Objective Based on the holistic view of traditional Chinese medicine,a more objective and comprehensive quality evaluation model for Huangjing Dami pills was established by combining external traits and internal qualities,and was applied to the optimization of the prescription process to verify its feasibility and applicability,so that it can provide reference for the optimization of the preparation process of other honey pills.Methods The texture characterization information of Huangjing Dami pills was collected based on the texture meter,and the water content and chemical composition information were collected based on the 2020 edition of the Chinese Pharmacopoeia.Given that the hardness and other texture characterization indexes are moderate indexes,the quality evaluation model established by the polar value method and principal component analysis(PCA)was used to quantify the values of the characterization evaluation indexes,which can be used to screen the significance of the influencing factors in the Plackett-Burman(PB)test;The quality evaluation model based on the optimal value method,the polar value method and the Analytic Hierarchy Process(AHP)-CRITIC method was used to characterize the quantification of the actual values of the evaluation indexes,and it can be used to optimize the process and derive the optimal process parameters for the steepest hill-climbing test,the response surface test and the validation test.Results The quality evaluation model based on the extreme value method-PCA was used in the PB test to screen out the three significant influencing factors of the ratio of honey to medicine,drying temperature and mesh number;the quality evaluation model based on the optimal value,extreme value method-AHP-CRITIC method was used in the steepest climb test,response surface test and validation test,which resulted in the optimal prescription process parameters of Huangjing Dami pills,namely,the ratio of medicine to honey was 1:0.64,the honey temperature was 60℃,the mesh number was 100 mesh,the drying temperature was 50.8℃,the drying time was 3 h,the sweating time was 1 day.Conclusion It was verified that the feasibility and applicability of the qualitative attributes guiding the optimization of prescriptions,and that the established quality evaluation model could guarantee the quality of the final product by taking into account the physical attributes and the chemical attributes during the optimization of the prescription,which showed a better prospect of application in the optimization of the process of honey pills and the method for the evaluation of the quality of honey pills preparation.

Objective:To evaluate the ability of ENDOANGEL artificial intelligence system to predict invasion depth and differentiation status of early gastric cancer using more diverse multi-center videos, and to test the performance of the new system upgraded from ENDOANGEL.Methods:Based on the completed 2020 man-machine competition for early gastric cancer diagnosis using single-center videos, the second man-machine competition was conducted in 2022, involving 30 endoscopists from 30 hospitals across 10 Chinese provinces. A multi-center video cohort was retrospectively collected from 12 institutions in 8 provinces/municipalities in China. The study proceeded in 3 stages. First, the ENDOANGEL was re-tested on multi-center videos, its performance on single and multi-center videos was compared, then the ENDOANGEL was upgraded to ENDOANGEL-2022. Second, the second man-machine competition was conducted between ENDOANGEL-2022 and 30 endoscopists using multi-center videos, and the performance between ENDOANGEL-2022, ENDOANGEL and endoscopists on multi-center videos were compared. Third, the ENDOANGEL-2022 was re-tested on the single-center videos previously collected in 2020, its performance on single and multi-center videos was also compared.Results:Compared with the performance on single-center videos, the sensitivity of ENDOANGEL for predicting submucosal invasion of early gastric cancer decreased significantly [18.18% (2/11) VS 70.00% (7/10), P=0.030], but demonstrated comparable ability to predict undifferentiated type of early gastric cancer ( P>0.05). On multi-center videos, in the respect of predicting submucosal invasion of early gastric cancer, the sensitivity of ENDOANGEL-2022 was higher than that of ENDOANGEL [40.00% (4/10) VS 18.18% (2/11), P=0.361], but inferior to that of 30 endoscopists [40.00% VS 52.04% (95% CI: 43.70%-60.38%), P<0.001]. The specificity of ENDOANGEL-2022 was lower than that of ENDOANGEL [82.86% (29/35) VS 100.00% (34/34), χ2=4.41, P=0.036] and higher than that of 30 endoscopists [82.86% VS 68.97% (95% CI: 60.83%-77.11%), P=0.018], the accuracy of ENDOANGEL-2022 was lower than that of ENDOANGEL [73.33% (33/45) VS 80.00% (36/45), χ2=0.56, P=0.455] and higher than that of 30 endoscopists [73.33% VS 65.30% (95% CI: 60.61%-69.99%), P=0.018]. In the respect of predicting undifferentiated type of early gastric cancer, the sensitivity of ENDOANGEL-2022 was higher than that of ENDOANGEL [71.43% (5/7) VS 57.14% (4/7), P>0.999] and 30 endoscopists [71.43% VS 63.11% (95% CI: 55.58%-70.64%), P=0.031], the specificity of ENDOANGEL-2022 was lower than that of ENDOANGEL [76.32% (29/38) VS 78.95% (30/38), χ2=0.08, P=0.783] and higher than that of 30 endoscopists [76.32% VS 65.27% (95% CI: 59.10%-71.44%), P=0.004],the accuracy of ENDOANGEL-2022 was similar to that of ENDOANGEL [75.56% (34/45) VS 75.56% (34/45), χ2=0.00, P>0.999] and higher than that of 30 endoscopists [75.56% VS 65.10% (95% CI: 59.96%- 70.24%), P<0.001]. Compared with performance in single center videos, the sensitivity [40.00% VS 60.00%(6/10), P=0.656], specificity [82.86% VS 93.75% (15/16), χ2=0.37, P=0.542] and accuracy [73.33% VS 80.77% (21/26), χ2=0.50, P=0.479] of ENDOANGEL-2022 for predicting submucosal invasion of early gastric cancer decreased; in predicting undifferentiated type of early gastric cancer, the sensitivity of ENDOANGEL-2022 increased [71.43% VS 37.50% (3/8), P=0.315], while the specificity [76.32% VS 100.00% (18/18), χ2=3.48, P=0.062] and accuracy [75.56% VS 80.77% (21/26), χ2=0.26, P=0.612] decreased. Conclusion:Multi-center cases introduce greater heterogeneity that may reduce artificial intelligence prediction accuracy, but the artificial intelligence system still outperforms endoscopists.

Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1 000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn't change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased im-mediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn't change signifi-cantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

Objective Based on the holistic view of traditional Chinese medicine,a more objective and comprehensive quality evaluation model for Huangjing Dami pills was established by combining external traits and internal qualities,and was applied to the optimization of the prescription process to verify its feasibility and applicability,so that it can provide reference for the optimization of the preparation process of other honey pills.Methods The texture characterization information of Huangjing Dami pills was collected based on the texture meter,and the water content and chemical composition information were collected based on the 2020 edition of the Chinese Pharmacopoeia.Given that the hardness and other texture characterization indexes are moderate indexes,the quality evaluation model established by the polar value method and principal component analysis(PCA)was used to quantify the values of the characterization evaluation indexes,which can be used to screen the significance of the influencing factors in the Plackett-Burman(PB)test;The quality evaluation model based on the optimal value method,the polar value method and the Analytic Hierarchy Process(AHP)-CRITIC method was used to characterize the quantification of the actual values of the evaluation indexes,and it can be used to optimize the process and derive the optimal process parameters for the steepest hill-climbing test,the response surface test and the validation test.Results The quality evaluation model based on the extreme value method-PCA was used in the PB test to screen out the three significant influencing factors of the ratio of honey to medicine,drying temperature and mesh number;the quality evaluation model based on the optimal value,extreme value method-AHP-CRITIC method was used in the steepest climb test,response surface test and validation test,which resulted in the optimal prescription process parameters of Huangjing Dami pills,namely,the ratio of medicine to honey was 1:0.64,the honey temperature was 60℃,the mesh number was 100 mesh,the drying temperature was 50.8℃,the drying time was 3 h,the sweating time was 1 day.Conclusion It was verified that the feasibility and applicability of the qualitative attributes guiding the optimization of prescriptions,and that the established quality evaluation model could guarantee the quality of the final product by taking into account the physical attributes and the chemical attributes during the optimization of the prescription,which showed a better prospect of application in the optimization of the process of honey pills and the method for the evaluation of the quality of honey pills preparation.

Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1 000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn't change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased im-mediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn't change signifi-cantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

