By combining the origin and research progress of the combination of disease and syndrome, the core pathogenesis, this article explored the research ideas and methods of the core pathogenesis of TCM. It is found that modern TCM is mostly guided by the idea of classification-staging-syndrome differentiation, the main prescription of the main disease, the special prescription of the special disease, and the idea of "dynamic-fixed sequential". The tongue image syndrome differentiation method, clustering analysis method, drug test syndrome method, compound pathogenesis method, "evidence-based pathogenesis-syndrome treatment system" research model, and the integration of traditional Chinese and Western medicine theory were used to explore the core pathogenesis of TCM under the condition of disease. Combined with the advantages of modern medical disease differentiation and TCM syndrome differentiation, the individualized diagnosis and treatment methods of integrated traditional Chinese and Western medicine have been continuously improved, in order to solve the stage contradictions of different clinical stages, effectively delay the progression of the disease and improve the prognosis of the disease.

Objective To compare the efficacy and safety of computed tomography (CT)-guided percutaneous versus electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) for the treatment of pulmonary nodules. Methods A retrospective analysis was conducted on the data of high-risk pulmonary nodule patients who underwent MWA at the Nanjing Drum Tower Hospital between 2022 and 2023. The pathological diagnosis rate, complications, and progression-free survival (PFS) rate were compared between the CT group and the ENB group. Results There were 61 patients in the CT group, including 30 males and 31 females, with an average age of (67.22±9.13) years. There were 53 patients in the ENB group, including 29 males and 24 females, with an average age of (65.29±13.76) years. The pathological diagnosis rate in the CT group was slightly higher than that in the ENB group (88.52% vs. 71.69%, P=0.03). However, the ENB group exhibited a lower incidence of perioperative complications, including pneumothorax (16.39% vs. 3.77%, P=0.03), hemoptysis (19.67% vs. 5.66%, P=0.05), and pain (22.95% vs. 7.55%, P=0.03). There was no statistically significant difference in PFS rate between the two groups [HR=1.17, 95%CI (0.23, 5.81), P=0.85]. Conclusion Both CT-guided and ENB-guided MWA are effective treatment modalities for high-risk pulmonary nodules.

Objective:To discuss the infection status and clinical outcomes in the patients with bullous pemphigoid(BP),and to analyze the risk factors for infection in hospitalized BP patients,as well as to construct and evaluate the risk prediction model.Methods:A total of 126 patients first diagnosed with BP were selected.According to the occurrence of infection,the patients were divided into infection group(52 cases)and non-infection group(74 cases).The infection status and outcomes of the patients in two groups were recorded;statistical analysis was performed on the general data,laboratory examination results,FRAIL scale scores for frailty screening,NRS2002 scores,and skin lesion severity of the patients in two groups;multivariate Logistic regression model was used to identify the risk factors for infection in the patients;the goodness-of-fit test was used to evaluate the model;receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the model for infection.Results:Among the 126 hospitalized BP patients,52 cases had infection,with an infection rate of 41.27％.The mortality rate of the patients in infection group was higher than that in non-infection group(P＜0.05),and the remission rate of the patients in non-infection group was higher than that in infection group(P＜0.05).The FRAIL scale score for frailty screening,NRS2002 score,serum albumin level,prealbumin level,number of hospitalization,skin lesion severity,and time of hospital stay of the patients in infection group were significantly higher than those in non-infection group(P＜0.05).The multivariate Logistic regression analysis results derived the regression equation:Logistic(P)=-7.63+0.922× skin lesion severity+2.565×FRAIL scale score for frailty screening+1.214×NRS2002 score.The area under the curve of the Logistic regression model was 0.916.Conclusion:The FRAIL scale score for frailty screening,NRS2002 score,and skin lesion severity are the risk factors for infection in the hospitalized BP patients.The constructed infection risk prediction model based on these factors has good predictive value and may provide new ideas for the prevention and control of infection in the hospitalized BP patients.

