Objective: To investigate morphological differences between obstructive and non-obstructive coronary artery disease (CAD) patients using computer-aided image analysis, and identify color and texture features for traditional Chinese medicine (TCM) syndrome differentiation. Methods: This prospective study enrolled patients undergoing coronary computed tomography angiography (CTA) at the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine between May 1, 2024 and August 7, 2025. Based on CTA results, patients were categorized into obstructive CAD and non-obstructive CAD groups. Standardized tongue images were acquired using a dedicated mobile application (Traditional Chinese Medicine Tongue Image-Assisted Diagnosis System) and analyzed for the overall tongue surface and three macroscopic features (tooth marks, fissures, and red dots) from which high-dimensional color and texture parameters were extracted. Multi-scale texture features were derived using spatial-domain Laplacian pyramid and frequency-domain wavelet transform methods. Dimensionality reduction and feature selection were performed using principal component analysis (PCA) and random forest with 5-fold cross-validation. Feature stability was assessed using Hodges-Lehmann estimator and Cliff’s δ. A multi-view XGBoost model was developed to differentiate the two groups and evaluated on a temporally independent validation set using accuracy and the area under the receiver operating characteristic curve (AUC). SHapley Additive exPlanations (SHAP) analysis was applied to interpret model decisions. Results: This study analyzed 373 CAD patients, including 167 with obstructive CAD and 206 with non-obstructive CAD according to CTA results. The whole cohort was divided into training set (n = 316, obstructive : non-obstructive = 142 : 174 ) and validation set (n = 57, obstructive : non-obstructive = 25 : 32), with balanced baseline characteristics (P > 0.05). Macroscopic tongue analysis revealed that patients with obstructive CAD had fewer tooth marks [odds ratio (OR) = 0.43, P < 0.05] and red dots (OR = 0.46, P < 0.05). High-dimensional color analysis identified pronounced intergroup differences, most notably a reduction in hue values in the hue-saturation-intensity (HSI) color space among obstructive CAD patients (Cliff’s δ = – 0.31, P = 2.72 × 10–6; Hodges-Lehmann estimator: – 0.31). PCA results suggested that tongue surface features explained the highest proportion of variance (48.2%). Random forest screening identified 77 stable features across all tongue regions, with wavelet-transformed texture features demonstrating the highest importance. The multi-view XGBoost fusion model achieved an accuracy of 75% and an AUC of 0.779 in the independent validation set. SHAP analysis identified the wavelet-based feature—left-handed lower-level gray-level size zone matrix zone variance (LHL_glszm_ZoneVariance) as the top predictor, accounting for 40.6% of the model's decision variance, and indicated that 85.3% of the predictive power came from wavelet-based texture features. Conclusion This study has provided objective evidence for the TCM concept that “the tongue reflects the heart” by identifying distinct morphological and colorimetric tongue patterns in patients with obstructive CAD through artificial intelligence (AI)-driven image analysis, and the promising performance of the computational model suggests its potential as a non-invasive adjunctive tool for CAD assessment.

Objective:To analyze the relationship between 24-hour urinary calcium (24 h UCa) level and the risk of end-stage kidney disease (ESKD), cardiovascular disease (CVD), and all-cause mortality.Methods:In the Chinese Cohort Study of Chronic Kidney Disease, we examined 3 375 patients aged 18-74 years with CKD stages 1-4. Kaplan-Meier survival and Cox proportional hazard regression models were used to test a time-to-event association between levels of 24 h UCa and incidence of ESKD, CVD, and all-cause mortality.Results:During a follow-up of 4.17 (3.37, 5.20) years, 179, 145, 104 and 38 ESKD events occurred in <0.60, 0.60-, 1.20-, ≥2.32 mmol 24 h UCa groups. Higher levels of 24 h UCa (1.20-,≥2.32 mmol) were independently associated with a lower incidence of ESKD events in patients with CKD, with HR (95% CI) of 0.71 (0.54-0.93) and 0.43 (0.29-0.64), respectively. No significant associations with CVD and all-cause mortality endpoints were detected. Conclusion:Among patients with CKD, levels of 24 h UCa displayed an association with the risk of ESKD among patients with CKD stages 1-4.

