The heart serves as the "energy factory" of the human body and is responsible for maintaining blood circulation and oxygen supplies.Its normal functioning thus relies on the generation of substantial amounts of ATP to support its mechanical activities.Under pathological conditions such as myocardial infarction,coronary artery sclerosis,and pulmonary hypertension,however,an insufficient blood supply leads to a reduced oxygen supply,subsequently activating a series of compensatory protective mechanisms.Hypoxia-inducible factor-1α(HIF-1α),as a nuclear transcription factor stably expressed under hypoxic conditions,has been shown to regulate oxygen transport by promoting angiogenesis and vasodilation,and to optimize oxygen utilization by regulating the balance of glucose and lipid metabolisms,thus participating in the regulation of various cardiac diseases.HIF-1α plays a crucial role in regulating cardiac energy metabolism and oxidative stress.This review systematically summarizes recent research regarding the various mechanisms of action of HIF-1α in reprogramming cardiac energy metabolism,explores its potential clinical applications in cardiovascular diseases,and proposes future research directions and possible treatment strategies.By comprehensively summarizing the mechanism of HIF-1α in ischemic heart disease,this article aims to provide new ideas and therapeutic targets for the prevention and treatment of cardiovascular diseases.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

BACKGROUND:Rev-erbα is involved in the regulation of inflammation,but pharmacological activation of Rev-erbα increases the risk for cardiovascular diseases.To reduce the relevant risk,an exploration on SR9009,a Rev-erbα agonist,combined with other drugs to relieve inflammation in skeletal myoblasts was conducted,laying the theoretical foundation for the treatment of inflammation-associated skeletal muscle atrophy. OBJECTIVE:To investigate the relationship of SR9009,indolepropionic acid and nuclear factor-κB signaling pathways in lipopolysaccharide-induced C2C12 myoblasts. METHODS:(1)C2C12 myoblasts were induced to differentiate in the presence of lipopolysaccharide(1 μg/mL).RNA-seq and KEGG pathway analysis were used to study signaling pathways.(2)C2C12 myoblast viability was assessed using the cell counting kit-8 assay to determine optimal concentrations of indolepropionic acid.Subsequently,cells were categorized into control group,lipopolysaccharide(1 μg/mL)group,SR9009(10 μmol/L)+lipopolysaccharide group,indolepropionic acid(80μmol/L)+lipopolysaccharide group,and SR9009+indolepropionic acid+lipopolysaccharide group.ELISA was employed to measure protein expression levels of interleukin-6 in the cultured supernatant.Real-time quantitative PCR were employed to measure mRNA expression levels of interleukin-6,tumor necrosis factor α,TLR4 and CD14.Western blot assay were employed to measure protein expression levels of NF-κB p65 and p-NF-κB p65.(3)After Rev-erbα was knocked down by siRNA,knockdown efficiency was assessed by RT-qPCR.And mRNA levels of interleukin-6 and tumor necrosis factor α were also measured. RESULTS AND CONCLUSION:Compared with the blank control group,lipopolysaccharide time-dependently inhibited myofibroblast fusion to form myotubes,the mRNA expression levels of interleukin-6 and tumor necrosis factor α were elevated,and the level of interleukin-6 in the cell supernatant was significantly increased.The results of KEGG pathway showed that the nuclear factor-κB signaling pathway was activated by lipopolysaccharide.Indolepropionic acid exhibited significant suppression of C2C12 myoblasts viability when its concentration exceeded 80 μmol/L.Indolepropionic acid and SR9009 inhibited the activation of NF-κB signaling pathway,thereby played an anti-inflammatory role,and suppressed the mRNA expression levels of interleukin-6,tumor necrosis factor α,TLR4 and CD14.Compared with the lipopolysaccharide group,the ratio of p-NF-κB p65/NF-κB p65 protein expression were downregulated.SR9009 combined with indolepropionic acid notably reduced lipopolysaccharide-induced inflammation,further downregulated the mRNA expression levels of interleukin-6,tumor necrosis factor α,TLR4 and CD14.The ratio of p-NF-κB p65/NF-κB p65 protein expression was significantly lower than that in the SR9009+lipopolysaccharide group or indolepropionic acid+lipopolysaccharide group.Rev-erbα increases time-dependently with lipopolysaccharide induction.The knockdown efficiency of Rev-erbα by siRNA reached over 58%,and lipopolysaccharide was added after Rev-erbα was successfully knocked down.Compared with the lipopolysaccharide group,the mRNA expression levels of interleukin-6 and tumor necrosis factor α were significantly up-regulated.These results conclude that Rev-erbα may act as a promising pharmacological target to reduce inflammation.SR9009 targeted activation of Rev-erbα combined with indolepropionic acid significantly inhibits the nuclear factor-κB signaling pathway and attenuates the inflammatory response of C2C12 myofibroblasts.Moreover,the combined anti-inflammatory effect is superior to that of the intervention alone.

