ObjectiveTo observe the clinical efficacy and safety of Sizi Powder （四子散， SP） orientation osmotherapy in the treatment of stroke patients with hemiplegia. MethodsIn this study， 94 patients with post-stroke hemiplegia were randomly divided into a control group and a treatment group with 47 patients in each group. The control group received conventional treatment， nursing and rehabilitation training， while the treatment group was treated with SP orientation osmotherapy in addition to the treatments in the control group. The treatment consisted of 20 minutes per session， once daily， 5 times a week， 2 weeks per course， with a total of 2 courses. Before the intervention， after 2 weeks intervention and after 4 weeks intervention， the upper limb motor function was evaluated by using the Fugl-Meyer Assessment （U-FMA）. The modified Ashworth Scale （MAS） was used to assess upper limb spasticity， and joint range of motion was measured for shoulder flexion， extension， abduction， internal rotation， external rotation， elbow flexion， wrist palmar flexion， dorsiflexion， ulnar deviation， and radial deviation. Clinical efficacy for spasticity was evaluated after 2 and 4 weeks of treatment. Skin conditions， including burns， allergic reactions， and blisters， were monitored during the treatment process. ResultsA total of 44 patients in the treatment group and 45 patients in the control group completed the study. The results showed that after 2 and 4 weeks of intervention， the U-FMA scores of both groups increased， with the treatment group showing higher scores than the control group （P＜0.05）. After 4 weeks of treatment， the MAS score distribution improved significantly in both groups （P＜0.05）， although no significant difference was found between the groups after 2 and 4 weeks treatment（P＞0.05）. The total effective rate of spasticity clinical efficacy in the treatment group after 2 and 4 weeks was 15.91% （7/44） and 40.91% （18/44）， respectively， while in the control group， it was 11.11% （5/45） and 22.22% （10/45）. There was no significant difference after 2 weeks treatment （P＞0.05）， but the treatment group showed a significantly higher total effective rate after 4 weeks treatment （P＜0.05）. After 2 and 4 weeks of treatment， the joint range of motion in the upper limbs was greater in both groups （P＜0.05）. After 2 weeks of intervention， the treatment group showed greater range of motion in shoulder flexion， extension， and abduction than the control group， and after 4 weeks of intervention， the treatment group demonstrated greater range of motion in shoulder flexion， extension， abduction， internal rotation， external rotation， and elbow flexion compared to the control group （P＜0.05）. During the treatment， one patient in the treatment group experienced mild skin allergy， while no other severe adverse reactions， such as intense pain， itching， blisters， or infection， were observed in any patients. ConclusionSP orientation osmotherapy can effectively improve upper limb motor function and joint range of motion in stroke patients with hemiplegia. After 4 weeks of treatment， it can reduce upper limb spasticity and improve clinical efficacy， with good safety.

Objective To analyze the trajectory of cardiovascular health score and its influencing factors in patients with CHD after PCI based on LCGM.Methods A total of 186 CHD patients undergoing PCI in our hospital from June 2021 to June 2023 were enrolled,and all of them re-ceived an assessment for cardiovascular health scores.LCGM analysis was performed on the change in their postoperative cardiovascular health scores.Multivariate logistic regression analysis was applied to identify the factors affecting the trajectory of the change in the scores of the patients.Results The cardiovascular health score was 6.34±1.38,6.76±1.44,7.49±1.85,and 8.06±2.07,respectively on the day of,and at 1,6 and 12 months after surgery.There were signifi-cant differences in the score among different time points(F=37.167,P＜0.01).LCGM model constructed by quadratic estimation showed that the trajectory of the cardiovascular health score in CHD patients after PCI could be divided into three types:growth type(98 cases,52.69％),sta-ble type(67 cases,36.02％)and volatile type(21 cases,11.29％).Statistical difference was ob-served in the score among the post-PCI CHD patients with different education level,per capita monthly family income,duration of coronary artery disease,and number of comorbid chronic dis-eases(P＜0.05,P＜0.01).The education level,per capita monthly family income,duration of cor-onary heart disease,and number of comorbid chronic diseases were all influencing factors for the trajectory of cardiovascular health score in the CHD patients after PCI(P＜0.01).Conclusion There are three types of trajectory in cardiovascular health score of CHD patients after PCI.Edu-cation level,family per capita monthly income,duration of coronary heart disease and number of chronic diseases are independent factors affecting the score of the patients.

