ObjectiveTo explore the construction of a machine learning model for the diagnosis of traditional Chinese medicine （TCM） syndromes in chronic cough and the optimization of this model using the Voting ensemble algorithm. MethodsA retrospective analysis was conducted using clinical data from 921 patients with chronic cough treated at the Respiratory Department of Dongfang Hospital， Beijing University of Chinese Medicine. After standardized processing， 84 clinical features were extracted to determine TCM syndrome types. A specialized dataset for TCM syndrome diagnosis in chronic cough was formed by selecting syndrome types with more than 50 cases. The synthetic minority over-sampling technique （SMOTE） was employed to balance the dataset. Four base models， logistic regression （LR）， decision tree （dt）， multilayer perceptron （MLP）， and Bagging， were constructed and integrated using a hard voting strategy to form a Voting ensemble model. Model performance was evaluated using accuracy， recall， precision， F1-score， receiver operating characteristic （ROC） curve， area under the curve （AUC）， and confusion matrix. ResultsAmong the 921 cases， six syndrome types had over 50 cases each， phlegm-heat obstructing the lung （294 cases）， wind pathogen latent in the lung （103 cases）， cold-phlegm obstructing the lung （102 cases）， damp-heat stagnating in the lung （64 cases）， lung yang deficiency （54 cases）， and phlegm-damp obstructing the lung （53 cases）， yielding a total of 670 cases in the specialized dataset. High-frequency symptoms among these patients included cough， expectoration， odor-induced cough， throat itchiness， itch-induced cough， and cough triggered by cold wind. Among the four base models， the MLP model showed the best diagnostic performance （test accuracy： 0.9104； AUC： 0.9828）. Compared with the base models， the Voting ensemble model achieved superior performance with an accuracy of 0.9289 on the training set and 0.9253 on the test set， showing a minimal overfitting gap of 0.0036. It also achieved the highest AUC （0.9836） in the test set， outperforming all base models. The model exhi-bited especially strong diagnostic performance for damp-heat stagnating in the lung （AUC： 0.9984） and wind pathogen latent in the lung （AUC： 0.9970）. ConclusionThe Voting ensemble algorithm effectively integrates the strengths of multiple machine learning models， resulting in an optimized diagnostic model for TCM syndromes in chronic cough with high accuracy and enhanced generalization ability.

Objective To assess mid- and long-term outcomes of ascending aortic wrapping (AAW) in adult patients undergoing aortic valve replacement (AVR). Methods We retrospectively analyzed clinical data of adult patients who underwent AVR and AAW in Fuwai Hospital from January 2010 to August 2019. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results A total of 33 patients were enrolled, including 23 males and 10 females aged 22-73 (51.06±12.61) years. There was no perioperative death. The mean preoperative, postoperative and follow-up AAD of the patients were (46.06±3.54) mm, (34.55±5.17) mm, and (37.12±5.64) mm, respectively. The differences in the AAD between pre-operation and post-operation, and between pre-operation and the last follow-up were both statistically significant (P<0.05). The median follow-up time was 38.20 (18.80-140.30) months. The median increase rate of diameter was 0.63 (−0.11, 1.36) mm per year after the surgery. The increase rate was >5 mm per year in 1 patient, and >3 mm in another one. Conclusion The mid- and long-term outcomes of AAW in adult patients undergoing AVR are satisfactory and encouraging.

