ObjectiveTo investigate the clinical effect of Ershen Zhenwu Decoction on chronic heart failure （CHF） due to heart-kidney Yang deficiency and blood stasis and its regulatory effects on miR-423-5p/Smad7/transforming growth factor-β₁ （TGF-β₁）/Smads axis and myocardial fibrosis indicators. MethodsOne hundred and fourteen patients with heart failure with reduced ejection fraction （HFrEF） and heart failure with mildly reduced ejection fraction （HFmrEF） were randomly allocated into a control group and an observation group. The control group was treated with dapagliflozin tablets， sacubitril-valsartan sodium tablets， metoprolol succinate， and spironolactone， and the observation group was treated with Ershen Zhenwu Decoction on the basis of the therapy in the control group. The course of treatment was 8 weeks in both groups. The 6-min walking distance， New York Heart Association （NYHA） heart function grade， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， angiotensin Ⅱ （Ang Ⅱ）， left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter （LVIDd）， left ventricular end-systolic diameter （LVIDs）， interventricular septum thickness at diastole （IVSd）， left ventricular end-diastolic posterior wall thickness （LVPWd）， left ventricular shortening fraction （FS）， miR-423-5p， Smad7， Smad2， Smad3， Smad4， TGF-β₁， Ang Ⅱ， type Ⅰ collagen （Col Ⅰ）， type Ⅲ collagen （Col Ⅲ）， mRNA levels of fibronectin （Fn） and α-smooth muscle actin （α-SMA） in the myocardial tissue were observed before and after treatment in both groups to evaluate the efficacy of cardiac function and drug safety. ResultsAfter treatment， both groups showed declined levels of NT-proBNP， Ang Ⅱ， miR-423-5p， Smad2， Smad3， Smad4， TGF-β₁， Col Ⅰ， Col Ⅲ， and mRNA levels of Fn and α-SMA （P0.05）， and the levels of the indicators above were lower in the observation group than in the control group （P0.05）. After treatment， the Smad7 level increased obviously in both groups （P0.05） and was higher in the observation group than in the control group （P0.05）. After treatment， both groups showed decreased MLHFQ scores and increased 6-min walking distance （P0.05）， and the observation group had lower MLHFQ score and longer 6-min walking distance than the control group （P0.05）. After treatment， the control group showed increased LVEF and FS （P0.05） and the observation group showcased decreased LVIDd and LVIDs and increased LVEF and FS （P0.05）. Moreover， the observation group had lower LVIDd and LVIDs （P0.05） and higher LVEF and FS （P0.05） than the control group. The total response rate of cardiac function in the observation group was 90.38% （47/52）， which was higher than that （70.59%， 36/51） in the control group （P0.05）. No adverse reactions associated with Ershen Zhenwu Decoction were observed during the study period. ConclusionErshen Zhenwu Decoction can improve the cardiac function， exercise tolerance， and quality of life， regulate neuroendocrine factors， and slow down/reverse myocardial remodeling in the patients with HFrEF and HFmrEF （syndrome of heart-kidney Yang deficiency and blood stasis by regulating the miR-423-5p/Smad7/TGF-β₁/Smads axis， inhibiting α-SMA and Fn expression， and alleviating myocardial fibrosis. It is worthy of further study.

