AIM: To investigate the diagnostic and prognostic value of differential expression of Cyclin D1 and p53 in eyelid tumors.METHODS: This retrospective study enrolled patients who underwent surgical resection for eyelid tumors at our hospital between March 2018 and March 2023. Participants were categorized into benign and malignant groups based on tumor characteristics. Clinical data were collected. Genetic data for eyelid tumors were obtained from the GEO database, and differential gene analysis, including volcano plot visualization and KEGG pathway enrichment analysis, was performed using the Sangerbox 3.0 platform. Immunohistochemistry was used to detect the expression levels of Cyclin D1, p53, and BAX in tissue samples. Correlations with clinical features were analyzed using Spearman analysis, and prognostic factors were identified via Logistic regression analysis.RESULTS: This study included 69 patients with eyelid tumors(78 eyes), categorized into a benign group(37 patients, 41 eyes)and a malignant group(32 patients, 37 eyes)based on tumor characteristics. There were significant differences between the two groups in histological subtype, TNM staging, vascular invasion, differentiation status, and local infiltration(all P<0.05). Among benign tumors: pigmented nevi in 11 eyes(27%), hemangiomas in 9 eyes(22%), squamous cell papillomas in 5 eyes(12%), epidermoid cysts in 5 eyes(12%), seborrheic keratoses in 4 eyes(10%), neurofibromas in 3 eyes(7%), and both calcifying epithelioma and xanthelasma in 2 eyes each(5%); among malignant tumors: basal cell carcinoma in 18 eyes(49%), meibomian gland carcinoma in 8 eyes(22%), squamous cell carcinoma in 5 eyes(14%), sebaceous gland carcinoma in 4 eyes(11%), lymphoma and malignant melanoma each in 1 eye(3%). At the follow-up cutoff date of March 2025, the 2-year survival rate in the benign group(95%)was significantly higher than that in the malignant group(78%; P<0.05). Bioinformatics analysis identified 4 103 differentially expressed genes, including Cyclin D1, p53, and BAX, which were predominantly involved in pathways such as the p53 signaling pathway and calcium-related signaling. Spearman analysis revealed that local invasion(rs=0.71, P<0.05)and TNM stage(rs=0.73, P<0.05)correlated with Cyclin D1 expression; local invasion(rs=0.76, P<0.05)and histological subtype(rs=0.65, P<0.05)correlated with p53 expression. Logistic regression results indicated that Cyclin D1, p53, TNM staging, and local invasion were prognostic risk factors. ROC curve analysis demonstrated that the combined detection of these four indicators had the highest predictive value for prognosis(AUC=0.83).CONCLUSION: High expression of cyclin D1 and p53 serves as molecular markers for distinguishing benign from malignant eyelid tumors and assessing prognosis. Combined detection of these markers with TNM staging and local invasion demonstrates high predictive value for prognosis.

To interpret the evidence-to-decision （EtD） framework and to illustrate its application in traditional Chinese medicine （TCM） guideline development using the example of the Pharmacovigilance Guideline of Chinese Patent Medicine， thereby providing methodological references for TCM guideline standardization. Based on the core three stages of the EtD framework （formulating the question， making an assessment of the evidence， and drawing conclusions）， critical decision points and evaluation evidence within the evidence-translation process were systematically addressed， aligning with the purpose， scope， and key questions of the guideline. Qualitative research methods， such as the nominal group technique， were employed to formulate recommendations. The analysis was conducted based on the EtD framework. During question formulation， the specific characteristics and practical needs of pharmacovigilance for Chinese patent medicines were clarified， focusing on the core objective of safety assurance throughout the product lifecycle. In the evidence assessment， multi-source evidence was integrated， including policy documents， literature research， and expert consensus， completing the evidence evaluation. Finally， in recommendation-forming， dispersed research evidence and expert experience were synthesized into consensus， culminating in the guideline's completion through solicitation of opinions and peer review. The EtD framework provides a structured tool for evidence-to-decision translation in TCM guideline development， effectively enhancing the transparency and scientific rigor of the process. Therefore， it is recommended that TCM guideline development adopt the EtD framework to improve the evidence-to-decision process with TCM characteristics.

