ObjectiveTo systematically compare the differential regulation of the maternal-fetal interface cell lineages and communication networks in the CBA/J×DBA/2 mouse model of recurrent pregnancy loss （RPL） by the two classic therapeutic methods-tonifying the kidney to stabilize the fetus and invigorating the spleen to stabilize the fetus （Shoutai Wan， Juyuan Jian）-of traditional Chinese medicine （TCM） at the single-cell resolution and clarify their modern scientific connotations. MethodsFemale non-pregnant CBA/J mice were caged with male BALB/c （blank group） and DBA/2 （modeling group） mice separately. Pregnant mice in the modeling group were randomly grouped as follows： high/low-dose Shoutai Wan， high/low-dose Juyuan Jian， model （RPL）， and positive control （dydrogesterone）， with 10 mice in each group. Starting from the day after the detection of the vaginal plug， mice were administrated with drugs or an equal volume of normal saline by gavage for 10 consecutive days. After the intervention， the following indicators were measured. ① Macroscopic evaluation： general conditions， uterine wet weight， embryo loss rate， four coagulation parameters ［prothrombin time （PT）， activated partial thromboplastin time （APTT）， fibrinogen （FIB）， and thrombin time （TT）］， and peripheral blood estradiol （E₂） and progesterone （Pg） levels. The decidua with embryos was stained with hematoxylin-eosin （HE） and evaluated by transmission electron microscopy （TEM）. The expression of B-cell lymphoma-2 （Bcl-2）， vascular endothelial growth factor （VEGF）， angiotensin Ⅱ （AngⅡ）， matrix metalloproteinase-2 （MMP-2）， interleukin-6 （IL-6）， leukemia inhibitory factor （LIF）， CXC chemokine ligand 12 （CXCL12）， and microtubule-associated protein 1 light chain 3 homolog （LC3）Ⅰ/Ⅱ was quantified by Western blot. ② Mechanism analysis at the single-cell level： The decidua with embryos from the blank， model， high-dose Shoutai Wan， and high-dose Juyuan Jian groups （6 mice per group， with 3 single-cell samples per group， totaling 24 mice） were analyzed by the BD Rhapsody™ platform， and the whole-cell atlas was drawn by uniform manifold approximation and projection （UMAP） dimensionality reduction clustering combined with the single-cell mouse cell atlas （scMCA）. The differentially expressed genes （DEGs） and cell interaction networks were analyzed via Gene Ontology （GO）， Kyoto Encyclopedia of Genes and Genomes （KEGG）， and CellChat， and the protein-protein interaction （PPI） map of subtype cells was constructed. The CytoTRACE pseudo-temporal analysis was performed to explore the developmental trajectories of core immune cells （natural killer cells， NK cells） from maternal and fetal sources. Results① Pathological and Western blot results indicated that compared with the blank group， the RPL group showed an increase in the embryo loss rate （P<0.01）， down-regulated expression of Bcl-2， LIF， MMP-2， and Vegf in the decidua with embryos （P<0.05）， up-regulated protein levels of CXCL-12， AngⅡ， and IL-6 （P<0.05）， blocked angiogenesis， apoptosis-inflammation imbalance， and coagulation dysfunction. Both prescriptions dose-dependently reduced the abortion rate and restored the angiogenesis-inflammation balance， and Shoutai pill showed superior performance in restoring the E₂ level to the Pg level （P<0.05）. ② Single-cell transcriptome analysis indicated that compared with the blank group， the RPL group showed differences in multiple key cell populations such as decidual cells， trophoblast cells， endothelial cells， erythroblasts， NK cells， and macrophages at the maternal-fetal interface. Immunity and angiogenesis were the key links in RPL. Compared with the RPL group， high-dose Shoutai Wan reversed the changes of NK cells in the embryonic layer （upregulating the mRNA levels of 17 genes and downregulating the mRNA levels of 29 genes） and macrophages （upregulating the mRNA levels of 117 genes and downregulating the mRNA levels of 53 genes） through the regulation of gene expression. High-dose Shoutai pill regulated the immune cells to affect unfolded proteins， cell adhesion， and programmed cell death， thereby promoting decidualization and angiogenesis and modulating embryo-membrane development. High-dose Juyuan Jian regulated the key subgroups of NK cells （up-regulating the mRNA levels of 9 genes and down-regulating the mRNA levels of 17 genes） and macrophages （up-regulating the mRNA levels of 110 genes and down-regulating the mRNA levels of 81 genes）， which affected decidual inflammation and apoptosis and intervened in glycolysis. ③ The pseudo-temporal analysis and communication network indicated that the communication frequency of the RPL group decreased. High-dose Shoutai Wan restored maternal-fetal tolerance through pathways such as NKG2D， CDH5， GDF， and FASLG. High-dose Juyuan Jian enhanced the IL-6/LIFR/JAK/signal transducer and activator of transcription 3 （STAT3） and desmosome/SEMA6/tumor necrosis factor-like weak inducer of apoptosis （TWEAK） signaling to improve endometrial receptivity. The RPL group showed an increased proportion of toxic dNK7， a decreased proportion of reparative dNK4， and blocked embryo fNK1. High-dose Shoutai Wan down-regulated dNK7 and up-regulated dNK4. High-dose Juyuan Jian inhibited the terminal differentiation of dNK7 and up-regulated LILRB1， thus restoring the balance of cytotoxicity and repair. ConclusionBoth the kidney-tonifying and spleen-invigorating methods are effective in treating RPL. NK and macrophages are the key immune cells in the interaction between the embryo and the membrane. The kidney-tonifying method （Shoutai Wan） has an advantage in regulating the phenotypes of unfolded protein， cell adhesion， and programmed cell death， and shows expression characteristics closer to the physiological state in the regulation of NKG2D and CDH5 signals. The spleen-invigorating method （Juyuan Jian） has an advantage in regulating epithelial-mesenchymal transition （EMT）， angiogenesis， and glycolysis and shows higher communication intensity in the IL-6 and LIFR pathways.

