Objective: To develop a 24 hour physical activity index for school aged children, and to analyze the association of 24 hour physical activity index with screening myopia and obesity, so as to provide a more effective assessment tool for student health risk screening. Methods: From April to June 2024, a total of 451 students in Grades 3-4 from two monitored primary schools in Shanghai were selected using stratified cluster random sampling method. Data on eight core indicators, including daily moderate to vigorous physical activity time, total physical activity time, outdoor activity time, screen time, sleep duration, sleep efficiency, social jetlag and daytime sleepiness, were collected through questionnaires and accelerometer monitoring. Each indicator was standardized and synthesized into a 0-80 point school aged children s 24 hour physical activity index. Spearman correlation analysis and t-test were used to assess consistency between questionnaire and accelerometer derived indices. Multivariate Logistic regression was applied to analyze the association of strength of the composite index with single behavior indicators in screening myopia and overweight/obesity. Results: The compliance rates were higher for moderate to vigorous physical activity time and screen time (50.8%, 98.7%), while the compliance rate for outdoor activity time was only 42.6%, and that for sufficient sleep duration was merely 10.2%. There was no significant difference between the total scores derived from the questionnaire and accelerometer methods (45.13±5.83, 45.05±6.87, t=0.29, P >0.05), but they showed a strong positive correlation ( r=0.58, P <0.01). Multivariate Logistic regression revealed that adjusting for individual behaviors such as grade, gender and both parents being myopic, among single behavior indicators of 24 hour physical activity index, only insufficient outdoor activity time was significantly associated with screening myopia among school aged children ( OR=1.50, 95%CI =1.01-2.21); the detection risk of screening myopia and obesity in the low index group were higher than those in the high index group ( OR=2.47, 95%CI =1.02-5.96; OR=16.63,95%CI = 5.99- 46.20) (all P <0.05). Conclusion The developed 24 hour physical activity index for school aged children demonstrates good measurement accuracy and shows stronger associations with screening myopia and obesity than single behavior indicator.

ObjectiveTo evaluate and analyze the syndrome characteristics of Qi and Yin deficiency accompanied by Qi stagnation and blood stasis in a rhein-induced cathartic colon （CC） rat model. MethodsTwenty-four rats were divided into a normal group and a model group （CC group）. The rats were administered equal volumes of physiological saline or 2% rhein suspension by gavage to establish the model over three cycles （approximately 118 days）. The first cycle lasted 46 days， with a dosage of 12 mL·kg^-1·d^-1， administered every other day. The second cycle lasted 37 days， with a dosage of 12 mL·kg^-1·d^-1， administered for 5 consecutive days followed by 2 days of cessation. The third cycle lasted 35 days， with a dosage of 16 mL·kg^-1·d^-1， also administered for 5 consecutive days followed by 2 days of cessation. Each cycle ended when 80% of the rats no longer exhibited loose stools. Body mass， 24 h food intake， coat condition， and coat red （R）， green （G）， and blue （B） values were recorded. The open field test （OFT） was used to measure the total distance traveled to evaluate Qi deficiency. The body mass coefficient and 24 h water intake were recorded to assess Yin deficiency. The sucrose preference test （SPT） was used to determine the sucrose preference rate （SPR）， and the average speed in OFT was measured to evaluate depressive status （liver depression and Qi stagnation）. Tongue images and their R， G， and B values were recorded. Whole blood viscosity （WBV） and plasma viscosity （PV） were measured using an automatic hemorheological analyzer to evaluate blood stasis. A carbon ink propulsion test was performed to determine the intestinal transit rate （ITR） for disease model evaluation. Hematoxylin-eosin （HE） staining was used to observe histopathological changes in the colon. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression of transient receptor potential ankyrin 1 （TRPA1） and tryptophan hydroxylase 1 （TPH1） in colon tissue. Western blot was used to detect the protein expression of TRPA1 and TPH1. ResultsIn terms of syndrome indicators， compared with the normal group， the body mass of the CC group decreased （P<0.05）， while 24 h food intake increased （P<0.01）. The coats of the CC group appeared withered， disheveled， and dull， and the R， G， and B values of the coat decreased （P<0.01）. The total distance traveled in OFT decreased （P<0.01）. The body mass coefficient decreased （P<0.01）， while 24 h water intake increased （P<0.05， P<0.01）. The SPR decreased （P<0.01）， and the average speed in OFT slowed （P<0.01）. The tongue appeared dark red， and the R， G， and B values of tongue images decreased （P<0.01）. WBV and PV increased （P<0.01）. Regarding disease indicators， compared with the normal group， the ITR decreased in the CC group （P<0.01）. Pathologically， HE staining showed necrosis and shedding of colonic mucosal epithelial cells， disruption of mucosal continuity， and infiltration of inflammatory cells in the lamina propria in the CC group. Semi-quantitative analysis showed increased HAI scores （P<0.05） and increased inflammatory cell counts and area proportion （P<0.05）. In terms of molecular biological indicators， compared with the normal group， the mRNA and protein expression levels of TRPA1 and TPH1 in colon tissue decreased in the CC group （P<0.05， P<0.01）. ConclusionThe rhein-induced CC rat model conforms to the traditional Chinese medicine syndrome characteristics of Qi and Yin deficiency accompanied by Qi stagnation and blood stasis.

