Objective To explore the risk factors of progression to dementia within 2 years in patients with recent subcortical small infarction (RSSI) complicated with cognitive dysfunction. Methods A total of 340 patients with RSSI complicated with cognitive dysfunction who were treated in the hospital and completed 2-year follow-up were selected from February 2021 to February 2025. According to whether the patients progressed to dementia, they were classified into dementia group (n=105) and non-dementia group (n=235). The clinical data were compared between both groups, and the independent risk factors were screened by Logistic regression analysis. Results Multivariate logistic regression analysis suggested that history of hypertension (OR=1.919), history of diabetes mellitus (OR=1.597), multiple infarctions (OR=1.455), severe white matter lesions (OR=1.595), no cognitive function training (OR=1.923), increased infarct size (OR=1.069), reduced MMSE score (OR=0.945) and increased levels of NfL (OR=1.049) and IL-6 (OR=1.038) were independent risk factors for the progression to dementia (all P<0.05). Conclusion The progression to dementia in patients with recent subcortical small infarction and cognitive dysfunction is affected by multiple factors. In clinical practice, the integration of vascular risk factors, imaging features, cognitive assessment and serum biomarkers (NfL, IL-6) helps to construct an early risk prediction model and implement targeted interventions for high-risk groups.

Objective To analyze drug resistance and clustering of environmental and clinical isolates of Acinetobacter baumannii (A. baumannii) in ICU of a medical institution in Shanghai. Methods The isolates of A. baumannii from ICU environments and clinic were used to analyze the contamination and distribution in 2021-2024. Antimicrobial susceptibility testing was carried out with microbroth dilution method. Whole genome sequencing was performed out of strains for MLST typing and SNP clustering. Results The detection rate of contamination in ICU environment was 7.67%, and the most serious contamination was found in pillows, bedding, hospital gowns and other items that patients directly contacted. Clinical isolates were predominantly from sputum specimens. The environmental and clinical isolates had a high level of resistance to third generation cephalosporins, third generation quinolones and carbapenems (more than 85%). Environmental isolates had a low level of resistance to polymyxin B, but none of the clinical isolates were resistant. MLST typing showed that ST2 was the dominant clone (66.67%), and SNP clustering found that isolates from different sources but with the same ST type were clustered together. Conclusion ST2 is the dominant clone of A. baumannii isolates in this medical institution, and there is cross-contamination between different samples. Monitoring of drug resistance and disinfection should be further strengthened to prevent the emergence and spread of pan-resistant or even fully resistant strains.

AIM: To analyze the effect of preoperative macular ganglion cell complex(GCC)thickness on visual quality after cataract combined with glaucoma surgery.METHODS:This retrospective study collected clinical data of patients with cataract and glaucoma who underwent phacoemulsification, intraocular lens implantation, and goniosynechialysis surgery in the hospital from January 2023 to December 2024. Preoperative macular GCC thickness was assessed and patients were divided into three groups according to preoperative macular GCC thickness using the tertile method: low thickness group(<43.8 μm), medium thickness group(43.8-60.4 μm), and high thickness group(>60.4 μm). Postoperative visual quality was evaluated by visual acuity(LogMAR), contrast sensitivity, visual field and subjective visual quality(QoV)at 1, 3 and 6 mo post-operation. Linear regression analysis was used to verify the effect of preoperative macular GCC thickness on visual acuity at 6 mo after surgery.RESULTS: Totally 115 patients(115 eyes)with cataract combined with glaucoma were enrolled, including 31 patients(31 eyes)in the low thickness group(17 males, 14 females, 65.23±8.11 y), 47 patients(47 eyes)in the medium thickness group(20 males, 27 females, 64.87±7.89 y)and 37 patients(37 eyes)in the high thickness group(23 males, 14 females, 63.92±7.44 y). There were significant differences in visual acuity, contrast sensitivity, mean deviation of visual field, and QoV scores among the three groups at different time points pre- and post-operation(all P<0.05). At 1, 3 and 6 mo postoperatively, the visual acuity(LogMAR)and QoV scores in the low thickness group were higher than those in the medium thickness and high thickness groups, and the medium thickness group showed higher values than the high thickness group(all P<0.05). The low thickness group had lower low-frequency, medium-frequency and high-frequency contrast sensitivity values as well as lower mean deviation of visual field compared with the medium and high thickness groups, and the medium thickness group had lower values than the high thickness group(all P<0.05). Visual acuity and QoV scores at 1, 3 and 6 mo post-operation were significantly decreased, while low-, medium- and high-frequency contrast sensitivity values and mean deviation of visual field were significantly elevated in the three groups compared with pre-operation.(all P<0.05). In all three groups, visual acuity(LogMAR)and QoV scores were higher at 1 mo postoperatively than those at 3 and 6 mo, and the values at 3 mo were higher than those at 6 mo(all P<0.05). Low-, medium- and high-frequency contrast sensitivity and mean deviation of visual field in three groups were lower at 1 mo postoperatively than those at 3 and 6 mo, with lower values at 3 mo than at 6 mo(all P<0.05). Through linear regression analysis, the model fit was good(F=32.435, PSymbol|@@0.001), and the thickness of GCC in the macular area pre-opertation had a negative impact on visual acuity(LogMAR)at 6 mo post-operation(β=-0.003, PSymbol|@@0.001). The regression equation was: Y=0.421-0.003×X preoperative macular GCC thickness. The model determination coefficient R2=0.223. It indicated that the preoperative macular GCC thickness could explain 22.3% of the variance in visual acuity at 6 mo postoperatively. For every 1 μm decrease in preoperative GCC thickness, the average visual acuity(LogMAR)increased by 0.003 at 6 mo postoperatively.CONCLUSION: Preoperative macular GCC thickness is a protective factor for visual quality after cataract combined with glaucoma surgery. The thicker the preoperative GCC thickness, the better the visual acuity, contrast sensitivity, and visual field recovery at 1, 3, and 6 mo post-operation. Moreover, for every 1 μm decrease in preoperative GCC thickness, the average visual acuity(LogMAR)at 6 mo after surgery increases by 0.003, which can be used as one of the preoperative predictive indicators for postoperative visual quality.

