ObjectiveTo observe the clinical efficacy and safety of Tangning Tongluo tablets in the treatment of nonproliferative diabetic retinopathy （DR）. MethodsFourteen research centers participated in this study， which spanned a time interval from September 2021 to May 2023. A total of 240 patients with nonproliferative DR were included and randomly assigned into an observation group （120 cases） and a control group （120 cases）. The observation group was treated with Tangning Tongluo tablets， and the control group with calcium dobesilate capsules. Both groups were treated for 24 consecutive weeks. The vision， DR progression rate， retinal microhemangioma， hemorrhage area， exudation area， glycosylated hemoglobin （HbA1c） level， and TCM syndrome score were assessed before and after treatment， and the safety was observed. ResultsThe vision changed in both groups after treatment （P<0.05）， and the observation group showed higher best corrected visual acuity （BCVA） than the control group （P<0.05）. The DR progression was slow with similar rates in the two groups. The fundus hemorrhage area and exudation area did not change significantly after treatment in both groups， while the observation group outperformed the control group in reducing the fundus hemorrhage area and exudation area. There was no significant difference in the number of microhemangiomas between the two groups before treatment. After treatment， the number of microhemangiomas decreased in both the observation group （Z=-1.437， P<0.05） and the control group （Z=-2.238， P<0.05）， and it showed no significant difference between the two groups. As the treatment time prolonged， the number of microhemangiomas gradually decreased in both groups. There was no significant difference in the HbA1c level between the two groups before treatment. After treatment， the decline in the HbA1c level showed no significant difference between the two groups. The TCM syndrome score did not have a statistically significant difference between the two groups before treatment. After treatment， neither the TCM syndrome score nor the response rate had significant difference between the two groups. With the extension of the treatment time， both groups showed amelioration of TCM syndrome compared with the baseline. ConclusionTangning Tongluo tablets are safe and effective in the treatment of nonproliferative DR， being capable of improving vision and reducing hemorrhage and exudation in the fundus.

Objective To observe the clinical efficacy of mind-regulating and meridians-dredging acupuncture combined with rehabilitation training in treating limb dysfunction in recovery period of cerebral infarction(CI).Methods A total of 110 cases of patients with limb dysfunction in recovery period of CI were randomly divided into observation group and control group,55 cases in each group,the control group was given routine rehabilitation training,and the observation group was treated with mind-regulating and meridians-dredging acupuncture on the basis of intervention of the control group,the course of treatment covered two consecutive weeks.After two weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes of scores of traditional Chinese medicine(TCM)syndrome,Fugl-Meyer Assessment(FMA),Berg Balance Scale(BBS)and Modified Barthel Index(MBI)before and after treatment of patients in the two groups were observed.The changes of electromyographic signal before and after treatment were compared between the two groups.And the safety and the occurrence of adverse reactions in the two groups were evaluated.Results(1)The total effective rate was 98.18%(54/55)in the observation group and 87.27%(48/55)in the control group.The efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(2)After treatment,the TCM syndrome scores of patients in the two groups were significantly improved(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,with a statistically significant difference(P<0.05).(3)After treatment,the FMA scores of patients in the two groups improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(4)After treatment,the BBS scores and MBI scores of the patients in the two groups improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(5)After treatment,the root mean square value(RMS)of biceps brachii muscle elbow flexion and triceps brachii muscle elbow extention of the two groups of patients improved significantly(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(6)During the treatment,there were no obvious adverse reactions occurred in both groups.Conclusion Mind-regulating and meridians-dredging acupuncture combined with rehabilitation training in treating limb dysfunction in recovery period of CI can significantly improve the motor ability of patients,and adjust the electromyographic signals of the affected limbs,with high safety.

