Objective To investigate the distribution of dense fine speckled(DFS)antinuclear antibody(ANA)in different ages,genders,and diseases,and to explore its clinical significance in the diagnosis of auto-immune disease(AID).Methods A retrospective summary was conducted on the clinical basic data of 53520 patients who visited the hospital from January 2022 to April 2024,as well as the results of indirect immunoflu-orescence(IIF)ANA fluorescence karyotype and titer,and immunoblotting ANA spectrum,and the relation-ship between DFS positivity and AID was analyzed.Results Of the 53 520 serum samples,the rate of ANA fluorescence positivity was 32.40％,with DFS-positive samples accounting for 1.18％of all ANA fluores-cence-positive samples.The male-to-female ratio of DFS positives was 1∶1.94,with the highest percentage of 51.9％in the 21-40 age group.Among DFS positive individuals,only 12.14％were clinically diagnosed with AID disease,significantly lower than other ANA fluorescent karyotype positive individuals(23.31％,P＜0.001).The overall positivity rate of ANA spectra using immunoblotting in DFS-positive individuals was 23.54％,which was significantly lower than that in other fluorescent karyotype positive ANA individuals(73.26％,P＜0.001).Moreover,DFS positive individuals were mainly accompanied by antibody positivity such as anti-Ro52 antibodies,which had no diagnostic specificity in AID diagnosis.When comparing DFS posi-tive individuals with similar fluorescence morphology to those with homogeneous nuclear granules and nuclei,at an ANA titer of 1∶100,the proportion of AID patients in homogeneous nuclear granules and nuclei was 20.04％,significantly higher than the proportion of AID patients in DFS positive individuals(9.44％,P=0.001).With the increase of ANA titer,the proportion of AID diseases significantly increased in both karyo-type samples.When the ANA titer of DFS positive samples was increased to ≥ 1∶320,the proportion of AID diseases significantly increased to 30.77％(P=0.002).Conclusion DFS is a rare ANA fluorescent karyo-type,and DFS positive individuals are mainly found in females aged 21-40,mostly non AID patients.Howev-er,high titers of DFS cannot rule out the possibility of AID.In clinical work,special attention should be paid to distinguishing it from the homogeneous nuclear granule type to avoid misdiagnosis.

Ischemic stroke （IS） is a serious cerebrovascular disease common in clinical practice. Targeting the pathogenesis of IS， intravenous thrombolysis for restoring blood flow is still the most effective therapy. However， intravenous thrombolysis has shortcomings such as increased bleeding risk， narrow therapeutic window， and contraindications， which limited its clinical application. Protection of the ischemic brain tissue before full recovery of blood flow is associated with the prognosis of IS. Studies have identified multiple pathways in the alleviation of the brain injury caused by IS， such as the mammalian target of rapamycin （mTOR） signaling pathway. Traditional Chinese medicine （TCM） has abundant therapies and unique advantages in the treatment of IS， especially in alleviating symptoms and improving the quality of life of patients. After the onset of IS， TCM can be integrated with Western medicine to play a role in the whole process of treatment， rehabilitation， and recurrence prevention as soon as possible， thus maximizing patient benefits. TCM has clinical significance for the recovery of neurological and motor functions after IS. Studies have shown that TCM can reduce the cerebral injury caused by IS by regulating and activating the mTOR signaling pathway， thereby regulating autophagy， inhibiting apoptosis of nerve cells， and reducing oxidative stress and inflammation. TCM exerts a positive effect for achieving cerebral protection and improving the prognosis of IS and provides new ideas for the prevention and treatment of IS. This article introduces the role of the mTOR signaling pathway in the pathogenesis of IS and reviews the research progress in the TCM regulation of this pathway in the treatment of IS， aiming to provide new therapeutic ideas and systematic scientific reference for the treatment of IS with TCM.

