ObjectiveTo observe the short-term and long-term efficacy of traditional Chinese medicine （TCM） surgical operations in treating mixed hemorrhoids. MethodsA multi-center retrospective cohort study was conducted， collecting clinical data from 17，831 mixed hemorrhoid surgery patients in 8 top-tier TCM hospitals in Jiangsu Province. Standardized and structured datasets were obtained through artificial intelligence models. Patients who underwent western surgical treatment were categorized into the western surgery group （11,646 cases）， and those receiving TCM surgical operations were categorized into the TCM surgery group （6185 cases）. Propensity score matching （1∶1 matching） was used to balance baseline data between groups. The primary outcome was the one-year recurrence rate， and secondary outcomes included the main symptoms （rectal bleeding， degree of prolapse） and secondary symptoms （anal distension， anal edema， wound secretion and exudation， anal stenosis， residual skin tags， perianal itching， and anal pain） measured on days 7， 28， and 60 after discharge. ResultsAfter matching， 2194 patients were included in each group. Symptom scores showed that at 28 days after discharge， the TCM surgical group had superior improvement in rectal bleeding ［OR=5.786， 95%CI （3.092，10.827）］， degree of prolapse ［OR=4.510， 95%CI （1.649，12.333）］， and anal edema ［OR=3.188， 95%CI （1.295，7.845）］ compared to the western surgical group. At 60 days post-discharge， the TCM group still showed advantages in improving rectal bleeding ［OR=5.237， 95%CI （1.077，25.464）］ and anal pain ［OR=11.697， 95%CI （1.186，115.336）］ （P＜0.05）. Long-term follow-up showed that the one-year recurrence rate in the TCM surgery group was 1.1% （8/726）， while that in the western surgery group was 2.3% （10/444）， with no statistically significant difference between the two groups （P＞0.05）. ConclusionBased on real-world data， TCM surgical treatment for mixed hemorrhoids shows significant short-term symptom improvement， particularly in terms of hemostasis， reducing swelling， and alleviating prolapse of anal masses.

ObjectiveTo study the pharmacological substances and mechanisms through which sesquiterpene ZH-13 from Aquilariae Lignum Resinatum improves neuroinflammation. MethodsBV-2 microglial cells were stimulated with lipopolysaccharide （LPS） to induce neuroinflammation. The cells were divided into the normal group， the model group， and the ZH-13 low- and high-dose treatment groups （10， 20 μmol·L^-1）. The model group was treated with 1 μmol·L^-1 LPS. Cell viability was assessed using the cell proliferation and activity assay （CCK-8 kit）. Nitric oxide （NO） release in the cell supernatant was measured using a nitric oxide kit （Griess method）. The mRNA expression levels of interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， inducible nitric oxide synthase （iNOS）， and interleukin-6 （IL-6） were detected by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The phosphorylation of mitogen-activated protein kinase （MAPK） pathway proteins was assessed by Western blot. ResultsCompared with the model group， ZH-13 dose-dependently reduced NO release from BV-2 cells under LPS stimulation （P<0.05， P<0.01）. In the 20 μmol·L^-1 ZH-13 treatment group， the mRNA expression levels of IL-1β， TNF-α， iNOS， and IL-6 were significantly reduced compared to the model group （P<0.05， P<0.01）. In both the low- and high-dose ZH-13 groups， the expression of the inflammatory factor TNF-α and the phosphorylation of c-Jun N-terminal kinase （JNK） in the upstream MAPK pathway were significantly reduced （P<0.05）. After stimulation with the JNK agonist anisomycin （Ani）， both low- and high-dose ZH-13 treatment groups showed reduced phosphorylation of JNK proteins compared to the Ani-treated group （P<0.01）. ConclusionThe sesquiterpene compound ZH-13 from Aquilariae Lignum Resinatum significantly ameliorates LPS-induced neuroinflammatory responses in BV-2 cells by inhibiting excessive JNK phosphorylation and reducing TNF-α expression. These findings elucidate the pharmacological substances and mechanisms underlying the sedative and calming effects of Aquilariae Lignum Resinatum.

