Chaihu Guizhi Ganjiangtang was first recorded in the Treatise on Cold Damage （Shang Han Lun）. This prescription is composed of Bupleuri Radix， Scutellariae Radix， Cinnamomi Ramulus， Zingiberis Rhizoma， Trichosanthis Radix， Ostreae Concha， and Glycyrrhizae Radix et Rhizoma. It has the effects of soothing Lesser Yang， warming the spleen， and stimulating the generation of body fluid. It is mainly used to treat digestive tract diseases such as chronic cholecystitis （CC）， irritable bowel syndrome， and non-alcoholic fatty liver disease. Dyspepsia caused by CC presents a variety of gastrointestinal symptoms such as abdominal pain， poor appetite， postprandial fullness， aversion to greasy food， soft stool， and bitter mouth， being a type of biliary dyspepsia. In modern medicine， dyspepsia caused by CC is mainly managed by medical treatment and surgical treatment. Internal medicine mainly focuses on reducing inflammation， promoting the function of gallbladder， resolving stones， alleviating spasms， and relieving the pain for CC， demonstrating definite short-term efficacy but suffering from single effects， high recurrence rate， and poor compliance. Although surgical treatment can cure cholecystitis， it is accompanied by the increased incidence of adverse events such as abdominal pain， diarrhea， and dyspepsia. Modern clinical studies have confirmed that Chaihu Guizhi Ganjiangtang can significantly alleviate the symptoms such as abdominal pain and dyspepsia of CC patients. Pharmacological studies have found that Chaihu Guizhi Ganjiangtang mainly contains active ingredients such as Bupleuri Radix saponins， baicalin， cinnamaldehyde， gingerol， Trichosanthis Radix polysaccharide， Ostreae Concha polysaccharide， and Glycyrrhizae Radix et Rhizoma total flavonoids. Chaihu Guizhi Ganjiangtang can ameliorate the symptoms of dyspepsia caused by CC by inhibiting inflammatory responses， improving gallbladder contraction and gastrointestinal motility， regulating the bile acid-intestinal flora axis and the brain-gut axis， and modulating blood lipids through multiple targets. By reviewing the previous literature， this article summarizes the research progress in the treatment of dyspepsia caused by CC with Chaihu Guizhi Ganjiangtang and its main active ingredients as well as the pathogenesis of this disease and puts forward the shortcomings and improvement strategies for the current research. The review aims to provide a reference for the further research on Chaihu Guizhi Ganjiangtang in the treatment of dyspepsia caused by CC.

Objective To discuss the application of enhanced MRI-based radiomics nomogram in predicting the efficacy of initial transcatheter arterial chemoembolization(TACE)in patients with intermediate to advanced hepatocellular carcinoma(HCC).Methods A total of 195 patients with advanced HCC(CNLC Ⅱ b-Ⅲb),who received initial TACE at the Affiliated Fifth Hospital of Wenzhou Medical University(Center 1)from January 2019 to March 2024,at the Lishui Municipal People's Hospital(Center 2)from July 2021 to June 2023,and at the Rui'an Municipal People's Hospital(Center 3)from January 2022 to January 2024,were enrolled in this study.A total of 134 patients from Center 1 were randomly divided into a training set(n=94)and an internal validation set(n=40)at a 7∶3 ratio;and other 61 patients from Center 2 and Center 3 were selected as the external validation set.Based on the modified Response Evaluation Criteria in Solid Tumors(mRECIST)criteria,the early efficacy of the initial TACE procedure was evaluated.The patients were divided into an effective group and an ineffective group.The tumor contours were delineated on the arterial,portal,and equilibrium phase images of enhanced MRI,and the corresponding radiomics features were extracted.Based on reduced-dimensional features,the Logistic regression,support vector machine,lightweight gradient boosting machine,and multi-layer perceptron models were established.Univariate analysis and multivariate logistic regression analysis were used to screen independent predictive factors,and a nomogram was established in conjunction with the optimal radiomics score.The area under the receiver operating characteristic curve(AUC)was used to evaluate the performance of the model,and decision curve analysis was adopted to calculate the net benefits.Results After screening,9 key radiomics features were obtained.The lightweight gradient boosting machine model showed good prediction performance.The AUCs of the training set,internal validation set,and external validation set were 0.909,0.836 and 0.783 respectively,which was selected as the optimal radiomics model.The nomogram constructed based on AFP level,peritumoral enhancement,and optimal radiomics score could further improve its performance,with AUC values of 0.962,0.890 and 0.821 in the training set,internal validation set,and external validation set respectively.Decision curve analysis showed that this model could bring higher net benefits to patients.Conclusion The nomogram constructed based on the enhanced MRI-based radiomics combined with AFP level and peritumoral enhancement can effectively predict the efficacy of the initial TACE in patients with intermediate to advanced HCC.

