" Lijie and yellowish sweating" originates from the chapter on stroke and arthralgia diseases in Synopsis of Golden Chamber. Later generations typically interpret it as yellow fluid oozing from painful joints, a characteristic manifestation of arthralgia. In Western medicine, Lijie corresponds to diseases such as gouty arthritis, with its primary clinical manifestations being redness, swelling, heat, and painful joints, most often without yellow fluid discharge. Therefore, the interpretation of " Lijie and yellowish sweating" contradicts the clinical manifestations often observed in this disease. Thus, this article reinterprets the meaning of " Lijie and yellowish sweating" from the pathogenesis of " sweat exposure to water, as if water harms the heart" , combined with the viewpoints of other medical practitioners. Determining the meaning of " yellowish sweating" is crucial for understanding the pathogenesis of arthralgia and clarifying the relationship between arthralgia and yellowish sweating. ZHANG Zhongjing mentioned arthralgia and " yellowish sweating" together, not to differentiate between the two diseases but to emphasize the common pathogenesis of the two, namely, the cold and dampness injuring the heart, blood, and vessels. This paper proposes a new explanation of " Lijie and yellowish sweating" , which suggests that " yellowish sweating" is not confined to the joints but can be found all over the body. The pathogenesis of " Lijie and yellowish sweating" lies in the insufficiency of the liver and kidney and exogenous water dampness, leading to disharmony between nutrient qi and defensive qi and between yin and yang. Primary treatment should harmonize yingfen and weifen, as well as tonify and replenish the liver and kidney. The clinical selection of medicines can be considered Guizhi Decotion, a type of formula. The pathogenesis of " Lijie and yellowish sweating" is complex, and clinical treatment should be comprehensively considered to achieve the best therapeutic effect.

Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

Objective To explore the medication law of Professor Wang Qingguo for the treatment of insomnia based on data mining technology.Methods Paper-based prescriptions for Professor Wang Qingguo's treatment of insomnia from December 2016 to August 2023 were collected and a database was constructed.The screened prescriptions were subjected to data mining such as frequency statistics,association rule analysis,and clustering analysis.Results Totally 399 effective outpatient prescriptions were screened-out,involving 276 kinds of Chinese materia medica,with a total frequency of 6738 times.There were 38 Chinese materia medica with a frequency of use≥50.The properties were mainly warm,cold and mild,the tastes were mainly sweet,bitter and pungent,and mainly belong to the lung,spleen and heart meridians.Association rule analysis showed that the most commonly used drug combinations were"Fructus Tritici Levis-Scutellariae Radix-Bupleuri Radix","Pericarpium Citri Reticulatae-Scutellariae Radix-Pinelliae Rhizoma",etc.Association rule network analysis obtained a core prescription containing 12 kinds of Chinese materia medica for insomnia.Four new drug combinations were obtained by clustering analysis.Conclusion Professor Wang's treatment of insomnia has the characteristics of following the original meaning of Huang Di Nei Jing and Nan Jing,making good use of the classical prescription,applying combined prescription,flexible use of prescription,combining ancient and modern prescriptions,using specific medicine.It deeply reflects the academic view of"Tongping Zhihe".

