Objective:To investigate the relationship between serum soluble thrombomodulin(sTM),soluble interleukin-2 receptor(sIL-2R)and short-term prognosis in patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)combine with type Ⅱ respiratory failure(RF).Methods:251 patients with AECOPD combine with type Ⅱ RF who were admitted to our hospital from April 2021 to April 2024 were selected,the serum sTM and sIL-2R levels of all patients were detected,and the prognosis of 10 d after admission of patients was counted,patients were divided into death group(n=40)and survival group(n=211)according to different prognosis.Influencing factors were analyzed by multivariate logistic regression analysis,predictive value was analyzed by receiver operating characteristic(ROC)curve.Results:Serum sTM and sIL-2R levels in death group were higher than those in survival group(P＜0.05).long course of chronic obstructive pulmonary disease(COPD)and severe RF,high sTM and high sIL-2R were risk factors for death of 10 d after admission of patients with AECOPD combine with type Ⅱ RF(P＜0.05).The area under the curve(AUC)of serum sTM and sIL-2R detection in predicting death of 10 d after admission of patients with AECOPD combine with type Ⅱ RF was 0.801 and 0.810,respectively,the AUC of joint detection of serum sTM and sIL-2R was 0.859,which was higher than that of each index alone.Conclusion:Serum sTM and sIL-2R levels in patients with AECOPD combine with type Ⅱ RF are significantly increase,which are relate to the occurrence of poor prognosis of 10 d after admission,serum sTM and sIL-2R are expect to be used as auxiliary predictive markers for short-term prognosis of patients with AECOPD combine with type Ⅱ RF,and long course of COPD and severe RF,APACHE Ⅱ score are the influencing factors of poor prognosis in patients with AECOPD combine with type Ⅱ RF.

Three-dimensional(3D)printing technology,which is based on computer aided design,presents innovative solutions for clinical surgical treatments and is increasingly being utilized in clinical settings.By integrating medical-image processing software and a 3D printer with customized materials,physicians can efficiently fabricate a 3D model layer by layer,thus realizing the reconstruction of human-body models with specific objectives.These models vividly showcase the anatomical structures,fracture types,and rupture severity,thereby facilitating doctors in understanding the fracture being examined.Beyond serving as a mere demonstration tool,the physi-cal model assists doctors in designing personalized implants and selecting customized surgical guide plates and fixation screws.Surgeons can improve the surgical accuracy and efficacy by refining the surgical plan via preoperative simulation operations.This article presents a summary of the application of computer-simulation surgery in conjunction with 3D printing technology in various complex surgeries.Addi-tionally,the significant potential applications of 3D printing technology in the clinical orthopedics field are discussed.

The aim of this paper was to investigate the serotypes,virulence factors and drug resist-ance of clinical isolates of Pasteurella rnultocida of porcine origin in recent years.Morphological screening and polymerase chain reaction(PCR)were used to isolate and identify 119 isolates from nasal swabs and lung tissue samples sent from swine farms in Zhejiang Province from 2010 to 2024.The isolates of Pasteurella multocida were subjected to capsular polysaccharide serotyping,lipopolysaccharide serotyping,virulence factor detection and drug resistance analysis by PCR and Kirby-Bauer disc agar diffusion method(K-B).The results showed that there were 64 strains(53.7％)of A-type,54 strains(45.3％)of D-type and 1 strain(0.9％)of F-type among the capsu-lar polysaccharide serotypes,and 10 strains(8.4％)of L1-type,20 strains(16.8％)of L3-type,86 strains(72.2％)of L6-type,and 3 strains(2.6％)of undetermined type among the lipopolysaccha-ride serotypes.The amplification results of 10 virulence genes showed that the detection rate of virulence genes hgbA,higbB and fimA was over 86.0％,the detection rate of toxA was 8.4％,while the virulence gene tbpA was not detected.There were also differences in the distribution vir-ulence genes in different capsular polysaccharide serotypes.Virulence factor pfhA was detected in type A and F but not in type D.The detection rate of adhesin gene tadD in serotype A(92.2％)was significantly higher than that of type D(9.3％),and,on the contrary,the detection rate of ad-hesin gene hsf-l in serotype D(90.7％)was significantly higher than that of type A(20.3％).Drug resistance analysis revealed that Pasteurella multocida showed high susceptibility to antimi-crobial drugs such as amoxicillin,ampicillin,cephalosporins,doxycycline,fosfenicol and ciprofloxa-cin,and showed strong resistance to antimicrobial drugs such as lincomycin,cotrimoxazole,genta-micin and amikacin,and there were 54 multi-drug resistant strains(78.3％).In summary,capsular polysaccharide serotypes were dominated by type A and D,lipopolysaccharide serotypes were dom-inated by L6,the distribution of some virulence genes varied greatly among different serotypes,and the proportion of multi-resistant strains was high,which provide reference for the prevention and control of this disease.

