Objective To analyze the practical value of spiral CT three-dimensional reconstruction techniquein evaluating triplane fractures of the distal tibia.Methods A retrospective analysis was conducted on183 patients with triplane fractures of the distal tibia admitted to Sichuan Orthopedic Hospital from January 2021 to March 2023.All patients underwent both X-ray and spiral CT examinations.Taking surgical reduction results as the gold standard for diagnosis,the diagnostic accuracies of X-ray examination and spiral CT three-dimensional reconstruction technique for triplane fractures of the distal tibia were analyzed.Results Fracture classification according to the number of fracture fragments showed that among the 183 patients with triplane fractures of the distal tibial,there were 44 cases of four-part fractures,62 cases of three-part fractures,and 77 cases of two-part fractures.The classification by the location of epiphyseal injury in the distal tibia showed 175 cases of lateral type and 8 cases of medial type.According to whether the fracture line involved the articular surface,they were categorized into 94 cases of type I,60 cases of type II,and 29 cases of type III.For the classification of the number of fracture fragments,X-ray misdiagnosed 9 cases of four-part fractures as three-part or two-part fractures,and 21 cases of three-part fractures as two-part fractures,resulting in a diagnostic accuracy of 83.60%.For theclassification of fracture line and articular surface position,X-ray led to misdiagnosis or inaccurate diagnosis in 39 cases,with a diagnostic accuracy of 78.69%.When spiral CT three-dimensional reconstruction technique was used to classify the number of fracture fragments,only 1 case of four-part fracture was misdiagnosed as three-part fracture,and 2 cases of three-part fractures were misdiagnosed as four-part fractures or two-part fractures,yielding a diagnostic accuracy of 98.36%.For the diagnosis of the positional relationship of the fracture line to the articular surface,spiral CT three-dimensional reconstruction technique had 8 misdiagnoses,with a corresponding diagnostic accuracy of 95.63%.Conclusion Spiral CT three-dimensional reconstruction technique can stereoscopically display the spatial information of the triplane fractures of the distal tibia,such as the location,shape,type,and articular surface,exhibiting high accuracy for classification diagnosis and significant application value in the reduction and treatment of triplane fractures of the distal tibia.

Objective:To establish a method for determination of fluoride in water using a fully automated biochemical analyzer (abbreviated as this method).Methods:Based on the parameters of the fully automatic biochemical analyzer, appropriate reagent volumes and reaction time were optimized to determine fluoride ions in water within the standard curve range (0.0 - 2.0 mg/L). The method was validated through evaluation of linear range, detection limit, precision, accuracy, and comparative analysis with the manual measurement results of fluoride reagent spectrophotometric method specified in the "Standard Examination Methods for Drinking Water - Part 5: Inorganic Nonmetallic indices" (GB/T 5750.5-2023).Results:Within the range of 0.0 - 2.0 mg/L fluoride mass concentration, the absolute values of the correlation coefficients were > 0.999 0 and the detection limit of this method was 0.082 mg/L. The relative standard deviation for the determination of fluoride level in water samples with low, medium and high fluoride mass concentrations was 4.03%, 2.16% and 1.68%, respectively. The spiked recovery rates were 98.1%, 99.5%, and 100.2%, respectively. There was no statistically significant difference between the results obtained by this method and manual measurement ( t = 1.07, P = 0.295). Conclusion:This method exhibits high sensitivity, accuracy, and efficiency in detecting fluoride, enabling rapid sample detection through instrumental automation instead of manual operation.

Objective:To identify the risk factors influencing the prognosis of patients with advanced breast cancer through LASSO-Logistic regression analysis and construct a nomogram model to evaluate their prognostic risk.Methods:A total of 178 patients with advanced breast cancer who visited the Department of Thyroid and Breast Surgery of Chengyang District People’s Hospital of Qingdao City from Jan. 2015 to Jan. 2023 were selected as the research subjects. According to the follow-up results, the patients were divided into a good-prognosis group and a poor-prognosis group. Clinical data of the patients were collected. LASSO-Logistic regression analysis was used to identify the risk factors affecting the prognosis of patients with advanced breast cancer. A nomogram model was constructed based on the analysis results. The predictive efficacy of the model for the prognostic risk of patients with advanced breast cancer was evaluated using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (H-L) test.Results:During the follow-up, 5 patients were lost to follow-up. Among the final 173 patients included, 60 had poor prognoses (accounting for 34.68%), and 113 had good prognoses (accounting for 65.32%). There were significant differences between the poor prognosis group and the good prognosis group in terms of the number of lymph node metastases ( χ 2=18.12), the number of organ metastases ( χ 2=14.28), the difference in ADC before and after treatment ( t=17.35), the difference in SER before and after treatment ( t=9.57), the enhancement of the echo behind the breast after treatment ( χ 2=13.00), and the proportion of increased calcification ( χ 2=8.06) (both P < 0.05). The clinical data with significant differences in the univariate analysis were included in the LASSO regression analysis. Six factors were finally selected: number of lymph node metastases > 5, number of organ metastases > 1, difference in ADC values before and after treatment, difference in SER values before and after treatment, enhanced echo behind the breast, and increased calcification. These six factors selected by LASSO regression were included in the Logistic regression analysis. The results showed that number of organ metastases > 1 ( OR=2.208, 95% CI: 1.153-3.263), small difference in ADC values before and after treatment ( OR=0.448, 95% CI: 0.287-0.608), enhanced echo behind the breast ( OR=2.474, 95% CI: 1.063-3.886), and increased calcification ( OR=3.762, 95% CI: 1.831-5.693) were independent risk factors for poor prognosis in patients with advanced breast cancer (both P<0.05). A nomogram model was constructed based on the analysis results. The ROC curve showed that the area under the curve (AUC) of the model was 0.778. The H-L test results showed that the calibration curve fit well with the ideal curve, with χ 2 = 0.69 and P = 0.273. Conclusion:The nomogram model constructed based on LASSO-Logistic regression analysis has good predictive efficacy for the prognosis of patients with advanced breast cancer.

