AIM: To evaluate the surgical outcomes and changes in the ocular surface microenvironment following radiofrequency minimally invasive treatment for conjunctivochalasis-induced epiphora.METHODS: Patients with epiphora primarily caused by conjunctivochalasis were enrolled. All patients had conjunctivochalasis of ≥grade II, and their symptoms showed no significant improvement after previous pharmacological treatment. All patients underwent radiofrequency minimally invasive correction of conjunctivochalasis, supplemented with artificial tears, anti-inflammatory therapy, and ocular surface repair treatment postoperatively. At 8 wk post-surgery, the ocular surface disease index(OSDI), eye redness, tear secretion, non-invasive tear break-up time, lipid layer thickness, tear ferning test, and conjunctival impression cytology were assessed to compare treatment efficacy and observe changes in the ocular surface microenvironment.RESULTS: A total of 43 cases(43 eyes)of conjunctivochalasis and with a main complaint of epiphora were included, including 23 males and 20 males, with a mean age of 64.69±3.36 years. The total effective rate of surgery was 91% at 8 wk postoperatively. Compared with preoperative values, the OSDI scores significantly decreased and the non-invasive tear break-up time was prolonged at 8 wk post-surgery(all P<0.05). No statistically significant differences were observed in lipid layer thickness or tear secretion at 8 wk postoperatively(all P>0.05). The normal rate of chloramphenicol taste test increased from 21% preoperatively to 63% postoperatively; the normal rate of eye redness increased from 40% to 70%; normal rate of tear ferning grading improved from 30% to 63%; and normal conjunctival impression cytology grading increased from 21% to 74%.CONCLUSION: Radiofrequency minimally invasive treatment is effective for conjunctivochalasis and is straightforward to perform. Patients with conjunctivochalasis often present with other ocular surface issues beyond conjunctivochalasis itself, such as insufficient tear secretion, reduced lipid layer thickness, and other dry eye-related problems. Therefore, a comprehensive approach emphasizing tear dynamics should be adopted during treatment.

Acute respiratory distress syndrome （ARDS） is believed to primarily result from a disorder of the qi movement， with qi dysfunction occurring first， followed by changes in fluids and blood. The disease is located in the lungs， with its root in qi and pathological changes in fluids and blood， aligning with the theory of "qi loses its regulatory function， fluids and blood follow the same path". Accordingly， ARDS is divided into three stages， the early stage with qi congestion， counterflow， fluids and blood obstruction， severe stage with qi collapse， yang depletion， fluids and blood out of control）， and recovery stage with qi consumption and fluids damage， residual pathogen retention. For the corresponding treatments， in the early stage， the focus is on diffusing the lung qi， opening the block， dissol-ving phlegm， and eliminating fluid retention， using Tingli Dazao Xiefei Decoction （葶苈大枣泻肺汤） and Xuanbai Chengqi Decoction （宣白承气汤） / Shegan Mahuang Decoction （射干麻黄汤） with modifications. In the severe stage， the priority is to reinforce qi， stabilize collapse， and promote diuresis and blood circulation， with modified Zhenwu Decoction （真武汤） and Shenge Powder （参蛤散）. During recovery stage， the emphasis shifts to replenishing qi and body fluids while clearing residual pathogens， with Shashen Maidong Decoction （沙参麦冬汤） and Bufei Decoction （补肺汤）. At the same time， from the perspective of "qi loses its regulatory function， fluids and blood follow the same path"， the mechanism of prone position ventilation （PPV） is explored. It is believed that the effect of "qi reaching the blood" via PPV by restoring the qi movement and unblocking qi， blood and water retention， which offers insights for the diagnosis and treatment of ARDS with integrated traditional Chinese and western medicine.

ObjectiveTo analyze the characteristics of 150 patients with spinal cord injury complicated with spasticity. MethodsA cross-sectional survey was conducted on 150 patients with spinal cord injury accompanied by spasticity from September, 2019 to December, 2024. Their age, gender, cause of injury, injury site, severity of injury, spasticity severity and other indicators were recorded. The relationships between different characteristics were analyzed, and a correlation analysis of disease duration, spasticity grade, injury level, injury severity and age were conducted. ResultsThere was no significant difference in age distribution between patients with tetraplegia and paraplegia (Z = 0.806, P = 0.420). The proportions of trauma (χ² = 3.982, P = 0.046) and tetraplegia (χ² = 10.559, P = 0.010) were higher in males than in females. Trauma was the main cause of injury in both tetraplegia and paraplegia patients; the proportion of tetraplegia was higher than paraplegia in trauma patients, while paraplegia was higher than tetraplegia in non-trauma patients (χ² = 11.885, P < 0.001). Patients with tetraplegia was dominated by incomplete injury, whereas patients with paraplegia was dominated by complete injury (χ² = 10.885, P = 0.012). Grade A injury was predominant in trauma patients (P = 0.003). Spasticity grade showed a very weak positive correlation with disease duration (r = 0.175, P = 0.032) and age (r = 0.168, P = 0.040). Injury severity showed a very weak positive correlation with age (r = 0.183, P = 0.025). ConclusionCharacteristics of patients with spinal cord injury complicated with spasticity is different with gender, cause of injury, injury level, injury severity.

