This article reports the diagnosis and treatment process of a 65-year-old male patient diagnosed with xanthoma dissseminatum. The patient sought medical attention due to reddish brown patchy rashes on the skin of the arms, knees and abdomen. The results of positron emission tomography and computed tomography (PET/CT) suggested that non-Langerhans cell histiocytosis might involve multiple blood vessels, the skin of the posterior neck and right forearm, multiple soft tissues, the descending duodenum and possibly the spine. Biopsy on skin of right arm showed non-Langerhans cell proliferative changes, with a pathological diagnosis of xanthoma dissseminatum. The rash improved after 6 cycles of monotherapy with cladribine. Follow-up PET/CT results indicated that multiple foci of abnormally increased glucose metabolism in the skin, joints, and soft tissues had decreased compared to previous examinations, suggesting disease remission. After stopping medication for 9 months, the patient underwent PET/CT reexamination, which showed new bone lesions. Bone marrow puncture was performed which suggested xanthoma dissseminatum involvement. Subsequently, the patient received chidamide combined with cladribine. By January 2025, the third cycle of chemotherapy had been completed. The patient is still under follow-up.

Objective To investigate the effects of dapagliflozin on inflammatory factors and prognosis in patients with type 2 diabetes mellitus (T2DM) and acute myocardial infarction (AMI). Methods In a randomized, double-blind trial, 146 patients with T2DM and AMI (within 7 days of onset) were divided into dapagliflozin (dapagliflozin 10 mg/d combining AMI standard therapy) and control (AMI standard therapy) groups, and were followed up for 12 months. Serum levels of interleukin-1β (IL-1β), IL-6, high-sensitivity C reactive protein (hs-CRP) at baseline, 1, 3, 6, and 12 months, and left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP), and major adverse cardiovascular events (MACE) rate at 12 months were compared between the two groups. Kaplan-Meier curves were used to analyze the cumulative incidences of MACE in the two groups. Results Three patients were withdrawn or dropped out. At 12 months, IL-1β, IL-6, and hs-CRP levels were significantly lower in dapagliflozin group (n＝71) than those in control group (n＝72, P＜0.01), approaching normal levels. Compared with the control group, LVEF was higher (P＜0.01), BNP was lower (P＜0.01), MACE incidence was lower (P＝0.047) in dapagliflozin group at 12 months. Generalized linear mixed models showed significant group-time interactions in IL-1β, IL-6, and hs-CRP (P＜0.001), and these factors declined faster in the dapagliflozin group. Kaplan-Meier curve showed the cumulative incidences of MACE and heart failure were lower in dapagliflozin group than those in non-dapagliflozin group (P＜0.05). Conclusions For patients with T2DM patients and AMI, dapagliflozin has good anti-inflammatory and cardioprotective effects.

OBJECTIVE To provide references for the accurate identification and management of immune-related cutaneous adverse events （irCAEs） caused by durvalumab， and ensuring safe clinical drug use. METHODS Clinical pharmacists participated in the diagnosis and treatment process of a patient with gallbladder cancer who developed irCAEs caused by durvalumab. The clinical pharmacists systematically reviewed the patient’s past medical history and medication history， and assisted physicians in assessing the association between adverse drug reactions and administered drugs. Meanwhile， the clinical pharmacists conducted a graded assessment of the adverse reaction， proposed recommendations such as discontinuing durvalumab and adjusting the administration regimen of glucocorticoids， assisted physicians in restarting immunotherapy， and carried out medication education and other pharmaceutical care. RESULTS The occurrence of irCAEs in this patient was “highly likely” related to durvalumab and was classified as severe. The physicians adopted the clinical pharmacist’s opinion， and after symptomatic treatment， the patient’s skin symptoms improved， and discharged with medication. After the completion of glucocorticoid therapy for the patient， the physician restarted immunotherapy with tislelizumab， and no related adverse reactions occurred again in the patient. CONCLUSIONS Durvalumab can cause irCAEs such as severe skin maculopapular rash. In clinical practice， it is crucial to promptly identify and discontinue suspicious drugs， immediately implement effective symptomatic treatment measures， and actively resume immunotherapy to ensure the continuity and safety of the patient’s treatment.

Chronic heart failure(CHF)is a common end-stage manifestation of cardiovascular disease,and the"spleen-small intestine-heart"axis is its important mechanism.Current studies have shown that the"spleen"in TCM and mitochondria function are similar,and the physiological dysfunction of the"small intestine"is also closely related to intestinal bacterial dysbiosis,and the pathology of the spleen and the small intestine will be transmitted to the heart to accelerate the occurrence and development of CHF.Based on the relevant theory of spleen-small intestine-heart,this article described the correlation between abnormal mitochondrial energy metabolism and imbalance of intestinal flora and CHF from the aspects of the spleen,small intestine and heart,and believed that the essence of CHF is a pathological condition formed by mitochondrial energy metabolism crisis and intestinal microecological disorders,which could provide theoretical references for the TCM prevention and treatment of CHF.

