Guided by ZHANG Jiebin's "water-fire of life gate theory"， this paper explored the etiology， pathoge-nesis， and syndrome differentiation-based treatment approach for esophageal cancer. It is proposed that the core pathogenesis of esophageal cancer， derived from the imbalanced state of water and fire in life gate， can be summarized into three manifestations. Firstly， decline of life gate fire leads to failure of qi transformation and accumulation of phlegm and blood stasis； secondly， fire fails to warm the earth resulting in dysfunctional ascending and descending， and qi stagnation and blood stasis； thirdly， deficiency of life gate water contributs to proliferation of cancerous toxins and physical deterioration. In terms of treatment， guided by ZHANG's treatment principles for dysphagia， three treatment methods are proposed， warming and tonifying kidney yang to promote qi transformation through steaming action， warming and nourishing the spleen and stomach to restore central pivot movement， and nourishing kidney water to replenish essence and blood， then support bodily nourishment. Clinical case examples are provided to illustrate the application of these methods.

[Objective]To explore the connotation of neo-Confucianism in ZHU Danxi medicine.[Methods]Combining the research methods of medicine and philosophy,based on ZHU Danxi's medical writings and related knowledge of neo-Confucianism,the connotation of neo-Confucianism of Danxi medicine was discussed from three aspects:"cognition view""sports view""cultivation view".[Results]ZHU Danxi was influenced by the thought of"one principle and different justics"and regarded medicine as the way to practice Confucian ideal.Using the understanding method of"thinking phyics",ZHU Danxi put forward some important medical theories such as"the theory of excess of Yang and deficiency of Yin"and"the theory of fire".Based on the concept of"movement was the heart of heaven and earth",the important significance of Qi movement and constant movement of"Xiang fire"to human life was realized.Based on the sports concept of"extreme things must be reversed"and"the gentleman should be careful to move",the author realized the great harm to the human body caused by the rash movement of"fire"and advocated the idea of"careful movement"for health preservation.Based on the cultivation view of"heart regulating temperament",the author put forward"king fire mastering prime minister fire",emphasized the active role of"heart"of"king fire",cultivated the"nature"of morality,controlled the"emotion"of desire,and maintained the constant movement of"corresponding fire"and supplemented life.Applying the cultivation view of"mastering static without desire"to health but disease required that through tempering appetite and lust,people's natural desires conformed to the Confucian"reason",in order to be no severely ill and spend the whole life.[Conclusion]ZHU Danxi's medical science is rich in connotation,which is a powerful witness of the influence of the reform of Confucianism on medical innovation in Song and Yuan Dynasties.On the one hand,Danxi's"aid theory into medicine"built a strong support for medical innovation,and made his medical theory rise to the height of"heaven theory",so that he was convinced in the Jinyuan period of medical contention;On the other hand,it also demonstrated the all-encompassing universality and supreme authority of"heavenly principles"as cosmic laws.

Objective:To explore the value of clinical and biparametric magnetic resonance imaging(bpMRI)in diagnosing extraprostatic ex-tension(EPE)of prostate cancer(PCa).Methods:This retrospective study assigned 107 patients into EPE(n=42)and organ-limited(n=65)groups based on their postoperative pathology after radical prostatectomy from August 2018 to May 2024 at Wuhu Second People's Hospit-al.The differences in the following clinical risk indicators were compared between the groups:age,total prostate specific antigen(tPSA),pro-state volume,prostate specific antigen density(PSAD)and International Society of Urological Pathology(ISUP)score for prostate puncture.The differences in MRI indicators,prostate imaging reporting and data system(PI-RADS)score and bpMRI were also identified.Binary Logist-ic regression analysis was used to construct clinical and joint models for diagnosing EPE,and screening independent influencing factors.The ROC curve analyze the independent influencing factors and diagnostic performance of the models.The DeLong test was used to compare the differences between the AUC models.A nomogram was draw,and performance evaluated.Results:The differences in tPSA,PSAD,ISUP score for prostate puncture,PI-RADS score,and bpMRI were statistically significant between the two groups(P<0.05).The clinical model AUC was 0.821;while the AUCs of the combined model and independent influencing factors PSAD(OR=25.992),ISUP score for prostate puncture(OR=1.676),and bpMRI(OR=10.729)were 0.899,0.813,0.770,and 0.793 respectively(P<0.001).The combined model was superior to the clinical model(Z=2.502 and P=0.012).The average AUC for 5-fold cross-validation was 0.887,with high model calibration and a threshold range of 5%-85%,indicating clinical benefits.Conclusions:The combined model nomogram derived from clinical and bpMRI indicators is highiy valuable for diagnosing PCa EPE.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

