Severe acute pancreatitis （SAP） is closely related to dysfunction of the spleen-stomach ascent and descent. Due to the influence of modern lifestyle and dietary factors， Qi deficiency in the spleen and stomach has become the pathological basis of SAP. Its pathogenesis is characterized by dampness， heat， pathogenic factors， stasis， stagnation， obstruction， Fu-organs Qi obstruction， pathogenic excess， and healthy Qi deficiency. At different stages of the disease course of SAP， there is a focus on both pathogenic excess and healthy Qi deficiency. It is specifically manifested as Fu-organs stagnation and heat accumulation， as well as pathogenic excess and healthy Qi deficiency， during the systemic inflammatory response phase， intermingling of blood stasis and pathogenic factors， as well as Qi deficiency and blood stasis， during the infection period， and weakness of the spleen and stomach， as well as healthy Qi deficiency and lingering pathogenic factors， during the residual infection period. Based on the theory that "the spleen and stomach are the acquired foundation"， a staged treatment method centered on the core principle of "strengthening healthy Qi to eliminate pathogenic factors" was developed. The staged treatment method included "clearing the Fu-organs to expel turbidity， replenishing Qi to harmonize the stomach， activating blood circulation to expel pathogenic factors， replenishing Qi to relieve pain， promoting digestion to stimulate appetite， and replenishing Qi to invigorate the spleen". In clinical practice， Hewei Tongxie mixture， Yikang mixture， and Shiwei Jianpi Xiaoshi powder were selected for staged treatment of SAP. This article systematically summarized the theoretical basis of traditional Chinese medicine， Western medicine foundation， modern pharmacological mechanisms， and clinical application experience of the staged treatment of SAP with "strengthening the healthy Qi to eliminate pathogenic factors"， providing new ideas for the treatment of SAP with traditional Chinese medicine.

Objective:To investigate the early warning value of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure (TcPO 2/TcPCO 2) monitoring in patients with pressure injury in ICU. Methods:A prospective clinical observation study was conducted. Patients were selected in the department of critical care medicine of Shenzhen Hospital Affiliated to University of Chinese Academy of Sciences from December 2020 to June 2022. The general information of all patients were recorded. The data of TcPO 2 and TcPCO 2 were monitored respectively in left lying position, supine position and right lying position. According to the Braden score of patients, they were divided into low risk group and high risk group, and the monitoring results of TcPO 2/TcPCO 2 were analyzed. Results:The study included a total of 80 patients, with 46 patients in the low risk group and 34 patients in the high risk group. There were no significant differences in gender and age between the two groups (both P>0.05). There were significant differences in the Braden score and the incidence of pressure injury between the two groups (both P<0.05). There were statistically significant differences in TcPO 2 at various time points in the left lying position, supine position and right lying position between the low risk and the high risk groups (all P<0.001). Except for the 15th minute of the left lying position and right lying position, there were statistically significant differences in TcPCO2 at all other time points in the supine and right lying positions between two groups (all P<0.05). There were statistically significant differences in TcPO 2/TcPCO 2 values at various time points in different positions between two groups (all P<0.001). In supine position, TcPO 2 and TcPO 2/TcPCO 2 were positively correlated with the Braden score ( r=0.680, 0.741). TcPCO 2 was negatively correlated with the Braden score ( r=-0.771). The Braden score, TcPO 2, TcPCO 2 and TcPO 2/TcPCO 2 all have moderate diagnostic value. The cut-off values were 12.50, 41.48 mmHg, 52.29 mmHg and 0.91, respectively. And the AUC were 0.899, 0.727, 0.816 and 0.719, respectively. However, there were no significant differences in AUC between the TcPO 2, TcPCO 2, TcPO 2/TcPCO 2 and Braden score (all P>0.05). Conclusions:TcPO 2, TcPCO 2 and TcPO 2/TcPCO 2 values all have higher diagnostic value about pressure injury for patients in ICU. TcPO 2/TcPCO 2 monitoring has early risk warning value for the occurrence of pressure injury in ICU, which is worthy of clinical promotion.

