[Objective]Based on ZHANG Jingyue's theory of"ministerial fire has a place and is visible",to explore the syndrome differentiation thinking and treatment plan about injury fever syndrome differentiation,in order to provide new ideas for the clinical treatment of internal injury fever such as deficiency fever,spermatorrhea,blood syndrome,diabetes syndrome and so on.[Methods]By studying the relevant works of ZHANG Jingyue's Jingyue Encyclopedia and Classified Classic,combined with the works of other doctors such as LIU Wansu,ZHU Danxi,LI Dongyuan,etc.,it discussed the application of ministerial fire thought in the syndrome differentiation and treatment of internal injury fever.Combined with medical records,three ideas of syndrome differentiation and treatment of internal injury fever were summarized:spleen-Qi deficiency,Yin essence deficiency and original Yang deficiency,corresponding to three treatment methods of regulating middle-Jiao,benefiting essence and blood,and warming body origin.Combined with clinical practice,it summarized the diagnostic and treatment thought of internal injury fever,and discussed the role of ZHANG Jingyue's ministerial fire theory in the treatment of specific febrile diseases such as deficiency fever,spermatorrhea,blood syndrome and diabetes syndrome.[Results]ZHANG Jingyue believed that ministerial fire"has a place",which was born in Mingmen and all over the viscera.All endogenous fevers in the human body were related to it.And ZHANG proposed that the incidence of internal injury fever was mainly deficiency,and ministerial fire was"tangible",which could be differentiated and treated according to the fact that ministerial fire must be damaged by"blood Qi,viscera and other evidence".Its pathogenesis mainly included three aspects:spleen-Qi deficiency,Yin essence deficiency and original Yang deficiency.The diagnosis and treatment should pay attention to regulating the middle palace and heat,benefiting essence and blood to make fire,warming kidney and life to absorb fire.According to the syndrome differentiation situation,in terms of medication,it should pay attention to the use of sweet and warm,sweet and cold drugs also warming and tonifying Yang prescriptions flexibly.[Conclusion]ZHANG Jingyue had a very profound understanding of the theory of ministerial fire.On the basis of absorbing the essence of predecessor's thoughts,he often had his own new insights.His theory of ministerial fire had important value in discussing the pathogenesis and treatment of internal injury fever,which was worthy of reference for the later generations.

Background and purpose:The Shanghai Municipal Center for Disease Control and Prevention provides annual updates on cancer statistics in Shanghai.Breast cancer is one of the common malignant tumors among women.In recent years,the incidence of female breast cancer was increasing,while its trend of mortality showed declining.This study aimed to investigate the survival rates of new female breast cancer cases in Shanghai from 2002 to 2017.Methods:Data of new cases and deaths of female breast cancer patients with follow-up information from 2002 to 2017 were obtained from the Population-based Cancer Registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention.Numbers,proportions,and survival rates were stratified by year of diagnosis,age,histological type and stage at diagnosis for analysis.The 5-year observed survival rates were calculated based on the life table method.The probabilities of surviving from 0 to 99 years were estimated with the Elandt-Johnson model,and then cumulative expected survival rates were calculated using the Ederer Ⅱ method.Finally,the 5-year relative survival rates were calculated.The annual percent change(APC)of survival rates was estimated by Joinpoint Regression Program.Results:A total of 73 600 new female breast cancer cases were diagnosed from 2002 to 2017 in Shanghai.Among them,67 681 cases were morphological verification,accounting for 91.96%.By December 31,2022,23 745(32.26%)cases had died,and 19 466(26.45%)cases had died of cancer.A total of 68 332(92.84%)cases,who were either dead or followed for over 5 years,were considered to have complete follow-up.The remaining 5 268(7.16%)cases were lost to follow-up.73 538(99.92%)cases were included in the observed cohort for survival analysis.The number of observed cases nearly doubled from 3330 in 2002 to 6095 in 2017.The 5-year observed survival rate changed from 78.77%in 2002 to 84.55%in 2017 dynamically,showed a low increasing trend with an average rate of 0.50%per year(APC=0.50%,t=8.75,P＜0.001).The 5-year relative survival rate also increased from 83.46%to 89.24%slowly,with an average rate of 0.47%(APC=0.47%,t=9.80,P＜0.001).The overall 5-year observation survival rate of female cancer was 83.24%(82.96%-83.52%),and the 5-year relative survival rate was 87.58%(87.29%-87.87%)in Shanghai from 2002 to 2017.It was increasing over time,decreasing with aging and advanced stage at diagnosis continuously.There was no significant difference in the 5-year relative survival rates between the groups aged 15 to 64(P＞0.05).The group with an unknown stage had the highest number of cases,followed by the stage Ⅱ group,and then the stage Ⅰ group.The 5-year relative survival rate of cases with stage Ⅰ disease reached 99.10%(98.78%-99.42%),but these cases only accounted for 25.51%of the total.The 5-year relative survival rate of cases with stage Ⅳ disease was 52.54%(50.98%-54.11%),and these cases accounted for 6.13%of the total.The 5-year relative survival rate of cases with s unknown stage was 82.04%(81.42%-82.65%),and these cases accounted for 31.05%of the total.Conclusion:The diagnostic levels and survival rates of female breast cancer in Shanghai were relatively high and continue to improve.However,the proportions of cases with unknown histological type and unknown stage remain relatively high,and the proportion of stage Ⅰ cases is not very large.The survival rates of stage Ⅳ cases are relatively low.This study provides evidence for further research,prevention and control efforts for female breast cancer.

