In the context of the digital-intelligent era of traditional Chinese medicine （TCM）， the lack of clinical thinking is a pressing issue that limits the overall effectiveness of TCM and talent cultivation. The "disease-pulse-syndrome-treatment differentiation" thinking model， originally developed by ZHANG Zhongjing in the Treatise on Cold Damage and Miscellaneous Diseases （Shang Han Za Bing Lun）， has served as a guideline and paradigm followed by generations of medical practitioners. This study aims to construct a digitalized "disease-pulse-syndrome-treatment differentiation" thinking system， develop a digital assessment system， and implement it for practical application. The goal is to recommend a digitalized assessment model for TCM and provide a reference for the integrated innovation of talent cultivation in medicine， education， and research. First， based on the complex diagnostic and treatment framework of the Treatise on Cold Damage Diseases （Shang Han Lun）， the research team previously established a "process" + "result" thinking model that included four processes and ten steps. This study integrates knowledge unit theory and digital technology to create a digital system for "disease-pulse-syndrome-treatment differentiation" with a dual-control model of "process control" and "result control". The system consists of 46 items across three categories： knowledge body （W=20%）， knowledge element （W=30%）， and knowledge element associations （W=50%）. Second， a mixed-methods research design was employed， combining qualitative and quantitative approaches. The Delphi method was used to establish hierarchical levels and screen items， while the analytic hierarchy process （AHP） was used to assign weights. Expert surveys were conducted to reach a consensus and further validate the rationale and necessity of the system. Finally， based on the system architecture and integrating key computer technologies， a digital assessment system for "disease-pulse-syndrome-treatment differentiation" was developed. The Treatise on Cold Damage Diseases （Shang Han Lun） was used as a case study to validate the system's feasibility. Statistical results showed that the difficulty level of the assessment question bank was moderate （DL ranging from 0.65 to 0.89）， with good discrimination （D>0.4）， and reasonable reliability and validity （Cronbach's α=0.84， KMO=0.72， Bartlett's test P<0.01）. The system can perform process-oriented evaluations of candidates' thinking in "disease-pulse-syndrome-treatment differentiation" and effectively achieve the goal of clinical thinking assessment through a combination of "process control" and "result control". The examination system offers three major advantages. It standardizes， objectifies， and streamlines the assessment of thought processes， facilitates the organic transformation of TCM education from outcome-based education to thinking-based education， and from exam-oriented education to competency-oriented education， and promotes the practical transformation of TCM assessments from qualitative to quantitative evaluation， as well as from theory to practice. In summary， this system not only represents a technological upgrade to traditional examinations but also empowers the cultivation and assessment of clinical talent in the digital-intelligent era， demonstrating broad application prospects.

Objective:To investigate the therapeutic effectiveness of double-anatomical plate-assisted reconstruction of a stable triangle in the treatment of chronic distal humerus fractures.Methods:A retrospective analysis was performed on the medical records of 10 patients with distal humerus fracture treated with double plate assisted reconstruction of a stable triangle from August 2021 to December 2024. All patients were followed up for more than 6 months. The cohort included 9 males and 1 female, with a mean age of 54.75±15.15 years (range, 31-73 years). Causes of injury: 4 cases of slip, 2 cases of high-energy fall, 3 cases of traffic accident, and 1 case of crush injury. According to the AO/OTA classification, all fractures were type C3, including 4 cases of C3.3 and 6 cases of C3.2. The operation duration, intraoperative blood loss, and length of hospital stay were recorded. Follow-up evaluations were conducted at 1, 3, and 6 months postoperatively and at the final follow-up. Radiographs were obtained to assess fracture reduction, healing, and implant positioning. Functional outcomes of the elbow were assessed using carrying angle, humeral condyle anteversion angle, modified trochleocapitellar index (mTCI), range of motion (ROM), visual analogue scale (VAS) for pain, Mayo elbow performance score (MEPS), and complication rates.Results:All 10 patients successfully completed the operation, with an average operation time of 221.75±48.73 min (range, 165-310 min), an average intraoperative blood loss of 462.50±215.05 ml (range 150-800 ml). 4 patients received blood transfusion. The average hospital stay was 10.75±2.55 d (range 6-14 d). The average carrying angle of 171.50°±5.37° (range 165°-179°) and the anterior angle of humeral condyle 39.75°±3.96° (range 34°-45°) were all within the standard range. At least one index in the mTCI was within the optimal range at the last follow-up. All patients were followed up with an average follow-up of 10.75±5.73 months (range 6-22 months). All 10 patients were healed after surgery with an average healing time of 4.75±2.05 months (range 3-9 months). At the final follow-up, the average elbow ROM was 93.75°±25.88° (range, 50°-115°), internal rotation was 83.13°±9.61° (range, 60°-90°), and external rotation was 88.13°±3.72° (range, 80°-90°). The mean VAS score was 0.63±0.92 (range, 0-2), and the average MEPS was 88.75±11.57 (range, 70-100), with 4 excellent, 4 good, and 2 fair outcomes, an excellent and good rate of 80%. Complications included one case of periarticular osteophyte formation, one case of transient ulnar nerve numbness that improved with conservative treatment, and three cases of occasional mild pain following increased activity. Conclusion Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.Conclusions:Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.

