Objective To discuss the main pathological types and imaging characteristics of pulmonary nodules that are highly suspected to be malignant in clinical practice but are pathologically confirmed to be benign. Methods A retrospective analysis was performed on the clinical data of patients with pulmonary nodules who were initially highly suspected of malignancy but were subsequently pathologically confirmed to be benign. These patients were treated at the First Affiliated Hospital of Xiamen University from December 2020 to April 2023. Based on the outcomes of preoperative discussions, the patients were categorized into a benign group and a suspicious malignancy group. The clinical data and imaging characteristics of both groups were compared. Results A total of 232 patients were included in the study, comprising 112 males and 120 females, with a mean age of (50.7±12.0) years. Among these, 127 patients were classified into the benign group, while 105 patients were categorized into the suspicious malignancy group. No statistically significant differences were observed between the two groups regarding age, gender, symptoms, smoking history, or tumor history (P>0.05). However, significant differences were noted in nodule density, CT values, margins, shapes, and malignant signs (P＜0.05). Further analysis revealed that in the suspicious malignancy group, solid nodules were predominantly characterized by collagen nodules and fibrous tissue hyperplasia (33.3%), followed by tuberculosis (20.4%) and fungal infections (18.5%). In contrast, non-solid nodules were primarily composed of collagen nodules and fibrous tissue hyperplasia (41.2%) and atypical adenomatous hyperplasia (17.7%). Conclusion Benign pulmonary nodules that are suspected to be malignant are pathologically characterized by the presence of collagen nodules, fibrous tissue hyperplasia, tuberculosis, atypical adenomatous hyperplasia, and fungal infections. Radiologically, these nodules typically present as non-solid lesions and may exhibit features suggestive of malignancy, including spiculation, lobulation, cavitation, and pleural retraction.

ObjectiveTo investigate the recurrence of ischemic stroke (IS) and to analyze the association between four indices of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) and the risk of IS recurrence by analyzing the follow-up data related to IS in the community-based natural population of Songjiang District, Shanghai, so as to provide a scientific basis for improving the prognosis of stroke patients in the community and controlling IS recurrence. MethodsA prospective follow-up study was conducted among the IS patients in the community-based cohort population, collecting data about patient’s age, gender, disease history, biochemical indicators, and etc. Cox regression model and restricted cubic spline model were used to analyze the relationship between different levels of plasma lipids and the recurrence of IS in these patients. ResultsA total of 1 368 patients with IS were included. The total follow-up duration was 7 171.46 person-years, with a median follow-up time of 6.24 years. There were 420 cases of IS recurrence, resulting in a cumulative recurrence rate of 30.70%. The results of multivariate Cox regression analysis showed that the recurrence risk of IS was reduced when the baseline TC and LDL-C levels of IS patients were in the ranges of 4.65‒5.67 mmol·L^-1 and 2.52‒3.46 mmol·L^-1, respectively. The results of restricted cubic spline analysis showed a U-shaped relationship between baseline TC and LDL-C levels and the recurrence risk in IS patients. ConclusionThe cumulative recurrence rate of patients with IS in the community of Songjiang District in Shanghai is high, and the levels of TC and LDL-C at baseline survey are correlated with the recurrence of IS in these patients. It is suggested to pay more attention to the levels of LDL-C and TC in patients with IS, so as to improve the prognosis.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Hypoxia-inducible factor (HIF-1α), a core transcription factor responding to changes in cellular oxygen levels, is closely associated with a wide range of physiological and pathological conditions. However, its differential impacts on vascular cell types and molecular programs modulating human vascular homeostasis and regeneration remain largely elusive. Here, we applied CRISPR/Cas9-mediated gene editing of human embryonic stem cells and directed differentiation to generate HIF-1α-deficient human vascular cells including vascular endothelial cells, vascular smooth muscle cells, and mesenchymal stem cells (MSCs), as a platform for discovering cell type-specific hypoxia-induced response mechanisms. Through comparative molecular profiling across cell types under normoxic and hypoxic conditions, we provide insight into the indispensable role of HIF-1α in the promotion of ischemic vascular regeneration. We found human MSCs to be the vascular cell type most susceptible to HIF-1α deficiency, and that transcriptional inactivation of ANKZF1, an effector of HIF-1α, impaired pro-angiogenic processes. Altogether, our findings deepen the understanding of HIF-1α in human angiogenesis and support further explorations of novel therapeutic strategies of vascular regeneration against ischemic damage.
Humans ; Vascular Endothelial Growth Factor A/metabolism* ; Endothelial Cells/metabolism* ; Transcription Factors/metabolism* ; Gene Expression Regulation ; Hypoxia/metabolism* ; Cell Hypoxia/physiology*

