ObjectiveThe Box-Behnken response surface methodology combined with BP neural network was used to optimize the preparation process of Hantaoye micropills.Methodspreparation of micropills of Hantaoye by extrusion rounding method was utilized， based on the one-way test，the ratio of micronized silica gel to MCC， wetting agent， loading capacity， rounding frequency and rounding time of excipients were examined as factors，and yield（%）， roundness， HR （hausner ratio） and brittleness（%） are used as evaluation indexs， based on G1-entropy weighting method， the evaluation indexs are combined and the comprehensive evaluation results are calculate-d， so as to optimize the prescription composition and its preparetion process， and a BP neural netw-ork model was established to select reasonable date for learning and validating and predicting theoptimal preparation process of Hantaoye micropills.ResultsThe optimum process for the preparation of Hantaoye micropills predicted by Box-Behnken response surface methododology and BP neural network was 1∶3（g∶g） ratio of micronized silica gel to MCC， 25% drug loading， and 22 round-ing frequency. The results of the validation test show that the absolute error of the mean value of the comprehensive evaluation results of the Box-Behnken response surface method with the theoretical value of the response surface optimization is 0.007 7， and the relative error is 0.79%.nse surface method combined with BP neural network multi-indicator optimization is stable， feasi-ble and more reasonable.ConclusionThe preparation process of Hantao leaf micro-pills based on Box-Behnken response.

ObjectiveTo analyze the factors affecting the prognosis of patients with carbapenem-resistant gram-negative bacteria （CRGNB） bloodstream infection， and to explore the effect of cefoperazone/sulbactam on clinical outcome in these patients.MethodsMedical records of patients diagnosed with CRGNB bloodstream infection from 2018 to 2021 were retrieved from Whonet 5.6 software and the electronic medical record system of the Second Affiliated Hospital of Shandong First Medical University. Statistical analysis was performed using SPSS 21.0 version. Univariate analysis was performed to screen the factors affecting the prognosis of patients， and logistic regression analysis was performed to screen the risk factors affecting the prognosis. The selected risk factors were joint predict the prognosis of these patients by ROC curve.ResultsA total of 56 patients with CRGNB bloodstream infection were included. Univariate analysis showed that there were significant differences （P< 0.05） between the death group and the survival group in APACHE II score， qPitt score， qSOFA score， ventilator days after bloodstream infection， ECFC score after blood culture extraction 72 ~ 96 h， unused of sulbactam formulation and used of tigecycline after bloodstream infection. Logistic regression analysis showed that ECFC score after blood culture extraction 72 ~ 96 h， unused of sulbactam formulation and used of tigecycline after bloodstream infection were independent risk factors for prognosis. The results of joint prediction analysis showed that the area under ROC curve was 0.903 （95%CI： 0.824 ~ 0.982）， the sensitivity， the specificity and the accuracy were 81.82% （18/22）， 85.29% （29/34） and 83.93% （47/58） respectively.ConclusionCefoperazone/sulbactam may be associated with a lower risk of death in patients with CRGNB bloodstream infection， whereas tigecycline may increase mortality， and treatment with cefoperazone/sulbactam following bloodstream infection may reduce the incidence of in-hospital death.

ObjectiveTo investigate the relationship between homocysteine level and type 2 diabetes mellitus with mild cognitive impairment in middle-aged and elderly patients.MethodsA total of 121 middle-aged and elderly patients with type 2 diabetes who were admitted to the Department of Endocrinology of the Second Affiliated Hospital of Shandong First Medical University from November 1， 2022 to September 30， 2023 were selected. 59 patients were divided into 59 cases of normal homocysteine group （≤ 15 μmol/L） and 62 were deivided into homocysteine elevated group （> 15 μmol/L） according to the serum homocysteine level， Their cognitive function was assessed and compared according to the MMSE and ADL.ResultsCompared with patients with normal homocysteine， patients with elevated homocysteine had a significantly higher rate of mild cognitive impairment， with a statistically significant difference （P< 0.001）. In the terms of the total score of MoCA scale， compared with the homocysteine normal group， the total score of MoCA scale in the homocysteine elevated group was significantly lower， and the difference was statistically significant （P< 0.001）. In the terms of visual space and executive function， naming， delayed recall， the scores of patients of the homocysteine elevated group were significantly lower than that of the homocysteine normal group， the difference was statistically significant （P< 0.001）.In the terms of attention， language and orientation， patients of the homocysteine elevated group scored significantly lower than the homocysteine normal group， the difference was statistically significant （P< 0.05）.In the terms of abstraction， there was no statistically significant difference in the scores of patients between the homocysteine normal group and the homocysteine elevated group （P> 0.05）.Conclusion1. Homocysteine is negatively correlated with the total score of the Montreal Cognitive Function Assessment Scale， and it is a risk factor for type 2 diabetes with mild cognitive impairment. 2. Elevated plasma homocysteine had significant effects on visuospatial and executive function， naming， delayed recall， attention， language， and orientation， especially on naming and delayed recall， but had no effect on abstract function.

