For a long time， simple asymptomatic renal hematuria has not been taken seriously. Current studies have confirmed that renal hematuria is a risk factor for the progression of renal function， but there is no effective treatment available. Because asymptomatic renal hematuria is highly concealed and lacks typical symptoms， individualized syndrome differentiation in traditional Chinese medicine （TCM） is difficult， making it a challenge in clinical diagnosis and treatment. Although TCM has a long history and solid theoretical basis in the treatment of hematuria， it urgently needs to break through the bottleneck of traditional syndrome differentiation. Based on classical TCM theories， research achievements in modern constitution studies， and relevant clinical and pathological evidence， this article focuses on the decisive influence of age on constitution distribution and its regular association with the evolution of core syndromes， and constructs a three-dimensional diagnostic and therapeutic system of "age-constitution-syndrome". It reveals that the syndrome manifestations of asymptomatic renal hematuria are profoundly shaped by constitution， and that constitution shows a group distribution pattern with age-children often present with deficiency of lung and spleen Qi combined with wind-heat， young and middle-aged individuals often present with deficiency of liver and kidney Yin combined with deficient fire and stasis heat， and elderly individuals often present with deficiency of spleen and kidney combined with cold-dampness and stasis obstruction. By analyzing the common pathogenic mechanisms， outcome characteristics， and internal mechanisms among different age groups， this study provides a basic syndrome framework and core intervention strategies for specific populations in clinical practice， offering a new evidence-based approach to addressing the dilemma of “no identifiable syndrome”.

According to the Qi-blood-body fluid theory and the association between the spleen in visceral manifestation theory of traditional Chinese medicine （TCM） and mitochondria in modern cellular biology， it is proposed that the role of the spleen in generating and transforming Qi and blood is analogous to the energy-producing function of mitochondria—both serving as fundamental power sources for vital activities of the human body. The spleen governs transportation and transformation， playing a critical role in energy metabolism and the digestion and absorption of nutrients. Similarly， mitochondria are vital for maintaining physiological functions such as cellular energy supply， cell survival， and overall human metabolism. Furthermore， spleen deficiency is closely linked to mitochondrial dysfunction. Accordingly， mitochondrial energy conversion and substance metabolism are regarded as the microscopic essence of the spleen's function in transportation and transformation. Spleen deficiency and mitochondrial dysfunction contribute to the formation of pathological products such as phlegm-turbidity and blood stasis. This aligns with the pathogenesis of chronic obstructive pulmonary disease （COPD）， with Qi deficiency as the root cause and phlegm-turbidity and blood stasis as the manifestations. Therefore， the integrative treatment of COPD should follow the therapeutic principle of invigorating the spleen and reinforcing healthy Qi， while also resolving phlegm and removing blood stasis to address both root cause and manifestations. This approach can improve the mitochondrial function， regulate energy metabolism， and reduce oxidative stress levels to alleviate COPD symptoms， slow down disease progression， and improve prognosis. By integrating the holistic concept of TCM with molecular mechanisms of modern medicine， this paper explores the pathogenesis and therapeutic principles of COPD from the spleen-mitochondria correlation. It not only provides a new direction for the modern development of TCM and the integration of Chinese and Western medicine but also offers a theoretical foundation for the integrated treatment of chronic， complex age-related diseases.

According to the Qi-blood-body fluid theory and the association between the spleen in visceral manifestation theory of traditional Chinese medicine （TCM） and mitochondria in modern cellular biology， it is proposed that the role of the spleen in generating and transforming Qi and blood is analogous to the energy-producing function of mitochondria—both serving as fundamental power sources for vital activities of the human body. The spleen governs transportation and transformation， playing a critical role in energy metabolism and the digestion and absorption of nutrients. Similarly， mitochondria are vital for maintaining physiological functions such as cellular energy supply， cell survival， and overall human metabolism. Furthermore， spleen deficiency is closely linked to mitochondrial dysfunction. Accordingly， mitochondrial energy conversion and substance metabolism are regarded as the microscopic essence of the spleen's function in transportation and transformation. Spleen deficiency and mitochondrial dysfunction contribute to the formation of pathological products such as phlegm-turbidity and blood stasis. This aligns with the pathogenesis of chronic obstructive pulmonary disease （COPD）， with Qi deficiency as the root cause and phlegm-turbidity and blood stasis as the manifestations. Therefore， the integrative treatment of COPD should follow the therapeutic principle of invigorating the spleen and reinforcing healthy Qi， while also resolving phlegm and removing blood stasis to address both root cause and manifestations. This approach can improve the mitochondrial function， regulate energy metabolism， and reduce oxidative stress levels to alleviate COPD symptoms， slow down disease progression， and improve prognosis. By integrating the holistic concept of TCM with molecular mechanisms of modern medicine， this paper explores the pathogenesis and therapeutic principles of COPD from the spleen-mitochondria correlation. It not only provides a new direction for the modern development of TCM and the integration of Chinese and Western medicine but also offers a theoretical foundation for the integrated treatment of chronic， complex age-related diseases.

