ObjectiveTo investigate the expression level of HBV cccDNA in patients in the convalescence stage of hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF） and its correlation with HBV markers and liver histopathological changes. MethodsA total of 30 patients in the convalescence stage of HBV-ACL who were hospitalized in The Ninth Hospital of Nanchang from January 2015 to October 2023 were enrolled as liver failure group， and 9 patients with chronic hepatitis B （CHB）， matched for sex and age， were enrolled as control group. The content of HBV cccDNA in liver tissue was measured， and its correlation with clinical data and laboratory markers was analyzed. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and a one-way analysis of variance or the Kruskal-Wallis H test was used for comparison between multiple groups； the Fisher’s exact test was used for comparison of categorical data between groups. A Spearman correlation analysis was performed. ResultsThe liver failure group had a significantly lower content of HBV cccDNA in liver tissue than the control group （-0.92±0.70 log₁₀ copies/cell vs -0.13±0.91 log₁₀ copies/cell， t=2.761， P=0.009）. In the liver failure group， there was no significant difference in the content of HBV cccDNA in liver tissue between the HBeAg-positive patients and the HBeAg-negative patients （P>0.05）； there was no significant difference in the content of HBV cccDNA in liver tissue between the patients with different grades （G0-G2， G3， and G4） of liver inflammatory activity （P>0.05）； there was no significant difference in the content of HBV cccDNA in liver tissue between the patients with different stages （S0-S2， S3， and S4） of liver fibrosis （P>0.05）； there was no significant difference in the content of HBV cccDNA in liver tissue between the patients with negative HBV DNA and those with positive HBV DNA （P>0.05）. For the liver failure group， the content of HBV cccDNA in liver tissue was positively correlated with the content of HBV DNA in liver tissue （r=0.426， P=0.043） and was not significantly correlated with the content of HBV DNA in serum （P>0.05）. ConclusionThere is a significant reduction in the content of HBV cccDNA in liver tissue in the convalescence stage of HBV-ACLF. HBV cccDNA exists continuously and stably in liver tissue and can better reflect the persistent infection and replication of HBV than HBV DNA in serum and liver tissue.

Background Air pollution exposure has a significant impact on maternal and child health. However, the research on the association between ambient ozone (O₃) exposure during pregnancy and the risk of premature birth in newborns is limited, and the conclusions are inconsistent. Objective To investigate the association of ambient O₃ exposure during pregnancy with the risk of preterm birth in Guangdong Province. Methods Data of pregnant women in Guangzhou from 2013 to 2019 and Foshan from 2018 to 2023 were collected, and O₃ concentrations during different trimesters were assessed according to maternal residential addresses. Bilinear interpolation was used to evaluate the concentrations of air pollution. A cohort study design was adopted in our study. Restricted cubic spline curves were used to evaluate the exposure-response relationship between O₃ exposure and preterm birth risk and explore potential exposure threshold of O₃. Logistic regression models were used to evaluate the association of O₃ exposure with preterm birth. Results A total of 702 924 pregnant women were included in this study, of whom 43 051 (6.12%) were preterm. The average O₃ exposure concentrations of pregnant women during the first, second, third, and whole trimesters were 95.51, 97.51, 100.60, and 97.87 μg·m⁻³, respectively. We observed J-shaped associations between O₃ exposure and preterm birth risk during the second, third, and whole trimesters of pregnancy using restricted cubic spline curves. This study found that there were threshold concentrations between O₃ exposure and preterm birth risk during different gestational periods, and the threshold concentrations in the first, second, third, and whole trimesters were 112.32, 99.83, 111.74, and 112.46 μg·m⁻³, respectively. During the second, third, and whole trimesters of pregnancy, after adjusting for maternal age, baby sex, pre-pregnancy body mass index, mode of delivery, baby birth weight, gestational diabetes, and gestational hypertension, the odds ratios (OR) of preterm birth were 1.02 (95%CI: 1.01, 1.04), 1.02 (95%CI: 1.00, 1.03), and 1.17 (95%CI: 1.13, 1.21) for each 10 μg·m⁻³ increase in O₃ concentration above the O₃ threshold. No significant association was found between O₃ exposure and the risk of preterm birth during the first trimester. Conclusion There is a nonlinear association between the risk of preterm birth and O₃ exposure during pregnancy, and higher concentrations of O₃ exposure during pregnancy are associated with the risk of preterm birth. Above the O₃ threshold concentration during pregnancy, especially during the second, third, and whole trimesters, the risk of preterm birth elevates with the increase of O₃ exposure concentrations.

