Objective:To study the effects of hypoxia on the autophagy level in the spleen of mice with OSAHS.Methods:Mouse OSAHS hypoxia model was established in 24 C57BL/6 mice and the mice were divided into 3 groups:normoxic group,hypoxic group and resveratrol group(n=8).Real time PCR,Western blot and immunohistochemical staining(IHC)were used to detect the mRNA and protein expression of autophagy related proteins microtube associated protein 1 light chain 3 B(LC3B),myosin-like BCL2 inteacting protein(Beclin1)and autophagy related gene 5(ATG5)in mouse spleen respectively.Results:The mRNA expres-sion of LC3B,Beclin1,and ATG5 in the hypoxic group was lower than that in the normoxic group(P＜0.01,P＜0.01,P＜0.001),resveratrol upregulated the expression levels of LC3B and ATG5 mRNA in the hypoxic group(P＜0.05,P＜0.001),but did not up-regulate the expression of Beclin1(P＞0.05).The protein expression levels of LC3B,Beclin1 and ATG5 in the hypoxic group were lower than that in the normoxic group(P＜0.05,P＜0.05,P＜0.01).Resveratrol upregulated the expression levels of LC3B and ATG5 in the hypoxic group(P＜0.05,P＜0.01),but did not upregulated the expression of Beclin1(P＞0.05).IHC test showed that the expression level of LC3B,Beclin1 and ATG5 in the hypoxic group was lower than that in the normoxic group(P＜0.01,P＜0.01,P＜0.001).Resveratrol increased the expression level of LC3B and ATG5 in the hypoxic group(P＜0.05,P＜0.01),but did not upregulate the expression of Beclin1(P＞0.05).Conclusion:Hypoxia may inhibite the autophagy level of spleen in mice.Resvera-trol derivatives increases the autophagy level of mice under hypoxia condition,but has no significant effect on Beclin1 expression.

Objective To identify the key points of forensic appraisal in ophthalmic medical-injury compensation cases and propose targeted measures to prevent disputes.Methods A retrospective analysis was conducted of the appraisal conclusions from 15 ophthalmology medical-injury liability lawsuits handled at a single tertiary hospital over the past five years.We summarized the constitutive characteristics of liability cases,causes of medical injury,and issues encountered during appraisal.Results Among cases undergoing medical-injury liability appraisal,retinal diseases and ocular tumors predominated.The main issues included inadequate informed consent,failure to exercise due care during surgery/treatment,non-standard medical record documentation,insufficient attention to medical risks,and inadequate clinical assessment.Conclusions By summarizing common faults in ophthalmic disputes and problems revealed by forensic appraisal,targeted responses can be implemented to ensure patient safety and promote high-quality medical services.

Objective:To summarize the experience of repairing partial areolar necrosis following reduction mammaplasty.Methods:A retrospective analysis was conducted on clinical data from patients who experienced partial areola necrosis after reduction mammaplasty. These patients were treated or consulted at the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, between January 2017 and February 2023. Preoperatively, daily dressing changes were performed on the necrotic areola wounds until the boundaries of necrosis were clearly defined. Debridement and repair were then carried out by resecting bilateral breast glandular tissue through the original incision to reduce breast volume, followed by narrowing the areola radius. If no areola defect remained after narrowing, direct suturing was performed; if defects persisted, the resected normal areola skin was used for grafting. Postoperative follow-up was conducted to observe areola recovery and complications. At the 6-month postoperative mark, patient satisfaction was evaluated using a 5-level scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied). An experienced plastic physician, not involved in the surgery, assessed areolar outcomes based on four criteria: color, softness, shape, and scarring, with each criterion scored from 1 to 4 (higher scores indicating better outcomes).Results:Eight female patients (9 necrotic areolas) were included in the study, with a mean age of (31.8±5.4) years and a mean body mass index of (24.1±1.8) kg/m 2. Among the 9 necrotic areolas, 3 had defect areas greater than 50% of the total areola area, while 6 had defects less than 50%. Direct suturing after areola narrowing was performed in 3 areolas, while free areola skin grafting was used in 6 areolas. Postoperatively, 2 cases exhibited mild epidermal erosion at the graft site, which improved with dressing changes. No complications such as infection, bleeding, hematoma, or seroma occurred. At the 6-month follow-up, all 8 patients demonstrated good wound healing, and all 9 areolas survived. The areolas exhibited consistent shape and color bilaterally, without significant pigmentation changes, depigmentation, or irregular shapes. In the 6 grafted areolas, the grafted skin color closely matched the surrounding native areola tissue, with no obvious demarcation or scar hyperplasia. Patient satisfaction was rated as very satisfied in 3 cases and satisfied in 5 cases. According to the physician’s evaluation, the scores for color, softness, shape, and scarring were (3.7±0.5), (3.8±0.4), (3.3±0.7) and (3.2±0.7) points, respectively. Conclusion:Partial areola necrosis following reduction mammaplasty can be effectively repaired by further reducing breast volume and narrowing the areola for direct suturing or by grafting excess areola skin to the defect site. A satisfactory appearance can be achieved after surgery.

