Objective To investigate the risk factors of hemodynamic instability after carotid artery stenting by meta-analysis.Methods Ten databases were searched:PubMed,ProQuest,ScienceDirect,Embase,Cochrane Library,Web of Science,China Knowledge Network,Wanfang Data,VIP Information Database,and China Biomedical Database.The search date was from inception until 2 February 2024,and meta-analysis was performed using Stata 16.0 statistical software.Results A total of 27 studies with 4199 subjects and 22 influencing factors were included.The studies showed a 37.4％(95％CI 30.3％-44.8％)incidence of haemodynamic instability after carotid stenting,Meta-analysis determined that age＞60 years(P＜0.001),hypertension(P＜0.001),calcified plaque(P＜0.001),stenosis＞70％(P=0.008),eccentric plaque(P=0.002),distance from the largest stenosis to the carotid bifurcation≤ 10 mm(P＜0.001),stenosis involvement of the balloon or bifurcation(P＜0.001),balloon post-dilation(P=0.003),open-loop stenting(P＜0.001),dilated balloon diameter≥5 mm(P=0.002),repeat balloon dilation(P=0.011)and balloon dilation pressure≥8 atm(P＜0.001)are risk factors for intraoperative and postoperative haemodynamic instability in patients undergoing carotid artery stenting surgery.Statin use was a protective factor(P＜0.001).Conclusions Medical staff working in the clinic should assess the patient's condition preoperatively,identify risk factors that may lead to haemodynamic instability,and avoid unnecessary intraoperative stimulation of patients who are already in a high-risk state.Reduce postoperative clinical complications in patients with carotid artery stenosis and improve patient recovery.

Objective To investigate the risk factors of hemodynamic instability after carotid artery stenting by meta-analysis.Methods Ten databases were searched:PubMed,ProQuest,ScienceDirect,Embase,Cochrane Library,Web of Science,China Knowledge Network,Wanfang Data,VIP Information Database,and China Biomedical Database.The search date was from inception until 2 February 2024,and meta-analysis was performed using Stata 16.0 statistical software.Results A total of 27 studies with 4199 subjects and 22 influencing factors were included.The studies showed a 37.4％(95％CI 30.3％-44.8％)incidence of haemodynamic instability after carotid stenting,Meta-analysis determined that age＞60 years(P＜0.001),hypertension(P＜0.001),calcified plaque(P＜0.001),stenosis＞70％(P=0.008),eccentric plaque(P=0.002),distance from the largest stenosis to the carotid bifurcation≤ 10 mm(P＜0.001),stenosis involvement of the balloon or bifurcation(P＜0.001),balloon post-dilation(P=0.003),open-loop stenting(P＜0.001),dilated balloon diameter≥5 mm(P=0.002),repeat balloon dilation(P=0.011)and balloon dilation pressure≥8 atm(P＜0.001)are risk factors for intraoperative and postoperative haemodynamic instability in patients undergoing carotid artery stenting surgery.Statin use was a protective factor(P＜0.001).Conclusions Medical staff working in the clinic should assess the patient's condition preoperatively,identify risk factors that may lead to haemodynamic instability,and avoid unnecessary intraoperative stimulation of patients who are already in a high-risk state.Reduce postoperative clinical complications in patients with carotid artery stenosis and improve patient recovery.

