ObjectiveTo investigate the mechanism by which Gegen Qinliantang（GQT） improves skeletal muscle insulin resistance. MethodsThe db/m mice were used as the normal group， while db/db mice were assigned to a model group， low-dose （3.12 g·kg^-1）， medium-dose （6.24 g·kg^-1）， and high-dose （12.48 g·kg^-1） GQT groups， and a Western medicine group （semaglutide， 0.045 mg·kg^-1），n=6 in each group. All groups received corresponding interventions. Intraperitoneal glucose tolerance test （IPGTT）， intraperitoneal insulin tolerance test （IPITT）， and hematoxylin-eosin （HE） staining were used to evaluate insulin resistance and therapeutic efficacy. Serum lipid levels were measured using an automatic biochemical analyzer， and apoptosis in skeletal muscle was assessed via TUNEL assay. Transcriptome sequencing combined with gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） analyses was performed to identify differentially expressed genes （DEGs）. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to validate gene expression. Molecular docking was applied to evaluate the binding patterns between active components of GQT and key regulatory genes to elucidate pharmacological mechanisms. ResultsCompared with the model group， the medium-dose and high-dose GQT groups showed significantly reduced fasting blood glucose （FBG） levels （P<0.01）. Triglycerides （TG）， total cholesterol （TC）， and low-density lipoprotein cholesterol （LDL-C） were markedly decreased （P<0.01）， while high-density lipoprotein cholesterol （HDL-C） was significantly increased （P<0.01）. IPGTT， IPITT， and HE staining demonstrated that GQT enhanced insulin sensitivity and restored skeletal muscle morphology. GQT also alleviated apoptosis in skeletal muscle tissue. Transcriptome analysis revealed that GQT primarily affected biological processes such as oxidative phosphorylation， metabolic pathways， cellular processes， and protein binding. Real-time PCR results showed that CBR2， CDK6， F830016B08Rik， IL-1β， Rab27b， and COLEC12 were key regulatory genes. Molecular docking demonstrated that CBR2， IL-1β， Rab27b， and COLEC12 formed stable binding with the main active components of GQT. The therapeutic effects of high- and medium-dose GQT were comparable to those of the semaglutide group. ConclusionGQT improves skeletal muscle insulin resistance， potentially by regulating apoptosis as part of its underlying biological mechanism.

Objective: To evaluate the safety and efficacy of the retroauricular transmeatal approach in the treatment of condylar head and neck fractures, and to provide a reference for clinical practice. Methods: This study has been reviewed and approved by the institutional medical ethics committee and has obtained informed consent from the patients. A retrospective analysis was conducted on the clinical data of patients with condylar head and neck fractures treated via the retroauricular transmeatal approach between March and October 2024. Postoperative follow-up was performed for at least 3 months, including clinical and radiographical evaluations. The assessed parameters included facial nerve function, temporal region numbness, hematoma, infection, salivary fistula, mouth opening, malocclusion, mandibular movement function, temporomandibular joint (TMJ) pain and clicking, external auditory canal (EAC) stenosis, hearing function impairment, surgical scar concealment, postoperative reduction and fixation outcomes. Results: A total of 16 patients with condylar fractures were treated via the retroauricular transmeatal approach, including 10 unilateral and 6 bilateral cases. Specifically, 18 sides were condylar head fractures, and 4 sides were condylar neck fractures. All patients achieved a House-Brackmann Grade I, indicating normal facial nerve function postoperatively. On postoperative day 1, 3 sides experienced temporal numbness in the temporal region on the surgical side, with spontaneous resolution in all cases. All patients recovered after surgery without hematoma, infection, or salivary fistula. Limited mouth opening was improved (14 cases with restricted mouth opening preoperatively vs. 3 cases postoperatively). No malocclusion occurred in any patient. All patients achieved satisfactory recovery of postoperative mandibular movement function, manifested as restored range of motion without pain. No TMJ clicking was observed within 3 months after surgery. One keloid-prone patient developed progressive EAC stenosis (2 mm lumen constriction) accompanied by conductive hearing impairment, which recovered after dilation therapy. All patients were satisfied with the aesthetic outcomes. Radiographically parametric assessment demonstrated satisfactory fracture reduction and fixation; with no loosening of titanium plates or screws. Conclusion The retroauricular transmeatal approach effectively reduces the risk of facial nerve injury and salivary fistulas formation with providing concealed scarring and high patient satisfaction. However, caution should be exercised regarding EAC stenosis, especially for keloid-prone patients.