Sulfuryl fluoride is a kind of pesticide with strong permeability, convenient use at low temperature, non-corrosive and other characteristics, which can kill food pests and has strong lethality to termites. In acute sulfuryl fluoride poisoning, patients can see recurrent convulsions, epileptic electroencephalogram abnormalities such as matrix spikes or high amplitude spikes. In this paper, a patient with sulfuryl fluoride poisoning with convulsion-based mental system symptoms was reported, and after clinical treatment with dexamethasone and phenobarbital sodium, the patient was cured and discharged.

Sulfuryl fluoride is a kind of pesticide with strong permeability, convenient use at low temperature, non-corrosive and other characteristics, which can kill food pests and has strong lethality to termites. In acute sulfuryl fluoride poisoning, patients can see recurrent convulsions, epileptic electroencephalogram abnormalities such as matrix spikes or high amplitude spikes. In this paper, a patient with sulfuryl fluoride poisoning with convulsion-based mental system symptoms was reported, and after clinical treatment with dexamethasone and phenobarbital sodium, the patient was cured and discharged.

Objective To evaluate the degree of brain atrophy in spinocerebellar ataxia type 3(SCA3)patients based on artificial intelligence(AI)technology,and to explore the correlation between the degree of brain atrophy and the severity of the disease.Methods The clinical and imaging data of 23 SCA3 patients(SCA3 group)and 24 healthy controls(HC)(HC group)were collected.The International Cooperative Ataxia Rating Scale(ICARS)was used to evaluate the severity of ataxia in patients with SCA3.AI technology was used to process the 3D-T1 WI MR image data of the SCA3 and HC groups to segment and measure the volume and volume percentage of brain,followed by correlation analyses between brain structural alterations and the severity of ataxia in SCA3 patients.Results There were no significant differences in gender and age between the two groups(P＞0.05).The SCA3 group had a significant reduction in the volume and volume percentage of various brain regions,such as the frontal,temporal,parietal,occipital,limbic,right cerebral white mat-ter,subcortical gray matter,cerebellum and brainstem,compared to the HC group(multiple hypothesis testing adjusted P＜0.01).In the SCA3 group,the ICARS showed positive correlation with patient age(r=0.571,P=0.004)and negative correlation with the vol-ume of the left cerebellar white matter,vermis,medulla oblongata,and the volume percentages of bilateral cerebellar white matter,vermis,pons,medulla oblongata(P＜0.05).Conclusion The significant atrophy of the supratentorial and subtentorial regions of the brain in SCA3 patients.The globus pallidus exhibits the most substantial atrophy,suggesting its potential as an imaging diagnostic marker of SC A3.

