OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

OBJECTIVE:Repetitive transcranial magnetic stimulation and transcranial direct current stimulation have shown positive effects in improving gross motor function in children with cerebral palsy.A network meta-analysis was performed to analyze the clinical efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation on the improvement of lower limb motor function and gait in children with cerebral palsy.METHODS:Randomized controlled trials(RCT)about repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor function and gait in children with cerebral palsy were collected from CNKI,WanFang,VIP,SinoMed,PubMed,Web of Science,Medline.The search time limit was from the inception to October 5,2024.After screening literature,extracting data and evaluating the risk of bias of included studies,Stata 15.0 software was used for network meta-analysis,AND GRADE profiler was used for quality evaluation.RESULTS:A total of 19 studies were included,involving 4 treatment measures:conventional therapy,high-frequency repetitive transcranial magnetic stimulation,low-frequency repetitive transcranial magnetic stimulation and anodic transcranial direct current stimulation.The results of network meta-analysis showed that in terms of improving gross motor function,low-frequency repetitive transcranial magnetic stimulation[mean difference(MD)=9.48,95％confidence interval(CI)(6.61,12.34),P＜0.05]was the most effective.In terms of alleviating spasticity,high-frequency repetitive transcranial magnetic stimulation[MD=-0.63,95％CI(-1.72,0.45),P＜0.05]had the best efficacy.In terms of improving ankle joint range of motion and step speed,transcranial direct current stimulation[MD=2.27,95％CI(1.37,3.17),P＜0.05;MD=0.11,95％CI(0.05,0.17),P＜0.05]was the most effective.CONCLUSION:Existing clinical evidence suggests that low-frequency repetitive transcranial magnetic stimulation has the best therapeutic effect compared with other intervention measures in terms of improving lower limb gross motor function.In terms of reducing spasticity,high-frequency repetitive transcranial magnetic stimulation has a more significant effect.In terms of improving gait,transcranial direct current stimulation has more advantages.

A 34-year-old female patient with multiple injuries in a car accident was admitted to hospital and received inosine injection.After 11 days,leukemioid reaction mainly characterized by"abnormal increase in white blood cell count"occurred,and the white blood cell count reached up to 38.26×109·L-1.Considering that inosine injection was the cause,the white blood cell count gradually decreased to 15.84×109·L-1 after the drug was stopped.Naranjo's assessment scale was used to evaluate the association of adverse reactions,with a score of 6,and the result was"very likely to be relevant".The cases reported in this paper belong to new adverse reactions caused by inosine injection,suggesting that inosine injection as an adjunct should pay attention to drug safety.If there is an abnormal increase in white blood cell count,it is necessary to be alert to the possibility of"leukemioid reaction"and stop the drug in time if necessary.

Objective The objective of this study was to investigate the effects of maytansine on proliferation,migration,in-vasion,apoptosis and autophagy of human thyroid cancer C643 cells.Methods C643 cells were treated with different concentrations(0.049,0.195,0.781,3.125,12.5,50 and 200 μmol/L)of maytansine,the effect of maytansine on the proliferation of C643 cells was detected by the sulforhodamine B(SRB)method,and the concentration of subsequent experiments was determined.C643 cells in the logarithmic growth stage period were divided into the control group,low-dose group,mid-dose group and high-dose group.The effects of maytansine on migration and invasion abilities of C643 cells were detected by cell scratch and Transwell chamber assay;The levels of reactive oxygen species(ROS)were detected by 2′,7′-dichlorofluorescein diacetate(DCFH-DA)fluorescent probe experi-ment;The apoptosis rate of C643 cells was detected by flow cytometry;The expression of proteins related to apoptosis or autophagy was detected by Western blot.Results Maytansine at concentrations of 0.049,0.195,0.781,3.125,12.5,50 and 200 μmol/L could in-hibit the proliferation of C643 cells(P<0.05),and exhibited a significant concentration time dependence.The half maximal inhibitory concentrations(IC50)at 24,48 and 72 h were 54.255,5.193 and 0.647 μmol/L,respectively;The cell scratch and Transwell chamber results showed that maytansine at concentrations of 0.1,1 and 10 μmol/L could reduce the migration and invasion abilities of C643 cells(P<0.05 and P<0.01).The fluorescence probe results showed that maytansine at concentrations of 0.1,1 and 10μmol/L could increase the intracellular ROS levels of C643 cells(P<0.01).The flow cytometry results showed that maytansine at concentrations of 0.1,1 and 10 μmol/L could concentration dependently increase the apoptosis rate of C643 cells(P<0.01).The Western blot results showed that with the increase of maytansine concentrations,the expression of Bax protein related to apoptosis in C643 cells increased(P<0.05),the expression of Bcl-2 decreased(P<0.05),the expression of LC3Ⅱ/Ⅰ(P<0.05)and Beclin-1(P<0.01)increased,while the expression of p62 decreased(P<0.001).Conclusion Maytansine can inhibit the proliferation,migration and invasion of human thyroid cancer C643 cells,and induce the synergistic effect on apoptosis and autophagy by increasing intracellular ROS levels.

