Hypoventilation in obesity has four stages, and the first two stages are associated with intermittent nocturnal hypercapnia. We report a 46-year-old man who belongs to Stage 1, with complete washout of nocturnally accumulated carbon dioxide (CO2) and associated concomitant severe obstructive sleep apnea and severe hypoxemia. That condition will lead to progressive right heart dysfunction secondary to persistently nocturnal impaired ventilation and hypoxemia via the pathomechanism of hypoxic pulmonary vasoconstriction and pulmonary vascular remodeling by cytokines and growth factors, supposedly once it is missed for early diagnosis and appropriate PAP therapy is not introduced in time. Early identification and diagnosis of such conditional disease and in-time appropriate treatment are very important before sequelae of disease develop so that we could be able to prevent cardiovascular morbidity and mortality before disease progression.

OBJECTIVE: Humans are exposed to complex mixtures of environmental chemicals and other factors that can affect their health. Analysis of these mixture exposures presents several key challenges for environmental epidemiology and risk assessment, including high dimensionality, correlated exposure, and subtle individual effects. METHODS: We proposed a novel statistical approach, the generalized functional linear model (GFLM), to analyze the health effects of exposure mixtures. GFLM treats the effect of mixture exposures as a smooth function by reordering exposures based on specific mechanisms and capturing internal correlations to provide a meaningful estimation and interpretation. The robustness and efficiency was evaluated under various scenarios through extensive simulation studies. RESULTS: We applied the GFLM to two datasets from the National Health and Nutrition Examination Survey (NHANES). In the first application, we examined the effects of 37 nutrients on BMI (2011-2016 cycles). The GFLM identified a significant mixture effect, with fiber and fat emerging as the nutrients with the greatest negative and positive effects on BMI, respectively. For the second application, we investigated the association between four pre- and perfluoroalkyl substances (PFAS) and gout risk (2007-2018 cycles). Unlike traditional methods, the GFLM indicated no significant association, demonstrating its robustness to multicollinearity. CONCLUSION GFLM framework is a powerful tool for mixture exposure analysis, offering improved handling of correlated exposures and interpretable results. It demonstrates robust performance across various scenarios and real-world applications, advancing our understanding of complex environmental exposures and their health impacts on environmental epidemiology and toxicology.
Humans ; Environmental Exposure/analysis* ; Linear Models ; Nutrition Surveys ; Environmental Pollutants ; Body Mass Index

Objective To explore the different potential subtypes of psychosocial adaptation among young and middle-aged stroke patients,and analyze the relationship between different potential subtypes and quality of life,so as to provide references for the subsequent development of targeted interventions.Methods A total of 406 young and middle-aged stroke patients in 4 tertiary hospitals in Suzhou from June 2023 to June 2024 were recruited by convenience sampling.The General Information Questionnaire,the Self-Report Psychosocial Adjustment to Illness Scale and the EuroQol five-dimensional questionnaire were conducted for investigation.Latent profile analysis was used to explore the potential subtypes of psychosocial adaptation among young and middle-aged stroke patients.Generalized linear regression analysis was conducted with quality of life as dependent variables.Results A total of 380 young and middle-aged stroke patients were included.The psychosocial adaptation of patients could be classified into 3 potential subtypes:high adaptation level type(23.90％),medium adaptation level with health concerns type(46.40％),and low adaptation level with psychological barriers type(29.70％).The results of generalized linear regression analysis showed that potential subtypes of psychosocial adaptation were the influencing factors for quality of life in young and middle-aged stroke patients(P＜0.05).Conclusion There was group heterogeneity in psychosocial adaptation among young and middle-aged stroke patients,and the potential subtype of psychosocial adaption was an important factor affecting the quality of life of patients.It is suggested that medical staff should focus on patients with low adaptation level with psychological barriers type,and take targeted interventions according to characteristics of different subtypes of patients,so as to improve their quality of life.

Aim To investigate the role of miR-130b-3p in regulating the USP47/NLRP3 inflammasome in airway remodeling associated with asthma and to explore its potential therapeutic value in asthma treat-ment.Methods An OVA-induced asthma mouse mod-el was established,and intervention with miR-130b-3p agomir was performed.Histological staining,quantita-tive real-time PCR,Western blot,immunofluorescence and flow cytometry were used to analyze the effects of miR-130b-3p on the expression of USP47,NLRP3,and related inflammatory factors,as well as the inflamma-some activity.Results miR-130b-3p was significantly downregulated in asthmatic mice,and its intervention significantly inhibited airway epithelial damage,inflam-matory cell infiltration,and collagen deposition.Addi-tionally,miR-130b-3p targeted USP47 and indirectly suppressed NLRP3 expression,leading to reduced in-flammasome activity and alleviated asthma-related in-flammatory responses.Conclusion miR-130b-3p re-duces asthma-related inflammatory responses by down-regulating USP47 expression and indirectly inhibiting NLRP3 inflammasome activity.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Hypoventilation in obesity has four stages, and the first two stages are associated with intermittent nocturnal hypercapnia. We report a 46-year-old man who belongs to Stage 1, with complete washout of nocturnally accumulated carbon dioxide (CO2) and associated concomitant severe obstructive sleep apnea and severe hypoxemia. That condition will lead to progressive right heart dysfunction secondary to persistently nocturnal impaired ventilation and hypoxemia via the pathomechanism of hypoxic pulmonary vasoconstriction and pulmonary vascular remodeling by cytokines and growth factors, supposedly once it is missed for early diagnosis and appropriate PAP therapy is not introduced in time. Early identification and diagnosis of such conditional disease and in-time appropriate treatment are very important before sequelae of disease develop so that we could be able to prevent cardiovascular morbidity and mortality before disease progression.

