Methods: Patients with Lenke 1 AIS undergoing posterior spinal fusion were included. Standing and fulcrum bending radiographs on the coronal and sagittal planes were analyzed at preoperative, immediate, and 2-year postoperative periods. The primary outcome was postoperative hypokyphosis (T5–12 thoracic kyphosis [TK] <20°). Risk factors for postoperative hypokyphosis were identified by multivariate logistic regression, and the optimal cutoff for significant risk factors was determined by receiver operating characteristic analysis. Results: In total, 156 patients were included in the analysis, of which 68 (43.6%) were hypokyphotic at 2-year follow-up. Low T5–12 TK on lateral view fulcrum bending films (immediate postoperative odds ratio [OR], 0.870; 95% confidence interval [CI], 0.826–0.917; 2-year postoperative OR, 0.916; 95% CI, 0.876–0.959; p<0.001) and high convex side implant density (2-year postoperative OR, 1.749; 95% CI, 1.056–2.897; p=0.03) were significant risk factors for postoperative hypokyphosis. Other baseline demographic and surgical factors did not affect postoperative kyphosis correction. The T5–12 TK cutoff on fulcrum bending for 2-year postoperative hypokyphosis was 12.45° (area under the curve, 0.773; 95% CI, 0.661–0.820). Conclusions Fulcrum bending radiography is useful in assessing coronal and sagittal flexibility for preoperative planning. In patients with T5–12 kyphosis <12.5° on lateral view fulcrum bending radiographs, Ponte osteotomies or releases, or a decrease in convex side implant density should be considered to improve kyphosis restoration and reduce the risk of 2-year postoperative hypokyphosis.

Objective:To explore whether perioperative oral probiotic therapy reduces infectious complications following pancreaticoduodenectomy (PD), aiming to obtain higher-level evidence for clinical practice.Methods:A total of 81 participants undergoing PD at the Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital & Affiliated Hospital of Medical School, Nanjing University, from May 2024 to December 2024 were enrolled in this single-center, prospective, randomized controlled trial. The participants were randomly divided into a probiotic treatment group and a control group (receiving conventional treatment without probiotics) using a random number method. The primary outcomes included the incidence of postoperative infectious complications and intra-abdominal infection, and the secondary outcomes were the recovery of gastrointestinal function, postoperative hospital stay, and duration and costs of antibiotic use. The hematological indicators including inflammation and immune markers on postoperative days (POD) 1, 3, 5, and 7 were also compared between these two groups.Results:Finally 72 cases (39 males and 33 females) were analyzed, with 36 patients in the probiotic treatment group and 36 patients in the control group. Compared to the control group, the probiotic treatment group showed statistically significant reductions in the incidence of infectious complications (33.3% vs. 66.7%, P=0.029), intra-abdominal infection (27.8% vs. 58.3%, P=0.030), and incidence of delayed gastric emptying (0 vs. 16.7%, P=0.033). Also, the probiotic treatment group exhibited significantly faster recovery in postoperative bowel movements and shorter time to defecation, liquid diet, and semi-liquid diet (all P<0.05). Additionally, the probiotic treatment group had significantly shorter hospital stay, reduced duration of antibiotic use, and lower antibiotic costs (all P<0.05). Finally, the probiotic treatment group had significantly higher lymphocyte counts on POD 1 ( P<0.05) and showed a significant downward trend in inflammatory markers such as interleukin-6 on PODs 3 and 5 and C-reactive protein on POD 7 (all P<0.05). Conclusions:Perioperative application of probiotic preparations in PD may reduce the incidence of postoperative infectious complications, especially intra-abdominal infection. Additionally, it can prevent delayed gastric emptying, promote the recovery of postoperative gastrointestinal function, shorten hospital stay, and reduce the use of antibiotics. These benefits may be related to the improvement of postoperative inflammatory status.

