ObjectiveTo explore the correlation between the blood stasis score of coronary heart disease（CAD） and mild cognitive impairment（MCI）， as well as the changes in plasma metabolic profile of blood stasis in patients with CAD combined with MCI（CADMCI） through a cross-sectional study， and further explore the impact of different degrees of blood stasis on the plasma metabolite profile of CADMCI patients. MethodsAccording to the diagnostic criteria of CAD and CAD blood stasis， patients hospitalized in Xiyuan Hospital of China Academy of Chinese Medical Sciences from October 2022 to October 2023 were continuously included. According to the Montreal Cognitive Assessment（MoCA） scale score， the enrolled patients were divided into CADMCI blood stasis group and CAD blood stasis group. The association between blood stasis score and MCI was analyzed by multivariate Logistic regression model. The receiver operating characteristic（ROC） curve was drawn， and the area under the curve（AUC） was calculated to evaluate the sensitivity and specificity of the model. According to the blood stasis score， the first 30 patients in the CADMCI blood stasis group and CAD blood stasis group were divided into mild blood stasis and severe blood stasis. Ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS） was used to detect plasma metabolites in each group of patients. The differential metabolites were screened according to variable importance in the projection（VIP） value≥1， fold change（FC）<0.67 or >1.5， and P<0.05. ROC curve analysis was further used to evaluate the discriminatory efficiency of the screened differential metabolites for each group of samples. ResultsA total of 266 CAD patients were included in this study. Multivariate Logistic regression analysis showed that the CAD blood stasis score was significantly correlated with MCI［odds ratio（OR）=1.619， 95% confidence interval（CI） 1.223-2.142， P<0.001， ROC curve AUC was 0.615（95% CI 0.547-0.683， P=0.001）］， indicating that the CAD blood stasis score has a certain predictive value for MCI. Plasma non-targeted metabolomics analysis showed that the main differential metabolites between CAD blood stasis and CADMCI blood stasis were lipid metabolites， among which phosphatidylcholine［20∶4（5Z， 8Z， 11Z， 14Z）/P-18∶1（11Z）］ had the best discriminatory efficiency（ROC curve AUC=0.867， 95% CI 0.754-0.942）. Further analysis of the differential metabolites between mild and severe blood stasis showed that lipid metabolites were also the main differential metabolites between mild and severe blood stasis. Among them， 1α，25-dihydroxy-2β-（2-hydroxyethoxy） vitamin D₃ had the best efficacy in distinguishing mild and severe CAD blood stasis（AUC=0.813， 95% CI 0.649-0.951）， and phosphatidylcholine 34∶2 had the best efficacy in distinguishing mild and severe CADMCI blood stasis（AUC=0.819， 95% CI 0.640-0.941）. ConclusionThere is a significant correlation between CAD blood stasis score and MCI. Phosphatidylcholine metabolites play an important role in the pathogenesis of CADMCI blood stasis and severe blood stasis. The CAD blood stasis score combined with the detection of phosphatidylcholine metabolites can provide a reference for the development of early and efficient identification strategies for CADMCI.

Objective:To fine-tune the mT5 (massively multilingual pre-trained text-to-text transformer) large language model, automatically generate report conclusions for teaching purposes from chest CT image descriptions, and assess the quality of automatically generated conclusions.Methods:The training set included 3 000 high-quality physical examination chest CT reports from one hospital, and the external validation set consisted of 600 physical examination chest CT reports from two other hospitals. Experienced radiology teaching physicians assessed the consistency between the generated conclusions and the original physician-written conclusions in the external validation set using a 5-point Likert scale across five linguistic indicators (correctness of examination information, correctness of lesion detection, standardization of terminology, applicability of the conclusions, and simplicity of conclusions). Using the original report conclusions as the reference, the accuracy of the conclusions generated based on the external validation set in describing four major thoracic conditions (pulmonary nodules, pneumonia, emphysema, pleural effusion) was evaluated. Perform chi square test using SPSS 25.0.Results:In the external validation set, the mean consistency score between the generated conclusions and the original conclusions given by the radiology teaching physicians was >4 points, indicating agreement with the original conclusions. In the generated conclusions, the description of the four major thoracic conditions demonstrated 0.95-1.00 (95% CI=0.91-1.00) accuracy, 0.76-1.00 (95% CI=0.59-1.00) sensitivity, and 0.97-1.00 (95% CI=0.91-1.00) specificity. Conclusions:The chest CT report conclusion generation system based on the mT5 large language model demonstrated high accuracy and is expected to provide immediate and efficient automated guidance for standardized residency training.

