1.A Systematic Strategy for Discovering First-in-class Anti-fibrotic Drugs from Traditional Chinese Medicine
Wen HUANG ; Guang XIN ; Sanyin ZHANG ; Tao WANG ; Wei CHEN ; Zeliang WEI ; Qilong ZHOU ; Ke LI ; Dan SUN ; Kui YU ; Shilin CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):296-307
Pulmonary fibrosis(PF) is a progressive and life-threatening disease with limited therapeutic options, highlighting the urgent need for innovative drug discovery strategies. To address this challenge, the authors propose the formula-originated rational intelligent screening&translation(FIRST), a systematic framework for developing anti-fibrotic monomers derived from classical traditional Chinese medicine(TCM). The strategy integrates three key dimensions, including tissue-oriented intelligent screening of active compounds, structural optimization based on drug-target spatial interactions and plant biosynthetic pathways, and cross-scale validation of drug. We further highlight its applications in discovering tissue-oriented novel drugs from clinically validated TCM, the development and mechanistic elucidation of anti-fibrotic therapeutics, as well as the clinical translation and secondary development of candidate drugs. This strategy paves the way for first-in-class, formula-derived monomeric drugs with defined structures, clarified mechanisms, and proven safety, offering a transformative avenue to meet the urgent therapeutic needs of PF and setting a new paradigm for TCM-based drug innovation.
2.A Systematic Strategy for Discovering First-in-class Anti-fibrotic Drugs from Traditional Chinese Medicine
Wen HUANG ; Guang XIN ; Sanyin ZHANG ; Tao WANG ; Wei CHEN ; Zeliang WEI ; Qilong ZHOU ; Ke LI ; Dan SUN ; Kui YU ; Shilin CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):296-307
Pulmonary fibrosis(PF) is a progressive and life-threatening disease with limited therapeutic options, highlighting the urgent need for innovative drug discovery strategies. To address this challenge, the authors propose the formula-originated rational intelligent screening&translation(FIRST), a systematic framework for developing anti-fibrotic monomers derived from classical traditional Chinese medicine(TCM). The strategy integrates three key dimensions, including tissue-oriented intelligent screening of active compounds, structural optimization based on drug-target spatial interactions and plant biosynthetic pathways, and cross-scale validation of drug. We further highlight its applications in discovering tissue-oriented novel drugs from clinically validated TCM, the development and mechanistic elucidation of anti-fibrotic therapeutics, as well as the clinical translation and secondary development of candidate drugs. This strategy paves the way for first-in-class, formula-derived monomeric drugs with defined structures, clarified mechanisms, and proven safety, offering a transformative avenue to meet the urgent therapeutic needs of PF and setting a new paradigm for TCM-based drug innovation.
3.Cross lagged analysis of association between problematic short video use and executive function among primary school students
WANG Wei, LIU Mengyu, HUANG Ke
Chinese Journal of School Health 2026;47(4):490-493
Objective:
To explore the association between problematic short video use (PSVU) and executive function among students in grades 3 to 6 of primary school, so as to provide references for intervening in primary school students PSVU.
Methods:
In September 2024 (T1), using a convenience sampling method, 520 students in grades 3 to 6 from a primary school in Xi an City of Shaanxi Province were selected as research subjects. They were followed up at three time points: T1, T2 (January 2025), and T3 (May 2025) using an adapted version of the Internet Addiction Test and Questionnaire of Executive Functioning of Chinese. Pearson correlation and cross lagged model were used to analyze the correlation between PSVU and executive function among primary school students at each time point.
Results:
The mean PSVU scores of primary school students at T1-T3 were (35.51±12.46, 34.86± 12.64 , 35.16±13.37) respectively, and the mean executive function scores were (68.31±12.95, 64.92±12.99, 66.58±14.13) respectively. Correlation analysis results indicated that PSVU scores and executive function scores were positively correlated in all three measurements ( r =0.26~0.62, all P <0.01). Cross lagged analysis results showed that executive function scores at T1 could positively predict PSVU scores at T2 ( β =0.21), and executive function scores at T2 could positively predict PSVU scores at T3 ( β = 0.20) (both P <0.01).
Conclusion
The level of executive function in students from grades 3 to 6 of primary school can unidirectionally predict the severity of their PSVU.
