Hebei Yiling Hospital

To evaluate the efficacy and safety of Tongxinluo in improving medium- and long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) in a real-world setting. This multicenter prospective cohort study enrolled STEMI patients from 122 certified chest pain centers in China. Participants were stratified into exposure (n=1,598) and non-exposure (n=1,600) groups based on Tongxinluo administration initiation before or within 24 h post-reperfusion. Both groups received percutaneous coronary intervention (PCI) or thrombolysis with guideline-based therapy. The primary endpoint was incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months. Secondary endpoints included the incidence of severe STEMI complications at 30 days; MACCEs at 30 days and 6 months; composite endpoint events at 6 and 12 months; and all-cause mortality at 30 days, 6 months, and 12 months. A total of 3,198 patients were included in the primary analysis. The primary endpoint, MACCEs incidence at 12 months, was significantly lower in the exposure group [40 (2.5%) vs. 106 (6.6%)], driven by reductions in cardiac death and stroke. In the secondary endpoint analysis, early risk reduction was pronounced at 30 days [MACCEs: 19 (1.2%) vs. 64 (4.0%)] and 6 months [MACCEs: 33 (2.1%) vs. 90 (5.6%)]. The exposure group exhibited 92% lower 30-day STEMI complications [16 (1.0%) vs. 210 (13.1%)], including reductions in cardiogenic shock, acute heart failure, mechanical complications, and malignant arrhythmias. Composite endpoint risks decreased by 65% at 6 months [36 (2.3%) vs. 104 (6.5%)] and 66% at 12 months [43 (2.7%) vs. 127 (7.9%)], with significant heart failure readmission reductions and 89% lower severe bleeding risk. More surprisingly, the risk of all-cause death at 30 days, 6 months, and 1 year was reduced by 71%, 61% and 59% in the exposure group. Adjunctive Tongxinluo therapy demonstrated significant improvement in 12-month cardiovascular outcomes with favorable safety profile, suggesting potential benefits of integrating traditional Chinese medicine with evidence-based STEMI management. (Registration No. ChiCTR100054466).

The constricted ear, also known as cup ear or lop ear, is visually characterized by the curling and lidding of the helix. As the deformity intensifies, it also involves structural abnormalities of the antihelix, scapha, and triangular fossa, resulting in the auricle presenting a lidding, protrusion, decreased vertical height and low position appearance. Exploring a cost-effective treatment strategy for all Tanzer types of constricted ears remains a significant challenge. Thirty-four patients with unilateral constricted ears who underwent surgical correction from January 2020 to January 2023 were enrolled in this study. Among them, there were two cases of Tanzer I, twenty-nine cases of Tanzer II, and three cases of Tanzer III. All patients were treated by using affected ear local skin flap and costal cartilage grafting technology, and their complications, aesthetic outcomes, and satisfaction were reviewed. On a scale of symmetry, size, shape, and scarring, the average aesthetic score was 3.8 and all patients were satisfied with the corrective outcomes and overall appearance. Most patients showed transient edema and recovered at about 1 month after the surgery. No other complications were observed during the follow-up. Our method maximizes the use of affected ear cartilage and skin through a simple incision, and with the assistance of single rib cartilage, each type of Tanzer constricted ear can be corrected effectively through a single procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Our study includes 103 patients aged between 51 and 60 years who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) from matched sibling donors (MSDs) (n = 36), haploidentical donors (HIDs) (n = 56), and unrelated donors (URDs) (n = 11). Multivariate analysis exploring the relationship between risk factors and survival confirmed that survival outcomes were only independently impacted by Eastern Cooperative Oncology Group (ECOG) score (ECOG scores ≥2vs. ECOG scores of 0-1, overall survival [OS] HR: 2.91 [95% CI 1.35-6.27], p = 0.006; failure free survival [FFS] HR: 2.93 [95% CI 1.33-5.88], p = 0.006; graft-versus-host disease-free/relapse-free survival [GRFS] HR: 2.80 [95% CI 1.33-5.88], p = 0.006), while age, specific donor source and hematopoietic cell transplantation-comorbidity index (HCT-CI) score did not significantly influence prognosis in this age group. After applying propensity score-matching (PSM) to balance the pretransplant clinical factors between patients with ECOG scores 0-1 cohort and those with ECOG scores ≥2 cohort, poor performance status remains a negative factor for survival outcomes (OS p = 0.04; FFS p = 0.03; GRFS p = 0.03). Further analysis in subgroup patients with HCT-CI scores 0-1 found the retained significance of ECOG score in predicting inferior survival. In conclusion, our results indicate good long-term results of allo-HSCT in elderly SAA adults regardless of donor type. Higher ECOG score is associated with poor post-transplant outcomes and has to be taken into account for patients, even at a low-risk comorbidly burden.

