OBJECTIVE To study the improvement effect and mechanism of Tripterygium wilfordii multiglucoside （TWM） on nephrotic syndrome in rats. METHODS The nephrotic syndrome model was established by intravenous injection of adriamycin via the tail vein. The modeling rats were randomly divided into the model group （distilled water）， prednisone group （10 mg/kg）， and TWM high- and low-dose groups （10 and 5 mg/kg， respectively）. Additionally， blank group （distilled water） without model induction was established. Each group consisted of 9 rats. Rats in each group were administered the corresponding drugs or distilled water by gavage， once a day， for 6 consecutive weeks. The histopathological morphology of kidney tissues in rats was observed； the levels of 24-hour urinary protein （24 h-UTP） and serum biochemical indicators [albumin （ALB）， blood urea nitrogen （BUN）， serum creatinine （SCr）， cholesterol （CHOL）， and triglyceride （TG）] in rats were determined； the levels of oxidative stress indicators [superoxide dismutase （SOD）， malondialdehyde （MDA）] in kidney tissue of rats were determined； expressions of hypoxia-inducible factor-1α （HIF-1α）/microRNA-155-5p （miR-155-5p）/nuclear factor erythriod 2- related factor 2 （Nrf2） signaling pathway-related mRNA and protein in the renal tissues of rats were detected. RESULTS Compared with the blank group， the rats in the model group exhibited disordered renal tissue structure， with a small amount of glomerular necrosis and edema of the renal tubular epithelial cells. 24 h-UTP， serum levels of SCr， BUN， CHOL and TG， MDA content， mRNA and protein expressions of HIF-1α and Keap1 as well as the expression of miR-155-5p in renal tissues were increased significantly （ P ＜0.05）. Serum level of ALB， SOD level in renal tissue as well as mRNA and protein expressions of Nrf2 were decreased significantly （ P ＜0.05）. Compared with the model group， TWM high-dose and low-dose groups exhibited significant improvements in renal injury， with notable reversals in the levels of the above quantitative indicators （ P ＜0.05）. CONCLUSIONS TWM can alleviate oxidative stress-induced damage and thereby improve nephrotic syndrome in rats by regulating the HIF-1α/miR-155-5p/Nrf2 signaling pathway.

ObjectiveTo observe the clinical effectiveness and safety of Qingfei Shenshi Decoction （清肺渗湿汤） combined with western medicine for patients with bronchial asthma of heat wheezing syndrome， and to explore its potential mechanism of action. MethodsEighty-six participants with bronchial asthma of heat wheezing syndrome were randomly divided into treatment group and control group， each group with 43 participants. The control group received conventional western medicine， and the treatment group was additionally administered Qingfei Shenshi Decoction orally on the basis of the control group， 1 dose per day. Both groups were treated for 14 days. The primary outcome measure was clinical effectiveness； secondary outcome measures included traditional Chinese medicine （TCM） syndrome score， asthma control test （ACT） score， pulmonary function indices such as forced expiratory volume in 1 second （FEV₁）， forced vital capacity （FVC）， peak expiratory flow （PEF）， serum inflammatory factor levels including interleukin-4 （IL-4）， tumour necrosis factor-α （TNF-α）， and high-sensitivity C-reactive protein （hs-CRP）， and immune function indices including CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺. All outcome measures were evaluated before and after treatment. Vital signs were monitored， and electrocardiography， blood routine， urine routine， liver function， and renal function tests were performed before and after treatment. Adverse events and reactions during the study were recorded. ResultsA total of 80 patients completed the trial with 40 in each group. The total clinical effective rate of the treatment group was 97.5% （39/40）， which was significantly higher than that of the control group （85.0%， 34/40， P＜0.05）. After treatment， both groups showed decreased TCM syndrome scores， IL-4， TNF-α， hs-CRP， and CD8⁺ levels， as well as increased ACT scores， CD3⁺， CD4⁺， CD4⁺/CD8⁺， FEV₁， FVC， and PEF levels （P＜0.05 or P＜0.01）. Moreover， the improvements in these indices were more significant in the treatment group than in the control group （P＜0.05 or P＜0.01）. No significant abnormalities in safety indicators were observed in either group， and no adverse events or reactions occurred. ConclusionQingfei Shenshi Decoction combined with conventional western medicine for patients with bronchial asthma of heat wheezing syndrome can effectively improve the clinical symptoms， pulmonary function， and clinical effectiveness， with good safety. Its mechanism may be related to reducing inflammatory factor levels and regulating T lymphocyte subsets to improve immune function.