Hypoventilation in obesity has four stages, and the first two stages are associated with intermittent nocturnal hypercapnia. We report a 46-year-old man who belongs to Stage 1, with complete washout of nocturnally accumulated carbon dioxide (CO2) and associated concomitant severe obstructive sleep apnea and severe hypoxemia. That condition will lead to progressive right heart dysfunction secondary to persistently nocturnal impaired ventilation and hypoxemia via the pathomechanism of hypoxic pulmonary vasoconstriction and pulmonary vascular remodeling by cytokines and growth factors, supposedly once it is missed for early diagnosis and appropriate PAP therapy is not introduced in time. Early identification and diagnosis of such conditional disease and in-time appropriate treatment are very important before sequelae of disease develop so that we could be able to prevent cardiovascular morbidity and mortality before disease progression.

Objective To evaluate the role of Talin1 in the migration of rat pulmonary artery smooth muscle cells(PASMCs)induced by the serum from rats with hepatopulmonary syndrome(HPS).Methods Twenty male Spra-gue-Dawley(SD)rats were used as HPS rat models by chronic common bile duct ligation,the serum was collected from abdominal aorta.PASMCs were seeded in 6-well and 24-well plates and randomly divided into control group and HPS group.The cells were transfected with Talin1 or control siRNA.The normal rat serum or HPS rat serum with a final concentration of 5％was added respectively.At 24 hours after cell transfection or at 24 hours(T1),48 hours(T2)and 72 hours(T3)of cell incubation,the protein expression of Talin1 and active Integin β1 in PASMCs were determined by Western blot;The migration of PASMCs was measured by Transwell chamber(T1)and scratch assay(T1 to T3).Results Compared to control group,with the extension of the stimula-tion time in the HPS group,the expression of Talin1 protein was upregulated,and the migration of PASMCs was gradually enhanced(P＜0.05);Talin1 siRNA effectively silenced the Talin1 gene;The expression of ac-tive Integin β1 protein and the migration of PASMCs in the HPS group+si control were enhanced(P＜0.05);Compared with the HPS group+si control,the expression of active Integin β1 protein and the migration of PASMCs in the HPS group+siTalin1 were significantly inhibited(P＜0.05).Conclusions Downregulating ex-pression of Talin1 protein inhibits migration of PASMCs and expression of active Integin β1 protein induced by the serum from HPS rats.

Objective To investigate the predictive value of temperature gradients on the mortality of sepsis patients and their correlation with fluid input.Methods By means of a prospective observational method,154 patients with sepsis or septic shock admitted to the Department of Critical Care Medicine at Nanfang Hospital,Southern Medical University from November 2019 to November 2021 were included as research subjects.They were divided into a survivor group(n=118)and a non-survivor group(n=36)according to whether they survived within 28 days.The core-to-toe temperature gradient(CTTG)and toe-to-room temperature gradient(TRTG)were monitored and calculated immediately upon admission to the intensive care unit(ICU)and 6 hours after admission.Receiver operating characteristic(ROC)curve was used to explore the predictive value of temperature gradients on mortality,and multivariate Cox regression analysis was performed to explore the risk factors of 28-day mortality in sepsis patients.The results were verified through survival analysis.Correlation analysis and multivariate analysis of variance were used to explore the correlation between temperature gradients and fluid input,as well as noradrenaline doses.Results Among the 154 patients,118 survived within 28 days(survivor group),and 36 died(non-survivor group).ROC curve and multivariate Cox regression analysis showed that a toe-to-room temperature gradient of≤5.35℃within 6 hours after admission was a risk factor for 28-day mortality.Compared with patients with a high toe-to-room temperature gradient(>5.35℃),patients with a low toe-to-room temperature gradient(≤5.35℃)had a 2.74-fold increase in the risk of 28-day mortality(P=0.004,95%CI 1.54,9.12).The CTTG and TRTG upon admission to the ICU and 6 hours after admission were not significantly associated with fluid input or noradrenaline doses(P>0.05).Conclusions A toe-to-room temperature gradient of less than or equal to 5.35℃within 6 hours after ICU admission is a risk factor for 28-day mortality in sepsis patients.The improvement of temperature gradients at different time points is not associated with fluid input.

Aim To investigate the role of miR-130b-3p in regulating the USP47/NLRP3 inflammasome in airway remodeling associated with asthma and to explore its potential therapeutic value in asthma treat-ment.Methods An OVA-induced asthma mouse mod-el was established,and intervention with miR-130b-3p agomir was performed.Histological staining,quantita-tive real-time PCR,Western blot,immunofluorescence and flow cytometry were used to analyze the effects of miR-130b-3p on the expression of USP47,NLRP3,and related inflammatory factors,as well as the inflamma-some activity.Results miR-130b-3p was significantly downregulated in asthmatic mice,and its intervention significantly inhibited airway epithelial damage,inflam-matory cell infiltration,and collagen deposition.Addi-tionally,miR-130b-3p targeted USP47 and indirectly suppressed NLRP3 expression,leading to reduced in-flammasome activity and alleviated asthma-related in-flammatory responses.Conclusion miR-130b-3p re-duces asthma-related inflammatory responses by down-regulating USP47 expression and indirectly inhibiting NLRP3 inflammasome activity.