[Objective]To summarize the clinical experience and the common herb pairs of Professor WANG Zhen in treating pulmonary nodules based on"resolving method".[Methods]To collect and analyse the common herb pairs,compatibility characteristics,drug characteristics and common dosage of WANG's experience in treating pulmonary nodules by copying the prescriptions;and a case was attached as evidence.[Results]Professor WANG believes that pulmonary nodules are the sthenia pathogenic factors caused by the accumulation of pathological products such as Qi stagnation,phlegm dampness,blood stasis and toxic pathogenic factors.Based on the"resolving method",he specifically adopts the methods of breaking Qi and promoting Qi,promoting blood circulation and removing blood stasis,expelling phlegm and removing dampness,softening and dispersing,and resolving stagnation and toxic factors."Sparganii Rhizoma-Curcumae Rhizoma""Citri Sarcodactylis Fructus-Aurantii Fructus""Persicae Semen-Carthami Flos""Angelicae Sinensis Radix-Lycopi Herba""Tsaoko Fructus-Atractylodis Macrocephalae Rhizoma""Prunellae Spica-Fritillariae Thunbergii Bulbus""Sargassum-Laminariae Thallus-Chloriti Lapis""Scutellariae barbatae Herba-Lobeliae chinensis Herba-Hedyotis diffusa Willd"are commonly used,the treatment is modified according to the symptoms,and the curative effect is remarkable.The patient in the case was characterized by phlegm-stasis blocking.The treatment was performed by promoting blood circulation and removing blood stasis,dispelling phlegm and dredging channel.Based on the"resolving method",the above-mentioned herb pairs were applied and modified according to the symptoms,and the curative effect was remarkable.[Conclusion]Professor WANG uses"resolving method"to treat pulmonary nodules,the selection of drugs is far-sighted and the herb pairs are concise and effective,which is worth further study.

[Objective]To summarize the clinical experience and the common herb pairs of Professor WANG Zhen in treating pulmonary nodules based on"resolving method".[Methods]To collect and analyse the common herb pairs,compatibility characteristics,drug characteristics and common dosage of WANG's experience in treating pulmonary nodules by copying the prescriptions;and a case was attached as evidence.[Results]Professor WANG believes that pulmonary nodules are the sthenia pathogenic factors caused by the accumulation of pathological products such as Qi stagnation,phlegm dampness,blood stasis and toxic pathogenic factors.Based on the"resolving method",he specifically adopts the methods of breaking Qi and promoting Qi,promoting blood circulation and removing blood stasis,expelling phlegm and removing dampness,softening and dispersing,and resolving stagnation and toxic factors."Sparganii Rhizoma-Curcumae Rhizoma""Citri Sarcodactylis Fructus-Aurantii Fructus""Persicae Semen-Carthami Flos""Angelicae Sinensis Radix-Lycopi Herba""Tsaoko Fructus-Atractylodis Macrocephalae Rhizoma""Prunellae Spica-Fritillariae Thunbergii Bulbus""Sargassum-Laminariae Thallus-Chloriti Lapis""Scutellariae barbatae Herba-Lobeliae chinensis Herba-Hedyotis diffusa Willd"are commonly used,the treatment is modified according to the symptoms,and the curative effect is remarkable.The patient in the case was characterized by phlegm-stasis blocking.The treatment was performed by promoting blood circulation and removing blood stasis,dispelling phlegm and dredging channel.Based on the"resolving method",the above-mentioned herb pairs were applied and modified according to the symptoms,and the curative effect was remarkable.[Conclusion]Professor WANG uses"resolving method"to treat pulmonary nodules,the selection of drugs is far-sighted and the herb pairs are concise and effective,which is worth further study.

