This article presents a case study of a patient who visited the Geriatric Department of Peking Union Medical College Hospital due to "palpitations, shortness of breath for more than 2 years, limb weakness for 6 months, edema, and nocturnal dyspnea for 2 months". The patient exhibited decreased muscle strength in the limbs and involvement of swallowing and respiratory muscles, alongside complications of heart failure and various arrhythmias which were predominantly atrial. Laboratory tests revealed the presence of multiple autoantibodies and notably anti-mitochondrial antibodies. Following a comprehensive multidisciplinary evaluation, the patient was diagnosed with anti-mitochondrial antibody-associated inflammatory myopathy. Treatment involved a combination of glucocorticoids and immunosuppressants, along with resistance exercises for muscle strength and rehabilitation training for lung function, resulting in significant improvement of clinical symptoms. The case underscores the importance of collaborative multidisciplinary approaches in diagnosing and treating rare diseases in elderly patients, where careful consideration of clinical manifestations and subtle abnormal clinical data can lead to effective interventions.

Objectives:To investigate the predictive value of the hemoglobin to serum creatinine ratio(Hb/SCr)for all-cause mortality within 3 years after percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods:A total of 687 STEMI patients who successfully underwent the first PCI at the Department of Cardiology,Gansu Provincial People's Hospital,from June 2016 to June 2020 were retrospectively enrolled.Patients were divided into survival and non-survival groups according to their vital status at 3 years post-PCI.Cox regression analysis was performed to identify predictive factors of all-cause mortality.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive value of Hb/SCr for all-cause mortality,and Kaplan-Meier survival curves were used to compare cumulative survival rates between subgroups stratified by Hb/SCr levels.Results:The median follow-up duration was 37(25,50)months.Among the 663 patients(96.51%)with complete follow-up data,41 cases(6.18%)experiencing all-cause death.Multivariable Cox regression analysis revealed that age(HR=1.086,95%CI:1.037-1.137,P=0.000),body mass index(HR=1.195,95%CI:1.128-1.266,P=0.000),fasting blood glucose(HR=1.069,95%CI:1.007-1.135,P=0.030),fibrinogen(HR=1.418,95%CI:1.120-1.795,P=0.004),TIMI flow grade 1(HR=4.968,95%CI:1.194-20.667,P=0.028),TIMI flow grade 2(HR=3.861,95%CI:1.336-11.156,P=0.013),and Hb/SCr(HR=0.858,95%CI:0.766-0.961,P=0.008)were the independent predictors of all-cause mortality.ROC curve analysis demonstrated that the area under the curve(AUC)of Hb/SCr was 0.721(95%CI:0.645-0.798)for predicting all-cause mortality,with a sensitivity of 65.9%and specificity of 71.2%,at the optimal cut-offvalue of 16.627.Kaplan-Meier analysis showed that patients with Hb/SCr<16.627 had significantly lower survival rates than those with Hb/SCr≥16.627(log-rank P=0.000).Conclusions:Hb/SCr is an independent predictor of 3-year all-cause mortality in STEMI patients after PCI and this indicator could be used as risk stratification parameter and patients with lower Hb/SCr might benefit comprehensive post-PCI management to improve their outcome.

Objective:To summarize and analyze the clinical efficacy and experience of ultrasound-guided radiofrequency ablation (RFA) in the treatment of Kasabach-Merritt syndrome (KMS).Methods:A retrospective analysis was conducted on the data of pediatric patients with KMS who underwent ultrasound-guided RFA in Department of Hemangioma Surgery, the Third Affiliated Hospital of Zhengzhou University, between March 2018 and March 2024. Preoperative laboratory tests and imageological examination were performed. Under general anesthesia, the working tip of the RFA electrode needle was precisely reached the bottom of the lesion under ultrasound guidance. The electrode needle was then gradually withdrawn until the entire lesion area was covered by hyperechoic signals, indicating complete ablation. Postoperative symptomatic and supportive treatments, such as ice pack application and dressing changes, were administered to the surgical area. Platelet detection was performed immediately after the operation. Complications were closely monitored and regular follow-ups were carried out.Results:A total of 30 pediatric patients were included, comprising 14 males and 16 females, from 10 min to 5 months and 29 d after birth, with a median time of 6 d. Lesions were located in the limbs and trunk in 27 cases, and head and neck region in 3 cases, with lesion volumes ranged from 2.4 cm×2.3 cm×1.2 cm to 14.4 cm×9.3 cm×3.3 cm. The mean preoperative platelet count was 43×10 9/L, among them, the platelet values of 11 cases were (10-30) ×10 9/L, and those of 6 cases were lower than 10×10 9/L, other 13 cases with progressive thrombocytopenia. All patients successfully underwent RFA, achieving complete lesion ablation and normalization of platelet counts postoperatively. Platelet counts recovered to above 300×10 9/L in 15 patients, with no severe complications observed. The RFA area became slightly hardened within 7 d postoperatively but gradually returned to normal after consistent dressing changes for 2 weeks. During the follow-up period of 6 months to 2 years, complete lesion ablation was confirmed, with disappearance of the mass, no recurrence, good local function, mild local scar formation, and satisfactory cosmetic appearance. Conclusion:Ultrasound-guided RFA for KMS has advantages of favorable therapeutic outcomes, minimal tissue damage, no significant complications, and satisfactory cosmetic result.

