ObjectiveTo evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke （AIS） patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI）. MethodsA total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study. According to random number table method，the patients were assigned into a control group （32 cases） and an observation group （31 cases）. The control group received conventional Western medical treatment，and the observation group took 200 mL Tongnaoyin after meals，twice a day from day 2 of admission on the basis of the treatment in the control group. After 7 days of treatment，the patients were examined by DCE-MRI. The baseline data for two groups of patients before treatment were compared. The National Institute of Health Stroke Scale （NIHSS） score and modified Rankin Scale （mRS） score were recorded before treatment and after 90 days of treatment for both groups. The rKtrans，rKep，and rVe values were obtained from the region of interest （ROI） of the infarct zone/mirror area and compared between the two groups. ResultsThere was no significant difference in the NIHSS or mRS score between the two groups before treatment. After 90 days of treatment，the NIHSS and mRS scores declined in both groups，and the observation group had lower scores than the control group （P<0.05）. After treatment，the rKtrans and rVe in the observation group were lower than those in the control group （P<0.01）. ConclusionCompared with conventional Western medical treatment alone，conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients，thereby ameliorating neurological impairment after AIS to improve the prognosis.

With the rapid advancement of artificial intelligence technology, chatbots have shown great potential in the healthcare sector. From personalized health advice to chronic disease management and psychological support, chatbots have demonstrated significant advantages in improving the efficiency and quality of healthcare services. As the scope of their applications expands, the relationship between technological complexity and practical application scenarios has become increasingly intertwined, necessitating a more comprehensive evaluation of both aspects. This paper, from the perspective of he althcare applications, systematically reviews the technological pathways and development of chatbots in the medical field, providing an in-depth analysis of their performance across various medical scenarios. It thoroughly examines the advantages and limitations of chatbots, aiming to offer theoretical support for future research and propose feasible recommendations for the broader adoption of chatbot technologies in healthcare.

On the earth,the majority of cellular functions are regulated by mechanical loads.The effects of cell response to mechanical loads under microgravity on the adaptive changes of physiological functions in space cannot be ignored.The cytoskeleton is widely considered as one of the key structures through which cells sense gravity variation and respond to mechanical loads.In this review,the research progress on the changes and mechanisms of the'cytoskeleton-LINC complex-nuclear lamina'pathway in cellular mechanoperception and mechanotransmission under microgravity is summarized,and the future research is prospected.

Objective To deeply analyze the problems of public hospitals in medical service satisfaction,construct a more applicable and explanatory service satisfaction evaluation model,and provide reference for the improvement path of patients'medical service satisfaction.Methods Based on the ESCI model,this paper puts forward a research hypothesis,compiles the"Medical Service Satisfaction Evaluation Scale of Public Hospitals in S City",selects S public hospitals as the research object,and evaluates medical service satisfaction from the perspective of patients.Results At present,the main problems affecting the improvement of patients'satisfaction with medical service management in public hospitals in S city are as follows:it is urgent to improve the diagnosis and treatment technology in terms of hardware quality and optimize the environmental hygiene of public hos-pitals,and it is an urgent task to shorten the waiting time for medical treatment in software quality.The score of medical service satisfaction evaluation of S public hospitals was 3.76,and the satisfaction of patients in S public hospitals with their medical serv-ices was at a moderately low level.Conclusion In view of the above problems,it is recommended to strengthen the construction of key specialties,strengthen the construction of talent team,optimize the medical process,open digital linkage services,and strengthen service management,so as to promote the improvement of patients'satisfaction with medical services.

Objectives:To examine the feasibility of using foundation model in computer vision for echocardiographic left ventricular ejection fraction measurement. Methods:Based on the most extensive publicly accessible repository of echocardiographic loops,EchoNet-Dynamic,featuring 10024 recordings from individual patients,a foundation model in computer vision,VideoMAE V2,was fine-tuned,validated,tested using 7460,1288,and 1276 echocardiographic loops,respectively. Results:The mean absolute error between left ventricular ejection fraction measurements of VideoMAE V2 and expert's measurements was 3.94％ (95％CI:3.79％-4.11％).The Pearson's correlation coefficient was 0.91 (95％CI:0.89-0.92).Additionally,VideoMAE V2 demonstrated exceptional accuracy in identifying patients with a left ventricular ejection fraction below 50％,achieving an AUC of 0.96 (95％CI:0.95-0.97). Conclusions:This study validates the feasibility of using foundation model in computer vision for measuring left ventricular ejection fraction in echocardiographic loops and lays the foundation for the development of a generalized multimodal automated interpretation system for echocardiography.

