ObjectiveIn the treatment of acute gouty arthritis （AGA）， western medicine is mostly used for anti-inflammatory and analgesic purposes to control the blood uric acid level， but some patients are still at risk of poor control and recurrent attacks. Chinese medicinal prescriptions， potent in resisting inflammation and relieving pain， are able to stabilize the blood uric acid level， reduce acute attacks， and improve the clinical efficacy of western medicine. However， there is a lack of evidence to support their use as evidence-based medicine. This study employed network Meta-analysis （NMA） to evaluate the efficacy and safety of common Chinese medicinal prescriptions in the treatment of AGA， aiming to provide evidence-based medical evidence for the clinical use of Chinese medicinal prescriptions in the treatment of AGA. MethodChinese and English databases were searched for prospective cohort studies and randomized controlled trials （RCTs） on Chinese medicinal prescriptions against AGA from database inception to December 1， 2022. Stata software and Review Manager were used for statistical analysis. ResultForty-four papers with 3 564 cases involved were included in the current NMA. In terms of reducing blood uric acid， the cumulative probability results showed that Mahuang Lianyao Chixiaodou Tang showed optimal efficacy （87.60%）. In terms of relieving joint pain， Danggui Niantongtang and Guizhi Shaoyao Zhimutang showed optimal efficacy （92.00% and 82.30%）. In terms of improving erythrocyte sedimentation rate （ESR）， Simiaowan was superior to other prescriptions （87.00%）. In terms of reducing C-reactive protein （CRP）， Simiaowan and Baihutang modified with Guizhitang showed superior efficacy （76.00% and 66.10%）. In terms of safety， except for the basic treatment group， Mahuang Lianyao Chixiaodou Tang had the lowest probability of adverse events， and Danggui Niantongtang had the highest probability of adverse reactions during treatment. According to the results of cluster analysis， Mahuang Lianyao Chixiaodou Tang and Simiaowan are effective and safe. ConclusionAccording to the results of NMA， Chinese medicinal prescriptions can assist in the treatment of AGA and improve the effectiveness of western medicine. For patients with AGA， clinicians can choose Mahuang Lianyao Chixiaodou Tang or Simiaowan as an auxiliary drug for routine western medicine treatment.

Objective:To evaluate the efficacy of daily use of a test emollient combined with topical glucocorticoids applied at the weekend for delaying the recurrence of atopic dermatitis (AD) in children during the maintenance period.Methods:A randomized, blank-controlled, multicenter clinical study was conducted in children with moderate AD from Beijing Children′s Hospital, Capital Medical University, Children′s Hospital of Chongqing Medical University and Shenzhen Children′s Hospital from March 2021 to February 2022. A total of 127 children aged 0 - 12 years with moderate AD were treated with topical glucocorticoids combined with emollients during the run-in period, 112 out of them achieved the investigator′s global assessment (IGA) score ≤ 1 point, and then the 112 patients were randomly divided into a test group (56 cases) and a control group (56 cases) at a ratio of 1∶1. Patients in the test group received treatment with a test emollient twice a day in combination with topical glucocorticoids applied at the weekend, and those in the control group were only treated with topical glucocorticoids at the weekend. Patients in the two groups were followed up at baseline, week 2 (± 3 d), week 4 (± 5 d), and week 12 (±7 d), as well as at the time of AD relapse, and the effect of the test emollient on the remission rate of AD in children during the maintenance period was evaluated, so were its effects on the dosage of topical glucocorticoids, pruritus, sleep, and skin pH. The occurrence of treatment-related adverse events was evaluated and recorded at the same time. Study endpoints were defined as AD relapse during the maintenance period, end of 12-week follow-up, or occurrence of serious adverse events. Comparisons of efficacy indicators between groups were conducted by using chi-square test, Kaplan-Meier survival analysis, Satterthwaite t′ test and Mann-Whitney U test. Results:In the full-analysis set, 45 (80.36%) patients with AD maintained remission in the test group (56 cases) and 30 (53.57%) in the control group (56 cases), and the remission rate difference between the two groups was 26.79% (95% confidence interval [ CI]: 10.09%, 43.49%; χ2 = 9.11, P = 0.003) ; the 12-week follow-up during the maintenance period showed that the time to first relapse was 75.05 ± 25.07 days in the test group, which was significantly longer than that in the control group (49.55 ± 33.92 days, t′ = 4.52, P < 0.001). At the study endpoint, the test group showed significantly decreased AD disease severity score (eczema area and severity index [EASI] score: 0.00 [0.00, 1.20] points vs. 0.60 [0.00, 4.00] points), pruritus visual analog scale (VAS) score (0.00 [0.00, 2.00] points vs. 2. 00 [0.00, 10.00] points), and sleep VAS score (0.00 [0.00, 0.00] points vs. 1.00 [0.00, 4.00] points) compared with the control group ( Z = -2.77, 2.43, 3.48, P = 0.006, = 0.015, < 0.001, respectively), while there was no significant difference in the pH value at the lesional sites between the test group and control group ( t = 0.97, P = 0.335). For the group aged 0 - 2 years, the average daily glucocorticoid dosage at the weekend in AD children during the maintenance period was significantly lower in the test group than in the control group ( Z = -1.97, P = 0.049) ; for the group aged >2 - 12 years, there was no significant difference in the average daily glucocorticoid dosage at the weekend between the two groups ( Z = -0.25, P = 0.802). During the study period, no significant difference was observed in the incidence of treatment-related adverse events between the test group (2/56, 3.57%) and control group (3/56, 5.36%; P = 1.000), and no serious adverse events occurred. Conclusion:Compared with the weekend treatment with topical glucocorticoids alone, the daily use of the test emollient combined with topical glucocorticoids at the weekend could markedly improve the remission rate of AD, prolong the time to relapse, and reduce the disease severity at relapse in children with AD during the maintenance period, which provides a new option for maintenance treatment of children with AD.