Objective To compare the short-term clinical effects of unilateral dual-channel endoscopic discectomy(UBED)and percutaneous endoscopic intervertebral discectomy(PEID)in the treatment of L5S,Lumbar disc herniation,LDH.Methods From January 2019 to January 2021,a total of 57 cases of L5S,LDH treated by UBED or PEID were analyzed retrospectively,including 30 cases in UBED group and 27 cases in PEID group.The operation time,intraoperative fluoroscopy times,postoperative hospitalization days and surgical complications were compared between the two groups.The visual analogue scale(VAS)and oswestry disability index(ODI)were used to compare the postoperative quality of life of the two groups,and the modified MacNab criteria was used to evaluate the clinical efficacy in the last follow-up.Results The operation time of UBED group and PEID group was(75.30±8.44)minutes and(68.37±4.63)minutes,respectively,and the difference between the two groups was statistically significant(P＜0.05).VAS and ODI of 1 week,3 months,1 year and 1.5 years after surgery in 2 groups were significantly decreased compared with those before surgery,with statistical significance(P＜0.05).The VAS score of low back pain in UBED group was higher than that in PEID group[(3.87±1.14)points vs(2.70±0.67)points]at 1 week after surgery(P＜0.05),and there was no significant difference in VAS and ODI at the other time points(P＞0.05).There was no statistical difference in the results of modified MacNab criteria in the last follow-up(P＞0.05).There were 2 cases of dural tear in PEID group,1 case of dural tear in UBED group and 1 case of temporary nerve root injury in PEID group after operation,all of which were cured after symptomatic treatment.Conclusion Compared with PEID,UBED has a longer operation time,more trauma and more obvious low back pain in the short term after operation.The short-term curative effect of the two operations on L5S1 LDH is similar,the incidence of complications is low,and the times of fluoroscopy are few.Both operations are safe and effective.

Objective To explore association between childhood trauma,resilience and non-suicidal self-injury in adolescents.Methods One hundred and fifty-eight first-episode adolescent patients with mood disorders were selected and divided into NSSI group(n=94)and non-NSSI group(n=64)based on presence or absence of NSSI.The Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),childhood trauma questionnaire(CTQ-SF)and Connor-Davidson resilience scale(CD-RISC)were used to evaluate the depression and anxiety symptoms,childhood trauma and resilience.Results There were more cases of younger age(16.17±1.67 vs.16.73±1.37),lower education level(30.9% vs.15.6% ),left behind experience(48.9% vs.29.7% ),school bullying(46.8% vs.25.0% ),suicide ideation(85.1% vs.37.5% )and history of attempted suicide(29.8% vs.6.3% )in the group with NSSI compared to those without NSSI.The HAMD score(27.99±5.94 vs.24.19±5.19),HAMA score(18.02±5.94 vs.15.45±4.99),CTQ total score(48.43±15.40 vs.41.97±9.75),emotional abuse score(12.77±6.06 vs.10.19±4.06),and emotional neglect score(11.40±5.34 vs.9.14±3.55)were higher in the group with NSSI,and the differences between the two groups were significant(P<0.05).The total scores of psychological resilience(39.83±10.27 vs.28.66±12.75),resilience(19.59±4.92 vs.12.28±6.47),strength(12.03±3.98 vs.9.99±4.67),and optimism(8.98±2.97 vs.6.47±3.73)in the group without NSSI were higher than those in the group with NSSI(P<0.05).Logistic regression analysis showed that left behind experience(OR=4.494,95% CI:1.192-16.940),school bullying(OR=5.983,95% CI:1.329-26.945),suicidal ideation(OR=13.225,95% CI:2.908-60.146),history of attempted suicide(OR=16.769,95% CI:1.845-152.379),HAMD(OR=1.264,95% CI:1.046-1.626),emotional abuse(OR=1.327,95% CI:1.093-1.612),and resilience(OR=0.468,95% CI:0.266-0.823)were significantly associated with adolescent mood disorders with NSSI(P<0.05).Conclusion Left behind experience,campus bullying,suicidal ideation and attempted suicide,emotional abuse,degree of depression,and psychological resilience may be associated with NSSI behavior in adolescents with mood disorders.

ABSTRACT: Meningiomas are the most common primary intracranial neoplasm with diverse pathological types and complicated clinical manifestations. The fifth edition of the WHO Classification of Tumors of the Central Nervous System (WHO CNS5), published in 2021, introduces major changes that advance the role of molecular diagnostics in meningiomas. To follow the revision of WHO CNS5, this expert consensus statement was formed jointly by the Group of Neuro-Oncology, Society of Neurosurgery, Chinese Medical Association together with neuropathologists and evidence-based experts. The consensus provides reference points to integrate key biomarkers into stratification and clinical decision making for meningioma patients. REGISTRATION Practice guideline REgistration for transPAREncy (PREPARE), IPGRP-2022CN234.
Humans ; Meningioma/pathology* ; Consensus ; Neurosurgical Procedures ; Meningeal Neoplasms/pathology*

