Objective : To observe the brain tissue injury during hypoxia-ischemia, as well as the pathological changes and the expression of ferroptosis-related factors after the use of Shenfu injection(SFI), and to explore the protective effect of SFI on hypoxic-ischemic brain injury(HIBD) by inhibiting ferroptosis. Methods : An animal model of HIBD in SD rats was constructed and intervened with SFI. Pathologic changes in brain tissue were observed by HE staining methods. Nissen staining was used to observe neuron survival. Glutathione Peroxidase 4(GPX4) and Divalent Metal Transporter 1(DMT1) expression were detected in brain tissue by Western blot, immunohistochemistry and immunofluorescence. Reduced Glutathione(GSH), Lactate Dehydrogenase(LDH), Malondialdehyde(MDA), Superoxide Dismutase(SOD) and tissue iron content were determined with the kits. BV-2 microglial cell line(BV2) cells were culturedin vitroand divided into control group(Ctrl group), oxygen-glucose deprivation group(OGD group), iron ferroptosis-inducing group(Erastin group), iron ferroptosis-inhibiting group(Fer-1 group), Shenfu injection group(SFI group), and Erastin+Shenfu injection group(Erastin+SFI group). 2′,7′-Dichlorodihydrofluorescein diacetate(DCFH-DA) reactive oxygen species(ROS) fluorescent probe was used to detect the ROS release level; Immunofluorescence was used to observe intracellular GPX4, DMT1 expression. Results : Compared with the Sham group, rats in the HIBD group showed significant neuronal cell damage in brain tissue, decreased GPX4 expression(P<0.01), increased DMT1 expression(P<0.01), decreased GSH and SOD levels(P<0.01), and increased LDH, MDA and tissue iron levels(P<0.05,P<0.05,P<0.01). In contrast, after the intervention of SFI, GPX4 expression was elevated(P<0.01), DMT1 expression decreased(P<0.01), GSH and SOD levels were elevated(P<0.01), and LDH, MDA, and tissue iron levels decreased(P<0.05,P<0.05,P<0.01). The cells experiments showed that compared with the Ctrl group, the OGD group had a significantly higher ROS content and a decrease in the expression of GPX4 fluorescence intensity, and an increase in the fluorescence intensity of DMT1(P<0.01), compared with the OGD group, the ROS content was reduced in the SFI group, while the expression of GPX4 was elevated and the expression of DMT1 was reduced(P<0.01). Conclusion Hippocampal and cortical regions are severely damaged after HIBD in neonatal rats, and their brain tissues show decreased expression of GPX4 and increased expression of DMT1. The above suggests that ferroptosis is involved in HIBD brain injury in neonatal rats. In contrast, Shenfu injection has a protective effect on HIBD experimental animal model and BV2 cell injury model by reducing iron aggregation and ROS production.

Objective: To systematically evaluate the influencing factors for repeated implantation failure (RIF) after in vitro fertilization-embryo transfer (IVF-ET) in China, so as to provide the evidence for prevention of RIF. Methods: Literature on influencing factors for RIF in China were retrieved from CNKI, Wanfang Data, VIP, China Medical Literature Service System, PubMed, Web of Science, Cochrane Library and Embase from inception to September, 2024. A meta-analysis was performed using RevMan 5.3 and Stata 14.0 softwares. Literature were excluded one by one for sensitivity analysis. Publication bias was evaluated using Egger's test. Results: Initially 4 836 relevant articles were retrieved, and 12 of them were finally included, with a total sample size of 11 554 individuals. There were 10 case-control studies, 1 cohort study, and 1 cross-sectional study; and 10 high-quality studies and 2 medium-quality studies. The meta-analysis showed that factors including advanced age (OR=1.121, 95%CI: 1.035-1.215), prolonged infertility duration (OR=1.237, 95%CI: 1.091-1.403), abnormal hysteroscopy findings (OR=2.205, 95%CI: 1.119-4.348), positive anti-nuclear antibody (ANA) (OR=2.393, 95%CI: 1.473-3.886), and positive anti-beta2 glycoprotein Ⅰ antibody (β2-GPⅠ-Ab) (OR=2.824, 95%CI: 1.987-4.013) were associated with an increased risk of RIF; while factors including the large number of embryos transferred (OR=0.309, 95%CI: 0.098-0.973), thicker endometrium (OR=0.601, 95%CI: 0.556-0.650), and higher granulocyte colony-stimulating factor (G-CSF) levels (OR=0.657, 95%CI: 0.511-0.845) were associated with a reduced risk of RIF. Conclusion IVF-ET RIF is associated with age, infertility duration, number of embryos transferred, endometrial thickness, hysteroscopy findings, G-CSF levels, ANA and β2-GPⅠ-Ab.

