Objective To explore the clinical information of female patients with pulmonary nodules and the distribution of traditional Chinese medicine (TCM) syndromes and their elements. Methods A cross-sectional study was conducted to collect the basic information, medical history data, image data, and four diagnostic information of female patients with pulmonary nodules. The distribution characteristics of TCM syndromes and their elements in female patients with pulmonary nodules were determined by KMO test, Bartlett spherical test, systematic cluster analysis, chi-square test, and other methods. Results A total of 721 female patients with pulmonary nodules were included in this study. The patients were mainly 45-59 years old, had secondary school education or above, and had a history of oil smoke exposure as clinical characteristics. The pulmonary nodules were mainly 6-10 mm in size and appeared as multiple and ground glass nodules. The clinical symptoms were mainly fatigue, emotional irritability, and shortness of breath. The main syndromes of disease location were the spleen, liver, and lung; and the main syndromes of disease were phlegm, dampness, and qi deficiency. The main complex syndromes were spleen deficiency and dampness, liver stagnation, and qi/yin deficiency. Conclusion Middle age, high education, and multiple small ground glass nodules are the clinical characteristics of female patients with pulmonary nodules. Exposure to oil smoke is an important cause of the occurrence of female pulmonary nodules. During treatment, attention should be paid to strengthening the spleen, removing dampness, soothing the liver, regulating and tonifying qi, and nourishing yin.

L-citrulline is a nonprotein amino acid that plays an important role in human health and has great market demand. Although microbial cell factories have been widely used for biosynthesis, there are still challenges such as genetic instability and low efficiency in the biosynthesis of L-citrulline. In this study, an efficient, plasmid-free, non-inducible L-citrulline-producing strain of Escherichia coli BL21(DE3) was engineered by combined strategies. Firstly, a chassis strain capable of synthesizing L-citrulline was constructed by block of L-citrulline degradation and removal of feedback inhibition, with the L-citrulline titer of 0.43 g/L. Secondly, a push-pull-restrain strategy was employed to enhance the L-citrulline biosynthesis, which realized the L-citrulline titer of 6.0 g/L. Thirdly, the NADPH synthesis and L-citrulline transport were strengthened to promote the synthesis efficiency, which achieved the L-citrulline titer of 11.6 g/L. Finally, fed-batch fermentation was performed with the engineered strain in a 3 L fermenter, in which the L-citrulline titer reached 44.9 g/L. This study lays the foundation for the industrial production of L-citrulline and provides insights for the modification of other amino acid metabolic networks.
Citrulline/biosynthesis* ; Escherichia coli/genetics* ; Metabolic Engineering/methods* ; Fermentation ; NADP/biosynthesis*

Objective: To evaluate the long-term effectiveness of an intelligent blood transfusion system in intraoperative blood management by comparing its performance with clinicians' decisions. Methods: A retrospective analysis of 26 760 surgical cases (2017-2024) was conducted, comparing pre- and post-implementation (2017-2019 vs 2020-2024) metrics, including transfusion prediction accuracy, rationality of blood use, and clinical outcomes. The system, powered by XGBoost, integrated patient demographics, laboratory results, and surgical data to predict red blood cell transfusion needs. Results: The intelligent blood transfusion systems achieved an accuracy of 80.62% in predicting transfusion necessity, significantly outperforming clinicians (24.83%, P<0.001). Its blood-use rationality rate was 83.92% vs 18.02% for clinicians (P<0.001). Post-implementation, major surgeries (grades Ⅲ-Ⅳ) increased while the requested blood units decreased. High physician compliance (>75%) correlated with 88.18% rationality. Conclusion: The intelligent blood transfusion system significantly improves the accuracy of transfusion decision-making, reduces excessive red blood cell use, optimizes perioperative transfusion management, and enhances the utilization of blood medical resources.

Objective:To describe the detail sampling design,weighting,instruments,filed procedures and quality control methods of the epidemiological survey on dementia among community residents in Tongliao City.Methods:A three-stage disproportionate probability sampling design was used to investigate the inhabitants aged 65 years and over in Tongliao City,Inner Mongolia Autonomous Region.The 10/66 Dementia Research Group(10/66 DRG)assessment instruments were used to diagnose dementia,using computer-assisted personal interview mode in the selected older people.Comprehensive quality control methods were implemented throughout the field-work.Results:A total of 166 villages or communities were sampled from nine counties or districts in Tongliao Cit-y.Totally 4 345 older people were interviewed with 96.2％response rate.By calculating sampling design weights,non-response adjustment weights and post-stratification adjustment weights,these weights were multiplied and per-formed trimming adjustment and standardization adjustment to generate final weights.The 171 interviewers were well-trained and qualified to carry out filed interview.Quality control methods included computer data check,audio record check,and telephone check in order to ensure the quality of the survey.Conclusion:This survey is imple-mented using a rigorous sampling design and timely quality control methods,and uses the 10/66 DRG assessment instruments with satisfactory international validity and reliability as survey instruments,which has international cross-cultural comparability.It provides a valid and feasible methodology of epidemiological survey on dementia for further studies in different regions in China.