The Notch signaling pathway is a highly conserved cell signaling system. Delta-like ligand 4 (Dll4), the only Notch ligand specifically expressed in endothelial cells, plays a critical role in the formation of abnormal vascular lumens under physiological and pathological conditions. The Dll4-Notch signaling pathway is essential for the regulation of gene transcription. Venous malformation, the most common type of vascular malformation, is a vascular disease characterized by progressive destruction of multiple tissues and organs; however, the mechanisms underlying its invasive progression remain unclear. This article summarizes the biological characteristics of the Dll4-Notch signaling pathway and its roles in vasculogenesis, venous malformations, and other vascular anomalies. It has been found that the Dll4-Notch signaling pathway can influence venous lumen structure and may contribute to the persistent abnormal development of malformed veins, leading to local invasion. Current research on the Dll4-Notch signaling pathway in venous malformations is still in its preliminary stages, and further in-depth experimental studies are required to untangle the relationship between them.

Objective:To observe the effects of acupuncture on the motor function of Parkinson disease(PD)model mice and to investigate the neuroprotective effects of acupuncture on PD from the perspective of cellular senescence.Methods:C57BL/6J mice were randomly divided into a normal control(NC)group,a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)group,an acupuncture(ACU)group,and a rasagiline(RAS)group,with 6 mice in each group.Except for the mice in the NC group,all mice were injected intraperitoneally with MPTP[30 mg/(kg·bw)]to establish a PD mouse model.After the models were successfully established,mice in the ACU group received acupuncture at Baihui(GV20)and bilateral Yanglingquan(GB34)for 15 min,once a day for 14 consecutive days.Mice in the RAS group were treated with gavage of rasagiline mesylate[0.5 mg/(kg·bw)],once daily for 14 d.Mouse balance and motor functions were detected using the mouse fatigue rotating rod apparatus.Immunohistochemistry staining was used to detect the number of tyrosine hydroxylase(TH)-positive neurons and the protein expression levels of special AT-rich sequence-binding protein 1(SATB1),p21,and p53 in the substantia nigra(SN)region of the mouse brain in each group.The glutathione peroxidase(GSH-Px)activity of mouse brain SN tissue was detected by enzyme-linked immunosorbent assay.The protein expression levels of interleukin(IL)-6 and senescence-associated β-galactosidase(SA-β-gal)in the SN tissue of mice in each group were detected by Western blotting.The relative expression of SATB1,p21,and p53 mRNA in the SN of each group was detected by real-time quantitative polymerase chain reaction.Results:Compared to the NC group,the overall rod performance(ORP)score,the number of TH-positive neurons,and GSH-Px activity in the SN region were significantly lower in the mice in the MPTP group(P<0.01);compared to the MPTP group,the ORP score,the number of TH-positive neurons,and GSH-Px activity were significantly increased in the ACU group and the RAS group(P<0.01 or P<0.05).Compared to the NC group,the protein levels of IL-6 and SA-β-gal in the SN tissue,the protein and mRNA expression levels of p21 and p53 were significantly increased(P<0.01);compared to the MPTP group,the protein levels of IL-6 and SA-β-gal in the SN tissue,the protein and mRNA expression levels of p21 and p53 were significantly decreased in the ACU group and the RAS group(P<0.01 or P<0.05).Compared to the NC group,the relative expression of SATB1 protein and mRNA in the SN of mice in the MPTP group was significantly decreased(P<0.01);compared to mice in the MPTP group,mice in the ACU group and the RAS group showed significant increases in the relative expression of SATB1 protein and mRNA(P<0.01 or P<0.05).Conclusion:Acupuncture can improve motor function and increase the number of TH-positive neurons in the SN of PD model mice.Its neuroprotective effect may relate to the regulation of the SATB1/p21 signaling pathway and the inhibition of cellular senescence-related biomarker expression in the SN.

