Objective To construct large medical model named by "Huaxi HongYi"and explore its application effectiveness in assisting medical record generation. Methods By the way of a full-chain medical large model construction paradigm of "data annotation - model training - scenario incubation", through strategies such as multimodal data fusion, domain adaptation training, and localization of hardware adaptation, "Huaxi HongYi" with 72 billion parameters was constructed. Combined with technologies such as speech recognition, knowledge graphs, and reinforcement learning, an application system for assisting in the generation of medical records was developed. Results Taking the assisted generation of discharge records as an example, in the pilot department, after using the application system, the average completion times of writing a medical records shortened (21 min vs. 5 min) with efficiency increased by 3.2 time, the accuracy rate of the model output reached 92.4%. Conclusion It is feasible for medical institutions to build independently controllable medical large models and incubate various applications based on these models, providing a reference pathway for artificial intelligence development in similar institutions.

Sennoside A (SA), a typical prodrug, exerts its laxative effect only after its transformation into rheinanthrone catalyzed by gut microbial hydrolases and reductases. Hydrolases have been identified, but reductases remain unknown. By linking a photoreactive group to the SA scaffold, we synthesized a photoaffinity probe to covalently label SA reductases and identified SA reductases using activity-based protein profiling (ABPP). From lysates of an active strain, Bifidobacterium pseudocatenulatum (B. pseudocatenulatum), 397 proteins were enriched and subsequently identified using mass spectrometry (MS). Among these proteins, chromate reductase/nicotinamide adenine dinucleotide (NADH) phosphate (NADPH)-dependent flavin mononucleotide (FMN) reductase/oxygen-insensitive NADPH nitroreductase (nfrA) was identified as a potent SA reductase through further bioinformatic analysis and The Universal Protein Resource (UniProt) database screening. We also determined that recombinant nfrA could reduce SA. Our study contributes to further illuminating mechanisms of SA transformation to rheinanthrone and simultaneously offers an effective method to identify gut bacterial reductases.

The comprehensive detection and identification of active ingredients in complex matrices is a crucial challenge.Liquid chromatography coupled with high-resolution mass spectrometry(LC-HRMS)is the most prominent analytical platform for the exploration of novel active compounds from complex matrices.However,the LC-HRMS-based analysis workflow suffers from several bottleneck issues,such as trace content of target compounds,limited acquisition for fragment information,and uncertainty in interpreting relevant MS2 spectra.Lycibarbarspermidines are vital antioxidant active ingredients in Lycii Fructus,while the reported structures are merely focused on dicaffeoylspermidines due to their low content.To comprehensively detect the new structures of lycibarbarspermidine derivatives,a"depict"strategy was developed in this study.First,potential new lycibarbarspermidine derivatives were designed according to the biosynthetic pathway,and a comprehensive database was established,which enlarged the coverage of lycibarbarspermidine derivatives.Second,the polarity-oriented sample prep-aration of potential new compounds increased the concentration of the target compounds.Third,the construction of the molecular network based on the fragmentation pathway of lycibarbarspermidine derivatives broadened the comprehensiveness of identification.Finally,the weak response signals were captured by data-dependent scanning(DDA)followed by parallel reaction monitoring(PRM),and the efficiency of acquiring MS2 fragment ions of target compounds was significantly improved.Based on the integrated strategy above,210 lycibarbarspermidine derivatives were detected and identified from Lycii Fructus,and in particular,170 potential new compounds were structurally characterized.The integrated strategy improved the sensitivity of detection and the coverage of low-response components,and it is expected to be a promising pipeline for discovering new compounds.