Objective To organize and summarize the medication rules of GU Nai-fang in treating skin diseases through real-world data.Methods We collected traditional Chinese medicine prescriptions for GU Nai-fang's treatment of skin diseases from the outpatient medical record system of Shanghai Traditional Chinese Medicine Hospital to establish a database.Statistical analysis of disease types,performance,and efficacy was conducted,and association rules and systematic clustering analysis were performed using SPSS Modeler 18.0 and SPSS 26.0 software,respectively.Results A total of 5 020 patients were included,and 5 020 prescriptions were collected,involving 241 traditional Chinese medicines with a total frequency of 85 758 uses.The frequency of using heat clearing drugs,deficiency tonifying drugs,blood activating and stasis removing drugs,surface clearing drugs,and wind and dampness dispelling drugs was relatively high;most drugs tended to be cold and warm,mainly targeting the heart,lungs,and colon meridians.The top 15 Chinese medicines with the highest frequency of use were Smilacis Glabrae Rhixoma,Cortex Moutan,Radix Paeoniae Rubra,Rehmanniae Radix,Scutellariae Radix,Cynanchi Paniculati Radix et Rhizoma,Schisandrae Chinensis Fructus,Violsse Herba,Mume Fructus,Herba Pyrolae,Hedyotis Diffusae Herba,Lonicerae Japonicae Flos,Cicadae Periostracum,Bombyx Batryticatus,Radix Salviae.Association rule analysis obtained 15 high-frequency combinations of 2 traditional Chinese medicines and 3 traditional Chinese medicines.Cluster analysis resulted in 7 clustered prescriptions.Conclusion GU Nai-fang commonly used heat clearing drugs,deficiency tonifying drugs,blood activating and stasis removing drugs,surface resolving drugs,and wind and dampness dispelling drugs in the treatment of skin diseases,and Smilacis Glabrae Rhixoma,Cortex Moutan,Radix Paeoniae Rubra,Rehmanniae Radix,and Scutellariae Radix were the most frequently used drugs.

Objective To establish an expert consensus on home exercise for prevention and rehabilitation of breast cancer related lymphedema.Methods Evidence-based nursing method was used to systematically retrieve and evaluate relevant studies in databases and guideline networks,with a search period from the establishment of the databases to October 2023.Evidence was synthesized to form the expert consensus draft after literature screening,quality evaluation,evidence extraction and evidence integration.Then the final draft was formed through expert discussion meeting and 2 rounds of expert letter consultation.Results The consensus includes 5 dimensions with a total of 22 items,involving evaluation of home exercise,management of home exercise,principles of home exercise,program of home exercise and significance of home exercise.Conclusion This"consensus"was constructed in a scientific and rigorous way,and can provide guidance for promoting the home exercise for prevention and rehabilitation of breast cancer related lymphedema,and ensure the safe and effective implementation of home exercise rehabilitation.