OBJECTIVE To investigate the expression and clinical significance of Periostin in tissues of patients with chronic rhinosinusitis(CRS).METHODS Real-time quantitative PCR and immunohistochemistry were used to detect periostin expression in eosinophilic CRS with nasal polyps(ECRSwNP),non-eosinophilic CRS with nasal polyps(non-ECRSwNP),CRS without nasal polyps(CRSsNP),and control tissues.Correlations between periostin levels and blood eosinophil percentage(Eos%),Lund-Mackay score,modified endoscopic score,and Japanese epidemiological survey of refractory eosinophilic chronic rhinosinusitis(JESREC)score were analyzed.Additionally,changes in SNOT-22 and VAS scores were compared at different preoperative and postoperative times.The predictive value of periostin for ECRSwNP was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Periostin expression was detected in all groups(ECRSwNP,non-ECRSwNP,CRSsNP,and controls),with predominant localization in the basement membrane and mucosal subepithelial lamina propria.Significantly elevated periostin levels were detected in the ECRSwNP group compared to the other three groups(P<0.001).Furthermore,Periostin mRNA expression showed significant positive correlations with blood Eos%,JESREC score,and Lund-Mackay score.SNOT-22 and VAS scores were significantly elevated in the ECRSwNP group at preoperative evaluation and 9 months postoperatively(P<0.001).ROC curve analysis demonstrated that periostin had a substantial predictive value for ECRSwNP(AUC=0.957).CONCLUSION Periostin plays a crucial role in the pathogenesis of chronic rhinosinusitis,contributing to the diagnosis,severity assessment,and prognosis evaluation of ECRSwNP,while offering potential therapeutic targets for CRS management.

OBJECTIVE To compare the expression characteristics of transforming growth factor-β1(TGF-β1),Smad2,Smad3,and epithelial-mesenchymal transition(EMT)-related markers(E-cadherin,N-cadherin,vimentin)in patients with different types of chronic sinusitis(CRS),to analyze the correlations of E-cadherin,N-cadherin and vimentin with TGF-β1 and the prognosis of surgical treatment in patients with different types of CRS.METHODS The expressions of E-cadherin,N-cadherin,vimentin,TGF-β1,Smad2 and Smad3 in patients with different types of CRS and the control group were compared by Western blotting(WB)and real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).Analyze its correlation with the improvement degree of each clinical score after the operation.RESULTS Compared with the control group,the expression of E-cadherin decreased in the CRSsNP group,the non-ECRSwNP group and the ECRSwNP group,while the expressions of vimentin and N-cadherin increased.The protein expression of TGF-β1 in the CRSsNP group was higher than that in the non-ECRSwNP group and the control group(P<0.001),and the expressions of Smad2 and Smad3 in the CRSsNP group were higher than those in the ECRSwNP group,the non-ECRSwNP group and the control group(P<0.001).In the CRSsNP group,there was a positive correlation between TGF-β1 and vimentin(r=0.675,P=0.011),and a negative correlation with E-cadherin(r=-0.802,P=0.001).The expression of E-cadherin was negatively correlated with the improvement amplitude of SNOT-22 nasal symptom scores in patients with different types of CRS(P<0.05).CONCLUSION The EMT phenomenon occurs in different types of CRS.In CRS SNPS,EMT may be related to the TGF-β1/Smad signaling pathway.The expressions of EMT markers E-cadherin,N-cadherin and vimentin are correlated with the decrease in the severity of postoperative disease in patients with CRS,suggesting a potential association between the EMT process and the surgical prognosis of patients with CRS.

Objective To investigate the status of coexistence with cancer in young and middle-aged patients with hepatocellular carcinoma(HCC)after receiving interventional therapy,and to analyze the factors influencing the status of coexistence with cancer.Methods Using convenience sampling method,a total of 189 young and middle-aged patients with HCC,who were admitted to a certain grade Ⅲ-A hospital in the Guangxi Zhuang Autonomous Region of China from October 2023 to January 2024,were selected and used as the subjects of research.The general information questionnaire,long-term conditions questionnaire(LTCQ),stress adaptation scale(SAS),and perceived social support scale(PSSS)were used to make the relevant analysis.Results The results of LTCQ analysis showed that in the young and middle-aged HCC patients the mean LTCQ score was(66.28±5.37)points.The multivariate linear regression analysis indicated that age,per capita monthly income of family members,marital status,main caregiver,hepatitis B history,stress adaptability and perceived social support level were the main factors influencing the status of coexistence with cancer(all P＜0.05),explaining 47.0％of the variations.Conclusion The status of coexistence with cancer in young and middle-aged patients with HCC after receiving interventional therapy is at a medium level.Medical workers should implement individualized interventions for patients with different clinical features,so as to improve the quality of life of patients and prevent adverse disease outcomes.

