ObjectiveTo observe the clinical effectiveness and safety of Qingfei Shenshi Decoction （清肺渗湿汤） combined with western medicine for patients with bronchial asthma of heat wheezing syndrome， and to explore its potential mechanism of action. MethodsEighty-six participants with bronchial asthma of heat wheezing syndrome were randomly divided into treatment group and control group， each group with 43 participants. The control group received conventional western medicine， and the treatment group was additionally administered Qingfei Shenshi Decoction orally on the basis of the control group， 1 dose per day. Both groups were treated for 14 days. The primary outcome measure was clinical effectiveness； secondary outcome measures included traditional Chinese medicine （TCM） syndrome score， asthma control test （ACT） score， pulmonary function indices such as forced expiratory volume in 1 second （FEV₁）， forced vital capacity （FVC）， peak expiratory flow （PEF）， serum inflammatory factor levels including interleukin-4 （IL-4）， tumour necrosis factor-α （TNF-α）， and high-sensitivity C-reactive protein （hs-CRP）， and immune function indices including CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺. All outcome measures were evaluated before and after treatment. Vital signs were monitored， and electrocardiography， blood routine， urine routine， liver function， and renal function tests were performed before and after treatment. Adverse events and reactions during the study were recorded. ResultsA total of 80 patients completed the trial with 40 in each group. The total clinical effective rate of the treatment group was 97.5% （39/40）， which was significantly higher than that of the control group （85.0%， 34/40， P＜0.05）. After treatment， both groups showed decreased TCM syndrome scores， IL-4， TNF-α， hs-CRP， and CD8⁺ levels， as well as increased ACT scores， CD3⁺， CD4⁺， CD4⁺/CD8⁺， FEV₁， FVC， and PEF levels （P＜0.05 or P＜0.01）. Moreover， the improvements in these indices were more significant in the treatment group than in the control group （P＜0.05 or P＜0.01）. No significant abnormalities in safety indicators were observed in either group， and no adverse events or reactions occurred. ConclusionQingfei Shenshi Decoction combined with conventional western medicine for patients with bronchial asthma of heat wheezing syndrome can effectively improve the clinical symptoms， pulmonary function， and clinical effectiveness， with good safety. Its mechanism may be related to reducing inflammatory factor levels and regulating T lymphocyte subsets to improve immune function.

ObjectiveThis study aimed to elucidate the mechanistic role of Staphylococcus aureus in the pathogenesis of atopic dermatitis (AD), a chronic inflammatory skin disorder characterized by pruritus and barrier dysfunction. A key focus was screening traditional Chinese medicine (TCM) active components with dual antibacterial and antipruritic efficacy, followed by systematic evaluation of their in vitro antibacterial activity. Additionally, a novel drug delivery system was constructed to enable localized efficient drug delivery, inhibiting S. aureus proliferation and alleviating its induced pruritus, thereby providing new strategies for targeted AD therapy. MethodsMale C57BL/6J mice aged 6-8 weeks (body weight 18-22 g) were used to establish an AD model via repeated oxazolone sensitization. On day 14, microbial samples were collected from the lesional area (1 cm²) using sterile cotton swabs, followed by vortex mixing, serial dilution, and plating on 5% sheep blood agar plates (incubated at 37°C for 24 h). Single colonies with complete transparent β-hemolytic zones were isolated and identified as vancomycin-intermediate S. aureus (VISA) via 16S rRNA sequencing. An S. aureus mono-infection animal model was then established by applying gauze saturated with bacterial suspension (McFarland turbidity 0.1) to the nape and back skin of mice. The pruritic phenotype and inflammatory cell infiltration induced by S. aureus were evaluated using comprehensive approaches including behavioral assays (e.g., scratching frequency recording), hematoxylin-eosin (HE) staining, and toluidine blue staining. The in vitro antibacterial efficacy of the TCM monomer pseudolaric acid B (PAB) and double network hydrogel (DN) was separately assessed by disk diffusion assay, while the minimum inhibitory concentration (MIC) of PAB was determined via broth dilution method. Further validation of the pharmacodynamic characteristics of