Chronic heart failure （CHF） refers to a clinical syndrome in which the function or structure of the heart is changed due to damage to the original myocardium， resulting in reduced pumping and/or filling functions of the heart. In recent years， the mechanisms， pathways， and targets of traditional Chinese medicine （TCM） in the treatment of CHF have been continuously confirmed， and the application of TCM theories in guiding the syndrome differentiation and precise treatment of CHF is currently a research hotspot. On the basis of the syndrome differentiation and treatment in TCM， Professor LI Candong innovatively proposed the thinking of five differentiation： Disease differentiation， syndrome differentiation， pathogenesis differentiation， symptom differentiation， and individual differentiation. This article explores the clinical diagnosis and treatment of CHF from this thinking， emphasizing comprehensive syndrome differentiation， objective analysis， dynamic assessment， and individualized treatment. In terms of diagnosis， the first is to identify the disease name， cause， location， severity， and type of CHF， determine the type and its evolution， and clarify the process of transmission and transformation between deficiency and excess. Secondly， it is necessary to distinguish the authenticity， severity， primary and secondary， urgency and complexity of CHF syndromes， providing scientific guidance for syndrome differentiation and treatment. Thirdly， according to the symptoms and the principles of deficiency and excess， the physician should identify the core pathogenesis of CHF from the perspectives of Qi， blood， Yin， Yang， deficiency， stasis， phlegm， water， and toxins. Fourthly， from the macro， meso and micro levels， the physician should carefully distinguish the presence or absence， severity， authenticity， and completeness of the symptoms to guide the diagnosis and treatment process of CHF. Finally， personalized medication for CHF should be promoted based on the patient's gender， age， constitution， and living habits. In terms of treatment， based on the thinking of five differentiation， we propose that the treatment of CHF should integrate the disease and syndrome， clarify the pathogenesis， and apply precise treatment. The treatment should be people-oriented， staged， and typed， and the medication should be adjusted according to symptoms. This diagnostic and therapeutic approach is based on the holistic concept and syndrome differentiation and treatment， and combines the three causes for appropriate treatment， providing new ideas and insights for the diagnosis and treatment of CHF.

OBJECTIVES: This study aimed to investigate the incidence, imaging characteristics, and clinical manifestations of the eruption failure of deciduous molars using panoramic radiographs to provide a foundation for diagnosis and treatment in this population. METHODS: This study retrospectively reviewed panoramic radiographs of children aged 4-8 years obtained from Stomatology Hospital, Zhejiang University School of Medicine between January 2021 and December 2023. A total of 31 331 subjects were included for the radiographic assessment of the tooth eruption failure of deciduous molars. Incidence, radiographic characteristics, and associated complications were documented. Statistical analysis was performed using SPSS 26.0. RESULTS: The incidence of the eruption failure of deciduous molars among children aged 4-8 years was 0.94% (296/31 331). The rate was 1.55 times higher in females than in males, demonstrating a significant gender difference (P<0.001). Among the affected deciduous molars, mandibular first deciduous molars accounted for 76.4%, followed by the mandibular second deciduous molars (13.8%), and the maxillary deciduous molars collectively comprised 9.8%. The severity of eruption disorders was significantly associated with the mesial and distal tilting of adjacent teeth and elongation of the antagonist (P<0.001). CONCLUSIONS The incidence of the eruption failure of deciduous molars in children aged 4-8 years was 0.94%, with a high prevalence in females and a predilection for the mandible, particularly the mandibular first deciduous molar. For deciduous molars with severe eruption failure, early intervention is crucial to mitigate complications such as malocclusion and space loss.
Humans ; Child ; Child, Preschool ; Tooth, Deciduous/diagnostic imaging* ; Female ; Molar/physiopathology* ; Male ; Retrospective Studies ; Tooth Eruption ; Radiography, Panoramic ; Incidence

