By employing the analytic hierarchy process(AHP), the CRITIC method(a weight determination method based on indicator correlations), and the AHP-CRITIC hybrid weighting method, the weight coefficients of evaluation indicators were determined, followed by a comprehensive score comparison. The grey correlation analysis was then performed to analyze the results calculated using the hybrid weighting method. Subsequently, a backpropagation-artificial neural network(BP-ANN) model was constructed to predict the extraction process parameters and optimize the extraction process for Shenxiong Huanglian Jiedu Granules(SHJG). In the extraction process, an L_9(3~4) orthogonal experiment was designed to optimize three factors at three levels, including extraction frequency, water addition amount, and extraction time. The evaluation indicators included geniposide, berberine, ginsenoside Rg_1 + Re, ginsenoside Rb_1, ferulic acid, and extract yield. Finally, the optimal extraction results obtained by the orthogonal experiment, grey correlation analysis, and BP-ANN method were compared, and validation experiments were conducted. The results showed that the optimal extraction process involved two rounds of aqueous extraction, each lasting one hour; the first extraction used ten times the amount of added water, while the second extraction used eight times the amount. In the validation experiments, the average content of each indicator component was higher than the average content obtained in the orthogonal experiment, with a higher comprehensive score. The optimized extraction process parameters were reliable and stable, making them suitable for subsequent preparation process research.
Drugs, Chinese Herbal/analysis* ; Neural Networks, Computer

OBJECTIVE: Humans are exposed to complex mixtures of environmental chemicals and other factors that can affect their health. Analysis of these mixture exposures presents several key challenges for environmental epidemiology and risk assessment, including high dimensionality, correlated exposure, and subtle individual effects. METHODS: We proposed a novel statistical approach, the generalized functional linear model (GFLM), to analyze the health effects of exposure mixtures. GFLM treats the effect of mixture exposures as a smooth function by reordering exposures based on specific mechanisms and capturing internal correlations to provide a meaningful estimation and interpretation. The robustness and efficiency was evaluated under various scenarios through extensive simulation studies. RESULTS: We applied the GFLM to two datasets from the National Health and Nutrition Examination Survey (NHANES). In the first application, we examined the effects of 37 nutrients on BMI (2011-2016 cycles). The GFLM identified a significant mixture effect, with fiber and fat emerging as the nutrients with the greatest negative and positive effects on BMI, respectively. For the second application, we investigated the association between four pre- and perfluoroalkyl substances (PFAS) and gout risk (2007-2018 cycles). Unlike traditional methods, the GFLM indicated no significant association, demonstrating its robustness to multicollinearity. CONCLUSION GFLM framework is a powerful tool for mixture exposure analysis, offering improved handling of correlated exposures and interpretable results. It demonstrates robust performance across various scenarios and real-world applications, advancing our understanding of complex environmental exposures and their health impacts on environmental epidemiology and toxicology.
Humans ; Environmental Exposure/analysis* ; Linear Models ; Nutrition Surveys ; Environmental Pollutants ; Body Mass Index

[This corrects the article DOI: 10.1016/j.apsb.2022.03.002.].

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To explore the effect of integrating clinical situational mode into experimental teaching of Pathogenic Biology,integrate early clinical concept into experimental teaching,and enhance students'ability to analyze and solve clinical problems,so as to improve the quality of teaching.Methods:A total of 179 students from class 7 to 12 of grade 2022 majoring in clinical medicine of a medical college were enrolled as the research subjects.Among them,88 students from class 7 to 9 were selected as the control group and comprehensive experimental content teaching according to the traditional teaching mode were carried out.A total of 91 students from class 10 to 12 were selected as the experimental group and experimental teaching system of Pathogenic Biology focusing on clinical case analysis and discussion,comprehensive experimental development,and diagnosis and treatment of infectious diseases were carried out.The results of process evaluation and summative evaluation were compared between the two groups,and the effect of integrating clinical situation mode into experimental teaching on improving the learning ability of students in the experimental group was evaluated in the form of a questionnaire survey.Results:Academic performances of process evaluation and summative evaluation in the experimental group were higher than those in the control group(P＜0.01).The integration of clinical situational mode into Pathogenic Biology significantly improved students'learning interest,theoretical comprehension,and cultivation of"early clinical"thinking.Conclusion:The integration of clinical situational mode into Pathogenic Biology experiment course can effectively motivated students'learning enthusiasm and cultivate high-quality medical talents with innovative ability and clinical thinking.

