Objective:Malnutrition is prevalent among patients with chronic obstructive pulmonary disease(COPD)and closely associ-ated with adverse outcomes.This study aimed to evaluate the effectiveness of three nutritional indices in predicting all-cause mortality among COPD patients.Methods:Based on the National Health and Nutrition Examination Survey(NHANES),this study included 1640 patients with COPD surveyed from 1999 to 2018.The optimal cutoff values for controlling nutritional status(CONUT)score,geri-atric nutritional risk index(GNRI),and prognostic nutritional index(PNI)were determined using receiver operating characteristic curves.The predictive value of these nutritional indices was assessed using the area under the receiver operating characteristic curve and C-index.Their predictive abilities were compared using the net reclassification improvement and integrated discrimination improvement.A Cox regression analysis was conducted to explore the association of the three nutritional indices with all-cause mortality.Results:Log-rank tests revealed lower overall survival rates in patients with higher nutritional risks(P<0.001).In multivariate Cox regression adjusting for all covariates,CONUT score(hazard ratio[HR]=1.31,95%CI=1.03-1.67,P=0.030),GNRI(HR=2.02,95%CI=1.26-3.24,P=0.004),and PNI(HR=2.05,95%CI=1.53-2.75,P<0.001)were independently associated with all-cause mortality.Conclusion:This study confirms that the three nutritional indices are effective predictors of all-cause mortality in COPD patients.Compared with PNI,CONUT score and GNRI demonstrate im-proved predictive abilities,and they are recommended for routine screening for high-risk malnutrition in COPD patients.

Objective:To investigate the effects of mirror therapy(MT)combined with kinesio taping(KT)on persistent pain and quality of life after breast cancer treatment.Method:Patients with persistent pain after breast cancer treatment were recruited from January 2022 to Decem-ber 2022 from Department of Rehabilitation Medicine,Jing'an District Central Hospital of Shanghai.A total of 43 patients were randomized into the combination group(MT+KT,n=22)and the KT group(n=21).Patients in both groups received conventional physical rehabilitation therapy.Additionally,the KT group received kinesio tap-ing and sham mirror therapy,while the combined group received kinesio taping and mirror therapy.Before treat-ment and after 4 weeks of treatment,numerical rating scales(NRSs)was used to evaluate pain,bilateral grip strength was measured using J-Tech grip strength device,shoulder range of motion(ROM)was measured using the goniometer,and quality of life was measured using the short form-36(SF-36)Result:There were no significant differences in NRSs score,grip strength difference,shoulder flexion and ab-duction difference,and SF-36 score between two groups before treatment(P＞0.05).After 4 weeks of interven-tion,the NRSs score,shoulder flexion and shoulder abduction of the combined group were significantly im-proved compared with those before treatment(P＜0.05).The NRSs score,shoulder flexion and shoulder abduc-tion in group KT were significantly improved compared with those before treatment(P＜0.05).Comparison be-tween groups showed that NRSs score of combined group was significantly lower than that of group KT(P=0.001),although grip strength,shoulder flexion and abduction of combined group were improved compared with group KT,but the difference was no statistically significant(P＞0.05).After 4 weeks of intervention,the scores of physiological function,general health and emotional function of SF-36 in combination group were significantly higher than those in group KT(P＜0.05).Conclusion:Mirror therapy combined with kinesio taping can effectively improve the persistent pain and spe-cific aspects of the quality of life in patients after breast cancer treatment.

