Objective: To determine the clinical efficacy and mechanism of Piwei Peiyuan Pill (PPP) combined with moxibustion for treating patients with chronic atrophic gastritis (CAG) with spleen and stomach weakness syndrome. Methods: Ninety-six CAG patients with spleen and stomach weakness syndrome who met the inclusion and exclusion criteria were enrolled at the Department of Spleen and Stomach Diseases of the Second Affiliated Hospital of Anhui University of Chinese Medicine from June 2022 to December 2023. The patients were randomly divided into a control, a Chinese medicine, and a combined group using a random number table method, with 32 cases in each group (two cases per group were excluded). The control group was treated with rabeprazole combined with folic acid tablets (both thrice daily), the Chinese medicine group was treated with PPP (8 g, thrice daily), and the combined group was treated with moxa stick moxibustion (once daily) on the basis of the Chinese medicine group for 12 consecutive weeks. Gastric mucosa atrophy in the three groups was observed before and after treatment. The gastric mucosal pathological score was evaluated. The Patient Reported Outcome (PRO) scale was used to evaluate the patients′ physical and mental health status and quality of life.An enzyme-linked immunosorbent assay was used to detect serum tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-4, IL-10, IL-37, and transforming growth factor (TGF)-β levels in each group. Real-time fluorescence PCR was used to detect the relative expression levels of signal transducer and activator of transcription 3 (STAT3) and mammalian target of rapamycin (mTOR) mRNA in each group. Western blotting was used to detect the relative expression levels of proteins related to the STAT3/mTOR signaling pathway, and the adverse drug reactions and events were recorded and compared. Results: There was no statistical difference in age, gender, disease duration, family history of gastrointestinal tumors, alcohol consumption history, and body mass index among the three groups of patients.The total therapeutic efficacy rates of the control, Chinese medicine, and combined groups in treating gastric mucosal atrophy were 66.67% (20/30), 86.67% (26/30), and 90.00% (27/30), respectively (P<0.05). Compared to before treatment, the pathological and PRO scale scores of gastric mucosa in each group decreased after treatment, and TNF-α, IL-1β, IL-37, and TGF-β levels decreased. The relative STAT3 and mTOR mRNA expression levels, as well as the relative STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels decreased (P<0.05), whereas the IL-4 and IL-10 levels increased (P<0.05). After treatment, compared to the control group, the pathological score of gastric mucosa, PRO scale score, TNF-α, IL-1β, IL-37, TGF-β content, relative STAT3 and mTOR mRNA expression levels, and relative STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels in the Chinese medicine and combined groups after treatment were reduced (P<0.05), whereas the IL-4 and IL-10 levels increased (P<0.05). After treatment, compared to the Chinese medicine group, the combined group showed a decrease in relative STAT3, mTOR mRNA expression levels, and STAT3, p-STAT3, mTOR, and p-mTOR protein expression levels (P<0.05). Conclusion The combination of PPP and moxibustion may regulate the inflammatory mechanism of the body by inhibiting the abnormal activation of the STAT3/mTOR signaling pathway, upregulating related anti-inflammatory factor levels, downregulating pro-inflammatory factor expression, and increasing related repair factor expression, thereby promoting the recovery of atrophic gastric mucosa, reducing discomfort symptoms, and improving the physical and mental state of CAG patients with spleen and stomach weakness syndrome.

Objective To investigate the relationship between tooth loss and the occurrence of esophageal cancer in a natural village in Wenfeng District, Anyang City, Henan Province. Methods A prospective cohort study was conducted to observe the occurrence of tooth loss and esophageal cancer among the asymptomatic residents of the natural village for 16 years from January 2008 to July 2024. Data were analyzed by chi-square test, binary logistic regression, and restricted cubic spline. Results Among the total population of 711 cases, 136 cases were lost to follow-up and 575 cases were included in the final statistics, including 45 cases with esophageal cancer. Significant statistical difference was found between esophageal cancer patients with and without tooth loss (P<0.05). Logistic regression analysis showed that tooth loss was associated with the occurrence of esophageal cancer (OR=3.977, 95%CI: 1.543-10.255). After the adjustment for confounders, tooth loss remained significantly associated with the occurrence of esophageal cancer (OR=3.038, 95%CI: 1.035-8.914). A nonlinear dose-response relationship was observed between the number of teeth lost and the incidence of esophageal cancer. When the number of teeth lost was less than 12, the risk of esophageal cancer increased with the number of teeth lost. When more than 12 teeth were lost, the risk of esophageal cancer decreased as the number of teeth lost increased. Conclusion Tooth loss is a risk factor for the occurrence of esophageal cancer in this natural village. When the number of teeth lost is less than 12, the risk of esophageal cancer increases with the number of teeth lost.