Objective:To optimize the scan parameters for ultra-low dose computed tomography (ULDCT) of the chest using spectral purification technology, and assess the feasibility of maintaining image quality while reducing radiation dosage.Methods:An anthropomorphic chest phantom embedded with simulated pulmonary nodules was utilized for low-dose computed tomography(LDCT) and ULDCT scans. LDCT was conducted using a reference tube current of 25 mAs and a pitch of 1.0. ULDCT incorporating spectral purification technology was conducted using four reference tube currents, i. e., 50, 100, 150, and 200 mAs (labeled ULDCT1-4), and a pitch of 1.5. Other parameters were consistent. The volume CT dose index and the dose-length product were extracted from the dose reports, and then the effective doses were calculated. The objective image quality was assessed using metrics including image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The subjective image quality of ULDCT images was assessed on a four-point scale with LDCT images as reference.Results:The ULDCT4 at a reference tube current of 200 mAs showed a lower effective dose compared to LDCT ( t = -17.30, P < 0.001). The objective image quality assessments indicated that noise levels in four ULDCT groups were higher than those in LDCT ( t = 21.96, 10.56, 3.15, 3.14, P < 0.05). Notably, the SNR and CNR for the aortic arch were higher in ULDCT4 compared to LDCT ( t = 3.55, 71.96, P < 0.05). The SNR of pulmonary nodules in ULDCT4 was comparable to that in LDCT ( P > 0.05), but the CNR was higher ( t = 0.79, P < 0.001). Subjective image quality assessments reveal that the image quality of ULDCT4 was higher than that of LDCT, with scores of 3.80±0.46 for noise, 3.70±0.46 for contrast and sharpness, and 3.37±0.66 for pulmonary nodules. Conclusions:ULDCT (200 mAs) using spectral purification technology can yield higher image quality than LDCT while substantially reducing the radiation dose, thus demonstrating substantial clinical potential and the promise of replacing LDCT in early lung cancer screening.

Objective:To study the characteristics of soil microbial composition in sheep sheds in agricultural and pastoral areas, and explore potential zoonotic pathogen species.Methods:Using cross-sectional survey method, soil samples from sheep sheds in the agricultural and pastoral areas of Darhan-Muminggan Joint County, Baotou City, Inner Mongolia Autonomous Region were collected from August to October 2023. Genomic DNA was extracted, and metagenomic second-generation sequencing was conducted. Microbial species annotation was carried out by Kaiju method, and the soil microbial composition and zoonotic pathogen species of sheep sheds in agricultural and pastoral areas were analyzed.Results:A total of 10 and 5 soil samples were collected from sheep sheds in agricultural and pastoral areas, respectively. The results of β diversity analysis showed that there was a significant separation trend in soil samples from sheep sheds in agricultural and pastoral areas, and the interpretation of principal co-ordinates analysis (PCoA) 1 and PCoA2 were 27.8% and 17.4%, respectively. There was no significant difference in the microbial composition of soil samples from sheep sheds in agricultural and pastoral areas ( R = 0.09, P = 0.242). At the phylum level, the dominant bacterial phyla were Actinobacteria, Proteobacteria, Firmicutes, and Bacteroidetes. At the genus level, the dominant bacterial genera were Corynebacterium, Luteimonas, Atopostipes, and Salinicoccus. A variety of zoonotic pathogens were detected, including Brucella melitensis, Mycobacterium tuberculosis, and Clostridium tetani in 15 soil samples. Conclusion:The soil microorganisms in sheep sheds in agricultural and pastoral areas are diverse, and zoonotic pathogens such as Brucella melitensis, Mycobacterium tuberculosis, and Clostridium tetani are detected.