Objective:To analyze the results of national external quality assessment (EQA) for transfusion compatibility test in 2023, and provide reference for quality management of clinical transfusion compatibility testing.Methods:The EQA of clinical transfusion compatibility testing by NCCL was performed 3 times in 2023 among included laboratories. The panel consisting of 22 samples was distributed to 4 186 laboratories across 31 provinces (Including 2 961 tertiary hospital laboratories, 1 085 secondary hospital laboratories, 23 primary hospital laboratories, 106 blood station laboratories and 11 independent clinical laboratories). Each panel contains 11 red blood cell and 11 plasma samples per 1.5 ml/tube. Each participant laboratory of the EQA program was required to carry out the detection and return results in expected time. Statistical analysis and evaluation on the reported results were conducted by NCCL from the aspects of regional distribution, laboratory grading, testing methodology, reagent and testing system usage.Results:The qualification rates of EQA for five items including ABO positive typing, ABO reverse typing, RhD blood type, antibody screening, and cross matching were 96.68%, 95.10%, 96.46%, 95.32%, and 91.04%, respectively. The EQA qualification rate of tertiary hospital laboratories was 87.77% (2 599/2 961), which was significantly higher than the 77.79% (844/1 085) of secondary hospital laboratories. There were significant differences in the qualification rate of participating laboratories among different regions. The utilization rates of micro column agglutination method in ABO positive typing, ABO reverse typing, RhD blood type, antibody screening, and cross matching were 80.81% (10 080/12 474), 75.06% (9 337/12 440), 81.38% (10 118/12 433), 89.59% (11 104/12 394) and 76.25% (9 495/12 453), respectively. The qualification rate of micro column agglutination method was significantly higher than that of saline slide method in ABO positive typing detection ( P<0.05). The qualification rate of micro column agglutination method was significantly higher than that of the polyamine method and anti-human globulin test tube method in antibody screening ( P<0.05). There were statistically significant differences in qualification rate of 7 reagents in ABO reverse typing, antibody screening and cross matching ( P<0.05). There was no statistically significant difference in the qualification rate between the two detection systems for other reagents, except for the ABO reverse typing where the qualification rate of reagent 1 in a single system was higher than that in a mixed system ( P<0.05). Conclusion:The testing capabilities of clinical laboratories in different regions and different type varied significantly in China. Micro column agglutination method was the most popular selection in transfusion compatibility testing. The regents used in these laboratories showed good performance. However, the detection efficiency of some reagents still need to be improved. EQA could be used to evaluate, monitor, and improve the quality of testing.

Objective:To construct a biosafety evaluation index system for major emergency public health events in medical institutions.Methods:Based on previous laboratory biosafety evaluation work, relevant regulations and standards on biosafety in China were collected through literature research and expert consultations. Candidate indicators for constructing the biosafety evaluation system for major emergency public health events in medical institutions were selected, and a framework was established. Two rounds of expert questionnaires were conducted to determine the content of the index system based on experts′ evaluation, and each indicator′s relevance and importance were scored. Finally, two rounds of Delphi consultations were carried out, and the Analytic Hierarchy Process (AHP) was applied to calculate the weights of indicators.Results:The response rates for the total four rounds of questionnaire surveys were all 100%. The first two rounds focused on determining the framework, while the latter two focused on determining the weights for each indicator. The authority coefficients of the expert consultations for the two rounds of weights were 0.65 and 0.70, respectively, indicating the reliability of the research results. In the final round of survey, the Kendall′s coefficients of concordance at each level were all greater than 0.1. Through statistical testing, the P-values were all less than 0.05, indicating good coordination of expert opinions. Ultimately, we established an operational biosafety evaluation system for major emergency public health events in medical institutions, consisting of 4 primary indicators, 26 secondary indicators, and 119 tertiary indicators, with additional deduction items, bonus items, unacceptable items, and monitoring indicators.Conclusions:Based on scientific theory, a biosafety evaluation system for major emergency public health events in medical institutions was constructed, achieving the integration of routine and emergency measures. This system can be used for self-assessment of laboratory biosafety during emergency public health events, addressing the lack of unified standards in biosafety evaluation. Through regular self-assessment, it can enhance the level of biosafety management in medical institution laboratories, to realize the value of application and dissemination.

