OBJECTIVES: To fabricate an injectable composite microsphere hydrogel reinforced with silk fibroin/hyaluronic acid microspheres, achieving synergistic enhance-ment of mechanical robustness and biofunctionality. METHODS: Methacrylated hyaluronic acid (HAMA) and thiolated silk fibroin (TSF) were synthesized. Monodisperse microspheres generated via microfluidics were UV-cured (420 nm) through thiol-ene click reaction. These microspheres were embedded in a TSF/HAMA matrix to form photo-cured composites. The grafting rate of TSF and HAMA was characterized by H1-NMR; particle size distribution of microsphere hydrogels in soybean oil was observed by optical microscopy; gel point of composite microsphere hydrogels was determined by advanced extensional rheometer; microscopic morphology of microsphere hydrogels was observed by scanning electron microscopy; elemental distribution of microsphere hydrogels was detected by X-ray energy dispersive spectroscopy; tunability of composite microsphere hydrogels was observed by inverted confocal microscopy; mechanical properties of composite microsphere hydrogels were tested by compression testing; swelling ratio, degradation rate and water retention rate of composite microsphere hydrogels were measured by gravimetric method. Cytotoxicity of the composite microsphere hydrogels was determined by Calcein-AM/propidium iodide dual staining and CCK-8 assay; cell migration capability was observed by scratch assay. RESULTS: The grafting rates of HAMA and TSF was 48.03% and 17.99%, respectively. Microsphere hydrogels with particle sizes of (43.3±1.2), (78.1±3.0), and (130.8±1.9) μm were prepared. The gel time of the composite microsphere hydrogels was 48-115s. The laser confocal imaging confirmed dynamic regulation characteristics of the composite microsphere hydrogels. The compressive strength of the composite microsphere hydrogels reached 22.7 kPa and maintained structural integrity at 40% strain after 20 compression cycles. The composite microsphere hydrogels exhibited differential deswelling behaviors in simulated physiological environments, and reducing microsphere particle size could significantly enhance its stability under moist conditions. The degradation rate of the composite microsphere hydrogels was (49.1±0.9)% after 200 h, and water retention rate was maintained at 40%-60% after 96 h. Biocompatibility assays confirmed >95% cell viability and unimpaired cell migration abilities. CONCLUSIONS The TSF/HAMA composite microsphere hydrogel developed in this study has characteristics of rapid fabrication, adjustable mechanical properties, enhanced environmental stability and excellent biocom-patibility, thus providing a new material solution for tissue repair and regenerative medicine.
Fibroins/chemistry* ; Hydrogels/chemistry* ; Microspheres ; Hyaluronic Acid/chemistry* ; Humans

Prescription optimization is a crucial aspect in the study of traditional Chinese medicine （TCM） compounds. In recent years， the introduction of mathematical methods， data mining techniques， and artificial neural networks has provided new tools for elucidating the compatibility rules of TCM compounds. The study of TCM compounds involves numerous variables， including the proportions of different herbs， the specific extraction parts of each ingredient， and the interactions among multiple components. These factors together create a complex nonlinear dose-effect relationship. In this context， it is essential to identify methods that suit the characteristics of TCM compounds and can leverage their advantages for effective application in new drug development. This paper provided a comprehensive review of the cutting-edge optimization experimental design methods applied in recent studies of TCM compound compatibilities. The key technical issues， such as the optimization of source material selection， dosage optimization of compatible herbs， and multi-objective optimization indicators， were discussed. Furthermore， the evaluation methods for component effects were summarized during the optimization process， so as to provide scientific and practical foundations for innovative research in TCM and the development of new drugs based on TCM compounds.