To interpret the evidence-to-decision （EtD） framework and to illustrate its application in traditional Chinese medicine （TCM） guideline development using the example of the Pharmacovigilance Guideline of Chinese Patent Medicine， thereby providing methodological references for TCM guideline standardization. Based on the core three stages of the EtD framework （formulating the question， making an assessment of the evidence， and drawing conclusions）， critical decision points and evaluation evidence within the evidence-translation process were systematically addressed， aligning with the purpose， scope， and key questions of the guideline. Qualitative research methods， such as the nominal group technique， were employed to formulate recommendations. The analysis was conducted based on the EtD framework. During question formulation， the specific characteristics and practical needs of pharmacovigilance for Chinese patent medicines were clarified， focusing on the core objective of safety assurance throughout the product lifecycle. In the evidence assessment， multi-source evidence was integrated， including policy documents， literature research， and expert consensus， completing the evidence evaluation. Finally， in recommendation-forming， dispersed research evidence and expert experience were synthesized into consensus， culminating in the guideline's completion through solicitation of opinions and peer review. The EtD framework provides a structured tool for evidence-to-decision translation in TCM guideline development， effectively enhancing the transparency and scientific rigor of the process. Therefore， it is recommended that TCM guideline development adopt the EtD framework to improve the evidence-to-decision process with TCM characteristics.

Given the increasing concern regarding antibacterial resistance, the antimicrobial properties of naphthoquinones have recently attracted significant attention. While 1,4-naphthoquinone and its derivatives have been extensively studied, the antibacterial properties of 5,8-dihydroxy-1,4-naphthoquinone derivatives remain relatively unexplored. This study presents a comprehensive in vitro and in vivo analysis of the antibacterial activity of 35 naturally sourced and chemically synthesized derivatives of 5,8-dihydroxy-1,4-naphthoquinone. Kirby-Bauer antibiotic testing identified three compounds with activity against methicillin-resistant Staphylococcus aureus (MRSA), with one compound (PNP-02) demonstrating activity comparable to vancomycin in minimum inhibitory concentration, minimum bactericidal concentration (MBC), and time-kill assays. Microscopic and biochemical analyses revealed that PNP-02 adversely affects the cell wall and cell membrane of MRSA. Mechanistic investigations, including proteomic sequencing analyses, Western blotting, and RT-qPCR assays, indicated that PNP-02 compromises cell membrane integrity by inhibiting arginine biosynthesis and pyrimidine metabolism pathways, thereby increasing membrane permeability and inducing bacterial death. In an in vivo mouse model of skin wound healing, PNP-02 exhibited antibacterial efficacy similar to vancomycin. The compound demonstrated low toxicity to cultured human cells and in hemolysis assays and remained stable during serum incubation. These findings suggest that PNP-02 possesses promising bioactivity against MRSA and represents a potential novel antibacterial agent.
Methicillin-Resistant Staphylococcus aureus/genetics* ; Anti-Bacterial Agents/chemistry* ; Naphthoquinones/administration & dosage* ; Animals ; Microbial Sensitivity Tests ; Mice ; Humans ; Staphylococcal Infections/microbiology* ; Molecular Structure

Occupational noise-induced hearing loss (NIHL) is an irreversible sensorineural hearing loss that severely endangers workers’ health, making early screening crucial. This article reviewed the research progress on early screening methods for occupational NIHL, introduced the testing mechanisms of three core screening methods—tympanometry, otoacoustic emissions, and extended high-frequency audiometry —and summarized their clinical application advantages and limitations. It is proposed that multimodal combined detection (e.g., the combination of tympanometry, otoacoustic emissions, and extended high-frequency audiometry) can significantly improve the accuracy and comprehensiveness of early screening. Meanwhile, future studies with prospective cohort design are encouraged to verify the long-term monitoring value of each method and to strengthen the joint development of screening technologies with cutting-edge approaches such as machine learning, in order to further improve screening efficiency and provide stronger protection for workers’ hearing health.

Objective:To identify prognostic factors associated with survival rates in patients with distal cholangiocarcinoma after radical surgery, and to construct a Nomogram prediction model based on these factors, as well as to perform internal validation of the model.Methods:A retrospective study was conducted on the clinical data of 162 patients (76 males and 86 females) with distal cholangiocarcinoma who underwent radical surgery at the Department of Hepatobiliary Surgery, Ningxia Medical University General Hospital from January 2011 to July 2019. The study used univariate and multivariate Cox regression analysis to identify independent risk factors and constructed a Nomogram prediction model using R software version 4.4.1. Additionally, the predictive accuracy of the model was evaluated through the C-index, the area under the receiver operating characteristic curve, and the calibration curve.Results:The median overall survival for the 162 patients was 18.4 months. The final multivariate Cox regression analysis revealed that the following factors were independent risk factors for poor postoperative prognosis in patients with distal cholangiocarcinoma: patient age [> 60 years, P = 0.004, hazard ratios ( HR) = 1.876], tumor diameter (> 2.0 cm, P < 0.001, HR = 0.174), tumor differentiation degree [moderately differentiated/moderately to highly differentiated/highly differentiated, P = 0.017, HR = 1.407], lymph node metastasis (Yes, P = 0.002, HR = 0.551), and vascular invasion (Yes, P = 0.025, HR = 1.329) (all P < 0.05). Based on these independent risk factors identified through statistical analysis, the C-index of the constructed nomogram prediction model was 0.793. The area under the receiver operating characteristic curve values for the model predicting postoperative 1-year, 3-year, and 5-year overall survival rates were 0.932, 0.771, and 0.758,respectively. Conclusions:Patient age, tumor diameter, tumor differentiation degree, lymph node metastasis, and vascular invasion are independent risk factors for poor postoperative prognosis in patients with distal cholangiocarcinoma. The final Nomogram prediction model demonstrates good predictive ability and has certain practical application potential.