Objective:To analyse the clinical efficacy of arthroscopic double-bundle Endobutton fixation of the thin bone channel in the treatment of Rockwood type III-V acromioclavicular joint dislocation.Methods:A total of 34 patients with acromioclavicular joint dislocation, 24 males and 10 females, aged 50.9±11.0 years (range, 21-74 years), who underwent arthroscopic double-bundle Endobutton fixation of the thin bone channel at Zhejiang Province Taizhou Hospital, Wenzhou Medical University, from February 2015 to February 2022 were retrospectively analyzed. There were 24 cases on the left side and 10 cases on the right side. Causes of injury: 23 cases of car accident, 7 cases of fall, 4 cases of falling from height. Rockwood classification: Type III 17 cases, type IV 9 cases, type V 8 cases. The visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and joint range of motion were used to evaluate shoulder pain and functional improvement.Results:All patients successfully completed the operation and were followed up for an average of 16.6±2.8 months (range, 12-24 months). Postoperative VAS scores were significantly lower compared to preoperative scores ( F=199.408, P<0.001), with the final follow-up VAS score being 1.32±0.47, significantly lower than the preoperative score of 4.71±1.19 ( P<0.001). Postoperative ASES scores were significantly higher compared to preoperative scores ( F=335.838, P<0.001), with the final follow-up ASES score being 88.85±6.41, significantly higher than the preoperative score of 34.76±5.79 ( P<0.001). The Constant-Murley scores of 3 months, 6 months after operation and the last follow-up were 77.79±5.34, 87.40±5.19 and 88.17±4.40, respectively, which were higher than that before operation 37.41±6.52, and the difference was statistically significant ( P<0.05). At the final follow-up, shoulder flexion, adduction, and abduction were 172.9°±6.4°, 59.2°±6.2°, and 59.3°±5.9°, respectively. The coracoclavicular distance was 1.76±0.42 mm, 0.84±0.19 mm, and 0.87±0.18 mm before operation, 3 months after operation, and at the last follow-up, respectively, and the difference was statistically significant ( F=101.160, P<0.001). Whereas, 3 months postoperative and the final follow-up were smaller than the preoperative ones, and the difference was statistically significant ( P<0.05). All incisions healed in one stage, and there was no vascular or nerve injury, internal fixation infection, coracoid process or clavicle bone tunnel fracture, or internal fixation loosening or breakage. Conclusion:Arthroscopic double-bundle Endobutton fixation with thin bone channel for the treatment of Rockwood type III-V acromioclavicular joint dislocation can improve shoulder function and reduce pain, with high surgical safety.

Objective:To investigate the application value of CT and MRI imageomics based on machine learning method in the diagnosis of pancreatic cancer.Methods:The clinical data of 62 patients with surgically resected and pathologically confirmed pancreatic cancer, who underwent enhanced CT scan, MRI plain or enhanced scan in Shanghai General Hospital between January 2014 and December 2021 were collected. According to the chronological order of surgery, 49 patients from January 2014 to December 2020 were enrolled in the training set and 13 patients from January 2021 to December 2021 were enrolled in the validation set. 3D-slicer 4.8.1 software was used to draw the region of interest in each layer of CT and MRI images for cancerous and paracancerous tissue segment. Image features were extracted by Python and the optimal feature set from the training set data was obtained by using Lasso regression model. The machine learning decision tree model was constructed. The receiver operating characteristic curve(ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the value of these three kinds of imageomics models in the diagnosis of pancreatic cancer.Results:The 1 767 CT features and 1 674 MRI features were obtained from enhanced CT scan, MRI plain scan and enhanced MRI scan, respectively. For the differential diagnosis model of cancerous tissue and paracancerous tissue, the enhanced CT scan data model obtained the optimal feature set involving 6 features, the MRI plain scan model obtained the optimal feature set involving 16 features, and the enhanced MRI scan model obtained the optimal feature set involving 15 features. The diagnostic model based on enhanced CT scan had an AUC of 0.98 in the training set and 1 in the verification group. The AUC of the MRI plain scan and enhanced MRI scan models in both the training set and the validation set was 1. The specificity and sensitivity of machine learning decision tree model based on the three kinds of imageomics models in the diagnosis of cancerous tissue and paracancerous tissue were 100%. For the differential diagnosis model of splenic artery wrapping, the enhanced CT scan model didn′t obtain the optimal features and had no diagnostic efficacy. The MRI plain scan model and enhanced MRI scan model obtained the optimal feature set involving 5 and 4 features, respectively. The AUC of the MRI plain scan model in the training set and the validation set were 0.862 and 0.750, respectively, with diagnostic sensitivity of 93.8% and 50.0%, and specificity of 78.6% and 100%, respectively. The AUC of the enhanced MRI scan model in the training set and the validation set were 0.950 and 0.861, respectively, with diagnostic sensitivity of 90.0% and 93.6%, and specificity of 100% and 78.6%, respectively.Conclusions:Based on the radiomics of CT enhanced, MRI plain scan and enhanced MRI scan, the machine learning diagnostic model has an accuracy of more than 90% in differentiating pancreatic cancer from paracancerous tissue. For the differentiation of splenic artery wrapping in pancreatic cancer, the diagnostic model based on enhanced MRI scan haS the best diagnostic efficiency.

