ObjectiveTo investigate the possible mechanism of Shenfuhuang Formula （参附黄配方） in prevention and treatment of epsis-associated encephalopathy from the perspective of brain genomics. MethodsC57BL/6 mice were randomly divided into sham surgery group， sepsis group， and Shenfuhuang group， with 20 mice in each group. The sepsis group and Shenfuhuang group were induced to develop sepsis by cecal ligation and puncture （CLP） procedure. At 4 hours after modelling， Shenfuhuang group were gavaged with 2.5 g/（kg·d） of Shenfuhuang Formula， 0.5 ml each time， at 12 hours intervals， for a total of 4 times after modelling. Sepsis group and sham surgery group were given 0.5 ml of purified water orally. At 48 hours after modeling， the transcriptome sequencing was used to explore the differential gene expression in the effects of Shenfuhuang Formula on the brain regions of septic mice， and real-time PCR and ELISA were later used to further validate the differential gene and proteins expression. ResultsA total of 4605 genes were differentially expressed in Shenfuhuang group compared with sepsis group， of which 2353 genes were up-regulated and 2252 genes were down-regulated. According to the results of previous publications， six key genes were screened， including serine/threonine-protein kinase （Nek1）， myelin-associated glycoprotein （Mag）， endothelial cell-specific tyrosine kinase receptor （Tek）， a disintegrin and metalloproteinase with thrombospondin motifs 20 （Adamts20）， lymphocyte antigen 86 （Ly86）， and E3 ubiquitin-protein ligase （Traip）. Further genetic and protein validation revealed that， compared to the sham surgery group， the mRNA levels and corresponding protein levels of Nek1， Mag， Tek， Adamts20， Ly86， and Traip in the brain tissue of septic mice significantly reduced （P＜0.05）. In comparison to the sepsis group， Shenfuhuang group showed significantly increased mRNA levels and corresponding protein levels of Nek1， Mag， Tek， Adamts20， Ly86， and Traip （P＜0.05）. ConclusionThe potential therapeutic targets of Shenfuhuang Formula for treating sepsis-associated encephalopathy may be related to the Nek1， Mag， Tek， Adamts20， Ly86， and Traip genes and their encoded proteins.

Medical education needs to cultivate medical students to master solid clinical knowledge and diagnosis and treatment experiences， form scientific research thinking， and acquire scientific research ability. Sharp scientific thinking is an essential ability for the professional growth and all-round development of clinical physicians. Teaching hospitals emphasize the organic integration of clinical diagnosis and treatment， scientific research， and education and teaching. Teaching hospitals need to pay attention to the comprehensive cultivation of medical students in the clinical stage from several aspects， such as clinical diagnosis and treatment， scientific research， and ethical awareness. In the process of cultivating medical students in the clinical stage， teaching hospitals need to focus on cultivating medical students’ innovative thinking and improving their scientific research abilities. In the process of teaching in the clinical stage， teaching hospitals attach importance to the theoretical teaching and training of research ethics， flexibly utilize multimedia teaching， and provide scientific research practice opportunities such as observing the quality control of clinical research， understanding the clinical research system， offering protocol templates， and guiding the writing process， so as to strengthen the application and understanding of medical students’ theoretical knowledge， and explore and practice the scientific research innovation education and teaching model for medical students in the clinical stage.

Objective To compare the prognostic differences between simple and complex segmentectomies. Methods We conducted a retrospective cohort analysis of patients with solid pulmonary nodules (≤2 cm) who underwent segmentectomy. Recurrence-free survival (RFS) and local recurrence rates were evaluated. Results We included57 patients undergoing complex segmentectomy and 53 patients undergoing simple segmentectomy. Among patients who did not receive adjuvant therapy, those in the complex group had a significantly lower five-year RFS than those in the simple group (69.86% vs. 85.97%, P=0.04). Furthermore, the local recurrence rate was significantly higher in the complex group (18.75% vs. 4.65%, P=0.003) than in the simple group. Conclusion For solid pulmonary nodules (≤2 cm), complex segmentectomy is associated with inferior local control and worse RFS than simple segmentectomy.

Research indicates that microbe activity within the human body significantly influences health by being closely linked to various diseases. Accurately predicting microbe-disease interactions (MDIs) offers critical insights for disease intervention and pharmaceutical research. Current advanced AI-based technologies automatically generate robust representations of microbes and diseases, enabling effective MDI predictions. However, these models continue to face significant challenges. A major issue is their reliance on complex feature extractors and classifiers, which substantially diminishes the models' generalizability. To address this, we introduce a novel graph autoencoder framework that utilizes decoupled representation learning and multi-scale information fusion strategies to efficiently infer potential MDIs. Initially, we randomly mask portions of the input microbe-disease graph based on Bernoulli distribution to boost self-supervised training and minimize noise-related performance degradation. Secondly, we employ decoupled representation learning technology, compelling the graph neural network (GNN) to independently learn the weights for each feature subspace, thus enhancing its expressive power. Finally, we implement multi-scale information fusion technology to amalgamate the multi-layer outputs of GNN, reducing information loss due to occlusion. Extensive experiments on public datasets demonstrate that our model significantly surpasses existing top MDI prediction models. This indicates that our model can accurately predict unknown MDIs and is likely to aid in disease discovery and precision pharmaceutical research. Code and data are accessible at: https://github.com/shmildsj/MDI-IFDRL.

