ObjectiveThis paper aims to find the identified and validated clinical biomarker data building upon a clinical study of early-phase phase Ⅱ and investigate the correlation analysis of Huanglian Jiedu Wan on syndrome improvement and clinical biomarkers in the treatment of "excess heat-toxicity" based on a machine learning model. Additionally， the effective prediction of clinical biomarker values for the main symptoms of the "excess heat-toxicity" syndrome was assessed. MethodsA total of 229 patients meeting the inclusion criteria for "excess heat-toxicity" syndrome were randomly divided into the Huanglian Jiedu Wan group and the placebo group. Syndrome score transition matrices were constructed for the Huanglian Jiedu Wan group and the placebo group based on three main symptoms of "excess heat-toxicity" syndrome， such as oral ulcers， sore throat， and gum swelling and pain. Data from the patients with these three syndromes were also integrated for an overall analysis. The corresponding syndrome score transition matrices were further constructed to visualize symptom change trends of the patients in the two groups via heatmaps. Based on the identified and validated clinical biomarkers related to inflammation， oxidative stress， and energy metabolism in the early phase， Spearman correlation analysis was employed to analyze and evaluate the associations between clinical biomarkers and syndrome improvement. Key clinical biomarkers reflecting the effect of Huanglian Jiedu Wan were screened through the comparison of differences between groups. An extreme gradient boosting （XGBoost） algorithm was used to develop a prediction model for main symptom classification， with classification performance evaluated through 10-fold cross-validation. Feature importance analysis was applied to identify variables with the greatest contribution to the prediction result. ResultsThe syndrome transition matrix results indicated that the Huanglian Jiedu Wan group showed a superior effect to the placebo group in improving oral ulcers， sore throat， and overall symptoms， with significant effects observed especially in sore throat and overall symptom analyses （P<0.01）. Spearman correlation analysis revealed that several clinical biomarkers positively correlated with "excess heat-toxicity" syndrome and its main symptom improvement， were also called "heat-related biomarkers"， including succinic acid， α-ketoglutaric acid， glycine， lactic acid， adenosine monophosphate （AMP）， tumor necrosis factor-α （TNF-α）， interferon-γ （IFN-γ）， interleukin-1β （IL-1β）， interleukin-4 （IL-4）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， interleukin-10 （IL-10）， and so on. Conversely， clinical biomarkers negatively correlated with symptom severity， were also called "heat-clearing related biomarkers" after administration of Huanglian Jiedu Wan， including malic acid， fumaric acid， cis-aconitic acid， adrenocorticotropic hormone （ACTH）， IL-1β， IL-4， IL-8， succinic acid， and citric acid. The XGBoost classification model using all 52 biomarkers as variables achieved an average test accuracy of 0.754 and an average F1 score of 0.777. Feature importance analysis identified the scores of glutamic acid in saliva and IL-6 were the highest in all the variables， with importance scores of 0.081 and 0.080， respectively. After screening out 14 key variables and optimizing the parameters， model performance improved to an average accuracy of 0.758 and an F1 score of 0.798. Feature importance analysis further determined that the glutamic acid in saliva and IL-6 showed obvious changes after screening the variables， confirming the good syndrome prediction ability of the model constructed by these key clinical biomarkers. ConclusionThis study systematically elucidates the correlation between syndrome improvement and clinical biomarkers of Huanglian Jiedu Wan in the treatment of "excess heat-toxicity" syndrome. An XGBoost classification model based on key clinical biomarkers is successfully established， achieving effective prediction of the symptoms related to the "excess heat-toxicity" syndrome such as oral ulcers and sore throat and providing a new insight for objective identification of traditional Chinese medicine syndromes.

