hyperemia score, tear film breakup time(BUT), tear meniscus height(TMH), corneal fluorescein staining(FL)score and tear secretion of the three groups of patients were compared before and at 4, 8 and 12 wk after treatment. The contents of inflammatory factors such as interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)in tears were detected before and at 12 wk after treatment.RESULTS: At 4, 8 and 12 wk after treatment, the scores of OSDI, conjunctival hyperemia score and FL in the three groups of patients were lower than those before treatment, and the BUT, TMH and tear secretion were higher than those before treatment(all P<0.001). The OSDI score of the group C was lower than that of the group A and B, and the group B was lower than the group A(all P<0.001). The BUT, TMH and tear secretion of the group C were higher than those of the group A and B, with the group B higher than the group A(all P<0.001). At 12 wk after treatment, the levels of IL-6, TNF-α and IL-1β in the tears of the three groups of patients were lower than those before treatment, with the group C lower than the group A and B, and the group B lower than the group A(all P<0.001). There was no statistical significant difference in the incidence of adverse reactions among the three groups of patients(P>0.05).CONCLUSION: The combined use of cyclosporine and lacrimal plug is safe and effective in improving the clinical symptoms of patients with moderate and severe dry eye, promoting the function of tear film and cornea, increasing tears secretion, and reducing the level of tear inflammatory factors.

AIM: To evaluate the efficacy of 0.05% cyclosporine eye drops in promoting ocular surface recovery following pterygium excision combined with autologous corneal limbal stem cell transplantation.METHODS:This study is a prospective randomized controlled trial, selecting 104 cases(104 eyes)of primary pterygium with monocular onset admitted to Baoding First Central Hospital from September 2023 to September 2024 as the initial sample. The patients were divided into an experimental group and a control group using a random number table method, with 52 eyes in each group. Both groups underwent pterygium excision and autologous corneal limbal stem cell transplantation performed by the same surgeon. The control group received tobramycin dexamethasone eye drops combined with 0.3% sodium hyaluronate eye drops, while the experimental group was additionally treated with 0.05% cyclosporine eye drops. The corneal epithelial repair status, ocular surface function [corneal fluorescein staining(FL)score, Schirmer I test(SIt), break-up time of tear film(BUT)] at preoperative and postoperative time points(1 and 3 mo), and dry eye symptoms [ocular surface disease index(OSDI), standard patient evaluation of eye dryness(SPEED)scores]. Additionally, the recurrence rate and postoperative complications were recorded.RESULTS: During the follow-up period, there was 1 case of loss to follow-up in both the experimental group and the control group, with lost to follow-up rate of 1.9%. Finally, 51 cases in each group completed all followed-up. No statistically significant difference was observed in preoperative general characteristics of patients between the two groups(P>0.05), and there was no statistically significant difference in corneal epithelial repair time or suture removal time(all P>0.05). At 1 mo postoperatively, the SIt and BUT decreased in both groups compared to preoperative levels, with the experimental group showing higher values than the control group(all P<0.05). FL scores increased compared to preoperative levels but were lower in the experimental group(all P<0.05). By 3 mo, the SIt, BUT and FL score of the control group were not statistically different from preoperative levels(all P>0.05), whereas the experimental group showed increased SIt and BUT, which were higher than the control group, and reduced FL scores, and decreased FL scores, which was lower than the control group(all P<0.05). At 3 mo postoperatively, both groups showed increased SIt and BUT compared to 1-month values, with the experimental group outperforming the control group(all P<0.05). FL scores decreased in both groups compared to 1-month values, with the experimental group maintaining lower scores(P<0.05). At 1 mo postoperatively, OSDI and SPEED scores were higher than preoperative levels, with the experimental group higher than the control group(all P<0.05); at 3 mo postoperatively, the scores returned to preoperative level(all P>0.05), and the OSDI and SPEED scores of the control group increased and higher than those of the experiment group(all P<0.05); at 3 mo postoperatively, the OSDI and SPEED scores decreased when compared with 1-month preoperative level, and the experiment group was lower than the control group(all P<0.05). There was no difference in the total incidence of postoperative complications between the two groups(P>0.05). According to the statistics of 6 mo follow-up after operation, there was no recurrence in the experimental group, and the recurrence rate was 11.8% in the control group(P<0.05).CONCLUSION: Adjunctive use of 0.05% cyclosporine eye drops after pterygium excision with limbal stem cell transplantation enhances ocular surface recovery, reduces dry eye symptoms, and lowers recurrence rates without compromising corneal epithelial healing or safety.

