ObjectiveThis study aims to explore the mechanism by which Yishen Huoxue Tongqiao Formula improves metabolism-neuroplasticity and treats unilateral vestibular labyrinth destruction by regulating the metabolic balance of glutamate （Glu）/γ-aminobutyric acid （GABA）. Methods48 Sprague-Dawley （SD） adult rats were randomly divided into the sham operation group， model group， Yishen Huoxue Tongqiao Formula groups with low， medium， and high doses （9.20， 18.39， 36.78 g·kg^-1）， and betahistine group （1.62 mg·kg^-1）. A unilateral vestibular labyrinth destruction （vestibular dysfunction） model was established by intratympanic injection of chloroform into the right ear， while the control group received intratympanic injection of normal saline. Drugs were administered once daily for seven consecutive days. During the period， behavioral tests were performed to evaluate the behaviors of rats after unilateral vestibular labyrinth destruction. Hematoxylin-eosin （HE） staining and Nissl staining were used to observe the neuronal morphology in the medial vestibular nucleus. Golgi staining was employed to assess the number of dendritic spines of neurons in the medial vestibular nucleus. Ultra-performance liquid chromatography-tandem mass spectrometry （LC-ESI-MS/MS） was utilized to detect Glu/GABA. Immunofluorescence and immunohistochemistry were used to detect the expressions of neuronal nuclei （NeuN）， growth-associated protein 43 （GAP-43）， and glial fibrillary acidic protein （GFAP）. Western blot and real-time fluorescent quantitative polymerase chain reaction （Real-time PCR） were applied to determine the expressions of glutamate-immunoreactive （Glu-IR）， GABA， GFAP， postsynaptic density protein 95 （PSD-95）， and GAP-43. ResultsCompared with the sham operation group， the model group presented with head deviation， balance disorder， increased tail suspension score， nuclear consolidation of medial vestibular nerve neurons， and decreased Nissl bodies （P<0.01）. The number of dendritic spines in neurons and NeuN-positive cells decreased. The content of Glu decreased. The content of GABA increased （Glu/GABA decreased）. The expression of GAP-43 was down-regulated， and GFAP was up-regulated （P<0.05， P<0.01）. The expressions of Glu-IR， PSD-95， and GAP-43 proteins， as well as Glu-IR mRNA decreased， while the expressions of GABA and GFAP proteins and mRNA increased （P<0.05， P<0.01）. Compared with those in the model group， the head deviation， imbalanced behavior， and tail suspension scores in each treatment group decreased， with alleviated neuronal injury and recovered Nissl bodies （P<0.01）. The number of dendritic spines of neurons increased， and the number of NeuN-positive cells rebounded. The content of Glu increased， and the content of GABA decreased （Glu/GABA increased）. GFAP was down-regulated， and GAP-43 was up-regulated （P<0.05， P<0.01）. The expressions of Glu-IR， PMD-95， and GAP-43 proteins， as well as Glu-IR mRNA increased， while the expressions of GABA and GFAP proteins and mRNA decreased. The effect was more significant in the high-dose group （P<0.01）. ConclusionThe Yishen Huoxue Tongqiao Formula can alleviate vestibular dysfunction， and its mechanism may be associated with regulating the metabolic balance of Glu/GABA， mitigating neural damage， improving synaptic plasticity （promoting GAP-43 expression and inhibiting GFAP expression）， and facilitating vestibular compensation.