Objective To investigatethe relationship between gastroesophageal reflux disease (GERD) symptoms and clinicopathological characteristics, p53 expression, and survival of Chinese patients with esophageal adenocarcinoma. Methods A total of 3882 patients with esophageal adenocarcinoma, 970 matched patients with esophageal squamous cell carcinoma, and 970 matched patients with gastric cardia adenocarcinoma were included to compare the incidence of GERD symptoms. Patients with esophageal adenocarcinoma were divided into two groups according to the presence and absence of GERD symptoms. The differences in clinicopathological characteristics and p53 expression between the two groups were compared by chi-square test, and the differences in survival between the two groups were compared by landmark analysis. Results The incidence of GERD symptoms increased successively in esophageal squamous cell carcinoma, esophageal adenocarcinoma, and gastric cardia adenocarcinoma. In patients with esophageal adenocarcinoma, the proportions of male, less than 65 years old, lower thoracic tumors, tumors without squamous cell carcinoma, poorly differentiation, early tumors (stage 0-I), and p53-positive tumors in the group with GERD symptoms were higher than those in the group without GERD symptoms; moreover, the long-term survival (≥15 years) was better. Conclusion GERD symptom is an important clinical sign of esophageal adenocarcinoma. It is closely related to specific clinicopathological characteristics, p53 overexpression, and good long-term prognosis.

Objective:To explore the risk factors for duodenal papillary adenocarcinoma by comparing the differences in clinical and endoscopic features between patients with duodenal papillary adenomas and adenocarcinomas.Methods:This study retrospectively included patients diagnosed as having duodenal papillary adenocarcinoma and adenoma from January 1st 2018 to June 1st 2023 at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. Demographic, clinical manifestations, laboratory tests, imaging, endoscopic and pathological characteristics of patients with adenomas and adenocarcinomas were collected and compared. Multivariable logistic regression analysis was employed to identify high-risk factors for duodenal papillary adenocarcinoma.Results:A total of 119 cases of adenocarcinoma and 171 cases of adenoma were included. There were statistically significant differences between the two groups in terms of patient age, body mass index (BMI), clinical symptoms, family history of malignant tumors, bile duct dilation, pancreatic duct dilation, lesion size, adenoma site classification, stage assessed by EUS, and involvement of the bile and pancreatic ducts ( P<0.05). Univariate logistic regression analysis revealed that non-ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, involvement of the bile and pancreatic ducts assessed by EUS, age ≥60 years, lesion size ≥1.5 cm, clinical symptoms, family history of malignant tumors, bile duct dilation, and pancreatic duct dilation were risk factors for duodenal papillary adenocarcinoma. Multivariate logistic regression analysis showed that non-ampullary lesions ( OR=7.00, 95% CI:1.44-34.15, P=0.016), involvement not limited to the major duodenal papilla assessed by EUS ( OR=13.77, 95% CI: 4.69-40.45, P<0.001), age ≥60 years ( OR=2.52, 95% CI: 1.23-5.18, P=0.011), bile duct dilation ( OR=2.58, 95% CI: 1.12-5.94, P=0.026), and lesion size ≥1.5 cm ( OR=2.76, 95% CI:1.36-5.59, P=0.005) were independent risk factors for duodenal papillary adenocarcinoma. Conclusion:This study shows the independent risk factors for duodenal papillary adenocarcinoma, which include non-ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, age ≥60 years, bile duct dilation, and lesion size ≥1.5 cm.

Central serous chorioretinopathy (CSC) is one of the main causes of impaired visual function in middle-aged men. CSC is characterized by a thickening of the choroid and hyperpermeability of the choroidal vessels, resulting in serous subretinal fluid. The pathogenesis of CSC is not fully understood. Since the introduction of indocyanine green angiography, the detection of the influence of the vortex veins in CSC, it has been established that the presence of a thick choroid may be caused by congestion of the vortex vein, resulting in new choroidal drainage through a vortex vein anastomosis. The study of vortex venous blood hemodynamics has elucidated the new concept of the pathogenesis of CSC, deepened our understanding of the disease, and provided a theoretical basis for new treatment methods. With a better understanding of the pathogenesis of CSC, we expect to be able to stratify patients at risk in the clinic and evaluate optimized treatment options for patients with CSC

