Objective:To evaluate the effect of statins combined with PCSK9 inhibitors on coronary artery atherosclerotic plaque, as well as to verify the lipid-lowering effect of the combined therapy.Methods:A computerized search of PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI databases was conducted to retrieve published literature from inception to December 20, 2022. The English search terms utilized included "PCSK9 inhibitors," "Alirocumab," "Evolocumab," "plaque," "IVUS," and "OCT." The corresponding Chinese search terms were "PCSK9 inhibitors," "plateau," "intravascular ultrasound," and "optical coherence tomography." The literature that examined the effect of statins alone or in combination with PCSK9 inhibitors on coronary atherosclerotic plaques using intravascular ultrasound or optical coherence tomography was identified. The collected data were subsequently processed using Review Manager (Revman) version 5.4.Results:In the final analysis, nine studies involving 1912 patients were included. The analysis results revealed that compared with statins alone, statins combined with PCSK9 inhibitors significantly reduced the percentage of atherosclerotic volume ( MD: -2.08 mm 3, 95% CI: -2.94 to -1.23 mm 3, P < 0.001), accelerated the regression of atherosclerotic volume ( MD: -1.13 mm 3, 95% CI: -1.49 to -0.77 mm 3, P < 0.001), slightly, but not significantly, reduced the overall atherosclerotic volume ( MD: -6.42 mm 3, 95% CI: -14.34-1.51 mm 3, P = 0.110). Nevertheless, the combined therapy contributed to a significant reduction in atherosclerotic volume ( MD: -5.16 mm 3, 95% CI: -7.09 to -3.23 mm 3, P < 0.001) and significantly increased the fiber cap thickness of thin cap plaques ( MD: 8.46 μm, 95% CI: 5.13-11.79 μm, P < 0.001). Additionally, this combined therapy significantly lowered blood lipid levels. Conclusion:The combination of statins and PCSK9 inhibitors can significantly improve the characteristics and phenotype of atherosclerotic plaques and significantly reduce blood lipid levels. For patients with high cardiovascular risk, it is recommended to initiate treatment with statins combined with PCSK9 inhibitors as soon as possible and maintain it for a long time to ensure more benefits.

Objective:To construct a model for predicting early recurrence of hepatocellular carcinoma (HCC) patients after radiofrequency ablation by different machine learning models based on multimodal MRI and clinical indicators, and to evaluate the predictive efficacy of the model.Methods:The data of patients with HCC who underwent radiofrequency ablation in Fourth Medical Center of Chinese PLA General Hospital and the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2021 were retrospectively analyzed. A total of 169 patients with HCC were enrolled, including 152 males and 17 females, aged (57.2±9.2) years. The training set ( n=135) and the test set ( n=34) were randomly divided according to 8∶2. There were 49 cases recurrence in training set and 12 cases recurrence in test set. Based on the training set, the clinical influencing factors of early recurrence in patients with HCC after radiofrequency ablation were screened by univariated and multivariate logistic analysis, and the imaging features were sequentially screened by variance threshold method, select K-best and LASSO regression. Support vector machine (SVM), logistic regression and random forest (RFOREST) were used to construct the prediction models of early postoperative recurrence with simple imagomics alone or combined clinical features, respectively, and the receiver operating characteristic (ROC) curve was used to evaluate the prediction efficiency of the models. Results:Multivariate logistic regression analysis showed that preoperative alpha-fetoprotein >20 μg/L, platelet count >140×10 9 and tumor location were the influential factors for early recurrence of HCC patients after radiofrequency ablation (all P<0.05). Through variance threshold analysis, select K-best and LASSO regression, 16 optimal image omics features were selected. SVM, logistic regression and RFOREST were used to construct a simple imaging omics model for predicting early recurrence of HCC patients after radiofrequency ablation. The areas under ROC curve of the test set were 0.826, 0.830 and 0.826, respectively. And the areas under ROC curve of the constructed imagomics combined clinical model of test set were 0.830, 0.830 and 0.909, respectively. The area under ROC curve of RFOREST in the test set was better than that of SVM and logistic regression ( Z=2.19, 3.98, P=0.008, 0.008). Conclusion:The combined model constructed by SVM, logistic regression and RFOREST based on clinical indicators and image omics features is effective in predicting the early recurrence of patients with HCC after radiofrequency ablation, and the model constructed by RFOREST is the best.

