OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

Diabetic nephropathy（DN） is a common and severe microvascular complication of diabetes. In recent years， the classical herbal formula Shenqi dihuang decoction has demonstrated unique advantages in the clinical treatment of DN. This article conducts a systematic review of the mechanisms of action and clinical applications of Shenqi dihuang decoction in the treatment of DN. It reveals that the mechanism by which this formula improves DN involves multi-target synergistic regulation. For instance, Shenqi dihuang decoction exerts multiple pharmacological effects by regulating signaling pathways including phosphatidy linostiol 3-kinase/protein kinase B， AMP-activated protein kinase/silent information regulator 1/forkhead box O1， and nuclear factor erythroid 2-related factor 2/heme oxygenase-1 pathways.These effects include regulating glucose and lipid metabolism， inhibiting oxidative stress， reducing inflammation， improving insulin resistance， modulating cell death （apoptosis/autophagy/ferroptosis/pyroptosis）， and preventing renal fibrosis. Existing clinical studies indicate that Shenqi dihuang decoction and its modified formulas， alone or in combination with other therapeutic methods， can significantly improve glucose and lipid metabolism， reduce proteinuria， and delay renal function decline in patients with DN. These effects are superior to those of Western medicines such as irbesartan， valsartan， and empagliflozin， and the treatment demonstrates good safety. Future research should leverage systems biology and artificial intelligence technologies to further elucidate the integrated mechanisms in the treatment of DN by Shenqi dihuang decoction， thereby advancing the precision and standardization of its clinical application.

Objective:To apply combined serological diagnostic methods for anti-BP180-type and anti-laminin 332 (Ln332) -type mucous membrane pemphigoid (MMP), and to summarize their clinical and immunoserological characteristics.Methods:A retrospective analysis was conducted on the data from 52 patients clinically suspected of having MMP at the Hospital of Dermatology, Chinese Academy of Medical Sciences from January 2017 to February 2022. Serum samples were collected, and combined serological tests, including indirect immunofluorescence on salt-split skin, enzyme-linked immunosorbent assay, and immunoblotting, were performed to analyze the immunoserological and clinical characteristics of the patients. The Fisher′s exact test was used to compare the lesion occurrence rates between groups.Results:Among the 52 patients clinically suspected of MMP, 32 (61.5%) were diagnosed with anti-BP180-type MMP, 10 (19.2%) with anti-Ln332-type MMP, and 4 (7.7%) with anti-BP180- and anti-Ln332-type MMP due to the presence of both anti-BP180 and anti-Ln332 antibodies; 2 tested positive for IgG on the epidermal side of salt-split skin, but no target antigens were identified by serological tests, and they were diagnosed with MMP (subtype pending) ; 4 tested negative by immunoserological tests. Ocular involvement was observed in 6 out of 10 patients with anti-Ln332-type MMP, whereas only 6 out of 32 anti-BP180-type MMP patients (18.8%) had ocular symptoms, and there was a significant difference in the occurrence rate of ocular involvement between the two groups ( P = 0.02) ; the occurrence rates of nasal involvement and multi-mucosal involvement were significantly higher in the anti-Ln332-type MMP patients (50%[5/10], 90%[9/10], respectively) than in the anti-BP180-type MMP patients (0, 25%[8/32], respectively, both P < 0.001). Scar formation occurred in 6 out of 10 anti-Ln332-type MMP patients, but occurred in only 6 out of 32 anti-BP180-type patients (18.8%, P = 0.02) . Conclusion:The combination of indirect immunofluorescence on salt-split skin, enzyme-linked immunosorbent assay, and immunoblotting could effectively identify anti-BP180 and anti-Ln332 autoantibodies in MMP patients, with BP180 being the most common target antigen; compared with anti-BP180-type MMP, anti-Ln332-type MMP appeared to be more frequently involve the ocular and nasal mucosae, associated with the involvement of multiple mucosal sites, carrying a higher risk of scar formation.

