Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It has a high prevalence and poor prognosis. The application of antiarrhythmic drugs and even surgery cannot completely treat the disease, and there are many sequelae. AF can be classified into the category of "palpitation" in Chinese medicine according to its symptoms. Acupuncture has a significant effect on AF. The authors find that an important mechanism of acupuncture in AF treatment is to regulate the cardiac vagus nerve. Therefore, this article intends to review the distribution and function of vagus nerve in the heart, the application and the regulatroy effect for the treatment of AF.
Atrial Fibrillation/physiopathology* ; Humans ; Acupuncture Therapy ; Vagus Nerve/physiology* ; Animals

Medical therapy and surgical intervention are the two primary approaches for treating myocardial bridge.However,there remains controversy regarding the use of coronary artery bypass grafting(CABG)and myocardial bridge unroofing.Here,we report a case of myocardial infarction following CABG in a patient with a myocardial bridge.The patient was admitted to Lanzhou First Peopie's Hospital with persistent chest pain,chest tightness,and shortness of breath lasting 2 hours.Physical examination revealed no significant abnormalities.Electrocardiography(ECG)indicated extensive anterior wall myocardial infarction.Laboratory findings showed myoglobin levels of 140.1 ng/ml and troponin Ⅰ levels of 2.59 ng/ml,with no other significant abnormalities.The initial diagnosis was acute extensive anterior wall myocardial infarction.Emergency coronary angiography revealed a myocardial bridge in the mid-segment of the left anterior descending artery(LAD).Emergency CABG using the left internal mammary artery to the LAD was performed,leading to symptomatic improvement,and the patient was discharged in stable condition.However,the patient experienced a recurrent myocardial infarction seven years post-surgery and received secondary preventive medical therapy.The patient is currently under ongoing follow-up care.CABG is an effective treatment for myocardial bridge.However,based on the case reported in this study,we recommend careful evaluation of whether a patient may benefit from CABG.

Objective To observe the clinical efficacy of traditional Chinese medicine(TCM)sequential therapy in treating patients with psoriasis vulgaris in Shenzhen,and to explore the syndrome differentiation and treatment for the patients with psoriasis vulgaris in Shenzhen region.Methods From January 2019 to February 2024,70 cases of psoriasis vulgaris admitted to Shenzhen Bao'an Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine(Shenzhen Bao'an Traditional Chinese Medicine Hospital Group)were retrospectively analyzed.The patients were divided into the observation group(39 cases)and the control group(31 cases)according to the treatment plans.In the control group,only topical application of Calcipotriol Ointment was given throughout the treatment,while in the observation group the patients were treated with TCM sequential therapy according to the illness stage on the basis of treatment for the control group,i.e.,internal administration of modified Shuiniujiao Huanglian Decoction was given in the acute stage and modified Sijunzi Shuiniujiao Decoction was given in the remission stage.Both groups were treated for 3 months.Before and after the treatment,the changes of Psoriasis Area and Severity Index(PASI)scores,Dermatology Life Quality Index(DLQI)scores and TCM syndrome scores in the two groups were observed.After treatment,the clinical efficacy and drug safety of the two groups were evaluated.Results(1)After 3 months of treatment,the total effective rate of the observation group was 89.74%(35/39),and that of the control group was 74.19%(23/31).The intergroup comparison(tested by chi-square test)showed that the efficacy of the observation group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the PASI scores for evaluating the severity of skin lesions in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease in the observation group was significantly superior to that in the control group(P＜0.05).(3)After treatment,the DLQI scores for evaluating the quality of life in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease in the observation group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the scores of TCM syndromes such as erythema,itching,vexation and dry mouth in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease in the observation group was significantly superior to that in the control group(P＜0.05).(5)During the treatment period,no obvious adverse reactions occurred in the two groups of patients,with high safety.Conclusion On the basis of conventional western medicine treatment,application of TCM sequential therapy exerts certain clinical efficacy in treating patients with psoriasis vulgaris in Shenzhen region,and the combined therapy is effective on controlling the patients'illness conditions,significantly alleviating the symptoms and improving the quality of life of the patients.

