ObjectiveThis study aimed to investigate whether Bushen Tongluo prescription inhibits macrophage polarization by regulating the Wnt3a/β-catenin signaling pathway， thereby reducing epithelial-mesenchymal transition and excessive extracellular matrix deposition， in order to elucidate the anti-pulmonary fibrosis mechanisms of Bushen Tongluo prescription and provide a new theoretical basis for the clinical treatment of pulmonary fibrosis. MethodsFifty male Sprague-Dawley （SD） rats were randomly divided into a blank group， model group， pirfenidone group， and high- and low-dose Bushen Tongluo prescription groups. Except for the blank group， the pulmonary fibrosis model was established by intratracheal instillation of bleomycin. Intervention was initiated on day 28 after modeling. The high- and low-dose Bushen Tongluo prescription groups were administered Bushen Tongluo prescription at doses of 30.88， 15.44 g·kg^-1， respectively， by intragastric gavage. The pirfenidone group was administered pirfenidone capsules at 110 mg·kg^-1 by intragastric gavage. The blank and model groups were given an equal volume of normal saline by gavage， once daily for 90 days. After treatment， the level of transforming growth factor-β₁ （TGF-β₁） in bronchoalveolar lavage fluid （BALF） was detected by enzyme-linked immunosorbent assay （ELISA）. Morphological changes in lung tissue and the collagen volume fraction were compared. The protein distribution and expression of E-cadherin， cytokeratin 19， α-smooth muscle actin （α-SMA）， vimentin， collagen type Ⅰ （Col Ⅰ）， and collagen type Ⅲ （Col Ⅲ） in lung tissue were detected by immunohistochemistry. The protein distribution and expression of CD68， arginase-1 （Arg-1）， inducible nitric oxide synthase （iNOS）， Wnt3a， and β-catenin in lung tissue were detected by immunofluorescence. The protein expression of Wnt3a and β-catenin in lung tissue was detected by Western blot， and the mRNA expression of Wnt3a and β-catenin was detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared with the blank group， a large number of inflammatory cells infiltrated the airway walls， alveolar spaces， and interstitial tissue in the model group， with obvious fibrous tissue hyperplasia. The level of TGF-β₁ in BALF was significantly increased. The protein expression of E-cadherin and cytokeratin 19 in lung tissue was decreased， whereas the protein expression of α-SMA， Vimentin， Wnt3a， β-catenin， Col Ⅰ， and Col Ⅲ was increased. The fluorescence-positive area ratios of CD68， Arg-1， iNOS， Wnt3a， and β-catenin in lung tissue were increased. The protein and mRNA expression levels of Wnt3a and β-catenin in lung tissue were significantly increased （P<0.01）. Compared with the model group， all treatment groups showed varying degrees of improvement in inflammatory cell infiltration and fibrous tissue hyperplasia in the airway walls， alveolar spaces， and interstitial tissue， decreased TGF-β₁ levels in BALF， increased protein expression of E-cadherin and cytokeratin 19 in lung tissue， decreased protein expression of α-SMA， Vimentin， Col Ⅰ， and Col Ⅲ， decreased fluorescence-positive area ratios of CD68， Arg-1， iNOS， Wnt3a， and β-catenin in lung tissue， and decreased protein and mRNA expression levels of Wnt3a and β-catenin in lung tissue （P<0.05， P<0.01）. ConclusionBushen Tongluo prescription can improve bleomycin-induced pulmonary fibrosis in rats by inhibiting epithelial-mesenchymal transition and reducing excessive extracellular matrix deposition. The mechanism may be related to inhibition of the Wnt3a/β-catenin signaling pathway and the macrophage polarization mediated by this pathway.

