BackgroundObstructive sleep apnea （OSA） represents a prevalent sleep disordered breathing condition characterized by complex pathophysiology. The arousal threshold （ArTH）， a core non-anatomical contributor to OSA pathogenesis， is intimately tied to the disease severity and clinical phenotypes. To date， research regarding factors associated with ArTH has yielded inconsistent findings， and ArTH profiles and disparities across populations with different genetic backgrounds are not fully elucidated. ObjectiveTo explore the differences of ArTH in OSA patients with different genetic backgrounds and analyze the key factors affecting ArTH， thereby providing evidence for understanding OSA pathophysiology and formulating targeted treatment regimens. MethodsA total of 285 patients who met the diagnostic criteria for OSA， as defined by the Multidisciplinary Diagnosis and Treatment Guidelines for Adult Obstructive Sleep Apnea， were retrospectively enrolled in this study. All participants underwent overnight polysomnography （PSG） at the Sleep Medicine Center of Inner Mongolia Mental Health Center from December 2022 to May 2024. Based on the study design， the cohort was stratified into two distinct genetic background subgroups （group A and group B）. Demographic and clinical characteristics， the Epworth Sleepiness Scale （ESS） score， and overnight PSG data were collected. The apnea hypopnea index （AHI）， the lowest pulse oxygen saturation （LSpO₂）， and fraction of hypopneas （F_Hypopneas） were utilized as surrogate indicators to estimate ArTH in OSA patients. The influencing factors of low ArTH were tested by binary Logistic regression analysis. ResultsAmong the 285 OSA patients， there were 227 cases （79.65%） in group A and 58 cases （20.35%） in group B. Comparisons between the two genetic background subgroups revealed no statistically significant differences in the proportion of low ArTH， ESS score， PSG parameters， and the three markers for low ArTH （AHI<30 events/h， LSpO₂>82.5%， F_Hypopneas>58.3%） （P>0.05）. Binary Logistic regression analysis identified sex （OR=2.421， 95% CI： 1.070–5.478）， BMI （OR=0.847， 95% CI： 0.770–0.932）， N1 sleep duration （OR=0.974， 95% CI： 0.963–0.985）， and hypertension （OR=0.348， 95% CI： 0.143–0.848） as independent factors associated with low ArTH in the total cohort. Stratified analysis by genetic backgrounds revealed that sex（OR=3.799， 95% CI： 1.389–10.392）， BMI（OR=0.819， 95% CI：0.723–0.929）， and N1 sleep duration（OR=0.973， 95% CI： 0.961–0.986） were independent factors of low ArTH in group A. In contrast， only N1 sleep duration （OR=0.951， 95% CI： 0.911–0.993） remained a significant factor in group B. ConclusionArthur may have conservative characteristics in patients with OSA with different genetic backgrounds， but the pathophysiological mechanism of OSA may have population heterogeneity. ［Funded by Inner Mongolia Autonomous Region Natural Science Fundation Project （number， 2024QN08050）； Intra-institutional Scientific Research Project of Inner Mongolia Mental Health Center （number， 2022QNWN0010）］

ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.

OBJECTIVE To investigate the epidemiological characteristics of infections in hemodialysis patients so as to provide bases for prevention and control of the infections in the hemodialysis patients.METHODS The patients who underwent maintenance hemodialysis in blood purification rooms of the Fifth Affiliated Hospital of Zhengzhou University in the first two working days each month from 2018 to 2022 were recruited as the research subjects.The incidence of hemodialysis-related events among the hemodialysis patients,including intravenous use of antibiotics,positive blood culture,exacerbation of pus,redness or swellings emerging at vascular access sites,were prospectively investigated.RESULTS A total of 386 case-times of hemodialysis-related events were moni-tored in 2018-2022,including 20 case-times of bloodstream infections,354 case-times of intravenous use of antibi-otics and 12 case-times of exacerbation of pus,redness or swellings emerging at vascular access sites.The inci-dence of hemodialysis-induced events was 4.19 per 100 patients each month,the average incidence rate of blood-stream infections was 0.22 per 100 patients each month.The patients with tunneled central venous catheter were 40.69 times the risk of bloodstream infections as the patients with intestinal fistula(95％CI:9.725～361.703,P＜0.001).The incidence of bloodstream infections was decreased by 53.85％among the hemodialysis patients in 2022 as compared with that in 2018.Staphylococcus aureus was the predominant species of pathogens causing the bloodstream infections.CONCLUSIONS The hemodialysis patients are the population at high risk of infections.The incidence of bloodstream infections and other infections is higher among the patients with tunneled central venous catheters than among the patients with other types of vascular accesses.The monitoring of hemodi-alysis-related infection events may reduce the incidence of bloodstream infections.

