Abstract:Polycythemia vera(PV)is a malignant clonal myeloproliferative neoplasm of pluripotent hema-topoietic stem cells.It is characterized by a marked increase in red blood cells and elevated hemoglobin levels.The disease may progress to myelofibrosis in the late stage,and very few patients develop transformation to acute myeloid leukemia.Transformation of PV to acute promyelocytic leukemia(M3 type)has been reported,while transformation of PV to acute megakaryoblastic leukemia is rare.Here,we report a case of PV transformed into acute megakaryoblastic leukemia,and review the relevant literature to summarize the factors including the types,interval,medication history,routine blood parameters at leukemic transformation,age and other features of PV transformation to acute myeloid leukemia,aiming to better understand the influencing factors of leukemic transformation from PV to acute myeloid leukemia.The analysis showed that the median time to leukemic transformation in the long-term medication group was longer than that in the short-term medication group[104.0(84.2,129.0)months vs 54.0(48.5,78.0)months],with a statistically significant difference between the two groups(Z=-2.006,P=0.045).Kaplan-Meier survival curve analysis indicated no statistically significant difference in leukemia-free survival between the two groups(Log-rank x2=1.598,P=0.206).There was a strong positive correlation between platelet count and time to leukemic transformation(r=0.698,P=0.008),and a positive correlation between age and time to leukemic transformation(r=0.554,P=0.049).

Abstract:Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with compound Congrong Yizhi capsules in the treatment of Parkinson's disease(PD)complicated with sleep disorders and its effects on serum levels of central nervous system-specific protein(S-100β)and regulated on activation,normal T cell expressed and secreted(RANTES).Methods A total of 88 patients with PD complicated with sleep disorders who were treated in the First Affiliated Hospital of Hebei North University from October 2023 to February 2024 were selected and divided into the control group and the observation group with 44 cases in each group by random number table method.The control group was treated with rTMS on the basis of conventional therapy,and the observation group was treated with compound Congrong Yizhi capsules on the basis of the control group's regimen.Sleep quality,quality of life,levels of inflammatory factors,serum levels of S-100β and RANTES,and clinical efficacy were compared between the two groups.Results After treatment,the Pittsburgh sleep quality index scores of both groups were lower than those before treatment(all P＜0.05),and the score of the observation group was lower than that of the control group[(7.5±0.9)vs(10.4±1.3)](P＜0.001).The unified PD rating scale scores and PD quality of life questionnaire scores of both groups were lower than those before treat-ment,and the scores of the observation group were lower than those of the control group(all P＜0.05).After treatment,the serum levels of tumor necrosis factor-α and interleukin-1β in both groups were lower than those before treatment,and the levels in the observation group were lower than those in the control group(all P＜0.05).The serum levels of S-100β and RANTES in both groups were lower than those before treatment,and the levels in the observation group were lower than those in the control group(all P＜0.05).The total clinical effective rate of the observation group was higher than that of the control group[97.7％(43/44)vs 81.8％(36/44)](P=0.014).Conclusion rTMS combined with compound Congrong Yizhi capsules has a good efficacy in the treatment of PD complicated with sleep disorders,which can improve sleep quality and quality of life,and reduce the levels of inflammatory factors as well as serum S-100β and RANTES.

Abstract:Objective To observe the clinical efficacy of cyclosporin A combined with Huaiqihuang granules in the integrated Chinese and western medicine treatment of children with aplastic anemia(AA).Methods The clinical data of 62 children with AA admitted to the First Affiliated Hospital of Xinjiang Medical University from October 2020 to October 2023 were collected for retrospective analysis.According to different treatment regimens,the patients were divided into the control group(32 cases,treated with oral cyclosporin capsules combined with stanozolol tablets)and the observation group(30 cases,treated with oral Huaiqihuang granules on the basis of the control group).The clinical efficacy,recovery indicators,traditional Chinese medicine(TCM)syndrome scores,blood routine indicators,T lymphocyte subsets,interferon-γ levels before and after treatment,and the incidence of adverse reactions were compared between the two groups.Results The total remission rate of the observation group was higher than that of the control group[96.7％(29/30)vs 68.8％(22/32)],the number of medical visits and severe infections,the length of each hospitalization were significantly less than those of the control group(all P＜0.05).After treatment,the TCM syndrome scores,CD4+,interferon-γ and T helper 17 cell levels in the observation group were lower than those in the control group,while the platelet count,hemoglobin and neutrophil levels were higher than those in the control group(all P＜0.05).There were no statistically significant differences in the incidence of various adverse reactions and the total incidence of adverse reactions between the two groups(all P＞0.05).Conclusion Huaiqihuang granules combined with cyclosporin A has high application value in the clinical treatment of children with AA,which can improve the clinical symptoms and immune function of patients with good safety and reliability.