ObjectiveTo develop and validate a nomogram based on the albumin-bilirubin （ALBI） score for predicting the risk of severe perioperative complications in patients undergoing hepatectomy for hepatolithiasis. MethodsA retrospective analysis was conducted on the clinical data of 163 hepatolithiasis patients who underwent hepatectomy. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for severe perioperative complications. A nomogram prediction model was constructed and its performance was evaluated. ResultsAmong the 163 patients， 66 and 97 were classified into the low-grade and high-grade ALBI groups， respectively. Significant intergroup differences were observed in gender， total bilirubin， albumin levels， and the incidence of severe complications （P0.05）. Severe complications occurred in 40 patients. Independent risk factors included age 60 years （OR=5.49， P0.001）， high-grade ALBI （OR=8.30， P0.001）， history of biliary surgery （OR=2.60， P=0.035）， hepatectomy （segmentectomy）≥3 （OR=2.75， P=0.028）， and open surgical approach （OR=4.00， P=0.009）. A nomogram for predicting severe perioperative complications was successfully established. Internal validation showed that the model had an area under the ROC curve （AUC） of 0.865， which outperformed traditional single predictors. The calibration curve closely aligned with the ideal curve， with a mean absolute error （MAE） of 0.027. Decision curve analysis （DCA） demonstrated a net clinical benefit when the threshold probability exceeded 10%， superior to that of traditional predictors. ConclusionThe ALBI score-based nomogram is successfully developed and validated to predict the risk of severe perioperative complications in hepatolithiasis patients undergoing hepatectomy. The model demonstrated favorable predictive performance and high clinical utility， serving as an effective tool for both preoperative risk assessment and postoperative risk stratification.

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: This study compared the effects of personalized exercise versus acupuncture on multidimensional cognitive function in individuals at high risk for stroke with mild cognitive impairment (MCI). Methods: A randomized controlled trial enrolled 200 stroke-risk adults aged 50−80 years. Ninety participants diagnosed with MCI (MMSE, HIS, CDR criteria) were randomly assigned to exercise (n = 30), acupuncture (n = 30), or control (n = 30) groups. Interventions lasted 6 months. Cognitive outcomes (MMSE, Raven’s Progressive Matrices, Digit Symbol Substitution Test, Animal Fluency, Rey-Osterrieth test, Stroop test) were assessed before and after intervention. Multivariate regression identified risk factors for MCI. ANOVA was used for group comparisons. Results: Hypertension (aOR = 1.5) and diabetes (aOR = 1.3) were significant risk factors for MCI. After intervention, the exercise group showed the largest MMSE improvement (Δ = 5.0), compared with acupuncture (Δ = 3.0) and control (Δ = 1.0) (p < 0.001). Exercise produced greater gains in non-verbal reasoning (31.8% vs. 26.1% in acupuncture, p < 0.01). Acupuncture more effectively enhanced processing speed and attention (DSST: Δ = 26 vs. Δ = 20 in exercise, p = 0.03) and executive function (Stroop interference time: Δ = 16 vs. Δ = 15 seconds in exercise, p = 0.04). Both interventions significantly improved verbal fluency (p < 0.001), with larger benefits in those with baseline MMSE ≤ 20. Conclusion Hypertension and diabetes are key risk factors for MCI in stroke-prone individuals. Exercise yields greater improvement in global cognition and memory, whereas acupuncture is more effective for enhancing attention and executive function. Both modalities benefit verbal fluency, particularly in lower-functioning participants.

