Jiuwei Xifeng Granules have become a Chinese patent medicine in the market. Because the formula contains Os Draconis, a top-level protected fossil of ancient organisms, the formula was to be improved by replacing Os Draconis with Ostreae Concha. To evaluate whether the improved formula has the same effectiveness and safety as the original formula, a randomized, double-blind, parallel-controlled, equivalence clinical trial was conducted. This study enrolled 288 tic disorder(TD) of children and assigned them into two groups in 1∶1. The treatment group and control group took the modified formula and original formula, respectively. The treatment lasted for 6 weeks, and follow-up visits were conducted at weeks 2, 4, and 6. The primary efficacy endpoint was the difference in Yale global tic severity scale(YGTSS)-total tic severity(TTS) score from baseline after 6 weeks of treatment. The results showed that after 6 weeks of treatment, the declines in YGTSS-TSS score showed no statistically significant difference between the two groups. The difference in YGTSS-TSS score(treatment group-control group) and the 95%CI of the full analysis set(FAS) were-0.17[-1.42, 1.08] and those of per-protocol set(PPS) were 0.29[-0.97, 1.56], which were within the equivalence boundary [-3, 3]. The equivalence test was therefore concluded. The two groups showed no significant differences in the secondary efficacy endpoints of effective rate for TD, total score and factor scores of YGTSS, clinical global impressions-severity(CGI-S) score, traditional Chinese medicine(TCM) response rate, or symptom disappearance rate, and thus a complete evidence chain with the primary outcome was formed. A total of 6 adverse reactions were reported, including 4(2.82%) cases in the treatment group and 2(1.41%) cases in the control group, which showed no statistically significant difference between the two groups. No serious suspected unexpected adverse reactions were reported, and no laboratory test results indicated serious clinically significant abnormalities. The results support the replacement of Os Draconis by Ostreae Concha in the original formula, and the efficacy and safety of the modified formula are consistent with those of the original formula.
Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Male ; Double-Blind Method ; Drugs, Chinese Herbal/therapeutic use* ; Tic Disorders/drug therapy* ; Treatment Outcome

Objective:To investigate the impact of flow diverter (FD) malapposition at the aneurysm neck on clinical outcomes and complications of intracranial aneurysms, and identify the influencing factors for intraoperative FD malapposition.Methods:A retrospective study was performed; 153 patients with unruptured saccular aneurysms at the C4-C7 segments of the internal carotid artery accepted single FD implantation at Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from June 2022 to March 2024 were chosen. Intraoperative high-resolution C-arm CT was utilized to assess FD apposition at the aneurysm neck. (1) Based on FD apposition at the aneurysm neck as shown, these 153 patients were divided into a malapposition group ( n=23, including 16 patients with malapposition being identified as residual malapposition after intraoperative corrective measures such as microwire massage and 7 patients with malapposition being newly detected in this study) and a complete apposition group ( n=130). Perioperative and follow-up complications were recorded. Clinical outcomes were assessed using modified Rankin Scale (mRS) at the final follow-up (mRS score of 0-2 as favorable outcome), and angiographic outcomes were evaluated by DSA at the final follow-up. Differences in clinical and angiographic outcomes and complication rate were compared between the malapposition group and complete apposition group. (2) Based on FD apposition at the aneurysm neck as shown, these 153 patients were divided into an intraoperative malapposition group ( n=74, including 67 patients with malapposition being detected during surgery and 7 patients with malapposition being newly detected in this study) and an intraoperative complete apposition group ( n=79). Univariate analysis was performed to compare the clinical variables between the intraoperative malapposition group and intraoperative complete apposition group; multivariate Logistic regression was further employed to identify the independent influencing factors for FD malapposition at the aneurysm neck. Results:(1) Four patients (all from the malapposition group) developed perioperative acute in-stent thrombosis. Nine patients experienced ischemic or hemorrhagic stroke during the follow-up, including 6 from the malapposition group and 3 from the complete apposition group; the complication rate in the malapposition group (6/23, 26.1%) was significantly higher than that in the complete apposition group (3/130, 2.3%) during the follow-up ( P<0.05). At the final follow-up, 2 patients (both from the malapposition group) had poor clinical outcome, while the remaining 151 patients had favorable outcome. Proportion of patients with favorable outcome between the two groups was statistically different (91.3%[21/23] vs. 100.0%[130/130], P<0.05). Delayed occlusion was detected in 46 patients (12 from the malapposition group and 34 from the complete apposition group) at the final angiographic follow-up. FD restenosis/re-occlusion was noted in 10 patients, including 6 from the malapposition group and 4 from the complete apposition group. Significant difference in delayed occlusion rate (52.2%[12/23] vs. 26.2%[34/130]) and long-term in-stent stenosis/occlusion rate (26.1%[6/23] vs. 3.1%[4/130]) was observed between the two groups ( P<0.05). (2) Significant difference in aneurysm neck diameter, FD angulation, parent artery stenosis, parent artery diameter ratio>1.2, and presence of branching vessels at the FD implantation site was noted between the intraoperative complete apposition group and intraoperative malapposition group ( P<0.05). Multivariate Logistic regression indicated that aneurysm neck diameter ( OR=1.431, 95% CI: 1.096-1.868, P=0.008), parent artery diameter ratio>1.2 ( OR=2.199, 95% CI: 1.083-4.463, P=0.029), and FD angulation ( OR=1.019, 95% CI: 1.002-1.036, P=0.027) were independent influencing factors for FD malapposition at the aneurysm neck. Conclusion:In FD implantation for intracranial aneurysms, FD malapposition at the aneurysm neck adversely affects delayed occlusion rate and complication rate; aneurysms with wider aneurysm neck diameter, parent artery diameter ratio>1.2, and greater FD angulation are trend to have FD malapposition at the aneurysm neck.