ObjectiveThis paper aims to find the identified and validated clinical biomarker data building upon a clinical study of early-phase phase Ⅱ and investigate the correlation analysis of Huanglian Jiedu Wan on syndrome improvement and clinical biomarkers in the treatment of "excess heat-toxicity" based on a machine learning model. Additionally， the effective prediction of clinical biomarker values for the main symptoms of the "excess heat-toxicity" syndrome was assessed. MethodsA total of 229 patients meeting the inclusion criteria for "excess heat-toxicity" syndrome were randomly divided into the Huanglian Jiedu Wan group and the placebo group. Syndrome score transition matrices were constructed for the Huanglian Jiedu Wan group and the placebo group based on three main symptoms of "excess heat-toxicity" syndrome， such as oral ulcers， sore throat， and gum swelling and pain. Data from the patients with these three syndromes were also integrated for an overall analysis. The corresponding syndrome score transition matrices were further constructed to visualize symptom change trends of the patients in the two groups via heatmaps. Based on the identified and validated clinical biomarkers related to inflammation， oxidative stress， and energy metabolism in the early phase， Spearman correlation analysis was employed to analyze and evaluate the associations between clinical biomarkers and syndrome improvement. Key clinical biomarkers reflecting the effect of Huanglian Jiedu Wan were screened through the comparison of differences between groups. An extreme gradient boosting （XGBoost） algorithm was used to develop a prediction model for main symptom classification， with classification performance evaluated through 10-fold cross-validation. Feature importance analysis was applied to identify variables with the greatest contribution to the prediction result. ResultsThe syndrome transition matrix results indicated that the Huanglian Jiedu Wan group showed a superior effect to the placebo group in improving oral ulcers， sore throat， and overall symptoms， with significant effects observed especially in sore throat and overall symptom analyses （P<0.01）. Spearman correlation analysis revealed that several clinical biomarkers positively correlated with "excess heat-toxicity" syndrome and its main symptom improvement， were also called "heat-related biomarkers"， including succinic acid， α-ketoglutaric acid， glycine， lactic acid， adenosine monophosphate （AMP）， tumor necrosis factor-α （TNF-α）， interferon-γ （IFN-γ）， interleukin-1β （IL-1β）， interleukin-4 （IL-4）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， interleukin-10 （IL-10）， and so on. Conversely， clinical biomarkers negatively correlated with symptom severity， were also called "heat-clearing related biomarkers" after administration of Huanglian Jiedu Wan， including malic acid， fumaric acid， cis-aconitic acid， adrenocorticotropic hormone （ACTH）， IL-1β， IL-4， IL-8， succinic acid， and citric acid. The XGBoost classification model using all 52 biomarkers as variables achieved an average test accuracy of 0.754 and an average F1 score of 0.777. Feature importance analysis identified the scores of glutamic acid in saliva and IL-6 were the highest in all the variables， with importance scores of 0.081 and 0.080， respectively. After screening out 14 key variables and optimizing the parameters， model performance improved to an average accuracy of 0.758 and an F1 score of 0.798. Feature importance analysis further determined that the glutamic acid in saliva and IL-6 showed obvious changes after screening the variables， confirming the good syndrome prediction ability of the model constructed by these key clinical biomarkers. ConclusionThis study systematically elucidates the correlation between syndrome improvement and clinical biomarkers of Huanglian Jiedu Wan in the treatment of "excess heat-toxicity" syndrome. An XGBoost classification model based on key clinical biomarkers is successfully established， achieving effective prediction of the symptoms related to the "excess heat-toxicity" syndrome such as oral ulcers and sore throat and providing a new insight for objective identification of traditional Chinese medicine syndromes.

