Objective To explore the independent risk factors for complicated coronary heart disease (CHD) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to construct a risk prediction model. Methods A retrospective study was performed to analyze the clinical data of 308 OSAHS patients who visited Jiangsu Provincial People's Hospital from January 2021 to June 2025. The patients were divided into the CHD group (n=80) and non-CHD group (n=228) according to the presence or absence of complicated CHD. Independent risk factors were identified using univariate analysis and multivariate logistic regression, and a nomogram prediction model was constructed. The model was evaluated using the calibration curve, Hosmer-Lemeshow test, Decision Curve Analysis (DCA) curve, and Receiver Operating Characteristic (ROC) curve. Results The incidence of CHD in OSAHS patients was 25.97%. Age, history of hypertension, oxygen desaturation index (ODI), severe polysomnography (PSG) grade, decreased high-density lipoprotein cholesterol, elevated homocysteine, and elevated troponin I were independent risk factors for OSAHS complicated with CHD (P<0.05). The nomogram model demonstrated good calibration (Hosmer-Lemeshow test, P=0.995), and the DCA curve showed high clinical net benefit. The area under the ROC curve was 0.940 (95% CI: 0.908~0.972), with a sensitivity of 0.842 and a specificity of 0.900. Conclusion Age, history of hypertension, ODI, PSG grade, high-density lipoprotein cholesterol, homocysteine, and troponin I are independent risk factors for CHD in OSAHS patients. The prediction model constructed based on these factors can provide a reliable tool for clinical nurses to early identify high-risk individuals and formulate targeted intervention strategies.

Objective To study the effect of Honokiol(HKL)on pulmonary microvascular endothelial cells in lipopolysaccharide(LPS)-induced acute respiratory distress syndrome(ARDS)and its potential mechanism.Methods Mouse lung microvascular endothelial cells(PMVECs)were cultured with DMEM+10％FBS in a six-well plate and divided into control(Con)group 1,Honokiol(HKL)group 1,LPS treated(LPS)group 1,and LPS+HKL treatment(HKL+LPS)group 1.The levels of malondialdehyde(MDA)and reactive oxygen species(ROS)in cell lysates were determined by lipid peroxidation assay kit and H2DCF-DA,respectively.TUNEL/DAPI double staining was used to detect apoptosis.Cell junctions were visualized via VE-cadherin/DAPI and Claudin-5/DAPI double staining.Western blot was used to detect caspase-3,cleaved caspase-3,Sirt3,SOD2,and acetylated SOD2(Ac-SOD2)expression.Thirty-two mice were randomly divided into control(Con)group 2,Honokiol(HKL)group 2,LPS treated(LPS)group 2,and LPS+HKL treatment(HKL+LPS)group 2.Hematoxylin and eosin(HE)staining was used to observe pathological changes to the lung tissue.Results HKL pretreatment significantly reversed the LPS-induced increase in ROS and MDA levels(P＜0.05),SOD2 acetylation and Sirt3 down-regulation(P＜0.05).TUNEL and caspase analysis showed that HKL protected against the apoptosis of PMVECs induced by LPS.VE-cadherin fluorescence staining demonstrated that HKL pretreatment prevented LPS from disrupting cell adhesion junctions.Claudin-5 fluorescence staining showed that HKL pretreatment prevented LPS from disrupting the tight junctions between cells.In the animal experiments,HE staining showed that HKL significantly inhibited the typical pathological changes of ARDS in the lung tissue of mice in the LPS group.Conclusions HKL can significantly inhibit the LPS-induced oxidative stress,apoptosis,and cell-connection breakdown of PMVECs,thereby alleviating ARDS symptoms.

