Objective: To characterize the sequence polymorphism of HLA-A, -B, and -C loci in the northern Han Chinese population and to evaluate their selection signals and phylogenetic patterns based on long-read sequencing data. Methods: A total of 408 unrelated healthy blood donors were enrolled. Long-read sequencing of HLA-A, -B, and -C loci was performed using the PacBio Sequel II platform. The Ewens-Watterson neutrality test, sliding-window nucleotide diversity (π) and Tajima′s D analyses were conducted, together with genetic distance heatmaps, principal coordinates analysis (PCoA), and maximum likelihood phylogenetic analysis to assess polymorphism distribution, selection signals, and phylogenetic structure across the three loci. Results: The analyzed sequence lengths for the HLA-A, -B, and -C loci were 3 257 bp, 3 794 bp, and 3 831 bp, respectively; the numbers of locus-specific sequence types were 44, 82, and 56, with corresponding locus-specific sequence type diversities of 0.905 2, 0.964 9, and 0.939 8, respectively. The Ewens-Watterson test showed no significant deviation from neutrality (P>0.05). Sliding-window analysis revealed elevated π and Tajima′s D values in exons 2 and 3 as well as in certain intronic regions of HLA-A and HLA-B, whereas HLA-C exhibited relatively lower overall diversity. Genetic distance heatmaps, PCoA, and phylogenetic analysis consistently showed clear clustering in HLA-A and HLA-C, while HLA-B displayed the highest phylogenetic heterogeneity. Conclusion: HLA-A, -B, and -C gene sequences in the northern Chinese Han population exhibit high levels of polymorphism and marked regional heterogeneity. HLA-B shows greater diversity, stronger signals of selection, and more complex phylogenetic structure compared with HLA-A and HLA-C.

Objective:To investigate the stress status and coping style of postgraduate students majoring in stomatology, and analyze the factors influencing stress status, and to provide a basis for promoting the mental health of postgraduate students of stomatology.Methods:From May to June 2022, a cluster of postgraduate students in the stomatology school of a university were selected by cluster sampling, and their stress status and coping style were surveyed using a modified stress status questionnaire for postgraduate students of stomatology and the Simplified Coping Style Questionnaire. A total of 142 usable questionnaires were returned, and the effective response rate was 98.61% (142/144). SPSS 25.0 was used to perform the t test, analysis of variance, and multiple linear regression analysis. Results:For all the postgraduate students of stomatology, the overall stress score was (2.46±0.66). The employment stress (3.19±1.01) and academic stress (3.00±0.61) were the top two stress sources. Their stress coping style tended to be mature in general. Stress status and coping style differed in postgraduate students of different types and features. The factors influencing stress status among postgraduate students were family economic status ( β=-0.294, P=0.002), self-health status ( β=-0.184, P=0.012), and stress coping style (positive coping style, β=-0.515, P<0.001; negative coping style, β=0.476, P<0.001). Conclusions:Efforts should be focused on employment and academic work to relieve the stress of postgraduate students. At the same time, targeted measures should be taken according to stress-related factors to improve their mental health level and stress coping ability.

