OBJECTIVE To systematically evaluate the relationship of semaglutide with malignant neoplasms in type 2 diabetes mellitus （T2DM） patients. METHODS Retrieved from the Cochrane Library， PubMed， Embase， ClinicalTrials.gov， CNKI， Wanfang data and CBM， randomized controlled trials （RCTs） about semaglutide in the treatment of T2DM patients with outcome measures including malignant tumor events were collected from the establishment of the database to June 2024. Meta- analysis was performed by using RevMan 5.3 software to assess the risk of malignant neoplasms. RESULTS A total of 24 RCTs （26 trials） involving 24 145 patients were included. Results of meta-analysis showed that compared to placebo， there was no statistical significance in the risk of semaglutide in pancreatic cancer [RR＝0.39， 95%CI（0.10， 1.50）， P＝0.17]， thyroid cancer [RR＝1.29， 95%CI（0.38， 4.36）， P＝0.68]， prostate cancer [RR＝1.05， 95%CI（0.36， 3.12）， P＝0.92]， skin cancer [RR＝1.27， 95%CI（0.80， 2.02）， P＝0.31]， gastrointestinal cancer [RR＝1.00， 95%CI（0.47， 2.14）， P＝1.00]， colorectal cancer [RR＝0.96， 95%CI（0.40， 2.26）， P＝0.92]， lung cancer [RR＝1.62， 95%CI（0.74， 3.55）， P＝0.23]， breast cancer [RR＝1.25， 95%CI（0.45， 3.51）， P＝0.67] or all malignant neoplasms [RR＝0.96， 95%CI（0.76， 1.21）， P＝0.73]. Compared to other antidiabetic drugs， there was no statistical significance in the risk of semaglutide in pancreatic cancer [RR＝0.62， 95%CI（0.18， 2.09）， P＝0.44]， thyroid cancer [RR＝1.09， 95%CI（0.25， 4.78）， P＝0.90]， prostate cancer [RR＝2.09， 95%CI（0.46， 9.47）， P＝0.34]， skin cancer [RR＝1.76， 95%CI（0.65， 4.72）， P＝0.26]， gastrointestinal cancer [RR＝0.68， 95%CI（0.19， 2.35）， P＝0.54]， colorectal cancer [RR＝0.60， 95%CI（0.20， 1.78）， P＝0.36]， lung cancer [RR＝1.00， 95%CI（0.24， 4.11）， P＝1.00]， breast cancer [RR＝0.82， 95%CI（0.25， 2.66）， P＝0.74] or all malignant neoplasms [RR＝1.36， 95%CI（0.96， 1.94）， P＝0.09]. CONCLUSIONS Semaglutide does not increase the risk of any type of malignant neoplasms in T2DM patients.

