This paper summarizes clinical experience in treating acne based on the staged therapeutic principles of "eruption in warm diseases". It is considered that acne results from wind-heat retained in the lungs， invading the ying level and obstructing the blood collaterals， and is primarily a disorder involving both the wei and ying systems. In clinical practice， the treatment emphasizes the use of acrid-cool and sweet-cold methods. The core prescription is namely Yinqiaosan Qu Douchi Jia Xishengdi Danpi Daqingye Bei Xuanshen Fang （from Epidemic Warm Diseases ［《温病条辨》］）， and is adjusted according to the stage of disease. In the non-inflammatory stage， when the pathogen initially attacks the wei level， treatment focuses on acrid-cool herbs to release the exterior， with supplementary bitter-sweet ingredients such as Yejuhua （Chrysanthemum Indicum）. In the inflammatory stage， with pronounced heat toxin in the qi level affecting the ying and blood， and local stagnation of qi and blood， the approach is to clear heat and resolve toxin， using blood-cooling and stasis-resolving herbs early to prevent progression. Herbs such as Pugongying （Taraxacum Mongolicum）， Zihuadiding （Viola Yedoensis）， Tiankuizi （Semiaquilegia Adoxoides）， Chonglou （Paris Polyphylla）， Machixian （Portulaca Oleracea）， Zaojiaoci （Gleditsia Sinensis）， Chuanshanjia （Manis Pentadactyla） may be added. In the post-inflammatory erythema stage， when yin of the ying level is depleted and internal deficiency-heat arises， sweet-cold herbs are recommended to nourish the stomach and generate fluids， with the possible addition of Yiwei Decoction （益胃汤）.

Objective:To explore the clinical manifestations of IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland, the diagnostic criteria for IgG4-related diseases and parotid malignant tumors, treatment regimens, and the application of fine-needle aspiration in disease diagnosis, so as to reduce clinical misdiagnosis and missed diagnosis. Methods:A retrospective analysis was conducted on the case data of a patient with IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland admitted to our department in March 2024. The clinical characteristics, imaging findings, preoperative puncture results, and postoperative pathological features were analyzed, and relevant literatures on both diseases were reviewed and summarized. Results:The elderly male patient was admitted due to "a mass in the parotid area in front of the right ear for more than 3 months". Through clinical examination, imaging examination, laboratory examination, and preoperative needle biopsy, the diagnosis of "right parotid moderately differentiated adenosquamous carcinoma complicated with IgG4-related disease" was considered. It was also considered that IgG4-related disease did not involve other organs before surgery, so no systemic hormone therapy was given before or after surgery. After surgery combined with postoperative radiotherapy, follow-up showed that neither the parotid tumor nor IgG4-related disease recurred. Conclusion:"IgG4-related disease complicated with moderately differentiated adenosquamous carcinoma"is a rare clinical disease. Both lack typical clinical manifestations and specific imaging features, and the diagnosis is mostly unclear before surgery. Pathological examination is of great significance in the diagnosis of the disease, while fine-needle aspiration has limited value in the diagnosis, which should attract the attention of clinicians. In addition, for patients with both diseases, individualized treatment plans should be formulated.
Humans ; Parotid Neoplasms/pathology* ; Male ; Carcinoma, Adenosquamous/pathology* ; Immunoglobulin G4-Related Disease/complications* ; Parotid Gland/pathology* ; Retrospective Studies ; Aged ; Biopsy, Fine-Needle ; Immunoglobulin G

Under the background of accelerating the development of new quality productivity,the current training of clin-ical compound talents in tertiary general hospitals is facing new challenges and is difficult to meet the growing health demands of the people.This study comprehensively employs multiple scientific methods such as the Delphi expert consultation method and lit-erature research to explore and construct a training system and path for clinical compound talents that meets the demands of new quality productivity development,consisting of 9 first-level indicators and 40 second-level indicators.While giving full play to the main,leading,and commanding role of high-level public hospitals,by cultivating clinical compound talents that meet the require-ments of new quality productivity,a path is sought in practice to improve the medical service level of tertiary general hospitals and promote the high-quality development of the medical and health care industry.