Objective:To investigate the changes in follicular helper T cells(Tfh)and related cytokines in pe-ripheral blood and endometrial tissue of patients with unexplained recurrent implantation failure(URIF),and evalu-ate their predictive value for URIF.Methods:Sixty-four patients with URIF who visited the Reproductive Medicine Centre of the First Affiliated Hospital of Xinjiang Medical University from December 2020 to June 2022 were select-ed as the study group(URIF group),and 61 healthy women of childbearing age who visited our centre for male in-fertility in the same period were selected as the healthy control group(HC group).GSE microarrays of patients with recurrent implant failure(RIF)were collected in the Gene Expression Omnibus(GEO)database,and the pro-portion of different immune cells was identified using the CIBERSORT algorithm,and immune cell infiltration analy-sis and visualisation processing were performed using the Cibersort.R package.Peripheral blood samples and endometrial tissue samples were collected from the two groups of patients,flow cytometry was used to detect the proportion of Tfh cells in peripheral blood,enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of IL-4,IL-6,and IL-21,and immunohistochemical staining was used to detect the expression of CXCR5,Bcl-6,and IL-21 in endometrial tissue.Factors associated with URIF were analysed using multifactorial Logistic re-gression analysis.The predictive value of individual and combined tests for each indicator for URIF was analysed using the operating characteristic curve(ROC).The Drug Therapy Target Database(TTD)was used to predict potential therapeutic agents for URIF targeting IL-6 and IL-21,respectively.Results:The results of immune cell in-filtration in the GSE dataset in the GEO database showed that compared with normal controls,the numbers of ac-tivated memory CD4+T cells,Tfh,regulatory T cells(Treg),inactive macrophages,and resting dendritic cells were increased in the endometrial tissues of the patients with RIF(P＜0.05).The number of initial B cells,yδT cells,M2-type macrophages and activated dendritic cells were all decreased(P＜0.05).The levels of peripheral blood Tfh,IL-6 and IL-21 in the URIF group were all significantly higher than those in the HC group,and the difference was statistically significant(P＜0.05).Immunohistochemical staining results suggested that the expression of CX-CR5,Bcl-6 and IL-21 in the endometrium of patients in the URIF group was increased compared with that in the HC group(P＜0.05).Multivariate Logistic regression analysis showed that IL-6,IL-2,and Tfh were independent risk factors for the occurrence of URIF(OR＞1,P＜0.05).The area under the curve(AUC=0.974)of peripheral blood Tfh combined with IL-6 and IL-21 for diagnosis of URIF was higher than that predicted by each index alone,according to ROC analysis(P＜0.05).Five drugs targeting IL-6 or IL-21 with potential therapeutic effects on URIF were detected and screened through the TTD database.Conclusions:The levels of Tfh,IL-6 and IL-21 in the pe-ripheral blood of patients with URIF were abnormally elevated,and CXCR5,Bcl-6 and IL-21 were abnormally ex-pressed in the endometrium of patients with URIF,suggesting that Tfh cells and their cytokines are closely related to the occurrence and development of URIF.The combined prediction of these indicators has good diagnostic val-ue and may serve as a therapeutic target.

Objective:To investigate the risk factors for severe hyperbilirubinemia complicated by acute bilirubin encephalopathy (ABE), and the value of total serum bilirubin (TSB) and bilirubin (B)/albumin (A) ratio in predicting ABE.Methods:Clinical data of children with severe hyperbilirubinemia admitted to the Affiliated Hospital of Inner Mongolia Medical University, Ordos Central Hospital, People's Hospital of Inner Mongolia Autonomous Region, the Fourth Hospital of Baotou, Tongliao Hospital, Maternal and Child Health Hospital of Hohhot, the Affiliated Hospital of Chifeng University, Manzhouli People's Hospital, and Chifeng Hospital from January 1, 2020, to December 31, 2021, were retrospectively collected. The subjects were divided into ABE and non-ABE groups based on the occurrence of ABE. Multivariate logistic regression analysis was used to identify high-risk factors for ABE. Statistical analysis was performed using t-test, Wilcoxon signed-rank test, or Chi-square tests. Indicators with statistically significant differences were included in the multivariate logistic regression model, and stepwise regression was used to analyze the influencing