ObjectiveTo investigate the protective effect of liver-targeted fibroblast growth factor 21 （FGF21） overexpression against CCl₄-induced acute liver injury （ALI） and its association with silent information regulator 1/glutathione peroxidase 4 （SIRT1/GPX4） expression and ferroptosis-related markers. MethodsFemale ICR mice （8 weeks old） were randomly divided into Control， CCl₄， adeno-associated virus （AAV）-FGF21， and AAV-FGF21 + CCl₄ groups. Liver-targeted FGF21 overexpression was achieved via tail vein injection of AAV8-FGF21 virus with green fluorescent protein （GFP） labeling. ALI was induced by intraperitoneal injection of CCl₄ （0.3 mL/kg）， with sample collection at 12 hours. Body weight and liver weight were recorded to calculate the liver weight/body weight. Alanine aminotransferase （ALT） and aspartate aminotransferase （AST） levels were measured using a biochemical analyzer. FGF21 expression in liver tissues was detected by immunofluorescence. Hepatic histopathology was evaluated by HE staining. RT-qPCR was performed to assess mRNA expression of ferroptosis and iron metabolism-related genes （ACSL4， PTGS2， HJV， FPN， GPX4）， FGF21， and SIRT1. Protein expression of FGF21， SIRT1， and GPX4 were determined by Western blot. Iron content， malondialdehyde （MDA）， glutathione （GSH）， and superoxide dismutase （SOD） activity in liver homogenate were quantified using assay kits. ResultsCompared with the Control group， the FGF21 mRNA and protein expression elevated in CCl₄ group； serum ALT/AST levels and liver weight/body weigh increased. The HE staining results showed that the liver cell membranes were ruptured. The mRNA levels of ACSL4 and PTGS2， the iron content and MDA levels all increased （P<0.01）. The mRNA levels of SIRT1， GPX4， HJV， and FPN， the GSH level and SOD activity all decreased （P<0.05）， and the protein levels of SIRT1 and GPX4 both decreased （P<0.05）. Compared with the CCl₄ group， the serum levels of ALT and AST in the AAV-FGF21 + CCl4 group were decreased （P<0.01）， and the liver/body ratio of mice decreased （P<0.01）. The results of HE staining showed that the degree of liver injury was alleviated. The mRNA levels of ACSL4 and PTGS2， iron content and MDA level all decreased （P<0.01）， while the mRNA levels of SIRT1， GPX4， HJV， FPN， GSH level and SOD activity all increased （P<0.05）. The protein levels of SIRT1 and GPX4 both increased （P<0.05）. ConclusionFGF21 overexpression is associated with enhanced SIRT1/GPX4 expression and suppression of ferroptosis features， thereby contributing to the alleviation of CCl₄-induced ALI.

