Objective:Based on the functional classification structure of the International Classification of Functioning, Disability and Health′s rehabilitation set (ICF-RS), the data available in the open database of the China Health and Retirement Longitudinal Study (CHARLS) were analyzed longitudinally to construct the development trajectories of different functional dimensions among China′s elderly population.Methods:The CHARLS data for 2013, 2015 and 2018 describing persons aged 60 and older were distributed using the ICF-RS′s classification structure. Group-based multi-trajectory modeling (GBMTM) was then applied to analyze the characteristics of the development trajectories of physical functioning, daily activities and social participation.Results:Different development trajectory subtypes emerged from the data. A gradual decline in physical functioning was evident throughout the study period, while daily activities first improved and then declined. Social participation was in decline throughout the period. There were, however, significant differences in the initial functional level, the degree of decline and the degree of decline reversal among the different subtype groups.Conclusions:The overall functional performance of the elderly in China shows a downward trend, but some functional dimensions can still improve with time, at least during the specific period covered in this open database. It is recommended that the ICF-RS be integrated into the CHARLS to comprehensively assess the classification of function and developmental changes among China′s elderly.

Objective To explore the clinical efficacy and safety of intravenous thrombolysis and dual antiplatelet therapy in the treatment of acute mild non-disabling ischemic stroke.Methods A retrospective cohort study was conducted,including 138 patients with acute mild non-disabling ischemic stroke[National Institutes of Health Stroke Scale(NIHSS)score≤5]from January 2022 to March 2024,within 6 h of onset.Patients were divided into an intravenous thrombolysis group(66 cases)and a dual antiplatelet group(72 cases).Propensity score matching was used to match patients 1∶1,resulting in 44 patients in each group after matching.Demographic data,clinical data,clinical outcome indicators,and adverse events were collected.The primary outcome was defined as a good functional outcome[modified Rankin Scale(mRS)score 0-2]at 90 d post-onset.Secondary outcomes included NIHSS scores at 24 h,72 h,and 7 d post-onset;the proportion of early neurological deterioration;intracranial and systemic hemorrhagic events within 90 d post-onset;and death within 90 d.Results ①Before matching,the intravenous thrombolysis group had a lower age and admission mRS score than that of the dual antiplatelet group,with statistically significant differences(all P＜0.05).After matching,there were no statistically significant differences between the two groups in terms of age,gender,hypertension,diabetes,cardiac disease,atrial fibrillation,hyper low density lipoprotein-cholesterol(LDL-C),hyperhomocysteinemia,prior stroke,prior smoking,admission NIHSS score,admission mRS score,location of stroke and TOAST classification(all P＞0.05);②There was no statistically significant difference in the proportion of patients with a good functional outcome at 90 d post-onset and the mRS score at 90 d between the intravenous thrombolysis group and the dual antiplatelet group[88.6％(39/44)vs 93.2％(41/44),P=0.458,P=0.308];③ The intravenous thrombolysis group had significantly lower median NIHSS scores at 24 h and 72 h post-onset compared to the dual antiplatelet group,with statistically significant differences[1 vs 2.5,1 vs 2,P=0.018,0.043].There were no statistically significant differences in the other efficacy and safety outcomes.Conclusions Intravenous thrombolysis therapy can bring significant short-term benefits to patients with acute mild non-disabling ischemic stroke,helping to shorten the time to recovery to a good neurological functional outcome,and does not increase the risk of bleeding and mortality.However,in terms of good functional outcomes at 90 d post-onset,its effects are similar to those of dual antiplatelet therapy.Nevertheless,there is an urgent need for larger sample,higher quality clinical studies to further validate these findings.

