ObjectiveTo investigate the clinical effects and safety of Shuhe Granules （舒和颗粒） in patients with rheumatoid arthritis （RA） comorbid with insomnia. MethodsA single-arm prospective exploratory design was adopted. Thirty RA patients comorbid with insomnia and diagnosed with the traditional Chinese medicine （TCM） syndrome of kidney-heart deficiency and qi-blood disharmony were enrolled. On the basis of maintaining their original RA treatment regimens， all patients received oral Shuhe Granules， one dose per day， for 12 consecutive weeks. The outcomes were assessed before treatment and at weeks 4， 8， and 12 after treatment. Sleep and related psychosomatic function were evaluated using the insomnia severity index （ISI）， Pittsburgh sleep quality index （PSQI）， fatigue severity scale （FSS）， patient health questionnaire-9 （PHQ-9）， generalized anxiety disorder-7 （GAD-7）， and Montreal cognitive assessment （MoCA） scores. RA-related assessments included the 28-joint disease activity score based on C-reactive protein （DAS28-CRP）， pain visual analog scale （VAS）， tender joint count （TJC28）， swollen joint count （SJC28）， morning stiffness duration， and health assessment questionnaire （HAQ） score. Laboratory parameters included erythrocyte sedimentation rate （ESR）， serum C-reactive protein （CRP）， anti-cyclic citrullinated peptide antibody （anti-CCP）， and rheumatoid factor （RF） levels. A literature-based historical control group was established through literature retrieval and meta-analysis. The ISI， PSQI， DAS28-CRP， and pain VAS scores were compared between the treatment group in the present study and the historical control group. Safety assessments were also performed. ResultsCompared with baseline before treatment， ISI and PSQI scores decreased at weeks 4， 8， and 12， while MoCA scores increased at weeks 4， 8， and 12. FSS scores decreased at weeks 4 and 12. At weeks 8 and 12， GAD-7 scores， DAS28-CRP scores， duration of morning stiffness， TJC28， and SJC28 were reduced. At week 12， PHQ-9， pain VAS， and HAQ scores significantly decreased （P＜0.05）. FSS and DAS28-CRP scores at week 12 were lower than those at week 4， and CRP levels at week 8 were lower than those at week 4 （P＜0.05）. Compared with the historical control group， the treatment group showed superior improvement in ISI and PSQI scores （P＜0.001）； however， no statistically significant differences were observed between the two groups in DAS28-CRP or pain VAS scores （P＞0.05）. No serious adverse events occurred during the study， and the 4 reported mild adverse events were all considered unrelated to the study medication. ConclusionShuhe Granules significantly improve sleep quality， fatigue， emotional status， cognitive function， RA-related symptoms， and joint function in patients with RA comorbid insomnia， with good safety and tolerability.

The generative network shows great potential for application in the field of medical imaging, as it can effectively address the scarcity of medical image data and the difficulty of labeling. In this review, the representative studies on mainstream generative networks in multimodal image synthesis, low-dose image reconstruction and structure preservation in recent years were reviewed. This includes an overview of the evolution of frameworks such as variational autoencoder, generative adversarial network and denoising diffusion probabilistic model, as well as their application in medical image generation. The current challenges and future research directions were also discussed in order to provide technical support for the clinical implementation of medical image generation methods.