Introduction: Prediabetes or intermediate hyperglycemia (IH) represents a critical phase in the trajectory toward type 2 diabetes mellitus (T2DM). Recent evidence from the International Diabetes Federation (IDF) suggests that 1-hour OGTT (1HOGTT) ≥8.6 mmol/L is a more sensitive biomarker for early beta-cell dysfunction, with enhanced detection of IH and future T2DM risk. Conventional screening using hemoglobin A1c (HbA1c) or 2-Hour OGTT (2HOGTT) may delay identification of prediabetes, narrowing the window for early intervention. This study evaluates 1HOGTT as a screening tool for prediabetes among Malaysians. Methodology: This cross-sectional study enrolled adults without prior T2DM or prediabetes. Participants underwent 1HOGTT, 2HOGTT, and HbA1c, classified as per the Malaysian Clinical Practice Guideline for T2DM (6th Edition) and IDF 2024 criteria. Agreement between tests was assessed using McNemar’s test and Cohen’s kappa. Diagnostic accuracy was evaluated via receiver operating characteristic (ROC) curve analysis. Cost-effectiveness was determined using reagent cost only. Results: The majority of the 310 participants were female (71.6%), Malay (87.1%), with average age of 40. The 1HOGTT identified prediabetes in 21.6% (n = 67) compared to 17.1% (n = 53) by HbA1c and 2.6% (n = 8) by 2HOGTT. McNemar’s test confirmed statistically significant discordance between 1HOGTT and 2HOGTT (chi-square = 53.397, p <0.001): 61 participants were prediabetic by 1HOGTT but normal by 2HOGTT, versus only 2 in the reverse direction. No significant discordance was found between 1HOGTT and HbA1c (chi-square = 2.817, p = 0.093). 1HOGTT demonstrated excellent discriminatory ability against 2HOGTT (AUC = 0.908; 95% CI: 0.837–0.978), significantly outperforming HbA1c (AUC = 0.664; CI: 0.462– 0.867; DeLong p = 0.012). In a population-level cost analysis, 1HOGTT achieved lowest cost per prediabetes case detected (RM 5.79) – approximately 8.3 times and 8.1 times more cost-effective than 2HOGTT (RM 48.08) and HbA1c (RM 46.78) respectively. Conclusion 1HOGTT identifies a significant proportion of individuals with prediabetes missed by 2HOGTT and HbA1c. Incorporating 1HOGTT enhances the detection of prediabetes, is cost-effective, and enables timely preventive measures in our population with high diabetes burden.
Glucose Tolerance Test ; Glycated Hemoglobin ; Prediabetic State

Introduction: Accurate preoperative localization is essential for the surgical management of primary hyperparathyroidism (PHPT). Although ultrasound, technetium-99m sestamibi scintigraphy, and 4D-CT provide high localization rates, a subset of patients have non-localizing or discordant imaging. Selective parathyroid venous sampling (PVS) is an invasive adjunct that measures regional parathyroid hormone (PTH) gradients to aid localization in challenging cases. We present a threepatient case series demonstrating the utility of PVS in diagnostically complex PHPT. Cases: We retrospectively reviewed three female patients (ages 44–63) with biochemically confirmed PHPT who underwent selective PVS following negative or discordant imaging. Venous sampling was performed via femoral access with catheterization of bilateral internal jugular, brachiocephalic, and bilateral thyroidal veins. PTH levels were measured at each site and compared to peripheral levels to identify regional gradients. Surgical findings, intraoperative parathyroid hormone monitoring (IOPTH), histopathology, and postoperative biochemical outcomes were recorded. All patients had non-localizing or discordant preoperative imaging (USG, sestamibi, 4D-CT). PVS identified significant PTH gradients, guiding focused parathyroidectomy. IOPTH monitoring confirmed successful excision in all operated patients. Histopathology confirmed parathyroid adenoma in two cases; in the third case, the parathyroid tissue was identified within the thyroid gland. Postoperative PTH levels suppressed (range 0.79–1.48 pg/mL) in keeping with successful parathyroidectomy. Conclusion PVS effectively lateralized disease in imaging-negative PHPT and directly guided surgical management. When conventional imaging fails, PVS combined with intraoperative PTH monitoring enables targeted surgery and favorable biochemical outcomes.
Humans

