ObjectiveTo investigate the incidence rate of primary liver cancer （PLC） and the progression of liver fibrosis in chronic hepatitis B （CHB） patients with low-level viremia （LLV） （HBV DNA<2 000 IU/mL but ≥20 IU/mL） after treatment adjustment， and to provide more robust evidence for clinical practice. MethodsA retrospective analysis was performed for the clinical data of LLV patients who initially received nucleos（t）ide analogue （NAs） for at least 48 weeks at the Fifth Medical Center of PLA General Hospital from August 2007 to April 2017 and subsequently underwent NAs adjustment due to LLV， and according to the virologic response after 48 weeks of treatment adjustment， the patients were divided into LLV group and complete virological response （CVR） group （HBV DNA<20 IU/mL）. The patients were followed up once every 3‍ ‍—‍ ‍6 months till the primary endpoint event of PLC or October 2024. The incidence rate of PLC and the progression of liver fibrosis were observed， and the progression of liver fibrosis was defined as an increase of ≥1 grade in fibrosis-4 （FIB-4） index. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups； the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative incidence rate of PLC， and the Log-rank test was used for comparison between groups； the Cox regression analysis was used to investigate the risk factors for PLC， and the Logistic regression analysis was used to investigate the influencing factors for the progression of liver fibrosis. ResultsA total of 307 patients were enrolled， with a mean age of 50.0 years， and the male patients accounted for 80.5%. After 48 weeks of treatment with the adjusted NAs regimen， 254 patients （82.7%） achieved CVR， and 53 patients （17.3%） still had LLV. For the LLV group， the incidence rate of PLC was 30.2% and the rate of liver fibrosis progression was 22.6%， while for the CVR group， the incidence rate of PLC was only 13.4%， and the rate of liver fibrosis progression was 7.5%. The multivariate regression analyses showed that LLV was an independent risk factor for the onset of PLC （hazard ratio=2.623， 95% confidence interval ［CI］： 1.315‍ ‍—‍ ‍5.234， P=0.006） and the progression of liver fibrosis （odds ratio=3.213， 95%CI： 1.385‍ ‍—‍ ‍7.455， P=0.007）. ConclusionActive adjustment of treatment is needed immediately after the diagnosis of LLV to improve CVR， and if LLV persists after treatment adjustment， it is necessary to enhance the monitoring of liver fibrosis progression and PLC， so as to facilitate early diagnosis and treatment.

Objective:s To investigate the risk factors for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in patients with acute carbon monoxide poisoning (ACOP) and to develop predictive models based on machine learning algorithms.Methods:Patients with ACOP hospitalized at the First Affiliated Hospital of Zhengzhou University from August 2019 to October 2024 were included, with the occurrence of DEACMP as the outcome measure. The dataset was randomly divided into training and validation sets at a ratio of 7:3. Lasso regression was used to select features influencing the outcome in training sets. Nine machine learning models—including Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Support Vector Machine (SVM)—were constructed. Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) calculated for each model. Calibration curves were used to assess accuracy, and decision curve analysis (DCA) was applied to evaluate clinical utility. The SHapley Additive exPlanations (SHAP) method was employed to visualize and interpret the best-performing model.Results:A total of 264 ACOP patients were included, of whom 54 (20.5%) developed DEACMP. Lasso regression identified eight key feature variables. Based on these factors, predictive models were constructed, showing good AUC stability across the nine machine learning models in both training (0.92–0.99) and validation sets (0.85–0.91). The RF model performed best, with an AUC of 0.99 in the training set and 0.90 in the validation set; its calibration curve and DCA curve also demonstrated excellent performance. SHAP analysis of the RF model revealed the importance ranking of factors from highest to lowest as follows: Glasgow Coma Scale (GCS) score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, diastolic blood pressure (DBP), and drinking history.Conclusions:The RF model exhibited the highest predictive performance for DEACMP occurrence in ACOP patients. The influencing factors, ranked in order of importance from highest to lowest, are as follows: GCS score, duration of coma, age, history of coronary heart disease, CK-MB level, monocyte count, DBP, and drinking history.

