Objective To explore the differences of regional homogeneity(ReHo)between overweight and normal weight male patients with type 2 diabetes mellitus(T2DM)during rest and their correlations with clinical features.Methods Twenty-five untreated male overweight T2DM(OW-T2DM)patients,25 untreated male normal weight T2DM(NW-T2DM)patients and 25 healthy controls(HC)were enrolled.The brain structure and resting-state functional magnetic resonance imaging(rs-fMRI)data were collected from all subjects.The brain structure and rs-fMRI data were preprocessed,and ReHo values of all brain regions were calculated for all subjects.ReHo values were compared among three groups and between groups respectively via the methods of one-way analysis of variance and two-sample t-test.To address the problem of multiple comparisons,the method of AlphaSim was performed(the threshold was set at P<0.005,the number of voxel clusters was>12).In addition,Pearson correlation analysis was performed to explore the relationships between ReHo values of the abnormal brain regions and clinical features in patients.Results(1)The brain regions showed differences of ReHo values among three groups were mainly distributed in the right hemisphere,including the superior parietal gyrus,superior marginal gyrus and superior occipital gyrus;(2)Compared with HC,NW-T2DM patients showed significantly decreased ReHo values in the right medial superior frontal gyrus,right middle cingulate gyrus and left anterior cingulate gyrus;(3)Compared with HC,OW-T2DM patients showed significantly decreased ReHo values in the bilateral postcentral gyrus and bilateral middle cingulate gyrus;(4)Compared with NW-T2DM patients,OW-T2DM patients showed significantly decreased ReHo values in the right superior parietal gyrus,right superior occipital gyrus and left cuneus;(5)ReHo values of the right medial superior frontal gyrus and right superior parietal gyrus were negatively correlated with hemoglobinA1c(HbA1c)level and body mass index(BMI),respectively,in all patients.Conclusion The occurrence of T2DM in male patients may lead to the declined activity of brain regions located in the default mode network(DMN),while overweight may further lead to decreased brain activity within the attention and visual recognition network in male T2DM patients.

Objective To investigate the effect of glycyrrhizin(GA)on the spasticity of hemiplegic spasticity in stroke rats by regulating the phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)/glycogen synthase kinase 3β(GSK3β)signaling pathway.Methods A rat model of post-stroke spasm(PSS)was established by middle cerebral artery occlusion(MCAO).Rats were divided into control group,sham operation group,model group,GA-L group,GA-H group and baclofen group.Rats in the model group,sham operation group and control group were intragastrically administered with the same amount of 0.9％NaCl every day,GA-H group was given 10.8 g·kg-1 GA by gavage daily,GA-L group was given 5.4 g·kg-1 GA by gavage every day,baclofen group was intragastrically administered with 5.4 mg·kg-1 baclofen every day for 4 weeks.Muscle tone was assessed by modified Ashworth scale.The volume of cerebral infarction was analyzed by 2,3,5-triphenyltetrazolium chloride(TTC)staining.The protective effect of GA on neuronal injury after cerebral ischemia-reperfusion injury was observed by Nissl staining and transmission electron microscopy.The expression levels of phosphorylated PI3K(p-PI3K),phosphorylated Akt(p-Akt)and phosphorylated GSK3β(p-GSK3β)in cerebral infarction and peripheral brain stem were detected by immunohistochemical staining.Results The volume of cerebral infarction in sham operation group,model group,GA-L group,GA-H group and baclofen group were 0,(34.23±1.21)％,(24.12±1.03)％,(18.26±1.08)％and(26.38±1.35)％,respectively.The contents of Nissl bodies in control group,sham operation group,model group,GA-L group,GA-H group were(126.23±8.13)％,(131.14±9.62)％,(52.21±6.11)％,(84.29±6.17)％and(112.24±8.21)％,respectively.At 4 weeks,the expressions of p-PI3K in sham operation group,model group,GA-L group,GA-H group and baclofen group in brain tissue surrounding cerebral infarction were 5.45±0.44,4.89±0.34,5.54±0.42,20.59±1.35,25.34±1.46 and 6.47±0.45;the expression of p-PI3K in the brain tissues around brain stem were 14.47±1.48,10.82±1.24,15.39±1.45,13.51±1.32,25.55±1.49 and 8.84±0.74;the expression levels of p-AKT in brain tissue surrounding cerebral infarction were 6.47±0.41,6.18±0.32,5.58±0.51,19.54±1.48,28.56±1.48 and 14.39±1.56;the expression of p-Akt in the surrounding brain tissue were 6.45±1.41,8.09±1.32,6.05±1.12,13.63±1.45,16.58±1.61 and 10.75±1.01;the expression levels of p-GSK3β in brain tissue surrounding cerebral infarction were 8.64±0.52,5.18±0.61,18.54±1.45,39.56±1.63,43.57±1.59 and 18.43±1.48;the expression of p-GSK3β in the surrounding brain tissue were 8.04±1.39,6.91±1.01,6.82±1.16,15.59±1.33,15.65±1.18 and 5.18±0.47.Compared with model group,the expressions of p-PI3K,p-Akt and p-GSK3β in cerebral infarction and peribrainstem brain tissue of rats in GA-L and GA-H groups were significantly up-regulated(all P＜0.05).Conclusion The inhibitory effect of GA on spasticity in PSS rats may be related to the up-regulation of PI3K/Akt/GSK3β pathway,which may be a supplementary treatment strategy for PSS.