Allergic diseases are one of the major chronic diseases worldwide.Epidemiological studies suggest that the clustering of multiple allergic diseases as multimorbidity within the same individual is a significant phenomenon that cannot be overlooked.Currently,there is a lack of targeted diagnostic and therapeutic guidelines for multimorbidity of allergic diseases,and their pathogenesis remains unclear.Traditional Chinese medicine constitution serves as the foundation for disease development and is a key target for preventing and treating multimorbidity.The inherited special constitution,qi-deficient constitution,and yang-deficient constitution are the primary constitution types associated with multimorbidity of allergic diseases,with the inherited special constitution being the most prevalent.Allergic constitution,a type of the inherited special constitution is a specific constitution formed on the basis of innate inheritance,characterized by heightened sensitivity to multiple allergens.Affected by environmental factors,people with allergic constitution may suffer from different allergic diseases,with specific types of allergic diseases being more prevalent at different stages of life,and they are often accompanied by multimorbidities such as psychological and immunological disorders.This paper proposed an integrated diagnostic and therapeutic model of"constitution differentiation-disease differentiation-syndrome differentiation"comprehensively considering constitution,disease,and syndrome.Combined with regulating constitution formula Guominkang and its modifications,this approach has demonstrated significant efficacy in treating allergic diseases and shows promise for managing multimorbidity of allergic diseases.

OBJECTIVE To investigate the potential mechanism of berberine improving diabetes mellitus type 2 （T2DM） combined with metabolic-associated fatty liver disease （MAFLD） by regulating ceramide. METHODS Thirty-two db/db mice with blood glucose levels＞11.1 mmol/L （T2DM model） were divided into four groups： model group， berberine low- and high-dose groups [100， 200 mg/（kg·d）] and metformin group [300 mg/（kg·d）]， with 8 mice in each group. Additionally， 8 wt/wt mice were selected as the normal control group. Mice in each group were administered the corresponding drug solution or water by gavage once daily for a continuous period of 6 weeks. During the experiment， the body weight of the mice was monitored， and the differences in final body weight were analyzed. After the last administration， the body shape of the mice in each group was observed， and their fasting blood glucose （FBG） and the lipid indicators [total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）] were measured. Fasting serum insulin （FINS） levels were also measured， and the insulin resistance index HOMA-IR） and insulin sensitivity index （ISI） were calculated. Liver weight， liver index and serum liver function indicators [alanine transaminase （ALT）， aspartate transaminase（AST）] were assessed， and hepatic histopathological changes were observed. Additionally， the expression of fatty acid synthesis-related proteins [sterol regulatory element-binding protein 1 （SREBP1）， fatty acid synthase （FASN）， acetyl-CoA carboxylase 1 （ACC1）] in liver tissue was examined. Serum samples from the normal control group， model group， and berberine high-dose group were collected for non-targeted lipidomics analysis and validation. RESULTS Compared with the model group， the pathological changes， including disordered liver tissue cell arrangement and lipid vacuoles， were significantly improved in the berberine low- and high-dose groups. The significant decreases or down-regulations were observed in body weight in the last week， as well as FBG， TC， TG， and LDL-C levels， HOMA-IR （except for the berberine low-dose group）， liver weight， liver index， AST and ALT levels， and protein expressions of SREBP1， FASN and ACC1. Additionally， HDL-C levels， FINS （except for the berberine high-dose group）， and ISI （except for the berberine low-dose group） were significantly increased （P＜0.05）. A total of 21 potential differential metabolites， including multiple types of ceramides， were identified； these metabolites were primarily enriched in sphingolipid metabolism and glycerophospholipid metabolism pathways. Verification experiments confirmed that high-dose berberine significantly reduced the serum content of ceramide in model mice （P＜0.05）. CONCLUSIONS Berberine reduces insulin resistance， improves liver damage and lipid accumulation in the T2DM combined with MAFLD mice， and these effects may be related to the reduction of ceramide content.