Objective:To assess the value of artificial intelligence（AI）assisted system in the diagnosis of malignancy in follicular thyroid tumours，and to compare with the diagnostic results of doctors with different levels of experience.Methods:A total of 101 nodules were retrospectively collected from 86 patients with follicular thyroid tumours who underwent surgical treatment at Peking Union Medical College Hospital，Chinese Academy of Medical Sciences，Peking Union Medical College from May 2016 to January 2018.The nodules were classified into risk group（29 patients，34 nodules，including 15 follicular carcinomas and 19 follicular tumours of indeterminable malignant potential）and benign group（59 atients，67 nodules，including 15 follicular adenomas and 52 nodular goitre adenomatoid hyperplasia）. The sensitivities，specificities and accuracies of the AI system，two doctors of different seniorities（one junior A and one senior B），and guidelines of thyroid ultrasound malignancy risk stratification［including the 2015 American Thyroid Guidelines（ATA），the 2017 American College of Radiology Thyroid Imaging Reporting and Data System（ACR TI-RADS），the 2020 Chinese Society of Ultrasound，Thyroid Imaging Reporting and Data System（C-TIRADS）］（classified by a senior doctor C）for diagnosing follicular tumours in the risk group and follicular carcinomas were calculated and compared.Results:The AI system showed a sensitivity of 46.7%，specificity of 89.6% and accuracy of 81.7% for diagnosing follicular carcinoma；and a sensitivity of 32.4%，specificity of 89.6% and accuracy of 70.3% for diagnosing follicular neoplasms（risk group）. Compared with junior doctor A，the specificity of AI system in diagnosing follicular cancer and follicular neoplasms（risk group）was higher（89.6% vs. 83.6%， P=0.020；89.6% vs. 73.1%， P=0.020），and the differences of sensitivity were not significant（46.7% vs. 32.4%， P=0.181；32.4% vs. 11.8%， P=0.073）. The difference of sensitivity and specificity were not statistically significant between the AI system and senior doctor B（all P＞0.05）.The differences in area under the curve for diagnosis of follicular carcinoma and follicular tumour（risk group）were not statistically significant between the AI system compared to junior doctor A，senior doctor B，the C-TIRADS，ATA guideline，and ACR TI-RADS（all P＞0.05）. Conclusions:Ultrasound-based AI-assisted diagnostic system is similarly efficient in diagnosing follicular thyroid tumours as experienced doctors，and the AI system diagnostic specificity is superior to that of junior doctors.

A 70-year-old female patient presented with fatigue and edema for 3 months and was found to have elevated serum creatinine for 3 weeks. During the course of the disease, she had fever and cough. Examinations revealed multiple ground-glass opacities in both lungs and positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibodies (ANCA), leading to a diagnosis of ANCA-associated vasculitis. The patient′s condition initially improved after pulse glucocorticoid therapy combined with cyclophosphamide. During treatment, however, the patient developed hematochezia, and colonoscopy revealed multiple colonic ulcers. Immunohistochemistry of colonic mucosal biopsy confirmed cytomegalovirus (CMV) positivity, establishing a diagnosis of CMV colitis. The patient was found to have concurrent Clostridioidesdifficile and pulmonary infections. During the disease course, the patient also developed deep vein thrombosis and roxadustat-associated central hypothyroidism. Given the presence of multiple comorbidities, rituximab was subsequently used for vasculitis treatment, resulting in sustained remission. This case highlights the importance of highly individualized treatment strategies for older patients with vasculitis, requiring adjustment of immunosuppressive therapy intensity based on disease progression.

Humanistic caring for patients in the operating room refers to providing the whole process of caring medical services for patients in the operating room. In order to standardize humanistic caring services for patients in the operating room of medical institutions, improve the comprehensive service level of the operating room, and enhance the surgical experience of patients, the Chinese Association for Life Care released the group standard " Humanistic Caring Management Standards for Patients in the Operating Room" in December 2023. This article interpreted the basic requirements for humanistic caring of patients in the operating room, the environment and facilities for humanistic caring, the procedures and measures for humanistic caring, and the quality management framework, aiming to assist administrators and clinical practitioners across various levels of medical institutions in accurately understanding and effectively implementing the standard, and to provide essential textual reference and practical guidance for promoting the application of the standard.

