ObjectiveTo systematically evaluate the efficacy and safety of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines in the treatment of coronary microvascular disease （CMD）. MethodsPubMed， Cochrane Library， CNKI， Wanfang Data， and VIP were searched for the randomized controlled trials （RCTs） on the treatment of CMD with Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis with the time interval from inception to December 31， 2023. The primary outcome indicators included the index of microcirculatory resistance （IMR）， coronary flow reserve （CFR）， and corrected TIMI flow frame count （cTFC）. The secondary outcome indicators included symptomatic efficacy， left ventricular ejection fraction （LVEF）， hypersensitive C-reactive protein （hs-CRP）， nitric oxide （NO）， and adverse events. Cochrane risk-of-bias assessment tool 2.0 （RoB 2.0） and Stata 17.0 were used for literature quality evaluation and meta-analysis of the included RCTs. The Grading of Recommendations， Assessment， Development and Evaluation （GRADE） was used to evaluate the quality of evidence. ResultsA total of 36 RCTs were included in this study， involving 3 029 patients. Compared with conventional Western medicine alone， the combined use of Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis and Western medicine reduced the IMR ［mean difference （MD）=-5.93， 95% confidence interval （95%CI） ［-8.73，-3.14］， n=382， P<0.01］， cTFC （MD=-9.35， 95%CI ［-13.94，-4.76］， n=618， P<0.01）， and hs-CRP ［standard mean difference （SMD）=-1.50， 95%CI ［-1.90，-1.11］， n=1 483， P<0.01］， improved the CFR （SMD=1.14， 95%CI ［0.08，2.19］， n=304， P=0.03）， symptomatic efficacy ［relative risk （RR）=1.36， 95%CI ［1.21，1.53］， n=756， P<0.01］， LVEF （MD=4.39， 95%CI ［2.31，6.47］， n=533， P<0.01）， and NO （SMD=3.16， 95%CI ［2.07，4.25］， n=946， P<0.01） of CMD patients. In terms of safety， the combined therapy reduced the occurrence of adverse events in CMD patients （RR=0.49， 95%CI ［0.29，0.82］， n=591， P=0.01）. GRADE showed moderate quality evidence for adverse events， low quality evidence for cTFC， symptomatic efficacy， LVEF， and NO， and very low quality evidence for IMR， CFR， and hs-CRP. ConclusionBased on microcirculatory function indicators， the combined use of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines and Western medicine may further improve the coronary microvascular function in CMD patients with good safety. The above conclusions remain to be verified with high-quality clinical trials.

ObjectiveTo study the effect of Taikong Yangxin Pills on the metabolism of simulated weightless rats based on metabolomics and discuss the metabolism mechanism. MethodsIn the simulated space capsule environment on the ground， the rat model of simulated weightlessness was established by the tail suspension method. Rats were randomly grouped as follows： out-of-capsule control， in-capsule control， model， and high （3.0 g·kg^-1） and low （1.5 g·kg^-1） doses of Taikong Yangxin Pills， and they were administrated with corresponding drugs by gavage for 28 days. The serum levels of endogenous metabolites in rats were determined by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry （UPLC-Q-TOF/MS）. The obtained data were processed by principal component analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA） to screen for differential metabolites and potential biomarkers. MetaboAnalyst 5.0 was used for pathway enrichment analysis to explain the metabolic regulation mechanism of the drug. ResultsCompared with the out-of-capsule control group， the in-capsule control group showed elevated levels of thirteen metabolites， including 14-hydroxyhexadecanoic acid， linoleic acid， and α-linolenic acid （P<0.05）， which suggested that the space capsule environment mainly affected the metabolism of α-linolenic acid and linoleic acid in the rats. Compared with the in-capsule control group， the model group showed lowered levels of fourteen metabolites， including 4-imidazolone-5-propionic acid， isocitric acid/citric acid， and L-tyrosine （P<0.05）， which were recovered after the treatment with Taikong Yangxin pills （P<0.05）. The pathway enrichment analysis revealed that weightlessness induced by tail suspension and drug intervention mainly involved the phenylalanine， tyrosine， and tryptophan biosynthesis， tyrosine metabolism， histidine metabolism， and citric acid cycle. ConclusionThe simulated space capsule environment and simulated weightlessness induced by tail suspension can both affect the metabolism level of rats. Taikong Yangxin pills can ameliorate the metabolic abnormality in the rat model of weightlessness by regulating various amino acids and energy metabolism-related pathways.

