ObjectiveTo investigate the effect of cerebellar intermittent theta-burst stimulation (iTBS) on postural control and fall risk in stroke patients. MethodsFrom October, 2024 to August, 2025, 45 stroke patients were recruited from Huadong Hospital Affiliated to Fudan University. They were randomly divided into control group (n = 15), group A (n = 15) and group B (n = 15). All the groups received conventional medication and rehabilitation. Group A was additionally administered iTBS over the ipsilesional primary motor cortex (M1), while group B received iTBS over the contralesional cerebellum, for three weeks. Before and after intervention, postural stability indexes (eyes open/closed), limits of stability, directional control score and reaction time were measured using Biodex Balance System, and they were assessed with Berg Balance Scale (BBS), Timed Up & Go Test (TUGT) and 10-meter walk test (10MWT). ResultsAfter intervention, significant group-time interaction effects were observed for eyes open/closed postural stability indexes, limits of stability, directional control score, reaction time, BBS score, TUGT and 10MWT (F > 23.487, P < 0.001). All the groups improved in all the indexes after intervention (P < 0.01). The eyes open/closed postural stability indexes, limits of stability, directional control score and reaction time were the best in group B, followed by group A, and the worst in the control group (P < 0.05), while BBS, TUGT and 10MWT were better in groups A and B than in the control group (P < 0.05). ConclusionCerebellar iTBS can effectively improve postural control disorders and reduce fall risk in stroke patients, and may be superior to M1 iTBS.

Sennoside A(SA),a typical prodrug,exerts its laxative effect only after its transformation into rhei-nanthrone catalyzed by gut microbial hydrolases and reductases.Hydrolases have been identified,but reductases remain unknown.By linking a photoreactive group to the SA scaffold,we synthesized a photoaffinity probe to covalently label SA reductases and identified SA reductases using activity-based protein profiling(ABPP).From lysates of an active strain,Bifidobacterium pseudocatenulatum(B.pseu-docatenulatum),397 proteins were enriched and subsequently identified using mass spectrometry(MS).Among these proteins,chromate reductase/nicotinamide adenine dinucleotide(NADH)phosphate(NADPH)-dependent flavin mononucleotide(FMN)reductase/oxygen-insensitive NADPH nitroreductase(nfrA)was identified as a potent SA reductase through further bioinformatic analysis and The Universal Protein Resource(UniProt)database screening.We also determined that recombinant nfrA could reduce SA.Our study contributes to further illuminating mechanisms of SA transformation to rheinanthrone and simultaneously offers an effective method to identify gut bacterial reductases.

AIM:Xiongshi Shiwei Wendan decoc-tion(SWD)comes from Xiong Jibai,a master of tra-ditional Chinese medicine,and has been widely used in the treatment of AS.ABCA1 is an important pathway for macrophages to export cholesterol and plays a protective role in the occurrence and development of AS.The purpose of this study was to study the effects of SWD on ABCA1 expression and cholesterol efflux through network pharmacol-ogy,molecular docking and in vitro experiments,and explore the pathway mechanism of promoting reverse cholesterol transport(RCT).METHODS:The active components of SWD drugs were screened by TCMSP and HERB databases,RCT targets were pre-dicted,the component-target network map was constructed,the PPI network was constructed and the GO and KEGG pathways were enriched and ana-lyzed by STRING database,and the key active com-ponents of SWD were selected for molecular dock-ing with ABCA1 protein and miR-33 by AutoDockVi-na.In vitro,RAW264.7 was used to establish foam cell model,oil red O staining,NBD-cholesterol staining and lentivirus overexpression cell miRNA-33 were used to study the effect of SWD on lipid accumulation and cholesterol outflow rate of RAW264.7 cells.Western blotting was used to de-tect the expression of ABCA1.RESULTS:According to network pharmacology,336 active components of SWD,267 targets of RCT and 46 targets of inter-section of RCT and SWD were obtained,which in-volved multiple signal pathways such as lipid and atherosclerosis.Molecular docking showed that the main active components had stable conforma-tion with ABCA1 and miR-33.In vitro experiment,it was found that the lipid content was significantly decreased(P＜0.01),the cholesterol outflow rate was significantly increased(P＜0.01)and the expres-sion of ABCA1 protein was up-regulated in SWD group(P＜0.01),but the expression of ABCA1 in miR-33 overexpression group was significantly de-creased(P＜0.01).CONCLUSION:SWD has the char-acteristics of multi-components and multi-targets,which can promote RCT and treat AS through miR-NA-33-ABCA1 pathway.

