Objective To explore the feasibility and safety of fastest recovery after surgery(FRAS)in laparoscopic surgery of gastrointestinal tumors.Methods The clinical data of patients undergoing laparoscopic surgery for gastrointestinal tumors under FRAS and enhanced recovery after surgery(ERAS)from Jan.2023 to May 2024 were collected,and perioperative safety and medical cost were analyzed.Results A total of 87 patients were enrolled,including 43 in the FRAS group and 44 in the ERAS group.Compared with the ERAS group,the FRAS group had significantly shorter surgical time(3.0[2.5,3.5]h vs 3.0[2.5,4.0]h),first postoperative movement time([2.85±4.29]h vs[20.18±6.13]h),first postoperative oral feeding time(2.0[2.0,3.0]h vs 24.0[15.0,48.0]h),postoperative hospital stay(24.0[20.0,40.0]h vs 192.0[150.0,216.0]h),lower hospitalization costs(50 515.61[46 650.44,56 827.12]yuan vs 65 555.09[58 683.21,86 239.02]yuan),and lower medication costs(2 671.09[2 063.31,3 127.09]yuan vs 7 326.90[5 104.66,10 674.26]yuan)(all P＜0.05).Conclusion It is safe and feasible to use FRAS during the perioperative period of laparoscopic radical gastrectomy for gastrointestinal tumors,and FRAS can also reduce the costs of hospitalization and medications.

Objective To explore the effect of acupuncture combined with manual reduction on pain and lumbar function in elderly patients with degenerative lumbar spondylolisthesis under the guidance of the Bone Strengthening and Tendon Softening Theory.Methods Ninety elderly patients with lumbar spondylolisthesis treated in our hospital from January 2021 to April 2023 were selected as study subjects.Based on a random number table method,the participants were divided into experimental group and control group,each consisting of 45 cases.The control group received acupuncture treatment,while the experimental group received manual reduction treatment on top of that.Both groups underwent continuous treatment for 4 weeks.We compared the two groups in Traditional Chinese Medicine(TCM)syndrome score,Visual Analog Scale(VAS)score,Japanese Orthopaedic Association(JOA)lumbar function score,Oswestry Disability Index(ODI),serum inflammatory factor level,and clinical efficacy between before and after treatment.Results Before treatment,there was no statistically significant difference in TCM syndrome scores or VAS scores between the two groups(P＞0.05).After treatment,both TCM syndrome scores and VAS scores significantly decreased in both groups,with the experimental group showing significantly lower scores than the control group(P＜0.05).Before treatment,there was no statistically significant difference in JOA scores and ODI scores between the two groups(P＞0.05).After treatment,JOA scores significantly increased in both groups,with the experimental group showing significantly higher scores than the control group(P＜0.05).ODI scores significantly decreased in both groups,with the experimental group showing significantly lower scores than the control group(P＜0.05).Before treatment,the two groups did not differ significantly in serum IL-6,TNF-α,or CRP levels(P＞0.05).After treatment,serum IL-6,TNF-α,and CRP levels significantly decreased in both groups,with the experimental group showing lower levels than the control group(P＜0.05).The total effective rate in the experimental group was 88.89％,significantly higher than 68.89％ in the control group(P＜0.05).Conclusion Acupuncture combined with manual reduction guided by the Bone Straightening and Tendon Softening theory can effectively alleviate pain,improve various TCM syndromes,enhance lumbar function level,and show significant clinical efficacy in patients.

