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.

Objective:To explore the clinical efficacy of DELTA endoscopic lumbar interbody fusion for the treatment of mild to moderate, single segment lumbar spondylolisthesis.Methods:A retrospective analysis was conducted on the clinical data of 48 surgical cases of grade Ⅰ to Ⅱ lumbar spondylolisthesis admitted to the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from February 2020 to March 2022. Among them, 24 cases treated with DELTA endoscopic lumbar interbody fusion surgery were classified as the DELTA group, and 24 cases treated with traditional minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery were classified as the MIS-TLIF group. Two groups of patients were compared in terms of perioperative indicators (surgical time, postoperative drainage volume, incision length, hospital stay), clinical efficacy [Visual Analogue Scale (VAS) score for low back and leg pain, lumbar Japanese Orthopaedic Association Scores (JOA), improved MacNab standard excellence rate], and lumbar fusion rate (Bridwell intervertebral fusion grade).Results:The DELTA group had longer surgical time than the MIS-TLIF group, and the postoperative drainage volume, incision length, and hospital stay were all lower than the MIS-TLIF group, with statistically significant differences (all P<0.05). The VAS score of lower back and leg pain and lumbar JOA score of the two groups of patients at 1 week, 3 months, and the last follow-up were significantly improved compared to those before surgery (all P<0.01), and the DELTA group had better VAS score of lower back and leg pain and lumbar JOA score at all time points after surgery than the MIS-TLIF group, with statistically significant differences (all P<0.05). The improved MacNab standard was used to evaluate the efficacy of the two groups of patients at the last follow-up after surgery, and there was no statistically significant difference in the excellent and good rates ( P>0.05); There was no statistically significant difference ( P>0.05) in the fusion rate between the two groups. Conclusions:DELTA endoscopic lumbar interbody fusion has a significant therapeutic effect on lumbar spondylolisthesis, with the advantages of small surgical incision and fast recovery; After crossing the DELTA endoscopic learning curve and optimizing surgical procedures, this technology can become an alternative to MIS-TLIF technology.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective To explore the clinical efficacy of Delta endoscopic lumbar decompression fusion for the treatment of giant lumbar disc herniation(GILDH).Method A retrospective analysis was performed on 36 cases of GILDH from April 2020 to May 2022,including 18 cases in the Delta group and 18 cases in the open group.There was no statistically significant difference in gender,age,and responsible section between the two groups of patients.Compare the surgical time,perioperative indicators,and clinical efficacy between the two groups.Results The intraoperative bleeding and drainage volume in the Delta group were lower than those in the open group,the incision length and hospital stay were shorter than those in the open group,the degree of paraspinal muscle injury was lighter than that in the open group,and the surgical time was longer than that in the open group,with statistical significance(P＜0.05);The lumbago visual analogue scale(VAS)of the two groups of patients at each postoperative period was significantly reduced compared to preoperative,and the lumbar spine function score of the Japanese Orthopaedic Association(JOA)was significantly increased compared to preoperative,with statistical significance(P＜0.05);The lumbago VAS of the Delta group was significantly lower than that of the open group at all postoperative stages,and the lumbar spine function JOA score was significantly higher than that of the open group,with statistical significance(P＜0.05);There was no statistically significant difference in the modified MacNab score between the two groups of patients at the last follow-up after surgery(P＞0.05).Conclusion Delta endoscopic lumbar decompression fusion for GILDH has significant therapeutic effects,with advantages such as less bleeding,small surgical incision,and fast postoperative recovery;After crossing the Delta endoscopic learning curve and optimizing the surgical process,this technology can become an alternative to conventional open surgery.

Objective: To establish a method for determination the S-phenylmercapturic acid in urine by dispersive solid-phase extraction using Humic Acid/Fe₃O₄ magnetic nanocomposite as adsorbent. Methods: The 5 ml of urine samples were adjusted to pH 1.0 and extracted by Fe3O4@HA. Then the analytes were separated on EC-C₁₈ capillary column and detected by HPLC-VWD. The S-phenylmercapturic acid was characterized by the retention time and quantified by peak area and external standard method. Results: The standard curves of SPMA showed significant linearity between 0.04~1.00 mg/L (r=0.999 7) . The average recovery was 94.2%~102.4%. The intra-day and inter-day precisions (RSD) were 2.9~6.7% (n=6) and 3.1~7.5% (n=6) respectively. The detect limit of SPMA was 0.012 g/L (S/N=3) . Conclusion This method is simple, rapid, sensitive and accurate. It is applicable for determination of SPMA in the urine of works who were exposed to benzene.