The single photon counting imaging detector based on microchannel plate(MCP)has the characteristics of high sensitivity and low dark count rate,and has been applied to the optical remote sensing detection of weak ultraviolet spectral signals in space.In this work,by using planar array single photon counting imaging detector as the detector,flat-field concave grating as the splitter,and electrodeless discharge lamp(EDL)as the excitation light source,a dispersion detection system suitable for hydride generation-atomic fluorescence spectrometry(HG-AFS)was developed.The wavelength calibration of the system was carried out,and the negative high pressure and EDL stability time of the planar array single photon counting imaging detector were analyzed and optimized.The characteristic emission spectral lines of As and Bi elements excited in the wavelength range of 180-320 nm were analyzed,and the scattering interference in the wavelength range of 257.3-306.7 nm was discussed.The results showed that the AFS dispersion detection system based on the planar array single photon counting imaging detector could detect and analyze the HG-AFS fluorescence signal initially,and the influence of scattering interference on the detection results was effectively avoided.The system had the advantages including simple structure,no refrigeration and temperature control,no moving parts and simultaneous measurement of multi-band.

Objective To investigate the prevalence of specific IgE antibodies against Alternaria alternata and Aspergillus fumigatus in serum samples from clinical allergy patients across selected provinces in China.Methods Data on specific IgE antibodies for Alternaria A.and Aspergillus F.were collected from 20 hospital laboratories in 17 cities spanning 11 provinces.The study analyzed the levels of specific IgE and their variations across different provinces and seasons.Results A total of 27 471 cases of Alternaria A.and 32 843 cases of Aspergillus F.specific IgE data were included.The national average positive rate of Alternaria A.IgE was 10.40%,with the highest rate of 22.68%in Jiangsu and the lowest rate of 2.06%in Guangxi.For Aspergillus F.specific IgE,the average positive rate was 4.24%,with Hubei province having the highest rate(7.25%)and Hunan province the lowest(1.23%).The difference in IgE levels for both Alternaria A.and Aspergillus F.among provinces were statistically significant(H=9 955,16 993,all P<0.0001).Among patients,5.85%had Alternaria A.specific IgE levels at grade 3 or above,while only 0.57%had Aspergillus F.specific IgE levels at this level.When examining seasonal variations using data from Liaoning,Hunan and Anhui provinces,significant seasonal changes were observed for both Alternaria A.and Aspergillus F.IgE antibodies(HAlternaria A=347.6,338.0,401.3,HAspergillus F=196.6,133.7,231.7,all P<0.0001).Conclusion The sensitization to Alternaria A.and Aspergillus F.exhibits distinct geographical characteristics and vary significantly with seasons.Given the relatively high IgE levels associated with Alternaria A.,it should be given adequate clinical attention.