Objective To evaluate the safety of the 13-valent pneumococcal polysaccharide conjugate vaccine (tetanus toxoid/diphtheria toxoid) (PCV13-TT/DT) among age-eligible children in Tianjin through a combination of active and passive surveillance methods. Methods From July 15, 2023, to August 31, 2024, active surveillance for adverse events following immunization (AEFI) was conducted among recipients of PCV13-TT/DT at 18 selected vaccination clinics in Tianjin. Recipients were monitored through on-site observation or telephone follow-up within 30 minutes after vaccination and on days 1, 3, 7, and 28. Passive surveillance for AEFI was conducted among recipients of PCV13-TT/DT at other vaccination clinics across the city. The incidence of AEFI was analyzed using descriptive epidemiological methods. Results A total of 24 916 recipients of PCV13-TT/DT were observed, with 440 AEFI cases reported, resulting in an overall incidence rate of 176.59 per 10 000. The incidence rate of AEFI in active surveillance was 813.79 per 10 000, significantly higher than that in passive surveillance (20.49 per 10 000; P< 0.001). The incidence rates of general reactions, abnormal reactions, and coincidental cases in active surveillance were 744.44 per 10 000, 8.16 per 10 000, and 61.19 per 10 000, respectively, all of which were higher than those in passive surveillance (18.49 per 10 000, 0.50 per 10 000, and 1.50 per 10 000), with P values < 0.05. General reactions were mainly characterized by fever, local redness, and local induration. Abnormal reactions included angioedema and allergic rash. Coincidental cases were mainly infections. No severe adverse reactions occurred. Conclusion The large-scale vaccination of PCV13-TT/DT after its launch has good safety, and continuous strengthening of vaccine safety monitoring is needed.

Sudden sensorineural hearing loss(SSNHL)is an idiopathic sensorineural hearing loss of at least 30 dB over three consecutive frequencies in less than 3 days.However,its pathogenesis is still unknown.Recent re-searches suggest that inflammation plays a very important role in its development and prognosis.For this reason,we reviewed the relationship between inflammation and SSNHL from the perspective of development and prognosis,and further discussed the role of inflammation in the pathogenesis of SSNHL.

