This article systematically reviews the current research status as well as diagnosis and treatment strategies of traditional Chinese medicine （TCM） for gastroesophageal reflux disease （GERD）. Studies demonstrate that TCM， based on the "disease-syndrome combination" approach， exhibits multi-target advantages in alleviating symptoms of various GERD subtypes， promoting mucosal repair， regulating emotions， and facilitating the reduction of western medication. To address clinical challenges such as symptom overlap and limited therapeutic efficacy， strategies have been proposed including "treating different diseases with the same method" and integrated regulation based on viscera correlation. Future efforts should focus on elucidating the mechanisms of compound prescriptions， promoting TCM drug development under the "three-combination" evaluation framework that integrates TCM theory， human experience and clinical trial evidence， and optimizing integrated traditional and western medicine models to enhance GERD management.

Purpose To investigate the correlation between intervertebral disc degeneration and paraspinal muscle fatty infiltration in chronic low back pain(CLBP)using quantitative MRI techniques.Materials and Methods A total of 63 CLBP patients and 42 volunteers in Zigong Fourth People's Hospital from September 2023 to March 2024 were retrospectively collected.Magnetic resonance scans were performed using multi-echo water-fat separation technique and T2 mapping technique.Intervertebral disc degeneration was assessed using the Pfirrmann grading,while paraspinal muscle fatty infiltration was evaluated using the Goutallier grading.Proton density fat fraction(PDFF)of the multifidus and erector spinae muscles,and T2 values of the nucleus pulposus were quantitatively measured.The relationships between these parameters and their associations with age and gender were analyzed.Results Compared with healthy volunteers,CLBP patients showed significantly reduced T2 values of the nucleus pulposusand significantly increased PDFF of the paraspinal muscles(Z=-5.54-4.65,all P<0.001).The Pfirrmann grading of intervertebral discs and the Goutallier grading of paraspinal muscles were significantly correlated with the T2 value of the nucleus pulposus and the PDFF of the paraspinal muscles(|r|>0.4,P<0.05).Age and Pfirrmann grading were independent predictors of paraspinal muscle fat infiltration(β=0.228-5.682,all P<0.001),and gender was also an independent predictor at the L4/5 intervertebral disc level(β=-2.834,-3.352,both P<0.05).Conclusion Intervertebral disc degeneration and paraspinal muscle fat infiltration are closely related in CLBP,age and gender also have an impact.

Purpose To investigate the correlation between intervertebral disc degeneration and paraspinal muscle fatty infiltration in chronic low back pain(CLBP)using quantitative MRI techniques.Materials and Methods A total of 63 CLBP patients and 42 volunteers in Zigong Fourth People's Hospital from September 2023 to March 2024 were retrospectively collected.Magnetic resonance scans were performed using multi-echo water-fat separation technique and T2 mapping technique.Intervertebral disc degeneration was assessed using the Pfirrmann grading,while paraspinal muscle fatty infiltration was evaluated using the Goutallier grading.Proton density fat fraction(PDFF)of the multifidus and erector spinae muscles,and T2 values of the nucleus pulposus were quantitatively measured.The relationships between these parameters and their associations with age and gender were analyzed.Results Compared with healthy volunteers,CLBP patients showed significantly reduced T2 values of the nucleus pulposusand significantly increased PDFF of the paraspinal muscles(Z=-5.54-4.65,all P<0.001).The Pfirrmann grading of intervertebral discs and the Goutallier grading of paraspinal muscles were significantly correlated with the T2 value of the nucleus pulposus and the PDFF of the paraspinal muscles(|r|>0.4,P<0.05).Age and Pfirrmann grading were independent predictors of paraspinal muscle fat infiltration(β=0.228-5.682,all P<0.001),and gender was also an independent predictor at the L4/5 intervertebral disc level(β=-2.834,-3.352,both P<0.05).Conclusion Intervertebral disc degeneration and paraspinal muscle fat infiltration are closely related in CLBP,age and gender also have an impact.

Objective To investigate the current situation and influencing factors of negative defensive medical practices among doctors in tertiary hospitals,construct a predictive model for negative defensive medicine.Methods Using cluster sampling,946 clinical doctors from 4 tertiary hospitals in Shandong Province were selected.A self-administered questionnaire was used to survey doctors'demographic characteristics,occupational characteristics,doctor-patient relationship status,and negative defensive medical behaviors.Logistic regression was used to screen the influencing factors of negative defensive medical behavior,while constructing a predictive model and analyzing the performance of the model.Results 72.1％ of doctors engaged in negative defensive medical practices,with the most common being reducing the number of patient contacts (671 people,70.9％).Logistic regression results showed that male gender,high seniority,high professional title,surgical specialty,negative doctor-patient relationship,experience of medical disputes,and high-risk perception were independent influencing factors for negative defensive medical behaviors (P<0.05).The logistic regression model incorporating the above 6 variables had an AUC of 0.846,good calibration,and a prediction accuracy of 88.6％ on the validation sample.Conclusion Negative defensive behavior is prevalent among doctors in tertiary hospitals.Interventions should focus on key populations and adopt targeted measures.The predictive model constructed in this study can be embedded into hospital management systems to achieve intelligent early warning.