Objective:To differentiate the nodular regenerative hyperplasia (NRH) from colorectal liver metastases in patients during chemotherapy based on magnetic resonance imaging (MRI) scan.Methods:Clinical data of 58 patients with liver NRH ( n=18) or metastases ( n=40) during postoperative chemotherapy for colorectal cancer admitted to Zhongshan Hospital Affiliated to Fudan University from July 2014 to December 2021 were retrospectively analyzed, including 39 males and 19 females, aged (56.8±10.6) years. The morphology, margin, plain scan and enhanced features of the lesions were compared, and the apparent diffusion coefficient (ADC) values of the lesions and the surrounding normal liver parenchyma were measured. Results:A total of 45 lesions were found in 18 patients with liver NRH, and 111 lesions in 40 patients with liver metastases. The distribution of lesions between liver NRH and liver metastases showed a statistically significant difference ( χ2=71.22, P<0.001). The boundaries of lesions in liver NRH were clearer than those in liver metastases [82.2% (37/45) vs. 46.8% (52/111), χ2=11.43, P=0.016]. The ADC values of 45 liver NRH lesions were (1.54±0.60)×10 -3 mm 2/s, which were close to the ADC values of the surrounding normal liver tissue (1.57±0.63)×10 -3 mm 2/s ( t=0.59, P=0.167). The ADC values of 111 liver metastatic lesions were (1.09±0.04)×10 -3 mm 2/s, which were lower than those of the surrounding normal liver tissue (1.50±0.10)×10 -3 mm 2/s ( t=30.31, P<0.001). The ADC values of liver metastatic lesions were lower than those of the liver NRH lesions [(1.09±0.04)×10 -3 mm 2/s vs. (1.54±0.60)×10 -3 mm 2/s, t=10.82, P<0.001]. Dynamic contrast-enhanced MRI scans showed that the arterial phase of 45 liver NRH lesions was more significantly enhanced, and continued to be enhanced in the portal vein, late and delayed phases. Conclusion:NRH lesions that occur in patients undergoing chemotherapy for colorectal cancer have clear boundaries, unrestricted diffusion, obvious enhancement in the arterial phase, and continuous enhancement in the portal venous phase and delayed phase. The above MRI features are helpful in distinguishing NRH from metastatic tumors.

Objective To apply a random forest model combined with logistic regression in the understudied area of pneumoconiosis complications,and to investigate the incidence and risk factors of pneumoconiosis complicated by bacterial pneumonia,and the effect of concomitant bacterial pneumonia on the survival and prognosis of patients with pneumoconiosis.Methods Pneumoconiosis patients admitted to the West China Fourth Hospital,Sichuan University,between January 2018 and April 2022 were enrolled and divided into a group of those with only pneumoconiosis and another group of those with pneumoconiosis complicated by bacterial pneumonia.Univariate analyses,including chi-squared test,t-test,or rank sum test,were conducted to examine the differences between the groups.A random forest model was used to screen the variables,and the risk factors of pneumoconiosis complicated by bacterial pneumonia were identified by stepwise forward logistic regression method.Cox regression was applied to the survival data to assess the effect of concomitant bacterial pneumonia on the survival and prognosis of pneumoconiosis patients.Results Among the 742 pneumoconiosis patients,536 cases(72.24%)had concomitant bacterial pneumonia.Among the 55 deaths,36 cases(65.45%)had concomitant bacterial pneumonia.Univariate analysis showed statistically significant differences in age,duration of disease,lung function,duration of exposure,lung lavage,pulmonary tuberculosis,and emphysema between the two groups(P<0.05).The variables were screened using the random forest model,and the risk factors were ranked in a descending order of their importance—the types of dust,duration of exposure,lung function,lung lavage,and pulmonary tuberculosis.After screening,multivariate logistic regression analysis showed that the types of dust(compared with silica dust,silicate dust:odd ratio[OR]=8.100,95%CI,1.386-47.331;carbon dust:OR=1.728,95%CI,1.034-2.887;artificial inorganic dust:OR=2.138,95%CI,1.146-3.988),impaired lung function(compared with undamaged lung function group,the group of patients with mild,moderate,and moderately severe damage:OR=2.292,95%CI,1.482-3.544),and pulmonary tuberculosis(OR=1.559,95%CI,1.071-2.271)were risk factors for pneumoconiosis complicated by bacterial pneumonia.The median follow-up was 30.0 months,ranging from 1.0 month to 64.0 months.Cox regression analysis showed that the mortality risk for pneumoconiosis patients with concomitant bacterial pneumonia was 2.369 times higher than that for patients without bacterial pneumonia(95%CI,1.286-4.367).Conclusion Pneumoconiosis patients are susceptible to bacterial pneumonia and are influenced by multiple risk factors.Concomitant bacterial pneumonia markedly affects the patient prognosis.

