Objective To observe the clinical efficacy of scalp acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of patients with mild to moderate vascular dementia and to explore its potential mechanism of action.Methods A total of 102 patients diagnosed with mild to moderate vascular dementia who were treated in the outpatient and inpatient departments of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2021 to May 2023 were selected as the study subjects.The patients were randomly divided into an observation group and a control group using a random number table,with 51 patients in each group.The control group received repetitive transcranial magnetic stimulation treatment,while the observation group received scalp acupuncture therapy in addition to the treatment given to the control group.The treatment lasted for 16 weeks.After treatment,the clinical efficacy of the two groups was evaluated.Changes in the Mini-Mental State Examination(MMSE)scores,Montreal Cognitive Assessment(MoCA)scores,and traditional Chinese medicine(TCM)syndrome scores were observed before and after treatment.Additionally,serum levels of brain-derived neurotrophic factor(BDNF),vascular endothelial growth factor(VEGF),and homocysteine(Hcy)were measured.The cerebral blood flow velocities in the anterior,middle,and posterior arteries,as well as the levels of lipid peroxide(LPO),malondialdehyde(MDA),and superoxide dismutase(SOD),were compared between the two groups before and after treatment.The safety and incidence of adverse reactions in both groups were also evaluated.Results(1)After treatment,the MMSE and MoCA scores of both groups were significantly improved(P＜0.05),and the observation group showed significantly better improvement in MMSE and MoCA scores compared to the control group,with a statistically significant difference(P＜0.05).(2)After treatment,the serum levels of BDNF,VEGF,and Hcy in both groups were significantly improved(P＜0.05),and the observation group showed significantly better improvement in these levels compared to the control group,with a statistically significant difference(P＜0.05).(3)After treatment,the cerebral blood flow velocities in the posterior,middle,and anterior arteries were significantly improved in both groups(P＜0.05),and the observation group showed significantly better improvement in these velocities compared to the control group,with a statistically significant difference(P＜0.05).(4)After treatment,the levels of LPO,MDA,and SOD were significantly improved in both groups(P＜0.05),and the observation group showed significantly better improvement in these levels compared to the control group,with a statistically significant difference(P＜0.05).(5)After treatment,the TCM syndrome scores improved significantly in both groups(P＜0.05),and the observation group showed significantly better improvement in these scores compared to the control group,with a statistically significant difference(P＜0.05).(6)The total effective rate in the observation group was 88.24%(45/51),while it was 70.59%(36/51)in the control group.The efficacy of the observation group was superior to that of the control group,with a statistically significant difference(P＜0.05).(7)The incidence of adverse reactions in the observation group was 3.92%(2/51),while it was 1.96%(1/51)in the control group.There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Scalp acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of mild to moderate vascular dementia helps regulate cerebral hemodynamics and neurotrophic factor expression,improves cognitive function,and demonstrates significant efficacy with good safety.

Objective To explore the characteristics of coagulation and immune function and their clinical significance in children with severe adenovirus pneumonia(SAP).Methods A total of 122 children with SAP and 120 children with non-severe adenovirus pneumonia(NSAP)were enrolled and assigned to severe group and non-severe group.The severe group was further subdivided into good prognosis subgroup(n=105)and poor prognosis subgroup(n=17)according to prognosis.Addition-ally,120 healthy children undergoing physical examination during the same period were included as control group.Coagulation function indicators,including prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and thrombin time(TT)were measured.Levels of immunoglobulin A(IgA),immunoglobulin G(IgG),and immunoglobulin M(IgM)were determined using the nephelometric immunoassay.Multivariate Cox regression analysis was conducted to explore the influencing factors of poor prognosis.Results Compared with the control group,children in both the non-severe and severe groups exhibited increased levels of white blood cells(WBC),neutrophils(N),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),procalci-tonin(PCT),FIB,and IgG,as well as decreased levels of B lymphocytes,natural killer(NK)cells,PT,APTT,IgA,and IgM(P＜0.05).Compared with the non-severe group,children in the severe group showed increased levels of WBC,N,CRP,ESR,IL-6,PCT,FIB,and IgG,as well as decreased levels of B lymphocytes,NK cells,PT,APTT,IgA,and IgM(P＜0.05).Compared with the good prognosis subgroup,the poor prognosis subgroup exhibited increased levels of CRP,IL-6,PCT,and IgG,as well as decreased levels of APTT,IgM,and IgA(P＜0.05).The results of multivariate Cox regression analysis showed that PCT,APTT,and IgM were influencing factors of poor prognosis in children with SAP(P＜0.05).Conclusion Children with SAP have decreased levels of PT,APTT,IgA,and IgM,as well as increased levels of FIB and IgG.Coagulation and im-mune function indicators are correlated with the prognosis of SAP.

