ObjectiveTo observe the clinical efficacy of Tangshen Dihuang decoction in treating diabetic kidney disease （DKD） with liver-kidney Yin deficiency and blood stasis syndrome and its impact on gut microbiota. MethodsA randomized controlled clinical trial was conducted， in which 102 DKD patients with liver-kidney Yin deficiency and blood stasis syndrome were randomly assigned to the Tangshen Dihuang decoction group and the control group. Each group consisted of 51 cases， and the treatment period was 3 months. The primary efficacy indicators included urinary albumin-to-creatinine ratio （UACR）， fasting blood glucose （FBG）， 2-hour postprandial blood glucose （2 hPBG）， glycated hemoglobin （HbA₁C）， serum creatinine （SCr）， blood urea nitrogen （BUN）， angiotensinⅡ （AngⅡ）， serum cystatin C （Cys-C）， urinary N-acetyl-β-D-glucosaminidase （NAG）， urinary β₂-microglobulin （Uβ₂-MB）， traditional Chinese medicine （TCM） symptom scores， and gut microbiota. ResultsAfter treatment， the total response rate in the Tangshen Dihuang decoction was 87.23% （41/47）， which was higher than that （69.57%， 32/46） in the control group （Z=4.30， P<0.05）. After treatment， the TCM symptom scores decreased in both groups （P<0.01） and were lower in the Tangshen Dihuang decoction group than in the control group （P<0.01）. After treatment， the control group showed decreases in UACR， Uβ₂-MG， AngⅡ， and FBG （P<0.05） as well as 2 hPBG and HbA₁C （P<0.01）， and no significant differences in BUN， Cys-C， eGFR， SCr， and NAG. The Tangshen Dihuang decoction group showed increased eGFR （P<0.05）， declined levels of UACR， BUN， Cys-C， Uβ₂-MB， AngⅡ， FBG， 2 hPBG， NAG， and HbA₁C （P<0.01）， and no significant difference in SCr. The Tangshen Dihuang decoction group had lower BUN （P<0.05）， Cys-C （P<0.05）， AngⅡ （P<0.05）， 2 hPBG （P<0.05）， Uβ₂-MG （P<0.01）， and NAG （P<0.01） and higher eGFR level （P<0.05） than the control group. After treatment， the control group showed declines in Shannon， Observed_species， and Chao1 indices （P<0.05）. The samples from both groups showed statistically significant differences in the principal coordinates analysis （PCoA） plot based on Anosim analysis （P<0.05）. After treatment， the Tangshen Dihuang decoction group showed decreased relative abundance of Actinobacteria （P<0.05）. Moreover， the relative abundance of Actinobacteria was significantly lower in the Tangshen Dihuang decoction group than in the control group （P<0.05）. At the genus level， the control group showed decreased relative abundance of Bifidobacterium （P<0.05）， and the Tangshen Dihuang decoction group presented increased relative abundance of Bifidobacterium and Blautia_A （P<0.05）. After treatment， the Tangshen Dihuang decoction group had higher relative abundance of Bifidobacterium than the control group （P<0.01）. ConclusionTangshen Dihuang decoction has a significant therapeutic effect on DKD patients with liver-kidney Yin deficiency and blood stasis syndrome. It can markedly relieve clinical symptoms and reduce proteinuria and postprandial blood glucose by antagonizing the local renin-angiotensin system （RAS） and alleviating gut microbiota dysbiosis.

