Epigenetic mechanisms play a crucial role in the development and progression of nonalcoholic fatty liver disease （NAFLD）， especially among lean individuals. The research on related epigenetic mechanisms has provided new clues and directions for revealing the underlying causes and treatment strategies of NAFLD. This article introduces the role of epigenetics in the development and progression of NAFLD among lean individuals in recent years， analyzes the latest research advances in the epigenetics of NAFLD in this population， and briefly describes the basic concepts of epigenetics， including DNA methylation， histone modifications， and non-coding RNA regulation. This article also discusses how epigenetic alterations impact the pathogenesis， disease progression， and treatment strategies of NAFLD in lean individuals.

Objective:To design a new jaw-lifting auxiliary tool and explore its effect in painless bronchoscopy.Methods:From January to December 2023, convenience sampling was used to select 160 patients who underwent painless bronchoscopy at the Endoscopy Center of the First Hospital of Jiaxing as subjects. The subjects were divided into an experimental group ( n=80) and a control group ( n=80) using a random number table method. During painless bronchoscopy, the experimental group used a new jaw-lifting auxiliary tool to open the airway, while the control group used traditional manual methods to open the airway. Two groups were compared patient oxygen saturation at different time points, and bronchoscopy passage time through the glottis. Results:The number of cases in which blood oxygen saturation <95% occurred at different time points in the experimental group was lower than that in the control group (all P<0.05). The time for bronchoscopy to pass through the glottis in the experimental group was shorter than that in the control group, and the difference was statistically significant [ (2.86±0.69) s vs. (3.20±0.96) s, P<0.05] . Conclusions:Using a new jaw-lifting auxiliary tool during painless bronchoscopy can reduce the decreased oxygen saturation in patients and shorten the time for bronchoscopy to pass through the glottis. It can be further promoted and applied in clinical practice.

Premature ovarian insufficiency(POI),also known as"ovarian insufficiency",has an incidence of 1％～5％.The incidence has been on the rise in recent years,seriously affecting women's physical and mental health and quality of life.At present,the cause and mechanisms of POI are still unclear,and the method and applications of model construction are also confusing.Most models have some shortcomings in pertinence and stability.The limitations greatly limit research into the clinical diagnosis and treatment of POI.This paper summarizes and discusses the etiology and pathogenesis of POI and the construction of POI animal models to provide a comprehensive reference for those studying POI.

Tracking changes in the number and function of T cells is of great value to clinical diagnosis and evaluation of the efficacy of allergen immunotherapy. This review summarizes research progress in detection methods for allergen-specific T cells and their application, such as carboxyfluorescein succinimidyl ester dilution assay, enzyme-linked immunospot assay, intracellular cytokine staining assay and microarray immunosensors, providing references for selecting and developing appropriate detection methods in clinical practice.

