ObjectiveTo explore the academic characteristics of contemporary renowned Chinese medicine masters in treating diabetic kidney disease （DKD） from the perspectives of principles， methods， formulas， and medications. MethodsIn strict accordance with the Systematic Review of Text and Opinion （SrTO） process developed by the Joanna Briggs Institute （JBI）， an Australian evidence-based healthcare center， the databases including China National Knowledge Infrastructure （CNKI）， VIP Database， Wanfang Data， and China Biomedical Literature Service System （SinoMed） were searched. Based on predefined inclusion and exclusion criteria， text information extraction， quality evaluation， and text information synthesis were conducted sequentially. The data were analyzed and presented in the form of text and figures. ResultsA total of 215 articles related to 43 contemporary renowned experts in the fields of Chinese medicine nephrology and endocrinology were included. The study found that the academic thoughts of these masters in the treatment of DKD are extensive， involving multiple levels such as disease understanding， therapeutic strategies， formula application， and medication use. In terms of disease understanding， the primary pathogenesis is characterized by deficiency in the root and excess in the manifestation. It is emphasized that internal factors， such as congenital endowment deficiency， interact with external factors such as improper diet， emotional disturbances， invasion of exogenous pathogens， and delayed or inappropriate treatment， to jointly induce the disease. This further gives rise to various pathogenetic theories， including obstruction of renal collaterals by blood stasis， toxin-induced damage to renal collaterals， latent wind disturbing the kidney， and internal heat leading to mass formation. In terms of therapeutic strategies and medication use， the principal treatment method is to replenish Qi and nourish Yin. Stage-based and syndrome-differentiated treatments are advocated. Flexible use of insect-derived drugs and wind-dispelling drugs is emphasized， along with proficiency in applying classical formulas and drug pairs. Integrated internal and external treatments， as well as the combined application of multiple therapeutic approaches， are commonly employed for comprehensive management. Meanwhile， the concept of "preventive treatment of disease" is upheld， and individualized long-term management of patients is advocated. ConclusionThrough the SrTO process， the academic thoughts of contemporary renowned Chinese medicine masters in the treatment of DKD have been systematically and standardly synthesized， providing a scientific and standardized basis for future theoretical exploration.

ObjectiveTo explore the academic characteristics of contemporary renowned Chinese medicine masters in treating diabetic kidney disease （DKD） from the perspectives of principles， methods， formulas， and medications. MethodsIn strict accordance with the Systematic Review of Text and Opinion （SrTO） process developed by the Joanna Briggs Institute （JBI）， an Australian evidence-based healthcare center， the databases including China National Knowledge Infrastructure （CNKI）， VIP Database， Wanfang Data， and China Biomedical Literature Service System （SinoMed） were searched. Based on predefined inclusion and exclusion criteria， text information extraction， quality evaluation， and text information synthesis were conducted sequentially. The data were analyzed and presented in the form of text and figures. ResultsA total of 215 articles related to 43 contemporary renowned experts in the fields of Chinese medicine nephrology and endocrinology were included. The study found that the academic thoughts of these masters in the treatment of DKD are extensive， involving multiple levels such as disease understanding， therapeutic strategies， formula application， and medication use. In terms of disease understanding， the primary pathogenesis is characterized by deficiency in the root and excess in the manifestation. It is emphasized that internal factors， such as congenital endowment deficiency， interact with external factors such as improper diet， emotional disturbances， invasion of exogenous pathogens， and delayed or inappropriate treatment， to jointly induce the disease. This further gives rise to various pathogenetic theories， including obstruction of renal collaterals by blood stasis， toxin-induced damage to renal collaterals， latent wind disturbing the kidney， and internal heat leading to mass formation. In terms of therapeutic strategies and medication use， the principal treatment method is to replenish Qi and nourish Yin. Stage-based and syndrome-differentiated treatments are advocated. Flexible use of insect-derived drugs and wind-dispelling drugs is emphasized， along with proficiency in applying classical formulas and drug pairs. Integrated internal and external treatments， as well as the combined application of multiple therapeutic approaches， are commonly employed for comprehensive management. Meanwhile， the concept of "preventive treatment of disease" is upheld， and individualized long-term management of patients is advocated. ConclusionThrough the SrTO process， the academic thoughts of contemporary renowned Chinese medicine masters in the treatment of DKD have been systematically and standardly synthesized， providing a scientific and standardized basis for future theoretical exploration.