Objective:Systematically integrate the real experience and multi-dimensional needs of patients with breast cancer related lymphedema (BCRL) in the process of self-management to provide reference for clinical development of targeted and systematic interventions.Methods:Computer searches were conducted on qualitative studies on the real experiences, psychological feelings, and multidimensional needs of BCRL patients during self-management in databases such as China National Knowledge Infrastructure, VIP Database, Wanfang Database, China Biomedical Literature Database, CINAHL, PubMed, Cochrane Library, Web of Science, and PsycINFO. The search period was from database establishment to January 31, 2024. According to the qualitative research quality evaluation criteria of the Joanna Briggs Institute Evidence Based Healthcare Center in Australia, the quality of literature was evaluated, and the results were analyzed and integrated using a pooled integration method.Results:A total of 10 articles were included, and 44 research results were extracted. Similar results were classified into 10 categories and synthesized into 3 integrated results, highlighting the difficulties and challenges encountered; need external multidimensional support and assistance; seeking a new normal and perceiving its benefits.Conclusions:BCRL patients face physical and mental challenges in their lifelong self-management process. Hospitals, society, and related institutions should attach importance to and pay attention to the needs, burdens, and beneficial experiences of patients, provide them with more professional guidance and supervision, and collaborate with families and peers to provide support and encouragement, helping patients reduce negative emotions and strengthen coping abilities, thereby improving overall quality of life.

Objective:To investigate relationship between expression of ADGRG5 and clinical prognosis and immune response in pancreatic adenocarcinoma(PAAD).Methods:ADGRG5 expression in PAAD and normal tissues were compared by Wilcoxon rank sum test.Diagnostic value of ADGRG5 was evaluated by ROC curve in PAAD.Kaplan-Meier method and Cox regres-sion analysis were used to evaluate prognostic factors.Gene set enrichment analysis(GSEA)and immune infiltration analysis were applied to annotate biological function of ADGRG5.Results:ADGRG5 expression in PAAD was significantly higher than normal tissue(P=2.8e-32).ADGRG5 had significant diagnostic and prognostic ability for PAAD(AUC=0.866).High ADGRG5 expression predicted a good progress free interval(PFI)(P=0.01),and expression of ADGRG5 was independently associated with PFI(HR:0.656,95%CI:0.433～0.972,P=0.035).ADGRG5 expression was related to regulation of immunomodulatory pathway and function of some types of immune infiltrating cells.Conclusion:Increased ADGRG5 may be a potential biomarker for PAAD diagnosis and prognosis,which affects prognosis of PAAD patients and significantly correlated with immune infiltration.

Objective:To summarize and analyze the clinical efficacy and experience of ultrasound-guided radiofrequency ablation (RFA) in the treatment of Kasabach-Merritt syndrome (KMS).Methods:A retrospective analysis was conducted on the data of pediatric patients with KMS who underwent ultrasound-guided RFA in Department of Hemangioma Surgery, the Third Affiliated Hospital of Zhengzhou University, between March 2018 and March 2024. Preoperative laboratory tests and imageological examination were performed. Under general anesthesia, the working tip of the RFA electrode needle was precisely reached the bottom of the lesion under ultrasound guidance. The electrode needle was then gradually withdrawn until the entire lesion area was covered by hyperechoic signals, indicating complete ablation. Postoperative symptomatic and supportive treatments, such as ice pack application and dressing changes, were administered to the surgical area. Platelet detection was performed immediately after the operation. Complications were closely monitored and regular follow-ups were carried out.Results:A total of 30 pediatric patients were included, comprising 14 males and 16 females, from 10 min to 5 months and 29 d after birth, with a median time of 6 d. Lesions were located in the limbs and trunk in 27 cases, and head and neck region in 3 cases, with lesion volumes ranged from 2.4 cm×2.3 cm×1.2 cm to 14.4 cm×9.3 cm×3.3 cm. The mean preoperative platelet count was 43×10 9/L, among them, the platelet values of 11 cases were (10-30) ×10 9/L, and those of 6 cases were lower than 10×10 9/L, other 13 cases with progressive thrombocytopenia. All patients successfully underwent RFA, achieving complete lesion ablation and normalization of platelet counts postoperatively. Platelet counts recovered to above 300×10 9/L in 15 patients, with no severe complications observed. The RFA area became slightly hardened within 7 d postoperatively but gradually returned to normal after consistent dressing changes for 2 weeks. During the follow-up period of 6 months to 2 years, complete lesion ablation was confirmed, with disappearance of the mass, no recurrence, good local function, mild local scar formation, and satisfactory cosmetic appearance. Conclusion:Ultrasound-guided RFA for KMS has advantages of favorable therapeutic outcomes, minimal tissue damage, no significant complications, and satisfactory cosmetic result.