Objective:To observe the clinical effect of retrograde distal tibial intramedullary nail fixation in the treatment of proximal ankle fracture of the distal tibia.Methods:A three-dimensional CT examination of 40 adult tibias was performed to measure anatomical indicators such as the posterior medial posterior torsion angle of the distal tibia, the height of torsion, and the height of the safety zone for nail placement. Based on the anatomy database of the human skeleton model, a retrograde distal tibial nail and its supporting instruments were developed in accordance with the anatomical characteristics of the distal tibia and the proximal ankle of Chinese people. From June 2019 to June 2023, a total of 25 patients with distal tibial proximal ankle fractures treated with retrograde intramedullary nail internal fixation in the 909th Hospital were retrospectively analyzed. There were 18 males and 7 females, aged 41.3±10.8 years (range, 22-65 years). The sample size was 1∶1 matched according to gender and age. Twenty-five patients with distal tibial proximal ankle fractures who underwent antegrade intramedullary nail fixation during the same period were matched, including 20 males and 5 females, aged 41.2±9.4 years (range 19-60 years). The reduction quality, postoperative Baird-Jackson score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, ankle range of motion and complications were observed.Results:All patients were successfully operated and followed up for 14.4±3.5 months (range, 12-24 months). The intraoperative blood loss and hospitalization time in retrograde intramedullary nail group were 33.12±7.38 ml and 10.32±1.75 d, less than 49.04±10.22 ml and 13.16±2.69 d in antegrade intramedullary nail group, and the difference was statistically significant ( P<0.05). The reduction quality was excellent in 23 cases and good in 2 cases in the retrograde intramedullary nail group, and was excellent in 17 cases and good in 8 cases in the anterograde intramedullary nail group. The proportion of excellent reduction quality in the retrograde intramedullary nail group was higher than that in the anterograde intramedullary nail group, and the difference was statistically significant (χ 2=4.500, P=0.034). The Baird-Jackson score and AOFAS ankle and hindfoot score in the retrograde intramedullary nail group were 85.6±2.5 and 85.8±3.3 at 3 months after operation, lower than those at 1 year after operation 95.3±3.1 and 95.8±3.6, and the difference was statistically significant ( P<0.05). The Baird-Jackson score and AOFAS ankle and hindfoot score of the antegrade intramedullary nail group were 85.1±3.3 and 86.1±2.5 at 3 months after operation, lower than 95.2±2.7 and 94.9±3.5 at 1 year after operation, and the difference was statistically significant ( P<0.05). There was no significant difference in Baird-Jackson score and AOFAS ankle and hindfoot score between the two groups at 3 months and 1 year after operation ( P>0.05). At the last follow-up, there was no ankle stiffness, neurovascular injury, deep vein thrombosis, infection or breakage of internal fixation in the two groups. Conclusion:The treatment of distal tibial proximal ankle fractures with retrograde intramedullary nail fixation has satisfactory reduction quality, good postoperative function recovery, and is helpful for early postoperative rehabilitation.