Objective:To compare and research dosimetric differences between auto plan and fall back plan in Ethos adaptive radiotherapy system in radiotherapy after breast conserving surgery for breast cancer,and explore the clinical value of two techniques under the Ethos platform in the radiotherapy after breast conserving surgery.Methods:The data of a total of 15 patients with breast cancer,who received radiotherapy after breast conserving surgery for breast cancer at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine in 2022,were selected.Based on the Ethos planning system,the auto plans of the average score of 7 fields(7F_IMRT),9 field(9F_IMRT)and 12 field(12F_IMRT),as well as a fall back plan of 12 fields,were designed respectively for each patient.The dosimetric differences of conformity index(CI)and homogeneity index(HI)of dose distribution of target region,and the dose of organs at risk(OAR)were compared and evaluated.Results:The fall back plan can improve dose distribution of target region,and the average HI value of the dose of target region of 15 patients was 0.020±0.005,which was superior to those[7F_IMRT(0.065±0.015),9F_IMRT(0.024±0.004)and 12F_IMRT(0.024±0.0045)]of 3 kinds of auto plans,and the differences of them between two kinds of plans were significant(F=12.687,3.638,4.885,P<0.05).In 8 patients with breast cancer at left side,the mean dose(Dmean),volume percentages in receiving 5,10,20,30 Gy doses(V5Gy,V10Gy,V20Gy,V30Gy)in the affected side of lung in fall back plan were better than those in auto plan,and the differences of them between two kinds of plans were significant(F=24.31,64.59,18.02,7.32,5.74,P<0.05).The average Dmean of receiving dose of heart,V5Gy,V10Gy and V30Gy of fall back plan were respectively(244.83±53.93)cGy,(9.64±2.94)%,(4.28±2.0)%and(0.51±0.5)%,which were better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=10.17,12.05,4.59,3.95,P<0.05).The Dmean and V5Gy of the health side of lung,and Dmean of health side of breast in fall back plan were better than those in three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=27.99,6.26,35.89,P<0.05).In 7 patients with breast cancer at right side,the Dmean,V5Gy,V10Gy,V20Gy and V30Gy of affected side of lung in fall back plan were better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=3.43,3.85,2.32,2.36,3.59,P<0.05).The Dmax,Dmean and V5Gy of heart in fall back plan were all better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=10,10.22,3.96,P<0.05).The Dmean and V5Gy of health side of lung,and the Dmean of health side of breast in fall back plan were better than those in three kinds of auto plans,and the differences of them between two plans were significant(F=20.87,4.17,59.83,P<0.05).Conclusion:Compared with auto plan of Ethos system of 7F_IMRT,9F_IMRT and 12F_IMRTB,the homogeneity of target region of the Fall Back plan is better,and the doses of lung and heart of affected side of that are lower,and the doses of other OAR all were within the requirement of clinical limitation.Fall back plan has higher clinical application value in radiotherapy after breast conserving surgery for breast cancer.

To further standardize the management of postoperative nausea and vomiting in China, the Chinese Society of Anesthesiology initiated the development of Clinical practice guidelines on postoperative nausea and vomiting(2024 edition). The guideline development strictly adhered to internationally recognized principles. This protocol primarily described the methodology and process of guideline formulation, including essential information, background, objectives, development principles, task force and responsibilities, selection of clinical question, evidence acquisition, evidence evaluation, and expert consensus formulation.

To further standardize the management of postoperative nausea and vomiting in China, the Chinese Society of Anesthesiology initiated the development of Clinical practice guidelines on postoperative nausea and vomiting(2024 edition). The guideline development strictly adhered to internationally recognized principles. This protocol primarily described the methodology and process of guideline formulation, including essential information, background, objectives, development principles, task force and responsibilities, selection of clinical question, evidence acquisition, evidence evaluation, and expert consensus formulation.