Abstract:Objective To investigate the association between C-reactive protein-triglyceride-glucose index(CTI)and hypertension based on data from the China health and retirement longitudinal study(CHARLS).Methods Participants aged ≥ 45 years recorded in the CHARLS database from 2011 to 2015 were enrolled.Cox regression was used to analyze the relationships of continuous CTI and CTI subgroups with the risk of incident hypertension.Restricted cubic spline(RCS)analysis was performed to explore the dose-response relationship between CTI and hypertension risk.Subgroup analyses were conducted according to age(≥ 60 years or not),gender,residence,smoking,and drinking status.Results A total of 5 210 participants were included,among whom 1 579 developed incident hypertension(hypertension group)and the remaining 3 631 were included in the non-hypertension group.Compared with the non-hypertension group,participants in the hypertension group were older,had a higher proportion of males,a lower proportion of married individuals,higher percentages of smokers and drinkers,higher prevalence rates of heart disease,diabetes,stroke,dyslipidemia,and lung disease,as well as higher levels of low-density lipoprotein cholesterol,body mass index,and CTI(all P＜0.05).Participants were divided into three groups by tertiles of CTI:T1(5.99≤CTI≤8.27),T2(8.27＜CTI ≤8.96),andT3(8.96＜CTI ≤ 12.79).In model 3,CTI was significantly associated with an increased risk of incident hypertension(hazard ratio=1.16,95％confidence interval:1.08-1.25,P＜0.001).Compared with T1,both T2 and T3 were signifi-cantly related to an increased risk of incident hypertension(T2:hazard ratio=1.20,95％confidence interval:1.04-1.38,P=0.015;T3:hazard ratio=1.35,95％confidence interval:1.17-1.57,P＜0.001).Trend test indicated that the risk of incident hypertension was significantly associated with elevated CTI subgroups(Pfor trend＜0.001).RCS analysis showed a linear relationship between CTI and the risk of hypertension in middle-aged and elderly Chinese individuals(Poverall＜0.001,Pnonlinear=0.254).Subgroup analyses revealed that the positive association between CTI and hypertension risk was significant in males and rural residents,and was not affected by age,smoking,or drinking status.Conclusion CTI increase is a risk factor for hypertension in middle-aged and elderly individuals.

Abstract:Objective To explore the predictive value of Caprini score combined with D-dimer for postoper-ative venous thromboembolism(VTE)in patients with gastrointestinal tumors.Methods A retrospective analysis was performed on the clinical data of 195 patients with gastrointestinal tumors who underwent surgical treatment in the Department of General Surgery,Beijing Anzhen Hospital,Capital Medical University from February 2023 to February 2025.According to the occurrence of postoperative VTE,the patients were divided into the VTE group(20 cases)and the control group(without VTE,175 cases).The clinical data,Caprini score and D-dimer levels were compared between the two groups.Logistic regression analysis was used to identify the risk factors for postop-erative VTE in patients with gastrointestinal tumors,and the predictive value of Caprini score and D-dimer for VTE was evaluated.Results There were statistically significant differences in age,operation duration and intraoperative blood transfusion rate between the two groups(all P＜0.05).The D-dimer levels of both groups after surgery were significantly higher than those before surgery,and the level in the VTE group was significantly higher than that in the control group[(467±155)μg/L vs(352±170)μg/L](all P＜0.01).The Caprini score of the VTE group after surgery was significantly higher than that of the control group[(7.6±1.3)vs(5.2±1.5)](P＜0.01).Logistic regression analysis showed that abnormally elevated D-dimer and Caprini score were independent risk factors for postoperative VTE in patients with gastrointestinal tumors(both P＜0.001).The areas under the curve(AUC)of D-dimer and Caprini score for predicting postoperative VTE in patients with gastrointestinal tumors were 0.713(95％confidence interval:0.593-0.832)and 0.875(95％confidence interval:0.801-0.949),respec-tively.The AUC of their combination was 0.892(95％confidence interval:0.827-0.957),which was higher than that of each single index(both P＜0.05).Conclusion Caprini score combined with D-dimer has high predictive value for postoperative VTE in patients with gastrointestinal tumors,which has important reference significance for clinical prevention of postoperative VTE.

