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A 5-year-old girl diagnosed with high-risk neuroblastoma enrolled in our clinical trial underwent 18F-MFBG PET/CT, showing multiple discrete focal "hot spots." Bone marrow aspiration confirmed metastatic neuroblastoma involvement. After 5 cycles of immunotherapy and chemotherapy, follow-up 18F-MFBG PET/CT revealed a marked shift in biodistribution: the multiple discrete focal "hot spots" pattern resolved, and diffuse and intense skeletal tracer uptake-consistent with a superscan pattern emerged-including both newly developed lesions-indicative of progressive disease. The present case showed the temporal evolution of 18F-MFBG uptake from multiple focal "hot spots" to a superscan.
Presymptomatic treatment for infants diagnosed with spinal muscular atrophy (SMA) through newborn screening (NBS) can dramatically improve the prognosis. This study aims to investigate the feasibility of the amplification refractory mutation system polymerase chain reaction-capillary electrophoresis (ARMS-PCR-CE) in SMA NBS. This technology combines multiplex fluorescence and automated capillary electrophoresis, achieving high sensitivity and multiplex detection through the size differences of fluorescently amplified fragments. The copy numbers (CNs) of survival motor neuron 1 (SMN1) and SMN2 exons 7 and 8 can be simultaneously determined in a single tube using specific primers designed based on differential bases. Two endogenous control genes were simultaneously assayed within the single-tube reaction system, while concordance of total CNs between exons 7 and 8 was comparatively assessed to ensure experimental veracity. Heterozygous with SMN1 1-copy were screened for 19 minor variants, and long-range amplification and exon sequencing were conducted to identify compound heterozygous SMA newborns. Among 20,193 dried blood spots (DBS) from eastern China, we identified 2 cases of SMN1 homozygous deletions and 380 individuals with heterozygous deletion yielding a carrier frequency of 1 in 53. Three minor SMN1 variations were found in 7 cases with SMN1 1-copy. The average detection time per sample was approximately 2.5 h, with median diagnostic time points occurring on the 7th postnatal day for SMN1/SMN2 CNs and the 11th day for minor variants. ARMS-PCR-CE is a comprehensive, accurate and rapid method for SMA DBS screening for SMN1/SMN2 CNs variations and minor variants detection.
Two of the most used hormones in sport, included in the WADA list of banned molecules, are human chorionic gonadotropin (hCG) and insulin-like growth factor (IGF-I). Male athletes may use pharmaceutical preparations of hCG to stimulate the production of testosterone before competition and IGF-I to stimulate muscle protein synthesis, promote glycogen storage, and improve lipolysis. Dry matrix microsampling and dried blood spots (DBS) are very promising strategies to improve current doping control activities, as they can lead to a significant improvement in compound stability, the simplification of sample collection and pre-analytic phases, the facilitation of their automation and a reduction of the risks of sample contamination and tampering. In this study, a protein extraction protocol from DBS, specifically hCG and IGF-I, was developed. Through the testing of various extraction solvents and subsequent analysis by Qubit fluorometry and nanoLC-MS/MS, we established an effective protein extraction procedure from DBS, specifically targeting hCG and IGF-I. The nanoLC-MS/MS bottom-up proteomic study reported a good protein extraction protocol from DBS, demonstrating good reproducibility and abundance related to the peptide sequences of hCG and IGF-I detected.
Despite the clinical importance of CD4 testing for identifying advanced HIV disease, access to conventional flow cytometry remains limited in many settings. Epigenetic quantitative PCR (qPCR)-based immune cell quantification represents a molecular alternative that may be compatible with simplified sample types such as dried blood spots (DBS). This study evaluated the analytical performance of an epigenetic CD4+ T-cell qPCR assay (Epimune diagnostics) using DBS samples. Residual EDTA whole blood specimens (n = 150) from HIV patients were applied to Whatman 903 DBS cards and tested following manual DNA extraction and qPCR using the iMune CD4 assay. CD4 counts derived from DBS were compared with reference flow cytometry using the AQUIOS PanLeucogating platform. Agreement was assessed using concordance correlation, Bland-Altman analysis, and percentage similarity. Assay repeatability, batch-related variability, and classification performance at clinically relevant CD4 thresholds were also evaluated. DBS-based epigenetic CD4 quantification demonstrated good agreement with flow cytometry (concordance correlation coefficient 0.91; 95% CI: 0.88-0.93) with a mean bias of -28 cells/μL (-6.9%). Repeatability was acceptable across the measurement range (coefficient of variation 4.0%-11.2%). At a threshold of 200 cells/μL, sensitivity and specificity were 93.8% and 88.9%, respectively. Increased variability was observed in larger manual extraction batches. These findings demonstrate the technical feasibility of epigenetic qPCR-based CD4 quantification from DBS and support further optimisation and validation.