Magnolol, a compound extracted from Magnolia officinalis, demonstrates potential efficacy in addressing metabolic dysfunction and cardiovascular diseases. Its biological activities encompass anti-inflammatory, antioxidant, anticoagulant, and anti-diabetic effects. Growth/differentiation factor-15 (GDF-15), a member of the transforming growth factor β superfamily, is considered a potential therapeutic target for metabolic disorders. This study investigated the impact of magnolol on GDF-15 production and its underlying mechanism. The research examined the pharmacological effect of magnolol on GDF-15 expression in vitro and in vivo, and determined the involvement of endoplasmic reticulum (ER) stress signaling in this process. Luciferase reporter assays, chromatin immunoprecipitation, and in vitro DNA binding assays were employed to examine the regulation of GDF-15 by activating transcription factor 4 (ATF4), CCAAT enhancer binding protein γ (CEBPG), and CCCTC-binding factor (CTCF). The study also investigated the effect of magnolol and ATF4 on the activity of a putative enhancer located in the intron of the GDF-15 gene, as well as the influence of single nucleotide polymorphisms (SNPs) on magnolol and ATF4-induced transcription activity. Results demonstrated that magnolol triggers GDF-15 production in endothelial cells (ECs), hepatoma cell line G2 (HepG2) and hepatoma cell line 3B (Hep3B) cell lines, and primary mouse hepatocytes. The cooperative binding of ATF4 and CEBPG upstream of the GDF-15 gene or the E1944285 enhancer located in the intron led to full-power transcription of the GDF-15 gene. SNP alleles were found to impact the magnolol and ATF4-induced transcription activity of GDF-15. In high-fat diet ApoE^-/- mice, administration of magnolol induced GDF-15 production and partially suppressed appetite through GDF-15. These findings suggest that magnolol regulates GDF-15 expression through priming of promoter and enhancer activity, indicating its potential as a drug for the treatment of metabolic disorders.
Lignans/pharmacology* ; Growth Differentiation Factor 15/metabolism* ; Animals ; Biphenyl Compounds/pharmacology* ; Endoplasmic Reticulum Stress/drug effects* ; Activating Transcription Factor 4/genetics* ; Mice ; Humans ; Male ; Magnolia/chemistry* ; CCAAT-Enhancer-Binding Proteins/genetics* ; Mice, Inbred C57BL

Objective:To evaluate the effect of esketamine on the quality of postoperative sleep in preschool children undergoing day surgery.Methods:This was a prospective randomized controlled study. One hundred and four preschool children of either sex, aged 4-7 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, underwent elective day surgery for strabismus correction under general anesthesia at the First Affiliated Hospital of Zhengzhou University from July to September 2024, were selected. The preschool children were divided into 2 groups ( n=52 each) by the random number table method: control group (group C) and esketamine group (group S). In group S, additional esketamine 0.25 mg/kg was intravenously injected during anesthesia induction. The sleep quality scores were evaluated using the Children′s Sleep Habit Questionnaire by the guardians on the night before surgery, the 1st night after surgery, the 3rd night after surgery and the 7th night after surgery, and development of postoperative sleep disorders (the Children′s Sleep Habit Questionnaire score >41) was recorded. The FLACC pain scores and usage rate of flurbiprofen axetil were recorded immediately before leaving the postanesthesia care unit (PACU) and on days 1, 3 and 7 after surgery. The time of laryngeal mask airway removal, length of stay in PACU and development of adverse reactions such as increased oral secretions, agitation, nausea and delirium within 48 h after surgery were recorded. Results:Compared with group C, the Children′s Sleep Habits Questionnaire score and incidence of postopoerative sleep disorders were significantly decreased on the 1st night after surgery, the FLACC pain scores were decreased immediately before discharge from the PACU and at 1 day after surgery, the usage rate of flurbiprofen axetil was decreased ( P<0.05), and no significant change was found in the time of laryngeal mask airway removal, length of stay in PACU and incidence of postoperative adverse reactions in group S ( P>0.05). Conclusions:Anesthesia induction with esketamine 0.25 mg/kg can improve the quality of postoperative sleep in preschool children undergoing day surgery.

