Obesity， a global chronic disease， is associated with adipose tissue dysfunction， which is one of the contributing factors to obesity. The cyclic adenosine monophosphate （cAMP） signaling pathway， a key regulator of lipid metabolism， plays a pivotal role in obesity development. Various of traditional Chinese medicine monomers， such as flavonoids， lignans， phenols， and terpenoids， as well as traditional Chinese medicine compound formulas like Xiaoyao powder， Shengmai powder， and Zexie decoction， can maintain energy homeostasis， balance adipose tissue function， regulate glucose metabolism， improve insulin resistance， and suppress inflammatory responses through cAMP signaling pathway regulation， thereby intervening in lipid metabolism for obesity treatment. Although a substantial amount of basic research has preliminarily elucidated the potential mechanisms by which traditional Chinese medicine intervenes in obesity through the cAMP signaling pathway， clinical translational research remains inadequate. There is an urgent need for large-sample， high-quality randomized controlled trials to validate these findings.

ObjectiveTo investigate the effect of solute carrier family 7 member 5 (SLC7A5) inhibitor JPH203 on renal fibrosis induced by unilateral ureteral obstruction in mice. MethodsSixteen SPF male C57BL/6 mice were randomly divided into the control group and the experimental group, with 8 mice in each group. The mouse model of renal fibrosis was established by unilateral ureteral obstruction. From the third day after surgery, the mice in the control group were intraperitoneally injected with phosphate-buffered saline (PBS) for 11 consecutive days, and the injection dose was 200 μL/d. Mice in the experimental group received intraperitoneal injection of JPH203 (50 mg/kg) every day for 11 days. On day 14, the mice were euthanized, then the kidney tissues were obtained. Hematoxylin and eosin (HE) staining was used to assess renal tissue damage, Masson staining was used to evaluate collagen fiber deposition in the extracellular matrix, and immunohistochemistry was used to detect the levels of fibroblast activation markers α-smooth muscle actin (α-SMA) and collagen type Ⅰ (COL-Ⅰ) in kidney tissues. Western blotting was further performed to measure the expression levels of SLC7A5 and transforming growth factor-β1 (TGF-β1), as well as the phosphorylation levels of mammalian target of rapamycin complex 1 (mTORC1) signaling pathway-related molecules. Real-time quantitative PCR was used to verify changes in the mRNA levels of SLC7A5, α-SMA, and COL-Ⅰ in kidney tissues. ResultsCompared with the control group, the experimental group showed reduced destruction of renal tissue structure and a significantly lower pathological injury score (P<0.05). Additionally, collagen deposition in the extracellular matrix was decreased, and the percentage of collagen fiber area was significantly reduced (P<0.001) in the experimental group. The levels of fibroblast activation markers α-SMA and COL-Ⅰ were significantly lower in the experimental group (both P<0.001). The expression levels of SLC7A5 and TGF-β1 were also significantly decreased (P<0.001), and the phosphorylation levels of mTORC1 signaling pathway-related proteins 4E-BP1 and mTORC1 were significantly reduced (P<0.001). Real-time quantitative PCR confirmed that the mRNA levels of SLC7A5, α- SMA, and COL-Ⅰ in kidney tissues were significantly lower in the experimental group (P<0.001). ConclusionJPH203 may inhibit the progression of renal fibrosis in mice by suppressing SLC7A5 expression, regulating the mTORC1 signaling pathway, and altering fibroblast activation status.

Objective:To explore the influence of non-motor symptoms on the change trajectory of early activities of daily living in patients with Parkinson disease, and to provide a reference for medical staff to implement intervention measures for people with low levels of activities of daily living in the preclinical stage.Methods:The longitudinal follow-up data of 431 patients with Parkinson disease in the Parkinson's progression Markers Initiative from baseline to five consecutive years after enrollment were selected by convenience sampling method in July 2024, including the scores of aceivities of daily living, the Rapid Eye Movement Sleep Behavioral Disorder Screening Questionnaire, etc. A latent class growth model classified change trajectory of activities of daily living, and the influencing factors were analyzed by univariate and binary Logistic regression.Results:Among the 431 patients, 260 were male and 171 were female, with an average age of (61.30 ± 9.60) years. The scores of activities of daily living of the patients at baseline, 12 months after enrollment, 36 months after enrollment, and 60 months after enrollment were (5.97 ± 4.30), (7.20 ± 4.61), (8.90 ± 5.60), and (10.57 ± 6.93) points, respectively. The model identified two types of trajectories: rapid decline in low activities of daily living group (25.3%, 109/431) and slow decline in lower activities of daily living group (74.7%, 322/431). The binary Logistic regression results showed that apathy ( OR=0.374, 95% CI 0.189-0.739), fatigue ( OR=0.261, 95% CI 0.138-0.495), University of Pennsylvania Smell Identification Test ( OR=1.039, 95% CI 1.005-1.074), the Rapid Eye Movement Sleep Behavioral Disorder Screening Questionnaire ( OR=0.880, 95% CI 0.795-0.973), and the gastrointestinal score of the Scales for Outcomes in PD-Autonomic ( OR=0.724, 95% CI 0.630-0.832) were independent influencing factors for the classification of the change trajectory of activities of daily living in patients with Parkinson disease (all P<0.05). Conclusions:Patients with Parkinson disease exhibit a decreasing trend in early activities of daily living, emphasizing the need for targeted interventions in those with fatigue, apathy, and high Rapid Eye Movement Sleep Behavioral Disorder Screening Questionnaire and Scales for Outcomes in Parkinson disease-Autonomic gastrointestinal scores to possibly decelerate disease advancement.

