OBJECTIVE To observe the expressions of transforming growth factor-β1(TGF-β1)/Smads signaling pathways in the primary nephrotic syndrome(NS)patients complicated with pulmonary infection and analyze the values in diagnosis of pulmonary infection and assessment of illness condition.METHODS A total of 108 NS pa-tients complicated with pulmonary infection who were treated in Huaihe Hospital of Henan University from Jan.2020 to Mar.2024 were assigned as the infection group and were divided into the mild group with 32 cases and the severe group with 76 cases according to the severity of pulmonary infection.The distribution of the pathogens was analyzed.Meanwhile,97 NS patients who were not complicated with pulmonary infection were chosen as the no infection group.The relative expression levels of peripheral blood TGF-β1,Smad2,Smad3 mRNA and proteins were detected for the patients confirmed with infection within 24 hours(for the patients with infection within 24 hours after the admission)by means of real-time fluorescent quantitative polymerase chain reaction.The values of the three indexes in diagnosis of the pulmonary infection and assessment of illness condition of the NS patients were analyzed.RESULTS Totally 122 strains of pathogens were isolated from sputum specimens of the 108 NS pa-tients complicated with pulmonary infection,78.69％of which were gram-negative bacteria.The relative expres-sion levels of TGF-β1,Smad2,Smad3 mRNA and proteins of the infection group were respectively 8.69±1.33,6.07±0.75 and 5.94±0.88,higher than 3.76±0.3,2.38±0.24 and 3.15±0.35 of the no infection group(P＜0.05);the levels of the indexes of the severe group were higher than those of the mild group(P＜0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the joint detection of TGF-β1,Smad2 and Smad3 was 0.972 in diagnosis of the pulmonary infection in the NS patients,0.912 in as-sessment of the severe pulmonary infection.CONCLUSIONS The NS patients complicated with pulmonary infection show remarkable rise of expressions of TGF-β1,Smad2 and Smad3.The joint detection of the above indexes has high clinical value in diagnosis of the pulmonary infection and assessment of illness condition.

Objective:To analyze the association between healthcare workers mental health,institu-tional supplies and facilities,inter-organizational coordination during infectious disease outbreaks,and the healthcare institution resilience.Methods:An online questionnaire survey was conducted among the healthcare workforce from 146 institutions in Beijing from January 13,2023 to February 9,2023,and a total of 1 434 eligible respondents were included.The sample comprised 408 responses from tertiary hos-pitals,117 from secondary hospitals,and 909 from primary care institutions.The resilience indicator for healthcare institutions was defined as the degree to which medical services met patient demands,with in-fluencing factors including physical factors,such as material shortages and facility space adaptation or ex-pansion,organizational factors such as information sharing and patient referral,and psychological factors were evaluated using job satisfaction(extrinsic satisfaction,intrinsic satisfaction),burnout(emotional exhaustion,depersonalization,reduced personal accomplishment),and depression status.Ordered mul-ticlassification Logistic regression was used to examine the impact of various factors on the degree to which healthcare services met patient needs;additionally,demographic factors that might influence institutional resilience were controlled.Results:During the emergency response phase,93％of hospitals maintained the capacity to meet patient needs,though tertiary hospitals demonstrated significantly higher rates of service inadequacy(21.05％).Material shortages were reported across all institutions,with tertiary hos-pitals experiencing more frequent multi-item shortages.Inter-institutional collaboration patterns revealed substantial variation:87.50％of primary care facilities,42.86％of secondary hospitals,and 31.58％of tertiary hospitals.Healthcare workers across all levels reported mild depressive symptoms and moderate-to-severe burnout levels.Regression analysis showed high satisfaction(overall satisfaction β=0.04,ex-trinsic satisfaction β=0.06,and intrinsic satisfaction β=0.08),low degree of job burnout(emotional exhaustion β=-0.04,depersonalization β=-0.07 and reduced personal accomplishment β=0.01),low degree of depression(β=-0.06)were significantly associated with higher healthcare institution re-silience.In addition,material shortages were significantly associated with lower resilience,and renova-tion and expansion of treatment spaces,and information sharing,were all associated with higher resilience.Demographic factors(age,gender,marital status,educational background,etc.)had no sig-nificant impact on resilience.Conclusion:Mental health status significantly influences healthcare institu-tion resilience.As human resources constitute the core asset of healthcare institutions,strategic optimiza-tion of workforce allocation and psychological support interventions can effectively strengthen resilience.Moreover,healthcare institution resilience is positively impacted by orderly material supply chains,timely resource distribution,and adaptive reconfiguration of clinical spaces.Finally,facilitating information sharing also enhances institutional resilience.