Lung cancer remains the most common cause of cancer death. Given the continued research into new drugs and combination therapies, outcomes in lung cancer have been improved, and clinical benefits have been expanded to a broader patient population. However, the overall cure and survival rates for lung cancer patients remain low, especially in metastatic cases. Among the available lung cancer treatment options, such as surgery, radiation therapy, chemotherapy, targeted therapies, and alternative therapies, immunotherapy has shown to be the most promising. The exponential progress in immuno-oncology research and recent advancements made in the field of immunotherapy will further increase the survival and quality of life for lung cancer patients. Substantial progress has been made in targeted therapies using tyrosine kinase inhibitors and monoclonal antibody immune checkpoint inhibitors with many US Food And Drug Administration (FDA)-approved drugs targeting the programmed cell death ligand-1 protein (e.g., durvalumab, atezolizumab), the programmed cell death-1 receptor (e.g., nivolumab, pembrolizumab), and cytotoxic T-lymphocyte-associated antigen 4 (e.g., tremelimumab, ipilimumab). Cytokines, cancer vaccines, adoptive T cell therapies, and Natural killer cell mono- and combinational therapies are rapidly being studied, yet to date, there are currently none that are FDA-approved for the treatment of lung cancer. In this review, we discuss the current lung cancer therapies with an emphasis on immunotherapy, including the challenges for future research and clinical applications.

To summarize the nursing experience of a patient with large skin ulcers caused by EBV positive T/NK-cell lymphoproliferative diseases based on TIME Clinical-Decision-Support-Tool. The main points of nursing care were as follows: early identification of the cause of ulceration and active treatment of the underlying disease; accurate and continuous assessment of patients and their wounds; multidisciplinary consultation to ensure the integrity and comprehensiveness of diagnosis and treatment; active identification of obstacle factors and risk control; providing different dressing change programs according to different wound healing stages; evaluation of treatment effects at any time; timely pain management; improving the nutritional status of patients; providing health education and psychological nursing care. After 367 days of wound dressing, the patient′s wound was fully healed, and EBV-DNA was not detected in genetic examination after hematopoietic stem cell transplantation.

Objective:To investigate the efficacy and adverse effects of first-line immunotherapy combined with chemotherapy in elderly patients with small cell lung cancer(SCLC)in population of real world.Methods:A total of 148 elderly SCLC patients(age ≥65 years old)underwent pathological diagnosis were retrospectively analyzed from January 2013 to June 2023.103 patients received chemotherapy(chemotherapy group), and 45 patients received immunotherapy combined with chemotherapy(combination group). Patients were divided into senior group(≥75 years old)and younger group(<75 years old)by age.To compare the efficacy of different regimens in first-line treatment, the expression of programmed death-ligand 1(PD-L1)and tumor mutational burden(TMB)were evaluated.Response evaluation criteria in solid tumors(RECIST)version 1.1 was used to evaluate the efficacy, and common terminology criteria for adverse events(CTCAE)version 4.03 was used to evaluate immune-related adverse.Kaplan-meier and Log-rank test were performed.Cox regression was used in prognostic analysis.Results:The overall response rate(ORR)of the first-line combination group in elderly SCLC patients was 79.1%(34/43), which was higher than that of the chemotherapy group 63.2%(60/95), but the difference did not reach statistical significance( χ2=3.451, P=0.063). ORR was significantly higher in the combination group than in the chemotherapy group for patients in the ≥75-year-old group, 87.5%(7/8) vs.48.6%(17/35), respectively( χ2=4.001, P=0.045). The difference in median progression-free survival time(mPFS)in the combination group compared with the chemotherapy group was not statistically significant in the overall patients(5.43 months vs.6.07 months, P=0.660). The combination group prolonged patients' median overall survival time(mOS)compared with the chemotherapy group, but the difference did not reach statistical significance(13.63 months vs.11.97 months, P=0.205). In patients ≥75 years old, mPFS was lower in the combination group than in the chemotherapy group(2.97 months vs.6.47 months), but mOS was prolonged compared with that in the chemotherapy group(13.50 months vs.11.40 months), and none of the differences reached statistical significance(both P>0.05). The differences in mPFS and mOS between the combination group and the chemotherapy group were not statistically significant in patients <75 years old(both P>0.05). In elderly patients with severe comorbidities, mPFS and mOS were lower in the combination group than in the chemotherapy group(5.40 months vs.7.30 months and 10.70 months vs.12.27 months, both P>0.05). In patients without severe comorbidities, the difference in mPFS between the combination group and the chemotherapy group was not statistically significant( P>0.05), but the mOS was significantly longer in the combination group(20.57 months vs.11.57 months, P=0.054). Elderly SCLC patients had a positive PD-L1 tumor cell positive proportion score(TPS)rate(≥1%)of 23.5%(4/17)and a high TMB(≥9 mut/Mb)expression rate of 69.0%(11/16). The overall incidence of immune-related adverse reactions was 71.0%(32/45), grade 3 or higher 33.3%(15/45), and the most common grade 3 adverse reactions were rash, immune-related pneumonia and malaise. Conclusions:First-line immune-combination chemotherapy improves ORR and mOS over chemotherapy in elderly SCLC patients; mOS benefit of immune-combination chemotherapy is more pronounced in patients ≥75 years of age without severe comorbidities, low PD-L1 positivity and high TMB expression are present in elderly SCLC patients, and immune-related adverse effects are generally manageable in elderly patients.

