Arteriovenous fistula dysfunction （AVF） is a frequent and often unforeseeable complication in hemodialysis patients， and the most common cause is venous outflow stenosis resulting from neointimal hyperplasia and outward remodeling. Currently， there have been few effective prevention and treatment measures for AVF， therefore， this paper reviews the interventions and preventive measures of the AVF.

Objective To explore the effects of fecal microbiota transplantation （FMT） on oxalate metabolism and renal protection in rats fed a high oxalate diet. Methods Twenty-four male SD rats were randomly divided into four groups： SC， SC + FMT， OD + PBS and OD + FMT. The SC group was set as the control group and was fed standard rat chow. The OD + PBS group and OD + FMT group were fed a diet containing 5% oxalate. Starting from day 14， the OD + PBS group， OD + FMT group and SC + FMT group received intragastric administration of PBS solution or filtered faecal microbiota solution from guinea pigs for 7 consecutive days. The 24-hour urine， feces， and venous serum of the rats were collected from the rats of all groups to determine the gut microbiota and biochemical markers. Real-time quantitative PCR and immunohistochemistry were conducted on the rat kidneys to detect the expression of renin， ACE， and OPN. Results The fecal microbiota transplantation altered the gut microbiota of rats. The gut microbiota of the SC + FMT group deviated from that of the SC group and showed increased similarity to that of the guinea pigs. Compared to the OD + PBS group， the OD + FMT group exhibited significant reductions in the urinary oxalate， urinary urea， uric acid， urinary creatinine， serum urea nitrogen/creatinine， and serum uric acid. Furthermore， after FMT treatment， the OD + FMT group exhibited reduced upregulation of renin mRNA expression and restored downregulation of OPN mRNA expression compared to the OD + PBS group； similar results were obtained from immunohistochemistry. Conclusion Fecal microbiome trans-plantation activated the microbial network in the rat gut， particularly the oxalate-degrading bacteria represented by Muribaculaceae. The kidney injury induced by high oxalate was partially restored by the microbiota network's degradation of oxalate， indicating the protective effect of fecal microbiota transplantation on the rat kidneys.

Objective The aim of this study was to investigate whether there are differences in the expression spectrums of RSK4 in different tumor cells and to predict the possible protein subtypes and their biological characteristics. Methods RNA was extracted from glioma cells GL261， ovarian cancer cells ID8， breast cancer cells 4T1 and 168FARN， colon cancer cells mc38 and CT26， gastric cancer cells MFC and lung cancer cells LLC1. The expressions and splicing isomers of RSK4 were detected by RT?PCR. The biological characteristics and functions of RSK4 were analyzed by bioinformatics. Results RT?PCR results showed that RSK4 was expressed in GL261， 4T1， mc38， CT26， MFC and LLC1； and multiple splicing isomers were expressed in different tumor cells. Open reading frame analysis revealed RSK4 may encode at least 11 protein subtypes. Secondary structure analysis showed that these protein subtypes encoded by the splicing isomers were composed of α?helix， extended strand， β?turn and random coil， and had the same conserved domain. The results of protein interaction network enrichment analysis showed that RSK4 exerted kinase activity in the nucleus and cytoplasm mainly through the mTOR signaling pathway and long?term potentiation. Conclusions RSK4 has different expression spectrums in different tumor cells， and may produces a variety of protein isoforms with different nitrogen terminals， which can be involved in different biological processes through multiple signaling pathways.

Objective The aim of this study was to investigate the impact and mechanisms of emodin on oxidative stress response in lipopolysaccharide （LPS）-induced murine mononuclear macrophages （RAW264.7）. Methods Involved the use of LPS， RAW264.7 cells， and emodin. Experimental groups included a control group， LPS（1 μg/mL） group， and LPS（1 μg/mL） + emodin （15 μmmol/L） pretreatment group. Aldehyde malondialdehyde （MDA） content， intracellular reactive oxygen species （ROS） levels， and silent information regulator 2（Sirt2） expression were evaluated at 6， 12， and 18 hours after LPS exposure. Additionally， RAW264.7 cells were pretreated with Sirt2 inhibitor AGK2 （20 μmol/L） followed by LPS stimulation， and the above-mentioned parameters were assessed at 6 hours. Results Compared to the control group， MDA content， ROS levels， Sirt2 mRNA， and protein expression in RAW264.7 cells in the LPS group increased at all time points （all P < 0.05）. At 6 and 18 hours， MDA content and ROS levels in RAW264.7 cells in the LPS + emodin group decreased significantly （all P < 0.05）， while at 12 hours， ROS levels were lower in the LPS group compared to the LPS + emodin group （P < 0.05）. Sirt2 mRNA and protein levels significantly increased at all time points （all P < 0.05） compared to the LPS group. In the LPS + emodin + AGK2 group， Sirt2 mRNA and protein levels decreased， and MDA content and ROS levels increased compared to the LPS + emodin group （all P < 0.05）. Conclusion LPS-induced oxidative stress in RAW264.7 cells and emodin attenuate LPS-induced oxidative stress in RAW264.7 cells through Sirt2.

