The study focuses on the concept of multifunctional traditional Chinese medicine (TCM) formulas and aims to evaluate the efficacy of the classical formula Xiaoyao San (逍遥散). Study employs the integrated evidence chain (Eff-iEC) method to organize, integrate, and evaluate its therapeutic efficacy in treating different diseases with the same therapy, and to investigate the feasibility of using Eff-iEC to evaluate the multifunctionality of TCM formulas. The evaluation covered Xiaoyao San's therapeutic effects on depression, premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Concurrently, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for evaluation, and authoritative medical documents were incorporated to corroborate the recognition of Xiaoyao San within the medical community. Depression and menopausal syndrome received higher ratings than other conditions in the Eff-iEC, GRADE, and Medical Community Recognition assessments. The Eff-iEC evidence grade for Xiaoyao San was rated as "High" or above for chronic hepatitis, irritable bowel syndrome, dyspepsia, and menopausal syndrome. Premenstrual syndrome received a "Moderate ⁺" rating. The GRADE evidence level was "Low-〇〇⨁⨁" for depression, premenstrual syndrome, and chronic hepatitis; "Moderate-〇⨁⨁⨁" for dyspepsia and menopausal syndrome; and "Very Low-〇〇〇⨁" for irritable bowel syndrome. Depression and menopausal syndrome had the highest inclusion frequency, appearing in all 4 categories. Premenstrual syndrome, chronic hepatitis, and dyspepsia are not recommended in Western medical guidelines, but they are included in TCM guidelines, the China National Basic Medical Insurance Drug List, and the China National Essential Drug List. Irritable bowel syndrome appears only in the China National Basic Medical Insurance Drug List and China National Essential Drug List. The evaluation results obtained using the Eff-iEC method align with Medical Community Recognition, providing an objective and comprehensive assessment of Xiaoyao San's efficacy. The findings suggest that Xiaoyao San has strong evidence for treating depression and menopausal syndrome. However, further experimental and clinical trials are needed to assess its efficacy in treating premenstrual syndrome, chronic hepatitis, irritable bowel syndrome, and dyspepsia. These results support the clinical efficacy and rational use of Xiaoyao San, expand the application scope of the Eff-iEC method, and offer valuable insights and methodological references for the comparative evaluation of multifunctional TCM formulas.

Objective:To understand the current status of residents′ cognition of doctor-patient relationship and its influencing factors in a certain area of Guangxi under the background of Healthy China, so as to provide references for building the harmonious doctor-patient relationship.Methods:Convenience sampling was used to conduct an online questionnaire survey among permanent residents in a certain area of Guangxi from June 1 to July 31, 2023. The survey included residents′ sociodemographic characteristics and their perceptions of doctor-patient relationships. A logistic regression model was employed to analyze the influencing factors of residents′ perceptions of doctor-patient relationships.Results:A total of 114 796 residents participated in the survey. Among them, 44.1% (50 593) believed that the current doctor-patient relationship was harmonious, 47.8% (54 874) considered it neutral, and 8.1% (9 329) perceived it as discordant. The multinomial logistic regression model revealed that males, urban residents, older age groups, unmarried individuals, those with higher education levels, and those in poor health were more likely to perceive the doctor-patient relationship as discordant( P<0.05). Residents who valued health-related behaviors and knowledge, as well as those aware of health policies, were more likely to agree that the doctor-patient relationship was harmonious( P<0.05). Conclusions:Over 90% of residents in a certain area of Guangxi perceived the current doctor-patient relationship as either harmonious or neutral. Strengthening health education and enhancing the promotion of health policies can positively contribute to a harmonious doctor-patient relationship.

