ObjectiveTo investigate the mechanism by which Bushao Tiaozhi capsules （BSTZ） ameliorate hyperlipidemia based on untargeted metabolomics and targeted bile acid quantification. MethodsA rat model of hyperlipidemia was established with a high-fat diet. The rats were randomized into five groups： normal control， model， atorvastatin calcium （1.8 mg·kg^-1）， and low-dose （2.88 g·kg^-1） and high-dose （5.76 g·kg^-1） BSTZ groups. All treatments were administered for four consecutive weeks. Serum levels of total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） were measured by biochemical assays. Hepatic histopathological changes were evaluated via hematoxylin-eosin （HE） staining， and lipid droplet deposition was assessed by oil red O staining. Integrated untargeted metabolomics and targeted bile acid quantification were employed to investigate BSTZ-induced alterations in hepatic metabolic profile and bile acid profile. Additionally， correlation analyses were conducted between differential bile acids and lipid parameters to identify key bile acids. ResultsCompared with the normal control group， the model group exhibited elevated serum TC， TG， and LDL-C levels （P<0.01） and a reduced HDL-C level （P<0.01）， along with marked hepatic steatosis and extensive lipid droplet deposition. Compared with the model group， all BSTZ treatment groups showed decreased TC， TG， and LDL-C levels （P<0.01） and increased HDL-C levels （P<0.01）， accompanied by notably alleviated hepatic steatosis and lipid deposition. Untargeted metabolomics and targeted bile acid quantification revealed that BSTZ significantly remodeled the hepatic bile acid profile， characterized by elevated levels of secondary bile acids （DCA， HDCA， TDCA， and TLCA） and reduced levels of primary bile acids （CDCA and TCDCA）. Correlation analyses further demonstrated strong associations between differential bile acids and lipid parameters： elevated secondary bile acids were negatively correlated with serum TC， TG， and LDL-C levels， whereas primary bile acids were positively correlated with these parameters. ConclusionBSTZ can ameliorate dyslipidemia and hepatic lipid accumulation in hyperlipidemic rats by regulating hepatic bile acid homeostasis， which provides metabolic clues for subsequent mechanism validation.

Objective:To establish criteria for diagnosing lymph node metastasis (LNM) in newly diagnosed papillary thyroid cancer (PTC) patients based on 18F-FDG PET/MR and evaluate its diagnostic efficiency. Methods:The data of 14 patients with PTC (all females, age (38.8±13.5) years) who underwent 18F-FDG PET/MR and ultrasound sequentially 2 weeks before surgery at the First Affiliated Hospital of the Air Force Medical University from May 2021 to August 2023 were retrospectively analyzed. Visual and semi-quantitative assessments were performed on all patients step by step (Ⅱ-Ⅵ area) and neck by neck (left, right, and central area). The dimensions of all suspected lymph nodes were measured on T 2 weighted imaging (WI)-MRI and SUV max was measured on PET. Taking postoperative pathology as the reference standard, the independent risk factors for predicting LNM were determined by multivariate logistic regression analysis, and the diagnostic efficiency of each model was evaluated by ROC curve analysis. Results:A total of 21 macroscopic regions of lymph nodes(15 were malignant, 6 were benign) and 178 lymph nodes (120 were malignant, 58 were benign) were cleared by surgery. Multivariate logistic regression analysis showed that SUV max (odds ratio ( OR)=1.865, 95% CI: 1.323-2.630, P<0.001) and short diameter on MRI (SD-MRI) ( OR=1.752, 95% CI: 1.189-2.580, P=0.005) were independent predictors of LNM. The cut-off value of SD-MRI in predicting LNM was 5.7mm (AUC=0.812, Youden index (YI)=0.463). For the SD-MRI cut-off values ≥5.7 or <5.7mm, the corresponding SUV max cut-off values were 1.6 and 1.8, respectively. When " dual threshold" quantitative criteria (SD-MRI≥5.7mm + SUV max≥1.6 or SD-MRI<5.7mm + SUV max≥1.8) was used as the diagnostic criteria of 18F-FDG PET/MR, the AUC and YI could be improved to 0.909 and 0.818. Based on the regional level analysis, sensitivity, specificity, and accuracy of LNM diagnosis by ultrasound, MRI, and 18F-FDG PET/MR " dual threshold" criteria were 11/15 vs 12/15 vs 13/15, 5/6 vs 3/6 vs 5/6, 76.2%(16/21) vs 71.4%(15/21) vs 85.7%(18/21), respectively. Conclusion:Compared with the ultrasound and MRI, the 18F-FDG PET/MR " dual threshold" criteria exhibits higher sensitivity and accuracy in determining the scope of LNM clearance for PTC patients.