Objective To explore the impact of integrated traditional Chinese and Western medicine on the overall survival(OS)of patients with biliary tract carcinoma(BTC),and to analyze the related factors affecting the OS of patients with BTC,so as to provide accurate prognosis assessment for clinical diagnosis and treatment.Methods The medical records of 198 patients with BTC in Henan Provincial Hospital of Traditional Chinese Medicine from February 2018 to October 2023 were retrospectively analyzed.The Cox proportional hazards model was utilized to analyze the independent prognostic factors affecting the OS of BTC patients.Survival curves were constructed using the Kaplan-Meier method,and the Log-rank test was employed to compare median OS differences among various groups.Results A total of 116 patients with BTC were included.There were 59 cases(50.86％)in the Western medicine group,with a median OS of(14±2.77)months,and the 1-,2-and 3-year OS rates were 81.36％,61.02％and 46.11％,respectively.There were 57 cases(49.14％)in the integrated traditional Chinese and Western medicine group,with a median OS of(29±3.91)months,and the 1-,2-and 3-year OS rates were 82.32％,67.64％and 58.00％,respectively.There was a statistically significant difference in survival time between the two groups(P=0.038).Univariate analysis indicated that age,clinical stage,surgical treatment,chemotherapy,targeted therapy,local therapy and integrated traditional Chinese and Western medicine were significantly correlated with OS in BTC patients(all P＜0.05).Multivariate analysis revealed that age,clinical stage,surgical treatment,chemotherapy,targeted therapy,local therapy,and integrated traditional Chinese and Western medicine had significant effects on the OS of patients with BTC(all P＜0.05).Conclusion The median OS of the traditional Chinese and Western medicine groups was significantly longer than that of the Western medicine group,and the long-term OS rate of the patients was significantly better than that of the Western medicine group.Age,clinical stage,surgery,chemotherapy,targeted therapy,local therapy,and integrated traditional Chinese and Western medicine are independent prognostic factors affecting OS in patients with BTC.

OBJECTIVE To explore the implementation and standardized management of infection control core ele-ments in grass-roots medical institutions within county-level medical communities.METHODS From Mar.2024 to Apr.2024,the current status of implementation of infection control core elements in the grass-roots medical institu-tions within county-level medical communities was investigated by means of questionnaire survey and qualita-tive interview,and the implementation strategies were further explored.RESULTS The infection management or-ganizational system and functions of the two county-level medical institutions within the county medical communi-ties were completed,there is no independent hospital infection management department in the primary medical in-stitutions.The infection management personnel in the 16 grass-roots medical institutions were part-time person-nel,the personnel with the educational background below junior college accounted for 84.21％,the personnel with the professional background of nursing accounted for 100.00％,the personnel with less than 5 years of working experience accounted for 78.95％,none of them had an on-the-job training certificate.The monitoring programs of the county-level medical institutions within the county medical communities were completed,there was no infec-tion management monitoring information platform in the grass-roots medical institutions.The infection cases,hand hygiene,environmental health and occupational exposures were monitored by people.The grass-roots medi-cal institutions had the highest requirements for various professional trainings and increase of training contents of prevention and control of public health infectious diseases(100.00％).The county-level medical institutions had inadequate capabilities of professional examination of medical equipment replacement and construction of medi-cal architecture.CONCLUSION It is necessary for the country and local levels of governments to attach great importance to the implementation of the infection control core elements in the grass-roots medical institutions within the county-lev-el medical communities,establish the county-level regional information platform,formulate the corresponding surveil-lance indexes and homogenized management systems,complete the cultivation of talents,and offer financial support.

Objective:To investigate the related factors of hyperuricemia(HUA)in adolescents with bipolar disorder.Methods:Fifty-nine adolescent patients with bipolar disorder and 60 normal controls were select-ed.General demographic and clinical data were collected.Serum uric acid(UA),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),fructosamine(FA)and other physiological indices were detected.The Hamilton Depression Scale 17(HAMD-17)and Bech-Rafaelsen Mania Scale(BRMS)were used to evaluate the emotional symptoms of the patients.Results:The detection rate of HUA was higher in the adolescent patients with bipolar disorder than in the normal control group(30.5％vs.18.3％,P＜0.05),and was higher in manic episode than in depressive episode(48.2％vs.20.8％,P＜0.05).Unconditioned logistic regression analysis showed that high level of TG and high BMI were risk factors for hyperuricemia in adolescents with bipolar disorder(OR=2.51,1.34).Conclusion:This study shows that adolescents with bipolar disorder may have a higher risk of HUA than normal controls,and its oc-currence is associated with high TG level and BMI.

