Current formulation of objective performance criteria （OPC） in traditional Chinese medicine （TCM） faces methodological challenges， including poor reporting quality， insufficient standardization of methods， limited comparability of study populations， and inadequate consideration of the genetic and environment particularities of ethnic minority populations. In response to these issues， this paper proposes optimization strategies for setting OPC in TCM， with particular attention to ethnic minority medicine. These include improving methodological techniques and statistical descriptions， ensuring transparency in meta-analyses and data sources； standardizing the estimation of point estimates and confidence intervals， and incorporating multidisciplinary expert consensus for value determination； introducing local real-world data from the same period， especially cohort study evidence， to compensate for the lack of high-quality randomized controlled trial data. Through process transparency and dynamic updating mechanisms， the credibility of OPC method can be enhanced， thereby providing methodological support for strengthening evidence-based research capacity in this field.

BACKGROUND:Research suggests that exercise interventions may be more advantageous than pharmacologic treatments or dietary restriction alone for fat loss,but fewer studies have simultaneously examined the effects of training modalities and training cycles on visceral and subcutaneous fat in obese populations. OBJECTIVE:To investigate the impact of training modalities and training cycles on visceral and subcutaneous fat in recessive obesity female college students. METHODS:Sixty-three female college students with hidden obesity(body mass index<24 kg/m2 and body fat content percentage≥30%)were recruited from Zhengzhou College of Commerce and Industry,and were randomly divided into a high-intensity intermittent training group(n=32)and a moderate-intensity continuous training group(n=31)using the lottery method.Subjects in both groups performed exercise training of corresponding intensity on a running platform and ensured that the exercise volume of both groups was equal,3 times per week,every 4 weeks as one training cycle for 16 weeks.Before training and at the end of each training cycle,subjects'visceral fat,subcutaneous fat,and overall fat were measured using the corresponding test devices. RESULTS AND CONCLUSION:The repeated measures F results indicated that the main effects of training cycles on visceral fat area,visceral fat index,abdominal subcutaneous fat thickness,percentage of body fat and body mass index were significant,while the main effects of training modalities were significant for subcutaneous fat thickness in the triceps brachii and scapula regions.All the interaction effects between training modalities and training cycles were significant(P<0.05).Results from the simple effect tests revealed that the significant simple effects of training modalities at the 4th and 12th weeks for visceral fat area and visceral fat index,at the 8th and 12th weeks for subcutaneous fat thickness in the triceps brachii,scapula region,and abdominal regions,and at the 8th week for the percentage of body fat and body mass index.Simple effects of training cycles were significant for all measures within each group.(3)The results of multiple comparison tests indicated that in the high-intensity intermittent training group,visceral fat area,visceral fat index,percentage of body fat,body mass index and abdominal subcutaneous fat thickness decreased sequentially at the 4th,8th,12th,and 16th weeks,and subcutaneous fat thickness of the triceps brachii and scapula decreased sequentially at the 8th,12th,and 16th weeks(P<0.05).In the moderate-intensity continuous training group,visceral fat area,visceral fat index,subcutaneous fat thickness of the triceps brachii and scapula,percentage of body fat and body mass index decreased successively at the 8th,12th,and 16th weeks,while abdominal subcutaneous fat thickness decreased successively at the 4th,8th,12th,and 16th weeks(P<0.05).To conclude,both training modalities and training cycles are factors influencing visceral and subcutaneous fat in recessive obesity female college students.Training modality primarily affects subcutaneous fat in the triceps brachii and scapular region,but the fat loss effects may converge over a longer training cycle;training cycle primarily affects visceral fat area,visceral fat index,abdominal subcutaneous fat,body fat content,and body mass index.

Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Objective:To explore the real experience of patients with diffuse large B-cell lymphoma in clinical trials of chimeric antigen receptor T (CAR-T) cell therapy, providing reference for clinical practice.Methods:This study was descriptive qualitative research. From January to December 2024, 15 patients with diffuse large B-cell lymphoma who completed a clinical trial of CAR-T cell therapy in Ward of Biological Immunotherapy of the First Affiliated Hospital of Zhengzhou University were selected by purposive sampling method for semi-structured interviews. The data was analyzed by content analysis method.Results:The experience of patients with diffuse large B-cell lymphoma participating in the clinical trial of CAR-T cell therapy were summarized into three themes and 12 sub-themes, namely, the pre-enrollment situation and attitude towards the clinical trial: survival from adversity (caught in the dilemma of treatment, grasping the last hope, survival desire overcoming fear, active psychological construction), social support and power source in the clinical trial: support network (unnoticeable personal strength, multi-dimensional family support system, professional medical support system, weak peer support system), and experience and feeling after CAR-T cell therapy: positive experience driven by efficacy (satisfaction with treatment effectiveness and clinical trials, pleased with reduced adverse reactions, increased confidence in treating diseases, adverse reactions were not scary) .Conclusions:Patients with diffuse large B-cell lymphoma have an overall positive experience during clinical trials of CAR-T cell therapy, but the negatives should not be ignored. Healthcare professionals should strengthen the health education of clinical trials, assist patients to improve the social support network, make up for the short board of patient support, alleviate the adverse reactions of patients, and then increase the enthusiasm of patients to participate in clinical trials.

Objective:To establish a three-dimensional U-shaped residual coordinated attention network (URCA-Net) based on enhanced CT images for small bowel polyp detection and analyze its application effectiveness in intelligent detection of small bowel polyps.Methods:Abdominal CT data of patients with small bowel polyps were collected from the Air Force Medical Center between June 2019 and July 2023. All patients underwent bowel preparation followed by thin-slice spiral CT scanning to obtain enhanced CT arterial phase images. The data were randomly divided into training, validation and test sets in an 8∶1∶1 ratio. The URCA-Net deep learning model was used for small bowel polyp segmentation. The training set was used for model parameter training, the validation set for hyperparameter adjustment and monitoring of model generalization performance and the test set for final unbiased evaluation of the model. An early intelligent detection model for small bowel polyps was constructed, and its performance was evaluated. Evaluation metrics included pixel-level metrics for the segmentation task [Dice Similarity Coefficient (DSC)], as well as sensitivity and precision for polyp detection. A two-stage segmentation strategy was adopted: the first stage segmented the small bowel region to remove external interference, and the second stage performed polyp segmentation within the small bowel region.Results:A total of 78 subjects were included in the study, with an average age of (54±7) years. A total of 23 400 scan images were extracted, including 136 hyperplastic polyps, 298 hamartomatous polyps, 14 adenomatous polyps, and 4 cancerous polyps. On the test set, the average DSC for the first stage (small bowel segmentation) and the second stage (polyp segmentation) was 0.790 and 0.314, respectively. In the second stage task (polyp segmentation based on small bowel region), the polyp segmentation DSC increased to 0.701, with a precision of 0.836 (95% CI: 0.700-0.972) and a sensitivity of 0.759 (95% CI: 0.631-0.888) for polyp detection. Conclusion:The URCA-Net deep learning technique demonstrates good auxiliary diagnostic effectiveness in small bowel polyp detection and can provide a reference for screening and detection of small bowel polyps. The model is capable of generating high-quality segmentation results, which could facilitate evaluating polyp lesion morphology and provide support for downstream tasks such as preoperative navigation and risk prediction.

