Objective:To investigate the effect of pre-stroke metformin (MET) use on early neurological improvement (ENI) and outcome after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with type 2 diabetes (T2DM).Methods:AIS patients with T2DM underwent IVT in the Department of Neurology, Yuncheng Central Hospital from January 2019 to February 2025 were included retrospectively. According to whether MET was used before onset, they were divided into MET group and non-MET group. Early neurological improvement (ENI) was defined as a decrease in the National Institutes of Health Stroke Scale (NIHSS) score ≥4 at 24 hours after IVT compared to admission, or the NIHSS score was 0-1. At 90 days after onset, the modified Rankin Scale was used for outcome assessment, and ≤2 was good outcome and >2 was poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of ENI and outcome. Results:A total of 115 AIS patients with T2DM were included in the study, with an age of 65.42±12.22 years. There were 83 males (72.2%). Fifty-four patients (47.0%) used MET, and 61 (53.0%) used other hypoglycemic drugs; 43 (37.4%) developed ENI, and 33 (28.7%) had poor outcome at 90 days. There were no significant difference in all baseline data between the MET group and the non-MET group, but the proportions of patients with ENI and good prognosis at 90 days in the MET group were significantly higher than those in the non-MET group (all P<0.05). The proportions of hypertensive patients and baseline NIHSS scores in the ENI group were significantly lower than those in the non-ENI group, while the proportions of patients using MET, antihypertensive drugs, statins, and patients with good outcome was significantly higher than that in the non-ENI group (all P<0.05). The body weight, high-density lipoprotein cholesterol, as well as the proportions of patients using antiplatelet drugs, MET, and patients with ENI in the good outcome group were significantly higher than those in the poor outcome group, while systolic blood pressure, fasting blood glucose, triglycerides, and the proportions of patients with hemorrhagic transformation, and symptomatic intracranial hemorrhage were significantly lower than those in the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that using statins (odds ratio [ OR] 5.291, 95% confidence interval [ CI] 1.599-17.514; P=0.006) and MET ( OR 3.018, 95% CI 1.125-8.092; P=0.006) were the independent influencing factors of ENI; using MET ( OR 0.014, 95% CI 0.001-0.246; P=0.004) and anterior circulation stroke ( OR 0.005, 95% CI 0.000-0.745; P=0.038) were significantly independently associated with good outcome, while high baseline NIHSS score ( OR 2.092, 95% CI 1.198-3.655; P=0.009) and serum homocysteine ( OR 1.202, 95% CI 1.024-1.411; P=0.024) were significantly independently associated with the poor outcome. Conclusion:The use of MET before stroke onset can help improve ENI and clinical outcome in AIS patients with T2DM after IVT.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Adenosine triphosphate(ATP),as a rich energy currency in cells,is released into the extracellular space through a variety of regulatory mechanisms.The role of extracellular ATP(eATP)and related purine and pyrimidine nucleotides as extracellu-lar signal molecules regulating immune cell function has been reported as evidence of purine signal transduction and has become the focus of attention as a therapeutic target for various diseases.Mast cells(MC)are distributed in tissues that come into contact with the external environment and are the first immune cells to respond to non-microbial environmental antigens.Although eATP is considered to be an activator of MC,the details remain to be further elucidated.This article describes the role of purine receptor signaling in MC degranulation.It expands the further understanding of the mechanism of allergic diseases,and further provides ideas for finding new targets for the treatment of allergic diseases and formulating new treatment strategies.

Obstructive sleep apnea(OSA)is a common sleep disorder characterized by repeated episodes of upper airway collapse and obstruction during sleep.Polysomnography is the gold standard for diagnosing OSA,but it is expensive,time-consuming,and can cause discomfort for patients.In recent years,acoustic-based approaches for detecting OSA have emerged as a research focus.This review summarizes recent advances in OSA automatic detection techniques based on snoring and speech signals,and systematically examines their applications in diagnosis,severity assessment,and localization of obstruction sites.Findings indicate that the acoustic features of snoring and speech signals hold significant value for OSA screening,and when combined with machine learning and deep learning models,it can achieve high diagnostic accuracy.Future research should focus on elucidating the relationship between acoustic features and the pathophysiological mechanisms of OSA,integrating multimodal information,and advancing the clinical application of wearable devices,with the aim of promoting intelligent,non-invasive,and cost-effective screening technologies for OSA.

