Guided by the turbidity toxin theory， it is believed that the key pathogenesis of constipation-predominant irritable bowel syndrome is the obstruction of turbidity toxin and the disruption of intestinal function. Treatment is based on the principles of dispelling turbidity toxin and promoting intestinal function. The clinical patterns can be divided into three types， turbidity toxin heat accumulation pattern， turbidity toxin combined with liver depression and qi stagnation pattern， and turbidity toxin combined with qi and yin deficiency pattern. The treatment can respectively use self-prescribed Tongfu Jiangzhuo Formula （通腑降浊方） to clear heat and unblock the bowels， direct the turbid downward and resolve toxins； use self-prescribed Shugan Jiangzhuo Formula （疏肝降浊方） to soothe the liver and move qi， direct the turbid downward and resolve toxins； use self-prescribed Mazhi Jiangzhuo Formula （麻枳降浊方） to boost qi and nourish yin， moisten the intestines to remove turbidity and resolve toxins.

OBJECTIVE To evaluate the effectiveness and safety of Panlongqi tablets in the treatment of fractures based on real-world research. METHODS From September 2021 to September 2023， fracture patients admitted to 33 medical institutions were collected retrospectively. Patients who received conventional treatment were divided into control group （n＝3 750）， and patients who received combination of Panlongqi tablets on the basis of conventional treatment were divided into observation group （n＝ 3 706）. Self-reported indicators of patients were collected through telephone follow-up at 0， 4， 7 and 14 days after treatment. The improvement values of pain score， swelling score and health utility value， as well as effective rate and adverse drug reactions were compared between 2 groups. The propensity matching score （PSM） method was adopted to perform baseline matching on patient’s age， gender， fracture site， fracture severity， surgical type， type of hospital， and other indicators. Statistical analysis was performed on each therapeutic effect indicator. RESULTS After PSM， a total of 6 425 patients were included， of which 3 055 were in the observation group and 3 370 were in the control group. After 14 days of treatment， the observation group showed significant improvement in pain score （4.768 vs. 4.353）， swelling fangshiyuan2008@126.com grading score （2.979 vs. 2.391）， and life quality utility value （0.430 vs. 0.363）， as well as effective rate （87.20% vs.75.99%） compared to the control group （P＜0.05）. The results of subgroup analyses conducted by gender， age， hospital type， and fracture site were consistent with the aforementioned results. In terms of safety， the observation group had no serious adverse reactions， with a total of 29 cases of mild adverse reactions such as dizziness， stomach pain， and allergies， with an incidence rate of 0.78%. CONCLUSIONS Panlongqi tablets combined with conventional treatment are significantly better than conventional treatment in improving pain， swelling， quality of life， and effective rate in patients with fractures， and have good safety.

Breast cancer remains a leading cause of mortality in women worldwide.Triple-negative breast cancer(TNBC)is a particularly aggressive subtype characterized by rapid progression,poor prognosis,and lack of clear therapeutic targets.In the clinic,delineation of tumor heterogeneity and development of effective drugs continue to pose considerable challenges.Within the scope of our study,high hetero-geneity inherent to breast cancer was uncovered based on the landscape constructed from both tumor and healthy breast tissue samples.Notably,TNBC exhibited significant specificity regarding cell prolif-eration,differentiation,and disease progression.Significant associations between tumor grade,prog-nosis,and TNBC oncogenes were established via pseudotime trajectory analysis.Consequently,we further performed comprehensive characterization of the TNBC microenvironment.A crucial epithelial subcluster,E8,was identified as highly malignant and strongly associated with tumor cell proliferation in TNBC.Additionally,epithelial-mesenchymal transition(EMT)-associated fibroblast and M2 macrophage subclusters exerted an influence on E8 through cellular interactions,contributing to tumor growth.Characteristic genes in these three cluster cells could therefore serve as potential therapeutic targets for TNBC.The collective findings provided valuable insights that assisted in the screening of a series of therapeutic drugs,such as pelitinib.We further confirmed the anti-cancer effect of pelitinib in an orthotopic 4T1 tumor-bearing mouse model.Overall,our study sheds light on the unique characteristics of TNBC at single-cell resolution and the crucial cell types associated with tumor cell proliferation that may serve as potent tools in the development of effective anti-cancer drugs.

