Objective:To develop and explore the clinical value of a nomogram model for the preoperative diagnosis of proliferative hepatocellular carcinoma (HCC) based on gadoxetate disodium (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI).Methods:The preoperative Gd-EOB-DTPA-enhanced MRI data and clinical pathological data of patients with pathologically confirmed proliferative (178 cases) and non-proliferative type HCC (378 cases) from September 2017 to November 2022 were retrospectively collected. The MRI features and clinicopathological features of proliferative and non-proliferative type HCC were evaluated. Multivariate logistic regression analysis was used to determine the independent predictive factors of proliferative-type HCC. The nomogram prediction model was constructed using R software. The receiver operating characteristic curve (ROC) was used to evaluate its diagnostic efficacy. The calibration curve and decision curve analysis (DCA) were drawn to evaluate the calibration performance and clinical application value of the nomogram model. The optimal threshold for distinguishing high-risk from low-risk was determined using the Youden index. The survival prognosis of proliferative and non-proliferative type HCC was analyzed and compared using the Kaplan-Meier survival curve and the log-rank test. The measurement data were analyzed using the independent sample t-test or the Mann-Whitney U test. The count data were compared using the χ2 test. Results:There were statistically significant differences in alpha-fetoprotein (AFP) levels ( χ2=17.244, P<0.001), tumor morphology ( χ2=13.669, P<0.001), intratumoral fatty degeneration ( χ2=10.495, P=0.001), abnormal enhancement of peritumoral abnormalities during arterial phase ( χ2=37.662, P<0.001), tumor capsule ( χ2=23.961, P<0.001), intratumoral necrosis ( χ2=77.184, P<0.001), intratumoral hemorrhage ( χ2=4.892, P=0.027), peritumoral hypointense in hepatobiliary phase ( χ2=47.675, P<0.001), rim arterial phase hyperenhancement ( χ2=115.976, P<0.001), intratumoral artery ( χ2=15.528, P<0.001) and intravenous tumor thrombus ( χ2=10.532, P=0.001) between proliferative and non-proliferative type HCC groups. Multivariate logistic regression analysis showed that AFP>200 μg/L ( OR=1.561, P=0.044), no intratumoral fatty degeneration ( OR=1.947, P=0.033), intratumoral necrosis ( OR=2.084, P=0.003), peritumoral hypointensity in the hepatobiliary phase ( OR=2.314, P=0.001), and annular hyperenhancement in the arterial phase ( OR=5.557, P<0.001) were independent predictors for preoperative diagnosis of proliferative-type HCC. A nomogram model for preoperative prediction of proliferative type HCC was constructed based on the independent predictors. The area under the ROC curve model for predicting proliferative-type HCC was 0.772 (95% CI: 0.735-0.807), with a sensitivity of 69.1% and a specificity of 75.4%. The calibration curve and DCA curve showed superior calibration performance and clinical applicability of the nomogram model. The Kaplan-Meier curve showed that the recurrence free survival rate after liver resection was significantly lower in patients with proliferative-type HCC than that of non-proliferative-type HCC ( P<0.001), and the high-risk group was significantly lower than the low-risk group ( P<0.001). Conclusions:The construction of a nomogram model based on Gd-EOB-DTPA-enhanced MRI features combined with AFP >200μg/L can accurately diagnose proliferative-type HCC and predict its preoperative prognosis.

