ObjectiveThis paper aims to investigate the distribution patterns of traditional Chinese medicine syndromes in patients with chronic hepatitis B （CHB） comorbid with metabolically associated fatty liver disease （MAFLD） and analyze their correlation with clinical characteristics and the progression of liver fibrosis. MethodsA cross-sectional study method was employed， and 506 patients with CHB comorbid with MAFLD who attended the Hepatology Outpatient Department of Public Health Clinical Center of Chengdu from June 2024 to December 2024 were enrolled. General information， traditional Chinese medicine syndromes information， laboratory indicators， and imaging examination results were collected using case report forms （CRF）. Tongue images of patients were acquired using a tongue diagnosis instrument， and tongue feature parameters were extracted using computer image processing technology. Frequency analysis， factor analysis， and cluster analysis， and other methods were used to explore syndrome categories and distribution patterns. Non-parametric tests were used to compare the differences in clinical characteristics among different syndromes. Univariate and multivariate logistic regression analyses were performed to investigate the correlation between traditional Chinese medicine syndromes and the progression of liver fibrosis. ResultsThe main traditional Chinese medicine syndromes in patients with CHB comorbid with MAFLD were mainly dominated by damp-heat accumulation syndrome， liver stagnation and spleen deficiency syndrome， and phlegm-blood stasis syndrome， with damp-heat accumulation syndrome accounting for the highest proportion （41.89%）. Compared with those without damp-heat accumulation syndrome， patients with damp-heat accumulation syndrome had significantly lower tongue proper H value， tongue coating H value， and tongue coating a^* value （P<0.05）， significantly higher tongue coating b^* value （P<0.05）， significantly increased levels of white blood cell （WBC）， red blood cell （RBC）， hemoglobin （HGB）， and glucose （GLU）， increased CAP values （P<0.05）， a higher proportion of males （P<0.05）， and a younger age （P<0.05）. Univariate and multivariate logistic regression analyses show that age， hepatitis B surface antigen （HBsAg）， diabetes， and damp-heat accumulation syndrome are independent risk factors for liver fibrosis （P<0.05）， and that damp-heat accumulation syndrome is predominantly distributed in liver fibrosis stage F0-F1. ConclusionDamp-heat accumulation syndrome is a typical syndrome in patients with CHB comorbid with MAFLD， which is significantly associated with enhanced inflammatory response， metabolic disorders， and early liver fibrosis， and is a key link in disease progression. Clinical attention and early intervention are needed.

ObjectiveThis paper aims to conduct the feature analysis and correlation analysis on the ocular collateral features and differential metabolites in patients with chronic hepatitis B （CHB） complicated by glucose metabolism disorder （GMD），particularly those with the damp-heat syndrome type，by integrating shadowless scleral imaging and metabolomics technologies. MethodsA total of 313 patients were recruited from the Hepatology and Endocrinology Outpatient Departments of Public Health Clinical Center of Chengdu according to the inclusion/exclusion criteria，and they were divided into a CHB group and a CHB complicated by GMD groups （damp-heat syndrome group and non-damp-heat syndrome group）. All patients underwent high-definition ocular image acquisition and feature extraction using an intelligent analysis system for shadowless scleral imaging to analyze the differences in the counting of morphological feature scores of ocular collaterals among groups. By using a digital sampling method，24 patients from each group were randomly selected，along with 20 healthy volunteers，for untargeted metabolomic analysis of peripheral serum. Differential metabolites were identified，statistically analyzed，and subjected to potential biomarker analysis and pathway enrichment. Spearman method was performed to conduct the correlation analysis on the differential ocular collateral features and differential metabolites，followed by correlation network construction. ResultsCompared with those in the CHB group，patients with CHB complicated by GMD showed significant changes in ocular collateral feature scores such as "hillock"，"blood vessels"，and "pale dusky coloration" （P<0.05）. In comparison with those in the healthy group，metabolites including N-acetylglucosamine，acetylhomoserine，and myo-inositol （AUC>0.7） were identified as potential biomarkers for the disease. Compared with those in the CHB complicated by GMD group with non-damp-heat syndrome，patients with damp-heat syndrome exhibited significant changes in feature scores of "plaques"，"yellow coloration"，"spleen"，and "gallbladder" （P<0.05）. In comparison with those in the healthy group，metabolites such as O²′-4a-cyclic tetrahydrobiopterin，theobromine，xanthurenic acid，and L-glutamic acid 5-phosphate （AUC>0.7） were identified as potential biomarkers for the damp-heat syndrome type. The Spearman correlation analysis reveals weak to moderate linear correlations between the differential scleral collateral features and metabolites. By constructing a "disease-syndrome" network of ocular diagnosis and metabolites，"xanthurenic acid-gallbladder" and "theobromine-plaque/yellow coloration" were identified as specific molecular-phenotypic correlated biomarker clusters for CHB complicated by GMD with dampness-heat syndrome. ConclusionPatients with CHB complicated by GMD demonstrate differential ocular diagnostic features and serum metabolites corresponding to disease states and dampness-heat syndrome. These objective biomarkers can guide both clinical syndrome differentiation and medication. The macro-micro integration based on ocular feature clusters and potential metabolic biomarkers offers an innovative approach to a combined traditional Chinese and Western medicine diagnosis and treatment model for this disease.

