Background: Chinese herbal pieces are an essential component of traditional Chinese medicine. Accurate identification and classification of these materials are crucial in clinical practice. Objective: This study aims to enhance the recognition efficiency of Chinese herbal pieces using deep learning technology, while addressing the limitations of traditional manual classification methods in terms of both quality and efficiency. Methods: A comprehensive dataset containing 201 types of Chinese herbal pieces was established. Based on Real-time Detection Transformer (RT-DETR), we designed and integrated a Feature-focused Diffusion Network (FDN), resulting in an improved model termed RT-DETR-FDN. The proposed FDN includes a Feature-focus Module and a feature diffusion mechanism, enabling the model to capture more extensive feature information from Chinese herbal pieces and diffuse it across multiple detection scales. Results: Experimental results show that RT-DETR-FDN achieved a precision of 0.925, a recall of 0.943, and an mAP50-95 of 0.851. In addition, the model was compared with representative You Only Look Once series models commonly used in object detection. Compared with these models, RT-DETR-FDN achieved higher recognition accuracy while maintaining a lightweight architecture. Conclusion: This study integrates deep learning with traditional Chinese medicine, providing a more effective solution for the recognition of Chinese herbal pieces.

OBJECTIVE To investigate the risk factors for sodium valproate （VPA）-induced hyperammonemia in neurocritical patients， and to construct a risk prediction model. METHODS Clinical data were retrospectively collected from 172 neurocritical patients who received VPA treatment in the Department of Critical Care Medicine， the Fourth Affiliated Hospital of Soochow University from January 2022 to June 2025. Patients were divided into the hyperammonemia group （73 cases） and the normal group （99 cases） based on their blood ammonia levels. Univariate analysis and LASSO regression analysis were used to screen for predictive variables. Independent factors were identified through multivariate Logistic regression analysis， and a nomogram was constructed accordingly. The performance of the model was evaluated using receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis （DCA）. RESULTS Combination of univariate analysis and LASSO regression analysis screened out seven predictive variables： body mass index （BMI）≥24.0 kg/m 2 ， concomitant use of benzodiazepines， VPA blood concentration， hemoglobin， serum urea， average daily VPA dose， and albumin. Multivariate Logistic regression analysis showed that concomitant use of benzodiazepines， BMI≥24.0 kg/m 2 ， VPA blood concentration， albumin and serum urea level （with odds ratios of 1.615， 1.538， 1.623， 1.942 and 0.637， respectively； 95% confidence intervals of 1.128-2.359， 1.059-2.251， 1.112-2.431， 1.106-3.598 and 0.402-0.980， respectively） were all significantly associated with VPA-induced hyperammonemia in neurocritical patients （ P ＜0.05）. The nomogram prediction model constructed based on these variables was evaluated， showing that the area under the ROC curve was 0.810 for the test set and 0.844 for the validation set. The calibration curves closely approximated t he actual curves， and the application of this model could improve the clinical net benefit. CONCLUSIONS Concomitant use of benzodiazepines， BMI≥24.0 kg/m 2 ， high VPA blood concentration and high albumin level are independent risk factors for VPA-induced hyperammonemia in neurocritical patients， while high serum urea level is an independent protective factor. The risk prediction model constructed based on these factors exhibits good discrimination， consistency， and clinical applicability， making it applicable for predicting the risk of VPA-induced hyperammonemia in neurocritical patients.

