OBJECTIVE To establish the fingerprint of Pinghuo tea standard decoction and a method for determination of multi-component to clarify the transfer relationship of quantities and quality from pieces and standard decoction. METHODS Fifteen batches of Pinghuo tea standard decoction were prepared and the extract rate was determined； the fingerprint of the preparation was established by using high-performance liquid chromatography（HPLC）； the similarity evaluation and the determination of common peaks were performed， and chemometric analysis was performed； the same method was used to determine the content of indicator components and the transfer rate was calculated. The chromatographic column was Venusil C18 column with mobile phase consisted of acetonitrile-0.1% phosphoric acid solution （gradient elution）； the column temperature was 30 ℃， and the detection wavelengths were 238 nm （0-37 min， 85-102 min） and 330 nm （37-85 min） at a flow rate of 1.0 mL/min with an injection volume of 10 μL. RESULTS The similarity of HPLC fingerprints for 15 batches of Pinghuo tea standard decoction was not lower than 0.968. A total of 24 common peaks were calibrated and 9 peaks were recognized， which were as follows neochlorogenic acid （peak 3）， chlorogenic acid （peak 6）， geniposide （peak 9）， glycyrrhizin （peak 10）， galuteolin （peak 11）， isochlorogenic acid A （peak 14）， luteolin （peak 21）， kaempferol （peak 23） and glycyrrhizic acid （peak 24）. Cluster analysis， principal component analysis and orthogonal partial least squares discriminant analysis showed consistent results， all of which could classify the 15 batches of samples into three categories. The linear range of indicator components in 15 batches of Pinghuo tea standard decoction， such as geniposide， luteolin， isochlorogenic acid A， glycyrrhizin， and glycyrrhizic acid， were 0.020 580-0.411 600， 0.001 617-0.080 850， 0.006 076-0.607 600， 0.005 125-0.071 740， and 0.017 288-0.432 200 mg/mL， respectively； RSDs of precision， repeatability， stability and recovery rate tests were all not higher than 4% （n＝6）. The mass fractions ranged 3.227 9-10.002 2， 0.297 4-0.554 6， 3.350 1-6.159 6， 0.720 6-1.073 3， 2.003 1-3.030 1 mg/g； transfer rates from the pieces and standard decoction were 19.762 8%-35.840 5%， 12.123 3%-21.254 0%， 46.097 2%-82.869 4%， 58.708 8%-91.629 6%， 39.114 3%-63.710 6%. The transfer rates of the extract from 15 batches of Pinghuo tea standard decoction ranged from 61.15%-84.68%. CONCLUSIONS Established HPLC fingerprint and content determination methods in this study are simple and accurate， which can provide reference for the quantitative value transfer study， quality control， clinical application and the development of subsequent formulations of Pinghuo tea standard decoction.

Objective To investigate the correlation between spread through air space (STAS) of sub-centimeter non-small cell lung cancer and clinical characteristics and radiological features, constructing a nomogram risk prediction model for STAS to provide a reference for the preoperative planning of sub-centimeter non-small cell lung cancer patients. Methods The data of patients with sub-centimeter non-small cell lung cancer who underwent surgical treatment in Nanjing Drum Tower Hospital from January 2022 to October 2023 were retrospectively collected. According to the pathological diagnosis of whether the tumor was accompanied with STAS, they were divided into a STAS positive group and a STAS negative group. The clinical and radiological data of the two groups were collected for univariate logistic regression analysis, and the variables with statistical differences were included in the multivariate analysis. Finally, independent risk factors for STAS were screened out and a nomogram model was constructed. The sensitivity and specificity were calculated based on the Youden index, and area under the curve (AUC), calibration plots and decision curve analysis (DCA) were used to evaluate the performance of the model. Results A total of 112 patients were collected, which included 17 patients in the STAS positive group, consisting of 11 males and 6 females, with a mean age of (59.0±10.3) years. The STAS negative group included 95 patients, with 30 males and 65 females, and a mean age of (56.8±10.3) years. Univariate logistic regression analysis showed that male, anti-GAGE7 antibody positive, mean CT value and spiculation were associated with the occurrence of STAS (P＜0.05). Multivariate regression analysis showed that associations between STAS and male (OR=5.974, 95%CI 1.495 to 23.872), anti-GAGE7 antibody positive (OR=11.760, 95%CI 1.619 to 85.408) and mean CT value (OR=1.008, 95%CI 1.004 to 1.013) were still significant (P＜0.05), while the association between STAS and spiculation was not significant anymore (P=0.438). Based on the above three independent predictors, a nomogram model of STAS in sub-centimeter non-small cell lung cancer was constructed. The AUC value of the model was 0.890, the sensitivity was 76.5%, and the specificity was 91.6%. The calibration curve was well fitted, suggesting that the model had a good prediction efficiency for STAS. The DCA plot showed that the model had a good clinically utility. Conclusion Male, anti-GAGE7 antibody positive and mean CT value are independent predictors of STAS positivity of sub-centimeter non-small cell lung cancer, and the nomogram model established in this study has a good predictive value and provides reference for preoperative planning of patients.