Introduction: Hemorrhagic suprarenal masses presenting with hypertensive emergency pose a significant diagnostic challenge, particularly when biochemical and radiological findings are inconclusive. The clinical presentation may mimic catecholamine-secreting tumors, necessitating consideration of a broad differential diagnosis, including pheochromocytoma, adrenocortical carcinoma, retroperitoneal hemorrhage, and hematological-related extramedullary lesions. Accurate diagnosis is essential, as management strategies differ significantly. Case: We report a 48-year-old male smoker with no known prior medical illness who presented with sudden left-sided chest pain radiating to the epigastrium, associated with vomiting. On arrival, he was markedly hypertensive (207/131 mmHg). He reported a 1-year history of paroxysmal palpitations, headaches, migraines, and intermittent diaphoresis. Computed tomography angiography excluded aortic dissection but demonstrated a left retroperitoneal hemorrhage with non-visualization of the adrenal gland, suggestive of adrenal or tumor-related hemorrhage. He was initially managed empirically as a pheochromocytoma while undergoing biochemical evaluation; however, urinary metanephrines were only mildly elevated. Repeat imaging demonstrated interval enlargement of a non-enhancing suprarenal mass, raising concern for tumor-related hemorrhage. Subsequent ultrasonography, however, favored a liquefied hematoma, and percutaneous drainage yielded 750 mL of sanguineous fluid, resulting in marked clinical improvement. Notably, an elevated hematocrit prompted further evaluation for erythrocytosis. Subsequent testing confirmed JAK2 mutation-positive polycythemia rubra vera, providing a unifying explanation for both the erythrocytosis and spontaneous adrenal hemorrhage. The patient was commenced on hydroxyurea and referred for hematology follow-up. Conclusion Adrenal hemorrhage may closely mimic pheochromocytoma in hypertensive emergencies. A systematic, multidisciplinary approach integrating clinical, biochemical, and imaging findings is essential to avoid misdiagnosis and guide appropriate management, particularly in patients with underlying hematological disorders.
Hypertensive Crisis ; Pheochromocytoma ; Polycythemia Vera ; Hematoma

Introduction: Primary adrenal lymphoma (PAL) is a rare extranodal lymphoma, accounting for less than 1% of cases. It often presents with non-specific constitutional symptoms and features of adrenal insufficiency. The absence of pathognomonic findings frequently leads to delayed diagnosis, by which time the disease is often advanced, contributing to poor prognosis. Case: A 59-year-old male with type 2 diabetes mellitus and previously treated pulmonary tuberculosis presented with 1 month of lethargy, anorexia, weight loss, and abdominal pain. He was cachectic but hemodynamically stable (BP 120/81 mmHg; glucose 5.1 mmol/L), with otherwise unremarkable systemic examination. Laboratory evaluation revealed hyponatremia (120 mmol/L), hyperkalemia (6.0 mmol/L), and severe hypercalcemia (4.4 mmol/L). A short Synacthen test confirmed adrenal insufficiency. Computed tomography demonstrated marked bilateral adrenal enlargement with bulky masses (8.9 × 8.7 × 8.7 cm right; 9.9 × 7.6 × 10.2 cm left), suggestive of malignant infiltration. Adrenal protocol imaging revealed indeterminate lesions with attenuation >40 Hounsfield Unit and relative washout <40%. Ultrasound-guided biopsy of the right adrenal gland was performed. The patient was discharged on hydrocortisone replacement with plans for early follow-up. One week later, he presented again in adrenal crisis with severe hypoglycemia (1.1 mmol/L) and cardiovascular collapse. Despite resuscitative efforts, he succumbed. Histopathology subsequently confirmed diffuse large B-cell lymphoma, activated B-cell subtype, consistent with PAL. Conclusion This case highlights the diagnostic pitfalls of PAL, particularly when constitutional symptoms mimic chronic infections such as tuberculosis. It underscores the need for high clinical suspicion in patients with bilateral adrenal masses and adrenal insufficiency. Early recognition, adequate steroid replacement including mineralocorticoid therapy, and prompt tissue diagnosis are critical to prevent rapid deterioration and improve outcomes.
Lymphoma