Through the dismantlement,analysis,and sorting of the method of clearing collaterals and nourishing yin in the differentiation of syndromes in Wenbing Tiaobian written by WU Tang,a renowned physician of the Qing Dynasty.This article concluded that WU Tang's clinical application of clearing collaterals can be divided into clearing the qi collateral heat,clearing the blood collateral stasis,and clearing collateral stagnant heat.The yin-nourishing method specifically includes the sweet-cold fluid-restoring,sour-sweet yin-generating,sweet-bitter yin qi-nourishing,sweet-moistening fluid-preserving,heat-clearing fluid-protecting,and emergency purgative yin-preserving methods.Our team explored the application of this approach in tumor treatment based on the academic perspective of"strengthening healthy qi to treat cancer"and in combination with the"clearing collaterals and nourishing yin"method.It proposes that within the relationship between"strengthening healthy qi to treat cancer"and the"clearing collaterals and nourishing yin"method,"nourishing yin to strengthen healthy qi"often serves as the foundation of tumor treatment,whereas"clearing collaterals to eliminate pathogens"acts as an auxiliary measure.This paper summarizes our team's clinical experience and evidence in further treating cancerous diseases based on this theory,citing examples such as Qinghao Biejia Decoction,Xijiao Dihuang Decoction,Zhibai Dihuang Pill,our team's empirical formulas,and the specialized use of medications for cancerous diseases.The further application of this method in cancer diseases can be expanded to improve the clinical effect by summarizing the theory of"strengthening healthy qi to treat cancer"and improving the understanding of clearing collaterals and nourishing yin.

VR technology can generate virtual,immersive,and interactive environments,allowing users to immerse themselves in these environments and interact with objects within them.AR technology,on the other hand,can accurately overlay virtual information onto real-world scenes,achieving a seamless integration of the virtual and the real.These two emerging technologies each possess unique advantages and exhibit broad development prospects.They have already begun to be applied in various aspects of medical education,such as basic theoretical teaching and skills training,with promising results.They can compensate for the shortcomings of traditional medical education,enhance students'learning enthusiasm and safety,and improve teaching effectiveness.However,limitations remain,such as the need for improved hardware infrastructure and a scarcity of teaching resources.Based on this,this paper systematically introduces the concepts of AR and VR technologies,reviews their application prospects,current status,advantages,and limitations in medical education,aiming to provide evidence-based support and feasible approaches for medical schools to develop digital teaching plans,promote educational reform,and drive research innovation.

Objective:To verify the prognostic value of perineural invasion and lymphovascular tumor embolus for patients with gastric cancer undergoing gastrectomy and postoperative chemotherapy, and establish a prognostic prediction nomogram model.Methods:According to 7∶3 radio, 781 gastric cancer patients were randomly divided into training cohort and internal validation cohort. One hundred fifty patients were utilized as the external validation cohort. Univariate and multivariate analysis were performed to evaluate the prognostic value of perineural invasion and lymphovascular tumor embolus, and construct the dynamic nomogram. The concordance index (C-index), net reclassification index and integrated discrimination improvement index, receiver operating characteristic curve, calibration curves and decision curve analysis were used to evaluate the nomogram.Results:Perineural invasion ( HR=1.486, 95% CI: 1.150-1.919, P<0.01) and lymphovascular tumor embolus ( HR=1.321, 95% CI: 1.030-1.693, P<0.05) were independent prognostic risk factors for patients with gastric cancer after gastrectomy and postoperative chemotherapy. C-index (training cohort: 0.734, internal validation cohort: 0.755, external validation cohort: 0.715), net reclassification index (training cohort: 0.228 for 3-year and 0.213 for 5-year OS prediction; internal validation cohort: 0.211 for 3-year and 0.279 for 5-year OS prediction; external validation cohort: 0.220 for 3-year and 0.440 for 5-year OS prediction) and integrated discrimination improvement index (training cohort: 0.051 for 3-year and 0.041 for 5-year OS prediction; internal validation cohort: 0.027 for 3-year and 0.036 for 5-year OS prediction; external validation cohort: 0.063 for 3-year and 0.153 for 5-year OS prediction) indicated that the nomogram performed better than the traditional TNM staging system ( P<0.05). Conclusions:Perineural invasion and lymphovascular tumor embolus are independent prognostic risk factors of gastric cancer patients after postoperative chemotherapy. The novel dynamic nomogram model based on perineural invasion and lymphovascular tumor embolus provides better assistance in evaluating prognosis of gastric cancer patients.

