Background: and Purpose Vertebrobasilar fusiform aneurysms (VBFAs) carry substantial morbidity and mortality, but optimal management for unruptured VBFAs remains unclear. We compared the safety and efficacy of conservative management (CM), stent-assisted coiling (SAC), and flow diverters (FDs) in patients with unruptured VBFAs, focusing on long-term prognosis. Methods: This study included data from a nationwide Chinese cohort of patients with vertebrobasilar dissecting aneurysms. Inverse probability of treatment weighting (IPTW) balanced confounders across groups. The primary outcome was poor prognosis (modified Rankin Scale score >2). Secondary outcomes included aneurysm rupture, ischemic stroke, compression symptoms, and VBFA-related deaths. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Among 1,115 patients with unruptured VBFAs, 838 (median age, 54 years; 655 men) were included. After IPTW, baseline characteristics were balanced. Median follow-up was 54 months. FD was associated with a lower risk of poor prognosis than CM (OR, 0.48 [95% CI, 0.30 to 0.77]; p=0.002), with no difference between CM and SAC. FD also reduced aneurysm rupture (OR, 0.20 [95% CI, 0.07 to 0.60]; p=0.004) and compression symptoms (OR, 0.30 [95% CI, 0.13 to 0.68]; p=0.004) versus CM. Time-to-event analyses further revealed significant differences in vertebral artery lesions and Type I–II VBFAs, whereas no significant differences were observed in basilar or vertebrobasilar junction lesions or in Type III–IV VBFAs. Conclusions Compared with CM, FD was associated with improved long-term outcomes in unruptured VBFAs, particularly in vertebral artery lesions and Type I–II VBFAs, although residual confounding cannot be excluded.

Objective To explore the traditional Chinese medicine(TCM)syndrome characteristics of patients with Chikungunya hemorrhagic fever and to provide empirical data to support the application of TCM in diagnosing and treating Chikungunya hemorrhagic fever.Methods A cross-sectional survey was conducted to collect clinical data(sex,age,days since onset,and comorbidity underlying disease conditions)and TCM with four-examination information(symptoms,tongue manifestations,and pulse manifestations)from 255 patients with Chikungunya hemorrhagic fever who visited Lecong Hospital of Shunde,Foshan,the Third People's Hospital of Shunde District of Foshan,Shunde Hospital of Southern Medical University Affiliated Chencun Hospital between July 23 and July 29,2025.Factor and cluster analyses were used to summarize TCM syndrome characteristics and analyze core pathogenesis in conjunction with clinical features.Results Among the 255 patients with Chikungunya hemorrhagic fever,131 were male and 124 were female,with a age of(49.05±17.93)years and a disease duration of(3.26±1.78)days.Among the four types of examination information in TCM,35 items exhibited a frequency exceeding 10%.The most prevalent symptoms were arthralgia(180 patients,70.59%),exanthem(153 patients,60.00%),fatigue(99 patients,38.82%),anhidrosis(98 patients,38.43%),pruritus(96 patients,37.65%),and fever(92 patients,36.08%).Tongue and pulse manifestations were primarily white fur(155 patients,60.78%),pink tongue(111 patients,43.53%),slippery pulse(143 patients,56.08%),and greasy fur(134 patients,52.53%).Patients with disease onset≤3 d had a higher incidence of arthralgia,fatigue,fever,aversion to cold,generalized muscle pain,aversion to wind,insomnia,headache,sweating,low-grade fever,poor appetite,loose stool,hyperhidrosis,and red tongue than those with disease onset≥4 d(P<0.05).Patients with disease onset≥4 d had a higher incidence of pink tongue and thick fur than those with disease onset≤3 d(P<0.05).The syndrome elements in patients with Chikungunya hemorrhagic fever predominantly manifested on the defensive exterior,with involvement of the sinew-bone joints,skin-muscle,and spleen.Pathogenic factors were primarily characterized by external winds,dampness,and heat.Factor and cluster analysis result indicated three TCM pathogenesis progression patterns:imbalance of the defensive exterior with wind-dampness conflict and heat transformation;dampness-heat flowing into muscles and meridians causing joint obstruction and qi blood stasis;and dampness-heat congelation resulting in qi mechanism obstruction,consumption of body fluids,and infiltration of the skin.Conclusion Patients with Chikungunya hemorrhagic fever primarily present with fever,joint pain,and rashes.In TCM,this condition falls under the category of"dampness-warmth"syndrome.Its etiology is attributed to pathogens,with transmission occurring through mosquito bites.The core pathogenesis of TCM is the invasion of the defensive exterior and dampness-toxic heat accumulation.The therapeutic principles focus on clearing heat pathogens,resolving dampness pathogens,dispersing wind pathogens,and promoting the resolution of rashes.

