Objective To investigate the correlation between platelet-to-albumin ratio(PAR)and occurrence of cerebral infarction after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF).Methods A retrospective study was conducted on 259 NVAF patients undergoing LAAC in our department between 2019 and 2023.According to occurrence of cerebral infarction after LAAC or not,they were divided into a control group(241 cases)and a study group(18 cases).Their general data were collected,and Cox proportional hazards regression model was used to identify the risk factors for cerebral infarction.ROC curve was plotted to assess the predictive value of PAR for cerebral infarction in NVAF patients after LAAC,and the AUC value was calculated.Kaplan-Meier survival curve was drawn to analyze the incidence of cerebral infarction after LAAC in NVAF patients with different PAR values.Results The study group had significantly advanced age,higher SBP at admission,increased WBC,neutrophil,monocyte and platelet counts,longer thrombin time,elevated international normalized ratio(INR)and high-sensitivity C-reactive protein(hs-CRP)level,and higher PAR than the control group(P＜0.05,P＜0.01).Multivariate Cox regression analysis showed that PAR(HR=2.286,95％CI:1.182-4.420,P＜0.05)was an independent risk factor for cerebral infarction in NVAF patients after LAAC.ROC curve indicated that the AUC value of PAR in predicting cerebral infarction after LAAC in NVAF patients was 0.721(95％CI:0.586-0.856,P＜0.01),with an optimal cut-off value of 4.137,a sensitivity of 66.39％,and a specificity of 77.78％.Kaplan-Meier survival curve revealed that the higher the PAR value was,the higher the risk of cerebral infarction was(P＜0.01).Conclusion PAR is significantly correlated with cerebral infarction in NVAF patients after LAAC.The higher the PAR,the higher the risk of cerebral infarction,demonstrating its predictive value and being worthy of clinical promotion.

Combined vaccines can simplify the vaccination process, improve coverage rates, reduce the risk of adverse events following immunization, lower social costs, and improve the timeliness of childhood vaccination. This article focuses on multi-component vaccines based on the diphtheria-tetanus-pertussis containing vaccine. Globally, multiple combined vaccines have been developed and marketed, but the development of combined vaccine is still in its infancy stage in China, with limited vaccine types and doses available. The research, development, and application of combined vaccines still face numerous challenges in China, including technical challenges in research and development, as well as insufficient motivation for research and development. Additionally, the high cost of existing combined vaccines, coupled with low public awareness and weak vaccination intentions, significantly hinders their widespread application, China should continue to rigorously implement the Vaccine Administration Law of the People's Republic of China, promote innovative development of combined vaccines, increase public awareness, strengthen child guardians' confidence in vaccination, and improve the accessibility and affordability of combined vaccines to protect public health across all life stages.

Objective To analyze the risk factors of postpartum mild uterine prolapse and to investigate the effects of Buzhong Yiqi Decoction on serum transforming growth factor β1(TGF-β1),matrix metalloproteinase 2(MMP-2),and microRNA-30d(miRNA-30d).Methods By blinded and controlled methods and through convenience sampling,80 postpartum patients with mild uterine prolapse were retrospectively collected from Tangshan Maternal and Children Health Hospital from January 2020 to January 2022,and they served as the uterine prolapse group.In addition,80 postpartum patients without uterine prolapse from the same department of the hospital in the same period served as the healthy group.Questionnaire investigation was performed for collecting the basic information such as delivery manner,age,parity,gestational weeks,neonatal weight and body mass index(BMI).The risk factors of postpartum uterine prolapse were investigated by univariate analysis and multivariate logistic regression analysis.The patients in the uterine prolapse group were then divided into the observation group and the control group according to the medication of Buzhong Yiqi Decoction or not,with 40 cases in each group.The control group was treated with electromyographic biofeedback therapy(EBT),while the observation group was treated with Buzhong Yiqi Decoction combined with EBT,and the course of treatment for the two groups covered one month.The changes of pelvic floor function and levels of serum TGF-β1,MMP-2,miRNA-30d in the patients of the two groups were observed before and after treatment.After treatment,the clinical efficacy of patients in the two groups was evaluated.Results(1)The results of univariate analysis showed that compared with the healthy group,the patients in the uterine prolapse group were elder,usually had given two childbirths or more by vaginal delivery,and accounted for a high percentage of overweight/obesity(BMI≥24.0 kg/m2)and perineal laceration,the difference being statistically significant(P<0.05 or P<0.01).(2)The results of multivariate logistic regression analysis showed that age,delivery manner,parity,laceration of perineum,and BMI were risk factors for postpartum uterine prolapse(P<0.01).(3)After one month of treatment,the total effective rate of Buzhong Yiqi Decoction in the observation group was 95.00%(38/40),while that in the control group was 77.50%(31/40),and the intergroup comparison(tested by chi-square test)showed that the efficacy of the observation group was significantly superior to that of the control group(P<0.05).(4)The observation of effects of Buzhong Yiqi Decoction on pelvic floor function showed that after treatment,the distance between the cervix and the hymenal edge,the maximum intravaginal pressure,the voltage of vaginal muscles,the contraction time of pelvic floor muscles of typeⅠand Ⅱmuscle fibers in the two groups of patients were significantly improved compared with those before treatment(P<0.05),and the improvement in the observation group was significantly superior to that in the control group(P<0.01).(5)The observation of effects of Buzhong Yiqi Decoction on serological indicators showed the post-treatment serum TGF-β1 levels in the two groups were increased compared with those before treatment(P<0.05),and the serum levels of MMP-2 and miRNA-30d were decreased compared with those before treatment(P<0.05),and the increase of serum TGF-β1 level and the decrease of serum MMP-2 and miRNA-30d levels in the observation group were both significantly superior to those in the control group(P<0.01).Conclusion The incidence of postpartum uterine prolapse is related to age,delivery manner,parity,laceration of perineum,BMI,etc.The treatment of Buzhong Yiqi Decoction on the basis of EBT can improve the pelvic floor function of the patients and regulate the expression of serum TGF-β1,MMP-2,and miRNA-30d,and the clinical efficacy is remarkable.

