Abstract:Objective: Addressing the compatibility issues between current Diagnosis-Related Group (DRG) payment rules and Traditional Chinese Medicine (TCM) clinical practice, this study focuses on the “dual-track” DRG practice in Chongqing. It aims to quantitatively map the core risk factors triggering DRG financial losses in different-tier TCM institutions through intelligent sensitivity testing, providing targeted empirical evidence for the differentiated optimization of medical insurance policies. Methods: A progressive research framework combining “macro-level empirical qualitative analysis and micro-level algorithmic simulation” was constructed. (1) Field research was conducted on 26 multi-tier TCM institutions in Chongqing via stratified random sampling to obtain baseline characteristics and execution pain points. (2) The Monte Carlo algorithm was introduced to generate a virtual micro-medical record dataset of 5,000 cases based on the surveyed macro-statistical distribution. (3) An intelligent sensitivity testing model based on the Random Forest algorithm was built with “whether a single case incurred a DRG settlement loss” as the dependent variable. This model quantitatively mapped the sensitivity (feature importance) of various clinical features causing losses under established rule constraints, with its efficacy verified by ROC curves and AUC values. Results: Chongqing’s “dual-track” reform had initially consolidated the positioning of grassroots TCM services, however, structural frictions persist at the micro-implementation level. The model’s sensitivity analysis revealed that tertiary hospitals were highly sensitive to the “TCM treatment rate” assessment, and their losses were primarily driven by the rigid reliance on modern medical interventions for severe cases (highest sensitivity contribution score). Conversely, secondary hospitals were highly sensitive to the “average length of stay,” where prolonged rehabilitation leading to fixed-quota cost inversion constitutes the core financial risk. Additionally, execution pain points such as the undervaluation of core TCM technologies were corroborated through field surveys. Conclusion: It is recommended to implement categorized optimization strategies based on the intelligent sensitivity test results: exploring flexible exemptions for the “TCM treatment rate” in specific intensive care departments and special-case negotiation mechanisms for tertiary hospitals; promoting a “DRG fixed quota + flexible bed-day” mixed payment model for secondary hospitals; and strengthening underlying data cross-system mapping and rational pricing mechanisms to further enhance the refinement and inclusivity of the TCM DRG payment system.

Abstract:Objective: Traditional medical image visualization technologies present several limitations including the poor intuitiveness of 2D images, overlapping imaging blind spots, and insufficient interactivity. These shortcomings make them unable to satisfy the demands of precision medicine and medical education. This study aims to develop a universal medical image demonstration system based on extended reality (XR) technology, which is compatible with devices such as the HoloLens. By employing 3D visualization and multimodal interaction design, the system provides a more efficient and intuitive approach for clinical diagnosis, medical education, and surgical simulation. Methods: The system employs Unreal Engine as the core platform for architecture framework construction, supporting customized medical image visualization for XR devices. Real chest CT images were utilized in this study. Image segmentation was performed using 3D Slicer, while mask preprocessing was conducted via Anaconda. The masked images and raw data were then imported into Unreal Engine. The core framework of the proposed system was developed using Unreal Engine’s Blueprint visual scripting and Unreal Motion Graphics (UMG) interface designer. A self-directed learning assessment experiment was designed to evaluate the efficacy and performance of the system. Results: The experimental group achieved a pulmonary window recognition accuracy of 82%, a mediastinal window accuracy of 88%, and an overall accuracy of 85%. By comparison, the control group exhibited a pulmonary window accuracy of 50%, a mediastinal window accuracy of 44%, and an overall accuracy of 47%. Conclusions: The medically oriented imaging demonstration system significantly improves recognition accuracy and learning effectiveness, verifying its practical utility and validity.

