The connotation of the "four-dimensional pivot-earth" qi transformation mode is a dialectical system of the ascending and descending of yin-yang qi movement， which presented as "the middle Jiao showing earth qi mediating， the left wheel showing water and wood ascending， and the right wheel showing fire and metal converting and descending". Based on this dialectical thinking， it is believed that the core pathogenesis of myasthenia gravis is deficiency of center qi and transportation failure to pivot-earth； the middle-stage characteristics of the disease progression are the loss of mediation of the central qi， resulting in water coldness and wood constraint， and clear yang failing to ascend； the final outcome of this disease is the loss of astringeing of lung metal and qi sinking. The treatment should be based on the rule of qi movement， so for the start-stage， Buzhong Yiqi Decoction （补中益气汤） should be used as the basis to nourish the earth and consolidate the root， and restrengthen the middle qi； for the middle-stage， herbs like Yingyanghuo （Epimedium brevicornu Maxim.）， Bajitian （Morinda officinalis How） could be combined to warm the water and soothe the wood， raise yang and boost qi； for the final stage， plus Sini Decoction （四逆汤） to astringe metal to stop collapse， and powerfully supplement original qi. All these medicinals can promote pivot-earth re-transportation， four-dimensional transformation， and regular circulation of qi movement， so as to provide thoughts for improving the clinical effectiveness of myasthenia gravis.

Objective To explore the advantages of indocyanine green clearance rate at 15 min(ICG-R15)combined with three-dimensional image reconstruction technology in preoperativ evaluation of liver cancer,as well as its impact on the efficacy of liver resection surgery.Methods The data of the patients with liver cancer undergoing preoperative three-dimensional image reconstruction evaluation(experimental group,n=65)and traditional CT evaluation(control group,n=70)in the Jining Municipal First People's Hospital from January 2018 to January 2021 were retrospectively analyzed.All patients performed the ICG-R15 test be-fore operation.In the experimental group,45 cases adopted laparotomy and 20 cases adopted laparoscopic sur-gery,which in the control group had 50 cases and 20 cases,respectively.The data of preoperative laboratory tests,intraoperative related indicators and postoperative laboratory tests were collected in the two groups.The influences between the two kinds of evaluation modes on the effects of laparotomy and laparoscopic surgery in liver cancer were compared.Results In laparotomy,compared with the control group,the operation time and postoperative drainage tube extraction time in the experimental group were significantly shortened,the intrao-perative bleeding volume was significantly decreased,the incidence rate of postoperative complications,direct bilirubin and AST levers on 7 d after operation were significantly decreased(P＜0.05);there were no statis-tically significant differences in the intraoperative blood transfusion rate,postoperative hospitalization dura-tion,levels of total bilirubin,ALT and albumin and prothrombin time on 7 d after operation between the two groups(P＞0.05).In laparoscopic surgery,compared with the control group,the postoperative hospitalization duration and postoperative drainage tube extraction time in the experimental group were significantly short-ened,the levels of AST and ALT on 7 d after operation were significantly decreased(P＜0.05);there was no statistically significant difference in the other observation indicators between the two groups(P＞0.05);in the control group,3 cases were converted to laparotomy due to inability to excision during laparoscopic explo-ration.Compared with the control group,the accuracy rate of preoperative evaluation of the number of liver tumors and Couinaud segmentation localization(96.9％vs.85.7％)and preoperative evaluation of liver vas-cular variation(100.0％vs.53.8％)were increased in the experimental group,the percentage of the patients with actual resection range greater than preoperative prediction range was lower(7.7％vs.20.0％),and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the accu-racy of preoperative evaluation of portal vein invasion between the two groups(P＞0.05).Conclusion ICG-R15 combined with three dimensional reconstruction technology in preoperatively assessing liver cancer has more advantages compared with combined traditional CT,moreover which is conducive to reduce intraoperative bleeding,shorten operation time and has the positive effect on the patients'prognosis.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Cbf-14 is a novel antimicrobial peptide composed of 14 amino acids.An optimized reversed phase high-performance liquid chromatographic method with electrospray-ionization quadrupole time-of-flight mass spectrometer (LC-ESI-QTOF/MS) method was developed for separation, identification and characterization of structurally related peptide impurities in Cbf-14 gel.Chromatographic separation was carried out on an Agilent ZORBAX SB-Phenyl column (150 mm × 4.6 mm, 3.5 μm), with acetonitrile-20 mmol/L ammonium formate buffer (adjusted to pH 3.0 with formic acid) as eluent using gradient elution.Under the established conditions, Cbf-14 and its structurally related peptide impurities were well separated; and a total of 24 impurities were detected and identified, of which 5 were impurities in the preparation manufacturing process and 19 were stressed products.Based on high resolution mass spectrometry analysis, the origins and formation mechanisms of these impurities were located.The obtained results are useful for the establishment of the manufacturing process, storage condition and quality control of Cbf-14 gel.

