Objective:Interpret the key differences between the China Health-care Security Diagnosis Related Groups(CHS-DRG)2.0 and CHS-DRG 1.1,and provide reference for optimizing management strategies in medical institutions.Methods:Text analysis was used to import the CHS-DRG 2.0 and 1.1 grouping scheme dictionary data into the SQL database in a structured table format using SQL Server 2014.The key differences between the two schemes in grouping structure,grouping rules,grouping results,and other aspects were identified.Results:CHS-DRG 2.0 version added 26 groups,deleted 3 groups,and refined 10 groups into 20 groups for 14 clinical specialties at the ADRG level compared to CHS-DRG 1.1.Some group codes,names,and grouping rules were adjusted;Adjusted some grouping conditions and grouping results at the DRG level.Conclusion:CHS-DRG 2.0 version has improved grouping efficiency compared to CHS-DRG 1.1,solved some clinical bottleneck problems,and standardized the role of clinical diagnosis in grouping from the perspective of resource consumption.However,it has not completely solved the grouping problems of multi disease co treatment,multi disease treatment,and combined surgery.The adjustment of DRG weights and rates,the follow-up of related supporting policy reforms,and the negative effects of DRG will still pose challenges for medical institutions.

The expert consensus on the clinical treatment of herpes zoster with fire needling was developed, and the commonly used fire needling treatment scheme verified by clinical research was selected to form a standardized diagnosis and treatment scheme for acute herpes zoster and postherpetic neuralgia (PHN), so as to answer the core problems in clinical application. The consensus focuses on patients with herpes zoster, and forms recommendations for 9 key clinical issues, covering simple fire needling and TCM comprehensive therapy based on fire needling, including fire needling combined with cupping, fire needling combined with Chinese herb, fire needling combined with cupping and Chinese herb, fire needling combined with filiform needling, fire needling combined with moxibustion, and provides specific recommendations and operational guidelines for various therapies.
Humans ; Herpes Zoster/therapy* ; Acupuncture Therapy/instrumentation* ; Consensus ; Clinical Protocols

Traditional Chinese medicine (TCM) represents a paradigmatic approach to personalized medicine, developed through the systematic accumulation and refinement of clinical empirical data over more than 2000 years, and now encompasses large-scale electronic medical records (EMR) and experimental molecular data. Artificial intelligence (AI) has demonstrated its utility in medicine through the development of various expert systems (e.g., MYCIN) since the 1970s. With the emergence of deep learning and large language models (LLMs), AI's potential in medicine shows considerable promise. Consequently, the integration of AI and TCM from both clinical and scientific perspectives presents a fundamental and promising research direction. This survey provides an insightful overview of TCM AI research, summarizing related research tasks from three perspectives: systems-level biological mechanism elucidation, real-world clinical evidence inference, and personalized clinical decision support. The review highlights representative AI methodologies alongside their applications in both TCM scientific inquiry and clinical practice. To critically assess the current state of the field, this work identifies major challenges and opportunities that constrain the development of robust research capabilities-particularly in the mechanistic understanding of TCM syndromes and herbal formulations, novel drug discovery, and the delivery of high-quality, patient-centered clinical care. The findings underscore that future advancements in AI-driven TCM research will rely on the development of high-quality, large-scale data repositories; the construction of comprehensive and domain-specific knowledge graphs (KGs); deeper insights into the biological mechanisms underpinning clinical efficacy; rigorous causal inference frameworks; and intelligent, personalized decision support systems.
Medicine, Chinese Traditional/methods* ; Artificial Intelligence ; Humans ; Precision Medicine ; Decision Support Systems, Clinical