Objective:To explore the effect of loneliness on self-perceived aging among elderly patients after gastric cancer surgery, and to examine the mediating role of emotion regulation strategies, in order to provide a basis for clinical interventions.Methods:A convenience sample of 220 elderly postoperative gastric cancer patients hospitalized in Shanxi Provincial Cancer Hospital between August and November 2024 was selected. Data were collected using a general demographic questionnaire, the Emotion Regulation Questionnaire (ERQ), the Cancer Loneliness Scale (CLS), and the Brief Aging Perceptions Questionnaire (B-APQ). A structural equation model was constructed using AMOS 26.0, and the significance of the mediating effect was tested using the bootstrap method with 5 000 resamples.Results:A total of 220 questionnaires were distributed in this study, and 203 valid questionnaires were recovered, with a response rate of 92.27%. The total B-APQ score was (47.45±11.43). For the ERQ, the score for cognitive reappraisal was (22.80±8.17), and for expressive suppression was (18.37±5.10). The CLS score was (18.19±6.11). Mediation analysis showed that loneliness had a direct effect of 0.353 on self-perceived aging. Emotion regulation strategy—cognitive reappraisal—partially mediated the relationship between loneliness and self-perceived aging, with a mediation effect value of 0.178, accounting for 33.52% of the total effect (0.178/0.531) .Conclusions:Clinical practitioners should implement interventions to reduce loneliness in elderly patients after gastric cancer surgery and guide them in adopting cognitive reappraisal as an emotion regulation strategy. These approaches may help promote positive aging in this patient population.

Purpose To explored the correlation between imaging features and patient's blood markers based on quantitative analysis of urate deposition in acute exacerbations of gouty arthritis of the knee by dual-energy spectrum CT(DECT).Materials and Methods A retrospective analysis was conducted on energy spectrum CT imaging of 72 patients clinically diagnosed with acute gouty knee osteoarthritis and 87 patients with non-gouty knee disease during the acute exacerbation period at the First Hospital of Qiqihar from January 2020 to September 2023.The analysis aimed to evaluate urate deposition in different parts of the knee joints and to analyze the influencing factors of urate deposition combined with the blood test indexes of the patients via receiver operating characteristic curves.Results The neutrophil lymphocyte ratio showed a positive correlation with C-reactive protein,erythrocyte sedimentation rate,and urate concentration at the site of urate deposition in gouty nodules of the knee(r=0.354,0.326,0.260,respectively,all P<0.05).The mean platelet volume was significantly positive correlated with the semi-quantitative data of monosodium urate crystals and urate concentration in the knee(r=0.563,0.257,respectively,P<0.05).In the gout group,C-reactive protein was positively correlated with pararticular soft tissue urate concentration and bone urate concentration(r=0.498,0.166,P<0.05),while erythrocyte sedimentation rate was positively correlated with pararticular soft tissue(tendons,ligaments,etc)urate concentration(r=0.325,P<0.01).Additionally,serum uric acid was positively correlated with gouty nodules in the knee joints and pararticular soft tissue(tendons,ligaments,etc)(r=0.264,0.243,respectively,P<0.05).The cut-off values of neutrophil lymphocyte ratio,platelet lymphocyte ratio and mean platelet volume combined with dual-energy energetic spectroscopic CT imaging data in the diagnosis of gouty knee osteoarthritis points were 2.190,122.96 and 9.049,respectively.Conclusion Energetic spectrum CT can identify and quantify urate crystals at the early stage.And blood test indexes such as mean platelet volume,erythrocyte sedimentation rate and serum uric acid have potential value in evaluating the activity of gout and the degree of migration of the disease in gouty knee osteoarthritis.

