This article summarized the clinical experience of national TCM master Zhang Zhen in treating gastroesophageal reflux cough by applying the theory of"dredging and regulating qi".Professor Zhang Zhen believes that the pathogenesis of gastroesophageal reflux cough lies in the abnormal ascending and descending of qi movement in the viscera.Specifically,it is manifested as weakness of the spleen and stomach,dysfunction of the pivot mechanism,failure of the liver to dredge and disperse,failure of the lung qi to descend,insufficiency of kidney yang,and failure of the kidney to receive qi.Clinically,the treatment method of dredging and regulating qi is adopted,and the Shutiao Decoction is used as the basic prescription.The disease is treated from three aspects,namely strengthening and regulating the spleen and stomach,soothing the liver and purifying the lung,and tonifying the kidney and helping it receive qi.The regulation of the qi movement of the whole body is organically combined with that of the local areas to jointly smooth the operation of the qi movement throughout the body.It is hoped that this can provide references and ideas for the treatment of gastroesophageal reflux cough in TCM.

ObjectiveTo develop the Evidence Grading Scale for Ancient classical prescriptions in Traditional Chinese medicine， assess its reliability and validity， and apply it in practice to provide multi-source evidence for clinical practice guidelines development. MethodsLiterature retrieval was conducted to extract and screen existing evaluation dimensions， then the initial items were summarized using thematic analysis. Experts in the clinical medicine， medical history and literature participated in the Delphi questionnaire survey to evaluate and refine the items. An expert consensus meeting was conducted to finalize the included items， refine the method for items evaluation and evidence grading. The evidence quality rating scale for ancient classical traditional Chinese medicine （TCM） prescriptions was then established and tested for reliability and validity. ResultsThrough literature review， extraction， screening and summarization， a total of 3 dimensions and 12 initial items were formed. Questionnaires were sent to 69 experts to evaluate the initial items， with a questionnaire response rate of 100% and an expert authority coefficient of 0.92. All 12 items were retained for they had importance scores above 4. The Evidence Grading Scale on Ancient classical prescriptions in Traditional Chinese medicine includes 3 dimensions with 12 items. The 3 dimensions includes ancient evidence， inheritance status， and modern application. Each dimension contains 4 items， and each item has a full score of 5 points. The evidence was rated as high-level， moderate-level， and low-level according to the final scores. The content validity index （CVI） of the 12 items was ＞0.9， the average CVI of the scale was 0.98， and the intraclass correlation coefficient （ICC） was 0.90. ConclusionThe Evidence Grading Scale on Ancient classical prescriptions in Traditional Chinese medicine has good reliability and validity， which is practical for use in the development of TCM clinical guidelines and can better support clinical decision-making.

Schistosomiasis cirrhosis (SAC), as the core pathological outcome of late-stage schistosomiasis, is an important challenge to global public health. Notably, there is still a significant disease burden, especially in the traditional endemic areas, such as the Yangtze River Basin in China. SAC has unique pathogenic characteristics, including insect-derived molecular-driven disease, chronic inflammation dominated by Th2 immunity, delayed pathogenicity, noticeable symptoms of portal hypertension, and an absence of significant correlation with liver cancer. Therefore, future research should focus on the determinants of individual susceptibility to SAC onset, the core mechanism of liver lesion progression post-pathogen clearance, time nodes, and intervention methods. Additionally, finding the high-risk individuals, analyzing of pathological mechanisms, and optimizing intervention strategies will help in promoting the development of clinical prevention and control and translational research.

