ObjectiveTo observe the clinical efficacy and safety of Yuyin Lidan granules （YYLD） in preventing the recurrence of common bile duct stones （CBDS） in patients with liver and gallbladder dampness-heat syndrome following endoscopic retrograde cholangiopancreatography （ERCP）. MethodsThis randomized， parallel， controlled trial enrolled postoperative CBDS-ERCP patients who met the inclusion and exclusion criteria. Sixty-four patients were randomly assigned to an observation group or a control group， with 32 cases in each. Both groups received conventional Western medical treatment after ERCP， while the observation group additionally received YYLD for 8 weeks. The follow-up period lasted for 1 year. The efficacy indicators included bile bilirubin levels， traditional Chinese medicine （TCM） syndrome scores， clinical efficacy rate， pancreatitis and inflammation markers， postoperative liver function， and CBDS recurrence rate at 1-year follow-up， which were used to jointly evaluate the clinical efficacy and safety of both groups. ResultsA total of 56 patients completed the study and were included in the final analysis， i.e.， 29 in the observation group and 27 in the control group. Baseline characteristics were comparable between the two groups. Compared with pre-treatment and with the control group after treatment， the bile bilirubin level in the observation group significantly decreased （P<0.05）. After treatment， the clinical cure and marked improvement rates were higher in the observation group than in the control group， showing a statistically significant difference in overall clinical efficacy （P<0.05）. Compared with pre-treatment， the primary and secondary symptoms in the observation group， as well as the primary symptom and the secondary symptom of nausea and vomiting in the control group （weeks 4 and 8）， were significantly reduced （P<0.05）. Compared with the control group after treatment， the observation group showed significant reductions in the primary symptom of loose stools/constipation （day 5 and week 4） and in three secondary symptoms， i.e.， bitter taste and sticky dry mouth， abdominal distension and poor appetite （throughout the treatment period）， and general heaviness and fatigue （day 5 and week 4）， with statistical differences （P<0.05）. Compared with pre-treatment， both groups showed decreased lipase and urinary amylase levels （P<0.05）. However， no significant between-group differences were observed in pancreatitis or inflammation-related indices after treatment. Compared with pre-treatment， all liver function indicators in the observation group and alanine aminotransferase （ ALT ）， γ-glutamyl transferase （ γ-GT ）， alkaline phosphatase （ALP）， and conjugated bilirubin in the control group significantly decreased at weeks 4 and 8 （P<0.05）. Compared with the control group after treatment， only serum total bilirubin and unconjugated bilirubin were significantly reduced in the observation group during the treatment period （P<0.05）. ConclusionYYLD combined with conventional Western medical treatment can effectively regulate bilirubin metabolism （in bile and serum）， improve TCM clinical symptoms， and prevent CBDS recurrence after ERCP in patients with liver and gallbladder dampness-heat syndrome. This regimen is safe and effective and is worthy of further clinical research and promotion.

This paper summarizes Professor WANG Yaoxian's experience in treating diabetic kidney disease （DKD） from the perspective of spleen and stomach based on the "internal heat leading to concretions" theory. It is considered that internal heat leading to concretions constitutes the core pathogenesis of DKD， with the spleen and stomach serving as the source of internal heat； therefore， treatment should be based on regulating the spleen and stomach. In the early stage of DKD， dysfunction of the spleen and stomach leads to the initial generation of internal heat. Common syndrome patterns include gastrointestinal heat accumulation and constrained heat in the liver and stomach， for which modified Gegen Qinlian Decoction （葛根芩连汤） can be used to clear heat bind while modified Dachaihu Decoction （大柴胡汤） is used to clear stomach and soothe liver， respectively. In the middle stage of DKD， weakness of the spleen and stomach results in the initial formation of concretions and conglomerations. Common patterns include spleen deficiency with prevalence of dampness and deficiency of both the spleen and kidney. Treatment emphasizes strengthening the spleen and resolving dampness， raising yang and boosting the stomach with modified Shengyang Yiwei Decoction （升阳益胃汤）， or supplementing spleen and boosting kidney， dissipating bind and dispe-ring concretions with modified Shenqi Dihuang Decoction （参芪地黄汤）， respectively. In the late stage of DKD， it is characterized by spleen and stomach depletion， and rampant accumulation of turbidity and toxin， and the common syndrome patterns are damp-turbidity obstruction in the middle jiao （焦） and spleen-kidney yang deficiency. Treatment aims to remove turbidity and harmonize the stomach， or to warm the kidney and strengthen the spleen while elimina-ting turbidity， using modified Dahuang Gancao Decoction（大黄甘草汤） and Jupi Zhuru Decoction （橘皮竹茹汤） or modified Baoyuan Decoction （保元汤） and Lizhong Decoction （理中汤）， respectively. In clinical practice， appropriate formulas and medications are flexibly selected according to specific syndromes.