ObjectiveTo compare the mosquito capture efficacy of the BG-trap method and the light trap method, and to explore the precisely applicable scenarios for the two monitoring approaches. MethodsFrom May to October 2024, one BG-trap and one light trap were placed at eight monitoring sites, with a distance of over 10 meters between the two traps at each site. Surveillance was performed twice monthly to compare the two surveillance methods in terms of mosquito species composition, the proportional distribution of female mosquitoes across different habitats, and seasonal fluctuations in mosquito density. ResultsThere were statistically significant differences in mosquito species composition (χ²=60.61, P<0.001) and female mosquito species composition (χ²=37.12, P<0.001) between the BG-trap method and the light trap method, with the BG-trap method capturing a higher proportion of Aedes albopictus than the light trap method. The average density of mosquitoes monitored by the BG-trap method [13.36 mosquitoes·(trap·night)^-1] was higher than that monitored by the light trap method[4.70 mosquitoes·(trap·night)^-1]. There was statistically significant difference (t=6.70, P<0.001) for the mosquito density between the two methods, and there was a significant positive correlation (r=0.909, P<0.001) for the mosquito density indices between the two methods. The average density of female mosquitoes monitored by the BG-trap method [8.18 mosquitoes·(trap·night)^-1] was higher than that monitored by light trap method [3.36 mosquitoes·(trap·night)^-1]. There was statistically significant difference (t=6.00, P<0.001) for the female mosquito density between the two methods, and there was a significant positive correlation (r=0.929, P<0.001) for the female mosquito density indices between the two methods. In the four different habitats, the constituent ratio of mosquitoes and female mosquitoes monitored by the BG-trap method in descending order were urban residential area (43.80% and 40.25%), rural farm households (35.55% and 38.60%), hospital (12.70% and 12.87%), and park (7.95% and 8.28%), while the constituent ratio of mosquitoes and female mosquitoes monitored by the light trap method in descending order were rural farm households (34.37% and 43.34%), hospital (33.26% and 30.03%), park (17.96% and 15.17%), and urban residential area (14.41% and 11.46%). In different habitats, there were statistically significant differences for mosquito composition ratios (χ²=189.64, P<0.001) and female mosquito composition ratios (χ²=109.15, P<0.001) between the two monitoring methods. ConclusionThe BG-trap method offers advantages such as simple operation, compact equipment, and high efficiency, with a higher trapping rate for Aedes albopictus compared to the light trap method. In routine monitoring, the BG-trap method can serve as a supplement to the light trap method, while for emergency monitoring of Aedes albopictus in dengue fever outbreak areas and mosquito collection efforts, the BG-trap method is more effective than the light trap method.

ObjectiveTo investigate the effects of lectin-like oxidized low-density lipoprotein receptor-1 （LOX-1） gene G501C on brain structure and cognitive function in patients with white matter hyperintensities （WMH）. MethodsA total of 118 patients with WMH were enrolled. All participants underwent T1-weighted and T2-fluid-attenuated inversion recovery （T2-FLAIR） MRI to assess gray matter structure and WMH burden， and completed the mini-mental state examination （MMSE） and Montreal cognitive assessment （MoCA）. Partial correlation and mediation analyses were performed to explore the impact of LOX-1 polymorphism on cognitive function. ResultsParticipants were divided into GG+GC group （n = 35） and CC group （n = 83）. The GG+GC group showed lower MMSE and MoCA scores （MMSE： P=0.003； MOCA： P=0.015）， as well as greater WMH burden （all P0.001）， compared with the CC group. Voxel-based morphometry （VBM） analysis revealed reduced left thalamic volume in the GG+GC group， which was correlated with cognitive scores （all P0.05）. Subregional thalamic analysis further showed volume reductions in the lateral， ventral， medial， and pulvinar thalamic regions （all P0.05） in the GG+GC group， all positively associated with cognitive performance （all P0.05）. Mediation analyses indicated that volumes of the medial and pulvinar thalamic regions mediated the association between genotype and cognitive function （MMSE， MoCA）， and that WMH volume mediated the effect on MoCA scores. ConclusionThe LOX-1 G501C polymorphism may indirectly affect cognitive function by influencing specific thalamic subregional volumes and white matter damage， suggesting a potential mediating role of thalamic structures between genetic background and cognitive impairment.

ObjectiveTo address abnormal foam formation during liquid fermentation of Trichoderma reesei(T. reesei) for cellulase production through process optimization.MethodsUsing quadruple fermentation tank, the process was optimized through four key parameters: medium composition, seed source preparation, feeding rate and feeding methodology. Different feeding strategies were evaluated, including time-sequence feeding, dissolved oxygen(DO) process value(PV)-linked feeding, and PID algorithm-controlled user defined function(UDF) feeding. The effects of coarse wheat bran supplementation and seed culture sources(plate vs. shake flask) on the fermentation process were also examined. Cellulase activity and biomass accumulation were monitored throughout the fermentation process.ResultsBoth reduced feeding rate and coarse wheat bran supplementation effectively decreased foam formation during protein expression, preventing abnormal foaming and overflow phenomena. The PID algorithm-controlled feeding strategy enhanced microbial growth, achieving a maximum biomass of 442. 9 g/L at 145 h. Shake flask-derived seed cultures demonstrated superior enzyme production compared to plate-derived seeds, maintaining higher enzyme activity levels after 66 h of fermentation. The combination of coarse wheat bran supplementation, time-sequence feeding strategy(sequence 1), and shake flask-derived seed culture promoted optimal cellulase accumulation, reaching an enzyme activity of 60. 096 U/mL at 145 h.ConclusionAn optimized fermentation process for T.reesei was developed, which effectively controls foam formation while maintaining high enzyme productivity.The findings provide new solutions for addressing foam-related issues in T. reesei liquid fermentation and offer valuable data support for scaling up cellulase production.