Objective:To investigate the application value of dual-layer detector spectral CT in the precise outlining of gross tumor volume (GTV) in lung cancer patients.Methods:Imaging data of 39 patients with pathologically confirmed lung cancer on dual-energy enhanced CT scans in Hebei Medical University Third Hospital were retrospectively analyzed. Among them, 13 patients were not complicated with lung atelectasis and 26 cases were complicated with lung atelectasis and 9 of them received positron emission computed tomography (PET-CT) scan. The virtual single-energy images of arterial and venous dual-phase 40 keV images were reconstructed with the spectral base images of Iqon dual-energy CT, and the GTV of the primary foci was outlined using the reconstructed images and conventional enhanced CT images. The GTV outlined by conventional enhanced CT image, 40 keV virtual monoenergetic (VM) CT image, 40 keV VM-iodine density (VM-ID) fusion image in the arterial phase, conventional enhanced CT image, 40 keV VM image and 40 keV VM-ID image in the venous phase and PET-CT image was defined as GTV ACT, GTV A40VM, GTV A40VMID, GTV VCT, GTV V40VM, GTV V40VMID and GTV PET-CT, respectively. The consistency of target area outlining was assessed by calculating the GTV volume, the Dice similarity coefficient (DSC), and the 95 th percentile of the Hausdorff distance (HD95). Pairwise comparison among groups was conducted by Friedman test and corrected by Bonferroni correction. Results:In GTV comparisons, the differences in GTV ACT, GTV VCT, GTV A40VM and GTV V40VM in patients without pulmonary atelectasis were not statistically significant ( χ2=1.89, P=0.595). The DSC and HD95 of GTV ACTvs. GTV A40VM were 0.96 and 3.00, and the DSC and HD95 of GTV VCTvs. GTV V40VM were 0.94 and 2.93, respectively. The differences in GTV ACT, GTV A40VM, GTV A40VMID, GTV VCT, GTV V40VM, GTV V40VMID and GTV PET-CT in patients complicated with pulmonary atelectasis were statistically significant (all P<0.001). Pairwise comparison of Bonferroni correction showed that there was no statistically significant difference in GTV A40VM, GTV A40VMID, GTV V40VM, GTV V40VMID and GTV PET-CT (all P=1.000), all of which were significantly smaller than those of GTV ACT and GTV VCT (both P=0.001), and there was no statistically significant difference between GTV ACT and GTV VCT (both P=1.000). Based on the tumor extent shown by PET-CT (standardized uptake value =2.5), DSC were slightly higher and HD95 were slightly lower than conventional enhanced CT of GTV A40VM, GTV V40VM, GTV A40VMID, GTV V40VMIDvs. GTV PET-CT, respectively. When the arterial phase sequences were compared with PET-CT, pairwise comparison of Bonferroni correction showed that the DSC and HD95 of GTV A40VMvs. GTV PET-CT and GTV ACTvs. GTV PET-CT were statistically significant (both P<0.01), and the differences were not statistically significant among the remaining groups (all P>0.05). When intravenous phase sequences were compared with PET-CT, pairwise comparison of Bonferroni correction revealed that the DSC and HD95 of GTV V40VMIDvs. GTV PET-CT and GTV VCTvs. GTV PET-CT were statistically significant (both P<0.01), and the differences were not statistically significant among the remaining groups (all P>0.05). Conclusions:The use of 40 keV VMI-ID fusion images to outline the target area of the primary tumor lesions is closer to that of PET-CT, which provides a novel option for the precise outlining of the target area of clinical radiotherapy.

Objective A new occipital bone removal technology was applied to improve the success rate of brain removal.Methods The skull was sawed based on the traditional brain removal technology,and part of the occipital bone was removed downward centered in external occipital protuberance to the foramen magnum,then exposed the telencephalon,cerebellum and posterior medulla oblongata.After that,removed the tentorium cerebelli and cut down the medulla oblongata and the related cranial nerves at the skull base,then removed the brain tissues.Results The removed brain tissues had structurally intact telencephalon,cerebellum and brain stem,clear vessels in the cerebral sulci,and relatively intact optic chiasm,olfactory tracts and vertebro-basilar arteries.Conclusion Brain removal through a fenestration on the external occipital protuberance can effectively preserve the integrity of brain specimens,and improve the success rate of brain removal,which is of great significance for central nervous system teaching and improvement of human brain tissue repositories.

