The connotation of the "four-dimensional pivot-earth" qi transformation mode is a dialectical system of the ascending and descending of yin-yang qi movement， which presented as "the middle Jiao showing earth qi mediating， the left wheel showing water and wood ascending， and the right wheel showing fire and metal converting and descending". Based on this dialectical thinking， it is believed that the core pathogenesis of myasthenia gravis is deficiency of center qi and transportation failure to pivot-earth； the middle-stage characteristics of the disease progression are the loss of mediation of the central qi， resulting in water coldness and wood constraint， and clear yang failing to ascend； the final outcome of this disease is the loss of astringeing of lung metal and qi sinking. The treatment should be based on the rule of qi movement， so for the start-stage， Buzhong Yiqi Decoction （补中益气汤） should be used as the basis to nourish the earth and consolidate the root， and restrengthen the middle qi； for the middle-stage， herbs like Yingyanghuo （Epimedium brevicornu Maxim.）， Bajitian （Morinda officinalis How） could be combined to warm the water and soothe the wood， raise yang and boost qi； for the final stage， plus Sini Decoction （四逆汤） to astringe metal to stop collapse， and powerfully supplement original qi. All these medicinals can promote pivot-earth re-transportation， four-dimensional transformation， and regular circulation of qi movement， so as to provide thoughts for improving the clinical effectiveness of myasthenia gravis.

OBJECTIVE To evaluate the efficacy and safety of ceftazidime/avibactam （CAZ/AVI） combined with amikacin （AMK） in the treatment of carbapenem-resistant Enterobacteriaceae （CRE） severe pneumonia. METHODS A retrospective cohort study was conducted on 240 patients diagnosed with severe pneumonia caused by CRE infection in the intensive care unit （ICU） of the Affiliated Hospital of Xuzhou Medical University from January 2022 to December 2024. The patients were divided into a combination group （CAZ/AVI combined with AMK， n＝136） and a control group （CAZ/AVI alone， n＝104）. The 28-day mortality rate， clinical efficacy，mechanical ventilation time， ICU stay， infectious markers [C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， white blood cell count （WBC）， and neutrophil percentage （N%）]， Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） scores， and total incidence of adverse reactions were compared between two groups of patients. At the same time， subgroup analysis was conducted based on the severity of the condition， mechanical ventilation status， and baseline renal function. RESULTS The 28-day mortality rate of patients in the combination group was significantly lower than that in the control group （20.6% vs. 34.6%， P＝0.022）， and the clinical effective rate was significantly higher than that in the control group （80.1% vs. 65.4%， P＝0.004）. The mechanical ventilation time and ICU hospitalization time in the combination group were significantly shorter than those in the control group （[ 7.2±2.4） days vs. （10.4±3.6） days， （10.5±3.1） days vs. （13.7±3.8） days； P＜0.01].After 7 days of treatment， the CRP， PCT， IL-6， WBC， N% and APACHE Ⅱ scores of patients in the combination group significantly decreased compared to before treatment， and the decrease was significantly greater than that of the control group （P＜0.01）. There was no statistically significant difference in the total incidence of adverse reactions between the two groups of patients （11.8% vs. 13.5%， P＝0.690）. Subgroup analysis showed that among high-risk （APACHE Ⅱ score≥15） and mechanically ventilated patients， the 28-day mortality rate and weaning time of the combination group were significantly lower/ shorter than those of the control group （P＜0.05）， while there was no significant difference in the total incidence of adverse reactions between the combination group and the control group after dose adjustment in patients with chronic renal insufficiency （P＞0.05）. CONCLUSIONS The CAZ/AVI combined with AMK regimen has better anti-infective efficacy and good safety in patients with severe pneumonia caused by CRE infection compared to the CAZ/AVI regimen alone； the survival benefits of this joint regimen are more significant in high-risk and mechanically ventilated patients， with critically ill patients being the main beneficiaries.