OBJECTIVE To explore the effect of Zi Zhu Ointment combined with herbal fumigation on wound heal-ing,oxidative stress and microribonucleic acid(miR)-200b of the patients with diabetic foot infection.METHODS A total of 102 patients with diabetic foot infection who were treated in Heping Hospital Affiliated to Changzhi Medical College from Sep.2020 to Sep.2023 were enrolled in the study and were divided into the control group with 48 cases and the study group with 54 cases according to the treatment program.The control group was trea-ted with conventional therapy and herbal fumigation,the study group was given additional Zi Zhu Ointment on ba-sis of the treatment of the control group,and both groups were persistently treated for 1 month.The clinical cura-tive effect,wound healing status,hemodynamics indexes of dorsal foot,pain score,oxidative stress indexes and miR-200b expression levels were observed and compared between the two groups of patients.RESULTS The effec-tive rate of clinical treatment of the study group was higher than that of the control group after the treatment(Z=2.138,P=0.033).The wound area of the study group was(0.42±0.05)cm2 after the treatment,smaller than that of the control group;the cover area of neoplastic granulation tissue of the study group was(16.87±3.21)cm2,larger than that of the control group;the coverage fraction of the neoplastic granulation tissue of the study group was(55.23±6.17)％,greater than that of the control group;there were significant differences between the two groups(P＜0.05).The blood vessel diameter of dorsal foot of the study group was greater than that of the control group after the treatment,the blood flow velocity of the study group was greater than that of the control group,and the visual analogue scale(VAS)score of the study group was lower than that of the control group(P＜0.05).There were no significant differences in the expression levels of advanced oxidative protein product(AOPP),superoxide dismutase(SOD),malondialdehyde(MDA)and miR-200b between the two groups of pa-tients before the treatment;the expression levels of AOPP,MDA and miR-200b of the study group were lower than those of the control group after the treatment,while the SOD level of the study group was higher than that of the control group(P＜0.05).CONCLUSIONS Zi Zhu Ointment combined with herbal fumigation can remarkably improve the clinical curative effect on the patients with diabetic foot infection,promote the wound healing,im-prove the arterial hemodynamics of dorsal foot,and relieve the pain.The mechanism may be associated with the improvement of oxidative stress response and downregulated expression level of miR-200b.

BACKGROUND:Finite element analysis is an advanced computer-based engineering technique that uses mathematical approximations to simulate the human body.This method accurately reflects the biomechanical characteristics within the knee,providing a powerful tool for understanding knee disease pathogenesis,optimizing surgical protocols,and developing new implant materials.OBJECTIVE:To review the establishment of finite element modelling of the knee joint and its application in the study of knee joint diseases,and look forward to the future development trend.METHODS:The first author searched the PubMed and EI databases in April 2024 by applying a computer with English search terms"finite element analysis,FEA,knee joint,finite element model,knee biomechanics,knee osteoarthritis,knee prosthesis,knee ligaments,meniscus"and searched CNKI and WanFang databases with Chinese search terms"finite element analysis,finite element model,knee joint,biomechanics,osteoarthritis,computational model,knee prosthesis,knee ligament,meniscus."Finally,75 papers were included in the analysis.RESULTS AND CONCLUSION:(1)Finite element analysis method uses medical imaging data to obtain a three-dimensional human model,simplifies the complex human joint structure into finite and interconnected units,and visually displays the internal stress distribution of the knee joint by applying external loads to the model.(2)The researchers deeply study the internal stress and strain distribution of the knee joint under different working conditions by means of finite element analysis,revealing the overloading of the articular cartilage and the decrease of load in some areas when the balance of the internal load distribution of the knee joint is changed,and that such long-term abnormal stresses cause deformation,wear and tear,and eventual loss of cartilage,which is crucial for understanding how biomechanical factors cause degenerative changes of the knee joint.(3)The effect of physical therapy methods such as Tai Chi and gait adjustment in patients with osteoarthritis of the knee joint was evaluated by finite element analysis,and the results showed that these treatments reduced the overloading of the cartilage,which provided a scientific theoretical basis for clinical treatment.(4)Clinicians are able to optimize surgical treatment strategies by performing three-dimensional reconstruction,data measurement,and simulation of surgery before surgery through finite element analysis.Furthermore,the mechanical characteristics of different prostheses can be simulated to improve the shape,material,and fixation of the prostheses,reduce patient complications,and improve patient outcomes.(5)The combination of artificial intelligence and finite element analysis makes the construction of finite element models more accurate and easy to operate,greatly contributing to the efficiency of clinicians'medical practice and patient outcomes.(6)Finite element analysis is only a digital simulation,which is still somewhat different from the real physical state.

