Modernization of theories of traditional Chinese medicine (TCM) is a key issue for the development of Chinese medicine. As TCM concepts are too vague and lack precise definition, it is difficult to test those theories by modern technologies. Methods of TCM classification are not accepted by Western medicine so far. Because of the diversity and complexity of Chinese herbal medicines, the molecules of Chinese herbal medicines are difficult to be separated, and efficacy is difficult to be verified and classified by biological and chemical methods. In order to verify the scientificity of TCM classification, molecular properties can be studied by their spectrum, and be combined with latent semantic analysis technology and weighting method which are widely used in the Internet search engine. 48 Chinese herbal medicines belonging to four kinds of Chinese herbal medicines:nourishing yin, tonifying yang, invigorating qi, and enriching blood, are analyzed through NIRS, and the results are almost the same as the TCM classification.

Objective To explore the mechanism of self-awareness in the heavy smokers(HS)by using regional homogeneity(ReHo)combined with resting-state functional MRI(fMRI).Methods Thirty HS and 31 healthy non-smokers(NS)matched for age and sex underwent a 3.0 T resting-state fMRI.The data were post-processed by SPM 5 and then the ReHo values were calculated by REST software.The ReHo values between the two groups were compared by two-sample t-test.The brain map with significant difference of ReHo value was obtained.Results Compared with that in NS group,the regions with decreased ReHo value included the bilateral precuneus,superior frontal gyrus,medial prefrontal cortex,right angular gyrus,inferior frontal gyrus,inferior occipital gyrus,cerebellum,and left middle frontal gyrus in HS group.The regions of increased ReHo value included the bilateral insula,parahippocampal gyrus,white matter of parietal lobe,pons,left inferior parietal lobule,lingual gyrus,thalamus,inferior orbital gyrus,white matter of temporal-frontal lobe,and cerebellum.The difference was more obvious in the left hemisphere.Conclusions In HS,abnormal ReHo on a resting state which reflects network of smoking addiction.This method may be helpful in understanding the mechanism of self-awareness in HS.

Objective:To investigate the prognostic value of pulmonary vascular permeability index(PVPI)combined with carbohydrate antigen 125(CA125)and interleukin-6(IL-6)in patients with acute pulmonary edema.Methods:A total of 86 patients with acute pulmonary edema admitted to our hospital from Feb 2022 to May 2023 were selected.After admission,all patients were treated with mechanical ventilation.According to their 28-day survival,they were divided into the survival group(n=63)and the death group(n=23).PVPI,CA125,IL-6,acute physiology and chronic health status score system Ⅱ(APACHEⅡ),infection-related organ failure score system(SOFA)and oxygenation index(PaO2/FiO2)were compared between the two groups,and the correlation between the level of each index and the prognosis and its effect on prognosis were analyzed.Results:Three days after admission,the scores of PVPI,CA125,IL-6,APACHEⅡ and SOFA in the death group were significantly higher than those in the survival group,and the PaO2/FiO2 was lower than that in the survival group(P＜0.05).PVPI,CA125 and IL-6 were negatively correlated with PaO2/FiO2,but positively correlated with APACHEⅡ and SOFA scores(P＜0.01).The AUC of PVPI,CA125,and IL-6 alone in predicting poor prognosis of acute pulmonary edema was 0.728,0.712,and 0.761,respectively,and the cut-off value was 3.20,58.87 U/ml,28.84 pg/ml.The AUC of combined prediction was 0.834,and the sensitivity was 86.96%,the specificity was 87.30%,which was significantly higher than that of each index alone(P＜0.05).The risk of poor prognosis in patients with high PVPI,CA125,and IL-6 was 3.701,2.945 and 4.217 times that of patients with low PVPI,CA125,and IL-6,respectively(P＜0.05).Conclusions:PVPI,CA125 and IL-6 are significantly correlated with the prognosis of patients with acute pulmonary edema.Combined detection can be used as an important auxiliary way to predict poor prognosis of patients with acute pulmonary edema.

