Immune checkpoint inhibitors can induce a rare but fatal complication known as hemophagocytic lymphohistiocytosis(HLH). However, reports of ICI-related HLH in breast cancer are extremely limited, and no cases induced by the combination of toripalimab with chemotherapy have been documented. This article reports a case of a breast cancer patient who developed persistent high fever 13 days after receiving toripalimab combined with chemotherapy. Diagnostic evaluations met the HLH-2004 diagnostic criteria. Following methylprednisolone pulse therapy, the patient's symptoms improved rapidly, with subsequent consolidation treatment involving low-dose etoposide. Follow-up examinations one month after discharge showed normal results. This case suggests that toripalimab may induce HLH in breast cancer patients and that initial treatment with glucocorticoids alone can be effective. It provides a reference for the early clinical identification and management of such severe immune-related adverse events.

Objective: To analyze the cause of discrepancy between ABO genotype B102/O01 and serological results in one case by PCR-SSP, to clarify the serological characteristics of this special blood group, and to explore relevant blood transfusion strategies. Methods: Blood group serological tests were performed on blood donor in August and December 2024, including forward and reverse ABO typing using tube method, H antigen identification, direct anti-human globulin test by tube method, red blood cell absorption-elution test, and determination of ABH blood group substance in saliva. Exons 1-7 of the ABO gene were amplified by PCR-SSP and sequenced. Results: The two separate serological tests consistently identified the donor as having an A B phenotype, but the results of gene sequencing indicated a B102/O01 genotype, showing an discrepancy between serological and genetic results. Conclusion: It is very likely that the blood type of the blood donor is B102/O01 with a microchimerism of type A, or an AB type masked by A type reference gene.

Based on the theory of "shaoyang（少阳） resembling the pivot" and collateral diseases， this article proposes that pulmonary fibrosis （PF） can be divided into three stages including wind bi （痹）， constraint bi， and atrophy bi. The core pathogenesis of PF is the obstruction of the pivot and pulmonary collateral obstruction. In terms of treatment， the basic principles are to harmonize and regulate the pivot， and to promote the circulation of the lung collaterals. Depending on the different characteristics of the "essence-attribute-function"， treatment methods such as harmonizing and regulating the pivot， resolving phlegm and removing stasis， supplementing deficiency and harmonizing collaterals are suggested. This approach ensures the regulation of the pivot， smooth circulation of qi and blood， unblocking of the lung collaterals and nourishing the lung body， achieving the goals of balancing the ascending and descending of qi， removing phlegm and stasis， and relieving cough and wheezing.

ObjectiveTo investigate the effects of Huanglian Jiedutang （HLJDT） on cognitive function in mice with ischemic stroke （IS） and to elucidate whether its neuroprotective effects are mediated by inhibition of the nuclear factor-κB （NF-κB） signaling pathway and subsequent suppression of NF-κB-regulated neuronal apoptosis. MethodsAn IS model was established using middle cerebral artery occlusion （MCAO）. Sixty C57BL/6J mice were randomly assigned to five groups （n =12 per group）， i.e.