This paper summarizes Professor ZHAI Shuangqing's clinical experience in using metal and mineral medicines to treat mental disorders. Based on xiang thinking， the symptoms of mental disorders are classified into five categories， depression-xiang， wind-xiang， fire-xiang， phlegm-xiang， and deficiency-xiang， and the mechanisms of disease development are discussed accordingly. Metal and mineral medicines are key treatments for mental disorders， not only having the function of calming the mind but also promoting qi， stabilizing wind， expelling evil， and tonifying. In clinical practice， the emphasis is placed on harmonizing the disease and its symptoms. Based on self-developed prescription formulas， the appropriate metal and mineral medicines are selected according to the properties， flavors， meridian tropism， and actions of the medicines， as well as the xiang patterns of the mental disorder. For example， Attention Deficit Hyperactivity Disorder （ADHD） is treated by Modified Xiehuang Powder （泻黄散） with Sijunzi Decoction （四君子汤） and adding Fulonggan （Testudinis Carapax） and Longgu （Os Draconis）. Persistent insomnia is treated by combining a self-developed insomnia formula with Longgu （Os Draconis）， Hupo （Succinum）， and Cishi （Magnetitum）. Obsessive-compulsive disorder （OCD） is treated by combining a self-developed OCD formula with Longchi （Dens Draconis）， Qingmengshi （Fluoritum）， and Zheshi （Haematitum）. Epilepsy is treated by combining an anti-epilepsy decoction with Qingmengshi （Fluoritum）， Longchi （Dens Draconis）， and Shengtieluo （Ferrum Rudis）.

Objective: To improve the efficiency and standardization of preoperative anemia diagnosis and treatment by establishing a systematic intelligent management platform for preoperative anemia. Methods: A multidisciplinary collaborative model was adopted to develop a preoperative anemia management system that integrates intelligent early warning, standardized treatment pathways, and quality control. The system utilizes natural language processing technology to automatically capture laboratory data and establish evidence-based medical decision support functions. A pre-post study design was employed to compare changes in preoperative anemia screening rates, preoperative anemia intervention rates, reasonable use of iron supplements, and perioperative red blood cell transfusion rates before and after system implementation. Results: After system implementation, the standardization of anemia diagnosis and treatment significantly improved: 1) Screening effectiveness: The anemia screening rate increased to 50.00% (an increase of 27.24%); 2) Intervention effectiveness: The anemia treatment rate rose to 56.30% (an increase of 14.02%); 3) Treatment standardization: The reasonable use rate of iron supplements increased to 55.33% (an increase of 21.02%); the red blood cell transfusion rate decreased to 18.29% (a decrease of 4.07%), and the amount of red blood cell transfusions was reduced by 291 units. Conclusion: This system achieves full-process management of preoperative anemia through information technology, significantly enhancing the standardization of diagnosis and treatment as well as intervention effectiveness, providing an effective solution for perioperative anemia management.

OBJECTIVE: To explore the effectiveness of arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release in the treatment of non-traumatic elbow stiffness. METHODS: The clinical data of 15 patients with non-traumatic elbow stiffness treated with arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release between April 2019 and September 2023 were retrospectively analyzed. There were 6 males and 9 females with an average age of 46 years ranging from 34 to 56 years. The causes included rheumatoid arthritis in 3 cases, gouty arthritis in 2 cases, loose bodies in 3 cases, and elbow osteoarthritis in 7 cases. There were 4 cases with ulnar neuritis and 3 cases with synovial osteochondromatosis. The duration of elbow stiffness ranged from 6 to 18 months, with an average of 10 months. The operation time and intraoperative blood loss were recorded. The effectiveness was evaluated by visual analogue scale (VAS) score, range of elbow motion (maximum flexion, maximum extension, and total flexion and extension), Mayo score, and Hospital for Special Surgery (HSS) elbow score. RESULTS: The operation time was 60-90 minutes, with an average of 65 minutes, and the intraoperative blood loss was 40-100 mL, with an average of 62 mL. All patients were followed up 13-18 months, with an average of 14 months. There was no complication such as vascular and nerve injury, poor wound healing, collateral ligament injury, elbow joint space narrowing, osteophyte proliferation, or loose body formation around the joint. At last follow-up, the elbow range of motion (maximum flexion, maximum extension, and total flexion and extension), VAS score, and Mayo score significantly improved when compared with those before operation ( P<0.05). The HSS elbow score was 85-95, with an average of 92; 12 cases were excellent, 3 cases were good, and the excellent and good rate was 100%. CONCLUSION Arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release is an effective way to treat non-traumatic elbow stiffness, which has the advantages of small trauma, short operation time, and good effectiveness. It can carry out early elbow rehabilitation training and significantly improve elbow function.
Humans ; Male ; Female ; Arthroscopy/methods* ; Adult ; Middle Aged ; Elbow Joint/physiopathology* ; Retrospective Studies ; Range of Motion, Articular ; Treatment Outcome ; Ulnar Nerve/surgery* ; Operative Time

