Huang Yuanyu, a famous TCM doctor in the Qing Dynasty, believed that the human body's qi system revolves around the spleen and stomach as the pivot, with the liver, heart, lungs, and kidneys as the four major organs, and the circulation is constant. TCM guided therapy regulates qi and blood by regulating the body, heart, and breath, which is in line with this theory. Based on Huang Yuanyu's "pivot movement" theory, this article explored the application of guided therapy in refractory gastroesophageal reflux disease (rGERD). Guided by the "pivot movement" theory, which includes the left path wood fire rising and falling, the right path gold water converging and falling, and the adjustment of the focal point through the mediation of earth and qi, and referring to the guidance movement methods in the Ba Duan Jin and Zhu Bing Yuan Hou Lun, a "pivot guidance method" for rGERD patients is developed, five movements: adjusting the body and heart, turning the waist and benefiting the kidneys, including rubbing the abdomen and regulating the spleen, soothing the liver and bending the knees, and tightening the lungs and reducing reflux. The aim is to promote smooth circulation of qi throughout the body and improve symptoms of gastroesophageal reflux. In clinical practice, guided therapy should be applied under the guidance of a doctor, with slow and gentle movements, attention to regulating breathing, and long-term persistence.

Wuhutang is the 51st Chinese medicine prescription of Han ethnic group on in the catalogue of ancient classical prescriptions （the second batch） ，which originated from Renzhai' Straight Diections Prescriptions （《仁斋直指方》） by YANG Shiying in the Song dynasty，it is composed of 5 medicines， including Ephedrae Herba，Armeniacae Semen Amarum， Glycyrrhizae Radix et Rhizoma， tea and Gypsum Fibrosum. It treats shortness of breath and phlegm. Following the principle of textual research on the key information of ancient classical famous prescriptions， the author collected and recorded the ancient books of traditional Chinese medicine of Wuhutang with the method of Bibliometrics， and screened out 53 valid data， involving 41 ancient books. Based on the historical evolution， drug composition， main treatment of disease and syndrome， drug dosage， method of preparation and usage， drug origin and processing， the author conducted a dig and a systematic study of Wuhutang. The results show that：in the later generations， besides inheriting the original prescription， the composition of medicine was added or subtracted， and the frequency of addition of Mori Cortex was the most；in the treatment of disease and syndrome， most of them inherited the original prescription mainly treating asthma syndrome， also see in the treatment of asthma， cough and other lung disease， in the drug dosage and method of use ， it is suggested to inherit the original prescription， the dosage of each medicine is： Ephedrae Herba 2.89 g， Armeniacae Semen Amarum 4.13 g， Glycyrrhizae Radix et Rhizoma 1.65 g， tea 3.30 g， Gypsum Fibrosum 6.20 g， decoction， take warm clothes before eating；on the source of medcine，ephedra is made from the dried herbaceous stems of Ephedra sinica （Ephedraceae），bitter almond is made from the dried and mature seeds of Prunus armeniaca （Rosaceae），Licorice is made from the dried roots and rhizomes of Glycyrrhiza uralensis（Legumes）， tea is made from the buds leaves of Camellia sinensis（Camellia），plaster is made from Gypsum Fibrosum of sulfate mineral gypsum family. At the same time， we collected and sorted the modern clinical application literature of Wuhutang， and obtained 73 effective literatures， all of which are for the treatment of respiratory system diseases， especially for children's pneumonia and asthma， and mostly belong to"phlegm-heat obstructing the lung syndrome". Through the analysis and study of ancient books and modern applied literature， the historical evolution and prescription evolution of Wuhutang are clarified， and its key information is determined， in order to provide more accurate reference for the research and development of the classic Wuhutang and the rational addition and subtraction of the application.