Objective:To differentiate the nodular regenerative hyperplasia (NRH) from colorectal liver metastases in patients during chemotherapy based on magnetic resonance imaging (MRI) scan.Methods:Clinical data of 58 patients with liver NRH ( n=18) or metastases ( n=40) during postoperative chemotherapy for colorectal cancer admitted to Zhongshan Hospital Affiliated to Fudan University from July 2014 to December 2021 were retrospectively analyzed, including 39 males and 19 females, aged (56.8±10.6) years. The morphology, margin, plain scan and enhanced features of the lesions were compared, and the apparent diffusion coefficient (ADC) values of the lesions and the surrounding normal liver parenchyma were measured. Results:A total of 45 lesions were found in 18 patients with liver NRH, and 111 lesions in 40 patients with liver metastases. The distribution of lesions between liver NRH and liver metastases showed a statistically significant difference ( χ2=71.22, P<0.001). The boundaries of lesions in liver NRH were clearer than those in liver metastases [82.2% (37/45) vs. 46.8% (52/111), χ2=11.43, P=0.016]. The ADC values of 45 liver NRH lesions were (1.54±0.60)×10 -3 mm 2/s, which were close to the ADC values of the surrounding normal liver tissue (1.57±0.63)×10 -3 mm 2/s ( t=0.59, P=0.167). The ADC values of 111 liver metastatic lesions were (1.09±0.04)×10 -3 mm 2/s, which were lower than those of the surrounding normal liver tissue (1.50±0.10)×10 -3 mm 2/s ( t=30.31, P<0.001). The ADC values of liver metastatic lesions were lower than those of the liver NRH lesions [(1.09±0.04)×10 -3 mm 2/s vs. (1.54±0.60)×10 -3 mm 2/s, t=10.82, P<0.001]. Dynamic contrast-enhanced MRI scans showed that the arterial phase of 45 liver NRH lesions was more significantly enhanced, and continued to be enhanced in the portal vein, late and delayed phases. Conclusion:NRH lesions that occur in patients undergoing chemotherapy for colorectal cancer have clear boundaries, unrestricted diffusion, obvious enhancement in the arterial phase, and continuous enhancement in the portal venous phase and delayed phase. The above MRI features are helpful in distinguishing NRH from metastatic tumors.

Objective: This study aimed to determine the predictive performance of non-contrast CT (NCCT) signs for hemorrhagic growth after intracerebral hemorrhage (ICH) when stratified by onset-to-imaging time (OIT). Materials and Methods: 1488 supratentorial ICH within 6 h of onset were consecutively recruited from six centers between January 2018 and August 2022. NCCT signs were classified according to density (hypodensities, swirl sign, black hole sign, blend sign, fluid level, and heterogeneous density) and shape (island sign, satellite sign, and irregular shape) features. Multivariable logistic regression was used to evaluate the association between NCCT signs and three types of hemorrhagic growth: hematoma expansion (HE), intraventricular hemorrhage growth (IVHG), and revised HE (RHE). The performance of the NCCT signs was evaluated using the positive predictive value (PPV) stratified by OIT. Results: Multivariable analysis showed that hypodensities were an independent predictor of HE (adjusted odds ratio [95% confidence interval] of 7.99 [4.87–13.40]), IVHG (3.64 [2.15–6.24]), and RHE (7.90 [4.93–12.90]). Similarly, OIT (for a 1-h increase) was an independent inverse predictor of HE (0.59 [0.52–0.66]), IVHG (0.72 [0.64–0.81]), and RHE (0.61 [0.54– 0.67]). Blend and island signs were independently associated with HE and RHE (10.60 [7.36–15.30] and 10.10 [7.10–14.60], respectively, for the blend sign and 2.75 [1.64–4.67] and 2.62 [1.60–4.30], respectively, for the island sign). Hypodensities demonstrated low PPVs of 0.41 (110/269) or lower for IVHG when stratified by OIT. When OIT was ≤ 2 h, the PPVs of hypodensities, blend sign, and island sign for RHE were 0.80 (215/269), 0.90 (142/157), and 0.83 (103/124), respectively. Conclusion Hypodensities, blend sign, and island sign were the best NCCT predictors of RHE when OIT was ≤ 2 h. NCCT signs may assist in earlier recognition of the risk of hemorrhagic growth and guide early intervention to prevent neurological deterioration resulting from hemorrhagic growth.

