Objective To observe the value of MR vessel wall imaging(VMI)for predicting instability status of intracranial aneurysm(IA).Methods MR angiography(MRA)and vascular wall imaging(VWI)data of 506 patients with single IA were retrospectively analyzed.Asymptomatic IA was included in stable status group(n=349),while those with enlargement during follow-up or threatened rupture symptoms were taken as instable status group(n=157).The patients were divided into training set(n=354)and validation set(n=152)at a ratio of 7:3.The least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression were performed to screen risk factors associated with IA instability based on clinical data,MRA and VWI manifestations.Then model 1 was constructed based the above indexes,while model 2 was established based only on MRA manifestations of IA.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting IA instability.Results LASSO and multivariate logistic regression showed that female patient,age＜50 years with history of cerebral infarction and IA wall enhancement on MRA were all independent predictors of IA instability status.The AUC of model 1 for predicting instability status of IA was 0.733 and 0.742 in training set and validation set,respectively,both higher than that of model 2(0.593 and 0.609,both P＜0.05).Conclusion MR VWI was helpful for predicting IA instability status.

Objective To observe the value of MR vessel wall imaging(VMI)for predicting instability status of intracranial aneurysm(IA).Methods MR angiography(MRA)and vascular wall imaging(VWI)data of 506 patients with single IA were retrospectively analyzed.Asymptomatic IA was included in stable status group(n=349),while those with enlargement during follow-up or threatened rupture symptoms were taken as instable status group(n=157).The patients were divided into training set(n=354)and validation set(n=152)at a ratio of 7:3.The least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression were performed to screen risk factors associated with IA instability based on clinical data,MRA and VWI manifestations.Then model 1 was constructed based the above indexes,while model 2 was established based only on MRA manifestations of IA.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting IA instability.Results LASSO and multivariate logistic regression showed that female patient,age＜50 years with history of cerebral infarction and IA wall enhancement on MRA were all independent predictors of IA instability status.The AUC of model 1 for predicting instability status of IA was 0.733 and 0.742 in training set and validation set,respectively,both higher than that of model 2(0.593 and 0.609,both P＜0.05).Conclusion MR VWI was helpful for predicting IA instability status.

Objective To explore the effect of Huangqi Yanghe Decoction on wound healing of diabetic foot ulcer(DFU)rats based on phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/nuclear factor-κB(NF-κB)signal pathway.Methods DFU rat model was constructed,and 48 rats successfully modeled were randomly divided into the model group,the Huangqi Yanghe Decoction low(8.5 g/kg)group,the Huangqi Yanghe Decoction high(17 g/kg)dose group and the Huangqi Yanghe Decoction high dose(17 g/kg)+LY294002(PI3K/AKT pathway inhibitor,0.3 mg/kg)group.There were 12 rats in each group.Another 12 rats were selected as the control group.Rats in each group were given corresponding drug intervention for 4 weeks.After the 14th and 28th day-administration,the general state and wound changes of rats were observed,and the wound healing rate was calculated.The fasting blood glucose(FBG)level of rats was measured,and the percutaneous partial pressure of oxygen(TcpO2)of tissue around the wound was detected.Serum levels of vascular endothelial growth factor(VEGF),hypoxia inducible factor-1α(HIF-1α),C-reactive protein(CRP)and interleukin(IL)-6 were determined by enzyme linked immunosorbent assay.Histopathological changes of the wound were observed by hematoxylin-eosin staining.Immunohistochemical staining was used to measure the microvascular density of rat wound tissue.The protein expression levels of PI3K,phosphorylated PI3K(p-PI3K),AKT,phosphorylated AKT(p-AKT),NF-κB p65,phosphorylated NF-κB p65(p-NF-κB p65)and NF-κB inhibitory protein α(IκB-α)in rat wound tissue were determined by Western blot assay.Results Rats in the control group had smooth hair color,normal diet,drinking water and excretion,more active,wound healing fast,less inflammatory reaction in wound tissue,and there were more new blood vessels.Fibroblasts and collagen matrix were abundant in granulation tissue.In the model group,the fur color of rats was dull and matte,and the activity was reduced.The symptoms of polydipsia,polyphagia and polyuria were appeared in the model group,the wound color was dark,and edema and ulcer appeared in the surrounding tissue,a large number of inflammatory cells infiltrated in the wound tissue,accompanied by tissue necrosis and exudation,fewer neovascularization and fibroblasts were observed.Wound healing rate,TcpO2 in wound surrounding tissue,serum VEGF,HIF-1α,microvascular density,p-PI3K,p-AKT and IκB-α protein expression levels in wound tissue were decreased,and FBG,serum CRP,IL-6,p-NF-κB p65 protein expression in wound tissue were increased(P＜0.05).Compared with the model group,the state of rats was gradually improved in the Huangqi Yanghe Decoction low and high dose groups,and the lesion degree of wound tissue was reduced successively,wound healing rate,TcpO2 in wound surrounding tissue,serum VEGF,HIF-1α,microvascular density,p-PI3K,p-AKT and IκB-α protein expression levels in wound tissue were increased in turn(P＜0.05).The FBG,serum CRP,IL-6 and p-NF-κB p65 protein expression in wound tissue were decreased in turn(P＜0.05).LY294002 could partially reverse the therapeutic effect of high-dose Huangqi Yanghe Decoction on DFU rats(P＜0.05).Conclusion Huangqi Yanghe Decoction can regulate PI3K/AKT/NF-κB pathway,inhibit inflammatory response in DFU rats,promote angiogenesis and thus promote wound healing.

