AIM: To explore the efficacy of 0.05% cyclosporine A(CsA)eye drops for preventing dry eye after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK).METHODS: In this prospective randomized controlled study, a total of 80 patients(80 eyes)who underwent FS-LASIK surgery at the Affiliated Hospital of Xuzhou Medical University from January 2025 to September 2025 were enrolled, and only the data from the right eye were included for analysis. Before surgery, these patients were randomly assigned in a 1:1 ratio using a computer-generated sequence to a control group or an experimental group. All patients received standard postoperative treatment starting from postoperative day 1, including 0.5% levofloxacin eye drops, 0.1% fluorometholone eye drops, and 0.1% sodium hyaluronate eye drops(four times daily for 3 mo). The experimental group additionally received 0.05% cyclosporine A eye drops in addition to the standard treatment. The following parameters were compared between the two groups preoperatively and at 1 and 3 mo postoperatively: ocular surface disease index(OSDI)score, numerical rating scale(NRS)for ocular symptoms, lipid layer thickness(LLT), meibomian gland dropout score, Schirmer's Ⅰ test(SⅠt), corneal fluorescein staining(CFS)score, non-invasive tear breakup time(NIBUT), and tear meniscus height(TMH). Confocal microscopy was employed to evaluate corneal nerve parameters, including corneal nerve fiber density(CNFD), corneal nerve branch density(CNBD), corneal nerve fiber length(CNFL), and corneal total branch density(CTBD), and to count Langerhans cell density(DCD). In addition, levels of interferon-gamma(IFN-γ), interleukin(IL)-1β, IL-6, IL-10, and matrix metalloproteinase-9(MMP-9)in the tear were measured using liquid chip technology.RESULTS: A total of 72 patients completed the final follow-up, including 37 patients(15 males, 22 females, mean age 24.05±4.00 y)in the experimental group, 35 patients(16 males, 19 females, mean age 23.77±3.71 y)in the control group. At 1 and 3 mo postoperatively, the experimental group showed significantly lower OSDI scores, NRS eye pain scores, and CFS scores(all P<0.01), and significantly higher NIBUT and TMH values, compared with the control group. Confocal microscopy revealed that DCD was significantly lower in the experimental group at 1 and 3 mo postoperatively, whereas CNFD, CNBD, CNFL, and CTBD were significantly higher at 3 mo postoperatively(all P<0.01). Analysis of tear inflammatory cytokines showed that the levels of IFN-γ, IL-1β, IL-6, and MMP-9 were significantly lower in the experimental group at 1 and 3 mo postoperatively compared with the control group(all P<0.01). Spearman correlation analysis revealed that OSDI and NRS scores were negatively correlated with NIBUT, corneal nerve parameters(CNFD, CNBD, CNFL, CTBD), and corneal sensitivity(all P<0.01), and positively correlated with CFS scores, tear inflammatory cytokines(IFN-γ, IL-10, IL-1β, IL-6, and MMP-9), and DCD(all P<0.01). Tear inflammatory cytokines were negatively correlated with corneal nerve parameters, NIBUT, and corneal sensitivity(all P<0.01), and positively correlated with CFS scores and DCD(all P<0.01). No significant correlations were observed among the remaining parameters(P>0.05).CONCLUSION: Prophylactic use of 0.05% cyclosporine A eye drops significantly improves dry eye symptoms and signs, suppresses ocular surface inflammation, and promotes the restoration of tear film stability in patients after FS-LASIK. Through its dual anti-inflammatory and neuroregenerative effects, cyclosporine A constitutes an effective adjuvant therapy for reestablishing ocular surface microenvironment homeostasis after refractive surgery.