Objective This research aimed to investigate the expression and mechanism of miR-155 and suppressor of cytokine signaling 1 （SOCS1） in rheumatoid arthritis （RA）. Methods RT-PCR and flow cytometry were applied to detect the expression differences of miR-155， Th17， and Treg cells in peripheral blood of RA patients （RA group） and control group （HC group）. Bioinformatics analysis and dual-luciferase reporter assay were conducted to investigate the regulatory relationship between miR-155 and SOCS1. CD4⁺T cells were isolated from peripheral blood of RA patients and transfected with miR-155 inhibitor， si-SOCS1， and their respective negative control sequences， and divided into four groups： miR-NC group， miR-155 inhibitor group， miR-155 inhibitor+si-NC group， and miR-155 inhibitor+si-SOCS1 group. The cells were treated with Th17-inducing differentiation medium， and flow cytometry was used to determine the ratio of Th17 cells in each group of CD4⁺T cells. Western blot was used to determine the ratio of p-STAT3/STAT3 in the cells. Results Compared to the HC group， RA patients showed increased expression of miR-155 and Th17 ratio （P < 0.01）， and decreased Treg cell ratio （P < 0.01）. MiR-155 could target and inhibit the expression of SOCS1. Compared to the miR-NC group， the miR-155 inhibitor group， miR-155 inhibitor+si-NC group， and miR-155 inhibitor+si-SOCS1 group showed decreased Th17 ratio and p-STAT3/STAT3 ratio （P < 0.01）. Compared to the miR-155 inhibitor group， the miR-155 inhibitor+si-SOCS1 group exhibited increased Th17 ratio and p-STAT3/STAT3 ratio in CD4⁺T cells （P < 0.05）. Conclusion Elevated expression of miR-155 in RA patients may mediate the differentiation of CD4⁺ T cells into Th17 cells through the SOCS1/STAT3 pathway， contributing to the imbalance of Th17/Treg cells in peripheral blood of RA patients.

Objective To investigate the effect of iTBS stimulation on walking function in patients with stroke. Methods Fifty patients with post-stroke walking dysfunction who met the inclusion criteria were selected for 3-week rehabilitation treatment， and were randomly divided into iTBS group（n = 25） and sham group（n = 25）. The iTBS group was treated with conventional rehabilitation therapy combined with iTBS stimulation of contralesional cerebellum， and the sham group was treated with conventional rehabilitation therapy plus iTBS stimulation of contralesional cerebellum. Relevant indicators were analyzed before treatment and at 21 days of treatment. Lower limb motor function scores of the two groups were compared before and after treatment. Fugl-Meyer motor function lower limb activity score， Berg Balance Scale score， Brunnstrom stage（lower limb）， hamstring/quadriceps（H/Q）on the affected side， Modified Barthel index （MBI）， gait analysis parameters， and TMS-MEP were used to evaluate the effectiveness of cerebellar iTBS in the rehabilitation of walking dysfunction after stroke. Results After 21 days of treatment， the improvements of Brunnstrom stage， Holden grade， Berg score， FMA score， 6-minute walking distance， NIHSS score and MBI score in iTBS group were significantly better than those in sham group （P < 0.05）. After treatment， the H/Q in iTBS group was significantly higher thanbefore （P < 0.05）， but there was no significant difference between the two groups （P > 0.05）.Stride speed， stride frequency， stride width， single support phase on the affected side and GDI score in iTBS group were significantly improved compared with sham group （P < 0.05）， and there was no significant difference in stride length between the two groups after treatment （P > 0.05）. The amplitude of MEP in the affected cerebral cortex of iTBS group was lower after treatment than before （P < 0.05）. Conclusion Contralesional cerebellar iTBS combined with routine rehabilitation could improve lower limb walking function and daily living ability of stroke patients.

