This article introduces Professor Zhou Peng's clinical experience in treating generalized anxiety disorder(GAD)using spirit-regulating and root-strengthening integrated acupuncture.Based on the pathological characteristics of GAD,Professor Zhou Peng summarizes its pathogenesis as"disharmony of qi,blood,yin,and yang,"pointing out that"deficiency"is the essence of its onset,with spleen and kidney deficiency being the root cause.He advocates treating GAD from the perspective of"deficiency and decline,"focusing on strengthening the spleen and kidneys,consolidating the root,and nourishing the source,while also regulating the mind.The integrated acupuncture therapy includes needling,refined moxibustion,and intradermal needle embedding.Needling is used to harmonize qi and blood,refined moxibustion to regulate and supplement yin and yang to consolidate the root,and intradermal needle embedding to regulate the mind and consolidate the therapeutic effects of acupuncture.Starting from improving patients'compliance with treatment and ensuring sustained therapeutic effects,Professor Zhou emphasizes that acupuncture manipulation should be fast,gentle,and soft,with needle insertion resembling a swift crane touching the waves and needle manipulation like a deer drinking from a clear spring.He places great importance on patients'sensations and aims to holistically regulate the body's qi,blood,yin,and yang,restoring the balance of body and mind,thereby effectively treating generalized anxiety disorder.

Objective To investigate the effects of modified Banxia Baizhu Tianma Decoction(BBTD)on blood pressure and lipid metabolism in patients with metabolic hypertension and dyslipidemia of phlegm-damp obstruction syndrome,guided by Professor Tong Xiaolin's"state-target differentiation and treatment"theory.Methods Sixty eligible patients treated at Chongqing Beibei Hospital of Traditional Chinese Medicine from February 2024 to February 2025 were randomly assigned to treatment group(n=30,receiving conventional therapy plus modified BBTD)and control group(n=30,conventional therapy alone)for 4 weeks.The changes in blood pressure,lipid profiles,body mass index(BMI),fasting blood glucose(FBG),serum uric acid(SUA)were observed,and the antihypertensive efficacy and traditional Chinese medicine(TCM)syndrome efficacy were evaluated.Results(1)Regarding participant dropout,during the study,2 cases in the treatment group were lost to follow-up,while no dropouts occurred in the control group.Ultimately,58 patients were included in the efficacy analysis(28 in the treatment group,30 in the control group).(2)In terms of antihypertensive efficacy,after 4 weeks of treatment,the total effective rate was 92.86％(26/28)in the treatment group versus 36.67％(11/30)in the control group.The intergroup comparison(by chi-square test)demonstrated significantly superior antihypertensive efficacy in the treatment group(P＜0.05).(3)For TCM syndrome efficacy,the marked improvement rate and total effective rate in the treatment group were 60.71％(17/28)and 92.86％(26/28)respectively,compared to 0.00％(0/30)and 33.33％(10/30)in the control group.The treatment group showed significantly better outcomes in marked improvement rate(by chi-square test),total effective rate(by chi-square test),and overall efficacy(by rank-sum test)(all P＜0.05).(4)Regarding blood pressure,post-treatment systolic blood pressure(SBP)and diastolic blood pressure(DBP)were significantly decreased in the treatment group(P＜0.05)but remained unchanged in the control group(P＞0.05).The treatment group exhibited significantly greater reductions in both SBP and DBP compared to controls(P＜0.05).(5)For lipid profiles,the treatment group showed significant post-treatment reductions in total cholesterol(TC),triglycerides(TG),and low-density lipoprotein cholesterol(LDL-C)(P＜0.05).The control group demonstrated increased TG(P＜0.05),with nonsignificant decreases in TC and LDL-C,and a slight increase of HDL-C(P＞0.05).The treatment group achieved significantly greater TC and TG reductions versus controls(P＜0.05).(6)The treatment group showed decreased BMI,fasting glucose,and serum uric acid(P＜0.05),whereas the control group had unchanged BMI and fasting glucose(P＞0.05)but increased uric acid(P＜0.05).The treatment group's reductions in fasting glucose and uric acid were significantly superior to those of control group(P＜0.05).Conclusion State-target-guided modified BBTD effectively treats metabolic hypertension with dyslipidemia of phlegm-damp obstruction syndrome,demonstrating comprehensive metabolic benefits beyond blood pressure control.

