es in this setting.INTRODUCTION Dreaminess is one of the common symptoms of sleep disorders and often leads to complaint of poor sleep quality and morning fatigue.  https://www.selleckchem.com/products/alantolactone.html  Literatures on the relationship between obstructive sleep apnea (OSA) and dreams have been reported with contradictory results. In this case report, we identified a moderate OSA related dreaminess that was successfully treated by continuous positive airway pressure (CPAP). PATIENT CONCERNS We present a case of a 47-year-old woman who was bothered by all-night dreaminess for over 20 years. DIAGNOSIS An overnight polysomnography (PSG) examination showed the apnea-hypopnea index (AHI) was 21.7 events/hour and the rapid eye movement (REM)-AHI was 46.3 events/hour. The patient was diagnosed with moderate OSA. INTERVENTIONS The patient received auto CPAP therapy. OUTCOMES The symptoms of dreaminess and daytime functioning significantly improved after CPAP treatment. During the 4-month follow up, 3 CPAP titrations showed that OSA events and OSA related REM interruption almost disappeared. On the night of PSG diagnosis, only 1 non-rapid eye movement sleep 3 (N3) episode occurred before the first REM episode. Nevertheless, N3 episodes were observed before the majority of REM episodes on all three nights of CPAP titration. CONCLUSION This case suggests that specific REM related OSA could be the main reason for dreaminess symptoms and could be successfully treated by CPAP. The identification of OSA, especially for mild-moderate OSA, has not received enough attention in the management of complaints of dissatisfactory sleep issues. We believe this case has educational value in clinical practice.BACKGROUND Lumbar disc herniation (LDH) is a common disease that seriously affects patients' quality of life. Although several articles have reported that acupuncture can improve the symptoms of LDH, different guidelines do not evaluate the efficacy of acupuncture consistently, new randomized controlled trials have been published in recent years.The purpose of this study is to evaluate the efficacy and safety of acupuncture for LDH. METHOD Electronic resource databases, trial registration platform, and different types of grey literature will be systematically searched for eligible studies by 2 authors independently. The type of trial will be limited to randomized controlled trials on acupuncture treatment for LDH. Search strategy will be a combination of terms associated with LDH (eg, low back pain or sciatica) and study of design (eg, randomized controlled trials or clinical trial). Data from homogeneous studies will be combined in a fixed-effects model, and the evidence level will be measured by grading of recommendations assessment, development, and evaluation. RESULTS This study will provide high-quality evidence to evaluate the relief of pain intensity and improvement of dysfunction of acupuncture in patients with LDH, and to evaluate the safety of acupuncture. CONCLUSION This study will provide strong evidence for evaluating whether acupuncture therapy is effective and safe for LDH patients. PROSPERO REGISTRATION NUMBER CRD 42019137399.Diffuse gliomas are the most common primary brain tumors. The Cancer Genome Atlas (TCGA) database provides correlative evidence between altered molecular pathways and gliomas. Dysregulated cholesterol homeostasis emerges as a potential indicator of the pathogenesis of gliomas.Mining large cohorts from the TCGA together with database from the Chinese Glioma Genome Atlas (CGGA) for confirmation, we compared gene expression of cholesterol synthesis master regulator SREBP2 and its regulatory networks in low grade glioma (LGG) and glioblastoma (GBM).Our analysis shows that expression of SREBP2 and related genes is lower in GBM than in LGG, indicating that cholesterol metabolism processes, including de novo synthesis, cholesterol uptakes, and cholesterol conversion and efflux, are suppressed in GBM.Overall, our data suggests that SREBP2 transcript could serve as a potential prognosis marker or therapeutic target in diffuse glioma including GBM.To investigate factors related to poor prognosis of patients with stage IV esophageal cancer and to provide some bases on which proper therapeutic schemes could be formulated for stage IV esophageal cancer patients with performance status (PS) score between 0 and 2.Clinical data of 60 patients with stage IV esophageal cancer were retrospectively analyzed, and the relationships of clinical characteristics and therapeutic methods with patients' prognosis were explored. Univariate analysis on factors possibly affecting the prognosis of patients with stage IV esophageal cancer was performed using Log-rank test, and independent risk factors for the prognosis were estimated in multivariate Cox regression analysis through embracing variables which showed statistical significance in univariate analyses.According to univariate analysis results, nutritional status, anemia, therapeutic method, esophageal stent, and visceral metastasis were main influencing factors for the prognosis of stage IV esophageal cancer (P  less then  .05). While in multivariate Cox regression analysis, visceral metastasis was revealed to be an independent risk factor for poor prognosis in patients with stage IV esophageal cancer.Visceral metastasis is an independent risk factor for poor prognosis in patients with stage IV esophageal cancer. Optimizing therapeutic modes according to with or without combined visceral metastasis possesses certain clinical significance in prolonging survival time and in improving the quality of life among patients with stage IV esophageal cancer.INTRODUCTION Polymyxin B hemoperfusion (PMX-HP) is an adjuvant therapy for sepsis or septic shock that removes circulating endotoxin. However, PMX-HP has seldom achieved expectations in randomized trials targeting nonspecific overall sepsis patients. If used in an optimal population, PMX-HP may be beneficial. This study aimed to identify the optimal population for PMX-HP in patients with septic shock. METHODS We used a prospective nationwide cohort targeting consecutive adult patients with severe sepsis (Sepsis-2) in 59 intensive care units in Japan. Associations between PMX-HP therapy and in-hospital mortality were assessed using multivariable Cox proportional hazard regression models. To identify best targets for PMX-HP, we developed a non-linear restricted cubic spline model including two-way interaction term (treatment × Acute Physiology and Chronic Health Evaluation [APACHE] II score/Sequential Organ Failure Assessment [SOFA] score) and three-way interaction term (treatment × age × each score). RESULTS The final study cohort comprised 741 sepsis patients (92 received PMX-HP, 625 did not).