Objective:To evaluate the association between erectile dysfunction(ED)and myocardial infarction(MI)using two sample Mendelian randomization.Methods:A Mendelian randomization study was conducted using comprehensive data on ED and MI from extensive genome-wide association data.Using inverse variance weighted analysis for causal relationships,and correct for confounding factors using multivariate Mendelian randomization,the potential mediating effects were evaluated as well.Based on Gene-card data,the genes related to ED and MI were identified.Molecular docking was used to reveal spontaneously bound drug molecules.Results.Our study found that exposure to ED was a risk factor for MI(OR:1.001 0,95％CI:1.000 2-1.001 8,P=0.017 7),which also held true in the validation dataset(OR:1.028 5,95％CI:1.005 0-1.052 6,P=0.017 2).No statistically significant heterogeneity or horizontal pleiotropy was found.The results of reverse Mendelian randomization analysis showed any reverse causal re-lationship between ED and MI.In multivariate Mendelian randomization analysis,after excluding confounding factors(excluding tri-glycerides and high-density lipoprotein),the P-value remained less than 0.05,and the OR ranged from 1.000 1 to 1.000 7,indica-ting that ED was still a risk factor for MI.In the mediation analysis,it was found that the current mediation ratio of smoking to MI was 13.06％.In summary-data-based mendelian randomization analysis,it was found that the gene PTPN11 was a common target gene for MI and ED(OR=0.990,P＜0.001).Subsequent molecular docking with sildenafil,clopidogrel,and dapoxetine could spontaneous-ly bind to the PTPN11 gene receptor.Conclusion:There is a causal relationship between ED and MI,with smoking as a potential mediating factor,and the gene PTPN11 being a co-target gene.

Objective:To investigate the relationship between serum soluble thrombomodulin(sTM),soluble interleukin-2 receptor(sIL-2R)and short-term prognosis in patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)combine with type Ⅱ respiratory failure(RF).Methods:251 patients with AECOPD combine with type Ⅱ RF who were admitted to our hospital from April 2021 to April 2024 were selected,the serum sTM and sIL-2R levels of all patients were detected,and the prognosis of 10 d after admission of patients was counted,patients were divided into death group(n=40)and survival group(n=211)according to different prognosis.Influencing factors were analyzed by multivariate logistic regression analysis,predictive value was analyzed by receiver operating characteristic(ROC)curve.Results:Serum sTM and sIL-2R levels in death group were higher than those in survival group(P＜0.05).long course of chronic obstructive pulmonary disease(COPD)and severe RF,high sTM and high sIL-2R were risk factors for death of 10 d after admission of patients with AECOPD combine with type Ⅱ RF(P＜0.05).The area under the curve(AUC)of serum sTM and sIL-2R detection in predicting death of 10 d after admission of patients with AECOPD combine with type Ⅱ RF was 0.801 and 0.810,respectively,the AUC of joint detection of serum sTM and sIL-2R was 0.859,which was higher than that of each index alone.Conclusion:Serum sTM and sIL-2R levels in patients with AECOPD combine with type Ⅱ RF are significantly increase,which are relate to the occurrence of poor prognosis of 10 d after admission,serum sTM and sIL-2R are expect to be used as auxiliary predictive markers for short-term prognosis of patients with AECOPD combine with type Ⅱ RF,and long course of COPD and severe RF,APACHE Ⅱ score are the influencing factors of poor prognosis in patients with AECOPD combine with type Ⅱ RF.

This study was aimed at establishing a method of ultra-fast quantitative PCR for Brucella detection.We used an exogenous recombinant plasmid as the internal reference and targeted the T4SS secretion system,an important Brucella viru-lence factor,to design specific primers and probes.The sensitivity,specificity,and repeatability of this method were evaluated,and a standard curve was constructed.The coincidence rate of detection findings with this method versus quantitative PCR was determined.This method markedly decreased the detection time to only 10 minutes.The standard curve demonstrated a good linear relationship(Y=-3.410 7x+38.357,R2=0.998 5)with a low minimum detection limit of 10 copies/μL.The method exhibited good specificity and did not specifically amplify several common clinical bacteria other than Brucella.The de-tection of three concentrations of positive plasmids yielded coefficients of variation(CVs)of 0.20％to 0.91％,thus demonstra-ting the method's excellent repeatability.Furthermore,140 clinical samples were analyzed concurrently with the fluorescence PCR method,which yielded a 100％compliance rate and consistent results.Our findings indicated that the Brucella ultra-fast quantitative PCR was ultrafast;had high sensitivity,high specificity,and good specificity;and can be used for the clinical de-tection of Brucella and emergency investigation of epidemics.Therefore,this method is valuable for the early diagnosis of Bru-cella.

