BackgroundObstructive sleep apnea （OSA） represents a prevalent sleep disordered breathing condition characterized by complex pathophysiology. The arousal threshold （ArTH）， a core non-anatomical contributor to OSA pathogenesis， is intimately tied to the disease severity and clinical phenotypes. To date， research regarding factors associated with ArTH has yielded inconsistent findings， and ArTH profiles and disparities across populations with different genetic backgrounds are not fully elucidated. ObjectiveTo explore the differences of ArTH in OSA patients with different genetic backgrounds and analyze the key factors affecting ArTH， thereby providing evidence for understanding OSA pathophysiology and formulating targeted treatment regimens. MethodsA total of 285 patients who met the diagnostic criteria for OSA， as defined by the Multidisciplinary Diagnosis and Treatment Guidelines for Adult Obstructive Sleep Apnea， were retrospectively enrolled in this study. All participants underwent overnight polysomnography （PSG） at the Sleep Medicine Center of Inner Mongolia Mental Health Center from December 2022 to May 2024. Based on the study design， the cohort was stratified into two distinct genetic background subgroups （group A and group B）. Demographic and clinical characteristics， the Epworth Sleepiness Scale （ESS） score， and overnight PSG data were collected. The apnea hypopnea index （AHI）， the lowest pulse oxygen saturation （LSpO₂）， and fraction of hypopneas （F_Hypopneas） were utilized as surrogate indicators to estimate ArTH in OSA patients. The influencing factors of low ArTH were tested by binary Logistic regression analysis. ResultsAmong the 285 OSA patients， there were 227 cases （79.65%） in group A and 58 cases （20.35%） in group B. Comparisons between the two genetic background subgroups revealed no statistically significant differences in the proportion of low ArTH， ESS score， PSG parameters， and the three markers for low ArTH （AHI<30 events/h， LSpO₂>82.5%， F_Hypopneas>58.3%） （P>0.05）. Binary Logistic regression analysis identified sex （OR=2.421， 95% CI： 1.070–5.478）， BMI （OR=0.847， 95% CI： 0.770–0.932）， N1 sleep duration （OR=0.974， 95% CI： 0.963–0.985）， and hypertension （OR=0.348， 95% CI： 0.143–0.848） as independent factors associated with low ArTH in the total cohort. Stratified analysis by genetic backgrounds revealed that sex（OR=3.799， 95% CI： 1.389–10.392）， BMI（OR=0.819， 95% CI：0.723–0.929）， and N1 sleep duration（OR=0.973， 95% CI： 0.961–0.986） were independent factors of low ArTH in group A. In contrast， only N1 sleep duration （OR=0.951， 95% CI： 0.911–0.993） remained a significant factor in group B. ConclusionArthur may have conservative characteristics in patients with OSA with different genetic backgrounds， but the pathophysiological mechanism of OSA may have population heterogeneity. ［Funded by Inner Mongolia Autonomous Region Natural Science Fundation Project （number， 2024QN08050）； Intra-institutional Scientific Research Project of Inner Mongolia Mental Health Center （number， 2022QNWN0010）］

The prescription Mahuang Shengmatang in the Treatise on Cold Damage （《伤寒论》） has sparked considerable debate among medical practitioners throughout history， with varying opinions on its indications， pathogenesis described in the text， principle of compatibility， and clinical applications. Both ancient and modern interpreters of Mahuang Shengmatang often focus on herbal compatibility as a primary approach to deduce the pathogenesis and treatment methods. Building upon this foundation， this paper utilizes herbal dosage as a clue to discern the primary and secondary herbs in the prescription. It further analyzes the principle of compatibility based on herbal indications， summarizing the indications and therapeutic principles of this prescription. Ultimately， it reveals the underlying pathogenesis reflected in the text. The internal closure of heat and toxin leads to the stagnation of Qi， preventing Yang Qi from reaching the extremities and causing cold hands and feet. When the pathogenic Qi finds no outlet， it floods both the upper and lower regions of the body， attacking the throat and causing cough with expectoration of pus and blood， and descending to the large intestine to consume Yin fluids， resulting in persistent diarrhea. Based on this pathogenesis， the paper expands the scope of symptoms and signs associated with the prescription， providing a more detailed portrayal of the applicable patient population and enhancing the basis for clinical prescription references. Additionally， the paper presents considerations on several controversial topics， suggesting that the "lower pulse" described in the text refers to the lower limb arterial pulsation， and the symptoms and signs resemble those of septic shock in modern medicine. Therefore， Mahuang Shengmatang should be categorized as a prescription for treating warm diseases and it is not developed by ZHANG Zhongjing. By employing a detailed discussion on the syndrome， pathogenesis， and clinical application in the texts of Mahuang Shengmatang from the dosage， principle of compatibility， and herbal indications， this paper not only enriches the theoretical foundation of Mahuang Shengmatang but also provides a comprehensive perspective and fresh ideas for understanding its clinical application.