BACKGROUND:Stroboscopic visual training can force sensory reweighting to restore the original weights by increasing sensitivity to proprioceptive information,which may be an effective method to improve proprioception. OBJECTIVE:To determine the effects of balance training in three conditions,low frequency,high frequency and normal vision,on ankle proprioception in patients with chronic ankle instability. METHODS:Thirty-six patients with chronic ankle instability recruited from the students of Southwest Medical University were randomly assigned to a low-frequency vision training group,a high-frequency vision training group,and a normal vision training group,with 12 subjects in each group.Subjects in the three groups underwent progressive hop stabilization and balance training,in which the low-frequency vision training group and the high-frequency vision training group wore stroboscopic spectacles during the training,with a stroboscopic frequency of 1.75 and 5 Hz,respectively.The training in each group was performed three times a week for 4 consecutive weeks.Assessments,including ankle proprioception,ankle stability self-assessment and dynamic postural stability,were performed before training and within 1 week after the completion of training. RESULTS AND CONCLUSION:There was a significant main effect of time factor in ankle proprioception(P<0.05).Compared with the pre-training period,subjects in the low-frequency vision training group and the high-frequency vision training group showed significant improvement in ankle proprioception after 4 weeks of training(P<0.05);and subjects in the low-frequency vision training group showed a significant improvement in ankle proprioception compared with that of the normal vision training group after 4 weeks of training(P<0.05).There were significant main effects of time factor and group×time interaction in ankle proprioception(P<0.05).Compared with the pre-training period,the ankle stability self-assessment in all three groups was improved after 4 weeks of training(P<0.05).And the ankle stability self-assessment in high-frequency visual training group was higher than that in normal vision training group after 4 weeks of training(P<0.05).Compared with the pre-training period,subjects in the low-frequency vision training group and the high-frequency vision training group showed significant improvements in forward dynamic postural stability,posteromedial dynamic postural stability,and posterolateral dynamic postural stability after 4 weeks of training(P<0.05),while in the normal vision training group,forward dynamic postural stability and posterolateral dynamic postural stability were significantly improved after 4 weeks of training(P≤0.05).To conclude,balance training under stroboscopic visual conditioning improves proprioception,ankle stability self-assessment,and dynamic postural stability in patients with chronic ankle instability regardless of frequency.

