Objective:To analyze the clinical manifestations,imaging characteristics,treatment measures,and efficacy of mitral valve aneurysm(MVA),and to enhance the clinicians'understandings of MVA.Methods:The clinical data of one patient with aortic valve bicuspid malformation leading to mitral valve anterior leaflet aneurysm were collected.The clinical diagnosis was confirmed based on the clinical characteristics and imaging features,the treatment methods were selected,and the efficacy was analyzed.The relevant literatures were reviewed.Results:The patient,a 68-year-old female,was admitted due to palpitations and shortness of breath for 13 years,and the symptoms worsened one month ago.Thirteen years ago,the patient experienced palpitations and shortness of breath without any inducement and was diagnosed with"heart valve disease"in the local hospital.The symptoms worsened one month ago,leading to hospitalization.The transthoracic two-dimensional echocardiography(TTE)results showed the left ventricular hypertrophy,bicuspid aortic valve with thickened and echogenic leaflets,the forward flow velocity was increased,and the aortic valve orifice area was 2.0 cm2;the mitral valve anterior leaflet margin was slightly thickened and echogenic,presenting a cystic"honeycomb-like"structure closely related to the aortic valve regurgitation jet,which appeared to enter the"sac".The preoperative transesophageal echocardiography(TEE)results showed the bicuspid aortic valve malformation with the anterior leaflet prolapsing into the left ventricular outflow tract during diastole;a"sac-like"structure was detected on the atrial surface of the mitral valve anterior leaflet,changing shape with the cardiac cycle and communicating with left ventricular blood flow.The ultrasound diagnosis was bicuspid aortic valve malformation with transverse fissure,severe regurgitation with mild stenosis,and mitral valve anterior leaflet aneurysm.Intraoperatively,the aortic valve annulus was enlarged with the significant leaflet regurgitation.The leaflets were excised,and a 23 mm bioprosthetic valve was implanted in the aortic position.Upon exploration through the aortic valve orifice,a"sac-like"structure was found on the mitral valve anterior leaflet,which was not specially treated.The postoperative TEE results showed good echo and activity of the aortic bioprosthetic valve,and the"sac-like"structure on the mitral valve remained unchanged.The follow-up results at 10 d and 4 months after operation showed good echo and activity of the aortic bioprosthetic valve,and compared with before operation,there was no significant change in the nature and size of the mitral valve cystic lesion.Conclusion:MVA is clinically rare.TTE is currently the most valuable imaging diagnostic method for MVA,especially when combined with TEE,which is the best diagnostic method and can assist in the treatment and efficacy evaluation.

Tetrandrine(TET),a natural bisbenzyl isoquinoline alkaloid extracted from Stephania tetrandra S.Moore,has diverse pharmacological effects.However,its effects on melanoma remain unclear.Cellular prolif-eration assays,multi-omics analyses,and xenograft models were used to determine the effect of TET on melanoma.The direct target of TET was identified using biotin-TET pull-down liquid chromatograph-mass spectrometry(LC-MS),cellular thermal shift assays,and isothermal titration calorimetry(ITC)analysis.Our findings revealed that TET treatment induced robust cellular autophagy depending on activating transcription factor 6(ATF6)-mediated endoplasmic reticulum(ER)stress.Simultaneously,it hindered autophagic flux by inducing cytoskeletal protein depolymerization in melanoma cells.TET treatment resulted in excessive accumulation of reactive oxygen species(ROS)and simultaneously triggered mitophagy.Sirtuin 5(SIRT5)was ultimately found to be a direct target of TET.Mechanistically,TET led to the degradation of SIRT5 via the ubiquitin(Ub)-26S proteasome system.SIRT5 knockdown induced ROS accumulation,whereas SIRT5 overexpression attenuated the TET-induced ROS accumula-tion and autophagy.Importantly,TET exhibited anti-cancer effects in xenograft models depending on SIRT5 expression.This study highlights the potential of TET as an antimelanoma agent that targets SIRT5.These findings provide a promising avenue for the use of TET in melanoma treatment and underscore its potential as a therapeutic candidate.

