This paper summarizes Professor SHI Zaixiang's clinical experience in treating high fever caused by sepsis using Chaihu Guizhi Ganjiang Decoction （柴胡桂枝干姜汤）. He holds that the key pathogenesis of sepsis involves constrained heat in the shaoyang and internal accumulation of water and fluids. The clinical manifestations such as high fever， chills， and alternating sensations of cold and heat are attributed to pathogenic heat constrained in the shaoyang. Meanwhile， soft tissue edema and serous cavity effusions are due to shaoyang dysfunction and internal water retention. In clinical practice， treating sepsis-related high fever requires addressing both the shaoyang-constrained heat and the associated edema and effusions. The therapeutic approach focuses on harmonizing the shaoyang and resolving internal fluids， using Chaihu Guizhi Ganjiang Decoction as the base formula with flexible modifications. Professor SHI emphasizes that this formula shows a rapid antipyretic effect， particularly in cases where multiple anti-infective treatments have failed.

Objective:To investigate the impact of non-alcoholic fatty liver disease (NAFLD) on the outcome of patients with acute ischemic stroke (AIS).Methods:Patients with AIS visited the Affiliated Jiangning Hospital of Nanjing Medical University between June 2017 and December 2023 were included retrospectively. At 3 months after onset, the modified Rankin Scale was used to evaluate the outcome, with scores of 0-2 defined as good outcome and >2 defined as poor outcome. Multivariate logistic regression analysis was used to determine the impact of NAFLD on the outcome of patients with AIS. Results:A total of 143 patients with AIS were enrolled, including 95 males (66.43%), aged 67.79±11.15 years. Ninety six patients (67.13%) had good outcome, and 47 (32.87%) had poor outcome. Multivariate logistic regression analysis showed that after adjusting for confounding factors, NAFLD was independently associated with the poor outcome in patients with AIS (odds ratio 2.500, 95% confidence interval 1.015-6.161; P=0.046). Conclusion:NAFLD is an independent risk factor for poor outcome in patients with AIS.

Objective:To change the current situation that immune molecules presented only by schematic diagram or static model in the textbook of Medical Immunology,and to present the specific and vivid molecular morphology and functions to students.And set up corresponding elective course to let students personally explore the structure and function of immune molecules.Methods:On one hand,the teaching team applied the molecular simulation technology of scientific research to the production of teaching materi-als for the specific morphology,structural characteristics and functions of immune molecules,which were used in the teaching of medi-cal immunology for medical undergraduates majoring in clinical,oral and preventive medicine.On the other hand,a related elective course research on the love of molecule was opened to give students the opportunity to operate relevant software by themselves and learn the structure and function of immune molecules.Results:The application of molecular simulation in teaching improved teachers'teaching ability,strengthened teachers'immunology knowledge,enhanced the interaction between teachers and students,and achieved good teaching results.Conclusion:It is feasible to apply molecular simulation technology to medical immunology teaching for undergraduates,which can improve the teaching quality.

The evaluation, diagnosis, real-time monitoring, and guided operation conducted by ultrasound specialist nurses in acute and critical care can provide an objective basis for nursing decision-making, which is of great significance for optimizing nursing procedures and improving the survival rate and rehabilitation rate of patients. This paper summarizes the concept, origin, training status, and practice scope of ultrasound specialist nurses in the field of acute and critical care and puts forward the prospect of development in order to provide a reference for the training of ultrasound specialist nurses in the field of acute and critical care in China.

Objective:To explore the white matter structural characteristics in patients with bipolar disorder(BD)using diffusion tensor imaging(DTI)and investigate their relationship with cognitive function.Methods:A total of 15 patients with BD type Ⅰ and 26 patients with BD type Ⅱ who met the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)diagnostic criteria and 37 normal controls were included.Cognitive function was assessed with the Trail Making Test(TMT)and Repeatable Battery for the Assessment of Neuropsy-chological Status(RBANS).The tract-based spatial statistics(TBSS)method was used to explore the differences in fractional anisotropy(FA)and mean diffusivity(MD)among the three groups and perform correlation analyses with cognitive function.Results:Patients with BD Ⅰ and BD Ⅱ had lower scores in attention(P＜0.001),delayed memory(P＜0.01),and total scores(P＜0.001)on the RBANS compared to the normal control group.They also exhibited lower FA values in the corpus callosum and right superior corona radiata compared to the normal control group(P＜0.05).In the BD Ⅰ group,there was a positive correlation between FA values in the genu of corpus cal-losum and visuospatial/constructional scores(r=0.74,P＜0.05),while in the BD Ⅱ group,a positive correlation was found between FA values in the same region and language function scores(r=0.55,P＜0.05).Conclusion:It suggests that patients with bipolar disorder may have impaired white matter integrity in the corpus callosum and right superior corona radiata,which may be associated with cognitive impairment.

