This paper interprets the disease name related to bi （痹） disease in traditional Chinese medicine （TCM） from the perspective of micropathological phenotypes in knee osteoarthritis （KOA）. By systematically reviewing classical TCM literature on the pathogenesis and clinical features of different subtypes such as damp-retention bi， bone bi， and tendon bi， and integrating these with current research on pathological subtypes of KOA including the synovitis type， cartilage-meniscus type， and subchondral bone type， the study explores the correlation between traditional disease terms and modern micropathological phenotypes. The author proposes subtype classifications of damp-retention bi corresponding to synovial inflammation， bone bi related to abnormal subchondral bone remodeling， and tendon bi representing cartilage and meniscus degeneration. This approach provides a microscopic biological explanation for TCM syndrome differentiation and offers new perspectives for advancing integrative diagnostic and therapeutic strategies in both Chinese and western medicine.

ObjectiveTo evaluate the overall dietary intake of adult residents in Sijing Town, Songjiang District, Shanghai, and to explore the association between dietary health literacy and diet quality. MethodsA total of 1 280 adult residents were selected as the research subjects using a multi-stage sampling method, and face-to-face questionnaire surveys were administered on site. Dietary intake data were collected using a Food Frequency Questionnaire (FFQ), and the overall diet quality of the participants was evaluated based on the Chinese Healthy Eating Index (CHEI). Participants were divided into low- and high-CHEI groups according to the median CHEI score. Logistic regression models were used to examine the association between dietary health literacy and diet quality. ResultsThe median CHEI score for adults in the area was 63.68 points. Multivariate logistic regression analysis revealed that adults with lower dietary health literacy had lower CHEI scores and poorer overall diet quality compared to those with higher dietary health literacy (OR=1.435, 95%CI:1.132‒1.819). ConclusionThe overall diet quality of adult residents in this region requires improvement. There is a significant positive correlation between the level of dietary health literacy and CHEI scores, suggesting that enhancing dietary health literacy may be an important strategy to improve resident’ dietary quality.

Objective:To investigate the clinical and pathological characteristics of adrenocortical carcinoma (ACC) patients, and to analyze the correlation between clinical features and Ki-67 index.Methods:Retrospectively analyze the clinical data of ACC patients admitted into Peking Union Medical College Hospital from January 1984 to January 2024. Inclusion criteria: ①The patient underwent puncture or surgery, and was diagnosed as ACC; or those who had typical manifestations of adrenocortical multi-band disorders, extremely high FDG uptake in the adrenal area and distant metastasis, and the diagnosis of ACC was considered after multidisciplinary consultation in our hospital; ②The patient had undergone thoracic, abdominal and pelvic CT scan, and could determine the size of the tumor and whether metastasis occurred. Exclusion criteria: ①without pathological diagnosis of ACC or no diagnosis of ACC without multidisciplinary consultation in our hospital; ②no records of symptoms, signs, examinations and other information at the time of initial diagnosis. The baseline data (age, gender, tumor side, etc.), clinical manifestations, endocrine examination, imaging and pathological examination results of the patients were collected, and the relationship between the maximum tumor diameter, the stage of the European Network for the Study of Adrenal Tumors (ENSAT), the functional status of the tumor, the maximum uptake value of 18F-FDG (SUVmax) and the Ki-67 index was analyzed. Results:A total of 164 patients were included in this study. There were 65 males and 99 females, with a male to female ratio of 1∶1.52. The median age at diagnosis was 48 (40, 58) years old. 71 tumors were located (43.29%) on the left side with 91 cases (55.49%) on the right side, and 2 cases (1.22%) on both sides. The median tumor diameter was 9 (7, 12) cm, of which 147 cases (147/158, 93.04%) were>5 cm. A total of 162 patients had ENSAT stages, including 9 stages Ⅰ(5.56%), 72 stage Ⅱ (44.44%), 51 stage Ⅲ (31.48%) and 30 stage Ⅳ(18.52%), respectively. Among the 154 cases with evaluable symptoms, 101 had no typical clinical manifestations and 53 patients had typical clinical manifestations. There were 41 cases (26.62%) of Cushing syndrome, 36 (23.38%) cases of abnormal sexual characteristics, and 19 cases (12.34%) of primary aldosteronism. 100 patients (64.94%) had abnormal endocrine examinations. The results of pathological examination showed 138 cases (90.20%) of traditional subtype, 13 cases (8.50%) of eosinophilic subtype, 1 case of mucinous type (0.65%) and 1 case of sarcomatoid ACC (0.65%). The detection rate of intravascular tumor thrombus was 14.63% (24/164), and the inferior vena cava and renal vein thrombus (10.37, 17/164) were the most common. The median Ki-67 index was 20% (10%, 40%), and 93.13% (122/131) had a Ki-67 index higher than 5%. The median Ki-67 index of ENSAT stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 20%(10%, 35%), 15%(10%, 30%), 30%(20%, 60%), 30%(20%, 60%), respectively. Compared with stage Ⅱ, ENSAT stage Ⅲ ( P=0.0007) and stage Ⅳ ( P=0.0011) ACC had a higher Ki-67 index; there was no statistical correlation between Ki-67 index and tumor maximum diameter, SUVmax of the primary lesion, and functional status of tumor (all P>0.05). Conclusions:ACC has the characteristics of late staging upon initial diagnosis, low proportion of patients with typical symptoms, and low detection rate of intravascular tumor thrombus. ENSAT stage was correlated with the Ki-67 index. Compared with Stage Ⅱ, ENSAT stage Ⅲ and Ⅳ ACC had a higher Ki-67 index.

