Endocrine therapy is mainly used as preoperative neoadjuvant therapy and postoperative adjuvant therapy for breast cancer patients and as salvage therapy for advanced breast cancer patients.Osteoporosis is the common adverse reaction of endocrine therapy for breast cancer,which seriously affects the quality of life of the patients.The theory of"liver and kidney sharing the common source"is closely related to the etiology,pathogenesis and therapeutic principle of osteoporosis.It is believed that the pathogenesis of endocrine therapy associated osteoporosis in breast cancer is most closely related to liver and kidney,and is characterized by deficiency in origin and excess in superficiality.Deficiency in origin manifests as deficiency of liver and kidney,and excess in superficiality manifests as blood stasis blocking collaterals.Chinese herbal medicine with the actions of nourishing liver and kidney can be used for interventions of various stages of endocrine therapy for breast cancer.In the stage of preoperative neoadjuvant therapy,Chinese herbal medicine intervention focuses on inhibiting cancer,so as to achieve synergistic anticancer actions with neoadjuvant therapy;the intervention can also be supplemented by medicine for supporting healthy qi with modified Liuwei Dihuang Pills,thus to reduce the incidence of adverse reactions.In the stage of postoperative adjuvant therapy,Chinese herbal medicine intervention focuses on supporting healthy qi,so as to promote the recovery of body functions and prevent the occurrence of osteoporosis,and modified treatment with Duhuo Jisheng Decoction or Zuogui Pills can be chosen.In the advanced stage of salvage treatment,Chinese herbal medicine intervention focuses on supporting healthy qi,and medicines for nourishing liver and kidney,strengthening muscles and bones,and activating qi and blood circulation to relieve pain can be chosen;in addition,medicinals with affinity to flesh and blood can be added to enhance the actions of nourishing liver and kidney.

In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.

Objective To investigate whether chemokine CCL2(also known as monocyte chemotactic protein 1 or MCP-1)has a causal relationship with lung cancer.Methods Genetic data of chemokine CCL2 and different pathological subtypes of lung cancer were extracted from genome-wide association studies(GWAS),and inverse-variance weighted(IVW)analysis was used as main analysis,while weighted median,simple model,MR-Egger regression,and weighted model were chosen as supplementary analyses.Sensitivity analyses were performed to verify the reliability of the data.Results The result of IVW analysis on chemokine CCL2 to lung adenocarcinoma was OR = 1.065,95%CI(0.919～1.234),P = 0.401.The result of IVW analysis on chemokine CCL2 to squamous cell lung carcinoma was OR = 1.059,95%CI(0.931～1.205),P = 0.381.The result of IVW analysis on chemokine CCL2 to small cell lung carcinoma was OR = 0.959,95%CI(0.760～1.208),P = 0.720.Conclusions There is no direct causal relationship between chemokine CCL2 and lung cancer.

Discipline construction is the power source to realize the high quality development of public hospitals,and high quality scientific research management is the inevitable path to realize the connotative development of public hospitals.The quality improvement of scientific research project process management is step-by-step,and mid-term inspection is a representative work.This paper applies PDCA cycle theory to the mid-term inspection of scientific research projects,analyzes the problems encountered in the mid-term inspection of scientific research projects from the four stages of plan,implementation,check and act,and develops effective intervention measures.The mid-term inspection mode,which combines publicity activities of scientific research norms with self-examination by researchers and on-the-spot inspection by the scientific research department,should be carried out to standardize the process of mid-term inspection of scientific research projects and promote the high-quality development of scientific research in hospitals.

