Background In the context of global climate change, heatwaves pose an increasing threat to human health. Emergency ambulance calls are an important outcome indicator of acute health response in populations during heatwave weather. However, studies on the association between emergency ambulance calls and heatwaves in China have primarily focused on the southern regions, and less attention is paid to the northern regions, which hinders a comprehensive assessment of acute health impact posed by extreme heat. Objective To quantify the association between heatwaves and emergency ambulance calls in Dezhou City, Shandong Province. Methods The data on daily records of emergency ambulance calls, meteorological factors, and air pollution from May to September of 2020 to 2022 in Dezhou City, Shandong Province were collected. Heatwaves were defined by combining thresholds at the 90th, 92.5th, 95th, and 97.5th percentiles (P₉₀, P_92.5, P₉₅, and P_97.5) of the year-round daily mean temperature and durations of ≥2, 3, or 4 consecutive days, respectively. A generalized additive model with a distributed lag nonlinear model was used to estimate the relative risk of emergency ambulance calls during heatwave days compared with non-heatwave days. Results During the study period, a total of 143393 emergency ambulance calls were analyzed, with 59.75% of individuals aged <65 years, 53.38% male, and 44.94% due to respiratory causes. Compared to non-heatwave periods, all 12 types of defined heatwaves were significantly associated with an increased risk of emergency ambulance calls. The heatwave effect intensified progressively with higher temperature thresholds and longer durations. The cumulative relative risk rose from 1.12 (95%CI: 1.07, 1.17) for the P₉₀_2d type to 1.26 (95%CI: 1.14, 1.40) for the P_97.5_4d type. No significant gender difference was observed in the association between heatwaves and emergency ambulance calls. Regarding age, older adults were more vulnerable, with a relative risk of 1.60 (95%CI: 1.42, 1.81) for the most severe heatwave type P_97.5_4d compared with non-heatwave periods. Among the different causes of calls, the association between respiratory diseases and heatwaves was the most pronounced, with the relative risk increasing from 1.22 (95%CI: 1.15, 1.29) for the mildest heatwave type P₉₀_2d to 1.72 (95%CI: 1.54, 1.93) for the most severe heatwave type P_97.5_4d. Conclusion In Dezhou City, Shandong Province, heatwaves are significantly associated with an increased risk of emergency ambulance calls. The effects of heatwaves on emergency ambulance calls vary by age and disease type, with the elderly and patients with respiratory diseases being more susceptible. These groups should take protective measures.

BACKGROUND: The effect of the interval between previous Helicobacter pylori (H. pylori) eradication and rescue treatment on therapeutic outcomes remains unknown. The aim of this study was to investigate the association between eradication rates and treatment interval durations in H. pylori infections. METHODS: This prospective observational study was conducted from December 2021 to February 2023 at six tertiary hospitals in Shandong, China. We recruited patients who were positive for H. pylori infection and required rescue treatment. Demographic information, previous times of eradication therapy, last eradication therapy date, and history of antibiotic use data were collected. The patients were divided into four groups based on the rescue treatment interval length: Group A, ≥4 weeks and ≤3 months; Group B, >3 and ≤6 months; Group C, >6 and ≤12 months; and Group D, >12 months. The primary outcome was the eradication rate of H. pylori . Drug compliance and adverse events (AEs) were also assessed. Pearson's χ2 test or Fisher's exact test was used to compare eradication rates between groups. RESULTS: A total of 670 patients were enrolled in this study. The intention-to-treat (ITT) eradication rates were 88.3% (158/179) in Group A, 89.6% (120/134) in Group B, 89.1% (123/138) in Group C, and 87.7% (192/219) in Group D. The per-protocol (PP) eradication rates were 92.9% (156/168) in Group A, 94.5% (120/127) in Group B, 94.5% (121/128) in Group C, and 93.6% (190/203) in Group D. There was no statistically significant difference in the eradication rates between groups in either the ITT ( P = 0.949) or PP analysis ( P = 0.921). No significant differences were observed in the incidence of AEs ( P = 0.934) or drug compliance ( P = 0.849) between groups. CONCLUSION: The interval duration of rescue treatment had no significant effect on H. pylori eradication rates or the incidence of AEs. REGISTRATION ClinicalTrials.gov , NCT05173493.
Humans ; Helicobacter Infections/drug therapy* ; Helicobacter pylori/pathogenicity* ; Male ; Female ; Prospective Studies ; Middle Aged ; Anti-Bacterial Agents/adverse effects* ; Adult ; Aged ; Treatment Outcome ; Proton Pump Inhibitors/therapeutic use*

