OBJECTIVE:Exercise intervention is one of the main treatments for fibromyalgia,but there is no consistent conclusion on the choice of different exercise modalities.In this article,a network Meta-analysis was used to comprehensively and quantitatively evaluate the effects of different exercise modalities on fibromyalgia syndrome. METHODS:PubMed,EMbase,Scoups,The Cochrane Library,Web of Science,CNKI,WanFang Database,and China Biomedical Literature Database were searched for relevant literature,with a search timeframe from the establishment of each database to June 2023.The outcome indicators included five continuous variables,including fibromyalgia impact questionnaire-revised(FIQ)scores,visual analogue scale(VAS)scores,quality of life,quality of sleep,and depression.The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the included literature.RevMan 5.4 software was used to perform effect sizes,subgroup analyses,and sensitivity analyses of the data.Stata 17 software was used to perform reticulation and network Meta-analysis of the data. RESULTS:A total of 13 articles with 14 randomized controlled trials were finally included.The overall methodological quality of the literature was high.The results of traditional Meta-analysis showed that,compared with the control group,exercise therapy significantly improved the FIQ score[standardized mean difference(SMD)=-0.67,95％confidence interval(CI):-0.83 to-0.50,P<0.01],VAS score(SMD=-0.72,95％CI:-0.90 to-0.54,P<0.01),quality of life(SMD=1.03,95％CI:0.45 to 1.61,P=0.000 5),sleep quality(SMD=-0.62,95％CI:-0.98 to-0.25,P=0.001),and depression(SMD=-0.63,95％CI:-1.09 to-0.18,P=0.007).Network Meta-analysis showed that the probability of optimal intervention effect of exercise modalities on FIQ scores was ranked as:mind-body exercise(86.5)>resistance exercise(70.5)>aerobic exercise(41.7);the probability of optimal intervention effect of exercise modalities on VAS scores was ranked as:resistance exercise(85.3)>mind-body exercise(74.3)>aerobic exercise(34.5). CONCLUSION:Exercise therapy significantly improves FIQ scores,VAS scores,quality of life,sleep quality,and depression in patients with fibromyalgia syndrome.Mind-body exercise and resistance exercise are the most effective exercise modalities to reduce FIQ scores and VAS scores in patients with fibromyalgia syndrome.

