Objective To investigate the indications,therapeutic effects,and compatibility patterns of modified Sini San formulas.Methods Modified Sini San formulas recorded in the Selected Compilation of Encyclopedia of Chinese Medicinal Formulas were retrieved.Frequency analysis,cluster analysis,and association rule mining were performed on the herbs of Sini San modified formulas.Results A total of 34 modified Sini San formulas were included,involving 127 additional medicinals.Analysis of the properties,flavors,and meridian tropism of the top 30 high-frequency additional medicinals,including Chuanxiong Rhizoma,Angelicae Sinensis Radix,Scutellariae Radix,Cortex Magnoliae Officinalis,Rehmanniae Radix,Rhei Radix et Rhizoma,Poria,Ginseng Radix et Rhizoma,Cyperi Rhizoma,Pinelliae Rhizoma,Atractylodis Rhizoma,and Citri Reticulatae Pericarpium,revealed that the additional medicinals were predominantly warm in nature,bitter in flavor,and acted the spleen meridian.Cluster analysis yielded six categories of medicinal combinations.Association rule mining identified that Sini San was frequently prescribed by combining with single herbs of Chuanxiong Rhizoma,Angelicae Sinensis Radix,and Rehmanniae Radix,or with herbal groups of Chuanxiong Rhizoma-Angelicae Sinensis Radix,Angelicae Sinensis Radix-Rehmanniae Radix,Angelicae Sinensis Radix-Persicae Semen,Angelicae Sinensis Radix-Carthami Flos,Platycodonis Radix-Chuanxiong Rhizoma,and Carthami Flos-Persicae Semen-Angelicae Sinensis Radix.Conclusion Later physicians have expanded the application of Sini San after modification to treat externally contracted diseases with exterior syndrome,epidemic diseases,abdominal masses,eye disorders,and other conditions.Sini San is often used in combination with formulas such as Taohong Siwu Decoction and Yueju Pills.Commonly-paired additional medicinals fall into six primary categories corresponding to its expanded therapeutic applications,i.e.,stasis-resolving,blood-activating,exterior-releasing,qi-regulating,deficiency-supplementing,and purgative medicinals.The analytical results may provide new insights for modern clinical applications-pharmacological research on Sini San.

Objective To investigate the relationship between kinase insert domain receptor(KDR)rs2305948 polymorphism and clopidogrel resistance(CR)in patients with acute coronary syndrome after receiving percutaneous coronary intervention(PCI).Methods A total of 468 patients with acute coronary syndrome,who were admitted to the Zhangjiakou Municipal First Hospital of China from September 2022 to September 2023,were selected as the subjects of study.All patients received PCI treatment and took medication of clopidogrel after the treatment.The occurrence of CR was recorded.The factors influencing the occurrence of CR were analyzed.The clinical significance of KDR rs2305948 polymorphism in predicting CR in patients with acute coronary syndrome after receiving PCI was evaluated.Results Of 468 patients with acute coronary syndrome,116(24.79％)developed CR.Logistic multivariate regression analysis indicated that low-density lipoprotein cholesterol(LDL-C,95％CI=1.420-8.390,OR=3.452),type 2 vascular endothelial growth factor receptor(VEGFR-2,95％CI=1.374-8.118,OR=3.340),KDR rs2305948 T/T genotype(95％CI=1.677-9.905,OR=4.076),and T allele(95％CI=1.390-8.207,OR=3.377)were the independent factors influencing the occurrence of CR inpatients with acute coronary syndrome after receiving PCI(all P＜0.05).Receiver operating characteristic(ROC)curve analysis showed that the sensitivity,specificity,and area under ROC curve(AUC)of the T/T genotype of KDR rs2305948 in predicting CR in patients with acute coronary syndrome after receiving PCI were 75.86％,70.45％,and 0.773(95％CI=0.666-0.880)respectively.Conclusion In patients with acute coronary syndrome after receiving PCI,the risk of developing CR is higher.The KDR rs2305948 polymorphism is correlated with CR in patients with acute coronary syndrome after receiving PCI,and it has a certain predictive value for CR.