Under the current legal framework， living will， as an important legal tool for safeguarding patients’ autonomy and dignity， have been widely recognized and implemented in many countries and regions. In China， the promotion of living will also has a solid legal foundation， with their legitimacy reflected in several provisions of the Civil Code of the People’s Republic of China. One of the highlights of the Medical Regulations of the Shenzhen Special Economic Zone （revised in 2022） is the clarification of the legal effect of living will. To ensure that patients’ living will can be accurately implemented at critical moments， the rights and obligations of patients， family members， and healthcare professionals should be clearly defined within the legal framework， and clear guidance should be provided at every stage of implementation.

The expert consensus on the clinical treatment of herpes zoster with fire needling was developed, and the commonly used fire needling treatment scheme verified by clinical research was selected to form a standardized diagnosis and treatment scheme for acute herpes zoster and postherpetic neuralgia (PHN), so as to answer the core problems in clinical application. The consensus focuses on patients with herpes zoster, and forms recommendations for 9 key clinical issues, covering simple fire needling and TCM comprehensive therapy based on fire needling, including fire needling combined with cupping, fire needling combined with Chinese herb, fire needling combined with cupping and Chinese herb, fire needling combined with filiform needling, fire needling combined with moxibustion, and provides specific recommendations and operational guidelines for various therapies.
Humans ; Herpes Zoster/therapy* ; Acupuncture Therapy/instrumentation* ; Consensus ; Clinical Protocols

Urticarial vasculitis is a skin disease with urticaria-like lesions and a histopathological pattern of leukocytoclastic vasculitis. It is considered a "hidden rash" in traditional Chinese medicine. Xuanfu is the portal that regulates qi, blood, fluid, and the ascending, descending, exiting, and entering of nutrition qi and defensive qi. Collaterals are the pathways for the circulation of qi and blood. The two accompany each other, connecting zang-fu organs, reaching the surfaces of the skin, hair, and external body, circulating qi and fluid, and moistening and protecting the skin. Based on the theory of Xuanfu-collateral, this study aimed to clarify the etiology, pathogenesis, and treatment method of urticarial vasculitis. External assault by wind and Xuanfu blockage are believed to be the initiating factors of this disease. The malnutrition of Xuanfu and collaterals and accumulated dampness-heat are important links in the occurrence and development of urticarial vasculitis. It spreads from Xuanfu to the collaterals, and blockage of the collaterals is the immanent trend of this disease. Clinically, by closely adhering to the core pathogenesis of blockage of Xuanfu-collateral, treatment method such as using wind medicinals to open Xuanfu with pungent and dispersing properties, using the method of supplement deficiency and removing the blockage, and using medicinals to promote blood circulation and remove blood stasis to unblock the blocked collaterals. The herbs are flexibly added or subtracted to unblock Xuanfu and collaterals, harmonize qi and blood, thus all symptoms can be relieved. We hope that this study will provide new ideas for the treatment of urticarial vasculitis with traditional Chinese medicine.

Objective:To investigate the risk factors of pleural effusion after spinal separation surgery for patients with spinal metastatic tumors.Methods:A total of 427 patients with spinal metastatic tumors from January 2014 to January 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed. There were 252 males and 175 females, with an average age of 59±12 years (range, 15-87 years). All patients underwent separation surgery. Based on the chest CT within 1 month after surgery, the volume of pleural effusion was measured individually by reconstruction software. Pleural effusion was defined as small volume (0-500 ml), moderate volume (500-1 000 ml), and large volume (above 1 000 ml). Baseline data and perioperative clinical outcomes were compared between the groups, and indicators with statistically significant differences were included in a binary logistic regression analysis to determine the independent risk factors for the development of pleural effusion after isolation of spinal metastatic cancer. Receiver operating characteristic (ROC) curves were conducted to calculate the area under the curve (AUC) for each independent risk factor.Results:All patients successfully completed the operation. Among the 427 patients, there were 35 cases of large pleural effusion, 42 cases of moderate pleural effusion, and 350 cases of small pleural effusion. There were significant differences in tumor size (χ 2=9.485, P=0.013), intraoperative blood loss ( Z=-2.503, P=0.011), blood transfusion ( Z=-2.983, P=0.003), preoperative total protein ( Z=2.681, P=0.007), preoperative albumin ( Z=1.720, P= 0.085), postoperative hemoglobin ( t=2.950, P=0.008), postoperative total protein ( Z=4.192, P<0.001), and postoperative albumin ( t=2.268, P=0.032) in the large pleural effusion group versus the small and moderate pleural effusion group. Logistic regression analysis showed that decreased preoperative albumin ( OR=0.89, P=0.045) and metastases located in the thoracic spine ( OR=4.01, P=0.039) were independent risk factors for the occurrence of large pleural effusion after separation surgery. The ROC curve showed that the AUC and 95% CI for preoperative albumin, lesion location, and the combined model were 0.637 (0.54, 0.74), 0.421 (0.36, 0.48), and 0.883 (0.81, 0.92). The combined predictive model showed good predictive value. Conclusion:The volume of pleural effusion can be measured individually and quantitatively based on chest CT. Decreased preoperative albumin and metastases located in the thoracic spine are independent risk factors for the occurrence of large pleural effusion after separation surgery. The combined prediction of the two factors has better predictive efficacy.