OBJECTIVE To observe the expressions of transforming growth factor-β1(TGF-β1)/Smads signaling pathways in the primary nephrotic syndrome(NS)patients complicated with pulmonary infection and analyze the values in diagnosis of pulmonary infection and assessment of illness condition.METHODS A total of 108 NS pa-tients complicated with pulmonary infection who were treated in Huaihe Hospital of Henan University from Jan.2020 to Mar.2024 were assigned as the infection group and were divided into the mild group with 32 cases and the severe group with 76 cases according to the severity of pulmonary infection.The distribution of the pathogens was analyzed.Meanwhile,97 NS patients who were not complicated with pulmonary infection were chosen as the no infection group.The relative expression levels of peripheral blood TGF-β1,Smad2,Smad3 mRNA and proteins were detected for the patients confirmed with infection within 24 hours(for the patients with infection within 24 hours after the admission)by means of real-time fluorescent quantitative polymerase chain reaction.The values of the three indexes in diagnosis of the pulmonary infection and assessment of illness condition of the NS patients were analyzed.RESULTS Totally 122 strains of pathogens were isolated from sputum specimens of the 108 NS pa-tients complicated with pulmonary infection,78.69％of which were gram-negative bacteria.The relative expres-sion levels of TGF-β1,Smad2,Smad3 mRNA and proteins of the infection group were respectively 8.69±1.33,6.07±0.75 and 5.94±0.88,higher than 3.76±0.3,2.38±0.24 and 3.15±0.35 of the no infection group(P＜0.05);the levels of the indexes of the severe group were higher than those of the mild group(P＜0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the joint detection of TGF-β1,Smad2 and Smad3 was 0.972 in diagnosis of the pulmonary infection in the NS patients,0.912 in as-sessment of the severe pulmonary infection.CONCLUSIONS The NS patients complicated with pulmonary infection show remarkable rise of expressions of TGF-β1,Smad2 and Smad3.The joint detection of the above indexes has high clinical value in diagnosis of the pulmonary infection and assessment of illness condition.

AIM:To exploring the mechanism of Xin Mai Jia(XMJ)in inhibiting hypertensive cardiac hypertrophy through network pharmacology and animal experiments.METHODS:Retrieving the ac-tive ingredients and target points of XMJ by search-ing the TCMSP database and related literature re-ports;using the Gene Cards,OMIM,and Drug Bank databases to screen targets for hypertensive cardi-ac hypertrophy;constructing a network of tradi-tional Chinese medicine-active ingredients-poten-tial targets and a protein-protein interaction(PPI)network;using DAVID software for target gene on-tology(GO)functional enrichment analysis and Kyo-to Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis;using Auto Dock soft-ware for molecular docking.A spontaneously hy-pertensive rat(SHR)model was established,and hematoxylin-eosin(HE)staining was used to detect the morphology of cardiac tissue and cellular hy-pertrophy,Masson staining was used to detect col-lagen deposition in cardiac tissue,and Western blot to detect the expression of heat shock protein(HSP90AA1),mammalian target of rapamycin(mTOR),peroxisome proliferator-activated receptor y(PPARG),and tumor necrosis factor(TNF-α)in car-diac tissue.RESULTS:A total of 56 potential active ingredients were identified in XMJ,and 5,492 tar-gets related to hypertensive cardiac hypertrophy were obtained.The targets in the core network were ranked according to their Degree values,and four main targets were selected:HSP90AA1,mTOR,PPARG,and TNF-α.The results of HE staining showed that compared with the normal group,the average area of cardiomyocytes in the SHR group increased significantly(P＜0.05),while there was no significant change in the XMJ group.The hypertro-phy in the SHR+XMJ group was significantly alleviat-ed(P＜0.05).The results of Masson staining showed that compared with the normal group,the levels of interstitial fibrosis and perivascular fibrosis in the SHR group rats increased significantly(P＜0.01),and XMJ could significantly reduce the fibrosis levels in the SHR group rats(P＜0.01).The results of Western blot showed that compared with the normal group rats,the expression of HSP90AA1 and PPARG in the myocardial tissue of SHR group rats was downregu-lated,mTOR phosphorylation was downregulated,and TNF-α was significantly upregulated(P＜0.01).In the SHR+XMJ group,the expression of HSP90AA1,PPARG,and TNF-α in the myocardial tis-sue of rats returned to normal levels,and mTOR phosphorylation returned to normal levels.In the XMJ group,there were no significant changes in the above indicators compared with the normal group rats.CONCLUSION:The mechanism underly-ing the inhibitory effect of XMJ on myocardial cell hypertrophy in hypertension involves a comprehen-sive action through multiple components,multiple targets,and multiple pathways.