Objective:To explore the clinical efficacy of laparoscopic left hemi-fundoplica-tion for gastroesophageal reflux disease (GERD).Method:The retrospective and descriptive study was conducted. The clinical data of 45 patients with GERD who were admitted to Hebei Provincial Hospital of Traditional Chinese Medicine from July 2019 to July 2022 were collected. There were 26 males and 19 females, aged (46±12) years. All patients underwent laparoscopic left hemi-fundoplication. Observation indicators: (1) intraoperative and postoperative conditions; (2) follow-up. Measurement data with normal distribution were expressed as Mean± SD. Count data were expressed as absolute numbers. The paired samples t-test was used for comparison of indicators before and after surgery. Result:(1) Intraoperative and postoperative conditions. All 45 patients successfully underwent the operation, with no conversion to open surgery or intraoperative complications. The operation time was (86±8)minutes, volume of intraoperative blood loss was (12±3)mL, and time to postoperative first flatus was (2.2±0.8)days. Among the 45 patients after surgery, 4 cases had fever, 3 cases had retrosternal dull pain and discomfort, 4 cases had dysphagia, 3 cases had abdominal distension, and 5 cases had constipation. All these symptoms were cured or relieved spontaneously after sympto-matic treatment. The duration of postoperative hospital stay was (3.5±0.5)days. There was no patient with infection, delayed bleeding or perforation.(2) Follow-up. All 45 patients were followed up for 1 year after surgery, with no recurrence of GERD. Gastroscopy showed no esophageal mucosal damage such as erosion or ulcer, and no hiatal hernia occurred. Before surgery, the reflux symptom index score, GERD questionnaire score, reflux disease questionnaire score, lower esophageal sphincter resting pressure, and DeMeester score of 24-hour esophageal pH monitoring were 24.3±1.9, 12.5±2.1,20.1±4.5, (7.1±1.1)mmHg (1 mmHg=0.133 kPa), and 31.4±6.4, respectively. At 1 year after surgery, the above indicators were 2.2±0.7, 6.5±0.5, 4.0±2.6, (23.2±2.9)mmHg, and 6.0±1.4, respectively. There were significant differences before and after surgery ( t=80.75, 18.70,20.09, -33.45, 26.15, P<0.05). Conclusion:Laparoscopic left hemi-fundoplication is safe and feasible for GERD, which can improve the clinical symptoms of patients.

Objective:To explore the clinical efficacy of laparoscopic left hemi-fundoplica-tion for gastroesophageal reflux disease (GERD).Method:The retrospective and descriptive study was conducted. The clinical data of 45 patients with GERD who were admitted to Hebei Provincial Hospital of Traditional Chinese Medicine from July 2019 to July 2022 were collected. There were 26 males and 19 females, aged (46±12) years. All patients underwent laparoscopic left hemi-fundoplication. Observation indicators: (1) intraoperative and postoperative conditions; (2) follow-up. Measurement data with normal distribution were expressed as Mean± SD. Count data were expressed as absolute numbers. The paired samples t-test was used for comparison of indicators before and after surgery. Result:(1) Intraoperative and postoperative conditions. All 45 patients successfully underwent the operation, with no conversion to open surgery or intraoperative complications. The operation time was (86±8)minutes, volume of intraoperative blood loss was (12±3)mL, and time to postoperative first flatus was (2.2±0.8)days. Among the 45 patients after surgery, 4 cases had fever, 3 cases had retrosternal dull pain and discomfort, 4 cases had dysphagia, 3 cases had abdominal distension, and 5 cases had constipation. All these symptoms were cured or relieved spontaneously after sympto-matic treatment. The duration of postoperative hospital stay was (3.5±0.5)days. There was no patient with infection, delayed bleeding or perforation.(2) Follow-up. All 45 patients were followed up for 1 year after surgery, with no recurrence of GERD. Gastroscopy showed no esophageal mucosal damage such as erosion or ulcer, and no hiatal hernia occurred. Before surgery, the reflux symptom index score, GERD questionnaire score, reflux disease questionnaire score, lower esophageal sphincter resting pressure, and DeMeester score of 24-hour esophageal pH monitoring were 24.3±1.9, 12.5±2.1,20.1±4.5, (7.1±1.1)mmHg (1 mmHg=0.133 kPa), and 31.4±6.4, respectively. At 1 year after surgery, the above indicators were 2.2±0.7, 6.5±0.5, 4.0±2.6, (23.2±2.9)mmHg, and 6.0±1.4, respectively. There were significant differences before and after surgery ( t=80.75, 18.70,20.09, -33.45, 26.15, P<0.05). Conclusion:Laparoscopic left hemi-fundoplication is safe and feasible for GERD, which can improve the clinical symptoms of patients.

