ObjectiveTo systematically evaluate the effect of intermittent theta burst stimulation (iTBS) on lower extremity motor function and balance function in patients with stroke. MethodsA systematic literature search was conducted in the Cochrane Library, Embase, PubMed, Web of Science, CNKI, SinoMed, Wanfang data and VIP from inception to February 19, 2025. Randomized controlled trials comparing iTBS with conventional rehabilitation or sham iTBS in patients with post-stroke lower extremity motor and balance dysfunction were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using RevMan 5.4 and Stata 14.0. ResultsA total of 16 articles involving 647 patients were included. Meta-analysis showed that iTBS improved the Fugl-Meyer Assessment-Lower Extremities score (MD = 2.58, 95%CI 1.61 to 3.55, P < 0.001), Berg Balance Scale score (MD = 4.11, 95%CI 2.43 to 5.79, P < 0.001), Barthel Index score (MD = 4.95, 95%CI 0.97 to 8.92, P = 0.010) and motor-evoked potential (MEP) latency (MD = -1.42, 95%CI -2.54 to -0.30, P = 0.010). Subgroup analyses suggested that at subacute stage, cerebellar iTBS, more than ten treatment sessions, and 1 200 pulses per day may be more effective. ConclusioniTBS may improve lower extremity motor function and activities of daily living in patients with stroke, and shorten MEP latency, and it may also confer potential benefits in improving balance function in these patients.

ObjectiveTo investigate the mechanism of ferroptosis mediated by long-chain acyl-CoA synthetase 4 （ACSL4） signalling pathway in rats with coronary heart disease with blood stasis syndrome and the intervention effect of Xuefu Zhuyutang. MethodsSPF male SD rats were randomly divided into normal group， sham-operation group， model group， trimetazidine group （5.4 mg·kg^-1）， low-， medium-， and high-dose group （3.51， 7.02，14.04 g·kg^-1） of Xuefu Zhuyutang. The coronary artery left anterior descending ligation method was used to prepare a model of coronary heart disease with blood stasis syndrome， and continuous treatment for 7 d was conducted， while the sham-operation group was only threaded and not ligated. The general macroscopic symptoms of the rats were observed， and indicators such as electrocardiogram， echocardiography， and blood rheology were detected. The pathological morphology of myocardial tissue was observed by hematoxylin-eosin （HE） staining， and the changes in mitochondria in myocardial tissue were observed by transmission electron microscopy. The level of iron deposition in myocardial tissue was observed by Prussian blue staining. The levels of 12-hydroxyeicosatetraenoic acid （12-HETE） and 15-HETE were detected in serum by enzyme-linked immunosorbent assay. A biochemical colourimetric assay was used to detect the levels of Fe²⁺， lipid peroxidation （LPO）， glutathione （GSH）， and T-GSH/glutathione disulfide （GSSG） in myocardial tissue. DCFH-DA fluorescence quantitative assay was employed to detect the levels of reactive oxygen species （ROS）. Western blot and Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was adopted to detect the protein and mRNA expressions of glutathione peroxidase 4 （GPX4）， ferritin heavy chain 1 （FTH1）， ACSL4， and ly-sophosphatidylcholine acyltransferase3 （LPCAT3） in myocardial tissue. ResultsCompared with those in the normal group， the rats in the model group were poor in general macroscopic symptoms. The electrocardiogram showed widened QRS wave amplitude and increased voltage， bow-back elevation of the ST segments， elevated T waves， J-point elevation， and accelerated heart rate. Echocardiography showed a significant reduction in left ventricular ejection fraction （LVEF） and left ventricular fraction shortening （LVFS） （P<0.01）. Blood rheology showed that the viscosity of the whole blood （low， medium， and high rate of shear） was significantly increased （P<0.01）. HE staining showed an abnormal structure of myocardial tissue. There was a large area of myocardial necrosis and inflammatory cell infiltration and a large number of connective tissue between myocardial fibers. Transmission electron microscopy showed that the mitochondria were severely atrophy or swelling. The cristae were reduced or even broken， and the matrix was flocculent or even vacuolated. Prussian blue staining showed that there were a large number of iron-containing particles， and the iron deposition was obvious. The content of 12-HETE and 15-HETE in the serum was significantly increased （P<0.01）. The content of Fe²⁺， LPO， and ROS in myocardial tissue was significantly increased （P<0.01）. The content of GSH was significantly decreased （P<0.01）， and T-GSH/GSSG was decreased （P<0.01）. The protein and mRNA expressions of GPX4 and FTH1 in myocardial tissue were both significantly decreased （P<0.05， P<0.01）， while those of ACSL4 and LPCAT3 increased significantly （P<0.01）. Compared with the model group， the general macroscopic symptoms and electrocardiogram results of rats in low-， medium- and high-dose groups of Xuefu Zhuyutang were alleviated， and the differences in LVEF/LVFS ratios were all significantly increased （P<0.05， P<0.01）. The differences in whole-blood viscosity （low， medium， and high rate of shear） were all significantly decreased （P<0.01）. The results of HE staining and transmission electron microscopy showed that the morphology， structure， and mitochondria of cardiomyocytes were improved. The content of 12-HETE and 15-HETE in serum was reduced to different degrees in low-， medium-， and high-dose groups of Xuefu Zhuyutang （P<0.05， P<0.01）. The content of Fe²⁺， LPO， and ROS was significantly reduced in the medium- and high-dose groups of Xuefu Zhuyutang （P<0.05， P<0.01）， and the content of GSH and T-GSH/GSSG was significantly increased （P<0.05， P<0.01）. The protein and mRNA expressions of GPX4 and FTH1 were significantly increased to varying degrees in the medium- and high-dose groups of Xuefu Zhuyutang （P<0.05， P<0.01）， and ACSL4 and LPCAT3 were decreased to different degrees in the low-， medium-， and high-dose groups of Xuefu Zhuyutang （P<0.05， P<0.01）. ConclusionXuefu Zhuyutang can regulate iron metabolism and anti-lipid oxidation reaction to mediate ferroptosis through the ACSL4 signalling pathway， thus exerting a protective effect on rats with coronary heart disease with blood stasis syndrome.

