ObjectiveTo investigate the regulatory effects and underlying mechanisms of Liuhuang Zhike prescription （LHZK） on blood glucose in type 2 diabetic db/db mice based on the AMP-activated protein kinase/protein kinase B/glycogen synthase kinase-3β （AMPK/Akt/GSK-3β） signaling pathway. MethodsDb/db mice were used as the model animals， and db/m mice served as the blank control. Forty db/db mice were randomly divided into the model group， metformin group （0.14 g·kg^-1）， and low-， medium-， and high-dose （4.11， 8.21， 16.43 g·kg^-1） LHZK groups， with 8 mice in each group. The db/db mice in the metformin and LHZK groups were administered the corresponding drugs by gavage， while the blank control and model groups were given distilled water by gavage once daily for 8 consecutive weeks. Food intake， water consumption， body weight， and fasting blood glucose （FBG） were measured weekly. An automatic biochemical analyzer was used to determine glycated serum protein （GSP）， serum triglycerides （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C） levels. Hematoxylin-eosin （HE） staining was used to observe pathological morphological changes in the liver and pancreatic tissues. Oil red O staining was used to assess lipid accumulation in liver tissue. The anthrone colorimetric method was used to determine hepatic glycogen content. Real-time quantitative PCR （Real-time PCR） was used to detect the mRNA expression levels of insulin receptor substrate-1 （IRS-1）， Akt2， phosphoenolpyruvate carboxykinase （PEPCK）， and glucose-6-phosphatase （G6Pase） in liver tissue. Western blot was used to detect the protein expression of AMPKα， phosphorylated AMPKα （p-AMPKα）， GSK-3β， p-GSK-3β， glycogen synthase （GS）， and phosphorylated GS （p-GS） in liver tissue. ResultsCompared with the blank control group， the model group showed significantly increased food intake， water consumption， body weight， FBG， and GSP levels （P<0.01）. Pancreatic islets exhibited marked parenchymal cell hyperplasia and interstitial inflammatory cell infiltration. Liver tissue showed obvious steatosis， accompanied by a compensatory increase in hepatic glycogen content （P<0.01）. Hepatic G6Pase mRNA expression was increased， while IRS-1 and Akt2 mRNA expression levels were significantly decreased （P<0.01）. The p-AMPKα/AMPKα protein expression ratio showed a decreasing trend， whereas the p-GSK-3β/GSK-3β and p-GS/GS protein expression ratios were significantly increased （P<0.01）. Compared with the model group， food intake and water consumption showed decreasing trends in all treatment groups. Food intake was significantly reduced in the low- and high-dose LHZK groups and in the metformin group （P<0.05， P<0.01）， and water consumption was significantly reduced in the low-dose LHZK group and in the metformin group （P<0.05， P<0.01）. No statistically significant differences in body weight were observed among the LHZK groups， whereas body weight in the metformin group was significantly increased （P<0.05， P<0.01）. FBG showed a decreasing trend in all treatment groups， with significant decreases in the low-dose LHZK group and the metformin group （P<0.05， P<0.01）. GSP levels were significantly reduced in the low-dose LHZK group and in the metformin group （P<0.05， P<0.01）. Hepatic steatosis and pancreatic pathological injury were alleviated to varying degrees in all treatment groups. Hepatic glycogen content further increased in all treatment groups， with significant increases in the medium- and high-dose LHZK groups （P<0.05）. Real-time PCR results showed that all treatment groups downregulated the mRNA expression of G6Pase and PEPCK in the liver tissues of db/db mice， with significant downregulation of PEPCK mRNA in the low-dose LHZK and metformin groups （P<0.01）. Meanwhile， all treatment groups upregulated IRS-1 and Akt2 mRNA expression， with the most pronounced upregulation observed in the medium-dose LHZK group （P<0.01）. The p-AMPKα/AMPKα protein expression ratio was significantly increased in the low- and medium-dose LHZK groups （P<0.01）. The p-GSK-3β/GSK-3β protein expression ratio was significantly increased in all treatment groups （P<0.05， P<0.01）， whereas the p-GS/GS protein expression ratio was significantly decreased in all treatment groups （P<0.01）. ConclusionLHZK effectively reduces FBG and GSP levels in type 2 diabetic mice and improves hepatic steatosis and pancreatic islet pathological injury. Its hypoglycemic mechanism may be associated with regulation of the AMPK/Akt/GSK-3β signaling pathway and promotion of hepatic glycogen synthesis.

