OBJECTIVE To investigate the mechanism of Huangqin decoction in improving ulcerative colitis （UC） through the gut microbiota-tryptophan metabolism-aryl hydrocarbon receptor （AhR） axis. METHODS Mice were randomly divided into normal group （normal saline）， model group （normal saline）， microbiota depletion-model group （normal saline）， microbiota depletion-Huangqin decoction group （9.1 g/kg， by crude drug， similarly hereinafter）， Huangqin decoction group and mesalazine group （positive control group， 0.4 g/kg）， with 6 mice in each group. Microbiota depletion was achieved by providing free access to a mixed antibiotics for 10 days. The UC model was induced by administering 2.5% dextran sulfate sodium solution for 7 days. After successful modeling， each treatment group received corresponding drugs or normal saline intragastrically once daily for 10 days. After the final administration， body weight change ratio， disease activity index （DAI） score， and colon length were evaluated； colon pathological changes were observed； serum levels of interleukin-6 （IL-6）， IL-10， IL-22， and tumor necrosis factor-α （TNF-α） were measured； the expressions of Occludin， zonula occluden-1 （ZO-1）， and AhR in colon tissue were detected； fecal samples were subjected to high-throughput sequencing to analyze targeted tryptophan metabolomics. RESULTS Compared with the model group， Huangqin decoction group showed reduced infiltration of inflammatory cells in the colon tissue and restoration of the intestinal mucosal structure. Body weight change ratio， colon length， serum content of IL-10， the expressions of Occludin， ZO-1 and AhR in colon tissue and the contents of tryptophan metabolites indole-3-propionic acid （IPA）， N -acetylserotonin （NAS） and indole-3-acetic acid （IAA） were all significantly increased （ P ＜0.05）； DAI score， serum levels of IL-6， TNF-α， and IL-22 and the content of tryptophan metabolite indole-3-ethanol were significantly decreased （ P ＜0.05）； gut microbiota structure was improved， with increased relative abundances of beneficial bacteria such as Lactobacillus ， and decreased relative abundances of pathogenic bacteria such as Escherichia-Shigella . However， after antibiotic-induced microbiota depletion， although Huangqin decoction significantly increased the content of NAS in the feces of mice， the expression of AhR protein in colon tissue did not increase concurrently. CONCLUSIONS Huangqin decoction can repair the intestinal mucosal barrier in UC mice by regulating the gut microbiota and promoting the production of IPA and IAA， thereby activating AhR. This suggests that an intact gut microbiota is an important prerequisite for Huangqin decoction to exert its AhR-regulating effects.

ObjectiveTo investigate the effect of the multidisciplinary team （MDT） management model in improving the prognosis of patients with cirrhotic portal hypertension. MethodsA total of 86 patients with cirrhotic portal hypertension who were admitted to Shenzhen Third People’s Hospital from May 2022 to July 2024 were enrolled， and according to whether the MDT treatment regimen was implemented， they were divided into execution group with 51 patients and non-execution group with 35 patients. Baseline clinical data were collected， and the patients were observed in terms of gastrointestinal bleeding， hepatic encephalopathy， liver cancer， and death from admission to the end of follow-up （January 2025）. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves for the cumulative incidence rates of endpoint events （gastrointestinal bleeding， hepatic encephalopathy， liver cancer， and death）， and the Log-rank test was used for comparison between groups. The Cox proportional-hazards regression model analysis was used to investigate the effect of MDT management on the prognosis of patients. ResultsThere were significant differences between the execution group and the non-execution group in diameter of the portal vein （t=1.216， P=0.017） and ascites （χ²=4.515， P=0.034） at baseline. The patients were followed up for 14.6±6.2 months， and the survival curve analysis showed that there was a significant difference in the cumulative incidence rate of gastrointestinal bleeding between the two groups （χ²=4.573， P=0.024）， while there were no significant differences in the incidence rates of other outcome events between the two groups （all P>0.05）. The Cox regression analysis showed that the execution group had a reduced risk of gastrointestinal bleeding （hazard ratio=0.262， 95% confidence interval： 0.110 — 0.630， P=0.003）. ConclusionImplementation of the MDT treatment regimen can significantly reduce the short-term risk of gastrointestinal bleeding in patients with cirrhotic portal hypertension， while its long-term benefits require further follow-up verification.