Objective To develop a risk prediction model for ischemic stroke in symptomatic intracranial atherosclerotic stenosis(ICAS)patients based on high-resolution magnetic resonance imaging(HR-MRI)and arterial spin labeling(ASL)imaging.Methods A total of 142 patients were included and divided into acute ischemic stroke(AIS)and transient ischemic attack(TIA)groups based on stroke occurrence.Clinical risk factors,plaque characteristics,and arterial transit artifact(ATA)presence on ASL images were compared between the two groups.Multivariate logistic regression analysis was performed,incorporating clinical risk factors,plaque characteristics,and double post labeling delay(PLD)ATA presence.The predictive value of different models was compared using receiver operating characteristic(ROC)curve and DeLong tests.Results Hypertension,positive lumen remodeling,plaque enhance-ment rate,1.5 s-ATA presence,and 2.5 s-ATA presence were independent risk factors for AIS(P＜0.05).The combination of HR-MRI and ASL imaging predicted AIS most effectively[area under the curve(AUC)=0.908;95％ confidence interval(CI)0.862-0.954].No significant difference was found between the prediction performances of HR-MRI and ASL(95％CI-0.041-0.082,Z=0.659,P=0.509).Conclusion ASL is more convenient than HR-MRI for predicting ischemic stroke in ICAS patients.A model combining plaque characteristics and ATA presence effectively predicts AIS occurrence.

Objective To investigate the protective effect of carvacrol(CAR)on high glucose(HG)-induced retinal ganglion cell(RGC)damage by regulating the protein kinase B(PKB,also known as Akt)/nuclear factor erythroid 2-relat-ed factor 2(Nrf2)signaling pathway.Methods The RGC-5 cells in the logarithmic growth phase were inoculated into 96-well cell culture plates with 4 × 104 cells/well and then treated with CAR(5.0 μmol·L-1,10.0 μmol·L-1,20.0 μmol·L-1,40.0 μmol·L-1,80.0 μmol·L-1,and 160.0 μmol·L-1)together with 30.0 mmol·L-1 glucose for 24 hours.Cell viability was detected by the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)assay to screen the ex-perimental concentration of CAR.Then,these RGC-5 cells were inoculated into 6-well plates and randomly assigned into the Control group,30.0 mmol·L-1 glucose(HG)group,low-,medium-,and high-concentration CAR groups(CAR-L group,CAR-M group,and CAR-H group),and high-concentration CAR+Nrf2 pathway inhibitor(ML385)group(CAR-H+ML385 group).Flow cytometry was used to detect the apoptosis of RGC-5 cells.The fluorescent probe was used to de-tect the level of oxidative stress in RGC-5 cells.The enzyme-linked immunosorbent assay(ELISA)was employed to detect the level of superoxide dismutase(SOD),lactate dehydrogenase(LDH),malondialdehyde(MDA),glutathione peroxidase(GSH-PX),and reactive oxygen species(ROS)in the supernatant of RGC-5 cells.Western blot was used to detect the ex-pression of proteins related to the Akt/Nrf2 signaling pathway.Results Compared with the HG group,the survival rate of RGC-5 cells increased significantly when the concentration of CAR was above 20.0 μmol·L-1(all P＜0.05).Therefore,20.0 μmol·L-1,40.0 μmol·L-1,and 80.0 μmol·L-1 of CAR were used for subsequent experiments.Compared with the Control group,the apoptosis rate of RGC-5 cells in the HG group increased significantly,the protein expression of Bax and Caspase-3 was up-regulated significantly,the level of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),ROS,LDH,and MDA increased significantly,and the level of SOD and GSH-PX decreased significantly(all P＜0.05).Compared with the HG group,the apoptosis rate of RGC-5 cells in the CAR-L,CAR-M,and CAR-H groups de-creased significantly,the protein expression of Bax and Caspase-3 was down-regulated significantly,the level of IL-1β,IL-6,TNF-α,ROS,LDH,and MDA decreased significantly,and the level of SOD and GSH-PX increased significantly(all P＜0.05).Compared with the CAR-H group,the apoptosis rate of RGC-5 cells in the CAR-H+ML385 group increased signifi-cantly,the protein expression of Bax and Caspase-3 was up-regulated significantly,the level of IL-1β,IL-6,TNF-α,ROS,LDH,and MDA increased significantly,and the level of GSH-PX and SOD decreased significantly(all P＜0.05).Compared with the Control group,the p-Akt/Akt expression ratio and the relative expression level of Nrf2 in RGC-5 cells decreased significantly in the HG group(both P＜0.05).Compared with the HG group,the p-Akt/Akt expression ratio and the rela-tive expression level of Nrf2 in RGC-5 cells increased significantly in the CAR-L,CAR-M,and CAR-H groups(all P＜0.05).Compared with the CAR-H group,the p-Akt/Akt expression ratio and the relative expression level of Nrf2 decreased signifi-cantly in the CAR-H+ML385 group(both P＜0.05).Conclusion CAR may reduce the inflammatory response level in RGC-5 cells by activating the Akt/Nrf2 signaling pathway,thus inhibiting oxidative stress-related injury and apoptosis.

