ObjectiveTo establish an animal model of atrial fibrillation（AF） that accurately reflects the phlegm-heat and blood stasis（TRYZ） pathogenesis in traditional Chinese medicine. MethodsForty SPF-grade SD rats were randomly assigned using a random number table to the following groups：the control group， the TRYZ+AF group，the AF group and the TRYZ group， with ten rats in each group. The TRYZ+AF and TRYZ groups underwent a high-fat diet combined with intraperitoneal lipopolysaccharide（LPS） injection to simulate the pathological alterations of TRYZ syndrome. Groups TRYZ+AF and AF were induced with acetylcholine-calcium chloride（Ach-CaCl₂） via caudal vein injection to induce AF. The control group received no intervention and was maintained under normal conditions. The modeling period lasted 3 weeks. Electrocardiography was used to assess AF episodes and duration， echocardiography evaluated left atrial dimensions and cardiac function， fully automated biochemical analyzer measured the levels of total cholesterol（TC）， triglycerides（TG）， high-density lipoprotein cholesterol（HDL-C） and low-density lipoprotein cholesterol（LDL-C）， hemoreometer analyzed the whole blood viscosity， plasma viscosity， and whole blood reduced viscosity， a coagulation analyzer assessed prothrombin time（PT）， activated partial thromboplastin time（APTT）， thrombin time（TT）， and fibrinogen（FIB）， enzyme-linked immunosorbent assay（ELISA） was used to determine the levels of C-reactive protein（CRP）， interleukin（IL）-1β， IL-6， IL-17， tumour necrosis factor（TNF）-α， matrix metalloproteinase-9（MMP-9）， galectin-3（Gal-3）， Collagen Ⅰ， and α-smooth muscle actin（α-SMA）. Hematoxylin-eosin（HE） staining and Masson's trichrome staining were used to analyze pathological changes in atrial myocardium， Western blot was employed to detect MMP-9， Collagen Ⅰ and α-SMA protein expression in myocardial tissue， real-time quantitative polymerase chain reaction（Real-time PCR） evaluated fibrous factor gene expression levels. Changes in the TRYZ syndrome were assessed via body weight， tongue color［red（R）， green（G）， and blue（B）］， and rectal temperature. Ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS） was employed to detect differential metabolites between the control group and the TRYZ+AF group. ResultsFollowing three weeks of sustained modeling， compared with the control group， rats in the TRYZ+AF and the TRYZ groups exhibited reduced body weight， dry faeces， elevated rectal temperature， dark red tongue， decreased RGB values on the tongue surface， and markedly elevated TC and LDL-C levels（P<0.05， P<0.01）. The TRYZ+AF， TRYZ， and AF groups exhibited significantly decreased TT， APTT and PT， along with markedly elevated whole blood viscosity and FIB（P<0.05， P<0.01）. Rats in the TRYZ+AF and AF groups exhibited AF rhythm， markedly decreased heart rate， prolonged RR intervals， enlarged left atrium， and significantly reduced ejection fraction and shortening fraction（P<0.05， P<0.01）. Serum levels of CRP， IL-1β， IL-6， IL-17， TNF-α， MMP-9， Gal-3， Collagen Ⅰ， and α-SMA were elevated in rats from the TRYZ+AF， TRYZ， and AF groups compared to the control group， with the most pronounced increase observed in the TRYZ+AF group（P<0.05， P<0.01）. Histopathology revealed that the collagen fiber deposition in the atrial of rats in the TRYZ+AF， TRYZ and AF groups was higher than that in the control group（P<0.05， P<0.01）. Western blot and Real-time PCR results further demonstrated that the protein and mRNA expression levels of MMP-9， Collagen Ⅰ and α-SMA in the myocardial tissue of the TRYZ+AF group were higher than those in the other three groups（P<0.05， P<0.01）. Metabolomic analysis revealed 173 differentially expressed metabolites in the TRYZ+AF group and the control group， primarily enriched in pathways such as glycerophospholipid metabolism and glycolysis/gluconeogenesis. ConclusionThis study successfully establishes a rat model of AF integrated with the TRYZ syndrome， demonstrating the pathological process where the interactions of phlegm， heat and stasis jointly trigger tremor， this provides a reliable experimental tool for in-depth research into the biological basis of this disease syndrome.

