Objective:To integrate the best available evidence regarding the management of perinatal intraventricular hemorrhage (IVH) in preterm infants.Methods:Using keywords such as "intracranial hemorrhage", "intraventricular hemorrhage", "germinal matrix hemorrhage", and their Chinese equivalents, we systematically searched for clinical decisions, guidelines, expert consensuses, evidence summaries, group standards, systematic reviews, and meta-analyses related to IVH management in preterm infants. Data sources included BMJ Best Practice, UpToDate, World Health Organization website, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, National Guideline Clearinghouse, American Academy of Pediatrics, Canadian Paediatric Society, European Foundation for the Care of Newborn Infants, British Association of Perinatal Medicine, Yiigle, Cochrane Library, Joanna Briggs Institute, PubMed, Web of Science, CINAHL, MEDLINE, Embase, China National Knowledge Infrastructure, Wanfang Data, and SinoMed. The search period spanned from January 2015 to December 2024. Literature screening, quality appraisal, evidence extraction, and synthesis were performed independently according to uniform standards.Results:A total of 12 publications were included, comprising three clinical decisions, three evidence-based guidelines, and six expert consensuses. Thirty-seven best evidence statements were synthesized across four domains: risk factor identification, diagnosis and monitoring, antenatal and delivery room management, and neonatal intensive care unit management. These included 28 strong recommendations (Grade A) and nine weak recommendations (Grade B).Conclusion:The 37 summarized best evidence statements provide an evidence-based foundation for developing clinical management protocols for perinatal IVH in preterm infants.

Objective To summarize the imaging characteristics of occult rib fracture(ORF),analyze the causes of missed diagnosis and misdiagnosis of ORF,and explore strategies to improve the detection rate of ORF.Methods A total of 142 patients with rib fractures who underwent multi spiral computed tomography(MSCT)were selected.The initial examination was conducted within 1 week after the injury,and follow-up examinations were performed at multiple time points after 1 week post-injury.A retrospective analysis was conducted to review the fracture detection and locations during the follow-up period.The time of fracture edge sclerosis or callus growth was observed in the young group(17 cases),middle-aged group(64 cases),and elderly group(61 cases).Results The anterior segment of the ribs was the predilection site for occult fractures,with 199 cases(53.4％).The missed diagnosis rates of fracture were higher for fractures near the costal cartilage segment and the posterior segment of the ribs,with missed diagnosis rates of 49.4％and 58.8％,respectively.Compared with the number of rib fractures identified in the initial examination,there was a statistically significant difference in the number of rib fractures at 3-6 weeks after injury(P＜0.05).The time of local sclerosis or callus growth in the young,middle-aged and elderly groups was(18.76±3.849)d,(26.14±6.597)d,and(37.69±5.726)d,respectively,with statistically significantl differences between the groups(P＜0.05).Conclusion MSCT has certain limits in diagnosing ORF in the short term after injury.Primarily observing the predilection sites and missed sites of occult fractures,systematically recognizing the imaging characteristics of ORF,and adopting the optimal detection-time window for patients of different age groups can reduce the missed diagnosis rate and misdiagnosis rate of ORF and improve the detection rate of fractures.This provides accurate and objective basis for clinical and forensic identification,with significant clinical importance and application value.

Objective:To develop one kind of alarm system with pressure sensor,so as to prevent compression injuries of patients with upper limb dysfunction due to the movement of the examination bed during computed tomography(CT)examination.Methods:The alarm system with pressure sensor was constructed on the basis of Arduino UNO open-source main control board and the HX711 weighing module.The Arduino E3 power supply module was used to provide power for system,and ESP8266 main control board was used to realize remote alarm,and its 3 dimension(3D)printed customized shell can directly be installed at the edge of examination bed.A total of 228 patients with upper limb dysfunction who underwent CT examination at Xianxian County Hospital of TCM during July 2022 and October 2022 were selected.They were randomly divided into observation group and control group by using a computer-generated random number sequence.The observation group was monitored for possibly potential compression risks on upper limb of patients by using the alarm system with pressure sensor.The patients of control group were respectively accompanied by one accompanying personnel to go into the scanning room,and they wore lead aprons,lead skirts,and other protective appliances for radiation protection.When a patient is found to be at risk of being crushed,an alarm should be raised by calling a halt.The valid alarm rates of the two alarm methods were calculated.Results:There were 37 times of alarm in observation group in examination,and 31 times were valid alarms and 6 times were invalid alarms in them.In control group,there were 49 times of alarm from accompanying personnel,and 29 times were valid alarms and 20 times were invalid alarms in 49 times of alarm.The valid alarm rate of observation group was significantly higher than that of control group,and the difference was statistically significant(x2=6.048,P<0.05).Conclusion:The installation of alarm system with pressure sensor is easy,and its use is convenient,and it has a higher valid alarm rate during CT examination,and it can effectively protect patients to prevent compression injuries.