Objective:To investigate the clinical characteristics and aeromedical assessment conclusions of bronchial asthma in military pilots.Methods:The clinical data of 24 military pilots was retrospectively analyzed who were diagnosed with bronchial asthma and hospitalized at the Air Force Medical Center between January 2010 and March 2024. These pilots were divided into a qualified group and a grounded group based on aeromedical assessment conclusions. The basic information, clinical data, diagnosis and treatment, and aeromedical assessment conclusions were compared between the 2 groups.Results:There were 11 military pilots in the qualified group and 13 in the grounded group. No statistically significant differences were observed between the 2 groups in terms of age at initial asthma diagnosis, body mass index, flying hours, aircraft types, smoking status, or family history of bronchial asthma (all P>0.05). The time intervals between the symptom onset, initial diagnosis and treatment and ground observation were shorter in the qualified group than in the grounded group, with statistically significant differences ( Z=-1.77, -2.73, P=0.047, 0.006). No statistically significant differences were found between the 2 groups in terms of cough variant asthma, concurrent allergic rhinitis, eosinophil count and percentage, and abnormal pulmonary function (all P>0.05). The proportion of military pilots with identified allergens was significantly higher in the grounded group than in the qualified group ( P=0.005). In the qualified group, one fighter pilot was aeromedically assessed as being restricted to dual-seat fighter aircraft. After 3 months of ground observation without disease recurrence, the dual-seat restriction was lifted. The other 2 fighter pilots were qualified for downgraded aircraft types (from fighters to bombers, transporters, or helicopters). Eight non-fighter pilots were aeromedically concluded as eligible for flight. After [43.0(15.8, 66.3)] months of treatment and ground observation, the 13 military pilots in the grounded group were found to be under poor symptom control with recurrent episodes before being grounded. Conclusions:Bronchial asthma in military pilots is closely related to allergic rhinitis, with early clinical symptoms often being atypical and prone to delayed diagnosis and treatment. Patients with bronchial asthma should receive individualized treatment based on their condition. Both the US military and the Chinese military stipulate that pilots with bronchial asthma be ineligible for flight. However, for cases with mild illness, no sudden acute severe attacks, symptom resolution after treatment, normal pulmonary function, and in stable condition after 3-6 months of ground observation, an aeromedical assessment can be conducted based on the aircraft types and flight duties.

Background and purpose:Human papilloma virus(HPV)infection status is crucial for diagnosing cervical precancerous lesions and classifying cervical cancer.High-risk(HR)HPV is often linked to P16 protein overexpression,so P16 detection via immunohistochemistry(IHC)is commonly used to assess HPV infection.However,the differences between HPV status and P16 expression remains unclear.An in-depth study of the correlation between HPV and P16 is essential for clinical guidance.Methods:We retrospectively collected clinical and pathological data of cervical lesions from 618 patients diagnosed at the Department of Pathology,Fudan University Shanghai Cancer Center from January 2020 to December 2023(Ethical number:050432-4-2307E).Polymerase chain reaction(PCR)reverse dot hybridization was used to detect HPV including HR and low-risk(LR)subtypes,and immunohistochemistry was used to detect P16 for comparative analysis.Based on different clinical and pathological diagnoses,the sensitivity and specificity of P16 expression in evaluating HPV infection were evaluated.Among the 618 cases of cervical lesions,there were 92 cases of cervical squamous cell carcinoma,257 cases of cervical adenocarcinoma,79 cases of high-grade squamous intraepithelial lesions(HSIL),105 cases of low-grade squamous intraepithelial lesions(LSIL),and 85 cases of chronic cervical inflammation.Results:According to clinical diagnosis,the HR-HPV positive rate in cervical squamous cell carcinoma was 88.0%(81/92),the P16 positive rate was 91.3%(84/92),and the overall consistency rate between P16 and HPV detection was 90.2%(88/92);for HR-HPV infection,the sensitivity and specificity of P16 were 96.3%and 45.5%.The positive rate of HR-HPV in adenocarcinoma was 54.5%(140/257),the positive rate of P16 was 58.8%(151/257),and the overall consistency rate between P16 and