Objective To evaluate the value of an optimized three-dimensional inversion-recovery with real reconstruction (3D-real IR) sequence with a longer repetition time (TR, 16 000 ms) based on modulated flip angle technique in refocused imaging with extended echo train (MATRIX) in the endolymphatic hydrops (EH) imaging after intratympanic gadolinium (Gd) administration, and to compare it with a conventional 3D-real IR based on the turbo spin echo (TSE) sequence. Methods From July 2021 to November 2022, twenty-seven patients received both the conventional and optimized 3D-real IR sequences after bilateral intratympanic Gd administration. Images of the two sequences were qualitativly evaluated and compared. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and area ratio of endolymph against the total lymphatic space from the two sequences were measured and compared. Results 14(25.9%) ears with insufficient contrast for the EH diagnosis on the conventional sequence were clearly displayed on the optimized sequence. Image score, CNR and SNR of the optimized sequence were significantly higher than those of the conventional sequence (P ＜ 0.001). The scanning time of two sequences was similar. The area ratio of endolymph against the total lymphatic space in the cochlear was significantly higher on the conventional 3D-real IR than that on the optimized 3D-real IR (P ＜ 0.001); there was no statistical difference in the vestibule between the two sequences. Conclusions Compared with conventional sequence, optimized 3D-real IR sequence with a longer TR may be better for evaluation of EH after intratympanic Gd administration.

Objective To investigate the value of artificial intelligence-assisted compressed sensing (ACS) technology for intravenous gadolinium contrast-enhanced magnetic resonance imaging of the inner ear using three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence. Methods The patients received gadolinium contrast-enhanced magnetic resonance imaging using ACS and united compressed sensing (uCS) 3D-FLAIR at Zhongshan Hospital, Fudan University from January to November 2024 were prospectively enrolled. The repetition time was 16 000 ms, and acquisition time was 6 min 40 s and 10 min 24 s in ACS 3D-FLAIR and uCS 3D-FLAIR, respectively. The images on the two sequences were evaluated independently by two radiologists. The image quality of the two sequences was subjectively evaluated and compared. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between the two sequences. The grading consistencies using two sequences and between the two doctors were analyzed. Results There was no statistically difference in subjective score of image quality between the two sequences. SNR and CNR of the ACS 3D-FLAIR sequence were significantly higher than those of the uCS 3D-FLAIR sequence (P＜0.001). The kappa values of grades of cochlear and vestibular endolymphatic hydrops were 0.942 and 0.888 using two sequences (P＜0.001). The kappa values of grades of cochlear and vestibular endolymphatic hydrops using the ACS 3D-FLAIR sequence between the two doctors were 0.784 and 0.831, respectively (P＜0.001); the kappa values of grades of cochlear and vestibular endolymphatic hydrops using uCS 3D-FLAIR sequence between the two doctors were 0.725 and 0.756, respectively (P＜0.001). Conclusions ACS 3D-FLAIR could provide higher SNR and CNR than uCS 3D-FLAIR, and is more suitable for intravenous gadolinium contrast-enhanced magnetic resonance imaging of the inner ear; the endolymphatic hydrops grades using ACS 3D-FLAIR is similar to use uCS 3D-FLAIR.

Spinal cord injury is characterized by high mortality and disability rates, posing a major challenge to global medicine. Microenvironmental disruption represents a critical pathological feature of spinal cord injury, closely associated with disease progression and prognosis. Elucidating the dysregulated microenvironment and developing strategies to restore its homeostasis are crucial for improving the efficacy of spinal cord repair. Addressing the question of how to reestablish microenvironmental homeostasis, the authors analyzed cellular heterogeneity within the microenvironment, summarized recent advances in targeted microenvironment remodeling, and discussed current challenges and future directions, so as to provide new perspectives for the treatment of spinal cord injury.