Objective:To investigate the changes of brain microstructure in active Crohn's disease (CD) patients with or without anxiety by diffusion kurtosis imaging (DKI), and to explore the relationship between brain microstructure and anxiety in patients with CD.Methods:Thirty-seven patients with CD who were treated in Changzhou Second People's Hospital Affiliated to Nanjing Medical University from January 2022 to January 2023 were included as the CD group, and 20 healthy subjects were included as the healthy control group during the same period. All subjects were assessed with hospital anxiety and depression scale-anxiety (HADS-A) before magnetic resonance imaging(MRI) scan. According to the HADS-A score, CD patients were divided into the CD group with anxiety (16 cases) and the CD group without anxiety (21 cases). After MRI scan, DKI parameters were obtained by DKE software. One-way analysis of variance was used to compare DKI parameters between the two groups of CD patients and the healthy control group. Pearson correlation was used to analyze the correlation between DKI parameters in different brain areas and psychological scale scores in the two groups of CD patients.Results:The axial diffusion kurtosis(AK)values in the right insula, the left superior temporal gyrus, the right thalamus, the left middle temporal gyrus, the right inferior temporal gyrus, the left lingual gyrus and the right anterior cuneus were significantly different among the three groups ( F=3.060-9.627, all P<0.05).There were significant differences in the radial diffusion kurtosis(RK) values in the right cerebellar region 6 and the left hippocampus among the three groups ( F=4.124, 3.536, 4.200, all P<0.05). Further multiple comparison results showed that the AK values of the right insula (0.701±0.028)( P=0.019), the left superior temporal gyrus (0.764±0.016)( P=0.002) and the right thalamus (0.728±0.016)( P=0.001) in the CD group without anxiety were lower than those of the healthy control group(0.726±0.010, 0.780±0.015, 0.771±0.082), and the RK value of the right cerebellar region 6 ( P=0.021) was lower than that of the healthy control group. The AK values of the right insula ( P=0.023), the left superior temporal gyrus ( P=0.015), the right thalamus ( P=0.031), the left middle temporal gyrus ( P=0.006), the right inferior temporal gyrus ( P=0.001) and the left lingual gyrus ( P=0.007) in the CD group with anxiety were lower than those in the healthy control group. The RK values of right cerebellar region 6 ( P=0.012) and left hippocampus ( P=0.004) were lower than those of healthy control group. The AK values of the right insula ( P=0.002) and the right anterior cuneus ( P=0.017) in the group with anxiety were lower than those in the CD group without anxiety. In the CD group with anxiety, the AK value of the right insula was correlated with erythrocyte sedimentation rate(ESR)( r=-0.47, P=0.048), HADS-A score ( r=-0.68, P=0.002), SES-CD( r=-0.84, P<0.001) and duration of disease ( r=-0.61, P=0.008) were negatively correlated. AK values in the left superior temporal gyrus with anxiety CD group were negatively correlated with HADS-A score ( r=-0.51, P=0.030) and SES-CD score ( r=-0.48, P=0.046). Conclusion:The microstructure of some brain regions was damaged in CD patients with or without anxiety, which was manifested as decreased RK and AK values in DKI parameter values, which may be related to the anxiety state in active CD patients.

The bacterial ATP-competitive GyrB/ParE subunits of type II topoisomerase are important anti-bacterial targets to treat super drug-resistant bacterial infections. Herein we discovered novel pyrrolamide-type GyrB/ParE inhibitors based on the structural modifications of the candidate AZD5099 that was withdrawn from the clinical trials due to safety liabilities such as mitochondrial toxicity. The hydroxyisopropyl pyridazine compound 28 had a significant inhibitory effect on Gyrase (GyrB, IC₅₀ = 49 nmol/L) and a modest inhibitory effect on Topo IV (ParE, IC₅₀ = 1.513 μmol/L) of Staphylococcus aureus. It also had significant antibacterial activities on susceptible and resistant Gram-positive bacteria with a minimum inhibitory concentration (MIC) of less than 0.03 μg/mL, which showed a time-dependent bactericidal effect and low frequencies of spontaneous resistance against S. aureus. Compound 28 had better protective effects than the positive control drugs such as DS-2969 ( 5) and AZD5099 ( 6) in mouse models of sepsis induced by methicillin-resistant Staphylococcus aureus (MRSA) infection. It also showed better bactericidal activities than clinically used vancomycin in the mouse thigh MRSA infection models. Moreover, compound 28 has much lower mitochondrial toxicity than AZD5099 ( 6) as well as excellent therapeutic indexes and pharmacokinetic properties. At present, compound 28 has been evaluated as a pre-clinical drug candidate for the treatment of drug-resistant Gram-positive bacterial infection. On the other hand, compound 28 also has good inhibitory activities against stubborn Gram-negative bacteria such as Escherichia coli (MIC = 1 μg/mL), which is comparable with the most potent pyrrolamide-type GyrB/ParE inhibitors reported recently. In addition, the structure-activity relationships of the compounds were also studied.

