OBJECTIVE To establish population pharmacokinetic model of levetiracetam （Lev） for Chinese patients with post- stroke epilepsy （PSE）， and provide reference for formulating individualized dosing regimens for Lev therapy in this specific population. METHODS Blood concentration data and clinical diagnosis and treatment information of PSE patients meeting the inclusion criteria were retrospectively collected and divided into model group and validation group at an 8∶2 ratio using a random number method. Based on the model group data， a population pharmacokinetic model was developed using nonlinear mixed-effects modeling. Internal evaluation was performed through goodness-of-fit tests and bootstrap analysis， while external validation was conducted using the validation group data. RESULTS A total of 75 blood concentration measurements from 70 PSE patients were collected， with 60 measurements from 55 patients used for model development and 15 measurements from 15 patients reserved for external validation. The final model estimated a population typical value of clearance at 2.98 L/h. Estimated glomerular filtration rate， daily dose， and homocysteine level significantly influenced clearance of Lev （P＜0.01）. The model demonstrated satisfactory predictive performance， as evidenced by goodness-of-fit tests， bootstrap analysis， and external validation results. CONCLUSIONS Daily dose， estimated glomerular filtration rate， and homocysteine level are identified as significant covariates influencing Lev clearance in Chinese PSE patients. When making clinical decisions， comprehensive consideration should be given to the patient’s treatment response， physiological and pathological conditions， and the occurrence of adverse reactions， etc. The dosage of Lev should be adjusted based on the results of population pharmacokinetic model.

This comprehensive review systematically explores the multifaceted applications, inherent challenges, and promising future directions of artificial intelligence (AI) within the medical domain. It meticulously examines AI's specific contributions to basic medical research, disease prevention, intelligent diagnosis, treatment, rehabilitation, nursing, and health management. Furthermore, the review delves into AI's innovative practices and pivotal roles in clinical trials, hospital administration, medical education, as well as the realms of medical ethics and policy formulation. Notably, the review identifies several key challenges confronting AI in healthcare, encompassing issues such as inadequate algorithm transparency, data privacy concerns, absent regulatory standards, and incomplete risk assessment frameworks. Looking ahead, the future trajectory of AI in healthcare encompasses enhancing algorithm interpretability, propelling generative AI applications, establishing robust data-sharing mechanisms, refining regulatory policies and standards, nurturing interdisciplinary talent, fostering collaboration among industry, academia, and medical institutions, and advancing inclusive, personalized precision medicine. Emphasizing the synergy between AI and emerging technologies like 5G, big data, and cloud computing, this review anticipates a new era of intelligent collaboration and inclusive sharing in healthcare. Through a multidimensional analysis, it presents a holistic overview of AI's medical applications and development prospects, catering to researchers, practitioners, and policymakers in the healthcare sector. Ultimately, this review aims to catalyze the deep integration and innovative deployment of AI technology in healthcare, thereby driving the sustainable advancement of smart healthcare.

As the volume of medical research using large language models (LLM) surges, the need for standardized and transparent reporting standards becomes increasingly critical. In January 2025, Nature Medicine published statement titled by TRIPOD-LLM reporting guideline for studies using large language models. This represents the first comprehensive reporting framework specifically tailored for studies that develop prediction models based on LLM. It comprises a checklist with 19 main items (encompassing 50 sub-items), a flowchart, and an abstract checklist (containing 12 items). This article provides an interpretation of TRIPOD-LLM’s development methods, primary content, scope, and the specific details of its items. The goal is to help researchers, clinicians, editors, and healthcare decision-makers to deeply understand and correctly apply TRIPOD-LLM, thereby improving the quality and transparency of LLM medical research reporting and promoting the standardized and ethical integration of LLM into healthcare.

