Objective Through studying the chemical composition changes before and after the compatibility of Hedysari Radix Paeparata Cum Melle(HRPCM)-vinegar processed Curcumae Rhizoma(VPCR);To discuss the significance of the compatibility of HRPCM and VPCR;To establish the fingerprints before and after their compatibility.Methods ZORBAX Eclipse Plus C18 column was used;acetonitrile-0.01%phosphoric acid water was set as mobile phase,with gradient elution;column temperature was 30℃;detection wavelength was 214 nm;sample injection was 10 μL,which was used to investigate the content difference of major chemical components such as vanillic acid,calycosin-O-β-D-glucopyranoside,ononin,calycosin,onocerin,curdione,cincumol and germacrone,and establish the fingerprint of HRPCM,VPCR and HRPCM-VPCR.Results HPLC chromatographic conditions were established for the determination of 8 components in HRPCM-VPCR.Meanwhile,fingerprints were established before and after the compatibility of HRPCM-VPCR.26 common peaks were identified,among which 11 components such as vanillic acid were derived from HRPCM,14 components such as curcuma zedoariae were derived from VPCR,and 1 component was shared by both.Conclusion The material basis of the compatibility of HRPCM-VPCR differs from that of HRPCM and VPCR.The content of most chemical components decreases while the content of some components increases.The established HPLC method for content determination and fingerprint is simple,stable and reproducible,which can be used to evaluate and control the quality of HRPCM and VPCR.

Objective:To establish a model based on the characteristics of breast cancer ultrasound images through deep learning methods to predict the risk of axillary lymph node metastasis（ALNM）in patients with breast cancer（maximum diameter ≤2.5 cm）before surgery.Methods:A total of 419 patients（3 433 breast tumor ultrasound images）with breast cancer（maximum diameter ≤2.5 cm）who underwent axillary lymph node dissection at Beijing Tiantan Hospital，Capital Medical University from January 2019 to December 2024 were retrospectively included. According to the pathological results of axillary lymph nodes，they were divided into 220 cases in the ALNM occurrence group（positive group）and 199 cases in the non-ALNM occurrence group（negative group）. The breast cancer ultrasound images of the two groups of cases were randomly classified into the training set（2 404 images），the validation set（687 images）and the test set（342 images）according to a ratio of 7∶2∶1. YOLOv8 was used as the basic model of You Only Look Once（YOLO）and optimized. The optimized model was applied to locate and capture the potential ultrasound features of breast cancer cases in the training set. A prediction model was constructed based on the captured ultrasound features. The model was adjusted and optimized through the validation set，and then matched with the case images in the test set. The confusion classification matrix graph and the curve graph for measuring the model performance were used to evaluate the model prediction performance and interpret the model，and the efficacy of this model in identifying breast cancer patients at risk of ALNM was analyzed.Results:There were statistically significant differences between the positive and negative groups in terms of the pathological maximum diameter of breast tumors，pathological T staging，the differentiation degree，the presence of distant metastasis，the maximum diameter measured by ultrasound，the quadrant of breast tumor occurrence，the Breast Imaging - Reporting and Data System（BI-RADS）classification of breast tumors，and the presence of abnormal ultrasound features of lymph node（all P<0.05）. The established deep learning model could automatically perform bounding box localization for the breast cancer of patients.The breast tumors in the positive group had potential ultrasound features that could be captured by the model compared with those in the negative group. The mean average precision（mAP）50 was 0.883，mAP 50-95 was 0.636，PR-AUC was 0.884 5，strict PR-AUC was 0.636 4，the sensitivity was 90.5%，and the specificity was 91.2%，and it had a good predictive efficacy. Conclusions:This prediction model based on the ultrasound characteristics of breast cancer through deep learning can effectively predict breast cancer（maximum diameter ≤ 2.5 cm）with the risk of ALNM，providing an effective basis for the clinical management of axillary lymph nodes in breast cancer patients.

Objective Through studying the chemical composition changes before and after the compatibility of Hedysari Radix Paeparata Cum Melle(HRPCM)-vinegar processed Curcumae Rhizoma(VPCR);To discuss the significance of the compatibility of HRPCM and VPCR;To establish the fingerprints before and after their compatibility.Methods ZORBAX Eclipse Plus C18 column was used;acetonitrile-0.01%phosphoric acid water was set as mobile phase,with gradient elution;column temperature was 30℃;detection wavelength was 214 nm;sample injection was 10 μL,which was used to investigate the content difference of major chemical components such as vanillic acid,calycosin-O-β-D-glucopyranoside,ononin,calycosin,onocerin,curdione,cincumol and germacrone,and establish the fingerprint of HRPCM,VPCR and HRPCM-VPCR.Results HPLC chromatographic conditions were established for the determination of 8 components in HRPCM-VPCR.Meanwhile,fingerprints were established before and after the compatibility of HRPCM-VPCR.26 common peaks were identified,among which 11 components such as vanillic acid were derived from HRPCM,14 components such as curcuma zedoariae were derived from VPCR,and 1 component was shared by both.Conclusion The material basis of the compatibility of HRPCM-VPCR differs from that of HRPCM and VPCR.The content of most chemical components decreases while the content of some components increases.The established HPLC method for content determination and fingerprint is simple,stable and reproducible,which can be used to evaluate and control the quality of HRPCM and VPCR.