Objective:To evaluate the accuracy of an artificial intelligence (AI) model in measuring key angles on pelvic radiographs of the hip and assess its effectiveness in diagnosing developmental dysplasia of the hip (DDH) and borderline developmental dysplasia of the hip (BDDH).Methods:A retrospective analysis was conducted using anteroposterior pelvic X-ray films from 1,029 patients with suspected DDH. The data were collected from the Department of Radiology, Fourth Medical Center of the Chinese PLA General Hospital. Among the patients, 273 were male, and 756 were female, with an average age of 57.01 ± 18.16 years (range, 12-88 years). The dataset was randomly divided into a training set (720 cases), a test set (206 cases), and a validation set (103 cases). Two radiologists identified and marked key anatomical points of the hip joint to establish the training dataset, which was then used to develop a deep learning-based AI model capable of locating these key anatomical positions. Using the identified anatomical points, the AI model automatically measured and calculated the Sharp angle, center-edge (CE) angle, and T?nnis angle in the test dataset. The measurement results from the AI model were compared with those of the radiologists to evaluate the model's accuracy. The validation set was used to optimize model parameters, and the test dataset was used to evaluate the diagnostic performance of DDH. Receiver operating characteristic (ROC) curves were employed to assess the diagnostic efficacy of the AI model for DDH and BDDH.Results:The accuracy rates of the AI model in measuring the left Sharp angle, CE angle, and T?nnis angle for diagnosing DDH were 89.8%, 90.1%, and 86.8%, respectively. For the right side, the accuracy rates were 93.7%, 92.2%, and 80.5%, respectively. There were no statistically significant differences in the mean values of the Sharp, T?nnis, and CE angles between manual and AI measurements ( P>0.05). Pearson correlation tests and intraclass correlation coefficient (ICC) analyses revealed high consistency between AI and manual measurements of the Sharp angle, T?nnis angle, and CE angle, with r-values and ICC values exceeding 0.75. Additionally, the AI model performed measurements significantly faster (1.7±0.1 s) than radiologists (88.1±8.4 s and 90.3±7.4 s, P<0.001). The areas under the ROC curves (AUCs) for diagnosing DDH using the Sharp angle, CE angle, and T?nnis angle measured by the AI model were 0.883, 0.922, and 0.908 (left side) and 0.924, 0.871, and 0.922 (right side), respectively. For diagnosing BDDH, the AUCs of the left and right CE angles measured by the AI model were 0.787 and 0.676, respectively. Kappa test results indicated good agreement between the AI model and manual measurements as well as final clinical diagnoses. For the CE angle, the κ value of the AI model was 0.663, while κ values for the Sharp and T?nnis angles were all greater than 0.800. Conclusion:The convolutional neural network-based AI model effectively and automatically measures the Sharp, CE, and T?nnis angles and demonstrates high diagnostic efficacy for DDH and BDDH.

Malocclusion,identified by the World Health Organization(WHO)as one of three major oral diseases,profoundly impacts the dental-maxillofacial functions,facial esthetics,and long-term development of～260 million children in China.Beyond its physical manifestations,malocclusion also significantly influences the psycho-social well-being of these children.Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition,by mitigating the negative impact of abnormal environmental influences on the growth.Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development,ranging from fetal stages to the early permanent dentition phase.From an economic and societal standpoint,the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated,underlining its profound practical and social importance.This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children,emphasizing critical need for early treatment.It elaborates on corresponding core principles and fundamental approaches in early orthodontics,proposing comprehensive guidance for preventive and interceptive orthodontic treatment,serving as a reference for clinicians engaged in early orthodontic treatment.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

