Based on the traditional Chinese medicine （TCM） theories of body fluid metabolism and turbid phlegm obstructing the orifices， and drawing on recent advances in cerebrospinal fluid-interstitial fluid （CSF-ISF） exchange， glymphatic clearance， and extracellular matrix （ECM） regulation， this article discusses the possible scientific connotation of "invisible phlegm" from the perspectives of pathogenesis， clinical manifestations， and therapeutic implications. Impaired brain fluid exchange may lead to reduced clearance， the retention of metabolic wastes and pathological proteins. Abnormal ECM remodeling may further disrupt molecular diffusion and local microenvironmental homeostasis， resulting in a pathological process characterized by slowed fluid movement， reduced clearance， and abnormal retention. This process bears a certain functional resemblance to the TCM pathogenesis of impaired distribution of body fluids， endogenous formation of turbid phlegm and obstruction of the brain orifices， and may also be associated with manifestations such as a clouded sensation in the head， cognitive abnormalities， and emotional disturbances. On this basis， the potential effects of certain phlegm-dissolving Chinese medicines in improving brain clearance function and extracellular microenvironmental homeostasis warrant further investigation. We therefore propose that， the "invisible phlegm" of TCM in brain tissue may manifest as a pathological retention state characterized by restricted fluid exchange， impaired clearance function， and extracellular microenvironmental imbalance. This perspective may provide a new avenue for investigating TCM treatment of neurological and psychiatric disorders from the perspective of phlegm.

Based on the traditional Chinese medicine （TCM） theories of body fluid metabolism and turbid phlegm obstructing the orifices， and drawing on recent advances in cerebrospinal fluid-interstitial fluid （CSF-ISF） exchange， glymphatic clearance， and extracellular matrix （ECM） regulation， this article discusses the possible scientific connotation of "invisible phlegm" from the perspectives of pathogenesis， clinical manifestations， and therapeutic implications. Impaired brain fluid exchange may lead to reduced clearance， the retention of metabolic wastes and pathological proteins. Abnormal ECM remodeling may further disrupt molecular diffusion and local microenvironmental homeostasis， resulting in a pathological process characterized by slowed fluid movement， reduced clearance， and abnormal retention. This process bears a certain functional resemblance to the TCM pathogenesis of impaired distribution of body fluids， endogenous formation of turbid phlegm and obstruction of the brain orifices， and may also be associated with manifestations such as a clouded sensation in the head， cognitive abnormalities， and emotional disturbances. On this basis， the potential effects of certain phlegm-dissolving Chinese medicines in improving brain clearance function and extracellular microenvironmental homeostasis warrant further investigation. We therefore propose that， the "invisible phlegm" of TCM in brain tissue may manifest as a pathological retention state characterized by restricted fluid exchange， impaired clearance function， and extracellular microenvironmental imbalance. This perspective may provide a new avenue for investigating TCM treatment of neurological and psychiatric disorders from the perspective of phlegm.

BACKGROUND:Currently,spinal endoscopic technology has become the mainstream technology in minimally invasive spinal surgery.The specifications of the instruments for different operating systems are different,and the choice of specific surgical protocols needs to be combined with the actual situation of the patient and the choice of the clinical surgeon. OBJECTIVE:To compare the early efficacy of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation under the iLESSYS Delta System and Endo-Surgi Plus System. METHODS:Totally 80 patients with L5-S1 disc herniation were treated with percutaneous endoscopic interlaminar discectomy.Patients were divided into two groups based on the endoscopic system used.Among them,37 cases received the iLESSYS Delta System(Delta group)and 43 cases received the Endo-Surgi Plus System(Plus group).Patient demographic characteristics,perioperative indicators,and complications were analyzed between the two groups.Clinical outcomes were quantified using back and leg visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores at 1 day,1,3,and 6 months after surgery.Patient satisfaction was assessed according to modified MacNab criteria at final follow-up. RESULTS AND CONCLUSION:(1)The operative time and number of arthroplasties in the Plus group were less than those in the Delta group,and the differences were statistically significant(P<0.05).(2)Compared with the preoperative period,the visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in both groups improved at all follow-up time points,and the difference was statistically significant(P<0.001).(3)There was no statistically significant difference in the comparison of pain visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in the two groups(P>0.05).(4)At 6-month follow-up after surgery,the MacNab standard excellent and good rates in the Delta group and Plus group were 81%and 79%,respectively,with no significant difference(P=0.823).(5)The incidence of complications was 3%in the Delta group and 2%in the Plus group,but there was no significant difference between the two groups(P=0.914).(6)It is concluded that both iLESSYS Delta and Endo-Surgi Plus surgical systems achieved satisfactory early clinical results in the treatment of lumbar disc herniation,with Endo-Surgi Plus surgical moulding being more efficient and safer.

