Objective: To explore the long term trend of forced vital capacity to weight index (FWI) among Chinese Han students aged 7-18 from 2000 to 2019, and to predict its changes over the next decade, so as to provide scientific evidences for targeted health interventions and school health policies. Methods: Based on the data of the five Chinese National Surveys on Students Constitution and Health conducted from 2000 to 2019, a total of 216 500, 233 565, 215 267, 214 256 and 212 632 Han students aged 7-18 were included, respectively. The long term trend of FWI among students was analyzed, and the GM (1,1) grey model was used to predict FWI changes over the next decade. Subgroup analyses were conducted by sex, age, and urban-rural residence. Results: The FWI levels of Chinese Han students aged 7-18 were (55.30±11.47)(47.43±11.92)(48.11±12.46)(48.75±12.81)(50.93±13.11)mL/kg in 2000, 2005, 2010, 2014, and 2019, respectively. The FWI of Chinese Han students showed a decreasing then increasing trend from 2000 to 2019, reaching the lowest point of approximately 47.03 mL/kg around 2006, and was projected to recover to 52.88 mL/kg by 2029. Boys had higher FWI for each year and the total level than girls from 2000 to 2019( t =72.58-304.66), and the decline between 2000 and 2005 was smaller in boys (13.1%) than in girls (15.4%). However, the gender gap gradually narrowed and was projected to reduce to 5.36 mL/kg by 2029. FWI increased with age, with the largest difference observed in 2014 between the 7-9 and 16-18 age groups (8.62 mL/kg). Before 2014, urban boys had slightly lower FWI than rural boys; the gap narrowed thereafter, and their FWI levels were expected to become similar by 2029. Urban girls generally had higher FWI than rural girls, and the urban-rural gap showed an increasing trend. By 2029, the largest difference was projected to occur in the 13-15 age group, reaching 7.74 mL/kg. Conclusions The FWI of Chinese Han students showed a trend of initial decline followed by a gradual increase from 2000 to 2019, with notable differences across sex, age, and urban-rural residence. Greater attention should be paid to the respiratory health of rural girls, and effective measures should be taken to reduce urban-rural disparities.

AIM: To explore the clinical efficacy of 25G minimally invasive vitrectomy combined with 41G ultra-micro subretinal injection of tissue plasminogen activator(t-PA)in the treatment of subretinal hemorrhage(SMH).METHODS: Retrospective study. A totally 60 patients(60 eyes)who visited the Ophthalmology Department of Yuebei People's Hospital from June 2022 to September 2024 and were diagnosed with submacular hemorrhage were selected. According to different treatment methods, they were divided into a control group of 30 eyes(25G vitrectomy combined with intravitreal injection of t-PA)and an observation group of 30 eyes(25G vitrectomy combined with 41G subretinal injection of t-PA). The complete clearance rate of macular hemorrhage, best corrected visual acuity(BCVA), changes in intraocular pressure, central retinal thickness(CRT), the occurrence of postoperative complications were observed in the two groups of patients.RESULTS:The two groups of general data are comparable. After treatment for 7 d, the rate of complete clearance of macular hemorrhage was higher in the observation group than in the control group(100% vs 80%, P<0.05). There was no significant difference between the two groups in the comparison of BCVA at 1 d and 6 mo postoperatively(all P>0.05), and in the comparison of BCVA between the two groups at 7 d, 1, and 3 mo postoperatively, BCVA of the observation group was better than that of the control group(all P<0.05); and the intraocular pressure of the observation group was lower than that of the control group at 1 d, 7 d, and 1 mo postoperatively(all P<0.05), and there was no significant difference between the two groups in the comparison of intraocular pressure at 3 and 6 mo postoperatively(all P>0.05). There was no significant difference between the two groups in the comparison of CRT at 1 d and 6 mo postoperatively(all P>0.05), and CRT was lower than that of the control group at 7 d, 1 and 3 mo postoperatively(all P<0.05). The total incidence of complications in the observation group was not statistically different from that in the control group(0 vs 10%, P>0.05).CONCLUSION: The 25G minimally invasive vitrectomy combined with 41G ultra-microsubretinal injection of t-PA is more efficient in removing subretinal hemorrhage, promotes early anatomical restoration, and has a comparable long-term visual prognosis to the conventional method, with a favorable safety profile.