OBJECTIVE: To explore the main components and potential mechanisms of Sangqi Qingxuan Liquid in the treatment of arterial vascular endothelial cells (AVECs) injury in hypertension through network pharmacology. METHODS: Traditional Chinese Medicine Systems Pharmacology and Analysis Platform (TCMSP) and Traditional Chinese Medicine Integrated Database (TCMID) were used to screen the active components of Sangqi Qingxuan Liquid (SQQX), which met the oral utilization rate and drug similarity criteria. An active component-target network was constructed using Cytoscape 3.6 software. A protein-protein interaction (PPI) network of targets associated with SQQX treatment for hypertension was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database. The Metascape database was used to perform enrichment analysis of gene ontology biological functions and MSigDB pathway enrichment analysis of proteins in the PPI network. Further analysis of the main components of SQQX was performed using UPLC-MS. Based on the results of network pharmacology, the mechanism of SQQX to improve the injury of AVECs in hypertension was verified through lentiviral transfection by Wnt/ β -catenin signaling pathway. AVECs induced by angiotensin II (Ang II ) was used to establish a model of endothelial function injury in hypertension. Cell viability, intracellular nitric oxide content, malonaldehyde content, and superoxide dismutase activity were measured to determine the optimal induction conditions. The optimal intervention conditions for SQQX were determined based on cell viability, cellular DNA activity, and the gradient method. The cells were further divided into blank, model, overexpression lentivirus negative control, overexpression lentivirus, overexpression lentivirus + SQQX intervention (2.47 mg/mL, 12 h), inhibition lentivirus negative control, inhibition lentivirus, and inhibition lentivirus + SQQX intervention (2.47 mg/mL, 12 h) groups. Finally, quantitative real-time PCR and Western blotting were performed to analyze the molecular mechanisms of SQQX in the Wnt/ β -catenin signaling pathway. RESULTS: The main SQQX components were betaine, buddleoside, and chlorogenic acid, in descending order. Network pharmacology analysis screened 12 pathways associated with the hypertensive vascular endothelium. The results showed that 1 µ mol/L for 12 h was the optimal condition for Ang II to induce AVECs injury, and 2.47 mg/mL SQQX intervention for 12 h was the optimal condition for treating AVECs injury. In the experimental validation based on the interaction network of the Wnt/ β -catenin signaling pathway, SQQX significantly decreased the expressions of β -catenin, Smad2, peroxisome proliferator-activated receptors (PPARs), endothelial nitric oxide synthase (eNOS), and endothelin-1 (ET-1) caused by the β -catenin overexpression lentivirus (P<0.05 or P<0.01). The function of vascular endothelial cells can be improved by the β -catenin inhibition lentivirus, and no obvious changes were observed after further intervention with SQQX. CONCLUSION SQQX may protect against AVECs injury by regulating the Wnt/β -catenin signaling pathway.
Drugs, Chinese Herbal/therapeutic use* ; beta Catenin/metabolism* ; Hypertension/metabolism* ; Endothelial Cells/metabolism* ; Protein Interaction Maps/drug effects* ; Humans ; Wnt Signaling Pathway/drug effects* ; Network Pharmacology ; Endothelium, Vascular/injuries* ; Cell Survival/drug effects* ; Angiotensin II/pharmacology* ; Nitric Oxide/metabolism*

Insulin is an important protein hormone that participates in multiple metabolic pathways.Biosynthetic insulin has been widely used in the treatment of type 1 and type 2 diabetes.Currently,the number of reported cases of insulin overdose both at home and abroad is gradually increasing,and insulin homicide is no longer a means of"committing murder without leaving a trace".At present,there are no systematic protocols for the identification of insulin overdose in the field of forensic medi-cine in China.This article introduces the causes,toxicological characteristics,forensic examination,labo-ratory testing methods and indicator reference of insulin overdose.Based on the identification practice and research results and referring to relevant studies on insulin overdose at home and abroad,this pa-per aims to provide recommendations and references for the formulation of forensic identification guide-lines for insulin overdose cases.

Objective:To summarize the clinical characteristics of suicidal behavior in children and provide a reference for further developing strategies for preventing childhood suicide.Methods:The medical records of children hospitalized in the pediatric intensive care unit（PICU）at Beijing Children's Hospital for suicidal behavior in the electronic medical record system from January 1,2018,to December 31,2022 were retrospectively selected.Clinical data of children with suicidal behavior were collected.Results:A total of 3 249 patients were admitted to the PICU,including 62 suicide patients.There were 20(32.3%) males,and 42(67.7%) females,with a male-to-female ratio of 1:2.1.The average age was (13.1 ± 1.5) years old,with a minimum age of 7.9 years and a maximum age of 15.7 years.There were 17 (27.4%) children with previously diagnosed mental illnesses.Notably 58.1% children had triggering factors for suicidal behavior.Analysis of suicide methods,53(85.5%) cases were intentional drug ingestion,six(9.7%) cases were jumping from height,and three(4.8%) cases were hanging.Additionally 26.4% cases of poisoning were male,while 66.7% of cases of jumping from height and hanging were male.There was a statistical difference in suicide methods between genders (χ 2=5.704, P=0.025).The poisoning ingestions were classified as 20(37.7%) cases of toxins; 14(26.4%) cases of antidepressants; 10(18.9%) cases of over-the-counter drugs; five(9.4%) cases of other prescription drugs; three(5.7%) cases of sedative drugs; one(1.9%) case of daily chemical.Sources of ingestions: 18(34.0%) cases were purchased personally (pharmacies or online shopping); 16(30.2%) cases were storing medicines at home; 13(24.5%) cases were daily taking antidepressants.Compared with non-poisoning patients,poisoning patients had a significantly shorter PICU duration (Z=-2.884, P=0.004).The total mortality rate of children admitted to PICU due to suicide was 16.1%(10/62).There was a statistical difference in the mortality rate among different suicide methods (χ 2=7.883, P=0.019). Conclusion:School aged children and boys are more likely to choose impulsive and more harmful suicide behaviors such as jumping from heights and hanging,and adolescent girls are more likely to choose intentional poisoning as their suicide method.Attention should be paid to the suicide risk of different age and gender groups.Intentional drug ingestion is the main method of suicide in children.Herbicide poisoning and antidepressant drug poisoning are the leading causes of suicide death.The death risk of suicidal behavior in children may be reduced by controlling the way of getting pesticides (especially herbicides) and obtaining maximum doses of antidepressants.

