Objective: To explore the causal relationship between gut microbiota and upper urinary tract stones using Mendelian randomization (MR) analysis，and to investigate the potential mediating role of plasma metabolites. Methods: Data on gut microbiota，plasma metabolites，and upper urinary tract stones were obtained from publicly available Genome-wide Association Studies (GWAS).Bidirectional MR analysis was performed to examine the causal relationship between gut microbiota and upper urinary tract stones.Subsequently，a two-step MR approach was employed to determine whether gut microbiota contribute to upper urinary tract stones through plasma metabolites，and the mediating effects and mediator ratio were calculated.The inverse variance weighted (IVW) method was used as the primary analytical tool，supplemented by Bayesian weighted Mendelian randomization (BWMR)，MR-Egger，and weighted median (WM) analyses.Horizontal pleiotropy and heterogeneity tests were conducted to ensure the robustness of the findings. Results: Bidirectional MR analysis identified causal associations between 7 gut microbial taxa and 6 microbial metabolic pathways with upper urinary tract stones，while the development of upper urinary tract stones affected 13 gut microbial taxa and 5 metabolic pathways.Additionally，43 plasma metabolites (including 27 identified metabolites，8 unidentified metabolites，and 8 metabolite ratios) were causally associated with upper urinary tract stones.The two-step MR analysis identified 11 potential causal pathways.After metabolic pathways and unidentified metabolites were excluded，a causal link mediated by Bacteroides faecis between galactarate and upper urinary tract stones was confirmed，with a mediation proportion of 16.99% (95%CI：5.76%-33.95%，P=0.0371). Conclusion: This study establishes a causal relationship between parabacteroides and upper urinary tract stones，and elucidates the mediating role of galactarate，offering new insights into the pathogenesis and prevention strategies for upper urinary tract stones.

ObjectiveTo evaluate the clinical efficacy of Maxing Loushi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with phlegm turbidity obstructing lung syndrome， and to investigate its effects on inflammatory factors， immune function， and the programmed death-1（PD-1）/programmed death-ligand 1 （PD-L1） signaling pathway. MethodsA randomized controlled study was conducted， enrolling 90 hospitalized patients with AECOPD and phlegm turbidity obstructing lung syndrome in the Respiratory and Emergency Departments of Dongzhimen Hospital， Beijing University of Chinese Medicine， from April 2024 to December 2024. Patients were randomly assigned to a control group and an observation group using a random number table， with 45 patients in each group. The control group received conventional Western medical treatment， while the observation group received additional Maxing Loushi decoction for 14 days. Clinical efficacy， COPD Assessment Test （CAT） score， modified Medical Research Council Dyspnea Scale （mMRC）， 6-minute walk test （6MWT）， serum inflammatory factors， T lymphocyte subsets， and serum PD-1/PD-L1 levels were compared between the two groups before and after treatment. ResultsThe total clinical effective rate was 78.57% （33/42） in the control group and 95.35% （41/43） in the observation group， with the observation group showing significantly higher efficacy than that of the control group. The difference was statistically significant （χ² = 5.136， P<0.05）. After treatment， both groups showed significant reductions in CAT and mMRC scores （P<0.05， P<0.01） and significant increases in 6MWT compared to baseline （P<0.01）. The observation group demonstrated significantly greater improvements than the control group in this regard. Levels of inflammatory markers including C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， monocyte chemoattractant protein-1（MCP-1）， and macrophage inflammatory protein-1α （MIP-1α） were significantly reduced in both groups （P<0.05， P<0.01）， with greater reductions in the observation group （P<0.05， P<0.01）. CD8⁺ levels were significantly reduced （P<0.01）， while CD3⁺， CD4⁺， and CD4⁺/CD8⁺ levels were significantly increased in both groups after treatment （P<0.05， P<0.01）， with more significant improvements observed in the observation group （P<0.05， P<0.01）. Serum PD-1 levels were reduced （P<0.05， P<0.01）， and PD-L1 levels were increased significantly in both groups after treatment （P<0.05， P<0.01）， with more pronounced changes in the observation group （P<0.05）. ConclusionMaxing Loushi decoction demonstrates definite therapeutic efficacy as an adjunctive treatment for patients with AECOPD and phlegm turbidity obstructing lung syndrome. It contributes to reducing serum inflammatory factors， improving immune function， and regulating the PD-1/PD-L1 signaling pathway.