The new generation of artificial intelligence technology,represented by deep learning,has emerged as a crucial driving force in the advancement of new drug research and development.This article creatively proposes a workflow named"Molecular Factory"for the design and optimization of drug molecules based on artificial intelligence technology.This workflow integrates intelligent molecular generation models,high-performance molecular docking algorithms,and accurate protein-ligand binding affinity prediction methods.It has been integrated as a core module into DrugFlow,a one-stop drug design software platform,providing a comprehensive set of mature solutions for the discovery and optimization of lead compounds.Utilizing the"Molecular Factory"module,we conducted the research of second-generation inhibitors against Menin that can combat drug resistance.Through the integration of computational and experimental approaches,we rapidly identified multiple promising compounds.Among them,compound RG-10 exhibited the IC50 values of 9.681 nmol/L,233.2 nmol/L,and 40.09 nmol/L against the wild-type Menin,M327I mutant,and T349M mutant,respectively.Compared to the positive reference molecule SNDX-5613,which has entered Phase Ⅱ clinical trials,RG-10 demonstrated significantly enhanced inhibitory activity against the M327I and T349M mutants.These findings fully demonstrate the unique advantages of the"Molecular Factory"technology in practical drug design and development scenarios.It can rapidly and efficiently generate high-quality active molecules targeting specific protein structures,holding significant value and profound implications for advancing new drug discovery.

Objective:To analyze the epidemiological and clinical characteristics of children with acute brucellosis, providing reference for early diagnosis and standardized treatment of brucellosis in children.Methods:The data of 140 children with acute brucellosis at Xi'an Children's Hospital from April 2012 to October 2021 were collected. Their general information, epidemiological characteristics, clinical manifestations, laboratory and imaging examinations, treatment and prognosis were analyzed retrospectively.Results:Among 140 children with acute brucellosis, there were 78 males and 62 females, with a median age of onset and interquartile range of 3.4 (1.8, 5.8) years; 88.6% (124/140) of these children came from rural areas. The peak season for the onset of brucellosis was summer (47.1%, 66/140); 92.9% (130/140) had a confirmed epidemiological history; 7.9% (11/140) of the affected children were latent carriers. Among the 129 children with obvious clinical manifestations, fever accounted for 99.2% (128/129), hyperhidrosis accounted for 52.7% (68/129), and involvement of the reticuloendothelial system, joints, and nervous system accounted for 46.5% (60/129), 44.2% (57/129), and 6.2% (8/129), respectively, joint effusion accounted for 64.9% (37/57). All patients tested positive for tiger red plate agglutination test; 97.9% (137/140) of the patients had a serum tube agglutination test titer ≥1 ∶ 100. Positive blood culture accounted for 85.7% (120/140). The positive detection rate of serum tube agglutination test was higher than that of blood culture (χ 2 = 13.69, P < 0.001). Brucella was cultured from the cerebrospinal fluid of 8 children with concomitant encephalitis. The initial treatment plan for all children was oral compound sulfamethoxazole/doxycycline + rifampicin. In cases of arthritis, osteomyelitis or encephalitis, third-generation cephalosporins or meropenem were used intravenously at the same time. Dexamethasone was used for patients suffered from bilateral abductor nerve damage. All patients were cured without recurrence. Two cases had sequelae, namely introverted vision in the right eye and knee joint movement disorders. Conclusions:Most children with acute brucellosis have a confirmed epidemiological history and are mainly distributed in rural areas. The main clinical manifestation is fever, and joint involvement is also common. Standardized treatment can cure them.