Objective:To investigate predictive value of dynamic electrocardiogram heart rate variability(HRV)combined with three-dimensional spot tracking echocardiography(3D-STE)for postoperatively major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD).Methods:The clinical data of 80 CHD patients,who underwent percutaneous coronary intervention(PCI)treatment at Beijing Rehabilitation Hospital affiliated with Capital Medical University from January 2022 to December 2023,were retrospectively collected.All patients underwent dynamic electrocardiogram HRV and 3D-STE examination before surgery,and 1-year follow-up.The condition of occurring MACE during the follow-up period was analyzed as statistical method,and the patients were divided into occurrence group(21 cases)and non-occurrence group(59 cases).The relevant parameters of dynamic electrocardiogram HRV and 3D-STE examination of occurring MACE of CHD patients between two groups were compared,and the predictive value of dynamic electrocardiogram HRV combined with 3D-STE examination for postoperative MACE of CHD patients was analyzed.Results:In 80 CHD patients,21 cases occurred postoperative MACE,with an incidence rate of 26.25%.The standard deviation of the average NN intervals(SDANN)(65.26±9.65)ms of 5-minute sinus,the standard deviation of normal-to-normal intervals index(SDNN Index)(40.15±6.36)ms of 5-minute in continuous 24 hours,the root mean square of successive differences(r-MSSD)(36.86±4.55)ms between the normal adjacent cardiac cycles,the left atrial emptying fraction(LAEF)(40.25±4.53)%,and the left atrial storage phase strain(LASr)(15.24±3.62)%in CHD patients with MACE were lower than those without MACE[(87.45±10.22)ms,(52.45±7.85)ms,(46.54±6.25)ms,(48.54±6.33)ms,(19.99±4.55)%],and the left atrial pre-contraction volume(LAVp)(42.51±3.65)ml was higher than that(35.18±2.99)mL in patients without MACE,with statistically significant differences(t=8.666,6.457,6.499,9.093,5.510,4.317,P<0.05).Logistic regression analysis showed that SDANN,SDNN Index,r-MSSD,LAVp,LAEF,LASr were correlations with the occurrence of postoperative MACE in CHD patients(OR=0.756,0.772,0.694,2.481,0.721,0.739,P<0.05).The receiver operating characteristics(ROC)curves indicated that the area under curve(AUC)values of SDANN,SDNN Index,r-MSSD,LAVp,LAEF and LASr were all greater than 0.70 in predicting postoperative MACE in CHD patients,which indicated all of them had predictive value,and the predictive value of the combined detection was higher.Conclusion:Dynamic electrocardiogram HRV and 3D-STE parameters have a certain predictive value for the occurrence of postoperative MACE in CHD patients,and the predictive value of the combined detection for the them are higher.Therefore,dynamic electrocardiogram HRV and 3D-STE parameters can be used as one of the important reference schemes of assessing postoperative MACE of patients.

Objective:To investigate the diagnostic efficacy of artificial intelligence(AI)software combined with contrast-enhanced ultrasound(CEUS)on portal hypertension of cirrhosis.Methods:A retrospective analysis was conducted on 106 patients with cirrhosis who admitted to Handan Communicable Disease Hospital from January 2024 to June 2024 and were confirmed by surgical pathology.In them,60 cases with positive portal hypertension were included in positive group,and 46 cases with negative portal hypertension were included in negative group.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic values of ultrasound characteristics via preoperative AI quantization,enhanced ultrasound mode and the combination of them for portal hypertension of cirrhosis.Results:The mean peak intensity,mean vessel density and branching morphology index of AI software were respectively 201.23±10.18,0.62±0.11 and 1.23±0.24 in diagnosing portal hypertension of positive group,all of which were significantly higher than those of negative group(t=8.551,3.707,2.054,P<0.05).However,the mean peak reaching time,uniformity of flow perfusion,mean flow velocity and uniformity of microcirculation perfusion of the positive group were respectively(18.22±2.18)seconds,(75.22±5.46)%,(10.09±2.22)cm/s,(80.78±5.11)%,all of which were significantly lower than those in the negative group(t=3.729,5.237,4.969,4.491,P<0.05).The enhancement speed and degree of liver parenchyma,the enhancement speed of portal vein,and the enhancement speed and degree of spleen in CEUS of positive group were significantly higher than those of negative group,and the differences were significant(t=4.770,12.781,7.313,5.501,4.645,7.513,P<0.05).ROC curve analysis showed that the area under curve(AUC)value of CEUS combined with AI algorithm was 0.926 in diagnosis,which was significantly better than single CEUS and single AI analysis(0.853,0.925).Conclusion:CEUS technique combines with AI software can show higher diagnostic efficacy in the diagnosis for portal hypertension of cirrhosis,which diagnostic effect was better than single either of two methods.