Objective:To evaluate the effectiveness of opioid-free anesthesia on postoperative outcomes in elderly patients following laparoscopic cholecystectomy.Methods:In this randomized controlled trial, 90 patients of either sex, aged 65-75 yr, with a body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=45 each) using a table of random numbers: conventional general anesthesia group (GA group) and opioid-free anesthesia group (OFA group). Anesthesia was induced with intravenous etomidate, sufentanil and cisatracurium besylate and maintained with infusion of propofol and remifentanil combined with inhalation of sevoflurane in GA group. In OFA group, bilateral ultrasound-guided transversus abdominis plane block was performed via the posterior gluteal approach (injection of 0.25% ropivacaine 20 ml respectively) before anesthesia induction, anesthesia was induced with intravenous dexmedetomidine, esketamine, etomidate and cisatracurium besylate and maintained with infusion of dexmedetomidine, esketamine and propofol combined with inhalation of sevoflurane. In both groups, mechanical ventilation was performed with a laryngeal mask airway after anesthesia induction, and ketorolac tromethamine 30 mg (for postoperative analgesia) and metoclopramide 10 mg (to prevent postoperative nausea and vomiting) were intravenously injected at the end of surgery. The intraoperative adverse cardiovascular events, emergence time, laryngeal mask airway removal time, time of postanesthesia care unit stay, and postoperative rescue analgesia, nausea and vomiting and delirium were recorded. Results:No gallbladder cardiac reflex was found during operation in either group. Compared with GA group, the incidence of intraoperative bradycardia (11% versus 22%) was significantly increased ( P<0.05), the incidence of intraoperative hypotension and postoperative nausea, vomiting and delirium (17% versus 8%, 29% versus 16%, 16% versus 4% and 18% versus 4%), and requirements for rescue analgesia and antiemetics (31% versus 7% and 13% versus 4%) were decreased ( P<0.05), the postoperative emergence time, time of laryngeal mask airway removal and time of postanesthesia care unit stay were prolonged ( P<0.05), and no statistically significant difference was found in discharge time in OFA group ( P>0.05). Conclusions:The results of this study, as a single-center, small-sample randomized controlled trial, indicate that referenced to conventional general anesthesia, opioid-free anesthesia (esketamine-dexmedetomidine based anesthesia combined with bilateral transversus abdominis plan block) can improve the short-term postoperative outcomes to a certain extent in elderly patients following laparoscopic cholecystectomy.

Objective:To investigate and analyze basic status of radiotherapy units in Hebei Province in 2024.Methods:Led by the Fourth Hospital of Hebei Medical University, the Radiation Oncology Branch of the Hebei Medical Association, and the Radiation Oncology Expert Committee of the Hebei Society of Clinical Oncology, a province-wide survey was conducted using structured questionnaires. The survey covered key aspects such as basic information of radiotherapy institutions, personnel allocation, equipment configuration, and implementation of radiotherapy techniques. Collected data were summarized and descriptively analyzed comparing with a 2013 survey of radiotherapy in Hebei Province.Results:All 158 radiotherapy institutions across Hebei Province participated in the survey. A total of 2273 radiotherapy professionals were reported, including 1317 radiation oncologists (57.94%), 332 medical physicists (14.61%), 71 radiotherapy engineers (3.12%), and 553 radiotherapy technologists (24.33%). The number of radiotherapy devices significantly increased from 121 in 2013 to 237 in 2024, including 68 domestic radiotherapy equipment. The current inventory includes 195 medical linear accelerators (2.61 units per million population), 2 cobalt-60 units, 27 afterloading machines, 9 tomotherapy (TOMO) systems, 3 CyberKnife units, and 1 proton therapy system. Three-dimensional conformal radiotherapy and stati intensity-modulated radiotherapy have been widely adopted across the province, while advanced techniques such as volumetric-modulated arc therapy, stereotactic body radiotherapy, and respiration-gated technology, and respiratory gating are gradually being implemented.Conclusions:In recent years, the configuration of radiotherapy personnel in Hebei Province has become more balanced, and the availability of precision radiotherapy equipment has significantly improved. There is a growing trend in the adoption of domestically manufactured radiotherapy equipment, marking substantial progress in the development of radiation oncology services in the region.

