This article introduces the clinical experience of Professor WANG Jihong in treatment of post-stroke hypermyotonia with Lai's tongyuan therapy (therapy for removing obstruction and consolidating vital essence). Regarding the pathogenesis of this disease, Professor WANG Jihong emphasizes a "trinity" approach, "the mind disturbed, qi and blood unbalanced, and yuan (vital essence) not consolidated". In treatment, "the unblocking, conducting and nourishing are taken as the fundamental" to "prevent from over-dredging, balancing yin and yang, and avoiding over-replenishing". In clinical practice, the combined measure is adopted with acupuncture, tuina and herbal medicine. In acupuncture, the acupoints are selected according to the front-back combination of the points of the conception vessel and the governor vessel (basic prescription: Yintang [GV24⁺], Baihui [GV20] and Niesanzhen; prescription for promoting the governor vessel: Dazhui (GV14), Jinsuo [GV8], Xinshu [BL15], Pishu [BL20] and etc.; and the prescription for consolidating the vital essence: Danzhong (CV17), Zhongwan [CV12], Tianshu [ST25], Qihai [CV6]) and etc., as well as those on the four limbs for "opening, closing and pivoting of yin and yang" (on the upper limbs of the affected side: Jiquan [HT1], Jianyu [LI15], Quchi [LI11], Quze [PC3] and etc.; on the lower limbs of the affected side: Huantiao [GB30], Liangqiu [ST34], Xuehai [SP10], Yanglingquan [GB34]) and etc. The above points co-act on regulating the conception vessel and the governor vessel, and balancing yin and yang. Tuina is delivered on the governor vessel, the bladder meridian of foot-taiyang and wind points on the area between the head and nape, so as to promote the governor vessel, benefit the orifices, strengthen the spine and relax tendons. Herbal medicine works on nourishing the liver to soften tendons, nourishing blood to remove wind, regulating qi to replenish the spleen, consolidating the root to cultivate the vital essence, activating blood circulation to unblock meridians, and removing stasis to resolve phlegm. Tongyuan therapy provides a certain instruction in treatment of post-stroke hypermyotonia.
Humans ; Acupuncture Therapy ; Acupuncture Points ; Stroke/complications* ; Male ; Female ; Middle Aged ; Aged ; Drugs, Chinese Herbal ; Adult

BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Objective:To evaluate the accuracy of the optical surface imaging system (OSI) using stereotactic radiosurgery (SRS) algorithm in single-center non-coplanar treatment of multiple brain metastases.Methods:Data of phantom and 15 patients with multiple brain metastases who underwent single-center non-coplanar radiotherapy in West China Hospital of Sichuan University from February to April 2022 were retrospectively analyzed. kV/MV and OSI imaging were used for imaging of the patients and phantoms under the same non-coplanar couch angle, respectively. The accuracy of OSI imaging of the phantoms and patients was evaluated using kV/MV imaging as reference image. The difference between the OSI and kV/MV systems is defined as accuracy, and the percentage of the absolute difference ≤1.00 mm in the translational direction or ≤0.50° in the rotational direction is defined as the threshold pass rate. Origin software was used to draw radar maps and Bland-Altman plots for statistical analysis.Results:When OSI images were used for the phantom imaging, the average differences in six-dimensional directions of lateral, long, vertical, rotational, roll and pitch were 0.03 mm, -0.09 mm, -0.27 mm, 0.04°, 0.17° and -0.19°, respectively. The maximum values were -2.20 mm, -2.30 mm, -1.20 mm, 0.60°, -1.00°, and -1.00°, respectively. When OSI system was utilized for the imaging of 15 patients, the average differences in six-dimensional directions were 0.44 mm, 0.16 mm, -0.20 mm, -0.11°, 0.10°, and -0.12°, respectively. The maximum values were -1.80 mm, 2.00 mm, 0.90 mm, -0.90°, -0.70°, and 0.80°, respectively. The translational errors mainly occurred in the lateral and long directions. The qualified rates of the threshold values of the phantoms and patients were 77% and 75% in the lateral direction, 82% and 89% in the long direction, respectively. In addition, 57% and 56% of patients met the threshold conditions of ±1.00 mm and ±0.50° in the six-dimensional directions, respectively.Conclusions:The OSI system using new SRS algorithm cannot meet the high accuracy requirements of single-center non-coplanar radiotherapy for multiple brain metastasis, especially in the lateral and long directions. It is not recommended for non-coplanar image guidance.