Objective To investigate the protective effect of Linggui Zhugan Decoction on myocardial injury in diabetic rats;To explore its molecular mechanism.Methods The diabetes myocardial injury rat model was established by intraperitoneal high fat diet combined with injection of streptozotocin.Successfully modeled rats were randomly divided into model group,simvastatin group(5 mg/kg)and Linggui Zhugan Decoction low-and high-dosage group(3.75,7.5 g/kg).Normal rats were set as blank group,and each medication group was intervened with corresponding drugs.Fasting and random blood glucose were monitored using a glucometer,the left ventricular ejection fraction(LVEF)was measured,serum contents of total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),superoxide dismutase(SOD)and malondialdehyde(MDA)were detected by biochemical kits,the contents of cardiac troponin I(cTnI)and creatine kinase-MB(CK-MB)were detected by ELISA,the myocardial morphology and fibrosis were observed by HE and Masson staining,the positive expression of PDCD4 was detected by immunohistochemistry,the mRNA expressions of miR-21,PDCD4,PTEN and p53 were detected by RT-qPCR,and the protein expressions of PDCD4,PTEN and p53 were detected by Western blot.Results Compared with the blank group,fasting blood glucose and random blood glucose significantly increased at different time points in the model group(P<0.05,P<0.01),LVEF significantly decreased(P<0.01),the contents of serum TC,TG,LDL-C,HDL-C,MDA,cTnI,CK-MB significantly increased(P<0.05,P<0.01),and the content of SOD significantly decreased(P<0.01);the inflammatory cells infiltration and fibrosis injury in myocardial tissue were significantly aggravated(P<0.01),the expression of miR-21 in myocardial tissue significantly decreased,and the mRNA and protein expressions of PDCD4,PTEN,p53 significantly increased(P<0.05,P<0.01).Compared with the model group,fasting blood glucose significantly decreased in simvastatin group and Linggui Zhugan Decoction high-dosage group(P<0.05),LVEF significantly increased(P<0.01),the contents of serum TC,TG,LDL-C,HDL-C,MDA,cTnI and CK-MB significantly decreased(P<0.05,P<0.01),the content of SOD significantly increased(P<0.05,P<0.01);the inflammatory cells infiltration and fibrosis injury in myocardial tissue were significantly improved(P<0.01),the expression of miR-21 in myocardial tissue significantly increased,and the mRNA and protein expressions of PDCD4,PTEN,p53 significantly decreased(P<0.05,P<0.01).Conclusion Linggui Zhugan Decoction may inhibit the expressions of PDCD4,PTEN and p53 by increasing miR-21,thereby alleviating myocardial injury in diabetic rats.

Objective:To analyze the epidemiological characteristics of the population receiving assisted reproductive technology (ART) therapy and the health status of their offspring in Shanghai from 2011 to 2020.Methods:Based on the birth cohort of the entire population in Shanghai, the proportion and trend changes of ART offspring in the birth cohort were analyzed. The characteristics of ART and naturally conceived populations, including household registration, education level, maternal age, and reproductive history, were examined. Additionally, the health status between ART offspring and naturally conceived offspring were compared.Results:From 2011 to 2020, a total of 70 729 ART offspring were born in Shanghai, accounting for 3.69% of the total births. In 2020, this proportion reached 7.79%. The ART conception rate for primiparous women was higher than that for multiparous women, with both showing upward trends and reaching 9.87% and 2.36%, respectively, in 2020. The ART conception rate was higher in women with higher education levels and local household registration than in those with lower education levels and non-local household registration. The incidence rates of preterm birth and low birth weight in ART singleton offspring were 7.76% and 4.82%, respectively, higher than the 4.69% and 2.87% in naturally conceived offspring, but no increasing trend was observed in naturally conceived offspring. Among twin and multiple newborns, the incidence rates of preterm birth and low birth weight were 56.98% and 46.82% for ART, lower than the 58.51% and 51.32% for natural conception.Conclusions:The difference in social and demographic characteristics was obvious in population receiving ART, suggesting that the differed demand of some people for ART therapy, and it is necessary to strengthen the construction of public health services and further expand the coverage and accessibility of ART services. With technological advancements, the rates of preterm birth and low birth weight remain relatively stable, and even decrease in twin and multiple newborns.

