Objective: This prospective study evaluated the feasibility of chemical exchange saturation transfer (CEST) MRI for assessing disease activity in thyroid-associated ophthalmopathy (TAO). Materials and Methods: A total of 88 patients with active TAO, 76 with inactive TAO, and 30 healthy controls were enrolled. CEST MRI-derived magnetization transfer ratio (MTR) and MTR asymmetry (MTRasym) at 1 ppm, 2 ppm, and 3.5 ppm were calculated. Clinical data, MTR, and MTRasym values for the extraocular muscles (one representative muscle per eye, yielding two measurements per participant) were compared among the groups. Spearman’s correlation was used to examine associations between imaging parameters and the clinical activity score (CAS) in patients with TAO. Logistic regression analysis was used to identify independent associations between imaging parameters and disease activity in patients with TAO (active vs. inactive). Receiver operating characteristic (ROC) analysis was conducted to evaluate the diagnostic performance for discriminating active from inactive TAO. Results: Patients with active TAO showed lower MTR values (P < 0.001) and higher MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) (all P < 0.001) compared with those with inactive TAO. MTR was negatively correlated with CAS (r = -0.402; P < 0.001), while MTRasym (1 ppm), MTRasym (2 ppm), and MTRasym (3.5 ppm) were positively correlated with CAS (r = 0.369, 0.350, and 0.349, respectively;all P < 0.001). MTR and MTRasym (1 ppm) were independently associated with TAO activity. The areas under the ROC curve (AUCs) for MTR and MTRasym (1 ppm) in discriminating active from inactive TAO were 0.772 and 0.730, respectively. Combining MTR with MTRasym (1 ppm) significantly improved diagnostic performance compared with either parameter alone, achieving an AUC of 0.805 (P = 0.029 and 0.001). Conclusion MTR and MTRasym (1 ppm) were independently associated with TAO activity. Their combination further enhanced diagnostic performance in distinguishing active from inactive TAO, suggesting their potential as quantitative imaging biomarkers to guide treatment in patients with TAO.

Objective To propose a liver ultraound image classification model based on bimodal fusion and deep residual network to enhance the diagnosis accuracy of space-occupying lesions(SOLs)of liver.Methods Firstly,a liver ultrasound dataset containing 164 lesions from 100 patients was constructed,including the ultrasound and ultrasonography videos of the patients.Secondly,the parallel residual block was introduced to improve the ResNet-18 network,and the simple attention module and coordinate attention mechanism were used to extract the image features of ultrasound and echography videos,respectively.Finally,a bimodal fusion network was developed with the image features of ultrasound and sonography videos,which was combined with the improved ResNet-18 network to form an ultrasound image classification model.The ultrasound image classification model proposed underwent performance verification by ablation experiment,application evaluation,diagnosis efficacy evaluation,significance evaluation for assisting surgical operation and comparison with the existing classification models in terms of image classification ability.Results The ablation experiment results showed that the proposed model performed the best in classification speed and accuracy when compared with the existing classification models,with a floating-point operation speed of 5.328×109/s,an average accuracy of 0.941 and a calculation speed of 245.266 frames/s.The application evaluation results indicated when compared with the existing classification models the proposed model had the best convergence performance of the loss function curve and the lowest misdiagnosis rate of 7.03%.The diagnosis efficacy evaluation results proved the proposed model gained advantages over other models in diagnostic efficacy,with a sensitivity of 89.38%,a specificity of 94.12%,an accuracy of 90.85%,a positive predictive value of 97.12%and a negative predictive value of 80.00%.The significance evaluation for assisting surgical operation found when compared with the existing classification models the proposed model had the shortest end-to-end delay of 723 ms;laparoscopic hepatectomy assisted with the proposed model had the blood loss reduced by 109.832 mL when compared with the traditional laparoscopic procedure,with the difference being statistically significant(P<0.05).Conclusion The proposed model enhances the diagnosis efficiency and accuracy of ultrasond SOLs of liver,providing support for clinical diagnosis and surgical assistance.[Chinese Medical Equipment Journal,2025,46(10):9-16]

