Objective To explore the current situation of disease perception in patients with tophi and its correlation with the quality of life. Methods A retrospective analysis was conducted on 303 gout patients admitted to the Shanghai Sixth People's Hospital from January 2023 to December 2024. The patients were classified into tophi gout (n=150) and non-tophi gout (n=153) groups based on whether they were tophi gout or not. The current disease perception status and quality of life of the two groups were compared using Simplified Chinese Version of the Disease Cognition Questionnaire (BIPQ) and Short Form of Health Survey (SF-36). Logistic regression was used to analyze the influencing factors of the quality of life of patients with tophi gout. Results Compared with the non-tophaceous gout group, the tophaceous gout group had a higher BIPQ score, and a lower SF-36 score (P<0.05). Among patients with tophaceous gout, 80 cases had good quality of life, and 70 cases had poor quality of life. These patients were included in the good quality of life group (n=80) and the poor quality of life group (n=70), respectively. Compared with the good quality of life group, patients in the poor quality of life group had longer gout course and average duration of each gout attack, as well as higher 20-item tophi impact questionnaire (TIQ-20) score and BIPQ score (P<0.05). Logistic regression analysis showed that the course of gout (OR=1.070, 95% CI: 1.017-1.126, P=0.009), TIQ-20 score (OR=1.048, 95% CI: 1.022-1.075, P<0.001), and BIPQ score (OR=1.055, 95%CI: 1.009-1.104, P=0.019) were risk factors affecting the quality of life in patients with tophaceous gout (P<0.05). Conclusion The course of gout, TIQ-20 score and BIPQ score are risk factors affecting the quality of life of patients with tophi gout.

Objective: To analyze the association between drinking behaviors and anxiety symptoms, with the mediating role of insomnia symptoms among college freshmen, so as to provide a reference basis for reducing the occurrence of anxiety symptoms in college freshmen. Methods: From October to December 2021, 31 856 freshmen were selected by the purposive sampling method in 22 colleges across 11 provinces (Fujian, Jiangsu, Guangdong, Henan, Anhui, Hubei, Shanxi, Jiangxi, Shaanxi, Yunnan, Chongqing) in China. The Semi quantitative Food Frequency Questionnaire was used to investigate college freshmen drinking behaviors. The Depression Anxiety Stress Scale 21 and the Insomnia Severity Index were used to assess anxiety symptoms and insomnia symptoms in college freshmen. The generalized linear model was employed to analyze the association between drinking behaviors and anxiety symptoms in college freshmen, and the structural equation modeling was used to assess the mediating effect of insomnia symptoms on the association. Results: The detection rate of anxiety symptoms among college freshmen was 28.2%, the detection rates of the mild, moderate, severe and extremely severe were 6.6%, 15.9%, 3.2% and 2.6%, respectively. While 23.6% of college freshmen reported drinking in the past month, the rates were 39.8% among boys and 15.9% among girls. After adjusting for demographic variables (ethnicity, education, major, etc.) and confounding variables (self evaluation of learning burden, number of close friends, screen time, etc.), the results of generalized linear model analysis showed that beer consumption was associated with anxiety symptoms in college freshmen( β =0.09, 95% CI =0.04-0.14), girls( β =0.14, 95% CI =0.07-0.21) and those aged 19-20 years ( β =0.12, 95% CI =0.05-0.19)(all P <0.05). Red wine consumption was associated with anxiety symptoms in male students ( β =0.13, 95% CI =0.02-0.24, P <0.05). Alcohol and beer consumption were associated with insomnia in college freshmen[ β (95% CI ) =0.22(0.08-0.36),0.31(0.23-0.39),both P <0.01]. Insomnia symptoms partially mediated the association between drinking behaviors and anxiety symptoms among college freshmen with a mediating effect value of 0.05, accounting for 50.49% of the total effect. Conclusions Insomnia symptoms partially mediates the association between drinking behaviors and anxiety symptoms in college freshmen. Measures should be taken to simultaneously intervene in the drinking behaviors and insomnia symptoms of college freshmen to prevent the occurrence of their anxiety symptoms.