Objective To investigate the effects of DNA demethylation drugs combined with histone deacetylase in-hibitors on fragile X mental retardation 1 neighbor protein (FMR1NB) expression and its promoter methylation in human oral cancer cells and try to find a strategy of weakening the heterogeneity of FMR1NB expression.Methods Human oral cancer cell lines Cal27 and SCC-9 were treated with decitabine (DAC) , an inhibitor of DNA meth-yltransferase, combined with trichostatin A (TSA) and valproic acid (VPA), inhibitors of histone deacetylase.Then reverse transcription-polymerase chain reaction (RT-PCR) , quantitative real-time PCR (qRT-PCR) and Western blot were used to detect the expression of FMR1 NB and pyrosequencing was used to detect the methylation of FMR1NB promoter.Results Compared with the blank control group, DAC and its combination with TSA and VPA significantly induced the expression of FMR1NB mRNA and protein in Cal27 and SCC-9 cells.Compared with DAC alone group, FMR1NB mRNA expression of each DAC-combined drug groups significantly increased, but FMR1NB protein did not significantly change in Cal27 cells; for SCC-9 cells, except for DAC+TSA group, the mRNA and protein levels of FMR1NB significantly increased in all other groups.In addition, there was no signifi-cant difference in the expression of FMR1 NB mRNA and protein between the three-combined drugs group and two-combined drugs groups.Further methylation assay showed that the methylation level of the overall FMR1NB promot-er and its each CpG site measured were reduced to varying degrees in all treatment groups except for three-combina-tion drug group of SCC-9.Conclusion DAC and its combination with TSA and VPA can enhance the expression of FMR1NB by mediating the demethylation of FMR1NB promoter, wherein the enhanced expression effect of the com-bination of the two drugs is stronger, suggesting that they have the potential to weaken the heterogeneity of FMR1NB expression and improve the immunotherapy effect of oral cancer.

Objective:To understand the epidemiological characteristics and spatiotemporal distribution of viral encephalitis in children and adolescents in Henan Province from 2012 to 2023.Methods:The information about viral encephalitis cases from October 1, 2012 to July 26, 2023 were collected from Zhengzhou Children's Hospital (National Children's Regional Medical Center),Henan Provincial Children's Hospital for the analyses on temporal distribution the cases, the severe illness rate, age distribution, pathogen type and imaging findings of the cases.Results:A total of 6 276 cases of viral encephalitis were included in this study after excluding cases with incomplete information. The cases mainly originated from Zhengzhou (38.96%), followed by Zhoukou (9.93%), Xuchang (8.68%), Zhumadian (7.90%) and Pingdingshan (7.39%). The cases in boys accounted for 62.13% and the cases in girls accounted for 37.87%. Most cases (72.45%) occurred in age group 7-13 years. The overall rate of severe illness cases was 4.51% from 2012 to 2023. There were significant differences in severe illness cases among different areas and years ( χ2=5.33, P=0.021; χ2=48.14, P<0.001). Enteroviruses were mainly detected (31.57%), in which Coxsackie virus was predominant (58.37%). Imaging findings showed that cerebral hemisphere damage was most common in children and adolescents with viral encephalitis (54.93%). Conclusions:From 2012 to 2023, more cases of viral encephalitis occurred in boys in Henan. Children and adolescents aged 7-13 years were the main affected group. The prevention of enteroviruses infection, especially Coxsackie virus, needs to be strengthened. Special attention should be paid to the prevention of cerebral hemisphere damage after viral encephalitis diagnosis.