Objective:Interpret the key differences between the China Health-care Security Diagnosis Related Groups(CHS-DRG)2.0 and CHS-DRG 1.1,and provide reference for optimizing management strategies in medical institutions.Methods:Text analysis was used to import the CHS-DRG 2.0 and 1.1 grouping scheme dictionary data into the SQL database in a structured table format using SQL Server 2014.The key differences between the two schemes in grouping structure,grouping rules,grouping results,and other aspects were identified.Results:CHS-DRG 2.0 version added 26 groups,deleted 3 groups,and refined 10 groups into 20 groups for 14 clinical specialties at the ADRG level compared to CHS-DRG 1.1.Some group codes,names,and grouping rules were adjusted;Adjusted some grouping conditions and grouping results at the DRG level.Conclusion:CHS-DRG 2.0 version has improved grouping efficiency compared to CHS-DRG 1.1,solved some clinical bottleneck problems,and standardized the role of clinical diagnosis in grouping from the perspective of resource consumption.However,it has not completely solved the grouping problems of multi disease co treatment,multi disease treatment,and combined surgery.The adjustment of DRG weights and rates,the follow-up of related supporting policy reforms,and the negative effects of DRG will still pose challenges for medical institutions.

Objective:To construct a predictive model for the risk of major adverse cardiovascular events(MACE) after surgery in patients with symptomatic arteriosclerosis obliterans(ASO) .Methods:From Jan 2018 to Dec 2021, 957 patients with symptomatic ASO admitted to Nanjing Drum Tower Hospital were selected and divided into MACE and non-MACE groups according to whether they had a post-op MACE. A risk prediction model was constructed based on a stepwise regression method with multi-factor COX regression analysis. The model was evaluated using the receiver operating characteristic curve (ROC), the calibration curve to assess the model fit, and the Bootstrap method for internal validation.Results:MACE occurred in 143 patients (14.94%). After COX regression analysis, BMI, creatinine clearance, fibrinogen, rivaroxaban and previous history of surgery were enrolled into model constructing. The ROC curve assessed the model with a C-statistic of 0.690 (95% CI: 0.644-0.736), sensitivity and specificity of 49.2% and 80.7% respectively, a Jorden index of 0.299 and an optimal cut-off value of 0.086. Calibration curves showing agreement between predicted and actual observed values. Internally validated C-statistic of 0.689 (95% CI: 0.672-0.700). The population was divided into high and low risk groups based on the best cut-off value and analysed for survival. The difference between the two groups was statistically different. Conclusion:The risk prediction model for the occurrence of MACE based on clinical parameters is simple and convenient, with good predictability and good discriminatory ability, and can provide reference for the assessment and treatment of MACE in ASO patients.

Clinical research is usually aimed at and guided by therapeutic efficacy. Clarifying the placebo effect and the nocebo effect from treatment outcomes is an important issue in clinical research. This paper reviews the meaning of the placebo effect， suggesting that factors that may produce the placebo effect in clinical practice include past experience associations， patient expectations， suggestion， and doctor-patient relationships. It also summarizes the characteristics of the nocebo effect， its influencing factors， and its impact on clinical prognosis. Combining the characteristics of traditional Chinese medicine， this paper explores the design of acupuncture clinical trials that can reflect the measurement of the placebo effect， attempting to provide a clearer interpretation of the placebo effect in the evaluation of acupuncture efficacy in traditional Chinese medicine. Taking primary insomnia as an example， a prospective randomized placebo-controlled trial is designed to observe and evaluate the relationship between the treatment effects of acupuncture and the placebo effect in different patients under the treatment of the same doctor. Group comparisons will help better distinguish clinical effects in different situations. The authors also attempt to explore the responsive population to the placebo effect and the effects of placebos in different populations.

Restless legs syndrome (RLS) is a common sensorimotor disorder. Although it does not pose a threat to life, it seriously affects the quality of life of patients. RLS pathogenesis is still unclear, and its incidence is associated with a variety of risk factors, including genetic factors and non-genetic factors. Genetic factors involve more than 20 risk genes, such as meis homeobox 1 ( MEIS1), BTB domain containing 9 ( BTBD9), mitogen-activated protein kinase kinase 5 ( MAP2K5), and protein tyrosine phosphatase receptor type Db ( PTPRD). Non-genetic factors include regional age, gender, obesity, medical related diseases, neuropsychiatric diseases and drugs. This paper reviews the recent advance in risk factors and related pathogenesis of RLS to provide references for early prevention and treatment of the disease.