Objective:To investigate the acute effects of persistent high exposure to atmospheric fine particulate matter (PM 2.5) on residents' outpatient visits for respiratory diseases. Methods:We collected daily outpatient records from 92 hospitals in 13 cities across the Beijing-Tianjin-Hebei region, along with daily PM 2.5, nitrogen dioxide (NO 2), and meteorological data from 2013 to 2018. Five persistent high PM 2.5 exposure scenarios were defined in terms of daily mean PM 2.5 concentrations (>75 μg/m 3 and >150 μg/m 3), duration (≥2 days and ≥3 days), and whether or not there was concurrent exposure to high levels of NO 2 (daily mean NO 2 concentration >50 μg/m 3). A two-stage statistical analysis strategy based on a generalized linear model was applied to conduct a time-series analysis to assess the exposure-response relationship between persistent high PM 2.5 exposure scenarios and residents' outpatient visits for a variety of respiratory diseases, and to estimate excess outpatient visits. Results:During the period, M ( Q1, Q3) PM 2.5 and NO 2 concentrations were 61.2 (42.3, 95.1) μg/m 3 and 40.2 (31.4, 54.4) μg/m 3, respectively, and the daily respiratory disease outpatient visits were 57 (52, 66) cases. When compared with non-permanent high PM 2.5 exposure periods, exposure scenarios with PM 2.5 >75 μg/m 3 and lasting for ≥2 days caused an increased risk of outpatient visits for respiratory diseases by 2.10% (95% CI: 1.44%-2.77%), and resulted in 43 787 (95% CI: 30 025-57 757) excess visits; in this scenario, the concurrent exposure to high levels of NO 2 had a greater acute effect on respiratory disease visits than the absence of exposure to high levels of NO 2 ( P<0.001). The risk of respiratory disease visits increased substantially by 4.41% (95% CI: 3.15%-5.68%) when the daily mean PM 2.5 concentration exceeded 150 μg/m 3 for ≥2 days. Subgroup disease analyses showed that scenarios with daily mean PM 2.5 concentrations exceeding 75 μg/m 3 for ≥3 days caused a significant increase in the risk of lower respiratory tract infections, chronic lower respiratory disease, and asthma visits. Conclusions:Sustained persistent high PM 2.5 exposure increases the risk of outpatient visits for various respiratory diseases; concurrent exposure to high concentrations of NO 2 leads to a greater risk of visiting the clinic, suggesting that the prevention and control of PM 2.5 pollution should be synchronized with the control of mobile source emissions, to synergistically manage the compound pollution of PM 2.5 and NO 2 in the atmosphere.

Objective To explore the diagnostic significance of fecal calprotectin(FC)in infectious diarrhea in children.Methods A total of 190 children with infectious diarrhea who were hospitalized in Hangzhou Children's Hospital from August 2021 to July 2024 were selected and divided into bacterial group(115 cases)and viral group(75 cases)according to type of pathogen.48 children who underwent health examination in the hospital during the same period were included in control group.The FC,white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)of three groups of children were detected.The diagnostic efficacy of FC,WBC,CRP and PCT for bacterial infectious diarrhea was evaluated by using the receiver operating characteristic(ROC)curve.Results The proportions of fever and hematochezia,the highest body temperature,frequency of defecation,and fecal white blood cells in bacterial group were significantly higher than those in viral group,while the proportion of vomiting was significantly lower than that in viral group(P＜0.05).There were statistically significant differences in levels of WBC,CRP,PCT and FC among three groups of children(P＜0.05),and the levels were all in the order of bacterial group＞viral group＞control group.The results of ROC curve showed that area under the curve(AUC)of FC for diagnosing bacterial diarrhea was 0.941,with a sensitivity of 87.0％and a specificity of 85.4％.The AUC,sensitivity and specificity of the diagnosis by FC combined with CRP were 0.987,93.0％and 97.9％respectively.Correlation analysis indicated that FC was positively correlated with WBC and CRP levels(r-0.221,0.159,P＜0.05).Conclusion FC is helpful in differentiating bacterial diarrhea from viral diarrhea,and the combined detection of FC and CRP can effectively improve the effectiveness of differential diagnosis and reduce the misdiagnosis rate.