the composite system (PAB@DN, composed of PAB and DN) was conducted through behavioral assays, HE staining, and dermatitis scoring, with its drug release profile evaluated by mass spectrometry analysis. Based on scratching behavioral analysis and dermatitis scoring, the optimal ratio and concentration of PAB@DN were optimized. ResultsThe S. aureus load in AD lesional tissues was significantly higher than in normal skin ((5.3±0.33)×10⁶ CFU vs. (3.6±0.26)×10⁷ CFU, P<0.001). In the S. aureus mono-infection group, mice exhibited a 6.7-fold increase in scratching frequency compared to the control group. HE staining revealed marked epidermal thickening ((10.4±2.39) μm vs. (85.6±1.95) μm, P<0.000 1), and toluidine blue staining showed a 23-fold increase in mast cell degranulation. Pseudolaric acid B exhibited a significant concentration-dependent inhibitory effect onS. aureus growth, with its in vitro antibacterial effect being 57% that of the antibiotic cefepime (inhibition zone diameter: PAB (1.885±0.036) cm vs. cefepime (3.636±0.005) cm, P<0.000 1) and a minimum inhibitory concentration (MIC) of 1 g/L. The carrier double network hydrogel (DN) itself lacked direct antibacterial activity (no significant difference in inhibition zone diameter compared to the control) but effectively ameliorated the dry symptoms of AD-like lesions. The PAB@DN composite system demonstrated a synergistic effect compared to individual components, resulting in a 50% reduction in scratching behavior, an 86% decrease in dermatitis score, and a 60% reduction in epidermal thickening. It also reduced the S. aureus load in mouse skin by approximately 34%, with the optimal effective formulation being PAB at 1 g/L loaded onto DN. ConclusionS. aureus colonization plays a critical driving role in the onset and progression of AD. Using an S. aureus infection model, this study confirmed that the pseudolaric acidB-hydrogel composite delivery system (PAB@DN) can effectively alleviate S. aureus-induced pruritus and skin damage, providing experimental evidence for microbiota-targeted therapy of AD.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective To develop a deep learning model based on fundus retinal images to improve the detection rate of mild cognitive impairment(MCI)in patients with coronary heart disease,achieve early intervention and improve prognosis.Methods The study was a single-center cross-sectional study that retrospectively included patients diagnosed with coronary heart disease(CHD)by coronary angiography(≥50％ stenosis of at least one coronary vessel)from Beijing Anzhen Hospital between November 2021 and December 2022.The whole data set was randomly divided into the training set and the testing set according to the ratio of 8∶2 for model development.After that,the patient data of the same center from January 2023 to April 2023 were included in the time verification method to verify the model.The diagnostic criteria for MCI were MMSE＜27 or MoCA＜26.Four kinds of convolutional neural network(CNN)architectures were used to train fundus images,and a comprehensive vision model of MCI detection was established through model integration.The area under the curve(AUC),sensitivity and specificity of the receiver operating curve(ROC)were used to evaluate the performance of the AI model.Results We collected 5 880 eligible fundus images from 3 368 CHD patients.Based on the results of the MMSE scale,the algorithm was labeled,including 2 898 males and 527 MCI patients.The AUC of the deep learning model in the test group is 0.733(95％CI 0.688-0.778),and the sensitivity of the algorithm in the test group is 0.577(95％CI 0.528-0.625)by using the operating point with the maximum sum of sensitivity and specificity.With a specificity of 0.758(95％CI 0.714-0.802),corresponding to a validated AUC of 0.710(95％CI 0.601-0.818).Based on the results of the MoCA scale,the algorithm labels 2 437 males and 1 626 MCI patients.The AUC of the deep learning model in the test group was 0.702(95％CI 0.671-0.733).The operating point with the maximum sum of sensitivity and specificity was selected,and the sensitivity of the algorithm was 0.749(95％CI 0.719-0.778)and the specificity was 0.561(95％CI 0.527-0.595),corresponding to the AUC value of the verification group was 0.674(95％CI 0.622-0.726).Conclusions The deep learning algorithm model based on fundus images has good diagnostic performance,and may be used as a new non-invasive,convenient and rapid screening method for MCI in CHD population.