Objective:To estimate the costs of dementia from a societal perspective in Tongliao City and ex-plore the influencing factors of these costs.Methods:Dementia was diagnosed using the 10/66 Dementia Research Group assessment instruments.Data on healthcare utilization,caregiver's care time or costs,and the distress due to caregiving were collected.The cost-proportion conversion method was used to estimate the per capita cost of health services based on data from the National Statistical Yearbook.The human capital approach was used to estimate the unit value of informal care time,and the willingness-to-pay method was used to measure the intangible costs of car-egivers.The total societal costs of dementia were calculated based on the reference year 2023,and a two-part model was employed to analyze the factors influencing the societal costs.Results:A total of 390 dementia patients were di-agnosed,with an average societal cost per capita of 117 877 Yuan.The largest cost component was informal care provided by unpaid family members,accounting for 73.1％of the total societal cost.The societal costs for female patients were 61 395 Yuan higher than those for male patients.Patients with comorbid stroke had a higher societal cost of 63 008 Yuan compared to patients without stroke,and each additional chronic disease added 5 868 Yuan to societal costs.Additionally,each non-memory dimension impairment in the Clinical Dementia Rating Scale in-creased the societal costs by 53 997 Yuan.Conclusion:Dementia poses a significant socio-economic burden,with informal care being the major component of this burden.

Objective To investigate the effects of high-definition transcranial direct current stimulation(HD-tDCS)on the modulation of the H-reflex and M-wave during ankle dorsiflexion-plantar flexion fatigue tasks to provide direction for the application of HD-tDCS in mitigating neuromuscular fatigue.Methods Twenty healthy young male participants were recruited and randomly assigned to either the real stimulation or sham stimulation group,with 10 participants in each group.The intervention consisted of a 5-day single-blind HD-tDCS application(duration:20 min;intensity:2 mA;target:Cz).Baseline measurements of the H-reflex and M-wave under resting conditions,M-wave during maximal voluntary isometric contraction(MVIC)of the dorsiflexor muscle,and MVIC torque of the dorsiflexor and plantar flexor muscles were obtained.An ankle dorsiflexion fatigue task was performed to determine the time to achieve fatigue for the task.The same fatigue task was repeated and evaluated one day after the intervention.A repeated-measures two-factor(stimulation condition x pre/post fatigue)analysis of variance(ANOVA)was used to analyze the effects of independent variables on the mechanical properties of the muscles and α-motoneuron conduction characteristics.Results After fatigue,voluntary activation(VA),maximal H-reflex(Hmax),maximal M-wave(Mmax),and dorsiflexor and plantar flexor MVIC torques in both groups were significantly reduced compared with pre-fatigue levels(P＜0.05).However,compared to the real stimulation group,the sham stimulation group showed a more significant decline in VA and plantar flexor MVIC torque(P＜0.05).Conclusions A continuous 5-day HD-tDCS intervention can effectively increase α-motoneuron activity at the spinal segment.It can also exert an inhibitory effect on reducing information transmission capacity at the peripheral neuromuscular junction under the ankle dorsi-plantarflexion fatigue task.

With the increasing maturity of laparoscopic surgery, laparoscopic radical resec-tion of colorectal cancer has been widely used in colorectal surgery. Accurate localization of colorectal tumors and surgical margins in the absence of tactile sensation during surgery, ensuring sufficient blood flow perfusion at the anastomotic site and effectively reducing the incidence of anastomotic leakage have become barriers to the development of laparoscopic radical resection of colorectal cancer. The application of indocyanine green fluorescence imaging (ICG-FI) technology is expected to provide feasible solutions to the above-mentioned problems. Through this technology, accurate localization of colorectal tumors, evaluation of blood supply to the anastomotic site, lymphatic system imaging, detection of colorectal liver metastases, and protection of pelvic autonomous nerves and ureters can be achieved during laparoscopic surgery, thereby further improving the surgical quality of laparoscopic radical resection of colorectal cancer. However, the clinical application of ICG-FI technology in colorectal surgery is relatively short, which is still in the stage of exploration and experience accumulation, and there are few guideline or consensus available for reference. Therefore, the authors aim to provide a reference for the clinical application of this technology by reviewing and summarizing relevant literature based on different application types of ICG in colo-rectal cancer surgery.