In the context of non-alcoholic fatty liver disease (NAFLD), characterized by dysregulated lipid metabolism in hepatocytes, the quest for safe and effective therapeutics targeting lipid metabolism has gained paramount importance. Sanhuang Xiexin Tang (SXT) and Baihu Tang (BHT) have emerged as prominent candidates for treating metabolic disorders. SXT combined with BHT plus Cangzhu (SBC) has been used clinically for Weihuochisheng obese patients. This retrospective analysis focused on assessing the anti-obesity effects of SBC in Weihuochisheng obese patients. We observed significant reductions in body weight and hepatic lipid content among obese patients following SBC treatment. To gain further insights, we investigated the effects and underlying mechanisms of SBC in HFD-fed mice. The results demonstrated that SBC treatment mitigated body weight gain and hepatic lipid accumulation in HFD-fed mice. Pharmacological network analysis suggested that SBC may affect lipid metabolism, mitochondria, inflammation, and apoptosis-a hypothesis supported by the hepatic transcriptomic analysis in HFD-fed mice treated with SBC. Notably, SBC treatment was associated with enhanced hepatic mitochondrial biogenesis and the inhibition of the c-Jun N-terminal kinase (JNK)/nuclear factor-kappa B (NF-κB) and extracellular signal-regulated kinase (ERK)/NF-κB pathways. In conclusion, SBC treatment alleviates NAFLD in both obese patients and mouse models by improving lipid metabolism, potentially through enhancing mitochondrial biogenesis. These effects, in turn, ameliorate inflammation in hepatocytes.
Humans ; Mice ; Animals ; Non-alcoholic Fatty Liver Disease/metabolism* ; NF-kappa B/metabolism* ; Organelle Biogenesis ; Retrospective Studies ; Mice, Inbred C57BL ; Obesity/metabolism* ; Liver ; Inflammation/metabolism* ; Body Weight ; Lipid Metabolism ; Lipids ; Diet, High-Fat/adverse effects*

Abstract: Objective　To understand the epidemiological characteristics of the migratory bird population with hypertension in Hainan and to provide a basis for the health management of the migratory bird population. Methods　One hundred and eighty migratory birds with hypertension who had lived in in the Mangrove Bay community of Chengmai, Hainan for 3 months or more were selected as the study population. Demographic data, including gender, age, ethnicity, occupation, medication use, family history of hypertension, hometown living environment, Hainan living environment (presence of water area and greenbelt around the residence, type of water area and greenbelt), smoking and alcohol consumption, and height and weight were collected by questionnaire and physical examination to investigate the epidemiological characteristics of the study subjects, and unconditional dichotomous logistic regression analysis was used to identify factors affecting the reduction of blood pressure among the hypertensive migratory bird population before and after taking medication in Hainan. Results　A total of 180 study subjects were included, including 77 (42.8%) males and 103 (57.2%) females, with 78 (43.3%) subjects aged ≤65. The hypertension levels were: 87 (48.3%) had normal high blood pressure, 56 (31.1%) had grade 1 hypertension and 37 (20.6%) had grade 2 hypertension. The higher the blood pressure classification, the lower the percentage of migratory individuals whose blood pressure dropped during their stay in Hainan. Age, hypertension classification, dietary habits, living environment, body mass index (BMI), and alcohol consumption were associated with a decrease in blood pressure during Hainan among the study participants who took hypertension medication regularly. Salty diet (OR=2.778, 95%CI:1.070-7.213, P=0.036) and alcohol consumption (OR=2.686, 95%CI:1.042-6.925, P=0.041) were unfavorable factors for lower diastolic blood pressure before taking medication; overweight (OR=3.487, 95%CI:1.306-9.310, P=0.013) was an unfavorable factor in the reduction of diastolic blood pressure after taking medication. Conclusion　The blood pressure reduction is more significant in migratory individuals in migratory individuals under 65 years old, with a light diet, no alcohol consumption and normal BMI. Environmental factors, age, dietary habits and lifestyle are the main causes of blood pressure, which can provide a reference basis for the health management of the migratory birds with hypertension in Hainan.