Objective:To investigate whether dual-energy computed tomography(DECT) measurement of monosodium urate(MSU) crystal loading can predict the risk of gout flares.Methods:A single-center, prospective, observational study included 229 gout patients initially diagnosed at the Gout Clinic of Qingdao University from August 2021 to February 2022. The patients underwent MSU assessment of the bilateral feet using DECT. Following enrolment, all patients commenced uric acid-lowering therapy(ULT) and were followed up at 3 and 6 months. Patients who experienced at least one flare within 6 months were compared with those who did not, and the odds ratio( OR) for the risk of gout flares was calculated. Results:Patients who experienced gout flare had a significantly longer disease duration[(6.69±5.42) vs(4.14±4.86) years, P<0.01], a higher number of flares in the past year(4.80±1.73 vs 2.02±1. 23, P<0.01), a higher proportion of fatty livers(11.0% vs 1.4%, P<0.05), and a greater volume of MSU crystals in the feet[(3.52±9.74) vs(0.29±0.98)cm 3,P<0.05] compared to patients without gout flare. The results of the multifactorial logistic regression analysis indicated that the number of flares in the past year( OR=1.295, 95% CI 1.032-1.613, P<0.05) and feet MSU crystal volume( OR=3.245, 95% CI 1.164-9.064, P<0.05) were independent risk factors for gout flares. The receiver operating characteristic(ROC) curve indicated the integration of the MSU prediction model into the clinical prediction model resulted in a comprehensive prediction model with an area under curve(AUC) value of 0.780(95% CI 0.710-0.840), sensitivity of 0.83, and specificity of 0.62. Internal validation of the comprehensive prediction model using the Bootstrap method yielded a C-index of 0.770(95% CI 0.701-0.833) for predicting flares. The calibration curve of the model demonstrated a good fit between the predicted probability of flares and the actual probability, indicating high calibration accuracy. Conclusion:The volume of MSU crystals in the feet is an independent risk factor for flares following ULT. A larger volume of MSU crystals in the foot increases the likelihood of a flare. This study provides a basis for early prediction of flare and a reference for early preventive treatment.

ObjectiveTo explore the evolution principles of symptoms including deficiency， phlegm and blood stasis， and of the functional near-infrared spectroscopy （fNIRS） cerebral hemodynamic characteristics at various stages in patients of Alzheimer's disease. MethodsA total of 497 patients with complaint of memory loss were included， and were divided into subjective cognitive decline （SCD） group （198 participants）， mild cognitive impairment （MCI） group （228 participants） and dementia （AD） group （71 participants）. Neuropsychological evaluation， traditional Chinese medicine （TCM） syndrome investigation， and fNIRS data collection of prefrontal cortex were performed in each group. Descriptive statistics were used to analyze the distribution of TCM syndromes and the difference of TCM syndrome scores in each group； logistic regression was used to analyze the influence of TCM syndromes on the incidence of the patients； association rules were used to analyze the TCM syndromes of the patients； the hemodynamic characteristics of fNIRS in the prefrontal cortex of each group were compared. ResultsKidney essence deficiency syndrome was the dominant syndrome in all stages of AD. There were statistically significant differences in the distribution frequency of kidney essence deficiency， phlegm turbidity obstructing orifices， blood stasis obstructing collaterals， qi and blood deficiency， heat toxin in the interior， and fu-organ stagnation and turbidity retention syndromes among the three groups （P＜0.01）， and the scores of kidney essence deficiency syndrome among the three groups were statistically significant （P＜0.01）. Logistic regression analysis showed that kidney essence deficiency， and qi and blood deficiency syndromes were the main risk factors for the SCD group （P＜0.05）， phlegm turbidity obstructing orifices syndrome was the main risk factor for the MCI group （P＜0.05）， and heat toxin in the interior， and fu-organ stagnation and turbidity retention syndromes were the main risk factors for the AD group （P＜0.05）. The association rule analysis showed that the combination of kidney essence deficiency plus phlegm turbidity obstructing orifices had the highest support （33.33%） in the SCD group， and the combination of kidney essence deficiency plus blood stasis obstructing collaterals had the highest support （32.90% and 52.13%） in both the MCI and AD group. The prefrontal fNIRS results showed that the mean ∆HbO₂ concentration in the left dorsolateral prefrontal cortex （LDLPFC） decreased sequentially among the three groups （P＜0.05）， and the mean ∆HbO₂ concentration in the LDLPFC was negatively correlated with the MoCA score among the three groups （r = -0.142， P＜0.05）. Further analysis showed that the mean ∆HbO₂ concentration in the LDLPFC of patients with kidney essence deficiency syndrome were statistically significant differences among the three groups （P＜0.05）. ConclusionKidney deficiency is the basis of the pathogenesis of AD， and the key brain area damaged is the LDLPFC. Turbid pathogens such as phlegm and blood stasis are the pathological factors that aggravate the disease， and the syndromes of AD show the evolution law of deficiency and excess as “kidney deficiency→phlegm turbidity→blood stasis→turbid toxin”. The changes in prefrontal hemodynamics based on fNIRS are consistent with the changes in the characteristics of symptoms， which can be used to assess the degree of cognitive impairment in AD patients.