BACKGROUND:The gluteus medius not only abducts the hip joint,but also plays an important role in limiting the external movement of the femoral head.At present,there is a lack of research on the correlation between gluteus medius status and non-traumatic femoral head necrosis. OBJECTIVE:To investigate the relationship between the gluteus medius width ratio and the medial space ratio of the hip joint and the progression of non-traumatic femoral head necrosis,and to explore the effect of gluteus medius atrophy on the surface and necrotic zone stress of the femoral head necrosis through finite element analysis. METHODS:Retrospective analysis of unilateral non-traumatic femoral head necrosis patients admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine was performed.All patients were followed up for an average of more than 2 years.They were divided into a collapsed group and a non-collapsed group based on whether there was collapse of the femoral head during the follow-up.Medial space ratio,gluteus medius width ratio,Sharp angle,gluteus medius length ratio,and gluteus medius activation angle were measured and calculated.The differences in these indicators were compared between the two groups.At the first visit and follow-up at 3,6,12,and 24 months,the medial space ratio and gluteus medius width ratio were measured and calculated to explore the changes of these two indicators in the course of non-traumatic femoral head necrosis.In addition,using three-dimensional finite element analysis,a Japanese Investigation Committee classification C1 type femoral head necrosis model was constructed based on CT data.At the same time,based on MRI data,a model of the gluteus medius muscle was constructed and divided into a gluteus medius muscle atrophy group(gluteus medius width ratio:74%-76%)and a gluteus medius muscle normal group(gluteus medius width ratio:94%-96%).Each group constructed 10 models,with 6 degrees of freedom of the distal femur constrained to zero.600 N pressures were applied along the Z-axis to the upper surface of the sacrum.The stress distribution,maximum stress values on the surface and necrotic area of the femoral head,and the maximum displacement of the necrotic area were compared between two groups of models. RESULTS AND CONCLUSION:(1)A total of 153 patients(67 males and 86 females)with 153 hips were included in this study.(2)At the 24-hour follow-up,the medial space ratio of the collapsed group was significantly higher than that of the non-collapsed group(P<0.05).The gluteus medius width ratio of the collapsed group was significantly lower than that of the non-collapsed group(P<0.05).There was no statistically significant difference in Sharp angle,gluteus medius activation angle,and gluteus medius length ratio between the two groups(P>0.05).(3)Since the follow-up time exceeded 3 months,the gluteus medius width ratio of the collapsed group was lower than that of the non-collapsed group(P<0.05).Since the follow-up time exceeded 12 months,the medial space ratio of the collapsed group was higher than that of the non-collapsed group(P<0.05).(4)Pearson correlation analysis showed a significant positive correlation between follow-up time and medial space ratio in the collapsed group(P<0.05),and a significant negative correlation between follow-up time and gluteus medius width ratio(P<0.05).The regression coefficient of gluteus medius width ratio was larger than that of medial space ratio.(5)The group with middle gluteal muscle atrophy showed significant stress concentration on the surface of the femoral head,and the stress zone was significantly located on the outside.The maximum stress on the surface of the femoral head in the group with middle gluteal muscle atrophy was significantly greater than that in the group with normal middle gluteal muscle(P<0.05).There was significant stress concentration in the necrotic area of the middle gluteal muscle atrophy group,and the maximum stress was located at the edge of the necrotic area.The maximum stress and maximum displacement in the necrotic area of the middle gluteal muscle atrophy group were significantly greater than those of the normal group(P<0.05).(6)It is indicated that gluteus medius width ratio is an effective indicator for evaluating changes in gluteal muscle atrophy.In the progression of non-traumatic femoral head necrosis,atrophy of the gluteus medius muscle first occurs,followed by widening of the medial hip joint space.The mechanical mechanism may be that the atrophy of the gluteus medius muscle affects the stability of the hip joint,leading to external displacement of the femoral head,and increasing stress and displacement on the surface and necrotic area of the femoral head.

Objective To investigate the serological changes of blood type and whether hemolytic reactions occurred in a patient with ABw subtype after type A therapeutic plasma exchange(TPE)retrospectively.Methods The ABO blood group identification and genotyping was carried out by microcolumn gel method,microcolumn glass bead method,saline tube method and absorption-elution test,and the laboratory results before and after TPE were analyzed.Results The patient un-derwent 2 000 mL type A TPE in other hospitals and was transferred to our hospital.On the second day of hospitalization,the test showed consistency between forward and reverse blood typing.On the third day,the detection showed that Bc was±～1+,and discrepancy was found between forward and reverse typing.The presence of B antigen was confirmed through tube method and human anti-B absorption-elution test,and was identified as ABw03 by molecular biological method.After type A TPE,Hb and Plt both temporarily decreased,creatinine slightly increased,ALT and AST continued to decrease,while TBIL,DBIL and IBIL showed a temporary decrease followed by an increase,indicating a slight hemolytic reaction.Conclu-sion Infusion of large volume of plasma may cause hemolytic reactions when ABO subtype patients contain weak A or B an-tigens.The blood type should be strictly identified according to the ABO blood type forward and reverse typing standards.Ad-ditional laboratory tests combined with molecular biology techniques are required for weak agglutination,which can reduce the missed detection of ABO subtypes and reduce the occurrence of transfusion reactions.

Objective To identify antibody specificity in an elderly patient with hydronephrosis accompanied by ureter-al stones and shock who had multiple antibodies.Methods Microcolumn gel method was used to screen unexpected anti-bodies of red blood cells and identify antibodies.Enzyme method and antibody absorption method were used to help judge the specificity of antibodies in patients.The ABO blood type,Rh blood type and MNS blood type of patient were determined by saline tube method.Results The patient′s blood types were O,CCDee,NNss,and a combination of anti-E,anti-c,anti-M and anti-S antibodies was detected.Conclusion Repeated blood transfusion may lead to the presence of one or more un-expected antibodies in patients.Patients with multiple or high-frequency antibodies may experience difficulties in identifica-tion and delayed blood use.