[摘 要] 目的：探讨肿瘤坏死因子受体相关蛋白1（TRAP1）在结肠癌组织和细胞中的表达及其与临床病理特征和患者预后的关系和相关分子机制。方法：通过TCGA和GEO数据全面分析TRAP1在结肠癌中的表达及其与临床病理特征和患者预后的关系，选取2020年10月至2021年03月间在山西医科大学第一医院手术切除的10例结肠癌组织及相应癌旁组织标本，用IHC染色法检测中国人结肠癌组织中TRAP1的表达进行验证，运行R包（survival和survminer）进行Kaplan-Meier生存分析；在线分析TRAP1蛋白的信号肽及穿膜结构域，通过基因富集分析软件进行GO分析和KEGG分析。培养结肠癌SW480和SW620细胞，将si-NC和si-TRAP1转染结肠癌细胞，实验分为空白对照组、si-NC组和si-TRAP1组，采用qPCR法检测转染后各组结肠癌细胞中TRAP1的表达，FCM检测转染后各组细胞的细胞周期和凋亡情况。结果：与癌旁组织比较，TRAP1在结肠癌组织中呈高表达（P<0.01），TRAP1表达水平与淋巴结转移有关联（P<0.05），TRAP1高表达组结肠癌患者5年OS率较低（P<0.05）。TRAP1蛋白属于细胞质蛋白，功能富集结果显示TRAP1及其相关分子与细胞周期、核糖体生物发生等信号通路有关（均P<0.01），TRAP1高表达组的结肠癌代谢重编程基因簇和线粒体蛋白输入基因簇水平升高（均P<0.01）。敲减TRAP1后，结肠癌细胞周期阻滞于G1期，细胞凋亡水平显著升高（均P<0.01）。结论：TRAP1在结肠癌组织中呈高表达，且与患者淋巴结转移和低OS率相关联，敲减TRAP1可阻滞结肠癌细胞周期并促进其凋亡。

The dysfunction of coronary microcirculation is an important cause of coronary artery disease (CAD). The index of microcirculatory resistance (IMR) is a quantitative evaluation of coronary microcirculatory function, which provides a significant reference for the prediction, diagnosis, treatment, and prognosis of CAD. IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions, and is closely associated with coronary hemodynamic parameters such as flow rate, distal coronary pressure, and aortic pressure, which have been widely applied in computational studies of CAD. However, there is currently a lack of consensus across studies on the normal and pathological ranges of IMR. The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified, which limits the application of IMR in computational CAD studies. In this paper, we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD. Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.
Coronary Angiography ; Coronary Artery Disease ; Coronary Circulation ; Humans ; Microcirculation ; Predictive Value of Tests ; Vascular Resistance

Objective To retrieve,appraise and summarize the available evidence on management and prevention of implantable venous access port occlusion in adult patients.Methods We searched the BMJ best practice,UpToDate,Cochrane Library,Joanna Briggs Institute Library,Registered Nurses' Association of Ontario,National Guideline Clearinghouse,PubMed,EMbase,CNKI and CBM to collect literatures including guidelines,evidence summary,best practice information sheet,recommended practice,systematic review and consensus.Results Five references including one guideline,one systematic review,two evidence summaries,and one expert consensus were included.A total of eight items of best evidence were summarized with regard to syringe size,flush volume,flush technique and frequency of administration,choose of needleless connectors,management of mechanical occlusion,drug/mineral precipitation,and thrombotic occlusion.Conclusion Healthcare workers should regulate the standard of venous access port flushing and locking and manage catheter occlusion in a timely manner,to avoid adverse incidents like interruptions in treatment,bacteremia,and venous thrombosis.