Lactic acid bacteria (LAB) are promising candidates for live bacterial drug delivery systems owing to their safety, probiotic properties, and ability to colonize the intestinal tract. At present, most research focuses on engineering LAB as carriers for the delivery of therapeutic proteins. As model organisms equipped with a versatile set of genetic tools, LAB can be readily modified to target various diseases and yield significant therapeutic effects. LAB-based carriers offer multiple advantages, including non-invasive delivery, ease of genetic manipulation, and suitability for large-scale production. Consequently, the use of LAB as recombinant protein expression vectors has attracted extensive research interest worldwide. The foundational principles, strategies for enhancing bioavailability, genetic engineering approaches, and the current research and application status of LAB-based drug delivery systems were summarized in this paper.

ObjectiveTo investigate the current professional competency among full-time and part-time personnel of the nosocomial infection control administration in Shanghai, so as to provide a scientific basis for future training programmes. MethodsIn December 2024, a questionnaire survey was conducted by the Shanghai Nosocomial Infection Quality Control Center among full-time and part-time personnel of the nosocomial infection control administration across medical institutions at various levels and types in Shanghai using convenience sampling method. The questionnaire consisted of two parts: demographic information and professional competency assessment. The professional competency scale comprised four dimensions: fundamental cognition, basic skills, professional expertise, and personal qualities, totaling 35 items. ResultsA total of 1 179 questionnaires were distributed, with 1 144 valid responses collected, yielding an effective response rate of 97.03%. Statistically significant differences were observed among full-time and part-time personnel of the nosocomial infection control administration in terms of age (t=5.32, P=0.021), professional background (χ²=9.90, P=0.019), educational qualifications (χ²=19.10, P<0.001), professional titles (χ²=12.60, P=0.002), and the levels of medical institutions (χ²=111.08, P<0.001). The scores of full-time personnel of the nosocomial infection control administration in fundamental cognition [92 (82, 99) points] and basic skills [88 (78, 96) points] were significantly higher than those of part-time personnel(Z=-2.21, P=0.027;Z=-2.74, P=0.006). Statistically significant differences were found in fundamental cognition scores between full-time and part-time personnel of the nosocomial infection control administration regarding occupational safety protection, definition of healthcare-associated infection outbreaks, types of drug-resistant bacteria and their prevention and control strategies, and transmission routes of different infectious diseases (all P<0.05). Statistically significant differences were also observed in basic skills scores including proficient use of monitoring platforms, formulation and revision of standard operating procedures (SOPs), independent completion of targeted surveillance, guidance on basic infection control skills, guidance for key departments, and follow-up of personnel with occupational exposure (all P<0.05). However, no statistically significant differences were found in scores of professional knowledge and personal qualities (P>0.05). ConclusionThere are certain differences in professional competency between full-time and part-time personnel of the nosocomial infection control administration in Shanghai in terms of fundamental cognition and basic skills. Part-time personnel can effectively improve their professional competency through systematic training on basic infection control knowledge and practical skills, thereby comprehensively enhancing the overall quality of the nosocomial infection administration team.

Allergic conjunctivitis is a common ocular inflammatory disease, with intense itching being the most typical and distressing symptom for patients. In recent years, with the in-depth study of the interaction between the nervous and immune systems, significant progress has been made in understanding the mechanism of itching in allergic conjunctivitis. This review elaborates on the neurobiological basis of itching in allergic conjunctivitis, with a focus on the complex dialogue between immune cells and sensory neurons, particularly the core role of the IL-33-ST2-CGRP signaling axis in mediating itching. Additionally, this article introduces new findings in genetic susceptibility research, including the identification of susceptibility genes for allergic conjunctivitis through transcriptome-wide association studies. The sensory nervous system not only transmits itch signals but also actively participates in the formation of antigen channels related to conjunctival goblet cells, thereby regulating the local uptake of allergens and the initiation of the immune response. Moreover, targeted novel therapeutic strategies offer hope for patients with refractory allergic conjunctivitis. Exploring the molecular and cellular mechanisms of itching in allergic conjunctivitis will provide a theoretical basis for the development of more effective treatment methods.