Objective:To evaluate the effect of cathepsin B(CTSB)/NOD-like receptor pyrin domain containing 3(NLRP3)pathway on the polarization of macrophages induced by LPS.Methods:The well-growing RAW264.7 mouse mononuclear macrophage lines were cultured in vitro and divided into 3 groups(n=6)according to the random number table method:control group(C group),LPS group(L group)and LPS+CA074-me(CTSB inhibitors)group(B group).C group was cultured normally for 24 h,L group was cultured with LPS concentration of 1 μg/ml medium for 24 h.B group was pretreated with CTSB inhibitor CA074-me 30 μmol/L for 1 h before LPS induction,and co-cultured with LPS concentration of 1 μg/ml medium for 24 h.After 24 hours,the morphological changes of the cells were observed by microscope,the concentrations of IL-1β and IL-18 in the supernatant were determined by ELISA.The ex-pressions of cathepsin B precursor(pro-CTSB),mature cathepsin B(mature-CTSB),NLRP3,apoptosis-related speck protein(ASC)and apoptosis-related speck protein-1(caspase-1)were detected by Western blot.The mRNA expression levels of CD32,inducible ni-tric oxide synthase(iNOS),arginase 1(Arg-1)and CD206 were detected by qRT-PCR.The positive expression rates of M1 macro-phage surface marker CD86 and M2 macrophage surface marker CD206 were detected by flow cytometry.Results:Compared with group C,the morphology of cells in groups L and B became larger and pseudopodia appeared.The concentrations of IL-1β and IL-18 in cell supernatant were increased,the expressions of pro-CTSB,mature-CTSB,NLRP3,ASC and caspase-1 were increased,and the expressions of CD32,iNOS mRNA were up-regulated and the positive rates of CD86 and CD206 were increased(P<0.01).Arg-1 and CD206 mRNA in group B were up-regulated(P<0.01).Compared with group L,the pseudopodia of group B were reduced,and the morphology was closer to group C.The concentration of IL-1β and IL-18 in the supernatant,the expression of mature-CTSB,NLRP3,ASC and caspase-1,CD32 and iNOS mRNA and the positive rate of CD86 were down-regulated in group B.The expression of pro-CTSB,Arg-1 and CD206 mRNA and the positive rate of CD206 were increased(P<0.01).Conclusion:Inhibition of CTSB/NLRP3 pathway can reduce the inflammatory response,reduce the LPS-induced polarization of RAW264.7 cells to M1 macrophages,and pro-mote their polarization to M2 macrophages.

Spinal trauma, primarily caused by high-energy external forces, predominantly manifest as vertebral fracture and spinal cord injury. These conditions are characterized by spinal pain, restricted mobility, and sensory and autonomic dysfunction, significantly compromising patients′ quality of life and life expectancy. Current diagnostic and therapeutic practices for spinal fracture remain susceptible to subjective clinical experience, resulting in misdiagnosis, underdiagnosis, and imprecise surgical execution. Similarly, the therapeutic efficacy of spinal cord injury rehabilitation is frequently limited by a lack of personalized treatment protocols. The growing integration of artificial intelligence (AI) in medicine presents novel opportunities to overcome these obstacles. By excelling in image interpretation, data analytics, clinical decision support, and personalized rehabilitation planning, AI has emerged as a prominent focus of modern research. To this end, the authors reviewed the research progress in the application of AI in the diagnosis and treatment of spinal fracture and rehabilitation of spinal cord injury, providing a reference for AI-assisted precision diagnosis and treatment of vertebral fracture and rehabilitation of spinal cord injury.

Lower urinary tract dysfunction (LUTD) is common in children, but treatment is difficult in some cases, and it might causes upper urinary tract damage in the late stage. Recently, botulinum toxin A(BTX-A) has been recommended as an effective procedure for refractory LUTD, which has significantly improved symptoms and reduced the occurrence of upper urinary tract damage in children with LUTD. At present, there is a lack of international consensus on the application indication and dose selection of BTX-A in LUTD children, and the safety and long-term efficacy of repeated BTX-A injection are also clinical concerns. This article reviews the current application perspectives and progress of BTX-A in the treatment of children with LUTD, especially the clinical application indications and methods.BTX-A provides a minimally invasive, safe and effective treatment option for children with LUTD, which can significantly improve clinical symptoms and urodynamic parameters. With the further clarification of indications and the improvement of administration methods, BTX-A will be able to assist more children with LUTD in enhancing their quality of life and lessening their physical and mental burden.