Objective:To investigate the effect of iron deficiency on the prognosis of elderly patients with ejection fraction preserved heart failure (HFpEF).Methods:The clinical data of old patients (>75 years) with HFpEF from November 2021 to May 2023 in General Hospital of Eastern Theater of the Chinese People′s Liberation Army were retrospectively analyzed. The patients were divided into iron deficiency group (65 cases) and non-iron deficiency group (90 cases) according to serum ferritin (SF) and transferrin saturation (TSAT) at admission. The first hematological indexes and echocardiogram examination results after admission were compared between two groups. The patients were followed up until November 2023, the poor prognosis was recorded. The correlation between iron deficiency, iron metabolism indexes and poor prognosis in elderly patients with HFpEF was analyzed by Spearman correlation analysis. The Kaplan-Meier survival curve was drawn to analyze the effect of iron deficiency on the cumulative survival in elderly patients with HFpEF.Results:There were no statistical difference in triglyceride, total cholesterol, low density lipoprotein cholesterol, C-reactive protein, hemoglobin and echocardiogram indexes between the two groups ( P>0.05). The N-terminal pro-brain natriuretic peptide (NT-proBNP), creatinine, procalcitonin (PCT) and interleukin-6 (IL-6) in iron deficiency group were significantly higher than those in non-iron deficiency group: 427.23 (281.00, 736.90) pmol/L vs. 313.50 (182.47, 363.25) pmol/L, (167.93 ± 51.22) μmol/L vs. (121.71 ± 11.99) μmol/L, 0.12 (0.05, 0.22) μg/L vs. 0.07 (0.04, 0.16) μg/L and 25.60 (8.38, 47.01) ng/L vs. 10.15 (4.75, 19.89) ng/L, the SF, serum iron (SI) and TSAT were significantly lower than those in non-iron deficiency group: 75.40 (42.30, 198.00) μg/L vs. 207.00 (281.00, 736.90) μg/L, (6.49 ± 2.66) μmol/L vs. (12.75 ± 4.24) μmol/L and (16.65 ± 6.26)% vs. (33.78 ± 11.16)%, and there were statistical differences ( P<0.01 or <0.05). The patients were followed up for (12.06 ± 7.58) months, the all-cause mortality, cardiovascular mortality, readmission rate and heart failure readmission rate in iron deficiency group were significantly higher than those in non-iron deficiency group: 40.0% (26/65) vs. 20.0% (18/90), 18.5% (12/65) vs. 4.4% (4/90), 90.8% (59/65) vs. 70.0% (63/90) and 66.2% (43/65) vs. 17.8% (16/90), and there were statistical differences ( P<0.01). Spearman correlation analysis result showed that the iron deficiency was positive correlation with all-cause death, cardiovascular death, readmission and heart failure readmission in elderly patients with HFpEF ( P<0.01); the SI and TSAT were negative correlation with all-cause death, cardiovascular death, readmission and heart failure readmission ( P<0.01 or <0.05); and the SF was not correlation with the indexes ( P>0.05). Kaplan-Meier survival analysis result showed that the risk of all-cause death was significantly increased in elderly HFpEF patients with iron deficiency, and the cumulative survival rate was significantly reduced (log-rank χ2 = 6.48, P<0.05). Conclusions:The elderly HFpEF patients with iron deficiency have poor prognosis with high mortality and readmission rate.

Objective To summarize the experience of anesthesia management of transapical transcatheter aortic valve replacement(TA-TAVR).Methods Clinical data of 60 cases of TA-TAVR in the Cardiovascular Surgery Department of our hospital from January 2023 to January 2024 were retrospectively analyzed,including 34 cases of aortic stenosis and 26 cases of aortic insufficiency.According to the New York Heart Association(NYHA)functional classification,there were 4 cases of class Ⅱ,11 cases of class Ⅲ,and 45 cases of class Ⅳ.According to the American Society of Anesthesiologists(ASA)classification,there were 12 cases of grade Ⅱ,44 cases of grade Ⅲ,2 cases of grade Ⅳ,and 2 cases of grade V.The European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ)score was 8.3％-54.1％[mean,(20.0±10.3)％].All the patients received general anesthesia with endotracheal intubation.Results Intraoperative ventricular fibrillation occurred in 3 cases.The median mechanical ventilation time of the 60 patients was 17 h(range,0-192 h),including 5 cases of 0 h(extubation in the operating room,which was ultra-fast track anesthesia),17 cases of extubation within 6 h after surgery(fast track anesthesia),31 cases of extubation between 6 and 48 h,and 7 cases of mechanical ventilation time＞48 h.Rescue analgesia after surgery was required in 8 cases.The median ICU stay time was 21 h(range,3-407 h),and the postoperative hospital stay was(7.8±4.5)d.Postoperative complications included 1 case of emergency thoracotomy because of artificial aortic valve dislocation,3 cases of permanent pacemaker implantation because of third-degree atrioventricular block,and 2 cases of tracheal intubation again because of hypoxemia.Conclusion Optimizing the anesthesia intervention measures(anesthesia details,anesthesia monitoring methods,and anesthesia analgesia plan)is helpful for early extubation,achieving ultra-fast track and fast track anesthesia of TA-TAVR.