Objective:To develop and explore the clinical value of a nomogram model for the preoperative diagnosis of proliferative hepatocellular carcinoma (HCC) based on gadoxetate disodium (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI).Methods:The preoperative Gd-EOB-DTPA-enhanced MRI data and clinical pathological data of patients with pathologically confirmed proliferative (178 cases) and non-proliferative type HCC (378 cases) from September 2017 to November 2022 were retrospectively collected. The MRI features and clinicopathological features of proliferative and non-proliferative type HCC were evaluated. Multivariate logistic regression analysis was used to determine the independent predictive factors of proliferative-type HCC. The nomogram prediction model was constructed using R software. The receiver operating characteristic curve (ROC) was used to evaluate its diagnostic efficacy. The calibration curve and decision curve analysis (DCA) were drawn to evaluate the calibration performance and clinical application value of the nomogram model. The optimal threshold for distinguishing high-risk from low-risk was determined using the Youden index. The survival prognosis of proliferative and non-proliferative type HCC was analyzed and compared using the Kaplan-Meier survival curve and the log-rank test. The measurement data were analyzed using the independent sample t-test or the Mann-Whitney U test. The count data were compared using the χ2 test. Results:There were statistically significant differences in alpha-fetoprotein (AFP) levels ( χ2=17.244, P<0.001), tumor morphology ( χ2=13.669, P<0.001), intratumoral fatty degeneration ( χ2=10.495, P=0.001), abnormal enhancement of peritumoral abnormalities during arterial phase ( χ2=37.662, P<0.001), tumor capsule ( χ2=23.961, P<0.001), intratumoral necrosis ( χ2=77.184, P<0.001), intratumoral hemorrhage ( χ2=4.892, P=0.027), peritumoral hypointense in hepatobiliary phase ( χ2=47.675, P<0.001), rim arterial phase hyperenhancement ( χ2=115.976, P<0.001), intratumoral artery ( χ2=15.528, P<0.001) and intravenous tumor thrombus ( χ2=10.532, P=0.001) between proliferative and non-proliferative type HCC groups. Multivariate logistic regression analysis showed that AFP>200 μg/L ( OR=1.561, P=0.044), no intratumoral fatty degeneration ( OR=1.947, P=0.033), intratumoral necrosis ( OR=2.084, P=0.003), peritumoral hypointensity in the hepatobiliary phase ( OR=2.314, P=0.001), and annular hyperenhancement in the arterial phase ( OR=5.557, P<0.001) were independent predictors for preoperative diagnosis of proliferative-type HCC. A nomogram model for preoperative prediction of proliferative type HCC was constructed based on the independent predictors. The area under the ROC curve model for predicting proliferative-type HCC was 0.772 (95% CI: 0.735-0.807), with a sensitivity of 69.1% and a specificity of 75.4%. The calibration curve and DCA curve showed superior calibration performance and clinical applicability of the nomogram model. The Kaplan-Meier curve showed that the recurrence free survival rate after liver resection was significantly lower in patients with proliferative-type HCC than that of non-proliferative-type HCC ( P<0.001), and the high-risk group was significantly lower than the low-risk group ( P<0.001). Conclusions:The construction of a nomogram model based on Gd-EOB-DTPA-enhanced MRI features combined with AFP >200μg/L can accurately diagnose proliferative-type HCC and predict its preoperative prognosis.

