Minimally conscious state （MCS） is at the edge between closed and open consciousness， but it still belongs to the category of "wind-strike block" syndrome. The basic pathogenesis of MCS is the obstruction of pathogenic qi， orifices closed and spirit hidden， with pathological factors including phlegm， fire， and blood stasis. Wind movement and water retention may also be present， and often leading to deficiency syndrome due to the exhaustion of qi， blood， yin， and yang at later stages. Treatment chooses Shexiang （Moschus） as the chief medicinal， emphasizing combination of medicinals and urgency of medication administration； the key therapeutic method is to open the orifices， with focuses on expelling pathogens and reinforcing healthy qi. For patients with severe phlegm or fire， use Xiaochengqi Decoction （小承气汤） to open the lower orifices， discharge heat and unblock the bowels， combined with Shexiang （Moschus） and Niuhuang （Bovis Calculus） to open the upper orifices， awaken the spirit and guide qi. For patients with turbid phlegm as the predominant， temporarily replace Shexiang （Moschus） with Baizhi （Angelicae dahuricae radix）， using Ditan Decoction （涤痰汤） to eliminate phlegm to open the orifices， when turbid phlegm gradually subsided， Shexiang （Moschus） could be added. For patients with blood stasis as the predominant， Tongqiao Huoxue Decoction （通窍活血汤） will be used to activate blood and open orifice， if the blood circulates， the endogenous wind will be calmed， the water will be induced， the orifices will open and the consciousness will restore. For patients with closed orifices and body deficiency， the treatment should open the orifices and reinforce healthy qi， and consider the root and branch simultaneously； qi deficiency syndrome can be addressed with Buyang Huanwu Decoction （补阳还五汤） to boost qi and reinforce healthy qi； yin deficiency syndrome can be treated with Shaoyao Gancao Decoction （芍药甘草汤） combined with Fengsui Pill （封髓丹） to nourish yin， soften sinews， and secure kidney essence； yang deficiency can be managed by using Dihuang Yinzi Decoction （地黄饮子） to enrich yin， supplement yang， and open the orifices.

Objective To evaluate the anticoagulation efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in patients with high-risk atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI). Methods A computer-based search was conducted on PubMed, EMbase, The Cochrane Library, CNKI, SinoMed, and VIP databases to identify studies on the application of NOACs and VKAs in high-risk AF patients after TAVI. The search period was from database inception to January 2023. The quality of the included studies was assessed using the Cochrane risk assessment tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4 software. Results A total of 7 studies involving 24 592 patients were included. The meta-analysis results showed that compared to patients using VKAs, those treated with NOACs had a significantly lower risk of all-cause mortality [RR=0.74, 95%CI (0.58, 0.94), P=0.01]. Subgroup analysis indicated that when the follow-up period was less than 1 year, there was no significant difference in all-cause mortality between the NOAC and VKA groups [RR=0.57, 95%CI (0.17, 1.88), P=0.35]; however, when the follow-up period was ≥1 year, the VKA group had a higher all-cause mortality rate than the NOAC group, with a statistically significant difference [RR=0.73, 95%CI (0.57, 0.95), P=0.02]. No significant differences were found between the two groups regarding early stroke [RR=0.50, 95%CI (0.19, 1.28), P=0.15], stroke during follow-up [RR=1.04, 95%CI (0.88, 1.22), P=0.64], bleeding [RR=0.94, 95%CI (0.73, 1.21), P=0.61], major or life-threatening bleeding [RR=0.80, 95%CI (0.49, 1.31), P=0.38], or acute kidney injury [RR=0.51, 95%CI (0.16, 1.59), P=0.24]. Conclusion Compared to VKAs, the use of NOACs in patients with high-risk AF undergoing TAVI may reduce the risk of all-cause mortality, especially during long-term anticoagulation therapy, potentially offering greater benefits. However, further evidence from randomized controlled trials is needed to confirm these findings.

Objective To investigate the relationship between interlukin-10(IL-10)gene polymorphisms and acute kidney injury(AKI)and its related mechanisms.Methods A prospective study was conducted on 100 patients with AKI admitted to our hospital from March 2021 to March 2023,who were selected as the study group.Following the 1∶1 pairing principle,100 healthy individuals who underwent physical examinations during the same period were included as the control group.General data,IL-10 genotypes,and gene frequency distributions of the two groups were compared.The factors influencing AKI were assessed using a logistic regression analysis,and the interaction between IL-10gene polymorphisms and conventional risk factors was analyzed using multifactor dimension reduction(MDR).Results The quantitative values of serum creatinine(sCr),blood urea nitrogen(BUN),and urine protein in the study group were higher than those in the control group.The proportion of the GG genotype at IL-10-1082 was lower than that in the control group,and the proportions of the AA genotype and A allele were higher than those in the control group(P<0.05).Logistic regression analysis showed that BUN(OR=4.487),urinary protein quantitation(OR=5.905),sCr(OR=3.573),AA genotype at position 1082(OR=4.823),and the A allele(OR=4.479)were risk factors for AKI(P<0.05).Interaction display,IL-10-1082 polymorphism×sCr,IL-10-1082 polymor-phism×BUN,IL-10-1082 polymorphism×urinary protein quantification,and IL-10-1082 polymorphism×sCr×BUN×urinary protein quantification models exhibited good accuracy and cross-consistency(P<0.05).Conclusion IL-10gene polymorphisms are strongly associated with the development of AKI.

