To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

Objective:To systematically review the risk prediction models for postoperative pulmonary infection in elderly patients with hip fractures.Methods:PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Database and VIP Database were systematically searched to collect literature on the risk prediction models for postoperative pulmonary infection in elderly patients with hip fractures from inception to June 30, 2024. The languages were limited to Chinese and English. Two researchers screened the literature according to the inclusion and exclusion criteria. Data extraction was performed using the checklist for critical appraisal and data extraction for systematic reviews of prediction modeling studies (CHARMS), encompassing basic study characteristics, model development features, and model performance metrics. The predictors, validation methods, presentation formats, and predictive performance of the risk prediction models for postoperative pulmonary infection in elderly patients with hip fractures were evaluated. The prediction model risk-of-bias assessment tool (PROBAST) was employed to assess risk of bias and applicability of the included studies.Results:A total of 11 studies, comprising of 16 prediction models, were included, with a total sample size of 283-1 508 patients and a pulmonary infection incidence rate of 5.4%-16.25%. The independent predictive factors repeatedly included in the models were age, American Society of Anesthesiologists (ASA) scale, preoperative comorbidities, chronic obstructive pulmonary disease (COPD), preoperative albumin level, white blood cell count (WBC), and C-reactive protein (CRP) level. The models were internally validated in 7 studies and externally validated in 3. The models were visualized in the form of a nomogram in 7 studies and a web-based risk calculator in 1. Model prediction performance was analyzed: (1) In terms of the discrimination, 9 studies reported the area under the receiver operating characteristic curve (AUC), with the overall AUC range of 0.664-0.905. (2) In terms of the calibration, 5 studies had Hosmer-Lemeshow test, with the P-values all above 0.05; 2 studies reported the calibration plots, with the slopes close to 1 and the Brier scores of 0.016 and 0.112; 4 studies reported the sensitivity of the models of 73.91%-92.40% and specificity of 57.10%-92.41%. According to PROBAST, all 11 studies exhibited certain risk of bias while maintaining favorable applicability. Conclusions:Age, ASA scale, preoperative comorbidities, COPD, preoperative albumin level, WBC, and CRP level are found to be independent predictive factors repeatedly reported in the risk prediction models for postoperative pulmonary infection in elderly patients with hip fractures. The existing models demonstrate a robust overall prediction performance despite certain risks of bias.

Objective Exploring the components of complex scenarios of healthcare surges triggered by major epidemics to provide a theorical basis for building resilience in healthcare organizations.Methods A hybrid analysis method is used to summarize macro-meso-micro multi-level and multi-source heterogeneous information,extract the elements of complex scenarios of medical surge and evaluate the rationality.Fault Tree Analysis method is used to clarify the logical relationship between various scenario elements and construct scenario reasoning paths.Results 10 scenario states,11 disaster-bearing,24 emergency management and 23 scenario results are summarized and extracted to form the key elements of complex surge scenarios.Among them,M4 expansion and coordinated scheduling of key positions,B2 conventional drug inventory emergency/insufficient core treatment drugs,B emergency medical material transportation breakage,S3 disease symptom spectrum shift to severe disease,R13 prevention and control awareness laxity,and M5 media information dissemination management are the key driving factors that promote a major turning point in the scenario.The most positive scenario result is the orderly operation of the medical service system,and the most negative scenario result is the paralysis of the medical service system.Conclusion Medical institutions need to improve emergency plans based on the complex evolution scenarios of medical surges and agile governance capabilities targeting key turning points,focus on dynamically expanding and scheduling personnel in key positions,strengthen material rotation and reserve mechanisms,maintain smooth emergency logistics channels,and improve efficient management of media and public opinion,so as to comprehensively improve overall resilience.

Objective To explore the coupling mechanism between medical surge response resources and the spread of secondary risks during public health emergencies,as well as the effectiveness of relevant interventions.Methods Based on complex network theory,a dual-layer network model of medical resources and secondary events was constructed.The interactive feedback between medical resource status and secondary event risk,as well as the effects of network structure,were analyzed through MATLAB simulations,REPAST agent-based modeling,and mean-field analysis.Results Simulation and prediction results show that an increase in first-layer resource-deficient nodes significantly raises the activation rate and transmission speed of secondary events,while the clustering and spread of secondary events in the second layer,in turn,intensify resource depletion,creating a negative feedback loop.Mean-field analysis indicates a nonlinear positive correlation between the adequacy of medical resources and the likelihood of secondary events.Network structure analysis reveals that when the average node degree exceeds 8,resource allocation efficiency improves markedly.Conclusion There exists a dynamic coupling and bidirectional feedback relationship between medical resource status and secondary event risks.Enhancing the flexible allocation and responsiveness of medical resources,improving multi-sectoral collaborative monitoring and coordinated regulation,optimizing network connectivity and coordination mechanisms for resource distribution,and establishing dynamic monitoring and tiered early warning systems are key strategies for strengthening the resilience of healthcare systems and effectively containing the spread of secondary events.

