This study explores the diagnosis and treatment of needle knife therapy for ankylosing spondylitis (AS) at middle and advanced stage based on the theory of meridian tendons, from a holistic perspective and syndrome differentiation. The treatment strategy includes "harmonizing yin and yang" to address root causes and "tendons-based release" to harmonize qi and blood, with the "tendons nodule points" as the core acupoint selection criterion. Based on this approach, the study systematically elaborates on two needle knife methods for AS: "governor vessel bone-piercing technique" and "below-the-umbilicus release technique", covering indications, acupoint location, and procedures. Clinical case examples are provided to enrich needle knife therapy guided by the theory of meridian tendons, offering insights for clinical and research work on AS.
Humans ; Acupuncture Points ; Acupuncture Therapy/methods* ; Meridians ; Spondylitis, Ankylosing/physiopathology* ; Tendons/physiopathology*

ObjectiveTo mine the medication patterns of Chinese medicines for neurodermatitis based on contemporary medical cases in published articles. MethodThe medical cases of treating neurodermatitis with Chinese medicines were retrieved from the medical case articles published by contemporary famous and old Chinese medicine doctors in the library of Shandong University of Traditional Chinese Medicine， CNKI， VIP， and Wanfang Data. A case library was established， and SPSS Statistics 26.0 and SPSS Modeler 18.0 were employed to analyze the symptoms and syndromes of neurodermatitis and mine the medication patterns. ResultAccording to the inclusion and exclusion criteria， 130 medical case articles were included in this study. Neurodermatitis was prevalent in young adults between 20 and 39 years old （female patients of 30-49 years old and male patients of 20-39 years old）， and male patients were more than female patients. The patients mainly presented the clinical manifestations of itchy rashes， thickened skin， and lichenification. Symptoms included skin injury， emotional abnormalities， and Yin damage caused by prolonged illness. Red tongue， thin white or yellow tongue coating， and wiry pulse were common in the patients. The patients with the syndrome of blood deficiency and wind dryness were often treated with Angelicae Sinensis Radix， Rehmanniae Radix， Glycyrrhizae Radix et Rhizoma， Tribuli Fructus， and Chuanxiong Rhizoma. The commonly used herb pairs included Chuanxiong Rhizoma-Paeoniae Radix Alba， Chuanxiong Rhizoma-Glycyrrhizae Radix et Rhizoma， and Rehmanniae Radix Praeparata-Saposhnikoviae Radix， and the commonly used prescriptions were Siwutang and Dangguiyinzi. The patients with the syndrome of muscle and skin dystrophy were mainly treated with Rehmanniae Radix， Sophorae Flavescentis Radix， Paeoniae Radix Alba， Tribuli Fructus， and Dictamni Cortex. The commonly used herb pairs included Polygoni Multiflori Caulis-Sophorae Flavescentis Radix， Polygoni Multiflori Caulis-Dictamni Cortex， and Salviae Miltiorrhizae Radix et Rhizoma-Paeoniae Radix Alba， and the commonly used prescriptions were Jingjie Siwutang and Baixianpiyin. The patients with the syndrome of liver depression transforming into fire were often treated with Rehmanniae Radix， Gentianae Radix et Rhizoma， Gardeniae Fructus， Bupleuri Radix， and Scutellariae Radix. The commonly used herb pairs included Gentianae Radix et Rhizoma-Polygoni Multiflori Caulis， Polygoni Multiflori Caulis-Gardeniae Fructus， and Gentianae Radix et Rhizoma-Saposhnikoviae Radix， and the commonly used prescriptions were Longdan Xiegantang and Danzhi Xiaoyaosan. ConclusionThis study enriches the knowledge about neurodermatitis， clarifies the treatment principles and methods as well as the medication patterns， and provides a theoretical basis for clinical treatment and medication based on syndrome differentiation.

