The knowledge graph has the characteristic of visualizing structural knowledge and has gradually become a research hotspot in the field of TCM diagnosis and treatment.This article reviewed the development trend and construction techniques of knowledge graph,summarized its application status in the field of TCM diagnosis and treatment,and provided a comprehensive review from the aspects of basic knowledge of TCM,inheritance of experience of renowned doctors,TCM question answering systems,and exploration of auxiliary decision-making.It also summarized the problems of knowledge graph technology in solving the informationization and intelligence process of TCM,and discussed and prospect the research and application directions of knowledge graph in the field of informationization and intelligence of TCM based on the characteristics of TCM knowledge.

Objective:To characterize the epidemiology, antimicrobial susceptibility, and molecular mechanisms of carbapenem-resistant Enterobacterales (CRE) carrying multiple carbapenemase genes in China, and to provide evidence for infection control and antibiotic stewardship.Methods:From 2016 to 2023, 115 CRE isolates harboring at least two carbapenemase genes were collected from 41 hospitals in 18 provinces across China. Species identification, antimicrobial susceptibility testing, and whole-genome sequencing were performed. Multilocus sequence typing (MLST) and capsular typing were conducted using Kleborate, plasmid replicon types were identified with PlasmidFinder, and a core genome phylogenetic tree was constructed.Results:The majority of isolates belonged to Klebsiella spp. (80.0%, 92/115), followed by E. cloacae (8.7%, 10/115) and E. coli (6.1%, 7/115). The isolates were mainly from Hebei, Beijing, Shandong, and Hunan (60.9%, 70/115), and sputum was the predominant specimen (43.5%, 50/115). The most common genotype was bla KPC+bla NDM (73.0%, 84/115), primarily in Klebsiella spp. (79.8%, 67/84), followed by bla NDM+bla IMP (15.7%, 18/115). The prevalent plasmid replicon types were IncFII (77.5%, 86/111), IncFIB (68.5%, 76/111), IncR (51.4%, 57/111), and IncX3 (20.7%, 23/111). Notably, 88.6% (31/35) of ST11-KL64 K. pneumoniae strains co-harbored IncFII, IncFIB, and IncR plasmids simultaneously. Between 2016 and 2022, the dominant subtype among Klebsiella spp. isolates was bla KPC-2+bla NDM-1 (56.2%, 36/64). In 2023, the bla KPC-2+bla NDM-13 subtype (29.5%, 19/64) emerged and exhibited clonal transmission (single nucleotide polymorphism 2?74 bp) in Hebei, Beijing, and Jilin. Susceptibility testing showed widespread resistance to β-lactams (90.2%-100%). Aztreonam-avibactam, tigecycline, and colistin retained high activity, with susceptibility rates of 90.16%-98.36%. Conclusions:In China, the majority of clinical Enterobacteriaceae strains that harbor multiple carbapenemases are Klebsiella spp. co-producing KPC and NDM enzymes. Dissemination is driven by both clonal expansion of ST11-KL64 and horizontal transfer of IncFII, IncFIB, and IncR plasmids. The recent emergence and regional clonal spread of the bla KPC-2+bla NDM-13 genotype underscore the urgent need for strengthened surveillance and containment measures.

With obesity rates climbing worldwide, metabolic and bariatric surgery has evolved over seven decades into a pivotal therapeutic approach for treating severe obesity and related disorders. Recent research highlights that new anti-diabetic and weight-loss drugs, especially GLP-1 receptor agonists (GLP-1 RA), are catalyzing a paradigm shift in obesity management. Within this context, the key scientific challenge in metabolic surgery is thoroughly investigating how pharmacological interventions and surgical procedures work together in weight management, especially evaluating if new drugs can match bariatric surgery's long-term effectiveness, complication management, and metabolic changes. Resolving this interdisciplinary debate will influence precision medicine in obesity treatment and reshape future multidisciplinary care models for metabolic disorders.