factors of ABE. Results:(1) A total of 543 children were included in this study, accounting for 3.7% (543/14 831) of the total admissions during the same period. Among the 543 children, 81 (14.9%) had ABE, and 462 (85.1%) did not. The age at admission was (7.2±2.1) d, and the length of hospital stay was (5.2±2.2) d. The breastfeeding initiation time was 2 d (1-4 d) after birth. The peak TSB of the 543 cases was (385.98±51.22) μmol/L, and the age at peak TSB was (4.4±2.1) d. Fourteen cases (2.5%) gradually reached the peak TSB after admission [(392.01±61.24) μmol/L], while 529 cases (97.5%) had already reached the peak TSB at admission [(386.42±50.22) μmol/L]. Among the 543 cases, 356 had a clear etiology (65.6%, with 278 cases having a single cause and 78 cases having more than two causes), and 187 cases (34.4%) had an unknown etiology. (2) Compared with the non-ABE group, the breastfeeding initiation in the ABE group was later [6 h (2-6 h) vs. 2 h (1-3 h), Z=－6.87] and the length of hospital stay was longer [(6.5±1.9) d vs. (5.0±2.1) d, t=0.55]. The proportions of breastfeeding, delayed meconium passage, isoimmune hemolysis, and maternal gestational diabetes, as well as peak TSB and B/A ratio at peak TSB, were higher in the ABE group than in the non-ABE group [64.2% (52/81) vs. 36.8% (170/462), χ2=21.96; 16.0% (13/81) vs. 2.4% (11/462), χ2=27.32; 27.2% (22/81) vs. 10.6% (40/462), χ2=16.61; 24.7% (20/81) vs. 13.6% (63/462), χ2=6.50; (442±68) vs. (375±39) μmol/L, t=－8.55; (11.9±1.6) vs. (9.8±1.2), t=－11.61; all P<0.05]. The admission weight, proportion of transfer from the hospital's obstetrics department, unknown etiology, and breast milk jaundice were lower in the ABE group than in the non-ABE group [(3 098±482) vs. (3 278±493) g, t=3.04; 12.3% (10/81) vs. 42.4% (196/462), χ2=30.48; 3.7% (3/81) vs. 39.8% (184/462), χ2=39.83; 0.0% (0/81) vs. 5.8% (27/462), χ2=3.81; all P<0.05]. (3) Isoimmune hemolysis, peak TSB, and B/A ratio at peak TSB were independent risk factors for ABE [ OR(95% CI) were 2.924 (1.209-7.073), 1.006 (0.997-1.014), and 2.647 (1.841-3.805), respectively]. When the peak TSB was 380.05 μmol/L and the B/A ratio at peak TSB was 10.45, the sensitivity for predicting ABE was 0.963, the specificity was 0.789, and the area under the receiver operating characteristic curve was 0.752. Conclusions:Isoimmune hemolysis, peak TSB, and B/A ratio at peak TSB are independent risk factors for ABE. The B/A ratio at peak TSB and peak TSB can effectively predict ABE.

Objective:To explore the role of methyltransferase-like 3 (METTL3) on endometrial decidualization.Methods:Bioinformatics was used to analyze the expression of 26 N6-methyladenosine (m6A) regulators in recurrent implantation failure (RIF), recurrent spontaneous abortion (RSA) and the decidualization of endometrial stromal cells. Using Medroxyprogesterone and Dibutyryl-cAMP to induce human endometrial stromal cell s (HESCs)decidualization, we examined changes in the expression of total m6A, METTL3, Forkhead framing protein O1 (FOXO1), and decidualization markers insulin-like growth factor binding protein 1 (IGFBP1) and prolactin in the control and decidualization group. Constructing HESC models with METTL3 interference using lentivirus, we used CCK-8 and Edu to detect proliferation in the negative control and knockdown METTL3 group. Lentiviral transfection was successfully followed by induction of decidualization, and we examined changes in the expression of FOXO1 and decidualization markers.Results:The results of bioinformatics analysis showed that the expression of METTL3 was significantly downregulated in the endometrium of patients with RIF and RSA ( P=0.014, P=0.016), while it was significantly upregulated in the endometrium with decidualization ( P=0.029). In vitro, induction of HESCs decidualization increased in the expression levels of total m6A, METTL3, and FOXO1 proteins in the decidualization group ( P=0.015, P=0.016, P=0.004). Knocking down METTL3 resulted in a decrease in FOXO1 protein expression in HESCs ( P=0.009). The CCK-8 and Edu results showed that the proliferation of HESCs was inhibited after knocking down METTL3. After inducing the knockdown of METTL3 in vitro, there was no statistically significant difference in the expression levels of IGFBP1 mRNA, PRL mRNA, and FOXO1 protein in HESCs compared with the negative control group (all P>0.05). Conclusion:In endometrial stromal cells, METTL3 can regulate the expression of FOXO1, promote the expression of IGFBP1 and PRL, and affect the decidualization of endometrial cells.

