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.

ObjectiveThis study employed the scoping review method to systematically retrieve and analyze the basic information and clinical research evidence of expensive Chinese patent medicines （CPMs）， aiming to provide a basis for future related research and clinical applications. MethodsEight Chinese and English databases were systematically searched for the clinical research evidence on expensive CPMs. ResultsEleven expensive CPMs （Angong Niuhuang Wan， Jufang Zhibao Wan， Suhexiang Wan， Pien Tze Huang， Niuhuang Qingxin Wan， Qinggong Shoutao Wan， Compound Realgar Natural Indigo Tablets， Xihuang Wan， Dingkun Wan， Babao Wan， and Guilingji Capsules） were selected. A total of 365 related studies were included in this review， comprising 331 clinical studies （of which 291 were randomized controlled trials）， 30 systematic reviews and Meta-analyses， 3 expert consensus， and 1 rapid health technology assessment. Among the 11 CPMs， 2（Angong Niuhuang Wan and Jufang Zhibao Wan） had a daily price over 500 yuan. The famous and precious Chinese medicinal materials involved included Moschus （frequency of 7）， Bovisc Alculus （7）， and Borneol （5）. The dosage forms included pills， capsules， oral liquid， tablets， and lozenges. The diseases treated by these CPMs mainly included malignant tumors， cerebrovascular diseases， gynecological diseases， and hepatobiliary system diseases. The sample sizes of the clinical studies were mainly concentrated within the range of 51-100 cases， and the main control form was CPM + basic Western medicine treatment vs. basic Western medicine treatment. The 331 clinical studies reported a total of 44 adverse events occurred， of which 36 were determined to be adverse reactions. ConclusionThe scarcity of raw materials leads to the high prices of expensive CPMs. The difficulty of conducting clinical research and the critical and severe cases treated lead to a lack of clinical research evidence with large sample sizes. The uneven distribution of existing studies， incomplete information on medicine package， and non-standard clinical research designs remain to be addressed in the future.

Objective To investigate the expression and significance of heat shock protein 70(HSP70),apoptosis-associated speck-like protein(ASC),and vitamin D in children with febrile seizures(FS).Methods A total of 200 children with FS admitted to our hospital from June 2022 to December 2023 were selected as FS group,including 158 cases of simple FS and 42 cases of complex FS.Another 200 febrile children without FS were selected as fever group,and 50 healthy children were selected as control group.The differences in HSP70,ASC mRNA,and vitamin D expression a-mong the three groups were compared.The differences in HSP70,ASC mRNA,and vitamin D ex-pression at different time points in children with different types of FS were compared.The influencing factors and predictive value of complex FS were analyzed.Results At admission,the expression lev-els of HSP70 and ASC mRNA gradually decreased,while the vitamin D levels gradually increased in the FS group,fever group,and control group,with statistically significant between-group differences(P＜0.01).One hour after admission,the levels of HSP70 and ASC mRNA in both the complex FS group and the simple FS group were lower than those at admission(P＜0.01).The levels of HSP70 and ASC mRNA in the complex FS group at admission and 1 hour after admission were higher than those in the simple FS group,while the vitamin D level was lower(P＜0.01).Multivariate Logistic regression analysis showed that elevated HSP70 and ASC mRNA levels at admission were independ-ent risk factors for complex FS(P＜0.001),while elevated vitamin D level was an independent protective factor for complex FS(P＜0.001).The area under the curve(AUC)for HSP70,ASC mRNA,and vitamin D in assessing complex FS were 0.785(95％CI,0.721 to 0.840),0.766(95％CI,0.701 to 0.823),and0.760(95％CI,0.695 to 0.817),respectively.The combined AUC of HSP70,ASC mRNA,and vitamin D for assessing complex FS was 0.915,with a sensitivity of 90.48％and a specificity of 81.65％.The AUC of combined assessment of complex FS by vari-ous factors was greater than that of HSP70,ASC mRNA,and vitamin D alone(Z=2.743,2.749,3.086,P=0.006,0.006,0.002).Conclusion The levels of HSP70 and ASC mRNA are elevat-ed,while the vitamin D level is reduced in children with complex and simple FS.The combined as-sessment of HSP70,ASC mRNA,and vitamin D at admission has high value in assessing complex FS.

Objective To investigate the correlation between physical activity duration,sleep quality,weight control,and PRO(patient-reported outcomes)in individuals with hypertension,providing effective information for enhancing patient-reported outcomes in this population.Methods A total of 625 hypertensive patients were randomly selected from four counties in Yunnan Province from April to June 2020 to participate in a field survey.The questionnaire included patients'basic information,lifestyle,health status and the PRO Scale for Hypertension-PROISCD-HY(V1.0).Statistical analyses including t-tests,one-way ANOVA,and multivariate linear regression were conducted to investigate the relationships between physical activity duration,sleep quality,weight control,and PRO,with the Bootstrap method used to examine potential mediating effects.Results After adjusting for potential covariates,the multiple linear regression model indicated a significant association between a physical activity duration of≥2 hours with PRO[B=6.551,95%CI(2.611,10.491)].Stratified analysis showed that this association was only present among males,females,and younger adults,but not in older adults.Additionally,a positive correlation was found between good sleep quality and PRO[B=1.870,95%CI(0.449,3.291)],with this association being consistent across all populations after stratification.Patients who managed their condition through exercise and diet had higher PRO scores[B=1.904,95%CI(0.383,3.424)],while those controlling weight through diet and other methods exhibited a decrease in PRO scores[B=-4.873,95%CI(-7.860,-1.887);B=-7.105,95%CI(-12.211,-1.999)],with variations among different groups.The bootstrap method revealed that physical activity duration had both direct and indirect effects on PRO,with sleep quality acting as a partial mediator between physical activity duration and PRO.Conclusion A Physical activity duration of at least 2 hours,good sleep quality,and weight control have been shown to improve PRO in individuals with hypertension.