Background With the events reporting on odors in drinking water, odorous substances in water have become a hot topic in water quality analysis. Due to the low concentration of the odor threshold and the complexity of the odor components in water, it is difficult to make accurate qualitative and quantitative analysis. So it is necessary to develop a highly sensitive and accurate qualitative and quantitative analysis method. Objective To establish a method for simultaneous determination of four odorous substances, including dimethyl disulfide, dimethyl trisulfide, 2-methylisoborneol, and geosmin in water by purge and trap-gas chromatography-tandem mass spectrometry. Methods A certain amount of water sample was stored in the sample vial of a purge and trapinstrument. Through nitrogen purging, the odorous substances in water were purged out and enriched in the trap. Subsequently, the odorous substances were rapidly released at high temperatures after heating the trap, and then carried by carrier gas into gas chromatograph. After temperature programming, the substances were separated by an Agilent DB-624 capillary chromatographic column (30 m×0.25 mm, 1.4 μm) and determined by tandem mass spectrometry in multiple reaction monitoring modes, with internal standard method for quantification. The current project optimized purge time, sodium chloride concentration in water sample, desorption temperature, desorption time, and split ratio during the experimental process. Under the optimized experimental conditions, the standard curve, detection limit, and quantification limit were validated. Recovery tests with spiking concentrations of 5.0, 10.0, 30.0, 80.0 ng·L⁻¹ and precision tests were conducted on water samples. Finally, the established method was applied to detect odorous substances in source water, finished water, and pipeline water in Deqing County of Huzhou City. Result After the optimization, the purge time was 20 min, the desorption temperature was 280 ℃, the desorption time was 2 min, the split ratio was 10∶1, and no sodium chloride was added during the purge process. Under the optimized experimental conditions, the calibration curves for the four odorous substances showed an excellent linearity in the range of 1 to 100 ng·L⁻¹ (R>0.999), with 0.3 ng·L⁻¹ limit of detection and 1.0 ng·L⁻¹ limit of quantitation. The average recoveries were from 85.5% to 102.4% and relative standard deviations (RSD) from 1.6% to 5.2%. After applying this method to detect local source water, finished water, and pipeline water, it was found that the positive rates of 2-methylisoborneo, and geosmin were relatively high, while the positive rates of dimethyl disulfide and dimethyl trisulfide were relatively low. Only one sample of source water tested positive for dimethyl disulfide, and all samples were negative for dimethyl trisulfide. Conclusion Combined with the superiority of purge and trap and tandem mass spectrometry, the method has the advantages of easy to perform, strong anti-interference ability, good accuracy and precision, which meet the limit requirements of the four odorous substances in the expanded indices and reference indices of Hygienic standards for drinking water (GB 5749-2022). It also provides technical support for water quality assessment and analysis of odorous substances.

Ankylosing spondylitis(AS)is a chronic inflammatory autoimmune disease characterized by inflammatory back pain.Its pathological features mainly include inflammation,bone destruction,and pathologic new bone formation.The etiology of AS is complex,and it may be related to genetics,infections,the environment,and intestinal flora.Its pathogenesis has not yet been clarified.In recent years,osteoimmunology,as a new theme in the study of inflammatory arthritis,plays an important role in the pathogenesis and development of AS,which was embodied in the inflammatory response and imbalance of bone metabolism.Traditional Chinese medicine(TCM)has the characteristics of multiple pathways,multiple components,multiple targets and multiple levels.TCM can improve the inflammatory response and bone metabolism imbalance of AS by regulating the osteoblasts of the skeletal system and the related factors of the immune system,thus to prevent and control AS.For this reason,the paper summarizes the role of bone immunology in the pathogenesis of AS,and reviews the current status of research on the intervention of TCM in bone immunology for the treatment of AS,with a view to providing certain references for the future clinical application of TCM in the prevention and treatment of AS.

Aim To explore the application value of a predictive model constructed based on superb microvascu-lar imaging(SMI)blood flow grading indicators and serological indicators in evaluating the risk of carotid plaque shedding.Methods A total of 122 patients diagnosed with carotid plaque in Lishui Central Hospital from February 2019 to February 2021 were selected.SMI was used to observe the blood flow grading and plaque characteristics in carotid plaque,and baseline clinical data of the patients were recorded.All patients were followed up for a period of 2 years,with the occur-rence of transient ischemic attack(TIA)or acute ischemic stroke(AIS)as the endpoint event,and were divided into plaque shedding group and non-shedding group.Clinical data of the two groups were compared and analyzed,and multiple regression analysis was conducted to identify the relevant factors affecting carotid plaque shedding.According to the SMI ultrasound characteristics and serological indicators,R software was adopted to establish the nomogram model and evaluate effectiveness of the model.Results During the 2-year follow-up period,21 TIA cases and 14 AIS cases were found in the remaining 112 patients excluding 10 lost to follow up.The SMI blood flow grading,neutrophil to lymphocyte ratio(NLR),matrix metalloproteinase-9(MMP-9),and low density lipoprotein cholesterol(LDLC)levels in the plaque shedding group were higher than those in the non-shedding group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that SMI blood flow grade 3(OR=38.095),LDLC(OR=19.730),NLR(OR=34.525)and MMP-9(OR=1.225)were independent risk factors for carotid plaque shedding(P＜0.05).The R software established a column chart model and applied it to the ROC curve analysis.The AUC of the col-umn chart model in early prediction of plaque shedding was 0.917,with a sensitivity of 82.86％and a specificity of 90.91％.Conclusion The predictive model constructed by combining blood flow grading within carotid artery plaques and serological indicators through SMI can provide early warning of plaque shedding and guide clinical early intervention to reduce the risk of TIA and AIS.

