ObjectiveTo explore the dose-effect relationship and safety of high， medium， and low doses of raw Astragali Radix in the modified Huangqi Chifengtang （MHCD） for treating proteinuria in immunoglobulin A （IgA） nephropathy， and to provide scientific evidence for the clinical use of high-dose Astragali Radix in the treatment of proteinuria in IgA nephropathy. MethodsA total of 120 patients with IgA nephropathy， diagnosed with Qi deficiency and blood stasis combined with wind pathogen and heat toxicity， were randomly divided into a control group and three treatment groups. The control group received telmisartan combined with a Chinese medicine placebo， while the treatment groups were given telmisartan combined with MHCD containing different doses of raw Astragali Radix （60， 30， 15 g）. Each group contained 30 patients， and the treatment period was 12 weeks. Changes in 24-hour urinary protein （24 hUTP）， traditional Chinese medicine （TCM） syndrome scores， effective rate， and renal function were observed before and after treatment. Safety was assessed by monitoring liver function and blood routine. ResultsAfter 12 weeks of treatment， 24 hUTP significantly decreased in the high， medium， and low-dose groups， as well as the control group （P<0.05， P<0.01）. The TCM syndrome scores in the high， medium， and low-dose groups also significantly decreased （P<0.01）. Comparisons between groups showed that the 24 hUTP in the high-dose group was significantly lower than in the medium， low-dose， and control groups （P<0.05， P<0.01）， and the 24 hUTP in the medium-dose group was significantly lower than in the control group （P<0.05）. The TCM syndrome scores in the high and medium-dose groups were significantly lower than in the low-dose and control groups （P<0.05， P<0.01）. The total effective rates for proteinuria in the high， medium， low-dose， and control groups were 92.59% （25/27）， 85.19% （23/27）， 60.71% （17/28）， and 57.14% （16/28）， respectively. The effective rates in the high and medium-dose groups were significantly higher than in the low-dose and control groups （χ²=13.185， P<0.05， P<0.01）. The effective rates for TCM syndrome scores in the high， medium， low-dose， and control groups were 88.89% （24/27）， 81.48% （22/27）， 71.43% （20/28）， and 46.43% （13/28）， respectively. The efficacy of TCM syndrome scores in the high and medium-dose groups was significantly higher than in the control group （χ²=14.053， P<0.01）. Compared with pre-treatment values， there was no statistically significant difference in eGFR and serum creatinine in the high and medium-dose groups. However， eGFR significantly decreased in the low-dose and control groups after treatment （P<0.05）， and serum creatinine levels increased significantly in the control group （P<0.05）. No statistically significant differences were observed in urea nitrogen， uric acid， albumin， total cholesterol， triglycerides， liver function， and blood routine before and after treatment in any group. ConclusionThere is a dose-effect relationship in the treatment of IgA nephropathy with high， medium， and low doses of raw Astragali Radix in MHCD. The high-dose group exhibited the best therapeutic effect and good safety profile.

