Spleen-stomach damp-heat syndrome is currently the most prevalent TCM pattern in patients with chronic atrophic gastritis (CAG), with internal damp-heat accumulation regarded as a key factor contributing to its prolonged and refractory course. This syndrome represents a critical stage in the progressive pathogenesis of CAG, characterized by a deepening pathological evolution. Modern TCM practitioners generally agree that its core pathogenesis lies in "deficiency in root and excess in superficiality, with internal damp-heat retention", and emphasize a treatment strategy that combines eliminating pathogenic factors and reinforcing the body's healthy qi through dynamic syndrome differentiation. Chinese materia medica used in treating CAG with spleen-stomach damp-heat syndrome can effectively relieve clinical symptoms, improve the internal damp-heat environment, mitigate gastric mucosal atrophy and intestinal metaplasia, and delay the inflammation-to-cancer transformation. Its mechanisms may involve eradication of Helicobacter pylori, repair of gastric mucosal injury, regulation of immune inflammatory response and other aspects, which has the advantages of multi-channel and multi-target.

Objective To compare the safety of laparoscopic pancreatoduodenectomy(LPD)and open pancreatoduodenectomy(OPD)and analyze the learning curve and safety at different stages of LPD.Methods A retrospective analysis was conducted on the clinical data of 50 LPD patients and 54 OPD patients in the Department of Hepatopancreatobiliary Surgery of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2024,and intraoperative and postoperative conditions were compared.The Cumulative Sum(CUSUM)analysis method was used to analyze the technical nodes of the LPD learning curve.Results There were no significant differences in operation time and intraoperative blood loss between the LPD group and the OPD group(P＞0.05).There was also no significant difference in the incidence rates of pancreatic fistula(grade B and C),delayed gastric emptying,postoperative bleeding,biliary fistula and intra-abdominal infection between the LPD group and the OPD group(P＞0.05).A time series plot of operation time was drawn based on the patient's operation time and surgical sequence,yielding a fitted curve.Curve analysis showed initial stage and stable stage were finished at the 17th and 24th cases.The LPD learning curve could be divided into three stages:stage Ⅰ characterized as the initial stage(cases 1 to 17),stage Ⅱ characterized as the stable stage(cases 18 to 24),and stage Ⅲ characterized as the proficient stage(cases 25 to 50).The operation time in stages Ⅱ and Ⅲ was significantly shorter than that in stage Ⅰ,and the intraoperative blood loss in stage Ⅰ was significantly higher than that in stage Ⅲ(P＜0.05).There was no significant difference in the incidence of complications among the three stages(P＞0.05).Conclusion LPD and OPD show no significant differences in indications and safety.The LPD learning curve can be divided into three stages.As the number of surgeries completed increa-ses,the operation time of physicians gradually shortens,and the incidence of complications of patients gradually decreases.

Objective:To investigate long-term auditory changes and characteristics of Alport syndrome（AS） patients with different degrees of renal injury. Methods:Retrospectively analyzing clinical data of patients diagnosed AS from January 2007 to September 2022, including renal pathology, genetic detection and hearing examination. A long-term follow-up focusing on hearing and renal function was conducted. Results:This study included 70 AS patients, of which 33（25 males, 8 females, aged 3.4-27.8 years） were followed up, resulting in a loss rate of 52.9%.The follow-up period ranged from 1.1to 15.8 years, with 16 patients followed-up for over 10 years. During the follow-up, 10 patients presenting with hearing abnormalities at the time of diagnosis of AS had progressive hearing loss, and 3 patients with new hearing abnormalities were followed up, which appeared at 5-6 years of disease course. All of which were sensorineural deafness. While only 3 patients with hearing abnormalities among 13 patients received hearing aid intervention. Of these patients,7 developed end-stage renal disease（ESRD）, predominantly males （6/7）. The rate of long-term hearing loss was significantly different between ESRD group and non-ESRD group（P=0.013）. There was no correlation between the progression of renal disease and long-term hearing level（P>0.05）. kidney biopsies from 28 patients revealed varying degrees of podocyte lesion and uneven thickness of basement membrane. The severity of podocyte lesion was correlated with the rate of long-term hearing loss（P=0.048）, and there was no correlation with the severity of hearing loss（P>0.05）. Among 11 cases, theCOL4A5mutationwas most common （8 out of 11）, but there was no significant correlation between the mutation type and hearing phenotype（P>0.05）. Conclusion:AS patients exhibit progressive hearing loss with significant heterogeneity over the long-term.. THearing loss is more likely to occur 5-6 years into the disease course. Hearing abnormalities are closely related to renal disease status, kidney tissue pathology, and gene mutations, emphasizing the need for vigilant long-term hearing follow-up and early intervention.
Male ; Child ; Female ; Humans ; Nephritis, Hereditary/pathology* ; Retrospective Studies ; Kidney ; Deafness ; Hearing Loss/genetics* ; Kidney Failure, Chronic/pathology* ; Mutation

