ObjectiveTo develop a standardized classification model for traditional Chinese medicine （TCM） syndrome patterns of mixed hemorrhoids using multi-center real-world data， and unveil their distribution patterns and core risk factors， thereby providing evidence-based support for standardizing TCM syndrome differentiation and implementing precision interventions. MethodsA multi-center cross-sectional study was conducted， enrolling 13 283 mixed hemorrhoid patients from eight hospitals in Jiangsu Province between September 1st， 2023 and December 31st， 2024. DeepSeek-R1-Distill-Qwen-7B and LLaMA-3.3 large language models （LLM） were integrated with latent class analysis （LCA） to perform unsupervised learning and latent class modeling of TCM symptomatology. Potential risk factors were screened via univariate analysis， followed by logistic regression to identify independent risk factors for each syndrome pattern. ResultsThe model's performance indicators were stable and reliable across different clinical data types，i.e. in the outpatient records， past medical history （F1=99.7%）， current medical history （F1=94.9%）， and specialist examination （F1=90.7%）； in inpatient records， past medical history （F1=98.2%）， current medical history （F1=91.2%）， specialist examination （F1=90.3%）， and discharge status （F1=90.6%）. Latent class mode-ling identified four core TCM syndrome patterns including spleen deficiency and qi sinking syndrome （915 cases， 6.89%）， damp-heat pouring downward syndrome （10 820 cases， 81.46%）， qi stagnation and blood stasis syndrome （1252 cases， 9.43%）， and wind injuring intestinal collaterals syndrome （296 cases， 2.22%）， with respective latent class probabilities of 0.069， 0.815， 0.094， and 0.022. Logistic regression demonstrated that gender， age， disease duration， hypertension， diabetes， hyperlipidemia， constipation， smoking history， and alcohol consumption were independent risk factors for pattern differentiation （P＜0.05）. The efficacy validation evaluation revealed that the cure rates for patients with spleen deficiency and qi sinking syndrome and qi stagnation and blood stasis syndrome were higher than those for patients with damp-heat pouring downward syndrome （adjusted P＜0.05）， with no statistically significant differences among other syndrome patterns. ConclusionDamp-heat pouring downward syndrome is the predominant syndrome in mixed hemorrhoids. Gender， age， disease duration， hypertension， diabetes， hyperlipi-demia， constipation， smoking history， and alcohol consumption are independent risk factors for the differentiation of syndrome types.

Objective To analyze the technical essentials of single-microport assisted micro-uni-port thoracoscopic surgery, and to investigate its surgical efficacy and promotional value. Methods Clinical data of patients who consecutively underwent radical upper lobectomy in the Department of Thoracic Surgery of Xi'an International Medical Center Hospital from March 2023 to June 2024 were retrospectively analyzed. According to the surgical approach, patients were divided into two groups: the single-microport assisted group (underwent upper lobectomy via single-microport assisted micro-uni-port thoracoscopy) and the traditional uniportal group (underwent traditional uniportal thoracoscopic lobectomy). Clinical outcomes were compared between the two groups. Results A total of 62 patients were enrolled. There were 30 patients in the single-microport assisted group, with a mean age of (57.4±10.8) years, and 32 patients in the traditional uniportal thoracoscopic group, with a mean age of (57.6±8.7) years. The baseline data were comparable between the two groups. All patients in both groups successfully underwent minimally invasive surgery without conversion to thoracotomy. The operative time in the single-microport assisted group was significantly shorter than that in the traditional uniportal group [(146.03±30.79) min vs. (171.41±36.41) min, P=0.004]. However, there were no statistically significant differences between the two groups in intraoperative blood loss, number of dissected lymph nodes, duration of chest tube drainage, postoperative pain score, postoperative hospital stay, hospitalization cost, or incidence of postoperative complications (all P>0.05). Conclusion Single-microport assisted micro-uni-port thoracoscopic surgery for upper lobectomy can maximally integrate the advantages of three-port and uni-port VATS while effectively avoiding their disadvantages. It significantly shortens the operative time without increasing postoperative pain or complications, and represents a more minimally invasive, safer, and more convenient surgical approach.