OBJECTIVE: To observe the clinical efficacy of acupuncture based on the "head qijie" theory combined with endovascular intervention in the treatment of ischemic stroke (IS). METHODS: Sixty-six IS patients were randomly divided into an experimental group (33 cases, 3 cases dropped out) and a control group (33 cases, 3 cases dropped out). The control group received endovascular intervention. On the basis of the treatment in the control group, the experimental group received acupuncture based on the "head qijie" theory starting from the second day after surgery, Baihui (GV20) and bilateral Fengchi (GB20), Tianzhu (BL10), etc. were selected, once a day, 6 times a week for 2 weeks. Before and after treatment, the scores of National Institutes of Health stroke scale (NIHSS), modified Barthel index (MBI) and modified Rankin scale (mRS) were observed in the two groups, the clinical efficacy and safety were evaluated. RESULTS: After treatment, the NIHSS and mRS scores were decreased compared with those before treatment in both groups (P<0.01), the NIHSS and mRS scores in the experimental group were lower than those in the control group (P<0.05). After treatment, the MBI scores were increased compared with those before treatment in both groups (P<0.01), the MBI score in the experimental group was higher than that in the control group (P<0.05). The total effective rate in the experimental group was 86.7% (26/30), which was higher than 66.7% (20/30) in the control group (P<0.05). The incidence of adverse events in the experimental group was 6.7% (2/30), which was lower than 13.3% (4/30) in the control group (P<0.05). CONCLUSION Acupuncture based on the "head qijie" theory combined with endovascular intervention in treating IS has good efficacy, improves neurological function, and enhances daily living ability.
Humans ; Male ; Female ; Acupuncture Therapy ; Middle Aged ; Aged ; Ischemic Stroke/therapy* ; Acupuncture Points ; Endovascular Procedures ; Treatment Outcome ; Adult ; Combined Modality Therapy

Nucleotide-binding oligomerization domain (NOD)-like receptor protein 3 (NLRP3) is a cytosolic pattern recognition receptor that recognizes multiple pathogen-associated molecular patterns and damage-associated molecular patterns. It is a cytoplasmic immune factor that responds to cellular stress signals, and it is usually activated after infection or inflammation, forming an NLRP3 inflammasome to protect the body. Aberrant NLRP3 inflammasome activation is reportedly associated with some inflammatory diseases and metabolic diseases. Recently, there have been mounting indications that NLRP3 inflammasomes play an important role in liver injuries caused by a variety of diseases, specifically hepatic ischemia/reperfusion injury, hepatitis, and liver failure. Herein, we summarize new research pertaining to NLRP3 inflammasomes in hepatic injury, hepatitis, and liver failure. The review addresses the potential mechanisms of action of the NLRP3 inflammasome, and its regulation in these liver diseases.
Humans ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; Inflammasomes/physiology* ; Animals ; Liver Diseases/metabolism* ; Liver/metabolism* ; Reperfusion Injury/metabolism*

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective:To develop a comprehensive training curriculum to enhance the effective implementation of the national initiative promoting dementia care and prevention.Methods:The Delphi method was utilized in an expert consultation that included 44 participants.The initial draft of the training curriculum was developed based on the current state of dementia care and prevention.This draft was subsequently evaluated for its importance, feasibility, and ease of dissemination.Experts offered targeted modifications and additional recommendations.Results:The recovery rate of the expert consultation questionnaire was 95.5%, with a recovery validity rate of 90.9%.The expert authority coefficient was 0.91, and the Kendall's coordination coefficient( W)for expert scoring was 0.316, with a significance level of P<0.001.Four course modules were ultimately identified: the foundation of memory clinic work, the complete management practice skills, group counseling techniques for caregivers, and practical skills for caregivers.The importance of these modules was rated with a mean of 4.92 to 4.95, and the coefficient of variation ranged from 0.044 to 0.063.Each module had a mean value of 4.92 to 4.95, with a coefficient of variation of 0.044 to 0.063; the mean value for practicality was between 4.78 and 4.92, with a coefficient of variation of 0.055 to 0.098; and the mean value for ease of generalization ranged from 4.28 to 4.65, with a coefficient of variation from 0.140 to 0.203.The four modules comprised a total of 55 specific course content items, with the mean value for each item ranging from 4.76 to 5.00 and a coefficient of variation from 0.000 to 0.121.The mean value of usefulness assigned to each entry ranged from 4.55 to 4.98, with a coefficient of variation from 0.031 to 0.150.Additionally, the mean value for ease of propagation assigned to each entry ranged from 4.00 to 4.83, with a coefficient of variation from 0.091 to 0.245. Conclusions:The developed training curriculum, which comprises four course modules and 55 items, demonstrated consistently high levels of importance, practicality, and ease of dissemination.These findings indicate that the curriculum is well-aligned with national initiatives aimed at enhancing dementia care and prevention.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.