ObjectiveTo investigate the clinical effect of Ershen Zhenwu Decoction on chronic heart failure （CHF） due to heart-kidney Yang deficiency and blood stasis and its regulatory effects on miR-423-5p/Smad7/transforming growth factor-β₁ （TGF-β₁）/Smads axis and myocardial fibrosis indicators. MethodsOne hundred and fourteen patients with heart failure with reduced ejection fraction （HFrEF） and heart failure with mildly reduced ejection fraction （HFmrEF） were randomly allocated into a control group and an observation group. The control group was treated with dapagliflozin tablets， sacubitril-valsartan sodium tablets， metoprolol succinate， and spironolactone， and the observation group was treated with Ershen Zhenwu Decoction on the basis of the therapy in the control group. The course of treatment was 8 weeks in both groups. The 6-min walking distance， New York Heart Association （NYHA） heart function grade， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， angiotensin Ⅱ （Ang Ⅱ）， left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter （LVIDd）， left ventricular end-systolic diameter （LVIDs）， interventricular septum thickness at diastole （IVSd）， left ventricular end-diastolic posterior wall thickness （LVPWd）， left ventricular shortening fraction （FS）， miR-423-5p， Smad7， Smad2， Smad3， Smad4， TGF-β₁， Ang Ⅱ， type Ⅰ collagen （Col Ⅰ）， type Ⅲ collagen （Col Ⅲ）， mRNA levels of fibronectin （Fn） and α-smooth muscle actin （α-SMA） in the myocardial tissue were observed before and after treatment in both groups to evaluate the efficacy of cardiac function and drug safety. ResultsAfter treatment， both groups showed declined levels of NT-proBNP， Ang Ⅱ， miR-423-5p， Smad2， Smad3， Smad4， TGF-β₁， Col Ⅰ， Col Ⅲ， and mRNA levels of Fn and α-SMA （P0.05）， and the levels of the indicators above were lower in the observation group than in the control group （P0.05）. After treatment， the Smad7 level increased obviously in both groups （P0.05） and was higher in the observation group than in the control group （P0.05）. After treatment， both groups showed decreased MLHFQ scores and increased 6-min walking distance （P0.05）， and the observation group had lower MLHFQ score and longer 6-min walking distance than the control group （P0.05）. After treatment， the control group showed increased LVEF and FS （P0.05） and the observation group showcased decreased LVIDd and LVIDs and increased LVEF and FS （P0.05）. Moreover， the observation group had lower LVIDd and LVIDs （P0.05） and higher LVEF and FS （P0.05） than the control group. The total response rate of cardiac function in the observation group was 90.38% （47/52）， which was higher than that （70.59%， 36/51） in the control group （P0.05）. No adverse reactions associated with Ershen Zhenwu Decoction were observed during the study period. ConclusionErshen Zhenwu Decoction can improve the cardiac function， exercise tolerance， and quality of life， regulate neuroendocrine factors， and slow down/reverse myocardial remodeling in the patients with HFrEF and HFmrEF （syndrome of heart-kidney Yang deficiency and blood stasis by regulating the miR-423-5p/Smad7/TGF-β₁/Smads axis， inhibiting α-SMA and Fn expression， and alleviating myocardial fibrosis. It is worthy of further study.