Objective:To compare the efficacy of proximal femoral nail antirotation (PFNA) with metaphyseal expansion or non-expansion in the treatment of femoral intertrochanteric fracture in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 349 elderly patients with femoral intertrochanteric fracture, comprising 168 males and 181 females, aged 60-84 years [(73.5±8.6)years]. According to AO fracture classification, 108 patients were classified as type A1, 164 type A2, and 77 type A3. Of them, 168 patients received PFNA with metaphyseal expansion (expansion group), while 181 received PFNA with metaphyseal non-expansion (non-expansion group). The operation time, intraoperative blood loss, recessive blood loss, postoperative drainage volume, total blood loss, intraoperative blood transfusion rate and length of hospital stay were compared between the two groups. Visual analogue scale (VAS) scores preoperatively, at 2 and 6 weeks postoperatively of the two groups were detected. The neck-shaft angle and tip-apex distance were measured preoperatively, immediately after surgery, and at 6 months postoperatively. Harris hip score was evaluated at 1, 3, and 6 months postoperatively. Additionally, time to weight-bearing ambulation, fracture healing time, and postoperative complication rate were compared between the two groups.Results:All the patients were followed up for 6-10 months [(7.8±1.2)months]. The operation time for the expansion group was (69.6±12.4)minutes, significantly longer than (65.3±11.5)minutes of the non-expansion group ( P<0.01). Intraoperative blood loss, recessive blood loss, postoperative drainage volume and total blood loss were (124.8±16.9)ml, (684.1±95.3)ml, (123.9±25.1)ml and (932.8±125.4)ml respectively, which were more than those of the non-expansion group [(96.3±12.6)ml, (623.4±87.4)ml, (110.6±29.7)ml, and (830.3±112.6)ml] ( P<0.01). The intraoperative blood transfusion rate was 50.0% (84/168), higher than 38.1% (69/181) of the non-expansion group ( P<0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). There was no significant difference in VAS scores between the two groups before surgery, at 2 and 6 weeks after surgery ( P>0.05). The VAS scores of the two groups at 2 and 6 weeks after surgery were lower than those before surgery, and there were significantly lower scores at 6 weeks after surgery when compared with those at 2 weeks after surgery ( P<0.05). There were no significant differences in neck-shaft angle and tip-apex distance of the two groups before surgery, immediately after surgery and at 6 months after surgery ( P>0.05). In both groups, the neck-shaft angle immediately after surgery and at 6 months after surgery decreased while the apex distance increased when compared with those before surgery ( P<0.05). Furthermore, significantly lower neck-shaft angle and larger apex distance were observed at 6 months after surgery when compared with those immediately after surgery ( P<0.05). There was no significant difference in Harris hip scores at 1, 3 and 6 months after surgery between the two groups ( P>0.05). In both groups, the Harris hip scores at 3 and 6 months after surgery were higher than those at 1 month after surgery ( P<0.05) and the Harris hip scores at 6 months after surgery were higher than that those at 3 months after surgery ( P<0.05). There were no significant differences in time to weight-bearing ambulation, fracture healing time and total postoperative complication rate between the two groups ( P>0.05). Conclusions:For the elderly patients with femoral intertrochanteric fractures, PFNA with proximal metaphyseal expansion or non-expansion is equally effective in shortening hospital stay, relieving pain, improving reduction quality, promoting hip function recovery and reducing complication rate. However, PFNA with non-expansion treatment can shorten the operation time, reduce intraoperative blood loss, recessive blood loss, postoperative drainage volume and total blood loss, and lower intraoperative blood transfusion rate.

Objective To study the changes in peripheral blood T lymphocytes in patients with ankylosing spondylitis and their correlation with the disease's severity and prognosis.Methods We selected 120 patients with ankylosing spondylitis treated between January 2020 and March 2023 as the research group and 120 healthy people who had medical examinations in the same period as the health group.We detected the changes in CD4+,CD8+and CD4+/CD8+values of peripheral blood T lymphocyte subsets with flow cytometry,compared the differences in T lymphocyte subsets between the two groups,and analyzed the correlation with the disease severity of the patients.All the 120 patients with ankylosing spondylitis were followed up for 6 months after treatment to assess their prognosis.General information and T lymphocyte sub-groups CD4+,CD8+level,CD4+/CD8+value changes were compared among patients with different prognosis.We analyzed the value of T lymphocyte sub-groups in predicting the prognosis of patients with ankylosing spondylitis.Results In the research group CD4+and CD4+/CD8+were lower but CD8 1 was higher than those in the healthy group(P＜0.05).CD4+and CD4+/CD8 were lower but CD8+was higher in patients with advanced ankylosing spondylitis than in early and mid-term patients(P＜0.05).The ROC curve analysis showed that the AUC of CD4+,CD8+,and CD4+/CD8+combined diagnosis of ankylosing spondylitis patients was 0.878,with higher diagnostic sensitivity than that of the single diagnosis(P＜0.05).In the poor prognosis group,CD8+was higher than that in the excellent prognosis group,but CD4+and CD4+/CD8 value were lower than the latter(P＜0.05).The results of Pearson test showed that CD4+and CD4+/CD8+were negatively correlated with the prognosis of patients with ankylosing spondylitis(r=-0.568,-0.656,P＜0.001).CD8+was positively correlated with the prognosis of patients with ankylosing spondylitis(r=0.623,P＜0.001).ROC curve analysis showed that the AUC of the combined diagnosis of CD4+,CD8+and CD4+/CD8+for ankylosing spondylitis patients was 0.910,and the diagnostic sensitivity was higher than that of single diagnosis(P＜0.05).Conclusion The abnormal levels of peripheral blood T lymphocyte subsets in patients with ankylosing spondylitis are closely related to the severity and prognosis of the disease,and can be used as a reference indicator for diagnosing the severity and prognosis of ankylosing spondylitis.