In this study, the distribution of five Alzheimer's disease (AD)-related single nucleotide polymorphisms (SNPs) in the Han population was examined in combination with the evaluation of clinical cognition and brain pathological analysis. The associations among SNPs, clinical daily cognitive states, and postmortem neuropathological changes were analyzed in 110 human brains from the Chinese Academy of Medical Sciences/Peking Union Medical College (CAMS/PUMC) Human Brain Bank. APOE ε4 (OR = 4.482, P = 0.004), the RS2305421 GG genotype (adjusted OR = 4.397, P = 0.015), and the RS10498633 GT genotype (adjusted OR = 2.375, P = 0.028) were associated with a higher score on the ABC (Aβ plaque score, Braak NFT stage, and CERAD neuritic plaque score) dementia scale. These results advance our understanding of the pathogenesis of AD, the relationship between pathological diagnosis and clinical diagnosis, and the SNPs in the Han population for future research.
ADAM10 Protein ; genetics ; Adult ; Aged ; Aged, 80 and over ; Alzheimer Disease ; genetics ; pathology ; Amyloid Precursor Protein Secretases ; genetics ; Antiporters ; genetics ; Apolipoprotein E4 ; genetics ; Asian Continental Ancestry Group ; genetics ; Brain ; pathology ; Cognitive Dysfunction ; genetics ; pathology ; Female ; Genetic Predisposition to Disease ; Humans ; Male ; Membrane Proteins ; genetics ; Middle Aged ; Polymorphism, Single Nucleotide

Brain ; pathology ; China ; Humans ; Organ Preservation ; standards ; Tissue Banks ; ethics ; standards

The antibacterial activity and mechanism of the antimicrobial peptide mutant Cbf-14-2 against NDM-1 carrying recombinant bacteria (E.coli BL21 (DE3)-NDM-1) was investigated in this study.The minimum inhibitory concentration (MIC),minimum bactericidal concentration (MBC) and killing curves (KCs) in vitro were determined by the broth microdilution method.Mice septicemia model was established by interaperitotoneal injection of E.coli BL21 (DE3)-NDM-1 to evaluate the antibacterial activity of this peptide in vivo.Results showed that Cbf-14-2 exhibited a potent antibacterial activity with MIC of 16 μg/mL and killed almost all recombinant bacteria within 120 min.Meanwhile,it significantly improved the survival rate of infected mice up to 70％ with the decreasing of bacterial load in mice lung,liver,spleen and kidney.This powerful clearance ability of Cbf-14-2 against bacteria mainly related to its enhanced membrane penetration ability through neutralizing the negative charges and disrupting the integrity of the bacterial cell membrane.Therefore,Cbf-14-2 is expected to be a potential antimicrobial agent for the treatment of infection induced by multi-drug resistant bacteria,especially for the NDM-1carrying bacteria.

Objective To develop a machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding and to evaluate its effectiveness of field application,so as to provide a novel Oncomelania hupensis snail control technique in the large?scale marshlands. Methods The machine simultaneously integrating mechanized environmental clean?ing and automatic mollusciciding,which was suitable for use in complex marshland areas,was developed according to the mech?anization and automation principles,and was used for O. hupensis snail control in the marshland. The effect of the machine on environmental cleaning and plough was evaluated,and the distribution of living snails was observed at various soil layers follow? ing plough. The snail control effects of plough alone and plough followed by mollusciciding were compared. Results The ma?chine could simultaneously complete the procedures of getting vegetation down and cut vegetation into pieces,plough and snail control by spraying niclosamide. After plough,the constituent ratios of living snails were 36.31% ,25.60% ,22.62% and 15.48% in the soil layers at depths of 0-5,6-10,11-15 cm and 16-20 cm respectively,and 61.91% living snails were found in the 0-10 cm soil layers. Seven and fifteen days after the experiment,the mortality rates of snails were 9.38% and 8.29% in the plough alone group,and 63.04% and 80.70% in the plough + mollusciciding group respectively(c27 d = 42.74,c215 d =155.56,both P values < 0.01). Thirty days after the experiment,the densities of snails were 3.02 snails/0.1 m2 and 0.53 snails/0.1 m2 in the soil surface of the plough alone group and the plough + mollusciciding group,which decreased by 64.92% and 93.60% ,respectively,and the decrease rate of snail density was approximately 30% higher in the plough + mollusciciding group than that in the plough alone group. Conclusions The machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding achieves the integration of mechanical environmental cleaning and automatic niclosamide spraying in the complex marshland areas,which provides a novel technique of field snail control in the large?scale setting in Chi?na.