ObjectiveTo investigate the possible mechanism by which Zhiqiao Gancao Decoction （枳壳甘草汤， ZGD） delays intervertebral disc degeneration （IDD） based on the Hippo-yes-associated protein （YAP）/transcriptional co-activator with PDZ-binding motif （TAZ） signaling pathway. MethodsA total of 50 SD rats were randomly divided into sham surgery group， model group， low-dose ZGD group， high-dose ZGD group， and high-dose ZGD + inhibitor group， with 10 rats in each group. In the sham surgery group， the rats were pierced in the skin and muscle at the Co6/7/8 segments of the tail with a 21G needle （depth approximately 2 mm） without damaging the intervertebral disc. In the other groups， rats were injected with a 21G needle at the Co6/7/8 segments of the tail to establish an IDD model by piercing the tail intervertebral disc 5 mm. One week after modeling， rats in the low-dose and high-dose ZGD groups were given 6.24 and 12.24 g/（kg·d） of the decoction via gastric gavage， respectively. The high-dose ZGD + inhibitor group was given 12.24 g/（kg·d） of the decoction and an intraperitoneal injection of YAP/TAZ inhibitor Verteporfin 10 mg/kg. The sham surgery and model groups were given 5 ml/（kg·d） of normal saline via gavage. The gavage was given once a day， and the intraperitoneal injection was given every other day. After 4 weeks of continuous intervention， the pathological changes of the tail intervertebral discs were observed using HE staining， Oil Red O-Green staining， and Toluidine Blue staining. Immunohistochemistry was used to detect the expression of aggrecan and MMP3 in the nucleus pulposus. TUNEL fluorescence staining was performed to detect apoptosis in the nucleus pulposus， and the apoptosis rate was calculated. Western blot was used to detect the Hippo-YAP/TAZ signaling pathway， including YAP， phosphorylated YAP （p-YAP）， phosphorylated MST1/2 （p-MST1/2）， phosphorylated TAZ （p-TAZ） and apoptosis-related proteins， such as Cleaved Caspase 3， P53， Bcl-2 and Bax. ResultsCompared with sham surgery group， the rats in the model group showed significant degenerative changes in the intervertebral disc. The levels of aggrecan， Bcl-2， and YAP proteins in the nucleus pulposus decreased， while the levels of p-MST1/2， p-YAP， p-TAZ， P53， Bax， Cleaved Caspase 3， MMP3 proteins， and the apoptosis rate increased （P < 0.01）. Compared with the model group， the drug intervention groups showed partial recovery in intervertebral disc degeneration. The levels of aggrecan， Bcl-2， and YAP proteins increased， while the levels of p-MST1/2， p-YAP， p-TAZ， P53， Bax， Cleaved Caspase 3， MMP3 proteins， and the apoptosis rate decreased （P＜0.05 or P＜0.01）. The high-dose ZGD group showed more significant recovery in intervertebral disc degeneration compared to the low-dose ZGD group， with a decrease in the levels of p-MST1/2， p-YAP， p-TAZ， P53， Bax， Cleaved Caspase 3， MMP3 proteins， and apoptosis rate， and an increase in the levels of aggrecan， Bcl-2， and YAP proteins （P＜0.05 or P＜0.01）. Compared with the high-dose ZGD group， the high-dose ZGD + inhibitor group showed a reduced recovery in intervertebral disc degeneration， with an increase in the levels of p-MST1/2， p-YAP， p-TAZ， P53， Bax， Cleaved Caspase 3， MMP3 proteins， and apoptosis rate， and a decrease in the levels of aggrecan， Bcl-2， and YAP proteins （P＜0.05 or P＜0.01）. ConclusionZGD may delay intervertebral disc degeneration by inhibiting the phosphorylation of YAP in the nucleus pulposus， maintaining the function of the Hippo-YAP/TAZ signaling pathway， and reducing apoptosis of nucleus pulposus cells.

Fungal keratitis represents a significant cause of blindness, with current therapeutic approaches yielding limited success. The disease's onset and progression are primarily driven by fungal virulence factors and the host's immune response. The innate immune system is the first to respond, with neutrophils playing a pivotal role in the antifungal defense. Although neutrophils are critical for pathogen clearance, their excessive or abnormal activation can lead to tissue damage, exacerbating the disease. Thus, elucidating the mechanisms underlying neutrophil activity in fungal keratitis is crucial for refining treatment strategies. This article aims to systematically review the principal antimicrobial mechanisms employed by neutrophils, including phagocytosis, degranulation, and the formation of neutrophil extracellular traps(NETs). Furthermore, it explores the crosstalk between neutrophils and macrophages, alongside their collective impact and underlying mechanisms in the context of fungal keratitis. Exploration of the mechanisms of fungal keratitis facilitates precise intervention and enhances the efficacy of treatment.

