The "theory of Zangqi method" in Huangdi Neijing the "Tangye Jingfa picture" in Dunhuang's posthumous book Fuxingjue both contain the relationship between the five medicinal tastes and the reinforcing-reducing treatment of the five Zang organs. This article made a systematic comparative analysis of the two methods from the aspects of narrative methods， specific content， mathematical logic， clinical experience， and real treatment effect. From the perspective of narrative methods， they both adopted the expression structure of three medicinal tastes corresponding to one organ， which were respectively described as tonic， laxative， and urgent tastes， with the same way of thinking and the narrative frame shared. From the perspective of reinforcing-reducing content， out of a total of 15 attributes related to the corresponding tonic， laxative， and urgent tastes of the five organs involved in the two methods， there were seven inconsistencies between the two methods. In terms of medicinal taste distribution， the "Tangye Jingfa Tu" presented the order of "liver， heart， spleen， lung， and kidney"， Whether tonic， laxative， or transforming tastes， they were all pungent， salty， sweet， sour， or bitter. However， the "theory of Zangqi method" showed no such pattern. From the perspective of mathematical modeling analysis， the distribution of medicinal tastes in the "Tangye Jingfa Tu" conformed to the mathematical logic of the outer product of a five-dimensional space vector， while the "theory of Zangqi method" had no such law. From the perspective of clinical experience， the effect of removing the heart-fire with a bitter taste in the "Tangye Jingfa Tu" was more consistent with the clinical cognition of clearing heat and detoxification effects of traditional Chinese medicine （TCM） with a sweet taste in the "theory of Zangqi method". From the perspective of understanding prescriptions and solving prescriptions， the combination and compatibility principle of 160 common classical prescriptions in the Formulas of Traditional Chinese Medicine can be analyzed by using the "Tangye Jingfa Tu". Therefore， the authors believed that the relationship between the five medicinal tastes and the reinforcing-reducing treatment of the five zang organs in the Fuxingjue was more rigorous and logical， in line with clinical empirical cognition than the relevant records in the Yellow Emperor's Canon of Medicine.

The "theory of Zangqi method" in Huangdi Neijing the "Tangye Jingfa picture" in Dunhuang's posthumous book Fuxingjue both contain the relationship between the five medicinal tastes and the reinforcing-reducing treatment of the five Zang organs. This article made a systematic comparative analysis of the two methods from the aspects of narrative methods， specific content， mathematical logic， clinical experience， and real treatment effect. From the perspective of narrative methods， they both adopted the expression structure of three medicinal tastes corresponding to one organ， which were respectively described as tonic， laxative， and urgent tastes， with the same way of thinking and the narrative frame shared. From the perspective of reinforcing-reducing content， out of a total of 15 attributes related to the corresponding tonic， laxative， and urgent tastes of the five organs involved in the two methods， there were seven inconsistencies between the two methods. In terms of medicinal taste distribution， the "Tangye Jingfa Tu" presented the order of "liver， heart， spleen， lung， and kidney"， Whether tonic， laxative， or transforming tastes， they were all pungent， salty， sweet， sour， or bitter. However， the "theory of Zangqi method" showed no such pattern. From the perspective of mathematical modeling analysis， the distribution of medicinal tastes in the "Tangye Jingfa Tu" conformed to the mathematical logic of the outer product of a five-dimensional space vector， while the "theory of Zangqi method" had no such law. From the perspective of clinical experience， the effect of removing the heart-fire with a bitter taste in the "Tangye Jingfa Tu" was more consistent with the clinical cognition of clearing heat and detoxification effects of traditional Chinese medicine （TCM） with a sweet taste in the "theory of Zangqi method". From the perspective of understanding prescriptions and solving prescriptions， the combination and compatibility principle of 160 common classical prescriptions in the Formulas of Traditional Chinese Medicine can be analyzed by using the "Tangye Jingfa Tu". Therefore， the authors believed that the relationship between the five medicinal tastes and the reinforcing-reducing treatment of the five zang organs in the Fuxingjue was more rigorous and logical， in line with clinical empirical cognition than the relevant records in the Yellow Emperor's Canon of Medicine.

