ObjectiveTo observe the clinical effectiveness and safety of Qingfei Shenshi Decoction （清肺渗湿汤） combined with western medicine for patients with bronchial asthma of heat wheezing syndrome， and to explore its potential mechanism of action. MethodsEighty-six participants with bronchial asthma of heat wheezing syndrome were randomly divided into treatment group and control group， each group with 43 participants. The control group received conventional western medicine， and the treatment group was additionally administered Qingfei Shenshi Decoction orally on the basis of the control group， 1 dose per day. Both groups were treated for 14 days. The primary outcome measure was clinical effectiveness； secondary outcome measures included traditional Chinese medicine （TCM） syndrome score， asthma control test （ACT） score， pulmonary function indices such as forced expiratory volume in 1 second （FEV₁）， forced vital capacity （FVC）， peak expiratory flow （PEF）， serum inflammatory factor levels including interleukin-4 （IL-4）， tumour necrosis factor-α （TNF-α）， and high-sensitivity C-reactive protein （hs-CRP）， and immune function indices including CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺. All outcome measures were evaluated before and after treatment. Vital signs were monitored， and electrocardiography， blood routine， urine routine， liver function， and renal function tests were performed before and after treatment. Adverse events and reactions during the study were recorded. ResultsA total of 80 patients completed the trial with 40 in each group. The total clinical effective rate of the treatment group was 97.5% （39/40）， which was significantly higher than that of the control group （85.0%， 34/40， P＜0.05）. After treatment， both groups showed decreased TCM syndrome scores， IL-4， TNF-α， hs-CRP， and CD8⁺ levels， as well as increased ACT scores， CD3⁺， CD4⁺， CD4⁺/CD8⁺， FEV₁， FVC， and PEF levels （P＜0.05 or P＜0.01）. Moreover， the improvements in these indices were more significant in the treatment group than in the control group （P＜0.05 or P＜0.01）. No significant abnormalities in safety indicators were observed in either group， and no adverse events or reactions occurred. ConclusionQingfei Shenshi Decoction combined with conventional western medicine for patients with bronchial asthma of heat wheezing syndrome can effectively improve the clinical symptoms， pulmonary function， and clinical effectiveness， with good safety. Its mechanism may be related to reducing inflammatory factor levels and regulating T lymphocyte subsets to improve immune function.

Objective This study investigated the diversity of rodent populations and the infection status of Bartonella at three ports along the China-Mongolia border in 2022. Methods Rodents at three Belt and Road ports along the China-Mongolia border, namely Ganqimaodu, Erenhot, and Zhuengadabuqi, were morphologically identified. The Bartonella citrate synthase(gltA)gene was amplified by nested polymerase chain reaction(PCR), and PCR-positive products were sequenced. The resulting sequences were then analyzed for genetic characteristics. Phylogenetic analysis was performed using MEGA 11.0 software using Neighbor-Joining and Maximum-Likelihood method. Results A total of 94 rodents were captured, representing seven species from five families and six genera: Mus musculus, Meriones unguiculatus, Meriones meridianus, Spermophilus dauricus, Allactaga sibirica, Dipus sagitta, and Phodopus roborovskii. Among them, M. unguiculatus was the most abundant species, with 58 rodents, accounting for 61.70% of the total. Overall,11 positive Bartonella pathogen sequences were obtained from the three ports, with a positive detection rate of 11.70%(11/94). The infected rodent species included M. unguiculatus, M. meridianus, and A. sibirica, and two species of Bartonella were detected. Conclusions Rodents at Ganqimaodu, Erenhot, and Zhuengadabuqi ports along the China-Mongolia border were naturally infected with Bartonella. Rodent monitoring and pathogen prevention and control in this area should be strengthened.