Objective To analyze the distribution characteristics of TCM syndromes in patients with mild cognitive impairment of coronary heart disease(CHD-MCI);To provide reference for the TCM prevention and treatment of CHD-MCI.Methods A prospective,cross-sectional study design was adopted to collect general information and TCM diagnosis information of CHD-MCI patients who attended Xiyuan Hospital of China Academy of Chinese Medical Sciences from July 2022 to December 2023.Descriptive statistics were conducted,retaining the main syndrome entries.Multivariate statistical methods such as factor analysis and clustering analysis were used to enrich and summarize the TCM syndrome characteristics of CHD-MCI patients and analyze their distribution patterns.Results This study collected information on the TCM four diagnostic methods from 220 CHD-MCI patients,retaining clinical syndrome items with a frequency of>20%,including 29 symptoms and 13 tongue pulse information.Common clinical symptoms included chest tightness,thirst,palpitations,chest pain,fatigue,severe physical activity or fatigue,dizziness and soreness in the waist and knees.Common tongue symptoms included greasy tongue coating,yellow tongue coating and dull red tongue.Common pulse conditions included pulse string,sinking pulse and astringency.Factor analysis was conducted on 42 variable items,obtaining 17 common factors with a cumulative contribution rate of 66.298%.Based on this,clustering analysis was applied,combined with clinical diagnosis and treatment experience and expert group opinions,to determine that there were four common types of TCM syndromes in CHD-MCI(ranked from high to low in proportion):kidney deficiency and blood stasis syndrome(38.18%),qi stagnation and blood stasis syndrome(28.18%),heart kidney deficiency syndrome(25.00%)and qi deficiency and phlegm obstruction syndrome(8.64%).Conclusion Patients with CHD-MCI can be classified into four types of TCM syndromes,with kidney deficiency and blood stasis syndrome being the most common.Based on the information from the TCM four diagnostic methods,the key points of each type of syndrome can be determined,providing a basis for the objective classification and differentiation of TCM syndromes in this disease.

Objective To analyze the distribution characteristics of TCM syndromes in patients with mild cognitive impairment of coronary heart disease(CHD-MCI);To provide reference for the TCM prevention and treatment of CHD-MCI.Methods A prospective,cross-sectional study design was adopted to collect general information and TCM diagnosis information of CHD-MCI patients who attended Xiyuan Hospital of China Academy of Chinese Medical Sciences from July 2022 to December 2023.Descriptive statistics were conducted,retaining the main syndrome entries.Multivariate statistical methods such as factor analysis and clustering analysis were used to enrich and summarize the TCM syndrome characteristics of CHD-MCI patients and analyze their distribution patterns.Results This study collected information on the TCM four diagnostic methods from 220 CHD-MCI patients,retaining clinical syndrome items with a frequency of>20%,including 29 symptoms and 13 tongue pulse information.Common clinical symptoms included chest tightness,thirst,palpitations,chest pain,fatigue,severe physical activity or fatigue,dizziness and soreness in the waist and knees.Common tongue symptoms included greasy tongue coating,yellow tongue coating and dull red tongue.Common pulse conditions included pulse string,sinking pulse and astringency.Factor analysis was conducted on 42 variable items,obtaining 17 common factors with a cumulative contribution rate of 66.298%.Based on this,clustering analysis was applied,combined with clinical diagnosis and treatment experience and expert group opinions,to determine that there were four common types of TCM syndromes in CHD-MCI(ranked from high to low in proportion):kidney deficiency and blood stasis syndrome(38.18%),qi stagnation and blood stasis syndrome(28.18%),heart kidney deficiency syndrome(25.00%)and qi deficiency and phlegm obstruction syndrome(8.64%).Conclusion Patients with CHD-MCI can be classified into four types of TCM syndromes,with kidney deficiency and blood stasis syndrome being the most common.Based on the information from the TCM four diagnostic methods,the key points of each type of syndrome can be determined,providing a basis for the objective classification and differentiation of TCM syndromes in this disease.

