BACKGROUND: Preclinical studies have indicated that Angong Niuhuang Pills (ANP) reduce cerebral infarct and edema volumes. This study aimed to investigate whether ANP safely reduces cerebral infarct and edema volumes in patients with moderate to severe acute ischemic stroke. METHODS: This randomized, double-blind, placebo-controlled pilot trial included patients with acute ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores ranging from 10 to 20 in 17 centers in China between April 2021 and July 2022. Patients were allocated within 36 h after onset via block randomization to receive ANP or placebo (3 g/day for 5 days). The primary outcomes were changes in cerebral infarct and edema volumes after 14 days of treatment. The primary safety outcome was severe adverse events (SAEs) for 90 days. RESULTS: There were 57 and 60 patients finally included in the ANP and placebo groups, respectively for modified intention-to-treat analysis. The median age was 66.0 years, and the median NIHSS score at baseline was 12.0. The changes in cerebral infarct volume at day 14 were 0.3 mL and 0.4 mL in the ANP and placebo groups, respectively (median difference: -7.1 mL; interquartile range [IQR]: -18.3 to 2.3 mL, P = 0.30). The changes in cerebral edema volume of the ANP and placebo groups on day 14 were 11.4 mL and 4.0 mL, respectively ( median difference: 3.0 mL, IQR: -1.3 to 9.9 mL, P = 0.15). The rates of SAE within 90 days were similar in the ANP (3/57, 5%) and placebo (7/60, 12%) groups ( P = 0.36). Changes in serum mercury and arsenic concentrations were comparable. In patients with large artery atherosclerosis, ANP reduced the cerebral infarct volume at 14 days (median difference: -12.3 mL; IQR: -27.7 to -0.3 mL, P = 0.03). CONCLUSIONS: ANP showed a similar safety profile to placebo and non-significant tendency to reduce cerebral infarct volume in patients with moderate-to-severe stroke. Further studies are warranted to assess the efficacy of ANP in reducing cerebral infarcts and improving clinical prognosis. TRAIL REGISTRATION Clinicaltrials.gov , No. NCT04475328.
Aged ; Female ; Humans ; Male ; Middle Aged ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Ischemic Stroke/drug therapy* ; Pilot Projects ; Stroke/drug therapy* ; Treatment Outcome

Objective: To compare the effects of high intensity interval training (HIIT) exercise prescription based on machine vision and routine on HIIT the physical and mental health of female college students with simple obesity, so as to provide a basis for the development of weight loss intervention plans for this population. Methods: From August 2023 to February 2024, 115 female college students with simple obesity, selected from Lianyungang Vocational and Technical College and East China Normal University, were randomly divided into a control group ( n =57) and an observation group ( n =58) according to a random number table. The control group received routine HIIT, while the observation group received machine vision based on HIIT exercise prescription (including image acquisition module, image processing module, database management module, backend computer processing and feedback, intelligent evaluation module, which could be customized according to the subjects preferences, providing exercise prescription based on the selected training program and supervised its standardized completion of the training plan). Both were intervened for 12 weeks, 30 minutes each time, once every 2 days, and rest every Sunday. The t-test was used to compare body shape, glucose and lipid metabolism, cardiopulmonary function indicators, anxiety and depression states between two groups before and after intervention. Results: Before intervention, there were no statistically significant differences in physical and mental health status indicators between two groups of female college students ( t =0.13-0.86, all P >0.05). After intervention, body mass indexes, waist hip ratios, body fat percentage, fasting plasma glucose, 2hour postprandial plasma glucose, hemoglobin A1c, triglycerides, total cholesterol, lowdensity lipoprotein cholesterol (LDL-C), anxiety and depression scores were all reduced in both groups ( t-observation =-6.94 to -12.92, t-control =-2.71 to -10.95 ), of which the observation group [(23.46±2.18)kg/m 2, 0.70±0.06, (28.03±3.16)%, (4.55±0.67)mmol/L, (6.03±0.74)mmol/L, (5.10±0.70)%, (1.63±0.31)mmol/L, (4.24±0.58)mmol/L, (2.45±0.43)mmol/L, 35.28±4.76, and 33.03±4.03] were lower compared with the control group [(26.54±2.32)kg/m 2, 0.77±0.06, (30.74±4.38)%, (5.03±0.76)mmol/L, (6.62±0.82)mmol/L, (5.82±0.73)%, (1.98±0.35)mmol/L, (4.95±0.61)mmol/L, (2.88±0.47)mmol/L, 39.18±5.04, and 37.25±4.16] ( t =-7.34, -6.26 , -3.81, -3.59, -4.05, -5.40, -5.68, -6.40, -5.12, -4.27, -5.53)(all P <0.05). After intervention, high density lipoprotein cholesterol, stroke volume, left ventricular ejection fraction, maximum oxygen consumption, volume of tidal, and vital capacity increased in both groups ( t-observation =7.43-18.23, t-control =3.89-10.13), of which the observation group [(1.49±0.22)mmol/L, ( 72.35± 4.69)mL, (68.95±5.10)%, (36.97±3.22)mL/(kg ·( min), (25.29±4.11)mL/(kg · ( min), and (3 374.26±169.54)mL] were higher compared with the control group [(1.23±0.20)mmol/L, (67.32±4.06)mL, (64.83±5.05)%, (33.24±3.14)mL/(kg · ( min), (23.01± 3.58 )mL/(kg · ( min), and (3 197.50±125.81)mL] ( t =6.63, 6.15, 4.35, 6.29, 3.17, 6.34)(all P <0.05). Conclusion HIIT exercise prescription based on machine vision has better effects than routine HIIT on impoving the body shape, glucose and lipid metabolism, cardiopulmonary function of female college students with simple obesity, and also their mental health.

