Background: and Purpose Live cell-based assays (LCBA) are increasingly used for serological antibody detection due to their ability to preserve antigen conformation, offering moderately higher sensitivity than fixed cell-based assays. However, the clinical necessity of prioritizing LCBA for the detection of aquaporin-4 immunoglobulin G (AQP4-IgG) in neuromyelitis optica spectrum disorder (NMOSD) remains unclear, especially when compared to its established role in diagnosing myelin oligodendrocyte glycoprotein antibody-associated disease. Methods: We compared the performance of live cell-based assays using immunofluorescence (LCBA-IF) and fixed cell-based assays using immunofluorescence (FCBA-IF) in detecting AQP4-IgG in 90 cases of NMOSD meeting 2015 International Panel for Neuromyelitis Optica Diagnosis criteria, alongside 40 controls. Additionally, we further investigated the relationship between AQP4-IgG titers as measured by LCBA-IF and FCBA-IF and clinical parameters in NMOSD patients. Results: Results showed 96.9% agreement between LCBA-IF and FCBA-IF (Cohen’s κ=0.935), with a strong Spearman correlation (0.977, p<0.001). Both methods demonstrated 100% specificity, with LCBA-IF showing slightly higher sensitivity compared to FCBA-IF. Within LCBAIF-tested groups, statistically significant differences in annualized relapse rates were observed across all pairwise comparisons (low-titer vs. moderate-titer, low-titer vs. high-titer, and moderate-titer vs. high-titer; all p<0.050). However, this association reached statistical significance in some FCBA-IF-tested groups. Conclusions Overall, there is a strong concordance between LCBA-IF and FCBA-IF in detecting AQP4-IgG, where LCBA-IF shows slightly higher sensitivity. Furthermore, there is a potential link between elevated AQP4-IgG titers and an increased risk of relapse, and this correlation may appear more pronounced when using LCBA-IF.

AIM: To evaluate the effects of different corneal cap thicknesses during small-incision lenticule extraction(SMILE)on corneal densitometry(CD), visual quality, and corneal biomechanics during the first postoperative year, and to explore its safety.

METHODS: A prospective randomized contralateral controlled design was employed. Thin cap(110-120 μm)and thick cap(130-140 μm)SMILE procedures were performed on the two eyes of the same myopic patients undergoing surgery, respectively. Postoperative evaluations at 1 wk, 1, 3, 6 mo, and 1 y included CD, uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), contrast sensitivity, wavefront aberrations, and corneal biomechanics. A linear mixed-effects model was used for statistical analysis.

RESULTS:A total of 60 patients(120 eyes, 60 eyes in the thin-cap group and 60 eyes in the thick-cap group)completed the surgery successfully and attended scheduled follow-up visits. The mean age was 26.3±3.8 y, including 34 males(57%)and 26 females(43%).The intended cap thickness was 115.24±3.10 μm in the thin-cap group and 135.28±3.45 μm in the thick-cap group. There were significant intergroup differences in lenticule thickness and ablation depth(P<0.001), whereas the residual stromal bed(RSB)thickness was comparable between groups(P=0.301). Central 0-6 mm CD significantly decreased over time(P<0.001), and the thin-cap group had overall higher densitometry values than the thick-cap group(P<0.001), with significant differences persisting from 1 wk to 1 y postoperatively(Bonferroni-corrected P<0.05). At 1 y, significant CD differences were most pronounced in the anterior and central layers(both P<0.05), with no significant differences in posterior layers. The thick-cap group showed a significant improvement in UDVA(P=0.002)and better contrast sensitivity(corrected P<0.05), while the thin-cap group had higher values of total root mean square of higher-order aberrations(HOA-RMS), spherical aberration, and coma(all P<0.05). No statistical differences were observed between groups in corneal biomechanical parameters(DA, CBI, SSI)(all P >0.05), and the incidence of safety events was also comparable between the two groups(P≥0.5).

CONCLUSION: Given an equivalent RSB thickness, thicker corneal caps can reduce anterior-layer CD, improve contrast sensitivity and higher-order aberration outcomes, without obvious increases in biomechanical risks or safety concerns.Therefore, it warrants consideration as a preferred intraoperative strategy for SMILE.