VR technology can generate virtual,immersive,and interactive environments,allowing users to immerse themselves in these environments and interact with objects within them.AR technology,on the other hand,can accurately overlay virtual information onto real-world scenes,achieving a seamless integration of the virtual and the real.These two emerging technologies each possess unique advantages and exhibit broad development prospects.They have already begun to be applied in various aspects of medical education,such as basic theoretical teaching and skills training,with promising results.They can compensate for the shortcomings of traditional medical education,enhance students'learning enthusiasm and safety,and improve teaching effectiveness.However,limitations remain,such as the need for improved hardware infrastructure and a scarcity of teaching resources.Based on this,this paper systematically introduces the concepts of AR and VR technologies,reviews their application prospects,current status,advantages,and limitations in medical education,aiming to provide evidence-based support and feasible approaches for medical schools to develop digital teaching plans,promote educational reform,and drive research innovation.

Objective:To verify the prognostic value of perineural invasion and lymphovascular tumor embolus for patients with gastric cancer undergoing gastrectomy and postoperative chemotherapy, and establish a prognostic prediction nomogram model.Methods:According to 7∶3 radio, 781 gastric cancer patients were randomly divided into training cohort and internal validation cohort. One hundred fifty patients were utilized as the external validation cohort. Univariate and multivariate analysis were performed to evaluate the prognostic value of perineural invasion and lymphovascular tumor embolus, and construct the dynamic nomogram. The concordance index (C-index), net reclassification index and integrated discrimination improvement index, receiver operating characteristic curve, calibration curves and decision curve analysis were used to evaluate the nomogram.Results:Perineural invasion ( HR=1.486, 95% CI: 1.150-1.919, P<0.01) and lymphovascular tumor embolus ( HR=1.321, 95% CI: 1.030-1.693, P<0.05) were independent prognostic risk factors for patients with gastric cancer after gastrectomy and postoperative chemotherapy. C-index (training cohort: 0.734, internal validation cohort: 0.755, external validation cohort: 0.715), net reclassification index (training cohort: 0.228 for 3-year and 0.213 for 5-year OS prediction; internal validation cohort: 0.211 for 3-year and 0.279 for 5-year OS prediction; external validation cohort: 0.220 for 3-year and 0.440 for 5-year OS prediction) and integrated discrimination improvement index (training cohort: 0.051 for 3-year and 0.041 for 5-year OS prediction; internal validation cohort: 0.027 for 3-year and 0.036 for 5-year OS prediction; external validation cohort: 0.063 for 3-year and 0.153 for 5-year OS prediction) indicated that the nomogram performed better than the traditional TNM staging system ( P<0.05). Conclusions:Perineural invasion and lymphovascular tumor embolus are independent prognostic risk factors of gastric cancer patients after postoperative chemotherapy. The novel dynamic nomogram model based on perineural invasion and lymphovascular tumor embolus provides better assistance in evaluating prognosis of gastric cancer patients.

