[摘 要] 目的：构建负载STING激动剂DMXAA的锰卟啉金属有机框架纳米颗粒（DPM），探讨其对三阴性乳腺癌（TNBC）细胞4T1及其小鼠移植瘤的治疗效果。方法：通过物理吸附法制备 DPM 纳米颗粒，利用透射电镜、扫描电镜及纳米粒度电位仪表征其形貌与理化性质。常规培养4T1细胞，细胞实验分为对照组、超声辐照组（US组）、DPM治疗组（DPM组）和DPM治疗联合超声辐照组（DPM + US组），用CCK-8法检测细胞活性，免疫荧光法检测高迁移率族蛋白B1（HMGB1）和钙网蛋白（CRT）的表达，WB法检测STING通路相关蛋白的表达。构建4T1细胞移植瘤小鼠模型，分为四组，处理同细胞实验，测量肿瘤体积，免疫荧光法检测移植瘤组织中Ki-67、HMGB1、CRT和缺氧诱导因子-1ɑ（HIF-1ɑ）蛋白的表达，TUNEL法检测细胞凋亡，流式细胞术检测免疫细胞活化情况，对主要器官进行H-E染色，以评估纳米材料的体内安全性。结果：DPM呈梭形，平均粒径（268 ± 3.302）nm，电位（33.1 ± 0.87）mV。细胞实验中，DPM联合超声辐照可明显抑制4T1细胞的增殖（P < 0.001），提高4T1细胞中ROS水平（P < 0.001），诱导4T1细胞CRT表达上调（P < 0.001），HMGB1从细胞核中移至细胞质，激活STING信号通路[p-STING、p-TBK1、p-IRF3蛋白表达均显著增加（均P < 0.001）]。体内实验中，DPM联合超声辐照可显著抑制4T1细胞移植瘤生长（P < 0.001）并促进免疫细胞表型转化（P < 0.001），抑制移植瘤组织中Ki-67、HIF-1α蛋白表达（均P < 0.01），谷胱甘肽（GSH）产生（P < 0.01），促进CRT、HMGB1蛋白表达、ROS产生（P < 0.001），对主要器官结构无明显影响。结论： DPM联合超声辐照可通过激活STING通路显著抑制4T1细胞及其移植瘤的生长，诱导抗肿瘤免疫应答，且对主要器官无明显毒性。

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

Psoriasis is a common chronic inflammatory systemic disease in dermatology. Its high prevalence， recurrence rate， and numerous comorbidities impose a significant physical and mental burden on patients. With the continuous advancement of modern medicine， the emergence of biological agents has improved clinical efficacy， making it possible to overcome psoriasis， in addition to classical treatments. However， in clinical practice， adverse reactions， drug resistance， recurrence rates， and immune drift cannot be ignored. Traditional Chinese medicine （TCM） has a history of thousands of years in treating psoriasis， demonstrating good efficacy， high safety， and a low recurrence rate， but a standardized management system is lacking. Therefore， the 25^th Clinical Diseases Responding Specially to TCM Treatment Series （Psoriasis） Youth Salon， hosted by the Chinese Association of Chinese Medicine and organized by the Youth Committee of the Chinese Association of Chinese Medicine， invited 29 experts and scholars from TCM， Western medicine， and interdisciplinary fields to actively discuss the "Advantages， Challenges， and Clinical Transformation of TCM and Western Medicine in the Diagnosis and Treatment of Psoriasis". The experts at the meeting concluded that the advantages of TCM in the treatment of psoriasis are as follows. Firstly， in the TCM-led treatment plan， TCM's understanding of psoriasis follows the principle of combining the differentiation of disease and syndrome. This approach distinguishes the basic contradiction from the current main contradiction and enables a clear grasp of the dynamic process of psoriasis development. Based on the system of syndrome differentiation and treatment， TCM intervention is applied to address the current main contradiction， and the optimal TCM treatment plan is formulated by combining internal and external treatments. Adhering to the principle of "what is visible outside must be addressed inside"， TCM can prevent and treat psoriasis comorbidities early by differentiating syndrome types. Secondly， in the integrated TCM and Western medicine treatment plan， the combination of both methods not only enhances efficacy but also reduces the adverse reactions of immunosuppressants and biological agents， lowering the recurrence rate. This conference provides a reference for the diagnosis and treatment of psoriasis using TCM and integrated TCM and Western medicine， opening up new ideas for clinical and basic research and guiding future research directions.