Objective To explore the relationship between lactate dehydrogenase to albumin ratio （LAR） and short?term prognosis in patients with sepsis?associated acute kidney injury （AKI）. Methods A retrospective analysis was conducted on 463 sepsis patients treated in the intensive care unit （ICU） of Beijing Shijitan Hospital， Capital Medical University， from January 2018 to June 2022. The patients were divided into two groups： a group with secondary AKI （AKI group） and the one without acute kidney injury （non?AKI group）. Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ）， Sequential Organ Failure Assessment （SOFA）， and levels of procalcitonin （PCT）， C?reactive protein （CRP）， serum creatinine （SCr）， lactate dehydrogenase （LDH）， and albumin （ALB） were compared between the two groups. Multivariate logistic regression analysis was used to determine prognostic factors for sepsis?associated acute kidney injury， and Receiver Operating Characteristic （ROC） analysis was performed to assess the predictive value of APACHE Ⅱ score， SOFA score， PCT， SCr， and lactate dehydrogenase to albumin ratio （LAR） for short?term prognosis of sepsis?associated acute kidney injury. Results The 28?day mortality rate in the non?AKI group was lower than that in the AKI group， and the length of stay in ICU was shorter in the non?AKI group than in the AKI group （P < 0.05）. APACHE Ⅱ score， SOFA score， PCT， SCr and LAR were independent influencing factors for 28?days death in patients with sepsis?associated acute kidney injury. The ROC curve analysis showed that LAR level had a higher predictive value for short?term prognosis in patients with sepsis?associated AKI as compared with APACHE Ⅱ score， SOFA score， PCT， and SCr. Conclusions LAR is an independent risk factor for sepsis?associated AKI and is associated with 28?day mortality in patients.

Objective To investigate the expression level of serum ubiquitin-conjugating enzyme 2C （UBE2C） and tripartite motif-containing protein 27 （TRIM27） in patients with endometrial cancer （EC） and their correlation with pathological parameters. Methods A total of 96 EC patients from March 2020 to March 2023 were selected as EC group； 65 patients with endometrial atypical hyperplasia （EAH） as EAH group， and 80 healthy subjects as the control group. Enzyme linked immunosorbent assay was applied to analyze the expression level of serum UBE2C and TRIM27. The relationship between serum UBE2C， TRIM27， and pathological data was analyzed； receiver operating characteristic was applied to evaluate the predictive value of serum UBE2C and TRIM27 level for EC. Results The level of serum UBE2C and TRIM27 of EC patients was obviously higher than that in healthy subjects （P < 0.05）， and was correlated with tumor diameter， tumor differentiation， lymph node metastasis， FIGO stage， muscle layer invasion depth， cervical involvement， estrogen receptor expression， and progestogen receptor expression （P < 0.05）. There was positive correlation between serum UBE2C and TRIM27 （r = 0.475， P < 0.001）； and the level of serum UBE2C and TRIM27 was positively correlated with tumor diameter， lymph node metastasis， FIGO stage， and depth of musclular invasion， but negatively with tumor differentiation， estrogen receptor expression， and progestogen receptor expression （P < 0.05）. The combination of UBE2C and TRIM27 had obviously higher AUC in evaluating EC than single detection （Z_{UBE2C-combination}=3.406， P < 0.001， Z_{TRIM27-combination} = 3.285， P = 0.001）. Conclusion The expression level of UBE2C and TRIM27 in serum of EC patients is up-regulated， which is closely related to pathological parameters. The level of serum UBE2C and TRIM27 can provide reference for early diagnosis of EC.