BACKGROUND:Currently,hormone replacement therapy is the main treatment in Western medicine for patients with decreased ovarian function,but these patients are not sensitive to exogenous hormones,leading to unsatisfactory therapeutic effect.Zishen-Yutai pills can nourish the blood and calm the fetus,tonify the kidney and spleen,invigorate qi and strengthen the body.Studies have confirmed that Zishen-Yutai pill is effective in reducing follicle-stimulating hormone index and improving traditional Chinese medicine symptoms in patients with diminished ovarian reserve.However,few studies have been conducted to improve the implantation rate of patients by improving endometrial receptivity. OBJECTIVE:To evaluate the effect of Zishen-Yutai pills on the clinical outcome of patients with diminished ovarian reserve undergoing frozen-thawed embryo transfer again. METHODS:A total of 300 patients with diminished ovarian reserve who underwent frozen-thawed embryo transfer to assist pregnancy after the first failure in the Center of Reproductive Medicine,Changzhou Maternal and Child Health Care Hospital from January 2019 to December 2021 were selected as the study subjects.Subjects were randomly treated with a placebo or Zishen-Yutai pills in a ratio of 1:2,with 100 cases in the treatment group and 200 cases in the control group.However,13 patients fell off due to lack of contact,refusal to take medicine or other reasons.Finally,90 cases in the treatment group and 197 cases in the control group were included in the study.Oral medication was administered 7 days before frozen-thawed embryo transfer transplantation at a dose of 5 g/time,3 times/day.To investigate whether taking Zishen-Yutai pills could improve the clinical outcome of patients with diminished ovarian reserve after frozen-thawed embryo transfer again,the primary outcome measures included clinical pregnancy rate,implantation rate,abortion rate,live birth rate,offspring birth weight and birth defects. RESULTS AND CONCLUSION:Compared with the control group,the clinical pregnancy rate(P<0.05)and implantation rate(P=0.009)were significantly increased after the oral administration of Zishen-Yutai pills.Correlation analysis showed that taking the Zishen-Yutai pill was positively correlated with the number of implanted embryos(r=0.200,P=0.001)and clinical pregnancy(r=0.235,P=0.000).There was no correlation between taking Zishen-Yutai pills and indexes of endometrial thickness and blood flow.It is indicated that Zishen-Yutai pills can improve the clinical pregnancy rate and implantation rate of frozen-thawed embryo transfer recurrence in patients with diminished ovarian reserve.

ObjectiveThis study aimed to evaluate the clinical efficacy of Ruyi Zhenbaowan（RYZBW）in the treatment of initial and early knee osteoarthritis （KOA） through a prospective multicenter，randomized，double-blind，and placebo-parallel controlled trial. MethodFrom October 13^th， 2021 to December 25^th， 2021， 240 KOA subjects meeting the acceptance criteria were enrolled in 15 sub-centers including Wangjing Hospital， Chinese Academy of Chinese Medical Sciences， and they were randomly divided into observation group and control group， with 120 cases in each group. The intervention measures for the observation group were RYZBW + health education， and the intervention measures for the control group were RYZBW placebo + health education. The intervention period in both groups was four weeks， and they were followed up for four weeks after the intervention. The primary outcome measure was the total score of Western Ontario and McMaster University Osteoarthritis Index score （WOMAC score）， and the secondary outcome measures were the response rate of visual scale （VAS） pain score， WOMAC sub item scores （joint pain， joint stiffness， and joint function）， quality of life （SF-12） score， and traditional Chinese medicine （TCM） syndrome score. Result（1） Efficacy evaluation. The marginal model results showed that the observation group was better than the control group in improving the WOMAC total score and WOMAC pain score in the treatment of KOA with RYZBW， and the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in improving VAS score response rate， WOMAC function score， WOMAC stiffness score， SF12-PCS （quality of life-physical health） score， SF12-MCS （quality of life-mental health） score， and TCM syndrome score. （2） Subgroup analysis. ① In terms of VAS score response rate， the response rate of the observation group was higher than that of the control group for subjects with baseline VAS score of （4， 5］， and the difference was statistically significant （P<0.05）. ② In terms of TCM syndrome score， for subjects aged ［56， 60］ and ［61， 65］， the decrease in total TCM syndrome score in the observation group was better than that in the control group， and the difference was statistically significant （P<0.05）. ConclusionTibetan medicine RYZBW has good clinical efficacy in improving WOMAC total score， VAS score response rate， WOMAC pain score， WOMAC function score， and TCM syndrome score for patients with initial and early KOA， which can fill the lack of Tibetan medicine RYZBW in the treatment of KOA and make a demonstration study for the inheritance and development of ethnic medicine.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective:To search, review and summarize the best evidence on promoting maturation of autologous arteriovenous fistula (AVF) in patients undergoing maintenance hemodialysis (MHD) .Methods:In accordance with the relevant methods of evidence-based nursing, evidence was retrieved from relevant websites and databases according to the "6S" pyramid model, including clinical decision-making, guidelines, expert consensus, group standards, and systematic reviews. The search time limit was from April 20, 2012 to April 20, 2022. Two investigators assessed the quality of the evidence, and the evidence team extracted and summarized the evidence.Results:A total of 17 articles were included, including 1 clinical decision-making, 6 guidelines, 1 expert consensus, 1 group standard and 8 systematic reviews. Totally 28 best evidences were summarized from 6 aspects: team education, perioperative management, functional exercise, physical therapy, drug application, first puncture timing and scheme.Conclusions:The best evidence provides a reference for medical staff to standardize the management of AVF in MHD patients. It is recommended that medical staff develop individualized plans based on medical conditions, clinical judgment, and patient wishes when applying relevant evidence.