4.Effect of Changji'an Formula (肠激安方) on the miR-29b-3p/TRAF3/NF-κB/MLCK Axis in Colonic Tissues in Diarrhea-predominant Irritable Bowel Syndrome Model Rat with Liver Depression and Spleen Deficiency Syndrome
Yongfu WANG ; Wei KE ; Xiangyu XIE ; Hongmei TANG ; Liuze SI ; Yuna CHAI
Journal of Traditional Chinese Medicine 2026;67(4):439-446
ObjectiveTo explore the potential mechanism of Changji'an Formula (肠激安方) on intestinal permeability for rats with diarrhea-predominant irritable bowel syndrome (IBS-D) of liver depression and spleen deficiency syndrome by the microRNA-29b-3p (miR-29b-3p)/tumor necrosis factor receptor-associated factor 3 (TRAF3)/nuclear factor-κB (NF-κB)/myosin light chain kinase (MLCK) axis. MethodsTwenty-four 1-day-old male Sprague-Dawley (SD) suckling rats were selected, and the IBS-D rat model of liver depression and spleen deficiency syndrome was established via a three-factor method,i.e. maternal separation plus acetic acid stimulation and restraint stress, for 6 consecutive weeks. After successful modeling, the rats were randomly divided into a model group, pinaverium bromide group, low-dose and high-dose Changji'an Formula groups, with 6 rats in each group. Another 6 age-matched non-modeled SD rats were included as the control group. The low-dose and high-dose Changji'an Formula groups were given intragastric administration of Changji'an Formula solution at doses of 16.74 g/(kg·d) and 33.48 g/(kg·d), respectively; the pinaverium bromide group received intragastric administration of pinaverium bromide tablets at 0.018 g/(kg·d); and the control group was given distilled water at 10 ml/(kg·d) via intragastric gavage. The intervention was conducted once daily for 14 consecutive days. After the gavage treatment, the fecal water content of rats in each group was measured. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of intestinal permeability indicators, including D-lactic acid (D-LA), diamine oxidase (DAO), and lipopolysaccharide (LPS). Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to determine the mRNA expression levels of miR-29b-3p, TRAF3, tumor necrosis factor-α (TNF-α), p65, p50, and MLCK in colonic tissues. Western Blot analysis was employed to detect the protein expression levels of TRAF3, TNF-α, p65, phosphorylated p65 (p-p65), MLCK, myosin light chain (MLC), phosphorylated MLC (p-MLC), and tight junction proteins including junctional adhesion molecule-A (JAM-A), Occludin, and Claudin-1 in colonic tissues. ResultsCompared with the control group, the model group exhibited significantly increased fecal water content and serum levels of D-LA, DAO, and LPS, along with decreased protein expression levels of JAM-A, Occludin, and Claudin-1 in colonic tissues (P<0.05 or P<0.01). Additionally, in the model group, the mRNA expression levels of miR-29b-3p, TNF-α, p65, p50, and MLCK in colonic tissues were up-regulated, while the mRNA and protein expression levels of TRAF3 were down-regulated; the protein levels of TNF-α and MLCK, as well as the ratios of p-p65/p65 and p-MLC/MLC, significantly elevated (P<0.01). Compared with the model group, all treatment groups showed reduced fecal water content and serum levels of D-LA, DAO, and LPS, along with down-regulated mRNA expression levels of miR-29b-3p, TNF-α, p65, p50, and MLCK, and up-regulated TRAF3 mRNA expression in colonic tissues. Moreover, the pinaverium bromide group and high-dose Changji'an Formula group presented increased protein levels of Occludin, Claudin-1, and TRAF3, as well as decreased protein levels of TNF-α and MLCK, and reduced ratios of p-p65/p65 and p-MLC/MLC in colonic tissues (P<0.05 or P<0.01). Compared with the low-dose Changji'an Formula group, the high-dose group had lower fecal water content and serum levels of DAO and LPS (P<0.01). In comparison with the pinaverium bromide group, the high-dose Changji'an Formula group showed a significant decrease in serum DAO level (P<0.01). ConclusionsChangji'an Formula can reduce intestinal permeability and restore intestinal barrier function in IBS-D rats of liver depression and spleen deficiency syndrome by regulating the miR-29b-3p/TRAF3/NF-κB/MLCK axis.
5.The effect of body mass index and inferior pulmonary ligament division on the residual lung expansion after right upper lobectomy: A retrospective cohort study in a single center
Guang MU ; Wenhao ZHANG ; Hongchang WANG ; Yan GU ; Chenghao FU ; Wentao XUE ; Shiyuan XIE ; Tong WANG ; Ke WEI ; Yang XIA ; Liang CHEN ; Jun WANG
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(02):261-266
Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2<BMI≤23 kg/m2), a group B (23 kg/m2<BMI≤29 kg/m2) and a group C (BMI>29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of (59.7±11.2) years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.