Objective:To develop the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy and evaluate its reliability and validity.Methods:Based on the theory of unpleasant symptoms, a preliminary version of the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy was developed through literature analysis, semi-structured interviews, and the Delphi method. After revising certain items in the pre-survey, convenience sampling was used to select patients who underwent bladder instillation chemotherapy in the Department of Urology Surgery of three ClassⅢ Grade A hospitals in Yunnan Province from January to July 2024 as research subjects to test the reliability and validity of the scale.Results:A total of 168 questionnaires were distributed, and 162 valid questionnaires were collected, with a valid response rate of 96.429% (162/168). The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy covered two areas of symptom severity and symptom distress, comprising five dimensions and 27 items. The Cronbach's α coefficient for the total scale was 0.953, and the split-half reliability coefficient was 0.806. Exploratory factor analysis revealed that the four common factors for symptom severity contributed to 73.196% of the cumulative variance, while the single common factor for symptom distress accounted for 68.285% of the cumulative variance. Confirmatory factor analysis revealed that all indicators met the fit criteria, indicating that the model possessed good goodness-of-fit. The content validity index at the scale level was 0.940, while the content validity index at the item level ranged from 0.833 to 1.000.Conclusions:The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy developed in this study demonstrates good reliability and validity, and is suitable for evaluating symptoms in patients undergoing bladder infusion chemotherapy.

Objective:To develop the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy and evaluate its reliability and validity.Methods:Based on the theory of unpleasant symptoms, a preliminary version of the Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy was developed through literature analysis, semi-structured interviews, and the Delphi method. After revising certain items in the pre-survey, convenience sampling was used to select patients who underwent bladder instillation chemotherapy in the Department of Urology Surgery of three ClassⅢ Grade A hospitals in Yunnan Province from January to July 2024 as research subjects to test the reliability and validity of the scale.Results:A total of 168 questionnaires were distributed, and 162 valid questionnaires were collected, with a valid response rate of 96.429% (162/168). The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy covered two areas of symptom severity and symptom distress, comprising five dimensions and 27 items. The Cronbach's α coefficient for the total scale was 0.953, and the split-half reliability coefficient was 0.806. Exploratory factor analysis revealed that the four common factors for symptom severity contributed to 73.196% of the cumulative variance, while the single common factor for symptom distress accounted for 68.285% of the cumulative variance. Confirmatory factor analysis revealed that all indicators met the fit criteria, indicating that the model possessed good goodness-of-fit. The content validity index at the scale level was 0.940, while the content validity index at the item level ranged from 0.833 to 1.000.Conclusions:The Symptom Assessment Scale for Patients Undergoing Bladder Irrigation Chemotherapy developed in this study demonstrates good reliability and validity, and is suitable for evaluating symptoms in patients undergoing bladder infusion chemotherapy.

Precancerous lesions of gastric cancer （PLGC） are a group of pathological changes caused by abnormalities in the structure， morphology， and differentiation of gastric mucosal epithelial cells. Since the early symptoms are hidden and non-specific， PLGC is not easy to be diagnosed and it has often developed into intermediate or advanced gastric cancer once being diagnosed and missed the best time for treatment. Accordingly， the incidence of this disease is increasing year by year， which lifts a heavy burden on the patients. The pathogenesis of PLGC is complex， involving inflammatory microenvironment， bile reflux， glycolysis， autophagy， and apoptosis. Currently， PLGC is mainly treated with anti-inflammatory and endoscopic therapies， which are difficult to curb the development of PLGC. Therefore， seeking a safe and effective therapy is an important topic of modern research. Traditional Chinese medicine （TCM）， characterized by treatment based on syndrome differentiation and a holistic view， exerts effects via multiple pathways， mechanisms， and targets. Recent studies have confirmed that TCM can regulate the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR）， Wnt/β-catenin， Sonic Hedgehog， nuclear factor-κB （NF-κB）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， hypoxia-inducible factor-1α （HIF-1α）， neurogenic locus notch homolog protein （Notch）， nuclear factor E₂-related factor 2 （Nrf2） and other signaling pathways. By targeting these pathways， TCM can inhibit aerobic glycolysis， reduce oxidative stress， repair the inflammatory microenvironment， regulate cellular autophagy， and promote vascular normalization， thereby delaying or reversing PLGC. However， few researchers have systematically summarized the TCM regulation of PLGC-associated pathways. By reviewing the relevant articles at home and abroad， this paper summarized the roles of the above signaling pathways in the development of PLGC and the research progress in the regulation of signaling pathways by TCM in the treatment of PLGC， with a view to providing a new theoretical basis for the clinical research on PLGC and the drug development for this disease.