Objective:To develop and evaluate a deep learning-based automatic measurement model for panoramic ultrasound biomicroscopy (UBM) images.Methods:A diagnostic test study was conducted.Preoperative UBM examination results of 372 patients who underwent implantable collamer lens (ICL) implantation were collected at the Eye Center of Renmin Hospital of Wuhan University between February 2021 and March 2023.A total of 1 368 panoramic UBM images were obtained to establish an image database.The dataset was divided into a training set (760 images), a validation set (86 images) and an internal test set (522 images).An expert panel consisting of three ophthalmologists annotated the images.The UNet+ + network was used to automatically segment anterior segment tissues, such as the cornea, lens and iris.In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA) and sulcus-to-sulcus distance (STS) to complete the measurement of these parameters.Additionally, 480 panoramic UBM images of 135 patients (240 eyes) from Aier Eye Hospital of Wuhan University were used as an external test set to further evaluate the performance of the model in different centers.The consistency between the measurements from the model and expert panel, the Pentacam system was assessed.Finally, 150 images were randomly selected from the external test set for a human-machine comparison to further evaluate the model's performance.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY-2022-K109) and Aier eye Hospital of Wuhan University (No.2023IRBKY120903).Written informed consent was obtained from each subject.Results:In the internal test dataset and external test dataset, with manual labeling as the reference standard, the model achieved a mean Dice coefficient of not less than 0.882.At least 95.65% of the anatomical landmark localization results had Euclidean distance differences within 250 μm.The intraclass correlation coefficients (ICCs) for the measurements of PD, ACD, angle-to-angle ATA, and STS were at least 0.958, with mean relative errors not exceeding 2.407%.With the Pentacam measurements as the reference standard, the ICCs for PD in the internal and external test sets were 0.540 and 0.466, respectively, while the ICCs for ACD were 0.946 and 0.908, respectively.In the human-machine comparison, the ICCs between the model's measurements and those of senior experts were all not lower than 0.969.Conclusions:The deep learning-based model can automatically measure anterior segment parameters from preoperative panoramic UBM images of patients undergoing ICL surgery.The model demonstrates a consistency comparable to that of senior experts, while providing higher efficiency.In terms of ACD measurement, the model shows good agreement between the measurements obtained from the model and Pentacam system.