Objective:To compare postoperative anal function recovery between laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis for slow transit constipation.Methods:This multicenter retrospective cohort study enrolled patients meeting the following criteria: (1) severe constipation symptoms (<2 bowel movements/week), absent or insignificant defecation urge, abdominal distension, requiring laxatives to maintain bowel movements or laxatives being ineffective; (2) constipation symptoms for over 5 years, ineffective after >2 years of medical treatment, with strong desire for surgery; (3) significantly prolonged colon transit time (>72 hours) without significant gastric or small intestinal transit dysfunction; (4) no organic colonic lesions confirmed by colonoscopy and abdominal CT. Exclusion criteria: (1) patients undergoing open surgery; (2) exclusion of outlet obstruction constipation (e.g., rectocele, rectal prolapse, puborectalis spasm) by functional defecation MRI; (3) comorbid psychiatric disorders; (4) missing clinical data or loss to follow-up (postoperative follow-up <24 months). Based on these criteria, clinical and follow-up data were collected from 220 patients who underwent either laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSC group, n = 115) or laparoscopic total colectomy with ileorectal anastomosis (LTC group, n = 105) for slow transit constipation between January 2013 and December 2022. Subjective anal function (Constipation Severity Score and Wexner Fecal Incontinence Score) and objective anal function (positive rate of rectoanal inhibitory reflex [RAIR] and anorectal manometry) were observed preoperatively and at 6, 12, and 24 months postoperatively. Results:No significant differences were found in baseline characteristics between the two groups (all P >0.05). All surgeries were completed successfully without major significant complications. Subjective anal function assessment: At 24 months postoperatively, Constipation Severity Scores decreased significantly compared to preoperative scores in both groups [LSC group: (25.2±2.8) vs. (2.9±1.8), P <0.001; LTC group: (25.8±2.9) vs. (2.8±1.9), P<0.001]. No significant differences were found between the groups at 6, 12, and 24 months postoperatively (all P>0.05). Wexner Fecal Incontinence Scores at 24 months were significantly lower than those at 6 months in both groups [LSC group: (12.9±1.8) vs. (3.9±2.5), P<0.001; LTC group: (12.6±1.8) vs. (5.4±2.4), P<0.001]. Although no significant difference was found at 6 months ( P = 0.190), the LSC group had significantly lower Wexner scores than the LTC group at 12 and 24 months postoperatively (both P < 0.001). Objective anal function assessment: (1) Positive RAIR rate: Preoperative positive RAIR rates were 33.0% (38/115) in the LSC group and 25.7% (27/105) in the LTC group ( P > 0.05). At 24 months, positive rates increased significantly in both groups [LSC: 66.1% (76/115); LTC: 63.8% (67/105)] compared to preoperative rates (both P<0.001), but no significant differences were found between groups at 6, 12, and 24 months (all P>0.05). (2) Resting pressure (RP) and squeeze pressure (SP): No significant differences were found in preoperative RP and SP between groups (all P>0.05). The LSC group had significantly higher RP and SP than the LTC group at 6 and 12 months postoperatively (all P<0.05), but no significant differences were found at 24 months ( P>0.05). Conclusion:Both laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis are safe for patients with slow transit constipation. However, laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis offers superior postoperative anal function recovery.