Microvascular diseases （MVD） can affect multiple systems in the body and are important factors in the occurrence and development of cardiovascular， cerebrovascular， renal， and metabolic diseases， as well as the aging process. It is proposed that the key pathogenesis of MVD is "cold constraint in sanjiao （三焦）". Based on the theory of cold pathogen， and by integrating the common and local pathologies of sanjiao， a treatment principle of promoting blood circulation and warming is established. A basic prescription for promoting blood circulation and warming is formulated， with modifications based on the specific pathogenesis of the upper， middle， and lower jiao （焦）. For the upper jiao， cold constraint primarily involves the failure of the clear yang to rise and qi and blood stagnation， for which treatment should focus on diffusing and unblocking the heart and the lung， opening constraint and vibrating yang， commonly adding Shengxian Decoction （升陷汤） for warming and dispersing to assist in diffusion and dissipation， and using Guizhi Decoction （桂枝汤）-series formulas to harmonize ying-wei （营卫） and open the striae and interstices； both formulas can invigorate yang qi. For the middle jiao， cold constraint primarily involves the dysfunction of the central yang and internal accumulation of turbid pathogen， for which treatment should focus on harmonizing the spleen and stomach， warming and reinforcing yang； formulas such as Sini Powder （四逆散）， Zhishi Xiaopi Pill （枳实消痞丸）， and Banxia Xiexin Decoction （半夏泻心汤） can be used to restore qi flow， promote digestion， and balance cold and heat； Shengyang Yiwei Decoction （升阳益胃汤） can further enhance raising the clear and directing the turbid downward， expelling cold and removing dampness. For the lower jiao， cold constraint primarily involves damage to the original yang and dysfunction of qi transformation， for which the treatment should focus on tonifying original qi and reinforcing the foundation， as well as promoting diuresis and supporting yang； depending on the degree of deficiency and the presence of internal water accumulation， formulas like Jingui Shenqi Pill （金匮肾气丸）， Fuzi Decoction （附子汤）， and Zhenwu Decoction （真武汤） can be used. Based on the theory of cold constraint， the principle of promoting blood circulation and warming method runs through the differentiation and treatment of MVD. By further incorporating the pathological characteristics of sanjiao， flexible treatment strategies can be developed， which helps deepen the understanding of the disease's etiology and pathogenesis， while broadening clinical diagnostic and therapeutic approaches.

ObjectiveTo observe the short-term and long-term efficacy of traditional Chinese medicine （TCM） surgical operations in treating mixed hemorrhoids. MethodsA multi-center retrospective cohort study was conducted， collecting clinical data from 17，831 mixed hemorrhoid surgery patients in 8 top-tier TCM hospitals in Jiangsu Province. Standardized and structured datasets were obtained through artificial intelligence models. Patients who underwent western surgical treatment were categorized into the western surgery group （11,646 cases）， and those receiving TCM surgical operations were categorized into the TCM surgery group （6185 cases）. Propensity score matching （1∶1 matching） was used to balance baseline data between groups. The primary outcome was the one-year recurrence rate， and secondary outcomes included the main symptoms （rectal bleeding， degree of prolapse） and secondary symptoms （anal distension， anal edema， wound secretion and exudation， anal stenosis， residual skin tags， perianal itching， and anal pain） measured on days 7， 28， and 60 after discharge. ResultsAfter matching， 2194 patients were included in each group. Symptom scores showed that at 28 days after discharge， the TCM surgical group had superior improvement in rectal bleeding ［OR=5.786， 95%CI （3.092，10.827）］， degree of prolapse ［OR=4.510， 95%CI （1.649，12.333）］， and anal edema ［OR=3.188， 95%CI （1.295，7.845）］ compared to the western surgical group. At 60 days post-discharge， the TCM group still showed advantages in improving rectal bleeding ［OR=5.237， 95%CI （1.077，25.464）］ and anal pain ［OR=11.697， 95%CI （1.186，115.336）］ （P＜0.05）. Long-term follow-up showed that the one-year recurrence rate in the TCM surgery group was 1.1% （8/726）， while that in the western surgery group was 2.3% （10/444）， with no statistically significant difference between the two groups （P＞0.05）. ConclusionBased on real-world data， TCM surgical treatment for mixed hemorrhoids shows significant short-term symptom improvement， particularly in terms of hemostasis， reducing swelling， and alleviating prolapse of anal masses.