[Abstract] [Objective] To assess the effect of a centrifugal haemocyte separator on platelet counts in patients with neurological immune-mediated disorders during/after therapeutic plasma exchange (TPE). [Methods] This study included 189 patients (108 females and 81 males) who were treated in the department of neurology at Huashan Hospital, Fudan University, from March 2021 to March 2022. A total of 820 TPE treatments were carried out. Each patient received 2 to 5 TPEs, with each TPE amounting to the patient's plasma volume. The peripheral blood cell counts of the patients were evaluated before TPE and after 2 to 5 TPEs. [Results] The duration of a single TPE in this study was 94(84,107) minutes, and the actual volume of a single TPE replacement was 2 456(2 142, 2 785) mL. The number of patients who underwent TPE for 2, 3, 4, and 5 sessions was 17, 28, 18, and 126, respectively. The platelet (PLT) counts of the patients before and after the TPE were 195×10⁹/L (range:150 to 245) and 220×10⁹/L (range:170 to 270), respectively (P<0.05). Consequently, the overall PLT counts exhibited a significant decrease from baseline following TPE, yet the PLT counts remained within the normal range after TPE. Spearman's correlation analysis indicated that platelet loss did not correlate with the duration of TPE (ρ=0.037), the age of the patient (ρ=0.015), or the volume of the single replacement fluid (ρ=0.034), P>0.05, weakly correlated with the number of TPE sessions (ρ=0.017), and moderately correlated with the PLT counts before TPEs (ρ=0.446). [Conclusion] The TPE procedure exhibited a measurable impact on the patients' platelet levels, but the platelet counts remained within the normal range, therefore did not interfere with the patients' subsequent treatment protocols. The decrease in platelet level was correlated with the baseline platelet level before treatment and the number of TPE sessions.

Objective:To investigate the metabolism-related proteins and their presence in the plasma of female androgenetic alopecia (FAGA) patients.Methods:From March 2021 to March 2023, FAGA patients aged 18-50 (FAGA group) and healthy women (HC group) were recruited from the Dermatology Outpatient Department of Huashan Hospital. 3 ml of peripheral venous blood was collected from each participant and centrifuged to obtain plasma. Olink proteomics analysis was performed on the collected plasma, differentially expressed proteins were screened with R language, the diagnostic accuracy of the differentially expressed proteins was assessed using receiver operating characteristic (ROC) curve. Gene ontology (GO) analysis was performed on differentially expressed proteins. Immunofluorescence analysis on hair follicles in the parietal region of the FAGA group and the occipital region of the HC group was performed to validate the differentially expressed proteins identified. SPSS 25.0 software was used to analyze the data, with normal distribution metric data represented by Mean±SD. Student’s t-test was used to compare the basic information of two groups of subjects and the relative fluorescence intensity of differentially expressed proteins in hair follicles. Pearson correlation analysis was performed on plasma metabolism-related proteins and the basic information of subjects. P<0.05 indicates a statistically significant difference. Results:Sixty-one cases were included in the FAGA group, with an average age of (33.8±7.4) years and an onset age of (29.5±7.8) years. Among them, 38 cases were mild FAGA, 14 cases were moderate, and 9 cases were severe. Twenty-seven cases were included in the HC group, with an average age of (32.0±7.7) years. There was no statistically significant difference in the basic information (age, body mass index, testosterone, 25-hydroxyvitamin D, uric acid, and ferritin levels) between the two groups of subjects ( P>0.05). Compared to the HC group, the plasma of the FAGA group showed 26 significantly upregulated differentially expressed proteins ( P<0.05), with AHCY and NECTIN2 exhibiting the most significant differences (all P=0.003). The ROC curve evaluation revealed that the area under the curve for AHCY and NECTIN2 was greater than 0.7, indicating good diagnostic accuracy. The GO analysis revealed that the differentially expressed proteins were primarily enriched in the BAT3 complex (cellular component), ubiquitin-dependent ERAD pathway, natural killer cell activation (biological process), as well as ubiquitin protein ligase binding and ubiquitin-specific protease binding (molecular function). Pearson correlation analysis revealed that AHCY ( r=-0.23, P=0.010) and NECTIN2 ( r=-0.31, P=0.033) were negatively correlated with the severity of hair loss in FAGA patients. The results of hair follicle immunofluorescence analysis showed that the relative fluorescence intensity of AHCY and NECTIN2 in the FAGA group was higher than that in the HC group ( P<0.05). In other words, both AHCY and NECTIN2 were upregulated in the FAGA group. Conclusion:Metabolism-related proteins play an important role in FAGA. AHCY and NECTIN2 may serve as early diagnostic biomarkers for FAGA.