Objective To analyze the value of heparin-binding protein(HBP)and interleukin-17A(IL-17A)levels in bronchoalveolar lavage fluid in predicting prognosis of elderly patients with se-vere pneumonia.Methods A total of 105 elderly patients with severe pneumonia in the hospital from May 2022 to May 2024 were selected and divided into death group(n=32)and survival group(n=73)based on their survival outcomes within 28 days after admission.The levels of HBP and IL-17A in bronchoalveolar lavage fluid were compared between the two groups;the Logistic regression analysis was conducted to explore the influencing factors for prognosis in elderly patients with severe pneumoni-a;the receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficiencies of HBP and IL-17A in bronchoalveolar lavage fluid for the prognosis of elderly patients with severe pneumonia.Results The levels of HBP and IL-17A in bronchoalveolar lavage fluid in the death group were significantly higher than those in the survival group(P＜0.01).There were significant differ-ences in the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score and blood lac-tate(Lac)level between the two groups(P＜0.01).Logistic regression analysis showed that HBP(OR=3.084,95％CI,1.326 to 4.694),IL-17A(OR=4.521,95％CI,2.164 to 7.841),APACHE Ⅱscore(OR=2.039,95％CI,1.069 to 2.859),and Lac(OR=2.627,95％CI,1.168 to 3.058)were influencing factors for the prognosis of elderly patients with severe pneumonia(P＜0.05).When the optimal cut-off values were set at 15.92 ng/mL for HBP and 109.34 pg/mL for IL-17A,the area under the curve(AUC)for the combined prediction of prognosis by HBP and IL-17A in bronchoalveolar lavage fluid was 0.852,with a 95％CI of 0.801 to 0.948.The AUC for the com-bined prediction of prognosis by HBP and IL-17A in bronchoalveolar lavage fluid was significantly higher than that for single tests(Z=2.906,2.416,P=0.007,0.014).Conclusion Increased levels of HBP and IL-17A in bronchoalveolar lavage fluid,decreased APACHE Ⅱ score,and in-creased Lac are influencing factors for the prognosis of elderly patients with severe pneumonia.Com-bined detection of HBP and IL-17A in bronchoalveolar lavage fluid has high sensitivity in predicting the prognosis of elderly patients with severe pneumonia.

Polycystic kidney disease (PKD) is a hereditary kidney disease characterized by the formation of numerous cysts in the kidneys, which progressively impairs renal function over time. PKD is primarily divided into two types: autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD), with ADPKD being more prevalent. Current treatments primarily focus on symptom relief and disease progression delay, lacking a curative approach. However, the development of gene editing technologies such as clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein 9 (CRISPR-Cas9) and adeno-associated virus (AAV) vectors has offered new therapeutic possibilities for ADPKD and ARPKD. These include approaches like antisense oligonucleotides (ASO), adenovirus-mediated gene knockdown, CRISPR- Cas9, Pkd1 gene enhancement therapy, and the use of induced pluripotent stem cells (iPSCs), which have shown potential efficacy in animal models and early clinical studies. Despite facing technological challenges, ethical and legal issues, and high costs, gene therapy presents an unprecedented hope for PKD treatment. Future interdisciplinary collaboration and international cooperation are essential for developing more effective treatment strategies for PKD patients.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

The decline of ovarian function due to aging is an irreversible natural physiological process, manifested by the progressive depletion of follicles and the decrease of oocyte quality in the ovary. Existing studies have shown that the Sirtuins family is involved in the development of ovarian aging through various pathways, such as regulation of nicotinamide adenine dinucleotide levels, oxidative stress, chromosome segregation and genomic stability. In this paper, we review the current roles of Sirtuins family proteins in ovarian aging and their molecular mechanisms.

Objective:To investigate the embryo development and clinical pregnancy outcomes in patients with ovarian hyperstimulation syndrome (OHSS) undergoing assisted reproductive technology (ART).Methods:A retrospective cohort study was conducted on data from 4 080 cycles of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer treatments performed at the Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University from August 2019 to August 2021. Patients were divided into OHSS group ( n=524) and non-OHSS group (control group, n=3 556) based on whether OHSS occurred, and the OHSS group was further divided into OHSS combined with polycystic ovary syndrome (PCOS) subgroup ( n=231) and OHSS combined with non-PCOS subgroup ( n=293) based on the presence of PCOS. General information, embryo developmental data and clinical outcomes were compared between the two groups. Results:1) Patients in the OHSS group [(30.7±3.6) years] were younger than those in control group [(31.5±4.8) years, P<0.001], and the number of retrieved oocytes (28.2±5.7), rates of high-quality embryos [52.7% (4 982/9 463)], blastocyst formation [54.0% (5 059/9 371)], biochemical pregnancy [75.0% (393/524)], clinical pregnancy [69.5% (364/524)], and live birth [58.0% (304/524)] were significantly higher in the OHSS group than in control group [12.5±6.7, 49.8% (14 042/28 204), 51.4% (14 279/27 797), 59.5% (2 115/3 556), 54.1% (1 924/3 556), 43.6% (1 550/3 556), respectively; all P<0.001]. 2) Patients in the OHSS combined with PCOS subgroup [(30.2±3.1) years] were younger than those in the OHSS combined with non-PCOS subgroup [(31.1±4.0) years, P=0.009], and the estradiol level [165.0 (101.0, 222.5) pmol/L] was higher than that in the OHSS combined with non-PCOS subgroup [141.0 (81.0,202.0) pmol/L, P=0.005]; rates of high-quality embryos [56.3% (2 413/4 284)], blastocyst formation [67.1% (2 846/4 239)], and high-quality blastocysts [57.7% (2 445/4 239)] were also significantly higher in the OHSS combined with PCOS subgroup than in the OHSS combined with non-PCOS subgroup [49.6% (2 569/5 179), 60.3% (3 092/5 132), 50.9% (2 614/5 132), respectively; all P<0.001]. Conclusion:There is a certain correlation between OHSS and female age. The occurrence of OHSS does not affect embryo development and does not increase adverse pregnancy outcomes in infertile patients. The presence of PCOS does not affect the pregnancy outcomes of OHSS patients. However, in ART, we still strive to avoid the occurrence of adverse events such as OHSS as much as possible.

