Objective:To establish a digital quality evaluation system for Salvia miltiorrhiza-Monascus fermentation products,screen critical quality markers,and provide methodological support for their intelligent quality control.Methods:Ultra-performance liquid chromatography coupled with quadrupole-orbitrap mass spectrometry(UPLC-Q-Orbitrap-MS)was employed to quantitatively analyze 34 bioactive components(e.g.,tanshinone Ⅱ A and alvianol-ic acid B)in 20 batches of fermentation products.The key markers were screened through hierarchical cluster anal-ysis and partial least squares discriminant analysis,and an intelligent discriminant model was constructed with sup-port vector machine machine learning algorithm to digitally analyze the characteristics of quality differences between batches.Results:Thirty-four common peaks were calibrated across all batches.Combined with partial least squares analysis,six key difference markers were further screened,including terpenoids such as isotanshinone Ⅱ A and tan-shinone Ⅱ A and phenolic acids such as salvianolic acid G.The support vector machine model can achieve 100％accuracy of origin discrimination by optimizing parameters jointly with genetic algorithm and grid search.Conclusion:This study developed a digital quality evaluation system for Salvia miltiorrhiza-Monascus fermentation products through a three-step analytical strategy("chemical feature exploration-marker screening-model valida-tion"),providing a transferable technical pathway for the intelligent transformation of traditional Chinese medicine quality control.

Objective:To establish a digital quality evaluation system for Salvia miltiorrhiza-Monascus fermentation products,screen critical quality markers,and provide methodological support for their intelligent quality control.Methods:Ultra-performance liquid chromatography coupled with quadrupole-orbitrap mass spectrometry(UPLC-Q-Orbitrap-MS)was employed to quantitatively analyze 34 bioactive components(e.g.,tanshinone Ⅱ A and alvianol-ic acid B)in 20 batches of fermentation products.The key markers were screened through hierarchical cluster anal-ysis and partial least squares discriminant analysis,and an intelligent discriminant model was constructed with sup-port vector machine machine learning algorithm to digitally analyze the characteristics of quality differences between batches.Results:Thirty-four common peaks were calibrated across all batches.Combined with partial least squares analysis,six key difference markers were further screened,including terpenoids such as isotanshinone Ⅱ A and tan-shinone Ⅱ A and phenolic acids such as salvianolic acid G.The support vector machine model can achieve 100％accuracy of origin discrimination by optimizing parameters jointly with genetic algorithm and grid search.Conclusion:This study developed a digital quality evaluation system for Salvia miltiorrhiza-Monascus fermentation products through a three-step analytical strategy("chemical feature exploration-marker screening-model valida-tion"),providing a transferable technical pathway for the intelligent transformation of traditional Chinese medicine quality control.

