Objective To investigate the association between obstructive sleep apnea hypopnea syndrome （OSAHS） and white matter lesions （WMLs）. Methods A total of 91 patients who attended Department of Neurology and Department of Epilepsy and Sleep Disorders in The Second Affiliated Hospital of Harbin Medical University from June 2019 to December 2020 and met the diagnostic criteria for WMLs were enrolled as WMLs group， and 61 patients without WMLs were enrolled as control group. All subjects underwent brain MRI and PSG examinations， and related data were collected， including demographic data， past history， personal history， laboratory examination， and imaging findings. Results The WMLs group had a prevalence rate of OSAHS of 92.3% and an AHI of （32.85±19.86） events/hour on PSG， which were significantly higher than those in the control group （P<0.05）. The Spearman rank correlation analysis showed a strong positive correlation between WMLs severity and OSAHS severity（r=0.602 52，P<0.0001）. Conclusion The WMLs group is more susceptible to OSAHS than the control group， and the severity of WMLs is positively correlated with the severity of OSAHS.

Objectives To explore the expression, biological function, and mechanism of MKI67 in pancreatic cancer and its clinical significance. Methods The expression level, diagnosis, and prognostic value of MKI67 in pancreatic cancer were analyzed using public databases. We also investigated the association between the MKI67 with immune cell infiltration and immune checkpoint molecules. We analyzed the functional pathway enrichment to uncover the possible molecular mechanisms. qRT-PCR and Western blot assay were used to verify the expression of MKI67 mRNA and protein. Immunohistochemistry staining was used to detect the expression of MKI67 in tissue protein. Results The high expression of MKI67 was significantly associated with high histological grades and poor outcomes in pancreatic cancer. High MKI67 expression was correlated with poor prognosis of pancreatic cancer patients (P=0.009). MKI67 was an independent risk factor for the patient outcome (95%CI: 1.084-1.743, P<0.05). The MKI67 expression was positively correlated with the helper T cell 2 levels but negatively correlated with plasmacytoid DC, NK cells, mast cells, the T follicular helper, immune DC, and CD8 T cells. Conclusion MKI67 may serve as a biomarker for the diagnosis and prognosis of pancreatic cancer and the mechanism might be associated with immune escape or immunosuppression.

ObjectiveTo investigate the efficacy of percutaneous transhepatic variceal embolization （PTVE） alone or in combination with partial splenic embolization （PSE） in the treatment of portal hypertensive hemorrhage in liver cirrhosis through a meta-analysis. MethodsThis study was conducted according to PRISMA guideline， with a PROSPERO registration number of CRD42023396690. Wanfang Med Online， CNKI， CBM， VIP Databases， PubMed， Embase， the Cochrane Library， and Web of Science databases were searched for articles on PTVE alone or in combination with PSE in the treatment of portal hypertensive hemorrhage in liver cirrhosis published up to December 23， 2022. The articles were selected based on inclusion and exclusion criteria， and related data were extracted. The RevMan 5.4.1 statistical analysis software was used to perform the meta-analysis. ResultsEight articles were finally included， with a total sample size of 592 cases， among which there were 316 cases in the PTVE+PSE group and 276 cases in the PTVE group. The meta-analysis showed that compared with the PTVE group， the PTVE+PSE group had significantly lower postoperative portal vein pressure （standardized mean difference ［SMD］=-1.75， 95% confidence interval ［CI］： -2.33 to -1.16， P<0.05）， postoperative diameter of the portal vein （SMD=-0.87， 95%CI： -1.64 to -0.10， P<0.05）， postoperative rebleeding rate （odds ratio ［OR］=0.17， 95%CI： 0.11 — 0.28， P<0.05）， mortality rate （OR=0.13， 95%CI： 0.04 — 0.37， P<0.05）， and incidence rate of postoperative portal hypertensive gastrointestinal disease （OR=0.17， 95%CI： 0.07 — 0.45， P<0.05］， as well as a significantly higher postoperative platelet level （SMD=0.79， 95%CI： 0.52 — 1.06， P<0.05）， while there were no significant differences between the two groups in the incidence rates of postoperative ascites. ConclusionCompared with PTVE alone， PTVE combined with PSE can effectively reduce the rebleeding rate and mortality rate of portal hypertensive hemorrhage in liver cirrhosis， the incidence rate of portal hypertensive gastrointestinal disease， and portal vein pressure， and it can also shorten the diameter of the portal vein and increase platelet level. Therefore， it is an effective interventional method for the treatment of portal hypertension hemorrhage in liver cirrhosis.