Allergic diseases are one of the major chronic diseases worldwide.Epidemiological studies suggest that the clustering of multiple allergic diseases as multimorbidity within the same individual is a significant phenomenon that cannot be overlooked.Currently,there is a lack of targeted diagnostic and therapeutic guidelines for multimorbidity of allergic diseases,and their pathogenesis remains unclear.Traditional Chinese medicine constitution serves as the foundation for disease development and is a key target for preventing and treating multimorbidity.The inherited special constitution,qi-deficient constitution,and yang-deficient constitution are the primary constitution types associated with multimorbidity of allergic diseases,with the inherited special constitution being the most prevalent.Allergic constitution,a type of the inherited special constitution is a specific constitution formed on the basis of innate inheritance,characterized by heightened sensitivity to multiple allergens.Affected by environmental factors,people with allergic constitution may suffer from different allergic diseases,with specific types of allergic diseases being more prevalent at different stages of life,and they are often accompanied by multimorbidities such as psychological and immunological disorders.This paper proposed an integrated diagnostic and therapeutic model of"constitution differentiation-disease differentiation-syndrome differentiation"comprehensively considering constitution,disease,and syndrome.Combined with regulating constitution formula Guominkang and its modifications,this approach has demonstrated significant efficacy in treating allergic diseases and shows promise for managing multimorbidity of allergic diseases.

Objective:To summarize the clinical characteristics of children with mitochondrial short-chain enoyl-CoA hydratase-1 deficiency (ECHS1D) caused by c.489G>A (p.Pro163=) compound heterozygous variants in the ECHS1 gene, and to explore genotype-phenotype correlations.Methods:A case series study was performed to analyze clinical, biochemical, metabolic, imaging, genetic, treatment and follow-up outcomes of 24 children with ECHS1 gene c.489G>A(p.Pro163=) variant, who were diagnosed in the Department of Neurology, Beijing Children′s Hospital from July 2010 to June 2024. Disease severity was assessed using the Newcastle Paediatric Mitochondrial Disease Scale, and Fisher exact test was applied to compare the improvement rate between valine-restricted and non-restricted groups.Results:These 24 children were all diagnosed after 2022, with a disease duration of 3.35 (1.25, 6.52) years at diagnosis. A total of 8 children initially had negative genetic results, and were finally confirmed by abnormal splicing of ECHS1 gene via skin fibroblast RNA sequencing, with the longest diagnostic time of 14 years. All 24 children presented with Leigh syndrome, including 11 boys and 13 girls, with an onset age of 1.46 (0.96, 2.79) years; 16 children (67%) were mild cases. Common initial symptoms included developmental delay (9 cases) and paroxysmal dystonia (9 cases), followed by developmental regression (3 cases), nystagmus (2 cases), and epilepsy (1 case). Main manifestations were dystonia (18 cases), developmental regression (14 cases), nystagmus (12 cases), developmental delay (11 cases), ataxia (10 cases), vision loss (9 cases), seizures (2 cases), and hearing impairment (1 case). Among 22 children who underwent blood and urine metabolic screening, 21 children (95%) had elevated urinary 2, 3-dihydroxy-2-methylbutyric acid and 19 children (86%) had elevated urinary S-(2-hydroxypropyl) cysteamine. All 24 children had symmetric abnormal signals in bilateral globus pallidus on cranial magnetic resonance imaging, 10 children had isolated globus pallidus involvement, and other common involved sites included caudate nucleus and brainstem (9 cases each), putamen (7 cases), and cerebral white matter (5 cases). At last follow-up, all 24 children survived, with a follow-up duration of 5.40 (2.75, 8.02) years and a maximum age of 17.8 years; 17 children (71%) had varying degrees of clinical improvement. There was no statistical difference in the improvement rate between children with or without valine-restricted diet (12/14 vs. 5/8, P=0.309). A total of 18 pathogenic variants in the ECHS1 gene were identified among 24 children, 13 of which were distributed in exons 7 and 8; those carrying c.308T>C, c.523G>A, c.796A>G, and c.832G>A variants were mostly severe cases. Conclusions:Children carrying ECHS1 gene c.489G>A(p.Pro163=) compound heterozygous variants face significant diagnostic delay. Clinical awareness of this synonymous variant needs further improvement for timely diagnosis. All these cases present as Leigh syndrome, mostly mild, with no clear genotype-phenotype correlation identified.