Purpose To investigate the clinicopathologic,molecular genetic features of metastatic adenoid cystic carcinoma(ACC)of the liver.Methods The histological morphological characteristics,immunophenotype and prog-nosis of metastatic ACC in 4 cases of liver biopsy specimens collected were retrospectively analyzed,and the genetic characteristics were analyzed by fluorescence in situ hybridization(FISH).Results There were 3 male patients and 1 female patients,ranging in age from 41 to 66 years,with an average age of 52.5 years.Pathologically,the tumor cells showed a variety of tubular,cribriform or solid structures.The tumor cells had a bland morphology,composed of two layers of cells:the luminal cells with eosinophilic cytoplasm and round nuclei,and the peripheral cell with deeply stained,triangular or irregular nuclei.Immunohistochemistry showed that CK7,CK19 and CD117 were positive in lu-minal cells.p63,Calponin,SMA and CK5/6 were positive in peripheral cells.TTF-1,Napsin A,CD10,CD56 and CRP were negative,and Ki67 proliferation index was 8％-20％.4 patients had a history of adenoid cystic carcinoma of lung or submandibular gland.FISH results showed that MYB gene rearrangement in case 3 and MYB gene amplifica-tion in case 2.All 4 patients were diagnosed with liver metastatic ACC.After 27 to 65 months of follow-up,all the 4 patients had multiple systemic metastases such as bone and lymph nodes,of which 1 patient died of disease 36 months after surgery,and 3 patients survived with tumor.Conclusion The histological morphology of metastatic ACC in the liver is similar to that of benign and malignant tumors and metastatic tumors of the primary bile duct in the liver,espe-cially when it presents as small tubular form.The characteristic morphology of the two layers of epithelia should be carefully observed during diagnosis,and the patient history should be asked.Combined with the histochemical results and molecular detection,it can distinguish from primary and metastatic tumors such as hepatic bile duct adenoma,in-trahepatic small bile duct type cholangiocarcinoma,hepatic metastatic epithelial-myoepithelial carcinoma and metastatic adenocarcinoma.

Objective To compare the macular retinal thickness characteristics of diabetic kidney disease(DKD)patients with different blood pressure levels and explore the relationship between blood pressure and macular retinal damage in DKD patients.Methods A total of 435 DKD patients were selected and divided into four groups based on medical history and blood pressure:the non-hypertensive group(NH group,n=100),the well-controlled blood pressure group(G0 group,n=176),the grade 1 hypertension group(G1 group,n=118)and the grade 2 hypertension group(G2 group,n=41).General information,routine laboratory test results as well as the average thickness of the macular retinal nerve fiber layer(RNFL),ganglion cell layer(GCL),ganglion cell complex(GCC),choroidal layer(CL)and central macular retinal thickness(CMT)were compared between the four groups.The correlation between macular retinal thickness in both eyes and clinical data was analyzed.Results Compared with the G1 group and the G2 group,the G0 group had a longer duration of hypertension.Compared to the NH group,the G2 group had higher fasting plasma glucose(FPG).Compared to the G0 group,the G1 group and the G2 group had higher FPG,and the G2 group had higher glycated hemoglobin(HbA1c)and lower estimated glomerular filtration rate(eGFR).Compared to the NH group,the G0 group had decreased thickness in the GCL and GCC(P<0.05).The macular retinal thickness of the GCL and GCC in both eyes was negatively correlated with diastolic blood pressure(r=-0.158 and-0.195,respectively,P<0.05).Conclusion Macular retinal thickness is helpful in assessing the long-term effects of hypertension on optic nerve and microvascular damage in DKD patients.

Objective:To investigate the impact of the number of examined lymph nodes (ELN) on survival outcomes in gastric cancer patients with postoperative pathological stage pN3b.Methods:This retrospective cohort study included 279 pN3b gastric cancer patients who underwent D2 gastrectomy at Nanfang Hospital, Southern Medical University (September 2008 to April 2023), with 35 patients receiving combination chemotherapy and anti-PD-1 therapy (immunotherapy group) and 244 receiving adjuvant chemotherapy alone (nonimmunotherapy group). Additionally, 422 patients with pN3b from the SEER database (2005 to 2020) were collected as an external validation cohort to determine the optimal cutoff value for the number of lymph nodes examined in the nonimmunotherapy group. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS) in the nonimmunotherapy group of the Nanfang Hospital cohort, stratified by whether the number of examined lymph nodes was above or below the ELN optimal cutoff value. These findings were subsequently validated in the SEER cohort.Results:The optimal ELN cutoff value (34 nodes) was determined using X-tile software and by constructing an ELN-HR fitting model with inflection point identification. In the nonimmunotherapy group, patients with ELN >34 exhibited significantly prolonged survival compared to ELN ≤34 (median OS: 25.0 (95%CI:20.5-29.5) to 17.0 (95%CI:12.7-21.3) months, P=0.004; median RFS: 19.0 (95%CI:15.6-22.4) to 13.0 (95%CI:9.5-16.5) months, P=0.048). Multivariate Cox analysis also showed ELN >34 to be an independent protective factor for both OS (HR=0.576, 95%CI: 0.397-0.836) and RFS (HR=0.701, 95%CI: 0.492-0.998). In the SEER cohort, ELN >34 was associated with a 5-month OS extension (19 to 14 months, P=0.065), with multivariate analysis supporting its independent prognostic significance (HR=0.729, 95%CI: 0.580-0.915, P=0.006). Notably, in the immunotherapy group, patients with ELN >34 ( n=30) achieved a median OS of 41 months, but the median OS had not been reached in the ELN ≤34 group ( n=5) (1 death at 48 months). Conclusion:Higher ELN (>34) correlates with improved survival in nonimmunotherapy-treated pN3b gastric cancer patients. However, in pN3b gastric cancer patients treated with immunotherapy, the optimal ELN threshold requires further exploration to determine.