Objective To study the clinical efficacy of buccal acupuncture in the treatment of refractory tinnitus in the elderly.Methods In this study,50 elderly patients with refractory tinnitus were randomly divided into two groups:the experimental group(n=26)received buccal acupuncture therapy on the neck,upper neck,scapula zone,shoulder,back,mastoid process,thoracic plexus,abdominal plexus and pelvic plexus on the affected side,and the control group(n=24)received sound therapy.After 8 weeks of treatment intervention,the two groups were comprehensively evaluated for the changes in the tinnitus evaluation scale(TEQ),self-rating depression scale(SDS),and blood rheological indexes,including whole blood high-cut viscosity(HSV),plasma viscosity(PSV)and fibrinogen in blood(FIB)clotting.Results After treatment,the total effective rate of the experimental group was 84.6％(22/26),higher than 54.2％(13/24)in the con-trol group.The difference in total effective rate and efficacy level between the two groups was statistically significant(P＜0.05).TEQ and SDS were significantly lower in the two groups compared to pre-treatment(P＜0.05),and HSV,PSV and FIB in the experimental group were significantly lower compared to pre-treatment(P＜0.05).The experimental group demonstrated better post-treatment outcomes in TEQ,SDS,HSV,and FIB compared to the control group(P＜0.05).Conclusion Buccal acupuncture treatment is effective in improving the symptoms of refractory tinnitus in the elderly,relie-ving the depression complicated by tinnitus,and is helpful in changing blood flow resistance and reducing blood coagulation probably.

Objective:To screen the Alzheimer's disease(AD)-related genes and construct its diagnostic model using bioinformatics technology and machine learning(ML)algorithms,to discuss the immunological characteristics of AD patients,and to provide novel biomarkers for AD diagnosis.Methods:The AD-related gene expression dataset GSE125583 was downloaded from the Gene Expression Omnibus(GEO)database.Differentially expressed genes(DEGs)were identified through differential analysis.Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analyses were performed to explore the biological functions and signaling pathways of DEGs.A protein-protein interaction(PPI)network was constructed,and hub genes were screened using Cytoscape software combined with three ML algorithms:Least Absolute Shrinkage and Selection Operator(LASSO),eXtreme Gradient Boosting(XGBoost),and Random Forest(RF).The screened hub genes were utilized to build an AD diagnostic model via RF,followed by feature importance ranking.The model's efficacy and key genes were evaluated using a test set.Single-sample gene set enrichment analysis(ssGSEA)was used for immune cell infiltration analysis between AD group and control group.Results:Differential analysis identified 1 287 DEGs.The GO functional enrichment analysis results revealed that DEGs were primarily involved in biological functions related to neural signaling,synapses,and vesicles.KEGG signaling pathway enrichment analysis indicated significant enrichment of DEGs in ion transport,neurotransmitter,and ligand-gated channel pathways.Nine overlapping hub genes were screened by the three ML algorithms.In the AD diagnostic model,the top four key genes with highest diagnostic performance were adenylate cyclase-activating polypeptide 1(ADCYAP1),brain-derived neurotrophic factor(BDNF),platelet-derived growth factor receptor β(PDGFRB),and C-X-C motif chemokine receptor 4(CXCR4),with corresponding area under the curve(AUC)values of 0.852,0.795,0.820,and 0.756,respectively.The model achieved an AUC of 0.828,accuracy of 81.25%,sensitivity of 84.40%,and specificity of 71.43%.The immune cell infiltration analysis results demonstrated higher infiltration of macrophages,monocytes,natural killer(NK)cells,and lymphocytes in AD tissue.Among these,NK/natural killer T(NKT)cells and plasmacytoid dendritic cells showed significant correlations with the four key genes(P<0.05).Conclusion:The feature genes screened based on bioinformatics and ML exhibit diagnostic potential for AD.Genes such as ADCYAP1 may serve as potential biomarkers for AD diagnosis,offering significant implications for early prevention and treatment.