Objective To describe and evaluate the clinical studies of postoperative pain sensitization caused by sleep deprivation through the evidence map system,understand the distribution of evidence in this field,and provide reference for subsequent evidence research.Methods A computer-based search of PubMed,EMBASE,Cochrane library,Web of Science,CNKI,Wanfang Data,VIP and Chinese Biomedical Literature Database from inception to August 2023 was conducted to obtain intervent ion studies,observational studies and systematic reviews/Meta-analysis of postoperative pain sensitization caused by sleep deprivation.The research characteristics and methodological quality were analyzed and evaluated.The Cochrane Handbook for Systematic Reviews,the Newcastle-Ottawa Scale(NOS)and the AMSTAR-2 scale were used to evaluate the quality of the included studies,and the evidence was comprehensively analyzed and displayed by means of bubble chart,table and text.Results A total of 35 observational studies(31 cohort studies and 4 case-control studies),15 randomized controlled trials and 4 systematic reviews/Meta-analyses were included.The number of publications increased rapidly after 2018 and peaked in 2022,and clinical studies in this field mainly fo-cused on cohort studies,with fewer randomized controlled trials and systematic reviews/Meta-analysis studies.The results of the evidence map showed that in terms of quality,22 studies were'high quality',24 studies were'medium quality',and 8 studies were'low quality'.Thirty studies showed that sleep deprivation could induce postoperative pain sensitization.Only 2 studies suggested that sleep disorders were not significantly asso-ciated with postoperative pain sensitization,and ten studies were uncertain whether sleep deprivation could in-duce postoperative pain sensitization.Conclusions Overall evidence shows that sleep deprivation can induce postoperative pain sensitization,but the evaluation dimensions are limited and the methodological quality of the included literature needs to be improved.More high-quality,large-sample and standardized clinical studies should be carried out in the future to provide better scientific basis for clinical work.

BACKGROUND: The main cause of restenosis after percutaneous transluminal angioplasty (PTA) is the excessive proliferation and migration of vascular smooth muscle cells (VSMCs). Lin28a has been reported to play critical regulatory roles in this process. However, whether CCAAT/enhancer-binding proteins β (C/EBPβ) binds to the Lin28a promoter and drives the progression of restenosis has not been clarified. Therefore, in the present study, we aim to clarify the role of C/EBPβ-Lin28a axis in restenosis. METHODS: Restenosis and atherosclerosis rat models of type 2 diabetes ( n   =  20, for each group) were established by subjecting to PTA. Subsequently, the difference in DNA methylation status and expression of C/EBPβ between the two groups were assessed. EdU, Transwell, and rescue assays were performed to assess the effect of C/EBPβ on the proliferation and migration of VSMCs. DNA methylation status was further assessed using Methyltarget sequencing. The interaction between Lin28a and ten-eleven translocation 1 (TET1) was analysed using co-immunoprecipitation (Co-IP) assay. Student's t -test and one-way analysis of variance were used for statistical analysis. RESULTS: C/EBPβ expression was upregulated and accompanied by hypomethylation of its promoter in restenosis when compared with atherosclerosis. In vitroC/EBPβ overexpression facilitated the proliferation and migration of VSMCs and was associated with increased Lin28a expression. Conversely, C/EBPβ knockdown resulted in the opposite effects. Chromatin immunoprecipitation assays further demonstrated that C/EBPβ could directly bind to Lin28a promoter. Increased C/EBPβ expression and enhanced proliferation and migration of VSMCs were observed after decitabine treatment. Further, mechanical stretch promoted C/EBPβ and Lin28a expression accompanied by C/EBPβ hypomethylation. Additionally, Lin28a overexpression reduced C/EBPβ methylation via recruiting TET1 and enhanced C/EBPβ-mediated proliferation and migration of VSMCs. The opposite was noted in Lin28a knockdown cells. CONCLUSION Our findings suggest that the C/EBPβ-Lin28a axis is a driver of restenosis progression, and presents a promising therapeutic target for restenosis.
Animals ; Cell Proliferation/genetics* ; Cell Movement/genetics* ; Muscle, Smooth, Vascular/metabolism* ; Rats ; DNA Methylation/physiology* ; CCAAT-Enhancer-Binding Protein-beta/genetics* ; Male ; Myocytes, Smooth Muscle/cytology* ; Rats, Sprague-Dawley ; RNA-Binding Proteins/genetics* ; Cells, Cultured ; Coronary Restenosis/metabolism*

Objective To screen and analyze 23 mutation sites of deafness susceptibility genes in newborns in Shenzhen using microfluidic chip technology,aiming to enhance the efficiency and accuracy of early diagnosis of congenital deafness.Methods A total of 10 561 newborns delivered in 19 hospitals in Shenzhen between November 2021 and January 2023 were selected.Heel blood samples were collected from them,and 23 key mutation sites within four core deafness susceptible genes(GJB2,SLC26A4,12S rRNA and GJB3)were detected using microfluidic chip technology.Results The results revealed that 21.87%(2 310/10 561)of the newborns carried at least one mutation in deafness susceptibility genes,with the mutation carrier rate of the GJB2 gene reaching as high as 20.42%(2 157/10 561),57 newborns were found to has compound heterozygous mutations.To further verify the accuracy of the screening results,1 203 newborns out of the 2 310 initially screened as deafness gene carriers were recalled for Sanger sequencing,the gold standard,for verification.The verification results were fully consistent with the initial screening results.Conclusion The method combining microfluidic chip technology with Sanger sequence verification significantly improves the detection efficiency and accuracy of neonatal deafness genes,providing scientific evidence and practical guidance for implementing the three-level prevention strategy for congenital deafness.

