Objective: To address the lack of fine-grained clinical recognition for specific Yang deficiency syndrome subtypes and the limitations of conventional object detection models in extracting irregular, low-contrast tongue phenotypes. This study aims to develop an objective subtype recognition framework based on an improved You Only Look Once nano (YOLO11n) architecture, using a standardized visual phenotype matrix to translate macroscopic traditional Chinese medicine (TCM) descriptions into quantifiable clinical targets. Methods: This cross-sectional diagnostic study consecutively enrolled adult inpatients admitted to the Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wannan Medical University (Yijishan Hospital), between September 1, 2024 and June 1, 2025, who were suspected of having Yang deficiency constitution based on initial TCM consultation. Clinical tongue image data were collected for analysis. Based on an Expert Visual Phenotype Annotation Matrix, a five-category recognition system was established, including the following TCM syndrome subtypes: spleen-dampness exuberance syndrome, mild kidney Yang deficiency syndrome, upper heat and lower cold syndrome, simultaneous Yin-Yang deficiency syndrome, and Yin deficiency and fluid depletion syndrome (negative control). The proposed Yang deficiency YOLO (YD-YOLO) model, built upon the YOLO11n baseline, integrates the Cross Stage Partial with kernel size 2 (C3k2)-GhostBottleneck-Dynamic Convolution (GBDC) module into the backbone to adaptively extract low-contrast features, and embeds the multipath aggregation coordinate attention (MACA) mechanism into the neck to suppress background interference through multi-scale spatial coordination. Gradient-weighted class activation mapping (Grad-CAM) was used to visualize feature attribution and evaluate the biological plausibility of the model’s focus. Model performance was evaluated through ablation and comparative experiments using mean average precision (mAP), precision, recall, F1 score, inference speed (frames per second, FPS), overall accuracy, Cohen’s kappa, and the area under the receiver operating characteristic (ROC) curve (AUC). Results: Based on the final inclusion of 1 186 clinical cases, the YD-YOLO model had an overall accuracy of 91.5%, a Cohen’s kappa of 0.912, and an mAP@50 of 0.731 [higher than the YOLO11n baseline (0.681)], with AUC ranging from 0.91 to 0.97 across all TCM syndrome subtypes. Among the TCM syndrome subtypes, the mild kidney Yang deficiency syndrome had the highest mAP@50 (0.900), and the inference speed reached 89.00 FPS. Grad-CAM analysis showed that the model localized activation to key TCM pathological features, such as marginal tooth marks and focal root coatings, while suppressing non-diagnostic oral background noise. Conclusion The YD-YOLO model demonstrates the feasibility of deep learning for the fine-grained classification of TCM Yang deficiency subtypes. By integrating visual phenotype quantification with model interpretability, the proposed framework provides an objective basis for syndrome differentiation, supporting the development of standardized digital diagnostic systems and the provision of clinical decision support in TCM practice.

This study systematically dissects the core pathogenesis of chronic heart failure （CHF） featured by internal deficiency and external excess，imbalance of Qi，blood，Yin，and Yang，and intermingling of phlegm，blood stasis，and fluid retention. According to the traditional Chinese medicine （TCM） therapeutic principles of simultaneously treating root cause and symptoms，regulating Yin and Yang，replenishing Qi and activating blood，and promoting urination to relieve edema，this article deeply explores the formula-syndrome correspondence of Qili Qiangxin （QLQX） capsules in the treatment of CHF，providing a solid theoretical basis for the multi-effect characteristics of this drug. CHF is a common critical cardiovascular disease in clinical practice，and its pathological process involves multiple links including myocardial injury，neurohumoral disturbance，and ventricular remodeling. Its TCM pathogenesis is complex and involves multiple Zang-Fu organs，making it difficult for a single therapeutic method to achieve comprehensive coverage. QLQX capsules，formulated based on classical TCM theory，perfectly matches the pathogenic characteristics of CHF. Modern pharmacological studies have confirmed that QLQX capsules possess definite cardiotonic，diuretic，and vasodilatory effects. The active ingredients of QLQX capsules can rapidly and effectively alleviate the core clinical symptoms such as chest tightness，shortness of breath，decreased exercise tolerance，limb edema，palpitations，and fatigue of CHF patients by enhancing myocardial contractility and coronary blood flow，improving renal water excretion function，dilating peripheral blood vessels，and reducing cardiac load，thereby significantly improving patients' quality of life. On the basis of analyzing the symptomatic treatment of CHF with QLQX capsules，this study further expounds that the drug can intervene in ventricular remodeling through multiple pathways and targets，regulate the pathological mechanism of CHF，improve vascular endothelial function，mediate the activation of related signaling pathways，inhibit the transdifferentiation of cardiac fibroblasts，and regulate myocardial energy metabolism，thus delaying disease progression. QLQX capsules exert significant benefits in reducing composite cardiac events，improving New York Heart Association （NYHA） cardiac function classification，left ventricular ejection fraction （LVEF），6-minute walking distance （6MWD），and quality of life，demonstrating favorable clinical value. With the TCM pathogenesis of CHF as the guiding principle and modern pharmacology as the evidence，this study systematically clarifies the core advantage of QLQX capsules in treatment based on syndrome differentiation and multi-target synergy through the in-depth integration of TCM theory and modern pharmacology. It provides academic support with both theoretical depth and practical value for TCM intervention in CHF，and contributes TCM wisdom and schemes to the construction of a chronic disease management system with Chinese characteristics.

