ObjectiveTo observe the short-term and long-term efficacy of traditional Chinese medicine （TCM） surgical operations in treating mixed hemorrhoids. MethodsA multi-center retrospective cohort study was conducted， collecting clinical data from 17，831 mixed hemorrhoid surgery patients in 8 top-tier TCM hospitals in Jiangsu Province. Standardized and structured datasets were obtained through artificial intelligence models. Patients who underwent western surgical treatment were categorized into the western surgery group （11,646 cases）， and those receiving TCM surgical operations were categorized into the TCM surgery group （6185 cases）. Propensity score matching （1∶1 matching） was used to balance baseline data between groups. The primary outcome was the one-year recurrence rate， and secondary outcomes included the main symptoms （rectal bleeding， degree of prolapse） and secondary symptoms （anal distension， anal edema， wound secretion and exudation， anal stenosis， residual skin tags， perianal itching， and anal pain） measured on days 7， 28， and 60 after discharge. ResultsAfter matching， 2194 patients were included in each group. Symptom scores showed that at 28 days after discharge， the TCM surgical group had superior improvement in rectal bleeding ［OR=5.786， 95%CI （3.092，10.827）］， degree of prolapse ［OR=4.510， 95%CI （1.649，12.333）］， and anal edema ［OR=3.188， 95%CI （1.295，7.845）］ compared to the western surgical group. At 60 days post-discharge， the TCM group still showed advantages in improving rectal bleeding ［OR=5.237， 95%CI （1.077，25.464）］ and anal pain ［OR=11.697， 95%CI （1.186，115.336）］ （P＜0.05）. Long-term follow-up showed that the one-year recurrence rate in the TCM surgery group was 1.1% （8/726）， while that in the western surgery group was 2.3% （10/444）， with no statistically significant difference between the two groups （P＞0.05）. ConclusionBased on real-world data， TCM surgical treatment for mixed hemorrhoids shows significant short-term symptom improvement， particularly in terms of hemostasis， reducing swelling， and alleviating prolapse of anal masses.

ObjectiveTo construct a risk prediction model for frequent acute exacerbations of chronic obstructive pulmonary disease （COPD） under disease-syndrome combination， thus providing decision support for precise clinical intervention. MethodsA total of 2 029 patients with acute exacerbations of COPD admitted to the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2020 to August 2024 were retrospectively included. These patients were classified into groups of frequent acute exacerbations （≥2 times/year） and infrequent acute exacerbations （<2 times/year） according to the hospitalization times per year. Risk factors were screened by LASSO regression combined with logistic regression， and a nomogram model was constructed. The model performance was assessed based on the area under the curve （AUC）， calibration curves， and decision curve analysis （DCA）. ResultsThe differences in baseline characteristics between the frequent acute exacerbations group （1 196 cases） and infrequent acute exacerbations group （833 cases） were not statistically significant. LASSO regression combined with multivariate logistic regression screened the following independent risk factors： body mass index （BMI）， hospitalization days， number of smoking years， place of residence， use of noninvasive ventilators， oxygen-demanding therapy， liver cirrhosis， use of systemic glucocorticosteroids， and traditional Chinese medicine syndrome （phlegm and stasis obstructing the lung）. The nomogram model showed good discrimination and calibration in both the training set （AUC=0.748） and validation set （AUC=0.774）. ConclusionThe risk prediction model for frequent acute exacerbations of COPD， integrating traditional Chinese medicine syndrome， constructed in this study has high accuracy. It can provide a scientific basis for early clinical identification of high-risk patients and individualized intervention.