ObjectiveTo explore the mechanisms of action of Ganlu Xiaodu Dan in treating viral pneumonia by combining network pharmacology and molecular docking with in vivo experimental validation. MethodsNetwork pharmacology and molecular docking were used to predict the core components， target genes， and major pathways of Ganlu Xiaodu Dan. Molecular docking was then applied to verify the interactions between the core components and key targets. Sixty male C57BL/6 mice were randomly divided into six groups （n = 10 per group）， including blank， model， dexamethasone， and Ganlu Xiaodu Dan low-， medium-， and high-dose groups. The blank and model groups were gavaged with physiological saline （10 mL·kg^-1） every 12 h. The dexamethasone group received intraperitoneal injections of dexamethasone （5 mg·kg^-1）. The low-， medium-， and high-dose groups of Ganlu Xiaodu Dan were gavaged with solutions at concentrations of 7.2， 14.4， and 21.6 g·kg^-1， respectively， every 12 h. Lung wet/dry weight ratio （W/D） was measured. Hematoxylin-eosin （HE） staining was used to observe pathological changes in lung tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the expression levels of tumor necrosis factor-α （TNF-α）， interleukin （IL）-17， and IL-1β in bronchoalveolar lavage fluid （BALF）. Western blot was performed to detect the expression of phosphoinositide 3-kinase （PI3K） and protein kinase B （Akt） in lung tissue for further validation. ResultsTwelve potential active components of Ganlu Xiaodu Dan were identified through network pharmacology. A total of 306 overlapping target genes were obtained between Ganlu Xiaodu Dan and viral pneumonia. PPI network analysis identified the top 20 key targets， and GO and KEGG enrichment analyses revealed the top 20 signaling pathways. An “active component–target–pathway” network was constructed. Molecular docking demonstrated strong affinity between the core components of Ganlu Xiaodu Dan and key targets related to viral pneumonia. In animal experiments， compared with the blank group， the model group showed severe bronchial epithelial damage， disordered alveolar structure， massive inflammatory cell infiltration， widened alveolar septa， and obvious interstitial edema. W/D， levels of IL-1β， TNF-α， and IL-17 in BALF， and protein expression of p-PI3K/PI3K and p-Akt/Akt in lung tissue were all significantly increased （P<0.05）. Compared with the model group， lung injury in the Ganlu Xiaodu Dan groups and the dexamethasone group was alleviated. W/D and TNF-α levels were significantly decreased （P<0.05）. IL-1β and IL-17 levels were significantly reduced in the medium- and high-dose groups and the dexamethasone group， and the protein expression levels of p-PI3K/PI3K and p-Akt/Akt in lung tissue were significantly decreased （P<0.05）. ConclusionGanlu Xiaodu Dan can alleviate lung injury in viral pneumonia by suppressing the inflammatory response， and its mechanism may be related to the inhibition of PI3K/Akt pathway activation.

ObjectiveTo explore the mechanisms of action of Ganlu Xiaodu Dan in treating viral pneumonia by combining network pharmacology and molecular docking with in vivo experimental validation. MethodsNetwork pharmacology and molecular docking were used to predict the core components， target genes， and major pathways of Ganlu Xiaodu Dan. Molecular docking was then applied to verify the interactions between the core components and key targets. Sixty male C57BL/6 mice were randomly divided into six groups （n = 10 per group）， including blank， model， dexamethasone， and Ganlu Xiaodu Dan low-， medium-， and high-dose groups. The blank and model groups were gavaged with physiological saline （10 mL·kg^-1） every 12 h. The dexamethasone group received intraperitoneal injections of dexamethasone （5 mg·kg^-1）. The low-， medium-， and high-dose groups of Ganlu Xiaodu Dan were gavaged with solutions at concentrations of 7.2， 14.4， and 21.6 g·kg^-1， respectively， every 12 h. Lung wet/dry weight ratio （W/D） was measured. Hematoxylin-eosin （HE） staining was used to observe pathological changes in lung tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the expression levels of tumor necrosis factor-α （TNF-α）， interleukin （IL）-17， and IL-1β in bronchoalveolar lavage fluid （BALF）. Western