Objective:To explore the relationship between medical students'family function and anxiety/depression,and the mediating role of loneliness in this relationship.Methods:A total of 577 medical students were surveyed using stratified cluster sampling.Questionnaires assessed family function,loneliness,anxiety,and depression.Spearman correlation analysis was used to examine the relationships among family function,loneliness,anxiety,and depression.The mediating effects were tested using SPSS 26.0 PROCESS program model 4.Results:Medical students'family function,loneliness,anxiety,and depression scores were 8.00(5.00,10.00),16.00(12.00,19.00),3.00(2.00,4.00),and 3.00(2.00,4.00),respectively.Spearman correlation analysis showed that family function was negatively correlated with loneliness(r=-0.337),anxiety(r=-0.237),and depression(r=-0.257)(all P＜0.01).Loneliness was positively correlated with anxiety(r=0.394)and depression(r=0.392)(both P＜0.01).Anxiety was positively correlated with depression(r=0.746,P＜0.01).Family function negatively predicted anxiety(β=-0.118,P＜0.01),depression(β=-0.105,P＜0.01),and loneliness(β=-0.322,P＜0.01).Loneliness positively predicted anxiety(β=0.348,P＜0.01)and depression(β=0.346,P＜0.01).Loneliness played a partial mediating role in the relationship of family function with anxiety and depression among medical students,with mediating effects of 49.0%and 43.2%,respectively.Conclusions:Family function not only directly affects medical students'anxiety and depression but also indirectly affects them by influencing loneliness.Therefore,improving medical students'family function can effectively reduce their loneliness,thereby helping to alleviate anxiety and depression.

Objective:To discuss the effects of kallikrein 5(KLK5)overexpression on the proliferation,invasion and cisplatin(DDP)sensitivity of cervical cancer cells,and to clarify its mechanism.Methods:Western blotting method was used to verify the stable transfection and overexpression of KLK5 in the cervical cancer cell(ME180-OE-KLK5).The cervical cancer ME180-NC-KLK5 and ME180-OE-KLK5 cells in logarithmic growth phase were subcutaneously inoculated into the nude mice to establish the subcutaneous xenograft models.After successful modeling,the mice were randomly divided into normal saline control group(NC-KLK5+0.9％NaCl group),DDP treatment group(NC-KLK5+DDP group),KLK5 overexpression group(OE-KLK5+0.9％NaCl group)and KLK5 overexpression combined with DDP group(OE-KLK5+DDP group),with 5 mice in each group.The nude mice in NC-KLK5+DDP group and OE-KLK5+DDP group were given intraperitoneal injection of DDP at a dose of 5 mng·kg-1;the nude mice in NC-KLK5+0.9％NaCl group and OE-KLK5+0.9％NaCl group were given intraperitoneal injection of normal saline at a dose of 0.01 mL·g-1.The body weights of nude mice were measured every 2 d,and the long diameter and short diameter of the tumors were recorded to calculate the tumor volume and plot the tumor growth curve.At 24 h after the last administration on day 14,the nude mice were sacrificed,and the tumors were dissected and weighed.HE staining method was used to observe the pathomorphology of tumor tissue in the nude mice in various groups;immunohistochemistry staining method was used to observe the expression levels of KLK5,Ki67 and matrix metalloproteinase-9(MMP-9)proteins in the tumor tissues of the nude mice in various groups.Results:Compared with ME180-NC-KLK5 cells,the expression level of KLK5 protein in ME180-OE-KLK5 cells was increased(P＜0.05).In the first week after