Objective This study aims to analyze the proteomic characteristics of peripheral blood in patients with lung cancer coexistent with pulmonary tuberculosis （LC?PTB）， identify the differential proteins compared with lung cancer （LC） patients， and conduct functional analysis on these proteins. Methods The study included 8 LC?PTB patients and 10 LC patients. The LC patients were newly diagnosed and confirmed by pathology and did not receive any anti?tumor treatment before， while the PTB patients were Mycobacterium tuberculosis positive at the time of sampling. Liquid chromatography?tandem mass spectrometry （LC?MS/MS） was applied to perform proteomic mass spectrometry to assess the differential proteins， and then functional analysis was conducted via bioinformatics. Results A total of 5，185 proteins were detected between two groups. Through differential expression screening， 190 proteins （58 upregulated and 132 downregulated） were identified to be differentially expressed. Subcellular localization analysis revealed that the differential proteins were mainly concentrated in the cytoplasm， nucleus， and extracellular matrix. KEGG pathway and GO analysis showed the roles of differential proteins in biological processes including immune response， metabolism， and secretion regulation. Protein interaction network analysis highlighted the importance of SORT1， SAR1B， RPS6KB1， VWF， SHC1， SRPRB， CTSD， TARDBP， RPLP0， PSMA2， RPS6， XPO1， PRKACB， and HLA?DRB1 in LC?PTB. Additionally， the expression changes in proteins like ADA2， MAP3K1， and GLS2 might be closely associated with the development of LC?PTB. Conclusions The proteomic profile comprehensively described the proteomic characteristics of LC?PTB and identified numerous differentially expressed proteins， which could provide further clues for research on biological mechanism of LC?PTB.

Objective To investigate the impact of preoperative abdominal aortic balloon occlusion and modified uterine vascular occlusion on repeat cesarean delivery in patients with placenta previa and placenta accreta spectrum disorders. Methods A total of 97 patients with placenta previa and placenta accreta spectrum disorders who underwent repeat cesarean section at Hefei Maternal and Child Health Hospital between April 2016 and December 2022 were included in this study. Among them， the control group consisted of 48 cases who underwent abdominal aortic balloon occlusion before the operation， while the observation group comprised 49 cases who underwent modified uterine vascular occlusion during the operation. Intraoperative and postoperative complications were observed and compared between the two groups. Results The number of bilateral uterine artery embolization post-operation and the average hospitalization cost in the observation group were significantly lower compared to those in the control group （P < 0.05）. However， there were no significant differences observed between the two groups regarding average intraoperative blood loss， red blood cell suspension transfusion volume， hysterectomy rate， and bladder rupture rate （P > 0.05）. Conclusions Both surgical methods effectively reduce intraoperative bleeding in the treatment of repeat cesarean section in patients with placenta previa and placenta accreta spectrum disorders. However， modified uterine vascular occlusion demonstrates no complications related to vascular intervention or X-ray exposure， ensuring high maternal and child safety while significantly reducing hospitalization costs. Therefore， it is highly recommended for clinical promotion.

Objective To investigate the relationship between the expression of serum angiopoietin?like protein 8 （ANGPTL8） and Kruppel?like factor 2 （KLF2） and the degree of coronary artery disease and the occurrence of major adverse cardiac events （MACE） in patients with acute myocardial infarction （AMI）. Methods A total of 106 patients with AMI who were hospitalized in our hospital from January 2021 to June 2023 were selected as the research objects. According to the degree of coronary artery disease， the patients were grouped into mild group （52 cases） and severe group （54 cases）. According to the occurrence of MACE， the patients were grouped into MACE group （18 cases） and non?MACE group （88 cases）. General patient data were collected. Serum ANGPTL8 and KLF2 levels were detected by enzyme?linked immunosorbent assay （ELISA）. Spearman correlation analysis was applied to analyze the correlation between serum ANGPTL8 and KLF2 levels and Gensini score in AMI patients. Multivariate logistic regression was applied to analyze the influencing factors of coronary artery disease degree in patients with AMI. Receiver operating characteristic （ROC） curves were drawn to analyze the value of serum ANGPTL8 and KLF2 levels in predicting the occurrence of MACE in AMI patients. Results The proportions of patients with history of hypertension and hyperlipidemia， systolic blood pressure， diastolic blood pressure， levels of triacylglycerol （TG）， N?terminal pro?B?type natriuretic peptide （NT?proBNP）， cardiac troponin I （cTnI）， Gensini score， and level of serum ANGPTL8 in the severe group were higher than those in the mild group （P < 0.05）. The level of high?density lipoprotein cholesterol （HDL?C） and serum KLF2 in the severe group were lower than those in the mild group （P < 0.05）. The number of lesions in the mild group and the severe group was statistically obvious （P < 0.05）. Serum ANGPTL8 level in AMI patients was positively correlated with Gensini score （r = 0.638， P < 0.05）， and serum KLF2 level was negatively correlated with Gensini score （r = -0.612， P < 0.05）. History of hypertension， hyperlipidemia， cTnI and ANGPTL8 were risk factors for the progression of severe coronary artery disease in patients with AMI （P < 0.05）， while HDL?C and KLF2 were protective factors （P < 0.05）. The serum level of ANGPTL8 in AMI patients in the MACE group was higher than that in the non?MACE group （P < 0.05）， and the serum KLF2 level in the MACE group was lower than that in the non?MACE group （P < 0.05）. The area under the curve of serum ANGPTL8 and KLF2 levels and their combination in predicting the occurrence of MACE in AMI patients was 0.740 （95%CI： 0.646 ~ 0.820）， 0.799 （95%CI： 0.710 ~ 0.870）， and 0.806 （95%CI： 0.717 ~ 0.876）， respectively. Conclusion The expressions of serum ANGPTL8 and KLF2 are closely related to the degree of coronary artery disease in patients with AMI， and have certain predictive value for the occurrence of MACE.