Objective To investigate the effect of berberine and its mechanism in delaying silica-induced lung injury via network pharmacology and molecular docking, followed by verification with animal experiments. Methods i) Targets of berberine and silicosis were obtained from multiple databases, and the common targets were identified. A protein-protein interaction network was constructed using the STRING database, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on the common targets via the DAVID database. Molecular docking was conducted using AutoDock software for validation. ii) Specific pathogen-free Wistar rats were randomly divided into five groups, with six rats in each group. Rats in the model group, pirfenidone group, and low- and high-dose berberine groups received a single non-exposure intratracheal instillation of 1.00 mL silica suspension at a mass concentration of 100 g/L, whereas rats in the control group received an equal volume of 0.9% sodium chloride solution. Rats in the pirfenidone group were administered with pirfenidone solution at a dose of 100 mg/kg body weight, and rats in the low- and high-dose berberine groups were administered with berberine solutions at doses of 100 and 200 mg/kg body weight, respectively. The remaining two groups received equal volumes of 0.9% sodium chloride solution. All treatments were administered by gavage once daily for 28 consecutive days from 24 hours after silica exposure. After intervention, rats in each group were sacrificed. Histopathological changes in lung tissues were observed, and the lung organ coefficient was detected. Serum malondialdehyde (MDA) was detected by colorimetry. Serum inflammatory cytokine were detected by enzyme-linked immunosorbent assay. The expression of fibrosis markers in lung tissues was detected by immunohistochemistry. The protein expression of phosphatidylinositol 3-kinase (PI3K), protein kinase B (AKT), and phosphorylated AKT (p-AKT) in lung tissues was determined by Western blot. Results i) Network pharmacology analysis identified 46 potential targets. The core targets included AKT1, tumor protein p53, caspase-3, matrix metalloproteinase-9, and albumin. GO enrichment analysis revealed that the targets related to the anti-fibrotic effect of berberine against silicosis were mainly enriched in biological processes including signal transduction, negative regulation of apoptosis, extracellular matrix degradation, and response to reactive oxygen species. KEGG enrichment analysis showed that berberine exerted anti-silicosis effects through multiple signaling pathways, such as the PI3K/AKT pathway, hypoxia-inducible factor-1 pathway, and advanced glycation end product (AGE)-receptor for AGE pathway. ii) Histopathological examination revealed that rats in the model group presented typical pulmonary fibrotic lesions. Pathological lung injury of rats was alleviated in all three intervention groups (pirfenidone group, low- and high-dose berberine group) compared with the model group. The improvement in the high-dose berberine group was superior to that in the low-dose berberine group and was comparable with that in the pirfenidone group. rats in the model group showed increased lung organ coefficient, serum MDA, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) (all P<0.05), as well as increased expression of typeⅠcollagen (COLⅠ), α-smooth muscle actin (α-SMA) and PI3K, and p-AKT/AKT ratio in lung tissues (all P<0.05) when compared with the control group. The above indicators were lower in rats in both the low- and high-dose berberine groups than those in the model group (all P<0.05). Serum MDA, IL-1β, and TNF-α, as well as relative expression of COLⅠ and α-SMA in lung tissues, were lower in the high-dose berberine group than in the low-dose berberine group (all P<0.05). Conclusion Berberine may alleviate pulmonary inflammation and fibrosis in rats through regulation of the PI3K/AKT signaling pathway, thereby delaying the progression of silicosis.

Objective: To evaluate the in vitro procoagulant efficacy and in vivo potential thrombogenic risk of self-prepared activated prothrombin complex concentrate (aPCC). Methods: The preparation was administered at a dose of 0.5 IU per milliliter of plasma. For in vitro assays, the self-prepared aPCC concentrate was added to plasma spiked with factorⅧ (FⅧ) inhibitors. Calibrated automated thrombin generation (CAT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (Fib) quantification were performed. Normal saline and FEIBA were set as controls to evaluate the procoagulant capacity of the self-prepared aPCC concentrate. For in vivo animal studies, the self-prepared aPCC concentrate was injected into rats via the jugular vein. A ferric chloride (FeCl3) filter paper patch was applied to induce carotid arterial thrombosis. Laser speckle blood flow imaging was used to continuously monitor thrombus formation in the rat carotid artery. Plasma samples were collected from rats for CAT, PT, APTT, TT and Fib testing, with normal saline and FEIBA as controls to evaluate the potential thrombogenic risk of the self-prepared aPCC concentrate. Results: Supplementation with aPCC significantly shortened APTT and PT values in inhibitor-spiked plasma (all P<0.001). There were no statistically significant differences in APTT and PT between FEIBA and self-prepared aPCC (P>0.05). CAT results demonstrated that adding aPCC to inhibitor-containing plasma markedly increased endoge-nous thrombin potential (ETP) and peak thrombin concentration (Peak) (P<0.001), with both parameters higher than those of normal plasma (P<0.05). No significant intergroup difference in ETP was observed between self-prepared aPCC and FEIBA (P>0.05). Carotid blood flow imaging in rats revealed that, compared with FEIBA , thrombi induced by self-prepared aPCC were smaller and less stable, and all underwent spontaneous lysis, accompanied by better restoration of carotid blood perfusion. Conclusion: The self-prepared aPCC restores coagulation function in inhibitor-spiked plasma to a comparable extent as FEIBA , while exhibiting a lower thrombogenic risk.