Objective:To establish a model based on the characteristics of breast cancer ultrasound images through deep learning methods to predict the risk of axillary lymph node metastasis（ALNM）in patients with breast cancer（maximum diameter ≤2.5 cm）before surgery.Methods:A total of 419 patients（3 433 breast tumor ultrasound images）with breast cancer（maximum diameter ≤2.5 cm）who underwent axillary lymph node dissection at Beijing Tiantan Hospital，Capital Medical University from January 2019 to December 2024 were retrospectively included. According to the pathological results of axillary lymph nodes，they were divided into 220 cases in the ALNM occurrence group（positive group）and 199 cases in the non-ALNM occurrence group（negative group）. The breast cancer ultrasound images of the two groups of cases were randomly classified into the training set（2 404 images），the validation set（687 images）and the test set（342 images）according to a ratio of 7∶2∶1. YOLOv8 was used as the basic model of You Only Look Once（YOLO）and optimized. The optimized model was applied to locate and capture the potential ultrasound features of breast cancer cases in the training set. A prediction model was constructed based on the captured ultrasound features. The model was adjusted and optimized through the validation set，and then matched with the case images in the test set. The confusion classification matrix graph and the curve graph for measuring the model performance were used to evaluate the model prediction performance and interpret the model，and the efficacy of this model in identifying breast cancer patients at risk of ALNM was analyzed.Results:There were statistically significant differences between the positive and negative groups in terms of the pathological maximum diameter of breast tumors，pathological T staging，the differentiation degree，the presence of distant metastasis，the maximum diameter measured by ultrasound，the quadrant of breast tumor occurrence，the Breast Imaging - Reporting and Data System（BI-RADS）classification of breast tumors，and the presence of abnormal ultrasound features of lymph node（all P<0.05）. The established deep learning model could automatically perform bounding box localization for the breast cancer of patients.The breast tumors in the positive group had potential ultrasound features that could be captured by the model compared with those in the negative group. The mean average precision（mAP）50 was 0.883，mAP 50-95 was 0.636，PR-AUC was 0.884 5，strict PR-AUC was 0.636 4，the sensitivity was 90.5%，and the specificity was 91.2%，and it had a good predictive efficacy. Conclusions:This prediction model based on the ultrasound characteristics of breast cancer through deep learning can effectively predict breast cancer（maximum diameter ≤ 2.5 cm）with the risk of ALNM，providing an effective basis for the clinical management of axillary lymph nodes in breast cancer patients.

OBJECTIVE To provide a reference for the pharmaceutical care of a patient with type 2 diabetes mellitus(T2DM)and limb-girdle muscular dystrophy(LGMD)who developed euglycemic diabetic ketoacidosis(euDKA)after taking empagliflozin.METHODS Clinical pharmacists provided pharmaceutical care for a patient with T2DM and LGMD who developed euDKA after taking empagliflozin.According to the patient's recent use of medications and his conditions,clinical pharmacists assessed the correlation between euDKA and empagliflozin as"very likely".As to euDKA,clinical pharmacists suggested discontinuing empagliflozin and metformin,and giving intravenous infusion of 10％Glucose injection instead of 5％Glucose injection for fluid resuscitation.Clinical pharmacists monitored the patient's laboratory indicators such as arterial blood gas analysis,blood/urine ketones and electrolytes.They assisted physicians to decide when to stop intravenous supplements of liquid and insulin.Clinical pharmacists also assisted physicians to adjust the antidiabetic drugs and educated the patient to avoid empagliflozin or other sodium-glucose linked transporter 2 inhibitors(SGLT2i).RESULTS Physicians adopted the suggestions of clinical pharmacists.After treatment,the patient's condition improved,and he was allowed to be discharged with medication.CONCLUSIONS euDKA is a relatively rare and serious adverse reaction associated with SGLT2i,and the patients with LGMD are susceptible to euDKA.Clinical pharmacists assist physicians in developing personalized medication plans by evaluating the association between euDKA and empagliflozin,adjusting medication regimens,conducting pharmaceutical monitoring,and other pharmaceutical services.Meanwhile,they provide medication education to patients to ensure their medication safety.