Objective To investigate the relationship between interleukin-1β (IL-1β) and miR-185-5p in the process of joint injury in acute gouty arthritis (AGA). Methods The serum miR-185-5p levels of 89 AGA patients and 91 healthy volunteers were detected by real-time quantitative PCR. The correlation between miR-185-5p expression level and VAS score or IL-1β expression level was evaluated by Pearson correlation coefficient method. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of miR-185-5p in AGA. THP-1 cells were induced by sodium urate (MSU) to construct an in vitro acute gouty inflammatory cell model. After the expression level of miR-185-5p in THP-1 cells was upregulated or downregulated by transfection of miR-185-5p mimics or inhibitors in vitro, inflammatory cytokines of THP-1 cells, such as IL-1β, IL-8 and tumor necrosis factor α (TNF-α), were detected by ELISA. The luciferase reporter gene assay was used to determine the interaction between miR-185-5p and the 3'-UTR of IL-1β. Results Compared with the healthy control group, the expression level of serum miR-185-5p in AGA patients was significantly reduced. The level of serum miR-185-5p was negatively correlated with VAS score and IL-1β expression level. The area under the curve (AUC) was 0.905, the sensitivity was 80.17% and the specificity was 83.52%. Down-regulation of miR-185-5p significantly promoted the expression of IL-1β, IL-8 and tumor necrosis factor (TNF-α), while overexpression of miR-185-5p showed the opposite results. Luciferase reporter gene assay showed that IL-1β was the target gene of miR-185-5p, and miR-185-5p negatively regulated the expression of IL-1β. Conclusion miR-185-5p alleviates the inflammatory response in AGA by inhibiting IL-1β.
Humans ; 3' Untranslated Regions ; Arthritis, Gouty/genetics* ; Interleukin-1beta/genetics* ; Interleukin-8 ; Luciferases ; MicroRNAs/genetics* ; Tumor Necrosis Factor-alpha

Following the principles of evidence-based medicine,in accordance with the structure and drafting rules of standardized documents,based on literature research,according to the characteristics of chronic cough in children and issues that need to form a consensus,the TCM Guidelines for Diagnosis and Treatment of Chronic Cough in Children was formulated based on the Delphi method,expert discussion meetings,and public solicitation of opinions.The guideline includes scope of application,terms and definitions,eti-ology and diagnosis,auxiliary examination,treatment,prevention and care.The aim is to clarify the optimal treatment plan of Chinese medicine in the diagnosis and treatment of this disease,and to provide guidance for improving the clinical diagnosis and treatment of chronic cough in children with Chinese medicine.

