OBJECTIVE: To observe the effects of moxibustion at different temperatures on cognitive function and blood glucose levels in patients with cognitive impairment associated with type 2 diabetes mellitus (T2DM). METHODS: A total of 66 T2DM patients with cognitive impairment were randomly assigned to a high-temperature group (22 cases, 1 case dropped out, 1 case was eliminated), a medium-temperature group (22 cases, 2 cases were eliminated), and a low-temperature group (22 cases, 2 cases were eliminated). All groups received moxibustion at Baihui (GV20), Dazhui (GV14), and Shenting (GV24) based on their existing glycemic control treatment. Moxibustion temperatures were maintained at 44-46 ℃ (high-temperature group), 41-43 ℃ (medium-temperature group), and 38-40 ℃ (low-temperature group), respectively, for 20 min per session, every other day, 3 times a week for 3 months. The Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, short-term memory (STM) accuracy and average reaction time, Rey-Osterrieth complex figure (ROCF) score, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were assessed before and after treatment. Clinical efficacy was evaluated after treatment. RESULTS: After treatment, MMSE scores in all three groups were higher than those before treatment (P<0.05). In the high-temperature group, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, naming, language, and abstraction were higher than those before treatment (P<0.05); the scores of ROCF copy, immediate recall, and delayed recall were higher than those before treatment (P<0.05); the HbA1c level was lower than that before treatment (P<0.05). In the medium-temperature group, the total MoCA score and the scores of memory and delayed recall, attention, and language were higher than those before treatment (P<0.05). STM accuracy was higher than before treatment (P<0.05), and STM average reaction time was shorter than before treatment (P<0.05) in both the high-temperature and medium-temperature groups. After treatment, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, and language in the high-temperature group were higher than those in the medium- and low-temperature groups (P<0.05); MMSE score, STM accuracy, and ROCF immediate recall and delayed recall scores were higher than those in the medium- and low-temperature groups (P<0.05); STM average reaction time was shorter than that in the medium- and low-temperature groups (P<0.05); HbA1c level was lower than that in the low-temperature group (P<0.05). The total MoCA score, attention score, and MMSE score in the medium-temperature group were higher than those in the low-temperature group (P<0.05), and STM average reaction time was shorter than that in the low-temperature group (P<0.05). There were no statistically significant differences in FPG within or between the three groups before and after treatment (P>0.05). The total effective rates were 75.0% (15/20) in the high-temperature group, 50.0% (10/20) in the medium-temperature group, and 15.0% (3/20) in the low-temperature group; the total effective rate in the high-temperature group was significantly higher than that in the low-temperature group (P<0.05). CONCLUSION Moxibustion at different temperatures has a dose-effect relationship in treating cognitive impairment in T2DM patients. A temperature range of 44-46 ℃ is more effective in improving cognitive function and stabilizing average blood glucose levels over 2-3 months.
Humans ; Diabetes Mellitus, Type 2/therapy* ; Male ; Female ; Moxibustion ; Middle Aged ; Aged ; Cognitive Dysfunction/psychology* ; Cognition ; Temperature ; Blood Glucose/metabolism* ; Adult ; Acupuncture Points

With the rapid development of artificial intelligence, computational pathology has been seamlessly integrated into the entire clinical workflow, which encompasses diagnosis, treatment, prognosis, and biomarker discovery. This integration has significantly enhanced clinical accuracy and efficiency while reducing the workload for clinicians. Traditionally, research in this field has depended on the collection and labeling of large datasets for specific tasks, followed by the development of task-specific computational pathology models. However, this approach is labor intensive and does not scale efficiently for open-set identification or rare diseases. Given the diversity of clinical tasks, training individual models from scratch to address the whole spectrum of clinical tasks in the pathology workflow is impractical, which highlights the urgent need to transition from task-specific models to foundation models (FMs). In recent years, pathological FMs have proliferated. These FMs can be classified into three categories, namely, pathology image FMs, pathology image-text FMs, and pathology image-gene FMs, each of which results in distinct functionalities and application scenarios. This review provides an overview of the latest research advancements in pathological FMs, with a particular emphasis on their applications in oncology. The key challenges and opportunities presented by pathological FMs in precision oncology are also explored.
Humans ; Precision Medicine/methods* ; Medical Oncology/methods* ; Artificial Intelligence ; Neoplasms/pathology* ; Computational Biology/methods*