Background The contamination of public baths with Legionella pneumophila contamination has become a growing public health concern in recent years. However, research on its association with bacterial community characteristics in water samples remains limited. The integration of 16S rRNA sequencing and random forest modeling provides a new approach to elucidate the bacterial community characteristics of public bath water and their association with Legionella pneumophila contamination. Objective To investigate the bacterial community structure and diversity of public bath water in Shanghai, explore the association between Legionella pneumophila contamination and bacterial community characteristics, and identify key bacterial genera associated with contamination, thereby providing a scientific basis for formulating hygiene management regulations for public bath water. Methods From February to March 2023, water samples were collected from ten public baths in Shanghai which were selected based on business scale, regional distribution, and functional differences. Water quality parameters were evaluated, and the samples were categorized into Legionella-positive and Legionella-negative groups based on the detection results of Legionella pneumophila. The bacterial community structure, α-diversity, and β-diversity were analyzed using 16S rRNA sequencing. Redundancy analysis (RDA) was employed to examine the relationship between physicochemical factors and bacterial community diversity. A random forest model was employed to identify key bacterial genera distinguishing the two groups, with the importance of genera being evaluated based on the mean decrease accuracy (MDA). Results The oxygen consumption in the Legionella-positive group was significantly lower than that in the Legionella-negative group (mean values: 1.85 mg·L⁻¹ vs. 6.81 mg·L⁻¹, P< 0.05), while no significant differences were observed in other physicochemical indicators. The sequencing results revealed a total of 27 bacterial phyla and 454 bacterial genera, with Proteobacteria (63.00%) being the dominant phylum. The dominant genera included Pelomonas (8.50%), Acidovorax (8.13%), Mycobacterium (7.93%), and Acinetobacter (6.59%). The α-diversity analysis indicated that bacterial community richness (Chao1 and ACE indices) was significantly higher in the Legionella-positive group than in the Legionella-negative group (P<0.01). The β-diversity analysis showed no significant difference in the bacterial community structure between the two groups (P>0.05). The RDA analysis demonstrated that the bacterial community diversity was positively correlated with pH and negatively correlated with oxygen consumption and free residual chlorine. The RDA1 and RDA2 explained 23.92% and 21.30% of the bacterial community diversity, respectively. The random forest model identified 20 key genera significantly influencing the microbial community distribution between the two groups, including unclassified_Bradyrhizobiaceae (MDA=2.42), Meiothermus (MDA=2.37), and Flavihumibacter (MDA=2.26). Conclusion The diversity of bacterial communities in public bath water is influenced by pH, oxygen consumption, and free residual chlorine. Samples contaminated with Legionella pneumophila exhibit greater microbial richness and contain characteristic key bacterial genera that contribute to community differences. Machine learning random forest technology helps identify these distinctive key bacterial genera. The findings provide a basis for carrying out risk early warning strategies in such settings.