The diagnostic value of Mycobacterium tuberculosis(MTB)complex and rifampicin resistance test kits(fluorescence PCR method)in detecting for MTB complex and rifampicin resistancein sputum samples was evaluated.A total of 271 patients with suspected tuberculosis were prospectively and consecutively enrolled at Hunan Chest Hospital between April 1,2024,and November 30,2024.Of these,229 patients were confirmed to have tuberculosis,whereas 42 patients were not-tuberculosis samples were col-lected from all patients and subjected to fluorescence PCR,Xpert MTB/RIF(abbreviated as Xpert),and MGIT 960 culture and drug sensitivity testing.Clinical diagnosis and MTB culture results served as reference standards for TB diagnosis,whereas phenotypic drug susceptibility testing and Xpert served as reference standards to for assessment of rifampicin resistance.The sensitivity,specificity,positive predictive value,and negative predictive value of the fluorescence PCR method were analyzed.Kappa tests were performed to analyze the concordance between detection techniques.With clinical diagnosis as the gold standard,the sensitivity and specificity of the fluorescence PCR method for the diagnosis of TB were 65.1%(149/229)and 97.6%(41/42),and the consistency test for the fluo-rescence PCR and Xpert methods showed high consistency(Kappa value=0.993).With the MGIT 960 liquid culture as the reference standard,the positive detection rate of the fluorescence PCR method for the detection of patients with positive cultures was 91.9%(102/111,95%CI:85.2%-96.2%),and the positive detection rate for 147 patients with sputum culture-negative TB was 27.9%(41/147,95%CI:21.3%-35.6%).With the phenotypic drug sensitivity test as the gold standard,the sensitivity and specificity of the fluo-rescence PCR method for the detection of rifampicin resistance were 100.0%(31/31)and 96.6%(28/29)respectively,and the consis-tency between tests was high(Kappa value=0.967).With Xpert as the gold standard,the sensitivity and specificity of fluorescence PCR for the detection of rifampicin resistance were 95.8%(46/48)and 99.0%(99/100),respectively,and the consistency between tests was high(Kappa value=0.953).Finally,samples with rifampicin resistance detected with the fluorescence PCR method had a clear rpoB gene mutation type according to one-generation sequencing.In conclusion,the fluorescence PCR method showed high sen-sitivity in detecting MTB complex groups and rifampicin resistance,and had high concordance with Xpert.Therefore,this technique can serve a rapid test for TB diagnosis to increase the rate of positive TB pathology and detection of rifampicin resistance.This method is particularly suitable for use in lower-income countries and economically disadvantaged grassroots communities.

Objective:To investigate the molecular mechanism of Xiaoshuantongmai Decoction(XSTMD)targeting JAK2/STAT3 signaling pathway to regulate the function of dendritic cells(DCs)in treatment of deep vein thrombosis(DVT).Methods:After treatment of DVT with XSTMD,expressions of fibrinogen beta chain(FGB)and D-dimer(D2D)protein in plasma of patients with DVT were detected by ELISA,proportion of plasmacytoid dendritic cell(pDC)and conventional dendritic cell(cDC),and expression of HLA-DR protein in peripheral blood mononuclear cells(PBMCs)of patients with DVT were detected by flow cytometry,expressions of CD80 and CD86 mRNA were detected by qRT-PCR,Western blot was used to detect protein levels of JAK2,STAT3 and phosphory-lation(p-JAK2 and p-STAT3)in PBMC of DVT patients and mice.LPS-induced mouse DC2.4 cells were treated with XSTMD drug-containing serum.Western blot was used to determine the protein levels of JAK2,STAT3,p-JAK2 and p-STAT3.ELISA was used to detect protein levels of IL-6,TNF-α,IL-10 and TGF-β1 in cell culture supernatant.Results:After treatment with XSTMD,weight and length of thrombus were significantly reduced in mice with DVT(P<0.001).Compared with before treatment,expressions of FGB and D2D were significantly decreased in plasma of DVT patients(P<0.001),proportion of pDC was significantly increased,while pro-portion of cDC was significantly decreased in PBMC of DVT patients(P<0.01),expression of HLA-DR protein and mRNA levels of CD80 and CD86 were significantly decreased in PBMC of DVT patients(P<0.05,P<0.01,P<0.001)after treatment with XSTMD.Levels of p-JAK2 and p-STAT3 protein were significantly increased in PBMC from DVT patients and mice treated with XSTMD(P<0.05).After treatment with serum containing XSTMD,protein levels of p-JAK2 and p-STAT3 induced by LPS were significantly increased in murine DC2.4 cells(P<0.05).Protein expressions of IL-6 and TNF-α were significantly decreased,while protein expressions of IL-10 and TGF-β1 were significantly increased in cell supernatant(P<0.01,P<0.001).Conclusion:XSTMD effectively treats DVT by pre-cisely regulating the JAK2/STAT3 signaling pathway to promote the differentiation of DCs into pDC and alleviate inflammatory injury.