Objective:Based on bioinformatics analysis, this study aimed to identify the complement component 5a receptor 1(C5aR1)and chemokine C-C motif ligand-2(CCL2)genes in vascular dementia(VaD)and to explore the expression and clinical significance of serum C5aR1 and CCL2 levels in VaD patients.Methods:The GSE122063 dataset was selected from the Gene Expression Omnibus(GEO)database to screen for consistently differentially expressed genes in the frontal and temporal lobes of VaD patients and non-dementia patients.The Matascape database was used to analyze the functions and pathways of differentially expressed genes, and the STRING network and Cytoscape software were used to identify key genes.In this case-control study, 53 VaD patients seeking care at the Department of Neurology of the Affiliated Hospital of Jiangsu University between January 2022 and December 2022 were included in the VaD group, and 50 non-dementia individuals were included in the control group.General information, Montreal Cognitive Assessment(MoCA)scores, Mini-Mental State Examination(MMSE)scores, and scores of the total cerebral small vessel disease(CSVD)burden were collected for both groups, and serum C5aR1 and CCL2 expression was detected.The correlation of serum C5aR1 and CCL2 levels with MoCA scores, MMSE scores, and scores of the total CSVD burden in the VaD group was analyzed.Receiver operating characteristic(ROC)curve analysis was used to assess the diagnostic value of serum C5aR1 and CCL2 levels in VaD.Results:In the GSE122063 dataset, compared with non-dementia patients, there were 43 upregulated genes and 63 downregulated genes simultaneously in the frontal and temporal lobes in the VaD group.After importing 106 genes into the Cytoscape software and using the Stress and Betweenness algorithms in the cytoHubba plugin, two key genes, C5aR1 and CCL2, were identified.Serum levels of C5aR1[(57.25±10.34)μg/L vs.(43.26±8.24)μg/L, t=7.607, P<0.001]and CCL2[(210.42±42.19)ng/L vs.(151.73±36.04)ng/L, t=7.570, P<0.001]in the VaD group were higher than those in the control group.Serum levels of C5aR1 and CCL2 were negatively correlated with MoCA scores( r=-0.691, -0.668, P<0.001)and MMSE scores( r=-0.736, -0.729, P<0.001), and positively correlated with scores of the total CSVD burden( r=0.598, 0.582, P<0.001).The areas under the ROC curve for serum C5aR1 and CCL2 levels in diagnosing VaD was 0.838 and 0.845, respectively.The area under the ROC curve with the combination of C5aR1 and CCL2 for the diagnosis of VaD was 0.896. Conclusions:Serum levels of C5aR1 and CCL2 are elevated in VaD patients and closely related to their cognitive function and the total CSVD burden, and may be used as an auxiliary diagnostic tool for VaD patients.

Objective To observe the value of CT angiography(CTA)for classifying type of peripheral arteriovenous fistula(AVF)in children.Methods Totally 22 children with peripheral AVF were retrospectively enrolled,the type of AVF was classified with preoperative CTA,and therapeutic planning was developed.Taken digital subtraction angiography(DSA)findings during interventional therapy as gold standards,the efficacy of CTA for classifying type of AVF was analyzed.Results Among 22 cases,DSA detected 3 cases of type Ⅰ,13 cases of type Ⅱa and 6 cases of typeⅡb peripheral AVF,while 3 cases of type Ⅰ,14 cases of type Ⅱa and 5 cases of type Ⅱb peripheral AVF were classified based on CTA.CTA misdiagnosed 1 case of type Ⅱa as type Ⅱb,and 2 cases of type Ⅱb as type Ⅱa peripheral AVF,its accuracy of CTA for classifying type Ⅰ,Ⅱa and Ⅱb peripheral AVF was 100%(3/3),92.31%(12/13)and 66.67%(4/6),respectively.Among 22 cases,13 cases underwent interventional closure,2 cases underwent interventional therapy combined with surgery,while 3 cases did not receive relevant treatment due to drainage vein occlusion.One month after treatments,the symptoms of 19 cases who underwent treatment improved significantly,and no signs of AVF was found with re-examination of ultrasound nor CTA.Conclusion CTA was helpful to classifying type of peripheral AV in children,which could provide references for interventional therapy.

