BACKGROUND:Cervical disc herniation can cause pain in the neck and shoulder area,as well as radiating pain in the upper limbs.The incidence rate is increasing year by year and tends to affect younger individuals.Fully understanding the biomechanical characteristics of the cervical spine in adolescents is of great significance for preventing and delaying the onset of cervical disc herniation in this age group. OBJECTIVE:To reconstruct cervical spine models for both healthy adolescents and adolescent patients with cervical disc herniation utilizing finite element analysis techniques,to analyze the motion range of the C1-T1 cervical vertebrae as well as the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and the cartilage of the small joints. METHODS:A normal adolescent's cervical spine and an adolescent patient with cervical disc herniation were selected in this study.The continuous scan cervical spine CT raw image data were imported into Mimics 21.0 in DICOM format.The C1-T1 vertebrae were reconstructed separately.Subsequently,the established models were imported into the 3-Matic software for disc reconstruction.The perfected models were then imported into Hypermesh software for meshing of the vertebrae,nucleus pulposus,annulus fibrosus,and ligaments,creating valid geometric models.After assigning material properties,the final models were imported into ABAQUS software to observe the joint motion range of the C1-C7 cervical vertebrae segments under different conditions,and to analyze the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and small joint cartilage of each cervical spine segment. RESULTS AND CONCLUSION:(1)In six different conditions,the joint motion range of the C1 vertebra in the cervical spine models of both normal adolescent and adolescent patient with cervical disc herniation was higher than that of the other vertebrae.Additionally,the joint motion range of each cervical spine segment in normal adolescent was greater than that in adolescent patient with cervical disc herniation.(2)In the cervical spine model of normal adolescent,the maximum stress values in the annulus fibrosus and nucleus pulposus were found on the left side during C2-3 flexion conditions(0.43 MPa and 0.17 MPa,respectively).In the cervical spine model of adolescent patient with cervical disc herniation,the maximum stress values were found on the left side during C7-T1 flexion conditions(0.54 MPa and 0.18 MPa,respectively).(3)In the cervical spine model of normal adolescent,the maximum stress value on the endplate was found on the left side of the upper endplate of C3 during flexion conditions(1.46 MPa).In the model of adolescent patient with cervical disc herniation,the maximum stress value on the endplate was found on the left side of the lower endplate of C7 during flexion conditions(1.32 MPa).(4)In the cervical spine model of normal adolescent,the maximum stress value in the small joint cartilage was found in the C2-3 left rotation conditions(0.98 MPa).In adolescent patient with cervical disc herniation,the stress in the small joint cartilage significantly increased under different conditions,especially in C1-2,with the maximum stress found during left flexion(3.50 MPa).(5)It is concluded that compared to normal adolescent,adolescent patient with cervical disc herniation exhibits altered cervical curvature and a decrease in overall joint motion range in the cervical spine.In adolescent with cervical disc herniation,there is a significant increase in stress on the annulus fibrosus,nucleus pulposus,and endplates in the C7-T1 segment.The stress on the left articular cartilage of the C1-2 is notable.Abnormal cervical curvature may be the primary factor causing these stress changes.