Objective:To observe the application effect of outcome-based education (OBE) concept on the teaching of otorhinolaryngology nursing.Methods:A total of 97 nursing interns from the Department of Otorhinolaryngology in The Second Affiliated Hospital of Army Medical University were selected as the research objects. Among them, 46 ones from March 2017 to February 2019 were collected as the control group, and 51 ones from March 2019 to February 2021 as the observation group. The control group adopted traditional nursing clinical teaching, and the observation group adopted the nursing clinical teaching based on the OBE concept. All the nursing students had an internship for 3 weeks, and had an evaluation in terms of the clinical communication ability of the two groups of nursing students when they leave the department (the nursing students' clinical communication ability assessment scale), the daily life problem solving ability (simplified Chinese version of the daily life problem solving questionnaire), theoretical and operational assessment results, and the internship satisfaction (nursing student internship satisfaction scale). SPSS 19.0 was used for independent-sample t test. Results:When leaving the department, the observation group's clinical communication ability scores were significantly higher than those of the control group in such dimensions as establishing a harmonious relationship, keen listening, confirming patient problems, participating together, transmitting effective information, and verifying feelings ( P<0.05). The scores of simplified Chinese version of the daily life problem solving questionnaire of rational problem solving and positive problem orientation of the observation group were significantly higher than those of the control group ( P<0.05), while the scores of negative problem orientation, avoidance style and impulsivity/carelessness style were significantly lower than those of the control group ( P<0.05). The scores of theoretical and operational evaluations of the observation group were significantly higher than those of the control group ( P<0.05). The practice satisfaction scores on each dimension of the observation group, including clinical teaching, classroom teaching, and internship plan, support and resources were significantly higher than those of the control group ( P<0.05). Conclusion:The OBE concept applied in the teaching of otorhinolaryngology nursing can enhance the clinical communication ability and daily life problem-solving ability of nursing students, increase the theoretical and operational assessment results, and improve the satisfaction of internship.

Alzheimer's disease (AD) is the most common form of dementia in the elderly, and there is no specific treatment to stop or reverse its progression. Mild cognitive impairment (MCI) is an important entry point for early diagnosis and prevention of AD. More and more studies have explored the risk factors and biomarkers for conversion from MCI to AD, and a series of risk prediction models have been established. This article analyzes and summarizes the different predictors and risk prediction models so as to provide basis for early identifying the high-risk group of AD, managing the controllable risk factors, and providing references for the selection and improvement of these models.

Objective: To investigate the clinical effect of percutaneous transhepatic bile duct drainage guided by ultrasound. Methods: From June 2016 to June 2018, 100 patients with obstructive jaundice in Lishui Central Hospital were treated with ultrasound-guided percutaneous transhepatic bile duct drainage.The success rate and postoperative complications of the patients were analyzed. Results: Among 100 cases, 98 cases were successful, 2 cases failed, and the failure rate was 2%.The success rate of one-time catheterization in 0.5-2.0 cm patients with intrahepatic bile duct diameter(98.91%) was significantly higher than that in intrahepatic bile duct diameter 0.3-0.4 cm patients(87.50%), compared with two different diameter puncture catheterization, the difference was statistically significant(χ²=12.369, P<0.05). All 98 cases with successful puncture were followed up after operation (P<0.05), and there was no statistically significant difference between the two groups(P<0.05). The drainage tube was removed in 2 cases, bile duct infection was found in 2 cases, the remaining patients were unobstructed, and there were no obvious complications. Conclusion Ultrasound-guided percutaneous transhepatic catheterization and drainage for the treatment of obstructive jaundice caused by malignant tumor is simple, reliable, safe and effective, and has a certain clinical value.It is worthy of popularizing and application.

Objective To compare the diagnostic value of ultrasound,molybdenum target,magnetic resonance(MRI)and single examination for breast cancer.Methods From January 2017 to February 2018,100 patients with suspected breast cancer in Lishui Central Hospital were selected in the study.All patients were detected by ultrasound,mammography and MRI three ways for diagnosis.The results were verified with postoperative pathologic results as the standard.The diagnosis accuracy of three ways for breast cancer were analyzed.Results The detection accuracy of three ways joint detection in patients with breast cancer was the highest(91.00％),which was significantly higher than that of ultrasound(63.00％),mammography(72.00％)and MRI(72.00％)in single mode,the differences were statistically significant(χ2 =22.364,20.154,16.032,all P<0.05).Conclusion Ultrasonography,molybdenum target X ray and MRI have their respective advantages in the process of breast cancer differentiation and diagnosis,and the detection rate can be significantly improved if combined use.

Objective:To analyze the dosage distribution and the frequency of each dosage of high-risk tablets in the hospitalized patients in a children's hospital,and study whether the existing specifications of high-risk tablets meet the pediatrics clinical needs. Methods:All the prescriptions including high risk tablets were analyzed from 2014 to 2016 in Shanghai children's medical center. The frequency of every dosage of every drug was analyzed,and the current specifications were judged according to the frequency. New specifications were proposed when the existing specifications did not match the clinical needs. The new frequency of the proposed speci-fications was re-accounted for all the three-year prescriptions in order to evaluate whether the proposed new specifications met the clini-cal needs. Results:Among the five kinds of high-risk oral tablets,methotrexate tablets and vitamin A acid tablets were in accordance with the actual clinical requirements. Mercaptopurine tablets should add two specifications including 12.5 mg and 17 mg,and warfarin sodium tablets should add one specification(1.25 mg). Hydroxyurea tablets(250 mg) and warfarin sodium tablets(1 mg) were rec-ommended used in the children's hospital. Conclusion:The existing specifications of high-risk oral tablets can't fully meet the clini-cal needs,therefore,specifications still needs to be adjusted.