The chapter Zhouyu in Guoyu says "Qi of the heaven and the earth moves without losing its order." With lucidity ascending and turbidity descending， Qi moves in a normal state， and Yin and Yang consolidate the foundation of the body. The mutual interference between lucidity and turbidity leads to the disorder of Qi movement， thus causing diseases. It is a pathological state of disorder between ascending and descending， as well as between entering and exiting， gradually evolving into a state of turbidity affecting lucidity and transforming into pathogen， which can be used to interpret and analyze the core of disease pathogenesis. The theory of lucidity and turbidity is connected with the harmony of nutrient and defensive aspects， Qi circulation， and sweat pore associating with Qi movement， and it has common implications with immune responses and nutrient metabolism system， intestinal mucosal barrier function， and mitochondrial energy synthesis. Modern studies have shown that intestinal flora imbalance， bile acid receptor inactivation， macrophage polarization imbalance， epithelial-mesenchymal transition， ferroptosis and other related microscopic pathological mechanisms are involved in the development and progression of ulcerative colitis. By delving into the common meaning of the classic theory of mutual interference between lucidity and turbidity in traditional Chinese medicine and modern medical pathological mechanisms， this paper summarizes the correspondence between the micropathological mechanism and the theory of mutual interference between lucidity and turbidity in the regulation and mamagement of ulcerative colitis. The combined use of sweet and warm medicinal materials consolidates the middle Qi and activates Qi circulation， thus ascending lucidity and descending turbidity. The combined use of pungent medicinal materials for dispersing and bitter medicinal materials for descending simultaneously raises warm and clear Qi. Wind-extinguishing medicinal materials facilitate the ascending of Qi and the opening of sweat pores. Accordingly， turbidity descends and lucidity ascends. The prescriptions incorporating these medication principles are in agreement with the therapeutic approach of following the normal flow of lucidity and turbidity. This paper clarifies the scientific connotation and micropathologic mechanism of ulcerative colitis from the perspective of mutual interference between lucidity and turbidity， providing new theories and prescriptions for the clinical diagnosis， treatment， and prevention of ulcerative colitis.

The theory of "Yang transforming Qi while Yin constituting form" in the Huangdi's Internal Classic is derived from the application， transformation， movement， and balance of Tao. It is highly condensed， revealing the true meaning of Tao and guiding the changes and progress of all natural things， including diseases. Therefore， the appearance of various physical diseases is the manifestation of Yin-Yang Qi transformation. Sweat pore， formed by the Qi transformation of Yin and Yang， is the nourishing and regulating system. It serves as the hub and channel， assisting in the flow and transformation of Qi， facilitating the exchange of material， energy， and information with the outside world. With sweat pore as the hub and based on the macro-control and holistic thinking of "Yang transforming Qi while Yin constituting form"， this paper explores the microscopic mechanisms underlying chronic liver disease. In combination with the roles of mitochondria， exosomes， and the ultraliver sieve structure in the formation and progression of chronic liver disease， this paper elucidates the close internal relationship between the disease's initial quality， symptom signs， and its physiological and pathological functions under the guidance of this theory. Modern studies have shown that autophagy， intestinal flora disorders， glucose and lipid metabolism disturbances， activation of inflammatory factors， ferroptosis， and other microscopic pathological mechanisms are involved in the occurrence and development of chronic liver disease. The common connotation of the Yin-Yang concept in traditional Chinese medicine （TCM） and the pathological mechanisms in modern medicine is deeply analyzed. The corresponding relevant microscopic mechanisms and the guiding role of the theory of "Yang transforming Qi while Yin constituting form-sweat pore" in the management of chronic liver disease are summarized. Wind medicine promotes growth and transformation through sweat pore. The combination of pungent and sweet medicines facilitates Yang and disperse Yin. The formulas， combining the characteristics of wind medicine and pungent and sweet medicines， fit the principle of "Yang transforming Qi while Yin constituting form-sweat pore". This paper combines both macro and micro perspectives to explain the scientific connotation and microscopic mechanisms of chronic liver disease based on the theory of "Yang transforming Qi while Yin constituting form-sweat pore"， and explore the prevention and treatment of chronic liver disease through the principles， methods， prescriptions， and medicines featured by combination of pungent and sweet medicines， facilitating Yang， activating sweat pore， and dispersing Yin， providing new ideas and reference for the clinical treatment of chronic liver disease.