Objective: To investigate the associations of sleep quality and weight stigma with depressive mood among college students, so as to provide evidence for mental health promotion in higher education institutions. Methods: From September to November 2024, a stratified cluster random sampling method was used to survey 4 524 undergraduate students from the first to third year in comprehensive universities across various cities in Inner Mongolia. The χ 2 test was used to compare the detection rates of poor sleep quality, experiences of weight stigma, and depressive mood among students with different characteristics, and multivariate Logistic regression analysis was conducted to examine the independent and combined associations between sleep quality, the number of types of weight stigma experienced, and depressive mood. Results: Among students, the detection rate of poor sleep quality was 21.60%; those with experiences of weight stigma had a detection rate of 11.52%; those with depressive mood had a detection rate of 9.46%. Multivariate Logistic regression analysis showed that, compared with those who had good sleep quality, individuals with poor sleep quality were more likely to experience depressive mood [ OR (95% CI )=2.99(2.41- 3.71 )]; compared with those who had no experience of weight stigma, individuals who experienced ≥2 types of weight stigma were more likely to experience depressive mood [ OR (95% CI )=4.51(2.82-7.22)] (both P <0.01). Multivariate Logistic regression analysis, with "good sleep quality and no weight stigma experience" as the reference group, showed that all other joint groups had a higher likelihood of developing depressive mood, with the highest likelihood observed among students who had poor sleep quality and had experienced ≥2 types of weight stigma [ OR (95% CI )=14.21(6.95-29.06), P <0.01]. Conclusions Poor sleep quality and a greater number of weight stigma types are both associated with depressive mood among college students. Mental health programs in higher education institutions should simultaneously address students sleep problems and weight related adverse experiences, and implement comprehensive interventions.

Autoimmune hepatitis (AIH) is a kind of immune-mediated chronic liver disease, and its specific pathogenesis has not yet been fully elucidated. In recent years, the International Autoimmune Hepatitis Expert Group has revised histology and autoantibody evaluation criteria for diagnosing AIH and has clarified the definition of treatment response. The current standard treatment regimen is still glucocorticoids and azathioprine, but novel biological agents offer new therapeutic options for patients with refractory AIH. This article reviews the new progress in the diagnosis and treatment of AIH and explores the current challenges and future research directions.

Objective To observe the value of neurite orientation dispersion and density imaging(NODDI)for diagnosing unilateral temporal lobe epilepsy(TLE)complicated with hippocampal sclerosis(HS)(TLE-HS).Methods Brain diffusion kurtosis imaging(DKI),3D T1WI and 3D fluid attenuated inversion recovery(FLAIR)sequence images were prospectively collected in 55 patients with unilateral TLE-HS(TLE-HS group)and 55 healthy controls(HC group),and NODDI parameter maps were acquired.The hippocampus NODDI parameters values and FLAIR signal intensity were compared among the affected side,the healthy side in TLE-HS group and HC group,as well as between each two,and their value for diagnosing unilateral TLE-HS were analyzed.Results Significant differences of hippocampus intracellular volume fraction(ICVF),isotropic volume fraction(ISOVF),orientation dispersion index(ODI)values and FLAIR signal intensity were found among the affected side,the healthy side in TLE-HS group and HC group(all P＜0.05).There were significant differences of ICVF,ISOVF and ODI values between the affected side and the healthy side in TLE-HS group(all P＜0.05),of ICVF,ISOVF,ODI values and FLAIR signal intensity between the affected side in TLE-HS group and HC group(all P＜0.05),and of ISOVF values and FLAIR signal intensity between the healthy side in TLE-HS group and HC group(both P＜0.05).The area under the curve(AUC)of ICVF,ISOVF,ODI and their combination for differentiating the affected side and the healthy side of TLE-HS was 0.913,0.712,0.912 and 0.964,for differentiating the affected side of TLE-HS and HC was 0.940,0.822,0.871 and 0.971,respectively,and the combination both had the highest AUC(both P＜0.05).The AUC of ISOVF,ODI and their combination for differentiating the healthy side of TLE-HS and HC was 0.666,0.630 and 0.744,respectively,being not significant different(all P＞0.05).The AUC of FLAIR signal intensity for differentiating the affected side and the healthy side of TLE-HS,the affected side of TLE-HS and HC,the healthy side of TLE-HS and HC was 0.627,0.756 and 0.653,respectively.Conclusion Bilateral hippocampus NODDI parameters were helpful for diagnosing unilateral TLE-HS,which might be superior to commonly used FLAIR sequence.