Objective To study the clinical efficacy of buccal acupuncture in the treatment of refractory tinnitus in the elderly.Methods In this study,50 elderly patients with refractory tinnitus were randomly divided into two groups:the experimental group(n=26)received buccal acupuncture therapy on the neck,upper neck,scapula zone,shoulder,back,mastoid process,thoracic plexus,abdominal plexus and pelvic plexus on the affected side,and the control group(n=24)received sound therapy.After 8 weeks of treatment intervention,the two groups were comprehensively evaluated for the changes in the tinnitus evaluation scale(TEQ),self-rating depression scale(SDS),and blood rheological indexes,including whole blood high-cut viscosity(HSV),plasma viscosity(PSV)and fibrinogen in blood(FIB)clotting.Results After treatment,the total effective rate of the experimental group was 84.6％(22/26),higher than 54.2％(13/24)in the con-trol group.The difference in total effective rate and efficacy level between the two groups was statistically significant(P＜0.05).TEQ and SDS were significantly lower in the two groups compared to pre-treatment(P＜0.05),and HSV,PSV and FIB in the experimental group were significantly lower compared to pre-treatment(P＜0.05).The experimental group demonstrated better post-treatment outcomes in TEQ,SDS,HSV,and FIB compared to the control group(P＜0.05).Conclusion Buccal acupuncture treatment is effective in improving the symptoms of refractory tinnitus in the elderly,relie-ving the depression complicated by tinnitus,and is helpful in changing blood flow resistance and reducing blood coagulation probably.

Objective:To summarize the experience of repairing partial areolar necrosis following reduction mammaplasty.Methods:A retrospective analysis was conducted on clinical data from patients who experienced partial areola necrosis after reduction mammaplasty. These patients were treated or consulted at the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, between January 2017 and February 2023. Preoperatively, daily dressing changes were performed on the necrotic areola wounds until the boundaries of necrosis were clearly defined. Debridement and repair were then carried out by resecting bilateral breast glandular tissue through the original incision to reduce breast volume, followed by narrowing the areola radius. If no areola defect remained after narrowing, direct suturing was performed; if defects persisted, the resected normal areola skin was used for grafting. Postoperative follow-up was conducted to observe areola recovery and complications. At the 6-month postoperative mark, patient satisfaction was evaluated using a 5-level scale (very satisfied, satisfied, neutral, dissatisfied, very dissatisfied). An experienced plastic physician, not involved in the surgery, assessed areolar outcomes based on four criteria: color, softness, shape, and scarring, with each criterion scored from 1 to 4 (higher scores indicating better outcomes).Results:Eight female patients (9 necrotic areolas) were included in the study, with a mean age of (31.8±5.4) years and a mean body mass index of (24.1±1.8) kg/m 2. Among the 9 necrotic areolas, 3 had defect areas greater than 50% of the total areola area, while 6 had defects less than 50%. Direct suturing after areola narrowing was performed in 3 areolas, while free areola skin grafting was used in 6 areolas. Postoperatively, 2 cases exhibited mild epidermal erosion at the graft site, which improved with dressing changes. No complications such as infection, bleeding, hematoma, or seroma occurred. At the 6-month follow-up, all 8 patients demonstrated good wound healing, and all 9 areolas survived. The areolas exhibited consistent shape and color bilaterally, without significant pigmentation changes, depigmentation, or irregular shapes. In the 6 grafted areolas, the grafted skin color closely matched the surrounding native areola tissue, with no obvious demarcation or scar hyperplasia. Patient satisfaction was rated as very satisfied in 3 cases and satisfied in 5 cases. According to the physician’s evaluation, the scores for color, softness, shape, and scarring were (3.7±0.5), (3.8±0.4), (3.3±0.7) and (3.2±0.7) points, respectively. Conclusion:Partial areola necrosis following reduction mammaplasty can be effectively repaired by further reducing breast volume and narrowing the areola for direct suturing or by grafting excess areola skin to the defect site. A satisfactory appearance can be achieved after surgery.

Objective To identify the key points of forensic appraisal in ophthalmic medical-injury compensation cases and propose targeted measures to prevent disputes.Methods A retrospective analysis was conducted of the appraisal conclusions from 15 ophthalmology medical-injury liability lawsuits handled at a single tertiary hospital over the past five years.We summarized the constitutive characteristics of liability cases,causes of medical injury,and issues encountered during appraisal.Results Among cases undergoing medical-injury liability appraisal,retinal diseases and ocular tumors predominated.The main issues included inadequate informed consent,failure to exercise due care during surgery/treatment,non-standard medical record documentation,insufficient attention to medical risks,and inadequate clinical assessment.Conclusions By summarizing common faults in ophthalmic disputes and problems revealed by forensic appraisal,targeted responses can be implemented to ensure patient safety and promote high-quality medical services.