Objective:To observe the effect of computerized cognitive remediation therapy(CCRT) in the patients with mild cognitive impairment (MCI).Methods:A randomized, single-blinded clinical study was carried out from the April to June in 2019. 46 patients who met MCI criteria were randomly allocated into a CCRT group ( n=24) and a control group ( n=22). In CCRT group, the CCRT was conducted five times a week (30 minutes each time) for a total of 8 weeks (40 times), while a natural observation was performed in the control group. All the subjects were assessed by the Mini-Mental State Examination(MMSE) and the Montreal Cognitive Assessment(MoCA) before and after the treatment. The Wilcoxon test in the paired rank-sum test of two related samples was used to evaluate the effect of CCRT on MCI before and after the intervention, and the Mann-Whitney U test in the rank-sum test of two independent samples was used to compare the differences in MMSE and MoCA scores between the two groups. Results:Before treatment, there were no statistically significant differences in MMSE, MoCA total scores and each factor between the CCRT group and the control group ( P>0.05). A total of 21 patients in CCRT group completed CCRT treatment. After 8 weeks of treatment, the difference between two groups in the total score of MMSE ( Z=-2.83), attention and calculation( Z=-2.58), time orientation( Z=-2.00) and visual spatial function ( Z=-2.45) scores were higher than those before the treatment ( P<0.05); the difference between two groups in MoCA total score ( Z=-3.40), visual space and executive function( Z=-3.41), attention ( Z=-3.09) were higher than those before the treatment ( P<0.05). Conclusion:CCRT may improve the cognitive function of MCI patients, especially the attention and visuospatial functions.

Objective:To observe the effect of computerized cognitive remediation therapy(CCRT) in the patients with mild cognitive impairment (MCI).Methods:A randomized, single-blinded clinical study was carried out from the April to June in 2019. 46 patients who met MCI criteria were randomly allocated into a CCRT group ( n=24) and a control group ( n=22). In CCRT group, the CCRT was conducted five times a week (30 minutes each time) for a total of 8 weeks (40 times), while a natural observation was performed in the control group. All the subjects were assessed by the Mini-Mental State Examination(MMSE) and the Montreal Cognitive Assessment(MoCA) before and after the treatment. The Wilcoxon test in the paired rank-sum test of two related samples was used to evaluate the effect of CCRT on MCI before and after the intervention, and the Mann-Whitney U test in the rank-sum test of two independent samples was used to compare the differences in MMSE and MoCA scores between the two groups. Results:Before treatment, there were no statistically significant differences in MMSE, MoCA total scores and each factor between the CCRT group and the control group ( P>0.05). A total of 21 patients in CCRT group completed CCRT treatment. After 8 weeks of treatment, the difference between two groups in the total score of MMSE ( Z=-2.83), attention and calculation( Z=-2.58), time orientation( Z=-2.00) and visual spatial function ( Z=-2.45) scores were higher than those before the treatment ( P<0.05); the difference between two groups in MoCA total score ( Z=-3.40), visual space and executive function( Z=-3.41), attention ( Z=-3.09) were higher than those before the treatment ( P<0.05). Conclusion:CCRT may improve the cognitive function of MCI patients, especially the attention and visuospatial functions.

Objective To explore the effects of early psychological trauma and corticotropin?releasing factor receptor 1(CRHR1) gene polymorphism on working memory. Methods 1534 healthy adult volunteers were recruited and divided into 3 groups according to whether ever being exposed to the Tangshan earthquake in their early life:infant exposure group (IEG, n=176), fetal exposure group (FEG, n=172), and control group (n=182). The fetal exposure group was further divided into three subgroups:exposure in the first trimester (1～3months, n=50), exposure in the second trimester (4～6months, n=59), and exposure in the third trimester (7～9months, n=63). Brief Visuospatial Memory Test?Revised (BVMT?R) and Hopkins Verbal Learning Test?Revised (HVLT?R) were used to measure their working memory. The DNA extracted from the peripheral blood were analyzed to determine the CRHR1 rs242924 and rs7209436 gene polymorphism real?time PCR.The CRHR1 genotype was further divided into two groups:A/T gene carrier and C gene carrier. Possible interactions between psychological impact of the earthquake in early life time and the CRHR1 genotype were explored. Results The total scores of BVMT?R in the FEG and IEG groups were significantly lower than that in the control group; The total BVMT?R scores of the CRHR1 C gene carriers in the IEG and FEG groups were significantly lower than that in the control group (22.5 ± 8.1 vs. 28.9 ± 5.7;t=-4.231, P<0.01;23.0 ± 8.5 vs. 28.9 ± 5.7, t=-3.201, P<0.05);Within the control group, the BVMT?R total score of the C gene carriers was higher than that of the A/T gene carrier (28.9±5.7 vs. 25.8±7.3, t=2.215, P<0.05). The earthquake early exposure and the genotype of CRHR1 had interactive effect on the BVMT?R total score (F=4.028, P<0.05). There was no significant difference in the HVLT?R score among the three groups (P>0.05). Conclusions The early psychological traumatic stress after earthquake exposure may contribute to the adulthood visual spatial memory decline, which may be explained partly by the interaction of the early psychological stress with the CRHR1 vulnerable genotype.