Objective:To verify the reliability and validity of the Chinese version of the Gaming Disorder Scale for Adolescents (GADIS-A) among middle school students aged 12-17 years old.Methods:A total of 1 370 middle school students were assessed with the Chinese version of the GADIS-A, the Chinese version of the Young′s Internet Addiction Self-rating Questionnaire, and the self-compiled basic information questionnaire. Ten percent of the subjects were retested after two weeks. The reliability of the scale was tested by homogeneous reliability, split-half reliability and test-retest reliability. The validity of the scale was examined by exploratory factor analysis and confirmatory factor analysis. The standard validity of the Chinese version of Young′s self-assessment questionnaire on Internet addiction and the Chinese version of the Adolescent Play Disorder Scale was tested by Pearson correlation analysis.Results:Item analysis showed that there were significant mean differences among each item ( P<0.001). The Cronbach′s Alpha coefficient of the Chinese version of the GADIS-A total scale was 0.870, and the Cronbach′s Alpha coefficient of factor 1 and factor 2 were both 0.823. The test-retest reliability of the total scale was 0.894, the test-retest reliability of factor 1 was 0.813, and the test-retest reliability of factor 2 was 0.768. The total scores of the Chinese version of the Yang′s Internet Addiction Self-Assessment Questionnaire and the subscale scores of getting along with parents, family atmosphere, and academic performance were significantly correlated with the total score, factor 1 score, and factor 2 score of the GADIS-A. Exploratory factor analysis revealed a two-factor structure in the GADIS-A. The eigenvalue of factor 1 was 4.371, the eigenvalue of factor 2 was 1.035, and the cumulative variance was 0.638. The factor loading of items loaded noto factor 1 were between 0.633 and 0.821, the factor loading of items loaded noto factor 2 ranged from 0.570 to 0.866, and the loading of each item was above 0.500. Confirmatory factor analysis showed that the fit indexes of the Chinese version of GADIS-A were as follows: χ 2/ df=4.537, GFI=0.963, TLI=0.941, CFI=0.957, and RMSEA=0.072. Conclusion:The Chinese version of the GADIS-A has good reliability and validity and could be used as an assessment tool for Chinese adolescents aged 12-17 years old in detecting gaming disorders.

Objective:To explore the clinical characteristics and genetics of a pedigree with Stargardt disease, and investigate the pathogenicity of ABCA4 (ATP binding cassette subfamily A member 4) gene mutations in Stargardt disease.Methods:The proband was admitted to the Second People′s Hospital of Jinan in May 2021 due to diminution of vision. The proband was diagnosed with Stargardt disease according to the clinical diagnostic criteria of Stargardt disease. Detailed ophthalmological examinations was also performed on family members of the proband. Genomic DNA were extracted from the proband and the family members, and the whole exon sequencing was performed to find pathogenic gene mutations. The hazard of mutations was analyzed by polyphen-2, SIFT and MutationTaster websites. Sanger sequencing was used to verify the mutations. Conserved analysis of homologous species and 3-dimensional (3D) molecular model of the protein were used to analyze the pathogenicity.Results:Ophthalmological examinations showed reduced binocular vision, macular atrophy and "bull′s eye sign" in the proband and there was no abnormal signs and symptoms among the family members. Through whole exon sequencing analysis and Sanger sequencing verification, the compound heterozygous mutations (c.215G>A and c.6563T>C) of ABCA4 gene were co-segregated with this disease in this family. SIFT, Polyphen-2 and MutationTaster predicted that these two mutations were pathogenic. Conservative analysis and 3D molecular model of protein showed that mutations could cause changes in protein structure and affect protein function.Conclusion:The compound heterozygous mutations (C.215G>A and C.6563T>C) of ABCA4 gene are the pathogenic mutations of Stargardt disease in this pedigree.

