Impaired glucose regulation （IGR） is an intermediate state between normal blood glucose and diabetes， falling under the category of splenic pure heat in traditional Chinese medicine （TCM）. The core pathogenesis is believed to be the dysfunction of the zang-fu （脏腑） organs， leading to metabolic abnormalities of subtle essence and the generation of "turbid pathogen". Its accumulation can block qi movement， damage the vessel collaterals， and promote the disease progression toward diabetes. The concept of "turbid pulse" is proposed as an early sign of IGR， characterized by full and heavy sensation with stagnated and astringent circulation， which can serve as an effective supplement to clinical screening. The differentiation and treatment approach in clinical practice is summarized as follows. If the ascending and descending mechanisms of qi movement in the middle jiao （焦） are disrupted， with mutual interference between the clear and the turbid， treatment should focus on harmonizing the ascending and the descending， and transforming dampness with aromatic medicinals. For spleen-stomach qi deficiency due to long-term restriction of the spleen and stomach's function of transportation and transformation， it is suggested to fortify spleen and harmonize stomach， and transport turbid with sweet-warm medicinals. For spleen deficiency and liver constraint induced by internal generation of damp-heat in the middle jiao， the treatment should focus on soothing the liver and opening constraint， and directing the turbid downward with sour-sweat medicinals. For solid accumulation and stagnation caused by liver qi constraint， it is recommended to unblock intestine and remove stagnation， and discharge turbid with bitter-cold medicinals. When the disease is transmitted to the lower jiao， and the kidneys are affected， the treatment should be regulating spleen and kidney， and rectifying turbid with salty-sour medicinals. In conclusion， it is emphasized to promote the transformation of turbid pathogen to restore metabolic homeostasis， providing methods for the clinical diagnosis and treatment of IGR.

Objective To investigate the influence of the and mechanism of liver failing to convey and disperse on age-related changes in attentional search based on ERPs.Methods oddball attention search task was administrated to record and analyze behavioral and EEG data(N2pc、SPCN、N2pc-Ptc components)of 120 subjects.Results Compared with liver controlling conveyance and dispersion group,the accuracy in subjects with liver failing to convey and disperse decreased significantly(P<0.05).The elderly group had a lower accuracy(P<0.001)and a longer reaction time(P<0.001)compared to the young group.The N2pc amplitude in subjects with liver failing to convey and disperse was significantly greater than that in subjects with liver controlling conveyance and dispersion(P<0.05).The interaction effect of SPCN amplitude between age and liver failing to convey and disperse status was significant(P=0.024).And in the elderly group,SPCN amplitude in subjects with liver dysregulation was significantly smaller than that of liver controlling conveyance and dispersion(P=0.042).The N2pc-Ptc peak to peak amplitude interaction effect between age and liver regulation status was marginal significant(P=0.087),and in liver failing to convey and disperse group,N2pc-Ptc peak to peak amplitude of the elderly was significantly smaller than that of the young(P=0.008).Conclusion Attention search ability is impaired in the elderly with liver failing to convey and disperse,and the electrophysiological abnormalities,such as directed attention allocation,spatiotemporal dynamic cohesion and short-term memory maintenance,may be part of the mechanism.

Objective To explore the neuroelectrophysiological mechanism of the decline of overall cognitive function and prospective memory,the syndrome manifestation of liver failing to govern conveyance and dispersion of the middle-aged and elderly people in the community with long-term emotional disturbance were evaluated.Methods Eysenck personality questionnaire(EPQ)and general condition questionnaire were used to screen the middle-aged and elderly people from 46 to 65 years old in the community who met the high and low neuroticism criteria,which were included in the long-term emotional disturbance group and the control group.According to the principle of matching sex,age(±2 years)and years of education(±2 years),60 subjects in each group were included.The scores of livers meridian syndrome,anxiety factor,depression factor and the total scores of three factors in the two groups were detected with the emotion rating scale for Ganzangxiang of traditional Chinese medicine.The overall cognitive function,the overall level of prospective memory and the dual-task paradigm of event-related memory were evaluated and event-related potential components were detected.Results Compared to the control group,the total scores of emotion rating scale for Ganzangxiang of traditional Chinese medicine and the scores of liver meridian syndrome factor,anxiety factor and depression factor all increased in the long-term emotional disturbance group significantly(P<0.05).The total scores of MoCA scale(after correction)and the level scores of visual space and executive function,attention and delayed recall decreased significantly(P<0.05),and the total scores of prospective memory questionnaire decreased significantly(P<0.05).The correct rates of ongoing tasks and prospective memory tasks in the event-based prospective memory dual task paradigm were decreased,and the reaction time was prolonged in the long-term emotional disorder group significantly(P<0.05).The amplitude of P200 of ongoing task and prospective memory task were increased in the long-term emotional disorder group(0.05