HPV detection was 82.5%(212/257);for HR-HPV infection,the sensitivity and specificity of P16 were 87.9%and 76.1%.In HSIL,the HR-HPV positive rate was 75.9%(60/79),the positive rate of P16 was 70.9%(56/79),and the overall consistency rate between P16 and HR-HPV detection was 82.2%(65/79);for HR-HPV infection,the sensitivity and specificity of P16 were 85.0%and 73.7%.In LSIL,the HR-HPV positive rate was 73.3%(77/105),the positive rate of P16 was 8.5%(9/105),and the overall consistency rate between P16 and HR-HPV detection was 33.3%(35/105);for HR-HPV infection,the sensitivity and specificity of P16 were 10.4%and 96.4%.In chronic cervical inflammation,the HR-HPV positive rate was 20%(17/85),the positive rate of P16 was 0.0%(0/85);for HR-HPV infection,the sensitivity and specificity of P16 were 0.0%and 100.0%.There was a significant positive correlation between P16 positivity and HPV16/18 in cervical squamous cell carcinoma,adenocarcinoma,and HSIL(P=0.000),while there was no significant correlation in LSIL and chronic cervical inflammation(P＞0.05).Conclusion:In cervical squamous cell carcinoma and adenocarcinoma,the consistency of P16 expression and HPV DNA positivity are high,especially in HPV16/18 subtype.There is a good concordance between HR-HPV positivity and P16 protein overexpression.The positive expression of P16 in HSIL may initially reflect HPV infection status.However,in LSIL and chronic cervicitis,P16 expression may not accurately correlate with HPV infection.The inconsistency between P16 and HPV DNA testing could be influenced by multiple factors,including HPV subtypes,histopathological categories,specimen quality,and technical limitations.In clinical practice,it is recommended to conduct comprehensive analysis or employ multiple diagnostic methods to confirm HPV infection status for precise evaluation.

Objective:To investigate the clinical characteristics and aeromedical assessment conclusions of bronchial asthma in military pilots.Methods:The clinical data of 24 military pilots was retrospectively analyzed who were diagnosed with bronchial asthma and hospitalized at the Air Force Medical Center between January 2010 and March 2024. These pilots were divided into a qualified group and a grounded group based on aeromedical assessment conclusions. The basic information, clinical data, diagnosis and treatment, and aeromedical assessment conclusions were compared between the 2 groups.Results:There were 11 military pilots in the qualified group and 13 in the grounded group. No statistically significant differences were observed between the 2 groups in terms of age at initial asthma diagnosis, body mass index, flying hours, aircraft types, smoking status, or family history of bronchial asthma (all P>0.05). The time intervals between the symptom onset, initial diagnosis and treatment and ground observation were shorter in the qualified group than in the grounded group, with statistically significant differences ( Z=-1.77, -2.73, P=0.047, 0.006). No statistically significant differences were found between the 2 groups in terms of cough variant asthma, concurrent allergic rhinitis, eosinophil count and percentage, and abnormal pulmonary function (all P>0.05). The proportion of military pilots with identified allergens was significantly higher in the grounded group than in the qualified group ( P=0.005). In the qualified group, one fighter pilot was aeromedically assessed as being restricted to dual-seat fighter aircraft. After 3 months of ground observation without disease recurrence, the dual-seat restriction was lifted. The other 2 fighter pilots were qualified for downgraded aircraft types (from fighters to bombers, transporters, or helicopters). Eight non-fighter pilots were aeromedically concluded as eligible for flight. After [43.0(15.8, 66.3)] months of treatment and ground observation, the 13 military pilots in the grounded group were found to be under poor symptom control with recurrent episodes before being grounded. Conclusions:Bronchial asthma in military pilots is closely related to allergic rhinitis, with early clinical symptoms often being atypical and prone to delayed diagnosis and treatment. Patients with bronchial asthma should receive individualized treatment based on their condition. Both the US military and the Chinese military stipulate that pilots with bronchial asthma be ineligible for flight. However, for cases with mild illness, no sudden acute severe attacks, symptom resolution after treatment, normal pulmonary function, and in stable condition after 3-6 months of ground observation, an aeromedical assessment can be conducted based on the aircraft types and flight duties.