Objective:To screen key genes that co-regulate immune and mitochondrial energy metabolism through bioinformatics methods and to investigate the relationship between the key genes and immune infiltration.Methods:A total of 671 glioma samples (the tumor group) and 5 non-tumor brain tissue samples (the control group) were collected from the Cancer Genome Atlas (TCGA) database on November 13, 2023. Through a comprehensive search of the GeneCards database and immune-related genes (IRG) and mitochondrial energy metabolism-related genes (MEMRG) in previous published literatures, 76 IRG and MEMRG (IR & MEMRG) were obtained by taking the intersection of IRG and MEMRG after merging and deduplicating. The limma package in R software was used to screen the differentially expressed genes (DEG) between the tumor group and the control group. Then, immune-related & mitochondrial energy metabolism-related differentially expressed genes (IR&MEMRDEG) were obtained by intersecting with IR & MEMRG. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted on the IR&MEMRDEG through the clusterProfiler package in R software. The STRINGv12.0 online database (https://cn.string-db.org/) was employed to construct a protein interaction network based on IR&MEMRDEG and to identify the top 5 key core genes. Single-sample gene-set enrichment analysis (ssGSEA) was used to determine the relative abundance of immune cell infiltration in all samples, and the immune cell infiltration matrices for both the tumor and the control groups were acquired. The expression differences in infiltration abundance of the immune cells in the tumor group and the control group were analyzing by using the ggplot2 package in R software. The heat map was drawn by utilizing the R software pheatmap package to show self-correlation of immune cells. The correlation between the top 5 key genes in the protein interaction network and immune cells was calculated by using the Spearman algorithm and the R software ggplot2 package.Results:A total of 3 623 DEGs were identified from the TCGA database in both groups, including 1 711 up-regulated genes and 1 912 down-regulated genes. After taking the intersection of DEG and IR&MEMRG, 11 IR&MEMRDEG were obtained including EIF4EBP1, TP53, IDH1, PRCKZ, CD200, GPI, PGM2, PKLR, AK2, ATP4A, and ALDH3B1. GO enrichment analysis results showed that 11 IR&MEMRDEG were mainly enriched in ADP metabolic process, ATP metabolic process, purine nucleoside diphosphate metabolic process, purine ribonucleoside diphosphate metabolic process, and ribonucleoside diphosphate metabolic process at the biological level; in the fibronectin-1 rich granule, secretory granule lumen, cytoplasmic vesiclelumen, vesiclelumen, and nuclear matrix at the cellular component level; in magnesium ion binding, potassium ion binding, and alkali metal ion binding at the molecular functional level. The KEGG enrichment analysis results showed that 11 IR&MEMRDEGs were mainly enriched in glycolysis/gluconeogenesis, carbon metabolism, insulin signaling pathway, pentose phosphate pathway, starch and sucrose metabolism signaling pathways. The protein interaction network analysis from the STRING database revealed that 5 highest scoring core proteins were identified, namely EIF4EBP1, TP53, IDH1, PRKCZ, and AK2.The immune infiltration abundances of 28 immune cells were calculated by using the ssGSEA algorithm. The infiltration abundance of 15 immune cells in the tumor group was higher than that in the control group, and the differences were statistically significant (all P < 0.05). The findings from the immune infiltration analysis indicated a positive correlation among 15 types of immune cells, in which there was a strongest correlation between effector memory CD8 + T cell and myeloid derived suppressor cells. EIF4EBP1, TP53, IDH1, and AK2 exhibited a positive correlation with a large number of immune cells (all P < 0.05), whereas PRKCZ demonstrated a negative correlation with more immune cells (all P < 0.05). Conclusions:PRKCZ, AK2, and EIF4EBP1 have the potential to be the new targets of immunotherapy for gliomas.

Objective:To investigate the effects of compound Duzhong Jiangu Granules on joint function and gut microbiota in patients with Kashin-Beck disease.Methods:A single group pre- and post-experimental design was conducted, the patients with Kashin-Beck disease were selected as the subjects in Xunyi County, Xianyang City, Shaanxi Province; and treated with oral administration of compound Duzhong Jiangu Granules (12 g/bag, 1 bag/time, 3 times/day) for a period of 1 month. The improvement of joint function was evaluated using the joint dysfunction index scoring method before and after treatment. Morning stool samples of patients were collected and the changes in gut microbiota were analyzed before and after treatment using 16S rDNA sequencing technology.Results:A total of 87 patients with Kashin-Beck disease were included, including 44 males and 43 females; the age was (60.38 ± 7.12) years old, and the body mass index was (23.67 ± 3.59) kg/m 2. The comprehensive scores of joint dysfunction index for patients with Kashin-Beck disease before and after treatment were (7.27 ± 2.05) and (5.86 ± 2.01) points, respectively, and the difference was statistically significant ( t = 5.88, P < 0.001). The sequencing results of gut microbiota showed that there were statistically significant differences in the alpha diversity (chao1, observed species index) and beta diversity of gut microbiota in patients with Kashin-Beck disease before and after treatment ( Z = - 5.08, - 5.03, R = 0.09, P < 0.001). In the distribution of gut microbiota, Firmicutes was the dominant phylum, with relative abundances of 50.21% and 52.09% before and after treatment, respectively; the Bifidobacterium was the dominant bacterial genus, with relative abundances of 16.83% and 18.81% before and after treatment, respectively. At the genus level, a total of 17 gut microbiota genera were screened out, among which the relative abundances of Hafnia-Obesumbacterium, Gammaproteobacteria_unclassified, Acinetobacter, Pantoea, Leuconostoc, and Akkermanisia were significantly higher than before treatment ( Z = - 2.40, - 2.24, - 2.06, - 3.59, - 2.24, - 2.11, P < 0.05). The relative abundances of Dubosiella, Selenomonas, Anaeroplasma, Lachnospiraceae_ NK4A136_group, Rikenella, Prevotella, Megasphaera, Lactobacillus, Prevotella-9, Phascolarctobacterium, and Desulfovibrio were significantly lower than before treatment ( Z = - 9.38, - 2.61, - 2.18, - 8.43, - 2.45, - 2.46, - 2.49, - 7.29, - 2.29, - 2.55, - 2.08, P < 0.05). Conclusions:Compound Duzhong Jiangu Granules can effectively improve the joint function of patients with Kashin-Beck disease, and alter the diversity and richness of the gut microbiota community. It may reduce clinical symptoms in patients by regulating the structure of gut microbiota.