Objective:To study the relationship between serum adiponectin level and early vascular aging (EVA).Methods:The cross-sectional study method was used. Six hundred and seventy-two subjects who completed health checkup from June to December 2023 in the Affiliated Hospital of Qingdao University were selected. The subjects were divided into the EVA group (237 cases) and the control group (435 cases) based on brachial-ankle pulse wave velocity (baPWV). According to the adiponectin tertiles method, the subjects were divided into low adiponectin subgroup (2.4 to 6.6 mg/L, 225 cases), medium adiponectin subgroup (6.7 to 9.1 mg/L, 227 cases) and high adiponectin subgroup (9.2 to 19.8 mg/L, 220 cases). The basic demographic information, past history and serological indexes were recorded. Univariate and multivariate binary Logistic regression analyses were used to analyze the risk factors for EVA, and multivariate Logistic regression was used to analyze the effect of adiponectin on EVA.Results:The male proportion, age, body mass index (BMI), systolic blood pressure, diastolic blood pressure, triglycerides (TG), fasting blood glucose (FBG), uric acid, glycated hemoglobin (HbA 1c), homocysteine, baPWV and alcohol history proportion in EVA group were significantly higher than those in control group: 64.98% (154/237) vs. 53.33% (232/435), 53 (47, 57) years old vs. 46 (39, 52) years old, (26.34 ± 3.37) kg/m 2 vs. (25.16 ± 3.91) kg/m 2, (132.27 ± 15.48) mmHg (1 mmHg = 0.133 kPa) vs. (117.30 ± 13.04) mmHg, (81.79 ± 11.04) mmHg vs. (71.93 ± 10.10) mmHg, 1.45 (1.03, 2.03) mmol/L vs. 1.08 (0.76, 1.65) mmol/L, 5.52 (5.03, 6.21) mmol/L vs. 5.14 (4.77, 5.56) mmol/L, (380.04 ± 96.43) μmol/L vs. (362.18 ± 94.94) μmol/L, 5.80 (5.50, 5.90)% vs. 5.70 (5.40, 5.82)%, 10.70 (9.01, 12.90) μmol/L vs. 9.96 (8.30, 12.20) μmol/L, 1 586 (1 511, 1 719) cm/s vs. 1 299 (1 215, 1 367) cm/s and 19.41% (46/237) vs. 13.56% (59/435), the adiponectin was significantly lower than that in control group: 7.00 (5.70, 8.75) mg/L vs. 8.40 (6.40, 10.60) mg/L, and there were statistical differences ( P<0.01 or <0.05). There were no statistical differences in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine and smoking history proportion between two groups ( P>0.05). The male proportion, BMI, systolic blood pressure, diastolic blood pressure, TG, FBG, uric acid, creatinine, HbA 1c, homocysteine, EVA incidence, baPWV, smoking history proportion and alcohol history proportion in low adiponectin subgroup and medium adiponectin subgroup were significantly higher than those in high adiponectin subgroup, furthermore, the indexes except HbA 1c in low adiponectin subgroup were significantly higher than those in medium adiponectin subgroup, and there were statistical differences ( P<0.05); the HDL-C in low adiponectin subgroup and medium adiponectin subgroup was significantly lower than that in high adiponectin subgroup, furthermore, that in low adiponectin subgroup was significantly lower than that in medium adiponectin subgroup, and there were statistical differences ( P<0.05); there were no statistical differences in age, TC and LDL-C among the three subgroups ( P>0.05). Univariate binary Logistic regression analysis result showed that age, male, BMI, alcohol history, systolic blood pressure, diastolic blood pressure, TG, FBG, uric acid and HbA 1c were the risk factors for EVA ( P<0.01 or <0.05), while the adiponectin was a protective factor for EVA ( P<0.01). Multivariate binary Logistic regression analysis result showed that age, systolic blood pressure, TG and FBG were risk factors for EVA ( OR = 1.098, 1.066, 1.209 and 1.268; 95% CI 1.069 to 1.127, 1.050 to 1.082, 1.007 to 1.451 and 1.069 to 1.502; P<0.01 or <0.05), while adiponectin was a protective factor ( OR = 0.892, 95% CI 0.828 to 0.962, P<0.01). Multivariable Logistic regression analysis result showed that adiponectin consistently remained a protective factor for EVA across unadjusted, preliminary adjusted and fully adjusted covariate models ( OR = 0.553, 0.580 and 0.576; 95% CI 0.451 to 0.678, 0.440 to 0.764 and 0.435 to 0.763; P<0.01). Conclusions:The serum APN level is negatively correlated with the risk of EVA, which may be an independent protective factor for the EVA.

Since 2017,twelve chimeric antigen receptor gene-modified T lymphocyte(CAR-T cell)products have been approved for the treatment of hematological malignancies,including relapsed/refractory acute B lymphoblastic leukemia(B-ALL),specific subtypes of B cell lymphoma,and multiple myeloma.However,CAR-T cell therapy faces numerous challenges in its clinical application,such as resistance,lengthy production cycles,high individuation and costs in hematological tumors,and tumor heterogeneity/antigen escape,insufficient infiltration capability,immunosuppressive microenvironments,and poor therapeutic response in solid tumors.With the in-depth exploration of tumor immunology and the development of genetic engineering technology,various new strategies have been attempted to enhance the efficacy and generalizability of CAR-T cell therapy.This paper presents a commentary on CAR-T cell therapy,with a focus on key clinical issues and corresponding countermeasures,providing valuable insights for future basic research and clinical transformation of CAR-T cell therapy.

Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Objective:To explore the clinical efficacy of anterolateral thigh perforator flap (ALTPF) in treatment of extensive wound of Degree IV burns in limbs.Methods:A retrospective analysis was conducted on 9 patients who had extensive wound of Degree IV burns in limbs caused by stove burns admitted to Department of Burns and Plastic Surgery, the 988th Hospital of the Joint Logistics Support Force of the Chinese PLA between January 2017 and January 2024. Among the patients, there were 8 males and 1 female, aged between 36 and 63 years. Three patients had the wound from anterior leg to dorsal foot, 3 from leg down to ankle, 1 from forearm to hand and 2 from arm to forearm. Area of burns ranged from 20 cm × 15 cm to 30 cm × 25 cm, and all patients were treated by free ALTPF. According to whether the main artery at the recipient site was feasible for direct anastomosis with the vessels carried in flap, 4 patients were treated by bilateral parallel ALTPFs, and 5 were treated by unilateral ultra-long internally supercharged ALTPF. A total of 13 ALTPFs were harvested, with individual flap size at 20 cm × 8 cm to 46 cm × 12 cm. Donor sites were directly sutured. Time for flap harvesting, flap survival and wound healing time were records. Scheduled postoperative follow-up was conducted at outpatient clinic and via telephone interviews to evaluate functional recovery. Follow-up assessments included evaluation of flap condition, two-point discrimination (TPD), recovery of joint function at recipient sites, flap appearance and donor site recovery.Results:The time for flap harvest was 1.0 to 4.5 hours. All 13 ALTPFs successfully survived. The time from surgery to healing of recipient sites was 18 to 72 days, and all donor sites healed. Over the postoperative follow-up that lasted for 6 to 34 months, the recipient sites had found with good cosmetic outcomes, without osteomyelitis or deep tissue infection. Four ALTPFs in 2 patients were found swelling, which were revised at 6 months after surgery. Four ALTPFs in other 2 patients had pigment deposition at edges. One ALTPF was scalded, which healed after dressing changes but left with patchy scars. The remaining ALTPFs were soft, elastic, free from pain and well-perfused, with regained protective sensation at S 3. However, all of the ALTPFs failed to detect TPD. Six patients with lower limb injuries were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scoring system: 2 patients were rated as excellent and 4 were rated as good. Three patients with upper limb injuries were evaluated using Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association: 1 patient was rated as excellent and 2 were rated as good. Only linear scars left at the 13 donor sites, with normal blood supply to the distal limbs, and without restrictions in range of motion of knee joints nor muscle strength of quadriceps. Conclusion:The ALTPF offers advantages such as anatomical consistency, reliable blood supply and flexible combination in treatment of extensive wound of Degree Ⅳ burns in limbs. It is an ideal surgical procedure for treatment of large soft tissue defects of extremities.

Objective:To establish a three-dimensional U-shaped residual coordinated attention network (URCA-Net) based on enhanced CT images for small bowel polyp detection and analyze its application effectiveness in intelligent detection of small bowel polyps.Methods:Abdominal CT data of patients with small bowel polyps were collected from the Air Force Medical Center between June 2019 and July 2023. All patients underwent bowel preparation followed by thin-slice spiral CT scanning to obtain enhanced CT arterial phase images. The data were randomly divided into training, validation and test sets in an 8∶1∶1 ratio. The URCA-Net deep learning model was used for small bowel polyp segmentation. The training set was used for model parameter training, the validation set for hyperparameter adjustment and monitoring of model generalization performance and the test set for final unbiased evaluation of the model. An early intelligent detection model for small bowel polyps was constructed, and its performance was evaluated. Evaluation metrics included pixel-level metrics for the segmentation task [Dice Similarity Coefficient (DSC)], as well as sensitivity and precision for polyp detection. A two-stage segmentation strategy was adopted: the first stage segmented the small bowel region to remove external interference, and the second stage performed polyp segmentation within the small bowel region.Results:A total of 78 subjects were included in the study, with an average age of (54±7) years. A total of 23 400 scan images were extracted, including 136 hyperplastic polyps, 298 hamartomatous polyps, 14 adenomatous polyps, and 4 cancerous polyps. On the test set, the average DSC for the first stage (small bowel segmentation) and the second stage (polyp segmentation) was 0.790 and 0.314, respectively. In the second stage task (polyp segmentation based on small bowel region), the polyp segmentation DSC increased to 0.701, with a precision of 0.836 (95% CI: 0.700-0.972) and a sensitivity of 0.759 (95% CI: 0.631-0.888) for polyp detection. Conclusion:The URCA-Net deep learning technique demonstrates good auxiliary diagnostic effectiveness in small bowel polyp detection and can provide a reference for screening and detection of small bowel polyps. The model is capable of generating high-quality segmentation results, which could facilitate evaluating polyp lesion morphology and provide support for downstream tasks such as preoperative navigation and risk prediction.