Objective:To investigate the imaging characteristics of small intestinal epithe-lioid angiosarcoma.Methods:The retrospective and descriptive study was conducted. The clinical data of 5 male patients with small intestinal epithelioid angiosarcoma who were admitted to 3 medical centers, including Yantaishan Hospital of Yantai et al, from January 2013 to December 2023 were collected. The age of 5 patients was 54 (range, 36-73)years. All 5 patients underwent computer tomography (CT) plain scan and dynamic contrast-enhanced scan, with 1 patient also undergoing magnetic resonance imaging (MRI) plain scan. Observation indicators: (1) results of CT and MRI examination; (2) surgical conditions and postoperative pathological examination; (3) follow-up. Measurement data with skewed distribution were represented as M(range), and count data were described as absolute numbers. Results:(1) Results of CT and MRI examination. Of the 5 patients with small intestinal epithelioid angiosarcoma, two cases were primary small intestinal epithelioid angiosarcoma and the other three cases were metastatic small intestinal epithelioid angiosarcoma. None of the five patients exhibited metastasis to other solid organs, and no significant ascites or peritoneal metastases. ① In two cases of primary small intestinal epithelioid angiosarcoma, three tumors were identified, appearing as round soft tissue nodules on CT plain scan, primarily growing intraluminally. The CT value for tumors of those two cases on plain scan were 30, 35, 32 HU, respec-tively. During the arterial phase of enhanced CT scan, moderate enhancement was observed for tumors of those two cases, with CT value of 57, 72, 65 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those two cases, with CT value of 76, 86, 88 HU, respectively. During the delayed phase of enhanced CT scan, slightly decreased enhancement was observed for tumors of those two cases, with CT value of 74, 79, 72 HU, showing no significant necrosis or cystic changes within the tumors. ② In three cases of metastatic small intestinal epithelioid angiosarcoma, four tumors were identified with uneven thickening of the intestinal wall appeared on CT plain scan. The CT value for tumors of those three cases on plain scan were 39, 37, 38, 28 HU, respectively. During the arterial phase of enhanced CT scan, mild to moderate enhancement was observed for tumors of those three cases, with CT value of 57, 56, 52, 45 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those three cases, with CT value of 84, 88, 82, 77 HU, respectively. During the delayed phase of enhanced CT scan, further changes of increased or decreased enhancement was observed for tumors of those three cases, with CT value of 95, 78, 72, 70 HU. One case of those three patients had thickened intestinal wall with low signal on T1-weighted imaging, heterogeneous high signal on fat-suppressed T2-weighted imaging, significant high signal on diffusion-weighted imaging and low signal on apparent diffusion coefficient imaging on MRI scan. (2) Surgical conditions and post-operative pathological examination. All five cases underwent complete tumor resection. In two cases of primary epithelioid angiosarcoma with three small intestinal tumor foci, there were two tumors invading the serosa and one tumor invading the submucosa. All three metastatic epithelioid angio-sarcoma cases showed four tumors invasion through the serosa, with one case exhibiting mesenteric lymph node metastasis. Microscopic examination revealed hemorrhagic necrosis on the tumor mucosal surface, with tumor cells located in the submucosa or throughout the intestinal wall, displaying infiltrative growth patterns. The distribution was diffuse, with local networks forming irregularly sized vascular-like structures, containing red blood cells and forming blood sinuses and vascular networks. Tumor cells were arranged in solid sheets, strands, and nests, exhibiting spindle-shaped or epithelioid characteristics, with marked atypia, large nuclei, prominent nucleoli, and mitotic figures. Immunohistochemical analysis showed diffuse strong positivity for CD31, Fli-1, and Vim in all five patients. (3) Follow-up. All five patients were followed up postoperatively for 6(range, 3?48)months. During the follow-up period, four patients succumbed to widespread metastasis. One patient with metastatic small intestinal epithelioid angiosarcoma underwent six cycles of chemotherapy and remained in good condition four years post-surgery.Conclusion:The imaging characteristics of small intestinal epithelioid angiosarcoma include abnormal thickening or masses of the intestinal wall.

