OBJECTIVE To investigate the effects and mechanism of the Yishen paidu formula on renal fibrosis in rats with chronic renal failure （CRF） through the reactive oxygen species （ROS）/thioredoxin-interacting protein （TXNIP）/NOD-like receptor thermal protein domain associated protein 3 （NLRP3） pathway. METHODS Rats were randomly divided into control group， model group， Yishen paidu formula low-dose （Yishen paidu formula-L） group， Yishen paidu formula high-dose （Yishen paidu formula- H） group， Yishen paidu formula-H+pcDNA-NC group， and Yishen paidu formula-H+ pcDNA-TXNIP group， with 10 rats in each group. Except for control group， all other rats were fed a diet containing 0.5% adenine to establish a CRF model； the rats were then administered corresponding drugs or normal saline intragastrically or via tail vein， once daily， for 8 consecutive weeks. After the last administration， the levels of serum creatinine （Scr）， blood urea nitrogen （BUN）， ROS， superoxide dismutase （SOD）， malondialdehyde （MDA）， tumor necrosis factor-α （TNF-α）， interleukin （IL）-6， and IL-1β were measured in each group. Pathological changes in renal tissue were observed， and the protein expression levels of Collagen Ⅲ， α-smooth muscle actin （α-SMA）， transforming growth factor-β1 （TGF-β1）， TXNIP and NLRP3 in renal tissue were detected. RESULTS Compared with model group， the renal histopathological damage and fibrosis of rats in Yishen paidu formula-L group and Yishen paidu formula-H group were significantly alleviated. The levels of Scr， BUN， ROS， MDA， TNF- α， IL-6 and IL-1β， and the protein expressions of Collagen Ⅲ， α-SMA， TGF-β1， TXNIP and NLRP3 were significantly decreased， while SOD levels were significantly increased （P＜0.05）. Moreover， the changes were more pronounced in the Yishen paidu formula-H group （P＜0.05）. Compared with Yishen paidu formula-H+pcDNA-NC group， above indexes of rats in Yishen paidu formula-H+pcDNA-TXNIP group were reversed significantly （P＜0.05）. CONCLUSIONS Yishen paidu formula can inhibit renal fibrosis in CRF rats by suppressing the ROS/TXNIP/NLRP3 pathway.

Objective: To develop a dual-branch deep learning framework for accurate multi-label classification of fundus diseases, addressing the key limitations of insufficient complementary feature extraction and inadequate cross-modal feature fusion in existing automated diagnostic methods. Methods: The fundus multi-label classification dataset with 12 disease categories (FMLC-12) dataset was constructed by integrating complementary samples from Ocular Disease Intelligent Recognition (ODIR) and Retinal Fundus Multi-Disease Image Dataset (RFMiD), yielding 6 936 fundus images across 12 retinal pathology categories, and the framework was validated on both FMLC-12 and ODIR. Inspired by the holistic multi-regional assessment principle of the Five Wheels theory in traditional Chinese medicine (TCM) ophthalmology, the dual-branch multi-label network (DBMNet) was developed as a novel framework integrating complementary visual feature extraction with pathological correlation modeling. The architecture employed a TransNeXt backbone within a dual-branch design: one branch processed red-green-blue (RGB) images to capture color-dependent features, such as vascular patterns and lesion morphology, while the other processed grayscale-converted images to enhance subtle textural details and contrast variations. A feature interaction module (FIM) effectively integrated the multi-scale features from both branches. Comprehensive ablation studies were conducted to evaluate the contributions of the dual-branch architecture and the FIM. The performance of DBMNet was compared against four state-of-the-art methods, including EfficientNet Ensemble, transfer learning-based convolutional neural network (CNN), BFENet, and EyeDeep-Net, using mean average precision (mAP), F1-score, and Cohen's kappa coefficient. Results: The dual-branch architecture improved mAP by 15.44 percentage points over the single-branch TransNeXt baseline, increasing from 34.41% to 44.24%, and the addition of FIM further boosted mAP to 49.85%. On FMLC-12, DBMNet achieved an mAP of 49.85%, a Cohen’s kappa coefficient of 62.14%, and an F1-score of 70.21%. Compared with BFENet (mAP: 45.42%, kappa: 46.64%, F1-score: 71.34%), DBMNet outperformed it by 4.43 percentage points in mAP and 15.50 percentage points in kappa, while BFENet achieved a marginally higher F1-score. On ODIR, DBMNet achieved an F1-score of 85.50%, comparable to state-of-the-art methods. Conclusion DBMNet effectively integrates RGB and grayscale visual modalities through a dual-branch architecture, significantly improving multi-label fundus disease classification. The framework not only addresses the issue of insufficient feature fusion in existing methods but also demonstrates outstanding performance in balancing detection across both common and rare diseases, providing a promising and clinically applicable pathway for standardized, intelligent fundus disease classification.

