OBJECTIVE To investigate the effects and mechanisms of Buyang huanwu decoction （BYHWD） and its active fractions in ameliorating non-alcoholic fatty liver disease. METHODS BYHWD and its effective fractions obtained through ethanol precipitation， as well as 30% ethanol， 50% ethanol， and 75% ethanol fractions （namely， the CC effective fraction， 30YC effective fraction， 50YC effective fraction， and 75YC effective fraction）， were prepared. These preparations were administered to rats via intragastric administration to prepare corresponding drug-containing serum （blank serum and simvastatin-containing serum were prepared using the same protocol）. Human L02 hepatocytes were divided into control group， model group， simvastatin-containing serum group， BYHWD-containing serum group， CC-containing serum group， 30YC-containing serum group， 50YC-containing serum group， and 75YC-containing serum group. Except for the control group， other groups were given 0.2 mol/L oleic acid for 24 h to induce a lipid accumulation model， and then intervened with 20% drug-containing serum/blank serum for 24 h. The lipid deposition in cells was observed， and the proportion of lipid droplet area was calculated； the levels of triglycerides （TG） and indicators of oxidative stress [malondialdehyde （MDA）， superoxide dismutase （SOD）] as well as liver function [alanine amino- transferase （ALT）， aspartate amino-transferase （AST）] in cells were detected； protein and mRNA expressions of AMP-activated protein kinase （AMPK）/sterol regulatory element-binding protein-1 （SREBP-1）/glycerol-3-phosphate acyltransferase （GPAT） signaling pathway were also measured. RESULTS Compared with the control group， cells in the model group exhibited severe cellular steatosis， with a significantly increased proportion of lipid droplet area， as well as the elevated levels of TG， ALT， AST， and MDA in cells， along with significantly up-regulated mRNA and protein expression levels of SREBP-1 and GPAT （P＜0.05）. The level of SOD， mRNA expression of AMPK， as well as the protein phosphorylation level of AMPK were decreased significantly （P＜0.05）. Compared with the model group， cellular steatosis was alleviated in all drug-containing serum groups， and the levels of most of the aforementioned quantitative indicators were significantly reversed （P＜0.05）. CONCLUSIONS BYHWD and its active fractions can exert a therapeutic effect on improving non-alcoholic fatty liver disease by regulating the AMPK/SREBP-1/GPAT signaling pathway， inhibiting oxidative stress responses， and reducing lipid deposition.

As a fundamental aspect of bone fracture treatment, fracture reduction plays a decisive role in restoring the structural integrity and function of bones. At present, fracture reduction techniques mostly rely on semi-automatic interaction methods or healthy-side bone templates for registration, which have many limitations in clinical practice. In order to enhance treatment efficiency and accuracy, an automatic fracture reduction algorithm is proposed. This algorithm utilizes the similarity of fracture cross-sections for registration, thereby reducing the workload of physicians and eliminating the need for a healthy-side bone template. Initially, the closed edge is identified and extracted by analyzing the differences in the fracture surface and the calorific value diagram of the roughness distribution. Next, the fracture section is determined by using the identified closed edge as a guideline for regional expansion and similarity matching. During the registration phase, the iterative closest point (ICP) algorithm is highly sensitive to distance. Therefore, the geometric features of point clouds are incorporated into the objective function of the registration algorithm to mitigate the influence of noise, and fracture section registration is implemented one by one. Finally, the algorithm is tested and compared on 180 simulated datasets and 16 publicly available datasets. The results show that the proposed algorithm significantly improves the registration accuracy, and the registration error of clinical bone fracture cases is controlled within 1.7 mm.