Objective:To explore the risk factors for contralateral central lymph nodes (Cont-CLNs) metastasis of unilateral papillary thyroid carcinoma (PTC) and to guide the decision-making of clinical surgical scope.Methods:The data of 362 patients who underwent total thyroidectomy and bilateral central lymph node dissection at the Sichuan Cancer Hospital from September 2020 to April 2022 and were confirmed as unilateral PTC by postoperative pathology were retrospectively analyzed. Among them, 87 were male and 275 were female, aged from 11 to 76 years. According to whether presence of Cont-CLNs metastasis, they were divided into the metastasis group (115 cases) and the non-metastasis group (247 cases). The relationship between the demographic characteristics, clinicopathological characteristics and other indicators of the two groups of patients and their metastases of Cont-CLNs was analyzed. Univariate analysis, multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to screen the risk factors for Cont-CLNs metastasis. Postoperative follow up was performed in the patients.Results:Univariate analysis showed that age, gender, combined Hashimoto′s thyroiditis, extranodal invasion, pretracheal and prelaryngeal lymph node metastasis, ipsilateral central lymph nodes (Ipsi-CLNs) metastasis on the affected side, lateral cervical lymph node metastasis on the affected side, lesion location, and tumor diameter were associated with Cont-CLNs metastasis (all P values<0.05). Multivariate revealed that: each of male gender, Ipsi-CLNs metastasis, pretracheal and prelaryngeal lymph node metastasis, cancer focus location in the isthmus, and unilateral glandular lobe combined with isthmus was an independent risk factor for Cont-CLNs metastasis. For predicting the metastasis risk of Cont-CLNs, the optimal critical value of the number of metastasized Ipsi-CLNs was 2.5, and the area under the ROC curve (AUC) was 0.700; the optimal cut-off value of the number of metastasized pretracheal and prelaryngeal lymph nodes was 1, with an AUC of 0.681. The AUC of gender was 0.630, and the AUC of the cancer lesion location was 0.545. Multivariate ROC curve analysis for Cont-CLNs metastasis based on gender, the number of metastasized Ipsi-CLNs, the number of metastasized pretracheal and prelaryngeal lymph nodes, and the location of cancer foci showed an AUC of 0.794. The patients were followed up until January 2025. Excluding 3 cases with hoarseness caused by recurrent laryngeal nerve invasion before the operation and 3 cases with resection and reconstruction of invaded recurrent laryngeal nerves discovered during the operation, there were no patients with permanent recurrent laryngeal nerve palsy after the operation. There were 3 cases with postoperative permanent hypoparathyroidism. There no patients with postoperative recurrence. Conclusion:Risk factors for Cont-CLNs metastasis include male sex, Ipsi-CLNs metastasis, pretracheal and prelaryngeal lymph nodes metastasis, and tumor location in the isthmus or unilateral lobe plus isthmus. In unilateral PTC with the risk factors, Cont-CLNs dissection may be considered.

Objective To identify the key influencing factors and role mechanisms of large-scale medical equip-ment allocation decision-making in public hospitals,and to provide a reference basis for optimizing resource alloca-tion strategies.Methods Through searching the literature related to large-scale medical equipment decision-making in public hospitals and combing the policies,the system of decision-making influencing factors was initially screened.The Delphi method and decision-making trial and evaluation laboratory method were used to obtain the key influencing factors of equipment allocation decision-making and to determine the interaction effects among the factors.Results A total of seven cause factors and nine effect factors were screened.Among them,cost-benefit analysis,equipment technical performance,and evaluation of similar equipment were the top three key drivers;leadership emphasis,equipment market price,and equipment supporting facilities were the top three key con-straints.Conclusion Priority be given to strengthening the management of driving factors,mainly by conducting a full-cycle assessment of cost-effectiveness,paying attention to the clinical value output of equipment technical performance,and monitoring regionally similar equipment.A dynamic response mechanism for constraints should be established,mainly to strengthen leadership decision-making,implement a centralized procurement price nego-tiation model and improve the pre-assessment system for ancillary facilities.