Objective To investigate the effect of non humidification,200 ml and 100 ml distilled water humidification on oxygen output flow of Venturi mask,and to provide basis and reference for clinical application of Venturi mask oxygen therapy.Methods In August 2024,the output end of an oxygen flow meter installed with a water humidification device was connected with a Venturi mask and an external flow sensor of a ventilator in turn.The oxygen output flow of the Venturi mask was measured under the conditions of no humidification,200 ml distilled water humidification and 100 ml distilled water humidification,respectively,at oxygen concentration set of 24％,26％,28％,31％,35％,40％and 50％.The measured output flow data of the 3 groups were statistically analyzed.Results The oxygen output flow of the Venturi mask ranged from 7.6 to 45.6 L/min,and the input flow was 3 L/min or 6 L/min.The higher the oxygen concentration,the lower the oxygen output flow of the Venturi mask.Under the same oxygen concentration,the average output flow of 200 ml distilled water humidification group was lower than that of 100 ml distilled water humidification group and non humidification group(P＜0.05).When the oxygen concentration was set at 24％,26％,31％and 35％,the oxygen output flow of non humidification group was higher than that of 100 ml distilled water humidification group(P＜0.05).At 40％and 50％oxygen concentration,the oxygen output flow of 100 ml distilled water humidification group was higher than that of non humidification group(P＜0.05).Conclusion The overall output flow of the Venturi mask is low,and the input flow is the same.The higher the oxygen concentration,the lower the output flow.The humidification of 200ml distilled water may lead to insufficient oxygen flow in patients,while the humidification of 100ml distilled water has little effect on the output flow of Venturi mask.

Objective To evaluate the application of flipped classroom(FC)approach in endocrine system integrated course for students from 4+4 clinical medicine pilot class at Peking Union Medical College(PUMC).Methods The study included the students of 4+4 clinical medicine pilot class grades 2019-2023 in PUMC.The students of grades 2019-2021(n=77)served as the control receiving traditional teaching method,while the students of grades 2022 and 2023(n=76)were selected as the experimental group,which were taught by FC approach.The selected teaching content is thyroid theme.The scoring rates of thyroid related questions in the final exam were as-sessed and a questionnaire survey was conducted to evaluate teaching satisfaction and effectiveness.Results The scoring rates of experimental group were significantly higher as compared to that of control group(P＜0.05).Over 90％of the students in the experimental group strongly satisfied or satisfied with the teaching content arrangement,design form,classroom atmosphere,teacher-student interaction of FC and expressed willingness to continue with this methodology.In addition,over 90％of the students strongly agreed or agreed that FC stimulated learning inter-est,improved self-learning ability,strengthened the connection between theory and clinical practice,inspired clini-cal reasoning,enhanced the abilities to analyze and solve problems,and cultivated communication and teamwork skills.Conclusions The application of FC approach in endocrine system integrated course achieved excellent teaching outcomes with high satisfaction of the students.