OBJECTIVE To evaluate the efficacy and safety of three aromatase inhibitors （exemestane， anastrozole， letrozole） for postmenopausal hormone receptor （HR）-positive early breast cancer. METHODS PubMed， the Cochrane Library， Embase， CNKI， Wanfang Data， VIP and SinoMed were searched to collect randomized controlled trials （RCTs） of the above three drugs in the treatment of postmenopausal HR-positive early breast cancer patients. The retrieval time limit was from the establishment of the database to October 25， 2024. After literature screening， data extraction and literature quality evaluation， network meta-analysis was performed by using RevMan 5.3 and Stata 18.0 software. RESULTS A total of 15 RCTs involving 44 055 patients were included. The results of network meta-analysis showed that the objective response rate of letrozole group was significantly higher than anastrozole group （P＜0.05）， and the order of surface under the cumulative ranking curve （SUCRA） from high to low was letrozole （85.6%）＞anastrozole （61.5%）＞exemestane （2.8%）. The disease-free survival rate of anastrozole group was significantly higher than exemestane and placebo groups （P＜0.05）， and the order of SUCRA from high to low was letrozole （85.8%）＞ anastrozole （67.3%）＞exemestane （41.4%）＞placebo （5.5%）. The total incidence of adverse reactions in anastrozole group was significantly higher than letrozole and placebo groups （P＜0.05）， and the order of SUCRA from high to low was exemestane （87.4%）＞letrozole （63.9%）＞anastrozole （47.0%）＞placebo （1.7%）. The results of subgroup analysis according to the course of treatment≥104 weeks were consistent with them. CONCLUSIONS Compared with anastrozole， letrozole has better efficacy and safety in the treatment of postmenopausal HR-positive early breast cancer， and the efficacy of exemestane is limited.

[This corrects the article DOI: 10.1016/j.jpha.2023.08.006.].

Objective To investigate the functional changes of oligodendrocytes in a mouse model of cognitive impairment induced by microwave radiation and the mechanism.Methods C57BL/6N male mice were exposed to S-band microwave at 2.856 GHz and 8 mW/cm2 for 15 min.The rectal temperature of mice was monitored by an optical fiber thermometer during microwave radiation.The changes of autonomous exploration behavior and learning and memory ability of mice on the 1st and 7th days after microwave radiation were detected via the open field test and novel object recognition test.Immunofluorescence was used to detect the expression and distribution of neuroglia-2 proteoglycan(NG2)and myelin basic protein(MBP)in the hippocampus of mice on the 1st and 7th days after radiation.Clemastine fumarate,a drug that promoted the maturation of oligodendrocyte precursor cells was administered by gavage,and the expression levels of brain-derived neurotrophic factor(BDNF)and fibroblast growth factor 2(FGF2)in hippocampal tissues were detected by radioimmunoassay at 1 and 7 days after radiation.The changes of myelin sheath structure an 1 and 7 days after radiation were observed by transmission electron microscopy.The effects of clemastine fumarate on learning and memory impairment induced by microwave exposure in mice were assessed via open field and new object recognition experiments.Results Under the experimental conditions,the rectal temperature in mice caused by microwave radiation increased by less than 1 ℃,which was within the thermal safety range of the body.The open field test showed that compared with the control group,the microwave radiation group didn't change significant in terms of movement speedon the 1st and 7th days,but the time spent exploring in the central area was significantly reducedon the 1st day after radiation(P＜0.05).In the novel object recognition test,the indexes of the mice on the 1st day were significantly reduced(P＜0.05),indicating that the anxiety like behavior and cognitive function of the mice were impaired after microwave radiation.Compared with the control group,the proportion of NG2+area in the hippocampus was significantly decreased(P＜0.05)in the microwave radiation group,while that of MBP+area hardly changed on the 1st day after microwave radiation(P＞0.05).The expression level of oligodendrocyte related BDNF in the hippocampus was significantly decreased(P＜0.05).The myelin of the corpus callosum was broken,and the myelin g ratio was significantly increased(P＜0.05),suggesting that micro wave radiation could reduce the number of oligodendrocyte precursors and damage the secretion and myelin function of oligodendrocyte.Compared with the radiation group,the expression levels of BNDF and FGF2 in the radiation combined with clemastine fumarate group were up-regulated,the myelin g ratio was significantly decreased on the 1st day after radiation(P＜0.05),and the novel object recognition index was significantly increased(P＜0.05).Conclusion Pulsed microwave radiation below the body's fever threshold can cause cognitive dysfunction and other brain damage in mice.The impaired secretion and myelin function of oligodendrocytes and the decreased self-repair ability are the important mechanisms of cognitive dysfunction induced by microwave radiation.

