OBJECTIVE To investigate the effects and mechanisms of Lycium ruthenicum Murr. in improving sleep. METHODS Network pharmacology was employed to identify the active components of L. ruthenicum and their associated disease targets， followed by enrichment analysis. A caffeine‑induced zebrafish model of sleep deprivation was established ， and the zebrafish were treated with L. ruthenicum Murr. extract （LRME） at concentrations of 0.1， 0.2 and 0.4 mg/mL， respectively； 24 h later， behavioral changes of zebrafish and pathological alterations in brain neurons were subsequently observed. The levels of inflammatory factors [interleukin-6 （IL-6）， IL-1β， IL-10， tumor necrosis factor-α （TNF-α）]， oxidative stress markers [superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， catalase （CAT）]， and neurotransmitters [5- hydroxytryptamine （5-HT）， γ-aminobutyric acid （GABA）， glutamic acid （Glu）， dopamine （DA）， and norepinephrine （NE）] were measured. The protein expression levels of protein kinase B1 （AKT1）， phosphorylated AKT1 （p-AKT1）， epidermal growth factor receptor （EGFR）， B-cell lymphoma 2 （Bcl-2）， sarcoma proto-oncogene，non-receptor tyrosine kinase （SRC）， and heat shock protein 90α family class A member 1 （HSP90AA1） in the zebrafish were also determined. RESULTS A total of 12 active components and 176 intersecting disease targets were identified through network pharmacology analysis. Among these， apigenin， naringenin and others were recognized as core active compounds， while AKT1， EGFR and others served as key targets； EGFR tyrosine kinase inhibitor resistance signaling pathway was identified as the critical pathway. The sleep improvement rates in zebrafish of LRME low-， medium-， and high-dose groups were 54.60%， 69.03% and 77.97%， 开发。E-mail：hjp_yft@163.com respectively， while the inhibition ratios of locomotor distance were 0.57， 0.83 and 0.95， respectively. Compared with the model group， the number of resting counts， resting time and resting distance were significantly increased/extended in LRME medium- and high-dose groups （P＜0.05）. Neuronal damage in the brain was alleviated. Additionally， the levels of IL-6， IL-1β， TNF-α， MDA， Glu， DA and NE， as well as the protein expression levels of AKT1， p-AKT1， EGFR， SRC and HSP90AA1， were markedly reduced （P＜0.05）， while the levels of IL-10， SOD， GSH-Px， CAT， 5-HT and GABA， as well as Bcl-2 protein expression， were significantly elevated （P＜0.05）. CONCLUSIONS L. ruthenicum Murr. demonstrates sleep-improving effects， and its specific mechanism may be related to the regulation of inflammatory responses， oxidative stress， neurotransmitter balance， and the EGFR tyrosine kinase inhibitor resistance signaling pathway.

AIM: To explore the diagnostic value of 18 MHz color Doppler ultrasonography for epiretinal membrane.METHODS: A total of 44 cases(80 eyes)of patients with proposed diagnosis of cataract and vitreous opacity by fundus examination in our hospital between January 2020 and January 2022 were collected, and the affected eyes were examined by optical coherence tomography(OCT)and 18 MHz color Doppler ultrasonography, and the differences in the diagnostic sensitivity, specificity, and accuracy were compared between 18 MHz color Doppler ultrasonography and OCT for the diagnosis of epiretinal membrane.RESULTS: In the 80 eyes detected by 18 MHz color Doppler ultrasonography, 62 had epiretinal membrane and 18 had non epiretinal membrane. Totally 54 eyes were confirmed to have epiretinal membrane by OCT, 13 eyes were not diagnosed with epiretinal membrane, 5 eyes were missed diagnosis, and 8 eyes were misdiagnosed. The diagnostic consistency between 18 MHz color Doppler ultrasonography and OCT was high(Kappa=0.892, P<0.05); the 18 MHz color Doppler ultrasonography detection sensitivity of epiretinal membrane was 92%, specificity was 62%, missed diagnosis rate was 8%, misdiagnosis rate was 38%, and accuracy was 84%; compared with OCT detection, 18 MHz color Doppler ultrasonography detected a lower specificity, correct rate, positive prediction accuracy, negative prediction accuracy, and higher misdiagnosis rate(all P<0.05), and the difference in diagnostic sensitivity compared with leakage rate was not statistically significant(all P>0.05).CONCLUSION: 18 MHz color Doppler ultrasonography has some value in identifying epiretinal membrane lesions and is consistent with OCT testing.