ObjectiveTo elucidate the critical role of rehabilitation medical records (including electronic records) in rehabilitation medicine's clinical practice and management, comprehensively analyzed the structure, core content and data standards of rehabilitation medical records, to develop a standardized medical record data architecture and core dataset suitable for rehabilitation medicine and to explore the application of rehabilitation data in performance evaluation and payment. MethodsBased on the regulatory documents Basic Specifications for Medical Record Writing and Basic Specifications for Electronic Medical Records (Trial) issued by National Health Commission of China, and referencing the World Health Organization (WHO) Family of International Classifications (WHO-FICs) classifications, International Classification of Diseases (ICD-10/ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), this study constructed the data architecture, core content and data standards for rehabilitation medical records. Furthermore, it explored the application of rehabilitation record summary sheets (home page) data in rehabilitation medical statistics and payment methods, including Diagnosis-related Groups (DRG), Diagnosis-Intervention Packet (DIP) and Case Mix Index. ResultsThis study proposed a systematic standard framework for rehabilitation medical records, covering key components such as patient demographics, rehabilitation diagnosis, functional assessment, rehabilitation treatment prescriptions, progress evaluations and discharge summaries. The research analyzed the systematic application methods and data standards of ICD-10/ICD-11, ICF and ICHI Beta-3 in the fields of medical record terminology, coding and assessment. Constructing a standardized data structure and data standards for rehabilitation medical records can significantly improve the quality of data reporting based on the medical record summary sheet, thereby enhancing the quality control of rehabilitation services, effectively supporting the optimization of rehabilitation medical insurance payment mechanisms, and contributing to the establishment of rehabilitation medical performance evaluation and payment based on DRG and DIP. ConclusionStructured rehabilitation records and data standardization are crucial tools for quality control in rehabilitation. Systematically applying the three reference classifications of the WHO-FICs, and aligning with national medical record and electronic health record specifications, facilitate the development of a standardized rehabilitation record architecture and core dataset. Standardizing rehabilitation care pathways based on the ICF methodology, and developing ICF- and ICD-11-based rehabilitation assessment tools, auxiliary diagnostic and therapeutic systems, and supporting terminology and coding systems, can effectively enhance the quality of rehabilitation records and enable interoperability and sharing of rehabilitation data with other medical data, ultimately improving the quality and safety of rehabilitation services.