Objective:To develop a simple, rapid, and convenient analysis method for the identification of breast cancer and its molecular sub-types.Methods:A laser confocal Raman spectrometer was used to collect Raman spectrograms of normal breast cells and different molecular sub-types of breast cancer cells, and assign the material origin of the Raman spectral peaks. First, Savitzky-Golay smoothing (with a window size of 9) was selected to perform smoothing and denoising on the Raman spectrogram. Subsequently, an iterative adaptive weighted penalty least squares method was employed for baseline correction, and principal component analysis was used to eliminate outliers. The recognition model of normal breast cells and breast cancer cells and the recognition model of different molecular sub-types of breast cancer cells were established by using three algorithms with different principles, including partial least squares discriminant analysis (PLS-DA), K-nearest neighbor (KNN), and support vector machine (SVM).Results:The Raman spectrogram and Raman peak shifts of normal breast cells and breast cancer cells were similar, but there were significant differences in intensity. The results of the machine learning models showed that the recognition accuracy of PLS-DA and SVM algorithms for distinguishing between normal breast cells and breast cancer cells was above 92.03% and 90.67%, respectively. The recognition accuracy of PLS-DA and SVM algorithms for different molecular sub-types of breast cancer cells was (83.66 ± 2.77)% and (90.55 ± 0.06)%, respectively.Conclusions:The combination of Raman spectroscopy and machine learning algorithms can achieve accurate identification of normal breast cells, breast cancer cells, and different molecular sub-types of breast cancer cells.

As the largest cancer in the world, breast cancer has both benefits and risks from its diversified treatments. Shared decision-making can respect the patient's right to information and autonomy, consider their preferences and value orientations, and help patients obtain the most suitable treatment plan, it also can reduce their decision-making difficulties and improve their disease knowledge awareness and decision-making satisfaction. This paper reviews the definition of shared decision-making, the influencing factors, steps, tools and clinical effects of shared decision-making in the treatment decision-making of breast cancer patients, in order to provide reference for the research of shared decision-making in breast cancer patients in China.

Objective To explore the potential categories and influencing factors of dietary behavioral adherence trajectories in young and middle-aged patients with type 2 diabetes mellitus.Methods A convenience sampling method was used to investigate 277 young and middle-aged patients with type 2 diabetes mellitus admitted to the Department of Endocrinology of a tertiary A hospital in Huai'an City,China,from September 2022 to March 2023.The baseline data were collected using a general information questionnaire,the Dietary Behavioral Compliance Scale for Patients with Type 2 Diabetes Mellitus,the Diabetes Self-Efficacy Scale,the Diabetes Knowledge Text,the Health Beliefs Questionnaire,and the Family APGAR Index Questionnaire.The baseline information was collected on the patients'behavioral adherence trajectories a day prior to hospital discharge(T0),a week post-discharge(T1),a month post-discharge(T2),and 3 months post-discharge(T3)to assess the level of patients'dietary behavioral adherence,using latent variable growth mixed models to identify trajectory categories,and univariate and multivariate logistic regression to analyze the influences on dietary adherence trajectories.Results A total of 3 trajectories of dietary behavior adherence in young and middle-aged patients with type 2 diabetes mellitus were identified,namely,low adherence-fluctuating group(49.8%),high adherence-slowly regressing group(31.4%),and medium adherence-continuously rising group(18.8%),and the results showed that age,literacy level,self-efficacy,health beliefs,and family caring were the factors influencing potential categories of dietary behavioral adherence for young and middle-aged patients with type 2 diabetes mellitus.Conclusion There is heterogeneity in the adherence trajectories of young and middle-aged patients with type 2 diabetes mellitus,and healthcare professionals can develop targeted interventions according to the influencing factors of the trajectory categories in order to improve their adherence.

Objective To analyze the clinical and imaging features of hemichorea associated with non-ketotic hyperglycemia(HC-NH)and to explore the perfusion of cerebral blood flow in the patients.Methods A retrospective study was conducted on 23 HC-NH patients diagnosed in Henan Provincial People's Hospital from January 2018 to December 2023.The clinical manifesta-tions,imaging features and prognosis were collected and analyzed,and the correlation with cere-bral blood flow hypoperfusion was investigated.Results The symptoms were all lateral involun-tary movements,of which 4 cases presented only single upper limb(1 case was left upper limb,the other 3 cases were right upper limb),and 19 cases had both upper and lower limbs involved(10 cases were left limb,and 9 cases were right limb).After the onset of the symptoms,the blood glucose level was 19.72±4.72 mmol/L,glycated hemoglobin level was(13.60±3.68)％,but all of patients were negative to urine ketone bodies.Hyperdense lesions in the contralateral basal ganglia region on CT images were observed in 6 cases.Strip or patchy hyperintensity was seen on T1-weighted MR images.All patients had ipsilateral stenosis of the vessels and regional hypoperfu-sion of cerebral blood flow as shown by MR perfusion-weighted imaging.All symptoms were re-lieved after actively controlling blood glucose,improving blood circulation,and symptomatic man-agement.Conclusion HC-NH is quite rare in clinical practice,and its occurrence may be related to cerebral blood flow hypoperfusion triggered by basal nucleus degeneration.

