Objective To evaluate the degree of brain atrophy in spinocerebellar ataxia type 3(SCA3)patients based on artificial intelligence(AI)technology,and to explore the correlation between the degree of brain atrophy and the severity of the disease.Methods The clinical and imaging data of 23 SCA3 patients(SCA3 group)and 24 healthy controls(HC)(HC group)were collected.The International Cooperative Ataxia Rating Scale(ICARS)was used to evaluate the severity of ataxia in patients with SCA3.AI technology was used to process the 3D-T1 WI MR image data of the SCA3 and HC groups to segment and measure the volume and volume percentage of brain,followed by correlation analyses between brain structural alterations and the severity of ataxia in SCA3 patients.Results There were no significant differences in gender and age between the two groups(P＞0.05).The SCA3 group had a significant reduction in the volume and volume percentage of various brain regions,such as the frontal,temporal,parietal,occipital,limbic,right cerebral white mat-ter,subcortical gray matter,cerebellum and brainstem,compared to the HC group(multiple hypothesis testing adjusted P＜0.01).In the SCA3 group,the ICARS showed positive correlation with patient age(r=0.571,P=0.004)and negative correlation with the vol-ume of the left cerebellar white matter,vermis,medulla oblongata,and the volume percentages of bilateral cerebellar white matter,vermis,pons,medulla oblongata(P＜0.05).Conclusion The significant atrophy of the supratentorial and subtentorial regions of the brain in SCA3 patients.The globus pallidus exhibits the most substantial atrophy,suggesting its potential as an imaging diagnostic marker of SC A3.

ObjectiveTo explore the method of optimizing the performance of traditional Chinese medicine （TCM） syndrome diagnostic models using Stacking ensemble learning. MethodsTaking the construction of TCM syndrome diagnostic model for lung cancer as an example， 2598 cases of clinical symptoms and signs from lung cancer patients in 9 hospitals were used as independent variables （i.e.， feature variables）， TCM syndrome information as dependent variables， and the clinical data were divided into training set and testing set in 8：2 ratio according to random number table method using Python 3.7 software. The stable features of TCM syndrome of lung cancer were screened using chi-square test， Spearman's correlation test， and Least Absolute Shrinkage and Selection Operator （LASSO） logistic regression analysis； nine machine learning algorithms are trained， including support vector machines （SVMs）， k-nearest neighbors （KNN） algorithm， Random Forest （RF）， Extremely Randomized Trees， Extreme Gradient Boosting （XGBoost）， Lightweight Gradient Boosting （LightGBM）， Adaptive Boosting （AdaBoost）， Gradient Boosting （GB） and the multi-layer perceptron （MLP）， to obtain 9 basic models. Four models with better performance were screened out from the above basic models and fused to form a fusion model by using the Stacking ensemble learning， and the fusion model was trained twice by the above nine machine learning algorithms and evaluated by accuracy rate， micro-average ROC curves， area under the curve （AUC）， and confusion matrix metrics， to screen the optimal diagnostic model. ResultsAfter data processing， 79 stable features and 13 TCM syndromes were obtained. In the basic model training， the comprehensive performance of RF， ExtraTrees， MLP and SVM basic models were better， so the predicted distributions of the syndromes of these four models were used as the secondary training data， and nine fusion models were obtained based on the Stacking ensemble learning （SVM， KNN， RF， ExtraTree， XGBoost， LightGBM， GB， AdaBoost， MLP）. Among them， the XGBoost fusion model performed the best， with an accuracy of 0.850 and 0.838 in the training set and test set， respectively， an overfitting difference of 0.012， and an area under the micro-average ROC curve of 0.996. All fusion models showed an improvement in accuracy and area under the micro-average ROC curve compared with the base model in the test set. ConclusionTaking the TCM syndrome information of lung cancer as an example， the XGBoost fusion model has significant advantages in improving the diagnostic performance of TCM syndrome information of lung cancer through Stacking ensemble learning. It can be seen that the advantages of Stacking ensemble learning to integrate multiple models and effectively improve the diagnostic efficiency of TCM diagnostic models， which provided a methodological reference for similar studies.