Aim To investigate the intervention effect of Rehmannia radix water extract on bleomycin(BLM)-induced pulmonary fibrosis in mice combined with metabolomics and to reveal the potential mechanism,in order to provide new ideas for clinical treatment of pul-monary fibrosis.Methods Male C57BL/6N mice were randomly divided into the control group,model group,pirfenidone group(positive control,PFD,270 mg·kg-1),and low dose(DH-L,4.55 g·kg-1)group,medium dose(DH-M,9.1 g·kg-1)group and high dose(DH-H,18.2 g·kg-1)group of Rehman-nia.Except for the control group,BLM(5 mg·kg-1)was instilled into the trachea to establish the model of pulmonary fibrosis in the other groups.The survival rate,lung index and blood oxygen saturation of mice in each group were evaluated.HE and Masson staining were used to observe the pathological changes of lung tissue.WBP was used to detect lung function.Flow cytometry was used to detect the apoptosis of primary lung cells,ROS and immune cells.ELISA was used to detect the levels of fibrosis markers and inflammatory factors(α-SMA,collagen Ⅰ,collagen Ⅲ,TGF-β1,TNF-α,IL-1 β,and IL-6).Biochemical method was employed to detect the contents of GSH-Px,T-SOD and MDA.Liquid chromatograph mass spectrometer(LC-MS)metabolomics was used to analyze the changes of serum metabolic profile.Results Water extract of Re-hmannia significantly increased the survival rate,oxy-gen saturation and lung function of mice with pulmona-ry fibrosis,reduced the lung coefficient,ameliorated pathological damage and collagen deposition in lung tissue,reduced the levels of apoptosis and oxidative stress,and down-regulated the levels of inflammatory factors in lung tissue.It regulated the levels of metabo-lites such as bile acid metabolism,sphingolipid metabo-lism,and unsaturated fatty acid metabolism.Conclu-sions Water extract of Rehmannia inhibits lung injury and collagen deposition in mice with pulmonary fibrosis by inhibiting inflammatory response,which may be a-chieved by regulating the levels of inflammatory factors through the metabolic pathways of bile acid and sphin-golipid.

To meet the domestic clinical demand timely,the national health commission has released three batches of encourage generic drug catalogues,which plays a good guiding role in improving the supply level and accessibility of generic drugs.Based on literature investigation,the typical cases of novel pharmaceutical preparations were analyzed,and the pharmaceutical considerations were put forward in terms formulation,manufacturing process and quality control,aimed to provide scientific reference for research and development of such drugs.

Objective:To assess the impact of different exercise modalities on cognitive and physical functions in elderly patients with cognitive frailty using a network meta-analysis based on frequency theory.Methods:A comprehensive computer and manual search was conducted in PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine disc for randomized controlled trials on the effects of exercise training on cognitive and physical functions in elderly patients with cognitive frailty. The search covered studies published until December 31, 2023. To ensure the rigor of the study, two researchers independently screened the literature, evaluated the quality using the Cochrane risk of bias tool, and extracted data. Statistical analysis was conducted using Stata 14.0 software.Results:A total of 16 studies were included, involving 10 different exercise interventions (Baduanjin, Tai Chi Chuan, Mindfulness-based Tai Chi Chuan, Otago exercise, high-intensity interval training, dual-task exercise training, multicomponent exercise, aerobic exercise, resistance exercise, and combined aerobic and resistance exercise). The network meta-analysis results showed that, compared with non-exercise control groups, Baduanjin and dual-task exercise training improved cognitive function in elderly patients with cognitive frailty ( P<0.05), with Baduanjin showing the best effect ( SUCRA=0.79). Multicomponent exercise improved frailty ( P<0.05) with the best effect ( SUCRA=1.00), it also improved grip strength ( P<0.05), with the best effect ( SUCRA=0.89). Multicomponent exercise and dual-task exercise training improved walking speed ( P<0.05), multicomponent exercise had the best effect ( SUCRA=1.00) . Conclusions:Baduanjin has an advantage in improving cognitive function in elderly patients with cognitive frailty, while multicomponent exercise is more effective in improving frailty, grip strength, and walking speed. However, the conclusions of this study need further validation.