Objective To evaluate the effect of ultrasound-guided superior laryngeal nerve block(SLNB)in endotracheal intubation during geriatric general anesthesia surgery.Methods A total of 40 elderly patients scheduled for elective general anesthesia surgery were selected,and randomly divided into the observation group(with ultrasound-guided SLNB)and the control group(without any local anesthesia).The mean arterial pressure(MAP),heart rate(HR),blood glucose,and concentrations of epinephrine,norepinephrine,and cortisol before intubation(T0),and 1 minute(T1),5 minutes(T2),and 15 minutes(T3)after intubation were compared between the two groups.The incidences of sore throat and hoarseness 30 minutes and 24 hours after extubation were compared between the two groups.Results The MAP and HR at T1,T2,and T3 of the observation group were significantly lower than those of the control group(P<0.05).The blood glucose and cortisol at T1 of the observation group were significantly lower than those of the control group(P<0.05).The serum concentrations of epinephrine and norepinephrine at T1,T2 and T3 in the observation group were lower than those in the control group(P<0.05).The incidences of sore throat 30 minutes and 24 hours after extubation in the observation group were lower than those in the control group(P<0.05).The incidence of hoarseness 30 minutes after extubation in the observation group was higher than that in the control group(P<0.05);the incidence of hoarseness 24 hours after extubation in the observation group was lower than that in the control group(P<0.05).Conclusion Ultrasound-guided SLNB has good clinical effect,which can effectively improve the stress response caused by endotracheal intubation and reduce intubation-related complications.

Objective:To digitally measure the three-dimensional (3D) size of primary tooth crowns and the dimensions of the dental arch in children with individual normal primary dentition, preliminarily obtaining baseline data on the 3D size of primary tooth crowns as well as the length and width of the dental arch, and their influence factors. This study aims to provide a data foundation for the design of reference models for primary dentition.Methods:From May to June 2021, 122 caries-free children aged 3.5-4.5 years with individual normal occlusion were selected from five kindergartens in Haidian District, Beijing. Impressions were taken and plaster models were cast. After preliminary screening, 67 eligible models were scanned to obtain digital dental models. Digital measurement software was used for landmark-based measurements. Parameters included 3D crown dimensions (mesiodistal diameter, buccolingual diameter, and occlusogingival height), dental arch dimensions (length and width at specific regions), and occlusal measurements (overjet and overbite at the primary central incisors, and Bolton index for anterior and full dentition). Gender differences in crown dimensions and bilateral symmetry of homologous teeth, as well as the correlations between arch dimensions and gender, height, weight, and body mass index (BMI) were analyzed.Results:The homonymous teeth of 67 children exhibited strong bilateral symmetry in all 3D dimensions ( P>0.05). Gender differences were observed in the buccolingual dimension for all deciduous molars except for the right mandibular first deciduous molar ( P<0.05). For the occlusogingival dimension, gender differences were found in the right maxillary first and second deciduous molars, left maxillary first deciduous molar, and left mandibular first and second deciduous molars ( P<0.05). For the mesiodistal dimension, only the left mandibular second deciduous molar and right mandibular deciduous canine showed gender differences ( P<0.05). All significant differences above indicated larger dimensions in boys compared to girls. In both maxillary and mandibular arches, the lengths and widths at various locations were significantly larger in boys than in girls ( P<0.05). Univariate correlation analysis revealed that body weight was positively correlated with the width of the terminal plane in both the maxilla and mandible and the total length of the mandibular dental arch, while BMI was positively correlated with the width of the maxillary terminal plane and the widths at all measured sites in the mandible ( P<0.05). Multiple regression analysis demonstrated that, after controlling for relevant variables, BMI was a significant positive predictor for the lengths and widths at various sites of the dental arch ( P<0.05), and height was a positive predictor for dental arch length ( P<0.05), as well as body weight was a positive predictor for the width in the molar region ( P<0.05). Overjet at the primary central incisors was 2.28 (1.57, 2.66) mm, and overbite was 1.13 (0.75, 1.92) mm. The anterior Bolton index was 0.79±0.03, and the overall Bolton index was 0.94±0.03. Conclusions:Primary tooth crowns of individual normal occlusion children demonstrate strong bilateral symmetry in homologous teeth. Most primary molars exhibit gender differences in buccolingual and occlusogingival dimensions, with larger values in boys. Arch dimensions (length and width) are consistently larger in boys.