subcutaneous xenograft inoculation,the nude mice in various groups showed good feeding and activity status,and their body weights gradually increased.The drug administration phase started from the second week.During the drug treatment period,the feeding and activity status as well as body weight of the nude mice in NC-KLK5+0.9％NaCl group showed no significant changes compared with the first week;compared with NC-KLK5+0.9％NaCl group,the nude mice in NC-KLK5+DDP group began to show loss of appetite,no increase in body weight,and decreased activity.During the drug treatment period in the third week,the feeding and activity status of the nude mice in NC-KLK5+0.9％NaCl group showed no significant changes compared with the second week,while they began to show no increase in body weight;compared with NC-KLK5+0.9％NaCl group,the feeding and activity status of the nude mice in NC-KLK5+DDP group were significantly weakened,and their body weights decreased.Compared with NC-KLK5+0.9％NaCl group,the volume of xenograft tumor in NC-KLK5+DDP group was decreased(P＜0.01);compared with NC-KLK5+DDP group,the volume of xenograft tumor OE-KLK5+DDP group was significantly increased(P＜0.001);compared with NC-KLK5+0.9％NaCl group,the volume of xenograft tumor of the nude mice in OE-KLK5+0.9％NaCl group was increased(P＜0.001);compared with OE-KLK5+0.9％NaCl group,the volume of xenograft tumors in the nude mice in OE-KLK5+DDP group showed no statistically significant difference(P＞0.05).Compared with NC-KLK5+0.9％NaCl group,the weight of xenograft tumor of the nude mice in NC-KLK5+DDP group was decreased(P＜0.05);compared with NC-KLK5+DDP group,the weight of xenograft tumors of the nude mice in OE-KLK5+DDP group was significantly increased(P＜0.001);compared with NC-KLK5+0.9％NaCl group,the weight of xenograft tumor of the nude mice in OE-KLK5+0.9％NaCl group was increased(P＜0.001);compared with OE-KLK5+0.9％NaCl group,the weight of xenograft tumors of the nude mice in OE-KLK5+DDP group showed no statistically significant difference(P＞0.05).Compared with NC-KLK5+0.9％NaCl group,the xenograft tumor cells of the nude mice in OE-KLK5+0.9％NaCl group showed greater nuclear heterogeneity;the xenograft tumor cells of the nude mice in OE-KLK5+DDP group and NC-KLK5+DDP group showed cytomorphological changes,manifested as nuclear pyknosis and fragmentation,reduced cell volume,and the appearance of necrosis and apoptosis.Compared with NC-KLK5+DDP group,the degree of necrosis in xenograft tumor of the nude mice in OE-KLK5+DDP group was more pronounced.Compared with NC-KLK5+0.9％NaCl group,the expression levels of KLK5,Ki67 and MMP-9 proteins in xenograft tumor tissue of the nude mice in NC-KLK5+DDP group were decreased(P＜0.05);compared with NC-KLK5+DDP group,the expression levels of KLK5,Ki67,and MMP-9 proteins in xenograft tumor tissue of the nude mice in OE-KLK5+DDP group were increased(P＜0.001);compared with NC-KLK5+0.9％NaCl group,the expression levels of KLK5,Ki67 and MMP-9 proteins in xenograft tumor tissue of the nude mice in OE-KLK5+0.9％NaCl group were increased(P＜0.001);compared with OE-KLK5+0.9％NaCl group,the expression levels of KLK5,Ki67 and MMP-9 in xenograft tumor tissue of the nude mice in OE-KLK5+DDP group showed no statistically significant differences(P＞0.05).Conclusion:KLK5 overexpression can promote the growth of subcutaneous xenograft tumors of cervical cancer ME 180 cells treated with DDP,up-regulate the expressions of Ki67 and MMP-9 in the xenograft tumor tissue,and reduce the sensitivity of the xenograft tumor to DDP.