Fresh Chinese herbal medicine,being distinct from the dried herbs,is one of the therapies of traditional Chinese medicine(TCM)widely used in dermatology.It is employed to treat various skin diseases,namely herpes simplex,herpes zoster,common warts,flat warts,boils,carbuncles,erysipelas,acne vulgaris,fungal skin diseases,psoriasis,contact dermatitis,insect bite dermatitis,and eczema.The commonly-used fresh herbs for skin diseases are fresh Portulacae Herba,fresh Houttuyniae Herba,fresh Rubiae Radix,fresh Lygodii Spora,fresh Patriniae Herba,fresh Aloe,fresh Plataginis Herba,fresh Pinelliae Rhizoma,and fresh Taraxaci Herba.These herbs usually have the actions of clearing heat,detoxifying,and cooling blood.For the treatment of skin diseases,fresh herbal medicine can be administered orally or applied topically,with a predominant use of topical application or a combination of oral and topical administration.Due to the rapid development of modern society,the supply and standardization of fresh herbs fail in meeting the demands of a large population of the patients,leading to their gradual decline in use.However,the efficacy of fresh herbs cannot be entirely replaced by that of the dried herbs.This article reviewed the advances in the modern application of fresh Chinese herbal medicine in dermatology,aiming to promote further research and expand its clinical application in treating skin diseases.

Objective:To develop an essential version of the Sleep Disorder ICF combination with assessment efficacy based on item response theory(IRT),and provide a basis for the connection between assessment and treat-ment.Method:Based on the sampling principle of the maximum variation strategy,convenience samples were col-lected.The control variables of maximum variation included age,body mass index(BMI),the physical com-ponent summary(PCS)and mental component summary(MCS)of SF-12,the Pittsburgh Sleep Quality Index(PSQI),and the Symptom Checklist 90(SCL-90).ICF core set of sleep disorders,Pittsburgh Sleep Quality Index(PSQI),Montreal Cognitive Assessment(MOCA),Symptom Checklist-90(SCL-90),and the 12-item Short Form Health Survey(SF-12)were administered to eligible participants.An abridged version of the ICF-based comprehensive core set was conducted for sleep disorders using IRT.Monte Carlo simulation was ap-plied to analyze the relationship between individual functional levels(θ)and item difficulty in person-item maps,and to calculate the degree of benefit from interventions.Result:A 3-parameter logistic model(3PLM)with 34 categories was developed,demonstrating high reliability(internal consistency reliability test results:Cronbach's α=0.9249,Guttman's λ-2=0.9320,MS statistic=0.9398,LCRC=0.9585)and validity(the scores of the 34 ICF categories were significantly correlated with the original ICF scores,PSQI scores,SCL-90 scores,and SF-12 scores,P<0.001).The person-item map was used to match individual sleep-related functional levels(θ)to the item difficulties,distinguishing between the mastered and challenging categories,The degree of benefit was calculated for each matched item,revealing a strong cor-relation between item difficulty and benefit degree(P<0.001,Pearson correlation coefficient was 0.777).Conclusion:This study constructed a parsimonious version of the ICF-based comprehensive core set for sleep disorders with 34 items using IRT.The model can effectively evaluate the sleep-related(including cognitive-be-havioral,psychological-emotional,and social)functional levels in individuals with sleep disorders.The applica-tion of the model analysis further provides a visual tool and the expected benefit after intervention items,which can offer new insights for the rehabilitation of sleep disorders.