Abstract:Objective To evaluate the application value of ultra-tension-relieving suture in incision repair after excision of benign skin tumors.Methods Clinical data of 54 patients who underwent excision of benign skin tumors and completed follow-up in the outpatient department of Beijing Anzhen Hospital,Capital Medical University from September 2023 to December 2024 were retrospectively analyzed.According to the suture method after skin tumor resection,patients were divided into control group(25 cases)receiving traditional tension-relieving suture and observation group(29 cases)receiving ultra-tension-relieving suture.Incision healing at 2 weeks after operation,incidence of complications,and scar appearance and texture at 6 months after operation were compared between the two groups.The Vancouver Scar Scale(VSS),Patient Scar Assessment Scale(PSAS)and Observer Scar Assessment Scale(OSAS)were used for scoring.Results There was no significant difference in delayed healing rate between the two groups(P=0.463).The incidence of infection and hematoma in the observation group was lower than that in the control group,and the pigmentation rate was similar to that in the control group,but the differences were not statistically significant(all P＞0.05).In each subscore of VSS,the scores of pigmentation,vascularity,pliability and total score in the observation group were significantly lower than those in the control group[1.0(1.0,1.0)vs 2.0(1.0,2.0),1.0(0.0,1.0)vs 1.0(1.0,2.0),1.0(1.0,1.0)vs 2.0(1.0,2.0),and(3.3±1.4)vs(5.4±2.5)](all P＜0.05).The scores of color,pliability,patient satisfaction,pain,itching and overall impression in PSAS of the observation group were significantly lower than those of the control group,and the scores of vascularity,pigmentation,pliability,surface roughness,area and overall impression in OSAS of the observation group were significantly lower than those of the control group(all P＜0.05).Conclusion Ultra-tension-relieving suture can effectively disperse incision tension,reduce scar formation and improve postoperative aesthetic effect.

Abstract:Cisplatin is a first-line chemotherapeutic agent for the treatment of various cancers,but its clinical application is limited due to its nephrotoxicity.Recent studies have found that cellular senescence plays a key role in the progression of cisplatin-induced acute kidney injury(AKI).Cellular senescence is characterized by irreversible cell cycle arrest,and senescent cells can form a senescence-associated secretory phenotype by secreting a variety of inflammatory and profibrotic factors,which alters the surrounding microenvironment and further drives the progression of AKI to chronic kidney disease.Therefore,targeted clearance of senescent cells may serve as a potential therapeutic target for renal protection during cisplatin treatment,while its specific mechanism remains unclear.This review aims to elaborate on the role of cellular senescence in cisplatin-induced AKI and renal fibrosis,hoping to provide a new theoretical basis for the prevention and treatment of cisplatin-induced toxic and side effects.

Abstract:Objective To observe the clinical efficacy of budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets in the treatment of patients with bronchiectasis complicated with severe chronic obstructive pulmonary disease(BCOS),and to explore its effect on improving dyspnea and small airway function in BCOS patients.Methods A total of 90 BCOS patients admitted to Hainan Hospital of Chinese PLA General Hospital from January 2023 to January 2024 were enrolled as research subjects.According to different treatment regimens,the patients were divided into the control group(45 cases,budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol alone)and the observation group(45 cases,budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets).The clinical data and therapeutic efficacy were compared between the two groups.A difference-in-differences model was established to evaluate the changes in comprehensive scores before and after treatment in the two groups.Repeated measures analysis of variance was used to analyze the changes in maximal expiratory flow at 25％of forced vital capacity(MEF25)and maximal expiratory flow at 50％of forced vital capacity(MEF50).The effects of MEF25 and MEF50 on therapeutic efficacy during treatment were analyzed.Results There were no statistically significant differences in clinical data between the two groups(all P＞0.05).After treatment,the scores of chronic obstructive pulmonary disease assessment test(CAT),St.George's respiratory questionnaire(SGRQ)and modified medical research council dyspnea scale(mMRC)in both groups were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group(all P＜0.05).The results of the difference-in-differences model showed that the CAT,SGRQ and mMRC scores decreased by 9.782,5.462 and 8.102 on average after treatment.The interac-tion coefficient of group × time had a significant effect on the comprehensive scores.The reduction amplitude of comprehensive scores in the observation group after treatment was higher than that in the control group,with an increase of 7.631,3.019 and 6.932 respectively.There were statistically significant differences in the inter-group effect,time effect and interaction effect of MEF25 and MEF50 levels in patients(all P＜0.05).The total effective rate of treatment in the observation group was significantly higher than that in the control group[95.6％(43/45)vs 82.2％(37/45)](x2=6.133,P=0.047).The results of stratified analysis showed that at each stratified level of MEF25 and MEF50 at 12 weeks of treatment,the therapeutic effect of the observation group was stronger than that of the control group(both P＜0.001).Conclusion Budesonide,glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets can improve the clinical efficacy of BCOS patients,alleviate dyspnea and improve small airway function.