Objective To investigate the correlation of vascular senescence indicators,brachial-ankle pulse wave velocity(baPWV),cardio-ankle vascular index(CAVI),ankle-brachial index(ABI)with total burden of MRI in patients with cerebral small vessel disease(CSVD).Methods A total of 200 CSVD patients admitted to our hospital from November 2023 to October 2024 were retrospectively recruited,and based on their total MRI burden,they were divided into a low-burden group(score:0-1,103 cases)and a high-burden group(score:2-4,97 cases).A athero-sclerosis monitoring device(VS-1500A)was used to detect baPWV,CAVI,and ABI values.The relationships of the three indicators with total MRI burden score and their predictive values for the burden score were analyzed.Results The high-burden group had significantly higher BMI,el-evated homocysteine and uric acid levels,and increased baPWV and CAVI,but lower ABI than the low-burden group(P＜0.01).Multivariate logistic analysis showed that baPWV,CAVI and ABI were independent influencing factors for high MRI burden of CSVD patients.Spearman correlation analysis showed that baPWV and CAVI values were positively correlated(r=0.589,P=0.000;r=0.458,P=0.000),and ABI was negatively correlated with the total MRI burden score of CSVD patients(r=-0.352,P=0.000).ROC curve analysis showed that baPWV(AUC=0.816,P=0.000),CAVI(AUC=0.725,P=0.000)and ABI(AUC=0.676,P=0.000)were all predic-tors for high MRI burden score in CSVD patients.Conclusion baPWV and CAVI are positively,and ABI is negatively correlated with the total MRI burden score of CSVD patients.baPWV,CAVI and ABI show higher predictive value for the high burden score,with baPWV most significant.

Objective To explore the predictive value of inflammatory burden index(IBI)combined with pregnancy-associated plasma protein-A(PAPP-A)for asymptomatic missed abortion.Methods A total of 108 asymptomatic women with missed abortions admitted to Northwest Women's and Children's Hospital from January 2020 to January 2023 were selected as the study group,and another 100 healthy pregnant women who were examined in the hospital during the same period were selected as the control group.The levels of C-reac-tive protein,neutrophils,lymphocytes,and PAPP-A of all research subjects were detected,and IBI was calcu-lated.The receiver operating characteristic curve was plotted to analyze the predictive value of IBI combined with PAPP-A for asymptomatic isolated abortion,and to explore the influencing factors of asymptomatic iso-lated abortion.Results The IBI of the study group was higher than that of the control group,and the PAPP-A was lower than that of the control group,the difference was statistically significant(P<0.05).The area under the curve(AUC)of the combined prediction of asymptomatic missed abortion by IBI and PAPP-A was higher than AUC predicted by IBI and PAPP-A alone(Z=9.251,10.030,P<0.001).There were statistically significant differences in the proportions of smoking history,drinking history,intrauterine operation history and reproductive tract infection between the study group and the control group(P<0.05).The results of multivariate Logistic regression analysis showed that smoking history,drinking history,intrauterine operation history,reproductive tract infection,and IBI were risk factors for asymptomatic missed abortion,while PAPP-A was a protective factor for asymptomatic missed abortion(P<0.05).Conclusion IBI combined with PAPP-A has certain clinical value in predicting asymptomatic missed abortion.

Objective To investigate the effectiveness of a higher-order thinking-oriented BOPPPS-based blended teach-ing model in otolaryngology-head and neck surgery education,focusing on its impact on the academic performance and teaching satisfaction of undergraduate clinical medicine students.Methods A total of 199 undergraduate clinical medicine students from Guangzhou Medical University were enrolled,divided into a control group(2021-2022 academic year,n=118)and an experi-mental group(2022-2023 academic year,n=81).The control group received conventional blended teaching via Chaoxing plat-form combined with case discussions,while the experimental group implemented the BOPPPS-integrated blended teaching model.Results Students in the experimental group achieved significantly higher average scores than the control group(Δ=11.71 points),with the excellent rate increasing from 0% to 11.1% and the failure rate decreasing to 1.2% .Additionally,the experi-mental group reported high satisfaction with the BOPPPS-integrated blended teaching model,with an overall satisfaction rate of 80.25%.Furthermore,54.32% of students expressed a preference for blended teaching approaches.Students widely acknowl-edged that this model facilitated flexible knowledge application.Conclusion The BOPPPS-integrated blended teaching model ef-fectively enhances the academic performance and teaching satisfaction of undergraduate clinical medicine students,providing a valuable reference for medical education reform oriented toward fostering higher-order thinking and clinical competency.