ObjectiveTo develop a standardized classification model for traditional Chinese medicine （TCM） syndrome patterns of mixed hemorrhoids using multi-center real-world data， and unveil their distribution patterns and core risk factors， thereby providing evidence-based support for standardizing TCM syndrome differentiation and implementing precision interventions. MethodsA multi-center cross-sectional study was conducted， enrolling 13 283 mixed hemorrhoid patients from eight hospitals in Jiangsu Province between September 1st， 2023 and December 31st， 2024. DeepSeek-R1-Distill-Qwen-7B and LLaMA-3.3 large language models （LLM） were integrated with latent class analysis （LCA） to perform unsupervised learning and latent class modeling of TCM symptomatology. Potential risk factors were screened via univariate analysis， followed by logistic regression to identify independent risk factors for each syndrome pattern. ResultsThe model's performance indicators were stable and reliable across different clinical data types，i.e. in the outpatient records， past medical history （F1=99.7%）， current medical history （F1=94.9%）， and specialist examination （F1=90.7%）； in inpatient records， past medical history （F1=98.2%）， current medical history （F1=91.2%）， specialist examination （F1=90.3%）， and discharge status （F1=90.6%）. Latent class mode-ling identified four core TCM syndrome patterns including spleen deficiency and qi sinking syndrome （915 cases， 6.89%）， damp-heat pouring downward syndrome （10 820 cases， 81.46%）， qi stagnation and blood stasis syndrome （1252 cases， 9.43%）， and wind injuring intestinal collaterals syndrome （296 cases， 2.22%）， with respective latent class probabilities of 0.069， 0.815， 0.094， and 0.022. Logistic regression demonstrated that gender， age， disease duration， hypertension， diabetes， hyperlipidemia， constipation， smoking history， and alcohol consumption were independent risk factors for pattern differentiation （P＜0.05）. The efficacy validation evaluation revealed that the cure rates for patients with spleen deficiency and qi sinking syndrome and qi stagnation and blood stasis syndrome were higher than those for patients with damp-heat pouring downward syndrome （adjusted P＜0.05）， with no statistically significant differences among other syndrome patterns. ConclusionDamp-heat pouring downward syndrome is the predominant syndrome in mixed hemorrhoids. Gender， age， disease duration， hypertension， diabetes， hyperlipi-demia， constipation， smoking history， and alcohol consumption are independent risk factors for the differentiation of syndrome types.

ObjectiveTo investigate the association between insulin resistance （IR） and cardiovascular metabolic indicators， including blood pressure， blood lipids， and serum uric acid， in a middle-aged population. MethodsBased on the baseline survey of the Hong Sifang cohort of China National Salt Industry Group， a total of 575 participants were included. According to the homeostasis model assessment of insulin resistance， the participants were divided into an IR group （n=116） and a non-IR group （n=459）. Differences between the two groups were compared using the t-test and chi-square test. Multivariate logistic regression analysis was performed to evaluate the associations between IR and abnormalities in metabolic indicators. ResultsA total of 575 participants were included， including 390 men and 185 women， with a mean age of （48.58 ± 5.14） years and a mean body mass index （BMI） of （24.16 ± 2.97） kg/m². Blood pressure， serum uric acid， and blood lipid levels were significantly higher in the IR group than in the non-IR group （P<0.001）. After adjusting for potential confounders including age， sex， and BMI， IR was independently associated with hypertension， dyslipidemia， and hyperuricemia， with odds ratios （OR） and 95% confidence intervals （CI） of 2.57 （1.61-4.09）， 3.81 （2.36-6.17）， and 2.68 （1.53-4.71）， respectively （all P<0.001）. ConclusionInsulin resistance is significantly associated with multiple cardiovascular metabolic risk factors in the middle-aged population. Monitoring IR may contribute to the early prevention and control of cardiovascular diseases.

