It is proposed that although allergic rhinitis manifests primarily in the nasal orifices， its root lies in deficiency of the lung and spleen and insecurity of the lung defensive qi， while deficiency of healthy qi with latent pathogen， triggering by external stimuli， and constraint of defensive yang constitute the key pathogenesis. The onset of disease is not caused solely by newly contracted external pathogens. Rather， on the basis of insecurity of the lung-defense qi， external stimuli such as wind-cold and abnormal qi， dust mites， pollen， and sudden climatic changes， activate the latent pathogen， resulting in constraint of defensive yang， disharmony between nutritive and defensive qi， impaired diffusion of lung qi， failure to contain body fluids， and dysfunction of the nasal orifices. The disease progression can be summarized as following steps， deficiency of healthy qi with latent pathogen， activation by external stimuli， constraint of defensive yang， dysfunction of the nasal orifices， incomplete elimination of the pathogen and incomplete recovery of healthy qi. The general therapeutic principle is to consolidate the defensive qi and vent the latent pathogen while regulating the lung and nasal orifices simultaneously. The empirical prescription Xingui Fangzhi Decoction （辛桂防芷汤） is used as the basic formula and modified dynamically according to the attack and remission stages. During the attack stage， treatment focuses on dispelling wind and cold， regulating defensive qi， and venting the latent pathogen； during the remission stage， it emphasizes supplementing qi， consolidating the defensive exterior， and reinforcing the spleen to resolve the latent pathogen.

Taking the theory of zang-qiao （脏窍， viscera and orifices） as the framework， this paper elaborates on the connotation and expression of the holistic concept of zang-qiao. It expounds the concept from two dimensions， which are "integration of viscera and orifices" and "integration of the seven orifices"， and explains the diagnostic and therapeutic approach characterized by "inferring the condition of the viscera through the orifices and conducting comprehensive diagnosis" in the context of ear， nose， pharynx and larynx diseases. Moreover， it explores specific therapeutic strategies for orifice-related diseases in otorhinolaryngology， including treatment of the orifices via viscera， simultaneous treatment of viscera and orifices， and external therapies targeting the orifices， which provides a multidimensional thinking model and practical path for clinical diagnosis and treatment.

Objective To investigate the correlation between ITPKB mutation's variant allele frequency (VAF) and prognosis of diffuse large B-cell lymphoma (DLBCL). Methods This study included 155 patients with DLBCL initially diagnosed in the People's Hospital of Xinjiang Uygur Autonomous Region from June 2014 to December 2020. Paraffin-embedded tumor tissue specimens were obtained, and tumor tissue DNA was extracted. A total of 475 hotspot genes including ITPKB were detected by the next generation sequencing to analyze the relationship of the VAF of high-frequency mutant gene with progression-free survival (PFS) and overall survival (OS). Results The mutation frequency of ITPKB was 18.71%. The PFS was significantly shorter in the patients with ITPKB mutations than in those without mutations (37 months vs. 108 months; HR=1.643, 95%CI: 0.920-2.934, P=0.093). The R-language based web tool was used to find the best VAF cutoff to differentiate prognosis. The patients were divided into two groups (VAF High vs. VAF Low+Wt) according to their VAF values. The optimal VAF threshold for ITPKB was 27.48% (HR=3.480, 95%CI: 1.70-7.13, P=0.00027). Multivariate Cox analysis was conducted using clinical indicators such as age, gender, COO classification, IPI, and LDH, and the results showed that PFS was associated with high ITPKB VAF (≥28%) (HR=3.592, 95%CI: 1.738-7.425, P < 0.001) which was an independent adverse predictor of PFS. Conclusion The high load of ITPKB mutation is an independent risk factor for the PFS of patients with DLBCL, and the VAF of ITPKB mutation has a prognostic predictive value for patients with DLBCL.

Background: High-dose dual therapy (HDDT) is a novel regimen for the eradication of Helicobacter pylori (Hp) infection, however, its efficacy and safety remain unclear. Aims: To evaluate the efficacy, safety and compliance of HDDT for Hp eradication. Methods: Randomized controlled trials (RCTs) on HDDT for eradication of Hp infection were retrieved from PubMed, Embase, The Cochrane Library, Web of Science from the date of database establishment to October 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the data were extracted. RevMan 5.2 software was used for performing meta-analysis. Results: Nine RCTs including 2 627 patients were included. Meta-analysis results showed that no significant differences in ITT eradication (85.4% vs. 79.8%, RR=1.03, 95% CI: 0.96-1.10, P=0.40), PP eradication (88.7% vs. 83.4%, RR=1.01, 95% CI: 0.95-1.08, P=0.68), and compliance (96.5% vs. 95.9%, RR=1.01, 95% CI: 0.99-1.02, P=0.37) were found between HDDT and the guideline-recommended regimens, however, the incidence of adverse events was significantly decreased in HDDT (15.3% vs. 27.0%, RR=0.57, 95% CI: 0.42-0.76, P=0.000 2). Conclusions: There are no significant differences in eradication rates and compliance between HDDT and the guideline-recommended regimens, however, HDDT is much safer.