Objective To analyze the clinical characteristics and risk factors of patients with confirmed venous thromboembolism (VTE) in order to improve recognition of VTE, and reduce the rate of missed diagnosis and wrong diagnosis. Methods A retrospectively review was performed for 205 patients diagnosed with VTE confirmed by CT pulmonary angiography (CTPA), radionuclide pulmonary ventilation/perfusion (V/Q) imaging, lower extremity deep vein ultrasound or venography in the First Affiliated Hospital of Bengbu Medical College from January 2009 to December 2018. The clinical manifestations, laboratory examination results, imaging results, treatment and prognosis of patients diagnosed with VTE were analyzed. The clinical possibility was assessed by pulmonary thromboembolism (PTE) simplified Wells score and deep venous thrombosis (DVT) Wells score. 130 non-VTE patients admitted in the same period were enrolled as controls, and the risk factors of VTE were screened by multivariate Logistic regression analysis. Results Among 205 VTE patients, 14 cases had incomplete data, 2 cases were complicated with other diseases deteriorated, 2 cases were excluded because of economic reasons, 10 cases abandoned treatment because of serious illness, and finally 177 cases were included in the analysis. The main clinical symptoms of VTE patients were chest tightness (36.16%), followed by chest pain (29.94%), dyspnea (29.38%) and hemoptysis (24.29%). Swelling or tenderness of unilateral/bilateral lower extremities (38.98%) and lung moist rale (20.90%) were the most common signs. ST-T changes were the main changes in electrocardiogram (ECG, 49.15%), followed by SⅠQⅢTⅢ or QⅢTⅢ changes (35.03%). Only 5.65% of the patients had plasma D-dimer less than 0.5 mg/L. 31.07% (55/177) patients had normal arterial blood gas results. Of the 177 VTE patients, 175 were diagnosed as PTE by CTPA, with bilateral/multi-lobar pulmonary artery embolism and its branches being the main type [44.57% (78/175)]. Two cases were diagnosed as PTE by V/Q imaging. Among them, 112 cases were received lower extremity deep venous ultrasound or lower extremity deep venography, 51 cases were diagnosed as lower extremity DVT, with thrombosis of popliteal and above vein as common [68.63% (35/51)]. The clinical possibility assessment showed that 67.23% (119/177) patients might have PTE (PTE simplified Wells score greater than or equal to 2), 38.98% (69/177) patients might have lower extremity DVT (DVT Wells score greater than or equal to 2). Multivariate Logistic regression analysis showed that operation less than 4 weeks [odds ratio (OR) = 5.503, 95% confidence interval (95%CI) = 1.577-19.206, P = 0.007], trauma or fracture less than 3 months (OR = 6.771, 95%CI = 1.510-30.370, P = 0.012), VTE history (OR = 0.072, 95%CI =0.009-0.549, P = 0.011) were independent risk factors for VTE occurrence. Thrombolytic therapy was administered in 13 cases while anticoagulant therapy alone was prescribed in 164 cases. 176 patients recovered, while 1 case died. Conclusions VTE clinical manifestations are not specific. Patients with risk factors should be vigilant, be strengthen with diagnostic awareness, paid attention to the evaluation of clinical possibilities. Timely thrombolytic or anticoagulant treatment after diagnosis, can improve the survival rate.

Objective To investigate the effects of the multidisciplinary cooperative management intervention model on the self‐management efficacy of patients with ileostomy irritant dermatitis. Methods Among the patients with irritative dermatitis in the ileostomy section of the Anorectal Surgery and Ostomy Clinic of Hwamei Hospital, the Chinese Academy of Sciences, 72 patients, who visited the clinic from August 2016 to August 2018, met the inclusion criteria and were finally included in the study. According to the random number table method, 36 patients each were assigned to the control and observation groups respectively. There were no significant differences in age, sex and education between the two cohorts. The control groups were compared. The control group was treated with routine nursing methods. The observation group underwent multidisciplinary nursing intervention that was based on the routine measures of the control group. The Chinese version of the cancer self‐management efficacy was used as the questionnaire survey that was administered before and after treatment. The results were compared and analyzed between the patient groups. The independent sample t‐test was used to compare the results between the groups, and the paired sample t‐test was used for intra‐group comparisons. Results After intervention, the total scores of self‐management efficacy and positive attitude, self‐decompression and self‐decision scores were higher in the observation group than in the control group (t=4.192, 3.095, 4.123, 2.267, P<0.05). The scores of self‐administration efficacy and each dimension of the two groups were higher than those before intervention, and the difference was statistically significant (P<0.01). After the intervention, 3 patients (10.0%) in the observation group with recurrent dermatitis and 13 patients (43.3%) in the control group. The recurrence rate of the observation group was significantly lower than that of the control group (χ2= 8.357, P<0.05). Conclusion Multidisciplinary cooperative management can improve the self‐management efficacy of patients with irritating dermatitis and reduce the incidence of this condition.