Health economics evidence plays an important role in linking clinical value evidence with health resource allocation decisions in the development of clinical practice guidelines. It can not only effectively balance clinical effectiveness and economic feasibility but also avoid forming "idealized" recommendations that are detached from the affordability of the healthcare system or the burden-bearing capacity of patients. To promote guideline developers to use health economics evidence more standardizedly and fully, this paper conducts an in-depth analysis of the current application status, existing challenges, access channels, and application processes of health economics evidence in current guidelines, and on this basis, puts forward considerations and suggestions for strengthening and standardizing the application of health economics evidence in China's clinical practice guidelines.

Objective To investigate the status of oral frailty(OF)in patients who underwent chemotherapy for lung cancer,identify key factors influencing OF,and develop a risk prediction model.Methods Using convenience sampling,431 lung cancer inpatient were recruited from three Tier-IIIA hospitals in Jiangsu Province between September and November 2024 as the training cohort.The patients were divided into OF and non-OF groups.Relevant data were compared between the two groups.Multifactorial logistic regression analysis was performed to determine factors that associated with OF,and a risk prediction model was created accordingly.Receiver operating characteristic(ROC)curve analysis was used to predict model performance.In December 2024,additional 185 patients from one other Tier-IIIA hospitals were recruited to validate the developed model.Results The prevalence of OF among lung-cancer patients undergoing chemotherapy was 58.93%.Following listed items were identified as the risk factors of OF(all P<0.05):older in age(OR=3.420),poor education(OR=0.030),brain metastasis(OR=7.880),high nutritional risk screening 2002 score(OR=1.550),elevated C-reactive protein(OR=1.100),and elevated lactate dehydrogenase(OR=1.010).ROC area under the curve(AUC)of the model was 0.860(95%CI:0.830-0.900)in modelling cohort and 0.840(95%CI:0.780-0.900)in validation cohort.Hosmer-Lemeshow goodness-of-fit test yielded χ 2=4.870,P=0.770 for the training set and χ 2=2.770,P=0.950 for the validation set.Conclusion The risk prediction model for OF developed in this study demonstrates a good predictive performance and can facilitate early identification of high-risk patients,thereby providing a scientific basis for clinical interventions.

AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in-hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im-proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu-mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi-bition of ferroptosis.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective:To analyze the relationship between magnetic resonance imaging (MRI) and pathological type, axillary lymph node metastasis and molecular biomarkers in patients with breast cancer.Methods:The clinical data of 50 patients with breast cancer (observation group) and 50 patients with benign breast lesions (control group) admitted to the Beijing Daxing District People′s Hospital from January 2021 to November 2022 were retrospectively analyzed. The pathological types of breast cancer patients were analyzed according to the pathological examination results, and the axillary lymph node metastasis of breast cancer patients was recorded. Reverse rate constant (Kep), transfer constant (K trans) and extravascular extracellular volume fraction (Ve) were calculated by MRI scanning. The expression level of molecular biomarkers of breast samples [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), Ki-67] were detected. MRI imaging characteristics of patients in the two groups were analyzed, and MRI imaging characteristics of breast cancer patients with different pathological types, axillary lymph node metastasis and different molecular biomarker levels were analyzed. Results:Kep, K trans and Ve in observation group were significantly higher than those in control group (all P<0.01). There were statistically significant differences in Kep, K trans and Ve among breast cancer patients with different pathologic types (invasive ductal carcinoma, invasive lobular carcinoma and mucinous carcinoma) (all P<0.05), and the highest Kep, K trans and Ve were found in invasive lobular carcinoma patients, and the differences were statistically significant (all P<0.05). Kep, K trans and Ve in patients with axillary lymph node metastasis were significantly higher than those without metastasis (all P<0.01). ER positive patients had lower Ve than ER negative patients, PR-positive patients had lower Kep than PR-negative patients, HER-2 positive patients had higher Kep than HER-2 negative patients, and Ve was lower than HER-2 negative patients, Ki-67 high expression patients had lower Kep than Ki-67 low expression patients, and Ve was higher than Ki-67 low expression patients. The differences were statistically significant (all P<0.05). Conclusions:MRI imaging features of breast cancer patients are related to pathological types, axillary lymph node metastasis and molecular biological markers of breast cancer patients. Clinical evaluation and analysis of breast cancer patients can be conducted by MRI imaging features.