ObjectiveTo observe and analyze the clinical efficacy of the combined treatment of Three-dimensional balanced chiropractic therapy and McKenzie therapy on lumbar disc herniation （LDH）， and its impact on the reabsorption of protrusions.MethodsFrom January 2022 to June 2023， Clinical data of patients with lumbar disc herniation who received three-dimensional balanced chiropractic therapy combined with McKenzie therapy at the Neck， Shoulder and Back Pain Hospital affiliated to Shandong First Medical University. Clinical data of patients with lumbar disc herniation were included in the treatment of three-dimensional balanced chiropractic technique， massage， acupuncture， and McKenzie therapy. All patients underwent MRI examination before treatment and during follow-up treatment， with an interval of ≥ 6 months between two MRI examinations and compared the clinical efficacy evaluation， VAS， JOA， SAS， and lumbar disc herniation resorption among the three groups.Results（1） The overall efficacy rate， as well as the VAS， JOA， and SAS scores of the comprehensive treatment group， were superior to those of the McKenzie treatment group， with statistically significant differences （allP< 0.05）； （2） The JOA and SAS scores of the comprehensive treatment group were superior to those of the three-dimensional balance therapy group， with statistically significant differences （allP< 0.05）， with a statistically significant difference（allP< 0.05）. （3） The comprehensive treatment group had 43.3% reabsorption of lumbar discherniation， which was higher than the three-dimensional balanced chiropractic therapy group and the Mackenzie treatment group，however， the difference was not statistically significant （P> 0.05）.ConclusionsThe combination of Three-dimensional balanced chiropractic therapy and McKenzie therapy has a good therapeutic effect on lumbar disc herniation， and the probability of protrusion reabsorption and complete absorption after treatment is higher than that of the three-dimensional balanced chiropractic therapy group and McKenzie therapy group.

Acute pancreatitis （AP） is one of the most clinically common acute abdominal disorders， with 10 to 20 percent progressing to severe acute pancreatitis （SAP）， which has a high mortality rate， rapid morbidity， and varied complications. There are two peaks in the death of SAP patients， the first peak occurs earlier and is associated with high mortality caused by systemic inflammatory response syndrome within two weeks of onset， and the second peak is associated with middle and late intestinal barrier damage and sepsis caused by bacterial displacement. High mortality in the middle and late stages of SAP is closely related to intestinal barrier damage and intestinal flora imbalance， and some important bacteria and its metabolites may become an important basis for diagnosis or even a target for disease treatment. Through consulting PubMed， Medline， CNKI and other databases， this paper further elaborated and summarized the relationship between intestinal flora and SAP， providing more possibilities for the treatment of SAP.

This paper searches for recent literature on the treatment of cervical radiculopathy with spinal manipulation， and reviews the unique features and limitations of spinal manipulation and related combined treatments for cervical radiculopathy. Spinal manipulation emphasize the importance of both tendons and bones， by correcting disordered joints and regulating the biomechanical structure of the neck to achieve a balance of tendons and bones， which has a significant effect on cervical radiculopathy. However， it involves a certain risk involved. Controlling the angle of rotation of the neck and the frequency of the adjustment， and avoiding the pursuit of a popping sound， can effectively reduce the risk. Establishing related standardized protocols would be of great help to the clinical treatment of cervical radiculopathy.

Osteoporosis is one of the primary comorbidities of chronic obstructive pulmonary disease （COPD）. Osteoporosis is mainly characterized by a reduction in bone mass and strength， leading to the occurrence of primary fragility fractures. The risk associated with decreased bone mineral density （BMD） can even surpass that of COPD itself， yet it often remains underdiagnosed and undertreated. This review summarizes the correlation between COPD and osteoporosis， and explores the cutting-edge advancements in osteoporosis screening for COPD patients through innovative imaging technologies， particularly the "CT spine bone quantification system" based on the 3D U-Net deep learning model. This article discusses current research on the pathogenesis of COPD and osteoporosis， the advantages and limitations of different BMD detection methods， and highlights the potential of the "CT spine bone quantification system" in enhancing screening efficiency and accuracy. Furthermore， the review explores future research directions， including the further optimization of imaging technologies and the development of personalized treatment strategies， to better manage the bone health of COPD patients.

Lung cancer is one of the malignant tumors with high morbidity and mortality in China. Therefore， it is particularly important to understand the mechanisms of its occurrence and development in order to adopt better strategies for prevention and treatment. The tumor-associated microenvironment plays an important role in the development of tumors，and tumor-associated neutrophils represent most inflammatory cells in the tumor microenvironment. Neutrophil extracellular trapping networks （NETs） is a network structure secreted by neutrophils. However， the mechanism which NETs promote the occurrence and development of lung cancer remains unclear， and this review focuses on the important role which plays in the development of lung cancer.

In recent years， there has been a gradual increase in the incidence of carotid artery stenosis. The relationship between cognitive function and carotid artery stenosis has always been an area of interest. Numerous studies have demonstrated that symptomatic carotid stenosis （SCS） leads to cognitive impairment. However， the impact of asymptomatic carotid stenosis （ACS） on cognitive function and its extent are still inconclusively determined. Possible mechanisms include cerebral hypoperfusion， cerebral microembolism， and cerebral white matter hyperintensities. Definitive evidence regarding whether carotid revascularization can improve cognitive impairment caused by carotid artery stenosis is still lacking. Early detection and proactive intervention before the onset of significant symptoms in patients with carotid artery stenosis can prevent cognitive decline， thereby benefiting patient prognosis. Based on an extensive review of domestic and foreign literature sources， this article reviews the association between carotid artery stenosis and cognitive function as well as its pathogenesis and explores the impact of ACS on cognitive function along with potential improvements through carotid revascularization.