Objective: To investigate the current status of iron metabolism among apheresis donors in Guangzhou and analyze the improvement effects of health education on iron deficiency in frequent apheresis donors. Methods: Using a generalized linear mixed model (GLMM), a 180-day follow-up was conducted on 261 eligible apheresis donors at the Guangzhou Blood Center from January to July 2024. Hemoglobin (Hb), serum ferritin (SF), unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), and transferrin saturation (TS) were selected as outcome variables. The effects of gender, age group, and number of donations within 180 days on these outcomes were analyzed and modeled. A general linear model (GLM) with repeated measures was applied to 55 donors who received health education interventions, comparing changes in Hb and iron metabolism-related indicators before and after follow-up and health education. Results: No significant difference in Hb levels was observed between first-time and regular apheresis donors, but SF levels were significantly higher in first-time donors (F=6.195, P<0.05). The GLMM revealed that female donors exhibited more significant reductions in Hb (T=-12.546) and SF (T=-5.829)(P<0.05 for both). Age group showed no interactive effects on Hb or SF changes. While number of donations within 180 days had no interactive effect on Hb, SF levels significantly decreased with increased number of donations (using ≥9 donations as the reference group; P<0.05 for all groups). After health education, Hb levels remained unchanged, but SF increased compared to pre-intervention levels (mean difference: -18.571, P<0.05), though a declining trend persisted compared to baseline (mean difference from baseline to post-intervention: 23.068,P<0.05). Conclusion: Female and number of donations are primary factors contributing to SF reduction in apheresis donors. Health education interventions promote SF recovery. Extending donation intervals and reinforcing iron deficiency-related health education may improve iron status in donors.

BACKGROUND: Electroacupuncture (EA) treatment is efficacious in patients with respiratory disorders, although the mechanisms of its action in lung-function protection are poorly understood. This study aimed to explore the neuroanatomical mechanisms of EA stimulation at the BL13 acupoint (Feishu, EA-BL13) improvement in asthma. METHODS: Allergic asthma was induced by intranasal 2.0% ovalbumin (OVA) instillation combined with intraperitoneal injection of the 10.0% OVA. The levels of interleukin (IL)-4 and IL-5 were detected by enzyme-linked immunosorbent assay. Hematoxylin and eosin and periodic acid-schiff stain were used to evaluate inflammatory cell infiltration and mucus secretion. Cellular oncogene fos induction in neurons after EA stimulation was detected by immunofluorescent staining. The messenger RNA expression levels of adrenergic receptors were quantified with real-time polymerase chain reaction. RESULTS: EA improved airway inflammation and mucus secretion mainly by activating somatosensory-sympathetic pathways ( P <0.001). Briefly, the intermediolateral (IML) nuclei of the spinal cord received signals from somatic EA stimulation and then delivered the information via the sympathetic trunk to the lung. Excited sympathetic nerve endings in lung tissue released large amounts of catecholamines that specifically activated the β2 adrenergic receptor (β2AR) on T cells ( P <0.01) and further decreased the levels of IL-4 and IL-5 ( P <0.001) through the cyclic adenosine monophosphate/protein kinase A signaling pathway. CONCLUSION This study provided a new explanation and clinical basis for the use of EA-BL13 as a treatment for allergic asthma in both the attack and remission stages and other respiratory disorders related to airway inflammation.
Electroacupuncture/methods* ; Animals ; Asthma/immunology* ; Rats ; Rats, Sprague-Dawley ; Male ; Inflammation/therapy* ; Interleukin-4/metabolism* ; Interleukin-5/metabolism*