Through consulting herbal medicine， medical books， and local chronicles from past dynasties to modern times， this paper systematically researched Spatholobi Caulis from name， origin， producing areas， harvesting， processing， usage， quality evaluation， functions and indications， providing a reference for the development and utilization of famous classical formulas containing Spatholobi Caulis. According to the research， Spatholobi Caulis was first recorded in the Annals of Shunning Prefecture from the Qing dynasty. It was originally a medicinal herb commonly used in Shunning， Yunnan， and was named from the red juice resembling chicken blood that flowed out after the vein was cut off. The mainstream original plants of each dynasty were Kadsura heteroclita and Spatholobus suberectus. Among them， K. heteroclita mainly focused on dispersing blood stasis and unblocking meridians， mainly treating rheumatic pain and injuries caused by falls or blows， and it is mostly used as the raw material of Jixueteng ointments. S. suberectus was commonly used as decoction pieces in decoction， which had the functions of promoting blood circulation and replenishing blood， activating meridians and collaterals， and mainly used for treating anemia， irregular menstruation， and rheumatic bone pain. The production area of Spatholobi Caulis recorded in the Qing dynasty was Yunnan. Currently， the main production area of S. suberectus is Guangxi， while the main production area of K. interior is Yunnan. In the Qing dynasty， the usage of Spatholobi Caulis was an individual prescription with other herbs before making ointments， which was usually composed of the juice of it， safflower， angelica， and glutinous rice. But in modern times， Spatholobi Caulis is mostly sliced and dried for use. The quality of Spatholobi Caulis is often determined by the number of reddish-brown concentric circles on the cut surface， with a higher number indicating better quality. Additionally， the presence of resinous secretions is also considered desirable. Based on the research findings， it is suggested that when developing famous classical formulas containing Spatholobi Caulis， the choice of the primary source should be S. suberectus or K. heteroclita， taking into consideration the therapeutic effects of the formula. It is also recommended that the latest plant classification be referenced in the next edition of Chinese Pharmacopoeia， adjusting the primary source of Kadsurae Caulis to K. heteroclita to avoid confusion caused by inconsistent original names， and the functions adjust to promote Qi circulation and relieve pain， disperse blood stasis and unblock collaterals， treating injuries caused by falls and bruises.

Objective: To investigate the positive rate of drug-induced antibodies produced by the clinical application of β-lactam antibiotics, and analyze the differences in the detection methods and related influencing factors. Methods: A total of 350 adult inpatients who developed anemia after using β-lactam antibiotics for 3 days or more in Inner Mongolia People's hospital were selected as the experimental group, and 240 adult inpatients treated with β-lactam antibiotics for 3 days or more who did not develop anemia as the control group. The drug-induced antibody tests, direct antiglobulin tests, and unexpected antibody screening were performed on both groups, and the influencing factors of drug-induced antibodies were analyzed. Results: The numbers of positive cases of drug-induced antibody detected by the drug-coated red blood cell method in the experimental group and the control group were 12(12/350, 3.43%) and 2(2/240, 0.83%) respectively, with statistically significant differences (P<0.05). No drug-induced antibodies were detected in either group using the drug addition method. In the experimental group, the red blood cell method detected β-lactam drug-induced antibodies in 12 cases (12/350, 3.43%), while the drug added method detected 0 cases (0/350, 0.00%), with statistically significant differences (P<0.05). In the control group, the detection rates of two methods showed no statistically significant difference (P>0.05). In the experimental group, 7 cases of β-lactam antibodies were detected in the cephalosporin group (7/293, 2.40%) and 5 cases in the non-cephalosporin group (5/58, 8.62%), with statistically significant differences (P<0.05). There was no statistically significant difference between the second-generation and third-generation cephalosporin drugs (P>0.05). When the experimental group was stratified according to the history of blood transfusion and the blood type of patients, no statistically significant differences were observed between subgroups (P>0.05). Conclusion: Anemia may be related to the production of drug-induced antibodies followingβ-lactam antibiotics treatment. Therefore, improving the clinical awareness of drug-induced antibodies to β-lactam antibiotics is of great significance to clarify the causes of anemia and reduce unnecessary blood transfusions.