Objective:To compare the prognostic performance of six trauma scoring systems—Injury Severity Score (ISS), Acute Physiology and Chronic Health EvaluationⅡ (APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA), Prehospital Index (PHI), Revised Trauma Score (RTS), and the Circulation, Respiration, Abdomen, Motor, Speech (CRAMS) score—in predicting 28-day mortality among patients with severe trauma in Southwest China.Methods:A retrospective cohort study was conducted involving 479 patients with severe trauma admitted to the First Affiliated Hospital of Army Medical University between January 2018 and October 2023. Inclusion criteria were: ① age ≥16 years; ② Injury Severity Score (ISS) ≥16; ③ admission within 24 hours post-injury. Exclusion criteria included: ① severe underlying chronic conditions; ② burns or electrical injuries; ③ incomplete clinical data. Based on 28-day outcomes, patients were stratified into a survival group ( n=424) and a death group ( n=55). All patients received standardized resuscitation and damage control interventions. Prehospital scores (PHI, RTS, CRAMS) were recorded at admission. In-hospital scores (ISS, APACHE Ⅱ, SOFA) were calculated using the worst physiological parameters within the first 24 hours. The Mann-Whitney U test was used for group comparisons. Discriminative ability was assessed by the area under the receiver operating characteristic curve (AUC), with pairwise comparisons using DeLong's test. Decision curve analysis (DCA) was performed to evaluate net clinical benefit. Results:The RTS and CRAMS scores were significantly higher in the survival group, whereas ISS, APACHE Ⅱ, SOFA, and PHI scores were significantly lower in the death group (all P<0.05). The AUC values for predicting 28-day mortality, in descending order, were: APACHE Ⅱ (0.917), RTS (0.897), SOFA (0.873), PHI (0.848), CRAMS (0.831), and ISS (0.708). No significant difference in AUC was found between APACHE Ⅱ and RTS ( P=0.325). DCA showed that across most decision thresholds, both APACHE Ⅱ and RTS provided greater net clinical benefit than "treat-all" or "treat-none" strategies and other scores. Conclusions:Among the six scoring systems, APACHE Ⅱ demonstrated the highest predictive accuracy for 28-day mortality in severe trauma patients, though its efficacy was comparable to RTS. DCA confirmed their superior clinical utility. A two-phase assessment strategy—using prehospital RTS for rapid triage followed by in-hospital APACHE Ⅱ for dynamic monitoring—is recommended to optimize clinical decision-making and improve patient outcomes in Southwest China.

Objective To explore the potential clinical value of the ratio of glycated albumin to albumin(GA/ALB)in the occurrence of heart failure(HF)among patients with coronary atherosclerotic heart disease(CHD).Methods A total of 337 CHD patients admitted to the Department of Cardiology in Shanxi Provincial People's Hospital from July 2023 to June 2024 were selected in this study.CHD patients were divided into HF group and non-HF group based on whether they progressed to HF.The clinical data and laboratory parame-ters of the two groups were compared.Restricted cubic spline curve was used to analyze the relationship be-tween GA/ALB levels and the risk of HF in CHD patients.Receiver operating characteristic curve was applied to evaluate the diagnostic efficacy of GA/ALB,GA,platelet to lymphocyte ratio(PLR),and monocyte to lym-phocyte ratio(MLR)in CHD patients with the occurrence of HF.Logistic regression was used to explore the relationship between serum GA/ALB levels and the risk of CHD patients occurrence of HF,and to analyze the degree of influence and stability of subgroup variables on results.Results There were statistically significant differences in GA/ALB,GA,PLR,MLR,and other indicators between the HF group and the non-HF group in CHD patients(P＜0.05).A non-linear relationship was observed between GA/ALB levels and the risk of HF in CHD patients.When the value of GA/ALB multiplied by 10 was less than 5.751,the risk of HF in CHD pa-tients increased with the increase of GA/ALB levels(P＜0.001).GA/ALB was an effective predictor for HF occurrence in CHD patients.Multivariable Logistic regression model showed that GA/ALB was an independ-ent risk factor for CHD patients with occurrence of HF.Subgroup analysis also confirmed the stability of GA/ALB in predicting the occurrence of HF in CHD patients.Conclusion GA/ALB is an independent risk factor for the occurrence of HF in CHD patients,and monitoring GA/ALB levels provides predictive value for the oc-currence of HF in these patients.