Identifying choroidal melanoma in the primary care setting represents a diagnostic challenge. We present a rare case of choroidal melanoma in a patient who presented with progressive superolateral quadrantanopia. A CT of the head identified an intraocular hyperdensity within the left globe. Fundoscopy confirmed a classic dome-shaped choroidal melanoma. Gene expression profiling demonstrated a class 1b uveal melanoma with PRAME positivity and mutations in GNAQ and SF3B1. Staging scans were negative for metastatic disease. Vision improved following four sessions of proton beam therapy. This case highlights the importance of multidisciplinary involvement, multimodal imaging, and gene expression profiling in facilitating early diagnosis and treatment.
The oriGen project represents a pioneering but institutionally anchored response to Mexico's regulatory gap. Yet, viewed through the lens of contemporary scholarship, its model-private university ownership, broad individual consent, and external sequencing partnerships-stands in tension with emerging global norms for equitable, transparent, and democratically governed genomic research.
To find the cause of infectious diseases such as urinary tract infections, a the diagnostic patterning test was used. In this method, the whole blood and serum samples for every person were dried on a glass substrate to create a special pattern due to formation of central and peripheral regions. This process was performed during 1 h at 25 °C which is much shorter than the classical and instrumental methods. The resulting patterns can be observed by an optical microscope. The study aimed to classify the UTI patients and healthy controls (N=600). In addition, the images of dried patterns were captured by a camera and the classification analysis was done by convolutional neural network algorithm, executed by graphical user interface. The result of analysis was available after a few minutes, indicating that the proposed method achieved accuracies of 90.8% (through the analysis of the dried blood spot) and 86.6% (through the evaluation of the dried serum spot) for discriminating the patients from healthy participants. This method could become popular because it has a simple design and does not require skilled personnel, toxic reagents and expensive equipment. Most importantly, it can identify the contaminated sample as well as the contaminant in a shorter time than other common methods.
Alternating twisted multilayer graphene presents a compelling multiband system, with a coexistence of Dirac bands and flat bands, for exploring superconductivity. However, the roles of flat bands and Dirac bands played in determining the superconductivity remain elusive. Here, we focus on the alternating twisted quadralayer graphene to reveal unconventional superconducting behaviors. We disentangle Dirac bands and flat bands, revealing a Coulomb interaction-induced band broadening effect. We further quantify the electric-field-dependent evolution of the critical temperature and coherence length, and estimate the flat-band Fermi velocity and superfluid stiffness via critical current measurements. Our results demonstrate an electric-field-tunable coupling strength within the superconducting phase, revealing unconventional properties with vanishing Fermi velocity and large superfluid stiffness. Combined with our theoretical analysis, these observations support a picture in which displacement-field-driven hybridization between flat and Dirac-like bands enhances the quantum-metric contribution to superconductivity, offering new insight into multiband flat-band superconductivity in moiré systems.
Retinal detachment (RD) is a vision- threatening emergency requiring timely recognition and referral. Rhegmatogenous RD is the most common type, arising from a retinal tear that allows subretinal fluid to accumulate and subsequent RD. Posterior vitreous detachment (PVD) is common and usually benign, but can induce retinal tears. Hallmark symptoms (flashes, floaters, field defects and failing vision - referred to as the '4 Fs') should alert clinicians to possible RD. To highlight the time-critical nature of  RD and provide practical guidance for  its recognition and management in general practice. Patients presenting with the '4 Fs', particularly high-risk groups, require urgent ophthalmic assessment. General practitioner (GP) evaluation for referral should include visual acuity, confrontation fields and, where feasible, fundoscopy.