Objective: To investigate the positive rate of drug-induced antibodies produced by the clinical application of β-lactam antibiotics, and analyze the differences in the detection methods and related influencing factors. Methods: A total of 350 adult inpatients who developed anemia after using β-lactam antibiotics for 3 days or more in Inner Mongolia People's hospital were selected as the experimental group, and 240 adult inpatients treated with β-lactam antibiotics for 3 days or more who did not develop anemia as the control group. The drug-induced antibody tests, direct antiglobulin tests, and unexpected antibody screening were performed on both groups, and the influencing factors of drug-induced antibodies were analyzed. Results: The numbers of positive cases of drug-induced antibody detected by the drug-coated red blood cell method in the experimental group and the control group were 12(12/350, 3.43%) and 2(2/240, 0.83%) respectively, with statistically significant differences (P<0.05). No drug-induced antibodies were detected in either group using the drug addition method. In the experimental group, the red blood cell method detected β-lactam drug-induced antibodies in 12 cases (12/350, 3.43%), while the drug added method detected 0 cases (0/350, 0.00%), with statistically significant differences (P<0.05). In the control group, the detection rates of two methods showed no statistically significant difference (P>0.05). In the experimental group, 7 cases of β-lactam antibodies were detected in the cephalosporin group (7/293, 2.40%) and 5 cases in the non-cephalosporin group (5/58, 8.62%), with statistically significant differences (P<0.05). There was no statistically significant difference between the second-generation and third-generation cephalosporin drugs (P>0.05). When the experimental group was stratified according to the history of blood transfusion and the blood type of patients, no statistically significant differences were observed between subgroups (P>0.05). Conclusion: Anemia may be related to the production of drug-induced antibodies followingβ-lactam antibiotics treatment. Therefore, improving the clinical awareness of drug-induced antibodies to β-lactam antibiotics is of great significance to clarify the causes of anemia and reduce unnecessary blood transfusions.

OBJECTIVE To assess the cost-effectiveness of durvalumab combined with chemotherapy as a first-line treatment for advanced biliary tract cancer from the perspective of the Chinese healthcare system. METHODS Using data from the TOPAZ-1 clinical trial， a three-state Markov model comprising progression-free survival （PFS）， progressive disease （PD） and death was developed， with a cycle length of 21 days and a 10-year time horizon. Patients in the observation group received durvalumab in combination with gemcitabine and cisplatin， whereas those in the control group received placebo plus the same chemotherapy regimen. The evaluation indexes were quality-adjusted life year （QALY） and the incremental cost-effectiveness ratio （ICER）. The willingness-to-pay （WTP） threshold was set at three times the 2024 Chinese per capita gross domestic product （GDP） （287 247 yuan/QALY）. The sensitivity analyses， along with scenario analyses， were performed. RESULTS In the base-case analysis， the ICER of observation group compared to control group was 1 166 344.46 yuan/QALY， far exceeding the WTP threshold， indicating that the regimen was not cost-effective. One-way sensitivity analysis identified the PD state utility， discount rate， cost of durvalumab， and PFS state utility as the main drivers of ICER variation. Probabilistic sensitivity analysis showed that， at the above WTP threshold， the probability of the acceeptance of this regimen was 0， further supporting the robustness of the base-case findings. In the scenario analysis， inclusion of a patient assistance program reduced the ICER to 235 885.16 yuan/ QALY， below the above WTP threshold， suggesting cost-effectiveness under this assistance program. However， when applying a regional WTP threshold set at three times the per capita GDP （158 475 yuan/QALY） of Gansu Province （the province with the lowest GDP in China in 2024）， the ICER remained above the threshold， indicating that the regimen was not cost-effective at the regional level. CONCLUSIONS At current pricing， durvalumab plus chemotherapy as a first-line treatment for advanced biliary tract cancer is not cost-effective in China. Although the introduction of a patient assistance program can substantially reduce the ICER and achieve cost-effectiveness at a WTP threshold set at three times the 2024 per capita GDP of China， due to limited affordability in low-income areas， the program remains not cost-effective.

Objective:To analyze any effect of combining hyperbaric oxygen with qingkailing on the metabolic biomarkers of consciousness disorder (CD) caused by brain trauma using metabolomics technology. Also, to screen out diagnostic markers for clinical treatment and prognosis.Methods:Thirty-six patients with a CD caused by brain trauma formed the observation group, while 40 healthy gender-, age- and ethnicity-matched individuals were the control group. Both groups were given routine supportive treatment, while the observation group additionally received hyperbaric oxygen and oral qingkailing medication. Before and after 14 days consciousness disturbance was evaluated using the Glasgow Coma Scale (GCS). Venous blood was collected for metabolomic analysis using liquid chromatography linked to a mass spectrometer to screen out specific metabolic biomarkers. Metabolic markers associated with the disease and of diagnostic significance were thus identified.Results:After the treatment the average GCS score of the observation group had improved significantly and the degree of coma was significantly relieved. Twenty-one metabolic markers were found to be significant, with creatine, proline, uric acid, acetyl-L-carnitine, histidine, proline leucine, tryptophan and 9E-octagenoic acid potentially of high diagnostic value. After the treatment, all of those markers came close to the levels observed in the healthy control group.Conclusions:Proline, leucine, 9E-octagenoleic acid, uric acid and acetyl-L-carnitine could be used for diagnosis and evaluating efficacy with such patients. Hyperbaric oxygen supplemented with qingkailing can relieve coma, correct metabolic disorders and accelerate patients′ awakening. Metabolomics provides a new method for identifying endogenous metabolic abnormalities in patients with post-traumatic consciousness disorders. It can be useful in prognosis and clinical treatment.