Objective:To investigate the correlation between complement C3 and urine protein level and proteinuria remission status in patients with primary membranous nephropathy (PMN), and better guide individualized clinical treatment.Methods:It was a single-center retrospective study. The clinical data of PMN patients who underwent renal biopsy in the First Affiliated Hospital of Nanjing Medical University from January 2017 to June 2022 were collected. Patients with 24 h urinary protein ≥ 3.5 g were followed up after receiving standard treatment, and the last outpatient or inpatient review was used as the end point of follow-up. 24 h urine protein was collected to evaluate the remission status of proteinuria. Kaplan-Meier method was used to analyze the correlation between serum and renal complements and proteinuria remission. Cox regression analysis method was used to analyze the correlation between serum C3 level and renal tissue C3 deposition and proteinuria remission.Results:This study included 507 PMN patients with 312 (61.54%) males, aged 54 (43, 64) years old. Compared with 24 h urinary protein < 3.5 g group, proportion of males ( χ2=22.479, P<0.001), age ( Z=-2.521, P=0.012), systolic blood pressure ( Z=-4.148, P<0.001), diastolic blood pressure ( Z=-4.084, P<0.001), serum anti-phospholipase A2 receptor (PLA2R) antibody titer ( Z=-7.019, P<0.001), total cholesterol ( Z=-8.796, P<0.001), triglyceride ( Z=-6.158, P<0.001), low density lipoprotein cholesterol ( Z=-8.716, P<0.001), serum creatinine ( Z=-7.368, P<0.001), serum C3 ( Z=-3.663, P<0.001), serum C4 ( Z=-6.560, P<0.001), proportion of glucocorticoid use ( χ2=116.417, P<0.001) and proportion of immunosuppressant use ( χ2=53.839, P<0.001) were all higher, while serum albumin ( Z=12.518, P<0.001), estimated glomerular filtration rate ( Z=6.345, P<0.001) and serum IgG ( Z=7.321, P<0.001) were all lower in 24 h urinary protein ≥3.5 g group. There were 268 patients included in the follow-up cohort with baseline 24 h urinary protein of 7.15 (5.14, 10.24) g, serum anti-PLA2R antibody titer of 61.44 (14.35, 193.24) RU/ml, serum C3 of 1.005 (0.864, 1.150) g/L, and serum C4 of 0.260 (0.214, 0.317) g/L. Kaplan-Meier survival curve showed that the incomplete remission rate of proteinuria in serum C3 > 1.005 g/L group was lower than that in serum C3 ≤ 1.005 g/L group (log-rank χ2=4.757, P=0.029). There was no significant difference in the incomplete remission rate of proteinuria between serum C4 ≤ 0.260 g/L group and serum C4 > 0.260 g/L group (log-rank χ2=3.543, P=0.060). Renal C1q (log-rank χ2=0.167, P=0.683) and C4 (log-rank χ2=1.927, P=0.165) deposition had no significant effects on proteinuria remission in PMN patients. The incomplete remission rate of proteinuria in patients with renal C3 deposition was higher than that in patients without renal C3 deposition (log-rank χ2=7.018, P=0.008). Univariate Cox regression analysis showed that serum C3 level and C3 deposition in renal tissues were influencing factors of incomplete remission of proteinuria (both P<0.05), while adjusting for gender, age, mean arterial pressure, serum anti-PLA2R antibody, serum albumin and 24 h urinary protein, serum C3 ≤ 1.005 g/L ( HR=1.374, 95% CI 1.021-1.849, P=0.036), C3 deposition in renal tissues ( HR=1.949, 95% CI 1.098-3.460, P=0.023), and serum C3 ≤ 1.005 g/L combined with C3 deposition in renal tissues ( HR=1.472, 95% CI 1.093-1.983, P=0.011) were independent influencing factors of incomplete remission of proteinuria. Conclusions:The serum C3 level and C3 deposition in renal tissues are closely related to urinary protein level and proteinuria remission status in PMN patients. The patients with higher urinary protein have higher serum C3. For patients with massive proteinuria, serum C3 ≤ 1.005 g/L, C3 deposition in renal tissues, serum C3 ≤ 1.005 g/L combined with C3 deposition in renal tissues are independent risk factors of incomplete remission of proteinuria.