This paper summarized Professor ZHUANG Lixing's clinical experience in differentiating and treating levodopa-induced dyskinesia （LID） in Parkinson's disease. It is believed that the fundamental pathogenesis of LID lies in the disharmony or malnourishment of tendons and vessels. Based on the clinical manifestations， peak-dose LID is differentiated into two syndromes： syndrome of hyperactive liver yang causing wind and syndrome of deficiency of both liver and kidney. For the syndrome of hyperactive liver yang causing wind， the treatment focuses on calming the liver to stop the wind， and relaxing the tendons to stop tremors. The main prescription used is Zhengan Xifeng Decoction （镇肝熄风汤） with the addition of Shijueming （石决明） and Zhenzhumu （珍珠母）. For the syndrome of deficiency of both liver and kidney， the treatment focuses on nourishing the liver and kidneys， and replenishing yin to stop the wind. The main prescription used is Dabuyin Pills （大补阴丸） with modification. LID in the acoustic phase is differentiated into syndrome of phlegm-damp blocking middle jiao and syndrome of deficiency of both qi and yin. For the syndrome of phlegm-damp blocking middle jiao， the treatment focuses on dissipating phlegm and eliminating dampness， and nurturing tendons and vessels. Wendan Decoction （温胆汤） or Erchen Decoction （二陈汤） with modification is used. For the syndrome of deficiency of both qi and yin， the treatment focuses on replenishing qi and nourishing blood， and nurturing tendons and vessels. The main prescriptions used are Buzhong Yiqi Decoction （补中益气汤） or Bazhen Decoction （八珍汤） or Shenling Baizhu Powder （参苓白术散） with modification. Biphasic LID is differentiated as the Shaoyang pivot disadvantageousness， and the treatment focuses on harmonizing Shaoyang and regulating the pivot. The main prescription used is Xiaochaihu Decoction （小柴胡汤） with modification.

Objective:To construct and validate a risk prediction model for work-related musculoskeletal disorders (WMSDs) among nurses, so as to provide a scientific and objective reference tool for the screening of high-risk groups of WMSDs among nurses.Methods:This study was a cross-sectional study. From March to July 2021, convenience sampling was used to select 1 050 nurses from 25 hospitals in Beijing as the research subject. The risk factors for WMSDs were evaluated by issuing the Musculoskeletal Disease Questionnaire. All survey subjects were randomly divided into the training set ( n=715) and the validation set ( n=304) according to the ratio of 7∶3, and the training set was used to build the model. The predictive ability of the risk model was evaluated using the area under receiver operating characteristic curve (AUC) and the validation set was used for validation. A total of 1 050 questionnaires were distributed and 1 019 valid questionnaires were recovered, with a valid recovery rate of 97.05%. Results:Among 1 019 nurses, the weekly incidence of WMSDs was 84.0% (856/1 019) and the annual incidence was 86.7% (883/1 019) . The neck was the site with the highest incidence of WMSDs, the weekly incidence and annual incidence were 70.3% (716/1 019) and 70.1% (714/1 019) , respectively. The results of multivariate Logistic regression analysis showed that the risk factors of the weekly incidence of WMSDs among nurses included age ≥40 years old ( P<0.001) , tense work atmosphere ( P<0.001) , forward neck posture ( P=0.002) , doing the same job daily ( P=0.039) , needing to dealing with patients ( P=0.012) and keeping the back in the same posture for a long time ( P=0.002) , and the risk factors of the annual incidence of WMSDs among nurses included age ≥40 years old ( P=0.001) , did not participation in safety protection training ( P=0.003) , high education ( P=0.041) , stressful work atmosphere ( P=0.005) , significantly forward neck posture ( P=0.008) , needing to dealing with patients frequently ( P=0.001) , work involving cold or temperature changes ( P=0.017) , insufficient rest time ( P=0.019) , frequent shift change ( P=0.035) , frequent repetition of the same action of the trunk at work ( P=0.025) , hand bending ( P=0.006) . Based on the above screening variables, a nomogram model was established to predict the risk of weekly and annual incidence of WMSDs among nurses, and the AUC values of the model in the training set were 0.794 [95% CI: (0.750-0.838) ] and 0.789 [95% CI: (0.718-0.860) ], respectively. The validation set further confirmed the predictive ability of the nomogram model. The AUC values for predicting the risk of weekly and annual incidence of WMSDs among nurses were 0.782 [95% CI: (0.729-0.835) ] and 0.794 [95% CI: (0.721-0.868) ], respectively. Conclusions:The nomogram model has good predictive ability for the occurrence risk of WMSDs among nurses, which can help to screen high-risk groups and give effective intervention in time.