Objective To investigate Candida albicans(C.auris)colonization in patients and environmental con-tamination of non-intensive care unit(non-ICU)in a hospital,and evaluate the effectiveness of infection prevention and control measures in non-ICU.Methods In March 2024,a paraplegic patient admitted to the department of re-habilitation medicine was found to have C.auris in both urinary catheter and urine culture.The patient was immedia-tely isolated in single room,and patient transfer-in/out of non-ICU was suspended.Fungal cultures were performed on specimens from the ward environment,caregivers,doctors,nurses,and co-hospitalized patients.Mass spec-trometry and molecular biology techniques were used for strain identification and cluster analysis.Contact isolation was conducted on patient.Prevention and control measures were taken,including strict hand hygiene,1 000 mg/L chlorine-based(sodium hypochlorite)disinfection,2％chlorhexidine decolonization,and terminal disinfection of pa-tient-contact items.After discharge,these measures continued with regular C.auris surveillance.Results Five strains of C.auris were isolated from the patient's urine,urinary catheter,inguinal swab,perianal swab,and bed rail swab.Protein mass spectrometry cluster analysis confirmed clonal relatedness of all isolates.The strain showed resistance to fluconazole and amphotericin B,but susceptibility to echinocandins.No C.auris was detected from healthcare workers'hand/axillary/groin swabs.After intervention(such as decolonization and environmental disin-fection),follow-up cultures were negative for C.auris.Conclusion Based on the characteristics of admitted pa-tients,non-ICU should implement active prevention and control measures including:admission screening,contact precautions,object surface microbiological monitoring,decolonization,environmental disinfection,and community management.Hand hygiene,contact isolation,and terminal disinfection are crucial for preventing C.auris trans-mission.

Diabetic retinopathy(DR),as one of the most common microvascular complications in patients with diabe-tes mellitus(DM),has a complex and multifaceted etiology that involves multiple factors.The unique characterization of DR in genomics,epigenomics,transcriptomics,proteomics,and metabolomics has opened new avenues for the exploration and development of novel therapeutic strategies for this disease.However,the inherent limitation of single-omics approa-ches is that they can only analyze the biological and molecular mechanisms underlying the disease from a single dimension,which makes it difficult to comprehensively capture the complex nature of DR.With the rapid advancement of high-throughput sequencing technology,multi-omics joint analysis combines the advantages of different histological techniques and can explore the pathogenesis of DR from multiple dimensions and levels.This paper aims to comprehensively review the latest progress of multi-omics technologies in revealing the pathogenesis of DR and its complex molecular mechanisms and thoroughly explore the new opportunities,current challenges,and future development prospects of multi-omics tech-nologies for DR research.

Objective To evaluate the impact of lens capsule diameter and capsular tension ring(CTR)fit on the ro-tational stability and visual function of Toric intraocular lenses(IOLs)in patients with high myopia cataract after surgery,and to explore the main influencing factors.Methods A prospective study included 100 eyes of patients with high myopia(axial length≥26 mm)who underwent phacoemulsification cataract extraction combined with Toric IOL implantation at the Cataract Department of Hebei Eye Hospital from September 2023 to March 2024.Based on the ratio of the capsule equivalent diameter measured by anterior segment OCT(CASIA2)to the standard diameter of CTR,the eyes were divided into the matched group(ratio of 0.8-1.2)and the unmatched group.Follow-up was conducted at 1 week,1 month,3 months,6 months,and 12 months postoperatively to observe the rotation angle of Toric IOL,residual astigmatism,uncor-rected visual acuity,and other indicators.Safety was assessed based on intraoperative and postoperative complications.Correlation analysis and multiple linear regression were used to explore the impact of capsule-CTR fit,corneal astigmatism,axial length,and other factors on Toric IOL rotation and postoperative refractive status.Results The mean IOL rotation angle at each postoperative time point in the matched group was significantly smaller than that in the unmatched group,with statistically significant differences between groups at different time points(all P＜0.05).The matched group showed better stability in IOL decentration distance and tilt angle.At 12 months postoperatively,the residual astigmatism in the matched group was(0.53±0.29)D,which was better than that in the unmatched group(0.71±0.34)D(P=0.08).The matched group also had more significant improvement in uncorrected visual acuity and higher subjective visual quality scores.Multiple linear regression analysis showed that capsule-CTR fit and preoperative corneal astigmatism were the main independent factors affecting the rotation angle of Toric IOL(R2=0.52)and residual astigmatism(R2=0.46).Conclu-sion For patients with high myopia cataract,precise capsule-CTR matching based on CASIA2 measurement helps improve the rotational stability of Toric IOLs,reduce residual astigmatism,and enhance postoperative visual quality.Personalized CTR model selection is worth promoting and applying.

