ObjectiveTo observe the influence and therapeutic effect of quercetin on cuproptosis in rheumatoid arthritis rats and to explore its possible mechanism based on the solute carrier family 31 member 1 （SLC31A1）/ferredoxin 1 （FDX1） pathway. MethodsSixty male SD rats were divided into six groups： A control group， a model group， high- and low-dose quercetin groups （150 and 50 mg·kg^-1）， a cuproptosis inhibitor （tetrathiomolybdate， TTM） group （10 mg·kg^-1）， and a methotrexate group （2 mg·kg^-1）， 10 rats in each group. Except for the control group， the model of rheumatoid arthritis （CIA） rats was established by type Ⅱ collagen induction method. After successful modeling， each drug group was intervened according to the corresponding dose of drugs， and the control group and the model group were given the same amount of normal saline by gavage， once a day， which lasted for 4 weeks. The swelling degree of rats' feet was observed， and the clinical arthritis scores were determined. The levels of serum rheumatoid factor （RF）， matrix metalloproteinase-3 （MMP-3）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， interleukin-10 （IL-10）， and ceruloplasmin （Cp） were detected by enzyme-linked immunosorbent assay （ELISA）. The content of copper ion （Cu）， malondialdehyde （MDA）， superoxide dismutase （SOD）， and glutathione （GSH） in joint tissue was detected. Hematoxylin-eosin （HE） staining was used to observe the pathological changes of joint tissue. The levels of reactive oxygen species （ROS） and dihydrolipoic acid transacetylase （DLAT） were detected by immunofluorescence （IF）. The protein and mRNA expression of SLC31A1， FDX1， lipoic acid synthase （LIAS）， heat shock protein 70 （HSP70）， pyruvate dehydrogenase E1 subunit β （PDHB）， and copper transporting P-type ATPase β （ATP7B） was detected by immunohistochemistry （IHC） and real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared to the control group， the model group exhibited joint swelling and deformity， significantly increased clinical arthritis scores， obvious bone destruction， synovial hyperplasia， and inflammatory cell infiltration in joint tissue. In addition， the serum levels of RF， MMP-3， TNF-α， IL-1β， and Cp showed significant elevation， while the level of IL-10 was significantly reduced. The levels of Cu， MDA， ROS， and DLAT in joint tissue were markedly increased， whereas SOD and GSH content was significantly decreased. The protein and mRNA expression of SLC31A1 and HSP70 was significantly up-regulated， while the protein and mRNA expression of FDX1， LIAS， PDHB， and ATP7B was significantly down-regulated （P<0.01）. Compared to the model group， each treatment group exhibited varying degrees of improvement in joint swelling and deformation as well as clinical arthritis scores in rats. Additionally， there was a reduction in joint bone destruction， inflammatory cell infiltration， and synovial hyperplasia in rats. Furthermore， the serum levels of RF， MMP-3， TNF-α， IL-1β， and Cp significantly decreased， while the level of IL-10 increased significantly. In joint tissue， the levels of Cu， MDA， ROS， and DLAT showed significant decreases， while SOD and GSH content exhibited significant increases. The protein and mRNA expression of SLC31A1 and HSP70 was down-regulated， while the protein and mRNA expression of FDX1， LIAS， PDHB， and ATP7B was up-regulated （P<0.05）. ConclusionQuercetin effectively reduces synovial hyperplasia and inflammatory infiltration in rats with rheumatoid arthritis， thereby alleviating pathological damage to joint tissue. This effect may be attributed to the blockade of the SLC31A1/FDX1 signaling pathway activation and inhibition of excessive cuproptosis.

To guide transfusion practice in critically ill children who often need plasma and platelet transfusions, the Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB) developed Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children. This guideline addresses 53 recommendations related to plasma and platelet transfusion in critically ill children with 8 kinds of diseases, laboratory testing, selection/treatment of plasma and platelet components, and research priorities. This paper introduces the specific methods and results of the recommendation formation of the guideline.