Objectives:To explore the relationship between epicardial adipose tissue(EAT),left atrium and left atrial appendage(LAA)structures and LAA thrombosis in patients with non-valvular atrial fibrillation.Methods:Clinical data from non-valvular atrial fibrillation patients who underwent cardiac computed tomography angiography(CTA)and transesophageal echocardiography(TEE)at the Second Hospital of Hebei Medical University between November 2019 and October 2024,were retrospectively collected.Twenty-eight patients diagnosed with LAA thrombus by both CTA and TEE were enrolled as the LAA thrombus group(20 males,8 females,average age[65±9]years).Using an individual matching method,56 non-valvular atrial fibrillation patients without LAA thrombus,matched for gender and age(±3 years),were sequentially enrolled at a ratio of 1:2 as the no-thrombus group(40 males,16 females,average age[65±8]years).CTA was used to measure the epicardial adipose tissue volume(EATV),left atrial epicardial adipose tissue volume(LA-EATV),and structural parameters of the left atrium and LAA in both groups.The correlation between EAT,structural parameters of the left atrium/LAA and LAA thrombosis was evaluated.Results:In the LAA thrombus group,the proportions of patients with persistent atrial fibrillation and atrial fibrillation rhythm were significantly higher than in the no-thrombus group(both P<0.001).There were no statistically significant differences between the two groups in terms of age,gender composition,body mass index,duration of atrial fibrillation,and the proportions of patients with hypertension,diabetes,dyslipidemia,coronary heart disease,ischemic stroke,heart failure,vascular disease,and CHA2DS2-VASc scores(all P>0.05).Compared to the no-thrombus group,the EATV,LA-EATV,left atrial volume(LAV),LAA volume(LAAV),and LAA orifice area were significantly higher in the LAA thrombus group(all P<0.05).There was no significant difference between the two groups in the LAA depth(P=0.076).Conditional logistic regression analysis showed that LA-EATV(OR=1.092,95%CI:1.004-1.187,P=0.040)and LAV(OR=1.022,95%CI:1.003-1.041,P=0.025)were independent predictors of LAA thrombosis in non-valvular atrial fibrillation patients.The LA-EATV threshold for predicting LAA thrombosis was 27.16 cm3,with an area under the receiver operating characteristic curve(AUC)of 0.843(sensitivity 85.7%,specificity 76.8%);the LAV predictive threshold was 118.45 ml(AUC=0.853,sensitivity 82.1%,specificity 80.4%).Conclusions:LA-EATV and LAV measured by cardiac CTA are independent predictors of LAA thrombosis in patients with non-valvular atrial fibrillation.

This report presents a case of a 75-year-old patient with newly diagnosed gastric cancer,who had repeated symptoms of fatigue,confusion,and hyponatremia after 2 cycles of chemotherapy combined with nivolumab as neoadjuvant treat-ment and was later diagnosed with adrenal cortical insufficiency.After applying corticosteroid replacement therapy,there was im-provement,but cortisol remained low,and long-term corticosteroid therapy is needed.