Background The health effects of environmental exposures are often characterized by complex interactions. However, evidence on the joint health effects of ambient oxidizing pollutants and air temperature in the cold regions of Northern China remains limited. Objective To examine the independent and interactive effects of atmospheric oxidizing pollutants and air temperature on daily mortality among residents of Hohhot. Methods Daily data on air quality, meteorological factors, and cause-specific mortality in Hohhot from 2018 to2023 were collected. A quasi-Poisson generalized additive model (GAM) combined with a distributed lag non-linear model (DLNM) was used to examine the effects of ambient oxidant pollutants [ozone (O₃), nitrogen dioxide (NO₂), and total oxidant (Oₓ)] and air temperature on daily circulatory and respiratory mortality. Potential interactions between oxidizing pollutants and temperature were evaluated using bivariate exposure–response surface models and quantified through stratified analyses. Results For each 10 μg·m⁻³ increase in O₃, O_X, and NO₂ concentrations, the strongest associations with circulatory disease mortality occurred at lag1, with excess risks (ERs) of 1.10% (95%CI: 0.50%, 1.71%), 1.84% (95%CI: 0.94%, 2.75%), and 1.49% (95%CI: 0.36%, 2.62%), respectively. The strongest associations of O₃ and O_X with respiratory disease mortality were observed at lag2, with ERs of 1.61% (95%CI: 0.61%, 2.62%) and 2.61% (95%CI: 1.61%, 3.62%), respectively. NO₂ showed the strongest cumulative association with respiratory disease mortality at lag02, with an ER of 3.22% (95%CI: 1.24%, 5.25%). High temperature exhibited immediate or short-term effects, while low temperature showed lagged effects. The exposure–response relationships between temperature and mortality risks for respiratory circulatory diseases were U-shaped. Positive additive interactions were observed between high temperature and high concentrations of O₃ and O_X. For the joint exposure to high temperature and high O₃, the relative excess risks due to interaction (RERIs) for circulatory and respiratory disease mortality were 0.131 (95%CI: 0.086, 0.176) and 0.279 (95%CI: 0.198, 0.360), respectively. For the joint exposure to high temperature and high O_X, the corresponding RERI values were 0.080 (95%CI: 0.038, 0.123) and 0.154 (95%CI: 0.074, 0.234), respectively. In contrast, high temperature and high NO₂ concentration exhibited antagonistic or attenuating interactions. Conclusion Ambient oxidizing pollutants, high temperature, and low temperature are independently associated with increased circulatory and respiratory disease mortality. High temperature combined with high concentrations of O₃ or O_X exerts positive additive interactions, with the respiratory system showing particular vulnerability. The mortality risks associated with NO₂ are more pronounced under low temperature conditions, whereas its interaction with high temperature appear antagonistic, suggesting a temperature-dependent risk-modifying effect.

