Objective: To address the lack of fine-grained clinical recognition for specific Yang deficiency syndrome subtypes and the limitations of conventional object detection models in extracting irregular, low-contrast tongue phenotypes. This study aims to develop an objective subtype recognition framework based on an improved You Only Look Once nano (YOLO11n) architecture, using a standardized visual phenotype matrix to translate macroscopic traditional Chinese medicine (TCM) descriptions into quantifiable clinical targets. Methods: This cross-sectional diagnostic study consecutively enrolled adult inpatients admitted to the Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wannan Medical University (Yijishan Hospital), between September 1, 2024 and June 1, 2025, who were suspected of having Yang deficiency constitution based on initial TCM consultation. Clinical tongue image data were collected for analysis. Based on an Expert Visual Phenotype Annotation Matrix, a five-category recognition system was established, including the following TCM syndrome subtypes: spleen-dampness exuberance syndrome, mild kidney Yang deficiency syndrome, upper heat and lower cold syndrome, simultaneous Yin-Yang deficiency syndrome, and Yin deficiency and fluid depletion syndrome (negative control). The proposed Yang deficiency YOLO (YD-YOLO) model, built upon the YOLO11n baseline, integrates the Cross Stage Partial with kernel size 2 (C3k2)-GhostBottleneck-Dynamic Convolution (GBDC) module into the backbone to adaptively extract low-contrast features, and embeds the multipath aggregation coordinate attention (MACA) mechanism into the neck to suppress background interference through multi-scale spatial coordination. Gradient-weighted class activation mapping (Grad-CAM) was used to visualize feature attribution and evaluate the biological plausibility of the model’s focus. Model performance was evaluated through ablation and comparative experiments using mean average precision (mAP), precision, recall, F1 score, inference speed (frames per second, FPS), overall accuracy, Cohen’s kappa, and the area under the receiver operating characteristic (ROC) curve (AUC). Results: Based on the final inclusion of 1 186 clinical cases, the YD-YOLO model had an overall accuracy of 91.5%, a Cohen’s kappa of 0.912, and an mAP@50 of 0.731 [higher than the YOLO11n baseline (0.681)], with AUC ranging from 0.91 to 0.97 across all TCM syndrome subtypes. Among the TCM syndrome subtypes, the mild kidney Yang deficiency syndrome had the highest mAP@50 (0.900), and the inference speed reached 89.00 FPS. Grad-CAM analysis showed that the model localized activation to key TCM pathological features, such as marginal tooth marks and focal root coatings, while suppressing non-diagnostic oral background noise. Conclusion The YD-YOLO model demonstrates the feasibility of deep learning for the fine-grained classification of TCM Yang deficiency subtypes. By integrating visual phenotype quantification with model interpretability, the proposed framework provides an objective basis for syndrome differentiation, supporting the development of standardized digital diagnostic systems and the provision of clinical decision support in TCM practice.