6.Association between social jetlag and depressive symptoms among junior high school students in Chongqing
WAN Xiaoke, WEI Ke, WANG Zhouyan, CHEN Gen, PENG Chang, WANG Hong
Chinese Journal of School Health 2026;47(1):55-59
Objective:
To explore the relationship between social jetlag and depressive symptoms in junior high school students, as well as the potential gender differences, so as to provide a reference for developing effective interventions for depressive symptoms and promoting adolescents mental health.
Methods:
In October 2024, a total of 3 516 students from grades 7 to 9 were recruited from 4 junior high schools in Chongqing Municipality using a combination of cluster sampling and convenience sampling. A questionnaire survey was conducted using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Munich Chronotype Questionnaire (MCTQ). Statistical analyses included the χ 2 test, binary Logistic regression analysis, and stratified Logistic regression analysis.
Results:
The detection rate of depressive symptoms among the junior high school students was 34.3%. The number of students with social jetlag >2 h was 714 (20.3%), >1-2 h was 1 455(41.4%), and ≤1 h was 1 347(38.3%). Results from the binary Logistic regression analysis showed that compared to the group with social jetlag ≤1 h, the risk of depressive symptoms in the group with social jetlag >2 h was higher ( OR=1.59, 95%CI=1.28-1.98, P <0.01). Gender stratified analysis revealed that among females, the risk of depressive symptoms was higher in the groups with social jetlag of >1-2 h and >2 h compared to the ≤1 h group ( OR = 1.34 and 2.05, 95% CI =1.03-1.75 and 1.48-2.83, both P <0.05). However, among males, the associations were not statistically significant ( OR =1.11 and 1.29, 95% CI =0.86-1.43 and 0.95-1.77, both P >0.05).
Conclusions
Social jetlag is positively associated with depressive symptoms in junior high school students, demonstrating a threshold effect and gender differences. The findings suggest that reducing social jetlag may decrease the risk of depressive symptoms in adolescents, and targeted intervention measures should be developed considering different gender characteristics.
7.The Diversity of Filamentous Morphologies and Magnetic Sensitivity Modulated by Diverse MagR Expression in Bacteria
Ya-Fei CHANG ; Jing ZHANG ; Peng ZHANG ; Xiu-Juan ZHOU ; Meng-Ke WEI ; Tian-Tian CAI ; Pei-Qi HE ; Jun-Feng WANG ; Can XIE
Progress in Biochemistry and Biophysics 2026;53(5):1439-1456
Objective Magnetoreception, the remarkable ability of diverse animals to sense and utilize the geomagnetic field for orientation and navigation, remains a molecularly unresolved mystery in sensory biology. The putative magnetoreceptor (MagR, previously known as IscA1) is a highly conserved iron-sulfur protein implicated in both magnetoreception and iron metabolism; however, the functional diversity among its cross-species homologs remains poorly understood. Cellular morphology is a key genetically determined trait that can be altered through genetic or environmental modifications—a process known as cell morphology engineering. Constructing engineered cells with specific morphological features and magnetic sensitivity to achieve remote, non-invasive magnetic modulation represents a crucial goal in this field with significant application potential. Therefore, this study aims to systematically investigate the effects of MagR heterologous expression on bacterial morphology and magnetic sensing capabilities, screen for MagR-based magnetically sensitive morphology engineering pathways, and reveal the underlying molecular mechanisms. Methods We systematically screened 28 MagR homologous genes from diverse prokaryotic and animal taxa to evaluate their expression and corresponding phenotypic effects in Escherichia coli (E. coli). To compare the differential magnetic responses among bacteria expressing various recombinant MagR proteins, we utilized high-throughput automated bright-field microscopic imaging and scanning electron microscopy (SEM). Furthermore, comprehensive biochemical and biophysical characterizations of iron and iron-sulfur cluster binding were performed using Ferrozine colorimetric assays, electron paramagnetic resonance (EPR) spectroscopy, ultraviolet-visible (UV-Vis) absorption, and circular dichroism (CD) spectroscopy. Additionally, 100 mT static magnetic field (SMF) exposure experiments were conducted to assess magnetically tunable phenotypes, while the intrinsic magnetic properties of purified MagR proteins were directly measured using a superconducting quantum interference device (SQUID) magnetometer. Results Our results demonstrated that the heterologous expression of MagR homologs induced varying degrees of bacterial filamentation. From this comprehensive screen, two distinct morphological patterns were identified: hydra (Hydra vulgaris) MagR (hyMagR) promoted uniform cell elongation and filamentation, exhibiting robust magnetic sensitivity manifested as significantly enhanced filamentation under the 100 mT SMF. In contrast, pigeon (Columba livia) MagR (clMagR) induced only low-frequency, extreme filamentation (sporadically exceeding 80 μm) with a relatively weaker magnetic morphological response. Mechanistically, our data unambiguously proved that these phenotypic differences are primarily driven by distinct iron redox preferences rather than total cellular iron accumulation. Specifically, hyMagR preferentially binds ferrous iron (Fe2+), whereas clMagR favors ferric iron (Fe3+) and forms more stable iron-sulfur