Episodic memory, our ability to recall past experiences, is supported by structures in the medial temporal lobe (MTL) particularly the hippocampus, and its interactions with fronto-parietal brain regions. Understanding how these brain regions coordinate to encode, consolidate, and retrieve episodic memories remains a fundamental question in cognitive neuroscience. Non-invasive brain stimulation (NIBS) methods, especially transcranial magnetic stimulation (TMS), have advanced episodic memory research beyond traditional lesion studies and neuroimaging by enabling causal investigations through targeted magnetic stimulation to specific brain regions. This review begins by delineating the evolving understanding of episodic memory from both psychological and neurobiological perspectives and discusses the brain networks supporting episodic memory processes. Then, we review studies that employed TMS to modulate episodic memory, with the aim of identifying potential cortical regions that could be used as stimulation sites to modulate episodic memory networks. We conclude with the implications and prospects of using NIBS to understand episodic memory mechanisms.
Humans ; Memory, Episodic ; Transcranial Magnetic Stimulation/methods* ; Brain/physiology* ; Nerve Net/physiology* ; Mental Recall/physiology* ; Neural Pathways/physiology*

Objective To evaluate the efficiency of colored Doppler ultrasound for the differential diagnosis of benign and malignant thyroid nodules. Methods A total of 150 patients with thyroid nodules admitted to Wuwei Municipal People’s Hospital, Anhui Province, China during the period from July 2018 to December 2023 were enrolled. All patients underwent colored Doppler ultrasound of the thyroid gland and pathological examination of the thyroid nodules. The pathological examination of the thyroid nodules served as a gold standard to evaluate the value of colored Doppler ultrasound for the differential diagnosis of benign and malignant thyroid nodules. In addition, the value of different ultrasound image features for differential diagnosis of benign and malignant thyroid nodules was evaluated. Results With the pathological examination of the thyroid nodules as a gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the colored Doppler ultrasound were 100.00%, 95.87%, 85.29%, 95.87%, and 96.67% for the differential diagnosis of benign and malignant thyroid nodules. For differential diagnosis of benign and malignant thyroid nodules, a > 1 ratio of longitudinal to transverse diameters of thyroid nodules, irregular margin, and microcalcification showed a 100.00% sensitivity, irregular acoustic halos showed a 100.00% specificity, and microcalcification had the highest accuracy (98.00%). Conclusion Colored Doppler ultrasound has a high value for the differential diagnosis of benign and malignant thyroid nodules. A > 1 ratio of longitudinal to transverse diameters of thyroid nodules, irregular margin, and microcalcification provide valuable insights into the differentiation between benign and malignant thyroid nodules.

Objective To evaluate the efficiency of colored Doppler ultrasound for the differential diagnosis of benign and malignant thyroid nodules. Methods A total of 150 patients with thyroid nodules admitted to Wuwei Municipal People’s Hospital, Anhui Province, China during the period from July 2018 to December 2023 were enrolled. All patients underwent colored Doppler ultrasound of the thyroid gland and pathological examination of the thyroid nodules. The pathological examination of the thyroid nodules served as a gold standard to evaluate the value of colored Doppler ultrasound for the differential diagnosis of benign and malignant thyroid nodules. In addition, the value of different ultrasound image features for differential diagnosis of benign and malignant thyroid nodules was evaluated. Results With the pathological examination of the thyroid nodules as a gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the colored Doppler ultrasound were 100.00%, 95.87%, 85.29%, 95.87%, and 96.67% for the differential diagnosis of benign and malignant thyroid nodules. For differential diagnosis of benign and malignant thyroid nodules, a > 1 ratio of longitudinal to transverse diameters of thyroid nodules, irregular margin, and microcalcification showed a 100.00% sensitivity, irregular acoustic halos showed a 100.00% specificity, and microcalcification had the highest accuracy (98.00%). Conclusion Colored Doppler ultrasound has a high value for the differential diagnosis of benign and malignant thyroid nodules. A > 1 ratio of longitudinal to transverse diameters of thyroid nodules, irregular margin, and microcalcification provide valuable insights into the differentiation between benign and malignant thyroid nodules.

