OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

Meditation aims to guide individuals into a state of deep calm and focused attention, and in recent years, it has shown promising potential in the field of medical treatment. Numerous studies have demonstrated that electroencephalogram (EEG) patterns change during meditation, suggesting the feasibility of using deep learning techniques to monitor meditation states. However, significant inter-subject differences in EEG signals poses challenges to the performance of such monitoring systems. To address this issue, this study proposed a novel model-calibrated multi-source adversarial adaptation network (CMAAN). The model first trained multiple domain-adversarial neural networks in a pairwise manner between various source-domain individuals and the target-domain individual. These networks were then integrated through a calibration process using a small amount of labeled data from the target domain to enhance performance. We evaluated the proposed model on an EEG dataset collected from 18 subjects undergoing methamphetamine rehabilitation. The model achieved a classification accuracy of 73.09%. Additionally, based on the learned model, we analyzed the key EEG frequency bands and brain regions involved in the meditation process. The proposed multi-source domain adaptation framework improves both the performance and robustness of EEG-based meditation monitoring and holds great promise for applications in biomedical informatics and clinical practice.
Humans ; Electroencephalography/methods* ; Meditation ; Calibration ; Neural Networks, Computer ; Brain/physiology* ; Rest/physiology* ; Deep Learning ; Signal Processing, Computer-Assisted

Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.

Objective:To summarize oral hygiene management approaches applicable to patients with periodontitis, thus provide a basis for decision making by clinical staffs.Methods:Computerized decision systems, various guideline websites, dental association websites, evidence summary databases and journal databases for evidence involving oral hygiene management in patients with periodontitis were searched, including clinical decision making, guidelines, expert consensus, evidence summaries and systematic reviews/Meta-analyses. The search time was from January 2015 to November 2021, and the updated search was carried out in June 2022. Then performed pooled analyses, methodological quality evaluations, and evidence level evaluations.Results:Finally 12 studies, including three guidelines, an expert consensus and eight systematic reviews, and summarized 18 pieces of evidence in three aspects, risk assessment and control, oral hygiene guidance, and clinical practice promotion were included.Conclusions:The evidence from this study is generally scientific and practical, and it should be adapted to local conditions and patient preferences in order to maximize the transfer of evidence into clinical practice.

Ferroptosis is a new form of regulated cell death discovered in recent years, which is iron-dependent cell death characterized by peroxidation of polyunsaturated fatty acid phospholipids. Recent studies have shown that radiotherapy can induce ferroptosis in cancer cells via ionizing radiation. Targeting ferroptosis plays a synergistic role in tumor suppression with radiation, which not only further deepens the connotation of radiobiology, but also provides a new perspective for tumor radiosensitization. This review systematically summarizes the occurrence and defense of ferroptosis, focusing on the key role of ferroptosis in the radiobiological effects of tumor cells and the potential application of ferroptosis in radiosensitization.

Malocclusion has a higher incidence in adolescents and is one of the risk factors for the quality of life of adolescents. This review summarizes the current status of domestic and foreign research on the oral-related quality of life of adolescent malocclusion patients, assessment tools, and analysis of its scope of influence and intervention measures. It aims to strengthen the formation of oral health concepts among adolescents and parents, promote the implementation of clinical psychological education, and improve the quality of life of adolescent malocclusion patients.