BACKGROUND:Studies have shown that there is a close association between spinal cord injury and ferroptosis,and that tetramethylpyrazine has the function of regulating redox reactions. OBJECTIVE:To investigate the regulatory effect of tetramethylpyrazine on ferroptosis in rats with spinal cord injury and its mechanism. METHODS:Thirty-six female specific pathogen-free Sprague-Dawley rats were randomly divided into sham-operated group,model group and tetramethylpyrazine group,with 12 rats in each group.Animal models of spinal cord injury were established using the modified Allen's method in the latter two groups.No treatment was given in the sham-operated group,while rats in the model and tetramethylpyrazine groups were given intraperitoneal injection of normal saline and tetramethylpyrazine solution,once a day,for 28 days. RESULTS AND CONCLUSION:The Basso,Beattie&Bresnahan Locomotor Rating Scale score in the tetramethylpyrazine group was lower than that in the sham-operated group but higher than that in the model group after 14,21,and 28 days of treatment(P＜0.05).After 28 days of treatment,hematoxylin-eosin staining showed that in the model group,the spinal cord tissue of rats showed cavity formation,necrotic tissue and inflammatory infiltration with fibrous tissue formation;in the tetramethylpyrazine group,the area of spinal cord tissue defects was smaller,and inflammatory infiltration and fibrous tissue formation were less than those in the model group.After 28 days of treatment,Prussian blue staining showed that a large amount of iron deposition was seen in the spinal cord tissue of rats in the model group,and less iron deposition was seen in the spinal cord tissue of rats in the tetramethylpyrazine group than in the model group.After 28 days of treatment,the levels of glutathione and superoxide dismutase in the rat spinal cord tissue were decreased(P＜0.05)and the level of malondialdehyde was increased in the model group compared with the sham-operated group(P＜0.05);the levels of glutathione and superoxide dismutase in the rat spinal cord tissue were increased(P＜0.05)and the level of malondialdehyde was decreased in the tetramethylpyrazine group compared with the model group(P＜0.05).After 28 days of treatment,qRT-PCR and western blot assay showed that the mRNA and protein levels of glutathione peroxidase 4,ferritin heavy chain,and ferroportin in the rat spinal cord tissue in the model group were decreased compared with those in the sham-operated group(P＜0.05),while the mRNA and protein levels of glutathione peroxidase 4,ferritin heavy chain,and ferroportin in the rat spinal cord tissue in the tetramethylpyrazine group were increased compared with those in the model group(P＜0.05).Immunofluorescence staining showed that after 28 days of treatment,the neuronal nuclei positive staining in the spinal cord of rats was the most in the sham-operated group and the least in the model group.To conclude,tetramethylpyrazine can improve motor function and play a neuroprotective role in rats with spinal cord injury by regulating ferroptosis.

High flow nasal cannula（HFNC）is a novel oxygen therapy developed in recent years，and has been successfully used in pediatric diseases such as bronchiolitis and pneumonia.Although there has been a lack of clinical application guidelines in pediatrics，it has been increasingly applied to the treatment of exacerbations of bronchial asthma.This review focused on efficacy，application timing，complications and parameters adjustment of HFNC in children with asthma exacerbation，so as to further guide the clinical use.

Traditional spine surgery frequently encounters difficulties with inadequate surgical visualization and high risk.Robot-assisted spine surgery is quickly evolving,particularly in screw placement,providing three-dimensional imaging and precise positioning to optimize the surgical process. Robot-assisted systems can increase surgical precision,reduce operating time and radiation exposure,and improve patient prognosis. They also have strong image recognition and analysis capabilities,reducing intraoperative instability and fatigue and allowing remote manipulation.While robot-assisted spine surgery has demonstrated noteworthy advantages in regards to screw placement accuracy and reduced radiation exposure,its effects on operative time remain subject to debate,with cost being a significant hindrance to widespread implementation.Long-term clinical validation and studies of outcomes are necessary for the extensive use of robotic-assisted spine surgery.Future priorities include the enhancement of surgical navigation and imaging,integration of artificial intelligence,improvement of telesurgical capabilities,expansion of robotic functionality,and the development of policy guidance and clinical guidelines to accompany the growth of technology.Robot-assisted spine surgery enhances accuracy and safety,and is anticipated to assume an increasingly crucial role in spine surgery as technology advances and becomes more widely available.