Objective To investigate the factors affecting the number of lymph nodes obtained by unilateral lobectomy and isthmus combined with prophylactic ipsilateral central lymph node dissection for papillary thyroid cancer,and to analyze the pattern of change so as to provide an important basis for clinical treatment of papillary thyroid cancer.Methods Retrospective analysis was performed on the clinical and pathological data of 193 patients admitted to the department of Thyroid Surgery of the First Affiliated Hospital of Jinzhou Medical University from January 2019 to January 2022 for papillary thyroid cancer who underwent unilateral glandular lobe and isthmus resec-tion combined with prophylactic ipsilateral central lymph node dissection.The number of obtained lymph nodes was divided into a group with high number of obtained lymph nodes(n>6)and a group with low number of obtained lymph nodes(n≤6).Univariate analysis and multivariate analysis were used to explore the factors affecting the num-ber of obtained lymph nodes.The influence of the number of lymph nodes on the central lymph node metastasis was evaluated by correlation analysis,and the influence of the number of lymph nodes on the quality of life of patients by postoperative complications analysis.Results The number of lymph nodes obtained was positively correlated with the number of lymph node metastases in the central region(r = 0.240,P<0.05)and the rate of lymph node metastasis(r = 0.161,P<0.05),respectively.The number of lymph node metastases controlled remained unchanged,and the rate of lymph node metastasis decreased with the increase of the number of obtained lymph nodes(r =-0.444,P<0.05).Univariate analysis of the number of lymph nodes between the two groups showed no significant differences in terms of sex,age,operation duration,BMI,maximum tumor diameter,multifocality,Hashimoto's thyroiditis,focal location,capsular invasion,contralateral thyroid nodule,parathyroid transplantation and BRAF gene V600E mutation(P>0.05).There was statistical significance in the application of nano carbon between the two groups(P<0.05).Logistic binary regression analysis showed that the combination of Hashimoto's thyroiditis and the application of carbon nanoparticles were independent influencing factors for the high number of lymph nodes obtained(P<0.05).ROC curve analysis suggested that the area under the curve occupied by carbon nanoscale was 0.658(95%CI:0.580～0.735,P<0.05),and the area under the curve occupied by Hashimoto's thyroiditis was 0.584(95%CI:0.504～0.665,P<0.05).In addition,there was no significant difference in the incidence of vocal cord paralysis and lymphatic leakage between the two groups(P>0.05).Conclusions When the number of lymph nodes in the cen-tral region remained unchanged,the higher the number of lymph nodes obtained,the lower the rate of lymph node metastasis.The application of nano-carbon and patients with Hashimoto's thyroiditis could increase the number of lymph nodes obtained,and there is no significant difference in the incidence of postoperative complications between high and low number of lymph nodes obtained.