Objective:To investigate the influencing factors of diarrhea during early enteral nutrition(EEN)therapy in severe patients with temporary ileostomy.Method:A total of 154 patients with temporary ileostomy who received EEN in the Department of General Surgery,Jinling Hospital from November 2019 to November 2023 were included in this study.All patients were divided into two groups:the diarrhea group(n=43)and the non-diarrhea group(n=111).The clinical data of the patients were retrospectively collected and analyzed,and univariate analysis was performed to compare the differences between groups.The indicators with significant differences were subjected to multivariate logistic regression analysis to determine the influencing factors of diarrhea during EEN therapy in severe patients with temporary ileostomy.Result:Among the 154 patients,43 developed diarrhea during EEN therapy,with an incidence of 27.9%.Multivariate logistic regression analysis showed that enteral nutrition(EN)infusion rate(OR=6.342,P=0.001,95%CI:2.055～19.572),antibiotics type(OR=8.342,P=0.013,95%CI:1.577～44.119),mechanical ventilation(OR=7.011,P=0.001,95%CI:2.272～21.629),EN formulation type(OR=6.497,P=0.001,95%CI:2.177～19.392),and diabetes(OR=3.321,P=0.036,95%CI:1.080～10.215)were closely associated with EN-related diarrhea in severe patients with temporary ileostomy.Conclusion:There was a high incidence of diarrhea in severe patients with temporary ileostomy who received EEN.EN infusion rate,antibiotics use,mechanical ventilation,EN formulation type and diabetes were the influencing factors for presence of EEN-related diarrhea in the patients.Our data could provide a reference for preventing EEN-related diarrhea in severe patients with temporary ileostomy after surgery.

Objective To investigate the differential expression genes(DEGs)related to angiogenesis in rosacea(RA)by utilizing bioinformatics analysis in order to screen the key genes and verify their mRNA expression levels.Methods The gene microarray dataset GSE65914 was retrieved from the Gene Expression Omnibus(GEO)repository.Analyzed by R programming,the dataset was refined to identify DEGs related to RA,and then cross-referenced with angiogenesis-related genes from the GeneCards database to get a subset specific to RA angiogenesis.The process of identifying key genes was augmented by employing protein-protein interaction(PPI)network analysis and Cytoscape-based computational algorithms.The mRNA expression levels of the aforementioned pivotal genes were detected by real-time fluorescent quantitative reverse transcription PCR(RT-qPCR).Results A total of 947 RA-associated DEGs were identified from GEO dataset,and then 202 genes related to RA angiogenesis were further delineated.PPI network analysis and Cytoscape algorithm finally identified 3 key genes,that is,CXCL8,IL-1B,and STAT1.The results of RT-qPCR showed that the mRNA expression levels of MIP-2,GCP-2,IL-1B and STAT1 in RA lesions were significantly higher than those in normal controls(P<0.05).Conclusion With aid of bioinformatics analysis,our study has screened and validated key genes associated with angiogenesis in RA,namely CXCL8,IL-1B,and STAT1,which providing a theoretical basis for elucidating the potential mechanisms underlying RA-induced angiogenesis and developing targeted therapeutic strategies.