OBJECTIVE: To observe the effects of Tongdu Tiaoshen acupuncture (for unblocking the obstruction in the governor vessel and regulating the spirit) on depression-like behavior and the hippocampal Endophilin A1/reactive oxygen species (ROS) pathway in the chronic unpredictable mild stress (CUMS) model rats, and explore the mechanism of this therapy for depression. METHODS: Forty-eight male SD rats of SPF grade were randomly divided into a normal group (n=12) and a modeling group (n=36). In the modeling group, CUMS was performed to establish depression model. The successfully-modeled rats were randomized into a model group, a Tongdu Tiaoshen acupuncture group (referred to as the acupuncture group), and a fluoxetine group, with 12 rats in each group. In the acupuncture group, "Baihui" (GV20), "Shenting" (GV24), "Shuigou" (GV26) and "Dazhui" (GV14) were stimulated with acupuncture. This intervention measure was delivered once a day, continuously for 6 days; it was discontinued on day 7 and was completed in 28 days. In the fluoxetine group, intragastric administration was done with fluoxetine solution (2.1 mg/kg), once a day, and for 28 consecutive days. Before and after modeling, and after intervention completion, the body mass, sucrose preference rate and the total distance of movement and the boxes of horizontal crossing in the open field experiment were observed in each group. After intervention, using HE staining, the hippocampal neuron morphology was observed; using Nissl staining, the hippocampal Nissl body number was counted. The hippocampal mitochondria was observed under transmission electron microscopy. The average fluorescence intensity of ROS in hippocampal was determined using flow cytometry. With Western blot method, the protein expression of Endophilin A1, growth associated protein 43 (GAP-43), and brain-derived neurotrophic factor (BDNF) in hippocampal was detected; and with RT-qPCR method, the mRNA expression of Endophilin A1, GAP-43, and BDNF was recorded. Using the immunofluorescence, the average fluorescence intensity of Endophilin A1, GAP-43, and BDNF in hippocampal tissue was determined. RESULTS: Compared with the normal group, in the model group, the body mass, sucrose preference rate, and the total distance of movement and the boxes of horizontal crossing in the open field experiment decreased (P<0.01); the hippocampal neuronal structure was unclear, the matrix was relatively loose, and the number of Nissl body decreased (P<0.01); mitochondrial structure was disarranged, the outer membrane was ruptured, mitochondrial cristae was irregular or missed; the average fluorescence intensity of ROS in hippocampal tissue, the protein and mRNA expression and the average fluorescence intensity of Endophilin A1 in hippocampal tissue increased (P<0.01), while the protein and mRNA expression of GAP-43 and BDNF and its average fluorescence intensity decreased (P<0.01). Compared with the model group, the acupuncture group and the fluoxetine group showed the increase in body mass, sucrose preference rate, the total distance of movement and the boxes of horizontal crossing in the open field experiment (P<0.05, P<0.01); the hippocampal neuronal structure became relatively clear, the matrix was relatively dense, and the number of Nissl body was elevated (P<0.01); mitochondrial structure got normal and disarranged slightly, the average fluorescence intensity of ROS in hippocampal tissue, the protein and mRNA expression and the average fluorescence intensity of Endophilin A1 in hippocampal tissue were reduced (P<0.01), while the protein and mRNA expression of GAP-43 and BDNF and the average fluorescence intensity rose (P<0.01, P<0.05). Compared with the fluoxetine group, the acupuncture group presented the increase in the average fluorescence intensity of ROS, the protein expression and the average fluorescence intensity of Endophilin A1, the protein expression of GAP-43 and the mRNA expression of BDNF (P<0.01, P<0.05), and the decrease of the protein expression and the average fluorescence intensity of BDNF, the mRNA expression of Endophilin A1, and the average fluorescence intensity of GAP-43 (P<0.01, P<0.05). CONCLUSION Tongdu tiaoshen acupuncture alleviates depression-like behaviors in CUMS model rats and protects hippocampal neurons, which may be related to suppressing Endophilin A1/ROS signaling pathway and attenuating oxidative stress reactions.
Animals ; Male ; Hippocampus/metabolism* ; Acupuncture Therapy ; Rats, Sprague-Dawley ; Rats ; Depression/psychology* ; Humans ; Reactive Oxygen Species/metabolism* ; Disease Models, Animal ; Acupuncture Points

Hemolysis is one of the main complications associated with the use of ventricular assist devices. The primary factors influencing hemolysis include the shear stress and exposure time experienced by red blood cells. In addition, factors such as local negative pressure and temperature may also impact hemolysis. The different combinations of hemolysis prediction models and their empirical constants lead to significant variations in prediction results; compared to the power-law model, the OPO model better accounts for the complexity of turbulence. In terms of improving hemolytic performance, research has primarily focused on optimizing blood pump structures, such as adjustments to pump gaps, impellers, and guide vanes. A small number of scholars have studied hemolytic performance through control modes of blood pump speed and the selection of blood-compatible materials. This paper reviews the main factors influencing hemolysis, prediction methods, and improvement strategies for rotary blood pumps, which are currently the most widely used. It also discusses the limitations in current hemolysis research and provides an outlook on future research directions.

Objective:To explore genomic features associated with gemcitabine sensitivity, patient-derived organoid models of biliary tract cancer (BTC) were established and characterized.Methods:This is an experimental study. The tissue specimens of BTC were collected from patients who underwent surgical resection at the Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and December 2023. The tumor organoids were cultured in vitro and histologically characterized. Drug sensitivity testing was performed using gemcitabine,cisplatin,paclitaxel,fluorouracil,and lenvatinib etc. to evaluate cell viability. The correlation between the drug sensitivity of organoids and clinical therapeutic response was analyzed.Results:Thirty-eight patient-derived organoids (PDO) models were successfully established from 43 biliary tract malignancy patients with complete follow-up data,including gallbladder cancer PDO 14 cases,distal bile duct cancer PDO 16 cases,intrahepatic cholangiocarcinoma PDO 8 cases,achieving an overall success rate of 88.4%. Drug sensitivity testing (DST) was performed on the successfully generated PDO,with 35 models successfully completing DST experiments. The overall consistency rate between drug responses in PDOs and clinical survival outcomes in corresponding patients was 8/14. Transcriptomic analysis of gemcitabine-sensitive vs. gemcitabine-resistant PDO identified 71 differentially expressed genes in the resistant group,the significantly up-regulated genes including GLDC, LINC01595, IL-27, ANGPTL3, CYP7A1,and AKR1C1;the significantly down-regulated genes including P2RY2,LIPC,and ECHDC3. Conclusion:A biobank of patient-derived organoids of BTC has been established,which demonstrates its potential as preclinical models and tools for predicting chemotherapy responses for BTC patients.

