AIM To investigate the effects of Shuyu Pills combined with evolimus on the epithelial mesenchymal transformation of triple negative breast cancer cells 4T1 and MDA-MB-231 induced by TGF-β1.METHODS The 4T1 and MDA-MB-231 cells were divided into the blank group and the induction group to induce the epithelial mesenchymal transformation with TGF-β1 cytokine treatment,followed by the assignment into the model group,the Shuyu Pills group,the everolimus group and the Shuyu Pills combined with everolimus group.CCK8 method,plate cloning method,cell scratch test and Transewll test were used to detect the proliferation,cloning formation,migration and invasion ability of the cells whose expressions of E-cadherin,N-cadherin,Vimentin,MMP9,MMP2 and pathway proteins PTEN,PI3K,Akt and mTOR were detected by Western blot.RESULTS Compared with the blank group,the induction group displayed a cell morphological change from epithelioid to stromal,decreased expression of E-cadherin protein(P＜0.01);and increased protein expressions of N-cadherin and Vimentin(P＜0.05).Compared with the model group,each group intervened with the medicine displayed decreased proliferation,clone formation,migration and invasion ability of both kinds of cells(P＜0.01);increased protein expressions of PTEN and E-cadherin(P＜0.05,P＜0.01);and decreased protein expressions of PI3K,Akt,mTOR,N-cadherin,Vimentin,MMP9 and MMP2(P＜0.05,P＜0.01);and more significantly in the Shuyu Pills combined with evolimus group(P＜0.05,P＜0.01).CONCLUSION With a more ideal effect than the single uses in inhibiting the TGF-β1-induced epithelial mesenchymal transformation of triple-negative breast cancer cells,the combination use of Shuyu Pills and everolimus may work through the regulation of PI3K/Akt/mTOR signaling pathway.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Aim To explore the compatibility and po-tential mechanism of effective components of Biejia-Ezhu against triple negative breast cancer(TNBC)and verify it by experiments.Methods Effective compo-nents and targets of Biejia-Ezhu were obtained by TC-MSP and Swiss Target Prediction.Disease targets of TNBC were obtained from OMMI and GeneCards data-bases.The PPI network was constructed using STRING database.GO and KEGG path enrichment analysis was performed using DAVID database.Cytoscape3.9.1 software was used to construct the"drug-component-target-disease"network,screen key targets and compo-nents for molecular docking,and further verify the com-patibility of key components and targets in vitro.Re-sults ① A total of 71 effective components were iden-tified in the Biejia-Ezhu drug pair.There were 146 drug targets associated with the disease.A total of 113 signaling pathways were identified by KEGG analysis.The 71 potential active components of Biejia-Ezhu mainly acted on key targets such as mTORC1,ULK1,TNF,EGFR,ESR1,STAT3,HIF1A,and PTGS2.Mo-lecular docking results showed that glycine and curcu-min were the key active components of Biejia-Ezhu,and both had strong docking activity against key target proteins mTORC1 and ULK1.②The results of in vitro experiment showed that glycine combined with curcu-min significantly inhibited the proliferation and clonal formation ability of TNBC cells(P＜0.05),up-regula-ted the expression of autophagy marker LC3 Ⅱ/Ⅰ,down-regulated the expression of EGFR,down-regula-ted the expression of pathway protein mTORC1,p-mTOR,p-ULK1,and promoted the expression of path-way protein ULK1(P＜0.05).Conclusion The key component of Biejia-Ezhu against triple-negative breast cancer is glycine-curcumin,the mechanism of which may be related to the regulation of the mTORC1/ULK1 signaling pathway to promote autophagy.