Objective To analyze the technical essentials of single-microport assisted micro-uni-port thoracoscopic surgery, and to investigate its surgical efficacy and promotional value. Methods Clinical data of patients who consecutively underwent radical upper lobectomy in the Department of Thoracic Surgery of Xi'an International Medical Center Hospital from March 2023 to June 2024 were retrospectively analyzed. According to the surgical approach, patients were divided into two groups: the single-microport assisted group (underwent upper lobectomy via single-microport assisted micro-uni-port thoracoscopy) and the traditional uniportal group (underwent traditional uniportal thoracoscopic lobectomy). Clinical outcomes were compared between the two groups. Results A total of 62 patients were enrolled. There were 30 patients in the single-microport assisted group, with a mean age of (57.4±10.8) years, and 32 patients in the traditional uniportal thoracoscopic group, with a mean age of (57.6±8.7) years. The baseline data were comparable between the two groups. All patients in both groups successfully underwent minimally invasive surgery without conversion to thoracotomy. The operative time in the single-microport assisted group was significantly shorter than that in the traditional uniportal group [(146.03±30.79) min vs. (171.41±36.41) min, P=0.004]. However, there were no statistically significant differences between the two groups in intraoperative blood loss, number of dissected lymph nodes, duration of chest tube drainage, postoperative pain score, postoperative hospital stay, hospitalization cost, or incidence of postoperative complications (all P>0.05). Conclusion Single-microport assisted micro-uni-port thoracoscopic surgery for upper lobectomy can maximally integrate the advantages of three-port and uni-port VATS while effectively avoiding their disadvantages. It significantly shortens the operative time without increasing postoperative pain or complications, and represents a more minimally invasive, safer, and more convenient surgical approach.

It focuses on the lean management of cost accounting in public hospitals,indexed by the"technology-management-economy-paradigm",and explores the new quality productivity of cost accounting in public hospitals from the perspective of emerging technology applications and cost accounting management paradigm innovation.On the one hand,the application of emerging technologies in the field of cost accounting explains how new quality productivity empowers the lean development of cost accounting;on the other hand,it explores the multi-stage layered model of project cost accounting,the theoretical application of technology allocation coefficient method,and the innovation of departmental cost management paradigm,in order to explore new quality productivity in hospital cost accounting.Under the guidance of new quality productivity,taking emerging technologies and management paradigms as the starting point,exploring the path of lean cost accounting innovation,opening up new breakthroughs for improving the quality and efficiency of operational management,and further deepening the high-quality development of hospitals.

OBJECTIVE To investigate the molecular epidemiological characteristics of clinical isolates of carbapen-em-resistant Klebsiella pneumoniae(CRKP)resistant to ceftazidime/avibactam(CZA).METHODS From Jan.2022 to Dec.2023,totally 63 strains of non-repetitive CZA-resistant CRKP that were isolated for the first time from hospitalized patients of the First Affiliated Hospital of Nanchang University were enrolled in the study,and 50 strains of CZA-sensitive CRKP were randomly chosen as the research subjects.The drug susceptibility rates of the strains were observed.The drug resistance genes,virulence genes and capsular serotypes of the strains were detected by means of polymerase chain reaction(PCR).The molecular epidemiological characteristics of the strains were observed by using molecular biological techniques such as pulse field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).RESULTS Among the CZA-resistant CRKP strains,45(71.43％)were iso-lated from sputum.The result of drug susceptibility testing showed that the drug resistance rates of the CZA-re-sistant strains to amikacin,aztreonam and minocycline were lower than those of the CZA-sensitive strains(P＜0.05),and the drug resistance rates of the CZA-resistant strains to tigecycline was higher than that of the CAZ-sensitive strains(P＜0.05).The carrying rates of blaKPC,blaNDM,blaSHV-1,blaTEM-1,blaCTX-M,blaqnrS,blaacc(6')-Ib and blarmtB genes of the CZA-resistant strains were relatively high.Among the detected capsular serotypes,K64(n=18,28.57％)was dominant.ST11(n=25,39.68％)was predominant strain among the CZA-resistant CRKP strains.CONCLUSIONS ST11 is dominant among the CZA-resistant CRKP strains.The strains carry with multiple drug resistance genes and virulence genes.The drug resistance rate of the CZA-resistant strains to tigecycline is higher than that of the CZA-sensitive strains,and it is necessary to attach great importance during the clinical treatment.

