ObjectiveTo evaluate the clinical efficacy of Shenqi Yangxin decoction in the treatment of ischemic cardiomyopathy （ICM） with Qi and Yin deficiency and blood stasis syndrome and its effect on serum hydrogen sulfide （H₂S） and calcium ion （Ca²⁺）. MethodsA total of 64 ICM patients with Qi and Yin deficiency and blood stasis syndrome who met the inclusion criteria were randomly divided into a control group （n=32） and a treatment group （n=32）. All patients received conventional Western medicine treatment. The treatment group was additionally given Shenqi Yangxin decoction. The TCM syndrome score， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， left ventricular ejection fraction （LVEF）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， 6-minute walk test （6MWT）， New York Heart Association （NYHA） cardiac function classification， and serum H₂S and Ca²⁺ levels were compared between the two groups pre- and post-treatment. ResultsTwo cases dropped out from each group during the study. Finally， 30 patients in each group were included in the analysis. There were no significant differences in age， gender， course of coronary heart disease， underlying diseases， and laboratory tests between the two groups. Compared with baseline， the TCM syndrome score， MLHFQ score， and NT-proBNP in both treatment group and control group decreased significantly （P<0.01）， LVEF， 6MWT， and H₂S increased significantly （P<0.01）， and serum Ca²⁺ increased （P<0.05）. Compared with the control group after treatment， the MLHFQ score and NT-proBNP in the treatment group decreased （P<0.05）， the TCM syndrome score decreased significantly （P<0.01）， LVEF， 6MWT， and serum Ca²⁺ increased （P<0.05）， and H₂S increased significantly （P<0.01）. The improvement degree of the NYHA cardiac function classification in the treatment group was higher than that in the control group， but there was no significant difference. ConclusionShenqi Yangxin decoction is effective in treating ICM patients with Qi and Yin deficiency and blood stasis， which could significantly improve cardiac function and quality of life， and its therapeutic effect may be related to the regulation of serum H₂S and Ca²⁺ levels.

Objective To explore the prognostic factors for patients with descending duodenum gastrointestinal stromal tumors (GIST), analyze the impact of different surgical approaches on prognosis, and develop a predictive model for surgical approach selection. Methods This single-center retrospective cohort study included patients with primary descending duodenum GIST treated in Zhongshan Hospital, Fudan University from January 2010 to January 2015, with follow-up until August 2025. The primary outcomes were incidence of postoperative complications, disease-free survival (DFS) rate, and overall survival (OS) rate. Cox regression and logistic regression were used to identify factors influencing prognosis and surgical approach selection, respectively. A nomogram model for selecting the surgical approach was constructed. Results A total of 78 patients with descending duodenum GIST were included, with age of (56.14±11.76) years. The 1-, 5-, and 10-year OS rates were 100%, 98.7%, and 85.7%, respectively, and the corresponding DFS rates were 100%, 90.9%, and 82.3%. Intraoperative blood loss, postoperative gastroparesis, mucosal ulceration, maximum tumor diameter, and Ki-67-positive cell ratio were independent risk factors for DFS, while maximum tumor diameter and mitotic figure were independent risk factors for OS (P＜0.05). The 10-year DFS rate was higher in the local resection group than in the pancreaticoduodenectomy group (89.45% vs 74.24%; HR＝0.300, P＝0.013), but there was no statistical difference in OS between the two groups. The incidence of postoperative complications in the pancreaticoduodenectomy group was higher than that in the local resection group (P＜0.001). Maximum tumor diameter and distance from tumor to the duodenal papilla were independent factors influencing surgical approach selection. The nomogram model based on these two indices demonstrated good discrimination and accuracy upon internal validation. Conclusions The long-term prognosis of patients with descending duodenal GIST is favorable, and surgical treatment achieves satisfactory outcomes. The nomogram model developed in this study can effectively guide individualized surgical approach selection and provide a reference for clinical decision-making.