blot was performed to detect the expression of phosphoinositide 3-kinase （PI3K） and protein kinase B （Akt） in lung tissue for further validation. ResultsTwelve potential active components of Ganlu Xiaodu Dan were identified through network pharmacology. A total of 306 overlapping target genes were obtained between Ganlu Xiaodu Dan and viral pneumonia. PPI network analysis identified the top 20 key targets， and GO and KEGG enrichment analyses revealed the top 20 signaling pathways. An “active component–target–pathway” network was constructed. Molecular docking demonstrated strong affinity between the core components of Ganlu Xiaodu Dan and key targets related to viral pneumonia. In animal experiments， compared with the blank group， the model group showed severe bronchial epithelial damage， disordered alveolar structure， massive inflammatory cell infiltration， widened alveolar septa， and obvious interstitial edema. W/D， levels of IL-1β， TNF-α， and IL-17 in BALF， and protein expression of p-PI3K/PI3K and p-Akt/Akt in lung tissue were all significantly increased （P<0.05）. Compared with the model group， lung injury in the Ganlu Xiaodu Dan groups and the dexamethasone group was alleviated. W/D and TNF-α levels were significantly decreased （P<0.05）. IL-1β and IL-17 levels were significantly reduced in the medium- and high-dose groups and the dexamethasone group， and the protein expression levels of p-PI3K/PI3K and p-Akt/Akt in lung tissue were significantly decreased （P<0.05）. ConclusionGanlu Xiaodu Dan can alleviate lung injury in viral pneumonia by suppressing the inflammatory response， and its mechanism may be related to the inhibition of PI3K/Akt pathway activation.

OBJECTIVE To investigate the efficacy and safety of metformin in the treatment of diabetes mellitus type 2 （T2DM） complicated with sarcopenia in elderly patients. METHODS From January 2022 to January 2024， clinical data from eligible patients with T2DM complicated with sarcopenia treated at the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College were collected. Patients were randomly assigned into control group （70 cases） and observation group （70 cases） using a random number table. Both groups received routine interventions； control group additionally received subcutaneous injections of Insulin glargine injection before bedtime and Human insulin injection 30 minutes before breakfast， lunch and dinner every day. In addition to the same treatments as the control group， the observation group was administered 0.5 g of Metformin hydrochloride sustained-release tablets orally once daily. Both groups were treated continuously for 24 weeks. Comparisons were made between the two groups in terms of glucose metabolism indexes [fasting blood glucose （FBG）， 2 h postprandial blood glucose （2 hBG）， and glycosylated hemoglobin （HbA1c）]， homeostasis model assessment of insulin resistance （HOMA-IR）， appendicular skeletal mass muscle index （ASMI）， grip strength， walking speed， lipid metabolism indexes [serum total triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C）]， serological markers [high-sensitivity C reactive protein （hs-CRP）， interleukin-6 （IL-6）， and ferritin levels] and quality of life. The occurrence of ADR was recorded in both groups. RESULTS 65 patients in the control group and 63 patients in the observation group completed this study， respectively. After treatment， the levels of FBG， 2 hBG， HbA1c， HOMA-IR，TG and TC in both groups， and the levels of hs-CRP， IL-6 and ferritin in observation group were all significantly reduced compared to those before treatment （P＜0.05）， and the HOMA-IR in observation group was significantly lower than control group （P＜0.05）； additionally， the grip strength， walking speed， and scores for daily living and activity abilities of observation group were increased than those before treatment and the control group （P＜0.05）. The incidence of adverse drug reactions in both groups was 2.86%. CONCLUSIONS Metformin can reduce inflammatory factors and ferritin levels， promote the recovery of muscle mass and strength， improve insulin resistance， and quality of life in elderly patients with T2DM complicated with sarcopenia， and does not increase the occurrence of adverse drug reactions.