Abstract:Objective: To develop a multimodal deep learning-radiomics-clinical (DRC) model based on abdominal dual-phase contrast-enhanced CT (CECT) for the early prediction of acute pancreatitis-associated acute lung injury/acute respiratory distress syndrome (AP-ALI/ARDS). Methods: 320 AP patients were enrolled and randomly divided into a training set (n=189) and an internal test set (n=81) in a 7∶3 ratio, with an additional external test set (n=50). Clinical data and CECT images acquired within 48 hours after admission were collected. Independent clinical risk factors were selected using Logistic regression. The pancreatic parenchyma was manually delineated on both arterial and portal venous phase images, from which radiomics and deep learning features were subsequently extracted and screened. The random forest algorithm was used to construct the clinical model, radiomics model, deep learning model, and DRC model, respectively. Model performance was evaluated and compared using receiver operating characteristic (ROC) curves, the DeLong test, calibration curves, and decision curve analysis (DCA). Results: Among the 320 AP patients, 109 (34.06%) developed AP-ALI/ARDS. AP severity and blood glucose level were identified as independent risk factors. 6 radiomics features and 19 deep learning features were ultimately selected. The DRC model demonstrated superior predictive performance, achieving areas under the ROC curve (AUCs) of 0.973, 0.934, and 0.920 in the training, internal test, and external test sets, respectively. The DeLong test indicated that the AUC of the DRC model was significantly higher than those of the clinical and radiomics models (P<0.05). Calibration curves demonstrated that the DRC model exhibited the best performance, and DCA showed that it provided a greater overall net benefit across most threshold probabilities compared to other models. Conclusion: The DRC model exhibits excellent performance for the early prediction of AP-ALI/ARDS and shows potential as decision-support tool to guide clinical intervention.

Abstract:Objective: To investigate the diagnostic value of radiomics in thyroid nodules of American College of Radiology-Thyroid Imaging Reporting and Data System (ACRTI-RADS) grades 4 and 5. Methods: A retrospective study of 221 patients with ACRTI-RADS grades 4 and 5 who underwent thyroidectomy was performed. The data on clinicopathological and ultrasound examinations of the patients were analyzed. The images were randomized into a training set and a validation set. MaZda, a software for calculating texture parameters in digitized images, was employed to manually outline the images and extract radiomics features. Features were filtered through the univariate Logistic analysis and LASSO method. The Logistic regression model, Bayes model and KNN model were trained using the selected texture features. Results: 314 radiomics features were extracted from each patient’s ultrasound image ROI using the MaZda software package. The use of LASSO further filtered five most significant features. The KNN model, based on these features, performed the best, with ROC values of 0.849 for the training group and 0.885 for the testing group, and accuracy rates of 0.779 and 0.761, respectively. Compared to readings by experienced radiologists, the KNN model demonstrated superior performance. Conclusion: The ultrasound omics model based on thyroid ultrasound, which is superior to experienced physician-performed ultrasound diagnosis, has shown outstanding performance in diagnosing thyroid ACR grade 4, 5 nodules and provided an effective reference for the identification of clinical routine ACR4, 5 nodules.

Abstract:Objective: To achieve early identification of pulmonary nodules and visual interpretation of key variables through interpretable machine learning, and to facilitate precise prevention, control, early diagnosis and treatment of lung cancer. Methods: This study enrolled individuals at high risk of lung cancer and completed clinical screening. Their high-risk assessment data and imaging results were extracted. Participants were divided into high-risk and low-risk groups for pulmonary nodules based on China’s Lung Cancer Screening Standard (T/CPMA 013-2020). Variables with differences identified by univariate analysis were used as predictors, with pulmonary nodule grouping as the dependent variable, to construct an interpretable XGBoost-SHAP identification framework for early nodule detection and visual result interpretation. Results: A total of 644 high-risk individuals were included, with 199 (30.9%) in the high-risk pulmonary nodule group. The XGBoost model achieved an accuracy of 0.9146, sensitivity of 0.7587, specificity of 0.9843, F1-score of 0.8458, and AUC of 0.9741 for nodule grouping. SHAP analysis revealed that higher SHAP values—and thus increased risk of nodule enlargement—were associated with greater smoking intensity, exposure to secondhand smoke from colleagues/family, infrequent kitchen ventilation during cooking, excessive intake of processed foods, occupational exposure to asbestos/radon, insufficient intake of protein, fruits and vegetables, and manual labor occupation. Conclusion: The constructed interpretable framework performs well in early pulmonary nodule identification. Changes in nodule size are associated not only with traditional risk factors (e.g., smoking habits, secondhand smoke exposure, cooking fume exposure, occupational asbestos/radon exposure) but also with the participants’ dietary habits.

