AIM: To investigate and analyze serum nitric oxide synthase 4(NOX4)and matrix metalloproteinase(MMP)-2 expressions in patients with diabetes mellitus(DM)complicated with neovascular glaucoma(NVG)and their clinical significance.METHODS: A prospective study was conducted on 161 patients with DM complicated with NVG admitted to Handan City Eye Hospital(The Third Hospital of Handan)from June 2020 to June 2023. Based on whether complications occurred 1 a after trabeculectomy in the study group patients, they were divided into a group with good prognosis(n=90)and a group with poor prognosis(n=71). During the same period, 161 patients with chronic angle-closure glaucoma without iris neovascularization were selected as the control group. ELISA method was applied to detect the expression levels of serum NOX4 and MMP-2. ROC curve was plotted to evaluate the diagnostic value and postoperative complication prediction value of NOX4 and MMP-2 in patients with DM complicated with NVG. Pearson method was applied to analyze the correlation of NOX4 and MMP-2 with vascular endothelial growth factor(VEGF)and interleukin-6(IL-6). Multivariate Logistic regression was applied to analyze the influencing factors of postoperative complications in the study group.RESULTS:The general information of the study group and control group of patients is comparable. Compared with the control group, the expression levels of serum NOX4, MMP-2, VEGF, and IL-6 in the study group were significantly increased(P<0.001). According to Pearson analysis, serum NOX4 and MMP-2 levels significantly positively correlated with VEGF and IL-6 levels, respectively(P<0.001). According to ROC curve, the AUC of NOX4 combined with MMP-2 in the diagnosis of DM complicated with NVG was better than that of individual diagnosis of NOX4(Z=3.341, P<0.05)and MMP-2(Z=2.788, P<0.05). The duration of DM, the proportion of people with intraocular pressure >21 mmHg, and the expression levels of NOX4, MMP-2, VEGF, and IL-6 in the poor prognosis group were all higher than those in the good prognosis group(P<0.001). The duration of DM, intraocular pressure >21 mmHg, the levels of NOX4, MMP-2, VEGF, and IL-6 were all risk factors for poor prognosis in DM patients with NVG(P<0.001). According to ROC curve, the combined prediction of NOX4 and MMP-2 for postoperative complications in patients with DM complicated by NVG was superior to the AUC predicted by NOX4(Z=3.727, P<0.05)and MMP-2(Z=2.219, P<0.05), respectively.CONCLUSION:NOX4 and MMP-2 are upregulated in the serum of patients with DM complicated by NVG. Combined detection of these two markers holds significant clinical value for the early diagnosis and prognosis of patients with DM complicated by NVG.

AIM: To detect the distribution and expression of vascular endothelial growth factor(VEGF)in radiation retinopathy(RR)through fluorescence targeted imaging.METHODS:Covalent binding of fluorescein FITC with VEGF antibody ranibizumab to prepare targeted fluorescent imaging probe ranibizumab-FITC. SD rats were randomly divided into three groups based on the principle of weight balance: a normal control group(Con group), a low-dose radiation group(10 Gy group), and a high-dose radiation group(30 Gy group). Medical linear accelerators and lead blocks were used to locally irradiate the rat eyeballs for modeling. Western blot and qRT-PCR were used to detect the expression levels of VEGF-A in each group and to screen for appropriate modeling dose. The inverted fluorescence microscope and the confocal microscope were used to observe the distribution of VEGF and imaging probes in the retinas of control and RR model group rats, and to verify the effectiveness of targeted probes.RESULTS:The expression level of VEGF-A in the retina of rats in the high-dose radiation group(30 Gy group)was higher than that in the normal control group(Con group). In early RR, VEGF expression was observed to be associated with microaneurysms and abnormal microvessels in the retina. VEGF accumulation was observed at the site of capillary wall damage. When retinal capillary endothelial damage occurred, targeted probes gathered on the outer surface of the vessel wall.CONCLUSION:The expression level of VEGF in the retina of RR model rats is elevated, and fluorescent targeted molecular imaging probes can detect the spatial distribution of VEGF at the microvascular lesions in the retina of RR rats.