The aim of this study is to establish an gene editing method of Mesomycoplasma hyo-pneumoniae(Mhp)based on the homologous recombination principle.The restriction enzyme di-gestion and ligation method combined with gene synthesis were used to construct a shuttle plasmid to achieve replication in both Mhp and Escherichia coli(E.coli).The pGEM?-T vector was used as the skeleton.The oriC sequence of Mhp which can achieve the replication of the plasmid in Mhp was inserted into the vector.Sequences of the Spiroplasma promoter and puromycin resistance gene were then inserted into the above constructed plasmid to screen recombinant clones.The up-stream and downstream homologous arms of p97 were constructed to initiate homologous recombination.The recA gene of E.coli is inserted to improve the efficiency of homologous recom-bination.The obtained shuttle plasmid was then delivered into Mhp by electro-transformation or chemical transformation.A shuttle plasmid,pGEM?-Mhp-oriC-p 97,which can replicate in both Mhp and E.coli was constructed.With the transformation of this plasmid,the carried puromycin gene and recA gene can be expressed,the p97 gene can be edited.Finally,the genetically unstable p97 gene mutant was initially obtained.In this study,a tool for Mhp gene editing based on the principle of homologous recombination was established,which laid a foundation for the develop-ment of tools for studying the pathogenesis of Mhp.

Objective To analysis the relationship between the lactate-to-albumin ratio(LAR)and the 28-day prognosis in patients with sepsis.Methods Based on the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ)database,patients with sepsis aged≥18 years were selected.Patients were divided into survival and death groups according to their 28-day prognosis.The LAR was divided into quartiles:Q1(LAR<0.45),Q2(0.45≤LAR<0.70),Q3(0.70≤LAR<1.18),and Q4(LAR≥1.18);and into two groups based on the median LAR:low LAR group(LAR≤0.70)and high LAR group(LAR>0.70).Demographic characteristics,comorbidities,laboratory indicators,clinical treatments,and disease severity scores of patients were extracted.LAR was included as a continuous variable and a four-category variable in multiple Logistic regression models,with trend tests performed.Subgroup analyses were conducted based on gender,age,comorbidities,and sequential organ failure assessment(SOFA)score.Receiver operator characteristic curve(ROC curves)were plotted to analyze the predictive efficacy of lactate,albumin(Alb),LAR and SOFA score for the prognosis of sepsis patients.Kaplan-Meier survival curves were plotted to compare the difference of 28-day cumulative survival rates of sepsis patients in the high and low LAR groups.Results A total of 9 169 patients with sepsis were included,with 6 799 in the survival group and 2 370 in the death group.Compared with the survival group,the death group had older age[years:70.80(58.64,82.25)vs.65.07(53.56,76.92)],higher levels of potassium,creatinine,blood urea nitrogen(BUN),white blood cell count(WBC),lactate,LAR,SOFA score,simplified acute physiology scoreⅡ(SAPSⅡ),and higher proportions of chronic obstructive pulmonary disease(COPD),heart failure,use of vasopressors within 48 hours,and continuous renal replacement therapy(CRRT)[potassium(mmol/L):5.0(4.5,5.7)vs.4.8(4.4,5.4),creatinine(μmol/L):132.60(88.40,212.16)vs.97.24(70.72,159.12),BUN(mmol/L):11.42(7.14,18.56)vs.7.85(5.25,13.57),WBC(×109/L):13.1(8.7,19.1)vs.11.4(7.6,16.4),lactate(mmol/L):2.9(1.8,5.1)vs.2.0(1.4,3.1),LAR:1.03(0.63,1.88)vs.0.62(0.42,0.98),SOFA score:9(6,12)vs.6(4,8),SAPSⅡscore:52(42,64)vs.38(30,47),COPD:8.19%(194/2 370)vs.6.57%(447/6 799),heart failure:29.96%(710/2 370)vs.26.31%(1 789/6 799),use of vasopressors within 48 hours:62.19%(1 474/2 370)vs.37.56%(2 554/6 799),CRRT:19.45%(461/2 370)vs.9.56%(650/6 799),all P<0.05],while lower levels of body weight,chloride,calcium,hemoglobin(Hb),platelet count(PLT),Alb and lower proportions of hypertension were observed in the death group[body weight(kg):75.8(63.6,92.3)vs.78.7(66.5,95.0),chloride(mmol/L):104(98,109)vs.104(100,108),calcium(mmol/L):1.07(1.00,1.15)vs.1.09(1.03,1.15),Hb(g/L):103(87,120)vs.105(90,121),PLT(×109/L):173(104,246)vs.174(118,243),Alb(g/L):29(24,34)vs.33(28,37),hypertension:35.36%(838/2 370)vs.38.34%(2 607/6 799),all P<0.05].In the Logistic regression model adjusted for all confounding factors,the odds ratio(OR)and 95%confidence interval(95%CI)of LAR were 1.74(1.64-1.85),P<0.001;when LAR was treated as a four-category variable,the OR values of Q2,Q3,and Q4 increased progressively compared with Q1,being 1.49(1.22-1.82),2.27(1.88-2.75),and 5.05(4.20-6.08),respectively,P<0.001.Subgroup analyses showed that LAR was an independent risk factor for the 28-day prognosis of sepsis in different subgroups based on gender,age,comorbidities,and SOFA score(all P<0.001),with no interaction effects with the subgroup variables(all P>0.05).ROC curve analysis showed that the AUC of LAR predicted the 28-day prognosis of patients with sepsis was 0.688(0.675-0.700),higher than that of lactate[0.655(0.642-0.668)]and Alb[0.636(0.623-0.649)],both P<0.001,and not significantly lower than that of SOFA score[0.699(0.687-0.712),P=0.108].Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate was significantly higher in the low LAR group than in the high LAR group(Log-Rank test:χ2=533.24,P<0.001).Conclusion LAR is an independent risk factor for the 28-day prognosis of sepsis patients.Higher LAR is associated with adverse outcomes,and its predictive efficacy is superior to that of lactate and albumin.