Objective:To develop an artificial intelligence system using fully convolutional neural networks（FCN）to assist echocardiographers in the quantitative assessment of mitral regurgitation（MR）severity.Methods:From August 2021 to June 2024，echocardiographic images of 441 patients with MR were prospectively collected from Renmin Hospital of Wuhan University and the Central Hospital of Wuhan. After screening，a total of 269 patients（4 917 frames）were included in the study. Of these，3 644 frames（128 patients）of apical four-chamber color Doppler MR flow convergence images from Renmin Hospital of Wuhan University were selected as the training/validation set，while images from 121 patients（813 frames）were used as the internal test set. Additionally，images from 20 patients（460 frames）from the Central Hospital of Wuhan were selected as the external test set. The FCN algorithm was employed to capture features and segment the MR color region on the left atrial side，simultaneously outputting the regurgitant radius（r）for the calculation of the effective regurgitant orifice area and regurgitant volume. The severity of MR was then classified according to the 2017 guidelines of the American Society of Echocardiography. The segmentation and classification performance of the model was evaluated，and the measurement results of the AI system was compared with that of both senior and junior physicians.Results:In the internal test set，the accuracy of r identification for cases classified as Grade Ⅰ to Ⅳ was 0.48，0.81，0.86，and 0.87，respectively. In the external test set，the accuracy of r identification for cases classified as Grade Ⅰ to Ⅳ was 0.60，0.77，0.64，and 0.77，respectively. The average accuracy of MR classification in the internal and external test sets was 0.91 and 0.88，respectively.Conclusions:The FCN model is capable of segmenting the left atrial side regurgitant areas in apical four-chamber heart color Doppler images，aiding physicians in obtaining quantitative assessment parameters for MR，and assisting junior physicians in accurately assessing the severity of MR.

Objective To investigate the key targets and pathways of Juhongtai formula granules in improving acute lung injury(ALI).Methods Juhongtai formula granules and their drug-containing serum components were analyzed by UPLC-QTOF-MS/MS,and the active ingredients were screened based on the"Lipinski Rule of Five".The action targets of the above active ingredients were obtained through the TCMSP,Swiss Target Prediction and SuperPred databases,and the ALI-related targets were obtained from the GeneCards,OMIM,PharmGKB,CTD databases and GEO chip.The target protein-protein interaction network was constructed using the String database and Cytoscape to analyze the key targets.The DAVID database was used for GO functional annotation and KEGG pathway enrichment analysis,and the CB-dock2 platform was used for molecular docking verification.After one week of adaptive feeding,the experimental SD rats were randomly divided into the blank group,the model group,the positive control group,the negative control group and the Juhongtai formula granules group,with 6 rats in each group.The rat model of ALI was replicated by tracheal infusion of lipopolysaccharide.The pathological morphology of lung tissues in each group of rats was observed by HE staining,and the mRNA expressions of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-1 β(IL-1β)and nitric oxide were detected by reverse transcription quantitative polymerase chain reaction(RT-qPCR).Results In total,44 components of the Juhongtai formula granules were identified,including 26 drug-containing serum components,and 21 key compounds were screened.A total of 22 intersection targets were obtained.The pathway enrichment results indicated the action of these targets on the advanced glycation end product receptor(AGE-RAGE)and TNF signaling pathways.The docking results showed that limonin,kaempferol and naringenin could be matched with prostaglandin peroxidase 2,nitric oxide synthase 2 and TNF.Animal experiments confirmed that the Juhongtai formula granules can alleviate inflammatory infiltration in lung tissue and reduce the expressions of TNF-α,IL6,IL-1β mRNA and nitric oxide.Conclusion Juhongtai formula granules can inhibit ALI-related inflammatory targets through the synergistic effects of multiple components such as limonin and kaempferol,regulate signaling pathways such as AGE-RAGE and TNF,reduce the production of inflammatory factors and nitric oxide,and improve ALI.

Bacteroides uniformis(B.uniformis)is an obligate anaerobic Gram-negative bacteria,it belongs to Bacieroides spp..It is an important component of the normal gut microbiota in human body and rarely causes op-portunistic infection in clinical practice.Currently,there is no consensus on the clinical characteristics,diagnosis,treatment,and prognosis of infection caused by B.uniformis,and the resistance of anaerobic bacteria is difficult to be detected.This article reports a case of a lung tumor patient who developed diarrhea and bloodstream infection due to B.uniformis after chemotherapy.After empirical anti-infective treatment with cefoperazone/sulbactam,the pa-tient recovered and was discharged from hospital.This paper aims to improve clinical understanding on infection caused by opportunistic pathogens in the gut,and provide reference for timely diagnosis and effective treatment.