Objective:To evaluate the efficacy of individualized mini-fluid challenge test in determining the fluid responsiveness in the patients undergoing surgery in prone position.Methods:A total of 47 patients of either sex, aged > 18 yr, with boy mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective spinal surgery in prone position, were included. The volume-controlled mode was used for mechanical ventilation, and the tidal volume was set at 8 ml/kg. The hemodynamic parameters were monitored by FloTrac/Vigileo system. The patient was changed to prone position at 5 min after endotracheal intubation (T 1), hydroxyethyl starch 130/0.4 sodium chloride injection 2 ml/kg was intravenously given at 5 min of prone position (T 2), and fluid 3 ml/kg was continuously infused at 1 min after 2 ml/kg fluid infusion (T 3), and both infusion rates were 0.5 ml·kg -1·min -1. A mini-fluid challenge test was performed during T 2-T 3 period, the standard volume therapy (total infusion of liquid 5 ml/kg) was carried out from T 2 to 1 min after infusion of liquid 3 ml/kg (T 4). The rate of change in SV at T 3 time point (ΔSVT 3) was calculated relative to T 2 time point, and the rate of change in SV at T 4 time point (ΔSVT 4) was calculated relative to T 2 time point. Positive fluid responsiveness test was defined as an increase in ΔSVT 4≥10%, and patients were divided into volume response group (Rs group) and non-volume response group (NRs group). ΔSVT 3, ΔSVT 4 and stroke volume variation and pulse pressure variation at T 3 and T 4 time points were selected, the receiver operating characteristic curve predicting fluid responsiveness was generated, and the area under the receiver operating characteristic curve (AUC) was calculated. Results:Forty-one patients were finally enrolled, including 18 cases in Rs group and 23 cases in NRs group. The AUC of ΔSVT 3 determining fluid responsiveness was 0.976, with the sensitivity 0.944 and specificity 0.957. The AUC of ΔSVT 4 determining fluid responsiveness was 0.971, with sensitivity 0.889 and specificity 0.95. The AUC of stroke volume variation at T 3 and T 4 in predicting fluid responsiveness was 0.632 and 0.609, respectively. The AUC of pulse pressure variation at T 3 and T 4 predicting fluid responsiveness was 0.470 and 0.380, respectively. Conclusions:Individualized mini-fluid challenge test (2 mg/kg colloidal solution) can accurately determine the fluid responsiveness in the patients undergoing surgery in prone position.

Objectives:To analyze the clinical effect of bone mineral density(BMD)on the efficacy of oblique lateral interbody fusion(OLIF)in the treatment of lumbar degenerative spondylolisthesis(LDS).Methods:A retrospective analysis was conducted on the clinical data of patients with Meyerding grade Ⅰ LDS who underwent OLIF assisted with a minimally invasive spinal channel system between December 2017 and July 2020.Based on the preoperative BMD,the patients were divided into low bone mass group(-2.5＜T-score＜-1.0,n=30)and osteoporosis group(T-score≤-2.5,n=22).There was no statistical difference between the two groups in gender ratio,age,and segments of spondylolisthesis(P＞0.05).The operative time,intraopera-tive blood loss,ambulation time after surgery,length of hospital stay,and complications were collected and compared between the two groups.The postoperative 1 week reduction rate of spondylolisthesis,and postoper-ative 1 month improvement in spinal canal cross-sectional area,and intervertebral disc height restoration were counted and compared;Bone graft fusion was observed of the two groups of patients on X-ray images at 3 months,6 months,and 12 months of follow-up after operation.The Japanese Orthopaedic Association(JOA)scores were assessed at pre-operation,and 1,3,6 and 12 months after operation,and JO A score at 12 months after operation was used to determine the improvement rate of JOA score.Results:Comparing with the osteoporosis group,the low bone mass group was shorter in operative time(119.5±12.7min vs.163.3± 14.2min),less in intraoperative blood loss(98.9±22.4mL vs.211.5±29.8mL),shorter in ambulation time after surgery(2.3±0.9d vs.3.9±1.2d)and length of hospital stay(6.2±1.3d vs.8.9±1.6d)(P＜0.05).At 1 week postoper-atively,complete reduction was observed in 29 cases(96.7％)in the low bone mass group and 15 cases(68.2％)in the osteoporosis group.There was a statistically significant difference in the reduction outcomes between the two groups(P＜0.05).After OLIF treatment,statistically significant differences were noted between the postopera-tive dural sac cross-sectional area and the intervertebral disc height and the preoperative values,respectively(P＜0.05).The recovery of intervertebral disc height of the osteoporosis group was significant different from that of the low bone mass group(12.79±0.99mm vs.11.25±0.98mm,P＜0.05),while the improvement of the dural sac cross-sectional area was not(P＞0.05).The fusion rates were not significantly different between the two groups(93.3％vs 77.3％,P＞0.05).The JOA scores at 1 month and 3 months after surgery in the low bone mass group were statistically significant different from those of the osteoporosis group(P＜0.05),while the JOA scores at 6 and 12 months after surgery were not significantly different between the two groups(P＞0.05).Conclusions:OLIF can achieve satisfactory short-term clinical outcomes in low bone mass and osteoporosis LDS patients,and its efficacy is better in patients with low bone mass than patients with osteoporosis.