Objective This study aimed to explore the relationship between the spontaneous changes of mesiodistal angulation of lower second molars （L2M） and individual clinical characteristics in patients with early permanent dentition correction. Methods A total of 44 patients with a total of 88 mandibular second molars were included in this study after screening. Based on the frequency distribution histogram of the initial angle of inclination （L2M initial angle） of the L2M crown before treatment， it was divided into three groups： Group A： small angle group， L2M initial angle is 0° ~ 17.5°； Group B： medium angle group， L2M initial angle is 17.5° ~ 42.5°； Group C： large angle group， L2M initial angle is 42.5° ~ 60°. According to whether L2M has erupted and exposed most of the crown， it was divided into erupted group and unerupted group. According to the mandibular plane angle， it can be divided into high angle， low angle， and average angle. CBCT reconstructed panoramic images were used to measure the mesiodistal inclination of L2M and analyze the relationship between each group and the change in mesiodistal inclination angles of L2M. Results After treatment， L2M mesiodistal angulation in the small angle， large angle， non-eruption， and high angle groups became more significant. The angle in the middle angle group was significantly smaller. The L2M mesiodistal angulation in the eruption and average angle group did not change significantly.The angles of ANB， Y-axis， and mandibular plane have no correlation with the initial angle of L2M. Conclusion The L2M in patients with large and high angles is more likely to topple during a correction. During the correction， the L2M tends to approach the normal axial inclination.

Objective This study aims to investigate the feasibility and safety of Da Vinci robotic-assisted thoracoscopy for resecting mediastinal tumors in pediatric patients. Methods From November 2020 to June 2023， a total of 80 pediatric patients undergoing mediastinal tumor resection at Wuhan Children's Hospital were randomly assigned into two groups， with each group consisting of 40 participants. The control group underwent conventional thoracoscopy， while the observation group underwent Da Vinci robotic-assisted thoracoscopy. This study aimed to compare perioperative indicators between the two groups and establish learning curves based on surgical duration and intraoperative blood loss. Additionally， it assessed levels of pain mediators and stress response markers before surgery and at 24 hours post-surgery， as well as postoperative complications. Inflammatory marker levels were evaluated one month after surgery， and the children's quality of life was measured using the Pediatric Quality of Life Inventory （PedsQL） Generic Core Scales before surgery and one month post-surgery. Results The surgical duration for the observation group and the control group was （1.76 ± 0.33） hours and （2.82±0.62） hours， respectively， and the intraoperative blood loss was （49.83 ± 6.39） mL and （71.55 ± 8.19） mL， respectively. Furthermore， the postoperative drainage time， drainage volume， and hospital stay for the observation group were all lower than those for the control group （P < 0.05）. After surgery， the levels of BK， 5-HT， NPY， and PGE2 in the observation group were （8.06 ± 1.06） mg/L， （170.20 ± 13.21） ng/L， （201.82 ± 13.52） mg/L， and （241.82 ± 15.32） ng/L， respectively， indicating lower levels of pain mediators， stress response markers， and inflammatory factors compared to the control group （P < 0.05）. he overall incidence of complications was 2.50% in the observation group as opposed to 20.00% in the control group. Moreover， there was a statistically significant improvement in quality of life after surgery within the observation group when compared to that within the control group （P < 0.05）. Conclusion Da Vinci robotic-assisted thoracoscopy demonstrates enhanced feasibility and safety in pediatric mediastinal tumor resection， thereby justifying its clinical promotion.