Glioma is the most common primary malignant tumor of the central nervous system in adults. Despite the standard treatment of surgery combined with radiotherapy and chemotherapy, the prognosis for high-grade glioma patients remains poor, highlighting the urgent need to further explore its pathogenesis and develop new therapeutic strategies. This article reviews the research progress in the field of glioma in China in 2024, covering tumorigenesis mechanisms, tumor immune microenvironment composition, advances in imaging techniques and novel imaging agents, improvements in surgical approaches, mechanisms of radio- and chemoresistance, and explorations of new therapeutic modalities. These studies provide a solid theoretical foundation for advancing clinical diagnosis and treatment of gliomas and may offer new opportunities to improve patient outcomes.

Objective To investigate the influence of the and mechanism of liver failing to convey and disperse on age-related changes in attentional search based on ERPs.Methods oddball attention search task was administrated to record and analyze behavioral and EEG data(N2pc、SPCN、N2pc-Ptc components)of 120 subjects.Results Compared with liver controlling conveyance and dispersion group,the accuracy in subjects with liver failing to convey and disperse decreased significantly(P<0.05).The elderly group had a lower accuracy(P<0.001)and a longer reaction time(P<0.001)compared to the young group.The N2pc amplitude in subjects with liver failing to convey and disperse was significantly greater than that in subjects with liver controlling conveyance and dispersion(P<0.05).The interaction effect of SPCN amplitude between age and liver failing to convey and disperse status was significant(P=0.024).And in the elderly group,SPCN amplitude in subjects with liver dysregulation was significantly smaller than that of liver controlling conveyance and dispersion(P=0.042).The N2pc-Ptc peak to peak amplitude interaction effect between age and liver regulation status was marginal significant(P=0.087),and in liver failing to convey and disperse group,N2pc-Ptc peak to peak amplitude of the elderly was significantly smaller than that of the young(P=0.008).Conclusion Attention search ability is impaired in the elderly with liver failing to convey and disperse,and the electrophysiological abnormalities,such as directed attention allocation,spatiotemporal dynamic cohesion and short-term memory maintenance,may be part of the mechanism.

AIM:To analyze the reasons for screening failure and explore the influencing fac-tors in clinical trial in healthy volunteers,guidance was provided to improve the success rate of screen-ing in the future.clarify the reasons for the failure in healthy subjects(HS)screening,and to provide guidance for screening in phase Ⅰ clinical trials.METHODS:We performed a retrospective study that described the process of HS screening in phase Ⅰ clinical trials carried out in department of clinical pharmacology lab,Nanjing First Hospital be-tween 2019 and 2022.We analyzed the reasons for screening failure and their impact on the failure rate.A retrospective analysis was conducted on the data of subjects who participated in drug clinical trial screening 2019 to 2022.The reasons for screening failure were analyzed,and statistical methods were used to explore the independent factors that led to screening failure.RESULTS:A to-tal of 11 clinical trials were included in this study,and 502 out of 1 582 participants(31.7％)passed the screening.The analysis of the remaining 1 080 subjects showed that the items that did not pass the screening were laboratory examinations(631 cases,58.4％),abnormal vital signs results(228 cas-es,21.1％),intolerance to blood drawn(86 cases,8.0％),sufficient subjects(62 cases,5.7％),with-drawal at the screening(54 cases,5.0％),demogra-phy(54 cases,5.0％),urinary cotinine examination(42 cases,3.9％),imaging examination(31 cases,2.9％),electrocardiogram(24 cases,2.2％),inquiry(medical inquiry 19 cases,1.8％,smoking inquiry 2 cases,0.2％,alcohol inquiry 2 cases,0.2％)and identity verification(17 cases,1.8％).In the popula-tion with a body mass index(BMI)of 19.0 to 26.0,an increase in BMI is an independent factor signifi-cantly associated with screening failure(P＜0.000 1,OR=0.890 4,95％CI 0.841 9-0.941 3).The impact of different examination items on the screening fail-ure rate varies.CONCLUSION:In clinical trials of healthy subjects,laboratory tests,vital signs and in-tolerance to blood drawn are the main reasons for screening failure.Lowering the upper limit of BMI when recruiting subjects may increase the success rate of screening.Laboratory examinations,vital signs,intolerance to blood drawn are the most im-portant three reasons for screening failure,and im-provements can be made to reduce the screening failure rate of phase Ⅰ clinical trials in response to the main screening failure reasons.