Objective:To evaluate the effect of esketamine on the quality of postoperative sleep in preschool children undergoing day surgery.Methods:This was a prospective randomized controlled study. One hundred and four preschool children of either sex, aged 4-7 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, underwent elective day surgery for strabismus correction under general anesthesia at the First Affiliated Hospital of Zhengzhou University from July to September 2024, were selected. The preschool children were divided into 2 groups ( n=52 each) by the random number table method: control group (group C) and esketamine group (group S). In group S, additional esketamine 0.25 mg/kg was intravenously injected during anesthesia induction. The sleep quality scores were evaluated using the Children′s Sleep Habit Questionnaire by the guardians on the night before surgery, the 1st night after surgery, the 3rd night after surgery and the 7th night after surgery, and development of postoperative sleep disorders (the Children′s Sleep Habit Questionnaire score >41) was recorded. The FLACC pain scores and usage rate of flurbiprofen axetil were recorded immediately before leaving the postanesthesia care unit (PACU) and on days 1, 3 and 7 after surgery. The time of laryngeal mask airway removal, length of stay in PACU and development of adverse reactions such as increased oral secretions, agitation, nausea and delirium within 48 h after surgery were recorded. Results:Compared with group C, the Children′s Sleep Habits Questionnaire score and incidence of postopoerative sleep disorders were significantly decreased on the 1st night after surgery, the FLACC pain scores were decreased immediately before discharge from the PACU and at 1 day after surgery, the usage rate of flurbiprofen axetil was decreased ( P<0.05), and no significant change was found in the time of laryngeal mask airway removal, length of stay in PACU and incidence of postoperative adverse reactions in group S ( P>0.05). Conclusions:Anesthesia induction with esketamine 0.25 mg/kg can improve the quality of postoperative sleep in preschool children undergoing day surgery.

Objective:To evaluate the predictive efficacy of different comorbidity indices for hospitalization due to acute exacerbations in chronic obstructive pulmonary disease (COPD) patients with comorbidities (CO-COPD).Methods:This retrospective cohort study included 259 stable COPD patients with comorbidities from Beijing Tongren Hospital, Capital Medical University, between October 2021 and September 2023, all with ≥1-year follow-up. Patients were categorized into hospitalized ( n=75) and non-hospitalized ( n=184) groups based on acute exacerbation events. Clinical characteristics, comorbidities, and comorbidity indices, including Charlson Comorbidity Index (CCI), COPD-specific Comorbidity Test (COTE), and comorbidities in chronic obstructive lung disease index (COMCOLD) were compared between two goups. Risk facors of hospitalization due to acute exacerbations were analyzed by Cox regression. Modified indices were developed by incorporating additional respiratory comorbidities (asthma, bronchiectasis, lung cancer) weighted by hazard ratios (HRs) from Cox reguression. The predictive performance of different comorbidity indices for hospitalization was assessed by receiver operating characteristic (ROC) curves. Results:Hospitalized patients exhibited lower BMI, FEV 1% predicted, and FEV 1/FVC (all P<0.05), alongside higher modified British Medical Research Coucil (mMRC) scores and COPD assessment test (CAT) scores, eosinophil counts, and Global Initiative for Chronic Obstructive Lung Disease, (GOLD)severity ( t=3.73, Z=-3.43, Z=-2.43, Z=-11.10, Z=-11.32, Z=-1.80, χ2=17.62, all P<0.05); and also higher use rates of inhaled corticosteroid (ICS) and systemic oral corticosteroid (OCS) ( χ2=5.48, 7.15, all P<0.05). The comorbidities of asthma, bronchiectasis, lung cancer, hypertension, coronary atherosclerotic heart disease, anxiety and depression in hospitalized group were significantly higher ( χ2=22.49, 18.30, 15.63, 5.10, 4.68, 7.46, 5.16, all P<0.05), along with the increased CCI and COTE index ( P<0.05). Comorbid asthma, bronchiectasis, and lung cancer were independent risk factors for hospitalization ( HR=1.841, 2.924, and 2.076, respectively; all P<0.05). Original CCI and COTE showed moderate predictive value ( AUC=0.609 and 0.655), while modified CCI, COTE, and COMCOLD demonstrated improved performance ( AUC=0.730, 0.760, and 0.713, respectively). At optimal cutoffs (modified CCI>3.5, COTE>4.5, COMCOLD>6.5), sensitivities were 61.3%, 76.0%, and 58.7%, with specificities of 70.1%, 61.4%, and 72.3%. Age-stratified analysis revealed enhanced predictive utility of modified indices across age groups. Conclusions:CCI, COTE, and COMCOLD provide modest predictive value for hospitalization in CO-COPD. Modified indices incorporating respiratory comorbidities significantly improve risk stratification, offering clinical utility for identifying high-risk patients in primary care settings.