Objective:The obesity rate among middle-aged and young adults in China is increasing annually,and the incidence of cardiovascular diseases is becoming more prevalent in younger populations.However,it has not yet been reported whether obesity is associated with early vascular aging(EVA).This study aims to explore the correlation between obesity and EVA in middle-aged and young adult health check-up populations,providing a reference for the prevention of cardiovascular diseases. Methods:A total of 15 464 middle-aged and young adults aged 18-59 who completed brachial-ankle pulse wave velocity(baPWV)test in the Third Xiangya Hospital of Central South University from January to December 2020 were included.Among them,1 965 individuals with normal blood pressure and no cardiovascular risk factors were selected as the healthy population.The baPWV thresholds for determining EVA in each age group for males and females were calculated based on the baPWV values of the healthy population.The number and percentage of individuals meeting the EVA criteria in the middle-aged and young adult health check-up populations were statistically analyzed by age and gender.The differences in obesity indicators[visceral adiposity index(VAI),body mass index(BMI),waist circumference(WC)]between the EVA and non-EVA groups for males and females were compared.Using EVA as the dependent variable,VAI,BMI,and WC were included as independent variables in a Logistic model to analyze the correlation between each obesity indicator and EVA before and after adjusting for other influencing factors.Furthermore,the correlation between each obesity indicator and EVA in each age group was analyzed. Results:In the health check-up populations,the detection rate of EVA in different age groups was 1.65%-10.92%for males,and 1.16%-10.50%for females,the detection rate of EVA increased with age in both males and females.Except for the 40-<50 age group,the EVA detection rate was higher in males than in females in all other age groups.Regardless of gender,obesity indicators VAI,BMI,and WC were significantly higher in the EVA group than in the non-EVA group(all P<0.01).Before and after adjusting for other influencing factors,VAI and WC were both correlated with EVA(both P<0.05).BMI was a risk factor for EVA before adjusting for other influencing factors(P<0.01),but after adjustment,the correlation between BMI and EVA was not statistically significant(P=0.05).After adjusting for other influencing factors,the correlation between VAI and EVA was statistically significant in the 18-<40 and 50-<60 age groups(both P<0.05),while the correlation between BMI and WC with EVA was not statistically significant(both P>0.05).In the 40-<50 age group,the correlation between VAI and BMI with EVA was not statistically significant(both P>0.05),but the correlation between WC and EVA was statistically significant(P<0.01). Conclusion:VAI is closely related to the occurrence of EVA in middle-aged and young adults aged 18-<40 and 50-<60 years,while WC is closely related to the occurrence of EVA in those aged 40-<50 years.

Objective:To find the preferences of nursing staff when they provide " Internet + nursing service" for elderly patients.Methods:By means of the discrete choice experiment, a questionnaire was designed to investigate the preferences of nursing staff when they provide " Internet + nursing services" for elderly patients. In-service nursing staff from 8 medical and health institutions in Ningbo city and Wenzhou city were selected by random sampling, for an online questionnaire survey conducted from May to June 2022. The preferences of nursing staff on their service income, service content, service distance, service continuity and residence status of elderly patients when providing " Internet + nursing service" were analyzed by mixed logit regression.Results:A total of 420 valid questionnaires were collected. Compared to 50 yuan/order, nursing staff preferred to a price of 150 yuan/order ( β= 1.22, P<0.001) nursing services; Compared to specialized nursing services, nursing staff preferred to the routine care ( β= 0.86, P<0.001) and health promotion ( β= 0.86, P<0.05) service; Compared to<5 km, nursing staff were unwilling to provide nursing services for elderly patients at distances of 5-10 km and 11-15 km ( β=-0.66, P<0.05; β=-0.95, P<0.001) ; Compared to 1-2 visits per month, nursing staff preferred not to provide continuing care services ( β=-0.70, P<0.05); Compared to homestay with the patient family, nursing staff preferred to provide nursing services for elderly patients residing in nursing homes ( β= 1.21, P<0.001) . Conclusions:Considering the preference of nursing staff tend to provide " Internet + nursing service" for the elderly patients with services featuring appropriate price, non-specialist care, close distance, low continuity (moderate intensity used as the reference) and security assurance for practice.

Objective:To investigate the current situation and analyze the influencing factors of job satisfaction of infectious disease physicians in Jiangsu Province.Methods:From April to May 2021, a stratified random sampling method was used to select 10 municipal level infectious disease hospitals in Jiangsu province. An electronic questionnaire survey was conducted on the infectious disease physicians of these hospitals using an online questionnaire platform. The questionnaire mainly included the job satisfaction scale developed by Greenhaus and Wormley, and a self-designed job satisfaction influencing factor scale based on resource conservation theory. At the same time, semi-structured interviews were made with relevant insiders on such issues as salary and benefits, and career development among others. Descriptive analysis was conducted on the questionnaire data, while single factor analysis and multiple linear regression analysis were used to identify the factors that affect their job satisfaction, and the results of the interviews were studied with Colaizzi 7-step analysis.Results:A total of 457 valid questionnaires were recovered. The job satisfaction score of infectious disease physicians was (3.38±0.76). The results of univariate analysis showed significant differences in job satisfaction scores among infectious disease physicians of different ages, educational backgrounds, professional titles, and positions. The results of multiple linear regression analysis showed that salary and benefits ( B=0.141, P<0.001), work environment ( B=0.128, P<0.001), leadership support ( B=0.112, P=0.014), development security ( B=0.117, P<0.001), self-efficacy ( B=0.084, P=0.045) and social support ( B=0.285, P<0.001) were both influencing factors of their job satisfaction. The interview results identified such problems as low salary, insufficient salary security, large gap in social security levels between in-staff and off-staff physicians, and insufficient career development potential. Conclusions:The job satisfaction of infectious disease physicians in Jiangsu Province was found at an average level. It is recommended that the government increase the investment in personnel expenses for infectious disease physicians, optimize the salary and benefits structure, pay attention to the career development needs of middle-aged and young physicians, and care about the social relationship needs of infectious disease physicians to improve their job satisfaction.