Objective:To compare bowel preparation quality between 2.0 L and 1.5 L polyethylene glycol (PEG) regimens with optimized dietary restrictions.Methods:This study was a randomized controlled trial conducted in three hospitals: the First Affiliated Hospital of Naval Medical University ( n=57), Huadong Hospital Affiliated to Fudan University ( n=30), and General Hospital of Northern Theater Command ( n=30) from May 5th to 30th, 2024. Participants consumed food for special medical purpose one day before examination or therapeutic colonoscopy and were randomized to receive either 2.0 L PEG (group A) or 1.5 L PEG (group B). Outcomes included the completion rate of bowel preparation, the adequate/excellent bowel preparation rate, Boston bowel preparation scale scores, the subject/endoscopist satisfaction, the willingness to repeat the preparation regimen, and incidence of adverse events. Results:A total of 60 subjects in group A and 57 in group B were included. There was no significant difference in baseline characteristics between the two groups ( P>0.05). The adequate bowel preparation rate [81.7% (49/60) VS 64.9% (37/57), χ2=4.21, P=0.040] and endoscopist satisfaction [88.3% (53/60) VS 70.2% (40/57), χ2=5.91, P=0.015] in group A were significantly higher than those in group B. There were no significant differences in bowel preparation completion rates, the excellent bowel preparation rate, the bowel preparation score, subject satisfaction, willingness to repeat the preparation regimen, or incidence of adverse events ( P>0.05). Conclusion:When combined with optimized dietary restrictions, 2.0 L PEG provides superior bowel preparation quality compared with 1.5 L PEG.

Objective:To compare bowel preparation quality between 2.0 L and 1.5 L polyethylene glycol (PEG) regimens with optimized dietary restrictions.Methods:This study was a randomized controlled trial conducted in three hospitals: the First Affiliated Hospital of Naval Medical University ( n=57), Huadong Hospital Affiliated to Fudan University ( n=30), and General Hospital of Northern Theater Command ( n=30) from May 5th to 30th, 2024. Participants consumed food for special medical purpose one day before examination or therapeutic colonoscopy and were randomized to receive either 2.0 L PEG (group A) or 1.5 L PEG (group B). Outcomes included the completion rate of bowel preparation, the adequate/excellent bowel preparation rate, Boston bowel preparation scale scores, the subject/endoscopist satisfaction, the willingness to repeat the preparation regimen, and incidence of adverse events. Results:A total of 60 subjects in group A and 57 in group B were included. There was no significant difference in baseline characteristics between the two groups ( P>0.05). The adequate bowel preparation rate [81.7% (49/60) VS 64.9% (37/57), χ2=4.21, P=0.040] and endoscopist satisfaction [88.3% (53/60) VS 70.2% (40/57), χ2=5.91, P=0.015] in group A were significantly higher than those in group B. There were no significant differences in bowel preparation completion rates, the excellent bowel preparation rate, the bowel preparation score, subject satisfaction, willingness to repeat the preparation regimen, or incidence of adverse events ( P>0.05). Conclusion:When combined with optimized dietary restrictions, 2.0 L PEG provides superior bowel preparation quality compared with 1.5 L PEG.

Objective:To explore genomic features associated with gemcitabine sensitivity, patient-derived organoid models of biliary tract cancer (BTC) were established and characterized.Methods:This is an experimental study. The tissue specimens of BTC were collected from patients who underwent surgical resection at the Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and December 2023. The tumor organoids were cultured in vitro and histologically characterized. Drug sensitivity testing was performed using gemcitabine,cisplatin,paclitaxel,fluorouracil,and lenvatinib etc. to evaluate cell viability. The correlation between the drug sensitivity of organoids and clinical therapeutic response was analyzed.Results:Thirty-eight patient-derived organoids (PDO) models were successfully established from 43 biliary tract malignancy patients with complete follow-up data,including gallbladder cancer PDO 14 cases,distal bile duct cancer PDO 16 cases,intrahepatic cholangiocarcinoma PDO 8 cases,achieving an overall success rate of 88.4%. Drug sensitivity testing (DST) was performed on the successfully generated PDO,with 35 models successfully completing DST experiments. The overall consistency rate between drug responses in PDOs and clinical survival outcomes in corresponding patients was 8/14. Transcriptomic analysis of gemcitabine-sensitive vs. gemcitabine-resistant PDO identified 71 differentially expressed genes in the resistant group,the significantly up-regulated genes including GLDC, LINC01595, IL-27, ANGPTL3, CYP7A1,and AKR1C1;the significantly down-regulated genes including P2RY2,LIPC,and ECHDC3. Conclusion:A biobank of patient-derived organoids of BTC has been established,which demonstrates its potential as preclinical models and tools for predicting chemotherapy responses for BTC patients.