Objective To investigate the effect of left bundle branch area pacing （LBBaP） on new-onset atrial fibrillation （NOAF） and atrial high rate episodes （AHREs） in patients with atrioventricular block （AVB）. Methods Eighty-four patients with Ⅲ^°AVB for pacemaker implantaion were divided into the LBBaP group （n = 42） and the RVSP group （n = 42） based on the site of the ventricular leads. The two groupswere compared in terms of the pre- and post- operative QRSd， ventricular pacing parameters， complications， incidence of stroke， NOAF and AHREs. Results （1） The incidence of postoperative NOAF and AHREs in the LBBaP group was significantly lower compared with RVSP group （P < 0.05）. （2） The p-QRSd in the LBBaP group was significantly shorter compared with RVSP group （P < 0.05）. （3） The two groups showed no significant differences in ventricular pacing parameters， incidence of complications and stroke events （P > 0.05）. Conclusion LBBaP is superior to right ventricular pacing in reducing the incidence of postoperative AHREs and NOAF in patients after implantation and improving the prognosis of patients.

Objective To investigate the influencing factors of falls and serious falls among individuals aged 45 years and above in China， as well as explore the association between falls and multimorbidity， thereby providing empirical evidence for the formulation of effective strategies to prevent falls. Methods The study utilized data from the CHARLS 2020 dataset and employed various statistical methods， including descriptive statistics， χ² test， quadratic regression， and logistic regression. Additionally， subgroup analyses were conducted on key variables. Results The prevalence of falls and serious falls among individuals aged 45 and above in China was found to be 17.42% and 6.86%， respectively. Multimorbidity emerged as a significant determinant influencing both falls and serious falls， with a higher number of diseases being associated with an increased prevalence of these events. Conclusion In order to effectively address the issue of falls in middle-aged and elderly individuals， particularly those with multimorbidity， it is imperative to integrate multimorbidity considerations into the comprehensive fall intervention process.

Objective To investigate the effects of esketamine on respiration， complications and acute phase inflammatory factors in patients undergoing single-port thoracoscopic surgery under general anesthesia with preserved spontaneous respiration. Methods Ninety patients， aged 16 ~ 74 years， BMI 18 ~ 28 kg/m²， ASA physical status Ⅰ or Ⅱ， who were scheduled to undergo single-port thoracoscopic surgery under general anesthesia were selected. Patients were randomly divided into two groups by random number table： esketamine group （group E， n = 45） and control group （group C， n = 45）. Esketamine 0.5 mg/kg was given for induction of anesthesia，and 0.25 mg/kg again before cutting skin. In group C， sufentanilwas given at 0.15 μg/kg for induction of anesthesia. Other anesthesia induction and maintenance durgs in both groups were the same.S_P0₂， PaCO₂ and PaO₂ were recorded at the patient's entrance （T₀）， before pleuraopening （T₁）， 15 min after pleuraopening（T₂）， 30 min after pleuraopening（T₃）， and beforelaryngeal mask removal （T₄）. 3 mL of blood was extracted from themedian cubital vein at T₀ and 24 h after surgery （T₅） todetect the concentrations of TNF-α and IL-6. The length of spontaneous respiration recovery and laryngeal mask removal， the number of respiratory intervention， the incidence of body movement during operation， nausea， vomiting， psychiatric symptom， awareness， the length of hospital stay was recorded. Results Compared with group C， PaO₂was significantly decreased and PaCO₂was significantly increased in group E at T₁， PaO₂was significantly increased and PaCO₂was significantly decreased at T₂（P < 0.01）. Compared with group C， the length of spontaneous respiration recovery was significantly shortened and the number of respiratory intervention was significantly decreased in group E（P < 0.01）. Compared with group C， the concentrations of TNF-α and IL-6 in venous blood in group E at T₅ was significantly decreased（P < 0.01）. There were no significant difference in the length of laryngeal mask removal， and the incidenceofcomplications，hospitalstay between the two groups. Conclusion Esketamine reducesintraoperative respiratory depression， shortens spontaneous respiration recovery，maintains respiratory stability and reduces acute inflammatory response in patients under general anesthesia with preserved spontaneous respiration for single-port thoracoscopic surgery.