ObjectiveTo explore the effects of astragalin （AST） on autophagy and apoptosis of astrocytes in the L_4-5 dorsal horn of the spinal cord in mice with inflammatory pain induced by complete Freund's adjuvant （CFA）. MethodsTwenty-four male C57BL/6 mice， aged six months， were randomly assigned to four groups： control group， saline group， CFA model group， and CFA+AST group， six mice in each group. The inflammatory pain model was established by injection of 10 µL CFA into the right lateral malleolus fossa. The saline group were injected with an equal amount of normal saline at the same site. The inflammatory pain mice in CFA+AST group were further treated with AST （60 mg/kg） intraperitoneally once a day for 21 consecutive days. Multiplex immunofluorescence staining was used to detect the coexpression of autophagy-related factors including ATG 12 and Beclin-1， apoptosis-related factors including Cleaved-Caspase3 and Caspase9， and the astrocyte marker such as GFAP in the L_4-5 spinal dorsal horn of the mice in each group. Western blot was used to examine the protein expression levels of autophagy-related proteins（ATG12， Beclin-1） and apoptosis-related proteins（Caspase 3， Caspase 9） in the L_4-5 spinal dorsal horn of mice. ResultsImmunofluorescent staining showed that in the L_4-5 dorsal horn of the spinal cord， the fluorescence intensity of ATG12 （P<0.000 1） and Beclin-1 （P<0.000 1） was significantly increased， while that of Cleaved-Caspase 3 （P<0.001） and Caspase 9 （P<0.000 1） was decreased in the CFA+AST group when compared to the CFA model group. Furthermore， AST could inhibit the activation of astrocytes. Western blot further confirmed that AST significantly upregulated the expression of ATG12 （P<0.000 1） and Beclin-1 （P<0.000 1） in the L_4-5 spinal cord of CFA mice， and downregulated the expression of Caspase 3 （P<0.01） and Caspase 9 （P<0.001）. ConclusionsAST promotes autophagy of astrocytes and inhibits their apoptosis in the L_4-5 spinal dorsal horn of CFA mice.

BackgroundAs a high prevalence disorder， schizophrenia has caused significant burden to family and society due to the impairment of occupational and social function. Currently， the dominant vocational training model in China follows a paternalistic， clinician-led decision-making approach. Although it improves patients' social function to some extent， it undermines their autonomy and treatment adherence. Therefore， it is urgently necessary to explore a new intervention method to enhance treatment compliance and social function in patients. ObjectiveTo explore the impact of shared decision-making oriented vocational training on social function in hospitalized schizophrenia patients， so as to provide references for rehabilitation interventions. MethodsA total of 68 patients diagnosed with schizophrenia according to the International Classification of Diseases， tenth edition （ICD-10） criteria were consecutively enrolled from January to June 2024 at The Third People's Hospital of Wenjiang Distric， Chengdu. Participants were randomly allocated into the research group （n=34） and the control group （n=34） using a random number table method. Both groups received routine rehabilitation training， while the research group received shared decision-making oriented vocational training for 12 weeks， 2 times a week for 2 hours each time. Before and at the 4^th and 12^th week of intervention， two groups were evaluated by General Self-Efficacy Scale （GSES）， Stigma Scale for Mental Illness （SSMI）， Scale of Social function of Psychosis Inpatients （SSFPI） and Inpatient Psychiatric Rehabilitation Outcome Scale （IPROS）. ResultsA total of 63 participants completed the study， with 30 cases in the research group and 33 cases in the control group. Repeated measures ANOVA revealed statistically significant time effects and interaction effects in both groups for GSES， SSMI， SSFPI and IPROS scores （F=20.451， 16.022； 26.193， 12.944； 23.957， 5.023； 11.776， 3.985， P<0.05 or 0.01）， while no significant group effects were observed （F=0.188， 0.742， 1.878， 0.474， P>0.05）. At the 12^th week of intervention， there were statistically significant differences in GSES， SSMI， SSFPI and IPROS scores between the two groups. ConclusionShared decision-making oriented vocational training may help to improve social function in patients with schizophrenia. ［Funded by 2023 Chengdu Medical Research Project （number， 2023468）］

