ObjectiveTo elucidate the mechanism by which total flavonoids of Abelmoschi Corolla （TFA） treat immunoglobulin A （IgA） nephropathy （IgAN） through serum metabolomics analysis. MethodsSPF-grade male SD rats were randomly assigned into six groups （n=10）： blank， model， low-dose TFA （TFA-L， 27 mg·kg^-1）， medium-dose TFA （TFA-M， 54 mg·kg^-1）， high-dose TFA （TFA-H， 108 mg·kg^-1）， and losartan potassium （LST， 4.5 mg·kg^-1） groups. The remaining five groups， excluding the blank group， were modeled with bovine serum albumin （BSA）， lipopolysaccharide （LPS）， and carbon tetrachloride （CCl₄）. Specifically， from weeks 1 to 10， BSA was administered via gavage every other day， and a mixture of castor oil and CCl₄ was injected subcutaneously once a week， with LPS injected into the tail vein at weeks 6 and 8. After successful modeling， each intervention group was administrated with the medication prepared with distilled water once daily by gavage for a continuous period of 4 weeks. The levels of 24-hour urinary total protein （24 h UP） and serum creatinine （SCr） were quantified by kits， and the serum IgA level was determined by enzyme-linked immunosorbent assay （ELISA）. Renal pathological changes were observed by hematoxylin-eosin （HE） staining and periodic acid-Schiff （PAS） staining. Renal IgA deposition was assessed by immunofluorescence （IF）. Endoplasmic reticulum （ER） stress was observed by transmission electron microscopy. Western blot and immunohistochemistry （IHC） were employed to detect the expression of ER stress-related factors. Non-targeted metabolomics was used to screen differential metabolites for analysis， and key metabolites arachidonic acid （AA）， prostaglandin E₂ （PGE₂）， and cyclooxygenase-2 （COX-2） were validated. ResultsCompared with the blank group， the model group showed increased 24-hour urine protein （24 h UP） and serum creatinine （SCr） levels （P<0.01）， obvious renal pathological damage， elevated serum IgA level （P<0.01）， increased renal AA and PGE₂ levels （P<0.01）， and up-regulated protein levels of COX-2， glucose-regulated protein 78 （GRP78）， phosphorylated eukaryotic initiation factor 2α （P-EIF2α）， activating transcription factor 4 （ATF4）， inositol-requiring enzyme 1α （IRE1α）， and spliced X-box binding protein 1 （XBP1s） in the renal tissue （P<0.05， P<0.01）. Compared with the model group， the intervention groups showed reductions in 24 h UP and SCr levels （P<0.05， P<0.01）， alleviated renal pathological injury， decreased serum IgA level （P<0.05， P<0.01）， and reduced renal AA and PGE₂ levels （P<0.01）. Western blot and IHC results showed that TFA reduced the levels of COX-2， GRP78， P-EIF2α， ATF4， IRE1α， and XBP1s in the renal tissue （P<0.05， P<0.01）. Metabolomics results indicated that 51 commonly differential metabolites were found among the normal， model， and TFA-M groups. TFA ameliorated IgAN by affecting metabolic pathways related to the biosynthesis of arachidonic acid and arginine through L-aspartic acid， prostaglandin 2α， leukotriene B₄， leukotriene D₄， among others. ConclusionTFA can regulate the arachidonic acid metabolism pathway， thereby modulating ER stress， reducing renal damage， and ameliorating IgA nephropathy.

As an important part of the cause of socialism with Chinese characteristics,health care plays a basic strategic support role in China's modernization drive.Deepening the reform of the medical and health system is an important part of comprehensively deepening the reform.Therefore,it is a new starting point to further deepen the reform to explore the Marx's theoretical logic of Chinese medical reform from the logic of"two combinations"and find the basis of Marx's theory and the ideological power of Chinese excellent traditional culture for the"big country medical reform".Under the guidance of the logical logic of the"two combinations",the theoretical system of Xi Jinping's important treatises on health work is built,contributing to further enrich and develop Xi Jinping's thought of socialism with Chinese characteristics in a new era.

