One patient with gallbladder mass had transient jaundice and was diagnosed with gallbladder carcinoma by abdominal ultrasonography， contrast-enhanced CT， MRCP， and PET-CT. Surgical exploration showed enlarged gallbladder and a mass in the neck of the gallbladder pressing against the hilum of the liver， with no manifestation of tumor invasion， and there were no signs of liver metastasis. Only cholecystectomy was performed for the patient. The pathological diagnosis was tubular adenoma of the gallbladder without carcinogenesis. This case is characterized by a large gallbladder tumor， without marginal infiltration on imaging or malignant transformation based on pathology.

Objective To compare the clinical efficacy of anti-vascular endothelial growth factor(VEGF)combined with pars plana vitrectomy(PPV)treatment for patients with proliferative diabetic retinopathy(PDR)of different traditional Chinese medicine(TCM)syndrome types in the real world.Methods A prospective real-world study was performed in the 36 patients(involving 42 eyes)with PDR treated by anti-VEGF combined with PPV in the Department of Ophthalmology of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2019 to December 2019.According to the TCM syndrome manifestations,the patients were differentiated as qi-yin deficiency complicated with blood stasis obstructing collaterals type(15 cases,involving 18 eyes;shorten as qi-yin deficiency type),liver-kidney deficiency and ocular collaterals failing in the nourishment type(14 cases,involving 17 eyes;shorten as liver-kidney deficiency type),and yin-yang deficiency complicated with blood stasis and phlegm coagulation type(7 cases,involving 7 eyes;shorten as yin-yang deficiency type).The patients were treated with anti-VEGF therapy first and then received PPV after 5-7 days.Aqueous humor was sampled during anti-VEGF therapy and PPV.After treatment,the efficacy of PDR patients with different TCM syndromes was compared.Moreover,the patients were observed in the best corrected visual acuity(BCVA)of the affected eyes before surgery and 3 months after surgery,levels of cytokines in the aqueous humor before and after anti-VEGF treatment,macular central retinal thickness(CRT),area of the foveal avascular zone(FAZ),the blood density of macular center,inner ring,outer ring and intact macula 3 months after surgery,and the postoperative complications.Results(1)The difference of the therapeutic efficacy of PDR patients with various TCM syndrome types was statistically significant(P＜0.05).Among 3 syndrome types,the best efficacy was found in the qi-yin deficiency type,followed by liver-kidney deficiency type,and then yin-yang deficiency type,with the total efficacy rate being 88.89%(16/18),52.94%(9/17),and 42.86%(3/7),respectively.(2)Three months after surgery,the logarithmic value of minimum angle of resolution(LogMAR)for BCVA of patients with qi-yin deficiency type was significantly superior to that of patients with yin-yang deficiency type,with the difference being statistically significant(P＜0.05).After the anti-VEGF treatment,the levels of cytokines in the aqueous humor of the patients varied in the 3 syndrome types:vascular endothelial growth factor A(VEGF-A)level in the patients with the 3 syndrome types was significantly lower,placental growth factor(PLGF)and angiopoietin-like protein 4(ANGPTL4)levels in the patients with qi-yin deficiency type were higher,and interleukin 8(IL-8)level in the patients with liver-kidney deficiency type was higher than those before treatment,and the differences were statistically significant(P＜0.05 or P＜0.01).The blood density of macular outer ring and intact macula in the patients with qi-yin deficiency type and liver-kidney deficiency type was larger than that in the patients with yin-yang deficiency type,and the differences were statistically significant(P＜0.05).However,the differences of CRT,FAZ area,and blood density of macular center and inner ring among the 3 syndrome types were not statistically significant(P＞0.05).(3)The incidence of postoperative complications in the patients with yin-yang deficiency type was relatively high,but the difference among the 3 syndrome types was not statistically significant(P＞0.05).Conclusion In the real world,the best efficacy of anti-VEGF combined with PPV treatment in PDR patients with different TCM syndrome types can be achieved in the patients differentiated as qi-yin deficiency type,followed by liver-kidney deficiency type,and then yin-yang deficiency type.After anti-VEGF treatment,the levels of cytokines in the aqueous humor of the patients vary in the 3 syndrome types.Three months after the operation,the patients with qi-yin deficiency type and liver-kidney deficiency type have larger blood density of macular outer ring and intact macula,and exert good prognosis.