Objective To investigate the influencing factors for slowly progressive brainstem infarction and rapidly progressive brainstem infarction in patients with severe stenosis or occlusion of basilar artery.Methods A retrospective analysis was performed for 501 patients who attended Zhengzhou University People's Hospital from January 2013 to Decem-ber 2022 and were diagnosed with first-episode brainstem infarction after severe stenosis or occlusion of basilar artery by HR-MRI.The core volume of brainstem infarction was manually calculated,and the distribution of brainstem infarct vol-ume was analyzed.According to brainstem infarct volume and the time from stroke attack to imaging,the patients were di-vided into slowly progressive brainstem infarction group(0-<1 ml,6-24 hours)and rapidly progressive brainstem infarc-tion group(>5 ml,0-<6 hours),and the two groups were compared in terms of risk factors and collateral circula-tion.Results The 501 patients with severe stenosis or occlusion of basilar artery had a mean age of 66.14±10.37 years,among whom 39.13%were male patients.According to predefined thresholds,29 patients(16.29%)with severe stenosis or occlusion of basilar artery in the time window of 0-<6 hours were diagnosed with rapidly progressive brainstem infarc-tion,and 56 patients(17.34%)in the time window of 6-24 hours were diagnosed with slowly progressive brainstem infarc-tion.There were no significant differences between the two groups in the risk factors such as age,sex,NIHSS score,hy-pertension,diabetes,hyperlipidemia,and history of atrial fibrillation,coronary artery disease,and smoking.The Pear-son correlation analysis showed that collateral circulation in patients with severe stenosis or occlusion of the basilar artery was negatively correlated with rapidly progressive brainstem infarction(r=-0.619,P<0.001).Conclusions After se-vere stenosis or occlusion of the basilar artery,patients with good collateral circulation often have slowly progressive brain-stem infarction,while patients with poor collateral circulation often have rapidly progressive brainstem infarction.

Aim To explore the mechanism of oxidized lipoprotein(a)(oxLp(a))inducing pyroptosis of vascu-lar endothelial cells.Methods After incubating human umbilical vein endothelial cells(HUVEC)with 100 mg/L ox-Lp(a)for 24 hours,Western blot and RT-qPCR was used to detect pyroptosis related proteins,pro-inflammatory cytokines,mitochondrial related proteins NRF1,NRF2,PGC-1α and mitochondrial gene cytochrome b(CYTB),ELISA was used to detect the levels of inflammatory factors,scanning electron microscopy was used to detect cell membrane rup-ture,transmission electron microscopy was used to detect mitochondrial morphology,Hoechst33342/PI staining was used to detect cell apoptosis,MitoSOX probe was used to detect mitochondrial reactive oxygen species(mtROS),Flu-4AM probe was used to detect calcium ions,JC-1 probe was used to detect mitochondrial membrane potential(MMP),and Calcein AM staining was used to detect mitochondrial permeability transition pore(mPTP).Transfecting HUVEC with CYTB overexpressing lentivirus and analyzing its effects on oxLp(a)induced pyroptosis and mitochondrial function.Results After treatment with oxLp(a),the expression of NLRP3,pro-Caspase-1,Caspase-1,GSDMD and GSDMD-N proteins re-lated to pyroptosis were significantly increased(P＜0.05);the protein and mRNA levels of CYTB and pro-inflammatory cy-tokine IL-1β,IL-18 were significantly increased(P＜0.05).Small pores appeared on the cell membrane,the percentage of PI stained positive cells significantly increased(P＜0.05).OxLp(a)significantly inhibited the expression of mito-chondrial related proteins NRF1,NRF2 and PGC-1α,and the expression of mitochondrial gene CYTB,promoted an in-crease in mtROS generation,Ca2+overload,a decrease in ATP levels,a decrease in MMP,an increase in mPTP values,and abnormal mitochondrial morphology.After transfection with pHelper 2.0 lentivirus vector overexpressing CYTB,it was found that oxLp(a)induced HUVEC pyroptosis and mitochondrial morphological and functional abnormalities were par-tially reversed by overexpression of CYTB.Conclusion oxLp(a)promotes mitochondrial morphological and functional abnormalities and induces HUVEC pyroptosis by downregulating CYTB.