[Purpose]To analyze the incidence and mortality of thyroid cancer in Zhejiang cancer registration areas in 2021 and trends from 2000 to 2021.[Methods]Based on cancer data from 22 registries across Zhejiang Province between 2000 and 2021,the crude incidence/mortality rates,age-standardized incidence/mortality rates of thyroid cancer by Chinese and world standard population(ASIRC/ASMRC,ASIRW/ASMRW),cumulative rate(0～74 years old)and truncated rate(35～64 years old)were analyzed.Joinpoint regression model was employed to calculate the annual percentage change(APC)and average annual percentage change(AAPC)with 95％confidence in-terval(CI)for analyzing trends of thyroid cancer incidence and mortality rates from 2000 to 2021.[Results]The crude incidence rate of thyroid cancer increased from 3.62/105 in 2000 to 79.66/105 in 2021,and ASIRC rose from 3.11/105 to 69.49/105(AAPC=15.55％,95％CI:14.65％～16.61％).The AAPC for ASIRC was slightly higher in female(15.54％,95％CI:14.71％～16.49％)than that in male(15.02％,95％CI:13.53％～16.82％).The increase was significantly more pronounced in rural areas(AAPC=23.34％,95％CI:21.48％～25.33％)compared to urban areas(AAPC=14.12％,95％CI:13.15％～15.43％).Among age groups,the age group of 15～44 years old showed the fastest increase in crude incidence rate(AAPC=20.37％,95％CI:18.46％～22.31％),followed by the age group of 45～64 years old(AAPC=18.41％,95％CI:16.65％～20.19％).Between 2000 and 2021,the crude mortality rate of thyroid cancer rose from 0.34/105 to 0.56/105(AAPC=5.52％,95％CI:3.45％～7.70％),the trend of ASMRC was relatively stable.[Conclusion]From 2000 to 2021,the incidence of thyroid cancer in Zhejiang Province increased markedly,especially among females and younger to middle-aged adults,while the age-standardized mortality rate remained stable.

Purpose To explore the predictive value of fetal cardiothoracic ratio(CTR)and their Z-scores for homozygous α-thalassemia major in early pregnancy.Materials and Methods Retrospective analysis was conducted on fetuses at high risk of α-thalassemia major(at 11-13?? weeks of gestation)who received prenatal care at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from June 2016 to December 2023.Ultrasound examinations were performed on these fetuses to measure the CTRs[including cardiothoracic diameter ratio(CTDR),cardiothoracic circumference ratio(CTCR)and cardiothoracic area ratio(CTAR)],which were simultaneously converted into Z-scores.The receiver operating characteristic curve was used to evaluate the predictive efficacy of each group of CTRs and their corresponding Z-scores for fetal α-thalassemia major.Results ①A total of 363 high-risk fetuses were included,including 91(25.1%)in the affected group and 272(74.9%)in the control group.②All the CTRs(including CTDR,CTCR and CTAR)and their corresponding Z-scores in the affected group were significantly higher than those in the control group(t=3.705-21.320,all P<0.001).③The area under the curve(AUC)analysis showed that the AUCs of cardiothoracic ratio Z-scores were higher than those of the corresponding cardiothoracic ratios.The AUCs were ranked from largest to smallest as CTDR Z-score,CTDR,CTAR Z-score,CTCR Z-score,CTAR,CTCR,and the CTDR Z-score had the highest predictive efficacy(when the optimal cut-off value was 1.10,AUC=0.959,with a sensitivity of 94.5%and a specificity of 90.4%).Conclusion The predictive efficacy of fetal CTR Z-scores is higher than that of the corresponding CTRs,which are new indicators for effectively predicting homozygous α-thalassemia major in early pregnancy.Among them,the CTDR Z-score has the highest predictive efficacy,which can improve the prenatal diagnosis rate of this disease and reduce some unnecessary invasive procedures.