The coronavirus disease 2019 (COVID-19) pandemic poses negative impacts on psychological health among healthcare workers. If timely diagnosis and interventions are not given, the pandemic not only threatens physical and psychological health among healthcare workers, and greatly reduces the quality and efficiency of medical treatment. Based on review of national and international publications pertaining to psychological problems and interventions among healthcare workers during the COVID-19 pandemic, this article describes the prevalence of psychological problems among healthcare workers, influencing factors and psychological interventions, so as to provide insights into the protection of psychological health among healthcare workers.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective : To investigate the status of occupational stress and analyze its influencing factors among frontline employees working in a chemical fiber manufacturing enterprise, so as to provide insights into the development of occupational stress interventions. Methods : The frontline employees working in a chemical fiber manufacturing enterprise were selected as the study subjects using a cluster sampling method in October 2018. The status of occupational stress was investigated using the Chinese version of the effort-reward imbalance ( ERI ) questionnaire. The influencing factors for occupational stress were identified using a multivariable logistic regression model. Results : A total of 1 780 questionnaires were sent out, and 1 115 valid ones ( 62.64% ) were recovered. Among the 1 115 respondents, there were 427 men ( 38.30% ) and 688 women ( 61.70% ), and 71.22% were at ages of 21 to 39 years. There were 561 respondents with < 1 year of service ( 50.31% ), and the longest length of service was 11 years. In addition, there were 1 069 respondents ( 95.87% ) exposed to high noise, and 346 respondents ( 31.03% ) were diagnosed at a high occupational-stress state and 769 ( 68.97% ) at a low state. Multivariable logistic regression analysis identified 5 years or longer of service ( OR=1.540, 95%CI: 1.057-2.245 ) and exposure to high noise ( OR=1.917, 95%CI: 1.004-3.659 ) as risk factors for occupational stress among frontline employees in the chemical fiber manufacturing enterprise. Conclusions There are 31.03% of frontline employees at a high occupational-stress state in the chemical fiber manufacturing enterprise, and a high occupational-stress state is associated with exposure to high noise and 5 years or longer of service.

Objective:To evaluate the quality of a systematic review/Meta-analysis of auricular acupressure on pain, and provide decision making basis for Traditional Chinese Medicine (TCM) nursing.Methods:PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, Wanfang Data, VIP, CBM databases were searched to collect systematic reviews or Meta-analysis on auricular acupressure intervention pain from inception to October, 2020. Two researchers independently screened literature, extracted the data, and used AMSTAR 2 and GRADE to evaluate methodological quality and evidence quality.Results:A total of 8 systematic reviews were included. The AMSTAT2 evaluation showed that all the studies were in low methodological quality; GRADE tool graded 26 outcome indicators, including 6 intermediate quality indicators, 16 low-level quality indicatorsand 4 extremely low-level quality indicators. The research results showed that auricular acupressure is safe and effective in chronic low back pain, primary dysmenorrhea and partial postoperative pain. Another study found that it has no significant effect, but it can reduce the rate of adverse reactions.Conclusions:These studies show that auricular acupressure is safe on pain and has certain advantages, but its methodological quality and evidence quality are not high, which requires further research to confirm.

OBJECTIVE：To esta blish a sc ientific and objective post competency evaluation index system for the drug registration specialist. METHODS ：By searching the competency model literature of drug registration and registration related documents，combined with Spencer ’s Competency Dictionary and Hay ’s Competency Dictionary ，post competency evaluation index system for drug registration specialist was formulated preliminarily. Through two rounds of Delphi expert consultation ，experts in related fields of drug registration were consulted by letter ，the evaluation indexes were screnned and revised ，and the weight of the indexes was calculated by using the superior order diagram method. Based on questionnaire survey ，232 drug registration personnel were selected as research objects ，and then exploratory factor analysis ，confirmatory factor analysis and internal consistency reliability analysis were used to test the constructed evaluation index system. RESULTS ：The post competency evaluation system of drug registration specialist covered 4 core dimensions （registered professional ability ，relationship management ability ，professional development ability ，personal comprehensive quality ），11 sub-scales，and 41 measurement items ；the weight of the index was confirmed. The establishment process of the evaluation system showed that the expert consultation had high enthusiasm and good coordination；exploratory factor analysis and confirmatory factor analysis had proved the scientific rationality of the index system. CONCLUSIONS：The post competency evaluation index system for drug registration specialist is comprehensive ，integrated and scientific，can provide reference for evaluation and management of the drug registration specialist practice.