As the core vehicle for preserving and transmitting traditional Chinese medicine（TCM） academic thought and clinical experience， the establishment of a robust quality evaluation system for TCM clinical case reports is a crucial component in the current standardization and modernization of TCM. Based on the practical experience of constructing the China Clinical Cases Library of Traditional Chinese Medicine by the China Association of Chinese Medicine， this study conducted a comprehensive analysis of critical challenges， including insufficient authenticity and unfocused evaluation criteria. It proposed a three-dimensional evaluation framework grounded in the structure-process-outcome logic， encompassing three dimensions of authenticity and standardization， characteristics and advantages， application and translational impact. This framework integrated 12 key evaluation indicators in a systematic manner. The model preserved the academic characteristics of TCM syndrome differentiation and treatment， while aligning with modern scientific research standards， achieving a balance between individualized TCM experience and standardized evaluation. Concurrently， this study provided theoretical foundations and methodological guidance for evaluating the quality of TCM clinical cases， contributing significantly to the inheritance of TCM knowledge， evidence-based practice， and the reform of talent evaluation mechanisms.

ObjectiveThis paper aims to investigate the traditional Chinese medicine syndrome types in patients with chronic hepatitis B （CHB） complicated by metabolic dysfunction-associated fatty liver disease （MAFLD） and explore the correlations between these syndrome types and clinical indicators， as well as ocular manifestation characteristics， thereby providing a reference for syndrome differentiation and treatment strategies in traditional Chinese medicine. MethodsGeneral data， information from the four diagnostic methods of traditional Chinese medicine， clinical indicators， and ocular manifestation data were collected from 506 patients with CHB complicated by MAFLD enrolled at the Public Health Clinical Center of Chengdu between June 2024 and December 2024. Cluster analysis， principal component analysis， and complex network models were employed to identify the distribution patterns of traditional Chinese medicine syndromes. Correlations between different syndrome types and clinical indicators， as well as ocular manifestation characteristics， were further analyzed. ResultsThe predominant syndromes identified in patients with CHB complicated by MAFLD were dampness and heat accumulation （51.58%）， liver depression with spleen deficiency （31.62%）， blood stasis obstructing collaterals （8.89%）， and Qi-Yin deficiency （7.91%）. No statistically significant differences were found among the four syndrome types in routine blood tests and liver function indicators. However， patients with the dampness and heat accumulation type exhibited significantly higher levels of total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， liver stiffness measurement （LSM）， controlled attenuation parameter （CAP）， and alpha-fetoprotein （AFP）， along with lower levels of high-density lipoprotein cholesterol （HDL-C）， compared with those with other syndrome types. Regarding ocular manifestations， the incidence of moon halo signs was significantly higher in patients with the blood stasis obstructing collaterals type than in those with other syndrome types. Additionally， the incidence in scleral zone 3 （corresponding to the large intestine） was higher in patients with the damp and heat accumulation type. ConclusionDampness and heat accumulation is the core syndrome type in patients with CHB complicated by MAFLD， commonly accompanied by spleen deficiency， liver depression， blood stasis， and Yin deficiency. A complex syndrome pattern characterized by a predominance of dampness and heat， along with a mixture of deficiency and excess， is formed. Different traditional Chinese medicine syndrome types are associated with distinct clinical indicators and ocular manifestation characteristics. Among them， patients with the dampness and heat accumulation type exhibit more pronounced metabolic disturbances and liver injury， whereas those with the blood stasis type show a higher incidence of moon halo signs. Abnormalities in scleral zone 3 are also more prevalent in patients with dampness and heat type.