Abstract:Objective: To address the issues of complex operations, time consumption, high laboratory costs in molecular diagnostic technology, and the impact of human factors on accuracy during sample processing, a high-compatibility and high-throughput fully automated molecular diagnostic platform was developed. Methods: The LabEasy 8,000 Fully Automated Molecular Diagnostic Platform was designed, integrating reagent preparation, nucleic acid extraction, and PCR amplification processes through modular design, equipped with an AI-assisted recognition system, and compatible with mainstream domestic PCR reagents. Results: The platform achieved a detection throughput of 8,000 tests per single assay within 24 hours and 2,400 concurrent tests for multiple assays. Validated by the Gentier 96R fully automated PCR analysis system, the detection deviation for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) was less than 0.5 log IU/mL (100% detection rate), the intra-assay coefficient of variation (CV) was less than 5%, and the limit of detection (LOD) reached 10 IU/mL. Conclusion: The platform can effectively improve the efficiency and accuracy of molecular diagnosis, providing a technical reference for the development of domestic fully automated molecular diagnostic equipment.

Abstract:Objective: To investigate the effects of Lokomat robot-assisted gait training (RAGT) on lower limb motor function and cerebral hemodynamics in patients with severe hemiplegia based on conventional rehabilitation therapy. Methods: A total of 126 patients with severe hemiplegia were selected and divided into a control group (conventional rehabilitation therapy, n=69) and an observation group (conventional rehabilitation plus RAGT training, n=57) according to different rehabilitation methods. After propensity score matching, each group included 44 cases. Cerebral hemodynamics-related indicators, balance function and lower limb motor function scores, gait parameters, levels of angiopoietin-1 (Ang-1) and vascular endothelial growth factor (VEGF), and cerebral hemodynamics indicators including maximum blood flow velocity (Vmax), minimum blood flow velocity (Vmin), peripheral resistance (RV), and dynamic resistance (DR) were compared before treatment, at 2 weeks, and at 5 weeks of treatment. A difference-in-differences (DID) model was constructed to analyze changes in vascular active substances and cerebral hemodynamics indicators after treatment in patients with severe hemiplegia. Results: After treatment, the observation group showed higher scores than the control group in the Berg Balance Scale (P<0.001), Fugl-Meyer Assessment (P<0.001), Stroke Rehabilitation Motor Function Assessment Scale (P<0.001), as well as faster walking speed, longer step length, and higher step frequency (P<0.05). Ang-1 and VEGF levels in the observation group were higher than those in the control group (P<0.001). Vmax and Vmin were higher than in the control group, while RV and DR were lower than in the control group (P<0.05). DID model results showed that the group×time interaction had a significant effect on improving vascular active substances and cerebral hemodynamics indicators (P<0.05). Conclusion: On the basis of conventional rehabilitation therapy, adjunctive RAGT training has a favorable clinical therapeutic effect, significantly optimizes cerebral hemodynamics in patients with severe hemiplegia, promotes the secretion of substances related to angiogenesis, and markedly improves patients’ balance ability, lower limb motor function, and gait parameters.

Abstract:Objective: To investigate the effects of Fuzheng Xiaozheng Decoction (FZXD) on the ultrastructure and telomerase reverse transcriptase (TERT) expression in different subtypes of breast cancer cells. Methods: Twelve SPF-grade female BALB/c mice (4 weeks old, 16–22 g) were acclimated for 1 week and randomized into high-, medium-, and low-dose FZXD groups and a saline group (60, 40, 20 g/kg FZXD or saline by gavage) to determine the optimal dose. A second cohort of 40 mice was randomized into FZXD alone, paclitaxel (PTX) alone, FZXD+PTX combination, and blank control groups (n=10 each). FZXD was given at 60 g/kg twice daily, PTX injected intraperitoneally at 10 mg/kg twice weekly, and the combination group received both regimens for 7 days. One hour after the last dose, blood was collected, serum separated, heat-inactivated, and sterile-filtered (0.22 μm). Drug-containing serum was used to treat breast cancer cells. Cell proliferation (CCK-8), ultrastructure (TEM), TERT mRNA (RT-qPCR), TERT protein (Western blot), and telomere length (RT-qPCR, T/S ratio) were assessed. Results: High-dose FZXD-medicated serum reduced breast cancer cell viability below 50% at 48 h. TEM showed swollen mitochondria with ruptured outer membranes, disordered cristae, cytoplasmic vacuolization, and disrupted plasma membranes in FZXD, PTX, and combination groups. All treatment groups exhibited reduced TERT mRNA/protein levels and shortened telomeres vs. control. Conclusion: Fuzheng Xiaozheng Decoction suppresses breast cancer progression by downregulating TERT expression.