Objective:To investigate the effects of 2 650 MHz radiofrequency (RF) exposure on the behavior and neurotransmitter release of mice.Methods:Adult male C57BL/6N mice were divided into a normal control (CON) group and a radiofrequency radiation (RFR) group using the random number table method. The mice in the RFR group were subjected to single-dose whole-body exposure to a uniform 2 650 MHz RF electromagnetic field for 3 h. During the RF exposure, the field strength in the effective working area of the RF radiation platform was measured using an electromagnetic radiation analyzer, and the changes in the anal temperature of the mice were monitored using an optical fiber thermometer. Moreover, the changes in the cognition, social interaction, and emotion of the mice were determined through the new object recognition test, social preference test, and open field test. Finally, the changes in the hippocampal neurotransmitter release levels of the mice were detected using microdialysis sampling and mass spectrometry, and the changes in the hippocampal tissue structure and ultrastructure were observed via microscopy.Results:Under the test conditions, RF radiation improved the anal temperature of the mice, with a maximum increasing amplitude of 0.61℃, falling within the range of thermal safety. The mice in the RFR group experienced a significant decrease in the frequency and time for exploring new objects ( t=4.50, 2.53, P < 0.05) in the new object recognition test, a significant decrease in the frequency ( t=0.08, P<0.01) and time ( t=0.03, P<0.05) for exploring other mice in the social preference test, and no significant change in the frequency and time for exploring the central area ( P > 0.05) in the open field test. Compared to the CON group, the RFR group showed an increase in the release of 5-hydroxytryptamine (5-HT) ( t=-2.56, P < 0.05) and a decrease in the release of acetylcholine (ACh) ( t=2.21, P < 0.05), no significant difference in the release of glutamate (Glu) and γ-aminobutyric acid (GABA) ( P > 0.05), and no evident damage to the hippocampal tissue and structure and synaptic ultrastructure. Conclusions:2 650 MHz RF radiation may induce cognitive impairment and abnormal social preference in mice, which is attributed to neuronal dysfunctions and neurotransmitter release disorders under RF exposure.

Objective:To investigate the prospective association of sleep duration with the development of chronic obstructive pulmonary disease (COPD) in adults in Suzhou.Methods:The study used the data of 53 269 participants aged 30-79 years recruited in the baseline survey from 2004 to 2008 and the follow-up until December 31, 2017 of China Kadoorie Biobank (CKB) conducted in Wuzhong District, Suzhou. After excluding participants with airflow limitation, self-reported chronic bronchitis/emphysema/coronary heart disease history at the baseline survey and abnormal or incomplete data, a total of 45 336 participants were included in the final analysis. The association between daily sleep duration and the risk for developing COPD was analyzed by using a Cox proportional hazard regression model, and the hazard ratio ( HR) values and their 95% CI were calculated. The analysis was stratified by age, gender and lifestyle factors, and cross-analysis was conducted according to smoking status and daily sleep duration. Results:The median follow-up time was 11.12 years, with a total of 515 COPD diagnoses in the follow-up. After adjusting for potential confounders, multifactorial Cox proportional hazard regression analysis showed that daily sleep duration ≥10 hours was associated with higher risk for developing COPD ( HR=1.42, 95% CI: 1.03-1.97). The cross analysis showed that excessive daily sleep duration increased the risk for COPD in smokers ( HR=2.49, 95% CI: 1.35-4.59, interaction P<0.001). Conclusion:Longer daily sleep duration (≥10 hours) might increase the risk for COPD in adults in Suzhou, especially in smokers.

Objective To analyze the bed utilization efficiency of various clinical departments in a public hospital and provide reference for the rational allocation of departmental bed resources.Methods Based on the data from a tertiary specialized hospital in 2022,traditional bed efficiency indicators were used as the basis.The Case Mix Index(CMI)was introduced for ad-justment,and the reasonable range of beds for each department was calculated.Data Envelopment Analysis(DEA)was em-ployed to comprehensively evaluate the input-output efficiency of each clinical department and determine the direction for optimi-zing bed allocation.Results Among the 39 departments included in the study,10 departments had inappropriate bed settings.Among them,5 departments needed additional beds,while 5 departments needed to reduce the number of beds.Conclusion By adjusting the bed efficiency indicators using CMI and combining the DEA method,hospitals can obtain a scientific basis for dy-namically adjusting the number of beds in clinical departments.Hospitals should make rational use of bed resources and scientifi-cally plan departmental beds.