Objective:To study the reliability modeling method of rehabilitation diagnosis and treatment equipment based on non-homogeneous Poisson process,and to improve the reliability analysis effect of rehabilitation diagnosis and treatment equipment.Methods:Statistics and analysis of the total running time of rehabilitation diagnosis and treatment equipment in a specific period of time were performed,and the trend test of its operation data was conducted.The bathtub curve was used as the trend of rehabilitation diagnosis and treatment equipment failure,under the condition of bathtub curve change trend,a reliability model of non-homogeneous Poisson process of rehabilitation diagnosis and treatment equipment was established.The least squares estimation method was used to estimate the non-homogeneous Poisson process reliability model parameters of rehabilitation diagnosis and treatment equipment,determine the reliability index of rehabilitation diagnosis and treatment equipment,and complete the reliability modeling of rehabilitation diagnosis and treatment equipment.A total of 17 rehabilitation diagnosis and treatment equipment in clinical use in the Second Medical Center of PLA General Hospital from April to October 2022 were selected,including 6 pulse short-wave therapy instruments,5 interference electrical therapy instruments,3 swallowing disorder treatment instruments,and 3 air wave pressure therapy instruments.In July 2022,the reliability modeling method of rehabilitation diagnosis and treatment equipment based on non-homogeneous Poisson process was applied to the management of rehabilitation diagnosis and treatment equipment.The failure rate of rehabilitation diagnosis and treatment equipment before and after the application of the reliability modeling method based on non-homogeneous Poisson process was compared.Results:The average failure rate of 17 rehabilitation diagnosis and treatment equipment was 64.71%(11/17)before application and decreased to 23.53%(4/17)after application,of which the failure rate of 6 pulse shortwave therapy devices decreased from 66.7%(4/6)before application to 16.7%(1/6),the failure rate of 5 interference electrotherapy devices decreased from 60.0%(3/5)before application to 20.0%(1/5),and the failure rate of 3 dysphagia treatment instruments decreased from 66.7%(2/3)to 33.3%before application(1/3),the failure rate of the 3 air wave pressure therapy devices decreased from 66.7%(2/3)before application to 33.3%(1/3).Conclusion:The reliability modeling method for rehabilitation diagnosis and treatment equipment based on non-homogeneous Poisson process can accurately calculate the failure intensity function and cumulative failure intensity function of rehabilitation diagnosis and treatment equipment,reduce the failure rate of rehabilitation diagnosis and treatment equipment,and improve the quality of use of rehabilitation diagnosis and treatment equipment.

Objective:To systematically search and evaluate risk prediction models for ventilator-associated pneumonia (VAP) of ICU in order to provide references for developing higher-quality VAP risk prediction models.Methods:Relevant literature was retrieved from databases including China Biology Medicine disc, WanFang data, China National Knowledge Infrastructure, Embase, PubMed, CINAHL, Web of Science, and Cochrane Library. The search timeframe was from the establishment of the databases to September 30, 2023, limited to English and Chinese languages. Two researchers independently screened the literature and extracted data, and the PROBAST tool was used to evaluate the risk of bias and applicability of the included studies.Results:A total of 15 studies on VAP risk prediction models were included. The area under the receiver operating characteristic curve for the 15 models ranged from 0.722 to 0.982. The most frequently involved predictors were age, duration of mechanical ventilation, ICU length of stay, and comorbid chronic obstructive pulmonary disease. The overall adaptability was good, but the risk of bias was high. The main sources of bias included insufficient sample size, inappropriate data sources, lack of model performance evaluation, and inadequate attention to missing data.Conclusions:The risk of bias in studies on VAP risk prediction models is high, indicating that the field is still developing. Future research should focus on the effectiveness of different risk assessment methods to construct models with low bias, excellent predictive performance, and suitability for clinical practice in China.