Objective To investigate the current status of knowledge,attitude,and practice(KAP)re-garding the clinical application of graduated compression stockings(GCS)for preventing venous thromboem-bolism(VTE)among medical staff and analyze its influencing factors.Methods Through convenience sam-pling,5 706 medical staff from 85 hospitals in Chongqing were surveyed using the"Questionnaire on KAP of Clinical Application of GCS for VTE Prevention"between March 16 and 30,2024.Univariate and multiple lin-ear stepwise regression analyses were conducted to explore influencing factors.Results The scores for knowl-edge,attitude,and practice in the clinical application of GCS for VTE prevention among healthcare workers were(37.77±10.56),(16.85±3.05),and(24.85±7.51),respectively.Age,highest education level,seniori-ty,department,whether they had received GCS application training,hospital level,whether the hospital passed the national venous thrombosis prevention center certification,and GCS procurement channels were influen-cing factors for knowledge scores.Professional title,whether they had received GCS application training,hos-pital level,and whether the hospital passed the national venous thrombosis prevention center certification were influencing factors for attitude scores.Gender,age,highest education level,seniority,department,whether they had received GCS application training,hospital level,whether the hospital passed the national venous thrombo-sis prevention center certification,and GCS procurement channels were influencing factors for behavior scores.Conclusion Healthcare workers'knowledge of clinical application of GCS for VTE prevention is at a medium level,their attitude toward clinical application is positive,and practical behaviors are basically in compliance with standards.Hospital managers should emphasize training and assessment on clinical application of GCS for healthcare workers,strengthen quality control in practical implementation,and ensure patients receive stand-ardized mechanical VTE prevention.

Objective:To standardize the management of Investigator-Initiated Trials(IITs) and improve the quality of research projects, this study takes a tertiary hospital in Beijing as an example to analyze the key risk points in the implementation process of IITs and proposes countermeasures based on the issues identified during the management process.Methods:The study analyzed the IITs conducted at in the hospital from 2022 to 2023, focusing on 4 aspects: project classification evaluation and management (risk management), project implementation quality (process management), collaboration and support conditions(contract review and execution), and participant protection (medical ethics). It examined the key points and difficulties in project process management to standardize the quality management of IITs.Results:The implementation process management of IITs in medical institutions was an essential component for standardized clinical research management and an effective means to ensure the scientific nature of clinical research and the quality of data.Conclusions:Medical institutions should establish an effective and feasible IIT quality management system to comprehensively enhance the quality of IIT project, aiming to produce high-quality clinical research outcomes.