Objective To construct a nomogram model for prediction of constipation risk in adult patients with cardiovascular disease (CVD). Methods A total of 780 adult patients with CVD admitted to Zhongshan Hospital, Fudan University from June 15, 2025 to August 15, 2025 were prospectively enrolled and randomly divided into a training set and a validation set at a 7∶3 ratio. Risk factors for constipation were identified using the least absolute shrinkage and selection operator (LASSO) and Firth logistic regressions, and a nomogram model was subsequently constructed in the training set. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the discrimination ability of the model. Calibration curve and decision curve analysis (DCA) were used to assess calibration and clinical applicability. The value of model was evaluated in the validation set. Results Among 780 adult patients with CVD, 391 patients (50.1%) developed constipation. Eleven variables were selected by LASSO regression and Firth logistic regression, and a nomogram model was constructed. The ROC curve showed that the AUCs of the model to predict constipation in adult patients with CVD in training and validation sets were 0.881 and 0.883, respectively. Calibration curves and DCA demonstrated good calibration and predictive performance of the model in training and validation sets. Conclusions The nomogram model based on LASSO-Firth logistic regression demonstrates good predictive performance and may serve as a useful tool for identifying adult patients with CVD at high risk of constipation.

OBJECTIVE To investigate the current status of informatization tools applied to antimicrobial stewardship in county hospitals in China， and to provide a reference for promoting the informatization development of antimicrobial stewardship in county hospitals.METHODS From August to September 2025， an online questionnaire survey was conducted among 1 007 county hospitals across 31 provinces（autonomous regions， and municipalities） in China. The survey focused on the application of four types of informatization tools：the real-time monitoring system for antimicrobial use， the pre-prescription review system， the irrational use warning system， and the electronic prescription evaluation system（hereinafter referred to as the “monitoring system”“review system”“warning system”“evaluation system”，respectively）. Correlation analysis and binary Logistic regression analysis were employed to explore the influencing factors.RESULTS Of the county hospitals， 80.83% were equipped with at least one type of informatization tool for antimicrobial stewardship， while 19.17% had no relevant tool. Only 18.87% of the hospitals were equipped with all four types of tools. The monitoring system exhibited the highest equipped rate （70.80%）， whereas the warning system was equipped in only 33.96% of the hospitals. Four types of tools are evenly and adequately deployed in the eastern region， the central and western regions have far lower deployment rates of intervention tools including review system and warning system， accompanied by prominent intra-provincial gaps. The total number of the health technicians， hospital grade， and prescription review rate of outpatient antibacterial drug were significantly and positively correlated with the deployment rates of the four informatization tools （ P ＜0.05）. The results of the Logistic regression model fitting indicated that the model of the review system was rated “excellent” [area under the receiver operating characteristic curve （AUC）＝0.81]， and the model of the warning system was rated “further improvement” （AUC＝0.67）. The total number of health technicians was significantly positively correlated with the deployment rates of all four types of informatization tools （all P ＜0.05）.CONCLUSIONS The informatization of antimicrobial stewardship in county hospitals in China remains in the initial stage of transitioning from “passive statistics” to “active prevention and control”， with challenges such as structural imbalance and regional disparities. In the future， differentiated support strategies should be implemented， the allocation of resources should be optimized， to enhance the level of refined antimicrobial stewardship.