Objective:To investigate the current situation and influencing factors of work ability in gynecological cancer patients, so as to provide a reference for occupational rehabilitation management of cancer patients.Methods:A total of 183 gynecological cancer patients who visited the gynecological oncology outpatient department of Women′s Hospital of Nanjing Medical University from November 2022 to March 2023 were selected by the convenience sampling. The General Information Questionnaire, Return-to-Work Self-efficacy Questionnaire, Social Support Rating Scale, the European Organization for Research and Treatment of Cancer Quality of Life Quesionnaire Core 30, Work Ability Index were selected for cross-sectional investigaton. The multiple linear regression analysis was used to explore the influencing factors of work ability in gynecological cancer patients.Results:A total of 189 questionnaires were sent out in this study, and 183 were effectively collected, with an effective recovery rate of 96.83% (183/189). The patients were (44.64 ± 7.06) years old. The scores of the patients were (27.77 ± 7.58) points on Work Ability Index, (4.72 ± 1.14) points on Return-to-Work Self-efficacy Questionnaire, (86.93 ± 23.44) points on Social Support Rating Scale, (79.46 ± 19.53) points on overall health status area and (41.23 ± 27.80) points on the field of fatigue symptoms area of the European Organization for Research and Treatment of Cancer Quality of Life Quesionnaire Core 30. Multiple linear regression analysis showed that fatigue, comorbidities, clinical stage of disease, primary treatment, per capita monthly income of families, return-to-work self efficacy and job nature were independent influencing factors of work ability in gynecological cancer patients ( t values were -10.47-2.86, all P<0.05), which explained 67.9% of the total variance. Conclusions:Clinical medical staff should pay attention to the influencing factors that affect work ability in gynecological cancer patients, in order to take targeted occupational rehabilitation measures to improve their work ability.

Objective To explore the experience of social isolation among caregivers of stroke patients,and to provide corresponding references for the development of targeted intervention strategies.Methods A descriptive qualitative study was used to select 14 caregivers of hospitalized stroke patients attending the Department of Neurology and Neurosurgery of a tertiary-level hospital in Kunming City from September to November 2023 through purposive sampling method,and the data were analyzed using traditional content analysis.Results A total of 3 themes and 10 sub-themes were extracted,including characterization of social alienation(accumulation of negative emotions,limited social contact,dissolution of self-identity),drivers of social alienation(limitations of disease perception,multiple role conflicts,lack of support resources,constraints of caregiving responsibilities),and coping needs for social alienation(craving for informational support,appeal for emotional support,and expectation of policy support).Conclusion Caregivers of stroke patients are socially alienated due to limited social contact,multiple role conflicts,and lack of support resources,etc.Healthcare professionals should conduct regular assessments,provide targeted education and training,and strengthen multidimensional support in order to help them reintegrate into society and improve the overall quality of life of stroke families.