Objective:To analyze the clinical and imaging features of patients with COVID-19-related osmotic demyelination syndrome (ODS).Methods:COVID-19-related ODS cases diagnosed in the Department of Neurology, Peking Union Medical College Hospital from January 2020 to September 2023 were retrospectively reviewed. And their past medical history, possible triggers, clinical manifestations, imaging manifestations, treatment and prognosis were summarized.Results:A total of 5 patients with COVID-19-related ODS were included. Electrolyte disturbances acted as an inducement of ODS in all patients (5/5),4 of whom with hyponatremia. Four of 5 patients first presented with disturbance of consciousness, followed by predominant dystonia. Imaging of all patients (5/5) showed isolated extrapontine myelinolysis (EPM). With the prolongation of the course of disease, such signal intensity could return to normal, and lesions showed atrophic changes in some patients. The patients′ clinical symptoms were partly relieved within a few days to a few months after treatment.Conclusions:COVID-19-related ODS is mostly associated with hyponatremia, and EPM is more common. COVID-19 should be considered as a risk factor for ODS.

Objective·To explore the effect of online courses combined with the teach-back method among patients with laryngectomy and their family caregivers.Methods·Convenience sampling was used to select patients with laryngectomy treated in the Department of Otolaryngology,Shanghai Changhai Hospital from July 2022 to June 2023 and their family caregivers.The participants were divided into a control group and an observation group using the random number table method.The intervention was conducted in two different wards.General information of the two groups of patients and caregivers was collected.After admission,the control group watched offline videos recorded by the department.The videos introduced laryngocarcinoma-related knowledge and standard procedures of airway stoma care,suctioning,nasal feeding,etc.,which were divided into 4 sessions with 30 min each.The patients watched one session per week.The observation group watched the same videos(8 lessons)online on their own after admission,while the nursing staff used the teach-back method for health education,consolidating 2 lessons once a week,45 min/session for 4 weeks.The effectiveness of the intervention was evaluated by using Caregiver Preparedness Scale(CPS),Family Caregiver Task Inventory(FCTI),and Chinese Quality of Life Instruments for Cancer Patients-Head and Neck Cancer(QLICP-HN)at baseline(1st week),before discharge(4th week),and one month after discharge(8th week),as well as the incidence of adverse events during home care.Results·The study included a total of 120 pairs of patients and caregivers,with 60 pairs in each group.Five pairs in each group were excluded due to various reasons,leaving a total of 55 pairs in each group.There were no statistically significant differences between the two groups in terms of general information of the patients and the caregivers,QLICP-HN scores of the patients,and CPS and FCTI scores of the caregivers at baseline(P＞0.05).Before discharge and 1 month after discharge,the CPS scores of the caregivers and the QLICP-HN scores of the patients in the observation group were significantly higher than those in the control group,and the FCTI scores were significantly lower(lower scores indicating better nursing care),with statistically significant differences(P＜0.05).Within 1 month after discharge,the incidence of adverse home care events in the observation group was lower than that in the control group(5.5%vs 29.1%),and the difference was statistically significant(P＜0.05).Conclusion·The online courses combined with the teach-back method help improve the readiness to care and caregiving competence of family caregivers of post-laryngectomy patients,improve patients'quality of life,and reduce the incidence of adverse events during home care.