Objective:To explore the role of methyltransferase-like 3 (METTL3) on endometrial decidualization.Methods:Bioinformatics was used to analyze the expression of 26 N6-methyladenosine (m6A) regulators in recurrent implantation failure (RIF), recurrent spontaneous abortion (RSA) and the decidualization of endometrial stromal cells. Using Medroxyprogesterone and Dibutyryl-cAMP to induce human endometrial stromal cell s (HESCs)decidualization, we examined changes in the expression of total m6A, METTL3, Forkhead framing protein O1 (FOXO1), and decidualization markers insulin-like growth factor binding protein 1 (IGFBP1) and prolactin in the control and decidualization group. Constructing HESC models with METTL3 interference using lentivirus, we used CCK-8 and Edu to detect proliferation in the negative control and knockdown METTL3 group. Lentiviral transfection was successfully followed by induction of decidualization, and we examined changes in the expression of FOXO1 and decidualization markers.Results:The results of bioinformatics analysis showed that the expression of METTL3 was significantly downregulated in the endometrium of patients with RIF and RSA ( P=0.014, P=0.016), while it was significantly upregulated in the endometrium with decidualization ( P=0.029). In vitro, induction of HESCs decidualization increased in the expression levels of total m6A, METTL3, and FOXO1 proteins in the decidualization group ( P=0.015, P=0.016, P=0.004). Knocking down METTL3 resulted in a decrease in FOXO1 protein expression in HESCs ( P=0.009). The CCK-8 and Edu results showed that the proliferation of HESCs was inhibited after knocking down METTL3. After inducing the knockdown of METTL3 in vitro, there was no statistically significant difference in the expression levels of IGFBP1 mRNA, PRL mRNA, and FOXO1 protein in HESCs compared with the negative control group (all P>0.05). Conclusion:In endometrial stromal cells, METTL3 can regulate the expression of FOXO1, promote the expression of IGFBP1 and PRL, and affect the decidualization of endometrial cells.