Objective:To explore the incidence of non-thyroidal illness syndrome (NTIS) in children with type 1 diabetes mellitus (T1DM) and the correlation between triiodothyronine level and the severity of T1DM, thus providing evidence for clinical diagnosis and treatment.Methods:A total of 125 children initially diagnosed as T1DM at the Department of Endocrinology and Genetic Metabolism of Children′s Hospital of Shanghai Jiao Tong University from January 2015 to December 2019 were recruited.The data were retrospectively analyzed.The incidence of NTIS in T1DM children was explored.T1DM children were classified into euthyroid group and NTIS group, two independent sample t-test were used to compare the differences in multiple factors between euthyroid group and NTIS group in children with T1DM, and Spearman correlation analysis was used to further analyze the correlation between the levels of free triiodothyronine (FT3), total triiodothyronine (TT3) and the severity of children with primary T1DM. Results:The incidence of NTIS in 125 T1DM children was 26.4%(33/125 cases). FT3, TT3, total thyroxine (TT4), thyrotropin (TSH), pH value, HCO 3- and high density lipoprotein cholesterol (HDL-C) levels in NTIS group were significantly lower than those of euthyroid group [(3.10±0.45) pmol/L vs.(4.85±0.75) pmol/L, (0.60±0.28) nmol/L vs.(1.05±0.38) nmol/L, (65.77±23.41) nmol/L vs.(89.57±18.23) nmol/L, (0.91±0.89) mIU/L vs.(2.05±0.76) mIU/L, 7.21±0.17 vs.7.31±0.18, (11.49±7.54) mmol/L vs.(16.80±8.38) mmol/L, (1.08±0.49) mmol/L vs.(1.28±0.44) mmol/L]( t=4.56, 5.67, 4.48, 5.61, 2.82, 2.68, and 2.53, all P<0.05). Moreover, the anion gap (AG) level, blood glucose (BG) and triglyceride in NTIS group were significantly higher than those of euthyroid group [(22.53±8.33) mmol/L vs.(16.94±7.52) mmol/L, (24.85±4.71) mmol/L vs.(21.46±6.64) mmol/L, (2.72±2.05) mmol/L vs.(2.33±3.05) mmol/L]( t=3.22, 2.67 and 2.04, all P<0.05). The incidence of diabetic ketoacidosis (DKA) was statistically significant in euthyroid group, NTIS group and abnormal thyroid disease group (33.3% vs.63.6% vs.35.7%)( χ2=8.990, P<0.05). In T1DM children, FT3 was positively correlated with pH value and HCO 3-, and negatively correlated with AG level ( r=0.376 9, 0.439 7 and -0.411 9, all P<0.05). In addition, TT3 was positively correlated with pH value and HCO 3-, and negatively correlated with AG and BG ( r=0.513 2, 0.539 8, -0.482 4 and -0.211 5, all P<0.05). Conclusions:Children with T1DM are prone to have abnormal thyroid hormone levels, and the incidence of NTIS was 26.4%.The incidence of DKA differed in T1DM children with different thyroid functions.FT3 or TT3 level may contribute to evaluate the disease severity of T1DM children.

Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.

Objective:To investigate the effect and indications of pedicled myocutaneous flap and modified Masquelet technique in the repair of diabetic soft tissue and tibial bone defects.Methods:From January, 2017 to October, 2019, data of surgical treatment of 20 patients with diabetic soft tissue and tibial bone defects were retrospectively studied. The detects were repaired by the pedicled myocutaneous flap combined with modified Masquelet technique. There were 13 males and 7 females aged 40 to 65(average 51) years old. Preoperative ultrasound and CTA had confirmed that there was no occlusion in anterior and posterior tibial arteries. After debridement, the bone defect was 4-9 cm in length and the soft tissue defect was 3 cm×6 cm to 7 cm×10 cm. The initial antibiotic loaded bone cement filling of the bone and soft tissue defects was carried out. Then at 7-10 days later, had the bone cement placed earlier removed the remaining spaces of bone defect were again filled by antibiotic loaded bone cement. Meanwhile, the pedicled myocutaneous flap was transferred to repair the wound. The second stage of Masquelet technique was performed later, with an interval of 8-12(mean 9) weeks. The healing of wound and bone defect, and the complications were recorded. At 12 months after the surgery, the healing and appearance of the flap were evaluated by the standard proposed by Zhang Hao, and the functional recovery of the adjacent joint was evaluated by Johner-Wruhs standard. The treatment was considered successful when the symptoms were disappeared and no recurrence occurred.Results:All patients entered 13 to 28 months of follow-up, 20 months in average. The healing time for bone defect was 6-11 (average 9.0) months. All myocutaneous flaps survived with 18 flaps healed in the stage one and 2 delayed healing. Nine flaps appeared almost normal and 11 shown bloating. Seventeen flaps were found with partial sensation and 3 without sensation at all. The temperature of 7 flaps was found normal and 13 were slightly lower. Fourteen donor site scars were mild and 6 were obvious. The overall curative effect was satisfactory. Two patients had recurred infection. The rates of excellent and good functional recovery, infection control and success of treatment were at 90%(18/20) for each.Conclusion:Pedicled myocutaneous flap combined with modified Masquelet technique can repair diabetic soft tissue and tibial bone defects. It has a good therapeutic effect for short and medium terms.

In recent years, the use of fluorescent contrast agents staining to guide surgery has flourished in various fields of surgery under the concept of precision surgery, which is helpful to guide surgery and provide surgeons with actual visible fluorescence imaging.Clinically, fluorescent contrast agent can be used to display tumor’s outline with high recognition degree, guide operation in real time, locate lymph node metastasis, detect small metastases, and identify important anatomical structures during the operation to avoid possible side-injury. Great progress has been made in the study of fluorescent contrast agents that can mediate surgery, including the study and surgical application development of classical fluorescent contrast agents such as indocyanine green and methylene blue, etc, as well as the discovery and clinical application of new targeted fluorescent contrast agents such as folate receptor targeting contrast agents, monoclonal antibody based fluorescent targeting contrast agents and intelligent contrast agents, etc. This paper will review the research and surgical application of fluorescent contrast agents in two aspects: classical fluorescent contrast agents and new targeted fluorescent contrast agents.