Objective:To evaluate the accuracy and stability of stereotactic radiosurgery (SRS) algorithm in optical surface imaging (OSI) system in non-coplanar radiotherapy.Methods:Three OSI imaging systems were used to measure the phantom repeatedly at different couch rotation angles to analyze the accuracy and stability of OSI system. Seven patients with multiple brain metastases who underwent single-center non-coplanar radiotherapy were randomly selected, and the accuracy and stability of OSI for patient imaging were analyzed. Stability is defined as the difference between the two OSI measurements when the couch is turned from 0° to a non 0° angle, and then back to 0°, using the 0° cone beam CT (CBCT) as the "gold standard". Accuracy is defined as the difference between OSI and CBCT (at 0° couch angle) measurement data. The measurement data with normal distribution were described as Mean ± SD. The data with non-normal distribution were expressed as M (Q). The difference of the former data was compared by one-way ANOVA, and the difference of the latter data was assessed by Kruskal-Wallis H nonparametric test. Results:For non-coplanarity, the translation accuracy of the phantom and the patient was ≤ 1.30 mm and ≤ 1.00 mm, and the rotation accuracy was ≤ 0.50° and ≤ 0.60°, respectively. The translation errors mainly occurred in the left-right and head-foot directions. In terms of stability, the maximum standard deviation of phantom coplanar translation and rotation was 0.06 mm and 0.06°. The maximum standard deviation of patient translation and rotation was 0.17 mm and 0.19°.Conclusions:Although the new SRS algorithm improves the non-coplanar accuracy, it still cannot meet the precise requirements of non-coplanar single isocenter radiotherapy for multiple brain metastases, especially in the left-right and head-foot directions. When the couch rotation angle is large, OSI is not recommended for image-guided radiotherapy. However, its high stability can be used to monitor the intrafractional motion of patients.

ObjectiveTo explore the relationship between the intestinal flora and the impairment of liver and kidney in HIV-infected men who have heterosexual sex with healthy women. MethodsFecal samples from 41 HIV-infected heterosexual men who have sex with women （PMSW） and 43 age- and BMI-matched healthy heterosexual men who have sex with women （NMSW） were collected and subjected to 16S rDNA sequencing. The blood levels of AST， ALT， TBIL， UREA， Cr， UA， β2-MG and other liver and kidney function indicators were measured. Bioinformatics methods were used to analyze the characteristics of the intestinal flora of the patients in these two groups， to compare the differential bacteria strains， and to analyze their correlation with liver and kidney function indicators. ResultsIn comparison with NMSW， the alpha diversity of intestinal flora was decreased in PMSW， and the beta diversity analysis showed significant differences in flora characteristics between the two groups （P<0.05）. The abundance of Clostridium， Phylum thick-walled， Trichosporon， and Clostridium tumefaciens decreased but Fusobacteriota increased （LDA score >4）. The comparison of liver and kidney function indexes revealed that AST， β2-MG levels were higher in PMSW than in NMSW， while TBIL was lower in PMSW than in NMSW. The number of patients with abnormal β2-MG was much higher in PMSW than in NMSW， and the difference was statistically significant （P<0.001）. It was also found that AST was negatively correlated with Clostridium （P<0.05）； TBIL was negatively correlated with Clostridium and positively correlated with Phylum thick-walled and Trichosporon （P<0.05）. β2-MG was negatively correlated with Phylum thick-walled， Clostridium， Trichosporon and Rumenococcus （P<0.05） and positively correlated with Clostridium （P<0.05）. ConclusionIn PMSW group， the alpha diversity of the flora is decreased. AST and β2-MG levels are increased， and TBIL level is decreased. These changes were significantly correlated with different strains of bacteria in the intestinal flora.