Multimodal biometric identification technology,which combines multiple biometric methods,is being increasingly used in forensic science due to its advantages such as difficulty of forgery and great accuracy.However,the current identification mainly relies on unimodal biometrics including facial recognition,hand recognition,iris recognition,gait recognition,and voice recognition.Thus,to a large extent,the accuracy of identification depends on the quality of the unimodal data,which faces multiple challenges.In contrast,multimodal biometrics has more obvious advantages in the field of identification,which can not only effectively resist attacks,but also enrich the feature representation with complementary information from multimodal sources,mitigate the impact of environment on the identification performance,and enhance the robustness of the system.To this end,this paper combs through the relevant work in this field,and comprehensively reviews the current research status and development trend of biometric identification technology.First,based on bibliometrics,the paper combs through the relevant research results in the past ten years,analyzes,summarizes,and discusses the commonly used deep learning models in this field,respectively,from unimodal recognition to multi-modal fusion recognition.Then the paper discusses the future development direction of the multimodal biometric identification field in the light of the practical needs of court science and provides reference for identification research.

Objective:To investigate the effects of different doses of ionizing radiation on the changes in nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and reactive oxygen species (ROS) levels in the intestines of mice.Methods:C57BL/6 mice aged 6-8 weeks were randomly assigned to four groups (0 Gy, 0.1 Gy, 0.2 Gy, and 0.5 Gy; n=10/group) and subjected to single whole-body irradiation using a 60Co γ-ray source at a dose rate of 13 mGy/min. At 20 weeks post-irradiation, jejunal, ileal, and colonic tissues were collected. Immunohistochemistry, Western blotting, and reverse transcription-polymerase chain reaction (RT-PCR) were employed to assess mRNA and protein expression of NADPH oxidase components. Hydrogen peroxide (H 2O 2) levels and the expression of Nuclear Factor-kappa B (NF-κB), a transcriptional regulator of Dual Oxidase 2 (DUOX2), were also measured. Results:Compared with the 0 Gy group, mice in the 0.5 Gy group exhibited shortened villus length in the jejunum, villus fusion in the ileum, and increased crypt spacing in the colon, with statistically significant differences ( t=2.48, P < 0.05). No significant differences were observed in other dose groups compared to the 0 Gy group ( P > 0.05).The expression of H 2O 2 in the jejunum, ileum, and colon of the 0.1 Gy group was significantly elevated compared to the 0 Gy group ( t=4.12, 3.12, 3.12; P < 0.05). In the 0.5 Gy group, H 2O 2 expression in the jejunum and colon increased nearly twofold relative to the 0 Gy group ( t=8.67, 8.69; P < 0.05).At 20 weeks post-irradiation, DUOX2 protein expression levels in the jejunum, ileum, and colon were markedly higher in irradiated mice than in the 0 Gy group ( t=3.03, 10.29, 2.74; P < 0.05). DUOX2 mRNA levels in the jejunum, ileum, and colon of the 0.1 Gy group were significantly upregulated compared to the 0 Gy group ( t=12.75, 4.12, 11.14; P < 0.05). Additionally, NOX4 mRNA expression increased in the jejunum of the 0.2 Gy group ( t=4.54, P < 0.05) and in the ileum of the 0.1 Gy group ( t=4.13, P < 0.05).The nuclear factor kappa-B (NF-κB), a transcriptional regulator of DUOX2, showed an upward trend in expression in the jejunum, ileum, and colon of the 0.1 Gy group compared to the 0 Gy group, with statistically significant differences ( t=8.73, 8.18, 7.02; P < 0.05). Conclusion:Low-dose radiation induces long-term effects on the intestinal tract. Specifically, 0.5 Gy irradiation causes mild morphological alterations in the jejunum, ileum, and colon, while 0.1 Gy irradiation promotes the upregulation of DUOX2, a NADPH oxidase, in intestinal tissues.