AIM:To explore the effects of Jianpi Huatan formula on regulating T cells and helper T cells 17(Th17)cells in patients with polycystic ova-ry syndrome(PCOS)due to spleen deficiency and phlegm dampness syndrome,and conduct a model evaluation.METHODS:Ninety-two patients with spleen deficiency phlegm dampness syndrome(PCOS)admitted to our hospital from January 2023 to October 2024 were selected as the research sub-jects.Propensity score matching(PSM)method was used to match them in a 1:1 ratio,with 46 pa-tients in each group.The control group received conventional treatment,while the observation group received treatment with Jianpi Huatan for-mula on the basis of the control group.Compared and analyze the differences in clinical data and lab-oratory indicators between two groups;Compared the changes of sex hormone,glucose metabolism and TCM syndrome score before and after treat-ment in the two groups,and focused on the chang-es of regulatory T cells(Treg)and Th17 cells in the two groups before and after treatment;And used the Generalized Estimation Equation(GEE)model to analyze its improvement.Multiple linear regres-sion analysis was used to examine its correlation with the score of traditional Chinese medicine syn-drome.A time effect model of Jianpi Huatan formu-la for treating PCOS with spleen deficiency and phlegm dampness syndrome was established using a nonlinear mixed effects model.The fitting effect of the final model was evaluated through the good-ness of fit.Bootstrap was used to test and evaluate the stability of model parameters.Visual prediction testing was used to evaluate the predictive perfor-mance of the model.Typical time effect curves of traditional Chinese medicine symptom scores was simulated based on the final model for each base-line.RESULTS:After treatment,the total effective rate of the observation group was significantly high-er than that of the control group(χ2=4.842,P=0.028);Compared with before treatment,after 1months and 3 months of treatment,TC,TG,LDL-C,T,LH,FSH,AMH,FPG,FINS,HOMA-IR,the score of traditional Chinese medicine syndrome were sig-nificantly reduced,while E2 and HDL-C were signifi-cantly increased,and the improvement in the ob-servation group was significantly greater than that in the control group(P<0.05);The results of repeat-ed measures ANOVA showed significant difference-sin the time effects,inter group effects,and interac-tion effects of Treg,Th17,and Treg/Th17 between the two groups of patients(P<0.05).The GEE anal-ysis results showed that the improvement of Treg,Th17,and Treg/Th17 in the observation group were better than that in the control group(P<0.05);The results of multiple linear regression analysis showed that the levels of TC,TG,LDL-C,T,LH,FSH,AMH,FPG,FINS,HOMA-IR,Th17 were significantly positively correlated with TCM syndrome score,while the levels of E2,HDL-C,Treg,and Treg/Th17 were significantly negatively correlated with TCM syndrome score(P<0.05);The decrease in tradition-al Chinese medicine symptom score compared to baseline gradually increases over time,eventually reaching the pharmacological platform,which was consistent with the classic Emax model.After gradu-ally screening covariates,it was found that the baseline value of traditional Chinese medicine symptom score had a significant impact on the effi-cacy parameter Emax.The final model was Emax,i=15.42+1.21×(Baselinei-24.41).The goodness of fit results showed that the final model had a good fit-ting effect on the measured data.The model pa-rameters obtained from Bootstrap testing were very consistent with the original model,indicated that the model parameter estimation was robust.The visual prediction test results showed that the model had good predictive performance.The typi-cal efficacy time curve showed that the higher the baseline value of TCM symptom score,the greater the decrease in score.At 3 months of treatment,the TCM symptom score at each baseline basically decreased to below 10 points.CONCLUSION:The formula for strengthening the spleen and resolving phlegm can effectively improve the levels of Treg and Th17 in PCOS patients with spleen deficiency and phlegm dampness syndrome,and has good therapeutic effects,which is worthy of clinical appli-cation.

Objective:To explore the effect of integrating clinical situational mode into experimental teaching of Pathogenic Biology,integrate early clinical concept into experimental teaching,and enhance students'ability to analyze and solve clinical problems,so as to improve the quality of teaching.Methods:A total of 179 students from class 7 to 12 of grade 2022 majoring in clinical medicine of a medical college were enrolled as the research subjects.Among them,88 students from class 7 to 9 were selected as the control group and comprehensive experimental content teaching according to the traditional teaching mode were carried out.A total of 91 students from class 10 to 12 were selected as the experimental group and experimental teaching system of Pathogenic Biology focusing on clinical case analysis and discussion,comprehensive experimental development,and diagnosis and treatment of infectious diseases were carried out.The results of process evaluation and summative evaluation were compared between the two groups,and the effect of integrating clinical situation mode into experimental teaching on improving the learning ability of students in the experimental group was evaluated in the form of a questionnaire survey.Results:Academic performances of process evaluation and summative evaluation in the experimental group were higher than those in the control group(P＜0.01).The integration of clinical situational mode into Pathogenic Biology significantly improved students'learning interest,theoretical comprehension,and cultivation of"early clinical"thinking.Conclusion:The integration of clinical situational mode into Pathogenic Biology experiment course can effectively motivated students'learning enthusiasm and cultivate high-quality medical talents with innovative ability and clinical thinking.