Objective To investigate the prevalence of specific IgE antibodies against Alternaria alternata and Aspergillus fumigatus in serum samples from clinical allergy patients across selected provinces in China.Methods Data on specific IgE antibodies for Alternaria A.and Aspergillus F.were collected from 20 hospital laboratories in 17 cities spanning 11 provinces.The study analyzed the levels of specific IgE and their variations across different provinces and seasons.Results A total of 27 471 cases of Alternaria A.and 32 843 cases of Aspergillus F.specific IgE data were included.The national average positive rate of Alternaria A.IgE was 10.40%,with the highest rate of 22.68%in Jiangsu and the lowest rate of 2.06%in Guangxi.For Aspergillus F.specific IgE,the average positive rate was 4.24%,with Hubei province having the highest rate(7.25%)and Hunan province the lowest(1.23%).The difference in IgE levels for both Alternaria A.and Aspergillus F.among provinces were statistically significant(H=9 955,16 993,all P<0.0001).Among patients,5.85%had Alternaria A.specific IgE levels at grade 3 or above,while only 0.57%had Aspergillus F.specific IgE levels at this level.When examining seasonal variations using data from Liaoning,Hunan and Anhui provinces,significant seasonal changes were observed for both Alternaria A.and Aspergillus F.IgE antibodies(HAlternaria A=347.6,338.0,401.3,HAspergillus F=196.6,133.7,231.7,all P<0.0001).Conclusion The sensitization to Alternaria A.and Aspergillus F.exhibits distinct geographical characteristics and vary significantly with seasons.Given the relatively high IgE levels associated with Alternaria A.,it should be given adequate clinical attention.

Objective:To investigate the impact of flow diverter (FD) malapposition at the aneurysm neck on clinical outcomes and complications of intracranial aneurysms, and identify the influencing factors for intraoperative FD malapposition.Methods:A retrospective study was performed; 153 patients with unruptured saccular aneurysms at the C4-C7 segments of the internal carotid artery accepted single FD implantation at Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from June 2022 to March 2024 were chosen. Intraoperative high-resolution C-arm CT was utilized to assess FD apposition at the aneurysm neck. (1) Based on FD apposition at the aneurysm neck as shown, these 153 patients were divided into a malapposition group ( n=23, including 16 patients with malapposition being identified as residual malapposition after intraoperative corrective measures such as microwire massage and 7 patients with malapposition being newly detected in this study) and a complete apposition group ( n=130). Perioperative and follow-up complications were recorded. Clinical outcomes were assessed using modified Rankin Scale (mRS) at the final follow-up (mRS score of 0-2 as favorable outcome), and angiographic outcomes were evaluated by DSA at the final follow-up. Differences in clinical and angiographic outcomes and complication rate were compared between the malapposition group and complete apposition group. (2) Based on FD apposition at the aneurysm neck as shown, these 153 patients were divided into an intraoperative malapposition group ( n=74, including 67 patients with malapposition being detected during surgery and 7 patients with malapposition being newly detected in this study) and an intraoperative complete apposition group ( n=79). Univariate analysis was performed to compare the clinical variables between the intraoperative malapposition group and intraoperative complete apposition group; multivariate Logistic regression was further employed to identify the independent influencing factors for FD malapposition at the aneurysm neck. Results:(1) Four patients (all from the malapposition group) developed perioperative acute in-stent thrombosis. Nine patients experienced ischemic or hemorrhagic stroke during the follow-up, including 6 from the malapposition group and 3 from the complete apposition group; the complication rate in the malapposition group (6/23, 26.1%) was significantly higher than that in the complete apposition group (3/130, 2.3%) during the follow-up ( P<0.05). At the final follow-up, 2 patients (both from the malapposition group) had poor clinical outcome, while the remaining 151 patients had favorable outcome. Proportion of patients with favorable outcome between the two groups was statistically different (91.3%[21/23] vs. 100.0%[130/130], P<0.05). Delayed occlusion was detected in 46 patients (12 from the malapposition group and 34 from the complete apposition group) at the final angiographic follow-up. FD restenosis/re-occlusion was noted in 10 patients, including 6 from the malapposition group and 4 from the complete apposition group. Significant difference in delayed occlusion rate (52.2%[12/23] vs. 26.2%[34/130]) and long-term in-stent stenosis/occlusion rate (26.1%[6/23] vs. 3.1%[4/130]) was observed between the two groups ( P<0.05). (2) Significant difference in aneurysm neck diameter, FD angulation, parent artery stenosis, parent artery diameter ratio>1.2, and presence of branching vessels at the FD implantation site was noted between the intraoperative complete apposition group and intraoperative malapposition group ( P<0.05). Multivariate Logistic regression indicated that aneurysm neck diameter ( OR=1.431, 95% CI: 1.096-1.868, P=0.008), parent artery diameter ratio>1.2 ( OR=2.199, 95% CI: 1.083-4.463, P=0.029), and FD angulation ( OR=1.019, 95% CI: 1.002-1.036, P=0.027) were independent influencing factors for FD malapposition at the aneurysm neck. Conclusion:In FD implantation for intracranial aneurysms, FD malapposition at the aneurysm neck adversely affects delayed occlusion rate and complication rate; aneurysms with wider aneurysm neck diameter, parent artery diameter ratio>1.2, and greater FD angulation are trend to have FD malapposition at the aneurysm neck.