This study was aimed at exploring the prevalence and drug sensitivity of Gordonia strains isolated from sputum samples in Henan Province,to provide data to aid in the prevention and treatment of Gordonia infection.A combination of 16S rDNA and sec A1 gene sequencing was used to identify the isolated strains,and susceptibility to16 drugs was determined with the broth microdilution method.A total of 21 strains were identified through 16S rDNA gene and sec A1 gene sequencing,including five strains of Gordonia broncians,eight strains of Gordonia paraphernivans,seven strains of Gordonia sputi,and one strain of Gordonia aichiensis.Drug sensi-tivity testing showed high Gordonia sensitivity to drugs such as ceftriaxone,linezolid,doxycycline,amoxicillin/clavulanic acid,mino-cycline,cefotaxime,trimethoprim/sulfamethoxazole,imipenem,tobramycin,and clarithromycin.The sensitivity rates of the isolated strains were 90.48%(19/21),100%(21/21),90.48%(19/21),90.48%(19/21),95.24%(20/21),90.48%(19/21),90.48%(19/21),90.48%(19/21),and 95.24%(20/21),respectively.Gordonia showed high resistance to rifampicin and cefepime,with rates of 28.57%(6/21)and 19.05%(4/21),respectively.Meanwhile,the resistance varied among bacterial strains.The resistance rate of G.sputi to rifampicin reached 71.43%(5/7),whereas that of G.parapffinivoras to cefepime was 37.5%(3/8).The main species of Gordo-nia isolated from sputum samples of patients in Henan Province were G.bronchialis,G.paraffinivoras,G.sputi,and G.aichiensis.Drug sensitivity tests indicated that drugs including amoxicillin/clavulanic acid,ceftriaxone,cefotaxime,tobramycin,clarithromycin,mi-nocycline,trimethoprim/sulfamethoxazole,linezolid,and doxycycline had good antibacterial effects against Gordonia.

Objective:To develop and evaluate a deep learning-based automatic measurement model for panoramic ultrasound biomicroscopy (UBM) images.Methods:A diagnostic test study was conducted.Preoperative UBM examination results of 372 patients who underwent implantable collamer lens (ICL) implantation were collected at the Eye Center of Renmin Hospital of Wuhan University between February 2021 and March 2023.A total of 1 368 panoramic UBM images were obtained to establish an image database.The dataset was divided into a training set (760 images), a validation set (86 images) and an internal test set (522 images).An expert panel consisting of three ophthalmologists annotated the images.The UNet+ + network was used to automatically segment anterior segment tissues, such as the cornea, lens and iris.In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA) and sulcus-to-sulcus distance (STS) to complete the measurement of these parameters.Additionally, 480 panoramic UBM images of 135 patients (240 eyes) from Aier Eye Hospital of Wuhan University were used as an external test set to further evaluate the performance of the model in different centers.The consistency between the measurements from the model and expert panel, the Pentacam system was assessed.Finally, 150 images were randomly selected from the external test set for a human-machine comparison to further evaluate the model's performance.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY-2022-K109) and Aier eye Hospital of Wuhan University (No.2023IRBKY120903).Written informed consent was obtained from each subject.Results:In the internal test dataset and external test dataset, with manual labeling as the reference standard, the model achieved a mean Dice coefficient of not less than 0.882.At least 95.65% of the anatomical landmark localization results had Euclidean distance differences within 250 μm.The intraclass correlation coefficients (ICCs) for the measurements of PD, ACD, angle-to-angle ATA, and STS were at least 0.958, with mean relative errors not exceeding 2.407%.With the Pentacam measurements as the reference standard, the ICCs for PD in the internal and external test sets were 0.540 and 0.466, respectively, while the ICCs for ACD were 0.946 and 0.908, respectively.In the human-machine comparison, the ICCs between the model's measurements and those of senior experts were all not lower than 0.969.Conclusions:The deep learning-based model can automatically measure anterior segment parameters from preoperative panoramic UBM images of patients undergoing ICL surgery.The model demonstrates a consistency comparable to that of senior experts, while providing higher efficiency.In terms of ACD measurement, the model shows good agreement between the measurements obtained from the model and Pentacam system.

Ischemic stroke is one of the leading causes of mortality and disability,and it particularly inflicts brain damage through various mechanisms.However,there is a significant gap in the availability of specific drugs for the treatment of ischemic stroke.Numerous studies have demonstrated that exercise preconditioning can provide protective ef-fects against ischemic stroke through complex mechanisms.In this review,we aim to summarize the amount of exercise re-quired to induce exercise preconditioning and its potential mechanisms for improving outcomes in ischemic stroke.The fol-lowing benefits of exercise preconditioning have been identified in relation to ischemic stroke:(1)reduction of cerebral edema and infarct size,while promoting angiogenesis;(2)preservation of the integrity of the blood-brain barrier,reduc-tion of apoptosis,and mitigation of neurological damage;(3)inhibition of glutamate overactivation,alleviation of oxida-tive stress,and improvement of the inflammatory response.Ultimately,exercise preconditioning mitigates the damage caused by ischemic stroke through these pathways.

