In January 2023,the American Heart Association(AHA)released A Scientific Statement:Cancer Therapy Related Hypertension,provided an overview of the mechanisms and clinical management of anticancer therapy related hypertension.Contemporary anticancer drugs are mostly at the expense of cardiovascular toxicities,one of the most common side effects is hypertension,especially vascular endothelial growth factor inhibitors,as well as tyrosine kinase inhibitors and proteasome inhibitors.Cancer therapy related hypertension is often dose limiting,and is usually reversible after interruption or discontinuation of treatment.The exact molecular mechanisms underlying hypertension are unclear,recent discoveries indicate an important role for decreased nitric oxide,increased endothelin-1,endothelial dysfunction,increased sympathetic outflow,and microvascular rarefaction.Based on the International Cardio Oncology Society(IC-OS),this article provides an interpretation of the diagnosis and management of hypertension related to cancer treatment.Insufficient evidence exists supporting an antihypertensive medication strategy specific to patients with anticancer therapy induced hypertension,therefore,antihypertensive management should follow current guidelines for the general population..Multidisciplinary cooperation is needed to optimize management to ensure the optimal therapeutic effect from cancer treatment while minimizing competing cardiovascular toxicities.

Objective To construct a precise model for identifying traditional Chinese medicine(TCM)constitutions,thereby offering optimized guidance for clinical diagnosis and treatment plan-ning,and ultimately enhancing medical efficiency and treatment outcomes. Methods First,TCM full-body inspection data acquisition equipment was employed to col-lect full-body standing images of healthy people,from which the constitutions were labelled and defined in accordance with the Constitution in Chinese Medicine Questionnaire(CCMQ),and a dataset encompassing labelled constitutions was constructed.Second,heat-suppres-sion valve(HSV)color space and improved local binary patterns(LBP)algorithm were lever-aged for the extraction of features such as facial complexion and body shape.In addition,a dual-branch deep network was employed to collect deep features from the full-body standing images.Last,the random forest(RF)algorithm was utilized to learn the extracted multifea-tures,which were subsequently employed to establish a TCM constitution identification mod-el.Accuracy,precision,and F1 score were the three measures selected to assess the perfor-mance of the model. Results It was found that the accuracy,precision,and F1 score of the proposed model based on multifeatures for identifying TCM constitutions were 0.842,0.868,and 0.790,respectively.In comparison with the identification models that encompass a single feature,either a single facial complexion feature,a body shape feature,or deep features,the accuracy of the model that incorporating all the aforementioned features was elevated by 0.105,0.105,and 0.079,the precision increased by 0.164,0.164,and 0.211,and the F1 score rose by 0.071,0.071,and 0.084,respectively. Conclusion The research findings affirmed the viability of the proposed model,which incor-porated multifeatures,including the facial complexion feature,the body shape feature,and the deep feature.In addition,by employing the proposed model,the objectification and intel-ligence of identifying constitutions in TCM practices could be optimized.

ObjectiveTo explore the antioxidant and anti-human cervical cancer HeLa cell effect and mechanisms of Andrographis paniculata polysaccharide （APP）. MethodCell function assays were conducted to assess the effects of APP （400， 450， 500 mg·L^-1） on the proliferation， migration， and invasion of HeLa cells using the cell counting kit-8 （CCK-8） assay， scratch assay， and Transwell assay. Molecular mechanism experiments were conducted to detect the effects of APP on HeLa cell apoptosis and cell cycle-related mRNA and protein expression using flow cytometry， real-time fluorescence-based quantitative polymerase chain reaction （Real-time PCR）， and Western blot analysis. The antioxidant activity of APP was tested using DPPH⁺， OH^-， and reducing power assays. ResultCompared with the blank group， APP （400， 450， 500 mg·L^-1） significantly inhibited the migration， proliferation， and invasion abilities of HeLa cells in a time- and dose-dependent manner （P<0.05， P<0.01）. Flow cytometry with propidium iodide （PI） single staining was used to detect cell cycle. The results showed that compared with the blank group， the proportion of HeLa cells in the G₂/M phase increased after 48 hours of treatment with APP （400， 450， 500 mg·L^-1）， indicating that APP can arrest HeLa cells in the G₂/M phase. Flow cytometry with fluorescein isothiocyanate （Annexin V-FITC）/PI apoptosis kit was used to detect cell apoptosis. Compared with the blank group， the proportion of early and late apoptotic HeLa cells increased in a dose-dependent manner after 48 hours of APP （400， 450， 500 mg·L^-1） treatment （P<0.05， P<0.01）， indicating that APP promotes HeLa cell apoptosis. The results of Real-time PCR and Western blot assay showed that compared with the blank group， after 48 hours of APP （400， 450， 500 mg·L^-1） treatment resulted in decreased mRNA and protein expression of cell cycle-dependent kinase-1 （CDK-1）， Cyclin B₁， and B-cell lymphoma-2 （Bcl-2）， and increased mRNA and protein expression of cysteine aspartate protease （Caspase）-3， Caspase-8， Caspase-9， and Bcl-2-associated X protein （Bax） （P<0.05， P<0.01）. These findings were consistent with the flow cytometry results and showed a dose-dependent effect. In vitro antioxidant tests demonstrated that different concentrations of APP （50-1 000 mg·L^-1） were able to scavenge DPPH⁺ and OH^- radicals， indicating certain antioxidant activity. ConclusionAPP possesses antioxidant activity and can inhibit the viability of HeLa cells while promoting their apoptosis.