Objective:To explore the effectiveness of outcome-oriented TECK teaching in the standardized training of neurology resident physicians, and to evaluate its impact on clinical practice, clinical thinking, and self-learning abilities.Methods:A controlled study design was adopted, and 78 resident physicians who rotated through the Department of Neurology at Guangdong Provincial People's Hospital Affiliated to Southern Medical University between November 2022 and November 2024 were divided into a control group ( n=39) and an experimental group ( n=39) according to their admission order. The control group received the traditional "theoretical teaching, rotation training, exit assessment" mode. The experimental group received an outcome-oriented TECK teaching mode, which included four modules: theoretical class, experimental course/practice, case discussion, and knowledge reinforcement. The two groups of residents were evaluated for clinical practice ability, clinical thinking ability, and teaching satisfaction. SPSS 22.0 was used for t-test and chi-square test. Results:The experimental group outperformed the control group in all dimensions of clinical practice ability (except for doctor-patient communication ability) (all P<0.001), such as basic operational skills [(4.42±0.41) vs. (3.87±0.56)] and emergency management ability [(4.38±0.39) vs. (3.65±0.62)]. The clinical thinking ability scores of the experimental group were higher (all P<0.001), such as diagnostic logic [(4.43±0.38) vs. (3.92±0.51)] and decision-making basis [(4.45±0.42) vs. (3.78±0.63)]. In terms of self-learning ability, the experimental group showed significant improvements in literature search [(4.42±0.43) vs. (3.65±0.58)] and knowledge update [(4.38±0.39) vs. (3.42±0.61)] (both P<0.001). In terms of teaching satisfaction, the experimental group scored higher in dimensions such as course design [(4.42±0.41) vs. (3.89±0.58)] and clinical fit [(4.45±0.37) vs. (3.82±0.61)] (all P<0.001). Conclusions:The outcome-oriented TECK teaching mode can effectively enhance the clinical practice and thinking abilities of neurology residents in standardized training, and improve the effectiveness of self-learning, providing an innovative path for the training of specialized physicians. In the future, interdisciplinary integration and long-term tracking and evaluation need to be optimized.

Medical therapy and surgical intervention are the two primary approaches for treating myocardial bridge.However,there remains controversy regarding the use of coronary artery bypass grafting(CABG)and myocardial bridge unroofing.Here,we report a case of myocardial infarction following CABG in a patient with a myocardial bridge.The patient was admitted to Lanzhou First Peopie's Hospital with persistent chest pain,chest tightness,and shortness of breath lasting 2 hours.Physical examination revealed no significant abnormalities.Electrocardiography(ECG)indicated extensive anterior wall myocardial infarction.Laboratory findings showed myoglobin levels of 140.1 ng/ml and troponin Ⅰ levels of 2.59 ng/ml,with no other significant abnormalities.The initial diagnosis was acute extensive anterior wall myocardial infarction.Emergency coronary angiography revealed a myocardial bridge in the mid-segment of the left anterior descending artery(LAD).Emergency CABG using the left internal mammary artery to the LAD was performed,leading to symptomatic improvement,and the patient was discharged in stable condition.However,the patient experienced a recurrent myocardial infarction seven years post-surgery and received secondary preventive medical therapy.The patient is currently under ongoing follow-up care.CABG is an effective treatment for myocardial bridge.However,based on the case reported in this study,we recommend careful evaluation of whether a patient may benefit from CABG.

Objective:To develop an essential version of the Sleep Disorder ICF combination with assessment efficacy based on item response theory(IRT),and provide a basis for the connection between assessment and treat-ment.Method:Based on the sampling principle of the maximum variation strategy,convenience samples were col-lected.The control variables of maximum variation included age,body mass index(BMI),the physical com-ponent summary(PCS)and mental component summary(MCS)of SF-12,the Pittsburgh Sleep Quality Index(PSQI),and the Symptom Checklist 90(SCL-90).ICF core set of sleep disorders,Pittsburgh Sleep Quality Index(PSQI),Montreal Cognitive Assessment(MOCA),Symptom Checklist-90(SCL-90),and the 12-item Short Form Health Survey(SF-12)were administered to eligible participants.An abridged version of the ICF-based comprehensive core set was conducted for sleep disorders using IRT.Monte Carlo simulation was ap-plied to analyze the relationship between individual functional levels(θ)and item difficulty in person-item maps,and to calculate the degree of benefit from interventions.Result:A 3-parameter logistic model(3PLM)with 34 categories was developed,demonstrating high reliability(internal consistency reliability test results:Cronbach's α=0.9249,Guttman's λ-2=0.9320,MS statistic=0.9398,LCRC=0.9585)and validity(the scores of the 34 ICF categories were significantly correlated with the original ICF scores,PSQI scores,SCL-90 scores,and SF-12 scores,P<0.001).The person-item map was used to match individual sleep-related functional levels(θ)to the item difficulties,distinguishing between the mastered and challenging categories,The degree of benefit was calculated for each matched item,revealing a strong cor-relation between item difficulty and benefit degree(P<0.001,Pearson correlation coefficient was 0.777).Conclusion:This study constructed a parsimonious version of the ICF-based comprehensive core set for sleep disorders with 34 items using IRT.The model can effectively evaluate the sleep-related(including cognitive-be-havioral,psychological-emotional,and social)functional levels in individuals with sleep disorders.The applica-tion of the model analysis further provides a visual tool and the expected benefit after intervention items,which can offer new insights for the rehabilitation of sleep disorders.