It is believed that diabetes complicated with coronary heart disease is closely related to the functional interplay of the heart， spleen， and kidneys. This paper proposed the concept of the heart-spleen-kidney as a unified system for understanding and treating the disease. At the early stage， spleen and kidney deficiency leads to the internal accumulation of phlegm， dampness， and turbid lipids， causing impaired blood circulation and vascular obstruction， so treatment should focus on tonify the kidneys and strengthening the spleen， activating blood circulation and resolving stasis， using the self-prescribed Tangxin Maiwen Formula （糖心脉温方）. As the disease progresses， further decline of spleen and kidney function results in inadequate nourishment of the heart， leading to blood stasis and the accumulation of phlegm， dampness， and turbid lipids， which may transform into pathogenic heat and toxins， causing heart damage， then treatment should emphasize on boosting qi and nourishing yin， clearing heat， activating blood and resolving toxins， using the self-prescribed Tangxin Maiqing Formula （糖心脉清方）. In advanced stages， three zang organs， the heart， spleen， and kidneys， become severely impaired， leading to mental activity fail to be nourished and abnormal cognitive functions， so treatment should focus on harmonizing the three zang organs simultaneously， using the self-prescribed Yunpi Tiaoxin Decoction （运脾调心汤）. This approach aims to provide a clinical framework for the diagnosis and treatment of diabetes with coronary heart disease.

In November 2024， the Expert Group on Alcohol-related Liver Disease released a position statement on metabolic dysfunction and alcohol-related liver disease （MetALD）. MetALD is a new subtype of steatotic liver disease and refers to MASLD patients with a relatively large amount of alcohol consumption. The position statement points out the importance of accurate evaluation of alcohol consumption and recommends to quantify alcohol consumption using standard methods and alcohol biomarkers， and a comprehensive diagnosis should be made based on metabolic risk factors. In addition， the position statement analyzes the influence of drinking pattern on the diagnosis of MetALD and recommends to consider long-term drinking history during typing. The position statement also discusses the complex association between drinking and the diseases including metabolic syndrome， hepatic steatosis， fibrosis， and type 2 diabetes mellitus， and it is pointed out that the hierarchical management of patients should be optimized based on liver histological models and noninvasive models. The position statement elaborates on the definition of MetALD， drinking assessment， the interaction between alcohol use and metabolic dysfunction， and the methods for comprehensive management of MetALD， in order to facilitate learning and provide guidance for clinicians and researchers in clinical practice.

This article summarized clinical experience in differentiating and treating non-obstructive hypertrophic cardiomyopathy （HCM） based on the concept of nourishing the heart and softening the hardness. It is considered that HCM belongs to the category of "heart accumulation"， with the fundamental cause being depletion of the spleen and kidney， and phlegm-stasis accumulation， as well as qi-yin exhaustion， serving as the manifestations. Spleen and kidney depletion leads to the transformation of phlegm and stasis， which accumulate in the heart； over time， this phlegm-stasis accumulation consumes heart qi and yin， resulting in the heart being deprived of nourishment， which eventually leads to the damage to both the function and structure of heart. Therefore， the method of nourishing the heart and softening the hardness is proposed for the treatment of non-obstructive HCM. Emphasis is placed on softening hardness and dissipating masses throughout the entire treatment process， often using Modified Siwei Ruanjian Formula （四味软坚方加减）. During periods with prominent symptoms， the main treatment is boosting qi and nourishing yin to soften hardness and dissipate masses with self-made Yuxin Ruanjian Formula （自拟育心软坚方） in modifications； in stable periods， the main treatment is boosting kidney and fortifying spleen to soften hardness and dissipate masses with self-made Pishen Tongzhi Formula （脾肾同治方） in modifications.