Abstract:Objective To investigate the clinical efficacy of Shengmai Qiangxin granules in the treatment of senile chronic heart failure(CHF)and its regulatory effect on the renin-angiotensin-aldosterone system(RAAS).Methods A prospective randomized controlled trial was designed,and 94 elderly CHF patients with Qi-Yin deficiency complicated with blood stasis admitted to the Second Affiliated Hospital,Heilongjiang University of Chinese Medicine from January 2022 to January 2025 were enrolled.They were divided into the control group and the observation group with 47 cases in each group by the stratified block randomization method.The control group received conventional western medicine and Chinese medicine placebo treatment,while the observation group was given Shengmai Qiangxin granules on the basis of conventional western medicine treatment,with a course of 8 weeks.The curative effect,traditional Chinese medicine(TCM)syndrome score,6 min walk test distance,quality of life,cardiac function indexes,N-terminal pro-brain natriuretic peptide(NT-proBNP),troponin I(TnI),creatine kinase isoenzyme MB(CK-MB)and RAAS indexes including plasma renin activity(PRA),angiotensin Ⅱ(Ang Ⅱ)and aldosterone levels were compared between the two groups.The incidence of adverse reactions was also compared between the two groups.Results The total effective rate of the observation group after treatment was higher than that of the control group[93.6％(44/47)vs 74.5％(35/47)](P=0.011).After treatment,the TCM syndrome score,Minnesota living with heart failure questionnaire(MLHFQ)score,and serum levels of NT-proBNP,TnI,CK-MB,PRA,Ang Ⅱ and aldosterone in both groups were lower than those before treatment,while the 6 min walk test distance and left ventricular ejection fraction(LVEF)were longer/higher than those before treatment(all P＜0.05).After treatment,the TCM syndrome score,MLHFQ score,and serum levels of NT-proBNP,TnI,CK-MB,PRA,AngⅡ and aldosterone in the observation group were lower than those in the control group,while the 6 min walk test distance and LVEF were longer/higher than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Shengmai Qiangxin granules combined with conventional western medicine treatment can significantly inhibit the RAAS,and improve cardiac function and quality of life in elderly patients with CHF.

Abstract:Objective To explore the predictive value of early admission infection markers and T-cell subsets in children with severe Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 100 children with MPP admitted to the Affiliated Hospital of North Sichuan Medical College from January 2023 to December 2024 were enrolled as research subjects.According to the severity of the disease,the children were divided into the mild MPP group(70 cases)and the severe MPP group(30 cases).The general data,main clinical manifesta-tions,peripheral blood infection markers and T-cell subsets were compared between the two groups.Multivariate Logistic regression analysis was used to explore the correlation of C-reactive protein(CRP),procalcitonin,serum amyloid A(SAA),CD4+,CD8+and CD4+/CD8+ratio with severe MPP in children.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of each indicator alone or in combination.Results The duration of fever and the proportion of tachypnea in the severe MPP group were longer/higher than those in the mild MPP group(all P＜0.05).The serum levels of CRP,procalcitonin and SAA in the severe MPP group were higher than those in the mild MPP group,while CD4+,CD8+and CD4+/CD8+ratio were lower than those in the mild MPP group(all P＜0.05).Multivariate Logistic regression analysis showed that the increased levels of CRP,procalci-tonin and SAA,as well as the decreased levels of CD4+,CDg+and CD4+/CD8+ratio were closely associated with the occurrence of severe MPP in children(all P＜0.05).ROC curve analysis showed that the area under the curve of the combined detection of the six indicators(CRP,procalcitonin,SAA,CD4+,CD8+and CD4+/CD8+ratio)for predicting severe MPP in children was larger than that of each indicator alone(0.953 vs 0.756,0.852,0.861,0.777,0.724,0.719,all P＜0.05).Conclusion CRP,procalcitonin,SAA,CD4+,CD8+and CD4+/CD8+ratio all have certain predictive value for severe MPP in children,and the combined detection of the six indicators has higher predictive efficacy.