Objective:To investigate the glymphatic system dysfunction and white matter microstructural damage in type 2 diabetic mellitus patients with diabetic peripheral neuropathy (DPN), and to identify the early diagnostic imaging biomarkers.Methods:Thirty-one DPN patients and 31 type 2 diabetes mellitus (T2DM) patients who attended the First People's Hospital of Yancheng from March 2022 to October 2023 were included. In addition, 40 healthy controls (HC) were recruited. All subjects underwent 3.0T MRI scan with diffusion tensor imaging and 3D-T1WI sequences, and the diffusion tensor imaging analysis along the perivascular space(DTI-ALPS) index, perivascular space volume fraction in white matter(PVSVF-WM) and peak width of skeletonized mean diffusivity (PSMD) were calculated. SPSS 26.0 software was used to perform one-way ANOVA, t-tests, and Chi-square tests to compare clinical data and imaging indicators among the three groups. Partial correlation analysis was used to explore the relationships between DTI-ALPS index, PVSVF-WM, PSMD and clinical indicators in DPN patients. Finally, receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of DTI-ALPS index, PVSVF-WM, and PSMD for DPN. Results:The DPN group(1.46±0.19)had considerably lower DTI-ALPS index than the T2DM group (1.59±0.14) and HC group (1.60±0.17) (both P<0.05, Bonferroni correction). The DPN group (1.44±0.11) had significantly higher PVSVF-WM than both the T2DM group (1.35±0.14) and HC group (1.26±0.13) (both P<0.05, Bonferroni correction). The DPN group (1.84±0.31) and the T2DM group (1.83±0.25) had higher PSMD than HC group (1.60±0.24) (both P<0.05, Bonferroni correction), but the difference between the DPN group and the T2DM group was not statistically significant ( P>0.05). The DTI-ALPS index in the DPN group were negatively correlated with PSMD ( r=-0.379, P=0.035). The DTI-ALPS index was negatively correlated with the Toronto clinical scoring system (TCSS) score ( r=-0.456, P=0.01), while PSMD was positively correlated with TCSS scores ( r=0.686, P<0.001) in DPN group. The ROC curves showed that the area under the curve (AUC) was 0.777 ( P<0.001) for the combined diagnosis of DPN with the DTI-ALPS index, PVSVF-WM and PSMD. Conclusion:DPN patients exhibit glymphatic system dysfunction and white matter microstructural damage. The DTI-ALPS index and PSMD can serve as objective markers for assessing DPN severity. The combination of glymphatic system function indicators and white matter microstructural damage markers has moderate diagnostic value for peripheral neuropathy in T2DM patients.