Objective To investigate the viability and safety of laparoscopic sleeve gastrectomy(LSG)based on the TJ point at the junction of the posterior gastric wall and the apex of the medial edge of the left diaphragm.Methods A retrospective analysis of 135 patients with obesity or obesity with metabolic syndrome who underwent LSG from January 2019 to January 2022 were divided into two groups according to the different free modes of fundogastric body.68 patients underwent surgery using the TPOL model LSG.A control group of 67 patients was treated with conventional LSG surgery.To analyze and compare the duration of operation,gastric fundus free time,intraoperative blood loss time,hospital stay time,postoperative gastric fistula,bleeding rate,and occurrence of gastroesophageal reflux disease(GERD)between the two groups.Results All patients successfully completed LSG surgery and were safely discharged.They were followed for a period of 12 to 36 months.the duration of operation for the study group was(56.13±10.56)minutes,while for the control group it was(62.45±12.74)minutes.The gastric fundus was freed in(6.34±4.16)minutes for the study group and(12.58±6.37)minutes for the control group.The duration of hospitalization was(3.84±0.42)days for the study group and(4.06±0.69)days for the control group.The intraoperative blood loss was(10.87±1.28)ml for the study group and(15.56±3.39)ml for the control group.The incidence of postoperative GERD was 5(7.35％)for the study group and 13(19.40％)for the control group.The differences between the two groups were statistically significant(P＜0.05).The decrease in excess weight at 12 months after surgery,as well as complications such as bleeding and gastric fistula,were not statistically significant(P＞0.05).Conclusion LSG(TPOL model)extends from the TJ point(the Tri-junction point where the gastric left mesangium,gastric posterior mesangium,and pancreatic mesangium meet)to the apex of the medial foot edge of the left diaphragm.LSG(TPOL model)can be efficiently and safely achieve tension-free anastomosis,resulting in a complete free gastric fundus.This method is feasible,and has clinical value for the standardized free gastric fundus of LSG.

Objective:To explore the application effect of the goal-oriented comprehensive teaching method in the rotation of breast surgery residents.Method:A total of 40 residents who rotated in the Department of Breast Surgery of Xiangya Hospital of Central South University from January 2019 to January 2020 were selected as the control group, and another 41 residents who rotated from February 2020 to February 2021 were selected as the study group. The control group adopted the traditional teaching method, while the study group adopted the goal-oriented comprehensive teaching method. The scores of theory and skill operation examination after teaching, nurses' clinical ability before and after teaching and satisfaction with teaching were compared between the two groups. SPSS 25.0 was used for independent sample t test, paired t test and chi-square test. Results:After teaching, the scores of theory and skill operation in the study group were significantly higher than those in the control group [(86.19±4.64) vs. (79.27±5.36), (89.32±5.47) vs. (84.51±6.22)], with statistical differences ( P<0.05). After teaching, the scores of clinical abilities of the two groups were higher than those before teaching ( P<0.05), and the scores of clinical abilities of the study group were higher than those in the control group, with statistical differences ( P<0.05). The satisfaction with teaching form, content, effect and comprehensive evaluation of the study group were higher than that of the control group, with statistical differences ( P<0.05). Conclusion:The application of the goal-oriented comprehensive teaching method in the teaching of rotation training of residents in the department of breast surgery can enhance their learning and mastering of theoretical knowledge, operational skills and the cultivation of clinical ability, and improve the teaching quality, with high teaching satisfaction.

Objective To explore the application value of tissue dispersion quantitative analysis in rat liver fibrosis stages and provide a reference for clinical non-invasive diagnosis of liver fibrosis.Methods Seventy-two male Wistar rats were randomly divided into experimental group (n =64) and control group (n =8).The experimental groups of rats were gavaged with the volume fraction of 60％ CCl4 olive oil solution to form different stages of liver fibrosis,the control group did wvith normal saline,All the rat underwent tissue dispersion quantitative analysis to obtain 12 elastic parameters,the differences in above parameters were compared among rats with different liver fibrosis stages,then the correlation with pathological stages were analyzed.Results Except for COMP,ASM,CORR,there were significant differences in all parameters among rats of different liver fibrosis (P ＜0.05),which were correlated with pathological stages(P ＜0.05).Among these parameters,％ AREA had the highest correlation coefficient (r =0.891,P =0.001).The ROC curve was made by ％AREA to estimate the fibrosis stage.the area under ROC curve for ％ AREA was 0.914 (≥ the control group + S0),0.963 (≥early liver fibrosis S1 + S2),0.969 (≥middle liver fibrosis S3),0.948 (early cirrhosis S4),respectively.Conclusions The technique of tissue dispersion quantitative analysis has a good evaluation value for liver fibrosis stages,it is able to provide a preliminary reference for clinical non-invasive diagnosis of liver fibrosis.