Although metal blocks have been widely used for reconstructing uncontained tibial bone defects, the influence of their elastic modulus on the stability of tibial prosthesis fixation remains unclear. Based on this, a finite element model incorporating constrained condylar knee (CCK) prosthesis, tibia, and metal block was established. Considering the influence of the post-restraint structure of the prosthesis, the effects of variations in the elastic modulus of the block on the von Mises stress distribution in the tibia and the block, as well as on the micromotion at the bone-prosthesis fixation interface, were investigated. Results demonstrated that collision between the insert post and femoral prosthesis during tibial internal rotation increased tibial von Mises stress, significantly influencing the prediction of block elastic modulus variation. A decrease in the elastic modulus of the metal block resulted in increased von Mises stress in the proximal tibia, significantly reduced von Mises stress in the distal tibia, decreased von Mises stress of the block, and increased micromotion at the bone-prosthesis fixation interface. When the elastic modulus of the metal block fell below that of bone cement, inadequate block support substantially increased the risk of stress shielding in the distal tibia and fixation interface loosening. Therefore, this study recommends that biomechanical investigations of CCK prostheses must consider the post-constraint effect, and the elastic modulus of metal blocks for bone reconstruction should not be lower than 3 600 MPa.
Knee Prosthesis ; Humans ; Finite Element Analysis ; Tibia/surgery* ; Elastic Modulus ; Arthroplasty, Replacement, Knee/methods* ; Stress, Mechanical ; Metals ; Prosthesis Design ; Knee Joint/surgery* ; Biomechanical Phenomena

The intestinal microecology is closely related to the occurrence and development of hepatocellular carcinoma (HCC). The intestinal microbiota and its metabolites can regulate the tumor immune microenvironment through the "gut-liver axis", promoting cancer progression. Therefore, the intestinal microbiome is gradually demonstrating the potential as a biomarker for early diagnosis of HCC and prediction of the efficacy of immunotherapy. Targeted intervention on the intestinal microecology (such as probiotics, fecal microbiota transplantation, dietary regulation, etc.) may enhance the efficacy of immune checkpoint inhibitors (ICIs) and is becoming a promising combination therapy strategy. In the future, HCC treatment will rely on multi-omics integration, artificial intelligence-assisted diagnosis, and synthetic biology tools to promote the translation of precise gut flora intervention strategies from basic research to the clinic. This article summarized the latest research progress of intestinal microecology in HCC, explored its potential value and development direction for precision diagnosis and treatment of HCC, and provided a theoretical basis for the clinical application of related intervention strategies.

Huang Yuanyu, a famous TCM doctor in the Qing Dynasty, believed that the human body's qi system revolves around the spleen and stomach as the pivot, with the liver, heart, lungs, and kidneys as the four major organs, and the circulation is constant. TCM guided therapy regulates qi and blood by regulating the body, heart, and breath, which is in line with this theory. Based on Huang Yuanyu's "pivot movement" theory, this article explored the application of guided therapy in refractory gastroesophageal reflux disease (rGERD). Guided by the "pivot movement" theory, which includes the left path wood fire rising and falling, the right path gold water converging and falling, and the adjustment of the focal point through the mediation of earth and qi, and referring to the guidance movement methods in the Ba Duan Jin and Zhu Bing Yuan Hou Lun, a "pivot guidance method" for rGERD patients is developed, five movements: adjusting the body and heart, turning the waist and benefiting the kidneys, including rubbing the abdomen and regulating the spleen, soothing the liver and bending the knees, and tightening the lungs and reducing reflux. The aim is to promote smooth circulation of qi throughout the body and improve symptoms of gastroesophageal reflux. In clinical practice, guided therapy should be applied under the guidance of a doctor, with slow and gentle movements, attention to regulating breathing, and long-term persistence.

Objective:To investigate the expression characteristics of plasma proteins in patients with acute diquat poisoning by proteomic technology, and to screen the targets and biomarkers related to the diagnosis, treatment and prognosis of acute diquat poisoning.Methods:This study was a retrospective case-control study. Patients with diquat poisoning admitted to Nanjing University Affiliated Drum Tower Hospital from August 2022 to December 2023 were enrolled. Healthy volunteers matched for age and gender during the same period were selected as the control group. The general clinical data and plasma samples were collected, and qualitative and quantitative analyses of plasma proteins were performed by proteomic technology based on nanoliter liquid chromatography tandem quadrupole time-of-flight mass spectrometry. Mann-Whitney U test was used to compare differences of plasma protein expression between the two groups. Results:A total of 8 diquat poisoning patients and 7 healthy individuals were included in this study, and 491 plasma proteins were identified. Compared with control group, 76 differentially expressed proteins were obtained from the poisoned group, including 35 up-regulated proteins and 41 down-regulated proteins. GO analysis showed that the differentially expressed proteins were mainly associated with oxygen transporter activity, receptor binding, and hyaluronic acid-binding endopeptidase inhibitor activity. KEGG pathway enrichment analysis revealed that differentially expressed proteins were associated with complement and coagulation cascades, neutrophil extracellular trap formation, and platelet activation. In addition, the expression of adiponectin (ADIPOQ) was not only increased in poisoned patients, but also significantly higher in non-survivors than in survivors ( P<0.01). Conclusions:Multiple plasma proteins with abnormal expression may be involved in the pathological process of acute diquat poisoning. ADIPOQ may have potential application value in the diagnosis, treatment, and prognosis of acute diquat poisoning.