BACKGROUND: Peripheral helper T (T PH ) cells are uniquely positioned within pathologically inflamed non-lymphoid tissues to stimulate B-cell responses and antibody production. However, the phenotype, function, and clinical relevance of T PH cells in hepatocellular carcinoma (HCC) are currently unknown. METHODS: Blood, tumor, and peritumoral liver tissue samples from 39 HCC patients (Sep 2016-Aug 2017) and 101 HCC patients (Sep 2011-Dec 2012) at the Third Affiliated Hospital of Sun Yat-sen University were used. Flow cytometry was used to quantify the expression, phenotype, and function of T PH cells. Log-rank tests were performed to evaluate disease-free survival and overall survival in samples from 39 patients and 101 patients with HCC. T PH cells, CD19 + B cells, and T follicular helper (T FH ) cells were cultured separately in vitro or isolated from C57/B6L mice in vivo for functional assays. RESULTS: T PH cells highly infiltrated tumor tissues, which was correlated with tumor size, early recurrence, and shorter survival time. The tumor-infiltrated T PH cells showed a unique ICOS hi CXCL13 + IL-21 - MAF + BCL-6 - phenotype and triggered naïve B-cell differentiation into regulatory B cells. Triggering programmed cell death protein 1 (PD-1) induced the production of C-X-C motif chemokine ligand 13 (CXCL13) by T PH cells, which then suppressed tumor-specific immunity and promoted disease progression. CONCLUSION Our study reveals a novel regulatory mechanism of T PH cell-regulatory B-cell-mediated immunosuppression and provides an important perspective for determining the balance between the differentiation of protumorigenic T PH cells and that of antitumorigenic T FH cells in the HCC microenvironment.
Carcinoma, Hepatocellular/metabolism* ; Liver Neoplasms/metabolism* ; Humans ; T-Lymphocytes, Helper-Inducer/metabolism* ; Animals ; Mice ; Male ; Female ; Mice, Inbred C57BL ; Middle Aged ; B-Lymphocytes, Regulatory/metabolism* ; Flow Cytometry ; Interleukin-21 ; Aged ; Chemokine CXCL13/metabolism*