Objective To analyze the global distribution characteristics,sequence typing(ST),and the distribution of van genes in Enterococcus faecium globally to provide reference for the prevention,control and clinical treatment of glycopeptide-resistant strains in-fection.Methods This study used Aspera software to download all Enterococcus faecium genome sequence data from NCBI in batches up to December 7,2023.The nucleotide sequences and strain metadata of all genomes were then extracted from the downloaded GBK files using a Perl script.The sequence data of van resistance genes were obtained from the NCBI Pathogen Antimicrobial Resistance Gene Database and analyzed using BLASTN software to determine their distribution across genomes.For the ST analysis,allele se-quence files for seven housekeeping genes of Enterococcus faecium were downloaded from pubMLST website,and all of the strains were sequence typed using a self-developed ST_tool.Results A total of 2 781 Enterococcus faecium genomes were obtained,with isolation dates ranging from 1920 to 2023,showing an increasing peak of isolation rates observed in 2019.In terms of geographic distribution,China,the United States,and New Zealand accounted for 15.61％(434 strains),12.87％(358 strains),and 5.57％(155 strains)of the isolates,respectively,and ranked in the top three.A total of 771 strains originated from human samples,primarily isolated from u-rine(168 strains),feces(154 strains),and rectal swabs(69 strains).In terms of ST,2 781 Enterococcus faecium strains were clas-sified into 359 STs,with ST16(188 strains,7.29％),ST6(178 strains,6.90％),and ST179(150 strains,5.82％)being the pre-dominant types.On the national level,the dominant STs in the United States,China,and New Zealand were ST6(10.71％),ST16(9.59％),and ST108(67.10％),respectively.Additionally,282 Enterococcus faecium strains carried glycopeptide resistance genes,mainly vanA(207 strains)and vanB(72 strains),with ST108(100 strains)and ST6(43 strains)being the predominant types asso-ciated with vanA and vanB,respectively.Conclusion There are significant regional differences in the distribution of Enterococcus fae-cium globally.The vanA and vanB glycopeptide resistance genes are prevalent among resistant strains and exhibit a trend toward multi-drug resistance evolution,highlighting the need for enhanced clinical monitoring and control measures.

Objective:To analyze the clinical features and prognosis of acute B lymphoblastic leukemia (B-ALL) children carrying a TCF3: : PBX1 fusion gene and to evaluate the prognostic value of this gene.Methods:Retrospective cohort study.A total of 2 164 B-ALL children aged 0-18 years diagnosed and treated at 19 pediatric centers from October 2016 to June 2022 were enrolled.They were divided into the positive group and the negative group according to whether they carried a TCF3: : PBX1 fusion gene.The clinical characteristics, treatment response, adverse reactions, and prognosis of the 2 groups of patients were analyzed.The rank sum and Kruskal-Wallis tests were used to compare two and more than two groups of numerical variables, respectively.Fisher′s exact test was used to compare categorical variables.Results:Among the 2 164 patients, 116 (5.4%) were TCF3: : PBX1 positive, of which 70 patients were female, accounting for 60.3%.There were 840 female patients in the TCF3: : PBX1-negative group, accounting for 41.0%.There was a significant difference in the ratio of females between the TCF3: : PBX1-positive and TCF3: : PBX1-negative groups ( P<0.001).No significant difference was observed in age of onset between the two groups( P>0.05).The proportion of bone marrow naive cells [54.00 (14.00, 76.50)% vs.29.00 (3.00, 68.00)%], white blood cell counts [25.30 (10.46, 60.94)×10 9/L vs.9.03 (4.38, 30.73)×10 9/L] and hemoglobin counts [82.00(63.00, 101.00) g/L vs.74.00(60.00, 90.00) g/L] in the TCF3: : PBX1-positive group were significantly higher than those in the negative group at the onset (all P<0.05).In terms of treatment response, the proportion of peripheral blood naive cells on Day 8 in the TCF3: : PBX1-positive group was significantly higher than that in the negative group [2.00 (0, 9.00)% vs.0 (0, 2.00)%, P<0.001].The proportion of minimal residual disease <0.1% on Day 15 in the TCF3: : PBX1-positive group was significantly higher than that in the negative group ( P=0.038).There were no significant differences in cumulative recurrence rate, treatment-related mortality (TRM), and overall survival (OS) between the TCF3: : PBX1-positive group and TCF3: : PBX1-negative group (all P>0.05).The cumulative recurrence risk of TCF3: : PBX1-positive patients was 9.646 times higher than that of ETV6: : RUNX1-positive patients with better prognosis( HR=9.646, 95% CI: 1.026-90.700, P=0.047).There were no significant differences in TRM and OS between TCF3: : PBX1-positive and ETV6: : RUNX1-positive patients (all P>0.05).A significant enrichment of PAX5 mutations was detected in TCF3: : PBX1-positive patients.Among the 7 high-risk TCF3: : PBX1-positive patients in a single center, 4 patients had PAX5 mutations, and this proportion was significantly higher than that in other patients ( P<0.001). Conclusions:B-ALL children carrying a TCF3: : PBX1 fusion gene have a high remission rate and good long-term prognosis after intensive chemotherapy.It is suggesting that TCF3: : PBX1-positive B-ALL patients should be rated at intermediate risk to receive intensive chemotherapy.

