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）］

Colonic mucosal healing is the ultimate goal of ulcerative colitis (UC) treatment, but it remains difficult to realize. Given the higher incidence of UC in males and the beneficial effect of estrogen on UC, we conducted this study to examine the therapeutic potential of estrogen receptor β (ERβ), the primary ER subtype in colon, on mucosal healing in UC. Our study is the first to report that ERβ activation degree was positively correlated with mucosal healing in patients with UC. Furthermore, ERβ activation enhanced mucosal healing in mice with dextran sulfate sodium-induced and biopsy-induced colonic injuries. Mechanistically, ERβ activation promoted autophagy of colonic epithelial cells by inhibiting branched-chain amino acid transport, leading to focal adhesion kinase (FAK) activation. Activated FAK promoted focal adhesion turnover and colonic epithelial cell migration, ultimately facilitating mucosal healing. ERβ ^-/- colitis mice exhibited impaired mucosal healing compared to wild-type littermates, highlighting the crucial effect of ERβ. Importantly, combination with ERβ-agonist diarylpropionitrile enhanced the amelioration of 5-aminosalicylic acid, a standard UC treatment agent, against mouse colitis. These findings attest to the crucial role of ERβ activation in colonic mucosal healing and may further inform the development of novel strategies for UC treatment.

Objective : To investigate the therapeutic effects of a small interfering RNA(siRNA) vector targeting peptidyl arginine deaminase 4(PAD4) and splenocytes infected with a PAD4-siRNA virus, on collagen-induced arthritis(CIA) mice, and to elucidate the underlying mechanisms. Methods : The experiment mice were divided into four groups: control group, model group, therapy group 1 and therapy group 2, with 7 mice in each group. Control group mice were not treated. Initially, collagen-induced arthritis(CIA) mice model were established using bovine type II collagen. Model group mice were injected by PBS buffer Therapy group 1 mice were injected of PAD4-siRNA virus solution into the tail vein of the CIA mice, while therapy group 2 mice were injected of splenocytes infected with PAD4-siRNA virus via the same route. These injections were carried out once a week for a total of eight weeks. Subsequently, the alterations in T follicular helper(Tfh), T follicular regulatory(Tfr), T helper 1(Th1), and CD4+IL-10+T cells in the splenocytes of the mice were analyzed. Additionally, the pathological changes in the articular cartilage of the mice joints were detected. Results : Comparison with control group, mice of model group exhibited a significant increase in the proportions of Tfh and Th1 cells in the spleen(P<0.05), while the proportions of Tfr and CD4+IL-10+T cells remained unchanged. Comparison with model group, therapy group 1 and therapy group 2 demonstrated a significant decrease in the proportions of Tfh and Th1 cells(P<0.05), with no changes were observed in the proportions of Tfr and CD4+IL-10+T cells. Additionally, the articular surface in the mice of control group was smooth, whereas model group showed signs of inflammatory cell infiltration, rough articular surface, and cartilage destruction. Following treatment with PAD4-siRNA, the infiltration of inflammatory cells and cartilage destruction in the hind paws of CIA mice in therapy group 1 were reduced. However, no reduction was observed in the infiltration of inflammatory cells and cartilage destruction in the front paws of CIA mice. In contrast, therapy group 2 exhibited a reduction in the infiltration of inflammatory cells and cartilage destruction in both the front and hind paws of CIA mice. Conclusion Gene silencing of PAD4 expression can decrease the proportion of Tfh and Th1 cells, leading to an amelioration of pathological changes in joints and cartilage of hind paws. Furthermore, the therapeutic efficacy is observed in the front paws of CIA mice, and PAD4-siRNA plays a role on CIA mice by regulating T cells subpopulation of splenocytes.

Digital health technologies (DHT) not only enhance patient engagement in healthcare but also enable personalized treatment and care services, empowering patients to manage their own health well. This paper reviews the composition and characteristics of digital vulnerable groups, as well as the current application status, influencing factors, intervention measures, and insights of DHT in their care. This paper aims to provide theoretical and practical references for enhancing the quality of DHT care for digital vulnerable groups, thereby promoting targeted and effective development of DHT within the nursing field.