Objective:To investigate associations of serum vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor 2 (VEGFR2) with carotid plaque stability in elderly patients with acute ischemic stroke (AIS).Methods:Elderly AIS patients with carotid plaque detected by carotid ultrasound in the First People's Hospital of Xianyang from April 2022 to April 2024 were selected, and they were further divided into stable plaque group and vulnerable plaque group. Multivariate logisitic regression analysis was used to determine the correlation between serum VEGF/VEGFR2 and carotid plaque stability. Receiver operating characteristic (ROC) curve was used to analyze the differential value of serum VEGF and VEGFR2 on plaque stability. Results:A total of 183 patients were enrolled, including 139 males (75.96%), aged 68.10±4.97 years. One hundred and one patients (55.19%) had vulnerable plaques, and 82 (44.81%) had stable plaques. There were significant differences in age, triglycerides, VEGF, VEGFR2, baseline National Institutes of Health Stroke Scale scores, and the proportion of patients with hypertension, diabetes, smoking, and statins between the vulnerable plaque group and the stable plaque group (all P<0.05). Multivariate logistic regression analysis showed that serum VEGF (odds ratio [ OR] 1.021, 95% confidence interval [ CI] 1.004-1.037; P=0.015] and VEGFR2 ( OR 1.009, 95% CI 1.005-1.012; P<0.001) were independently associated with vulnerable plaques. ROC curve analysis showed that serum VEGF and VEGFR2 alone were effective in distinguishing plaque stability, and the areas under the curve were 0.744 (95% CI 0.673-0.815) and 0.809 (95% CI 0.749-0.870), respectively. The area under the curve of the combination of the two was 0.874 (95% CI 0.825-0.924). Conclusion:Serum VEGF and VEGFR2 are independently associated with vulnerable carotid plaques in elderly patients with AIS, and both alone or in combination have good discriminatory value for the stability of carotid plaques.

Objective:To compare proximal humerus internal locking system (PHILOS) and Multiloc intramedullary nail in the treatment of proximal humerus fracture-anterior dislocation.Methods:A retrospective study was performed to analyze the data of 33 patients with proximal humerus fracture-anterior dislocation who had been treated by open reduction and internal fixation from June 2015 to April 2021 at Department of Upper Limbs, Zhengzhou Orthopaedic Hospital. According to methods of internal fixation, the patients were divided into an extramedullary group and an intramedullary group. In the extramedullary group of 18 cases subjected to internal fixation with PHILOS, there were 8 males and 10 females with an age of (53.3 ± 10.6) years, and 1 2-part fracture, 15 3-part fractures and 2 4-part fractures by the Neer classification. In the intramedullary group of 15 cases subjected to internal fixation with Multiloc intramedullary nail, there were 8 males and 7 females with an age of (51.5 ± 11.2) years, and 14 3-part fractures and 1 4-part fracture by the Neer classification. The 2 groups were compared in terms of incision length, operation time, intraoperative blood loss, postoperative complications, and visual analog scale (VAS), range of shoulder motion, and Constant-Murley score at postoperative 12 months.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). All patients were followed up for (20.8 ± 4.7) months. The incision length in the intramedullary group [(11.6 ± 1.7) cm] was significantly shorter than that in the extramedullary group [(17.6 ± 2.0) cm], and the intraoperative blood loss in the former [(106.7 ± 34.4) mL] was significantly lower than that in the latter [(151.7 ± 45.7) mL] ( P<0.05). The VAS scores at 1 week and 1 month after surgery [2.0 (2.0, 3.0) and 0.0 (0.0, 1.0) respectively] in the intramedullary group were significantly lower than those in the extramedullary group [3.0 (3.0, 3.3) and 1.0 (0.0, 1.3) respectively] ( P<0.05). The external rotation of the shoulder at the last follow-up in the intramedullary group (65.3° ± 15.5°) was significantly larger than that in the extramedullary group (50.6° ± 13.9°) ( P<0.05). There were no significant differences in operation time, incidence of postoperative complications, VAS score at 12 months after operation, Constant-Murley score or range of shoulder motion at the last follow-up between the 2 groups ( P>0.05). Conclusions:In the treatment of proximal humerus fracture-anterior dislocation, open reduction and internal fixation with both PHILOS and Multiloc intramedullary nail can result in a favorable prognosis when the fracture-dislocation is well reduced and fixated. However, the Multiloc intramedullary nail may lead to better early pain relief, less surgical invasion, and better functional recovery of the external rotation of the shoulder.

Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.