Early neurological deterioration(END)occurs in patients with acute cerebral infarction after recombinant tissue-plasminogen activator(rt-PA)intravenous thrombolysis,which seriously affects the prognosis of patients and even causes death.However,there is no effective treatment.This report describes two patients with acute ischemic stroke presenting with right-sided limb weakness within 4.5 hours of onset.Brain CT ruled out cerebral hemorrhage and both patients were diagnosed with acute ischemic stroke.END occurred within 24 hours after intravenous thrombolysis with rt-PA.Reexamine Brain CT showed no evidence of cerebral hemorrhage.The patients were treated with continuous tirofiban infusion for 48 hours,overlapping with oral antiplatelet therapy for 4 hours and 6 hours,respectively.After discontinuation of tirofiban,no further neurological deterioration was observed.At the 3-month follow-up,there was no recurrence,and the modified Rankin scale(mRS)scores were 1 and 3,respectively.This study delineates the diagnostic and therapeutic trajectories of two paradigmatic cases to inform clinical decision-making for analogous presentations,thereby contributing to evidence-based management strategies.

Objective:To learn about the sales situation of edible salt in Gansu Province after the reform of salt industry system, and provide scientific basis for improving the prevention and control measures of iodine deficiency disorders (IDD).Methods:In 2022, a cross-sectional study method was used to divide the counties (districts) under 11 cities (prefectures) in Gansu Province into urban, suburban, and rural areas. A stratified sampling method was used to divide each city (prefecture) into five regions (east, west, south, north, and center), and 1 county (district) was randomly selected from each region. From each county (district), 5 - 10 edible salt sales outlets of varying scales were selected in each of the five directions. A questionnaire survey was used to investigate the quantity, type, price of edible salt sold, and IDD education efforts in each county (district) in the past six months. One bag of different types of edible salt sold at each sales outlet was randomly selected as a sample, and information such as the brand, manufacturer, and iodine level indicated on the outer packaging was recorded.Results:A total of 1 189 edible salt sales outlets were surveyed, including 157 large supermarkets, 197 medium-sized supermarkets, 760 small supermarkets (convenience/retail stores), 74 vegetable markets (farmers' markets), and 1 specialty salt store. The outlets were distributed in urban (438), suburban (99), and rural (652) areas. Among them, 12.11% (144/1 189) of the outlets sold both iodized and non-iodized salt. A total of 2 004 036 bags of edible salt were sold in 1 189 sales outlets, with a median sales quantity of 250 bags. There were statistically significant differences in sales quantity among sales outlets of different sizes and locations ( H = 57.97, 39.59, P < 0.001). The overall sales of iodized salt were higher than those of non-iodized salt ( Z = - 6.45, P < 0.001). Sales varied significantly by price ( H = 80.69, P < 0.001). A total of 1 740 samples of edible salt were surveyed, including 38 brands. Among them, China Salt Industry Group Co., Ltd. and its affiliated local companies had the highest sales quantity at 70.86% (1 233/1 740). The proportion of samples with iodine level < 5, 18 - 33, and 21 - 39 mg/kg indicated on the outer packaging was 4.08% (71/1 740), 7.01% (122/1 740), and 88.91% (1 547/1 740), respectively. Among 1 189 sales outlets, 26.24% (312/1 189) were aware of the iodine standard for edible salt in Gansu Province, 32.46% (386/1 189) had set up propaganda signs (slogans) for prevention and control of IDD, 59.13% (703/1 189) were aware of recommending iodized salt to pregnant women, and 51.39% (611/1 189) actively promoted knowledge of IDD prevention and control. Conclusions:After the reform of salt industry system, the sales network system of edible salt in Gansu Province has been improved, with multiple entities, brands, and varieties coexisting in the edible salt market. However, there is still a need to strengthen sales supervision and scientific iodine supplementation health education.

