Objective To investigate the effect of subanesthetic dose of esketamine on remifentanil-in-duced hyperalgesia after cesarean section under general anesthesia,and its effect on serum homocysteine(Hcy)level and postpartum depression.Methods A total of fifty patients undergoing cesarean section under general anesthesia were randomly divided into the esketamine group and the control group(25 cases in each group).The two groups were given esketamine 0.2 mg/kg and the same amount of normal saline by slow in-jection 10 min after fetal delivery.Then,the extubation time,visual analogue scale(VAS)score within two hours after operation,and consumption of morphine while in the post-anaesthesia care unit(PACU)were compared between the two groups.The Edinburgh Postnatal Depression Scale(EPDS)scores were compared at one day before surgery,one day,four days,and one month after surgery.Serum Hcy levels were measured at one day before surgery,one day and four days after surgery.Results There was no significant difference in extubation time between the two groups(P>0.05).Compared with the control group,it took a longer time for patients in the esketamine group to have a VAS score≥4 for the first time,but the time from morphine injection to a VAS score<4 was shortened(P<0.05).The amount of morphine used in the esketamine group was lower than that in the control group in PACU(P<0.05).Compared with the control group,the VAS scores of the esketamine group decreased at 15 min,30 min,45 min,one hour,and 90 min after surgery(P<0.05),while there was no statistical significance difference in VAS scores at two hours after surgery(P<0.05).EPDS scores in the esketamine group were lower than those in the control group at one day and four days after surgery(P>0.05),but there was no statistically significant between the two groups at one month after surgery(P>0.05).Serum Hcy level in the esketamine group was lower than that in the control group at one day and four days after surgery(P<0.05).Conclusion The subanesthetic dose of esketamine during caesarean section under general anesthesia can effectively relieve remifentanil-induced postoperative hy-peralgesia and prevent the occurrence of postpartum depression.

Objective To screen Cuproptosis genes and characteristic genes for differential prognosis in acute mye-loid leukemia(AML)and explore their prognosis in AML as well as their biological roles and correlations in the immune and tumor microenvironment.Methods AML clinical,transcriptome,genomic,and copy number data were downloaded from three major databases,TCGA,GEO,and UCSC,and Cuproptosis genes were collected from published studies.From the perspective of multiomics,the effects of Cuproptosis gene and characteristic gene on survival,immunity,tumor microenvironment,stem cell correlation and drug sensitivity were studied by various bioinformatics methods,meta-analysis and secondary typing.Results One Cuproptosis gene was identified as a differential prognostic gene in AML and five characteristic genes were identified as influencing the prognosis of AML patients by influencing Cuproptosis,and a prognostic model was established.The differential genes were mainly concentrated in mitochondrial activity,REDOX enzyme and energy metabolism.In terms of immunity,macrophage M0,neutrophils,activated memory CD4 T cells and Tregs were positively correlated with risk score,while macro-phage M2,resting mast cells,immature CD4 T cells,helper follicular T cells and memory B cells were negatively correlated with risk score.In terms of tumor microenvironment,the immune cell score of the low-risk group was lower than that of the high-risk group,and in the total score,the tumor microenvironment score of the low-risk group was also lower than that of the high-risk group,indicating that the tumor purity of the high-risk group was lower than that of the low-risk group.However,there was no significant association between stem cells in the high-risk and low-risk groups,and a total of 14 drugs were found to be sensitive to treat AML.Conclusion Cuproptosis gene and characteristic gene are closely related to immune and tumor microenvironment in AML by constructing a prognostic model of AML.

Objective To explore the correlation of serum levels of ADAMTS-4 and aβ2-GP1 anti-body with WML in elderly patients with ACI.Methods A retrospective study was conducted on 200 elderly ACI patients admitted in Department of Neurology of from January 2022 to January 2024.Based on Fazekas scoring,they were categorized into the control group(n=32),mild group(n=96),moderate group(n=49),and severe group(n=23).Their neurological function and ser-um levels of ADAMTS-4 and aβ2-GP1 were compared among the different groups.Results The NIHSS score and serum levels of ADAMTS-4 and aβ2-GP1 were significantly higher in the severe group than the moderate group,mild group and control group in order,and statistical difference were observed among them(P＜0.05).Serum ADAMTS-4 and aβ2-GP1 levels were significantly positively correlated with the severity of WML(P＜0.05).Serum ADAMTS-4 and anti-β2-GP1 were influencing factors for the occurrence of WML in elderly ACI patients(OR=2.149,95％CI:1.375-3.360,P=0.001;OR=1.702,95％CI:1.185-2.446,P=0.004).Conclusion The levels of serum ADAMTS-4 and aβ2-GP1 are closely related to the severity of WML and nerve damage in elderly ACI patients.