Objective:To analyze the differences in emergency rescue service capacities between county-level hospitals in Zhejiang and Jiangsu provinces, and propose targeted improvement suggestions.Methods:Cluster sampling was employed, with representative county-level hospitals recommended by provincial hospital alliances in Zhejiang and Jiangsu. Emergency departments voluntarily submitted data, resulting in 24 hospitals from Zhejiang and 34 from Jiangsu. Data were collected through the China County-Level Hospital Emergency Service Capability Evaluation System. Differences between provinces were analyzed. Spearman correlation analysis explored relationships between multidimensional indicators, and multivariate logistic regression identified factors influencing hospital grade B++ and above.Results:In terms of department scale, Jiangsu had a larger emergency department area (4 853 m 2vs. 1 927 m 2, P<0.001), more beds of comprehensive inpatient wards in the emergency department (25.5 beds vs. 5.5 beds, P=0.011), and higher scores for the ratio of emergency department area to beds (4.8 vs. 3.4, P=0.005) than Zhejiang. In terms of staffing, Jiangsu had a higher proportion of doctors with master's degrees or above (13.8% vs. 0.0%, P<0.001), a higher proportion of frontline emergency medical staff with over three years of clinical experience (100.0% vs. 91.5%, P=0.001), and more doctors (19 vs. 15, P=0.039) and nurses (46 vs. 32, P=0.039). In terms of quality and safety and medical service capacity, Zhejiang had a higher severe trauma resuscitation success rate (92.9% vs. 83.75%, P=0.003), annual emergency surgery volume (1 002 vs. 428, P=0.015), and number of emergency surgery procedures (125 vs. 42, P=0.027), but Jiangsu had a shorter emergency room stay time (87.5 min vs. 136.2 min, P=0.029). In terms of informatization, Zhejiang outperformed Jiangsu in all indicators, especially in patient information interconnection and sharing (100.0% vs. 82.4%, P=0.030) and in-hospital diagnosis and treatment timeline (91.7% vs. 73.5%, P=0.043). Correlation analysis showed that the total specialty scale score was significantly positively correlated with the in-hospital emergency rescue service capacity score ( r=0.576) and the staffing score ( r=0.455). The total evaluation score was significantly positively correlated with the informatization total score ( r=0.397) and the pre-hospital emergency rescue service capacity score ( r=0.322). Binary Logistic regression analysis showed that the emergency rescue service capacity score was significantly positively correlated with hospital grade ( B=1.431, P=0.03, OR=4.185, 95% CI:1.152-15.205). For every 1-unit increase in the emergency department area ( B=0.002, P=0.05), the probability of a hospital being upgraded to B++ or above increased by 0.2% ( OR=1.002, 95% CI:1.000-1.004). Conclusions:Both provinces exhibit distinct advantages in emergency department development. Departmental scale and configuration significantly impact emergency service capabilities, while staffing and quality management constitute core elements for improvement. Informatization construction notably enhances emergency service efficiency and quality.

Objective To investigate the epidemiological trends,temporal and spatial distribution characteristics of pulmonary tuberculosis in Lanping County.Methods Based on tuberculosis management data and basic information systems from the"China Disease Prevention and Control Information System,"pulmonary tuberculosis data from Lanping County for 2018-2023 were obtained.Descriptive epidemiology,concentration method,circular distribution method,and spatial autocorrelation analysis were used to conduct epidemiological and spatial analyses of the pulmonary tuberculosis data.Results A total of 2836 TB cases were reported in Lanping County from 2018 to 2023,with an average annual incidence rate of 233.26 per 100000,showing a declining trend.The male-to-female ratio was 1.95∶1,with the highest incidence among individuals aged 60 and above(932 cases,32.86%).Cases were predominantly among farmers(91.01%)and the Lisu ethnic group(52.68%).TB incidence showed weak seasonality with a bimodal distribution,with primary peak occurring from October to March and secondary peak from June to August.Tu'e Township(324.74 per 100,000),Shideng Township(307.42 per 100000),and Jinding Town(260.98 per 100,000)had the highest incidence rates,accounting for 1,284 cases or 45.28%of the county's total cases.In 2020,the incidence of pulmonary tuberculosis in Lanping County showed a spatial clustering distribution(global Morans's I value<0,P value<0.05),with Shideng Township consistently showing high-low aggregation characteristics.Conclusion Between 2018-2023,while the tuberculosis incidence rate in Lanping County has declined,it still falls short of Yunnan Province's tuberculosis prevention and control targets,and the prevention and control work continues to face significant challenges.Strengthening screening of high-risk populations and providing medical support to remote areas will be key measures for future prevention and treatment.