Objective To investigate the current situation and influencing factors of negative defensive medical practices among doctors in tertiary hospitals,construct a predictive model for negative defensive medicine.Methods Using cluster sampling,946 clinical doctors from 4 tertiary hospitals in Shandong Province were selected.A self-administered questionnaire was used to survey doctors'demographic characteristics,occupational characteristics,doctor-patient relationship status,and negative defensive medical behaviors.Logistic regression was used to screen the influencing factors of negative defensive medical behavior,while constructing a predictive model and analyzing the performance of the model.Results 72.1％ of doctors engaged in negative defensive medical practices,with the most common being reducing the number of patient contacts (671 people,70.9％).Logistic regression results showed that male gender,high seniority,high professional title,surgical specialty,negative doctor-patient relationship,experience of medical disputes,and high-risk perception were independent influencing factors for negative defensive medical behaviors (P<0.05).The logistic regression model incorporating the above 6 variables had an AUC of 0.846,good calibration,and a prediction accuracy of 88.6％ on the validation sample.Conclusion Negative defensive behavior is prevalent among doctors in tertiary hospitals.Interventions should focus on key populations and adopt targeted measures.The predictive model constructed in this study can be embedded into hospital management systems to achieve intelligent early warning.

BACKGROUND:It is reported that tailless-like protein (TLX) plays critical roles in the regulation of early developmental processes in vertebrates, and it plays a key role in stem cells proliferation and differentiation into neurons. OBJECTIVE: To construct recombinant plasmid pEGFPN1-TLX and study the transfection into dermal multipotential stem cells. DESIGN, TIME AND SETTING: Cytogene experiment was performed at the Department of Pathogen Biology, School of Basic Medical Science, the Third Military Medical University of Chinese PLA from March to December 2007. MATERIALS: An adult SD was obtained from the Experimental Animal Center of the Third Military Medical University of Chinese PLA; dermal moltipotential stem cells (DMSCs) were cultured by the Institute of Combined Injury of the Third Military Medical University of Chinese PLA; pEGFPN1 and DH5α was gifted by professor Xu.METHODS: Total RNA was extracted from rat brain tissue to amplify TLX-coded cDNA sequence using RT-PCR. T/A was cloned on pMD18-T vector and determined using BamHI and Hindlll. The products were positive recombinant plasmid pMD18-T-TLX segments, which were sub-cloned in pEGFPN1 to construct recombinant plasmid pEGFPN1-TLX. Finally, pEGFPN1-TLX was transfected into DMSCs.MAIN OUTCOME MEASURES: The fluorescence protein expression was observed under fluorescence microscope at 24 hours after transfection; TLX mRNA expression was detected using RT-PCR; neuronal differentiation was observed using immunohistochemical staining.RESULTS: TLX full length cDNA was successfully cloned into pEGFPN1, and pEGFPN1-TLX was successfully constructed by means of sequence analysis and enzyme cutting identification. As compared with non-transfected DMSCs, pEGFPN1-TLX transfected DMSCs were observed after 10 days, formed resistant clones after 15 days, and shown a green fluorescent protein expression. However, non-transfected DMSCs died at day 10. RT-PCR indicated that pEGFPN1-TLX transfected DMSCs could express TLX mRNA. At day 3 after induction, NF200 positive cells were increased, but glial fibrillary acidic protein positive cells were decreased after induction of pEGFPN1-TLX transfected DMSCs.CONCLUSION: TLX was successfully constructed and transfected into DMSCs. After transfection, neuronal differentiation of DMSCs was enhanced, and the differentiation to gliocytes was inhibited.

Objective　To study the pattern of activities of microglia, the patholgical changes of chronically hypoperfused brain of rats and the interrelationship between them. Methods　Model of chronically hypoperfused brain was established in rat by the ligation of both common carotid arteries, and the histopathological changes of brain were observed with light microscope. The activity of microglia of the brain were also observed with immunohistochemistry method and the number of microglia was measured with image analyzer. Results　Extensive activation of microglia was observed after chronic cerebral hypoperfusion and the activation was increased with the elapse of time of hypoperfusion. There were obvious pathological change in the brain after the chronic cerebral hypoperfusion, such as myelinic degeneration and formation of glial nodule in white matter. After treated with cyclosporin A, the number of microglia was obviously reduced, but the pathological change was evidently decreased. Conclusion　The activation of microglia resulted from chronic cerebral hypoperfusion is relates to the pathological changes of the brain. However, cyclosporin A can decrease the pathological change and inhibit the activation of microglia.