Ischemic stroke(IS)is a disease caused by insufficient blood and oxygen supply to cerebral vessels,with the main clinical manifestations of hemiplegia,sensory disturbance,aphasia,and ataxia.Studies have shown that hypoxia-inducible factor 1α(HIF-1α),as the core regulatory element of oxygen homeostasis,can be rapidly activated under hypoxia/ischemia conditions,thereby playing an important role in the pathophysiology of IS.In recent years,more and more articles have shown that the active components of tradi-tional Chinese medicine,Chinese patent drugs,and compound traditional Chinese medicine prescriptions can effectively regulate the HIF-1α-related signaling pathway in the treatment of IS,but there is no systematic summary on regulation of the HIF-1α signaling pathway in the treatment of IS.Therefore,this article mainly summarizes the structure and physiological activity of HIF-1α and its mechanisms of action in IS and reviews related studies on Chinese medicine monomers and compound prescriptions in the treatment of IS in the past five years in China and globally.It is pointed out that the Chinese medicine monomers and compound prescriptions can repair brain tissue,alleviate brain tissue damage,and exert a therapeutic effect on IS by regulating the HIF-1α pathway to promote an-giogenesis,inhibit neuroinflammation and oxidative stress,promote energy metabolism,and repair blood-brain barrier damage.

Objective:To construct a predictive model for hemorrhagic transformation (HT) after intravenous thrombolysis in elderly patients with acute cerebral infarction (ACI) using the Lasso-Logistic regression model, and to analyze the clinical utility of this predictive model.Methods:A total of 310 elderly ACI patients who received intravenous thrombolysis with alteplase (rt-PA) at the Beijing Rehabilitation Hospital Affiliated to Capital Medical University from May 2022 to May 2024 were selected. The occurrence of HT within 36 hours after intravenous thrombolysis was recorded, and the patients were divided into the HT group and non-HT group based on the presence or absence of HT. Clinical data were compared between the two groups. Lasso-Logistic regression analysis was used to screen the influencing factors of HT after intravenous thrombolysis in elderly ACI patients. A nomogram predictive model for HT after intravenous thrombolysis in elderly ACI patients was constructed based on these influencing factors, and the clinical value of the nomogram predictive model was analyzed.Results:The incidence of HT within 36 hours after rt-PA intravenous thrombolysis in elderly ACI patients was 29.35%(91/310). The proportions of patients with hypertension, diabetes, anticoagulant use, and atrial fibrillation in the HT group were higher than those in the non-HT group. The onset-to-thrombolysis time (ONT), admission National Institute of Health Stroke Scale (NIHSS) score, pre-thrombolysis peripheral blood platelet count, neutrophil-to-lymphocyte ratio (NLR), and serum levels of high-sensitivity C-reactive protein (hs-CRP), vascular endothelial cadherin (VE-cad), occludin, soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1), and endothelial cell-specific molecule 1 (ESM-1) in the HT group were higher than those in the non-HT group (all P<0.05). Lasso-Logistic regression analysis showed that atrial fibrillation, ONT, admission NIHSS score, pre-thrombolysis peripheral blood NLR, and serum levels of hs-CRP, VE-cad, occludin, sLOX-1, and ESM-1 were independent risk factors for HT after intravenous thrombolysis in elderly ACI patients (all P<0.05). The area under the curve (AUC) of the constructed nomogram predictive model for predicting HT after intravenous thrombolysis in elderly ACI patients was 0.914(95% CI: 0.879-0.949), indicating high predictive efficiency. When the threshold probability range was 0.05-0.83, the nomogram predictive model showed good net benefit in predicting HT after intravenous thrombolysis in elderly ACI patients and had high clinical utility in predicting the risk of HT. Conclusions:Atrial fibrillation, ONT, admission NIHSS score, pre-thrombolysis peripheral blood NLR, and serum levels of hs-CRP, VE-cad, occludin, sLOX-1, and ESM-1 are independent risk factors for HT after intravenous thrombolysis in elderly ACI patients. The nomogram predictive model constructed based on these factors has high predictive efficiency and clinical utility in predicting the risk of HT.