[Objective]To explore the application and value of Confucius'"Daoyi"(Tao-skill)educational thought in Medical Ancient Texts course.[Methods]This paper uses the research method of philology,studies the ancient and modern related books of"Daoyi"thought combines the experience of teaching reform of Medical Ancient Texts course,puts forward a new classification of teaching objectives,applied in Medical Ancient Texts course,and summarizes the application value.[Results]"Daoyi"thought materializes into four-level teaching objectives:"Yi,Ren,De and Dao"(skill,kind,morality and Tao).In Medical Ancient Texts course,the Yi objective is to master the reading skills starting from Chinese characters;the Ren objective is to cultivate social personality of loving people;the De objective is to cultivate the inner personality of morality and self-cultivation;and the Dao objective is to establish the thinking of exploring medical path.Using traditional learning methods can help to improve the reading ability of ancient books and establish traditional Chinese medicine philosophical thinking.[Conclusion]"Daoyi"thought combines skills,ideology and high-level teaching objectives,establishes philosophical thinking of seeking Dao.So it is worth further application and research.

Objective:To analyze the effect of meteorological conditions on mortality and population susceptibility of patients with acute myocardial infarction (AMI) in the Shantou area and to provide a scientific basis for the local public health system to prevent AMI.Methods:The AMI mortality data recorded in the resident cause of death surveillance database of Shantou from January 1, 2015, to December 31, 2020, were collected and the distribution lag nonlinear model was used to analyze the diurnal temperature range (DTR) and relative humidity (RH) on AMI mortality and the lag effect.Results:There were 13 932 deaths due to AMI in Shantou during the study period, with a male-to-female sex ratio of 1.3∶1. There was a significant association between high diurnal temperature difference exposure and low RH exposure and AMI deaths, with both single-day lag effects appearing and reaching a maximum at lag 2 day ( RR=1.019, 95% CI: 1.000-1.039; RR=1.018, 95% CI: 1.003-1.034); the cumulative lag effect was all maximal at lag 0-14 day ( RR=1.199, 95% CI: 1.025-1.401; RR=1.279, 95% CI: 1.117-1.465). The elderly (≥75 years) and female populations were susceptible to high DTR exposure and low RH exposure conditions. Conclusions:There was a significant association between DTR and RH and mortality of AMI in Shantou with a significant lag in their effects. Both female and elderly populations ≥75 years old were susceptible populations under high DTR and low RH exposure conditions.

Objective: To improve the social skills of children with ASD by using Program for the Education and Enrichment of Relational Skills(PEERS ), and to reduce the uncertainty towards ASD and negative emotions for mothers of ASD children. Methods: From September to October 2017, 30 dyads of autistic mother and child were recruited and divided into intervention group and control group (15 mother child dyads each). Based on the content of PEERS social skill, cognitive behavior therapy was delivered in group format, through demonstration, role play and group exercise. At the same time, mother child dyads were trained using parallel social technology. Mothers and children with ASD were investigated using Parents Perception of Uncertainty Scale (PPUS), Patient Health Questionnaire 9 (PHQ-9), Chinese Version of the Beck Depression Inventory II(BDI-Ⅱ-C), Beck Anxiety Inventory (BAI), State Trait Anxiety Inventory(STAI-Form Y), and Autism Behavior Checklist (ABC), Cildhood Autism Rating Scale (CARS), and Social Communication Questionnaire (SCQ). Results: Changes in ASD symptom score in children and emotional score of mothers in the intervention group were less than 0. The total score of mother disease uncertainty(74.93±13.58, 90.40± 9.21 ), ambiguity(31.13±7.07, 38.93±4.73), lack of clarity information(11.93±2.09, 13.80±2.54), unpredictability(9.60±1.99, 12.07±2.89), significantly changed after intervention( t =-3.65, -3.55, -2.20, -2.72, P <0.05). Conclusion Social PEERS group intervention can enhance the social skills of children with ASD, reduce uncertainty of illness among mother of ASD children. Timely disease related information, guidance for mothers to actively participate in child care and training, might help to reduce cognitive bias, depressive and anxiety symptoms among mothers.