ObjectiveTo evaluate the clinical efficacy of Maxing Loushi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with phlegm turbidity obstructing lung syndrome， and to investigate its effects on inflammatory factors， immune function， and the programmed death-1（PD-1）/programmed death-ligand 1 （PD-L1） signaling pathway. MethodsA randomized controlled study was conducted， enrolling 90 hospitalized patients with AECOPD and phlegm turbidity obstructing lung syndrome in the Respiratory and Emergency Departments of Dongzhimen Hospital， Beijing University of Chinese Medicine， from April 2024 to December 2024. Patients were randomly assigned to a control group and an observation group using a random number table， with 45 patients in each group. The control group received conventional Western medical treatment， while the observation group received additional Maxing Loushi decoction for 14 days. Clinical efficacy， COPD Assessment Test （CAT） score， modified Medical Research Council Dyspnea Scale （mMRC）， 6-minute walk test （6MWT）， serum inflammatory factors， T lymphocyte subsets， and serum PD-1/PD-L1 levels were compared between the two groups before and after treatment. ResultsThe total clinical effective rate was 78.57% （33/42） in the control group and 95.35% （41/43） in the observation group， with the observation group showing significantly higher efficacy than that of the control group. The difference was statistically significant （χ² = 5.136， P<0.05）. After treatment， both groups showed significant reductions in CAT and mMRC scores （P<0.05， P<0.01） and significant increases in 6MWT compared to baseline （P<0.01）. The observation group demonstrated significantly greater improvements than the control group in this regard. Levels of inflammatory markers including C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， monocyte chemoattractant protein-1（MCP-1）， and macrophage inflammatory protein-1α （MIP-1α） were significantly reduced in both groups （P<0.05， P<0.01）， with greater reductions in the observation group （P<0.05， P<0.01）. CD8⁺ levels were significantly reduced （P<0.01）， while CD3⁺， CD4⁺， and CD4⁺/CD8⁺ levels were significantly increased in both groups after treatment （P<0.05， P<0.01）， with more significant improvements observed in the observation group （P<0.05， P<0.01）. Serum PD-1 levels were reduced （P<0.05， P<0.01）， and PD-L1 levels were increased significantly in both groups after treatment （P<0.05， P<0.01）， with more pronounced changes in the observation group （P<0.05）. ConclusionMaxing Loushi decoction demonstrates definite therapeutic efficacy as an adjunctive treatment for patients with AECOPD and phlegm turbidity obstructing lung syndrome. It contributes to reducing serum inflammatory factors， improving immune function， and regulating the PD-1/PD-L1 signaling pathway.

Cataract is the world's leading cause of blindness, and surgery is the most effective treatment for cataract. With the development of femtosecond laser technology and ophthalmic surgical equipment, the application of femtosecond laser systems in cataract surgery is becoming increasingly widespread. It can be used in cataract surgery for corneal incisions, anterior capsulotomy, lens fragmentation, arcuate incisions and other key operations. Compared to traditional surgery, femtosecond laser assisted cataract surgery(FLACS)offers significant advantages in precision, safety and postoperative visual outcomes. Its clinical benefits have garnered growing recognition among ophthalmologists. However, the key technologies and high-precision equipment for FLACS remain predominantly controlled by Western countries. In China, the research in this field began later. This article reviews the technological advancements in FLACS, with a focus on femtosecond laser technology, optical coherence tomography(OCT), artificial intelligence, and clinical application progress. The objective is to provide theoretical foundations and practical insights for the development of ophthalmic medical technology in China.