Objective : A convolutional neural network (CNN) model was established to automatically analyze flow cytometry (FCM) data to achieve the preliminary diagnosis of acute myeloid leukemia(AML) , and explore the feasibility of applying CNN model to FCM data analysis. Methods : The exploratory study of CNN application was carried out using the bone marrow FCM data obtained by the FlowRepository database and the Clinical Testing Center of Xinjiang Uygur Autonomous Region People ′ s Hospital , and the data had been clinically confirmed whether AML was present. Among them , the public data was divided into training sets , validation sets and test sets according to 6 ∶ 2 ∶ 2 , and local data was used for external test; In order to adapt the FCM data to the CNN model , an FCM data structure based on the image matrix principle was proposed , and after preprocessing the original data , the variables related to the preliminary diagnosis of AML were extracted , including sidescattered light and the expression levels of CD45 , CD13 , CD33 , HLA⁃DR , CD117 , CD34 , and each variable was written into the matrix. Cell sampling and data augmentation methods were used to increase the sample size of the training set , the keras software package was used to build the LeNet⁃5 CNN model in Python , and the training set and the validation set were used for model training and parameter tuning respectively to evaluate the performance of the model on the test set. Results : The accuracy of CNN to identify AML on the two test sets was 0. 931 , 0. 851 , the sensitivity was 0. 667 , 0. 636 , the specificity was 0. 968 , 0. 940 , and the area under the receiver operating characteristic curve was 0. 940 and 0. 917. Conclusion Based on the proposed FCM data structure , the CNN model can realize the preliminary diagnosis of AML , indicating that CNN has certain application value in FCM data analysis.

Objective:To investigate the role of 20 MHz high-frequency ultrasound in evaluating scar thickness and morphology.Methods:The clinical data of patients with the initial stage of scar formation after burn trauma (<1 month), hypertrophic scar (1-6 months) and atrophic scar (>6 months) treated by the Department of Burn and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University from April 2019 to December 2020, were retrospectively analyzed. All patients were evaluated by 20 MHz high-frequency ultrasound, histopathology and Vancouver scar scale (VSS). Three measurement points were randomly selected at the scar during ultrasonic examination, and the average value was recorded as the ultrasonic thickness measurement value. The scar tissue samples were collected from the site of ultrasonic examination, and HE staining and Masson staining were performed. At the same time, scar thickness was evaluated by two physicians using VSS. The difference of scar thickness assessment result among the 3 method in patients at the initial stage of scar formation, hypertrophic scar and atrophic scar was compared. Meanwhile, the relationship between the characteristics of 20 MHz high-frequency ultrasound and histopathology was compared. The measurement data of normal distribution were expressed as Mean±SD. One-way ANOVA was used for comparison among three groups, and SNK- q test was used for pairwise comparison between groups. Counting data were analyzed by Chi-square test. Results:A total of 224 patients were included, including 91 males and 133 females, aged from 1 to 34 years, with an average age of 25.7 years. There were 79 patients at the initial stage of scar formation, 102 at the hypertrophic stage, and 43 at the atrophic stage. (1) In the initial stage of scar formation, the thickness measured by 20 MHz ultrasound was about (2.01±0.68) mm, the thickness evaluated by VSS was (1.72±0.49) mm, and the thickness measured by pathological section was (2.11±0.45) mm. In the hyperplastic scar stage, the thickness measured by 20 MHz ultrasound was (4.11±0.73) mm, the thickness evaluated by VSS was (3.02±0.47) mm, and the thickness measured by pathological section was (4.27±0.44) mm. In the atrophic scar stage, the thickness measured by 20 MHz ultrasound was (1.74±0.64) mm, the thickness measured by VSS was (1.77±0.61) mm, and the thickness measured by pathological section was (1.71±0.67) mm. For scars in the above three periods, there was no statistical significance between scar thickness measured by 20 MHz high-frequency ultrasound and that measured by pathological sections(all P<0.05). In the initial stage of scar formation and hypertrophic stage, the thickness evaluated by VSS was significantly different from that measured by 20 MHz high-frequency ultrasound and pathology (all P<0.05), respectively. (2) Echo intensity was evaluated by ultrasound. In the initial stage of scar formation, the thickness of the epidermis shown by high-frequency ultrasound was close to that of the normal epidermis and presented a high-intensity echo, but there was a strip of echoless or no echo zone of <1 mm between the high-intensity echo epidermis and dermis, which looked like dermal edema. Pathology showed that there were acanthoid changes in the epidermis of the scar at this stage, rich capillaries and a small amount of collagen fibrous tissue in the dermis. In the hyperplastic scar stage, the scar epidermis still showed strong echo, while the dermis showed uneven echo, the superficial dermis showed obvious isoecho, and the deep dermis showed no echo or hypoecho. Pathology showed that the epidermis was thin and smooth, and keratosis was obvious. Collagen fibers parallel to the epidermis could be seen in the superficial layer of the dermis, with regular arrangement. Collagen fibers were increased and thickened in the deep layer of the dermis, in the shape of nodules and swirls. In the atrophic scar stage, the scar epidermis presented a strong echo, and there was no obvious demarcation between the dermis and subcutaneous tissue, presenting a uniform echo. Pathological findings showed that the epidermis became thinner with a "skin nails" -like structure, the junction between the superficial and deep dermis was not obvious, and the collagen fibers were arranged in parallel or oblique direction, and the surface boundary was unclear. Conclusion:20 MHz high-frequency ultrasound is more accurate than VSS in the assessment of thickness of hypertrophic scar, and can reflect the collagen content and moisture ratio in scar. Compared with pathological examination, it has the advantages of non-invasive and fast, and is an effective means to evaluate scar thickness and morphology.