ObjectiveTo construct a group-based trajectory model (GBTM) for early medication adherence check-in, and to analyze the relationship between different trajectories and treatment outcomes in tuberculosis patients using data that were generated from smart tools for monitoring their medication adherence and check-in. MethodsFrom October 1, 2022 to September 30, 2023, a total of 163 pulmonary tuberculosis patients diagnosed in Fengxian District were selected as the study subjects. The GBTM was utilized to analyze the weekly active check-in trajectories of the subjects during the first 4 weeks and establish different trajectory groups. The χ² tests were employed to compare the differences between groups and logistic regression analysis was conducted to explore the relationship between different trajectory groups and treatment outcomes. ResultsA total of four groups were generated by GBTM analyses, of which a low level of punch card was maintained in group A, 6% of the drug users increased rapidly from a low level in group B, 17% of drug users increased gradually from a low level in group C, and 18% of drug users maintained a high level of punch card in group D. The trajectory group was divided into two groups according to homogeneity, namely the low level medication punch card group (group A) and the high level medication punch card group (group B, group C, and group D). The results of multivariate logistic regression analyses revealed that low-level medication check-in (OR=3.250, 95%CI: 1.089‒9.696), increasing age (OR=1.030, 95%CI: 1.004‒1.056), and not undergoing sputum examination at the end of the fifth month (OR=2.746, 95%CI: 1.090‒7.009) were significantly associated with poor treatment outcomes. ConclusionThe medication check-in trajectory of pulmonary tuberculosis patients within the first 4 weeks is correlated with adverse outcomes, or namely consistent low-level medication adherence check-ins are associated with poor treatment outcomes, while high-level medication adherence check-ins are associated with a lower incidence of adverse outcomes.

Three 2,3-diketoquinoxaline alkaloids were isolated from Heterosmilax yunnanensis Gagnep. Their structures were determined through 1D and 2D NMR, HR-ESI-MS, UV, and IR as 1-[5′-(3″-hydroxy-3″-methyl) glutaryl] ribityl-2,3-diketo-1,2,3,4-tetrahydro-6,7-dimethylquinoxaline (1), 1-[2′-(3″-hydroxy-3″-methyl) glutaryl]ribityl-2,3-diketo-1,2,3,4-tetrahydro-6,7-dimethylquinoxaline (2), and 1-ribityl-2,3-diketo-1,2,3,4-tetrahydro-6,7-dimethylquinoxaline (3). Compounds 1 and 2 are novel compounds, and 3 was isolated from H. yunnanensis for the first time. The hepatoprotective activity of these three compounds was evaluated, with compound 3 showing promising hepatoprotective activity.

Objective To assess the clinical effect of the Yiqi Huoxue Huazhuo therapy(the therapy for replenishing qi,activating blood and resolving turbidity)for the treatment of hepatic fibrosis in Wilson's disease(WD,also known as hepatolenticular degeneration).Methods Using retrospective research method,52 patients with liver fibrosis in WD of qi deficiency and blood stasis type were divided into 24 cases in the control group and 28 cases in the treatment group according to the treatment method.The control group was treated with conventional decopper therapy with western medicines,and the treatment group was treated with Chinese herbal decoction based on Yiqi Huoxue Huazhuo therapy together with conventional decopper therapy.Both groups were treated for a total of 4 weeks.Before and after the treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,Unified Wilson's Disease Rating Scale(UWDRS)hepatic symptom scores,serum levels of liver fibrosis indicators of pre-collagen typeⅢ(PCⅢ),hyaluronic acid(HA),collagenⅣ(CⅣ),and laminin(LN),C-X-C motif chemokine ligand 10(CXCL10)level,and the point shear-wave elastography(pSWE)values of hepatic ultrasound based on acoustic radiation force impulse imaging(ARFI).After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 4 weeks of treatment,the total effective rate of the treatment group was 85.71%(24/28),while that of the control group was 54.17%(13/24),and the intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the treatment group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the TCM syndrome scores in both groups were decreased compared with those before treatment(P＜0.01),and the decrease of TCM syndrome scores in the treatment group was significantly superior to that in the control group(P＜0.05).(3)After treatment,the UWDRS liver symptom scores in the two groups were decreased compared with those before treatment(P＜0.01),but the difference was not statistically significant when comparing between the two groups after treatment(P＞0.05).(4)After treatment,serum levels of liver fibrosis indicators of HA,LN,CⅣ and PCⅢ in the treatment group were all decreased compared with those before treatment(P＜0.01),while in the control group only serum LN and PCⅢlevels were decreased(P＜0.05).The intergroup comparison showed that the decrease of serum HA,LN,and PCⅢlevels in the treatment group was superior to that in the control group(P＜0.05 or P＜0.01),while the decrease of serum CⅣlevel tended to be superior to that in the control group,but the difference was not statistically significant(P＞0.05).(5)After treatment,the serum chemokine CXCL10 level in the treatment group was significantly decreased compared with that before treatment(P＜0.01),while the level tended to decrease in the control group,but the difference was not statistically significant(P＞0.05).The intergroup comparison showed that the reduction of serum CXCL10 level in the treatment group was significantly superior to that in the control group(P＜0.05).(6)After treatment,the pSWE values of hepatic ultrasound in the two groups were lower than those before treatment(P＜0.01),and the reduction of pSWE values in treatment group was significantly superior to that of the control group(P＜0.01).Conclusion Yiqi Huoxue Huazhuo therapy can effectively reduce the TCM syndrome scores of WD patients,improve the UWDRS hepatic symptom scores,down-regulate the liver fibrosis indicator level and serum CXCL10 expression level,reduce the pSWE values of hepatic ultrasound,and enhance the clinical efficacy.