Objective To evaluate the efficacy,safety and economy of efgartigimod alfa in the treatment of generalized myasthenia gravis by rapid health technology assessment,and to provide evidence-based evidence for clinical rational drug use.Methods PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP,WanFang Data,SinoMed database and relevant databases of health technology assessment institutions were electronically searched to collect health technology assessment reports,systematic reviews/Meta-analysis and pharmacoeconomic literatures of efgartigimod alfa for the treatment of generalized myasthenia gravis from the inception to June 21,2024.Two researchers screened the literature,extracted data,and evaluated the quality of the literature,summarised the finding and performed qualitative descriptive analysis.Results A total of 6 literature were included,involving 5 systematic reviews/Meta-analysis and one pharmacoeconomic study.In terms of efficacy,efgartigimod alfa demonstrated a significant reduction in MG-ADL,QMGs,and MG-QOLs 15R compared to placebo among generalized myasthenia gravis patients,these differences were statistically significant(P＜0.05).However,findings from different studies regarding comparisons with other biologics like batoclimab,ronzanolixizumab,and eculizumab yielded inconsistent conclusions.In terms of safety,the incidence of adverse events in adults generalized myasthenia gravis patients treated with efgartigimod alfa compared with that of the placebo was not statistically significant(P＞0.05).However,compared with other biological agents,the conclusions drawn from each study were inconsistent.In terms of economics,efgartigimod alfa did not exhibit cost-effectiveness advantages over traditional therapies.Conclusion Efgartigimod alpha showed better efficacy than placebo in the treatment of generalized myasthenia gravis,but there was no definitive conclusion compared with other biological agents.In terms of safety,the incidence of ADE in adult generalized myasthenia gravis patients treated with efgartigimod alpha was not statistically different from that of the placebo group,and no definite conclusion could be drawn when compared with other biological agents.According to U.S.drug economic data,efgartigimod alpha does not have economic advantages over traditional therapies.

Background Pesticides like organophosphorus and pyrethroids are extensively utilized, and associated potential human health risks arising from multi-route exposure, including environmental sources and dietary intake, cannot be overlooked. Conducting human exposure studies using pesticide exposure biomarkers is essential for an objective evaluation of human pesticide exposure levels. Objective To develop a rapid and precise liquid chromatography-tandem mass spectrometry method for the detection of 12 pesticide metabolites in urine, including 5 metabolites of organophosphorus pesticide, 4 metabolites of pyrethroid pesticide, 2 metabolites of herbicides, and 1 metabolite of insecticide. Methods After overnight enzymatic hydrolysis, urine samples were subjected to extraction and purification using Oasis HLB 96-well solid-phase extraction. Subsequently, the samples were analyzed by liquid chromatography-tandem mass spectrometry and quantified using the isotope internal standard method. The developed method was employed to analyze 143 urine samples from a general population to assess its effectiveness and to evaluate pesticide exposure levels. Results All 12 target compounds exhibited good linear ranges, with their correlation coefficients of calibration curves exceeding 0.999. The limits of detection (LOD) ranged from 0.02 to 0.19 μg·L⁻¹, while the limits of quantitation (LOQ) ranged from 0.06 to 0.27 μg·L⁻¹. The recoveries at three spiked levels ranged from 84% to 112%, and the inter- and intra- day precisions of targeted analystes were 0.43%-9.6% and 1.6%-9.7% respectively. Using this method, 143 urine samples from residents in Jiangsu region were analyzed, and 11 pesticides were detected except N,N-diethyl-m-toluamide (DEET). Conclusion The established method of solid-phase extraction combined with liquid chromatography-tandem mass spectrometry has the characteristics of low detection limit, good repeatability, and high throughput, which is suitable for quantitative detection of selected 12 pesticides in large batches of human urine samples, and provides technical support for pesticide internal exposure monitoring and health risk assessment.