Objective:To explore the diagnostic value of digital mammography combined with serum glutathione specific gamma-glutamyl transpeptidase 1(CHAC1)and retinoic acid-induced protein 14(RAI14)in identifying benign and malignant breast masses.Methods:A total of 189 patients with breast masses who were treated at Handan Maternal and Child Health Care Hospital from June 2019 to June 2024 were prospectively selected as the research subjects.According to the results of pathological biopsy,they were divided into benign mass group(128 cases)and malignant mass group(61 cases).All patients underwent digital mammography detection.The levels of serum CHAC1 and RAI14 were detected by enzyme-linked immunosorbent assay(ELISA).The general clinical data of the patients were collected and analyzed.Multivariate logistic regression analysis was used to analyze the factors of influencing benign and malignant nature of breast masses.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of CHAC1 and RAI14 for the benign and malignant nature of breast masses.The Kappa test was used to assess the consistency of results between each diagnostic method and the pathological detection.Results:For 189 patients with breast masses,digital mammography identified 56 cases of malignant masses and 133 cases of benign masses,and 13 cases of them were misdiagnosis and 18 cases of them were missed diagnosis.It showed a moderate consistency with the results of pathological detection(Kappa=0.617,P<0.05).Compared with the benign mass group,the levels of serum CHAC1 and RAI14 in the malignant mass group were significantly higher,and the differences of them between the two groups were statistically significant(t=12.249,12.512,P<0.05).The age,menopausal time,CHAC1 and RAI14 of the patients were all risk factors that can affect the benign and malignant nature of breast masses(OR=1.368,1.305,1.897,1.995,P<0.05).The area under curve(AUC),sensitivity and specificity of CHAC1 were respectively 0.816(95%CI:0.753～0.868),70.49%and 89.06%in diagnosing the benign and malignant nature of breast masses.These indicators of RAI14 were respectively 0.838(95%CI:0.778～0.888),68.85%and 89.84%in diagnosing the benign and malignant nature.The combined detection of the three methods identified 74 cases of malignant masses and 115 cases of benign masses,with 15 cases of misdiagnosis and 2 cases of missed diagnosis,which showed an extremely high consistency with the results of pathological detection(Kappa=0.805,P<0.001).The sensitivity(96.72%),negative predictive value(98.26%)and accuracy(91.01%)of the combined detection of digital mammography,serum CHAC1 and RAI14 were significantly higher than those of each alone detection of them,and the differences of them were significant(x2=15.310,16.623,15.310,11.690,12.402,11.572,5.276,5.276,4.677,P<0.05).Conclusion:The levels of serum CHAC1 and RAI14 appear increase in malignant breast masses,and digital mammography combined with serum CHAC1 and RAI14 has a certain of identification value for benign and malignant nature of breast masses.

Objective:To analyze four patients with a 16q22 fragile site with miscarriage or infertility by using cytogenetic methods.Methods:Four patients presented at Northwest Women′s and Children′s Hospital between January 2022 and December 2024 were selected as the study subjects. Peripheral blood samples were collected from the patients and subjected to G-banded chromosomal karyotyping, among whom two were also subjected to copy number variation (CNV) sequencing. This study has been approved by the Ethics Committee of the Hospital (Ethics No. 2020-022).Results:The chromosomal karyotypes of the patients were mos 46, XX, fra(16)(q22)[26]/47, XX, del(16)(q22), + chrb(16)(q22)[4]/46, XX, del(16)(q22)[3]/46, XX[91], mos 46, XY, fra(16)(q22)[21]/46, XY, del(16)(q22)[3]/46, XY[76], mos 46, XX, fra(16)(q22)[21]/ 46, XX, del(16)(q22)[4]/46, XX[75] and mos 46, XX, fra(16)(q22)[16]/46, XX, del(16)(q22)[7]/47, XX, del(16)(q22), + chrb(16)(q22)[6]/47, XX, fra(16)(q22), + chrb(16)(q22)[3]/46, XX[68], respectively. CNV sequencing of patients 2 and 4 revealed no deletion or duplication on chromosome 16.Conclusion:Identification of the 16q22 fragile site has facilitated genetic counseling for these patients.