Objective:To investigate the correlation of epithelial lesions among different biopsy sites in the female lower genital tract and the relationship between age and lesion distribution.Methods:A total of 406 148 patients with cervical biopsy specimens archived at the Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University from January 2010 to December 2021 were analyzed. Among them, 70 309 cases (17.31%) had concurrent vaginal biopsies, and 16 073 cases (3.96%) had concurrent vulvar biopsies. (1) Cases were divided into four 3-year intervals to compare vaginal or vulvar biopsy rates and high-grade squamous intraepithelial lesion (HSIL) or worse (HSIL +) detection rates across time periods. (2) Correlations between cervical lesions and vaginal or vulvar lesions were assessed. (3) Patients were stratified into three age groups (<30, 30-49, and ≥50 years) to compare vaginal or vulvar HSIL + detection rates. Results:Mean ages of patients with cervical, vaginal, and vulvar biopsies were (41.3±11.0), (47.4±12.5), and (41.9±13.2) years, respectively. Patients with vaginal biopsy were significantly older than cervical or vulvar groups (all P<0.001). (1) Vaginal biopsy rates increased markedly from 7.37% (2010—2012) to 22.76% (2019—2021; χ2=9 205.01, P<0.001); vulvar biopsy rates increased slightly from 2.80% to 5.69% ( χ2=1 777.25, P<0.001). Correspondingly, vaginal HSIL + detection rates rose from 0.28% to >0.5% (0.56% in 2013—2015, 0.59% in 2016—2018, 0.51% in 2019—2021; χ2=134.70, P<0.001), while vulvar HSIL + rates increased from 0.03% to 0.33% ( χ2=56.54, P<0.001). (2) Weak correlation existed between cervical and vaginal lesions ( r=0.28; P<0.001; n=70 309), while cervical-vulvar correlation was weaker ( r=0.22, P<0.001; n=16 073). (3) Vaginal HSIL + detection rates were higher in cervical HSIL + patients aged 30-49 years (26.65%) and ≥50 years (26.79%) versus <30 years (14.63%; both P<0.001). Conversely, vulvar HSIL + detection rates were higher in the <30 years group (23.08%) versus 30-49 years (13.83%) and ≥50 years (12.89%; both P<0.05). Conclusions:Vaginal or vulvar lesion detection rates increase with biopsy frequency. Vaginal lesions correlate with cervical abnormalities, whereas vulvar lesions are relatively independent. In cervical HSIL + patients, those <30 years are more prone to have vulvar HSIL +, while those ≥30 years show higher vaginal HSIL + incidence. These age-specific distribution patterns inform optimized biopsy strategies.

Objective:To analyze the effects of the disease and injury spectrum on health-adjusted life expectancy (HALE) among permanent residents aged 55 and above in Shenzhen from 2016 to 2030.Methods:Based on the mortality surveillance data and the permanent resident population data in Shenzhen from 2016 to 2022, the Sullivan method was used to calculate the HALE during 2016—2022. The Bayesian age-period-cohort model and the grey system model were used to predict the HALE during 2023—2030. The HALE changes in the two periods were decomposed into the contributions of 20 categories of diseases and injuries, respectively.Results:From 2016 to 2022, the HALE increased from 31.41 years (95% CI: 30.50-32.32) to 33.57 years (95% CI: 32.47-34.67). During this period, the mortality effect of neurological disorders slowed the increase of HALE, with a reduction of 0.27 years. By 2030, it is anticipated that the HALE will reach 36.40 years (95% CI: 34.78-38.01). This is expected to be influenced by the mortality effects of nutritional deficiencies (-0.40 years) and mental disorders (-0.29 years), as well as the disability effects of musculoskeletal disorders (-0.66 years), skin and subcutaneous diseases (-0.21 years) and nutritional deficiencies (-0.13 years). Conclusion:The HALE of permanent residents aged 55 years and above in Shenzhen demonstrated an increasing trend over time. Greater attention should be paid to the adverse effects of neurological disorders, nutritional deficiencies, mental disorders, musculoskeletal disorders, and skin and subcutaneous diseases on the continuous increase of HALE in this population.