As a chronic and lifelong disease， diabetes mellitus occurs across all age groups and gender groups. Since the disease requires lifelong treatment， it seriously affects the quality of life of patients. With the rising incidence on a global scale， diabetes mellitus has become a global problem that seriously affects public health. Moreover， the complications of this disease have aroused concern from the global medical research community， the World Health Organization， and the public. In the past， Western medicine was used in the clinical treatment of diabetes mellitus， which， however， had drug dependence， unsatisfactory efficacy， and side effects. Long-term oral administration of antidiabetics may cause liver and kidney function damage， hypoglycemia and other adverse symptoms. The treatment of diabetes mellitus has been faced with challenges such as limited efficacy and obvious side effects. Therefore， exploring more effective treatment means， especially tapping the potential of traditional Chinese medicine （TCM） in the treatment of diabetes mellitus， is a major issue to be solved. TCM has shown a great application value and a broad prospect in the treatment of diabetes mellitus because of multi-target regulation， a holistic view， synergistic effects， and high safety. TCM has a history of thousands of years in the prevention and treatment of diabetes mellitus， with rich experience accumulated and remarkable results achieved. Particularly， TCM demonstrates definite therapeutic effects on the complications. The application of TCM in the treatment of complications has been recognized and accepted by patients because of the definite therapeutic effect. In recent years， great progress has been achieved in the treatment of diabetes mellitus by the combination of Chinese and western medicine， which has made important contributions to the control of diabetes mellitus. This paper reviews the articles about the treatment of diabetes mellitus with TCM classic prescriptions， summarizes the treatment of clinical cases regarding the indications of these prescriptions， and provides an overview of the treatment mechanisms， aiming to offer fresh insights and strategies for the clinical diagnosis and treatment of diabetes mellitus.

Objective:To investigate the clinical significance of serum galectin-9 (Gal-9) in patients with dermatomyositis (DM) or clinically amyopathic dermatomyositis (CADM) .Methods:This cross-sectional study included 105 newly diagnosed patients with DM or CADM who were admitted to the Department of Dermatology in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2015 to October 2024, among whom 53 had cancer-associated DM/CADM (CRDM). Additionally, an age-matched control group was included, consisting of 30 newly diagnosed cancer patients without autoimmune diseases, 27 systemic lupus erythematosus (SLE) patients, and 31 healthy controls. Serum levels of Gal-9 and transcriptional intermediary factor 1-gamma (TIF1-γ) were measured using enzyme-linked immunosorbent assay. The relationship between Gal-9 levels and laboratory indicators of DM disease activity was analyzed. Comparisons between different groups were performed using the t-test, Mann-Whitney U test, and chi-square test. Spearman correlation analysis was used to assess the association between Gal-9 levels and laboratory indicators. The diagnostic efficacy of Gal-9 and TIF1-γ for CRDM was evaluated using receiver operating characteristic (ROC) curve analysis. Results:Among the 105 DM/CADM patients, 35 were male (33.3%) and 70 were female (66.7%), with a mean age of 53.2 ± 15.1 years. In the 53 CRDM patients, the incidence rates of V-neck sign, dyschromia, and dysphagia were higher than those in non-CRDM patients (all P > 0.05). Serum Gal-9 levels in DM/CADM patients (21.2 [12.2, 32.3] ng/ml) were significantly higher than those in healthy controls (6.8 [5.4, 7.9] ng/ml, P < 0.001), SLE patients (12.3 [8.1, 15.5] ng/ml, P = 0.011), and cancer patients without autoimmune diseases (7.5 [4.9, 8.5] ng/ml, P < 0.001). Gal-9 levels were positively correlated with serum TIF1-γ antibody levels ( rs = 0.21, P = 0.029), serum ferritin ( rs = 0.29, P = 0.003), lactate dehydrogenase ( rs = 0.44, P < 0.001), creatine kinase ( rs = 0.28, P = 0.004), aspartate aminotransferase ( rs = 0.42, P < 0.001), C-reactive protein ( rs = 0.34, P < 0.001), and erythrocyte sedimentation rate ( rs = 0.46, P < 0.001). Among CRDM patients, those who had not received cancer treatment had higher Gal-9 levels (30.1 [23.3, 38.3] ng/ml) than those in stable condition after cancer treatment (13.5 [10.5, 27.9] ng/ml, P = 0.007). The area under the ROC curve (AUC) for serum TIF1-γ in diagnosing CRDM was 0.718, with an optimal cutoff value of 23.02 U/ml. The AUC for serum Gal-9 was 0.719, with an optimal cutoff value of 55.02 ng/ml. When combining both markers, the AUC increased to 0.783, with a sensitivity of 0.85 and specificity of 0.74. Conclusions:Gal-9 was highly expressed in serum of DM/CADM patients, particularly in CRDM patients. Dynamic monitoring of Gal-9 in CRDM patients may be helpful to monitor the therapeutic effect of malignancies.