Objective To understand the pathogenic molecular characteristics of the latest prevalent Group A Streptococcus(GAS)in a suburban area of Beijing.Methods Throat swab specimens from children suspected of GAS infection in the outpatient setting of a sentinel surveillance hospital in a suburban area of Beijing from January 2023 to June 2025 were collected.GAS strains were detected and cultured.Antimicrobial susceptibility testing on 12 antimicrobial agents were performed,and molecular epidemiological characteristics of GAS strains was further ana-lyzed by whole genome sequencing technique.Results Data of 326 children suspected of GAS infection in outpatient setting were collected.A total of 41 GAS strains were detected and cultured,with a detection rate of 12.58％.The proportions of children with anterior cervical lymph node enlargement,tonsil congestion,and jaw congestion in the GAS positive group were all higher than those in the GAS negative group,and differences were all statistically sig-nificant(all P＜0.05).All 41 GAS strains carried both erm(B)and tet(M)resistance genes and exhibited a struc-tural type(cMLS)resistance phenotype.All of the emm12 strains were ST36,and emm1 strains were ST28.A to-tal of 6 emm12 subtypes and 1 emm1 subtype were detected,namely emm12.2,emm12.95,emm12.69,emm12.17,emm12.19,emm12.149,and emm1.12.Among them,emm12.149 was a newly discovered subtype.Nucleobase at the 175 100 locus in gene sequence had undergone an A→ T mutation.A total of 5 bacteriophages and 6 superanti-gens were detected.There were statistically significant differences in multi-nucleotide polymorphisms(MNPs)and insertion numbers in the genomes of emm12.0 and emm12 subtypes(both P＜0.05).The phylogenetic tree presen-ted a highly clonal group of 23 GAS strains in this area,accounting for 57.50％.Conclusion The prevalent GAS strain in this area is emm12.emm12.149 is a new subtype.The resistance genes and phenotypes are erm(B),tet(M),and structural type(cMLS).The genome has plenty genetic polymorphism,and the genome sequences of multiple GAS strains are highly cloned,indicating the possibility of clone transmission.This suggests that the sur-veillance of GAS in sentinel hospitals should continue to be strengthened,so as to provide theoretical basis for the prevention and control of GAS epidemics.

Objective The aim of this study was to analyze the incidence and mortality of lymphoma and their changing trends in cancer registration areas of Liaoning Province from 2016 to 2020,and to provide data support for lymphoma prevention and treatment.Methods The data of tumor registration areas in Liaoning province from 2016 to 2020 were collected and sorted out,and the crude incidence,mortality,China standardized incidence and mortality,world standardized incidence and mortality,and cumulative rate of lymphoma were calculated;Joinpoint 5.0.2 software was used to analyze the changing trends of the above indicators from 2016 to 2020.Results From 2016 to 2020,the crude incidence of lymphoma in tumor registration areas of Liaoning Province was 7.43/100,000,age-standardized incidence by Chinese standard population(ASIRC)was 4.07/100,000,and age-standardized incidence by world standard population(ASIRW)was 3.95/100,000;the crude mortality was 4.29/100,000,age-standardized mortality by Chi-nese standard population(ASMRC)was 2.07/100,000,and age-standardized mortality by world standard population(ASMRW)was 2.02/100,000.The ASIRC and ASMRC were higher in males(4.62/100,000 and 2.53/100,000,respectively)than in females(3.56/100,000 and 1.61/100,000,respectively),also higher in urban areas(4.65/100,000 and 2.32/100,000,respectively)than in rural areas(2.46/100,000 and 1.65/100,000,respectively).The incidence and mortality of lymphoma increased with age.The in-cidence reached its peak in the 70-79 age group,and the mortality reached its peak in the 80+age group.From 2016 to 2020,the crude incidence of lymphoma increased from 6.86/100,000 to 8.22/100,000,with a statistically significant trend(APC=5.06％,95％CI;1.13％-9.14％,P=0.026).ASIRC increased from 4.01/100,000 to 4.45/100,000,with no statistical significance(P＞0.05).The crude mortality increased from 3.85/100,000 to 4.53/100,000,while ASMRC decreased from 2.02/100,000 to 2.01/100,000,with no statistically significant trend in the two changes(P＞0.05).Conclusions The incidence and mortality of lymphoma in cancer registration areas of Liaoning Province are higher in men than those of women,and higher in cities than those in rural areas,and reach the peak in the elderly group.The prevention and control of key populations and health management should be strength-ened,especially pay attention to the health needs of the elderly population,and explore possible directions for multidisciplinary collab-orative diagnosis and treatment to reduce the disease burden.