Objective Using the advantages of LASSO regression in early screening of complex diseases and judging disease condi-tions,to search a tool for early evaluation of cardiac insufficiency and infection in elderly people with community-acquired pneumonia(CAP)combined with diabetes mellitus(DM)to guide clinical practice.Methods According to the levels of the indexes at admission,the maximum level of the indexes during hospitalization and the level of the indexes at discharge were analyzed by multivariate analysis,and the differences of the core characteristic indexes were compared between the elderly patients with CAP combined with DM(CAP+DM)and those with CAP without DM(CAP alone)to discuss the necessity of biochemical indicators for predicting the development of core characteristics of two groups of patients.Results In elderly CAP+DM patients,the higher level of the blood white blood cell count at admission,the maximum levels of N terminal-pro B type natriuretic peptide(NT-pro BNP)and urine white blood cell count during hospitalization were higher.The higher the urine white blood cell count at admission,the maximum levels of blood white blood cell count and urine white blood cell count during hospitalization were higher.According to the NT-pro BNP,blood routine,and urine routine in-dexes at admission of elderly CAP patients,LASSO regression was performed on the maximum levels of core indexes during hospitalization and the levels of core indexes at discharge.It was found that after adding biochemical indexes,the determination coefficients of maximum levels of NT-pro BNP and urine white blood cell count during hospitalization and the NT-pro BNP level at discharge were significantly increased.Conclusion In elderly CAP+DM patients,the level of blood white blood cell count at admission can be used as a predictor of the severity of cardiac insufficiency during hospitalization.For elderly CAP+DM patients with higher blood white blood cell count and urine white blood cell count,attention should be paid to screen urinary tract infection during hospitalization.Biochemical tests at admis-sion can effectively help elderly CAP patients judge the severity of cardiac insufficiency and urinary tract infection during hospitalization and the cardiac function at discharge.