Objective To analyze the clinical efficacy and safety of transurethral blue laser vaporization of prostate (BVP) in the treatment of benign prostatic hyperplasia (BPH), and to explore the feasibility of its promotion in primary hospitals. Methods Clinical data of 30 BPH patients undergoing BVP in our hospital during Sep. and Dec. 2024 were retrospectively analyzed. The preoperative prostate volume, decrease in hemoglobin level 2 hours after operation, operation time, postoperative bladder irrigation time, catheter indwelling time, and intra-/postoperative complications were recorded. The changes of international prostate symptom score (IPSS), quality of life (QoL) score, and maximum urinary flow rate (Qmax) were compared before operation and 6 months after operation. Results The mean prostate volume was (46.9±15.7) mL. BVP was successfully completed in 28 patients. The 2 unsuccessful cases (6.7%) converted to transurethral resection of the prostate (TURP) due to intraoperative bleeding. For the 28 successful cases, the median postoperative 2-hour hemoglobin decrease was 4 (2, 11) g/L, mean operation time (59.8±13.2) min, median postoperative bladder irrigation time 21 (18, 23) h, median postoperative catheter indwelling time 5 (5, 5) d, and median postoperative hospital stay 6 (5, 6) d. After catheter removal, urinary retention with infection occurred in 1 case (3.6%), and hemorrhage in 1 case (3.6%). No severe complications occurred during the perioperative period. At 6 months postoperatively, the 28 patients showed significant improvement compared to preoperative values in IPSS[11 (10, 11) vs. 22 (21, 26), P＜0.001], QoL score[2 (2, 3) vs. 5 (5, 6), P＜0.001], and Qmax[ (17.2±5.6) mL/s vs. (7.8±1.4) mL/s, P＜0.001]. Conclusion BVP is a safe and effective treatment for BPH, offering advantages such as minimal blood loss, short operation time, and few complications. It effectively improves patients' lower urinary tract symptoms and quality of life, and is recommended for promotion in primary hospitals.

Puerariae Lobatae Radix and Puerariae Thomsonii Radix are the dried roots of Pueraria lobata and Pueraria thomsonii of the Leguminosae family， respectively. Since their separate inclusion in the 2005 edition of Pharmacopoeia of the People's Republic of China， the two herbs have been individually recorded. Although they share the same functions and indications， the required content of puerarin differs by a factor of up to eightfold between them. The current quality standard relies solely on a single indicator， puerarin， which fails to reflect the correlation between chemical constituents and core therapeutic effects. This has resulted in prominent issues of mixed use in clinical practice and production， thereby constraining the high-quality development of the industry. Modern research has demonstrated that Puerariae Lobatae Radix contains a comprehensive range and higher content of isoflavonoid constituents， while Puerariae Thomsonii Radix is rich in starch and polysaccharides. Puerariae Lobatae Radix exhibits stronger effects in antipyresis， cardiovascular and cerebrovascular protection， and central analgesia， while Puerariae Thomsonii Radix demonstrates greater advantages in anti-inflammation， hypoglycemia， and peripheral analgesia. Based on this， the chemical material bases of Puerariae Lobatae Radix and Puerariae Thomsonii Radix at both the macromolecule and micromolecule levels were systematically reviewed and compared. The pharmacodynamic material bases and mechanisms of action underlying their three core therapeutic effects， namely "relieving exterior syndrome and clearing heat"， "promoting fluid production to quench thirst"， and "dredging channels and activating collaterals"， were summarized. The most highly correlated common metabolic pathway shared by both herbs for these three therapeutic effects is the arachidonic acid metabolic pathway， and their common core target is prostaglandin-endoperoxide synthase 2 （PTGS2）. This review provided clinical application recommendations based on the therapeutic differences between the two herbs， elucidated the scientific connotation of their "same origin but different effects"， and， grounded in the quality marker （Q-Marker）， proposed the concept of efficacy-related Q-Marker based on "substance-efficacy-syndrome" association， as well as a novel strategy for efficacy-oriented quality evaluation. Preliminary screening of quality markers associated with different therapeutic effects was also conducted. This study aims to provide critical scientific evidence for the precise clinical application of Puerariae Lobatae Radix and Puerariae Thomsonii Radix， the improvement of quality standards， and the high-quality development of the industry.

ObjectiveTo investigate the association between single and combined exposure to arsenic （As）， mercury （Hg）， and cadmium （Cd） in urine and hearing loss in adults. MethodsA total of 400 adult patients were recruited for the study， comprising 200 participants in the normal hearing group and 200 in the hearing loss group. General demographic information of the study subjects was collected by a self-administered questionnaire， morning urine samples were tested for As， Hg， and Cd concentrations， and hearing status was assessed by Pure Tone Audiometry. A binary Logistic regression model was used to explore the association between the concentrations of the three metals in urine and hearing loss， and a Bayesian kernel-machine regression （BKMR） model was used to further explore the association between the concentrations of the three metal mixtures and hearing loss. ResultsAfter correction for urinary creatinine， As， Hg， and Cd concentrations were higher in the hearing loss group than those in the normal hearing group （P<0.05）. Binary Logistic regression indicated that concentrations of As， Hg， and Cd were positively associated with hearing loss， and the risk of hearing loss was significantly higher in the second quartile of Cd concentration compared to the first quartile （OR=2.000， 95%CI： 1.009-3.964）. BKMR modeling analysis showed that the combined exposure levels of As， Hg， and Cd significantly increased the risk of hearing loss， with Cd being the most important contributor （posterior inclusion probability=0.412）， and that there were potential interactions between As and Cd， and Cd and Hg. ConclusionCombined exposure to As， Hg， and Cd in urine is significantly associated with adult hearing loss， with Cd being the primary contributor in the exposure combination. The interactions between As and Cd， as well as Cd and Hg， may have adverse effects on hearing loss.