Objective:To investigate the relationship between oxidative stress-related genes and pros-tate cancer(PCa)from a multi-omics perspective using summary-data-based Mendelian randomization(SMR),colocalization analysis,and cellular experiments.Methods:Summary-level data on DNA methylation,gene expression,and circulating proteins were obtained and filtered.The PRACTICAL con-sortium was used as the discovery cohort,with the deCODE database serving as the validation cohort.SMR analysis and heterogeneity in dependent instruments(HEIDI)tests were conducted to assess the association and heterogeneity between oxidative stress-related genes and PCa.Colocalization analysis was performed to determine whether oxidative stress-related genes and PCa shared common causal variants.Final-ly,CCK-8 assays,wound healing assays,and Transwell invasion assays and Western blotting,were con-ducted to examine the effects of oxidative stress-related genes on the biological behavior of the PCa cell line C4-2.Results:Multi-omics analysis identified SCP2 as significantly associated with increased PCa risk across gene methylation,gene expression,and circulating protein levels.GSTP1 showed significant associations at the methylation and protein levels,while LPO was associated at the protein level.At the methylation level,SCP2 sites cg00581603(OR=1.11,95％CI:1.05-1.17)and cg13078931(OR=1.12,95％CI:1.05-1.18)were identified as pathogenic.Among the four methylation sites in GSTP1,only cg05244766(OR=0.89,95％CI:0.84-0.95)was considered protective.At the gene expression level,SCP2(OR=1.05,95％CI:1.02-1.07)was also found to be a pathogenic factor.At the circu-lating protein level,SCP2(OR=2.10,95％CI:1.34-3.29)showed a consistent pathogenic trend.In addition,GSTP1(OR=1.16,95％CI:1.07-1.25)and LPO(OR=1.12,95％CI:1.05-1.19)were significantly associated with increased PCa risk.Further functional assays demonstrated that knock-down of SCP2 significantly reduced the oncogenic phenotype of prostate cancer cells.Conclusion:Through integrated multi-omics analysis and experimental validation,this study confirmed a significant as-sociation between SCP2 and increased PCa risk.These findings enhance our understanding of PCa patho-genesis and provide new potential targets and therapeutic directions for PCa treatment.

OBJECTIVE To investigate the renal protective effect and mechanism of Shenbining granule on IgA nephropathy （IgAN） rats by regulating the CXC chemokine motif ligand 12 （CXCL12）/CXC chemokine receptor 4 （CXCR4）/signal transducer and activator of transcription 3 （STAT3） signaling pathway. METHODS A total of 60 rats were randomly assigned into blank group （n＝12） and modeling group （n＝48）. IgAN model of modeling group was induced by using bovine serum albumin， carbon tetrachloride and lipopolysaccharide， followed by model validation. Ultimately， a total of 55 rats （9 in the blank group， 46 in the modeling group） were included in the subsequent study. The rats in the modeling group were randomly divided into model group （n＝10）， prednisone acetate group [positive control group， 6.25 mg/（kg·d）， n＝12]， Shenbining granule low- and high-dose groups [4.17， 8.33 g/（kg·d）， n＝12]. They were given relevant medicine/distilled water intragastrically， once a day， for 4 consecutive weeks. After the last medication， biochemical indicators in the urine and serum of rats were measured， and pathological morphological changes in the renal tissues of rats were observed. IgA deposition in the renal tissues， as well as the mRNA expression levels of CXCL12， CXCR4 and STAT3， and the protein expression levels of CXCL12， CXCR4， STAT3 and phosphorylated STAT3 （p-STAT3） were detected. Additionally， the level of interleukin-6 （IL-6） in the renal tissue was measured. RESULTS Compared with the model group， the low-dose and high-dose Shenbining granule groups showed significantly decreased urinary red blood cell count， 24 h total urinary protein， blood urea nitrogen， serum creatinine， and alanine amino-transferase， along with increased Alb levels （P＜0.05）. Pathological damage in the renal tissues was alleviated， with reduced IgA deposition in the mesangial region （P＜0.05）； protein and mRNA expressions of CXCL12， CXCR4 and STAT3， as well as phosphorylation level of STAT3 protein and the IL-6 level， were significantly decreased in renal tissue （P＜0.05）. CONCLUSIONS Shenbining granule may exert its renal protective effects in IgAN rats by inhibiting the activation of the CXCL12/ CXCR4/STAT3 signaling pathway， downregulating the expression of inflammatory factors such as IL-6， alleviating renal inflammation， and thereby improving renal pathological damage.