ObjectiveTo investigate the potential mechanism of Liangxue Tuizi Formula （凉血退紫方， LXTZF） in treating Henoch-Schönlein Purpura （HSP） by examining its regulatory effect on neutrophil extracellular trap （NETs） dysregulation via the rapidly accelerated fibrosarcoma kinase （RAF）/mitogen-activated protein kinase （MEK）/extracellular signal-regulated kinase （ERK） signaling pathway. MethodsSeventy Wistar rats were randomly allocated into a blank control group （n=14） and a modeling group （n=56）. Rats in the modelling group underwent an eight-week modelling period to establish HSP rat models with blood-heat syndrome via modified ovalbumin （OVA） induction method combined with oral administration of heat-property Chinese herbal medicine. Fifty successfully modeled rats were subsequently randomly divided into five groups （n=10 per group）， model group， compound glycyrrhizin group， LXTZF group， RAF inhibitor group， and LXTZF + RAF agonist group. Additionally， 10 rats were selected from the original blank control group for the final experiment. From the 11th week of modelling， rats in the blank control group and the model group received 1 ml/（100 g·d） ultrapure water via oral administration， in addition to 0.5 ml/（kg·d） 0.9% sodium chloride solution via intraperitoneal injection. The LXTZF group and the compound glycyrrhizin group received 7.5 g/（kg·d） LXTZF granule suspension via gavage， 13.5 mg/（kg·d） compound glycyrrhizin suspension via gavage， respectively. The RAF inhibitor group received 1 mg/（kg·d） GW5074 suspension via intraperitoneal injection and ultrapure water via oral administration； the LXTZF + RAF agonist group received 7.5 g/（kg·d） LXTZF granule suspension via gavage and 1 mg/（kg·d） paclitaxel suspension via intraperitoneal injection. All administrations were performed once daily for 4 weeks. After intervention， skin tissue histopathology was examined by hematoxylin and eosin （H&E） staining， immunoglobulin A （IgA） deposition was assessed via immunofluorescence， serum levels of neutrophil elastase （NE）， tumor necrosis factor-α （TNF-α）， and vascular cell adhesion molecule-1 （VCAM-1） were measured using enzyme-linked immunosorbent assay （ELISA）， serum myeloperoxidase （MPO） level was determined by a colorimetric assay； the mRNA expression levels of RAF， MEK， and ERK in skin tissue were detected by real-time quantitative polymerase chain reaction （RT-qPCR）； and the protein expression of RAF， MEK， ERK， as well as phosphorylated MEK （p-MEK） and phosphorylated ERK （p-ERK）， were analyzed by Western Blot. ResultsSkin tissue in the blank control group rats remained normal， whereas the model group exhibited neutrophil infiltration and haemorrhage with red blood cell rupture. In all drug intervention groups， neutrophil infiltration and haemorrhagic exudation reduced markedly， with LXTZF group demonstrating the most pronounced improvement. Compared with the blank control group， rats in the model group exhibited enhanced IgA fluorescence intensity in skin tissue， elevated serum levels of NE， MPO， TNF-α and VCAM-1， increased mRNA expression of RAF， MEK， ERK1 and ERK2， as well as heightened RAF protein levels and p-MEK/MEK and p-ERK/ERK ratios （P＜0.05）. Compared with the model group， the drug intervention groups exhibited reduced IgA fluorescence intensity in skin tissue， along with decreased serum levels of NE， MPO， TNF-α， and VCAM-1 （P＜0.05）. In LXTZF group and RAF inhibition groups， reduced mRNA expression of RAF， MEK， ERK1， and ERK2 was observed in rat skin tissue， alongside decreased RAF protein levels and reduced p-MEK/MEK and p-ERK/ERK ratios （P＜0.05）. Compared with LXTZF + RAF agonist group， the compound glycyrrhizin group， LXTZF group， and RAF inhibitior group exhibited reduced IgA fluorescence intensity in skin tissue， decreased serum NE， MPO， TNF-α， and VCAM-1 levels， and decreased MEK mRNA expression and p-MEK/MEK ratio （P＜0.05）. ConclusionThe potential mechanism by which LXTZF treats Henoch-Schönlein purpura with blood heat syndrome may involve blocking the RAF/MEK/ERK signaling pathway in skin tissue， and suppressing excessive formation of NETs， thereby reducing IgA deposition in dermal microvessels and attenuating systemic inflammatory responses.

The incidence and mortality of colorectal cancer （CRC） in China have been on a steady rise. Current therapeutic approaches can curb the progression of CRC to a certain extent， but issues such as toxic side effects， high metastasis rate， and high recurrence rate cannot be ignored. In recent years， alkaloid components derived from traditional Chinese medicine （TCM） have demonstrated tremendous potential in the prevention and treatment of CRC due to their diverse structures， complex mechanisms， and broad biological activities. Representative alkaloids such as matrine， berberine and evodiamine exert anti-CRC effects through multiple pathways： regulating signaling pathways including Wnt/β-catenin， nuclear factor-κB， signal transducer and activator of transcription 3， and phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin； inhibiting the proliferation， migration， and invasion of CRC cells； inducing cell apoptosis and autophagy； arresting the cell cycle progression； regulating the gut microbiota； suppressing cellular glycolysis； and inducing ferroptosis.