Objective To investigate whether the male adulthood brain volumes changes are correlated to their prenatal earthquake stress experience or suffering depression after birth. Methods A total of 956 adult males born in Tangshan during the earthquake were visited, and finally 41 subjects were recruited with 10 subjects in the stress?depression group (experienced prenatal earthquake stress and developed depression after birth), 18 subjects in stress-health group (experienced prenatal earthquake stress but no history of mental disorders after birth), and 13 blank control. 3.0 T magnetic resonance imaging was conducted on all subjects to record T1?weighted imaging. The curved surface?based morphology approach was employed to analyze the images, and to assess the changes in cortical gray matter volume, cortical thickness, cortical surface area, and subcortical nuclear volume. Results (1) There was significant difference in the age and HAMD17 score among the three groups (P<0.01). (2) Compared with the blank control group and corrected by whole brain volume, the gray matter volume of the left superior frontal gyrus (t=3.889, P=0.031) was significantly smaller in the stress-health group; the cortical thickness of the left superior frontal gyrus (t=4.968, P=0.046), left superior parietal lobule, left postcentral gyrus (t=4.362, P=0.015), and the right superior parietal lobule (t=4.212, P=0.010) significantly reduced in the stress-health group;the gray matter volume of the left superior frontal gyrus (t=4.365, P=0.049), and the left superior and middle frontal gyrus (t=4.231, P=0.042) in the stress?depression group significantly reduced; the cortical thickness of left superior frontal gyrus (t=4.878, P=0.012), left superior parietal lobule, left postcentral gyrus (t=4.741, P=0.004), right superior parietal lobule (t=4.323, P=0.005), right superior parietal lobule and the right precuneus (t=4.523, P=0.013) significantly decreased in the stress?depression group. Furthermore, the cortical surface area of left superior temporal gyrus (t=4.386, P=0.027) in the stress?depression group is significantly smaller than the stress-health group. And the volume of the right amygdala (P=0.022) in the stress?depression group also decreased in comparison with the blank control group. Conclusions The prenatal earthquake stress and later developing depression after birth may result in the change of their adulthood brain volumes, probably with more contribution coming from the prenatal earthquake stress. The biggest change can be observed in the ones who have both factors as a synergistic effect.

Objective To explore the effects of early psychological trauma and corticotropin?releasing factor receptor 1(CRHR1) gene polymorphism on working memory. Methods 1534 healthy adult volunteers were recruited and divided into 3 groups according to whether ever being exposed to the Tangshan earthquake in their early life:infant exposure group (IEG, n=176), fetal exposure group (FEG, n=172), and control group (n=182). The fetal exposure group was further divided into three subgroups:exposure in the first trimester (1～3months, n=50), exposure in the second trimester (4～6months, n=59), and exposure in the third trimester (7～9months, n=63). Brief Visuospatial Memory Test?Revised (BVMT?R) and Hopkins Verbal Learning Test?Revised (HVLT?R) were used to measure their working memory. The DNA extracted from the peripheral blood were analyzed to determine the CRHR1 rs242924 and rs7209436 gene polymorphism real?time PCR.The CRHR1 genotype was further divided into two groups:A/T gene carrier and C gene carrier. Possible interactions between psychological impact of the earthquake in early life time and the CRHR1 genotype were explored. Results The total scores of BVMT?R in the FEG and IEG groups were significantly lower than that in the control group; The total BVMT?R scores of the CRHR1 C gene carriers in the IEG and FEG groups were significantly lower than that in the control group (22.5 ± 8.1 vs. 28.9 ± 5.7;t=-4.231, P<0.01;23.0 ± 8.5 vs. 28.9 ± 5.7, t=-3.201, P<0.05);Within the control group, the BVMT?R total score of the C gene carriers was higher than that of the A/T gene carrier (28.9±5.7 vs. 25.8±7.3, t=2.215, P<0.05). The earthquake early exposure and the genotype of CRHR1 had interactive effect on the BVMT?R total score (F=4.028, P<0.05). There was no significant difference in the HVLT?R score among the three groups (P>0.05). Conclusions The early psychological traumatic stress after earthquake exposure may contribute to the adulthood visual spatial memory decline, which may be explained partly by the interaction of the early psychological stress with the CRHR1 vulnerable genotype.