Objective:To investigate the predictive value of differential distribution of peripheral lymphocyte subsets before and after the first 131I treatment on the therapeutic response to 131I treatment in patients with papillary thyroid cancer (PTC). Methods:A retrospective study was conducted on 46 PTC patients (16 males, 30 females, age 20-77 years) who underwent total thyroidectomy and received 131I treatment between January 2021 and August 2021 in First Hospital of Shanxi Medical University. Peripheral blood lymphocyte subsets (T, B, CD4 + T, CD8 + T, natural killer (NK), helper T (Th)1, Th2, Th17, and regulatory T (Treg) cells) were measured 1-2 d before and 30 d after 131I treatment. Based on serological and imaging evidence, therapeutic response at 6-12 months post- 131I therapy was categorized as either excellent response (ER) or non-excellent response (NER). Differences of preablative stimulated thyroglobulin (psTg) and clinical baseline characteristics between two groups were assessed by using independent-sample t test, paired t test, or Mann-Whitney U test. Predictive value of lymphocyte subsets before and after 131I treatment for therapeutic response was assessed through logistic regression analysis, ROC curve analysis, and decision curve analysis (DCA). Results:In ER group ( n=33) and NER group ( n=13), most lymphocyte subsets showed different degrees of reduction 30 d after 131I treatment compared to before 131I treatment, such as T, B, CD4 + T and Th1 cells in ER group, as well as T, B, CD4 + T, Th1, Th2, Th17, and Treg cells in NER group ( t values: 2.41-9.57, all P<0.05). Before 131I treatment, NER group had significantly higher levels of psTg, Th2, Th17, and Treg cells compared to the ER group ( t values: from -3.32 to -2.48, U=29.00, all P<0.05). After 131I treatment, most of lymphocyte subsets in NER group (T, B, CD4 + T, CD8 + T, Th1 and Treg cells) showed higher trend than those in ER group but without statistical significances ( t values: from -1.12 to -0.06, all P>0.05). Th2 cells before 131I treatment (odds ratio ( OR)=25.00, 95% CI: 1.36-459.10, P=0.030) was identified as a risk factor for NER. ROC curve analysis indicated that AUCs of psTg and Th2 cells for predicting therapeutic response were 0.932 and 0.790, respectively, which was 0.958 for the combined psTg and Th2 cells. DCA showed that within the threshold probability range of 10%-60%, the curves for psTg, Th2 cells, and the combined psTg and Th2 cells were all higher than the extreme curve, suggesting good effect. Conclusions:Most lymphocyte subsets decrease to varying degrees, and NER group shows a significant decrease 30 d after 131I treatment. Th2 cells may be a risk factor for poor response to 131I treatment, providing a certain value in predicting the therapeutic response to 131I treatment.

Objective:To investigate the efficacy of the intelligent version of the Montreal Cognitive Assessment Scale(MoCA)in identifying mild cognitive impairment(MCI)in elderly inpatients.Methods:Seventy-five patients diagnosed with mild cognitive impairment(MCI group)from the Neurology and Geriatrics Departments of a tertiary hospital in Changsha City, along with 195 patients with normal cognitive function(normal control group), were selected between July 2020 and December 2022.Both groups underwent evaluations using the intelligent version of the Montreal Cognitive Assessment(MoCA)and the Mini Mental State Examination(MMSE), and the results were analyzed.Results:The MCI group showed significantly lower total MoCA scores and MMSE scores[(19.73±2.42) vs.(24.8±2.33)]compared to the normal control group[(24.47±2.02) vs.(26.50±1.65)], with a statistically significant difference( P<0.01).The optimal cut-off score for the MoCA was found to be 23.5 points in diagnosing MCI, showing higher sensitivity, specificity, and kappa value(96.0%, 82.1%, and 0.690)compared to the MMSE scale(90.0%, 62.6%, and 0.428). Conclusions:The intelligent MoCA has a high screening accuracy for identifying MCI in this population, demonstrating superior sensitivity and specificity compared to the MMSE.