Objective To summarize the imaging characteristics of occult rib fracture(ORF),analyze the causes of missed diagnosis and misdiagnosis of ORF,and explore strategies to improve the detection rate of ORF.Methods A total of 142 patients with rib fractures who underwent multi spiral computed tomography(MSCT)were selected.The initial examination was conducted within 1 week after the injury,and follow-up examinations were performed at multiple time points after 1 week post-injury.A retrospective analysis was conducted to review the fracture detection and locations during the follow-up period.The time of fracture edge sclerosis or callus growth was observed in the young group(17 cases),middle-aged group(64 cases),and elderly group(61 cases).Results The anterior segment of the ribs was the predilection site for occult fractures,with 199 cases(53.4％).The missed diagnosis rates of fracture were higher for fractures near the costal cartilage segment and the posterior segment of the ribs,with missed diagnosis rates of 49.4％and 58.8％,respectively.Compared with the number of rib fractures identified in the initial examination,there was a statistically significant difference in the number of rib fractures at 3-6 weeks after injury(P＜0.05).The time of local sclerosis or callus growth in the young,middle-aged and elderly groups was(18.76±3.849)d,(26.14±6.597)d,and(37.69±5.726)d,respectively,with statistically significantl differences between the groups(P＜0.05).Conclusion MSCT has certain limits in diagnosing ORF in the short term after injury.Primarily observing the predilection sites and missed sites of occult fractures,systematically recognizing the imaging characteristics of ORF,and adopting the optimal detection-time window for patients of different age groups can reduce the missed diagnosis rate and misdiagnosis rate of ORF and improve the detection rate of fractures.This provides accurate and objective basis for clinical and forensic identification,with significant clinical importance and application value.

Objective:To develop one kind of alarm system with pressure sensor,so as to prevent compression injuries of patients with upper limb dysfunction due to the movement of the examination bed during computed tomography(CT)examination.Methods:The alarm system with pressure sensor was constructed on the basis of Arduino UNO open-source main control board and the HX711 weighing module.The Arduino E3 power supply module was used to provide power for system,and ESP8266 main control board was used to realize remote alarm,and its 3 dimension(3D)printed customized shell can directly be installed at the edge of examination bed.A total of 228 patients with upper limb dysfunction who underwent CT examination at Xianxian County Hospital of TCM during July 2022 and October 2022 were selected.They were randomly divided into observation group and control group by using a computer-generated random number sequence.The observation group was monitored for possibly potential compression risks on upper limb of patients by using the alarm system with pressure sensor.The patients of control group were respectively accompanied by one accompanying personnel to go into the scanning room,and they wore lead aprons,lead skirts,and other protective appliances for radiation protection.When a patient is found to be at risk of being crushed,an alarm should be raised by calling a halt.The valid alarm rates of the two alarm methods were calculated.Results:There were 37 times of alarm in observation group in examination,and 31 times were valid alarms and 6 times were invalid alarms in them.In control group,there were 49 times of alarm from accompanying personnel,and 29 times were valid alarms and 20 times were invalid alarms in 49 times of alarm.The valid alarm rate of observation group was significantly higher than that of control group,and the difference was statistically significant(x2=6.048,P<0.05).Conclusion:The installation of alarm system with pressure sensor is easy,and its use is convenient,and it has a higher valid alarm rate during CT examination,and it can effectively protect patients to prevent compression injuries.

Objective:To integrate the best available evidence regarding the management of perinatal intraventricular hemorrhage (IVH) in preterm infants.Methods:Using keywords such as "intracranial hemorrhage", "intraventricular hemorrhage", "germinal matrix hemorrhage", and their Chinese equivalents, we systematically searched for clinical decisions, guidelines, expert consensuses, evidence summaries, group standards, systematic reviews, and meta-analyses related to IVH management in preterm infants. Data sources included BMJ Best Practice, UpToDate, World Health Organization website, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, National Guideline Clearinghouse, American Academy of Pediatrics, Canadian Paediatric Society, European Foundation for the Care of Newborn Infants, British Association of Perinatal Medicine, Yiigle, Cochrane Library, Joanna Briggs Institute, PubMed, Web of Science, CINAHL, MEDLINE, Embase, China National Knowledge Infrastructure, Wanfang Data, and SinoMed. The search period spanned from January 2015 to December 2024. Literature screening, quality appraisal, evidence extraction, and synthesis were performed independently according to uniform standards.Results:A total of 12 publications were included, comprising three clinical decisions, three evidence-based guidelines, and six expert consensuses. Thirty-seven best evidence statements were synthesized across four domains: risk factor identification, diagnosis and monitoring, antenatal and delivery room management, and neonatal intensive care unit management. These included 28 strong recommendations (Grade A) and nine weak recommendations (Grade B).Conclusion:The 37 summarized best evidence statements provide an evidence-based foundation for developing clinical management protocols for perinatal IVH in preterm infants.