Objective: To analyze the association of participation in non-sports extracurricular tutoring classes with the prevalence of screening myopia, axial length (AL) and axial length to corneal radius ratio (AL/CR) among primary school students, so as to provide evidences for formulating myopia prevention and control policies. Methods: In December 2024, combination of convenience and cluster sampling method was used to select 2 273 students from two primary schools in Hefei City, Anhui Province. Ophthalmic examinations and questionnaire surveys were conducted to obtain information on myopia, AL, AL/CR and participation in various types of extracurricular tutoring. A binary Logistic regression model was used to analyze the association between non-sports tutoring and screening myopia, and multiple linear regression models were used to examine the associations between non-sports tutoring and AL and AL/CR. Results: Among the surveyed students, the participation rate in non-sports extracurricular tutoring classes was 64.9% , and the overall prevalence of screening myopia was 39.1%. The average AL and AL/CR were (23.60± 1.01 ) mm and (3.00±0.12), respectively. Univariate analysis showed that students who attended non-sports, music, or academic tutoring classes for ≥2 h per week had higher risks of screening myopia and greater AL/CR values than non-participants (screening myopia: OR =1.38, 1.82, 1.55; AL/CR: β =0.01, 0.03, 0.03; all P <0.05). After adjusting for sex, grade, and participation in sports tutoring, multivariate analysis indicated that participation in non-sports and musical instrument tutoring classes for ≥2 h per week remained significantly associated with higher risks of screening myopia ( OR =1.26, 1.49, both P <0.05). Multiple linear regression showed that participation in musical instrument tutoring for ≥2 h per week was positively correlated with AL ( β=0.14, P < 0.05). Conclusions Participation in non-sports extracurricular tutoring is common among primary school students. Attending non-sports tutoring classes for ≥2 h per week increases the risk of screening myopia.

Objective To compare the effects of six composite fixatives on paraffin sections of golden hamster retinal tissue, and to optimize the fixation methods for retinal tissue paraffin sections of golden hamsters. Methods Eighteen male SPF grade golden hamsters were taken and randomly divided into six groups of three animals each. After each animal was anesthetized by intraperitoneal injection of sodium pentobarbital, cardiac perfusion was performed using 4% paraformaldehyde, Bouin's, Carnoy, Davidson's, Zenker, and Helly fixatives, respectively. The eye tissues of each animal were taken out to make eye cups and put into the corresponding compound fixative solution for fixation, and then taken out for paraffin embedding after 48 h. The embedded blocks were sliced using microtome, and then stained with hematoxylin and eosin (HE). The morphological characteristics of retinal tissue cells were observed under a light microscope and scored in a double-blind method to statistically analyze the fixation effect and staining quality of various composite fixative solutions. ResultsRetinal sections fixed with Davidson's fixative exhibited intact morphology without breaks, clear structural layers, well-morphosed nuclei, and tight adhesion between the retina, sclera, and uvea. In contrast, sections fixed with 4% paraformaldehyde, Bouin's, and Carnoy fixatives showed varying degrees of retinal breaks and detachment from the sclera. Sections fixed with Zenker and Helly fixatives demonstrated the poorest quality, characterized by pronounced detachment, large fissures, unclear cell layers, and pale staining. Statistical analysis using SPSS 27.0 software revealed significant differences in mean scores among the six fixatives (P<0.001). The fixation quality ranking was as follows: Davidson's fixative > 4% paraformaldehyde > Bouin's fixative > Carnoy fixative > Helly fixative > Zenker fixative. Zenker and Helly fixatives showed significantly lower scores than the other fixatives (P<0.001), while no significant differences were observed among the remaining fixatives (P>0.05). Conclusion Davidson's fixative provides the best fixation and staining results, followed by 4% paraformaldehyde and Bouin's fixative. Carnoy fixative exhibits suboptimal performance, while Zenker and Helly fixatives result in the poorest outcomes. Therefore, Davidson's fixative is recommended as the optimal fixative for golden hamster retinal tissue, with 4% paraformaldehyde, Bouin's and Carnoy fixatives as alternative options.