Objective To evaluate the preliminary clinical effect of anterior anatomical reduction plate fixation on the treatment of atlantoaxial dislocation. Methods A retrospective case series study was conducted to analyze the 13 patients with atlantoaxial dislocation admitted to the second affiliated hospital of Xi'an Jiaotong University from January 2016 to December 2017. There were eight males and five females, aged 20-57 years, with an average age of 42 years. All patients received transoropharyngeal reconstruction and atlantoaxial anterior anatomical reduction plate fixation, 12 of which underwent the surgery for the first time but one had the revision surgery. The operation time and intraoperative bleeding were recorded. The angle of the clivus axis was measured, and the reduction of the atlantoaxial spine and the fusion of bone graft were observed. The neurological function was evaluated by Japanese Orthopedic Association ( JOA ) score and the improvement rate of spinal cord function was calculated. The complications were also recorded. Results All patients were followed up for 10-30 months [(14. 2 ± 5. 0)months]. The operation time was 150-285 minutes [(216. 8 ± 36. 7)minutes]. The intraoperative blood loss was 50-130 ml [(80. 5 ± 19. 7)ml]. The slope axis angle was (113. 2 ± 9. 1)° before operation and (145. 8 ± 6. 7)° after operation, with an average increase of 32. 6° (P<0. 01). Anatomical reduction was obtained in nine patients, and partial reduction in four patients. At the last follow-up, the atlantoaxial fusion was obtained in all patients, and the healing time was ( 4. 6 ± 1. 1 ) months. Postoperative neurological symptoms were improved compared with those before operation. The JOA score was improved from preoperative (8. 7 ± 1. 7) points to postoperative (14. 3 ± 1. 2) points, with an average increase of 5. 6 points (P<0. 01). The average improvement rate of spinal cord function was 69％. Except for one patient with cerebrospinal fluid leakage, there were no complications such as spinal cord, nerve, blood vessel injury or wound infection after operation. Conclusions Anterior atlantoaxial anatomical reduction plate fixation can effectively restore the dislocated atlantoaxial joint, restore slope axis angle, improve bone fusion rate, and improve nerve function. It can be used as an alternative or supplement to posterior fixation.

This paper introduced the legislative development of community benefits system of nonprofit hospitals at federal level in the United States,as well as state legislatures in this regard. Based on America's experiences, an analysis was made on the "community benefits and health promotion model", which refers to community health needs assessment, health promotion programs, program implementation, supervision and appraisal. Thus the authors put forward inspirations for the social responsibility system development of public hospitals in China as follows. This refers to the establishment of hospitals' social responsibility system; development of community health promotion planning based on health needs;and establishment of social responsibility information disclosure system for fulfillment of their social responsibilities.

Heat shock protein 90(Hsp90)which is a molecular chaperone that integrates multiple oncogenic pathways, is an important target in cancer therapy. The present research and development of the traditional N-terminal and C-terminal inhibitors has been restricted while targeting Hsp90 and cell division cycle protein Cdc37 has become the new direction of inhibiting Hsp90. Previous studies have demonstrated that various protein kinases rely on Cdc37 to load onto Hsp90 to complete their correct folding. Thus targeting Hsp90-Cdc37 is a promising strategy to inhibit protein kinases and alleviate the side effects. The interaction mechanism between Hsp90 and Cdc37 has become clearer in recent studies and many natural products have been reported to possess the ability to disassociate Hsp90-Cdc37. In this review, current knowledge on these small molecule inhibitors are summarized. The mode of action is also discussed as the references for the development of novel Hsp90 inhibitors.

Objective:To compare the results of operative versus interventional treatments in patients presenting with sentinel hemorrhage after hepatobiliary and pancreatic surgery.Methods:The clinical data of patients presenting with sentinel hemorrhage after hepatobiliary and pancreatic surgery at the Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University from August 2017 to July 2022 were retrospectively analyzed. Of 82 patients who were enrolled in this study, there were 50 males and 32 females, aged (59.0±7.7) years. The patients were divided into the interventional group ( n=42) and the surgical group ( n=40) based on the treatment they received for sentinel hemorrhage. The vascular injury rate, the first operation time for sentinel bleeding, the rate of successful hemostasis in a single operation, the number of deaths and other indicators were compared between groups. Results:In both the two groups of patients who underwent percutaneous transhepatic cholangial drainage, hepatectomy, endoscopic retrograde cholangiopancreatography, hilar cholangiocarcinoma resection and cholecystectomy were mainly performed hepatic artery injury, pancreaticoduodenectomy with gastroduodenal artery injury, and splenectomy with splenic artery injury. In the intervention group, 36 patients (85.7%) were successfully hemostasis after single treatment, and 32 patients (80.0%) in the operation group, and there was no significant difference between the two groups (χ 2=0.47, P=0.492). The first operation time for the intervention group was (40.5±8.5) min and the mortality rate was 2.4% (1/42), which were significantly better than that of the operation group (90.6±20.8) min and 15.0% (6/40) (all P<0.05). Conclusion:Interventional therapy can be used as the first-line diagnosis and treatment for sentinel bleeding after hepatobiliary and pancreatic surgery. It has the advantages of a lower mortality rate in treating these patients.