Gentianopsis barbata (G. barbata) represents a significant plant species with considerable ornamental and medicinal value in China. This investigation sought to elucidate the primary constituents within the plant and investigate their pharmacological properties. Fifty triterpenoids (1-50), including nine previously undescribed compounds (1, 2, 7, 10, 20, 28, 29, 37, and 41) were isolated and characterized from the whole plants of G. barbata. Notably, compounds 1 and 2 exhibited the novel 3,4;9,10-diseco-24-homo-cycloartane triterpenoid skeleton. The isolated triterpenoids demonstrated substantial anti-inflammatory activity through inhibition of tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) cytokine secretion in LPS-induced RAW264.7 macrophages, and hepatoprotective effects by preventing tert-butyl hydroperoxide (t-BHP)-induced oxidative injury in HepG2 cells. These results demonstrate both the presence of diverse triterpenoids in G. barbata and their therapeutic potential for inflammatory and hepatic conditions, providing scientific evidence supporting the clinical application of this traditional Mongolian medicinal plant.
Triterpenes/isolation & purification* ; Mice ; Anti-Inflammatory Agents/isolation & purification* ; Animals ; Humans ; RAW 264.7 Cells ; Hep G2 Cells ; Interleukin-6/genetics* ; Tumor Necrosis Factor-alpha/genetics* ; Medicine, Mongolian Traditional ; Macrophages/immunology* ; Protective Agents/isolation & purification* ; Liver/drug effects* ; Gentianaceae/chemistry* ; Plant Extracts/chemistry* ; Molecular Structure

Objective: To investigate the prevalence of Dengue virus (DENV) infection among voluntary blood donors in Xishuangbanna Dai Autonomous Prefecture, and to evaluate the necessity of implementing nucleic acid testing (NAT) for blood donors during the rainy season (May-October). Methods: Prior to initiating donor screening, the Xishuangbanna Central Blood Center conducted in-house validation of reagent performance and participated in external quality assessment (EQA) organized by the National Center for Clinical Laboratories (NCCL). During the surveillance period (August-October 2024), a total of 2 919 donor samples were screened using a 6-sample mini-pool NAT strategy. Daily internal quality controls were recorded. Samples that tested positive in pooled screening were deconvoluted and retested in duplicate; only those reactive in both replicate wells were sent to the NCCL for confirmatory testing. At NCCL, samples underwent re-testing using five domestic NAT reagents, as well as serological assays for NS1 antigen and DENV-specific IgG/IgM. Confirmed positive samples were further characterized by serotyping, envelope (E) gene sequencing, and phylogenetic analysis using the maximum likelihood method. Results: The DENV NAT reagent demonstrated consistent detection of 40 copies/mL controls in individual donor (ID)-NAT test (mean CT: 35.61±0.40). During the 63-day quality control monitoring, DENV detection remained stable (mean CT: 22.53±0.72). The center achieved full marks in EQA assessments for 2023 and 2024. Three reactive pools were identified in initial screening, and subsequent individual testing confirmed three DENV RNA-positive donors (sample numbers: 2401, 2402, and 2403). The confirmatory test results from NCCL were: all five NAT platforms consistently detected DENV RNA in the three samples; for serological tests, 2 samples (2402, 2403) were positive for NS1 antigen, while all three samples were negative for both IgG and IgM antibodies. DENV serotyping reagents identified DENV-2 in all cases, which were further confirmed as DENV-2 Genotype Ⅱ-Cosmopolitan by E gene sequencing. Phylogenetic analysis indicated that samples 2401 and 2402 clustered with Southeast Asian strains (Thailand/MZ636802.1, Laos/PQ775621.1), while sample 2403 closely matched a previously reported local Yunnan strain (PV544686.1). Conclusion: DENV-2 infection was detected among blood donors in Xishuangbanna during the rainy season, indicating concurrent risks of imported and local transmission. We recommend implementing pooled NAT screening for blood donors in high-risk areas during dengue epidemic seasons, along with strengthened laboratory quality control, to enhance blood safety.

Immunoglobulin A nephropathy is a common autoimmune nephropathy.A growing body of research suggests that immunoglobulin A nephropathy may be associated with dysfunction of the mucosal immune system.Immunoglobulin A nephropathy is characterized by thylakoid deposi-tion of galactose-deficient IgA1 immune complex-es,which are thought to originate from mucosal B-cells,which are abundantly present in the distal ile-um,which is rich in Pyle's collecting lymph nodes.A novel targeted release formulation of budesonide has been shown to deliver the drug to the distal ileum with the aim of minimizing adverse events in patients with immunoglobulin A nephrop-athy.This article reviews the mechanism of action,dosage form characteristics,clinical studies,drug interactions and adverse events,and limitations of budesonide extended-release capsules.