ObjectiveTo analyze the distribution characteristics of traditional Chinese medicine （TCM） syndrome elements in different risk populations of heart failure complicated with type 2 diabetes. MethodsClinical data of 675 type 2 diabetes patients were retrospectively collected. Lasso-multivariate Logistic regression was used to construct a clinical prediction nomogram model. Based on this， 441 non-heart failure patients were divided into a low-risk group （325 cases） and a high-risk group （116 cases） according to the median risk score of heart failure complicated with type 2 diabetes. TCM diagnostic information （four diagnostic methods） was collected for both groups， and factor analysis was applied to summarize the distribution of TCM syndrome elements in different risk populations. ResultsLasso-multivariate Logistic regression analysis identified age， disease duration， coronary heart disease， old myocardial infarction， arrhythmia， absolute neutrophil count， activated partial thromboplastin time， and α-hydroxybutyrate dehydrogenase as independent risk factors for heart failure complicated with type 2 diabetes. These were used as final predictive factors to construct the nomogram model. Model validation results showed that the area under the curve （AUC） of the receiver operating characteristic （ROC） curve for the modeling group and validation group were 0.934 and 0.935， respectively. The Hosmer-Lemeshow test （modeling group P = 0.996， validation group P = 0.121） indicated good model discrimination. Decision curve analysis showed that the curves for All and None crossed in the upper right corner， indicating high clinical utility. The low-risk and high-risk groups each obtained 14 common factors. Preliminary analysis revealed that the main disease elements in the low-risk group were qi deficiency （175 cases， 53.85%）， dampness （118 cases， 36.31%）， and heat （118 cases， 36.31%）， with the primary locations in the spleen （125 cases， 38.46%） and lungs （99 cases， 30.46%）. In the high-risk group， the main disease elements were yang deficiency （73 cases， 62.93%）， blood stasis （68 cases， 58.62%）， and heat （49 cases， 42.24%）， with the primary locations in the kidney （84 cases， 72.41%） and heart （70 cases， 60.34%）. ConclusionThe overall disease characteristics in different risk populations of type 2 diabetes patients with heart failure are a combination of deficiency and excess， with deficiency being predominant. Deficiency and heat are present throughout. The low-risk population mainly shows qi deficiency with dampness and heat， related to the spleen and lungs. The high-risk population shows yang deficiency with blood stasis and heat， related to the kidneys and heart.

Objective:To investigate the clinical efficacy of artificial humeral head replacement versus locking plate internal fixation in the treatment of comminuted proximal humeral fractures in older adult patients. Methods:A total of 30 older adult patients with proximal humeral comminuted fractures, admitted to Beifang Hospital, Huainan Xinhua Medical Group from January 2022 to December 2024, were included in this study. A prospective randomized controlled study design was used. The patients were divided into an observation group and a control group using a random number table method, with 15 patients in each group. The observation group underwent artificial humeral head replacement surgery, while the control group received internal fixation with a proximal humeral locking plate. Clinical treatment outcomes, shoulder joint function recovery, and complications were observed and compared between the two groups.Results:The intraoperative blood loss in the observation group was less than that in the control group [(182.24 ± 24.36) mL vs. (245.17 ± 46.08) mL]. The surgery duration [(71.84 ± 7.52) minutes vs. (93.67 ± 12.50) minutes] and hospital stay [(11.37 ± 1.89) days vs. (13.52 ± 2.67) days] were also significantly shorter in the observation group compared with the control group ( t = 4.68, 5.80, 2.55, all P < 0.05). The range of motion in the shoulder joint was greater in the observation group compared with the control group [forward elevation: (94.47 ± 7.66) ° vs. (86.14 ± 5.15) °, external rotation: (61.35 ± 6.57) ° vs. (52.40 ± 4.82) °, and internal rotation: (74.35 ± 4.80) ° vs. (62.76 ± 3.59) °]. The total Constant-Murley score was higher in the observation group [(92.91 ± 10.58) vs. (76.29 ± 7.48)], and the rate of excellent recovery of shoulder function was also higher in the observation group [73.33% (11/15) vs. 53.33% (8/15)] compared with the control group. The incidence of complications was lower in the observation group [6.66% (1/15) vs. 33.33% (5/15)] compared with the control group. All differences were statistically significant ( t = 3.50, 4.25, 7.49, 4.97, χ2 = 4.12, 5.12, all P < 0.05). Conclusions:For older adult patients with severe osteoporosis or irreparable proximal humeral comminuted fractures, artificial humeral head replacement yields more favorable outcomes compared with locking plate internal fixation, resulting in a better recovery of shoulder joint function.