Objective To investigate the clinical value of fiber nasopharyngoscope applied in adenoid hypertrophy(AH)combined with allergic rhinitis(AR)in children.Methods Clinical data of 174 pediatric patients from January 2021 to March 2024 was collected and analyzed.Among them,129 cases were diagnosed with AH via fiber nasopharyngoscope examination(79 cases with AR were assigned to the AH with AR group,the remaining 50 cases of simple AH without AR were assigned to the AH group),and 45 cases of simple AR without AH through fiber nasopharyngoscope examination were assigned to the AR group.And 25 healthy children who came to our pediatric health department for health examinations during the same period were selected as the healthy control(HC)group.On the day of admission,all subjects underwent lateral X-ray examination of the nasopharynx,and the ratio of the maximum thickness of adenoids to the anterior posterior diameter of the nasopharynx cavity(A/N ratio)was calculated.Meanwhile their of peripheral blood eosinophil(EOS)percentage,serum interleukin-17(IL-17),and tumor necrosis factor-α(TNF-α)levels were tested.The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-α levels were compared among the AH with AR group,AH group,AR group,and HC group.The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-α levels of children with different degrees of adenoid obstruction under fiber nasopharyngoscope were compared in AH and AR group.Spearman correlation coefficient was used to analyze the correlation between the degree of adenoid obstruction under fiber nasopharyngoscope and the levels of peripheral blood EOS percentage,serum IL-17 and TNF-α in children from AH and AR group.Result A/N ratio:the value in AH with AR group was higher than that in AH group(P＜0.05),the value in AH group was higher than that in AR group(P＜0.05),and the value in AR group was higher than that in HC group(P＜0.05).Peripheral blood EOS percentage,serum IL-17 and TNF-α levels:AH with AR group had higher levels than those in AR group(P＜0.05),AR group had higher levels than those in AH group(P＜0.05),and AH group had higher levels than those in HC group(P＜0.05).The A/N ratio,peripheral blood EOS percentage,serum IL-17 and TNF-α levels in children with adenoid obstruction degree Ⅲ～Ⅳ under fiber nasopharyngoscope in the AH group were significantly higher than those in children with degree Ⅰ～Ⅱ(P＜0.05).Spearman correlation analysis showed that the degree of adenoid obstruction under fiber nasopharyngoscope in children with AH accompanied by AR significantly positively correlated with peripheral blood EOS percentage,serum IL-17 and TNF-α levels(r values were 0.527,0.451,and 0.402 respectively,P＜0.05).Conclusion Fiber nasopharyngoscope can be used for the diagnosis of AH with AR in children,and can be positive in determining severity of the patient's condition when combined with peripheral blood EOS percentage,serum IL-17 and TNF-α levels.

The discussion and research on the clinical dominant diseases of traditional Chinese medicine （TCM） have attracted increasing attention. Through approaches including modern technology， evidence-based medical methods， and multi-disciplinary treatment， we should construct a sound TCM inheritance and innovation system， establish a collaborative innovation mechanism， and integrate major research projects， striving to make breakthroughs in TCM theory， methodology， standards， and regulation system， promoting the scientific and technological progress of TCM， and thereby improving its curative effect. The China Association of Chinese Medicine （CACM） carried out a series of youth salon seminars for clinical dominant diseases in TCM， discussing and sorting out the advantages of the dominant diseases in clinical diagnosis and treatment of TCM and integrated traditional Chinese and western medicine in specific diseases or fields. Authoritative experts in the industry were invited to give comment and guidance to form a report. Centering on clinical research of dominant diseases， thematic research was carried out in the aspects of practice， human experience-based evidence， and transformation path. Through the systematic study of the dominant diseases， the advantages of TCM in different stages of disease treatment were excavated to constantly improve the prevention and treatment ability of TCM and carry forward the advancement of TCM theory and practice. At the same time， the communication and understanding between traditional Chinese and western medicine were improved， laying the foundation for the further formation of industry guidelines or consensus and comprehensive promotion. These seminars are expected to provide references for the development of policy planning， clinical diagnosis and treatment， health economy， and social services in TCM and lay the foundation for the formation of a new modern diagnosis and treatment system with Chinese characteristics.