Objective:Investigating the efficacy of unilateral adrenalectomy in treatment for primary pigmented nodular adrenocortical disease (PPNAD).Methods:Clinical data of 26 patients with PPNAD treated in our hospital from January 2013 to June 2023 was retrospectively analyzed.There were 11 males and 15 females, with an average age of (19.4±4.7) years. 25 cases presented with typical Cushing's syndrome, and 16 cases were diagnosed with Carney's syndrome. PRKAR1A gene mutation detected in 8 out of 10 cases. CT showed multiple small nodules on bilateral adrenal glands in 14 cases, unilateral small nodules or mild thickening with normal contralateral glands in 8 cases, and no obvious abnormalities in 4 cases. All patients showed autonomous oversecretion of cortisol by endocrine laboratory tests, with a median 24 h-UFC of 408.35 (334.28, 800.78) μg/24 h and decreased level of adrenocorticotropic hormone. All 26 patients underwent laparoscopic unilateral adrenalectomy, with left side adrenalectomy in 8 cases and right side adrenalectomy in 18 cases.Results:The average surgical duration was (85.2±28.7) minutes, with intraoperative blood loss <50 ml in all cases. The median time to drainage tube removal post-operation was 3 (2, 3) days. One patient developed a postoperative pulmonary infection, and 3 patients required postoperative hormone replacement therapy. The median follow-up duration was 64 (31.5, 103.8) months, and all patients showed alleviation of Cushing syndrome clinical manifestations after operations. 19 patients (73.1%) had their 24 h-UFC levels normalized to a median of 42.0 (22.4, 58.3) μg/24 h within 8.5 (5, 46) days post-surgery. 7 patients (26.9%) did not achieve normal 24 h-UFC levels, yet experienced an average reduction of (73.2±10.4)%. 13 patients (50.0%) did not experience recurrence, with a median follow-up of 51 (7, 89.5) months, including two cases without recurrence at 10 years post-surgery. 13 patients showed recurrent increase in postoperative cortisol levels, with a median of 225.6 (188.9, 397.2) μg/24 h. The median time to increased 24 h-UFC post-surgery was 27 (13.5, 50.5) months, with the longest duration reaching 104 months. Among these, 9 cases exhibited clinical signs and symptoms of recurrence, while 4 cases did not. Of the 13 patients with recurrence, 9 underwent contralateral adrenalectomy or subtotal resection, while 4 were observed with follow-up.Conclusions:Unilateral adrenalectomy could be a surgical treatment option for PPNAD. Despite the recurrence in some patients postoperatively, unilateral adrenalectomy could effectively and rapidly reduce cortisol levels in PPNAD patients and alleviate the clinical manifestations of Cushing syndrome.

Objective To evaluate the application of a standardized multi-scenario comprehensive training system for graduate students majoring in urology.Methods A total of 11 professional graduate students majoring in urology at Peking Union Medical College Hospital from January 2023 to December 2023 were selected,and a multi-scenario comprehensive training system was adopted for their clinical training of urology.After the training was completed,graduate students were assessed and teaching outcomes were evaluated using a survey questionnaire.Results The ex-cellent rate of assessment reached 100%.The standardized multi-scenario comprehensive training system had signifi-cantly improved the theoretical and practical performance of graduate students.The feedback from the survey ques-tionnaire showed that the satisfaction from both graduates and teachers was extremely high.Conclusions Applying a standardized multi scenario comprehensive training system to clinical teaching practice in urology can significantly improve the clinical comprehensive capacity of urology professional graduate students.Both the trainers and trainees have high satisfaction with that training system,which is suitable for application and promotion.

In 2022, WHO updated the classification and concept of adrenal cortical and medullary tumors. In terms of adrenal cortical tumors, the WHO classification further standardizes the nomenclature of nodular adrenal cortical disease and refines the pathological classification of primary aldosteronism. In terms of adrenal medullary tumors, the WHO classification unifies the concepts of pheochromocytoma and paraganglioma, and reclassifies various concepts, including paraganglioma-like neuroendocrine tumors. The new standards not only cover the clinical manifestations of the disease, but also include other multiple aspects such as the histological origin of the disease, immunohistochemical manifestations, physiological mechanisms of the disease, hereditary susceptibility and prognostic factors. This article intends to explore how to improve the diagnostic and therapeutic level of adrenal tumors.