Objective:To observe the rehabilitation effect of balance training relying on tilted table on diaphragmatic function of patients with prolonged disorder of consciousness (pDoC).Methods:A prospective study was performed. Thirty patients with pDoC were enrolled from Department of Hyperbaric Oxygen Medicine and Rehabilitation, General Hospital of Southern Theater Command of PLA from May to December 2023. The pateints were divided into study group ( n=15) and control group ( n=15) according to different rehabilitation. Patients from the control group received conventional rehabilitation, while those in the study group received passive balance training relying on tilted table in addition to conventional rehabilitation. Diaphragmatic ultrasound examination was performed before treatment, and 4 and 8 weeks after treatment to measure diaphragm excursion (DE), diaphragm thickening inspiration (DTei), diaphragm thickening expiration (DTee) and diaphragm thickening fraction (DTF) so as to assess the diaphragmatic functions of patients with pDoC. Results:During treatment, 2 patients dropped out from the study group resulting from the willing of the family members, ultimately including 13 and 15 patients in the study and control groups, respectively. (1) Between-group comparison: no significant difference in DE, DTei, DTee or DTF was noted between the study group and control group 4 weeks after treatment ( P>0.05). However, 8 weeks after treatment, the study group had statistically increased DE, DTei and DTF compared with the control group ([1.65±0.32] cm vs. [1.21±0.22] cm; [2.07±0.26] cm vs. [1.83±0.26] cm; and [24.39±3.19]% vs. [18.93±2.50]%). (2) Within-group comparison: both group had significantly increased DE 4 and 8 weeks after treatment compared with those before treatment ( P<0.05); in the study group, DE 8 weeks after treatment was significantly increased compared with that 4 weeks after treatment ( P<0.05). No significant difference in DTei, DTee or DTF was noted in both groups between 4 weeks after treatment and before treatment ( P>0.05). In the study group, DTei, DTee and DTF 8 weeks after treatment were significantly higher than those before treatment and 4 weeks after treatment ( P<0.05). Conclusion:Balance training relying on tilted table is feasible and effective in improving diaphragmatic function in patients with pDoC, and the effect is positively correlated with treatment time within a certain time.

Objective To explore the dilution conditions and standards in detecting the semen samples with high sperm concentration using computer-aided sperm analysis(CASA)systems.Methods CASA systems with 10 μm depth disposable counting chambers were used for the examination.The samples were divided into undiluted group(Group 1∶sperm concentration＜50×106/mL)and diluted groups(Group 2∶50×106/mL≤ sperm concentration＜100× 106/mL;Group 3∶sperm concentration≥100× 106/mL).When sperm concentration＜50×106/mL,no dilution was performed.When sperm concentration≥50× 106/mL,the samples were diluted with saline at 1∶n/(50×106)ratio(n=sperm concentration,n/[50×106]rounded down)to＜50×106/mL of sperm concentration.The sperm concentration,progressive motility(PR),non-progressive motility(NP),total motility(PR+NP)and immotile sperm percent-age(IM)were analyzed before and after dilution.The consistency of results pre-and post-dilution was compared.ROC curve was used to analyze the optimal dilution threshold.Results The differences in the parameters pre-and post-dilution gradually rosed with the increased sperm concentration.ROC curve analysis showed optimal dilution thresholds were 133.05 × 106/mL,101.75 × 106/mL,118.60×106/mL,90.90×106/mL,111.83×106/mL for the sperm concentration,PR+NP,PR,NP and IM respectively.Considering sperm concentration and NP were most affected the undiluted high concentration samples,the optimal comprehensive dilution threshold was determined as 125.08× 106/mL.Conclusion When sperm concentration exceeds 125×106/mL,it is recommended to dilute semen sample with normal saline.