Objective To explore the clinical value of endoscopic intervention in preventing rebleeding of Forrest Ⅱb grade ulcers.Method A retrospective analysis was conducted on the clinical data of 114 patients from January 2015 to April 2023 due to gastrointestinal bleeding,who were confirmed by gastroscopy as Forrest Ⅱb grade ulcers.86 (75.4％,86/114) patients received endoscopic treatment as endoscopic treatment group,while 28 patients only received medication treatment as medication treatment group.Compare the effectiveness of endoscopic treatment and different endoscopic hemostatic methods for preventing rebleeding.Results There were no statistically significant differences in age,gender,clinical symptom,systolic pressure,hemoglobin concentration,and ulcer site between endoscopic and medication treatment patients (P>0.05).In terms of ulcer size,the length of ulcer in the endoscopic treatment group was smaller than that in the medication treatment group[(9.5±5.3) mm vs (12.8±7.7) mm],the difference was statistically significant (P=0.013).The rebleeding rate of medication treatment group was 21.4％ (6/28);Among the endoscopic treatment group,85 patients (98.8％,85/86) successfully underwent endoscopic treatment,with a rebleeding rate of 11.8％ (10/85),which was lower than that of medication treatment group,but the difference was not statistically significant (P=0.337).Among the patients who successfully underwent endoscopic treatment,62 cases were treated with injection of diluted adrenaline alone,6 cases with titanium clips,and 17 cases were treated with electrocoagulation or electrocoagulation combined with other hemostatic methods.The rebleeding rate were 12.9％ (8/62),16.7％ (1/6),and 5.9％ (1/17),respectively,which were lower than that of medication treatment patients,but the difference was not statistically significant (P=0.474).Due to the need for endoscopic treatment,15 patients were treated with a snare or thermal hemostatic forceps to remove the surface blood clot of the ulcer.Among them,3 cases had jet bleeding at the base (2 cases were successfully stopped by electrocoagulation;1 case had a large amount of bleeding,but endoscopic hemostasis failed,and intervention embolization successfully stopped the bleeding).Among of 16 patients with rebleeding,3 patients were treated with conservative management,and all of them were successfully stopped bleeding;6 cases underwent endoscopic treatment again,of which 4 cases were successfully hemostasis by endoscopy,and 2 cases were successfully hemostasis by surgery after endoscopic hemostasis failure;interventional embolization in 1 case,and successfully hemostasis;6 patients underwent direct surgical procedures,all of which successfully stopped bleeding,but one patient developed multiple organ failure during hospitalization and died without bleeding.Conclusion Endoscopic intervention can to some extent reduce the incidence of rebleeding in Forrest Ⅱb grade ulcers.The effect of electrocoagulation hemostasis on preventing rebleeding is better than that of injection dilution adrenaline method.However,there is a risk of iatrogenic rebleeding when removing blood clots on the surface of ulcers,and careful selection should be made when conditions permit.

Objective To explore the clinical value of endoscopic intervention in preventing rebleeding of Forrest Ⅱb grade ulcers.Method A retrospective analysis was conducted on the clinical data of 114 patients from January 2015 to April 2023 due to gastrointestinal bleeding,who were confirmed by gastroscopy as Forrest Ⅱb grade ulcers.86 (75.4％,86/114) patients received endoscopic treatment as endoscopic treatment group,while 28 patients only received medication treatment as medication treatment group.Compare the effectiveness of endoscopic treatment and different endoscopic hemostatic methods for preventing rebleeding.Results There were no statistically significant differences in age,gender,clinical symptom,systolic pressure,hemoglobin concentration,and ulcer site between endoscopic and medication treatment patients (P>0.05).In terms of ulcer size,the length of ulcer in the endoscopic treatment group was smaller than that in the medication treatment group[(9.5±5.3) mm vs (12.8±7.7) mm],the difference was statistically significant (P=0.013).The rebleeding rate of medication treatment group was 21.4％ (6/28);Among the endoscopic treatment group,85 patients (98.8％,85/86) successfully underwent endoscopic treatment,with a rebleeding rate of 11.8％ (10/85),which was lower than that of medication treatment group,but the difference was not statistically significant (P=0.337).Among the patients who successfully underwent endoscopic treatment,62 cases were treated with injection of diluted adrenaline alone,6 cases with titanium clips,and 17 cases were treated with electrocoagulation or electrocoagulation combined with other hemostatic methods.The rebleeding rate were 12.9％ (8/62),16.7％ (1/6),and 5.9％ (1/17),respectively,which were lower than that of medication treatment patients,but the difference was not statistically significant (P=0.474).Due to the need for endoscopic treatment,15 patients were treated with a snare or thermal hemostatic forceps to remove the surface blood clot of the ulcer.Among them,3 cases had jet bleeding at the base (2 cases were successfully stopped by electrocoagulation;1 case had a large amount of bleeding,but endoscopic hemostasis failed,and intervention embolization successfully stopped the bleeding).Among of 16 patients with rebleeding,3 patients were treated with conservative management,and all of them were successfully stopped bleeding;6 cases underwent endoscopic treatment again,of which 4 cases were successfully hemostasis by endoscopy,and 2 cases were successfully hemostasis by surgery after endoscopic hemostasis failure;interventional embolization in 1 case,and successfully hemostasis;6 patients underwent direct surgical procedures,all of which successfully stopped bleeding,but one patient developed multiple organ failure during hospitalization and died without bleeding.Conclusion Endoscopic intervention can to some extent reduce the incidence of rebleeding in Forrest Ⅱb grade ulcers.The effect of electrocoagulation hemostasis on preventing rebleeding is better than that of injection dilution adrenaline method.However,there is a risk of iatrogenic rebleeding when removing blood clots on the surface of ulcers,and careful selection should be made when conditions permit.