The decline of ovarian function due to aging is an irreversible natural physiological process, manifested by the progressive depletion of follicles and the decrease of oocyte quality in the ovary. Existing studies have shown that the Sirtuins family is involved in the development of ovarian aging through various pathways, such as regulation of nicotinamide adenine dinucleotide levels, oxidative stress, chromosome segregation and genomic stability. In this paper, we review the current roles of Sirtuins family proteins in ovarian aging and their molecular mechanisms.

Objective:To investigate the embryo development and clinical pregnancy outcomes in patients with ovarian hyperstimulation syndrome (OHSS) undergoing assisted reproductive technology (ART).Methods:A retrospective cohort study was conducted on data from 4 080 cycles of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer treatments performed at the Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University from August 2019 to August 2021. Patients were divided into OHSS group ( n=524) and non-OHSS group (control group, n=3 556) based on whether OHSS occurred, and the OHSS group was further divided into OHSS combined with polycystic ovary syndrome (PCOS) subgroup ( n=231) and OHSS combined with non-PCOS subgroup ( n=293) based on the presence of PCOS. General information, embryo developmental data and clinical outcomes were compared between the two groups. Results:1) Patients in the OHSS group [(30.7±3.6) years] were younger than those in control group [(31.5±4.8) years, P<0.001], and the number of retrieved oocytes (28.2±5.7), rates of high-quality embryos [52.7% (4 982/9 463)], blastocyst formation [54.0% (5 059/9 371)], biochemical pregnancy [75.0% (393/524)], clinical pregnancy [69.5% (364/524)], and live birth [58.0% (304/524)] were significantly higher in the OHSS group than in control group [12.5±6.7, 49.8% (14 042/28 204), 51.4% (14 279/27 797), 59.5% (2 115/3 556), 54.1% (1 924/3 556), 43.6% (1 550/3 556), respectively; all P<0.001]. 2) Patients in the OHSS combined with PCOS subgroup [(30.2±3.1) years] were younger than those in the OHSS combined with non-PCOS subgroup [(31.1±4.0) years, P=0.009], and the estradiol level [165.0 (101.0, 222.5) pmol/L] was higher than that in the OHSS combined with non-PCOS subgroup [141.0 (81.0,202.0) pmol/L, P=0.005]; rates of high-quality embryos [56.3% (2 413/4 284)], blastocyst formation [67.1% (2 846/4 239)], and high-quality blastocysts [57.7% (2 445/4 239)] were also significantly higher in the OHSS combined with PCOS subgroup than in the OHSS combined with non-PCOS subgroup [49.6% (2 569/5 179), 60.3% (3 092/5 132), 50.9% (2 614/5 132), respectively; all P<0.001]. Conclusion:There is a certain correlation between OHSS and female age. The occurrence of OHSS does not affect embryo development and does not increase adverse pregnancy outcomes in infertile patients. The presence of PCOS does not affect the pregnancy outcomes of OHSS patients. However, in ART, we still strive to avoid the occurrence of adverse events such as OHSS as much as possible.

The Hippo signaling pathway is highly conserved in evolution, and participates in the regulation of cell proliferation, differentiation, and tissular dynamic balance, and plays an important role in regulating tissue, organ size, and cell number. Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease and one of the most common causes of end-stage renal disease. Emerging studies have identified the Hippo signaling pathway is closely related to the occurrence and development of ADPKD. The abnormal activity and expression of the main members of the pathway affect the cilia and cell polarity of renal tubular epithelial cells and induce the formation of renal cysts. The review summarizes the potential mechanism of the Hippo pathway in the pathogenesis of ADPKD, the crosstalk with other signaling pathways, and the variances in different species, and discusses the strategies for the treatment of ADPKD based on the Hippo signaling pathway to provide new strategies for the treatment.