Objective To investigate the changes and diagnostic value of serum hypoxia inducible factor 1 subunit alpha(HIF-1α)and Toll-like receptor 4(TLR4)levels in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary Aspergillosis infection.Methods A total of 240 COPD patients who visited Xi'an Qinhuang Hospital(hereinafter referred to as the hospital)from December 2020 to Decem-ber 2023 were selected as the study subjects in the study,and another 218 volunteers who underwent physical examinations at the hospital were selected as the control group.The COPD patients were separated into an in-fected group(124 cases)and an uninfected group(116 cases)based on whether they had pulmonary Aspergil-losis infection.Enzyme-linked immunosorbent assay was applied to detect the levels of HIF-1α and TLR4 in patients.Fully automated biochemical analyzer was applied to detect lactate dehydrogenase(LDH)and albu-min(ALB)levels.Multivariate Logistic regression was applied to analyze the influencing factors of infection in COPD patients.Pearson correlation was applied to analyze the correlation between HIF-1α and TLR4 levels in the infected group.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic val-ue of HIF-1α and TLR4 levels for the occurrence of infection in COPD patients.Results Compared with the control group,the COPD group showed an increase in HIF-1α and TLR4 levels(P＜0.05).Compared with the uninfected group,the proportion of dyspnea,antibiotics＞3 types,the duration of antibiotic use ≥ 14 days,mechanical ventilation procedures,the longer glucocorticosteroid(GC)use time,and levels of LDH,HIF-1α,TLR4 in the infected group were higher(P＜0.05),while the level of ALB was lower(P＜0.05).The types of antibiotics＞3 types,the duration of antibiotic use ≥ 14 days,the duration of GC use,and elevat-ed levels of LDH,HIF-1α,and TLR4 were independent risk factors for infection in COPD patients(P＜0.05),while elevated level of ALB was an independent protective factor for infection in COPD patients(P＜0.05).The levels of HIF-1α and TLR4 in the infected group were positively correlated(r=0.453,P＜0.001).The area under the curve(AUC)of HIF-1α and TLR4 in diagnosing infection in COPD patients alone was 0.816 and 0.813,and the AUC of their combined diagnosis was 0.930,which was better than their indi-vidual diagnoses(Zcombination-HIF-1α=4.923,Z combination-TLR4=5.192,P＜0.001,P＜0.001).Conclusion The levels of HIF-1α and TLR4 increase in COPD patients,and further increase after infection with pulmonary Aspergil-lus.They are independent risk factors for infection in patients,and the two are positively correlated.The combined di-agnosis of pulmonary aspergillosis has certain value and provides a theoretical basis for clinical diagnosis.

Objective: To investigate the association between the parent-child relationship with depression among junior high school students, as well as the dual moderating effect of teacher support and gender, so as to provide a reference for depression interventions at family, school, and individual levels. Methods: In November 2024, a cluster sampling design was used to recruit 1 229 students from two junior high schools in Chengdu, Sichuan Province as participants. The survey employed the Interpersonal Relations Scale, the Patient Health Questionnaire-9 for depression, and the Students Perceived Teacher Support Behavior Questionnaire. Spearman s rank correlation analyses were used to examine the associations among the parent-child relationship, teacher support, gender, and depression. Through linear regression analysis, the dual moderating effects of teacher support and gender on the association between parent-child relationship and depression in middle school students were evaluated. Results: Scores for the parent-child relationship and for teacher support among middle school students were (4.03±1.00) and (4.23±0.86), respectively, and the depression score was 1.13 (1.00, 1.63). Parent-child relationships and teacher support showed positive correlations,while both the parent-child relationship and teacher support were negatively correlated with depression among junior high school students ( r =0.25, -0.55, -0.29, all P <0.01). Linear regression analyses showed that teacher support and gender jointly moderated the association between the parent-child relationship and depression. Further simple slopes analyses revealed that the negative impact of the parent-child relationship on depression was stronger in girls, peaking under low teacher support conditions ( β =-0.61); among boys, a negative effect was also present but weaker ( β =-0.48) (both P <0.05). Conclusion Teacher support and gender jointly moderated the association between the parent-child relationship and depression among junior high school students; girls depression are more closely linked to the quality of the parent-child relationship, while boys are more sensitive to changes in teacher support.