Objective To form the expert consensus on the limb management of patients with transvenous temporary cardiac pacing,standardize the limb management of patients with transvenous temporary cardiac pacing,and reduce complications related to the limb.Methods Using evidence-based methods,the evidence in this field was searched,evaluated and summarized,and relevant recommendations and research conclusions were extracted and classified by the level of evidence quality,and then the first draft of the consensus was formed.From December 2023 to January 2024,through 2 rounds of expert consultation and 4 rounds of expert meetings,the content was adjusted and the consensus was reached.Results Totally 16 experts participated in the consultation.The positive coefficient is 100%;the authoritative coefficient is 0.847 and 0.836;the average value of each index is more than＞3.8;the coefficient of variation is less than 0.21.The Kendall's harmony coefficient of the 2 rounds of expert consultation is 0.372 and 0.314,respectively,which were statistically significant.The consensus covers the preoperative,intraoperative and postoperative on limb management of patients with transvenous temporary cardiac pacing.Totally 11 themes were involved,including the preoperative preparation,position and catheter fixation in operation,position and catheter fixation in postoperative,activity,turn and transfer,duty shift on limb,nursing care after withdrawal of the catheter,prevention of deep vein thrombosis of the operative limb and prevent infection.Conclusion The consensus is highly scientific,and it is helpful to standardize the limb management of patients with transvenous temporary cardiac pacing.

Objective:To examine the prevalence of frailty among elderly patients in the emergency department and to investigate the potential relationship between vitamin D nutritional status and frailty.Methods:This study collected clinical data from elderly patients aged over 65 years in the emergency intensive care unit and emergency observation ward of Beijing Bo'Ai Hospital from January to September 2021.The data included blood routine, biochemical indicators, circulating interleukin-6, cortisol, thyrotropin, and 25-hydroxyvitamin D[25(OH)D], which were detected within 24 hours after enrollment.Additionally, the Frailty Screening Questionnaire(FSQ), FRAIL scale, and Clinical Frailty Scale(CFS)were used to score the patients.Based on the scores, the patients were divided into frail or non-frail groups, and the prevalence of frailty was reported accordingly using the criteria of the aforementioned scales.The consistency of the three scales was evaluated using the Spearman rank test and Kappa coefficient.We compared the differences in clinical data and laboratory indicators of patients between the frail and non-frail groups.Additionally, we used a multivariable Logistic regression model to analyze the association between vitamin D nutritional status and frailty.We also analyzed the prevalence of frailty in different vitamin D nutritional statuses and evaluated the predictive ability of serum 25(OH)D for frailty using the receiver operating characteristic(ROC)curve.Results:A total of 317 patients were included in the study.The prevalence of frailty in elderly patients in the emergency department was found to be 47.0%, 55.2%, and 69.4% according to the FSQ, FRAIL, and CFS scales, respectively.The study evaluated the consistency of these three scales, revealing a Spearman rank correlation coefficient of 0.761(95% CI: 0.715-0.806, P<0.001)and a Kappa coefficient of 0.536(95% CI: 0.451-0.621, P<0.001)between FSQ and FRAIL, which were the highest correlations observed.Logistic regression analysis, after adjusting for age, gender, BMI, and other factors, indicated that vitamin D deficiency( OR=5.994, 95% CI: 1.232-29.169, P=0.027)was independently associated with an increased prevalence of frailty as defined by FSQ criteria.The prevalence of frailty increased with the severity of vitamin D malnutrition.In the vitamin D deficiency group, the prevalence was higher compared to the vitamin D insufficiency and sufficiency groups( P<0.05 for all).The area under the ROC curves(AUCs)of serum 25(OH)D levels to predict frailty, as defined by FSQ, FRAIL, and CFS, were 0.806(95% CI: 0.744-0.868), 0.748(95% CI: 0.679-0.817), and 0.768(95% CI: 0.701-0.826)( P<0.001 for all).The optimal cut-off values were 12.0, 9.76, and 11.65 μg/L, respectively, yielding a Youden index of 0.553, 0.419, and 0.462. Conclusions:FSQ, FRAIL, and CFS demonstrated a strong level of consistency in assessing frailty.Additionally, serum 25(OH)D can serve as an independent predictor of frailty, aiding in the identification of frail individuals and enhancing the risk stratification of elderly patients in the emergency department.