Objective:To explore the hemodynamic characteristics of the middle cerebral artery (MCA) in atherosclerotic stenosis using four-dimensional flow (4D Flow) MRI, and combining high-resolution magnetic resonance vessel wall imaging (HR VW-MRI) to analyze the relationship between hemodynamics and the degree of stenosis, as well as the morphological characteristics of plaques.Methods:The study was a cross-sectional study. A total of 24 patients with middle cerebral artery(MCA) M1 atherosclerotic stenosis and 10 age and sex matched healthy controls (HC group) were prospectively recruited from September 2018 to March 2021 at Beijing Tiantan Hospital, Capital Medical University. All subjects underwent MRI examination. The hemodynamic of MCA were collected by 4D Flow MRI, and the hemodynamic parameters of proximal and distal MCA stenosis were calculated by blood flow post-processing software, including average blood flow rate (FR avg), average blood flow velocity (V avg), peak blood flow velocity (V pk), time average wall shear stress (TAWSS), minimum wall shear stress (WSS min) and oscillatory shear index (OSI). The differences in hemodynamic parameters among the proximal and distal ends of MCA stenosis and the HC group were compared using one-way ANOVA or Kruskal-Wallis H test. The stenosis rate and characteristics of MCA plaque were analyzed by HR VW-MRI, including remodeling index (RI), normalized wall index (NWI) and plaque length. Pearson or Spearman correlation analysis was used to explore the correlation between stenosis rate and hemodynamic parameters. Taking the stenosis rate as the control variable, partial correlation analysis was used to explore the correlation between plaque morphological characteristics and hemodynamic parameters. Results:There were statistically significant differences in FR avg, V avg, V pk, TAWSS, OSI, WSS min among the proximal and distal stenosis of MCA and HC groups ( P<0.05). The proximal end of the MCA stenosis had significantly higher FR avg, V avg, TAWSS and WSS min than those of the distal end of the stenosis ( P<0.01). The FR avg, V avg, V pk, TAWSS, and WSS min in the distal end of MCA stenosis were lower than those in the HC group, while the OSI was higher than that in the HC group ( P<0.01). The correlation analysis results showed that the MCA proximal V pk ( r=-0.425, P=0.027) and distal V pk ( r=-0.538, P=0.004) were negatively correlated with the diameter stenosis rate. When the stenosis rate was taken as the control factor, in the MCA proximal stenosis, V avg ( r=0.553, P=0.003), TAWSS ( r=0.543, P=0.004) and WSS min ( r=0.547, P=0.004) were positively correlated with RI, proximal OSI was negatively correlated with RI ( r=-0.492, P=0.011), and was positively correlated with the plaque length ( r=0.437, P=0.026). At the distal end of the stenosis, V pk was negatively correlated with NWI ( r=-0.556, P=0.003), OSI was negatively correlated with RI ( r=-0.511, P=0.008), NWI ( r=-0.390, P=0.049). TAWSS was positively correlated with RI ( r=0.393, P=0.047). Conclusions:The 4D Flow MRI demonstrates characteristic hemodynamic changes in the proximal and distal ends of the stenotic MCA. The local hemodynamic characteristics of the stenotic MCA are correlated with plaque morphological parameters, including lumen stenosis, plaque load, and RI. It suggests an interaction between the occurrence and development of MCA plaque and local hemodynamic changes.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To understand the current status of residents′ cognition of doctor-patient relationship and its influencing factors in a certain area of Guangxi under the background of Healthy China, so as to provide references for building the harmonious doctor-patient relationship.Methods:Convenience sampling was used to conduct an online questionnaire survey among permanent residents in a certain area of Guangxi from June 1 to July 31, 2023. The survey included residents′ sociodemographic characteristics and their perceptions of doctor-patient relationships. A logistic regression model was employed to analyze the influencing factors of residents′ perceptions of doctor-patient relationships.Results:A total of 114 796 residents participated in the survey. Among them, 44.1% (50 593) believed that the current doctor-patient relationship was harmonious, 47.8% (54 874) considered it neutral, and 8.1% (9 329) perceived it as discordant. The multinomial logistic regression model revealed that males, urban residents, older age groups, unmarried individuals, those with higher education levels, and those in poor health were more likely to perceive the doctor-patient relationship as discordant( P<0.05). Residents who valued health-related behaviors and knowledge, as well as those aware of health policies, were more likely to agree that the doctor-patient relationship was harmonious( P<0.05). Conclusions:Over 90% of residents in a certain area of Guangxi perceived the current doctor-patient relationship as either harmonious or neutral. Strengthening health education and enhancing the promotion of health policies can positively contribute to a harmonious doctor-patient relationship.

