Kleine-Levin syndrome (KLS) is a rare, recurrent-remitting sleep disorder characterized by periodic hypersomnia, hyperphagia, and hypersexuality, accompanied by cognitive dysfunction, perceptual disturbances, mood changes, or psychiatric abnormalities. Patients typically experience recurrent episodes, with hypersomnic periods lasting from several days to weeks. Most KLS patients exhibit normal functions during the intermission period, while early-onset KLS cases in adolescents are rare, often presenting with frequent episodes and complex symptoms, which can easily lead to misdiagnosis. Therefore, this case report analyzed the detailed medical history, laboratory findings, differential diagnosis, and treatment of a teenage patient with KLS, along with a review of the literature. This case aims to provide a deeper understanding of the complex symptoms and diagnostic challenges associated with early-onset KLS in adolescents.

Kleine-Levin syndrome (KLS) is a rare, recurrent-remitting sleep disorder characterized by periodic hypersomnia, hyperphagia, and hypersexuality, accompanied by cognitive dysfunction, perceptual disturbances, mood changes, or psychiatric abnormalities. Patients typically experience recurrent episodes, with hypersomnic periods lasting from several days to weeks. Most KLS patients exhibit normal functions during the intermission period, while early-onset KLS cases in adolescents are rare, often presenting with frequent episodes and complex symptoms, which can easily lead to misdiagnosis. Therefore, this case report analyzed the detailed medical history, laboratory findings, differential diagnosis, and treatment of a teenage patient with KLS, along with a review of the literature. This case aims to provide a deeper understanding of the complex symptoms and diagnostic challenges associated with early-onset KLS in adolescents.

Objective:To investigate the response of mandibular condylar chondroprogenitors to flow fluid shear stress(FFSS).Methods:Chondroprogenitors were in vitro cultured and stimulated with FFSS that can cause cell degeneration,and treated with sec-ond-generation high-throughput RNA sequencing.Differential gene expression was screened using DESeq2 software for gene ontology(GO)functional enrichment analysis,kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis and protein-protein interaction(PPI)network analysis.qRT-PCR was performed to validate the core genes screened by PPI.Results:A total of 1996 differentially expressed genes were obtained,mainly including inflammatory response and cell cycle related molecules.Among them,Actal,Atf3,Ccl2,116,Nfkbia,Ret and Vcaml were identified as the core genes.Conclusion:FFSS stimulation affects chondroprogenitor function by acting on inflammatory responses and cell cycle-related signaling pathways in chondroprogenitors.

Objective:To investigate the diagnosis, treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations (CCM).Methods:The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad.Results:A total of 10 flying personnel, all male, 20-41 years old, with an average age of 28.3 years, including 8 pilots, 2 air combat/technical personnel, with the flying hours of 110-4 000 h and the average flying hours of 1 102.0 h. The sizes of lesions were 3-12 mm, including 2 cases were smaller than 5 mm, 6 cases were 5-10 mm and 2 cases were bigger than 10 mm. All lesions were located under the cortex, including a case of occipital lobe, 4 cases of frontal lobe, 2 cases of temporal lobe and 3 cases of cerebellar hemisphere. Among the 10 flying personnel, only a case presented intracranial haemorrhage (right cerebellar hemisphere) as first symptom and was treated surgically. Three cases were temporarily grounded due to they were under the grounding observation. Other 7 flying personnel had been followed up for more than 6 months. Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities. Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot, and 2 dual-seat fighter pilots were qualified (limited to dual-seat fighter) and flight-qualified respectively. Two fighter pilots were qualified for lower performance aircraft (limited to bomber, transporter or helicopter).Conclusions:For CCM military flying personnel, the aeromedical assessment conclusion should be made according to the symptoms, lesion location and size, inflight incapacitation possibility assessment, treatment effect, ground observation and follow-up results, as well as the aircraft type and occupation.