Objective To develop a whole course management information system for breast cancer and verify its effect in disease management of breast cancer patients.Methods An integrated service plan and system construction of"screening-diagnosis-treatment-rehabilitation"was developed,and then an information system was developed.The method of historical control was used to conveniently sample 260 cases of breast cancer patients diagnosed in a tertiary A hospital.130 cases diagnosed from May 1 to December 31,2022 were taken as a test group,and 130 cases diagnosed from May 1 to December 31,2021 were taken as a control group.The test group was managed by the whole course management information system,and the control group was managed by conventional disease management.The relevant indicators of the screening and diagnosis period of patients,the completion rate of treatment,the incidence of treatment related side effects and the cancer care satisfaction of the 2 groups were compared.Results There was a statistically significant difference in puncture waiting time,admission waiting time,and screening admission time between the 2 groups(P＜0.05),while there was no statistically significant difference in pathological waiting time(P＞0.05).The treatment completion rate of the test group was higher(P＜0.05).The incidence of lymphedema,chest obstruction and abnormal sensation of upper limbs,subcutaneous hydrops within 6 months after operation and bone marrow suppression,liver function damage,radiation dermatitis and radiation pneumonia in the test group were lower than those in the control group(P＜0.05).The cancer care satisfaction of the test group after surgery and 6 months after surgery were higher than those of the control group(P＜0.05).Conclusion The whole course management information system for breast cancer can optimize the diagnosis and treatment process,raise the diagnosis and treatment efficiency,ensure the treatment completion rate,reduce the treatment complications and improve the cancer care satisfaction.

Benign prostatic hyperplasia(BPH)is one of the major chronic complications of type 2 diabetes mellitus(T2DM),and sex steroid hormones are common risk factors for the occurrence of T2DM and BPH.The profiles of sex steroid hormones are simultaneously quantified by LC-MS/MS in the clinical serum of patients,including simple BPH patients,newly diagnosed T2DM patients,T2DM complicated with BPH patients and matched healthy individuals.The G protein-coupled estrogen receptor(GPER)inhibitor G15,GPER knockdown lentivirus,the YAP1 inhibitor verteporfin,YAP1 knockdown/overexpression lentivirus,targeted metabolomics analysis,and Co-IP assays are used to investigate the molecular mechanisms of the disrupted sex steroid hormones homeostasis in the pathological process of T2DM complicated with BPH.The homeostasis of sex steroid hormone is disrupted in the serum of patients,accompanying with the proliferated prostatic epithelial cells(PECs).The sex steroid hormone metabolic profiles of T2DM patients complicated with BPH have the greatest degrees of separation from those of healthy individuals.Elevated 17β-estradiol(E2)is the key contributor to the disrupted sex steroid hormone homeostasis,and is significantly positively related to the clinical characteristics of T2DM patients complicated with BPH.Activating GPER by E2 via Hippo-YAP1 signaling exacerbates high glucose(HG)-induced PECs prolifer-ation through the formation of the YAP1-TEAD4 heterodimer.Knockdown or inhibition of GPER-mediated Hippo-YAP1 signaling suppresses PECs proliferation in HG and E2 co-treated BPH-1 cells.The anti-proliferative effects of verteporfin,an inhibitor of YAP1,are blocked by YAP1 overexpression in HG and E2 co-treated BPH-1 cells.Inactivating E2/GPER/Hippo/YAP1 signaling may be effective at delaying the progression of T2DM complicated with BPH by inhibiting PECs proliferation.

Objective:To measure the overall and lobulated volume of the liver with different degrees of liver fibrosis and to further observe pathological changes such as liver microvasculature, hepatocyte apoptosis, and regeneration in order to understand the macroscopic volume changes of the liver during liver fibrosis and its relationship with liver tissue microscopic pathology in patients with chronic liver disease.Methods:53 patients with chronic hepatitis B, alcoholic fatty liver disease, autoimmune liver disease, nonalcoholic fatty liver disease, and drug-induced chronic liver disease who underwent both liver biopsy tissue and abdominal magnetic resonance imaging were collected. Patients were divided into early (F1-2), middle (F3-4), and late (F5-6) in accordance with the Ishak fibrosis stage and Masson stain. The liver and spleen volumes were measured using ITK-SNAP software. CD31 immunohistochemical staining was used to reflect intrahepatic angiogenesis. Ki67 and HNF-4α multiplex immunohistochemical staining were used to reflect hepatocyte regeneration. GS staining was used to determine parenchymal extinction lesions. TUNEL staining was used to observe hepatocyte apoptosis. Spearman correlation analysis was used to analyze the relationship between liver volume changes and liver histopathological changes.Results:As liver fibrosis progressed, the total liver volume and right lobe liver volume gradually decreased ( P<0.05), while the spleen volume gradually increased ( P<0.05). The expression of CD31 and GS gradually increased ( P<0.05), and the expression of Ki67 first increased and then decreased ( P<0.05). The positivity rate of CD31 was negatively correlated with the right lobe liver volume ( r=-0.609, P<0.001) and the total liver volume ( r=-0.363, P=0.017). The positivity rate of Ki67 was positively correlated with the right lobe liver volume ( r=0.423, P=0.018), while the positivity rate of apoptotic cells was significantly negatively correlated with the total liver volume ( r=-0.860, P<0.001). The positivity rate of GS was negatively correlated with the right lobe liver volume ( r=-0.440, P=0.002), and the number of PELs was negatively correlated with RV ( r=-0.476, P=0.013). The CD31 positive staining area was negatively correlated with the Ki67 positive staining area( r=-0.511, P=0.009). Conclusion:As liver fibrosis progresses, patients with chronic liver disease have a depletion in total liver volume and right lobe liver volume, and this is mainly in correlation with fewer liver cells and liver tissue microvasculature disorders.