Objective:To understand the molecular characteristics of the mutant strain of polymerase basic protein 2 (PB2) gene of influenza A (H1N1pdm) in Guangdong province, and to explore its specific molecular sites, so as to provide scientific basis for the prevention and control of influenza virus.Methods:Throat swab samples were collected from 2 cases infected with PB2 gene variant strains for virus isolation, and 23 influenza virus strains were selected from Guangdong province for sequencing analysis. The reference sequences and vaccine strain sequences provided by GISAID were used to perform evolutionary analysis on hemagglutinin (HA) and PB2 genes. Virus strain antigen analysis and neuraminidase (NA) inhibition test were carried out. PB2 protein model was constructed and polymerase activity was analyzed.Results:H399N amino acid mutation occurred in the HA gene of PB2-D701N and PB2-A271S variant strains, both of which belonged to the branch of 6B.1A.5a.2a. They belonged to the same big branch and different small branches as the vaccine strain A/Victoria/4897/2022, and they are all vaccine-like strains. In the three-dimensional structure, the mutations of PB2-D701N and PB2-A271S change charge and hydrophobicity.Conclusions:PB2-D701 and A271 were highly conserved, and PB2 mutant strains were not the dominant strains. The PB2 mutant had high antigenicity with the vaccine. The PB2 mutant strain is sensitive to NA inhibitors. The three-dimensional model predicted that PB2-D701N mutation could enhance virulence and affect transmissibility of influenza virus, while PB2-A271S mutation could affect polymerase activity and polymerase complex synthesis of influenza virus.

In 2022, WHO updated the classification and concept of adrenal cortical and medullary tumors. In terms of adrenal cortical tumors, the WHO classification further standardizes the nomenclature of nodular adrenal cortical disease and refines the pathological classification of primary aldosteronism. In terms of adrenal medullary tumors, the WHO classification unifies the concepts of pheochromocytoma and paraganglioma, and reclassifies various concepts, including paraganglioma-like neuroendocrine tumors. The new standards not only cover the clinical manifestations of the disease, but also include other multiple aspects such as the histological origin of the disease, immunohistochemical manifestations, physiological mechanisms of the disease, hereditary susceptibility and prognostic factors. This article intends to explore how to improve the diagnostic and therapeutic level of adrenal tumors.

Objective To explore the clinical and imaging features of phosphaturic mesenchymal tumor(PMT).Methods The clinical presentations,laboratory examinations,and imaging manifestations of seven patients with PMT diagnosed by surgery and pathology were analyzed retrospectively.Results Among the 7 patients,four patients had clinical presentations of long-term fatigue and bone pain.All patients showed preoperative blood phosphorus reduction in varying degrees.X-ray examination showed systemic osteomalacia and osteoporosis,accompanied by multiple pathological fractures.On CT,the primary tumor appeared as a soft tissue density mass or a ground glass high-density nodule with irregular calcification and local bone destruction.MRI showed long T1,long T2 signal intensity,and irregular low signal foci were scattered in the T2WI fat-suppressed sequence.The enhanced scans showed moderate to significant inhomogeneous enhancement.One patient who underwent 18F-FDG PET/CT and two patients who underwent 18F-ALF-NOTA-Octreotide(18F-OC)PET/CT examinations showed varying degrees of radioactive concentration in the lesions.Conclusion The clinical presentations and laboratory examinations of patients with PMT have certain characteristics.Systemic osteomalacia with pseudofracture line,calcification matrix within the tumor,and significant inhomogeneous enhancement of the lesion are the key imaging features for diagnosing PMT.18F-OC PET/CT examination plays a crucial role in the systemic localization diagnosis of tumors.

Objective:To investigate the clinical efficacy of Cyclosporine A(CsA)in patients with unexplained repeated implantation failure(URIF),and to analyze the changes of peripheral blood lymphocyte subsets after CsA treatment.Methods:105 patients with URIF who underwent frozen-thawed embryo transfer(FET)in the De-partment of Reproductive Medicine in The Second Affiliated Hospital of Kunming Medical University from Septem-ber 30,2021 to March 1,2022 were selected.After informed consent,the patients were divided into CsA group(n=52)and control group(n=53)according to whether they received CsA treatment or not.Pregnancy outcomes and changes in lymphocyte subset were compared between the two groups.Results:The embryo implantation rate and clinical pregnancy rate in CsA group were higher than those in the control group,the difference was statisti-cally significant(48.91%vs.32.56%,P=0.027;53.85%vs.32.08%,P=0.024).The CsA group had a lower ear-ly abortion rate than the control group(10.71%vs.23.53%),but the difference was not statistically significant(P=0.25).The percentage of CD3-CD16+CD56+in CsA group was significantly decreased after treatment[(16.15±5.37)%vs.(18.23±7.10)%,P=0.012],it was also lower than that in the control group[(16.15±5.37)%vs.(18.67±5.16)%,P=0.018].Conclusions:CsA treatment can significantly improve the clinical preg-nancy rate and embryo implantation rate of frozen-thawed embryo transfer in patients with URIF,which may be a-chieved by promoting the distribution of peripheral blood lymphocytes to the direction of embryo implantation,es-pecially by down-regulating the percentage of CD3-CD16+CD56+.CsA has a certain application prospect in the field of assisted reproduction.