This paper is to clarify the concept of caregiver mutuality,introduce the main measuring tools of caregiver mutuality,analyze its influencing factors and its impact on caregivers. It elaborates the intervention measures of caregiver mutuality,in order to provide basis for better research.

Objective:To explore the mutuality among main caregivers of pancreatic cancer patients with surgery, and its correlations with the perceived social support and resilience.Methods:From March to July 2019, this study selected 150 main caregivers of pancreatic cancer patients with surgery of the First Affiliated Hospital with Nanjing Medical University as subjects by convenience sampling. All of patients were investigated with the General Information Questionnaire, the Mutuality Scale (MS) , Perceived Social Support Scale (PSSS) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) . A total of 150 questionnaires were sent out and 144 valid of them were collected.Results:Among 144 main caregivers of pancreatic cancer patients after surgery, the total average score of MS was (2.75±0.73) . Pearson correlation analysis results showed that the mutuality of main caregivers had positive correlations with the perceived social support and resilience with statistical differences ( P<0.05) . Hierarchical regression analysis showed that the genders, income, perceived social support and resilience went into the regression equation; except for the general information, the perceived social support and resilience could explain 24.5% of the variation. Conclusions:Main caregivers of pancreatic cancer patients with surgery have the above medium level of mutuality which has close correlations with the perceived social support and resilience. Medical staff should pay attention to maintaining the positive relations between caregivers and patients so as to promote the physical and mental health of caregivers.

Objective:To systematically evaluate and summarize the real care experience of family caregivers of pancreatic cancer patients.Methods:We searched The Cochrane Library, Joanna Briggs Institute (JBI) , PubMed, Embase, Institute for Scientific Information (ISI) Web of Science, PsycINFO, CINAHL, China Biology Medicine, China National Knowledge Infrastructure (CNKI) and VIP databases through computer systems to collect qualitative studies on care experience of family caregivers of patients with pancreatic cancer, and the search time was from the database establishment to October 2019. With reference to the Critical Appraisal Tool of Australian JBI Evidence-based Health Care Center (2016) for qualitative research, the collection integration method was used to integrate the existing conclusions.Results:A total of 7 literatures were included, and 44 complete and defined findings were extracted. The similar results were summarized into 10 new categories, and were combined into two integrated results including that the family caregivers of patients with pancreatic cancer experienced self-adjustment and showed positive feelings and responses during care, and they still faced difficulties and challenges in care which affecting their life trajectory.Conclusions:Family caregivers of patients with pancreatic cancer have both negative and positive experiences throughout the care process. Medical staff should be committed to promoting the growth of the personal role of caregivers, adapting and coping, and addressing the existing unmet needs.

Objective To investigate the surgical outcomes of one-stage repair of the ankle fracture combined with grade Ⅲ injury to the lateral ligament.Methods From April 2015 to December 2017,23 patients with ankle fracture and lateral ligament injury were treated at Department of Traumatic Reconstruction Surgery/Foot and Ankle Surgery,Zhongnan Hospital.There were 15 males and 8 females,aged from 18 to 65 years (average,37.8 years).After intraoperative treatment of their fractures,22 ruptures of the ligamentous insertion were repaired with suture anchor and one rupture of the middle ligament with Internal Brace.Routine postoperative X-rays,physical examination and Sefton grading system were used to evaluate the stability of the ankle joint and the subtalar joint.The Karlsson-Peterson and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the function and pain of the ankle.Results The follow-up for this cohort ranged from 12 to 24 months (average,13.9 months).The bone union time ranged from 6 to 24 weeks,averaging 10.1 weeks.There was no chronic instability of lateral ankle or subtalar joint in all the cases.Two cases developed osteochondral lesion of the medial talus which was treated with micro-fracture surgery one year after injury;one case suffered subtalar arthritis which was treated by subtalar arthrodesis 14 months after injury.Their Karlsson-Peterson scores averaged 84.6 points and AOFAS ankle-hindfoot scores 93.7 points with 19 excellent and 4 good cases.The Sefton grading system gave 9 cases of grade Ⅰ and 14 ones of grade Ⅱ.Conclusion One-stage repair of the ankle fracture combined with grade Ⅲ injury to the lateral ligament can lead to the stability of the ankle joint and the subtalar joint and improved function of the ankle.