Triatoma rubrofasciata is currently the most widely distributed species of Triatoma worldwide, and it is also widespread in southern China. T. rubrofasciata has been proven to transmit Trypanosoma cruzi, and is one of vectors transmitting Chagas disease, which poses a potential risk for transmission of imported Chagas disease in China. Findings from latest studies have shown that T. rubrofasciata naturally infects T. lewisi, T. conorhini, and T. rangeli, which undoubtedly increases significant risks of and challenges to trypanosomiasis control in China. This article briefly describes the species of T. rubrofasciata-transmitted trypanosomes, and summarizes the epidemiological characteristics of trypanosomiasis, so as to provide insights into T. rubrofasciata-transmitted trypanosomiasis surveillance and control, and prevention of trypanosomiasis development and transmission in China.

Background: Adrenocortical hormones, particularly 11-oxygenated androgens, are pivotal in female reproductive health and fertility. Standardized detection kits and population-specific reference intervals are lacking in China, hindering related clinical applications. Methods: A HPLC-tandem mass spectrometry (HPLC-MS/MS) pipeline was developed, rigorously validated, and applied to simultaneously quantify corticosterone, cortisone, cortisol, 18-OH cortisol, androstenedione (A4), 11β-hydroxyandrostenedione (11-OH A4), dehydroepiandrosterone, and dehydroepiandrosterone sulfate in serum samples from 455 reproductive-aged women (18–45 yrs) in Guangxi, China. Age-dependent concentration trends were analyzed, and reference intervals stratified by age (2.5th to 97.5th percentiles) were established. Correlations with body-composition metrics, ethnicity, and the menstrual cycle were investigated. Results: The HPLC-MS/MS method demonstrated high precision (intra- and inter-assay CVs < 15%), accuracy, and sensitivity. All eight hormones exhibited significant age-related declines (P < 0.001 for seven hormones; P = 0.001 for 11-OH A4). Notably, 11-OH A4 levels were significantly lower in the 35–45-yr (3.05 nmol/L) and 25–34-yr (3.09 nmol/L) age groups than in the 18–24-yr (3.57 nmol/L) age group, whereas no significant difference was observed between the 35–45-yr and 25–34-yr age groups. Weak negative correlations were observed between the body mass index and corticosterone and cortisone levels, whereas ethnicity and the menstrual cycle showed no significant associations with hormone levels. Conclusions We developed an HPLC-MS/MS-based method for simultaneously quantifying eight adrenocortical hormones, including 11-OH A4, and defined age-specific reference intervals for reproductive-aged Chinese women. These findings advance the clinical utility of adrenocortical hormones in diagnosing and managing reproductive disorders.