Sonogenetics is an emerging synthetic biology technique that uses sound waves to activate mechanosensitive ion channel proteins on the cell surface to regulate cell behavior and function.Due to the widespread presence of mechanically sensitive ion channel systems in cells and the advantages of non-invasion,strong penetrability,high safety and high accuracy of sonogenetics technology,it has great development potential in basic biomedical research and clinical applications,especially in neuronal regulation,tumor mechanism research,sonodynamic therapy and hearing impairment.This review discusses the basic principles of sonogenetics,the development status of sonogenetics and its application in the prevention and treatment of noise-induced hearing loss,summarizes and analyzes the current challenges and future development direction,thus providing a reference for further research and development of sonogenetics in the field of military medicine.

ObjectiveBased on fluorescence lifetime imaging technology, a novel method for viscosity detection is proposed and the capability of different weighting of fluorescence lifetimes in distinguishing the viscosity of glycerol-water mixtures is evaluated, aiming to enhance the accuracy and reliability of viscosity differentiation. MethodsThis approach incorporates the principles of electronic weighting, introducing both amplitude-weighted average fluorescence lifetime (τ_m) and intensity-weighted average fluorescence lifetime (τ_i). Viscosity changes in glycerol-water mixtures are detected through τ_m and τ_i. τ_m Reflects the relationship between fluorescence signal amplitude and time, while τ_i focuses on the time-varying characteristics of fluorescence signal intensity. ResultsThe results of both τ_m and τ_i mutually corroborate each other, not only enhancing the reliability in detecting viscosity changes in glycerol-water mixtures but also revealing their unique roles in the detection process. Although τ_m plays a crucial role in capturing changes in fluorescence signal amplitude, τ_i exhibits higher accuracy in viscosity detection when considering the time-varying characteristics of fluorescence signal intensity. It is particularly noteworthy that, due to τ_i’s greater sensitivity, microenvironment viscosity detection can be directly analyzed using τ_i. This provides a more convenient approach for real-time, highly sensitive microfluidic viscosity monitoring. Therefore, through the comprehensive utilization of τ_m and τ_i, a more thorough and accurate understanding of the viscosity information in glycerol-water mixtures can be obtained, and specific parameters can be selected for in-depth analysis based on specific needs. ConclusionThe combination of amplitude weighting and intensity weighting allows for a more sensitive identification of subtle changes in viscosity under different conditions. The innovation of this method lies in its simultaneous consideration of multiple parameters, enhancing sensitivity and distinguishability to variations in viscosity. Therefore, this weighted-dependent fluorescence lifetime imaging technique not only introduces a novel approach for viscosity detection in glycerol-water mixtures but also provides a powerful analytical tool for various fields, including microfluidics, rheology, and research on novel functional materials.

AIM To investigate the effects of Zhuangyao Shuanglu Tongnao Formula on neuronal apoptosis in rats with cerebral ischemia-reperfusion injury based on the study of oxidative stress and inflammatory response.METHODS The rats were randomly divided into the sham operation group,the model group,the edaravone group(3.0 mg/kg),the low,medium and high dose groups(9.0,18.0,36.0 g/kg)of Zhuangyao Shuanglu Tongnao Formula,with 18 rats in each group.The middle cerebral artery occlusion/reperfusion was conducted by thread embolism method to simulate cerebral ischemia reperfusion injury in rats followed by 6 days corresponding drugs administration.Subsequently,the rats had their neurological function deficit scored by Zeal Longa scoring method;their sizes of cerebral infarction areas measured by TTC staining;their pathological damage and apoptosis of neurons in hippocampal CA1 area of ischemic penumbra of the brain tissue detected by HE staining and TUNEL staining;their SOD activity and levels of GSH,MDA,IL-6,IL-1β,TNF-α in brain tissue detected by kits;and their protein expressions of Bax,Bcl-2,caspase-3,cleaved-capase-3,TLR4,NF-κB p65,Nrf2,HO-1 in rat brain tissue determined by Western blot.RESULTS Compared with the model group,the groups intervened with edaravone,medium and high dose of Zhuangyao Shuanglu Tongnao Formula displayed improvements in the scores of nerve function defects,the rate of cerebral infarction,the rate of neuronal apoptosis,the levels of IL-6,IL-1β,TNF-α and MDA in the ischemic penumbra of brain tissues,the protein expressions of Bax and TLR4,the ratio of cleaved-capase-3/caspase-3 and p-NF-κB p65/NF-κB p65(P＜0.05),the levels of GSH,the activity of SOD and the protein expressions of Bcl-2,Nrf2 and HO-1(P＜0.05).CONCLUSION Being an inhibitor of oxidative stress and inflammatory response,Zhuangyao Shuanglu Tongnao Formula can alleviate brain injury in rats with cerebral ischemia reperfusion injury through the inhibition of neuronal apoptosis and improvement of neural function mediated by the inhibition of TLR4/NF-κB signal pathway and activation of Nrf2/HO-1 signal pathway.

