Explore the vast range of titles available.

Background Congenital focal abdominal aortic coarctation (CAAC) is a rare vascular malformation frequently misdiagnosed as mid-aortic syndrome (MAS). A significant challenge in managing CAAC, particularly in young individuals, is addressing the coarctation while accommodating ongoing vascular growth and development. This case highlights the value of multidisciplinary collaboration and imaging-guided stentless balloon angioplasty in preserving vascular growth potential. Case presentation A 14-year-old male presented with a two-year history of refractory hypertension (peak:190/110mmHg) and exertional dizziness. Thoracoabdominal computed tomography angiography (CTA) revealed a focal coarctation (minimum luminal diameter: 4.2 mm, representing 70% stenosis) extending from the celiac artery origin to the superior mesenteric artery origin, without significant collateralization. Digital subtraction angiography (DSA)-guided balloon angioplasty (10 × 40 mm) resulted in a significant reduction of the transcoarctation pressure gradient from 45mmHg to 8mmHg, achieving normotension (120/80mmHg). At six-month follow-up, a 161% increase in aortic luminal diameter (to 11 mm) was observed, accompanied by complete regression of left ventricular hypertrophy (LVH), as evidenced by a decrease in interventricular septal thickness from 12 mm to 9 mm. Conclusions Stentless balloon angioplasty is an effective strategy in treating CAAC in adolescents, achieving both immediate hemodynamic relief and facilitating growth-adaptive aortic remodeling. Comprehensive aortic imaging is crucial for the diagnosis and management of refractory hypertension in adolescents.

Reliability-based design optimization (RBDO) combined with metamodel is a powerful tool to deal with variation of system output induced by uncertainties during practical engineering design. In this paper, the importance boundary sampling (IBS) method is proposed to enhance the efficiency of Kriging-model-based RBDO. Rather than fitting all the parts of the limit state constraints precisely within the design region, the proposed IBS mainly selects sample points on the critical parts of the limit state constraints. Two importance coefficients are proposed to identify these critical boundary parts: the first importance coefficient is determined by the objective function value; and the second one is calculated using the joint probability density value of the design variables. The sampling and optimization processes are conducted alternately to select the sample points more rationally. The computation capability of the proposed method is demonstrated using several mathematical RBDO problems and a box girder design application. The comparison results show that the proposed IBS method is very efficient.

Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes mellitus. The most common type is distal symmetric polyneuropathy, and lesions frequently lead to disabling neuropathic pain and even amputation, increasing the risk of death. At present, the pathogenesis of DPN has not been clarified, and its insidious onset and lack of obvious symptoms in most patients in the early stages often lead to delayed diagnosis, which is unfavourable for prevention and treatment. This article provides an overview of the existing research progress on early diagnostic markers of DPN, especially oxidative stress-related markers, neural tissue damage markers, inflammation-related markers, neurovascular damage markers, and gene-related markers, in the hope that it can provide a reference for early diagnosis and treatment of DPN, and slow down the occurrence and development of DPN.

Inpatients undergoing colonoscopy may be at increased risk of hypoglycemia. However, few high-quality studies have examined the relationship between hypoglycemia and colonoscopy in patients with type 2 diabetes mellitus (T2DM). A total of 1016 patients from a large tertiary hospital were enrolled in this retrospective study. We collected demographic information, laboratory indices, colonoscopy information and hypoglycemia information from the enrolled patients during hospitalization. Logistic regression analysis was adopted to estimate the adjusted odds ratios to determine the association between hypoglycemia and colonoscopy. Hypoglycemia occurred in 80 of 788 (10.1%) patients without colonoscopy exposure and 37 of 228 (16.2%) patients with colonoscopy exposure. 25 patients (67.6%) had hypoglycemic events from 3 hours to 68 hours after the end of colonoscopy. Adjusting for demographic and clinical covariates, the risk of hypoglycemia was 1.99 times higher in those who underwent colonoscopy than in those who did not (OR 1.99, 95% CI 1.25-3.19). The association was consistent in subgroups of females, the elderly, the overweight patients, patients with long duration of disease or patients with suboptimal glycemic control. A strong association between colonoscopy and an increased risk of hypoglycemia is observed in patients with T2DM. When performing a colonoscopy for diabetics, the risk of hypoglycemia should be considered even within 68 hours after colonoscopy.