Tumor immune checkpoint inhibitors (ICIs) present a dual nature, offering therapeutic benefits alongside possible toxic side effects. Despite their significant clinical advantages, immune-related adverse events (irAEs) are major concern. In particular, the multi-organ irAEs (MO-irAEs) caused by ICIs present complex clinical manifestations, affecting a high proportion of critically ill patients. There is a lack of clinical awareness and attention towards these adverse events, making management relatively difficult, thus potentially threatening the life of patients. Reasonable application of hormones and immune modulators, along with symptomatic and supportive treatment, as well as careful monitoring and long-term follow-up are crucial measures to control MO-irAEs. Clinical characteristics, peripheral blood indicators, and genetic predisposition can serve as predictive markers for MO-irAEs occurrence and progression to some extent. A comprehensive understanding of clinical features, intervention measures, prognosis, potential molecular mechanisms and predictive factors of MO-irAEs can help to effectively control MO-irAEs, ultimately improving patient outcomes.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Background::Understanding willingness to undergo pulmonary function tests (PFTs) and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease (COPD). This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs.Methods::We collected data from participants in the "Happy Breathing Program" in China. Participants who did not follow physicians’ recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs. We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs. We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs.Results::A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study. Out of these participants, 7660 (90.4%) were willing to undergo PFTs. Among those who were willing to undergo PFTs but actually did not, the main reasons for not doing so were geographical inaccessibility ( n = 3304, 43.1%) and a lack of trust in primary healthcare institutions ( n = 2809, 36.7%). Among the 815 participants who were unwilling to undergo PFTs, over half ( n = 447, 54.8%) believed that they did not have health problems and would only consider PFTs when they felt unwell. In the multivariable regression, individuals who were ≤54 years old, residing in rural townships, with a secondary educational level, with medical reimbursement, still working, with occupational exposure to dust, and aware of the abbreviation "COPD" were more willing to undergo PFTs. Conclusions::Willingness to undergo PFTs was high among high-risk populations. Policymakers may consider implementing strategies such as providing financial incentives, promoting education, and establishing community-based programs to enhance the utilization of PFTs.

This study utilized the CCK-8 assay to examine the effects of various concentrations of CoCl2(0,50,100,200,300,400 μmol/L)and different treatment durations(0,6,12,24,48 h)on the viability of adipocytes,in order to determine the most suitable treatment conditions.Western blot analysis was employed to investigate the impact of different concentrations of CoCl2(0,50,100,200,400 μmol/L)on the expression of hypoxia and its downstream key proteins in adipocytes.The results indicated that higher concentrations of CoCl2 led to lower adipocyte viability,with sig-nificant decreases in cell viability observed in the 300,400 μmol/L treatment groups(P＜0.01),while the 200 μmol/L group exhibited the highest cell viability.Compared to the control group,the 200 μmol/L CoCl2 treatment group showed a significant upregulation in the expression of hypoxia and its downstream signaling pathway key molecules:hypoxia-inducible factor 1-alpha(HIF-1α),glucose transporter type 4(GLUT4),vascular endothelial growth factor receptor 1(FLT-1),prolyl hydroxylase 2(PHD2),and vascular endothelial growth factor(VEGF)(P＜0.01).Addi-tionally,the 200 μmol/L CoCl2 treatment group exhibited higher levels of key lipolytic enzymes,including adipose triglyceride lipase(ATGL),perilipin 1(PLIN1),protein kinase A(PKA),and increased phosphorylation levels of hormone-sensitive lipase(HSL)in the 300 and 400 μmol/L groui ps(P＜0.01).CoCl2-mediated hypoxia in the 200 μmol/L treatment group also in-creased the protein expression of phosphatidylinositol 3-kinase(PI3K)and the phosphorylation level of protein kinase B(Akt).These findings suggest that adding 200 μmol/L CoCl2 can enhance the expression of hypoxia-related proteins,lipolytic enzymes,and insulin-related signaling proteins in primary bovine adipocytes.