Digital health technologies (DHT) not only enhance patient engagement in healthcare but also enable personalized treatment and care services, empowering patients to manage their own health well. This paper reviews the composition and characteristics of digital vulnerable groups, as well as the current application status, influencing factors, intervention measures, and insights of DHT in their care. This paper aims to provide theoretical and practical references for enhancing the quality of DHT care for digital vulnerable groups, thereby promoting targeted and effective development of DHT within the nursing field.

Objective:To investigate the therapeutic effect difference between first-line treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) and chemotherapy in non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) rare mutation.Methods:A retrospective case-control study was performed. Data of NSCLC patients with rare EGFR mutation who were treated in Shanxi Province Cancer Hospital from January 2013 to October 2019 were retrospectively analyzed. EGFR mutations in living tissues or blood were detected by using amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) before first-line treatment. According to first-line treatment methods,they were divided into EGFR-TKI treatment group and chemotherapy group. Objective remission rate (ORR) and disease control rate (DCR) of both groups were compared. Kaplan-Meier method was used to draw progression-free survival (PFS) and the overall survival (OS) curves. Log-rank test was used for comparison among groups. Single-factor and multi-factor Cox proportional risk models were used to analyze the influencing factors of PFS and OS.Results:A total of 169 patients with EGFR rare mutations were included, and the age [ M (IQR)] was 63 years (12 years); there were 96 cases (56.8%) < 65 years and 73 cases (43.2%) ≥65 years; 70 (41.4%)males and 99 (58.6%) females; 55 cases (32.5%) had EGFR G719X mutation,45 cases (26.6%) had L861Q mutation, 17 cases (10.1%) had S768I mutation, and 52 cases (30.8%) had complex mutation; 55 cases (32.5%) received the first-line chemotherapy and 114 cases (67.5%) received the first-line EGFR-TKI treatment. In the chemotherapy group, ORR was 36.4% (20/55) and DCR was 85.5% (47/55); in EGFR-TKI treatment group, ORR was 72.8% (83/114) and DCR was 90.4% (103/114). The ORR of EGFR-TKI treatment group was higher than that of chemotherapy group ( χ2 = 20.70, P = 0.001), and there was no statistically significant difference in DCR between two groups ( χ2 = 1.76, P = 0.184). Subgroup analysis showed that ORR in EGFR-TKI treatment group with G719X, L861Q and complex mutations was higher than that of the corresponding mutations in chemotherapy group, and the differences were statistically significant (all P < 0.05), while there were no significant differences in DCR among subgroups (all P > 0.05). The median PFS time was 9.7 months (95% CI: 6.0-13.4 months) and 3.8 months (95% CI: 3.1-7.1 months), respectively in EGFR-TKI treatment group and chemotherapy group, and there was a statistically significant difference in PFS between the two groups ( P < 0.001). The median OS time was 25.6 months (95% CI: 18.0-37.9 months) and 31.7 months (95% CI: 18.0-42.8 months), respectively in EGFR-TKI treatment group and chemotherapy group, and there was no statistically significant difference in OS between the two groups ( P = 0.231). Multivariate Cox regression analysis showed that brain metastasis [with vs. without: HR = 2.306, 95% CI: 1.452-3.661, P < 0.001] and the first-line treatment methods (EGFR-TKI vs. chemotherapy: HR = 0.457, 95% CI:0.317-0.658, P < 0.001) were independent influencing factors for PFS of NSCLC patients with EGFR rare mutation; brain metastasis (with vs. without: HR = 2.087, 95% CI: 1.102-3.953, P = 0.024; unknown vs. without: HR = 2.118,95% CI: 1.274-3.520, P = 0.004) were independent influencing factors for OS of NSCLC patients with EGFR rare mutation. Conclusions:Compared with the first-line chemotherapy, EGFR-TKI first-line treatment could improve objective remission and PFS of NSCLC patients with EGFR rare mutation, while no OS benefit is observed.