Breast cancer has become the most common malignant tumor in the world. Heat shock protein 90 (HSP90) is a kind of molecular chaperone which can promote protein folding and maintain protein stability. HSP90 includes HSP90α, HSP90β, GRP94 and TRAP1 subtypes. Previous studies have found that the level of HSP90 is significantly increased in malignant tumors such as breast cancer, and is closely related to the occurrence and development of tumors. Meanwhile, the research on inhibitors targeting HSP90 has also attracted much attention. In this paper, we reviewed the expression of four HSP90 subtypes in breast cancer and their relationship with the clinicopathologic feature and prognosis of patients, discussed the research progress of specific inhibitors of HSP90 subtypes in breast cancer, and analyzed the application prospect of HSP90 as biomarkers for breast cancer prognosis monitoring and therapeutic targets.

Objective·To explore the immune-related characteristics of non-small cell lung cancer(NSCLC),discover potential tumor markers in V-J genes,and lay the foundation for establishing a TCR-antigen recognition prediction model.Methods·A total of 704 NSCLC samples were collected to establish a comprehensive T-cell receptor(TCR)repertoire analysis workflow.The upstream analysis included steps such as raw data processing,quality control,filtering,TCR sequence identification,and extraction.The downstream analysis included repertoire clone distribution,clone typing,V-J gene sharing,CDR3 distribution characteristics,and clone tracking.The sample clone distribution was analyzed by using indices such as Shannon-Weiner index and Chaol index.Clone typing was performed based on the number of clone amplifications to explore differences among different types.The degree of V-J gene segment sharing was analyzed,and the sharing of low-frequency clone types was determined through clone amplification weight analysis of V-J genes by using two samples of papillary thyroid carcinoma.Finally,analysis of the distribution characteristics of V genes and high-frequency clone type CDR3,and clone tracking analysis were conducted to monitor changes in tumor immune clone frequencies before and after analysis,aiming to identify potential tumor markers.Results·① Significant differences were observed in clone distribution and clone typing among different NSCLC tissues,as well as among different ages and genders.② Specific highly-shared V-J genes were identified in the analysis of V-J gene sharing,and non-normal distribution of high-clone V genes and amino acid high-frequency clone types were found in the CDR3 distribution analysis.③ In the analysis of high-frequency clone type clone tracking,highly expressed or newly expressed high-frequency clone types were observed in NSCLC,suggesting that these clone types could serve as potential tumor-associated antigens or bind with CDR3 reference sequences of new antigens.④ It was found that the expression frequency of TRBJ2-5 gene,originally low-expressed,significantly increased,indicating its potential role as a key low-frequency gene in tumor immune response.Conclusion·The TRAV21 and TRBV6.5 genes show high clone amplification in NSCLC and could serve as potential tumor biomarkers.

Objectve:To observe the change of functional connectivity(FC)characteristic and its correlation with cognitive flexibility in type 2 diabetes mellites(T2DM)patients with cognitive flexibility decreased.Methods:A retro-spective analysis was performed in 24 T2DM patients with cognitive flexibility decreased(T2DM+CD),34 T2DM pa-tients without cognitive flexibility decreased(T2DM-CD)and 31 healthy controls(HC).Wisconsin Card Sorting Test(WCST)and the Stroop Color Word Test(Stroop)were respectively used in three groups of subjects to assess cognitive flexibility and functional magnetic resonance imaging(fMRI)scans was used to assess the FC.The differences of cogni-tive flexibility were found between three groups of subjects.The differences of FC between the bilateral(Left and Right,L.and R.)striatum(ST)and the dorsolateral prefrontal cortex(dlPFC)were found between three groups of subjects.Further analysis was focused on the interactive effect of T2DM and cognitive flexibility on FC changes.Results:Com-pared with T2DM-CD and HC,the number of response administered,errors responses,perseverative response,and time in WCST of T2DM+CD were significantly increased,while the number of correct responses was decreased.In Stroop,the number of correct,word-color contradiction and correct word-color indifference in T2DM+CD were lower than HC.In T2DM+CD,FC between L.ST-L.dlPFC,R.ST-L.dlPFC and R.ST-R.dlPFC were decreased,and decreased FC between R.ST-R.dlPFC was associated with cognitive flexibility scale scores.There existed an interactive effect between T2DM and cognitive flexibility on FC changes.Conclusion:Decreased FC between ST and dlPFC is the neural mechanism of cognitive flexibility impairment in T2DM.