clusters. Intriguingly, although SQUID magnetometry showed that purified clMagR exhibited approximately five-fold higher mass magnetic susceptibility than hyMagR, its cellular magnetic response was weaker. We hypothesize that the Fe2+-preferred intracellular environment associated with hyMagR overexpression primes the cell for enhanced generation of reactive oxygen species (ROS) via the Fenton reaction. Exposure to an SMF synergizes with this primed redox state, triggering the bacterial SOS response and upregulating cell division inhibitors to efficiently induce uniform filamentation. Conclusion Our findings identify the Fe2+/Fe3+ redox state as a critical determinant of MagR-mediated morphological remodeling and magnetic responsiveness. This discovery suggests a potential strategy for engineering magnetically responsive cellular systems for synthetic biology applications, and provides a plausible framework, which potentially combines intrinsic protein magnetism with redox-state modulation, for further investigating the evolutionary mechanisms of MagR-mediated magnetoreception.
8.The Diversity of Filamentous Morphologies and Magnetic Sensitivity Modulated by Diverse MagR Expression in Bacteria
Ya-Fei CHANG ; Jing ZHANG ; Peng ZHANG ; Xiu-Juan ZHOU ; Meng-Ke WEI ; Tian-Tian CAI ; Pei-Qi HE ; Jun-Feng WANG ; Can XIE
Progress in Biochemistry and Biophysics 2026;53(5):1439-1456
Objective Magnetoreception, the remarkable ability of diverse animals to sense and utilize the geomagnetic field for orientation and navigation, remains a molecularly unresolved mystery in sensory biology. The putative magnetoreceptor (MagR, previously known as IscA1) is a highly conserved iron-sulfur protein implicated in both magnetoreception and iron metabolism; however, the functional diversity among its cross-species homologs remains poorly understood. Cellular morphology is a key genetically determined trait that can be altered through genetic or environmental modifications—a process known as cell morphology engineering. Constructing engineered cells with specific morphological features and magnetic sensitivity to achieve remote, non-invasive magnetic modulation represents a crucial goal in this field with significant application potential. Therefore, this study aims to systematically investigate the effects of MagR heterologous expression on bacterial morphology and magnetic sensing capabilities, screen for MagR-based magnetically sensitive morphology engineering pathways, and reveal the underlying molecular mechanisms. Methods We systematically screened 28 MagR homologous genes from diverse prokaryotic and animal taxa to evaluate their expression and corresponding phenotypic effects in Escherichia coli (E. coli). To compare the differential magnetic responses among bacteria expressing various recombinant MagR proteins, we utilized high-throughput automated bright-field microscopic imaging and scanning electron microscopy (SEM). Furthermore, comprehensive biochemical and biophysical characterizations of iron and iron-sulfur cluster binding were performed using Ferrozine colorimetric assays, electron paramagnetic resonance (EPR) spectroscopy, ultraviolet-visible (UV-Vis) absorption, and circular dichroism (CD) spectroscopy. Additionally, 100 mT static magnetic field (SMF) exposure experiments were conducted to assess magnetically tunable phenotypes, while the intrinsic magnetic properties of purified MagR proteins were directly measured using a superconducting quantum interference device (SQUID) magnetometer. Results Our results demonstrated that the heterologous expression of MagR homologs induced varying degrees of bacterial filamentation. From this comprehensive screen, two distinct morphological patterns were identified: hydra (Hydra vulgaris) MagR (hyMagR) promoted uniform cell elongation and filamentation, exhibiting robust magnetic sensitivity manifested as significantly enhanced filamentation under the 100 mT SMF. In contrast, pigeon (Columba livia) MagR (clMagR) induced only low-frequency, extreme filamentation (sporadically exceeding 80 μm) with a relatively weaker magnetic morphological response. Mechanistically, our data unambiguously proved that these phenotypic differences are primarily driven by distinct iron redox preferences rather than total cellular iron accumulation. Specifically, hyMagR preferentially binds ferrous iron (Fe2+), whereas clMagR favors ferric iron (Fe3+) and forms more stable iron-sulfur clusters. Intriguingly, although SQUID magnetometry showed that purified clMagR exhibited approximately five-fold higher mass magnetic susceptibility than hyMagR, its cellular magnetic response was weaker. We hypothesize that the Fe2+-preferred intracellular environment associated with hyMagR overexpression primes the cell for enhanced generation of reactive oxygen species (ROS) via the Fenton reaction. Exposure to an SMF synergizes with this primed redox state, triggering the bacterial SOS response and upregulating cell division inhibitors to efficiently induce uniform filamentation. Conclusion Our findings identify the Fe2+/Fe3+ redox state as a critical determinant of MagR-mediated morphological remodeling and magnetic responsiveness. This discovery suggests a potential strategy for engineering magnetically responsive cellular systems for synthetic biology applications, and provides a plausible framework, which potentially combines intrinsic protein magnetism with redox-state modulation, for further investigating the evolutionary mechanisms of MagR-mediated magnetoreception.