Background and purpose:As one of the first-line treatment methods for differentiated thyroid cancer(DTC),131I treatment is an important therapeutic approach for most patients with medium-high recurrence risk DTC after total or near-total thyroidectomy.Risk stratification and real-time dynamic assessment before 131I treatment after surgery are important steps in deciding on 131I treatment,enabling individualized treatment.This retrospective study aimed to explore the role of diagnostic whole body scan(DxWBS)in the decision-making of treatment for DTC after surgery and before 131I therapy.Methods:DTC patients who underwent pre-ablation evaluation were included.Patients were divided into low,medium and high sTg groups based on their pre-131I treatment stimulated thyroglobulin(sTg)levels(＜1 ng/mL,1 ng/mL≤sTg＜10 ng/mL,sTg≥10 ng/mL).The concordance rates of DxWBS and post treatment whole body scan(RxWBS)in each patient of the whole cohort were compared.The lesion detection rate between DxWBS and RxWBS in different sTg level groups was also explored.The"thyroid stunning effect"by DxWBS was evaluated by RxWBS.Through these analyses,the role of DxWBS in 131I treatment decision-making and its predicting treatment objectives were assessed.This study was approved by the Ethics Committee of Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences(ethics number:JS-2151).Results:A total of 91 patients were included.The low,medium and high sTg groups accounted for 15.4%(14/91),34.1%(31/91)and 50.5%(46/91)of the patients,respectively.Comparison of DxWBS and RxWBS results in the same patients in each sTg group showed no evidence of a stunning effect on 131I treatment.The overall concordance rate between DxWBS and RxWBS was 89.0%(81/91);In different sTg level groups was 100.0%(14/14),90.3%(28/31),84.8%(39/46)respectively.Taking sTg levels into consideration,DxWBS accurately predicted the need for total thyroidectomy,with a 100%(20/20)agreement with RxWBS.Among the 71 patients who received adjuvant therapy and/or remnant ablation due to suspected elevated Tg or high recurrence risk stratification or the iodine-avid metastatic lesions identified by DxWBS,87.5%(63/71)showed only residual thyroid tissue by DxWBS;Through the purpose verification by RxWBS and single photon emission computed tomography(SPECT)/CT,only 12.7%(9/71)of cases were verified as adjuvant or tumoricidal treatment due to iodine-avid cervical lymph node and/or lung metastasis identified by RxWBS,87.3%(62/71)were residual thyroid ablation.In the medium and high sTg group,the overall detection rate of functional cervical lymph node metastasis by DxWBS and RxWBS was 5.5%(5/91).For the detection of functional lung metastases,the overall detection rate of DxWBS was slightly lower than that of RxWBS(3.3%vs 5.5%).This indicates that DxWBS can be used to accurately pre-judge the purposes of 131I treatment,particularly for thyroid ablation and adjuvant therapy.Conclusion:DxWBS did not induce"thyroid stunning"effect.Integrating DxWBS as a theranostic tool into the real-time decision-making and evaluation system of 131I treatment,as well as with sTg and other biochemical indicators,may help to bridge the limitations of static evaluations based on pathology and clinical data,and provides a clear understanding and more precise objectives of 131I treatment.

Objective To explore the experience of social isolation among caregivers of stroke patients,and to provide corresponding references for the development of targeted intervention strategies.Methods A descriptive qualitative study was used to select 14 caregivers of hospitalized stroke patients attending the Department of Neurology and Neurosurgery of a tertiary-level hospital in Kunming City from September to November 2023 through purposive sampling method,and the data were analyzed using traditional content analysis.Results A total of 3 themes and 10 sub-themes were extracted,including characterization of social alienation(accumulation of negative emotions,limited social contact,dissolution of self-identity),drivers of social alienation(limitations of disease perception,multiple role conflicts,lack of support resources,constraints of caregiving responsibilities),and coping needs for social alienation(craving for informational support,appeal for emotional support,and expectation of policy support).Conclusion Caregivers of stroke patients are socially alienated due to limited social contact,multiple role conflicts,and lack of support resources,etc.Healthcare professionals should conduct regular assessments,provide targeted education and training,and strengthen multidimensional support in order to help them reintegrate into society and improve the overall quality of life of stroke families.

With the accelerating global aging process,falls among older adults have emerged as a significant health problem,which not only significantly impacts their quality of life,but also brings a heavy social burden.Cognition-motor dual-task training,an important intervention for preventing falls,can significantly enhance the cognitive and motor functions in older adults.This article reviewed the implementation forms,mechanism and application effects.It aims to provide references for the implementation of cognition-motor dual-task training in older adults.

Objective A scoping review of domestically and internationally published studies on finite element analysis(FEA)based on three-dimensional(3D)human body model in preventing pressure ulcer(PU)was conducted,aiming to provide new directions for improving the prevention strategies of pressure ulcer.Methods We conducted a systematic search in both Chinese and English medical databases,including PubMed,Embase,CINAHL,Web of Science,Cochrane Library,Sinomed,CNKI,Wanfang and VIP,and engineering database(Engineering Village Compen-dex).The search period was from the inception of each database to July 29,2024.The information was extracted,and the results were analyzed and standardized for reporting.Results A total of 30 studies were included.The general methods of FEA based on 3D human body model include establishing geometric model,meshing,defining material properties,loading and setting boundary conditions,and solving equations.According to the contents of studies,they could be categorized into 4 distinct application domains,including identification of risk groups(n=9),position management(n=9),preventive dressings(n=10)and supportive surfaces(n=7).Conclusion FEA based on 3D human body model provides a foundation to PU biomechanical mechanism research and a scientific basis to the supplement and optimization of clinical prevention.Future studies should integrate clinical problems with simulations and further optimize simulations techniques and protocols.