Background:Optimizing cultivation techniques for traditional Chinese medicine has become a crucial means to improve the quality of medicinal materials.Microbial agents,as environmentally friendly and efficient plant growth promoters and soil conditioners,have increasingly attracted attention in eco-agriculture research.Objective:Our understanding remains limited regarding how the application of microbial agents,alone or in combination,affects changes in the rhizosphere microbiome and its association with the bioactive components of medicinal materials.Methods:In this study,Epimedium pubescens Maxim.was employed as a model plant to examine the effects of 2 microbial agents(Paenibacillus mucilaginosus and Bacillus subtilis)applied individually and in combination on plant growth and the accumulation of bioactive components.Additionally,this study explored the relationship between the rhizosphere microbiome and plant development.Results:The application of microbial agents increased the yield of E.pubescens leaves by 20.30％to 33.66％and enhanced the total flavonol glycosides content by 11.40％to 29.94％.Meanwhile,microbial treatments reshaped the rhizosphere microbiome,promoted the enrichment of beneficial microorganisms(e.g.,Frankia and Paenibacillus),suppressed phytopathogenic fungi such as Didymella and Scytalidium,and enhanced the stability of the soil microbial co-occurrence network.The partial least squares path model suggested that microbial agents not only directly impact the quality of medicinal herbs but also indirectly alter the accumula-tion of bioactive components by modulating the soil microbiome.Conclusion:These findings deepen our understanding of the relationship between medicinal plant quality and rhizosphere micro-biomes as mediated by microbial agents.They also provide a basis for designing and manipulating synthetic microbial communities to promote sustainable development in eco-agriculture.

Objective:To investigate the therapeutic effectiveness of double-anatomical plate-assisted reconstruction of a stable triangle in the treatment of chronic distal humerus fractures.Methods:A retrospective analysis was performed on the medical records of 10 patients with distal humerus fracture treated with double plate assisted reconstruction of a stable triangle from August 2021 to December 2024. All patients were followed up for more than 6 months. The cohort included 9 males and 1 female, with a mean age of 54.75±15.15 years (range, 31-73 years). Causes of injury: 4 cases of slip, 2 cases of high-energy fall, 3 cases of traffic accident, and 1 case of crush injury. According to the AO/OTA classification, all fractures were type C3, including 4 cases of C3.3 and 6 cases of C3.2. The operation duration, intraoperative blood loss, and length of hospital stay were recorded. Follow-up evaluations were conducted at 1, 3, and 6 months postoperatively and at the final follow-up. Radiographs were obtained to assess fracture reduction, healing, and implant positioning. Functional outcomes of the elbow were assessed using carrying angle, humeral condyle anteversion angle, modified trochleocapitellar index (mTCI), range of motion (ROM), visual analogue scale (VAS) for pain, Mayo elbow performance score (MEPS), and complication rates.Results:All 10 patients successfully completed the operation, with an average operation time of 221.75±48.73 min (range, 165-310 min), an average intraoperative blood loss of 462.50±215.05 ml (range 150-800 ml). 4 patients received blood transfusion. The average hospital stay was 10.75±2.55 d (range 6-14 d). The average carrying angle of 171.50°±5.37° (range 165°-179°) and the anterior angle of humeral condyle 39.75°±3.96° (range 34°-45°) were all within the standard range. At least one index in the mTCI was within the optimal range at the last follow-up. All patients were followed up with an average follow-up of 10.75±5.73 months (range 6-22 months). All 10 patients were healed after surgery with an average healing time of 4.75±2.05 months (range 3-9 months). At the final follow-up, the average elbow ROM was 93.75°±25.88° (range, 50°-115°), internal rotation was 83.13°±9.61° (range, 60°-90°), and external rotation was 88.13°±3.72° (range, 80°-90°). The mean VAS score was 0.63±0.92 (range, 0-2), and the average MEPS was 88.75±11.57 (range, 70-100), with 4 excellent, 4 good, and 2 fair outcomes, an excellent and good rate of 80%. Complications included one case of periarticular osteophyte formation, one case of transient ulnar nerve numbness that improved with conservative treatment, and three cases of occasional mild pain following increased activity. Conclusion Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.Conclusions:Double-anatomical plate-assisted reconstruction of a stable triangle provides effective and stable fixation for chronic AO/OTA C3 distal humerus fractures. The short-term postoperative outcomes are satisfactory, with good functional recovery and a low complication rate.