Objective:To describe the safety of using the Chinese-made robotic laparoscopic surgery system for laparoscopic sacrocolpopexy in the treatment of severe pelvic organ prolapse.Methods:A pilot descriptive clinical study was conducted, enrolling 16 severe pelvic organ prolapse patients at Peking University First Hospital from April 2023 to January 2024. Patients who consented to participate in this study underwent laparoscopic sacrocolpopexy for severe pelvic organ prolapse using Chinese-made robotic laparoscopic surgery system. Preoperative clinical basic data and perioperative data of the patients were collected, summarizing the data on perioperative bleeding and complications, and reviewed the surgical learning experience. The evaluation indicators related to the learning experience included: (1) efficiency evaluation: including equipment docking time, total surgery time, suturing time, mechanical arm operation time and hysterectomy time, which were timed and recorded during surgery; (2) equipment operability evaluation: including equipment operation task load assessment and intraoperative operation feeling score. The cumulative sum analysis method was used to quantify surgery time and fit the learning curve.Results:Sixteen patients were successfully enrolled and underwent surgery, including total hysterectomy with bilateral salpingo-oophorectomy or salpingectomy plus sacrocolpopexy, or sacrocolpopexy alone (for one case without uterus). The age of 16 cases was (56.7±7.6) years (ranged from 44 to 67 years), with body mass index of (25.4±2.5) kg/m2. Concurrent procedures included anterior vaginal wall repair in 12 cases (12/16), posterior vaginal wall repair in 13 cases (13/16), tension-free vaginal tape obturator system in 1 case (1/16), and recto-uterine pouch hernia repair in 4 cases (4/16). The total surgery time was (355.8±91.1) minutes, with docking time at (6.7±4.9) minutes, robotic operative time at (267.6±81.4) minutes, robotic suturing time at (155.6±53.9) minutes, and hysterectomy time at (112.0±45.3) minutes. Learning curve analysis revealed inflection points at 6 cases for total surgery time ( P<0.001, R2=0.944) and robotic operative time ( P<0.001, R2=0.982), 5 cases for docking time ( P<0.001, R2=0.989), and 6 cases for robotic suturing time ( P<0.001, R2=0.907). Hysterectomy time had an inflection point at 5 cases ( P=0.023, R2=0.700). Median blood loss was 30 ml (range: 10-1 000 ml), with severe bleeding in one patient (1/16). No conversions to open surgery or laparoscopy occurred, and no severe perioperative or postoperative complications were reported. Conclusion:The Chinese-made robotic laparoscopic surgery system demonstrates excellent short-time safety and ease of operation for laparoscopic sacrocolpopexy.

Objective To investigate the application of flipped classroom combined with teaching film-reading model in the teaching of filamentous fungal morphology for refresher doctors and evaluate its effect.Methods Fifteen refresher doctors taking microbiology from the 2022 batch of Guangdong Provincial People's Hospital were selected as the control group,and fifteen from the 2023 batch were se-lected as the experimental group.The"Morphological identification of Aspergillus and Mucor" was selected as the teaching content.The experimental group adopted flipped classroom combined with teaching film-reading model for teaching and the control group adopted tra-ditional teaching mode.The theoretical scores,operational scores,film-reading scores,and total scores of the two groups before and af-ter the implementation of teaching were compared and the teaching effect of the experimental group was evaluated using the Question-naire Star.Results The median scores of operational,film-reading,and total scores in the experimental group and control group were 40,30,and 95.5 and 36,27,and 85.5,respectively,and all the three scores in the experimental group were significantly higher than those in the control group(P＜0.05).Conclusion The flipped classroom combined with teaching film-reading model helps to improve the teaching effect of filamentous fungal morphology for refresher doctors,with high satisfaction,and can provide reference for subse-quent filamentous fungal morphology teaching.