Background Emerging evidence has shown the damage of air pollution and the benefits of physical activity to human health, and the effects of air pollution and physical activity on the nervous system need more research. Objective To explore the effects of short-term air pollution exposure and physical activity on neural damage biomarkers in healthy elderly. Methods Using a design of panel study, physically and mentally healthy retired employees were recruited from Xinxiang Medical University, and were followed up five times regularly from December 2018 to April 2019. The demographic characteristics and physical activity information were obtained by questionnaire, and the weekly physical activity level was calculated according to intensity and duration of physical activity. Biomarkers of neural damage in serum were measured, including brain-derived neurotrophic factor (BDNF), neurofilament light chain (NF-L), neuron specific enolase (NSE), protein gene product 9.5 (PGP9.5), and S100 calcium-binding protein B (S100B). Air pollution data (including PM_2.5, PM₁₀, O₃, SO₂, CO, and NO₂) of the follow-up period were collected. Generalized estimation equation was used to analyze the association of air pollution concentration and physical activity level with the concentration of neural damage biomarkers. Results A total of 29 volunteers were included in the study, with an average age of (63.5±5.9) years; there were 11 men accounting for 37.93%; more than half of them (62.07%) received above junior middle school education; the mean physical activity level was (80.23±54.51) MET-h·week⁻¹. The daily average concentrations of PM_2.5, PM₁₀, O₃, SO₂, CO, and NO₂ during the study period were (68.27±60.98) μg·m⁻³, (130.57±58.71) μg·m⁻³, (36.86±13.89) μg·m⁻³, (17.86±10.59) μg·m⁻³, (4.94±1.34) mg·m⁻³, and (50.83±8.03) μg·m⁻³, respectively. The average serum concentrations of BDNF, NF-L, NSE, PGP9.5, and S100B were (139.12±46.71) μg·L⁻¹, (402.60±183.31) ng·L⁻¹, (11.26±10.32) ng·L⁻¹, (14.32±13.57) ng·L⁻¹, and (127.57±41.74) ng·L⁻¹, respectively. The results of generalized estimation equation showed that a higher concentration of PM_2.5 or O₃ was associated with increased serum NSE (OR=1.359, 95%CI: 1.224-1.509, P<0.001; OR=1.286, 95%CI: 1.076-1.537, P=0.006), while a higher concentration of NO₂ was associated with decreased serum NSE (OR=0.692, 95%CI: 0.549-0.873, P=0.002); a higher concentration of O₃ or SO₂ was related to the reduction of serum NF-L concentration (OR=0.855, 95%CI: 0.740-0.989, P=0.035; OR=0.813, 95%CI: 0.700-0.946, P=0.007); a higher concentration of NO₂ was associated with decreased PGP9.5 in serum (OR=0.866, 95%CI: 0.777-0.965, P=0.009); a higher level of physical activity was associated with increased serum S100B (OR=1.038, 95%CI: 1.003-1.074, P=0.034); and no significant association of physical activity level or air pollution with BDNF (P>0.05). Conclusion Acute exposure to air pollution and high-level physical activity might affect the neural damage of elderly populations. Specifically, particulate matter (PM_2.5) could increase NSE, while gaseous pollutants (O₃, NO₂, and SO₂) could decrease NF-L and PGP9.5.