Objective To observe the incidence and prognosis of respiratory failure in patients after cardiac surgery,and the risk factors were analyzed.Methods A total of 559 patients who underwent cardiac surgery were enrolled in Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from July 2020 to November 2023.Clinical data were extracted through the hospital information system(HIS).This included general data such as gender,age,body mass index(BMI),smoking history,alcohol history,comorbidities,and basic disease data like occurrence of respiratory tract infection in the past 1 month before surgery,preoperative use of antimicrobial drugs,ejection fraction,operation time,cardiopulmonary bypass time,intraoperative blood transfusion,nasogastric tube indwelling,nosocomial infection,secondary thoracotomy,preoperative white blood cell count(WBC),length of intensive care unit(ICU)stay,secondary intubation and tracheostomy,discharge diagnosis,and outcome.The patients were divided into two groups according to whether or not they had expiratory failure.The difference of the above data between the two groups was compared.Multivariate Logistic regression was used to analyze the risk factors of respiratory failure in patients after cardiac surgery,the prediction model was constructed based on the above risk factors,and the receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of the prediction model for patients with respiratory failure.Results The incidence of respiratory failure in patients after cardiac surgery was 7.51%(42 cases).Multivariate Logistic regression analysis showed that intraoperative blood transfusion>2000 mL,nasogastric tube,and nosocomial infection were risk factors for respiratory failure in patients after cardiac surgery[odds ratio(OR)and 95%confidence interval(95%CI)were 4.136(1.794-9.535),3.162(1.454-6.878)and 3.488(1.262-9.638),all P<0.05].The ROC curve analysis showed that the prediction model had a certain predictive value for the occurrence of respiratory failure in patients after cardiac surgery[area under the curve(AUC)=0.738,95%CI was 0.658-0.818,P<0.001].The length of ICU stay of patients in the group with respiratory failure was significantly longer than that in the group without respiratory failure(hours:8.16±7.62 vs.4.52±3.95),the secondary intubation rate[80.95%(34/42)vs.0(0/517)]and the tracheostomy rate[88.10%(37/42)vs.0(0/517)]were significantly higher than those in the non-respiratory failure group,and the recovery/improvement rate was significantly lower than that in the non-respiratory failure group[59.52%(25/42)vs.90.13%(466/517)],the differences were statistically significant(all P<0.05).Conclusions Patients with intraoperative blood transfusion>2000 mL,nasogastric tube inserted,and nosocomial infection are the high-risk groups for respiratory failure after cardiac surgery.Medical staff should strengthen the identification of high-risk groups and actively take intervention measures to improve the prognosis of patients.

Objective:To evaluate the safety and clinical efficacy of hypofractionated radiotherapy (HFRT) at 36.5 Gy in 10 fractions for the chest wall and reginal lymph nodes following modified radical mastectomy for breast cancer.Methods:This was a prospective, single-arm, phase Ⅱ clinical study. A total of 85 patients who received HFRT at 36.5 Gy in 10 fractions to the chest wall ± supraclavicular region following modified radical mastectomy for locally advanced breast cancer from March 2014 to December 2015 were included. The primary endpoint was radiotherapy toxicities. The secondary endpoints were locoregional failure-free survival (LRFFS), disease-free survival (DFS), and overall survival (OS).Results:The median follow-up period was 98 (94.0-109.0) months. Radiotherapy toxicities were mild. The incidence rates of grade 1 acute cutaneous and pulmonary toxicities were 52.9% and 40%, and those of grade 1 late cutaneous, pulmonary, and cardiac toxicities and upper extremity edema were 10.6%, 29.4%, 2.4%, and 21.2%, respectively. Only 1 (1.2%) patient suffered from grade 2 radiation-induced brachial plexus injury. Of the 85 patients, one patient had regional recurrence (supraclavicular lymph nodes), six patients had distant metastasis, and six patients died of breast cancer. The 9-year LRFFS, DFS, and OS were 97.7%, 91.8%, and 92.8%, respectively.Conclusions:HFRT at 36.5 Gy in 10 fractions following modified radical mastectomy for breast cancer is associated with mild toxicities. A phase Ⅲ study is necessary for validating HFRT's clinical efficacy.

With rapid development of information technology,blended teaching model has gradually become mainstream teaching model in most colleges and universities.How to evaluate students'learning effect and analyze factors that affect students'per-formance is a key research direction of this teaching model.Taking blended teaching of Medical Immunology course in Xinxiang Medical University as an example,this paper introduces implementation process and evaluation system of blended teaching,analyzes main factors affecting students'performance and learning effect,and focuses on discussing influence of formative evaluation and"flipped classroom"on students'academic performance.