Objective To investigate and analyze the relationship between bone metabolism indicators,bone mineral density(BMD)T value,osteoporosis and fracture risk in patients with type 2 diabetes mellitus(T2DM).Methods A retrospective analysis was conducted on the clinical data of 175 patients with T2DM ad-mitted to the hospital from January to August 2024.According to the T value,they were divided into the oste-oporosis group(n=65),the osteopenia group(n=50),and the normal bone mass group(n=60).The general clinical data and bone metabolism indicators were compared among the three groups,including 25-hydroxyvi-tamin D3[25-(OH)D3],osteocalcin(OC),calcitonin(CT),type Ⅰ procollagen amino-terminal peptide(PⅠNP)and β-collagen degradation products(β-CTX),parathyroid hormone(PTH),T value,and the differences between the fracture risk assessment tools[FRAX,including 10-year major osteoporotic fracture(MOF)risk and 10-year hip fracture(HF)risk],analyzed the influencing factors of osteoporosis in T2DM patients,as well as the relationship between bone metabolism indicators,T values and fracture risk.Results The results of un-ivariate and multivariate logistic regression analyses showed that PⅠNP and β-CTX were risk factors for oste-oporosis in patients with T2DM,while estradiol(E2),testosterone(T),25-(OH)D3,OC,and T values were all protective factors(P<0.05).The 10-year risks of MOF and HF in the osteoporosis group were higher than those in the osteopenia group and the normal bone mass group,while the 10-year risks of MOF and HF in the osteopenia group were higher than those in the normal bone mass group,the differences were statistical-ly significant(P<0.05).According to Pearson correlation analysis,25-(OH)D3 and T values were negatively correlated with the risks of 10-year MOF and HF,while OC,PⅠNP,and β-CTx were positively correlated with the risks of 10-year MOF and HF(P<0.05),CT and PTH were not correlated with the risks of 10-year MOF and HF(P>0.05).Conclusion Bone metabolism indicators and BMD are important influencing factors for the occurrence of osteoporosis in patients with T2DM,and they are closely related to the occurrence of os-teoporotic fractures.Clinically,the monitoring of bone metabolism and BMD in patients with T2DM should be strengthened.

Objective To evaluate the therapeutic efficacy for surgical treatments among patients with hepatic cystic echinococcosis in Gansu Province from 2006 to 2023, so as to provide insights into optimization of the diagnosis and treatment strategies against hepatic cystic echinococcosis. Methods The demographic and clinical data of all echinococcosis cases included in central government fiscal transfer payment program for echinococcosis control and undergoing surgical treatments in Gansu Province from 2006 to 2023 were captured. Hepatic cystic echinococcosis patients with complete medical records and follow-up data were included in the study, and patients’ characteristics, including hospital where patients received diagnosis and treatment, methods of case identification, year of surgery, classification of lesions, number of lesions, size of lesions, course of disease, surgical methods, and post-surgical follow-up data. The cure and recurrence of hepatic cystic echinococcosis were evaluated according to the Guidelines for Management of Echinococcosis Patients in the Central Government Fiscal Transfer Payment Program, and the cure and recurrent rates were calculated. Results Data were collected from 1 686 surgical patients with hepatic cystic echinococcosis. According to the inclusion and exclusion criteria, 1 222 hepatic cystic echinococcosis patients undergoing surgical treatments were included during the period from 2006 to 2022, including 1 166 cured patients (95.42%) and 88 patients with postsurgical recurrence (7.20%), and the cure rate of surgical treatments appeared a tendency towards a rise among patients with hepatic cystic echinococcosis from 2008 to 2022 (χ²_trend = 19.39, P < 0.05). The cure rates of hepatic cystic echinococcosis were 100% (177/177), 94.81% (128/135) and 94.62% (861/910) among patients detected through regular physical examinations, screened by the central government fiscal transfer payment program for echinococcosis control, and those who passively sought healthcare services, respectively (χ² = 9.95, P < 0.05). The cure rates of hepatic cystic echinococcosis were 95.96% (1 