Background: and Purpose X-linked Charcot-Marie-Tooth disease type 1 (CMTX1) is characterized by peripheral neuropathy with or without episodic neurological dysfunction. We performed clinical, neuropathological, and genetic investigations of a series of patients with mutations of the gap-junction beta-1 gene (GJB1) to extend the phenotypic and genetic description of CMTX1. Methods: Detailed clinical evaluations, sural nerve biopsy, and genetic analysis were applied to patients with CMTX1. Results: We collected 27 patients with CMTX1 with GJB1 mutations from 14 unrelated families. The age at onset (AAO) was 20.9±12.2 years (mean±standard deviation; range, 2–45 years). Walking difficulties, weakness in the legs, and pes cavus were common initial symptoms. Compared with female patients, males tended to have a younger AAO (males vs. females=15.4±9.6 vs. 32.0±8.8 years, p=0.002), a longer disease course (16.8±16.1 vs. 5.5±3.8 years, p=0.034), and more-severe electrophysiological results. Besides peripheral neuropathy, six of the patients had special episodic central nervous system (CNS) evidence from symptoms, signs, and/or reversible white-matter lesions. Neuropathology revealed the loss of large myelinated fibers, increased number of regenerated axon clusters with abnormally thin myelin sheaths, and excessively folded myelin. Genetic analysis identified 14 GJB1 variants, 6 of which were novel. Conclusions These findings expand the phenotypic and genetic spectrum of CMTX1. Although CMTX1 was found to have high phenotypic and CNS involvement variabilities, detailed neurological examinations and nerve conduction studies will provide critical clues for accurate diagnoses. Further exploration of the underlying mechanisms of connexin 32 involvement in neuropathy or CNS dysfunction is warranted to develop promising therapies.

OBJECTIVE: The research progress of new multifunctional bone cement in bone tumor therapy in recent years was reviewed, in order to provide help for the future research of anti-tumor bone cement. METHODS: The related literature on the treatment of bone tumors with new multifunctional bone cement at home and abroad in recent years was extensively reviewed and summarized. RESULTS: The new multifunctional bone cements include those with the functions of photothermotherapy, magnetic thermotherapy, chemoradiotherapy, and antibacterial after operation, which are discussed from the aspects of anti-tumor, drug controlled release, and cytotoxicity. Controlled drug release has been achieved in multifunctional bone cements by adjusting heat and pH or incorporating particles such as chitosan oligosaccharides and γ-cyclodextrin. At present, multifunctional bone cement with hyperthermia, radiotherapy, and chemotherapy has effectively inhibited the local recurrence and distant metastasis of bone tumors. Broadening the application of bone cement for photothermal and magnetic thermal therapy to deeper bone tumors, investigating more precise controlled release of drug-loaded bone cement, and introducing nanoparticles with both thermal conversion and intrinsic enzymatic activities into bone cement for synergistic anti-tumor therapy are promising research directions. CONCLUSION The new multifunctional bone cement inhibits bone tumor cells, promotes new bone formation in bone defects, and prevents incision infection after tumor resection. Certain progress has been made in anti-tumor, antibacterial, drug-controlled release, and reduction of cytotoxicity. Expanding the deeper application range of the new multifunctional bone cement, verifying the safety in clinical application, and focusing on the individualized treatment of the new multifunctional bone cement are the problems that need to be solved in the future.
Humans ; Bone Cements/therapeutic use* ; Delayed-Action Preparations ; Bone Neoplasms/therapy* ; Anti-Bacterial Agents/therapeutic use* ; Nanoparticles/therapeutic use*

Objective:To summarize and analyze the clinical and genetic characteristics of Chinese patients with adrenomyeloneuropathy (AMN).Methods:Clinical data were collected and analyzed retrospectively on AMN patients who were diagnosed by genetic testing in Shanghai Sixth People′s Hospital, Shanghai Jiao Tong University School of Medicine from May 2008 to August 2022. Clinical characteristics of AMN patients with different types of gene mutations were compared. Loe score was used to evaluate the severity of white matter demyelinating, and the serum levels of very long-chain fatty acids (VLCFA) in patients with or without white matter demyelinating were compared. The motor function of the AMN patients was assessed using the Expanded Disability Status Scale (EDSS), and the association between EDSS scores and the course of disease was analyzed.Results:A total of 23 male patients with onset age of (29.52±9.91) years were included in this study. The first symptom of all patients was abnormal lower extremities, of which 17 patients showed stiffness and weakness in their lower limbs (73.9%, 17/23), and 6 patients showed numbness and pain in both lower limbs (26.1%, 6/23). The occurrence of symptoms was not related to the type of gene mutation. White matter demyelination occurred in 33.3% (7/21) of patients over a disease duration of (7.67±4.46) years. There was no statistically significant difference in serum VLCFA level between the white-matter demyelination group and the non-demyelination group. The EDSS score was positively correlated with the disease duration ( r=0.57, P=0.006). Sixteen ABCD1 gene mutations were found in this study, among which c.5_19delinsTCTCCAGG (p.P2Lfs *12) was reported for the first time. Four probands belonging to different families carried the c.1415_1416del (p.Q472Rfs *83) variant. Conclusions:Lower limb movement disorders and sensory dysfunction are the prominent clinical manifestations in AMN patients, with deterioration of motor function associated with the course of disease. AMN may be converted to cerebral type and VLCFA concentration is not associated with the phenotypic changes. The c.1415_1416del (p.Q472Rfs *83) mutation is a hot spot mutation of the disease.