9.The mediating role of cognitive flexibility between non-suicidal self-injury and suicide attempts in adolescents with depression
Lijun WANG ; Chengqian JIN ; Wei JIN ; Meizhi ZHENG ; Guanmei ZHAO ; Shiyu SUN ; Yuan LI ; Ke ZHAO
Chinese Journal of Nervous and Mental Diseases 2025;51(5):280-285
Objective This study aims to explore the association between non-suicidal self-injury(NSSI)and suicide attempts(SA)in adolescents and the mediating effect of cognitive flexibility.Methods A total of 218 depression patients with NSSI who met the Diagnostic and Statistical Manual of Mental Disorders,5th Edition(DSM-5)diagnostic criteria for NSSI were enrolled.Patients were divided into SA group(n=105)and non-SA group(n=113)according to the presence or absence of SA in the last one year.The adolescent non-suicidal self-injury assessment questionnaire(ANSAQ)and the Wisconsin card sorting tests(WCST)was used to assess the frequency of NSSI and cognitive flexibility,respectively.A mediation model was constructed to conduct path analysis,and the product distribution method was utilized to test the mediation effect.Results The difference between SA group and non-SA group in NSSI(20.1±10.7 vs.14.7±9.1)and WCST scores[correct responses percentage(67.3%±14.2%vs.72.9%±12.2%),error responses(39.8±20.3 vs.31.6±17.9),perseverative response(6.7±3.8 vs.5.3±2.9),and non-perseverative errors(37.6±21.0 vs.28.9±18.1)]were significant(P<0.05).Dichotomous logistic regression analysis showed that the frequency of NSSI(OR=1.051,95%CI:1.021-1.082)and the score of perseverative response(OR=1.100,95%CI:1.008-1.199)were significantly associated with suicidal behavior among adolescents with NSSI(P<0.05).Moreover,perseverative response partially mediated the association between NSSI and SA(95%CI of Za×Zb:0.0003-0.0168).Conclusion High NSSI and low cognitive flexibility are risk factors for suicide attempts in NSSI adolescents and NSSI may also affect SA indirectly by lowering cognitive flexibility.
