Medical therapy and surgical intervention are the two primary approaches for treating myocardial bridge.However,there remains controversy regarding the use of coronary artery bypass grafting(CABG)and myocardial bridge unroofing.Here,we report a case of myocardial infarction following CABG in a patient with a myocardial bridge.The patient was admitted to Lanzhou First Peopie's Hospital with persistent chest pain,chest tightness,and shortness of breath lasting 2 hours.Physical examination revealed no significant abnormalities.Electrocardiography(ECG)indicated extensive anterior wall myocardial infarction.Laboratory findings showed myoglobin levels of 140.1 ng/ml and troponin Ⅰ levels of 2.59 ng/ml,with no other significant abnormalities.The initial diagnosis was acute extensive anterior wall myocardial infarction.Emergency coronary angiography revealed a myocardial bridge in the mid-segment of the left anterior descending artery(LAD).Emergency CABG using the left internal mammary artery to the LAD was performed,leading to symptomatic improvement,and the patient was discharged in stable condition.However,the patient experienced a recurrent myocardial infarction seven years post-surgery and received secondary preventive medical therapy.The patient is currently under ongoing follow-up care.CABG is an effective treatment for myocardial bridge.However,based on the case reported in this study,we recommend careful evaluation of whether a patient may benefit from CABG.

Objective To explore the value of cardiopulmonary and additional ultrasound(CLAUS)protocol and point-of-care ultrasound rapid management(POCURM)protocol in etiological diagnosis of acute respiratory distress in critically ill patients in the emergency room.Methods A total of 242 patients with acute respiratory distress admitted to Jinhua City Central Hospital from January 2022 to January 2024 were selected as the research subjects.According to the final diagnosis after discharge,they were divided into cardiogenic group(n=144)and pulmonary group(n=98).Compare the CLAUS findings of two groups and accuracy of two protocols in diagnosing etiology of acute respiratory distress.Results The history of heart disease in cardiogenic group was higher than that in pulmonary group,and difference was statistically significant(P＜0.05).The lung disease history of patients in cardiogenic group was lower than that in pulmonary group,and difference was statistically significant(P＜0.05).The proportion of pleural smoothness/slight thickening,sliding presence/slight weakening,left heart dysfunction,right heart dysfunction,and B-line pulmonary ultrasound scores in cardiogenic group were higher than those in pulmonary group,and differences were statistically significant(P＜0.05).The sensitivity,specificity of POCURM protocol for diagnosing acute respiratory distress were 90.28％,91.84％.The sensitivity,specificity of CLAUS protocol for diagnosing acute respiratory distress were 96.53％,97.96％.Conclusion CLAUS regimen can effectively diagnose specific causes of acute respiratory distress in patients,with higher accuracy than POCURM regimen.

TAFRO syndrome is a systemic inflammatory disease with unknown etiology.It has low incidence rate and progresses rapidly,which poses a significant challenge for clinicians to make a timely diagnosis and provide reasonable treatment.This article retrospectively analyzed a 65-year-old male patient with iMCD-TAFRO admitted to Minhang Hospital,Fudan University,and visited the Department of Nephrology due to bilateral lower limb edema.The patient exhibited systemic edema,fever,and multiple enlarged lymph nodes.A comprehensive examination showed thrombocytopenia,renal dysfunction,elevated CRP levels,multiple serosal fluid accumulations,and bone marrow reticulin fibrosis.For further diagnosis and treatment,he visited the Hematology Clinic of Zhongshan Hospital,Fudan University.Based on the clinical manifestations,the diagnosis of TAFRO syndrome was considered.After further lymph node pathological consultation,the diagnosis was confirmed as idiopathic multicentric Castleman disease(iMCD)-TAFRO syndrome.Later,the patient was transferred to the hematology department of Minhang Hospital,Fudan University.After 15 days of treatment with methylprednisolone,cyclosporine A,rituximab,and thrombopoietin,there was no significant improvement in the condition.Due to personal reasons,the patient discontinued further treatment and passed away 2 weeks later.

