ObjectiveTo observe the short-term and long-term efficacy of traditional Chinese medicine （TCM） surgical operations in treating mixed hemorrhoids. MethodsA multi-center retrospective cohort study was conducted， collecting clinical data from 17，831 mixed hemorrhoid surgery patients in 8 top-tier TCM hospitals in Jiangsu Province. Standardized and structured datasets were obtained through artificial intelligence models. Patients who underwent western surgical treatment were categorized into the western surgery group （11,646 cases）， and those receiving TCM surgical operations were categorized into the TCM surgery group （6185 cases）. Propensity score matching （1∶1 matching） was used to balance baseline data between groups. The primary outcome was the one-year recurrence rate， and secondary outcomes included the main symptoms （rectal bleeding， degree of prolapse） and secondary symptoms （anal distension， anal edema， wound secretion and exudation， anal stenosis， residual skin tags， perianal itching， and anal pain） measured on days 7， 28， and 60 after discharge. ResultsAfter matching， 2194 patients were included in each group. Symptom scores showed that at 28 days after discharge， the TCM surgical group had superior improvement in rectal bleeding ［OR=5.786， 95%CI （3.092，10.827）］， degree of prolapse ［OR=4.510， 95%CI （1.649，12.333）］， and anal edema ［OR=3.188， 95%CI （1.295，7.845）］ compared to the western surgical group. At 60 days post-discharge， the TCM group still showed advantages in improving rectal bleeding ［OR=5.237， 95%CI （1.077，25.464）］ and anal pain ［OR=11.697， 95%CI （1.186，115.336）］ （P＜0.05）. Long-term follow-up showed that the one-year recurrence rate in the TCM surgery group was 1.1% （8/726）， while that in the western surgery group was 2.3% （10/444）， with no statistically significant difference between the two groups （P＞0.05）. ConclusionBased on real-world data， TCM surgical treatment for mixed hemorrhoids shows significant short-term symptom improvement， particularly in terms of hemostasis， reducing swelling， and alleviating prolapse of anal masses.

Irritable bowel syndrome （IBS） is a functional bowel disorder characterized primarily by abdominal pain and altered defecation habits. In recent years， traditional Chinese medicine （TCM） has made progress in multiple aspects of IBS research and treatment， including syndrome distribution， development of TCM formulas， clinical efficacy evaluation， external therapies， and psychosocial regulation. However， it still faces challenges such as over-reliance on symptomatic manifestations rather than biomarkers for diagnostic criteria， and the lack of high-quality evidence-based data supporting the efficacy of TCM formulas in treating IBS. This paper proposed that TCM diagnosis and treatment of IBS should adhere to the strategy of integrating the holistic concept with syndrome differentiation and treatment， combining TCM external therapies such as acupuncture， moxibustion and acupoint application）， and emphasizing individualized diagnosis and treatment for psychosomatic abnormalities. Future research should integrate multi-omics technologies， artificial intelligence and other methods to deepen the understanding of the pathogenesis of IBS and the mechanisms of TCM formulas， so as to promote the standardization and internationalization of TCM in the diagnosis and treatment of IBS.

OBJECTIVE: To explore the genetic etiology of 46 Chinese pedigrees affected with Hereditary multiple exostoses (HME) and provide genetic counseling and reproductive intervention. METHODS: Whole-exome sequencing and Sanger sequencing were carried out on 87 patients from the 46 pedigrees to analyze the variants of EXT1 and EXT2 genes. Pathogenicity of the variants was assessed based on the guidelines from the American College of Medical Genetics and Genomics and Association for Molecular Pathology (ACMG/AMP). Prenatal diagnosis and preimplantation genetic testing (PGT) were provided for couples with identified pathogenic mutations. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: LL-SC-SG-2014-010). RESULTS: In total 17 and 22 pathogenic variants were respectively identified in the EXT1 and EXT2 genes, among which 5 EXT1 and 12 EXT2 variants were unreported previously. Three patients with no family history were found to harbor de novo variants of the EXT1 gene. Twenty nine couples had opted for PGT or underwent prenatal diagnosis following natural conception, and 17 healthy babies were born. CONCLUSION This study has clarified the genetic etiology of 45 HME pedigrees and identified 17 novel variants, which has enriched the mutational spectrum of the EXT1 and EXT2 genes. Reproductive intervention through PGT and prenatal diagnosis have prevented the recurrence of HME in these families.
Humans ; Female ; Male ; Pedigree ; Exostoses, Multiple Hereditary/diagnosis* ; N-Acetylglucosaminyltransferases/genetics* ; Adult ; Exostosin 1 ; Asian People/genetics* ; Genetic Testing ; Exostosin 2 ; Mutation ; China ; Prenatal Diagnosis ; Pregnancy ; Genetic Counseling ; Preimplantation Diagnosis ; Exome Sequencing ; East Asian People