Objective To observe the clinical efficacy of Shengdi Xiexin Decoction combined with proton pump inhibitors(PPIs)in the treatment of acute non-variceal upper gastrointestinal bleeding(ANVUGIB)with stomach-heat congestion syndrome.Methods Sixty-two patients with ANVUGIB of stomach-heat congestion syndrome admitted to Dongguan Hospital of Guangzhou University of Chinese Medicine between January and December 2024 were randomly divided into a treatment group(n=31)and a control group(n=31)using a random number table.The control group received conventional western therapy(e.g.,Omeprazole Sodium),while the treatment group additionally received Shengdi Xiexin Decoction.Both groups were treated for 7 days,followed by 8 weeks of follow-up.The changes in traditional Chinese medicine(TCM)syndrome scores,hematological parameters[hemoglobin(Hb),red blood cells(RBC),hematocrit(Hct),albumin(ALB)],tissue perfusion and metabolic markers[blood urea nitrogen/creatinine ratio(BUN/Cr),lactate(Lac)levels],hemostasis time,time to resume oral diet,hospital stay duration,hospitalization costs,and rebleeding rates were observed to evaluate the clinical efficacy and drug safety.Results(1)After 7 days of treatment,the total effective rate was significantly higher in the treatment group(90.32％,28/31)than that in the control group(74.19％,23/31).The intergroup comparison(by chi-square test)showed that the treatment group,efficacy was superior to that of the control group(P＜0.05).(2)The treatment group showed significantly short hemostasis time,time to resume oral diet,and hospital stay duration(P＜0.05),as well as significantly low hospitalization costs(P＜0.05)compared to the control group.(3)Both groups exhibited significant reductions in the scores of epigastric burning pain,abdominal distension,acid regurgitation,restlessness,excessive thirst,scanty dark uring and dry stools,and total TCM syndrome scores(P＜0.05).The treatment group demonstrated significantly greater improvements in the scores of abdominal distension,acid regurgitation,restlessness,dark uring and dry stools,and total TCM syndrome scores(P＜0.05),while no significant differences were observed in epigastric burning pain and excessive thirst(P＞0.05).(4)Hb and Hct levels increased significantly in both groups(P＜0.05),with a greater increase in the treatment group(P＜0.05).Although RBC and ALB levels showed an upward trend,no significant differences were observed between groups(P＞0.05).Following treatment,intergroup comparisons revealed that the treatment group demonstrated significantly greater increases in Hb and Hct levels than the control group(P＜0.05).In contrast,the two groups showed comparable effects in elevating RBC and ALB levels,with no statistically significant differences(P＞0.05).(5)BUN/Cr ratio and Lac levels decreased significantly in both groups(P＜0.05),with a more pronounced reduction in the treatment group(P＜0.05).(6)No significant differences were found in early or delayed rebleeding rates between groups(P＞0.05).(7)Neither group experienced significant adverse events.Conclusion Shengdi Xiexin Decoction combined with PPIs significantly improves clinical outcomes in ANVUGIB patients with stomach-heat congestion syndrome.It is effective on enhancing hematological parameters,correcting tissue hypoperfusion,alleviating symptoms,shortening hemostasis time and hospitalization durations,and reducing medical costs,demonstrating excellent safety.