Ischemic stroke （IS） is characterized by a high incidence， a high disability rate， and a high mortality rate. Its pathological mechanism is complex， involving oxidative stress， neuroinflammation， glutamate excitotoxicity， blood-brain barrier （BBB） disruption， abnormal autophagy and apoptosis， energy metabolism disorder， ferroptosis， and cuproptosis. Long-term use of conventional clinical drugs is associated with certain adverse reactions. As a classic Chinese herbal medicine for replenishing Qi， Astragali Radix is widely used in the prevention and treatment of IS. Modern research has confirmed that it contains various active components， including total astragalosides， total polysaccharides， and total flavonoids， which exert cerebroprotective effects by regulating signaling pathways such as nuclear factor erythroid 2-related factor 2/heme oxygenase-1 （Nrf2/HO-1）， nuclear factor-κB （NF-κB）， phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， adenosine monophosphate-activated protein kinase/mammalian target of rapamycin （AMPK/mTOR）. These effects include anti-oxidation， anti-inflammation， inhibition of excitotoxicity， protection of BBB， regulation of autophagy and apoptosis， suppression of ferroptosis， and improvement of energy metabolism. This article systematically reviews the core pathological links of IS， summarizes the cerebroprotective effects of the main active components， classic herb pairs， and representative compound formulas of Astragali Radix， and analyzes their synergistic intervention patterns against the above pathological mechanisms. Furthermore， this paper discusses the current research limitations in clinical translation， material basis， and emerging cell death modalities， along with future perspectives， aiming to provide a theoretical reference for the clinical application of Astragali Radix and its combinations in treating IS and for the development of new drugs.

Objective To analyze the effect of percutaneous transhepatic cholangial drainage(PTCD)combined with percutaneous transhepatic papillary balloon dilation(PTPBD)in the treatment of common bile duct stone in elderly patients.Methods The clinical data of elderly patients treated with PTCD combined with PTPBD under digital subtraction angiography(DSA)for common bile duct stone were retrospectively collected,the changes in liver function,postoperative complications,and prognosis were analyzed.Results All 70 patients were successfully treated with PTCD,and other 3 patients died after PTCD operation,mainly due to severe infection combined with a variety of underlying diseases.Among the remaining 67 patients,65 cases(97.00%)were successfully treated with PTPBD,while other 2 cases(3.00%)experienced technical failure due to excessive stone size(>20 mm).Among the 70 cases after the pro-cedure,there were 5 cases with abdominal pain,2 cases with bleeding,4 cases with fever,and no serious complications occurred,such as bile duct perforation,intestinal perforation,or pancreatitis.The symptoms of 67 patients were improved from 3 to 7 days after PTCD,and the changes in leukocyte,total bilirubin,alanine aminotransferase and C-reactive protein before and after surgery were sta-tistically significant(P<0.05).Conclusion PTCD combined with PTPBD is a minimally invasive treatment method for common bile duct stone with a high success rate,safety,and effectiveness,which is especially suitable for elderly patients with multiple under-lying diseases,an inability to tolerate surgical and endoscopic treatments.It is worthy of clinical promotion and application.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City,and provide a basis for the rational use of antimicrobial agents in such surgeries.Methods Perioperative antimicrobial prophylaxis(PAP)in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively.The prophylactic use rate,types,rationality of selection,and timing of use of antimicrobial agents were analyzed comprehensively.Results From 2017 to 2022,a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City.The PAP rates in tertiary comprehensive hospitals,tertiary specialty hospitals,tertiary traditional Chinese medicine hospitals,and secondary comprehensive hospitals were 4.72％,1.79％,3.22％,and 6.63％,re-spectively.The overall PAP rate showed a yearly decreasing trend,from 6.39％in 2017 to 2.31％in 2021.Among different types of hospitals,the PAP rate in secondary comprehensive hospitals decreased most significantly,from 12.72％in 2017 to 0.53％in 2022.The main types of prophylactic antimicrobial use were first-,second-and third-generation cephalosporins,and quinolones.The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals(17.13％)and lowest in tertiary specialty hospitals(1.08％).The PAP rates in sys-temic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals(88.17％)and lowest in tertiary comprehensive hospitals(71.53％).The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals(80.87％)and lowest in tertiary specialty hospitals(13.26％).Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes.The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved.Enhanced management is necessary to promote more rational use of antimicrobial agents.