Objective:To investigate the causal relationship between intestinal flora and benign biliary diseases by genome-wide Mendelian randomization.Methods:This is a retrospective observational study. The data from the genome-wide association study of the gut microbiota from 18 340 samples from the MiBioGen consortium were selected as the exposure group,and the data from the genome-wide association study of biliary tract diseases were obtained from the FinnGen consortium R8 as the outcome group. There were 1 491 cases of primary sclerosing cholangitis,32 894 cases of cholelithiasis,3 770 cases of acalculous cholecystitis,and 34 461 cases of cholecystitis. Single nucleotide polymorphisms were screened as instrumental variables,and the Mendelian randomization method was used to infer the causal relationship between exposures and outcomes. The inverse variance weighting method (IVW) was used as the main basis, supplemented by heterogeneity,pleiotropy and sensitivity tests.Results:Coprococcus 2 was associated with a reduced risk of cholelithiasis (IVW OR=0.88,95% CI:0.80 to 0.97, P=0.012) and cholecystitis (IVW OR=0.88,95% CI:0.80 to 0.97, P=0.011). Coprococcus 3 was associated with cholelithiasis (IVW OR=1.15,95% CI:1.02 to 1.30, P=0.019) and acalculous cholecystitis(IVW OR=1.48, 95% CI: 1.08 to 2.04, P=0.016) and cholecystitis (IVW OR=1.17, 95% CI: 1.02 to 1.33, P=0.020). Peptococcus was associated with an increased risk of cholelithiasis (IVW OR=1.08, 95% CI:1.02 to 1.13, P=0.005) and cholecystitis (IVW CI=1.07, 95% CI:1.02 to 1.13, P=0.010). Clostridiumsensustricto 1 was associated with an increased risk of cholelithiasis (IVW OR=1.16,95% CI:1.02 to 1.31, P=0.020) and cholecystitis (IVW OR=1.16, 95% CI:1.03 to 1.30, P=0.015). Eubacterium hallii was associated with an increased risk of primary sclerosing cholangitis (IVW OR=1.43, 95% CI: 1.03 to 1.99, P=0.033). Eubacterium ruminantium (IVW OR=0.87, 95% CI: 0.76 to 1.00, P=0.043) and Methanobrevibacter (IVW OR=0.81, 95% CI: 0.68 to 0.98, P=0.027) were associated with a reduced risk of acalculous cholecystitis. Conclusions:Eight intestinal bacterial genera maybe play pathogenic roles in benign biliary diseases. Eubacterium hallii can increase the risk of primary sclerosing cholangitis. Peptococcus and Clostridiumsensustricto 1 can increase the risk of cholelithiasis and generalized cholecystitis. Coprococcus 3 have multiple correlations with biliary stones and inflammation.

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

Traditional spine surgery frequently encounters difficulties with inadequate surgical visualization and high risk.Robot-assisted spine surgery is quickly evolving,particularly in screw placement,providing three-dimensional imaging and precise positioning to optimize the surgical process. Robot-assisted systems can increase surgical precision,reduce operating time and radiation exposure,and improve patient prognosis. They also have strong image recognition and analysis capabilities,reducing intraoperative instability and fatigue and allowing remote manipulation.While robot-assisted spine surgery has demonstrated noteworthy advantages in regards to screw placement accuracy and reduced radiation exposure,its effects on operative time remain subject to debate,with cost being a significant hindrance to widespread implementation.Long-term clinical validation and studies of outcomes are necessary for the extensive use of robotic-assisted spine surgery.Future priorities include the enhancement of surgical navigation and imaging,integration of artificial intelligence,improvement of telesurgical capabilities,expansion of robotic functionality,and the development of policy guidance and clinical guidelines to accompany the growth of technology.Robot-assisted spine surgery enhances accuracy and safety,and is anticipated to assume an increasingly crucial role in spine surgery as technology advances and becomes more widely available.

