OBJECTIVE To investigate the clinical effectiveness of triptorelin combined with Biejiajian pill in the treatment of adenomyosis （AM）. METHODS Totally 186 patients with AM admitted to Nanyang First People’s Hospital from January 2022 to October 2024 were selected as subjects and randomized into control group （n＝93） and observation group （n＝93） using the random number table method. Patients in the control group received subcutaneous injections of triptorelin acetate around the umbilicus. In addition to the treatment of control group， patients in the observation group orally administered Biejiajian pill. Both groups underwent treatment for 12 weeks and were followed up for 6 months post-treatment. The clinical efficacy， recurrence and the occurrence of adverse drug reactions were compared between the two groups. Traditional Chinese medicine （TCM） symptoms， endometrial receptivity indicators （endometrial thickness， uterine volume， endometrial resistance index and vascular index）， laboratory indexes （serum luteinizing hormone， follicle stimulating hormone， estradiol， carbohydrate antigen 125， insulin-like growth factor-1， and matrix metalloproteinase 9） were compared between the two groups before and after treatment. RESULTS A total of 164 patients completed the treatment and follow-up， among whom 80 cases were in control group and 84 cases in the observation group. The overall effective rate in the observation group was significantly higher than that in the control group， while the incidence of low estrogen levels and recurrence rate were significantly lower in the observation group compared to the control group （P＜0.05）. There were no statistically significant differences in the incidence of nausea or abnormal liver and kidney function between the two groups （P＞0.05）. After treatment， the pain Visual Analogue Scale scores， Pictorial Blood Loss Assessment Chart， TCM symptoms scores， endometrial thickness， uterine volume， endometrial resistance index， and laboratory indicators in both groups were significantly lower than those before treatment within the same group （P＜0.05）. Moreover， these values were significantly lower in the observation group compared to the control group （except for follicle stimulating hormone） （P＜0.05）. The endometrial vascular index of the two groups was significantly higher than that in the same group before treatment， and the observation group was significantly higher than the control group （P＜0.05）. CONCLUSIONS Triptorelin combined with Biejiajian pill has a definite therapeutic effect on AM， which can effectively improve the degree of dysmenorrhea and menstrual flow， improve endometrial receptivity， lower the recurrence rate in patients， and demonstrate good safety.

ObjectiveTo explore the clinical efficacy and mechanism of Bupi Qingfei prescription （BPQF） in treating stable bronchiectasis in the patients with syndromes of lung-spleen Qi deficiency and phlegm-heat accumulation in the lungs. MethodsA randomized， double-blind， placebo-controlled trial was conducted. Patients were randomized into BPQF and placebo control （PC） groups. On the basis of conventional Western medicine treatment， the BPQF granules and placebo were respectively administered at 10 g each time， twice a day， for a course of 24 weeks. The TCM symptom scores， Quality of Life Questionnaire for Bronchiectasis （QOL-B） scores， lung function indicators， T lymphocyte subsets， level of inflammatory factors in the sputum， level of neutrophil elastase （NE） in the sputum， and occurrence of adverse reactions were observed before and after treatment in the two groups. ResultsA total of 64 patients completed the study， encompassing 32 in the BPQF group and 32 in the PC group. After treatment， the BPQF group showed decreased TCM symptom scores （P<0.01）， increased QOL-B scores （P<0.01）， and declined levels of tumor necrosis factor （TNF）-α and NE （P<0.05， P<0.01）. The PC group showed decreased TCM symptom （except spleen deficiency） scores （P<0.01）， increased the QOL-B health cognition and respiratory symptom domain scores （P<0.05， P<0.01）， and a declined TNF-α level （P<0.01）. Moreover， the BPQF group had lower TCM symptom （except chest tightness） scores （P<0.05， P<0.01）， higher QOL-B （except treatment burden） scores （P<0.05， P<0.01）， and lower levels of interleukin-6 and TNF-α （P<0.05） than the PC group. Neither group showed serious adverse reactions during the treatment process. ConclusionBPQF can ameliorate the clinical symptoms of stable bronchiectasis patients who have lung-spleen Qi deficiency or phlegm-heat accumulation in the lungs by regulating the immune balance and inhibiting airway inflammatory responses.