Objective To explore the effect of solution-focused approach on self perceived burden, anxiety and depression in elderly patients with coronary heart disease complicated with type 2 diabetes. Methods From January to June 2016, 76 elderly patients with coronary heart disease complicated with type 2 diabetes from inpatients department of Wuxi Second People's Hospital were selected as the research objects by convenience sampling method. The patients were divided into control group and observation group by random number table, each with 38 cases. Patients in the control group were given routine nursing and patients of the observation group were given solution-focused approach intervention on the basis of routine nursing. Self-perceived burden scale, self-rating anxiety scale and self-rating depression scale were used to evaluate theeffect of intervention.Results Compared with the score before intervention, there was statistical difference in the self-perceived burden score after intervention in two groups (P<0.05). Before intervention, there was no statistical difference in the self-perceived burden score between the patients of the two groups (P>0.05). After 3-month intervention, the self perceived burden score of the observation group was lower than that of the control group (P<0.05). After intervention, there was statistical difference in anxiety and depression score of the intervention group compared with that before intervention (P<0.05). Before the intervention, there was no statistical difference in anxiety and depression of the two groups (P>0.05). After 3-month intervention,the score of anxiety and depression in the intervention group was significantly lower than that in the control group (P<0.05).Conclusions Solution focused approach can reduce the self-perceived burden of the elderly coronary heart disease patients with type 2 diabetes and alleviate the patients' negative emotions effectively.

Objective To explore the influences of the path clinical health education on the self-management ability, health-promoting lifestyle, compliance, level of blood lipid in patients with PCI of one-day ward.Methods A total of 93 patients with PCI of one-day ward were selected as subjects and were randomly divided into observation group(n=47, the path of clinical health education) and control group(n=46, routine health education) by means of random number table. And then, we compared the self-care ability, health-promoting lifestyle, medication compliance, and level of blood lipid between two groups before and three months after intervention.Results After intervention, the proportion of low level, medium level, high level of self-care ability was 2.1%, 21.3%, 76.6% in observation group which was better than those(10.9%, 41.3%, 47.8%) in control group. The total score of health-promoting lifestyle in observation group [(157.40±17.86) points] was higher than that [(127.04±11.64) points] in control group. Moreover, the score of medication compliance in observation group [(27.98±3.89) points] was higher than that [(21.00±4.52) points] in control group. Besides, the level of total cholesterol, low density lipoprotein cholesterol, triglyceride in observation group was all lower than those in control. There were statistically significant differences in them between two groups( P<0. 05).Conclusions The path of clinical health education has an important role in improving health-promoting awareness and ability, self-management ability, compliance, level of blood lipid in patients with PCI.

Objective To evaluate left ventricular(LV) twist and untwist using velocity vector imaging(VVI) in patients with apical hypertrophic cardiomyopathy (ApHCM). Methods Twenty-three patients diagnosed with ApHCM were consecutively enrolled and compared with normal controls. After a standard echocardiographic examination, parasternal basal and apical short-axis planes were scanned to quantify LV rotations,twist and LV untwist using VVI. Results Compared with the normal controls, the rotation and rotaional velocity of apical subendocardial myocardium were markedly decreased in ApHCM patients during the period of systole ( P＜0.05) ,but the decreases in basal planes were not significant. As a consequence,LV twist was significantly lower in ApHCM patients (P＜ 0.05). Compared to normal controls,the velocity of LV untwisting was also significantly decreased in ApHCM patients ( P＜0.05).Conclusions The twist and untwist of LV subendocardial myocardium were decreased in ApHCM patients.VVI is a useful method to assess the characteristics of LV twist and untwist in ApHCM patients.

Objective To evaluate the echocardiographic features of apical hypertrophic cardiomyopathy( ApHCM). Methods Twenty-seven patients with ApHCM including 21 men and 6 women, average age (42.7 ± 5. 1 ) years old were followed up from 1995 to 2008 to investigate the clinical, electroeardiographic and echocardiographic features. Results The major features of ECG were increased R amplitude( V_4 > V_5 > V_3)and inverteted T wave(especially in V_(3-5) leads and the voltage of the inverteted T waves may be up to ≥10 mm). The major feature of echocardiography was the thickening of left ventricular apical wall to 15 - 37 ( 18. 0± 3. 3 ) mm. The final follow up showed that the mean thickness of the apical wall was ( 19. 7 ±3. 7) mm. The ratio of the thickness of left ventricular apical wall to posterior wall before and after the follow up was 1. 7 ±0. 3 and 1. 9 ±0. 9 respectively, with significant statistical difference ( P < 0. 05). There was no difference in the left ventricular end-diastolic dimension and left ventricular ejection fraction. The main cardiovascular events were atrial fibrillation ( 16 cases) , heart failure of NYHA ID-IV class (3 cases) , anterior wall myocardial infarction ( 1 case) and sudden death ( 1 case). Conclusions The final diagnosis of ApHCM depends on the characteristic inverteted T wave in ECG and apical hypertrophy in echocardiography. The prognosis of ApHCM is rather good for its progression is relatively slow.