Objective:To evaluate the clinical efficacy of Xiaoxuming Decoction combined with conventional Western medicine therapy in the treatment of patients with ischemic stroke in the recovery period.Methods:A randomized controlled clinical study was conducted. A total of the 118 patients with wind phlegm obstructing collaterlas syndrome during the recovery period of ischemic stroke in our hospital from September 2023 to July 2024 were selected as the observation subjects. They were divided into two groups using a random number table method, with 59 patients in each group. The control group was treated with conventional Western medicine therapy, while the TCM group was treated with modified Xiaoxuming Decoction on the basis of the control group. Both groups were treated for 2 months and followed up for 1 month. TCM syndrome scoring was performed before and after treatment, Barthel Index was used to evaluate daily living ability, and carotid artery ultrasound detector was used to evaluate the stability of carotid vascular plaques. Inter group comparisons were performed using t test, χ2 test, or repeated measures analysis of variance (RM-ANOVA). Results:RM-ANOVA showed that the time effect and inter group effect of TCM syndrome integration in the TCM group were significantly different from those in the control group ( Ftime=55.56, Ptime<0.001); Fbetween=18.94, Pbetween<0.001); there was no statistical significance in the interaction effect compared to the control group ( Finteraction=0.24, Pinteraction=0.866); the time effect, inter group effect, and interaction effect of Barthel Index in the TCM group were significantly different from those in the control group ( Ftime=44.57, Ptime<0.001); Fbetween=18.94, Pbetween<0.001; Finteraction=7.45, Pinteraction<0.001). The number of patients with unstable plaques in the TCM group after 3 months of treatment was lower than that in the control group ( χ2=4.52, P=0.033). Conclusion:The combination of modified Xiaoxuming Decoction and conventional Western medicine therapy can effectively improve the clinical symptoms and daily living ability of patients in the recovery period of ischemic stroke, improve the stability of cervical vascular plaques, and the clinical efficacy becomes more significant over time.

Retinal neovascularization is a common pathological feature of many blinding eye diseases,and these neovessels are usually fragile and prone to rupture and hemorrhage,which can lead to severe visual impairment.Caveolin-1 is an important membrane protein involved in cellular signaling,lipid metabolism,and cytoskeleton regulation.Currently,it has been proven that Caveolin-1 expresses in a variety of retinal cell types and can participate in retinal neovascularization by regulating multiple signaling pathways.In this article,the domestic and international studies on the role and mechanism of Caveolin-1 in neovascularization were reviewed,and the therapeutic prospect of Caveolin-1 in retinal neovascularization ophthalmopathy was analyzed.This study aims to provide ideas for exploring the pathogenesis of the disease and seeking potential targeted interventions.

Objective To evaluate the ability of longitudinal changes in urinary extracellular domain of neurotrophin receptor p75(p75ECD)to serve as a prognostic biomarker of severity,progression and survival time in patients with amyotrophic lateral sclerosis(ALS).Methods Forty patients with ALS attended follow-up appointments at 3-to 6-month interval,and 51 healthy control(HC)volunteers were recruited.The concentrations of urinary p75ECD were tested by a sandwich ELISA.The ALSFRS-r was used to quantify the severity of ALS.The change rate of urinary p75ECD(Δp75ECD)was calculated as the average monthly change during the period between the first and the last sampling.Results The concentration of urinary p75ECD was higher at the last follow-up than at baseline(P=0.002 3).Spearman analysis showed that there was a negative correlation between urinary p75ECD and ALSFRS-r score(r=-0.35,P=0.001 3);the course of ALS in the fast-changing Δp75ECD group was shorter than that in the slow-changing group(P=0.015 8);the Δp75ECD and course of ALS showed a negative correlation(r=-0.39,P=0.014),and the Δp75ECD in the fast-progression ALS group was significantly higher than in the slow-progression group(P=0.001 6).There was a positive correlation between Δp75ECD and progression in ALS patients(r=0.34,P=0.005).Kaplan-Meier survival analysis showed a longer median survival time in those with slow-changing Δp75ECD(P=0.03).Conclusion The change rate of urinary p75ECD has shown great potential as a biomarker for the prognosis of the severity,progression and survival time of ALS.

Objective To evaluate the ability of longitudinal changes in urinary extracellular domain of neurotrophin receptor p75(p75ECD)to serve as a prognostic biomarker of severity,progression and survival time in patients with amyotrophic lateral sclerosis(ALS).Methods Forty patients with ALS attended follow-up appointments at 3-to 6-month interval,and 51 healthy control(HC)volunteers were recruited.The concentrations of urinary p75ECD were tested by a sandwich ELISA.The ALSFRS-r was used to quantify the severity of ALS.The change rate of urinary p75ECD(Δp75ECD)was calculated as the average monthly change during the period between the first and the last sampling.Results The concentration of urinary p75ECD was higher at the last follow-up than at baseline(P=0.002 3).Spearman analysis showed that there was a negative correlation between urinary p75ECD and ALSFRS-r score(r=-0.35,P=0.001 3);the course of ALS in the fast-changing Δp75ECD group was shorter than that in the slow-changing group(P=0.015 8);the Δp75ECD and course of ALS showed a negative correlation(r=-0.39,P=0.014),and the Δp75ECD in the fast-progression ALS group was significantly higher than in the slow-progression group(P=0.001 6).There was a positive correlation between Δp75ECD and progression in ALS patients(r=0.34,P=0.005).Kaplan-Meier survival analysis showed a longer median survival time in those with slow-changing Δp75ECD(P=0.03).Conclusion The change rate of urinary p75ECD has shown great potential as a biomarker for the prognosis of the severity,progression and survival time of ALS.