OBJECTIVE To evaluate the status of microbial contamination in the environment of respiratory tract specimens sampling rooms and observe the association of the factors such as design and layouts of the sampling rooms with the potential risk of infections in the environment so as to provide scientific bases for optimizing the construction standards of fever clinics of the medical institutions.METHODS The sampling rooms of fever clinic were chosen from 10 tertiary or above medical institutions of Hangzhou,and the samples were collected from the key sites such as air,object surfaces and hands of health care workers.The respiratory tract pathogens in the sam-ples were detected by FilmArray full-automatic medical PCR analysis system,and the pathogens in the samples were detected by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry(MALDI-TOF MS).The data including the areas,windows,mechanical ventilation facilities,physical partitions,frequencies and modes of disinfection and daily amounts of diagnosis and treatment of the 10 sampling rooms were investigated,and the univariate analysis was performed for their association with the microbial contamination of environment.RESULTS The isolation rate of respiratory tract pathogens was 10.00％(4/40),respiratory syn-cytial virus,human rhinovirus and adenovirus were dominant among the respiratory tract pathogens.The isolation rate of bacteria was 71.88％(23/32),Staphylococcus ho minis and Staphylococcus epidermidis were the major species of opportunistic pathogens isolated.The result of univariate analysis indicated that both the presence of windows(P=0.012)and mechanical ventilation facilities(P=0.047)were associated with the potential risk of infections in the environment(P＜0.05);while the factors such as the areas of sampling rooms,physical parti-tions,disinfection modes and daily amounts of diagnosis and treatment were not remarkably associated with the potential risk of infections in the environment.CONCLUSION It is an effective way to physically separate the air-flow from other areas or fix the mechanical ventilation facilities to create proper airflow during the construction of fever clinic sampling rooms so as to reduce the potential risk of infections in the environment of sampling rooms.

OBJECTIVE To evaluate the status of microbial contamination in the environment of respiratory tract specimens sampling rooms and observe the association of the factors such as design and layouts of the sampling rooms with the potential risk of infections in the environment so as to provide scientific bases for optimizing the construction standards of fever clinics of the medical institutions.METHODS The sampling rooms of fever clinic were chosen from 10 tertiary or above medical institutions of Hangzhou,and the samples were collected from the key sites such as air,object surfaces and hands of health care workers.The respiratory tract pathogens in the sam-ples were detected by FilmArray full-automatic medical PCR analysis system,and the pathogens in the samples were detected by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry(MALDI-TOF MS).The data including the areas,windows,mechanical ventilation facilities,physical partitions,frequencies and modes of disinfection and daily amounts of diagnosis and treatment of the 10 sampling rooms were investigated,and the univariate analysis was performed for their association with the microbial contamination of environment.RESULTS The isolation rate of respiratory tract pathogens was 10.00％(4/40),respiratory syn-cytial virus,human rhinovirus and adenovirus were dominant among the respiratory tract pathogens.The isolation rate of bacteria was 71.88％(23/32),Staphylococcus ho minis and Staphylococcus epidermidis were the major species of opportunistic pathogens isolated.The result of univariate analysis indicated that both the presence of windows(P=0.012)and mechanical ventilation facilities(P=0.047)were associated with the potential risk of infections in the environment(P＜0.05);while the factors such as the areas of sampling rooms,physical parti-tions,disinfection modes and daily amounts of diagnosis and treatment were not remarkably associated with the potential risk of infections in the environment.CONCLUSION It is an effective way to physically separate the air-flow from other areas or fix the mechanical ventilation facilities to create proper airflow during the construction of fever clinic sampling rooms so as to reduce the potential risk of infections in the environment of sampling rooms.

Objective:This article reports a case of right sinonasal teratocarcinosarcoma. The patient was admitted to the hospital with symptoms of persistent nasal obstruction in both nostrils. Nasal endoscopy revealed the presence of new growths in the right nasal cavity and nasopharynx. Sinus CT imaging showed that the nasal cavity, paranasal sinuses, and nasopharynx were filled with soft tissue density shadows, with evidence of bone destruction. Transnasal endoscopic sinonasal surgery was performed, and postoperative pathology, along with immunohistochemical results, confirmed a diagnosis of sinonasal teratocarcinosarcoma. This case is analyzed, and relevant literature is reviewed.
Humans ; Carcinosarcoma ; Paranasal Sinus Neoplasms ; Nose Neoplasms ; Male ; Teratoma ; Middle Aged