Objective:To evaluate the efficacy of high-flow nasal cannula oxygen therapy for lumbosacral plexus block combined with intravenous anesthesia for hip replacement in elderly patients.Methods:Twenty-two elderly patients of either sex, aged 65-89 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective lateral approach to unilateral hip replacement, capable of cooperating to complete the Mini-Mental State Examination with a score of ≥25, were included. Preoperative lumbosacral plexus block was performed on the affected side under ultrasound guidance. Sufentanil 0.1 μg/kg was intravenously injected at 5 min before skin incision, and propofol was given by target-controlled infusion at a plasma target concentration of 1.0-2.0 μg/ml. During the operation, spontaneous breathing was preserved and high-flow nasal cannula oxygen therapy was performed. FiO 2 was set at 60%, gas flow rate at 60 L/min, temperature at 37 ℃, humidity at 100%. The values of Bispectral Index were 60 -75, and the Surgical Pleth Index value was 30-60. If the Surgical Pleth Index value > 60, an additional sufentanil 0.05 μg/kg was added. PaO 2, FiO 2 and PaCO 2 were recorded immediately before nerve block (T 1), immediately after the start of surgery (T 2), 30 min after the start of surgery (T 3), 90 min after the start of surgery (T 4), immediately after the end of surgery (T 5) and immediately after leaving postanesthesia care unit (T 6). Lung ultrasound scores were recorded at T 1 and T 6. The development of intraoperative hypotension, bradycardia and hypoxemia and occurrence of postoperative nausea and vomiting, new pulmonary infection, delirium and cognitive dysfunction were recorded. Results:Nerve block was completed within 15 min in all the patients, and all the patients underwent surgery successfully. PaO 2/FiO 2 increased at T 4 and T 5, while at T 6 it decreased to the level observed at T 1 ( P<0.05); PaCO 2 increased at T 2-T 6 and reached the peak value at T 2 ( P<0.05). There was no significant difference in lung ultrasound scores at all time points ( P>0.05). There were 8 patients (36%) with hypotension and 2 patients (9%) with bradycardia, and no hypoxemia was found during operation. Postoperative nausea and vomiting occurred in 2 cases (9%) and delirium in 2 cases (9%), and no new pulmonary infection or cognitive dysfunction was found after operation. Conclusions:High-flow nasal cannula oxygen therapy can be safely and effectively used in elderly patients undergoing hip replacement with lumbosacral plexus block combined with intravenous anesthesia.

Objective To investigate the possible association between cross-domain associative memory(AM)impairment and hippocampal subfield volumes in patients with schizophrenia(SCZ).Methods We enrolled 28 SCZ patients from Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,and 28 healthy controls(HCs)between 2019 and 2021.Based on an innovative AM paradigm and automated segmentation,3D-T1 weighted data of the objects were processed with PhiPipe and FreeSurfer.Differences in subfield volums between the two groups were analyzed using ANCOVA,while their relationship with AM scores was assessed using Pearson correlation.Results SCZ patients exhibited significantly poorer AM performance across three conditions compared with HCs.Marginally significant reductions were observed in the total volume of bilateral hippocampus,encompassing both the hippocampal head and body.Significant volume reductions were identified in the bilateral presubiculum and parasubiculum.The volumes of bilateral presubiculum head(r=0.273,P=0.042),parasubiculum(r=0.397,P=0.002),and CA1 head(r=0.382,P=0.004)exhibited positive correlations with cross-domain AM performance.Conclusion The bilateral presubiculum and parasubiculum,as hippocampal subregions significantly associated with cross-modal AM deficits in SCZ,may play a crucial role in the pathology of AM.

