ObjectiveThis paper aims to investigate and evaluate the staged efficacy and safety of the representative empirical prescription of the “Zhu Ke Jiao” theory， Qijia Rougan prescription， combined with entecavir in the treatment of hepatic fibrosis in chronic hepatitis B. MethodsA multicenter randomized controlled clinical study was conducted， and 101 patients diagnosed with chronic hepatitis B-related hepatic fibrosis （CHB-HF） who met the diagnosis and inclusion criteria were randomly assigned to an observation group （Qijia Rougan prescription + entecavir） and a control group （entecavir）. The treatment duration was 24 weeks. Liver stiffness measurement （LSM）， fibrosis-4 index （FIB-4）， portal vein diameter， hepatitis B serology， biochemical indicators， hepatic fibrosis markers in serum ［hyaluronic acid （HA）， laminin （LN）， procollagen Ⅲ peptide （PⅢP）， and type Ⅳ collagen （Ⅳ-C）］， and traditional Chinese medicine syndrome scores were used as efficacy evaluation indicators. Efficacy assessments and explorations of different staged subgroups of Qijia Rougan prescription were conducted according to LSM values based on the Metavir pathological staging standard. ResultsA total of 98 cases were included for statistical analysis， with 49 cases in the observation group and 49 in the control group. The general data of the patients in both groups were comparable. Compared with the same group before treatment， the observation group showed a significant reduction in LSM and FIB-4 （P<0.01）， as well as notable improvements in LN， Ⅳ-C， and various TCM syndrome scores （P<0.05， P<0.01）. When compared to the control group after treatment， the observation group demonstrated significant improvements in LSM， FIB-4， and various TCM syndrome score indicators （P<0.05， P<0.01）， indicating that the observation group performed better than the control group. Subgroup analysis of the regression of hepatic fibrosis stages showed that compared to the same group before treatment， the observation group had better improvement in regression of stages F2 and F3 （P<0.05）. When compared to the control group after treatment， the observation group exhibited superior improvement in regression of stage F3 （P<0.05）. No adverse events occurred in either group during the treatment period. ConclusionCompared with entecavir alone， the combination of Qijia Rougan prescription and entecavir significantly improves the degree of hepatic fibrosis and clinical TCM symptoms in patients. The optimal intervention period is primarily during stage F3， which is a potential “interception” point of the “Zhu Ke Jiao” theory.