Objective Based on the general belief that the tongue characteristics of blood stasis constitution is"purple tongue,tortuous sublingual vessels",this study systematically summarized blood stasis tongue characteristics using artificial intelligence image processing combined with expert evaluation.Methods A physical questionnaire survey was conducted on 1275 college students,and 100 cases were randomly selected from the blood stasis constitution group and the mild constitution group.After collecting the tongue images,Unet,OpenCV,YOLOv5 and YOLOv8 algorithms combined with expert evaluation method were used to extract and analyze the tongue features of the two groups.By comparing the differences of tongue image characteristics between the blood stasis constitution group and the mild constitution group,the tongue characteristics of blood stasis constitution were systematically summarized.Results Compared with the mild constitution group,the proportion of light dark tongue and light purple tongue in the blood stasis constitution group was significantly higher(P＜0.05).The I value,L value and a value of the tongue area 1 in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05).The S value and a value of area 2 and area 3 were significantly larger(P＜0.05),and the I value,L value,a value and b value of area 5 were significantly smaller(P＜0.01,P＜0.05).Compared with the mild constitution group,the proportion of tooth marks tongue in the blood stasis constitution group was significantly higher(P＜0.01),the proportion of cracked tongue in the blood stasis constitution group was significantly larger(P＜0.05),and the number of tooth marks,crack area,relative height of crack and relative width of crack in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05).Compared with the mild constitution group,the I value,L value,a value and b value of tongue coating area 1 in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05),the I value,L value,S value,a value and b value of tongue coating area 2 were significantly larger(P＜0.01,P＜0.05),the I value,S value,a value and b value of tongue coating area 3 were significantly larger(P＜0.01,P＜0.05),the b value of tongue coating area 4 was significantly larger(P＜0.05),the S value,a value and b value of tongue coating area 5 were significantly larger(P＜0.01,P＜0.05).The proportion of thick tongue coating and greasy tongue coating in the blood stasis group was significantly higher than that in the gentleness group(P＜0.05).Compared with the mild constitution group,the proportion of tortuous,thickened and nodular sublingual collaterals in the blood stasis constitution group was significantly larger(P＜0.01,P＜0.05).The a value,I value,S value,b value and relative width of sublingual collaterals in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05).Conclusion On the basis of the general belief that the characteristics of blood stasis constitution tongue are dark purple tongue and dark purple sublingual collaterals/varicose veins/thickening,blood stasis constitution people also have new tongue characteristics,such as redder tips and edges,more teeth marks and fissures,thicker and greasier coatings,and yellow fur.These findings offer new insights for"to identify the constitution of traditional Chinese medicine and prevent diseases by observing the tongue manifestation".