Objective To analyse phenotype and genetic variation of two congenital hypodysfibrinogenemia(Fg)caused by compound heterozygous variants and preliminary investigate their molecular pathogenic mechanisms.Metheds The proband A and B and their family members(a total of 19 members in 3 generations)who visited the First Hospital of Wenzhou Medical University on 4 May 2023 and 20 May 2023 for"parkinson's disease"and"pre-bilateral eyelid excision"were enrolled for the study.Prothrombin time(TT)and fibrinogen(Fg)activity were measured by coagulation assay and Fg antigen(Fg∶Ag)was measured by immunoturbidimetric assay for the two family members,and Fg aggregation assay was catalysed using human thrombin.FGG gene was amplified by PCR and se-quenced directly.The variant sites were analysed using Chromas software.Multiple sequence comparison was performed by ClustalX-2.1-win software.Pathogenicity analysis of the variant sites was performed using bioinformatics software.The analysis for FGG protein model was performed using PyMOL software.Results Phenotypic results showed TT of proband A and B extended to 27.5 s and 26.1 s,and plasma Fg activity reduced to 0.6 g/L and＜0.5 g/L,respectively.Genetic sequencing identified heterozygous c.1129+62_65delAATA on intron 8 of FGG gene in the both probands,resulting in the formation of aberrant amino acids at p.γGly377-Gly388 and an early ter-mination codon at p.γTyr389 site.A heterozygous missense variant c.103C＞A(p.AαArg35Ser)was found in exon 2 of the FGA gene of proband A,and a heterozygous missense variant c.569A＞G(p.BβAsn190Ser)was found in exon 4 of the FGB gene of proband B.Compared to the control group,the both probands showed significant decreases in peak and rate of Fg aggregation.Multiple sequence comparison analyses showed that all the three variant sites were conserved.Three bioinformatics software predicted both the missense variants were pathogenic.Protein modelling analysis showed that the number of hydrogen bonds in p.γGly377-Gly388 variant region was altered,resulting in steric hinderance.Conclusion All the two types of compound heterozygous variants,i.e.,c.1129+62_65delAATA and p.AαArg35Ser,c.1129+62_65delAATA and p.BβAsn190Ser,have been reported for the first time in Chi-na and worldwide to date,and the three variants may be related to the reduced Fg level and function in the two pedigree.

Isoflavones which mainly distributed in leguminous plants have plenty of health benefits.Isoflavone synthase(IFS)is a membrane-associated cytochrome P450 enzyme(CYP450)which carries out the unique aryl-ring migration and hydroxylation.So far,few crystal structures of plant P450s have been obtained.We determined the crystal structure of IFS from Medicago truncatula at 1.9 ? by MAD method using a selenomethionine substituted crystal and conducted molecular docking and mutagenesis study.The structure of IFS complexed with imidazole exhibits the helix Ⅰa-loop-helix Ⅰβ motif which cor-responds to helix Ⅰ of other P450s.Compared with structures of common P450s,IFS/imidazole structure contains an extra domain,i.e.,the γ-domain.The structure reveals a homodimer in which the γ-domain of one molecule interacts with the β-domain of another.The plane of heme group makes an angle of ap-proximately 40° with the helix Ⅰa-loop-helix Ⅰβ motif.Molecular docking combined with mutagenesis study suggested that Trp-128 and Asp-300 might play important roles in substrate binding and recogni-tion.Phe-301,Ser-303 and Gly-305 from the helix Ⅰa-loop-helix Ⅰβ motif may play important roles in the aryl-ring migration.These novel structural features reveal insights into the unique reaction mechanism of IFS and provide a basis for engineering IFS in leguminous crops for health purpose.