Objective To observe the effects of a stepped early activity program combined with lower limb joint rehabilitation devices in mechanically ventilated patients in the intensive care unit(ICU).Methods Sixty mechanically ventilated patients admitted to the ICU of Tianjin First Central Hospital from October 2022 to June 2023 were selected as study subjects and randomly divided into an intervention group(n=30)and a control group(n=30)using a random number table.The control group received routine rehabilitation nursing combined with lower limb joint rehabilitation devices,while the intervention group was additionally treated with the stepped early activity program.The duration of mechanical ventilation,length of ICU stay,incidence of delirium,Medical Research Council(MRC)muscle strength scores,phase angle(PA),and skeletal muscle mass index(SMI)were compared between the two groups.Results The intervention group showed significantly shorter durations of mechanical ventilation and the length of ICU stay compared to the control group[mechanical ventilation time(days):9.20±4.51 vs.11.73±4.59,the length of ICU stay(days):10.73±5.37 vs.14.00±6.03,both P<0.05].Post-intervention MRC muscle strength scores,PA,and SMI significantly increased in both groups,with greater improvements observed in the intervention group[MRC muscle strength score:54.17±2.10 vs.50.17±3.51;PA(°):5.80±0.60 vs.5.49±0.54;SMI(kg/m2):6.87±0.46 vs.6.62±0.45,all P<0.05].No statistically significant difference was found in delirium incidence between the two groups[26.7%(8/30)vs.33.3%(10/30),P>0.05].Conclusion The combination of a stepped early activity program and lower limb joint rehabilitation devices effectively shortens mechanical ventilation time and the length of ICU stay,restores muscle strength,and promotes recovery in mechanically ventilated ICU patients,demonstrating significant clinical value.

Objective To investigate the distribution of Streptococcus,sensitivity to commonly used antibiotics,and prognosis of the patients with bloodstream infections,and provide evidence for early diagnosis and selection of antibiotics.Methods The Streptococci i-solated from the blood samples of the First Affiliated Hospital of Nanjing Medical University from 2017 to 2022 were collected and di-vided into α-and β-hemolytic Streptococci according to the type of hemolysis.Their sensitivity to commonly used antibiotics was ana-lyzed.The differences in clinical data and prognosis between the two groups were also compared.Results A total of 314 strains of Streptococcus were isolated from 305 patients,including 270 strains of α-hemolytic Streptococcus and 44 β-hemolytic Streptococcus.The results of the drug sensitivity test showed that the proportion of Streptococcus strains with a diameter of 17-19 mm in the inhibition zone of vancomycin increased year by year.The positive alarm time of blood culture for β-hemolytic Streptococcus was significantly shorter than that for α-hemolytic Streptococcus(P＜0.001).Using 10.5 hours as the diagnostic threshold could assist in distinguishing blood-stream infections caused by α-and β-hemolytic Streptococcus.The overall mortality rate of patients with streptococcal bloodstream infec-tion was 15.1％,and there was no statistically significant difference in the mortality rate between the two groups(P=0.813).Conclu-sion The main Streptococcus causing bloodstream infections in our hospital is α-hemolytic Streptococcus.There are differences in the antimicrobial sensitivity and clinical characteristics among patients with different streptococcal bloodstream infections.The positive a-larm time of blood culture can assist in distinguishing the type of streptococcal bloodstream infections.In addition,the diameter of the inhibition zone of vancomycin against Streptococcus has drifted towards the breakpoint of drug resistance.