Objective: The purpose of this study is to investigate the anti-diabetic effects of linarin, a flavonoid extracted from Chrysanthemi Indici Flos (CIF), and its potential mechanisms. Methods: The effects of linarin on cell viability and glucose consumption in HepG2 cells were measured. Meanwhile, monosodium glutamate (MSG) mouse model was constructed to monitor the changes of insulin tolerance, glucose tolerance, triglyceride and cholesterol. The protein expression levels of p-AMPK, p-ACC, PEPCK and p-GS were detected by Western blot. Results: Linarin could increase the relative glucose consumption of HepG2 cells, improve insulin tolerance and glucose tolerance, and decrease the levels of triglyceride and cholesterol of MSG mice. Simultaneously, the expression levels of p-AMPK and p-ACC in HepG2 cells and the liver tissue of MSG mice were increased, while the expression levels of PEPCK and p-GS were decreased after treatment with linarin. Conclusion: Insulin resistance could be ameliorated by linarin in type 2 diabetes, and its mechanism may be related to AMPK signaling pathway.

Objective:To translate the Providing Mouth Care Scale (PMCs) into Chinese, and apply it to nurses to test its reliability and validity.Methods:From November to December 2021, convenience sampling was used to select 250 nurses from six ClassⅢ hospitals in Hebei Province as research objects to participate in the survey. The scale was translated according to the Brislin process, and the scale was culturally adjusted on the basis of expert consultation and pre-investigation to form the Chinese version of PMCs. The Chinese version of PMCs was used to survey nurses to measure the reliability and validity. A total of 250 questionnaires were distributed, and 223 questionnaires were effectively recovered, with an effective recovery rate of 89.2% (223/250) .Results:The Chinese version of PMCs consisted of two subscales, self-efficacy (SE-PMC) and attitude (A-PMC) . SE-PMC contained three dimensions, and A-PMC contained two dimensions, a total of 21 items. The content validity index of PMCs was 0.930, and the Cronbach's α coefficient was 0.807, and the test-retest reliability coefficient was 0.893. A total of 5 common factors were extracted, and the cumulative variance contribution rates were all >50%.Conclusions:The Chinese version of PMCs has good reliability and validity, and can be used to measure nurses' attitudes and self-efficacy towards oral health management.

Kinesitherapy has become an effective means of adjuvant treatment of cancer-related fatigue in patients with breast cancer. This paper reviews the concept of cancer-related fatigue, mechanism of kinesitherapy in relieving cancer-related fatigue and the common mode of exercise. It aims to find the best exercise way to relieve cancer-related fatigue in patients with breast cancer and to provide reference for clinical research and clinical practice.

Objective:To understand the research hotspots of external fixation nursing in the past 5 years and analyze the research status and development trend of this field, so as to provide a reference for external fixation nursing practice and research development in China.Methods:PubMed, Web of Science, China National Knowledge Internet (CNKI), Wanfang Database and VIP database were used to retrieve external fixation nursing related literature published from August 2015 to July 2020. Bibliographic information data mining system software and graph clustering toolkit software were used to perform bibliometric and cluster analysis.Results:A total of 720 literatures were included, including 318 English literatures and 402 Chinese literatures. A total of 25 English high-frequency words were extracted with frequency greater than or equal to 23 times, and 17 Chinese high-frequency words were extracted with frequency greater than or equal to 25 times. After cluster analysis, two English research hotspots were obtained, namely, information acquisition and application in nursing research, functional recovery after external fixation. Five Chinese research hotspots were obtained, including the prevention of needle-path infection, the nursing effect of systematic nursing on patients with external fixation, application of negative pressure sealing drainage technology in open fractures, perioperative nursing of patients with bone defects and rehabilitation nursing of fractures at different locations.Conclusions:It is possible to use information management and big data to analyze the risk factors of external fixation care for prevention, and to standardize the external fixation care process through standardized procedures and the introduction of nursing guidelines for different parts of the external fixation. At the same time, attention should be paid to the functional recovery of patients with external fixation in order to improve the nursing quality of external fixation.