OBJECTIVE To analyze the chemical constituents of Heihuang Chizhu Granules and the blood composition of rats af-ter administration by UPLC-Q-TOF-MS/MS.METHODS A Waters ACQUITY UPLC HSS T3 column(3 mm×100 mm,1.8 μm)was eluted with acetonitrile-0.1%formic acid as mobile phase,and the data were collected in electrospray ion source positive and neg-ative ion mode and then identified with the reference retention time,precise molecular weight,secondary fragment ions,and references to relevant literature.RESULTS A total of 104 chemical components were identified from Heihuang Chizhu Granules,including 26 flavonoids,24 organic acids,14 triterpenoids,8 terpenoids,7 phenylpropanoids,11 monoglycosides,and 14 other components(phe-nols,alkaloids,etc.).On this basis,39 blood-entering components were identified in the plasma of rats administered via gavage,in-cluding 28 prototypes and 11 metabolites.CONCLUSION The chemical constituents of Heihuang Chizhu Granules and the compo-nents entering the blood of rats are analyzed and identified for the first time in this study,and the results provide a scientific basis for the basic research of Heihuang Chizhu Granules and the establishment of process quality control standards.

[Objective]To explore the effects of astragalin(AST)on autophagy and apoptosis of astrocytes in the L4-5 dorsal horn of the spinal cord in mice with inflammatory pain induced by complete Freund's adjuvant(CFA).[Methods]Twenty-four male C57BL/6 mice,aged six months,were randomly assigned to four groups:control group,saline group,CFA model group,and CFA+AST group,six mice in each group.The inflammatory pain model was established by injection of 10 μL CFA into the right lateral malleolus fossa.The saline group were injected with an equal amount of normal saline at the same site.The inflammatory pain mice in CFA+AST group were further treated with AST(60 mg/kg)intraperitoneally once a day for 21 consecutive days.Multiplex immunofluorescence staining was used to detect the coexpression of autophagy-related factors including ATG 12 and Beclin-1,apoptosis-related factors including Cleaved-Caspase3 and Caspase9,and the astrocyte marker such as GFAP in the L4-5 spinal dorsal horn of the mice in each group.Western blot was used to examine the protein expression levels of autophagy-related proteins(ATG12,Beclin-1)and apoptosis-related proteins(Caspase 3,Caspase 9)in the L4-5 spinal dorsal horn of mice.[Results]Immunofluorescent staining showed that in the L4-5 dorsal horn of the spinal cord,the fluorescence intensity of ATG12(P<0.000 1)and Beclin-1(P<0.000 1)was significantly increased,while that of Cleaved-Caspase 3(P<0.001)and Caspase 9(P<0.000 1)was decreased in the CFA+AST group when compared to the CFA model group.Furthermore,AST could inhibit the activation of astrocytes.Western blot further confirmed that AST significantly upregulated the expression of ATG12(P<0.000 1)and Beclin-1(P<0.000 1)in the L4-5 spinal cord of CFA mice,and downregulated the expression of Caspase 3(P<0.01)and Caspase 9(P<0.001).[Conclusions]AST promotes autophagy of astrocytes and inhibits their apoptosis in the L4-5 spinal dorsal horn of CFA mice.

Objective:To observe the effect of Liuzijue on post-stroke fatigue patients with the type of Qi deficiency and blood stasis and the effect of pulmonary function.Method:From March 2022 to March 2023,a total of 68 post-stroke fatigue patients with Qi deficiency and blood stasis who were hospitalized in the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine and met the criteria were selected,the patients were divided into therapy group(n=34)and control group(n=34)according to random number table.The control group was treated with conventional reha-bilitation combined with conventional respiratory therapy,the therapy group was treated with conventional reha-bilitation combined with Liuzijue,30 minutes/time,5 times/week,a total of 12 weeks.The fatigue severity scale score(FSS),Qi Deficiency Syndrome and Blood Stasis factor diagnostic scale score,vital capacity(VC),forced vital capacity(FVC),peak expiratory flow(PEF),and maximal voluntary ventilation(MVV)were assessed in both groups before and after treatment.Result:After 12 weeks of treatment,the FSS scores and the Qi deficiency syndrome and blood stasis factor di-agnostic scale score exhibited significant differences in the therapy group compared with those before treatment(P＜0.05),and significant improvement compared with those in the control group(P＜0.05).The significant differ-ences were found in the VC、FVC、PEF and MVV of both two groups between before and after treatment(P＜0.05),and the degree of improvement was more pronounced in the therapy group.Conclusion:The Liuzijue applied to post-stroke fatigue patients with Qi deficiency and blood stasis can better improve the fatigue score and Qi deficiency syndrome and blood stasis score,as well as improve the level of pulmonary function of patients,which is worthy of clinical application.

