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Characterized by abnormalities of the blood vessel wall, hereditary hemorrhagic telangiectasia is an autosomal dominant disorder. Recurrent or spontaneous epistaxis is the most prevalent symptom of hereditary hemorrhagic telangiectasia, whose severity varies greatly, ranging from moderate self-limiting epistaxis to severe, life-threatening epistaxis, which often requires multiple treatments and is therefore a challenge for otorhinolaryngologists. This case report retrospectively analyzed the clinical data and family history of a patient who presented to the Department of Otorhinolaryngology, Hangzhou First People’s Hospital, with recurrent epistaxis for 60 years. The patient was treated with Little’s area septomucotomy combined with electrocoagulation for epistaxis, and her clinical symptoms and specialty findings showed significant improvement after four postoperative follow-up visits. This article reviews the possible mechanisms and treatment progress of epistaxis caused by hereditary hemorrhagic telangiectasia, with the aim of improving diagnosis and clinical management of this disease.

Currently, there is a lack of a comprehensive understanding of the behavior of polycyclic aromatic hydrocarbons (PAHs) in complex multimedia urban environmental systems. Taking Urumqi City as a case study, we developed an integrated multimedia urban environmental model to simulate the inter-media transport processes of PAHs across air, water, soil, sediment, vegetation, and impervious surfaces. The predictive results of this model were in good agreement with the actual monitoring data from 2021, confirming its accuracy. Notably, the simulated data for 2021 indicate that the total amount of PAHs in the soil reached 1.06 × 10 6 kg, accounting for 97.44% of the total PAHs in Urumqi City, highlighting soil as the primary sink for PAHs. Further analysis of transport fluxes revealed that atmospheric transfer pathways to soil and vegetation are the main mechanisms driving the distribution of PAHs in urban environments. Additionally, sensitivity analysis identified temperature, soil, and vegetation-related parameters as the primary factors influencing PAHs. Based on the simulated concentration, the risk assessment results showed that soil PAHs had a higher risk of carcinogenesis to human body. This study deepens our understanding of the behavior of PAHs in urban environments and provides insights into how human activities affect the fate and transformation of these contaminants in multimedia urban systems.

Sleep plays an essential role in all studied animals with a nervous system. However, sleep deprivation leads to various pathological changes and neurobehavioral problems. Astrocytes are the most abundant cells in the brain and are involved in various important functions, including neurotransmitter and ion homeostasis, synaptic and neuronal modulation, and blood–brain barrier maintenance; furthermore, they are associated with numerous neurodegenerative diseases, pain, and mood disorders. Moreover, astrocytes are increasingly being recognized as vital contributors to the regulation of sleep-wake cycles, both locally and in specific neural circuits. In this review, we begin by describing the role of astrocytes in regulating sleep and circadian rhythms, focusing on: (i) neuronal activity; (ii) metabolism; (iii) the glymphatic system; (iv) neuroinflammation; and (v) astrocyte–microglia cross-talk. Moreover, we review the role of astrocytes in sleep deprivation comorbidities and sleep deprivation-related brain disorders. Finally, we discuss potential interventions targeting astrocytes to prevent or treat sleep deprivation-related brain disorders. Pursuing these questions would pave the way for a deeper understanding of the cellular and neural mechanisms underlying sleep deprivation-comorbid brain disorders.

Sepsis associated Acute kidney injury (AKI) is a common clinical syndrome characterized by suddenly decreased in renal function and urinary volume. This study was designed to investigate the role of Aquaporin 1 (AQP1) and P53 in the development of sepsis-induced AKI and their potential regulatory mechanisms. Firstly, transcriptome sequencing analysis of mice kidney showed AQP1 expression was reduced and P53 expression was elevated in Cecal ligation and puncture (CLP)-induced AKI compared with controls. Bioinformatics confirmed that AQP1 expression was remarkably decreased and P53 expression was obviously elevated in renal tissues or peripheral blood of septic AKI patients. Moreover, we found in vivo experiments that AQP1 mRNA levels were dramatically decreased and P53 mRNA significantly increased following the increased expression of inflammation, apoptosis, fibrosis, NGAL and KIM-1 at various periods in septic AKI. Meanwhile, AQP1 and P53 protein levels increased significantly first and then decreased gradually in kidney tissue and serum of rats in different stages of septic AKI. Most importantly, in vivo and vitro experiments demonstrated that silencing of AQP1 greatly exacerbates renal or cellular injury by up-regulating P53 expression promoting inflammatory response, apoptosis and fibrosis. Overexpression of AQP1 prevented the elevation of inflammation, apoptosis and fibrosis by down-regulating P53 expression in Lipopolysaccharide (LPS)-induced AKI or HK-2 cells. Therefore, our results suggested that AQP1 plays a protective role in modulating AKI and can attenuate inflammatory response, apoptosis and fibrosis via downregulating P53 in septic AKI or LPS-induced HK-2cells. The pharmacological targeting of AQP1 mediated P53 expression might be identified as potential targets for the early treatment of septic AKI.