BACKGROUND:Early exercise treatment is the main prevention way for traumatic joint contracture and is also a research focus.Swimming may be a potential intervention for joint contracture due to the special physical properties of water. OBJECTIVE:To explore the effects of swimming on the development of joint contracture in a rat model and study its mechanisms. METHODS:Twenty-four Sprague-Dawley rats were randomly divided into a blank control group(n=8)and a joint contracture group(n=16).After the surgical operation of knee joint contracture rat models,the joint contracture group was randomly subdivided into a surgical control group(n=8)and a swimming treatment group(n=8).Swimming started in the swimming treatment group in the second week after surgery and lasted for a total of 5 weeks.At the 6th week after surgery,the body mass,knee joint range of motion,and quadriceps diameter were tested,and the diameter/body mass index was calculated.Hematoxylin-eosin staining was performed to detect the pathological changes in the knee joint capsule and quadriceps muscle,and Masson staining was used to observe fibrotic changes in the knee joint capsule.Furthermore,the protein expression of transforming growth factor β1 and type I collagen in the knee joint capsule was quantified by immunohistochemical assay and western blot was performed to detect the protein expression of MuRF1 in the quadriceps femoris. RESULTS AND CONCLUSION:Compared with the blank control group,the knee range of motion decreased in the surgical control and swimming treatment groups(P<0.01),and knee extension deficit and arthrogenic extension deficit were significantly increased(P<0.01),the diameter of the quadriceps muscle was decreased(P<0.01),the joint capsule showed significant fibrosis,the quadriceps muscle was atrophied,and the diameter/body mass index was decreased(P<0.01).Compared with the surgical control group,the swimming treatment group showed a significant increase in knee joint range of motion and quadriceps diameter(P<0.01),and significant improvement in joint capsule fibrosis and quadriceps atrophy.Compared with the blank control group,collagen fiber content and expression of transforming growth factor β1 and type I collagen were increased in the joint capsule of rats in both the surgical control group and the swimming treatment group(P<0.01).Compared with the surgical control group,collagen fiber content and expression of transforming growth factor β1 and type I collagen protein in the joint capsule were decreased in the swimming treatment group.Compared with the blank control group,the expression of MuRF1 protein in the quadriceps muscle of rats in the surgical control group and the swimming treatment group was increased(P<0.05).Compared with the surgical control group,the expression of MuRF1 protein in the quadriceps muscle of rats in the swimming treatment group was decreased(P<0.05).To conclude,early swimming intervention reduces transforming growth factor β1 and type I collagen expression in the joint capsule of traumatic joint contracture rats,decreases MuRF1 expression in the quadriceps muscle,and increases joint range of motion and quadriceps diameter,thereby inhibiting the development of joint contracture.

Aerosol-assisted plasma amplification laser-induced breakdown spectroscopy(LIBS)was employed for phosphorus detection in water.To address the multivariate coupling effects in LIBS and nebulization sampling system,an orthogonal experiment was employed to systematically optimize the key experimental parameters.Using the orthogonal experimental design,the parametric effects of laser energy(output voltage),signal acquisition delay,liquid velocity,and gas velocity on the signal to background ratio(SBR)of P I 213.618 nm were evaluated,and the optimal conditions were achieved,including laser energy of 86 mJ,delay time of 3 μs,gas velocity of 1.05 mL/min,and liquid velocity of 60 μL/min,which were in agreement with the control-variable optimization results.Moreover,the SBR response trends at P I 213.618 nm with all experimental parameters was strong in consistency with control-variable optimization results,which demonstrated the validity of the orthogonal array experimental design.This study established an efficient and accurate parameter optimization methodology for complex LIBS systems,significantly advancing the application of LIBS in environmental monitoring.