Objective: To analyze the effects of twirling reinforcing and reducing manipulations on protein expres-sion in parietal cortex of spontaneously hypertensive rats (SHRs), and elucidate the main mechanisms and differences between two manipulations in hypertension treatment. Methods: Rats were randomly divided into the control, model, twirling reinforcing manipulation (TRFM), and twirling reducing manipulation (TRDM) groups. The control and model groups received catch and fixation stimulations once a day for 14 days. The TRFM and TRDM groups were intervened once a day for 20 min for 14 days. On days 0, 2, 6, 10, and 14 after acupuncture, rat systolic blood pressures (SBPs) were measured. Differential protein (DP) expression in the rat parietal cortices was detected. Thereafter, GO functional significance and KEGG pathway enrichment analyses were performed. Results: Compared with the model group, SBP of rats in the TRDM and TRFM groups decreased on days 6 and 10 of acupuncture, respectively (P=.009; P<.001). Moreover, SBP of the TRDM group was signif-icantly lower than that of the TRFM group on days 10 and 14 of acupuncture (P = .015; P = .013). Compared with control group, 601 and 1040 DPs were up-and downregulated, respectively, in the model group. Compared with model group, 44 and 28 up-and downregulated DPs were expressed, respectively, in the TRFM group. Compared with model group, expression of 616 and 427 up-and downregulated DPs, respectively, was found in the TRDM group. After combining the results of GO and KEGG enrichment analyses, five and one pathways were found to be related to the central antihypertensive mechanism of the parietal cortex during twirling reducing and reinforcing manipulations, respectively. Conclusion: TRDM showed a more effective antihypertensive effect on SHRs than TRFM; this antihy-pertensive effect was related to the regulation of different proteins and their biological functions.

Objective:To investigate the effect of different strategies on auricle reconstruction in microtia with very low hairline according to the skin condition of retroauricular mastoid region and the degree of temporal bone development.Methods:The clinical data of patients with very low hairline congenital microtia admitted to the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2014 to June 2019 were retrospectively analyzed. Surgical plan: the patients with moderate temporal bone development and thin and poor elasticity skin were treated with retroauricular skin expansion combined with laser hair removal; the patients with moderate temporal bone development and thick and loose skin were treated with fasciocutaneous flap expansion combined with laser hair removal; the patients with poor temporal bone development were treated with temporal superficial fascia combined with Medpor frame for one-time reconstruction. All patients were followed up to investigate their satisfaction with the three-dimensional structure and subunit morphology of the reconstructed ear, and the complications were recorded.Results:A total of 68 patients, 55 males and 13 females, aged from 5 to 22 years old, with an average of 10.4 years old, were included in this study. Among them, 22 patients were treated with retroauricular skin expansion combined with laser hair removal, 41 patients were treated with retroauricular fasciocutaneous flap expansion combined with laser hair removal, and 5 patients were treated with temporoparietal superficial fascia combined with Medpor frame for one-stage reconstruction. The follow-up ranged from 10 to 24 months (average 13 months). The three-dimensional structure and local subunits of 66 cases of reconstructed ears were in good shape, and the operation area recovered well without obvious scar hyperplasia and chest deformity. Among them, 6 patients remained a small amount of hair after laser hair removal treatment, and the satisfactory effect was achieved after re-hair removal treatment. The satisfaction rate of patients was 97.1% (66/68). Two cases of auricle reconstruction by retroauricular skin expansion combined with laser hair removal showed cartilage exposure after operation, and recovered with temporoparietal fascial flap after. No subcutaneous hematoma, poor skin graft survival, cartilage absorption, deformation and other complications occurred in all cases.Conclusions:According to the skin condition and temporal bone development degree of patients with very low hairline, different treatment schemes can obtain better auricle shape, improve postoperative patient satisfaction and reduce complications.