OBJECTIVE To establish a quantitative analysis model for the contents of tussilagone， moisture， ethanol-soluble extract and total ash in Farfarae Flos based on near-infrared spectroscopy （NIRS）， providing a new idea for the rapid quality evaluation of Farfarae Flos and its preparations. METHODS Referring to the 2020 edition of the Chinese Pharmacopoeia， the contents of the main quality control indexes tussilagone， moisture， ethanol-soluble extract and total ash in 130 batches of Farfarae Flos from 19 producing areas were determined by HPLC， drying method， hot dip method and ash assay， respectively. The NIRS data information of the medicinal herbs of Farfarae Flos was collected， and then NIRS combined with the partial least squares method was used to establish the individual quantitative analysis models of the above quality control indexes in the samples， and the predictive model of the NIRS content was obtained after sample validation with validation set. RESULTS The range for the contents of tussilagone， moisture， ethanol-soluble extract and total ash in 130 batches of Farfarae Flos were 0.051 4%-0.103 5%， 7.75%-10.93%， 20.17%-31.12%， and 7.68%-12.10%， respectively. The internal cross-validation coefficients of determination （R2） of the established models for the quantitative analysis of tussilagone， moisture， ethanol-soluble extract and total ash in Farfarae Flos were 0.985 8， 0.968 4， 0.973 4， 0.988 0， respectively； the root mean square errors of calibration （RMSEC） were 0.001 54， 0.187， 0.478， 0.127， respectively； the root mean square errors of prediction （RMSEP） were 0.001 81， 0.212， 0.543， 0.149， respectively； RMSEP/RMSEC were 1.175 3， 1.133 7， 1.136 0 and 1.173 2， respectively， which were all within a reasonable range （1＜RMSEP/RMSEC≤1.2）. The mean absolute errors between the true and model-predicted values of the above four quality control indexes in the validation set of samples were －0.000 36， 0.061 43， 0.144 00， and 0.010 43， respectively，and the mean predicted recoveries were 99.65%， 100.72%，100.66%， and 100.15%， respectively. CONCLUSIONS The established NIRS quantitative analysis model has high stability and reliable results， which can be used for the rapid batch prediction of the content of relevant quality control indexes in Farfarae Flos.

OBJECTIVE:As one of the serious complications after total hip arthroplasty or total knee arthroplasty,periprosthetic joint infection has always been the focus of joint surgeons.Albumin/globulin ratio is emerging as a promising biomarker for the diagnosis of periprosthetic joint infection.This study aimed to investigate the diagnostic value of albumin/globulin ratio in diagnosing periprosthetic joint infection. METHODS:A systematic search was conducted in PubMed,Embase,and Cochrane Library databases on July 29,2023.The literature was screened according to the inclusion and exclusion criteria,and the literature related to diagnostic trials of albumin/globulin ratio was included in this study.QUADAS-2 method was used to evaluate the quality of the included articles.Bivariate mixed-effect model was applied to combine the sensitivity,specificity,likelihood ratio,and diagnostic odds ratio of the included articles,and the receiver operating characteristic curve and area under the curve were integrated to specifically evaluate the accuracy of D-dimer in the diagnosis of periprosthetic joint infection.Subgroup analysis was used to explore the sources of heterogeneity. RESULTS:We included eight eligible diagnostic studies,all of which were of medium to high quality.The sensitivity and specificity of the combined diagnosis were 0.78(95%CI:0.66-0.86)and 0.83(95%CI:0.78-0.88),respectively.The combined positive and negative likelihood ratios were 4.63(95%CI:3.43-6.22)and 0.27(95%CI:0.17-0.42),respectively.The combined diagnostic scores and diagnostic odds ratio were 2.85(95%CI:2.23-3.48)and 17.35(95%CI:9.29-32.45),respectively.The area under the summary receiver operating characteristic curve was 0.88(95%CI:0.85-0.90). CONCLUSION:The albumin/globulin ratio is of guiding significance in the diagnosis of periprosthetic joint infection.However,it is not universal in clinical practice,so it should be combined with specific clinical practice.In addition,there are relatively few studies on the threshold of albumin/globulin ratio,different sampling types,different laboratory detection methods,and different races,so more prospective clinical trials with large samples,multi-centers,and scientific design should be carried out for verification in the future.