Objective: To analyze the school tuberculosis (TB) outbreaks and preventive treatment in Hefei from 2022 to 2024, so as to provide reference for TB prevention and control in schools. Methods: Data were collected on all school based TB outbreaks occurring during 2022-2024 in Hefei, defined as ≥2 epidemiologically linked TB cases within the same school during a single semester. Statistical analyses were performed using the Chi square test. Results: Close contacts exhibited significantly higher TB incidence (2.88%) and latent mycobacterium tuberculosis infection (LTBI) rates (13.80%) in the school TB outbreaks, compared to non close contacts (0.12% and 2.63%, respectively). Among close contacts, secondary school students showed lower TB incidence (0.48%) and LTBI prevalence (3.42%) than both primary school or younger children (0.68%, 6.95%) and college students ( 0.78% , 6.50%), with statistically significant differences ( χ 2=360.91, 6.37; 791.71, 102.03, all P <0.05). The proportion of LTBI individuals recommended for preventive therapy was higher in primary school or younger groups (98.59%) than in secondary (95.25%) or college students (86.34%) ( χ 2=25.86, P <0.01). However, among those recommended, close contacts had higher uptake (85.82%) and completion rates (87.25%) of preventive therapy than non close contacts (69.63% and 70.57%); similarly, secondary school students demonstrated higher uptake (91.21%) and completion rates (86.45%) compared to primary school or younger (88.57%, 83.87%) and college students (57.28%, 64.08%) ( χ 2=30.52, 26.72; 125.17, 38.84, all P <0.01). Subsequent TB incidence among LTBI close contacts (13.30%) and among those who did not complete preventive therapy (22.73%) were significantly higher than among non close contacts (2.80%, 2.41%), respectively ( χ 2=32.19, 13.87, both P <0.05). Conclusions In school TB outbreaks, close contacts face higher LTBI prevalence and subsequent TB risk than non close contacts. College students show notably low adherence to preventive therapy. It is necessary to take targeted measures to improve the compliance of preventive measures among students.

ObjectiveTo explore the role of the histone deacetylase Sirtuin-1 （SIRT1）/p53 signaling pathway in promoting apoptosis of non-small cell lung cancer cells （NSCLC） induced by the co-stimulatory molecule B7 homolog 3 （B7-H3）. MethodsThe GEPIA 2 platform was used for survival analysis of NSCLC patients based on B7⁃H3 gene expression levels. The Gene Enrichment Analysis （GSEA） method was used to analyze the enrichment characteristics of B7⁃H3 molecules in the gene set of cell apoptosis. In the non-small cell lung cancer A549 cell line， B7⁃H3 was knocked down， and the protein expression levels of SIRT1 and p53 were detected by Western blot. B7⁃H3 was overexpressed in A549 cells and the apoptosis rate was analyzed by flow cytometry after Annexin V/PI double staining. Overexpression of B7⁃H3 and knockdown of SIRT1 were performed in A549 cell line. The expression levels of p53 and apoptosis-related proteins B-cell lymphoma/leukemia-2 （Bcl-2） and Bcl-2-associated X protein （Bax） were detected respectively by Western blot. Cell apoptosis rate was analyzed by flow cytometry after Annexin V/PI double staining. ResultsThe overall survival of the B7-H3 high-expression group was significantly lower than that of the low-expression group （P<0.01）. B7-H3 was significantly enriched in the cell apoptosis signaling pathway and the p53 signaling pathway （P<0.05）. Compared with the control group， the expression of SIRT1 was significantly downregulated， and p53 was significantly upregulated in the B7⁃H3 knockdown group （both P<0.001）. Overexpression of B7-H3 significantly up-regulated SIRT1 protein expression （P<0.05）， down-regulated p53 expression （P<0.01）， and markedly increased the Bcl-2/Bax ratio of apoptosis-related proteins （P<0.001）. The results of Annexin V/PI double staining showed that the apoptosis rate of A549 cells with overexpressed B7⁃H3 decreased （the apoptosis rate of the control group was 26.72%±4.13%， while that of the B7⁃H3 overexpression group was 13.87%±0.82%； P<0.01）. In B7-H3-overexpressing cell lines， SIRT1 knockdown significantly reversed apoptosis （P<0.05）， up-regulated p53 protein expression （P<0.001）， and markedly reduced the Bcl-2/Bax ratio （P<0.001）. ConclusionB7-H3 molecule inhibits the apoptosis of non-small cell lung cancer cells via the SIRT1/p53 signaling pathway.