Objective:To evaluate the efficacy and safety of oliceridine for treatment of moderate to severe pain after surgery with general anesthesia in patients.Methods:The patients with moderate to severe pain (numeric pain rating scale ≥4) after abdominal surgery with general anesthesia from 14 hospitals between July 6, 2021 and November 9, 2021 were included in this study. The patients were assigned to either experiment group or control group using a random number table method. Experiment group received oliceridine, while control group received morphine, and both groups were treated with a loading dose plus patient-controlled analgesia and supplemental doses for 24 h. The primary efficacy endpoint was the drug response rate within 24 h after giving the loading dose. Secondary efficacy endpoints included early (within 1 h after giving the loading dose) drug response rates and use of rescue medication. Safety endpoints encompassed the development of respiratory depression and other adverse reactions during treatment.Results:After randomization, both the full analysis set and safety analysis set comprised 180 cases, with 92 in experiment group and 88 in control group. The per-protocol set included 170 cases, with 86 in experiment group and 84 in control group. There were no statistically significant differences between the two groups in 24-h drug response rates, rescue analgesia rates, respiratory depression, and incidence of other adverse reactions ( P>0.05). The analysis of full analysis set showed that the experiment group had a higher drug response rate at 5-30 min after giving the loading dose compared to control group ( P<0.05). The per-protocol set analysis indicated that experiment group had a higher drug response rate at 5-15 min after giving the loading dose than control group ( P<0.05). Conclusions:When used for treatment of moderate to severe pain after surgery with general anesthesia in patients, oliceridine provides comparable analgesic efficacy to morphine, with a faster onset.

Paroxysmal atrial fibrillation can be attributed to the category of xinji （palpitations） and zhangchong （severe palpitations） in traditional Chinese medicine， and its onset has the characteristics of urgency， change， and movement， which is similar to the characteristics of diseases induced by wind pathogen. It is believed that the internal movement of wind pathogen runs through the whole course of this disease， and palpitations due to wind as the direct pathogenesis. Palpitations caused by wind pathogen showed different characteristics of deficiency and excess pattern. In the acute exacerbation period， excess wind is the main cause of disease. For excessive heat generating wind， the treatment is to clear the liver and extinguish wind by self-modified Lingxia Qinggan Decoction （羚夏清肝汤）； for blood stasis generating wind， the treatment is to remove blood stasis and stop wind by self-modified Yandan Limai Decoction （延丹理脉汤）； for phlegm-heat accumulation with wind， the treatment is to dissolve phlegm and eliminate wind by self-modified Lianlou Danxing Decoction （连蒌胆星汤）. In the prolonged recovery period， deficiency wind is more common. For stirring of wind due to yin deficiency， the treatment is to nourish yin and extinguish wind by self-modified Zaoshao Zhenzhu Deoction （枣芍珍珠汤）； for spleen deficiency generating wind， the treatment is to strengthen spleen and nourish wind by self-modified Shenying Dingji Deoction （参英定悸汤）. Clinical prescriptions closely follow the characteristics of wind， weigh the changes of deficiency and excess， tailor with the patterns， and regulate qi and blood of the zang-fu organs， in order to extinguish wind and arrest convulsion.