Objective:To analyze the impact of occupational health management assistance for small and micro enterprises in Suzhou on employers, exploring the assistance model for occupational health management in small and micro enterprises.Methods:From 2020 to 2022, a total of 318 small and micro enterprises with serious occupational disease hazards, weak occupational health management, and strong subjective improvement were selected as assistance objects annually by means of territorial recommendation and active registration of employers. The basic information of the enterprise and the status of occupational health management were obtained by means of questionnaire survey, archives review, workplace field investigation and occupational disease hazard factors detection. Pearson χ2 test was used to analyze the changes of occupational health management before and after helping enterprises. Results:The small and micro enterprises receiving assistance were mainly private enterprises (51.26%, 163/318) and limited liability companies (27.99%, 89/318). The occupational health training rates for enterprise leaders, management personnel, and workers increased from 77.36% (246/318), 82.08% (261/318) and 72.44% (4554/6287) before assistance to 90.57% (288/318), 95.28% (303/318) and 94.40% (5905/6255), the differences were statistically significant ( χ2=20.60, 27.63, 1092.67, all P<0.001). After the assistance, the distribution and wearing of personal protective equipment for workers, the detection of occupational hazard factors in the workplace and occupational health examination by enterprises increased by 3.34%, 18.39%, 13.21% and 15.10%, respectively. In terms of occupational health management, the comprehensive establishment rate of occupational health management system increased from 21.70% (69/318) before assistance to 64.47% (205/318). Compared with before assistance, the comprehensive notification rate/setting rate of warning signs and notification cards, labor contracts for occupational disease hazard positions, occupational health bulletin boards, and occupational health examination results were significantly increased after assistance ( χ2=120.08, 77.40, 149.18, 86.76, all P<0.001) . Conclusion:Suzhou adopts a model led by the health administrative department and supported by technical support from service institutions to assist small and micro enterprises, resulting in a significant improvement in the occupational health management level of small and micro enterprises.

Objective:To investigate the role of the Brock, Mayo, and PKUPH combined model in risk stratification of solitary pulmonary nodules (SPNs) in health check-up population.Methods:An ambispective cohort study was conducted on 668 eligible SPNs cases from the health management center in Chongqing General Hospital from June 2018 to June 2019. The exposure condition was prospectively followed or historically retrospected, and the clinical outcomes were prospectively followed. SPNs were classified into benign and malignant groups. Descriptive statistics and univariate analysis were performed to assess the differences in risk characteristics between two groups. Receiver operating characteristic (ROC) curve, clinical decision curve, and Hosmer-Lemeshow goodness-of-fit test were used to evaluate and compare the predictive performance, clinical utility, and calibration of the combined model versus individual Brock, Mayo, and PKUPH models.Results:Among the 668 SPNs cases, 82 (12.28%) were diagnosed as malignant. Age, sex, smoking history, extrapulmonary tumor history, diameter, upper lobe, clear border and spicule sign in the malignant group were significantly different from those in the benign group (all P<0.05). The combined model demonstrated superior predictive performance, clinical utility, and calibration compared to the best-performing individual Brock model [Area under the curve (AUC): 0.88 (95% CI: 0.84-0.92) vs 0.86 (95% CI: 0.82-0.91)]. Besides, multi-grade risk stratification enabled by the combined model was better than binary classification, with the malignant rate of the four risk levels were 0.60%, 4.62%, 14.58% and 56.07%, respectively. Conclusion:The combined model addresses the limitations of individual models in SPNs risk stratification for health examination populations, improving predictive performance, clinical utility, and calibration, while proposing a superior multi-grade risk stratification system.

Sj?gren syndrome(SS)is an immune disease mainly characterized by lymphocytes infiltrate in salivary and lacrimal glands,leading to glandular secretion disorders and dryness in the mouth and eyes.In recent years,clinical application of ultrasound elastography(USE)increased widespread,providing a new imaging method for diagnosis of SS.The research progresses of USE in SS were reviewed in this article.