ObjectiveTo analyze the detected results of CD4⁺T lymphocytes and viral load in newly identified human immunodeficiency virus (HIV) infected patients in Huangpu District of Shanghai in 2023, to explore the correlation between them, so as to provide a scientific basis for the development of targeted prevention and control measures and antiviral treatment programs. MethodsThe data of CD4 cell count, viral load and demographic characteristics of the newly infected patients living with HIV in Huangpu District, Shanghai in 2023 were collected and analyzed by using descriptive epidemiological method. ResultsThe mean CD4 cell count of the 67 newly identified HIV infected patients in Huangpu District was (301.22±235.19) cells·µL^-1, with a mean viral load of (5.15±1.28) ×10⁵ copies·mL^-1.There were statistically significant differences in CD4 cell count and viral load among different age groups (P<0.05), but there were no statistically significant differences by gender and marital status (both P>0.05). The CD4 cell count and CD4/CD8 ratio both were negatively correlated with the lg value of viral load (r=-0.290, -0.378; P=0.027, 0.002). ConclusionThe CD4 cell counts of the newly identified HIV infected patients in Huangpu District in 2023 were generally low, the proportion of patients with high viral load was high, but the risk for elderly infected with HIV was high. The elderly have gradually become the key population for AIDS prevention and control in Huangpu District. It is recommended to expand HIV screening in the elderly to reduce the risk of HIV transmission and increase the rate of early detection and treatment.

[Objective] : To improve the accuracy and professionalism of question-answering (QA) model in traditional Chinese medicine (TCM) lung cancer by integrating large language models with structured knowledge graphs using the knowledge graph (KG) to text-enhanced retrieval-augmented generation (KG2TRAG) method. [Methods] : The TCM lung cancer model (TCMLCM) was constructed by fine-tuning ChatGLM2-6B on the specialized datasets Tianchi TCM, HuangDi, and ShenNong-TCM-Dataset, as well as a TCM lung cancer KG. The KG2TRAG method was applied to enhance the knowledge retrieval, which can convert KG triples into natural language text via ChatGPT-aided linearization, leveraging large language models (LLMs) for context-aware reasoning. For a comprehensive comparison, MedicalGPT, HuatuoGPT, and BenTsao were selected as the baseline models. Performance was evaluated using bilingual evaluation understudy (BLEU), recall-oriented understudy for gisting evaluation (ROUGE), accuracy, and the domain-specific TCM-LCEval metrics, with validation from TCM oncology experts assessing answer accuracy, professionalism, and usability. [Results] : The TCMLCM model achieved the optimal performance across all metrics, including a BLEU score of 32.15%, ROUGE-L of 59.08%, and an accuracy rate of 79.68%. Notably, in the TCM-LCEval assessment specific to the field of TCM, its performance was 3% − 12% higher than that of the baseline model. Expert evaluations highlighted superior performance in accuracy and professionalism. [Conclusion] TCMLCM can provide an innovative solution for TCM lung cancer QA, demonstrating the feasibility of integrating structured KGs with LLMs. This work advances intelligent TCM healthcare tools and lays a foundation for future AI-driven applications in traditional medicine.

Objective To investigate the beneficial effect of Kai-Xin-San combined with fluoxetine in improving depression-like behaviors on chronic unpredictable mild stress(CUMS)induced depression model mice.Methods The present study aimed to assess the potential of Kai-Xin-San in combination with fluoxetine to ameliorate depression-like behaviors in a CUMS induced mouse depression model.Behavioral tests,such as the sucrose preference test were employed to evaluate the efficacy of the treatment.Additionally,the levels of suppressed stress factors were measured using the ELISA method.The morphology of hippocampal tissue was evaluated using the HE staining method,Nissl Staining and TUNEL staining methods.Furthermore,western blotting analysis was utilized to determine the expression levels of proteins such as Caspase-3,and Caspase-9.Results The co-administration of Kai-Xin-San and fluoxetine resulted in a significant increase in sucrose preference rate in model mice.This effect was comparable to that of fluoxetine alone at the standard clinical dose.Furthermore,the combination treatment up-regulated the levels of suppressed stress factors,reduced the apoptosis of hippocampus induced by depression and regulated the apoptosis signaling pathway in hippocampus.Conclusion The combination of Kai-Xin-San and fluoxetine has been shown to be an effective treatment for depression-like behavior in animal models,resulting in a reduction in the required clinical dosage of fluoxetine.This effect may be attributed to the up-regulation of neurotransmitter expression,inhibition of stress axis activation,and central nervous inflammation.

