Objective This study aimed to investigate the efficacy of modified endoscopic autologous cartilage eustachian tube pharyngeal orifice tuboplasty(MEACETT)in patients with patulous eustachian tube(PET).Meth-ods A retrospective analysis was conducted on the clinical data of 27 patients(30 ears)diagnosed with PET who underwent MEACETT.Autologous cartilage was used through the incision at the posterior end of the inferior turbi-nate and filled into the lateral wall of the pharyngeal orifice of the eustachian tube.Without affecting the movement function of the eustachian tube during swallowing,the collapse of the pharyngeal orifice was fully filled.Before and after the surgery,the visual analogue scale(VAS),the eustachian tube dysfunction questionnaire-7(ETDQ-7)and hospital anxiety and depression scale(HADS)was used for assessment to evaluate the surgical efficacy.Results There was no significant difference in depression scores before and after surgery(P＞0.05).However,postopera-tive anxiety scores,ETDQ-7 scores,and VAS scores were significantly lower than preoperative scores(P＜0.05).Among the 27 patients,9 showed significant symptom relief,13 exhibited partial relief,and 5 had no significant change compared to preoperative symptoms.The overall response rate of the treatment(significant relief and partial relief)was 81.48％(22/27).All surgeries were successfully performed.Except for secretory otitis media occurring in 2 cases,no major complications were observed.Conclusion MEACETT demonstrates significant symptom relief in PET patients,with high surgical safety and low complication rates,making it worthy of clinical promotion.

Objective To evaluate the diagnostic efficacy of the R value in tubomanometry(TMM)for the di-agnosis of patulous eustachian tube(PET).Methods The clinical data of 58 patients with PET and 65 controls were retrospectively analyzed.TMM was performed on both groups under nasopharyngeal pressures of 30,40,and 50 mbar respectively.The diagnostic efficacy of the R value for PET was evaluated through receiver operating char-acteristic(ROC)curves.Results In the control group,the average R values under nasopharyngeal pressures of 30,40,and 50 mbar were 0.86±0.50,0.76±0.41,and 0.68±0.34 respectively.In contrast,the corresponding R values in the PET group were significantly lower,which were 0.56±0.38,0.50±0.36,and 0.46±0.38 respec-tively.According to the ROC curve analysis,the areas under the curve(AUC)at these pressures were 0.62,0.74,and 0.74 respectively.The specificity and sensitivity of the R value under nasopharyngeal pressures of 30,40,and 50 mbar were 76.90％and 54.30％,74.60％and 68.10％,86.90％and 54.30％,respectively.Under pressures of 30,40,and 50 mbar,the incidence rates of R＞1 in the control group and the PET group were 29.23％(38/130)and 12.77％(12/94)(x2=8.69,P=0.003),20.00％(26/130)and 6.38％(6/94)(x2=7.20,P=0.007),10.00％(13/130)and 3.19％(3/94)(x2=2.87,P=0.09)respectively.Conclusion Although the low R value in TMM reflects the presence of PET to some extent,it does not provide adequate sensitivity and specificity to serve as an independent diagnostic criterion for PET.

OBJECTIVE To explore the significance of pharmaceutical care through the diagnosis and treatment of a patient with exogenous insulin autoimmune syndrome(EIAS),combined with the analysis of literature reports.METHODS Clinical pharmacist participated in the diagnosis and treatment process of one case of EIAS.Based on the characteristics of the patient's condition,the pharmacist provided medication suggestions and formulated pharmaceutical monitoring measures.At the same time,the pharmacist searched for relevant literature on insulin autoimmune syndrome(IAS)and EIAS,extracted data(gender,age,occurrence time,laboratory tests,clinical symptoms,intervention and outcome),and conducted analysis.RESULTS Based on the patient's medication information in the past 3 years,clinical pharmacist determined that the EIAS was likely caused by insulin aspartate 30.The clinician adopted the clinical pharmacist's suggestion to discontinue insulin and switch to oral hypoglycemic drugs.The patient improved after treatment.The literature analysis showed that among the 257 patients with IAS reported,212 cases were caused by drugs;among them,23 cases were caused by lipoic acid,and 56 cases were caused by exogenous insulin.There were no significant differences in age,glycosylated hemoglobin,and body mass index between the two groups.The lowest blood glucose level in the lipoic acid group was significantly lower than that in the exogenous insulin group(P＜0.05).The proportion of females and the proportion of fasting insulin≥1 000 μU/mL were significantly higher in the lipoic acid group than in the exogenous insulin group(P＜0.05).CONCLUSIONS Compared with EIAS,lipoic acid-induced IAS usually causes more severe hypoglycemia,and the fasting insulin level is usually higher than 1 000 μU/mL,which is more common in female patients.The participation of clinical pharmacists in the diagnosis and treatment of EIAS can help improve the diagnosis and treatment level of similar rare diseases and ensure the safety of patients'medication.