OBJECTIVE: To estimate the primary electron beam parameters (PEB), including energy, radial intensity distribution and average angular divergence, of the individual linear accelerator using the Monte Carlo method. METHODS: A model of the treatment head and a standard field were built by BEAMnrc, and the dose distribution was simulated in water phantoms by DOSXYZnrc to obtain the percentage depth dose curve and off-axis ratio. By debugging the parameters mentioned above until the simulation and measurement results could match. RESULTS: The simulation and measurement results could achieve the best match when the parameters mentioned above were 6.25 MeV, 0.95 mm and 0.1° respectively. CONCLUSION The PEB of a linear accelerator could have a significant impact on the output beam characteristics. Monte Carlo estimation is one of the most crucial steps in establishing an individual linear accelerator model.
Monte Carlo Method ; Particle Accelerators ; Electrons ; Radiotherapy Dosage ; Phantoms, Imaging

In recent decades, the prevalence of hyperuricemia and gout has increased dramatically due to lifestyle changes. The drugs currently recommended for hyperuricemia are associated with adverse reactions that limit their clinical use. In this study, we report that berberine (BBR) is an effective drug candidate for the treatment of hyperuricemia, with its mechanism potentially involving the modulation of gut microbiota and its metabolite, succinic acid. BBR has demonstrated good therapeutic effects in both acute and chronic animal models of hyperuricemia. In a clinical trial, oral administration of BBR for 6 months reduced blood uric acid levels in 22 participants by modulating the gut microbiota, which led to an increase in the abundance of Bacteroides and a decrease in Clostridium sensu stricto_1. Furthermore, Bacteroides fragilis was transplanted into ICR mice, and the results showed that Bacteroides fragilis exerted a therapeutic effect on uric acid similar to that of BBR. Notably, succinic acid, a metabolite of Bacteroides, significantly reduced uric acid levels. Subsequent cell and animal experiments revealed that the intestinal metabolite, succinic acid, regulated the upstream uric acid synthesis pathway in the liver by inhibiting adenosine monophosphate deaminase 2 (AMPD2), an enzyme responsible for converting adenosine monophosphate (AMP) to inosine monophosphate (IMP). This inhibition resulted in a decrease in IMP levels and an increase in phosphate levels. The reduction in IMP led to a decreased downstream production of hypoxanthine, xanthine, and uric acid. BBR also demonstrated excellent renoprotective effects, improving nephropathy associated with hyperuricemia. In summary, BBR has the potential to be an effective treatment for hyperuricemia through the gut-liver axis.

Methods: Patients with Lenke 1 AIS undergoing posterior spinal fusion were included. Standing and fulcrum bending radiographs on the coronal and sagittal planes were analyzed at preoperative, immediate, and 2-year postoperative periods. The primary outcome was postoperative hypokyphosis (T5–12 thoracic kyphosis [TK] <20°). Risk factors for postoperative hypokyphosis were identified by multivariate logistic regression, and the optimal cutoff for significant risk factors was determined by receiver operating characteristic analysis. Results: In total, 156 patients were included in the analysis, of which 68 (43.6%) were hypokyphotic at 2-year follow-up. Low T5–12 TK on lateral view fulcrum bending films (immediate postoperative odds ratio [OR], 0.870; 95% confidence interval [CI], 0.826–0.917; 2-year postoperative OR, 0.916; 95% CI, 0.876–0.959; p<0.001) and high convex side implant density (2-year postoperative OR, 1.749; 95% CI, 1.056–2.897; p=0.03) were significant risk factors for postoperative hypokyphosis. Other baseline demographic and surgical factors did not affect postoperative kyphosis correction. The T5–12 TK cutoff on fulcrum bending for 2-year postoperative hypokyphosis was 12.45° (area under the curve, 0.773; 95% CI, 0.661–0.820). Conclusions Fulcrum bending radiography is useful in assessing coronal and sagittal flexibility for preoperative planning. In patients with T5–12 kyphosis <12.5° on lateral view fulcrum bending radiographs, Ponte osteotomies or releases, or a decrease in convex side implant density should be considered to improve kyphosis restoration and reduce the risk of 2-year postoperative hypokyphosis.