Objective:To investigate the effects of different doses of ionizing radiation on the changes in nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and reactive oxygen species (ROS) levels in the intestines of mice.Methods:C57BL/6 mice aged 6-8 weeks were randomly assigned to four groups (0 Gy, 0.1 Gy, 0.2 Gy, and 0.5 Gy; n=10/group) and subjected to single whole-body irradiation using a 60Co γ-ray source at a dose rate of 13 mGy/min. At 20 weeks post-irradiation, jejunal, ileal, and colonic tissues were collected. Immunohistochemistry, Western blotting, and reverse transcription-polymerase chain reaction (RT-PCR) were employed to assess mRNA and protein expression of NADPH oxidase components. Hydrogen peroxide (H 2O 2) levels and the expression of Nuclear Factor-kappa B (NF-κB), a transcriptional regulator of Dual Oxidase 2 (DUOX2), were also measured. Results:Compared with the 0 Gy group, mice in the 0.5 Gy group exhibited shortened villus length in the jejunum, villus fusion in the ileum, and increased crypt spacing in the colon, with statistically significant differences ( t=2.48, P < 0.05). No significant differences were observed in other dose groups compared to the 0 Gy group ( P > 0.05).The expression of H 2O 2 in the jejunum, ileum, and colon of the 0.1 Gy group was significantly elevated compared to the 0 Gy group ( t=4.12, 3.12, 3.12; P < 0.05). In the 0.5 Gy group, H 2O 2 expression in the jejunum and colon increased nearly twofold relative to the 0 Gy group ( t=8.67, 8.69; P < 0.05).At 20 weeks post-irradiation, DUOX2 protein expression levels in the jejunum, ileum, and colon were markedly higher in irradiated mice than in the 0 Gy group ( t=3.03, 10.29, 2.74; P < 0.05). DUOX2 mRNA levels in the jejunum, ileum, and colon of the 0.1 Gy group were significantly upregulated compared to the 0 Gy group ( t=12.75, 4.12, 11.14; P < 0.05). Additionally, NOX4 mRNA expression increased in the jejunum of the 0.2 Gy group ( t=4.54, P < 0.05) and in the ileum of the 0.1 Gy group ( t=4.13, P < 0.05).The nuclear factor kappa-B (NF-κB), a transcriptional regulator of DUOX2, showed an upward trend in expression in the jejunum, ileum, and colon of the 0.1 Gy group compared to the 0 Gy group, with statistically significant differences ( t=8.73, 8.18, 7.02; P < 0.05). Conclusion:Low-dose radiation induces long-term effects on the intestinal tract. Specifically, 0.5 Gy irradiation causes mild morphological alterations in the jejunum, ileum, and colon, while 0.1 Gy irradiation promotes the upregulation of DUOX2, a NADPH oxidase, in intestinal tissues.

Objective:To conduct a latent profile analysis of general self-efficacy among postpartum nurses with two children and explore the influencing factors of different profiles.Methods:A stratified sampling approach was used to recruit 298 clinical nurses with two children who had resumed work from 12 public healthcare facilities in Mianyang during May and December 2023. Data were collected using a demographic questionnaire, Work-Family Conflict Scale, Nursing Stress Scale, Family Stress Scale, and General Self-Efficacy Scale. Latent profile analysis was performed via Mplus 8.3. Pearson correlation and logistic regression analyses were used to examine associations between self-efficacy, work-family conflict, nursing stress, family stress, and profile membership.Results:Data collection yielded 298 questionnaires, with 281 valid responses (94.3% response rate). Three latent profiles of general self-efficacy were identified: low efficacy group (43.8%), moderate efficacy group (42.7%), and high efficacy group (13.5%). Work position, hospital level, time since return to work, nursing stress, and family stress were significant predictors of profile membership ( P< 0.05) . Conclusions:General self-efficacy among nurses with two children post-childbirth is heterogeneous. Nursing administrators should deliver tailored interventions based on latent profile characteristics and develop individualized self-efficacy enhancement programs from both individual and organizational perspectives to improve adaptability and competency during post-return work transition.

To summarize Professor GAO Shuzhong's clinical experience in treating idiopathic tinnitus with a combination of acupuncture and Chinese meteria medica. It is believed that idiopathic tinnitus is mostly caused by weak lungs and spleen， kidney essence deficiency， liver constraint transforming into fire， and binding constraint of heart qi. Treatment advocates the combination of acupuncture and Chinese meteria medica in clinical practice. Acupuncture treatment mainly focus on the method of opening the orifices by syndrome identification in combination with Ermen （TE 21）， Tinggong （SI 19）， Tinghui （GB 2）， Shenmai （BL 62） to regulate qi and blood， and supporting with Baihui （GV 20）， Yintang （EX-HN 3）， Taichong （LR 3）， and Yanglingquan （GB 34） to soothe the liver， resolve constraint， and calm the mind. Oral administration of Chinese medicinal prescription usually includes modified Yiqi Congming Decoction （益气聪明汤） and Tongqi Powder （通气散）， and the external administration of Chinese medicinal prescription can apply self-prescribed Wenqing Powder （温清散） to navel moxibustion.