This report detailed a case of intrauterine intervention for fetal left-sided congenital cystic adenomatoid malformation with intralobar pulmonary sequestration. The mother had no significant medical history. Ultrasound at 22 gestational weeks showed a giant cystic-solid thoracic mass [32 mm×46 mm×61 mm; congenital pulmonary airway malformation volume ratio (CVR) 2.57], and the diagnosis was congenital cystic adenomatoid malformation complicated by intralobar pulmonary sequestration. After disease progression despite one course of antenatal corticosteroids (55 mm×47 mm×56 mm; CVR 3.33), ultrasound-guided percutaneous intrauterine laser ablation was performed at 24 +6 weeks to precisely coagulate the lesion's dominant feeding artery (confirmed by Doppler). Postoperatively, the mass showed progressive regression with normalized hemodynamic parameters. The infant was delivered vaginally at 37 weeks of gestation. The infant underwent resection of residual left lower lung lesions at five months of age, with normal cardiopulmonary function and developmental milestones confirmed at 15-month follow-up.

Objective:To construct a predictive model for hemorrhagic transformation (HT) after intravenous thrombolysis in elderly patients with acute cerebral infarction (ACI) using the Lasso-Logistic regression model, and to analyze the clinical utility of this predictive model.Methods:A total of 310 elderly ACI patients who received intravenous thrombolysis with alteplase (rt-PA) at the Beijing Rehabilitation Hospital Affiliated to Capital Medical University from May 2022 to May 2024 were selected. The occurrence of HT within 36 hours after intravenous thrombolysis was recorded, and the patients were divided into the HT group and non-HT group based on the presence or absence of HT. Clinical data were compared between the two groups. Lasso-Logistic regression analysis was used to screen the influencing factors of HT after intravenous thrombolysis in elderly ACI patients. A nomogram predictive model for HT after intravenous thrombolysis in elderly ACI patients was constructed based on these influencing factors, and the clinical value of the nomogram predictive model was analyzed.Results:The incidence of HT within 36 hours after rt-PA intravenous thrombolysis in elderly ACI patients was 29.35%(91/310). The proportions of patients with hypertension, diabetes, anticoagulant use, and atrial fibrillation in the HT group were higher than those in the non-HT group. The onset-to-thrombolysis time (ONT), admission National Institute of Health Stroke Scale (NIHSS) score, pre-thrombolysis peripheral blood platelet count, neutrophil-to-lymphocyte ratio (NLR), and serum levels of high-sensitivity C-reactive protein (hs-CRP), vascular endothelial cadherin (VE-cad), occludin, soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1), and endothelial cell-specific molecule 1 (ESM-1) in the HT group were higher than those in the non-HT group (all P<0.05). Lasso-Logistic regression analysis showed that atrial fibrillation, ONT, admission NIHSS score, pre-thrombolysis peripheral blood NLR, and serum levels of hs-CRP, VE-cad, occludin, sLOX-1, and ESM-1 were independent risk factors for HT after intravenous thrombolysis in elderly ACI patients (all P<0.05). The area under the curve (AUC) of the constructed nomogram predictive model for predicting HT after intravenous thrombolysis in elderly ACI patients was 0.914(95% CI: 0.879-0.949), indicating high predictive efficiency. When the threshold probability range was 0.05-0.83, the nomogram predictive model showed good net benefit in predicting HT after intravenous thrombolysis in elderly ACI patients and had high clinical utility in predicting the risk of HT. Conclusions:Atrial fibrillation, ONT, admission NIHSS score, pre-thrombolysis peripheral blood NLR, and serum levels of hs-CRP, VE-cad, occludin, sLOX-1, and ESM-1 are independent risk factors for HT after intravenous thrombolysis in elderly ACI patients. The nomogram predictive model constructed based on these factors has high predictive efficiency and clinical utility in predicting the risk of HT.