Objective:To investigate the alterations in the brain structural network properties related to cognitive emotion regulation strategies in young, first-episode and drug-naive (FEDN) patients with major depressive disorder (MDD).Methods:One hundred and twelve young patients who were diagnosed with FEDN MDD were enrolled in the Second Xiangya Hospital of Central South University between October 2019 and October 2023, and 143 healthy controls (HC) were recruited for reference during the same period. Clinical data and T 1 structural images of high-resolution magnetic resonance imaging were collected from all participants, and the cognitive emotion regulation was assessed using the Chinese version of the Cognitive Emotion Regulation Questionnaire (CERQ-C). The brain structural alterations related to cognitive emotion regulation strategies were explored using whole-brain voxel-based morphometry (VBM) group analysis and individual differential structural covariance network (IDSCN) analysis. Partial correlation analysis was performed between the IDSCN anomalous structural concatenated edge and subdimensions of the CERQ-C. Results:The scores on the sub-dimension of negative cognitive emotion regulation (self-condemnation, rumination, catastrophization, blaming others) in the young FEDN MDD patients in CERQ-C were significantly higher than those in HC (14.28±2.30 vs 12.45±2.00, t=6.501, P<0.001;14.40±2.97 vs 11.31±2.93, t=7.934, P<0.001;12.19±3.75 vs 7.59±2.58, t=10.553, P<0.001;10.26±3.00 vs 8.74±2.89, t=3.916, P<0.001; respectively). There was no statistically significant difference in the VBM group analysis (all P>0.05). However, IDSCN single sample t test results showed significant group differences between the left orbitofrontal inferior gyrus and the left supplementary motor area, the left orbitofrontal middle gyrus and the bilateral precuneus, and the left superior temporal gyrus and the bilateral hippocampus (all P<0.05). With controlling for age, sex, and other factors, partial correlation analysis results showed that the left orbital inferior frontal gyrus-left supplementary motor area connection in patients with MDD was positively correlated with the self-condemnation and acceptance scores of the CERQ-C ( r=0.226, P=0.027; r=0.216, P=0.035), while negatively correlated with the score of blaming others ( r=-0.252, P=0.013). Additionally, connections between the right hippocampus and left superior temporal gyrus were significantly associated with the scores on catastrophization subdimension of the CERQ-C ( r=0.229, P=0.025). Conclusion:Due to its sensitivity to individualized analyses, the IDSCN analysis found that abnormal topological property changes were mainly manifested in the limbic system, the sensorimotor system, and the default network in young FEDN MDD patients, and were linked to their negative cognitive emotion regulation strategies, even though the VBM group analysis did not yield any significant results.

Objective:To investigate the efficacy and safety of auricular composite tissue particle injection in the treatment of nasal collapse.Methods:Patients with flat nose in Yuyao People′s Hospital of Zhejiang Province from June 2021 to June 2023 were retrospectively enrolled, and were divided into two groups according to the treatment methods: Observation group, 41 cases were treated with ear complex tissue granule injection, including 16 males and 25 females, aged 19-45 (27.2±1.6) years; Control group, 54 cases underwent silicone prosthesis implantation, including 21 males and 33 females, aged 18-46 (26.4±1.8) years. The satisfaction rates of nasal tip and nasal shape at 1 week, 6 months and 1 year after surgery were compared between the two groups, and the effect maintenance rates of patients at 6 months and 1 year after surgery were compared between the two groups, and the occurrence of adverse reactions in the two groups was recorded.Results:The satisfaction rates of nasal tip at 1 week, 6 months, and 1 year after surgery were 79.6% (43/54), 64.8% (35/54), and 48.2% (26/54) in the control group, and 92.7% (38/41), 78.1% (32/41), and 63.4% (26/41) in the observation group, respectively, and the difference was not statistically significant (all P>0.05). The satisfaction rates of nasal shape at 1 week, 6 months and 1 year after surgery were 79.6% (43/54), 55.6% (30/54) and 40.7% (22/54) in the control group and 90.2% (37/41), 75.6% (31/41) and 56.1% (23/41) in the observation group, respectively, and the difference was not statistically significant (all P>0.05). There was no significant difference in the effect maintenance rate between the two groups at 6 months and 1 year after surgery (all P>0.05). The total incidence of adverse reactions in the observation group was 4.9% (2/41), which was lower than that of 27.8% (15/54) in the control group ( P=0.004). Conclusion:Compared with silicone implantation, there is no significant difference in the nasal tip, nasal shape satisfaction rate and effect maintenance rate of the auricular composite tissue particle injection in the treatment of flat nose , and the incidence of adverse reactions is low.