Objective To investigate the application value of bronchoalveolar lavage fluid(BALF)met-agenomic next-generation sequencing(mNGS)in elderly patients with severe pneumonia.Methods A total of 48 elderly patients with severe pneumonia admitted to the intensive care unit from January to August 2024 were selected and randomly divided into an observation group and a control group,with 24 patients in each group.BALF samples were collected within 24 hours of ICU admission from both groups,with lavage per-formed at the most radiologically evident lesion site.The control group underwent traditional culture at the hospital,while the observation group had one specimen sent for mNGS testing and another specimen subjected to traditional culture at the hospital.Comparison of detection results between mNGS and traditional culture in the observation group,pathogen distribution,infection markers(on days 4 and 7 of ICU admission),and prog-nostic outcomes were compared between the groups.Results The observation group showed higher positive detection rates and higher rates of detecting ≥2 pathogens by mNGS compared to both traditional culture in the same group and the control group(P＜0.05).Excluding Acinetobacter baumannii,Candida albicans,Can-dida glabrata,and Raoultella planticola,the observation group detected higher quantities of fungi,viruses,and rare pathogens than the control group.On days 4 and 7 of ICU admission,the observation group had signifi-cantly lower body temperature,white blood cell count,C reactive protein,and procalcitonin levels compared to the control group(P＜0.05).The observation group also demonstrated shorter ICU stays,reduced mechanical ventilation duration,and total lower hospitalization costs than the control group(P＜0.05).Conclusion BALF mNGS facilitates early identification of mixed and rare pathogens,improves detection rates,broadens microbial coverage,and shortens testing time.

Objective:To analyze mortality risk factors in patients with severe pneumonia and investigate their varying influences across different time periods.Methods:A total of 134 patients with severe pneumonia admitted to the Emergency Department of Xiang’an Hospital, Xiamen University, between June 2019 and February 2020 were enrolled. All patients were treated in the EICU and followed up for four years. Based on outcomes, they were categorized into a death group ( n=77) and a survival group ( n=57). COX regression analysis was employed to identify mortality risk factors at different time points, while logistic regression analysis was used to assess risk factors influencing mortality during hospitalization, ICU stay, 1-month, and 1-year follow-up periods. Results:Mortality rates were 11.9% ( n=16) during ICU admission, 20.8% ( n=28) during hospitalization, 16.4% ( n=22) within 1 month, and 31.3% ( n=42) within 1 year. By the end of the follow-up, 57.4% ( n=77) of patients had died. Ten mortality risk factors were identified, with the number increasing over time. During ICU admission and hospitalization, significant risk factors included total bilirubin levels, APACHE-II score, invasive ventilation, ARDS, and vasopressor use in the ICU. One-month mortality risk additionally involved bacterial infection. One-year mortality risk further incorporated advanced age and chronic heart failure. By the end of follow-up, acute kidney injury (AKI) during ICU admission also emerged as a contributing factor, while higher body weight was identified as a protective factor. Conclusions:The number of mortality risk factors in severe pneumonia patients increases progressively over time. Early-stage factors during hospitalization and ICU admission exert a stronger impact on short-term mortality, whereas bacterial infection, advanced age, and chronic heart failure become increasingly significant in later stages. These findings highlight the dynamic nature of risk factors and underscore the importance of tailored monitoring and intervention strategies at different disease phases.