Developing an intelligent agent for integrated traditional Chinese and western medicine diagnosis and treatment based on clinical practice guidelines is a key approach to advancing the standardization and intelligent deve-lopment of traditional Chinese medicine （TCM） and to supporting clinical decision-making. This paper argues for the necessity of building a knowledge base using guidelines as the sole data source， systematically identifies five core methodological challenges across the entire process， and proposes corresponding solutions. An ontology framework capable of distinguishing between TCM and western medicine concepts should be designed to address the difficulty of knowledge integration. A closed-loop "algorithm-based extraction-expert review" model is adopted to reduce data extraction errors. Expert consensus is incorporated to address decision gaps in specific clinical scenarios outlined in the guidelines， while a multi-stage， standardized output process for the AI system is established to eliminate model hallucinations. Furthermore， an evaluation framework reflecting clinical applicability is developed to enhance the AI system's accuracy and stability. Throughout the research process， it is essential to ensure the in-depth and continuous participation of multidisciplinary experts， strictly control the selection and quality evaluation of guidelines， and rely on the expert consensus method to address decision gaps in the knowledge base. Additionally， continuous validation and iterative optimization of intelligent agents are required to ensure the accuracy and stability of generated outputs. Limitations remain in the mechanisms for real-time knowledge synchronization in intelligent diagnostic and treatment systems， and further validation through large-scale real-world studies is warranted.

Objective: To determine the correlation between obesity related indicators and blood lipid levels among children and adolescents. Methods: A total of 5 812 participants were included. Height, weight, body composition, waist circumference, blood pressure were measured and fasting glucose and blood lipid levels were tested based on a cross sectional survey of children and adolescents 6-17 years in Beijing, 2022-2023. The body mass index (BMI), fat mass index (FMI), body roundness index (BRI) and waist to height ratio (WHtR) were calculated. Linear and Logistic regression were used to analyze the associations between the four obesity indicators (BMI, FMI, BRI, and WHtR) and blood lipids in children and adolescents. The area under the curve (AUC) of the receiver operating characteristic (ROC) was used to evaluate differences in the associations between different obesity indicators with dyslipidemia. Results: Linear regression showed that BMI, FMI, BRI, and WHtR were positively correlated with triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and non high density lipoprotein cholesterol (non HDL-C) levels (boys: β 6-9 years =0.02-0.28, β 10-17 years =0.02-0.37; girls: β 6-9 years =0.02-0.28, β 10-17 years =0.03-0.25), and negatively correlated with the high density lipoprotein cholesterol (HDL-C) level in both genders across age subgroups (boys: β BMI = -0.03, β FMI = -0.04 , β BRI =-0.09, β WHtR =-0.17; girls: β BMI =-0.03, β FMI =-0.04, β BRI =-0.11, β WHtR =-0.20) (all P <0.01). The associations between total cholesterol (TC) and remnant cholesterol (RC) levels with obesity indicators differed significantly by gender and age. The TC level was positively associated with obesity indicators in boys of all ages ( β BMI =0.01, β FMI =0.03, β BRI = 0.08 , and β WHtR =0.16) but only with FMI, BRI, and WHtR in girls 6-9 years of age ( β FMI =0.02, β BRI =0.05, and β WHtR =0.08) (all P <0.05). The RC level had a negative correlation with BRI in boys 10-17 years of age ( β =-0.01) and a positive correlation with BMI in girls 6- 9 years of age ( β =0.00) (all P <0.05). Logistic regression indicated that elevated obesity indicators were significantly associated with higher risks of elevated TG, LDL-C, and non HDL-C levels and a decreased HDL-C level in all gender age stratas (all P <0.01). Only the BMI and FMI in girls 6-9 years of age were significantly related to a high RC ( OR =1.07, 1.07, both P <0.05). ROC analysis revealed that FMI, BRI, and WHtR were more predictive than BMI of elevated TG, LDL-C, and non HDL-C levels. The BMI was superior in predicting a decreased HDL-C level in boys, while no significant difference was detected among indicators in girls. Indeed, all obesity indicators had poor predictive performance for elevated TC, RC, and LDL-C levels in girls (all AUC<0.7). Conclusions Obesity indicators reflecting body fat content and fat distribution are shown to be closely associated with dyslipidemia in children and adolescents with obvious age and gender differences. The FMI, BRI, and WHtR have potential advantages in the early identification of dyslipidemia among children and adolescents compared to the BMI alone.

