This paper proposes a two-stage method integrating visual foundation models （VFM） and diffusion models. The segment anything model （SAM） as VFM is combined with the SegRefiner diffusion model to construct the SAM-SegRefiner framework for automated segmentation of edema， inflammation， and thrombus regions in histopathological images of hemorrhoidal tissue， providing a reproducible technical tool for the objective quantification of pathological morphology and its application in traditional Chinese medicine （TCM） syndrome research. Trained and validated on multi-center retrospective data， the SAM-SegRefiner model achieved an average pixel accuracy of 95.32% and a mean intersection over union （mIoU） of 66.81% on an independent test set， significantly outperfor-ming comparative models such as U-Net， MixU-Net， and SAM-Med2D， and also demonstrating robust cross-center generalization capability. Furthermore， by correlating the quantitatively segmented results from the model with the patients' TCM syndrome types， the potential associations between pathomorphological features and TCM syndrome differentiation have been explored. The analysis revealed no statistically significant differences in the degree of inflammatory infiltration and thrombus formation among different syndrome types， suggesting a complex relationship between local pathological changes and systemic syndrome manifestations.

Objective: To evaluate the diagnostic potential of fluid suppression (FS) techniques combined with amide proton transferweighted imaging (APTw) for assessment of isocitrate dehydrogenase (IDH) mutation status, glioma subtypes, and tumor proliferation. Materials and Methods: This retrospective study included 117 patients with adult-type diffuse gliomas. Conventional APTw, FSAPTw, and spillover-corrected FS-APTw (SCFS-APTw) metrics were calculated from 3T MRI data in tumor parenchyma, necrotic or cystic regions, and contralateral normal-appearing white matter. APTw signals were compared across the three techniques within each region, between IDH-mutant and IDH-wildtype gliomas, and among astrocytoma, oligodendroglioma, and glioblastoma subtypes. Diagnostic performance for distinguishing IDH mutation status and glioma subtypes was assessed using receiver operating characteristic (ROC) analysis. Correlations between APTw metrics and Ki-67 expression were also analyzed. Results: Both FS-APTw and SCFS-APTw significantly reduced signal intensity in tumor parenchyma and necrotic or cystic regions, with SCFS-APTw demonstrating a stronger suppression effect. IDH-wildtype gliomas showed significantly higher APTw metrics than IDH-mutant gliomas (all P < 0.001). Glioblastomas exhibited significantly higher metrics than oligodendrogliomas (all corrected P ≤ 0.015) and astrocytomas (all corrected P < 0.001). SCFS-APTw achieved the highest area under the ROC curve (AUC) of 0.846 for identification of IDH mutation status. For differentiation between astrocytomas and glioblastomas, the 90th percentile of APTw yielded the highest AUC (0.860), followed by SCFS-APTw (0.849). For discrimination between oligodendrogliomas and glioblastomas, the highest AUC (0.832) was obtained using the 90th percentile of SCFS-APTw. None of these metrics successfully differentiated oligodendrogliomas from astrocytomas. SCFS-APTw demonstrated the strongest correlation with Ki-67 expression (r = 0.451). Conclusion FS techniques effectively reduce elevated APTw signals originating from fluid compartments. Their combination with APTw imaging enables evaluation of IDH mutation status, glioma subtypes, and tumor proliferative activity in adulttype diffuse gliomas.

Objective To explore the intention of chronic disease patients to use internet hospitals and its influencing factors based on the theory of planned behavior.Methods A convenience sampling survey was conducted using a questionnaire based on theory of planned behavior from July to October 2024.Structural equation modeling was employed to analyze the determinants of behavioral intention.Results The mean behavioral intention score was(96.25±11.62),indicating a moderate-to-high level.Structural equation modeling revealed significantly positive effects of subjective norms(β=0.696,P＜0.05)and perceived behavioral control(β=0.175,P＜0.05)on behavioral intention,while significant negative effects were observed for information risk perception(β=-0.286,P＜0.05)and medical risk perception(β=-0.221,P＜0.05).Conclusion Chronic disease patients demonstrate moderate-to-high intention to use internet hospitals.Key determinants of behavioral intention include subjective norms,perceived behavioral control,information risk perception,and medical risk perception.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent inflammation and joint damage, accompanied by the accumulation of plasma cells, which contributes to its pathogenesis. Understanding the genetic alterations occurring during plasma cell differentiation in RA can deepen our comprehension of its pathogenesis and guide the development of targeted therapeutic interventions. Here, our study elucidates the intricate molecular mechanisms underlying plasma cell differentiation by demonstrating that PRDX1 interacts with DOK3 and modulates its degradation by the autophagy-lysosome pathway. This interaction results in the inhibition of plasma cell differentiation, thereby alleviating the progression of collagen-induced arthritis. Additionally, our investigation identifies Salvianolic acid B (SAB) as a potent small molecular glue-like compound that enhances the interaction between PRDX1 and DOK3, consequently impeding the progression of collagen-induced arthritis by inhibiting plasma cell differentiation. Collectively, these findings underscore the therapeutic potential of developing chemical stabilizers for the PRDX1-DOK3 complex in suppressing plasma cell differentiation for RA treatment and establish a theoretical basis for targeting PRDX1-protein interactions as specific therapeutic targets in various diseases.