ObjectiveTo investigate the effects of different antiplatelet therapy regimens （aspirin versus clopidogrel at specific doses） on cognitive function， blood biomarkers and brain imaging biomarkers when used prophylactically in patients with cerebral small vessel disease （CSVD）. MethodsA randomized controlled trial was conducted involving 160 CSVD patients who were randomly assigned to four groups： aspirin group （ASA）， low-dose clopidogrel group （CLOP-50）， standard-dose clopidogrel group （CLOP-75）， and control group （HC）. Cognitive function ［auditory verbal learning test-immediate recall （AVLT-IR）， auditory verbal learning test-short-delay recall （AVLT-SDR）， auditory verbal learning test-long-delay recall （AVLT-LDR）， hamilton anxiety rating scale （HAMA）， and hamilton depression rating scale （HAMD）， ADL（activities of daily living scale ）， （ascertain dementia 8-item questionnaire，AD8）］， blood biomarkers ［platelet count （PLT） and mean platelet volume （MPV）］， and CSVD-related imaging biomarkers ［white matter hyperintensities （WMH） and cerebral microbleeds （CMB）］ were assessed in all groups at baseline and at the 6-month follow-up. ResultsAfter 6 months of treatment， within-group comparisons showed that， compared with baseline， the ASA group had significantly increased scores on the AVLT immediate recall （AVLT-IR）， short-delay recall （AVLT-SDR）， and long-delay recall （AVLT-LDR） （P<0.05）. The CLOP-75 group showed significantly decreased HAMA and HAMD scores （P<0.05）， along with a significant increase in AVLT-LDR scores （P<0.05）. The number of CMBs increased from baseline in both the ASA and CLOP-75 groups （P<0.05）， whereas no statistically significant changes in blood biomarkers were observed in either group. By contrast， the CLOP-50 and HC groups showed no significant changes in cognitive function， blood biomarkers， or CSVD-related imaging biomarkers compared with baseline （all P<0.05）. Comparisons between groups showed that the AVLT-LDR scores and the number of CMBs increased faster in the ASA group than in the HC group （β=-0.187， P=0.04； β=-0.805， P<0.001）. In addition， the rate of CMB increase was also faster in the ASA group than in the CLOP-50 group （β=-0.695， P<0.01）. The ADL scores increased faster in the HC group than in the ASA group （β=0.170， P=0.02）. The AD8 scores decreased faster in the CLOP-75 group than in the HC group （β=-0.128， P=0.04）， but the rate of CMB increase in the CLOP-75 group was also faster than that in the HC group （β=0.604， P=0.04）. ConclusionIn CSVD patients， aspirin 100 mg or clopidogrel 75 mg improves cognitive function but increases the risk of cerebral hemorrhage. Clopidogrel 50 mg shows no short-term clinical benefit or imaging improvement.

ObjectiveTo investigate the expression of family with sequence similarity 162 member A （Fam162a）， a mitochondrial inner membrane protein， in the fibrosis of cardiac fibroblasts and its regulatory role in modulating the fibrotic phenotype of cardiac fibroblasts. MethodsFam162a protein expression was detected in myocardial samples from patients with heart failure （HF） and mice with transverse aortic constriction （TAC）-induced myocardial remodeling. Primary neonatal mouse cardiac fibroblasts （mCFs） were isolated and cultured， and a cell model of angiotensin Ⅱ （Ang Ⅱ）-induced myocardial fibrosis was established to determine Fam162a protein expression. Recombinant adenovirus was used to mediate Fam162a overexpression， while small interfering RNA （si-RNA） was employed for Fam162a knockdown. Western blot was performed to detect the expression of fibrosis-related proteins， including COL1A1， COL3A1， and α-SMA. EdU staining assay was used to evaluate cell proliferation capacity， and scratch assay combined with Transwell assay was conducted to assess cell migration ability. Immunofluorescence assay was applied to measure mitochondrial membrane potential for reflecting mitochondrial dysfunction； reactive oxygen species （ROS） detection was performed to evaluate cellular oxidative stress status； MitoSox assay was used to reflect the degree of mitochondrial oxidative damage； and ATP detection was conducted to assess the overall cellular energy metabolism. ResultsFam162a expression was significantly downregulated in the myocardium of HF patients and TAC mice， and Ang Ⅱ-treated mCFs， accompanied by increased expression of COL1A1， COL3A1， and α-SMA （all P＜0.05）. Adenovirus-mediated overexpression of Fam162a significantly inhibited Ang Ⅱ-induced upregulation of fibrosis-related genes， as well as cell proliferation and migration. Accordingly， silencing Fam162a aggravated the fibrotic phenotypes of mCFs treated with Ang II. Further studies revealed that the inhibitory effect of Fam162a overexpression on Ang Ⅱ-induced fibrotic phenotype was suppressed following the addition of rotenone （a mitochondrial oxidative respiratory chain inhibitor）， which was accompanied by mitochondrial membrane potential depolarization， excessive ROS production， and insufficient ATP generation. ConclusionFam162a exerts its inhibitory effect on the fibrotic phenotype of cardiac fibroblasts by maintaining mitochondrial membrane potential， promoting ATP production， reducing reactive oxygen species （ROS） generation， and suppressing Smad3 signaling activation.

