The patients with skeletal class Ⅱ malocclusion are often accompanied by structural and functional abnormalities of the upper airway,and obstructive sleep apnea hypopnea syndrome(OSAHS)may occur in severe cases.The morphologic and fluid dynamic changes of the upper airway in one patient with skeletal class Ⅱ malocclusion accompanied by OSAHS after maxillomandibular advancement(MMA)surgery were observed.The patient was a 27-year-old male with skeletal class Ⅱ malocclusion and moderate OSAHS.Combined orthodontic and orthognathic treatment was conducted,involving the anterior movement of the maxilla and mandible.After surgery,the patient's facial and intraoral features showed a satisfactory occlusion relationship with normal overbite,overjet and canine-molar relationships.There was also a significant improvement in the upper airway flow field.Two years after surgery,the cross-sectional area of the nasopharyngeal airway increased by 10.76％with a 55.36％reduction in pressure.The oropharyngeal airway showed a 108.25％increase in cross-sectional area with a 98.14％pressure reduction.The hypopharyngeal airway exhibited a 97.51％increase in cross-sectional area with a 351.03％pressure reduction.The laryngopharyngeal airway demonstrated a 27.54％increase in cross-sectional area with a 95.62％pressure reduction.The apnea-hypopnea index(AHI)decreased by 55.45％,achieving the treatment goal.Morphological measurements combined with fluid dynamic analysis can comprehensively evaluate the condition of the upper airway.The approximate value of the critical closing pressure(Pcrit)obtained from computational fluid dynamics(CFD)analysis may serve as a simple quantitative indicator for assessing the upper airway condition.

Purpose To investigate the expression of chromogranin A(CgA)in gastroenteropancreatic neuroendo-crine neoplasms(GEP-NENs)and its relationship with clinicopathological features.Methods The clinicopathological data of GEP-NENs diagnosed in the Department of Pathology,Beijing Chao-yang Hospital,Capital Medical University from May 2011 to December 2024 were retrospectively analyzed.Immunohistochemical staining was applied to evaluate the expression of CgA,and the patients were divided into CgA(+)group and CgA(-)group.Differences in clinico-pathological features between the 2 groups were compared.Results The age of 229 patients ranged from 21 to 89 years,with an average age of 54.4 years.The most common primary site was the rectum(56.8％,130/229),fol-lowed by the stomach(16.6％,38/229),pancreas(14.4％,33/229),small intestine(6.1％,14/229),and colon(6.1％,14/229).There were 206 cases of single lesion and 23 cases of multiple lesions(number of tumors ≥2).There were 153 cases of G1(66.8％),29 cases of G2(12.7％),7 cases of G3(3.1％),and 40 cases of neuroendocrine carcinoma(NEC,17.5％).The positive rates of CgA in G1,G2,G3,and NEC groups were 37.2％,75.8％,71.4％,and 65.0％,respectively,with statistically significant differences(P＜0.001).The positive rates of CgA in T1,T2,T3,and T4 were 37.2％,83.3％,75.9％,and 57.7％,respectively,with statistically significant differences(P＜0.001).There were significant differences in age,vascular invasion,lymph node metasta-sis,and number of tumors between CgA(+)group and CgA(-)group(P＜0.001),but there was no significant difference in sex,tumor location,Syn,and CD56 expression between the two groups(P=0.595,P=0.098,P=0.173,P=0.557).Conclusion Immunohistochemical antibody CgA is a useful marker for GEP-NENs.CgA positiv-ity may be a poor prognostic factor for GEP-NENs patients.