ObjectiveTo explore the effect of cluster scalp acupuncture combined with Taijiquan training on depressive symptom, motor function, activities of daily living, serum markers, as well as brain functional connectivity (FC) and network topological properties in patients with post-stroke depression (PSD). MethodsA total of 40 PSD patients in the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from September, 2022 to September, 2023 were enrolled and randomly divided into control group (n = 20) and experimental group (n = 20). The control group received cluster scalp acupuncture alone, while the experimental group underwent Taijiquan training in addition, for four weeks. They were assessed with Hamilton Depression Scale-17 (HAMD-17), Fugl-Meyer Assessment (FMA) and Barthel Index (BI) before and after treatment, while the serum levels of dopamine (DA), 5-hydroxytryptamine (5-HT), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected with enzyme-linked immunosorbent assay. Resting-state functional magnetic resonance imaging (rs-fMRI) was applied to assess brain FC, as well as the global efficiency (Eg) and small-world property (σ) of brain networks. ResultsThe scores of HAMD-17, FMA and BI improved in both groups (t > 2.922, P < 0.01) after treatment, and improved more in the experimental group than in the control group (t > 2.517, P < 0.05). The serum levels of DA and 5-HT increased in both groups (t > 2.637, P < 0.05), and increased more in the experimental group (t > 2.192, P < 0.05). The serum levels of IL-6 and TNF-α decreased in the experimental group after treatment (t > 4.059, P < 0.001), and they were less than those in the control group (t > 2.154, P < 0.05). FC between left middle frontal gyrus and right anterior cingulate gyrus, as well as between left hippocampus and right precuneus were higher in the experimental group than in the control group after treatment (t > 3.867, P < 0.001), while Eg and σ increased in both groups (t > 2.828, P < 0.05), and they were higher in the experimental group (t > 2.675, P < 0.05). ConclusionCombination of Taijiquan training is more effective on depressive symptoms, motor function and activities of daily living in PSD patients, which may be related to up-regulation of serum DA and 5-HT, reduction of inflammatory factors, enhancement of prefrontal-limbic system functional connectivity and optimization of brain network topological properties.

Multidrug-resistant (MDR) bacterial infections have emerged as a serious challenge of global public health crisis. The overuse and misuse of conventional antibiotics have dramatically accelerated the emergence, evolution and worldwide spread of drug-resistant bacterial strains, necessitating urgent exploration of novel antibacterial strategies. Bacteriophages serve as natural bacterial predators offering distinct advantages including high host specificity, autonomous self-replication capabilities and cost-effective large-scale production. However, wild-type phages present significant clinical limitations due to their narrow host ranges, susceptibility to rapid immune clearance and poor penetration of bacterial biofilms, which severely restrict their therapeutic applications. The convergence of synthetic biology, nanotechnology and advanced gene editing technologies has accelerated the development of engineered bacteriophage platforms, providing programmable, scalable and clinically translatable pathways to overcome these inherent biological constraints. Here, we systematically delineate four fundamental strategies for engineered bacteriophage development. Chemical modification utilizes reactive functional groups such as amino, carboxyl and thiol moieties on capsid proteins through esterification, amidation or click chemistry reactions to achieve precise drug conjugation and surface functionalization. In vivo editing encompasses ultraviolet or chemical mutagenesis for random mutation induction, homologous recombination for targeted genetic alterations, recombineering methodologies including electroporation-mediated bacteriophage recombination engineering, and CRISPR-Cas systems for precise genome editing to enable exact genetic reconstruction and host range reprogramming. In vitro synthesis leverages genome engineering platforms where intact phage genomes are transferred into yeast or host bacteria to facilitate highly efficient homologous recombination, enabling large DNA fragment assembly and cross-gene host range expansion without bacterial toxicity constraints. Directed evolution combines artificial selection through mutation library screening with rational design approaches involving chimeric receptor binding protein construction or site-specific mutagenesis, effectively balancing the discovery of unknown adaptive pathways with targeted host specificity modification. Moreover, we comprehensively discuss therapeutic applications across diverse clinical scenarios. Engineered bacteriophage effectively disrupt bacterial biofilms through sophisticated functionalized delivery platforms including nanozyme-conjugated phages, phage-liposome nanoconjugates and bio-responsive hydrogels, demonstrating significantly enhanced bactericidal efficiency compared to unmodified free phages. These bioengineered vectors attenuate bacterial virulence and resensitize pathogens to antibiotics by delivering CRISPR-Cas systems or base editors to disrupt critical virulence factors such as pili, capsule synthesis machineries and quorum sensing systems, or by inactivating antibiotic resistance determinants including beta-lactamase genes. As an intelligent nanomedicine delivery platform, engineered bacteriophage enable precise pathogen elimination an through photocatalytic reactive oxygen species generation, immunomodulatory interventions, or controlled release of antibacterial drugs. Furthermore, oral administration of engineered bacteriophage facilitates microbiota modulation, which selectively eliminate intestinal pathogens while preserve beneficial commensal microbiota, thereby restoring microbial community balance and preventing complications associated with dysbiosis. Finally, we critically analyze persistent challenges including host strain matching complexity, evolution of bacterial resistance mechanisms, pharmacokinetic optimization requirements, optimal administration route selection, large-scale production quality control standards and clinical dosing determination protocols. Through multidisciplinary integration of synthetic biology, infectious disease medicine and immunology, future translational medicine studies of bacteriophage should establish comprehensive technical platforms encompassing rapid phage screening, intelligent rational design, rigorous in vivo evaluation and standardized clinical validation processes, ultimately advancing engineered bacteriophage from laboratory innovations to clinically approved therapeutics for effectively combating MDR bacterial infections.

Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication associated with significant morbidity and healthcare burden. Despite advances in diabetes care, recurrent DKA remains common, often reflecting gaps in treatment adherence and patient education. Identifying predictors of recurrence is crucial for risk stratification and targeted intervention. Methodology: We conducted a retrospective observational study of all adult DKA admissions to a tertiary centre between 2001 and 2025. Electronic medical records were reviewed for demographic data, biochemical parameters, precipitating factors, and clinical outcomes. DKA was defined using standard biochemical criteria. Recurrent DKA was defined as ≥2 admissions during the study period. Factors associated with recurrent DKA admissions were analyzed. Patients under the age of 18 years and those with missing vital information were excluded. Results: A total of 667 DKA admissions, comprising 566 patients, were identified, of which 101 admissions (15.1%) were recurrent, involving 65 patients. Among recurrent DKA episodes, the most common precipitating factors were infection (64.4%) and insulin omission (62.4%). After multivariate analyses, patients with type 1 diabetes mellitus (T1DM) were more likely to develop recurrent DKA compared to those with type 2 diabetes mellitus (aOR 4.16; 95% confidence interval [CI] 2.58–6.70; p <0.001). Insulin omission was strongly associated with recurrent DKA (aOR 2.29; 95% CI 1.46–3.60; p <0.001). In contrast, baseline glycated hemoglobin and chronic kidney disease were not significantly associated with recurrence. Diabetic counseling during the first DKA admission did not reduce recurrent DKA. There were no significant differences in mortality (3.9% vs 6.2%, p = 0.524) or critical care admission rates (40.6% vs 38.7%, p = 0.718) between recurrent and first DKA episodes. Conclusion Recurrent DKA accounts for a substantial proportion of DKA admissions and is strongly associated with insulin omission and T1DM. Our findings suggest that recurrent DKA is driven predominantly by behavioral and adherencerelated factors, indicating the need for multidisciplinary interventions beyond standard inpatient counseling.
Diabetic Ketoacidosis ; Retrospective Studies

Introduction: Diabetic ketoacidosis (DKA) in pregnancy is an uncommon yet life-threatening emergency, with disproportionate risks to both mother and fetus. Pregnancy-specific physiological changes predispose patients to rapid metabolic decompensation, often with atypical presentations. Despite this, local data remain limited. We describe the clinical profile, precipitating factors, and outcomes of DKA in pregnancy in a tertiary centre, with emphasis on potentially preventable triggers. Cases: Nine pregnant patients with DKA were identified from a retrospective review of all cases admitted for DKA from 2002 to 2025. Mean age was 31.67 ± 5.20 years; all were Malay. The majority had type 2 diabetes mellitus (55.6%), followed by type 1 diabetes (33.3%) and latent autoimmune diabetes in adults (11.1%). The mean period of amenorrhea was 19.67 ± 12.62 weeks. Infection was the leading precipitant (44.4%), with additional triggers including insulin omission (22.2%), hyperemesis gravidarum, preterm labor, steroid exposure, and perioperative fasting. Most diagnoses were made in the emergency department (55.6%). Biochemical parameters reflected significant severity (mean bicarbonate 7.89 ± 2.98 mmol/L; anion gap 25.00 ± 5.81), with 88.9% classified as severe DKA. Intensive Care Unit (ICU) care was required in 77.8% of cases. The majority (77.8%) were admitted to the ICU unit, with a median time to resolution of 13.00 ± 12.00 hours (interquartile range [IQR]), and the median hospital length of stay was 7.00 ± 5.00 days (IQR). Complications during treatment included hypokalemia (33.3%), acute kidney injury (22.2%), and hypoglycemia (11.1%). Rebound DKA occurred in one-third of patients. All patients were discharged clinically stable. Outcome data demonstrated pregnancy loss in three cases and one preterm birth. Conclusion DKA in pregnancy remains a severe and resource-intensive condition. This series highlights missed opportunities in prevention, with modifiable precipitants such as infection and insulin omission commonly identified. The high severity at presentation suggests delays in recognition. Early detection, optimized metabolic care, and targeted preventive strategies are crucial to improving maternal and fetal outcomes.