Objective To explore the value of thyroid nodule fine needle aspiration cytology(FNAC)combined with B-Raf proto-oncogene,serine/threonine kinase(BRAF)gene detection in the differential diagnosis of benign and malignant thyroid tumors.Methods According to the results of pathological examination,198 patients with thyroid nodules were divided into the benign lesion group(n=107)and the malignant lesion group(n=91).All patients underwent ultrasound-guided FNAC,and expression of BRAF gene was detected by real-time fluorescence quantitative polymerase chain reaction.The value of FNAC,BRAF gene detection and combined detection in the differential diagnosis of benign and malignant thyroid tumors was analyzed by Kappa consistency test and receiver operating characteristic(ROC)curves.Results The nodules were mostly under envelope in the malignant lesion group,while in the benign lesion group,which were mostly located within glands(P＜0.05).FNAC results showed that 62 cases with type II Bethesda,26 cases with type III Bethesda,29 cases with type IV Bethesda,14 cases with type V Bethesda and 67 cases with type VI Bethesda.There were significant differences in diagnostic positive rates between FNAC,BRAF gene detection,combined detection and pathological examination(P＜0.05).The area under ROC curve(AUC)of FNAC combined with BRAF gene detection for differentiating benign and malignant thyroid tumors was 0.871(95%CI:0.816-0.914),sensitivity was 90.11%,specificity was 84.11%and Kappa value was 0.737.The AUC of FNAC diagnosis was 0.833(95%CI:0.774-0.882),sensitivity was 76.92%,specificity was 89.72%and Kappa value was 0.672.The AUC of BRAF gene detection was 0.829(95%CI:0.770-0.879),sensitivity was 78.02%,specificity was 87.85%and Kappa value was 0.663.Conclusion FNAC combined with BRAF gene detection can improve differential diagnosis efficiency for benign and malignant thyroid lesions,especially enhancing the diagnostic sensitivity.

Objective Based on the theory of mutual admiration of spleen and kidney,this study intends to explore the medication patterns of traditional Chinese medicine for the treatment of spleen-kidney deficiency-type chronic kidney disease(CKD)by using data mining methods and to provide reference for the clinical treatment of spleen-kidney deficiency-type CKD.Methods The literatures included in China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,and VIP databases were used as data sources.The literature related to traditional Chinese medicine treatment of spleen-kidney deficiency-type CKD was analyzed by Excel 2021,IBM SPSS Modeler 18.0,IBM SPSS Statistics 27,and systematic clustering analysis and finally visualized by Cytoscape 3.7.2,RStudio.Results A total of 90 prescriptions were included,involving 146 flavors of drugs.The top 5 high-frequency drugs were Huangqi,Fuling,Baizhu,Dahuang,and Danshen.The medicinal properties are mainly mild and warm;The medicinal taste is characterized by sweetness,bitterness,and pungent;The main meridians of drugs are spleen,liver,and kidney meridians.Association rule analysis demonstrated that the commonly used couplet drugs were Huangqi-Fuling and Huangqi-Baizhu;Commonly used corner drugs included Huangqi-Baizhu-Fuling and Huangqi-Dahuang-Fuling.Cluster analysis found that the clustering effect of spleen-kidney deficiency-type CKD treatment drugs in five categories was better.Conclusion The medication rules of traditional Chinese medicine in the treatment of spleen-kidney deficiency-type CKD are preliminarily clarified,which provides a basis for clinical medication and new prescription development.

Objective To analyze the medication rules of traditional Chinese medicine compound patents for the prevention and treatment of urinary tract infection(UTI)through data mining technology.Methods The patents of traditional Chinese medicine compounds for the prevention and treatment of UTI in patent announcement module of China National Intellectual Property Administration website as data sources.The statistical analysis platforms of Excel 2021,IBM SPSS Modeler 18.0 and IBM SPSS Statistics 27.0 were used for frequency of use,medicinal properties,association rule analysis,and systematic clustering analysis and finally visualized by Cytoscape 3.7.2,RStudio.Results Through screening,a total of 179 compound patents met the inclusion criteria,involving 466 kinds of Chinese materia medica,and the top 5 high-frequency drugs were Pugongying,Huangbai,Gancao,Jinyinhua,Bianxu.The medicinal properties are mainly cold and mild;The medicinal taste is characterized by sweetness,bitterness,and bitterness;The main meridians of drugs are liver,lung and kidney meridians.Common couplet medicines included Qumai-Bianxu,Gancao-Bianxu and the three herb drug combinations included Cheqianzi-Qumai-Bianxu,Gancao-Qumai-Bianxu.A total of 5 high-frequency combinations of traditional Chinese medicine were obtained by cluster analysis.Conclusion This study preliminarily reveals the compatibility and medication rules of traditional Chinese medicine in the treatment of UTI,which provides data support for the optimization of clinical syndrome differentiation and treatment system and the development of new prescriptions.