Objective:To explore the clinical effect of surgery combined with photodynamic therapy on ear keloid.Methods:The clinical data of patients with ear keloid admitted to the Department of Dermatology and Venereology, the First People’s Hospital of Jinzhong were analyzed retrospectively. According to the treatment methods, they were divided into surgery combined with isotope therapy group (isotope group) and surgery combined with photodynamic therapy group (photodynamic group). Patients in both groups underwent surgical excision of keloid core first. In the isotope group, stitches were removed on the 7th day after the operation. After stitches were removed, 90Sr- 90Y applicator was applied to the skin close to the incision for 5 min each time, once every other day, with a dose of 6 Gy each time and a total dose of 18 Gy for three times, and the second course was conducted after an interval of 3 months. In the photodynamic group, photodynamic therapy was performed on the third day after the operation. The prepared 5-aminolevulinic acid solution with a concentration of 20% was applied to the incision of ear keloid surgery, and then it was sealed in the dark for 3 hours. After that, it was irradiated with a photodynamic laser therapeutic instrument with a wavelength of 635 nm, with an irradiation distance of 10 cm, an energy density of 80-100 J/cm 2, an irradiation time of 30 min. The treatment was performed 3 times with an interval of 7-10 days. Before the operation and one year after treatment, two dermatologists who participated in the treatment used Vancouver scar scale (VSS) to score scars, with a total score of 0-10 points. The higher the score, the more serious the scar. The patients scored the scar by the patient scar assessment scale (PSAS), with a total score of 6-60 points. The higher the score, the more serious the scar. One year after the end of treatment, the therapeutic effect (including cured, effective and ineffective) was evaluated, and the total effective rate [(cured cases+ effective cases)/total cases ×100%] and the recurrence rate (recurrent cases/total cases ×100%) were analysed. The treatment process and complications of the two groups were recorded. SPSS 22.0 software was used to analyze the data. The measurement data in accordance with normal distribution were expressed as Mean±SD. Comparisons between the groups were performed using t-test, and comparisons within the groups were performed using paired t-test. The counting data was expressed by the number of cases and percentage. Chi-square test was used for the comparison between groups. P<0.05 indicated that the difference was statistically significant. Results:Thirty-one patients (6 males and 25 females) were included in the isotope group. The age was (35.0±1.1) years. The course of disease was (2.0±1.1) years. The volume of keloid was (1.8±0.1)cm 3. Thirty cases were included in photodynamic group, 6 males and 24 females. The age was (34.0±4.8) years, the course of disease was (2.0±0.5) years, and the volume of keloid was (1.7±0.3) cm 3. There was no significant difference in general data between the two groups ( P>0.05). The ear keloids of 61 patients were all removed and the incision healed well. The VSS score in isotope group was (2.72±0.06) points one year after treatment, which was significantly lower than that before treatment [(8.36±0.12) points] ( t=2.75, P<0.001). The VSS score in photodynamic group was (2.81±0.04) points one year after treatment, which was also significantly lower than that before treatment [(8.21±0.34) points] ( t=2.77, P<0.001). There was no significant difference in VSS scores between the two groups before treatment and one year after treatment ( P>0.05). PSAS score in isotope group was (8.80±0.02) points one year after treatment, which was significantly lower than that before treatment [(44.51±0.15) points] ( t=2.83, P<0.001). The PSAS score in photodynamic group was (8.80±0.06) points one year after treatment, which was also significantly lower than that before treatment [(44.60±0.27) points] ( t=2.90, P<0.001). There was no significant difference in PSAS scores between the two groups before treatment and one year after treatment ( P>0.05). One year after treatment, 22 cases were cured, 7 cases were markedly effective and 2 cases were ineffective in the isotope group, with a total effective rate of 93.5% (29/31) and a recurrence rate of 6.5% (2/31). In the photodynamic group, 19 cases were cured, 8 cases were markedly effective and 3 cases were ineffective. The total effective rate was 90.0% (27/30) and the recurrence rate was 10.0% (3/30). There were no significant differences in the total effective rate, and the recurrence rate between the two groups ( P>0.05). All patients in the isotope group had itchy skin on the second day of treatment, and 22 cases were accompanied by desquamation. Symptoms disappeared in 25 cases after symptomatic treatment. Six patients developed radiation dermatitis, and the skin healed after symptomatic treatment. However, 2 patients with skin ulceration showed depigmentation at the skin lesions. The patients in the photodynamic group showed mild redness and swelling on the second day after treatment, accompanied by slight itching and desquamation, and the symptoms subsided spontaneously in 1-3 days. Pigmentation appeared in 12 cases at 1 week, and subsided spontaneously 1 week after treatment. No skin ulceration and depigmentation occurred. Conclusion:Surgery combined with photodynamic therapy can improve the appearance of ear keloids, relieve the clinical symptoms of patients and reduce the recurrence rate. Its curative effect is equivalent to isotope therapy, but there are fewer complications and higher safety.