Metastasis is the leading cause of death from cutaneous melanoma. Identifying metastasis-related targets and developing corresponding therapeutic strategies are major areas of focus. While functional genomics strategies provide powerful tools for target discovery, investigations at the protein level can directly decode the bioactive epitopes on functional proteins. Aptamers present a promising avenue as they can explore membrane proteomes and have the potential to interfere with cell function. Herein, we developed a target and epitope discovery platform, termed functional aptamer evolution-enabled target identification (FAETI), by integrating affinity aptamer acquisition with phenotype screening and target protein identification. Utilizing the aptamer XH3C, which was screened for its migration-inhibitory function, we identified the Chondroitin Sulfate Proteoglycan 4 (CSPG4), as a potential target involved in melanoma migration. Further evidence demonstrated that XH3C induces cytoskeletal rearrangement by blocking the interaction between the bioactive epitope of CSPG4 and integrin α4. Taken together, our study demonstrates the robustness of aptamer-based molecular tools for target and epitope discovery. Additionally, XH3C is an affinity and functional molecule that selectively binds to a unique epitope on CSPG4, enabling the development of innovative therapeutic strategies.

Traditional development of small protein scaffolds has relied on display technologies and mutation-based engineering, which limit sequence and functional diversity, thereby constraining their therapeutic and application potential. Protein design tools have significantly advanced the creation of novel protein sequences, structures, and functions. However, further improvements in design strategies are still needed to more efficiently optimize the functional performance of protein-based drugs and enhance their druggability. Here, we extended an evolution-based design protocol to create a novel minibinder, BindHer, against the human epidermal growth factor receptor 2 (HER2). It not only exhibits super stability and binding selectivity but also demonstrates remarkable properties in tissue specificity. Radiolabeling experiments with ^99mTc, ⁶⁸Ga, and ¹⁸F revealed that BindHer efficiently targets tumors in HER2-positive breast cancer mouse models, with minimal nonspecific liver absorption, outperforming scaffolds designed through traditional engineering. These findings highlight a new rational approach to automated protein design, offering significant potential for large-scale applications in therapeutic mini-protein development.

High mobility group box 1 (HMGB1), when released extracellularly, plays a pivotal role in the development of spinal cord synapses and exacerbates autoimmune diseases within the central nervous system. In experimental autoimmune encephalomyelitis (EAE), a condition that models multiple sclerosis, the levels of extracellular HMGB1 and interleukin-33 (IL-33) have been found to be inversely correlated. However, the mechanism by which IL-33 deficiency enhances HMGB1 release during EAE remains elusive. Our study elucidates a potential signaling pathway whereby the absence of IL-33 leads to increased binding of P300/CBP-associated factor with HMGB1 in the nuclei of astrocytes, upregulating HMGB1 acetylation and promoting its release from astrocyte nuclei in the spinal cord of EAE mice. Conversely, the addition of IL-33 counteracts the TNF-α-induced increase in HMGB1 and acetylated HMGB1 levels in primary astrocytes. These findings underscore the potential of IL-33-associated signaling pathways as a therapeutic target for EAE treatment.
Animals ; Encephalomyelitis, Autoimmune, Experimental/metabolism* ; Astrocytes/metabolism* ; Interleukin-33/metabolism* ; HMGB1 Protein/metabolism* ; Acetylation ; Mice, Knockout ; Mice, Inbred C57BL ; p300-CBP Transcription Factors/metabolism* ; Mice ; Spinal Cord/metabolism* ; Cells, Cultured ; Female ; Signal Transduction

The cooccurrence of NPM1, FLT3-ITD, and DNMT3A mutations (i.e., triple mutation) is related to dismal prognosis in patients with acute myeloid leukemia (AML) receiving chemotherapy alone. In this multicenter retrospective cohort study, we aimed to identify whether allogeneic hematopoietic stem cell transplantation (allo-HSCT) could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut AML across four transplant centers in China. Fifty-three patients with triple-mutated AML receiving allo-HSCT in complete remission were enrolled. The 1.5-year probabilities of relapse, leukemia-free survival, and overall survival after allo-HSCT were 11.9%, 80.3%, and 81.8%, respectively. Multivariate analysis revealed that more than one course of induction chemotherapy and allo-HSCT beyond CR1 were associated with poor survival. To our knowledge, this work is the largest study to explore the up-to-date undefined role of allo-HSCT in patients with triple-mutated AML. Our real-world data suggest that allo-HSCT could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut in AML.
Humans ; Nucleophosmin ; Leukemia, Myeloid, Acute/mortality* ; Hematopoietic Stem Cell Transplantation/methods* ; Male ; Female ; DNA Methyltransferase 3A ; Adult ; China ; Retrospective Studies ; DNA (Cytosine-5-)-Methyltransferases/genetics* ; Middle Aged ; Prognosis ; fms-Like Tyrosine Kinase 3/genetics* ; Mutation ; Young Adult ; Transplantation, Homologous ; Nuclear Proteins/genetics* ; Adolescent ; Aged