Objective:This study aimed to explore the status of radiological Kashin-Beck disease (KBD) among school-aged children in Chamdo City, Tibet, through a 3-year monitoring survey, providing epidemiological evidence for prevention and control strategies.Methods:The target areas for this study were Luolong, Bianba, and Basu counties in Chamdo City, Tibet Autonomous Region, identified as having the most severe historical cases of KBD. Children aged 7-12 years attending school were enrolled as study subjects. Anteroposterior X-ray films of the right-hand were taken, and radiological diagnoses were made based on the "Diagnosis of Kashin-Beck Disease" criteria (WS/T 207-2010). Two experienced researchers independently reviewed the X-rays, and intra- and inter-group consistency were assessed using weighted Kappa values and percentage agreement. Cross-sectional surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD, and logistic regression analysis was employed to construct a predictive model of risk factors for radiological KBD cases.Results:In 2017, a total of 5,711 children aged 7-12 years in Chamdo City, Tibet, participated in the baseline cross-sectional survey (average age 9.2 years, 48.0% female), with 28 cases of radiological KBD. The age- and gender-standardized prevalence rate was 0.527%. In 2020, 6,771 participants (average age 9.3 years, 49.5% female) underwent a second cross-sectional survey, with 9 cases of radiological KBD and a standardized prevalence rate of 0.134%. Logistic regression analysis indicated that older age [ OR=2.439, 95% CI(1.299, 4.580), P=0.006] and female gender [ OR=8.157, 95% CI(1.016, 65.528), P=0.048] were independent risk factors for radiological KBD cases. Conversely, higher residential altitude, under the premise of Tibet's high altitude, was a protective factor [ OR=0.995, 95% CI(0.990, 0.999), P=0.032). Conclusion:The radiographically positive detection rate of KBD among school-aged children in Chamdo City, Tibet Autonomous Region, is at an extremely low level and showing a declining trend, reaching the historical standard in 2020. Considering the absence of positive signs in affected children, it suggests that local KBD has been effectively eliminated.

With the aging population, the burden of diseases such as atrial fibrillation and venous thrombosis is gradually increasing. Anticoagulant therapy has a positive significance in preventing ischemic stroke, pulmonary embolism, and other related conditions in these patients. However, anticoagulant therapy can have the opposite effect on diseases caused by intracranial hemorrhage, such as falls in the elderly, cerebrovascular accidents, and car accidents. It is still difficult to determine whether and when to restart anticoagulation after cerebral hemorrhage. Although most studies have shown that restarting anticoagulant therapy can reduce stroke risk without significantly increasing bleeding risk, they are mostly based on observational studies, so more high-quality research is needed to guide clinical decision-making. This article reviews the research progress on restart anticoagulation, aiming to provide some assistance for clinical applications.