Objective:To establish and validate a nomogram for postoperative disease progression (including recurrence, metastasis, and death) in patients with primary liver cancer (PLC) based on quantitative CT measurements of relevant indicators.Methods:Clinical data of 290 patients with PLC admitted to Zhongshan Hospital Affiliated to Fudan University and Kunshan Hospital Affiliated to Jiangsu University from January 2016 to December 2021 were retrospectively collected, including 177 males and 113 females, aged (60.3±11.9) years. Two hundred and three patients admitted to Zhongshan Hospital Affiliated to Fudan University were used as the training set, and 87 patients admitted to Kunshan Hospital Affiliated to Jiangsu University were used as the validation set. The patient's condition of ascites , tumor length, number of lesions, tumor differentiation degree, relevant indicators of quantitative CT detection (including decreased muscle mass and increased intra-abdominal fat area), prognosis and other clinical data were recorded. The influencing factors of postoperative disease progression was analyzed through multiple logistic regression in the training set, and the nomogram model was constructed based on the results of multiple factor analysis. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves and calibration curves. The clinical applicability of predictive models was evaluated using the decision curve analysis.Results:The results of multiple logistic regression analysis showed that the increase in maximum tumor diameter ( OR=1.519, 95% CI: 1.251-1.843), multiple lesions ( OR=3.193, 95% CI: 1.493-6.830), low tumor differentiation ( OR=5.604, 95% CI: 2.442-12.863), ascites ( OR=3.321, 95% CI: 1.166-9.463), portal vein tumor thrombus ( OR=3.990, 95% CI: 1.681-9.474), decreased muscle mass ( OR=2.173, 95% CI: 1.051-4.492) and increased intra-abdominal fat area ( OR=2.634, 95% CI: 1.276-5.438) were independent risk factors for postoperative disease progression in patients with PLC (all P<0.05). A nomogram was constructed based on the above variables, and the area under the ROC curve for predicting postoperative disease progression in patients with PLC in the training set and validation set was 0.862 (95% CI: 0.810-0.914) and 0.879 (95% CI: 0.806-0.953), respectively. The calibration curve and ideal curve fit well, indicating that the predicted situation was basically consistent with the actual situation. Decision curve analysis showed that the column chart model had a high clinical net benefit and good clinical prediction effectiveness. Conclusion:The nomogram constructed based on the maximum diameter of the tumor, the number of lesions, the degree of tumor differentiation, ascites, portal vein tumor thrombus, decreased muscle mass, and increased intra-abdominal fat area has good predictive power for postoperative disease progression in patients with PLC.

The knowledge graph has the characteristic of visualizing structural knowledge and has gradually become a research hotspot in the field of TCM diagnosis and treatment.This article reviewed the development trend and construction techniques of knowledge graph,summarized its application status in the field of TCM diagnosis and treatment,and provided a comprehensive review from the aspects of basic knowledge of TCM,inheritance of experience of renowned doctors,TCM question answering systems,and exploration of auxiliary decision-making.It also summarized the problems of knowledge graph technology in solving the informationization and intelligence process of TCM,and discussed and prospect the research and application directions of knowledge graph in the field of informationization and intelligence of TCM based on the characteristics of TCM knowledge.

Objective:To characterize the epidemiology, antimicrobial susceptibility, and molecular mechanisms of carbapenem-resistant Enterobacterales (CRE) carrying multiple carbapenemase genes in China, and to provide evidence for infection control and antibiotic stewardship.Methods:From 2016 to 2023, 115 CRE isolates harboring at least two carbapenemase genes were collected from 41 hospitals in 18 provinces across China. Species identification, antimicrobial susceptibility testing, and whole-genome sequencing were performed. Multilocus sequence typing (MLST) and capsular typing were conducted using Kleborate, plasmid replicon types were identified with PlasmidFinder, and a core genome phylogenetic tree was constructed.Results:The majority of isolates belonged to Klebsiella spp. (80.0%, 92/115), followed by E. cloacae (8.7%, 10/115) and E. coli (6.1%, 7/115). The isolates were mainly from Hebei, Beijing, Shandong, and Hunan (60.9%, 70/115), and sputum was the predominant specimen (43.5%, 50/115). The most common genotype was bla KPC+bla NDM (73.0%, 84/115), primarily in Klebsiella spp. (79.8%, 67/84), followed by bla NDM+bla IMP (15.7%, 18/115). The prevalent plasmid replicon types were IncFII (77.5%, 86/111), IncFIB (68.5%, 76/111), IncR (51.4%, 57/111), and IncX3 (20.7%, 23/111). Notably, 88.6% (31/35) of ST11-KL64 K. pneumoniae strains co-harbored IncFII, IncFIB, and IncR plasmids simultaneously. Between 2016 and 2022, the dominant subtype among Klebsiella spp. isolates was bla KPC-2+bla NDM-1 (56.2%, 36/64). In 2023, the bla KPC-2+bla NDM-13 subtype (29.5%, 19/64) emerged and exhibited clonal transmission (single nucleotide polymorphism 2?74 bp) in Hebei, Beijing, and Jilin. Susceptibility testing showed widespread resistance to β-lactams (90.2%-100%). Aztreonam-avibactam, tigecycline, and colistin retained high activity, with susceptibility rates of 90.16%-98.36%. Conclusions:In China, the majority of clinical Enterobacteriaceae strains that harbor multiple carbapenemases are Klebsiella spp. co-producing KPC and NDM enzymes. Dissemination is driven by both clonal expansion of ST11-KL64 and horizontal transfer of IncFII, IncFIB, and IncR plasmids. The recent emergence and regional clonal spread of the bla KPC-2+bla NDM-13 genotype underscore the urgent need for strengthened surveillance and containment measures.