Objective:To investigate the effect of Qingjie Huagong decoction on the polarization of intestinal M1/M2 macro-phages in rats with severe acute pancreatitis and the related molecular mechanisms.Methods:Forty-eight SD rats were randomly divid-ed into blank group,model group,Qingjie Huagong decoction low,medium and high dose groups,and Western medicine group.The rat model of severe acute pancreatitis was established according to 5%sodium taurocholate retrograde pancreatic duct.Western medi-cine group was given intraperitoneal injection of ulinastatin injection,and Qingjie Huagong decoction low,medium and high dose groups were given corresponding concentrations of traditional Chinese medicine by intragastric.After 24 h of intervention,pancreatic and ileal tissues were taken for HE staining to observe pathological changes.The levels of serum amylase,TNF-α,IL-6,IL-10 and TGF-β in intestinal tissue homogenate were detected by ELISA.Western blot and Real-time PCR were used to detect phosphatidylino-sitol 3-kinase(PI3K),protein serine-threonine kinase(Akt),inducible nitric oxide synthase(iNOS),leukocyte differentiation anti-gen 86(CD86),and arginase in ileum tissue The relative expression levels of 1(Arg-1),leukocyte differentiation antigen 163(CD163)protein and mRNA.Results:Compared with the model group,the pathological injury of pancreas and small intestine in Qingjie Huagong low,medium and high groups were alleviated after intervention.ELISA method for detecting serum amylase and TNF-α,IL-6 levels significantly decreased(P<0.05),while the levels of IL-10 and TGF-β were increased(P<0.05);expression levels of p-PI3K/PI3K,p-Akt,iNOS,CD86 mRNA and protein were significantly reduced(P<0.05),while the levels of CD163,Arg-1 mRNA and protein were significantly increased(P<0.05),with the highest dose group showing the most significant changes.Conclu-sion:Qingjie Huagong decoction may regulation the PI3K/Akt pathway and interfere with M1 macrophage polarization,inducing M2 macrophage polarization,reducing intestinal inflammatory response,improving intestinal immune barrier,and play its role in anti-in-flammatory-immune regulation.

Objective:To investigate the mechanism of IL-23/STAT3/Th17 axis in severe acute pancreatitis(SAP)and the in-terventional effect of the Qingjie Huagong decoction(QJHGD).Methods:A rat model of SAP was established by injecting sodium tau-rocholate into the retrograde pancreatic duct.The blank group,model group,different doses of QJHGD administration groups and posi-tive group were set up respectively.HE staining was used to observe the pathology of pancreatic tissue.ELISA was used to detect serum lipase,α-amylase and inflammatory markers.By combining RT-qPCR,IHC,Western blot,and IF techniques,we elucidated the mechanism of QJHGD in protecting pancreatic tissue in SAP rats.Results:The levels of amylase,lipase,IL-1β,IL-6,IL-17,IL-23,TNF-α and TGF-β in the serum of SAP model rats in all dose groups of QJHGD were significantly reduced,and the effect was the best in medium dose group(P<0.05).The results of IHC and RT-qPCR revealed that the medium-and high-dose groups of QJHGD sig-nificantly reduced the expression of IL-23,STAT3,IL-17 protein and mRNA in the pancreatic tissue of this model(P<0.05).More-over,the Western blot results demonstrated that the expression of IL-23,STAT3,p-STAT3,and IL-17 proteins in SAP rats were sig-nificantly decreased in the medium-dose group of QJHGD(P<0.05);the IF assay indicated that Th17 cell differentiation in SAP rats was inhibited by all dose groups of QJHGD,with the most significant inhibition effect in the middle dose(P<0.05).Conclusion:QJH-GD regulates the activation of IL-23/STAT3/Th17 axis,thereby inhibiting Th17 cell differentiation and exerting a protective effect on pancreatic tissue.