Female ; Pregnancy ; Diabetic Ketoacidosis

Objective:To investigate the clinical features, diagnosis and treatment of eso-phageal fistula (EF) after radiofrequency catheter ablation (RFCA) for atrial fibrillation.Methods:The retrospective and descriptive study was conducted. The clinical data of 15 patients with EF after RFCA for atrial fibrillation who were admitted to Beijing Anzhen Hospital of Capital Medical University from January 2020 to December 2024 were collected. There were 11 males and 4 females, aged (64±7)years. All patients underwent surgical treatment. Observation indicators: (1) diagnosis and surgery; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean±SD, measurement data with skewed distribution were represented as M (range), and count data were represented as absolute numbers. Results:(1) Diagnodid and surgery. Of the 15 patients, radiofrequency catheter ablation included pulmonary vein isolation plus linear ablation in 13 cases and pulmonary vein isolation alone in 2 cases. The time to postoperative symptom onset of EF in 15 patients was (13±8)days. The main clinical manifestations included persistent chest pain in 14 cases, fever in 12 cases, dysphagia in 2 cases, and neurological symptoms in 2 cases (the same patient could have multiple symptoms). All patients presented with signs of infection of varying severity. Contrast-enhanced chest computed tomography (CT) or pulmonary vein CT angio-graphy revealed mediastinal emphysema, pneumopericardium with pericardial effusion, localized esophageal wall thickening with exudation, abnormalities in the posterior wall of the left atrium, or contrast extravasation in all patients. Cerebral imaging examination showed newly developed cerebral infarcts in 2 patients. The time from symptom onset to surgical intervention was 2(range, 1-10)days.All 15 patients underwent surgical treatment immediately after being diagnosed or highly suspected of EF via multidisciplinary collaboration. Among them, 11 patients with atrial-esophageal fistula (AEF) underwent left atrial defect repair plus left thoracic esophageal repair under cardio-pulmonary bypass through a median sternotomy, 3 patients with simple EF underwent left thoracic esophageal repair, 1 patient with AEF underwent atrial repair plus esophageal exclusion and drainage due to severe mediastinal infection. The diameter of the left atrial defect in the 15 patients was (12±5)mm, and the diameter of the esophageal defect was (11±4)mm. There was no patient cured with conservative treatment or converted to surgical treatment after failed conservative treatment.(2)Postoperative situations.Of the 15 patients, 3 cases developed pulmonary infection and were improved after anti-infective treatment. The duration of postoperative hospital stay was (21±5)days. (3) Follow-up. All 15 patients were followed up for 11(range, 3-18)months. Two of 15 patients died. One patient undergoing atrial repair plus esophageal diversion and drainage died postoperatively due to sepsis and multiple organ failure, and one patient undergoing left thoracic esophageal repair died of acute cardiac tamponade one week after surgery. The remaining 13 patients recovered well, without recurrence or new complications.Conclusions:The main clinical features of esophageal fistula after RFCA for atrial fibrillation include persistent chest pain, fever, accompanying signs of infection. Early contrast-enhanced chest CT or pulmonary vein CT angiography is helpful for diagnosis, and active surgical treatment after confirmation via multidisciplinary collaboration can improve patient prognosis.