Objective:To investigate the causal relationship between intestinal flora and benign biliary diseases by genome-wide Mendelian randomization.Methods:This is a retrospective observational study. The data from the genome-wide association study of the gut microbiota from 18 340 samples from the MiBioGen consortium were selected as the exposure group,and the data from the genome-wide association study of biliary tract diseases were obtained from the FinnGen consortium R8 as the outcome group. There were 1 491 cases of primary sclerosing cholangitis,32 894 cases of cholelithiasis,3 770 cases of acalculous cholecystitis,and 34 461 cases of cholecystitis. Single nucleotide polymorphisms were screened as instrumental variables,and the Mendelian randomization method was used to infer the causal relationship between exposures and outcomes. The inverse variance weighting method (IVW) was used as the main basis, supplemented by heterogeneity,pleiotropy and sensitivity tests.Results:Coprococcus 2 was associated with a reduced risk of cholelithiasis (IVW OR=0.88,95% CI:0.80 to 0.97, P=0.012) and cholecystitis (IVW OR=0.88,95% CI:0.80 to 0.97, P=0.011). Coprococcus 3 was associated with cholelithiasis (IVW OR=1.15,95% CI:1.02 to 1.30, P=0.019) and acalculous cholecystitis(IVW OR=1.48, 95% CI: 1.08 to 2.04, P=0.016) and cholecystitis (IVW OR=1.17, 95% CI: 1.02 to 1.33, P=0.020). Peptococcus was associated with an increased risk of cholelithiasis (IVW OR=1.08, 95% CI:1.02 to 1.13, P=0.005) and cholecystitis (IVW CI=1.07, 95% CI:1.02 to 1.13, P=0.010). Clostridiumsensustricto 1 was associated with an increased risk of cholelithiasis (IVW OR=1.16,95% CI:1.02 to 1.31, P=0.020) and cholecystitis (IVW OR=1.16, 95% CI:1.03 to 1.30, P=0.015). Eubacterium hallii was associated with an increased risk of primary sclerosing cholangitis (IVW OR=1.43, 95% CI: 1.03 to 1.99, P=0.033). Eubacterium ruminantium (IVW OR=0.87, 95% CI: 0.76 to 1.00, P=0.043) and Methanobrevibacter (IVW OR=0.81, 95% CI: 0.68 to 0.98, P=0.027) were associated with a reduced risk of acalculous cholecystitis. Conclusions:Eight intestinal bacterial genera maybe play pathogenic roles in benign biliary diseases. Eubacterium hallii can increase the risk of primary sclerosing cholangitis. Peptococcus and Clostridiumsensustricto 1 can increase the risk of cholelithiasis and generalized cholecystitis. Coprococcus 3 have multiple correlations with biliary stones and inflammation.

Objective:To assess the effectiveness and viability of 5G-enabled robot-assisted thoracolumbar internal fixation surgery, scrutinizing its benefits and potential limitations in a clinical setting.Methods:This retrospective case series study analyzed 61 patients who underwent robot-assisted remote thoracolumbar internal fixation surgery between April and December 2021. The orthopaedic robotic telesurgery system, centered at Beijing Jishuitan Hospital and utilizing 5G technology for network transmission, was used to assist in screw placement. The surgeries, distributed across ten hospitals and executed over an average distance of 1 617 km (maximum exceeding 3 000 km), were appraised by examining the accuracy of screw placement, intraoperative communication efficacy, complication rates, among other metrics, and benchmarked against traditional local procedures.Results:Telesurgery was completed successfully in all patients, averaging 92±32 minutes per operation. Out of 354 screws placed, 89.8% were positioned perfectly and 97.5% were deemed clinically acceptable. The 61 patients, followed-up for an average of 18.9±1.9 months, exhibited significant postoperative improvement in pain. The preoperative visual analogue scale (VAS) pain score was 5.74±1.30 and improved to 2.30±0.90 at discharge, a statistically significant difference ( t=11.002, P<0.001). 6 patients with thoracolumbar degenerative spine disease showed significant relief of claudication and pain symptoms postoperatively. 55 patients with thoracolumbar spine fractures had a preoperative height ratio of 62.78%±12.60% at the anterior margin of the injured vertebrae, which recovered to 85.36%±8.35% postoperatively, a statistically significant difference ( t=16.977, P<0.001). All fractures were healed at final follow-up. No perioperative complications, such as vascular or nerve injuries or infections, occurred. Additionally, there were no complications related to the use of the robot. The 5G network ensured stable transmission of robotic control signals, images, and audio signals during the procedure, with no signal delays or communication failures observed. The perfect rate (90.2% vs. 93.8%, χ 2=0.169, P=0.681) and clinical acceptability rate (99.0% vs. 100.0%, P=1.000) of remote versus local robotic-assisted screw placement in participating hospital 1 (Shantou Xin Sheng Orthopaedic Hospital) were similar. The perfect rate (87.0% vs. 85.4%, χ 2=0.075, P=0.784) and clinical acceptability rate (100.0% vs. 96.6%, χ 2=0.580, P=0.446) of remote versus local robotic-assisted screw placement in participating hospital 2 (Guizhou Provincial People's Hospital) were similar. Conclusion:5G technology enhances the remote application of robotic thoracolumbar surgery without compromising patient safety or outcome quality. It underscores the potential for broader adoption of surgical robotics, aiding in the standardization of medical practices across China, boosting healthcare efficiency, and aligning with the Healthy China strategy.