AIM:To investigate the effect of Bushen formulae(BHF)on bone metabolism and its possible mechanism in ovariectomized rats with high salt intake.METHODS:According to the random number table method,80 SPF-grade Sprague-Dawley rats were divided into sham group,ovariectomy(OVX)group,medium-high-salt diet(MSD)group,high-salt diet(HSD)group,BHF group,BHF with normal saline(BHF+NS)group,BHF+MSD group,and BHF+ HSD group,with 10 rats in each group.After modeling,different diets and BHF formula interventions were administered,and the concentrations of sodium chloride added to MSD group and HSD group were 2%(w/w)and 8%(w/w),respective-ly.The dose of BHF was 7.8 g·kg-1·d-1,once a day,and the treatment lasted for 12 weeks.Bone density,bone microar-chitecture,bone parameters,bone metabolism biomarkers,bone histopathological changes,the expression of epithelial sodium channel α(ENaCα),Na-Cl cotransporter(NCC),and voltage-gated chloride channel 3(ClC-3)proteins in bone tissue were detected in each group.RESULTS:Compared with sham group,the rats in OVX group had reduced bone density and destroyed bone microstructure.Compared with OVX group,the bone microstructure in MSD and HSD groups was more significantly damaged,while the levels of bone formation markers,bone glycoprotein(BGP)and type Ⅰ procolla-gen N-terminal peptide(PINP),were significantly increased in HSD group(P<0.05).Moreover,the levels of bone re-sorption markers,such as amino-terminal cross-linked telopeptides of type Ⅰ collagen(NTX),carboxy-terminal cross-linked telopeptides of type Ⅰ collagen(CTX)and tartrate-resistant acid phosphatase(TRACP),were significantly in-creased(P<0.05),indicating that bone metabolism was in high-conversion state.High-salt diet accelerated the structural destruction of bone trabeculae,and Western blot results showed that high-salt diet caused decreases in the protein expres-sion levels of ENaCα and ClC-3 and an increase in the protein expression level of NCC in femoral tissues(P<0.05).After BHF intervention,the expression of relevant ion channels caused by high salt could be regulated to different degrees.CONCLUSION:Bushen formulae could differentially regulate the expression of relevant ion channels ENaCα,ClC-3,and NCC induced by high salt to different degrees,which has certain ameliorative and therapeutic effects on the imbalance of bone metabolism.

Acute ST-segment elevation myocardial infarction with multivessel disease is one of the high-risk types of coronary heart disease.Early opening of infarct-related artery and reperfusion of myocardium could significantly reduce the mortality in acute phase.However,the presence of non-culprit lesions in non-infarct-related arteries is still at risk and has an important impact on the long-term prognosis of patients.It remains controversial on how to precisely evaluate the clinical significance and revascularization value of non-culprit lesions.This article aims to review the research status and progress of guidance strategies of non-culprit lesion revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease.