Objective:To study the methods of hormone-related teaching in standardized residency training of endocrinology.Methods:From February 2022 to June 2022, 25 residents in the Department of Endocrinology, Peking University Third Hospital were given a standardized residency training. The teaching mode combined with a hundred years of insulin development was adopted to practice insulin teaching, and questionnaires were evaluated before and after the teaching. Chi-square test was performed by SPSS 20.0.Results:A total of 31 physicians participated in the training, and 25 residents who were included in the first-stage standardized training were analyzed. Before the training, only 3 people (12%) knew the development history of insulin, and 10 people (40%) answered all the questions about clinical use of insulin correctly. After the training, 23 residents (92%) said they knew or were familiar with the history of insulin development, and 20 residents (80%) answered the questions about the clinical use of insulin correctly, all of which were higher than those before the training, and the difference was statistically significant.Conclusion:The integration of medical history in standardized residency training in endocrinology department can effectively improve the teaching effect, and enhance the humanity quality of young doctors, which can become an effective vehicle in standardized residency training.

To evaluate effects of PDCA cycle in improving residency diagnosis and treatment ability of endocrine and metabolic diseases, this paper selected the problems of insufficient diagnosis and treatment ability in the results of the endocrinology examination paper as the research breakthrough point, and investigated 62 residents receiving standardized residency training to analyze main reasons of the problems such as "busy clinical work", "special clinical thinking" and "difficult to remember knowledge of endocrinology". The study implemented information-based teaching and daily self-education, followed the law of memory, strengthened the construction of teaching staff, improved teaching methods, etc., and effects of these methods were assessed after the teaching. It's found that the application of PDCA cycle can improve the residents' ability of clinical diagnosis and treatment in endocrine and metabolic diseases.

Objective:We compared the clinical outcomes between β-blocker with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in patients with acute myocardial infarction (AMI) without left ventricular systolic dysfunction.Methods:A total of 750 patients who were diagnosed as AMI without left ventricular systolic dysfunction and successfully received percutaneous coronary intervention (PCI) in TEDA International Cardiovascular Hospital from October 2016 to September 2017 were collected retrospectively. We divided the patients into two groups: β-blocker + ACEI group (BB+ ACEI group, n=666) and β-blocker + ARB group (BB+ ARB group, n=84) according to discharge medications. The clinical datas were gathered and the end-point events were followed up. K-M curve was used to describe cumulative survival rate of the two groups. We used Cox regression analysis to compare the clinical outcomes of the two groups. Results:The occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) (8.3% vs 3.4%, HR=2.377, 95% CI: 1.006-5.616, P=0.048), all-cause death (3.6% vs 0.4%, HR=12.951, 95% CI: 1.947-86.159, P=0.008) and non-fatal myocardial infarction (3.6% vs 0.8%, HR=5.231, 95% CI: 1.193-22.934, P=0.028) in the BB+ ARB group was significantly higher than those in the BB+ ACEI group followed up for 13 months. However, there was no difference between the two groups in the incidence of stroke (1.2% vs 1.4%, HR=0.922, 95% CI: 0.117-7.276, P=0.516) and target vessel revascularization (3.6% vs 1.6%, HR=1.607, 95% CI: 0.384-6.729, P=0.516). The cumulative survival rate of BB+ ACEI group was higher than that of BB+ ARB group, with statistically significant difference ( P<0.05). Conclusions:Compared with β-blocker combined with ARB, β-blocker combined with ACEI are more beneficial to reduce the incidence of MACCE, all-cause death and non-fatal myocardial infarction in AMI patients without left ventricular systolic dysfunction after PCI.