The author analyzed the characteristics of phase Ⅰ clinical trials of macromolecular drugs,the characteristics of evaluation indicators of phase Ⅰ clinical trials of macromolecular drugs,such as safety evaluation,pharmacokinetic and pharmacodynamic evaluation,and efficacy evaluation.And the control points of subjects management,management of experimental macromolecule drugs,and identified and potential risk factors of macromolecule drugs in the implementation of risk management for phase Ⅰ clinical trials of macromolecule drugs were discussed in depth based on previous clinical trial research experience.Through discussion and analysis,the author suggests that each research center can formulate risk control strategies according to the actual situation,improve the efficiency of risk control,and facilitate the smooth implementation of clinical trials and improve the quality of clinical trials.

Objective To analyze the incidence and risk factors of hypothermia in elderly patients with malnutrition during proximal femoral nail antirotation(PFNA)internal fixation under general anesthesia.Methods A total of 139 elderly patients underwent PFNA internal fixation under general anesthesia were selected,and the nutritional status scores 1 day before surgery ranged from 0 to 11 points.Univariate and multivariate Logistic binary regression analysis was performed to analyze the related factors that may lead to intraoperative hypothermia.Results Among 139 elderly patients with preoperative nutritional scores of 0 to 11 points,79 cases(56.83%)developed intraoperative hypothermia.The results of univariate and multivariate Logistic binary regression analysis suggested that age≥75 years old,mini nutritional assessment short form(MNA-SF)nutritional score 0 to 7 points,BMI<18.5 kg/m2,duration of general anesthesia≥2 hours,intraoperative flushing fluid volume≥1 000 mL and intraoperative fluid volume≥1 000 mL were the risk factors for the occurrence of intraoperative hypothermia in elderly patients(OR>1,P<0.05).The use of warm blanket insulation was the protective factor against the occurrence of intraoperative hypothermia(OR<1,P<0.05).Conclusion The incidence of intraoperative hypothermia during PFNA internal fixation under general anesthesia in elderly patients with mainutrition before operation is high,and patients with poor nutritional status are more likely to develop intraoperative hypothermia.Patients with older age,poor nutritional status,lower BMI,longer duration of general anesthesia,and more intraoperative flushing fluid volume and intraoperative fluid volume are likely to lead to intraoperative hypothermia.The use of warm blanket can reduce the incidence of intraoperative hypothermia.

In the field of dental aesthetics,digital aesthetic design plays a crucial role in helping dentists to predict treatment outcomes vis-ually,as well as in enhancing the consistency of knowledge and understanding of aesthetic goals between dentists and patients.It serves as the foundation for achieving ideal aesthetic effects.However,there is no clear standard for this digital process currently in China and abroad.Many dentists lack of systematic understanding of how to carry out digital aesthetic design for treatment.To establish standardized processes for dental aesthetic design and to improve the homogeneity of treatment outcomes,Chinese Society of Digital Dental Industry(CSD-DI)convened domestic experts in related field to compile this consensus.This article elaborates on the key aspects of digital aesthetic data collection,integration steps,and the digital aesthetic design process.It also formulates a decision tree for dental aesthetics at macro level and outlines corresponding workflows for various clinical scenarios,serving as a reference for clinicians.