Objective:To systematically review and evaluate risk prediction models for radiation dermatitis in breast cancer patients, providing a reference for developing higher-quality prediction models.Methods:A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, and China Biomedical Literature Database for studies related to risk prediction models for radiation dermatitis in breast cancer patients. The search timeframe was from database inception to February 28, 2024. Two researchers independently screened relevant literature based on inclusion and exclusion criteria, extracted the basic characteristics of the studies, and performed analysis. The included models were assessed for risk of bias and applicability.Results:A total of 8 articles involving 9 models were included, covering a total sample size of 1 291 cases, with 10 to 144 outcome events. The number of predictors ranged from 2 to 10, with common predictors including body mass index, smoking history, and breast volume, radiation dose, etc. The AUC values of the included models ranged from 0.76 to 0.98. The overall risk of bias for the models was relatively high, mainly due to issues related to study design, missing data handling, variable selection, and model validation.Conclusions:Existing risk prediction models for radiation dermatitis in breast cancer patients have certain limitations. It is recommended that future research further improve study designs, validate and optimize existing models, and develop high-performance risk prediction models.

Factitious Disorder is a chronic and difficult-to-diagnose artificial illness characterized by the in-dividual's recurrent simulation of symptoms,deliberate self-harm to produce signs or symptoms,and a high likeli-hood of misdiagnosis and mistreatment in clinical settings.This article introduces a case of a 10-year-old girl with factitious disorder who was misdiagnosed as Henoch-Schonlein purpura in 4 medical institutions,which was the first simulated case of Henoch-Schonlein purpura in China.Based on the literature analysis of factitious disorder,the au-thor combed and analyzed the literature in order to improve clinicians'awareness of the disease and reduce misdiag-nosis and mistreatment.

Objective:To systematically review risk prediction models for frailty in maintenance hemodialysis (MHD) patients.Methods:Relevant literature on frailty risk prediction models for MHD patients were retrieved from PubMed, Web of Science, Embase, Cochrane Library, CINHAL, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine disc from inception to March 25, 2024. Two researchers independently screened the literature and extracted data. The PROBAST tool was used to assess the methodological quality of the prediction models. Meta-analysis of predictive factors was conducted using Stata 16.0 software.Results:A total of 13 studies were included, comprising 19 frailty risk prediction models for MHD patients. All studies exhibited a high risk of bias. Six studies conducted internal validation, and three studies conducted external validation. The area under the receiver operating characteristic curve ( AUC) of the included prediction models ranged from 0.720 to 0.998. Meta-analysis revealed that age [ OR=1.149, 95% CI (1.070, 1.234), P<0.001], female gender [ OR=4.472, 95% CI (1.799, 11.117), P<0.001], nutritional score [ OR=2.650, 95% CI (1.010, 6.970), P=0.048], comorbidities [ OR=1.990, 95% CI (1.500, 2.650), P<0.001], and serum albumin [ OR=0.830, 95% CI (0.790, 0.880), P<0.001] were significant influencing factors for frailty in MHD patients. Conclusions:Risk prediction models for frailty in MHD patients are still in the research stage. Healthcare professionals should pay close attention to frailty risks in older patients, females, those with malnutrition, comorbidities, and low serum albumin levels, and implement timely interventions.

Factitious Disorder is a chronic and difficult-to-diagnose artificial illness characterized by the in-dividual's recurrent simulation of symptoms,deliberate self-harm to produce signs or symptoms,and a high likeli-hood of misdiagnosis and mistreatment in clinical settings.This article introduces a case of a 10-year-old girl with factitious disorder who was misdiagnosed as Henoch-Schonlein purpura in 4 medical institutions,which was the first simulated case of Henoch-Schonlein purpura in China.Based on the literature analysis of factitious disorder,the au-thor combed and analyzed the literature in order to improve clinicians'awareness of the disease and reduce misdiag-nosis and mistreatment.

The heart serves as the "energy factory" of the human body and is responsible for maintaining blood circulation and oxygen supplies.Its normal functioning thus relies on the generation of substantial amounts of ATP to support its mechanical activities.Under pathological conditions such as myocardial infarction,coronary artery sclerosis,and pulmonary hypertension,however,an insufficient blood supply leads to a reduced oxygen supply,subsequently activating a series of compensatory protective mechanisms.Hypoxia-inducible factor-1α(HIF-1α),as a nuclear transcription factor stably expressed under hypoxic conditions,has been shown to regulate oxygen transport by promoting angiogenesis and vasodilation,and to optimize oxygen utilization by regulating the balance of glucose and lipid metabolisms,thus participating in the regulation of various cardiac diseases.HIF-1α plays a crucial role in regulating cardiac energy metabolism and oxidative stress.This review systematically summarizes recent research regarding the various mechanisms of action of HIF-1α in reprogramming cardiac energy metabolism,explores its potential clinical applications in cardiovascular diseases,and proposes future research directions and possible treatment strategies.By comprehensively summarizing the mechanism of HIF-1α in ischemic heart disease,this article aims to provide new ideas and therapeutic targets for the prevention and treatment of cardiovascular diseases.