Objective:To observe the efficacy and safety of ultra photon intense pulsed light combined with hydroquinone cream for the treatment of chloasma.Methods:From January 2020 to October 2022, a total of 30 patients with chloasma treated in the Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, ranged from 28 to 54 years old with an average age of 39 years, were randomly divided into three groups with 10 patients in each group: combined treatment group was treated with ultra photon intense pulsed light combined with hydroquinone cream; ultra photon intense pulsed light group was treated with ultra photon intense pulsed light alone; hydroquinone group was treated with hydroquinone cream alone. The efficacy and safety of the three groups were compared after four months of treatment.Results:After the treatment, 10 cases were effective in the combined treatment group, 5 cases were effective in the ultra photon intense pulsed light group and 2 cases were effective in the hydroquinone group. The total effective rate of the combined treatment group was significantly better than that of the ultra photon intense pulsed light group and the hydroquinone group, with statistical significance ( P<0.05). The average melasma area severity index score of the three groups after treatment was significantly decreased compared with that before treatment respectively ( P<0.05), and the average melasma area severity index score of the combined treatment group after treatment was significantly lower than that of hydroquinone group, with statistical significance ( P<0.05). No serious adverse reactions were observed in all the patients. Conclusions:Ultra photon intense pulsed light and hydroquinone cream can improve chloasma alone, but ultra photon intense pulsed light combined with hydroquinone cream has better therapeutic effect.

Objective:To investigate the application effects of flipped classroom combined with mini-clinical evaluation exercise (Mini-CEX) evaluation on the cultivation of clinical ability of professional postgraduates majoring in clinical medicine.Methods:A total of 32 trainees, the professional postgraduates majoring in clinical medicine integrated with standardized residency training who rotated in the Department of Neurology, The Southwest Hospital of Army Medical University from January 2019 to January 2020 were selected and divided into control group and the experimental group, with 16 ones in each group. The control group were taught with the traditional standardized residency training program, while the experimental group were assessed by Mini-CEX evaluation once every two weeks combined with flipped classroom in stages on the basis of the control group. At the end of the training, the application effects of these two teaching methods were evaluated by theoretical knowledge and clinical comprehensive ability (including 7 aspects of medical history collection, physical examination, clinical diagnosis, treatment plan, medical ethics, doctor-patient communication and overall evaluation). SPSS 22.0 was used for t test. Results:At the end of the training, the scores of theoretical knowledge in the experimental group were higher than those in the control group [(89.83±3.93) points vs. (85.75±5.34) points], with statistical differences ( P<0.05). For the clinical comprehensive ability, the scores of history collection, physical examination, clinical diagnosis, treatment plan, doctor-patient communication and overall evaluation were higher in the experimental group than in the control group ( P<0.05), except for the medical ethics. Conclusion:The application of flipped classroom combined with Mini-CEX evaluation improves the teaching quality and strengthens the clinical comprehensive ability of students, which is worth promoting in clinical practice.

Objective Toevaluatehysterosalpingography(HSG)and MRImanifestationsofintrauterineadhesion(IUA).Methods 40patientswithIUAconfirmedbyhysteroscopyunderwentHSGand MRIexamination.Wefoundoutthefeaturesofthoseimages, andworkedoutthedetectablerateofeachexamination.Results Inall40patients,19patientsweremildIUAprovedbyhysteroscopy,in which10patientswerediscoveredbyHSG,10patientsby MRIT2WI,16patientsby MRICUBE.16patientsweremiddleIUA,in which9patientswerediscoveredbyHSG,10patientsbyMRIT2WI,16patientsbyMRICUBE.5patientsweresevereIUA,allpatients werediscoveredbyHSG,MRIT2WIand MRICUBE.Andinallcases,therewere12casesofmembraneadhesions,inwhich5cases wereshowninHSG,8casesinMRIT2WIand10casesinMRICUBE.23caseswerefibrousadhesions,inwhich12caseswereshown in HSG,17casesinMRIT2WIand22casesinMRICUBE.5patientsweremuscularadhesions,allpatientswerediscoveredbyHSG, MRIT2WIandMRICUBE.Conclusion ComparingtoHSG,MRIexaminationshowshigherdetectablerateofIUA.MRICUBEsequences playsanimportantpartinthediagnosisofIUA.