OBJECTIVE To investigate the molecular mechanism of Tiaozhong huashi decoction in improving gastroesophageal reflux disease （GERD） by regulating endoplasmic reticulum autophagy in rat esophageal interstitial cells of Cajal （ICC） through p62 signaling pathway.METHODS After establishing a rat GERD model via the weak acid intragastric administration and irregular diet， the rats were randomly divided into model group， western medicine group [1.56 mg/（kg·d） of mosapride， 3.125 mg/（kg·d） of lansoprazole] and low-， medium- and high-dose Tiaozhong huashi decoction [4.713， 9.425， 18.85 g/（kg·d）] groups. A blank group was also set up， with 8 rats in each group. The rats in each group were intragastrically administered with corresponding liquid or normal saline twice a day for 14 days. During the intervention period， the general conditions of rats’ hair， spirit， diet and defecation were observed. After the last gavage， the pathological changes of esophageal tissue and the ultrastructure of ICC were observed. The relative expression and positive expression levels of p62， autophagy-related protein 8 （ATG8）， 200 kDa FAK family kinase-interacting protein （FIP200） and Unc-51 like autophagy activating kinase 1 （ULK1） in esophageal tissue were detected.RESULTS Compared with the blank group， rats in the model group exhibited listlessness； thickening of the esophageal basal layer， elongation of lamina propria papillae with inflammatory cell infiltration； markedly dilated endoplasmic reticulum appearing as round vacuolar cisternae with ribosome detachment； and a small number of accumulated autophagosomes. The relative expression and positive expression levels of p62， ATG8， FIP200， and ULK1 were significantly decreased （ P ＜0.05）. Compared with the model group， the above pathological injuries in the medium- and high-dose Tiaozhong huashi decoction groups had all improved to varying degrees； the damaged endoplasmic reticulum structure was repaired， and no autophagosome accumulation was observed. In particular， the relative expression levels and positive expression levels of p62， ATG8， FIP200， and ULK1 in esophageal tissue of rats in the medium-dose Tiaozhong huashi decoction group were significantly increased （ P ＜0.05）.CONCLUSIONS Tiaozhong huashi decoction ameliorated esophageal mucosal injury in GERD rats， and its mechanism was possibly associated with activation of the p62 signaling pathway and restoration of the endoplasmic reticulum structure， morphology， and autophagic capacity of ICC.

Objective:To compare the clinical effect of femoral neck system (FNS) and cannulated compression screw internal fixation in the treatment of femoral neck fractures in young and middle-aged patients.Methods:The databases of CNKI, Wanfang Data Knowledge Service Platform, VIP, Chinese Medical Journal Full-text Database, PubMed, Embase, Web of Science and Cochrane Library were searched. The intraoperative blood loss, intraoperative fluoroscopy times, hospital stay, fracture healing time, Harris hip function score, partial weight-bearing time and complication rate were extracted to compare the clinical efficacy of the two surgical methods. Stata18.0 statistical software was used for meta-analysis.Results:A total of 699 patients from 11 studies were included in this study. Compared with cannulated compression screw internal fixation, the FNS had a shorter operation time [ WMD= -8.54, 95% CI(-14.87, -2.21), P=0.008], fewer intraoperative fluoroscopy times[ WMD= -8.29, 95% CI(-11.45, -5.12), P< 0.001], a shorter fracture healing time [ WMD=-1.59, 95% CI(-2.49, -0.68), P=0.001], a shorter partial weight-bearing time[ WMD=-3.45, 95% CI(-4.43, -2.46), P<0.001], a lower incidence of postoperative complications [ RR=0.41, 95% CI(0.22, 0.76), P= 0.004], and a lower incidence of postoperative nonunion [ RR=0.40, 95% CI(0.18, 0.88), P=0.022]. Meanwhile, the FNS group had more intraoperative blood loss [ WMD=9.53, 95% CI(2.70, 16.35), P=0.006] and a higher Harris hip function score at the last follow-up [ WMD=3.50, 95% CI(2.11, 4.89), P<0.001] than the cannulated compression screw internal fixation group. There were no statistically significant differences in the length of hospital stay [ WMD=-0.48, 95% CI(-0.82, -0.13), P=0.092] or the incidence of femoral head necrosis [ RR=0.57, 95% CI(0.26, 1.24), P=0.159] between the two groups. Conclusion:Compared with cannulated compression screw internal fixation in the treatment of femoral neck fracture in young and middle-aged patients, FNS has more intraoperative blood loss, but it has more advantages in operation time, intraoperative blood loss, intraoperative fluoroscopy times, postoperative fracture healing time, Harris hip function score, partial weight-bearing time, postoperative nonunion rate and postoperative complications rate.