Objective:To explore the predictive and prognostic value of prognostic nutritional index(PNI)for patients with locally advanced esophageal squamous cell carcinoma(ESCC)undergoing induction chemotherapy combined with immune sequential radiotherapy.Methods:A retrospective analysis was conducted on clinical data from 126 locally advanced ESCC patients who had undergone induction chemotherapy combined with immune sequential radiotherapy at Zhejiang Cancer Hospital between May 2019 and August 2023.Receiver operating characteristic(ROC)curves were used to determine optimal PNI cutoff values within 1 week before induction chemoimmunotherapy,within 1 week before radiotherapy,and at 4±1 weeks after radiotherapy initiation,with subsequent patient stratification.The Kaplan-Meier method was used to generate survival curves and the log-rank test was used to compare overall survival(OS)and progression-free survival(PFS)between groups.Cox regression analysis was employed to identify factors affecting the prognosis of locally advanced ESCC patients undergoing induction chemoimmunotherapy combined with sequential radiotherapy.Results:A total of 126 locally advanced ESCC patients,118 males and 8 females,with a median age of 65 years(44-78 years)were included.The optimal critical values of PNI before induction chemoimmunotherapy,before radiotherapy and during radiotherapy identified using ROC curves were 46.2,48.3 and 37.9.The median OS and PFS were 47.3 and 28.2 months in the group with PNI≥48.3 before radiotherapy,and 18.7 and 15.2 months in the group with PNI<48.3 before radiotherapy,respectively(P<0.01,P<0.05).The median OS was not reached and the median PFS was 25.7 months in the group with PNI≥37.9 in radiotherapy,and the median OS and PFS were 17.0 and 12.5 months in the group with PNI<37.9 in radiotherapy,respectively(P<0.01,P<0.05).The median OS was not reached and the median PFS was 28.4 months in the group with elevated PNI after induction chemoimmunization;the median OS and PFS were 20.4 and 16.0 months in the group with reduced PNI(P<0.01,P<0.05).Multifactorial analysis showed that PNI in radiotherapy[HR=2.292,95%CI(1.264,4.159),P<0.05],and change in PNI after induction of chemoimmunization[HR=2.120,95%CI(1.007,4.463),P<0.05]were factors affecting OS.Conclusion:PNI during radiotherapy and changes in PNI after induction chemoimmunity correlate with patients'treatment efficacy and prognosis,and can be used as important indicators to predict the benefits of induction chemoimmunization combined with sequential radiotherapy for ESCC.

Objective:To establish and validate a nomogram for postoperative disease progression (including recurrence, metastasis, and death) in patients with primary liver cancer (PLC) based on quantitative CT measurements of relevant indicators.Methods:Clinical data of 290 patients with PLC admitted to Zhongshan Hospital Affiliated to Fudan University and Kunshan Hospital Affiliated to Jiangsu University from January 2016 to December 2021 were retrospectively collected, including 177 males and 113 females, aged (60.3±11.9) years. Two hundred and three patients admitted to Zhongshan Hospital Affiliated to Fudan University were used as the training set, and 87 patients admitted to Kunshan Hospital Affiliated to Jiangsu University were used as the validation set. The patient's condition of ascites , tumor length, number of lesions, tumor differentiation degree, relevant indicators of quantitative CT detection (including decreased muscle mass and increased intra-abdominal fat area), prognosis and other clinical data were recorded. The influencing factors of postoperative disease progression was analyzed through multiple logistic regression in the training set, and the nomogram model was constructed based on the results of multiple factor analysis. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves and calibration curves. The clinical applicability of predictive models was evaluated using the decision curve analysis.Results:The results of multiple logistic regression analysis showed that the increase in maximum tumor diameter ( OR=1.519, 95% CI: 1.251-1.843), multiple lesions ( OR=3.193, 95% CI: 1.493-6.830), low tumor differentiation ( OR=5.604, 95% CI: 2.442-12.863), ascites ( OR=3.321, 95% CI: 1.166-9.463), portal vein tumor thrombus ( OR=3.990, 95% CI: 1.681-9.474), decreased muscle mass ( OR=2.173, 95% CI: 1.051-4.492) and increased intra-abdominal fat area ( OR=2.634, 95% CI: 1.276-5.438) were independent risk factors for postoperative disease progression in patients with PLC (all P<0.05). A nomogram was constructed based on the above variables, and the area under the ROC curve for predicting postoperative disease progression in patients with PLC in the training set and validation set was 0.862 (95% CI: 0.810-0.914) and 0.879 (95% CI: 0.806-0.953), respectively. The calibration curve and ideal curve fit well, indicating that the predicted situation was basically consistent with the actual situation. Decision curve analysis showed that the column chart model had a high clinical net benefit and good clinical prediction effectiveness. Conclusion:The nomogram constructed based on the maximum diameter of the tumor, the number of lesions, the degree of tumor differentiation, ascites, portal vein tumor thrombus, decreased muscle mass, and increased intra-abdominal fat area has good predictive power for postoperative disease progression in patients with PLC.