Objective:To investigate the association between serum interleukin (IL) -6 and silent information regulator (SIRT) -1 and frailty in elderly patients in the emergency department.Methods:This was a cross-sectional study. Patients aged 60 years and above treated in the emergency department of Beijing Bo'Ai Hospital from January to December 2022 were collected. Blood routine, biochemical indicators, and serum IL-6 were detected within 24 h after enrollment. At the same time, fasting venous blood 2 mL was collected and the serum was stored at minus 80℃ after centrifugation. The level of SIRT-1 was detected by enzyme-linked immunosorbent assay. Nutritional risk screening 2002 was performed within 72 h, Barthel index was used to assess the ability of daily living and grip strength was measured. The patients were divided into frailty and non-frailty groups according to Fried frailty phenotype (FP). The differences of clinical data and laboratory indicators were compared between the two groups. Multivariable logistic regression model was used to analyze the association between serum IL-6, SIRT-1 and frailty. The predictive ability of serum IL-6 and SIRT-1 for frailty was evaluated by the receiver operating characteristic (ROC) curve.Results:A total of 316 elderly patients in the emergency department were included in this study and divided into frailty group ( n=156) and non-frailty group ( n=160) according to Fried FP criteria. Univariate analysis showed that serum IL-6 [33.3 (13.0, 69.2) ng/L vs. 20.0 (9.2, 41.3) ng/L, P=0.001] and SIRT-1 [(9.98±1.23) μg/L vs. (8.98±1.65) μg/L, P<0.001] of patients in the frailty group were higher than those in the non-frailty group. Multivariable logistic regression analysis showed that serum IL-6 ( OR=1.006, 95% CI: 1.001-1.011, P=0.036) and SIRT-1 ( OR=1.838, 95% CI: 1.475-2.290, P<0.001) were independently associated with frailty after adjusting for age, sex, body mass index, Barthel index and grip strength. The area under the curve (AUC) of serum IL-6 for predicting frailty was 0.671 (95% CI: 0.604-0.738, P<0.001), the predictive cut-off point was 33.8 ng/L. The AUC of SIRT-1 for predicting frailty was 0.736 (95% CI: 0.674-0.799, P<0.001), the predictive cut-off point was 9.13 μg/L. The AUC of the model of IL-6 combined with SIRT-1 was 0.765 (95% CI: 0.707-0.823, P<0.001), the sensitivity and specificity were 0.776 and 0.726, respectively, and its predictive efficacy was superior to that of IL-6 alone ( Z=2.119, P=0.034). Conclusion:Serum IL-6 and SIRT-1 are independent predictors of frailty in elderly patients in the emergency department.

Objective:To analyze the association between the transverse area of erector spine muscle at T 12 level and prognosis in elderly patients with acute coronary syndrome (ACS). Methods:This was a prospective cohort study. Clinical data of elderly patients with ACS admitted to the coronary care unit or the emergency intensive care unit in Beijing Bo'Ai Hospital from January 2019 to June 2022. Blood routine and biochemical indicators were detected and echocardiography was performed within 24 hours after admission, chest CT examination was completed and the cross-sectional areas of the left and right vertical spinalis muscles were calculated at T 12 level, thrombolysis in myocardial infarction (TIMI) was performed within 24 hours after admission. The occurrence of major adverse cardiovascular and cerebral events (MACCE) within 12 months was followed up. The differences of clinical data and laboratory indexes between the MACCE group and the non-MACCE group were compared. Multivariable logistic regression model was used to analyze the association between the cross-sectional area of vertical spinal muscle at T 12 level and the occurrence of MACCE within 12 months after ACS. Results:A total of 406 patients were enrolled in the study, the incidence of MACCE within 12 months was 22.2%. The cross-sectional area of erector spine muscle at T 12 level [(20.43±3.51) cm 2vs. (24.36±3.66) cm 2, (Z=4.412, P<0.001)] in the MACCE group was lower than that in the non-MACCE group. Logistic regression analysis showed that after adjusting for sex, age, body mass index (BMI), TIMI score and revascularization, the cross-sectional area of erector spine muscle at T 12 level ( OR = 0.883, 95% CI: 0.803-0.971, P=0.010) was independently associated with MACCE within 12 months after ACS. Conclusion:The transverse area of vertical spinal muscle at T 12 level can be used as an independent predictor of MACCE within 12 months in elderly patients with ACS.