Abstract:Objective: To explore the effect of dapagliflozin on pulmonary vascular remodeling and cardiac function in rats with pulmonary hypertension related to left heart failure (PH-LHF) by regulating the bone morphogenetic protein (BMP)/transforming growth factor-β (TGF-β) signaling pathway. Methods: A PH-LHF rat model was established via transverse aortic constriction (TAC) surgery. Rats were randomized into five groups (n=15 each): sham operation, model, low-dose dapagliflozin (1 mg/kg, ig), high-dose dapagliflozin (3 mg/kg, ig), and pathway activator (3 mg/kg dapagliflozin + 10 mg/kg TGF-β activator SRI-011381, ig). After treatment, right ventricular systolic pressure (RVSP) and left ventricular ejection fraction (LVEF) were measured. Right heart catheterization assessed pulmonary hypertension. Pulmonary arteriole pathology was evaluated via HE staining (wall thickness ratio [WT], vascular area ratio [WA]). Victoria blue and Van Giessen staining detected vascular lesions. ELISA measured serum laminin (LN), hyaluronic acid (HA), TGF-β1, and hydroxyproline (HYP). Western blot analyzed TGF-β/BMP pathway proteins. Results: Compared with the sham group, the model group showed pulmonary arteriole thickening, lumen narrowing, lung injury, and elevated RVSP, mPAP, mRVP, WT, WA, collagen fibers, LN, HA, HYP, TGF-β1, p-Smad1/2/3 (P<0.05); LVEF, elastic fibers, and BMPR2 decreased (P<0.05). Low/high-dose dapagliflozin improved vascular remodeling, cardiac function, and fibrosis markers (P<0.05), with high-dose being superior (P<0.05). The pathway activator reversed dapagliflozin’s beneficial effects (P<0.05). Conclusion: Dapagliflozin improves pulmonary vascular remodeling, cardiac function, and fibrosis in PH-LHF rats, likely via inhibiting the TGF-β/BMP pathway.

Abstract:Objective: To investigate the expression levels and clinical significance of B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) in peripheral blood mononuclear cells (PBMCs) and plasma of patients with systemic sclerosis (SSc). Methods: Peripheral blood samples were collected from 32 SSc patients (SSc group) and 32 healthy controls (HC group). PBMCs and plasma were isolated and extracted. The mRNA and protein expression levels of BAFF and APRIL in PBMCs were detected using real-time quantitative PCR (RT-qPCR) and Western blot, respectively. Plasma concentrations of the corresponding proteins were measured by ELISA. Correlations with clinical indicators were analyzed, and the diagnostic value for SSc was evaluated using receiver operating characteristic (ROC) curves. Results: Both mRNA and protein expression levels of BAFF and APRIL in PBMCs of SSc patients were higher than those in the HC group (P<0.05). Plasma BAFF levels were positively correlated with erythrocyte sedimentation rate (r=0.60), high-sensitivity C-reactive protein (r=0.40), anti-Scl-70 antibody (r=0.57), and joint involvement (r=0.39) (P<0.05), and negatively correlated with estimated glomerular filtration rate (r=-0.37) (P<0.05). APRIL levels were positively correlated with interstitial lung disease (r=0.52) and high-density lipoprotein (r=0.45) (P<0.05). The areas under the ROC curve (AUC) for diagnosing SSc using BAFF, APRIL, and their combination were 0.759, 0.654, and 0.792, respectively. Conclusion: The expression of BAFF and APRIL is elevated in SSc patients and closely associated with specific autoantibodies, inflammatory status, and organ damage. Combined detection of both markers may improve the diagnostic efficacy for SSc, suggesting their potential as biomarkers and therapeutic targets for SSc.

