This paper proposed to understand the pathogenesis and provide syndrome differentiated treatment for anxiety and depression-related dry eyes from the perspective of the liver and the lung， in order to provide ideas for treatment of this disease with traditional Chinese medicine. It is believed that the occurrence and development of anxiety and depression-related dry eyes is related to the ethereal qi and blood damage and blocked circulation of qi and blood. The liver and the lung are the main located zang-fu （脏腑） organs of the disease， and the qi movement， sweat pores， meridians and collaterals abnormalities of the liver and the lung are the pathological basis. The basic pathogenesis is disharmony of the liver and the lung， loss nourishment of eyes， and loss calm of the mind. In clinical practice， the root treatment is to restore the functions of the liver governing ascent and the lung governing descent， and to open up the sweat pores， meridians and collaterals， while the branch treatment is to promote the production of body fluids， nourish yin and calm the mind. Both the root and the branch causes are treated to restore the physiological functions， and Danzhi Xiaoyao Powder （丹栀逍遥散） combined with Shengmai Powder （生脉散） with modification is often used as the basic prescription.

Objective:To investigate the therapeutic effects of internal fixation via the posterolateral combined posteromedial approach in the treatment of posterior pilon fracture (Klammer type Ⅲ).Methods:A retrospective study was performed to analyze the 69 posterior pilon fractures (Klammer type Ⅲ) which had been treated by internal fixation with hollow screws or a buttress plate at Department of Orthopaedic Trauma, Yantai Shan Hospital from January 2015 to January 2020. There were 36 males and 33 females with an age of (45.3±10.0) years and duration from injury to surgery of (6.0±1.5) d. They were assigned into 2 groups according to different surgical approaches. The observation group (41 cases) was treated through the posterolateral combined posteromedial approach while the control group (28 cases) through the posterolateral approach alone. The therapeutic effects were evaluated by comparing the 2 groups in terms of incision length, intraoperative bleeding, operation time, fracture union time, fracture reduction (evaluated by the Burrwell-Charnley radiological score), the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) and complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All the 69 cases were followed up for (16.9±4.0) months, revealing primary healing of all the incisions and no vascular injury or wound infection. The incision length [(11.2±1.8) cm] and operation time [(76.0±6.6) min] in the observation group were significantly shorter than those in the control group [(12.4±1.9) cm and (79.7±6.8) min], the excellent and good rate of reduction in the observation group (97.6%, 40/41) was significantly higher than that in the control group (89.3%, 25/28), and the ankle-hindfoot scores of AOFAS at 1, 3 and 12 months after operation in the observation group [(78.4±5.6), (79.5±2.8) and (86.9±2.1)] were significantly higher than those in the control group [(75.2±5.5), (78.0±3.2) and (85.8±2.3)] (all P<0.05). There was no significant difference in the intraoperative bleeding between the 2 groups ( P>0.05). In the control group, 2 patients developed numbness in the dorsum of foot, which gradually disappeared after 3 months of treatment, but no other complications like persistent pain or flexor contracture within 1 year after operation. Conclusion:In the treatment of Klammer type Ⅲ posterior pilon fracture, the posterolateral combined posteromedial approach can result in satisfactory therapeutic effects, because the surgical approach can fully expose the fracture and facilitate better reduction.