Objective To explore a method for rapidly establishing a mouse model of atopic dermatitis (AD).Methods C57BL/6 mice served as model animals,and were randomly divided into 3 groups:calcipotriol + ovalbumin (OVA) group (n =6) topically treated with calcipotriol and OVA on the mouse ears,calcipotriol group (n =6) topically treated with calcipotriol on the ears,and control group (n =3) topically treated with 75％ alcohol on the ears.The treatment lasted 12 days.Before the model establishment and on day 14,the photos of the mouse ears were taken,and ear thickness was measured;moreover,blood samples were obtained from the mouse caudal vein,and serum levels of total IgE and OVAspecific IgE were detected.On day 14,the skin tissues of mouse auricles were resected and subjected to histopathological examination.Results On day 14,erythematous swelling,dryness and desquamation occurred on the mouse ear skin in the calcipotriol + OVA group and calcipotriol group,and both the two groups showed significantly increased ear thickness compared with those before the model establishment (both P ＜ 0.001).However,there was no significant difference in the ear thickness between the calcipotriol + OVA group (0.355 ± 0.03 mm) and calcipotriol group (0.370 ± 0.05 mm,q =0.674,P =0.231).Histopathological examination of the ear skin showed more obvious epidermal hyperplasia and infiltration of dermal inflammatory cells including eosinophils and mastocytes in the calcipotriol + OVA group compared with the calcipotriol group and control group.Immunohistochemical study revealed that there was no significant difference in the expression of thymic stromal lymphopoietin (TSLP) and interferon (IFN)-γ among the 3 groups (both P ＞ 0.05),while the expression of interleukin (IL)-13 significantly differed among the 3 groups (F =5.159,P =0.032),and was significantly higher in the calcipotriol + OVA group (77.12 ± 5.46) than in the control group (55.49 ± 9.92,q =3.170,P =0.021).On day 14,the calcipotriol + OVA group and calcipotriol group both showed markedly increased total serum IgE levels compared with those before the treatment,and the calcipotriol + OVA group showed a more significant increase (8 278.56 ± 3 297.68 vs.892.64 ± 82.83 μ g/L,t =4.132,P =0.026).Meanwhile,the serum level of OVA-specific IgE was significandy higher in the calcipotriol + OVA group (192.846 ± 15.391 μg/L) than in the calcipotriol group (8.492 ±:3.879 μg/L,q =22.476,P ＜ 0.001) on day 14.Conclusion The mouse model of allergeninduced AD can be rapidly established by topical application of calcipotriol and OVA for 12 consecutive days,which lays a foundation for further study on allergen-related pathogenesis of AD.

Objective To demonstrate the clinical characteristics and prognosis of invasive pulmonary aspergillosis (IPA) in respiratory intensive care unit (ICU), for early diagnosis and treatment. Methods The clinical features, treatment and outcome of 17 patients diagnosed as IPA in RICU from May 2015 to April 2018 were analyzed retrospectively. Results The basic diseases of 17 patients were mostly chronic respiratory diseases (14 cases, while 11 cases were chronic obstructive pulmonary disease). One case was proven by IPA criteria, 13 cases were probable and 3 cases were possible. All patients were treated with broad-spectrum antibiotics during hospitalization, and 6 patients were treated with glucocorticoids (oral/intravenous) within 3 weeks of admission and during hospitalization. The main clinical symptoms included cough sputum, dyspnea and fever, among which 4 cases had hemoptysis. Infiltrates were seen in 8 cases, multiple nodules with cavitary lesions in 4 cases, multiple small nodules along the bronchi in 2 cases, and left upper lobe consolidation in the proven case. Sixteen patients were treated with voriconazole alone or in combination with caspofungin. Fourteen patients were tested for voriconazole serum concentration, while 4 were in normal range, 10 were elevated (2 cases were significantly elevated, ＞10 μg/L). Serum concentration of bilirubin did not increase significantly in all paitents after treatment. Serum concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated in 4 cases with elevated serum concentration of voriconazole and 2 cases with normal serum concentration of voriconazole. Patients with elevated voriconazole concentration did not show significant difference in prognosis compared with those with normal concentration. Eight cases were improved and discharged and 9 gave up and died due to the worsening of the disease. Eight patients received mechanical ventilation (6 cases were invasive and 2 cases were non-invasive), 7 of them eventually gave up treatment and died. Conclusions The clinical features of chronic respiratory diseases with IPA are atypical, however, the patient is critically ill with high mortality. Elevated serum concentration of voriconazole might be more common in severe patients. For those who have a history of systemic application of glucocorticoids, clinical symptoms with hemoptysis, short of breath, radiology with infiltrates, nodular and/or with cavity, and with no response to antibiotics, clinicians should actively seeking evidence of IPA, for early diagnosis, standardized treatment, and improve the prognosis of patients with chronic respiratory diseases complicated with IPA.