Objective To explore the mechanism of Kangliu Zengxiao Jiandu Prescription(KLJD)in enhancing the efficacy of cisplatin chemotherapy in non-small cell lung cancer(NSCLC)through network pharmacology and in vivo/in vitro experiments.Methods Components of KLJD were screened via the TCMSP database to identify active components and potential targets.Lung cancer-related genes were obtained from the GeneCards and OMIM databases.GO and KEGG pathway enrichment analysis was performed on drug-disease intersection targets using the Metascape database;molecular docking was performed between core target proteins and main active components.A Lewis lung cancer mouse model was established,and intervened with KLJD and cisplatin.Organ indexes and tumor inhibition rate were counted,and Western blot and RT-PCR were used to detect the expressions of key pathway target proteins and mRNA;A549 and H1299 cells were intervened with KLJD,and Western blot was used to detect key target protein expressions.Results Network pharmacology identified 74 active components and 20 key targets of KLJD,primarily involved in biological processes such as cell proliferation and inflammatory response,and pathways in cancer and PI3K/AKT signaling pathway;molecular docking revealed stable binding between EGFR and major compounds.Animal experiments demonstrated that,compared with the model group,the KLJD group showed significantly higher tumor inhibition rate(P<0.01)and downregulation of EGFR,AKT and PI3K protein and mRNA expression in tumor tissues(P<0.05).Compared with the cisplatin group,the combination group exhibited significantly enhanced tumor inhibition rate(P<0.01),elevated thymic and splenic indices(P<0.01),and decreased EGFR,PI3K and AKT protein and mRNA expressions(P<0.01).Cell experiments showed that KLJD concentration-dependently inhibited A549 and H1299 cell proliferation(IC50:14.72 mg/mL and 14.68 mg/mL,respectively).Combined with cisplatin,KLJD synergistically down-regulated EGFR PI3K and AKT protein expressions(P<0.01).Conclusion KLJD effectively enhances cisplatin's chemotherapeutic efficacy in NSCLC by inhibiting the EGFR/PI3K/AKT pathway while improving immune organ function.Its mechanism likely involves multi-target regulation,including suppression of tumor proliferation,promotion of apoptosis,and modulation of the immune microenvironment.

Objective To compare the effect of transcranial direct current stimulation(tDCS)combined with seated Taijiquan Yun-shou in different sequences on brain functional activation in healthy youths.Methods From September to December,2024,14 healthy young medical interns or probationers were recruited from the Fifth Hospital of Xiamen.They randomly completed three interventions in a crossover design:Yunshou training followed immediately by tDCS(Y-S group),tDCS intervention followed immediately by Yunshou training(S-Y group),and simultaneous implementation of tDCS intervention and Yunshou training(Sim group).Yunshou was practiced in a seated position.For tDCS,the anode was placed over the left primary motor cortex(M1),and the cathode over the right M1.Changes in oxyhemoglobin(HbO2)concentration in the regions of interest were mea-sured using functional near-infrared spectroscopy.Results Three cases dropped down.The brain regions with significant differences before and after intervention included:CH3,CH7 and CH23 of right prefrontal cortex(PFC)in Y-S group;CH12 of left PFC in S-Y group;and CH9,CH10 and CH25 of the left PFC,CH13 and CH14 of the left sensorimotor cortex(SMC),CH15 of the right pre-motor and supplementary motor cortex(PMC),and CH16 of the right SMC in Sim group(P<0.05).After inter-vention,HbO2 concentration was the highest in the bilateral PFC,bilateral PMC and left SMC in the Y-S group(P<0.05);and it was almost the same between Sim group and S-Y group(P>0.05),except that of the right PFC decreased in Sim group.Conclusion The sequential combination of brain-limb integrated regulation is a key factor influencing the immediate cor-tical activation pattern.

Objective To compare the effect of transcranial direct current stimulation(tDCS)combined with seated Taijiquan Yun-shou in different sequences on brain functional activation in healthy youths.Methods From September to December,2024,14 healthy young medical interns or probationers were recruited from the Fifth Hospital of Xiamen.They randomly completed three interventions in a crossover design:Yunshou training followed immediately by tDCS(Y-S group),tDCS intervention followed immediately by Yunshou training(S-Y group),and simultaneous implementation of tDCS intervention and Yunshou training(Sim group).Yunshou was practiced in a seated position.For tDCS,the anode was placed over the left primary motor cortex(M1),and the cathode over the right M1.Changes in oxyhemoglobin(HbO2)concentration in the regions of interest were mea-sured using functional near-infrared spectroscopy.Results Three cases dropped down.The brain regions with significant differences before and after intervention included:CH3,CH7 and CH23 of right prefrontal cortex(PFC)in Y-S group;CH12 of left PFC in S-Y group;and CH9,CH10 and CH25 of the left PFC,CH13 and CH14 of the left sensorimotor cortex(SMC),CH15 of the right pre-motor and supplementary motor cortex(PMC),and CH16 of the right SMC in Sim group(P<0.05).After inter-vention,HbO2 concentration was the highest in the bilateral PFC,bilateral PMC and left SMC in the Y-S group(P<0.05);and it was almost the same between Sim group and S-Y group(P>0.05),except that of the right PFC decreased in Sim group.Conclusion The sequential combination of brain-limb integrated regulation is a key factor influencing the immediate cor-tical activation pattern.