Locally advanced thyroid cancer (LATC) can seriously invade the important organs of the neck, such as the trachea, esophagus and carotid artery, and has a poor prognosis. It is one of the leading causes of death in thyroid cancer. Diagnosis and treatment for LATC often involve multidisciplinary fields, the difficulty and risk of surgical are very high, and high-quality multidisciplinary comprehensive diagnosis and treatment can obtain a better prognosis. In order to realize the proceduralization, standardization and normalization of the LATC diagnosis and treatment model, the seven-step method for diagnosis and treatment of LATC is summarized by our center.

[Objective]Our study seeks to investigate the connection between systemic immune inflammatory index and renal function,as well as to assess its predictive capacity for the deterioration of renal function in chronic kidney disease patients with non-dialysis.[Methods]Adult non-dialyzing patients diagnosed with CKD were included.The computation of SII was calculated as the product of the peripheral blood neutrophil count(×10?/L)and platelet count(×10?/L),divided by the lymphocyte count(×10?/L).The logistic and Cox regression models were employed to scrutinize the linkage between SII levels and CKD.[Results]Out of the cohort,a significant portion of patients,numbering 244,which constitutes 17.2％,experienced progression of CKD.A notable upsurge in SII corresponded with an increased prevalence of advanced CKD and its progression,with significant difference.This trend was mirrored by a decline in the estimated glomerular filtration rate and hemoglobin levels,while serum creatinine,C-reactive protein,and lipoprotein(a)levels were on the rise.After adjusting for multiple variables,the natural logarithm of SII exhibited an independent association with advanced CKD[OR=1.85 95％CI(1.46,2.35),P<0.01].Furthermore,Cox proportional hazards model analysis revealed that SII acted as an independent predictor for CKD progression[adjusted HR=1.35,95％CI(1.09,1.67),P<0.01].Subgroup analysis indicated a significant interaction among SII,gender,and hypertension concerning CKD progression.[Conclusion]Our findings underscore the robust relationship between SII and renal function,positioning SII as a potential forecaster for the progression of CKD.

Objective To investigate the possible association between cross-domain associative memory(AM)impairment and hippocampal subfield volumes in patients with schizophrenia(SCZ).Methods We enrolled 28 SCZ patients from Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,and 28 healthy controls(HCs)between 2019 and 2021.Based on an innovative AM paradigm and automated segmentation,3D-T1 weighted data of the objects were processed with PhiPipe and FreeSurfer.Differences in subfield volums between the two groups were analyzed using ANCOVA,while their relationship with AM scores was assessed using Pearson correlation.Results SCZ patients exhibited significantly poorer AM performance across three conditions compared with HCs.Marginally significant reductions were observed in the total volume of bilateral hippocampus,encompassing both the hippocampal head and body.Significant volume reductions were identified in the bilateral presubiculum and parasubiculum.The volumes of bilateral presubiculum head(r=0.273,P=0.042),parasubiculum(r=0.397,P=0.002),and CA1 head(r=0.382,P=0.004)exhibited positive correlations with cross-domain AM performance.Conclusion The bilateral presubiculum and parasubiculum,as hippocampal subregions significantly associated with cross-modal AM deficits in SCZ,may play a crucial role in the pathology of AM.

Objective:To explore patterns of traditional Chinese medicine (TCM) use among patients with inflammatory bowel disease (IBD) in Jiangsu Province, China from 2019 to 2023.Methods:Using data from the IBD health data platform of the National Healthcare Big Data (Eastern) Center, a retrospective cohort study was conducted. We performed descriptive analyses on hospitalised patients diagnosed with IBD between 2019 and 2023, who received TCM treatment.Results:The study included 11 095 case records from 4 760 patients, with TCM diagnoses primarily indicating diarrhoea and abdominal pain. Ulcerative colitis (UC) accounted for 4 782 hospitalizations (3 103 patients), while Crohn's disease (CD) accounted for 6 313 hospitalizations (1 657 patients). Patient demographics showed a trend towards younger age and a higher proportion of males. Treatment utilisation was highest in southern Jiangsu compared with the central and northern regions. In terms of disease burden, all treatment costs showed a downward trend. In terms of external TCM therapies, UC patients tend to prefer plasters and enemas, while CD patients are more inclined to use acupuncture. Regarding herbal medicine, licorice, white atractylodes, and white peony root are commonly used single herbs for IBD patients.Conclusions:The number of IBD patients treated with TCM in Jiangsu Province has steadily increased from 2019 to 2023. It is important to identify effective TCM treatment methods to reduce the burden of patients.