OBJECTIVE To evaluate the quality of Lycopodium japonicum from different producing areas. METHODS Sixteen batches of L. japonicum from six provinces were used as samples. The contents of α -obscurine， β -obscurine， lycopodine， lycodoline， lyclaninol， 21-episerratenediol， stigmasterol and β-sitosterol in L. japonicum were detected by quantitative analysis of multi-components by single-marker （QAMS）. The results were compared with the results of external standard method. The extract and total ash were measured according to the appendix of Chinese Pharmacopoeia. Principal component analysis， orthogonal partial least squares-discriminant analysis and weighted technique for order preference by similarity to ideal solution （TOPSIS） methods were combined to evaluate its quality. RESULTS The contents of lyclaninol in the 16 batches of L. japonicum were 0.183-0.446 mg/g. Using lyclaninol as internal reference material， the contents of α-obscurine， β-obscurine， lycopodine， lycodoline， 21-episerratenediol， stigmasterol and β-sitosterol were 1.250-2.097， 0.690-1.184， 0.035-0.102， 0.076-0.150， 0.356-0.570， 0.085-0.229 and 0.238-0.855 mg/g， respectively， with no significant difference from the results of external standard method. The extract was 12.18%-22.78%， and the total ash was 3.16%-6.11%. Principal component analysis showed that samples S1-S6，S7-S11，S12-S16 could be clustered into 3 categories. The variable importance in projection values for α-obscurine， β-sitosterol， lyclaninol， β-obscurine and 21- episerratenediol were all greater than 1. The weighted TOPSIS evaluation results showed that sample S14 had the best quality （Jb＝ 0.709 2）. CONCLUSIONS L. japonicum from Suijiang county of Yunnan province had the best quality. The established QAMS combined with chemometric and weighted TOPSIS methods can be used for quality evaluation of L. japonicum from different producing areas.

Objective:To comprehensively evaluate the quality of Herba Clematidis Intricatae through HPLC multi-index components, chemometrics combined with EW-TOPSIS. Methods:A total of 18 batches of Herba Clematidis Intricatae samples from seven provinces were collected. Contents of luteolin-7-O-glucoside, rutoside, hyperoside, quercitrin, quercetin, luteolin, apigenin and kaempferol in Herba Clematidis Intricatae were simultaneously determined by HPLC. Chemometrics method was used to comprehensively analyze the content determination results, and the main potential markers affecting the quality of Herba Clematidis Intricatae were analyzed. The quality of Herba Clematidis Intricatae from different origins was evaluated. Results:The eight components showed good linear relationships within their respective ranges ( r≥0.999 1), and accuracy was good ( RSD<2.0%). The chemometrics method showed that 18 batches of Herba Clematidis Intricatae could be clustered into 3 categories, showing certain regional differences. Rutoside, hyperoside and luteolin-7-O-glucoside were the indicative components affecting the difference of chemical constituents in Herba Clematidis Intricatae; results of EW-TOPSIS method showed that the optimum quality of Herba Clematidis Intricatae from Inner Mongolia and Liaoning, followed by those of Hebei, Shanxi and Shanxi, and lowest in Qinghai and Gansu. Conclusion:The established HPLC method is convenient and accurate, and combined with chemometrics and EW-TOPSIS method can be used for the comprehensive evaluation of the quality of Herba Clematidis Intricatae.

China has classified the Corona Virus Disease 2019(COVID-19) as a statutory category B infectious disease and managed it according to Category B since January 8, 2023.In view that Omicron variant is currently the main epidemic strain in China, in order to guide the treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection in children with the times, refer to the Diagnosis and Treatment Protocol for Novel Coronavirus Infection (Trial 10 th Edition), Expert Consensus on Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fourth Edition) and the Diagnosis and Treatment Strategy for Pediatric Related Viral Infections.The Expert Consensus on the Diagnosis, Treatment and Prevention of Novel Coronavirus Infection in Children (Fifth Edition) has been formulated and updated accordingly on related etiology, epidemiology, pathogenic mechanism, clinical manifestations, auxiliary examination, diagnosis and treatment, and added key points for the treatment of COVID-19 related encephalopathy, fulminating myocarditis and other serious complications for clinical reference.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Since December 2019, severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections have raged globally for more than 2 years.China has always adopted scientific and effective prevention and control measures to achieved some success.However, with the continuous variation of SARS-CoV-2 cases and imported cases from abroad, the prevention and control work has become more difficult and complex.With the variation of the mutant strain, the number of cases in children changed, and some new special symptoms and complications were found, which proposed a new topic for the prevention and treatment of SARS-CoV-2 infection in children in China.Based on the third edition, the present consensus according to the characteristics of the new strain, expounded the etiology, pathology, pathogenesis, and according to the clinical characteristics and experience of children′s cases, and puts forward recommendations on the diagnostic criteria, laboratory examination, treatment, prevention and control of children′s cases for providing reference for further guidance of effective prevention and treatment of SARS-CoV-2 infection in children in China.