Objective To explore the mechanism of Kangliu Zengxiao Jiandu Prescription(KLJD)in enhancing the efficacy of cisplatin chemotherapy in non-small cell lung cancer(NSCLC)through network pharmacology and in vivo/in vitro experiments.Methods Components of KLJD were screened via the TCMSP database to identify active components and potential targets.Lung cancer-related genes were obtained from the GeneCards and OMIM databases.GO and KEGG pathway enrichment analysis was performed on drug-disease intersection targets using the Metascape database;molecular docking was performed between core target proteins and main active components.A Lewis lung cancer mouse model was established,and intervened with KLJD and cisplatin.Organ indexes and tumor inhibition rate were counted,and Western blot and RT-PCR were used to detect the expressions of key pathway target proteins and mRNA;A549 and H1299 cells were intervened with KLJD,and Western blot was used to detect key target protein expressions.Results Network pharmacology identified 74 active components and 20 key targets of KLJD,primarily involved in biological processes such as cell proliferation and inflammatory response,and pathways in cancer and PI3K/AKT signaling pathway;molecular docking revealed stable binding between EGFR and major compounds.Animal experiments demonstrated that,compared with the model group,the KLJD group showed significantly higher tumor inhibition rate(P<0.01)and downregulation of EGFR,AKT and PI3K protein and mRNA expression in tumor tissues(P<0.05).Compared with the cisplatin group,the combination group exhibited significantly enhanced tumor inhibition rate(P<0.01),elevated thymic and splenic indices(P<0.01),and decreased EGFR,PI3K and AKT protein and mRNA expressions(P<0.01).Cell experiments showed that KLJD concentration-dependently inhibited A549 and H1299 cell proliferation(IC50:14.72 mg/mL and 14.68 mg/mL,respectively).Combined with cisplatin,KLJD synergistically down-regulated EGFR PI3K and AKT protein expressions(P<0.01).Conclusion KLJD effectively enhances cisplatin's chemotherapeutic efficacy in NSCLC by inhibiting the EGFR/PI3K/AKT pathway while improving immune organ function.Its mechanism likely involves multi-target regulation,including suppression of tumor proliferation,promotion of apoptosis,and modulation of the immune microenvironment.

Objective To explore the clinical efficacy and safety of intravenous thrombolysis and dual antiplatelet therapy in the treatment of acute mild non-disabling ischemic stroke.Methods A retrospective cohort study was conducted,including 138 patients with acute mild non-disabling ischemic stroke[National Institutes of Health Stroke Scale(NIHSS)score≤5]from January 2022 to March 2024,within 6 h of onset.Patients were divided into an intravenous thrombolysis group(66 cases)and a dual antiplatelet group(72 cases).Propensity score matching was used to match patients 1∶1,resulting in 44 patients in each group after matching.Demographic data,clinical data,clinical outcome indicators,and adverse events were collected.The primary outcome was defined as a good functional outcome[modified Rankin Scale(mRS)score 0-2]at 90 d post-onset.Secondary outcomes included NIHSS scores at 24 h,72 h,and 7 d post-onset;the proportion of early neurological deterioration;intracranial and systemic hemorrhagic events within 90 d post-onset;and death within 90 d.Results ①Before matching,the intravenous thrombolysis group had a lower age and admission mRS score than that of the dual antiplatelet group,with statistically significant differences(all P＜0.05).After matching,there were no statistically significant differences between the two groups in terms of age,gender,hypertension,diabetes,cardiac disease,atrial fibrillation,hyper low density lipoprotein-cholesterol(LDL-C),hyperhomocysteinemia,prior stroke,prior smoking,admission NIHSS score,admission mRS score,location of stroke and TOAST classification(all P＞0.05);②There was no statistically significant difference in the proportion of patients with a good functional outcome at 90 d post-onset and the mRS score at 90 d between the intravenous thrombolysis group and the dual antiplatelet group[88.6％(39/44)vs 93.2％(41/44),P=0.458,P=0.308];③ The intravenous thrombolysis group had significantly lower median NIHSS scores at 24 h and 72 h post-onset compared to the dual antiplatelet group,with statistically significant differences[1 vs 2.5,1 vs 2,P=0.018,0.043].There were no statistically significant differences in the other efficacy and safety outcomes.Conclusions Intravenous thrombolysis therapy can bring significant short-term benefits to patients with acute mild non-disabling ischemic stroke,helping to shorten the time to recovery to a good neurological functional outcome,and does not increase the risk of bleeding and mortality.However,in terms of good functional outcomes at 90 d post-onset,its effects are similar to those of dual antiplatelet therapy.Nevertheless,there is an urgent need for larger sample,higher quality clinical studies to further validate these findings.