Background and aims:Primary sclerosing cholangitis(PSC)is an autoimmune liver disease characterized by complex pathogenesis and limited available therapeutic options.The mechanisms underlying the development and progression of PSCs remain unclear.Liver X receptor beta(LXR-β)is recognized to modulate lipid metabolism and immune response,but its specific involvement in the PSC has not been elucidated.Here,we explored the role and mechanism of LXR-β in PSC induced by 3,5-diethoxycarbonyl-1,4-dihydro-2,4,6-collidine(DDC).Methods:CRISPR-Cas9 technology was applied to generate Abcb4(coding MDR2,next named as Mdr2),Nr1h2(coding LXR-β,next named as Lxrβ),and Rag2(coding RAG2)knockout mice.DDC was used to induce PSC.Hematoxylin and eosin and Sirius red staining were used to assess the extent of hepatic injury and fibrosis.Flow cytometry was used to observe immune cell subsets.Results:We observed a declining trend in hepatic Lxrβ in the PSC model.Unexpectedly,Lxrβ knockout failed to modulate DDC-induced PSC pathogenesis.Concomitantly,assessment of the influence of Rag2 deficiency on PSC progression revealed the absence of aggravated or alleviated hepatic injury or fibrosis in the Rag2-/-DDC mice.However,Lxrβ depletion intensified DDC-induced PSC in the Rag2-/-mice,with more abundant infiltrative inflammatory cells and more severe liver fibrosis.Compared with Rag2-/-DDC mice,Lxrβ-/-Rag2-/-DDC mice had higher serum ALT and AST levels and mRNA expression of proinflammatory and profibrotic genes.Flow cytometry showed that LXR-β deficiency resulted in a diminished population of hepatic innate immune cells.Conclusion:This study indicated innate immune cell LXR-β deficiency can exacerbate hepatic injury and fibrosis in murine models of PSC suggesting that LXR-β may regulate the function of innate immunity in the fibrotic advancement of PSC.

Objective:To analyze the epidemiological characteristics of the population receiving assisted reproductive technology (ART) therapy and the health status of their offspring in Shanghai from 2011 to 2020.Methods:Based on the birth cohort of the entire population in Shanghai, the proportion and trend changes of ART offspring in the birth cohort were analyzed. The characteristics of ART and naturally conceived populations, including household registration, education level, maternal age, and reproductive history, were examined. Additionally, the health status between ART offspring and naturally conceived offspring were compared.Results:From 2011 to 2020, a total of 70 729 ART offspring were born in Shanghai, accounting for 3.69% of the total births. In 2020, this proportion reached 7.79%. The ART conception rate for primiparous women was higher than that for multiparous women, with both showing upward trends and reaching 9.87% and 2.36%, respectively, in 2020. The ART conception rate was higher in women with higher education levels and local household registration than in those with lower education levels and non-local household registration. The incidence rates of preterm birth and low birth weight in ART singleton offspring were 7.76% and 4.82%, respectively, higher than the 4.69% and 2.87% in naturally conceived offspring, but no increasing trend was observed in naturally conceived offspring. Among twin and multiple newborns, the incidence rates of preterm birth and low birth weight were 56.98% and 46.82% for ART, lower than the 58.51% and 51.32% for natural conception.Conclusions:The difference in social and demographic characteristics was obvious in population receiving ART, suggesting that the differed demand of some people for ART therapy, and it is necessary to strengthen the construction of public health services and further expand the coverage and accessibility of ART services. With technological advancements, the rates of preterm birth and low birth weight remain relatively stable, and even decrease in twin and multiple newborns.