Objective:To investigate applications of cold peppermint water spray in patients undergoing thoracoscopic pulmonary lobectomy, so as to establish a effectively thirst management strategy for patients.Methods:By a randomized controlled study method, a total of 100 patients undergoing thoracoscopic pulmonary lobectomy in Xiaogan Central Hospital from May 2022 to May 2023 were convenient collected, they were assigned to experimental group and control group according to the random number table method, with 50 cases in each group. Both groups were implemented routine nursing care, in additional, cold pure water spray (6-10 ℃) was carried out in the control group, while cold peppermint water spray (6-10 ℃) therapy was implemented in the experimental group. The clinical effect was compared by thirst score, salivary flow rate, lip mucosa moistening degree and oral comfort score between the two groups.Results:There were 28 males and 22 females in the control group, aged (58.30 ± 16.64) years old; 30 males and 20 females in the experimental group, aged (58.66 ± 16.68) years old. At 1, 2, 4, 6 h after intervention, the thirst scores were (5.96 ± 1.58), (5.08 ± 1.37), (4.48 ± 1.18), (3.76 ± 0.72) points in the experimental group, lower than those in the control group (6.78 ± 1.04), (5.60 ± 1.09), (5.10 ± 1.16), (4.52 ± 1.09) points, the differences were statistically significant ( t values were 2.10-4.11, all P<0.05). At 2, 4, 6 h after intervention, the salivary flow rate were (0.21 ± 0.04), (0.23 ± 0.05), (0.30 ± 0.08) ml/min in the experimental group, higher than those in the control group (0.18 ± 0.06), (0.19 ± 0.06), (0.21 ± 0.08) ml/min, the differences were statistically significant ( t=2.31, 3.22, 6.57, all P<0.05). At 2, 4, 6 h after intervention, the lip mucosa moistening scores were (2.52 ± 0.93), (2.26 ± 0.75), (1.82 ± 0.83) points in the experimental group, lower than those in the control group (2.98 ± 0.84), (2.88 ± 0.85), (2.30 ± 0.76) points, the differences were statistically significant ( t=2.59, 3.87, 2.38, all P<0.05). At 3, 6 h after intervention, the oral comfort scores were (4.54 ± 0.39), (5.68 ± 1.67) points in the experimental group, higher than in the control group (3.62 ± 0.21), (4.76 ± 1.22) points, the differences were statistically significant ( t=3.19, 3.14, both P<0.05). Conclusions:Cold peppermint water spray can effectively improve the thirst of patients undergoing thoracoscopic pulmonary lobectomy, improve the oral comfort of patients, and provide new ideas for clinical medical staff to care for patients with thirst.

Objective To observe splenic T cell apoptosis and XIAP-associated factor 1(XAF1),FAS,and tumor necrosis factor(TNF)-α protein expression levels in rats with acute lung injury(ALI),and to determine their roles in the protective effect of Yifei Jianpi formula.Methods Sixty male specific pathogen-free SD rats were divided randomly into blank,model,positive control,and high-,medium-,and low-dose Yifei Jianpi formula groups.Rats in the positive control group were given 0.5 g/kg dexamethasone by gavage,and rats in the high-,medium-,and low-dose Yifei Jianpi formula groups were given 12,6,and 3 g/kg Yifei Jianpi formula by gavage,respectively.Rats in the model and blank groups were given equal amounts of saline by gavage.All medications were administered once a day for 14 days.Lung function testing was carried out in all rats.We observed the imaging characteristics of the lungs and changes in the organ index and lung tissue wet/dry weight(W/D)in each group,and detected the pathological changes in lung tissues by hematoxylin-eosin staining.Splenic T-cell subpopulations(CD4+/CD8+)and apoptosis of splenic T-cells were detected by flow cytometry and XAF1,FAS,and TNF-α protein expression levels in the spleen were detected by Western Blot.Results Rats in the model group showed reduced lung function,decreased spleen and thymus organ indexes,and significantly higher W/D of lung tissue(P＜0.01).In addition,they had inflammatory exudation and alveolar rupture in the lung tissue,accompanied by thickening of the lung texture and large areas of ground-glass shadows,with a significant decrease in T-cell subsets(CD4+/CD8+)and significant increases in XAF1,FAS,and TNF-α proteins,and in the rate of T-cell apoptosis(P＜0.01).Yifei Jianpi formula significantly reduced the W/D spleen of rat lung tissues,significantly increased the thymus organ index(P＜0.05,P＜0.01)and the T-cell subpopulation(CD4+/CD8+),and significantly decreased the protein expression levels of XAF1,FAS,and TNF-α,and the T-cell apoptosis rate(P＜0.05,P＜0.01).Conclusions ALI induced up-regulation of XAF1,FAS,and TNF-α protein expression and T-cell apoptosis in the spleen of rats,and Yifei Jianpi formula may protect against ALI by down-regulating these factors.