OBJECTIVETo assess the accuracy of detection by automated breast volume scanner (ABVS) in diagnosis of high-risk and small breast lesions.

METHODSOne hundred and twelve patients with solid high-risk and small breast lesions were identified by ABVS. The patients were divided into benign lesion group and cancer group after pathological examination. The clinicopathological findings and ultrasonographic features of the lesions were compared.

RESULTSAmong the 112 lesions there were 49 benign and 63 malignant lesions. The mean size on ABVS and pathology were (1.59 ± 0.52) cm and (1.52 ± 0.58) cm. There was no significant difference in tumor sizes determined by ABVS and pathology (P = 0.194). The mean age of patients with benign lesions was (38.5 ± 7.4) years and that of malignant lesions was (52.4 ± 13.6) years, showing a significant difference between the two groups (P < 0.001) . The mass shape, orientation, margin, lesion boundary, echo pattern, calcification, BI-RADS category and retraction phenomenon were significantly different of the malignant and benign masses (P < 0.05). But there was no significant difference in the location of lesions and posterior acoustic features (P > 0.05) . Retraction phenomenon was significantly associated with pathological type and histologic grade of the breast cancer (P < 0.01). The specificity, sensitivity and accuracy of retraction phenomenon were 100% (46/46), 73.0% (46/63), and 84.8% (95/112), respectively.

CONCLUSIONSABVS provides advantages of better size prediction of high-risk and small breast lesions. Furthermore, the retraction phenomenon in coronal plane shows high specificity and sensitivity in detecting breast cancer.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Breast Neoplasms ; diagnostic imaging ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; pathology ; Female ; Fibroadenoma ; diagnostic imaging ; pathology ; Humans ; Image Enhancement ; methods ; Image Interpretation, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; methods ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Tumor Burden ; Ultrasonography, Mammary ; methods ; Young Adult

OBJECTIVETo compare the effectiveness and accuracy of the use of vacuum-assisted biopsy (VAB) versus wire localization (WL) in the diagnosis of non-palpable breast lesions (NPBL).

METHODSNinety-seven consecutive women with NPBL were randomized into VAB group and WL group. All specimens were identified by mammography. The patients were requested to score the cosmetic appearance of their breast after operation, and a numerical rating scale was used to measure pain on the first postoperative day. Underestimation rates for atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) were recorded if open surgical biopsy revealed DCIS and invasive cancer, respectively. Clear margins were also recorded in the two groups.

RESULTSVAB and WL located all the NPBL successfully. In the VAB group, the specimen volume was smaller than that of the WL group (2.3 cm(3) vs. 18.4 cm(3), P = 0.03). Underestimation rates of ADH and DCIS in the VAB group were 16.7% and 11.1%, respectively. The diagnostic accordance rate of VAB was 97.9%, the false negative rate was 2.1%, and there was no false positive case. The means of the numerical rating pain scale were different in both groups (1.7 for VAB vs. 2.5 for WL, P = 0.02). When cosmetic results were taken into account, 40 VAB patients had excellent outcomes and 8 good outcomes, compared with 25 excellent and 24 good for the WL group. There were better cosmetic outcomes with the VAB procedure (P < 0.05).

CONCLUSIONVAB is highly reliable and may avoid diagnostic open surgery in the majority of patients with benign lesions. However, because of the underestimation of histologic diagnosis and tumor margin involvement, VAB can not be used to completely substitute wire localization.

Adult ; Biopsy, Needle ; instrumentation ; methods ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; pathology ; Carcinoma in Situ ; diagnosis ; pathology ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Diagnostic Errors ; Female ; Fibroadenoma ; diagnosis ; pathology ; Humans ; Hyperplasia ; Middle Aged ; Precancerous Conditions ; diagnosis ; pathology ; Stereotaxic Techniques ; instrumentation ; Vacuum

From Prof. He’s growth road, academic thought and clinical experiences, it makes primary arrangement and research on He’s academic achievements, by summarizing: 1.emphasis on basis; 2.abide by “Golden Chamber”; 3.combine all famous TCM scientists’ doctrines, on academic thoughts; and differentiation and treatment of wet pestilence, metrorrhagia and metrostaxis, and tumor are provided as cases on clinical experience.