Objective To evaluate the impact of an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease (CHD) on perioperative and long-term outcomes of the arterial switch operation (ASO), and to analyze the efficacy of ASO in a single center. Methods This retrospective study analyzed the clinical data of 183 children who underwent ASO at Guangdong Provincial People’s Hospital from 2018 to 2024. The cohort included 106 (57.9%) patients of transposition of the great arteries with intact ventricular septum (TGA/IVS), 61 (33.3%) patients of transposition of the great arteries with ventricular septal defect (TGA/VSD), and 16 (8.7%) patients of Taussig-bing anomaly (TBA). Perioperative indicators were compared between 91 patients in the prenatal-postnatal integrated management group (an integrated group) and 92 patients in the traditional management group (a non-integrated group). Long-term survival and reoperation rates were analyzed using Kaplan-Meier curves. Results The overall perioperative mortality rate was 4.9% (9/183), showing a downward trend year by year. The primary cause of perioperative mortality was low cardiac output syndrome (LCOS), which occurred in 12 patients (6.6% incidence) with a mortality rate of 75.0%. The integrated group had a higher proportion of males (89.0% vs. 72.8%, P<0.05) and lower body weight [3.1 (2.7, 3.3) kg vs. 3.3 (3.0, 3.7) kg, P<0.05] compared to the non-integrated group. The age at surgery was significantly earlier in the integrated group [7 (3, 10) d vs. 14 (9, 48) d, P<0.05], and all children in the integrated group underwent ASO within the optimal surgical window (100.0% vs. 82.6%, P<0.05). Intraoperatively, cardiopulmonary bypass time [173 (150, 207) min vs. 186 (159, 237) min, P<0.05] and aortic cross-clamp time [100 (90, 117) min vs. 116 (97, 142) min, P<0.05] were significantly shorter in the integrated group. Although the integrated group had longer postoperative mechanical ventilation time [145 (98, 214) h vs. 116 (77, 147) h, P<0.05] and higher 48-hour maximum vasoactive inotropic score [15 (10, 21) points vs. 12 (8, 16) points, P<0.05], there was no statistically significant difference in the incidence of severe complications (LCOS, necrotizing enterocolitis, extracorporeal membrane oxygenation) or mortality rate (3.3% vs. 6.5%, P=0.51) between the two groups, despite earlier surgical intervention and a higher proportion of critically ill cases in the integrated group. The length of hospital stay in the emergency surgery group was significantly shorter than that in the elective surgery group [20 (15, 28) d vs. 25 (21, 30) d, P<0.05], suggesting that early surgery may be of potential benefit. A total of 163 patients were successfully followed up for a median of 4.7 years, with a 5-year survival rate of 95.1% and a freedom from reintervention survival rate of 95.1%. There were no late deaths, and the most common postoperative complication was pulmonary artery stenosis. Conclusion The integrated management model allowed critically ill children with lower body weights to safely undergo surgery, significantly optimizing the timing of surgery and shortening intraoperative times. The long-term risk of reoperation after ASO is primarily concentrated on pulmonary artery stenosis, necessitating long-term follow-up and monitoring.

As an innovative form of combining traditional aromatherapy with modern nasal medicine delivery technology， "olfactory administration of Chinese medicine" carries the theoretical essence of traditional Chinese medicine （TCM）， which is "moving and channeling Qi and fragrance， dredging and awakening the mind". Based on the systematic records of olfactory therapies in ancient books in emergency care， disorders of consciousness， lung system， and gynecological diseases， this paper examines the historical evolution of its clinical application， and elucidates the profound historical basis and theoretical feasibility of "olfactory administration of Chinese medicine" as a new form. Combined with the innovation and precise application of modern Chinese medicine olfactory agents in multi-system diseases such as nervous， respiratory， and cardiovascular diseases， this paper further analyzes the multi-dimensional mechanism of olfactory receptor pathway， olfactory brain pathway， nasal mucosal blood vessels， and lymphatic channels， and demonstrates its advantages of rapid onset， targeted brain entry， and systemic regulation. Under the background of continuous growth in the demand for external TCM treatment， continuous breakthroughs in the technology of nasal dosage forms， and increasingly accurate drug delivery paths， Chinese medicine olfactory agents have shown significant practical applicability and development potential. This study aims to provide theoretical support and practical direction for the system construction of this form.