Objective: Randomized controlled trials (RCTs) of Chinese patent medicines and classic traditional Chinese medicine prescriptions were systematically reviewed from both Chinese and English journals published in 2023. A preliminary summary and evaluation were conducted on the generation and translation of clinical evidence for these treatments. This analysis aims to inform future research on clinical efficacy evaluation and guide the rational application of evidence. Methods: RCTs of Chinese patent medicines and classic traditional Chinese prescriptions published in 2023 were comprehensively retrieved from the Artificial Intelligence Clinical Evidence Database for Chinese Patent Medicine (AICED-CPM), with supplementary searches conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (SinoMed), Cochrane Library, PubMed, Embase, and Web of Science. The study characteristics and methodological quality of these RCTs were systematically analyzed and evaluated. Results: A total of 1 443 RCTs of Chinese patent medicines were included, comprising 1 399 Chinese articles and 44 English articles. Additionally, 334 RCTs of classic traditional Chinese medicine prescriptions were found, with 331 published in Chinese and 3 in English. 196 567 participants were included, covering 585 types of Chinese patent medicines (487 oral, 61 injectable, and 37 topical) and 179 classic traditional Chinese medicine prescriptions. The involved studies encompassed 22 types of diseases, with research primarily focusing on diseases of the circulatory system, the respiratory system, and the genitourinary system. The sample sizes ranged from 18 to 3 777 participants, and most studies were conducted at a single center. Methodologically, the implementation of allocation concealment and blinding remained insufficiently emphasized. Conclusion Overall, compared with 2022, both the number of RCT publications and their methodological quality have improved in 2023, with heightened attention to research on diseases of the genitourinary system. However, quality control and standardized management in the design and implementation processes still require enhancement to produce more high-quality clinical evidence and accelerate the translation and application of this evidence.

Currently,human health due to corona virus disease 2019(COVID-19)pandemic has been seriously threatened.The coronavirus severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)spike(S)protein plays a crucial role in virus transmission and several S-based therapeutic approaches have been approved for the treatment of COVID-19.However,the efficacy is compromised by the SARS-CoV-2 evolvement and mutation.Here we report the SARS-CoV-2 S protein receptor-binding domain(RBD)inhibitor licorice-saponin A3(A3)could widely inhibit RBD of SARS-CoV-2 variants,including Beta,Delta,and Omicron BA.1,XBB and BQ1.1.Furthermore,A3 could potently inhibit SARS-CoV-2 Omicron virus in Vero E6 cells,with EC50 of 1.016 pM.The mechanism was related to binding with Y453 of RBD deter-mined by hydrogen-deuterium exchange mass spectrometry(HDX-MS)analysis combined with quan-tum mechanics/molecular mechanics(QM/MM)simulations.Interestingly,phosphoproteomics analysis and multi fluorescent immunohistochemistry(mIHC)respectively indicated that A3 also inhibits host inflammation by directly modulating the JNK and p38 mitogen-activated protein kinase(MAPK)path-ways and rebalancing the corresponding immune dysregulation.This work supports A3 as a promising broad-spectrum small molecule drug candidate for COVID-19.

Objective:To analyze the therapeutic effect and safety of simultaneous integrated boost intensity-modulated radiotherapy for lung cancer brain metastases.Methods:A total of 300 patients with lung cancer brain metastases admitted to the Department of Oncology, Qingdao Municipal Hospital from March 2021 to March 2023 were selected as the study objects. The patients were divided into control group ( n=150) and study group ( n=150) by random number table method. The control group received sequential three-dimensional conformal radiotherapy, while the study group received simultaneous integrated boost intensity-modulated radiotherapy. The short-term and medium-term efficacy, target dose, and adverse reactions were compared between the two groups. Results:The short-term and medium-term total effective rates of the study group were 73.33% (110/150) and 88.67% (133/150), respectively, which were higher than those of the control group [51.33% (77/150) and 71.33% (107/150) ] ( χ2=15.46, P<0.001; χ2=14.08, P<0.001). The D min in gross tumor planning target volume and whole brain clinical planning target volume of the study group were (23.78±1.11) and (58.46±0.55) Gy, respectively, which were higher than those in the control group [ (16.67±1.08) and (53.44±0.74) Gy], with statistically significant differences ( t=56.22, P<0.001; t=66.68, P<0.001). The D mean in gross tumor planning target volume and whole brain clinical planning target volume of the study group were (44.12±0.87) and (62.19±0.57) Gy, respectively, which were higher than those in the control group [ (37.55±0.89) and (57.78±0.82) Gy], with statistically significant differences ( t=64.65, P<0.001; t=54.08, P<0.001). The total incidence of adverse reactions was 30.67% (46/150) in the study group and 36.67% (55/150) in the control group, with no significantly significant difference ( χ2=1.20, P=0.271) . Conclusion:Compared with sequential three-dimensional conformal radiotherapy, simultaneous integrated boost intensity-modulated radiotherapy has better short-term and medium-term efficacy in patients with lung cancer brain metastases. Target dose can be increased without increasing adverse reactions.