Objective:To investigate the value of a deep learning model based on diffusion-weighted imaging (DWI) in quick identification of the TOAST etiology classification in patients with acute ischemic stroke (AIS).Methods:In this cross-sectional study, imaging and clinical data of 504 patients with AIS admitted to the First Affiliated Hospital of Xinjiang Medical University from March 2023 to February 2024 were retrospectively reviewed. Using the TOAST etiology classification, there were 252 large artery atherosclerosis type and 252 small-artery occlusion type. The 504 cases were divided into a training set ( n=302), a validation set ( n=101) and a test set ( n=101) using stratified randomization in the ratio of 6∶2∶2. All cases had DWI data. A DenseNet network framework was used to construct DenseNet models by optimizing the model configurations of different layers. Three DenseNet models with different layers (121, 169, 201) were constructed, named DenseNet169 model, DenseNet121 model, and DenseNet201 model. The data enhancement, Adam optimizer and cross-entropy loss function methods were used to improve the convergence speed and robustness of the model, and to balance the positive and negative sample imbalance problem. Independent sample t-test or χ2 was used to compare the clinical data of patients with large artery atherosclerosis type and small-artery occlusion type AIS. Receiver operating characteristic curves and area under the curve (AUC) were performed to evaluate the efficacy of each model in identification of patients with large artery atherosclerosis type and small-artery occlusion type AIS. Results:There were statistically significant differences in age, National Institutes of Health Stroke Scale score at admission, and stenosis or occlusion of large vessels between patients with large artery atherosclerosis type and small-artery occlusion (all P<0.05). In the test set, the AUC, sensitivity, accuracy, and F1 score values of the DenseNet201 model for discriminating patients with large artery atherosclerosis type AIS and small-artery occlusion type AIS (0.826, 0.902, 0.743, 0.780, respectively) were higher than those of DenseNet121 (0.801, 0.647, 0.723, 0.702, respectively) and DenseNet169 model (0.778, 0.882, 0.733, 0.769). Conclusions:The deep learning models based DWI constructed in this study can help with the TOAST etiology classification of AIS cases. DenseNet201 model shows the best and stable performance in the deep learning-based classification.

Zhigancao Tang （also known as Fumaitang） is a classic formula for treating "intermittent pulse and palpitations" and is widely used in clinical practice. Sanjia Fumaitang， included in the Catalogue of Ancient Classical Formulas （First Batch） published by the National Administration of Traditional Chinese Medicine of China in 2018， is derived from this formula. This paper employed bibliometric methods to comprehensively investigate and summarize the historical evolution， drug composition， herb origins and preparation， prescription meanings， and ancient and modern applications of Zhigancao Tang， analyzed the composition and usage of Zhigancao Tang， and discussed the reasons and applications of the "Fumaitang" variants created by Wu Jutong. A total of 47 valid pieces of data from 38 ancient texts were included. Results showe that Zhigancao Tang originates from the Treatise on Cold Damage （Shang Han Lun）， and the name "Fumaitang" is also recorded in the formula's description. Converted to modern measurements from the Han dynasty system， the recommended preparation for Zhigancao Tang includes 55.2 g of fried Glycyrrhizae Radix et Rhizoma， 41.4 g of Cinnamomi Ramulus， 27.6 g of Ginseng Radix et Rhizoma， 220 g of fresh Rehmannia glutinosa， 27.6 g of Asini Corii Colla， 53 g of Ophiopogonis Radix， 45 g of Cannabis Fructus， and 90 g of Jujubae Fructus. All herbs should be decocted with 1 400 mL of yellow rice wine and 1 600 mL of water until 600 mL. Once the Asini Corii Colla is fully dissolved， the decoction should be taken warm at a dosage of 200 mL， three times a day. Zhigancao Tang is effective for replenishing Qi， warming Yang， nourishing Yin， and nourishing blood and is primarily used to treat “intermittent pulse and palpitations” caused by deficiencies in heart Yin and Yang， as well as malnutrition of the heart meridian and conditions like lung atrophy. Modern applications mainly focus on cardiovascular and cerebrovascular diseases， including arrhythmias， coronary heart disease， and premature ventricular contractions. The findings from this research provide a reference for the further development of Zhigancao Tang.