Objective:To explore the symptoms of Ménière′s disease patients and their impact on quality of life.Methods:A cross-sectional study was conducted, consecutively enrolling patients of Ménière′s disease who visited the Otolaryngology Clinic at the Eye & ENT Hospital of Fudan University from October 2014 to December 2022. The Chinese version of the Ménière′s Disease Outcomes Questionnaire (MDOQ) and a Ménière′s disease-specific symptom checklist were utilized for assessment. SPSS 25.0 software was employed to perform multiple linear regression analysis to determine the impact of Ménière′s disease symptoms on patients′ quality of life.Results:A total of 790 patients with a definitive diagnosis of Ménière′s disease who met the inclusion and exclusion criteria were analyzed. The cohort comprised 418 males and 372 females, with a mean age of (54.8±13.1) years and a diagnosis duration ranging from 0 to 72 months, with a median of 3 months. The total score of the Chinese MDOQ was 61.0±12.0. The symptomatic presentations of the enrolled patients included hearing changes, tinnitus, aural fullness, drop attacks, vertigo episodes, visual instability, dizziness, and headache. Multiple linear regression analysis revealed that age, tinnitus, aural fullness, frequency of drop attacks, visual instability, dizziness, and headache were significant factors affecting the quality of life in Ménière′s disease patients ( F=145.50, P<0.05). Conclusions:The quality of life in Ménière′s disease patients requires improvement. Attention to the specific symptoms of Ménière′s disease and their impact on patients′ quality of life, along with targeted symptom interventions based on these findings, will be a focal point in future disease management.

AIM:Xiongshi Shiwei Wendan decoc-tion(SWD)comes from Xiong Jibai,a master of tra-ditional Chinese medicine,and has been widely used in the treatment of AS.ABCA1 is an important pathway for macrophages to export cholesterol and plays a protective role in the occurrence and development of AS.The purpose of this study was to study the effects of SWD on ABCA1 expression and cholesterol efflux through network pharmacol-ogy,molecular docking and in vitro experiments,and explore the pathway mechanism of promoting reverse cholesterol transport(RCT).METHODS:The active components of SWD drugs were screened by TCMSP and HERB databases,RCT targets were pre-dicted,the component-target network map was constructed,the PPI network was constructed and the GO and KEGG pathways were enriched and ana-lyzed by STRING database,and the key active com-ponents of SWD were selected for molecular dock-ing with ABCA1 protein and miR-33 by AutoDockVi-na.In vitro,RAW264.7 was used to establish foam cell model,oil red O staining,NBD-cholesterol staining and lentivirus overexpression cell miRNA-33 were used to study the effect of SWD on lipid accumulation and cholesterol outflow rate of RAW264.7 cells.Western blotting was used to de-tect the expression of ABCA1.RESULTS:According to network pharmacology,336 active components of SWD,267 targets of RCT and 46 targets of inter-section of RCT and SWD were obtained,which in-volved multiple signal pathways such as lipid and atherosclerosis.Molecular docking showed that the main active components had stable conforma-tion with ABCA1 and miR-33.In vitro experiment,it was found that the lipid content was significantly decreased(P＜0.01),the cholesterol outflow rate was significantly increased(P＜0.01)and the expres-sion of ABCA1 protein was up-regulated in SWD group(P＜0.01),but the expression of ABCA1 in miR-33 overexpression group was significantly de-creased(P＜0.01).CONCLUSION:SWD has the char-acteristics of multi-components and multi-targets,which can promote RCT and treat AS through miR-NA-33-ABCA1 pathway.

Objective To explore the value of the corrected-size ratio(c-SR)value of intracranial volume computed tomography angiography(CTA)in predicting the risk of intracranial aneurysm rupture.Methods A total of 81 patients with aneurysms who had follow-up records were selected.Among them,39 patients with unruptured aneurysms and underwent regular follow-ups,while 9 patients with unruptured aneurysms opted for surgical intervention.Additionally,surgery was performed on 33 patients with ruptured aneu-rysms.Three-dimensional reconstruction of CTA was performed to obtain the morphological parameters of aneurysms.The initial size ratio(SR)value of aneurysm and the follow-up SR value or postoperative c-SR value were obtained.The changes in SR values of unruptured aneurysms were analyzed,the preoperative SR values and postoperative c-SR values of aneurysms were analyzed.Finally,the correla-tion between the intial SR value of unruptured aneurysms and the c-SR value of ruptured aneurysms was compared.Results No sig-nificant difference was observed between the initial SR value of unruptured aneurysms and the follow-up SR value(P>0.05).Simi-larly,no significant difference was noted between the preoperative SR value of unruptured aneurysms and the postoperative c-SR value(P>0.05).The preoperative SR value of ruptured aneurysms differed significantly from the postoperative c-SR value(P<0.05).There was a significant difference between the initial SR value of unruptured aneurysms and the postoperative c-SR value of ruptured aneurysms(P<0.05).The receiver operating characteristic(ROC)curve analysis was performed on the initial SR value of unrup-tured aneurysms and the postoperative c-SR value of ruptured aneurysms.The area under the curve(AUC)was 0.860 and the best cut-off value was 1.045.Conclusion Unruptured aneurysms remain stable for an extended period of time,exhibiting no significant change in morphological parameters.It can be concluded that surgical intervention does not affect the SR value of aneurysms.In the case of subarachnoid hemorrhage caused by ruptured aneurysms,the parent artery become thinner,then the preoperative SR value of ruptured aneurysms may be exaggerated,which results in the distortion of the preoperative SR value of ruptured aneurysms.However,the postoperative c-SR value is the true SR value before the rup-ture of aneurysms.