Objective:To assess the efficacy and safety of Gongxuening Capsules in reducing post-abortion bleeding following artificial abortion.Methods:A multicenter, randomized, double-blind study was conducted. From May 31, 2022 to March 31, 2023, 484 women who underwent vacuum aspiration abortion for early intrauterine pregnancy were enrolled in 11 centers and randomly assigned to control group and the study group at a 1∶1 ratio using a center-block randomization method. Control group were administered a placebo of Gongxuening Capsules for 9 d, while the study group received the actual Gongxuening Capsules for the same duration. The outcomes measured included vaginal bleeding volume, duration of vaginal bleeding, endometrial thickness, time to menstrual recovery, and complications.Results:1) A total of 484 subjects were enrolled, and 472 completed the study. Totally 450 subjects were included in the efficacy analysis set, with 224 in control group and 226 in the study group; 468 subjects were included in the safety analysis set, with 236 in control group and 232 in the study group. The baseline characteristics of the two groups were comparable (all P>0.05). 2) The vaginal bleeding volume was lower in the study group [(13.30±12.14) mL] than in control group [(19.00±17.67) mL, P<0.001]. The proportion of subjects in the study group with bleeding days less than 4 d [29.65% (67/226)] was higher than that in control group [19.20% (43/224), P=0.010]. 3) No significant differences were observed between the two groups in terms of time to menstrual recovery and endometrial thickness (all P>0.05). 4) In the study group, 3 subjects experienced non-therapeutic-related complications, while 11 subjects in control group. The incidence of complications was lower in the study group [1.29% (3/232)] than in control group [4.66% (11/236), P=0.033]. Conclusion:The administration of Gongxuening Capsules to women following artificial abortion significantly reduced vaginal bleeding volume and was associated with good safety, with the treatment being well-tolerated by the subjects.

Objective To explore the effect of scalp combined with intradermal-needle acupuncture synchronized rehabilitation ther-apy on upper limb motor function in stroke patients.Methods From December,2022 to December,2023,144 stroke patients with upper limb motor dysfunction in the Affili-ated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control,intra-dermal-needle,scalp-acupuncture and acupuncture groups(36 cases repectively).All groups received convention-al treatment and upper limb rehabilitation training,the intradermal-needle group added intradermal-needle thera-py,the scalp-acupuncture group added scalp-acupuncture therapy,and the acupuncture group added both scalp-and intradermal-needle therapies,for four weeks.They were assessed with Fugl-Meyer Assessment-Upper Ex-tremities(FMA-UE),Wolf Motor Function Test(WMFT)and modified Barthel Index(MBI)before and after treatment.Twenty cases were selected randomly from each group,fractional anisotropy(FA)values and ratio of fractional anisotropy(rFA)of the lesion area and the posterior limb of the internal capsule were also measured with diffusion tensor imaging.Results Two cases dropped out in both the control group and the intradermal-needle group,while one case dropped out in both the scalp-acupuncture group and the acupuncture group.All groups showed significant improvement in FMA-UE,WMFT and MBI scores,as well as in the FA and rFA values of the lesion area and the posterior limb of the internal capsule(t>5.532,P<0.001)after treatment.The acupuncture group demonstrated the greatest pre-to post-treatment differences in FMA-UE scores,lesion-area FA and rFA values,and posterior-limb rFA val-ues compared with the other three groups(|Z|>3.256,P<0.05),and more WMFT and MBI improvements than those of the intradermal-needle group and the control group(|Z|>5.483,P<0.001).A significant interaction ef-fect was observed between intradermal and scalp acupuncture in improving FMA-UE scores(partial η2=0.035,P=0.029).The change in FMA-UE scores was positively correlated with the change in FA values of the posteri-or limb of the internal capsule(r>0.453,P<0.05)across four groups.Conclusion Scalp combined with intradermal-needle acupuncture synchronized rehabilitation therapy can more effec-tively improve upper-limb motor function in stroke patients,which may associate with the recovery of internal capsule.