Objective:To compare the clinical efficacy of ileocecal-preserving laparoscopic subtotal colectomy, antegrade peristaltic ascending colorectal anastomosis with antiperistalsis cecorectal anastomosis in the treatment of severe slow transit constipation.Methods:The clinical data of 42 patients with severe slow transit constipation undergoing surgery in Shulan (Hangzhou) Hospital from Jan 2016 to Oct 2021 were retrospectively analyzed. All 42 patients underwent ileocecal-preserving laparoscopic subtotal colectomy. Among them, 25 patients underwent antegrade peristaltic anastomosis of ascending colon and rectum, 17 patients underwent antiperistaltic anastomosis of cecum and rectum.Results:There was no significant difference in the operation time and hospitalization time between the two groups ( t=-0.464, P=0.645; t=0.010, P=0.992); Wexner constipation scores in both groups were significantly reduced at 6 and 12 months after surgery. There was no significant difference in the Wexner constipation scores ( t=-1.181, P=0.240; t=-1.717, P=0.090), the number of bowel movenents per day ( t=0.179, P=0.860; t=0.545, P=0.590) and stool shapes scores ( t=-0.316, P=0.750; t=0.447, P=0.660) between the two groups at 6 and 12 months after surgery. Gastrointestinal quality of life index scores in the antegrade peristaltic anastomosis group were significantly higher than those in the antiperistalsis anastomosis group at 6 and 12 months after surgery ( t=4.329, P<0.05; t=3.988, P<0.05), while abdominal pain scores were significantly lower than those in the antiperistalsis anastomosis group ( t=-4.386, P<0.05; t=-5.740, P<0.05). Conclusions:For patients with severe slow transit constipation, ileocecal-preserving laparoscopic subtotal colectomy has good surgical safety and near-to-medium-term clinical efficacy, whether it is antegrade peristaltic ascending colorectal anastomosis (the stump of the ascending colon is turned from front to back) or antiperistalsis cecorectal anastomosis. The antegrade peristaltic ascending colorectal anastomosis has lower abdominal pain score and better gastrointestinal quality of life than antiperistalsis cecorectal anastomosis, which should be recommended first. During the operation, the ileocolic mesentery should be fully separated to the root of mesentery and the ileocecal part should be turned from front to back to avoid the occurrence of mesenteric vascular torsion and small intestinal obstruction.

G protein-coupled receptor (GPR) 40, as one of GPRs family, plays a potential role in regulating glucose and lipid metabolism. To study the effect of GPR40 novel agonist SZZ15-11 on hyperglycemia and hyperlipidemia and its potential mechanism, spontaneous type 2 diabetic KKA^y mice, human hepatocellular carcinoma HepG2 cells and murine mature adipocyte 3T3-L1 cells were used. KKA^y mice were divided into four groups, vehicle group, TAK group, SZZ (50 mg·kg^-1) group and SZZ (100 mg·kg^-1) group, with oral gavage of 0.5% sodium carboxymethylcellulose (CMC), 50 mg·kg^-1 TAK875, 50 and 100 mg·kg^-1 SZZ15-11 respectively for 45 days. Fasting blood glucose, blood triglyceride (TG) and total cholesterol (TC), non-fasting blood glucose were tested. Oral glucose tolerance test and insulin tolerance test were executed. Blood insulin and glucagon were measured via enzyme-linked immunosorbent assay (ELISA). After mice′s execution, liver tissue was harvested to test TG and TC content. Then pathological morphology of liver was observed through hematoxylin-eosin (HE) staining, and the lipid metabolism relative signal pathway was analyzed by Western blot and RT-PCR. The experiments were approved by the Institutional Animal Care and Use Committee of the Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College. At the same time, Akt phosphorylation level in HepG2 cells and adiponectin in 3T3-L1 cells treated with TNFα were measured with Western blot. The results show that SZZ15-11 not only decreased blood glucose and lipid, improved insulin sensitivity, but also increased fasting blood glucagon and promoted insulin secretion after glucose loading in KKA^y mice. Additionally, SZZ15-11 alleviated hepatic steatosis and liver dysfunction in KKA^y mice. In liver tissue, SZZ15-11 increased AMPKα phosphorylation level and cholesterol metabolism relative gene Abcg8 transcription. In HepG2 cells, SZZ15-11 increased Akt phosphorylation level. In adipocyte 3T3-L1, SZZ15-11 recovered the decreased adiponectin expression by TNFα. This study proved that GPR40 agonist SZZ15-11 could be a candidate compound for regulating glucolipid metabolic disorder.