Objective To evaluate the accuracy of dose-length product (DLP) values in CT dose reports by comparing them with the DLP values measured using a pencil-type ionization chamber. Methods Experiments were conducted using four CT scanners with different detector row numbers from two manufacturers (A and B), along with a head phantom and a pencil-type ionization chamber. Other scanning parameters were fixed, while pairwise combinations of kV and mAs were tested. The DLP values were measured under various scanning conditions using the pencil-type ionization chamber (DLP_measured) and the corresponding DLP values in CT dose reports were recorded (DLP_reported). All data were subjected to statistical analysis. Results Differences were observed between DLP_reported and DLP_measured values. The smallest mean absolute value of ΔDLP was approximately 2.526 mGy·cm observed on the 40-row CT scanner of manufacturer A. There was a difference between the ΔDLPs of the four CT scanners. Both DLP_reported and DLP_measured exhibited a linear relationship with mAs. Conclusion The percentage errors between DLP_reported and DLP_measured values for all four CT scanners were within the national standard tolerance of 15%. DLP values in CT dose reports can serve as a reference for assessing patient radiation dose during scanning. However, for radiation dose-related research, data measured using dosimetric instruments such as pencil-type ionization chamber are recommended.

OBJECTIVE To explore the relationship between severe cardiotoxicity caused by oxaliplatin combined with capecitabine and genetic polymorphism， thereby providing references for safe clinical medication use. METHODS Clinical pharmacists conducted a correlation analysis on a case of severe cardiotoxicity in a rectal cancer patient at Qilu Hospital of Shandong University following first-time treatment with standard doses of oxaliplatin combined with capecitabine. Case reports of cardiotoxicity caused by oxaliplatin and capecitabine were retrieved from the Chinese and English databases such as CNKI and PubMed.Basic patient information， drug treatment plan， and cardiotoxic manifestations were extracted and summarized. Combined with the patient’s genetic polymorphism test results related to the metabolism and excretion of platinum-based and fluorouracil drugs， potential mechanisms and prevention strategies for cardiotoxicity induced by oxaliplatin and capecitabine were discussed. RESULTS The patient exhibited homozygous mutations in ABCB1 C3435T and G2677T/A， a heterozygous mutation in MTHFR A1298C， and a heterozygous mutation in GSTP1 A105G， indicating impaired metabolism and excretion of oxaliplatin and capecitabine. The pharmacists recommended discontinuing oxaliplatin and reducing capecitabine to 50% of the original dose for subsequent treatment. The physicians adopted this advice， and the patient experienced no further severe adverse reactions with stable disease progression. CONCLUSIONS Oxaliplatin and capecitabine may cause severe cardiotoxicity. Medical institutions with adequate resources should perform genetic polymorphism test related to drug metabolism and excretion in patients prescribed these agents. For patients with multiple gene mutations， close monitoring and appropriate dose reductions are recommended to ensure medication safety and efficacy.

OBJECTIVE: To explore the surgical method and clinical efficacy of hip arthroplasty in the treatment of old non-union femoral intertrochanteric fractures. METHODS: Fifteen unoperated patients suffering from old non-union femoral intertrochanteric fractures from Feburary 2013 to Feburary 2023 were treated with hip arthroplasty including 9 males and 6 females, aged 71 to 82 years old. Eleven cases detected deep venous thrombosis(DVT), 9 cases received lower vena cava filter implantation. The operation time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative hemoglobin content, procedure-related complications, and the range of motion of hip flexion, abduction motion were recorded. The degree of hip pain was evaluated using a visual analogue scale(VAS). The hip Harris scores were used to evaluated the clinical efficacy. RESULTS: All patients were followed up for 3 to 12 months. The intraoperative blood loss was 200 to 400 ml, intraoperative blood transfusion was 0 to 400 ml, and the operation time was 40 to 90 min. All 15 patients had different degrees of anemia after surgery, the 3 days postoperative hemoglobin was 72 to 97 g·L^-1, and the postoperative transfusion volume was 0 to 400 ml. All patients had no periprosthetic infection, poor incision healing, lower limb deep vein thrombosis, and cerebral infarction. One case occurred in the early postoperative period, which disappeared from 4 to 5 days after operation, and there was no further revision at the last follow-up. The VAS was 6 to 7 points before operation and 2 to 4 points at latest follow-up;the hip Harris score was 2 to 13 points before operation and 73 to 84 points at latest follow-up. CONCLUSION The unoperated patients of old non-union femoral intertrochanteric fractures had significant clinical and imaging characteristics. Hip arthroplasty combined with or without femoral calcar reconstruction in the treatment of old non-union femoral intertrochanteric fractures had the advantages of relatively simple manipulation, rigid fixation, relatively safe operation, and relatively exact efficacy.
Humans ; Male ; Female ; Aged ; Hip Fractures/physiopathology* ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/methods*