Scedosporium boydii infections pose diagnostic challenges due to their nonspecific clinical manifestations and slow growth characteristics in conventional cultures. This paper highlights the diagnostic value of molecular technology combined with targeted prolonged culture for rare fungi. Unitl now, only one case was identified using metagenomic next-generation sequencing (mNGS). This case represents the first report of a 20-day delayed culture confirmation of S. boydii guided by mNGS results in a non-immunocompromised chronic obstructive -with history of COPD who was admitted with fever and cough. Despite two weeks of antibacterial treatment, chest computed tomography (CT) showed worsening infection. To clarify the pathogen, mNGS and bacterial culture of bronchoalveolar lavage fluid (BALF) were performed. Subsequent culture and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) confirmed the growth of Scedosporium species. Based on clinical presentation, chest CT findings, mNGS results, pulmonary Scedosporiosis was diagnosed, and an antifungal treatment regimen (200 mg BID orally) was initiated. Subsequent culture confirmed S. boydii growth and antifungal susceptibility results were also obtained. After six weeks of voriconazole treatment, he was discharged from the hospital and continued to take oral medication for three months. He was fully recovered without recurrence after six months of follow-up. The present case suggests that mNGS findings can unveil cryptic pathogens like Scedosporium. Use mNGS results to trigger intentional, extended targeted cultivation– challenging standard incubation times– especially in non-immunocompromised hosts with underlying lung disease. Seamless clinician-laboratory collaboration is paramount for treatment success.

Osteogenic differentiation (OD) of human bone marrow mesenchymal stem cells (hBMSCs) plays a vital role in bone formation, and its impairment contributes to osteoporosis, particularly estrogen-deficient osteoporosis (EDO). Baicalein (BN) and silent information regulator of transcription 1 (SIRT1) have been implicated in bone metabolism; however, the upstream regulatory mechanisms of SIRT1 and the potential synergistic effect of BN with the transcription factor growth factor independent 1 (GFI1) remain unclear. In this study, target genes were identified via SwissTargetPrediction and GeneCards databases, and protein-protein interaction (PPI) networks were constructed with Cytoscape software. The mRNA and protein expression levels were analyzed by RT-qPCR and Western blotting. The Alkaline phosphatase (ALP) Assay Kit was employed to analyze ALP activity in osteogenically differentiated hBMSCs. Alizarin red S (ARS) staining was utilized to assess cell calcification. Apoptosis was determined by flow cytometry. Kits were used to test changes in ferroptosis-related indicators such as malondialdehyde (MDA), glutathione (GSH), reactive oxygen species (ROS) and Fe2+ content. Cell viability was determined by the CCK-8 assay. The binding of GFI1 to the SIRT1 promoter was confirmed by dual-luciferase reporter and chromatin immunoprecipitation (ChIP) assays. A rat osteoporosis model was established for in vivo validation. Bioinformatics analysis identified SIRT1 as a common target of BN, ferroptosis, and EDO. SIRT1 expression was significantly decreased in osteoporosis patients' peripheral blood but upregulated duringOD, paralleling increased GFI1 expression. ChIP assays confirmed GFI1's direct binding to the SIRT1 promoter, activating its transcription. BN treatment enhanced SIRT1 protein level. BN and GFI1 synergistically regulated SIRT1 at protein and transcriptional levels, respectively, promoting OD and inhibiting apoptosis and ferroptosis in hBMSCs. In vivo, BN facilitated OD in osteoporosis rats. These findings revealed a novel dual-level regulatory mechanism of SIRT1 by BN and GFI1, providing new insights into osteoporostic pathogenesis and suggesting potential therapeutic targets.

To our knowledge, this is the first reported case of a pulmonary mixed infection involving Nocardia cyriacigeorgica, Stenotrophomonas maltophilia, and human cytomegalovirus (HCMV) in a patient with minimal change nephrotic syndrome (MCNS), which is of great clinical significance. We report the case of an 18-year-old male with a two-month history of MCNS who was admitted due to fever, cough, and bright red hemoptysis. Upon admission, he was treated with piperacillin/tazobactam and moxifloxacin for one week; however, the therapeutic response was suboptimal. Metagenomic Next-Generation Sequencing (mNGS) and microbiological culture of bronchoalveolar lavage fluid identified a pulmonary mixed infection involving N. cyriacigeorgica, S. maltophilia, and HCMV. Following the initiation of combination therapy with linezolid, trimethoprim-sulfamethoxazole, and ganciclovir, the patient’s condition improved markedly, and he was discharged in a stable condition. One-year follow-up revealed complete recovery with no recurrence. This case highlights the critical role of incorporating advanced molecular diagnostic tools such as mNGS into clinical practice and the need to be vigilance about opportunistic infections involving multiple pathogens, especially in patients receiving immunosuppressive therapy.