Through the dismantlement,analysis,and sorting of the method of clearing collaterals and nourishing yin in the differentiation of syndromes in Wenbing Tiaobian written by WU Tang,a renowned physician of the Qing Dynasty.This article concluded that WU Tang's clinical application of clearing collaterals can be divided into clearing the qi collateral heat,clearing the blood collateral stasis,and clearing collateral stagnant heat.The yin-nourishing method specifically includes the sweet-cold fluid-restoring,sour-sweet yin-generating,sweet-bitter yin qi-nourishing,sweet-moistening fluid-preserving,heat-clearing fluid-protecting,and emergency purgative yin-preserving methods.Our team explored the application of this approach in tumor treatment based on the academic perspective of"strengthening healthy qi to treat cancer"and in combination with the"clearing collaterals and nourishing yin"method.It proposes that within the relationship between"strengthening healthy qi to treat cancer"and the"clearing collaterals and nourishing yin"method,"nourishing yin to strengthen healthy qi"often serves as the foundation of tumor treatment,whereas"clearing collaterals to eliminate pathogens"acts as an auxiliary measure.This paper summarizes our team's clinical experience and evidence in further treating cancerous diseases based on this theory,citing examples such as Qinghao Biejia Decoction,Xijiao Dihuang Decoction,Zhibai Dihuang Pill,our team's empirical formulas,and the specialized use of medications for cancerous diseases.The further application of this method in cancer diseases can be expanded to improve the clinical effect by summarizing the theory of"strengthening healthy qi to treat cancer"and improving the understanding of clearing collaterals and nourishing yin.

Purpose To explore the application of contrast-enhanced ultrasound in evaluating the local muscle microcirculation before and after acupuncture at Zusanli point in normal people.Materials and Methods A total of 72 healthy volunteers who visited the Department of Ultrasound,the Second Affiliated Hospital of Fujian Medical University from September 2018 to May 2020 were prospectively collected,all subjects performed ultrasound contrast before acupuncture,acupuncture with strongest deqi,and two hours after acupuncture to observe the blood flow perfusion of the microvessels in the tibialis anterior muscle.The pre-selected areas of interest the small arteries,muscle tissues and venules in the middle were analyzed to obtain the time-intensity curve and contrast transit time(CTTs)perfusion parameters.Needle sensation was evaluated using objective scoring criteria for acupuncture combined with moxibustion recipients.Gastrin,plasma gastrin,cholecystokinin,and secretin were measured in all subjects before acupuncture,when acupuncture had the strongest deqi,and two hours after acupuncture.Results ①CTTs of arterial-muscle,muscle-venous and arterial-venous of the tibialis anterior muscle at acupuncture with strongest deqi were significantly shorter than those at before acupuncture and two hours after acupuncture(all P<0.001),and there was no significant difference in CTTs before and after acupuncture and moxibustion(P>0.05);②when acupuncture deqi was strongest,serum gastrin,plasma prokinetics,cholecystokinin,and secretin were significantly increased compared with those before acupuncture and two hours after acupuncture,with statistically significant difference(all P<0.001),while there was no significant difference in these parameters between before acupuncture and two hours after acupuncture(P>0.05);③when acupuncture had the strongest deqi,there were positive correlations between gastrin,plasma prokinetic hormone,cholecystokinin,and secretin values and CTTs of arterial-muscle,muscle-venous,and arterial-venous(r=0.360-0.702,P<0.001).Conclusion Acupuncture of the Zusanli,when it gains the strongest deqi,can cause changes in the microcirculation around the skeletal muscle,leading to a significant shortening of CTTs,and also promotes the secretory function of the gastrointestinal tract.

Polyorchidism is a rare congenital malformation of the urogenital system, in which a man has three or more testes, and the excess testes are usually located in the scrotum. A case of polyorchidism was reported in this paper. The patient presented with a scrotal mass, and ultrasonography showed an echogenic mass resembling testicular tissue in the right scrotum. A palpable mass in the right lower pole of the testis was found during the operation and completely removed. Pathological examination showed that the nodule parenchyma was seminiferous tubules under the microscope, and the nodule was covered with a white structure, which was considered as polytorchidism. Six months after the operation, the bilateral testis and epididymis were normal.