ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

OBJECTIVE To systematically evaluate the correlation between dynamic changes in inflammatory markers during treatment with epidermal growth factor receptor-tyrosine kinase inhibitors （EGFR-TKIs） in non-small cell lung cancer （NSCLC） patients and therapeutic efficacy， with the aim of providing evidence-based support for clinical prognosis assessment and treatment strategy adjustment. METHODS Databases including PubMed， Embase， Cochrane Library， CNKI， Wanfang Data， and CBM were searched from the inception to July 20， 2025. Following literature screening， data extraction and quality assessment， descriptive analysis was conducted on the outcomes of included studies. RESULTS A total of eight studies were included to analyze the correlation of 6 inflammatory markers before and after treatment with EGFR-TKIs with therapeutic efficacy. The risk of bias assessment identified six high-quality studies and two moderate-quality studies. Among these studies， seven studies demonstrated that lower levels of neutrophil-to-lymphocyte ratio （NLR）， derived neutrophil-to-lymphocyte ratio （dNLR）， platelet-to-lymphocyte ratio （PLR）， and monocyte-to-lymphocyte ratio （MLR）， higher lymphocyte-to-monocyte ratio （LMR） before treatment， as well as decreased NLR and MLR and increased LMR after treatment were associated with longer median progression-free survival. Five studies indicated that lower levels of NLR， dNLR， PLR， and interleukin-6 （IL-6）， higher LMR before treatment as well as decreased NLR and dNLR and increased LMR were associated with longer median overall survival. Three studies indicated that lower levels of IL-6 were associated with a higher objective response rate， while the association of these markers after treatment remained controversial； another study showed that an early decline in NLR， MLR， and PLR after treatment may be associated with objective response benefit. CONCLUSIONS Lower inflammatory levels during EGFR-TKIs therapy correlate with better therapeutic efficacy in NSCLC patients.

Background China has the largest elderly population in the world, and age-related cognitive impairment has become an increasingly important public health issue. Objective To investigate the associations of exposure to selected essential metals (EMs) and non-essential metals (NEMs) with cognitive function among rural older adults and to examine whether EMs modified the association between NEW exposure and cognitive functions. Methods A total of 1045 adults aged 60 years and above were enrolled using baseline survey data from a cohort study. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine urinary concentrations of five EMs (selenium, cobalt, vanadium, manganese, and boron) and five NEMs (arsenic, chromium, cadmium, lithium, and tin). The Mini-Mental State Examination (MMSE) scale was used to assess cognitive function. Generalized linear models (GLMs) and restricted cubic spline (RCS) models were used to examine the associations of individual EMs and NEMs with MMSE scores. Quantile g-calculation (QGC) and Bayesian kernel machine regression (BKMR) models were used to evaluate the associations of EM and NEM mixtures with MMSE scores. Results The mean age of the participants was (69.72±6.63) years, and 511 participants (48.90%) were male. The mean MMSE score was 21.06±5.79. After adjustment for covariates, GLM analysis showed that cobalt (β=0.575, 95%CI: 0.233, 0.918), selenium (β=0.440, 95%CI: 0.045, 0.836), and vanadium (β=0.633, 95%CI: 0.251, 1.016) were positively associated with MMSE scores, whereas tin (β=−0.379, 95%CI: −0.728, −0.029) was negatively associated with MMSE scores. After categorizing metal concentrations into quartiles and including them in the GLM, cobalt (β_{Q4 vs. Q1}=1.697, 95%CI: 0.806, 2.589) and vanadium (β_{Q4 vs. Q1}=1.598, 95%CI: 0.719, 2.477) remained positively associated with MMSE scores, whereas tin (β_{Q4 vs. Q1}=−0.890, 95%CI: −1.771, −0.008) and lithium (β_{Q4 vs. Q1}=−0.794, 95%CI: −1.689, −0.007) were negatively associated with MMSE scores. RCS model showed linear positive associations of cobalt and vanadium with MMSE scores, a linear negative association of tin with MMSE scores, and an inverted U-shaped association between lithium and MMSE scores. Both QGC and BKMR models indicated that the EMs mixture was positively associated with MMSE scores, with cobalt contributing the most. The NEM mixture showed a negative but nonsignificant association with MMSE scores, with lithium contributing the most. When EMs and NEMs were jointly modeled, no significant association was observed between the overall metal mixture and MMSE scores. Interaction analysis suggested a positive interaction between EMs and NEMs in relation to MMSE scores. Stratified analysis showed that, compared with participants with high cobalt or EMs exposure, those with low cobalt or EMs exposure had a more pronounced and statistically significant negative association between NEMs exposure and MMSE scores. Conclusion The EM mixture is significantly and positively associated with MMSE scores, whereas the NEMs mixture shows a negative but nonsignificant association. EMs and NEMs have a positive interaction on MMSE scores; EMs attenuate the association between NEMs and MMSE scores.