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.

Objective:To explore the value of jellyfish sign, an abnormal ultrasonographic sign, in predicting adverse perinatal outcomes of women with complete placenta previa combined with placenta accreta spectrum disorders (PAS).Methods:This retrospective study analyzed the ultrasound images of 72 singleton gravidas, diagnosed with complete placenta previa combined with PAS, who underwent cesarean section at the First Affiliated Hospital of Nanjing Medical University between January 2020 and February 2023. Based on the presence and absence of the jellyfish sign in ultrasound images, these gravidas were divided into the jellyfish-sign group (15 cases, 20.8%) and the non-jellyfish-sign group (57 cases, 79.2%). The clinical data and perinatal outcomes of the two groups were analyzed. The adverse perinatal outcomes encompassed conditions such as abdominal aorta balloon block, uterine artery embolism, hysterectomy, postpartum hemorrhage, and neonatal intensive care unit (NICU) admission of their neonates. Statistical analysis was performed using two independent samples t-test, the Mann-Whitney U test and the Chi-square (or Fisher's exact) test. Results:(1) The jellyfish-sign group exhibited a higher parity [(1.6±0.7) times vs (1.2±0.6) times, t=2.01] and higher prenatal scores of placenta accreta [(12.3±1.5) scores vs (8.6±2.9) scores, t=6.59] than those in the non-jellyfish-sign group (both P<0.05). Among the 57 cases in the non-jellyfish-sign group, there were 14 cases of placenta creta (24.6%), 40 cases of placenta increta (70.2%), and three cases of placenta percreta (5.3%). Among the 15 cases in the jellyfish-sign group, nine cases were diagnosed with placenta increta, six with placenta percreta, and none with placenta creta. The difference in distribution between the two groups was statistically significant (Fisher's exact test, P<0.001). (2) Intraoperative blood loss [(for those who accepted abdominal aorta balloon block, 1 973±1 057) ml vs (1 211±576) ml, t=2.55], red blood cells transfused [4.0 U (2.0-23.0 U) vs 2.5 U (0.0-11.0 U), Z=－2.53], postoperative hospitalization time [(9.7±2.4) vs (7.5±2.2) d, t=3.36], the incidence of abdominal aorta balloon block [15/15 vs 38.6% (22/57), χ2=17.92], uterine artery embolism [for those who accepted abdominal aorta balloon block, 3/15 vs 1.8% (1/57), Fisher's exact test], and requiring blood transfusion [15/15 vs 63.2% (36/57), Fisher's exact test] were higher in the jellyfish-sign group than those in the non-jellyfish-sign group. However, the non-jellyfish-sign group had lower gestational age at delivery [(33.6±1.5) weeks vs (35.2±1.8) weeks, t=－3.24], and lower neonatal Apgar score at 1 min and 5 min [1 min: 8 scores (3-10 scores) vs 9 scores (4-10 scores), Z=－2.46; 5 min: 9 scores (7-10 scores) vs 10 scores (6-10 scores), Z=－2.02] (all P<0.05). There were no significant differences in emergency surgery rate, 24 h postoperative blood loss, neonatal birth weight, and proportion of NICU admission between the two groups. Additionally, no cases of hysterectomy or death were observed in the two groups. Conclusions:Ultrasound examination revealing jellyfish signs in patients with complete placenta previa and PAS is associated with an increased likelihood of adverse perinatal outcomes. Consequently, the management of these patients should be given greater attention.