AIM To investigate the variations in mercury dissolution from HgS-containing traditional medicines in three kinds of simulated gastrointestinal dissolution media.METHODS 39 batches of 15 types of HgS-containing traditional medicines were collected,total mercury content and dissolved mercury concentrations in simulated gastric fluid,simulated intestinal fluid,and L-cysteine-containing simulated intestinal fluid were measured.The maximum daily intake of total mercury and soluble mercury was calculated based on the maximum daily clinical dosage.RESULTS Among the 15 types of medicines,the maximum daily intake of total mercury varied by 156 times,the daily intake of soluble mercury varied by 3 502 times in simulated gastric fluid,313 times in simulated intestinal fluid,and 10 663 times in L-cysteine-containing simulated intestinal fluid,approximately.CONCLUSION For the 15 types of HgS-containing traditional medicines,the daily maximum intake of soluble mercury showed greater variations than that of total mercury.Soluble mercury concentration is more closely correlated with intestinal absorption of mercury and thus represents a more rational quality control indicator for HgS-containing traditional medicines.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To develop a predictive model for the risk of post-traumatic hydrocephalus (PTH) in patients with severe traumatic brain injury (sTBI) and validate its predictive performance.Methods:A retrospective case control study was conducted to analyze the clinical data of 580 sTBI patients admitted to the 904th Hospital of the Joint Logistics Support Force of the PLA between January 2016 and December 2023, including 413 males and 167 females, aged 18-88 years [(54.3±14.6)years]. Patients were stratified into PTH group ( n=195) and non-PTH group ( n=385), based on the presence of PTH within 6 months after injury. Data collected from the two groups such as general baseline indicators, TBI-related clinical indicators (including surgical data), laboratory findings, and radiological features. Except for the data collected during the operation, all the above data are the results of the first examination at admission. Univariate analysis and Lasso regression analysis were used to screen predictors for the risk of PTH in sTBI patients. Subsequent multivariate Logistic regression was employed to identify predictors and construct a regression equation. Based on this equation, a nomogram prediction model was developed using the R language. Model discrimination was estimated through the receiver operating characteristic (ROC) curve, and calibration performance via the Hosmer-Lemeshow (H-L) goodness-of-fit test and calibration curve. Moreover, decision curve analysis (DCA) and clinical impact curve (CIC) were used for evaluating the clinical utility of the model. Results:Univariate analysis revealed statistically significant differences in 37 variables between the two groups, including age, age group, heart rate, oxygen saturation, Glasgow coma scale (GCS) score, left pupil size, right pupil size, pupillary light reflex, intracranial pressure (ICP) monitoring, type of decompressive craniectomy, neutrophil count, lymphocyte count, monocyte count, red blood cell count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-lymphocyte-platelet ratio (N/LP), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), fibrinogen (FIB), D-dimer, D-dimer-to-fibrinogen ratio (DFR), serum albumin, prognostic nutritional index, blood glucose, status of basal cisterns, midline shift, degree of midline shift, cerebral herniation, epidural hematoma (EDH), subdural hematoma (SDH), intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), modified Fisher grade, and skull fracture ( P<0.05). Lasso regression analysis identified 24 potential predictors for PTH, including age, GCS score, pupillary light reflex, type of decompressive craniectomy, monocyte count, platelet count, NLR, PLR, N/LP, LMR, SII, D-dimer, DFR, serum albumin, prognostic nutritional index, blood glucose, status of basal cisterns, degree of midline shift, cerebral herniation, EDH, SDH, IVH, modified Fisher grade and skull fracture. Multivariate Logistic regression analysis demonstrated that age, unilateral pupillary light reflex, absent pupillary light reflex, bilateral decompressive craniectomy, monocyte count, PLR, cerebral herniation, SDH, IVH, linear skull fracture and depressed skull fracture were independent risk factors for PTH. In contrast, serum albumin was identified as an independent protective factor for PTH ( P<0.05). The regression equation derived from these factors was: Logit[ P/(1- P)]=0.05×"age"+1.65×"unilateral pupillary light reflex"+2.79×"absent pupillary light reflex"+1.60×"bilateral decompressive craniectomy"+1.90×"monocyte count"+0.02×"PLR"-0.12×"serum albumin"+2.07×"cerebral herniation"+2.59×"SDH"+2.23×"IVH"+1.24×"linear skull fracture"+ 1.66×"depressed skull fracture"-22.61. The prediction model built upon this equation achieved an area under the ROC curve (AUC) of 0.95(95% CI 0.93, 0.97), with a sensitivity of 91.79%, specificity of 85.97%, and Youden′s index of 0.78. The H-L goodness-of-fit test indicated good calibration ( χ2=7.90, P=0.545). DCA results showed that the bias-corrected curve closely aligned with the actual curve and approximated the ideal curve, indicating a high clinical net benefit. Furthermore, CIC results demonstrated that with threshold probabilities greater than 60%, the number of patients identified as high-risk by the model highly corresponded with the actual number of patients who developed PTH. Conclusion:The prediction model incorporating age, unilateral pupillary light reflex, absent pupillary light reflex, bilateral decompressive craniectomy, monocyte count, PLR, serum albumin, cerebral herniation, SDH, IVH, linear skull fracture and depressed skull fracture exhibits robust predictive performance for PTH in sTBI patients.