As a commonly used clinical herb, Ligustri Lucidi Fructus is renowned for its effects in nourishing the liver and kidneys, improving vision, and darkening hair. Its preparation originated from the "steaming on rice" method in the Song Dynasty. After centuries of inheritance and development, it has evolved into the diverse processing techniques used today. Ancient methods primarily included cleaning, cutting, soaking, honey-roasting, and steaming, while baking-though documented-was not a mainstream practice. Modern techniques have inherited traditional approaches such as cleaning, steaming, and roasting, while diversifying into specifications like wine-steaming, wine-stewing, plain steaming, vinegar-steaming, salt-roasting, and ultra-fine granules. However, variations in critical parameters, such as auxiliary material ratios and steaming duration across regions, have led to inconsistencies in the quality of processed Ligustri Lucidi Fructus. Notably, region-specific methods warrant further exploration, as they may embody unique processing principles and advantages with potential value for enhancing efficacy and quality. By systematically reviewing the historical evolution and regional variations of processing techniques for Ligustri Lucidi Fructus, key issues such as inconsistent processing parameters were identified, which provided a reference for the standardization of processing procedures and the improvement of quality standards.

The herb pair Hedysari Radix-Angelicae Sinensis Radix is a classic combination embodying the theory of replenishing Qi and tonifying blood in traditional Chinese medicine. The two herbs are often used together to achieve the effects of replenishing Qi， tonifying blood， activating blood， and unblocking collaterals. Clinically， this herb pair is widely applied in the treatment of blood deficiency syndrome and hematopoietic dysfunction disorders such as myelosuppression induced by radiotherapy and chemotherapy. Modern research indicates that Hedysari Radix-Angelicae Sinensis Radix and their active components can synergistically promote hematopoiesis through multiple targets and pathways. At the cellular level， the active components directly activate hematopoietic stem cells （HSCs） and hematopoietic progenitor cells （HPCs）， promoting their proliferation and differentiation， while simultaneously stimulating the production and release of peripheral blood cells. Regarding molecular regulation， this herb pair can regulate the expression of various hematopoietic-related cytokines， such as stem cell factor and erythropoietin. Additionally， it modulates key signaling pathways， including phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） and Wnt/β-catenin， providing signal support for the hematopoietic process. Furthermore， Hedysari Radix-Angelicae Sinensis Radix can improve the hematopoietic microenvironment， protect bone marrow stromal cells， and eliminate free radicals through antioxidant effects， thereby reducing damage to hematopoietic cells. Furthermore， this herb pair regulates apoptosis-related proteins to inhibit excessive apoptosis of hematopoietic cells and increase their survival rate. Its material basis primarily includes active components such as Hedysarum polybotrys polysacchcrides and flavonoids， as well as Angelica sinensis polysaccharides and ferulic acid， which synergistically contribute to its hematopoietic-promoting effects. By elaborating on the active components and mechanisms of Hedysari Radix-Angelicae Sinensis Radix in promoting hematopoiesis， this paper aims to elucidate the molecular mechanisms underlying their hematopoietic effects and provide a reference for further research and clinical application.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