Kirsten rat sarcoma viral oncogene homolog (KRAS) protein inhibitors are a promising class of therapeutics, but research on molecules that effectively penetrate the blood-brain barrier (BBB) remains limited, which is crucial for treating central nervous system (CNS) malignancies. Although molecular generation models have recently advanced drug discovery, they often overlook the complexity of biological and chemical factors, leaving room for improvement. In this study, we present a structure-constrained molecular generation workflow designed to optimize lead compounds for both drug efficacy and drug absorption properties. Our approach utilizes a variational autoencoder (VAE) generative model integrated with reinforcement learning for multi-objective optimization. This method specifically aims to enhance BBB permeability (BBBp) while maintaining high-affinity substructures of KRAS inhibitors. To support this, we incorporate a specialized KRAS BBB predictor based on active learning and an affinity predictor employing comparative learning models. Additionally, we introduce two novel metrics, the knowledge-integrated reproduction score (KIRS) and the composite diversity score (CDS), to assess structural performance and biological relevance. Retrospective validation with KRAS inhibitors, AMG510 and MRTX849, demonstrates the framework's effectiveness in optimizing BBBp and highlights its potential for real-world drug development applications. This study provides a robust framework for accelerating the structural enhancement of lead compounds, advancing the drug development process across diverse targets.

BACKGROUND:Cervical spondylosis is a chronic degenerative disease that has become one of the most common and frequent diseases threatening human health.At present,the initial diagnosis of the cervical spine and its surrounding structures mainly relies on the interpretation of medical images by radiologists,which not only requires a high level of technical requirements for operators,but also has the disadvantages of strong subjectivity,high labor intensity,and low efficiency.With the rapid development of artificial intelligence technology,its powerful data processing and image recognition capabilities have shown broad application prospects in the medical field.Deep learning has also made certain progress in the research of spinal diseases.OBJECTIVE:To summarize the current status and research progress in the application of artificial intelligence technology in cervical spine imaging images in recent years,evaluating the performance of artificial intelligence models as well as future trends and challenges to be overcome.METHODS:The first author searched the relevant articles in WanFang,CNKI,and PubMed in June 2024.The Chinese search terms were"artificial intelligence,deep learning,cervical spine."English serach terms were"artificial intelligence,Al,cervical vertebrae,cervical."Finally,101 articles were included and analyzed.RESULTS AND CONCLUSION:(1)Artificial intelligence technology can realize automatic segmentation of cervical vertebrae and measurement of curvature change by segmentation,classification,landmarks recognition of medical image parts,detect cervical vertebral fracture,nerve root,and spinal cord type cervical spondylosis,identify cervical spine ossification of posterior longitudinal ligament,and predict post-surgery related risk factors and cervical vertebra maturation classification.(2)Although artificial intelligence technology has shown great potential in the field of cervical spine research,it is still in the early stages of exploration and rapid development,with unlimited room for development and innovation.

BACKGROUND:Cervical spondylosis is a chronic degenerative disease that has become one of the most common and frequent diseases threatening human health.At present,the initial diagnosis of the cervical spine and its surrounding structures mainly relies on the interpretation of medical images by radiologists,which not only requires a high level of technical requirements for operators,but also has the disadvantages of strong subjectivity,high labor intensity,and low efficiency.With the rapid development of artificial intelligence technology,its powerful data processing and image recognition capabilities have shown broad application prospects in the medical field.Deep learning has also made certain progress in the research of spinal diseases.OBJECTIVE:To summarize the current status and research progress in the application of artificial intelligence technology in cervical spine imaging images in recent years,evaluating the performance of artificial intelligence models as well as future trends and challenges to be overcome.METHODS:The first author searched the relevant articles in WanFang,CNKI,and PubMed in June 2024.The Chinese search terms were"artificial intelligence,deep learning,cervical spine."English serach terms were"artificial intelligence,Al,cervical vertebrae,cervical."Finally,101 articles were included and analyzed.RESULTS AND CONCLUSION:(1)Artificial intelligence technology can realize automatic segmentation of cervical vertebrae and measurement of curvature change by segmentation,classification,landmarks recognition of medical image parts,detect cervical vertebral fracture,nerve root,and spinal cord type cervical spondylosis,identify cervical spine ossification of posterior longitudinal ligament,and predict post-surgery related risk factors and cervical vertebra maturation classification.(2)Although artificial intelligence technology has shown great potential in the field of cervical spine research,it is still in the early stages of exploration and rapid development,with unlimited room for development and innovation.