Objective The clinical characteristics of 21 cases of nocardiosis were reviewed and antimicrobial resistance of Nocardia strains was analyzed in order to improve the accuracy of clinical diagnosis and treatment of nocardiosis.Methods Clinical data of patients diagnosed with nocardiosis in Zhoukou Central Hospital from 2019-2023 and the corresponding results of antimicrobial susceptibility testing were retrospectively analyzed to summarize the clinical characteristics and outcomes of patients.Results Overall,the 21 cases of nocardiosis included 9 males and 12 females,aged 2-91 years.Underlying disease was reported in 15 patients.Most common type of nocardiosis was pulmonary nocardiosis in 15 cases,followed by skin and soft tissue infection,pleurisy,lymphadenitis,and disseminated nocardiosis.Laboratory tests showed increased levels of WBC,neutrophils percentage,erythrocyte sedimentation rate,C-reactive protein,and procalcitonin.The 21 strains of Nocardia included 4 strains of Nocardia cyriacigeorgica,2 strains each of Nocardia brasiliensis,Nocardia abscessus,Nocardia asiatica,Nocardia otitidiscaviarum and Nocardia beijingensis,and 1 strain each of Nocardia puris,Nocardia asteroides,Nocardia farcinica,Nocardia pneumoniae,Nocardia amamiensis,and 2 strains of unclassified Nocardia.All of the Nocardia strains(100％)were susceptible to linezolid,amikacin,and trimethoprim-sulfamethoxazole,followed by various levels of susceptibility to cefotaxime,moxifloxacin,imipenem and ceftriaxone,and lower susceptibility rate to cefepime,minocycline,ciprofloxacin and clarithromycin.Antimicrobial susceptibility of Nocardia strains varied with different Nocardia species.Of the 21 patients,two were referred to other hospitals,another two died,two patients received unknown treatment,and the remaining 15 patients were improved after antibiotic treatment,including sulfonamides combined with other antibiotics in 11 cases,other antibiotics in 4 cases.Conclusions Immunocompromised patients or those with underlying diseases are more susceptible to nocardiosis.The clinical features are complex and diverse.Antimicrobial susceptibility of Nocardia strains varied with different Nocardia species.Accurate identification and antimicrobial susceptibility test are essential for prescribing effective antibiotic treatment.

Objective The clinical characteristics of 21 cases of nocardiosis were reviewed and antimicrobial resistance of Nocardia strains was analyzed in order to improve the accuracy of clinical diagnosis and treatment of nocardiosis.Methods Clinical data of patients diagnosed with nocardiosis in Zhoukou Central Hospital from 2019-2023 and the corresponding results of antimicrobial susceptibility testing were retrospectively analyzed to summarize the clinical characteristics and outcomes of patients.Results Overall,the 21 cases of nocardiosis included 9 males and 12 females,aged 2-91 years.Underlying disease was reported in 15 patients.Most common type of nocardiosis was pulmonary nocardiosis in 15 cases,followed by skin and soft tissue infection,pleurisy,lymphadenitis,and disseminated nocardiosis.Laboratory tests showed increased levels of WBC,neutrophils percentage,erythrocyte sedimentation rate,C-reactive protein,and procalcitonin.The 21 strains of Nocardia included 4 strains of Nocardia cyriacigeorgica,2 strains each of Nocardia brasiliensis,Nocardia abscessus,Nocardia asiatica,Nocardia otitidiscaviarum and Nocardia beijingensis,and 1 strain each of Nocardia puris,Nocardia asteroides,Nocardia farcinica,Nocardia pneumoniae,Nocardia amamiensis,and 2 strains of unclassified Nocardia.All of the Nocardia strains(100％)were susceptible to linezolid,amikacin,and trimethoprim-sulfamethoxazole,followed by various levels of susceptibility to cefotaxime,moxifloxacin,imipenem and ceftriaxone,and lower susceptibility rate to cefepime,minocycline,ciprofloxacin and clarithromycin.Antimicrobial susceptibility of Nocardia strains varied with different Nocardia species.Of the 21 patients,two were referred to other hospitals,another two died,two patients received unknown treatment,and the remaining 15 patients were improved after antibiotic treatment,including sulfonamides combined with other antibiotics in 11 cases,other antibiotics in 4 cases.Conclusions Immunocompromised patients or those with underlying diseases are more susceptible to nocardiosis.The clinical features are complex and diverse.Antimicrobial susceptibility of Nocardia strains varied with different Nocardia species.Accurate identification and antimicrobial susceptibility test are essential for prescribing effective antibiotic treatment.