Objective To explore the factors that influence major adverse cardiovascular events(MACE)in atrial fibrillation(AF)patients undergoing radiofrequency ablation(RFA),as well as to compare the prognosis of patients with advanced AF to that of the general population.Methods We prospectively recruited AF patients who underwent RFA treatment at Peking University Third Hospital between January 2021 and March 2023.General patient data were collected through the hospital's inpatient system,and MACE were tracked through outpatient visits and telephone follow-ups.Patients were categorized into three age groups:Group 1(under 65 years),Group 2(65 to 75 years),and Group 3(over 75 years).In this study,MACE was defined as include cardiovascular death,all-cause death,readmission for heart failure,acute coronary syndrome(ACS),grade 2 or higher bleeding and stroke.Results A total of 431 patients were included in this study,with an average age of(66.17±12.22)years.Among these patients,259 were male(60.09％),and the mean of CHA2DS2-VASc score was(1.79±1.30).The median follow-up period was 16.0(11.3,21.3)months,during which 28(6.50％)patients experienced MACE,with ACS and stroke being the most common events.Variables were selected using LASSO regression,and a LASSO-Cox regression model was constructed.Age(HR 1.06,95％CI 1.02-1.10,P=0.006)and hypertrophic cardiomyopathy(HR 3.70,95％CI 1.27-8.68,P=0.008)were identified as independent predictors of MACE after RFA for AF.Subgroup analysis revealed that patients under 65 had significantly better prognoses compared to older AF patients(P=0.030 compared with group 2;P=0.021 compared with group 3).Conclusions Age and hypertrophic cardiomyopathy are independent risk factors for MACE in AF patients undergoing RFA.The prognosis for younger patients is better than that for older patients,while the prognosis for advanced patients is comparable to that of patients aged 65-75 years.

To formulate an expert consensus on the principles of preoperative hair removal and provide scientific guidance for standardized removal of hair before surgical procedures so as to reduce the incidence of surgical site infections.METHODS Led by the Hospital Management Institute of National Health Commission of the People's Republic of China,this consensus was reached with the joint efforts from the expects of relevant fields such as surgeries,interventional therapies,nursing,and infection prevention and control.The consensus facilitates the classification and evaluation of literatures by following the evidence grade formulated by Oxford Evidence-based Medicine Center and focuses on the association of preoperative hair removal with surgical site infection,it reaches the evidence grade of expert consensus and recommendation intensity by integrating with discussions on meetings and clinical experience of the expects from relevant fields.RESULTS A total of 6 items of consensus were reached by summarizing the latest evidence on the aspects including the indications for preoperative hair removal,tools,range,timing and places.CONCLUSION The consensus,to some extent,make supplements to and complete the exiting regulations and standards.It provides guidance for the medical institutions to carry out the preoperative hair removal.

Objective To investigate the effects of the ferroptosis inhibitor Ferrostatin-1 on the apoptosis of photore-ceptor cells and the Notch pathway in rats with retinal photochemical damage(RPD).Methods Male Sprague-Dawley(SD)rats were randomly divided into the Control group(normally fed rats,intraperitoneal injection of an equal volume of saline),RPD group(RPD model rats,intraperitoneal injection of an equal volume of saline),Ferrostatin-1 group(RPD model rats,intraperitoneal injection of 5 mg·kg-1 Ferrostatin-1),and Ferrostatin-1+JFC group[RPD model rats,intrap-eritoneal injection of 5 mg·kg-1 Ferrostatin-1 and 0.5 mg·kg-1 Jagged1/FC chimeric protein(JFC,a Notch pathway acti-vator)],with 15 rats in each group.The retinal histopathology of rats in each group was evaluated via hematoxylin-eosin(HE)staining.The apoptosis of photoreceptor cells was detected by the terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)assay.The expression level of ferrous ions(Fe2+),lactate dehydrogenase(LDH),malondialde-hyde(MDA),glutathione(GSH),and reactive oxygen species(ROS)in retinal tissues was measured using corresponding kits.Western blot was performed to assess the protein expression of transferrin receptor protein 1(TfR1),divalent metal transporter 1(DMT1),nuclear factor erythroid 2-related factor 2(Nrf2),solute carrier family 7 member 11(SLC7A11),recombinant glutathione peroxidase 4(GPX4),cleaved Caspase-3,Notch,and hairy and enhancer of split 1(Hes1).Results The thickness of the outer nuclear layer(ONL)in the Control group,RPD group,Ferrostatin-1 group,and Fer-rostatin-1+JFC group was(35.24±1.76)μm,(16.83±1.14)μm,(27.56±1.39)μm,and(21.48±1.23)μm,respec-tively;the apoptosis rate of photoreceptor cells in the four groups was(1.32±0.07)％,(18.57±1.63)％,(9.61±1.04)％,and(15.43±1.38)％,respectively.Compared with the Ferrostatin-1 group,the Ferrostatin-1+JFC group exhib-ited an aggravated retinal damage level,reduced ONL thickness,and increased apoptosis rate,and the differences were statistically significant(all P＜0.05).The expression level of Fe2+,MDA,LDH,and ROS and the relative protein expres-sion level of TfR1,DMT1,cleaved Caspase-3,Notch,and Hes1 in the RPD group were higher than those in the Control group;while the expression level of GSH and the relative protein expression level of Nrf2,SLC7A11,and GPX4 were lower than those in the Control group,and the differences were statistically significant(all P＜0.05).Compared with the RPD group,the Ferrostatin-1 group displayed a decrease in the expression level of Fe2+,MDA,LDH,and ROS and the relative protein expression level of TfR1,DMT1,cleaved Caspase-3,Notch,and Hes1 but an increase in the expression level of GSH and the relative protein expression level of Nrf2,SLC7A11,and GPX4,and the differences were statistically significant(all P＜0.05).The expression level of Fe2+,MDA,LDH,and ROS and the relative protein expression level of TfR1,DMT1,cleaved Caspase-3,Notch,and Hes1 in the Ferrostatin-1+JFC group were higher than those in the Ferrostatin-1 group;while the expression level of GSH and the relative protein expression level of Nrf2,SLC7A11,and GPX4 were lower than those in the Ferrostatin-1 group,and the differences were statistically significant(all P＜0.05).Conclusion Fer-rostatin-1 may alleviate retinal oxidative stress and the apoptosis of photoreceptor cells in RPD rats by inhibiting the Notch pathway,thereby mitigating retinal damage.