Objective To explore the factors that influence major adverse cardiovascular events(MACE)in atrial fibrillation(AF)patients undergoing radiofrequency ablation(RFA),as well as to compare the prognosis of patients with advanced AF to that of the general population.Methods We prospectively recruited AF patients who underwent RFA treatment at Peking University Third Hospital between January 2021 and March 2023.General patient data were collected through the hospital's inpatient system,and MACE were tracked through outpatient visits and telephone follow-ups.Patients were categorized into three age groups:Group 1(under 65 years),Group 2(65 to 75 years),and Group 3(over 75 years).In this study,MACE was defined as include cardiovascular death,all-cause death,readmission for heart failure,acute coronary syndrome(ACS),grade 2 or higher bleeding and stroke.Results A total of 431 patients were included in this study,with an average age of(66.17±12.22)years.Among these patients,259 were male(60.09％),and the mean of CHA2DS2-VASc score was(1.79±1.30).The median follow-up period was 16.0(11.3,21.3)months,during which 28(6.50％)patients experienced MACE,with ACS and stroke being the most common events.Variables were selected using LASSO regression,and a LASSO-Cox regression model was constructed.Age(HR 1.06,95％CI 1.02-1.10,P=0.006)and hypertrophic cardiomyopathy(HR 3.70,95％CI 1.27-8.68,P=0.008)were identified as independent predictors of MACE after RFA for AF.Subgroup analysis revealed that patients under 65 had significantly better prognoses compared to older AF patients(P=0.030 compared with group 2;P=0.021 compared with group 3).Conclusions Age and hypertrophic cardiomyopathy are independent risk factors for MACE in AF patients undergoing RFA.The prognosis for younger patients is better than that for older patients,while the prognosis for advanced patients is comparable to that of patients aged 65-75 years.

Objective:To determine whether the Rb1 of ginsenoside has protective effects on PA induced oxidative stress in endothelial cells.Methods:Established a model of palmitic acid-induced oxidative stress injury in human umbilical vein endothelial cells(HUVECs).Using MTT assay,flow cytometry,fluorescent probe staining,and Western blot analysis to detect whether Rb1 of ginsenoside has effects on the cell viability,apoptosis rate,ROS and NO production,mitochondrial membrane potential,and the expression levels of related proteins.Results:MTT assay and flow cytometry revealed that ginsenoside Rb1 can reduce PA-induced apoptosis in HUVECs(P＜0.05).The mechanism may be related to the following two points:(1)reducing ROS production and increasing NO levels,thereby enhancing the antioxidant capacity of HUVECs;(2)regulating the expression of Bcl-2 family proteins,increasing the BCL-2/Bax ratio(P＜0.05),modulating mitochondrial membrane permeability,reducing cytochrome C release(P＜0.001),and decreasing Caspase protein activation(P＜0.01),thereby attenuating PA-induced apoptosis.Conclusion:After the stimulation with PA,ROS production in human umbilical vein endothelial cells increased while NO content and cell activity decreased,oxidative stress induced apoptosis in cells.By regulating the production of ROS and NOx stabilizing the mitochondrial transmembrane potential,reducing the leakage of cytochrome C,Ginsenoside Rb1 can reduce HUVECs apoptosis induced by PA.