Objective To explore the application value of a special fence in percutaneous transhepatic cholangial drainage(PTCD)under the guidance of C-arm CT.Methods A total of 43 patients who underwent PTCD were randomly divided into observation group and control group.The intervention operation in the observation group was guided by C-arm CT and located by special fence;in the control group,the intervention operation was only performed under digital subtraction angiography(DSA)fluoroscopy.Respectively,the differences in operation time,number of puncture needles and number of complications between the two groups were compared.Results The operation time,puncture times and complications in the observation group were(39.33±12.96)min,(1.67±0.80)times and 3 cases respectively;in the control group were(86.77±22.70)min,(3.41±1.26)times and 13 cases respectively;There were significant differences between the two groups(P<0.05).Conclusion The application of special fence in PTCD under the guidance of C-arm CT can short the operation time,reduce the number of punctures and reduce complications,which has important clinical application value.

ObjectiveTo investigate the pathogenic spectrum and molecular characteristics of infectious diarrhea among children in Putuo District of Shanghai from 2018 to 2023， and to provide scientific basis for the prevention and control of infectious diarrhea in children. MethodsFecal samples from the cases visited sentinel hospitals for children’s diarrheal disease in Putuo District， Shanghai， were collected from January 2018 to December 2023. A total of 11 species of bacteria were isolated and cultured， and 5 species of viruses were detected by real-time fluorescent polymerase chain reaction （PCR）. The molecular typing of some positive strains was analyzed by the standard pulsed-field gel electrophoresis （PFGE） method. The polymerase-capsid protein linkage region of some norovirus-positive samples was amplified by reverse transcription PCR， and was sequenced and analyzed by bioinformatics software. The Chi-square test and Fisher’s exact probability test were used to compare the pathogen-positive rates in 2018‒2019 and 2020‒2023. ResultsOf the 707 cases of children with infectious diarrhea， the total positive rate was 47.67%， with a single bacterial positivity rate of 16.27%， a single viral positivity rate of 22.63%， and a mixed positivity rate of 8.77%， respectively. The dominant pathogens were rotavirus （10.75%）， norovirus （10.33%）， enteropathogenic Escherichia coli （8.06%）， Salmonella （6.36%）， enteroaggregative Escherichia coli （5.52%）， and Campylobacter （5.23%）. Bacterial infections were predominant in summer and fall， and viral infections were predominant in winter and spring. The total positive rate decreased in 2020‒2023 compared with that of 2018‒2019 （χ²=5.753，P<0.05）. Thirty-seven strains of Salmonella， 81 strains of diarrheagenic Escherichia coli， and 19 strains of Campylobacter were completed for the molecular typing analysis by PFGE， which were classified into 28， 80 and 18 banding types， respectively， with a wide range of banding similarity. Nineteen copies of norovirus GⅡ group gene sequences were analyzed and classified into 5 genotypes， which were mainly GⅡ.Pe-GⅡ.4 and GⅡ.P16-GⅡ.2 types. ConclusionRotavirus， norovirus， diarrheagenic Escherichia coli， Salmonella， and Campylobacter are the dominant pathogens of infectious diarrhea in children in Putuo District of Shanghai. The pathogen spectrum shows a trend of seasonal epidemic characteristics， with a diversity of molecular characteristics of some pathogens. Surveillance and monitoring on molecular characteristics of the pathogens of infectious diarrhea in children should be strengthened in different seasons， so as to provide a laboratory basis for the prevention and control of infectious diarrhea.