Objective To investigate the infection status and changing trend of hepatitis C virus(HCV)infection in hospitalized patients in medical institutions,and provide reference for formulating HCV infection prevention and control strategies.Methods HCV infection surveillance results from cross-sectional survey data reported to China Healthcare-associated Infection(HAI)Surveillance System in 2020 were summarized and analyzed,HCV positive was serum anti-HCV positive or HCV RNA positive,survey result was compared with the survey results from 2003.Results In 2020,1 071 368 inpatients in 1 573 hospitals were surveyed,738 535 of whom underwent HCV test,4 014 patients were infected with HCV,with a detection rate of 68.93％and a HCV positive rate of 0.54％.The positive rate of HCV in male and female patients were 0.60％and 0.48％,respectively,with a statistically sig-nificant difference(x2=47.18,P＜0.001).The HCV positive rate in the 50-＜60 age group was the highest(0.76％),followed by the 40-＜50 age group(0.71％).Difference among all age groups was statistically signifi-cant(x2=696.74,P＜0.001).In 2003,91 113 inpatients were surveyed.35 145 of whom underwent HCV test,resulting in a detection rate of 38.57％;775 patients were infected with HCV,with a positive rate of 2.21％.In 2020,HCV positive rates in hospitals of different scales were 0.46％-0.63％,with the highest in hospital with bed numbers ranging 600-899.Patients'HCV positive rates in hospitals of different scales was statistically signifi-cant(X2=35.34,P＜0.001).In 2020,12 provinces/municipalities had over 10 000 patients underwent HCV-rela-ted test,and HCV positive rates ranged 0.19％-0.81％,with the highest rate from Hainan Province.HCV posi-tive rates in different departments were 0.06％-0.82％,with the lowest positive rate in the department of pedia-trics and the highest in the department of internal medicine.In 2003 and 2020,HCV positive rates in the depart-ment of infectious diseases were the highest,being 7.95％and 3.48％,respectively.Followed by departments of orthopedics(7.72％),gastroenterology(3.77％),nephrology(3.57％)and general intensive care unit(ICU,3.10％)in 2003,as well as departments of gastroenterology(1.35％),nephrology(1.18％),endocrinology(0.91％),and general intensive care unit(ICU,0.79％)in 2020.Conclusion Compared with 2003,HCV positive rate decreased significantly in 2020.HCV infected patients were mainly from the department of infectious diseases,followed by departments of gastroenterology,nephrology and general ICU.HCV infection positive rate varies with gender,age,and region.