Objective:To investigate the diagnosis, treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations (CCM).Methods:The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad.Results:A total of 10 flying personnel, all male, 20-41 years old, with an average age of 28.3 years, including 8 pilots, 2 air combat/technical personnel, with the flying hours of 110-4 000 h and the average flying hours of 1 102.0 h. The sizes of lesions were 3-12 mm, including 2 cases were smaller than 5 mm, 6 cases were 5-10 mm and 2 cases were bigger than 10 mm. All lesions were located under the cortex, including a case of occipital lobe, 4 cases of frontal lobe, 2 cases of temporal lobe and 3 cases of cerebellar hemisphere. Among the 10 flying personnel, only a case presented intracranial haemorrhage (right cerebellar hemisphere) as first symptom and was treated surgically. Three cases were temporarily grounded due to they were under the grounding observation. Other 7 flying personnel had been followed up for more than 6 months. Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities. Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot, and 2 dual-seat fighter pilots were qualified (limited to dual-seat fighter) and flight-qualified respectively. Two fighter pilots were qualified for lower performance aircraft (limited to bomber, transporter or helicopter).Conclusions:For CCM military flying personnel, the aeromedical assessment conclusion should be made according to the symptoms, lesion location and size, inflight incapacitation possibility assessment, treatment effect, ground observation and follow-up results, as well as the aircraft type and occupation.

Objective:To explore feasible aeromedical evaluation methods and principles of obstructive sleep apnea (OSA) for Air Force by analyzing the diagnosis, treatment and assessment of cases of the military flying personnel at home and abroad.Literature resource and selection:Based on the journal papers and scientific reports published at home and abroad, we analyzed the evaluation methods and management of sleep disorders in United States Air Force (USAF) and the current situation of Chinese military flying personnel.Literature quotation:Forty-four related literatures, including 37 published articles, 2 medical standards, 3 monographs, 1 scientific report, 1 electric announcement, were cited.Literature synthesis:OSA related flight safety risk that induced by daytime sleepiness, cognitive impairment and emotional abnormalities is the importance of Aviation medicine concern. USAF’s diagnosis of OSA follows the criteria recommended by the American Academy of Sleep Medicine and is carried out by accredited professional sleep lab. Its treatment is conducted in conjunction with military deployment. The well-treated aircrew could be waivered but the special assessment and close follow-up of the treatment compliance are required. There are corresponding requirements in the medical selection of high-performance fighter pilots and armed helicopter pilots in China, but no provisions in physical standards for flying personnel. Inconsistencies exist among clinical diagnosis, treatment and medical assessment.Conclusions:It is necessary to formulate relevant physical examination standards of OSA for military flying personnel, improve the awareness of support departments at all levels, supplement OSA screening in regular physical examination, and assign accredited sleep health centers to undertake the diagnosis, treatment and medical assessment of OSA. Waiver could be considered to the flying personnel with good treatment compliance.

Objective:To explore feasible aeromedical evaluation methods and principles of obstructive sleep apnea (OSA) for Air Force by analyzing the diagnosis, treatment and assessment of cases of the military flying personnel at home and abroad.Literature resource and selection:Based on the journal papers and scientific reports published at home and abroad, we analyzed the evaluation methods and management of sleep disorders in United States Air Force (USAF) and the current situation of Chinese military flying personnel.Literature quotation:Forty-four related literatures, including 37 published articles, 2 medical standards, 3 monographs, 1 scientific report, 1 electric announcement, were cited.Literature synthesis:OSA related flight safety risk that induced by daytime sleepiness, cognitive impairment and emotional abnormalities is the importance of Aviation medicine concern. USAF’s diagnosis of OSA follows the criteria recommended by the American Academy of Sleep Medicine and is carried out by accredited professional sleep lab. Its treatment is conducted in conjunction with military deployment. The well-treated aircrew could be waivered but the special assessment and close follow-up of the treatment compliance are required. There are corresponding requirements in the medical selection of high-performance fighter pilots and armed helicopter pilots in China, but no provisions in physical standards for flying personnel. Inconsistencies exist among clinical diagnosis, treatment and medical assessment.Conclusions:It is necessary to formulate relevant physical examination standards of OSA for military flying personnel, improve the awareness of support departments at all levels, supplement OSA screening in regular physical examination, and assign accredited sleep health centers to undertake the diagnosis, treatment and medical assessment of OSA. Waiver could be considered to the flying personnel with good treatment compliance.