Objective To understand the discharge readiness of fathers of preterm infants in the Neonatal Intensive Care Unit(NICU),analyze its influencing factors,and provide a basis for formulating individualized discharge health education plans and continuous care plans.Methods A convenience sampling method was employed to select fathers of preterm infants admitted to the NICU in a tertiary A hospital in Zhejiang Province from March 2022 to June 2022 as the subjects of the study.A general information questionnaire and the Discharge Readiness-Parent Version scale were used for the survey.Multiple linear regression analysis was applied to analyze the factors influencing the discharge readiness of fathers of NICU preterm infants.Results A total of 186 fathers of NICU preterm infants were included in the study.The total score of the Discharge Readiness-Parent Version scale was(179.97±28.20)points;the standardized score was(7.82±1.16)points;33.3％of the fathers of preterm infants had a standardized score of＜7 points.Multiple linear regression analysis results showed that the factors influencing the discharge readiness of fathers of NICU preterm infants included the gestational age at birth,birth weight,length of hospital stay,distance to access healthcare service,as well as the fathers'age,annual family income,and number of children in the family.Conclusion The discharge readiness of fathers of NICU preterm infants is at a moderate level.Nursing staff need to pay attention to the discharge readiness of fathers of preterm infants who have lower gestational age at birth,lower birth weight,longer hospital stays,longer distance to healthcare service,and who are younger,have lower annual family income,and are having their first child.Individualized discharge health education plans and continuous care plans should be formulated for them to improve their caregiving knowledge and skills.

In this study, the pharmacodynamic substance basis of the therapeutic activity of different origin sources of the Tibetan medicinal herb Zha xun was evaluated, and the protective effect of the Zha xun, from Habahe county of Altay region, Xinjiang Uygur Autonomous Region; Gilgit region, Pakistan; Lhozhag county of Lhozhag city, Tibet Autonomous Region; Lhorong county of Chamdo city, Tibet Autonomous Region; and Jiulong county of Ganzi Tibetan Autonomous Prefecture, Sichuan Province, on 0.2% carbon tetrachloride (CCl₄)-induced acute liver injury in ICR mice was evaluated. The results showed that different sources of Zha xun significantly reduced serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) in the CCl₄-induced acute oxidative liver injury model, improved liver histopathological damage. Among them, Zha xun from Habahe County, Altay Region, Xinjiang Uygur Autonomous Region; Gilgit Region, Pakistan; and Lhorong County, Chamdo City, Tibet Autonomous Region significantly reduced the malondialdehyde (MDA) content in liver tissues (P < 0.05), increased the glutathione (GSH) content (P < 0.01), improved the oxidative stress in liver tissues. The preliminary evaluation of the hepatoprotective activity of Zha xun from different origins was carried out using the model of HepG2 cell injury induced by acetaminophen (APAP). The results showed that Zha xun from different origins could significantly inhibit APAP-induced hepatocellular injury and improve the survival rate of hepatocytes. The present study demonstrated that the different origins of Zha xun had definite hepatoprotective activities in vivo and ex vivo, among which, Zha xun from Lhorong County, Chamdo City, Tibet Autonomous Region, had stronger hepatoprotective activities. The animals used in this experiment and the related dispositions were in accordance with the requirements of animal welfare, and the experiment was approved by the Committee of Laboratory Animal Management and Use of the Institute of Pharmaceutical Sciences of the Chinese Academy of Medical Sciences (approval No. 00004024) before the experiment was carried out.