OBJECTIVE To provide technical support for improving recognition rate of adverse drug events （ADEs） related to traditional Chinese medicine （TCM） formula granules and decoction pieces among inpatient patients. METHODS By referencing the global trigger tool （GTT） whitepaper， literature on adverse reactions to TCM， and expert review opinions， ADE trigger items for TCM formula granules and decoction pieces used in the inpatients were established. GTT was applied to analyze ADEs in inpatients who had used TCM formula granules and decoction pieces in our hospital from August 2013 to August 2023， utilizing the Chinese Hospital Pharmacovigilance System. The effectiveness of GTT and the characteristics of these ADEs were analyzed. RESULTS A total of forty-eight triggers were established， including thirty-two laboratory test indexes， thirteen clinical symptoms， and three antidotes. Among the 1 682 patients included， GTT identified 652 potential ADEs， 284 true positive ADEs，with a trigger rate of 38.76% and a positive predictive value of 43.56%. After review by the auditor， 278 cases of ADEs were finally confirmed， with an incidence rate of 16.53%， significantly higher than the number of spontaneously reported ADEs during the same period （0）. The 278 cases of ADEs were mostly grade 1 （223 cases）， mainly involving hepatobiliary system， gastrointestinal system， blood- lymphatic system， etc；a total of 219 types of TCMs are involved，and the top five suspected TCMs used at a frequency higher than 1% were Poria cocos， Codonopsis pilosula， Atractylodes macrocephala， fried Glycyrrhiza uralensis， and Scutellaria baicalensis. CONCLUSIONS The established GTT can improve the recognition rate of ADEs for hospitalized patients using traditional Chinese medicine formula granules and decoction pieces.

ObjectiveTo construct a large language model （LLM）-based intelligent pre-consultation system for traditional Chinese medicine （TCM） to improve efficacy of clinical practice. MethodsA TCM large language model was fine-tuned using DeepSpeed ZeRO-3 distributed training strategy based on YAYI 2-30B. A weighted undirected graph network was designed and an agent-based syndrome differentiation model was established based on relationship data extracted from TCM literature and clinical records. An agent collaboration framework was developed to integrate the TCM LLM with the syndrome differentiation model. Model performance was comprehensively evaluated by Loss function， BLEU-4， and ROUGE-L metrics， through which training convergence， text generation quality， and language understanding capability were assessed. Professional knowledge test sets were developed to evaluate system proficiency in TCM physician licensure content， TCM pharmacist licensure content， TCM symptom terminology recognition， and meridian identification. Clinical tests were conducted to compare the system with attending physicians in terms of diagnostic accuracy， consultation rounds， and consultation duration. ResultsAfter 100 000 iterations， the training loss value was gradually stabilized at about 0.7±0.08， indicating that the TCM-LLM has been trained and has good generalization ability. The TCM-LLM scored 0.38 in BLEU-4 and 0.62 in ROUGE-L， suggesting that its natural language processing ability meets the standard. We obtained 2715 symptom terms， 505 relationships between diseases and syndromes， 1011 relationships between diseases and main symptoms， and 1 303 600 relationships among different symptoms， and constructed the Agent of syndrome differentiation model. The accuracy rates in the simulated tests for TCM practitioners， licensed pharmacists of Chinese materia medica， recognition of TCM symptom terminology， and meridian recognition were 94.09%， 78.00%， 87.50%， and 68.80%， respectively. In clinical tests， the syndrome differentiation accuracy of the system reached 88.33%， with fewer consultation rounds and shorter consultation time compared to the attending physicians （P＜0.01）， suggesting that the system has a certain pre- consultation ability. ConclusionThe LLM-based intelligent TCM pre-diagnosis system could simulate diagnostic thinking of TCM physicians to a certain extent. After understanding the patients' natural language， it collects all the patient's symptom through guided questioning， thereby enhancing the diagnostic and treatment efficiency of physicians as well as the consultation experience of the patients.