Objective To observe the clinical efficacy of scalp acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of patients with mild to moderate vascular dementia and to explore its potential mechanism of action.Methods A total of 102 patients diagnosed with mild to moderate vascular dementia who were treated in the outpatient and inpatient departments of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2021 to May 2023 were selected as the study subjects.The patients were randomly divided into an observation group and a control group using a random number table,with 51 patients in each group.The control group received repetitive transcranial magnetic stimulation treatment,while the observation group received scalp acupuncture therapy in addition to the treatment given to the control group.The treatment lasted for 16 weeks.After treatment,the clinical efficacy of the two groups was evaluated.Changes in the Mini-Mental State Examination(MMSE)scores,Montreal Cognitive Assessment(MoCA)scores,and traditional Chinese medicine(TCM)syndrome scores were observed before and after treatment.Additionally,serum levels of brain-derived neurotrophic factor(BDNF),vascular endothelial growth factor(VEGF),and homocysteine(Hcy)were measured.The cerebral blood flow velocities in the anterior,middle,and posterior arteries,as well as the levels of lipid peroxide(LPO),malondialdehyde(MDA),and superoxide dismutase(SOD),were compared between the two groups before and after treatment.The safety and incidence of adverse reactions in both groups were also evaluated.Results(1)After treatment,the MMSE and MoCA scores of both groups were significantly improved(P＜0.05),and the observation group showed significantly better improvement in MMSE and MoCA scores compared to the control group,with a statistically significant difference(P＜0.05).(2)After treatment,the serum levels of BDNF,VEGF,and Hcy in both groups were significantly improved(P＜0.05),and the observation group showed significantly better improvement in these levels compared to the control group,with a statistically significant difference(P＜0.05).(3)After treatment,the cerebral blood flow velocities in the posterior,middle,and anterior arteries were significantly improved in both groups(P＜0.05),and the observation group showed significantly better improvement in these velocities compared to the control group,with a statistically significant difference(P＜0.05).(4)After treatment,the levels of LPO,MDA,and SOD were significantly improved in both groups(P＜0.05),and the observation group showed significantly better improvement in these levels compared to the control group,with a statistically significant difference(P＜0.05).(5)After treatment,the TCM syndrome scores improved significantly in both groups(P＜0.05),and the observation group showed significantly better improvement in these scores compared to the control group,with a statistically significant difference(P＜0.05).(6)The total effective rate in the observation group was 88.24%(45/51),while it was 70.59%(36/51)in the control group.The efficacy of the observation group was superior to that of the control group,with a statistically significant difference(P＜0.05).(7)The incidence of adverse reactions in the observation group was 3.92%(2/51),while it was 1.96%(1/51)in the control group.There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Scalp acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of mild to moderate vascular dementia helps regulate cerebral hemodynamics and neurotrophic factor expression,improves cognitive function,and demonstrates significant efficacy with good safety.

Objective To explore the insomnia of naval officers and soldiers under long-term high-intensity tactical training,and to analyze the mediation effect of ruminative thinking in the impact of occupational stress on insomnia.Methods The insomnia severity index,effort-reward imbalance,and ruminative responses scale were used to assess the sleep quality of 585 naval officers and soldiers under long-term high-intensity tactical training in September 2023.Results The detection rate of insomnia in these soldiers under long-term high-intensity tactical training was 20.17%.Insomnia was positively correlated with occupational stress and rumination.Bootstrap mediation effect test showed that rumination played a partial mediating role in the effect of occupational stress on insomnia(95%CI:1.344-3.157),and the mediation effect accounted for 46.47%of the total effect.Conclusion There is a high incidence of insomnia in naval officers and soldiers under long-term high-intensity tactical training.Rumination plays a partial mediating role in the effect of occupational stress on insomnia.