Objective To investigate the prognosis of patients with negative sentinel lymph nodes(SLN)after neoadjuvant chemotherapy(NAC)for breast cancer who are exempt from axillary lymph node dissection(ALND)and evaluate its safety in clinical treatment.Methods Clinical data of 2,163 patients initially diagnosed with breast cancer and having negative SLNs after NAC were se-lected from the SEER database from 2018 to 2021.Among them,373 patients underwent only SLN biopsy(SLNB group),and 1,790 patients underwent ALND(ALND group).Propensity score matching(PSM)was used to control for confounding factors,and the Kaplan-Meier method was em-ployed to analyze the overall survival rate.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors influencing the exemption from ALND in patients with negative SLNs after NAC for breast cancer.Results Before PSM,significant differences were observed be-tween the two groups in terms of clinical tumor stage,molecular subtype,estrogen receptor(ER)sta-tus,progesterone receptor(PR)status,human epidermal growth factor receptor 2(HER-2)status,efficacy of NAC,and breast surgery method(P＜0.05).After PSM,363 patients were included in each group.Univariate Cox regression analysis after PSM revealed that age,clinical tumor stage,and ER status were associated with overall survival(OS)of patients(P＜0.05).There was no sig-nificant difference in OS between patients who underwent SLNB and those who underwent ALND(P＞0.05).Multivariate Cox regression analysis indicated that age and clinical tumor stage were independent factors influencing OS in patients with negative SLNs after NAC.Survival curve analysis after PSM showed no statistically significant difference in overall survival rate between the SLNB and ALND groups(P=0.278).Conclusion Exemption from ALND in patients with negative SLNs af-ter NAC is feasible and does not affect the overall survival rate of patients.

Objective To explore the clinical efficacy of single-port laparoscopy combined with gonado-tropin-releasing hormone agonist(GnRH agonist)in the treatment of deep infiltrating endometriosis and its influence on serum circATRNL1 levels,and analyze its predictive value for patient prognosis.Methods 220 patients with deep infiltrating endometriosis from June 2021 to October 2023 were enrolled as study subjects and divided into an experimental group(n=110)and a control group(n=110)according to different surgical methods.The experimental group received single-port laparoscopy surgery combined with GnRH agonist treatment,while the control group only received single-port laparoscopy surgery.The changes in circATRNL1 expression level before and after treatment between the two groups were compared,the short-term efficacy and long-term prognosis of the two groups were evaluated.Spearman correlation analysis was conducted to explore the relationship between circATRNL1 expression levels after treatment and long-term prognosis.All patients were regrouped based on whether they relapsed during follow-up into a relapse group(n=42)and a non-relapse group(n=178).The circATRNL1 levels before and after treatment were compared between the two groups,and the predictive value of circATRNL1 expression levels after treatment for long-term relapse after treatment in patients with endometriosis was analyzed using a receiver operating characteristic curve(ROC curve).Results After treatment,the serum circATRNL1 levels in the experimental group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).The postoperative pain VAS score of the experimental group was significantly lower than that of the control group,and the quality of life was significantly better than that of the control group,the recurrence rate was significantly lower than that of the control group,and the differences were statistically significant(P<0.05).The pregnancy rate of the experimental group was higher than that of the control group,and the postoperative dysmenorrhea rate was lower than that of the control group,but the differences were not statistically significant(P>0.05).Spearman correlation analysis showed that circATRNL1 expression levels after treatment was positively correlated with relapse among long-term prognosis indicators(r=0.290,P<0.05),but had no significant correlation with pregnancy rate(r=0.060,P>0.05).Compared to patients in the non-relapse group,the relapse group had significantly higher serum circATRNL1 expression levels after treatment,the difference was statistically significant(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for serum circATRNL1 expression levels in predicting long-term postoperative relapse in patients with endometriosis after treatment was 0.746,with a sensitivity of 64.29%and a specificity of 82.02%,indicating good predictive value.Conclusion The treatment regimen combining single-port laparoscopy with GnRH agonist can significantly reduce patients'pain levels,improve their quality of life,and decrease the recurrence rate.Furthermore,this combined therapy also notably decreases serum circATRNL1 levels.The serum circATRNL1 expression levels have good predictive value for the long-term recurrence of deep-infiltrating endometriosis patients post-surgery.