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This paper summarized professor ZHAI Shuangqing's clinical experience in treating obsessive-compulsive disorder （OCD） from the perspective of "qi constraint with harassing phlegm". It is believed that qi constraint with harassing phlegm is the core pathogenesis of OCD. Qi constraint and harassing phlegm interact with each other and together contribute to the disease. The formation of "qi constraint with harassing phlegm" is closely related to dysfunction of zang-fu （脏腑） organs such as the heart， spleen， liver， and gallbladder. Clinical treatment should focus on rectifying qi and dispelling phlegm， calming the mind with heavy sedatives. Based on the self-designed Jieyu Huatan Decoction（解郁化痰汤）， treatment should be tailored to the patient's condition and stage of the disease， with prescriptions incorporating medicinals that fortify the spleen and boost the stomach， nourish the heart and calm the mind， soothe the liver and promote gallbladder function， and nourish yin and warm yang. At the same time， it is emphasized to flexibly select heavy sedatives such as Longgu （Os Draconis）， Longchi （Dens Draconis）， Muli （Concha Ostreae） and Zhenzhumu （Concha Margaritiferae Usta） to calm the mind.

Objective To investigate the effects of icariin on high glucose-induced autophagy and apoptosis of podocytes,and the regulating effects on mammalian target of rapamycin(mTOR)/serine-threonine kinase(Akt)/cyclic adenosine monophosphate response element binding protein(CREB)pathway.Methods The mouse podocytes MPC5 were taken and divided into five groups:normal control group(5.5 mmol·L-1 glucose),high glucose group(30 mmol·L-1 glucose),icariin group(30 mmol·L-1glucose+5 μmol·L-1icariin),GDC-0349 group(30 mmol·L-1glucose+50 μmol·L-1 GDC-0349),icariin+GDC-0349 group(30 mmol·L-1 glucose+5 μmol·L-1 icariin+50 μmol·L-1 GDC-0349).Cultured for 48 hours,the tetramethylazozolium salt method was used to detect the viability of MPC5 cells;acridine orange staining was used to observe the autophagy of MPC5 cells;apoptosis of MPC5 cells was detected by flow cytometry;Western blotting was used to detect the expression of autophagy[microtubule associated protein one light chain 3(LC3)II,LC3Ⅰ,autophagy-related protein(Beclin-1)],apoptosis[Bcl-2 related X protein(Bax),B cell lymphoma-2(Bcl-2)]and mTOR/Akt/CREB pathway-related proteins of MPC5 cells.Results Compared with the normal control group,the cell viability,expression levels of Bcl-2,phosphorylated mTOR(p-mTOR)/mTOR,phosphorylated Akt(p-Akt)/Akt,phosphorylated CREB(p-CREB)/CREB protein of MPC5 cells in the high glucose group were significantly decreased(P＜0.05),the autophagy ability was enhanced,the autophagosome showed orange fluorescence,and the apoptosis rate,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bax protein expression levels were significantly increased(P＜0.05).Compared with the high glucose group,the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt,p-CREB/CREB protein expression levels of MPC5 cells in icariin group were significantly increased,the autophagy ability was further enhanced,the number of autophagosomes was increased,the autophagosomes showed brick red fluorescence(P＜0.05),the apoptosis rate and Bax protein expression level were significantly decreased(P＜0.05),and the cell viability,LC3Ⅱ/LC3Ⅰ,Beclin-1,Bcl-2,p-mTOR/mTOR,p-Akt/Akt and p-CREB/CREB proteins expression levels of MPC5 cells in GDC-0349 group were significantly decreased,the autophagy ability was weakened,the number of autophagosomes was reduced,the autophagosomes showed orange fluorescence(P＜0.05),and the apoptosis rate and Bax protein expression level were significantly increased(P＜0.05);icariin+GDC-0349 could reverse the effect of icariin on high glucose induced MPC5 cells(P＜0.05).Conclusion Icariin promotes elevated glucose-induced podocyte autophagy and inhibits apoptosis by activating the mTOR/Akt/CREB pathway.