To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.
Acute Coronary Syndrome/etiology* ; Dyspnea/etiology* ; Humans ; Pharyngitis/diagnosis* ; Pharynx ; Retrospective Studies

Objective:To evaluate the performance, efficacy and safety of a novel portable endoscopy system for upper gastrointestinal examination.Methods:A multicentered, open-label, randomized, non-inferiority controlled study was conducted in 3 clinical research centers from June 2019 to June 2020, and a total of 90 outpatients admitted to Department of Gastroenterology were randomly assigned to the trial group ( n=44) undergoing portable endoscopy and the control group ( n=46) undergoing Olympus endoscopy. The examination success rate, image quality, performance, overall operation satisfaction rate, biopsy success rate and adverse events of the two groups were compared. Results:The examination success rates of the trial group and the control group were 97.73% (43/44) and 100.00% (46/46) respectively with a difference of -2.27% (95% CI: -6.68%-2.13%), higher than the set non-inferiority margin of -10%. Rates of good and excellent image quality were 100% in both groups, and the difference of 0 was higher than the set non-inferiority margin of -10%. There was no significant difference in the rate of good and excellent performance of the operating system between the two groups [97.67% (42/43) VS 100.00% (46/46), P=0.483]. There was significant difference in the overall satisfactory rate of the operation between the two groups [86.05% (37/43) VS 100.00% (46/46), P=0.011]. A total of 9 cases underwent endoscopic biopsy, including 5 cases in the trial group and 4 cases in the control group. The biopsy channels in both groups were smooth and the biopsy were successfully completed. There was no significant difference in adverse event rate between the two groups [25.00% (11/44) VS 10.87%(5/46), χ2=3.07, P=0.080]. All adverse events disappeared in 48 hours, and no severe adverse events or device defect events occurred. Conclusion:The novel portable endoscopic system is comparable to Olympus endoscopic system in terms of the operating performance, the image quality and safety. Therefore, this system is safe and effective for upper gastrointestinal examination.

We reported a clinical caseof gas gangrene in the lower back and buttocks due to local intramuscular injection. A 43-year-old male was treated by local private clinic for low back pain. He underwent local intramuscular injection in his lower back and buttocks. 5 or 6 hours after the treatment,he felt worsen of low back pain (VAS 5 points)with a fever. After one day of treatment, the lower back pain was even worse(VAS 8 points). And he had soy-sauce urine and a high fever. The results of laboratory examination and clinical manifestation suggested multiple organ failure within a short period of time. Imaging (CT) suggested large area of gas and muscle necrosis in the lower back and buttocks. Considering the progress of the disease, emergency surgery on lumbar back and right buttocks was performed after hospitalization. Rapid bacterial smear reported gram-positive coarse bacteria. Anaerobic culture suggested clostridium perfringens. Aerobic culture result did not show any bacterial growth. According to the clinical manifestation, imaging (CT), intraoperative judgment and postoperative anaerobic culture results, the clinical diagnosis was gas gangrene. Gas gangrene is a special infectious disease in clinic, which can be characterized by low morbidity, difficult early diagnosis,rapid disease progression and high mortality. Sinceintramuscular injection leaded to this disease in our case, the importance of standardized aseptic procedures should be emphasized.