Objective Microneedle fractional radiofrequency (MFR) is a novel method for reju-venation that combines radiofrequency and microneedles .The aim of this study was to evaluate pro-spectively the efficacy and safety of MFR in the treatment of facial photoaging .Methods Between De-cember 2017 and December 2018 ,a total of 24 female subjects with facial photoaging aged 45 to 60 (45 .9 ± 8 .7)years ,the course of 1 to 20 (8 .88 ± 5 .06) years ,were collected from the Department of Dermatology ,Pepole's Hospital of Xinjiang Uygur Autonomous Region .They received 3 treatments at 4-week intervals .Global scores for photoaging (GSP) were evaluated at baseline ,after 1 treatment and 3 treatments respectively .Facial wrinkles ,skin texture ,pigmentation ,telangiectasia ,and skin tightness were evaluated by the 4-point method after 1 treatment and 3 treatments respectively .Visual analogue scale (VAS) was used for self-assessment of pain during treatment .At the third treatment self assessment on the degree of satisfaction with therapeutic effects was conducted in subiects .The adverse reactions were evaluated at every treatment immediately and the third day and seventh day .Results The GSP score of 24 subjects before treatment was (2 .83 ± 0 .92) ,(2 .25 ± 0 .95) after 1 treatment ,and (1 .67 ± 0 .48) after 3 treatments .The difference between before and after 1 treatment was statistically significant (t = 2 .17 , P < 0 .05) ,and between before and after 3 treatments , the difference was statistically significant (t = 5 .52 , P < 0 .05) .There were statistically significant differ-ences in facial wrinkles ,skin texture and skin tightness improvement scores between the first treat-ment and the third treatment (t = 5 .48 ,3 .88 ,5 .46 , P < 0 .05) .There were statistically significant differences in pigmentation and telangiectasia scores between the first treatment and the third treat -ment (t = 2 .46 and 2 .17 ,P < 0 .05) .After the third treatment ,the VAS value was 3 .2 ± 1 .2 ,indica-ting mild to moderate pain .The total satisfactory rate of the 24 subjects was 83 .33％ .The subjects had no adverse reactions .Conclusions MFR can effectively improve the symptoms of facial photoaging without obvious adverse reactions .

Background:Serum pepsinogens (PGs),as a serologic marker for gastric mucosal lesions,can reflect the functional status of gastric mucosa. Helicobacter pylori (Hp)infection can cause pathological changes in gastric mucosa,and has been reported to influence the serum level of PGs. Aims:To explore the influence of Hp infection on diagnostic performance of serum PGs for gastric mucosal lesions. Methods:The endoscopic findings,biopsy pathology (including Giemsa staining) and serum PGs test in 1216 cases of patients from July 2014 to June 2015 at the First Affiliated Hospital of Jiaxing University were collected. Patients were categorized according to the pathological diagnosis and Hp status,and the results of serum PGs test were analyzed between different groups. Results:When patients were classified by gastric mucosal lesion,no significant differences were found in serum levels of PGⅠ,PGⅡ,ratio for PGⅠ/ Ⅱ (PGR)and proportion of PG-positive (PGⅠ≤70 μg/ L and PGR < 3. 0)patients of different mucosal lesion groups with Hp-positive status (P >0. 05),whereas significant differences were observed in serum levels of PGⅠ,PGⅡ,PGR and proportions of patients with PGⅠ≤70 μg/ L or PGR < 3. 0 of different mucosal lesion groups with Hp-negative status (P < 0. 05). When patients were classified by Hp status,PGⅠ level and PGR were lower and PGⅡ level and proportion of PG-positive patients were higher in Hp-positive patients than in Hp-negative patients in any of the gastric mucosal lesion groups (P < 0. 05 in part of the comparisons). Conclusions:Hp infection is strongly associated with the alterations in serum PGs test,which narrows the differences in PGs between groups with different gastric mucosal lesions and expands that within the same mucosal lesion, subsequently decreasing PGR and increasing the proportion of PG-positive patients. Patients negative for Hp infection may need new cut-off value of serum PGs test to improve the sensitivity for diagnosis of gastric mucosal lesion.