， sham operation， model， HLJDT low-dose （3.9 g·kg^-1·d^-1）， HLJDT high-dose （7.8 g·kg^-1·d^-1）， and Ginkgo biloba extract （GBE， 31.2 mg·kg^-1·d^-1）. Post-operatively， neurological deficit scores （Longa score）， cerebral infarct volume assessed by 2，3，5-triphenyltetrazolium chloride （TTC） staining， and brain water content were evaluated. Learning and memory were assessed using new object recognition （NOR） and fear conditioning （FC） tests. Hippocampal pathology was examined via hematoxylin and eosin （HE） staining. Immunofluorescence detected expression of glial fibrillary acidic protein （GFAP， astrocyte marker）， cellular oncogene Fos （c-Fos， neuronal activation marker）， and glutamate decarboxylase 65 （GAD65）. Western blot measured nuclear factor-κB inhibitor protein α （IκBα）， phosphorylated IκBα （p-IκBα）， NF-κB p65， phosphorylated NF-κB p65 （p-NF-κB p65）， ionic calcium binding adapter molecule 1 （Iba-1）， tumor necrosis factor （TNF）-α， interleukin （IL）-1β， and apoptosis-related proteins， such as cleaved cysteinyl aspartate-specific protease 3 （Caspase-3）， B-cell lymphoma 2 （Bcl-2）， and Bcl-2-associated X protein （Bax）. Real-time quantitative PCR （Real-time PCR） was used to assess mRNA levels of Iba-1， TNF-α， IL-1β， NF-κB p65， cleaved Caspase-3， Bax， and Bcl-2. ResultsCompared with the sham group， the model group exhibited significantly increased neurological deficit scores， brain water content， and cerebral infarct volume （P<0.01）. Hippocampal CA1 neurons were disorganized， showing nuclear pyknosis and karyolysis. NOR exploration time and FC freezing time were significantly reduced （P<0.01）. GFAP and c-Fos expression were increased， while GAD65 expression was decreased （P<0.01）. Cleaved Caspase-3 and Bax were upregulated， Bcl-2 was downregulated， and the Bax/Bcl-2 ratio was elevated （P<0.01）. Expression levels of p-IκBα， p-NF-κB p65， IL-1β， TNF-α， and Iba-1 were significantly increased （P<0.01）. Compared with the model group， HLJDT high-dose， low-dose， and GBE groups showed significant improvements in all parameters （P<0.01）. Among them， the HLJDT high-dose group showed the most pronounced neuronal structural recovery and superior performance in NOR and FC tests （P<0.01）. In this group， GFAP and c-Fos decreased， GAD65 increased （P<0.01）， apoptosis-related protein expression was reversed， and NF-κB signaling and related inflammatory factor expression were suppressed （P<0.01）. ConclusionHLJDT ameliorates cognitive dysfunction in mice after IS， potentially by inhibiting the NF-κB signaling pathway， thereby reducing neuroinflammation and hippocampal neuronal apoptosis.

ObjectiveTo investigate the intervention effect of modified Xiangsha Liujunzitang （M-XSLJZ） on insulin resistance-regulated fatty acid synthesis via Lon protease 1 （Lonp1） in the liver of spleen-deficiency hyperlipidemia rats. MethodsA total of 70 male SD rats were randomly allocated into seven groups （n=10）： blank control group， high-fat diet （HFD） group， spleen-deficiency hyperlipidemia （PX-HFD） model group， low-， medium-， and high-dose Modified Xiangsha Liujunzitang （JW-L， JW-M， JW-H）， and rosuvastatin group. The spleen-deficiency model was induced in the PX-HFD， JW-L， JW-M， JW-H， and rosuvastatin groups by irregular diet combined with exhaustive swimming. Except for the control group， all groups were fed an HFD for 10 weeks to establish a hyperlipidemia rat model. Following modeling， the rats in the JW-L， JW-M， and JW-H groups received the decoction by gavage at 3.51， 7.02， 14.04 g·kg^-1， respectively， while the rosuvastatin group received 9×10^-4 g·kg^-1. After 8 weeks of administration， samples were collected. D-xylose excretion rate was quantified using the phloroglucinol method. Serum levels of total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C） were measured by an automatic biochemical analyzer. Hepatic TG content was quantified by the glycerol phosphate oxidase-peroxidase anti-peroxidase （GPO-PAP） method. Serum insulin （INS）， fasting blood glucose （FBG）， hepatic reactive oxygen species （ROS） levels， and mitochondrial complex Ⅰ activity were assessed by enzyme-linked immunosorbent assay （ELISA）. The mRNA levels of Lonp1， and acetyl-CoA carboxylase 1 （ACC1） were determined by real-time quantitative PCR （Real-time PCR）. Protein expression levels of Lonp1， c-Jun N-terminal kinase （JNK）， phosphorylated （p）-JNK， insulin receptor substrate 1 （IRS1）， p-IRS1， and ACC1 in liver tissues were analyzed by Western blot. ResultsCompared with the control group， the HFD