Objective:To evaluate the ability of ENDOANGEL artificial intelligence system to predict invasion depth and differentiation status of early gastric cancer using more diverse multi-center videos, and to test the performance of the new system upgraded from ENDOANGEL.Methods:Based on the completed 2020 man-machine competition for early gastric cancer diagnosis using single-center videos, the second man-machine competition was conducted in 2022, involving 30 endoscopists from 30 hospitals across 10 Chinese provinces. A multi-center video cohort was retrospectively collected from 12 institutions in 8 provinces/municipalities in China. The study proceeded in 3 stages. First, the ENDOANGEL was re-tested on multi-center videos, its performance on single and multi-center videos was compared, then the ENDOANGEL was upgraded to ENDOANGEL-2022. Second, the second man-machine competition was conducted between ENDOANGEL-2022 and 30 endoscopists using multi-center videos, and the performance between ENDOANGEL-2022, ENDOANGEL and endoscopists on multi-center videos were compared. Third, the ENDOANGEL-2022 was re-tested on the single-center videos previously collected in 2020, its performance on single and multi-center videos was also compared.Results:Compared with the performance on single-center videos, the sensitivity of ENDOANGEL for predicting submucosal invasion of early gastric cancer decreased significantly [18.18% (2/11) VS 70.00% (7/10), P=0.030], but demonstrated comparable ability to predict undifferentiated type of early gastric cancer ( P>0.05). On multi-center videos, in the respect of predicting submucosal invasion of early gastric cancer, the sensitivity of ENDOANGEL-2022 was higher than that of ENDOANGEL [40.00% (4/10) VS 18.18% (2/11), P=0.361], but inferior to that of 30 endoscopists [40.00% VS 52.04% (95% CI: 43.70%-60.38%), P<0.001]. The specificity of ENDOANGEL-2022 was lower than that of ENDOANGEL [82.86% (29/35) VS 100.00% (34/34), χ2=4.41, P=0.036] and higher than that of 30 endoscopists [82.86% VS 68.97% (95% CI: 60.83%-77.11%), P=0.018], the accuracy of ENDOANGEL-2022 was lower than that of ENDOANGEL [73.33% (33/45) VS 80.00% (36/45), χ2=0.56, P=0.455] and higher than that of 30 endoscopists [73.33% VS 65.30% (95% CI: 60.61%-69.99%), P=0.018]. In the respect of predicting undifferentiated type of early gastric cancer, the sensitivity of ENDOANGEL-2022 was higher than that of ENDOANGEL [71.43% (5/7) VS 57.14% (4/7), P>0.999] and 30 endoscopists [71.43% VS 63.11% (95% CI: 55.58%-70.64%), P=0.031], the specificity of ENDOANGEL-2022 was lower than that of ENDOANGEL [76.32% (29/38) VS 78.95% (30/38), χ2=0.08, P=0.783] and higher than that of 30 endoscopists [76.32% VS 65.27% (95% CI: 59.10%-71.44%), P=0.004],the accuracy of ENDOANGEL-2022 was similar to that of ENDOANGEL [75.56% (34/45) VS 75.56% (34/45), χ2=0.00, P>0.999] and higher than that of 30 endoscopists [75.56% VS 65.10% (95% CI: 59.96%- 70.24%), P<0.001]. Compared with performance in single center videos, the sensitivity [40.00% VS 60.00%(6/10), P=0.656], specificity [82.86% VS 93.75% (15/16), χ2=0.37, P=0.542] and accuracy [73.33% VS 80.77% (21/26), χ2=0.50, P=0.479] of ENDOANGEL-2022 for predicting submucosal invasion of early gastric cancer decreased; in predicting undifferentiated type of early gastric cancer, the sensitivity of ENDOANGEL-2022 increased [71.43% VS 37.50% (3/8), P=0.315], while the specificity [76.32% VS 100.00% (18/18), χ2=3.48, P=0.062] and accuracy [75.56% VS 80.77% (21/26), χ2=0.26, P=0.612] decreased. Conclusion:Multi-center cases introduce greater heterogeneity that may reduce artificial intelligence prediction accuracy, but the artificial intelligence system still outperforms endoscopists.

Objective To study the effect of silica in soil on the extraction of biological evidence DNA at the crime scene using the silica bead method.Methods Mud suspension and diluted blood were mixed to prepare biological samples mixed with dust and soil,which is to simulate biological evidence at the crime scene.Cell lysis was performed using heating lysis and guanidine salt chemical lysis,respectively.DNA was extracted using the silica bead method,amplified by PCR using Identifiler Plus kit and detected by capillary electrophoresis.The electrophoresis results were compared.Using mud suspension instead of silica beads to extract diluted blood DNA to validate the effect of silica in soil on the extraction of biological evidence DNA at crime scene using silica beads method.Results The complete STR loci were obtained after the extraction and amplification of 4 μL,20 μL dilute blood mixed with mud and lysed with heating cracking,whoes average peak heights arel 969.7±376.9 RFU and 9 706.7±349.8 RFU.For the 4 μL dilute blood mixed with mud guanidine salt chemical lysis,it cannot obtain complete STR loci after extraction and amplification.20 μL dilute blood mixed with mud guanidine salt was chemically cleaved and amplified to obtain complete STR loci with an average peak height of 1 899.8±801.3 RFU.After extraction and amplification by mud suspension instead of silica beads to extract 20 μL diluted blood DNA,complete STR loci were obtained.Conclusion Silicon dioxide in soil can bind to DNA in the presence of guanidine salts,leading to a decrease in the efficiency of recovering on-site biological evidence DNA using the silicon bead method.

