Objective To explore the factors influencing blood drug concentrations of first-line anti-tuberculosis drugs in fixed-dose combinations by analyzing therapeutic drug monitoring data from tuberculosis patients receiving these regimens.Methods This retrospective study enrolled 224 patients who received treatment at Guangzhou Chest Hospital between January 2020 and December 2024.All participants underwent standardized therapy during the intensive phase,with therapeutic drug monitoring of first-line anti-tuberculosis drugs(ANTDs),including isoniazid(INH)and rifampicin(RFP).Data collection was completed in January 2025,at which time clinical records and measured INH and RFP plasma concentrations were updated.Data analysis was conducted from January to February 2025.Eight baseline variables—gender,age,hypoproteinemia(serum albumin<35 g/L),glomerular filtration rate(GFR),and others—were collected.Univariate chi-square tests and multivariate logistic regression analyses were performed to identify independent risk factors associated with subtherapeutic INH and RFP plasma concentrations.Results Among the study participants,71.43%(160/224)exhibited blood drug concentrations below the reference range for INH,compared to 41.07%(92/224)for RFP.The mean blood concentrations(mg/L,±SD)were 2.532±1.371 for INH and 9.428±4.317 for RFP,respectively.One-way analysis indicated significant associations between male gender,positive etiological test results,and subtherapeutic RFP concentrations(P<0.05),suggesting statistically significant differences.Multivariate regression analysis further revealed that male gender(OR=1.992,95%CI:1.094～3.628)and positive etiological tests(OR=1.929,95%CI:1.058～3.517)were independent risk factors for low RFP levels.Conclusions This study demonstrates that therapeutic drug monitoring(TDM)frequently identifies subtherapeutic RFP concentrations in tuberculosis patients undergoing treatment.Multivariate analysis reveals that male sex and positive pathogen test results are independent risk factors associated with low RFP plasma levels.Consequently,clinicians should exercise heightened vigilance in patients exhibiting these characteristics,promptly implementing TDM to guide individualized dose adjustments.Such an approach is crucial for optimizing treatment efficacy and minimizing the risk of drug resistance development.

Objective To explore the effectiveness of integrating virtual simulation technology with case-based learning(CBL)in the teaching of clinical blood transfusion testing technology.Methods From January to June 2024,99 undergraduate students majoring in medical laboratory science at our university were selected and divided into an observation group(50 students)and a control group(49 students)based on their classes.The control group followed a traditional theoretical teaching model,while the observation group employed virtual simulation technology combined with CBL.Results The study compared as-sessment scores for theory learning,practical skills,case analysis,and comprehensive quality,teaching effects such as coordina-tion and cooperation abilities,self-efficacy measured by the GSES scale,and teaching satisfaction between the two groups.The results indicated that the observation group had significantly higher scores in all assessment categories,teaching effect abilities,and total GSES scores compared to the control group(P＜0.05).The total teaching satisfaction rate in the observation group reached 100%,significantly higher than the 80% in the control group(P＜0.05).Conclusion The integration of virtual simu-lation technology with CBL innovates the teaching model for clinical blood transfusion testing courses,effectively enhancing students'professional skills and comprehensive quality,boosting self-efficacy,and achieving high student satisfaction,demon-strating significant potential for broader application.

A multi-layer feature attention enhanced network is proposed to further improve the diagnostic accuracy of the severity of diabetic retinopathy.To address the inconsistent expression of global and local features when processing diabetic retinopathy images,a dual-branch parallel model combining ResNet-50 and DeiT-S is employed as the backbone architecture,and a feature fusion module is designed at the end of the network.Concurrently,a multi-scale location awareness enhancement module is developed to extract multi-scale information through dilated convolution with positional attention mechanism for enhancing the feature representation of lesions in fundus images,and a local feature enhancement module is constructed to strengthen the model's capability in extracting local information,thus improving model's capability to identify small lesions and minor changes.The experimental results show that the proposed multi-layer feature attention enhanced network achieves an accuracy of 87.61%,exhibiting excellent classification performance.This advancement provides a strong support for further development of diabetic retinopathy detection technology.