Parental burnout is a set of negative symptoms resulting from parenting roles and chronic paren-ting stress,such as feelings of depletion associated with the parenting role and maintaining emotional distance from children.This paper analyzes a representative body of literature on parental burnout published through 2023 and pro-vides an overview of the literature around parental burnout definition and measurement,antecedent variables,and consequential variables.The results indicate that demographic variables,individual and family factors can influence parental burnout,and that the consequences of parental burnout are primarily reflected in the parents themselves and their children.The prevalence of parental burnout is influenced by sociocultural factors,but the mechanism of action is unclear and there is less research on interventions for parental burnout.Future research should pay full attention to the role and place of sociocultural factors in the study of parental burnout and actively pursue intervention research on parental burnout.

Objective:To revise the Effort-Reward Imbalance in Household and Family Work(ERI-HF)in a sample of middle school parents,and examine its adaptation.Methods:The Parenting Behavior Effort-Reward Im-balance Scale(ERI-PB)was formed by translating and linguistically adjusting ERI-HF,combining with expert eval-uation results.Parents of 1 062 seventh-grade students in a middle school were selected and surveyed twice with an interval of one and a half months on a family basis.The Perceived Partner Responsiveness Scale(PPRS),Parenting Anxiety Questionnaire(PAQ),and Satisfaction with Marital Scale(SMS)were used to test the criterion-related va-lidity.Results:There were 22 items in ERI-PB,which contained 3 factors of effort,reward,and over-commitment,the factor load of each factor was 0.39-0.84,and the cumulative variance explanation rate was 47.27％.The ab-solute values of correlations between the scores of effort,reward,over-commitment and PPRS,PAQ,SMS were 0.14-0.53(Ps＜0.01).The Cronbach α coefficients of the three factors were 0.76-0.91,the McDonaldωcoef-ficients were 0.76-0.91,and the retest reliabilities(ICC)were 0.50-0.70.Conclusion:The ERI-PB shows good validity and reliability in a group of parents of middle school students.

Parental burnout is a set of negative symptoms resulting from parenting roles and chronic paren-ting stress,such as feelings of depletion associated with the parenting role and maintaining emotional distance from children.This paper analyzes a representative body of literature on parental burnout published through 2023 and pro-vides an overview of the literature around parental burnout definition and measurement,antecedent variables,and consequential variables.The results indicate that demographic variables,individual and family factors can influence parental burnout,and that the consequences of parental burnout are primarily reflected in the parents themselves and their children.The prevalence of parental burnout is influenced by sociocultural factors,but the mechanism of action is unclear and there is less research on interventions for parental burnout.Future research should pay full attention to the role and place of sociocultural factors in the study of parental burnout and actively pursue intervention research on parental burnout.

Objective:To revise the Effort-Reward Imbalance in Household and Family Work(ERI-HF)in a sample of middle school parents,and examine its adaptation.Methods:The Parenting Behavior Effort-Reward Im-balance Scale(ERI-PB)was formed by translating and linguistically adjusting ERI-HF,combining with expert eval-uation results.Parents of 1 062 seventh-grade students in a middle school were selected and surveyed twice with an interval of one and a half months on a family basis.The Perceived Partner Responsiveness Scale(PPRS),Parenting Anxiety Questionnaire(PAQ),and Satisfaction with Marital Scale(SMS)were used to test the criterion-related va-lidity.Results:There were 22 items in ERI-PB,which contained 3 factors of effort,reward,and over-commitment,the factor load of each factor was 0.39-0.84,and the cumulative variance explanation rate was 47.27％.The ab-solute values of correlations between the scores of effort,reward,over-commitment and PPRS,PAQ,SMS were 0.14-0.53(Ps＜0.01).The Cronbach α coefficients of the three factors were 0.76-0.91,the McDonaldωcoef-ficients were 0.76-0.91,and the retest reliabilities(ICC)were 0.50-0.70.Conclusion:The ERI-PB shows good validity and reliability in a group of parents of middle school students.