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Objective To investigate the anti-tumor effect of Job's tears oral solution on lung cancer mice.Methods Observe the histopathological morphology of the tumor;Flow cytometry detected the changes in the levels of CD4+T and CD8+T in splenic lymphocytes;Elisa detected the contents of immunoglobulins IgA,IgG,IL-2 and IFN-γ;Blood routine was detected;the kit determined the levels of liver and kidney glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)content;Serum alanine aminotransferase(ALT),alkaline phosphatase(ALB),azelaic transaminase(AST),urea nitrogen(BUN),and blood creatinine(CRE)were measured in each group of mice.The transcriptome was found differential genes and pathway enrichment was performed.Western blot was used to detect the expression of proteins related to IL-17 signaling pathway(STAT3,NF-κB,VEGF)and TNF signaling pathway(PI3K/AKT,MAPK,JNK).Results Tumor histopathological and morphological changes were obvious in each administration group,and the heterogeneity was gradually reduced.Compared with the cisplatin group,the levels of CD4+T,CD8+T,CD4+T/CD8+T,IL-2,IFN-γ,and IgG in the Job's tears group were significantly increased(P<0.01).The blood routine results:compared with the model group,WBC,RBC,HGB,PLT,Lym%and GR%in the Job's tears group decreased significantly(P<0.01);Compared with the cisplatin group,WBC,RBC,PLT,HGB and Lym%in the Job's tears group increased significantly(P<0.01).The antioxidant indexes of liver and kidney showed that the levels of GSH and SOD in the liver and kidney tissues of the Job's tears group increased significantly(P<0.01),and the level of MDA decreased significantly(P<0.01).Effects on liver and kidney function indexes in mice AST,ALT,BUN and CRE decreased significantly in the Job's tears group(P<0.01),and ALB level increased significantly in the Job's tears group(P<0.01).Transcriptome results,Job's tears high-dose group mainly exerted anti-tumor effects by affecting TNF signaling pathway and IL-17 signaling pathway.Western blot results,in the IL-17 signaling pathway,S-TAT3 and VEGF decreased in the cisplatin group and the Job's tears group compared with the model group(P<0.01),and NF-κB decreased in the Job's tears high-dose group(P<0.01);Compared with the cisplatin group,STAT3 and NF-κB were decreased in the Job's tears group(P<0.01);VEGF was decreased in the Job's tears low-dose group(P<0.01);In the TNF signaling pathway,PI3K and MAPK were decreased in the cisplatin group and Job's tears group(P<0.01);AKT and P-AKT were decreased in the Job's tears group(P<0.01).Compared with the cisplatin group,the Job's tears group AKT,PI3K,and MAPK decreased(P<0.01);P-AKT decreased in the high dose group of Job's tears(P<0.01).Conclusion High-dose Job's tears oral solution inhibits tumor proliferation,attenuates inflammatory response,enhances immunity,improves blood routine and reduces liver and kidney injury in lung cancer mice mainly by inhibiting IL-17 and TNF signaling pathway.

Objective To investigate the anti-tumor effect of Job's tears oral solution on lung cancer mice.Methods Observe the histopathological morphology of the tumor;Flow cytometry detected the changes in the levels of CD4+T and CD8+T in splenic lymphocytes;Elisa detected the contents of immunoglobulins IgA,IgG,IL-2 and IFN-γ;Blood routine was detected;the kit determined the levels of liver and kidney glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)content;Serum alanine aminotransferase(ALT),alkaline phosphatase(ALB),azelaic transaminase(AST),urea nitrogen(BUN),and blood creatinine(CRE)were measured in each group of mice.The transcriptome was found differential genes and pathway enrichment was performed.Western blot was used to detect the expression of proteins related to IL-17 signaling pathway(STAT3,NF-κB,VEGF)and TNF signaling pathway(PI3K/AKT,MAPK,JNK).Results Tumor histopathological and morphological changes were obvious in each administration group,and the heterogeneity was gradually reduced.Compared with the cisplatin group,the levels of CD4+T,CD8+T,CD4+T/CD8+T,IL-2,IFN-γ,and IgG in the Job's tears group were significantly increased(P<0.01).The blood routine results:compared with the model group,WBC,RBC,HGB,PLT,Lym%and GR%in the Job's tears group decreased significantly(P<0.01);Compared with the cisplatin group,WBC,RBC,PLT,HGB and Lym%in the Job's tears group increased significantly(P<0.01).The antioxidant indexes of liver and kidney showed that the levels of GSH and SOD in the liver and kidney tissues of the Job's tears group increased significantly(P<0.01),and the level of MDA decreased significantly(P<0.01).Effects on liver and kidney function indexes in mice AST,ALT,BUN and CRE decreased significantly in the Job's tears group(P<0.01),and ALB level increased significantly in the Job's tears group(P<0.01).Transcriptome results,Job's tears high-dose group mainly exerted anti-tumor effects by affecting TNF signaling pathway and IL-17 signaling pathway.Western blot results,in the IL-17 signaling pathway,S-TAT3 and VEGF decreased in the cisplatin group and the Job's tears group compared with the model group(P<0.01),and NF-κB decreased in the Job's tears high-dose group(P<0.01);Compared with the cisplatin group,STAT3 and NF-κB were decreased in the Job's tears group(P<0.01);VEGF was decreased in the Job's tears low-dose group(P<0.01);In the TNF signaling pathway,PI3K and MAPK were decreased in the cisplatin group and Job's tears group(P<0.01);AKT and P-AKT were decreased in the Job's tears group(P<0.01).Compared with the cisplatin group,the Job's tears group AKT,PI3K,and MAPK decreased(P<0.01);P-AKT decreased in the high dose group of Job's tears(P<0.01).Conclusion High-dose Job's tears oral solution inhibits tumor proliferation,attenuates inflammatory response,enhances immunity,improves blood routine and reduces liver and kidney injury in lung cancer mice mainly by inhibiting IL-17 and TNF signaling pathway.