Objective:To explore the risk factors of deaths caused by influenza-associated encephalopathy (IAE) in children.Methods:A case control study was conducted.The clinical data (including baseline fata, organ function indices, inflammatory factors, imaging data, treatment, and outcomes) of IAE children hospitalized in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital, School of Medicine, Shanghai Jiao Tong University from January 2020 to December 2023 were retrospectively analyzed.The children were divided into a survival group and a death group.The Logistic regression and receiver operating characteristic (ROC) curve were used to analyze the risk factors of death in IAE children.Results:A total of 46 cases were included, with an onset age of 74.8(46.0, 92.5) months.The main cause of IAE was influenza A virus infection, which was detected in 45 cases(97.8%), and 32 cases (69.6%) of them had H3N2.One child (2.2%) was infected by influenza B virus.Eight children died, showing a mortality of 17.4%.There was significant difference in Glasgow Coma Scale between the survival and death groups when they were admitted into the PICU [10 (9, 11) points vs.3 (3, 5) points] ( Z=-4.510, P<0.05).All patients in the death group had multiple organ dysfunction syndrome, respiratory failure and circulatory system failure.Serum procalcitonin (PCT)[15.7 (3.3, 37.4) μg/L], interleukin-6 (IL-6)[1 039.1 (319.3, 2 884.3) ng/L], and cerebrospinal fluid protein(CSFP)[13 050.0 (5 865.0, 21 100.0) mg/L] in the death group compared with those in the survival group [0.2 (0.1, 0.8) μg/L, 15.5 (7.9, 44.8) ng/L, 227.0 (190.0, 332.0) mg/L]were highly increased ( Z=-3.364, -4.088, -3.757, all P<0.001).Logistic regression analysis showed that PCT ( OR=0.660, P<0.05), IL-6 ( OR=1.014, P<0.05) and CSFP ( OR=1.001, P<0.05) were risk factors of death in IAE.The areas under the ROC curve for these three factors were 0.88 (95% CI: 0.77-0.97), 0.96 (95% CI: 0.86-1.00) and 0.93 (95% CI: 0.76-1.00), respectively.When a cutoff value of 2.50 μg/L, 269.67 ng/L and 5 240.00 mg/L was taken, PCT achieved a sensitivity of 0.875 and a specificity of 0.816, IL-6 achieved a sensitivity of 0.875 and specificity of 0.974, and CSFP achieved a sensitivity of 0.875 and specificity of 0.974, respectively. Conclusions:High levels of serum PCT, IL-6 and CSFP at PICU admission are risk factors of poor prognosis in children with IAE.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

The rapid development of artificial intelligence (AI), especially generative AI (GenAI), has already brought, and will continue to bring, revolutionary changes to our daily production and life, as well as create new opportunities and challenges for diagnostic and therapeutic practices in the medical field. Haihe Hospital of Tianjin University collaborates with the National Supercomputer Center in Tianjin, Tianjin University, and other institutions to carry out research in areas such as smart healthcare, smart services, and smart management. We have conducted research and development of a full-process disease diagnosis and treatment assistance system based on GenAI in the field of smart healthcare. The development of this project is of great significance. The first goal is to upgrade and transform the hospital's information center, organically integrate it with existing information systems, and provide the necessary computing power storage support for intelligent services within the hospital. We have implemented the localized deployment of three models: Tianhe "Tianyuan", WiNGPT, and DeepSeek. The second is to create a digital avatar of the chief physician/chief physician's voice and image by integrating multimodal intelligent interaction technology. With generative intelligence as the core, this solution provides patients with a visual medical interaction solution. The third is to achieve deep adaptation between generative intelligence and the entire process of patient medical treatment. In this project, we have developed assistant tools such as intelligent inquiry, intelligent diagnosis and recognition, intelligent treatment plan generation, and intelligent assisted medical record generation to improve the safety, quality, and efficiency of the diagnosis and treatment process. This study introduces the content of a full-process disease diagnosis and treatment assistance system, aiming to provide references and insights for the digital transformation of the healthcare industry.
Artificial Intelligence ; Humans ; Delivery of Health Care ; Generative Artificial Intelligence

Background: and Purpose This study aimed to investigate the association between residual inflammatory risk (RIR) and vulnerable plaques using high-resolution magnetic resonance imaging (HRMRI) in symptomatic intracranial atherosclerotic stenosis (ICAS). Methods: This retrospective study included 70%–99% symptomatic ICAS patients hospitalized from January 2016 to December 2022. Patients were classified into four groups based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L), and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). Vulnerable plaque features on HRMRI included positive remodeling, diffuse distribution, intraplaque hemorrhage, and strong enhancement. Results: Among 336 included patients, 21, 60, 58, and 197 were assigned to the RCIR, RIR, RCR, and NRR groups, respectively. Patients with RCIR (adjusted odds ratio [aOR], 3.606; 95% confidence interval [CI], 1.346–9.662; P=0.011) and RIR (aOR, 3.361; 95% CI, 1.774–6.368, P<0.001) had higher risks of strong enhancement than those with NRR. Additionally, patients with RCIR (aOR, 2.965; 95% CI, 1.060–8.297; P=0.038) were more likely to have intraplaque hemorrhage compared with those with NRR. In the sensitivity analysis, RCR (aOR, 2.595; 95% CI, 1.201–5.608; P=0.015) exhibited an additional correlation with an increased risk of intraplaque hemorrhage. Conclusion In patients with symptomatic ICAS, RIR is associated with a higher risk of intraplaque hemorrhage and strong enhancement, indicating an increased vulnerability to atherosclerotic plaques.