Abstract:Objective To establish a predictive model for CD34+cell collection efficacy during mobilization in patients with non-Hodgkin lymphoma(NHL)based on white blood cell count(WBC)and platelet count(PLT).Methods A total of 90 NHL patients who underwent peripheral blood stem cell(PBSC)collection at Zhejiang Provincial People's Hospital from January 2023 to January 2025 were retrospectively selected.The number of CD34+cells collected in a single apheresis was used as the criterion for poor/failed PBSC collection.Clinical data and blood index results of the patients were collected to analyze the risk factors for poor/failed PBSC collection in NHL patients.A predictive model was constructed based on the results of multivariate Logistic regression analysis,and the constructed model was evaluated.Results A total of 90 NHL patients were divided into the poor/failed PBSC collection group(31 cases)and the successful collection group(59 cases)according to the collection results.Compared with the successful collection group,the poor/failed collection group had a higher number of chemotherapy cycles and lower levels of WBC,PLT,and hemoglobin(all P＜0.05).Multivariate Logistic regression analysis showed that WBC,PLT were independent protective factors for poor/failed PBSC collection,and number of chemotherapy was an independent risk factor(all P＜0.05).The receiver operating characteristic curve indicated that the area under the curve of the nomogram model was 0.93.The Hosmer-Lemeshow goodness-of-fit test for the model yieldedx2=3.595 and P=0.892.Decision curve analysis demonstrated that the nomogram model could provide better clinical net benefits.Conclusion NHL patients with low WBC,low PLT,and more number of chemotherapy have an increased risk of poor/failed PBSC collection.The nomogram model established based on these factors exhibits good predictive value for the risk of poor/failed PBSC collection.

Abstract:Objective To investigate the clinical characteristics and related factors in patients with acute appendicitis of different pathological types.Methods A retrospective analysis was conducted on the clinical data of 2 482 patients diagnosed with acute appendicitis and undergoing surgical treatment in Linyi People's Hospital,Shandong Province from January 2018 to December 2023.Relevant data including age,gender,pathological type,complicated underlying diseases,fever degree,appendiceal location and history of appendicitis were collected.Multivariate Logistic regression analysis was used to identify the differential related factors in patients with acute appendicitis of different pathological types.Results The mean age of the 2 482 patients was(41±17)years old,ranging from 14 to 99 years old.Multivariate Logistic regression analysis showed that compared with gangrenous/perforated appendicitis,younger age and shorter appendiceal length were more likely to be associated with acute simple appendicitis,while complicated underlying diseases,absence of fever and history of appendicitis were more likely to be associated with gangrenous/perforated appendicitis(odds ratios=0.974,0.003,13.435,12.945,3.665,all P＜0.05).Compared with gangrenous/perforated appendicitis,shorter appendiceal length and specific appendiceal locations(retroileal,preileal,retrocecal,paracecal)were more likely to be associated with acute suppurative appendicitis,while complicated underlying diseases,absence of fever and specific appendiceal location(pelvic)were more likely to be associated with gangrenous/perforated appendicitis(odds ratios=0.095,＜0.001,0.001,0.001,0.004,2.765,3.978,202.520,all P＜0.05).Conclusion Younger age and shorter appen-diceal length are more likely to indicate acute simple appendicitis,while complicated underlying diseases may lead to gangrenous/perforated appendicitis even in the absence of fever.