Objective:To investigate the value of carotid，radial and podalic artery intima thickness（CIT，RIT，PIT）combined with monocyte to high-density lipoprotein ratio（MHR）in predicting the severity of coronary artery stenosis in patients with premature coronary artery disease（PCAD）.Methods:A total of 80 patients with PCAD who received treatment in Henan Provincial People's Hospital from October 2023 to May 2024 were prospectively recruited，and they were divided into high group（≥41 score，40 cases）and low group（＜41 score，40 cases）according to the median dichotomy of Gensini score. Thirty-four gender，age and body mass index（BMI）-matched healthy volunteers were selected as the control group. The CIT，RIT，PIT，media and intima media thickness of carotid，radial artery and podalic artery（CMT，RMT，PMT，CIMT，RIMT，PIMT）were measured using 24 MHz ultra-high frequency ultrasound probe，and the ratio of intima to media thickness（CIT/CMT，RIT/RMT，PIT/PMT）was calculated. The differences of general clinical data，laboratory indexes and ultrasonic parameters among the three groups were compared. Risk factors affecting the severity of coronary stenosis in PCAD patients were explored by binary logistic regression. Subject working characteristic curves were plotted，area under the curve（AUC）was calculated，and the values of each ultrasound parameter and MHR in the independent and combined diagnosis of the severity of coronary artery stenosis in PCAD patients were evaluated.Results:①There were no statistically significant differences in age，gender，BMI，total cholesterol，CMT，RMT and PMT among the three groups（all P＞0.05）. There were no statistically significant differences in the comparison of smoking，hypertension，diabetes mellitus，systolic blood pressure，diastolic blood pressure，low-density lipoprotein cholesterol，total cholesterol，and triglycerides between the two subgroups of the PCAD（all P>0.05）. ②CIT，CIMT，CIT/CMT，RIT，RIMT，RIT/RMT，PIT，PIMT，PIT/PMT were thickened in the high group compared with the low group，and MHR was higher than in the low group（all P<0.05），the differences in the above parameters remained statistically significant when comparing the PCAD group with the control group（all P<0.05）. ③The AUC values for MHR，CIT，RIT and PIT alone to predict the severity of coronary stenosis in patients with PCAD were 0.781，0.767，0.780 and 0.722，respectively. The combined diagnostic efficiency of the four parameters was better than the independent diagnostic efficiency（AUC = 0.885）. Conclusions:CIT，RIT and PIT are thicker in PCAD patients with high Gensini score and the combination of artery intima thickness and MHR has good efficacy in predicting the severity of coronary artery stenosis in PCAD patients.

Objective:To evaluate the changes of carotid intima thickness（CIT）and stiffness parameters in ankylosing spondylitis（AS）patients by 24 MHz ultra-high frequency ultrasound probe and RF-data based quantitative analysis on vessel stiffness（R-VQS），and to explore its influencing factors.Methods:Sixty patients with AS who underwent consultation at Henan Provincial People's Hospital from November 2023 to May 2024 were prospectively collected as AS group，54 healthy volunteers matched for sex，age，and body mass index were collected as control group. CIT were measured using a 24 MHz ultra-high frequency ultrasound probe，hardness coefficien（HC）and pulse wave velocity（PWV）were measured by R-VQS，the differences of the parameters between the two groups were compared. The changes of carotid artery elasticity and intima thickness and their influencing factors in patients with AS were explored by univariate and multivariate linear regression analysis.Results:①C-reactiveprotein，erythrocyte sedimentation rate（ESR），neutrophil count and neutrophil to lymphocyte ratio（NLR）were elevated in the AS group compared with the control group，and the differences were statistically significant（all P < 0.05）. ②CIT，carotid intima-media thickness（CIMT），HC，PWV and epicardial adipose tissue thickness（EATT）were all increased in the AS group compared with the control group，and the differences were statistically significant（all P < 0.05）. ③Multifactorial linear regression analysis showed that EATT，ESR were the main influencing factors of HC，PWV and CIT（ β=2.192，0.031；1.792，0.002；0.097，0.001；all P＜0.05）. Conclusions:Carotid CIT，CIMT，HC，PWV and EATT are all higher in the AS patients，and ESR and EATT are the main influencing factors of HC，PWV，and CIT，suggesting that more attention should be paid to the detection of ESR and EATT in patients with AS when interventions are performed clinically.

