Regarding the pathway and distribution of twelve channels， the current general view emphasizes their longitudinal distribution along the surface of the human body. Based on such a positioning， it is difficult to interpret the three yin and three yang "opening-closing- pivoting" theory， and the theory of the six channels transmission of externally-contracted febrile disease. Through combing the relevant contents in The Inner Canon of Yellow Emperor （《黄帝内经》）， it is proposed that， in addition to the longitudinal regional distribution of the channels on the human body， they also exhibit characteristics of layered distribution between the exterior and interior. The formation of this theory stems from the combination of body tissue and channels， that is， the taiyang governs the function of skin， yangming governs the function of flesh， and shaoyang governs the function of bone； taiyin governs the function of spleen and stomach， jueyin governs the function of liver， and shaoyin governs the function of heart. The process of integration of the channels with the body tissues has a relatively clear imprint in the syndrome differentiation of febrile disease in The Inner Canon of Yellow Emperor. The exterior-interior relationships of channels are the foundation and prerequisite for the theory of the three yin and three yang "opening-closing-pivoting" and the theory of the six channels transmission in Plain Questions·Treatise on Heat （《素问·热论篇》）.

Objective:To understand the incidence and epidemiological characteristics of enteritis due to norovirus infection in Guizhou Province from 2016 to 2023, and provide reference for the prevention and control of enteritis caused by norovirus.Methods:The data were from National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention. To collect the data of other infectious diarrhea cards in Guizhou from 2016 to 2023, which were annotated as enteritis due to norovirus and food-borne disease surveillance sentinel report in Guizhou, which were positive for norovirus detection. The data of cluster/outbreaks were from the Public Health Emergency Event Surveillance System and the field investigation reports of CDC at all levels. Descriptive epidemiological method was used to describe the characteristics of its three-dimension distribution, epidemic situation and pathogen spectrum. R 4.2.2 software was used for statistical analysis.Results:A total of 2 340 cases of enteritis due to norovirus were reported in Guizhou Province during this period, with an average annual reported incidence of 0.79/100 000, and the incidence showed an upward trend (trend χ2=1 723.80, P<0.001). The high incidence season is from October to March (winter and spring). The male to female ratio of the cases was 1.39∶1 (1 362∶978). A total 1 382 cases occurred in age group under 5 years old (59.06%) and 1 249 cases occurred in children living scatteredly (53.38%). The average annual reported incidence in 6 prefectures (muniipality)(1.15/100 000 in Qiandongnan Miao and Dong Autonomous Prefecture, 1.08/100 000 in Guiyang, 1.07/100 000 in Liupanshui, 1.06/100 000 in Qianxinan Buyi and Miao Autonomous Prefecture, 0.91/100 000 in Qiannan Buyi and Miao Autonomous Prefecture and 0.89/100 000 in Tongren) in Guizhou Province was higher than provincial level, and the affected areas gradually expanded from southeastern counties (districts) to western and northern counties (districts). The average annual reported incidence rate was higher in urban area (1.12/100 000) than in rural area (0.39/100 000). A total of 31 cluster/outbreaks of enteritis due to norovirus were reported, in which 83.87% (26/31) occurred in child care settings, primary and secondary schools, in which 74.19% (23/31) were caused by human-to-human transmission. In the 2 340 cases, 2 147 were laboratory diagnosed (91.75%), and 193 were clinically diagnosed (8.25%). In the laboratory diagnosed cases, 2 026 (94.36%) were caused by single norovirus infection and 121 (5.64 %) were caused by mixed infection. Conclusions:On the whole, the incidence of enteritis due to norovirus in Guizhou Province was on the rise from 2016 to 2023, and winter and spring were the high incidence seasons. Effective prevention and control measures should be taken for key populations, key regions and key places, and multi-channel and multi-pathogen surveillance and health education should be strengthened.