AIM: To investigate the relationship between serum levels of sirtuins(Sirts)1-6 and oxidative stress markers, and to evaluate their diagnostic value for age-related cataract(ARC).METHODS:A prospective cohort of ARC patients admitted to the hospital between June 2019 and July 2021 was enrolled as the study subjects. Concurrently, age-matched healthy individuals undergoing routine physical examinations at the hospital during the same period were recruited as the control group. Baseline demographic and clinical characteristics were compared between the two groups. Serum levels of Sirt1-6 and oxidative stress markers including malondialdehyde(MDA), superoxide dismutase(SOD), glutathione peroxidase(GSH-Px), and total antioxidant capacity(TAC)were compared. Pearson correlation analysis was performed to assess the associations between serum Sirt1-6 levels and oxidative stress parameters. Multivariate Logistic regression analysis was conducted to analysis risk factors associated with ARC occurrence. Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of serum Sirt1-6 levels and oxidative stress indicators for ARC.RESULTS: The study included 127 ARC patients, comprising 68 men and 59 women, with a mean age of 66.05±2.58 y; the concurrent control group consisted of 121 patients, comprising 63 men and 58 women, with a mean age of 65.54±2.86 y. Serum levels of Sirt1, 3 and 6, SOD, GSH-Px, and TAC were significantly lower in the ARC group compared to the control group(all P<0.001), whereas MDA levels were markedly elevated(P<0.001). Pearson correlation analysis revealed that serum levels of Sirt1, Sirt3, Sirt6 in the ARC group were positively correlated with SOD, GSH-Px, and TAC, and negatively correlated with MDA. Multivariate Logistic regression analysis demonstrated that serum Sirt1, Sirt6, MDA, SOD, and GSH-Px were significantly associated with the occurrence of ARC(all P<0.001). ROC curve analysis showed that the combination of Sirt1, Sirt6, MDA, SOD, and GSH-Px yielded an area under the curve(AUC)of 0.995 for diagnosing ARC, which was significantly higher than that of Sirt1 alone(Z=4.978,P<0.001), Sirt6 alone(Z=7.487,P<0.001), MDA alone(Z=6.449,P<0.001), SOD alone(Z=5.773,P<0.001), or GSH-Px alone(Z=5.056,P<0.001), indicating superior diagnostic accuracy of the multimarker panel(P<0.05). CONCLUSION: Serum levels of Sirt1, 3, and 6 are generally reduced in ARC patients and are closely associated with oxidative stress imbalance. Specifically, decreased serum levels of Sirt1 and Sirt6, along with oxidative stress markers(elevated MDA and reduced SOD and GSH-Px)are identified as risk factors for ARC. Moreover, the combined detection of these indicators presents high diagnostic value for ARC.

BackgroundIndividuals with chronic multimorbidity exhibit a high prevalence of sleep disturbances， which impair their physical and psychological well-being and impede chronic disease management. Although sleep quality is closely influencing with psychological functioning， empirical evidence regarding the longitudinal trajectories of sleep quality and their influencing factors in this population remains insufficient. ObjectiveTo investigate the longitudinal trajectories of sleep quality and associated factors among patients with chronic multimorbidity from hospitalization through 6 months post-discharge， aiming to facilitate the early identification of high-risk individuals and the development of personalized sleep interventions. MethodsA total of 228 inpatients with chronic multimorbidity， primarily with cardiovascular and metabolic chronic conditions， were enrolled via random sampling at The Third People's Hospital of Fuyang from January 2023 to September 2024. Baseline assessments were conducted during hospitalization using the general socio-demographic questionnaire， the Sleep Dysfunction Rating Scale （SDRS）， the Ruminative Response Scale （RRS）， and the Hospital Anxiety and Depression Scale （HADS）. Sleep quality was further evaluated using the SDRS at 1-， 3-， and 6-month post-discharge. Latent class growth model was employed to delineate trajectories of sleep quality. Multivariate logistic regression analysis was subsequently performed to identify influencing factors of sleep quality. ResultsA total of 201 patients with chronic diseases were included.Based on four predefined assessment time points （baseline， 1 month， 3 months， 6 months post-discharge）， the latent class growth model identified three distinct trajectories of sleep quality： persistent high sleep disturbance （n=72， 35.82%）， moderate sleep disturbance-progression （n=73， 36.32%）， and low sleep disturbance （n=56， 27.86%）. Multivariate logistic regression analysis revealed that， compared with the low sleep disturbance group， multiple factors increased the odds of membership in the persistent high sleep disturbance group： per capita monthly household income of <3 000 yuan （β=13.131， P<0.01） or 3 000–5 000 yuan （β=5.913， P<0.05）， aged 45–65 years （β=9.536， P<0.05）， presence of 3 （β=7.792， P<0.05） or >3 comorbid chronic conditions （β=6.626， P<0.05）， as well as higher RRS （β=0.334， P<0.01） and HADS score （β=1.628， P<0.01）. Additionally， patients aged 45–65 years （β=2.777， P<0.05）， with 3 （β=3.802， P<0.01） or >3 comorbid chronic conditions （β=2.463， P<0.01）， and with higher RRS （β=0.111， P<0.01） and HDAS scores （β=0.350， P<0.05） also demonstrated significantly increased odds of belonging to the moderate sleep disturbance–progression group. ConclusionThere is significant population heterogeneity in sleep quality trajectories among patients with chronic multimorbidity， with age， per capita household monthly income， number of comorbidities， rumination， and anxiety/depression symptoms being identify as the primary influencing factors.