OBJECTIVE To provide a reference for improving the relevant standard operating procedures （SOP） and biological sample management in drug clinical trials. METHODS According to Good Clinical Practice， Data On-site Verification Points of Drugs Clinical Trials， Human Genetic Resources Management Regulations Implementation Rules， Qualification Examination Rules of Drug Clinical Trials Institution， based on the experience of managing clinical trials programs， the irregularities in biological samples management were analyzed by using statistical quality control tables and protocol deviation （PD） reported by sponsors， in the context of the quality control of drug clinical trials projects managed by the author from July 2016 to May 2023. The precautions in various aspects of sample management were put forward. RESULTS & CONCLUSIONS A total of 101 biospecimen- related irregularities were found in the 60 drug clinical trials projects. Biological sample collection， preservation， and handling were the aspects with the highest incidence of irregular operations in biological sample management， accounting for 37.62%， 25.74%， and 21.78%， respectively. Regulating the management of biospecimens requires multiple efforts. The institutional office and the ethics committee carefully reviewed the consistency of the protocols， informed consent， and genetic office application involving biospecimen collection and handling when the project was initiated. Institutional office quality controllers should pay attention to the attendance and training of authorized personnel at project initiation. The principal investigator， research nurse， collector， handler， transporter， relevant personnel of the central laboratory， and institutional office quality controller have their roles during the project implementation phase. On this basis， all parties involved in the management of biological samples should do a good job of effective communication， find problems and report them in time， and conduct special studies on key aspects.

OBJECTIVE To investigate the current situation of clinical trial institutions in Chongqing after the recording system of clinical trial institutions, and to put forward suggestions. METHODS A total of 34 clinical trial institutions in Chongqing were selected as the research objects. The research contents mainly included the basic situation of the institutions, staffing, hardware and software construction, project operation and work difficulties, etc. Combined with the research results, suggestions were put forward for the difficulties of the new and old institutions in the operation of clinical trial institutions. RESULTS A total of 29 questionnaires were collected and 29 were valid. The release of clinical trial resources in Chongqing were not sufficient and uniform, there were problems such as insufficient incentive policies, lack of information platform construction, and the number and professional degrees of practitioners need to be improved. The new institutions had certain advantages in project load, office space and willingness to undertake, but it was restricted by principle investigator qualification, project experience and institutional reputation. CONCLUSION It is suggested to clarify the incentive mechanism, enhance the enthusiasm of clinical trials and establish a standardized training mechanism for clinical trial professionals. Make full use of the information platform to improve the efficiency of clinical trials, build a regional information platform to share information and resources, and accelerate the development of regional clinical trials.