Algorithms ; Fractures, Bone/therapy* ; Humans

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To construct a risk prediction model based on ultrasound signs of prenatal fetal and accessory for adverse pregnancy outcomes of patients with placental implantation disease.Methods:This study is a prospective study.A total of 120 pregnant women who underwent hospital delivery in Tangshan maternal and child health care hospital from January 2022 to June 2023 were selected as the research objects,including 39 cases with placenta implantation and 81 cases without placenta implantation.The cases with placenta implantation were divided into adverse pregnancy group(19 cases)and good pregnancy group(20 cases)according to the different pregnancy outcome.The placental location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line,and cervical sinusoids of all cases were compared.Logistic multivariate analysis was adopted to verify and construct the risk model of placenta implantation and adverse pregnancy outcomes.Results:There was significant difference in placental thickness between the cases with placenta implantation[(37.26±0.52)cm]and the cases without placenta implantation[(36.02±0.25)cm](t=14.127,P<0.05).There were significant differences between the two groups in the placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids(x2=4.061,5.112,8.381,4.771,17.021,32.341,P<0.05),respectively.There was significant difference in placental thickness between the adverse pregnancy group[(36.85±0.42)cm]and the good pregnancy group[(37.45±0.24)cm](t=5.440,P<0.05).There were statistically significant differences between the two groups in the cases number of placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids(x2=6.037,6.041,11.351,6.741,12.321,13.552,P<0.05),respectively.The results of multivariate analysis indicated that placental thickness,placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids were the risk factors for placenta implantation of pregnant women(OR=3.300,3.374,2.995,3.384,2.843,2.878,3.053,P<0.05),respectively.Placental thickness,placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids were respectively the risk factors that caused adverse pregnancy outcomes for pregnant women(OR=2.821,2.886,3.287,3.377,2.942,3.177,3.168,P<0.05).The result of receiver operating characteristic(ROC)curve indicated that the area under curve(AUC)values of the above model for placenta implantation and adverse pregnancy outcome were larger than 0.700.Conclusion:The prediction based on the model of ultrasound signs of prenatal fetal and accessory is more accurate,which can be used as important reference in clinically early diagnosis.

Objective:To establish a quantitative analysis of multi-components by single marker(QAMS)for the determination of 6 alkaloid components,which is benzoylmesaconine,benzoyl-hypaconine,benzoylaconine,mesaconitine,hypaconitine,and aconitine in Zhachong Shisanwei Pills,and prove the scientificity and feasibility of the method in the quality analysis.Methods:The chromatographic separation was performed on an Agilent Eclipse Plus C18(250 mm×4.6 mm,5 μm)with gradient elution using 0.1 mol·L-1 ammonium acetate(0.5 mL of gla-cial acetic acid per 1 000 mL)(A)-acetonitrile:tetrahydrofuran(25∶15)(B),as the mobile phase(0-50 min,18%B-28%B),the detection wavelength was switched from 235 nm,the column temperature was kept at 40℃and the flow rate was 1.0 mL·min-1.The relative correction factors(fs/i)were established with the other 5 compo-nents to be measured using benzoylaconine as the internal reference,which were used to calculate the mass fraction of each component.At the same time,the mass fractions of the 6 effective constituents in Zhachong Shisanwei Pills were calculated by the external standard method(ESM).By comparing the content results of ESMand QAMS,the accura-cy of QAMS method were evaluated.Results:The relative correction factors(fs/i)of benzoylmesaconine,benzoylhyp-aconine,mesaconitine,hypaconitine,and aconitine in Mongolian medicine Zhachong Shisanwei Pills were reproduci-ble with good reproducibility,which were 0.680 4,0.450 6,0.850 8,0.676 1 and 0.757 0,the result obtained by QAMS approximated those obtained by external standard method(ESM).Conclusion:The method is simple,stable and reproducible,and can be used for the quality control of 6 alkaloid components in Zhachong Shisanwei Pills.