Acute ischemic stroke(AIS)is associated with high mortality and disability rates,presenting a substantial challenge to global public health challenge.Intravenous thrombolysis(IVT)is recognized as a cornerstone of early AIS treatment and is recommended as the standard therapeutic approach by both national and international guidelines.However,the clinical efficacy of IVT remains suboptimal due to several limitations,including a narrow therapeutic time window and the inevitable activation of the coagulation system and platelet aggregagation during thrombolysis.These factors may contribute to adverse outcomes such as early neurological deterioration(END)and vascular re-occlusion.Antiplatelet therapy(APT),which inhibits platelet aggregations,reduces microthrombus formation,and stabilizes the vascular endothelium with multifaceted mechanisms,has emerged as a promising adjunctive strategy to IVT,offering potential synergistic effects.This review summarized the latest evidence from both domestic and international studies,focusing on the mechanisms of APT,recent clinical advancements in IVT combined with APT,and the safety and efficacy of APT administration at different time windows relative to IVT.Emphasis is placed on the influence of various antiplatelet agents,dosing regimens,and initiation timing on therapeutic outcomes,alongside a comprehensive evaluation in the context of current guideline recommendations and clinical practice.Current guidelines recommend initiating APT 24 h after IVT,following imaging confirmation to exclude the risk of intracranial hemorrhage.However,the efficacy and safety of earlier APT initiation remain inconclusive.Individualized treatment strategies,such as early administration of low-dose,short-acting APT or combination therapy in specific patient subgroups,may effectively balance therapeutic benefits and risks.The adjunctive use of APT in IVT holds promise for enhancing efficacy and improving clinical outcomes,but precise stratification of safety and efficacy is essential.Future research should focus on optimizing combination IVT and APT strategies through individualized patient profiling,appropriate drug selection,and dynamic imaging monitoring to achieve precision management in AIS treatment.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

BACKGROUND: Stroke is the leading cause of death and long-term disability worldwide, including China. This study aimed to provide timely updates on stroke burden and stroke-related risk factors to help improve population-based prevention and control strategies. METHODS: Based on the Global Burden of Disease study 2021, incidence rate, prevalence rate, mortality rate, and disability-adjusted life-year (DALY) rate were used to estimate stroke burden trend from 1990 to 2021. RESULTS: In 2021, China had 4.1 million incident stroke cases, 26.3 million prevalent stroke cases, 2.6 million stroke related deaths, and 53.2 million stroke related DALYs, compared to 11.9 million incident stroke cases, 93.8 million prevalent stroke cases, 7.3 million stroke related deaths, and 160.5 million stroke-related DALYs worldwide. In 2021, the top six risk factors contributing to stroke burden were high blood pressure, air pollution, tobacco consumption, dietary risk factors, high low-density lipoprotein cholesterol, and high fasting plasma glucose, both in China and worldwide. From 1990 to 2021, China had significant increases of incidence rate, prevalence rate, mortality rate, and DALY rate for stroke, with estimates of 100.6 (95% uncertainty intervals [UI]: 87.2, 114.1)%, 102.9 (95% UI: 95.5, 110.9)%, 40.0 (95% UI: 14.9, 72.3)% and 15.7 (95% UI: -4.6, 41.2)%, respectively, while global incidence rate, prevalence rate, mortality rate and DALY rate for total stroke showed relatively moderate increases or even decreases, with estimates of 15.0 (95% UI: 12.1,18.0)%, 25.8 (95% UI: 23.7, 28.0)%, -2.6 (95% UI: -10.6, 5.5)%, and -10.7 (95% UI: -17.7, -3.6)%, respectively. CONCLUSION Stroke remains a huge disease burden worldwide and in China, and compared to the worldwide China has a significantly higher burden of stroke.
Humans ; Stroke/etiology* ; China/epidemiology* ; Risk Factors ; Global Burden of Disease ; Disability-Adjusted Life Years ; Prevalence ; Incidence ; Female ; Quality-Adjusted Life Years ; Male