Objective:To understand the current situation of psychological crisis vulnerability among elderly individuals with multimorbidity and analyze the factors that influence it, to provide insights for improving their coping abilities.Methods:A cross-sectional survey design was conducted at Renmin Hospital of Wuhan University from May 1 to November 30, 2022.The attitudes toward aging, sense of meaning of life, and vulnerability to psychological crisis were analysed among outpatients and inpatients.Statistical analysis was performed on the questionnaire results, and the influencing factors of vulnerability to psychological crisis in elderly patients with co-morbidities were analyzed using one-way linear regression and multivariate linear regression.Additionally, the correlation between aging attitudes, sense of meaning of life, and vulnerability to psychological crisis was examined using Pearson correlation analysis.Results:A total of 685 questionnaires were distributed, and 602 valid questionnaires were collected, resulting in a valid recovery rate of 87.9%.The total score for the sense of meaning of life in elderly co-morbid patients was(39.2±8.3), while the total score for aging attitudes was(80.2±13.5).The total score for psychological crisis vulnerability was(69.4±12.8), indicating a medium-high level of vulnerability.The results of multiple linear regression analysis revealed that the factors influencing psychological crisis vulnerability in elderly multimorbidity, in descending order, were residence status, economic situation, marital status, age, type of chronic disease, and hospitalization history in the past six months.Psychological crisis vulnerability in elderly multimorbidity showed a negative correlation with the sense of meaning of life and the attitude of aging( r=-0.315, -0.264, both P<0.01), while the attitude of aging exhibited a positive correlation with the sense of meaning of life( r=0.515, P<0.01). Conclusions:The vulnerability of elderly individuals with multimorbidity to psychological crises is influenced by several factors.Healthcare professionals should prioritize individuals who are elderly, residing in nursing institutions, widowed, financially disadvantaged, experiencing multiple illnesses, and not currently hospitalized.

Objective:To understand the cognition and training status of basic life support among medical staff in Linfen, Shanxi Province, and to provide reference for the development of targeted training strategies and programs.Methods:A questionnaire survey was conducted among medical staff in 12 county hospitals in Linfen, Shanxi Province by convenience sampling method. The survey included the general characteristics of departments and medical staff, previous basic life support training assessment and cognitive status.Results:A total of 839 medical staff were included, 756 (90.1%) completed the survey, 183 (24.2%) were doctors and 573 (75.8%) were nurses. Most personnel lacked awareness of environmental safety, emergency response system start-up, adequate compression, airway management, and electrical defibrillation.Conclusions:The cognitive status of basic life support of medical staff in Linfen county is not optimistic. It is necessary to construct an applicable precision training course and retraining assessment system to improve the cognitive level and practical operation ability.

Objective:To investigate the allele distribution of aldehyde dehydrogenase 2 (ALDH2) gene polymorphism in elderly patients with type 2 diabetes mellitus (T2DM) and to analyze its correlation with the presence and severity of coronary stenosis.Methods:A total of 94 elderly patients with T2DM who were admitted to the Affiliated Hospital of Jining Medical University from March 2020 to March 2022 were selected as the observation group, and 50 age- gender-matched healthy subjects were selected as the control group. The observation group was further divided into stenosis group and non-stenosis group based on the presence of coronary stenosis. Clinical data were collected from all participants, and blood samples were taken for analysis. The ALDH2 gene polymorphism (rs671 locus) was detected using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technology. The distribution of ALDH2 genotypes was observed in elderly patients with T2DM, and multivariate logistic regression analysis was used to identify independent factors associated with the development of coronary stenosis in elderly patients with T2DM. The degree of coronary stenosis was compared between patients with different genotypes.Results:The allele A frequency of ALDH2 gene (rs671 locus) was significantly higher in the observation group than in the control group ( P<0.05). The proportion of patients with diabetes duration≥5 years and smoking history in the stenosis group was significantly higher than that in the non-stenosis group (all P<0.05). Serum levels of glucose (GLU), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were significantly higher in the stenosis group than in the non-stenosis group, while high-density lipoprotein cholesterol (HDL-C) level was significantly lower in the stenosis group than in the non-stenosis group (all P<0.05). The proportion of ALDH2 genotypes AA and allele A frequency were significantly higher in the stenosis group than in the non-stenosis group (all P<0.05). Long duration of diabetes, low HDL-C level, and ALDH2 genotypes AA were independent risk factors for the development of coronary stenosis in elderly patients with T2DM (all P<0.05). The proportion of patients with three or more coronary artery lesions in the stenosis group with genotype AA was significantly higher than that in the stenosis group with genotypes GG and GA (all P<0.05). Conclusions:ALDH2 gene polymorphism is associated with the development of T2DM in elderly patients, and allele A carriers may have a higher risk of developing coronary stenosis and more severe disease severity.