Objective To investigate the effects of penehyclidine hydrochloride(PHC)admin-istered at different time points on neurological function and the blood-brain barrier(BBB)in rat model of severe intracerebral hemorrhage(ICH),and to preliminarily explore its potential mechanism of action based on the growth arrest-specific protein 6(GAS6)/receptor tyrosine kinase(Axl)signaling pathway.Methods ICH model rats were established via intracerebral injection of a collagenase type Ⅳ solu-tion.The model rats were randomly divided into sham operation group(intracerebral injection of an equal volume of saline),model group(intracerebral injection of 0.4 μL of collagenase type Ⅳ solu-tion),24 h drug administration group(intracerebral injection of 0.4 μL of collagenase type Ⅳ solu-tion combined with intraperitoneal injection of 2 mg/kg PHC 24 h after successful model establish-ment),6 h drug administration group(intracerebral injection of 0.4 μL of collagenase type Ⅳ solu-tion combined with intraperitoneal injection of 2 mg/kg PHC 6 h after successful model establish-ment),pre-drug administration group(intraperitoneal injection of 2 mg/kg PHC before modeling combined with intracerebral injection of 0.4 μL of collagenase type Ⅳ solution),and pathway in-hibitor group(intraperitoneal injection of 2 mg/kg PHC before modeling combined with intracerebral injection of 0.4 μL of collagenase type Ⅳ solution and intraperitoneal injection of 75 mg/kg R428,a GAS6/Axl signaling pathway inhibitor,after successful model establishment).The degree of neu-rological impairment in rats was assessed after successful model establishment and at the end of treat-ment;brain tissue water content in rats was calculated;brain tissue damage and Evans blue(EB)content in rats were evaluated using hematoxylin-eosin(HE)and EB staining methods;western blot was used to detect the expression levels of Claudin-5,zonula occludens-1(ZO-1),Occludin,ma-trix metalloproteinase-9(MMP-9),and proteins related to the GAS6/Axl signaling pathway in brain tissue.Results HE staining revealed that compared with the sham operation group,the model group exhibited irregular arrangement of brain tissue cells,a large number of necrotic cells,and sig-nificant infiltration of inflammatory cells;compared with the model group,the 24 h drug administra-tion,6 h drug administration,pre-drug administration,and pathway inhibitor groups showed more orderly brain tissue cells,reduced cell gaps,and decreased infiltration of inflammatory cells;com-pared with the 24 h drug administration group,the 6 h drug administration,pre-drug administration,and pathway inhibitor groups exhibited more intact brain tissue cell structures,reduced cell gaps,and decreased infiltration of inflammatory cells;compared with the pre-drug administration group,the 6 h drug administration and pathway inhibitor groups showed slight swelling of brain tissue cells and a small amount of inflammatory cell infiltration.Compared with the sham operation group,the model group had increased neurological function scores,brain tissue water content,EB content in brain tissue,and MMP-9 protein levels,along with decreased levels of ZO-1,Occludin,Claudin-5 proteins,and GAS6 and p-Axl protein expression;compared with the model group,the 24 h drug administration,6 h drug administration,pre-drugadministration,and pathway inhibitor groups had decreased neurological function scores,brain tissue water content,EB content in brain tissue,and MMP-9 protein levels,along with increased levels of ZO-1,Occludin,Claudin-5 proteins,and GAS6 and p-Axl protein levels in brain tissue;compared with the 24 h drug administration group,the 6 h drug administration,pre-drug administration,and pathway inhibitor groups had decreased neurological function scores,brain tissue water content,EB content in brain tissue,and MMP-9 protein levels,along with increased levels of ZO-1,Occludin,Claudin-5 proteins,and GAS6 and p-Axl protein expression;compared with the pre-drug administration group,the 6 h drug administra-tion and pathway inhibitor groups had increased neurological function scores,brain tissue water con-tent,EB content in brain tissue,and MMP-9 protein levels,along with decreased levels of ZO-1,Occludin,Claudin-5 proteins,and GAS6 and p-Axl protein expression in brain tissue;the between-group differences mentioned above were statistically significant(P＜0.05).Conclusion Early ad-ministration of PHC can improve neurological function and the BBB in ICH rats by reducing brain tissue damage and brain edema,and its mechanism may be related to the activation of the GAS6/Axl signaling pathway.

The biological nitrogen removal technology utilizing heterotrophic nitrification-aerobic denitrification (HN-AD) bacteria has shown effectiveness in wastewater treatment. However, the nitrogen removal efficiency of HN-AD bacteria significantly decreases as the salinity increases. To tackle the challenge of treating high-salt and high-nitrogen wastewater, we isolated a moderately halophilic HN-AD strain 5505 from a salt lake in Xinjiang. The strain was identified based on morphological, physiological, and biochemical characteristics and the 16S rRNA gene sequence. Single-factor experiments were carried out with NH₄⁺-N, NO₃^--N, and NO₂^--N as sole or mixed nitrogen sources to study the nitrifying effect, denitrifying effect, and nitrogen metabolism pathway of the strain. The strain was identified as Halomonas sp.. It can grow in the presence of 1%-25% (W/V) NaCl and exhibited efficient nitrogen removal ability in the presence of 3%-8% NaCl. At the optimal NaCl concentration (8%), the strain showed the NH₄⁺-N, NO₃^--N and NO₂^--N removal rates of 100.0%, 94.11% and 74.43%, respectively. Strain 5505 removed inorganic nitrogen mainly by assimilation, which accounted for over 62.68% of total nitrogen removal. In the presence of mixed nitrogen sources, strain 5505 showed a preference for utilizing ammonia, with a potential HN-AD pathway of NH₄⁺→NH₂OH→NO₂^-→NO₃^-→NO₂^-→NO/N₂O/N₂. The findings provide efficient salt-tolerant bacterial resources, enhance our understanding of biological nitrogen removal, and contribute to the nitrogen removal efficiency improvement in the treatment of high-salt and high-nitrogen wastewater.
Halomonas/classification* ; Nitrogen/isolation & purification* ; Denitrification ; Nitrification ; Wastewater/microbiology* ; Aerobiosis ; Biodegradation, Environmental ; Salinity