10.Analysis of the influencing factors of early neurological deterioration and short-term prognosis in minor acute ischemic stroke patients
Longsheng CHU ; Xianjun HUANG ; Chenglei WANG ; Bohao WEI ; Yuepei GAO ; Ameng LI ; Ke YANG ; Junfeng XU ; Xianjin SHANG ; Zhiming ZHOU
Chinese Journal of Cerebrovascular Diseases 2025;22(8):524-536
Objective To investigate the influencing factors associated with early neurological deterioration(END)in patients with minor acute ischemic stroke(mAIS),develop a clinical prediction model for END,and identify independent risk factors for 90-day neurological functional outcomes after stroke.Methods mAIS patients admitted consecutively to the Department of Neurology,Yijishan Hospital of Wannan Medical College(the First Affiliated Hospital of Wannan Medical College),from July 2023 to July 2024 were retrospectively collected.A minor ischemic stroke was defined as acute ischemic stroke with a National Institutes of Health stroke scale(NIHSS)score≤5 on admission.Baseline,clinical,and imaging data of all mAIS patients were collected and recorded,including demographic information(age,sex),past medical history(hypertension,diabetes mellitus,hyperlipidemia,coronary heart disease,atrial fibrillation),smoking history,alcohol consumption,baseline blood pressure,pre-onset modified Rankin scale(mRS),NIHSS scores at admission and during hospitalization(24 hours,48 hours,72 hours after admission),motor component subscore of the NIHSS scores,NIHSS scores at discharge,trial of Org 10172 in acute stroke treatment(TOAST)classification,laboratory indicators(fasting blood glucose,hemoglobin A1c[HbA1c],total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein),clinical treatment information(intravenous thrombolysis,mono antiplatelet therapy,dual antiplatelet therapy,anticoagulation therapy)and length of stay.The status of stenosis and occlusion in the culprit vessel were assessed based on imaging results.Mild-to-moderate stenosis was defined as a stenosis rate of 0%to 69%,severe stenosis as a stenosis rate of 70%to 99%,and occlusion as complete interruption of the supplying artery.END was defined as an increase in NIHSS score of ≥2 points from baseline within 72 hours after admission,combined with an increase of at least 1 point in the motor score compared to the score at admission.Prognosis was assessed via telephone follow-ups at 90-day after onset using mRS score,with an mRS score ≤ 2 indicating a favorable outcome and an mRS score>2 indicating a poor outcome.Variables with P<0.05 in the univariate analysis were incorporated into multivariate Logistic regression analysis to identify the independent risk factors for END in mAIS patients.A nomogram model was constructed,and calibration curves along with decision curve analysis were plotted to evaluate the model's goodness-of-fit and clinical utility.Univariate and multivariate Logistic regression analyses were performed to identify factors associated with poor 90-day functional outcome after mAIS.Results(1)A total of 826 patients were included,aged 33-94 years,with a median age of 67(57,76)years.There were 571 males and 255 females.The NIHSS score at admission ranged from 0 to 5,with a median NIHSS score at admission of 3(2,4).The NIHSS motor subscore at admission ranged from 0 to 5,with a median baseline NIHSS motor score of 2(0,2).Among them,119 patients(14.4%)were in the END group and 707 patients(85.6%)were included in the non-END group.At 90days after stroke,744 patients(90.1%)had a favorable outcome,while 82 patients(9.9%)had a poor outcome.(2)Univariate analysis showed that there were statistically significant differences between the END group and the non-END group in terms of HbA1c,fasting blood glucose,baseline NIHSS score,baseline NIHSS motor subscore,history of alcohol consumption,diabetes mellitus,culprit vessel stenosis and occlusion,and TOAST classification(all P<0.05).Statistically significant differences were observed between the favorable outcome group and the poor outcome group in HbA1c,fasting blood glucose,incidence of END,baseline NIHSS score,discharge NIHSS score,culprit vessel stenosis and occlusion,TOAST classification,and history of alcohol consumption(all P<0.05).(3)Multivariate Logistic regression analysis indicated that mAIS patients with severe stenosis of the culprit vessel(OR,5.88,95%CI2.32-14.91,P<0.01),occlusion of the culprit vessel(OR,5.74,95%CI 2.25-14.62,P<0.01),history of alcohol consumption(OR,5.59,95%CI3.41-9.17,P<0.01),elevated HbA1c(OR,1.67,95%CI 1.35-2.08,P<0.01),and higher baseline NIHSS motor score(OR,1.43,95%CI 1.08-1.89,P=0.012)had an increased risk of END.A higher discharge NIHSS score(OR,2.59,95%CI 1.89-3.57,P<0.01)and the occurrence of END(OR,18.42,95%CI 5.13-66.18,P<0.01)were associated with poor 90-day functional outcome after mAIS.(4)The nomogram model constructed based on independent risk factors of END in mAIS patients demonstrated an AUC of 0.78(95%CI 0.73-0.83)for predicting END,with a sensitivity of 0.8 and a specificity of 0.7.The model showed good calibration,and the Hosmer-Lemeshow test indicated good agreement between predicted and observed values(P=0.333).Decision curve analysis revealed that the model provided a high net benefit across a range of high-risk thresholds(0.1-0.7),suggesting its potential clinical utility.Conclusions Severe stenosis of the culprit vessel,occlusion of the culprit vessel,glycated hemoglobin levels,baseline NIHSS motor subscale scores,and history of alcohol consumption are independent risk factors for END in patients with mAIS.The nomogram model constructed based on these factors demonstrated good predictive performance.END and NIHSS scores at discharge are independent predictors of poor 90-day outcomes in patients with mAIS.


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