The diagnosis of occupational radiation diseases, with the diagnostic criteria as main technical basis, has always been one of the emphases of China's occupational health work. This study compared the diagnostic standards for occupational radiation diseases between China and the International Labour Organization (ILO) across three aspects—types, classifications/grades, and diagnostic dose requirements—categorizing the diseases into tissue reactions and stochastic effects. ① For tissue reactions, 8 types are included both in China and ILO standards, 13 unique to China's standards, and 4 unique to the ILO standards; significant differences exist in classifaton/grading; China's standards are either consistent with or stricter (i.e., requiring higher diagnostic dose values) than the ILO standards. ② For stochastic effects (radiation-induced cancer), 12 types were included in both standards; China's standards provide more comprehensive coverage for certain malignancies (e.g., bone cancer); while 5 types were unique to the ILO standards have, some (e.g. salivary gland cancer) are primarily observed in non-occupational populations. Overall, China’s standards include more disease types and maintain more stringent diagnostic dose requirements. However, specific discrepancies require further deliberation during future revisions. Finally, based on these results, recommendations were provided for basic research and the evaluation of Chinese diagnostic criteria.

The diagnosis of occupational radiation diseases, with the diagnostic criteria as main technical basis, has always been one of the emphases of China's occupational health work. This study compared the diagnostic standards for occupational radiation diseases between China and the International Labour Organization (ILO) across three aspects—types, classifications/grades, and diagnostic dose requirements—categorizing the diseases into tissue reactions and stochastic effects. ① For tissue reactions, 8 types are included both in China and ILO standards, 13 unique to China's standards, and 4 unique to the ILO standards; significant differences exist in classifaton/grading; China's standards are either consistent with or stricter (i.e., requiring higher diagnostic dose values) than the ILO standards. ② For stochastic effects (radiation-induced cancer), 12 types were included in both standards; China's standards provide more comprehensive coverage for certain malignancies (e.g., bone cancer); while 5 types were unique to the ILO standards have, some (e.g. salivary gland cancer) are primarily observed in non-occupational populations. Overall, China’s standards include more disease types and maintain more stringent diagnostic dose requirements. However, specific discrepancies require further deliberation during future revisions. Finally, based on these results, recommendations were provided for basic research and the evaluation of Chinese diagnostic criteria.