This experiment was divided into two parts:in vivo and in vitro.In the in vivo experi-ment,10 healthy and 10 ketotic cows were selected,and adipose tissues were collected.ELISA re-sults showed that malonaldehyde(MDA)content and reactive oxygen species(ROS)activity were higher in adipose tissues of cows with clinical ketotic compared with healthy cows,and glutathione peroxidase(GPP)activity was higher than that of cows with clinical ketotic.Western blot results showed that compared with the healthy group,adipose tissue of the ketotic group showed a signifi-cant increase in the expression level of TP53 induces glycolysis and apoptosis factors(TIGAR)protein,a significant up-regulation in the expression level of Nrf2-HMOX1 signaling pathway pro-tein,and a significant increase in the expression level of oxidative stress protein in adipose tissue of the ketotic group.The expression level of TIGAR protein was significantly up-regulated,the pro-tein level of Nrf2-HMOX1 signaling pathway was significantly up-regulated,and the protein levels of oxidative stress-related indexes SOD1,catalase(CAT)and glutathione S-transferase(GST)were significantly increased.It indicated that oxidative stress occurred in the adipose tissue of ketotic cows in vivo.In vitro experiments were carried out to detect the effect of TIGAR on oxida-tive stress in bovine adipocytes by adenoviral silencing or overexpression of TIGAR in isolated and cultured bovine primary adipocytes as well as by the addition of hydrogen peroxide in vitro for 2 h.The Western blot results showed that the hydrogen peroxide group showed enhanced oxidative stress compared with the control group,and the nuclear correlation factor 2 was significantly in-creased.correlation factor 2(Nrf2)pathway,decreased expression of Nrf2 and hemeoxygenase-1(HMOX1),and decreased expression of related oxidative stress proteins in the hydrogen peroxide group;compared with the hydrogen peroxide group,the protein expression levels of Nrf2-HMOX1 and related oxidative stress proteins were up-regulated in the group with overexpression of TIGAR and hydrogen peroxide,and the expression levels of related oxidative stress proteins were up-regu-lated in the group with overexpression of TIGAR and hydrogen peroxide.Expression level was up-regulated,and the expression of related oxidative stress proteins SOD1,CAT and GST increased.This indicates that overexpression of TIGAR alleviated hydrogen peroxide-induced oxidative stress in adipocytes.Protein expression of Nrf2-HMOX1 signaling pathway and oxidative stress-related proteins SOD1,CAT and GST were down-regulated in the silencing TIGAR plus hydrogen perox-ide group compared to the hydrogen peroxide group.It indicates that silencing TIGAR exacerbated the oxidative stress caused by hydrogen peroxide to adipocytes.

Purpose Based on European lumbar spine phantom,to investigate the effect of different noise index(NI)combined with adaptive statistical interactive reconstruction-veo(ASiR-V)weights on the measurement of lumbar spine bone density,and to explore the optimal combination of the two parameters.Materials and Methods Using GE Revolution CT spectral imaging scanning,54 groups of scanning parameters with NI values of 4-20(interval 2)combined with ASiR-V weights of 0-100%(interval 20%)were selected for spectral scanning of European lumbar spine phantom.Regions of interest were placed in the middle of L1,L2 and L3,respectively.hydroxyapatite(HAP)-H2O based substances were selected to measure the HAP content of each vertebral body.The differences between the measured bone density value and the true value under different NI combined with different ASiR-V were compared to evaluate its accuracy.Results There were statistically significant differences in HAP measurements of L1,L2 and L3 vertebra in 54 groups of scanning conditions(all P<0.001).When NI=14,ASiR-V80%;NI=16,ASiR-V100%;NI=18,ASiR-V60%;NI=18,ASiR-V80%;NI=20,ASiR-V60%;NI=20,ASiR-V80%;NI=20,ASiR-V100%,there was no statistically significant difference between HAP measured value and true body model value(P>0.05).Conclusion With NI=18,ASiR-V60%,spectral CT can accurately measure lumbar spine bone density and significantly reduce the radiation dose.In clinical application,bone density can be measured by low dose scanning by increasing the weight of NI and ASiR-V.