Objective:To investigate the effects of mirror therapy(MT)combined with kinesio taping(KT)on persistent pain and quality of life after breast cancer treatment.Method:Patients with persistent pain after breast cancer treatment were recruited from January 2022 to Decem-ber 2022 from Department of Rehabilitation Medicine,Jing'an District Central Hospital of Shanghai.A total of 43 patients were randomized into the combination group(MT+KT,n=22)and the KT group(n=21).Patients in both groups received conventional physical rehabilitation therapy.Additionally,the KT group received kinesio tap-ing and sham mirror therapy,while the combined group received kinesio taping and mirror therapy.Before treat-ment and after 4 weeks of treatment,numerical rating scales(NRSs)was used to evaluate pain,bilateral grip strength was measured using J-Tech grip strength device,shoulder range of motion(ROM)was measured using the goniometer,and quality of life was measured using the short form-36(SF-36)Result:There were no significant differences in NRSs score,grip strength difference,shoulder flexion and ab-duction difference,and SF-36 score between two groups before treatment(P＞0.05).After 4 weeks of interven-tion,the NRSs score,shoulder flexion and shoulder abduction of the combined group were significantly im-proved compared with those before treatment(P＜0.05).The NRSs score,shoulder flexion and shoulder abduc-tion in group KT were significantly improved compared with those before treatment(P＜0.05).Comparison be-tween groups showed that NRSs score of combined group was significantly lower than that of group KT(P=0.001),although grip strength,shoulder flexion and abduction of combined group were improved compared with group KT,but the difference was no statistically significant(P＞0.05).After 4 weeks of intervention,the scores of physiological function,general health and emotional function of SF-36 in combination group were significantly higher than those in group KT(P＜0.05).Conclusion:Mirror therapy combined with kinesio taping can effectively improve the persistent pain and spe-cific aspects of the quality of life in patients after breast cancer treatment.

Objective To analyze the global distribution characteristics,sequence typing(ST),and the distribution of van genes in Enterococcus faecium globally to provide reference for the prevention,control and clinical treatment of glycopeptide-resistant strains in-fection.Methods This study used Aspera software to download all Enterococcus faecium genome sequence data from NCBI in batches up to December 7,2023.The nucleotide sequences and strain metadata of all genomes were then extracted from the downloaded GBK files using a Perl script.The sequence data of van resistance genes were obtained from the NCBI Pathogen Antimicrobial Resistance Gene Database and analyzed using BLASTN software to determine their distribution across genomes.For the ST analysis,allele se-quence files for seven housekeeping genes of Enterococcus faecium were downloaded from pubMLST website,and all of the strains were sequence typed using a self-developed ST_tool.Results A total of 2 781 Enterococcus faecium genomes were obtained,with isolation dates ranging from 1920 to 2023,showing an increasing peak of isolation rates observed in 2019.In terms of geographic distribution,China,the United States,and New Zealand accounted for 15.61％(434 strains),12.87％(358 strains),and 5.57％(155 strains)of the isolates,respectively,and ranked in the top three.A total of 771 strains originated from human samples,primarily isolated from u-rine(168 strains),feces(154 strains),and rectal swabs(69 strains).In terms of ST,2 781 Enterococcus faecium strains were clas-sified into 359 STs,with ST16(188 strains,7.29％),ST6(178 strains,6.90％),and ST179(150 strains,5.82％)being the pre-dominant types.On the national level,the dominant STs in the United States,China,and New Zealand were ST6(10.71％),ST16(9.59％),and ST108(67.10％),respectively.Additionally,282 Enterococcus faecium strains carried glycopeptide resistance genes,mainly vanA(207 strains)and vanB(72 strains),with ST108(100 strains)and ST6(43 strains)being the predominant types asso-ciated with vanA and vanB,respectively.Conclusion There are significant regional differences in the distribution of Enterococcus fae-cium globally.The vanA and vanB glycopeptide resistance genes are prevalent among resistant strains and exhibit a trend toward multi-drug resistance evolution,highlighting the need for enhanced clinical monitoring and control measures.