Objective:To verify the reliability and validity of the Chinese version of the Gaming Disorder Scale for Adolescents (GADIS-A) among middle school students aged 12-17 years old.Methods:A total of 1 370 middle school students were assessed with the Chinese version of the GADIS-A, the Chinese version of the Young′s Internet Addiction Self-rating Questionnaire, and the self-compiled basic information questionnaire. Ten percent of the subjects were retested after two weeks. The reliability of the scale was tested by homogeneous reliability, split-half reliability and test-retest reliability. The validity of the scale was examined by exploratory factor analysis and confirmatory factor analysis. The standard validity of the Chinese version of Young′s self-assessment questionnaire on Internet addiction and the Chinese version of the Adolescent Play Disorder Scale was tested by Pearson correlation analysis.Results:Item analysis showed that there were significant mean differences among each item ( P<0.001). The Cronbach′s Alpha coefficient of the Chinese version of the GADIS-A total scale was 0.870, and the Cronbach′s Alpha coefficient of factor 1 and factor 2 were both 0.823. The test-retest reliability of the total scale was 0.894, the test-retest reliability of factor 1 was 0.813, and the test-retest reliability of factor 2 was 0.768. The total scores of the Chinese version of the Yang′s Internet Addiction Self-Assessment Questionnaire and the subscale scores of getting along with parents, family atmosphere, and academic performance were significantly correlated with the total score, factor 1 score, and factor 2 score of the GADIS-A. Exploratory factor analysis revealed a two-factor structure in the GADIS-A. The eigenvalue of factor 1 was 4.371, the eigenvalue of factor 2 was 1.035, and the cumulative variance was 0.638. The factor loading of items loaded noto factor 1 were between 0.633 and 0.821, the factor loading of items loaded noto factor 2 ranged from 0.570 to 0.866, and the loading of each item was above 0.500. Confirmatory factor analysis showed that the fit indexes of the Chinese version of GADIS-A were as follows: χ 2/ df=4.537, GFI=0.963, TLI=0.941, CFI=0.957, and RMSEA=0.072. Conclusion:The Chinese version of the GADIS-A has good reliability and validity and could be used as an assessment tool for Chinese adolescents aged 12-17 years old in detecting gaming disorders.

The mammalian central nervous system (CNS) is considered an immune privileged system as it is separated from the periphery by the blood brain barrier (BBB). Yet, immune functions have been postulated to heavily influence the functional state of the CNS, especially after injury or during neurodegeneration. There is controversy regarding whether adaptive immune responses are beneficial or detrimental to CNS injury repair. In this study, we utilized immunocompromised SCID mice and subjected them to spinal cord injury (SCI). We analyzed motor function, electrophysiology, histochemistry, and performed unbiased RNA-sequencing. SCID mice displayed improved CNS functional recovery compared to WT mice after SCI. Weighted gene-coexpression network analysis (WGCNA) of spinal cord transcriptomes revealed that SCID mice had reduced expression of immune function-related genes and heightened expression of neural transmission-related genes after SCI, which was confirmed by immunohistochemical analysis and was consistent with better functional recovery. Transcriptomic analyses also indicated heightened expression of neurotransmission-related genes before injury in SCID mice, suggesting that a steady state of immune-deficiency potentially led to CNS hyper-connectivity. Consequently, SCID mice without injury demonstrated worse performance in Morris water maze test. Taken together, not only reduced inflammation after injury but also dampened steady-state immune function without injury heightened the neurotransmission program, resulting in better or worse behavioral outcomes respectively. This study revealed the intricate relationship between immune and nervous systems, raising the possibility for therapeutic manipulation of neural function via immune modulation.

Objective To explore an ideal surgical method for mid-low face lifting.Methods In this procedure,the first surgical step was subcutaneous undermining that was performed through the incision along temporal hairline,anteriorear,and mastoideae.It extended distally beyond the furthest skin fold and along the mandibular border or the midline of the neck if nacessary.Then three layers suspension were performed,which included three procedures:first,SMAS was purse string sutured in certain direction;secondly,the malar fat pad was suspended to tow directions backward and upward and anchored in the periosteum of zygoma and SMAS too;lastly,through traction suture of reducing tension step-by-step,lots of the tension was relieved from the incision;at the same time,new retaining ligaments between flap and SMAS were reestablished.And redundant skin was removed in incision at the end of the procedure.Results A total of 22 cases received this operation.16 cases were followed up from 3 months to 24 months after operation.The results of operation were divided into three degrees:excellent,acceptable and poor;and those were evaluated by patients themselves.14 cases obtained excellent result (87.5 ％),2 cases regarded that their results were acceptable (12.5 ％).The total satisfactory rate was 100 ％.None serious complication occurred in those eases except some slight complications,such as local edema,skin numbness and small hematoma which relieved in 3 to 6 months after operation.Scar was inconspicuous.Conclusions This technique can correct the posies of lower tow-third face better,especially for mitigating the nasolabial fold and enhancing the elastic of face skin.Simultaneously,it is an effective,safe and simple technique.