Acute ischemic stroke(AIS)is associated with high mortality and disability rates,presenting a substantial challenge to global public health challenge.Intravenous thrombolysis(IVT)is recognized as a cornerstone of early AIS treatment and is recommended as the standard therapeutic approach by both national and international guidelines.However,the clinical efficacy of IVT remains suboptimal due to several limitations,including a narrow therapeutic time window and the inevitable activation of the coagulation system and platelet aggregagation during thrombolysis.These factors may contribute to adverse outcomes such as early neurological deterioration(END)and vascular re-occlusion.Antiplatelet therapy(APT),which inhibits platelet aggregations,reduces microthrombus formation,and stabilizes the vascular endothelium with multifaceted mechanisms,has emerged as a promising adjunctive strategy to IVT,offering potential synergistic effects.This review summarized the latest evidence from both domestic and international studies,focusing on the mechanisms of APT,recent clinical advancements in IVT combined with APT,and the safety and efficacy of APT administration at different time windows relative to IVT.Emphasis is placed on the influence of various antiplatelet agents,dosing regimens,and initiation timing on therapeutic outcomes,alongside a comprehensive evaluation in the context of current guideline recommendations and clinical practice.Current guidelines recommend initiating APT 24 h after IVT,following imaging confirmation to exclude the risk of intracranial hemorrhage.However,the efficacy and safety of earlier APT initiation remain inconclusive.Individualized treatment strategies,such as early administration of low-dose,short-acting APT or combination therapy in specific patient subgroups,may effectively balance therapeutic benefits and risks.The adjunctive use of APT in IVT holds promise for enhancing efficacy and improving clinical outcomes,but precise stratification of safety and efficacy is essential.Future research should focus on optimizing combination IVT and APT strategies through individualized patient profiling,appropriate drug selection,and dynamic imaging monitoring to achieve precision management in AIS treatment.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

Objective:To establish criteria for diagnosing lymph node metastasis (LNM) in newly diagnosed papillary thyroid cancer (PTC) patients based on 18F-FDG PET/MR and evaluate its diagnostic efficiency. Methods:The data of 14 patients with PTC (all females, age (38.8±13.5) years) who underwent 18F-FDG PET/MR and ultrasound sequentially 2 weeks before surgery at the First Affiliated Hospital of the Air Force Medical University from May 2021 to August 2023 were retrospectively analyzed. Visual and semi-quantitative assessments were performed on all patients step by step (Ⅱ-Ⅵ area) and neck by neck (left, right, and central area). The dimensions of all suspected lymph nodes were measured on T 2 weighted imaging (WI)-MRI and SUV max was measured on PET. Taking postoperative pathology as the reference standard, the independent risk factors for predicting LNM were determined by multivariate logistic regression analysis, and the diagnostic efficiency of each model was evaluated by ROC curve analysis. Results:A total of 21 macroscopic regions of lymph nodes(15 were malignant, 6 were benign) and 178 lymph nodes (120 were malignant, 58 were benign) were cleared by surgery. Multivariate logistic regression analysis showed that SUV max (odds ratio ( OR)=1.865, 95% CI: 1.323-2.630, P<0.001) and short diameter on MRI (SD-MRI) ( OR=1.752, 95% CI: 1.189-2.580, P=0.005) were independent predictors of LNM. The cut-off value of SD-MRI in predicting LNM was 5.7mm (AUC=0.812, Youden index (YI)=0.463). For the SD-MRI cut-off values ≥5.7 or <5.7mm, the corresponding SUV max cut-off values were 1.6 and 1.8, respectively. When " dual threshold" quantitative criteria (SD-MRI≥5.7mm + SUV max≥1.6 or SD-MRI<5.7mm + SUV max≥1.8) was used as the diagnostic criteria of 18F-FDG PET/MR, the AUC and YI could be improved to 0.909 and 0.818. Based on the regional level analysis, sensitivity, specificity, and accuracy of LNM diagnosis by ultrasound, MRI, and 18F-FDG PET/MR " dual threshold" criteria were 11/15 vs 12/15 vs 13/15, 5/6 vs 3/6 vs 5/6, 76.2%(16/21) vs 71.4%(15/21) vs 85.7%(18/21), respectively. Conclusion:Compared with the ultrasound and MRI, the 18F-FDG PET/MR " dual threshold" criteria exhibits higher sensitivity and accuracy in determining the scope of LNM clearance for PTC patients.