Objective To investigate the effect of long-chain non-coding ribonucleic acid maternal expression 3(MEG3)on high glucose-induced pancreatic islet β-cell injury through the transforming growth factor-β-Smad 2/3 signaling pathway.Methods INS-1 rat insulinoma cells were divided into normal control(Con)group,HG group,negative control(si-NC)group,HG+si-NC group,siRNA targeting MEG3(si-MEG3)group,HG+si-MEG3 group,HG+si-MEG3+TGF-β-Smad2/3 signaling pathway inhibitor(HG+si-MEG3+LY2109761)group.Cell viability was detected by cell counting kit-8(CCK-8).The mRNA expression of MEG3 and pyroptosis-associated markers was detected by qRT-PCR.Autophagic vesicles were tested by transmission electron microscopy,and expression of autophagy-associated proteins and pyroptosis-associated proteins was detected by Western blot and immunofluorescence.TGF-β-Smad2/3 protein expression was detected by Western blot.Results Glucose downregulated MEG3 mRNA expression in a dose-dependent manner.Compared with si-NC group,p-Smad2,TGF-β1,Beclin1,LC3-II/LC3-I,NLRP3,GSDMD-N,IL-1β,ASC,and c-Caspase1 protein expression was elevated(P<0.05),and cell viability was decreased in HG+si-NC group(P<0.05).Compared with the HG+si-NC group,TGF-β1,NLRP3,GSDMD-N,IL-1β,ASC,c-Caspase1 protein expression was elevated(P<0.05),and p-Smad2,cell viability,Beclin1,and LC3-II/LC3-I were decreased in the HG+si-MEG3 group(P<0.05).Compared with HG+si-MEG3 group,NLRP3,GSDMD-N,IL-1β,ASC,and c-Caspase1 protein expression was elevated(P<0.05),and cell viability,p-Smad2,TGF-β1,Beclin1,and LC3-II/LC3-I protein expression was decreased in HG+si-MEG3+LY2109761 group(P<0.05).Conclusions MEG3 regulates autophagy and pyroptosis in pancreatic β-cells through the TGF-β-Smad2/3 signaling pathway.

Objective To explore the factors influencing blood drug concentrations of first-line anti-tuberculosis drugs in fixed-dose combinations by analyzing therapeutic drug monitoring data from tuberculosis patients receiving these regimens.Methods This retrospective study enrolled 224 patients who received treatment at Guangzhou Chest Hospital between January 2020 and December 2024.All participants underwent standardized therapy during the intensive phase,with therapeutic drug monitoring of first-line anti-tuberculosis drugs(ANTDs),including isoniazid(INH)and rifampicin(RFP).Data collection was completed in January 2025,at which time clinical records and measured INH and RFP plasma concentrations were updated.Data analysis was conducted from January to February 2025.Eight baseline variables—gender,age,hypoproteinemia(serum albumin<35 g/L),glomerular filtration rate(GFR),and others—were collected.Univariate chi-square tests and multivariate logistic regression analyses were performed to identify independent risk factors associated with subtherapeutic INH and RFP plasma concentrations.Results Among the study participants,71.43%(160/224)exhibited blood drug concentrations below the reference range for INH,compared to 41.07%(92/224)for RFP.The mean blood concentrations(mg/L,±SD)were 2.532±1.371 for INH and 9.428±4.317 for RFP,respectively.One-way analysis indicated significant associations between male gender,positive etiological test results,and subtherapeutic RFP concentrations(P<0.05),suggesting statistically significant differences.Multivariate regression analysis further revealed that male gender(OR=1.992,95%CI:1.094～3.628)and positive etiological tests(OR=1.929,95%CI:1.058～3.517)were independent risk factors for low RFP levels.Conclusions This study demonstrates that therapeutic drug monitoring(TDM)frequently identifies subtherapeutic RFP concentrations in tuberculosis patients undergoing treatment.Multivariate analysis reveals that male sex and positive pathogen test results are independent risk factors associated with low RFP plasma levels.Consequently,clinicians should exercise heightened vigilance in patients exhibiting these characteristics,promptly implementing TDM to guide individualized dose adjustments.Such an approach is crucial for optimizing treatment efficacy and minimizing the risk of drug resistance development.