Objective:To prepare advanced platelet-rich fibrin (A-PRF)/chitosan thermosensitive hydrogel (hereinafter referred to as composite hydrogel) and explore the effects of composite hydrogel on full-thickness skin defect wound healing in diabetic rats.Methods:This study was an experimental study. The composite hydrogel with porous mesh structure and thermosensitive characteristics was successfully prepared, containing A-PRF with mass concentrations of 10, 15, 20, 50, and 100 g/L. Diabetic model was successfully established in male Sprague-Dawley rats aged 6-8 weeks by intraperitoneal injection of streptozotocin, and 4 full-thickness skin defect wounds were established on the back of each rat (finally the model was successfully established in 36 rats). Three wounds of each rat were divided into blank group (no drug intervention), positive control group (dropping recombinant human granulocyte-macrophage stimulating factor gel), and chitosan hydrogel group (dropping chitosan hydrogel solution). Thirty rats were collected, and the remaining one wound of each rat (totally 30 wounds) was divided into 10, 15, 20, 50, and 100 g/L composite hydrogel groups, with 6 wounds in each group, which were dropped with composite hydrogel solution containing 10, 15, 20, 50, and 100 g/L A-PRF, respectively. Taking the remaining six rats, the remaining one wound from each rat was dropped with composite hydrogel solution containing 100 g/L A-PRF. On 14 d after injury, 6 rats with one wound dropped with composite hydrogel containing 100 g/L A-PRF were selected for hematoxylin-eosin (HE) staining to observe the inflammation, hemorrhage, or necrosis of the heart, liver, spleen, lung, and kidney. On 10 d after injury, 6 rats with one wound dropped with composite hydrogel containing 15 g/L A-PRF were selected to observe the blood perfusion of wounds in the four groups (with sample size of 6). On 7 and 14 d after injury, the wound healing rates in the eight groups were calculated. On 14 d after injury, the wound tissue in the eight groups was taken for HE and Masson staining to observe the formation of new epithelium and collagen formation, respectively; the positive expressions of CD31 and vascular endothelial growth factor A (VEGFA) were detected by immunohistochemistry, and the percentages of positive areas were calculated; the protein expressions of CD31 and VEGFA were detected by Western blotting; the mRNA expressions of CD31 and VEGFA were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction method (with all sample sizes of 4).Results:On 14 d after injury, no obvious inflammation, hemorrhage, or necrosis was observed in the heart, liver, spleen, lung, and kidney in the 6 rats. On 10 d after injury, the blood perfusion volume of wound in 15 g/L composite hydrogel group was significantly more than that in blank group, positive control group, and chitosan hydrogel group, respectively (with P values all <0.05). On 7 and 14 d after injury, the wound healing rates of blank group were (26.0±8.9)% and (75.0±1.8)%, which were significantly lower than those of positive control group, chitosan hydrogel group, and 10, 15, 20, 50, and 100 g/L composite hydrogel groups, respectively ((45.8±3.2)%, (49.8±3.7)%, (51.2±2.9)%, (68.5±2.4)%, (68.8±1.5)%, (72.7±2.1)%, (75.0±3.7)% and (79.1±1.9)%, (77.2±1.7)%, (82.3±1.3)%, (89.6±1.9)%, (89.8±1.3)%, (87.3±1.1)%, (87.9±1.3)%), P<0.05; the wound healing rates of positive control group, chitosan hydrogel group, and 10 g/L composite hydrogel group were significantly lower than those of 15, 20, 50, and 100 g/L composite hydrogel groups ( P<0.05). On 14 d after injury, the wound epithelialization degrees of 15, 20, 50, and 100 g/L composite hydrogel groups were higher than those of the other 4 groups, the new microvascular situation was better, and the collagen was more abundant and arranged more neatly. On 14 d after injury, the percentages of CD31 and VEGFA positive areas in wounds in positive control group and the percentage of VEGFA positive area in wounds in chitosan hydrogel group were significantly higher than those in blank group ( P<0.05), the percentage of VEGFA positive area in wounds in 10 g/L composite hydrogel group was significantly higher than that in blank group, chitosan hydrogel group, and positive control group (with P values all <0.05), and the percentages of CD31 and VEGFA positive areas in wounds in 15, 20, 50, and 100 g/L composite hydrogel groups were significantly higher than those in blank group, positive control group, chitosan hydrogel group, and 10 g/L composite hydrogel group ( P<0.05). On 14 d after injury, the protein and mRNA expressions of CD31 and VEGFA in wound tissue in chitosan hydrogel group, positive control group, and 10 g/L composite hydrogel group were significantly higher than those in blank group ( P<0.05); the protein expression of VEGFA in wound tissue in 10 g/L composite hydrogel group was significantly higher than that in positive control group ( P<0.05), and the mRNA expressions of CD31 and VEGFA in wound tissue in 10 g/L composite hydrogel group were significantly higher than those in positive control group and chitosan hydrogel group ( P<0.05); the protein and mRNA expressions of CD31 and VEGFA in wound tissue in 15, 20, 50, and 100 g/L composite hydrogel groups were significantly higher than those in blank group, positive control group, chitosan hydrogel group, and 10 g/L composite hydrogel group ( P<0.05); the mRNA expressions of CD31 and VEGFA in wound tissue in chitosan hydrogel group were significantly lower than those in positive control group ( P<0.05). Conclusions:The composite hydrogel has high biological safety, can improve wound blood perfusion, effectively promote the formation of blood vessels and collagen in wound tissue, thus promoting the wound healing of full-thickness skin defects in diabetic rats. 15 g/L is the optimal mass concentration of A-PRF in composite hydrogel.