ObjectiveQi deficiency and phlegm dampness syndrome is a common type of clinical traditional Chinese medicine（TCM） syndrome. However， there is no standard， scientific， and accurate report on the construction of animal models of Qi deficiency and phlegm dampness syndrome. This study aims to construct a mouse model of Qi deficiency and phlegm dampness syndrome by using a multi-factor composite modeling method and to evaluate the model. MethodsTwenty-one C57BL/6 mice were randomly divided into three groups with seven mice in each group， which were the normal group， model group， and Shenling Baizhusan （SLBZ） group. The control group was fed with ordinary diet and kept in a normal environment. The model group and SLBZ group were fed with a high-fat diet in a high-humidity environment. Swimming with heavy weights until exhaustion and gavage with cold water or lard were used to establish the mouse model of Qi deficiency and phlegm dampness syndrome. In order to test the syndrome by prescription， mice in the SLBZ group were treated with SLBZ for 14 days after model construction. The exhaustive swimming time， body weight， serum lipid levels， tongue changes， "Qi deficiency and phlegm dampness" assessment scale score， and cecal index of mice in each group were measured. The feces of each group of mice were sent for metagenomics and metabolome sequencing， and the changes in intestinal flora and metabolites were analyzed. ResultsAfter the modeling of Qi deficiency and phlegm dampness syndrome， the exhaustive swimming time of mice was obviously shortened （P<0.01）. The serum total cholesterol， low density lipoprotein cholesterol， and non-high density lipoprotein cholesterol of mice were significantly increased （all P<0.01）. The tongue of mice was significantly different from that of the normal group， and the score of the assessment scale was significantly higher than that of the control group （P<0.01）. Cecal index decreased significantly （P<0.01）. The serum lipid level， tongue image， assessment scale score， and cecal index were reversed in the SLBZ group. Metagenomic and metabolome sequencing results showed that intestinal flora and fecal metabolites were significantly changed in mice with Qi deficiency and phlegm dampness syndrome. Akkermansia_muciniphila， Faecalibaculum_rodentium， Eubacterium_plexicaudatum， Eubacterium sp 14_2， Candida glabrata， Romboutsia_ilealis， Turicibacter sp TS3， and other bacteria had significant changes， and the expressions of intestinal metabolites such as chenodeoxycholic acid， choline， L-phenylalanine betaine， and 2-phenylbutyric acid were significantly changed. Related metabolic pathways such as linoleic acid metabolism， primary bile acid biosynthesis， lysine degradation， arginine biosynthesis， and alpha-linolenic acid metabolism were affected. ConclusionThe Qi deficiency and phlegm dampness model of mice can be constructed by the multi-factor composite modeling method of high-fat diet feeding， high-humidity environment feeding， exhaustive swimming with heavy weight， and intragastric administration with cold water or lard. The blood lipid level， tongue change， score of "Qi deficiency and phlegm dampness assessment scale"， cecal index， and changes in related intestinal flora and metabolites of mice can be used as key indicators for model evaluation.

To summarize the distribution characteristics of human papillomavirus(HPV) infection types in patients with cervical squamous intraepithelial lesion(SIL) and cervical cancer(CC), and to explore the impact of HPV vaccination, HPV infection types, and general clinical data on different grades of cervical lesions.

Objective To explore the latent classes and influencing factors of blood glucose trajectories after transplantation in lung transplantation patients,and provide references for identifying high-risk population of post-transplant diabetes mellitus.Methods 122 lung transplantation patients who were hospitalized in a tertiary A general hospital in Hangzhou from January 2022 to March 2023 were selected conveniently as survey subjects.Socio-demographic and disease-related data were collected,and fasting plasma glucose at 1 week before surgery(T0),1 week after surgery(T1),1 month after surgery(T2),3 months after surgery(T3),6 months after surgery(T4),1 year after surgery(T5)were collected.Growth mixture model was used to identify categories of blood glucose trajectories after lung transplantation,and binary Logistic regression analysis was used to explore the influencing factors.Results A total of 109 lung transplantation patients were enrolled in the study,and 2 latent classes of blood glucose trajectories were identified:high risk(23.85％)and low risk(76.15％)of post-transplant diabetes mellitus.BMI,drinking history,afternoon blood glucose and tacrolimus trough concentration were the influencing factors of latent classes of blood glucose trajectories after lung transplantation(all P＜0.05).Conclusion There are 2 latent classes of blood glucose trajectories after lung transplantation,namely high risk and low risk of post-transplant diabetes mellitus.Medical staff should pay attention to diabetes screening and assessment of lung transplantation patients who are overweight or obese,have a drinking history before transplantation,have high afternoon blood glucose in early stage of transplantation and have high tacrolimus trough concentration in stable stage of transplantation,so as to formulate a comprehensive and individualized blood glucose management program.

This paper summarizes the nursing experience of a pregnant woman with congenital heart disease who developed pulmonary artery hypertension crisis after cesarean section.Nursing key points:monitoring and management of inhaled nitric oxide therapy to reduce pulmonary hypertension;providing sequential respiratory support care and dynamically adjusting oxygen therapy regimen;precise volume regulation and alertness to serious complications;optimizing puerperal supervision strategy to reduce the risk of infection;preventing and controlling stress bleeding and implementing a stepped dietary management strategy;implementing phased rehabilitation training to accelerate the recovery process;carrying out personalized psychological care and health education.With comprehensive nursing care,the patient recovered well and was discharged smoothly after an 18-day hospital stay.