Objective To revise Guidelines for Diagnosis and Treatment of Commom Diseases of Pediatrics in Traditional Chinese Medicine·Recurrent Respiratory Tract Infections in Children through the Delphi method-based expert questionnaire survey.Methods Bsaed on a comprehensive literature review,the expert questionnaire was developed for the 2024 Edition of the guidelines.Using the Delphi method,the questionnaire was distributed in three rounds to gather expert opinions.Statistical analyses were conducted on expert positivity coefficients and consensus levels,evaluated by expert familiarity,the concentration of expert opinions,and their degree of coordination.Results After three rounds of consultation,consensus was achieved among experts regarding the terminology and definitions,diagnosis,syndrome differentiation,treatment,prevention and health related to recurrent respiratory tract infections in children.This led to the formulation of a draft version of the 2024 Edition of the guidelines for further consultation.Conclusion The participating experts were geographically diverse,held senior titles,and possessed extensive clinical experience,ensuring the credibility of the findings.Their high level of engagement throughout the survey process indicates strong motivation.The content of the expert questionnaire of the Guidelines for the Diagnosis and Treatment of Traditional Chinese Medicine in Children with Recurrent Respiratory Tract Infections in Children(2024 Edition)objectively reflects the core perspectives of the experts,and the results are authentic and reliable,providing a solid foundation for the development of the guidelines.

Objective:To establish a prognostic model based on endoplasmic reticulum stress-related genes for evaluating the prognosis of patients with renal cell carcinoma.Methods:This study utilized Non-negative Matrix Factorization to identify molecular subgroups based on endoplasmic reticulum stress-related genes and employed Weighted Correlation Network Analysis to determine co-expressed genes associ-ated with these subgroups.A risk prognostic model was constructed using univariate Cox regression analysis and Lasso regression analysis.Preliminary experimental validations were conducted to elucidate the biological functions of model genes in renal cell carcinoma.Results:Two molecular subgroups with distinct survival prognoses were identified,and an intersection of related genes was used to construct a nov-el endoplasmic reticulum stress-related prognostic model.Patients in the high-risk group exhibited significantly poorer overall survival in both the training and validation cohorts.In vivo experiments demonstrated that PCK1,a model gene,could inhibit the proliferation,migra-tion,and invasion of renal cell carcinoma cells.Conclusions:The risk scoring model developed in this study effectively predicts the survival probability of renal cell carcinoma patients and can serve as an independent prognostic indicator.This model offers a new direction for per-sonalized treatment strategies in renal cell carcinoma patients.

Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Objective:This study aims to investigate the therapeutic efficacy of staged endoscopic surgery for Shin-Ⅲ stage external auditory canal cholesteatoma. Methods:A retrospective analysis was conducted on the clinical data of 25 patients diagnosed with Shin-Ⅲ cholesteatoma of the external auditory canal, who were admitted to the Otology Center of the First People's Hospital of Foshan City from May 2020 to October 2024. All patients initially underwent endoscopic cholesteatoma removal. Based on the outcomes of the first-stage postoperative follow-up, patients were categorized into two groups: the repair type and the non-repair type. The non-repair type was further subdivided into simple and complex types. Of the total cases, 10 patients were of the repair type, with 9 requiring no further surgical intervention. The non-repair type comprised 15 patients, of which 8 were classified as simple type and underwent either tympanoplasty type Ⅰ or external auditory canal wall reconstruction during the second stage. The remaining 7 patients, identified as complex type, received open mastoidectomy or tympanotomy in the second stage, with or without ossicular chain reconstruction. Results:All patients were monitored for a minimum of six months postoperatively. The incidence of dry ear was observed in 22 patients, corresponding to a dry ear rate of 88.0%. Four cases experienced primary complications. Conclusion:Endoscopic phased operation for managing Shin-Ⅲ stage cholesteatoma of the external auditory canal can ensure that the surgical options match the severity of the lesions, reducing unnecessary surgical trauma and achieving good efficacy.
Humans ; Retrospective Studies ; Ear Canal/surgery* ; Endoscopy/methods* ; Cholesteatoma/surgery* ; Male ; Tympanoplasty ; Female ; Treatment Outcome ; Adult ; Middle Aged ; Cholesteatoma, Middle Ear/surgery* ; Mastoidectomy

In recent years, machine learning and its subset, deep learning, have made significant progress in medical image analysis. Magnetic resonance imaging (MRI) technology has become a critical tool for the diagnosis of autism spectrum disorder (ASD) by providing high-resolution data of brain structure and function. In this review, the characteristics of ASD in MRI were summarized, ASD-related MRI datasets and preprocessing methods were discussed, MRI feature selection and extraction techniques of ASD were examined, machine learning-based diagnostic approaches and their interpretablility were evaluated, and future research directions were proposed.