Objective:To analyze the feasibility and safety of laparoscopic transhepatic section biliary exploration without T-tube drainage in the treatment of intrahepatic and extrahepatic bile duct stones.Methods:A retrospective analysis was conducted on the clinical data of 200 patients with intrahepatic and extrahepatic bile duct stones who underwent surgical treatment in Ankang Central Hospital from January 2020 to December 2024, including 79 males and 121 females, with the average age of (64.1±6.1) years. Among the 200 patients, 100 underwent laparoscopic hepatectomy and stone removal through transhepatic section cholangiography and choledochoscopy and were included in the observation group. Another 100 patients underwent laparoscopic hepatectomy, common bile duct incision, choledochoscopic exploration and stone removal, and T-tube drainage and were included in the control group. The intraoperative blood loss, operation time, postoperative hospital stay, hospitalization cost, postoperative pain score, time to get out of bed and move around, recovery time of intestinal function, abdominal drainage time, total complication rate, recurrence of stones, biliary tract infection, etc. were compared between the two groups.Results:The operation time, intraoperative blood loss, postoperative hospital stay and hospitalization cost of the observation group (165.8±29.9 min, 158.9±23.7 ml, 8.8±1.8 d and 46, 037.8±312.6 yuan, respectively) were all lower than those of the control group (220.3±37.5 min, 232.5±36.7 ml, 12.5±2.5 d, and 57 006.2±528.5 yuan) and the differences were statistically significant (all P<0.05). The postoperative pain score of the control group was (4.8±1.3) points, the postoperative time to get out of bed for activities was (1.6±0.5) d, the postoperative recovery time of intestinal function was (3.2±0.7) d, and the abdominal drainage time was (5.0±0.8) d. All were higher than those of the observation group (3.2±0.8) points, (0.8±0.2) d, (1.8±0.5) d, and (2.5±0.6) d, and the differences were statistically significant (all P<0.05). The total incidence of complications, recurrence of stones and infection rate of biliary tract in the observation group were 6.0%(6/100), 3.0%(3/100) and 2.0%(2/100) respectively, which were lower than those in the control group at 36.0%(36/100), 11.0%(11/100) and 9.0%(9/100). The differences were all statistically significant (all P<0.05). Conclusion:Laparoscopic transhepatic section biliary exploration without T-tube drainage for the treatment of intrahepatic and extrahepatic bile duct stones is feasible and safe.

Objective To analyze the influencing factors of cholecystolithiasis among Tibetan residents living at extreme altitude.Methods From Aug.10 to 17,2023,Nima County People's Hospital in Nagqu,in collaboration with Tibetan-aid doctors,organized physical examinations for Tibetan residents in Jiwa Township.The physical examination data were collected,and the general information and dietary habits of the examinees were recorded.Based on the results of abdominal ultrasound examination,the 448 enrolled participants were assigned to a cholecystolithiasis group(106 cases)and a non-cholecystolithiasis group(342 cases).Additionally,multivariable logistic regression analysis was conducted to investigate the factors influencing the occurrence of cholecystolithiasis among Tibetan residents.Results There were significant differences in age,weight,body mass index,systolic blood pressure,diastolic blood pressure,finger pulse oxygen,and educational level between the 2 groups(all P＜0.05).The results of multivariate logistic regression analysis showed that age(odds ratio[OR]=1.062,95％confidence interval[CI]1.020-1.106),weight(OR=1.120,95％CI 1.067-1.176),smoking(OR=4.751,95％CI 1.627-13.869),cholesterol(OR=1.429,95％CI 1.129-1.810),amount of butter tea drink(OR=2.123,95％CI 1.656-2.721),alanine transaminase(OR=1.045,95％CI 1.028-1.062),low educational level(OR=6.994,95％CI 2.615-18.702),fatty liver(OR=4.409,95％CI 1.499-12.968)and meat-based diet(OR=3.725,95％CI 1.255-11.055)were correlated with cholecystolithiasis.Conclusion The incidence of cholecystolithiasis among Tibetan residents living at extreme altitude may be related to various factors mentioned above,which provides clues for the prevention,early diagnosis,and treatment of local cholecystolithiasis.