Objective To systematically analyze the literature on ABO-incompatible(ABOi)organ transplantation and explore the research hotspots and trends in this field.Methods CiteSpace software was used for visual analysis of ABOi organ transplantation literature collected from the China National Knowledge Infrastructure,VIP web,Wanfang Data,and the Web of Science Core Collection database from January 1,2013 to December 31,2023 after cleaning,including the volume of literature published,authors,countries,institution and keywords.Results A total of 588 valid foreign-language author publications and 85 valid Chinese-language author publications were included.Since 2021,the volume of foreign literature publications has shown a downward trend,while the volume of domestic literature published has generally shown a upward trend.The top two core Chinese authors are Wang Yi and Zhu Zhijun;the top three core authors in foreign literature are Nakatani Tatsuya,Tanabe Kazunari,and Uchida Junji.The most active institution in China is Huazhong University of Science and Technology,followed by Zhejiang University and Sichuan University,with relatively insufficient closeness in cooperation between related institutions.The institutions with the most publications abroad are Ulsan University,Seoul National University and Tokyo Women's Medical University in Japan.The top three countries in English-language literature publications are Japan,Republic Korea,and the United States,and China ranked 5th.Keyword cluster analysis shows that the research focus of at home and abroad is mainly on nine topic clusters including ABOi organ transplantation,cryoprecipitation,kidney transplantation,liver transplantation,blood type antigen detection technology and post-transplant complications.Conclusions At present,The research in the field of ABOi organ transplantation is mainly concentrated on kidney transplantation and liver transplantation,showing an overall positive development trend.In the future,it is expected to further promote development of this field by strengthening international cooperation,expanding research investment and promoting the application of advanced technologies.

Neoadjuvant therapy for locally advanced colorectal cancer has made great progress in the past 20 years, but there are still limitations such as side effects, organ dysfunction and unsatisfactory control of metastasis. In recent years, with the improvement of surgical techniques and further development of molecular research, how to further improve local control, reduce distant metastasis, and even avoid surgery according to clinical remission to achieve organ preservation, is the current demand and research goal. With the advancement of molecular research, colorectal cancer has different treatment strategies based on microsatellite status. For patients with microsatellite instability locally advanced colorectal cancer, immune checkpoint inhibitor therapy significantly increased the pathologic complete response rate, reduced the incidence of adverse events and improved organ function compared with conventional chemoradiotherapy. For patients with microsatellite stable locally advanced colon cancer, neoadjuvant therapy is still in the exploratory stage. The standard of care is surgery combined with perioperative chemotherapy. For microsatellite stable locally advanced rectal cancer, the complete response rate is improved by enhancing neoadjuvant therapy, which helps to preserve organs. On the other hand, selective radiotherapy preserves organ function and improves quality of life. This article reviews the neoadjuvant treatment strategies for locally advanced colorectal cancer based on organ-sparing strategies.

Neoadjuvant therapy for locally advanced colorectal cancer has made great progress in the past 20 years, but there are still limitations such as side effects, organ dysfunction and unsatisfactory control of metastasis. In recent years, with the improvement of surgical techniques and further development of molecular research, how to further improve local control, reduce distant metastasis, and even avoid surgery according to clinical remission to achieve organ preservation, is the current demand and research goal. With the advancement of molecular research, colorectal cancer has different treatment strategies based on microsatellite status. For patients with microsatellite instability locally advanced colorectal cancer, immune checkpoint inhibitor therapy significantly increased the pathologic complete response rate, reduced the incidence of adverse events and improved organ function compared with conventional chemoradiotherapy. For patients with microsatellite stable locally advanced colon cancer, neoadjuvant therapy is still in the exploratory stage. The standard of care is surgery combined with perioperative chemotherapy. For microsatellite stable locally advanced rectal cancer, the complete response rate is improved by enhancing neoadjuvant therapy, which helps to preserve organs. On the other hand, selective radiotherapy preserves organ function and improves quality of life. This article reviews the neoadjuvant treatment strategies for locally advanced colorectal cancer based on organ-sparing strategies.