Objective:Childhood traumatic experiences greatly influenced the brain network activities of patients with depression,and there is an urgent need to explore the temporal dynamics for these changes.This study aims to investigate the abnormalities of resting-state electroencephalogram(EEG)microstates in eye-open state of depressed adolescents and to explore the correlations between their EEG microstates and the childhood traumatic experience. Methods:Using resting-state EEG microstate analysis,we explored the temporal dynamics of brain activity in patients with adolescent depression.This study selected 66 adolescents with depression as a patient group,and 27 healthy adolescents as a healthy control group.A modified k-means clustering algorithm was used to classify the 64-channel resting-state EEG data into different microstates.Independent sample t-tests were used to compare the microstate parameters between the 2 groups and further assciations between these parameters and childhood traumatic experience in patients were explored via using Spearman correlation. Results:In this study,significant differences were observed in the occurrence and transition probabilities of EEG microstates between the healthy control and the patient group.Notably,there was a statistically significant difference(P＜0.05)in the occurrence of microstate A across 2 groups,exhibiting a negative correlation with the emotional abuse component within the childhood trauma scores(Spearman's rho=-0.31,P=0.013).Furthermore,patient-specific,non-random transitions from microstate B to A(Spearman's rho=-0.30,P=0.015)and C to A(Spearman's rho=-0.31,P=0.013)were inversely associated with the scores of emotional abuse factors from childhood trauma in the patient group,showing statistically significant differences when comparing to the healthy controls(P＜0.05).Upon stratification into quartiles based on the emotional abuse factor scores,the occurrence of microstate A,as well as the transition rates from microstates B to A and C to A,retained statistical significance following adjustment for multiple comparisons(all P＜0.05). Conclusion:The abnormal temporal dynamics in brain networks of adolescents with depression are linked to childhood emotional abuse.Those who have suffered severe emotional abuse may show greater impairments in the brain's visual and central executive networks.EEG microstate analysis could be a potential tool for detecting adolescent depression with severe childhood trauma.

Objective To observe the effect of deep muscle relaxation by rocuronium on oxygenation of normal frequency jet ventilation during rigid bronchoscopy procedures.Methods From December 2021 to February 2023,60 patients with central airway diseases underwent rigid bronchoscopy under general anesthesia,they were randomly divided into deep muscle relaxation group(group D,n = 30)and moderate muscle relaxation group(group M,n = 30).After induction of general anesthesia,the patients were inserted rigid bronchoscopy for jet ventilation,muscle relaxant was rocuronium in induction and maintenance.Train of four(TOF)stimulation was used to measure the depth of muscle relaxation in group M,and the TOF count was maintained at 1 or 2;In Group D,the depth of muscle relaxation was measured by post tetanic count(PTC),and the PTC was maintained at 1 or 2.After operation,Sugammadex antagonized residual muscle relaxation.Results There was no significant difference in operation time,recovery time and extubation time between the two groups(P＞0.05).The total operation time,operation pause time and anesthesia time in group D were shorter than those in group M,the dosage of muscle relaxant in group D was more than that in group M,the incidence of hypoxemia during surgery in group D was less than that in group M,the operators'satisfaction in group D was better than that in group M,and the arterial partial pressure of oxygen(PaO2)in group D was higher than that in group M at 15 min(T1)and 30 min(T2)after jet ventilation,the number of patients with postoperative sore throat in group D was less than that in group M,the differences were statistically significant(P＜0.05).Conclusion The application of deep muscle relaxation by rocuronium in rigid bronchoscopy procedures can improve the oxygenation effect of normal frequency jet ventilation,reduce the operation pause time and anesthesia time,improve the satisfaction of operators,antagonizing residual muscle relaxation with Sugammadex can relieve the worry of delayed recovery from deep muscle relaxation.

Objective To observe the value of subregional non-contrast CT(NCCT)radiomics features based on habitat imaging technology for predicting hematoma expansion(HE)in patients with spontaneous intracranial hemorrhage(sICH).Methods Data of 228 sICH patients with negative conventional imaging signs were retrospectively analyzed and divided into HE group(n=99)or non HE(NHE)group(n=129)based on the occurrence of HE nor not.also divided into training set(n=182)or test set(n=46)at a ratio of 8:2.Clinical data,NCCT data and laboratory examination results were compared between groups.Logistic regressive analysis was performed to screen the impact factors of HE.ROI of whole hematoma(ROIwhole)was sketched and clustered into 3 sub-regions(ROIsub1,ROIsub2 and ROIsub3,the latter located in the critical area between hematoma and brain tissue)with habitat imaging technology,and radiomics features of ROI were extracted and screened.Then 4 prediction models were constructed based on the above 4 ROI,and the efficacy of each model for predicting HE was analyzed.Results The fasting blood glucose in HE group was higher than that in NHE group(t=2.047,P=0.041),which was not independent impact factor for predicting HE in sICH patients(P=0.070)according to logistic regression analysis.The area under the curve of ROIsub3 radiomics model for predicting sICH HE in training and test set was 0.945 and 0.863,respectively,not significantly different with that of ROIwhole(0.921,0.813),ROIsub1(0.925,0.807)nor ROIsub2(0.909,0.720)(all P＞0.05).Decision curve analysis showed that ROIsub3 radiomics model could bring greater benefits than the other 3 models.Conclusion NCCT radiomics features of the critical area between hematoma and brain tissue based on habitat imaging technology had high value for predicting HE in sICH patients.