ObjectiveTo observe ovarian microvascular damage in rats with cold coagulation and blood stasis syndrome and to explore the mechanism by which Liangfang Wenjing decoction improves this condition in rats. MethodsFifty SPF female SD rats were randomly divided into a blank group， a model group， low-dose （8.1 g·kg^-1） and high-dose groups （16.2 g·kg^-1） of Liangfang Wenjing decoction， and a 4-phenylbutyric acid （0.1 g·kg^-1） group， with 10 rats in each group. The ice-water bath method was employed to establish the rat model of cold coagulation and blood stasis syndrome. Concurrent with modeling， Liangfang Wenjing decoction was administered continuously for 21 days， once daily. The rats' syndrome manifestations and estrous cycles were recorded. The enzyme-linked immunosorbent assay （ELISA） was used to detect serum reproductive hormone levels and levels of endothelin-1 （ET-1）， nitric oxide （NO）， thrombomodulin （TM）， and von Willebrand factor （vWF） in ovarian tissue. Prothrombin time （PT）， activated partial thromboplastin time （APTT）， thrombin time （TT）， and fibrinogen （FIB） were measured. The ovarian microcirculatory blood perfusion was detected by laser speckle contrast imaging. Hematoxylin-eosin （HE） staining was performed to observe the ovarian histopathology， flow cytometry to detect ovarian apoptosis rate， and transmission electron microscopy to observe the ultrastructure of ovarian microvascular endothelial cells. Western blot was employed to detect the protein expression of endothelial nitric oxide synthase （eNOS）， phosphorylated eNOS （p-eNOS）， Caspase-3， B-cell lymphoma-2 （Bcl-2）， Bcl-2-associated X protein （Bax）， glucose-regulated protein 78 （GRP78）， C/EBP homologous protein （CHOP）， inositol-requiring enzyme1α （IRE1α）， p-IRE1α， apoptosis signal-regulating kinase 1 （ASK1）， p-ASK1， c-Jun N-terminal kinase （JNK）， and p-JNK. Immunofluorescence was used to detect ovarian Bax and Bcl-2 expression in microvascular endothelial cells. ResultsCompared with the blank group， the model group showed signs of cold coagulation and blood stasis syndrome， prolonged estrus cycles， and reproductive hormone disorders. Histopathological results revealed a decrease in follicle counts at all stages and disorganized granulosa cell arrangement. Ovarian microcirculatory perfusion was significantly decreased （P<0.01）. PT， APTT， and TT were reduced （P<0.05， P<0.01）， while FIB levels were increased （P<0.05）. In ovarian tissue， NO content was decreased， while ET-1， vWF， and TM levels were increased significantly （P<0.01）. The apoptosis rate of ovarian cells was markedly increased （P<0.01）. Furthermore， p-eNOS/eNOS and Bcl-2 were decreased （P<0.05）， whereas Bax， cleaved-Caspase-3/Caspase-3， GRP78， CHOP， p-IRE1α/IRE1α， p-ASK1/ASK1， and p-JNK/JNK expression showed significant increases （P<0.05， P<0.01）. Compared with the model group， Liangfang Wenjing decoction intervention alleviated the symptoms of cold coagulation and blood stasis， gradually restored the estrus cycle， and improved ovarian histopathology and endothelial cell ultrastructure. Microcirculatory blood perfusion was significantly elevated （P<0.05）. NO content in ovarian tissue was elevated， while ET-1， vWF， and TM levels were significantly decreased （P<0.05， P<0.01）. The p-eNOS/eNOS ratio and Bcl-2 expression were significantly elevated （P<0.05）， while the expression of Bax， cleaved-Caspase-3/Caspase-3， GRP78， CHOP， p-IRE1α/IRE1α， p-ASK1/ASK1， and p-JNK/JNK was significantly decreased （P<0.05， P<0.01）. ConclusionLiangfang Wenjing decoction may regulate the IRE1α/ASK1/JNK signaling pathway to inhibit endoplasmic reticulum stress， attenuate apoptosis， and improve microvascular endothelial injury in ovaries of rats with cold coagulation and blood stasis syndrome.