Objective To investigate the clinical significance of combined cerebrospinal fluid （CSF） and routine blood parameter analysis in differentiating between multiple cerebral glioma （MCG） and primary central nervous system lymphoma （PCNSL）. Methods We Rretrospectively analyzed the clinical data， CSF and routine blood indicators levels of 62 MCG patients and 56 PCNSL patients admitted to Beijing Tiantan Hospital， Capital Medical University from November 2017 to March 2023. Additionally， we assessed the diagnostic value of individual meaningful indicators as well as their combinations in distinguishing between MCG and PCNSL. Results The levels of CSF total cell count， CSF white cell count， CSF： pro， lactate， routine bloodperipheral neutrophil count， and neutrophil percentage were significantly higher in the MCG group than in the PCNSL group （P < 0.05）； while the levels of CSF： Glu， CSF： cl， routine blood lymphocyte count， eosinophil， lymphocyte percentage， and eosinophil percentage were significantly higher in the PCNSL group than in the MCG group （P < 0.05）. The AUCs of CSF cell count， CSF white cell count， CSF： pro， lactate， routine blood neutrophil count， neutrophil percentage for differentiating MCG from PCNSL were 0.900， 0.899， 0.797， 0.867， 0.828 and 0.772 respectively； sensitivities were 72.4%， 77.6%， 63.8%， 67.2%， 72.4%， 82.8%， 77.6% and 81%， with sensitivities of 97.1%， 100%， 88.2%， 91.2%， 88.2%， 64.7%， 100% and 94.1%， respectively. In addition， the combined detection of CSF total cell count， CSF white cell count， CSF： pro， routine blood neutrophil count and neutrophil percentage in CSF had an AUC of 0.919 for differentiating MCG from PCNSL， with a sensitivity and specificity of 77.6% and 100%， respectively. Conclusions Combined detection of CSF indicators including CSF total cell count， CSF white cell count， CSF： pro， along with routine blood markers such as neutrophil count and neutrophil percentage， holds significant clinical utility for differentiating between MCG and PCNSL.

Objective To investigate the characteristics of pulmonary artery diameter in patients with human immunodeficiency virus （HIV） infection-associated pulmonary hypertension （PAH）， and to explore the clinical significance of pulmonary artery diameter correlation indices combined with tumor necrosis factor-α （TNF-α） for early screening and diagnosis of HIV-associated pulmonary hypertension， aiming to provide valuable clinical insights. Methods A retrospective analysis was conducted on 65 HIV-infected patients admitted to the Eighth Hospital Affiliated to Guangzhou Medical University between May 2017 and December 2023. Based on echocardiography findings， the patients were categorized into an observation group （23 cases with PAH） and a control group （42 cases without PAH）. Measurements of pulmonary artery diameter （PA）， distal pulmonary artery diameter （dPA）， and aortic diameter were obtained in both groups， and the ratio of dPA to aortic diameter （rPA） was calculated. Additionally， serum TNF-α levels were recorded. The clinical significance of each index in early screening and diagnosis of HIV-related pulmonary hypertension was analyzed. Results The PA， dPA， rPA， and TNF-α levels in the observation group were significantly higher compared to those in the control group. Pearson linear correlation analysis revealed a significant positive correlation between TNF-α and both dPA and rPA. Two-column correlation analysis demonstrated a significant association between HIV-PAH and PA， dPA， rPA， as well as TNF-α （P < 0.05）. The combined measurement of serum TNF-α with dPA and rPA exhibited an area under the curve （AUC） of 0.891 for diagnosing HIV-APAH， with a sensitivity of 0.870 and specificity of 0.881. Conclusion The combination of pulmonary artery diameter and TNF-α provides a more accurate indication of the presence of HIV-PAH， enabling early screening， follow-up， or intervention in high-risk patients. This finding holds significant implications for enhancing patient prognosis.