Objective To explore the efficacy,safety,and technical advantages of laparoscopic combined with calyceal lithotomy in the simultaneous treatment of parapelvic cyst with renal calculi.Methods The clinical data of two patients diagnosed with parapelvic cyst and renal calculi in our hospital were retrospectively analyzed.Both patients received transabdominal laparoscopic excision of parapelvic cyst and calyceal lithotomy under general anesthesia.Preoperative CT plus intravenous pyelography(IVP)was performed to localize the calculi within the renal calyx.During operation,the cyst wall was dissected and exposed using an ultrasonic scalpel,followed by incision of the cyst wall,aspiration of cystic fluid,and excision of redundant cyst wall.Methylene blue was instilled through the ureteral catheter to mark the renal pelvis and calyces,followed by incision of the target calyx and extraction of the calculi.The changes of the cysts and calculi were analyzed.Operation time and complications were recorded.Results Both patients were admitted due to recurrent right flank pain as the chief complaint and were diagnosed with right renal multiple calculi complicated with hydronephrosis and parapelvic cysts through preoperative imaging examinations.The parapelvic cyst measured approximately 6.4 cm ×5.3 cm and 4.5 cm × 4.1 cm,respectively.The operations were successfully completed without major complications such as hemorrhage or infection.The operation time was 180 and 125 minutes,respectively.Postoperative ultrasound and abdominal plain film confirmed complete resolution of cysts and calculi.During the 2-year follow-up,both patients experienced complete resolution of flank pain with no recurrence of cysts or calculi.Conclusion Transabdominal laparoscopic combined with calyceal lithotomy is a safe and feasible technique for synchronous treatment of parapelvic cysts with renal calculi,offering advantages such as minimal trauma,rapid postoperative recovery,and low recurrence rates.This procedure should be performed in patients with parapelvic cysts larger than 4 cm.Intraoperative ureteral catheterization with methylene blue infusion is utilized to delineate the renal pelvis and calyces,which is combined with preoperative imaging findings to assist in precise stone localization.

Objective:To investigate the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage in Chinese population from childhood to middle age.Methods:This study is a population-based, long-term follow-up cohort study. Participants who had their blood pressure measured at least 5 times in the Hanzhong Adolescent hypertension cohort from 1987 to 2023 were included in this study. Group-based trajectory modeling was used to identify different systolic and diastolic blood pressure trajectories, and the subjects were divided into low-increasing group, moderate-increasing group and high-increasing group according to blood pressure trajectories. Blood pressure variability was assessed using standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). Target organ damage was evaluated during the final follow-up in 2023 (middle age). Logistic regression models were used to analyze the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage.Results:A total of 2 447 subjects were included, with a median age of 48 years, of whom 1 373 were male (56.1%). Based on systolic blood pressure, 868 were in the low-increasing group, 1 238 in the moderate-increasing group, and 341 in the high-increasing group. For diastolic blood pressure, the distribution was 894, 1 263 and 290, respectively. Compared with the low-increasing group of systolic blood pressure, the moderate-increasing group (arteriosclerosis: OR=4.14, 95% CI 2.96-5.79; proteinuria: OR=2.06, 95% CI 1.38-3.07; left ventricular hypertrophy: OR=1.68, 95% CI 1.00-2.82) and high-increasing group (arterial stiffness: OR=15.44, 95% CI 10.14-23.50; proteinuria: OR=5.80, 95% CI 3.63-9.29; left ventricular hypertrophy: OR=2.93, 95% CI 1.55-5.53) had a higher risk of target organ damage (all P<0.005). The moderate-increasing group of diastolic blood pressure had a higher incidence of arterial stiffness ( OR=3.72, 95% CI 2.69-5.12) and proteinuria ( OR=1.67, 95% CI 1.15-2.42) than the low-increasing group (all P<0.005), while the high-increasing group had a significantly higher risk of all type of target organ damage compared to the low-increasing group (arterial stiffness: OR=10.84, 95% CI 7.08-16.61; proteinuria: OR=3.72, 95% CI 2.31-5.99; left ventricular hypertrophy: OR=2.38, 95% CI 1.23-4.59; all P<0.005). Additionally, higher systolic blood pressure variability was associated with an increased incidence of arterial stiffness (SD: OR=2.25, 95% CI 1.96-2.57; VIM: OR=1.64, 95% CI 1.45-1.86; ARV: OR=1.70, 95% CI 1.50-1.93) and proteinuria (SD: OR=1.65, 95% CI 1.44-1.89; VIM: OR=1.41, 95% CI 1.22-1.63; ARV: OR=1.45, 95% CI 1.26-1.67; all P<0.005). The results for diastolic blood pressure variability indicators were similar to those for systolic blood pressure. Conclusion:Early-life blood pressure trajectories are predictive of target organ damage risk in middle age. Higher blood pressure variability is related to an increased risk of arterial stiffness and proteinuria, but was less associated with left ventricular hypertrophy. Focusing on the risk of high blood pressure early in life can help prevent the occurrence of target organ damage in middle age.