Objective:The Social Isolation Scale for people with type 2 diabetes mellitus (T2DM) was developed and tested for reliability and validity, which provided an effective tool for measuring the social isolation level of patients with T2DM.Methods:The initial scale was developed through literature review, qualitative interviews, and expert consultation. Convenience sampling method was used to select T2DM patients who met the inclusion and exclusion criteria for questionnaire survey. The item analysis method was used to select the items of the scale. Exploratory and confirmatory factor analyses were used to evaluate construct validity. The content validity of the scale was evaluated by the scale-level content validity index and the item-level content validity index. The criterion validity was verified by using the Lubben Social Network Scale-6 and the De Jong Gierveld Loneliness Scale. Reliability was tested through internal consistency and test-retest reliability.Results:Through literature review and qualitative interviews, 30 items of the scale were selected to form the first version scale. After two rounds of inquiries from 16 experts (expert authority coefficient = 0.897), the second version of the scale was formed. A total of 407 questionnaires were distributed in two stages using the second version scale. Among the 407 patients, there were 214 males and 193 females. Exploratory factor analysis extracted 4 common factors, with a cumulative variance contribution rate of 61.338%. The final scale was determined to include 4 dimensions and 16 items, with the dimensions being "social support network", "frequency of social participation", "satisfaction with interpersonal relationships", and "diabetes-related sense of isolation".The average content validity index at the scale level was 0.929, the content validity index at the item level was 0.830 - 1.000, and the criterion validity was - 0.647 and 0.681. The Cronbach′s α coefficient of the total scale was 0.822, and the test-retest reliability was 0.858.Conclusions:The Social Isolation Scale for people with T2DM has good reliability and validity. It is a reliable and valid tool for assessing social isolation in T2DM patients.

Objective To explore the changes in neural activity in patients with type 2 diabetes mellitus(T2DM)and their corre-lation with executive function,and to analyze the neural mechanisms underlying the decline in executive function in T2DM patients.Methods Thirty-one T2DM patients(T2DM group)and thirty-two healthy controls(HC)(HC group)matched for body mass index(BMI)underwent resting-state functional magnetic resonance imaging(rs-fMRI)scans and N-back task tests were included.Differ-ences in the amplitude of low-frequency fluctuation(ALFF),regional homogeneity(ReHo),and seed-based functional connectivity(FC)between the two groups were compared,and partial correlation analyses were performed between the difference results and N-back task performance.Results The T2DM group showed prolonged reaction time(RT)in the 1-back and 2-back tasks.T2DM patients exhibited increased ALFF in the bilateral caudate nucleus,left medial superior frontal gyrus,and right postcentral gyrus,as well as elevated ReHo in the right putamen.FC analysis revealed significant alterations in FC between the caudate nucleus,putamen,and multiple brain regions in T2DM patients,with some of these FC changes significantly correlated with RT and accuracy(ACC)in the N-back task.Conclusion The decline in executive function in T2DM patients may be associated with abnormal neural activity in brain regions such as the striatum,salience network,and frontoparietal control network.FC further decreases under increased cognitive load.These findings provide evidence for the study of the neural mechanisms of executive function impairment in T2DM patients.