Objective:To explore the value of a model combining 18F-FDG PET/CT radiomics and clinical factors in prediction of lymphovascular invasion (LVI) in rectal cancer. Methods:This retrospective cohort study was conducted on 120 patients (86 males and 34 females; age (62.2±11.6) years) with rectal adenocarcinoma from the Affiliated Hospital of Qingdao University between January 2017 and November 2023. Patients were divided into a training set ( n=96) and testing set ( n=24) at the ratio of 8∶2 using simple random sampling without replacement with a fixed random seed. An external validation cohort consisted of 31 patients (17 males and 14 females; age (61.2±8.2) years) with rectal adenocarcinoma from Affiliated Hospital of Jining Medical University and Linyi Cancer Hospital between January 2020 and June 2024 was obtained. PET/CT-derived features were selected to build radiomics model. The χ2 test and logistic regression were used to identify clinical predictors of LVI for clinical modeling. A combined radiomics-clinical nomogram was developed, after that ROC analysis was conducted to evaluate the predictive performance. Results:Significant differences were found between LVI-positive ( n=40) and LVI-negative ( n=56) subgroups in body weight, carbohydrate antigen (CA) 19-9, metabolic tumor volume (MTV), and peak of SUV (SUV peak) in the training set ( χ2 values: 4.01-13.64, all P<0.05). Binary logistic regression identified body weight (odds ratio ( OR)=0.320, 95% CI: 0.095-0.906, P=0.033), CA19-9 ( OR=0.402, 95% CI: 0.120-0.917, P=0.033), and MTV ( OR=0.192, 95% CI: 0.090-0.575, P=0.002) as independent predictors of LVI, forming the clinical model. Thirteen PET features and fifteen CT features were selected and a radiomics model was built. ROC curve analysis showed that AUCs for the clinical model in the training, testing, and external validation sets were 0.765, 0.567, and 0.777, respectively; AUCs for the radiomics model were 0.925, 0.881, and 0.823; AUCs for the joint model were 0.938, 0.889, and 0.841. Conclusion:The joint model of 18F-FDG PET/CT radiomics and clinical factors can effectively predict LVI in rectal cancer, guiding preoperative therapy and surgical planning.

Objective:To explore the value of a model combining 18F-FDG PET/CT radiomics and clinical factors in prediction of lymphovascular invasion (LVI) in rectal cancer. Methods:This retrospective cohort study was conducted on 120 patients (86 males and 34 females; age (62.2±11.6) years) with rectal adenocarcinoma from the Affiliated Hospital of Qingdao University between January 2017 and November 2023. Patients were divided into a training set ( n=96) and testing set ( n=24) at the ratio of 8∶2 using simple random sampling without replacement with a fixed random seed. An external validation cohort consisted of 31 patients (17 males and 14 females; age (61.2±8.2) years) with rectal adenocarcinoma from Affiliated Hospital of Jining Medical University and Linyi Cancer Hospital between January 2020 and June 2024 was obtained. PET/CT-derived features were selected to build radiomics model. The χ2 test and logistic regression were used to identify clinical predictors of LVI for clinical modeling. A combined radiomics-clinical nomogram was developed, after that ROC analysis was conducted to evaluate the predictive performance. Results:Significant differences were found between LVI-positive ( n=40) and LVI-negative ( n=56) subgroups in body weight, carbohydrate antigen (CA) 19-9, metabolic tumor volume (MTV), and peak of SUV (SUV peak) in the training set ( χ2 values: 4.01-13.64, all P<0.05). Binary logistic regression identified body weight (odds ratio ( OR)=0.320, 95% CI: 0.095-0.906, P=0.033), CA19-9 ( OR=0.402, 95% CI: 0.120-0.917, P=0.033), and MTV ( OR=0.192, 95% CI: 0.090-0.575, P=0.002) as independent predictors of LVI, forming the clinical model. Thirteen PET features and fifteen CT features were selected and a radiomics model was built. ROC curve analysis showed that AUCs for the clinical model in the training, testing, and external validation sets were 0.765, 0.567, and 0.777, respectively; AUCs for the radiomics model were 0.925, 0.881, and 0.823; AUCs for the joint model were 0.938, 0.889, and 0.841. Conclusion:The joint model of 18F-FDG PET/CT radiomics and clinical factors can effectively predict LVI in rectal cancer, guiding preoperative therapy and surgical planning.