Postsurgical hypoparathyroidism is a common cause of hypoparathyroidism, with a variety of clinical manifestations. It is life-threatening in acute and severe cases, and may lead to poor quality of life in chronic patients. It is imperative to consistently enhance the identification and governance of such circumstance. Focusing on the pathophysiological changes, clinical and biochemical features, acute and chronic treatments of postsurgical hypoparathyroidism, a consensus was developed by domestic experts from surgery, endocrinology and nephrology.

At the end of 2022,the Fifth International Workshop on Primary Hyperparathyroidism(PHPT)released the most recent guidelines for the evaluation and management of PHPT.These guidelines offer a comprehensive overview and provide guideline recommendations on various aspects of PHPT,including epidemiology,pathophysiology,genetics,clinical manifestations,as well as both surgical and non-surgical management.This paper focuses on surgical management issues concerning PHPT as addressed in these guidelines,with the aim of further improving the diagnosis and treatment of PHPT in China and promoting the standardization of surgical management for PHPT.

Objective:To determine the correlation of tumor volume and weight with biochemical parameters in patients with parathyroid adenoma (PA) .Methods:A prospective electronic database collected clinical data on 208 patients with PA treated for the first time by surgery at department of general surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College.The relationship between biochemical parameters and tumor volume and weight was analyzed with Spearman’s correlation.Results:Tumor volume and weight were positively correlated with parathyroid hormone (PTH) ( r=0.33, P<0.001; r=0.39, P<0.001), calcium ( r=0.16, P=0.018; r=0.18, P=0.007) and alkaline phosphatase levels ( r=0.24, P<0.001; r=0.27, P<0.001), respectively. Clinical correlates affecting serum PTH were age, serum calcium and tumor weight ( F=30.325, P<0.001) . Conclusions:Tumor burden in patients with PA correlates with some laboratory biochemical parameters. Age and cystic lesions of the tumor may influence the actual serum PTH levels.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

In recent years, artificial intelligence technology has been empowering various industries and leading industrial upgrading. The progress of artificial intelligence in medical image analysis and surgical navigation positioning is revolutionizing the entire medical field and gradually penetrating into the diagnosis and treatment of thyroid and parathyroid diseases. This article focuses on the application of artificial intelligence in the surgical diagnosis and treatment of thyroid and parathyroid diseases, emphasizing the research and application progress of deep learning based artificial intelligence systems in preoperative evaluation, intraoperative decision-making assistance, and postoperative prognosis prediction, and exploring future development prospects.

Minimally invasive surgery is the development direction of surgery in the 21st century, and thoracoscopic or laparoscopic skills are essential skills that all surgeons must master. Thoracoscopic or laparoscopic skills training is an important part of surgical resident training. However, there are various methods for thoracoscopic or laparoscopic skill training internationally. The assessment is still in the stage of examiners’ visual observation and subjective evaluation. Here, we reviewed the current research status of thoracoscopic and laparoscopic simulation training and assessment, discussed the development experience and application achievements of Huaxi Intelligent Thoracoscopic Skill Training and Assessment System. We aimed to provide a theoretical basis and practical experience for the development of thoracoscopic or laparoscopic simulation education.