Based on the theory of the liver's"using bitter herbs to nourish or purge"from Huangdi Neijing,this paper systematically elucidates the theoretical foundation for treating functional constipation from liver.Focusing on the physiological characteristic of"liver desires to disperse"and the pathological manifestation of"liver bitterness and urgency,"combined with the"liver communicates with the large intestine"theory,this paper establishes a diagnostic and therapeutic framework for managing functional constipation by regulating liver function.The pathological evolution of functional constipation manifests in three distinct stages:in the early stage,liver qi stagnation leads to large intestine qi obstruction,where damaged by an excess of seven emotions resulting in symptoms such as difficult defecation,abdominal bloating,and hypochondriac pain;in the middle stage,liver depression transforms into fire,scorching bodily fluids to generate dryness,thereby creating a pathological interplay of stagnation,fire,and dryness,which is marked by anal heat,dry mouth,and yellow urine;in the late stage,yin deficiency in liver and kidney causes large intestine malnutrition,resulting in a complex pathological state where yin deficiency,collateral blockage,dryness accumulation,and blood stasis intertwine,clinically manifesting as pellet-like stools(resembling sheep feces)and soreness and weakness of the waist and knees.In treatment,the formula design follows the principle of"sweetness to relieve,acridity to tonify,and sourness to purge,"with treatment principles varying across stages.In the early stage,the focus is on dispersing liver and regulating qi,and unblocking the zang-fu viscera;in the middle stage,the priority shifts to clearing heat-fire,nourishing large intestine,and promoting fluid production;whereas,in the late stage,the emphasis lies on nourishing yin,unblocking collaterals,and promoting blood circulation.This staged treatment of functional constipation overcomes the limitations of solely focusing on nourishing large intestine and facilitating feces excretion,thereby advancing the treatment of different stages based on syndrome differentiation and personalized treatment.It provides theoretical support for improving patients' intestinal function and enhancing overall health outcomes.

Objective To investigate the status of oral frailty(OF)in patients who underwent chemotherapy for lung cancer,identify key factors influencing OF,and develop a risk prediction model.Methods Using convenience sampling,431 lung cancer inpatient were recruited from three Tier-IIIA hospitals in Jiangsu Province between September and November 2024 as the training cohort.The patients were divided into OF and non-OF groups.Relevant data were compared between the two groups.Multifactorial logistic regression analysis was performed to determine factors that associated with OF,and a risk prediction model was created accordingly.Receiver operating characteristic(ROC)curve analysis was used to predict model performance.In December 2024,additional 185 patients from one other Tier-IIIA hospitals were recruited to validate the developed model.Results The prevalence of OF among lung-cancer patients undergoing chemotherapy was 58.93%.Following listed items were identified as the risk factors of OF(all P<0.05):older in age(OR=3.420),poor education(OR=0.030),brain metastasis(OR=7.880),high nutritional risk screening 2002 score(OR=1.550),elevated C-reactive protein(OR=1.100),and elevated lactate dehydrogenase(OR=1.010).ROC area under the curve(AUC)of the model was 0.860(95%CI:0.830-0.900)in modelling cohort and 0.840(95%CI:0.780-0.900)in validation cohort.Hosmer-Lemeshow goodness-of-fit test yielded χ 2=4.870,P=0.770 for the training set and χ 2=2.770,P=0.950 for the validation set.Conclusion The risk prediction model for OF developed in this study demonstrates a good predictive performance and can facilitate early identification of high-risk patients,thereby providing a scientific basis for clinical interventions.

Under the background of the integrated development of the Guangdong-Hong Kong-Macao Greater Bay Area,the demand for medical services from Hong Kong and Macao residents in Guangdong continues to grow.As the main force in pro-viding medical services in Guangdong,public hospitals play a crucial role.This article aims to explore the current situation of the development of medical services for Hong Kong and Macao residents in Guangdong and propose development strategies from the perspective of hospitals to contribute to the integrated development of the Greater Bay Area.The SWOT method is used to system-atically evaluate the strengths,weaknesses,opportunities,and threats of Guangdong public hospitals in the development of medi-cal services for Hong Kong and Macao residents.A SWOT matrix is then constructed to formulate development countermeasures.The analysis shows that Guangdong public hospitals have advantages such as convenient transportation,cultural affinity,abundant medical resources,high service efficiency,and relatively low costs.However,they also face challenges such as inadequate cover-age of cross-border medical insurance,immature specialized services,inconsistent service standards,and insufficient exploration of cross-border medical care.At the same time,there are opportunities provided by national strategic support and strong market demand,while fierce market competition and slow integration of medical regulations among the three regions pose external threats.Based on the analysis,this article proposes countermeasures and suggestions,including strengthening publicity and innovative in-dustry cooperation,phased development of business,striving for policy coverage,enhancing business coordination,accelerating cooperation with the Hong Kong and Macao in medical care,and promoting international accreditation of hospitals.These sugges-tions provide decision-making references for the development of medical services for Hong Kong and Macao residents in Guang-dong's public hospitals.