Objective To investigate the key targets and pathways of Juhongtai formula granules in improving acute lung injury(ALI).Methods Juhongtai formula granules and their drug-containing serum components were analyzed by UPLC-QTOF-MS/MS,and the active ingredients were screened based on the"Lipinski Rule of Five".The action targets of the above active ingredients were obtained through the TCMSP,Swiss Target Prediction and SuperPred databases,and the ALI-related targets were obtained from the GeneCards,OMIM,PharmGKB,CTD databases and GEO chip.The target protein-protein interaction network was constructed using the String database and Cytoscape to analyze the key targets.The DAVID database was used for GO functional annotation and KEGG pathway enrichment analysis,and the CB-dock2 platform was used for molecular docking verification.After one week of adaptive feeding,the experimental SD rats were randomly divided into the blank group,the model group,the positive control group,the negative control group and the Juhongtai formula granules group,with 6 rats in each group.The rat model of ALI was replicated by tracheal infusion of lipopolysaccharide.The pathological morphology of lung tissues in each group of rats was observed by HE staining,and the mRNA expressions of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-1 β(IL-1β)and nitric oxide were detected by reverse transcription quantitative polymerase chain reaction(RT-qPCR).Results In total,44 components of the Juhongtai formula granules were identified,including 26 drug-containing serum components,and 21 key compounds were screened.A total of 22 intersection targets were obtained.The pathway enrichment results indicated the action of these targets on the advanced glycation end product receptor(AGE-RAGE)and TNF signaling pathways.The docking results showed that limonin,kaempferol and naringenin could be matched with prostaglandin peroxidase 2,nitric oxide synthase 2 and TNF.Animal experiments confirmed that the Juhongtai formula granules can alleviate inflammatory infiltration in lung tissue and reduce the expressions of TNF-α,IL6,IL-1β mRNA and nitric oxide.Conclusion Juhongtai formula granules can inhibit ALI-related inflammatory targets through the synergistic effects of multiple components such as limonin and kaempferol,regulate signaling pathways such as AGE-RAGE and TNF,reduce the production of inflammatory factors and nitric oxide,and improve ALI.

Dihydromyricetin(DMY),a flavonoid compound extracted from Ampelopsis grossedentata,exhibits diverse pharmacological activities,including anti-inflammatory,antioxidant,antitumor,neuroprotective,and immuno-modulatory effects.Recent studies have demonstrated that DMY can suppress inflammatory responses and oxidative stress through multiple molecular pathways,as well as regulate bile acid metabolism and maintain intestinal microbiota balance.These actions help reduce histopathological damage,improve gastrointestinal barrier function,and alleviate the symptoms of digestive system diseases.DMY has shown significant therapeutic effects in the treatment of gastrointestinal inflamma-tion,liver diseases,and digestive tract tumors.This review systematically summarizes the mechanisms of action and thera-peutic potential of DMY in digestive system diseases,providing a scientific basis and theoretical support for its clinical ap-plication and the development of new drugs.

Objective To explore the internal correlation mechanism among symptoms and influencing factors in first-ever subacute stroke patients.Methods A cross-sectional survey method was employed to conveniently select stroke patients hospitalized in a tertiary hospital in Guangdong Province from October 2022 to June 2023.Data were collected using a general information questionnaire,Symptom Experience Scale for Stroke Survivors,Fear of Progression Questionnaire-Short Form,Acceptance of Illness Scale,Herth Hope Index,and the Memorial University of Newfoundland Scale of Happiness.Results A total of 316 stroke patients were included.The incidence of symptom burden ranged from 17.41％to 87.97％,with the core,bridge,and sentinel symptoms as decreased attention and restricted limb movements,restricted limb movements and decreased self-care ability,and limb weakness and delayed response,respectively.Age,stroke type,disease stage,self-care ability,fear of disease progression,hope level,and happiness level were predictive factors for symptom burden in patients.Mixed network analysis showed direct correlation between foot inversion and stroke type,fear of disease progression was directly associated with limb weakness and limb pain.Low mood was directly correlated with hope level and happiness level.Conclusion Symptoms in patients with first-episode subacute stroke are interrelated.Nurses should pay attention to the identification of core,bridge,and sentinel symptoms,understand the associations between symptoms and influencing factors,and provide comprehensive and personalized clinical symptom management strategies for patients.