Objective Through the detection of treponema pallida antibody in the unpaid blood donors in Wenzhou area,the recall self-test and recall test were carried out on the blood donors who were reactive to enzyme-linked immunosorbent assay(ELISA)test,and the feasibility of the recall plan was evaluated.Methods From January 2021 to May 2023,275 652 blood donors who successfully participated in unpaid blood donation were tested by anti-treponema pallidum(TP)ELISA,the reactivity rate and S/CO value of different reagents were compared,and the reactivity of single reagent was detected by ELISA.In addition,24 blood donors who volunteered to participate in the recall more than six months after the last blood donation screening were informed of the recall by way of interview,targeted health consultation,general examination and preliminary screening test were passed,and blood samples were collected for recall self-test and recall test.Results A total of 275 652 people were tested by anti-TP ELISA,and 627 cases were found to be reactive,with a reactivity rate of 0.23% ,including a double reagent reactivity rate of 0.12% and a single reagent reactivity rate of 0.11% .The ratio of S/CO≥5.00 with double reagent was 73.6% (240/326),and the ratio of S/CC＜5.00 with single reagent was 92.4% (278/301).24 people entered the recall process,20 people were successfully recalled,3 people failed to pass the self-test and 1 person failed to pass the test.The recall success rate was 83.3% (20/24).Conclusion The problem of false reactivity of anti-TP ELISA test single reagent in blood collection and supply institutions is prominent.Through the established recall scheme,the self-test and recall test of blood donors with strong recall intention can not only ensure the safety of blood donors,but also improve the construction of blood collection and supply service system.

Objective To explore the clinical efficacy of recombinant human prourokinase during emergency coronary intervention (PCI) in patients with acute inferior wall ST segment elevation myocardial infarction (STEMI) without reflow or slow blood flow.Methods Eighty patients with acute inferior wall STEMI admitted to Xinyi People's Hospital from January 2022 to December 2023 were selected.The patients were divided into two groups,40 cases in each group.The control group patients accepted PCI after receiving 100μg nitroglycerin or nitroprusside via catheter;On the basis of control group,the observation group patients received 20mg recombinant human prourokinase via catheter until infarct related artery,and PCI was performed.Using thrombolysis in myocardial infarction (TIMI) blood flow grading method,compared the immediate myocardial perfusion after surgery.Results Comparison of immediate TIMI blood flow grading between two groups of patients during surgery,with grades ranging from level 0 to 1:1 case (2.5％) in observation group and 7 cases (17.5％) in control group.The difference between two groups was statistically significant (P<0.05);Level 2:3 cases (7.5％) in observation group and 8 cases (20.0％) in control group.There was no statistically significant difference between two groups (P>0.05);Level 3:36 cases (90.0％) in observation group and 25 cases (62.5％) in control group.The difference between two groups was statistically significant (P<0.05).Conclusion Recombinant human prourokinase can effectively improve the coronary blood flow of infarct related artery during emergency PCI in patients with acute inferior wall STEMI,improve myocardial ischemia,and do not increase adverse reactions such as bleeding,which is of great significance for improving patient's prognosis.