Objective To evaluate the effects of low-dose intrathecal morphine(ITM)combined with liposomal bupivacaine adductor canal block(LB-ACB)on postoperative analgesia and opioid-sparing efficacy in patients undergoing total knee arthroplasty(TKA).Methods In this randomized,double-blind,controlled trial,80 TKA patients were allocated to either an intervention group(ITM 0.1 mg+LB-ACB,n=40)or a control group(intrathecal saline+LB-ACB,n=40).Primary outcomes included resting/movement visual analog scale(VAS)scores at 6,12,24,48,and 72 hours postoperatively,48-hour morphine consumption,time to first rescue analgesia,and incidence of complications.Results(1)The intervention group showed significantly lower resting and movement VAS scores at 6,12,24,and 48 hours postoperatively compared with controls(all P<0.05),except at 72 hours(P>0.05).(2)The intervention group had a significant reduction in 48-hour morphine consumption(4.58±1.0 mg vs.9.34±4.8 mg,P=0.027),a significantly lower rescue analgesia rate(15.0%vs.47.5%,P=0.002),and a significantly prolonged time to first rescue analgesia(48.8±7.5 h vs.14.5±5.5 h,P<0.001).(3)The intervention group demonstrated a significant decrease in the incidence of nausea(from 15.0%to 35.0%,P=0.039)and vomiting(from 10.0%to 27.5%,P=0.045),but no significant differences were observed in the incidences of pruritus,urinary retention,or motor block(all P>0.05).Conclusion Low-dose ITM(0.1 mg)combined with LB-ACB significantly enhances early postoperative analgesia,reduces opioid consumption,and decreases nausea/vomiting risk,without increasing the risks of other complications.This regimen aligns with enhanced recovery after surgery(ERAS)principles.

Objective:To analyze the infiltration of immune cells in different molecular subtypes of endometrial cancer(EC)at the protein level and explore the correlation between immune infiltration and clinicopathological features.Methods:Clinical data from 75 mismatch repair-deficient(MMR-D)EC cases and 74 mismatch re-pair-proficient(MMR-P)EC cases with comparable differentiation levels,diagnosed at Sichuan Provincial People's Hospital between January 2013 and January 2021,were selected.Molecular classification of EC was con-ducted according to the ProMisE standard.Immunohistochemistry(IHC)staining and fluorescent multiplexed im-munohistochemistry(F-mIHC)techniques were used to quantify the distribution of CD8+T cells,regulatory T cells(Tregs),and macrophages.The clinicopathological features and immune infiltration characteristics of different subtypes were investigated.Results:Among 149 samples,75 were MMR-D,8 were POLE-mutated(POLEmut),13 were p53-mutated(p53abn),and 53 were p53 wild-type(p53wt).The infiltration characteristics of CD8+T cells,Tregs,and macrophages were no statistically significant differences correlated with age and pathological stage(P>0.05).Among the molecular subtypes of EC,MMR-D tumors demonstrated a significantly higher densi-ty of CD8+T cells and Tregs compared to MMR-P tumors(P<0.05).Further comparison across the four EC mo-lecular subtypes revealed that the MMR-D subtype,which had a favorable prognosis,displayed a significantly high density of CD8+T cells compared to the p53abn subtype and the p53wt subtype(P<0.05).Additionally,the Tregs density of the MMR-D tumors was significantly higher than that of the p53wt tumors,in both the tumor area(P<0.05)and the stroma area(P<0.05).The POLEmut type tumors,which had the best prognosis,showed a high infiltration of CD8+T cells and Tregs cells compared to the p53abn and p53wt types,although there was no signifi-cant statistical difference(P>0.05).The p53wt subtype,which had a moderate prognosis,exhibited low density of CD8+T cells(P<0.05)and Tregs(tumor area,P<0.01,stroma area,P<0.05)compared to MMR-D tumors.The p53abn subtype,which was associated with the worst prognosis,exhibited higher infiltration of M2-like macro-phages than the MMR-D subtype(P<0.05)and the p53wt subtype(P<0.05)in tumor region,and lower CD8+T cell density than the MMR-D subtype(P<0.05).No significant statistical difference was observed in the density of M1-like macrophages across the four molecular subtypes in either the tumor or stroma areae(P>0.05).Conclu-sions:There was no statistically significant relation found between infiltration characteristics of immune cells and clinicopathological features.The types and distribution of infiltrated immune cells were different across these EC molecular subtypes.This indicated that ECs with different molecular subtype exhibited different features of immune infiltration which is closely associated with patient prognosis.