Objective To investigate the molecular mechanism by which long non-coding RNA(lncRNA)titin antisense RNA 1(TTN-AS1)regulates the microRNA(miR)-134-5p/epidermal growth factor receptor(EGFR)axis in breast cancer cell proliferation,apoptosis and glycolysis.Methods Western blot was used to detect EGFR protein expression.Quantitative real-time poly-merase chain reaction(qRT-PCR)was employed to measure the expression levels of lncRNA TTN-AS1,miR-134-5p and EGFR mRNA in breast epithelial cells MCF-10A and breast cancer cell lines MCF-7,MDA-MB-231 and SKBR-3.MDA-MB-231 cells were selected for subsequent experi-ments,and were divided into control,si-lncRNA TTN-AS1,si-lncRNA TTN-AS1+miR-134-5p-in-hibitor and si-lncRNA TTN-AS1+EGFR-mimic groups.Cell proliferation rates were determined u-sing the CCK-8 assay.Apoptosis rates were assessed by flow cytometry.Lactic acid,glucose and a-denosine triphosphate(ATP)kits were used to detect glucose intake,lactic acid and ATP produc-tion in each group,respectively.Dual-luciferase reporter assays were performed to identify the bind-ing sites between lncRNA TTN-AS1 and miR-134-5p,as well as between miR-134-5p and EGFR.Results Compared with MCF-10A cells,the expression levels of lncRNA TTN-AS1 and EGFR mR-NA were significantly higher,while miR-134-5p expression was significantly lower in breast cancer cell lines(P＜0.05).Among these,MDA-MB-231 cells exhibited the highest expression levels of lncRNA TTN-AS1 and EGFR mRNA,and the lowest expression level of miR-134-5p(P＜0.05).Compared with the control group,the expression level of miR-134-5p was significantly increased,while the expression levels of lncRNA TTN-AS1,EGFR mRNA,and EGFR protein were significant-ly decreased in the si-lncRNA TTN-AS1 group(P＜0.05).Compared with the si-lncRNA TTN-AS1 group,the expression levels of EGFR mRNA and EGFR protein were significantly increased,and miR-134-5p expression was significantly decreased in the si-lncRNA TTN-AS1+miR-134-5p-inhibitor group and si-lncRNA TTN-AS1+EGFR-mimic group(P＜0.05).Compared with the con-trol group,cell proliferation rates were significantly reduced in the si-lncRNA TTN-AS1 group(P＜0.05).Compared with the si-lncRNA TTN-AS1 group,cell proliferation rates were significantly in-creased in the si-lncRNA TTN-AS1+miR-134-5p-inhibitor group and si-lncRNA TTN-AS1+EGFR-mimic group(P＜0.05).Compared with the control group,apoptosis rates were significantly in-creased in the si-lncRNA TTN-AS1 group(P＜0.05).Compared with the si-lncRNA TTN-AS1 group,apoptosis rates were significantly reduced in the si-lncRNA TTN-AS1+miR-134-5p-inhibitor group and si-lncRNA TTN-AS1+EGFR-mimic group(P＜0.05).Compared with the control group,glucose uptake,lactate production and ATP generation were significantly decreased in the si-lncRNA TTN-AS1 group(P＜0.05).Compared with the si-lncRNA TTN-AS1 group,glucose up-take,lactate production and ATP generation were significantly increased in the si-lncRNA TTN-AS1+miR-134-5p-inhibitor group and si-lncRNA TTN-AS1+EGFR-mimic group(P＜0.05).The du-al-luciferase reporter assay confirmed that lncRNA TTN-AS1 had a targeted binding site with miR-134-5p,and miR-134-5p has a targeted binding site with EGFR.Conclusion The lncRNA TTN-AS1 may negatively regulate the miR-134-5p/EGFR axis,thereby affecting the proliferation,apop-tosis and glycolysis of breast cancer.

Based on the analysis of the existing problems and implementation dilemmas in family doctor contracting and first-return-visits faced by primary medical institutions in China, the authors propose countermeasures to provide reference for managers of primary health care institutions.

Objective To evaluate the scientificity,transparency and applicability of Chinese guidelines and expert consensuses on nursing published in 2022,in order to improve the quality of guidelines and consensuses.Methods Databases including Medline,Embase,Web of Science,CBM,CNKI,WanFang database,Chinese Medical Journal,and related websites were electronically searched,as well as China Hong Kong,Macao and Taiwan medical journals,to collect Chinese guidelines and expert consensuses on nursing from January to December 2022.STAR tool was used to evaluate the quality of each guidelines and consensuses by 3 assessors independently.Total score,scoring rate of each domain and item were adopted to analyze the outcomes.Results A total of 3 guidelines and 33 expert consensuses were included.The total guidelines and expert consensuses STAR score(33.5±14.3).The quality of guidelines and consensuses was low.The quality of guidelines was moderate with average score of 55.1,and the quality of consensuses was low with average score of 31.5.The included guidelines and consensuses had a highest score rate(52.4％)in the domain of recommendation.Among 39 items of STAR tool,the top 4 items including listing participants and institutions,explaining additional instructions for implementation,describing consensus method,and listing references for recommendations had a high score rate of 100％,83.3％,77.8％,75.0％respectively.However,the items of registration,providing registration information,protocols being searched on public platforms and explaining the role of funding had a low score rate,urgent need for attention and upgrading.Conclusion The overall quality of the Chinese guidelines and expert consensuses on nursing published in 2022 was low.As a medical and nursing practice guidance document,the quality of guidelines and expert consensuses should be improved by encouraging registration,strengthening management of interest conflict,enhancing the rigor of guideline developing process,and expanding the dissemination.