Objective:To establish and validate a multimodal model based on radiomics and deep learning for predicting acute pancreatitis (AP) complicated with acute respiratory distress syndrome (ARDS).Methods:Patients diagnosed with AP from The First Affiliated Hospital of Soochow University, Donghai County People's Hospital and Jintan Affiliated Hospital of Jiangsu University between January 2017 and December 2023 were enrolled. Based on the diagnosis of ARDS within 1 week after admission, the patients were classified into the ARDS group and the non-ARDS group. Patients in the First Affiliated Hospital of Soochow University ( n=406) was used as the training set (non-ARDS group n=212 vs ARDS group n=194), while Donghai and Jintan hospitals served as the test set ( n=175; non-ARDS group n=104 vs ARDS group n=71). Clinical data, laboratory tests and the occurrence of systemic inflammatory response syndrome (SIRS) within 24 hours after admission were collected. Scoring systems such as bedside index for severity in acute pancreatitis (BISAP), Ranson score and modified CT severity index (MCTSI) were calculated. Radiomics features were extracted from three-dimensional CT images to develop a radiomics model based on XGBoost algorithm. At the same time, a deep learning model was constructed using deep convolutional networks to extract deep features. Finally, clinical features and the predictions from the aforementioned models were integrated to establish a multimodal model based on XGBoost algorithm. To enhance model visualization, variable importance ranking and local interpretable visualization were used. The receiver operating characteristic (ROC) curves of the three models and the three scores including BISAP, Ranson and MCTSI were plotted and the area under the curves (AUCs) were calculated to evaluate the prediction performance for ARDS in AP patients, as well as sensitivity and specificity. Results:In the multimodal model for predicting ARDS in AP patients, predictions of the deep learning model and the radiomics model were the most important variables, followed by SIRS, C-reactive protein, procalcitonin, albumin, glucose, creatinine, neutrophil, and Ca 2+. In the training set, the multimodal model achieved an AUC of 0.933 for predicting ARDS in AP patients, higher than the radiomics model (0.727), the deep learning model (0.877), MCTSI (0.870), Ranson (0.620) and BISAP (0.898). In the test set, the model's AUC was 0.916 for predicting ARDS in AP patients, higher than the radiomics model (0.660), the deep learning model (0.864), MCTSI (0.851), Ranson (0.609), and BISAP (0.860). Conclusions:Based on clinical structured data, radiomics and deep learning features, the multimodal model could predict the risk of ARDS in AP patients at an early stage, whose performance is better than the single-modal models and the traditional scoring systems.

Objective To investigate the relationship between cognitive function and sleep quality in patients with Alzheimer's disease(AD).Methods A case-control trial was conducted on 151 patients admitted to our department from May 2024 to December 2024.The patients with mild-to-moderate AD were assigned into the AD group(59 cases),and the cognitively normal patients in-to the control group(92 cases).All patients received neuropsychological assessment and sleep quality evaluation,including mini-mental state examination(MMSE),Montreal cognitive assess-ment(MoCA)and Pittsburgh sleep quality index(PSQI).The general clinical data and sleep qual-ity were compared between the two groups.Spearman correlation analysis was applied to analyze the relationship between cognitive function and sleep quality in the AD patients.Results The education level,MMSE score,MoCA score,instant story recall(ISR)score,delayed story recall(DSR)score,clock dawning test(CDT)score and Boston naming test score were significantly lower,while the activity of daily living(ADL)score was obviously higher in the AD group than the cognitively normal group(P＜0.05,P＜0.01).The AD patients had notably higher total score of PSQI and scores of sleep efficiency,nocturnal sleep disturbance and daytime dysfunction than the cognitively normal patients(P＜0.05,P＜0.01).In the AD patients,the total sleep time was positively correlated with the DSR score and the CDT score(r=0.300,P=0.021;r=0.308,P=0.018);hypnotic medication was negatively correlated with MMSE score,ISR score,and DSR score,and positively with ADL score(r=-0.320,P=0.013;r=-0.400,P=0.002;r=-0.331,P=0.010;r=0.355,P=0.006).Multiple linear regression analysis showed that benzodiazepines use and education level were independent influencing factors for cognitive function in the AD patients(P＜0.05,P＜0.01).Conclusion In AD patients,sleep quality is closely associated with cognitive function,as manifested by decreased sleep quality,reduced sleep efficiency,and worsened nocturnal sleep disturbances and daytime dysfunction.Administration of benzodiazepines may exacerbate cognitive impairment in AD patients.So,it is recommended that AD patients should be cautious about taking such drugs.