This report detailed a case of intrauterine intervention for fetal left-sided congenital cystic adenomatoid malformation with intralobar pulmonary sequestration. The mother had no significant medical history. Ultrasound at 22 gestational weeks showed a giant cystic-solid thoracic mass [32 mm×46 mm×61 mm; congenital pulmonary airway malformation volume ratio (CVR) 2.57], and the diagnosis was congenital cystic adenomatoid malformation complicated by intralobar pulmonary sequestration. After disease progression despite one course of antenatal corticosteroids (55 mm×47 mm×56 mm; CVR 3.33), ultrasound-guided percutaneous intrauterine laser ablation was performed at 24 +6 weeks to precisely coagulate the lesion's dominant feeding artery (confirmed by Doppler). Postoperatively, the mass showed progressive regression with normalized hemodynamic parameters. The infant was delivered vaginally at 37 weeks of gestation. The infant underwent resection of residual left lower lung lesions at five months of age, with normal cardiopulmonary function and developmental milestones confirmed at 15-month follow-up.

Objective:To summarize the clinical features of primary segmental volvulus (PSV) in neonates.Methods:A retrospective analysis was conducted on the clinical data of neonates with PSV who were admitted to the Department of Neonatal Surgery, Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2014 to May 2023. The clinical manifestations, auxiliary examinations, treatment and prognosis of the neonates were summarized, and descriptive statistical analysis was performed on the collected data.Results:A total of 10 neonates with PSV were included, with a mean gestational age of (34.1±3.0) weeks and birth weight of (2 291±646) g. Eight cases had an onset age of 3 d or less, and 2 cases had an onset age of more than 3 d. Abdominal distension was observed as the main manifestation in all cases, while bilious vomiting occurred in seven cases and hematochezia in five cases. Imaging examinations mainly revealed low intestinal obstruction without specific manifestations. Laboratory tests showed metabolic acidosis and varing degrees of anaemia. Nine cases underwent diagnostic abdominal puncture, of which five had bloody ascites, two had clear ascites, one had bloody mixed with fecal-like ascites, and one had chylous ascites. All the cases underwent emergency exploratory laparotomy and segmental small bowel resections with either primary intestinal anastomosis or enterostomy. All cases were successfully cured and had been followed up to the age of 4 months to 9 years with good growth and development as normal children of the same age.Conclusions:Neonatal PSV is an independent abdominal emergency characterized by non-specific clinical manifestations and difficult preoperative diagnosis, but the overall prognosis is favorable after active surgical treatment.

Objective:To analyze the changes and management in perioperative circulatory function in neonates with congenital diaphragmatic hernia (CDH).Methods:A retrospective analysis was conducted on 52 cases of CDH children who were prenatally consulted and postnatally intubated and transported to the Neonatal Surgery Department of Children's Hospital, Capital Institute of Pediatrics from May 2021 to May 2023. The cases were divided into a survival group (42 cases) and a death group (10 cases) based on perioperative mortality. General data, left ventricular ejection fraction (LVEF) and pulmonary hypertension (PH) grading at different times (on the day of birth and seven days post-birth), as well as vasoactive inotropic score (VIS), treprostinil dosage, and urine output within 48 h post-surgery, were analyzed. Statistical analyses were performed using independent sample t-tests, rank-sum tests, Chi-square tests (or Fisher's exact test), or Wilcoxon non-parametric rank-sum tests. Results:(1) The gestational age at the first detection of CDH in the death group was earlier than that in the survival group [(22.9±3.0) weeks vs. (26.3±4.7) weeks, t=－2.17], and the proportion of liver herniation was higher in the death group [6/10 vs. 14% (6/42), χ2=10.56] (both P<0.05). In the death group, six cases underwent surgery, while four cases had unstable vital signs and no surgical opportunity. The proportion of open surgery and the use of patches were higher in the death group than in the survival group [4/6 vs. 14% (6/42); 4/6 vs. 9% (4/42); Fisher's exact test, both P<0.05]. (2) Among the operated cases in the death group, the VIS and treprostinil dosage within 48 h post-surgery were higher than those in the survival group {22.5 points (13.0-36.6 points) vs. 13.0 points (11.5-26.3 points), Z=－2.54; 19.5 ng/(kg·min) [8.0-22.5 ng/(kg·min)] vs. 9.0 ng/(kg·min) [4.8-20.0 ng/(kg·min)], Z=－2.52}; and the urine output was less than that in the survival group {1.4 ml/(kg·h) [0.7-2.0 ml/(kg·h)] vs. 3.0 ml/(kg·h) [2.8-3.7 ml/(kg·h)], Z=－2.61, all P<0.05)}. The LVEF on the day of birth and at 7 days post-birth in the death group were lower than those in the survival group [(63.8±8.5)% vs. (68.7±5.5)%, t=－2.09; (58.0±10.8)% vs. (69.6±4.8)%, t=－4.69; P<0.05], and the proportion of moderate to severe PH was higher than that in the survival group [moderate and severe on the day of birth were 0/10 vs. 33.3% (14/42) and 10/10 vs. 61.9% (26/42), χ2=－2.31; at seven days post-birth were 1/10 vs. 26.2% (11/42) and 9/10 vs. 7.1% (3/42), χ2=4.82; all P<0.05]. Conclusion:Infants with CDH often have circulatory dysfunction after birth, with more severe dysfunction in critically ill CDH infants. The rational use of vasoactive drugs, combined control of persistent pulmonary hypertension of the newborn with multiple drugs, and reasonable volume control may help improve the circulatory function of infants with CDH.

