Beijing Shijingshan Hospital

This study aimed to investigate the relationship between anemia, stroke severity, short-term prognosis, and imaging features of infarction. The clinical features and imaging data of patients with anemia and acute ischemic stroke were retrospectively analyzed. All patients were divided into anemia and non-anemia groups, and according to the degree of anemia, they were divided into mild anemia group and moderate and severe anemia group. Stroke severity, short-term prognosis, and infarct lesion characteristics were compared between all groups. Among the 238 AIS patients, we found that the prevalence of anemia was 25.6%. There was significant correlation between the severity of anemia and NIHSS at admission (P = 0.01); The severity of anemia affected 90-day mRS (P = 0.01), and increased the length of hospital (P < 0.01). In the moderate and severe anemia group, there were 16 cases of watershed infarction, 15 of cerebral infarction, and 14 of corona radiata and centrum semiovale infarction. Multiple infarcts were more significantly common in the moderate and severe anemia group (P < 0.01). The degree of anemia correlated with the severity of acute ischemic stroke. Furthermore, the severity of anemia was closely related to patient prognosis. The infarct sites of moderate and severe anemia were mostly in the cerebral lobe, corona radiata, and centrum semiovale, and the watershed area was prone to infarction with multiple infarction lesions, which may be related to tissue hypoperfusion. By analyzing the clinical features and imaging of patients with anemia combined with acute ischemic stroke, we found: The anemia group had higher NIHSS at admission than the non-anemia group; The short-term prognosis of moderate and severe anemia group was worse than mild anemia group and non-anemia group; Imaging findings illustrated the infarct sites of the moderate and severe anemia group were mostly in the cerebral lobe, corona radiata, and centrum semiovale, and the watershed area was prone to infarction with multiple infarction lesions.

ObjectiveWe compared the clinical efficacy of different surgical approaches for recurrent lumbar disc herniation (RLDH) after percutaneous endoscopic transforaminal discectomy (PETD).MethodsEighty-seven patients with RLDH were included between June 2013 and June 2022, of whom 38 underwent percutaneous endoscopic interlaminar discectomy (PEID) and 49 underwent PETD again. We compared perioperative variables as well as clinical and imaging outcomes. Clinical evaluations consisted of visual analog scale for back pain (VAS-B) and leg pain (VAS-L), Japanese Orthopedic Association score (JOA), and Oswestry disability index (ODI). Imaging measurements consisted of disc height index (DHI), range of motion (ROM), and sagittal translation (ST).ResultsCompared to the PETD group, the PEID group presented shorter operative time and fewer fluoroscopy times (P < 0.05); nevertheless, intraoperative blood loss, hospital stay, incision length, and the complication rate showed no significant between-group difference (P > 0.05). Both groups showed significant clinical improvement postoperatively (P < 0.05). At 7 days after surgery, VAS-B, VAS-L, JOA, and ODI showed greater improvement in the PEID group compared with the PETD group (P < 0.05). There were no significant between-group differences in imaging data (P > 0.05). Postoperative ROM and ST remained below instability thresholds, and no lumbar instability was observed.ConclusionFor patients with RLDH after PETD, both PEID and PETD achieve satisfactory clinical efficacy. PEID provides advantages over PETD by reducing operative time and fluoroscopy, and is effective in avoiding scar tissue formation from initial surgery. These findings suggest that PEID may be preferable in selected recurrent cases, particularly where scar tissue or anatomical barriers compromise transforaminal access.

Mild ischemic stroke (MIS) patients with disabling symptoms often receive intravenous thrombolysis; however, the optimal post-thrombolysis antiplatelet regimen, especially for those at risk of early neurological deterioration (END), remains uncertain. To compare the clinical efficacy and safety of three post-thrombolysis antiplatelet strategies in MIS patients with disabling symptoms or END. This retrospective cohort study included 243 MIS patients (NIHSS ≤ 3) who received intravenous thrombolysis. Patients were assigned to one of three groups based on antiplatelet regimens initiated 24 hours post-thrombolysis: aspirin monotherapy, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel, or tirofiban bridging followed by sequential DAPT. Clinical outcomes, including NIHSS improvement, modified Rankin Scale (mRS) scores, and adverse events, were evaluated on Day 7 and Day 90. Multivariate logistic regression was used to identify predictors of favorable functional outcomes (mRS ≤ 2 at 90 days). At Day 7, the tirofiban group exhibited significantly lower NIHSS scores (1.5 ± 1.1) compared to the aspirin group (2.1 ± 1.3; P = 0.04). At Day 90, the tirofiban group had the highest rate of functional independence (84.6% vs. 75.0% in the aspirin group). Multivariate analysis identified tirofiban bridging as an independent predictor of favorable outcomes (OR = 2.08, 95% CI: 1.01-4.30; P = 0.047). Safety outcomes, including symptomatic intracranial hemorrhage and systemic bleeding, were comparable across all groups. Tirofiban bridging followed by dual antiplatelet therapy may enhance early neurological recovery and long-term functional outcomes without increasing bleeding risk in MIS patients with disabling symptoms or END.