AIM: To explore the clinical therapeutic effect of teprotumumab combined with glucocorticoid pulse therapy for thyroid-associated ophthalmopathy(TAO), and its impacts on thyroid function, levels of inflammatory factors, and adverse reactions in patients. METHODS: Active TAO patients admitted to the Ophthalmology Department were enrolled and randomly divide into the steroid group and the combined group. Then the steroid group was treated with glucocorticoid pulse therapy, while the combined group was combined with intravenous infusion of teprotumumab on the basis of the steroid group. The clinical therapeutic effect, the CAS, OSDI, M-C-TAO-QOL scores, ocular sign indicators(fissure width, proptosis), levels of inflammatory factors(TNF-α, CRP, IL-17), thyroid function(TSH, FT3, FT4)before and after treatment, and occurrence of adverse reactions were compared between two groups.RESULTS:Totally 96 TAO patients(192 eyes)were included, with 48 cases(96 eyes)in each group. In the combined group, there were 17 males and 31 females, with an average age of 51.85±3.53 y; in the steroid group, there were 14 males and 34 females, with an average age of 51.26±3.84 y. The total effective rate of the combined group(94%)was higher than that of the steroid group(79%)(P<0.05). After treatment, the CAS score, OSDI score, fissure width, proptosis, levels of TNF-α, CRP, and IL-17 in the combined group were all lower than those in the steroid group, and the M-C-TAO-QOL score was higher than that in the steroid group(P<0.05). However, there was no difference in thyroid function indicators and adverse reactions between two groups after treatment(P>0.05). CONCLUSION: The combination of teprotumumab and glucocorticoid pulse therapy for TAO has a prominent therapeutic effect. Meantime, it can more effectively control ocular inflammation, improve ocular signs and quality of life of patients, and has no obvious adverse effect on thyroid function, with controllable safety.

Network Meta-analysis was conducted to evaluate the efficacy and safety of different traditional Chinese medicine injections combined with conventional western medicine in treatment of cerebral small vessel disease(CSVD). Computerized searches were conducted in PubMed, Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, VIP, and SinoMed for randomized controlled trial(RCT) published in Chinese or English using traditional Chinese medicine injections to treat CSVD. The search time is from the inception to July 15, 2024. Literature screening and statistical analysis were conducted with NoteExpress 3.0.3, RevMan 5.3.5, and Stata 15.1.6. A total of 45 articles were included, involving 3 717 patients, with 1 944 patients in the treatment group and 1 773 patients in the control group. A total of 15 kinds of traditional Chinese medicine injections were involved. Network Meta-analysis indicated that,(1) in terms of improving clinical total effective rate, the best intervention in SUCRA was Ciwujia Injection + conventional western medicine.(2) In terms of reducing NIHSS scores, the best intervention in SUCRA was Xueshuantong Injection + conventional western medicine.(3) In terms of improving ADL scores, the best intervention in SUCRA was Danshen Injection + conventional western medicine.(4) In terms of improving MMSE scores, the best intervention in SUCRA was Xueshauntong Injection + conventional western medicine.(5) In terms of improving MoCA scores, the best intervention in SUCRA was Salvianolate Injection + conventional western medicine.(6) In terms of reducing plasma viscosity(PV), the best intervention in SUCRA was Danhong Injection + conventional western medicine.(7) In terms of reducing the hematocrit, the best intervention in SUCRA was Xuesaitong Injection + conventional western medicine.(8) In terms of reducing fibrinogen, the best intervention in SUCRA was Xuesaitong Injection + conventional western medicine.(9) In terms of reducing erythrocyte sedimentation rate(ESR), the best intervention in SUCRA was Danshen Injection + conventional western medicine.(10) In terms of reducing total cholesterol(TC), triglycerides(TG), and low-density lipoprotein(LDL), the best intervention in SUCRA was Danshen Injection + conventional western medicine. The radar chart results indicated that the advantage of Salvianolate Injection lies in improving cognitive function, while the advantage of Xueshuantong Injection lies in improving neurological function. The advantage of Xuesaitong Injection lies in improving hemodynamic parameters, and the advantage of Danshen Injection lies in improving behavioral ability, hemodynamics, and blood lipid levels. In terms of safety, there was no significant difference in the incidence of adverse reactions between the traditional Chinese medicine injection treatment group and the conventional western medicine group, and no serious adverse reactions occurred. The results showed that the combination of traditional Chinese medicine injections and conventional western medicine can effectively improve the clinical total effective rate, the neurological and cognitive functions, hemodynamic parameters, and blood lipid levels of patients suffering from CSVD. In addition, more double-blind, multi-center, large-sample RCT is needed to verify these findings and to provide more high-quality evidence on the efficacy and safety of traditional Chinese medicine injections for CSVD.
Humans ; Cerebral Small Vessel Diseases/drug therapy* ; Drugs, Chinese Herbal/administration & dosage* ; Injections ; Randomized Controlled Trials as Topic