OBJECTIVES: With the increasing detection rate of lung nodules, the qualitative problem of lung nodules has become one of the key clinical issues. This study aims to evaluate the value of combining dynamic contrast-enhanced (DCE) MRI based on time-resolved imaging with interleaved stochastic trajectories-volume interpolated breath hold examination (TWIST-VIBE) with T₁ weighted free-breathing star-volumetric interpolated breath hold examination (T₁WI star-VIBE) in identifying benign and malignant lung nodules. METHODS: We retrospectively analyzed 79 adults with undetermined lung nodules before the operation. All nodules of patients included were classified into malignant nodules (n=58) and benign nodules (n=26) based on final diagnosis. The unenhanced T₁WI-VIBE, the contrast-enhanced T₁WI star-VIBE, and the DCE curve based on TWIST-VIBE were performed. The corresponding qualitative [wash-in time, wash-out time, time to peak (TTP), arrival time (AT), positive enhancement integral (PEI)] and quantitative parameters [volume transfer constant (Ktrans), interstitium-to-plasma rate constant (Kep), and fractional extracellular space volume (Ve)] were evaluated. Besides, the diagnostic efficacy (sensitivity and specificity) of enhanced CT and MRI were compared. RESULTS: There were significant differences in unenhanced T₁WI-VIBE hypo-intensity, and type of A, B, C DCE curve type between benign and malignant lung nodules (all P<0.001). Pulmonary malignant nodules had a shorter wash-out time than benign nodules (P=0.001), and the differences of the remaining parameters were not statistically significant (all P>0.05). After T₁WI star-VIBE contrast-enhanced MRI, the image quality was further improved. Compared with enhanced CT scan, the sensitivity (82.76% vs 80.50%) and the specificity (69.23% vs 57.10%) based on MRI were higher than that of CT (both P<0.001). CONCLUSIONS T₁WI star-VIBE and dynamic contrast-enhanced MRI based on TWIST-VIBE were helpful to improve the image resolution and provide more information for clinical differentiation between benign and malignant lung nodules.
Adult ; Humans ; Retrospective Studies ; Magnetic Resonance Imaging ; Plasma ; Tomography, X-Ray Computed ; Lung

Objective: To understand parents attitudes towards adolescent sexual education in Baoshan City of Yunnan Province, and to explore the correlation between attitudes and their proactive behavior in adolescent sexual education, so as to provide reference for improving parents initiative in adolescent sexual health education. Methods: From November to December 2022, a stratified random cluster sampling method was used to select 7 389 parents of students from 35 primary, middle, and high schools in Baoshan City of Yunnan Province for a questionnaire survey on adolescent sexual health education in parents schools. Chi-square tests were conducted to compare the attitudes of parents towards sexual health education among different groups and their proactive behavior in providing sexual health education to their children. A multivariate Logistic regression model was used to analyze the correlation between parents attitudes towards sexual education and proactive sexual health education. Results: Totally 43.17% ( 3 190 ) of parents had a more open attitude towards sex education for their children, with parents of girls, parents of elementary school students, mothers, <30 years old, junior high school education, workers, service personnel, married, harmonious relationships with their children and democratic parents had a higher rate of actively providing sex education for their children ( χ 2=4.65, 401.92, 23.53 , 197.50, 38.18, 13.65, 6.54, 8.07, 32.17, 96.58, P <0.05). Parents with a more conservative attitude towards sex education and parents of boys were negatively correlated with parents actively providing adolescent sexual health education to their children ( OR =0.86, 0.38, P <0.05). Parents who were <30, 30-<40, 40-50 years old, individuals/businesses, married, divorced, had a good and decent relationship with their children were positively correlated with their parents proactive adolescent sexual health education for their children ( OR =1.50, 1.90, 1.37, 1.22, 1.60, 1.32, 1.94, 1.53, P <0.05). Conclusion A more open attitude towards adolescent sexual health education can serve as a predictive factor for proactive adolescent sexual health education. In order to increase the rate of family sexual health education, it is recommended to enhance parents awareness of their responsibility for their children s sexual health education, promote harmonious parent-child relationships between parents and children, and communicate with their children with an open attitude.

Poor response or intolerance to ursodeoxycholic acid may occur in the treatment of primary biliary cholangitis (PBC), and after switch to obeticholic acid or fibrates alone or in combination, poor response or intolerance is also observed in some treatment regimens. Clinical studies on obeticholic acid and fibrates will gradually solve these issues, and obeticholic acid/fibrates combined with ursodeoxycholic acid is safe and effective in PBC patients without advanced liver cirrhosis.