Obstructive sleep apnea(OSA)is a common sleep disorder characterized by repeated episodes of upper airway collapse and obstruction during sleep.Polysomnography is the gold standard for diagnosing OSA,but it is expensive,time-consuming,and can cause discomfort for patients.In recent years,acoustic-based approaches for detecting OSA have emerged as a research focus.This review summarizes recent advances in OSA automatic detection techniques based on snoring and speech signals,and systematically examines their applications in diagnosis,severity assessment,and localization of obstruction sites.Findings indicate that the acoustic features of snoring and speech signals hold significant value for OSA screening,and when combined with machine learning and deep learning models,it can achieve high diagnostic accuracy.Future research should focus on elucidating the relationship between acoustic features and the pathophysiological mechanisms of OSA,integrating multimodal information,and advancing the clinical application of wearable devices,with the aim of promoting intelligent,non-invasive,and cost-effective screening technologies for OSA.

Adenosine triphosphate(ATP),as a rich energy currency in cells,is released into the extracellular space through a variety of regulatory mechanisms.The role of extracellular ATP(eATP)and related purine and pyrimidine nucleotides as extracellu-lar signal molecules regulating immune cell function has been reported as evidence of purine signal transduction and has become the focus of attention as a therapeutic target for various diseases.Mast cells(MC)are distributed in tissues that come into contact with the external environment and are the first immune cells to respond to non-microbial environmental antigens.Although eATP is considered to be an activator of MC,the details remain to be further elucidated.This article describes the role of purine receptor signaling in MC degranulation.It expands the further understanding of the mechanism of allergic diseases,and further provides ideas for finding new targets for the treatment of allergic diseases and formulating new treatment strategies.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

The latest research findings on bidirectional regulation of neuro-immunity through traditional neural circuits shed new light on the theoretical basis of the role of vidian neurectomy (VN). This article aims to provide a comprehensive understanding of VN, including the history of VN, the principle of neuroimmuno-interaction, the applied anatomy of VN as well as the methods of transnasal endoscopic surgery. Additionally, we introduce the concept of the nose-brain axis, which was proposed based on the advancement in the area of neuro-immune interactions.

Organic acids are organic compounds that can be synthesized using biological systems. They often contain one or more low molecular weight acidic groups, such as carboxyl group and sulphonic group. Organic acids are widely used in food, agriculture, medicine, bio-based materials industry and other fields. Yeast has unique advantages of biosafety, strong stress resistance, wide substrate spectrum, convenient genetic transformation, and mature large-scale culture technology. Therefore, it is appealing to produce organic acids by yeast. However, challenges such as low concentration, many by-products and low fermentation efficiency still exist. With the development of yeast metabolic engineering and synthetic biology technology, rapid progress has been made in this field recently. Here we summarize the progress of biosynthesis of 11 organic acids by yeast. These organic acids include bulk carboxylic acids and high-value organic acids that can be produced naturally or heterologously. Finally, future prospects in this field were proposed.
Saccharomyces cerevisiae/metabolism* ; Organic Chemicals ; Carboxylic Acids/metabolism* ; Metabolic Engineering ; Fermentation ; Acids

Objective:To explore the current situation of evidence-based practice competence of masters of nursing specialist at Class Ⅲ hospitals and its influencing factors so as to provide decision-making basis for optimizing the construction and educational management of clinical teaching base for masters of nursing specialist.Methods:From July to October 2021, 141 masters of nursing specialist of Class Ⅲ hospitals in Tianjin were selected as subjects by purposive sampling. All students were investigated with the Chinese version of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) and the Barriers to Research Utilization Scale. Multiple linear regression was used to analyze the influencing factors.Results:Among 141 masters of nursing specialist, the total scores of the EBP-COQ and the Barriers to Research Utilization Scale were 95.35 ± 11.90 and 72.52 ± 26.28 respectively. Multiple linear regression analysis showed that the influencing factors of evidence based practice competence of masters of nursing specialist included the results of availability and the awareness of evidence-based nursing ( r = -2.85, -2.41, both P<0.05). Conclusions:Masters of nursing specialist have the intermediate level of evidence-based practice competence and positive attitudes to evidence based practice, but their evidence-based knowledge and skills need to be improved. Clinical teaching base managers should pay attention to the training of evidence-based nursing practice ability of professional nursing master students, provide more supportive resources and environment, and promote the development of specialty nursing practice.