The high-quality development requirements for public hospitals,national examination orientations,and DIP medical insurance payment reforms present significant challenges to the refined management of public hospitals.Therefore,it is essential to enhance the operational management of these institutions.This paper aims to develop an operation evaluation index system for clinical departments using the Delphi method for assessing the efficiency of resource input and output across various clinical departments.It provides a scientific basis for decision-making regarding resource allocation,transformation towards re-fined management,and the enhancement of operational guidance for departments.

For the past few years, the indocyanine green fluorescence imaging has been widely used in the diagnosis and treatment of biliary tract diseases. Fluorescence visualization of the biliary system by indocyanine green accurately localize the diseased tissue and identify the biliary structures precisely, which effectively avoids the damage to the natural biliary structure and greatly improves the accuracy and safety of biliary surgery. However, the application of this new technology in biliary surgery is still at the exploratory stage, showing great potential for application while also exposing many problems and controversies. It is believed that with the continuous development and improvement, the indocyanine green fluorescence cholangiography will play a more important role in the diagnosis and treatment of biliary tract diseases in the future, and bring more benefits to patients.

Objective To explore the doctor's willingness to adopt artificial intelligence aided diagnosis and treatment system(ADTS)and its influencing factors,clarify the key links in the implementation of ADTS,and then propose suggestions for optimizing technology and management.Methods On the basis of UTAUT model,factors such as perceived risk,cognitive trust and legal supervision were added to design a questionnaire.After pre-investigation,226 officially recovered questionnaire data were analyzed for reliability and validity,hypothesis testing and SEM fitting,and the relationship chain model of doctors'ADTS adoption intention was obtained.Results Performance expectation,cognitive trust and social influence have a direct positive impact on doctors'willingness,among which social influence has the greatest effect.Facilitating conditions and legal supervision have indirect influence.It also found that doctors who have used ADTS have higher scores in various aspects such as performance expectations,effort expectations,and learning adaptability.Conclusion To implement the application of ADTS,attention should be paid to training,the software and hardware operation and maintenance system,and risk responsibility regulations should be improved,requiring joint efforts from multiple parties.

Objective To explore the doctor's willingness to adopt artificial intelligence aided diagnosis and treatment system(ADTS)and its influencing factors,clarify the key links in the implementation of ADTS,and then propose suggestions for optimizing technology and management.Methods On the basis of UTAUT model,factors such as perceived risk,cognitive trust and legal supervision were added to design a questionnaire.After pre-investigation,226 officially recovered questionnaire data were analyzed for reliability and validity,hypothesis testing and SEM fitting,and the relationship chain model of doctors'ADTS adoption intention was obtained.Results Performance expectation,cognitive trust and social influence have a direct positive impact on doctors'willingness,among which social influence has the greatest effect.Facilitating conditions and legal supervision have indirect influence.It also found that doctors who have used ADTS have higher scores in various aspects such as performance expectations,effort expectations,and learning adaptability.Conclusion To implement the application of ADTS,attention should be paid to training,the software and hardware operation and maintenance system,and risk responsibility regulations should be improved,requiring joint efforts from multiple parties.