OBJECTIVE To investigate the molecular epidemiological characteristics of clinical isolates of carbapen-em-resistant Klebsiella pneumoniae(CRKP)resistant to ceftazidime/avibactam(CZA).METHODS From Jan.2022 to Dec.2023,totally 63 strains of non-repetitive CZA-resistant CRKP that were isolated for the first time from hospitalized patients of the First Affiliated Hospital of Nanchang University were enrolled in the study,and 50 strains of CZA-sensitive CRKP were randomly chosen as the research subjects.The drug susceptibility rates of the strains were observed.The drug resistance genes,virulence genes and capsular serotypes of the strains were detected by means of polymerase chain reaction(PCR).The molecular epidemiological characteristics of the strains were observed by using molecular biological techniques such as pulse field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).RESULTS Among the CZA-resistant CRKP strains,45(71.43％)were iso-lated from sputum.The result of drug susceptibility testing showed that the drug resistance rates of the CZA-re-sistant strains to amikacin,aztreonam and minocycline were lower than those of the CZA-sensitive strains(P＜0.05),and the drug resistance rates of the CZA-resistant strains to tigecycline was higher than that of the CAZ-sensitive strains(P＜0.05).The carrying rates of blaKPC,blaNDM,blaSHV-1,blaTEM-1,blaCTX-M,blaqnrS,blaacc(6')-Ib and blarmtB genes of the CZA-resistant strains were relatively high.Among the detected capsular serotypes,K64(n=18,28.57％)was dominant.ST11(n=25,39.68％)was predominant strain among the CZA-resistant CRKP strains.CONCLUSIONS ST11 is dominant among the CZA-resistant CRKP strains.The strains carry with multiple drug resistance genes and virulence genes.The drug resistance rate of the CZA-resistant strains to tigecycline is higher than that of the CZA-sensitive strains,and it is necessary to attach great importance during the clinical treatment.

Objective:To compare the efficacies of endovascular therapy (EVT) and standard medical therapy in acute ischemic stroke (AIS) patients aged ≥85 years, and analyze the independent influencing factors for poor prognosis of AIS patients after EVT.Methods:Sixty-nine AIS patients aged ≥85 years admitted to Department of Neurology, Xi'an Third Hospital from January 2018 to April 2024, including 40 accepted EVT and 28 accepted standard medicinal therapy, were enrolled. Modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 90 days after onset. General data, prognosis and complications between the EVT group and standard medical therapy group were compared. General data, treatment processes and complications between patients with good prognosis and poor prognosis in the EVT group were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in AIS patients after EVT.Results:Compared with the standard medical therapy, the EVT group had significantly lower NIHSS score at discharge, greater improvement in NIHSS score (NIHSS score at admission-NIHSS score at discharge), lower mRS score 90 days after onset, higher good prognosis rate, lower mortality rate within 90 days of onset, and longer hospital stay ( P<0.05). In the EVT group, 11 patients (27.5%) had good prognosis and 29 patients (72.5%) had poor prognosis 90 days after onset. Compared with the good prognosis group, the poor prognosis group had significantly higher blood glucose level and lower Alberta Stroke Program Early CT Score (ASPECT) on admission ( P<0.05). Multivariate Logistic regression analysis showed that blood glucose on admission ( OR=2.363, 95% CI: 1.134-4.928, P=0.022) and ASPECT score on admission ( OR=0.273, 95% CI: 0.088-0.854, P=0.026) were independent influencing factors for poor prognosis in AIS patients after EVT. Conclusion:AIS patients aged ≥85 years received EVT have better prognosis compared with those accepted standard medical therapy; these patients with high glucose level and low ASPECT score on admission have poor prognosis.