BACKGROUND:The highest incidence of spinal fracture is in the thoracolumbar segment,and its symptoms are back pain,posterior convexity deformity,activity limitation,or with spinal cord nerve injury causing lower limb pain,numbness,and even paraplegia and other complications.The finite element method is a digital computer modeling technique,which can simulate the physical model and carry out force analysis realistically.OBJECTIVE:To review the application of finite element method in thoracolumbar spine fractures.METHODS:We searched the Chinese and English literature databases PubMed,Web of Science,and CNKI for relevant literature on the application of the finite element analysis method in spinal thoracolumbar fracture published before March 2024.The search terms in Chinese and English were:finite element analysis methods,biomechanical phenomena,stress analysis,thoracolumbar fractures,spinal fractures.Finally,55 papers were included.RESULTS AND CONCLUSION:(1)The exploration of thoracolumbar fractures caused by different etiologies(osteoporotic,traumatic,and pathological)through the finite element method is conducive to a deeper understanding of the biomechanics of various types of thoracolumbar fractures,and to improve the individualized and fine-tuned treatment of thoracolumbar fractures.(2)The finite element analysis of a single sample or a small number of samples has the chance,and a larger number of samples are required for the future finite element analysis to reduce the chance caused by the sample.(3)The rigid structure of bones alone cannot meet the biomechanical working conditions of the integrity of the physical object,and future finite element models need to incorporate all the structures of the physical object(e.g.,soft tissues,such as muscles and ligaments)as far as possible.(4)The finite element method has been used in more studies on osteoporotic and traumatic thoracolumbar spine fractures,which will need to be more in-depth in the future,and less in the field of pathologic thoracolumbar fractures,which has a wider scope for future research.

Objectives:To investigate the prognostic value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with atrial fibrillation(AF)and heart failure(HF).Methods:Patients with AF and HF from hospitals diagnosed by the Heart Failure Center in Guangdong Province between January 2017 and December 2021 were selected.Major adverse cardiovascular events(MACE)were used as the follow-up endpoint.Statistical methods such as the area under the receiver operating characteristic(ROC)curve(AUC),net reclassification index(NRI),and integrated discrimination improvement(IDI)were applied to evaluate the predictive value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with AF and HF.Results:A total of 1 839 patients were enrolled in this study,comprising 703 patients in the MACE group and 1 136 patients in the non-MACE group.Compared with the non-MACE group,the MACE group exhibited significantly advanced age,higher prevalence of New York Heart Association class Ⅳ and coronary artery disease,lower diastolic blood pressure and estimated glomerular filtration rate levels,and elevated serum N-terminal pro-B-type natriuretic peptide concentrations(all P<0.05).Additionally,significantly lower proportions of patients in the MACE group received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors,beta-blockers,mineralocorticoid receptor antagonists,or anticoagulant therapy(all P<0.05).Multivariable logistic regression analysis revealed that each 1-point increment in both CHA2DS2-VASc and R2CHA2DS2-VASc scores was associated with approximately 10%increased risk of MACE.ROC curve analysis demonstrated that the AUC values for predicting MACE in AF patients with HF were 0.555(95%CI:0.528-0.582,P<0.001)for CHA2DS2-VASc and 0.576(95%CI:0.549-0.608,P<0.001)for R2CHA2DS2-VASc,indicating marginally superior discriminatory capacity of the R2CHA2DS2-VASc score.Delong's test confirmed statistically significant differences between the two scoring systems(P=0.001).The R2CHA2DS2-VASc score demonstrated a NRI of 0.259(95%CI:0.166-0.352,P<0.001)and an IDI of 0.007(95%CI:0.005-0.010,P<0.001)compared with the conventional CHA2DS2-VASc score.Although the R2CHA2DS2-VASc score exhibited slightly better predictive accuracy and outcome discrimination capacity than the original scoring system,both scores demonstrated suboptimal clinical predictive performance.Conclusions:Both the R2CHA2DS2-VASc and CHA2DS2-VASc scores show suboptimal performance for predicting the risk of MACE in patients with AF and HF,and the predicting performance of R2CHA2DS2-VASc score is marginally superior to CHA2DS2-VASc score in this patient cohort.