This study systematically dissects the core pathogenesis of chronic heart failure （CHF） featured by internal deficiency and external excess，imbalance of Qi，blood，Yin，and Yang，and intermingling of phlegm，blood stasis，and fluid retention. According to the traditional Chinese medicine （TCM） therapeutic principles of simultaneously treating root cause and symptoms，regulating Yin and Yang，replenishing Qi and activating blood，and promoting urination to relieve edema，this article deeply explores the formula-syndrome correspondence of Qili Qiangxin （QLQX） capsules in the treatment of CHF，providing a solid theoretical basis for the multi-effect characteristics of this drug. CHF is a common critical cardiovascular disease in clinical practice，and its pathological process involves multiple links including myocardial injury，neurohumoral disturbance，and ventricular remodeling. Its TCM pathogenesis is complex and involves multiple Zang-Fu organs，making it difficult for a single therapeutic method to achieve comprehensive coverage. QLQX capsules，formulated based on classical TCM theory，perfectly matches the pathogenic characteristics of CHF. Modern pharmacological studies have confirmed that QLQX capsules possess definite cardiotonic，diuretic，and vasodilatory effects. The active ingredients of QLQX capsules can rapidly and effectively alleviate the core clinical symptoms such as chest tightness，shortness of breath，decreased exercise tolerance，limb edema，palpitations，and fatigue of CHF patients by enhancing myocardial contractility and coronary blood flow，improving renal water excretion function，dilating peripheral blood vessels，and reducing cardiac load，thereby significantly improving patients' quality of life. On the basis of analyzing the symptomatic treatment of CHF with QLQX capsules，this study further expounds that the drug can intervene in ventricular remodeling through multiple pathways and targets，regulate the pathological mechanism of CHF，improve vascular endothelial function，mediate the activation of related signaling pathways，inhibit the transdifferentiation of cardiac fibroblasts，and regulate myocardial energy metabolism，thus delaying disease progression. QLQX capsules exert significant benefits in reducing composite cardiac events，improving New York Heart Association （NYHA） cardiac function classification，left ventricular ejection fraction （LVEF），6-minute walking distance （6MWD），and quality of life，demonstrating favorable clinical value. With the TCM pathogenesis of CHF as the guiding principle and modern pharmacology as the evidence，this study systematically clarifies the core advantage of QLQX capsules in treatment based on syndrome differentiation and multi-target synergy through the in-depth integration of TCM theory and modern pharmacology. It provides academic support with both theoretical depth and practical value for TCM intervention in CHF，and contributes TCM wisdom and schemes to the construction of a chronic disease management system with Chinese characteristics.