Objective:To scientifically measure and morphologically evaluate the anatomical shape of the skin in the first web space based on cadavers, and to guide the design of flap in this area.Methods:Sixteen human cadavers fixed with 10% formaldehyde without injury or deformity on the hand were selected in the Department of Hand Surgery, the Third Hospital of Suqian. According to the characteristics of the first web area, marker points were selected for measurement and morphological observation. Morphological characteristics of the first web with thumb radial abduction(r) or palmar abduction(p) were measured and compared. The t-test was used for statistical analysis. P<0.05 was considered statistically significant. According to the results of measurement, standardised shapes and parameters of the skin were obtained for flap repair of defect of the first web. Results:When the thumb was in palmar abduction, the maximum distance [a(p)] of the first web of female(F) and male(M) was 5.78/8.42 cm(F/M), and the skin [S(p)] was 17.09/23.63 cm 2(F/M), both were significantly greater than the distance [a(r)] at 4.86/6.28 cm and the area of skin area [S(r)] at 14.39/20.15 cm 2 when thumb was in the radial abduction position( P<0.05). There was no significant difference in the length of [b(r)] and [b(p)] alone the long axis of flap between palmar and radial abductions(7.54/9.38 cm and 7.34/9.74 cm, respectively) of the thumb( P>0.05). It was found that the area of first web was not shaped as a symmetrical spindle, but an irregular quadrilateral inclined to the index finger. Conclusion:Design and measurement of a flap for the first web space should take the maximum palmar abduction of a thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and characteristics in the region.

Microneedle percutaneous immunization is achieved by puncturing the stratum corneum of the skin with microneedles so that the vaccine is efficiently recognized by antigen-presenting cells to induce a specific immune response. Due to the advantages of efficient induction of immune response, low pain and easy storage, transdermal immunization by microneedles has been widely used for immunization of various vaccines in recent years. This review summarizes the materials of microneedles, application for transcutaneous immunization, as well as the challenges that need to be addressed.
Administration, Cutaneous ; Drug Delivery Systems ; Needles ; Vaccination ; Vaccines

Objective:To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations.Methods:The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed.Results:The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes.Conclusions:NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.

Background: and Purpose As a leading cause of disability and death in China, stroke as well as its epidemiologic features have gained increasing attention. Prior studies, however, have overgeneralized the north-to-south gradient in China. Whether the differences exist across urban and rural areas remains unexplored. This study therefore aims to investigate the north-to-south gradient in stroke incidence across urban and rural China. Methods: The present prospective cohort study analyzed data from the China Health and Nutrition Survey 1997 to 2015. By including 16,917 individuals from diverse social contexts, we calculated the age-standardized incidence of stroke across regions and the age-adjusted risk ratio (aRR). Cox proportional hazards models with time-varying covariates were employed to analyze variations in incident stroke. Results: During the follow-up, age-standardized incidence of stroke ranged from 4.17 per 1,000 person-years (95% confidence interval [CI], 3.38 to 4.96) in the north region to 1.95 (95% CI, 1.60 to 2.30) in the south region (aRR, 2.04; 95% CI, 1.58 to 2.64; P<0.001). The north-to-south gradient of stroke incidence was observed only in rural areas, but not in urban areas. Hierarchical modelling analyses further indicated that the regional differences could be mostly explained by the disparities in the prevalence of hypertension. Conclusions The present study extends the current evidence on the north-to-south gradient by demonstrating that the difference varied across urban and rural China. Our findings highlight the importance of hypertension management as the measure for alleviating regional differences in stroke incidence.