Objective:Based on the functional classification structure of the International Classification of Functioning, Disability and Health′s rehabilitation set (ICF-RS), the data available in the open database of the China Health and Retirement Longitudinal Study (CHARLS) were analyzed longitudinally to construct the development trajectories of different functional dimensions among China′s elderly population.Methods:The CHARLS data for 2013, 2015 and 2018 describing persons aged 60 and older were distributed using the ICF-RS′s classification structure. Group-based multi-trajectory modeling (GBMTM) was then applied to analyze the characteristics of the development trajectories of physical functioning, daily activities and social participation.Results:Different development trajectory subtypes emerged from the data. A gradual decline in physical functioning was evident throughout the study period, while daily activities first improved and then declined. Social participation was in decline throughout the period. There were, however, significant differences in the initial functional level, the degree of decline and the degree of decline reversal among the different subtype groups.Conclusions:The overall functional performance of the elderly in China shows a downward trend, but some functional dimensions can still improve with time, at least during the specific period covered in this open database. It is recommended that the ICF-RS be integrated into the CHARLS to comprehensively assess the classification of function and developmental changes among China′s elderly.

Background and Purpose:The early prediction of local tumor progression-free survival(LTPFS)after radiofrequency ablation(RFA)for colorectal cancer(CRC)lung metastases has significant clinical importance.The application of radiomics in the prediction of tumor prognosis has been explored.This study aimed to construct a radiomics-based nomogram for predicting LTPFS after RFA in CRC patients with lung metastases.Methods:This study retrospectively analyzed 172 CRC patients with 401 lung metastases admitted to Department of Interventional Radiology,Fudan University Shanghai Cancer Center from August 2016 to January 2019.This study was reviewed by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:2402291-24).After augmentation of pre-ablation and immediate post-ablation computed tomography(CT)images,the target metastases and ablation regions were segmented manually to extract the radiomic features.Maximum relevance and minimum redundancy algorithm(MRMRA)and least absolute shrinkage and selection operator(LASSO)regression models were applied for feature selection.The clinical model,the radiomics model,and the fusion model were constructed based on the selected radiomic features and clinical variables screened by the multivariate analysis.The Harrell concordance index(C-index)and area under receiver operating characteristic(ROC)curves(AUC)were calculated to evaluate the prediction performance.Finally,the corresponding nomogram of the best model was drawn.Results:Among all the lung metastases,102(25.4%)had final recurrence,and 299(74.6%)had complete response(CR).The median follow-up time was 21 months(95%CI:19.466-22.534),and the LTPFS rates at 1,2,and 3 years after RFA were 76.5%(95%CI:72.0-80.4),72.1%(95%CI:66.6-76.9)and 69.9%(95%CI:64.0-75.1).In both the training and test dataset,the fusion model based on the final 12 radiomic features through the LASSO regression and 4 clinical variables screened by multivariate analysis achieved the highest AUC values for LTPFS,with C-index values of 0.890(95%CI:0.854-0.927)and 0.843(95%CI:0.768-0.916),respectively.Conclusion:The fusion model based on radiomic features and clinical variables is feasible for predicting LTPFS after RFA of CRC patients with lung metastases,whose performance is superior to the single radiomic and clinical model.At the same time,the nomogram of the fusion model can intuitively predict the prognosis of CRC patients with lung metastases after RFA,thus assisting clinicians in developing individualized follow-up review plans for patients and adjusting treatment strategies flexibly.

Objective To summarize experience of anti-cancer drug management for clinical trials,and to explore a more efficient and standardized management model of anti-cancer drugs used in clinical trials.Methods Based on our current work in central pharmacy,the particularity and complexity of anti-cancer drug management for clinical trials were analyzed.In the meantime,we identified high-risk parts in the drug management process.Based on those risks,feasible measures were taken and presented in detail.Results Management of anti-cancer drugs used in clinical trials has its characteristics,such as long cycle,low error-tolerant rate,closed-loop model,etc.Recognizing these representative high-risk parts during the trials and making responses,including standardization of drug management records and disposition of drugs and packaging returned by subjects,should be achieved as soon as possible.Conclusion Establishing and observing strict rules and regulations,improving the hardware and software performance of the central pharmacy as well as implementing risk-based drug management is beneficial to conduct clinical trials normatively.