Objective:To establish an irritant contact dermatitis(ICD)model induced by sodium dodecyl sulfate(SDS)in mice,and explore its endotype to provide an experimental and theoretical basis for subsequent precise treatment.Methods:Mice were randomly divided into two groups(model group and control group),4%SDS was topically applied to induce ICD in mice,saline was used on control group,the dose and frequency were consistent with model group,and the skin lesions of mice were observed.Epidermal thickness and inflammatory cell infiltration were analyzed by HE staining,toluidine blue staining and immunofluorescence staining.Real-time quantitative PCR was performed to investigate mRNA expression levels of cytokines.Results:Compared with control group,mice in ICD model group showed epidermal thickness on the back of neck,and the numbers of inflammatory cells were increased in dermis.The number of neutrophils,macrophages and T cells were increased.Expressions of Il17a and Il17f mRNA levels were increased.Conclusion:SDS-induced ICD model is successfully established,with the elevated infiltration of neutrophils,macrophages and T cells,and secretion of type 17 cytokines.

Objective To construct a machine learning prediction model for postoperative liver injury in patients with non-liver surgery based on preoperative and intraoperative medication indicators.Methods A case-control study was conducted on 315 patients with liver injury after non-liver surgery selected from the databases developed by 3 large general hospitals from January 2014 to September 2022.With the positive/negative ratio of 1 ∶3,928 cases in corresponding period with non-liver surgery and without liver injury were randomly matched as negative control cases.These 1243 patients were randomly divided into the modeling group(n=869)and the validation group(n=374)in a ratio of 7∶3 using the R language setting code.Preoperative clinical indicators(basic information,medical history,relevant scale score,surgical information and results of laboratory tests)and intraoperative medication were used to construct the prediction model for liver injury after non-liver surgery based on 4 machine learning algorithms,k-nearest neighbor(KNN),support vector machine linear(SVM),logic regression(LR)and extreme gradient boosting(XGBoost).In the validation group,receiver operating characteristic(ROC)curve,precision-recall curve(P-R),decision curve analysis(DCA)curve,Kappa value,sensitivity,specificity,Brier score,and F1 score were applied to evaluate the efficacy of model.Results The model established by 4 machine learning algorithms to predict postoperative liver injury after non-liver surgery was optimal using the XGBoost algorithm.The area under the receiver operating characteristic curve(AUROC)was 0.916(95%CI:0.883～0.949),area under the precision-recall curve(AUPRC)was 0.841,Brier score was 0.097,and sensitivity and specificity was 78.95%and 87.10%,respectively.Conclusion The postoperative liver injury prediction model for non-liver surgery based on the XGBoost algorithm has effective prediction for the occurrence of postoperative liver injury.

Objective:To investigate the clinical efficacy of conbercept combined with whole retina laser photocoagulation in the treatment of ischemic central retinal vein occlusion (iCRVO) with macular edema (ME) and its effect on visual prognosis and retinal blood flow.Methods:A prospective study was conducted on 80 patients (80 eyes) with iCRVO and ME admitted to the Chongqing Aier Eye Hospital from January 2019 to November 2020. They were randomly divided into two groups using a random number table method, with 40 patients in each group. Among them, the observation group was treated with conbercept combined with whole retina laser photocoagulation, while the control group was treated with whole retina laser photocoagulation alone. We compared the clinical efficacy and safety between two groups. Before and after treatment, the best corrected visual acuity (BCVA), central macular thickness (CMT), and retinal blood flow parameters [retinal superficial capillary plexus (SCP) blood flow density, and macular foveal avascular zone (FAZ) area] were examined in both groups of patients. The Low Vision Quality of Life Scale (CLVQOL) was used to evaluate the quality of life of patients before and after treatment.Results:The total effective rate of the observation group was 95.00%(38/40), which was higher than 77.50%(31/40) of the control group ( P<0.05). The BCVA at 1 week, 1 month, and 3 months after treatment in both groups was significantly higher than that before treatment in this group, while the CMT was significantly lower than that before treatment in this group (all P<0.05). The BCVA of the observation group at 1 week, 1 month, and 3 months after treatment was significantly higher than that of the control group at the same time point (all P<0.05), while the CMT of the observation group at 3 months after treatment was significantly lower than that of the control group at the same time point (all P<0.05). There were no significant changes in SCP blood flow density and macular FAZ area before and after treatment in both groups (all P>0.05). The CLVQOL scale scores and total scores at 1 week, 1 month, and 3 months after treatment in the observation group were significantly higher than before treatment (all P<0.05). After 1 week, 1 month, and 3 months of treatment, the scores and total scores of the CLVQOL scale for distant vision, movement and light perception, and regulatory ability in the control group were significantly higher than those before treatment (all P<0.05); At 1 and 3 months after treatment, the scores of reading, fine work, and daily living ability on the CLVQOL scale were significantly higher than those before treatment (all P<0.05). The CLVQOL scale scores and total scores of distant vision, movement and light perception, reading and fine work in the observation group at 1 and 3 months after treatment were significantly higher than those in the control group at the same time point (all P<0.05); The regulatory ability dimension score of the CLVQOL scale at 3 months after treatment was significantly higher than that of the control group at the same time point (all P<0.05). There was no serious adverse event in both groups during the treatment. Conclusions:Conbercept combined with whole retina laser photocoagulation for iCRVO with ME can safely and effectively improve patients′ vision, promote ME regression, and improve their quality of life. Although the impact on retinal blood flow is not significant, it is beneficial for delaying the progression of the disease.