Objective:To investigate the characteristics of cell subsets in rheumatoid arthritis patients complicated with interstitial lung disease (RA-ILD).Methods:The clinical data of 344 patients with RA admitted to the Affiliated Hospital of Nantong University from June 2022 to November 2023 were analyzed. The patients were categorized into two groups based on the diagnostic criteria of ILD: 120 cases in the RA associated with ILD group (RA-ILD group) were included and 224 cases in the RA without ILD group (RA group), the clinical characteristics were compared between the RA-ILD group and the RA group. The influence factors of RA-ILD were analyzed by univariate and multivariate logistic regression.Results:Compared with RA patients, RA-ILD patients were more common in males, with older age, longer course of disease, and higher smoking rate ( P<0.05). The high titer anti-cyclic citrullinated peptide (CCP) antibody, white blood cells, neutrophil, neutrophil to lymphocyte count ratio, aspartate aminotr-ansferase(AST), creatinine (Cr) and lactate dehydrogenase (LDH) levels in RA-ILD patients were higher than those in RA patients. The triglyceride level was lower than that of RA patients ( P<0.05). The percentage of total T cells in peripheral blood lymphocyte subsets in RA-ILD patients [68.65%(62.22%, 76.78%)] was lower than that in RA patients [71.88%(65.83%, 78.39%)] ( Z=-2.26, P=0.024). The percentage of CD4 +T cells [40.2% (32.10%, 45.23%)] was lower than that of RA patients [46.5% (39.74%, 53.19%)] ( Z=-6.29, P<0.001). CD4 +T cell count [486.50 (324.25, 636.75)cells/μl] was lower than that of RA patients [564.50 (438.25, 752.00)cells/μl] ( Z=-4.50, P<0.001). CD4 +/CD8 + levels [1.86 (1.26, 2.18)] were lower than those of RA patients [2.03 (1.40, 2.94)] ( Z=-2.79, P=0.005). B cell count [127.00 (78.00, 207.25)cells/μl] was lower than that of RA patients [163.50 (91.25, 231.50)cells/μl] ( Z=-2.11, P=0.035), The percentage of NK cells in peripheral blood lymphocyte subsets in RA-ILD patients [19.72%(13.14%, 25.83%)] was higher than that in RA patients [12.55% (8.23%, 17.80%)] ( Z=6.13, P<0.001). NK cell count [182.50 (109.00, 293.75)cells/μl] was higher than that of RA patients [156.00 (89.00, 194.75)cells/μl] ( Z=3.17, P=0.002). The percentage of CD8 +T cells [25.10 %(18.74%, 29.86%)] was higher than that of RA patients [22.27% (17.32%, 29.21%)] ( Z=2.00, P=0.046). Imaging types of RA-ILD patients showed that usual interstitial pneumonia (UIP) was more common, followed by non-specific interstitial pneumonia (NSIP). CD8 + T cell count and percentage expression level in UIP were higher than NSIP, and CD4 +/CD8 + expression level was lower than NSIP ( P<0.05). Multivariate logistic regression analysis of indicators with statistical differences were male gender [ OR(95% CI)=2.888 (1.556, 5.360), P=0.001], age [ OR(95% CI)=1.065 (1.033, 1.098), P<0.001], disease duration [ OR(95% CI)=1.004 (1.001, 1.007), P=0.013], high titer anti-CCP antibody [ OR(95% CI)=2.764 (1.214, 6.292), P=0.015], LDH [ OR(95% CI)=1.006 (1.002, 1.009), P=0.001], CD4 +T cell percentage [ OR(95% CI)=0.964 (0.929, 1.000), P=0.049], CD4 +T cell count [ OR(95% CI)=0.998 (0.996, 1.000), P=0.011] and NK cell count [ OR(95% CI)=1.004 (1.001, 1.007), P=0.003]. These indicators were correlated factors for RA-ILD. Conclusion:Male patients with older age, history of smoking and a long disease course are more likely to develop ILD. Male gender with older, long disease course, high titer anti-CCP antibody, increased LDH and NK cell count, CD4 +T cell percentage and decreased CD4 +T cell count are correlation factors for RA-ILD, which may help RA patients to recognize ILD early.

Diabetic retinopathy(DR),as one of the most common microvascular complications in patients with diabe-tes mellitus(DM),has a complex and multifaceted etiology that involves multiple factors.The unique characterization of DR in genomics,epigenomics,transcriptomics,proteomics,and metabolomics has opened new avenues for the exploration and development of novel therapeutic strategies for this disease.However,the inherent limitation of single-omics approa-ches is that they can only analyze the biological and molecular mechanisms underlying the disease from a single dimension,which makes it difficult to comprehensively capture the complex nature of DR.With the rapid advancement of high-throughput sequencing technology,multi-omics joint analysis combines the advantages of different histological techniques and can explore the pathogenesis of DR from multiple dimensions and levels.This paper aims to comprehensively review the latest progress of multi-omics technologies in revealing the pathogenesis of DR and its complex molecular mechanisms and thoroughly explore the new opportunities,current challenges,and future development prospects of multi-omics tech-nologies for DR research.