Objective To explore the risk factors of residual displacement after Kirschner wire internal fixation for unstable humeral supracondylar fracture in children.Methods A total of 128 children who underwent Kirschner wire internal fixation for humeral supracondylar fracture in our hospital from March 2019 to October 2023 were selected.According to the degree of humeral supracondylar displacement after recovery,the patients were divided into the normal group(n=63),grade Ⅰ group(n=29),grade Ⅱ group(n=22)and grade Ⅲgroup(n=14).The mechanical parameters before and after the operation and general data of patients in each group were compared.A LASSO regression model was established to screen the influencing factors of residual displacement.Multivariate Logistic regression analysis was used to analyze the risk factors of postoperative residual displacement in patients with grade Ⅲ.A risk factor model of postoperative residual displacement was constructed and evaluated.Results After treatment with Kirschner wire internal fixation,the humeral supracondylar mechanical parameters of the patients significantly improved compared to those before operation(P<0.05).There were statistically significant differences among the groups in terms of fracture healing time,fracture fixation time,Gartland classification,reduction method,postoperative complications,Flynn score,anterior inclination angle of the humeral head,Baumann angle,carrying angle,and distal humeral torsion angle(P<0.05).The LASSO regression model indicated that fracture healing time,Gartland classification,postoperative complications,Baumann angle,distal humeral torsion angle,and Flynn score were the relevant indicators of residual displacement.The Logistic regression analysis revealed that fracture healing time≥50 minutes,Gartland classification of grade Ⅲ,occurrence of postoperative complications,and Flynn score(average or poor)were independent risk factors for residual displacement after surgery in patients with grade Ⅲ.The receiver operating characteristic(ROC)curve showed that this risk factor model had good discrimination ability[area under the curve(AUC)=0.858,95%CI:0.823 to 0.897].Conclusion The internal fixation with Kirschner wire for treatment of humeral supracondylar fracture has a remarkable therapeutic effect,and it can significantly improve the humeral supracondylar mechanical parameters of the patients.The fracture healing time≥50 minutes,Gartland classification of grade Ⅲ,occurrence of postoperative complications,and Flynn score(average or poor)are risk factors for residual displacement after internal fixation with Kirschner wire in patients with humeral supracondylar fracture.

Objective To investigate the clinical efficacy and safety of modified single-port thoracoscopic sympathectomy combined with disconnection ventilation in the treatment of primary palmar hyperhidrosis(PPH).Methods The perioperative indexes,clinical efficacy and postoperative complications of 20 patients with PPH who underwent modified single-port thoracoscopic sympathectomy combined with disconnection ventilation in Wuming Hospital of Guangxi Medical University from June 2020 to July 2024 were retrospectively analyzed.Results All patients successfully completed the operation without serious complications and death.The average operation time was(56.15±16.00)min,and the average intraoperative blood loss was(3.35±1.39)ml.The treatment effective rate was 100%,the average postoperative hospitalization time was(2.15±0.86)days,and the average hospitalization cost was(9485.56±1601.77)yuan.During the follow-up period of 1 to 45 months,there were no recurrent cases and no obvious cases of compensatory hyperhidrosis.Conclusion The modified single-port thoracoscopic sympathectomy combined with disconnection ventilation has good efficacy and safety in the treatment of PPH.