ObjectiveTo observe the effect of the Fangfeng Tongshengsan on post-chemoembolization syndrome with primary liver cancer or postoperative liver metastases of colorectal cancer. MethodSeventy-two patients suffered from post-chemoembolization syndrome after transcatheter hepatic arterial chemoembolization were randomly divided into 2 groups， including a Fangfeng Tongshengsan group and a control group， with 36 patients in each group. The patients in Fangfeng Tongshengsan group orally took the decoction for consecutive 7 d. The patients in the control group were physically cooled down with alcohol rub bath and ice pack for consecutive 7 d. Furthermore， the difference of fever， Karnofsky performance status （KPS）， pain in the liver region， nausea vomiting， constipation， and liver function between these two groups were observed. ResultCompared with the control group， Fangfeng Tongshengsan significantly relieved fever， reduced the body temperature （P<0.05）， and shortened the duration of fever （P<0.05）， indicating that Fangfeng Tongshengsan remarkably improved the KPS （P<0.05）. Meanwhile， Fangfeng Tongshengsan obviously alleviated nausea， vomiting， and constipation status and shortened the duration time compared with the control group （P<0.05）. In addition， the parameters of liver function including alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， γ-glutamyl transpeptidase （GGT）， and total bilirubin （TBIL） were significantly decreased in the Fangfeng Tongshengsan group （P<0.05）， which indicated that Fangfeng Tongshengsan alleviated liver dysfunction of patients with post-chemoembolization syndrome. ConclusionFangfeng Tongshengsan can be used to treat post-chemoembolization syndrome with primary liver cancer and postoperative liver metastases of colorectal cancer.

Objective To clarify the distribution of etiological factors in elderly versus non-elderly outpatients with vertigo/dizziness for optimizing the diagnosis and therapy. Methods We retrospectively analyzed data of outpatients with vertigo/dizziness in Shaanxi Provincial People's Hospital from April 2015 to April 2017 and conducted diagnoses in accordance with the currently wide-accepted diagnostic criteria. Results A total of 3 356 patients with chief complains of vertigo/dizziness were recruited ,and their top seven etiological factors were benign paroxysmal positional vertigo (n＝ 1 320 ,39.3%) ,chronic subjective dizziness(n＝680 ,20.3%) ,vestibular migraine(n＝386 ,11.5%) ,posterior circulation ischemia (n＝213 ,6.4%) ,Meniere's disease (n ＝ 138 ,4.1%) ,vestibular neuritis (n＝ 121 ,3.6%) ,and vestibular paroxysmia(n＝76 ,2.3%). The top four etiological factors for the elderly patients (n＝1 255)were benign paroxysmal positional vertigo (n＝ 498 ,39.7%) ,chronic subjective dizziness (n＝ 279 ,22.2%) ,posterior circulation ischemia(n＝161 ,12.8%) ,and vestibular migraine(n＝73 ,5.8%) ;while the top four etiological factors for non-elderly patients (n＝ 2 101)were benign paroxysmal positional vertigo (n＝ 822 ,39.1%) , chronic subjective dizziness(n＝401 ,19.1%) ,vestibular migraine(n＝313 ,14.9%) ,and vestibular neuritis(n＝105 ,5.0%). The detection rate in elderly patients versus non-elderly patients was significantly higher in chronic subjective dizziness (22.2% vs.19.1%,P＝ 0.032 )and in posterior circulation ischemia (12.8%vs.2.5%,P＝0.000) ,and was significantly lower in vestibular neuritis (1.3% vs.5.0%,P＝ 0.000 ) ,in vestibular migraine(5.8% vs.19.4%,P ＝ 0.000)and in other causes (1.0% vs.2.7%,P ＝ 0.002) . Conclusions The ratio of posterior circulation ischemia is markedly higher in elderly outpatients than in non-elderly outpatients ,whereas the ratios of vestibular migraine and vestibular neuritis in elderly patients are lower than in non-elderly outpatients.