Objective:Exploration on the mechanism of acupuncture-targeted therapy for rheumatoid arthritis and identification of candidate Chinese materia medica.Methods:Targets of acupuncture for RA were collected from related literature, and GSE205962 gene chips were obtained from GEO database. The weighted co-expression network (WGCNA) was constructed by screening differentially expressed genes using R 4.3.1. The collection targets were taken to intersect with the differential genes, and the common genes were obtained for high-throughput GO and KEGG enrichment. The Hub genes were screened by constructing protein interaction networks using the String database and Cytoscape 3.9.0 software. The CIBERSORT algorithm was used to explore the mechanisms of RA immune infiltration, and finally the Coremine Medical database was applied to predict Chinese materia medica.Results:A total of 8 key targets were selected (RHOA, JAK1, FYN, LCK, STAT1, STAT3, EGF, GATA3). The results of immune infiltration analysis showed that various immune cells were closely related to the biological processes of rheumatoid arthritis, including γδ T cells, monocytes, regulatory T cells, CD8 T cells, etc. Saposheikovize Radix, Cinnamomi Ramulus, Anemarrhenae Rhizoma, Dendrobii Caulis, Rehmannine Radix, Lonicerae Japonicae Flos, Pinelliae Rhizoma, Cimicifugae Rhizoma, Poria, Stephaniae Tetrandrae Radix were the 10 kinds of commonly used key Chinese materia medica in the treatment of RA.Conclusions:Acupuncture and moxibustion may treat RA by regulating RHOA, JAK1, FYN, LCK and other core targets. This study predicts that Chinese materia medica can be used as a source of drugs for the treatment of RA, and can provide new ideas for the combination of acupuncture and medicine for the treatment of RA.

ObjectiveTo explore the intervention mechanism of Xiangsha Liujunzi Tang in rats with functional dyspepsia （FD） based on the Ras homolog gene family member A （RhoA）/Rho-associated coiled-coil containing protein kinase 2 （ROCK2）/Myosin phosphatase target Subunit 1 （MYPT1） pathway. MethodSixty male SD suckling rats in SPF grades were randomly divided into blank group （n=10） and model group （n=50）. The comprehensive modeling method （gavage administration of iodoacetamide+exhaustion of swimming+disturbance of hunger and satiety） was used to replicate the rat model of FD. After successful replication of the model， the rats in the model group were randomly divided into model group， mosapride group， and high， middle， and low-dose Xiangsha Liujunzi Tang groups， with 10 rats in each group. Rats in the blank group and model group were given 10 mL kg^-1·d^-1 normal saline， those in the mosapride group were given 1.35 mg·kg^-1·d^-1 mosapride， and those in the high， middle， and low-dose Xiangsha Liujunzi Tang groups were given 12， 6， and 3 g·kg^-1·d^-1 Xiangsha Liujunzi Tang， respectively. The intervention lasted 14 days. The general living conditions of rats were observed before and after modeling and administration， and the 3-hour food intake and body mass of rats were measured. After intervention， the intestinal propulsion rate of rats was measured， and the pathological changes in the gastric tissue were observed by hematoxylin-eosin （HE） staining. The content of choline acetyl transferase （ChAT） and vasoactive intestinal peptide （VIP） in the medulla oblongata and gastric tissue homogenate was determined by enzyme-linked immunosorbent assay （ELISA）， the distribution of adenosine triphosphate （ATP） enzyme in gastric antrum smooth muscle was observed by frozen section staining， and the protein expression levels of RhoA， ROCK2， and phosphorylated-myosin phosphatase target subunit 1 （p-MYPT1） in the gastric tissue were detected by Western blot. ResultCompared with the blank group， the model group had withered hair， lazy movement， slow action， poor general living condition， lower 3-hour food intake， body mass， and lower intestinal propulsion rate （P<0.05）， whereas no obvious abnormality in gastric histopathology. In the model group， the content of ChAT in the medulla oblongata and gastric tissue decreased， the content of VIP in gastric tissue increased， the distribution of ATP enzyme in gastric antrum smooth muscle decreased significantly， and the protein expression levels of RhoA， ROCK2， and p-MYPT1 in the gastric tissue decreased significantly （P<0.05）. As compared with the model group， the general living condition of rats in each intervention group was significantly improved， and the 3-hour food intake， body mass， and intestinal propulsion rate were significantly increased （P<0.05）. There was no significant difference in gastric pathology in the intervention groups. The content of ChAT in the medulla oblongata and gastric tissue increased significantly， the content of VIP in the gastric tissue decreased， the distribution of ATP enzyme in gastric antrum smooth muscle increased significantly， and the protein expression levels of RhoA， ROCK2， and p-MYPT1 in the gastric tissue increased significantly （P<0.05）. The intervention effect of Xiangsha Liujunzi Tang group on the above indexes was dose-dependent. ConclusionXiangsha Liujunzi Tang can effectively improve the general living condition and gastric motility of rats with FD， and its specific mechanism may be related to the activation of the RhoA/ROCK2/MYPT1 pathway in the gastric tissue to regulate smooth muscle relaxation and contraction and promote gastric motility.