Objective　To investigate the effect of fluid attenuated inversion recovery (FLAIR) on hyperintense vascular sign in patients with unilateral middle cerebral artery chronic occlusion.Changes of HVS and prediction of cerebral infarction were also analyzed.Methods　Patients with unilateral middle cerebral artery chronic occlusion who were hospitalized in Jiangdu People’s Neurology Department of Yangzhou City from July 2016 to August 2021 were enrolled.According to the presence or absence of cerebral infarction,they were divided into non-cerebral infarction group and cerebral infarction group.According to whether the cerebral infarction recurred during the follow-up,the cerebral infarction group was divided into recurrence group and non-recurrence group.Multivariate logistic regression model and ROC curve were used to analyze the risk and predictive value of FVHs and cerebral infarction in patients with unilateral middle cerebral artery chronic occlusion.Results　(1)Univariate analysis showed that the fibrinogen level,HVS signs and FVHs score in cerebral infarction group were significantly higher than those in non-cerebral infarction group (P<0.05).The baseline FVHs score of recurrent cerebral infarction patients were significantly higher than that of non-recurrent cerebral infarction patients (P<0.05).(2)Logistic regression analysis showed that FVHs score had a significant independent positive correlation with the first occurrence of cerebral infarction (OR=2.499; 95%CI 1.481~4.218;P=0.001),and FVHs score was not independently associated with cerebral infarction recurrence (OR=1.356;95%CI 0.922~1.994;P=0.112);(3)ROC curve analysis showed that FVHs score ≥4 had certain predictive value for cerebral infarction in patients with unilateral middle cerebral artery chronic occlusion,with sensitivity of 73.3%,specificity of 66.2%,area under curve (AUC) of 0.669 (95%CI 0.476~0.861;P=0.041).Conclusion　For patients with unilateral middle cerebral artery chronic occlusion,HVS may change in a process from scratch,and once the occurrence of HVS signs suggests that cerebral blood flow is decompensated,which is prone to cerebral infarction.FHVs score has certain predictive value for cerebral infarction.

Objective:To investigate the clinical significance of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) in patients with chronic atherosclerotic middle cerebral artery occlusion.Methods:From July 2016 to November 2020, patients admitted to the Department of Neurology, Jiangdu People's Hospital of Yangzhou and first found chronic atherosclerotic middle cerebral artery occlusion were enrolled. The demographic, clinical and MRI imaging data were collected. According to the presence or absence of acute cerebral infarction, they were divided into the non-acute cerebral infarction group and the acute cerebral infarction group. According to the modified Rankin Scale score at 3 months after the onset, patients with acute cerebral infarction were further divided into the good outcome group (≤2) and the poor outcome group (>2). A multivariate logistic regression model was used to analyze the independent correlation between FVHs and the risk of cerebral infarction in patients with chronic atherosclerotic middle cerebral artery occlusion and the outcome in patients with cerebral infarction. Results:A total of 94 patients with chronic atherosclerotic middle cerebral artery occlusion were enrolled, including 38 with non-acute cerebral infarction (40.4%) and 56 with acute cerebral infarction (59.6%). In patients with acute cerebral infarction, 13 (23.2%) had a poor outcome, and 43 (76.8%) had a good outcome. The fibrinogen level, the proportion of patients with FVHs and the FVHs score in the cerebral infarction group were significantly higher than those in the non-cerebral infarction group (all P<0.05). Multivariate logistic regression analysis showed that the FVHs score was significantly, independently, and positively correlated with the risk of acute cerebral infarction (odds ratio 2.524, 95% confidence interval 1.400-4.552; P=0.002). The National Institutes of Health Stroke Scale score at admission, the modified Rankin Scale score at admission, and FVHs score in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that there was a significant independent negative correlation between the FVHs score and the outcome of patients with cerebral infarction (odds ratio 0.144, 95% confidence interval 0.045-0.459; P=0.001). Conclusions:FVHs suggest that the blood supply is in a state of decompensation. When FVHs are present, the risk of cerebral infarction in patients with chronic middle cerebral artery occlusion is significantly increased; the wider the range of FVHs, the higher the risk of poor outcome after cerebral infarction.