Objective To explore the role of matrix metalloproteinase 9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1)in patients with acute exacerbation of severe chronic obstructive pulmonary diseases (AECOPD)treated with glucocorticoids.Methods The serum levels of MMP-9 and TIMP-1 were measured by ELISA in 41 patients with AECOPD before and after treatment with glucocorticoids and in 40 patients with regular methods(control group).Results ①After treatment with glucocorticoids,the serum levels of MMP-9(189.25±52.38)μg/L、TIMP-1(198.38±43.45)μg/L,ratio of MMP-9/TIMP-1(0.92±0.37)were decreased significantly than before((246.10±68.64)μg/L,(217.63±62.34)μg/L,(1.09±0.23))(P<0.01,P<0.05,P<0.05);but there were no differences(P>0.05)in regular methods(control group);② After treatment with glucoeorticoids, FEV_1、FEV_1%((0.83±0.35)L,(46±17)%)were impmved than before((0.72±0.48)L,(34±15)%)(P<0.05).Conclusions After treatment with glucocorticoids,the serum levels of MMP-9、TIMP-1、ratio of MMP-9/TIMP-1 from patients with COPD were decreased significandy,and FEV_1、FEV_1%were improved significant;Glucocorticoids can alleviate severs AECOPD to some degrees,which might be related to improving the imbalance of MMP-9/TIMP-1.

Objective To explore the relationship of neutrophil and interleukin-8(IL-8)with exercise-induced asthma(EIA).Methods From May 15,2001 to Dec 19.2005 the levels of peripheral neutrophil superoxide anion and IL-8 in the blood and the induced sputum from patients with EIA,non EIA and normal control subjects were measured respectively before and after exercises,meanwhile a comparison was made among them.Results Before exercise:the level of neutrophil superoxide anion was slightly higher in EIA group and non EIA group than that in control group;however,the differences were insignificant;the IL-8 and MDA levels in blood and induced sputum were higher in EIA group and non EIA group than those in control group,but there was no significant difference between EIA group and non EIA group;however,they were significantly different between EIA group and control group,non EIA group and control group respectively( P 0.05).Conclusion Oxyradical produced by neutrophil and IL-8 has significant effect on the production of EIA.

Objective To study the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the lung tissues of smoking cessation rat model. Methods Fifty Wistar rats were randomly divided into the normal control rats which were exposed to room air for 4 and 6 months respectively(groups A and C), the smoking rats which were exposed to cigarette smoke for 4 and 6 month respectively(groups B and D), and the smoking cessation group which was exposed to room air for 2 months after 4 months' smoke exposure.The expressions of mRNA and proteins of MMP-9 and TIMP-1 in the lung tissues were detected by in situ hybridization and immunohistochemistry respectively. The collagen Ⅳ expression in the lung tissues was assessed by immunohistochemistry. Results Compared with groups A and C, the expression levels of MMP-9 and TIMP-1 in the lung tissues of groups B and D significantly elevated(P

Objective To investigate influences of nasal continuous positive airway pressure to sleep architecture of obstructive sleep apnea syndrome and the reason of daytime sleepiness. Methods 34 patients with severe OSAS were monitored with polysomnography (PSG) before and after nCPAP treatment. Results Apnea hypoventilation index (AHI) decreased and the lowest SaO2 increased and sleep architecture was improved in all patients. Conclusion The nCPAP therapy can effectively improve the disturbances of sleep architecture and respiratory parameters.