Diarrhea-predominant irritable bowel syndrome （IBS-D） is a common digestive system disease with high prevalence and recurrence rates for years， high treatment costs， and serious impacts on patients' quality of life and economic burden. Therefore， it is important to explore new and safe treatment methods. The pathogenesis of IBS-D is complex， in which the gut-brain axis is a key factor. The gut-brain axis， a bidirectional signaling pathway connecting the gastrointestinal tract and the central nervous system， regulates gastrointestinal motility， secretion， and immune responses， playing a key role in the occurrence and development of IBS-D. Up to now， antidiarrheal agents， probiotics， and neurotransmitter modulators are the main methods for the clinical treatment of IBS-D. Although they can partially curb the progression of this disease， the therapeutic effects remain to be improved. Studies have confirmed that traditional Chinese medicine （TCM） has significant advantages in the treatment of IBS-D since it can regulate the gut-brain axis via multiple pathways and targets to improve the gastrointestinal motility and strengthen immune defenses. However， there is a lack of systematic reviews on the regulation of the gut-brain axis by TCM in the treatment of IBS-D. Based on the review of IBS-D-related articles published in recent years， this paper systematically summarized the relationship between the gut-brain axis and IBS-D and the role of TCM in the treatment， providing new ideas for the treatment of IBS-D.

Acute pancreatitis （AP） is one of the most clinically common acute digestive disorders characterized by quick onset，rapid progression，severe condition，and high mortality. If the disease is not timely intervened in the early stage，it can develop into severe AP in the later stage，which damages the long-term quality of life and brings serious economic burden to patients and their families. However， the pathogenesis of this disease is complex and has not been fully explained. The generation and development of AP is closely related to many signaling pathways. Among them，Toll-like receptor 4（TLR4），as a transmembrane signal transduction receptor，can mediate immune response and inflammatory response，and play a key role in the occurrence and development of AP. Traditional Chinese medicine（TCM）can regulate the TLR4 signaling pathway with multiple targets，multiple effects，and multiple administration methods to inhibit inflammatory response，and effectively intervene in the progression of AP， which has gradually become a new craze for preventing and treating AP. Many studies have shown that TCM has obvious advantages in the prevention and treatment of AP. It can effectively treat AP by regulating TLR4 signaling pathway，strengthening immune resistance and defense，and inhibiting inflammatory response. Despite of the research progress，there is still a lack of comprehensive review on TCM regulation of TLR4 signaling pathway in the treatment of AP. Therefore，the literature on TCM regulation of TLR4 signaling pathway published in recent years was systematically reviewed and elaborated，aiming to provide new ideas for the treatment of AP and further drug development.

BACKGROUND:MRI is important for the diagnosis of early knee osteoarthritis.MRI image recognition and intelligent segmentation of knee osteoarthritis using deep learning method is a hot topic in image diagnosis of artificial intelligence. OBJECTIVE:Through deep learning of MRI images of knee osteoarthritis,the segmentation of femur,tibia,patella,cartilage,meniscus,ligaments,muscles and effusion of knee can be automatically divided,and then volume of knee fluid and muscle content were measured. METHODS:100 normal knee joints and 100 knee osteoarthritis patients were selected and randomly divided into training dataset(n=160),validation dataset(n=20),and test dataset(n=20)according to the ratio of 8:1:1.The Coarse-to-Fine sequential training method was used to train the 3D-UNET network deep learning model.A Coarse MRI segmentation model of the knee sagittal plane was trained first,and the rough segmentation results were used as a mask,and then the fine segmentation model was trained.The T1WI and T2WI images of the sagittal surface of the knee joint and the marking files of each structure were input,and DeepLab v3 was used to segment bone,cartilage,ligament,meniscus,muscle,and effusion of knee,and 3D reconstruction was finally displayed and automatic measurement results(muscle content and volume of knee fluid)were displayed to complete the deep learning application program.The MRI data of 26 normal subjects and 38 patients with knee osteoarthritis were screened for validation. RESULTS AND CONCLUSION:(1)The 26 normal subjects were selected,including 13 females and 13 males,with a mean age of(34.88±11.75)years old.The mean muscle content of the knee joint was(1 051 322.94±2 007 249.00)mL,the mean median was 631 165.21 mL,and the mean volume of effusion was(291.85±559.59)mL.The mean median was 0 mL.(2)There were 38 patients with knee osteoarthritis,including 30 females and 8 males.The mean age was(68.53±9.87)years old.The mean muscle content was(782 409.18±331 392.56)mL,the mean median was 689 105.66 mL,and the mean volume of effusion was(1 625.23±5 014.03)mL.The mean median was 178.72 mL.(3)There was no significant difference in muscle content between normal people and knee osteoarthritis patients.The volume of effusion in patients with knee osteoarthritis was higher than that in normal subjects,and the difference was significant(P<0.05).(4)It is indicated that the intelligent segmentation of MRI images by deep learning can discard the defects of manual segmentation in the past.The more accuracy evaluation of knee osteoarthritis was necessary,and the image segmentation was processed more precisely in the future to improve the accuracy of the results.