Objective:To investigate the effect of different strategies on auricle reconstruction in microtia with very low hairline according to the skin condition of retroauricular mastoid region and the degree of temporal bone development.Methods:The clinical data of patients with very low hairline congenital microtia admitted to the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2014 to June 2019 were retrospectively analyzed. Surgical plan: the patients with moderate temporal bone development and thin and poor elasticity skin were treated with retroauricular skin expansion combined with laser hair removal; the patients with moderate temporal bone development and thick and loose skin were treated with fasciocutaneous flap expansion combined with laser hair removal; the patients with poor temporal bone development were treated with temporal superficial fascia combined with Medpor frame for one-time reconstruction. All patients were followed up to investigate their satisfaction with the three-dimensional structure and subunit morphology of the reconstructed ear, and the complications were recorded.Results:A total of 68 patients, 55 males and 13 females, aged from 5 to 22 years old, with an average of 10.4 years old, were included in this study. Among them, 22 patients were treated with retroauricular skin expansion combined with laser hair removal, 41 patients were treated with retroauricular fasciocutaneous flap expansion combined with laser hair removal, and 5 patients were treated with temporoparietal superficial fascia combined with Medpor frame for one-stage reconstruction. The follow-up ranged from 10 to 24 months (average 13 months). The three-dimensional structure and local subunits of 66 cases of reconstructed ears were in good shape, and the operation area recovered well without obvious scar hyperplasia and chest deformity. Among them, 6 patients remained a small amount of hair after laser hair removal treatment, and the satisfactory effect was achieved after re-hair removal treatment. The satisfaction rate of patients was 97.1% (66/68). Two cases of auricle reconstruction by retroauricular skin expansion combined with laser hair removal showed cartilage exposure after operation, and recovered with temporoparietal fascial flap after. No subcutaneous hematoma, poor skin graft survival, cartilage absorption, deformation and other complications occurred in all cases.Conclusions:According to the skin condition and temporal bone development degree of patients with very low hairline, different treatment schemes can obtain better auricle shape, improve postoperative patient satisfaction and reduce complications.

Birth defects is one of the most important problems of human society. External birth defect is one of the major research fields of plastic surgery. This kind of disorders damages the body image of patients in mild or severe way, affects severely the social confidence of the patients themselves and their families. we summarized the research progress of the common external birth defects (the incidence top 10) from the aspects of pathogenesis, prevention, treatments and so on, in order to provide reference materials to the prevention and treatment of them.

Objective:To find the chromosomal malfomations among microtia patients and the neighbouring genes of chromosomal aberrations or genes in the extra or deleted chromosome fragments would be screened to investigate the possible causative genes.Methods:According to the inclusion criteria, case group was selected from microtia patients referred to Plastic Surgery Hospital, Chinese Academy of Medical Science, between January 2012 and January 2014, and the control group was the normal people of similar age received plastic surgery in the same hospital in the same time who did not have any congenital genetic disease. Blood samples of two groups were collected, and genomic DNA was extracted, then copy number variation (CNV) analysis was performed in the two groups with gene chip technology and associated software for large fragment chromosomal malformations. The variations of chromosome copy number were recorded to further analyze the type and length of chromosome structure variation. The genes at the loci of break points were further screened referring to B allele frequency to interpret associated genes related to the occurrence of microtia. Fisher exact test were used for statistical analysis, and the difference was statistically significant ( P< 0.05). Results:942 patients with congenital microtia were included in the case group, 695 males and 247 females, aged (11.4±3.2) years; 1 802 normal controls, 1 290 males and 512 females, aged (11.6±4.9) years. Large chromosomal fragments variations were detected in 5 patients in chromosome in case group( P=0.003). The difference between the two groups was statistically significant( P=0.003). Three cases were found to carry an extra X chromosome. Among the 3 cases, one patient suffered from XXY karyotype and the other 2 patients X trisomy. Two cases were proved to be associated with chromosome structural variations. The malformations of the first case presented partial duplication of the long arm of chromosome 13 and 14. On searching for causative genes, OTX2, BMP4 and GSC were detected to be in the chromosome structural variations. The second case presented to be partial duplication of the long arm of chromosome 5. FGF pathway associated genes FGF18, FGFR4, FGF1 and BMP pathway associated genes FST, MSX2, SMAD5 were incorporated in the extra duplicated chromosome for possible gene dosage effect. Conclusions:The results indicated the possible association of chromosome abnormity and microtia and provide new insights in microtia-associated chromosome instability. Ten related genes were involved in the occurrence of microtia through various ways.