Objective:To evaluate the safety and feasibility of endovascular recanalization for non-acute internal carotid artery occlusion (NA-ICAO), and to propose a new angiographic classification.Methods:From April 2015 to October 2019, 95 consecutive patients with symptomatic NA-ICAO who received endovascular recanalization were retrospectively analyzed in Beijing Tiantan Hospital, Capital Medical University. All the patients were divided into four groups according to DSA: type Ⅰ, petrous segments were distally reconstituted by collateral vessels; type Ⅱ, cavernous segments were distally reconstituted by collateral vessels; type Ⅲ, ophthalmic segments were distally reconstituted by collateral vessels; type Ⅳ, communicating segments were distally reconstituted by collateral vessels. Study data including clinical characteristics, surgical details, lesion classification, recanalization rate and perioperative complications. For the counting data, the χ 2 test was used to compare between groups. For the quantitative data, the ANOVA was used for the normal distribution data, otherwise the Kruskal-Wallis H test was used. The primary safety outcome was any stroke or death within 30 days. Results:Among the 95 patients, 67 (70.53%) had successful recanalization. The recanalization rates of type Ⅰ－Ⅳ were 92.31% (36/39), 81.82% (18/22), 47.83% (11/23) and 18.18% (2/11) respectively (χ2=29.557, P<0.001). And the complication rates of the four types were 5.13% (2/39), 13.64% (3/22), 21.74% (5/23) and 9.10% (1/11) respectively. The incidence of perioperative ischemic stroke was 2.11% (2/95). No other serious stroke and death occurred. Conclusions:Endovascular recanalization may be feasible and safe for carefully selected patients with NA-ICAO and therefore represents an alternative treatment. The patients with type Ⅰ and Ⅱ lesions had higher recanalization rates, while the patients with type Ⅳ lesions had significantly lower recalculation rate. The new angiographic classification is conducive to the selection of suitable patients and difficulty in grading.

At present, severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still rampant worldwide.As of September 10, 2021, there were about 222 million confirmed cases of corona virus disease 2019(COVID-19)and more than 4.6 million deaths worldwide.With the development of COVID-19 vaccines and the gradual vaccination worldwide, the increasing number of cases in children and unvaccinated young people has drawn attention.According to World Health Organization surveillance data, the proportion of COVID-19 infection cases in children gradually increased, and the proportion of cases in the age groups of under 5 years and 5-14 years increased from 1.0% and 2.5% in January 2020 to 2.0% and 8.7% in July 2021, respectively.At present, billions of adults have been vaccinated with various COVID-19 vaccines worldwide, and their protective effects including reducing infection and transmission, reducing severe disease and hospitalization, and reducing death, as well as high safety have been confirmed.Canada, the United States, Europe and other countries have approved the emergency COVID-19 vaccination in children and adolescents aged 12 to 17 years, and China has also approved the phased vaccination of COVID-19 vaccination in children and adolescents aged 3 to 17 years. For smooth advancement and implementation of COVID-19 vaccination in children, academic institutions, including National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health, and The Society of Pediatrics, Chinese Medical Association organized relevant experts to reach this consensus on COVID-19 vaccination in children.

Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is still worldwide.As a vulnerable group, severe and dead pediatric cases are also reported.Under this severe epidemic situation, children should be well protected.With the widespread vaccination of SARS-CoV-2 vaccine in adults, the infection rate have decreased.Therefore, SARS-CoV-2 vaccine inoculation for children groups step by step is of great significance to the protection of children and the prevention and control of corona virus disease 2019(COVID-19) as a whole.But the safety of children vaccinated with SARS-CoV-2 vaccine is a main concern of parents.Therefore, in order to ensure the safety of vaccination and the implementation of vaccination work, National Clinical Research Center for Respiratory Diseases, National Center for Children′s Health and the Society of Pediatrics, Chinese Medical Association organized experts to interpret the main issue of parents about SARS-CoV-2 vaccine for children, in order to answer the doubts of parents.