Objective To explore the improvement effect of ultrasound microbubble blasting assisted bone marrow mesenchymal stem cells(BMSC)transplantation on diabetic nephropathy(DN)in terms of inflammatory response and renal function via the Toll like receptor 4(TLR-4)/nuclear factor-kappa B(NF-κB)signaling pathway,as well as its specific mechanism.Methods A rat DN model was estab-lished and randomly grouped into the following:Model group,BMSC group,BMSC+microbubble group,and BMSC+microbubble+TLR-4/NF-κB pathway activator lipopolysaccharide(LPS)group,with 12 rats in each group.Additionally,12 rats were selected as the control(CK)group.Biochemical and biuret analysis,HE and Masson staining,ELISA,and Western blotting testing were employed to detect fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),serum creatinine(sCr),blood urea nitrogen(BUN),24-hour urinary total protein(24 h-UTP),pathological changes in renal tissue,fibrosis status,and the expression of interleukin-1 β(IL-1β),tumor necrosis factorα(TNF-α),TLR-4,and NF-κB proteins of rats in each group.Results The renal tissue in the CK group was structurally normal with few collagen fibers.The Model group showed obvious renal tissue lesions and severe collagen fiber deposition;the lesions in the BMSC group and BMSC+microvesicle group were alleviated in turn,while the lesions were aggravated after the addition of LPS compared with the BMSC+microvesicle group.Compared with the CK group,the levels of FBG,TC,TG,sCr,BUN,24 h-UTP,as well as the expression of IL-1β,TNF-α,TLR-4,and NF-κB proteins were increased in the Model group(P＜0.05).Compared with the Model group,the above-men-tioned indices and protein expression were decreased in the BMSC group(P＜0.05).Compared with the BMSC group,the above-men-tioned indices and protein expression were further decreased in the BMSC+microvesicle group(P＜0.05).Compared with the BMSC+mi-crovesicle group,the above-mentioned indices and protein expression were increased in the BMSC+microvesicle+LPS group(P＜0.05).Conclusion The improvement effect of ultrasound microbubble blasting-assisted BMSC transplantation on DN rats may be related to the inhibition of the TLR-4/NF-κB signaling pathway.

Objective:To investigate the association between high-risk human papillomavirus (hrHPV) persistent infection and vaginal microecology.Methods:A total of 53 women were enrolled in the gynecological clinic of Beijing Obstetrics and Gynecology Hospital from January 2020 to January 2021, including 7 women without HPV and 46 women with hrHPV infection. Among the hrHPV infected women, 24 woemn who did not use any drugs were classified as the observation group and the other 22 women who were given standardized interferon vaginal administration for 3 months were regarded as the treatment group. Vaginal secretions of all women were taken for Gram-stained microecological test at the time of enrollment and at the 4, 8, and 12 month follow-up. HPV turning negative was taken as the end point of follow-up.Results:(1) Women of hrHPV persistent infection in the observation and treatmnet groups had more times of abortions ( P=0.180). (2) The hrHPV negative conversion rate was 17% (4/24) in the observation group and 36% (8/22) in the treatment group, but the difference was not significant ( P=0.183). The median hrHPV negative conversion time were 11.0 months and 7.5 months in the observation and treatment groups, respectively, and the difference was statistically significant ( P=0.001). (3) Vaginal microecology was generally normal at the time of enrollment and at the end of follow-up in women with HPV natural negative conversion in the observation group. While vaginal microecological disorders were more common in women with hrHPV persistent infection in the observation and treatmnet groups, including high vaginal pH value, poor vaginal cleanliness, poor grade of Lactobacillus and increased vaginal clutter bacteria, and the vaginal microecological situation did not improve after the 12-month follow-up. (4) In the treatment group, women who turned HPV negative within six months all had normal vaginal microecology when enrollment (5/5). While those who turned negative six months later had a higher proportion of vaginal clutter bacteria (2/3), a poor grade of Lactobacillus (2/3) and a higher proportion of vaginal dysbiosis (2/3). Conclusions:(1) Interferon therapy could shorten the negative turning time of hrHPV. (2) Women with normal vaginal microecology have the ability to naturally clear hrHPV. (3) The vaginal microecological Gram-stain test has limited value in predicting hrHPV clearance, perhaps due to its inability to detect Lactobacillus subtypes.