Objective To investigate the classification effect of deep neural networks in irregular time series data,and to predict the recurrence risk of 362 patients with diffuse large B-cell lymphoma(DLBCL)in a hospital in Shanxi from 2014 to 2020.Methods A total of 362 diagnosed DLBCL patients who achieved complete remission after initial chemotherapy were collected retrospectively,and the recurrence risk was predicted within the next two years.First,LASSO regression was used to screen the variables.Then a deep neural network model of irregular time series data based on GRU-ODE-Bayes was constructed and compared with some traditional models and other deep neural network models.Results Among all the models under study,the traditional models do not perform as well as the deep neural network models in classification.The GRU-ODE-Bayes model was the best,with AUC of 0.85,sensitivity of 0.84,specificity of 0.71,and G-means of 0.77.Conclusion Compared with other models,the GRU-ODE-Bayes model can predict the recurrence of DLBCL patients more accurately.It could benefit the individualized treatment for patients and decision-making for physicians.

Objectives To construct a prediction model of relapse in diffuse large B-cell lymphoma within two years after complete remission based on multiple randomized empirical kernel learning machine to provide a basis for patient treatment decisions.Methods Using the information of 445 patients who met the requirements of this study in the electronic medical record database of a tertiary hospital in Shanxi Province from 2010 to 2020,a relapse prediction model was constructed based on five common categories of imbalance treatment methods and a multiple stochastic empirical kernel learning machine,and compared with the five classifiers.Results The recurrence prediction model based on SMOTE Tomek Links+multiple randomized empirical kernel learning machine achieved optimal classification performance(accuracy=0.89,precision=0.87,recall=0.92,f1-Score=0.89,brier score=0.11).Conclusion For the actual DLBCL dataset,in this paper,we used SMOTE Tomek links to process the imbalance data and construct a multiple randomized empirical kernel learning machine,which achieves the optimal model performance with low computational complexity and can provide a powerful reference for DLBCL recurrence prediction.

Glycogen storage diseases(GSDs)are a group of autosomal recessive disorders of glucose metabolism.GSDs are caused by congenital deficiency of enzymes in glycogen synthesis or decomposition,which results in glycogen accumulation in organs.According to the types of enzyme deficiency,GSDs can be classified into more than ten types,among which GSD Ⅻ is a super-rare type of GSD.Two brothers with a 5-year age difference presented severe neonatal asphyxia,myasthenia,myocardial damage,anemia,and mental retarda-tion,being GSD Ⅻ homozygous cases with neonatal onset.The results of gene detection showed that nucleotide and amino acid alterations(c.619G＞A,p.E207K)of the ALDOA gene existed in the two brothers,being ho-mozygous,and the genotypes in the parents were heterozygous.This article summarized the clinical features,di-agnosis,and treatment of GSD Ⅻ,providing reference for exploring the etiology and treatment of severe asphyxia,myasthenia,anemia,and multiple organ damage in neonates after birth.

Objective:To investigate the correlation between digital breast tomosynthesis(DBT)image features,pathological features,and the results of breast-conserving surgery(BCS)in early stage breast cancer.Methods:We retrospectively analyzed 422 cases of BCS resulting in successful breast preservation and 211 BCS cases that were followed by mastectomy.All of the patients underwent surgery at Tianjin Medical University Cancer Institute&Hospital between January 2019 and December 2023.Preoperative DBT images and clinicopathological features were assessed.A univariate Logistic regression analysis was performed to screen out the characteristics associated with BCS surgic-al results,after which multivariate Logistic regression analysis was performed to screen out the characteristics.Results:Univariate Logistic regression analysis showed that age(P=0.020),architectural distortion(P<0.001),breast composition(extremely dense,P=0.001),and mo-lecular subtype(Her2,P=0.001)were statistically different between the two groups.Multivariate Logistic regression analysis showed that ar-chitectural distortion(P<0.001),breast composition(extremely dense breast,P=0.003),and molecular subtype(Her2,P<0.001)differed signi-ficantly between the two groups.Conclusions:Breast composition,architectural distortion,and molecular subtype correlated with BCS res-ults.Extremely dense breast composition,architectural distortion,and Her2 subtype are associated with a higher possibility of conversion to mastectomy.These factors serve as effective predictive indicators of BCS results and thus aid clinicians in deciding the appropriate surgical strategies in the treatment of breast cancer.