Purpose To investigate the correlation of the expression of Cyclin D1 and BRAF ( V600E) mutation in papillary thyroid carcinoma ( PTC) and their clinical significance, and to analyze their role in the pathogenesis of PTC. Methods The expression of CK34βE12 and MC protein was detected by immunohistochemical EnVision method in 52 cases of PTC and 52 cases of thyroid benign lesions (25 cases of nodular goiters, 15 cases of Hashimoto’s thyroiditis, 12 cases of follicular adenoma), and the mutation status of BRAF gene protein in above specimens were detected by polymerase chain reaction and DNA sequencing. Expression of Cyclin D1 and BRAF (V600E) mutation in papillary thyroid carcinoma and their correlation clinicopathologic features were also analyzed. Results The positive rate of Cyclin D1 in 88 cases of PTC was 84. 6%,and the immunoreactivity score (4. 6 ± 2. 4), compared with thyroid be-nign lesions (1. 3 ± 1. 6), was statistically significant difference (t=8. 525, P<0. 01). Expression of Cyclin D1 was closely related with lymph node metastasis, capsular invasion, tumor stage Ⅲ+Ⅳ and BRAF (V600E) mutation (P<0. 05), but not related with age, gender, number and diameter of tumor nodules. In 52 cases of PTC BRAF gene mutation rate was 63. 5%, but in thyroid benign lesions mutation rate was 0, with significant difference (P<0. 01). The BRAF mutation is closely related with lymph node metastasis, capsular invasion and tumor stage Ⅲ+Ⅳ(P<0. 05), but not related with age, gender, number and diameter of tumor nodules. The expression of Cyclin D1 in BRAF (V600E) mutation group was stronger, the positive expression rate was significantly higher than that of wild group (100% vs 57. 9%), and expression of the mean score was higher than that of the wild group (5. 7 ± 1. 6 vs 4. 0 ± 2. 5);the comparison between the two groups showed statistical difference (t=2. 652, P<0. 05). Conclusions The expression of Cyclin D1 and BRAF (V600E) mutation are positively related, which are also closely related with the occurrence and development of PTC, and can be used as an index to predict the invasion and metastasis in PTC.

[Objective]To study the indication and methods of bone grafts used in tibial plateau fracture and compare the character of allograft with autograft.[Method]A retrospective study was done in 105 cases of hospitalized from Jan.2000 to Aug.2004.Seventy-four cases accepted bone graft.These 74 cases were divided into two groups.Patienets in group A accepted autograft (n=40),the patients were 19 to 75 years old,with a mean age of 45.3 years.Among them,there were Schatzker type Ⅱ in 13 cases,type Ⅲ 13 cases,type Ⅳ 5 cases,type Ⅴ 4cases,type Ⅵ 5 cases.Patients in group B accepted allograft(n=34),the patients were 21 to 74 years old,with a mean age of 43.6 years,including Schatzker type Ⅱ in 12 cases,type Ⅲ 11 cases,type PC 3 cases,type Ⅴ 4 cases,type Ⅵ 4 cases,We have straight longitudinal and parapatellar incision,fixed with semiscrewed、L-plate、T-plate.According to the Schatzker classification,we use corresponding methods in bone graft.The two groups with operation time,complication,bone healing period,height lost were compared during the 6～12 months.we use Lysholm evaluation system.[Result]Among all 105 cases,there are 74 cases accepted bone grafted.The patients were followed up 6 months to 4 years,with an average of 27.6 months.Compared with group B,group A has a short operation time,more blood loss,a shorter healing time of suture.There was no significant difference in bone healing period,height loss during the 6～12 months and Lysholm evaluating.Complication of group A was mainly in donor site,11 cases have pain in donor site,1 case has a fracture of ilium.In group B,complication were mainly in recept site,8 cases have wound effusion,3 cases have delayed wound healing.[Conclusion]Bone graft is one of the most important step in treating tibial plateau fracture,mastering its application and methods is crucial to the prognosis.Allograft and autograft have their own characters,allograft is an advertising method.