OBJECTIVE To explore the effect of Tuoli Xiaodusan(MDX)on ischemia-reperfusion injury of rat skin flaps and its potential mechanism.METHODS Rats were randomly divided into sham operation group(Sham group),Model group,MDX high-dose group(MDX-H group)and MDX low-dose group(MDX-L group),with 10 rats in each group.After the rat back skin flap model was successfully constructed,the drug was administered by gavage immediately,once a day for 14 consecutive days.The changes of rat skin flaps in each group after surgery were observed,and the survival rate of rat skin flaps in each group was measured on the 14th day after surgery;the histopathological changes of rat skin flaps were observed by HE staining;the protein expression of p-p65 and p-IκBα in the rat skin flap tissue was detected by Western blot;ELISA method was used to detect the expression of TNF-α,IL-1β,and IL-6 cytokines;Ki67 and CD31 immunohistochemical staining were used to observe epidermal basal layer cell prolifera-tion and vascular regeneration.RESULTS Compared with Model group,MDX-H group and MDX-L group had a small amount of e-dema and inflammatory fluid exudation after surgery,and the scab removal time was advanced;the ischemic necrosis of the skin flap was significantly improved,the area of skin flap necrosis was significantly decreased,and the survival rate of rat skin flaps was signifi-cantly increased(P<0.01).In addition,MDX could significantly improve the pathological morphology of ischemia-reperfusion injury in rat back skin flaps,reduce the expression of p-p65 and p-IκBα proteins(P<0.001),and decrease the levels of TNF-α,IL-1β,IL-6 inflammatory factor levels(P<0.05,P<0.01,P<0.001,P<0.000 1).The differences in Ki67 and CD31 also suggested that treatment with MDX accelerate re-epithelialization and blood vessel formation after ischemic flap injury.CONCLUSION MDX plays a role in improving ischemia-reperfusion injury of skin flaps by regulating the NF-κB signaling pathway and accelerating epithelializa-tion and angiogenesis.

Objective To investigate the effect of age on the incidence of cirrhosis and liver cancer in patients with chronic hepatitis B.Methods 279 patients with chronic hepatitis B were divided into the senior group and the younger group according to the age of the patients.The cumulative incidence of cirrhosis and liver cancer during 25 years of follow-up was calculated by using SPSS and R language through the long-term follow-up of HIS system,and the risk factors were analyzed by multivariate logistic regression.Results During follow-up,24 cases developed cirrhosis and 12 cases developed liver cancer.The cumulative incidence of liver cirrhosis was 1.5%,2.1%,5.4%,11.6%and 15.5%in the 5-year,10-year,15-year,20-year and 25-year group,and 5.5%,9.8%,22.9%,29.0%and 52.1%in the elderly,respectively.The difference between the younger age group and senior age group was statistically significant(P<0.001).A total of 2 risk factors(age and follow-up time)were included in the regression model.Two cases in the younger group developed into liver cancer after 17 and 21 years of follow-up,respectively.The cumulative incidence rates at 5,10,15,20 and 25 years were 1.8%,3.8%,18.5%,21.8%and 26.7%.A total of five factors(initial age,HBV-DNA load,HBV-DNA turned negative before the end-point,follow-up time,and sex)were included in the regression model.Conclusions The incidence of cirrhosis and liver cancer in CHB patients aged≥40 years,especially in male patients,is significantly higher than younger CHB patients.Timely initiation of antiviral therapy can delay disease progression and reduce the incidence of termi-nal liver disease.Whether antiviral therapy should be initiated for people aged 30 to 40 years remains to be studied.

Hypertension has a high prevalence in China, and the predominant reliance on drug treatment consumes enormous medical resources.Physical exercise is the only widely-accepted nonpharmacologic therapy for hypertension and is potentially cost-effective.How to incorporate exercise into a prescription for rational treatment of hypertension is a topic that needs to be addressed.This review examines the research progress on the treatment of hypertension combining physical exercise with anti-hypertensive drugs in elderly people, aiming to provide some information and options to promote personalized treatment strategies for hypertension in elderly people.