Objective To evaluate the effect of nimodipine combined with 7.5％ hypertonic saline (HS) on postoperative cognitive function in aged rats.Methods Ninety-six healthy male Wistar rats,aged 18 months,weighing 450-500 g,were assigned into 4 groups (n=24 each) using a random number table:splenectomy group (group S),nimodipine group (group N),group HS and nimodipine plus HS group (group N+HS).Nimodipine 1 mg/kg was intraperitoneally injected in group N.In group HS,7.5％ HS 4 ml/kg was injected via the caudal vein.The equal volume of normal saline was injected intraperitoneally or via the caudal vein in group S.Splenectomy was performed under sevoflurane anesthesia at 30 min after the end of administration.On 1 day before operation and 3 and 7 days after operation,Morris water maze test was performed,and blood sainples from the caudal vein were simultaneously collected for determination of the concentrations of serum S100β protein and neuron-specific enolase (NSE) by enzyme-linked immunosorbent assay.Results Compared with group S,the frequency of crossing the original platform was significantly increased,the escape latency was shortened,and the concentrations of serum S100β protein and NSE were decreased at each time point after operation in N,HS and N+HS groups (P＜0.05).Compared with group N or group HS,the frequency of crossing the original platform was significantly increased,the escape latency was shortened,and the concentrations of serum S100β protein and NSE were decreased at each time point after operation in group N+HS (P＜0.05).Conclusion Nimodipine combined with 7.5％ HS exerts better efficacy than either alone in improving postoperative cognitive function in aged rats.

Objective To compare the clinical and sonographic characteristics of aggressive and nonaggressive papillary thyroid microcarcinomas(PTMC)in order to improve the preoperative predictive value of aggressive PTMC.Methods A total of 309 patients with PTMC from January 2014 to December 2016 were included in this study.Patients with lymphatic metastasis,extrathyroidal invasion,reccurence, distant metastasis and death were classified into aggressive PTMC group,and patients without above characteristics were classified into nonaggressive group.Clinical and sonographic features were reviewed and compared between the two groups.Results Among the 309 patients,76 cases(24.6%)were aggressive PTMC,and 233 cases(75.4%)were nonaggressive.Patients were younger and larger cancerous nodules, microcalcification,capsular inconnection and multifocality were seen more frequently in aggressive PTMC group compared with nonaggressive group.The best cut-off value of age and diameter were 44.5 years and 0.66 cm respectively.Advanced age was the protective factor and larger tumor size and multifocality were independent risk factors for PTMC aggressiveness.The capsular invasion was related with the lateral cervical lymph node metastasis while other features were not.Conclusions Extra attention should be paid to patients with age<44.5 years,tumor size>0.66 cm and multifocal cancerous nodules because their PTMCs are more likely to be aggressive.Thyroid capsule adjacent to the cancerous nodule should be observed carefully.If there is interruption in the capsule,lateral cervical lymph nodes should be carefully examed.

OBJECTIVE To clarify the long-term toxicity to the respiratory system in a rat model of acute lung injury (ALI) induced by a single low-dose of perfluoroisobutylene(PFIB) inhalation expo?sure,and observe the possible beneficial effect of early intervention via Qingkailing(QKL) injection. METHODS Totally 224 male Wistar rats were randomly divided into 4 groups:normal control group in which air exposure was followed by a saline 10 mL · kg-1(ip),QKL control group in which QKL 10 mL · kg-1 was ip given after air exposure,PFIB exposure group in which rats were exposed to PFIB 280 mg·m-3 for 5 min only,and QKL treatment group in which QKL 10 mL·kg-1 was given ip at 1 h after PFIB exposure. Lung functions of rats were measured at 24 h,3,6,12,24,36 and 48 weeks after exposure. The arterial blood gas,lung coefficient,protein content in bronchoalveolar lavage fluid(BALF),hydroxy?proline(HYP) content in lung tissue and plasma,and other indicators were detected or analyzed. RESULTS Within 24 h after PFIB exposure,the lung coefficient and protein content in BALF were increased significantly(P<0.01),whereas the PaO2(P<0.01) and SaO2(P<0.05) indices in arterial blood decreased significantly in PFIB group compared with normal control. The inhalation time , exhalation time,tidal volume(TV),expired volume(EV)and relaxed time were reduced significantly (P<0.01). However,all the above indicators returned to normal in 3 weeks,but TV,EV and peak expiratory flow were significantly lower than in normal group at 48 weeks(P<0.05). HYP contents in lung tissues,compared with normal control(P<0.05),were reduced significantly within 24 h after PFIB exposure,increased significantly in 6 weeks(P<0.05),then returned to normal in 12 weeks. HYP contents in plasma increased significantly compared with normal control(P<0.05) within 24 h after PFIB exposure but returned to normal in 3 weeks. The protein contents in BALF of QKL treatment group were significantly lower than those in PFIB group(P<0.01) within 24 h after PFIB exposure. From 24 h to 24 weeks after PFIB exposure,changes of pulmonary functions were similar to those in PFIB group. At 48 weeks,TV and EV in QKL treatment group were more significantly increased than those in PFIB group(P<0.05). CONCLUSION Rats with ALI induced by a single low dose of PFIB exposure undergo compensatory repair except for pulmonary capacity and pulmonary ventilation functions. Early treatment with QKL reduces protein content of BALF and alleviates pulmonary edema,and has some beneficial effect on lung function recovery later.

