The core pathogenesis of childhood IgA vasculitis nephritis （IgAVN） lies in the intermingled conditions of heat， stasis and deficiency. Deficiency is the fundamental cause， while heat acts as the predominant manifestation at the initial stage， and stasis serves as the key factor leading to protracted illness. Based on this understanding， the overall therapeutic principle of clearing heat and cooling blood， dissolving stasis and unblocking collaterals， reinforcing healthy qi and consolidating the root is established. A self-formulated Qingre Zhixue Formula （清热止血方） is used as the basic prescription. According to the characteristics of different disease stages， childhood IgAVN is further classified into three main syndrome types， including blood heat with stasis obstruction， deficiency of both qi and yin， and deficiency of both spleen and kidney， with corresponding syndrome-based treatments. Throughout the treatment process， emphasis is placed on dissolving stasis and unblocking collaterals， while protecting the spleen and stomach of children and maintaining healthy qi. This paper provides new perspectives for diagnosis and treatment of childhood IgAVN with traditional Chinese medicine.

The core pathogenesis of childhood IgA vasculitis nephritis （IgAVN） lies in the intermingled conditions of heat， stasis and deficiency. Deficiency is the fundamental cause， while heat acts as the predominant manifestation at the initial stage， and stasis serves as the key factor leading to protracted illness. Based on this understanding， the overall therapeutic principle of clearing heat and cooling blood， dissolving stasis and unblocking collaterals， reinforcing healthy qi and consolidating the root is established. A self-formulated Qingre Zhixue Formula （清热止血方） is used as the basic prescription. According to the characteristics of different disease stages， childhood IgAVN is further classified into three main syndrome types， including blood heat with stasis obstruction， deficiency of both qi and yin， and deficiency of both spleen and kidney， with corresponding syndrome-based treatments. Throughout the treatment process， emphasis is placed on dissolving stasis and unblocking collaterals， while protecting the spleen and stomach of children and maintaining healthy qi. This paper provides new perspectives for diagnosis and treatment of childhood IgAVN with traditional Chinese medicine.

Objective To explore the characteristics,potential challenges,and optimization paths of high-quality development policies for public hospitals in China,and to provide reference for policy formulation and implementation.Methods The 31 policy documents on high-quality development of public hospitals issued at the central and provincial levels between 2021 and 2024 were coded using Nvivo 11 software,and a three-dimensional analytical framework was constructed on the basis of the policy tools,stakeholders,and system dimensions,combining both quantitative and qualitative methods for content analysis.Results It found that the distribution of policy content in the three dimensions was characterized by stage imbalance:policy tools were mainly environmental,followed by supply,and demand;stakeholder attention was focused on public hospitals and healthcare administrations,and patient attention was low;The system dimension focused mainly on the macro level,with less distribution at the meso and micro levels.Although the unbalanced distribution of policy instruments is relevant at certain stages,the long-term structural imbalance may lead to insufficient systemic policies and weakened stakeholder synergies,and there is an urgent need to optimize the structure of instruments.Conclusions It is recommended to increase the proportion of demand-based policy instruments in policy design and dynamically adjust the synergistic application of the three types of instruments;to strengthen the attention to vulnerable stakeholders,such as patients;and to optimize the design of policies at the meso-levels and micro-levels in order to enhance the systemicity and sustainability of policy implementation.

Objective To investigate the value of stress hyperglycemia ratio(SHR)in predicting symptomatic intracranial hemorrhage(sICH)after successful recanalization of endovascular ther-apy(EVT)in patients with non-diabetic acute large vascular occlusive(LVO)stroke.Methods A total of 150 non-diabetic patients with acute stroke due to LVO admitted in our hospital from June 2022 to June 2024 were recruited,and all of them underwent EVT and obtained successful recanalization.According to whether sICH occurred 24 h after surgery,they were divided into a sICH group(15 cases)and a non-sICH group(135 cases).They were also assigned into a poor prognosis group(55 cases)and a good prognosis group(95 cases)according to the prognosis in 3 months after surgery.The general clinical data were compared between groups,and multivariate logistic regression analysis was used to identify the influencing factors for sICH and prognosis after successful EVT recanalization in the non-diabetic acute stroke patients.ROC curves were plotted to analyze the predictive value of SHR in sICH and prognosis after successful EVT reca-nalization in the patients.Results Significantly larger proportion of embolic occlusion,higher NIHSS score at admission and SHR were observed in the sICH group than the non-SICH group(66.67％vs 37.04％,P＜0.05;20.15±3.68 vs 15.62±3.10,P＜0.01;1.25±0.25 vs 1.01±0.28,P＜0.01).The poor prognosis group had obviously larger female ratio,advanced age,higher NIHSS score at admission,larger proportion of previous stroke history and higher SHR than the good prognosis group(49.09％vs 29.47％,P＜0.05;75.41±5.38 years old vs 72.56±5.63 years old,P＜0.01;18.65±3.71 vs 16.27±3.21,P＜0.01;32.73％vs 14.74％,P＜0.05;1.16±0.23 vs 1.02±0.25,P＜0.01).Multivariate logistic regression analysis showed that embolic occlusion,NIHSS score at admission and SHR were risk factors for sICH after successful EVT recanaliza-tion in non-diabetic acute stroke due to LVO(OR=2.038,95％CI:1.138-4.234,P=0.000;OR=2.026,95％CI:1.173-4.317,P=0.000;OR=1.996,95％CI:1.101-4.027,P=0.000),while gender,age,NIHSS score at admission,previous stroke history,and SHR were risk factors for poor prognosis in the patients(OR=2.004,95％CI:1.085-3.407,P=0.000;OR=2.075,95％CI:1.138-4.067,P=0.000;OR=2.010,95％CI:1.208-4.106,P=0.000;OR=2.034,95％CI:1.137-4.821,P=0.000;OR=2.038,95％CI:1.138-4.234,P=0.000).ROC curve analysis showed that the AUC value of SHR in predicting sICH and prognosis of the non-diabetic patients with acute stroke due to LVO after successful EVT recanalization was 0.797 and 0.823,with a sensitivity of 80.00％and 81.82％,and a specificity of 82.22％and 80.00％,respectively.Conclusion SHR can affect sICH and prognosis after successful EVT recanalization in non-diabetic acute LVO stroke patients,and it has a certain predictive value for sICH and poor prog-nosis of the patients.