Objective:To study the effect of glucosamine combined with sodium hyaluronate on serum interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels in patients with Kashin-Beck disease (KBD).Methods:In a prospective design, patients with KBD admitted to South Hospital of Yantaishan Hospital from January 2017 to January 2019 were selected and divided into control, observation, and replacement groups. The control group was treated with glucosamine sulfate, the observation group was treated with intra-articular injection of sodium hyaluronate on the basis of the control group, and the replacement group was treated with artificial knee arthroplasty. The clinical efficacy, visual analogue scale (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) of the three groups were compared before treatment, 6 weeks and 6 months after treatment. Blood samples were collected from the patients, and the serum levels of IL-1β and TNF-α were measured by enzyme-linked immunosorbent assay (ELISA) to compare the serum levels of IL-1β and TNF-α in the three groups before treatment, 6 weeks and 6 months after treatment.Results:The age of patients in the control group was (53.76 ± 7.33) years old, including 19 males and 23 females. The age of patients in the observation group was (54.18 ± 7.06) years old, including 20 males and 22 females. The age of the replacement group was (55.17 ± 6.43) years old, including 17 males and 13 females. The total effective rate in observation group (92.86%, 39/42) was significantly higher than that of the control group (76.19%, 32/42, χ 2 = 4.459, P < 0.05). At 6 weeks and 6 months after treatment, the VAS scores in the observation group [(4.10 ± 1.21), (3.16 ± 0.95) points] were significantly lower than those in the control group [(5.48 ± 1.17), (4.06 ± 0.74) points, P < 0.05]; at 6 weeks after treatment, the VAS score in the replacement group [(3.28 ± 0.89) points] was significantly lower than that in the observation group ( P < 0.05). At 6 weeks and 6 months after treatment, the WOMAC scores in the observation group [(40.72 ± 4.19, 25.86 ± 3.02) points] were significantly lower than those in the control group [(48.29 ± 2.16), (36.81 ± 3.13) points, P < 0.05]; the WOMAC scores in the replacement group [(29.68 ± 4.22), (23.57 ± 3.86) points] were significantly lower than those of the observation group ( P < 0.05). The serum levels of IL-1β [(9.28 ± 2.74), (6.85 ± 2.27) pg/ml] and TNF-α [(12.66 ± 4.54), (10.34 ± 3.48) pg/ml] in the observation group were significantly lower than those in the control group [(12.78 ± 2.79), (10.36 ± 2.63), (15.51 ± 4.63), (14.64 ± 4.27) pg/ml, P < 0.05], the serum levels of IL-1β [(6.12 ± 3.55), (5.39 ± 2.23) pg/ml], TNF-α [(10.42 ± 3.13) , (8.19 ± 3.15) pg/ml] in the replacement group were significantly lower than those in the observation group at 6 weeks and 6 months after treatment ( P < 0.05). Conclusion:Glucosamine combined with intra-articular injection of sodium hyaluronate can relieve inflammation, improve pain and promote joint function recovery in patients with KBD, but there is still a certain gap compared with knee arthroplasty.