Objective To explore the effectiveness of integrating virtual simulation technology with case-based learning(CBL)in the teaching of clinical blood transfusion testing technology.Methods From January to June 2024,99 undergraduate students majoring in medical laboratory science at our university were selected and divided into an observation group(50 students)and a control group(49 students)based on their classes.The control group followed a traditional theoretical teaching model,while the observation group employed virtual simulation technology combined with CBL.Results The study compared as-sessment scores for theory learning,practical skills,case analysis,and comprehensive quality,teaching effects such as coordina-tion and cooperation abilities,self-efficacy measured by the GSES scale,and teaching satisfaction between the two groups.The results indicated that the observation group had significantly higher scores in all assessment categories,teaching effect abilities,and total GSES scores compared to the control group(P＜0.05).The total teaching satisfaction rate in the observation group reached 100%,significantly higher than the 80% in the control group(P＜0.05).Conclusion The integration of virtual simu-lation technology with CBL innovates the teaching model for clinical blood transfusion testing courses,effectively enhancing students'professional skills and comprehensive quality,boosting self-efficacy,and achieving high student satisfaction,demon-strating significant potential for broader application.

A multi-layer feature attention enhanced network is proposed to further improve the diagnostic accuracy of the severity of diabetic retinopathy.To address the inconsistent expression of global and local features when processing diabetic retinopathy images,a dual-branch parallel model combining ResNet-50 and DeiT-S is employed as the backbone architecture,and a feature fusion module is designed at the end of the network.Concurrently,a multi-scale location awareness enhancement module is developed to extract multi-scale information through dilated convolution with positional attention mechanism for enhancing the feature representation of lesions in fundus images,and a local feature enhancement module is constructed to strengthen the model's capability in extracting local information,thus improving model's capability to identify small lesions and minor changes.The experimental results show that the proposed multi-layer feature attention enhanced network achieves an accuracy of 87.61%,exhibiting excellent classification performance.This advancement provides a strong support for further development of diabetic retinopathy detection technology.

Objective To investigate the effect of long-chain non-coding ribonucleic acid maternal expression 3(MEG3)on high glucose-induced pancreatic islet β-cell injury through the transforming growth factor-β-Smad 2/3 signaling pathway.Methods INS-1 rat insulinoma cells were divided into normal control(Con)group,HG group,negative control(si-NC)group,HG+si-NC group,siRNA targeting MEG3(si-MEG3)group,HG+si-MEG3 group,HG+si-MEG3+TGF-β-Smad2/3 signaling pathway inhibitor(HG+si-MEG3+LY2109761)group.Cell viability was detected by cell counting kit-8(CCK-8).The mRNA expression of MEG3 and pyroptosis-associated markers was detected by qRT-PCR.Autophagic vesicles were tested by transmission electron microscopy,and expression of autophagy-associated proteins and pyroptosis-associated proteins was detected by Western blot and immunofluorescence.TGF-β-Smad2/3 protein expression was detected by Western blot.Results Glucose downregulated MEG3 mRNA expression in a dose-dependent manner.Compared with si-NC group,p-Smad2,TGF-β1,Beclin1,LC3-II/LC3-I,NLRP3,GSDMD-N,IL-1β,ASC,and c-Caspase1 protein expression was elevated(P<0.05),and cell viability was decreased in HG+si-NC group(P<0.05).Compared with the HG+si-NC group,TGF-β1,NLRP3,GSDMD-N,IL-1β,ASC,c-Caspase1 protein expression was elevated(P<0.05),and p-Smad2,cell viability,Beclin1,and LC3-II/LC3-I were decreased in the HG+si-MEG3 group(P<0.05).Compared with HG+si-MEG3 group,NLRP3,GSDMD-N,IL-1β,ASC,and c-Caspase1 protein expression was elevated(P<0.05),and cell viability,p-Smad2,TGF-β1,Beclin1,and LC3-II/LC3-I protein expression was decreased in HG+si-MEG3+LY2109761 group(P<0.05).Conclusions MEG3 regulates autophagy and pyroptosis in pancreatic β-cells through the TGF-β-Smad2/3 signaling pathway.

Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.