Objective:To analyze the clinical efficacy and safety of camrelizumab combined with apatinib as a second-line therapy for unresectable hepatocellular carcinoma (HCC).Methods:Ninety-four cases with mid-and advanced-stage HCC who received camrelizumab combined with apatinib as second-line treatment were enrolled. Routine blood test, blood biochemical indexes, tumor stage, tumor imaging characteristics, previous treatment strategies and other clinical data before treatment were documented. Imaging examination follow-up results and adverse reactions during treatment were followed up until the end of follow-up or loss of follow-up or death. Kaplan-Meier method was used to analyze the clinical efficacy.Results:As of the last follow-up, 94 cases with mid-and advanced-stage HCC had received camrelizumab combined with apatinib as second-line treatment. Among them, 15 cases were lost to follow-up, 31 cases died, and 48 cases survived. The overall remission rate was 31.9%. The overall disease control rate was 71.3%. The median time to disease-free progression was 6.6 months. The median time to disease progression was not yet available. The 1-year cumulative survival rate was 62.3%. Grade 3 and above adverse reactions mainly included were thrombocytopenia (7.4%), abdominal pain (4.3%), active hepatitis (4.3%), leukopenia (4.3%), diarrhea (3.2%), hand-foot syndrome (3.2%). All adverse reactions were effectively controlled.Conclusion:Camrelizumab combined with apatinib can effectively prolong the survival period of patients with mid-and advanced-stage HCC, and it is well tolerated.

Objective: To investigate differentially expressed genes and related signaling pathways in patients with dermatomyositis/clinical amyopathic dermatomyositis (DM/CADM) complicated by interstitial lung disease or malignant tumors. Methods: From January 2017 to January 2018, 27 DM/CADM patients were enrolled from Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and divided into 3 groups according to the complications: 10 with interstitial lung disease, 8 with malignant tumors, and 9 without interstitial lung disease or malignant tumors. Meanwhile, 7 healthy controls were enrolled into this study. High-throughput RNA sequencing was performed to screen differentially expressed genes in peripheral blood in the above 4 groups. Then, these genes were subjected to gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Results: Compared with the healthy controls, 4 820 up-regulated genes and 137 down-regulated genes were identified in DM/CADM patients; GO analysis revealed 49 significantly enriched items in the DM/CADM patients, 37 (75.5%) of which were associated with biological processes; KEGG analysis showed that differentially expressed genes were mainly enriched in infection-, tumor- and immune-related pathways in DM/CADM patients. Compared with the patients without interstitial lung disease or malignant tumors, 272 up-regulated genes and 158 down-regulated genes were identified in the patients with interstitial lung disease; GO analysis revealed 157 significantly enriched items, 114 (72.6%) of which were associated with biological processes; KEGG analysis showed that differentially expressed genes were mainly enriched in bacterial infection- and autoimmune/inflammatory-related pathways in the patients with interstitial lung disease. Compared with the patients without interstitial lung disease or malignant tumors, 398 up-regulated genes and 68 down-regulated genes were identified in the patients with malignant tumors; GO analysis revealed 117 significantly enriched items, 94 (80.3%) of which were associated with biological processes; KEGG analysis showed that differentially expressed genes were mainly enriched in glycosylation-, metabolism- and tumor-related signaling pathways in the patients with malignant tumors. Conclusions Differences existed in transcriptomes and pathways between the DM/CADM patients and healthy controls, as well as between the patients with interstitial lung disease or malignant tumors and patients without these complications. Bacterial infection- and cytokine/chemokine-related pathways were significantly enriched in the patients with DM/CADM complicated by interstitial lung disease, while those pathways related to glycosylation, protein metabolism, angtigen presentation and cytotoxic effects of natural killer cells were significantly enriched in the patients with DM/CADM complicated by malignant tumors.