ObjectiveBased on traditional quality evaluation of Gardeniae Fructus（GF） recorded in historical materia medica， this study systematically compared the quality differences between wild and cultivated GF from morphological characteristics， microscopic features， and contents of primary and secondary metabolites. MethodsVernier calipers and analytical balances were used to measure the length， diameter and individual fruit weight of wild and cultivated GF， and the aspect ratio was calculated. A colorimeter was used to determine the chromaticity value of wild and cultivated GF， and the paraffin sections of them were prepared by safranin-fast green staining and examined under an optical microscope to observe their microstructure. Subsequently， the contents of water-soluble and alcohol-soluble extracts of wild and cultivated GF were detected by hot immersion method under the general rule 2201 in volume Ⅳ of the 2020 edition of the Pharmacopoeia of the People's Republic of China， the starch content was measured by anthrone colorimetric method， the content of total polysaccharides was determined by phenol-sulfuric acid colorimetric method， the sucrose content was determined by high performance liquid chromatography coupled with evaporative light scattering detection（HPLC-ELSD）， and the contents of representative components in them were measured by ultra-performance liquid chromatography（UPLC）. Finally， correlation analysis was conducted between quality traits and phenotypic traits， combined with multivariate statistical analysis methods such as principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， key differential components between wild and cultivated GF were screened. ResultsIn terms of traits， the wild GF fruits were smaller， exhibiting reddish yellow or brownish red hues with significant variation between batches. While the cultivated GF fruits are larger， displaying deeper orange-red or brownish red. The diameter and individual fruit weight of cultivated GF were significantly greater than those of wild GF， while the blue-yellow value（b^*） of wild GF was significantly higher than that of cultivated GF. In the microstructure， the mesocarp of wild GF contained numerous scattered calcium oxalate cluster crystals， while the endocarp contained stone cell class round， polygonal or tangential prolongation， undeveloped seeds were visible within the fruit. In contrast， the mesocarp of cultivated GF contained few calcium oxalate cluster crystals， or some batches exhibited extremely numerous cluster crystals. The stone cells in the endocarp were predominantly round-like， with the innermost layer arranged in a grid pattern. Seeds were basically mature， and only a few immature seeds existed in some batches. Regarding primary metabolite content， wild GF exhibited significantly higher total polysaccharide level than cultivated GF（P<0.01）. In category-specific component content， wild GF exhibited significantly higher levels of total flavonoids and total polyphenols compared to cultivated GF（P<0.01）. Analysis of 12 secondary metabolites revealed that wild GF exhibited significantly higher levels of Shanzhiside， deacetyl asperulosidic acid methyl ester， gardenoside and chlorogenic acid compared to cultivated GF（P<0.01）. Conversely， the contents of genipin 1-gentiobioside， geniposide and genipin were significantly lower in wild GF（P<0.01）. ConclusionThere are significant differences between wild and cultivated GF in terms of traits， microstructure， and contents of primary and secondary metabolites. At present， the quality evaluation system of cultivated GF remains incomplete， and this study provides a reference for guiding the production of high-quality GF medicinal materials.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To explore the application effect of special quality control management for thyroid and breast ultrasound in community hospitals.Methods:This study was a prospective interventional study. From November 2024 to March 2025, the Department of Ultrasound, China-Japan Friendship Hospital conducted special quality control management for thyroid and breast ultrasound in 17 community hospitals in Chaoyang District. Through measures such as standardized training in thyroid and breast ultrasound as well as quality control investigations before and after the training, changes in the qualification rates of ultrasound image storage, report writing, and nodule grading accuracy for thyroid and breast in community hospitals before and after the implementation of this management were compared, A paired t-test was used for statistical analysis. Results:Thyroid ultrasound quality control effects: Image storage qualification rates significantly improved: the qualification rate of image adjustment increased from 62.94%±22.01% to 85.88%±14.17% ( t=6.35, P<0.001), and body markers application rose from 76.47%±4.93% to 95.29%±7.17% ( t=11.14, P<0.001). The qualification rates for nodule sections and blood flow sections both exceeded 95% ( P<0.001). In report writing: the qualification rates for items such as nodule location, measurement, and echo increased by 10%-25%. The description of nodule margins reached 100% ( t=8.79, P<0.001), and the description of echogenic foci features increased from 41.76% to 79.41% ( t=5.46, P<0.001). Nodule classification accuracy significantly improved: The guideline application rate increased from 55.29% to 91.18% ( t=4.84, P<0.001), and the classification correctness rate rose from 54.71% to 69.41% ( t=5.14, P<0.001). Breast ultrasound quality control effects: Overall improvement in image storage qualification rates: body marker application increased from 75.29%±21.54% to 97.00%±65.88% ( t=3.82, P=0.002). The qualification rates for nodule sections and blood flow section imaging both exceeded 94% ( P<0.001). In report writing: the qualification rates for items like nodule location, measurement, and echo increased by 10%-30%. The classification rate of the Breast Imaging Reporting and Data System (BI-RADS) classification rate rose from 68.82% to 98.24% ( t=3.68, P=0.002), and the classification correctness rate increased from 57.65% to 70.00% ( t=2.74, P=0.014). Conclusion:The implementation of special quality control management for thyroid and breast ultrasound is an effective method to improve the quality of ultrasound medical services in community hospitals.