Objective To investigate whether ginsenoside Rg3 can ameliorate glomerular endothelial injury in diabetic nephropathy(DN)mice through Ras homologous gene family member A(Rho A)/Rho-associated coiled-coil forming protein kinase,(ROCK1)/NLR family pyrin domain protein 3(NLRP3)pathway.Methods Forty mice were randomly divided into 4 groups:control group,DN group,ginsenoside(ginsenoside Rg3)group and RhoA/ROCK pathway inhibition(FD)group,with 10 mice in each group.Fasting blood glucose(FBG)was measured by glucose meter.The levels of urinary protein,urea nitrogen(BUN)and serum creatinine(SCr)were detected by ELISA.PAS staining was used to detect glomerular morphology and structure and to evaluate glomerular injury index(GDI).The expression of platelet-endothelial cell adhesion molecule(PECAM-1 or CD31),von Willefibrilia factor(vWF),RhoA,ROCK and NLRP3 protein related to pyrodeath were detected by immunofluorescence staining.Western blotting detected the expression of intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),the inflammatory factor interleukin-1β(IL-1β)and IL-18 protein in the glomerulus.Results Compared with the control group,the levels of FPG,urinary protein,BUN and SCr in DN group were increased,and the differences were statistically significant(t=17.59～43.81,all P<0.05).The glomerular structure was significantly damaged and GDI was increased(t=20.73,P<0.05).The expressions of CD31,RhoA,ROCK and NLRP3 in glomeruli were increased,while the expression of vWF was decreased.The expressions of ICAM-1,VCAM-1,IL-1β and IL-18 in renal tissues were increased,and the differences were statistically significant(t=27.95～40.10,all P<0.05).Compared with the DN group,the levels of FPG,urinary protein,BUN and SCr in ginsenoside group were decreased,and the differences were statistically significant(t=14.87～20.33,all P<0.05).The damage of glomerular structure was improved and GDI was decreased(t=19.80,P<0.05),the expression of CD31,RhoA,ROCK and NLRP3 in glomerular was decreased,and the expression of vWF was increased.The expressions of ICAM-1,VCAM-1,IL-1β and IL-18 in renal tissues of FD group were decreased,and the differences were statistically significant(t=12.62～39.68,all P<0.05).Conclusion Ginsenosides Rg3 can improve the level of glomerular endothelial injury and pyroptosis in DN mice by down-regulating RhoA/ROCK/NLRP3 pathway.

Objective To investigate whether ginsenoside Rg3 can ameliorate glomerular endothelial injury in diabetic nephropathy(DN)mice through Ras homologous gene family member A(Rho A)/Rho-associated coiled-coil forming protein kinase,(ROCK1)/NLR family pyrin domain protein 3(NLRP3)pathway.Methods Forty mice were randomly divided into 4 groups:control group,DN group,ginsenoside(ginsenoside Rg3)group and RhoA/ROCK pathway inhibition(FD)group,with 10 mice in each group.Fasting blood glucose(FBG)was measured by glucose meter.The levels of urinary protein,urea nitrogen(BUN)and serum creatinine(SCr)were detected by ELISA.PAS staining was used to detect glomerular morphology and structure and to evaluate glomerular injury index(GDI).The expression of platelet-endothelial cell adhesion molecule(PECAM-1 or CD31),von Willefibrilia factor(vWF),RhoA,ROCK and NLRP3 protein related to pyrodeath were detected by immunofluorescence staining.Western blotting detected the expression of intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),the inflammatory factor interleukin-1β(IL-1β)and IL-18 protein in the glomerulus.Results Compared with the control group,the levels of FPG,urinary protein,BUN and SCr in DN group were increased,and the differences were statistically significant(t=17.59～43.81,all P<0.05).The glomerular structure was significantly damaged and GDI was increased(t=20.73,P<0.05).The expressions of CD31,RhoA,ROCK and NLRP3 in glomeruli were increased,while the expression of vWF was decreased.The expressions of ICAM-1,VCAM-1,IL-1β and IL-18 in renal tissues were increased,and the differences were statistically significant(t=27.95～40.10,all P<0.05).Compared with the DN group,the levels of FPG,urinary protein,BUN and SCr in ginsenoside group were decreased,and the differences were statistically significant(t=14.87～20.33,all P<0.05).The damage of glomerular structure was improved and GDI was decreased(t=19.80,P<0.05),the expression of CD31,RhoA,ROCK and NLRP3 in glomerular was decreased,and the expression of vWF was increased.The expressions of ICAM-1,VCAM-1,IL-1β and IL-18 in renal tissues of FD group were decreased,and the differences were statistically significant(t=12.62～39.68,all P<0.05).Conclusion Ginsenosides Rg3 can improve the level of glomerular endothelial injury and pyroptosis in DN mice by down-regulating RhoA/ROCK/NLRP3 pathway.