Abstract:Objective To investigate the relationship between urinary albumin-to-creatinine ratio(UACR)and amino acid metabolism in patients with type 2 diabetes mellitus(T2DM).Methods A total of 117 T2DM patients admitted to the Department of Endocrinology,Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine from January to November 2021 were enrolled as research subjects.According to the UACR test results,the patients were divided into three groups:normal group(UACR≤30 mg/g,44 cases),microalbuminuria group(30 mg/g＜UACR ≤ 300 mg/g,41 cases),and macroalbuminuria group(UACR＞300 mg/g,32 cases).The general data and biochemical indicators of the three groups were compared.Spearman correlation analysis and multivariate Logistic regression analysis were used to analyze the relationship between UACR level and amino acid metabolism.Receiver operating characteristic(ROC)curve was used to evaluate the relationship between amino acids and UACR levels in each group.Results There were no significant differences in gender and age among the three groups(x2=3.011,P=0.222;Z=2.261,P=0.323).The difference in disease duration among the three groups was statistically significant(Z=34.356,P＜0.001).The levels of serum creatinine and blood urea nitrogen in the macroalbuminuria group were higher than those in the microalbuminuria group and the normal group,while the estimated glomerular filtration rate was lower than that in the microalbuminuria group and the normal group(all P＜0.05).There were significant differences in the levels of lysine,proline,threonine,citrulline,tyrosine and valine among the three groups(all P＜0.05).Spearman correlation analysis showed that UACR level was negatively correlated with the metabolic levels of lysine,threonine,tyrosine and valine(r=-0.215,-0.226,-0.363,-0.221,all P＜0.05),and positively correlated with the metabolic level of citrulline(r=0.424,P＜0.001).Multivariate Logistic regression analysis showed that high citrulline metabolic level was an influencing factor for the increase of UACR level(P＜0.001).ROC curve analysis showed that the area under the curve of citrulline in predicting the increase of UACR was 0.782(95％confidence interval:0.675-0.890,P＜0.001),with the optimal cut-off value of 40.615 μmol/L,sensitivity of 75.0％and specificity of 82.4％.Conclusion Serum citrulline is a sensitive marker for the increase of UACR in T2DM patients,which can well predict and evaluate the occurrence of diabetic nephropathy.

Abstract:Immune thrombocytopenia(ITP)is an autoimmune disease characterized by thrombocytopenia and bleeding tendency,and clinical platelet transfusion refractoriness(PTR)is a crucial factor affecting therapeutic efficacy.This study aimed to explore the immune mechanisms of PTR in ITP and their impacts on clinical manage-ment,with a focus on analyzing the distinct mechanisms of antibody-mediated and T cell-mediated PTR.Through literature review,we found that antibody-mediated PTR is mainly induced by specific antibodies such as human leukocyte antigen and anti-platelet membrane glycoprotein Ⅱ b/Ⅲ a antibodies.These antibodies clear transfused platelets via complement activation and phagocytosis by macrophages,significantly increasing the risk of bleeding.In contrast,T cell-mediated PTR involves the abnormal activation of CD8+T cells,which inhibits megakaryocyto-poiesis and leads to a chronic disease course.Based on these mechanisms,this study proposed a strategy of"mechanism-oriented classified diagnosis and treatment".It is suggested that human leukocyte antigen-matched transfusion combined with immunoglobulin therapy be adopted for antibody-mediated PTR,while the combined intervention of thrombopoietin receptor agonists and immunosuppressants be applied for T cell-mediated PTR.Future research should focus on the application of dynamic immune monitoring technologies,the development of bifunctional biological agents and the realization of individualized precision medicine,so as to significantly improve the therapeutic efficacy and quality of life of ITP patients.This study provides an important theoretical basis and practical guidance for the individualized treatment of ITP.

Abstract:Objective To explore the evaluation value of serum Dickkopf-related protein 1(DKK-1)combined with apnea-hypopnea index(AHI)for acute ischemic stroke(AIS)risk in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A total of 223 OSAHS patients treated in Yan'an University Affiliated Hospital from January 2021 to December 2024 were enrolled.According to the occurrence of AIS during follow-up,the patients were divided into the AIS group and non-AIS group.They were further divided into the high-expression group and low-expression group according to the serum DKK-1 level.Enzyme-linked immunosorbent assay was used to detect the serum DKK-1 level of all OSAHS patients.Meanwhile,the clinical data and AHI of all OSAHS patients were collected for comparison,and the evaluation value of serum DKK-1 and AHI for AIS risk in OSAHS patients was analyzed.Results All 223 patients completed the follow-up,including 182 cases in the non-AIS group and 41 cases in the AIS group.The age,proportion of atrial fibrillation,serum DKK-1 level and AHI in the AIS group were significantly higher than those in the non-AIS group(all P＜0.05).Multivariate Logistic regression model analysis showed that atrial fibrillation,high serum DKK-1 level and high AHI were risk factors for AIS in OSAHS patients(odds ratio=2.812,2.654,2.370,all P＜0.05).Receiver operating charac-teristic curve analysis showed that serum DKK-1 and AHI had good evaluation value for AIS risk in OSAHS patients,with the areas under the curve(AUC)of 0.766(95％confidence interval:0.662-0.869)and 0.763(95％confidence interval:0.666-0.860),respectively.The AUC of their combination was increased to 0.896(95％confidence interval:0.830-0.963),which was superior to that of each single index(both P＜0.05).The incidence of AIS and AHI in the DKK-1 high-expression group were significantly higher than those in the low-expression group[25.6％(21/82)vs 14.2％(20/141),(27±5)times/h vs(21±5)times/h](both P＜0.05).Conclusion High serum DKK-1 level and high AHI are risk factors for AIS in OSAHS patients,and the combination of serum DKK-1 and AHI has good evaluation value for AIS risk in OSAHS patients.