Objective:To explore the relationship between gallbladder polyps and colorectal polyps, providing insights into whether the presence of gallbladder polyps can serve as an indicator for colonoscopy screening.Methods:Clinical data from 2 542 patients who underwent colonoscopy and abdominal ultrasound at the First Affiliated Hospital of Shihezi University between January and December 2022 were retrospectively analyzed. Patients were divided into colorectal polyp group ( n=1 266) and non-colorectal polyp group ( n=1 276) based on colonoscopy findings. Univariate and multivariate Logistic regression models were used to analyze the relationship between gallbladder polyps and colorectal polyps. Results:The prevalence rates of gallbladder polyp in colorectal polyp group and non-colorectal polyp group were 16.67% (211/1 266) and 11.21% (143/1 276). Multivariate Logistic regression analysis showed a lower risk of colorectal polyps in women ( P<0.001, OR=0.523, 95% CI: 0.440-0.622). Age ( P<0.001, OR=1.059, 95% CI: 1.050-1.068), and hypertriglyceridemia ( P=0.013, OR=1.350, 95% CI: 1.066-1.709), low level of high-density lipoprotein ( P<0.001, OR=1.588, 95% CI: 1.280-1.969), and gallbladder polyp ( P<0.001, OR=1.712, 95% CI: 1.344-2.180) were independent risk factors for colorectal polyp. There was no significant difference in hypercholesterolemia, elevated low-density lipoprotein, hyperuricemia, or cholecystectomy between colorectal polyp group and non-colorectal polyp group ( P>0.05). Conclusion:The identification of gallbladder polyps via abdominal ultrasound may indicate a higher likelihood of colorectal polyps in patients, underscoring the need for further colonoscopy screening in individuals with gallbladder polyps.

Objective To develop a risk prediction model for ischemic stroke in symptomatic intracranial atherosclerotic stenosis(ICAS)patients based on high-resolution magnetic resonance imaging(HR-MRI)and arterial spin labeling(ASL)imaging.Methods A total of 142 patients were included and divided into acute ischemic stroke(AIS)and transient ischemic attack(TIA)groups based on stroke occurrence.Clinical risk factors,plaque characteristics,and arterial transit artifact(ATA)presence on ASL images were compared between the two groups.Multivariate logistic regression analysis was performed,incorporating clinical risk factors,plaque characteristics,and double post labeling delay(PLD)ATA presence.The predictive value of different models was compared using receiver operating characteristic(ROC)curve and DeLong tests.Results Hypertension,positive lumen remodeling,plaque enhance-ment rate,1.5 s-ATA presence,and 2.5 s-ATA presence were independent risk factors for AIS(P＜0.05).The combination of HR-MRI and ASL imaging predicted AIS most effectively[area under the curve(AUC)=0.908;95％ confidence interval(CI)0.862-0.954].No significant difference was found between the prediction performances of HR-MRI and ASL(95％CI-0.041-0.082,Z=0.659,P=0.509).Conclusion ASL is more convenient than HR-MRI for predicting ischemic stroke in ICAS patients.A model combining plaque characteristics and ATA presence effectively predicts AIS occurrence.