Background and purpose:Rectal cancer occurs on the inner wall of the rectum,and metastasis-associated in colon cancer 1(MACC1)can promote drug resistance in colon cancer cells.This study aimed to investigate the effect of MACC1 on oxaliplatin resistance in rectal cancer and its mechanism.Methods:Biosignal analysis of MACC1 and TCF7 expressions in rectal cancer tissues and signaling pathways enriched for MACC1 were carried out.The expressions of MACC1 and TCF7 in rectal cancer cells and rectal cancer oxaliplatin-resistant cells were detected by real-time fluorescence quantitative polymerase chain reaction(RTFQ-PCR),cell viability was detected by cell counting kit-8(CCK-8),and cell proliferation was detected by cell colony formation assay.ECAR values,lactate production and glucose consumption were detected by Seahorse Biosciences XF96.Western blot was used to detect the expressions of glycolysis-related proteins.Dual luciferase reporter gene and ChIP were used to validate the regulatory relationship between MACC1 and TCF7.Normality test and homogeneity of variance analysis was performed on the data of each group by GraphPad Prism 8.0.If it conformed to normal distribution,one-way ANOVA or t-test would be used for inter group comparison,otherwise the comparison between groups would be conducted using Wilcoxon rank sum test.Using a two-sided test,P＜0.05 was considered statistically significant.Results:MACC1 and TCF7 expressions were upregulated in rectal cancer,and knockdown of MACC1 significantly inhibited the viability of rectal cancer drug-resistant cells and the IC50 values of different concentrations of oxaliplatin treatments,as well as reduced the proliferation ability of rectal cancer oxaliplatin-resistant cells.Overexpression of MACC1 was able to promote the proliferation and glycolytic capacity of rectal cancer cells.Further studies revealed that the transcription factor TCF7 existed in the upper reaches of MACC1.Besides,this study analyzed the data from Cancer Genome Atlas Program(TCGA),and the result showed that knockdown of TCF7 was able to attenuate the promotional effect of overexpression of MACC1 on the glycolytic capacity and oxaliplatin resistance of rectal cancer cells.Conclusion:This study demonstrated that the TCF7/MACC1 axis could promote aerobic glycolysis and thus oxaliplatin resistance in rectal cancer cells.The findings suggest that targeting the TCF7/MACC1 axis or inhibiting the aerobic glycolysis pathway may be a novel therapeutic approach to inhibit oxaliplatin resistance in rectal cancer.

Objective:To elucidate the drug resistance characteristics and molecular epidemiological features of carbapenem-resistant Klebsiella pneumoniae (CRKP) in this region, and to provide a basis for clinical anti-infective therapy. Methods:A total of 92 CRKP isolates were collected from the First Affiliated Hospital of Ningbo University and Ningbo No.2 Hospital. Antimicrobial susceptibility testing was performed using the VITEK2 Compact analyzer. Whole-genome sequencing was used to analyze their molecular characteristics including capsular serotypes, sequence types (multilocus sequencing typing) and resistance genes. Plasmid replicon types were identified using PlasmidFinder, and core genome phylogenetic analysis was performed with Parsnp.Results:The CRKP isolates were mainly isolated from critically ill elderly patients, with sputum (51.09%, 47/92) and urine (13.04%, 12/92) as the major specimen sources, followed by blood (8.70%, 8/92). Most of the infections were reported in the intensive care unit (33.70%, 31/92). All isolates showed high resistance to commonly used antibiotics, but lower resistance to polymyxin B (6.52%, 6/92). The predominant resistance gene, capsule serotype and ST were blaKPC-2 (78.26%, 72/92), KL64 (48.91%, 45/92), and ST11 (54.35%, 50/92), respectively. ST11-KL64 was the predominant clone, accounting for 46.74%(43/92) and carried multiple plasmids with IncR and IncFⅡ as the major types. Conclusions:CRKP in this region mainly harbored the blaKPC-2 resistance gene and showed high resistance to commonly used antibiotics. The ST11-KL64 clone spread widely in this region and the strains circulating in the two hospitals were similar. Thus, the surveillance should be strengthened.