Objective:To investigate brain damage and treatment efficacy in patients with first-episode schizophrenia with comorbid auditory and visual hallucinations and cognitive decline based on brain magnetic resonance imaging (MRI).Methods:This study adopted a retrospective cohort design. Eighty patients with first-episode schizophrenia who received treatment at Wenzhou Seventh People's Hospital from January to June 2024 were included in this study. The patients were divided into an observation group (40 cases of first-episode schizophrenia with comorbid auditory and visual hallucinations) and a control group (40 cases of first-episode schizophrenia without comorbid auditory and visual hallucinations) based on whether they had symptoms of comorbid auditory and visual hallucinations. Forty healthy individuals who concurrently underwent physical examinations were included in the normal group. All patients received standardized treatment. Cranial MRI data were collected from all subjects. Cranial MRI data, Positive and Negative Syndrome Scale (PANSS) score, Global Assessment of Functioning (GAF) score, and changes in cognitive function were compared among the three groups. Additionally, the changes in cranial MRI data, PANSS score, GAF score, and the score of MATRICS Consensus Cognitive Battery (MCCB) in the observation group were compared between before and after treatment.Results:The horizontal distance between the corpus callosum and the underside of the cingulate gyrus, the vertical distance between the corpus callosum and the underside of the cingulate gyrus, and PANSS and GAF scores in the observation group were all significantly higher than those in the normal and control groups (all P < 0.05). The scores on all MCCB scales in the observation group were significantly lower than those in the normal and control groups (all P < 0.05). After treatment, the left horizontal distance between the corpus callosum and the underside of the cingulate gyrus [(5.72 ± 0.71) mm] and the right horizontal distance [(5.13 ± 0.55) mm], as well as the left vertical distance [(6.37 ± 0.69) mm] and the right vertical distance [(5.61 ± 0.67) mm], were all significantly lower than the pre-treatment values [(6.98 ± 0.83) mm, (6.07 ± 0.49) mm, (7.54 ± 0.58) mm, and (6.52 ± 0.51) mm, t = 7.30, 8.07, 8.21, 6.84, all P < 0.05]. Post-treatment PANSS scores [(39.95 ± 6.65)] were significantly lower than pre-treatment scores [(97.47 ± 18.47)], while post-treatment GAF scores [(71.26 ± 8.87)] were significantly higher than pre-treatment scores [(34.68 ± 7.71), t = 18.53, 19.69, both P < 0.05]. Post-treatment scores for the MCCB [(8.57 ± 2.45), (2.25 ± 0.47), (25.16 ± 2.43), (24.10 ± 2.64), (17.08 ± 2.25), (20.43 ± 3.76), (2.07 ± 0.36), (22.16 ± 3.24), (57.81 ± 7.69), (0.28 ± 0.05)] were significantly higher than pre-treatment scores [(5.65 ± 1.37), (1.62 ± 0.34), (21.21 ± 2.27), (20.27 ± 1.78), (12.16 ± 2.08), (14.56 ± 2.34), (1.71 ± 0.25), (17.92 ± 1.64), (40.29 ± 6.56), (0.21 ± 0.03), t = 6.58, 6.87, 7.51, 7.61, 10.15, 8.38, 5.19, 7.38, 10.96, 7.59, all P < 0.05]. Conclusions:The comorbid auditory and visual hallucinations in patients with first-episode schizophrenia, based on brain MRI findings, are closely related to cognitive decline and brain damage. After treatment, both cognitive function and cranial damage in these patients have considerably improved, which is worthy of clinical consideration.

Objective To explore the intention of chronic disease patients to use internet hospitals and its influencing factors based on the theory of planned behavior.Methods A convenience sampling survey was conducted using a questionnaire based on theory of planned behavior from July to October 2024.Structural equation modeling was employed to analyze the determinants of behavioral intention.Results The mean behavioral intention score was(96.25±11.62),indicating a moderate-to-high level.Structural equation modeling revealed significantly positive effects of subjective norms(β=0.696,P＜0.05)and perceived behavioral control(β=0.175,P＜0.05)on behavioral intention,while significant negative effects were observed for information risk perception(β=-0.286,P＜0.05)and medical risk perception(β=-0.221,P＜0.05).Conclusion Chronic disease patients demonstrate moderate-to-high intention to use internet hospitals.Key determinants of behavioral intention include subjective norms,perceived behavioral control,information risk perception,and medical risk perception.