A 51-year-old male presented to Nanfang Hospital, Southern Medical University, on September 30, 2024, with a 2-month history of cough and a 1-week history of fever. He had a medical history of human immunodeficiency virus (HIV) infection. The patient developed a paroxysmal cough in mid-July 2024, accompanied by a small amount of white phlegm and no fever. Despite treatment at a local community hospital, his symptoms persisted. After treatment at another local hospital on August 13, his cough improved. On September 23, the patient developed an unexplained fever. On September 25, a lump appeared below the left popliteal fossa and enlarged, prompting admission to our hospital. The patient presented with fever for one week and was found to have multiple abscesses in the lungs, buttocks, popliteal fossa, and other areas. Inflammatory markers (white blood cell count, neutrophil count, C-reactive protein, procalcitonin) were significantly elevated. Imaging and pathological findings were consistent with infection. Cultures grew Nocardia spp. Matria assisted laser desorption/ionization time of flight mass spectrometry suggested Nocardia veterana (confidence 80%), whereas 16S rRNA gene sequencing identified Nocardia nova. Both species belong to the Nocardia nova complex, which cannot be reliably differentiated by mass spectrometry alone. After admission, empirical antibacterial therapy was initiated with piperacillin-tazobactam and enrofloxacin, supplemented by antiretroviral therapy for HIV, Pneumocystis jirovecii pneumonia prophylaxis, gastric protection, nebulization, antihistamines, and correction of fluid and electrolyte imbalances. Local drainage of the left popliteal abscess was performed. On October 13, based on the pathogenic results from bronchoalveolar lavage fluid and pus, the diagnosis was disseminated nocardiosis. The antibiotic regimen was adjusted to trimethoprim-sulfamethoxazole and imipenem, after which the patient became afebrile. At discharge, the patient was afebrile with stable vital signs. The left popliteal abscess had decreased in size. Inflammatory markers showed a continuous downward trend. The patient was discharged on continued antibiotic therapy.

Objective:To investigate effect of esketamine combined with ultrasound-guided stellate ganglion block(SGB)on stress response and postoperative immune function in elderly patients undergoing colorectal resection.Methods:A retrospective analy-sis was conducted in clinical data from 70 cases of elderly patients undergoing elective colorectal resection in Xuzhou Hospital of Tradi-tional Chinese Medicine,Nanjing University of Chinese Medicine from September 2020 to April 2022,who were randomly divided into observation group(n=35)and control group(n=35),control group was treated with ultrasound-guided SGB,observation group was treated with esketamine combined ultrasound-guided SGB.Heart rate(HR),mean arterial pressure(MAP),product of heart rate and systolic blood pressure(RPP)and stress response levels[cortisol(CORT),SOD,MDA,IL-6,TNF-α,IL-1β]were compared between two groups at 5 min before SGB(t0),immediately after tracheal intubation(t1),1 h after operation(t2)and end of operation(t3).CD3+T,CD4+T,CD8+T and CD4+T/CD8+T at t0,t3,24 h after operation(t4)and 72 h after operation(t5)were compared,respec-tively.Recovery time,first exhaust time,bowel sound recovery time and first oral feeding time and incidence of adverse reactions during anesthesia were compared between two groups.Results:HR,MAP,RPP,CORT,SOD,MDA,IL-6,TNF-α,IL-1β,CD3+T,CD4+T,CD8+T and CD4+T/CD8+T at different time points in two groups were compared by repeated measures analysis of variance,and there were significant differences between groups and at different time points(P<0.05).Compared with control group,observation group had shorter recovery time,first exhaust time,bowel sound recovery time,first oral feeding time,postoperative time out of bed(P<0.05),and less intraoperative pain medication consumption,incidence of adverse reactions during anesthesia was reduced[48.57%(17/35)vs 25.71%(9/35),P<0.05].Conclusion:Esketamine combined with ultrasound-guided SGB in elderly patients undergoing enterectomy can promote recovery of postoperative gastrointestinal function,reduce perioperative stress response,has little impact on immune function of patients,reduce perioperative adverse reactions.