Objective:To establish a scoring system for preoperative prediction of the malignant potential of gastric stromal tumors based on gastroscopic and endoscopic ultrasound features, along with validation.Methods:A total of 286 patients who were treated in Jiangsu Province Hospital of Chinese Medicine from January 1, 2017 to December 31, 2023 and diagnosed as having gastric stromal tumors by postoperative pathology were enrolled in the modeling group. According to National Institutes of Health classification system, 227 very-low/low-risk patients were classified into the low malignant potential (LMP) group, and the 59 intermediate/high-risk patients into the high malignant potential (HMP) group. LASSO regression analysis was performed to identify predictive factors for HMP gastric stromal tumors, and a nomogram prediction model was developed. Internal validation using the Bootstrap method was performed on the modeling group, and external validation was performed on data from 85 patients who were treated and diagnosed as having gastric stromal tumors by postoperative pathology in Taizhou People's Hospital from January 1, 2021 to December 31, 2023. The receiver operator characteristic (ROC) curves, calibration curves, and decision curve analyses were employed in both the modeling and external validation groups.Results:Tumor size (coef=0.755), tumor shape (coef=0.015), tumor location (coef=0.008), growth pattern (coef=-0.026), cystic change (coef=0.685), and surface unceration change (coef=-0.545) were the independent predictive factors for HMP gastric stromal tumors. The nomogram-based prediction model constructed using these factors achieved an area under the ROC curve of 0.959 (95% CI: 0.898-0.903) in the modeling group and 0.959 (95% CI: 0.857-1.000) in the external validation group. The model demonstrated good accuracy (0.917) and a Kappa value of 0.737 in internal validation. Calibration curve and decision curve analyses indicated strong calibration and high net benefit in both the modeling and the external validation groups. Conclusion:Tumor size, tumor shape, tumor location, growth pattern, cystic change, and surface ulceration change are independent predictive factors for HMP gastric stromal tumors. The nomogram model developed based on these factors offers effective and convenient visualization for clinicians to predict the malignant potential of gastric stromal tumors preoperatively.

Objective:To assess the diagnostic performance of serum anti-toxocara immunoglobulin G (anti-T-IgG) in ocular toxocariasis (OT) patients.Methods:A diagnostic tests. A total of 109 patients (109 eyes) with clinically-suspected OT who treated in Department of Ophthalmology of Xuzhou First People’s Hospital from June 2015 to December 2022 were included. Patients were divided into two groups, 76 with OT and 33 with non-OT, according to the clinical manifestations and Goldmann-Witmer coefficient. Paired serum and intraocular fluid samples from each patient were collected and analyzed for specific anti-T-IgG using enzyme linked immunosorbent assay. Mann-Whitney test was performed for comparison between groups. The area under the receiver operating characteristic curve (ROC) was used to assess the diagnostic performance of serum anti-T-IgG. Kappa analysis was performed to examine the consistency of serum or intraocular fluid anti-T-IgG positive rate with OT diagnostic result. Spearman’s rank correlation test was performed to assess the association.Results:Compared with the non-OT group, the proportions of children and history of exposure to cats and dogs ( χ2=9.785, 12.026) were significantly higher in OT group, and the differences were statistically significant ( P<0.01). The positive rate ( χ2=24.551) and U value ( Z=-4.379) of serum anti-T-IgG in OT group were higher than those in non-OT group, and the differences were statistically significant ( P<0.000 1). The recommended serum anti-T-IgG cut-off value of 11 U had 0.72 sensitivity, 0.79 specificity, 0.89 positive predictive value, 0.55 negative predictive value, and 0.77 area under the ROC with 95% confidence interval ( CI) 0.669-0.860. Correlation analysis showed that serum anti-T-IgG was positively correlated with intraocular fluid anti-T-IgG ( r s=0.520, 95% CI 0.363-0.648, P<0.000 1). The Kappa values of serum and intraocular fluid anti-T-IgG positive rate with OT diagnosis were 0.457 (95% CI 0.292-0.622) and 0.711 (95% CI 0.582-0.840), respectively. The Kappa value of serum anti-T-IgG positive rate with OT diagnosis was lower than that of intraocular fluid. Conclusion:The sensitivity and specificity of serum anti-T-IgG and the consistency between serum anti-T-IgG positive rate and OT diagnosis are low, suggesting that serum anti-T-IgG level cannot be used as a basis for OT diagnosis.

Osteoporosis (OP) is a systemic disease characterized by decreased bone mass, increased bone fragility due to damage to the microstructure of bone tissue, and susceptibility to fractures.At present, it mainly relies on pharmacologic treatment.Because the occurrence of OP and some eye diseases are associated with a series of age-related pathological mechanisms, and OP therapeutic drugs also have anti-non-infectious inflammation, antioxidant, anti-apoptosis, and sex hormone-regulating effects, there is a certain correlation with the pathogenesis of some ophthalmic diseases, and thus affect the onset and progression of eye diseases.The application of OP therapeutic drugs such as vitamin D and its derivatives, estrogen, bisphosphonates, and desuximab may increase the risk of age-related macular degeneration, dry eye, and ocular inflammation, and may also play a preventive role in some eye diseases such as dry eye, cataract, glaucoma, and choroidal neovascularization.Therefore, when OP therapeutic drugs are used clinically, the changes of related eye diseases should be regularly monitored.This article reviews the research on the effects of OP therapeutic drugs on eye diseases.