The Notch signaling pathway is a highly conserved cell signaling system. Delta-like ligand 4 (Dll4), the only Notch ligand specifically expressed in endothelial cells, plays a critical role in the formation of abnormal vascular lumens under physiological and pathological conditions. The Dll4-Notch signaling pathway is essential for the regulation of gene transcription. Venous malformation, the most common type of vascular malformation, is a vascular disease characterized by progressive destruction of multiple tissues and organs; however, the mechanisms underlying its invasive progression remain unclear. This article summarizes the biological characteristics of the Dll4-Notch signaling pathway and its roles in vasculogenesis, venous malformations, and other vascular anomalies. It has been found that the Dll4-Notch signaling pathway can influence venous lumen structure and may contribute to the persistent abnormal development of malformed veins, leading to local invasion. Current research on the Dll4-Notch signaling pathway in venous malformations is still in its preliminary stages, and further in-depth experimental studies are required to untangle the relationship between them.

Objective:To observe the effects of acupuncture on the motor function of Parkinson disease(PD)model mice and to investigate the neuroprotective effects of acupuncture on PD from the perspective of cellular senescence.Methods:C57BL/6J mice were randomly divided into a normal control(NC)group,a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)group,an acupuncture(ACU)group,and a rasagiline(RAS)group,with 6 mice in each group.Except for the mice in the NC group,all mice were injected intraperitoneally with MPTP[30 mg/(kg·bw)]to establish a PD mouse model.After the models were successfully established,mice in the ACU group received acupuncture at Baihui(GV20)and bilateral Yanglingquan(GB34)for 15 min,once a day for 14 consecutive days.Mice in the RAS group were treated with gavage of rasagiline mesylate[0.5 mg/(kg·bw)],once daily for 14 d.Mouse balance and motor functions were detected using the mouse fatigue rotating rod apparatus.Immunohistochemistry staining was used to detect the number of tyrosine hydroxylase(TH)-positive neurons and the protein expression levels of special AT-rich sequence-binding protein 1(SATB1),p21,and p53 in the substantia nigra(SN)region of the mouse brain in each group.The glutathione peroxidase(GSH-Px)activity of mouse brain SN tissue was detected by enzyme-linked immunosorbent assay.The protein expression levels of interleukin(IL)-6 and senescence-associated β-galactosidase(SA-β-gal)in the SN tissue of mice in each group were detected by Western blotting.The relative expression of SATB1,p21,and p53 mRNA in the SN of each group was detected by real-time quantitative polymerase chain reaction.Results:Compared to the NC group,the overall rod performance(ORP)score,the number of TH-positive neurons,and GSH-Px activity in the SN region were significantly lower in the mice in the MPTP group(P<0.01);compared to the MPTP group,the ORP score,the number of TH-positive neurons,and GSH-Px activity were significantly increased in the ACU group and the RAS group(P<0.01 or P<0.05).Compared to the NC group,the protein levels of IL-6 and SA-β-gal in the SN tissue,the protein and mRNA expression levels of p21 and p53 were significantly increased(P<0.01);compared to the MPTP group,the protein levels of IL-6 and SA-β-gal in the SN tissue,the protein and mRNA expression levels of p21 and p53 were significantly decreased in the ACU group and the RAS group(P<0.01 or P<0.05).Compared to the NC group,the relative expression of SATB1 protein and mRNA in the SN of mice in the MPTP group was significantly decreased(P<0.01);compared to mice in the MPTP group,mice in the ACU group and the RAS group showed significant increases in the relative expression of SATB1 protein and mRNA(P<0.01 or P<0.05).Conclusion:Acupuncture can improve motor function and increase the number of TH-positive neurons in the SN of PD model mice.Its neuroprotective effect may relate to the regulation of the SATB1/p21 signaling pathway and the inhibition of cellular senescence-related biomarker expression in the SN.