Objective To evaluate the effectiveness and safety of acupuncture in patients with Major Depressive Disorders.Methods Search the database for relevant literature published before April 15,2023.Select randomized controlled trial that meeting the enrollment criteria,evaluate the quality of the literature and classify before meta-analysis systematic evaluation.Results 15 RCTs are included in this study,with a total of 1077 patients.The results showed that acupuncture treatment,compared with antidepressants alone,The score of Hamilton Depression Scale(HAMD)in patients with liver-qi depression disorder[MD=-0.73,95%CI(-1.22,-0.24),P<0.05],the score of TCM Syndrome Scale[MD=-1.89,95%CI(-2.35,-1.44),P<0.001],effective rate[RR=1.09,95%CI(1.03,1.153),P=0.001]and TESS score[MD=-2.76,95%CI(-3.68,-1.85),P<0.001]were statistically significant.Compared with fluoxetine hydrochloride,the effective rate of HAMD scale score was statistically significant[RR=1.07,95%CI(1.01,1.14),P<0.05].Conclusion Compared with antidepressants alone,acupuncture therapy has the advantages for the improvement of HAMD score in patients,the improvement of Traditional Chinese medicine symptoms,and significantly less adverse effects than those in the control group.Through this study,it is considered that acupuncture can be a safe and effective treatment modality.However,due to the quantity and quality of the included literature,the above conclusions still need to be verified by more high-quality clinical trials.

Objective To observe the echocardiographic manifestations of infective endocarditis(IE)complicated with valve damage in children.Methods Totally 104 children with IE were retrospectively enrolled and divided into non-damage group(n=34),mild damage group(n=39)and dysfunction group(n=31)according to whether complicated with valve damage and damage's degree.The general and echocardiographic data were compared among groups,and the echocardiographic characteristics of IE complicated with valve damage in children were analyzed.Results Significant difference of the proportion of combining with other congenital heart diseases(excluding bicuspid aortic malformations),the incidence of embolization events during hospital stay,also of endocarditis of left cardiac system were found among groups(all P＜0.05).Pairwise comparison showed that in non-damage group,the proportion of combining with other congenital heart diseases was higher,while the incidence of endocarditis of left cardiac system was lower than those in both mild damage group and dysfunction group(all P＜0.05).The incidence of embolization events during hospital stay in non-damage group was lower than that in dysfunction group(P＜0.05).Among 70 cases of IE complicated with valve damage,mitral valve(30/70,42.86％)was the most common involved valve,mostly presented as valve stenosis(63/70,90.00％).No significant difference of valve involvement site,valve structural lesions nor the incidence of valve stenosis was found between mild damage group and dysfunction group(all P＞0.05).Conclusion IE complicated with valve damage in children mostly involved left cardiac system,and the risk of embolization events was higher than that of IE children without valve damage.Echocardiography could be used as an important method for evaluating the site of valve involvement and the degree of damage.

Objective:To explore the adjustment ranges of auto-segmentation contours for organs at risk (OAR) in patients with nasopharyngeal carcinoma and assess the dosimetric impacts of the contours from varying sources on radiotherapy plans.Methods:Twenty-five patients with early-stage nasopharyngeal carcinoma were investigated. Through expert delineation, deep learning-based automatic delineation, and atlas-based automatic delineation of their spinal cord, brainstem, optic nerves, optic chiasm, parotid glands, oral cavity, hypopharynx, and mandible, as well as expert correction of these automatic delineations, five structure sets were formed. Moreover, the contours delineated by experts (also referred to as the expert contours) of the target volumes and other OARs were copied into the images for subsequent research. The Dice similarity coefficients (DSCs) of the structure sets were calculated. Using the radiotherapy plans optimized based on expert contours as templates, the radiotherapy plans and dose distributions of all the structure sets were established. The expert contours and contours determined using automatic delineation and corrected by experts (also referred to as the corrected contours) were defined as clinical contours. Then, three research objectives were set: the dosimetric effects of inter-observer clinical contour variations, the impacts of contour variations on plan optimization, and the impacts of contour variations on plan evaluation.Results:The average DSC of the visual pathway was 0.62±0.10, lower than that of other OARs (0.86±0.04). After expert correction, the DSCs of contours obtained using deep learning- and atlas-based automatic delineation increased by 7.61% and 10.69%, respectively. For the dosimetric effects of inner-observer contour variations, the Dmax of the optic chiasm was the maximum (3.96±6.02)Gy, while the Dmean of the hypopharynx was the minimum (0.81±0.55 Gy). When the impacts of contour variations on plan optimization were assessed based on expert contours, the dose differences (Δ D) exceeding ±3 Gy accounted for 22%, 14%, 46%, and 42%, respectively for the spinal cord, brainstem, optic nerve, and optic chiasm and accounted for only 2% for other OARs. After expert correction, the Δ D between automatic and expert contours decreased, with Δ D exceeding ±3 Gy decreased by 16% and 14%, respectively for the optic nerves and optic chiasm. When the average distance of the overlap volume histogram (OVH) exceeded 3.5 cm, all Δ Dmax fell within ±3 Gy. When the average distance of OVH was greater than 1.5 cm, all Δ Dmean fell within ±2 Gy. For contours obtained using deep learning and atlas-based automatic delineation, the doses of 50.0%±17.3% and 52.6%±19.3% of patients fell within the dose ranges of clinical contours, respectively. The numbers of patients for whom the Dmax of the spinal cord, optic nerve, optic chiasm and the D1 cm 3 of the mandible in the two types of automatic contours fell within the dose ranges of clinical contours were statistically different ( t = -4.24, -3.99, -3.16, 3.51, P < 0.05). Conclusions:After expert correction, the automatic delineation results from different sources exhibited certain geometric differences. The expert correction reduced the impacts of automatic contours on plan optimization. The average distance of OVH is identified as an important feature used to determine dose differences. For small-volume serial organs close to the target volumes, meticulous corrections are required before applying auto-segmentation to clinical practice.