BACKGROUND:Slow bone repair and poor bone formation quality are still problems during masquelet technique in the treatment of large segment bone defects.H-type vessels can induce osteogenesis,enhance the local angiogenesis and osteogenesis coupling,and promote bone repair.However,there are few reports on the role of H-type blood vessels in the bone induced membrane.OBJECTIVE:To construct a large segment bone defect model of SD rat tibia,observe the expression characteristics of H-type blood vessels in the bone induced membrane,then to identify the expression peak point of H-type blood vessels in the bone induced membrane and determine the optimal period of bone grafting.METHODS:Sixty SD rats were randomly divided into a control group(n=30)and a model group(n=30)by random number table method.The two groups were further divided into three subgroups at 4,6,and 8 weeks after bone cement implantation,with 10 rats in each group.A 4 mm bone defect model of the right tibia was constructed in both the control and the model groups.Polymethyl methacrylate bone cement was implanted in the model group to induce bone biomembrane formation,while bone cement was not implanted in the control group.At 4,6,and 8 weeks after bone cement implantation,6 rats were randomly selected at each time point.The bone induction membrane tissue was cut from the model group,and the non-bone soft tissue of the corresponding part was cut from the control group.The dynamic expressions of H-type blood vessels in the bone induced membrane were identified by immunofluorescence.The morphological changes of the bone induced membrane were observed by hematoxylin-eosin staining.The formation of blood vessels in the bone induced membrane was observed by angiography.The expression levels of osteoblast-specific transcription factor in the bone induced membrane were detected by immunohistochemistry.Four rats remained at each time point.In the model group,the bone induced membrane was cut open and the bone cement was removed and autologous coccyx was implanted.In the control group,autologous coccyx was implanted in the bone defect area.Micro-CT evaluation of the tibial defect was performed 8 weeks after bone grafting.RESULTS AND CONCLUSION:(1)Immunofluorescence staining showed that the expression of H-type vessels in the model group was most obvious 6 weeks after bone cement implantation,and the expression of H-type vessels in the model group at each time point after bone cement implantation was higher than that in the control group(P＜0.05).(2)Hematoxylin-eosin staining and angiography showed that the number and volume of new blood vessels at each time point after bone cement implantation in the model group were greater than those in the control group(P＜0.05).The order of the number and volume of new blood vessels in the model group was:8 weeks after bone cement implantation＞6 weeks after bone cement implantation＞4 weeks after bone cement implantation.(3)Immunohistochemical staining showed that the positive expression of osteoblast-specific transcription factors at each time point after bone cement implantation in the model group was higher than that in the control group(P＜0.05),and the positive expression of osteoblast-specific transcription factors in the model group was most obvious 6 weeks after bone cement implantation.(4)Micro-CT detection showed that the bone repair effect of the three subgroups in the model group was significantly better than that of the corresponding subgroups in the control group,and the bone repair effect of the subgroup in the model group 6 weeks after bone cement implantation was better than that of the subgroups 4 and 8 weeks after bone cement implantation.The results indicate that H-type blood vessels are dynamically expressed in the bone induced membrane and reached a peak 6 weeks after bone cement implantation.Good bone repair effects can be obtained by the bone induced membrane bone grafting 6 weeks after bone cement implantation.

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.

Objective To investigate the drug resistance of Mycobacterium tuberculosis(MT)in Shaanxi Province in the past five years.Methods A total of 744 patients with culture-positive sputum specimens at the former Shaanxi Provincial Institute for Tuberculosis Control and Prevention from January 2019 to December 2023 were selected as the study subjects,and the results of their strain identification and drug susceptibility tests were collected to analyze the resistance to six antituberculosis drugs.Results The overall resistance rate of the MT complex of 726 strains was 33.33%(242/726).The rates of mono-resistance,multi-resistance,multi-drug resistance and extensive resistance were 12.95%(94/726),7.44%(54/726),12.95%(94/726)and 0.41%(3/726).The resistance rate was 31.73%(204/643)in primaries and 45.78%(38/83)in retreatment patients,and the difference between the resistance rates of primaries and retreatment patients was statistically significant(χ2=6.536,P=0.011).The resistance rates of the 6 antituberculosis drugs,in descending order,were as follows:streptomycin(SM)22.87%(166/726),isoniazid(INH)22.73%(165/726),rifampicin(RFP)15.15%(110/726),ofloxacin(OFX)9.09%(66/726),ethambutol(EMB)7.30%(53/726),kanamycin(KM)2.89%(21/726).The resistance rates for each year from 2019～2023 were 39.61%(61/154),33.33%(44/132),34.47%(81/235),24.54%(40/163)and 38.10%(16/42),respectively,and the difference in resistance rates between years was not statistically significant(χ2=8.967,P=0.062).Conclusion The burden of drug-resistant tuberculosis remains heavy in Shaanxi,and the situation of multidrug-resistant tuberculosis,in particular,is more serious,and control measures need to be strengthened and improved to reduce the incidence and spread of drug-resistant tuberculosis.