Gastrointestinal (GI) cancers are a leading cause of cancer morbidity and mortality worldwide. Despite advances in treatment, cancer relapse remains a significant challenge, necessitating novel therapeutic strategies. In this study, we engineered nanobody-based chimeric antigen receptor (CAR) natural killer (NK) cells targeting cadherin 17 (CDH17) for the treatment of GI tumors. In addition, to enhance the efficacy of CAR-NK cells, we also incorporated CV1, a CD47-SIRPα axis inhibitor, to evaluate the anti-tumor effect of this combination. We found that CDH17-CAR-NK cells effectively eliminated GI cancers cells in a CDH17-dependent manner. CDH17-CAR-NK cells also exhibit potent in vivo anti-tumor effects in cancer cell-derived xenograft and patient-derived xenograft mouse models. Additionally, the anti-tumor activity of CDH17-CAR-NK cells is synergistically enhanced by CD47-signal regulatory protein α (SIRPα) axis inhibitor CV1, likely through augmented macrophages activation and an increase in M1-phenotype macrophages in the tumor microenvironment. Collectively, our findings suggest that CDH17-targeting CAR-NK cells are a promising strategy for GI cancers. The combination of CDH17-CAR-NK cells with CV1 emerges as a potential combinatorial approach to overcome the limitations of CAR-NK therapy. Further investigations are warranted to speed up the clinical translation of these findings.

BACKGROUND:Degenerative scoliosis is defined as a condition that occurs in adulthood with a coronal cobb angle of the spine>10° accompanied by sagittal deformity and rotational subluxation,which often produces symptoms of spinal cord and nerve compression,such as lumbar pain,lower limb pain,numbness,weakness,and neurogenic claudication.The finite element method is a mechanical analysis technique for computer modelling,which can be used for spinal mechanics research by building digital models that can realistically restore the human spine model and design modifications. OBJECTIVE:To review the application of finite element method in the etiology and treatment of degenerative scoliosis. METHODS:The literature databases CNKI,PubMed,and Web of Science were searched for articles on the application of finite element method in degenerative scoliosis published before October 2023.Search terms were"finite element analysis,biomechanics,stress analysis,degenerative scoliosis,adult spinal deformity"in Chinese and English.Fifty-four papers were finally included. RESULTS AND CONCLUSION:(1)The biomechanical findings from the degenerative scoliosis model constructed using the finite element method were identical to those from the in vivo experimental studies,which proves that the finite element method has a high practical value in degenerative scoliosis.(2)The study of the etiology and treatment of degenerative scoliosis by the finite element method is conducive to the prevention of the occurrence of the scoliosis,slowing down the progress of the scoliosis,the development of a more appropriate treatment plan,the reduction of complications,and the promotion of the patients'surgical operation.(3)The finite element method has gradually evolved from a single bony structure to the inclusion of soft tissues such as muscle ligaments,and the small sample content is increasingly unable to meet the research needs.(4)The finite element method has much room for exploration in degenerative scoliosis.