Objective:To investigate the current status of vision-related quality of life in elderly patients with dry eye disease and explore its influencing factors.Methods:A convenience sampling method was used to select elderly patients with dry eye disease who visited the ophthalmology outpatient department of the Affiliated Hospital of Jiangnan University from June to December 2023. Data were collected using a general information questionnaire, the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), the Brief Illness Perception Questionnaire (BIPQ), and the Social Support Rating Scale (SSRS). Multiple linear regression analysis was conducted to identify factors influencing vision-related quality of life.Results:A total of 410 questionnaires were distributed and 407 valid responses were received, with an effective response rate of 99.3%. The mean score of NEI-VFQ-25 among the 407 elderly patients with dry eye disease was (61.14±18.11). Multiple linear regression analysis showed that illness perception, social support, education level, age, gender, smoking, and previous health education experience were significant factors influencing vision-related quality of life in these patients ( P<0.05) . Conclusions:Vision-related quality of life in elderly patients with dry eye disease is at upper middle level. Illness perception, social support, education level, age, gender, smoking, and health education experience are primary influencing factors. Targeted interventions by healthcare providers are necessary to improve the vision-related quality of life in elderly patients with dry eye disease.

Objective:To investigate the current status of vision-related quality of life in elderly patients with dry eye disease and explore its influencing factors.Methods:A convenience sampling method was used to select elderly patients with dry eye disease who visited the ophthalmology outpatient department of the Affiliated Hospital of Jiangnan University from June to December 2023. Data were collected using a general information questionnaire, the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), the Brief Illness Perception Questionnaire (BIPQ), and the Social Support Rating Scale (SSRS). Multiple linear regression analysis was conducted to identify factors influencing vision-related quality of life.Results:A total of 410 questionnaires were distributed and 407 valid responses were received, with an effective response rate of 99.3%. The mean score of NEI-VFQ-25 among the 407 elderly patients with dry eye disease was (61.14±18.11). Multiple linear regression analysis showed that illness perception, social support, education level, age, gender, smoking, and previous health education experience were significant factors influencing vision-related quality of life in these patients ( P<0.05) . Conclusions:Vision-related quality of life in elderly patients with dry eye disease is at upper middle level. Illness perception, social support, education level, age, gender, smoking, and health education experience are primary influencing factors. Targeted interventions by healthcare providers are necessary to improve the vision-related quality of life in elderly patients with dry eye disease.

Objective:To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) in achalasia of cardia (AC) patients with the long course.Methods:A total of 159 AC patients who received POEM from January 2015 to March 2022 in the First Affiliated Hospital of Soochow University were divided into the long course group (≥10 years) and the non-long course group (<10 years). The baseline information, POEM procedure and postoperative recurrence were compared and the differences between the recurrent patients and non-recurrent patients in the long course group were explored.Results:The age (57.09±14.30 years VS 42.08±15.68 years, t=5.569, P<0.001), the rate of treatment history [28.9% (13/45) VS 9.6% (11/114), χ2=9.319, P=0.020], the proportion of Henderson grade Ⅲ esophagus [17.8% (8/45) VS 6.1% (7/114), χ2=7.020, P=0.030] in the long course group were significantly higher than those in the non-long course group. The recurrence rate in the long course group was significantly higher than that in the non-long course group [33.3% (15/45) VS 14.9% (17/114), χ2=6.811, P=0.009]. In the long course group, the age (62.50 ± 16.94 years VS 53.77 ± 12.95 years, t=-2.121, P=0.040), and the rate of treatment history [53.3% (8/15) VS 16.7% (5/30), χ2=6.544, P=0.016] in the recurrent patients were higher than those in the non-recurrent patients. Conclusion:POEM is safe and effective for long-course AC patients. In patients with the long course, the aged patients with previous treatment are more likely to relapse.