OBJECTIVE To investigate the molecular epidemiological characteristics of clinical isolates of carbapen-em-resistant Klebsiella pneumoniae(CRKP)resistant to ceftazidime/avibactam(CZA).METHODS From Jan.2022 to Dec.2023,totally 63 strains of non-repetitive CZA-resistant CRKP that were isolated for the first time from hospitalized patients of the First Affiliated Hospital of Nanchang University were enrolled in the study,and 50 strains of CZA-sensitive CRKP were randomly chosen as the research subjects.The drug susceptibility rates of the strains were observed.The drug resistance genes,virulence genes and capsular serotypes of the strains were detected by means of polymerase chain reaction(PCR).The molecular epidemiological characteristics of the strains were observed by using molecular biological techniques such as pulse field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).RESULTS Among the CZA-resistant CRKP strains,45(71.43％)were iso-lated from sputum.The result of drug susceptibility testing showed that the drug resistance rates of the CZA-re-sistant strains to amikacin,aztreonam and minocycline were lower than those of the CZA-sensitive strains(P＜0.05),and the drug resistance rates of the CZA-resistant strains to tigecycline was higher than that of the CAZ-sensitive strains(P＜0.05).The carrying rates of blaKPC,blaNDM,blaSHV-1,blaTEM-1,blaCTX-M,blaqnrS,blaacc(6')-Ib and blarmtB genes of the CZA-resistant strains were relatively high.Among the detected capsular serotypes,K64(n=18,28.57％)was dominant.ST11(n=25,39.68％)was predominant strain among the CZA-resistant CRKP strains.CONCLUSIONS ST11 is dominant among the CZA-resistant CRKP strains.The strains carry with multiple drug resistance genes and virulence genes.The drug resistance rate of the CZA-resistant strains to tigecycline is higher than that of the CZA-sensitive strains,and it is necessary to attach great importance during the clinical treatment.

Objective:To investigate brain damage and treatment efficacy in patients with first-episode schizophrenia with comorbid auditory and visual hallucinations and cognitive decline based on brain magnetic resonance imaging (MRI).Methods:This study adopted a retrospective cohort design. Eighty patients with first-episode schizophrenia who received treatment at Wenzhou Seventh People's Hospital from January to June 2024 were included in this study. The patients were divided into an observation group (40 cases of first-episode schizophrenia with comorbid auditory and visual hallucinations) and a control group (40 cases of first-episode schizophrenia without comorbid auditory and visual hallucinations) based on whether they had symptoms of comorbid auditory and visual hallucinations. Forty healthy individuals who concurrently underwent physical examinations were included in the normal group. All patients received standardized treatment. Cranial MRI data were collected from all subjects. Cranial MRI data, Positive and Negative Syndrome Scale (PANSS) score, Global Assessment of Functioning (GAF) score, and changes in cognitive function were compared among the three groups. Additionally, the changes in cranial MRI data, PANSS score, GAF score, and the score of MATRICS Consensus Cognitive Battery (MCCB) in the observation group were compared between before and after treatment.Results:The horizontal distance between the corpus callosum and the underside of the cingulate gyrus, the vertical distance between the corpus callosum and the underside of the cingulate gyrus, and PANSS and GAF scores in the observation group were all significantly higher than those in the normal and control groups (all P < 0.05). The scores on all MCCB scales in the observation group were significantly lower than those in the normal and control groups (all P < 0.05). After treatment, the left horizontal distance between the corpus callosum and the underside of the cingulate gyrus [(5.72 ± 0.71) mm] and the right horizontal distance [(5.13 ± 0.55) mm], as well as the left vertical distance [(6.37 ± 0.69) mm] and the right vertical distance [(5.61 ± 0.67) mm], were all significantly lower than the pre-treatment values [(6.98 ± 0.83) mm, (6.07 ± 0.49) mm, (7.54 ± 0.58) mm, and (6.52 ± 0.51) mm, t = 7.30, 8.07, 8.21, 6.84, all P < 0.05]. Post-treatment PANSS scores [(39.95 ± 6.65)] were significantly lower than pre-treatment scores [(97.47 ± 18.47)], while post-treatment GAF scores [(71.26 ± 8.87)] were significantly higher than pre-treatment scores [(34.68 ± 7.71), t = 18.53, 19.69, both P < 0.05]. Post-treatment scores for the MCCB [(8.57 ± 2.45), (2.25 ± 0.47), (25.16 ± 2.43), (24.10 ± 2.64), (17.08 ± 2.25), (20.43 ± 3.76), (2.07 ± 0.36), (22.16 ± 3.24), (57.81 ± 7.69), (0.28 ± 0.05)] were significantly higher than pre-treatment scores [(5.65 ± 1.37), (1.62 ± 0.34), (21.21 ± 2.27), (20.27 ± 1.78), (12.16 ± 2.08), (14.56 ± 2.34), (1.71 ± 0.25), (17.92 ± 1.64), (40.29 ± 6.56), (0.21 ± 0.03), t = 6.58, 6.87, 7.51, 7.61, 10.15, 8.38, 5.19, 7.38, 10.96, 7.59, all P < 0.05]. Conclusions:The comorbid auditory and visual hallucinations in patients with first-episode schizophrenia, based on brain MRI findings, are closely related to cognitive decline and brain damage. After treatment, both cognitive function and cranial damage in these patients have considerably improved, which is worthy of clinical consideration.