AIM:To investigate the mechanism of Qianggu-Kangshu formula(QGKSF)in the treatment of rheumatoid arthritis(RA)bone destruction based on network pharmacology,molecular docking,and cell experiments.METHODS:The main active ingredients and potential targets of QGKSF were obtained through TCMSP database and litera-ture search.OMIM database and GeneCards database were used to search the targets related to RA bone destruction,and Venny 2.1.0 was employed to screen the intersected targets of QGKSF and RA bone destruction.The protein-protein inter-action network of potential intersected targets was constructed by STRING database,and topological analysis was carried out by Cytoscape software to screen core targets.The screened targets of QGKSF related to RA bone destruction were evalu-ated through the Metascape system.Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gene Ontology were applied to complete enrichment analysis.AutoDock and PyMOL software was used to carry out molecular docking between the core components and the core proteins.Mouse RAW264.7 macrophages were cultured in vitro,and the cell viability was de-tected by CCK-8 assay.The number of tartrate-resistant acid phosphatase(TRAP)positive multinucleated cells in each group was calculated by TRAP staining.The enzyme activity of the cells was evaluated by determination of TRAP activity.F-actin ring formation was detected by phalloidin staining.Western blot analysis was conducted to detect the protein levels of nuclear factor of activated T cells 1(NFATc1),TRAP,cathepsin K(CTSK),c-Fos,matrix metalloproteinase 9(MMP9),osteoprotegerin(OPG),receptor activator of nuclear factor κB(RANK),RANK ligand(RANKL)and phos-phorylated protein kinase B(p-AKT).RESULTS:A total of 136 active ingredients and 126 targets were selected corre-lated with QGKSF,whil 207 intersected targets of QGKSF and RA bone destruction were screened,175 of which were core targets.There were 199 pathways obtained by GO enrichment,and 20 pathways related to osteoclasts were screened out,including phosphatidylinoinosiol 3-kinase/AKT signaling pathway and osteoclast differentiation,etc.The results of TRAP staining,TRAP enzyme activity determination and phalloidin staining showed less positive cell formation,de-creased enzyme activity and decreased F-actin ring formation in QGKSF and methotrexate(MTX)groups compared with model group.Western blot results showed that compared with model group,the protein levels of NFATc1,TRAP,CTSK,c-Fos,MMP9,p-AKT,RANK and RANKL were decreased(P＜0.05),while the expression of OPG protein was in-creased(P＜0.05)in QGKSF and MTX groups.CONCLUSION:Treatment with QGKSF inhibits RANKL-induced dif-ferentiation of RAW264.7 cells into osteoclasts possibly by inhibiting the over-differentiation of osteoclasts via regulating RANKL/RANK/OPG signaling pathway.

Objective To explore the clinical efficacy of single-port laparoscopy combined with gonado-tropin-releasing hormone agonist(GnRH agonist)in the treatment of deep infiltrating endometriosis and its influence on serum circATRNL1 levels,and analyze its predictive value for patient prognosis.Methods 220 patients with deep infiltrating endometriosis from June 2021 to October 2023 were enrolled as study subjects and divided into an experimental group(n=110)and a control group(n=110)according to different surgical methods.The experimental group received single-port laparoscopy surgery combined with GnRH agonist treatment,while the control group only received single-port laparoscopy surgery.The changes in circATRNL1 expression level before and after treatment between the two groups were compared,the short-term efficacy and long-term prognosis of the two groups were evaluated.Spearman correlation analysis was conducted to explore the relationship between circATRNL1 expression levels after treatment and long-term prognosis.All patients were regrouped based on whether they relapsed during follow-up into a relapse group(n=42)and a non-relapse group(n=178).The circATRNL1 levels before and after treatment were compared between the two groups,and the predictive value of circATRNL1 expression levels after treatment for long-term relapse after treatment in patients with endometriosis was analyzed using a receiver operating characteristic curve(ROC curve).Results After treatment,the serum circATRNL1 levels in the experimental group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).The postoperative pain VAS score of the experimental group was significantly lower than that of the control group,and the quality of life was significantly better than that of the control group,the recurrence rate was significantly lower than that of the control group,and the differences were statistically significant(P<0.05).The pregnancy rate of the experimental group was higher than that of the control group,and the postoperative dysmenorrhea rate was lower than that of the control group,but the differences were not statistically significant(P>0.05).Spearman correlation analysis showed that circATRNL1 expression levels after treatment was positively correlated with relapse among long-term prognosis indicators(r=0.290,P<0.05),but had no significant correlation with pregnancy rate(r=0.060,P>0.05).Compared to patients in the non-relapse group,the relapse group had significantly higher serum circATRNL1 expression levels after treatment,the difference was statistically significant(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for serum circATRNL1 expression levels in predicting long-term postoperative relapse in patients with endometriosis after treatment was 0.746,with a sensitivity of 64.29%and a specificity of 82.02%,indicating good predictive value.Conclusion The treatment regimen combining single-port laparoscopy with GnRH agonist can significantly reduce patients'pain levels,improve their quality of life,and decrease the recurrence rate.Furthermore,this combined therapy also notably decreases serum circATRNL1 levels.The serum circATRNL1 expression levels have good predictive value for the long-term recurrence of deep-infiltrating endometriosis patients post-surgery.