Objective:To screen genetic and epigenetic expression differences associated with pulmonary embolism through integrated bioinformatics analysis.Methods:Four patients with pulmonary embolism and healthy physical examination in the Third Affiliated Hospital of Xinjiang Medical University in 2019 were selected as the research objects, using high-throughput sequencing technologies and methylation chip technology to detect, screening and integrated peripheral blood difference genomes and the epigenome data to identify the pathogenesis of pulmonary embolism caused by methylation of drive and differentially expressed genes, GO and KEGG enrichment analysis were performed.Results:Coexpression analysis of DNA methylation and gene expression data between the pulmonary embolism group and the healthy control group showed that differential methylation in the upstream region of genes was negatively correlated with gene expression. Among them, 8 significantly methylated genes in the upstream region of genes were screened out, and independent sample t-test and Pearson correlation analysis were done. In the pulmonary embolism group, there were 6 significant methylated genes of TSS1500, namely TSPO2, C1QA, AQP1, TNFSF9, MIA and STAB1, and the differential expression multiple log2FC of corresponding genes was 1.298, 1.629, 1.024, 2.746, 2.539, 1.060, respectively. The correlation between gene expression and gene methylation were -0.908, -0.900, -0.824, -0.784, -0.783, -0.779, respectively, and the methylation differences between the two groups were -0.049, -0.053, -0.048, -0.057, -0.050, respectively. -0.053 ( P < 0.05). There were three significantly methylated genes in the TSS200 region, namely TSPO2, SLC9A, and SIGLEC1. The gene expression differential multiple log2FC was 1.298, -2.252, and 1.866, respectively. The correlation between gene expression and gene methylation was -0.860, -0.774, and -0.739, respectively. The methylation difference between the two groups was -0.051, 0.027, -0.048 ( P < 0.05). In the pulmonary embolism group, 7 genes, including TSPO2, C1QA, AQP1, TNFSF9, MIA, STAB1 and SIGLEC1, showed hypomethylation and high expression in the TSS region. SLC9A3 gene showed high methylation and low expression. In the analysis of GO function, significant enrichment was obtained in complement activation, immune response and activation protein cascade. In the KEGG signaling pathway, the immune system, bacterial infection, and signaling molecules and interactions are significantly enriched, thereby regulating the occurrence of pulmonary embolism. Conclusions:Based on the combined analysis of DNA methylation and gene expression, a new idea of the occurrence and development of pulmonary embolism has been found, which can be further studied in the future.

Objective:To explore the molecular mechanism of circDDX17 regulating the proliferation and apoptosis of non-small cell lung cancer cells by targeting the miR-223-3p/RIP3 molecular axis.Methods:The expression levels of circDDX17, miR-223-3p, and RIP3 in human normal lung epithelial cell lines BEAS-2B and non-small cell lung cancer cells H1299, A549, and H446 were detected by reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). The plasmids of pcDNA, pcDNA-circDDX17, anti-miR-con, anti-miR-223-3p, pcDNA-circDDX17 and miR-con, pcDNA-circDDX17 and miR-223-3p mimics were transfected into H1299 cells. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay was used to detect the cell proliferation. Flow cytometry was used to detect the cell cycle and cell apoptosis. Plate cloning experiment was used to detect cell proliferation ability. The dual luciferase report experiment was applied to verify the targeting relationship between miR-223-3p with circDDX17 and RIP3. Western blot was used to detect the protein expression of cyclinD1, CDK2, cleaved caspase-3 and Bax.Results:The expression levels of circDDX17 and RIP3 mRNA in H1299, A549, and H446 cells were significantly reduced ( P<0.05), the expression level of miR-223-3p mRNA was significantly increased ( P<0.05) compared with BEAS-2B. The cell viability [(69.46±4.68)%], the number of cell clones (83.49±7.86), the proportion of cells in S phase [(22.52±1.41) %], the protein expression levels of cyclinD1 and CDK2 in PCDNa-CircDDX17 group were lower than those in pcDNA group [(97.54±7.72)%, 205.03±13.37, (28.69±1.49)%, respectively, P<0.05], while the percentage of G 0/G 1 phase cells [(64.45±3.56)%], apoptosis rate [(18.36±1.63)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17 group were higher than those of pcDNA group [(51.33±2.76) % and (5.21±0.54) %, respectively, P<0.05]. The viability [(72.64±5.44)%], the number of cell clones (78.16±8.23), the proportion of S-stage cells [(21.34±1.59) %], the protein expression levels of CyclinD1 and CDK2 in anti-miR-223-3p group were lower than those in anti-miR-con group [(103.47±6.25)%, 169.32±14.53, (28.43±1.26)%, respectively, P<0.05]. Percentage of G 0/G 1 phase cells [(62.86±3.28)%], apoptosis rate [(14.64±1.67)%], the protein expression levels of cleaved caspase-3 and Bax in the anti-miR-223-3p group were higher than those of anti-miR-con group [(51.33±2.71)% and (4.83±0.39)%, respectively, P<0.05]. MiR-223-3p has complementary sites with circDDX17 or RIP3. The viability [(135.45±9.28)%], the number of cell clones (174.64±10.68), the proportion of S-phase cells [(26.39±2.25)%], the protein expression levels of cyclinD1 and CDK2 in pcDNA-circDDX17+miR-223-3p group were higher than those in pcDNA-circDDX17+miR-con group [(101.56±6.68)%, 107.65±7.62, (21.64±1.72)%, P<0.05]. Percentage of G 0/G 1 phase cells [(56.64±2.76)%], apoptosis rate [(8.34±0.76)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17+miR-223-3p group were lower than those of pcDNA-circDDX17+miR-con group [(64.03±3.48)% and (15.21±1.18)%, respectively, P<0.05]. Conclusion:circDDX17 could inhibit the proliferation and induce apoptosis of non-small cell lung cancer cells via targeting the miR-223-3p / RIP3 molecular axis.