Objective:To explore the effectiveness of outcome-oriented TECK teaching in the standardized training of neurology resident physicians, and to evaluate its impact on clinical practice, clinical thinking, and self-learning abilities.Methods:A controlled study design was adopted, and 78 resident physicians who rotated through the Department of Neurology at Guangdong Provincial People's Hospital Affiliated to Southern Medical University between November 2022 and November 2024 were divided into a control group ( n=39) and an experimental group ( n=39) according to their admission order. The control group received the traditional "theoretical teaching, rotation training, exit assessment" mode. The experimental group received an outcome-oriented TECK teaching mode, which included four modules: theoretical class, experimental course/practice, case discussion, and knowledge reinforcement. The two groups of residents were evaluated for clinical practice ability, clinical thinking ability, and teaching satisfaction. SPSS 22.0 was used for t-test and chi-square test. Results:The experimental group outperformed the control group in all dimensions of clinical practice ability (except for doctor-patient communication ability) (all P<0.001), such as basic operational skills [(4.42±0.41) vs. (3.87±0.56)] and emergency management ability [(4.38±0.39) vs. (3.65±0.62)]. The clinical thinking ability scores of the experimental group were higher (all P<0.001), such as diagnostic logic [(4.43±0.38) vs. (3.92±0.51)] and decision-making basis [(4.45±0.42) vs. (3.78±0.63)]. In terms of self-learning ability, the experimental group showed significant improvements in literature search [(4.42±0.43) vs. (3.65±0.58)] and knowledge update [(4.38±0.39) vs. (3.42±0.61)] (both P<0.001). In terms of teaching satisfaction, the experimental group scored higher in dimensions such as course design [(4.42±0.41) vs. (3.89±0.58)] and clinical fit [(4.45±0.37) vs. (3.82±0.61)] (all P<0.001). Conclusions:The outcome-oriented TECK teaching mode can effectively enhance the clinical practice and thinking abilities of neurology residents in standardized training, and improve the effectiveness of self-learning, providing an innovative path for the training of specialized physicians. In the future, interdisciplinary integration and long-term tracking and evaluation need to be optimized.

The patient,a male newborn,was admitted to the hospital 2 hours after birth due to prematurity(gestational age 27+5 weeks)and respiratory distress occurring 2 hours postnatally.After admission,the infant developed fever and elevated C-reactive protein levels.On the fourth day after birth,metagenomic next-generation sequencing of cerebrospinal fluid indicated a positive result for Mycoplasma hominis(9 898 reads).On the eighth day,a retest of cerebrospinal fluid metagenomics confirmed Mycoplasma hominis(56 806 reads).The diagnosis of purulent meningitis caused by Mycoplasma hominis was established,and the antibiotic treatment was switched to moxifloxacin[5 mg/(kg·day)]administered intravenously for a total of 4 weeks.After treatment,the patient's cerebrospinal fluid tests returned to normal,and he was discharged as cured on the 76th day after birth.This article focuses on the diagnosis and treatment of neonatal Mycoplasma hominis purulent meningitis,introducing the multidisciplinary diagnosis and treatment of the condition in extremely preterm infants.[Chinese Journal of Contemporary Pediatrics,2024,26(4):432-436]