Objective:To analyze the changes and management in perioperative circulatory function in neonates with congenital diaphragmatic hernia (CDH).Methods:A retrospective analysis was conducted on 52 cases of CDH children who were prenatally consulted and postnatally intubated and transported to the Neonatal Surgery Department of Children's Hospital, Capital Institute of Pediatrics from May 2021 to May 2023. The cases were divided into a survival group (42 cases) and a death group (10 cases) based on perioperative mortality. General data, left ventricular ejection fraction (LVEF) and pulmonary hypertension (PH) grading at different times (on the day of birth and seven days post-birth), as well as vasoactive inotropic score (VIS), treprostinil dosage, and urine output within 48 h post-surgery, were analyzed. Statistical analyses were performed using independent sample t-tests, rank-sum tests, Chi-square tests (or Fisher's exact test), or Wilcoxon non-parametric rank-sum tests. Results:(1) The gestational age at the first detection of CDH in the death group was earlier than that in the survival group [(22.9±3.0) weeks vs. (26.3±4.7) weeks, t=－2.17], and the proportion of liver herniation was higher in the death group [6/10 vs. 14% (6/42), χ2=10.56] (both P<0.05). In the death group, six cases underwent surgery, while four cases had unstable vital signs and no surgical opportunity. The proportion of open surgery and the use of patches were higher in the death group than in the survival group [4/6 vs. 14% (6/42); 4/6 vs. 9% (4/42); Fisher's exact test, both P<0.05]. (2) Among the operated cases in the death group, the VIS and treprostinil dosage within 48 h post-surgery were higher than those in the survival group {22.5 points (13.0-36.6 points) vs. 13.0 points (11.5-26.3 points), Z=－2.54; 19.5 ng/(kg·min) [8.0-22.5 ng/(kg·min)] vs. 9.0 ng/(kg·min) [4.8-20.0 ng/(kg·min)], Z=－2.52}; and the urine output was less than that in the survival group {1.4 ml/(kg·h) [0.7-2.0 ml/(kg·h)] vs. 3.0 ml/(kg·h) [2.8-3.7 ml/(kg·h)], Z=－2.61, all P<0.05)}. The LVEF on the day of birth and at 7 days post-birth in the death group were lower than those in the survival group [(63.8±8.5)% vs. (68.7±5.5)%, t=－2.09; (58.0±10.8)% vs. (69.6±4.8)%, t=－4.69; P<0.05], and the proportion of moderate to severe PH was higher than that in the survival group [moderate and severe on the day of birth were 0/10 vs. 33.3% (14/42) and 10/10 vs. 61.9% (26/42), χ2=－2.31; at seven days post-birth were 1/10 vs. 26.2% (11/42) and 9/10 vs. 7.1% (3/42), χ2=4.82; all P<0.05]. Conclusion:Infants with CDH often have circulatory dysfunction after birth, with more severe dysfunction in critically ill CDH infants. The rational use of vasoactive drugs, combined control of persistent pulmonary hypertension of the newborn with multiple drugs, and reasonable volume control may help improve the circulatory function of infants with CDH.