To characterize the genomes of different emm-type group A Streptococcus (GAS), their virulence genes and drug resistance profiles in Tianjin City from 2011 to 2024. After PCR, a total of 42 strains with different years and emm types were selected for whole genome sequencing and multi-locus sequence typing (MLST), and the core genomes were used to generate a phylogenetic tree, after which the virulence genes and resistance genes were identified and analyzed, followed by the drug susceptibility test. In this study, the GAS strains were dominated by emm1 (50.0%) and emm12 (40.4%), and the MLST phenotypes were categorized into six types: ST36 (40.4%), ST1274 (26.1%), ST28 (23.8%), ST921 (4.7%), ST46 (2.3%), and ST403 (2.3%). There was a high consistency between their emm-types and ST types. A total of 68 virulence genes were detected in the genomes of 42 GAS strains, involving functional genes encoding exotoxin, bacterial adhesion, extracellular enzymes, etc. The virulence genes they carried were significantly different between emm1-type and emm12-type strains, such as speA. At the same time, the carrying rates of some virulence genes in the same emm-type strains changed with time, such as hyl. The resistance genes were basically the same among different emm-type strains except for the vanSE gene detected in all emm12 strains. The results of drug sensitivity showed that the GAS strains isolated in Tianjin City from 2011 to 2024 were sensitive to penicillin, cefazolin, chloramphenicol, vancomycin, and levofloxacin, while the resistance rates to erythromycin, azithromycin, clarithromycin, and clindamycin ranged from 88.5% to 100.0%, and there was a certain degree of consistency between the resistance phenotypes and the detected resistance genes. Overall, the main emm types and evolutionary features of GAS in Tianjin City from 2011 to 2024 were consistent with the dominant types in China, and the carrying rate of virulence genes and drug resistance genes differed significantly among different emm-type strains, and there were continuous evolution and variation in the prevalence of virulence genes in GAS.

Diarrhea-predominant irritable bowel syndrome （IBS-D） is a common digestive system disease with high prevalence and recurrence rates for years， high treatment costs， and serious impacts on patients' quality of life and economic burden. Therefore， it is important to explore new and safe treatment methods. The pathogenesis of IBS-D is complex， in which the gut-brain axis is a key factor. The gut-brain axis， a bidirectional signaling pathway connecting the gastrointestinal tract and the central nervous system， regulates gastrointestinal motility， secretion， and immune responses， playing a key role in the occurrence and development of IBS-D. Up to now， antidiarrheal agents， probiotics， and neurotransmitter modulators are the main methods for the clinical treatment of IBS-D. Although they can partially curb the progression of this disease， the therapeutic effects remain to be improved. Studies have confirmed that traditional Chinese medicine （TCM） has significant advantages in the treatment of IBS-D since it can regulate the gut-brain axis via multiple pathways and targets to improve the gastrointestinal motility and strengthen immune defenses. However， there is a lack of systematic reviews on the regulation of the gut-brain axis by TCM in the treatment of IBS-D. Based on the review of IBS-D-related articles published in recent years， this paper systematically summarized the relationship between the gut-brain axis and IBS-D and the role of TCM in the treatment， providing new ideas for the treatment of IBS-D.

To characterize the genomes of different emm-type group A Streptococcus (GAS), their virulence genes and drug resistance profiles in Tianjin City from 2011 to 2024. After PCR, a total of 42 strains with different years and emm types were selected for whole genome sequencing and multi-locus sequence typing (MLST), and the core genomes were used to generate a phylogenetic tree, after which the virulence genes and resistance genes were identified and analyzed, followed by the drug susceptibility test. In this study, the GAS strains were dominated by emm1 (50.0%) and emm12 (40.4%), and the MLST phenotypes were categorized into six types: ST36 (40.4%), ST1274 (26.1%), ST28 (23.8%), ST921 (4.7%), ST46 (2.3%), and ST403 (2.3%). There was a high consistency between their emm-types and ST types. A total of 68 virulence genes were detected in the genomes of 42 GAS strains, involving functional genes encoding exotoxin, bacterial adhesion, extracellular enzymes, etc. The virulence genes they carried were significantly different between emm1-type and emm12-type strains, such as speA. At the same time, the carrying rates of some virulence genes in the same emm-type strains changed with time, such as hyl. The resistance genes were basically the same among different emm-type strains except for the vanSE gene detected in all emm12 strains. The results of drug sensitivity showed that the GAS strains isolated in Tianjin City from 2011 to 2024 were sensitive to penicillin, cefazolin, chloramphenicol, vancomycin, and levofloxacin, while the resistance rates to erythromycin, azithromycin, clarithromycin, and clindamycin ranged from 88.5% to 100.0%, and there was a certain degree of consistency between the resistance phenotypes and the detected resistance genes. Overall, the main emm types and evolutionary features of GAS in Tianjin City from 2011 to 2024 were consistent with the dominant types in China, and the carrying rate of virulence genes and drug resistance genes differed significantly among different emm-type strains, and there were continuous evolution and variation in the prevalence of virulence genes in GAS.