Objective To observe the impact factors of abdominal wall edema degree after high intensity focused ultrasound(HIFU)ablation for uterine leiomyoma(UL).Methods Totally 128 patients with solitary UL who underwent HIFU were retrospectively enrolled.Edema degree of abdominal wall showed on T2WI were classified into grade Ⅰ,Ⅱand Ⅲ according to the involved layers and subcutaneous indurations.Patients'general data,MRI characteristics of UL,HIFU parameters and adverse reactions were compared among grades.Multinomial logistic regression analysis was used to screen the impact factors of edema degree.Results Among 128 patients,grade Ⅰ edema was found in 79 cases(79/128,61.72%),while grade Ⅱ and Ⅲ were observed in 27(27/128,21.09%)and 22(22/128,17.19%)cases,respectively.Compared with patients with grade Ⅲ edema,those with grades Ⅰ and Ⅱ had lower body mass index(BMI),and patients with grade Ⅰ edema had decreased subcutaneous fat thickness and decreased total thickness of subcutaneous fat and muscle layers(both adjusted P＜0.05).The proportion of abdominal scars in patients with grade Ⅰedema was lower than that with grade Ⅱ(adjusted P＜0.05).No significant difference of MRI findings of UL before HIFU nor HIFU parameters was noticed among different grades of edema(all P＞0.05).BMI and abdominal scar were both impact factors for distinguishing grade Ⅰ and Ⅲ,while BMI was the impact factor for distinguishing grade Ⅱ and Ⅲ edema after HIFU for UL(all P＜0.05).Conclusion BMI and abdominal scar were both impact factors for abdominal wall edema degree after HIFU for UL.

As an important part of the cause of socialism with Chinese characteristics,health care plays a basic strategic support role in China's modernization drive.Deepening the reform of the medical and health system is an important part of comprehensively deepening the reform.Therefore,it is a new starting point to further deepen the reform to explore the Marx's theoretical logic of Chinese medical reform from the logic of"two combinations"and find the basis of Marx's theory and the ideological power of Chinese excellent traditional culture for the"big country medical reform".Under the guidance of the logical logic of the"two combinations",the theoretical system of Xi Jinping's important treatises on health work is built,contributing to further enrich and develop Xi Jinping's thought of socialism with Chinese characteristics in a new era.

Objective·To explore the diagnostic,therapeutic,and prognostic value of metagenomics next-generation sequencing(mNGS)in patients with pneumonia-induced sepsis.Methods·This study consisted of a multicenter,prospective,non-randomized controlled trial and a diagnostic test.Patients with pneumonia-induced sepsis who were hospitalized in four hospitals across China were enrolled between March 2020 and October 2021.All patients met the Sepsis-3 criteria issued by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine,as well as the clinical diagnostic standard of pneumonia.Enrolled patients were assigned based on their preference to either the conventional test-only group[receiving only conventional test(CMT)]or the combined mNGS test group(receiving CMT and mNGS concurrently).The primary outcome was the 7-day all-cause mortality rate,and secondary outcomes included the changes in SOFA and APACHE Ⅱ scores from baseline to day 7,28-day all-cause mortality rate,the composite endpoint of mechanical ventilation or death within 28 d,28 d ventilation-free days,28 d hospital-free days,and the average daily hospitalization cost.Propensity score matching was used to balance covariates between the two groups.Kaplan-Meier curves were plotted and Cox proportional hazards models were built to compare the risk of death between the two groups.Pathogen detection results from infection site samples in the combined mNGS test group were used for the diagnostic test.The clinically-adjudicated causative pathogens was used as the reference standard.The results of traditional pathogen detection and mNGS detection were compared respectively with the reference standard.The positive percent agreement,negative percent agreement,positive predictive value,and negative predictive value between the two methods and the reference standard were calculated.McNemar's χ2 test was used to evaluate the causative pathogen detection capabilities of the two methods.Results·A total of 533 patients were enrolled,of whom 311 opted for additional mNGS testing,while 222 received only conventional pathogenetic testing.In the non-randomized controlled trial,after propensity score matching to balance covariates,the 7-day all-cause mortality was lower in the combined mNGS test group compared to the conventional test-only group[4.8%vs 8.6%,HR 0.37(95%CI 0.15?0.91),P=0.031].Additionally,the 28-day ventilation-free days were increased in the combined mNGS test group(19.9 d vs 18.4 d,P=0.041).No significant difference was observed between the two groups in terms of 28-day all-cause mortality or the average daily hospitalization costs.In the diagnostic test,compared to the reference standard,the positive percent agreement of mNGS with the clinical composite judgment for causative pathogens was higher than that of CMT[91.9%(95%CI 87.7%?95.0%)vs 56.1%(95%CI 49.7%?62.4%),P<0.001].Conversely,the negative percent agreement of mNGS was lower than that of CMT[29.2%(95%CI 18.6%?41.8%)vs 69.2%95%CI 56.6%?80.1%),P<0.001].The negative predictive value of nNGS was higher than that of CMT[48.7%(95%CI 32.4%?65.2%)vs 29.4%(95%CI 22.3%?37.3%),P=0.001].Conclusion·In patients with pneumonia-induced sepsis,mNGS of infection site samples demonstrated a higher detection rate of causative pathogen compared to CMT.Furthermore,the combination of mNGS with CMT may help reduce the 7-day all-cause mortality,suggesting that mNGS has clinical value and potential for application in the management of sepsis caused by pulmonary infections.