Objective To investigate the expression of serum Sestrin2 and Toll-like receptor 7(TLR7)in patients with severe pneumonia and sepsis and their predictive value for heart failure.Methods A total of 86 patients with severe pneumonia and sepsis complicated with heart failure(complicated with heart failure group)and 86 patients with severe pneumonia and sepsis(uncomplicated with heart failure group)who were diagnosed and treated in Shanxi Provincial People's Hospital from February 2022 to May 2023 were studied.Another 86 patients who underwent health examinations were included as the control group.Enzyme linked immunosorbent assay(ELISA)method was applied to measure serum levels of Sestrin2 and TLR7.Color doppler echocardiography was applied to measure cardiac function related indicators:left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),and left ventricular end systolic diameter(LESD).The expression of Sestrin2 and TLR7 levels and cardiac function in three groups was analyzed.Pearson correlation was applied to analyze the relationship between serum levels of Sestrin2 and TLR7 and cardiac function related indicators in patients with heart failure.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum levels of Sestrin2 and TLR7 in patients with severe pneumonia and sepsis complicated with heart failure.Results The serum levels of Sestrin2(11.59±3.31 ng/ml,16.13±3.62 ng/ml),TLR7(48.93±9.52 ng/ml,61.74±10.11 ng/ml),and cardiac function related indicators[LVEDD(53.28±5.76 mm,62.54±6.11 mm)and LESD(38.16±4.38 mm,48.15±5.02 mm)]were higher in uncomplicated heart failure group and complicated heart failure group than those in control group(7.11±2.34 ng/ml,40.12±10.16 ng/ml,44.86±5.02 mm,29.02±4.07 mm),with significant differences(qSestrin2=13.241,26.659,qTLR7=8.224,20.182,qLVEDD=13.824,29.028,qLESD=18.805,39.359,all P＜0.05),and those values in complicated with heart failure group were higher than those in uncomplicated with heart failure group,with significant differences(q=13.418,11.985,15.203,20.554,all P＜0.05).The LVEF(55.43％±6.62％,41.67％±5.84％)index in uncomplicated heart failure group and complicated heart failure group was lower than that in control group(62.75％±7.16％),with significant differences(q=10.344,29.789,all P＜0.05),and the index in complicated with heart failure group was lower than that in uncomplicated with heart failure group,with significant difference(q=19.455,P＜0.05).Pearson correlation analysis showed that serum levels of Sestrin2 and TLR7 in patients with heart failure were negatively correlated with LVEF(r=-0.419,-0.467,all P＜0.05),and positively correlated with LVEDD and LESD(r=0.456,0.419;0.402,0.437,all P＜0.05).Sestrin2 was positively correlated with TLR7(r=0.641,P＜0.05).ROC curve results showed that the area under the curve(AUC)of serum Sestrin2 combined TLR7 for predicting heart failure in severe pneumonia sepsis patients was 0.940,with sensitivity of 74.9％and specificity of 73.3％.Conclusion The serum levels of Sestrin2 and TLR7 in patients with severe pneumonia and sepsis were elevated and may have good predictive value for patients with heart failure.

Objective:To explore the application effect of hydration therapy in patients with intermittent claudication (IC) of peripheral arterial disease, and to provide reference for clinical application.Methods:A randomized controlled trial method was used to select 86 patients with IC of peripheral arterial disease who attended the Department of Vascular Surgery of Shanxi Bethune Hospital from June to September 2023 as the study subjects by convenience sampling method, and they were divided into the control group and the intervention group by using the method of randomized numerical table, each group had 43 cases. In the control group, routine care was provided, and in the intervention group, hydration therapy was implemented on the basis of the control group. Ankle-brachial index, transcutaneous partial pressure of oxygen, and claudication distance were assessed in both groups 1d before and 6 months after the intervention.Results:Forty-two patients in each group completed the study, 21 males and 21 females, aged (61.33 ± 8.93) years in the intervention group; 24 males and 18 females, aged (61.33 ± 9.01) years in the control group. Compared with the ankle-brachial index, transcutaneous oxygen partial pressure and limp distance of the 2 groups 1 d before intervention, the differences were not statistically significant (all P>0.05), and 6 months after the intervention, the transcutaneous oxygen partial pressure of the patients in the intervention group was (37.69 ± 8.86) mmHg (1 mmHg=0.133 kPa), and that of the control group was (29.69 ± 7.79) mmHg, and the differences between the 2 groups were statistically significant ( t=4.40, P<0.05). The differences in patients′ transcutaneous partial pressure of oxygen and limp distance before and after intervention in the intervention group were -7.00 (-13.00, -1.75) mmHg and -50.00 (-100.00, 0.00) m, respectively, and in the control group were 0.01 (-1.00, 1.00) mmHg and 0.01 (-1.25, 20.00) m, respectively, and the differences between the 2 groups were statistically were statistically significant ( Z=5.59, 4.33, both P<0.05). Conclusions:Hydration therapy improves transcutaneous oxygen partial pressure values and claudication distance in patients with peripheral arterial disease IC, and improves microcirculation of the affected limbs in patients.