Objective To fabricate a large-diameter vascular graft with a pore size gradient structure mimicking that of natural blood vessels, using poly-L-lactic acid (PLLA) and polycaprolactone (PCL) as base materials through electrospinning and ultrasonic pore-forming techniques, and to evaluate its application potential. Methods A three-layered tubular graft was fabricated from a PCL/PLLA blend (mass ratio 6 : 4) via electrospinning, followed by an ultrasonic pore-forming process to create a gradient porosity. The resulting graft (diameter: 2 cm, length: 4 cm) was implanted into the descending thoracic aorta of an experimental pig using an end-to-end anastomosis. Graft patency and anastomotic sites were monitored by computed tomography angiography (CTA) at 1 and 6 weeks post-surgery. After 2 months, the graft was explanted for systematic evaluation of vascular regeneration and repair through gross examination, histopathology (H&E and elastic fiber staining), immunohistochemistry [for ETS-related gene (ERG), Actin, and Vimentin], and scanning electron microscopy (SEM). Results Postoperative CTA confirmed excellent graft patency at both 1 and 6 weeks, with no evidence of thrombosis or anastomotic stenosis. Gross examination of the 2-month explant revealed a smooth luminal surface covered by neotissue. Histopathological analysis demonstrated that the graft successfully induced the formation of a three-layered structure resembling a native vessel wall, comprising endothelial cells, smooth muscle cells, and fibroblasts. Immunohistochemistry further verified coverage of the luminal surface by endothelial cells (ERG-positive), along with the presence of neosmooth muscle (Actin-positive) and fibroblasts (Vimentin-positive). Endothelial cells were observed adhering to the inner surface of the artificial vessel under SEM. Conclusion The biomimetic, three-layered PLLA/PCL large-diameter vascular graft, constructed via electrospinning and ultrasonic pore-forming, exhibits excellent short-term patency and biocompatibility in a large animal model. More importantly, it demonstrates a significant potential to promote host cell infiltration and achieve in situ regeneration of a three-layered vascular wall structure, providing a promising experimental basis for the development of next-generation functional vascular substitutes.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective To observe the complication incidences after percutaneous lung biopsy and sealed the tract with different sealants.Methods A total of 129 patients with solitary pulmonary nodule who underwent CT-guided percutaneous lung biopsy were retrospectively included and divided into group A(n=37),B(n=47)and C(n=45).The biopsy tract was sealed with sealant A(1 g gelatin sponge particles mixed with 10 ml 50％glucose solution)in group A,with sealant B(1 g gelatin sponge particles mixed with 10 ml normal saline)in group B,while with sealant C(1 g gelatin sponge particles mixed with the coagulant enzyme from Bothrops atrox venom and 10 ml normal saline)in group C.The incidence rate of complications such as pneumothorax and hemoptysis were comparatively observed among groups.Binary logistic regression was performed to screen the independent influencing factors associated with complications of percutaneous lung biopsy.Results No significant difference of gender,age,proportion of smoking history nor emphysema,diameter of pulmonary nodules,depth of puncture into lung parenchyma nor times of puncture was found among groups(all P＞0.05).Complications occurred in 43 cases(43/129,33.33％),i.e.27 cases in group B(27/47,57.45％),11 cases in group A(11/37,29.73％)and 5 cases in group C(5/45,11.11％),and the complication rates decreased order of group B,A and C(all P＜0.05).Compared with sealant A,sealant B was associated with increased risk(OR[95％CI]=3.190[1.183,8.598],P=0.022),whereas sealant C was associated with reduced risk(OR[95％CI]=0.266[0.079,0.889],P=0.031)of complications.Conclusion After percutaneous lung biopsy,the complication incidences decreased sequentially when the needle tract was sealed with saline B,A and C.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective:To introduce the clinical application of "page-turning" superior pancreatic lymph node dissection in laparoscopic D2 radical gastrectomy for gastric cancer.Methods:Patients who were confirmed to have adenocarcinoma by preoperative gastroscopy and pathological biopsy, with tumor staging evaluated by imaging as cT1~4aN0~3M0, without neoadjuvant therapy, and without absolute surgical contraindications, underwent laparoscopic radical gastrectomy for gastric cancer with "page-turning" superior pancreatic lymph node dissection. The "page-turning" superior pancreatic lymph node dissection was performed in four steps: (1) Expose the posterior gastric mesentery and dissect No.11p lymph nodes; (2) Expose the left gastric mesentery and dissect No.7, No.8a and No.9 lymph nodes; (3) Expose the right gastric mesentery and dissect No.5 lymph nodes; (4) Expose the left edge of the portal vein and dissect No.12a lymph nodes.Results:From April 2018 to October 2024, 112 patients with gastric cancer underwent laparoscopic D2 radical gastrectomy with "page-turning" superior pancreatic lymph node dissection, including 21 cases in the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 78 cases in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and 13 cases in the Department of Gastrointestinal Surgery, Jilin Provincial People's Hospital. The TNM staging of all patients was as follows: 31 cases in stage Ⅰ, 24 cases in stage Ⅱ, and 57 cases in stage Ⅲ; 62 cases of differentiated adenocarcinoma and 50 cases of undifferentiated adenocarcinoma; the median length of tumors was 3.8 cm. All patients successfully completed the operation without conversion to open surgery, no intraoperative massive hemorrhage or postoperative death. The median total number of lymph nodes dissected in all patients was 32, and the median number of positive lymph nodes was 4.5. The overall postoperative complication rate was 5.4% (6/112), all of which were Clavien-Dindo grade Ⅱ, including pulmonary infection, pleural effusion, and incisional infection, all cured by symptomatic treatment. The median follow-up was 41.8 (2-78) months, with 7 cases lost to follow-up. During the follow-up period, 27 cases (25.7%) had tumor recurrence and 16 cases (15.2%) died.Conclusions:The "page-turning" superior pancreatic lymph node dissection technique is safe and feasible in laparoscopic radical gastrectomy for gastric cancer.

Objective To observe the complication incidences after percutaneous lung biopsy and sealed the tract with different sealants.Methods A total of 129 patients with solitary pulmonary nodule who underwent CT-guided percutaneous lung biopsy were retrospectively included and divided into group A(n=37),B(n=47)and C(n=45).The biopsy tract was sealed with sealant A(1 g gelatin sponge particles mixed with 10 ml 50％glucose solution)in group A,with sealant B(1 g gelatin sponge particles mixed with 10 ml normal saline)in group B,while with sealant C(1 g gelatin sponge particles mixed with the coagulant enzyme from Bothrops atrox venom and 10 ml normal saline)in group C.The incidence rate of complications such as pneumothorax and hemoptysis were comparatively observed among groups.Binary logistic regression was performed to screen the independent influencing factors associated with complications of percutaneous lung biopsy.Results No significant difference of gender,age,proportion of smoking history nor emphysema,diameter of pulmonary nodules,depth of puncture into lung parenchyma nor times of puncture was found among groups(all P＞0.05).Complications occurred in 43 cases(43/129,33.33％),i.e.27 cases in group B(27/47,57.45％),11 cases in group A(11/37,29.73％)and 5 cases in group C(5/45,11.11％),and the complication rates decreased order of group B,A and C(all P＜0.05).Compared with sealant A,sealant B was associated with increased risk(OR[95％CI]=3.190[1.183,8.598],P=0.022),whereas sealant C was associated with reduced risk(OR[95％CI]=0.266[0.079,0.889],P=0.031)of complications.Conclusion After percutaneous lung biopsy,the complication incidences decreased sequentially when the needle tract was sealed with saline B,A and C.