Bluetongue virus is an arbovirus that seriously harms ruminants such as sheep,this study aims to investigate the molecular mechanism of bluetongue virus infection and host cell interferon antiviral immune response.The study was conducted to characterize the mRNA expression of inter-feron pathway genes by real-time fluorescence quantitative PCR,as well as Western blot analysis of MDA5,TRAF3,RIG-Ⅰ,and TBK1 protein expression in BHK-21 cells induced by BTV with a multiplicity of infections(MOI)of 1 for 18,24,and 36 h.The results showed that the most pro-nounced changes in the expression of interferon signaling pathway genes were observed at 24 h of induction,the gene mRNA expression levels of the IFN-α,IFN-β,RIG-Ⅰ,TBK1,MDA5,VISA,and TRAF3 genes were upregulated.However,the mRNA expression levels of IKKε and TRAF6 genes were downregulated.At the protein level,MDA5 and TBK1 proteins were upregulated while RIG-1 and TRAF3 proteins were downregulated,which showed that BTV infection induces a typeⅠ interferon immune response in BHK-21 cells.This study lays the foundation for further exploring the antiviral immunity mechanism of IFN-Ⅰ signaling pathway regulatory genes in host cells infected with BTV infection.

Pulmonary fibrosis is a respiratory system disorder characterized by damage to alveolar epithelial cells,pathological proliferation and transformation of fibroblasts,excessive deposition of extracellular matrix,leading to structural damage and loss of function in lung tissues,with a high mortality rate and limited effective treatment methods.This article was based on the TCM understanding of"lung connecting to large intestine",namely the theory of"lung and the large intestine being interior-exterior related",and set the modern medical understanding of"lung connecting to large intestine",namely the theory of"gut-lung axis"as the key.Combining the TCM pathogenesis of pulmonary fibrosis and the related mechanisms of"gut-lung axis"in pulmonary fibrosis,it preliminarily expounded the connotation of TCM regulating the"gut-lung axis"to treat pulmonary fibrosis,aiming to provide new ideas for clinical treatment of pulmonary fibrosis through the"gut-lung axis".

Objective:To investigate the clinicopathological characteristics of dedifferentiated endometrial carcinoma/undifferentiated endometrial carcinoma (DDEC/UDEC) with loss of expression of SMARCA4.Methods:A total of 10 cases with loss of expression of SMARCA4 were diagnosed at Fujian Cancer Hospital between January 2019 and December 2023. A retrospective analysis was conducted on the clinical characteristics, morphology, immunophenotype, molecular classification, and prognosis.Results:(1) Clinical characteristics: among 10 cases of DDEC/UDEC with loss of expression of SMARCA4, the patients′ age ranged from 48 to 65 years, with a median age of 56 years.Five cases were classified as International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ-Ⅱ, while the remaining five were categorized as stages Ⅲ-Ⅳ. (2) Pathological features: tumor cells exhibited poor cell adhesion, with common intravascular tumor emboli (8/10), occasional vacuolated nuclei (6/10), rhabdoid cells (4/10), and starry sky phenomenon formed by tissue cell phagocytosis apoptosis bodies or fragments (4/10). Six cases (6/10) showed loss of mismatch repair (MMR) protein expression, two cases (2/10) exhibited p53 mutant expression, and five cases (5/10) tested positive for programmed cell death ligand 1 (PD-L1). (3) Molecular subtyping: molecular subtyping revealed POLEmut in 1 case (1/10), mismatch repair deficient (MMR-d) in 5 cases (5/10), p53 abn in 1 case (1/10), and no specific molecular profile (NSMP) in 3 cases (3/10). (4) Prognosis: the follow-up period ranged from 7 to 42 months, with a median of 20 months. Five patients succumbed to the tumor, whereas the remaining five exhibited no recurrence during subsequent postoperative evaluations. The 2-year progression-free survival rates and overall survival rates were 58.3% and 52.5%, respectively.Conclusions:Loss of expression of SMARCA4 occurs in approximately 1/5 of DDEC/UDEC, which presents with an aggressive clinical course and a poor prognosis. About half of them show MMR protein loss expression and PD-L1 positive expression, suggesting that there might be benefit from treatment with immune checkpoint inhibitors.