Objective:To evaluate the therapeutic efficacy of an upper limb rehabilitation robot on the recovery of elbow function recovery following arthroscopic elbow joint release.Methods:Seventy-two patients who underwent arthroscopic elbow joint release at Shanghai Sixth People’s Hospital from December 2022 to December 2023 were recruited. All patients were randomly assigned to either the conventional group (n=36; 16 males, 20 females; age 34.39±9.04 years, range 24-56; fractures: 4 intercondylar humerus, 18 olecranon, 8 radial head, 6 other) which received conventional rehabilitation postoperatively, or the robot-assisted group (n=36; 18 males, 18 females; age 33.78±9.98 years, range 20-59; fractures distribution identical to the conventional group) receiving conventional rehabilitation combined with robot-assisted upper limb rehabilitation therapy. The active range of motion (ROM) of elbow joint, Mayo elbow performance score (MEPS), visual analogue scale (VAS) of elbow joint were recorded preoperatively and at 4 weeks and 3 months postoperatively. The surface electromyography were analyzed at 3 months postoperatively.Results:All patients completed the 3-month rehabilitation program. At 4 weeks postoperatively, the conventional group exhibited a mean active ROM of 106.78°±9.91°, MEPS of 67.78±7.68, VAS of 2.11±0.74; the robot-assisted group showed active ROM of 113.72°±7.06°, MEPS of 73.33±9.28, VAS of 21.89±0.46. By 3 months postoperatively, the conventional group achieved a mean active ROM of 118.11°±6.75°, MEPS of 85.00±8.66, VAS of 0.67±0.67; robot-assisted achieved a mean active ROM of 127.61°±6.61°, MEPS of 91.11±6.57, VAS of 0.39±0.49. Both groups exhibited significant improvements in active ROM and MEPS, and significant reductions in VAS scores at 4 weeks and 3 months postoperatively compared with preoperatively values ( P<0.05). The robot-assisted group demonstrated significantly higher active ROM and MEPS at both 4 weeks and 3 months postoperatively, and a significantly lower VAS score at 3 months postoperatively, compared with the conventional group ( P<0.05). Surface electromyography at 3 months revealed significantly higher biceps brachii root mean square and significantly lower co-contraction index in the robot-assisted group compared to the conventional group ( P<0.05). No adverse symptoms were reported in the treated elbows of either group during the operation and follow-up period. Conclusion:The integration of upper limb rehabilitation robot-assisted therapy and conventional rehabilitation program significantly enhances the recovery of elbow range of motion and functional outcomes at 3 months following arthroscopic elbow joint release.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

The objectification of tongue and pulse diagnosis in TCM transforms tongue and pulse images into quantitative data through modern technology, and shows multi-dimensional application value in tumor diagnosis and treatment. In terms of tongue diagnosis, the characteristic tongue images of tumor patients are related to pathological indicators such as serum factors and tongue coating microflora, which can assist in diagnosis, syndrome differentiation and efficacy evaluation. The machine learning model preliminarily realizes the recognition of tongue images of tumors such as gastric cancer. In terms of pulse diagnosis, the abnormal pulse condition collected by the sensor is related to the abnormal vascular structure and hemodynamics. The Jin's "chongbo" index and pulse graph parameters can be used for tumor malignancy judgment and efficacy monitoring. The deep learning algorithm improves the accuracy of pulse analysis. However, there are some problems in the current research, such as small sample size, inconsistent equipment standards, and insufficient tongue and pulse information fusion. In the future, through multi-modal data integration, machine learning optimization and large sample verification, it is necessary to promote the combination of tongue and pulse objectification technology and TCM syndrome differentiation theory, build a standardized diagnosis model, and provide objective support for accurate diagnosis and treatment of tumors.