Retinal neovascularization is a common pathological feature of many blinding eye diseases,and these neovessels are usually fragile and prone to rupture and hemorrhage,which can lead to severe visual impairment.Caveolin-1 is an important membrane protein involved in cellular signaling,lipid metabolism,and cytoskeleton regulation.Currently,it has been proven that Caveolin-1 expresses in a variety of retinal cell types and can participate in retinal neovascularization by regulating multiple signaling pathways.In this article,the domestic and international studies on the role and mechanism of Caveolin-1 in neovascularization were reviewed,and the therapeutic prospect of Caveolin-1 in retinal neovascularization ophthalmopathy was analyzed.This study aims to provide ideas for exploring the pathogenesis of the disease and seeking potential targeted interventions.

OBJECTIVE To investigate the epidemiological characteristics of infections in hemodialysis patients so as to provide bases for prevention and control of the infections in the hemodialysis patients.METHODS The patients who underwent maintenance hemodialysis in blood purification rooms of the Fifth Affiliated Hospital of Zhengzhou University in the first two working days each month from 2018 to 2022 were recruited as the research subjects.The incidence of hemodialysis-related events among the hemodialysis patients,including intravenous use of antibiotics,positive blood culture,exacerbation of pus,redness or swellings emerging at vascular access sites,were prospectively investigated.RESULTS A total of 386 case-times of hemodialysis-related events were moni-tored in 2018-2022,including 20 case-times of bloodstream infections,354 case-times of intravenous use of antibi-otics and 12 case-times of exacerbation of pus,redness or swellings emerging at vascular access sites.The inci-dence of hemodialysis-induced events was 4.19 per 100 patients each month,the average incidence rate of blood-stream infections was 0.22 per 100 patients each month.The patients with tunneled central venous catheter were 40.69 times the risk of bloodstream infections as the patients with intestinal fistula(95％CI:9.725～361.703,P＜0.001).The incidence of bloodstream infections was decreased by 53.85％among the hemodialysis patients in 2022 as compared with that in 2018.Staphylococcus aureus was the predominant species of pathogens causing the bloodstream infections.CONCLUSIONS The hemodialysis patients are the population at high risk of infections.The incidence of bloodstream infections and other infections is higher among the patients with tunneled central venous catheters than among the patients with other types of vascular accesses.The monitoring of hemodi-alysis-related infection events may reduce the incidence of bloodstream infections.

Objective Amyotrophic lateral sclerosis(ALS)is a progressive and fatal neurodegenerative disease.Mutations in the Cu/Zn superoxide dismutase 1 gene(SOD1)have been identified as the cause of familial ALS.Sequencing the SOD1 gene may be helpful for patients with a suspected family history of ALS.This article reports for the first time a case of amyotrophic lateral sclerosis with SOD1-p.A5S mutation in Han Chinese and summarizes its clinical characteristics.Method and Results This is the first report on Chinese Han of ALS with SOD1-p.A5S mutation and review of relevant case literature to summarize its clinical characteristics.The study case is a 34-year-old male who was admitted to the Neurology Department of The First Affiliated Hospital of Xi'an Jiaotong University with a complaint of"weakness in both lower limbs for 2 years,worsening with both hands for 6 months".The main clinical manifestations were progressive limb weakness,no swallowing difficulties or cognitive impairment.Further improvement of routine examinations and electromyography after admission were made to rule out other diagnoses,and genetic testing was conducted.Based on the patient's typical clinical manifestations and evidence of involvement of lower motor neurons in the cervical,thoracic,and lumbar spinal cord areas indicated by electromyography,other diagnoses and characteristic gene testing results were reasonably excluded,and ALS was diagnosed.The genetic testing results indicated that the patient had a heterozygous mutation in SOD1 exon 1,c.13G＞T(p.A5S),and his mother had a suspicious medical history but died without genetic verification.After discharge,the follow-up period lasted until August 21,2022,with a total of 38 months and a course of 62 months.Further review of the clinical characteristics of other patients with the same site mutation reported in the literature reveals that the progress of this patient with the mutation was slower than that of other patients with the same site mutation reported in the literature.Conclusion This study shows that gene sequencing is a powerful tool for diagnosing familial ALS.The mutation of c.13G＞T(p.A5S)in exon 1 of SOD1 is a rare pathogenic variation.The progress of patients with this subtype is slow,which further indicates that gene detection has important value in the diagnosis and prognosis of ALS.