The piston wind induced by a high-speed train passing through tunnel accelerates the heat transfer between air inside and outside tunnel in cold regions, thereby exacerbating tunnel frost damage. It is importance for enhancing the anti-freezing capability to study the temperature distribution of a tunnel in cold regions under the influence of piston wind. However, its influence on the tunnel temperature field is always neglected in existing research. In this paper, an unsteady gas-thermal-solid coupled heat transfer model for a tunnel in cold regions considering train passing is established. The air pressure distribution and airflow characteristics in the tunnel during train passing are analyzed to reveal the mechanism and influence of piston wind on the tunnel temperature field. The results show that (1) During a train passing, air pressure field in tunnel changes significantly, inducing a high-pressure zone and a low-pressure zone at the train head and train tail, respectively. This pressure difference alters the movement and flow direction of air in tunnel. (2) Air at train head is pushed into the deeper position of the tunnel, air at the tunnel vault is squeezed and flows towards train tail, and air outside tunnel is drawn into the tunnel, leading to a significant heat exchange between air inside and outside tunnel. (3) After a train passing, air temperature at entrance section remarkably decreases, air temperature at tunnel middle drops slightly, while air temperature at exit section temporarily increases. (4) Under multiple trains passing in one day, air temperature in tunnel fluctuates considerably and rapidly, which is closely related to the convection heat transfer between tunnel lining and air during the interval of two trains passing.

Background/objectives Sepsis-related acute kidney injury (SA-AKI) is a severe condition characterized by high mortality rates. The utility of the sCAR (secrum creatinine/albumin) and LAR (Lactate dehydrogenase/albumin) as diagnostic markers for persistent severe SA-AKI remains unclear. Methods We acquired training set data from the MIMIC-IV database and validation set data from the First Affiliated Hospital of Harbin Medical University. Logistic regression analysis was used to identify key predictors of persistent severe SA-AKI, considering factors such as sCAR, LAR, PAR (Platelet/albumin), BAR (BUN/albumin), and LAO (Lactic/albumin). Independent predictors, sCAR and LAR, were combined into a composite Log(sCAR)_Log(LAR) score, denoted as the Log(sCAR)_Log(LAR) score. Possible confounding factors were screened out by univariate logistic regression, and multivariable logistic regression was applied to evaluate the association of Log (sCAR) _Log (LAR) score with persistent severe sepsis and other secondary clinical outcomes. The ROC curve was utilized to obtain the best cutoff value of the Log(sCAR)_Log(LAR) score. The Kaplan–Meier curve was used to evaluate the prognosis predictive ability of the risk model. Results Logistic regression analysis indicated that sCAR and LAR independently predicted persistent severe SA-AKI. This led to the creation of Log(sCAR)_Log(LAR) score on the base of logarithms of sCAR and LAR. ROC curve analysis showed that the Log(sCAR)_Log(LAR) score was more effective in predicting persistent severe SA-AKI (AUC = 0.71) than Log(sCAR) (AUC = 0.69), Log(LAR) (AUC = 0.65), SOFA score (AUC = 0.66) and Δ Scr (AUC = 0.70). Multivariate regression identified that the SOFA score, PT, ΔScr, Tbil, chronic liver disease, and Vasopressor use as independent risk factors for persistent severe SA-AKI (P < 0.05). A basic clinical prediction model was created using these variables, and its predictive ability, recognition capability, and clinical utility improved with the inclusion of the Log(sCAR)_Log(LAR) score. The model's predictive ability for secondary outcomes, such as renal replacement therapy (RRT), also improved with the addition of the Log(sCAR)_Log(LAR) score. The sensitivity analysis further corroborated the stability of the Log(sCAR)_Log(LAR) score in predicting persistent severe SA-AKI and secondary outcomes, such as RRT. Conclusions The Log(sCAR)_Log(LAR) score effectively predicted persistent severe SA-AKI, potentially aiding intensive care physicians in risk assessment.

This research examined the impact of illness perception, fear of progression, and self-compassion on insomnia among maintenance hemodialysis patients in China. A cross-sectional study was conducted in Chongqing from January 2025 to May 2025. The Brief Illness Perception Questionnaire, Athens Insomnia Scale, Fear of Progression Questionnaire-Short Form, and Self-Compassion Scale-Short Form were evaluated in 332 maintenance hemodialysis patients. This research found that 55.72% of the patients suffered from insomnia. Insomnia showed a positive relationship with illness perception (  = 0.629,  < 0.01) and fear of progression (  = 0.479,  < 0.01), but a negative relationship with self-compassion (  = -0.451,  < 0.01). The mediating role of fear of progression in the relationship between illness perception and insomnia accounted for 17.5% of the total impact. Analysis of simple slopes revealed that illness perception was a significant predictor of fear of progression at both low (  = 0.477,  = 5.131, and  < 0.001) and high (  = 0.732,  = 8.187, and  < 0.001) self-compassion levels. Our study's findings contribute to the understanding of factors affecting insomnia among maintenance hemodialysis patients and offer a theoretical foundation and practical advice for improving their sleep quality.