AIM To investigate the effects of Shuyu Pills combined with evolimus on the epithelial mesenchymal transformation of triple negative breast cancer cells 4T1 and MDA-MB-231 induced by TGF-β1.METHODS The 4T1 and MDA-MB-231 cells were divided into the blank group and the induction group to induce the epithelial mesenchymal transformation with TGF-β1 cytokine treatment,followed by the assignment into the model group,the Shuyu Pills group,the everolimus group and the Shuyu Pills combined with everolimus group.CCK8 method,plate cloning method,cell scratch test and Transewll test were used to detect the proliferation,cloning formation,migration and invasion ability of the cells whose expressions of E-cadherin,N-cadherin,Vimentin,MMP9,MMP2 and pathway proteins PTEN,PI3K,Akt and mTOR were detected by Western blot.RESULTS Compared with the blank group,the induction group displayed a cell morphological change from epithelioid to stromal,decreased expression of E-cadherin protein(P＜0.01);and increased protein expressions of N-cadherin and Vimentin(P＜0.05).Compared with the model group,each group intervened with the medicine displayed decreased proliferation,clone formation,migration and invasion ability of both kinds of cells(P＜0.01);increased protein expressions of PTEN and E-cadherin(P＜0.05,P＜0.01);and decreased protein expressions of PI3K,Akt,mTOR,N-cadherin,Vimentin,MMP9 and MMP2(P＜0.05,P＜0.01);and more significantly in the Shuyu Pills combined with evolimus group(P＜0.05,P＜0.01).CONCLUSION With a more ideal effect than the single uses in inhibiting the TGF-β1-induced epithelial mesenchymal transformation of triple-negative breast cancer cells,the combination use of Shuyu Pills and everolimus may work through the regulation of PI3K/Akt/mTOR signaling pathway.

Objective:To construct a predictive model for benign and malignant colorectal lesions based on modal ultrasound parameters and clinical indicators,and evaluate the effectiveness of the predictive model.Methods:Clinical data of 198 patients with colorectal lesions treated in Hebei Petro China Central Hospital from March 2020 to March 2024 were recorded.According to pathological diagnosis,they were grouped into a benign lesion group of 102 cases and a malignant lesion group of 96 cases.All patients underwent multimodal ultrasound examination.Multivariate Logistic re-gression analysis was applied to screen the influencing factors of colorectal cancer progression.R software package was applied to build a nomogram prediction model.Hosmer-Lemeshow test,calibration curve,ROC curve,and clinical deci-sion curve were used for validation.Results:There were statistically obvious differences in internal echo,morphology,blood flow signal,rise time(RT),contrast agent of"fast in and fast out",mean Young's modulus(Emean),age,positive fecal occult blood,and polyps between the benign and malignant lesion groups(P＜0.05).Uneven internal echoes,irregu-lar shapes,abundant blood flow signals,contrast agent of"fast in and fast out",age ≥ 60 years,positive fecal occult blood,and polyps ≥ 2 were independent risk factors for colorectal cancer(P＜0.05),while RT is a protective factor for colorectal cancer(P＜0.05).The internal validation results of the nomogram prediction model showed that the Hosmer-Lemeshow test showed x2=3.661 and P=0.886.The calibration curve showed that the actual probability was basically consistent with the predicted probability,and the AUC of the ROC curve was 0.802(95％CI:0.732-0.871),indicating that the calibration and discrimination of the column chart prediction model were good.Within the high-risk threshold range of 0.28-0.98,the decision curve was above the All line and None line,indicating a high net benefit and clinical practicality.Conclusion:Internal echo,morphology,blood flow signal,contrast agent of"fast in and fast out",age,positive fecal occult blood,polyps,and RT are influencing factors for the occurrence of colorectal cancer.The column chart prediction model constructed based on this has good predictive performance and provides reference for early inter-vention by clinical physicians.