group showed a significant increase in body weight （P<0.01）. The PX-HFD group showed a significant decrease in D-xylose excretion rate （P<0.01）. Both the HFD and PX-HFD groups exhibited significantly elevated serum levels of TC， TG， HDL-C， LDL-C， FBG， INS， and HOMA-IR （P<0.01）， along with increased orange-red lipid droplets， prominent fatty vacuoles， and significantly elevated hepatic TG level （P<0.01）. Mitochondrial complex Ⅰ activity significantly decreased （P<0.05）， while ROS level， Lonp1 mRNA and protein expression， and ACC1 mRNA and protein expression significantly increased （P<0.05， P<0.01）. The p-IRS1/IRS1 protein expression ratio significantly decreased （P<0.01）， whereas the p-JNK/JNK protein expression ratio significantly increased （P<0.01）. Compared with the HFD group， the PX-HFD group showed significantly reduced D-xylose excretion rate and serum HDL-C level （P<0.01）， significantly decreased hepatic TG level （P<0.05）， and significantly increased HOMA‑IR index （P<0.01）. Hepatic Lonp1 mRNA and protein expression significantly decreased （P<0.05， P<0.01）， p‑IRS1/IRS1 protein expression ratio was significantly decreased （P<0.01）， while ACC1 mRNA and protein expression and p‑JNK/JNK protein expression ratio were significantly increased （P<0.01）. Compared with the PX-HFD group， all treatment groups showed significantly reduced serum TC， TG， LDL-C levels， and HOMA-IR index （P<0.05， P<0.01）， with ameliorated orange‑red lipid droplet deposition and significantly reduced hepatic TG and ROS levels （P<0.05， P<0.01）. The JW-M， JW-H， and rosuvastatin groups exhibited significantly decreased body weight （P<0.05， P<0.01）， significantly increased D‑xylose excretion rate （P<0.01）， significantly decreased HDL‑C level （P<0.05， P<0.01）， significantly increased mitochondrial complex I activity， Lonp1 mRNA and protein expression， and p-IRS1/IRS1 protein expression ratio （P<0.05， P<0.01）， as well as significantly decreased p-JNK/JNK protein expression ratio （P<0.01）. ConclusionM-XSLJZ may exert its lipid‑lowering effect by regulating Lonp1 expression in rat liver， thereby improving insulin resistance and subsequently inhibiting hepatic lipid synthesis.

OBJECTIVE To establish population pharmacokinetic model of levetiracetam （Lev） for Chinese patients with post- stroke epilepsy （PSE）， and provide reference for formulating individualized dosing regimens for Lev therapy in this specific population. METHODS Blood concentration data and clinical diagnosis and treatment information of PSE patients meeting the inclusion criteria were retrospectively collected and divided into model group and validation group at an 8∶2 ratio using a random number method. Based on the model group data， a population pharmacokinetic model was developed using nonlinear mixed-effects modeling. Internal evaluation was performed through goodness-of-fit tests and bootstrap analysis， while external validation was conducted using the validation group data. RESULTS A total of 75 blood concentration measurements from 70 PSE patients were collected， with 60 measurements from 55 patients used for model development and 15 measurements from 15 patients reserved for external validation. The final model estimated a population typical value of clearance at 2.98 L/h. Estimated glomerular filtration rate， daily dose， and homocysteine level significantly influenced clearance of Lev （P＜0.01）. The model demonstrated satisfactory predictive performance， as evidenced by goodness-of-fit tests， bootstrap analysis， and external validation results. CONCLUSIONS Daily dose， estimated glomerular filtration rate， and homocysteine level are identified as significant covariates influencing Lev clearance in Chinese PSE patients. When making clinical decisions， comprehensive consideration should be given to the patient’s treatment response， physiological and pathological conditions， and the occurrence of adverse reactions， etc. The dosage of Lev should be adjusted based on the results of population pharmacokinetic model.