Objective:To estimate the effect of comorbid gestational diabetes mellitus (GDM) and depression on glucose metabolism and neonatal morphology.Methods:From March 2015 to October 2018, recruited 18 to 28 weeks pregnant women who met the criteria in the Hefei First People′s Hospital or First Affiliated Hospital of Anhui Medical University or Anhui Maternal and Child Health Hospital, including a total of 4 380 study subjects, of which the birth outcome information of 3 827 newborns were collected. The self-made questionnaire "Maternal Health Questionnaire for Hefei City" and Edinburgh Postpartum Depression Scale were used to obtain basic demographic characteristics and emotional state of depression. Data from the 75-g oral-glucose-tolerance test were obtained at 24-28 weeks of gestation. After delivery, delivery outcome information were collected from the hospital medical records. Covariance analysis was used to analyze the differences in glucose metabolism indicators and neonatal outcome indicators in pregnant women with different GDM and depression status. Multiple logistic regression model was used to analyze the correlation between GDM and depression, with different groups of GDM and depression status (no GDM and depression, simple depression, simple GDM, comorbid GDM and depression)as independent variables and whether they were large for gestational age as dependent variables. The interaction between GDM and depression was also analyzed.Results:The 4 380 pregnant women were (28.8±4.2) years old. The incidence of GDM was 19.5% (852/4 380), and the detection rates of depression in the second and third trimesters were 12.1% (526/4 380) and 12.3% (536/4 367). PG-1h and AUC in the comorbid GDM and depression group were significantly higher than those in the group with no GDM and depression ( P<0.05) and the single GDM group ( P<0.05). After adjusting for factors such as the childbirth age, education level, family′s main economic income, BMI before pregnancy, parity, number of physical activities, and weight gain during pregnancy, compared with the group with no GDM and depression, the RR(95% CI) of LGA occurred in the single depression group, the single GDM group and the comorbid group were 1.31(0.89-1.91), 1.51(1.14-2.00) and 2.43(1.29-4.57), respectively. Further analysis showed that the association between GDM pregnant women with depression and newborn LGA ［ RR (95% CI): 2.12 (1.01-4.49)］ was stronger than that between GDM pregnant women without depression and newborn LGA ［ RR (95% CI): 1.50 (1.12-1.99)］, the P interaction value was<0.05. Conclusion:The status of comorbid GDM and depression can impair glucose metabolism and increase the risk of LGA.

Objective:To estimate the effect of comorbid gestational diabetes mellitus (GDM) and depression on glucose metabolism and neonatal morphology.Methods:From March 2015 to October 2018, recruited 18 to 28 weeks pregnant women who met the criteria in the Hefei First People′s Hospital or First Affiliated Hospital of Anhui Medical University or Anhui Maternal and Child Health Hospital, including a total of 4 380 study subjects, of which the birth outcome information of 3 827 newborns were collected. The self-made questionnaire "Maternal Health Questionnaire for Hefei City" and Edinburgh Postpartum Depression Scale were used to obtain basic demographic characteristics and emotional state of depression. Data from the 75-g oral-glucose-tolerance test were obtained at 24-28 weeks of gestation. After delivery, delivery outcome information were collected from the hospital medical records. Covariance analysis was used to analyze the differences in glucose metabolism indicators and neonatal outcome indicators in pregnant women with different GDM and depression status. Multiple logistic regression model was used to analyze the correlation between GDM and depression, with different groups of GDM and depression status (no GDM and depression, simple depression, simple GDM, comorbid GDM and depression)as independent variables and whether they were large for gestational age as dependent variables. The interaction between GDM and depression was also analyzed.Results:The 4 380 pregnant women were (28.8±4.2) years old. The incidence of GDM was 19.5% (852/4 380), and the detection rates of depression in the second and third trimesters were 12.1% (526/4 380) and 12.3% (536/4 367). PG-1h and AUC in the comorbid GDM and depression group were significantly higher than those in the group with no GDM and depression ( P<0.05) and the single GDM group ( P<0.05). After adjusting for factors such as the childbirth age, education level, family′s main economic income, BMI before pregnancy, parity, number of physical activities, and weight gain during pregnancy, compared with the group with no GDM and depression, the RR(95% CI) of LGA occurred in the single depression group, the single GDM group and the comorbid group were 1.31(0.89-1.91), 1.51(1.14-2.00) and 2.43(1.29-4.57), respectively. Further analysis showed that the association between GDM pregnant women with depression and newborn LGA ［ RR (95% CI): 2.12 (1.01-4.49)］ was stronger than that between GDM pregnant women without depression and newborn LGA ［ RR (95% CI): 1.50 (1.12-1.99)］, the P interaction value was<0.05. Conclusion:The status of comorbid GDM and depression can impair glucose metabolism and increase the risk of LGA.