Objective:To explore the current status of the artificial intelligence (AI) developments in medical imaging in China, and to provide data for the development of AI.Methods:In May 2022, the Radiology Branch of the Chinese Medical Association and the China Medical Imaging AI Industry-University-Research Innovation Alliance jointly launched a nationwide survey on the application status and development needs of medical imaging AI in China in the form of a questionnaire. This survey was carried out for different groups of people, focusing on the clinical applications of medical imaging AI, enterprise development, and educational needs in colleges and universities, with the descriptive statistical analysis performed.Results:China′s medical imaging AI has made great progress in clinical applications, in enterprise developments, as well as in the education and teaching areas. In terms of clinical application, 90.8% (5 765/6 347) of the survey respondents had a preliminary understanding of AI. There were 62.1% (3 798/6 119) doctors confirmed the applications medical imaging AI products in their departments. AI products were applied in the whole process of medical imaging examination, especially in assistance of the diagnosis. The application of pulmonary nodules screening accounted for 89.5% (3 401/3 798) of all medical imaging AIs. The main factors restricting the rapid development of medical imaging AI included lack of experts [47.3% (3 002/6 347)], poor data quality [45.7% (2 898/6 347)] and imperfect function of the products [40.4% (2 566/6 347)]; in terms of enterprises, there were 65.4% enterprises with a scale of less than 100 employees (17/26), and 34.6% with a scale of more than 100 employees (9/26). The main group of the customers were the hospitals above the second level, accounting for about 92.3% (24/26); in terms of education, the number and quality of AI courses, practical operations and lectures currently carried out by schools vary between different levels. The AI courses for graduated students accounted for about 22.5% (86/381), which were the largest in number; while the proportion of AI courses for junior college students, undergraduates and regular trainees were less than 15%. More than 60% of the students thought it necessary for schools to establish AI courses. Among all the students, the master′s and doctoral candidates had the greatest demand for additional AI courses [84.8% (323/381)].Conclusions:The development and popularization of medical imaging AI in China continues to prosper, with opportunities and challenges coexisting. It is necessary to adhere to the orientation of clinical needs, and to realize the coordinated development of clinical application, enterprise development, as well as education and teaching.

Numerous studies have reported that the resistance of biofilm bacteria to antibiotics can be up to 10-1 000 fold higher than that of planktonic bacteria. Bacterial biofilms are reported to be responsible for more than 80% of human microbial infection, posing great challenges to the healthcare sector. Many studies have reported that plant extracts and their active ingredients can inhibit the formation and development of bacterial biofilms, including reducing biofilm biomass and the number of viable bacteria in biofilms, as well as eradicating mature biofilms. This review summarized the plant extracts and their active ingredients that are inhibitory to bacterial biofilms, and analyzed the underpinning mechanisms. This review may serve as a reference for the development of plant drugs to prevent and treat biofilm infections.
Anti-Bacterial Agents/pharmacology* ; Bacteria ; Biofilms ; Humans ; Plant Extracts/pharmacology* ; Quorum Sensing