Objective To develop a deep learning model based on fundus retinal images to improve the detection rate of mild cognitive impairment(MCI)in patients with coronary heart disease,achieve early intervention and improve prognosis.Methods The study was a single-center cross-sectional study that retrospectively included patients diagnosed with coronary heart disease(CHD)by coronary angiography(≥50％ stenosis of at least one coronary vessel)from Beijing Anzhen Hospital between November 2021 and December 2022.The whole data set was randomly divided into the training set and the testing set according to the ratio of 8∶2 for model development.After that,the patient data of the same center from January 2023 to April 2023 were included in the time verification method to verify the model.The diagnostic criteria for MCI were MMSE＜27 or MoCA＜26.Four kinds of convolutional neural network(CNN)architectures were used to train fundus images,and a comprehensive vision model of MCI detection was established through model integration.The area under the curve(AUC),sensitivity and specificity of the receiver operating curve(ROC)were used to evaluate the performance of the AI model.Results We collected 5 880 eligible fundus images from 3 368 CHD patients.Based on the results of the MMSE scale,the algorithm was labeled,including 2 898 males and 527 MCI patients.The AUC of the deep learning model in the test group is 0.733(95％CI 0.688-0.778),and the sensitivity of the algorithm in the test group is 0.577(95％CI 0.528-0.625)by using the operating point with the maximum sum of sensitivity and specificity.With a specificity of 0.758(95％CI 0.714-0.802),corresponding to a validated AUC of 0.710(95％CI 0.601-0.818).Based on the results of the MoCA scale,the algorithm labels 2 437 males and 1 626 MCI patients.The AUC of the deep learning model in the test group was 0.702(95％CI 0.671-0.733).The operating point with the maximum sum of sensitivity and specificity was selected,and the sensitivity of the algorithm was 0.749(95％CI 0.719-0.778)and the specificity was 0.561(95％CI 0.527-0.595),corresponding to the AUC value of the verification group was 0.674(95％CI 0.622-0.726).Conclusions The deep learning algorithm model based on fundus images has good diagnostic performance,and may be used as a new non-invasive,convenient and rapid screening method for MCI in CHD population.