Abstract:Objective: To investigate the effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on heart rate variability and subclinical myocardial injury in elderly patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods: A total of 102 elderly patients with T2DM and hypertension were enrolled and divided into an observation group and a control group, with 51 patients in each group, according to different treatment regimens. The control group received routine basic treatment, while the observation group received empagliflozin in addition to routine basic treatment. After 6 months of treatment, the two groups were compared in terms of blood pressure and blood glucose levels, standard deviation of normal RR intervals (SDNN), root mean square of successive differences of adjacent normal RR intervals (RMSSD), low-frequency power (LF), high-frequency power (HF), LF/HF ratio, left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), ratio of early to late diastolic mitral inflow velocity (E/A), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin I (hs-cTnI), glutathione peroxidase (GSH-Px), catalase (CAT), malondialdehyde (MDA), levels of TLR4/NF-κB signaling pathway-related indicators, and the occurrence of adverse events. Results: After treatment, systolic and diastolic blood pressure in the observation group were lower than those in the control group (P<0.05); fasting blood glucose, 2-hour postprandial blood glucose, and glycated hemoglobin were all lower in the observation group than in the control group (P<0.05). SDNN, RMSSD, LF, and HF were all higher in the observation group than in the control group (P<0.05), and the LF/HF ratio was lower in the observation group than in the control group (P<0.05). There was no statistically significant difference in LVEF between the two groups after treatment (P>0.05). LVMI was lower in the observation group than in the control group (P<0.05), and E/A was higher in the observation group than in the control group (P<0.05). Serum hs-cTnI and NT-proBNP levels were lower in the observation group than in the control group (P<0.05); serum GSH-Px and CAT levels were higher in the observation group than in the control group (P<0.05), and MDA levels were lower in the observation group than in the control group (P<0.05). The mRNA expression levels of TLR4, NF-κB, IL-1β, IL-6, and TNF-α were all lower in the observation group than in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse events between the two groups (P>0.05). Conclusion: The combined use of the SGLT2 inhibitor empagliflozin can improve blood pressure and blood glucose control in elderly patients with T2DM and hypertension, optimize cardiac autonomic nerve regulation, reduce subclinical myocardial injury, inhibit oxidative stress response, and downregulate TLR4/NF-κB pathway-mediated inflammatory response.

Abstract:Objective: To observe the effect of modified Chaihu Guizhi Longgu Muli decoction on the psychological status and sleep in patients with liver depression and qi stagnation type of insomnia. Methods: A total of 144 patients with insomnia of liver depression and qi stagnation type were selected and divided into two groups according to treatment methods: the control group (n=72) received conventional Western medicine treatment, while the treatment group (n=72) was treated with modified Chaihu Guizhi Longgu Muli decoction. Both groups were treated for 4 weeks. The clinical efficacy, TCM syndrome scores, psychological status (Hamilton Depression Scale [HAMD] and Hamilton Anxiety Scale [HAMA] scores), sleep quality (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI] scores), serum neurotransmitters (cortisol [Cor], epinephrine [E]) before and after treatment, and incidence of adverse reactions were compared between the two groups. Results: The overall response rate in the treatment group was higher than that in the control group (P<0.05). After 4 weeks of treatment, the scores of TCM syndromes, PSQI, ISI, HAMD, and HAMA in both groups were decreased compared with those before treatment, and the treatment group showed lower scores (P<0.05). The levels of Cor and E in both groups at 4 weeks of treatment were decreased compared with those before treatment, and the treatment group showed lower levels (P<0.05). The incidence of adverse reactions in the treatment group was lower than that in the control group (P<0.05). Conclusion: Modified Chaihu Guizhi Longgu Muli decoction can effectively regulate psychological status and sleep in patients with insomnia of liver depression and qi stagnation type, with few adverse reactions and high safety.