Objective:To analyze the short-term hospital-based transmission characteristics and gene variation of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) by genome-wide technique to provide evidence for transmission control. Methods:The experimental strain was derived from all the CRKP isolated in Affiliated Hospital of North China University of Science and Technology from October 2022 to December 2023. Strain identification and drug susceptibility were tested with VITEK 2-Compact automatic bacterial identification drug susceptibility analyzer or disk method, and the results were interpreted through whole genome sequencing. The ST type, carbapenem resistance gene, virulence factor, and O serotype of the collected strains were analyzed.Results:Among the 115 strains of CRKP, 94 strains were isolated from the intensive care unit (ICU), accounting for 81.7%, and 21 strains were isolated from the non-intensive care unit (NICU), accounting for 18.3%. The 115 strains of CRKP can be divided into 11 ST types, of which ST11 type was the most (54.8%, 63/115), followed by ST15 type (22.6%, 26/115) and ST5492 type (15.7%, 18/115). Type ST5492 was a new clonal group in the region. The 115 strains of CRKP could be divided into 7 O serotypes, most of which were O2a type(32.2%,37/115), followed by O5 type(30.4%,35/115) and O1 type(27.8%,32/115). The resistance genes of carbapenem antibiotics showed that there were 107 strains carrying the blaKPC-2 gene, one strain with the blaNDM-1 gene, and one strain with both the blaKPC-2 and blaNDM-13 genes. Virulence genes were detected in 55 CRKP strains (47.8%, 55/115), among which six strains detected peg-344, iucA, iroB, rmpA, and rmpA2 virulence genes (5.2%, 6/115). Four virulence genes ( peg-344, iucA, rmpA, and rmpA2) were detected in 34 strains (29.6%, 34/115). Three virulence genes ( iucA, iroB and rmpA) were detected in two strains (1.7%, 2/115). Three virulence genes ( peg-344, iucA and rmpA) were detected in one strain (0.8%, 1/115). IucA and rmpA virulence genes were detected in 12 strains (10.4%, 12/115). KPC-2_ST11_O2a, KPC-2_ST15_O1 and KPC-2_ST5492_O5 were dominant clones, and their distribution was mainly in the intensive care unit. The whole genome sequence analysis showed that there were three dominant clones, among which ST11 clones were subdivided into three dominant O serotypes, all of which were mainly in the intensive care unit. Conclusion:The popular strain in the hospital of CRKP is a KPC-2_ST11 clone group carrying iucA, rmpA/rmpA2, with cross-department transmission and mutation. ST5492 is a newly-launched clone type. The intensive care unit of hvKP carrying five virulence genes, including peg-344, should be alert to the epidemic risk of CR-hvKP outbreak.