Objective:To compare the clinical effect of femoral neck system (FNS) and cannulated compression screw internal fixation in the treatment of femoral neck fractures in young and middle-aged patients.Methods:The databases of CNKI, Wanfang Data Knowledge Service Platform, VIP, Chinese Medical Journal Full-text Database, PubMed, Embase, Web of Science and Cochrane Library were searched. The intraoperative blood loss, intraoperative fluoroscopy times, hospital stay, fracture healing time, Harris hip function score, partial weight-bearing time and complication rate were extracted to compare the clinical efficacy of the two surgical methods. Stata18.0 statistical software was used for meta-analysis.Results:A total of 699 patients from 11 studies were included in this study. Compared with cannulated compression screw internal fixation, the FNS had a shorter operation time [ WMD= -8.54, 95% CI(-14.87, -2.21), P=0.008], fewer intraoperative fluoroscopy times[ WMD= -8.29, 95% CI(-11.45, -5.12), P< 0.001], a shorter fracture healing time [ WMD=-1.59, 95% CI(-2.49, -0.68), P=0.001], a shorter partial weight-bearing time[ WMD=-3.45, 95% CI(-4.43, -2.46), P<0.001], a lower incidence of postoperative complications [ RR=0.41, 95% CI(0.22, 0.76), P= 0.004], and a lower incidence of postoperative nonunion [ RR=0.40, 95% CI(0.18, 0.88), P=0.022]. Meanwhile, the FNS group had more intraoperative blood loss [ WMD=9.53, 95% CI(2.70, 16.35), P=0.006] and a higher Harris hip function score at the last follow-up [ WMD=3.50, 95% CI(2.11, 4.89), P<0.001] than the cannulated compression screw internal fixation group. There were no statistically significant differences in the length of hospital stay [ WMD=-0.48, 95% CI(-0.82, -0.13), P=0.092] or the incidence of femoral head necrosis [ RR=0.57, 95% CI(0.26, 1.24), P=0.159] between the two groups. Conclusion:Compared with cannulated compression screw internal fixation in the treatment of femoral neck fracture in young and middle-aged patients, FNS has more intraoperative blood loss, but it has more advantages in operation time, intraoperative blood loss, intraoperative fluoroscopy times, postoperative fracture healing time, Harris hip function score, partial weight-bearing time, postoperative nonunion rate and postoperative complications rate.

Objective To compare the association of the incidence and mortality of leukemia and the human development index(HDI)in different countries or regions in 2022,and the trend of leukemia incidence and mortality with age in countries with different HDI levels.Methods GLOBOCAN 2022 data related to leukemia incidence and mortality in different countries or regions worldwide and HDI were evaluated by Pearson correlation analysis and Kruskal-Wallis test.The incidence and mortality rates of each age and the age change trend were analyzed using the Joinpoint Regression model.Results Age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and mortality to incidence ratio(M/I)were statistically significantly different among the four groups of HDI countries(P<0.001).HDI was positively correlated with ASIR and ASMR and negatively correlated with M/I.Among all ages,ASIR and ASMR of leukemia of the four groups had similar trends with age,and the risk of leukemia was high at ages less than 15 and more than 40.The incidence of leukemia in all age groups in China differed from those in other countries with high HDI,while the mortality rate was lower than those in other countries with high HDI.Conclusion Countries or regions with higher HDI have higher ASIR and ASMR and lower M/I because of their better medical condition.

Objective:To investigate the application value of indocyanine green (ICG) injection via percutaneous transhepatic portal vein under ultrasound guidance during laparoscopic anatomical liver resection.Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 17 male patients with hepatocellular carcinoma who underwent laparoscopic anatomical liver resection in Mengchao Hepatobiliary Hospital of Fujian Medical University from October 2022 to May 2024 were collected. The patients were aged 59(range, 27-74)years. Patients underwent ICG fluorescence-guided laparoscopic anatomical liver resection after ICG injection via percutaneous transhepatic portal vein under ultrasound guidance. Obsevation indicators: (1)surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers. Results:(1) Surgical situations. All 17 patients were successfully punctured and injected with ICG via percutaneous transhepatic portal vein under ultrasound guidance, with a puncture time of 6(range,3-12)minutes. The fluorescence staining successfully displayed at the target liver segment without infiltration, and the distance from the fluorescence staining border to the tumor edge was greater than 1.0 cm, which was consistent with preoperative three-dimensional reconstruction imaging. Among the 17 patients, 11 cases had punctures in one branch of the portal vein, 4 cases had punctures in two branches, and 2 had punctures in three branches. The operation time was (229±51)minutes, volume of intraoperative blood loss was 200(range, 100-300)mL. No blood transfusion or conversion to open surgery was required during the operation. (2) Postoperative situations. Two of 17 patients had a small pleural effusion of grade Ⅰ-Ⅱ of Clavien-Dindo classification, and were recovered without treatment. The duration of postoperative hospital stay was 5(range, 5-6)days. Postoperative pathological examina-tion showed hepatocellular carcinoma with negative surgical margin. The tumor diameter was 4.5(range, 1.8-12.5)cm. (3) Follow-up. All the 17 patients were followed up for 14(range, 2-30)months, without tumor recurrence.Conclusion:Injection of ICG via percutaneous transhepatic portal vein under ultrasound guidance during laparoscopic anatomical liver resection is safe and feasible.