Objective To explore the application of the DeepSeek large languagemodel in assessing prescription ration-ality and evaluating its implementation effectiveness.Methods A random sample of 5 099 outpatient and emergency prescrip-tion records from our hospital in a specific month of 2024 was collected.The DeepSeeK large language model employs vector data-base technology for prescription review.An evaluation metrics analysis was conducted between the DeepSeeK's reviews and phar-macist evaluations.Performance metrics including accuracy,precision,recall,specificity,and F1 were systematically calculated.Error pattern analysis encompassed false positive rate,false negative rate,and categorical comparison of discrepant prescriptions.Statistical deviation assessments were performed using x2 and Kappa coefficient to quantify inter-rater consistency.Results This study contains a total of 5 099 data,pharmacist group's review results are reasonable for 4 879 cases and unreasonable for 220 cases.In contrast,The Deepseek model's review results in the AI group are reasonable for 4904 cases and unreasonable for 195 cases.The evaluation accuracy rate of the DeepSeeK model is approximately 93.82%,the precision rate is approximately 25.64%,the recall rate is approximately 22.73%,the specificity is approximately 97.03%,and the F1 value of the model is ap-proximately 24.13%.Conclusion With rapid advancements in artificial intelligence,large language models like DeepSeek,leveraging their superior language comprehension and knowledge reasoning capabilities,can effectively assist pharmacists in pre-scription review,offering new technical support for clinical medication safety.

Objective:To analyze the clinical characteristics and treatment of patients with acute Q fever in Dali Bai Autonomous Prefecture, Yunnan Province.Methods:A total of 26 patients with acute Q fever admitted to People′s Hospital of Yunnan Dali Bai Autonomous Prefecture from October 2022 to December 2023 were enrolled. A retrospective cross-sectional study analysis was performed to analyze the demographic characteristics, epidemiology, clinical manifestations, laboratory tests and pathogen detection of these patients.Results:Of the 26 patients, 25 were male and one was female. The age ranged from 18 to 82 years with an average age of (45.6±17.2) years. All of them were sporadic cases. The neighbors of eight patients had sheep and cattle, 11 cases had a history of field work, and four cases had a history of field trip. Coxiella burnetii was detected in 26 patients by different molecular diagnostic techniques, including 21 cases by blood quantitative polymerase chain reaction (qPCR), three cases by sputum multi-pathogen targeted next-generation sequencing (tNGS), one case by alveolar lavage fluid tNGS, and one case by cerebrospinal fluid metagenomic next-generation sequencing (mNGS). Routine blood cultures of 19 cases were negative. All 26 patients presented with chills and fever, 21 cases (80.8%) with headache, 19 cases (73.1%) with fatigue, 14 cases (53.8%) with generalized aches and pains, 12 cases (46.2%) with poor appetite, and 14 cases (53.8%) with cough. Twenty-four cases had concurrent hepatitis, 12 cases had pneumonia, one had encephalitis, and 19 cases had myocardial damage. The laboratory tests showed that 23 cases (88.5%) had normal white blood cell count, eight cases (30.8%) had decreased platelet count, 25 cases (96.2%) had C-reactive protein elevated, 24 cases (92.3%) had procalcitonin elevated, 14 out of 17 cases had elevated erythrocyte sedimentation rate, and 19 cases had elevated D-dimer levels. Liver function tests showed that alanine aminotransferase increased in 24 cases (92.3%) (all less than 10 times of upper limit of normal (ULN)), aspartate aminotransferase increased in 23 cases (88.5%) (all less than 10 times of ULN), alkaline phosphatase increased in 10 cases (38.5%)(all less than two times of ULN), and γ-glutamyl transpeptidase increased in 19 cases (73.1%), which were all less than 10 times of ULN. Myocardial enzymes were detected in 21 cases, of which seven cases (33.3%) had elevated lactate dehydrogenase and 12 cases (57.1%) had elevated hydroxybutyrate dehydrogenase (all less than three times of ULN). In terms of treatment, 16 cases were treated with doxycycline alone, and nine cases were treated with doxycycline combined with azithromycin or quinolones or rifampicin, and one with tigecycline. After treatment, the conditions of patients improved. The overall length of hospital stay was (7.7±5.0) d, and that of eight patients treated with doxycycline combined with quinolones or azithromycin was 4.8 to 6.0 days. Conclusions:Acute Q fever often has no clear epidemiological history, and the clinical manifestations and laboratory tests are lack of specificity. qPCR, tNGS, mNGS can provide pathogenic diagnostic evidence for suspected cases. In terms of treatment, doxycycline is the first choice for treatment of acute Q fever, and combined treatment with azithromycin or quinolones could result in a shorter hospital stay.