Objective To investigate the predictive value of edema metabolic and hematoma dynamics changes on motor and cog-nitive recovery outcomes in patients with intracerebral hemorrhage(ICH).Methods The CT data of ICH patients were collected to evaluate hematoma volume changes from admission to day 3.On day 3,multivoxel magnetic resonance spectroscopy(MRS)was per-formed with region of interest located in the edema region and contralateral normal tissue.Motor and cognitive function recovery was assessed using the simplified F-M scale and the Montreal cognitive assessment(MoCA)on day 3 and at the 3-month follow-up,respec-tively.Overall clinical outcomes were assessed using the Glasgow outcome scale(GOS),and all patients were divided into good and poor outcome groups.Clinical data and metabolic differences in the edema region between the two groups were compared,respec-tively.Logistic regression analysis and receiver operating characteristic(ROC)curves were used to identify and evaluate independent prognostic factors.Subgroup analysis were performed via stratification of hematoma location.Results The logistic regression analy-sis indicated that intraventricular extension,hematoma changes,and the ratio of N-acetyl aspartate(NAA)around the hematoma to contralateral normal brain parenchyma NAA(rNAA)were inde-pendent prognostic factors for poor outcomes(P＜0.05).The area under the curve(AUC)for each factor and the combined model were 0.69,0.73,0.79,and 0.82,respectively.In patients with ICH in the basal ganglia region,△F-M was negatively correlated with hematoma changes and positively correlated with rNAA value(P＜0.001).In patients with ICH in the thalamic and lobar regions,△MoCA was not significantly correlated with hematoma changes(P＞0.05),but was positively correlated with rNAA value(P＜0.001).Conclusion The rNAA holds predictive value for motor and cognitive recovery outcomes following standard treatment.

Objective:To systematically evaluate the effectiveness of home care services nurse practitioners provide for older adults.Methods:Randomized controlled trials of home care services provided by nurse practitioners were electronically searched in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine disc. The search period was from database establishment to January 30, 2024. Literature was screened according to the inclusion and exclusion criteria. The Cochrane Collaboration risk of bias assessment tool was used to evaluate the methodological quality of the literature, and meta-analysis was performed using Stata 15 software.Results:A total of 19 articles were included, involving 29 217 older adults. Meta-analysis showed that compared with conventional group, older adults who received home care services provided by nurse practitioners had better systolic blood pressure [ WMD=-5.607, 95% CI (-10.692, -0.522), P=0.031], body mass index [ WMD=-2.497, 95% CI (-4.550, -0.444), P=0.017], service satisfaction [ SMD=0.484, 95% CI (0.003, 0.964), P=0.049] and family caregiver burden [ SMD=-0.366, 95% CI (-0.670, -0.062), P=0.018], but higher total monthly medical costs per person [ WMD=105.103, 95% CI (24.932, 185.274), P=0.010]. There were no differences between the two groups regarding unplanned hospitalization rates, emergency room visits, blood glucose levels, lipid levels, mortality, quality of life, and activities of daily living. Conclusions:Home care services provided by nurse practitioners have improved older adults' satisfaction while lowering older adults' systolic blood pressure and body mass index and reducing the burden on family caregivers. However, the total cost of medical care per older adult per month is high. Although subgroup analyses of key indicators were conducted, it was still impossible to clarify the factors that influence the effectiveness of services provided by nurse practitioners.

Objective:To explore the direct effect of perceived social support on self-advocacy and the mediating effect of active coping strategies in breast cancer patients.Methods:A convenience sampling method was used to select 240 breast cancer patients hospitalized at Qilu Hospital of Shandong University from April 2023 to April 2024. General information questionnaire, the Female Self-Advocacy Scale in Cancer Survivorship (FSACS), the Simplified Ways of Coping Questionnaire (SWCQ), and the Perceived Social Support Scale (PSSS) were used to collect the data.Results:The effective response rate for the questionnaires was 93.75% (225/240). The total score for FSACS in 225 breast cancer patients was (75.36±9.88), the active coping score for SWCQ was (21.68±6.07), and the total score for PSSS was (55.63±8.04). The mediating effect analysis revealed that perceived social support had a direct positive predictive effect on self-advocacy ( β=0.420, P<0.01). Active coping played a mediating role in the relationship between perceived social support and self-advocacy, with a mediating effect value of 0.210, a 95% confidence interval of 0.112 to 0.318, and the mediating effect accounting for 33.33% of the total effect. Conclusions:Perceived social support not only positively affects the self-advocacy level of breast cancer patients but also indirectly influences it through the mediating role of active coping. Medical staff should emphasize improving perceived social support levels and encourage patients to adopt active coping strategies to enhance their self-advocacy.