Objective To explore the diagnostic value of energy spectrum CT quantitative parameters combined with serum thy-roid stimulating hormone receptor-messenger ribonucleic acid(TSHR-mRNA)for papillary thyroid microcarcinoma(PTMC).Methods A total of 105 patients with thyroid micronodules confirmed by surgery and pathology were collected,61 of whom were PTMC(PTMC group),and 44 patients with micronodular goiter(MNG)(MNG group).Energy spectrum CT quantitative parameters and serum TSHR-mRNA expression were compared between the two groups.The diagnostic value of energy spectrum CT quantitative parame-ters alone and combined with serum TSHR-mRNA for PTMC was analyzed by receiver operating characteristic(ROC)curve.Results The iodine concentration and slope of energy spectrum CT quantitative parameters between PTMC group and MNG group were signifi-cantly different in plain scan,arterial and venous phases(P＜0.05).The mean serum TSHR-mRNA expression in the PTMC group was higher than that in MNG group(P＜0.05).The area under the curve(AUC)for diagnosing PTMC using quantitative parame-ters of energy spectrum CT combined with serum TSHR-mRNA was 0.913,and the accuracy,sensitivity,and negative predictive value of diagnosing PTMC were significantly higher than those of quantitative parameters of energy spectrum CT or serum TSHR-mRNA(P＜0.05).Conclusion Both energy spectrum CT quantitative parameters and serum TSHR-mRNA can be used to diagnose PTMC alone,and the combination of both is more accurately.

Abstract Vanadium is widely used in the steel manufacturing, aerospace and medical industries because of its good plasticity and malleability, and is released into the environment in large quantities. Human were exposed mainly through environmental and occupational exposure. Vanadium and its compounds can cause multi-system damage to the reproductive, respiratory, neurological, and immune systems, and the toxic mechanisms may be related to oxidative stress, epigenetic damage, DNA damage and repair, apoptosis, and dysregulation of cell proliferation. This article summarizes the health hazards caused by vanadium exposure and its mechanism, providing the reference for the studies into the toxic effects of vanadium and its compounds.

Objective: To evaluate the effect of visual training on children with myopia, so as to provide the evidence for the intervention of children with myopia. Methods: Ninety myopic children aged 8 to 10 years who visited the ophthalmology outpatient department of Zhoushan Hospital in 2021 were selected, and randomly divided into a control group, an intervention group 1, and an intervention group 2, with 30 cases in each group. The control group received medical glasses prescription, the intervention group 1 received a combined intervention of medical glasses prescription and visual training, and the intervention group 2 received only visual training intervention. Basic information, best corrected visual acuity and strabismus degree were collected through questionnaire surveys. Equivalent spherical lens power, positive and negative relative accommodation, amplitude of accommodation, and accommodative facility were measured before and after 1 month, 3 months, 6 months and 12 months intervention. The intervention effects among the three groups were compared using variance analysis of repeated-measures analysis of variance. Results: There were no significant differences in gender, age, sleep time, parents' myopia status, outdoor activity time, best corrected visual acuity and strabismus degree among the three groups of children (all P>0.05). The results of analysis of variance for repeated measures revealed no significant differences in spherical equivalent, positive/negative relative accommodation, accommodation of amplitude, and accommodative facility among three groups of myopic children, with no interaction between groups and time (all P>0.05). Significant differences in these parameters were noted across the intervention times within each group (P<0.05). After 6 and 12 months of intervention, the spherical equivalent, positive/negative relative accommodation, amplitude of accommodation, and accommodative facility of the myopic children in the intervention group 1 and intervention group 2 were higher than those before intervention and at 1 and 3 months of intervention (all P<0.05). Conclusions Visual training has certain effect on myopia children. However, no differences were found in the intervention effects of medical glasses prescription alone, or when combined with visual training on myopia children.