The purpose of this paper is to analyze the four female characters in the film Ne Zha 2 -Lady Yin, Crane Girl, Ao Run, and Lady Shiji-by exploring the ways in which their roles are presented in the film, it reveals how traditional gender biases and societal expectations affect women's position in the power structure.Lady Yin, as a mother and female general, is marginalized as a sacrificial character in the story despite her leadership.Crane Girl has a high status among the divine attendants, yet remains as a subordinate to the male characters, reflecting a clear gender hierarchical order.The characters of Ao Run and Lady Shiji also present different gendered behaviors and dilemmas, demonstrating the invisible limitations of women in power struggles in traditional Chinese culture.This paper argues that these female role settings reflect deeper social gender norms and contribute to gender bias in contemporary media.

Network meta-analysis of multiple treatment comparisons of recurrence lumbar disc herniation. The purpose of comparing the differences between different surgical approaches for recurrent lumbar disc herniation (LDH). The PubMed, Embase, MEDLINE, Cochrane Library, Web of Science, Google Scholar and China National Knowledge Infrastructure databases were searched for articles published before April 10th, 2024. The Markov chain Monte Carlo methods were used to perform a hierarchical Bayesian NMA in R version 4.3.3 using a random effects consistency model. The assessing outcomes were pain intensity, disability, complications and recurrence. 20 studies including 1556 patients and 7 different approaches (PELD, MED, MIS-TLIF, TLIF, Unilat -TLIF, PLIF and OD) were retrospectively retrieved. the efficacy of each approach was the same in relieving pain, OD was significantly better than PELD and MIS-TLIF in relieving dysfunction (SMD: 1.9[0.21,3.4] and 2.0[0.084,3.8], respectively), In addition, MIS-TLIF was significantly lower than PELD and MED in the complication rate (SMD: 0.37[0.14,0.84] and 0.15[0.034,0.68], respectively), TLIF was significantly Lower than MED in the complication rate (SMD:0.14 [0.027,0.70]), PELD was significantly higher than MIS-TLIF, TLIF and PLIF in the recurrence rate (SMD: 1.3e-17 [2.4e-44,0.00016],1.2e-12[2.1e-36,0.34] and 1.4e-12[6.2e-35,0.013], respectively), MED was significantly higher than MIS-TLIF and PLIF in the recurrence rate (SMD: 2.6e-17[5.6e-44,0.0037] and 3.1e-12[1.6e-34,0.022], respectively), OD was significantly higher than MIS-TLIF, TLIF and PLIF in the recurrence rate (SMD:4.6e+16[2.3e+02,3.0e+43], 4.3e+11[2.4,2.5e+35] and 4.1e+11[35,8.7e+33], respectively). In the treatment of recurrent lumbar disc herniation, vertebral fusion surgery is superior to repeat discectomy. At the same time, MIS-TLIF may be a preferable surgical procedure in the treatment of recurrent lumbar disc herniation.

Exosomes derived from various cells have been demonstrated to contribute to cardiac repair by regulating macrophage polarization in myocardial infarction. However, how exosomes secreted from cardiomyocytes under hypoxia-ischemia (Hypo-Exo) regulate macrophage polarization in the local tissues is elusive. This study aimed to determine the underlying mechanisms by which Hypo-Exo polarized M2 macrophages. Hypo-Exo was harvested from the supernatant of oxygen glucose deprivation (OGD)-conditioned H9c2, identified using transmission electron microscopy, nanoparticle tracking analysis, and western blot, and then applied to RAW264.7 and C57BL/6N mice. Echocardiography, TTC, H&E, Masson, and immunofluorescence staining were used to evaluate the therapeutic effects of Hypo-Exo in the MI mouse model. The effects of Hypo-Exo on RAW264.7 were examined by RT-qPCR. Hypo-Exo labeled with PKH26 could be engulfed by RAW264.7 cells and promote M2 macrophage polarization. Hypo-Exo inhibited atrial natriuretic peptide (ANP) mRNA expression in RAW264.7 cells, and three cargo miRNAs of Hypo-Exo were upregulated to degrade the ANP expression. Instead of downregulating ANP, OGD supernatant upregulated ANP expression to activate M1 macrophages. Our study demonstrated a novel mechanism that Hypo-Exo carried with miRNAs as a communicator to degrade the expression level of ANP mRNA in macrophages by which Hypo-Exo polarized M2 macrophages to improve recovery from MI in mice.