Objective To observe the value of CT angiography(CTA)for classifying type of peripheral arteriovenous fistula(AVF)in children.Methods Totally 22 children with peripheral AVF were retrospectively enrolled,the type of AVF was classified with preoperative CTA,and therapeutic planning was developed.Taken digital subtraction angiography(DSA)findings during interventional therapy as gold standards,the efficacy of CTA for classifying type of AVF was analyzed.Results Among 22 cases,DSA detected 3 cases of type Ⅰ,13 cases of type Ⅱa and 6 cases of typeⅡb peripheral AVF,while 3 cases of type Ⅰ,14 cases of type Ⅱa and 5 cases of type Ⅱb peripheral AVF were classified based on CTA.CTA misdiagnosed 1 case of type Ⅱa as type Ⅱb,and 2 cases of type Ⅱb as type Ⅱa peripheral AVF,its accuracy of CTA for classifying type Ⅰ,Ⅱa and Ⅱb peripheral AVF was 100%(3/3),92.31%(12/13)and 66.67%(4/6),respectively.Among 22 cases,13 cases underwent interventional closure,2 cases underwent interventional therapy combined with surgery,while 3 cases did not receive relevant treatment due to drainage vein occlusion.One month after treatments,the symptoms of 19 cases who underwent treatment improved significantly,and no signs of AVF was found with re-examination of ultrasound nor CTA.Conclusion CTA was helpful to classifying type of peripheral AV in children,which could provide references for interventional therapy.

Objective To investigate the predictive value of edema metabolic and hematoma dynamics changes on motor and cog-nitive recovery outcomes in patients with intracerebral hemorrhage(ICH).Methods The CT data of ICH patients were collected to evaluate hematoma volume changes from admission to day 3.On day 3,multivoxel magnetic resonance spectroscopy(MRS)was per-formed with region of interest located in the edema region and contralateral normal tissue.Motor and cognitive function recovery was assessed using the simplified F-M scale and the Montreal cognitive assessment(MoCA)on day 3 and at the 3-month follow-up,respec-tively.Overall clinical outcomes were assessed using the Glasgow outcome scale(GOS),and all patients were divided into good and poor outcome groups.Clinical data and metabolic differences in the edema region between the two groups were compared,respec-tively.Logistic regression analysis and receiver operating characteristic(ROC)curves were used to identify and evaluate independent prognostic factors.Subgroup analysis were performed via stratification of hematoma location.Results The logistic regression analy-sis indicated that intraventricular extension,hematoma changes,and the ratio of N-acetyl aspartate(NAA)around the hematoma to contralateral normal brain parenchyma NAA(rNAA)were inde-pendent prognostic factors for poor outcomes(P＜0.05).The area under the curve(AUC)for each factor and the combined model were 0.69,0.73,0.79,and 0.82,respectively.In patients with ICH in the basal ganglia region,△F-M was negatively correlated with hematoma changes and positively correlated with rNAA value(P＜0.001).In patients with ICH in the thalamic and lobar regions,△MoCA was not significantly correlated with hematoma changes(P＞0.05),but was positively correlated with rNAA value(P＜0.001).Conclusion The rNAA holds predictive value for motor and cognitive recovery outcomes following standard treatment.

Objective:To systematically evaluate the effectiveness of home care services nurse practitioners provide for older adults.Methods:Randomized controlled trials of home care services provided by nurse practitioners were electronically searched in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine disc. The search period was from database establishment to January 30, 2024. Literature was screened according to the inclusion and exclusion criteria. The Cochrane Collaboration risk of bias assessment tool was used to evaluate the methodological quality of the literature, and meta-analysis was performed using Stata 15 software.Results:A total of 19 articles were included, involving 29 217 older adults. Meta-analysis showed that compared with conventional group, older adults who received home care services provided by nurse practitioners had better systolic blood pressure [ WMD=-5.607, 95% CI (-10.692, -0.522), P=0.031], body mass index [ WMD=-2.497, 95% CI (-4.550, -0.444), P=0.017], service satisfaction [ SMD=0.484, 95% CI (0.003, 0.964), P=0.049] and family caregiver burden [ SMD=-0.366, 95% CI (-0.670, -0.062), P=0.018], but higher total monthly medical costs per person [ WMD=105.103, 95% CI (24.932, 185.274), P=0.010]. There were no differences between the two groups regarding unplanned hospitalization rates, emergency room visits, blood glucose levels, lipid levels, mortality, quality of life, and activities of daily living. Conclusions:Home care services provided by nurse practitioners have improved older adults' satisfaction while lowering older adults' systolic blood pressure and body mass index and reducing the burden on family caregivers. However, the total cost of medical care per older adult per month is high. Although subgroup analyses of key indicators were conducted, it was still impossible to clarify the factors that influence the effectiveness of services provided by nurse practitioners.