Objective:To explore the application value of the artificial intelligence (AI) morphological assisted analysis system in the pre-classification of blood cells in patients with acute myeloid leukemia, myelodysplasia-related (AML-MR).Methods:A retrospective analysis was conducted on the bone marrow and peripheral blood cell morphology of patients initially diagnosed with AML-MR at Taizhou Hospital in Zhejiang Province from September 1, 2022, to December 31, 2023. A total of 44 patients, including 25 males and 19 females, with a median age of 71 (63.5, 75.3) years. Bone marrow and peripheral blood morphology were examined using the Morphogo cell morphology assisted analysis system, with the artificial classification results serving as the gold standard. A confusion matrix was constructed to evaluate the precision, sensitivity, and specificity of the AI system in identifying various cell types in bone marrow and peripheral blood for AML-MR diagnosis. The impact of dysplastic hematopoiesis on AI pre-classification was analyzed by comparing AI and manual classification results.Results:The AI system completed the pre-classification of 44 bone marrow smears and 42 corresponding peripheral blood smears from AML-MR patients. For bone marrow smears, the precision, sensitivity, and specificity of AI in pre-classifying blast cells were 85.78%, 91.01%, and 94.58%, respectively. For peripheral blood smears, these values were 87.11%, 87.05%, and 98.29%, respectively. The precision and sensitivity of AI in pre-classifying promyelocytes were 54.26% and 46.93%, respectively, while for monocytes, they were 58.16% and 68.34%, both lower than those for blast cells. The precision and sensitivity of AI in identifying myelocytes and metamyelocytes also decreased (77.47%, 66.25% and 81.91%, 63.29%, respectively). The precision and sensitivity of AI in pre-classifying erythroblasts/proerythroblasts (67.71%, 69.89%) were lower than those for polychromatic and orthochromatic normoblasts (83.43%, 85.53% and 92.97%, 86.96%, respectively). The confusion matrix and comparative analysis of AI and manual classification indicated that the decline in AI pre-classification precision and sensitivity was due to frequent misclassification between promonocytes and monocytes, as well as between monocytes and promyelocytes. Additionally, this decline is associated with dysplasia. However, the impact of dysplasia on the AI pre-classification of mature-stage granulocytes was minimal.Conclusion:The AI system demonstrated high precision, sensitivity, and specificity in pre-classifying blast cells in bone marrow and peripheral blood smears from AML-MR patients. The AI-assisted morphological analysis system can be effectively utilized for the pre-classification of blood cells in AML-MR patients.

Objective:To analyze the clinical characteristics, treatment strategies, and prognostic outcomes of patients infected with Listeria monocytogenes, thereby providing evidence-based insights for the prevention and control of this disease.Methods:A retrospective analysis was performed on the clinical data, diagnostic tests, treatment protocols, and prognostic outcomes of patients definitively diagnosed with Listeria monocytogenes infection at Sichuan Provincial People's Hospital over the past decade. Additionally, a comprehensive literature review was conducted, encompassing studies published between 2014 and 2024, sourced from CNKI, Wanfang Data, and PubMed. This review focused on summarizing the clinical features, treatment regimens, and prognostic outcomes of patients with Listeria monocytogenes infection.Results:The study cohort comprised 17 patients, with a mean age of (61.29 ± 16.24) years. The confirmed cases included 7 cases of bloodstream infections, 3 cases of central nervous system infections, and 7 cases of combined infections. Sepsis developed in 9 patients. The average time from symptom onset to the initiation of empirical antibiotic therapy was 72 hours, while the mean time to definitive diagnosis was 102 hours. Antimicrobial regimens predominantly featured penicillins, meropenem, and vancomycin. The average hospitalization duration was 16 days, with 9 patients experiencing adverse outcomes. A total of 78 relevant literature pieces were retrieved, encompassing data from 85 patients. The average age of these patients was (57.96 ± 16.48) years. Primary diagnostic methods relied on blood/cerebrospinal fluid cultures and Next-Generation Sequencing (NGS). Treatment regimens primarily involved antibiotics such as penicillins, aminoglycosides, carbapenems, and glycopeptides. Despite these interventions, the proportion of patients with poor prognosis remained significantly high at 30.6% (26/85). Logistic regression analysis identified sepsis and delayed antibiotic administration as independent predictors of poor prognosis.Conclusions:Listeriosis, caused by an opportunistic pathogen, necessitates early antibiotic administration and timely identification of at-risk populations to mitigate the risk of poor prognostic outcomes in patients.