Objective:To investigate clinical efficacy and safety of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) complicated with asthma.Methods:A self-controlled study before and after treatment was conducted to retrospectively analyze 45 patients with moderate to severe atopic dermatitis combined with asthma who received dupilumab in the respiratory allergy clinic of North Theater Command General Hospital from January 2021 to May 2024, which age ≥12 years, including 27 males, 18 females. The treatment period was 4 to 12 months. All patients were treated with dupilumab combined with inhaled glucocorticoids and long-acting beta2-receptor agonists, as well as symptomatic drugs for atopic dermatitis. Analyze the clinical data of the patients before and after treatment, including lung function, asthma and AD-related assessment scales. Generalized estimation equation was used to analyze the simple effect of time on the repeated measurement data following non-normal distribution, and Wilcoxon signed rank test was used to compare the differences of each observation index before and after treatment.Results:Among 45 patients with moderate to severe atopic dermatitis complicated with asthma, after treatment with dupilumab, the FEV 1 increased from 2.39 (1.87, 2.83) L at baseline to 2.50 (1.84, 2.97) L 3 months after treatment ( Z=2.417, P=0.016), 2.60 (1.95, 3.14) L 6 months after treatment ( Z=2.896, P=0.004); the FEV 1pred% increased from 74.10% (67.70%, 78.75%) at baseline to 77.09% (68.40%, 80.24%) at 3 months after treatment ( Z=2.574, P=0.010), and 77.20% (71.10%, 80.72%) at 6 months after treatment ( Z=2.861, P=0.004). Meanwhile, there were statistically significant differences in the ACT and Mini-AQLQ scales at 3, 6, and 12 months after treatment compared with those before treatment (ACT score Z=3.170, 4.216, 5.723; Mini-AQLQ score Z=3.231, 4.133, 5.826; all P<0.05). The EASI scale decreased from baseline 25.90 (18.95, 33.45) to 6.20 (1.15, 8.35) at 4 months after treatment ( Z=5.842, P<0.05) and 4.90 (2.75, 8.35) at 6 months after treatment ( Z=5.841, P<0.05), 4.00 (3.15, 5.05) at 12 months after treatment ( Z=5.841, P<0.05); The scores of each scale of IGA, NRS and DLQI decreased significantly compared with the baseline after 4 months, 6 months and 12 months of treatment, and this trend became more obvious with the extension of treatment time. The differences were statistically significant (IGA score Z=6.247, 6.070, 5.946; NRS score Z=5.960, 5.893, 5.879; DLQI score Z=5.880, 5.850, 5.848; all P<0.05). During treatment, 1 patient had local adverse reactions at the injection site and 1 patient had conjunctivitis. Conclusion:Dupilumab may have a positive effect on improving the clinical efficacy of patients with moderate to severe atopic dermatitis complicated with asthma. During the 12-month observation period, this biological agent generally demonstrated good safety characteristics.