Objective To compare the effects of ticagrelor and clopidogrel on platelet aggregation rate, myocardial perfusion and prognosis in patients with acute myocardial infarction. Methods One hundred and sixty-nine patients with acute ST segment elevation myocardial infarction (STEMI) and emergency percutaneous coronary intervention (PCI) were recruited and randomly divided into ticagrelor group (85 cases) and clopidogrel group (84 cases). The TIMI blood flow before and after PCI was recorded, and the ST segment fall rate of 1 h ECG after PCI was calculated. The platelet aggregation rate was measured. After 12 months' follow-up, the incidence of major adverse cardiac events (MACE) was recorded. The Logistic regression analysis was used to discover the factors of MACE. Results One hundred and sixty-nine patients with acute STEMI were recruited including 85 cases treated with ticagrelor and 84 cases in clopidogrel group. The ECG ST segment fall rate after PCI in ticagrelor group was significantly higher than that in clopidogrel group: (61.3 ± 30.7)％ vs. (47.8 ± 26.6)％, P<0.05. The platelet aggregation rate 2 h, 24 h and 7 d after PCI in ticagrelor group was significantly lower than that in clopidogrel group (P<0.05). MACE occurred in 19 cases (22.4％) in ticagrelor group and in 21 cases (25.0％) in clopidogrel group, and there was no significant difference (P > 0.05). Multiple Logistic regression analysis revealed that age and ECG ST segment fall rate were independent risk factors for MACE (P<0.05). Conclusions Compared with clopidogrel, ticagrelor can effectively reduce platelet aggregation rate and accelerate ST segment fall in STEMI patients, but their long-term prognosis is similar.

Objective To investigate the predictive value of serum adiponectin level on morbidity of acute myocardial infarction, and to evaluate its impact on prognosis in patients with acute myocardial infarction after percutaneous coronary intervention (PCI). Methods We prospectively recruited patients with acute ST segment elevation myocardial infarction (STEMI) who had underwent primary PCI. Their serum adiponectin levels were measured. The TIMI blood flow classification of culprit vessel was recorded after PCI. Echocardiography was performed in 24 h after PCI to evaluate left ventricular ejection fraction (LVEF). Major adverse cardiac events (MACE) were recorded including cardiac death, recurrent nonfatal myocardial infarction, target vessel reascularization, and readmission for heart failure after 18 months′ followed-up. Results 108 consecutive patients with STEMI and 38 control patients without coronary artery stenosis were recruited. The serum adiponectin level in STEMI group was significantly lower than that in control: (1 413.9 ± 218.8) ng/L vs.(1 756.3 ± 205.5) ng/L (P<0.01). STEMI patients with LVEF < 50% had lower serum adiponectin level compared with LVEF ≥50%: (1 334.1 ± 226.3) ng/L vs. (1 453.0 ± 213.8) ng/L , P<0.01. The serum adiponectin level in the TIMI 0-2 group after PCI was significantly lower than that in the TIMI 3 group:(1 350.7 ± 214.9) ng/L vs. (1 430.6 ± 218.5) ng/L, P < 0.01. Multiple logistic regression analysis revealed that lower serum adiponectin level was an independent predictor of STEMI ( OR=0.992, 95% CI 0.987-0.996, P<0.01). MACE occurred in 22 patients (20.4% ). Cox regression analysis revealed that lower serum adiponectin level remained an independent predictor of MACE ( OR=0.996, 95% CI 0.993-0.999, P < 0.01). Conclusions Lower serum adiponectin level is significantly associated with morbidity of STEMI and adverse prognosis in patients with acute myocardial infarction.

Objective To explore the prognostic value of ventricular wall motion score (WMS) and left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction (AMI) combined with heart failure (HF) in the recent 12 months Methods We selected hospitalized AMI patients in our department from Jan. 2014 to Nov. 2014. Cardiac ultrasound was performed to detect WMS and LVEF within 48 hours and during the 6?month follow?up period and the occurrence of HF was recorded. Results Totally 127 AMI patients were recruited, including 20 cases combined with HF. The WMS was higher in HF group than those in non?HF group (23.55 ± 3.73 vs 20.11 ± 3.13, P<0.01), while the LVEF in HF group was lower than those in non?HF group (48.77 ± 8.08 vs 56.99 ± 5.17, P<0.01). Multiple logistic regression analysis revealed that WMS and LVEF were both independent predictors of HF in the recent 12 months (P < 0.05). The prediction effect of WMS ROC curve area was 0.81 (P < 0.01) , and LVEF 0.76 (P < 0.05). WMS and LVEF combined assessment area under ROC curve was 0.82 (P < 0.01). Conclusion WMS and LVEF are independent predictors of HF in patients with AMI in the recent 12 months and the combined application of WMS and LVEF can significantly improve the prediction effect.