Reactive oxygen species (ROS) are major contributors to radiation therapy-induced side effects in cancer patients. A fusion antioxidant enzyme comprising glutathione S-transferase (GST), superoxide dismutase 1 (SOD1), and a transmembrane peptide has been shown to effectively mitigate ROS-induced damage. To enhance its targeting capability, the fusion protein was further modified by incorporating a matrix metalloproteinase-2/9 substrate peptide (X) and the transmembrane peptide R9, yielding the antioxidant enzyme GST-SOD1-X-R9 (GS1XR). This modification reduced its transmembrane ability in tumor cells, thereby selectively protecting normal cells from oxidative stress. However, the use of non-human GST poses potential immunogenicity risks. In this study, we employed seamless cloning technology to construct an expression vector containing the human GST gene to replace the non-human GST gene, and then expressed and purified novel fusion antioxidant enzymes GS1R and GS1XR. The protective effects of newly constructed GS1R and GS1XR against hydrogen peroxide (H₂O₂)-induced oxidative damage in L-02 cells were then evaluated using GS1 as a control. Enzymatic activity assays revealed that the specific activity of GST in GS1XR remained unchanged compared to the unmodified protein, while SOD activity was enhanced. Exposure to 200 μmol/L H₂O₂ transiently activated the nuclear factor-erythroid 2-related factor 2 (Nrf2) pathway; however, this activation diminished after 24 h, reducing cell viability to 48.4%. Both GS1R and GS1XR effectively scavenged intracellular ROS, directly counteracting oxidative stress and promoting Nrf2 nuclear translocation, thereby activating antioxidant pathways and restoring cell viability to normal levels. The two enzymes showed comparable efficacy. In contrast, GS1, lacking transmembrane capability, was restricted to scavenging extracellular ROS and provided only limited protection. In conclusion, both novel fusion antioxidant enzymes demonstrated significant potential in safeguarding normal cells from ROS-mediated oxidative damage. The findings provide a foundation for further investigation in related field.
Humans ; Oxidative Stress/drug effects* ; Hydrogen Peroxide ; Antioxidants/metabolism* ; Glutathione Transferase/metabolism* ; Recombinant Fusion Proteins/pharmacology* ; Superoxide Dismutase-1 ; Reactive Oxygen Species/metabolism* ; Superoxide Dismutase/biosynthesis*

The study aims to investigate the impacts of prolyl oligopeptidase (POP) on the replication of foot-and-mouth disease virus (FMDV) in BHK-21 cells. Firstly, the effects of FMDV replication on POP expression in BHK-21 cells were analyzed by Western blotting and Real-time reverse transcription polymerase chain reaction (RT-qPCR). Secondly, a eukaryotic expression plasmid for POP was constructed, and the effects of POP overexpression on the replication of two different serotypes of FMDV were assessed by Western blotting, RT-qPCR, and virus titer assays. Thirdly, specific small interfering RNAs (siRNAs) targeting POP were synthesized, and their efficiency in interfering with endogenous POP expression was identified by RT-qPCR. The impacts of downregulating endogenous POP expression on FMDV replication were further evaluated by Western blotting, RT-qPCR, and virus titer assays. The results indicated that FMDV infection did not significantly affect POP expression in BHK-21 cells. Overexpression of POP dose-dependently enhanced the replication of both FMDV/O and FMDV/A serotypes. Conversely, siRNA-mediated downregulation of endogenous POP expression markedly suppressed FMDV/O replication. This study is the first to demonstrated that the role of the host POP protein in promoting FMDV replication in BHK-21 cells, thereby providing a critical theoretical foundation and potential molecular targets for developing efficient candidate cell strains for foot-and-mouth disease inactivated vaccines.
Foot-and-Mouth Disease Virus/genetics* ; Virus Replication/genetics* ; Prolyl Oligopeptidases ; Serine Endopeptidases/physiology* ; Animals ; Cell Line ; RNA, Small Interfering/genetics* ; Foot-and-Mouth Disease/virology* ; Cricetinae

Objective To compare the analgesic effects and adverse reactions between intercostal nerve block (ICNB) and patient controlled intravenous analgesia (PCIA). Methods From August 2022 to January 2023, 180 patients with lung cancer who underwent thoracoscopic surgery were randomly divided into two groups: ICNB group (n=90) and PCIA group (n=90). The postoperative pain degree (VAS), location, nature; adverse events, such as nausea, vomiting, and dizziness; and other clinical symptoms were analyzed. Results The most common site of postoperative pain in both groups was surgical incision, and the nature of pain was distending pain. At 12 and 24 h after the operation, the pain degree in the ICNB group (1.10±0.91, 3.12±1.29) was markedly lower than that in PCIA group (1.44±0.86, 4.32±1.30, P=0.010, P<0.001). The incidence of nausea, vomiting, and dizziness in the ICNB group (5.56%, 23.33%) was noticeably lower than that in the PCIA group (35.56%, 51.11%, P<0.001, P<0.001). Total hospitalization expense in the ICNB group (41 043.16±10 885.63 yuan) was significantly lower than that in PCIA group (45 283.99±11 036.36 yuan, P=0.010). Conclusion The analgesic effect of intercostal nerve block is better than that of patient-controlled intravenous analgesia pump in patients with lung cancer after minimally invasive surgery, and the incidence of adverse reactions is low.