Objective:To analyse the clinical effect of percutaneous transhepatic papillary balloon dilatation (PTPBD) combined with lithotriptic basket in the treatment of large-diameter common bile duct stone (CBDS) after percutaneous transhepatic cholangia drainage (PTCD).Methods:The clinical data of 50 patients treated with PTPBD combined with lithotriptic basket after PTCD under digital subtraction angiography (DSA) for large-diameter CBDS in the Department of Interventional Radiology, the Second Affiliated Hospital of Nantong University from October 2021 to September 2024 were retrospectively analyzed, including 38 males and 12 females, aged (57.6±3.6) years. Clinical data, including gender, age, long diameter of the stone, and surgery-related complications, were recorded. Changes in leukocyte count, total bilirubin, alanine transaminase and C-reactive protein were compared before PTCD and on the 5th postoperative day.Results:All 50 cases were successfully treated with PTCD. Significant improvements were observed in white blood cell count [(7.35±2.36)×10 9/L vs. (11.34±2.81)×10 9/L], total bilirubin [(27.58±6.24) μmol/L vs. (74.35±12.26) μmol/L], alanine transaminase [(41.25±8.65) U/L vs. (141.41±29.16) U/L] and C-reactive protein [(39.34±13.45) mg/L vs. (81.43±31.35) mg/L] before and after PTCD (all P<0.001). The time interval between PTCD and PTPBD was (14.46±1.01) d. Among the 50 patients, 48 cases (96.0%) were successfully treated with PTPBD combined with a lithotriptic basket, while 2 cases (4.0%) failed due to the basket's inability to retrieve the stones. Among the 50 patients after PTCD, 2 cases (4.0%) of abdominal pain, 2 cases (4.0%) of bleeding, and 2 cases (4.0%) of fever. Following PTPBD with lithotriptic basket stone removal, abdominal pain occurred in 3 patients (6.0%) and fever in 2 (4.0%). Conclusion:PTPBD combined with lithotriptic basket in the second stage after PTCD under DSA is a minimally invasive treatment for large-diameter CBDS with safety and effectiveness.

Objective:To elucidate the prognostic differences and risk factors associated with different patterns of recurrence and metastasis following pancreatic cancer (PC) resection.Methods:This is a retrospective case series study. Clinicopathological data and follow-up information were retrospectively collected from 210 patients who underwent surgery for PC at the Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, between January 2014 and December 2023. There were 114 males and 96 females; the age was (64.5±10.3) years (range: 29 to 89 years). Survival functions based on different times to recurrence and metastasis and different patterns of recurrence and metastasis were estimated using the Kaplan-Meier method, and survival differences among groups were compared using the Log-rank test. Identifying the optimal cutoff for time to postoperative recurrence/metastasis predicting overall survival (OS) in pancreatic cancer patients via the minimum p-value approach. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS following pancreatectomy.Results:A total of 210 patients met the inclusion and exclusion criteria. Among them, 71 patients remained free of recurrence and metastasis, while 139 developed recurrence and metastasis. The patterns included local recurrence ( n=34), liver metastasis ( n=39), lung metastasis ( n=11), peritoneal metastasis ( n=13), multiple sites metastasis ( n=38), bone metastasis ( n=3), and kidney metastasis ( n=1). OS was significantly shorter in the group with postoperative recurrence and metastasis compared to the group without recurrence/metastasis (23.07 months vs.not reached, P<0.01). The optimal cut-off time distinguishing early from late recurrence and metastasis was 13 months. There was a significant difference in post-recurrence survival between patients with early and late recurrence and metastasis (16.03 months vs. 52.40 months, P=0.009). The Kaplan-Meier survival curve showed that different postoperative recurrence and metastasis patterns had different impacts on OS, with lung metastasis showing the best prognosis compared to local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastasis ( P<0.01). Multivariate Cox analysis revealed that Eastern Cooperative Oncology Group (ECOG) score 1, postoperative carcinoembryonic antigen (CEA) ≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for postoperative recurrence and metastasis (all P<0.05). Conclusions:Considerable prognostic heterogeneity exists in postoperative PC patients depending on the site and pattern of recurrence or metastasis. Specifically, lung metastasis portends a significantly more favorable prognosis than liver metastasis, peritoneal metastasis, local recurrence, or multiple sites metastases. ECOG score 1, postoperative CEA≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for OS in postoperative PC patients.