Objective:To explore the molecular mechanism of circDDX17 regulating the proliferation and apoptosis of non-small cell lung cancer cells by targeting the miR-223-3p/RIP3 molecular axis.Methods:The expression levels of circDDX17, miR-223-3p, and RIP3 in human normal lung epithelial cell lines BEAS-2B and non-small cell lung cancer cells H1299, A549, and H446 were detected by reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). The plasmids of pcDNA, pcDNA-circDDX17, anti-miR-con, anti-miR-223-3p, pcDNA-circDDX17 and miR-con, pcDNA-circDDX17 and miR-223-3p mimics were transfected into H1299 cells. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay was used to detect the cell proliferation. Flow cytometry was used to detect the cell cycle and cell apoptosis. Plate cloning experiment was used to detect cell proliferation ability. The dual luciferase report experiment was applied to verify the targeting relationship between miR-223-3p with circDDX17 and RIP3. Western blot was used to detect the protein expression of cyclinD1, CDK2, cleaved caspase-3 and Bax.Results:The expression levels of circDDX17 and RIP3 mRNA in H1299, A549, and H446 cells were significantly reduced ( P<0.05), the expression level of miR-223-3p mRNA was significantly increased ( P<0.05) compared with BEAS-2B. The cell viability [(69.46±4.68)%], the number of cell clones (83.49±7.86), the proportion of cells in S phase [(22.52±1.41) %], the protein expression levels of cyclinD1 and CDK2 in PCDNa-CircDDX17 group were lower than those in pcDNA group [(97.54±7.72)%, 205.03±13.37, (28.69±1.49)%, respectively, P<0.05], while the percentage of G 0/G 1 phase cells [(64.45±3.56)%], apoptosis rate [(18.36±1.63)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17 group were higher than those of pcDNA group [(51.33±2.76) % and (5.21±0.54) %, respectively, P<0.05]. The viability [(72.64±5.44)%], the number of cell clones (78.16±8.23), the proportion of S-stage cells [(21.34±1.59) %], the protein expression levels of CyclinD1 and CDK2 in anti-miR-223-3p group were lower than those in anti-miR-con group [(103.47±6.25)%, 169.32±14.53, (28.43±1.26)%, respectively, P<0.05]. Percentage of G 0/G 1 phase cells [(62.86±3.28)%], apoptosis rate [(14.64±1.67)%], the protein expression levels of cleaved caspase-3 and Bax in the anti-miR-223-3p group were higher than those of anti-miR-con group [(51.33±2.71)% and (4.83±0.39)%, respectively, P<0.05]. MiR-223-3p has complementary sites with circDDX17 or RIP3. The viability [(135.45±9.28)%], the number of cell clones (174.64±10.68), the proportion of S-phase cells [(26.39±2.25)%], the protein expression levels of cyclinD1 and CDK2 in pcDNA-circDDX17+miR-223-3p group were higher than those in pcDNA-circDDX17+miR-con group [(101.56±6.68)%, 107.65±7.62, (21.64±1.72)%, P<0.05]. Percentage of G 0/G 1 phase cells [(56.64±2.76)%], apoptosis rate [(8.34±0.76)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17+miR-223-3p group were lower than those of pcDNA-circDDX17+miR-con group [(64.03±3.48)% and (15.21±1.18)%, respectively, P<0.05]. Conclusion:circDDX17 could inhibit the proliferation and induce apoptosis of non-small cell lung cancer cells via targeting the miR-223-3p / RIP3 molecular axis.