Objective To analyze the hot research spots of MOOC research of higher medical edu-cation in China. Methods We searched the database of China National Knowledge Infrastrucure (CNKI), VIP database of Chinese journal (VIP), Wanfang Database for published studies on MOOC research of higher medical education from 2005 to April 2015. The high frequency words were counted by an analysis program-Bibliographic Item Co-occurrence Matrix Builder (BICOMB). According to the ranking word frequency threshold formula by Donohue, we collected the high-frequency keywords. The corresponding co-word ma-trixes were constructed by Bibexcel, then the data was input into SPSS 19.0 software for hierarchical clus-tering analysis. Results Finally 2 459 articles were included. 11 177 keywords and 13 high frequency words (the number of the real selected was 24) were taken into account. The keywords “stanford” clus-tered with “education module”, “online education”, “online courses”, “distance education”, “learning pro-cess”, “self-regulated learning”, “information technology”, “classroom teaching”. The keywords “network course” clustered with “teaching design”. The keywords “online learning” clustered with itself. The key-words “challenge” clustered with “colleges and universities”. The keywords “flipped classroom” clustered with“micro-lecture”,“MOOC”,“higher education”, “library”, “teaching module”, “teaching reform”, “big data”,“open education”. The keywords“SPOC”clustered with itself. Conclusion The research of MOOC research of higher medical education in our country has formed the basic characteristics with six hot spots involving teaching design, the model of online learning, dispassion thinking, teaching reform, and develop-ment. And there are many potential areas.

Objective To investigate the influencing factors of strain ratio(SR) value in differential diagnosis of benign and malignant thyroid nodules by using real-time tissue elastosonography (RTE).Methods One hundred and seventy-one patients with a total of 171 thyroid nodules were analyzed retrospectively.Their images,including 2D ultrasound,color Doppler flow imaging (CDFI) and RTE were reviewed and conventional ultrasonic features (including the maximum diameter,composition,shape,magin,calcification,intranodular blood flow,depth) and SR value were recorded.Receiver-operating characteristic (ROC) curve was employed to assess the diagnostic efficiency of SR value in differentiating malignant nodules from benign ones.Firstly,the correlation between the aforementioned factors and SR value was assessed by using malignant lesions as the research subjects.And then,the multiple linear regressions (MLR) was employed to evaluate the influence of particular features which turned out to be an important disturbing factor affecting SR value of the lesion in the first step of analysis and pathological type in all nodules (benign and malignant) on SR value.Results With a cut-off point of SR value 3.67,the sensitivity and specificity of SR value in differential diagnosis of benign and malignant thyroid nodules was 85.6％ and 81.1 ％,respectively,and the area under ROC curve was 0.891.Correlation between the maximum diameter and calcification and SR value was significant(r =0.345 and 0.261 respectively,P ＜0.05).However,there was no significant correlation between other features(5 factors) and SR value(P ≥0.05).MLR indicated that the maximum diameter,calcification and the type of pathology of the nodule were associated with SR value (P ＜ 0.05).Among them,pathological nature was the most significant impact factor with a standardized coefficient 0.494).Conclusions SR value can be used to evaluate the hardness of thyroid nodules semi-quantitatively.Its value mainly depends on the pathological nature of the nodules.The maximum diameter and calcification are also the influencing factors of SR value.However,the composition,shape,margin,intranodular blood flow and depth have no obvious effect on SR value.