Shewanella putrefaciens(S.putrefaciens)is an opportunistic pathogen,which rarely causes pulmo-nary infection in clinic.This article reports a case with fever and expectoration as the primary clinical manifestations on the basis of diabetes.It was confirmed as S.putrefaciens infection by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS).Relevant literature from China and abroad was reviewed sys-tematically.High-risk factors,clinical manifestations,diagnosis,and drug treatment of infection caused by this pathogen were summarized,so as to improve the understanding on this pathogen and provide reference for the for-mulation of anti-infection programs.

Objective To explore the optimal warning threshold of motor evoked potentials(MEP)in decompression surgery for ossification of the posterior longitudinal ligament(OPLL)at cervical and thoracic segments,and the predictive role of different MEP parameters on postoperative lower extremity motor function.Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital.There were 131 males and 96 females,with an average age of(60±10)years.All patients underwent continuous neuro-physiological monitoring during the operation,and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation(Dmax)and the ratio of MEP terminal amplitude change to the baseline at the end of the operation(Dend)were recorded.The correlations between these two ratios and the lower extremity motor func-tion immediately after the operation and at 1 year were compared.According to the Medical Research Council muscle strength score(MRC)standard,a postoperative score increase of≥1 point compared to preoperative was defined as postoperative motor dysfunction.Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year.Receiver operating characteristic(ROC)curves were drawn to predict postoperative lower extremity motor dysfunc-tion using Dmax and Dend.Results Among the 227 patients,186 had cervical OPLL and 41 had thoracic OPLL.The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases(3.76%)and 2 cases(1.08%)in the cervical group,and 9 cases(21.95%)and 3 cases(7.32%)in the thoracic group,respectively.The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group(P<0.001).The baseline induction rate of bilateral lower extremity MEPs was 98.92%(368/372)in the cervical group and 96.34%(79/82)in the thoracic group.The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax,and the differences were statistically significant(cervical group:r=0.669,0.517,P=0.001 2;thoracic group:r=0.882,0.727,P=0.003 6),while the differences in the Pearson corre-lation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant(cervical group:r=0.457,0.352,P=0.088;thoracic group:r=0.760,0.625,P=0.098).The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year,and the cut-off values of Dmax were 0.881 and 0.978,respectively.For the thoracic group,the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year,and the cut-off values of Dmax were 0.532 and 0.640,respec-tively.Conclusions In OPLL surgery,the MEP monitoring strategy should be adjusted according to the surgical segment.For the cervical segment,Dmax should be emphasized to balance high sensitivity and specificity,while for the thoracic segment,Dmax or Dend can be flexibly selected.Higher MEP warning thresholds are required for cervical OPLL surgery(Dmax:0.881 immediately after the operation and 0.978 at 1 year;Dend:0.853),while significantly lower thresholds are needed for thoracic OPLL(Dmax/Dend:0.532 immediately after the operation and 0.640 at 1 year).

To assess the cross-contamination risk and genetic evolution ofStaphylococcus aureus(S.aureus)at various stages in a swine slaughterhouse,and to provide a reference for risk evalua-tion and control measures of S.aureus contamination during swine slaughtering,we conducted whole-genome sequencing on 31 isolates of S.aureus collected and preserved from the slaughter-house.Bioinformatics analyses were performed to investigate the genomic characteristics and genet-ic relationships of these isolates.Results revealed cross-contamination across different slaughter-house stages,predominantly with ST398-t1451 strains.Additionally,highly virulent ST9-t899 strains and ST398-t11 strains with numerous resistance genes were detected at various stages.The strains predominantly carried virulence genes such as hlgA,hlgB,and hlgC,with varying num-bers of resistance genes.Notably,two strains carried the optrA gene and three strains carried the cfr gene;the presence of the optrA gene is relatively rare among S.aureus.These genes confer re-sistance to novel synthetic antibiotics such as oxazolidinones and florfenicol and have the potential for horizontal gene transfer,increasing the risk of dissemination both within and beyond the slaughterhouse.Importantly,the study also detected a LA-MRSA-ST9 strain in water samples from the slaughterhouse,which could potentially infect humans.This strain exhibits zoonotic char-acteristics,highlighting the need for stricter protective measures for slaughterhouse workers to mitigate occupational exposure and infection risks.