Objective:To explore the effect of integrating open laboratories into Medical Microbiology experimental teaching for students majoring in Medical Laboratory Technology to enhance teaching quality.Methods:A total of 58 students from the grade 2020 majoring in Medical Laboratory Technology at a medical college were selected as the control group,receiving traditional teaching methods without open laboratory contents.A total of 58 students from the grade 2021 majoring in Medical Laboratory Technology were selected as the experimental group,integrating open laboratory contents into Medical Microbiology experimental teaching.The impact of open laboratories on teaching quality in Medical Microbiology experimental teaching was evaluated through analysis of final examination scores and questionnaire surveys.Results:Compared with the control group,the experimental group showed significant improvements in experimental report scores,experimental theory assessment scores,practical skill assessment scores,classroom performance scores,and overall scores(P＜0.01).The learning interest,multi-channel learning,mastery of key concepts,and ability to apply and expand knowledge of the experimental group also significantly improved(P＜0.01).The satisfaction rate of the experimental group in terms of participation level,acquired knowledge,mastered skills,and improved learning outcomes was all above 90%.Conclusion:Integrating open laboratory content into Medical Microbiology experimental teaching for students majoring in Medical Laboratory Technology can effectively stimulate students'engagement,enhance teaching quality,and help students better understand and master professional knowledge.

Given the lack of annotations for key lung organs and tissues in existing public datasets,this study collected 863 cases of chest CT scan images and constructed the first comprehensive dataset containing annotations of pulmonary vessels,airways,and nodules using a semi-automated method that combines computer vision algorithms with manual corrections by radiologists.On this basis,a lung nodule segmentation model based on multi-task learning is proposed.By incorporating annotations of pulmonary vessels(pulmonary arteries and veins)and the trachea to enhance model's ability to learn lung features,the proposed model reduces the false discovery rate in lung nodule detection,and improves generalization ability.Additionally,the use of larger image patches further optimizes model performance.The trained VAAN_128 model achieves the best performance,with a Dice coefficient of 0.694 and a false discovery rate of 0.210 for lung nodule segmentation.Moreover,it simultaneously provides accurate segmentation results of pulmonary vessels and the trachea,assisting in the formulation of more precise diagnosis and treatment plans.Based on the VAAN_128 model,a software system for navigation and localization in biopsy procedures is developed.In clinical practice,this system can assist physicians in accurately locating lung nodules,distinguishing critical tissues,and improving preoperative planning efficiency.This provides precise and efficient technical support for early diagnosis and disease monitoring of lung diseases,and is of great significance for path planning in clinical navigation system and future lung imaging research.