Objective:To evaluate the clinical efficacy of a single-session implantation of spinal cord electrical stimulation with neurophysiological monitoring a spinal cord electrical stimulator under general anesthesia with neurophysiological monitoring for the treatment of high-risk diabetic foot.Methods:The clinical data of seven patients with high-risk diabetic foot who underwent spinal cord electrical stimulation in neurosurgery ward nine of Tianjin Huanhu Hospital from May 2022 to May 2023 were collected. The operation was performed under general anesthesia with the "C" arm X ray machine guidance and neurophysiological monitoring. The arterial diameter and peak flow rate of lower extremity, lower extremity skin temperature (calf skin temperature, foot skin temperature), visual analog scale (VAS), continuous distance of movement, blood glucose level and toe wound were compared between patients before and after surgery.Results:A total of seven patients with high-risk diabetic foot were included. The diameters and peak flow rates of femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery and dorsal foot artery in both lower limbs were significantly improved after surgery. All patients had different degrees of lower limb pain before operation. After operation, VAS score decreased significantly (1.1±0.9 vs. 6.8±3.4), the pain was significantly relieved, and the calf skin temperature and foot skin temperature were significantly higher than those before surgery [calf skin temperature (℃): 33.3±0.9 vs. 30.9±0.7, foot skin temperature (℃): 31.4±0.8 vs. 29.1±0.6], fasting blood glucose and postprandial blood glucose were significantly lower than those before surgery [fasting blood glucose (mmol/L): 7.6±1.4 vs. 10.5±1.2, postprandial blood glucose (mmol/L): 9.3±2.3 vs. 13.5±1.1], the differences were statistically significant (all P < 0.01). The lower limb movement of all seven patients was significantly improved after surgery, including one patient who needed wheelchair travel before surgery, and one patient who had intermittent claudication before surgery. Among them, one patient needed wheelchair travel and one patient had intermittent claudication before surgery. All patients could walk normally at 2 weeks after operation. Among the seven patients, two patients had the diabetic foot wound ulceration before surgery, which could not heal for a long time. One month after surgery, blood flow around the foot wound recovered and the healing was accelerated. The wound was dry and crusted around the wound, and the wound healed well. Conclusion:For diabetic high-risk foot patients who are intolerant to diabetic peripheral neuralgia and local anesthesia spinal cord electrical stimulation test, one-time implantation of spinal cord electrical stimulator under general anesthesia under neurophysiological monitoring can effectively alleviate peripheral neuralgia and other diabetic foot related symptoms, improve lower limb blood supply, and reduce the risk of toe amputation. Clinical practice has proved the effectiveness of this technique, especially for the early treatment of diabetic high-risk foot patients.

BACKGROUND:Mesenchymal stem cells are susceptible to senescence during in vitro expansion,which greatly hinders their application in vivo and in vitro.How to improve the replicative senescence of mesenchymal stem cells is an urgent problem to be solved in tissue engineering. OBJECTIVE:To determine whether vascular endothelial growth factor combined with basic fibroblast growth factor can improve the aging of bone marrow mesenchymal stem cells caused by replicative passage. METHODS:Rat bone marrow mesenchymal stem cells were extracted by whole bone marrow adhesion method.Passage 2 cells were selected as normal control group.Passage 7 and later algebraic cells were selected as aging model group.Vascular endothelial growth factor(50 μg/L),basic fibroblast growth factor(10 μg/L),and their combination were administered.Cell proliferation was detected by CCK-8 assay.Cell senescence was observed by β-galactosidase activity staining.Cytoskeleton size and colony formation ability were observed by phalloidine staining and Giemsa staining,respectively,and the levels of senescence-related genes P16,P21,and P53 were detected by qRT-PCR.Gene expression levels of P16,P21,and P53 were tested by qRT-PCR. RESULTS AND CONCLUSION:(1)Vascular endothelial growth factor combined with basic fibroblast growth factor could promote the proliferation of aged bone marrow mesenchymal stem cells,which began to enter the plateau stage on day 9,and the absorbance value of the combined intervention group was significantly higher than that of the model group on day 9(P<0.05).(2)The phenotypic markers of the cells in the combined intervention group did not change,and the cell morphology changed from broad to slender.(3)Compared with the model group,the positive rate of β-galactosidase was significantly decreased(P<0.01);the number of nuclei increased(P<0.001);the total area of cytoskeleton increased(P<0.01);colony formation ability was enhanced(P<0.05);expression level of P16 was decreased(P<0.01)in the combined intervention group.These results indicate that vascular endothelial growth factor combined with basic fibroblast growth factor can improve the senescence of bone marrow mesenchymal stem cells caused by replicative passage without changing the cell phenotype.