Aim To investigate the intervention effect of Rehmannia radix water extract on bleomycin(BLM)-induced pulmonary fibrosis in mice combined with metabolomics and to reveal the potential mechanism,in order to provide new ideas for clinical treatment of pul-monary fibrosis.Methods Male C57BL/6N mice were randomly divided into the control group,model group,pirfenidone group(positive control,PFD,270 mg·kg-1),and low dose(DH-L,4.55 g·kg-1)group,medium dose(DH-M,9.1 g·kg-1)group and high dose(DH-H,18.2 g·kg-1)group of Rehman-nia.Except for the control group,BLM(5 mg·kg-1)was instilled into the trachea to establish the model of pulmonary fibrosis in the other groups.The survival rate,lung index and blood oxygen saturation of mice in each group were evaluated.HE and Masson staining were used to observe the pathological changes of lung tissue.WBP was used to detect lung function.Flow cytometry was used to detect the apoptosis of primary lung cells,ROS and immune cells.ELISA was used to detect the levels of fibrosis markers and inflammatory factors(α-SMA,collagen Ⅰ,collagen Ⅲ,TGF-β1,TNF-α,IL-1 β,and IL-6).Biochemical method was employed to detect the contents of GSH-Px,T-SOD and MDA.Liquid chromatograph mass spectrometer(LC-MS)metabolomics was used to analyze the changes of serum metabolic profile.Results Water extract of Re-hmannia significantly increased the survival rate,oxy-gen saturation and lung function of mice with pulmona-ry fibrosis,reduced the lung coefficient,ameliorated pathological damage and collagen deposition in lung tissue,reduced the levels of apoptosis and oxidative stress,and down-regulated the levels of inflammatory factors in lung tissue.It regulated the levels of metabo-lites such as bile acid metabolism,sphingolipid metabo-lism,and unsaturated fatty acid metabolism.Conclu-sions Water extract of Rehmannia inhibits lung injury and collagen deposition in mice with pulmonary fibrosis by inhibiting inflammatory response,which may be a-chieved by regulating the levels of inflammatory factors through the metabolic pathways of bile acid and sphin-golipid.

Objective To improve and refine the relevant regulations and guiding principles of warnings on drug instructions and labels in China.Methods This paper sorted out the drug instructions of small molecule anti-tumor drugs listed by the U.S.Food and Drug Administration(FDA)from 2005 to 2022,included the drugs mentioned in the QT interval prolongation risk,analyzed the clinical research and QT research results,and sorted out the identification and warning rules of the instructions.Results A total of 35 drugs were included,4 drugs wrote the risk of QT interval prolongation in the black box warning,21 drugs were wrote in the warning and precautions position,6 drugs were wrote in the adverse reaction section,and 2 drugs were only described under clinical pharmacology section.According to the severity of the QT interval prolongation caused by the drug and whether there were serious clinical consequences,they were displayed in the warnings(black box warnings),precautions(warnings and precautions)and adverse reactions in the instructions.Conclusion The aim of this article is to provide a reference for the writing of QT risk warning information of the instructions of domestic drug production enterprises and regulatory departments.It is recommended to clarify the severity of drug safety and the location of the instructions in clinical research,and continue to carry out safety monitoring and update the instructions in time after listing.

Objective To explore the association between nocturnal blood pressure decline rate and chronic heart failure(CHF).Methods In this study,a total of 711 individuals who underwent 24-h ambulatory blood pressure monitoring were divided into control group(n=433)and CHF group(n=278).The characteristics of the study population and nocturnal blood pressure decline rate were compared between CHF group and control group.Restricted spline analysis was utilized to examine the linear or non-linear association between nocturnal blood pressure decline rate and the prevalence of CHF.The relationship between nocturnal blood pressure decline rate and CHF was further investigated based on multivariable Logistic regression model.Results Nocturnal systolic blood pressure decline rate was significantly different in CHF group and control group[(3.3±7.1)mmHg vs.(5.0+6.7)mmHg,P=0.001].No significant difference in nocturnal diastolic blood pressure was found between the two groups[(5.7±7.6)mmHg vs.(6.8±7.2)mmHg,P=0.061].Restricted spline analysis showed a significant linear association between nocturnal systolic blood pressure decline rate and CHF risk.After adjusting for age,sex,smoking,body mass index,24-hour systolic blood pressure,24-hour diastolic blood pressure,type 2 diabetes mellitus and hyperlipidemia,multivariate Logistic regression analysis revealed that nocturnal systolic blood pressure decline rate was negatively associated with the prevalence of CHF(OR=0.97,95％CI:0.95-0.99;P=0.010).However,no significant association was found between nocturnal diastolic blood pressure decline rate and CHF risk.Conclusion Nocturnal systolic blood pressure decline rate is associated with the prevalence of CHF.Individuals with decreased nocturnal systolic blood pressure decline have a significantly increased risk of CHF.