Objective:To explore the dynamic trends of family caregivers' supportive care needs and family resilience in enterostomy patients and to analyze the reciprocal predictive relationship between the two.Methods:This study was longitudinal. Convenience sampling was used to select 370 family primary caregivers of colorectal cancer patients with enterostomy in the Affiliated Cancer Hospital of Xinjiang Medical University and the Xinjiang Bazhou People's Hospital from December 2023 to September 2024 as study subjects. Patients were surveyed using the General Information Questionnaire, Family Hardiness Index, and Supportive Care Needs Survey-Partners and Caregivers at four time points of admission (T1), discharge (T2), one month after surgery (T3), and three months after surgery (T4). Spearman correlation was used to analyze the correlation between supportive care needs of family caregivers of enterostomy patients and family resilience at different time points, and a cross-lagged model was constructed to explore the predictive role of supportive care needs on family resilience.Results:A total of 370 questionnaires were distributed and 336 valid questionnaires were finally recovered, with a valid recovery rate of 90.81% (336/370). Supportive care needs of family caregivers and family resilience of 336 family caregivers of enterostomy patients showed an increasing and then decreasing trend during hospitalization to three months after surgery ( P<0.05). Spearman correlation analysis showed that supportive care needs of family caregivers of enterostomy patients were negatively correlated with family resilience ( P<0.01). Cross-lagged model showed that supportive care needs of family caregivers of enterostomy patients at T1, T2, and T3 negatively predicted family resilience in the next period (β=-0.308, -0.204, and -0.243; all P<0.05), but not vice versa. Conclusions:Family caregiver supportive care needs and family resilience of enterostomy patients showed a dynamic trend of increasing and then decreasing during the hospitalization to three months postoperatively, and family caregiver supportive care needs are able to influence subsequent family resilience. Healthcare professionals should assess the supportive care needs of family caregivers and take targeted measures to meet their supportive care needs in a timely manner, in order to enhance the family resilience, create a good family environment for patients' recovery, and improve the quality of life of patients and their family caregivers.

This article summarized the clinical experience of national TCM master Zhang Zhen in treating gastroesophageal reflux cough by applying the theory of"dredging and regulating qi".Professor Zhang Zhen believes that the pathogenesis of gastroesophageal reflux cough lies in the abnormal ascending and descending of qi movement in the viscera.Specifically,it is manifested as weakness of the spleen and stomach,dysfunction of the pivot mechanism,failure of the liver to dredge and disperse,failure of the lung qi to descend,insufficiency of kidney yang,and failure of the kidney to receive qi.Clinically,the treatment method of dredging and regulating qi is adopted,and the Shutiao Decoction is used as the basic prescription.The disease is treated from three aspects,namely strengthening and regulating the spleen and stomach,soothing the liver and purifying the lung,and tonifying the kidney and helping it receive qi.The regulation of the qi movement of the whole body is organically combined with that of the local areas to jointly smooth the operation of the qi movement throughout the body.It is hoped that this can provide references and ideas for the treatment of gastroesophageal reflux cough in TCM.

Objective:To explore the dynamic trends of family caregivers' supportive care needs and family resilience in enterostomy patients and to analyze the reciprocal predictive relationship between the two.Methods:This study was longitudinal. Convenience sampling was used to select 370 family primary caregivers of colorectal cancer patients with enterostomy in the Affiliated Cancer Hospital of Xinjiang Medical University and the Xinjiang Bazhou People's Hospital from December 2023 to September 2024 as study subjects. Patients were surveyed using the General Information Questionnaire, Family Hardiness Index, and Supportive Care Needs Survey-Partners and Caregivers at four time points of admission (T1), discharge (T2), one month after surgery (T3), and three months after surgery (T4). Spearman correlation was used to analyze the correlation between supportive care needs of family caregivers of enterostomy patients and family resilience at different time points, and a cross-lagged model was constructed to explore the predictive role of supportive care needs on family resilience.Results:A total of 370 questionnaires were distributed and 336 valid questionnaires were finally recovered, with a valid recovery rate of 90.81% (336/370). Supportive care needs of family caregivers and family resilience of 336 family caregivers of enterostomy patients showed an increasing and then decreasing trend during hospitalization to three months after surgery ( P<0.05). Spearman correlation analysis showed that supportive care needs of family caregivers of enterostomy patients were negatively correlated with family resilience ( P<0.01). Cross-lagged model showed that supportive care needs of family caregivers of enterostomy patients at T1, T2, and T3 negatively predicted family resilience in the next period (β=-0.308, -0.204, and -0.243; all P<0.05), but not vice versa. Conclusions:Family caregiver supportive care needs and family resilience of enterostomy patients showed a dynamic trend of increasing and then decreasing during the hospitalization to three months postoperatively, and family caregiver supportive care needs are able to influence subsequent family resilience. Healthcare professionals should assess the supportive care needs of family caregivers and take targeted measures to meet their supportive care needs in a timely manner, in order to enhance the family resilience, create a good family environment for patients' recovery, and improve the quality of life of patients and their family caregivers.