Objective:To investigate the imaging characteristics of small intestinal epithe-lioid angiosarcoma.Methods:The retrospective and descriptive study was conducted. The clinical data of 5 male patients with small intestinal epithelioid angiosarcoma who were admitted to 3 medical centers, including Yantaishan Hospital of Yantai et al, from January 2013 to December 2023 were collected. The age of 5 patients was 54 (range, 36-73)years. All 5 patients underwent computer tomography (CT) plain scan and dynamic contrast-enhanced scan, with 1 patient also undergoing magnetic resonance imaging (MRI) plain scan. Observation indicators: (1) results of CT and MRI examination; (2) surgical conditions and postoperative pathological examination; (3) follow-up. Measurement data with skewed distribution were represented as M(range), and count data were described as absolute numbers. Results:(1) Results of CT and MRI examination. Of the 5 patients with small intestinal epithelioid angiosarcoma, two cases were primary small intestinal epithelioid angiosarcoma and the other three cases were metastatic small intestinal epithelioid angiosarcoma. None of the five patients exhibited metastasis to other solid organs, and no significant ascites or peritoneal metastases. ① In two cases of primary small intestinal epithelioid angiosarcoma, three tumors were identified, appearing as round soft tissue nodules on CT plain scan, primarily growing intraluminally. The CT value for tumors of those two cases on plain scan were 30, 35, 32 HU, respec-tively. During the arterial phase of enhanced CT scan, moderate enhancement was observed for tumors of those two cases, with CT value of 57, 72, 65 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those two cases, with CT value of 76, 86, 88 HU, respectively. During the delayed phase of enhanced CT scan, slightly decreased enhancement was observed for tumors of those two cases, with CT value of 74, 79, 72 HU, showing no significant necrosis or cystic changes within the tumors. ② In three cases of metastatic small intestinal epithelioid angiosarcoma, four tumors were identified with uneven thickening of the intestinal wall appeared on CT plain scan. The CT value for tumors of those three cases on plain scan were 39, 37, 38, 28 HU, respectively. During the arterial phase of enhanced CT scan, mild to moderate enhancement was observed for tumors of those three cases, with CT value of 57, 56, 52, 45 HU, respectively. During the venous phase of enhanced CT scan, significant enhancement was observed for tumors of those three cases, with CT value of 84, 88, 82, 77 HU, respectively. During the delayed phase of enhanced CT scan, further changes of increased or decreased enhancement was observed for tumors of those three cases, with CT value of 95, 78, 72, 70 HU. One case of those three patients had thickened intestinal wall with low signal on T1-weighted imaging, heterogeneous high signal on fat-suppressed T2-weighted imaging, significant high signal on diffusion-weighted imaging and low signal on apparent diffusion coefficient imaging on MRI scan. (2) Surgical conditions and post-operative pathological examination. All five cases underwent complete tumor resection. In two cases of primary epithelioid angiosarcoma with three small intestinal tumor foci, there were two tumors invading the serosa and one tumor invading the submucosa. All three metastatic epithelioid angio-sarcoma cases showed four tumors invasion through the serosa, with one case exhibiting mesenteric lymph node metastasis. Microscopic examination revealed hemorrhagic necrosis on the tumor mucosal surface, with tumor cells located in the submucosa or throughout the intestinal wall, displaying infiltrative growth patterns. The distribution was diffuse, with local networks forming irregularly sized vascular-like structures, containing red blood cells and forming blood sinuses and vascular networks. Tumor cells were arranged in solid sheets, strands, and nests, exhibiting spindle-shaped or epithelioid characteristics, with marked atypia, large nuclei, prominent nucleoli, and mitotic figures. Immunohistochemical analysis showed diffuse strong positivity for CD31, Fli-1, and Vim in all five patients. (3) Follow-up. All five patients were followed up postoperatively for 6(range, 3?48)months. During the follow-up period, four patients succumbed to widespread metastasis. One patient with metastatic small intestinal epithelioid angiosarcoma underwent six cycles of chemotherapy and remained in good condition four years post-surgery.Conclusion:The imaging characteristics of small intestinal epithelioid angiosarcoma include abnormal thickening or masses of the intestinal wall.