Objective To compare the association of the incidence and mortality of leukemia and the human development index(HDI)in different countries or regions in 2022,and the trend of leukemia incidence and mortality with age in countries with different HDI levels.Methods GLOBOCAN 2022 data related to leukemia incidence and mortality in different countries or regions worldwide and HDI were evaluated by Pearson correlation analysis and Kruskal-Wallis test.The incidence and mortality rates of each age and the age change trend were analyzed using the Joinpoint Regression model.Results Age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and mortality to incidence ratio(M/I)were statistically significantly different among the four groups of HDI countries(P<0.001).HDI was positively correlated with ASIR and ASMR and negatively correlated with M/I.Among all ages,ASIR and ASMR of leukemia of the four groups had similar trends with age,and the risk of leukemia was high at ages less than 15 and more than 40.The incidence of leukemia in all age groups in China differed from those in other countries with high HDI,while the mortality rate was lower than those in other countries with high HDI.Conclusion Countries or regions with higher HDI have higher ASIR and ASMR and lower M/I because of their better medical condition.

Objective:To analyze the effect of donepezil hydrochloride combined with memantine on cognitive function in patients with Alzheimer's disease (AD).Methods:A randomized controlled trial was conducted among 90 patients with AD who were treated at the Zaozhuang Mental Health Center from January 2021 to March 2023. The patients were divided into a donepezil group and a combination group using a random number table grouping method, with 45 patients in each group. The donepezil hydrochloride group received only oral administration of donepezil hydrochloride tablets, while the combination group received oral administration of both donepezil hydrochloride tablets and memantine tablets. The two groups were continuously treated for 12 weeks. Before and after treatment, the Activities of Daily Living scale (ADL) score, the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) score, the Mini-Mental State Scale (MMSE) score, and biochemical indicators (homocysteine, neuron-specific enolase, and S100 β) were compared between the two groups. Adverse drug reactions were observed in each group.Results:After treatment, the ADL, BEHAVE-AD, and MMSE scores in the combination group were (78.9 ± 6.1) points, (5.2 ± 0.5) points, and (22.8 ± 2.2) points, respectively, and they were (65.2 ± 5.9) points, (9.6 ± 0.9) points, and (19.4 ± 2.4) points, respectively, in the donepezil hydrochloride group. The ADL and MMSE scores in the combination group were significantly higher than those in the donepezil hydrochloride group ( t = 10.83, 7.01, both P < 0.001). The BEHAVE-AD score in the combination group was significantly lower than that in the donepezil hydrochloride group ( t = -28.67, P < 0.001). After treatment, serum levels of homocysteine, neuron-specific enolase, and S100 β in the combination group were (17.8 ± 3.6) μmol/L, (16.8 ± 2.7) μg/L, and (17.4 ± 7.5) μg/L, respectively, which were significantly lower than (21.5 ± 3.3) μmol/L, (20.4 ± 3.7) μg/L, and (23.5 ± 5.1) μg/L in the donepezil hydrochloride group ( t = -5.08, -5.27, -4.51, all P < 0.001). The incidence of adverse drug reactions in the combination group was 13.3% (6/45), which was slightly, but not significantly, higher than 8.9% (4/45) in the donepezil group ( χ2 = 0.45, P = 0.502). Conclusion:The combination of donepezil hydrochloride and memantine can effectively improve the mental and behavioral symptoms and cognitive function of patients with AD, improve daily living ability, and do not increase adverse reactions. The combined therapy has high clinical application value.

Gastroesophageal reflux disease （GERD） is a gastrointestinal motility disorder characterized by the reflux of gastric contents into the esophagus， leading to symptoms such as acid reflux and heartburn. The incidence of GERD is closely associated with psychological disorders， including anxiety and depression. The brain-gut axis， serving as a mediator of the bidirectional connection between the brain and the gastrointestinal tract， plays a crucial role in the occurrence and development of GERD with anxiety and depression. Various therapeutic approaches， including compound Chinese medicine internal therapy （such as Pingchong jiangni decoction， Tiaozhong huashi decoction， etc.）， combination therapy of internal and external Chinese medicine （such as Lianzhi xiere decoction combined with acupoint application， acupuncture at the back segment of governor vessel plus Chinese medication of soothing the liver and gallbladder， etc.）， and combination therapy of internal Chinese and western medicine （including Jianpi shugan decoction combined with rabeprazole， rabeprazole combined with Jianzhong jiangni decoction， etc.）， have been shown to regulate brain-gut peptides， intestinal flora， inflammatory factors and gastrointestinal hormones， thereby effectively alleviating GERD symptoms， anxiety and depression， and enhancing patients’ quality of life.