Objective To investigate the value of high-resolution magnetic resonance imaging (HR-MRI) for assessing the plaque stability as well as the risk factors for unstable plaque and severe stenosis in patients with symptomatic carotid stenosis.Methods The patients with symptomatic carotid stenosis were enrolled.HR-MRI was use to evaluate carotid plaque compositions and identify the stability of plaques.The carotid plaques from the patients underwent carotid endarterectomy were collected for pathological examination.The consistency of the preoperative HR-MRI and the postoperative pathological findings were compared.The clinical data of all patients were collected and the risk factors for the stability of carotid plaques and the severity of vascular stenosis were analyzed.Resulls A total of 219 patients with symptomatic carotid stenosis (stenosis ＞ 50％) who underwent HR-MRI were enrolled.Among them,102 patients (46.6％) had stable plaques and 117 (53.4％) had unstable plaques;118 (53.9％) had moderate stenosis and 101 (46.1％) had severe stenosis.Thirty-fiwe patients received carotid endarterectomy,HR-MRI showed that the plaque in 19 (54.3％) of them were instable,and pathological examination showed that the plaque in 20 (57.1％) cases were instable,and both were highly consistent (κ =0.942,P ＜ 0.001).The proportions of male (P =0.007),hyperlipidemia (P =0.013),smoking (P ＜0.001),as well as the levels of total cholesterol (P =0.001),low-density lipoprotein cholesterol (P ＜0.01),and fasting blood glucose (P =0.001) in the unstable plaque group were significantly higher than those in stable plaque group.Multivariate logistic regression analysis showed that male (odds ratio [OR] 2.33,95％ confidence interval [CI] 1.08-5.04;P=0.032),smoking (OR 3.45,95％ CI 1.67-7.14;P=0.001),and higher fasting blood glucose level (OR 1.26,95％ CI 1.07-1.48;P =0.006) were the independent risk factors for unstabke plaque.All the data did not show any significant difference between the moderate stenosis group and the severe stenosis group.Conclusions HR-MRI accurately assessed the plaque stability in patients with symptomatic carotid stenosis.Sex,smoking,and fasting blood glucose level were the independent risk factors for carotid artery unstable plaque.

Objective: To analyze the clinical characteristics and diagnosis of multisystemic smooth muscle dysfunction syndrome(MSMDS). Method: Clinical data of a case diagnosed as MSMDS and hospitalized in our hospital in July 2016 was retrospectively analyzed. Literature search was performed at databases of PubMed, Wanfang, China National Knowledge Infrastructure and VIP with the key words "multisystemic smooth muscle dysfunction syndrome" "ACTA2" . The literature retrieval was confined from January 1980 to November 2016.The characteristics of MSMDS were summarized through review of literature. Result: A girl aged 1.6 years had recurrent cough and wheeze for more than 1 year, complicated with congenital fixed dilated pupils, patent ductus arteriosus, pulmonary hypertension, chronic lung disease, and cerebrovascular abnormalities. We had done gene analysis for the patient and found ACTA2 c. 536C>T(p.R179H) heterozygous mutations, but her parents were normal. Totally 11 reports were retrieved from foreign language literature and no report from Chinese literature could be found; the retrieved articles reported a total of 25 cases of multiple system smooth muscle dysfunction syndrome. The minimum age was 11 months, 17 cases were female, 8 were male. The clinical common characteristic is congenital fixed dilated pupils, patent ductus arteriosus, cerebrovascular disease, pulmonary hypertension, chronic lung disease, and so on. Conclusion Genetic testing for ACTA2 gene mutations should be considered in infants presenting with congenital fixed dilated pupils and patent ductus arteriosus.