The axillary management of breast cancer patients after neoadjuvant therapy(NAT)is undergoing optimization.Sentinel lymph node biopsy(SLNB)has become an important means for evaluating the status of axillary lymph node(ALN),especially in early-stage breast cancer patients with initially clinically negative ALN(cN0),where it can replace traditional ALN dissection(ALND)to reduce unnecessary surgical risks and complications.However,SLNB has some limitations in terms of false negative rate(FNR)and variability when applied to breast cancer patients with initially clinically positive ALN(cN+)after NAT.By removing≥3 SLN,using dual tracers(such as radioactive isotopes combined with blue dye),and conducting pathological assessment in combination with immunohistochemistry(IHC),the FNR can be significantly reduced to an acceptable range(4.9%-9.1%).Moreover,various optimization schemes have been developed,such as marking ALN with radioactive iodine(MARI),targeted axillary dissection(TAD),and radioactive iodine seed placement in the axilla with SLNB(RISAS),all of which demonstrate low FNR.Not only that,non-invasive imaging techniques such as positron emission tomography and computed tomography(PET/CT),magnetic resonance imaging(MRI),conventional ultrasound and contrast-enhanced ultrasound(CEUS)can all be used to evaluate the axillary response after NAT,with varying diagnostic efficacies.This article summarized recent studies on the optimization of axillary management and SLNB diagnosis and treatment for breast cancer patients with cN+after NAT.

MicroRNA(miRNA),an important type of non-coding RNAs existing widely in viruses and eukaryotes,regulate gene expression at transcriptional and post-transcriptional levels.Recent studies have demonstrated that plant miRNAs could enter microorganisms,animals and human bodies to affect their physiological and pathological processes by cross-kingdom regulation of gene expression.This review summarized the current knowledge of cross-kingdom regulation of gene expression by plant miRNAs,introduced the research progress in intervention of human diseases with plant miRNAs,including anti-virus,anti-tumor,anti-inflammation,immune regulation,anti-fatigue,anti-fibrosis,vascular protection,nerve protection,etc.,and analyzed the reasons why plant miRNAs remain stable in vivo and in vitro and the underlying mechanisms how they regulate human gene expression.Furthermore,the impact of cross-kingdom regulation by plant miRNAs on exploring new active ingredients of traditional Chinese herbs and elucidating their pharmacology were evaluated.Finally,"constructing the complex regulatory network of traditional Chinese medicine miRNAs in human body"and"exploring new mechanisms of gene expression regulation by traditional Chinese medicine miRNAs"were pointed out,which were two scientific problems worthy of further investigation.

The axillary management of breast cancer patients after neoadjuvant therapy(NAT)is undergoing optimization.Sentinel lymph node biopsy(SLNB)has become an important means for evaluating the status of axillary lymph node(ALN),especially in early-stage breast cancer patients with initially clinically negative ALN(cN0),where it can replace traditional ALN dissection(ALND)to reduce unnecessary surgical risks and complications.However,SLNB has some limitations in terms of false negative rate(FNR)and variability when applied to breast cancer patients with initially clinically positive ALN(cN+)after NAT.By removing≥3 SLN,using dual tracers(such as radioactive isotopes combined with blue dye),and conducting pathological assessment in combination with immunohistochemistry(IHC),the FNR can be significantly reduced to an acceptable range(4.9%-9.1%).Moreover,various optimization schemes have been developed,such as marking ALN with radioactive iodine(MARI),targeted axillary dissection(TAD),and radioactive iodine seed placement in the axilla with SLNB(RISAS),all of which demonstrate low FNR.Not only that,non-invasive imaging techniques such as positron emission tomography and computed tomography(PET/CT),magnetic resonance imaging(MRI),conventional ultrasound and contrast-enhanced ultrasound(CEUS)can all be used to evaluate the axillary response after NAT,with varying diagnostic efficacies.This article summarized recent studies on the optimization of axillary management and SLNB diagnosis and treatment for breast cancer patients with cN+after NAT.