Objective To investigate the efficacy of Fumai Zhuyu Decoction combined with radial shock wave therapy(RSWT)in treating convalescent stroke patients with lower limb spasm,and to observe its effect on serum neuron-specific enolase(NSE)and transforming growth factor-β1(TGF-β1).Methods From January 2022 to January 2024,a total of 111 convalescent stroke patients with lower limb spasm of qi deficiency and blood stasis syndrome were selected from the First Affiliated Hospital of Hebei North University.According to the treatment method,the patients were divided into two groups.The 55 patients in the western medicine(WM)group were treated with RSWT,and 56 patients in the traditional Chinese medicine(TCM)group were treated with Fumai Zhuyu Decoction orally and RSWT.The course of treatment for the two groups covered 6 months.Before and after treatment,the two groups were observed in the changes of modified Ashworth Scale(MAS)score for the evaluation of muscle tone of hemiplegic limbs,Clinical Spasticity Index(CSI)score,Barthel Index(BI)score for the evaluation of activities of daily living,three-dimensional gait parameters(velocity,cadence,step length),serum levels of NSE and TGF-β1,and hemorheological indicators of plasma viscosity(PV),low-shear blood viscosity(LBV),high-shear blood viscosity(HBV)and platelet aggregation rate(PAR).After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 6 months of treatment,the total effective rate of the TCM group was 94.64%(53/56),and that of the WM group was 76.36%(42/55).The intergroup comparison(tested by chi-square test)showed that the efficacy of the TCM group was significantly superior to that of the WM group(P＜0.01).(2)After treatment,the MAS and CSI scores of the two groups were lowered(P＜0.05)and the BI scores were increased compared with those before treatment(P＜0.05).The decrease of MAS and CSI scores and the increase of BI scores in the TCM group were significantly superior to those in the WM group(P＜0.01).(3)After treatment,the three-dimensional gait parameters of velocity,cadence,and step length in the two groups were increased compared with those before treatment(P＜0.05),and the increase of gait parameters in the TCM group was significantly superior to that in the WM group(P＜0.01).(4)After treatment,the serum NSE level of the two groups was significantly decreased that before treatment(P＜0.05),and the serum TGF-β1 level was significantly increased compared with that before treatment(P＜0.05).The decrease of serum NSE level and the increase of serum TGF-β1 level in the TCM group were significantly superior to those in the WM group(P＜0.01).(5)After treatment,the hemorheological indexes such as PV,LBV,HBV and PAR in the two groups were significantly lowered compared with those before treatment(P＜0.05),and the decrease in the TCM group was significantly superior to that in the WM group(P＜0.01).Conclusion Fumai Zhuyu Decoction combined with RSWT can effectively improve the limb spasm degree and walking function,reduce serum NSE level,increase serum TGF-β1 level,and correct the abnormal blood hemorheology in convalescent stroke patients with lower limb spasm of qi deficiency and blood stasis syndrome.The curative effect of the combined treatment is significantly superior to that of RSWT alone.