Objective To evaluate the application effect of broth microdilution(BMD)method in susceptibility testing of multidrug-resistant Mycobacterium tuberculosis(MDR-MTB).Methods The Roche's proportion method and BMD method were adopted in drug susceptibility testing on 108 MDR-MTB strains and 11 non-MDR-MTB strains in Hainan Province.Whole genome sequencing(WGS)was performed on strains with inconsistent results by the above two methods.Results The average time to acquire drug susceptibility testing results by Roche's propor-tional method and BMD method were 28.0 and 8.5 days,respectively.Roche's proportional method showed higher resistance rates to isoniazid(INH),rifampicin(RFP),ethambutol(EMB),kanamycin(KM),and capreomycin(CPM)than BMD method(all P＜0.001).BMD method showed higher resistance rates to protionamide(PTO)and para-aminosalicylic acid(PAS)than Roche's proportional method(both P＜0.001).Taking Roche's proportional method as the gold standard,the sensitivity and specificity of BMD method for testing drug resistance were 50.00％-100％and 95.69％-100％,respectively.Except EMB(87.39％)and INH(94.96％),the consistency rates of the BMD method in testing drug resistance of other drugs were all ≥95.00％.The overall consistency rate between Roche's proportional method and WGS was 76.19％(32/42),while the consistency rate between BMD method and WGS was 23.81％(10/42),difference was statistically significant(x2=23.048,P＜0.001).34 MTB strains showed inconsistent results by two drug susceptibility testing methods.Among the 26 MTB strains that were resis-tant in Roche's proportion method but sensitive in BMD method,22 strains(84.62％)had mutations in relevant re-sistance genes.Among the 11 MTB strains that were sensitive in Roche's proportion method but resistant in BMD method,5 strains(45.45％)had mutations in relevant resistance genes.Conclusion BMD method is an accurate and rapid MDR-MTB susceptibility testing method,but further improvement and optimization are still needed.Drug resistance is closely related to mutations in relevant resistance genes.

Objective To explore the independent risk factors for central line-associated bloodstream infection(CLABSI),provide basis for developing intervention measures for infection prevention and control as well as con-ducting targeted treatment.Methods Patients who were diagnosed with CLABSI in a hospital from January 2019 to December 2023 were recruited retrospectively and defined as the infection group.According to 1:4 propensity score matching method,patients who received central venous catheter(CVC)without infection were taken as the control group.With whether CLABSI occurred as the dependent variable,the possible risk factors of the matched two groups as the independent variables,logistic regression analysis was conducted,and independent risk factors for pa-tients developing CLABSI were explored.Results A total of 42 patients in the CLABSI group and 168 patients in the non-CLABSI group were matched.Multivariate logistic regression analysis showed that high score of acute physiology and chronic health evaluation(APACHE)Ⅱ(OR=1.217,95％CI[1.094-1.357],P＜0.001),long duration of central venous catheterization(OR=1.273,95％CI[1.157-1.400],P＜0.001),and femoral venous catheterization(OR=6.846,95％CI[1.511-31.014],P=0.013)were independent risk factors for CLABSI.A total of 118 strains of pathogens were isolated from 42 CLABSI patients,with Gram-negative bacteria being the ma-jority(n=56).Conclusion High score of APACHE Ⅱ,long duration of central venous catheterization,and femo-ral venous catheterization are independent risk factors for CLABSI.The main pathogens are Gram-negative bacilli.Strict prevention and control measures for CLABSI should be implemented to reduce the risk of infection.

Objective To assess the efficacy of endoscopic ultrasound-guided enteroenterostomy(EUS-EE)in the management of malignant bowel obstruction(MBO).Methods Retrospective analysis was conducted on clinical data from 14 patients who underwent EUS-EE for MBO from June 2022 to December 2023.A modified intestinal preparation protocol was employed prior to the procedure,and the resolution of symptoms,improvement in nutritional status,and occurrence of complications were statistically analyzed post-EUS-EE.Results EUS-EE was successfully performed in all 14 cases.The Colorectal obstruction scoring system(CrOSS)was used to evaluate preoperative and postoperative symptom relief and alleviation of bowel obstruction.One week after the procedure,CrOSS scores increased from 1 to 2 before surgery to 2～4.The patient-generated subjective global assessment(PG-SGA)score for malignancy patients demonstrated a mean score of(9.64±3.13)one week after surgery among the study cohort of 14 patients.This score showed a significant decrease compared to their preoperative PG-SGA score(12.36±3.22),with a statistical difference(t=2.26,P=0.032).Postoperatively,five patients experienced elevated body temperature,three had pneumoperitoneum,and two developed short bowel syndrome;However,these complications were effectively managed through symptomatic treatment resulting in recovery or relief thereof.At one-year follow-up,the median survival time was recorded as 81(41,500)d with a one-year survival rate at 64.29％.Conclusion EUS-EE offers advantages such as high remission rates for symptoms,minimal trauma,and low reintervention rates.For patients with poor baseline conditions or limited life expectancy,EUS-EE can alleviate physical discomfort symptoms,improve quality of life,and prolong survival period.