Acute pancreatitis （AP） is one of the most clinically common acute digestive disorders characterized by quick onset，rapid progression，severe condition，and high mortality. If the disease is not timely intervened in the early stage，it can develop into severe AP in the later stage，which damages the long-term quality of life and brings serious economic burden to patients and their families. However， the pathogenesis of this disease is complex and has not been fully explained. The generation and development of AP is closely related to many signaling pathways. Among them，Toll-like receptor 4（TLR4），as a transmembrane signal transduction receptor，can mediate immune response and inflammatory response，and play a key role in the occurrence and development of AP. Traditional Chinese medicine（TCM）can regulate the TLR4 signaling pathway with multiple targets，multiple effects，and multiple administration methods to inhibit inflammatory response，and effectively intervene in the progression of AP， which has gradually become a new craze for preventing and treating AP. Many studies have shown that TCM has obvious advantages in the prevention and treatment of AP. It can effectively treat AP by regulating TLR4 signaling pathway，strengthening immune resistance and defense，and inhibiting inflammatory response. Despite of the research progress，there is still a lack of comprehensive review on TCM regulation of TLR4 signaling pathway in the treatment of AP. Therefore，the literature on TCM regulation of TLR4 signaling pathway published in recent years was systematically reviewed and elaborated，aiming to provide new ideas for the treatment of AP and further drug development.

BACKGROUND:MRI is important for the diagnosis of early knee osteoarthritis.MRI image recognition and intelligent segmentation of knee osteoarthritis using deep learning method is a hot topic in image diagnosis of artificial intelligence. OBJECTIVE:Through deep learning of MRI images of knee osteoarthritis,the segmentation of femur,tibia,patella,cartilage,meniscus,ligaments,muscles and effusion of knee can be automatically divided,and then volume of knee fluid and muscle content were measured. METHODS:100 normal knee joints and 100 knee osteoarthritis patients were selected and randomly divided into training dataset(n=160),validation dataset(n=20),and test dataset(n=20)according to the ratio of 8:1:1.The Coarse-to-Fine sequential training method was used to train the 3D-UNET network deep learning model.A Coarse MRI segmentation model of the knee sagittal plane was trained first,and the rough segmentation results were used as a mask,and then the fine segmentation model was trained.The T1WI and T2WI images of the sagittal surface of the knee joint and the marking files of each structure were input,and DeepLab v3 was used to segment bone,cartilage,ligament,meniscus,muscle,and effusion of knee,and 3D reconstruction was finally displayed and automatic measurement results(muscle content and volume of knee fluid)were displayed to complete the deep learning application program.The MRI data of 26 normal subjects and 38 patients with knee osteoarthritis were screened for validation. RESULTS AND CONCLUSION:(1)The 26 normal subjects were selected,including 13 females and 13 males,with a mean age of(34.88±11.75)years old.The mean muscle content of the knee joint was(1 051 322.94±2 007 249.00)mL,the mean median was 631 165.21 mL,and the mean volume of effusion was(291.85±559.59)mL.The mean median was 0 mL.(2)There were 38 patients with knee osteoarthritis,including 30 females and 8 males.The mean age was(68.53±9.87)years old.The mean muscle content was(782 409.18±331 392.56)mL,the mean median was 689 105.66 mL,and the mean volume of effusion was(1 625.23±5 014.03)mL.The mean median was 178.72 mL.(3)There was no significant difference in muscle content between normal people and knee osteoarthritis patients.The volume of effusion in patients with knee osteoarthritis was higher than that in normal subjects,and the difference was significant(P<0.05).(4)It is indicated that the intelligent segmentation of MRI images by deep learning can discard the defects of manual segmentation in the past.The more accuracy evaluation of knee osteoarthritis was necessary,and the image segmentation was processed more precisely in the future to improve the accuracy of the results.