Objective To investigate the effects of hyaluronic acid and proteoglycan-linked protein 1 (HAPLN1) secreted by synovial fibroblasts (FLS) on the polarization of macrophages (Mϕ) in rheumatoid arthritis (RA). Methods Human monocytic leukemia cells (THP-1) were differentiated into Mϕ, which were subsequently exposed to recombinant HAPLN1 (rHAPLN1). RA-FLS were transfected separately with HAPLN1 overexpression plasmid (HAPLN1^OE) or small interfering RNA targeting HAPLN1 (si-HAPLN1), and then co-cultured with Mϕ to establish a co-culture model. The viability of Mϕ was assessed using the CCK-8 assay, and the proportions of pro-inflammatory M1-type and anti-inflammatory M2-type Mϕ were analyzed by flow cytometry. Additionally, the expression levels of inflammatory markers, including interleukin 1β (IL-1β), tumor necrosis factor α (TNF-α), and inducible nitric oxide synthase (iNOS), were quantified using quantitative real-time PCR and Western blot analysis. Results The viability of Mϕ was increased in the rHAPLN1 group compared to the control group. Furthermore, both the M1/Mϕ ratio and inflammatory factor levels were elevated in the rHAPLN1 and HAPLN1^OE groups. In contrast, the si-HAPLN1 group exhibited a decrease in the M1/Mϕ ratio and inflammatory factor expression. Notably, the introduction of rHAPLN1 in rescue experiments further promoted Mϕ polarization towards the M1 phenotype. Conclusion HAPLN1, secreted by RA fibroblast-like synoviocytes (RA-FLS), enhances Mϕ polarization towards the M1 phenotype.
Humans ; Arthritis, Rheumatoid/genetics* ; Macrophages/immunology* ; Fibroblasts/metabolism* ; Phenotype ; Extracellular Matrix Proteins/genetics* ; Proteoglycans/genetics* ; Synovial Membrane/cytology* ; Tumor Necrosis Factor-alpha/genetics* ; Interleukin-1beta/genetics* ; Nitric Oxide Synthase Type II/genetics* ; Cell Differentiation ; Coculture Techniques ; THP-1 Cells

Objective To systematically evaluate the efficacy and safety of three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma.Methods This study was conducted according to PRISMA guidelines,with a PROSPERO registration number of CRD42023488398.PubMed,Embase,Web of Science,the Cochrane Library,CNKI,Wanfang Data,VIP,and CBM were searched for Chinese and English articles on three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma published up to March 2023.After quality assessment and data extraction of the studies included,RevMan 5.4 software was used to perform the meta-analysis.Results A total of 11 studies were included,with 972 patients in total,among whom 447 underwent ablation assisted by three-dimensional visualization technology(3D group)and 525 underwent ablation assisted by traditional two-dimensional imaging technology(2D group).The meta-analysis showed that compared with the 2D group,the 3D group had significantly higher success rate of first-time ablation treatment(odds ratio[OR]=5.43,95%confidence interval[CI]:2.64—11.18,P<0.001),technical efficiency(OR=6.15,95%CI:3.23—11.70,P<0.001),and complete ablation rate(OR=2.50,95%CI:1.08—5.78,P=0.03),as well as significantly lower incidence rate of major complications(OR=0.45,95%CI:0.24—0.87,P=0.02),local recurrence rate(OR=0.35,95%CI:0.17—0.72,P=0.004),and local tumor progression rate(OR=0.29,95%CI:0.16—0.50,P<0.001),while there was no significant difference in the incidence rate of mild complications between the two groups(P>0.05).Conclusion Three-dimensional visualization technology is safe and feasible in assisting ablation therapy for hepatocellular carcinoma and can improve ablation rate and reduce the incidence rate of serious complications,local recurrence rate,and local tumor progression rate,thereby showing an important application value in clinical practice.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective: To analyze the characteristics of school injury among students aged 3 to 18 years in Yantian District of Shenzhen City, Guangdong Province, so as to provide the reference for developing the strategies for prevention and control of school injury. Methods: Data of the students aged 3 to 18 years who were initially diagnosed as injury in sentinel hospitals and whose injuries occurred in nurseries, primary or middle schools in Yantian District in 2023, were collected from the Shenzhen Injury Surveillance System. The onset time, places, activities, characteristics and sites of injury were descriptively analyzed. Results: A total of 1 681 cases of school injuries among students aged 3 to 18 years were reported in Yantian District in 2023, including 1 182 boys and 499 girls, with a boy-to-girl ratio of 2.37∶1. There were 206 preschool children (12.25%), 856 primary school students (50.92%), 358 junior high school students (21.30%) and 261 high school students (15.53%). The peak months for school injuries were February to June, accounting for 49.97%; the peak time period was from 15: 00 to 18: 59, accounting for 44.68%. The main causes of injuries included falls (41.94%) and blunt injury (33.85%). The activities at the time of injury mainly included leisure activities (57.70%) and physical activities (21.83%). Contusion/abrasion was the main characteristics (49.20%). Mild injury was predominant, accounting for 74.60%, and there was no fatal case. The top three injury sites were the head and neck, upper limbs and lower limbs, accounting for 36.94%, 27.54%, and 24.33%, respectively. Boys had higher proportions of blunt injuries and contusion/abrasion (AR=4.8 and 4.0). The proportion of sports injuries, sprains/strains and lower limb injuries increased with grade (all P<0.05). Conclusions School injury among students predominantly occur in spring when having leisure or physical activities in Yantian District. The main causes of injuries are falls and blunt injury, with boys and primary school students being the high-risk groups.