Objective:To investigate, for multi-sensitized allergic rhinitis (AR) patients allergic to dust mites combined with other allergens (pollen, mold, animal dander, etc.), whether the single dust mite subcutaneous immunotherapy (SCIT) can improve the specific symptoms caused by other allergens in the patients, and to analyze the relationship between the effectiveness of symptom improvement in these patients and the type, quantity and severity of the allergens.Methods:A multicenter retrospective study was conducted to collect mul-sensitized AR patients from allergy or respiratory departments of 5 hospitals who received house dust mite allergen preparation SCIT for 12 to 36 months and met other inclusion and exclusion criteria from February to July 2024. General clinical data were collected and the perennial or seasonal symptoms before and after treatment were evaluated with visual analogue scale (VAS) to assess whether there was an perennial or allergen-specific symptom improvement (VAS score decrease ≥30%), by which the patients were divided into effective group and ineffective. R software was used to analyze the differences between groups by using Fisher′s exact test and Mann-Whitney U test. Results:A total of 62 patients were enrolled, and the treatment were effective in 39 of them, with an effective rate of 62.9%. For allergen-specific symptoms, the median age of the effective group was higher than that of the ineffective group (12 years old vs. 8 years old, P=0.039), and the effective rate in dust mite specific immunoglobin E (sIgE) grade ≤5 group was higher than that in sIgE grade >5 group (81.6% vs. 45.5%, P=0.008), and the effective rate of mold sIgE grade ≤2 group was higher than that of sIgE grade >2 group (83.3% vs. 28.6%, P=0.045), and there was no statistically significant correlation between the other allergen grades and the effective rate ( P>0.05). For perennial symptoms, the effective rate in the mold grade ≤2 group was higher than that in the sIgE grade >2 group (91.3% vs. 28.6%, P=0.010), and there was no statistically significant correlation between the other allergen grades and the effective rate ( P>0.05). There was no significant correlation between the treatment effectiveness of perennial or allergen-specific symptoms and the number of combined allergens, the grade of skin test, and the difference between the grade of combined allergens and that of dust mites ( P>0.05). Conclusion:Among the patients with multi-sensitized AR allergic to dust mites included in this study, single dust mite SCIT is effective in some of them, and for allergen-specific symptoms, the effective group was elder, and dust mite sIgE grade 6 and mold sIgE grade ≥2 was related to the low effective rate of SCIT. The present results are insufficient for selecting single or multiple AIT in any type of multi-sensitized patients.

Medical artificial intelligence （AI） is a new type of application formed by the combination of machine learning， computer vision， natural language processing， and other technologies with clinical medical treatment. With the continuous iteration and development of relevant technologies， medical AI has shown great potential in improving the efficiency of diagnosis and treatment， and service quality， but it also increases the possibility of triggering ethical issues. Ethical issues resulting from the clinical application of medical AI were analyzed， including the lack of algorithmic interpretability and transparency of medical AI， leading to information asymmetry and cognitive discrepancies； the concerning status of security and privacy protection of medical data； and the complex and unclear division of responsibilities due to the collaborative participation of multiple subjects in the clinical application of medical AI， resulting in increased difficulty in the identification of medical accidents and clarification of responsibilities. The paper proposed the principles of not harming patients’ interests， physician’s subjectivity， fairness and inclusiveness， and rapid response. It also explored the strategies and implementation paths for responding to the ethical issues of medical AI from multiple perspectives， including standardizing the environment and processes， clarifying responsibility attribution， continuously assessing the impact of data protection， guaranteeing data security， ensuring model transparency and interpretability， carrying out multi-subject collaboration， as well as the principles of being driven by ethical values and adhering to the “human health-centeredness.” It aimed to provide guidance for the healthy development of medical AI， ensuring technological progress while effectively managing and mitigating accompanying ethical risks， thereby promoting the benign development of medical AI technology and better serving the healthcare industry and patients.

OBJECTIVE: To develop an objective quantitative evaluative model of manual acupuncture manipulation (MAM) using three-dimensional motion tracking technology and machine learning, so as to provide a new approach to the study on acupuncture and moxibustion education and manipulation standardization. METHODS: A total of 120 undergraduate students in the major of acupuncture-moxibustion and tuina were recruited. The Simi Motion Ver.8.5 motion tracking system was used to collect the data of three types of MAM, balanced reinforcing and reducing by twisting, reinforcing technique by twisting and reducing technique by twisting. Eight quantitative parameters covering movement performance and stability were established. With 5 types of machine learning algorithms (logistic regression, random forest, support vector machine, K-nearest neighbor, and decision tree) adopted, the evaluative model was constructed, and the feature importance analyzed. RESULTS: In the evaluation of different types of MAM, the support vector machine presented the best for the effects of the balanced reinforcing and reducing by twisting, and the reducing by twisting (accuracy rates were both 0.88); and the logistic regression algorithm showed the optimal performance in evaluating the reinforcing by twisting (1.00 of accuracy rate). Feature importance analysis revealed that twisting velocity was the dominant parameter for evaluating the balanced reinforcing-reducing manipulation. The reinforcing and reducing of acupuncture techniques were more dependent on the left-hand twisting parameters and comprehensive performances, respectively. CONCLUSION The objective evaluative model of MAM based on three-dimensional motion tracking technology and machine learning demonstrates a reliable evaluative performance, providing a new technical approach to standardized assessment in acupuncture and moxibustion education.
Humans ; Male ; Acupuncture Therapy/instrumentation* ; Machine Learning ; Female ; Young Adult ; Adult ; Motion