Objective Under the operation background of Diagnosis-Intervention Packet(DIP),whether there is interaction between reducing medical cost and average length of stay combined with pre-hospitalization mode,and whether there is difference between different departments and diseases in interaction.Methods Based on real-world data from 71 453 patients admitted to Guizhou Provincial People's Hospital from July to December 2021,a two-way analysis of variance was employed.When the interaction effect was statistically significant,parameter estimation was used to determine the magnitude and direction of the interaction effect,followed by subgroup analyses by department and disease.Results Without adjustment,both total medical costs and average length of stay exhibited a negative interaction effect(P＜0.05).Subgroup analyses revealed that in terms of total medical costs,the effect size for the surgical system was 0.18％,lower than that for the internal medicine system(0.70％);for core diseases,it was 6.62％,lower than that for comprehensive diseases(7.71％).Regarding average length of stay,the effect size for the surgical system was 0.55％,better than that for the internal medicine system(0.22％);for core diseases,it was 8.70％,higher than that for comprehensive diseases(2.90％).Conclusion The combination of DIP payment reform and pre-admission management model demonstrates a synergistic effect,effectively reducing patients' medical costs and length of stay.This effect is influenced by disease complexity and the standardization of diagnostic and treatment processes.

The drug resistance of the carbapenem-resistant Enterobacteriaceae(CRE)strains was mainly induced by multiple approaches such as production of carbapenemases,increase of bacterial outer membrane permeability,activation of active efflux pump system,formation of biofilm and drug modifying mechanisms.Those mecha-nisms involve deletion,mutation,insertion and posttranscriptional modification of relevant encoding genes,which may affect the susceptibility of the CRE strains to antibiotics.At present,the conventional clinical thera-pies include the use of traditional antibiotics,either the one-drug use or combined use of drugs.The development of novel antibacterial therapy is under way.The epidemiological characteristics of CRE infections,drug resist-ance mechanisms,current and prospective treatment strategies for CRE infections(covering new application of the drugs in available,the novel drugs such as ceftazidime/avibactam,meropenem/vaborbactam and imipenem/rele-bactam)were deeply reviewed in this article,so as to provide reliable reference for clinical prevention,control and treatment of CRE infections.

Objective To explore the correlation between aging and idiopathic pulmonary fibrosis(IPF)and reveal the underlying molecular mechanisms.Methods IPF models were established using young(2-month-old)and aged(18-month-old)C57BL/6J mice by intratracheal instillation of bleomycin(BLM)hydrochloride(2.5 mg/kg)after fully exposing the trachea.The control groups received an equal volume of saline administered in the same manner.Mice were divided randomly into four groups:a young control(Ctrl-Y)group,young model(IPF-Y)group,aged control(Ctrl-A)group,and aged model(IPF-A)group.Histopathological changes were evaluated by hematoxylin-eosin and Masson staining.Collagen type Ⅰ alpha 1 chain(COL1A1),α-smooth muscle actin(SMA),and fibronectin(FN)expression were detected by immunohistochemistry.Cell senescence was detected by senescence-associated beta-galactosidase(SA-β-Gal)staining.Differentially expressed genes were detected by transcrip tome sequencing,followed by gene ontology functional annotation(GO)and kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis.Core gene expression was validated by quantitative reverse transcription-polymerase chain reaction.Results The fibrosis score was significantly higher in the IPF-A group compared with the IPF-Y group(P＜0.05).Expression levels of α-SMA,and FN were significantly upregulated in the IPF-A group versus the IPF-Y group by 36％,and 25％,respectively(P＜0.05).The SA-β-Gal-positive area indicating senescence was significantly larger in the IPF-A group than in the IPF-Y group.Fifty-five senescence-IPF interactive genes were identified,among which Cdkn1a,MMP3,and Pdcd1 were synergistically upregulated in the IPF-A group(P＜0.05).KEGG analysis revealed the activation of signaling pathways such as extracellular matrix(ECM)-receptor interaction,phagosome,cytokine-cytokine receptor interaction,efferocytosis,and PI3K-Akt(FDR＜0.05).Conclusions aging promotes IPF progression,which induces lung tissue senescence.The underlying mechanism may involve ECM remodeling driven by immunosenescence,inflammatory accumulation,and metabolic disorders.