Objective Through organizing a proficiency evaluation activity for animal illuminance testing laboratories,to assess the accuracy of testing data from participating laboratories,and to propose suggestions for testing methods.Methods In September 2024,China National Institute for Food and Drug Control(NIFDC)organised reference laboratories to conduct on-site testing through open registration.A total of 35 laboratories participated,completed on-site testing,and submitted their reports.The samples to be tested were two adjacent guinea pig breeding rooms in the NIFDC laboratory animal facility.In order to reduce the impact of room voltage fluctuations on animal illumination,chip on board(COB)light sources powered by regulated power supply were used,and brightness was adjusted by regulating voltage output.Split-level test sample pairs were used to set animal illuminance in both rooms,and the reference laboratories conducted testing according to Laboratory animals——Environment and housing facilities(GB 14925-2023).Each reference laboratory was assigned a 3-digit random code,conducted 2 tests for each breeding room,and submitted an on-site test report,original records,and illuminance meter verification or calibration certificate.WPS Spreadsheet 12.1 was used to summarize data,Grubbs' test(α=0.01)was used to check the data and remove outliers,and SPSS 26.0 software was used for data processing and graph drawing.The median value from each reference laboratory was used as the specified value,the robust standard deviation was used as the uncertainty,the robust z-score method(both intra-laboratory and inter-laboratory z-scores)was used to evaluate the test results from each laboratory,and the factors affecting results were analyzed from aspects of personnel,equipment,and operational environment.Results Under the detection level of α=0.01,no outliers were identified.The specified values for Room 1 and Room 2 were 17.80 lx and 19.00 Ix,respectively.The results obtained from 34 laboratories were evaluated as"satisfactory",while the results from one laboratory were"unsatisfactory".Through analysis of illuminance meter calibration certificates from various laboratories,it was found that some reference laboratories had insufficient calibration points and coverage,which caused test results to fail to accurately reflect the actual illuminance of the facility.Conclusion The present study reveals that factors such as personnel,equipment,and operation environment have different impacts on animal illuminance measurements.The present study concentrates exclusively on animal illuminance in guinea pig breeding rooms,where the testing environment is relatively dim.Future research should focus on the development of more efficient methods for selecting measurement sites,with the combination of illuminance meters equipped with wireless probes and storage functions to enhance testing efficiency.

Objective To explore the effect of scalp combined with intradermal-needle acupuncture synchronized rehabilitation ther-apy on upper limb motor function in stroke patients.Methods From December,2022 to December,2023,144 stroke patients with upper limb motor dysfunction in the Affili-ated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control,intra-dermal-needle,scalp-acupuncture and acupuncture groups(36 cases repectively).All groups received convention-al treatment and upper limb rehabilitation training,the intradermal-needle group added intradermal-needle thera-py,the scalp-acupuncture group added scalp-acupuncture therapy,and the acupuncture group added both scalp-and intradermal-needle therapies,for four weeks.They were assessed with Fugl-Meyer Assessment-Upper Ex-tremities(FMA-UE),Wolf Motor Function Test(WMFT)and modified Barthel Index(MBI)before and after treatment.Twenty cases were selected randomly from each group,fractional anisotropy(FA)values and ratio of fractional anisotropy(rFA)of the lesion area and the posterior limb of the internal capsule were also measured with diffusion tensor imaging.Results Two cases dropped out in both the control group and the intradermal-needle group,while one case dropped out in both the scalp-acupuncture group and the acupuncture group.All groups showed significant improvement in FMA-UE,WMFT and MBI scores,as well as in the FA and rFA values of the lesion area and the posterior limb of the internal capsule(t>5.532,P<0.001)after treatment.The acupuncture group demonstrated the greatest pre-to post-treatment differences in FMA-UE scores,lesion-area FA and rFA values,and posterior-limb rFA val-ues compared with the other three groups(|Z|>3.256,P<0.05),and more WMFT and MBI improvements than those of the intradermal-needle group and the control group(|Z|>5.483,P<0.001).A significant interaction ef-fect was observed between intradermal and scalp acupuncture in improving FMA-UE scores(partial η2=0.035,P=0.029).The change in FMA-UE scores was positively correlated with the change in FA values of the posteri-or limb of the internal capsule(r>0.453,P<0.05)across four groups.Conclusion Scalp combined with intradermal-needle acupuncture synchronized rehabilitation therapy can more effec-tively improve upper-limb motor function in stroke patients,which may associate with the recovery of internal capsule.