Objective:To estimate the influence of metabolic parameters in 18F-FDG PET/CT and clinically relevant indicators on the prognosis of patients with cervical cancer. Methods:A total of 174 patients with cervical cancer (age (53.6±11.1) years) who underwent baseline 18F-FDG PET/CT examination in the Affiliated Hospital of Qingdao University from May 2011 to December 2020 were retrospectively collected. Metabolic parameters (metabolic tumor volume of primary lesion (MTV p), total lesion glycolysis of primary lesion (TLG p), MTV sum of total lesions (MTV total) in the whole body, TLG sum of total lesions (TLG total)) and clinical parameters (International Federation of Gynecology and Obstetrics (FIGO) stage, tumor maximum diameter ( Dmax), et al) were collected. Cox regression and Kaplan-Meier method were performed to evaluate the prognostic and predictive values of those parameters. Results:The follow-up time was 6-120 months, during which 52 patients (29.9%, 52/174) developed progression. The 5-year overall survival (OS), progression-free survival (PFS), local control (LC) and distant metastasis-free survival (DMFS) rates were 83.3%(145/174), 70.1%(122/174), 75.3%(131/174) and 82.8%(144/174), respectively. Cox regression showed that FIGO stage and MTV total were independent factors for predicting PFS, OS and LC (hazard ratio ( HR): 1.005-11.605, all P<0.05). FIGO stage and TLG total were independent factors for predicting DMFS ( HR: 1.002-12.258, all P<0.05). Conclusion:MTV total and FIGO stage are effective predictors of patients with cervical squamous cell carcinoma.

Objective To explore the risk factors for SBI after CEA in elderly patients with CS.Methods A total of 216 elderly CS patients undergoing CEA in our department from April 2020 to April 2023 were divided into SBI group(39 cases)and non-SBI group(177 cases)according to the occurrence of SBI in 30 d after surgery or not.The risk factors for SBI after CEA in elderly CS patients were screened out,and then a prediction model of SBI was constructed based on these risk factors.The prediction model was validated and its prediction efficacy was evaluated.Results Significantly larger proportions of severe CS,non-hyperechoic plaque and vulnerable carotid plaque,and higher levels of Hcy and TG were observed in the SBI group than the non-SBI group(P＜0.05).The severe carotid stenosis,non-hyperechoic plaque,vulnerable carotid artery plaque,Hey ≥13.81 μmol/L,and TG≥4.76 mmol/L were all risk factors for SBI after CEA in elderly CS patients(P＜0.05).The AUC value,sensitivity and specificity of the constructed model was 0.871(95％CI:0.715-0.939),94.50％and 76.30％respectively.Conclusion Severe carotid artery ste-nosis,non-hyperechoic plaque,vulnerable carotid artery plaque,Hey ≥13.81 μmol/L and TG ≥4.76 mmol/L are all risk factors for SBI after CEA.The prediction model based on the above risk factors has high predictive value for the occurrence of SBI after CEA in elderly CS patients.