Objective:To evaluate the training efficacy of the autonomic nervous system stability assessing and enhancing capsule (hereinafter referred to as the EC), and to study the difference in physiological indicators for autonomic nervous system stability training between the EC and a non-capsule environment.Methods:A total of 1 478 male military pilots under autonomic nervous system stability training between February 2022 and February 2024 were selected before they completed training sessions in both the EC and a non-capsule environment. The pre-training time-domain and frequency-domain indices of heart rate variability (HRV) and the 0.1 Hz index were compared with the post-training ones, and across difficulty levels (low, moderate, and high). The difference that the EC made in relaxation training was analyzed.Results:①Time-domain indices of HRV were of statistical significance in the main effects of training difficulty, those of training environments, and their interactions ( F=4.40-160.80, all P<0.05 or 0.01). Simple effect analysis revealed that in the same phase of training the standard deviation of all NN intervals (SDNN) at the low level of difficulty in the EC was lower than in the non-capsule environment. However, all time-domain indices after training were higher in the EC than in the non-capsule environment. The differences were statistically significant (all P<0.05 or 0.01).②For frequency-domain HRV indices, significant differences were observed in both the main effect of training difficulty and the interactions ( F=4.40-1 524.33, all P<0.01). Very low frequency power (VLF), high frequency (HF), the ratio of low frequency to high frequency (LF/HF), normalized low frequency (LFnorm), and normalized high frequency (HFnorm) were significantly different in the main effect of training environments ( F=4.24, 12.00, 6.91, 23.39, 23.39, P=0.040, <0.001, =0.009, <0.001, <0.001). Simple effect analysis revealed that at the same level of training difficulty, the EC delivered significantly lower values of LF and LFnorm but higher values of HF and HFnorm than the non-capsule environment before training (all P<0.05). VLF across levels of training difficulty and LF/HF at the high level of difficulty level were significantly lower in the EC than in the non-capsule environment. After training, total power, VLF, LF, HF, and HFnorm were significantly higher in the EC than in the non-capsule environment, but LF/HF and LFnorm were significantly lower (all P<0.05). ③For the 0.1 Hz index, significant differences were observed in both the main effect of training difficulty and the interactions ( F=2 147.75, 6.63, both P<0.001). Subsequent simple effect analysis revealed that at the same level of training difficulty, 0.1 Hz indices of pilots in the EC were lower than in the non-capsule environment before and after training (all P<0.01). Conclusions:During the autonomic nervous system stability training, the EC can effectively and quickly regulate and alleviate pilots′ fatigue and stress. Furthermore, it provides sustained autonomic nervous system training, thereby stabilizing pilots′ autonomic nervous system.

Objective The aim of this study was to explore the mechanism of Naotaifang(NFT)in preventing neuronal pyroptosis in cerebral ischemia-reperfusion injury(CIRI).Methods Firstly,a network Meta-analysis was conducted to compare the clinical efficacy of Naotaifang and dl-3-n-butylphthalide in treating ischemic stroke,and dl-3-n-butylphthalide was identified as the positive control drug in this study.Then,a rat CIRI model was established using the middle cerebral artery occlusion/reperfusion(MCAO/R)method.Sixty adult male SD rats were randomly divided into model group(Model group),low-dose Naotaifang group(NTF-L group),medium-dose Naotaifang group(NTF-M group),ahigh-dose Naotaifang group(NTF-H group),NBP group(NBP group),and a sham surgery group(Sham group)using a random number table method,with 10 rats in each group.After MCAO/R,rats received NTF(4.5 g/kg for NTF-L,9 g/kg for NTF-M,and 18 g/kg for NTF-H)or Nimodipine(60 mg/kg)or distilled water(Sham group and Model group)via gavage for seven consecutive days.Neurological function was evaluated using the Zea Longa method,infarct volume was assessed by TTC staining,and HE and Nissl staining were used to observe changes in neurons in the ischemic cortex.ELISA was used to measure serum IL-1β and IL-18 levels,and Western blot was used to detect caspase-1 and GSDMD expression in the ischemic cortex.Results Network Meta-analysis showed no significant difference in clinical efficacy,neurological function scores,and TXB2 expression between Nimodipine and NTF interventions.Animal experiments revealed that neurological scores of the Model group was significantly increased,the volume of cerebral infarction was significantly enlarged,the structure of nerve cells in the ischemic cortical area was destroyed,and the number of nerve cells and Nissl bodies was significantly reduced,and expressions of IL-1β,IL-18 inflammatory factors and caspase-1,and GSDMD focal proteins were significantly decreased(P<0.01).The NTF-H group significantly reduced neurological function scores and cerebral infarction volume of rats in the Model group,significantly improved morphology of nerve cells and the number of Nissl body,and significantly decreased the expressions of IL-1β,IL-18 inflammatory factors,caspase-1,and GSDMD necroptosis proteins(P<0.01).There was no significant difference between the NTF-H group and the NBP group in terms of neurological scores,volume of cerebral infarction,IL-1β,IL-18 levels,and caspase-1 and GSDMD protein expression(P>0.05).Conclusion Both NTF and Nimodipine have therapeutic effects on ischemic stroke patients,with no significant difference between them,making Nimodipine a suitable positive control drug.NTF may alleviate CIRI by reducing pyroptosis through the caspase-1/GSDMD signaling pathway.