Objective:To analyze the proportion of patients with acute primary angle-closure glaucoma (PACG) after the outbreak of coronavirus disease 2019 (COVID-19) in patients undergoing glaucoma surgery and the factors influencing morbidity.Methods:A cross-sectional study was performed.The cluster sampling method was used to collect 141 glaucoma patients hospitalized for glaucoma surgery after the outbreak of COVID-19 in Xuzhou First People's Hospital from December 16, 2022, to January 16, 2023, and 231 glaucoma patients hospitalized for surgery in the same 1-month period from 2019 to 2020, 2020 to 2021, 2021 to 2022 through the hospital information system.Ninety-two eyes of 92 patients with acute PACG after the outbreak were selected as a study group, and 21 eyes of 21 patients with acute PACG hospitalized during the same 1-month period from 2021 to 2022 were selected as a control group.The proportion of patients with different types of glaucoma during the observation period was analyzed.The proportion of patients with acute PACG and the clinical characteristics of acute PACG were analyzed, including age, sex, visual acuity, intraocular pressure (IOP), and anterior chamber angle status.Epidemiological data such as the use of anti-cold medications, and changes in living habits and moods (including daily water intake and anxiety) of patients after COVID-19 infection were obtained by telephone follow-up.Anxiety levels of patients in the study group were assessed using the Hospital Depression and Anxiety Scale (HADS).The triggering factors of acute PACG attack after the COVID-19 outbreak were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xuzhou First People's Hospital (No.xyyll[2023]114).Written informed consent was obtained from each subject.Results:The proportion of acute PACG patients in Xuzhou First People's Hospital within one month after the outbreak in 2022 to 2023 increased significantly compared with the same period in 2021 to 2022, 2020 to 2021 and 2019 to 2020, and the differences were statistically significant ( χ2=31.066, 33.331, 20.804; all at P<0.001).There was no statistical significance in the distribution of the number of eyes with different grades of visual acuity, IOP, the number of eyes with IOP ≥30 mmHg (1 mmHg=0.133 kPa), and the distribution of the number of eyes with different anterior chamber angles between the two groups (all at P>0.05).Patients in the control group had no history of COVID-19 infection or use of cold medicines at disease onset.During disease onset, all 92 (100%) patients in the study group had positive COVID-19 nucleic acid test results, of which 57 (61.96%) patients had a history of oral anti-cold medication use.During the same period, 49 (100%) hospitalized patients with other types of glaucoma had positive COVID-19 nucleic acid test results, of which 20 (40.82%) patients had a history of oral cold medication.There was a statistically significant difference in the proportion of patients taking oral cold drugs between acute PACG and other types of glaucoma in the study group ( χ2=5.764, P=0.016).During the outbreak of COVID-19, the study group reported that the daily water intake had increased to varying degrees than before.In the study group, 76 patients had anxiety, accounting for 82.6%.Multiple linear regression analysis showed that IOP=19.052+ 0.009×daily water intake+ 0.858×HADS score ( R2=0.780), and the standardized coefficients of daily water intake and HADS score were 0.542 and 0.452, respectively.Daily water intake had a greater effect on IOP than HADS score. Conclusions:The proportion of acute PACG patients among hospitalized surgical glaucoma patients increased significantly after the COVID-19 outbreak, which is related to risk factors such as oral anti-cold medications containing vasoconstrictors or antihistamines, increased daily water intake, anxiety and other lifestyle, and mood changes.

Objective:To develop an " AI-Doctor" collaborative intelligent model for precise segmentation of retinal non-perfusion areas and evaluate its effectiveness.Methods:Seventy-three retinal non-perfusion images were collected from diabetic retinopathy patients who visited Xuzhou Medical University Affiliated Xuzhou Municipal Hospital and underwent the ultra-widefield fluorescein angiography (UWFA) from December 2022 to January 2024.These images were divided into a training set of 38 images, a validation set of 10 images, and a test set of 25 images.A VGG-UNet model was created, which is an optimization of the combination of VGG-16 and U-Net.Large-scale and small-scale training datasets were created from the UWFA images, and the VGG-UNet was trained on each to obtain corresponding large-scale and small-scale networks.Initial segmentation of non-perfusion areas in UWFA images was conducted using the large-scale network.A physician interaction module was introduced to enhance local segmentation accuracy via the small-scale network, allowing for precise segmentation of non-perfusion areas in UWFA images.The efficacy of the " AI-Doctor" collaborative model was then compared with that of traditional physician annotation methods.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xuzhou Medical University Affiliated Xuzhou Municipal Hospital (No.xyy11[2023]069).Written informed consent was obtained from each subject.Results:The VGG-UNet model was generally able to accurately segment retinal non-perfusion areas.However, problems such as missegmentation, omission, and imprecision were observed at the edge of the eyeball.After the introduction of the physician interaction module, the average segmentation accuracy was improved to 90.36%, showing a significant improvement over conventional methods.Based on the VGG-UNet, a collaborative intelligent segmentation model of " AI-Doctor" was constructed, which can accurately segment images of the non-perfusion area of retinal blood vessels.The validation results showed that the average time of " AI-Doctor" collaborative annotation was about 3.0 minutes, which was significantly shorter than the 29.6 minutes of the traditional annotation method, and the efficiency was improved by about 10 times, and the segmentation accuracy reached 90.36%.Conclusions:An intelligent segmentation model with " AI-Doctor" collaboration is successfully established to achieve efficient and accurate segmentation of the non-perfused area of retinal blood vessels.

