ObjectiveTo evaluate the clinical efficacy of Huayu Tongluo Formula （化瘀通络方， HTF） in patients with mid-stage diabetic kidney disease of blood stasis syndrome and explore its potential mechanisms. MethodsA multi-center， randomized， double-blind， placebo-controlled clinical trial was conducted. Ninety patients of mid-stage diabetic kidney disease of blood stasis syndrome were divided into a control group of 46 cases and a treatment group of 44 cases. Both groups received conventional western medicine treatment， the treatment group additionally taking HTF， while the control group taking a placebo of the formula. The treatment was administered once daily for 24 weeks. The primary outcomes included 24-hour urine total protein （24 h-UTP）， serum albumin （Alb）， glycated hemoglobin （HbA1c）， and serum creatinine （Scr）.The secondary outcomes included changes in levels of endothelin-1 （ET-1）， nitric oxide （NO）， vascular endothelial growth factor （VEGF）， and traditional Chinese medicine （TCM） syndrome scores before and after treatment. Clinical efficacy was evaluated based on TCM syndrome scores and overall disease outcomes. Adverse reactions and endpoint events were recorded. ResultsIn the treatment group after treatment， 24 h-UTP， ET-1， and VEGF levels significantly decreased （P＜0.05）， Alb and NO levels significantly increased （P＜0.05）； while the TCM syndrome scores for edema， lumbar pain， numbness of limbs， dark purple lips， dark purple tongue or purpura， and thin， rough pulse all significantly decreased （P＜0.05）. In the control group， no significant changes were observed in any of the indicators after treatment （P＞0.05）.Compared with the control group， the treatment group showed significant reductions in 24 h-UTP， ET-1， and VEGF levels， and increases in Alb and NO levels （P＜0.05）. The TCM syndrome scores for edema， lumbar pain， dark purple tongue or purpura， and thin， rough pulse were all lower in the treatment group than in the control group （P＜0.05）. The total effective rate of TCM syndrome in the treatment group was 59.09% （26/44）， and the overall clinical effective rate was 45.45% （20/44）. In the control group， these rates were 15.22% （7/46） and 8.7% （4/46）， respectively， with the treatment group showing significantly better outcomes （P＜0.05）. A total of 7 adverse events occurred across both groups， with no significant difference （P＞0.05）. No endpoint events occurred during the study. ConclusionOn the basis of conventional treatment of Western medicine， HTF can further reduce urinary protein levels and improve clinical symptoms in patients with mid-stage diabetic kidney disease of blood stasis syndrome. The mechanism may be related to its effects on endothelial function.

BACKGROUND: Quantitative flow ratio (QFR) holds significant value in guiding drug-coated balloon (DCB) treatment and enhancing outcomes. However, the predictive capability of post-angioplasty QFR for long-term clinical events in patients with de novo lesions who receive DCB treatment remains uncertain. The aim of this study was to explore the potential significance of post-angioplasty QFR measurements in predicting clinical outcomes in patients underwent DCB treatment for de novo lesions. METHODS: Patients who underwent DCB-only intervention for de novo lesions were enrolled. QFR was conducted after DCB treatment. The patients were then categorized based on post-angioplasty QFR. The primary endpoint was major adverse cardiac events (MACE), encompassing all-cause death, cardiovascular death, nonfatal myocardial infarction, stroke, and target vessel revascularization. RESULTS: A total of 553 patients with 561 lesions were included. The median follow-up period was 505 days, during which 66 (11.8%) MACEs occurred. Based on post-procedural QFR grouping, there were 259 cases in the high QFR group (QFR > 0.93) and 302 cases in the low QFR group (QFR ≤ 0.93). Kaplan-Meier analysis revealed a significantly higher cumulative incidence of MACE in the low QFR group (log-rank P = 0.004). The multivariate Cox proportional hazards model demonstrated a significant inverse correlation between QFR and the occurrence of MACEs (HR = 0.522, 95%CI: 0.289-0.942, P = 0.031). Landmark analysis indicated that high QFR had a significant reducing effect on the cumulative incidence of MACEs within 1 year (log-rank P = 0.016) and 1-5 years (log-rank P = 0.026). CONCLUSIONS In patients who underwent DCB-only treatment for de novo lesions, higher post-procedural QFR values (> 0.93) were identified as an independent protective factor against adverse prognosis.

Objective To identify disulfidptosis-related gene(DRG)in acute myocardial infarction(AMI)by bioinformatics,analyze the molecular pattern of DRGs in AMI,and construct a DRGs-related prediction model.Methods AMI-related datasets were downloaded from the Gene Expression Omnibus database,and DRGs with differential expression were screened in AMI.CIBERSORT method was used to analyze the immune infiltration.Based on the differentially expressed DRGs,the AMI patients were classified into distinct subtypes via consensus clustering,followed by immune infiltration analysis,differential expression analysis,gene ontology and Kyoto encyclopedia of genes and genomes enrichment analysis,and gene set variation analysis.Weighted gene co-expression network analysis(WGCNA)was then performed to construct subtype-associated modules and identify hub genes.Finally,least absolute shrinkage and selection operator,random forest,and support vector machine-recursive feature elimination were used to screen feature genes to construct a DRGs-related prediction model.The model's diagnostic efficacy was evaluated by nomogram and receiver operating characteristic(ROC)curve analysis,followed by external validation.Results Nine differentially expressed DRGs were identified between AMI patients and controls.Based on the expression levels of these nine DRGs,AMI patients were divided into two DRGs subtypes,C1 and C2.Increased infiltration of monocytes,M0 macrophages,and neutrophils was observed in AMI patients and C1 subtype(all P<0.05),indicating a close correlation between DRGs and immune cells.There were 257 differentially expressed genes between the C1 and C2 subtypes,which were related to biological processes such as myeloid leukocyte activation and positive regulation of cytokines.Fcγ receptor-mediated phagocytosis and NOD-like receptor signaling pathway activity were enhanced in C1 subtype.WGCNA analysis suggested that the brown module exhibited the strongest correlation with DRG subtypes(r=0.67),from which 23 differentially expressed genes were identified.The feature genes screened by three machine learning methods were interpolated to obtain a DRGs-related prediction model consisting of three genes(AQP9,F5 and PYGL).Nomogram and ROC curves(AUC_train=0.891,AUC_test=0.840)showed good diagnostic efficacy.Conclusions DRGs were closely related to the occurrence and progression of AMI.The DRGs-related prediction model consisting of AQP9,F5 and PYGL may provide targets for the diagnosis and personalized treatment of AMI.
Humans ; Myocardial Infarction/diagnosis* ; Transcriptome ; Computational Biology ; Gene Expression Profiling ; ROC Curve ; Gene Regulatory Networks ; Nomograms ; Disulfidptosis