Objective:To evaluate the feasibility and safety of a fascial space priority approach to total pelvic exenteration (TPE) in patients with pelvic malignancy.Methods:This was a descriptive case series. Relevant clinical data of patients who had undergone TPE via a fascial space priority approach at Tianjin Union Medical Center from September 2017 to March 2025 were retrospectively collected. All operations had been performed via a fascial space priority approach, the guiding principle of which is separating the avascular pelvic spaces first and then transecting the vessels and nerves of the pelvic organs. That is, the avascular planes around all the pelvic organs are dissected first, after which the relevant vessels and nerves are fully dissected and transected, followed by en bloc resection of pelvic organs distally or via perineal approach. The variables studied included relevant surgical parameters, postoperative pathological findings, complications (classified according to the Clavien-Dindo criteria); recurrence-free survival (RFS), overall survival, and tumor-specific survival. Results:The study cohort comprised 41 patients, including 30 (73.2%) with primary tumors and 11 (26.8%) with recurrent tumors. Open TPE was performed on five patients (12.2%) and laparoscopic TPE on the remaining 36 (87.8%). All procedures were successfully completed with a fascial space priority approach and there were no intraoperative deaths. R0 resection was achieved in 34 patients (82.9%) and R1 resection in seven (17.1%). The operation time was 500 (265-740) min, and the amount of bleeding 200 (10-3,500) mL. Twelve patients (29.3%) developed postoperative complications, two of which were Clavien-Dindo Grade III complications. One of these patients required re-operation to manage a pelvic hematoma 29 days after the primary TPE. No active bleeding was observed during the re-operation. Another patient underwent interventional angiography for an episode of postoperative bleeding; this showed a pseudoaneurysm of the internal iliac artery that was successfully treated by interventional embolization via the internal iliac artery. Five days after undergoing a primary TPE with bladder preservation, a third patient was found to have a urinary fistula and underwent laparoscopic bladder resection with percutaneous ureterostomy. The median duration of follow-up was 18 (1-90) months. The 5-year RFS and overall survival were 46.7% and 52.2%, respectively, whereas the 5-year tumor-specific survival was 67.8%. Univariate Cox regression analysis identified a positive surgical margin ( P < 0.001), lateral pelvic sidewall invasion ( P=0.014), and vascular invasion ( P=0.004) as significantly associated with RFS, whereas multivariate analysis identified only a positive surgical margin (HR: 21.93, 95% CI: 3.78-127.42, P<0.001) as an independent predictor of RFS. Conclusions:It is safe and feasible to perform TPE with a fascial space priority approach on patients with pelvic malignancy. Positive surgical margins are significantly associated with RFS.

Objective:To understand the incidence and epidemiological characteristics of enteritis due to norovirus infection in Guizhou Province from 2016 to 2023, and provide reference for the prevention and control of enteritis caused by norovirus.Methods:The data were from National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention. To collect the data of other infectious diarrhea cards in Guizhou from 2016 to 2023, which were annotated as enteritis due to norovirus and food-borne disease surveillance sentinel report in Guizhou, which were positive for norovirus detection. The data of cluster/outbreaks were from the Public Health Emergency Event Surveillance System and the field investigation reports of CDC at all levels. Descriptive epidemiological method was used to describe the characteristics of its three-dimension distribution, epidemic situation and pathogen spectrum. R 4.2.2 software was used for statistical analysis.Results:A total of 2 340 cases of enteritis due to norovirus were reported in Guizhou Province during this period, with an average annual reported incidence of 0.79/100 000, and the incidence showed an upward trend (trend χ2=1 723.80, P<0.001). The high incidence season is from October to March (winter and spring). The male to female ratio of the cases was 1.39∶1 (1 362∶978). A total 1 382 cases occurred in age group under 5 years old (59.06%) and 1 249 cases occurred in children living scatteredly (53.38%). The average annual reported incidence in 6 prefectures (muniipality)(1.15/100 000 in Qiandongnan Miao and Dong Autonomous Prefecture, 1.08/100 000 in Guiyang, 1.07/100 000 in Liupanshui, 1.06/100 000 in Qianxinan Buyi and Miao Autonomous Prefecture, 0.91/100 000 in Qiannan Buyi and Miao Autonomous Prefecture and 0.89/100 000 in Tongren) in Guizhou Province was higher than provincial level, and the affected areas gradually expanded from southeastern counties (districts) to western and northern counties (districts). The average annual reported incidence rate was higher in urban area (1.12/100 000) than in rural area (0.39/100 000). A total of 31 cluster/outbreaks of enteritis due to norovirus were reported, in which 83.87% (26/31) occurred in child care settings, primary and secondary schools, in which 74.19% (23/31) were caused by human-to-human transmission. In the 2 340 cases, 2 147 were laboratory diagnosed (91.75%), and 193 were clinically diagnosed (8.25%). In the laboratory diagnosed cases, 2 026 (94.36%) were caused by single norovirus infection and 121 (5.64 %) were caused by mixed infection. Conclusions:On the whole, the incidence of enteritis due to norovirus in Guizhou Province was on the rise from 2016 to 2023, and winter and spring were the high incidence seasons. Effective prevention and control measures should be taken for key populations, key regions and key places, and multi-channel and multi-pathogen surveillance and health education should be strengthened.