ObjectiveTo evaluate the clinical efficacy and safety of Ganjie Bingmei Tablet （甘桔冰梅片， GBT） in treating acute pharyngitis with wind-heat invading the lung syndrome. MethodsUsing multi-center， rando-mized， double-blind， double-dummy， positive and parallel controlled clinical trial design， 144 acute pharyngitis patients with wind-heat invading the lung syndrome from October 8th， 2022 to March 31st， 2023 were collected and randomly assigned to the treatment group and the control group， with 72 cases in each group. The treatment group was treated by GBT （0.4 g each time， 4 times a day） combined with Ganjie Qingyan Granules （甘桔清咽颗粒， GQG） placebo （10 g each time， 3 times a day）， while the control group was treated by GQG （10 g each time， 3 times a day） combined with GBT placebo （0.4 g each time， 4 times a day）， both for 5 days. The clinical efficacy of the two groups was observed， and the disappearance rate of pharyngalgia and the efficacy regarding TCM syndromes were compared between groups after treatment. The visual analog scale （VAS） score before and after treatment was assessed， and the safety was evaluated. ResultsThe disappearance rate of pharyngalgia in the treatment group was 98.61%（71/72）， significantly higher than 80.56%（58/72） in the control group （P＜0.01）. The VAS scores in both groups significantly decreased after treatment （P＜0.05）， and lower score was found in the treatment group than the control group （P＜0.05）. The total effective rate regarding TCM syndromes was 100% in both groups， but the curative rate was significantly higher in the treatment group（73.61%， 53/72） than the control group （62.50%， 45/72， P＜0.05）. There were no obvious adverse reactions in the both groups. ConclusionGBT is effective and safe in treating acute pharyngitis with wind-heat affecting the lung syndrome.

BACKGROUND:As a unique structure of the cervical spine,the occurrence,development and progression of the uncovertebral joint directly affect the stability and range of motion of the cervical spine,and are also closely related to the pathogenesis of cervical spondylosis.A thorough understanding of the developmental characteristics of the uncovertebral joint is of great significance for the pathogenesis,diagnosis,and treatment of cervical spondylosis. OBJECTIVE:By using imaging and three-dimensional reconstruction technology to measure and observe the cervical uncinate process-related angle in a large sample of different age groups,the aim is to reveal the characteristics of its changes with age and vertebral growth,as well as its relationship with cervical spine stability. METHODS:Using a retrospective research design,we collected 1 447 cases of raw CT imaging data that meet the study requirements for complete cervical spine segments.The raw data were imported into Mimics 21.0 software in DICOM format for post-processing and measurement of angle of uncinate process and sagittal angle of uncinate process.The data were grouped based on gender,age,and side. RESULTS AND CONCLUSION:(1)With the increase of vertebral sequence,the angle of uncinate process increased in a V-shaped shape,and the lowest peak was at C5.The overall population showed a sharp peak with the increase of age,and the peak value mostly occurred in the age range of 30-39 years.(2)The sagittal angle of the uncinate process increased like a fishhook with the increase of the vertebral sequence,and the overall angle of the uncinate process increased with age,and the peak value mostly occurred in the age range of 20-29 years.The uncinate process angle and sagittal angle showed only partial significant differences between sides and genders(P<0.05).(3)It is concluded that the angle of the uncinate process increased with the increase of vertebral sequence in a V-shaped manner.The sagittal angle of the uncinate process increases like a fish hook with increasing vertebral order,while the two angles generally peak with increasing age.The angle of the uncinate process is about 131°,which may be closely related to the stability of the cervical spine,while the sagittal angle of the uncinate process is about 14°,and its function may play a certain role in limiting the excessive rotation of the cervical spine.