Abstract:Objective: To explore the efficacy and safety of general anesthesia for children with severe early childhood caries (S-ECC) and its impact on postoperative caries risk. Methods: A total of 260 children with S-ECC were enrolled and divided into a general anesthesia group (n=156) and a control group (n=104) based on treatment methods. The general anesthesia group received dental treatment under general anesthesia, while the control group was treated under protective immobilization. Oral hygiene, dietary habits, oral health-related quality of life (assessed via the Chinese version of the Early Childhood Oral Health Impact Scale [ECOHIS]), and caries susceptibility (detected using the Cariostat system) were compared between the two groups before and 1 month after treatment to evaluate caries risk. Results: One month post-treatment, the proportions of children brushing teeth morning and evening, using fluoride toothpaste, and brushing for ≥2 minutes increased significantly in both groups (P<0.05), with the control group showing higher adherence than the general anesthesia group (P<0.05). No significant changes were observed in dietary habits (e.g., sweetened beverage/dessert intake >1 time/day) post-treatment (P>0.05). Both groups exhibited reduced plaque index and Cariostat scores (P<0.05), with the general anesthesia group showing lower values than the control group (P<0.05). ECOHIS scores (child impact: oral function, symptoms, psychological/social relationships; family impact: parental guilt, economic burden) decreased significantly post-treatment (P<0.05), with the general anesthesia group demonstrating lower scores than the control group (P<0.05). Conclusion: General anesthesia is safe and effective for treating S-ECC in children. It improves short-term oral conditions, reduces caries risk, and enhances quality of life. However, postoperative oral health education should be strengthened to promote long-term healthy oral hygiene habits.

Abstract:Objective: To investigate the correlation between gut microbiota dysbiosis and histological activity grading in patients with ulcerative colitis (UC). Methods: A total of 120 patients with UC were enrolled. According to the Nancy histological index, patients were divided into a mild activity group (score 2, n=58) and a severe activity group (score 4, n=62). Scores of crypt abscesses, inflammatory cell infiltration, glandular destruction, and composite histological severity were compared between the two groups. 16S rRNA sequencing data were used to quantify the relative abundance of key bacterial taxa: Firmicutes, Proteobacteria, Faecalibacterium, Bifidobacterium, and Escherichia?Shigella. Spearman correlation analysis was performed to assess associations between major taxa and inflammatory indicators, including C?reactive protein (CRP), erythrocyte sedimentation rate (ESR), Mayo clinical activity index (Mayo score), and composite histological score. Results: Compared with the mild group, the severe group had lower hemoglobin and albumin (P<0.05), higher white blood cell and platelet counts, CRP, ESR, and positive fecal occult blood (all P<0.05). Histologically, the severe group showed higher scores for crypt abscesses, inflammation, glandular destruction, and composite severity (P<0.001). Microbiota analysis revealed lower Firmicutes, Faecalibacterium, and Bifidobacterium, but higher Proteobacteria and Escherichia?Shigella in severe disease (P<0.05). Escherichia?Shigella correlated positively with CRP, ESR, Mayo score, and composite histological score (P<0.01). Faecalibacterium showed moderate negative correlations with these indicators (P<0.05), and Bifidobacterium showed mild?to?moderate negative correlations with CRP, Mayo score, and composite histological score (P<0.01). Conclusion: Distinct gut microbiota profiles exist across UC histological activity grades. Severe activity is characterized by enriched pathobionts (Escherichia?Shigella, Proteobacteria) and depleted beneficial taxa (Faecalibacterium, Bifidobacterium). Consistent correlations between bacterial taxa and inflammatory/histological indicators suggest gut microbiota features may serve as potential microbial markers reflecting mucosal inflammation severity in UC, providing valuable references for disease assessment.