Objective To evaluate and improve missing data imputation methods to enhance the performance of binary classification prediction model.Methods By simulating data missing scenes,the effects of direct elimination,mean imputation,random forest(RF)imputation algorithm,and multiple imputation-random forest(MI-RF)on the performance of the prediction model were jointly evaluated by receiver operating characteristic area under curve(AUC)and root mean square error(RMSE).Bayesian Network was introduced for the random forest imputation algorithm to optimize the imputation method using the correlations between variables.Results Under different missing proportions,both AUC and RMSE indicated that Bayesian network optimized random forest(BN-RF)imputation algorithm was better.In addition,when the missing proportion was 10％-20％,various imputation methods had roughly the same improvement effect for the prediction model;when the proportion of missing data was 30％-40％,compared to the mean imputation,except for the BN-RF,RF was more effective and its effect was slightly better than MI-RF;however,when the proportion of missing data was close to 50％,even if the model performance was still appropriate,the imputation data gradually deviated from the true data features,resulting in a decrease in the usability of the model.Conclusion The overall effect of BN-RF is satisfactory,and it should be chosen when random missing was 30％-40％.

Objective:To explore the curative effect of abdominal flap carried with combined perforating vessels in reconstruction of extra large and complicated defect in extremities.Methods:A retrospective analysis was conducted on 16 patients who were admitted to the Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital for treatment of extra large and complex wounds in extremities, from January 2020 to December 2023. There were 6 defects in upper limbs and 10 in lower limbs. Fourteen patients had a combination of fracture and 6 of tendon defects. The defects were large and sized from 30.0 cm×9.0 cm to 35.0 cm×15.0 cm. The defects were reconstructed by large sized abdominal flaps at 32.0 cm×10.0 cm to 36.0 cm×16.0 cm. According to the size of the defect, perforators of different arteries carried by the abdominal flap were combined by anastomosis in a manner of internal and external supercharging in order to boost the blood supply of the flap. The supercharging vessel anastomosis was as follows: one superficial circumflex iliac artery (or superficial inferior epigastric artery) was anastomosed with the contralateral branch of the deep inferior epigastric artery, with the veins were anastomosed with the corresponding veins, and the main trunk of the deep inferior epigastric artery was anastomosed end-to-end or end-to-side with the main branch of the recipient artery. Alternatively, both of the left and right superficial iliac circumflex (or inferior epigastric) arteries were directly anastomosed end-to-side or end-to-end with the main trunk or its branches in the recipient site, and the veins were anastomosed end-to-side or end-to-end with the adjacent veins. The donor site was pulled and relaxed by a pull-rod wound expander and sutured layer by layer. After surgery, routine anti-infection, anti-vasospasm, anticoagulation, enhancement of blood circulation and other symptomatic treatment were given. Postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews. The colour and the sign of capillary reflux of the flap were closely observed.Results:All patients were included in the postoperative follow-up for 6-26 months, with an average of 13 months. Fifteen flaps survived after surgery. One flap had partial necrosis and the necrosis was found being caused by a thrombosis at the vessel anastomotic site. The necrotic tissue was removed and the defect was reconstructed by a flap transfer. The abdominal donor sites healed by first intention, and the navel was normal in terms of location and shape. There was no muscle hernia, except a minor scar hyperplasia. The flaps healed well, with satisfactory appearance and soft texture, without obvious bloating. The donor site healed well with partial scar formation.Conclusion:When an abdominal flap is used to reconstruct an extremely large and complex defect in extremities, the perforating vessels of different source arteries carried by the flaps can be anastomosed in a manner of combination, hence the flap can be flexibly freed, with satisfactory treatment effects.