Objective:To understand molecular characteristics and antibiotic resistance of Clostridioides ( C.) difficile isolated from children in China, and provide data support the development of disease risk assessment and burden studies. Methods:A total of 155 strains of C. difficile isolated from children aged <12 years in 14 provinces (autonomous regions, municipalities) in China from 2010 to 2023 were used for the analyses on molecular characteristics and antibiotic resistance of C. difficile by PCR and drug susceptibility test. Results:A total of 26 sequence types (STs) and 18 ribotypes (RTs) were identified in the 155 C. difficile isolates, in which ST3 (20.65%), ST54 (16.13%), ST35 (12.90%), and RT012/ICDC007 (14.84%), RT001/ICDC001 (11.61%), RT046/ICDC018 (8.39%) were the most common. One highly virulent strain with RT078 and 27 non-toxin-producing strains were also found; the predominant toxin gene was tcdA+ tcdB+ cdt-. All the strains were sensitive to metronidazole and vancomycin, and there were 29 multidrug-resistant strains, in which 1 strain was resistant to all the seven antibiotics except for vancomycin and metronidazole. Conclusions:Molecular characteristics and antibiotic resistance of C. difficile in children were similar to those in whole population in China, but there were regional distribution differences. It is necessary to strengthen the routine drug-resistance surveillance for C. difficile infection in children in China.

Objective:To provide references for standardizing the post-operative aeromedical assessment of heart valve disease of flying personnel by analyzing the pathogenesis characteristics and treatment.Methods:The case data of flying personnel with heart valve disease hospitalized in Air Force Medical Center from November of 2010 to December of 2021 were collected, which was called the clinical group; the relevant cases of heart valve disease in domestic flying personnel reported in the literature were retrieved, which was called the literature group. The retrospective study was carried out and the data was analyzed according to the aircraft type, lesion location, treatment method and identification results.Results:There were 20 cases in the clinical group. According to the number of detected cases, the valve positions order was the aortic valve (12 cases), the mitral valve (7 cases), the tricuspid valve (4 cases, all concomitant), and the pulmonary valve (1 case). The literature group had 11 cases, mainly were aortic valve disease (10 cases) and tricuspid valve (1 case). Most of these aortic valve lesions were based on the pathology of bicuspid aortic valve (BAV). Among the cases of aortic valve disease, 12 cases were flight-qualified, 1 case was restricted flight, 1 case of fighter aircraft was transferred to fly transporter, 3 cases were temporary unqualified for flight, 3 cases were unqualified for flight, and 2 cases were waivered. Among the cases of mitral valve disease, 3 cases were flight-qualified, 4 cases were temporary unqualified for flight, 1 case of tricuspid valve and 1 case of pulmonary valve were qualified for flight.Conclusions:The lesion site of valve is the main factor influencing the aeromedical assessment result. The aortic valve is the most common site of valve disease among flying personnel, and BAV is the most common pathologic type. It should be strengthened physical examination identification and prevention.