Objective To observe the effects of LINC01915 on the proliferation,migration and invasion of human colorectal cancer cells,and to explore its possible regulatory mechanism.Methods The colorectal cancer cell lines of SW620,SW480,LOVO,HCT116 and the normal colorectal cell line of NCM460 were selected,and the expression of LINC01915 was detected by RT-qPCR.HCT116 cell line with the highest expression of LINC01915 was taken and divided into the upregulation group,the downregulation group,the upregulation control group,the downregulation control group and the blank group.The transfection efficiency of each group was detected by fluorescence microscope;RT-qPCR was used to detect the expression of LINC01915 in each group;methyl thiazolyl tetrazolium(MTT)assay was used to detect the proliferative activity in each group;scratch wound healing assay and Transwell assay were used to detect the migration and invasion activities in each group;RT-qPCR was used to detect the expression of miR-92a-3p and mRNA expression of large tumor suppressor homolog 2(LATS2),transcription factor 21(TCF21)and Kruppel like factor 4(KLF4);and Western blot was used to detect the expression of LATS2,TCF21,and KLF4 proteins.Dual-fluorescein reporter assay was used to verify the targeting relationship between LINC01915 and miR-92a-3p.Results The expression of LINC01915 in various human colorectal cancer cell lines were lower than that in the NCM460 cell(P<0.05),and the highest LINC01915 expression in human colorectal cancer cell lines was observed in HCT116(P<0.05).The transfection efficiency of cells in each transfection group was high.Compared with the blank group and the upregulation control group,the expression of LINC01915,and mRNA and protein expression of LATS2,TCF21,and KLF4 in the upregulation group increased(P<0.05),and the A value,scratch healing rate,number of invasive cells and miR-92a-3p expression decreased(P<0.05).Compared with the blank group and the downregulation control group,the expression of LINC01915,and mRNA and protein expression of LATS2,TCF21,and KLF4 in the downregulation group decreased(P<0.05),and the A value,scratch healing rate,number of invasive cells and miR-92a-3p expression increased(P<0.05).LINC01915 had binding sites with miR-92a-3p,and compared with the miR-NC group,the miR-92a-3p mimics group showed a decrease in the luciferase activity of WT-LINC01915(P<0.05).Conclusion The expression of LINC01915 in the human colorectal cancer cell lines decreases,and upregulation of LINC01915 expression can inhibit cell proliferation,migration,and invasion,which may be related to the up-regulation of the expression of LATS2,TCF21 and KLF4 by inhibiting miR-92a-3p.

Objective To investigate the associations between physical health status,refraction and ocular biometrics in school-age children,and further clarify the relation of eyes'refractive status to physical growth and development,so as to provide scientific evidences for myopia prevention and con-trol.Methods A total of 1718 children(977 boys and 741 girls)aged 8-12 years were enrolled in this study.They were collected uncorrected visual acuity,refraction and ocular biometrics,including spherical equivalent,cylindrical equivalent,axial length(AL),corneal refraction(K1,K2)and anteri-or chamber depth(ACD),as well as the AL/CR ratio and spherical equivalent refraction(SER).Moreover,their height,weight and physical fitness level were measured,including speed,strength,flexibility,agility and aerobic endurance.Then all data were analyzed using the Pearson correlation,One-way ANOVA and multiple linear regression model.Results The overall prevalence of myopia was 43.83%,which was higher in girls than in boys(46.96%vs.41.45%).Moreover,the height and weight of school-age children were negatively correlated with SER(P<0.01),but positively correlated with AL,ACD and AL/CR(P<0.01).After controlling the age and gender variables in the multiple linear regression model,it was found that for 10-cm increase in height,SER decreased by 0.013 D(P<0.01),AL extended by 0.022 mm(P<0.01),and ACD increased by 0.002 mm(P<0.05).In addi-tion,for 10-kg increase in the body weight,the AL would be 0.009 mm longer(P<0.05)and ACD 0.002 mm deeper(P<0.05).Moreover,the speed,strength and agility were negatively correlated with SER(P<0.01,P<0.05),but positively correlated with AL,ACD and AL/CR(P<0.01,P<0.05).The maximal oxygen uptake level was positively correlated with SER(P<0.01),and negatively correlated with AL,ACD and AL/CR(P<0.01,P<0.05).After controlling the age and gender variables in the multiple linear regression model,it was found that the children with worse speed quality had shorter AL(-0.043 D,P<0.05).Meanwhile,the better agility was accompanied by the lower SER(-0.003 D,P<0.01),longer AL(+0.002 mm,P<0.05),lighter ACD(+4.812e-4 mm,P<0.05),and higher AL/CR(+2.446e-4,P<0.05).Conclusion With variables of age and gender controlled,the height,weight,and the speed and agility quality are highly associated with eyes'refractive status among chil-dren aged 8-12 years old.It is suggested that the human body may have a coordination mechanism to regulate the development of the body stature,physical fitness and ocular biometrics in the early child-hood,which should be considered in their myopia prevention and control.