Objective:To explore the feasibility and safety of the clinical application of the diagnosis and treatment mode combining rapid frozen pathological examination of prostate biopsy tissue with radical prostatectomy.Methods:Suspected prostate cancer patients with PSA>10 ng/ml and PI-RADS score ≥4 in, Northern Jiangsu People's Hospital from April to September 2021 were collected. The included patients underwent mpMRI/TRUS image fusion-guided transperineal prostate targeted biopsy with 16G biopsy needle, 2-3 needles for biopsy, and rapid frozen pathological examination. Robot-assisted laparoscopic radical prostatectomy (RALP) was performed immediately for patients with prostate cancer with rapid freezing pathology. For undiagnosed prostate cancer, 18G biopsy needle for prostate targeted + systematic biopsy were used, 18-22 needles for systematic biopsy, and routine pathological examination. The baseline data, frozen pathological results, perioperative conditions, pathological results and follow-up data of all patients were collected.Results:Eleven patients were included in the study, the mean age of the patients was 69.9(66-73) years, the mean BMI was 22.8(19-26) kg/m 2, the mean PSA was 23.2(14.25-32.00), the mean prostate volume was 45(32-52) ml, mean PSAD 0.54(0.33-0.75). PI-RADS score was 4 in 3 cases and 5 in 8 cases; digital rectal examination was positive in 5 cases. All 11 cases underwent rapid freezing and the pathological results showed that: 9 cases were prostate adenocarcinoma, and RALP was performed immediately. The operation time was 111.5(96-126) min, the intraoperative blood loss was 78.9(55-105) ml, and the postoperative extubation time was 4.3(3.5-5.0) days, postoperative hospital stay 5.8(5.0-6.5) days. Postoperative pathology showed that Gleason score 3+ 4=7 in 1 case, 4+ 3=7 in 3 cases, 8 points in 4 cases, and 10 points in 1 case; 3 cases had positive resection margins, and 1 case had seminal vesicle invasion, the average number of dissected lymph nodes was 10.9 (8.5-14.0), and there was no tumor metastasis. Pathological T staging included 2 cases of T 2b stage, 5 cases of T 2c stage, 1 case of T 3a stage, and 1 case of T 3b stage. Two patients were undiagnosed by rapid freezing pathology, of which one was prostate adenocarcinoma with a Gleason score of 4+ 3=7, and then received RALP; the other one was prostate inflammation. 11 patients were followed up; the postoperative follow-up time was 3-7 months, with an average of 5.2 months. Among the 10 patients who underwent RALP, 8 patients recovered urinary continence 2 weeks after surgery, and all recovered within 2 months after surgery. Three patients with positive surgical margins were given regular androgen deprivation therapy in the second week after surgery. PSA did not drop below 0.1 ng/ml in patients with positive margins and seminal vesicle invasion 3 months after surgery. No complications of Clavien grade Ⅰ or higher occurred after operation and during follow-up. Conclusions:For patients with high suspicion of prostate cancer, rapid frozen pathological examination of prostate biopsy tissue is performed. RALP is performed immediately for patients with prostate cancer. The results show that this diagnosis and treatment model could be safe and feasible.