PSMA PET/CT has transformed prostate cancer management, yet its diagnostic utility is not absolute. It fails to detect PSMA-suppressed disease variants, including treatment-induced neuroendocrine prostate cancer (t-NEPC) and dedifferentiated tumors, and is inherently blind to second primary malignancies (SPMs). This study evaluated the additional diagnostic yield and direct clinical impact of incorporating [¹⁸F]FDG PET/CT into a systematic, indication-driven dual-tracer protocol in high-risk prostate cancer patients. In this retrospective, STROBE-compliant, single-center cohort study, 82 patients with histologically confirmed prostate cancer who underwent both [⁶⁸Ga]Ga-PSMA-11 and [¹⁸F]FDG PET/CT were analyzed. Clinical indications encompassed suspected SPM, suspected dedifferentiation or t-NEPC, initial staging of very high-risk disease, pre-[¹⁷⁷Lu]Lu-PSMA therapy evaluation, and equivocal PSMA findings. The primary endpoint was the proportion of patients in whom [¹⁸F]FDG PET/CT provided additional diagnostic information. Secondary endpoints included concordance analysis and the rate of management changes. Median age was 72 years (IQR 65-75). [⁶⁸Ga]Ga-PSMA-11 demonstrated superior prostate cancer detection compared to [¹⁸F]FDG (70.7% vs. 25.6%; McNemar's p < 0.0001). However, [¹⁸F]FDG PET/CT provided clinically critical additional information and directly altered management in 51.2% of patients (95% CI: 40.6-61.7%). The most impactful contributions were histopathologically confirmed SPM detection (30.5%, predominantly lung and colorectal adenocarcinomas) and identification of PSMA-negative/FDG-positive discordant disease signaling dedifferentiation. No significant correlation was found between PSMA and FDG SUVmax values (Spearman rho = 0.149, p = 0.422), underscoring their biologically distinct and complementary targets. [¹⁸F]FDG PET/CT is not a redundant adjunct to PSMA imaging; it fills a critical diagnostic blind spot. When applied through an indication-driven framework, dual-tracer imaging directly reshapes clinical decision-making in more than half of selected high-risk prostate cancer patients, enabling detection of occult malignancies and guiding pivotal treatment decisions that PSMA PET/CT alone cannot support.
This study aimed to compare the outcomes of intraoperative conventional panretinal photocoagulation (CPRP) with the modified peripheral panretinal photocoagulation (PPRP) technique in pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR). Sixty-three eyes of 56 patients with PDR were retrospectively studied. Patients with very severe proliferation were excluded in this study. Twenty-six patients (30 eyes) received CPRP and 30 patients (33 eyes) received modified PPRP in PPV. Preoperative and postoperative ophthalmologic examinations were performed. Best corrected visual acuity (BCVA) was performed at baseline and 3 months after surgery. Central macular thickness (CMT) was measured at 1 week and 3 months after surgery. Postoperative inflammation was examined at 1 day and 3 months after surgery. Other postoperative complications were also analyzed at 3 months after surgery. Of all the included eyes, 24 eyes (38.1%) were diagnosed with neovascularization elsewhere (NVE) and/or neovascularization of the disc (NVD) and 39 eyes (61.9%) were diagnosed with tractional retinal detachment (TRD) preoperatively. The number of laser spots in the CPRP group ranged from 858 to 2245, with an average of 1232 (1048,1369) spots. The number of laser spots in the PPRP group ranged from 394 to 992, with an average of 673 (579, 798) spots. The mean logMAR BCVA before surgery was 1.71 ± 0.57 in the CPRP group and 1.57 ± 0.64 in the modified PPRP group, with no statistical difference between the two groups (P = 0.476). The mean logMAR BCVA was 1.15 ± 0.74 in the CPRP group and 0.77 ± 0.54 in the PPRP group at 3 months after surgery, showing that the PPRP group had more visual acuity improvement than the CPRP group (P = 0.037). There was a significant correlation between BCVA and the number of laser spots (P = 0.006). The difference of CMT between the two groups was statistically significant at 1 week after surgery (P = 0.02), but not at 3 months after surgery (P = 0.587). The postoperative inflammation in the CPRP group was significantly more severe than that in the PPRP group at the first day after surgery (P = 0.002). The postoperative inflammation in both groups was significantly reduced 3 months after surgery, with no statistical difference (P = 0.593). There was a significant correlation between the degree of inflammation and the number of laser spots at the first day after surgery (P = 0.016). There was no significant difference in the incidence of other complications between the two groups. The modified PPRP technique was used during PPV in patients with PDR in this study, resulting in better BCVA, decreased CMT, and reduced early postoperative inflammation without increasing the incidence of adverse events in PDR.