Objective:To explore the improvement of image quality of different acceleration factors in breath-hold three-dimensional magnetic resonance cholangiopancreatography (3D MRCP) using deep learning (DL) and compressed sensing (CS) technology.Methods:A total of 68 patients who underwent upper abdominal 3D MRCP examination at West China Hospital of Sichuan University from March to August 2023 were prospectively included. The patients were subdivided into three groups randomly with the following paramters: CS group with an acceleration factor of 24 (CS-24); DL-CS group with acceleration factors 24 (DL-CS-24) and 33 (DL-CS-33) respectively. The signal-to-noise ratio (SNR), contrast ratio (CR) and contrast-to-noise ratio (CNR) of the three sets of images were measured, and the overall image quality, background suppression, artifacts, and visibility of bile ducts and pancreatic ducts at all levels were subjectively evaluated. Chi-square test and Friedman test were used to perform statistical analysis on the number of unsatisfactory diagnostic images and subjective and objective indicators of the three groups of sequences respectively.Results:The scanning time of the DL-CS-33 group (9 s) was 30% shorter than that of the CS-24 group and DL-CS-24 group (13s). The images of DL-CS-33 group from 68 patients all met the clinical diagnostic requirements and statistically differences were found between the images from CS-24 group and DL-CS-24 group (all P<0.05). There were no statistically differences in SNR, CR, CNR, overall image quality, artifacts, and visibility scores of bile ducts and pancreatic ducts at all levels between the DL-CS-33 group and the CS-24 group (all P>0.05). The SNR, CR, CNR, intrahepatic bile duct, main pancreatic duct and overall image quality of the DL-CS -24 group were better than those of the CS-24 group (all P<0.05). Conclusions:DL-CS technology could improves breath-hold 3D MRCP image quality with the 24 acceleration factor with no additioanl scanning time. DL-CS technology combined with a high acceleration factor of 33 further reduces scanning time while ensuring overall image quality, providing a fast breath-hold scanning solution.

BACKGROUND:Human plantar pressure can reflect the health status of the lower limbs and even the whole body,which is an important basis for gait analysis,and body mass index is an important influencing factor. OBJECTIVE:To investigate the effect of body mass index on plantar pressure. METHODS:Twenty young college students from Xuzhou Medical University,including 10 males and 10 females aged 19-21 years,were selected as test subjects and divided into three groups according to the body mass index value:overweight group(body mass index>25 kg/m2,n=3),lean group(body mass index<18 kg/m2,n=4),and normal group(body mass index 18-25 kg/m2,n=13).A natural walking gait test was carried out on the three groups of subjects with a Zebris pressure distribution measurement plate to obtain the complete gait cycle parameters.The time proportion of support time phase,peak pressure,time to peak force,peak force and impulse volume were analyzed and the correlation between each parameter and the body mass index was analyzed by Person analysis. RESULTS AND CONCLUSION:(1)Compared with the other two groups,the time proportion of support time phase of subjects in the overweight group was relatively small,while the time proportion in the foot heel contact period and forefoot extension period was relatively large.There was a positive correlation of the time proportion of the foot heel contact period and forefoot extension period with body mass index,while there was a negative correlation between the time proportion of the arch support period and body mass index.(2)The peak pressure of the left arch and palm of the foot of the subjects of the overweight group was higher than that of the normal group,and the peak pressure of the left and right palm of the foot of the lean group was lower than that of the normal group.The peak pressure was positively correlated with the body mass index during the foot heel contact period.There was a significant positive correlation between the peak pressure of the left foot and body mass index during the arch support period as well as the peak pressure of both feet and body mass index during the forefoot extension period.(3)Plantar peak force time in the order of the gait cycle in increasing order:heeltoe/middle 2-4 metatarsal>lateral heel>medial and lateral metatarsal>arch;medial heel peak force was the largest,and the arch peak force was the smallest.Except for the toe of the left foot,there was a significant positive correlation between peak force and body mass index.(5)The maximum ground impulse of the lean group and the overweight group was in the foot heel contact stage,the minimum ground impulse was in the forefoot extension period,and the minimum ground impulse of the arch was in the normal group.There was a significant positive correlation between ground impulse and body mass index at different periods.(6)The results show that young people should control their body mass index,wear appropriate shoes,protect their feet and ankles,and prevent the occurrence of flat feet.