This study was aimed at comparing the effects of storage conditions on the Brucella survival number in brain heart infu-sion medium,to provide experimental data support for the selection of storage conditions for Brucella strains.We created bacterial sus-pensions of seven strains of Brucella melitensis,Brucella abortus,and Brucella suis(denoted A,B,C,D,E,F,G)by using 30%glycerol brain heart infusion medium,then conducted stability testing.For accelerated stability tests,the bacterial solution was placed in a 37℃chamber for 1,2,3,or 4 weeks continuously,and the Brucella survival number at each time point was measured.For freeze-thaw stability testing,the bacterial solutions were frozen at-80℃,transferred to room temperature for 4 hours,and melted in one freeze-thaw cycle,and the Brucella survival number was measured for 2,4,6,and 8 freeze-thaw times.For long-term stability testing,the bacterial solutions were stored at-80℃,and the Brucella survival number was measured at various time points during the first,third,sixth,and twelfth months of storage.A line graph was plotted to demonstrate the changes in Brucella survival number at each time point in the three stability tests.IBM SPSS Statistics 22 software was used to assess statistically significant differences in Brucella survival number at each time point and the initial Brucella survival number.Accelerated stability tests showed that the Bru-cella survival number of the seven strains significantly decreased,and a statistically significant difference in Brucella survival number was observed after 1 week.In freeze-thaw stability tests,with increasing freeze-thaw times,the Brucella survival number of the seven strains showed a decreasing trend.Strains C and F showed statistically significant differences with respect to the initial Brucella sur-vival number after two times of freeze-thaw;strains A and D showed statistically significant differences with respect to the initial Bru-cella survival number after four times of freeze-thaw;strain G showed statistically significant differences with respect to the initial Bru-cella survival number after six times of freeze-thaw;and strain E showed statistically significant differences with respect to the initial Brucella survival number after eight times of freeze-thaw.The data for strain B showed abnormalities.In long-term stability testing,the Brucella survival number for strains C and F after storage for 1 month showed a statistically significant difference with respect to the initial bacterial solution.No statistically significant difference in Brucella survival number was observed for strains B and E after stor-age for 1,3,6,or 12 months.The data for strains A,D,and G showed abnormalities.The sterile 30%glycerol brain heart infusion medium maintained the Brucella survival number in an-80℃environment,and freezing and thawing multiple times should be avoided.Compared with the traditional freeze-drying method,this method is not only easy to perform but also avoids potential bio-safety hazards,and provides a reliable Brucella culture preservation scheme for researchers in related fields.

This study was aimed at comparing the effects of storage conditions on the Brucella survival number in brain heart infu-sion medium,to provide experimental data support for the selection of storage conditions for Brucella strains.We created bacterial sus-pensions of seven strains of Brucella melitensis,Brucella abortus,and Brucella suis(denoted A,B,C,D,E,F,G)by using 30%glycerol brain heart infusion medium,then conducted stability testing.For accelerated stability tests,the bacterial solution was placed in a 37℃chamber for 1,2,3,or 4 weeks continuously,and the Brucella survival number at each time point was measured.For freeze-thaw stability testing,the bacterial solutions were frozen at-80℃,transferred to room temperature for 4 hours,and melted in one freeze-thaw cycle,and the Brucella survival number was measured for 2,4,6,and 8 freeze-thaw times.For long-term stability testing,the bacterial solutions were stored at-80℃,and the Brucella survival number was measured at various time points during the first,third,sixth,and twelfth months of storage.A line graph was plotted to demonstrate the changes in Brucella survival number at each time point in the three stability tests.IBM SPSS Statistics 22 software was used to assess statistically significant differences in Brucella survival number at each time point and the initial Brucella survival number.Accelerated stability tests showed that the Bru-cella survival number of the seven strains significantly decreased,and a statistically significant difference in Brucella survival number was observed after 1 week.In freeze-thaw stability tests,with increasing freeze-thaw times,the Brucella survival number of the seven strains showed a decreasing trend.Strains C and F showed statistically significant differences with respect to the initial Brucella sur-vival number after two times of freeze-thaw;strains A and D showed statistically significant differences with respect to the initial Bru-cella survival number after four times of freeze-thaw;strain G showed statistically significant differences with respect to the initial Bru-cella survival number after six times of freeze-thaw;and strain E showed statistically significant differences with respect to the initial Brucella survival number after eight times of freeze-thaw.The data for strain B showed abnormalities.In long-term stability testing,the Brucella survival number for strains C and F after storage for 1 month showed a statistically significant difference with respect to the initial bacterial solution.No statistically significant difference in Brucella survival number was observed for strains B and E after stor-age for 1,3,6,or 12 months.The data for strains A,D,and G showed abnormalities.The sterile 30%glycerol brain heart infusion medium maintained the Brucella survival number in an-80℃environment,and freezing and thawing multiple times should be avoided.Compared with the traditional freeze-drying method,this method is not only easy to perform but also avoids potential bio-safety hazards,and provides a reliable Brucella culture preservation scheme for researchers in related fields.