Objective To explore the autoregulation mechanism of cerebral blood flow in a patient with asymptomatic orthostatic hypotension after cervical spinal cord injury.Methods The patient underwent an upright tilt experiment to measure brachial artery blood pressure,cerebral blood flow parameters were monitored by TCD,and cerebral vascular resistance(CVR)was calculated.Results The data showed that the patient's blood pressure,right middle cerebral artery systolic peak flow velocity(Vs),end diastolic blood flow velocity(Vd),mean blood flow velocity(Vm),pulsatile index(PI),and CVR were normal in the supine position.However,when tilted at 30°,60°,and 90°,blood pressure,Vs,Vd,Vm,and CVR decreased,while PI increased.Conclusion When the patient with asymptomatic orthostatic hypotension after cervical spinal cord injury experiences with orthostatic hypotension,the cerebral vascular constricts and cerebral blood flow reduces.

Objective Traditional Chinese medicine tongue diagnosis plays an important role in the clinical diagnosis and treatment of diseases,but the current research results are not applicable to the evaluation of clinical efficacy.This study conducted a hierarchical quantitative study on tongue color based on hyperspectral data of tongue images,making it suitable for clinical efficacy evaluation.Methods Establish inclusion and exclusion criteria,obtain tongue images of different spectral wavelengths within the visible light range of 400-1000 nm,and use traditional Chinese medicine clinical experts to distinguish between red tongue and yellow coating in four different color levels(mild,moderate,severe,and severe).Finally,establish a quantitative prediction model for the grade of red tongue and yellow coating based on machine learning models.Results There were significant differences in hyperspectral curve characteristics between red tongue and yellow coating with different color levels,which could be used as the basis for grade quantification.With the help of principal component analysis+random forest model,85.79%and 88.34%of the red tongue and yellow coating with different color levels could be predicted.Conclusion The use of hyperspectral image data features and machine learning models for predicting different color levels of tongue color has achieved good accuracy.

Objective To investigate the correlation between fatty infiltration(FI),relative cross-sectional area(rCSA)of the multifidus(MF),erector spinae(ES)and postoperative new symptomatic vertebral compression fractures(NSVCF)for osteoporotic lumbar vertebral compression fractures(OLVCF).Methods The clinical and imaging data of 157 patients with OLVCF treated by surgery were collected.They were divided into postoperative re-fracture group(24 cases)and postoperative non-fracture group(133 cases)according to the presence or absence of NSVCF during the follow-up period.The FI,rCSA of lumbar paravertebral muscles(MF and ES)in the two groups were measured and calculated using Image J software.Univariate difference analysis was performed to compare whether there were differences in gender,age,T value of bone mineral density(BMD),body mass index(BMI),FI and rCSA between the two groups.Multivariate binary logistic regression analysis was used to determine the risk factors for NSVCF after surgery for OLVCF.Results Univariate difference analysis showed there were significant statistical differences in age(t=-2.596,P=0.010),T value of BMD(t=2.415,P=0.017)and FI(t=-5.006,P＜0.001)between the two groups.There were no significant statistical differences in gender(x2=0.528,P=0.468),BMI(t=1.354,P=0.178)and rCSA(t=-0.057,P=0.955).Multivariate binary logistic regression analysis showed there were significant statistical differences in FI(x2=15.560,P＜0.001),T value of BMD(x2-4.193,P=0.041)between the two groups.Conclusion The higher FI of lumbar paravertebral muscle and the lower T value of BMD of lumbar spine are the risk factors for postoperative NSVCF in patients with OLVCF.It is recommended that clinicians should pay attention to the functional exercise of lumbar dorsal muscles and the anti-osteoporosis therapy in the relevant patients.