Objective:To evaluate the impact of roxadustat on thyroid function and to identify the associated factors in patients undergoing maintenance peritoneal dialysis (PD).Methods:This study was a single-center retrospective study. PD patients who received roxadustat or recombinant human erythropoietin (rHuEPO) treatment at Nanjing Drum Tower Hospital between January 2020 and June 2024 were included. The general and clinical information as well as laboratory indexes were collected. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were compared before and after treatment initiation. Hemoglobin (Hb) responses were also observed between the two groups. Logistic regression analysis was performed to explore the factors associated with thyroid function changes.Results:A total of 120 patients were enrolled, with an age of (55.17±16.42) years, including 66 males (55.0%). There were 81 patients received roxadustat (roxadustat group) and 39 patiens received rHuEPO (rHuEPO group). Compared to the rHuEPO group, the roxadustat group had a higher proportion of patients with diabetes ( χ 2= 4.172, P=0.041), a shorter PD vintage ( Z=-3.406, P=0.002), a lower serum level of total cholesterol ( Z=-2.082, P=0.037) and a lower level of fasting blood glucose ( Z=-2.589, P=0.010). Following treatment with roxadustat, the levels of FT4 ( Z=-5.349, P<0.01) and TSH ( Z=-3.720, P<0.01) decreased significantly. In contrast, no significant changes in FT4 or TSH levels were observed in the rHuEPO group (both P>0.05). For both roxadustat and rHuEPO groups, there were no significant changes in FT3 levels after treatment (both P>0.05). Multivariate analysis identified that higher baseline TSH (TSH≥2.27 μIU/ml, OR=1.581, 95% CI 1.196-2.089, P=0.001) and roxadustat exposure ( OR=3.432, 95% CI 1.410-8.355, P=0.007) as independent associated factors of subsequent TSH decline, and identified that higher baseline FT4 (FT4≥14.9 pmol/L, OR=1.390, 95% CI 1.162-1.662, P=0.001) and roxadustat exposure ( OR=5.798, 95% CI 2.225-15.113, P=0.001) as independent associated factors of subsequent FT4 decline. The degrees of hemoglobin changes after roxadustat or rHuEPO treatment did not differ significantly between roxadustat group and rHuEPO group ( t=-1.062, P=0.290). Of the 31 patients who underwent a second thyroid function test during roxadustat treatment, 24 continued with the original regimen, while 7 discontinued roxadustat. Among 24 patients who maintained roxadustat treatment, TSH ( Z=-0.400, P=0.689) and FT4 ( t=0.143, P=0.888) remained stable between the second and third tests. All 7 patients who discontinued roxadustat treatment showed TSH rebound and the changes of TSH levels were more significant than that in continuers ( Z=-2.505, P=0.012). FT4 recovery occurred in only 3 of them, with no significant difference in FT4 change between discontinuers and continuers ( Z=-0.685, P=0.493). Conclusions:Roxadustat commonly suppresses TSH and FT4, but not FT3, in PD patients. Baseline levels of TSH and FT4 are key associated factors of the inhibitory effect of roxadustat on thyroid function. This suppression does not intensify with prolonged exposure and is reversible after discontinuation, with TSH levels normalizing more quickly than FT4. Roxadustat-induced thyroid suppression does not compromise its efficacy in treating renal anemia.