Objective:To investigate the role of 20 MHz high-frequency ultrasound in evaluating scar thickness and morphology.Methods:The clinical data of patients with the initial stage of scar formation after burn trauma (<1 month), hypertrophic scar (1-6 months) and atrophic scar (>6 months) treated by the Department of Burn and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University from April 2019 to December 2020, were retrospectively analyzed. All patients were evaluated by 20 MHz high-frequency ultrasound, histopathology and Vancouver scar scale (VSS). Three measurement points were randomly selected at the scar during ultrasonic examination, and the average value was recorded as the ultrasonic thickness measurement value. The scar tissue samples were collected from the site of ultrasonic examination, and HE staining and Masson staining were performed. At the same time, scar thickness was evaluated by two physicians using VSS. The difference of scar thickness assessment result among the 3 method in patients at the initial stage of scar formation, hypertrophic scar and atrophic scar was compared. Meanwhile, the relationship between the characteristics of 20 MHz high-frequency ultrasound and histopathology was compared. The measurement data of normal distribution were expressed as Mean±SD. One-way ANOVA was used for comparison among three groups, and SNK- q test was used for pairwise comparison between groups. Counting data were analyzed by Chi-square test. Results:A total of 224 patients were included, including 91 males and 133 females, aged from 1 to 34 years, with an average age of 25.7 years. There were 79 patients at the initial stage of scar formation, 102 at the hypertrophic stage, and 43 at the atrophic stage. (1) In the initial stage of scar formation, the thickness measured by 20 MHz ultrasound was about (2.01±0.68) mm, the thickness evaluated by VSS was (1.72±0.49) mm, and the thickness measured by pathological section was (2.11±0.45) mm. In the hyperplastic scar stage, the thickness measured by 20 MHz ultrasound was (4.11±0.73) mm, the thickness evaluated by VSS was (3.02±0.47) mm, and the thickness measured by pathological section was (4.27±0.44) mm. In the atrophic scar stage, the thickness measured by 20 MHz ultrasound was (1.74±0.64) mm, the thickness measured by VSS was (1.77±0.61) mm, and the thickness measured by pathological section was (1.71±0.67) mm. For scars in the above three periods, there was no statistical significance between scar thickness measured by 20 MHz high-frequency ultrasound and that measured by pathological sections(all P<0.05). In the initial stage of scar formation and hypertrophic stage, the thickness evaluated by VSS was significantly different from that measured by 20 MHz high-frequency ultrasound and pathology (all P<0.05), respectively. (2) Echo intensity was evaluated by ultrasound. In the initial stage of scar formation, the thickness of the epidermis shown by high-frequency ultrasound was close to that of the normal epidermis and presented a high-intensity echo, but there was a strip of echoless or no echo zone of <1 mm between the high-intensity echo epidermis and dermis, which looked like dermal edema. Pathology showed that there were acanthoid changes in the epidermis of the scar at this stage, rich capillaries and a small amount of collagen fibrous tissue in the dermis. In the hyperplastic scar stage, the scar epidermis still showed strong echo, while the dermis showed uneven echo, the superficial dermis showed obvious isoecho, and the deep dermis showed no echo or hypoecho. Pathology showed that the epidermis was thin and smooth, and keratosis was obvious. Collagen fibers parallel to the epidermis could be seen in the superficial layer of the dermis, with regular arrangement. Collagen fibers were increased and thickened in the deep layer of the dermis, in the shape of nodules and swirls. In the atrophic scar stage, the scar epidermis presented a strong echo, and there was no obvious demarcation between the dermis and subcutaneous tissue, presenting a uniform echo. Pathological findings showed that the epidermis became thinner with a "skin nails" -like structure, the junction between the superficial and deep dermis was not obvious, and the collagen fibers were arranged in parallel or oblique direction, and the surface boundary was unclear. Conclusion:20 MHz high-frequency ultrasound is more accurate than VSS in the assessment of thickness of hypertrophic scar, and can reflect the collagen content and moisture ratio in scar. Compared with pathological examination, it has the advantages of non-invasive and fast, and is an effective means to evaluate scar thickness and morphology.