Research indicates that microbe activity within the human body significantly influences health by being closely linked to various diseases.Accurately predicting microbe-disease interactions(MDIs)offers critical insights for disease intervention and pharmaceutical research.Current advanced AI-based technologies automatically generate robust representations of microbes and diseases,enabling effec-tive MDI predictions.However,these models continue to face significant challenges.A major issue is their reliance on complex feature extractors and classifiers,which substantially diminishes the models' generalizability.To address this,we introduce a novel graph autoencoder framework that utilizes decoupled representation learning and multi-scale information fusion strategies to efficiently infer po-tential MDIs.Initially,we randomly mask portions of the input microbe-disease graph based on Bernoulli distribution to boost self-supervised training and minimize noise-related performance degradation.Secondly,we employ decoupled representation learning technology,compelling the graph neural network(GNN)to independently learn the weights for each feature subspace,thus enhancing its expressive power.Finally,we implement multi-scale information fusion technology to amalgamate the multi-layer outputs of GNN,reducing information loss due to occlusion.Extensive experiments on public datasets demonstrate that our model significantly surpasses existing top MDI prediction models.This indicates that our model can accurately predict unknown MDIs and is likely to aid in disease discovery and precision pharmaceutical research.Code and data are accessible at:https://github.com/shmildsj/MDI-IFDRL.

Objective To investigate the diagnosis value of narrow band imaging(NBI)endoscopy in evalua-ting the degenerative properties of vocal cord leukoplakia.Methods A retrospective analysis of clinical data from 95 cases(153 sides)of vocal cord leukoplakia patients was conducted.All patients underwent electronic laryngoscopy before microlaryngoscopy.The lesions of vocal cords were examined with white light and then with NBI mode.The superficial IPCL patterns were classified into six types(types Ⅰ-Ⅵ).Under the NBI endoscope,the vocal cord leu-koplakia was classified as 1)Group A:types Ⅰ,Ⅱ,and Ⅲ.The pathological results were regarded as the gold standard for definitive diagnosis of vocal cord leukoplakia.and 2)Group B:types Ⅳ,Ⅴ,and Ⅵ.All patients un-derwent laryngeal microsurgery under general anesthesia,and lesions were sent for pathological examination.The results of NBI assessment were compared with those of pathology.The sensitivity,specificity,accuracy and Kappa-Cohen index of NBI in assessing the nature of lesions were calculated.Results According to NBI endoscopy,123 lesions(80.4％)were classified as low-risk group(type Ⅰ:18,type Ⅱ:41,type Ⅲ:64)and possibly benign le-sions,while 30 lesions(19.6％)were classified as high-risk group(type Ⅳ:2,type Ⅴ:25,type Ⅵ:3)and possi-bly malignant lesions.The pathological results showed that the 121 lesions(79.1％)were hyperkeratosis(20 le-sions),mild(39 lesions),moderate atypical hyperplasia(62 lesions),and the 32 lesions(20.9％)were severe a-typical hyperplasia(5 lesions),carcinoma in situ(22 lesions),and invasive carcinoma(5 lesions).In the low-risk group,2 lateral lesions were pathologically severe atypical hyperplasia.The sensitivity,specificity,positive predic-tive value,negative predictive value,and accuracy of NBI in predicting the malignancy of leukoplacia were 100％,97.6％,90％,100％,and 98％,respectively.Kappa-Cohen index was 0.90(95％confidence interval 82.3％to 100％).Conclusion NBI endoscopy can accurately evaluate the pathological properties of vocal cord leukoplakia.

Objective:To verify the therapeutic effect of Astragalus on mice with acute respiratory distress syndrome with sepsis and to explore its mechanism.Methods:Seventy SPF-grade C57 mice were divided into astragalus group ( n=30), control group ( n=30) and sham surgery group ( n=10) according to random number table method, and CLP surgery was performed on Astragalus group and control group to induce sepsis acute respiratory distress syndrome, and CLP sham surgery was performed in the sham surgery group. After surgery, the astragalus group was treated with astragalus decoction for gastric gavage, the sham surgery group and the control group were gavaged with normal saline, and the mice were sacrificed 12 hours and 24 hours after the operation, and the lung histopathology was observed, the ratio of dry to wet weight of lung tissue, the protein concentration of alveolar lavage fluid was determined, the alveolar lavage fluid and serum were analyzed proteomics, and the differential proteins were enriched and analyzed. Results:Astragalus reduced the total protein concentration of BALF in ARDS mice, reduced the dry-to-wet ratio of ARDS mice, and HE staining of lung tissues showed that Astragalus decoction improved acute alveolar injury in ARDS mice. Proteomic analysis of serum samples and BALF samples showed that there were certain differential proteins between astragalus group and control group, and enrichment analysis showed that it was mainly enriched in the pathway of inflammatory factors, confirming that astragalus decoction may play a role by inhibiting the activation and release of inflammatory factors.Conclusions:Astragalus decoction can effectively reduce the inflammatory exudation of lung tissue in acute respiratory distress syndrome of sepsis, and its mechanism of action may be to inhibit the expression of inflammatory factors.