Aim To explore the compatibility and po-tential mechanism of effective components of Biejia-Ezhu against triple negative breast cancer(TNBC)and verify it by experiments.Methods Effective compo-nents and targets of Biejia-Ezhu were obtained by TC-MSP and Swiss Target Prediction.Disease targets of TNBC were obtained from OMMI and GeneCards data-bases.The PPI network was constructed using STRING database.GO and KEGG path enrichment analysis was performed using DAVID database.Cytoscape3.9.1 software was used to construct the"drug-component-target-disease"network,screen key targets and compo-nents for molecular docking,and further verify the com-patibility of key components and targets in vitro.Re-sults ① A total of 71 effective components were iden-tified in the Biejia-Ezhu drug pair.There were 146 drug targets associated with the disease.A total of 113 signaling pathways were identified by KEGG analysis.The 71 potential active components of Biejia-Ezhu mainly acted on key targets such as mTORC1,ULK1,TNF,EGFR,ESR1,STAT3,HIF1A,and PTGS2.Mo-lecular docking results showed that glycine and curcu-min were the key active components of Biejia-Ezhu,and both had strong docking activity against key target proteins mTORC1 and ULK1.②The results of in vitro experiment showed that glycine combined with curcu-min significantly inhibited the proliferation and clonal formation ability of TNBC cells(P＜0.05),up-regula-ted the expression of autophagy marker LC3 Ⅱ/Ⅰ,down-regulated the expression of EGFR,down-regula-ted the expression of pathway protein mTORC1,p-mTOR,p-ULK1,and promoted the expression of path-way protein ULK1(P＜0.05).Conclusion The key component of Biejia-Ezhu against triple-negative breast cancer is glycine-curcumin,the mechanism of which may be related to the regulation of the mTORC1/ULK1 signaling pathway to promote autophagy.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To explore the applicability of endoscopic retrograde appendicitis therapy (ERAT) and methods of aeromedical assessment of military flying personnel with appendicitis.Methods:The diagnosis, ERAT process and aeromedical assessment of 2 military flying personnel with appendicitis were analyzed while the related literature was reviewed.Results:Two military flying personnel diagnosed with appendicitis underwent ERAT after appendiceal perforation or intra-abdominal infection was ruled out. Abdominal pain was resolved within one day of ERAT while inflammatory markers were normalized within one week. Both patients returned to flight duties 1-2 weeks after the procedure. During a follow-up of over one year, both remained excellent in flight performance.Conclusions:For military flying personnel with uncomplicated appendicitis, ERAT is a safe and effective treatment. Patients can return to flight duties within 1-2 weeks of resolution of postoperative abdominal pain symptoms. Compared with traditional appendectomy, ERAT can shorten the grounding time for military flying personnel.

Objective:To explore the applicability of endoscopic retrograde appendicitis therapy (ERAT) and methods of aeromedical assessment of military flying personnel with appendicitis.Methods:The diagnosis, ERAT process and aeromedical assessment of 2 military flying personnel with appendicitis were analyzed while the related literature was reviewed.Results:Two military flying personnel diagnosed with appendicitis underwent ERAT after appendiceal perforation or intra-abdominal infection was ruled out. Abdominal pain was resolved within one day of ERAT while inflammatory markers were normalized within one week. Both patients returned to flight duties 1-2 weeks after the procedure. During a follow-up of over one year, both remained excellent in flight performance.Conclusions:For military flying personnel with uncomplicated appendicitis, ERAT is a safe and effective treatment. Patients can return to flight duties within 1-2 weeks of resolution of postoperative abdominal pain symptoms. Compared with traditional appendectomy, ERAT can shorten the grounding time for military flying personnel.

Objective:To construct a predictive model for benign and malignant colorectal lesions based on modal ultrasound parameters and clinical indicators,and evaluate the effectiveness of the predictive model.Methods:Clinical data of 198 patients with colorectal lesions treated in Hebei Petro China Central Hospital from March 2020 to March 2024 were recorded.According to pathological diagnosis,they were grouped into a benign lesion group of 102 cases and a malignant lesion group of 96 cases.All patients underwent multimodal ultrasound examination.Multivariate Logistic re-gression analysis was applied to screen the influencing factors of colorectal cancer progression.R software package was applied to build a nomogram prediction model.Hosmer-Lemeshow test,calibration curve,ROC curve,and clinical deci-sion curve were used for validation.Results:There were statistically obvious differences in internal echo,morphology,blood flow signal,rise time(RT),contrast agent of"fast in and fast out",mean Young's modulus(Emean),age,positive fecal occult blood,and polyps between the benign and malignant lesion groups(P＜0.05).Uneven internal echoes,irregu-lar shapes,abundant blood flow signals,contrast agent of"fast in and fast out",age ≥ 60 years,positive fecal occult blood,and polyps ≥ 2 were independent risk factors for colorectal cancer(P＜0.05),while RT is a protective factor for colorectal cancer(P＜0.05).The internal validation results of the nomogram prediction model showed that the Hosmer-Lemeshow test showed x2=3.661 and P=0.886.The calibration curve showed that the actual probability was basically consistent with the predicted probability,and the AUC of the ROC curve was 0.802(95％CI:0.732-0.871),indicating that the calibration and discrimination of the column chart prediction model were good.Within the high-risk threshold range of 0.28-0.98,the decision curve was above the All line and None line,indicating a high net benefit and clinical practicality.Conclusion:Internal echo,morphology,blood flow signal,contrast agent of"fast in and fast out",age,positive fecal occult blood,polyps,and RT are influencing factors for the occurrence of colorectal cancer.The column chart prediction model constructed based on this has good predictive performance and provides reference for early inter-vention by clinical physicians.