Objective·To compare the safety and short-term outcomes of robot-assisted versus laparoscopic-assisted proximal gastrectomy combined with double-flap esophagogastrostomy in the treatment of early upper gastric cancer.Methods·A retrospective cohort study was conducted to analyze the clinical and pathological data of 31 early gastric cancer patients who underwent proximal gastrectomy combined with double-flap esophagogastrostomy for gastrointestinal reconstruction at the Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,from September 2023 to March 2024.Based on the surgical approach,patients were divided into the robot-assisted surgery group(robotic group,20 cases)and the laparoscope-assisted surgery group(laparoscopic group,11 cases).General clinical data,intraoperative conditions,and postoperative recovery between the two groups were compared.At the 6-month postoperative follow-up,upper gastrointestinal radiography and esophagogastroscopy were performed to assess anastomotic stricture and gastroesophageal reflux disease.Additionally,the gastric cancer-specific module of the European Organization for Research and Treatment of Cancer(EORTC),Quality of Life Questionnaire-Stomach 22(QLQ-STO22),was used to evaluate the patients' quality of life.Results·The general data of the two groups,including gender,age,preoperative comorbidities,American Society of Anesthesiologists(ASA)classification,Siewert classification,and pathological staging of tumors,showed no statistically significant differences(all P>0.05).All patients successfully underwent the procedure without conversion to open surgery.The time for gastroesophageal anastomosis was significantly shorter in the robotic group compared to the laparoscopic group[(31.09±8.23)min vs(43.73±8.83)min,P<0.001],while there were no statistically significant differences in other intraoperative and postoperative parameters,including operative time,intraoperative blood loss,number of lymph nodes removed,duration of gastric tube placement,time to start a liquid diet,length of postoperative hospital stay,and incidence of postoperative complications(all P>0.05).At the 6-month postoperative follow-up,30 patients completed the follow-up,with one patient lost to follow-up in the robotic group.Upper gastrointestinal radiography and esophagogastroscopy results showed that only one patient in the laparoscopic group developed an anastomotic stricture,while one patient in the robotic group developed grade A and one developed grade B gastroesophageal reflux disease(GERD).In addition,one patient in the laparoscopic group also developed grade B GERD.The incidences of GERD and anastomotic stricture showed no statistically significant differences between the two groups(both P>0.05).EORTC QLQ-STO22 results indicated that the robotic group had significantly lower scores in the dimensions of dysphagia,gastroesophageal reflux,and dietary restrictions,as well as in the total score,compared to the laparoscopic group(all P<0.05).Conclusion·Robot-assisted proximal gastrectomy combined with double-flap esophagogastrostomy is safe and feasible.It shortens anastomosis time and offers potential advantages in postoperative functional recovery and quality of life improvement.

Background and purpose:Accurate preoperative differentiation between vagal nerve cervical schwannomas(SCCS)and sympathetic chain cervical schwannomas(SCCS)in the neck is crucial because of their different postoperative complication.This study aimed to construct and validate a Diagnosis Score and vascular displacement nomogram for the preoperative differentiation of VNCS from SCCS in the neck.Methods:This cross-sectional study retrospectively analyzed patients with pathologically confirmed VNCS and SCCS at Fudan University Shanghai Cancer Center from January 2017 to April 2022.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(approval number:1612167-18).Inclusion criteria:① histopathological diagnosis of VNCS or SCCS through biopsy or surgical resection;② patients with complete clinic data;③availability of preoperative contrast-enhanced computed tomography(CT)or magnetic resonance imaging(MRI)examinations.Patients were excluded for:① contrast agent contraindications;② poor image quality;③ severe artifacts;④ non-standard scanning protocols.The cohort was randomly divided into training and validation sets in a 7∶3 ratio.Two radiologists(one resident and one attending physician)independently evaluated tumor characteristics(location,size and vascular displacement patterns)on preoperative imaging.Independent predictors were selected using LASSO regression analysis to construct a diagnostic scoring system and nomogram,with model performance evaluated by the receiver operating characteristic(ROC)curve.Results:A total of 110 patients were enrolled,with 77 cases allocated to the training set and 33 cases to the validation set.The age range was 24-78 years,and the mean age was(51.22±12.36)years.There were no statistically significant differences in baseline characteristics including age,gender,tumor location and size between the two patient groups(P＞0.05).ICA/ECA splaying was significantly associated with SCCS(P＜0.001),while the ICA/IJV splaying was significantly associated with VNCS(P＜0.001).Lateral and posterior ICA displacement were significantly associated with SCCS(P＜0.001),and medial and anterior ICA displacement were significantly associated with VNCS(P＜0.001).Five features including tumor size,ICA displacement direction,IJV displacement direction,ICA/ECA splaying and ICA/IJV splaying were used to establish the Diagnosis Score and nomogram.The nomogram combined imaging features showed favorable preference value for differentiating VNCS from SCCS,with area under curve(AUC)values of 0.953(95%CI:0.912-0.994)and 0.939(95%CI:0.885-0.993)for the training and validation cohorts,respectively.Conclusion:The Diagnosis Score and vascular displacement nomogram showed favorable predictive efficacy for differentiating VNCS from SCCS in the neck,and might be useful for clinical decision-making.