To investigate the current status of sleep quality among nurses in tertiary hospitals in China, analyze the correlations of work stress and perceived organizational support with the risk of sleep problems, and further examine the mediating effect of perceived organizational support between work stress and sleep problems in nurses.

Childhood primary renal tubular diseases are chronic kidney diseases characterized by impaired renal tubular reabsorption. Primary renal tubular disease has diverse clinical manifestations and lacks of specificity. Laboratory tests are limited，making it prone to missed diagnosis and misdiagnosis. Based on the current knowledge of renal tubular diseases，authors propose early warning signals of renal tubular diseases such as family history of primary tubular diseases，unexplained polyhydramnios during pregnancy，polydipsia，polyuria，delayed growth and development or rickets，decreased muscle strength and tone，unexplained electrolyte disturbance，hyperuricemia，acid-base disturbance，positive urine sugar test，renal tubular proteinuria，urinary imaging examination suggesting kidney stones，calcium deposition，renal cysts and early onset of eye，ear，joint and neuron injury.Meanwhile，some universal management strategies for primary renal tubular disease are proposed，emphasizing the importance of multidisciplinary collaboration，genetic testing and individualized intervention to improve the long-term prognosis of childhood primary renal tubular diseases.

Objective:To investigate the impact of Wenyang Ligong Decoction on pregnancy outcomes after transcervical resection of adhesions (TCRA) in patients with intrauterine adhesions (IUA).Methods:A retrospective cohort study was conducted to collect clinical data from 151 patients with IUA who underwent TCRA in the Reproductive Medicine Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine between January 2020 and January 2023. Patients were divided into a Traditional Chinese medicine (TCM) group (79 patients) and a control group (72 patients) based on whether they received Wenyang Ligong Decoction after TCRA. The TCM group received estrogen and progesterone sequential therapy post-surgery, combined with Wenyang Ligong Decoction for 2-3 menstrual cycles. The control only received sequential treatment with estrogen and progesterone.Pregnancy outcomes one year after surgery were compared between the two groups. After adjusting for confounding factors using multivariate Cox regression analysis, the effect of Wenyang Ligong Decoction on pregnancy outcomes after TCRA in patients with IUA was observed.Results:The live birth rate [54.43%　(43/79)], the ongoing pregnancy rate [56.96% (45/79)], and the clinical pregnancy rate [52.03% (49/79)] were higher in the TCM group than in the control [26.39% (19/72), P<0.001; 30.56% (22/72), P=0.001;37.50% (27/72), P=0.003], with statistically significant differences. There were no statistically significant differences in early abortion rate and late abortion rate between the TCM group and the control (all P>0.05). According to the stratified analysis by preparation methods, in the natural conception group, the live birth rate [60.78% (31/51)], the ongoing pregnancy rate [62.75% (32/51)], and the clinical pregnancy rate [68.63% (35/51)] in the TCM group were significantly higher than those in control group [21.43% (12/56), P<0.001; 26.79% (15/56), P<0.001; 33.93% (19/56), P<0.001]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05). In the assisted reproductive technology group, there were no statistically significant differences in live birth rate, ongoing pregnancy rate, clinical pregnancy rate, early miscarriage rate, and late miscarriage rate between the two groups (all P>0.05). According to the stratified analysis by age, in the <35-year-old patients, the live birth rate [66.00% (33/50)], the ongoing pregnancy rate [70.00% (35/50)], and the clinical pregnancy rate [74.00% (37/50)] in the TCM group were significantly higher than those in control group [41.30% (19/46), P=0.015; 47.83% (22/46), P=0.027; 54.35% (25/46), P=0.044]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05). In the ≥35-year-old patients, the live birth rate [34.48% (10/29)], the ongoing pregnancy rate [34.48% (10/29)], and the clinical pregnancy rate [41.38% (12/29)] in the TCM group were significantly higher than those in control group [0%, P=0.001; 0%, P=0.001; 7.69% (2/26), P=0.004]; there were no statistically significant differences in early miscarriage rate and late miscarriage rate between the two groups (both P>0.05).Univariate Cox regression analysis showed that age, number of previous uterine cavity interventions, IUA score, degree of IUA, and endometrial thickness after TCRA were independent risk factors for live births, and age, IUA score, degree of IUA, intima thickness after TCRA, and treatment group were the influencing factors of persistent pregnancy (all P<0.05). After adjusting for confounding factors, multivariate Cox regression analysis showed that Wenyang Ligong Decoction significantly improved the live birth rate ( HR=3.19, 95% CI: 1.77-8.11, P=0.001) and the rate of continuous pregnancy ( HR=3.66, 95% CI: 1.80-7.48, P<0.001) in patients with IUA. Conclusion:Wenyang Ligong Decoction can significantly improve pregnancy outcomes after TCRA in patients with IUA.