Objective To explore the value of Turbo-Flash mode CT scanning for displaying calcification of ligamentum arteriousum(CLA)in infants and young children.Methods Chest CT data obtained with Turbo-Flash mode scanning of 1 762 infants and young children(aged 1 to 36 months)with suspected lung,trachea or bronchi lesions were retrospectively analyzed.Children were divided into group A to L according to age at 3-month intervals.CLA was evaluated and its CT manifestations were analyzed.The incidence of CLA in each group was counted,the density of CLA was measured,and their correlations with age were observed.Results Among 1 762 children,912 was found with CLA(912/1 762,51.76%).The incidence of CLA in group A—L was 34.29%(12/35)—59.35%(92/155),respectively.All CLA located in the arterial ligaments between the left side of pulmonary trunk and the origin level of left subclavian artery of the aorta and shaped differently.The density of CLA in group A—L was(183.36±50.16)—(295.80±105.91)HU,respectively.The incidence of CLA in group A—F was positively(r=0.945,P=0.002),while in group F—L was negatively correlated with age(r=-0.765,P=0.045).Meanwhile,the density of CLA in group A—F was positively correlated with age(r=0.775,P=0.020),but no significant correlation between CLA density and age was found in G—L group(P=0.593).Conclusion Turbo-Flash mode CT scanning had high clinical application value for displaying CLA in infants and young children.

To enhance understanding of myeloid/lymphoid neoplasms with ETV6:: ABL1 fusion, we retrospectively analyzed the clinical data of a patient with myeloid lymphoid neoplasms with ETV6:: ABL1 fusion. A review of the relevant literature was also conducted. The patient, a 33-year-old male, presented with a "10-month history of fatigue" and was initially diagnosed with "atypical chronic myeloid leukemia" following comprehensive clinical evaluation. Treatment with imatinib (400 mg once daily) was initiated. Based on findings from the literature and in accordance with the "World Health Organization 5th edition classification of hematopoietic and lymphoid tumors" and "the 2022 International Consensus Classification," the diagnosis was revised to "myeloid/lymphoid neoplasm with ETV6:: ABL1 fusion (M/LN-ETV6::ABL1) ." Following treatment, the patient’s fatigue significantly improved, and the fusion gene became undetectable. M/LN-ETV6:: ABL1 fusion are extremely rare and often clinically resemble CML, making them susceptible to misdiagnosis and underdiagnosis.

Objective To explore the value of Turbo-Flash mode CT scanning for displaying calcification of ligamentum arteriousum(CLA)in infants and young children.Methods Chest CT data obtained with Turbo-Flash mode scanning of 1 762 infants and young children(aged 1 to 36 months)with suspected lung,trachea or bronchi lesions were retrospectively analyzed.Children were divided into group A to L according to age at 3-month intervals.CLA was evaluated and its CT manifestations were analyzed.The incidence of CLA in each group was counted,the density of CLA was measured,and their correlations with age were observed.Results Among 1 762 children,912 was found with CLA(912/1 762,51.76%).The incidence of CLA in group A—L was 34.29%(12/35)—59.35%(92/155),respectively.All CLA located in the arterial ligaments between the left side of pulmonary trunk and the origin level of left subclavian artery of the aorta and shaped differently.The density of CLA in group A—L was(183.36±50.16)—(295.80±105.91)HU,respectively.The incidence of CLA in group A—F was positively(r=0.945,P=0.002),while in group F—L was negatively correlated with age(r=-0.765,P=0.045).Meanwhile,the density of CLA in group A—F was positively correlated with age(r=0.775,P=0.020),but no significant correlation between CLA density and age was found in G—L group(P=0.593).Conclusion Turbo-Flash mode CT scanning had high clinical application value for displaying CLA in infants and young children.