Abstract:Acute myocardial infarction is a common cardiovascular emergency,usually caused by coronary artery occlusion,while that induced by non-obstructive coronary artery disease is relatively rare and prone to misdi-agnosis.This paper reports a case of a 44-year-old female patient with chest pain.Electrocardiogram showed ST-segment elevation,and coronary angiography indicated myocardial bridge of the anterior descending artery without significant stenosis.The patient subsequently developed severe complications such as cardiac tamponade and cardiac arrest,and improved after comprehensive rescue treatments including pericardiocentesis,cardiopulmo-nary resuscitation and extracorporeal membrane oxygenation.Combined with relevant literature,we discuss the pathogenesis,diagnosis and treatment strategies of acute non-obstructive myocardial infarction,aiming to improve clinicians' awareness of atypical myocardial infarction.

Abstract:Objective To investigate the correlation between the optimization of emergency timeliness and survival outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation(ECPR),and to provide evidence-based medical evidence for the establishment of an efficient ECPR rapid response system.Methods The clinical data of 167 critically ill patients who underwent ECPR treatment at Beijing Anzhen Hospital,Capital Medical University from January 2017 to December 2024 were retrospectively analyzed.Key indicators including the extracorporeal membrane oxygenation(ECMO)initiation time(the time from the ECMO team receiving the emergency call to start the emergency process to the successful initiation of ECMO),installation location and catheterization method were recorded,and their relationships with clinical outcomes such as in-hospital mortality and weaning success rate were analyzed.Results The in-hospital mortality rate was 71.9％(120/167)and the weaning success rate was 41.9％(70/167)among the 167 ECPR patients.The ECMO initiation time was shorter in the operating room and intensive care unit,and the longest in the emergency department,with no statistically significant difference(P=0.131).The initiation time of pre-catheterization and percutaneous puncture was signifi-cantly shorter than that of incision,puncture combined with incision(all P＜0.05).The initiation time of in-hos-pital survivors was significantly shorter than that of in-hospital non-survivors[30.00(21.00,40.00)min vs 35.00(26.00,48.00)min](Z=-2.275,P=0.023).The initiation time of successful weaning patients was also significantly shorter than that of unsuccessful weaning patients[30.00(21.00,40.50)min vs 35.00(28.00,49.00)min](Z=-2.223,P=0.026).Multivariate Logistic regression analysis showed that catheterization method was the only independent risk factor affecting ECPR initiation time(hazard ratio=2.273,95％confidence interval:1.354-3.815,P=0.002).Logistic regression model analysis showed that when the initiation time was 40 min,the risk of death in patients increased significantly and the weaning success rate decreased significantly(all P＜0.05).Conclusion Initiation time is a key factor affecting the prognosis of ECPR patients.The application of percutaneous puncture catheterization technology and optimization of initiation time(controlled within 40 min)can significantly improve the survival outcomes of patients.Medical institutions should establish a professional ECPR rapid response team,formulate standardized emergency processes,and improve the rescue success rate of patients with refractory cardiac arrest.