Objective:To optimize the scan parameters for ultra-low dose computed tomography (ULDCT) of the chest using spectral purification technology, and assess the feasibility of maintaining image quality while reducing radiation dosage.Methods:An anthropomorphic chest phantom embedded with simulated pulmonary nodules was utilized for low-dose computed tomography(LDCT) and ULDCT scans. LDCT was conducted using a reference tube current of 25 mAs and a pitch of 1.0. ULDCT incorporating spectral purification technology was conducted using four reference tube currents, i. e., 50, 100, 150, and 200 mAs (labeled ULDCT1-4), and a pitch of 1.5. Other parameters were consistent. The volume CT dose index and the dose-length product were extracted from the dose reports, and then the effective doses were calculated. The objective image quality was assessed using metrics including image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The subjective image quality of ULDCT images was assessed on a four-point scale with LDCT images as reference.Results:The ULDCT4 at a reference tube current of 200 mAs showed a lower effective dose compared to LDCT ( t = -17.30, P < 0.001). The objective image quality assessments indicated that noise levels in four ULDCT groups were higher than those in LDCT ( t = 21.96, 10.56, 3.15, 3.14, P < 0.05). Notably, the SNR and CNR for the aortic arch were higher in ULDCT4 compared to LDCT ( t = 3.55, 71.96, P < 0.05). The SNR of pulmonary nodules in ULDCT4 was comparable to that in LDCT ( P > 0.05), but the CNR was higher ( t = 0.79, P < 0.001). Subjective image quality assessments reveal that the image quality of ULDCT4 was higher than that of LDCT, with scores of 3.80±0.46 for noise, 3.70±0.46 for contrast and sharpness, and 3.37±0.66 for pulmonary nodules. Conclusions:ULDCT (200 mAs) using spectral purification technology can yield higher image quality than LDCT while substantially reducing the radiation dose, thus demonstrating substantial clinical potential and the promise of replacing LDCT in early lung cancer screening.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

This study aimed to identify mutations in the human insulin receptor gene (INSR) and investigate their role in the pathogenesis of severe insulin resistance syndrome. Sanger sequencing of the INSR gene was performed on a patient clinically suspected of having type A insulin resistance syndrome admitted to the Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital. Upon identifying mutations, relevant exons were sequenced in her first-degree relatives. Additionally, control groups consisting of individuals with type 2 diabetes and those with normal glucose tolerance were screened for the mutation detected in the patient. Functional predictions of the INSR protein were made using MutationTaster, SIFT, and PolyPhen2 software. A previously unreported heterozygous missense mutation, c.3652G/A (Asp1218Asn), in exon 20 was identified in both the proband and her father. This mutation was not present in any of the control individuals. Multiple prediction tools indicate that this mutation likely disrupts gene/protein structure or function. The c.3652G/A (Asp1218Asn) heterozygous mutation in INSR is a novel variant that plays a significant role in the pathogenesis of severe insulin resistance in this Chinese family.

Background:Optimizing cultivation techniques for traditional Chinese medicine has become a crucial means to improve the quality of medicinal materials.Microbial agents,as environmentally friendly and efficient plant growth promoters and soil conditioners,have increasingly attracted attention in eco-agriculture research.Objective:Our understanding remains limited regarding how the application of microbial agents,alone or in combination,affects changes in the rhizosphere microbiome and its association with the bioactive components of medicinal materials.Methods:In this study,Epimedium pubescens Maxim.was employed as a model plant to examine the effects of 2 microbial agents(Paenibacillus mucilaginosus and Bacillus subtilis)applied individually and in combination on plant growth and the accumulation of bioactive components.Additionally,this study explored the relationship between the rhizosphere microbiome and plant development.Results:The application of microbial agents increased the yield of E.pubescens leaves by 20.30％to 33.66％and enhanced the total flavonol glycosides content by 11.40％to 29.94％.Meanwhile,microbial treatments reshaped the rhizosphere microbiome,promoted the enrichment of beneficial microorganisms(e.g.,Frankia and Paenibacillus),suppressed phytopathogenic fungi such as Didymella and Scytalidium,and enhanced the stability of the soil microbial co-occurrence network.The partial least squares path model suggested that microbial agents not only directly impact the quality of medicinal herbs but also indirectly alter the accumula-tion of bioactive components by modulating the soil microbiome.Conclusion:These findings deepen our understanding of the relationship between medicinal plant quality and rhizosphere micro-biomes as mediated by microbial agents.They also provide a basis for designing and manipulating synthetic microbial communities to promote sustainable development in eco-agriculture.