Kounis syndrome is an acute coronary syndrome triggered by an allergic reaction, which is clinically rare and frequently subject to misdiagnosis or missed diagnosis. This article presents a case report of a 70-year-old male patient who developed a rash, pruritus, and chest pain following colon polyp resection. Coronary angiography revealed occlusion of the left anterior descending artery, and blood flow was restored after stent implantation. However, the patient experienced recurrent symptoms accompanied by loss of consciousness. Drug skin tests confirmed positive reactions to chlorhexidine and fondaparinux sodium, leading to a diagnosis of type Ⅱ Kounis syndrome. By avoiding allergenic drugs and combining antihistamines with symptomatic treatment to correct myocardial ischemia, the patient′s clinical symptoms significantly improved, and he eventually recovered and was discharged from the hospital. This case underscores the importance of maintaining vigilance for this syndrome in patients with allergies accompanied by chest pain and promptly identifying and avoiding allergens.

Objective To investigate the association between the Chinese visceral adiposity index (CVAI) and diabetes mellitus, hypertension, diabetes mellitus or hypertension, and diabetes with hypertension among elderly people in Hebei Province. Methods In 2020, a stratified multi-stage random sampling was used to conduct questionnaire survey, physical examination and laboratory detection among permanent residents of 10 monitoring sites in Hebei Province. Logistic regression was used to analyze the association between CVAI and diabetes mellitus, hypertension, diabetes mellitus or hypertension, and diabetes with hypertension. The area under the ROC curve (AUC) was used to evaluate the predictive value of CVAI for diabetes mellitus, hypertension, diabetes mellitus or hypertension, and diabetes with hypertension. Results The detection rates of diabetes mellitus, hypertension, diabetes mellitus or hypertension, and diabetes with hypertension were 19.8%, 74.6%, 78.2%, and 16.2%, respectively. Multivariate logistic regression analysis showed that compared with the lowest quartile of CVAI group Q1, the OR (95% CI) of diabetes mellitus, hypertension, diabetes mellitus or hypertension, and diabetes with hypertension in the highest quartile Q4 group were 3.55 (2.58~4.89), 2.52 (1.92~3.31), 3.09 (2.31~4.12), and 4.92 (3.40~7.12), respectively. The ROC curve results showed that CVAI had the best predictive value in the diagnosis of diabetes with hypertension, and the optimized critical values in males and females were 128.54 and 141.88, respectively. Conclusion The detection rates of diabetes mellitus and hypertension are high in the elderly population in Hebei Province. CVAI is positively associated with the risk of diabetes mellitus, hypertension, diabetes mellitus or hypertension, and diabetes with hypertension among the elderly in Hebei. CVAI has the strongest prediction ability for diabetes with hypertension.

AIM: To investigate the correlation of serum C-reactive protein(CRP)-to-albumin(ALB)ratio(CAR)and neutrophil-to-lymphocyte count ratio(NLR)with pathological staging and prognosis of retinopathy of prematurity(ROP), and the predictive value of its combined testing for the prognosis of infants.METHODS:Prospective study. A total of 147 children with ROP who were born in our hospital from March 2022 to September 2024 were served as the ROP group, and 100 premature infants without ROP were served as the control group in the same period. Fully automatic biochemical analyzer was used to detect serum CRP and ALB; the flow cytometry nucleic acid fluorescence staining was used to count neutrophils and lymphocytes, and the CAR and NLR were calculated. Spearman correlation was used to analyze the relationship of serum CAR and NLR with ROP staging. Logistic regression was used to analyze the factors affecting the prognosis of children with ROP. ROC curve was drew to analyze the predictive value of serum CAR and NLR for the prognosis of ROP.RESULTS: There was comparability between the ROP group and the control group. The ROP group had significantly higher serum CRP, CAR, neutrophil count, and NLR than the control group, and clearly lower ALB and lymphocyte count than the control group(all P<0.05). Children with stage IV ROP had clearly higher serum CAR and NLR than stages I, II, and III, and the differences among stages I, II, and III were significant(all P<0.05). Serum CAR and NLR were positively correlated with ROP staging(r=0.529, 0.587, all P<0.05), and there was a positive correlation between serum CAR and NLR(r=0.546, P<0.05). The poor prognosis group had clearly higher serum CAR and NLR than good prognosis group(all P<0.001). Elevated serum CAR and NLR were risk factors affecting the prognosis of children with ROP(all P<0.05). The AUC of serum CAR, NLR, and joint detection in predicting the prognosis of ROP children was 0.803, 0.825, and 0.938, respectively. The joint detection showed better predictive performance(Zcombinatoion-CAR=2.637, Zcombinatoion-NLR=2.528, all P<0.05).CONCLUSION:Serum CAR and NLR are elevated in children with ROP, and they are closely related to pathological staging and prognosis. The joint detection has a higher predictive value in evaluating the prognosis of ROP.