A young female patient with acne and elevated testosterone level underwent plasma steroid hormones testing and found a significant increase in aldosterone. We excluded testing interference and verified the absence of hypertension, hypokalemia, and adrenal occupancy, as well as primary and secondary hyperaldosteronism. During follow-up, a temporal correlation was found between aldosterone levels and the use of drospirenone and ethinylestradiol tablets. It was observed that the combination of drospirenone and ethinylestradiol could lead to the increase of aldosterone level and the concentration ratio of aldosterone to direct renin through different mechanisms. Drospirenone exerts an antagonistic effect on mineralocorticoid receptor to prevent the development of hypertension or hypokalemia. In clinical practice, it is necessary to pay attention to the effect of this drug on screening markers for primary aldosteronism. In the laboratory examination, when female patients with no symptoms of hypertension and hypokalemia but with elevated aldosterone levels are encountered, it can be verified whether they have a history of use of compound estrogen-progestin such as drospirenone and ethinylestradiol tablets, and appropriate tips are provided in the report.

Objective To observe the value of ultrasound radiomics for distinguishing early and middle-late stage endometrial cancer(EC).Methods A total of 294 women with EC were retrospectively enrolled,including 196 in early stage and 98 in middle-late stage.The patients were randomly divided into training set(n=206)and validation set(n=88)at the ratio of 7∶3.Clinical data were compared between different stages,and a clinical model was constructed.Radiomics features were extracted and screened based on ultrasound data,and radiomics models were constructed with logistic regression(LR),random forest(RF),support vector machine(SVM),Gaussian naive Bayes(GNB)and extreme gradient boosting(XGBoost),respectively.Finally,a clinical-radiomics model was constructed.The value of each model for distinguishing early and middle-late stages EC was observed.Results Significant differences of age of consultation,menstrual disorders,abdominal pain and proportion of menopause were found between patients with early and middle-late stage EC(all P＜0.05).Among these 5 radiomics models,RF model had the highest area under the curve(AUC)for distinguishing early and middle-late stage EC.Pairwise comparison of clinical model,RF radiomics model and clinical-RF radiomics model showed that significant differences of AUC were found between each 2 models(all P＜0.05),and clinical-RF radiomics model had the highest AUC.Conclusion Ultrasound radiomics based on RF were helpful for distinguishing early and middle-late stage EC,and better diagnostic efficacy could be obtained through combining with clinical data.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Purpose/Significance To construct a Chinese medical knowledge Q&A corpus dataset as a standardized evaluation bench-mark for large language models(LLMs)in the medical domain,so as to improve the accuracy and efficiency of LLMs in handling Chinese medical questions.Method/Process Chinese medical paper knowledge,medical terminology explanations and supplementary questions are acquired from the Chinese medical licensing examination,and open-source Chinese medical Q&A datasets are encompassed in the developed Q&A datasets.Result/Conclusion The Chinese medical knowledge Q&A corpus datasets enrich the sources of existing datasets and promote the objective and comprehensive quantitative evaluation of large models in the medical field.In the near future,additional data such as electronic medical records and those from online health communities will be used to strengthen the support of artificial intelli-gence for the Healthy China strategy.