ObjectiveTo investigate the effect of dapagliflozin on liver lipid metabolism and gut microecology in mice with metabolic associated fatty liver disease （MAFLD）， and to clarify its potential mechanism. MethodsA total of 50 male C57 mice were randomly divided into Control group， type 2 diabetes+MAFLD group （MAFLD group）， dapagliflozin group （DAPA group）， meldonium group （THP group）， and dapagliflozin+meldonium group （DAPA+THP group）， with 10 mice in each group. High-fat diet combined with streptozotocin was used to establish a mouse model of MAFLD. Treatment outcomes were assessed based on histopathology and biochemical parameters such as blood glucose and blood lipid levels， and the transcriptomic and metagenomic analyses were used to identify differentially expressed genes and the changes in gut microbiota. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups， and the Nemenyi test was used for comparison between two groups. ResultsHistopathological examination showed that the mice in the MAFLD group had excessive lipid deposition and hepatocyte steatosis； compared with the MAFLD group， the DAPA group had a significant improvement in hepatocyte steatosis， while the THP group and the DAPA+THP group had a less significant improvement compared with the DAPA group. Compared with the Control group， the MAFLD group had a significant increase in fasting blood glucose （P<0.05）， significant increases in the serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， malondialdehyde， total cholesterol， triglyceride， and low-density lipoprotein cholesterol （P<0.05）， and a significant reduction in high-density lipoprotein cholesterol （P<0.05）. Compared with the MAFLD group， the DAPA group， the THP group， and the DAPA+THP group had significant reductions in the serum levels of ALT and AST （P<0.05）. The results of 16S rRNA sequencing showed that compared with the Control group， the MAFLD group had significant changes in gut microbiota， with an increase in Firmicutes and a reduction in Bacteroidetes， as well as reductions in S24-7 and Erysipelotrichaceae and an increase in Lactobacillaceae. The levels of the above flora were upregulated to normal levels in the DAPA group， the THP group， and the DAPA+THP group. The liver transcriptomic analysis showed that the enriched metabolic pathways included steroid hormone biosynthesis， bile secretion， inflammatory mediator regulation of TRP， fatty acid elongation， and lipid biodegradation processes， and the related genes mainly involved the key targets of lipid metabolism such as Acot2， Angptl4， Scd2， and Npc1l1. ConclusionDapagliflozin can alleviate MAFLD through the pathways such as steroid hormone biosynthesis， bile secretion， inflammatory mediator regulation of TRP， and fatty acid elongation， as well as by regulating gut microbiota homeostasis.

Neuropathic pain is frequently comorbidity with cognitive deficits. Neuralized1 (Neurl1)-mediated ubiquitination of CPEB3 in the hippocampus is critical in learning and memory. However, the role of Neurl1 in the cognitive impairment in neuropathic pain remains elusive. Herein, we found that lumbar 5 spinal nerve ligation (SNL) in male rat-induced neuropathic pain was followed by learning and memory deficits and LTP impairment in the hippocampus. The Neurl1 expression in the hippocampal CA1 was decreased after SNL. And this decrease paralleled the reduction of ubiquitinated-CPEB3 level and reduced production of GluA1 and GluA2. Overexpression of Neurl1 in the CA1 rescued cognitive deficits and LTP impairment, and reversed the reduction of ubiquitinated-CPEB3 level and the decrease of GluA1 and GluA2 production following SNL. Specific knockdown of Neurl1 or CPEB3 in bilateral hippocampal CA1 in naïve rats resulted in cognitive deficits and impairment of synaptic plasticity. The rescued cognitive function and synaptic plasticity by the treatment of overexpression of Neurl1 before SNL were counteracted by the knockdown of CPEB3 in the CA1. Collectively, the above results suggest that the downregulation of Neurl1 through reducing CPEB3 ubiquitination and, in turn, repressing GluA1 and GluA2 production and mediating synaptic plasticity impairment in hippocampal CA1 leads to the genesis of cognitive deficits in neuropathic pain.
Animals ; Male ; Neuralgia/metabolism* ; Rats ; Down-Regulation/physiology* ; Ubiquitination/physiology* ; Neuronal Plasticity/physiology* ; Rats, Sprague-Dawley ; CA1 Region, Hippocampal/metabolism* ; Cognitive Dysfunction/metabolism* ; RNA-Binding Proteins/metabolism* ; Receptors, AMPA/metabolism*

Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic acute kidney injury (SAKI) is one of the most common complications of sepsis, and the occurrence of acute kidney injury (AKI) indicates that the patient's condition is critical with a poor prognosis. The traditional view holds that the main mechanism of SAKI is the reduction of renal blood flow, inadequate renal perfusion, inflammatory response, and microcirculatory dysfunction caused by sepsis, which subsequently leads to ischemia and necrosis of renal tubular cells. Recent research findings indicate that processes such as autophagy and other forms of programmed cell death play an increasingly important role. Autophagy is a programmed intracellular degradation process and is a form of programmed cell death. Cells degrade their cytoplasmic components via lysosomes, breaking down and recycling intracellular constituents to meet their metabolic needs, maintain intracellular homeostasis, and renew organelles. During SAKI, autophagy plays a crucial protective role through various mechanisms, including regulating inflammation and immune responses, clearing damaged organelles, and maintaining stability in the intracellular environment. In recent years, the role of autophagy in the pathogenesis and treatment of SAKI has received widespread attention. Research has confirmed that various intracellular signaling pathways and signaling molecules targeting autophagy [such as mammalian target of rapamycin (mTOR) signaling pathway, AMP-activated protein kinase (AMPK) signaling pathway, nuclear factor-κB (NF-κB) signaling pathway, and Sirtuins (SIRT), autophagy associated factor Beclin-1, and Toll-like receptor (TLR)] are involved in the development of SAKI. Due to the complex pathogenesis of SAKI, current treatment strategies include fluid management, infection control, maintenance of internal environment balance, and renal replacement therapy; however, the mortality remains high. In recent years, it has been found that autophagy plays a critical protective role in sepsis-mediated AKI. As a result, an increasing number of drugs are being developed to alleviate SAKI by regulating autophagy. This article reviews the latest advances in the role of autophagy in the pathogenesis and treatment of SAKI, with the aim of providing insights for the development of new drugs for SAKI patients.
Humans ; Acute Kidney Injury/etiology* ; Autophagy ; Sepsis/complications* ; Signal Transduction

To rapidly detect and differentiate Mycoplasma gallisepticum(MG)and Mycoplasma synovialis(MS),two sets of specific primers and TaqMan probes were designed in this study based on the conserved regions of the 16S rRNA gene of two pathogens in NCBI.A dual TaqMan fluorescence quantitative PCR method for simultaneous detection of MG and MS was established by optimizing the reaction conditions,and the specificity,sensitivity,repeatability,and reliability of the method were verified.The results showed that this method could specifically amplify MG and MS without cross reactivity with 21 pathogens.The sensitivity experiment results showed that the detection limits of this method for MG and MS were 5.40×10 1 copies/μL and 6.60 × 10 1 copies/μL,and the sensitivity was 10 to 100 times higher than that of known methods.In addition,the re-sults of repetitive experiments showed that the coefficient of variation within and between groups was less than 1％.Compared with the single PCR amplification method in NY/T 553-2015,the positive sample detection coincidence rate,negative sample detection coincidence rate,and total sample detection coincidence rate were all 100.00％,indicating the strong reliability of this method.Using this method to detect 84 suspected Mycoplasma infected chicken samples,the results showed that the MG positivity rate was 32.14％(27/84),the MS positivity rate was 22.62％(19/84),and the positivity rate of samples infected with MG and MS was 16.67％(14/84).Concurrent-ly,182 healthy chicken cloacal swab samples,118 healthy chicken nasal swab samples,and 74 chicken farm environmental samples were detected,and the results showed that all samples were positive for Mycoplasma.The above results indicate that this method can be applied to the detec-tion of various clinical samples.In summary,the method established in this study had the advanta-ges of high specificity,high sensitivity,and good reproducibility.It could be used for clinical differ-ential diagnosis,epidemiological investigation,and pathogen purification of MG and MS infections.