Objective:To evaluate the role of nuclear factor E2-related factor 2 (Nrf2)/heme oxygenase (HO-1) signaling pathway in the attenuation of endotoxin-induced acute lung injury (ALI) by hydromorphone and the relationship with Golgi apparatus stress (GA stress) in mice.Methods:Eighteen SPF wild-type (WT) and 18 Nrf2 knockout (Nrf2 KO) male C57BL/6J mice, aged 6-8 weeks, weighing 18-20 g, were divided into 3 groups ( n=6 each) using a random number table method: control groups (WT+ Con group, Nrf2 KO+ Con group), ALI groups (WT+ ALI group, Nrf2 KO+ ALI group) and ALI+ hydromorphone groups (WT+ ALI+ HM group, Nrf2 KO+ ALI+ HM group). ALI was induced by injecting lipopolysaccharide (LPS) 15 mg/kg via the tail vein in anesthetized animals. Hydromorphone 120 μg was intraperitoneally injected at 15 min before LPS injection in WT+ ALI+ HM group and Nrf2 KO+ ALI+ HM group, and the equal volume of normal saline was given instead in control groups. The animals were sacrificed after anesthesia at 12 h after LPS injection, and lung tissues were obtained for examination of the pathological changes which were scored and Golgi ultrastructure (with a transmission electron microscope) and for determination of the content of malondialdehyde (MDA), activity of superoxide dismutase (SOD), and expression of Nrf2, HO-1 and Golgi stress-related markers (Golgi matrix protein 130 [GM130], Golgi autoantigen 97 kDa [Golgin-97], ATPase secretory pathway Ca 2+ Transporting 1 [ATP2C1], Golgi phosphoprotein 3 [GOLPH3]) (by Western blot). Results:Compared with WT+ Con group and Nrf2 KO+ Con group, the lung injury scores and content of MDA were significantly increased, the activity of SOD was decreased, the expression of GM130, Golgin-97 and ATP2C1 was down-regulated, the expression of GOLPH3 was up-regulated ( P<0.05), no significant changes were found in the expression of Nrf2 and HO-1 ( P>0.05), and the damage to the Golgi apparatus was aggravated in WT+ ALI group and Nrf2 KO+ ALI group. Compared with WT+ ALI group, the lung injury scores and content of MDA were significantly decreased, the activity of SOD was increased, the expression of Nrf2, HO-1, GM130, Golgin-97 and ATP2C1 was up-regulated, the expression of GOLPH3 was down-regulated ( P<0.05), and the damage to the Golgi apparatus was significantly attenuated in WT+ ALI+ HM group. Compared with Nrf2 KO+ ALI group, the lung injury scores were significantly decreased, and the activity of SOD was increased ( P<0.05), no significant changes were found in the content of MDA and expression of Nrf2, HO-1, GM130, Golgin-97, ATP2C1 and GOLPH3 ( P>0.05), and no significant reduction in the damage to the Golgi apparatus was found in Nrf2 KO+ ALI+ HM group. Compared with WT+ ALI+ HM group, the lung injury scores and content of MDA were significantly increased, the activity of SOD was decreased, the expression of Nrf2, HO-1, GM130, Golgin-97 and ATP2C1 was down-regulated, the expression of GOLPH3 was up-regulated ( P<0.05), and the damage to the Golgi apparatus was aggravated in Nrf2 KO+ ALI+ HM group. Conclusions:Nrf2/HO-1 signaling pathway is involved in the attenuation of endotoxin-induced ALI by hydromorphone, and it is associated with the inhibition of Golgi stress.

Xiao Chaihutang， originating from the Treatise on Typhoid and Miscellaneous Diseases， is a classic formula for harmonizing the Shaoyang. It excels in regulating the pivotal mechanism and unblocking the triple energizer， corresponding to the pathogenesis of digestive system tumors characterized by the interlocking of deficiency， stasis， phlegm， and toxicity， as well as disharmony between Yin and Yang. This paper systematically reviews research findings from China and abroad over the past decade， exploring the anti-tumor effects of Xiao Chaihutang on digestive system tumors from three dimensions： theoretical rationale， clinical efficacy， and molecular mechanisms. At the level of principle and method， Xiao Chaihutang takes "harmonization" as its core therapeutic guideline. By reconciling the exterior and interior to restore the Shaoyang pivot， harmonizing Yin and Yang to improve the tumor microenvironment， and regulating the liver and spleen to consolidate and protect the foundation of postnatal essence， it promotes the restoration of the body's dynamic balance of Yin and Yang. Clinical studies have demonstrated that Xiao Chaihutang， used alone or in combination with modern medical therapies， shows definite efficacy against digestive system tumors such as hepatocellular carcinoma， pancreatic carcinoma， and gastrointestinal carcinoma. It can significantly improve patients' quality of life， inhibit tumor progression， effectively relieve concomitant symptoms such a s cancer-related fever， anxiety， depression， and insomnia， and alleviate postoperative embolic syndromes as well as adverse reactions to radiotherapy and chemotherapy. Experimental studies have revealed that Xiao Chaihutang can inhibit tumor cell proliferation， induce apoptosis， arrest the cell cycle， suppress tumor cell invasion and metastasis， and improve the tumor microenvironment. Through the above analysis， this study elucidates the current clinical and experimental research status of Xiao Chaihutang in the treatment of digestive system tumors， aiming to provide theoretical support for its precise clinical application. On this basis， it further explores key issues in the identification of pharmacodynamic substances and the accumulation of evidence in evidence-based medicine， thereby offering a new perspective for the innovative development of integrative Chinese and Western medicine in synergistic cancer therapy.