Stroke is an acute cerebrovascular disease with high morbidity,disability and mortality.It has a rapid onset,multifarious morbidity and complex pathogenesis,with phlegm representing as an important pathogenic factor.The treatment of the acute phase of stroke is of paramount importance in determining the prognosis of patients.The method of eliminating phlegm and opening the orifices represents a pivotal approach within the domain of Chinese medicine for the treatment of the acute phase of stroke.Moreover,contemporary medical science has corroborated the efficacy of this method through the examination of its applications from a multitude of perspectives.In this paper,the theoretical basis of the method of eliminating phlegm and opening the orifices is elaborated in depth,and the mechanism and clinical application of this method in the acute phase of stroke,such as phlegm-heat and visceral solidity,phlegm-fire stasis,wind-phlegm obstruction,and phlegm-stasis inter-conjugation,are summarized in detail,with a view to providing references to the clinical treatments.

Objective:To explore the application of near-infrared spectroscopy monitoring in the diagnosis of necrotizing enterocolitis (NEC) in extremely/very low birth weight infants.Methods:Extremely/very low birth weight infants suspected of having NEC who were hospitalized in the Neonatal Intensive Care Unit of Guangzhou Women and Children′s Medical Center from September 2019 to November 2021 were selected as the research subjects. The regional intestinal oxygen saturation (rintSO 2) and regional cerebral oxygen saturation (rcSO 2) of the children within 72 hours after the onset were monitored by near-infrared spectrometer. The mean values of rintSO 2 and rcSO 2, intestinal fractional tissue oxygen extraction (intFTOE), and splanchnic-cerebral oxygenation ratio (SCOR) during the monitoring period were calculated. According to whether NEC was diagnosed or not, the patients were divided into the non-NEC group and the NEC group. The NEC group was further divided into the common NEC group and the severe NEC group. The rintSO 2, rcSO 2, intFTOE and SCOR of each group were compared. Results:A total of 78 cases were included, including 50 cases in the non-NEC group and 28 cases in the NEC group. Among them, there were 17 cases in the common NEC group and 11 cases in the severe NEC group. The rcSO 2 in the NEC group was lower than that in the non-NEC group (65.2±6.1 vs 73.2±7.0), and the SCOR was higher than that in the non-NEC group (0.88±0.05 vs 0.81±0.07), and the differences were statistically significant (all P<0.05). There was no statistically significant difference in rintSO 2 and intFTOE between the two groups (all P>0.05). Both rintSO 2 and rcSO 2 in the severe NEC group were lower than those in the common NEC group [(52.0±4.6 vs 61.2±5.0) and (60.3±3.8 vs 68.3±5.0)], and intFTOE was higher than that in the common NEC group (0.46±0.05 vs 0.36±0.06). The differences were all statistically significant (all P<0.05). There was no statistically significant difference in SCOR between the two groups (all P>0.05). Conclusions:The monitoring values of near-infrared spectroscopy are correlated with the incidence of NEC in extremely/very low birth weight infants. Lower rcSO 2 and higher SCOR are helpful for identifying NEC, while lower rintSO 2, rcSO 2 and higher intFTOE are helpful for identifying severe NEC.

Objective:To explore the application of near-infrared spectroscopy monitoring in the diagnosis of necrotizing enterocolitis (NEC) in extremely/very low birth weight infants.Methods:Extremely/very low birth weight infants suspected of having NEC who were hospitalized in the Neonatal Intensive Care Unit of Guangzhou Women and Children′s Medical Center from September 2019 to November 2021 were selected as the research subjects. The regional intestinal oxygen saturation (rintSO 2) and regional cerebral oxygen saturation (rcSO 2) of the children within 72 hours after the onset were monitored by near-infrared spectrometer. The mean values of rintSO 2 and rcSO 2, intestinal fractional tissue oxygen extraction (intFTOE), and splanchnic-cerebral oxygenation ratio (SCOR) during the monitoring period were calculated. According to whether NEC was diagnosed or not, the patients were divided into the non-NEC group and the NEC group. The NEC group was further divided into the common NEC group and the severe NEC group. The rintSO 2, rcSO 2, intFTOE and SCOR of each group were compared. Results:A total of 78 cases were included, including 50 cases in the non-NEC group and 28 cases in the NEC group. Among them, there were 17 cases in the common NEC group and 11 cases in the severe NEC group. The rcSO 2 in the NEC group was lower than that in the non-NEC group (65.2±6.1 vs 73.2±7.0), and the SCOR was higher than that in the non-NEC group (0.88±0.05 vs 0.81±0.07), and the differences were statistically significant (all P<0.05). There was no statistically significant difference in rintSO 2 and intFTOE between the two groups (all P>0.05). Both rintSO 2 and rcSO 2 in the severe NEC group were lower than those in the common NEC group [(52.0±4.6 vs 61.2±5.0) and (60.3±3.8 vs 68.3±5.0)], and intFTOE was higher than that in the common NEC group (0.46±0.05 vs 0.36±0.06). The differences were all statistically significant (all P<0.05). There was no statistically significant difference in SCOR between the two groups (all P>0.05). Conclusions:The monitoring values of near-infrared spectroscopy are correlated with the incidence of NEC in extremely/very low birth weight infants. Lower rcSO 2 and higher SCOR are helpful for identifying NEC, while lower rintSO 2, rcSO 2 and higher intFTOE are helpful for identifying severe NEC.