Objective Exploring the clinical value of pulmonary ultrasound B-line score,left ventricular ejection fraction(LVEF),insulin-like growth factor binding protein-7(IGFBP7),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in diagnosing cardiogenic acute dyspnea.Methods A retrospective analysis was conducted on the clinical data of 80 patients with acute dyspnea diagnosed and treated at Jinhua Municipal Central Hospital from February 2021 to February 2024.According to the discharge diagnosis of patients,they were divided into cardiogenic group(cardiogenic acute dyspnea,50 cases)and non-cardiogenic group(non-cardiogenic acute dyspnea,30 cases).The pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP levels of two groups of patients were compared,their correlations were analyzed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of each index for cardiogenic acute dyspnea.Results There were no statistically significant differences in the clinical baseline data such as age,gender,body mass index,proportion of atrial fibrillation,urea nitrogen,serum creatinine,systolic blood pressure,arterial partial pressure of oxygen,heart rate and blood oxygen saturation between two groups of patients(P＞0.05).The pulmonary ultrasound B-line score,the levels of IGFBP7 and NT-proBNP in cardiogenic group were significantly higher than those in non-cardiogenic group,and the LVEF was significantly lower than that in non-cardiogenic group(P＜0.05).Pearson correlation analysis showed that the pulmonary ultrasound B-line score was positively correlated with both IGFBP7 and NT-proBNP(P＜0.05),with no significant correlation with LVEF(P＞0.05).The results of ROC curve showed that the pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP all had high diagnostic value for cardiogenic acute dyspnea,and the area under the curve were 0.917,0.855,0.946 and 0.925,respectively.Conclusion The pulmonary ultrasound B-line score,LVEF,IGFBP7,and NT-proBNP levels have high diagnostic value for cardiogenic acute dyspnea and are worthy of clinical promotion and application.

Objective To assess the clinical value of a novel surgical technique—Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in the resection of anterior mediastinal masses. Methods Patients who underwent tubeless subxiphoid uniportal video-assisted thoracoscopic surgery via balance-shaped sternal elevation device in anterior mediastinal masses process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to April 2025 were included, and their clinical data were analyzed. Results A total of 4 patients were included, with 2 males and 2 females, aged 58-75 years. The diameter of the tumor was 2.5-3.0 cm. The operation time was 60.0-150.0 min, intraoperative blood loss was 5-10 mL, pain score on the 3rd day after surgery was 0 points, and postoperative hospital stay was 2-3 days. All patients achieved complete resection of the masses and thymus without perioperative complications. Conclusion The tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device technique optimizes surgical visualization and instrument maneuverability while avoiding complications related to conventional anesthesia and tubing, thereby markedly enhancing the minimally invasive profile of anterior mediastinal masses resections. In addition to maintaining procedural safety, this approach effectively reduces postoperative pain and accelerates patient recovery, highlighting its potential for widespread clinical adoption.

Increasing evidence has underscored the significance of post-stroke alterations along gut-brain axis, while its role in pathogenesis and treatment of ischemic stroke (IS) remains largely unexplored. This study aimed to elucidate the therapeutic effects and action targets of Panax notoginseng saponins (PNS) on IS and explore a novel pathogenesis and treatment strategy of IS via profiling the microbial community and metabolic characteristics along gut-brain axis. Our findings revealed for the first time that the therapeutic effect of PNS on IS was microbiota-dependent. Ischemia/reperfusion (I/R) modeling significantly down-regulated Lactobacilli in rats, and PNS markedly recovered Lactobacilli, particularly Lactobacillus reuteri (L.Reu). Metabolomics showed a significant reduction in serum histidine (HIS) in clinical obsolete IS patients and rehabilitation period I/R rats. Meanwhile, the L.Reu colonization in I/R rats exhibited significant neuroprotective activity and greatly increased HIS in serum, gut microbiota, and brain. Moreover, exogenous HIS demonstrated indirect neuroprotective effects through metabolizing to histamine. Notably, vagus nerve severance in I/R rats was performed to investigate HIS's neuroprotective mechanism. The results innovatively revealed that PNS could promote HIS synthesis in gut by enhancing L.Reu proportion, thereby increasing intracerebral HIS through peripheral pathway. Consequently, our data provided novel insights into HIS metabolism mediated by L.Reu in the pathogenesis and treatment of IS.