Objective:To construct and verify a prognosis model of nomogram for the patients with locally advanced oral squamous cell carcinoma(OSCC).Methods:7 118 clinical cases with locally advanced OSCC from 2010 to 2015 in SEER database were in-cluded and randomly divided into training set(TS)and validation set(VS)by a 7:3 ratio.In TS,univariate and multivariate Cox proportional risk models were used to screen and determine the prognostic factors of locally advanced OSCC,and a nomogram predic-tion model was constructed to predict the cancer specific survival rate(CSS)of patients in 3 and 5 years.In TS and VS,the consis-tency index(C-index)and ROC curves were used to evaluate the differentiation of the model,the calibration curves were used to eval-uate the prediction accuracy of the model,and the decision curve analysis(DC A)method was used to evaluate the clinical applicabil-ity of the model.Results:4 984 and 2 134 cases were respectively included in TS and VS.No statistical difference of the analysis in-dexes was found between the 2 sets(P＞0.05).10 risk factors affecting the prognosis of the patients with locally advanced OSCC were identified in TS,including age,sex,race,marital status,location of onset,degree of histological differentiation,T stage,N stage,with or without operation and radiotherapy(P＜0.05).In the TS and VS,the C-index of the nomogram was 0.702 and 0.704 respectively,and the AUC of the 3-year and 5-year CSS was between 0.727 and 0.736.The calibra-tion curves showed that the 3-and 5-year CSS predicted by the nomogram model was in good agreement with the actual CSS.The DCA curves showed that the clinical benefit of the nomogram was better than that of the 7th e-dition of the AJCC TNM staging system.Conclusion:The nomogram constructed in this study can accurately predict the survival rate of OSCC patients with locally advanced tumor.

Gallbladder cancer constitutes the most prevalent malignant tumor of the biliary tract. It exhibits clinical characteristics such as challenging diagnosis in early stages, aggressive invasiveness, and poor prognosis. Studies have discovered that the occurrence, development, and metastasis of malignant tumors are closely associated with the inflammatory response, and the level of systemic inflammation within the body can be reflected by peripheral blood inflammatory indicators. This review delineates the research progress on the correlation between peripheral blood inflammatory markers and the prognosis of gallbladder cancer, with the intention of providing references for the diagnosis, treatment, and prognosis evaluation of gallbladder cancer.

Objective:To evaluate the effect of combined cognitive and physical intervention on mild cogni-tive impairment(MCI)using meta-analysis.Methods:Five databases including CNKI,PubMed,Web of Science,Cochrane and Embase were retrieved.Randomized Control Trials containing the combined cognitive and physical therapies on MCI were included.Statistical analysis,including the evaluation of the effects on global cognition,memory and executive function or attention,as well as the subgroup analysis were conducted using Stata 15.0.Results:A total of 28 articles was eventually included,with 2 796 participants.Results showed that the effec-tiveness of combined intervention on global cognitive function(SMD=0.68,95％CI:0.39-0.97),memory(SMD=0.35,95％CI:0.01-0.68)as well as executive function or attention(SMD=-0.28,95％CI:-0.51--0.05)were significantly better than the control group.Subgroup analysis indicated that the effects of combined intervention on the above domains of cognitive function among the participants were affected by the intervention mode,control type,whether there were other interventions and intervention frequency.Conclusion:Combined cogni-tive and physical intervention could effectively improve mild cognitive impairment.

Objective:To understand the contamination risk, drug resistance and virulence characteristics of cooked food pathogens in Tianjin.Methods:Pathogenic bacteria were isolated and identified in cooked food sold in Tianjin from 2019 to 2021, drug susceptibility test and whole genome sequencing were conducted for the isolates, and multilocus sequence typing, drug resistance gene, phenotype and virulence gene were analyzed for the data.Results:Ten pathogenic bacteria were isolated from 245 cooked food samples collected. The ST types of 7 Salmonella strains were ST40, ST198, ST14, ST13 and ST155. The two strains of Vibrio parahaemolyticus were ST647 and ST2622 respectively. One strain of Cronobacter sakazakii was ST8 type. All the 6 isolates were drug-resistant, and 3 of them were multidrug-resistant (MDR). A total of 63 drug-resistant genes were predicted in 10 isolates. Two Salmonella strains were ampicillin-chloramphenicol-streptomycin-sulfamethoxazole-tetracycline resistant (MDR-ACSSuT), and both Salmonella strains carried gyrA double mutations (S83F, D87N) and parC mutations (S80I). Vibrio parahaemolyticus mainly carries blaCARB and tet (35) genes, while Cronobacter sakazakii carries only one resistance gene blaCSA-1. A total of 163 virulence genes were predicted from 10 isolates. Conclusions:In this study, pathogenic bacteria are repeatedly detected in quail eggs, warning that other eggs besides chicken eggs should also pay special attention to the risk of contamination. The isolates in this study are all of the prevalent ST type with widespread drug resistance, and MDR-ACSSuT strains should be paid attention to. The key role of gyrA double mutation (S83F, D87N) and parC mutation (S80I) in the development of quinolone resistance should not be ignored. T3SS (typeⅢ secretory system) and T6SS (typeⅥ secretory system) are important virulence gene clusters of Salmonella and Vibrio parahemolyticus.