Objective To investigate the associations of immune cells,CD8+and CD4+T cells,and high-sensitivity C-reactive protein(hs-CRP)with cognitive function,and to explore the relation-ships among immunity,chronic inflammation,and Alzheimer's disease-related cognitive impair-ment.Methods A cross-sectional study was conducted on 101 patients with primary complaints of memory decline who visited the Alzheimer's Disease Clinic of Dongzhimen Hospital from June to December 2024.Mini-Mental State Examination(MMSE)and Delayed Story Recall Task(DSR)were performed to assess their cognitive function,and according to the results,they were divided into observation group(cognitively impaired,60 cases)and control group(cognitively normal,41 cases).Peripheral blood levels of CD8+T cells,CD4+T cells,and hs-CRP were compared between the two groups.Results The observation group exhibited significantly lower total scores and scores of different dimensions of MMSE and DSR scores,but notably higher activities of daily liv-ing scores than the control group(P＜0.05,P＜0.01).Serum hs-CRP level was obviously elevated in the observation group than the control group(P＜0.05).Binary logistic regression analysis revealed that CD8+T cells(OR=0.998,95％CI:0.996-1.000,P=0.038)and body mass index(OR=0.843,95％CI:0.719-0.990,P=0.037)were protective factors,while hs-CRP(OR=2.004,95％CI:1.215-3.306,P=0.006)was an independent risk factor for cognitive impairment.Spearman's rank correlation analysis showed a significant positive correlation between hs-CRP and CD4+T cells(P=0.011),but no significant association with CD8+T cells(P＞0.05).Conclusion Chronic inflammation and immune dysregulation synergistically contribute to cogni-tive decline.Hs-CRP may serve as a potential screening biomarker for cognitive impairment in pri-mary care settings.

Objective To compare the mid- and long-term clinical results of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of functional mitral regurgitation (FMR). Methods Patients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected. The patients who underwent MVP were divided into a MVP group, and those who underwent MVR into a MVR group. The clinical data and mid-term follow-up efficacy of two groups were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group, including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 males and 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the two groups in the extracorporeal circulation time, aortic occlusion time, postoperative hospital and ICU stay, intraoperative blood loss, or hospitalization death (P＞0.05), but the time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group (P=0.022). The total follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was (3.60±2.55) years. There were statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac function between the two groups compared with those before surgery (P<0.05). The postoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery (P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrial diameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitral regurgitation in the MVP group was higher than that in the MVR group, and the difference was statistically significant (10.0% vs. 1.5%, P=0.003). There were 14 deaths in the MVP group and 19 in the MVR group. The cumulative survival rate (P=0.605) and cardiovascular events-free survival rate (P=0.875) were not statistically significant between the two groups by Kaplan-Meier survival analysis. Conclusion The safety, and mid- and long-term clinical efficacy of MVP in the treatment of FMR patients are better than MVR, and the left atrial and left ventricular diameters are statistically reduced, and cardiac function is statistically improved. However, the surgeon needs to be well aware of the indications for the MVP procedure to reduce the rate of mitral regurgitation recurrence.

The development of traditional Chinese medicine (TCM) diagnosis and treatment has undergone multiple paradigms, evolving from sporadic experiential practices to systematic approaches in syndrome differentiation and treatment and further integration of disease and syndrome frameworks. TCM is a vital component of the medical system, valued alongside Western medicine. Treatment based on syndrome differentiation embodies both personalized treatment and holistic approaches; however, the inconsistency and lack of stability in syndrome differentiation limit clinical efficacy. The existing integration of diseases and syndromes primarily relies on patchwork and embedded systems, where the full advantages of synergy between Chinese and Western medicine are not fully realized. Recently, driven by the development of diagnosis and treatment concepts and advances in analytical technology, Western medicine has been rapidly transforming from a traditional biological model to a precision medicine model. TCM faces a similar need to progress beyond traditional syndrome differentiation and disease-syndrome integration toward a more precise diagnosis and treatment paradigm. Unlike the micro-level precision trend of Western medicine, precision diagnosis and treatment in TCM is primarily reflected in data-driven applications that incorporate information at various levels, including precise syndrome differentiation, medication, disease management, and efficacy evaluation. The current priority is to accelerate the development of TCM precision diagnosis and treatment technology platforms and advance discipline construction in this area.