Objective:To investigate the values of two-dimensional and three-dimensional echocardiographic parameters in predicting pulmonary vascular resistance (PVR) in chronic pulmonary thromboembolic pulmonary hypertension (CTEPH).Methods:A total of 141 patients diagnosed with CTEPH in China-Japan Friendship Hospital from November 2015 to December 2022 were included. Two-dimensional echocardiographic indicators reflecting PVR were constructed according to the calculation formula of PVR: echocardiographic estimated systolic pulmonary artery pressure (sPAP Echo)/left ventricular end-diastolic diameter (LVIDd), echocardiographic estimated mean pulmonary artery pressure (mPAP Echo)/LVIDd. sPAP Echo/left ventricular end-diastolic volume (LVEDV), sPAP Echo/left ventricular cardiac output (LVCO) were measured by three-dimensional echocardiography. The correlations between two-dimensional and three-dimensional echocardiographic ratios and invasive PVR were then analyzed using the Spearman correlation method. Using receiver operating characteristic curve analysis, cut-off values for the ratios were generated to identify patients with PVR>1 000 dyn·s -1·cm -5. Pre- and postoperative hemodynamics and echocardiographic data were analyzed, as well as the correlation between the reduction rate of the echocardiographic index and PVR in 54 patients who underwent pulmonary endarterectomy (PEA). Results:sPAP Echo/LVIDd, sPAP Echo/LVEDV and sPAP Echo/LVCO were moderately correlated with PVR( rs=0.62, 0.52, 0.63, both P<0.001). The ratio of sPAP Echo to LVEDV, when greater than or equal to 1.41, had a sensitivity of 0.800 and a specificity of 0.930 for determining PVR >1 000 dyn·s -1·cm -5 (AUC=0.860, P<0.001). Similarly, the ratio of sPAP Echo to LVIDd, when greater than or equal to 2.14, had a sensitivity of 0.647 and a specificity of 0.861 for determining PVR >1000 dyn·s -1·cm -5 (AUC=0.830, P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd significantly decreased after PEA (both P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd reduction rate (ΔsPAP Echo/LVIDd and ΔmPAP Echo/LVIDd) were significantly correlated with PVR reduction rate (ΔPVR), respectively ( rs=0.61, 0.63, both P<0.05). Conclusions:Two-dimensional ratio sPAP Echo/LVIDd and three-dimensional ratio sPAP Echo/LVEDV can be used to noninvasively estimate PVR in CTEPH patients. The conventional ratio sPAP Echo/LVIDd is convenient and reproducibly suitable for monitoring the improvement of PVR before and after treatment, and its ratio of 2.14 can predict the significant increase of PVR in CTEPH patients (>1 000 dyn·s -1·cm -5).

Objective To propose strategies for developing clinical predictive models,aiming to assist researchers in conducting standardized clinical prediction model studies.Methods Literature review was conducted to summarize the operational steps and content for developing clinical predictive models.Then,a methodological framework was summarized and refined through expert consultation.Results The 11-step methodological framework for developing clinical predictive models was obtained by synthesizing the experience of 456 clinical predictive modeling studies and expert consultation,and the details were analyzed and elaborated.Conclusions This study presents methodological strategies and recommendations for the development of clinical predictive models,intended to serve as a guide for researchers.

Objective To explore the risk factors for SBI after CEA in elderly patients with CS.Methods A total of 216 elderly CS patients undergoing CEA in our department from April 2020 to April 2023 were divided into SBI group(39 cases)and non-SBI group(177 cases)according to the occurrence of SBI in 30 d after surgery or not.The risk factors for SBI after CEA in elderly CS patients were screened out,and then a prediction model of SBI was constructed based on these risk factors.The prediction model was validated and its prediction efficacy was evaluated.Results Significantly larger proportions of severe CS,non-hyperechoic plaque and vulnerable carotid plaque,and higher levels of Hcy and TG were observed in the SBI group than the non-SBI group(P＜0.05).The severe carotid stenosis,non-hyperechoic plaque,vulnerable carotid artery plaque,Hey ≥13.81 μmol/L,and TG≥4.76 mmol/L were all risk factors for SBI after CEA in elderly CS patients(P＜0.05).The AUC value,sensitivity and specificity of the constructed model was 0.871(95％CI:0.715-0.939),94.50％and 76.30％respectively.Conclusion Severe carotid artery ste-nosis,non-hyperechoic plaque,vulnerable carotid artery plaque,Hey ≥13.81 μmol/L and TG ≥4.76 mmol/L are all risk factors for SBI after CEA.The prediction model based on the above risk factors has high predictive value for the occurrence of SBI after CEA in elderly CS patients.

Pathological specimen sampling is not only the prerequisite of a good pathological diagnosis, but also the primary clinical skill that must be mastered by the standardized residency training trainees (resident trainees) in clinical pathology department. In view of the problems and difficulties encountered in the teaching of specimen sampling, through five years of exploration and attempt, this paper has gradually established a new model with five basic elements, including theory teaching, practice teaching, promoting teaching effect by examination, learning from senior students, and review teaching. The results of evaluation analysis and questionnaire survey show that the teaching mode can make the trainees master the methods of specimen sampling quickly and efficiently, learn and improve clinical skills in practice, and lay a solid foundation for the subsequent standardized training of histopathological diagnosis.