Colouration can affect predation risk through camouflage, signalling, or other mechanisms that shape predator perception and decision-making. The Rosalia longicorn (Rosalia alpina), a flagship longhorn beetle of European beech forests, has a bluish-grey exoskeleton with conspicuous black spots, yet the function of this colour pattern remains unclear. We tested whether its blue body colouration is consistent with background matching to beech bark and whether black spotting reduces predation risk beyond that provided by the blue body colouration alone. We measured reflectance spectra of the blue body colouration, black spots and beech bark, modelled chromatic contrasts under avian vision, and deployed plasticine beetle models in three colour variants: black, blue and a natural pattern with blue and black spots. Visual modelling showed that both beetle colours were chromatically distinguishable from beech bark, but black spots had lower chromatic contrast than blue body colouration, suggesting that the black component may match the bark background more closely than the blue component. In the field experiment, attack occurrence varied with colour, sampling session and their interaction. In September, blue and patterned models were less likely than black models to be attacked. Patterned models also received fewer marks than black models. By October, these colour differences had weakened or disappeared. These findings indicate that the blue body colouration and the natural colour pattern may reduce predation risk relative to an entirely black phenotype, particularly early in the season. However, we found no clear evidence that black spotting provides protection beyond that afforded by the blue body colouration alone. Alternative functions of the spots, including thermoregulation or signalling, remain plausible.
The pandemic highlighted geographic inequities in COVID-19 mortality worldwide, reflecting structural and social vulnerabilities that exacerbated respiratory disease outcomes. The primary aim of this study was to examine the spatial relationship between COVID-19 mortality and communities characterized by greater social disadvantage in North Carolina. This application highlights the value of spatial analytic approaches when considering inequities in respiratory mortality. This study analyzed 25,051 COVID-19 deaths occurring in North Carolina from March 2020 through April 2022 using state vital statistics data and the Centers for Disease Control and Prevention, Social Vulnerability Index data. SaTScan™ was used to identify mortality hot spots, and Moran's I in ArcGIS Pro was used to assess spatial autocorrelation at the ZIP-Code Tabulation Area level. The Mann-Whitney U test was used to assess differences in social vulnerability index scores in mortality hot spots areas and non-hot spots areas. Local bivariate analysis identified moderate spatial clustering characterized by high-high (mortality-vulnerability) hot spots and spatial outliers. In non-parametric testing, COVID-19 mortality hot spot areas had significantly higher, but modestly elevated, median overall social vulnerability index scores compared with non-hot spot areas (0.58 vs. 0.45; p < 0.001). Social vulnerability partially explains the observed spatial heterogeneity in COVID-19 mortality (2020-2022), with statistically significant spatial clustering consistently concentrated in areas of higher social vulnerability. This study highlights how pre-existing inequities in healthcare access and social conditions intensified mortality disparities during the pandemic.
Cooperative Vehicle-Infrastructure Systems (CVIS) can significantly enhance tunnel safety, yet most research relies on driving simulators that lack the psychological realism of actual confined environments. This study addresses the gap by evaluating Human-Machine Interaction (HMI) effectiveness in real-world tunnel blind spots, where restricted visibility and confined roadway geometry create high-risk scenarios. A naturalistic driving experiment was conducted in the Guayanling Tunnel, China. Participants drove a vehicle equipped with eye-tracking and onboard data units through a curved blind spot under four conditions: no warning, informative (implicit), instructive, and commanding (explicit) warnings. The study analyzed vehicle data (speed, braking, lateral acceleration) and eye-tracking metrics to assess safety and effectiveness, while also examining the influence of driver gender, experience, and driving style. Across the fixed sequential warning rounds, commanding warnings were associated with the largest changes in speed regulation and earlier braking, but they were also associated with increased lateral-control variability. Instructive warnings also advanced braking, whereas informative warnings showed smaller behavioral effects. Formal interaction analyses provided limited support for subgroup moderation: braking responses varied by driving experience, whereas gender- and driving-style-related differences were weak or exploratory. Explicit, commanding HMIs are superior for immediate hazard response in tunnel blind spots but impose a higher cognitive load. The effectiveness of warnings is not universal; it varies significantly based on individual driver characteristics. Therefore, relying solely on generic warning strategies may be insufficient for diverse driver populations.
Neurofibromatosis Type 1 (NF1) and Sturge-Weber syndrome (SWS) are both genetic disorders with distinct clinical manifestations. NF1 is characterized by multiple neurofibromas, café-au-lait spots, axillary freckling, and potential optic gliomas due to mutations in the NF1 gene on chromosome 17. In contrast, SWS is marked by capillary malformations, leptomeningeal angiofibromas, and congenital glaucoma resulting from post-zygotic mutations in the Guanine Nucleotide-Binding Protein (G Protein), subunit Alpha (GNAQ) gene. Here, we report an exceptional coexistence of both NF1 and SWS. The patient displayed multiple café-au-lait spots, neurofibromas, axillary freckling, fulfilling the criteria for NF1. Concurrently, the patient exhibited a port-wine stain in the periorbital territory aligning with the clinical features of SWS.