Objective To discover the mechanism by which miR-1287-5p affects the sensitivity of human esophageal cancer cell line KYSE30 to paclitaxel.Methods KYSE30 cells were divided into control group,group of transfected with miR-1287-5p mimic and inhibitor groups.RT-qPCR was used to detect the transfection rate.A paclitaxel-resistant cell line was established and cell viability and half inhibitory concentration(IC50)were detected by CCK-8 assay.The scratch test,Transwell chamber test and TUNEL method were used to evaluate the migration,invasion and apoptosis of cells.Western blot and immunocytochemistry(ICC)were used to detect the expression and localization of Akt and GSK-3β in cells.Results The expression level of miR-1287-5p in the miR-1287-5p mimic group was significantly higher than that in the miR-NC group and control group(P＜0.05),while the ex-pression level of the miR-1287-5p inhibitor group was significantly lower than that in miR-NC group and control group(P＜0.05).The cell survival rate of the miR-1287-5p mimic group was higher than that of the miR-NC group and the miR-1287-5p inhibitor group(P＜0.05).The cell migration rate and number of invasive cells in the miR-1287-5p mimic group were higher than those of the miR-NC group(P＜0.05),and the apoptosis rate was lower than that of the miR-NC group(P＜0.05).While in miR-1287-5p,the cell migration rate was lower and invasive cells were less in the inhibitor group and the apoptosis rate was increased as compared to the miR-NC group(P＜0.05).The expression of Akt and GSK-3β in the miR-1287-5p mimic group was significantly increased than in the miR-NC group(P＜0.05),while the expression in the miR-1287-5p inhibitor group was significantly inhibited than in miR-NC group(P＜0.05).Conclusions Up-regulation of miR-1287-5p can promote the migration and invasion of paclitaxel-resistant cell lines,inhibit cell apoptosis and thereby promote the development of paclitaxel resistance.

Objective To explore the application value of a holistic nursing model based on the Delphi method in patients with acute myocardial infarction(AMI).Methods A total of 110 AMI patients treated at Diqing Shangri-La People's Hospital in Yunnan Province from January 2019 to January 2020 were enrolled and divided into a control group and an observation group,with 55 patients in each,based on their admission order.The control group received routine nursing care,while the observation group received holistic nursing model intervention based on Delphi in addition to the routine nursing care.After 6 months of nursing,the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),general self-efficacy scale(GSES)score,complications,and changes in nursing satisfaction were compared and analyzed between the two groups.Results(1)After nursing,the LVEF significantly increased and the LVEDV and LVESV significantly decreased in both groups;the increase in LVEF was more significant,and the decrease in LVEDV and LVESV was more pronounced in the observation group(P<0.05);(2)The GSES scores of patients in both groups improved compared to before nursing,with a more significant improvement in the observation group(P<0.05);(3)The incidence of adverse events during hospitalization was lower in the observation group than in the control group(P<0.05);(4)The satisfaction rate was higher in the observation group than in the control group after nursing(P<0.05).Conclusion The application of a holistic nursing model based on Delphi in AMI patients can effectively improve cardiac function and self-management efficacy,reduce the incidence of complications,and enhance nursing satisfaction,demonstrating high feasibility.

Aortic aneurysm(AA)and aortic dissection(AD)are critical cardiovascular disease emergencies that seriously threaten human life and health.Due to various factors,the progressive reduction of various types of cells,such as smooth muscle cells and endothelial cells in the aortic wall,is an essential mechanism for developing AA and AD.On this basis,AD is induced by mechanical stresses such as hypertension,leading to damaged endothelial rupture or hemor-rhage within the aortic wall.However,AA causes the aortic wall to thin and expand outward in response to stimuli such as prolonged blood flow impingement.At present,increasing evidence shows that various programmed cell death,such as apoptosis,necroptosis,pyroptosis,ferroptosis,copper death,poly ADP-ribose polymerase 1(PARP-1)-dependent cell death,and immunogenic cell death,play essential roles in the pathogenesis of AA and AD.Therefore,understanding the key molecules and pathways in the pathogenesis of AA and AD from the perspective of programmed cell death and searching for inhibitors of various types of programmed death is essential to prevent aortic destruction and disease progression.The review summarizes the roles and research progress of different types of programmed cell death modalities in the development of AA and AD,clarifies the central position of programmed cell death in forming AA and AD,and searches for new thera-peutic methods for the clinic.

Objective:The purpose of this study was to develop a dynamic prediction model for patients with gastric signet ring cell cancer (GSRCC)following laparoscopic radical gastrectomy in order to improve the precision and usefulness of prognoses prediction for overall survival and disease-free survival.Methods:From 2011 to 2018, 914 National Cancer Center patients participated in the study. To find independent prognostic indicators and create a prognostic nomogram model, univariate and multivariate regression analyses were performed. Calibration curves, receiver operating characteristic curves, and consistency indices were used to assess the model's performance. To make clinical application more convenient, two web-based prediction tools were created.Results:A training set of 639 cases and a validation set of 275 instances were randomly selected from among the patients. Important predictive variables such as age, tumor size, location, pN and pT staging, and postoperative chemotherapy were all incorporated in the model (all P<0.05). The model's consistency index and area under the receiver operating characteristic curves were both higher than 0.7, and the calibration curves demonstrated a good fit between the expected and actual values, indicating high accuracy and consistency in postoperative survival prediction for patients with gastric signet ring cell carcinoma. Conclusion:We successfully developed two dynamic prediction models in this study, which improved its clinical practicability using web-based tools and is anticipated to be crucial to clinical practice going forward.