Purpose To investigate the clinicopathological features,differential diagnosis and prognosis of atypical fibroxanthoma(AFX).Methods Pathological features of 15 cases of AFX and 3 cases of pleomorphic dermal sarcoma(PDS)misdiagnosed as AFX were retrospectively analyzed by hematoxylin and eosin staining and immunohistochemical EnVision staining technology.Clinical information was collected and analyzed,and the relevant literatures were re-viewed.Results The age of the 15 patients with AFX ranged from 18 to 78 years,with an average age of 57 years.4 cases occurred in the head and neck,and 11 cases occurred in the trunk and limbs.3 patients with PDS misdiagnosed as AFX were aged from 56 to 60 years,with an average age of 58 years.The tumors were located in the trunk and limbs.Microscopically,15 cases of AFX and 3 cases of PDS misdiagnosed as AFX were composed of proliferative pleo-morphic and atypical spindle cells interspersed with a varying number of multinucleated cells.15 cases of AFX tumors were superficial and located in the dermis.In 3 cases of PDS misdiagnosed as AFX,1 case was located in subcutane-ous adipose tissue,1 case had superficial subcutaneous extension,and the third case had positive basal margin.Immu-nohistochemically,the immunophenotypes of the two groups were consistent.CD10 was expressed in all cases,CD68 was positive in most cases,SMA was expressed in a few cases,desmin was focal expressed in a very few cases,and S-100,SOX10,CD34,HMB-45,Melan A,STAT6 and CK(AE1/AE3)were not expressed in all cases.Ki67 prolifera-tion index ranged from 2％to 30％.15 patients with AFX were followed up from 12 to 108 months.One patient had tumor recurrence 1 year and 3 years after operation due to positive basal margin.Most of the other patients underwent extended resection after diagnosis and were in good condition without tumor recurrence and metastasis.3 cases of PDS misdiagnosed as AFX were followed up for 31 to 78 months.One patient had lung metastasis after 2 years,one patient recurred 4 times after operation,and the other patient died after 4 times of recurrence.Conclusion AFX is a rare dis-ease with similar pathological characteristics and immunophenotype to PDS.AFX can be diagnosed only when the tumor is small and completely confined to the dermis.When the maximum diameter of the tumor is more than 3 cm,or the presence of any form of subcutaneous extension requires a high level of vigilance for PDS.Careful differentiation and correct classification of AFX and PDS are very important for the treatment and prognosis of the disease.

[Objective]To investigate the value of radiomics based on contrast-enhanced computed tomography(CT)image in predicting the traditional Chinese medicine(TCM)differentiation typing of primary non-small cell lung cancer(NSCLC).[Methods]A total of 130 patients diagnosed as NSCLC by pathology from July 2018 to October 2023 in Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University were retrospectively analyzed.According to the diagnostic criteria of TCM,all the enrolled patients were divided into deficiency syndrome group(67 cases)and excess syndrome group(63 cases),and then assigned to training cohort(91 cases)and validation cohort(39 cases)in a ratio of 7:3.The largest diameter slice of lesion on cross-sectional images was selected and the regions of interest were contoured at unenhanced,arterial and venous phases respectively,and then the radiomics features were extracted.The linear correlation among features and L1 regularization were used for feature selection,and then logistic regression was used to construct the radiomics model based on radiomics features of each phase.The receiver operating characteristic(ROC)curve was used to evaluate the effectiveness of the model in predicting deficiency and excess syndromes of NSCLC.The Delong test was used for comparison of area under curve(AUC)between the two models.[Results]In the training cohort,a total of 7 radiomics models were constructed,including three single-phase radiomics models,three two-phase combination radiomics models and one three-phase combination radiomics model.The AUC of combination radiomics model was higher than that of the single-phase radiomics model.The AUC of three-phase combination radiomics model was the largest,which was 0.876[95%confidence interval(CI)(0.807～0.945)]and 0.755[95%CI(0.603～0.908)]in the training cohort and validation cohort respectively.[Conclusion]The radiomics model based on contrast-enhanced CT image has high efficacy in predicting the TCM differentiation typing of NSCLC,and the three-phase combination radiomics model demonstrates the best diagnostic efficacy.