Objective:To evaluate the significance of the lumbar bowstring ratio (LBR) and sagittal spine-pelvis parameters in predicting postoperative neurogenic pain in adult patients with high-grade lumbar isthmic spondylolisthesis following spinal fusion surgery.Methods:A retrospective analysis was conducted on the clinical and imaging data of 95 adult patients with high-grade lumbar isthmic spondylolisthesis treated by spinal surgery at Xiangya Hospital of Central South University from August 2012 to January 2023. Each patient was followed for a minimum of six months. Participants were categorized into pain and non-pain groups based on the presence of persistent radicular pain (≥8 weeks) and a visual analogue scale (VAS) score of ≥3 postoperatively. The pain group comprised 15 patients (5 males, 10 females; mean age 55.47±6.42 years, range 46-71 years), while the non-pain group included 80 patients (20 males, 60 females; mean age 60.98±11.50 years, range 40-85 years). Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and VAS scores. LBR was defined as the ratio of the vertical distance from the anterior convexity of the L 1-L 5 anterior longitudinal ligament to a line connecting the posterior superior margin of the L1 vertebra and the posterior margin of the S1 vertebra, to the distance between these two points. Spinal-pelvic parameters measured included pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), PT/SS ratio, and changes in LBR before and after surgery (ΔLBR). Statistical comparisons of demographic and imaging parameters were performed between the two groups, and variables showing significant differences were subjected to binary logistic regression analysis to identify independent risk factors for postoperative neurogenic pain. Results:All 95 patients achieved complete anatomical reduction of the dislocation without reported wound infections. Follow-up was completed at 7.68±2.98 months (range 6-12 months) postoperatively. Among the patients, 15 developed iatrogenic radicular pain. Postoperative complications included pulmonary infection (4 cases: 1 in the pain group, 3 in the non-pain group), cerebrospinal fluid leakage (8 cases: 2 in the pain group, 6 in the non-pain group), and delirium (5 cases: 2 in the pain group, 3 in the non-pain group). No significant differences were observed in demographic data between the groups ( P>0.05). Both groups demonstrated significant improvements in ODI (pain group Z=-3.413, P=0.001; non-pain group Z=-7.772, P<0.001) and VAS scores (pain group Z=-3.426, P=0.001; non-pain group Z=-7.838, P<0.001) at the 6-month follow-up compared to preoperative values. Significant differences were found between the pain and non-pain groups in PI ( t=3.315, P=0.004), PT ( t=5.087, P<0.001), SS ( t=7.431, P<0.001), LL ( t=3.764, P<0.001), PT/SS ( t=7.267, P<0.001), LBR ( t=6.455, P<0.001), and ΔLBR ( Z=5.362, P<0.001) before and after surgery. Binary logistic regression analysis identified smaller preoperative PT/SS [ OR=0.760, 95% CI(0.601, 0.961), P=0.022] and larger preoperative LBR [ OR=5.721, 95% CI (1.068, 30.634), P=0.042] as independent risk factors for postoperative neurogenic pain. Conclusion:High LBR and reduced PT/SS are significant risk factors for neurogenic pain following complete discectomy and fusion in adult patients with high-grade lumbar isthmic spondylolisthesis. For such patients, careful consideration is warranted regarding anatomical complete reduction during surgical intervention.