The purpose of this systematic review was to assess potential gender differences in prevalence and clinical relevance of insulin-related lipohypertrophy (LH). Five electronic databases (PubMed, Embase, CNKI, Wanfang and VIP) were systematically searched for studies, from inception to 1st Sep 2022, on the prevalence of insulin-related LH. The eligibility of articles was independently screened, and the included studies were evaluated using standardized quality assessment tools. A total of 22 studies mentioned the LH prevalence in different genders, of which two are about gestational diabetes; therefore, 20 studies were eventually included, providing data on 6238 patients. The prevalence of LH varied from 30.26% to 72.54%. Ten studies (4392 patients) were conducted with the adult diabetes patients of different genders over the age of 18, the total prevalence rate of LH was 51.73%, the LH prevalence in male gender was from 41.94% to 68.57% and the rate of the total population was 54.89% (2046 patients); The LH prevalence in female gender was from 33.18% to 70% and the rate of the total population was 48.98% (2346 patients), and the prevalence of LH was significantly different between male and female gender ( <0.001). Interestingly, only one study (n=1227) showed that there were dramatic differences between different genders ( <0.001), the subjects were T2DM patients, the LH prevalence rate of male vs female was 70.52% (299/424) VS 52.18% (419/803), while the other studies either only include T1DM or both T1DM and T2DM. The evidence shows that the results of gender differences in the LH prevalence are inconsistent with different types of DM. Probably, there is no gender differences in the LH prevalence in adult patients with T1DM, but it has a gender difference between male and female in T2DM. More strictly designed clinical studies are needed to further verify and reveal the underlying mechanisms.

Diabetic retinopathy (DR) is one of the common and serious microvascular complications of diabetes mellitus (DM), DR carries a high risk of blindness and significantly impairs patients' quality of life. This study aims to systematically evaluate the efficacy and safety of Chinese Medicine Eye Nebulization (CMEN) therapy for DR and further explore its mechanisms of action. As a single-center, randomized, double-blind, placebo-controlled, parallel-group clinical trial, this study will enroll 80 patients with non-proliferative diabetic retinopathy (NPDR) at stage II, characterized by the TCM syndrome of Qi-Yin deficiency with blood stasis. Participants will be randomized in a 1:1 ratio to receive either CMEN therapy (n=40) or placebo aerosol therapy (n=40). The intervention will be administered continuously for 2 weeks. The primary outcome measures include the improvement of clinical symptoms (blurred vision, dry eyes) and quality of life, assessed using the \"Xiaoke Eye Disease Primary Symptom Score Scale\", the Ocular Surface Disease Index (OSDI) Dry Eye Score Scale, and the Diabetes Mellitus Quality of Life Scale (DMQLS) Chinese Version for type 2 diabetes. Secondary outcomes encompass changes in visual acuity, fall risk assessment, levels of inflammatory and oxidative stress biomarkers (VEGFA, TNF-α, IL-6, IL-8, CCL2, MDA, SOD, GSH), and the progression of fundus lesions evaluated by optical coherence tomography (OCT). Assessments will be conducted at baseline, the end of the 2-week treatment period, and the end of the 4-week follow-up period. Multivariate analysis of variance (MANOVA) will be employed to examine the associations between different groups, time points, and group-time interactions. This study represents the pioneering application of CMEN therapy in the treatment of DR, with a specific focus on its effects on core clinical symptoms (blurred vision and dry eyes), quality of life, as well as inflammatory and oxidative stress biomarkers in DR patients.

Paraffin-based nanocomposites are widely used in the energy, microelectronics and aerospace industry as thermal energy storage materials due to their outstanding thermophysical properties. This paper investigates the effects of functionalization on thermal properties of graphene/n-octadecane nanocomposite during phase transition by using non-equilibrium molecular dynamics simulation. Different composite systems containing pristine graphene and graphene functionalized by hydroxyl, carboxyl and ethyl are constructed and studied. The results indicate that the thermal properties like diffusion coefficient, phase change temperature, heat capacity and thermal conductivity can be changed by both the functional types and functional coverage. Comparing with the unfunctionalized system, the system functionalized by ethyl obtained a 10 K increase in phase change temperature, a 12% increase in isobaric heat capacity at 300 K and a 59.8% increase in thermal conductivity at 320 K, and these values are larger than that of the systems functionalized by carboxyl and ethyl. The present findings provide a better understanding of the thermal mechanism of graphene/paraffin nanocomposites and effective guidance for improving their thermophysical properties.