Objective:To investigate the reliability and accuracy of a semi-quantitative evaluation method for assessing the severity of pharyngeal delay by fiberoptic laryngoscopy.Method:Fifty-seven fiberoptic endoscopic evaluation of swallowing(FEES)videos and the corresponding 57 video fluoroscopic swallowing study(VFSS)videos were reviewed and analyzed independently by two investi-gators.The semiquantitative evaluation method of pharyngeal delay in the expert consensus on assessment and treatment of swallowing disorders in China(2017 version)was used to rate fiberoptic endoscopic evaluation of swallowing videos.The pharyngeal delay time(PDT)was calculated by the corresponding video fluoroscop-ic swallowing study videos.The intraclass correlation coefficient(ICC)was used as an indicator to verify the consistency of the retention position of the bolus on set of swallowing in VFSS and FEES.The Kruskal-Wal-lis H test was used to compare the difference in PDT between the different classes.Spearman's rank correla-tion analysis was used to test the correlation between the retention position of bolus on set of swallowing and aspiration under VFSS and FEES.The correlation was statistically significant at P<0.05.Result:The consistency index ICC for determining retention position of bolus on set of swallowing in VFSS and FEES was 0.707(P<0.001)indicating moderate agreement.Therefore,the PDT measured by VFSS corre-sponding to different grades of pharyngeal delay in FEES could be compared between groups.The results showed that:between normal and mild groups(P=0.003),between normal and moderate groups(P<0.0001),and between the normal and severe groups(P<0.0001).However,there were no significant differences be-tween the mild and moderate groups(P=1.000),the mild and severe groups(P=0.141),and the moderate and severe groups(P=1.000).The correlation between retention position of bolus on set of swallowing and as-piration was not significant(P=0.642 under VFSS and P=0.920 under FEES).Conclusion:The semi-quantitative evaluation scale of pharyngeal delay under FEES has limited ability to re-flect the severity of swallowing delay,and the degree of differentiation between grades is low,only distin-guishing the normal group from the abnormal group.Thus,it is recommended that this evaluation scale be ad-justed to three levels:normal level:the head of the bolus reaches the root of the tongue and swallowing is initiated;abnormal level:the bolus reaches a site below the tongue base and lingers for a certain period of time before swallowing is initiated.No swallowing level:the bolus lingered anywhere below the tongue base and no swallowing initiation was observed.

Hyperlipidemia refers to abnormal transport of lipids and metabolic disorders in the blood,which can easily cause cardiovascular diseases.At present,there are many adverse reactions and poor tolerance of chemical drugs.Traditional Chinese medicine and minority medicine have a long history and rich clinical experience,which have the advantages of low cost,convenience,high efficiency and little side effects.To provide reference for clinicians and researchers,the clinical research of traditional Chinese medicine and ethnic medicine in the prevention and treatment of hyperlipidemia was summarized.

Hyperlipidemia refers to abnormal transport of lipids and metabolic disorders in the blood,which can easily cause cardiovascular diseases.At present,there are many adverse reactions and poor tolerance of chemical drugs.Traditional Chinese medicine and minority medicine have a long history and rich clinical experience,which have the advantages of low cost,convenience,high efficiency and little side effects.To provide reference for clinicians and researchers,the clinical research of traditional Chinese medicine and ethnic medicine in the prevention and treatment of hyperlipidemia was summarized.

Objective:To investigate the reliability and accuracy of a semi-quantitative evaluation method for assessing the severity of pharyngeal delay by fiberoptic laryngoscopy.Method:Fifty-seven fiberoptic endoscopic evaluation of swallowing(FEES)videos and the corresponding 57 video fluoroscopic swallowing study(VFSS)videos were reviewed and analyzed independently by two investi-gators.The semiquantitative evaluation method of pharyngeal delay in the expert consensus on assessment and treatment of swallowing disorders in China(2017 version)was used to rate fiberoptic endoscopic evaluation of swallowing videos.The pharyngeal delay time(PDT)was calculated by the corresponding video fluoroscop-ic swallowing study videos.The intraclass correlation coefficient(ICC)was used as an indicator to verify the consistency of the retention position of the bolus on set of swallowing in VFSS and FEES.The Kruskal-Wal-lis H test was used to compare the difference in PDT between the different classes.Spearman's rank correla-tion analysis was used to test the correlation between the retention position of bolus on set of swallowing and aspiration under VFSS and FEES.The correlation was statistically significant at P<0.05.Result:The consistency index ICC for determining retention position of bolus on set of swallowing in VFSS and FEES was 0.707(P<0.001)indicating moderate agreement.Therefore,the PDT measured by VFSS corre-sponding to different grades of pharyngeal delay in FEES could be compared between groups.The results showed that:between normal and mild groups(P=0.003),between normal and moderate groups(P<0.0001),and between the normal and severe groups(P<0.0001).However,there were no significant differences be-tween the mild and moderate groups(P=1.000),the mild and severe groups(P=0.141),and the moderate and severe groups(P=1.000).The correlation between retention position of bolus on set of swallowing and as-piration was not significant(P=0.642 under VFSS and P=0.920 under FEES).Conclusion:The semi-quantitative evaluation scale of pharyngeal delay under FEES has limited ability to re-flect the severity of swallowing delay,and the degree of differentiation between grades is low,only distin-guishing the normal group from the abnormal group.Thus,it is recommended that this evaluation scale be ad-justed to three levels:normal level:the head of the bolus reaches the root of the tongue and swallowing is initiated;abnormal level:the bolus reaches a site below the tongue base and lingers for a certain period of time before swallowing is initiated.No swallowing level:the bolus lingered anywhere below the tongue base and no swallowing initiation was observed.