Schistosomiasis cirrhosis (SAC), as the core pathological outcome of late-stage schistosomiasis, is an important challenge to global public health. Notably, there is still a significant disease burden, especially in the traditional endemic areas, such as the Yangtze River Basin in China. SAC has unique pathogenic characteristics, including insect-derived molecular-driven disease, chronic inflammation dominated by Th2 immunity, delayed pathogenicity, noticeable symptoms of portal hypertension, and an absence of significant correlation with liver cancer. Therefore, future research should focus on the determinants of individual susceptibility to SAC onset, the core mechanism of liver lesion progression post-pathogen clearance, time nodes, and intervention methods. Additionally, finding the high-risk individuals, analyzing of pathological mechanisms, and optimizing intervention strategies will help in promoting the development of clinical prevention and control and translational research.

Objective To assess the possible correlations between chronic gastrointestinal symptoms(GISs)and mental health status(anxiety,depression,etc)after coronavirus disease 2019(COVID-19).Methods A random survey related to GISs and mental health status was performed in 326 gastrointestinal outpatients with a history of COVID-19 in Department of Gastroenterology,The First Affiliated Hospital of Naval Medical University from July 1,2023 to September 1,2023.Results Deriving from mean scores of the survey questionnaire,participants as a whole presented a state of somatic problems(PHQ-15=5-9)and health anxiety(SHAI>15)during and after COVID-19.History of gastrointestinal diseases(P<0.05)and health anxiety(P<0.001)were associated with the GISs frequency.Somatic symptoms,especially GISs,presented more frequently(P=0.003)and people were more likely to show signs of depression(P=0.004)during COVID-19.The outpatients who felt sick during COVID-19 and had GISs after COVID-19 were more likely to show anxiety symptoms.Conclusion COVID-19 aggravates the presence of GISs and depression.Anxiety has a significant influence on the frequency of GISs,which provides evidence that cognitive-behavioral therapy may be beneficial for gastrointestinal outpatients and offers a new perspective for the treatment of digestive diseases.

Objective:To analyse the differences of related genes between serum alpha-fetoprotein (AFP) positive gastric cancer and AFP negative gastric cancer, and the relationship between related genes and prognosis of serum AFP positive gastric cancer.Methods:A total of 1 144 gastric cancer patients undergoing surgery at the 940th Hospital , Joint Logistic Support Force, People's Liberation Army from Jan 2013 to Dec 2018 were retrospectively analyzed. Of them, 47 cases were of AFP positive gastric cancer, and 47 serum AFP negative case were obtained by proper matching method.Results:Forty-seven patients with serum AFP positive gastric cancer, accounting for 4.1% of all gastric cancer patients during the same period. The prognosis of serum AFP negative gastric cancer is better than that of serum AFP positive gastric cancer. The 1-, 3- and 5-year cumulative survival rates were 95.6% vs. 63.8%, 48.9% vs. 23.4% and 26.7% vs. 14.9%, respectively. There were statistical differences in the immunohistochemistry of AFP, HER2, VEGF, GPC3, SALL4, P53 and Ki67 between the two groups ( χ2=67.758, P<0.001; χ2=4.004, P=0.044; χ2=19.299, P<0.001; χ2=5.232, P=0.022; χ2=6.359, P=0.012; χ2=6.224, P=0.013; χ2=5.232, P=0.022). The more co-positive expressions of AFP, GPC3, VEGF and SALL4, the more likely they were to affect pTNM stage, vascular invasion and liver metastasis ( χ2=5.328, P=0.021; P=0.013; χ2=5.887, P=0.015; χ2=3.923, P=0.048). Univariate and multivariate survival analysis of serum AFP positive gastric cancer showed:AFP, GPC3, VEGF and SALL4 were risk factors for AFP positive gastric cancer ( HR=3.700, P=0.036; HR=4.237, P=0.003; HR=3.916, P=0.004; HR=3.412, P=0.001). Conclusions:Serum AFP positive gastric cancer is a rare and highly invasive special type of gastric cancer. AFP, GPC3, VEGF and SALL4 are overexpressed in serum AFP positive gastric cancer, which is correlated with tumor stage, vascular invasion and liver metastasis. The final diagnosis of serum AFP positive gastric cancer still needs immunohistochemical examination. Preoperative serum AFP level is an important basis for AFP positive gastric cancer screening and AFP immunohistochemical examination.