Objective:To investigate the clinical features and predictive indicators of children with recurrent simple febrile seizures, providing theoretical guidance for the early identification of such patients in clinical practice.Methods:This study is a single-center, retrospective analysis. It included 152 children with febrile seizures who were admitted to Department of Emergency, Hangzhou Children's Hospital from January 2021 to December 2023. Based on whether multiple episodes of simple febrile seizures occurred within 24 hours, the children were divided into a recurrent simple febrile seizure group ( n = 44) and a simple febrile seizure group ( n = 108). Demographic characteristics, clinical data, and laboratory test results were collected. Statistical analysis was performed using univariate and multivariate logistic regression, correlation analysis, and receiver operating characteristic curves. Results:Among the 152 children with febrile seizures included in this study, 44 (28.95%) were diagnosed with recurrent simple febrile seizures. Children with recurrent simple febrile seizures had lower temperatures upon admission, were younger at the time of their first febrile seizure, and had a higher proportion of cases where the time interval from fever to seizure was < 12 hours ( t = 2.84, 4.25, 8.45, all P < 0.05). Pearson correlation analysis showed that recurrent simple febrile seizures were negatively correlated with admission temperature and age at first febrile seizure ( r = -0.599, -0.609, both P < 0.001) and positively correlated with the time interval from fever to seizure ( r = 0.568, P = 0.004). Logistic regression analysis indicated that age at first febrile seizure and a time interval from fever to seizure of ≥ 12 hours were influential factors of recurrent simple febrile seizures ( OR = 2.864, 2.145, P = 0.004, 0.007). Receiver operating characteristic curve analysis revealed that admission temperature, age at first febrile seizure, a time interval from fever to seizure of ≥ 12 hours, and their combination were all effective in detecting recurrent simple febrile seizures. However, the combined assessment had higher sensitivity and specificity than any single assessment, with a sensitivity of 88.60%, specificity of 89.80%, a cutoff value of 0.840, and an area under the curve of 0.886. Conclusions:Lower admission temperatures, younger age at the time of the first febrile seizure, and a time interval of < 12 hours from fever to seizure are associated with an increased likelihood of simple febrile seizures developing into recurrent simple febrile seizures.