Objective:To observe the changes of chorioidal thickness (ChT) in patients with central serous chorioretinopathy (CSC) in different mode of vortic venous dilation.Methods:A prospective cross-sectional observational study. A total of 80 patients with 89 eyes (CSC group) diagnosed in Department of Ophthalmology, General Hospital of Central Theater Command from April to October 2023 were included in the study. Among them, 64 males had 71 eyes and 17 females had 18 eyes. A total of 15 healthy volunteers matched in age and sex were selected as the control group. Among them, 14 men had 26 eyes and one woman had two eyes. The macular region was examined by ultra-wide-angle scanning frequency source optical coherence tomography (OCTA) with BM400K BMizar made by TowardPi (Beijing) Medical Technology Co., LTD. Scanning rate 1 536 A scanning×1 280 B scanning, scanning range 24 mm×20 mm. The accompanying software delineated nine subfields (superotemporal, upper, superonasal, temporal, central, nasal, inferotemporal, lower, inferonasal regions) to record ChT. En-face OCTA mode was utilized to observe the anatomy and functional anastomosis of the vortex veins above and below the choroidal blood layer. Eyes in the CSC group were further categorized into upper-dominant, symmetrical, and lower-dominant groups based on the difference in vortex vein expansion shown in the choroidal layer of the en-face image, with 36, 35, and 18 eyes respectively. Statistical analysis included the use of independent samples t-test or Mann-Whitney test for comparison between two groups, one-way analysis of variance or Kruskal-Wallis H test for comparison between multiple groups, and the χ test or Fisher test for categorical variables. Results:Compared with the control group, ChT in the CSC group was thickened in the foveal area and different areas of the macula, with the greatest difference in the fovea, and the differences were statistically significant ( t=3.345, 5.018, 2.902, 4.667, 7.276, 3.307, 3.868, 4.795, 2.583; P<0.05). Compared with the ChT of the control group, there was no statistically significant difference in the superotemporal, region of the upper-dominant group ( t=1.510, P>0.05); in other regions, the differences were statistically significant ( t=3.207, 5.163, 2.526, 4.310, 6.285, 2.656, 3.812, 2.173; P<0.05). The differences in the foveal area and other areas in the symmetrical group were statistically significant ( t=4.488, 5.554, 3.457, 5.314, 7.256, 3.507, 5.584, 6.019, 2.994; P<0.05). In the superotemporal, and superonasal, regions of the lower dominant group, the differences were not statistically significant ( t=1.150, 1.465; P<0.05); in other regions, the differences were statistically significant ( t=2.278, 4.168, 5.244, 2.783, 5.040, 3.432, 2.095; P<0.05). Conclusion:The dilated distribution of vortex veins on en-face ultra-wide-angle OCTA has a corresponding relationship with ChT. In eyes with CSC, the superior vortex vein drainage system may be the primary route for choroidal drainage.

Cerebrospinal fluid morphology examination is an important method of diagnosing central nervous system diseases, but manual microscopy has shortcomings such as low efficiency, long staff training period, and poor homogeneity of test results. In recent years, the application of artificial intelligence in the medical field has developed rapidly, providing new technical means for cerebrospinal fluid morphology examination. In the future, AI-assisted morphological examination of cerebrospinal fluid will not only realize digitalization and networking, but also improve the level and efficiency of intelligent diagnosis of cerebrospinal fluid morphology, which has a broad application prospect in the intelligent assisted diagnosis of cerebrospinal fluid.

Objective To explore the diagnostic value of musculoskeletal ultrasound in patients with limb pain.Methods A total of 80 patients with limb pain admitted to the First Hospital of Nanchang from January 2021 to December 2022 were included in the study.All patients received magnetic resonance imaging(MRI)and musculoskeletal ultrasound on admission.The consistency and coincidence rate of musculoskeletal ultrasound and MRI in diagnosing the cause of limb pain were compared.Results In the 80 patients,MRI and musculoskeletal ultrasound detected positive results in 78 cases,accounting for 97.50%,and 2 cases had no clear disease type.According to the results of MRI,there were 75 cases in which musculoskeletal ultrasound diagnosis of the cause of limb pain was consistent with the MRI results,and total coincidence rate was 96.15%(75/78),with excellent consistency(Kappa=0.907).Conclusion Musculoskeletal ultrasound can clearly display the fine tissue structure,and the diagnosis accuracy of limb pain is high,and the diagnosis consistency with MRI is excellent.