Objective:To verify the applicability of the flight potential evaluation system in the psychological selection of pilots by testing the reliability and validity of the system.Methods:Between September and October 2021, 82 subjects, including 32 pilots and 50 volunteers, were recruited from the Aviation Force and the Air Force Medical Center to complete the flight potential evaluation system test. The pilots and volunteers were divided into the high score group (the top 27% in terms of scores) and low score group (the 27% from the bottom) according to the total score of the evaluation. In order to ensure the consistency of evaluation conditions, some subjects were selected to complete a second evaluation test one week later for reliability analysis. Six flight experts completed the Content Evaluation Form of the Flight Potential Evaluation System while the officer completed the Flight Performance Evaluation Questionnaire as the performance data of the pilots. The pass rates of the pilots and volunteers and discriminability of the flight potential evaluation system were analyzed to test the stability and effectiveness of the system.Results:①The flight potential evaluation system demonstrated a pass rate of 0.75 and a discriminability of 0.30 in pilots, compared with 0.30 and 0.51 in volunteers. The total scores of pilots and volunteers were (7.00±1.16) points and (3.38±2.15) points, respectively, with a statistically significant difference ( t=9.87, P<0.001). Significant differences were found in test scores between high-score group and low-score group for both pilots ( t=10.01, P<0.001) and volunteers ( Z=-4.65, P<0.001). ②Thirty-seven subjects (including 32 pilots and 5 volunteers, all from the Aviation Force) were tested twice, and the Pearson product-moment correlation coefficient for the paired results of 2 identical tests was r=0.750 ( P<0.001). ③As for the content of the evaluation system test, the experts′ degree of agreement and unanimity rate were 1. The evaluation score by the officer was positively correlated with the test score ( r=0.389, P=0.041). Conclusions:The flight potential evaluation system has a strong ability to distinguish flight-related abilities, suggesting that the system can be applied to the psychological selection of pilots and provide data for subsequent tests during the recruitment of candidates.

Loss-of-function variants in CSDE1 have been strongly linked to neuropsychiatric disorders, yet the precise role of CSDE1 in neurogenesis remains elusive. In this study, we demonstrate that knockout of Csde1 during cortical development in mice results in impaired neural progenitor proliferation, leading to abnormal cortical lamination and embryonic lethality. Transcriptomic analysis revealed that Csde1 upregulates the transcription of genes involved in the cell cycle network. Applying a dual thymidine-labelling approach, we further revealed prolonged cell cycle durations of neuronal progenitors in Csde1-knockout mice, with a notable extension of the G1 phase. Intersection with CLIP-seq data demonstrated that Csde1 binds to the 3' untranslated region (UTR) of mRNA transcripts encoding cell cycle genes. Particularly, we uncovered that Csde1 directly binds to the 3' UTR of mRNA transcripts encoding Cdk6, a pivotal gene in regulating the transition from the G1 to S phases of the cell cycle, thereby maintaining its stability. Collectively, this study elucidates Csde1 as a novel regulator of Cdk6, sheds new light on its critical roles in orchestrating brain development, and underscores how mutations in Csde1 may contribute to the pathogenesis of neuropsychiatric disorders.
Animals ; Neurogenesis/genetics* ; Cell Cycle/genetics* ; Mice, Knockout ; Mice ; Neural Stem Cells/metabolism* ; DNA-Binding Proteins/metabolism* ; Cyclin-Dependent Kinase 6/genetics* ; Cell Proliferation ; 3' Untranslated Regions ; Cerebral Cortex/embryology* ; RNA-Binding Proteins ; Mice, Inbred C57BL