Objective:To investigate the efficacy of the combination of sintilimab and docetaxel in the treatment of cervical cancer and its impact on laboratory indicators.Methods:A total of 86 patients with advanced cervical cancer treated at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2019 to June 2022 were selected as the study subjects. The patients were divided into a study group ( n=43) and a control group ( n=43) according to the treatment method. The study group was treated with a combination of sintilimab and docetaxel, while the control group was treated with docetaxel. After 6 cycles of treatment, the clinical efficacy, vascular endothelial growth factor receptor (VEGFR) levels, tumor marker levels, immune function indicators, programmed death-1 (PD-1), programmed death-ligand 1 (PD-L1) levels, and adverse reactions during treatment between the two groups were compared. 1-year progression-free survival (PFS) rate and overall survival (OS) rate between the two groups of patients were compared. Results:After 6 cycles of treatment, the objective response rates (ORR) of the study group and the control group were 48.84% (21/43) and 30.23% (13/43), respectively, with no statistically significant difference ( χ2=3.11, P=0.078); the disease control rates (DCR) of the two groups were 86.05% (37/43) and 62.79% (27/43), respectively, with a statistically significant difference ( χ2=6.11, P=0.013). Before treatment, the levels of VEGFR2 and VEGFR3 in the study group were (223.42±57.89), (3.25±1.22) ng/L, respectively, while those in the control group were (220.56±58.45), (3.31±1.17) ng/L, respectively, with no statistically significant differences ( t=0.23, P=0.820; t=0.23, P=0.817). After treatment, the VEGFR2 and VEGFR3 levels in the study group were (123.21±36.97), (0.81±0.21) ng/L, respectively, while those in the control group were (151.22±37.34), (1.33±0.37) ng/L, respectively, with statistically significant differences ( t=3.50, P=0.001; t=8.02, P<0.001). However, the levels of VEGFR2 and VEGFR3 in both groups of patients decreased after treatment compared to before treatment (all P<0.05). Before treatment, the levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), and squamous cell carcinoma antigen (SCC-Ag) in the study group were (8.73±1.02) ng/ml, (29.73±5.88) U/ml, and (7.23±1.34) ng/ml, respectively, while those in the control group were (8.41±1.23) ng/ml, (30.12±5.93) U/ml, and (7.37±1.43) ng/ml, respectively, with no statistically significant differences ( t=1.31, P=0.193; t=0.31, P=0.760; t=0.47, P=0.641). After treatment, the CEA, CA125, and SCC-Ag levels in the study group were (3.52±0.78) ng/ml, (13.28±1.82) U/ml, and (2.33±0.49) ng/ml, respectively, while those in the control group were (3.87±0.62) ng/ml, (14.12±1.72) U/ml, and (2.65±0.54) ng/ml, respectively, with statistically significant differences ( t=2.30, P=0.024; t=2.20, P=0.031; t=2.88, P=0.005). However, the levels of CEA, CA125, and SCC-Ag in both groups of patients decreased after treatment compared to before treatment (all P<0.05). Before treatment, the T cell subsets CD4 +, CD8 +, and CD4 +/CD8 + in the study group were (27.53±2.23) %, (29.34±3.78) %, and 0.93±0.33, respectively, while those in the control group were (28.32±2.31) %, (30.03±3.27) %, and 0.94±0.42, respectively, with no statistically significant differences ( t=1.61, P=0.110; t=0.91, P=0.368; t=0.12, P=0.903). After treatment, the T cell subsets CD4 +, CD8 +, and CD4 +/CD8 + in the study group were (35.33±3.36) %, (44.32±4.33) %, and 0.80±0.22, respectively, while those in the control group were (30.31±3.23) %, (42.21±4.31) %, and 0.71±0.19, respectively, with statistically significant differences ( t=7.06, P<0.001; t=2.27, P=0.026; t=2.03, P=0.046). After treatment, the CD4 + and CD8 + T cell subsets in both groups were higher than before treatment, while the CD4 +/CD8 + was lower than before treatment (all P<0.05). Before treatment, the levels of PD-1 and PD-L1 mRNA in peripheral blood mononuclear lymphocytes of the study group were 1.21±0.21 and 0.73±0.15, respectively, while those in the control group were 1.23±0.25 and 0.79±0.14, respectively, with no statistically significant differences ( t=0.40, P=0.689; t=1.92, P=0.059). After treatment, the levels of PD-1 and PD-L1 mRNA in peripheral blood mononuclear lymphocytes of the study group were 0.77±0.13 and 0.52±0.13, respectively, while those in the control group were 0.93±0.19 and 0.66±0.17, respectively, with statistically significant differences ( t=4.56, P<0.001; t=4.29, P<0.001). However, the levels of PD-1 and PD-L1 mRNA in both groups of patients decreased after treatment compared to before treatment (all P<0.05). The 1-year PFS rate and OS rate of the study group patients were 60.47% and 72.09%, respectively; while those in the control groups were 51.16% and 65.12%, respectively, with no statistically significant differences ( χ2=1.31, P=0.253; χ2=0.82, P=0.365). The incidences of digestive system response, abnormal liver and kidney function, hematuria, bone marrow suppression, and rash in the study group were 39.53% (17/43), 13.95% (6/43), 13.95% (6/43), 23.26% (10/43), and 37.21% (16/43), respectively, while those in the control group were 32.56% (14/43), 9.30% (4/43), 11.63% (5/43), 18.60% (8/43), and 30.23% (13/43), respectively, with no statistically significant differences ( χ2=0.45, P=0.500; χ2=0.45, P=0.501; χ2=0.10, P=0.747; χ2=0.28, P=0.596; χ2=0.47, P=0.494) . Conclusions:Compared with monotherapy with docetaxel, the combination of sintilimab and docetaxel has a higher DCR in the treatment of advanced cervical cancer. To a certain extent, it effectively reduces the expression levels of VEGFR, serum tumor markers, and PD-1, PD-L1 in peripheral blood mononuclear lymphocytes, improves the immune function of patients, and has comparable drug safety. However, the two treatment options have comparable 1-year survival rates.