Objective : To investigate the effect of the miR-155-5p/silent information regulator 1(sirt1) signaling pathway on the immune function ofCandida albicansinduced Kawasaki disease model mice. Methods : C56BL/6 mice were separated into control group, Kawasaki disease group, antagonist control group, miR-155-5p antagonist group, miR-155-5p antagonist+si-NC group, and miR-155-5p antagonist+si-sirt1 group, with 12 mice in each group. Except for the control group, mice in all other groups were used to construct a Kawasaki disease model by intraperitoneal injection of water-solubleCandida albicans. After successful modeling, administration was performed once a day for 7 days. QRT-PCR was applied to detect the expression of miR-155-5p in coronary arteries. Western blot was applied to detect sirt1 protein in coronary arteries. HE staining was applied to detect pathological changes in coronary arteries. Mouse thymus index and spleen index were detected. Flow cytometry was applied to detect helper T cells 17(Th17)/regulatory T cells(Treg) in peripheral blood. ELISA was applied to detect the levels of interleukin(IL)-17 and IL-10 in mouse serum. The targeting relationship between sirt1 and miR-155-5p was validated. Results: Compared with the control group, there was a large amount of inflammatory cell infiltration in the coronary arteries of mice in the Kawasaki disease group. The miR-155-5p expression, Th17 ratio, Th17/Treg ratio, and IL-17 level increased. The sirt1 protein expression, thymus index, spleen index, Treg ratio, and IL-10 level decreased(P<0.05). Compared with the Kawasaki disease group, the inflammatory cell infiltration in the coronary arteries of mice in the miR-155-5p antagonist group was alleviated. The miR-155-5p expression, Th17 ratio, Th17/Treg ratio, and IL-17 level decreased. The sirt1 protein expression, thymus index, spleen index, Treg ratio, and IL-10 level increased(P<0.05). Si-sirt1 weakened the promoting effect of miR-155-5p inhibition on Th17/Treg balance and the inhibitory effect on vascular inflammation in Kawasaki disease mice, miR-155-5p targeted and regulated sirt1. Conclusion The mechanism by which inhibiting miR-155-5p promotes Th17/Treg balance and inhibits vascular inflammation in Kawasaki disease mice may be related to the upregulation of sirt1 expression.

Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

OBJECTIVE: To evaluate the clinical efficacy and safety of Yangxue Qingnao Pills (YXQNP) combined with amlodipine in treating patients with grade 1 hypertension. METHODS: This is a multicenter, randomized, double-blind, and placebo-controlled study. Adult patients with grade 1 hypertension of blood deficiency and Gan (Liver)-yang hyperactivity syndrome were randomly divided into the treatment or the control groups at a 1:1 ratio. The treatment group received YXQNP and amlodipine besylate, while the control group received YXQNP's placebo and amlodipine besylate. The treatment duration lasted for 180 days. Outcomes assessed included changes in blood pressure, Chinese medicine (CM) syndrome scores, symptoms and target organ functions before and after treatment in both groups. Additionally, adverse events, such as nausea, vomiting, rash, itching, and diarrhea, were recorded in both groups. RESULTS: A total of 662 subjects were enrolled, of whom 608 (91.8%) completed the trial (306 in the treatment and 302 in the control groups). After 180 days of treatment, the standard deviations and coefficients of variation of systolic and diastolic blood pressure levels were lower in the treatment group compared with the control group. The improvement rates of dizziness, headache, insomnia, and waist soreness were significantly higher in the treatment group compared with the control group (P<0.05). After 30 days of treatment, the overall therapeutic effects on CM clinical syndromes were significantly increased in the treatment group as compared with the control group (P<0.05). After 180 days of treatment, brachial-ankle pulse wave velocity, ankle brachial index and albumin-to-creatinine ratio were improved in both groups, with no statistically significant differences (P>0.05). No serious treatment-related adverse events occurred during the study period. CONCLUSIONS Combination therapy of YXQNP with amlodipine significantly improved symptoms such as dizziness and headache, reduced blood pressure variability, and showed a trend toward lowering urinary microalbumin in hypertensive patients. These findings suggest that this regimen has good clinical efficacy and safety. (Registration No. ChiCTR1900022470).
Humans ; Amlodipine/adverse effects* ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Hypertension/complications* ; Middle Aged ; Treatment Outcome ; Drug Therapy, Combination ; Adult ; Blood Pressure/drug effects* ; Double-Blind Method ; Aged ; Antihypertensive Agents/adverse effects*