Metastasis is the leading cause of mortality in bladder cancer (BC). This study investigates the antimetastatic potential of ZSTK474, a phosphatidylinositol 3-kinase (PI3K) inhibitor developed for solid tumor therapy. Specifically, the study evaluates the effects of ZSTK474 on tumor cell migration and invasion, two critical processes in metastasis using in vitro assays. Human BC cell lines, CAL29 and BIU87, were treated with ZSTK474 at concentrations of 0, 0.05, 0.25, and 1.5µM. Cell proliferation was assessed using the BrdU incorporation assay. Migration capacity was evaluated through scratch and Transwell migration assays, while invasion potential was determined using a Matrigel-coated Transwell invasion assay. Western blotting was performed to analyze the expression levels of Girdin, phosphorylated Girdin (p-Girdin), phosphorylated Akt (p-Akt), and PI3K. Treatment with ZSTK474 significantly inhibited BC cell proliferation, as demonstrated by the BrdU incorporation assay. Additionally, a substantial reduction in cell invasion was observed in the Transwell invasion assay (p < 0.01). Western blot analysis revealed that ZSTK474 suppressed the phosphorylation of Girdin in BC cells. Higher concentrations of ZSTK474 were associated with decreased relative expression levels of Girdin, p-Girdin, p-Akt, and PI3K. However, no significant inhibitory effect on Akt expression was detected following ZSTK474 treatment. Although total Akt protein levels remained unchanged, whereas phosphorylated Akt (p-Akt) was significantly reduced. The findings of this study suggest that ZSTK474 effectively inhibits bladder cancer cell migration and invasion by suppressing key signaling pathways involved in metastasis. Specifically, ZSTK474 reduces the phosphorylation of Girdin, an Akt substrate implicated in tumor migration and invasion. These results provide further evidence supporting the therapeutic potential of ZSTK474 in mitigating metastatic progression in bladder cancer.

Immune checkpoint inhibitors (ICIs) combined with anti‐angiogenic agents manifest improved survival in advanced hepatocellular carcinoma (HCC), but responses remain heterogeneous. Although high PIVKA‐II expression correlates with advanced disease stage, early recurrence, shorter survival, and may predict resistance to anti‐PD‐1 plus lenvatinib therapy, the tumor microenvironment (TME) and resistance mechanisms in HCC with high PIVKA‐II expression remain unclear. Clinical data from 156 resected HCC patients and 104 patients treated with anti‐PD‐1 plus lenvatinib are analyzed to correlate PIVKA‐II expression with clinical features and outcomes. Single‐cell RNA sequencing (scRNA‐seq) is performed on tumors from 15 untreated and 7 treated patients. Mechanistic findings are validated in vitro and in vivo. High PIVKA‐II expression is associated with advanced disease stage, increased microvascular invasion (MVI), early recurrence, and poor response to therapy. ScRNA‐seq revealed an immunosuppressive TME enriched with regulatory T cells (Tregs), exhausted CD8⁺ T cells, and SPP1⁺ tumor‐associated macrophages (TAMs). Mechanistically, tumors with high PIVKA‐II expression upregulated NQO1, which stabilized p65 by inhibiting ubiquitination, activating the NF‐κB/CXCL12 axis, and recruiting Tregs. This pathway mediated therapeutic resistance. Plerixafor, a CXCL12 inhibitor, disrupted this axis and significantly enhanced anti‐tumor efficacy when combined with anti‐PD‐1 plus lenvatinib in vivo. PIVKA‐II is a potentially effective biomarker for predicting resistance to anti‐PD‐1 plus lenvatinib therapy. Its high expression denotes an immunosuppressive TME. Targeting the NQO1/CXCL12/Tregs axis with Plerixafor may restore sensitivity and improve outcomes.