Objective To explore the efficacy of Yishen Yangyin Gujing Prescription[derived from Zuogui Wan(Bolus for Replenishing Kidney-Yin)]for the treatment of diabetic nephropathy in type 2 diabetes mellitus(T2DM)with qi and yin deficiency syndrome,and to observe its effects on inflammatory responses,pancreatic β-cell function and renal function.Methods A total of 162 T2DM patients with diabetic nephropathy of qi and yin deficiency syndrome who admitted to the Affiliated Hospital of Shaanxi University of Chinese Medicine from May 2020 to July 2023 were randomly divided into an observation group and a control group according to the random number table method,with 81 cases in each group.The control group was given conventional western medicine treatment for lowering blood pressure and renal protection,while the observation group was treated with Yishen Yangyin Gujing Prescription on the basis of treatment for the control group.The course of treatment for the two groups covered 12 weeks.Before and after the treatment,the changes in the outcomes of the two groups were observed,and the outcomes included the total scores of traditional Chinese medicine(TCM)syndrome,insulin sensitivity index,insulin secretion index,24-h urine total protein quantification(24hUTP),and serum levels of glycosylated hemoglobin(HbA1c),fasting insulin(FINS),fasting blood glucose(FBG),serum creatinine(SCr),blood urea nitrogen(BUN),transforming growth factor β1(TGF-β1),NLRP3 inflammasome,interleukin 6(IL-6),superoxide dismutase(SOD)and sphingosine-1-phosphate(S1P).After treatment,the clinical efficacy of the two groups of patients was compared.Results(1)After 12-week treatment,the total effective rate of the observation group was 93.83%(76/81),and that of the control group was 83.95%(68/81).The intergroup comparison showed that the efficacy of the observation group was significantly superior to that of the control group(χ2=9.163,P<0.05).(2)After treatment,the insulin sensitivity index and insulin secretion index in the two groups of patients were increased(P<0.05)and the total scores of TCM syndromes were decreased(P<0.05)when compared with those before treatment,and the increase of insulin sensitivity index and insulin secretion index as well as the decrease of the total scores of TCM syndrome in the observation group was significantly superior to that in the control group(P<0.05).(3)After treatment,the serum levels of HbA1c,FINS,FBG,SCr,BUN and 24hUTP in the two groups of patients were decreased when compared with those before treatment(P<0.05),and the decrease of the above indicators in the observation group was significantly superior to that in the control group(P<0.05).(4)After treatment,the serum TGF-β1,IL-6,and NLRP3 inflammasome levels in the two groups of patients were decreased(P<0.05)and the serum S1P and SOD levels were increased(P<0.05)when compared with those before treatment,and the decrease of serum TGF-β1,IL-6,and NLRP3 inflammasome levels as well as the increase of serum S1P and SOD levels in the observation group was significantly superior to that in the control group(P<0.05).Conclusion For T2DM patients with diabetic nephropathy of qi and yin deficiency syndrome,the combined use of western medicine and Yishen Yangyin Gujing Prescription treatment is helpful to alleviate inflammatory response,improve the function of pancreatic β-cells,regulate the blood glucose level,improve renal function,and enhance the clinical efficacy.

Although the incidence of each type of rare tumor is extremely low, the cumulative patient population is large due to the wide variety of such tumors. The diagnosis and treatment of rare tumors in China are currently faced with numerous challenges, such as diagnostic difficulties and limited therapeutic options: traditional histopathological diagnosis has certain limitations, and most treatment regimens still rely on conventional approaches including surgery, radiotherapy and chemotherapy. With the advancement of molecular diagnostic technologies and precision medicine, especially the application of next-generation sequencing, liquid biopsy and artificial intelligence technologies, the diagnostic accuracy of rare tumors has been significantly improved. Meanwhile, innovative therapies such as bispecific antibodies, antibody-drug conjugates, and gene and cell therapies have brought new hope for patients. In the future, China needs to establish a hierarchical diagnosis and treatment network for rare tumors, strengthen drug development and clinical trial exploration, improve relevant medical insurance policies, and build a prevention, diagnosis and treatment system with Chinese characteristics for rare tumors, so as to provide better diagnosis and treatment services for patients.

ObjectiveTo develop a nomogram-based risk prediction model for chronic obstructive pulmonary disease (COPD) incidence among the community-dwelling population aged 40 years old and above, so as to provide targeted references for the screening and prevention of COPD. MethodsBased on a natural population cohort in suburban Shanghai, a total of 3 381 randomly selected participants aged ≥40 years underwent pulmonary function tests between July and October 2021. Cox stepwise regression analysis was used to develop overall and gender-specific risk prediction models, along with the construction of corresponding risk nomograms. Model predictive performance was evaluated using the C-indice, area under the curve (AUC) values, and Brier score. Stability was assessed through 10-fold cross-validation and sensitivity analysis. ResultsA total of 3 019 participants were included, with a median follow-up duration of 4.6 years. The COPD incidence density was 17.22 per 1 000 person-years, significantly higher in males (32.04/1 000 person-years) than that in females (7.38/1 000 person-years) (P<0.001). The overall risk prediction model included the variables such as gender, age, education level, BMI, smoking, passive smoking, and respiratory comorbidities. The male-specific model incorporated the variables such as age, BMI, respiratory comorbidities, and smoking, while the female-specific model included age, marital status, respiratory comorbidities, and pulmonary tuberculosis history. The C-indices for the overall, male-specific, and female-specific models were 0.829, 0.749, and 0.807, respectively. The 5-year AUC values were 0.785, 0.658, and 0.811, with Brier scores of 0.103, 0.176, and 0.059, respectively. Both 10-fold cross-validated C-indices and sensitivity analysis (excluding participants with a follow-up duration of <6 months) yielded C-indices were above 0.740. ConclusionThis study developed concise and practical overall and gender-specific COPD risk prediction models and corresponding nomograms. The models demonstrated robust performance in predicting COPD incidence, providing a valuable reference for identifying high-risk populations and formulating targeted screening and personalized management strategies.