Gastric cancer (GC) is characterized by high morbidity and mortality rates. Chinese agarwood comprises the resin-containing wood of Aquilaria sinensis (Lour.) Gilg., traditionally utilized for treating asthma, cardiac ischemia, and tumors. However, comprehensive research regarding its anti-GC effects and underlying mechanisms remains limited. In this study, Chinese agarwood petroleum ether extract (CAPEE) demonstrated potent cytotoxicity against human GC cells, with half maximal inhibitory concentration (IC₅₀) values for AGS, HGC27, and MGC803 cells of 2.89, 2.46, and 2.37 μg·mL^-1, respectively, at 48 h. CAPEE significantly induced apoptosis in these GC cells, with B-cell lymphoma-2 (BCL-2) associated X protein (BAX)/BCL-2 antagonist killer 1 (BAK) likely mediating CAPEE-induced apoptosis. Furthermore, CAPEE induced G₀/G₁ phase cell cycle arrest in human GC cells via activation of the deoxyribonucleic acid (DNA) damage-p21-cyclin D1/cyclin-dependent kinase 4 (CDK4) signaling axis, and increased Fe²⁺, lipid peroxides and reactive oxygen species (ROS) levels, thereby inducing ferroptosis. Ribonucleic acid (RNA) sequencing, real-time quantitative polymerase chain reaction (RT-qPCR), and Western blotting analyses revealed CAPEE-mediated upregulation of heme oxygenase-1 (HO-1) in human GC cells. RNA interference studies demonstrated that HO-1 knockdown reduced CAPEE sensitivity and inhibited CAPEE-induced ferroptosis in human GC cells. Additionally, CAPEE administration exhibited robust in vivo anti-GC activity without significant toxicity in nude mice while inhibiting tumor cell growth and promoting apoptosis in tumor tissues. These findings indicate that CAPEE suppresses human GC cell growth through upregulation of the DNA damage-p21-cyclin D1/CDK4 signaling axis and HO-1-mediated ferroptosis, suggesting its potential as a candidate drug for GC treatment.
Animals ; Humans ; Mice ; Antineoplastic Agents, Phytogenic ; Apoptosis/drug effects* ; Cell Line, Tumor ; Cyclin D1/genetics* ; Cyclin-Dependent Kinase 4/genetics* ; DNA Damage/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Ferroptosis/drug effects* ; G1 Phase Cell Cycle Checkpoints/drug effects* ; Heme Oxygenase-1/genetics* ; Mice, Inbred BALB C ; Mice, Nude ; Plant Extracts/pharmacology* ; Stomach Neoplasms/physiopathology* ; Thymelaeaceae/chemistry* ; Up-Regulation/drug effects*

Objective:To analyze the impact of occupational health management assistance for small and micro enterprises in Suzhou on employers, exploring the assistance model for occupational health management in small and micro enterprises.Methods:From 2020 to 2022, a total of 318 small and micro enterprises with serious occupational disease hazards, weak occupational health management, and strong subjective improvement were selected as assistance objects annually by means of territorial recommendation and active registration of employers. The basic information of the enterprise and the status of occupational health management were obtained by means of questionnaire survey, archives review, workplace field investigation and occupational disease hazard factors detection. Pearson χ2 test was used to analyze the changes of occupational health management before and after helping enterprises. Results:The small and micro enterprises receiving assistance were mainly private enterprises (51.26%, 163/318) and limited liability companies (27.99%, 89/318). The occupational health training rates for enterprise leaders, management personnel, and workers increased from 77.36% (246/318), 82.08% (261/318) and 72.44% (4554/6287) before assistance to 90.57% (288/318), 95.28% (303/318) and 94.40% (5905/6255), the differences were statistically significant ( χ2=20.60, 27.63, 1092.67, all P<0.001). After the assistance, the distribution and wearing of personal protective equipment for workers, the detection of occupational hazard factors in the workplace and occupational health examination by enterprises increased by 3.34%, 18.39%, 13.21% and 15.10%, respectively. In terms of occupational health management, the comprehensive establishment rate of occupational health management system increased from 21.70% (69/318) before assistance to 64.47% (205/318). Compared with before assistance, the comprehensive notification rate/setting rate of warning signs and notification cards, labor contracts for occupational disease hazard positions, occupational health bulletin boards, and occupational health examination results were significantly increased after assistance ( χ2=120.08, 77.40, 149.18, 86.76, all P<0.001) . Conclusion:Suzhou adopts a model led by the health administrative department and supported by technical support from service institutions to assist small and micro enterprises, resulting in a significant improvement in the occupational health management level of small and micro enterprises.