Objective To investigate the characteristics and rules of tongue image in patients with chronic fatigue syndrome(CFS)with different fatigue degree.Methods Totally 917 patients with severe chronic fatigue syndrome(severe CFS group),351 patients with mild chronic fatigue syndrome(mild CFS group)and 1216 healthy controls(healthy control group)were enrolled in the physical examination center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.The tongue image data of subjects in the three groups were collected using TFDA-1 digital tongue and face diagnostic instrument,and the color space indexes of RGB,HSI,Lab and YCrCb were used to analyze the tongue image differences of CFS people with different fatigue degrees and the tongue image features of CFS patients with liver-qi stagnation syndrome,damp-heat stasis syndrome and spleen deficiency syndrome.Results Compared with the healthy control group,the tongue image indexes TB-R,TB-G,TB-B,TB-I,TB-L,TB-Y,TC-H,TC-I,TC-L and TC-Y increased in the severe CFS group;TB-S,TB-a,TC-S,TC-a,TC-Cr decreased(P<0.05).TB-R,TB-G,TB-B,TB-I,TB-L,TB-Y,TC-R,TC-G,TC-B,TC-I,TC-L and TC-Y increased in severe CFS group compared with mild CFS group.TB-H and TB-b increased in mild CFS group compared with healthy control group.The comparison of syndromes in severe CFS group showed that TB-a,TB-Cr,TC-S,TC-a,TC-Cr and TB-S increased in liver-qi stagnation syndrome compared to damp-heat stasis syndrome;TB-G,TB-B,TB-I,TB-L,TB-Y,TB-b,TB-Cb,TC-G,TC-B,TC-H,TC-I,TC-L,TC-Y and perAll decreased(P<0.05).Compared with spleen deficiency syndrome,TB-a,TB-Cr,TB-CON,TB-ENT,TB-MEAN,TC-a,TC-Cr,TC-CON,TC-ENT,TC-MEAN increased in liver-qi stagnation syndrome;TB-ASM,TC-S and TC-ASM decreased(P<0.05).Compared with spleen deficiency syndrome,TB-a,TB-b,TB-Cr,TB-Cb,TB-CON,TB-ENT,TB-MEAN,TC-G,TC-B,TC-H,TC-I,TC-L,TC-a,TC-Y,TC-Cr,TC-CON,TC-ENT,TC-MEAN,perAll increased;TB-ASM,TC-S and TC-ASM decreased(P<0.05).The comparison of mild CFS syndrome showed that there was no statistical significance between liver-qi stagnation syndrome and spleen deficiency syndrome(P>0.05).TB-Cr,TC-a,TC-Cr and perAll increased and TC-S decreased in damp-heat stasis syndrome compared with spleen deficiency syndrome(P<0.05).TB-S,TB-a,TB-Cr,TC-S,TC-a,TC-Cr increased,and TB-G,TB-B,TB-I,TB-Cb,TB-b,TC-b and TC-Cb decreased(P<0.05)in liver-qi stagnation syndrome compared with damp-heat syndrome.The distribution trend of TC-S was as follows:dampness-heat syndrome

Objective To design and construct a syndrome differentiation knowledge graph that integrates TCM facial color diagnosis information;To explore the hidden relationships between the knowledge.Methods The literature data came from ancient classics,textbooks,as well as standard literature related to inspection included in the CNKI,VIP and Wanfang Data from the establishment of the databases to December 31,2022.The clinical data was sourced from 30 elderly individuals who underwent TCM health examinations at the Community Health Service Center in Jiading Industrial Zone,Shanghai in September 2022.Facial image acquisition was performed using TFDA-1 digital tongue and facial diagnostic instrument.By following the steps of knowledge extraction,knowledge fusion and quality assessment to construct a graph,and with the assistance of TCM experts for interpretation,using Access 2019 to integrate qualitative textual data and quantitative objective image digital information,a syndrome differentiation knowledge graph integrating TCM facial diagnosis was designed and completed in the Neo4j graph database.In addition,a method was designed to shift facial diagnosis knowledge from qualitative to quantitative.Results There were a total of 194 nodes under 8 entity term types and 12 entity term labels,as well as 361 relationships under 13 semantic relationships in knowledge graph.The Neo4j graph database provided a visualized TCM facial color diagnosis and differentiation,which could be queried and fed back using Cypher language.Conclusion The knowledge graph constructed based on the theory of TCM facial color diagnosis visually shows the complex correlation between facial color diagnosis and syndrome differentiation diagnosis,with a knowledge representation model that forms qualitative data of image features → semantic relationships → syndrome differentiation diagnosis forms.