Objective To explore the influence of combination of recombinant human collagen dressing and promestriene ointment on symptoms and vaginal microecology in patients with atrophic vaginitis.Methods The data of patients with atrophic vaginitis admitted to the General Hospital of the People's Liberation Army were retrospectively collected from April 2017 to April 2024.According to treatment methods,the enrolled patients were divided into a study group(recombinant human collagen dressing combined with promestriene ointment for 7 days)and a control group(promestriene ointment for 7 days).The efficacy,symptom disappearance time,vaginal microecology and adverse reactions were compared between groups,and recurrence rate of atrophic vaginitis within 1 month was observed.Results A total of 150 patients were screened and included,77 in the study group and 73 in the control group.After treatment,the total therapeutic efficacy in the study group was higher than that in the control group(89.61％vs.76.71％,P＜0.05).The disappearance durations of abnormal leucorrhea,vulva pruritus and vulva burning pain in the study group were significantly shorter compared with those in the control group(all P＜0.05).The vaginal pH value in the study group was lower,while the positive rate of Lactobacillus and proportions of vaginal flora density grade Ⅱ-Ⅲ and diversity grade Ⅱ-Ⅲ were higher compared to the control group(all P＜0.05).During treatment,no significant difference was exhibited in the total incidence rate of adverse reactions between the two groups(P＞0.05).The recurrence rate was lower in the study group than that in the control group within 1 month of follow-up(P＜0.05).Conclusion Recombinant human collagen dressing combined with promestriene ointment is more effective than promestriene ointment alone in improving the efficacy of patients with atrophic vaginitis,and can better shorten the disappearance durations of symptoms such as abnormal leucorrhea,vulva pruritus and vulva burning pain,correct the disorder of vaginal microecology,and reduce the short-term recurrence rate of vaginitis,and offer good safety.

Objectives:To explore the relationship between epicardial adipose tissue(EAT),left atrium and left atrial appendage(LAA)structures and LAA thrombosis in patients with non-valvular atrial fibrillation.Methods:Clinical data from non-valvular atrial fibrillation patients who underwent cardiac computed tomography angiography(CTA)and transesophageal echocardiography(TEE)at the Second Hospital of Hebei Medical University between November 2019 and October 2024,were retrospectively collected.Twenty-eight patients diagnosed with LAA thrombus by both CTA and TEE were enrolled as the LAA thrombus group(20 males,8 females,average age[65±9]years).Using an individual matching method,56 non-valvular atrial fibrillation patients without LAA thrombus,matched for gender and age(±3 years),were sequentially enrolled at a ratio of 1:2 as the no-thrombus group(40 males,16 females,average age[65±8]years).CTA was used to measure the epicardial adipose tissue volume(EATV),left atrial epicardial adipose tissue volume(LA-EATV),and structural parameters of the left atrium and LAA in both groups.The correlation between EAT,structural parameters of the left atrium/LAA and LAA thrombosis was evaluated.Results:In the LAA thrombus group,the proportions of patients with persistent atrial fibrillation and atrial fibrillation rhythm were significantly higher than in the no-thrombus group(both P<0.001).There were no statistically significant differences between the two groups in terms of age,gender composition,body mass index,duration of atrial fibrillation,and the proportions of patients with hypertension,diabetes,dyslipidemia,coronary heart disease,ischemic stroke,heart failure,vascular disease,and CHA2DS2-VASc scores(all P>0.05).Compared to the no-thrombus group,the EATV,LA-EATV,left atrial volume(LAV),LAA volume(LAAV),and LAA orifice area were significantly higher in the LAA thrombus group(all P<0.05).There was no significant difference between the two groups in the LAA depth(P=0.076).Conditional logistic regression analysis showed that LA-EATV(OR=1.092,95%CI:1.004-1.187,P=0.040)and LAV(OR=1.022,95%CI:1.003-1.041,P=0.025)were independent predictors of LAA thrombosis in non-valvular atrial fibrillation patients.The LA-EATV threshold for predicting LAA thrombosis was 27.16 cm3,with an area under the receiver operating characteristic curve(AUC)of 0.843(sensitivity 85.7%,specificity 76.8%);the LAV predictive threshold was 118.45 ml(AUC=0.853,sensitivity 82.1%,specificity 80.4%).Conclusions:LA-EATV and LAV measured by cardiac CTA are independent predictors of LAA thrombosis in patients with non-valvular atrial fibrillation.