Objective To explore the effect of acupuncture combined with manual reduction on pain and lumbar function in elderly patients with degenerative lumbar spondylolisthesis under the guidance of the Bone Strengthening and Tendon Softening Theory.Methods Ninety elderly patients with lumbar spondylolisthesis treated in our hospital from January 2021 to April 2023 were selected as study subjects.Based on a random number table method,the participants were divided into experimental group and control group,each consisting of 45 cases.The control group received acupuncture treatment,while the experimental group received manual reduction treatment on top of that.Both groups underwent continuous treatment for 4 weeks.We compared the two groups in Traditional Chinese Medicine(TCM)syndrome score,Visual Analog Scale(VAS)score,Japanese Orthopaedic Association(JOA)lumbar function score,Oswestry Disability Index(ODI),serum inflammatory factor level,and clinical efficacy between before and after treatment.Results Before treatment,there was no statistically significant difference in TCM syndrome scores or VAS scores between the two groups(P＞0.05).After treatment,both TCM syndrome scores and VAS scores significantly decreased in both groups,with the experimental group showing significantly lower scores than the control group(P＜0.05).Before treatment,there was no statistically significant difference in JOA scores and ODI scores between the two groups(P＞0.05).After treatment,JOA scores significantly increased in both groups,with the experimental group showing significantly higher scores than the control group(P＜0.05).ODI scores significantly decreased in both groups,with the experimental group showing significantly lower scores than the control group(P＜0.05).Before treatment,the two groups did not differ significantly in serum IL-6,TNF-α,or CRP levels(P＞0.05).After treatment,serum IL-6,TNF-α,and CRP levels significantly decreased in both groups,with the experimental group showing lower levels than the control group(P＜0.05).The total effective rate in the experimental group was 88.89％,significantly higher than 68.89％ in the control group(P＜0.05).Conclusion Acupuncture combined with manual reduction guided by the Bone Straightening and Tendon Softening theory can effectively alleviate pain,improve various TCM syndromes,enhance lumbar function level,and show significant clinical efficacy in patients.

Objective:To investigate the effect of Qingjie Huagong decoction on the polarization of intestinal M1/M2 macro-phages in rats with severe acute pancreatitis and the related molecular mechanisms.Methods:Forty-eight SD rats were randomly divid-ed into blank group,model group,Qingjie Huagong decoction low,medium and high dose groups,and Western medicine group.The rat model of severe acute pancreatitis was established according to 5%sodium taurocholate retrograde pancreatic duct.Western medi-cine group was given intraperitoneal injection of ulinastatin injection,and Qingjie Huagong decoction low,medium and high dose groups were given corresponding concentrations of traditional Chinese medicine by intragastric.After 24 h of intervention,pancreatic and ileal tissues were taken for HE staining to observe pathological changes.The levels of serum amylase,TNF-α,IL-6,IL-10 and TGF-β in intestinal tissue homogenate were detected by ELISA.Western blot and Real-time PCR were used to detect phosphatidylino-sitol 3-kinase(PI3K),protein serine-threonine kinase(Akt),inducible nitric oxide synthase(iNOS),leukocyte differentiation anti-gen 86(CD86),and arginase in ileum tissue The relative expression levels of 1(Arg-1),leukocyte differentiation antigen 163(CD163)protein and mRNA.Results:Compared with the model group,the pathological injury of pancreas and small intestine in Qingjie Huagong low,medium and high groups were alleviated after intervention.ELISA method for detecting serum amylase and TNF-α,IL-6 levels significantly decreased(P<0.05),while the levels of IL-10 and TGF-β were increased(P<0.05);expression levels of p-PI3K/PI3K,p-Akt,iNOS,CD86 mRNA and protein were significantly reduced(P<0.05),while the levels of CD163,Arg-1 mRNA and protein were significantly increased(P<0.05),with the highest dose group showing the most significant changes.Conclu-sion:Qingjie Huagong decoction may regulation the PI3K/Akt pathway and interfere with M1 macrophage polarization,inducing M2 macrophage polarization,reducing intestinal inflammatory response,improving intestinal immune barrier,and play its role in anti-in-flammatory-immune regulation.