Objective:To investigate the influencing factors of the outcome of patients with acute minor ischemic stroke (AMIS) in medium- to high-altitude areas.Methods:Patients with AMIS admitted to Qinghai Provincial People's Hospital between October 2016 and July 2019 were included retrospectively. At 90 days after onset, the modified Rankin Scale was used to evaluate the outcome, 0-1 was defined as good outcome and ≥2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome. Results:A total of 102 patients with AMIS in high-altitude areas were enrolled, including 58 males (56.9%), aged 61.41±4.72 years. One patiente experienced intracranial hemorrhage, 19 (18.6%) experienced recurrent ischemic stroke, and 24 (23.5%) had poor outcome. Multivariate logistic regression analysis showed that recurrent ischemic stroke (odds ratio [ OR] 10.680, 95% confidence interval [ CI]1.824-62.540; P=0.009), higher low-density lipoprotein cholesterol ( OR 3.980, 95% CI 1.654-6.711; P=0.014), hyperviscosity ( OR 2.374, 95% CI 1.679-5.263; P=0.027), and higher hematocrit ( OR 8.545, 95% CI 1.869-49.978; P=0.010) were the independent risk factors for poor outcome, while dual antiplatelet therapy after admission ( OR 0.876, 95% CI 0.769-0.978; P=0.023) was an independent protective factor for good outcome. Conclusions:More than 1/5 of patients with AMIS in medium- to high-altitude areas have poor outcome at 90 days after onset. Independent risk factors for poor outcome include recurrent ischemic stroke, higher low-density lipoprotein cholesterol, hyperviscosity and higher hematocrit, while dual antiplatelet therapy after admission is independently associated with good outcome.

Objective:To establish an HPLC fingerprint of Shenling Baizhu Powder and Shenling Baizhu Pills; To evaluate the quality consistency of commercial Shenling Baizhu Powder and Shenling Baizhu Pills.Methods:HPLC method was adopted with Agilent TC-C18 column (250 mm×4.6 mm, 5 μm). The mobile phase was 0.05% phosphoric acid-acetonitrile with gradient elution; the flow rate was 1.0 ml/min; the detection wavelength was 203 nm; the column temperature was 25 ℃. The HPLC fingerprints of Shenling Baizhu Powder and Shenling Baizhu Pills from different manufacturing enterprises were established and analyzed by using the Similarity Evaluation System of Chromatographic Fingerprint of TCM (Version 2012) software for similarity evaluation, and the main chromatographic peaks were identified.Results:The control fingerprints of Shenling Baizhu Powder and Shenling Baizhu Pills were obtained. 73 common peaks and 79 common peaks were identified respectively. The similar degrees of all samples were over 0.92. The quality consistency of drugs different batches of different production enterprises was good. A total of 10 components were identified, including Liquiritin, Ginsenoside Rg1, Ginsenoside Rb1, Glycyrrhizin, Isoliquiritin, Ginsenoside Rd, Glycyrrhizic acid, AtractylenolideⅠ, AtractylenolideⅡ and AtractylenolideⅢ.Conclusions:The established HPLC fingerprints can quickly evaluate the formulation quality of Shenling Baizhu Powder and Shenling Baizhu Pills, providing basis the quality control.

Objective To assess the effectiveness and safety of prone positioning in the treatment of neonatal respiratory distress syndrome(NRDS)using invasive respiratory support.Methods A prospective study was conducted from June 2020 to September 2023 at Suining County People's Hospital,involving 77 preterm infants with gestational ages less than 35 weeks requiring invasive respiratory support for NRDS.The infants were randomly divided into a supine group(37 infants)and a prone group(40 infants).Infants in the prone group were ventilated in the prone position for 6 hours followed by 2 hours in the supine position,continuing in this cycle until weaning from the ventilator.The effectiveness and safety of the two approaches were compared.Results At 6 hours after enrollment,the prone group showed lower arterial blood carbon dioxide levels,inspired oxygen concentration,oxygenation index,rates of tracheal intubation bacterial colonization,and Neonatal Pain,Agitation and Sedation Scale scores compared to the supine group(P<0.05).There were no significant differences between the groups in terms of pH,arterial oxygen pressure,positive end-expiratory pressure,duration of mechanical ventilation,accidental extubation,ventilator-associated pneumonia,air leak syndrome,skin pressure sores,feeding intolerance,and grades II-IV intraventricular hemorrhage(P>0.05).Conclusions Compared to supine positioning,prone ventilation effectively improves oxygenation,increases comfort,and reduces tracheal intubation bacterial colonization in neonates requiring mechanical ventilation for NRDS,without significantly increasing adverse reactions.