Bladder cancer (BCa) presents a significant clinical challenge, with a pressing need for biomarkers to predict prognosis and guide immunotherapy. Aly/REF export factor (ALYREF) is a key regulator in various cancers, but its role in bladder cancer (BCa) remains unclear. This study aimed to investigate the clinical significance of ALYREF and its association with immunotherapy response and metastatic potential in BCa. We integrated pan-cancer bioinformatic analyses with clinical validation using RT-qPCR, immunohistochemistry, and Western blot on patient samples. We assessed ALYREF’s correlation with clinicopathological features, survival, and response to immune checkpoint inhibitors (ICIs). Circulating tumor cell (CTC) counts were analyzed to link ALYREF to metastatic potential. Functional roles in migration and invasion were validated in vitro using the T24 cell line. ALYREF was significantly upregulated in BCa tissues, correlating with higher tumor grade and poorer overall survival. Paradoxically, high ALYREF expression was also associated with a better response to ICI therapy. Furthermore, elevated ALYREF levels in tumors corresponded to increased CTC counts. In vitro experiments confirmed that ALYREF promotes BCa cell migration and invasion. ALYREF is a dual-role biomarker in BCa. Its overexpression signifies aggressive tumor biology and metastatic risk yet also predicts a favorable response to immunotherapy. ALYREF holds promise for refining patient stratification and personalizing BCa treatment.

PU.1 deficiency, also known as Autosomal Dominant Agammaglobulinemia-10 (AGM10), is a rare primary immunodeficiency caused by mutations in the gene, leading to B cell deficiency and hypogammaglobulinemia. To date, human cases of -related immunodeficiency have been reported in only a limited number of publications, highlighting the scarcity of clinical data and the importance of further characterization. We describe a Chinese patient with recurrent respiratory infections, agammaglobulinemia, and profound B cell lymphopenia. Initial genetic screening using a targeted Primary Immunodeficiency Panel did not identify any related pathogenic variants. Subsequent whole-exome sequencing revealed a novel nonsense mutation in the gene(NM_003120.3:c.130G>T, p.Glu44Ter). The patient subsequently underwent hematopoietic stem cell transplantation (HSCT). Immunological recovery progressed favorably, with B-cell reconstitution and normalization of immunoglobulin levels occurring by approximately 10 months post-HSCT. However, the clinical course was complicated by severe viral meningoencephalitis occurring around two months post-HSCT, which presented as recurrent fever. Cerebrospinal fluid analysis confirmed infection with cytomegalovirus (CMV) and torque teno virus (TTV). This infection resulted in progressive neurological deterioration and permanent paralysis. We report the first Chinese case of PU.1 deficiency caused by a novel mutation. Our finding reinforces the need to include SPI1 in diagnostic panels for agammaglobulinemia. Moreover, the severe viral meningoencephalitis after HSCT, despite immune reconstitution, underscores the critical need for aggressive peri-transplant surveillance.

Background This study sought to assess, using subjective (self-assessment) and objective (MCQ) methods, the efficacy of using heart models with ventricular septal defect lesions produced with three-dimensional printing technology in a congenital heart disease curriculum for medical students. Methods Three computed tomography datasets of three subtypes of ventricular septal defects (perimembranous, subarterial and muscular, one for each) were obtained and processed for building into and printing out 3D models. Then a total of 63 medical students in one class were randomly allocated to two groups (32 students in the experimental, and 31 the control). The two groups participated in a seminar with or without a 3D heart model, respectively. Assessment of this curriculum was carried out using Likert-type questionnaires as well as an objective multiple choice question test assessing both knowledge acquisition, and structural conceptualization. Open-ended questions were also provided for getting advice and suggestion on 3D model utilization in CHD education. Results With these 3D models, feedback shown in the questionnaires from students in experimental group was significantly more positive than their classmates in the control. And the test results also showed a significant difference in structural conceptualization in favor of the experimental group. Conclusion It is effective to use heart models created using current 3D printing technology for congenital heart disease education. It stimulates students’ interest in congenital heart disease and improves the outcomes of medical education.