Abstract:Objective: To analyze the effects of feeding methods on dynamic changes of intestinal flora in infants by metagenomics sequencing. Methods: A total of 60 normal full-term neonates delivered in the Obstetrics Department were enrolled. According to different feeding methods, they were divided into a breastfeeding group (n=23) and a formula feeding group (n=37). Total fecal DNA was extracted, sequenced, and analyzed using a high-throughput sequencing platform. The effects of different feeding methods on the establishment and development of intestinal flora in infants were compared. Results: There was no significant difference in Alpha diversity and Beta diversity of intestinal flora between the formula feeding group and the breastfeeding group (P>0.05). At 3 and 12 months of age, the relative abundance of Firmicutes C was higher in the breastfeeding group than in the formula feeding group (P<0.05). At 3 months of age, the relative abundance of Veillonella was higher in the breastfeeding group than in the formula feeding group (P<0.05). At different ages, there was no significant difference in the relative abundance of different dominant bacteria at the species level between the two groups (P>0.05). Conclusion: Feeding methods have certain effects on the evolution and development of intestinal flora in infants. Among them, breastfeeding is more conducive to the establishment of high-abundance intestinal flora and the normal development of intestinal flora.

Abstract:Objective: To explore the changes and correlation of brain fractional amplitude of low frequency fluctuation (fALFF) and cognitive function in children with first-episode unmedicated attention deficit and hyperactivity disorder (ADHD). Methods: The case data of 46 children with first-episode unmedicated ADHD were retrospectively analyzed and included in the observation group, and 42 healthy children undergoing physical examination during the same period were selected as the control group. The differences in cognitive function (completed category count, persistent response count, persistent error count, and error response count of Wisconsin Card Sorting Test (WCST), and error rate of interference response inhibition evaluated by Simon task) and fALFF in brain regions were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between cognitive function and fALFF in abnormal brain regions in children with ADHD. Results: Compared with the control group, the observation group had a lower completed category count, and higher persistent response count, persistent error count, error response count and interference response inhibition error rate (P<0.05). Compared with the control group, the fALFF values in the left superior postcentral gyrus and the right medial superior temporal gyrus were decreased in the observation group, while the fALFF values in the left caudate nucleus, posterior cingulate gyrus and right superior temporal gyrus were increased (P<0.05). Pearson correlation analysis showed that fALFF values in the left superior postcentral gyrus and right medial superior temporal gyrus of ADHD children were negatively correlated with error rate of interference response inhibition (P<0.05). Conclusion: There is a certain correlation between cognitive function changes and brain fALFF in children with first-episode unmedicated ADHD, and cognitive impairment may be related to abnormal changes in brain regions.

Abstract:Objective: To explore the effect of external application of Daxusong plaster combined with acupuncture therapy in treating knee osteoarthritis and the impact on serum indexes and pain. Methods: According to the treatment plan, 120 patients with knee osteoarthritis were divided into the acupuncture group (conventional acupuncture) and the treatment group (acupuncture combined with external application of Daxusong plaster), with 60 cases in each group. The efficacy, TCM syndrome scores, serum indexes [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), cartilage oligomeric matrix protein (COMP), C-terminal cross-linked telopeptide of type II collagen (CTX-II), receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG)], pain degree [Visual Analog Scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)], and adverse reactions were compared between the two groups. Results: After treatment, the total effective rate and OPG level in the treatment group were higher than those in the acupuncture group (P<0.05), while TCM syndrome scores, VAS scores, WOMAC, IL-6, TNF-α, COMP, CTX-II, and RANKL were lower than those in the acupuncture group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: External application of Daxusong plaster combined with acupuncture is effective in treating KOA (cold-dampness obstruction syndrome), which can effectively alleviate clinical symptoms and pain, improve inflammation and bone metabolism, and has good safety.

Abstract:Objective To investigate the relationship between serum diamine oxidase (DAO), serum-ascites albumin gradient (SAAG) levels and liver function, and disease severity in patients with cirrhosis and ascites.Methods The clinical data of 207 patients with cirrhosis and ascites were retrospectively analyzed. According to the tertiles of DAO, patients were divided into DAO1, DAO2, and DAO3 groups. According to the tertiles of SAAG, patients were divided into SAAG1, SAAG2, and SAAG3 groups. Based on Model for End-Stage Liver Disease (MELD) scores, patients were divided into high MELD score group (≥13) and low MELD score group (<13). Liver function indicators [serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL)], DAO, and SAAG levels were compared between groups. Pearson’s correlation was used to analyze the correlation between DAO/SAAG and liver function indicators. Multivariate Logistic regression analysis was used to analyze the relationship between DAO/SAAG and MELD score.Results There were significant differences in serum ALT, AST, and TBIL levels among patients with different DAO and SAAG levels (P<0.05). DAO and SAAG levels were positively correlated with ALT, AST, and TBIL levels (P<0.05). The high MELD score group had higher serum DAO and SAAG levels than the low MELD score group (P<0.05). Elevated DAO and SAAG levels were influencing factors of high MELD score (P<0.05).Conclusion Serum DAO and SAAG levels are correlated with liver function indicators in patients with cirrhosis and ascites. The two may be influencing factors of disease severity.