Objective:This study aims to systematically compare the differences in severity, clinical manifestations, and treatment processes between patients with foodborne and iatrogenic botulism, thereby providing evidence-based support for clinical diagnosis and management.Methods:A retrospective analysis was conducted on botulism patients admitted to the Second Hospital of Hebei Medical University between January 2010 and July 2024. The foodborne group was diagnosed according to the WS/T 83-1996 standard. The iatrogenic group required a documented history of type A botulinum toxin injection and typical clinical manifestations. Individuals with comorbid neurological disorders or incomplete clinical data were excluded. The severity of poisoning was classified into three groups: mild, moderate, and severe, according to the "Diagnosis and Treatment Protocol for Botulism". SPSS 26.0 software was used to statistically analyze the distribution of poisoning severity between groups and to compare clinical symptoms and course indicators across severity grades.Results:A total of 220 botulism patients were included in this study, comprising 86 cases of foodborne poisoning (39.1%) and 134 cases of iatrogenic poisoning (60.9%). There was a significant difference in the distribution of poisoning severity between the two groups ( P=0.001), the proportion of severe poisoning was significantly higher in the foodborne group. Analysis of clinical symptoms indicated that, among patients with mild poisoning, the incidence of nausea and vomiting was significantly higher in the foodborne group, compared to that in the iatrogenic group (44.0% vs. 16.4%, P=0.006). In patients with moderate poisoning, the iatrogenic group exhibited a significantly higher prevalence of hoarseness (60.5% vs. 35.7%, P=0.041) and neck weakness (53.5% vs. 17.9%, P=0.003) compared to the foodborne group. Conversely, the foodborne cohort experienced a notably longer interval before seeking medical attention when compared to their iatrogenic counterparts (2.25 d vs. 1.50 d, P=0.003). Among severe poisoning patients, the foodborne group exhibited a higher likelihood of experiencing fever (51.5% vs. 25.0%, P=0.044) and abdominal distension accompanied by constipation (69.7% vs. 41.7%, P=0.034) when compared to the iatrogenic group. Furthermore, the foodborne cohort demonstrated a significantly shorter incubation period (1.00 d vs. 2.45 d, P<0.001), an extended length of hospitalization (22.0 d vs. 16.00 d, P=0.001), and a prolonged duration of antitoxin therapy (14.00 d vs. 9.50 d, P<0.001), alongside a markedly higher total dosage administered (315 900 U vs. 163 300 U, P<0.001) compared to their iatrogenic counterparts. Conclusions:Statistically significant differences exist between food-borne and iatrogenic botulism. Food-borne botulism is characterized by acute onset, greater severity, and a prolonged course, predominantly featuring systemic symptoms and gastrointestinal dysfunction. In contrast, iatrogenic botulism primarily manifests with ocular and oropharyngeal muscle symptoms and is generally less severe.

Objective: To analyze the trend of the incidence of pulmonary tuberculosis in Yecheng County of Xinjiang from 2011 to 2022 and the influence of age, period and birth cohort effect on the incidence of pulmonary tuberculosis, so as to provide a new theoretical reference for the prevention and control of local pulmonary tuberculosis. Methods : Based on the registration data of new pulmonary tuberculosis cases in Yecheng County, Xinjiang from 2011 to 2022, the connection point regression model was used to calculate the crude incidence rate, age-standardized incidence rate, annual percentage change(APC), and average annual percentage change(AAPC) to describe the epidemic trend of pulmonary tuberculosis. The age-period-cohort model was used to explore the influence of age, period and birth cohort effect on the trend of pulmonary tuberculosis incidence. Results : From 2011 to 2022, a total of 17 057 new cases of pulmonary tuberculosis were registered in Yecheng County, Xinjiang. The crude incidence and standardized incidence were 416.07/100 000 and 496.01/100 000, respectively. The incidence of pulmonary tuberculosis increased first and then decreased during the 12 years, with an upward trend from 2011 to 2018. The APC values of the standardized incidence of pulmonary tuberculosis in the total population, males and females were 24.42%(95%CI: 11.55-38.78), 27.24%(95%CI: 12.35-44.10) and 21.79%(95%CI: 9.81-35.09), respectively. From 2018 to 2022, there was a downward trend. The APC values of the standardized incidence of tuberculosis in the total population, males and females were-38.51%(95%CI:-53.27--19.09),-38.18%(95%CI:-54.59--15.85) and-38.73%(95%CI:-52.96--20.19), respectively. With the increase of age, the incidence of pulmonary tuberculosis showed a trend of rising first and then fluctuating steadily. The risk of the population increased first and then decreased over time, and the later the birth, the lower the risk of the cohort. Conclusion The incidence of pulmonary tuberculosis in Yecheng County of Xinjiang showed a trend of increasing first and then decreasing in the past 12 years, and gradually increased with age. The earlier the birth, the higher the risk of the disease. Men and the elderly are the key targets of tuberculosis prevention and control in Yecheng County, Xinjiang. It is recommended to strengthen the screening of key populations.