Acyl-CoA synthetase long chain family member 5 (ACSL5), is a member of the acyl-CoA synthetases (ACSs) family that activates long chain fatty acids by catalyzing the synthesis of fatty acyl-CoAs. The dysregulation of ACSL5 has been reported in some cancers, such as glioma and colon cancers. However, little is known about the role of ACSL5 in acute myeloid leukemia (AML). We found that the expression of ACSL5 was higher in bone marrow cells from AML patients compared with that from healthy donors. ACSL5 level could serve as an independent prognostic predictor of the overall survival of AML patients. In AML cells, the ACSL5 knockdown inhibited cell growth both in vitro and in vivo. Mechanistically, the knockdown of ACSL5 suppressed the activation of the Wnt/β-catenin pathway by suppressing the palmitoylation modification of Wnt3a. Additionally, triacsin c, a pan-ACS family inhibitor, inhibited cell growth and robustly induced cell apoptosis when combined with ABT-199, the FDA approved BCL-2 inhibitor for AML therapy. Our results indicate that ACSL5 is a potential prognosis marker for AML and a promising pharmacological target for the treatment of molecularly stratified AML.
Humans ; Antineoplastic Agents/therapeutic use* ; Apoptosis ; beta Catenin/metabolism* ; Biomarkers, Tumor/metabolism* ; Cell Line, Tumor ; Coenzyme A Ligases/metabolism* ; Leukemia, Myeloid, Acute/metabolism* ; Lipoylation ; Prognosis ; Wnt Signaling Pathway

Objective:To explore the role of hierarchical teaching based on the "competency-based" concept in the standardized training of respiratory nursing interns.Methods:A total of 70 nursing interns who came to the Department of Respiratory Medicine in Beijing Jishuitan Hospital for standardized training from September 2019 to August 2020 were selected as the study subjects. They were randomly divided into the study group and the control group by coin tossing method, 35 in each group. The study group used hierarchical teaching based on the "competency-based" concept, while the control group adopted conventional hierarchical teaching. The nursing ability and teaching quality of the two groups of nurses were compared. SPSS 23.0 was used for t-test and Chi-square test. Results:The theoretical knowledge scores of the nurses in the two groups after the standardized training [(95.29±3.13), (86.29±5.13)] were higher than those before the training [(78.22±4.48), (77.29±5.13)]. The scores of theoretical knowledges, operation skills, medical record reporting, and the comprehensive quality scores of the study group after the standardized training were higher than those of the control group, and the differences were statistically significant ( P<0.05). The satisfaction of teaching quality in study group was higher than that in control group, and the difference was statistically significant ( P<0.05). Conclusion:The hierarchical teaching based on the "competency-based" concept can significantly improve the teaching quality in the standardized training and the comprehensive quality of respiratory nursing interns, which is worthy of application.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease with unknown etiology and limited therapeutic options. Activation of fibroblasts is a prominent feature of pulmonary fibrosis. Here we report that lncRNA DACH1 (dachshund homolog 1) is downregulated in the lungs of IPF patients and in an experimental mouse model of lung fibrosis. LncDACH1 knockout mice develop spontaneous pulmonary fibrosis, whereas overexpression of LncDACH1 attenuated TGF-β1-induced aberrant activation, collagen deposition and differentiation of mouse lung fibroblasts. Similarly, forced expression of LncDACH1 not only prevented bleomycin (BLM)-induced lung fibrosis, but also reversed established lung fibrosis in a BLM model. Mechanistically, LncDACH1 binding to the serine/arginine-rich splicing factor 1 (SRSF1) protein decreases its activity and inhibits the accumulation of Ctnnb1. Enhanced expression of SRSF1 blocked the anti-fibrotic effect of LncDACH1 in lung fibroblasts. Furthermore, loss of LncDACH1 promoted proliferation, differentiation, and extracellular matrix (ECM) deposition in mouse lung fibroblasts, whereas such effects were abolished by silencing of Ctnnb1. In addition, a conserved fragment of LncDACH1 alleviated hyperproliferation, ECM deposition and differentiation of MRC-5 cells driven by TGF-β1. Collectively, LncDACH1 inhibits lung fibrosis by interacting with SRSF1 to suppress CTNNB1 accumulation, suggesting that LncDACH1 might be a potential therapeutic target for pulmonary fibrosis.

Hepatic hydrothorax (HH) is a challenging complication of liver cirrhosis associated with portal hypertension, and its pathogenesis and therapeutic measures remain unknown. This article summarizes and reviews the advances and challenges in the research on the pathogenesis, clinical manifestations, diagnosis, and treatment of HH and proposes a multidisciplinary treatment strategy, including reducing the production of ascites, preventing effusion from entering the thoracic cavity, removing pleural effusion, occluding the pleural cavity, and performing liver transplantation, so as to provide a reference for more clinicians.