Objective:To analyze the factors influencing sarcopenia in older patients with chronic diseases, both in community settings and hospitals, and to develop a risk prediction model for sarcopenia.Methods:We recruited a total of 403 older adults with chronic diseases, consisting of 251 individuals from a community in Nanjing, Jiangsu Province, and 152 hospitalized patients from the Department of Geriatrics at Jiangsu Province Hospital.Assessments were conducted using a general information questionnaire, serum sample collection, the mini nutritional assessment-short form(MNA-SF), the mini-mental state examination(MMSE), and the geriatric depression scale(GDS).Binary Logistic regression analysis was employed to identify influencing factors and to construct a risk prediction model for sarcopenia, which was illustrated using a nomogram.The model's discrimination was evaluated using the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results:The prevalence of sarcopenia among community-dwelling older adults with chronic conditions was found to be 4.0%(10/251).In contrast, the prevalence in hospitalized older adults with chronic conditions was significantly higher at 36.2%(55/152).Binary Logistic regression analysis identified several independent risk factors for sarcopenia, including hospitalization( OR=14.391、95% CI: 6.284-32.955、 P<0.001), male gender( OR=3.321、95% CI: 1.587-6.950、 P=0.001), lower low-density lipoprotein cholesterol(LDL-C)levels( OR=2.542、95% CI: 1.160-5.572、 P=0.020), cognitive impairment( OR=2.654、95% CI: 1.269-5.550、 P=0.010), and the use of four or more types of medication( OR=2.328、95% CI: 1.952-5.689、 P=0.044).Based on these risk factors, a nomogram was developed as a predictive model for assessing sarcopenia risk.The AUC for this prediction model was 0.860(95% CI: 0.815-0.912), indicating a sensitivity of 0.831 and a specificity of 0.760. Conclusions:The incidence of sarcopenia is notably high among older patients with chronic diseases.A risk prediction model that incorporates factors such as hospitalization history, gender, LDL-C levels, cognitive function, and types of medication demonstrates significant potential for predicting sarcopenia.This model serves as a valuable foundation for the early screening and intervention of sarcopenia.

Objective:To evaluate the diagnostic value of rapid on-site evaluation (ROSE) performed by endoscopists for solid pancreatic lesions requiring tissue for immunohistochemistry (IHC) staining with different approach of endoscopic ultrasound-guided tissue acquisition (EUS-TA).Methods:After screening 1 573 cases who underwent EUS-TA operation at the Endoscopy Center of Peking Union Medical College Hospital between August 2018 and October 2022, a total of 65 cases of solid pancreatic lesions whose diagnosis rely on IHC staining was collected and summarized with clinical data of each case. Among 65 cases, there were 46 cases of pancreatic neuroendocrine tumors (PNETs), 13 cases of pancreatic solid pseudo-papillary tumors (SPTs), and 6 cases of lymphomas and mesenchymal. Patients were categorized into ROSE group (36 cases) and non-ROSE group (29 cases) according to the presence or absence of endoscopists performed ROSE during EUS-TA operation. They were further divided into subgroups of FNA-ROSE (26 cases), FNB-ROSE (10 cases), FNA-non-ROSE (24 cases) and FNB-non-ROSE (5 cases) according to the type of EUS-TA. Diagnostic accuracy and IHC success rate were compared between different groups and subgroups. Binomial logistic multifactorial regression analysis was used to evaluate the influence of ROSE and EUS-TA type on diagnostic accuracy and IHC success rate.Results:There were no statistically significant differences between ROSE group and non-ROSE group in terms of age, gender, bilirubin level, CA19-9 level, lesion site, lesion size, composition ratio of diagnosis, and surgical rate. The differences in mean size of lesions, needle gauge, location of puncturation, and number of needle pass between subgroups were not statistically significant. The diagnostic accuracy was 88.9% in ROSE group and 79.3% in non-ROSE group, and the difference between the two groups was statistically significant ( P=0.023). The diagnostic accuracy of FNA-ROSE group was higher than that of FNA-non-ROSE group (88.5% vs 75.0%), but the difference was not statistically significant ( P>0.100). The differences in diagnostic accuracy and success rate of IHC between FNB-ROSE group and FNB-non-ROSE group were not statistically significant. Binomial logistic multifactorial regression analysis did not reveal any independent influences on diagnostic accuracy. Conclusions:ROSE performed by endoscopists improved diagnostic accuracy of EUS-TA in solid pancreatic lesions requiring IHC staining, and therefore is potentially valuable for improving the diagnostic efficiency of EUS-TA for such diseases.