Objective To explore the role of Piezo2 in venous vascular smooth muscle cell(VSMC)dysfunction and neointimal hyperplasia following exposure of veins to an arterial mechanical environment,and elucidate its potential role in venous restenosis after coronary artery bypass grafting(CABG)and arteriovenous fistula(AVF)surgery.Methods Based on transcriptomic datasets,differentially expressed genes between AVF or grafted veins with normal veins were analyzed using GEO2R and GO.Immunofluorescence was used to detect expression of Piezo2 in two AVF clinical samples.The FX-5000TM cyclic stretch application system was used to apply 1.25 Hz stretch with 15%amplitude to VSMCs to simulate arterial conditions in vitro.The protein expressions of Piezo2,SM22(VSMC phenotypic marker),and PCNA(proliferation-related molecule)were measured with Western Blot.The calcium-free medium was further used to remove extracellular Ca2+,and the effect of Ca2+on stretch-induced changes in related molecules were analyzed.Results Transcriptomic analysis revealed that Piezo2 was upregulated in AVF and grafted veins compared to normal veins.Immunofluorescence showed the increased protein expression of Piezo2 in AVF tissues compared to normal veins.Notably,in the neointimal tissue of AVF samples,Piezo2 was significantly upregulated,while SMA was downregulated.In vitro,15%cyclic stretch upregulated Piezo2 and PCNA expression but downregulated SM22 expression,which suggested a phenotypic switch of venous VSMCs from the contractile phenotype to the synthetic phenotype.Removal of extracellular Ca2+partially reversed the stretch-induced VSMC phenotypic switch and proliferation.Conclusions After veins are exposed to an arterial mechanical environment,the upregulated Piezo2 may induce neointimal hyperplasia by promoting VSMC phenotypic switch.This study may provide mechanobiological insights and potential therapeutic targets for the prevention and treatment of venous restenosis following CABG and AVF surgeries.

Objective To establish an expert consensus on home exercise for prevention and rehabilitation of breast cancer related lymphedema.Methods Evidence-based nursing method was used to systematically retrieve and evaluate relevant studies in databases and guideline networks,with a search period from the establishment of the databases to October 2023.Evidence was synthesized to form the expert consensus draft after literature screening,quality evaluation,evidence extraction and evidence integration.Then the final draft was formed through expert discussion meeting and 2 rounds of expert letter consultation.Results The consensus includes 5 dimensions with a total of 22 items,involving evaluation of home exercise,management of home exercise,principles of home exercise,program of home exercise and significance of home exercise.Conclusion This"consensus"was constructed in a scientific and rigorous way,and can provide guidance for promoting the home exercise for prevention and rehabilitation of breast cancer related lymphedema,and ensure the safe and effective implementation of home exercise rehabilitation.

Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Objective:To investigate the correlation between mutations in KRAS, NRAS, BRAF, and PIK3 CA and the clinical characteristics of elderly colorectal cancer(CRC)patients. Methods:Paraffin-embedded tissue samples were obtained from 191 elderly CRC patients who consulted at Huadong Hospital, affiliated to Fudan University, between January 2022 and July 2023.Following deoxyribonucleic acid(DNA)extraction, the amplification refractory mutation system polymerase chain reaction(ARMS-PCR)was employed to detect the mutation profiles of KRAS, NRAS, BRAF, and PIK3 CA.Concurrently, serum samples collected prior to radical resection were analyzed for carcinoembryonic antigen(CEA), carbohydrate antigen 19-9(CA19-9), and carbohydrate antigen 72-4(CA72-4)using electrochemical luminescence.A comparative analysis of the clinical characteristics and preoperative serological tumor marker concentrations among patients with different gene mutations was conducted to elucidate their correlation. Results:A total of 191 elderly CRC patients were enrolled in the study, with ages ranging from 60 to 94 years(mean age 72.1±7.8 years), including 112 males.The mutation rate of KRAS, NRAS, BRAF, and PIK3 CA, as determined by combined detection, was found to be 49.21%(94/191)among elderly CRC patients. KRAS exhibited the highest mutation rate at 35.08%, with statistically significant differences observed in gender, primary site, degree of differentiation, and neurovascular invasion between patients with and without KRAS mutations( P<0.05 for all comparisons).The BRAF mutation rate was 8.90%, and significant differences in gender, age, primary site, and degree of differentiation were also noted between patients with and without BRAF mutations( P<0.05 for all).The mutation rates for NRAS and PIK3 CA were 2.62% and 5.24%, respectively, with no statistically significant differences in the clinical characteristics of patients across different groups( P>0.05 for all).Additionally, the proportion of patients over the age of 90 in the double mutation group was significantly higher( P<0.01).Significant differences in serum CA19-9 concentrations were observed among the various mutation types( P<0.05). Conclusions:There are notable differences in age, gender, primary site, degree of differentiation, and neurovascular invasion among elderly CRC patients with varying mutation statuses of KRAS, NRAS, BRAF, and PIK3 CA.Patients with double mutations exhibited higher concentrations of CA19-9 in preoperative serum.