This study is aimed at reporting detailed longitudinal changes in best-corrected visual acuity (BCVA) and retinal structure in a patient with central serous chorioretinopathy (CSC) and persistent serous retinal detachment over one and a half years. A man in his 40s presented with unilateral mild vision loss. On the initial examination, the BCVA was 20/25 OS. Optical coherence tomography (OCT) revealed macular serous retinal detachment, and fluorescein angiography identified two focal leakage spots within this area, leading to the diagnosis of CSC. Despite the persistence of serous retinal detachment after several focal photocoagulations, the patient refused photodynamic therapy, which resulted in the serous retinal detachment remaining for 18 months. In the affected eye, the BCVA and outer nuclear layer (ONL) thickness were initially 20/25 and 86 μm, respectively. These values subsequently deteriorated to 20/67 and 73 μm at 6 months and further decreased to 20/200 and 46 μm at 18 months. The reflectivity of the photoreceptor layer progressively increased, leading to the formation of intraretinal hyperreflective foci 18 months from baseline. A patient with CSC and persistent serous retinal detachment may present a relatively rapid decline in BCVA and progressive retinal damage. The chronicity of CSC is associated with specific structural findings, such as thinning of the ONL and photoreceptor layer and increased photoreceptor reflectivity leading to intraretinal hyperreflective foci.
The WHO guideline for the public health control of Strongyloides stercoralis recommends the deployment of Baermann or agar plate culture to estimate the infection prevalence. However, the guideline includes the possible use of antibody-based assays, which might be preferred in some countries. An ELISA based on two recombinant antigens (Strongy Detect ELISA by InBios), performed on dried blood spots (DBS), demonstrated suitable for use in a diagnostic study carried out in remote areas of Ecuador ("ESTRELLA"). A new version of that assay, which aimed at improving specificity according to the indications reported in the target product profile (TPP) for the diagnostics for S. stercoralis, was recently made available in the market. Aim of this study was to compare the performance of the two versions of that ELISA. The DBS collected in the context of the study in Ecuador were tested with the new ELISA. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) were calculated with Bayesian Latent Class Analysis (BLCA). Bayesian estimates were reported as posterior medians with corresponding 95% credible intervals (CrI). Test agreement was calculated with both BLCA and Cohen's kappa. Sensitivity was 66.7% (95% CrI 52.8-80.6) for the new assay, versus 78.8% (95% CrI 66.7-89.2) of the old version (posterior probability that the new test had higher sensitivity = 0.1). Specificity was markedly higher for the new version compared to the previous assay: 98.8% (95% CrI 97.9-99.4) versus 90.1% (95% CrI 87.6-92.4), respectively (posterior probability that the new test had higher specificity = 1). PPV for the new ELISA proved good at all prevalence values considered, going from 80.1% (CrI 67.0-89.4%) when prevalence was 7% to 95.8% (92.5%, 97.9%) with 30% prevalence. The agreement was fair (Cohen's kappa 0.38; 95% CI 0.26-0.49). The new version of the Strongy Detect ELISA demonstrated improved specificity with a moderate reduction in sensitivity compared to the previous version, meeting the TPP requirements in terms of diagnostic performance. Adherence with the other TPP requirements was out of the scope of this study, and should be assessed elsewhere.