Neoadjuvant chemoradiotherapy (NACRT) is the standard treatment for locally advanced rectal cancer (LARC), yet the pathological complete response (pCR) rates remain suboptimal. The introduction of immunotherapy has opened new avenues for LARC management, particularly in patients with mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H) status. In this subset, anti-programmed cell death protein-1 (PD-1) monoclonal antibodies demonstrate marked efficacy, achieving high rates of clinical complete response (cCR) and pCR, thereby facilitating non-operative watch-and-wait (W&W) strategies. However, long-term outcomes and large-scale validation are still awaited. Conversely, in patients with LARC who have proficient mismatch repair (pMMR) or microsatellite stability (MSS), PD-1 inhibition alone shows limited benefit. Current research thus focuses on combinatorial approaches. Combining immunotherapy with chemoradiotherapy has shown promise in improving pCR rates in pMMR/MSS LARC, without significantly exacerbating severe adverse events. However, the discordance between post-treatment imaging assessments and pathological findings complicates clinical decision-making. Future directions include optimizing immune checkpoint inhibitor (ICI) regimens for pMMR/MSS LARC, with ongoing investigations into dual immunotherapy and anti-angiogenic synergism. Additionally, biomarker discovery, which is leveraging multi-omics and artificial intelligence (AI), will be pivotal in achieving precision therapy that balances short-term efficacy with long-term survival benefits.

Objective To report the individualized rehabilitation protocol administered to a patient suffering from corpus callosum injury subsequent to cerebral infarction,manifesting clinically as alien hand syndrome,attention deficits,spatial neglect and gait apraxia;and to emphasize the application of functional near infrared spectroscopy(fNIRS)in the assessment of cerebral activation.Methods A 54-year-old male with corpus callosum damage following cerebral infarction was assessed by a comprehen-sive array of neuropsychological assessments,such as Mini-Mental State Examination,Montreal Cognitive As-sessment,Loewenstein Occupational Therapy Cognitive Assessment and Wisconsin Card Sorting Test,etc.Based on these assessments,a personalized rehabilitation program was devised,incorporating physical therapy,occupa-tional therapy,task-oriented training,mirror therapy,computer-assisted cognitive training,as well as Schulte's square attention training,bilateral limb coordination training and transcranial magnetic stimulation(TMS).fNIRS was used to evaluate changes in brain activation before and after rehabilitation.Results After more than a month of comprehensive rehabilitation,the patient experienced significant improvements in Alien hand syndrome,attention deficit and spatial neglect.Gait was normalized,and enhancements were ob-served in motor function,cognition and activity of daily living.fNIRS analysis revealed favorable alterations in cerebral activation patterns.Conclusion For the intricate symptoms associated with corpus callosum injury,a multidisciplinary rehabilitation ap-proach,particularly the incorporation of Schulte's square attention training,bilateral coordination exercises and TMS,alongside fNIRS for monitoring cerebral activation,showed significant rehabilitation effects.