During the hyperacute phase of intracerebral hemorrhage (ICH), the mass effect and blood components mechanically lead to brain damage and neurotoxicity. Our findings revealed that the mass effect and transferrin precipitate neuronal oxidative stress and iron uptake, culminating in ferroptosis in neurons. M6A (N6-methyladenosine) modification, the most prevalent mRNA modification, plays a critical role in various cell death pathways. The Fto (fat mass and obesity-associated protein) demethylase has been implicated in numerous signaling pathways of neurological diseases by modulating m6A mRNA levels. Regulation of Fto protein levels in neurons effectively mitigated mass effect-induced neuronal ferroptosis. Applying nanopore direct RNA sequencing, we identified voltage-dependent anion channel 3 (Vdac3) as a potential target associated with ferroptosis. Fto influenced neuronal ferroptosis by regulating the m6A methylation of Vdac3 mRNA. These findings elucidate the intricate interplay between Fto, Vdac3, m6A methylation, and ferroptosis in neurons during the hyperacute phase post-ICH and suggest novel therapeutic strategies for ICH.
Ferroptosis/physiology* ; Alpha-Ketoglutarate-Dependent Dioxygenase FTO/genetics* ; Animals ; Neurons/metabolism* ; Transferrin/pharmacology* ; Mice ; Methylation ; Mice, Inbred C57BL ; Adenosine/metabolism* ; RNA, Messenger/metabolism* ; Male ; Oxidative Stress/physiology*

OBJECTIVE: Rhodiolae Crenulatae Radix et Rhizoma (Hongjingtian in Chinese, RCRR), the roots and rhizomes of Rhodiola crenulata and its application in the medicinal market is very chaotic. In this study, DNA barcoding database and identification engine of Rhodiola species were established, decoction pieces from the medicinal market were identified, and the application and challenges of DNA barcoding in the rapid radiation of Rhodiola species were analyzed. This study provides reference for the protection, rational development, and utilization of endangered resources within Rhodiola species. METHODS: A total of 50 original plant samples from 20 species of the genus Rhodiola from Hebei, Xinjiang, Tibet, Jilin, and other major production areas were collected. Theses samples cover the typical distribution area (Qinghai-Tibetan Platea) of Rhodiola species and other scattered alpine regions (Changbai Mountain, Taibai Mountain, Lushan Mountain, etc.), it encompasses all Rhodiola species with thick rhizomes in China. ITS2 and psbA-trnH barcode of Rhodiola database (BORD) were established and an identification engine named Rhodiola-IDE was developed. The stability and accuracy of the standard DNA barcoding database were evaluated using two datasets. Rhodiola-IDE identified 31 decoction pieces of RCRR from the medicinal material market. RESULTS: The BORD containing 1 532 sequences of 88 Rhodiola species has been established, and the identification efficiency results showed good accuracy and stability. According to the Chinese Pharmacopoeia (2020 edition), 23 samples (74.2%) were identified as authentic R. crenulata, while the rest of the marketed varieties were R. kirilowii, R. dumulosa, and R. fastigiata. The product label "Larger flower, Hongjingtian" was identified as R. crenulata. Samples labeled as "Smaller flower, Hongjingtian" were identified as R. crenulata, R. kirilowii, and R. fastigiata. CONCLUSION ITS2 and psbA-trnH barcodes can identify monophyletic groups represented by R. crenulata. However, for non-monophyletic species, it is necessary to collect as many samples as possible and combine them with multiple markers for joint identification. This study discussed the application and challenges of DNA barcodes in Rhodiola under rapid radiation conditions, providing a scientific basis for the rational development and utilization of Rhodiola varieties.