Purpose To investigate the predictive value of nomogram based on preoperative CT imaging for predicting programmed cell death receptor ligand 1(PD-L1)expression in patient with lung adenocarcinoma.Materials and Methods A total of 158 patients with lung adenocarcinoma were enrolled in Shenzhen people's Hospital from January 2021 to July 2022,of which 82 were negative for PD-L1 and 76 were positive for PD-L1.They were randomly divided into training set(n=119)and verification set(n=39)according to the proportion of 7:3.The significant characteristics between PD-L1 negative and PD-L1 positive were screened by univariate and multivariate Logistic regression to construct a clinical model.Radiomics features were extracted from preoperative CT images,and then features were screened and modeled.Finally,the combined model was established by clinical factors and radiomics features,which was visualized by nomogram.The diagnostic performance of the model was evaluated using receiver operating characteristic curves and area under the curve(AUC).Results The area under the curve(AUC)of the clinical model composed of carcinoembryonic antigen and vascular convergence sign was 0.774(95%CI 0.687-0.860)and 0.808(95%CI 0.670-0.947)in the training set and validation set,respectively.Through feature screening,the radiomics model was composed of 17 radiomics features,and the AUC of the training and validation sets was 0.837(95%CI 0.764-0.910)and 0.778(95%CI 0.633-0.923).The training set and validation set of the combined model composed of carcinoembryonic antigen,vascular convergence sign and radiomics score were AUC 0.892(95%CI 0.832-0.952)and 0.853(95%CI 0.737-0.968).In the training set,the AUC of the combined model was higher than that of the other two models(Z=-2.640,-2.855,P＜0.05).Conclusion Based on preoperative CT radiomics nomogram,it had high predictive efficacy on the expression of PD-L1 in lung adenocarcinoma and could provide decision-making support for the selection of clinical treatment regimens for lung adenocarcinoma patients.

Granulocytic myeloid-derived suppressor cells(G-MDSCs)are the principal subsets of myeloid-derived suppressor cells(MDSCs),which involved in development and progression of a variety of tumor and non-tumor diseases.G-MDSCs mediated disfunction of immune effector cells(such as T cells and NK cells)through producing Arg-1,ROS,iNOS,etc.is major cause of its immunosuppressive function.To date,a large number of studies have focused on tumor-promoting effects of G-MDSCs.However,their complex immunomodulatory functions,especially their positive effects in diseases such as autoimmune arthritis,are often overlooked.Besides,G-MDSCs share the same origin and phenotype with neutrophils,but their immune functions are heterogeneous.Therefore,precision of G-MDSCs targeted therapy will be largely improved if the two can be accurately distinguished,though this field is still under exploration.At present,there are abundant experimental studies on G-MDSCs at home and abroad,mainly in tumors,but there are no domestic reports on the immunomodulatory function of G-MDSCs in tumors and non-tumor diseases.Therefore,in this review,we summarizes the different roles played by G-MDSCs in tumor and non-tumor diseases,in order to reveal the important and complex functions of G-MDSCs in immune regulation.

Objective To explore the correlation between serum hypoxia-inducible factor-1α(HIF-1α)levels and cerebral microbleeds(CMBs)and cognitive impairment and to assess the predictive value of HIF-1α for CSVD-related cognitive impairment.Methods A total of 104 patients with CSVD who attended the Department of Neurology,First Affiliated Hospital of Xinxiang Medical University from June 2022 to November 2023 were enrolled.All enrolled patients were subjected to basic statistics,cranial nuclear magnetic resonance examination,cognitive function assessment,and serum HIF-1α test,and the number and location of CMBs were counted.Based on the above data the enrolled patients were grouped.The correlation between HIF-1α and cognitive function and CMBs was studied the influencing factors of CMBs and cognitive impairment were analyzed,and the predictive value of HIF-1α on the occurrence of cognitive impairment was evaluated.Results There were statistically significant differences in HIF-1α levels and cognitive function among different CMBs groups.Serum HIF-1α levels were significantly negatively correlated with overall cognitive function,visuospatial and executive function,attention,and delayed recall,and serum HIF-1α was positively correlated with the number of CMBs.HIF-1α may be a risk factor for CMBs and cognitive impairment associated with CSVD,and serum HIF-1α has potential in predict the cognitive impairment caused by CSVD.Conclusion Serum levels of HIF-1α were associated with the number of CMB and CSVD-related cognitive impairment,and serum levels of HIF-1α may have a predictive value for CSVD-related cognitive impairment.

Objective To explore the application value of quadriceps fat fraction(FF)in the early diagnosis of patellofemoral arthritis(PA).Methods A total of 98 patients were selected for conventional knee MRI examination and IDEAL-IQ sequence imaging.The FFm,FFl and FFt of quadriceps were measured.The patient group[chondromalacia patellae(CMP)(CMP group)and PA group]was compared with normal control(NC)(NC group).The receiver operating characteristic(ROC)curve was applied to assess diag-nostic efficacy.Results FFm,FFl,and FFt in the NC group were significantly lower than those in the patient group(P＜0.001).The FFm and FFl in the PA group were significantly higher than those in the CMP group(P=0.015,P=0.011).Additionally,within both CMP and PA groups,FFl was significantly higher than FFm(P＜0.01).The diagnostic efficacy of FFm was the highest for early PA diagnosis,with an optimal threshold of 8.4％.Conclusion The quadriceps FF can effectively quantify muscle fat infiltration in PA patients,especially in the lateral muscle.An increase in FF value can serve as an early quantitative biomarker for PA,providing sig-nificant reference value for clinical diagnosis and disease progression monitoring.