Objective:To investigate the factors affecting the effect of periprostatic nerve block (PNB), establish a prediction model of pain degree, and verify the prediction efficiency.Methods:The clinical data of 314 patients who underwent transperineal prostate biopsy in our hospital from June 2022 to January 2023 were retrospectively analyzed. The median age was 71 (65, 76) years, the median prostate-specific antigen (PSA) was 14.6 (10.70, 24.65) ng/ml, and the median puncture needle number was 21 (19, 23) needles, median prostate volume 45.86 (31.52, 67.96) ml, median body mass index (BMI)24.02(22.97, 25.33)kg/m 2, including 109 patients with a history of diabetes, 90 patients with a history of surgery, and 57 patients with a history of severe trauma. The patients were divided into mild pain group (1-3 points), moderate pain group (4-6 points) and severe pain group (7-10 points) according to the intraoperative visual analogue scale (VAS). According to the clinical characteristics, the factors affecting the effect of PNB were analyzed by univariate analysis and multiple ordered logistic regression method. R language was used to construct a nomogram model for predicting PNB effect, receiver operating characteristic (ROC) curve and calibration curve were drawn, and Hosmer-Lemeshow test was carried out to verify the prediction efficiency of the model. Results:The results of univariate analysis showed that 171 patients in the mild pain group had a median age of 71 (65, 75) years, a median PSA14.5 (9.6, 24.6) ng/ml, a median number of puncture needles of 20 (18, 22), and a median prostate volume of 34.94 (26.36, 45.12) ml, median BMI24.17(23.14, 25.79)kg/m 2, including 74 patients with a history of diabetes, 51 patients with a history of surgery, and 40 patients with a history of severe trauma; There were 110 patients in the moderate pain group, the median age was 71 (65, 76) years, the median PSA14.8 (11.03, 24.27) ng/ml, the median number of puncture needles was 23 (20, 24) needles, median prostatic volume 63.24 (49.14, 78.72) ml, median BMI23.91(22.58, 24.88)kg/m 2, including 26 patients with a history of diabetes, 29 patients with a history of surgery, and 10 patients with a history of severe trauma; In the severe pain group, 33 patients had a median age of 73 (67, 78) years, a median PSA14.6 (10.85, 34.80) ng/ml, and a median puncture needle number of 23 (22.5, 24) needles, median prostate volume 70.64 (61.50, 104.51) ml, median BMI24.32(23.00, 26.06)kg/m 2, including 9 patients with a history of diabetes, 10 patients with a history of surgery, and 7 patients with a history of severe trauma. The results of univariate analysis showed that the number of puncture needles ( P<0.01), prostate volume ( P<0.01), history of diabetes ( P=0.002) and history of major trauma ( P= 0.009) were the factors affecting the effect of PNB. Multiple logistic regression analysis showed that puncture needle number ( P=0.009), prostate volume ( P<0.01) and diabetes history ( P=0.041) were independent risk factors for PNB effect. The area under ROC curve (AUC) of the moderate and above pain prediction model was 0.872, P<0.01; the area under ROC curve of the severe pain prediction model was 0.817, P<0.01; the result of Hosmer-Lemeshow test of the moderate and above pain prediction model was χ2=5.001, P=0.757. The results of the severe pain prediction model were χ2=4.452 and P=0.814. The calibration curve was established, which showed that the prediction probability of pain degree was in good agreement with the actual risk. Conclusions:The number of puncture needles, prostate volume and history of diabetes are the risk factors affecting the effect of PNB. The prediction model of PNB effect based on this model can be used to predict the pain degree of patients undergoing prostate biopsy after PNB.

[Objective] To identify the risk factors associated with uric acid stones, construct a nomogram model for predicting the occurrence of the disease, and evaluate its predictive performance. [Methods] A retrospective analysis was conducted on the general and clinical data of 876 patients who underwent surgical treatment for stones at the Department of Urology, the First Affiliated Hospital of Soochow University, during Jan.2020 and Dec.2022.Based on the analysis results of stone composition, the patients were divided into the uric acid stone group (n=82) and non-uric acid stone group (n=794). All patients were then randomly split into the training group (n=526) and validation group (n=350) in a ratio of 6∶4.The training group underwent LASSO regression, univariate, and multivariate logistic regression analyses to identify predictive factors associated with the occurrence of uric acid stones.Based on the factors, a nomogram model was constructed.The performance of the model was evaluated using the validation group data by comparing it with models from other research centers. [Results] LASSO regression, univariate, and multivariate logistic regression analyses revealed that cystatin C, urine pH, and stone CT values were predictive factors for uric acid stones.The area under the receiver operating characteristic curve (AUC) of the model was 0.968 for the training group and 0.956 for the validation group.Compared to other models, this model showed better predictive performance.The integrated discrimination improvement (IDI) and net reclassification index (NRI) in the training group were 0.420 0(95%CI: 0.328 2-0.511 8), P<0.001, and 0.484 2(95%CI: 0.321 3-0.647 2), P<0.001, respectively.In the validation group, the IDI and NRI were 0.405 9 (95%CI: 0.330 7-0.481 1), P<0.001, and 0.365 3 (95%CI: 0.211 6-0.519 0), P<0.001, respectively. [Conclusion] The nomogram model based on cystatin C, urine pH, and stone CT values can predict the occurrence of uric acid stones more accurately than other models, and can serve as a clinical supportive tool for the treatment and prevention of stone recurrence.