AIM:To investigate whether total alkaloids of Cocculus orbiculatus(COTA)attenuate ulcerative colitis(UC)in mice via PINK1/parkin mitophagy pathway.METHODS:Sixty C57BL/6 mice were randomly divided into normal control group,model group,positive drug mesalazine group,and low-,medium-and high-dose(0.162,0.324 and 0.486 g/kg)COTA groups,with 10 mice in each group.Except for normal control group,the mice in all groups were given free access to 3%dextran sulfate sodium(DSS)solution for 7 consecutive days to establish a UC model in mice,and were then treated with COTA or mesalazine via oral gavage.The general condition of the mice was observed,and the colon length and disease activity index(DAI)score were determined.Colon histopathological damage was observed by HE staining.The serum levels of interleukin-1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)were detected by ELISA.The pro-tein levels of PINK1,parkin,microtubule-associated protein 1 light chain 3(LC3),P62 and beclin-1 in colon tissues were determined by Western blot.The protein expression of LC3 and parkin was detected by immunofluorescence.RE-SULTS:Compared with normal control group,the mice in model group showed varying degrees of soft stools or bloody stools,decreased body weight(P<0.05),increased DAI score,shortened colon length(P<0.05),and obvious pathologi-cal damage in the colon tissue.The serum levels of IL-1β,IL-6 and TNF-α were elevated(P<0.05).The protein levels of parkin,PINK1,LC3-II and beclin-1 were significantly decreased(P<0.05),while P62 protein expression was in-creased(P<0.05).Immunofluorescence showed a small number of autophagosomes in the colon tissue.In contrast,com-pared with model group,the mice in total alkaloids of Cocculus orbiculatus groups exhibited increased body weight(P<0.05),decreased DAI score,increased colon length(P<0.05),and reduced levels of IL-1β,IL-6 and TNF-α(P<0.05).The protein levels of parkin,PINK1,LC3 and beclin-1 were elevated(P<0.05),while P62 expression was re-duced(P<0.05),with numerous autophagosomes visible in the colon tissue via immunofluorescence.CONCLUSION:Total alkaloids of Cocculus orbiculatus can enhance the expression of mitophagy-related proteins PINK1,parkin,LC3 and beclin-1,activate mitophagy,and reduce the expression of inflammatory factors,thereby attenuating the inflammatory re-sponse in the colon mucosa of DSS-induced UC mice.

Objective:To investigate the efficacy of vital pulp therapy versus pulp revascularization in the treatment of irreversible pulpitis and apical periodontitis in young permanent teeth. Methods:This study used a retrospective design. Fifty-six children with irreversible pulpitis and apical periodontitis in young permanent teeth, admitted to Shaoxing Stomatological Hospital from January 2022 to June 2024, were selected for the study. The children were divided into Group A ( n = 28) and Group B ( n = 28) based on treatment methods. Group A received vital pulp therapy, while Group B underwent pulp revascularization. The efficacy of both groups was compared 12 months after surgery. The root length and apical foramen size were compared between the two groups before surgery, as well as 3 and 12 months after surgery. The imaging findings were also compared between the two groups 3 and 12 months after surgery. Results:There was no significant difference in efficacy between the two groups ( P>0.05). The root lengths in Group A at 3 and 12 months after surgery were (13.17 ± 1.52) mm and (14.34 ± 1.68) mm, respectively, which were significantly greater than those in Group B [(11.86 ± 1.29) mm, (13.09 ± 1.45) mm; t = 3.48, 2.98, both P<0.05]. The apical foramen sizes in Group A at 3 and 12 months after surgery were (2.17 ± 0.32) mm and (1.61 ± 0.27) mm, respectively, and were significantly smaller than those in Group B [(2.53 ± 0.37) mm, (1.98 ± 0.31) mm; t = -7.03, -4.76, both P<0.05]. The proportion of children with an open apical foramen in Group A at 3 months after surgery was significantly lower than that in Group B [35.71% (10/28) vs. 64.29% (18/28); χ2 = 4.57, P<0.05). However, there was no statistically significant difference in the proportion of open apical foramina between the two groups at 12 months after surgery ( P>0.05). Conclusions:Vital pulp therapy shows good efficacy in the treatment of irreversible pulpitis and apical periodontitis in young permanent teeth. Compared with pulp revascularization, vital pulp therapy can remarkably reduce apical foramen size and increase root length, making it a valuable option for clinical practice.