This study was aimed at characterizing the variations in hemagglutinin(HA)and neuraminidase(NA)genes of influenza virus subtype A(H1N1)pdm09 isolated during the 2022-2023 influenza monitoring year in Shandong Province,to provide a scientific basis for influenza prevention and control.A total of 14 A(H1N1)pdm09 subtype influenza strains were se-lected randomly by city by the influenza monitoring network laboratory.The vaccine strains recommended by the WHO served as references for whole gene sequencing analysis.A fluorescence method was used to conduct neuraminidase inhibition experi-ments to evaluate drug sensitivity.The A(H1N1)pdm09 influenza virus in Shandong Province,2022-2023 belonged to the 5a.2a evolutionary cluster in the 6B.1A branch.Nucleotide sequence analysis indicated that the HA and NA genes were closely re-lated to the Northern Hemisphere vaccine strain A/Victoria/2570/2019 in the years 2021-2023,and showed homology of 98.5％to 98.7％and 98.8％to 99.1％,respectively.Amino acid sequence analysis revealed 20 amino acid sequence mutations in the HA protein,but only one virus strain was found to have antigen drift,and three virus strains showed loss of HA protein glycosylation sites.No mutations were found at important sites affecting NA enzymes.The neuraminidase inhibition experiment indicated viral sensitivity to anti-influenza drugs.In conclusion,the monitored virus strains had high overall homology with vac-cine strains but showed some amino acid variation.In the future,continued monitoring of the genetic variation characteristics of influenza viruses will be necessary to understand the risk of influenza epidemics,and the effectiveness of influenza vaccines and therapeutic drugs.

This study was aimed at understanding the pollution distribution pattern of avian influenza virus in the environ-ment in poultry related places in Shandong Province,to provide a scientific basis for the prevention,control,prediction,and early warning regarding human infection with avian influenza.From 2020 to 2023,6 523 environmental samples were collected in 16 cities in Shandong Province from four types of poultry-related places.Fluorescence quantitative PCR was used for nucleic acid testing of influenza A virus.Positive samples were further identified for the H5,H7,and H9 subtypes of avian influenza virus.The epidemiological characteristics of avian influenza viruses in the poultry related environment of Shandong Province were described,and inter-rate comparisons were performed with the x2 test.During 2020-2023,6 523 environmental samples were collected,and 1 007 cases positive for avian influenza virus were detected,with a positivity rate of 15.44％.H5,H7,and H9 subtypesand mixed infections were detected.H9 was the main subtype(88.48％)in positive specimens.A significant difference in positivity rates was observed among regions(x2=431.956,P＜0.001),and the highest positivity rate was 28.93％.Significant differences in positivity rates were observed among monitoring sites(x2=304.604,P＜0.001),sample types(x2=109.678,P＜0.001),and quarters(x2=64.963,P＜0.001).The positive detection rate was highest at monitoring sites in urban and rural live poultry markets(20.12％),and the positive detection rate of samples collected by wiping meat cut-ting board surfaces was higher than that of other samples(22.56％).The peak positive detection rate occurred in spring(20.31％).Widespread contamination with avian influenza virus was observed in poultry environments in Shandong Prov-ince.The H9 subtype,the main pathogen,coexisted with H5 and H7 subtypes,thus posing a risk of human infection with avian influenza.Therefore,prevention and control of avian influenza must be strengthened in key seasons,areas,places,and links.

Objective To observe the clinical efficacy of electroacupuncture at Shuigou(DU26)combined with warming-needle moxibustion in the treatment of acute cerebral infarction.Methods Nighty-six patients with acute cerebral infarction were randomly divided into observation group and control group,48 cases in each group.Both groups were given routine basic treatment.The control group was treated with warming-needle moxibustion.The observation group was treated with electroacupuncture at Shuigou point on the basis of the control group.The treatment was performed 5 days a week for a total of 3 weeks.After 3 weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes of National Institutes of Health Stroke Scale(NIHSS)score,Barthel Index(BI)score and Fugl-Meyer motor function assessment scale score of the two groups were observed before and after treatment.The changes of interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)and homocysteine(Hey)levels were compared before and after treatment between the two groups.The safety and adverse reactions of the two groups were evaluated.Results(1)The total effective rate of the observation group was 95.83％(46/48),and that of the control group was 81.25％(39/48).The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,the NIHSS scores,BI scores,and FMA scores of the patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the NIHSS scores,BI scores,and FMA scores,with a statistically significant difference(P＜0.05).(3)After treatment,the serum IL-6,hs-CRP,and Hey levels of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the serum inflammatory factors of IL-6,hs-CRP,and Hey levels,with statistically significant differences(P＜0.05).(4)Comparing the incidence of adverse reactions between the observation group and the control group,the difference was not statistically significant(P＞0.05).Conclusion Electroacupuncture at Shuigou point combined with warming-needle moxibustion in the treatment of acute cerebral infarction can significantly promote the recovery of patients'neurological function,thus improving their motor and living ability,effectively reducing the levels of inflammatory factors and homocysteine,and the clinical efficacy is remarkable.