Objective:To analyze the economic operation and efficiency of village clinics in Jiangsu Province,explore the issues and put forward the countermeasures.Methods:Descriptive statistic method was applied to analyze the income,expenditure and balance of village clinics.Malmquist index was applied to analyze the input-output efficiency of village clinics from 2013 to 2022.Results:The proportion of medical income to total income of village clinics decreased continuously from 2016 to 2022 in Jiangsu province.The proportion of medical income to total income was 56.34%in 2022.The proportion of drug income to medical income was 75.77%.The average subsidy from the superiors per institution was 71 800 yuan in 2022.The proportion of personnel expenditure to total expenditure of village clinics was 49.24%in 2022,and per capita personnel expenditure was 41 500 yuan.The income-expenditure balance of drugs declined continuously from 2016 to 2020.The average income-expenditure balance per village clinic was 15 600 yuan in 2022.The Malmquist index results showed that the average value of Total Factor Productivity(TFP)index of village clinics in Jiangsu was 0.992 from 2013 to 2022 in Jiangsu province.The value of TFP index of 8 village clinics was less than 1.0 in eight cities.Conclusions:The proportion of drug income to medical income was high.The personnel funds were relatively low in village clinics.The average income-expenditure balance of village clinics was insufficient.The input-output efficiency of village clinics was low in some regions.It is needed to further improve the compensation mechanism of income,increase the financial subsidies and improve the service ability and service level of village clinics.

ObjectiveTo investigate the therapeutic effect of Siegesbeckiae Herba water decoction （SWD） at different doses on atherosclerosis （AS） in a mouse model induced by a high-fat diet and analyze its potential mechanism of action. MethodsThirty-six male ApoE^-/- mice were randomly divided into six groups： blank control group， model group， low-dose， medium-dose， and high-dose SWD groups， and positive control group. Firstly， the AS mouse model was created by feeding mice a high-fat diet. After successful modeling， the low-， medium-， and high-dose SWD groups were intragastrically administered with SWD at 0.65， 1.3， 2.6 g·kg^-1， respectively. The positive control group was intragastrically administered with 30 mg·kg^-1 of atorvastatin calcium aqueous solution， while the blank and model groups received an equal volume of 0.9% sodium chloride solution via oral gavage， all administered for 12 weeks. During the administration period， the general condition of the mice was observed and recorded daily. Before sampling， color Doppler ultrasound was performed to observe the pathological changes in atherosclerotic plaques in the aortic wall of mice. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in aortic tissue in mice， and oil red O staining was used to detect the atherosclerotic plaque area in the aorta. Enzyme-linked immunosorbent assay （ELISA） was used to detect the serum lipid indices and the levels of interleukins （IL-1β， IL-4， IL-6， and IL-10） and tumor necrosis factor-α （TNF-α） in mice. Protein expression levels of IKKα， IKKβ， and NF-κB p65 in mouse aortic tissue were detected by Western blot. ResultsCompared with the blank control group， the model group showed a significant increase in body weight. The results of color Doppler ultrasound showed enhanced vascular wall echo， suggesting the presence of atherosclerotic plaques. HE staining showed foam cell aggregation， fibrous connective tissue proliferation， and vascular intima injury in the aortic tissue. Oil red O staining showed a significant increase in the plaque area in the aortic tissue （P<0.01）. ELISA results indicated significantly elevated levels of IL-1β， IL-6， TNF-α， total cholesterol （TC）， triglyceride （TG）， and low-density lipoprotein （LDL） in mouse serum （P<0.01）， as well as significantly decreased levels of IL-4， IL-10， and high-density lipoprotein （HDL） （P<0.01）. Western blot results showed that the expression of IKKα， IKKβ， and NF-κB p65 in mouse aortic tissue increased significantly （P<0.01）. Compared with those in the model group， mice in the middle- and high-dose SWD groups showed significant weight loss. In the high-dose group， the aortic vascular wall echoes were weakened， and the atherosclerotic plaques were reduced. The aortic lesions of mice in the medium- and high-dose SWD groups were significantly alleviated. The plaque area percentage showed an inverse correlation with the administered dose in all groups treated with SWD （P<0.05）. In the medium-dose SWD group， serum levels of IL-1β， IL-6， TNF-α， TC， TG， and LDL were significantly decreased （P<0.05， P<0.01）， while those of IL-4 and IL-10 were significantly increased （P<0.01）. In the high-dose SWD group， levels of IL-1β， IL-6， TNF-α， TC， TG， and LDL were significantly decreased （P<0.01）， while IL-4， IL-10， and HDL were significantly increased （P<0.01）. The IKKα and IKKβ expression was significantly decreased in the low-dose SWD group （P<0.05）， and IKKα， IKKβ， and NF-κB p65 were significantly decreased in the medium- and high-dose SWD groups （P<0.05， P<0.01）. ConclusionSWD may exert therapeutic effects on AS by regulating the expression of related inflammatory factors through the NF-κB signaling pathway， thereby reducing inflammation， plaque area， and lipid content in the body.