Objective:To understand the current status of epidemiological investigation task force construction and the performance of infectious disease epidemic response in county (district) Centers for Disease Control and Prevention (CDCs) in China, analyze the influencing factors and provide scientific evidence to improve the construction of grassroot epidemiological investigation task force.Methods:A survey was conducted in epidemiological investigation staff in county (district) CDCs in 31 provinces (autonomous regions/municipalities) and Xinjiang Production and Construction Corps in China. A self-designed questionnaire was used to collect information based on the epidemiological dynamic data collection platform of China CDC. A descriptive epidemiological analysis was conducted, and multiple linear regression models were used to identify the factors associated with the performance of infectious disease epidemic response.Results:A total of 24 934 epidemiological investigation task force members from 2 897 county (district) CDCs were surveyed in the study. In the epidemiological investigation task force, women, those with bachelor's degree and public health workers accounted for 62.46%, 71.36%, and 49.05% respectively. Up to 91.72% of the task force members had participated in field epidemic response. The average score of awareness of epidemic investigation procedures was 60.00, while the average score of key skill proficiency in the investigation was 42.22. The epidemic response performance showed correlations with area, gender, age, education level, major, and field epidemiology training programs, those who had received longer training showed higher competency scores (all P<0.001). Conclusions:Progress has been made in the construction of epidemiological investigation task force in grass-root CDCs in China, but further improvements are needed, especially in the knowledge awareness and investigation skills of the task force. Field epidemiology training demonstrated substantial impact on the improvement of epidemic response performance, indicating that it is necessary to further strengthen the training in grassroot public health workers for the better response to infectious disease epidemics.

The paper reports a case of endocapillary proliferative glomerulonephritis without immune complex deposition, presenting with acute kidney injury and proteinuria. Renal pathology was characterized by predominant T cells and CD68 + macrophages infiltration in glomerular capillaries without immunocomplex deposits. After glucocorticoid therapy, the patient's condition has improved and reached complete remission. This type of renal pathology is extremely rare. Through literature review, it is considered that they may be caused by abnormal immune cells such as T cells and/or macrophages-mediated immune responses. It should be taken seriously in clinical practice, and its underlying causes and pathogenesis need further research.

Objective:To evaluate the long-term clinical efficacy and the influence on anal function of surgery combined with ustekinumab (UST) in active Crohn's disease (CD) patients with perianal fistula.Methods:A retrospective cohort study was conducted. Clinical data of active CD patients with perianal fistula undergoing surgery combined with UST at Longhua Hospital of Shanghai University of Traditional Chinese Medicine from August 2020 to December 2022 were collected. The primary endpoints were clinical healing rate, Wexner score, and anorectal manometry values at week 52 of treatment. Secondary endpoints included the Crohn's disease activity index (CDAI), perianal Crohn's disease activity index (PDAI), laboratory indicators [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC) ], endoscopic remission rate, Van Assche score, and radiographic healing rate at week 52 of treatment.Results:A total of 28 patients were included, with 22 males (78.6%) and 6 females (21.4%) ; age (25.2 ± 7.7) (16.0-52.0) years. There was 1 patient (3.6%) of simple anal fistula. There were 27 patients (96.4%) of complex anal fistulas, including 12 of high intersphincteric type, 15 of high transsphincteric type, in which 15 with branched tracts (or ≥2 fistula tracts). The pre-treatment CDAI was 187.0 (156.0, 245.0), and the PDAI was 10.0 (9.0, 12.0). Among the 28 patients, 23 (82.1%) underwent fistulotomy, 1 (3.6%) underwent transanal opening of intersphincteric space (TROPIS), and 4 (14.3%) underwent video-assisted anal fistula treatment (VAAFT) combined with fistula-tract laser closure (FiLaC). All the patients received UST treatment postoperatively, without concurrent use of immunosuppressants or corticosteroid therapy. At week 52 of treatment, 28 (100%) patients achieved clinical healing. Compared to pre-treatment, Wexner score of patients at week 52 of treatment was significantly lower [0 (0, 0) vs. 1.0 (0, 3.0), P < 0.001], maximum anal sphincter pressure increased [ (137.6±40.9) mmHg vs. (105.1±29.2) mmHg, P < 0.001], maximum anal sphincter contraction time extended [9.0 (5.0, 15.0) s vs. 4.0 (2.0, 6.0) s, P < 0.001], and there was no significant decrease in anal resting pressure ( P > 0.05). Compared to pre-treatment, CDAI, PDAI, Van Assche scores, and simple endoscopic score for Crohn's disease (SES-CD) of patients at week 52 of treatment all significantly decreased (all P < 0.001), and CRP, ESR, and FC all decreased (all P < 0.05), with statistically significant differences. The radiographic healing rate at week 52 of treatment was 75.0% (21/28), and the radiographic remission rate was 92.9% (26/28). The endoscopic remission rate was 57.1% (16/28), and the endoscopic response rate was 82.1% (23/28) . Conclusion:The long-term clinical healing rate of active CD patients with perianal fistula receiving surgery combined with UST is high, and the anal function can be improved significantly.

Low-intensity pulsed ultrasound（LIPUS），with its remarkable advantages of higher safety and better penetrability，has gradually become a novel method of physical adjuvant therapy. Previous studies have verified that LIPUS can modulate the immune response of different immune cells such as macrophage，T lymphocyte，and neutrophil by reducing the level of pro-inflammatory cytokines. Therefore，it plays a crucial role on acceleration of fracture healing，expedition of wound repair，and repairation of myocardial injury. The review summarizes the regulatory effects and potential mechanisms of LIPUS on abnormal immune cell responses triggered by various diseases.