OBJECTIVE To enhance the training quality of anticoagulation specialty clinical pharmacists,address the resource limitations of a single training base,and promote homogenization of training quality.METHODS A multi-base joint training system for anticoagulation specialty clinical pharmacists in the Beijing area was established.A mixed research method was employed,collecting data through performance comparisons,questionnaires,and qualitative interviews to compare the differences between the joint training model(experimental group,n=16)and traditional teaching model(the control group,n=17).RESULTS The established joint training system encompassed a unified joint training teaching plan,the formation of a joint training teaching team,the establishment of joint theoretical teaching courses,the implementation of joint case discussions and literature presentations,as well as strengthening the assessment throughout the joint training process.Compared to the control group[theoretical assessment of(76.44±3.66)points,case assessment of(84.31±3.27)points],the experimental group students achieved higher scores in theoretical assessment[(79.85±4.64)points]and case assessment[(88.70±5.51)points](P＜0.05).Through questionnaires and qualitative interviews,the trainees in experimental group were highly satisfied with the joint training model in terms of theoretical learning,communication skills,and teaching interaction.CONCLUSIONS The multi-base collaborative training system for anticoagulation specialty clinical pharmacists can integrate advantageous resources and significantly enhance the training effectiveness of anticoagulation specialty clinical pharmacists,offering value for wider promotion.

Spinal cord injury is characterized by high mortality and disability rates, posing a major challenge to global medicine. Microenvironmental disruption represents a critical pathological feature of spinal cord injury, closely associated with disease progression and prognosis. Elucidating the dysregulated microenvironment and developing strategies to restore its homeostasis are crucial for improving the efficacy of spinal cord repair. Addressing the question of how to reestablish microenvironmental homeostasis, the authors analyzed cellular heterogeneity within the microenvironment, summarized recent advances in targeted microenvironment remodeling, and discussed current challenges and future directions, so as to provide new perspectives for the treatment of spinal cord injury.

Objective To analyze the relationship between the common clinical indicators and diabetic foot ulcer(DFU)in type 2 diabetes mellitus(T2DM)patients by using the cross-sectional study and to provide the reference indicators for clinical DFU monitoring and prognosis evaluation.Methods A total of 115 T2DM patients admitted to the Department of Endocrinology,the Second Affiliated Hospital of Kunming Medical University from June 2021 to June 2023 were selected as the study objects and were divided into group A(with DFU)and group B(without DFU)according to whether they had DFU.Those in group A were then divided into group A1(Wagner0-1),group A2(Wagner2-3)and group A3(Wagner4)according to Wagner classification.The differences of general data,blood pressure,blood glucose,blood lipids and other common clinical indicators among all of the groups were compared,and the correlation between DFU and the above indicators was explored.Results Diabetes duration,D-dimer(DD),systolic blood pressure and other indexes in group A were higher than those in group B and there was a statistically significant difference(P<0.05).DD was the main risk factor for DFU in T2DM patients.Diabetic course in patients with DFU was positively correlated with the age(r>0,P<0.05),and negatively correlated with fasting blood glucose(FPG)level and 2hPG level at 2 hours after meals(r<0,P<0.05).The levels of interleukin-6(IL-6)and C-reactive protein(CRP)in A1 and A2 groups were lower than those in A3 group,the levels of neutrophils and leukocytes in A1 group were lower than those in A3 group,and the high density lipoprotein cholesterol(HDL-C)in A1 group was higher than that in A2 group and there was a statistically significant difference(P<0.05).Conclusion DD and systolic blood pressure are the main risk factors for DFU,and DD is closely related to DFU.The older the patients with T2DM,the later the onset of DFU.The worse the blood glucose control,the earlier the onset of DFU.HDL-C is a protective factor for peripheral vascular disease in T2DM patients.

Diabetic foot(DF)is one of the most severe chronic complications of diabetes mellitus(DM),and it is an important cause of disability and mortality inpatients with DM.Changes in proteins in the tissues,organs and circulation of organisms can serve as microscopic reflections of the disease development process.Proteomics is an important technologyto explore the pathogenesis and treatment mechanism of dis-ease,and to find potential therapeutic targets and prognostic biomarkers of diseases.This article reviews the progress of proteomics research in DF.

A 63-year-old female patient with multiple systemic metastases from lung adenocarcinoma was treated with befotertinib (75 mg orally once daily) and other symptomatic supportive treatments. Before treatments, her platelet count (PLT) was 177×10 9/L. After 35 days of medication, the patient had a transient loss of consciousness with chest tightness and shortness of breath. Computed tomography pulmonary angiography showed multiple embolism in bilateral pulmonary arteries. Laboratory tests showed that D-dimer was 35.16 g/L, and PLT was 34×10 9/L. The pulmonary embolism and throm-bocytopenia were considered to be caused possibly by befotertinib. Befotertinib was stopped, and enoxaparin sodium injection and rivaroxaban were given successively for anticoagulation. Thirteen days later, the chest tightness and shortness of breath were significantly improved, D-dimer was 0.57 g/L, and the PLT was 123×10 9/L.