Objective:To evaluate the efficacy of high-flow nasal cannula oxygen therapy for lumbosacral plexus block combined with intravenous anesthesia for hip replacement in elderly patients.Methods:Twenty-two elderly patients of either sex, aged 65-89 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, scheduled for elective lateral approach to unilateral hip replacement, capable of cooperating to complete the Mini-Mental State Examination with a score of ≥25, were included. Preoperative lumbosacral plexus block was performed on the affected side under ultrasound guidance. Sufentanil 0.1 μg/kg was intravenously injected at 5 min before skin incision, and propofol was given by target-controlled infusion at a plasma target concentration of 1.0-2.0 μg/ml. During the operation, spontaneous breathing was preserved and high-flow nasal cannula oxygen therapy was performed. FiO 2 was set at 60%, gas flow rate at 60 L/min, temperature at 37 ℃, humidity at 100%. The values of Bispectral Index were 60 -75, and the Surgical Pleth Index value was 30-60. If the Surgical Pleth Index value > 60, an additional sufentanil 0.05 μg/kg was added. PaO 2, FiO 2 and PaCO 2 were recorded immediately before nerve block (T 1), immediately after the start of surgery (T 2), 30 min after the start of surgery (T 3), 90 min after the start of surgery (T 4), immediately after the end of surgery (T 5) and immediately after leaving postanesthesia care unit (T 6). Lung ultrasound scores were recorded at T 1 and T 6. The development of intraoperative hypotension, bradycardia and hypoxemia and occurrence of postoperative nausea and vomiting, new pulmonary infection, delirium and cognitive dysfunction were recorded. Results:Nerve block was completed within 15 min in all the patients, and all the patients underwent surgery successfully. PaO 2/FiO 2 increased at T 4 and T 5, while at T 6 it decreased to the level observed at T 1 ( P<0.05); PaCO 2 increased at T 2-T 6 and reached the peak value at T 2 ( P<0.05). There was no significant difference in lung ultrasound scores at all time points ( P>0.05). There were 8 patients (36%) with hypotension and 2 patients (9%) with bradycardia, and no hypoxemia was found during operation. Postoperative nausea and vomiting occurred in 2 cases (9%) and delirium in 2 cases (9%), and no new pulmonary infection or cognitive dysfunction was found after operation. Conclusions:High-flow nasal cannula oxygen therapy can be safely and effectively used in elderly patients undergoing hip replacement with lumbosacral plexus block combined with intravenous anesthesia.

OBJECTIVE To investigate the molecular epidemiological characteristics of clinical isolates of carbapen-em-resistant Klebsiella pneumoniae(CRKP)resistant to ceftazidime/avibactam(CZA).METHODS From Jan.2022 to Dec.2023,totally 63 strains of non-repetitive CZA-resistant CRKP that were isolated for the first time from hospitalized patients of the First Affiliated Hospital of Nanchang University were enrolled in the study,and 50 strains of CZA-sensitive CRKP were randomly chosen as the research subjects.The drug susceptibility rates of the strains were observed.The drug resistance genes,virulence genes and capsular serotypes of the strains were detected by means of polymerase chain reaction(PCR).The molecular epidemiological characteristics of the strains were observed by using molecular biological techniques such as pulse field gel electrophoresis(PFGE)and multilocus sequence typing(MLST).RESULTS Among the CZA-resistant CRKP strains,45(71.43％)were iso-lated from sputum.The result of drug susceptibility testing showed that the drug resistance rates of the CZA-re-sistant strains to amikacin,aztreonam and minocycline were lower than those of the CZA-sensitive strains(P＜0.05),and the drug resistance rates of the CZA-resistant strains to tigecycline was higher than that of the CAZ-sensitive strains(P＜0.05).The carrying rates of blaKPC,blaNDM,blaSHV-1,blaTEM-1,blaCTX-M,blaqnrS,blaacc(6')-Ib and blarmtB genes of the CZA-resistant strains were relatively high.Among the detected capsular serotypes,K64(n=18,28.57％)was dominant.ST11(n=25,39.68％)was predominant strain among the CZA-resistant CRKP strains.CONCLUSIONS ST11 is dominant among the CZA-resistant CRKP strains.The strains carry with multiple drug resistance genes and virulence genes.The drug resistance rate of the CZA-resistant strains to tigecycline is higher than that of the CZA-sensitive strains,and it is necessary to attach great importance during the clinical treatment.