Nonalcoholic steatohepatitis （NASH） is a chronic liver disease with the main pathological features of hepatic steatosis， inflammatory cell infiltration， and interstitial fibroplasia， and it is an important risk factor for liver fibrosis， liver cirrhosis， and hepatocellular carcinoma. NOD-like receptor protein 3 （NLRP3） inflammasome is the core of innate immunity， and the abnormal activation of NLRP3 inflammasome is closely associated with the development and progression of NASH， which involves multiple links such as inflammatory response and oxidative stress. A large number of studies have shown that the active ingredients of traditional Chinese medicine （TCM） and TCM compound prescriptions can improve oxidative stress， regulate lipid metabolism， and alleviate liver inflammation by regulating NLRP3 inflammasome. TCM treatment applied in clinical practice has achieved a good therapeutic effect， while inflammasome is one of the key pathways or targets for TCM in improving NASH. This article reviews the mechanism of action of NLRP3 inflammasome in NASH and the research advances in TCM intervention of NLRP3 inflammasome， in order to provide ideas for the clinical TCM treatment of NASH， as well as reference targets and research directions for the research and development of new TCM drugs.

Objective To investigate the therapeutic efficacy of combination of dapagliflozin and sacubitril valsartan on patients with heart failure(HF)complicated with type 2 diabetes mellitus(T2DM).Methods A retrospective study was conducted on 160 patients with HF and T2DM admitted to our hospital from November 2020 to November 2022.According to drug treatment,they were classified into sacubitril valsartan group(80 cases)and combined group(dapagliflozin combined with sacubitril valsartan,80 cases).After 3 months of treatment,the differences were compared between the two groups in following aspects:blood glucose fluctuations,left ventricular diastolic function,and vascular endothelial function,and the incidence of adverse events after 1 year of follow-up.Results After 3 months of treatment,serum FPG,2 h-PG and HbAlc levels,and MAGE,LAGE,MODD and SDBG values were significantly lower in the combined group than the sacubitril valsartan group(P＜0.05,P＜0.01).The combined group had obviously higher e'and LVEF values while lower LVMI and BNP levels than the other group(P＜0.05,P＜0.01).After 3 months of treatment,NO and FMD were notably higher[96.18±6.70 ng/L vs 92.34±6.85 ng/L,P=0.000;(8.25±1.16)％vs(7.72±1.28)％,P=0.007],while ET-1(59.72±4.95 ng/L vs 63.90±4.63 ng/L,P=0.000)was remarkably lower in the combined group than the sacubitril valsartan group.There was no statistical significance in the total incidence of adverse events between both groups after 1 year of follow-up(P＞0.05).Conclusion The combination of dapagliflozin and sacubitril valsartan has a significant improvement effect on blood glucose,left ventricular diastolic function and vascular endothelial function in T2DM patients with HF,with good drug safety.

Objective To evaluate the frailty status and risk factors among hospitalized elderly patients after percutaneous coronary intervention(PCI),and to provide a reference for improving and delaying their frailty.Methods From March to August 2024,using convenience sampling,patients aged over 75 years who underwent PCI in a tertiary cardiovascular disease specialist hospital in Beijing were selected as the survey participants.Patient-related informations were collected through a self-designed general information questionnaire.The Fried Phenotype Frailty Scale,the Katz Activities of Daily Living,Lawton Instrumental Activities of Daily Living(IADL)scale,the Charlson Comorbidity Index,the Morse Fall Scale,the Mini Nutritional Assessment-Short Form(MNA-SF),and the 15-item Geriatric Depression Scale(GDS-15)were evaluated postoperatively until discharge.Univariate and multivariate logistic analyses were conducted to identify factors associated with frailty among patients after PCI.Results A total of 278 patients were included.The incidence of frailty after PCI was 52.16％.Based on Fried Phenotype scores,patients were divided into a non-frail group and a frail group.Univariate analysis showed statistically significant differences between the 2 groups in terms of age,gender,hemoglobin,NT-ProBNP,LVEF,IADL scores,living alone status,nutrition status,falls risk,and depression level(P＜0.05).Multivariate logistic regression analysis revealed that age,Lawton IADL scores,falls risk,nutrition status,depression level were factors influencing frailty,with odds ratios of 1.167,0.575,1.597,0.399,and 3.610,respectively(P＜0.05).Conclusion The incidence of frailty is high among patients aged over 75 years after PCI,and there are multiple risk factors affecting their frailty status.Clinical healthcare providers should prioritize long-term management of these patients and implement comprehensive interventions with the consideration of their physiological,psychological,and social conditions.