Objective:To explore the therapeutic effect and mechanism of Baicalin(BG)on chronic migraine(CM)rats.Methods:CM rat model was established by intermittent subcutaneous injection of nitroglycerin.Rats were randomly grouped into con-trol group,chronic migraine group(CM group),low-dose and high-dose Baicalin groups(BG-L group,BG-H group),Baicalin+MIP-1α recombinant protein group(BG+MIP-1α group)and CCR1 inhibitor ZK811752 group(CCR1-ZK group),with 10 rats in each group.General behavior of rats were observed and scored;von Frey fiber optic pain gauge was applied to measure the mechanical pain threshold of rats;Nissl staining was applied to observe the neuronal structure of ventrolateral periaqueductal gray(vlPAG);ELISA was applied to detect levels of TNF-α and IL-1β;immunohistochemical method was applied to detect expressions of pain related pro-teins c-Fos and CGRP;Western blot was applied to detect expressions of MIP-1α and CCR1 proteins.Results:Compared with Control group,the body mass,mechanical pain threshold,and the number of Nissl bodies in vlPAG area of rats in CM group were obviously reduced,the general behavioral score,levels of TNF-α,IL-1β,and expressions of c-Fos,CGRP,MIP-1α and CCR1 were obviously increased(P<0.05);compared with CM group,the body mass,mechanical pain threshold,the number of Nissl bodies in vlPAG area of rats in BG-L group,BG-H group and CCR1-ZK group were obviously increased,the general behavioral score,levels of TNF-α,IL-1β,and expressions of c-Fos,CGRP,MIP-1α and CCR1 were obviously reduced(P<0.05);compared with BG-H group,the body mass,mechanical pain threshold,and the number of Nissl bodies in vlPAG area of rats in BG+MIP-1α group were obviously reduced,general behavioral score,levels of TNF-α,IL-1β,and expressions of c-Fos,CGRP,MIP-1α and CCR1 were obviously increased(P<0.05).Conclusion:Baicalin has certain therapeutic effect on chronic migraine rats,and its mechanism may be related to inhibiting the activation of MIP-1α/CCR1 signaling pathway.

Purpose To investigate the value of peritumoral expansion-based radiomics from tumor regions of interest(ROIs)for predicting epidermal growth factor receptor(EGFR)mutation status and to identify the optimal peritumoral expansion margin.Materials and Methods This retrospective study included 390 patients with pathologically confirmed non-small cell lung cancer(NSCLC)and definitive EGFR genotyping results from the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University(December 2021 to September 2023).Patients were randomly divided into training and validation sets(8∶2 ratio,310 vs.80 patients;CT slice thickness:5-7 mm).An additional independent test set of 100 patients undergoing thin-section CT(1-2 mm)was included to assess model generalizability across slice thicknesses.Clinical characteristics and CT semantic features were analyzed.After automated tumor segmentation with manual refinement,ROIs were sequentially expanded outward by 1,2,3,4 and 5 mm.A total of 2 264 radiomic features were extracted from each ROI.Feature selection using minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithms was performed in the training set to calculate radiomics scores.Logistic regression was used to develop prediction models.A combined model integrating optimal peritumoral radiomics score with clinical and CT features was established,with performance compared across models.Results Gender(χ2=24.922,P<0.001),smoking history(χ2=11.199,P=0.001),emphysema(χ2=40.802,P<0.001),and lymph node metastasis(χ2=5.674,P=0.017)were associated with EGFR mutation status.In the validation set,the area under the curve for the tumor ROI-based radiomics model was 0.676,while the five expansion models achieved area under the curve of 0.723,0.720,0.734,0.681,and 0.598,respectively.The combined model based on 3 mm expansion demonstrated superior performance to individual radiomics and clinical models,with area under the curve of 0.826,0.734,0.711 in the validation set,and 0.809,0.760,0.702 in the independent test set.Conclusion Peritumoral expansion-based CT radiomics demonstrates value for predicting EGFR mutations in NSCLC,with 3 mm identified as the optimal expansion margin.Integration with clinical information further enhances predictive accuracy.