Objective:To evaluate the efficacy of shockwave therapy,acupuncture,hyperthermia,biofeedback therapy,elec-trical nerve stimulation,magnetotherapy and ultrasound therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS),and to provide evidence-based support for clinical decision-making.Methods:Two researchers independently searched PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang,VIP and Chinese Biomedical Literature databases for randomized controlled trials(RCTs)on the effects of different interventions on CP/CPPS from the establishment of the databases to August 2024.We evaluated the quality of the included literature and extracted the relevant data according to the Cochrane Handbook for Systematic Reviews of Interventions,followed by network meta-analysis using Revman 5.3,R 4.33 and Stata17 software.Results:A total of 25 RCTs involving 1 794 cases were included.The results of network meta-analysis showed that electrical nerve stimulation,shockwave therapy,biofeedback therapy,magnetotherapy,ultrasound therapy and acupuncture were significantly superior to conventional medication and placebo in the total NIH-CPSI scores(P＜0.05),and so were electrical nerve stimulation and shock-wave therapy to acupuncture and hyperthermia(P＜0.05),magnetic therapy to hyperthermia,and ultrasound therapy to placebo(P＜0.05).Shockwave therapy,biofeedback therapy,electrical nerve stimulation,magnetotherapy and ultrasound therapy achieved re-markably better clinical efficacy than conventional medication and placebo in the treatment of CP/CPPS,and so did shockwave therapy than electrical nerve stimulation,hyperthermia,ultrasonic therapy,magnetotherapy and acupuncture.Conclusion:For the treat-ment of CP/CPPS,electrical nerve stimulation is advantageous over the other interventions in improving total NIH-CPSI scores,and shockwave therapy is advantageous in relieving pain symptoms and clinical efficacy.This conclusion,however,needs to be further veri-fied by more high-quality clinical studies.

Aim To design and synthesize a series of glycyrrhetinic acid derivatives by using glycyrrhetinic acid as the parent nucleus,screen their antitumor activ-ities,and investigate the in vitro and in vivo antitumor effects and mechanisms of the most active compound.Methods MTT assay was used to screen for the com-pound with the most potent antitumor activity.MTT as-say,wound healing assay,colony formation assay and Transwell migration assay were used to evaluate the effects of the compound on tumor cell viability and mi-gration.Flow cytometry was employed to assess the im-pact of the compound on tumor cell cycle progression and apoptosis.Western blot was conducted to verify the effects on the expression of pro-apoptotic proteins Bax,caspase-3 and cleaved caspase-3.A mouse model of hepatocellular carcinoma ascites tumor was estab-lished to examine the antitumor effects of the compound in vivo.Results Compound C22 was identified as having the most significant inhibitory effect on hepato-cellular carcinoma cells.C22 inhibited the viability and migration of hepatocellular carcinoma cells in a time and concentration-dependent manner.C22 upreg-ulated the expression of pro-apoptotic proteins Bax,caspase-3 and cleaved caspase-3 in hepatocellular car-cinoma cells,induced apoptosis,and arrested the cell cycle in the G0/G1 and S phases.C22 significantly re-duced the growth of mouse hepatocellular carcinoma as-cites tumors and prolonged survival.Conclusion Glycyrrhetinic acid derivative C22 significantly inhibits the viability and migration of hepatocellular carcinoma cells in vitro and in vivo,and induces cell cycle arrest and apoptosis.