Objective:To explore the effect of manual prompts in the first detection of lung function and fractional exhaled nitric oxide (FeNO) in patients with airway inflammation of unknown origin.Methods:From May 2018 to December 2020, convenience sampling was used to select 810 patients with airway inflammation of unknown origin in the Department of Respiratory of the China-Japan Union Hospital of Jilin University as the subject. Subjects were divided into a observation group ( n=406) and a control group ( n=404) . This study compared the quality control parameters of lung function detection [forced expiratory time (PET) , backward extrapolated volume (VBE) , time from forced expiratory to peak flow rate (FET-PET) , percentage of backward extrapolated volume to forced vital capacity (VBE/FVC%) ] , reproducibility parameters [variation between optimal and suboptimal forced vital capacity (ΔFVC) , variation between optimal and suboptimal first second forced expiratory volume (ΔFEV 1) ] , and detection efficiency indicators (detection time for lung function and FeNO, one-time success rate of FeNO detection) between two groups. Results:The VBE/FVC%, ΔFVC, and ΔFEV 1 in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The lung function and FeNO detection time of the observation group were shorter than those of the control group, and the one-time success rate of FeNO detection was higher than that of the control group, with statistical differences ( P<0.05) . Conclusions:In lung function and FeNO detection for the first time among patients with airway inflammation of unknown origin, manual prompts can improve the quality control and reproducibility of the detection, shorten the detection time, and increase the one-time success rate of FeNO detection.

Hexokinase(HK),as the first rate-limiting enzyme for glycolysis,promotes tumor progression by improving levels of aerobic glycolysis in tumor cells.By binding to the voltage-dependent anion channel(VDAC)on the outer mitochondrial membrane,HK2 is involved in increasing the stability of mitochondrial membranes,thereby inhibiting apoptosis of tumor cells and promoting tumor survival,which is why HK2 may be one of the factors that promote tumor resistance to chemotherapy drugs.This article reviews the research progress in the role of HK2 in tumor glucose metabolism,mitochondrial apoptosis and drug resistance.

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Objective:To explore the correlation between early pupillary light reflex reduction and delirium in mechanically ventilated patients receiving sedation in the Intensive Care Unit (ICU) .Methods:From December 2020 to March 2021, convenience sampling was used to select 97 ICU patients with mechanical ventilation who received sedation in the China-Japan Union Hospital of Jilin University as the research subject. On the second to fourth days of the patient's stay in the ICU, the quantitative pupillary light reflex (q-PLR) and pupillary contraction velocity (CV) of the patients after photostimulation were measured by an automatic infrared pupillometer with a frequency of two times a day. Patients were assessed using the Richmond Agitation-Sedation Scale (RASS) . When the RASS score was≥-2, the patient was screened for delirium using the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) with a frequency of two times a day. According to the screening results, patients were divided into delirium group and non-delirium group.Results:The incidence of delirium in 97 ICU mechanically ventilated patients who received sedation was 58.76% (57/97) . Binomial Logistic regression showed that q-PLR on the second day was an influencing factor for delirium in mechanically ventilated ICU patients receiving sedation ( P<0.05) . Conclusions:Early pupillary light reflex reduction is associated with delirium in mechanically ventilated ICU patients receiving sedation.

Objective:To explore the application effect of health management in extended nursing for patients with hemorrhagic stroke.Methods:Using the convenient sampling method, a total of 120 patients with hemorrhagic stroke who were admitted to the First People's Hospital of Lianyungang in Jiangsu Province from August 2018 to August 2019 were selected as the research objects. According to the random number table method, they were divided into the control groups and the observation group, with 60 cases in each group. The control group and the observation group were respectively given traditional family follow-up nursing and extended nursing based on health management. The mastery degree of knowledge about hemorrhagic stroke disease, self-health management ability, medication compliance and psychological status of patients with hemorrhagic stroke were observed in the two groups.Results:After the implementation of extended nursing based on health management, the total scores of mastery degree of knowledge about nursing for hemorrhagic stroke and self-health management ability in the observation group were respectively (90.38±2.13) and (149.65±4.65) , which were higher than (59.07±2.45) and (115.79±5.34) of the control group, and the differences were statistically significant ( P<0.01) . The total compliance rate of patients in the observation group was 86.67% (52/60) , which was higher than 43.33% (26/60) in the control group, and the difference was statistically significant ( P<0.01) . After the intervention, scores of SDS and SAS of the observation group were (41.87±8.23) and (40.68±7.34) , which were lower than (54.23±7.45) and (52.02±9.86) of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The extended nursing based on health management is well applied in the family follow-up work of patients with hemorrhagic stroke. Mastery degree of knowledge of patients, self-health management ability, and treatment compliance are improved and levels of depression and anxiety are reduced.