Objective:To explore the curative effect of abdominal flap carried with combined perforating vessels in reconstruction of extra large and complicated defect in extremities.Methods:A retrospective analysis was conducted on 16 patients who were admitted to the Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital for treatment of extra large and complex wounds in extremities, from January 2020 to December 2023. There were 6 defects in upper limbs and 10 in lower limbs. Fourteen patients had a combination of fracture and 6 of tendon defects. The defects were large and sized from 30.0 cm×9.0 cm to 35.0 cm×15.0 cm. The defects were reconstructed by large sized abdominal flaps at 32.0 cm×10.0 cm to 36.0 cm×16.0 cm. According to the size of the defect, perforators of different arteries carried by the abdominal flap were combined by anastomosis in a manner of internal and external supercharging in order to boost the blood supply of the flap. The supercharging vessel anastomosis was as follows: one superficial circumflex iliac artery (or superficial inferior epigastric artery) was anastomosed with the contralateral branch of the deep inferior epigastric artery, with the veins were anastomosed with the corresponding veins, and the main trunk of the deep inferior epigastric artery was anastomosed end-to-end or end-to-side with the main branch of the recipient artery. Alternatively, both of the left and right superficial iliac circumflex (or inferior epigastric) arteries were directly anastomosed end-to-side or end-to-end with the main trunk or its branches in the recipient site, and the veins were anastomosed end-to-side or end-to-end with the adjacent veins. The donor site was pulled and relaxed by a pull-rod wound expander and sutured layer by layer. After surgery, routine anti-infection, anti-vasospasm, anticoagulation, enhancement of blood circulation and other symptomatic treatment were given. Postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews. The colour and the sign of capillary reflux of the flap were closely observed.Results:All patients were included in the postoperative follow-up for 6-26 months, with an average of 13 months. Fifteen flaps survived after surgery. One flap had partial necrosis and the necrosis was found being caused by a thrombosis at the vessel anastomotic site. The necrotic tissue was removed and the defect was reconstructed by a flap transfer. The abdominal donor sites healed by first intention, and the navel was normal in terms of location and shape. There was no muscle hernia, except a minor scar hyperplasia. The flaps healed well, with satisfactory appearance and soft texture, without obvious bloating. The donor site healed well with partial scar formation.Conclusion:When an abdominal flap is used to reconstruct an extremely large and complex defect in extremities, the perforating vessels of different source arteries carried by the flaps can be anastomosed in a manner of combination, hence the flap can be flexibly freed, with satisfactory treatment effects.

Objective:To analyze the epidemiological characteristics and delay in detection of reported brucellosis cases in Nangang District of Harbin City, Heilongjiang Province, in order to provide a basis for improving targeted measures for brucellosis prevention and control.Methods:Data on brucellosis reported in Nangang District of Harbin City between 2018 and 2022 were obtained from the China Disease Prevention and Control Information System. A descriptive analysis was conducted to outline the epidemiological status, epidemiological features, and sources of cases. Seasonal patterns of brucellosis were assessed using the concentration degree and seasonal index methods. Joinpoint regression model was used to analyze the trend of delay in detection.Results:From 2018 to 2022, a total of 4 428 cases of brucellosis were reported in Nangang District, with 1 183 cases (26.72%) reported in 2018 and 528 cases (11.92%) reported in 2022. The gender ratio of the cases was 2.80 ∶ 1.00 (3 264 ∶ 1 164). Most cases occurred in individuals aged 30 to 59 years (73.19%, 3 241/4 428). Occupationally, farmers comprised the majority of cases (88.73%, 3 929/4 428), followed by homemakers/unemployed individuals (3.73%, 165/4 428), and students (2.03%, 90/4 428). Regarding case origin, 31.48% (1 394/4 428) were from Harbin City, while 64.97% (2 877/4 428) originated from other cities within Heilongjiang Province, predominantly from Suihua City (38.89%, 1 722/4 428). Additionally, 157 cases (3.55%, 157/4 428) were reported from outside Heilongjiang Province, all of which were from Inner Mongolia Autonomous Region and Jilin Province. Brucellosis incidence showed weak seasonality ( M = 0.230), with the epidemic period spanning from March to August. During this period, seasonal indices C exceeded 100%, peaking in July (168.02%). From 2018 to 2022, the average annual delay rate in case detection was 20.14% (892/4 428). The delayed detection rates of brucellosis cases in each year were 30.68% (363/1 183), 17.86% (200/1 120), 17.23% (117/679), 12.75% (117/918), and 17.99% (95/528), respectively (average annual percentage change = - 17.52%, P = 0.090). Conclusions:Brucellosis in Nangang District of Harbin Citydemonstrates weak seasonality, with peak incidence occurring from March to August. Detection delays remain a concern, highlighting the need for sustained surveillance and the implementation of integrated, multi-sectoral prevention and control measures.