The practice form of medical humanities has the most fundamental significance among many forms of medical humanities.The value of medical humanities can only be truly realized and exert a practical impact across different levels and areas of healthcare when other forms are ultimately transformed into practical processes and achieve practical results.Clinical practice is the main venue for the practice of medical humanities,and the doctor-patient relationship is the primary field where medical humanities exert their influence.In the fields of social health care system construction,medical education and its reform,medical humanities can really play a role through its practice form and operation process.It is the essence of medical humanities that practice forms play a role effectively.The effective role of practice is the essential prescriptive nature of medical humanities.

Psychiatric ethics is a component of Fan Ruiping's book Contemporary Medicine and Confucian Thought with unique academic perspectives.Fan Ruiping stood from the Confucian bioethical standpoint,analyzing and criticizing the medical individualism stance reflected in Article 30 of the Mental Health Law.of People's Republic of china on the voluntariness principle of in-patient therapy for mental disorders.Based on the comparison of cognitive paths and practical methods of bioethics in Eastern and Western,through in-depth analysis of multiple cases,he reflected on how Confucian psychiatric ethics should develop in the contemporary era and the necessity of improving Confucian family-oriented ethical practices.With the help of Fan Ruiping's cognitive conclusions,this paper questioned the moral basis of Article 30 of the Mental Health Law,discussed the special ethical regulations of the"autonomy"of patients with mental disorders,and advised Fan Ruiping's on the multifaceted issues confronting Confucian family ethics in response to international psychiatric ethics.

A 55-year-old male patient was admitted to the hospital due to "recurrent chest pain for 8 months, with worsening symptoms for 2 weeks". After admission, comprehensive relevant examinations led to the consideration of a giant chronic left ventricular pseudoaneurysm caused by myocardial infarction with non-obstructive coronary arteries. Surgical treatment was performed at our hospital. We discuss the diagnosis and treatment of this patient.

Objective Aberrant expression of ATP binding cassette subfamily B member 1(ABCB1)plays a key role in several cancers.However,influence of G protein coupled receptor family C group 5 type A(GPRC5A)-regulated ABCB1 expression on lung adenocarcinoma proliferation remains unclear.Therefore,this study investigated the effect of GPRC5A regulated ABCB1 expression on the proliferation of lung adenocarcinoma. Methods ABCB1 expressions in lung adenocarcinoma cell lines,human lung adenocarcinoma tissues,and tracheal epithelial cells and lung tissues of GPRC5A knockout mice and wild-type mice were analyzed with RT-PCR,Western blot,or immunohistochemical analysis.Cell counting kit-8 assay was performed to analyze the sensitivity of tracheal epithelial cells from GPRC5A knockout mice to chemotherapeutic agents.Subcutaneous tumor formation assay was performed to confirm whether down-regulation of ABCB 1 could inhibit the proliferation of lung adenocarcinoma in vivo.To verify the potential regulatory relationship between GPRC5A and ABCB1,immunofluorescence and immunoprecipitation assays were performed. Results ABCB1 expression was up-regulated in lung adenocarcinoma cell lines and human lung adenocarcinoma tissues.ABCB1 expression in the tracheal epithelial cells and lung tissues of GPRC5A deficient mice was higher than that in the wild type mice.Tracheal epithelial cells of GPRC5A knockout mice were much more sensitive to tariquidar and doxorubicin than those of GPRC5A wild type mice.Accordingly,28 days after injection of the transplanted cells,the volume and weight of lung tumor in ABCB1 knockout cell-transplanted GPRC5A-/-C57BL/6 mice were significantly smaller than those in wild type cell-transplanted mice(P=0.0043,P=0.0060).Furthermore,immunofluorescence and immunoprecipitation assays showed that GPRC5A regulated ABCB1 expression by direct binding. Conclusion GPRC5A reduces lung adenocarcinoma proliferation via inhibiting ABCB1 expression.The pathway by which GPRC5A regulates ABCB1 expression needs to be investigated.

With the popularity of imaging examination and the increase in average life expectancy,the detection rate of pancreatic cystic neoplasm(PCN)is also increasing.Different subtypes of PCN have different risks of malignancy,therefore,accurate stratification of the malignant potential is crucial for providing surveillance plans and making surgical decision.In recent years,many guidelines have identified several imaging features(cyst size,mural nodules,and main pancreatic duct diameter)as risk factors for PCN malignancy.However,the measurement standards for individual feature are not uniform and their diagnostic capabilities are limited;models that integrate multiple features perform poorly in diagnosis.This article reviews the value of imaging risk factors in PCN malignancy prediction and the application of radiomics and artificial intelligence,providing direction for further imaging research and improving the accuracy of preoperative PCN risk stratification.