The development of organ transplantation has brought new hope to many patients with organ failure and their families， but it has also raised numerous ethical issues. How to balance the rights and interests between organ donors and recipients， as well as ensure the fairness and transparency of the transplantation process has become an urgent problem to be solved. Based on the latest Regulations on Organ Donation and Transplantation and the Working Rules of the Ethics Committee for Human Organ Transplantation， the current difficulties and challenges in organ transplantation ethics were deeply analyzed. Taking the ethical review practice of Shenzhen Third People’s Hospital as an example， this paper explored issues such as full informed consent of both donors and recipients， risk assessment of marginal donors， and the review of relationships between donors and recipients. It also explored and constructed a set of complete ethical review models for organ transplantation through refined management. This model improved the efficiency and quality of ethical review as well as enriched the related knowledge system. It is expected that the implementation of this model can provide a reference for promoting effective ethical review nationwide， advancing the improvement and development of ethical review work in organ transplantation. Meanwhile， more medical ethics experts and practitioners are called upon to focus on and engage in the research and practice of ethical review in organ transplantation， jointly promoting progress in this field.

ObjectiveThis study aims to investigate the dynamic changes in general body parameters, blood glucose, and blood lipid profiles in obese cynomolgus monkeys, exploring the correlations among these parameters and providing a reference for research on the obese cynomolgus monkey model. Methods30 normal male cynomolgus monkeys aged 5 - 17 years old (with body mass index < 35 kg/m² and glycated hemoglobin content < 4.50%) and 99 spontaneously obese male cynomolgus monkeys (with body mass index ≥35 kg/m² and glycated hemoglobin content < 4.50%) were selected. Over a period of three years, their abdominal circumference, skinfold thickness, body weight, body mass index, fasting blood glucose, glycated hemoglobin, and four blood lipid indicators were monitored. The correlations between each indicator were analyzed using repeated measurement ANOVA, simple linear regression, and multiple linear regression correlation analysis method. Results Compared to the control group, the obese group exhibited significantly higher levels of abdominal circumference, skinfold thickness, body weight, body mass index, and triglyceride (P＜0.05). In the control group, skinfold thickness increased annually, while other indicators remained stable. Compared with the first year, the obese group showed significantly increased abdominal circumference, skinfold thickness, body weight, body mass index, triglyceride, and fasting blood glucose in the second year(P＜0.05), with this increasing trend persisting in the third year (P＜0.05). In the control group, the obesity incidence rates in the second and third years were 16.67% and 23.33%, respectively, while the prevalence of diabetes remained at 16.67%. In the obese group, the diabetes incidence rates were 29.29% and 44.44% in years 2 and 3, respectively. Among the 11-13 year age group, the incidence rates were 36.36% and 44.68%, while for the group older than 13 years, the rates were 28.13% and 51.35%. Correlation analysis revealed significant associations (P＜0.05) between fasting blood glucose and age, abdominal circumference, skinfold thickness, body weight, and triglyceride in the diabetic monkeys. Conclusion Long-term obesity can lead to the increases in general physical indicators and fasting blood glucose levels in cynomolgus monkeys, and an increase in the incidence of diabetes. In diabetic cynomolgus monkeys caused by obesity, there is a high correlation between their fasting blood glucose and age, weight, abdominal circumference, skinfold thickness, and triglyceride levels, which is of some significance for predicting the occurrence of spontaneous diabetes.

Peripheral nerve injury (PNI) encompasses damage to nerves located outside the central nervous system, adversely affecting both motor and sensory functions. Although peripheral nerves possess an intrinsic capacity for self-repair, severe injuries frequently result in significant tissue loss and erroneous axonal junctions, thereby impeding complete recovery and potentially causing neuropathic pain. Various therapeutic strategies, including surgical interventions, biomaterials, and pharmacological agents, have been developed to enhance nerve repair processes. While preclinical studies in animal models have demonstrated the efficacy of certain pharmacological agents in promoting nerve regeneration and mitigating inflammation, only a limited number of these agents have been translated into clinical practice to expedite nerve regeneration. Chinese herb medicine (CHM) possesses a longstanding history in the treatment of various ailments and demonstrates potential efficacy in addressing PNI through its distinctive, cost-effective, and multifaceted methodologies. This review critically examines the advancements in the application of CHM for PNI treatment and nerve regeneration. In particular, we have summarized the most commonly employed and rigorously investigated CHM prescriptions, individual herbs, and natural products, elucidating their respective functions and underlying mechanisms in the context of PNI treatment. Furthermore, we have deliberated on the prospective development of CHM in both clinical practice and fundamental research.
Drugs, Chinese Herbal/pharmacology* ; Humans ; Peripheral Nerve Injuries/drug therapy* ; Animals ; Nerve Regeneration/drug effects* ; Medicine, Chinese Traditional

Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.