Cognitive dysfunction refers to dysfunction of individual perception,memory,understanding,learning,creation and other dysfunctions caused by abnormal brain function and structure.Based on the fact that the spleen can't regulate transportation and transformation,govern blood and send up essential substance,combined with the microbiota-gut-brain axis,this article discussed the etiology and pathogenesis of intestinal flora imbalance affecting cognitive dysfunction in TCM.It was proposed that the spleen in TCM and intestinal flora are connected in physiology and pathology:the spleen regulates spirit and governs cognition,when the spleen fails to function normally that it can't dominate transportation and transformation,govern blood and send up essential substance will cause that the brain spirit can not be nourished;intestinal flora is closely related to the spleen in TCM,and affects brain function through the nervous system,endocrine,immune and metabolic mechanisms.This article can provide explore new ideas for the clinical research and treatment of cognitive dysfunction of traditional Chinese and Western medicine.

Acute respiratory distress syndrome is one of the common complications of sepsis syndrome, belonging to the "Chuan syndrome", "Baochuan", and "Chuantuo" in the TCM field, and the disease is mainly located in the lung. The main etiology and pathogenesis of sepsis syndrome is deficient healthy qi and blood stasis with toxin blocking collaterals. Blood stasis and toxin invade the lung, causing heat and toxin to burn the body fluid in the blood. Blood viscosity and poor circulation lead to the accumulation of blood stasis and toxin in the lung. Acute deficiency syndrome, heat toxin damaging qi, heat toxin burning body fluid deficiency with little ability to dissipate qi, resulting in deficiency of healthy qi, inability to regulate breathing, inability to consolidate body fluid, inability to promote blood circulation, causing phlegm, dampness, and blood stasis blocking the lung. This disease is characterized by blood stasis with toxin blocking collaterals, deficient lung qi, and obstruction of lung qi caused by phlegm, water, dampness, and blood stasis. Therefore, blood stasis with toxin blocking collaterals, as well as deficient healthy qi are TCM pathogenesis of ARDS with sepsis syndrome.

Objective:To study the efficacy of Barbed reposition pharyngoplasty (BRP) combined with Han-Uvulopalatopharyngoplasty (H-UPPP) in surgical treatment of OSAHS patients.Methods:OSAHS patients admitted to our department from June 2021 to February 2022 who met the surgical enrollment criteria were divided into two groups by surgical procedure: H-UPPP operation group [Control group, 47 cases, including 42 males and 5 females, aged 18-64 (37.77±11.65)years, and H-UPPP+BRP group [Study group, 48 cases, including 45 males and 3 females, aged 23-60 (39.10±9.86) years]. The surgical efficacy 6 months after operation was retrospectively analyzed. Meanwhile, the relationship between the surgical efficacy and modified Friedman pharyngeal anatomical stages was analyzed. The postoperative pain VAS score at first 3 days and the incidence of foreign body sensation in pharynx after 6 months of operation were compared between the two groups. Statistical analysis was conducted by SPSS 23.0.Results:There were no significant differences in gender, age, BMI, Friedman pharyngeal anatomical stages, ESS score, AHI and LSpO 2 between the two groups, preoperatively ( P>0.05). There was significant difference between the two groups in ratio of cumulative time of oxygen saturation below 90% to total sleep time(CT90), preoperatively. Surgical efficacy of H-UPPP operation group was 48.9% (23/47), while H-UPPP+BRP operation group was 70.8% (34/48), which was statistically significant ( χ2=4.74, P=0.029). H-UPPP+BRP group seemed to have a higher surgical efficacy than H-UPPP group in patients with Friedman Ⅱb (87% vs. 61.9%) and Ⅲ stage (44.4% vs. 15%), but there was no statistically significant difference ( P>0.05). H-UPPP+BRP group had a higher pain VAS score in first three days ( t=-3.10, P=0.003), also had higher incidence of pharyngeal foreign body sensation after 6 months of operation ( χ2=4.727, P=0.030). Conclusions:In the surgical treatment of OSAHS patients, the overall efficacy of BRP combined H-UPPP surgery is higher than that of H-UPPP surgery alone. It may be more suitable for OSAHS patients with modified Friedman type Ⅱb and type Ⅲ stage.