Objective To analyze the trajectory of cardiovascular health score and its influencing factors in patients with CHD after PCI based on LCGM.Methods A total of 186 CHD patients undergoing PCI in our hospital from June 2021 to June 2023 were enrolled,and all of them re-ceived an assessment for cardiovascular health scores.LCGM analysis was performed on the change in their postoperative cardiovascular health scores.Multivariate logistic regression analysis was applied to identify the factors affecting the trajectory of the change in the scores of the patients.Results The cardiovascular health score was 6.34±1.38,6.76±1.44,7.49±1.85,and 8.06±2.07,respectively on the day of,and at 1,6 and 12 months after surgery.There were signifi-cant differences in the score among different time points(F=37.167,P＜0.01).LCGM model constructed by quadratic estimation showed that the trajectory of the cardiovascular health score in CHD patients after PCI could be divided into three types:growth type(98 cases,52.69％),sta-ble type(67 cases,36.02％)and volatile type(21 cases,11.29％).Statistical difference was ob-served in the score among the post-PCI CHD patients with different education level,per capita monthly family income,duration of coronary artery disease,and number of comorbid chronic dis-eases(P＜0.05,P＜0.01).The education level,per capita monthly family income,duration of cor-onary heart disease,and number of comorbid chronic diseases were all influencing factors for the trajectory of cardiovascular health score in the CHD patients after PCI(P＜0.01).Conclusion There are three types of trajectory in cardiovascular health score of CHD patients after PCI.Edu-cation level,family per capita monthly income,duration of coronary heart disease and number of chronic diseases are independent factors affecting the score of the patients.

Objective:To compare and research dosimetric differences between auto plan and fall back plan in Ethos adaptive radiotherapy system in radiotherapy after breast conserving surgery for breast cancer,and explore the clinical value of two techniques under the Ethos platform in the radiotherapy after breast conserving surgery.Methods:The data of a total of 15 patients with breast cancer,who received radiotherapy after breast conserving surgery for breast cancer at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine in 2022,were selected.Based on the Ethos planning system,the auto plans of the average score of 7 fields(7F_IMRT),9 field(9F_IMRT)and 12 field(12F_IMRT),as well as a fall back plan of 12 fields,were designed respectively for each patient.The dosimetric differences of conformity index(CI)and homogeneity index(HI)of dose distribution of target region,and the dose of organs at risk(OAR)were compared and evaluated.Results:The fall back plan can improve dose distribution of target region,and the average HI value of the dose of target region of 15 patients was 0.020±0.005,which was superior to those[7F_IMRT(0.065±0.015),9F_IMRT(0.024±0.004)and 12F_IMRT(0.024±0.0045)]of 3 kinds of auto plans,and the differences of them between two kinds of plans were significant(F=12.687,3.638,4.885,P<0.05).In 8 patients with breast cancer at left side,the mean dose(Dmean),volume percentages in receiving 5,10,20,30 Gy doses(V5Gy,V10Gy,V20Gy,V30Gy)in the affected side of lung in fall back plan were better than those in auto plan,and the differences of them between two kinds of plans were significant(F=24.31,64.59,18.02,7.32,5.74,P<0.05).The average Dmean of receiving dose of heart,V5Gy,V10Gy and V30Gy of fall back plan were respectively(244.83±53.93)cGy,(9.64±2.94)%,(4.28±2.0)%and(0.51±0.5)%,which were better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=10.17,12.05,4.59,3.95,P<0.05).The Dmean and V5Gy of the health side of lung,and Dmean of health side of breast in fall back plan were better than those in three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=27.99,6.26,35.89,P<0.05).In 7 patients with breast cancer at right side,the Dmean,V5Gy,V10Gy,V20Gy and V30Gy of affected side of lung in fall back plan were better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=3.43,3.85,2.32,2.36,3.59,P<0.05).The Dmax,Dmean and V5Gy of heart in fall back plan were all better than those of three kinds of auto plans,and the differences of them between two kinds of plans were significant(F=10,10.22,3.96,P<0.05).The Dmean and V5Gy of health side of lung,and the Dmean of health side of breast in fall back plan were better than those in three kinds of auto plans,and the differences of them between two plans were significant(F=20.87,4.17,59.83,P<0.05).Conclusion:Compared with auto plan of Ethos system of 7F_IMRT,9F_IMRT and 12F_IMRTB,the homogeneity of target region of the Fall Back plan is better,and the doses of lung and heart of affected side of that are lower,and the doses of other OAR all were within the requirement of clinical limitation.Fall back plan has higher clinical application value in radiotherapy after breast conserving surgery for breast cancer.