Abstract:Objective: To evaluate the immediate effects of prone position ventilation (PPV) on right ventricular-pulmonary arterial coupling (RV-PA) and right heart function in patients with acute respiratory distress syndrome (ARDS) complicated by shock using transesophageal echocardiography (TEE), and to analyze its relationship with prognosis. Methods: A total of 110 patients with ARDS complicated by shock who received PPV were enrolled as subjects. For all patients, TEE was used to monitor right heart function indicators before PPV (supine position) and 1 hour after PPV. These indicators included tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), and pulmonary artery systolic pressure (PASP). The TAPSE/PASP ratio was calculated to assess RV-PA coupling. Hemodynamic parameters, oxygenation indices before and after treatment, and 28-day mortality were also recorded. Results: At 1 hour after PPV, the patients' oxygenation index (PaO?/FiO?) improved (P<0.05). Right heart function indicators RVFAC and TAPSE increased (P<0.05), while PASP and right ventricular myocardial performance index (RMPI) decreased (P<0.05). The TAPSE/PASP ratio markedly increased (P<0.05). Multivariate Logistic regression analysis demonstrated that an increased TAPSE/PASP ratio and a decreased RMPI following PPV were independent predictors of 28-day all-cause mortality (P<0.05). Conclusion: PPV can immediately improve right heart function and RV-PA coupling in ARDS patients with shock. The TAPSE/PASP ratio monitored by TEE can serve as an important indicator for assessing the hemodynamic effects of PPV and predicting patient prognosis.

Abstract:<正>1 Case Report The patient is a 56-year-old male who presented with infiltrative red patches on the extensor surfaces of both lower legs accompanied by pruritus for 2 years. He had previously sought treatment at another hospital, where he received traditional Chinese medicine but showed poor efficacy. He was referred to our dermatology department on February 20, 2024. Physical examination revealed infiltrative red patches on the extensor surfaces of both lower legs. The lesions were intact without ulceration, hair growth, or local hypertrophy. They had well-defined borders from surrounding tissues, limited mobility, and a deep base without tenderness or blanching upon pressure. A biopsy was recommended. Laboratory tests, including complete blood count, biochemical panel, and preoperative infectious disease screening, showed no abnormalities. Macroscopic findings of the right lower extremity lesion: an irregularly shaped gray-brown tissue block with skin, measuring 1.7 cm × 0.7 cm × 0.8 cm. The tissue was excised along the skin surface, revealing a gray-white cut surface with medium consistency and myxoid texture.

Abstract:Objective: To explore the application effect of implementing hospital-community-family linkage supervision model under the concept of behavioral goal attainment among elderly patients with stable chronic obstructive pulmonary disease (COPD). Methods: The clinical data of 107 elderly patients with stable COPD were collected. According to different nursing measures, the patients were divided into supervised group (n=54, hospital-community-family linkage supervision model under the concept of behavioral goal attainment) and control group (n=53, routine high-quality nursing). Both groups were nursed until the patients were discharged from hospital. The compliance behavior, pulmonary function, self-care ability and quality of life were compared between the two groups. Results: The scores of dimensions of COPD pulmonary rehabilitation training knowledge-attitude-practice questionnaire, pulmonary function level, scores of dimensions of exercise of self-care agency scale (ESCA) and score of COPD assessment test(CAT) in supervised group after intervention were higher than those in control group(P <0.05). Conclusion: Hospital-community-family linkage supervision model under the concept of behavioral goal attainment can effectively promote the compliance, improve the pulmonary function, enhance the self-care ability and improve the quality of life in elderly patients with stable COPD.