Objective:To establish a rat model of vulvovaginal candidiasis (VVC) and to directly observe the histopathological and ultrastructural characteristics of vaginal mucosal barrier after Candida albicans infection and treatment with Lactobacillus crispatus.Methods:Female unmated SD rats were used to establish the VVC model and divided into three groups (normal group, VVC group, and Lactobacillus group; n=6 per group). Lactobacillus group received intravaginal administration of Lactobacillus crispatus suspension, while rats in VVC group and normal group were infused with phosphate buffered solution instead. Vaginal tissues were collected on day 4 post-treatment for HE staining and transmission electron microscopy (to observe ultrastructural pathological changes). Results:The results of HE staining revealed the disruption and desquamation of vaginal epithelium, necrotic epithelial tissues, neutrophil infiltration in Candida albicans-infected rats. Lactobacillus crispatus intervention restored the damaged vaginal mucosal structure (mucosal layers and thickness) to normal levels, mucosal layers of Lactobacillus group and normal group were 9.50±1.38 vs 10.67±1.03 ( P=0.226), mucosal thickness of Lactobacillus group and normal group were (116.50±12.14) vs (130.33±13.91) μm ( P=0.211). The results of transmission electron microscopy revealed intercellular desmosome rupture, loss of microvilli and glycocalyx on superficial cells, and mitochondrial swelling in Candida albicans-infected rats. Lactobacillus crispatus intervention restored the damaged vaginal mucosal ultrastructures (mitochondria and intercellular connections, etc.) to normal levels. Conclusions:Fungal infection severely disrupte the vaginal mucosal barrier in rats. Lactobacillus crispatus could restore the vaginal mucosal barrier and epithelial ultrastructures.

OBJECTIVE T o assess the in vitro antimicrobial activity of aztreonam-avibactam against metallo-β—lacta-mase(MBL)-producing carbapenem-resistant Enterobacteriaceae(CRE)using different antimicrobial susceptibility testing methods,evaluate the consistency of results based on the latest breakpoints recommended by European Committee on Antimicrobial Susceptibility Testing(EUCAST),and analyze the clinical applicability.METHODS The imipenem-or meropenem-resistant Enterobacteriaceae strains were isolated from the clinical specimens of Bei-jing Chaoyang Hospital from Jan.2019 to Mar.2023,MBL-producing CRE were selected after they were con-firmed by colloidal gold immunoassay and Sanger sequencing as the study subjects.The minimum inhibitory con-centrations(MICs)of single aztreonam and aztreonam-avibactam compounds were determined by using broth mi-crodilution method.In addition,the disk diffusion method and the gradient diffusion method were employed to further detect the in vitro susceptibility to aztreonam-avibactam.RESULTS Among the 87 strains of MBL-producing CRE that were included in the study,Escherichia coli was the most common species,accounting for 44.83％.NDM-5 was the predominant carbapenemase type,detected in 48.28％of the isolates.According to the latest EUCAST break-points,6 isolates were aztreonam-avibactam-resistant strains based on broth microdilution method,all of which were E.coli,and the resistance rate was 6.90％(6/87).However,the resistance rate that was determined by the disk diffu-sion method was significantly higher(22.99％,20/87).Among these,14 strains was within the area of technical uncer-tainty/resistant,making result interpretation difficult.In addition,the categorical agreement between the gradient diffu-sion method and the broth microdilution method reached up to 98.85％.CONCLUSIONS Aztreonam-avibactam has high antimicrobial activity against MBL-producing CRE.However,based on the latest EUCAST breakpoints,the antimicrobial susceptibility testing by the disk diffusion method results of some strains are hard to interpret.It is necessary to integrate with other methods for further validation.