Objective:To investigate the risk factors for severe hyperbilirubinemia complicated by acute bilirubin encephalopathy (ABE), and the value of total serum bilirubin (TSB) and bilirubin (B)/albumin (A) ratio in predicting ABE.Methods:Clinical data of children with severe hyperbilirubinemia admitted to the Affiliated Hospital of Inner Mongolia Medical University, Ordos Central Hospital, People's Hospital of Inner Mongolia Autonomous Region, the Fourth Hospital of Baotou, Tongliao Hospital, Maternal and Child Health Hospital of Hohhot, the Affiliated Hospital of Chifeng University, Manzhouli People's Hospital, and Chifeng Hospital from January 1, 2020, to December 31, 2021, were retrospectively collected. The subjects were divided into ABE and non-ABE groups based on the occurrence of ABE. Multivariate logistic regression analysis was used to identify high-risk factors for ABE. Statistical analysis was performed using t-test, Wilcoxon signed-rank test, or Chi-square tests. Indicators with statistically significant differences were included in the multivariate logistic regression model, and stepwise regression was used to analyze the influencing factors of ABE. Results:(1) A total of 543 children were included in this study, accounting for 3.7% (543/14 831) of the total admissions during the same period. Among the 543 children, 81 (14.9%) had ABE, and 462 (85.1%) did not. The age at admission was (7.2±2.1) d, and the length of hospital stay was (5.2±2.2) d. The breastfeeding initiation time was 2 d (1-4 d) after birth. The peak TSB of the 543 cases was (385.98±51.22) μmol/L, and the age at peak TSB was (4.4±2.1) d. Fourteen cases (2.5%) gradually reached the peak TSB after admission [(392.01±61.24) μmol/L], while 529 cases (97.5%) had already reached the peak TSB at admission [(386.42±50.22) μmol/L]. Among the 543 cases, 356 had a clear etiology (65.6%, with 278 cases having a single cause and 78 cases having more than two causes), and 187 cases (34.4%) had an unknown etiology. (2) Compared with the non-ABE group, the breastfeeding initiation in the ABE group was later [6 h (2-6 h) vs. 2 h (1-3 h), Z=－6.87] and the length of hospital stay was longer [(6.5±1.9) d vs. (5.0±2.1) d, t=0.55]. The proportions of breastfeeding, delayed meconium passage, isoimmune hemolysis, and maternal gestational diabetes, as well as peak TSB and B/A ratio at peak TSB, were higher in the ABE group than in the non-ABE group [64.2% (52/81) vs. 36.8% (170/462), χ2=21.96; 16.0% (13/81) vs. 2.4% (11/462), χ2=27.32; 27.2% (22/81) vs. 10.6% (40/462), χ2=16.61; 24.7% (20/81) vs. 13.6% (63/462), χ2=6.50; (442±68) vs. (375±39) μmol/L, t=－8.55; (11.9±1.6) vs. (9.8±1.2), t=－11.61; all P<0.05]. The admission weight, proportion of transfer from the hospital's obstetrics department, unknown etiology, and breast milk jaundice were lower in the ABE group than in the non-ABE group [(3 098±482) vs. (3 278±493) g, t=3.04; 12.3% (10/81) vs. 42.4% (196/462), χ2=30.48; 3.7% (3/81) vs. 39.8% (184/462), χ2=39.83; 0.0% (0/81) vs. 5.8% (27/462), χ2=3.81; all P<0.05]. (3) Isoimmune hemolysis, peak TSB, and B/A ratio at peak TSB were independent risk factors for ABE [ OR(95% CI) were 2.924 (1.209-7.073), 1.006 (0.997-1.014), and 2.647 (1.841-3.805), respectively]. When the peak TSB was 380.05 μmol/L and the B/A ratio at peak TSB was 10.45, the sensitivity for predicting ABE was 0.963, the specificity was 0.789, and the area under the receiver operating characteristic curve was 0.752. Conclusions:Isoimmune hemolysis, peak TSB, and B/A ratio at peak TSB are independent risk factors for ABE. The B/A ratio at peak TSB and peak TSB can effectively predict ABE.