Objectives:To analyze and summarize the clinical experience of the Y-incision technique in aortic root enlargement surgery.Methods:A retrospective analysis was conducted based on the data of 53 patients who underwent aortic root enlargement using the Y-shaped incision technique by the same surgical team from January to December 2024.The primary endpoint of the study was the efficacy of the technique,as measured by the enlargement size of the valve annulus.The secondary endpoint focused on the safety of the procedure,specifically the incidence of major complications,including re-sternotomy due to bleeding,third-degree atrioventricular block,and major adverse cardiovascular events(MACE).MACE included cardiovascular death,myocardial infarction,stroke,and re-aortic valve intervention.Echocardiography was performed at 3 months after discharge.Root blood flow compliance was analyzed by computer fluid dynamics.Results:Among the 53 patients,30 were male(56.6%),with a mean age of(59.3±13.3)years(range:13-81 years).Five cases(9.4%)were reoperations.Biological valves were replaced in 36 cases(67.9%),and mechanical valves in 17 cases(32.1%).The intraoperatively measured mean native annulus diameter was(20.5±2.2)mm,the post-root enlargement implanted valve size was(25.4±2.5)mm,with a mean enlargement of(4.9±1.5)mm.The mean cardiopulmonary bypass time was(159.9±46.1)minutes,aortic cross-clamp time was(123.3±35.6)minutes,postoperative intensive care unit stay was(2.6±3.0)days,and invasive mechanical ventilation duration was(18.3±29.7)hours.One case(1.9%)required re-exploration for postoperative bleeding.One case(1.9%)developed transient postoperative elevation of cardiac troponin I,and coronary computed tomography angiography(CTA)confirmed asymptomatic compression of the coronary ostium.Follow-up at 1 month showed normal coronary blood flow.No third-degree atrioventricular block or MACE occurred in the entire cohort.Postoperative computer fluid dynamics analysis showed that the high-speed blood flow at the root disappeared after the operation,the blood flow compliance was improved,and no signs of tilt of the prosthetic valve were found.The mean follow-up was(6.2±2.7)months.The follow-up completion rate was 100%,and no death occurred during the follow-up.Both the aortic prosthetic valve and mitral valve functioned well,there was no dysfunction caused by mitral curtain injury.One case of moderate patient-prosthesis mismatch(PPM)occurred in a reoperation patient,there was no severe PPM post surgery.Compared with the preoperative values,left ventricular ejection fraction,peak transaortic valve flow velocity,and the degree of mitral regurgitation all significantly improved at 3 months after discharge(all P<0.001).Conclusions:The Y incision technique is safe and effective for aortic root enlargement,enabling the implantation of larger-diameter prosthetic valves and providing better hemodynamic outcomes.Further follow-up is required to assess its long-term efficacy.

Objective To investigate the distribution characteristics of Klebsiella pneumoniae(KP),hyperviru-lent Klebsiella pneumoniae(hvKP),carbapenem-resistant Klebsiella pneumoniae(CRKP),and hypervirulent car-bapenem-resistant Klebsiella pneumoniae(hv-CRKP/CR-hvKP)in the environment of general intensive care unit(ICU)at medical institutions,and provide reference for environment assessment as well as healthcare-associated in-fection(HAI)prevention and control in ICU.Methods A total of 3 336 environmental specimens were collected from general ICUs of medical institutions in Shanghai in 2019 and 2023.After strain isolation,antimicrobial suscep-tibility testing and whole genome sequencing were conducted.Results The detection rate of KP was 1.59％(n=53),among which hvKP,CRKP,and hv-CRKP/CR-hvKP accounted for 37.74％(20/53),52.83％(28/53),and 24.53％(13/53)of the total detected strains,respectively.The main types of hvKP were ST11-KL64 and ST11-KL25,CRKP were ST15-KL19 and ST11-KL25,hv-CRKP/CR-hvKP were ST11-KL25 and ST11-KL64.The main carried resistance genes included fosA,oqx AB,tet(A),blaTEM-1B,blaKPC-2,qnrS11,etc.All strains carried viru-lence genes fimH,iutA,ent A,entB,entC,entD,entE,and entF,with only one strain carrying rmp A gene.Conclusion KP contamination is widespread in general ICU environment of medical institutions,predominantly ST11 and ST15,presenting a polymorphic distribution.CRKP and hvKP account for a relatively high proportion,and multidrug resistance is serious.Co-evolution of drug resistance and virulence presents in KP,and poses signifi-cant infection and pathogenic risks to patients,necessitating enhanced clinical vigilance and preparedness for poten-tial outbreaks.