Objective:To explore the effects of different approaches for second-trimester multifetal pregnancy reduction on pregnancy outcome in women with dichorionic triamniotic (DCTA) triplet.Methods:A retrospective study was performed on 51 women with DCTA triplet pregnancies who were referred to Guangdong Women and Children Hospital for second-trimester multifetal pregnancy reduction from January 2014 to January 2020. All participants were divided into either preventive group ( n=39) or treatment group ( n=12) according to the indication for multifetal pregnancy reduction, and they were further allocated to three subgroups based on different reduction methods, which were reduction to dichorionic twin by radiofrequency ablation (RFA) (RFA subgroup), reduction to monochorionic singleton (KCl-singleton subgroup) or monochorionic twin (KCl-twin subgroup) by cardiac injection of potassium chloride. Pregnancy loss rate, neonatal birth weight, gestational age at delivery, incidence of intrauterine death, and neonatal death were compared and analyzed between different groups using t-test, analysis of variance, Chi-square test, Fisher's exact test and Bonferroni correction. Results:(1) The mean gestational week at operation in the treatment group was significantly later than that in the preventive group [(18.5±3.1) vs (15.0±2.3) weeks, t=-4.209, P<0.001]. In the preventive group, the mean gestational week at operation in the RFA subgroup was later than the KCl-singleton and KCl-twin subgroup[(17.2±1.6) vs (13.8±1.5) and (12.7±1.0) weeks, t=6.630 and 3.875, respectively, both P<0.05]. (2) The postoperative pregnancy loss rate in the preventive group was decreased compared with the treatment group [10.3%(4/39) vs 5/12, Fisher's exact test, P<0.05], and the live birth ratio was increased [ 85.7%(48/56) vs 10/18, χ2=5.640, P=0.018]. No live birth infants with birth weight <1 500 g was reported in the KCl-singleton subgroup in preventive group, and the statistical significance was observed in the intra-group differences ( P<0.05) rather than the pairwise comparison differences in the preventive group. For the proportion of live births, there was a statistically significant difference in the intra-group comparison in the treatment group, which was higher in the RFA subgroup than that in the KCl-twin subgroup (6/6 vs 1/6, P=0.045). No significant difference was revealed among pregnancy loss rate, gestational weeks at delivery, the mean birth weight, premature delivery <32 gestational weeks, and full-term birth rate among three different approaches within the two groups. (3) No monochorionic twin complications or perinatal death occurred in any RFA or KCl-singleton subgroups in the two groups. In the KCl-twin subgroups including five cases with ten fetuses, including three live birth, four miscarriage, three intrauterine death occured, while no neonatal death was reported. One case with selective fetal uterine growth restriction in the preventive group delivered two live births, and one case with twin-to-twin transfusion syndrome in the treatment group had intrauterine death in one fetus and one survival neonate. Conclusions:The pregnancy outcome of multifetal pregnancy reduction to dichorionic diamniotic twins by RFA or reduction to singleton by cardiac injection of potassium chloride are comparative in women with DCTA triplet, regardless of whether it is a preventive or therapeutic reduction.

AIM: To observe the effect of acute normovolemic hemodilution (ANH) autologous blood transfusion on the EEG bispectral index and muscle relaxation in elderly patients undergoing orthopedic surgery to explore the influence of autologous blood transfusion containing anesthetic components on the quality and safety of postoperative anesthesia recovery. METHODS: Forty patients, aged 65-75, weighing 55-80 kg, ASA grade I-II, with an estimated intraoperative blood loss of more than 600 mL, were selected for elective orthopedic surgery. The patients were randomly divided into two groups (n=20): group A was given acute normovolemic hemodilution (ANH), and the target value of Hct was 28%-30% after induction of anesthesia; group B was the control group which was given routine fluid infusion during operation without ANH. Bispectral index (BIS), TOF values and plasma concentrations of propofol and cisatracurium were measured at the beginning of autotransfusion (T