As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*

Background: and Purpose Intravenous tenecteplase (TNK) efficacy has not been well demonstrated in acute ischemic stroke (AIS) beyond 4.5 hours after onset. This study aimed to determine the effect of intravenous TNK for AIS within 4.5 to 24 hours of onset. Methods: In this pilot trial, eligible AIS patients with diffusion-weighted imaging (DWI)-fluid attenuated inversion recovery (FLAIR) mismatch were randomly allocated to intravenous TNK (0.25 mg/kg) or standard care within 4.5–24 hours of onset. The primary endpoint was excellent functional outcome at 90 days (modified Rankin Scale [mRS] score of 0–1). The primary safety endpoint was symptomatic intracranial hemorrhage (sICH). Results: Of the randomly assigned 80 patients, the primary endpoint occurred in 52.5% (21/40) of TNK group and 50.0% (20/40) of control group, with no significant difference (unadjusted odds ratio, 1.11; 95% confidence interval 0.46–2.66; P=0.82). More early neurological improvement occurred in TNK group than in control group (11 vs. 3, P=0.03), but no significant differences were found in other secondary endpoints, such as mRS 0–2 at 90 days, shift analysis of mRS at 90 days, and change in National Institutes of Health Stroke Scale score at 24 hours and 7 days. There were no cases of sICH in this trial; however, asymptomatic intracranial hemorrhage occurred in 3 of the 40 patients (7.5%) in the TNK group. Conclusion This phase 2, randomized, multicenter study suggests that intravenous TNK within 4.5–24 hours of onset may be safe and feasible in AIS patients with a DWI-FLAIR mismatch.

The main components and working principle of the fluid infusion and blood transfusion warmer were introduced,and the causes for the adverse events of the warmer were summarized based on National Medical Device Adverse Event Monitoring Information System and related literature in the world.The potential risks of the warmer were analyzed during operation,and the quality concerns and corresponding evaluation methods were proposed for the warmer from the aspects of device marking and documentation,structure,and temperature.References were provided for standard preparation,pre-market technical review and system verification of the fluid infusion and blood transfusion warmer.[Chinese Medical Equipment Journal,2023,44(10):76-80]

Objective: To investigate the expression of programmed death ligand-1 (PD-L1, SP142) and PD-L1 (22C3) in triple-negative breast cancer (TNBC), and analyze their correlation with the clinicopathological factors and prognosis. Methods: The clinicopathologic data of 259 patients with TNBC treated in Cancer Hospital from August 2010 to December 2013 were collected. Whole section of surgical tissue samples were collected to conduct PD-L1 (SP142) and PD-L1 (22C3) immunohistochemical (IHC) staining. The PD-L1 expression in tumor cells and tumor infiltrating immune cells were visually assessed respectively, the relationship between PD-L1 expression and clinicopathologic characterizes were analyzed. Univariable and multivariable Cox proportional hazards regression models were used to test the correlations between PD-L1 expression and disease-free survival (DFS) and overall survival (OS). Results: The positive rates of SP142 (immune cell score, ICs≥1%) and 22C3 (combined positive score, CPS≥1) were 42.1%(109/259) and 41.3%(107/259) in TNBC tissues, respectively, with a total coincidence rate of 82.3%. The Kappa value of positive expression cases was 0.571 and the distribution difference of SP142 and 22C3 positive expression cases was statistically significant (P<0.001). The PD-L1 positive patients were less likely to have vascular invasion (P<0.05), but with higher histological grade and Ki-67 proliferation index (P<0.05). The recurrence/metastasis cases(8) of the patients with positive PD-L1 (SP142) was significantly lower than that of patients with negative PD-L1(SP142, 27, P=0.016). The positive expression of PD-L1 (SP142) patients were longer DFS (P=0.019). The OS of patients with positive PD-L1 (SP142) were longer than those with negative PD-L1 (SP142), but without significance (P=0.116). The positive expression of PD-L1 (22C3) was marginally associated with DFS and OS of patients (P>0.05). Conclusions: The expression of PD-L1 (22C3) is different from that of PD-L1 (SP142) in TNBC, and the two antibodies can't be interchangeable for each other in clinical tests. PD-L1 (SP142) status is an independent prognostic factor of DFS in TNBC. The DFS is significantly prolonged in patients with positive expression of PD-L1 (SP142).
B7-H1 Antigen/genetics* ; Humans ; Immunohistochemistry ; Prognosis ; Triple Negative Breast Neoplasms/pathology*