INTRODUCTION: Achieving low-density lipoprotein cholesterol (LDL-C) levels is key to preventing atherosclerotic cardiovascular events. However, many high-risk cardiovascular patients still experience poor LDL-C goal attainment and receive suboptimal lipid-lowering therapy (LLT) prescriptions. Herein, we evaluated LLT prescription patterns, LDL-C goal attainment and cardiovascular mortality among this population group in Singapore. METHODS: This prospective observational cohort study included 555 patients with ischaemic heart disease (IHD) admitted to the hospital in 2020. The LLT prescriptions, corresponding LDL-C levels and cardiovascular outcomes were assessed over a 24-month period. RESULTS: Most participants were male (82.3%), with 48.5% identified as Chinese. High-intensity statin prescriptions increased from 45.4% at hospital admission to 87.1% at discharge and remained stable at approximately 80% at 6, 12, and 24 months post-discharge. Combination LLT prescriptions increased from 12.3% at discharge to 33.8% by 24 months. Ezetimibe was the most commonly prescribed second-line LLT (40.8%), followed by inclisiran (1.09%) and anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapies (0.87%). Over 24 months, LDL-C goal attainment rates were 22.1% for LDL-C < 1.4 mmol/L and 47.2% for LDL-C < 1.8 mmol/L. Multivariable Cox proportional hazards regression indicated that achieving LDL-C < 1.8 mmol/L goal was associated with a reduction in all-cause mortality at 24 months (hazard ratio 0.53, 95% confidence interval 0.30-0.94, P = 0.030). CONCLUSION Treatment gaps in lipid management persist in 80% of the study population, indicating that statin monotherapy alone is insufficient to achieve LDL-C goals. Greater efforts to improve LDL-C goal attainment rates in high-risk cardiovascular patients are imperative.
Humans ; Male ; Cholesterol, LDL/blood* ; Female ; Myocardial Ischemia/drug therapy* ; Middle Aged ; Prospective Studies ; Aged ; Singapore/epidemiology* ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Ezetimibe/therapeutic use* ; Anticholesteremic Agents/therapeutic use* ; Treatment Outcome

OBJECTIVE: To evaluate the clinical efficacy of ultrasound-guided acupuncture at myofascial trigger points (MTrPs) on treating post-stroke foot drop. METHODS: Sixty patients with post-stroke foot drop were randomly assigned to an observation group 1 (20 cases, 1 case dropped out), an observation group 2 (20 cases, 2 casses dropped out), and a control group (20 cases). The control group received conventional acupuncture at Yanglingquan (GB34), Jiexi (ST41), Taichong (LR3), Zusanli (ST36), Xuanzhong (GB39), and Qiuxu (GB40) on the affected side, once daily. In addition to the treatment of the control group , the observation group 1 received acupuncture at the tibialis anterior and gastrocnemius MTrPs, once every other day, while the observation group 2 received ultrasound-guided acupuncture at the tibialis anterior and gastrocnemius MTrPs, once every other day. All groups were treated for two weeks. Three-dimensional gait analysis was performed using an infrared motion capture system, and the Holden walking scale was used to evaluate walking ability before and after treatment in the three groups. RESULTS: Compared before treatment, the patients in the observation groups 1 and 2 showed increased walking speed (P<0.05, P<0.01), and improved Holden walking scale grades (P<0.05, P<0.01) after treatment; the patients in the observation group 2 also showed increased ankle dorsiflexion angles (P<0.05). The walking speeds of the observation groups 1 and 2 were faster than those of the control group after treatment (P<0.05), the Holden walking scale grade in the observation group 2 was superior to that in the control group (P<0.05). CONCLUSION The ultrasound-guided acupuncture at MTrPs could effectively improve gait function in post-stroke foot drop patients.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Stroke/physiopathology* ; Aged ; Trigger Points/physiopathology* ; Gait ; Acupuncture Points ; Adult ; Ultrasonography ; Treatment Outcome ; Gait Disorders, Neurologic/etiology*