Objective:To investigate the clinical effect of combined treatment of comminuted inferior pole patellar fracture with micro-plate and tension-band wire.Methods:A retrospective cohort study was conducted in 50 patients with comminuted inferior pole patellar fracture (AO classification of type 34-A1) admitted to First Affiliated Hospital of University of Science and Technology of China from October 2018 to October 2020, including 28 males and 22 females, aged 17-77 years［(51.4±11.5)years］. A total of 23 patients were treated with micro-plate combined with tension-band wire (Group A) and 27 patients were treated with cable wire looping combined with tension-band wire (Group B). Fracture union, union time and last follow-up evaluation of knee range of motion and Bostman score were compared between the two groups. Complications (infection, internal fixation failure, internal fixation irritation, etc.) were also observed.Results:All patients were followed up for 12-18 months［(14.1±2.1) months］. All patients had bone union, with no statistical difference between Group A［(9.9±1.8)weeks］and Group B［(10.3±1.4)weeks］in union time ( P>0.05). Knee range of motion was (129.2±9.7)° in Group A at the last follow-up, better than (122.3±11.0)° in Group B ( P<0.05). Knee Bostman score was (27.6±1.8)points in Group A, showing no statistical difference from that in Group B［(26.8±1.9)points］( P>0.05). There were no postoperative complications in Group A. Two patients with tension band shedding of Kirschner wire after fracture healing were found in Group B, with no special treatment given due to no obvious discomfort. Conclusions:For comminuted inferior pole patellar fracture, micro-plate combined with tension-band wire is more effective and provides better knee mobility with no complications of implant failure as compared with cable wire looping combined with tension-band wire. Therefore, the technique deserves clinical promotion.

This paper reports 3 cases of acute hepatitis of unknown cause in children who met the case definition of WHO. Human adenovirus group C was detected in case 3, and the quantity of viral DNA was relatively high, which may be related to the liver function damage in the patient, but its role in pathogenesis needs further study to confirm.

Objective:To evaluate the accuracy of mini-fluid challenge test in predicting fluid responsiveness in elderly patients undergoing surgery in prone position.Methods:Forty-eight elderly patients, aged ≥ 65 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective spinal surgery, were enrolled.Patients were mechanically ventilated using a volume-controlled mode with a tidal volume of 6 ml/kg of ideal body weight during operation.A radial arterial catheter was inserted and connected to FloTrac/Vigileo system to monitor hemodynamic parameters.At 5 min after prone position, volume expansion was started when the hemodynamics was stable: lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, 1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, 1 min later lactated Ringer′s solution 1 ml/kg was intravenously infused over 1 min, and 1 min later operation was started.After tracheal intubation and before prone position (T 1), 5 min of prone position (T 2), 1 min after 1st infusion of 1 ml/kg liquid (T 3), and 1 min after 2nd infusion of 1 ml/kg liquid (T 4) and 1 min after infusion of 3 ml/kg fluid (T 5), heart rate, mean arterial pressure, cardiac output, cardiac index, stroke volume, stroke volume index (SVI), stroke volume variability (SVV), pulse pressure variability (PPV), and changes in SVI induced by rapid infusion of 1, 2 and 5 ml/kg crystalloid (ΔSVI 1 ml/kg, ΔSVI 2 ml/kg, ΔSVI 5 ml/kg) were calculated.Positive fluid challenges were defined as an increase in SVI of 10% or more from baseline, and the patients were divided into responder group (R) and non-responder group (NR). Receiver operating characteristic curves predicting fluid responsiveness were generated for ΔSVI 1 ml/kg, ΔSVI 2 ml/kg, SVV and PPV, and areas under the receiver operating characteristic curves (AUC) were calculated. Results:Thirty patients were enrolled in group R and 18 cases in group NR.The AUC of ΔSVI 1 ml/kg in predicting fluid volume responsiveness was 0.87 with a diagnostic threshold of 7%, a sensitivity of 80%, and a specificity of 83%.The AUC of ΔSVI 2 ml/kg in predicting fluid responsiveness was 0.928 with a diagnostic threshold of 8%, a sensitivity of 78%, and a specificity of 89%.The AUC of SVV and PPV in predicting fluid responsiveness was 0.65 and 0.53, respectively. Conclusion:Mini-fluid challenge test guided by ΔSVI can predict fluid responsiveness in elderly patients undergoing surgery in prone position, and rapid infusion of 2 ml/kg crystalloid provides better accuracy than 1 ml/kg.