OBJECTIVE: To develop an artificial intelligence-assisted system for the automatic detection of the features of common 21 auricular points based on the YOLOv8 neural network. METHODS: A total of 660 human auricular images from three research centers were collected from June 2019 to February 2024. The rectangle boxes and features of images were annotated using the LabelMe5.3.1 tool and converted them into a format compatible with the YOLO model. Using these data, transfer learning and fine-tuning training were conducted on different scales of pretrained YOLO neural network models. The model's performance was evaluated on validation and test sets, including the mean average precision (mAP) at various thresholds, recall rate (recall), frames per second (FPS) and confusion matrices. Finally, the model was deployed on a local computer, and the real-time detection of human auricular images was conducted using a camera. RESULTS: Five different versions of the YOLOv8 key-point detection model were developed, including YOLOv8n, YOLOv8s, YOLOv8m, YOLOv8l, and YOLOv8x. On the validation set, YOLOv8n showed the best performance in terms of speed (225.736 frames per second) and precision (0.998). On the external test set, YOLOv8n achieved the accuracy of 0.991, the sensitivity of 1.0, and the F1 score of 0.995. The localization performance of auricular point features showed the average accuracy of 0.990, the precision of 0.995, and the recall of 0.997 under 50% intersection ration (mAP⁵⁰). CONCLUSION The key-point detection model of 21 common auricular points based on YOLOv8n exhibits the excellent predictive performance, which is capable of rapidly and automatically locating and classifying auricular points.
Humans ; Neural Networks, Computer ; Artificial Intelligence ; Acupuncture Points

Objective:To investigate the changes in blood betatrophin in overweight and obese children，and analyze the relationship with glucose and lipid metabolism.Methods:A total of 177 children，including overweight-obese children and healthy controls，who visited the pediatric endocrinology clinic of Tianjin First Central Hospital from July 1，2021 to May 31，2023 were selected as study subjects. They were divided into an overweight-obese group（104 cases）and a normal control group（73 cases）. Data from both groups were collected and analyzed to explore the relationship between betatrophin and parameters such as body mass index（BMI）and glycolipid metabolism-related indicators.Results:The age［10.5（8.0，12.0）years vs 8.0（6.0，12.0）years］，fasting insulin［19.99（11.47，31.60）μIU/ml vs 7.27（5.02，10.99）μIU/ml］，triglyceride［0.95（0.74，1.31）mmol/L vs 0.75（0.62，0.92）mmol/L］，total cholesterol［（3.88 ± 0.72）mmol/L vs（3.60 ± 0.66）mmol/L］，low-density lipoprotein cholesterol［（2.37 ± 0.63）mmol/L vs（2.06 ± 0.62）mmol/L］，uric acid［353.20（287.40，434.12）μmol/L vs 278.60（218.00，313.80）μmol/L］，Betatrophin［22.54（17.08，27.53）mIU/L vs 19.30（15.78，23.33）mIU/L］，and fatty liver［31 cases（29.8%）vs 1 case（1.4%）］in overweight-obese group children were all higher than those in the normal control group children，and the differences were statistically significant（all P<0.01）.After adjusting for confounding factors such as age and BMI，partial correlation analysis revealed a positive correlation between betatrophin and triglycerides（ P<0.05）. Receiver operating characteristic（ROC）curve analysis indicated that a betatrophin level of 22 mIU/L had predictive value for hypertriglyceridemia，with an area under the curve（AUC）of 0.705（95% CI：0.566-0.843），showing statistical significance（ P=0.014）. Conclusion:Betatrophin may be associated with weight gain in children，mainly involved in the triglyceride metabolism.