Objective:To investigate the influencing factors for microvascular invasion (MVI) in hepatocellular carcinoma based on three-dimensional visualization and the construction of its nomogram model.Methods:The retrospective cohort study method was conducted. The clinico-pathological data of 190 patients with hepatocellular carcinoma who were admitted to Henan University People′s Hospital from May 2018 to May 2021 were collected. There were 148 males and 42 females, aged (58±12)years. The 190 patients were randomly divided into the training set of 133 cases and the validation set of 57 cases by the method of random number table in the ratio of 7:3. The abdominal three-dimensional visualization system was used to characterize the tumor morphology and other imaging features. Observation indicators: (1) analysis of influencing factors for MVI in hepatocellular carcinoma; (2) construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q3), and non-parametric rank sum test was used for comparison between groups. Count data were expressed as absolute numbers, and the chi-square test was used for comparison between groups. Corresponding statistical methods were used for univariate analysis. Binary Logistic regression model was used for multivariate analysis. Receiver operator characteristic (ROC) curves were plotted, and the nomogram model was assessed by area under the curve (AUC), calibration curve, and decision curve. Results:(1) Analysis of influencing factors for MVI in hepatocellular carcinoma. Among 190 patients with hepatocellular carcinoma, there were 97 cases of positive MVI (including 63 cases in the training set and 34 cases in the validation set) and 93 cases of negative MVI (including 70 cases in the training set and 23 cases in the validation set). Results of multivariate analysis showed that alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology were independent factors affecting the MVI of patients with hepatocellular carcinoma ( odds ratio=5.06, 3.62, 1.00, 2.02, 2.59, 95% confidence interval as 1.61-15.90, 1.28-10.20, 1.00-1.01, 1.02-3.98, 1.03-6.52, P<0.05). (2) Construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. The results of multivariate analysis were incorporated to construct a nomogram prediction model for MVI of hepatocellular carcinoma. ROC curves showed that the AUC of the training set of nomogram model was 0.85 (95% confidence interval as 0.79-0.92), the optimal fractional cutoff based on the Jordon′s index was 0.51, the sensitivity was 0.71, and the specificity was 0.84. The above indicators of validation set were 0.92 (95% confidence interval as 0.85-0.99), 0.50, 0.90, and 0.82, respectively. The higher total score of the training set suggested a higher risk of MVI in hepatocellular carcinoma. The calibration curves of both training and validation sets of nomogram model fitted well with the standard curves and have a high degree of calibration. The decision curve showed a high net gain of nomogram model. Conclusions:Alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology are independent influencing factors for MVI in patients with hepatocellular carcinoma. A nomogram model constructed based on three-dimensional visualized imaging features can predict MVI in hepatocellular carcinoma.

Objective To explore the protective effect and possible mechanism of Periplaneta americana powder on rats with spinal cord injury.Methods Forty-eight male SD rats were randomly divided into sham operation,saline,Periplaneta americana powder,and Toll-like receptor 4(TLR4)inhibitor groups.Except for the sham operation group,a rat spinal cord hemi-transection injury model was established in the other three groups.The sham operation group received no treatment after the operation,saline and drug groups were subjected to intragastric administration of equal volumes of normal saline and Periplaneta americana powder(630 mg/kg),respectively,and the TLR4 inhibitor group was administered an intraperitoneal injection of TLR4 inhibitor(3 mg/kg).On days 1,3,7,and 14 after the operation,the motor function of rat hind limbs was evaluated by the Basso,Beattie,and Bresnahan(BBB)score.Histopathological changes of the spinal cord were observed by hematoxylin-eosin staining.Changes in the number of neurons were observed by immunohistochemistry.The levels of inflammatory factors IL-1,IL-6,IL-10,and TNF-α were measured by ELISA,and expression of TLR4,myeloid differentiation factor 88(MyD88),and NF-κB p65 was detected by Western Blot.Results Compared with the sham operation group,the BBB score and number of neurons in the saline group were significantly decreased,while the degree of pathological damage,and IL-1,IL-6,TNF-α,TLR4,MyD88,and NF-κB p65 levels were significantly increased(P＜0.05).Compared with the saline group,periplaneta americana powder and TLR4 inhibitor groups showed an increase in BBB scores and the number of neurons,and decreases in the degree of pathological damage and IL-1,IL-6,TNF-α,TLR4,MyD88,and NF-κB p65 levels(P＜0.05).Compared with the TLR4 inhibitor group,the periplaneta americana powder group had better increases in the BBB score,number of neurons and decreases in the degree of pathological damage and expression of IL-1 and TNF-α.Conclusions Periplaneta americana powder reduces the production of inflammatory factors after spinal cord injury by inhibiting the TLR4/MyD88/NF-κB pathway,protects nerves,and promotes motor recovery.

Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease that can lead to the damage of multiple tissues and organs throughout the body.Stimulator of interferon genes(STING)is an endoplasmic reticulum membrane protein that acts as an indirect cytoplasmic DNA sensor.The activation of the STING signaling pathway may be involved in T2DM and its microvascular complications through various mechanisms.This article reviews the research progress in the mechanism of STING in T2DM and its microvascular complications.