Objective:To investigate changes in the expression of Cosmc and T-synthase in peripheral B lymphocytes and in serum levels of galactose-deficient IgA1 (Gd-IgA1) in patients with Henoch-Sch?nlein purpura (HSP) .Methods:From January to August 2014, 56 patients with HSP were collected from outpatient or inpatient department of dermatology and venereology in the Second Hospital of Hebei Medical University, and were divided into 4 groups, including skin type group (22 cases) , joint type group (9 cases) , abdominal type group (12 cases) and renal type group (13 cases) . Twenty healthy volunteers served as healthy controls. Real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of Cosmc and T-synthase in peripheral B lymphocytes, and a lectin-based enzyme-linked immunosorbent assay (ELISA) to detect the serum level of Gd-IgA1. Comparisons among multiple groups were performed using one-way analysis of variance or Kruskal-Wallis H test, multiple comparisons were performed using least significant difference (LSD) - t test or Nemenyi test, and correlation analysis was performed using Spearman rank correlation analysis. Results:There was a significant difference in the duration from disease onset to the clinic visit ( χ2= 26.19, P < 0.05) among the skin type group (6.27 ± 3.09 d) , joint type group (5.56 ± 3.05 d) , abdominal type group (6.75 ± 3.75 d) , and renal type group (26.23 ± 14.12 d) , and the duration from disease onset to the clinic visit was significantly longer in the renal type group than in the other 3 groups (all P < 0.05) . The Cosmc mRNA expression significantly differed among the skin type group, joint type group, abdominal type group, renal type group and healthy control group (0.849 ± 0.239, 0.767 ± 0.181, 0.719 ± 0.183, 0.459 ± 0.121, 1.146 ± 0.232, F= 23.37, P < 0.05) , was significantly lower in the 4 patient groups than in the healthy control group ( P < 0.01) , and lower in the renal type group than in the other 3 patient groups (all P < 0.01) . There was no significant difference in the T-synthase mRNA expression in peripheral B lymphocytes among the patient groups and healthy control group ( F= 1.05, P > 0.05) . The serum level of Gd-IgA1 significantly differed among the skin type group, joint type group, abdominal type group, renal type group and healthy control group ( F= 7.06, P < 0.05) . Moreover, the Gd-IgA1 level was significantly higher in the patient groups than in the healthy control group (all P < 0.05) , and higher in the renal type group than in the other 3 patient groups (all P < 0.05) . The serum level of Gd-IgA1 in the HSP patients was significantly and negatively correlated with the mRNA expression of Cosmc ( rs=-0.50, P < 0.01) . Conclusion:Decreased mRNA expression of Cosmc and increased serum levels of Gd-IgA1 were observed in patients with HSP, and there was a negative correlation between the two indices.

To introduce the diagnosis and treatment of one male case with accessory breast. The patient was a 27-year-old male. An additional nipple on the left posterior axillary line was found on birth, which enlarged and became darken since adolescence. The clinical diagnosis was accessory breast, and a complete surgical excision was performed. Pathological examination proved the diagnosis of accessory breast.

Objective To analyze the effects of Hual qi huang granules on children with mycoplasma pneumoniae pneumonia.Methods A randomized,multicenter parallel controlled clinical trial was carried out.A total of 3 000 cases of hospitalized children with mycoplasma pneumoniae pneumonia were selected.All of them were given treatment for mycoplasma pneumoniae pneumonia with macrolide antibiotics and symptomatic treatment.They were randomly divided into 2 groups:research group and control group.The children of research group were give oral Huai qi huang granules for three months.According to the classification of pneumonia,these two groups were divided into:lobar pneumonia research group,lobar pneumonia control group,lobular pneumonia research group,lobular pneumonia control group.The hospitalization duration of fever,length of hospital stay,the absorption area of lung inflammation and pneumonia severity sores were observed.The frequency of upper respiratory infections,bronchitis,pneumonia were observed in 3 months after discharge.Results 2 378 cases were investigated.The hospitalization duration of fever,length of hospital stay of research group were significantly shorter than that of in control group (P ＜ 0.001).The children with lobar pneumonia,2 weeks after treatment,the absorption of consolidation of the lobar pneumonia research group is significantly better than lobar pneumonia control group (P ＜0.001).After two weeks treatment,the pneumonia scores of lobar pneumonia research group is lower than lobar pneumonia control group (P ＜ 0.05).Followup of 3 months after hospital discharge,frequency of upper respiratory infection and bronchitis of research group,were significantly lower than that of control.In addition,appetite increased significantly in research group than control (P ＜ 0.001).There are 21 cases with drug associated adverse reactions (mild diarrhea),including 12 cases of research group,9 cases of control group,and there was no statistical significance (P ＞0.05).Conclusion Standard treatment combined with oral Huai qi huang granules in the treatment of mycoplasma pneumoniae pneumonia,can significantly shorten hospitalization duration of fever,length of hospital stay and reduce the severity score of pneumonia.Three months oral Huai qi huang granules can significant reduce the frequency of respiratory infections and bronchitis,also can increase patients appetite,and be safe.