Objective:To develop a prognostic prediction model for patients with colorectal cancer based on a peripheral blood cell composite score (PBCS) system.Methods:This retrospective observational study included patients who had primary colorectal cancer without distant metastasis, who did not undergo radiotherapy or chemotherapy before surgery, who did not receive leukocyte or platelet-raising therapy within 1 month before surgery, and whose postoperative pathology confirmed colorectal adenocarcinoma with complete tumor resection. Patients with severe anemia, infection, or hematologic diseases before surgery, as well as those with severe heart, lung, or other important organ diseases or concurrent malignant tumors, were excluded. In total, 1021 patients with colorectal cancer who underwent surgical treatment in the Department of Gastrointestinal Surgery of the Fourth Hospital of Hebei Medical University from April 2018 to April 2020 were retrospectively included as the training set (766 patients) and the internal validation set (255 patients). Additionally, using the same criteria, 215 patients with colorectal cancer who underwent surgical treatment in another treatment group from March 2015 to December 2020 were selected as the external validation set. The "surv_cutpoint" function in R software was used to analyze the optimal cut-off values of neutrophils, lymphocytes, and platelets, and a PBCS system was established based on the optimal cut-off values. The scoring rules of the PBCS system were as follows: Neutrophils and platelets below the optimal cut-off value = 1 point, otherwise 0 points; Lymphocytes above the optimal cut-off value = 1 point, otherwise 0 points. The scores of the three cell types were added together to obtain the PBCS. Univariate and multivariate Cox regression analyses were performed to explore the correlation between patients' clinicopathological features and prognosis, and a nomogram was constructed based on the Cox regression analysis to predict patients' prognosis. The accuracy of the nomogram prediction model was validated using the C-index, calibration curve, and decision curve analysis.Results:The optimal cut-off values for neutrophils, lymphocytes, and platelets were 4.40×10 9/L, 1.41×10 9/L, and 355×10 9/L, respectively. The patients were divided into high and low groups according to the optimal cut-off values of these cells. Survival curve analysis showed that a high lymphocyte count (training set: P=0.042, internal validation: P=0.010, external validation: P=0.029), low neutrophil count (training set: P=0.035, internal validation: P=0.001, external validation: P=0.024), and low platelet count (training set: P=0.041, internal validation: P=0.030, external validation: P=0.024) were associated with prolonged overall survival (OS), with statistically significant differences in all cases. Survival analysis of different PBCS groups showed that patients with a high PBCS had longer OS than those with a low PBCS ( P<0.05). Univariate and multivariate Cox regression analysis results showed that aspirin use history, vascular thrombus, neural invasion, CA19-9, N stage, operation time, M stage, and PBCS were independent factors affecting OS (all P<0.05). The PBCS was also an independent factor affecting disease-specific survival ( P<0.05), but not progression-free survival ( P>0.05). The above independent risk or protective factors were included in R software to construct a nomogram for predicting OS. The C-index (0.873), calibration curve, and decision curve analysis (threshold probability: 0.0%–75.2%) all indicated that the nomogram prediction model had good predictive performance for OS. Conclusion:This study demonstrates that the PBCS constructed based on preoperative peripheral blood levels of neutrophils, lymphocytes, and platelets is an independent factor associated with the prognosis of patients with colorectal cancer. The nomogram model constructed based on this score system exhibits good predictive efficacy for the prognosis of these patients.