Objective Using event-related potentials(ERPs)technology to study the effect of long term emotional distress on selective attention distraction inhibition function in college students and its neuroelectrophysiological mechanism.Methods The Eysenck personality questionnaire(EPQ)adult version was used to screen the high and low neuroticism groups among college students,and 35 subjects in each group were included in the long term emotional distress group and the emotional smoothness control group,respectively,and the response time,correct rate,N2 and P3 amplitude and latency results of the participants to complete the negative priming paradigm task were collected and analyzed.Results Compared with the control group,① the long term emotional distress group showed a prolonged response trend(P=0.072).② the long term emotional distress group had a prolonged N2 and P3 latency(P<0.05).Conclusion Selective attention distraction inhibition in college students with long term emotional distress decreased,and the decline mechanism may be related to the decline of inhibition processing and attention resource allocation ability.

Objective To investigate the effect of Qi stagnation on inhibitory control function and its neuroelectrophysiological mechanism in college students.Methods The population of peace and Qi depression was screened from college students through the scale of"Classification and Judgment Criteria of Traditional Chinese Medicine Constitution",and 35 subjects were included in each group.Combined with event-related potential technology,the two groups were collected to complete the Flanker paradigm behavioral indicators(accuracy,response time)and EEG data indicators(amplitude and latency of N2 and P3 components),and the behavioral differences and neuroelectrophysiological mechanisms between the two groups under the Flanker paradigm were explored.Results Compared with the flat group,the reaction time of the gas depression group was longer(P=0.07).Compared with the consistent dondition,the reaction time was longer under the inconsistent condition(P<0.001),and the accuracy rate was lower under the inconsistent condition significantly(P<0.001).Compared with the peaceful group,the N2 amplitude of the air depression group was higher(P<0.05).There was a statistically significant difference in the main effect of brain regions in the N2 latency period(P<0.001).Frontal lobe zero(Fz)in frontal region was greater than Frontal lobe central zero(FCz)in frontal region and greater than Central zero(Cz)in central region(P<0.05).There was a statistically significant difference in the main effect of brain region(P<0.001).FCz in the frontal central region was significantly greater than that in the frontal region Fz(P<0.001),and the difference was statistically significant in the central region Cz was significantly greater than that in the frontal region(P<0.001).The incubation period of P3 component was significantly smaller than that of inconsistent stimulation(P<0.001).Conclusion Qi stagnation has a negative effect on the inhibitory control function of college students,and the decline of conflict monitoring and control ability is one of the possible mechanisms.