Objective: To analyze the trends in incidence of cardiovascular disease (CVD) among residents in Dongcheng District, Beijing Municipality from 2007 to 2022, so as to provide the evidence for formulating targeted prevention and control measures. Methods: Data of the incidence of four subtypes of CVD, including acute coronary syndrome, unstable angina pectoris, acute coronary heart disease, and acute myocardial infarction, in Dongcheng District from 2007 to 2022 were collected through the Beijing Chronic Disease Management Monitoring System. The incidence rates were calculated and standardized using the data of the seventh national population census in 2020. The trends in incidence of CVD were analyzed using average annual percent change (AAPC). Results: A total of 177 964 cases of CVD were reported in Dongcheng District from 2007 to 2022, with a crude incidence rate of 1 144.83/105 and a standardized incidence rate of 1 141.41/105. The crude incidence rates of acute coronary syndrome, unstable angina pectoris, acute coronary heart disease and acute myocardial infarction were 434.45/105, 277.04/105, 272.87/105 and 160.47/105, respectively. The crude incidence rates of CVD and the four subtypes showed an upward trend (AAPC=4.467%, 4.576%, 5.937%, 4.070% and 2.353%, all P<0.05), with unstable angina pectoris rising more rapidly. The crude incidence rate of CVD in males was higher than that in females (1 413.08/105 vs. 884.68/105, P<0.05), and both of them showed an upward trend from 2007 to 2022 (both P<0.05), with a faster increase in males than in females (AAPC=5.552% vs. 2.905%). The crude incidence rate of CVD increased with age (P<0.05), and the crude incidence rate of acute coronary heart disease increased significantly after the age of 65 years, rising from 477.58/105 at the age of 65-<75 years to 2 888.02/105 at the age of 85 years and above. Conclusions The crude incidence rates of CVD and its four subtypes showed an upward trend in Dongcheng District from 2007 to 2022, with unstable angina pectoris rising more rapidly. Males and older adults are key populations for early screening and comprehensive intervention for CVD.

Objective: To analyze the semen quality parameters of sperm donor volunteers, so as to provide insights into male infertility control and related research. Methods: A total of 155 sperm donors were recruited from the Human Sperm Bank of Zhejiang Province using the convenience sampling method from January to March 2021. Demographic information were collected through questionnaire surveys. Semen were collected, and parameters including semen volume, sperm concentration, total number of sperm, forward motility rate and total sperm viability were measured. Semen quality was evaluated according to the WHO Laboratory Manual for the Examination and Processing of Human Semen. : Results Conclusion There were 20.65% of the 155 sperm donors with unqualified semen, and the unqualified rates of forward motility rate and total sperm viability were relatively high.

Objective:To evaluate the clinical efficacy of heat-sensitive moxibustion combined with kneading and massage manipulation at pain points in treating patients with lumbar disc herniation (LDH) and chronic low back pain (LBP).Methods:Randomized controlled trial. A total of 91 patients with LDH and LBP who were admitted to Lu'an Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were selected as the observation subjects. They were divided into the experimental group (46 cases) and the control group (45 cases) by random number table method. The control group was treated with conventional massage manipulation, while the experimental group was treated with heat-sensitive moxibustion combined with kneading and massage manipulation at pain points. Both groups received 4 weeks of continuous treatment. The degree of lumbar pain was evaluated with the Visual Analogue Scale (VAS), and the degree of lumbar dysfunction was evaluated with modified Oswestry Disability Index (ODI). Plasma viscosity, hematocrit, whole blood low shear viscosity and whole blood high shear viscosity were measured using a blood rheometer. Clinical efficacy was evaluated.Results:The total clinical effective rates in the experimental group and the control group were 93.48% (43/46) and 77.78% (35/45), with a statistical significance between groups ( χ2=4.58, P=0.032). After treatment, the VAS score [(3.81±0.74) vs. (4.29±0.85), t=2.88] and ODI score [(8.79±2.65) vs. (11.25±3.74), t=3.63] of the experimental group were lower than those of the control group ( P<0.01). Plasma viscosity [(1.35±0.06) mPa?s vs. (1.41±0.08) mPa?s, t=4.05], hematocrit [(37.46±2.38)% vs. (40.15±2.94)%, t=4.80], whole blood low shear viscosity [(7.41±1.53) mPa?s vs. (8.64±1.72) mPa?s, t=3.61] and whole blood high shear viscosity [(3.81±0.29) mPa?s vs. (4.07±0.31) mPa?s, t=4.13] were lower than those in the control group ( P<0.01). Conclusion:Heat-sensitive moxibustion combined with kneading and massage manipulation at pain points can effectively relieve LBP in patients with LDH and chronic LBP, improve lumbar dysfunction and hemodynamic status, and enhance clinical efficacy.

As the main product of anaerobic or aerobic glycolysis,lactic acid has long been considered to be only the metabolic waste of this process,but now researches have are gradually revealing that lactic acid,as an important signaling molecule,plays a key immune regulatory role by acting on lactic acid transporters,lactate receptors and intracellular direct sensors in immune cells.In chronic inflammatory diseases,lactic acid helps maintain a pro-inflammatory environment that encourages immune cells to remain at the site of inflammation.In the event of infection,lactic acid impairs host immunity.In the tumor microenvironment(TME),the increase in lactic acid production and the resulting TME acidification promote tumor growth and invasion,and inhibit the body's immune response to tumor antigens.This review focuses on the recent research progress on the role of lactic acid in immune regulation.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.