Gastric cancer is the most prevalent gastrointestinal tumor in China， threatening the life and health of patients. Surgery is one of the available therapies， which， however， induces postoperative gastrointestinal dysfunction （PGD） and other common complications. The pathogenesis of PGD is still unclear and no efficient targeted drug is available. In addition， the limited treatment measures fail to effectively improve gastrointestinal function. As a result， patients generally suffer from low quality of life and poor prognosis. In Chinese medicine， PGD belongs to the categories of "vomiting"， "stuffiness and fullness"， "regurgitation"， "abdominal distension"， "intestinal impediment"， and "intestinal accumulation". In recent years， there has been an explosion of research on the PGD of gastric cancer in Chinese medicine， and many research results have been obtained. On this basis， this study introduced PGD in modern medicine， and causes and pathogenesis， syndrome differentiation-based treatment， and clinical studies of PGD. It was found that diverse internal and external treatments are available in Chinese medicine for PGD such as internal use of Chinese medicine， Chinese medicine enema， auricular point seed-embedding， acupuncture， and moxibustion， which feature ease of implementation， small side effects， definite efficacy， and significant effect in combination with other therapies. This paper summarized the ideas and measures for treatment of PGD of gastric cancer by Chinese medicine， the research outcomes， limitations， and research directions， which can serve as a reference for further research on treatment of PGD of gastric cancer by Chinese medicine.

Objective:To evaluate the surgical effect of repairing soft tissue defect of hand and foot with medial gastrocnemius fascia flap combined with skin graft.Methods:From January, 2018 to June, 2019, 10 patients were treated with transfers of free medial gastrocnemius fascia flaps combined with skin graft to repair soft tissue defect of hand and foot. The size of free fascial flap was 5.0 cm×8.0 cm-12.0 cm×15.0 cm. After successful transfer on the wound, the skin was grafted onto the fascial flap, and the donor site was sutured directly. The appearance and function of the recipient and donor sites were observed and the effect of the operation was evaluated. Sensory recovery was assessed by the standard set by British Medical Research Council (BMRC) at the last follow-up.Results:All the free medial gastrocnemius fascia flap survived. After 6-10 days of granulation tissue growing, the skin grafts were transferred and all survived. All patients entered follow-up for 3-9 months, with an average of 7.5 months. The tissue at the recipient sites were soft and wear-resistant without swelling or ulceration. According to the self-designed evaluation system of soft tissue defect reconstruction, 10 patients had score from 68 to 92 (average, 75.2) . At the last follow-up, sensory recovery was assessed by BMRC, 7 cases were excellent and 3 cases were good.Conclusion:The repair of hand and foot soft tissue defect by the free medial gastrocnemius fascia flap combined with skin graft has advantages in constancy of vascular anatomy of free fascia tissue, long vascular pedicle and for repair of various types of hand and foot defects. Skin of the recipient area is soft with good appearance without swelling after the reconstruction of fascia flap. It is a method of treatment in repair of soft tissue defect of hand and foot by avoiding the thinning of a flap in the second procedure.

At present,the prevention and control of the COVID-19 is still severe,its pathogen SARS-CoV-2 is highly infectious and pathogenic,and the population is generally susceptible.Thus,it requires a higher standard to diagnose and treat patients with acute abdomen.The first step is to carry out procedures to identify whether the patient is infected or not.Those who are not infected can go through the normal treating procedures.For patients diagnosed with COVID-19 or suspected patients,the second step is to achieve classified diagnoses and treatments,and to adopt a treating plan that integrates TCM and western medicine.In order to protect patients and medical staff,the COVID-19 in hospital transmission must be avoided.For patients with COVID-19 who need emergency surgery,we must strictly comply with the hospital 's protection regulations,closely coordinate the relevant departments of surgery,perform the three-level protection,operate in accordance with the principle of damage control in the negative pressure surgery room,and return to the isolation ward according to the prevention and control process after operation.For units without surgical conditions,patients should be transferred to hospital in time on the premise of maximum damage control,and patients must not be delayed for timely diagnosis and treatment due to the epidemic.