Objective:To evaluate the effect of different psychosocial interventions on fertility concerns in cancer patients using network Meta-analysis.Methods:Randomized controlled trials or quasi-experimental studies on the effects of different psychosocial interventions on fertility concerns in cancer patients were electronically searched in China National Knowledge Infrastructure, Wanfang Data, VIP, China Biology Medicine disc, PubMed, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO. The search period was from database establishment to October 31, 2024. Two researchers independently conducted literature screening and data extraction. Conventional Meta-analysis of the included literature was performed using RevMan 5.4, and network Meta-analysis was performed using Stata 18.0.Results:A total of 10 studies involving 835 cancer patients and seven psychosocial interventions were included. Network Meta-analysis showed that there was a statistically significant difference in the intervention effect of fertility counseling ( MD=18.24, 95% CI: 2.85-33.62, P<0.05) and mental awareness training ( MD=17.97, 95% CI: 3.09-32.85, P<0.05) on fertility concerns in cancer patients as compared to routine nursing. The ranked probability plot showed that fertility counseling and mental awareness training had superior results. Conclusions:Fertility counseling has a superior effect on fertility concerns in cancer patients. Mental awareness training may be effective in improving fertility concerns in cancer patients, and further research is needed to validate the effectiveness of mindfulness-based stress reduction, cognitive behavioral therapy, dyadic coping interventions, and educational interventions in improving fertility concerns in cancer patients.

A 51-year-old male presented to Nanfang Hospital, Southern Medical University, on September 30, 2024, with a 2-month history of cough and a 1-week history of fever. He had a medical history of human immunodeficiency virus (HIV) infection. The patient developed a paroxysmal cough in mid-July 2024, accompanied by a small amount of white phlegm and no fever. Despite treatment at a local community hospital, his symptoms persisted. After treatment at another local hospital on August 13, his cough improved. On September 23, the patient developed an unexplained fever. On September 25, a lump appeared below the left popliteal fossa and enlarged, prompting admission to our hospital. The patient presented with fever for one week and was found to have multiple abscesses in the lungs, buttocks, popliteal fossa, and other areas. Inflammatory markers (white blood cell count, neutrophil count, C-reactive protein, procalcitonin) were significantly elevated. Imaging and pathological findings were consistent with infection. Cultures grew Nocardia spp. Matria assisted laser desorption/ionization time of flight mass spectrometry suggested Nocardia veterana (confidence 80%), whereas 16S rRNA gene sequencing identified Nocardia nova. Both species belong to the Nocardia nova complex, which cannot be reliably differentiated by mass spectrometry alone. After admission, empirical antibacterial therapy was initiated with piperacillin-tazobactam and enrofloxacin, supplemented by antiretroviral therapy for HIV, Pneumocystis jirovecii pneumonia prophylaxis, gastric protection, nebulization, antihistamines, and correction of fluid and electrolyte imbalances. Local drainage of the left popliteal abscess was performed. On October 13, based on the pathogenic results from bronchoalveolar lavage fluid and pus, the diagnosis was disseminated nocardiosis. The antibiotic regimen was adjusted to trimethoprim-sulfamethoxazole and imipenem, after which the patient became afebrile. At discharge, the patient was afebrile with stable vital signs. The left popliteal abscess had decreased in size. Inflammatory markers showed a continuous downward trend. The patient was discharged on continued antibiotic therapy.

Objective:To investigate effect of esketamine combined with ultrasound-guided stellate ganglion block(SGB)on stress response and postoperative immune function in elderly patients undergoing colorectal resection.Methods:A retrospective analy-sis was conducted in clinical data from 70 cases of elderly patients undergoing elective colorectal resection in Xuzhou Hospital of Tradi-tional Chinese Medicine,Nanjing University of Chinese Medicine from September 2020 to April 2022,who were randomly divided into observation group(n=35)and control group(n=35),control group was treated with ultrasound-guided SGB,observation group was treated with esketamine combined ultrasound-guided SGB.Heart rate(HR),mean arterial pressure(MAP),product of heart rate and systolic blood pressure(RPP)and stress response levels[cortisol(CORT),SOD,MDA,IL-6,TNF-α,IL-1β]were compared between two groups at 5 min before SGB(t0),immediately after tracheal intubation(t1),1 h after operation(t2)and end of operation(t3).CD3+T,CD4+T,CD8+T and CD4+T/CD8+T at t0,t3,24 h after operation(t4)and 72 h after operation(t5)were compared,respec-tively.Recovery time,first exhaust time,bowel sound recovery time and first oral feeding time and incidence of adverse reactions during anesthesia were compared between two groups.Results:HR,MAP,RPP,CORT,SOD,MDA,IL-6,TNF-α,IL-1β,CD3+T,CD4+T,CD8+T and CD4+T/CD8+T at different time points in two groups were compared by repeated measures analysis of variance,and there were significant differences between groups and at different time points(P<0.05).Compared with control group,observation group had shorter recovery time,first exhaust time,bowel sound recovery time,first oral feeding time,postoperative time out of bed(P<0.05),and less intraoperative pain medication consumption,incidence of adverse reactions during anesthesia was reduced[48.57%(17/35)vs 25.71%(9/35),P<0.05].Conclusion:Esketamine combined with ultrasound-guided SGB in elderly patients undergoing enterectomy can promote recovery of postoperative gastrointestinal function,reduce perioperative stress response,has little impact on immune function of patients,reduce perioperative adverse reactions.