Objective:To investigate the clinical phenotype and genetic characteristics of a family with mitochondrial DNA depletion syndrome (MTDPS8B) caused by RRM2B gene mutation. Methods:Data of a family with MTDPS8B admitted to Department of Pediatric Neurology, Linyi People's Hospital in November 2019 were collected. Whole exome sequencing, mitochondrial loop gene sequencing and Sanger sequencing were used for genetic test in the child and family members, and pathogenicity analysis and protein 3D modeling on the mutation sites were conducted. The clinical phenotype and genetic characteristics of the family members were summarized.Results:Six subjects in these 8 individuals from the three generations of this family underwent genetic test. Four subjects had c.627G>A(p.M209I) (NM_001172477) heterozygous variation in RRM2B gene on the chromosome 8, and the variation was highly conserved; and no report on this variation has been found in domestic and foreign databases yet. Protein 3D modeling found that this variation may affect protein stability and function. The proband (male) and two older sisters carried the same variant had MTDPS8B, manifested as gastrointestinal dysfunction and progressive decline in motor function and intelligence, while the mother carried the same variant only had intellectual disability; the father and eldest sister did not carry the mutation and had normal clinical phenotype; the maternal grandparents had normal clinical phenotype and had passed away without genetic test; variation and disease were isolated in this family. The variation was interpreted as pathogenic (PM1+PM2+PP1+PP3) according to the American College of Medical Genetics and Genomics variant classification criteria and guidelines. Conclusion:The c.627G>A variant can cause RRM2B gene-related disease, and family members carried the same variants vary in clinical severity.

Objective To explore the efficacy and safety of different antiplatelet drugs combined with rivaroxaban in patients with lower extremity arteriosclerosis obliterans.Methods The clinical data of patients with lower extremity arteriosclerosis obliterans who were symptomatic and underwent surgical treatment at the Vascular Surgery Department of Nanjing Drum Tower Hospital from January 2018 to December 2021 were retrospectively analyzed.According to the different antiplatelet medications taken by patients,patients were categorized into aspirin group,clopidogrel group and cilostazol group.Baseline data of patients were collected,and patients were followed up and the incidence of major adverse cardiovascular events,major adverse limb events,major bleeding and clinically related non-major bleeding events were compared in different groups.Results A total of 632 patients were included in the study.There was no significant difference in the incidence of major adverse cardiovascular events,major adverse limb events,major bleeding and clinically related non-major bleeding events after the baseline data was balanced by inverse probability of treatment weighting.The results of subgroup analysis were generally consistent with those of the overall study.Conclusion The combination of clopidogrel or cilostazol with rivaroxaban may serve as a novel option for dual antithrombotic therapy in patients diagnosed with lower extremity arteriosclerotic obliterans.