Objective:To provide references for standardizing the post-operative aeromedical assessment of heart valve disease of flying personnel by analyzing the pathogenesis characteristics and treatment.Methods:The case data of flying personnel with heart valve disease hospitalized in Air Force Medical Center from November of 2010 to December of 2021 were collected, which was called the clinical group; the relevant cases of heart valve disease in domestic flying personnel reported in the literature were retrieved, which was called the literature group. The retrospective study was carried out and the data was analyzed according to the aircraft type, lesion location, treatment method and identification results.Results:There were 20 cases in the clinical group. According to the number of detected cases, the valve positions order was the aortic valve (12 cases), the mitral valve (7 cases), the tricuspid valve (4 cases, all concomitant), and the pulmonary valve (1 case). The literature group had 11 cases, mainly were aortic valve disease (10 cases) and tricuspid valve (1 case). Most of these aortic valve lesions were based on the pathology of bicuspid aortic valve (BAV). Among the cases of aortic valve disease, 12 cases were flight-qualified, 1 case was restricted flight, 1 case of fighter aircraft was transferred to fly transporter, 3 cases were temporary unqualified for flight, 3 cases were unqualified for flight, and 2 cases were waivered. Among the cases of mitral valve disease, 3 cases were flight-qualified, 4 cases were temporary unqualified for flight, 1 case of tricuspid valve and 1 case of pulmonary valve were qualified for flight.Conclusions:The lesion site of valve is the main factor influencing the aeromedical assessment result. The aortic valve is the most common site of valve disease among flying personnel, and BAV is the most common pathologic type. It should be strengthened physical examination identification and prevention.

Clostridioides difficile is a key pathogen of antibiotic related diarrhea and hospital associated infection, causing several outbreaks in Europe and North Americans and resulting in severe disease burden. However, the standardized diagnostic principle and detection specifications in C. difficile infection (CDI) survey are limited in China, and the infection rate and disease burden of CDI in China are unclear. Therefore, National Institute for Communicable Disease Control and Prevention,National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, together with another 11 institutions, draft the group standard entitled "Diagnosis of Clostridium difficile infection (T/CPMA 008-2020)" of Chinese Preventive Medicine Association. Based on the principle of "legality, scientificity, advancement, and feasibility", this standard clarifies risk factors, diagnosis principles, diagnoses and differential diagnoses in order to improve the accuracy of CDI diagnosis in clinical practice, guide the surveillance for CDI, and understand the infection rate and disease burden of CDI in China .

Objective:To study clinical pathological characteristics, immunohistochemical, molecular genetical changes and prognosis in pediatric eosinophilic solid and cystic renal cell carcinoma (ESC RCC) with TSC2 gene mutations.Methods:The tissue samples were collected from two pediatric ESC RCC patients between 2017 and 2018. The tissues were subjected to histological examination and immunohistochemistry using EnVision system. The TFE3, TFEB gene rearrangements were tested using FISH and molecular genetic study. The paraffin sections were used for DNA extraction, PCR amplification and NGS sequencing.Results:The two patients with ESC RCC were both male, aged at 9 years and 8 months, and 13 years, respectively. The tumors were from the right kidney, 5 cm and 7 cm in size, respectively, with solid and cystic changes in cross section, and grey-reddish or grey-whitish fish meat appearance. Microscopic observation revealed the tumors had fibrous capsules, which were infiltrated by the tumor cells. The tumor cells were diffusely distributed, round-shaped, or polygon-shaped, and had voluminous cytoplasm, eosinophilic cytoplasm, various sizes of vacuoles and clear cell-like appearance. There were papillary structures in some areas, with visible fiber septa. The nuclei were round and vesicular, with multi-nucleated cells and megakaryocytes. The mitoses were not seen. A few cystic structures were visible in different sizes, and capsule walls were covered with a single layer of spike-like tumor cells. Thick-walled blood vessels were seen in the stroma, with focal lymphocytic infiltration, eosinophilic necrosis, calcifications and cholesterol crystals. Immunohistochemistry of the tumor cells was positive for PAX8 (diffuse), CK20 (focal), CKpan (focal), CK10 (1 focal, 1 diffuse), INI1, vimentin, CD68, and Ki-67 (5%~10%); the tumor cells were negative for HMB45, S-100, Melan A, p53, desmin, TFE3, CK7, CK19, EMA, CD56, CgA, Syn, CD30, CD117, WT1 and SMA. Molecular genetic study showed that TFE3 and TFEB gene rearrangements were not detected by FISH. NGS sequencing showed TSC2 p.Lys574Ter (0.198) was found in patient one and TSC2 p.Arg406Ter (0.355) in patient two.Conclusions:ESC RCC in children is a rare disease, and can be misdiagnosed easily. It has unique pathological characteristics, and immunohistochemical, molecular and genetic changes. The prognosis is relatively good.