Objective:To explore the application value of the artificial intelligence (AI) morphological assisted analysis system in the pre-classification of blood cells in patients with acute myeloid leukemia, myelodysplasia-related (AML-MR).Methods:A retrospective analysis was conducted on the bone marrow and peripheral blood cell morphology of patients initially diagnosed with AML-MR at Taizhou Hospital in Zhejiang Province from September 1, 2022, to December 31, 2023. A total of 44 patients, including 25 males and 19 females, with a median age of 71 (63.5, 75.3) years. Bone marrow and peripheral blood morphology were examined using the Morphogo cell morphology assisted analysis system, with the artificial classification results serving as the gold standard. A confusion matrix was constructed to evaluate the precision, sensitivity, and specificity of the AI system in identifying various cell types in bone marrow and peripheral blood for AML-MR diagnosis. The impact of dysplastic hematopoiesis on AI pre-classification was analyzed by comparing AI and manual classification results.Results:The AI system completed the pre-classification of 44 bone marrow smears and 42 corresponding peripheral blood smears from AML-MR patients. For bone marrow smears, the precision, sensitivity, and specificity of AI in pre-classifying blast cells were 85.78%, 91.01%, and 94.58%, respectively. For peripheral blood smears, these values were 87.11%, 87.05%, and 98.29%, respectively. The precision and sensitivity of AI in pre-classifying promyelocytes were 54.26% and 46.93%, respectively, while for monocytes, they were 58.16% and 68.34%, both lower than those for blast cells. The precision and sensitivity of AI in identifying myelocytes and metamyelocytes also decreased (77.47%, 66.25% and 81.91%, 63.29%, respectively). The precision and sensitivity of AI in pre-classifying erythroblasts/proerythroblasts (67.71%, 69.89%) were lower than those for polychromatic and orthochromatic normoblasts (83.43%, 85.53% and 92.97%, 86.96%, respectively). The confusion matrix and comparative analysis of AI and manual classification indicated that the decline in AI pre-classification precision and sensitivity was due to frequent misclassification between promonocytes and monocytes, as well as between monocytes and promyelocytes. Additionally, this decline is associated with dysplasia. However, the impact of dysplasia on the AI pre-classification of mature-stage granulocytes was minimal.Conclusion:The AI system demonstrated high precision, sensitivity, and specificity in pre-classifying blast cells in bone marrow and peripheral blood smears from AML-MR patients. The AI-assisted morphological analysis system can be effectively utilized for the pre-classification of blood cells in AML-MR patients.

Objective: To investigate the creation of smoke-free environments in public places in Hangzhou City, so as to provide insights into effective implementation of the tobacco control policy. Methods: The party and government administrations at each level, medical institutions, educational places, restaurants and entertainment places, and open public places were enrolled. The creation of smoke-free environments was investigated in these places through undercover investigation with field observations and concealed photography by a third-party professional investigation company from November to December, 2022. The building of smoke-free environments (totally 60 scores) and no smoking indoors (totally 40 scores) were evaluated according to the Criteria for Scoring of Smoke-free Organizations in Hangzhou City. Results: Totally 909 places were investigated, and the comprehensive score of smoke-free environment building was (82.83±14.13) points. There were 285 party and government administrations with a comprehensive score of (84.19±12.85) points, 65 medical institutions with a comprehensive score of (90.35±6.95) points, 65 educational places with a comprehensive score of (83.43±16.81) points, 403 dining and entertainment places with a comprehensive score of (80.68±14.75) points, and 91 open public places, with a comprehensive score of (82.34±14.77) points. There were 397 places with standardized tobacco control tips at entrances (43.67%), 308 places with tobacco control signs posted as required (33.88%), 707 places that set outdoor smoking areas correctly (77.78%), 68 places with smoking paraphernalia (7.48%), 28 places with tobacco sales (3.08%). There were 732 places without signs of indoor smoking (80.53%), 850 places without indoor smoking (93.51%) and 24 places without dissuading from smoking (2.64%). Conclusion The indoor no-smoking is overall satisfactory in public places in Hangzhou City; however, standardizing no-smoking tips at entrances, standardizing the posting of no-smoking signs and assignment of tobacco control materials remain to be improved.