Objective To compare choroidal parameters and morphological changes in asymptomatic contralateral eyes of patients with pachychoroid neovasculopathy(PNV)and central serous chorioretinopathy(CSC)using ultra-wide-field swept-source optical coherence tomography angiography(UWF SS-OCTA).Methods A prospective,cross-section-al,observational study was conducted,including 23 asymptomatic contralateral eyes of 23 CSC patients and 19 asympto-matic contralateral eyes of 19 PNV patients treated in our Ophthalmology Department from April 2023 to September 2023,as well as 22 eyes of 22 age-and sex-matched healthy individuals.These eyes were divided into the CSC contralateral eye group,PNV contralateral eye group,and healthy eye group,respectively.There was no statistically significant difference in age,male ratio,and best corrected visual acuity among the three groups(all P＞0.05).All subjects underwent UWF SS-OCTA imaging examination and comparison,and their choroidal thickness(CT),vascular density(VD)in the major vas-cular layer of the choroid(ratio of blood flow pixel area to total area of the target area),and choroidal vascular index(CVI)(ratio of choroidal vascular lumen volume to total volume of choroidal vessels and stromata)in 9 zones(superior temporal,superior,superior nasal,temporal,foveal,nasal,inferior temporal,inferior,and inferior nasal)were measured and recorded,respectively.The macular subfoveal retinal thickness,subfoveal choroidal thickness(SFCT),and asymmet-ric dilation and anastomosis of the vortex veins were examined and compared in each group of patients.Results There was a statistically significant difference in macular SFCT among the three groups(all P＜0.01).There was a statistically significant difference in the proportion of asymmetric dilation or anastomosis of the vortex veins among the three groups(all P＜0.001).The CVI in the superior nasal and nasal zones in the CSC contralateral eye group were higher than those in the PNV contralateral eye group(both P＜0.05).The CVI and average CVI in the superior nasal,temporal,foveal,inferi-or,and inferior nasal zones in the CSC contralateral eye group were higher than those in the healthy eye group(all P＜0.05).The CVI in the temporal,foveal,and inferior zones in the PNV contralateral eye group were higher than those in the healthy eye group(all P＜0.05).The VD in the major vascular layer of the choroid in the superior temporal,superior,su-perior nasal,foveal,and inferior temporal zones in the CSC contralateral eye group were lower than those in the healthy eye group(all P＜0.05).The VD in the major vascular layer of the choroid in the PNV contralateral eye group were lower than that in the healthy eye group in all zones(all P＜0.001).The CT in the superior temporal and superior nasal zones in the CSC contralateral eye group were higher than those in the PNV contralateral eye group(both P＜0.05).The CT in the superior temporal,superior,superior nasal,temporal,foveal,inferior,and inferior nasal zones in the CSC contralateral eye group were higher than those in the healthy eye group(all P＜0.05).The CT in the superior,temporal,foveal,and in-ferior zones in the PNV contralateral eye group were higher than those in the healthy eye group(all P＜0.05).Conclu-sion This study provides validation from the perspective of the fellow eye that CSC and PNV may not be different stages of the same disease.CSC and PNV are not unilateral diseases,but bilateral choroida diseases that manifest in one eye.

Objective To observe the efficacy of 577 nm subthreshold micropulse laser photocoagulation(SMLP)on central serous chorioretinopathy(CSC)and explore the baseline characteristics and prognostic features of multimodal ima-ging-based CSC.Methods A retrospective analysis was conducted on 44 patients(46 eyes)with CSC diagnosed at the Ophthalmology Department of the General Hospital of Central Theater Command,PLA from June 2017 to May 2022.The pa-tients were classified into the simple CSC group(23 eyes)and the complex CSC group(23 eyes)based on the multimodal imaging classification.All patients underwent 577 nm SMLP treatment.The best corrected visual acuity(BCVA)and cen-tral macular thickness(CMT)of patients between the two groups were compared before treatment and at 1,3 and 6 months after treatment.The intra-group and inter-group changes and the complete absorption rate of subretinal fluid(SRF)in CSC eyes of patients between the two groups were assessed before treatment and at 6 months after follow-up.Results The BCVA of patients in the simple CSC group significantly improved at 6 months after treatment compared with the base-line(P=0.010);the BCVA of patients in the complex CSC group significantly improved at 3 and 6 months after treatment compared with the baseline(both P＜0.01).The CMT of patients in the simple CSC group was significantly lower than the baseline at 1,3,and 6 months after treatment(all P＜0.05);the CMT of patients in the complex CSC group was signifi-cantly lower than the baseline at 1 and 6 months after treatment(both P＜0.05);the change in CMT from baseline after 6 months of treatment for simple CSC was(-163.74±88.10)μm,the change in CMT from baseline after 6 months of treat-ment for complex CSC was(-71.96±164.30)μm,and the difference between the two groups was statistically significant(P=0.023).During the follow-up period,the number of eyes with persistent SRF in the simple CSC group was significant-ly lower than that in the complex CSC group(P＜0.05).The complete absorption rate of SRF at 6 months after treatment in the simple CSC group was greater than that in the complex CSC group(P＜0.05).Conclusion The prognosis of sim-ple CSC treated with 577 nm SMLP is better than that of complex CSC,and the new multimodal imaging classification has a certain value in predicting the prognosis of CSC after SMLP.