ObjectiveMicrotube associated protein-2 （MAP-2）， alpha-tubulin （α-tubulin）， and synaptophysin （SYP） are important proteins in neuronal signal communication. This paper observed the effects of modified Zhigancao Tang on the expression of serum α-Synuclein （α-Syn） and its oligomers， MAP-2， α-tubulin， and SYP of patients with liver and kidney deficiency of Parkinson's disease （PD）， analyzed their correlation， and evaluated the therapeutic effect of modified Zhigancao Tang in patients with liver and kidney deficiency of PD based on α-Syn transmission pathway mediated by neuronal communication in vivo. MethodsA total of 60 patients with PD who met the inclusion criteria were randomly divided into a treatment group （30 cases） and a control group （30 cases）. Both groups were treated on the basis of PD medicine， and the treatment group was treated with modified Zhigancao Tang. Both groups were treated for 12 weeks. The changes in UPDRS score， TCM syndrome score， and expression of serum α-Syn and its oligomers， MAP-2， α-tubulin， and SYP were observed before and after 12 weeks of treatment in each group. The correlation between the above-mentioned serum biological indexes and the levels of serum α-Syn and its oligomers was analyzed. ResultsAfter treatment， the TCM syndrome score， UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ score of the treatment group were significantly decreased （P<0.05， P<0.01）. The UPDRS score， UPDRS-Ⅱ score， and UPDRS-Ⅲ scores in the treatment group were significantly decreased compared with those in the control group after treatment （P<0.05）. After treatment， the total effective rate of the control group was 63.3% （19/30）， and that of the treatment group was 86.7% （26/30）. The clinical effect of the observation group was better than the control group （Z=-2.03， P<0.05）. The total effective rate of the observation group was better than that of the control group， and the difference was statistically significant （χ²=5.136， P<0.05）. After treatment， the oligomer level of serum α-Syn and MAP-2 level in the treatment group were significantly decreased （P<0.05， P<0.01）. The levels of serum α-Syn and its oligomers， as well as α-tubulin in the treatment group， were significantly decreased compared with those in the control group after treatment （P<0.05， P<0.01）. Serum α-Syn was correlated with serum MAP-2 and α-Syn oligomer in patients with PD （P<0.05， P<0.01） but not correlated with serum SYP . Serum α-Syn oligomers of patients with PD were correlated with serum MAP-2 and α-tubulin （P<0.05， P<0.01） but not correlated with serum SYP level. Serum SYP of patients with PD was correlated with serum MAP-2 （P<0.05）. ConclusionModified Zhigancao Tang has a therapeutic effect on patients with liver and kidney deficiency of PD by inhibiting the production of α-Syn oligomers and intervening α-Syn microtubule transport pathway in vivo.