Psoriasis and atopic dermatitis are common inflammatory skin diseases in the elderly, characterized by chronic inflammation and immune imbalance, making their management challenging. The emergence of biologics and small-molecule drugs has revolutionized the treatment of psoriasis and atopic dermatitis by markedly improving efficacy and safety compared to conventional therapies. However, their application in elderly patients poses challenges. Due to the presence of comorbidities in elderly patients, accurate diagnosis is critical by differentiating psoriasis and atopic dermatitis from other skin diseases, with an emphasis on the auxiliary role of histopathological examination and laboratory tests. In the treatment of elderly patients with psoriasis and atopic dermatitis using biologics and small-molecule drugs, comprehensive treatment should address both skin symptoms and systemic health, with careful drug selection tailored to individuals. Safety monitoring, particularly vigilance for risks such as infections, lipid abnormalities, and cardiovascular events, is essential during treatment. Education efforts are needed to improve patient knowledge and acceptance of biologics and small molecule drugs. Future research should focus on accumulating clinical data in elderly populations to provide a basis for precision treatment of elderly patients with psoriasis and atopic dermatitis.

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.

Objective:To establish a monitoring and evaluation index system for the building project of national children′s regional medical centre (shorted as the evaluation system), so as to provide quantitative supports for output hospitals to fulfil their primary responsibilities and offer guidance for project hospitals to implement target management.Methods:From April to June 2024, through searching literature and policy document, and combining with the actual situation of national regional medical center construction, the initial indicators of the evaluation system were screened. An evaluation system were constructed using two rounds of Delphi method, and the weights of indicators were determined by analytic hierarchy process.Results:This study invited 17 experts. The participation rates of experts in the two rounds of consultation exceeded 90.00%, with an expert authority coefficient of 0.96. The final evaluation system comprised 2 primary indicators, 8 secondary indicators, and 52 tertiary indicators. The primary indicators included project implementation status and project outcomes, with relative weights of 44.44% and 55.56% respectively. Project implementation status included 4 secondary indicators: project organisation, resource allocation, project progress, and safeguard mechanisms. Project outcomes encompassed 4 secondary indicators: healthcare service capacity, regional talent development outreach, and collaborative innovation.Conclusions:The evaluation system established in this study demonstrated a high degree of scientificity and feasibility. It could effectively supported the process management and outcome evaluation of establishing the national children′s regional medical centre. This system provided a scientific basis for enhancing the quality and efficiency of children′s healthcare services, optimising policy formulation and resource allocation.

Objective:To develop an artificial intelligence (AI)-based platelet review strategy to identify abnormal platelet histograms with no significant difference between initial impedance platelet count (PLT-I) and PLT-F results.Methods:This study included 5 119 routine blood analysis in Nanfang Hospital of Southern Medical University and its Ganzhou branch from July 2023 and March 2024. Specimens exhibiting abnormal platelet histograms and an initial platelet count >40×10?/L underwent review using the fluorescent platelet count (PLT-F) channel. Consistency of the results was defined as a difference between impedance platelet count (PLT-I) and PLT-F less than ±20% of the PLT-F results. A deep learning model was developed using platelet and red blood cell histogram data from a training set of 3 807 specimens. The model′s diagnostic performance was evaluated on an independent external validation set ( n=805) using receiver operating characteristic (ROC) curve analysis. Changes in the number of reviewed samples and sample turnaround time were analyzed to assess its clinical utility. Results:The deep learning model based on platelet and red blood cell histograms achieved an area under the ROC curve (AUC) of 0.854 in the training set. At a cutoff value of 0.1, the sensitivity was 0.954 and specificity was 0.358. The model could reduce review by 16.80% (190/1 131). In the validation set, the AUC was 0.805, with a sensitivity of 0.955 and specificity of 0.307, corresponding to a reduction of 17.41% (47/270) in reviewed specimens.Conclusion:The platelet review prediction model developed based on deep learning technology can efficiently identify samples with consistent results before and after review, reducing unnecessary reviews and shortening specimen testing time, thereby improving the efficiency of platelet test.