Objective To investigate the relationship and predictive value of blood urea nitrogen （BUN） levels with the risk of in-hospital mortality in patients with septic shock. Methods Clinical data of 328 patients diagnosed with septic shock from January 1， 2018 to September 30， 2023 in Shenzhen Second People's Hospital were retrospectively collected. The primary outcome indicator was in-hospital death in patients with septic shock. Simple logistic regression analyses was used to explore the correlation between BUN and in-hospital death in patients with septic shock； multiple logistic regression analyses model was used to explore the quantitative relationship between BUN and in-hospital death in septic shock， sensitivity analyses was utilized to test the stability of the results. Results Simple logistic regression analyses suggested that BUN was a risk factor for in-hospital mortality in patients with septic shock. Multiple logistic regression analyses showed a positive correlation between BUN and in-hospital mortality in patients with septic shock： the risk of in-hospital mortality in patients with septic shock was increased by 3.3% for every 1 mmol/L increase in BUN （OR = 1.033，P < 0.01）； after adjusting for different variables， the risk of in-hospital death increased by 2.9% （OR = 1.029，P < 0.05） and 3.2% （OR = 1.032，P < 0.05） for each 1 mmol/L increase in BUN， respectively. Sensitivity analyses further confirmed the stability of the results （OR = 1.04，P < 0.05）. Conclusion There is a positive correlation between BUN levels and in-hospital death in patients with septic shock， and it has a predictive value for the risk of in-hospital death in patients with septic shock.

Objective To observe the effectiveness and safety of Regional Citrate Anticoagulation （RCA） in CRRT combined with artificial liver treatment. Methods Clinical data of 54 sessions of CRRT linked with artificial liver treatment using RCA in 21 patients with acute on chronic liver failure （ACLF） combined with acute kidney injury （AKI） admitted to our center from December 2019 to June 2023 were collected.. The improvement of liver and kidney function indicators， anticoagulant effect and adverse reactions of citric acid， and patient outcomes were observed and analyzed before and after treatment. Results The 54 cases of liver and renal function indexes were improved， which showed a statistically significant difference （P < 0.05）； All 54 cases of CRRT linked artificial liver treatment were successfully completed， and no obvious blood clots were found in the extracorporeal circulation tubing， filters， and adsorbers； There was no statistically significant difference （P > 0.05） in the total calcium and ionized calcium levels of all patients at each stage of artificial liver treatment compared to before treatment； However， three cases of CRRT combined with PE and one case of CRRT combined with DPMAS+LPE experienced citrate accumulation after treatment， which returned to normal after 24 hours of timely correction and supplementation； The 30-day survival rate of the 21 patients was 13 survivors， 5 deaths， and 3 discharged automatically. Conclusion Under strict monitoring and timely adjustment， the application of RCA in CRRT series artificial liver treatment is safe and feasible， and is worthy of clinical promotion.

MELAS syndrome is a genetic disease caused by mutations in mitochondrial DNA （mtDNA） or nuclear DNA. Eighty percent of the cases are caused by m.3243A>G mutation. Heteroplasmy， defined as the presence of both normal and mutant mtDNA in cells， is related with the severity of MELAS syndrome. This article reviews the research in mtDNA heterogeneity related to MELAS syndrome， aiming to provide an insight into new therapies for the syndrome.

Selenium is a crucial trace element within the human body， intricately involved in maintaining cellular redox balance， metabolism， and other aspects. In recent decades， the incidence of dyslipidemia in the Chinese population has significantly increased. The pivotal role of selenium in lipid metabolism stems from its ability to catalyze and eliminate lipid peroxides through selenoprotein. This review delves into the intricate relationship between selenium nutritional status and dyslipidemia， drawing insights from cross?sectional studies， cohort studies， and randomized control trials and thus providing reference for further research.

T cell exhaustion occurs mostly in chronic infections， cancers and autoimmune diseases. Continuous antigenic stimulation leads to the generation of exhausted T cells， which is characterized by progressive loss of effector function， continuous high expression of inhibitory receptors， transcription and epigenetic changes， and metabolic disorders. The in-depth study of the specific mechanism of T cell exhaustion is providing new ideas for the immunotherapy of chronic infection， lung cancer and chronic airway inflammatory disease in respiratory diseases. This paper discussed the influencing factors and characteristics of T cell exhaustion and reviewed the current research status of T cell exhaustion and respiratory diseases.