Objective To explore the value of detecting the levels of paraoxonase 1 (PON1), programmed death factor-1 (PD-1), and interferon gamma-induced protein-10(IP-10) in peripheral blood of patients with paraquat poisoning. Methods A prospective study was conducted in 120 patients with paraquat poisoning in the 980th Hospital of the Joint Logistics Support Force of Chinese people's Liberation Army from May 2017 to April 2023. The mortality and survival status of patients with paraquat poisoning within 30 days were statistically analyzed. The clinical data and peripheral blood PON1, PD-1, and IP-10 levels of patients with different prognoses were compared. Pearson correlation analysis was used to analyze the correlations of the peripheral blood PON1, PD-1, and IP-10 levels with the toxic dose, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation System Ⅱ(APACHE Ⅱ). The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the peripheral blood PON1, PD-1, and IP-10 levels for the prognosis of patients with paraquat poisoning. Results During the follow-up period, a total of 35 patients died (29.17%), with the toxic dose, SOFA score, APACHE Ⅱ score, IP-10 level, PD-1 level of the dead patients were higher than those of the surviving patients, and the peripheral blood PON1 level was lower than that of the control group (P < 0.05). The correlation analysis showed that the level of PON1 in peripheral blood of paraquat poisoning patients was negatively correlated with the dose of poisoning, APACHE Ⅱ, and SOFA scores, while the levels of PD-1 and IP-10 were positively correlated with the dose of poisoning, APACHE Ⅱ, and SOFA scores (P < 0.05). The area under the curve (AUC) values for predicting paraquat poisoning using PON1, PD-1, and IP-10 were 0.738, 0.774, and 0.770, respectively. The combined prediction AUC value of the three was 0.922, which was significantly higher than that of each individual indicator. Conclusion Combined peripheral blood PON1, PD-1, and IP-10 testing in patients with paraquat poisoning is of high value in determining prognosis of patients.

Objective To explore the clinical outcome of modified turtle shell moxibustion along the meridian for patients with primary dysmenorrhea caused by cold congelation and blood stasis.Methods Sixty patients with primary dysmenorrhea caused by cold congelation and blood stasis who were treated in Fuyang Women and Children's Hospital from August 2020 to August 2021 were included in this study.The patients were divided into test group and control group according to the random number table method,with 30 cases in each group.The control group was treated with ibuprofen granules,and the test group was treated with modified soft-shelled turtle moxibustion along the meridian pushing and ironing in addition to the treatment of the control group.Both groups were treated for 3 menstrual cycles.The Traditional Chinese Medical symptom scores,pain duration,visual analogue scale(VAS)score,clinical efficacy,serum prostaglandin E2(PGE2),prostaglandin F2a(PGF2a)and adverse reactions were compared between the two groups.Results The scores of cold pain in lower abdomen,chills in extremities,lumbosacral soreness,and dark menstrual blood with blood stasis,as well as the VAS score after treatment were significantly lower than those before treatment in both groups(P＜0.05),and these scores in the test group were significantly lower than those in the control group after treatment(P＜0.05).The duration of pain was significantly shortened after treatment in both groups,and the duration of pain in the test group was significantly shorter than that in the control group(P＜0.05).The total effective rate of the test group was significantly higher than that of the control group(P＜0.05).After treatment,serum PGE2 level was significantly increased and the PGE2a level was significantly decreased in both groups(P＜0.05),and the test group had higher level of PGE2 and lower level of PGF2a than the control group after treatment(P＜0.05).No gastrointestinal reactions or bleeding occurred.Conclusion The modified turtle shell moxibustion through meridian pushing and ironing is a safe and effective treatment for primary dysmenorrhea due to cold blood stasis syndrome.It can improve clinical symptoms and regulate the level of prostaglandins.