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Objective To develop engineered bacterial membrane biomimetic nanoparticles,Angiopep-2 E.coli membrane(ANG-2 EM)@PDA-PEI-CpG(ANG-2 EM@PPC),for efficient targeted drug delivery in the treatment of glioma,and to provide theoretical and technical support for targeted glioma therapy.Methods The expression of inaX-N-angiopep-2 engineered bacteria was constructed in the laboratory,and ANG-2 EM was obtained through lysozyme treatment and ultrafiltration centrifugation.ANG-2 EM@PPC was prepared by ultrasonication of bacterial membranes.Western blotting,agarose gel electrophoresis,and transmission electron microscopy(TEM)were used to verify the preparation.Particle size and Zeta potential were measured to investigate the stability of ANG-2 EM@PPC.Regarding cell experiments,CCK-8 assay was performed to determine the effect of ANG-2 EM@PPC on the survival rate of neutrophils.A flow chamber model was designed and constructed,and the uptake efficiency of neutrophils was measured by flow cytometry to investigate the hitchhiking efficiency of ANG 2 EM@PPC on neutrophils in inflammatory environment.Neutrophil death patterns were characterized by fluorescence microscopy,and flow cytometry and Western blotting were performed to examine neutrophil apoptotic bodies and the proportion of apoptotic bodies produced.Regarding animal experiments,a mouse model of in situ glioma was established and the inflammatory environment of tumor tissue was verified.The tumor model mice were divided into three groups,including DiR group,EM@PPC group,and ANG-2 EM@PPC group(all n=3),which were injected with DiR,ANG-2 EM@PDA-PEI-CpG,and EM@PDA-PEI-CpG via the tail vein,respectively(all at 10 mg/kg).Fluorescence images of organs and the brain were used to examine the distribution of the three formulations in vivo and in the brain.The tumor model mice were further divided into PBS group,PDA group,PC group,PPC group,EM@PPC group,and ANG-2 EM@PPC group(all n=4),which were injected with PBS,PDA,PC,PPC,EM@PPC,and ANG-2 EM@PPC injected via the tail vein,respectively(all at 10 mg/kg).Imaging was performed in vivo to observe tumor regression,and the survival rate and body mass of mice were measured to evaluate in vivo pharmacodynamics.TUNEL staining(brain tissue)and HE staining(brain,heart,liver,spleen,lung and kidney tissues)were performed to evaluate the therapeutic effect.Results The results of TEM showed successful preparation of engineered bacterial membrane biomimetic nanoparticles,with PPC exhibiting a distinct shell-core structure and a shell thickness of about 8.2 nm.Due to the coating of ANG-2 EM,the shell thickness of ANG-2 EM@PPC increased to about 9.6 nm,with a clear bacterial membrane layer on the surface.Stability was maintained for at least one week.ANG-2 EM@PPC had no significant effect on the activity of neutrophils according to the findings from the CCK-8 assay.Flow cytometry showed that ANG-2 EM@PPC uptake is enhanced in activated neutrophils and hitchhiking on neutrophils was more efficient in the stationary state than that in the flowing condition.Compared with the EM@PPC group,the neutrophil hitchhiking ability of the ANG-2 EM@PPC group was enhanced(uptake efficiency 24.9%vs.31.1%).Fluorescence microscopy showed that ANG-2 EM@PPC changed the death pathway of neutrophils from neutrophil extracellular traps-osis(NETosis)to apoptosis.Western blot confirmed the production of neutrophil apoptotic bodies,and flow cytometry showed that the production rate was as high as 77.7%.Animal experiments showed that there was no significant difference in the distribution of engineered bacterial membrane biomimetic nanoparticles in the organs(heart,liver,spleen,lungs,and kidney)in the DiR group,the EM@PPC gropu,and the ANG-2 EM@PPC group(P＞0.05),but there was higher distribution in the brain tissue in EM@PPC and ANG-2 EM@PPC groups compared to the DiR group(P＜0.05).Engineered bacterial membrane biomimetic nanoparticles crossed the blood-brain barrier(BBB),and exhibited high affinity to and internalization by neutrophils located in brain tumors.Compared with PBS,PDA,PC,and PPC groups,the survival rate and body mass of mice in the EM@PPC group were improved,tumor fluorescence intensity was weakened,and apoptotic cells were increased.These trends were even more prominent in the ANG-2 EM@PPC group.No abnormality was found in the HE staining of any group.Conclusion An ANG-2 EM@PPC nanodelivery system with inflammation response characteristics was successfully prepared,capable of crossing BBB and targeting the tumor inflammatory microenvironment to improve the anti-glioma efficacy.This study provides a new drug delivery strategy for glioma treatment and offers a new idea for targeted drug delivery in the non-invasive inflammatory microenvironments in other central nervous system diseases.