Objective To investigate the clinical value of re-using ultrafiltrated and concentrated ascites fluid for refractory ascites in patients with hepatitis B cirrhosis. Methods A retrospective study was conducted, one hundred and thirteen patients with intractable ascites (all patients received intraperitoneal reinfusion of ultrafiltrated and concentrated ascites fluid therapy) admitted to the Department of Gastroenterology of No.254 Hospital of the Chinese People's Liberation Army from December 2013 to November 2016 were enrolled and assigned as the study group, fifty-two patients with intractable ascites admitted in the same period as above group in this hospital without undergoing above ascites fluid reinsfusion were served as the control group. Both groups were given conventional therapies, including measures for hepatoprotection, increase of plasma osmotic pressure, correction of hypoproteinemia (intravenous injection albumin 10 g, 3 times a week), reduction of portal venous pressure (octreotide 0.2 mg, q8 h), improvement of microcirculation, correction of water and electrolyte balance disorders, diuresis (furosemide 100 mg/d), etc. On the basis of the above conventional treatment, the system with ascites ultrafiltration, concentration and reinfusion into abdominal cavity was applied to carry out the concentrated ascites fluid reinfusion therapy in the study group. The relieve of abdominal bloating, conscious, blood pressure, 24-hour urine output, endogenous creatinine clearance rate (CCr), serum potassium ion (K+), serum sodium ion (Na+), ascites albumin quantity, serum albumin levels before treatment and after treatment for 1 week, abdominal infection situation after treatment for 1 week were observed in the study group. The difference in incidence of abdominal infection between the study group and control group (at the end of 12 weeks after treatment) was compared. Results In the study group, after treatment, the patients with abdominal bloating had different degrees of relief, 24-hour urine output was increased compared with that before treatment (mL: 1291.3±123.4 vs. 1265.0±61.5, P = 0.051), no cases with conscious changes, blood pressure instable. There were no statistical significant difference in blood K+ and Na+ (P > 0.05). And ascites albumin concentration was increased compared with before treatment (g/L: 19.1±2.9 vs. 17.2±4.1, P = 0.000); 1 week after treatment, CCr was significantly higher than that before treatment (μmol/L: 71.2±8.7 vs. 56.1±5.4, P = 0.000); serum albumin was increased after 3 times of treatment in 1 week (g/L: 25.7±4.4 vs. 24.6±3.0), but the difference was not statistically significant (P = 0.054). No abdominal infection occurred within 1 week after treatment were observed in patients of study group. There was no statistical significant difference in the incidence of abdominal infection between the study group and control group in 12 weeks after treatment [9.7% (11/113) vs. 13.6% (7/52), P = 0.476]. Conclusions The re-using of ultrafiltrated and concentrated ascites fluid can effectively relieve the abdominal bloating symptom, improve CCr, be beneficial to the re-use of ascites albumin, and does not increase the incidence of abdominal infection within 12 weeks after the therapy, therefore the treatment has relatively high therapeutic value for intractable ascites in patients with hepatitis B cirrhosis.

Objective To evaluate the therapeutic effeet of one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft versus traditional posterior and anterior approach surgery in the treatment of severe thoracolumbar fractures.Methods A retrospective case-control study was done on 40 cases of type C thoracolumbar fractures admitted from January 2012 to December 2015.There were 28 males and 12 females,with age range of 20-48 years (mean,30.6 years).The fractures were located at T11 in 4 cases,at T12 in 16,at L1 in 14,and at L2 in 6.All cases were divided into two groups (with 20 cases per group) according to treatment method difference.The cases in posterior group had one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft,and the others in posterior and anterior group were treated by traditional posterior and anterior approach surgery.The operation duration,volume of blood loss,hospital stay,kyphosis correction rate,visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups.Results All patients were followed up for 10-46 months (mean,28.6 months).In posterior group,the average operation time was 154 minutes,the average blood loss was 564 ml,the postoperative suction drainage was 180.5 ml,the time period between surgery and recovery of walking ability was 5.9 days,and the hospital stay was 10.6 days.While in posterior and anterior group,the average operation time was 248.5 minutes,with the average blood loss of 960.8 ml,the postoperative suction drainage of 359.2 ml,the time duration between surgery and recovery of walking ability of 8.4 days,and the hospital stay of 14.5 days (P ＜ 0.05).At one week and six months postoperatively,the height ratio of anterior edge,Cobb angle,VAS and ODI in both groups were improved compared to the preoperative status (P ＜ 0.05).But there was no significant difference of these indicators between two groups (P ＞ 0.05) except for lumbar back pain one week after operation (P ＞ 0.05).Conclusions Through single pathway of posterior approach,one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft can complete reduction of fractured vertebral body,spinal cord decompression,and anterior-middle column stability reconstruction.Compared with traditional combined posterior and anterior approach surgery,this technique has many advantages including simpler manipulation,less invasion,shorter rehabilitation time and equal bony fusion and hence is an ideal option for type C thoracolumbar fractures.