Objectives Advanced gastric cancer poses a therapeutic challenge worldwide. In randomised clinical trials, anti-VEGF has been reported as an essential agent for the treatment of advanced gastric cancer. This review aims at assessing the treatment outcome of anti-angiogenesis therapy through the VEGF pathway in the management of patients with advanced gastric cancer. Results During this review, 38 clinical trials were identified. Of these, 30 clinical trials were excluded, leaving eight trials of phase II and III. Ramucirumab, as a second line treatment of advanced gastric cancer, decreases the risk of disease progression (37–52%) and death (19–22%). Compare ramucirumab and bevacizumab in combination with traditional chemotherapy; ramucirumab has shown to improve progression-free survival and overall survival. Apatinib tyrosine kinase inhibitor combined with traditional chemotherapy has shown to improve overall response rate and progression-free survival with marginal improvements in overall survival. Chemotherapy, in combination with anti-VEGF drugs, in the management of advanced gastric cancer significantly improves the outcome of overall response rate, progression-free survival and overall survival when compared to chemotherapy alone. Therefore, we recommend that anti-VEGF drugs are the drugs of choice in the management of patients with advanced gastric cancer.

Background Even after the COVID-19 outbreak, mental health challenges are both serious and widespread among medical staff in infectious disease departments, with nurses being particularly affected. There has been limited research on the relationships between common conditions such as depression, anxiety, and emotional exhaustion. Network analysis (NA) is a novel method for quantifying the relationships between mental variables using mathematical approaches. The purpose of this study was to examine the relationship between depression, anxiety and emotional exhaustion symptoms through NA among nurses working in infectious disease departments. Method Employing a cross-sectional design, we utilized validated scales to assess depression, anxiety and emotional exhaustion in a sample of 1,849 infectious disease nurses. We assessed depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9), anxiety symptoms with the Generalized anxiety disorder-7 (GAD-7), and burnout symptoms with the Chinese version of the Maslach Burnout Inventory-Human Service Survey (MBI-HSS). Interactions between depression, anxiety and emotional exhaustion were constructed using NA. In the network model, central and bridge symptoms were identified using the R package qgraph. The network structure’s stability was assessed with the help of the bootnet R package. Results This study revealed a prevalence of clinically significant depressive symptoms (24.61%) and anxiety (9.30%). The average score of emotional exhaustion was 17.59 ± 10.98. Within the depression-anxiety-emotional exhaustion network, stronger connections were observed between PHQ8(Psychomotor problems)-GAD5(Restlessness), as well as between PHQ9(Suicidal ideation)-GAD5(Restlessness). EE5 (I feel burned out from my work) was anticipated to have the greatest impact on central symptoms, with GAD4 (Trouble relaxing) and GAD5 (Restlessness) following. The highest weights for bridge symptoms were given to GAD5 (Restlessness), PHQ8 (Psychomotor problems) and GAD6 (Irritability). The correlation stability coefficients of 0.75 for both central and bridge symptoms indicate a high level of stability in the network structure. Conclusions The GAD5 (Restlessness) symptom was the key factor connecting depression, anxiety, and emotional exhaustion. Focusing on this symptom can help identify mental disorders and alleviate mental health syndromes among infectious disease nurses in the post-COVID-19 era .

As the heat exchange interface between atmosphere and permafrost, land cover regulates the influence of climate warming on permafrost. With the development of desertification on the Qinghai-Tibetan Plateau (QTP), aeolian sand has emerged as a significant environmental factor influencing the hydrothermal process of permafrost. To reveal the hydro-thermal process within aeolian sand layer and the thermal effect of sand layer on permafrost in the QTP, a coupled hydro-thermo-vapor model considering rainfall and evaporation was established, and the long-term hydrothermal variation of stratum covered by aeolian sand were analyzed. The results show that: 1) Aeolian sand layer is conducive to alleviating permafrost degradation. The alleviation effect is related to the thickness of sand layer. 2) Water redistribution in sand layer and water accumulation in stratum are connected to thickness of sand layer. For the thin sand layer, the water content is low and remains unchanged in different years. The thick sand layer, acting as a permeability diode, makes the degree of water accumulation in sand layer considerable and the water storage of the stratum increase continuously. 3) When the sand layer becomes thicker, the increment of the equivalent thermal conductivity in cold season is larger than that in warm season, which will lead to the decrease of annual conductive heat. 4) In thin sand layer, heat convection and heat conduction are relatively small in the early stage, and heat conduction is the primary mode in the long term. In thick sand layer, heat transfer is dominated by heat convection and heat conduction in the early stage, but it is primarily reliant on heat convection in the long term.