[Objective]Our study seeks to investigate the connection between systemic immune inflammatory index and renal function,as well as to assess its predictive capacity for the deterioration of renal function in chronic kidney disease patients with non-dialysis.[Methods]Adult non-dialyzing patients diagnosed with CKD were included.The computation of SII was calculated as the product of the peripheral blood neutrophil count(×10?/L)and platelet count(×10?/L),divided by the lymphocyte count(×10?/L).The logistic and Cox regression models were employed to scrutinize the linkage between SII levels and CKD.[Results]Out of the cohort,a significant portion of patients,numbering 244,which constitutes 17.2％,experienced progression of CKD.A notable upsurge in SII corresponded with an increased prevalence of advanced CKD and its progression,with significant difference.This trend was mirrored by a decline in the estimated glomerular filtration rate and hemoglobin levels,while serum creatinine,C-reactive protein,and lipoprotein(a)levels were on the rise.After adjusting for multiple variables,the natural logarithm of SII exhibited an independent association with advanced CKD[OR=1.85 95％CI(1.46,2.35),P<0.01].Furthermore,Cox proportional hazards model analysis revealed that SII acted as an independent predictor for CKD progression[adjusted HR=1.35,95％CI(1.09,1.67),P<0.01].Subgroup analysis indicated a significant interaction among SII,gender,and hypertension concerning CKD progression.[Conclusion]Our findings underscore the robust relationship between SII and renal function,positioning SII as a potential forecaster for the progression of CKD.

Objective To investigate the possible association between cross-domain associative memory(AM)impairment and hippocampal subfield volumes in patients with schizophrenia(SCZ).Methods We enrolled 28 SCZ patients from Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,and 28 healthy controls(HCs)between 2019 and 2021.Based on an innovative AM paradigm and automated segmentation,3D-T1 weighted data of the objects were processed with PhiPipe and FreeSurfer.Differences in subfield volums between the two groups were analyzed using ANCOVA,while their relationship with AM scores was assessed using Pearson correlation.Results SCZ patients exhibited significantly poorer AM performance across three conditions compared with HCs.Marginally significant reductions were observed in the total volume of bilateral hippocampus,encompassing both the hippocampal head and body.Significant volume reductions were identified in the bilateral presubiculum and parasubiculum.The volumes of bilateral presubiculum head(r=0.273,P=0.042),parasubiculum(r=0.397,P=0.002),and CA1 head(r=0.382,P=0.004)exhibited positive correlations with cross-domain AM performance.Conclusion The bilateral presubiculum and parasubiculum,as hippocampal subregions significantly associated with cross-modal AM deficits in SCZ,may play a crucial role in the pathology of AM.

Arsenic is a semi-metal,and lipid-soluble arsenic compounds are one of the widespread forms in the environment and food chain,but there is a lack of standards for lipid-soluble arsenic compounds,which is one of the bottlenecks in the current analytical detection and toxicological studies of organic arsenic.In this study,four saturated arsenic-containing hydrocarbons,AsHC 318,AsHC 332,AsHC 346,and AsHC 374(The number is relative molecular mass),were successfully synthesized in three steps by using dimethylarsinic acid,potassium iodide,sodium hydroxide,and four brominated alkanes(1-Bromotetradecane,1-bromopentadecane,1-bromohexadecane,and 1-bromooctadecane)as raw materials.The structures of these four saturated arsenic-containing hydrocarbons were characterized by proton nuclear magnetic resonance(1H NMR)spectroscopy,13C nuclear magnetic resonance(13C NMR)spectroscopy,and high-resolution mass spectrometry(HR-MS).The yields of the method were 8%-10%,and the synthesized compounds could be used in subsequent toxicity evaluation experiments to assess the toxic effects and mechanisms of action of arsenic-containing hydrocarbons.This study provided an effective method for synthesis of arsenic-containing hydrocarbons,enriching the synthesis methods of arsenic-containing hydrocarbons,and provided raw materials for the subsequent toxicological studies of arsenic-containing hydrocarbons.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*