Objective To compare and analyze the disease burden of stroke related to high systolic blood pressure(HSBP)in China and globally.Methods Data were collected and organized from the GBD 2021 on the age-specific and sex-specific mortali-ty rates and disability-adjusted life years(DALY)rates for stroke attributable to HSBP in China and globally from 1990 to 2021.The Joinpoint regression model was used to analyze trends in the disease burden of stroke attributable to HSBP.The Bayesian age-period-cohort(BAPC)model was applied to predict future disease burden of stroke attributable to HSBP in China and globally.Results From 1990 to 2021,the age-standardized mortality rate(ASMR)and age-standardized disability-adjusted life years(ASDR)for stroke attributable to HSBP in China were both higher than the global trends,and the rate of decline was slower than that of the global trend.The decline was slower in males compared to females.By 2021,China's ASMR and ASDR had decreased to 77.73 per 100000(AAPC=-1.31％)and 1484.39 per 100000 person-years(AAPC=-1.34％),respective-ly.The disease burden of stroke attributable to HSBP both in China and globally was primarily concentrated in the elderly popu-lation.In China,except for the 25-34 age group,the mortality rate and DALY rate in all other age groups showed a downward trend.It is projected that,over the next 10 years,both China's and the global ASMR and ASDR for stroke attributable to HSBP will continue to decline,and the decline in China was expected to be greater than the global trend.Conclusion Although the ASMR and ASDR for stroke attributable to HSBP in China show a declining trend,the prevention and treatment situation re-mains challenging.The disease burden is higher among the elderly and males,and the lack of improvement in the disease burden among the 25-34 age group requires attention.In the future,preventive and treatment measures for stroke related to HSBP should be further refined based on existing experience.

The Yi Ethnic group's medical culture boasts a profound heritage and a long-standing history.Despite enduring the ravages of war,it has consistently served as a vital healthcare resource in the southwestern region,safeguarding the reproduction,well-being,and prosperity of the Yi people and other ethnic groups residing there.From the perspective of intangible cultural heritage,this paper expounds on the modern-day value and notable achievements of the inheritance and innovation of Yi Ethnic medicine in contemporary society,while also analyzing the existing problems.It puts forward countermeasures and suggestions for the inheritance and innovation of Yi Ethnic medicine under the framework of intangible cultural heritage from the following four aspects:firstly,strengthening scientific and standardized research on Yi Ethnic medicine to establish its inheritance status within the modern pharmaceutical industry;Secondly,intensifying efforts in the cultivation and recognition of diverse talents in Yi Ethnic medicine,and establishing a modern safeguard system for a workforce of compound professionals;Thirdly,actively integrating into the development of the bio-pharmaceutical and big health industries to enhance the inheritance and innovation capabilities of the Yi Ethnic medicine sector;and fourthly,improving digital management capabilities,reinforcing financial support and supply,and ensuring the recognition and widespread education of Yi Ethnic medicine.

Objective:To construct a risk prediction model for non-suicidal self-injury (NSSI) in adolescents with mood disorders, providing a basis for identifying and intervening in high-risk patients.Methods:A convenience sampling method was used to retrospectively analyze 724 adolescent patients with mood disorders admitted to the open ward of Qingdao Mental Health Center from January 2019 to July 2023. Patients admitted from January 2019 to December 2022 (641 cases) were randomly divided into a modeling group and an internal validation group in a 7∶3 ratio, while patients admitted from January to July 2023 (83 cases) were used as an external validation group. A binary multivariate logistic regression analysis was used to construct a nomogram prediction model for NSSI risk in adolescents with mood disorders. The predictive performance of the model was evaluated using the area under the curve (AUC), sensitivity, and specificity.Results:There were 179 males and 545 females, aged 15 (14, 17) years old. Among the 724 patients, 449 were in the modeling group, 192 in the internal validation group, and 83 in the external validation group. The incidence of NSSI in the modeling group was 32.96% (148/449). Reduced food intake ( OR=10.980, 95% CI 4.462-27.017), passive contact ( OR=4.681, 95% CI 1.986-11.031), Hamilton Depression Rating Scale-17 score >17 ( OR=12.235, 95% CI 4.657-32.141), Hamilton Anxiety Rating Scale score>15 ( OR=27.888, 95% CI 8.700-124.630), Insomnia Severity Index score >15 ( OR=6.357, 95% CI 2.257-17.899), and higher levels of past self-injury ( OR=1.663, 95% CI 1.428-1.935) were independent risk factors for NSSI in adolescents with mood disorders (all P<0.05). The AUC of the nomogram model based on these six factors was 0.973, with a sensitivity of 0.94 and a specificity of 0.89. Conclusions:The risk prediction model for NSSI in adolescents with mood disorders has good discrimination, accuracy, and practicality, and can help identify high-risk NSSI populations among adolescents with mood disorders.