BACKGROUND:Transcranial direct current stimulation(tDCS),as a non-invasive brain stimulation technique,can enhance human muscle strength or improve single-leg landing stability instantly,but no relevant research has demonstrated this yet. OBJECTIVE:To investigate the effect of tDCS on the stability of single-leg landings in human subjects. METHODS:Male undergraduate students from Wuhan Sports University were recruited as study participants.They were divided into two groups,A(n=6)and B(n=5),using a random number table.Group A underwent a sham stimulation session followed by a 3-day washout period,after which they received tDCS.Conversely,Group B received tDCS initially,followed by a 3-day washout period,and subsequently underwent the sham stimulation session.Following the respective stimulation sessions,an immediate single-leg landing test was administered to assess and collect biomechanical parameters.Data resulting from the tDCS intervention were aggregated and analyzed as the experimental group dataset,whereas data stemming from the sham stimulation were consolidated as the control group dataset. RESULTS AND CONCLUSION:Regarding core stability,the tDCS intervention showed a significant interaction with landing height on the maximal trunk flexion angle(P＜0.05).A paired comparison of the data showed a significant decrease in the maximum trunk flexion angle following true stimulation compared to sham stimulation at a 30-cm landing height.Additionally,the tDCS intervention had a significant main effect on the maximum trunk lateral bending angle and the mean trunk lateral bending angular velocity(P＜0.05).Following true stimulation,there was a significant decrease in the maximum trunk lateral bending angle and the mean trunk lateral bending angular velocity compared to sham stimulation.In terms of lower limb joint stability,the tDCS intervention had a significant main effect on the maximum dynamic ankle valgus angle(P＜0.05).This resulted in a significant decrease in the angle following true stimulation compared to sham stimulation.In addition,the tDCS intervention had a significant main effect on the peak muscle activation of the lateral head of the gastrocnemius lateralis(P＜0.05).This showed a significant increase after true stimulation compared to sham stimulation.An interaction between the tDCS intervention and landing height was observed for the peak muscle activation of the tibialis anterior(P＜0.05).Paired comparison analyses revealed a significant increase in muscle activation after true stimulation specifically at a 60-cm landing height.Regarding center of pressure stability,there were no significant interactions or main effects of the tDCS intervention on the mean lateral displacement,mean lateral displacement velocity,mean anterior-posterior displacement,or mean anterior-posterior displacement velocity at the center of pressure(P＞0.05).Furthermore,the tDCS intervention had no significant main effects on any of the center of pressure indicators(P＞0.05).In conclusion,tDCS can immediately improve core stability and lower limb joint stability during single-leg landing,making it an effective warm-up technique for improving single-leg landing stability and reducing the risk of lower limb injuries.

Obejective　To investigate and compare the clinical efficacy of aroma massage with traditional massage in the treatment of chronic fatigue syndrome （CFS）. MethodsSeventy-two CFS patients were randomized into the aroma massage group and the traditional massage group， with 36 patients in each group. Both groups were treated with essential oil aromatherapy and massage were performed on the head， face， and abdomen stimultaneously. The aroma massage group used antifatigue oil， while the traditional massage group used placebo essential oil. The two groups were treated for 30 minutes each time， once every other day， three times a week， for a total of 4 weeks. The fatigue scale （FS-14） score， traditional Chinese medicine （TCM） syndrome score and patient satisfaction evaluation scale score before and after the treatment of the two groups were assessed to study the improvement of fatigue and other clinical symptoms of the patients as well as the changes of the TCM symptom scores， and to evaluate the clinical efficacy of the two groups. ResultsWith three drop-outs in the traditional massage group and two drop-outs in the aroma massage group， 33 cases in the traditional massage group and 34 cases in the aroma massage group were included in the outcome analysis. The FS-14 scores and TCM syndrome scores significantly decreased after treatment in both groups （P＜0.01）； compared to those in the traditional massage group （FS-14： 4.42±2.44； TCM syndrome score： 34.12±7.67）， the FS-14 score （3.06±2.37） and TCM syndrome score （28.79±5.62） in the aroma massage group were significantly lower （P＜0.05 or P＜0.01）. There was no significant difference in the satisfaction scores of the patients in the two groups after the treatment （P＞0.05）. The total effective rate of the aroma massage group was 94.12% （32/34）， which was significantly higher than 84.85% （28/33） of the traditional massage group （P＜0.05）. ConclusionBoth aromatherapy and traditional massage can improve the clinical symptoms of fatigue in CFS patients， and aromatherapy is more effective， which is easy to operate with high patient acceptance.