Objective To explore the effects of Jingling Oral Liquid(mainly composed of Polygoni Multiflori Radix,Polygonati Rhizoma,Platycladi Semen,Nelumbinis Semen,Ligustri Lucidi Fructus,Poria,and Lilii Bulbus)as an adjunctive therapy on cognitive,motor,and social abilities in children with global developmental delay(GDD).Methods A total of 120 children with GDD who visited the Department of Neurological Rehabilitation at Hebei Children's Hospital from July 2021 to November 2023 were selected as the study subjects.The children were randomly divided into a control group and a trial group using a random number table,with 60 children in each group.The control group received conventional comprehensive rehabilitation training,while the trial group received Jingling Oral Liquid as an adjunctive therapy in addition to the control group's treatment.The treatment course lasted 12 weeks.Before and after treatment,the changes in Gesell Developmental Scale(GDS)scores,Peabody Developmental Motor Scales(PDMS)scores,motor function scores,and language ability scores in both groups were observed to evaluate the cognitive,motor,and social abilities of the children.Results(1)After treatment,the scores of all dimensions of the GDS,including adaption,developmental quotient of fine motor,language developmental quotient,and personal-social developmental quotient,were significantly increased in both groups compared to those before treatment(P＜0.01),and the improvement of GDS scores in the trial group was significantly superior to that in the control group(P＜0.01).(2)After treatment,the scores of all dimensions of the PDMS,including fine developmental quotient score,standardized score of visual-motor integration,and standardized score of grasping,were significantly increased in both groups compared to those before treatment(P＜0.01),and the improvement of PDMS scores in the trial group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the scores of motor function indicators of fine motor quotient(FMQ),gross motor quotient(GMQ),and total motor quotient(TMQ)were significantly increased in both groups compared to those before treatment(P＜0.01),and the improvement of motor function scores in the trial group was significantly superior to that in the control group(P＜0.01).(4)After treatment,the language ability scores were significantly increased in both groups compared to those before treatment(P＜0.01),and the improvement of language ability scores in the trial group was significantly superior to that in the control group(P＜0.01).Conclusion The combination of Jingling Oral Liquid with conventional comprehensive rehabilitation training can effectively improve the cognitive,motor,and social abilities of children with GDD.

Objective To evaluate the effects of Qitan Decoction(QTD)combined with radial shockwave therapy(RSWT)on walking ability,balance function,and neural injury markers in stroke patients with lower limb spasticity during convalescence.Methods A retrospective study was conducted on 100 stroke patients with lower limb spasticity of qi deficiency and blood stasis type treated at the First Affiliated Hospital of Hebei North University from December 2021 to December 2023.Patients were divided into a conventional group(n=49,receiving RSWT alone)and an trial group(n=51,receiving RSWT plus QTD)based on treatment protocols.Both groups received standard stroke care(including cerebral metabolism improvement,neurotrophic support,and antiplatelet therapy).The intervention lasted 6 months.The changes in Modified Ashworth Scale(MAS)scores,Functional Gait Assessment(FGA)scores,Berg Balance Scale(BBS)scores,Stroke-Specific Quality of Life(SS-QOL)scores,serum neural injury markers[gama-aminobutyric acid(GABA),brain-derived neurotrophic factor(BDNF)],and kinematic parameters(peak knee flexion,peak hip flexion)were observed,and the clinical efficacy was compared between groups.Results(1)After 6 months of treatment,the total effective rate of the trial group was 94.12％(48/51),and that of the conventional group was 75.51％(37/49),and the intergroup(by chi-square test)comparison showed that the efficacy of the trial group was significantly superior to that of the conventional group(P＜0.01).(2)After treatment,the MAS scores of patients in the two groups were lower than before treatment(P＜0.05),and the FGA,BBS,and SS-QOL scores were higher than before treatment(P＜0.05),and the reduction of the MAS scores and the increase of the FGA,BBS,and SS-QOL scores of the trial group were significantly superior to those of the conventional group(P＜0.01).(3)After treatment,the serum GABA and BDNF levels of patients in the two groups were higher than those before treatment(P＜0.05),and the increase in serum GABA and BDNF levels in the trial group was significantly superior to that in the conventional group(P＜0.01).(4)After treatment,the peak knee flexion and peak hip flexion of patients in the two groups were elevated compared with those before treatment(P＜0.05),and the trial group's elevation of peak knee flexion and peak hip flexion was significantly superior to that of the conventional group(P＜0.01).Conclusion QTD combined with RSWT effectively alleviates spasticity,enhances walking/balance function,mitigates neural injury,and improves quality of life in stroke patients with lower limb spasticity of qi deficiency and blood stasis syndrome during convalescence.