Objective:To evaluate the performance of the automated digital cell morphology instrument in detecting platelet (PLT) clumps.Methods:A total of 4271 blood samples whose PLT reached the reviewing rules of thrombocytopenia were selected from inpatients having blood analysis in Xijing Hospital from January 1 st to June 30 th, 2019, including 2 200 males and 2 071 females,with a median age of (35±7.03) years old. The smears for these cases were made, stained by Wright-Giemsa, and examined to capture PLT clumps by digital cell morphology system and manual microscope separately. The digital cell analysis system (hereinafter referred to as the instrument method) as an evaluation method and the microscope method as a reference method were used to calculate the positive rate of platelet clump detection and evaluate the comparison of two methods and bias assessments. The chi-square test was used to compare counting data rates. Results:Among 4, 271 samples reaching the reviewing rule of thrombocytopenia, 128 cases with platelet clumps were detected by manual microscope(initial) with a positive detection rate of 96.24%, and a total 133 of cases with PLT clumps were detected by microscope (initial+reconfirmation) with a positive detection rate of 100 %. Meanwhile, 129 cases with platelet clumps were detected by instrument method with a positive detection rate of 96.9%. There was no significant difference in terms of positive rate of PLT clumps detection between the instrumental method and the microscope method (initial) ( χ2 =0.115, P=0.73); the positive rate of clumps detection by the instrumental method was lower than microscope method (initial+reconfirmation), and the difference was statistically significant (χ 2 =4.061, P=0.04). For instrument method, the positive rate of PLT clumps detection by simultaneous observation of RBC analysis interface+PLT aggregation interface+WBC analysis interface was higher than only observation of PLT aggregation interface, and the difference was statistically significant (χ 2 =5.090, P=0.02). The average error of the deviation of PLT counting results before and after correction of the cases with PLT plumps missed by instrument method was significantly higher than microscope method (initial), and the difference was statistically significant (χ 2 =56.26, P<0.001). Conclusion:The automated digital cell morphology system has a good consistency with manual microscope(initial) in terms of the sensitivity of platelet clumps detection and can be used as a supplementary method for detecting platelet aggregation.

The phosphatase and tensin homolog deleted on chromosome ten (PTEN) is a common oncogene located in the 10q23.3 region on the long arm of human chromosome l0, which regulates a variety of biological processes such as proliferation, survival, cell structure, motility, energy metabolism and genomic stability. Inactivation of PTEN is prevalent in almost all malignancies and correlates with tumor progression. Thyroid malignancies are among the most common endocrine malignancies, and PTEN has been shown to be critically associated with their development. The aim of this review is to describe the structural function of PTEN, as well as to summarize and discuss the recent findings of PTEN in thyroid malignancies.