This study was aimed at exploring the prevalence and drug sensitivity of Gordonia strains isolated from sputum samples in Henan Province,to provide data to aid in the prevention and treatment of Gordonia infection.A combination of 16S rDNA and sec A1 gene sequencing was used to identify the isolated strains,and susceptibility to16 drugs was determined with the broth microdilution method.A total of 21 strains were identified through 16S rDNA gene and sec A1 gene sequencing,including five strains of Gordonia broncians,eight strains of Gordonia paraphernivans,seven strains of Gordonia sputi,and one strain of Gordonia aichiensis.Drug sensi-tivity testing showed high Gordonia sensitivity to drugs such as ceftriaxone,linezolid,doxycycline,amoxicillin/clavulanic acid,mino-cycline,cefotaxime,trimethoprim/sulfamethoxazole,imipenem,tobramycin,and clarithromycin.The sensitivity rates of the isolated strains were 90.48%(19/21),100%(21/21),90.48%(19/21),90.48%(19/21),95.24%(20/21),90.48%(19/21),90.48%(19/21),90.48%(19/21),and 95.24%(20/21),respectively.Gordonia showed high resistance to rifampicin and cefepime,with rates of 28.57%(6/21)and 19.05%(4/21),respectively.Meanwhile,the resistance varied among bacterial strains.The resistance rate of G.sputi to rifampicin reached 71.43%(5/7),whereas that of G.parapffinivoras to cefepime was 37.5%(3/8).The main species of Gordo-nia isolated from sputum samples of patients in Henan Province were G.bronchialis,G.paraffinivoras,G.sputi,and G.aichiensis.Drug sensitivity tests indicated that drugs including amoxicillin/clavulanic acid,ceftriaxone,cefotaxime,tobramycin,clarithromycin,mi-nocycline,trimethoprim/sulfamethoxazole,linezolid,and doxycycline had good antibacterial effects against Gordonia.

Objective:To investigate the efficacy and safety of lenvatinib plus drug-eluting bead transarterial chemoembolization (DEB-TACE) and FOLFOX-based hepatic arterial infusion chemotherapy (Len+DEB-TACE+HAIC) versus lenvatinib plus DEB-TACE (Len+DEB-TACE) for hepatocellular carcinoma (HCC) larger than 7 cm with portal vein tumor thrombosis (PVTT).Methods:The data from patients diagnosed with HCC (>7 cm) and PVTT who received either Len+DEB-TACE+HAIC ( n=99) or Len+DEB-TACE ( n=102) between July 2019 and June 2021 at six institutions in China were collected and retrospectively analyzed. Tumor responses were evaluated based on modified Response Evaluation Criteria in Solid Tumors. Objective response rate (ORR), disease control rate (DCR), time to progression (TTP), overall survival (OS), and treatment-related adverse event (TRAE) were compared between the two groups by propensity score matching. Subgroup analyses were performed for TTP and OS. Results:After propensity score matching, 83 pairs of patients were included in the study cohorts. The ORR for the Len+DEB-TACE+HAIC group and the Len+DEB-TACE group was 66.3% and 38.6% ( χ2=12.78, P<0.001), respectively. The DCR for the Len+DEB-TACE+HAIC group and the Len+DEB-TACE group was 91.6% and 79.5% ( χ2=4.87, P=0.027), respectively. The median TTP and median OS for the Len+DEB-TACE+HAIC group were significantly longer than those for the Len+DEB-TACE group (TTP, 10.1 months vs. 6.1 months, χ2=35.28, P<0.001; OS, 17.3 months vs. 12.9 months, χ2=16.84, P<0.001). The incidence of ≥grade 3 TRAEs was 38.6% in the Len+DEB-TACE+HAIC group and 33.7% in the Len+DEB-TACE group ( χ2=0.42, P=0.518). Conclusion:Compared with Len+DEB-TACE, Len+DEB-TACE+HAIC led to improved tumor response, TTP and OS with an acceptable safety profile in patients with large HCC and PVTT.