Tranexamic acid is widely used in joint orthopedic surgery.At the same time,it has high safety and few adverse drug reactions.It can effectively improve intraoperative bleeding and promote early functional recovery of patients.This article reviews the mode of administration,safe dose,administration time and adverse drug reactions of tranexamic acid in the perioperative period of joint replacement and arthroscopic surgery,in order to provide reference for the clinical application of tranexamic acid.

Ceria nanoparticles(CeO2 NPs)have become popular materials in biomedical and industrial fields due to theirpotential applications in anti-oxidation,cancer therapy,photocatalytic degradation of pollutants,sensors,etc.Many methods,including gas phase,solid phase,liquid phase,and the newly proposed green synthesis method,have been reported for the synthesis of CeO2 NPs.Due to the wide application of CeO2 NPs,concerns about their adverse impacts on human health have been raised.This review covers recent studies on the biomedical applications of CeO2 NPs,including their use in the treatment of various diseases(e.g.,Alzheimer's disease,ischemic stroke,retinal damage,chronic inflammation,and cancer).CeO2 NP toxicity is discussed in terms of the different systems of the human body(e.g.,cytotoxicity,genotoxicity,respiratory toxicity,neurotoxicity,and hepatotoxicity).This comprehensive review covers both fundamental discoveries and exploratory progress in CeO2 NP research that may lead to practical developments in the future.

Objective:To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods:The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed. According to anesthesia methods, these patients were divided into an observation group ( n = 89) and a control group ( n = 47). The observation group was given thoracic segment epidural anesthesia, while the control group was given remifentanil infusion anesthesia. The tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels in the epithelial lining fluid collected from the non-dependent lung, the plasma levels of TNF-α, IL-6, and malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, the incidence of complications, the incidence of re-operations, numeric rating scale score, and the length of hospital stay were compared between the two groups. The effects of different anesthesia methods on lung cancer surgery were evaluated. Results:In each group, TNF-α, IL-6, and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation (T2) compared with those measured before one-lung ventilation (T1) ( t = 7.71, 77.10, 7.59, 3.41, 57.51, 5.74, all P < 0.05). In the observation group, TNF- α [(1.59 ± 0.53) ng/L, (1.89 ± 0.64) ng/L] measured at T1 and T2, IL-6 [(2.96 ± 0.82) ng/L] and IL-10 [(1.99 ± 0.53) ng/L] measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group ( t = 10.45, 2.59, 2.00, 7.19, all P < 0.05). In the observation group, IL-6 measured at T2 [(38.91 ± 5.84) ng/L] was significantly lower than that in the control group ( t = 33.25, P < 0.001), and IL-10 measured at T2 [(2.51 ± 0.67) ng/L] was slightly, but not significantly higher than that in the control group ( P > 0.05). There was no significant difference in the plasma level of TNF- α measured at T1 and T2 between the two groups (both P > 0.05). Plasma levels of IL-6 in the two groups [(42.98 ± 5.29) ng/L, (27.93 ± 4.17) ng/L] measured at T2 were significantly increased compared with those measured at T1 ( t = 54.14, 61.06, both P < 0.001). In the observation group, TNF-α measured at T2 [(1.60 ± 0.56) ng/L] and IL-6 measured at T1 and T2 [(0.92 ± 0.16) ng/L, (27.93 ± 4.17) ng/L] were significantly lower compared with the control group ( t = 3.39, 6.96, 18.20, all P < 0.05). There were no significant differences in plasma level of malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, numeric rating scale score, the incidence of complications, the incidence of re-operation, and the length of hospital stay between the two groups (all P > 0.05). Conclusion:Thoracic segment epidural anesthesia can reduce the local inflammatory response of the lung during lung cancer surgery.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.