A type of designated hospitals in Medicare is referred to as Long-Term Care Hospital (LTCH). LTCH is one of Post-Acute Care settings(I. e. Intermediate care)and the only facilities certified by length of stays. This article reviewed the milestones and payment methods of Medicare Long-Term Care Hospital payment system, for perfection of the medical insurance and construction of China′s intermediate care system.

Objective To sort out the functional composition of the official App of a tertiary general hospital, and its usage. Methods Taking the tertiary general hospitals identified from the national hospital quality monitoring system as the research objects, statistically analyzing their functional composition, and comparing the App and WeChat public platform of two hospitals as examples.In addition, collecting relevant data from the official website of the hospital, and analyzing the influencing factors of its download and usage with multiple linear regression methods. Results There were 469 tertiary general hospitals nationwide, of which 137 had official Apps, with an accessibility rate of 29.21%.The accessibility rated in the eastern, central and western regions were 27.85% , 13.48% and 17.43% respectively.Hospital App prioritized in turn appointment registration (94.9% ), test report ( 76.8% ), and hospital navigation ( 71.7% ). The development of the hospital App in the eastern region taked the lead compared to the middle and western ones.The App′s score and the total outpatient visits of hospital had a positive impact on the download and use of the hospital App.The App′s scoring had a noteworthy impact. Conclusions Hospitals should enable to innovate their services, and highlight their characteristics.App should optimize its interface, improve its functions, enhance the interconnection of App functions, strengthen data security management, strengthen its publicity and expand its influence.

Objective To investigate whether advanced glycation end products (AGEs) can induce the expression of Ros,JC-1 and its apoptosis-related proteins in glomerular mesangial cells under high glucose environment,induce apoptosis and injury of glomerular mesangial cells.Methods Rat glomerular mesangial cell line HBZY-1 was cultured in vitro.The cells were cultured with different concentrations of AGEs for 0,12,24 and 48 hours respectively.MTT assay was used to observe the cell proliferation ability.After the optimal time and concentration of AGEs were selected,the caspase enzyme inhibitor Z-VAD-fmk and reactive oxygen species (ROS) scavenger N-acetyl-L-cysteine (NAC) were cultured and the apoptosis rate was detected by cell death detection apoptosis ELISA plus and Annexin V-FITC/PI kit.JC-1 staining was used to detect the changes of mitochondrial membrane potential (MMP).Cell ROX deep red flow cytometry was used to detect the total ROS level.The expression of anti-apoptotic protein Bcl-2,pro-apoptotic protein BAX,caspase-9,caspase-3 and poly ADP-ribose polymerase (PARP)-activated fragments was detected by Western blotting.Results AGEs could decrease the activity of glomerular mesangial cells in a time and concentration-dependent manner,and induce cell death.The percentage of apoptotic cells in glomerular mesangial cells was significantly increased after treatment with 250 mg/L AGEs for 24 h (P ＜ 0.01),and Z-VAD-fmk could significantly alleviate AGEs-induced glomerular mesangial cell apoptosis (P ＜ 0.01).Compared with the control group,AGEs increased the level of intracellular reactive oxygen species and decreased MMP in a time-dependent manner,and the two time points that AGEs significantly caused the change were 1 h and 2 h (all P ＜ 0.01).AGEs also reduced the expression of antiapoptotic protein Bcl-2 and increased the expression of pro-apoptotic protein Bax,cleaved caspase-9,cleaved caspase-3 and cleaved PARP (all P ＜ 0.01).Compared with AGEs group,NAC could significantly stabilize MMP (P ＜ 0.01),increase Bcl-2 expression (P ＜ 0.01),and decrease the expression of BAX,cleaved caspase-9,cleaved caspase-3 and cleaved PARP (all P ＜ 0.01).Conclusion AGEs induce mitochondrial pathway apoptosis in glomerular mesangial cells by increasing intracellular ROS level and destroying MMP.