Objective : To explore the feasibility of machine learning methods in the discrimination of tuberculosis patients. Methods : The data of 15 observation indicators of 860 patients were obtained from a tertiary hospital. Through in-depth mining and analysis of the data, support vector machine, random forest and neural network model methods were used to discriminate the diseases of patients. Results : The accuracies of the TB suspected patient discrimination models based on support vector machine, random forest and neural network were 90%, 91% and 88%, respectively. Conclusion All three machine learning methods can be used for discriminative analysis of suspected tuberculosis patients. In comparison, random forest performs better in discriminating patients with tuberculosis from those with pneumonia.

Objective: To investigate the characteristics of temporal and spatial distribution of tuberculosis epidemics in Shache County, Kashgar Region, Xinjiang. Methods: Information on the incidence of tuberculosis in Sacha County from 2019—2021 was collected and spatiotemporally analyzed by applying the circular distribution method, local spatial autocorrelation analysis, hot and cold spot analysis, directional distribution and spatial center of gravity methods. Results : The total number of tuberculosis cases in Shache County in 2019—2021 was 8 345, of which 52.03%were male and 47.97% were female, and the patients were predominantly 60-75 years old. The number of reported incidences of TB in Tagarqi Township, Shache Township, and Chajek Township ranked among the top three in the county. Spring and summer were the disease-prone seasons for TB, and mid-March to mid-July was the period of high disease incidence. Misha Township and Ishkuli Township are the “high and high” gathering areas, while the “low and low” gathering areas are mainly concentrated in Khoshrav Township and Karasu Township. The hotspots of TB incidence in Shache county were Tagarqi township, Misha township, and Ishkuli township. During the study period, the center of gravity of TB incidence in Shache county of Kashgar area gradually shifted from the southwest to the northeast. Conclusion In Shache county, there is a certain degree of aggregation of tuberculosis outbreaks, with more men than women reporting illnesses, a larger proportion of older people, and a strong seasonal incidence of the disease, with Mixia township and Ishikuli township being the key areas of incidence. Relevant departments should continue to strengthen the disease surveillance of key populations and regions during the high incidence of tuberculosis, and take appropriate intervention measures to reduce the risk of tuberculosis transmission.

Objective : To analyze the epidemiological characteristics of tuberculosis in Urumqi and assess the im⁃pact of the national health examination policy , as well as COVID⁃19 prevention and control measures , on tuberculo⁃sis incidence in Xinjiang. Methods: The seasonal patterns of pulmonary tuberculosis were examined using the seasonal index method and circular distribution analysis. An Interrupted Time Series (ITS , Interrupted Time Series) model was employed to investigate how the national health examination policy and COVID_19 interventions influenced trends in tuberculosis incidence in Urumqi. Results: From 2013 to 2021 , a total of 19 ,049 cases of tuberculosis were reported in Urumqi. The peak incidence day occurred on May 25th , indicating a consistently high rate throughout the year, particularly during spring and summer months. The results of the interrupted time series model indicated that the initial monthly incidence rate of pulmonary tuberculosis in Urumqi was 5. 05 per 100 ,000. From January 2013 to September 2016 , the incidence rate of pulmonary tuberculosis showed a slow upward trend , and the upward trend was significant (β1 = 0. 039 ,P < 0. 05) . After the implementation of the universal health checkup policy , the incidence rate of pulmonary tuberculosis showed a slow downward trend , and the downward trend was significant(β3 = - 0. 109 ,P < 0. 05) . After the outbreak of the COVID_19 epidemic in January 2020 , the incidence rate of pulmonary tuberculosis in Urumqi first dropped rapidly and then entered a slow upward stage , and the upward trend was significant(β5 = 0. 082 , P < 0. 05) . Conclusion It is recommended that public health authorities prioritize timely identification of potential TB patients during periods with elevated incidence rates observed in spring and summer months. While significant progress has been made through implementing national health examinations policies , attention must be directed towards understanding how ongoing epidemics affect TB patient detection. Thus , enhancing surveillance efforts and intervention strategies are essential in adapting to this new normal. Key words tuberculosis ; seasonal index method ; circular distribution method ; national health examination ; COVID_19 ; interruption time series