Objective:To explore the treatment methods and prognosis of pregnancy-related uterine arteriovenous malformation (UAVM).Methods:A retrospective analysis was conducted on clinical data from 81 patients with UAVM treated at Peking Union Medical College Hospital between March 2019 and March 2024. Clinical manifestations, diagnostic approaches, treatment strategies and prognosis were evaluated.Results:(1) General Information: the age of patients with UAVM was (32.7±4.6) years, with median gravidity and parity of 1 (quartile range: 1, 2) and 0 (0, 1), respectively. Pregnancy termination methods included surgical abortion or curettage in 46 cases (57%, 46/81), medical induction in 17 cases (21%, 17/81), spontaneous abortion in 16 cases (20%, 16/81), vaginal delivery in 1 case (1%, 1/81), and laparoscopic pregnancy tissue removal in 1 case (1%, 1/81). (2) Clinical manifestations: clinical presentations comprised vaginal bleeding in 59 cases [73%, 59/81; median blood loss: 740 ml (440, 1 360 ml)], massive hemorrhage in 9 cases (11%, 9/81, and bleeding combined with lower abdominal pain in 8 cases (10%, 8/81). Ultrasonography revealed intrauterine masses in 65 cases [80%, 65/81; median size: 2.5 cm (1.8, 4.2 cm)]. Elevated serum human chorionic gonadotrophin-β subunit (β-hCG) levels were observed in in 55 cases [85%, 55/65; median: 62.6 U/L (14.9, 300.1 U/L)]. The median time to UAVM diagnosis via ultrasound was 30.0 days (16.0, 52.0 days) after pregnancy termination, with median peak systolic velocity (PSV) and resistance index of 59.8 cm/s (45.0, 79.6 cm/s) and 0.39 (0.36, 0.43), respectively. (3) Treatment and prognosis: treatment modalities included expectant management in 49 cases (36%, 29/81), medication in 13 cases (16%, 13/81), lesion resection in 31 cases (38%, 31/81), and uterine artery angiography in 8 cases (10%, 8/81; 5 confirmed as arteriovenous fistula). The median time of PSV returning to normal after treatment was 53.8 days (36.0, 93.4 days). The average time for β-hCG returning to normal was (60.4±20.4) days. The median return time of menses was 59.0 days (43.0, 75.4 days).Conclusions:Pregnancy-related UAVM carries a high risk of life-threatening hemorrhage, necessitating management in centers equipped for emergency uterine artery embolization. Informed consent must emphasize disease progression risks and prognosis. Treatment stratification should integrate clinical parameters and imaging features.

Objective Through organizing a proficiency evaluation activity for animal illuminance testing laboratories,to assess the accuracy of testing data from participating laboratories,and to propose suggestions for testing methods.Methods In September 2024,China National Institute for Food and Drug Control(NIFDC)organised reference laboratories to conduct on-site testing through open registration.A total of 35 laboratories participated,completed on-site testing,and submitted their reports.The samples to be tested were two adjacent guinea pig breeding rooms in the NIFDC laboratory animal facility.In order to reduce the impact of room voltage fluctuations on animal illumination,chip on board(COB)light sources powered by regulated power supply were used,and brightness was adjusted by regulating voltage output.Split-level test sample pairs were used to set animal illuminance in both rooms,and the reference laboratories conducted testing according to Laboratory animals——Environment and housing facilities(GB 14925-2023).Each reference laboratory was assigned a 3-digit random code,conducted 2 tests for each breeding room,and submitted an on-site test report,original records,and illuminance meter verification or calibration certificate.WPS Spreadsheet 12.1 was used to summarize data,Grubbs' test(α=0.01)was used to check the data and remove outliers,and SPSS 26.0 software was used for data processing and graph drawing.The median value from each reference laboratory was used as the specified value,the robust standard deviation was used as the uncertainty,the robust z-score method(both intra-laboratory and inter-laboratory z-scores)was used to evaluate the test results from each laboratory,and the factors affecting results were analyzed from aspects of personnel,equipment,and operational environment.Results Under the detection level of α=0.01,no outliers were identified.The specified values for Room 1 and Room 2 were 17.80 lx and 19.00 Ix,respectively.The results obtained from 34 laboratories were evaluated as"satisfactory",while the results from one laboratory were"unsatisfactory".Through analysis of illuminance meter calibration certificates from various laboratories,it was found that some reference laboratories had insufficient calibration points and coverage,which caused test results to fail to accurately reflect the actual illuminance of the facility.Conclusion The present study reveals that factors such as personnel,equipment,and operation environment have different impacts on animal illuminance measurements.The present study concentrates exclusively on animal illuminance in guinea pig breeding rooms,where the testing environment is relatively dim.Future research should focus on the development of more efficient methods for selecting measurement sites,with the combination of illuminance meters equipped with wireless probes and storage functions to enhance testing efficiency.