OBJECTIVE To learn the common proto col deviation （PD）in the process of drug clinical trials and discuss the methods and precautions for preventing and reducing PD so as to provide reference for the standardization of drug clinical trials. METHODS According to Good Clinical Practice ，Notice on Issuing Guidelines for Planning and Reporting of Data Management and Statistical Analysis of Drug Clinical Trials ，Guidelines for Ethical Review of Drug Clinical Trials ，ICH E 3，ICH E 6（R2）and other regulations ，the PD reported in the relevant projects managed by the author from March 2017 to February 2022，as well as the PD found in the submission materials and project quality control ，were sorted out and statistically analyzed. RESULTS & CONCLUSIONS A total of 39 drug clinical trials were included ，and 212 subjects were selected. In all projects ，258 PDs were reported，including 28 major PD （accounting for 10.85％）and 230 ordinary PD （accounting for 89.15％）. The report of PD mainly included missed inspections/tests （93 reports，accounting for 36.05％），lack of visits （36 reports，accounting for 13.95％）， inspection/testing out-of-window （29 reports，accounting for 11.24％），dosage and usage of test drugs （28 reports，accounting for 10.85％），drug over-temperature/missing temperature （21 reports，accounting for 8.14％），etc. Avoiding and reducing the occurrence of PD requires the efforts of multiple parties ：the sponsor designs a reasonable protocol with appropriate interview rate and window period after listening to the opinions of multiple parties ；the investigators and clinical research coordinator should strengthen their own learning and training ，and be familiar with the protocol ，Good Clinical Practice and corresponding regulations；the compliance education of the subjects should be strengthened ；the institutional offices and ethics committees should conduct multi-angle and whole-process supervision and management when a drug clinical trial is approved ，in progress ，and jsyj- concluded，to ensure the safety rights and interests of the zdcxX0079） subjects and the quality of clinical trials. On this basis ，all parties should communicate effectively and timely ，report PD in time ，and conduct special studies on major PD that have com occurred and key links that are prone to PD.

Objective To compare rotational techniques used by Chinese and world elite men’s shot put athletes, so as to provide scientific references for Chinese male shot putters to improve their sports performance and results in international competitions. Methods Three-dimensional (3D) kinematics data from Chinese male shot putters in actual competitions were obtained, and kinematic parameters of Chinese and world elite men’s shot put athletes were calculated and compared. Namely, shot velocities and hip-shoulder separation angles at five critical instants of rotational techniques: right foot off, left foot off, right foot touchdown, left foot touchdown and release, as well as phase durations and shot travel distances during four critical phases: first single support, air-born flight, second single support and final delivery. ResultsCompared with world elite athletes, Chinese male shot putters using rotational techniques had significantly lower vertical release velocity, longer air-borne duration, smaller hip-shoulder separation angles at left foot off and touchdown instant, and longer shot travel distance during air-borne flight, but shorter shot travel distance during final shot delivery. Conclusions The difference in lower extremity strength is a primary casue leading to different sports performance between Chinese and world elite male shot putters. The technique differences in Chinese and world elite male shot putters mainly lie in different phase timing and shot travel distances during different techinique phases.