Objective This study aimed to investigate the efficacy of modified endoscopic autologous cartilage eustachian tube pharyngeal orifice tuboplasty(MEACETT)in patients with patulous eustachian tube(PET).Meth-ods A retrospective analysis was conducted on the clinical data of 27 patients(30 ears)diagnosed with PET who underwent MEACETT.Autologous cartilage was used through the incision at the posterior end of the inferior turbi-nate and filled into the lateral wall of the pharyngeal orifice of the eustachian tube.Without affecting the movement function of the eustachian tube during swallowing,the collapse of the pharyngeal orifice was fully filled.Before and after the surgery,the visual analogue scale(VAS),the eustachian tube dysfunction questionnaire-7(ETDQ-7)and hospital anxiety and depression scale(HADS)was used for assessment to evaluate the surgical efficacy.Results There was no significant difference in depression scores before and after surgery(P＞0.05).However,postopera-tive anxiety scores,ETDQ-7 scores,and VAS scores were significantly lower than preoperative scores(P＜0.05).Among the 27 patients,9 showed significant symptom relief,13 exhibited partial relief,and 5 had no significant change compared to preoperative symptoms.The overall response rate of the treatment(significant relief and partial relief)was 81.48％(22/27).All surgeries were successfully performed.Except for secretory otitis media occurring in 2 cases,no major complications were observed.Conclusion MEACETT demonstrates significant symptom relief in PET patients,with high surgical safety and low complication rates,making it worthy of clinical promotion.

Objective To evaluate the diagnostic efficacy of the R value in tubomanometry(TMM)for the di-agnosis of patulous eustachian tube(PET).Methods The clinical data of 58 patients with PET and 65 controls were retrospectively analyzed.TMM was performed on both groups under nasopharyngeal pressures of 30,40,and 50 mbar respectively.The diagnostic efficacy of the R value for PET was evaluated through receiver operating char-acteristic(ROC)curves.Results In the control group,the average R values under nasopharyngeal pressures of 30,40,and 50 mbar were 0.86±0.50,0.76±0.41,and 0.68±0.34 respectively.In contrast,the corresponding R values in the PET group were significantly lower,which were 0.56±0.38,0.50±0.36,and 0.46±0.38 respec-tively.According to the ROC curve analysis,the areas under the curve(AUC)at these pressures were 0.62,0.74,and 0.74 respectively.The specificity and sensitivity of the R value under nasopharyngeal pressures of 30,40,and 50 mbar were 76.90％and 54.30％,74.60％and 68.10％,86.90％and 54.30％,respectively.Under pressures of 30,40,and 50 mbar,the incidence rates of R＞1 in the control group and the PET group were 29.23％(38/130)and 12.77％(12/94)(x2=8.69,P=0.003),20.00％(26/130)and 6.38％(6/94)(x2=7.20,P=0.007),10.00％(13/130)and 3.19％(3/94)(x2=2.87,P=0.09)respectively.Conclusion Although the low R value in TMM reflects the presence of PET to some extent,it does not provide adequate sensitivity and specificity to serve as an independent diagnostic criterion for PET.

AIM:To investigate the expression of AU-rich element RNA-binding factor 1(AUF1),an RNA-binding protein,in hepatocellular carcinoma(HCC),and to explore its potential role in HCC progression through regula-tion of metabolism-related genes.METHODS:A tissue microarray containing 99 HCC samples and 95 adjacent nontu-morous liver tissues was used to assess AUF1 expression.The associations between AUF1 expression and HCC clinical pa-rameters were analysed using the GEPIA and UALCAN databases.The AUF1 gene was knocked down in human hepato-blastoma HepG2 cells by siRNA,and transcriptomic and TMT quantitative proteomic analyses were performed to identify alterations in metabolism-related genes.RESULTS:The AUF1 expression was significantly elevated in HCC tissues and correlated with a poor prognosis.Knockdown of AUF1 in HepG2 cells resulted in reduced cell viability and increased apop-tosis.Integrative analyses of transcriptomic and proteomic data revealed that AUF1 knockdown in HepG2 cells led to up-regulation of carboxylesterase 3(CES3),fibrinogen gamma chain(FGG)and 4-hydroxy-2-oxoglutarate aldolase 1(HOGA1),and down-regulation of lamin B receptor(LBR),riboflavin kinase(RFK),sterol O-acyltransferase 1(SOAT1)and TWIST neighbor(TWISTNB).Clinical data from GEPIA and UALCAN databases suggested that the expression of these metabolism-related genes in HCC patients exhibited an opposite trend.CONCLUSION:Our findings suggest that AUF1 is highly expressed in HCC,and may contribute to tumor progression and poor prognosis by modulating the expres-sion of a series of metabolism-related genes.