Objective: To evaluate the dietary quality for preschool children by diet balance index(DBI_C), and to provide an empirical reference for scientific guidance for a reasonable diet and controlling and preventing iron deficiency anemia(IDA). Methods: During September to December of 2018, 306 left behind children and 598 non left behind children aged 3-6 years old of Anhui Province were selected. Four scoring methods (TS Total Score, LBS Low Bound Score, HBS High Bound Score, DQD Diet Quality Distance) were used to evaluate the dietary quality by DBI_C, and multivariate Logistic regression was used to assess the relationship between DBI_C and IDA. Results: The anemia prevalence (AP) was 13.3% among the 3-6 year old children in Anhui rural area, whereas the left behind children (LBC) was 16.7% and the non left behind children was 10.9%, and there was statistical significance of the differences ( χ 2=8.8, P <0.05). There were significant differences of TS[-18.3(25.2，-12.7)，-15.2(-19.8，-8.6)], LBS[25.4(18.3，32.5)，22.7(16.5，30.6)] and DQD[36.8(23.9，43.4)，34.1(27.5，41.0)] in DBI_C scores between anemia group and nonanemia group ( P <0.05). There were significant differences of milk and beans [-5.9(-10.7，-0.4)，-5.0(-8.7，0.2)], animal food [-2.4(-5.6，0.8)，-0.6(3.5，1.9)], food species [-7.5(-9.1，-4.8)，-6.3(-8.0，-2.9)] in food intake scores between anemia group and non anemia group ( P <0.05). Left behind children ( OR =1.27, 95% CI =1.15-1.49) had higher proportions of getting anemia. Meat consumption >3 times per week ( OR =0.81, 95% CI =0.68-0.94) and ≥two types of fresh vegetable consumption every day ( OR =0.84, 95% CI =0.73-0.95) were associated with lower rate of anemia( P <0.05). Conclusion The AP was relatively high in 3-6 year old children in Anhui rural area, especially in those LBC. Anemia should be reduced by improving the caregivers dietary literacy, increasing intakes of animal foods and fresh vegetables.

Objective:To explore the early response of hepatobiliary biochemical indexes after short-term ursodeoxycholic acid treatment in patients with primary biliary cholangitis (PBC).Methods:According to the Child-Pugh (C-P) score, the patients with newly diagnosed PBC were divided into groups A, B and C. The early biochemical response was defined as the improvement of hepatobiliary biochemical indexes while daily dose of 13-15 mg/kg ursodeoxycholic acid(UDCA) was administrated for 3-4 weeks. Rank sum test was used to compare the alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), total bile acid (TBA) and total bilirubin (TBil) before and after treatment between groups. Chi-square test was used to analyze the differences in numerical data between groups. ROC curve was also used for data an-alysis.Results:The levels of AST, ALP, GGT and TBil of groups A and B after treatment were lower than those of before treatment ( P<0.05). And there was no significant difference in group C ( P>0.05). On the contrast, TBA levels after treatment in group A, B and C were significantly higher than those of before ( P<0.05). ROC curve analysis of the baseline ALP, GGT and AST indexes that declineed less than 20% showed that their cut-off value of indexes were 211.00, 285.85 and 86.68 U/L respectively in group A. And then the cut-off value of above parameters in group B was 505.00, 353.10 and 179.15 U/L respectively. But no statistical significant difference was found in ROC curve analysis of above indexes of group C. The baseline TBil level declined synchronously with the decline of ALP, AST and GGT less than 20% were analyzed by ROC curve, but no statistical significant difference was found in group A, B and C. ROC curve analysis of the treatment showed that increased of TBA level was synchronously to the decline of ALP, AST and GGT less than 20% showed that cut-off value were 38.75 and 35.95 μmol/L respectively in group A and B. There was no statistically significant difference in ROC curve analysis of TBA in group C. As for baseline ALP, GGT and AST their level were decreased with treatment, and less than 40%, ROC curve analysis did not find statistical significant difference in above indexes. Conclusion:After 3-4 weeks of UDCA treatment, the cut off values of ALP, GGT and AST in Grade A or B of C-P are met, and the biochemical response could be reduced by 20% or more, among which the accuracy of ALP is higher. The TBA level of C-P in grade A or B PBC patients after UDCA treatment increases, and when the Cut-off value is met, it suggests that ALP, GGT and AST indexes may decrease by 20% or more. Total bilirubin does not show response to treatment.