The aim of this study was to evaluate the association of paraspinal muscle morphology and composition with sagittal spinopelvic alignment (SSA). This review was registered at PROSPERO (CRD42022371879). Four databases including PubMed, Embase, Cochrane, and Web of Science were searched from their inception until December 15, 2024. The scope of paraspinal muscles included multifidus (MF), erector spinae (ES), psoas major (PM), and paraspinal extensor muscles (PEM; combined multifidus and erector spinae). The cross-sectional area (CSA) and fat signal fraction (FSF) were the metrics for quantifying paraspinal muscle morphology and composition, respectively. The outcomes of interest were SSA parameters, including C7-S1 sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and PI minus LL mismatch (PI - LL). The methodological quality and risk of bias of each included studies was assessed using the Newcastle-Ottawa Scale and its adapted form. Correlation coefficients extracted from included studies were transformed to a Fisher's z correlational coefficient to perform a meta-analysis and to generate a pooled effect size (z) and 95% confidence intervals (CIs). Sixteen observational studies with 1535 participants were included in the meta-analysis. We found a positive association of paraspinal muscle CSA with TK (MFCSA, z = 0.17, 95% CI: 0.01 to 0.32, p = 0.041; PEMCSA, z = 0.17, 95% CI: 0.06 to 0.28, p = 0.002) and LL (PMCSA, z = 0.12, 95% CI: 0.02 to 0.22, p = 0.019), whereas a negative correlation with SVA (MFCSA, z = - 0.35, 95% CI: -0.67 to - 0.02, p = 0.036; PEMCSA, z = - 0.25, 95% CI: -0.45 to - 0.05, p = 0.015), PT (PMCSA, z = - 0.22, 95% CI: -0.39 to - 0.05, p = 0.012), PI (PMCSA, z = - 0.13, 95% CI: -0.23 to - 0.02, p = 0.020), and PI-LL (MFCSA, z = - 0.50, 95% CI: -0.69 to - 0.30, p < 0.00001; PMCSA, z = - 0.20, 95% CI: -0.34 to - 0.05, p = 0.007; PEMCSA, z = - 0.28, 95% CI: -0.38 to - 0.18, p < 0.00001). Meanwhile, paraspinal muscle FSF showed a positive correlation with SVA (PEMFSF, z = 0.39, 95% CI: 0.30 to 0.47, p < 0.00001), PT (PEMFSF, z = 0.45, 95% CI: 0.35 to 0.54, p < 0.00001), and PI-LL (PEMFSF, z = 0.29, 95% CI: 0.17 to 0.41, p < 0.00001), while a negative correlation with PI (PMFSF, z = - 0.14, 95% CI: -0.27 to - 0.01, p = 0.029) and SS (PEMFSF, z = - 0.25, 95% CI: -0.41 to - 0.08, p = 0.004). We also observed the associations were stronger in populations without degenerative spinal diseases, in studies that used computed tomography for paraspinal muscle morphology and composition assessment, and in studies with moderate study quality. Of the 15 significant associations reported here, only 3 were supported by moderate to high-level evidence, while others were supported by very low to low evidence certainty. Paraspinal muscle morphology and composition were associated with SSA. Further studies are warranted to establish causality and to elucidate the underlying mechanisms.

BackgroundPost-stroke shoulder-hand syndrome (SHS) significantly impacts patients' quality of life and functional recovery. While both acupuncture and rehabilitation training have shown promise individually, their combined effect needs systematic evaluation.MethodsA comprehensive search was conducted across seven databases (PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, and Wanfang) for randomized controlled trials comparing combined acupuncture-moxibustion-rehabilitation therapy vs. rehabilitation alone. The primary outcomes included Fugl-Meyer Assessment (FMA) scale, visual analog scale (VAS), and Barthel Index (BI) scores. Risk of bias was assessed using the Cochrane tool.ResultsTwenty-seven randomized controlled trials involving 2,175 participants were included. Meta-analysis showed significant improvements in the combination therapy group compared to rehabilitation alone: VAS score (SMD = 1.62, 95% CI: 1.19–2.06), FMA scale (SMD = 1.78, 95% CI: 1.41–2.15), and BI/MBI scores (SMD = 1.01, 95% CI: 0.48–1.54). The combination therapy also showed superior effects on swelling reduction (SMD = −1.75, 95% CI: −2.08, −1.42) and total response rate (RR = 1.21, 95% CI: 1.01–1.44). Most studies demonstrated low to moderate risk of bias.ConclusionThe combination of acupuncture and moxibustion with rehabilitation training appears to be more effective than rehabilitation alone for post-stroke SHS, improving motor function, pain relief, and activities of daily living. However, high heterogeneity warrants careful interpretation and further high-quality studies.

BackgroundThe HEART Pathway is used for the rapid assessment of acute chest pain patients and identification of high-risk patients. However, there is no consensus regarding the safety and accuracy of HEART Pathway in stratifying risk in chest pain patients. The present work focused on systematically assessing the effectiveness and safety of the HEART Pathway in stratifying risk of acute chest pain patients.MethodsWeb of Science, PubMed, Cochrane Library, Embase, and CNKI were thoroughly searched up to May 30, 2024, for relevant studies on HEART Pathway for stratifying risk among acute chest pain patients. Two independent researchers screened the literatures, extracted the data, and performed a meta-analysis using Stata/MP 16.0.ResultsThere were altogether 10 articles being enrolled. HEART Pathway demonstrated combined sensitivity, specificity, diagnostic odds ratio, positive and negative diagnostic likelihood ratios of 0.97 [95% CI (0.95, 0.98)], 0.47 [95% CI (0.40, 0.55)], 27.34 [95% CI (18.22, 41.04)], 1.83 [95% CI (1.60, 2.09)], and 0.07 [95% CI (0.04, 0.10)], separately. In addition, the area under the summary receiver operating characteristic curve was 0.91 [95% CI (0.88, 0.93)].ConclusionThe HEART Pathway efficiently triages patients who have a low chest pain risk while ensuring the high safety level, emphasizing its significant clinical applicability.