Abstract:Breast cancer is one of the most common malignant tumors in women.Although comprehensive treatment has significantly improved the survival rate,how to advance the prevention and control threshold and construct a disease prevention strategy with traditional Chinese medicine(TCM)characteristics remains a clinical difficulty and research hotspot.The"pathogenic deficient evil"theory in Huangdi Neijing holds that the onset of disease is a process in which the body's healthy Qi is insufficient to resist the invasion of pathogenic factors.Breast cancer is also the result of the mutual restriction and confrontation between healthy Qi and cancer toxin,and"pathogenic deficient evil"is one of the important pathogenesis of its occurrence and development,which is highly consistent with the immune escape and immunosuppressive microenvironment in modern tumor immunology.By systematically searching and sorting out the relevant literatures on"pathogenic deficient evil"and disease prevention in Huangdi Neijing and medical scholars of all dynasties,combined with clinical and basic research data on breast cancer epidemiology,molecular typing,tumor immune microenvironment and TCM intervention at home and abroad,this study adopted the methods of parallel reading,induction and theoretical integration to conduct isomorphic docking between the core propositions such as"deficiency as the root cause,pathogenic factors arising from deficiency,and deficiency complicated with excess"and the processes of immunoediting and immune escape.On this basis,the disease prevention strategies for breast cancer were systematically discussed from three levels:preventing disease before its onset,preventing disease progression after its onset,and preventing recurrence after recovery.A hierarchical prevention and control idea was proposed,which is based on constitution regulation and intervention of high-risk groups,and takes strengthening healthy Qi and eliminating pathogenic factors to improve the systemic and local immune microenvironment as the core.By sorting out the relevant studies on representative Qi-invigorating Chinese medicinal herbs such as Astragali Radix and Ganoderma,the possible mechanism by which they intervene in the"pathogenic deficient evil-immune escape"process through pathways such as programmed cell death protein 1/programmed cell death ligand 1 and transforming growth factor-β was explored.This study aims to construct a breast cancer prevention and treatment framework with isomorphic relationship between the"pathogenic deficient evil"theory and modern tumor immunology,and provide theoretical basis and ideas for building an integrated traditional Chinese and western medicine disease prevention model that can be embedded in the existing comprehensive treatment pathways.

Abstract:As a key multifunctional adaptor protein in cells,sequestosome-1(p62)is not only a substrate receptor in the autophagy pathway,but also a hub connecting signal transduction and metabolic regulation.Although studies have shown that p62 is abnormally highly expressed in various malignant tumors such as hepato-cellular carcinoma,pancreatic cancer,renal cancer and colorectal cancer,the molecular mechanism by which it drives tumor metabolic reprogramming remains incompletely clear.This article systematically reviews the molecular mechanism by which p62 integrates mammalian target of rapamycin complex 1,nuclear factor erythroid 2-related factor 2,and nuclear factor-κB signaling axes through non-canonical autophagy pathways to coordinately regulate the stability of glucose transporters,glycolytic rate-limiting enzymes,and glutamine transporters,thereby remodeling the glycolipid metabolic network of tumor cells.In addition,this article further discusses metabolic intervention therapeutic strategies targeting p62 signaling nodes,providing a theoretical basis for the development of novel combined anti-tumor therapies.

Abstract:Objective To explore the relationship between novel coronavirus infection(COVID-19)and electrocardiographic abnormalities,so as to provide evidence for the early diagnosis and treatment of COVID-19-related myocardial injury.Methods A retrospective parallel controlled study was conducted.A total of 1 801 outpatients who underwent electrocardiography without COVID-19 admitted to Beijing Anzhen Hospital,Capital Medical University from December 7 to December 14,2021 were enrolled as the non-infected group,and 631 outpatients with confirmed COVID-19 receiving electrocardiographic examination from December 7 to December 14,2022 were enrolled as the infected group.General electrocardiographic indicators such as P wave and QRS wave,electrocardiographic diagnosis,and the incidence of arrhythmia were compared between the two groups.Subgroup analysis was performed according to the presence or absence of arrhythmia.Results There were no significant differences in age and gender between the infected group and the non-infected group(both P＞0.05).The P wave duration,PR interval,QRS duration,QT interval and QTc interval in the infected group were significantly prolonged compared with the non-infected group(all P＜0.05).The proportion of sinus rhythm in the infected group was lower[74.3％(469/631)vs 80.5％(1 449/1 801)](P＜0.05),while the proportions of sinus tachycardia and atrial fibrillation were higher[7.0％(44/631)vs 3.8％(69/1 801),6.2％(39/631)vs 3.9％(70/1 801)](both P＜0.05).Subgroup analysis showed that among patients with sinus rhythm,P wave duration,PR interval,QRS duration and QTc interval in infected patients were significantly longer than those in non-infected patients(all P＜0.05);among patients with arrhythmia,the average heart rate of infected patients was significantly higher than that of non-infected patients(P＜0.05).Conclusion COVID-19 can induce significant but relatively mild electrocardiographic abnormalities,including mild prolongation of conduction intervals,slight widening of QTc interval,and increased incidence of arrhythmias such as atrial fibrillation.