Objective To observe the value of 3D Res2Net deep learning model for predicting volume doubling time(VDT)of solid pulmonary nodule.Methods Chest CT data of 734 patients with solid pulmonary nodules were retrospectively analyzed.The patients were divided into progressive group(n=218)and non-progressive group(n=516)according to whether lung nodule volume increased by ≥25％during follow-up or not,also assigned into training set(n=515)and validation set(n=219)at a ratio of 7∶3.Then a clinical model was constructed based on clinical factors being significantly different between groups,CT features model was constructed based on features of nodules on 2D CT images using convolutional neural network,and 3D Res2Net model was constructed based on Res2Net network using 3D CT images as input.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated.Taken actual VDT as gold standard,the efficacy of the above models for predicting solid pulmonary nodule'VDT≤400 days were evaluated.Results No significant difference of predicting efficacy for solid pulmonary nodule'VDT≤400 days was found among clinical model,CT feature model and 3D Res2Net model,the AUC of which was 0.689,0.698 and 0.734 in training set,0.692,0.714 and 0.721 in validation set,respectively.3D Res2Net model needed 5-7 s to predict VDT of solid pulmonary nodules,with an average time of(5.92±1.08)s.Conclusion 3D Res2Net model could be used to predict VDT of solid pulmonary nodules,which might obviously reduce manual interpreting time.

BACKGROUND:Ankylosing spondylitis is a chronic inflammatory disease with chronic rheumatic immunity.Soft tissue ossification and fusion and spinal stiffness can cause biomechanical changes. OBJECTIVE:To reconstruct the lumbar-sacral intervertebral disc in ankylosing spondylitis patients with lumbar kyphosis by finite element analysis,and to study the range of motion of each segment of T11-S1 and the biomechanical characteristics of annulus fibrosus and nucleus pulposus. METHODS:The imaging data were obtained from an ankylosing spondylitis patient with lumbar kyphosis.The original CT image data of continuously scanned spine were imported into Mimics 21.0 in DICOM format,and T11-S1 was reconstructed respectively.The established model was imported into 3-Matic software in the format of"Stl"to reconstruct the intervertebral disc,and the fibrous intervertebral disc model was obtained.The improved model was further imported into Hypermesh software,and the vertebra,nucleus pulposus,annulus fibrosus and ligament were mesh-divided.After the material properties were given,the model was imported into ABAQUS software to observe the range of motion of each vertebral body in seven different working conditions of T11-S1,and analyze the biomechanical characteristics of each segment of annulus fibrosus and nucleus pulposus. RESULTS AND CONCLUSION:(1)The range of motion of L1 vertebrae was higher than that of other vertebrae under six different working conditions:extension,forward flexion,rotation(left and right),and lateral flexion(left and right).The maximum range of motion was 2.18° during L1 vertebral flexion,and the minimum range of motion was 0.12° during L5 vertebral extension.(2)The annular fiber flexion at L2-L3 segments was greater than the extension(P<0.05),and the annular fiber flexion at L3-L4 and L4-L5 segments was less than the extension(P<0.05).The left rotation of L1-L2 annular fibers was greater than the right rotation(P<0.05).The left flexion of the annulus was greater than the right flexion in L1-L2,L2-L3,L3-L4,L4-L5 and L5-S1 segments(P<0.05).(3)The nucleus pulposus stresses of T11-L12,L1-L2,L2-L3,L3-L4 and L4-L5 segments in forward flexion were greater than in extension(P<0.05).The left rotation of T12-L1 and L3-L4 segments was smaller than the right rotation(P<0.05),and that of T11-T12,L1-L2,and L2-L3 segments was larger than the right rotation(P<0.05).The left flexion was larger than the right flexion in the T11-S1 segment.(4)It is concluded that in ankylosing spondylitis patients with lumbar kyphosis,the minimum range of motion of the vertebral body is located at the L5 vertebral body in extension.To prevent fractures,it is recommended to avoid exercise in the extension position.During the onset of lumbar kyphosis in patients with ankylosing spondylitis,the maximum stress of the annulus fibrosus and nucleus pulposus is located in the L1-L2 segment,which is fixed and will not alter with the change of body position.The late surgical treatment and correction of deformity should focus on releasing the pressure of the annulus fibrosus and nucleus pulposus in this segment to avoid the rupture of the annulus fibrosus and the injury of the nucleus pulposus.