Purpose To investigate the expression of chromogranin A(CgA)in gastroenteropancreatic neuroendo-crine neoplasms(GEP-NENs)and its relationship with clinicopathological features.Methods The clinicopathological data of GEP-NENs diagnosed in the Department of Pathology,Beijing Chao-yang Hospital,Capital Medical University from May 2011 to December 2024 were retrospectively analyzed.Immunohistochemical staining was applied to evaluate the expression of CgA,and the patients were divided into CgA(+)group and CgA(-)group.Differences in clinico-pathological features between the 2 groups were compared.Results The age of 229 patients ranged from 21 to 89 years,with an average age of 54.4 years.The most common primary site was the rectum(56.8％,130/229),fol-lowed by the stomach(16.6％,38/229),pancreas(14.4％,33/229),small intestine(6.1％,14/229),and colon(6.1％,14/229).There were 206 cases of single lesion and 23 cases of multiple lesions(number of tumors ≥2).There were 153 cases of G1(66.8％),29 cases of G2(12.7％),7 cases of G3(3.1％),and 40 cases of neuroendocrine carcinoma(NEC,17.5％).The positive rates of CgA in G1,G2,G3,and NEC groups were 37.2％,75.8％,71.4％,and 65.0％,respectively,with statistically significant differences(P＜0.001).The positive rates of CgA in T1,T2,T3,and T4 were 37.2％,83.3％,75.9％,and 57.7％,respectively,with statistically significant differences(P＜0.001).There were significant differences in age,vascular invasion,lymph node metasta-sis,and number of tumors between CgA(+)group and CgA(-)group(P＜0.001),but there was no significant difference in sex,tumor location,Syn,and CD56 expression between the two groups(P=0.595,P=0.098,P=0.173,P=0.557).Conclusion Immunohistochemical antibody CgA is a useful marker for GEP-NENs.CgA positiv-ity may be a poor prognostic factor for GEP-NENs patients.

Objective:To evaluate the effect of different psychosocial interventions on fertility concerns in cancer patients using network Meta-analysis.Methods:Randomized controlled trials or quasi-experimental studies on the effects of different psychosocial interventions on fertility concerns in cancer patients were electronically searched in China National Knowledge Infrastructure, Wanfang Data, VIP, China Biology Medicine disc, PubMed, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO. The search period was from database establishment to October 31, 2024. Two researchers independently conducted literature screening and data extraction. Conventional Meta-analysis of the included literature was performed using RevMan 5.4, and network Meta-analysis was performed using Stata 18.0.Results:A total of 10 studies involving 835 cancer patients and seven psychosocial interventions were included. Network Meta-analysis showed that there was a statistically significant difference in the intervention effect of fertility counseling ( MD=18.24, 95% CI: 2.85-33.62, P<0.05) and mental awareness training ( MD=17.97, 95% CI: 3.09-32.85, P<0.05) on fertility concerns in cancer patients as compared to routine nursing. The ranked probability plot showed that fertility counseling and mental awareness training had superior results. Conclusions:Fertility counseling has a superior effect on fertility concerns in cancer patients. Mental awareness training may be effective in improving fertility concerns in cancer patients, and further research is needed to validate the effectiveness of mindfulness-based stress reduction, cognitive behavioral therapy, dyadic coping interventions, and educational interventions in improving fertility concerns in cancer patients.