Objective:To evaluate the impact of short-term exposure to daytime heatwaves, nighttime heatwaves, and compound heatwaves on the risk of road traffic mortality and calculate the attributable mortality burden.Methods:This study collected road traffic mortality data from the Disease Surveillance System in Guangdong, Hunan, Zhejiang, Yunnan, and Jilin Provinces from 2013 to 2018. A time-stratified case-crossover design was used in this study, with the death date for each case serving as the case day. Control days were selected from the same year, month, and day of the week as the case day. A conditional logistic regression model was employed to estimate the cumulative associations of short-term exposure to daytime heatwaves, nighttime heatwaves, and compound heatwaves on the risk of road traffic mortality (lag 0-1 day) and to calculate the attributable fractions (AF).Results:Compared to non-heatwave days, the excess risk ( ER) of road traffic mortality on daytime heatwave days, nighttime heatwave days, and compound heatwave days was 5.3% (95% CI: 0.5%-10.2%), 4.9% (95% CI: 0.5%-9.4%) and 7.5% (95% CI: 2.3%- 12.9%), with corresponding AF of 5.0% (95% CI: 0.5%-9.3%), 4.7% (95% CI: 0.5%-8.6%), and 6.9% (95% CI: 2.3%-11.4%), respectively. Stratified analysis showed that the risk of traffic mortalities caused by daytime heatwaves was higher in females ( ER=15.7%, 95% CI: 5.8%-26.5%) than in males ( ER=1.8%, 95% CI: -3.6%-7.4%). Elderly individuals over 64 years old ( ER=10.9%, 95% CI: 0.3%- 22.6%) had a higher risk of road traffic mortalities from compound heatwaves than those under 45 years old ( ER=2.6%, 95% CI: -5.4%-11.2%). The risk of road traffic injury mortality from motor vehicle accidents caused by compound heatwaves ( ER=16.6%, 95% CI:2.4%-32.7%) was higher than that from non-motor vehicle accidents ( ER=5.7%, 95% CI:0.1%-11.5%). Conclusions:Short-term exposure to daytime heatwaves, nighttime heatwaves, and compound heatwaves was associated with an increased risk of road traffic mortality, with the strongest association observed for compound heatwaves. The mortality burden attributable to compound heatwaves was higher than that for daytime and nighttime heatwaves. Heatwaves were more significantly associated with road traffic mortality risk among females, elderly individuals over 64 years old, and motor vehicle accidents.

Objective:To assess the association between temperature and risk of animal injury, and identifying vulnerable populations.Methods:Based on a time-stratified case-crossover design, the number of animal injuries monitored in hospitals of Guangdong Provincial Injury Surveillance System in 2011 and 2015-2016 was included, and the daily meteorological data were derived from the fifth generation of European ReAnalysis-Land, which was produced by the European Centre for Medium-Range Weather Forecasts. Conditional logistic regression combined with a distributed lagged nonlinear model was applied to analyze the association of temperature and animal-specific injuries. We also conducted stratified analysis by region, sex, age, occupation, and location of injury occurrence.Results:There was an almost linear relationship between temperature and the occurrence of animal injury. The excess risk ( ER) of animal injury was 2.65% (95% CI: 2.27%-3.04%) for a 1 ℃ rise in temperature with much higher risk of occurrence ( ER=9.34%, 95% CI: 7.57%-11.13%) for non-mammalian injury than that for mammalian injuries ( ER=2.30%, 95% CI: 1.90%-2.70%). Stratified analysis revealed that the occurrence of animal injury was more susceptible to temperature influences in urban ( ER=2.78%, 95% CI: 2.35%-3.21%), female ( ER=2.71%, 95% CI: 2.16%-3.27%), the elderly aged 60 years and above ( ER=3.05%, 95% CI: 1.65%- 4.47%), farmer ( ER=4.66%, 95% CI: 3.03%-6.32%) and agricultural area ( ER=10.63%, 95% CI: 7.57%-13.79%) than their correspondents. In terms of mammalian injury, dog bites showed the highest risk ( ER=2.71%, 95% CI: 2.12%-3.30%). In terms of non-mammalian,snake injuries were highly influenced by temperature ( ER=16.74%, 95% CI: 11.33%-22.40%). Conclusions:The ambient temperature rises could increase the risk of animal injury with much higher risk for non-mammalian than that for mammalian injuries. Our findings suggest that global warming may increase the risk and disease burden from animal injuries.

Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.