Functional dyspepsia (FD), characterized by persistent or recurrent dyspeptic symptoms without identifiable organic, systemic or metabolic causes, is an increasingly recognized global health issue. The objective of this guideline is to equip clinicians and nursing professionals with evidence-based strategies for the management and treatment of adult patients with FD using traditional Chinese medicine (TCM). The Guideline Development Group consulted existing TCM consensus documents on FD and convened a panel of 35 clinicians to generate initial clinical queries. To address these queries, a systematic literature search was conducted across PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, China Biology Medicine (SinoMed) Database, Wanfang Database, Traditional Medicine Research Data Expanded (TMRDE), and the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS). The evidence from the literature was critically appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The strength of the recommendations was ascertained through a consensus-building process involving TCM and allopathic medicine experts, methodologists, pharmacologists, nursing specialists, and health economists, leveraging their collective expertise and empirical knowledge. The guideline comprises a total of 43 evidence-informed recommendations that span a range of clinical aspects, including the pathogenesis according to TCM, diagnostic approaches, therapeutic interventions, efficacy assessments, and prognostic considerations. Please cite this article as: Zhang SS, Zhao LQ, Hou XH, Bian ZX, Zheng JH, Tian HH, Yang GH, Hong WS, He YY, Liu L, Shen H, Li YP, Xie S, Shu J, Zeng BF, Li JX, Liu Z, Xiao ZH, Xiao JD, Zheng PY, Huang SG, Chen SL, Fei GJ. International clinical practice guideline on the use of traditional Chinese medicine for functional dyspepsia (2025). J Integr Med. 2025; 23(5):502-518.
Dyspepsia/drug therapy* ; Humans ; Medicine, Chinese Traditional/methods* ; Practice Guidelines as Topic ; Drugs, Chinese Herbal/therapeutic use*

Shock is a clinical syndrome caused by a sharp decrease in effective blood volume and tissue hypoperfusion from various etiologies.In the treatment of patients with shock,mechanical ventilation is one of the commonly used medical interventions.Mechanical ventilation directly affects intrapleural pressure(Ppl),which in turn has a direct impact on circulatory function,making it an important mediator in the pathophysio-logical interaction between mechanical ventilation and shock.Dynamic changes in Ppl affect respiratory and circulatory functions through mechanisms such as cardiopulmonary interactions.In the state of shock,imbal-ances in Ppl regulation can aggravate tissue hypoperfusion and organ dysfunction.The bidirectional effects of mechanical ventilation manifest in that positive pressure ventilation can improve oxygenation,but may also in-hibit venous return and increase ventricular afterload by raising mean Ppl.This article reviews the physiologi-cal significance of Ppl and its dynamic changes under shock conditions,and analyzes the clinical application and challenges of individualized mechanical ventilation strategies based on Ppl monitoring in patients with shock.

Objective:To investigate the effect of local food-source enteral nutrition(EN) to improve the nutritional status of stroke patients.Methods:The clinical data of 180 patients with ischemic stroke admitted to the First People′s Hospital of Chengdu and the Second People′s Hospital of Chengdu during the period from June 2021 to June 2023 were selected retrospectively, patients in both groups received EN at 24 to 48 h after admission, and total energy intake was evaluated 7 d later, which was divided into the standard calorie group (90 cases) and the low- calorie group (90 cases) according to total energy intake. The total energy intake of patients in the standard calorie group increased to 125 -146 kJ/ (kg·d) after 7 d. Patients in the low-calorie group gradually increased to 105 kJ/ (kg·d) after 7 d. The changes in inflammatory factors and nutritional indexes before and after treatment were compared between the two groups, and the incidence of malnutrition and neurological function deficit before and after treatment were compared between the two groups.Results:After treatment, the levels of serum interleukin 1β, tumor necrosis factor-α, ultrasensitive C-reactive protein in the low-calorie group were lower than those in the standard calorie group: (16.74 ± 4.33) ng/L vs. (20.15 ± 5.68) ng/L, (25.58 ± 5.09)ng/L vs. (30.04 ± 6.46) ng/L, (12.41 ± 3.29) mg/L vs.(15.24 ± 4.18) mg/L, there were statistical differences ( P<0.05); the levels of serum total protein, albumin, transferrin were higher than those in the standard calorie group: (66.42 ± 8.32) g/L vs. (60.58 ± 8.32) g/L, (46.32 ± 6.39) g/L vs. (41.42 ± 5.34) g/L, (3.44 ± 0.65) g/L vs. (3.12 ± 0.31) g/L, there were statistical differences ( P<0.05). The incidence of malnutrition in the low-calorie group was lower than that in the standard calorie group: 3.33%(3/90) vs. 12.22%(11/90), there was statistical difference ( χ2 = 9.05, P<0.05). After 1 month and 3 months of treatment, the scores of National Institute of Health stroke scale (NIHSS) scores in the low-calorie group were lower than that in the standard calorie group: (15.76 ± 3.54) scores vs. (22.34 ± 6.24) scores, (8.65 ± 2.74) scores vs. (11.76 ± 4.83) scores, there were statistical differences ( P<0.05). Conclusions:Early local food-borne EN can improve the nutritional status of stroke patients, reduce the expression of inflammatory factors, and facilitate the improvement of neurological damage.