Objective This study aimed to develop and empirically evaluate a sarcopenia management program for lung transplant candidates based on the Transtheoretical Model(TTM).The objective was to improve preopera-tive muscle condition and enhance patients' tolerance to lung transplantation.Methods Using the TTM as the the-oretical framework,the sarcopenia management program was developed through a literature review and 2 rounds of expert consultations.A convenience sampling method was employed to recruit inpatients from the lung transplant department of a tertiary hospital in Zhejiang Province between January 2022 and January 2024.Patients admitted between February 2023 and January 2024 were assigned to an intervention group,while those admitted between January 2022 and January 2023 were allocated to a control group.The intervention group received an 8-week sar-copenia management program based on the TTM in addition to standard prehabilitation care,whereas the control group received only standard prehabilitation care.Outcome measurements included pre-and post-intervention com-parisons of the modified Strength,Assistance with Walking,Rise from a Chair,Climb Stairs,Falls,and Calf Circum-ference(SARC-CalF)score,handgrip strength,6-minute walking distance(6MWD),and upper arm circumference,as well as their respective changes before and after the intervention.Additionally,stage-based behavioral change as-sessment and adverse event incidence were compared between the 2 groups.Results A total of 8 patients from the intervention group and 9 from the control group dropped out,resulting in a final sample of 32 patients in the intervention group and 31 in the control group.Compared to the control group,the intervention group demonstrated significantly greater improvements in SARC-CalF scores,handgrip strength,6MWD,and upper arm circumference(P＜0.05).After the intervention,the intervention group had a statistically significant difference in behavioral stage tran-sition compared to the control group(P＜0.05).During the intervention process,neither group experienced any ad-verse events.Conclusion The sarcopenia management program based on the TTM effectively improved patient ad-herence,enhanced preoperative muscle condition,and demonstrated potential benefits in improving physical function and nutritional status.

With the rapid development of generative artificial intelligence(GAI)technologies,their widespread application in academic research and writing is continuously expanding the boundaries of sci-entific inquiry.However,this trend has also raised a series of ethical and regulatory challenges,inclu-ding issues related to authorship,content authenticity,citation accuracy,and accountability.In light of the growing involvement of AI in generating academic content,establishing an open,controllable,and trustworthy ethical governance framework has become a key task for safeguarding research integrity and maintaining trust within the academic community.This expert consensus outlines ethical requirements across key stages of AI-assisted academic writing-including topic selection,data management,citation practices,and authorship attribution.It aims to clarify the boundaries and ethical obligations surrounding AI use in academic writing,ensuring that technological tools enhance efficiency without compromising in-tegrity.The goal is to provide guidance and institutional support for building a responsible and sustainable research ecosystem.

Biliary tract carcinoma (BTC) is a highly aggressive malignancy,and the majority of patients present with advanced stage at first diagnosis which resulting in poor prognosis. Traditional chemotherapy and monotherapy have shown limited efficacy in treating BTC. However,with the continuous emergence of clinical research findings and updates to relevant guidelines,there have been some breakthroughs in systemic therapies for BTC. This paper analyzes domestic and international literature on neoadjuvant therapy and conversion therapy for BTC,aiming to provide a reference for clinical research. Overall,research on neoadjuvant therapy and conversion therapy remains in the preliminary exploration phase. Current evidence suggests that combination strategies involving immunotherapy and chemotherapy,with or without targeted therapy,have demonstrated promising clinical efficacy,offering new hope for neoadjuvant therapy and conversion therapy in BTC. Furthermore,the evolution of precision targeted therapies offers better opportunities for personalized treatment,and the combination of local interventions and systemic therapies demonstrates promising therapeutic potential. However,the optimal strategies and timing for surgery of neoadjuvant therapy and conversion therapy have not yet been standardized. Moreover,most studies lack precise designs to address the heterogeneity of BTC,new therapies have not yet reached the ideal stage of personalized treatment,further research is warranted to address these challenges.