Objective:To analyze the clinical features and prognosis of acute B lymphoblastic leukemia (B-ALL) children carrying a TCF3: : PBX1 fusion gene and to evaluate the prognostic value of this gene.Methods:Retrospective cohort study.A total of 2 164 B-ALL children aged 0-18 years diagnosed and treated at 19 pediatric centers from October 2016 to June 2022 were enrolled.They were divided into the positive group and the negative group according to whether they carried a TCF3: : PBX1 fusion gene.The clinical characteristics, treatment response, adverse reactions, and prognosis of the 2 groups of patients were analyzed.The rank sum and Kruskal-Wallis tests were used to compare two and more than two groups of numerical variables, respectively.Fisher′s exact test was used to compare categorical variables.Results:Among the 2 164 patients, 116 (5.4%) were TCF3: : PBX1 positive, of which 70 patients were female, accounting for 60.3%.There were 840 female patients in the TCF3: : PBX1-negative group, accounting for 41.0%.There was a significant difference in the ratio of females between the TCF3: : PBX1-positive and TCF3: : PBX1-negative groups ( P<0.001).No significant difference was observed in age of onset between the two groups( P>0.05).The proportion of bone marrow naive cells [54.00 (14.00, 76.50)% vs.29.00 (3.00, 68.00)%], white blood cell counts [25.30 (10.46, 60.94)×10 9/L vs.9.03 (4.38, 30.73)×10 9/L] and hemoglobin counts [82.00(63.00, 101.00) g/L vs.74.00(60.00, 90.00) g/L] in the TCF3: : PBX1-positive group were significantly higher than those in the negative group at the onset (all P<0.05).In terms of treatment response, the proportion of peripheral blood naive cells on Day 8 in the TCF3: : PBX1-positive group was significantly higher than that in the negative group [2.00 (0, 9.00)% vs.0 (0, 2.00)%, P<0.001].The proportion of minimal residual disease <0.1% on Day 15 in the TCF3: : PBX1-positive group was significantly higher than that in the negative group ( P=0.038).There were no significant differences in cumulative recurrence rate, treatment-related mortality (TRM), and overall survival (OS) between the TCF3: : PBX1-positive group and TCF3: : PBX1-negative group (all P>0.05).The cumulative recurrence risk of TCF3: : PBX1-positive patients was 9.646 times higher than that of ETV6: : RUNX1-positive patients with better prognosis( HR=9.646, 95% CI: 1.026-90.700, P=0.047).There were no significant differences in TRM and OS between TCF3: : PBX1-positive and ETV6: : RUNX1-positive patients (all P>0.05).A significant enrichment of PAX5 mutations was detected in TCF3: : PBX1-positive patients.Among the 7 high-risk TCF3: : PBX1-positive patients in a single center, 4 patients had PAX5 mutations, and this proportion was significantly higher than that in other patients ( P<0.001). Conclusions:B-ALL children carrying a TCF3: : PBX1 fusion gene have a high remission rate and good long-term prognosis after intensive chemotherapy.It is suggesting that TCF3: : PBX1-positive B-ALL patients should be rated at intermediate risk to receive intensive chemotherapy.