046/1 090) among patients with a disease course of 2 years and less and 90.90% (120/132) among patients with a disease course of over 2 years (χ² = 6.87, P < 0.05), and there were significant differences in the cure rates among patients with hepatic cystic echinococcosis in terms of number of lesions (χ² = 24.44, P < 0.05) and surgical methods (P < 0.05). The cure rate of hepatic cystic echinococcosis patients was significantly higher following initiation of the central government fiscal transfer payment program for echinococcosis control (96.06%, 1 096/1 141) than before the program (86.42%, 70/81) (χ² = 16.06, P < 0.05), and the cure rate of hepatic cystic echinococcosis patients was significantly higher in designated hospitals (96.48%, 741/768) than in non-designated hospitals (93.37%, 366/392) (χ² = 5.78, P < 0.05). The median follow-up period was 4 (interquartile range, 7) years among 1 222 hepatic cystic echinococcosis patients undergoing surgical treatments. The recurrent rate of hepatic cystic echinococcosis appeared a tendency towards a decline from 2008 to 2022 (χ²_trend = 36.86, P < 0.05), with a reduction from 23.08% (9/39) in 2008 to 1.85% (1/54) in 2021, and the post-surgical recurrence rate of hepatic cystic echinococcosis was lower following initiation of the central government fiscal transfer payment program for echinococcosis control (5.87%, 67 / 1 141) than before the program (25.93%, 21/81) (χ² = 45.51, P < 0.05). In addition, the post-surgical recurrence rate of hepatic cystic echinococcosis was higher in non-designated hospitals (10.46%, 41/392) than in designated hospitals (5.60%, 43/768) (χ² = 9.12, P < 0.05), and there was a significant difference in the post-surgical recurrence rate among patients with hepatic cystic echinococcosis in terms of surgical methods (P < 0.05), with the highest recurrence rate (11.54%) seen among patients undergoing percutaneous fine-needle aspiration of cyst fluids-based surgical procedures (P < 0.05). Conclusion Since the initiation of the central government fiscal transfer payment program for echinococcosis control in Gansu Province in 2006, an increase in the surgical cure rate and a reduction in the recurrence of hepatic cystic echinococcosis had been found among patients with hepatic cystic echinococcosis, indicating a high overall therapeutic efficacy.

Objective:To explore the clinical efficacy of coiling dragon needling plus chin tuck against resistance(CTAR)training for post-stroke deglutition disorders and its impact on surface electromyography.Methods:A total of 100 patients with post-stroke deglutition disorders were randomly divided into two groups,with 50 cases in each group.Both groups received the same CTAR training,and the observation group was treated with additional coiling dragon needling.Both groups were treated for 2 weeks.The clinical efficacy,swallowing function,average value of the maximum amplitude of surface electromyography,quality of life,and the difference in adverse reactions were compared between the two groups.Results:The total effective rate of the observation group was higher than that of the control group(P<0.05).After treatment,the standardized swallowing assessment(SSA),aspiration score,and deglutition disorders score of the videofluoroscopic swallowing study(VFSS)in both groups were significantly lower than those before treatment(P<0.05).The average value of the maximum amplitude of surface electromyography in the relaxed state,dry swallowing state,and the state of swallowing water,and the swallowing quality of life questionnaire(SWAL-QOL)score were all significantly higher than those before treatment in the two groups(P<0.05).After treatment,the SSA score,VFSS aspiration score,and VFSS deglutition disorders score in the observation group were lower than those in the control group(P<0.05),and the average value of the maximum amplitude of surface electromyography in the relaxed state,dry swallowing state,and the state of swallowing water,and the SWAL-QOL score in the observation group were higher than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Compared to CTAR treatment alone,coiling dragon needling plus CTAR treatment can enhance the clinical efficacy in treating patients with post-stroke deglutition disorders,enhancing the contraction ability of swallowing muscles and improving their swallowing function and quality of life.