Objective To investigate the effects of the ferroptosis inhibitor Ferrostatin-1 on the apoptosis of photore-ceptor cells and the Notch pathway in rats with retinal photochemical damage(RPD).Methods Male Sprague-Dawley(SD)rats were randomly divided into the Control group(normally fed rats,intraperitoneal injection of an equal volume of saline),RPD group(RPD model rats,intraperitoneal injection of an equal volume of saline),Ferrostatin-1 group(RPD model rats,intraperitoneal injection of 5 mg·kg-1 Ferrostatin-1),and Ferrostatin-1+JFC group[RPD model rats,intrap-eritoneal injection of 5 mg·kg-1 Ferrostatin-1 and 0.5 mg·kg-1 Jagged1/FC chimeric protein(JFC,a Notch pathway acti-vator)],with 15 rats in each group.The retinal histopathology of rats in each group was evaluated via hematoxylin-eosin(HE)staining.The apoptosis of photoreceptor cells was detected by the terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)assay.The expression level of ferrous ions(Fe2+),lactate dehydrogenase(LDH),malondialde-hyde(MDA),glutathione(GSH),and reactive oxygen species(ROS)in retinal tissues was measured using corresponding kits.Western blot was performed to assess the protein expression of transferrin receptor protein 1(TfR1),divalent metal transporter 1(DMT1),nuclear factor erythroid 2-related factor 2(Nrf2),solute carrier family 7 member 11(SLC7A11),recombinant glutathione peroxidase 4(GPX4),cleaved Caspase-3,Notch,and hairy and enhancer of split 1(Hes1).Results The thickness of the outer nuclear layer(ONL)in the Control group,RPD group,Ferrostatin-1 group,and Fer-rostatin-1+JFC group was(35.24±1.76)μm,(16.83±1.14)μm,(27.56±1.39)μm,and(21.48±1.23)μm,respec-tively;the apoptosis rate of photoreceptor cells in the four groups was(1.32±0.07)％,(18.57±1.63)％,(9.61±1.04)％,and(15.43±1.38)％,respectively.Compared with the Ferrostatin-1 group,the Ferrostatin-1+JFC group exhib-ited an aggravated retinal damage level,reduced ONL thickness,and increased apoptosis rate,and the differences were statistically significant(all P＜0.05).The expression level of Fe2+,MDA,LDH,and ROS and the relative protein expres-sion level of TfR1,DMT1,cleaved Caspase-3,Notch,and Hes1 in the RPD group were higher than those in the Control group;while the expression level of GSH and the relative protein expression level of Nrf2,SLC7A11,and GPX4 were lower than those in the Control group,and the differences were statistically significant(all P＜0.05).Compared with the RPD group,the Ferrostatin-1 group displayed a decrease in the expression level of Fe2+,MDA,LDH,and ROS and the relative protein expression level of TfR1,DMT1,cleaved Caspase-3,Notch,and Hes1 but an increase in the expression level of GSH and the relative protein expression level of Nrf2,SLC7A11,and GPX4,and the differences were statistically significant(all P＜0.05).The expression level of Fe2+,MDA,LDH,and ROS and the relative protein expression level of TfR1,DMT1,cleaved Caspase-3,Notch,and Hes1 in the Ferrostatin-1+JFC group were higher than those in the Ferrostatin-1 group;while the expression level of GSH and the relative protein expression level of Nrf2,SLC7A11,and GPX4 were lower than those in the Ferrostatin-1 group,and the differences were statistically significant(all P＜0.05).Conclusion Fer-rostatin-1 may alleviate retinal oxidative stress and the apoptosis of photoreceptor cells in RPD rats by inhibiting the Notch pathway,thereby mitigating retinal damage.

Objective:To explore the therapeutic effect of drug-coated balloon(DCB)combined drug-eluting stent(DES)on coronary bifurcation lesions.Methods:A total of 108 patients with coronary bifurcation lesions admitted in Shanghai Ninth People's Hospital Huangpu Branch,Shanghai Jiaotong University School of Medicine between February 2021 and March 2023 were enrolled in this randomized controlled study.Patients were randomly divided into combined treatment group(n=54,DCB was implanted in the sub-branch,and DES was implanted in the main branch)and DES group(n=54,DES were implanted in both main branch and sub-branch).Clinical therapeutic effect,coronary angiography quantitative parameters before,instant and 9 months after operation and clinical out-comes during 1-year follow-up after operation were compared between two groups.Results:The total effective rate of combined treatment group was significantly higher than that of DES group(96.30％vs.87.04％,P=0.030).Compared to those in DES group,instant and 9 months after operation,patients in the combined treatment group had significant higher diameters of main branch vessel[(3.13±0.31)mm vs.(3.01±0.25)mm,(2.99±0.33)mm vs.(2.84±0.23)mm],sub-branch vessel[(2.51±0.26)mm vs.(2.42±0.13)mm,(2.44±0.24)mm vs.(2.29±0.36)mm],and significant lower main branch stenosis rate[(6.05±0.21)％vs.(6.24±0.31)％,(9.06±0.23)％vs.(10.12±0.12)％]and sub-branch stenosis rate[(7.38±0.42)％vs.(7.63±0.18)％,(8.07±0.39)％vs.(11.25±0.22)％](P＜0.05 or＜0.01).There were no significant difference in incidence of target lesion revascularization,cardiogenic death and major adverse cardiovascular events between two groups(P＞0.05 all).Conclusion:Drug-eluting stent combined drug-coated balloon may promote vascular branch dilation of coro-nary artery lesions,increase the minimum lumen diameter of sub-branch vessels,and reduce the occurrence of ste-nosis in the treatment of coronary bifurcation lesion,which had similar effectiveness and safety with drug-eluting stent technique.