Objective:To establish a quantitative analysis of multi-components by single marker(QAMS)for the determination of 6 alkaloid components,which is benzoylmesaconine,benzoyl-hypaconine,benzoylaconine,mesaconitine,hypaconitine,and aconitine in Zhachong Shisanwei Pills,and prove the scientificity and feasibility of the method in the quality analysis.Methods:The chromatographic separation was performed on an Agilent Eclipse Plus C18(250 mm×4.6 mm,5 μm)with gradient elution using 0.1 mol·L-1 ammonium acetate(0.5 mL of gla-cial acetic acid per 1 000 mL)(A)-acetonitrile:tetrahydrofuran(25∶15)(B),as the mobile phase(0-50 min,18%B-28%B),the detection wavelength was switched from 235 nm,the column temperature was kept at 40℃and the flow rate was 1.0 mL·min-1.The relative correction factors(fs/i)were established with the other 5 compo-nents to be measured using benzoylaconine as the internal reference,which were used to calculate the mass fraction of each component.At the same time,the mass fractions of the 6 effective constituents in Zhachong Shisanwei Pills were calculated by the external standard method(ESM).By comparing the content results of ESMand QAMS,the accura-cy of QAMS method were evaluated.Results:The relative correction factors(fs/i)of benzoylmesaconine,benzoylhyp-aconine,mesaconitine,hypaconitine,and aconitine in Mongolian medicine Zhachong Shisanwei Pills were reproduci-ble with good reproducibility,which were 0.680 4,0.450 6,0.850 8,0.676 1 and 0.757 0,the result obtained by QAMS approximated those obtained by external standard method(ESM).Conclusion:The method is simple,stable and reproducible,and can be used for the quality control of 6 alkaloid components in Zhachong Shisanwei Pills.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To construct a risk prediction model based on ultrasound signs of prenatal fetal and accessory for adverse pregnancy outcomes of patients with placental implantation disease.Methods:This study is a prospective study.A total of 120 pregnant women who underwent hospital delivery in Tangshan maternal and child health care hospital from January 2022 to June 2023 were selected as the research objects,including 39 cases with placenta implantation and 81 cases without placenta implantation.The cases with placenta implantation were divided into adverse pregnancy group(19 cases)and good pregnancy group(20 cases)according to the different pregnancy outcome.The placental location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line,and cervical sinusoids of all cases were compared.Logistic multivariate analysis was adopted to verify and construct the risk model of placenta implantation and adverse pregnancy outcomes.Results:There was significant difference in placental thickness between the cases with placenta implantation[(37.26±0.52)cm]and the cases without placenta implantation[(36.02±0.25)cm](t=14.127,P<0.05).There were significant differences between the two groups in the placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids(x2=4.061,5.112,8.381,4.771,17.021,32.341,P<0.05),respectively.There was significant difference in placental thickness between the adverse pregnancy group[(36.85±0.42)cm]and the good pregnancy group[(37.45±0.24)cm](t=5.440,P<0.05).There were statistically significant differences between the two groups in the cases number of placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids(x2=6.037,6.041,11.351,6.741,12.321,13.552,P<0.05),respectively.The results of multivariate analysis indicated that placental thickness,placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids were the risk factors for placenta implantation of pregnant women(OR=3.300,3.374,2.995,3.384,2.843,2.878,3.053,P<0.05),respectively.Placental thickness,placenta location,posterior low gyrus vocal cords of placenta,placental multiple lacunae,basal blood vessels,bladder line and cervical sinusoids were respectively the risk factors that caused adverse pregnancy outcomes for pregnant women(OR=2.821,2.886,3.287,3.377,2.942,3.177,3.168,P<0.05).The result of receiver operating characteristic(ROC)curve indicated that the area under curve(AUC)values of the above model for placenta implantation and adverse pregnancy outcome were larger than 0.700.Conclusion:The prediction based on the model of ultrasound signs of prenatal fetal and accessory is more accurate,which can be used as important reference in clinically early diagnosis.