Objective:To explore the feasibility of using ultrasound to evaluate the abdominal fat volume to predict bone quality.Methods:A total of 376 men, aged from 34 to 90 years, were recruited.The trabecular bone score(TBS)was measured by TBS iNsight ? software.Bone mineral density(BMD)of the femoral neck, total hip, and lumber spine, as well as android and gynoid fat mass were measured using dual-energy X-ray absorptiometry(DXA).Preperitoneal fat thickness and intraperitoneal visceral fat thickness were assessed by ultrasound. Results:BMD of the femoral neck, total hip, and lumber spine was significantly positively correlated with body mass index(BMI)( r=0.346, 0.378, 0.218, all P<0.001), while TBS was significantly negatively associated with BMI( r=-0.353, P<0.001); Femoral neck BMD, lumbar BMD and TBS were positively correlated with total lean mass( β=0.296, P<0.001; β=0.280, P<0.001; β=0.182, P=0.009; respectively), while femoral neck BMD, total hip BMD and TBS were negatively correlated with total fat mass( β=-0.161, P=0.036; β=-0.160, P=0.041; β=-0.354, P<0.001; respectively).Compared with fat mass, BMD was more closely correlated with BMI( P<0.001), while TBS was negatively correlated only with android fat mass( β=-0.297, P=0.017).TBS was inversely associated only with visceral fat thickness( β=-0.244, P=0.04), but not preperitoneal fat thickness( β=-0.119, P=0.256). Conclusions:Abdominal fat mass, especially intraperitoneal visceral fat mass, may have adverse effects on bone quality.Intraperitoneal visceral fat thickness measured by ultrasound is helpful for the prediction of bone quality.

Objective:To analyze the clinical characteristics and management strategy of carotid web (CW)-related stroke and improve the understanding of CW.Methods:The clinical data of 6 patients with CW-related stroke treated at Xuanwu Hospital, Capital Medical University, from January 2018 to September 2022 were retrospectively analyzed. Relevant data included clinical manifestations, bronchial magnetic resonance imaging (MRI), CT angiography (CTA)/digital subtraction angiography (DSA), carotid ultrasonography, and transcranial color-coded Doppler sonography (TCCD). Treatments and follow-ups were also reported.Results:All 6 patients were middle-aged or young, without traditional risk factors for cerebrovascular disease. The male-to-female ratio was 2∶4. All patients had recurrent strokes, with a score of 2-4 on the National Institutes of Health Stroke Scale at the time of onset. Head MRI showed 5 patients with cerebral infarction in the middle cerebral artery supply area; 1 patient had no intracranial infarction. No significant stenosis of the vessels at the site of the CW was observed in any of the 6 patients. Four patients had ipsilateral stenosis or occlusion of the middle cerebral artery, 1 patient had microembolic signals in the middle cerebral artery, and 1 patient had no significant abnormalities in the intracranial artery. All 6 patients were initially diagnosed by ultrasound. Diagnoses were confirmed by CTA/DSA in 5 cases; the other patient did not show any significant abnormalities. All 6 patients underwent a carotid endarterectomy after a pathological examination to confirm the diagnosis. Postoperatively, regular antiplatelet aggregation and statin lipid-lowering therapies were administered. A follow-up of 0.5 to 5.2 years showed no stroke recurrence in any patient.Conclusions:CW-related stroke is a rare cause of cryptogenic stroke and has a high recurrence rate. For stroke patients who do not have traditional risk factors for cerebrovascular disease while repeatedly experiencing embolic events of the internal carotid artery system, attention should be paid to the combination of the carotid and cerebral arteries, and comprehensive hemodynamic characteristics should be checked for the presence of a CW. Carotid artery ultrasound and TCCD combined with other imaging methods can improve the detection rate of a CW. Simple antiplatelet aggregation therapy cannot effectively prevent stroke recurrence. For patients with confirmed CW-related cerebral infarction, surgical resection can be performed, and the treatment effect can be evaluated using ultrasonography.