Objective:To investigate the application value of dual-layer detector spectral CT in the precise outlining of gross tumor volume (GTV) in lung cancer patients.Methods:Imaging data of 39 patients with pathologically confirmed lung cancer on dual-energy enhanced CT scans in Hebei Medical University Third Hospital were retrospectively analyzed. Among them, 13 patients were not complicated with lung atelectasis and 26 cases were complicated with lung atelectasis and 9 of them received positron emission computed tomography (PET-CT) scan. The virtual single-energy images of arterial and venous dual-phase 40 keV images were reconstructed with the spectral base images of Iqon dual-energy CT, and the GTV of the primary foci was outlined using the reconstructed images and conventional enhanced CT images. The GTV outlined by conventional enhanced CT image, 40 keV virtual monoenergetic (VM) CT image, 40 keV VM-iodine density (VM-ID) fusion image in the arterial phase, conventional enhanced CT image, 40 keV VM image and 40 keV VM-ID image in the venous phase and PET-CT image was defined as GTV ACT, GTV A40VM, GTV A40VMID, GTV VCT, GTV V40VM, GTV V40VMID and GTV PET-CT, respectively. The consistency of target area outlining was assessed by calculating the GTV volume, the Dice similarity coefficient (DSC), and the 95 th percentile of the Hausdorff distance (HD95). Pairwise comparison among groups was conducted by Friedman test and corrected by Bonferroni correction. Results:In GTV comparisons, the differences in GTV ACT, GTV VCT, GTV A40VM and GTV V40VM in patients without pulmonary atelectasis were not statistically significant ( χ2=1.89, P=0.595). The DSC and HD95 of GTV ACTvs. GTV A40VM were 0.96 and 3.00, and the DSC and HD95 of GTV VCTvs. GTV V40VM were 0.94 and 2.93, respectively. The differences in GTV ACT, GTV A40VM, GTV A40VMID, GTV VCT, GTV V40VM, GTV V40VMID and GTV PET-CT in patients complicated with pulmonary atelectasis were statistically significant (all P<0.001). Pairwise comparison of Bonferroni correction showed that there was no statistically significant difference in GTV A40VM, GTV A40VMID, GTV V40VM, GTV V40VMID and GTV PET-CT (all P=1.000), all of which were significantly smaller than those of GTV ACT and GTV VCT (both P=0.001), and there was no statistically significant difference between GTV ACT and GTV VCT (both P=1.000). Based on the tumor extent shown by PET-CT (standardized uptake value =2.5), DSC were slightly higher and HD95 were slightly lower than conventional enhanced CT of GTV A40VM, GTV V40VM, GTV A40VMID, GTV V40VMIDvs. GTV PET-CT, respectively. When the arterial phase sequences were compared with PET-CT, pairwise comparison of Bonferroni correction showed that the DSC and HD95 of GTV A40VMvs. GTV PET-CT and GTV ACTvs. GTV PET-CT were statistically significant (both P<0.01), and the differences were not statistically significant among the remaining groups (all P>0.05). When intravenous phase sequences were compared with PET-CT, pairwise comparison of Bonferroni correction revealed that the DSC and HD95 of GTV V40VMIDvs. GTV PET-CT and GTV VCTvs. GTV PET-CT were statistically significant (both P<0.01), and the differences were not statistically significant among the remaining groups (all P>0.05). Conclusions:The use of 40 keV VMI-ID fusion images to outline the target area of the primary tumor lesions is closer to that of PET-CT, which provides a novel option for the precise outlining of the target area of clinical radiotherapy.