Objective:To investigate the high risk factors,diagnostic accuracy of ultrasonography and pregnan-cy outcomes of umbilical cord wrapped around the neck for≥4 loops.Methods:The clinical data of 64 pregnant women with umbilical cord around the neck for≥4 loops(the group with umbilical cord around the neck≥4 loops)in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2011 to February 2024 were retrospectively analyzed.At the same time,80 cases with umbilical cord around the neck for 1-2 loops(the group with umbilical cord around the neck 1-2 loops)were randomly selected as the controls.General information,clinical manifestations,ultrasound diagnosis and other data of the two groups were collected.The risk factors of umbilical cord around the neck≥4 loops and diagnostic accuracy of ultrasonography were ana-lyzed with univariate and multivariate Logistic regression analysis,and the pregnancy outcomes were compared between the two groups.Results:①The incidence of pregnancy,abortion,delivery and history of cesarean sec-tion were lower in the group with umbilical cord around the neck ≥4 loops than those in the group with umbilical cord around the neck 1-2 loops.The incidence of consciously abnormal fetal movement,abnormal umbilical ar-tery systolic/diastolic(S/D)ratio,abnormal fetal heart rate monitoring(NST)and fetal distress were higher in the group with umbilical cord around the neck≥4 loops than those in the group with umbilical cord around the neck 1-2 loops,and the differences were statistically significant(P＜0.05).②Multivariate Logistic regression analysis showed that polyhydramnios and excessively long cord were independent risk factors for umbilical cord around the neck≥4 loops(OR＞1,P＜0.05).③When the time between ultrasound diagnosis and the operation was 2 days,the consistency rate between ultrasound diagnosis of umbilical cord around the neck≥4 loops and intrao-perative diagnosis was the highest,and the difference was statistically significant with＞3 days(46.2％vs.6.30％,P＜0.05).Compared with umbilical cord around the neck 3 loops,ultrasound diagnosis of umbilical cord loops around the neck at 4 or 5 loops had a higher consistency rate with intraoperative diagnosis,and the differ-ence was statistically significant(P＜0.05).④The incidence of premature delivery,neonatal asphyxia and admis-sion to neonatology in the group with umbilical cord around the neck ≥4 loops were higher than those in the group with umbilical cord around the neck 1-2 loops,and the difference was statistically significant(P＜0.05);and the gestational week and birth weight of newborns were significantly lower(P＜0.05).Conclusions:Polyhydramnios and excessively long cord are high risk factors for umbilical cord around the neck≥4 loops.The closer the ultra-sound diagnosis is to the time before cesarean section and the more times the umbilical cord is around the neck in ultrasonic diagnosis,the higher the diagnostic accuracy.Fetal outcomes with umbilical cord around the neck≥4 loops are worse.

Objective:To investigate the high risk factors,diagnostic accuracy of ultrasonography and pregnan-cy outcomes of umbilical cord wrapped around the neck for≥4 loops.Methods:The clinical data of 64 pregnant women with umbilical cord around the neck for≥4 loops(the group with umbilical cord around the neck≥4 loops)in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2011 to February 2024 were retrospectively analyzed.At the same time,80 cases with umbilical cord around the neck for 1-2 loops(the group with umbilical cord around the neck 1-2 loops)were randomly selected as the controls.General information,clinical manifestations,ultrasound diagnosis and other data of the two groups were collected.The risk factors of umbilical cord around the neck≥4 loops and diagnostic accuracy of ultrasonography were ana-lyzed with univariate and multivariate Logistic regression analysis,and the pregnancy outcomes were compared between the two groups.Results:①The incidence of pregnancy,abortion,delivery and history of cesarean sec-tion were lower in the group with umbilical cord around the neck ≥4 loops than those in the group with umbilical cord around the neck 1-2 loops.The incidence of consciously abnormal fetal movement,abnormal umbilical ar-tery systolic/diastolic(S/D)ratio,abnormal fetal heart rate monitoring(NST)and fetal distress were higher in the group with umbilical cord around the neck≥4 loops than those in the group with umbilical cord around the neck 1-2 loops,and the differences were statistically significant(P＜0.05).②Multivariate Logistic regression analysis showed that polyhydramnios and excessively long cord were independent risk factors for umbilical cord around the neck≥4 loops(OR＞1,P＜0.05).③When the time between ultrasound diagnosis and the operation was 2 days,the consistency rate between ultrasound diagnosis of umbilical cord around the neck≥4 loops and intrao-perative diagnosis was the highest,and the difference was statistically significant with＞3 days(46.2％vs.6.30％,P＜0.05).Compared with umbilical cord around the neck 3 loops,ultrasound diagnosis of umbilical cord loops around the neck at 4 or 5 loops had a higher consistency rate with intraoperative diagnosis,and the differ-ence was statistically significant(P＜0.05).④The incidence of premature delivery,neonatal asphyxia and admis-sion to neonatology in the group with umbilical cord around the neck ≥4 loops were higher than those in the group with umbilical cord around the neck 1-2 loops,and the difference was statistically significant(P＜0.05);and the gestational week and birth weight of newborns were significantly lower(P＜0.05).Conclusions:Polyhydramnios and excessively long cord are high risk factors for umbilical cord around the neck≥4 loops.The closer the ultra-sound diagnosis is to the time before cesarean section and the more times the umbilical cord is around the neck in ultrasonic diagnosis,the higher the diagnostic accuracy.Fetal outcomes with umbilical cord around the neck≥4 loops are worse.