Objective Exploring the clinical value of pulmonary ultrasound B-line score,left ventricular ejection fraction(LVEF),insulin-like growth factor binding protein-7(IGFBP7),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in diagnosing cardiogenic acute dyspnea.Methods A retrospective analysis was conducted on the clinical data of 80 patients with acute dyspnea diagnosed and treated at Jinhua Municipal Central Hospital from February 2021 to February 2024.According to the discharge diagnosis of patients,they were divided into cardiogenic group(cardiogenic acute dyspnea,50 cases)and non-cardiogenic group(non-cardiogenic acute dyspnea,30 cases).The pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP levels of two groups of patients were compared,their correlations were analyzed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of each index for cardiogenic acute dyspnea.Results There were no statistically significant differences in the clinical baseline data such as age,gender,body mass index,proportion of atrial fibrillation,urea nitrogen,serum creatinine,systolic blood pressure,arterial partial pressure of oxygen,heart rate and blood oxygen saturation between two groups of patients(P＞0.05).The pulmonary ultrasound B-line score,the levels of IGFBP7 and NT-proBNP in cardiogenic group were significantly higher than those in non-cardiogenic group,and the LVEF was significantly lower than that in non-cardiogenic group(P＜0.05).Pearson correlation analysis showed that the pulmonary ultrasound B-line score was positively correlated with both IGFBP7 and NT-proBNP(P＜0.05),with no significant correlation with LVEF(P＞0.05).The results of ROC curve showed that the pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP all had high diagnostic value for cardiogenic acute dyspnea,and the area under the curve were 0.917,0.855,0.946 and 0.925,respectively.Conclusion The pulmonary ultrasound B-line score,LVEF,IGFBP7,and NT-proBNP levels have high diagnostic value for cardiogenic acute dyspnea and are worthy of clinical promotion and application.

Objective To explore the value of cardiopulmonary and additional ultrasound(CLAUS)protocol and point-of-care ultrasound rapid management(POCURM)protocol in etiological diagnosis of acute respiratory distress in critically ill patients in the emergency room.Methods A total of 242 patients with acute respiratory distress admitted to Jinhua City Central Hospital from January 2022 to January 2024 were selected as the research subjects.According to the final diagnosis after discharge,they were divided into cardiogenic group(n=144)and pulmonary group(n=98).Compare the CLAUS findings of two groups and accuracy of two protocols in diagnosing etiology of acute respiratory distress.Results The history of heart disease in cardiogenic group was higher than that in pulmonary group,and difference was statistically significant(P＜0.05).The lung disease history of patients in cardiogenic group was lower than that in pulmonary group,and difference was statistically significant(P＜0.05).The proportion of pleural smoothness/slight thickening,sliding presence/slight weakening,left heart dysfunction,right heart dysfunction,and B-line pulmonary ultrasound scores in cardiogenic group were higher than those in pulmonary group,and differences were statistically significant(P＜0.05).The sensitivity,specificity of POCURM protocol for diagnosing acute respiratory distress were 90.28％,91.84％.The sensitivity,specificity of CLAUS protocol for diagnosing acute respiratory distress were 96.53％,97.96％.Conclusion CLAUS regimen can effectively diagnose specific causes of acute respiratory distress in patients,with higher accuracy than POCURM regimen.

Objective To conduct a bibliometric analysis of domestic and international literature on the research of Sijunzi Decoction over the past 20 years,and to explore the research status,hotspots,and development trends of Sijunzi Decoction.Methods This article retrieved journal articles related to the research of Sijunzi Decoction from 2004 to 2024 in the CNKI,Wanfang,VIP,and Web of Science databases.Microsoft Excel was used for publication volume analysis,while CiteSpace software was employed for keyword co-occurrence,clustering,and burst analysis,and then the analysis results were visualized.Results After literature retrieval and screening,3 573 Chinese articles and 113 English articles were included.Over the past two decades,the publication volume showed a trend of steadily increasing.The most frequent keywords in Chinese and English literature on the research of Sijunzi Decoction were spleen deficiency syndrome and gene expression,while the keywords with strongest burst were experimental research and data mining.Conclusion The research of Sijunzi Decoction in the last 20 years was mainly through animal experiments and clinical applications,and the research hotspots focus on the treatment of diseases of spleen deficiency syndrome and on the improvement of immune function of cancer patients.The extraction and identification of active components in Sijunzi Decoction and the study on the therapeutic mechanism in diseases of spleen deficiency syndrome are probably the future research trends.