Objective To explore the changes in the levels of serum myocardial injury markers troponin I(cTNI),myoglobin(MYO),creatine kinase isoenzyme(CK-MB),and N-terminal pro-B natriuretic peptide precursor(NT-proBNP)in elderly patients with hypertension complicated with heart failure and their clinical value.Methods A total of 110 elderly patients with hypertension complicated with heart failure in the hospi-tal from February 2022 to February 2024 were selected as the hypertension complicated with heart failure group.During the same period,110 patients with simple heart failure were selected as the heart failure group,and 110 patients with simple hypertension were selected as the hypertension group.The levels of serum cTNI,MYO,CK-MB and NT-proBNP in each group were compared.Multivariate Logistic regression was used to an-alyze the influencing factors of hypertension complicated with heart failure.The receiver operating characteris-tic(ROC)curve was drawn to analyze the diagnostic efficacy of serum cTNI,MYO,CK-MB and NT-proBNP for hypertension complicated with heart failure.Results Compared with the hypertension group,the levels of serum cTNI,MYO,CK-MB and NT-proBNP in the hypertension combined with heart failure group and the heart failure group increased(P＜0.05);Compared with the heart failure group,the levels of serum MYO and NT-proBNP in the hypertension combined with heart failure group increased(P＜0.05).The results of multi-variate Logistic regression analysis showed that NT-proBNP was an independent influencing factor for hyper-tension complicated with heart failure(P＜0.05).The results of the ROC curve showed that the areas under the curve of serum cTNI,MYO,CK-MB,and NT-proBNP alone and in combination for the diagnosis of hyper-tension complicated with heart failure were 0.768,0.729,0.687,0.904,and 0.905,respectively.The sensitivi-ties were 96.4％,50.0％,79.1％,90.0％and 90.9％respectively,and the specificities were 54.1％,100.0％,60.0％,78.2％and 75.0％respectively.Conclusion Serum cTNI,MYO,CK-MB and NT-proBNP are highly expressed in elderly patients with hypertension complicated with heart failure.The combination of the four has a high diagnostic value for hypertension complicated with heart failure.

Huang Yuanyu, a famous TCM doctor in the Qing Dynasty, believed that the human body's qi system revolves around the spleen and stomach as the pivot, with the liver, heart, lungs, and kidneys as the four major organs, and the circulation is constant. TCM guided therapy regulates qi and blood by regulating the body, heart, and breath, which is in line with this theory. Based on Huang Yuanyu's "pivot movement" theory, this article explored the application of guided therapy in refractory gastroesophageal reflux disease (rGERD). Guided by the "pivot movement" theory, which includes the left path wood fire rising and falling, the right path gold water converging and falling, and the adjustment of the focal point through the mediation of earth and qi, and referring to the guidance movement methods in the Ba Duan Jin and Zhu Bing Yuan Hou Lun, a "pivot guidance method" for rGERD patients is developed, five movements: adjusting the body and heart, turning the waist and benefiting the kidneys, including rubbing the abdomen and regulating the spleen, soothing the liver and bending the knees, and tightening the lungs and reducing reflux. The aim is to promote smooth circulation of qi throughout the body and improve symptoms of gastroesophageal reflux. In clinical practice, guided therapy should be applied under the guidance of a doctor, with slow and gentle movements, attention to regulating breathing, and long-term persistence.

Epidermal growth factor receptor(EGFR)gene exon 20 insertion(ex20ins)mutation is a common driver gene activation mutation in non-small cell lung cancer(NSCLC).Tumors harboring this gene mutation are characterized by high heterogeneity,high malignancy,low detectability,poor response to conventional therapies,and poor prognosis.In recent years,significant progress has been made in the study of EGFR ex20ins mutation.The wide application of next-generation sequencing has improved the detection rate.The U.S.Food and Drug Administration(FDA)has approved the relevant indications of amivantamab in NSCLC patients with EGFR ex20ins mutation.A variety of new drugs have also achieved good results in previous studies.This article will summarize the structural characteristics,detection methods and clinical treatment progress of NSCLC patients with EGFR ex20ins mutations,hoping to provide help for the choice of clinical treatment for such patients.