Objective:To evaluate the feasibility and safety of a fascial space priority approach to total pelvic exenteration (TPE) in patients with pelvic malignancy.Methods:This was a descriptive case series. Relevant clinical data of patients who had undergone TPE via a fascial space priority approach at Tianjin Union Medical Center from September 2017 to March 2025 were retrospectively collected. All operations had been performed via a fascial space priority approach, the guiding principle of which is separating the avascular pelvic spaces first and then transecting the vessels and nerves of the pelvic organs. That is, the avascular planes around all the pelvic organs are dissected first, after which the relevant vessels and nerves are fully dissected and transected, followed by en bloc resection of pelvic organs distally or via perineal approach. The variables studied included relevant surgical parameters, postoperative pathological findings, complications (classified according to the Clavien-Dindo criteria); recurrence-free survival (RFS), overall survival, and tumor-specific survival. Results:The study cohort comprised 41 patients, including 30 (73.2%) with primary tumors and 11 (26.8%) with recurrent tumors. Open TPE was performed on five patients (12.2%) and laparoscopic TPE on the remaining 36 (87.8%). All procedures were successfully completed with a fascial space priority approach and there were no intraoperative deaths. R0 resection was achieved in 34 patients (82.9%) and R1 resection in seven (17.1%). The operation time was 500 (265-740) min, and the amount of bleeding 200 (10-3,500) mL. Twelve patients (29.3%) developed postoperative complications, two of which were Clavien-Dindo Grade III complications. One of these patients required re-operation to manage a pelvic hematoma 29 days after the primary TPE. No active bleeding was observed during the re-operation. Another patient underwent interventional angiography for an episode of postoperative bleeding; this showed a pseudoaneurysm of the internal iliac artery that was successfully treated by interventional embolization via the internal iliac artery. Five days after undergoing a primary TPE with bladder preservation, a third patient was found to have a urinary fistula and underwent laparoscopic bladder resection with percutaneous ureterostomy. The median duration of follow-up was 18 (1-90) months. The 5-year RFS and overall survival were 46.7% and 52.2%, respectively, whereas the 5-year tumor-specific survival was 67.8%. Univariate Cox regression analysis identified a positive surgical margin ( P < 0.001), lateral pelvic sidewall invasion ( P=0.014), and vascular invasion ( P=0.004) as significantly associated with RFS, whereas multivariate analysis identified only a positive surgical margin (HR: 21.93, 95% CI: 3.78-127.42, P<0.001) as an independent predictor of RFS. Conclusions:It is safe and feasible to perform TPE with a fascial space priority approach on patients with pelvic malignancy. Positive surgical margins are significantly associated with RFS.

Objective To observe the effects of Tiaojing Cuyun Prescription on endometrial receptivity and AREG/EGFR/HIF-1α signaling pathway of embryo implantation dysfunction(EID)infertility mice;To explore its mechanism on improving endometrial receptivity.Methods On the first day of pregnancy,80 Kunming mice were randomly divided into control group,model group,progesterone group and Tiaojing Cuyun Prescription group,with 20 mice in each group.Progesterone group and Tiaojing Cuyun Prescription group were given corresponding drugs by gavage.On the fourth day of pregnancy,mifepristone solution was subcutaneously injected(2.3 mg/kg)to establish the EID infertility model except the normal group,while the normal group was subcutaneously injected with equal volume of propylene glycol.On the fifth day of pregnancy,10 mice were randomly selected from each group,and the endometrium morphology were observed by HE and Masson staining,the pinopodes were observed by scanning electron microscope,the content of AREG in endometrial tissue was detected by ELISA,and the expressions of EGFR,p-EGFR and HIF-1α were detected by Western blot and immunofluorescence,the rest of the mice were gavaged until the eighth day of pregnancy,and the average number of embryo implantation points was recorded.Results Compared with the normal group,the average number of embryo implantation points of model group significantly decreased(P<0.01),and the glandular development in the endometrium was poor,collagen fibers increased,and blood vessels and pinopodes decreased,the AREG content in endometrial tissue was significantly decreased(P<0.01),and the expressions of p-EGFR and HIF-1α protein were significantly decreased(P<0.05).Compared with the model group,the average number of embryo implantation points in Tiaojing Cuyun Prescription group significantly increased(P<0.05),the proliferation of collagen fibers in the endometrium was reduced,and the number of glands,blood vessels and pinopodes in stroma significantly increased,the development of pinopodes were full and uniform,the AREG content in endometrial tissue significantly increased(P<0.01),and the expressions of p-EGFR and HIF-1α protein significantly increased(P<0.05,P<0.01).The immunofluorescence results were consistent with Western blot.Conclusion Tiaojing Cuyun Prescription can promote the development of endometrial glands and blood vessels,enrich the number of pinopodes,improve the endometrial receptivity of EID infertility mice,facilitates embryo adhesion and implantation,and thus increase the pregnancy rate.Its mechanism may be related to activating AREG/EGFR/HIF-1α signaling pathway,improving endometrial perfusion,and restoring the relatively hypoxic environment of the endometrium.

At present, there are still some problems in the standardized residency training. Some standardized training bases often regard the resident trainees as ordinary practitioners, and devote their time and energy to the daily medical procedural work without giving enough training and teaching, ignoring the basic skills training of resident trainees. Therefore, this study constructed an active knowledge push system based on business scenarios. The system mainly includes three parts: sensitive operation identification layer, knowledge index layer and resource push layer in order to cultivate the norms of diagnosis and treatment of standardized training students and reasonably solve the problem of inconvenient resource acquisition in clinical work. Through the preliminary application, it was found that the system has effectively improved the mini-clinical evaluation exercise (Mini-CEX) score of the trainees and achieved good results.