Objective:To investigate the additional prognostic value of coronary CT angiography (CCTA)-based flow reserve fraction (CT-FFR) over semi-quantitative CCTA risk scores in predicting the occurrence of major adverse cardiovascular events (MACE) in type 2 diabetic patients.Methods:A total of 231 patients with type 2 diabetes mellitus who underwent CCTA at Lanzhou University from May 2020 to April 2021 were retrospectively enrolled. Clinical baseline data were collected, and patients were divided into a MACE-positive group (20 cases) and a MACE-negative group (211 cases) based on follow-up results. The CCTA images of all patients were analyzed by semi-quantitative CCTA risk score, which included coronary artery disease reporting and data system classification, segment involvement score, segmental stenosis score, Leaman score, and Leiden score. CT-FFR measurements of CCTA data of all patients were performed using Coronary Analysis software. t-test, U-test, and χ2 test were used to compare baseline parameters between MACE-positive and MACE-negative groups. The Cox proportional hazards regression model was used to analyze the relationship between semi-quantitative CCTA risk score and CT-FFR with the occurrence of MACE, and the area under the curve (AUC) of the receiver operating characteristic (ROC) was used to calculate the efficacy of the prediction model established by the semi-quantitative CCTA risk score combined with CT-FFR. Results:There was no statistically significant difference in baseline data between patients in the MACE-positive and MACE-negative groups ( P>0.05), and there were significant differences in semi-quantitative CCTA risk scores and CT-FFR ( P<0.05). Multivariate Cox proportional risk regression analysis of CT-FFR≤0.80 ( HR=3.860, 95% CI 1.477-10.087, P=0.006) and Leaman score≥5 ( HR=5.210, 95% CI 1.136-23.908, P=0.029) were the best and independent predictors for the occurrence of MACE events. The combined CT-FFR and Leaman score prediction model (AUC=0.791, 95% CI 0.733-0.842, P<0.001) was a better predictor of MACE than CT-FFR alone (AUC=0.718, 95% CI 0.656-0.775, P<0.001) and Leaman score alone (AUC=0.711, 95% CI 0.648-0.768, P<0.001) both had better predictive efficacy ( Z=2.62, 1.98, P=0.009, 0.047). Conclusion:CT-FFR independently predict the occurrence of MACE in patients with type 2 diabetes mellitus and significantly improve the predictive capacity of semi-quantitative CCTA risk score for MACE.

Lung cancer (LC) complicated with interstitial lung disease (ILD) is a relatively common comorbidity in clinical practice, and its management remains complex and challenging. As one of the primary treatment modalities for LC, radiotherapy carries a risk of inducing acute exacerbation of ILD and severe radiation pneumonitis; therefore, it should be used with caution in LC-ILD patients. Advances in radiotherapy technology now allow for more precise tumor targeting and better sparing of healthy lung tissues, potentially offering greater therapeutic benefits for these patients. In this article, current status and recent research progress in the application of radiotherapy in LC-ILD were reviewed, aiming to provide theoretical basis and reference for clinical practice.

AIM:To investigate the expression of AU-rich element RNA-binding factor 1(AUF1),an RNA-binding protein,in hepatocellular carcinoma(HCC),and to explore its potential role in HCC progression through regula-tion of metabolism-related genes.METHODS:A tissue microarray containing 99 HCC samples and 95 adjacent nontu-morous liver tissues was used to assess AUF1 expression.The associations between AUF1 expression and HCC clinical pa-rameters were analysed using the GEPIA and UALCAN databases.The AUF1 gene was knocked down in human hepato-blastoma HepG2 cells by siRNA,and transcriptomic and TMT quantitative proteomic analyses were performed to identify alterations in metabolism-related genes.RESULTS:The AUF1 expression was significantly elevated in HCC tissues and correlated with a poor prognosis.Knockdown of AUF1 in HepG2 cells resulted in reduced cell viability and increased apop-tosis.Integrative analyses of transcriptomic and proteomic data revealed that AUF1 knockdown in HepG2 cells led to up-regulation of carboxylesterase 3(CES3),fibrinogen gamma chain(FGG)and 4-hydroxy-2-oxoglutarate aldolase 1(HOGA1),and down-regulation of lamin B receptor(LBR),riboflavin kinase(RFK),sterol O-acyltransferase 1(SOAT1)and TWIST neighbor(TWISTNB).Clinical data from GEPIA and UALCAN databases suggested that the expression of these metabolism-related genes in HCC patients exhibited an opposite trend.CONCLUSION:Our findings suggest that AUF1 is highly expressed in HCC,and may contribute to tumor progression and poor prognosis by modulating the expres-sion of a series of metabolism-related genes.

Image 1.