OBJECTIVES: To investigate the effect of orexin-A-mediated regulation of ionotropic glutamate receptors for promoting motor function recovery in rats with spinal cord injury (SCI). METHODS: Thirty-six newborn SD rats (aged 7-14 days) were randomized into 6 groups (n=6), including a normal control group, a sham-operated group, and 4 SCI groups with daily intrathecal injection of saline, DNQX, orexin-A, or orexin-A+DNQX for 3 consecutive days after PCI. Motor function of the rats were evaluated using blood-brain barrier (BBB) score and inclined plane test 1 day before and at 1, 3, and 7 days after SCI. For patch-clamp experiment, spinal cord slices from newborn rats in the control, sham-operated, SCI, and SCI+orexin groups were prepared, and ventral horn neurons were acutely isolated to determine the reversal potential and dynamic indicators of glutamate receptor-mediated currents under glutamate perfusion. RESULTS: At 3 and 7 days after SCI, the orexin-A-treated rats showed significantly higher BBB scores and grip tilt angles than those with other interventions. Compared with those treated with DNQX alone, the rats receiving the combined treatment with orexin and DNQX had significantly higher BBB scores and grip tilt angles on day 7 after PCI. In the patch-clamp experiment, the ventral horn neurons from SCI rat models exhibited obviously higher reversal potential and greater rise slope of glutamate current with shorter decay time than those from sham-operated and orexin-treated rats. CONCLUSIONS Orexin-A promotes motor function recovery in rats after SCI possibly by improving the function of the ionotropic glutamate receptors.
Animals ; Spinal Cord Injuries/drug therapy* ; Rats ; Rats, Sprague-Dawley ; Receptors, Ionotropic Glutamate/metabolism* ; Recovery of Function/drug effects* ; Orexins/pharmacology* ; Male ; Female ; Animals, Newborn ; Neuropeptides/pharmacology* ; Intracellular Signaling Peptides and Proteins/pharmacology*

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OBJECTIVE: To explore the clinical features of the sepsis in immunocompromised hosts and establish an early warning equation. METHODS: A retrospective study was conducted on sepsis patients admitted to the intensive care unit (ICU) of Binzhou Medical University Hospital from October 2011 to October 2022. General information, infection site, etiology results and drug susceptibility, clinical symptoms, inflammatory indicators, acute physiology and chronic health status evaluation II (APACHE II), sequential organ failure assessment (SOFA), incidence of immune paralysis, and outcome during hospitalization were collected. Based on whether they met the diagnostic criteria for immunocompromised hosts, patients were divided into immunocompromised group and immune normal group. The clinical information of the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of patients with immunocompromised sepsis and the regression equation model was initially established. Omnibus test and Hosmer-Lemeshow test were used to evaluate the model. RESULTS: A total of 169 patients with sepsis were included, including 61 in the immunocompromised group and 108 in the normal immune group. The top 3 infection sites in the immunocompromised group were bloodstream infection, pulmonary infection and abdominal infection. The top 3 infection sites in the normal immune group were pulmonary infection, bloodstream infection and abdominal infection. The infection rate of Gram-negative bacteria in the immunocompromised group was significantly lower than that in the normal group [49.2% (30/61) vs. 64.8% (70/108), P < 0.05]. The infection rate of Gram-positive bacteria [27.9% (17/61) vs. 13.9% (15/108)] and multidrug-resistant bacteria [54.1% (33/61) vs. 29.6% (32/108)] were significantly higher than those in normal immune group (both P < 0.05). In terms of clinical symptoms, the proportion of fever in the immunocompromised group was significantly lower than that in the immune normal group [49.2% (30/61) vs. 66.7% (72/108), P < 0.05]. Neutrophil count (NEU) and neutrophil percentage (NEU%) in the immunocompromised group were significantly lower than those in the normal immune group. Lymphocyte percentage (LYM%), neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), APACHE II score, combined shock rate, incidence of immune paralysis, and mortality during hospitalization in the immunocompromised group were significantly higher than those in the normal immune group. Logistic regression analysis showed that NLR, CRP and PCT were risk factors for patients with immunocompromised sepsis (all P < 0.05). The above indicators were used as covariables to construct a Logistic regression equation, that was, Logit (P) = 0.025X₁+0.010X₂+0.013X₃-2.945, where X₁, X₂ and X₃ represent NLR, CRP and PCT respectively. Omnibus test and Hosmer-Lemeshow test show that the model fits well and has certain early warning value. CONCLUSIONS Patients with immunocompromised sepsis have more intense inflammatory response, with Gram-negative bacteria being the predominant pathogen, and a higher incidence of Gram-positive bacterial infections and multi-drug resistant infections. The severity of the disease, in-hospital mortality, the incidence of shock and the incidence of immune paralysis after sepsis were significantly higher. NLR, CRP and PCT were independent risk factors for sepsis in immunocompromised hosts. The regression equation constructed based on this may have early warning significance for patients with immunocompromised sepsis.
Humans ; Sepsis/immunology* ; Immunocompromised Host ; Retrospective Studies ; Risk Factors ; Intensive Care Units ; Logistic Models ; Male ; APACHE ; Female ; Middle Aged ; Aged