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

The spread of current emerging outbreaks of virus infections already poses a serious threat to public health and has the potential to trigger devastating epidemics worldwide. Therefore, it is especially significant to strengthen the detection of viral diseases. Next-generation sequencing (NGS) not only enables the accurate identification of pathogens but can also be combined with bioinformatics to monitor emergent infectious diseases based on the sequencing of pathogen genomes, further enhancing the level of clinical diagnosis and microbiological recognition. This review discusses the application of NGS to detect the pathogens of emerging outbreaks of viral diseases, and to further investigate their variation and evolution characteristics, pathogenic mechanisms and transmission patterns, and apply NGS in clinical practice to address the diagnosis of difficult infectious diseases so that more effective strategies can be developed to prevent emerging outbreaks.

To evaluate the efficacy and safety of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) over 75 years. A total of 82 patients with AF who underwent LAAO successfully in Beijing Anzhen Hospital from March 2014 to March 2019 were divided into two groups according to age: the elderly group (aged>75 years) and the young group (aged ≤75 years). Risk of perioperative complications and incidence of ischemic stroke and major bleeding during follow-up were retrospectively analyzed. The results showed that there were no significant differences in procedure-related ischemic stroke(0 vs.1.6%, P=0.768) and major bleeding (0 vs.1.6%, P=0.768) during perioperative period between the two groups. No complications as death or pericardial tamponade occurred in the two group. During a (25.9±15.9) months period of followed up, ischemic stroke event rate was 3.6/100 person-years in the elderly group and 4.9/100 person-years in the young group, respectively. Major bleeding event rate was 2.5/100 person-years in the elderly group and 0/100 person-years in the young group, respectively. Compared with the expected ones, the relative risk reduction (RRR) of stroke in the elderly group was more profound than that in the young group (32.0% vs. 25.0%), while the risk of major bleeding in the young group was significantly lower than that in the elderly group (RRR 100% vs. 56.9%). Therefore, LAAO might be suitable for stroke prevention in the elderly AF patients.

Objective To investigate the expressions of programmed death-ligand 1 (PD-L1) and PD-L2 and phosphorylated protein kinase B (p-AKT) in diffuse large B-cell lymphoma (DLBCL) patients and their correlations with clinicopathological features and prognosis. Methods A total of 68 paraffin-embedded specimens of DLBCL patients diagnosed in Shanxi Provincial Cancer Hospital with detailed follow-up record from January 2010 to December 2012 were included in the study. The expressions of PD-L1, PD-L2 and p-AKT proteins in DLBCL were detected by using immunohistochemistry (IHC). Results The positive rate of PD-L1 protein in DLBCL patients was 22.1％ (15/68), which was related to germinal center B-cell (GCB) subtype or not (χ2= 5.591, P= 0.018), clinical stage (χ2= 3.969, P= 0.046), international prognostic index (IPI) grades (χ2=4.178, P=0.041) and treatment remission rate (χ2=6.587, P=0.010). The positive rate of PD-L2 protein in DLBCL patients was 14.7％ (10/68), which was related to extranodal metastasis or not (χ2=6.772, P= 0.009). The positive rate of p-AKT for DLBCL patients was 61.8％ (42/68), which was correlated with age (≥60 years old) or not (χ2=6.227, P=0.013), Eastern Cooperative Oncology Group (ECOG) grades (χ2=4.005, P=0.045), B symptoms (χ2=10.187, P=0.001) and treatment remission rate (χ2=4.096, P=0.043). Univariate survival analysis showed that the overall survival (OS) rate and progression free survival (PFS) rate of PD-L1 protein positive expression group were lower than those of PD-L1 protein negative expression group (both P< 0.05). In the patients with non-GCB subtype, OS rate and PFS rate of PD-L1 protein positive expression group were lower than those of PD-L1 protein negative expression group (both P<0.05). p-AKT protein positive expression group had poorer OS rate and PFS rate compared to p-AKT negative expression group (both P< 0.05). Correlation analysis showed that PD-L1 protein expression was correlated with PD-L2 and p-AKT proteins expressions (r= 0.380, P= 0.001;r= 0.273, P= 0.025). The prognosis was worse when p-AKT and PD-L1 proteins was co-expressed (P< 0.05). Multivariate analysis suggested high expressions of PD-L1 and p-AKT proteins were independent prognosis risk factors in DLBCL (both P<0.05). Conclusions The expressions of PD-L1 and p-AKT proteins may be involved in the occurrence and development of DLBCL. Blocking PD-1 and PD-L1 access or combined blocking could provide a promising future for the clinical therapy.