Objective:To study the effects of hypoxia on the autophagy level in the spleen of mice with OSAHS.Methods:Mouse OSAHS hypoxia model was established in 24 C57BL/6 mice and the mice were divided into 3 groups:normoxic group,hypoxic group and resveratrol group(n=8).Real time PCR,Western blot and immunohistochemical staining(IHC)were used to detect the mRNA and protein expression of autophagy related proteins microtube associated protein 1 light chain 3 B(LC3B),myosin-like BCL2 inteacting protein(Beclin1)and autophagy related gene 5(ATG5)in mouse spleen respectively.Results:The mRNA expres-sion of LC3B,Beclin1,and ATG5 in the hypoxic group was lower than that in the normoxic group(P＜0.01,P＜0.01,P＜0.001),resveratrol upregulated the expression levels of LC3B and ATG5 mRNA in the hypoxic group(P＜0.05,P＜0.001),but did not up-regulate the expression of Beclin1(P＞0.05).The protein expression levels of LC3B,Beclin1 and ATG5 in the hypoxic group were lower than that in the normoxic group(P＜0.05,P＜0.05,P＜0.01).Resveratrol upregulated the expression levels of LC3B and ATG5 in the hypoxic group(P＜0.05,P＜0.01),but did not upregulated the expression of Beclin1(P＞0.05).IHC test showed that the expression level of LC3B,Beclin1 and ATG5 in the hypoxic group was lower than that in the normoxic group(P＜0.01,P＜0.01,P＜0.001).Resveratrol increased the expression level of LC3B and ATG5 in the hypoxic group(P＜0.05,P＜0.01),but did not upregulate the expression of Beclin1(P＞0.05).Conclusion:Hypoxia may inhibite the autophagy level of spleen in mice.Resvera-trol derivatives increases the autophagy level of mice under hypoxia condition,but has no significant effect on Beclin1 expression.

Objective:To explore the safety and efficacy of ureteroscopy-assisted laparoscopic ureteroplasty in the healthy side-lying running position for the treatment of ureteral stenosis after pelvic surgery.Methods:The data of 92 patients with ureteral stenosis after surgery admitted to Ganzhou People’s Hospital from June 2017 to February 2023 were retrospectively analysed. There were 31 male patients and 61 female patients, with an average age of (46.4±23.3) years. Of the 92 patients, 53 patients had previously undergone stone fragmentation or stone retrieval surgery for urinary system stones, 35 patients had undergone gynecologic laparoscopic surgery for gynecologic diseases, 2 patients had previous intestinal surgery, and 2 patients had undergone laparoscopic ureteral reconstruction surgery. The mean preoperative serum creatinine was (120.33±16.52) μmol/L, the mean blood urea nitrogen was (14.28 ± 2.47) mmol/L, and the mean renal pelvis dilation was (3.23±2.47) cm. All patients were placed in healthy side-lying running position with general anesthesia. The patient's lower limbs were in the oblique supine position, and the angle of the lower limbs was 60-80°. By using a transabdominal approach, the narrow section of the ureter was mobilized and excised under the guidance of ureteroscopy. The posterior wall of the ureter was sutured and a zebra guidewire was placed into the renal pelvis. An F7 double-J stent was then retrogradely advanced over the guidewire. Then the anterior wall of the ureter was anastomosed to complete the surgery. The operation time, average length of hospital stay, perioperative complications, preoperative and postoperative pyelectasis and renal function changes were recorded, and the clinical efficacy were evaluated by comparative analysis.Results:Of the 92 patients, 90 patients were successfully treated with ureterovesical anastomosis. Two patients underwent ureterovesical reimplantation because of the low position and heavy adhesion of the stenosis segment. There were no cases of conversion to open surgery or intraoperative death. The mean surgery duration was (121.52±22.35) min, the mean drainage tube indwelling time was (3.16±1.23) d, and the mean hospital stay was (6.46±2.37) d. A patient with moderate hydronephrosis exhibited postoperative urinary leakage. Two patients developed symptoms of hematuria after ambulation. Following treatment with bed rest, adequate drainage, and appropriate hemostatic medication, all patients recovered smoothly and were discharged. The double J tube was removed 3 months after operation, and the CT reexamination after extubation showed that the degree of pyelectasis was (2.52±1.54) cm, the average serum creatinine was (89.64±15.21) μmol/L, and urea nitrogen was (9.42±1.36) mmol/L, which was all significantly different from that before operation ( P<0.05). The patients were followed up for 6 to 12 months, and there was no ureteral restenosis. Conclusions:Ureteroscopic-assisted laparoscopic ureteroplasty in the healthy side-lying running position is a safe and effective surgical method for the treatment of short segment (narrow segment <3 cm) ureteral cicatrix stenosis after surgery. And this surgical method has the advantages of accurate positioning of the narrow segment, safe and convenient ureteral free, exact ureteral anastomosis, and easy placement of double J tube.