Tuberculosis (TB) remains a major public health challenge in Thailand, a high-burden country undergoing both epidemiological transition and pandemic-related disruption. This study examined temporal and spatial patterns of age-standardized TB incidence from 2012 to 2023 across Thailand's 13 health regions and 77 provinces. This nationwide ecological study used annual TB case notifications (2012-2023) for all 77 Thai provinces from Thailand's National Disease Surveillance System (Report 506), Bureau of Epidemiology, with mid-year and age-stratified provincial populations. Age-standardized incidence rates (ASR) were calculated using the WHO World Standard Population (2000-2025). Temporal trends were assessed by Joinpoint regression with Bayesian-Information-Criterion model selection (maximum 2 joinpoints) and validated by generalized additive models. Spatial clustering was evaluated by Global Moran's I and Local Indicators of Spatial Association (LISA) under queen contiguity, with sensitivity analyses across alternative weights and Benjamini-Hochberg false-discovery-rate correction. Provinces were classified into long-term trend categories combining effect size (AAPC) and significance, and COVID-19 impact was quantified by 2019-2023 ASR percent change. National TB incidence declined substantially from 2012 to 2023, although marked regional heterogeneity persisted. Five health regions showed the strongest long-term reductions: region 3 [AAPC: - 20.51, 95% confidence interval (CI): - 33.00 to - 13.77], region 9 (- 19.42, 95% CI: - 28.98 to - 8.57), region 4 (- 17.53, 95% CI: - 23.64 to - 12.89), region 11 (- 11.79, 95% CI: - 22.16 to - 0.04), and region 13 (- 11.19, 95% CI: - 22.44 to - 3.74). Region 6 showed an early decline followed by stabilisation, and region 12 showed a mid-period increase before a post-2019 reduction. Thailand has achieved substantial overall reductions in TB incidence over the past decade, but pronounced regional and provincial disparities persist. Localized hot-spots, biphasic regional trajectories that may reflect surveillance and programmatic transitions, and compound vulnerability during the COVID-19 period underscore the need for geographically targeted monitoring, equitable resource allocation, and pro-poor interventions to sustain progress toward TB elimination.
Chest radiography (CXR) remains the most frequently performed imaging modality worldwide and serves as the first-line investigation for cardiopulmonary conditions. Despite its widespread use, interpretation is limited by the two-dimensional representation of three-dimensional anatomy, resulting in structural overlap and reduced lesion conspicuity. This review provides a structured, pattern-based approach to commonly overlooked regions on CXR, emphasizing key anatomical blind spots including the lung apices, pleura, trachea, lung bases, hila, mediastinum, retrocardiac region, thoracic skeleton, soft tissues, upper abdomen, and medical devices. Both perceptual and cognitive errors are highlighted, particularly satisfaction of search and under-recognition of subtle abnormalities.
Using microorganisms to improve and repair soil and assist plant growth is an effective ecological restoration method. The compound microbial inoculant prepared by mixing several microorganisms with different functions is one of the hot spots in the current research of agricultural green development and food security. In this study, four treatments were set up: no microbial agent (CK), Trichoderma harzianum agent (H), Bacillus subtilis agent (K), and compound microbial agent (K + H). The effects of single and compound microbial agents on tomato growth, rhizosphere soil physical and chemical properties, enzyme activity and microbial community structure and function were investigated, and the correlation between soil nutrients and microbial community was analyzed. The results showed that the application of microbial agents significantly promoted the growth of tomato, and the effect of K + H treatment was the best. The fresh weight, dry weight, plant height and stem diameter of tomato were 25.06%, 17.61%, 3.05% and 16.62% higher than CK, respectively. Microbial agents changed the physical and chemical properties and enzyme activities of rhizosphere soil, significantly increased the content of alkali-hydrolyzable nitrogen and significantly decreased the activity of catalase, and the activity of alkaline phosphatase increased the most under K treatment. High-throughput sequencing showed that microbial agents had a significant effect on the diversity and structure of microbial community in rhizosphere soil. In terms of microbial community diversity, K + H treatment significantly increased the Simpson index of bacteria, and significantly reduced the Chao1, ACE richness index and Shannon, Simpson diversity index of fungi. In the microbial community structure, the dominant phylum of the bacterial community is Proteobacteria, Gemmatimonadota, Actinobacteriota and Acidobacteriota, and the fungi are Ascomycota and Basidiomycota. After microbial inoculant treatment, the relative abundance of Gemmatimonadota, Acidobacteriota, Chloroflexi and Ascomycota increased significantly, while the relative abundance of Actinobacteriota, Olpidiomycota and Chytridiomycota decreased. At the genus level, the abundance of KD4-96, SC-I-84, Penicillium and Trichoderma spp. changed significantly. Microbial agents also regulated microbial functions, and bacterial amino acid transport and metabolic functions were the most active. K + H treatment increased the relative abundance of fungal saprophytic nutrients to 52.37%, which was the highest in each treatment. Redundancy analysis showed that soil alkaline phosphatase, catalase and alkali-hydrolyzable nitrogen were the key environmental factors affecting microbial community structure, which were significantly correlated with the dominant genera of bacteria and fungi. This study confirmed that Bacillus subtilis and Trichoderma harzianum compound inoculants had a good synergistic effect in promoting tomato growth and improving soil microecology, which provided theoretical and practical basis for the development and application of microbial inoculants in tomato production.