Tigecycline(TGC)is a recently developed broad-spectrum and highly effective glycylcy-cline antibiotic that overcomes traditional tetracycline resistance mechanisms.It is widely used in the treatment of complex skin and intra-abdominal infections.However,the emergence of TGC re-sistance in recent years poses a significant challenge,and its underlying resistance mechanisms re-main incompletely understood,warranting further investigation.This study induced TGC resistance in Klebsiella aerogenes(ATCC-43864)under in vitro conditions and evaluated phenotypic chan-ges,including growth curves,motility,multidrug susceptibility,and ultrastructural alterations,be-fore and after induction.Whole-genome sequencing(WGS)and transcriptome sequencing(RNA-seq)were employed to analyze resistance-related genetic changes,which were further validated.Ef-flux pump inhibition assays and Red homologous recombination were used to investigate the roles of efflux pumps,lon deletion,and rpsM mutation in TGC resistance.A stable resistant strain,CF-T-32,was obtained,with a 32-fold increase in TGC minimum inhibitory concentration(MIC).CF-T-32 exhibited an enlarged periplasmic space between the cell wall and membrane,reduced growth and motility,and no significant changes in susceptibility to 28 antimicrobial agents,including doxy-cycline,gentamicin,and ciprofloxacin.Genomic analysis revealed no significant differences in ge-nome composition or interference from exogenous plasmids between the parental and induced strains.However,two missense mutations were identified in rpsM and lon.Transcriptomic analysis and qPCR validation showed significant upregulation of efflux pump genes(acrA and acrB)in the AcrAB-TolC system and downregulation of ribosomal protein genes(rpsM,rpsJ,and rpsC).Ef-flux pump inhibition and Red homologous recombination experiments demonstrated that the rpsM C287T missense mutation,leading to a Pro96Leu substitution and reduced expression,is likely the primary factor contributing to TGC resistance in the induced strain.

Objective:To analyze the association of apolipoprotein E(ApoE),soluble semaphoring 4D(sSema4D),and cyclophilin A(CypA)levels with unfavorable outcome in patients with chronic heart failure(CHF).Methods:We retrospectively enrolled 108 patients with CHF admitted in the Fifth Affiliated Hospital of Zhengzhou Universi-ty between March 2019 and March 2022.According to the outcome during 6-month follow-up,patients were di-vided into favorable outcome group(n=71)and unfavorable outcome group(n=37).ApoE,sSema4D and CypA levels were compared between the two groups,and multivariate Logistic regression was employed to identify the risk factors of unfavorable outcome within 6-month follow-up in CHF patients.Results:Compared to patients in the favorable outcome group,those in the unfavorable outcome group had significant higher proportion of NYHA classⅣ(59.46％vs.25.35％),serum creatinine[(80.74±3.89)μmol/L vs.(71.36±3.63)μmol/L],ApoE[(69.87±4.25)mg/L vs.(47.36±3.17)mg/L],sSema4D[(916.62±7.32)ng/L vs.(426.42±6.25)ng/L]and CypA[(6.74±1.32)ng/L vs.(4.38±0.72)ng/L](P＜0.001 all).Multivariate Logistic regression indicated that NY-HA class Ⅳ(OR=2.782,95％CI 1.166～6.636),serum creatinine(OR=29.893,95％CI 6.782～131.768),ApoE(OR=12.046,95％CI 4.694～30.913),sSema4D(OR=8.390,95％CI 2.260～31.146)and CypA(OR=6.486,95％CI 1.780～23.635)were independent risk factors for unfavorable outcome within 6-month follow-up in CHF patients(P＜0.05 or＜0.01).Conclusion:The levels of ApoE,sSema4D and CypA were closely associated with short-term unfavorable outcome in patients with chronic heart failure.

Premature ovarian insufficiency(POI)is a disease that seriously affects the health and life of women,which is also one of the main causes of female infertility.The incidence of POI is increasing in recent years.The diagnostic criteria of POI are not uniform,and different diagnostic criteria have inconsistent thresholds for various indicators.Strict diagnostic criteria are more conducive to early detection and treatment of POI.At present,complementary and alternative therapies such as traditional Chinese medicine,acupuncture and moxibustion are widely used in the treatment of POI.This article reviewed the recent studies on the complementary and alternative therapy of traditional Chinese medicine in the treatment of POI,and finds that the dialectical treatment of traditional Chinese medicine is based on the perspective of traditional Chinese medicine theory and puts forward corresponding treatment plans for different dialectical types.For example,treatment from the kidney,tonifying kidney filling essence,regulating chongren;Treatment from the liver,soothing the liver,regulating qi,nourishing blood and softening the liver;Treatment from the heart and spleen,nourishing Yangming,tonifying the spleen and nourishing the heart.In terms of acupuncture treatment,regulating menstruation and promoting pregnancy and regulating the conception vessel and toning the governor vessel and toning the kidney are often used to treat POI.In addition,moxibustion regulates body function by stimulating the bladder meridian and conception vessel and governor vessel acupoints.Other methods,such as ear acupoint bean-pressing,acupoint thread-embedding and acupoint injection,have also shown potential in the treatment of POI.This article summarizes the role and characteristics of traditional Chinese medicine in the treatment of POI,in order to provide ideas and basis for clinical treatment of POI.