Objective:To observe the changes of peripheral blood T cell subsets and serum tumor necrosis factor (TNF)-α and interleukin (IL)-6 contents in narcolepsy type 1 (NT1) patients and their correlations with narcolepsy, and provide basis for finding the biological markers of narcolepsy.Methods:A retrospective analysis was performed. From March 2022 to December 2023, 23 patients with NT1 admitted to Epilepsy and Sleep Disorder Center, Second Affiliated Hospital of Harbin Medical University and 23 healthy controls underwent physical examination of nervous system in our center were enrolled. T lymphocyte subsets CD4 + and CD8 + in peripheral blood were calculated by flow cytometry. Serum TNF-α and IL-6 contents were detected by enzyme-linked immunosorbent assay. Multivariate Logistic regression was used to determine the correlations of NT1 with CD4 + T lymphocyte count and IL-6 and TNF-α contents, and diagnostic values of CD4 + T lymphocyte and TNF-α in NT1 were evaluated via area under receiver operating characteristics (ROC) curve. Results:Compared with the healthy controls, the NT1 patients had significantly increased peripheral blood CD4 + T lymphocyte count ([820.61±316.87] /μL vs. [1121.04±387.47] /μL), and significantly higher serum TNF-α and IL-6 contents ([39.97±10.64] pg/mL vs. [57.01±19.92] pg/mL; [22.50±6.09] pg/mL vs. [33.66±17.28] pg/mL, P<0.05). No significant difference in peripheral blood CD8 + T lymphocyte count was noted between the 2 groups ([668.65±276.45] pg/mL vs. [592.52±217.78] pg/mL, P>0.05). Multivariate Logistic regression showed that CD4 + T lymphocyte count and serum TNF-α content were independent risk factors for NT1 ( OR=1.004, 95% CI: 1.001-1.006, P=0.007; OR=1.133, 95% CI: 1.032-1.243, P=0.009). Area under ROC curve of the two combined indexes was 0.881(95% CI: 0.784-0.977, P=0.001), enjoying sensitivity of 0.783 and specificity of 0.870. Conclusion:Combination of peripheral blood CD4 + T lymphocyte count and serum TNF-α content has high diagnostic performance in predicting NT1.

Objective:To investigate the predictive value of heparin binding protein(HBP) combined with pediatric sequential organ failure assessment(pSOFA) in children with sepsis.Methods:Children with sepsis admitted to PICU of Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2021 to June 2022 were selected as study group,while those who underwent elective surgery for inguinal hernia and assessment of precocious puberty and short stature during the same period were selected as control group.All children with sepsis were divided into sepsis group and septic shock group according to their severity as well as survival group and death group according to prognosis.The study group was monitored for HBP on the 1st,3rd,and 7th day of admission,while the control group was monitored for HBP on the 1st day of admission.Patients in the sepsis group received pSOFA scores immediately after admission.The laboratory results and HBP concentrations were compared between groups，and a joint model was established in combination with pSOFA to observe its predictive performance in sepsis prognosis.Results:A total of 50 children with sepsis were included in study group，including 45 children with sepsis and five children with septic shock.There were 27 males and 23 females，aged 1 month～13 years（median age two years）.There were 7 deaths in this study，including two patients with sepsis and five patients with septic shock.The HBP concentration in the study group was significantly higher than that in the control group on the 1st day，and the HBP concentration in the group gradually decreased with the prolongation of hospital stay.The concentration of HBP on the first day of septic shock group was higher than that of sepsis group，and the difference was statistically significant（ P<0.001）.The concentration of HBP on the 1st day in the sepsis death group was significantly higher than that in the sepsis survival group（ P=0.023）.The receivor operator characteristic curve analysis showed that HBP and pSOFA had good predictive value for the death of children with sepsis，and the joint model of HBP and pSOFA（75.1×pSOFA-0.1×HBP）had the best predictive performance for the death of children with sepsis，but there was no significant difference with the pSOFA. Conclusion:The HBP level significantly increases in children with sepsis，and gradually decreases with the length of hospital stay，and HBP has great value in predicting the outcome of death in children with sepsis，and the combination of pSOFA could improve its predictive ability of death,but not better than pSOFA.