Objective:To develop a deep learning model based on super-resolution endorectal ultrasound（ERUS）images for the preoperative prediction of perineural invasion（PNI）in patients with rectal cancer，thereby providing a reference for risk stratification and individualized treatment planning.Methods:A retrospective analysis was conducted on 382 patients with rectal cancer who underwent total mesorectal excision at Fujian Medical University Union Hospital between June 2019 and February 2024. Patients were randomly divided into a training set（ n=305）and a test set（ n=77）at a ratio of 8∶2，and further grouped into PNI-negative group and PNI-positive group subgroups based on pathological results. Super-resolution ultrasound images were generated from original ERUS images using a generative adversarial network（GAN）. Deep convolutional neural networks were developed based on features from intratumoral and peritumoral regions to identify the optimal region of interest（ROI）. The dSR5_ResNet18 and dSR5_ResNet50 models were constructed using the super-resolution images with a 5-pixel peritumoral extension. Representative clinical features were selected for subgroup analysis based on sample size and intergroup statistical differences between PNI-positive and PNI-negative patients. Forest plots were used to evaluate model applicability and robustness across subgroups. Results:The dSR5_ResNet18 model，built using super-resolution images of the tumor combined with a 5-pixel peritumoral region，achieved the best predictive performance，with an AUC of 0.867（95% CI=0.782 - 0.952）in the test set. Decision curve analysis demonstrated that the dSR5_ResNet18 model provided the greatest net clinical benefit. Forest plot analysis indicated strong generalizability of the models across subgroups such as pathological N stage，maximum lesion length，and lymph node enlargement，though relatively weaker performance was observed in the carcinoembryonic antigen（CEA）subgroup. Among all models，dSR5_ResNet18 exhibited the most consistent performance across subgroups，with the narrowest confidence intervals and highest robustness. Conclusions:The deep learning model incorporating ERUS-based super-resolution reconstruction demonstrated excellent performance in the preoperative prediction of PNI in rectal cancer. It offers significant advantages in image quality and generalizability，and may serve as a valuable tool to assist clinicians in formulating personalized treatment strategies.

The risk factors for thromboembolism caused by Mycoplasma pneumoniae infection include severe Mycoplasma pneumoniae pneumonia，elevated D-dimer levels，abnormal inflammatory markers，platelet abnormalities，lung consolidation，lung necrosis and pleural effusion，and so on.In terms of treatment，tetracycline and quinolone antibiotics have shown new advantages in addressing the recent prevalence of macrolide resistant mycoplasma.Regarding anticoagulant therapy，direct oral anticoagulants represented by rivaroxaban have significant advantages and are safe in children's medication.In addition，the application of traditional Chinese medicine for promoting blood circulation and removing blood stasis needs to be developed.The identification and intervention of risk factors related to coagulation disorders and thromboembolism caused by Mycoplasma pneumoniae infection can help improve treatment effectiveness.