OBJECTIVE To observe the effect of acupuncture combined with a modified Zhengan Xifeng Decoction on the early clinical symptoms and oxidative stress status of patients with hypertensive intracerebral hemorrhage(HICH)of liver-kidney yin defi-ciency syndrome.METHODS A total of 60 patients with hypertensive intracerebral hemorrhage(liver-kidney yin deficiency syn-drome)who successfully received 24-hour acute-phase treatment at the Department of Neurosurgery,Acupuncture and Rehabilitation Department,and wards of Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine(Kunshan Traditional Chinese Medi-cine Hospital)from July 2021 to January 2023 were recruited.A randomization table generated by SPSS 22.0 software was used to di-vide the patients into a control group and an observation group,with 30 patients in each group.The control group received symptomatic treatment,conventional rehabilitation training,and modified Zhengan Xifeng Decoction,while the observation group received additional acupuncture treatment on the basis of the control group.The treatment course was 1 month for both groups.Clinical effective rate,TCM syndrome scores,motor and neurological function scores[Activity of Daily Living(ADL)scale,National Institutes of Health Stroke Scale(NIHSS),Modified Ashworth Scale(MAS),Simplified Fugl-Meyer Assessment(FMA)scale],improvement in hematoma lesions,Fraction anisotropy(FA)ratio(rFA),and serum levels of antioxidant stress response factors Kelch-like ECH-associated protein 1(Keap1)and nuclear factor-E2-related factor 2(Nrf2)were observed before and after treatment in both groups.RESULTS After treat-ment,the clinical effective rate in the observation group was significantly higher than that in the control group(P<0.05);the TCM syn-drome scores in both groups decreased significantly(P<0.05),with the observation group showing better results than the control group(P<0.05);the ADL and FMA scores in both groups reduced significantly(P<0.05,P<0.01),while the NIHSS and Ashworth Scale scores increased significantly(P<0.05,P<0.01),with the observation group showing better improvement than the control group(P<0.05);serum Keap1 levels decreased significantly in both groups(P<0.01),while Nrf2 levels enhanced significantly(P<0.05,P<0.01),with the observation group showing better improvement than the control group(P<0.05);imaging studies showed that after treat-ment,the residual hematoma volume decreased significantly in both groups(P<0.05,P<0.01),and the rFA value increased signifi-cantly(P<0.05,P<0.01),with the observation group showing better results than the control group(P<0.01).CONCLUSION On the basis of standard treatment for the acute phase,acupuncture combined with Zhengan Xifeng Decoction can significantly improve the early clinical symptoms of HICH patients with liver-kidney yin deficiency,reduce oxidative stress levels,and promote the recovery of nerve and motor functions.

Objective:To investigate the application effect of entrustable professional activities (EPAs) in competency evaluation of dermatology residents, to practice the goal of hierarchical progressive training for EPAs competency in dermatology residents, and to improve the competency of physicians.Methods:A questionnaire survey was conducted among 8 clinical instructors and 165 residents who received standardized residency training in Department of Dermatology, The First Affiliated Hospital of Jinzhou Medical University, from September 2019 to September 2022, and self-assessment and trainer-assessment were performed based on EPAs. The Kruskal-Wallis H test and the Mann-Whitney U test were used for comparison of entrustable level between the dermatology residents of different grades. Results:The scores of both trainer-assessment and self-assessment based on EPAs increased with the increase in the grade of the resident physicians, and the resident physicians of the third year (the PGY3 group) had the highest levels of trainer-assessment and self-assessment based on EPAs. The resident physicians of all grades showed relatively low assessment scores of EPA4 (making a medical decision), EPA8 (recognize a patient requiring urgent or emergent care and initiate evaluation and management), EPA14 (clinical teaching), and EPA15 (public health events management). There were significant differences in all EPAs items of trainer-assessment and self-assessment between the residents of different grades (Kruskal-Wallis test, P<0.05). There was a significant difference in trainer-assessment between PGY1 and PGY2 and between PGY1 and PGY3 (Bonferroni P correction, P<0.05), while there was no significant difference between the PGY2 and PGY3 groups ( P>0.05). Conclusions:There are differences in the evaluation of EPAs in dermatology residents of different grades, and hierarchical progressive training of EPAs competency can effectively improve the clinical competency of dermatology residents. Given the inconsistency between the scores of self-assessment and trainer-assessment, it is necessary to improve the feedback plan in the future.