Objective:To analyze the neuropsychological characteristics of patients with chronic heart failure (CHF) complicated by mild cognitive impairment (MCI) and investigate the factors that influence the development of CHF complicated by MCI.Methods:A case-control study was conducted to retrospectively analyze the clinical data of 98 patients with CHF admitted to Baoji Hospital of Traditional Chinese Medicine from January 2019 to October 2020. Based on the Petersen MCI screening criteria, the patients were divided into the MCI group ( n = 48) and the normal cognitive group (NC group, n = 50). The neuropsychological characteristics were analyzed using the Mini-Mental State Examination and the Montreal Cognitive Assessment. The cognitive domain scores of the two groups were tested and compared. Logistic regression analysis was performed to identify the factors influencing the development of CHF complicated by MCI. Results:The total scores of the Mini-Mental State Examination and the Montreal Cognitive Assessment in the NC group were 28.45 ± 1.10 and 27.90 ± 1.35, respectively, which were significantly higher than those in the MCI group (23.50 ± 2.25, 22.95 ± 1.35, t = 13.92, 18.15, both P < 0.001). In addition, the NC group outperformed the MCI group in terms of the number of correct readings, time taken, attention, visuospatial function, memory, and language function ( t = 2.94, 7.29, 3.15, 9.90, 14.69, 4.87, all P < 0.01). The MCI group had a greater proportion of patients who were aged ≥ 65 years, had an education level of junior high school or below, experienced sleep disorders, and were classified as New York Heart Association (NYHA) functional class Ⅲ, compared with the NC group ( χ2 = 4.18, 4.08, 6.88, 4.70, all P < 0.05). Additionally, the cardiac output was lower in the MCI group than in the NC group ( t = 4.70, P < 0.05). Logistic regression analysis revealed that age ≥ 65 years ( OR = 3.904, 95% CI: 1.530-9.963), education level of junior high school or below ( OR = 2.565, 95% CI: 1.571-4.187), sleep disorders ( OR = 3.080, 95% CI: 1.445-6.564), and low cardiac output ( OR = 1.784, 95% CI: 1.168-2.725) were independent risk factors for CHF complicated by MCI ( P < 0.05). Conclusions:Patients with CHF complicated by MCI are more likely to experience impairments in visuospatial function, executive function, attention, language function, and memory. Independent risk factors for CHF complicated by MCI include age ≥ 65 years, education level of junior high school or below, sleep disorders, and low cardiac output.

Objective:To investigate the efficacy and safety of intravesical injections of botulinum toxin A (BTX-A) for the treatment of pediatric refractory urinary frequency and incontinence (UFI), and to analyze the factors predicting the therapeutic effect of BTX-A injections.Methods:A retrospective case series study was made on 35 children with UFI [(12.3±4.2) years old], including 13 males (37.1%) and 22 females (62.9%), treated in the First Affiliated Hospital of Zhengzhou University from January 2021 to March 2024.Urotherapy and drug treatments were ineffective in all children, who then received intravesical injections of BTX-A.The urodynamic study (UDS) was performed 1 week before treatment and 3 months after treatment, and the Overactive Bladder Symptom Score (OABSS) and Incontinence Quality of Life (I-QOL) were collected.Perioperative and postoperative adverse events were also recorded.A global response assessment (GRA) score of ≥2 at 3 months postoperatively was defined as effective treatment.According to the postoperative GRA score, the patients were divided into effective and ineffective groups to explore the predictive factors affecting the outcome of BTX-A treatment, such as age, gender, preoperative urodynamic parameters, and the types of urinary incontinence. t-test was used to compare quantitative data such as age, UDS parameters, OABSS, and I-QOL scores.The comparison of count data such as gender and urinary incontinence types was conducted using Fisher′s exact test. Results:The bladder compliance, bladder capacity ratio, OABSS and I-QOL scores of patients significantly improved after BTX-A injection (all P<0.05).The 77.1% (27/35) of the patients were satisfied with BTX-A treatment effects.The main adverse event during the follow-up was a temporary increase in postvoid residual urine after injecting BTX-A (7 cases), which was alleviated by the Creade action or clean intermittent catheterization.There was significant difference in age [(13.00±4.32) years vs.(10.00±2.67) years] and preoperative bladder compliance [(11.21±5.74) mL/cmH 2O vs.(5.13±2.42) mL/cmH 2O] between effective (27 cases) and ineffective groups (8 cases) ( t=2.383, 2.899, all P<0.05).The differences in preoperative bladder capacity ratio, maximum filling detrusor pressure, postvoid residual urine, voiding efficiency, gender, and the types of urinary incontinence were not statistically significant between the two groups (all P>0.05). Conclusions:Intravesical injection of BTX-A is a safe and effective treatment for children with refractory UFI.A young age and poor bladder compliance at treatment are associated with poor prognosis of BTX-A treatment.