OBJECTIVE To explore the relationship between peripheral blood interferon γ(IFN-γ)/interleukin-4(IL-4)and the short-term prognosis of children with Mycoplasma pneumoniae pneumonia(MPP),and to analyze the influencing factors for the short-term prognosis of children with MPP.METHODS A total of 170 children with MPP admitted to the hospital from Jan.2021 to Jan.2024 were selected(MPP group).Based on the condition 28 days after treatment,they were divided into a poor prognosis group(n=49)and a good prognosis group(n=121).Clinical data of the children were collected,and the levels of peripheral blood interleukin-4(IL-4)and inter-feron-γ(IFN-γ)were measured to calculate the IFN-γ/IL-4 ratio.Multivariate Logistic regression model was used to analyze the factors affecting the short-term prognosis of children with MPP.RESULTS In the poor prognosis group,the duration of antibiotic use,the proportion of pleural effusion,the proportion of extrapulmonary compli-cations,and the levels of peripheral blood IL-4 and IFN-γ were higher than those in the good prognosis group,while the IFN-γ/IL-4 ratio was lower than that in the good prognosis group(P＜0.05).Logistic regression re-sults showed that persistent fever,prolonged antibiotic use and the occurrence of extrapulmonary complications were risk factors for the short-term prognosis of children with MPP(P＜0.05),and a high IFN-γ/IL-4 ratio was a protective factor(P＜0.05).CONCLUSION Persistent fever,prolonged antibiotic use and extrapulmonary com-plications are risk factors for the short-term prognosis of children with MPP,and high IFN-γ/IL-4 values is a pro-tective factor.

Objective:To summarize the drug resistance characteristics of clinical pathogen isolates in a tuberculosis specialized hospital from 2017 to 2023，and understand the distribution characterisitics of pathogens and their resistance to antimicrobial agents.Methods:The isolates from January 2017 to December 2023 were identified and subjected to drug susceptibility tests using the VITEK 2-compact system. The susceptibilities of the isolates to antimicrobial agents were determined by the minimum inhibitory concentration（MIC）methods according to the CLSI（2023）guideline. The data of detection of different kinds of bacteria，specimen distribution and the detection rates of major drug-resistant gram-negative bacteria in hospital antimicrobial resistance were analyzed. Chi square test were performed to analyze one or more sets of data related to detection rate or drug resistance rate by SPSS 17.0.Results:A total of 9 993 isolates were detected，among which 9 079（90.9%）were gram-negative bacteria and 914（9.1%）were gram-positive bacteria. From 2017 to 2022，among all gram-negative isolates，the top three most frequently isolated pathogens were Klebsiella pneumonia，followed by Pseudomonas aeruginosa and Acinetobacter baumannii. The overall resistance rates to carbapenems in Acinetobacter baumannii， Pseudomonas aeruginosa， Klebsiella pneumonia，and Escherichia coli were 43.7%（495/1 133），19.4%（276/1 423），8.4%（279/3 304），3.6%（19/521），respectively. The overall detection rates of ceftriaxone/ciprofloxacin-resistant Klebsiella pneumonia（CTX/CRO-R-KPN），or Escherichia coli（CTX/CRO-R-ECO），and quinolone-resistant Escherichia coli（QNR-ECO）were 19.5%（644/3 304），57.6%（300/521），77.4%（403/521），respectively. The difference in resistance rates between imipenem-resistant and imipenem-susceptible Klebsiella pneumoniae was statistically significant（ P<0.05）. Except for CTX/CRO-R-ECO（ χ2=7.9 ，P>0.05），significant differences were observed in the detection rates of other major drug-resistant gram-negative bacteria in hospital（ P<0.05）. The detection of some drug-resistant strains showed an upward trend in recent years. Carbapenem-resistant Acinetobacter baumannii， Pseudomonas aeruginosa，and Escherichia coli exhibited higher resistance rate to other antibiotics. Conclusions:The detection rates of major drug-resistant gram-negative bacteria have increased in the past two years. Carbapenem-resistant strains exhibit relatively high resistance rate to cephalosporin and quinolone antibiotics. Although carbapenem antibiotics remain effective against Enterobacteriaceae，strengthened antimicrobial resistance monitoring and control of multidrug-resistant bacteria spread are necessary.