Objective:To develop a robotic digestive endoscope system (RDES) and to evaluate its feasibility, safety and control performance by experiments.Methods:The RDES was designed based on the master-slave control system, which consisted of 3 parts: the integrated endoscope, including a knob and button robotic control system integrated with a gastroscope; the robotic mechanical arm system, including the base and arm, as well as the endoscopic advance-retreat control device (force-feedback function was designed) and the endoscopic axial rotation control device; the control console, including a master manipulator and an image monitor. The operator sit far away from the endoscope and controlled the master manipulator to bend the end of the endoscope and to control advance, retract and rotation of the endoscope. The air supply, water supply, suction, figure fixing and motion scaling switching was realized by pressing buttons on the master manipulator. In the endoscopy experiments performed on live pigs, 5 physicians each were in the beginner and advanced groups. Each operator operated RDES and traditional endoscope (2 weeks interval) to perform porcine gastroscopy 6 times, comparing the examination time. In the experiment of endoscopic circle drawing on the inner wall of the simulated stomach model, each operator in the two groups operated RDES 1∶1 motion scaling, 5∶1 motion scaling and ordinary endoscope to complete endoscopic circle drawing 6 times, comparing the completion time, accuracy (i.e. trajectory deviation) and workload.Results:RDES was operated normally with good force feedback function. All porcine in vivo gastroscopies were successful, without mucosal injury, bleeding or perforation. In beginner and advanced groups, the examination time of both RDES and ordinary endoscopy tended to decrease as the number of operations increased, but the decrease in time was greater for operating RDES than for operating ordinary endoscope (beginner group P=0.033; advanced group P=0.023). In the beginner group, the operators operating RDES with 1∶1 motion scaling or 5∶1 motion scaling to complete endoscopic circle drawing had shorter completion time [1.68 (1.40, 2.17) min, 1.73 (1.47, 2.37) min VS 4.13 (2.27, 5.16) min, H=32.506, P<0.001], better trajectory deviation (0.50±0.11 mm, 0.46±0.11 mm VS 0.82±0.26 mm, F=38.999, P<0.001], and less workload [42.00 (30.00, 50.33) points, 43.33 (35.33, 54.00) points VS 52.67 (48.67, 63.33) points, H=20.056, P<0.001] than operating ordinary endoscope. In the advanced group, the operators operating RDES with 1∶1 or 5∶1 motion scaling to complete endoscopic circle drawing had longer completion time than operating ordinary endoscope [1.72 (1.37, 2.53) min, 1.57 (1.25, 2.58) min VS 1.15 (0.86, 1.58) min, H=13.233, P=0.001], but trajectory deviation [0.47 (0.13, 0.57) mm, 0.44 (0.39, 0.58) mm VS 0.52 (0.42, 0.59) mm, H=3.202, P=0.202] and workload (44.62±21.77 points, 41.24±12.57 points VS 44.71±17.92 points, F=0.369, P=0.693) were not different from those of the ordinary endoscope. Conclusion:The RDES enables remote control, greatly reducing the endoscopists' workload. Additionally, it gives full play to the cooperative motion function of the large and small endoscopic knobs, making the control more flexible. Finally, it increases motion scaling switching function to make the control of endoscope more flexible and more accurate. It is also easy for beginners to learn and master, and can shorten the training period. So it can provide the possibility of remote endoscopic control and fully automated robotic endoscope.