Postoperative stress symptoms are caused by surgical trauma,and now still lack active intervention methods to promote the recovery of body function in the field of western medicine.Professor Cai Bingqin analyzed the etiology and pathogenesis of stress symptoms after abdominal surgery,which usually manifested as abnormal sweating,sleep disorders,emotional disorders,and gastrointestinal dysfunction,and then put forward the concept of postoperative stress syndrome for the perioperative period.Professor Cai Bingqin believes that surgical stimulation,as the important etiological factor responsible for postoperative stress symptoms,can cause excessive stress in the body,which results in a series of symptoms affecting the recovery of patients.Liver plays a defensive and adaptive role in postoperative stress by regulating qi movement,blood circulation and emotions.The symptoms of abnormal sweating,sleep disorders and emotional disorders are related with the function of the liver in governing emotions,housing the ethereal soul,and ensuring the free movement of qi,while the gastrointestinal dysfunction manifestations of poor appetite,abdominal distention and constipation are due to the disharmony of liver and spleen.For the treatment of postoperative stress syndrome,Professor Cai proposes the principle of treating disease from the perspective of liver,and the methods of soothing liver and alleviating depression,and warming and activating qi movement are adopted.Sini San(Sini Powder for Soothing Liver and Regulating Qi)is commonly used as the basic prescription to ensure the normal function of liver and to ensure the free movement of qi,and then the harmony of qi and blood and the unobstruction of blood vessels will be achieved.Additionally,the assistance of therapy for invigorating spleen to dissolve dampness,and replenishing qi to consolidate superficies can adjust zang-fu organs'dysfunction,and will restore the balance of qi-blood and yin-yang.The proposal of"postoperative stress syndrome"will provide an approach to the management of perioperative period with traditional Chinese medicine,and will become the beneficial supplement to the existing fast-track surgery system.

OBJECTIVE To explore the effect and mechanism of Zhiqiao gancao decoction （ZQGCD） on pathological angiogenesis of degenerative intervertebral disc. METHODS The rats were randomly divided into sham operation group （normal saline）， model group （normal saline）， hypoxia inducible factor-1α （HIF-1α） inhibitor （YC-1） group [2 mg/（kg·d）， tail vein injection]， and ZQGCD low-dose， medium-dose and high-dose groups [3.06， 6.12， 12.24 g/（kg·d）]， with 8 rats in each group. Except for sham operation group， lumbar disc degeneration model of rat was constructed in all other groups. After modeling， they were given relevant medicine once a day， for consecutive 3 weeks. After the last medication， pathological changes and angiogenesis of the intervertebral disc tissue in rats were observed； the levels of inflammatory factors [interleukin-1β （IL-1β）， IL-6， tumor necrosis factor-α （TNF-α）] and the expressions of angiogenesis-related proteins [HIF-1α， vascular endothelial growth factor （VEGF）， VEGF receptor 2 （VEGFR2）， angiotensin 1（Ang 1）， Ang 2] in the com intervertebral disc tissue in rats were all determined. In cell experiment， the primary nucleus pulposus cells were isolated and cultured from rats， and cellular degeneration was induced using 50 ng/mL TNF-α. The cells were divided into blank control group （10% blank control serum）， TNF-α group （10% blank control serum）， YC-1 group （10% blank control serum+0.2 mmol/L YC-1）， and 5%， 10%， 15% drug-containing serum group （5%， 10%， 15% drug-containing serum）. After 24 hours of intervention， the nucleus pulposus cells were co-cultured with HUVEC. The expressions of Collagen Ⅱ， matrix metalloproteinase-3 （MMP-3） in nucleus pulposus cells were detected. HUVEC proliferation， migration and tube forming ability were detected， and the expression levels of the HIF-1α/VEGF/Ang signal axis and angiogenesis- related proteins （add MMP-2， MMP-9） in HUVEC were detected. RESULTS Animal experiments had shown that compared with model group， the positive expression of CD31 in the intervertebral disc tissues of rats in each drug group was down-regulated （P＜ 0.05）， the levels of inflammatory factors and angiogenesis-related proteins were decreased significantly （P＜0.05）， and the pathological changes in the intervertebral disc were alleviated. Cell experiments had shown that compared with TNF-α group， the expression of Collagen Ⅱ in nucleus pulposus cells of all drug groups was significantly up-regulated （P＜0.05）， and the expression of MMP-3 was significantly down-regulated （P＜0.05）； the proliferation， migration and tubulogenesis of HUVEC were significantly weakened （P＜0.05）. The mRNA and protein expressions of HIF-1α， VEGF， Ang 2 as well as the expression of angiogenesis-related proteins （except for the expression of Ang 2 mRNA and HIF-1α， VEGFR2， Ang 2 protein in 5% drug- containing serum group） were significantly down-regulated （P＜0.05）. CONCLUSIONS ZQGCD may inhibit the HIF-1α/VEGF/ Ang signal axis to weaken the angiogenic ability of vascular endothelial cells， improve pathological angiogenesis in the intervertebral disc， and delay the degeneration of the intervertebral disc.

This article briefly introduces the new concept of burnout and the new burnout assessment tool BAT. In the past, the most famous burnout definition was proposed by Maslach and Leiter. The Maslach Burnout Inventory (MBI) developed by Maslach has also been the gold standard for evaluating burnout. With the development of burnout research, the concept of burnout has a certain defect. MBI has also been criticized in conceptual, practical and psychological measurement. It may hinder new research, and urgently needs to improve the concept and evaluation of burnout. Therefore, Schaufeli redefined the concept of burnout, and developed a new burnout assessment tool for groups and individuals based on the new concept of burnout-Burnout Assessment Tool (BAT) . This paper systematically reviews the proposal of the new concept of burnout, the development of the BAT scale and its application at home and abroad, and analyzes the advantages and application prospects of the BAT scale.