Objective:To compare the resting energy expenditure(REE)characteristics among young men with different body mass indexes(BMI).Methods:Thirty young men[average age was(26.93± 4.16)years]were enrolled in this study.They underwent resting metabolism tests in the Department of Sports Medicine of Peking University Third Hospital from December 2017 to June 2021.The resting meta-bolic rate(RMR)was measured by indirect calorimetry,the body composition was measured by bioresis-tance antibody component analyzer.The REE characteristics were analyzed,and 11 predictive equations were used to estimate RMR and compared with the measured value.The differences were analyzed by paired t-test and intra-class correlation coefficient(ICC).Results:The RMR of the overall 30 young men was(1 960.17±463.11)kcal/d(1 kcal=4.186 8 kJ).Including(1 744.33±249.62)kcal/d in those with normal BMI,which was significantly lower than that in those who were overweight or obese[(2 104.06±520.32)kcal/d,P＜0.01],but the weight-corrected RMR in those with normal BMI was significantly higher than that in those who were overweight or obese[(24.02±2.61)kcal/(kg·d)vs.(19.98±4.38)kcal/(kg·d),P＜0.01].The RMR was significantly and positively correlated with body weight,adiposity,lean body mass,body surface area,and extracellular fluid in the subjects with diffe-rent BMI(all P＜0.05).The predicted values of the 11 prediction equations were not in good agreement with the measured values(all ICC＜0.75),with relatively high agreement between the pre-dicted and measured values of the World Health Organization(WHO)equation in overweight obese young men(ICC=0.547,P＜0.01).Conclusion:There were significant differences in RMR among young men with different BMI,and the RMR after weight correction should be considered for those who were overweight or obese.The consistency between the predicted values of different prediction equations and the actual measured values of RMR was relatively poor,and it is recommended to accurately measure RMR by indirect calorimetry.For overweight or obese young men,the WHO prediction equation can be considered to calculate RMR,but it is necessary to establish an RMR prediction equation applicable to different BMI populations.

To evaluate the safety and efficacy of neoadjuvant radiohormonal therapy for oligometastatic prostate cancer (OMPC), we conducted a 3 + 3 dose escalation, prospective, phase I/II, single-arm clinical trial (CHiCTR1900025743), in which long-term neoadjuvant androgen deprivation was adopted 1 month before radiotherapy, comprising intensity modulated radiotherapy to the pelvis, and stereotactic body radiation therapy to all extra-pelvic bone metastases for 4-7 weeks, at 39.6, 45, 50.4, and 54 Gy. Robotic-assisted radical prostatectomy was performed after 5-14 weeks. The primary outcome was treatment-related toxicities and adverse events; secondary outcomes were radiological treatment response, positive surgical margin (pSM), postoperative prostate-specific antigen (PSA), pathological down-grading and tumor regression grade, and survival parameters. Twelve patients were recruited from March 2019 to February 2020, aging 66.2 years in average (range, 52-80). Median baseline PSA was 62.0 ng/mL. All underwent RARP successfully without open conversions. Ten patients recorded pathological tumor down-staging (83.3%), and 5 (41.7%) with cN1 recorded negative regional lymph nodes on final pathology. 66.7% (8/12) recorded tumor regression grading (TRG) -I and 25% (3/12) recorded TRG-II. Median follow-up was 16.5 months. Mean radiological progression-free survival (RPFS) was 21.3 months, with 2-year RPFS of 83.3%. In all, neoadjuvant radiohormonal therapy is well tolerated for oligometastatic prostate cancer.
Male ; Humans ; Prostatic Neoplasms/radiotherapy* ; Prostate-Specific Antigen/therapeutic use* ; Neoadjuvant Therapy ; Androgen Antagonists/therapeutic use* ; Prospective Studies

OBJECTIVE: To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. METHODS: Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI. RESULTS: The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697). CONCLUSION UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Humans ; Imaging, Three-Dimensional ; Lumbar Vertebrae/surgery* ; Minimally Invasive Surgical Procedures ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome

Humans ; Mass Vaccination ; COVID-19 Vaccines/therapeutic use* ; COVID-19/prevention & control* ; Immunity, Herd ; Vaccination

Prostate cancer is one of the most common malignant tumors in the world.Without typical early manifestations in the early stage, it is often too late when found. Therefore, early diagnosis, treatment, and prognosis are critical to improving the survival rate of patients with prostate cancer. Over the past few years, artificial intelligence(AI) has developed rapidly in the field of prostate cancer. In terms of diagnosis, AI is used as a tool to screen the images to reduce the error caused by the professionalism and subjectivity of the technician and to improve the repeatability of the results; In the prediction of prognosis, the algorithm calculates and evaluates disease-related parameters such as recurrence rate, lymph node metastasis rate and mortality rate, so as to assistant clinicians in decision-making and treatment improvements. This reviews aims to introduce the application of artificial intelligence in the diagnosis, treatment and prognosis of prostate cancer in recent years, as well as the prospect and challenges faced by artificial intelligence in the medical field.