Objective:Differences between randomized controlled trial (RCT) results and real world study (RWS) results may not represent a true efficacy-effectiveness gap because efficacy-effectiveness gap estimates may be biased when RWS and RCT differ significantly in study design or when there is bias in RWS result estimation. Secondly, when there is an efficacy- effectiveness gap, it should not treat every patient the same way but assess the real-world factors influencing the intervention's effectiveness and identify the subgroup likely to achieve the desired effect.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:Ten articles were included to discuss how to use the RCT research protocol as a template to develop the corresponding RWS research protocol. Moreover, based on correctly estimating the efficacy-effectiveness gap, evaluate the intervention effect in the patient subgroup to confirm the subgroup that can achieve the expected benefit-risk ratio to bridge the efficacy-effectiveness gap.Conclusion:Using real-world data to simulate key features of randomized controlled clinical trial study design can improve the authenticity and effectiveness of study results and bridge the efficacy-effectiveness gap.

Objective:Randomized controlled trials (RCT) usually have strict implementation criteria. The included subjects' characteristics of the conditions for the intervention implementation are quite different from the actual clinical environment, resulting in discrepancies between the risk-benefit of interventions in actual clinical use and the risk-benefit shown in RCT. Therefore, some methods are needed to enhance the extrapolation of RCT results to evaluate the real effects of drugs in real people and clinical practice settings.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:A total of 12 articles were included. Three methods in the included literature focused on: ①improving the design of traditional RCT to increase population representation; ②combining RCT Data with real-world data (RWD) for analysis;③calibrating RCT results according to real-world patient characteristics.Conclusions:Improving the design of RCT to enhance the population representation can improve the extrapolation of the results of RCT. Combining RCT data with RWD can give full play to the advantages of data from different sources; the results of the RCT were calibrated against real-world population characteristics so that the effects of interventions in real-world patient populations can be predicted.

Objectives:To explore the risk factors for recurrent in-stent restenosis(R-ISR)in patients with coronary heart disease after percutaneous coronary intervention(PCI)and to develop a risk prediction model for R-ISR using a nomogram. Methods:All patients treated for ISR at the Fuwai Hospital,Chinese Academy of Medical Sciences from January to December 2017 were eligible for this study.A total of 1 102 ISR patients were included for analysis.Based on the recurrence of ISR after PCI,patients were divided into R-ISR group and non-R-ISR group.Univariate Cox regression analyses,LASSO regression analyses,and the combination of clinical experience were used to select predictors of R-ISR.A multivariate Cox regression model was used to analyze the independent risk factors of R-ISR and to develop a risk prediction model. Results:The median follow-up duration for participants was 1 264(1 169,1 334)days,the incidence rate of R-ISR after PCI was 10.1%.Multivariate Cox regression analysis showed that age(HR=0.98,95%CI:0.96-0.99),total bilirubin(HR=0.95,95%CI:0.91-0.99),apolipoprotein A1(HR=0.08,95%CI:0.02-0.42),high-sensitivity C-reactive protein(HR=1.05,95%CI:1.01-1.10),and reference vessel diameter(HR=0.65,95%CI:0.44-0.98)were independent determinants of R-ISR.Accordingly,the R-ISR risk prediction model was developed with a nomogram,the AUC of this model to predicto R-ISR was 0.70(95%CI:0.64-0.77). Conclusions:Coronary heart disease patients with younger age,lower levels of total bilirubin and apolipoprotein A1,smaller vessel diameter,and higher levels of high-sensitivity C-reactive protein are at higher risk of R-ISR.The developed visual risk prediction model for R-ISR shows promising predictive performance but still requires further optimization and validation.