Objective:To analyze the epidemiological and clinical characteristics of respiratory pathogens in China.Methods:This study was a cross-sectional study, which encompassed 19 core units of the clinical pathogen network and established a three-tiered clinical pathogen surveillance system. Thirty respiratory samples were collected every two weeks from various units from January to December 2024, and the clinical and pathogen diagnostic information were gathered. A total of 11 864 samples were tested using this system. The tier-1 clinical pathogen surveillance system covered influenza A virus (Flu-A), influenza B virus (Flu-B), respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The tier-2 clinical pathogen surveillance system focused on 18 key respiratory pathogens. The tier-3 clinical pathogen surveillance system further clarified whether any emerging infectious diseases had occurred.Results:The tier-1 clinical pathogen surveillance system showed Flu-A predominated in December, Flu-B predominated in January, SARS-CoV-2 peaked in March and August, whereas RSV circulated sporadically throughout the year. Geographic trends were broadly consistent across the seven major regions, although Flu-A detection in December was notably higher in Northeast China (48.1%(111/231)) and East China (36.2%(148/409)), and RSV detection was concentrated in the Northwest and South China from January to March. Data from the tier-2 clinical pathogen surveillance system indicated that Streptococcus pneumoniae, Mycoplasma pneumoniae, rhinovirus, and adenovirus were detected year-round, of these, Streptococcus pneumoniae and rhinovirus showed elevated positive detection rates from August to September, while adenovirus peaked in January. Legionella pneumophila was not detected throughout the year, and other pathogens fluctuated throughout the year without a consistent pattern. The predominant etiologic agents of pediatric pneumonia were Mycoplasma pneumoniae (35.0%(105/300)), rhinovirus (25.7%(77/300)), and adenovirus (17.3%(52/300)), whereas adult pneumonia was mainly caused by Streptococcus pneumoniae (10.5%(29/277)), Staphylococcus aureus (6.9%(19/277)), Mycoplasma pneumoniae (6.9%(19/277)), and Flu-A (6.1%(17/277)). The tier-3 clinical pathogen surveillance system did not identify any emerging respiratory pathogens. Conclusion:Respiratory pathogens in China in 2024 exhibit distinct temporal and spatial distribution patterns and vary among different populations.

Objective:To observe the applying effect of teamwork cooperation model of encephalopathy in the clinical teaching of Neurology.Methods:Sixty undergraduate students who practiced in our hospital were randomly divided into the control group and the experimental group,with 30 students in each group.The control group was arranged for internship according to the traditional department-based model,while the experimental group was arranged according to the teamwork cooperation model of encephalopathy discipline group.The theoretical examination scores and clinical skills scores of the two groups were compared,and the Mini-Clinical Evaluation Exercise(Mini-CEX)scale was used for dual evaluation by teachers and students from seven aspects:inquiry skills,physical examination skills,humanistic care,clinical judgment,communication skills,organizational effectiveness,and overall clinical competence.Result:There were statistically significant differences between the experimental group and the control group in theoretical examination scores,clinical skills scores,and dual evaluation by teachers and students(P＜0.05).Conclusion:Compared with the traditional teaching model,the teamwork cooperation model of encephalopathy discipline group has achieved better results in the clinical teaching of Neurology.

Objective:To explore the repair mechanism of bone marrow stromal cells(BMSCs)transfected with miR-21 in rat sciatic nerve injuries.Methods:In vitro,rat BMSCs were transfected with miR-21 agonist(agomir-21)or blocker(antagomir-21)and their respective empty vectors,respectively,and divided into Control group,agomir-21 group,agomir-NC group,antagomir-21 group and antagomir-NC group.A 12 mm rat sciatic nerve injury model contai-ning decellularized nerve area was prepared,and the cells in each group were labeled with Hoechst33342 for postopera-tive implantation of decellularized nerve area.At 14 d after operation,the recovery of neuromotor function was evaluated by footprint test and the wet weight ratio of gastrocnemius.Immunofluorescence staining was applied to detect the expression of neurofilament protein 200(NF200),myelin basic protein(MBP),S100 calcium binding protein β(S100β)and glial fibrillary acidic protein(GFAP)within the regenerating nerve.Results:Compared with Control group,the sciatic nerve function index(SFI)and the wet weight ratio of gastrocnemius were significantly increased in agomir-21 group(P<0.05);and the density of regenerated nerve fibers and the expression of myelin marker proteins were increased,and the differentiation rate of BMSCs into Schwann cell-like cells(SCLCs)was elevated significantly(P<0.05).Conclusion:miR-21 significantly promotes peripheral nerve regeneration by enhancing the differentiation of BMSCs into SCLCs in vivo.