Objective:To investigate the changes in follicular helper T cells(Tfh)and related cytokines in pe-ripheral blood and endometrial tissue of patients with unexplained recurrent implantation failure(URIF),and evalu-ate their predictive value for URIF.Methods:Sixty-four patients with URIF who visited the Reproductive Medicine Centre of the First Affiliated Hospital of Xinjiang Medical University from December 2020 to June 2022 were select-ed as the study group(URIF group),and 61 healthy women of childbearing age who visited our centre for male in-fertility in the same period were selected as the healthy control group(HC group).GSE microarrays of patients with recurrent implant failure(RIF)were collected in the Gene Expression Omnibus(GEO)database,and the pro-portion of different immune cells was identified using the CIBERSORT algorithm,and immune cell infiltration analy-sis and visualisation processing were performed using the Cibersort.R package.Peripheral blood samples and endometrial tissue samples were collected from the two groups of patients,flow cytometry was used to detect the proportion of Tfh cells in peripheral blood,enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of IL-4,IL-6,and IL-21,and immunohistochemical staining was used to detect the expression of CXCR5,Bcl-6,and IL-21 in endometrial tissue.Factors associated with URIF were analysed using multifactorial Logistic re-gression analysis.The predictive value of individual and combined tests for each indicator for URIF was analysed using the operating characteristic curve(ROC).The Drug Therapy Target Database(TTD)was used to predict potential therapeutic agents for URIF targeting IL-6 and IL-21,respectively.Results:The results of immune cell in-filtration in the GSE dataset in the GEO database showed that compared with normal controls,the numbers of ac-tivated memory CD4+T cells,Tfh,regulatory T cells(Treg),inactive macrophages,and resting dendritic cells were increased in the endometrial tissues of the patients with RIF(P＜0.05).The number of initial B cells,yδT cells,M2-type macrophages and activated dendritic cells were all decreased(P＜0.05).The levels of peripheral blood Tfh,IL-6 and IL-21 in the URIF group were all significantly higher than those in the HC group,and the difference was statistically significant(P＜0.05).Immunohistochemical staining results suggested that the expression of CX-CR5,Bcl-6 and IL-21 in the endometrium of patients in the URIF group was increased compared with that in the HC group(P＜0.05).Multivariate Logistic regression analysis showed that IL-6,IL-2,and Tfh were independent risk factors for the occurrence of URIF(OR＞1,P＜0.05).The area under the curve(AUC=0.974)of peripheral blood Tfh combined with IL-6 and IL-21 for diagnosis of URIF was higher than that predicted by each index alone,according to ROC analysis(P＜0.05).Five drugs targeting IL-6 or IL-21 with potential therapeutic effects on URIF were detected and screened through the TTD database.Conclusions:The levels of Tfh,IL-6 and IL-21 in the pe-ripheral blood of patients with URIF were abnormally elevated,and CXCR5,Bcl-6 and IL-21 were abnormally ex-pressed in the endometrium of patients with URIF,suggesting that Tfh cells and their cytokines are closely related to the occurrence and development of URIF.The combined prediction of these indicators has good diagnostic val-ue and may serve as a therapeutic target.

Pectate lyase is widely applied in ramie degumming and fabric bioscouring in the textile industry. Compared to conventional processes that involve high alkaline and high temperature treatment, enzyme based treatments have significant advantages in fibers protectiveness, improved efficiency of refining, reduced energy consumption and pollution. Hence, it would be highly desirable to construct high-yield alkaline pectate lyase engineered strains and reduce the pectate lyase production cost. In the previous study, pectate lyase gene pel from Bacillus subtilis168 was expressed in Pichia pastoris GS115 after codon usage optimization based on the vector pHBM905A. To improve the expression level, the vector pHBM905BDM with optimized promoter and signal peptide was used to express the optimized gene pels in GS115. The transformant had increased activity from 68 U/mL to 100 U/mL with the improvement in the transcription level by 27% measured by qPCR. The transformants were further screened on pectin plates, where higher halo forming strains were picked for shake-flask fermentation and strain GS115-pHBM905BDM-pels4 showed the highest activity of 536 U/mL. Then plasmid pPIC9K-pels was constructed and electroporated into the GS115-pHBM905BDM-pels4 cells. Subsequently, high-copy transformant was screened by using the medium containing antibiotics G418, strain GS115-pHBM905BDMpPIC9K- pels1 was identified with increased activity of 770 U/mL and the copy number of pels was 7 confirmed by qPCR. Finally, the activity of pectate lyase produced by GS115-pHBM905BDM-pPIC9K-pels1reached to 2 271 U/mL in a 5-L fermentor. The activity of pectate lyase in our study reached the highest level of expression in P. pastoris, showing good application potential in the textile industry.