Objective To analyze the sensitization spectrum of common inhaled allergens for respiratory allergic diseases in Mento-ugou district of Beijing,and explore the safety of domestic intradermal test reagents.Methods A total of 19 kinds of inhaled allergen re-agents were used to conduct intradermal test in patients with suspected or definite respiratory allergic diseases(bronchial asthma or allergic rhinitis with bronchial asthma)who visited Department of Respiratory and Critical Care Medicine,Beijing Jingmei Group General Hospital from January 2018 to October 2021.The trends of age,gender and distribution of allergens were compared,and the safety of domestic in-tradermal test reagents were observed.Results A total of 4775 patients were conducted,the positive rate of intradermal test was 52％(2483/4775);the top 5 inhaled allergen positive rates were indoor dust with 29.78％(1422/4775),summer and autumn pollen Ⅰ with 28.06％(1340/4775),dust mite with 23.54％(1124/4775),kochia scoparia with 20.52％(980/4775),spring pollen Ⅱ with 18.03％(861/4775).The positive rate of intradermal test decreased with the increase of age.Patients with respiratory allergic diseases often combined a variety of substances allergy.Before and after CO VID-19 infection,the positive rate of allergens decreased significantly after scientific protection.Adverse effect was observed in 7 patients,the severity of the adverse reaction was all level Ⅰ.Conclusion The inhaled allergens are mainly dust,pollen and dust mite.The main allergens have not changed significantly from 2018 to 2021.Scien-tific protection can effectively reduce the incidence of allergic diseases.Domestic intradermal reagents has high safety and can serve the clinic well.

Objective:To analyze the contamination characteristics and pathogenic potential of Listeria monocytogenes (LM) in pre-packaged and refrigerated ready-to-eat cooked meat products in Chengdu City. Methods:From September 2022 to May 2023, pre-packaged and refrigerated ready-to-eat cooked meat products were collected from six districts and counties in Chengdu City. Qualitative and quantitative determination of LM was performed on these samples. Whole genome sequencing was carried out on the isolated strains. Different ST strains were selected for cell adhesion and invasion experiments. The results were expressed as adhesion rate and invasion rate. One-way ANOVA was used for comparison between groups, and the Dunnett t-test was used for pairwise comparison. Results:A total of 145 samples were collected, and LM was detected and isolated in 29 samples. The total detection rate was 20.00%, and the detection rate of braised pork was the highest (68.18%). The contamination level of LM in 9 samples (31.03%) was greater than 100.00 MPN/g. The 29 strains of Listeria monocytogenes belonged to 7 STs, including ST 3 (27.59%), ST 8 (17.24%) and ST 87 (13.79%). The strain of ST 87 carried Listeria pathogenicity islands 4 (LIPI-4), which was a highly virulent strain. The medium and high virulence strains accounted for 79.31%. Some moderately virulent and highly virulent strains of ST 8 and ST 87 were closely related to clinical patient strains. Some LM isolates of the same ST type had little SNP differences (1-6) in the same manufacturer at different stages. In vitro cell experiments showed that the highly virulent strain ST 87 had the strongest adhesion and invasion ability towards Caco-2 cells. Conclusion:The pre-packaged and refrigerated cooked meat products have a high contamination rate. Some samples have high contamination levels and carry medium and high virulence strains, posing potential health risks to human beings. LM residues continue to persist in some manufacturers′ production and processing stages.