Objective To systematically evaluate and integrate the experiences of people living with HIV in peer support,and to provide references and suggestions for improving peer support for HIV patients in clinical practice.Methods The computer retrieval was performed in PubMed,CINAHL(EBSCO),Web of Science,ProQuest,CNKI and Wanfang Data from January 1,1996 to September 30,2022,to collect qualitative studies in the experience of people living with HIV participating in peer support.This qualitative systematic review was conducted under the Joanna Briggs Institute guideline.This paper was written according to the enhancing transparency in reporting the synthesis of qualitative research(ENTREQ).Results A total of 7 qualitative studies were included,and 26 findings were extracted,which were summarized into 12 categories and integrated into 4 synthesized findings.Findings included that peer support provides patients with information and help them establish and maintain a healthy lifestyle;patients receive emotional support in peer support;patients receive instrumental support in peer support;the objective requirements and scenarios of peer support.Conclusion AIDS peer support has a positive effect on AIDS prevention and treatment,and it is important to address the practical needs of people living with HIV/AIDS.The practice of HIV peer support needs further theoretical support and scientific guidance.Building an HIV peer support model,providing systematic training and professional guidance to HIV peers is conducive to improving the accuracy of HIV peer support behaviors,the development of HIV peer support activities,and optimizing the effectiveness and sustainability of peer support for people living with HIV/AIDS.

Objective:To explore whether multi-parametric MRI (mpMRI) combined with 68Ga-prostate specific membrane antigen (PSMA) PET/CT can improve the detection efficiency of clinically significant prostate cancer (csPCa). Methods:Clinical and imaging data of 152 patients (age (68.5±8.5) years) who underwent mpMRI and 68Ga-PSMA PET/CT examination for suspected prostate cancer in the First Affiliated Hospital of the Air Force Medical University from January 2021 to November 2022 were retrospectively analyzed, with the histopathological results from transrectal ultrasound guided biopsy as reference. Lesions with Gleason scores (GS) ≥3+ 4 from the biopsy were diagnosed with csPCa, and lesions with negative biopsy or GS 6 were diagnosed with non-csPCa. MpMRI was evaluated independently by two radiologists according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. The radioactive uptake of 68Ga-PSMA PET/CT in prostate lesions was evaluated by SUV max. The independent-sample t test, Mann-Whitney U test and χ2 test were used to compare differences between the two groups, and then multivariate logistic regression analysis was performed. ROC curves analysis was used to analyze the diagnostic efficacies of individual and combined factors and Delong test was used. Results:There were 85 csPCa and 67 non-csPCa confirmed. Prostate specific antigen (PSA), PI-RADS score and SUV max were significantly different between the csPCa group and the non-csPCa group ( χ2=68.06, U values: -7.66, -8.98, all P<0.001). Multivariate logistic regression analysis indicated that PI-RADS score (odds ratio ( OR)=3.424, 95% CI: 1.651-7.100) and SUV max ( OR=1.931, 95% CI: 1.403-2.658) were independent predictors of csPCa (both P<0.001). ROC curves analysis revealed that the cut-off value for diagnosing csPCa was 4 for PI-RADS score and 5.6 for SUV max. The accuracy of mpMRI and PET/CT alone in csPCa diagnosis was 80%(122/152) (AUC of 0.789(95% CI: 0.711-0.866) with the sensitivity and specificity of 91%(77/85) and 67%(45/67)), and 87%(132/152) (AUC of 0.876(95% CI: 0.817-0.936) with the sensitivity and specificity of 81%(69/85) and 94%(63/67)), respectively. Several joint models incorporating 68Ga-PSMA PET/CT with mpMRI data were investigated, the model of PI-RADS 5 or PI-RADS 3-4 and SUV max>5.6 showed better performance than mpMRI and PET/CT alone and other joint models ( z values: 2.01-3.64, all P<0.05), with the accuracy of 91%(138/152) (AUC of 0.910(95% CI: 0.857-0.962) with the sensitivity and specificity of 89%(76/85) and 93%(62/67)). Conclusion:MpMRI combined with 68Ga-PSMA PET/CT can significantly improve the detection efficiency of csPCa, with the principal effect being improved in risk stratification of PI-RADS 3-4 lesions in mpMRI.