Objective:To investigate the glymphatic system dysfunction and white matter microstructural damage in type 2 diabetic mellitus patients with diabetic peripheral neuropathy (DPN), and to identify the early diagnostic imaging biomarkers.Methods:Thirty-one DPN patients and 31 type 2 diabetes mellitus (T2DM) patients who attended the First People's Hospital of Yancheng from March 2022 to October 2023 were included. In addition, 40 healthy controls (HC) were recruited. All subjects underwent 3.0T MRI scan with diffusion tensor imaging and 3D-T1WI sequences, and the diffusion tensor imaging analysis along the perivascular space(DTI-ALPS) index, perivascular space volume fraction in white matter(PVSVF-WM) and peak width of skeletonized mean diffusivity (PSMD) were calculated. SPSS 26.0 software was used to perform one-way ANOVA, t-tests, and Chi-square tests to compare clinical data and imaging indicators among the three groups. Partial correlation analysis was used to explore the relationships between DTI-ALPS index, PVSVF-WM, PSMD and clinical indicators in DPN patients. Finally, receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of DTI-ALPS index, PVSVF-WM, and PSMD for DPN. Results:The DPN group(1.46±0.19)had considerably lower DTI-ALPS index than the T2DM group (1.59±0.14) and HC group (1.60±0.17) (both P<0.05, Bonferroni correction). The DPN group (1.44±0.11) had significantly higher PVSVF-WM than both the T2DM group (1.35±0.14) and HC group (1.26±0.13) (both P<0.05, Bonferroni correction). The DPN group (1.84±0.31) and the T2DM group (1.83±0.25) had higher PSMD than HC group (1.60±0.24) (both P<0.05, Bonferroni correction), but the difference between the DPN group and the T2DM group was not statistically significant ( P>0.05). The DTI-ALPS index in the DPN group were negatively correlated with PSMD ( r=-0.379, P=0.035). The DTI-ALPS index was negatively correlated with the Toronto clinical scoring system (TCSS) score ( r=-0.456, P=0.01), while PSMD was positively correlated with TCSS scores ( r=0.686, P<0.001) in DPN group. The ROC curves showed that the area under the curve (AUC) was 0.777 ( P<0.001) for the combined diagnosis of DPN with the DTI-ALPS index, PVSVF-WM and PSMD. Conclusion:DPN patients exhibit glymphatic system dysfunction and white matter microstructural damage. The DTI-ALPS index and PSMD can serve as objective markers for assessing DPN severity. The combination of glymphatic system function indicators and white matter microstructural damage markers has moderate diagnostic value for peripheral neuropathy in T2DM patients.

Objective:To compare the effect of metal prefabricated crowns and 3M350 universal resin on the dental caries of deciduous teeth.Methods:Retrospective analysis was performed on the clinical data of 89 children with proximal molar caries restoration admitted to Nantong Stomatological Hospital from January 2020 to January 2022. According to treatment methods, they were divided into observation group (metal prefabricated crowns restoration treatment, 49 cases of 49 teeth) and control group (3M350 universal resin restoration treatment, 40 cases of 40 teeth). The repair effect, occlusal function, periodontal index, treatment satisfaction and complications were compared.Results:The success rate of repair in the observation group (93.88%, 46/49) was higher than that in the control group (77.50%, 31/40), and the difference was statistically significant ( P<0.05). The maximum biting force and masticatory efficiency of the two groups after treatment were higher than those before treatment, and the observation group was higher than the control group, and the difference was statistically significant (all P<0.05). Comparison of periodontal indexes between the experimental and control groups comparison of probing depth (PD), plaque index (PLI), and bleeding index (BI) between the two groups before treatment, the differences were not statistically significant (all P>0.05); after treatment, PD, PLI, and BI were lower in both groups, and lower in the experimental group (all P<0.05). The total satisfaction of the observation group (87.76%, 43/49) was higher than that of the control group (65.00%, 26/40), and the difference was statistically significant ( P<0.05). The incidence of complications in the observation group (6.12%, 3/49) was lower than that in the control group (22.50%, 9/40), and the difference was statistically significant ( P<0.05). Conclusions:Compared with 3M350 general purpose resin, metal prefabricated crowns has better repairing effect and lower complication rate on adjacent caries of deciduous teeth, so it can be widely used in clinic.