Aim Amyotrophic lateral sclerosis (Alii) is a neurodegenerative disease caused by the selective loss of upper and lower motor neurons.Its pathogenesis is complex and not yet fully understood.Accumulating evidences show that energy metabolism defieits and homeostasis imbalance lead to selective degeneration of motor neurons in ALS.Adenosine phosphate-activated protein kinase ( AMPK) and silent information regulator-1 (SIRT1) are known to sense energy metabolism at the cellular level, playing an essential part in regulating the energy homeostasis and autophagy by activating downstream pathways.AMPK activates SIRT1 to activate the deaeetylation and activation of downstream genes involved in energy metabolism such as peroxisome proliferator-aetivated receptor 7 ( PPAR-y) and eoaetivator la ( PGC-la) , thereby increasing the level of mitochondrial biosynthesis.Therefore, the mechanism by which AMPK/SIRT1 participates in the regulation of energy metabolism is highly likely to be a potential target for ALS treatment.Here we first review the important role of energy metabolism defects and mitochondrial abnormalities in the pathogenesis of ALS, and briefly address the therapeutic potential of AMPK/SIRT1/PGC-1 a pathway as a treatment target in ALS, and how targeted regulation of this signaling pathway makes it an effective therapeutic strategy for ALS.

Aged ; Cognitive Dysfunction/epidemiology* ; Cross-Sectional Studies ; Geriatric Assessment ; Humans ; Independent Living ; Sarcopenia/epidemiology*

Objective:To evaluate effect of addition and subtraction therapy of Buyang Huanwutang combined with Si Junzitang and acupuncture to poststroke fatigue （PSF） and syndrome of Qi deficiency and blood stasis， at the same time we studied the antioxidant and anti-inflammatory effects. Method:One hundred and forty-four patients were randomly divided into control group and observation group （1∶1） by random number table. 66 patients in control group completed the therapy （4 patients were falling off or missing visit， 2 patients were eliminate）， 67 patients in observation group completed the therapy （2 patients were falling off or missing visit， 3 patients were eliminate）. In control group， patinets got acupuncture， 1 time/day， 6 times/week， they also got Geqi Tongmai grain， 10 g/time， 3 times/day. Patients in observation group got acupuncture （the same as which in control group）， and addition and subtraction therapy of Buyang Huanwutang combined with Si Junzitang， 1 dose/day， and courses of treatment in two groups were 4 weeks. Before and after treatment， fatigue severity scale （FSS）， NIH stroke scale （NIHSS）， syndrome of Qi deficiency and blood stasis， stroke specific quality of life scale （SS-QOL）， and scores of ability of daily life （ADL） were recorded. And levels of superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， homocysteine （Hcy）， interleukin-1β （IL-1β）， IL-6， tumor necrosis factor-α （TNF-α） and C-reactive protein （CRP） were detected. And the safety evaluated. Result:Disease effect in observation group was better than which in control group （Z=2.118， P<0.05）. And effect after using traditional Chinese medicine （TCM） was also better than that in control group （Z=2.046， P<0.05）. Scores of FSS， syndrome of Qi deficiency and blood stasis， NIHSS， and levels of IL-1β， IL-6， Hcy， CRP， TNF-α and MDA in observation group were all lower than those in control group （P<0.01）， and scores of SS-QOL， ADL， and levels of GSH-Px and SOD were all higher than those in control group （P<0.01）. Then there was no related safety issues caused by drug. Conclusion:Addition and subtraction therapy of Buyang Huanwutang combined with Si Junzitang and acupuncture had effect of anti-oxidation and anti-inflammatory， and can significantly reduce fatigue and degree of neurological impairment and can improve patients' quality of life and daily life ability. The clinical effect is significant and safe， which is worthy of further research and application.