In recent years,artificial intelligence(AI)has been widely used in the medical field.Research shows that medical AI can not only improve diagnosis and treatment efficiency,but also enable personalized health management and optimize the allocation of medical resources,demonstrating enormous potential.However,while"technology empowers",medical AI is also accompanied by a series of ethical paradoxes,mainly manifested as the conflict between technological innovation and the protection of humanistic value.Based on the AI ethical framework proposed by Italian philosophy and ethicist Floridi,this paper systematically analyzes paradoxical manifestations of medical AI and the possible causes in 5 core ethical principles:respecting autonomy,not harming,doing good,fairness,and interpretability.It also explains the causes of these paradoxes from technical,social,and philosophical levels,and puts forward the following coping strategies:first,to improve explainability,algorithm audit technology,differentiated data collection technology,privacy protection technology,and human supervision and control technology,strengthening technical governance;second,to improve ethical regulations and establish a dynamic ethical governance mechanism that adapts to the pace of technological development,a hierarchical management model,and a responsible innovation mechanism,further improving the legal and regulatory frameworks in terms of data security,algorithm ethical responsibility recognition,etc;and third,to establish a global collaborative system,build a global governance framework for medical AI,establish unified development and application standards,and promote cross-border policy coordination and technical standard docking.

Objective:To explore the feasibility of applying deep learning image reconstruction (DLIR) in low-radiation dose liver dual-energy CT to further improve image quality, diagnostic confidence of lesion, and accuracy of iodine concentration (IC) measurement.Methods:This prospective cohort study enrolled 60 patients scheduled for enhanced liver CT at the First Affiliated Hospital of Anhui Medical University from June 2023 to January 2024. The participants were randomly assigned into the standard dose group and low radiation dose group with 30 cases in each using randomized block method. The standard radiation dose group underwent standard-radiation dose 120 kVp scans during the venous phase, while the low radiation dose group underwent low radiation dose scans with a rapid kVp-switching spectral scanning mode at 80 kVp and 140 kVp. The effective radiation dose (ED) was calculated for both groups. The standard radiation dose group was reconstructed using adaptive statistical iterative reconstruction-V (ASIR-V) algorithm 40% (AR40 120 kVp). The low radiation dose group using high-intensity DLIR (DLIR-H) to reconstructed 40 keV and 50 keV virtual monoenergetic images (VMI) (DH-VMI 40 keV, DH-VMI 50 keV). The image quality of the above three groups was objectively evaluated through the measurement of image noise and calculation of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) for the liver and portal vein; and the image quality was subjectively scored for image noise, contrast, lesion conspicuity, and diagnostic confidence. In the low radiation dose group, DLIR-H and ASIR-V40% reconstructed iodine maps were used to measure the liver and portal vein of IC values, standard deviations (SD), and coefficients of variation (CV). One-way analysis of variance or Kruskal-Wallis H test was used to compare the differences of subjective and objective image quality among the three groups, and paired t-test was used to compare the differences in measurement indexes between DLIR-H and ASIR-V40% reconstructed iodine maps. Results:The ED in the low radiation dose group [(2.2±0.5) mSv] was reduced by 56.8% compared to the conventional radiation dose group [(5.4±1.4) mSv]. Objective evaluations demonstrated that DH-VMI 40 keV had higher image noise, CNR, and SNR for liver and portal veins compared to AR40 120 kVp ( P<0.001). DH-VMI 50 keV had lower image noise ( P=0.200), with higher CNR and SNR for the liver and portal vein compared to AR40 120 kVp( P<0.001). In subjective evaluation, there was no statistically significant difference in image noise scores between DH-VMI 40 keV and AR40 120 kVp ( P>0.05), while the image noise score for DH-VMI 50 keV was lower than that of AR40 120 kVp ( P<0.05). Both DH-VMI 40 keV and DH-VMI 50 keV had higher scores for contrast, lesion conspicuity, and diagnostic confidence compared to those of AR40 120 kVp ( P<0.05). In the low radiation dose group, there was no statistically significant difference in IC values for the liver and portal vein between the ASIR-V40% and DLIR-H algorithm reconstructed iodine maps ( P>0.05). The SD and CV of liver and portal vein in the DLIR-H reconstructed iodine maps were lower than those in the ASIR-V40% reconstructed iodine maps ( P<0.001). Conclusions:DLIR can effectively reduce the image noise of low-energy (40, 50 keV) VMI, enhance lesion conspicuity and diagnostic confidence, and improve measurement accuracy without affecting IC values.