Functional dyspepsia （FD） is a prioritized disease category where traditional Chinese medicine （TCM） demonstrates distinct therapeutic advantages. The current western medicine treatment for FD is mainly based on proton pump inhibitors and prokinetic agents， with digestive enzymes， probiotics and antidepressants serving as adjuvant medication， yet such therapies still have certain limitations. TCM treatment for FD includes oral administration of Chinese herbal formulas and Chinese patent medicines， as well as external TCM therapies such as acupuncture and moxibustion， acupoint application， hot medicinal compress therapy， rubbing with ointment， medicinal iontophoresis， auricular acupoint therapy and tui na （Chinese medical massage）. The combined treatment of FD with integrated TCM and western medicine can significantly improve clinical effectiveness and reduce adverse reactions. The common mechanisms underlying the therapeutic effects of both TCM and western medicine revolve around the core pathological processes of FD， mainly focusing on restoring gastrointestinal motility， regulating the levels of brain-gut peptides， modulating intestinal microecology， and ameliorating inflammatory status. The differential mechanisms lie in the precise targeting feature of western medicine versus the holistic-regulating and multi-target characteristics of TCM， and the two approaches exert a synergistic effect to enhance efficacy. This paper proposes to leverage the advantages of TCM in holistic regulation and the strengths of western medicine in targeted treatment， so as to provide personalized and comprehensive treatment regimens for FD patients.

Objective: To analyze the correlation between serum homocysteine (Hcy) and both folic acid (FA) and sperm DNA fragmentation index (DFI), so as to provide the evidence for male fertility assessment. Methods: Males who visited and measured the serum Hcy in the Reproductive Medicine Center of Huzhou Maternal and Child Health Care Hospital from September 2022 to September 2023 were selected as the study subjects. Sperm quality parameters and sperm DFI were analyzed by collecting sperm. Hcy and FA were measured by collecting venous blood. Participants were stratified into a high Hcy group (Hcy≥15.0 μmol/L) and a normal group (Hcy<15.0 μmol/L). The correlations between serum Hcy and FA and sperm DFI were evaluated using linear regression models. Results: A total of 173 participants were enrolled, including 39 in the high Hcy group and 134 in the normal group. The sperm concentration in the high Hcy group was significantly lower than that in the normal group [(91.77±61.11)×106/mL vs. (144.21±106.82)×106/mL, P<0.05]. No statistically significant differences were observed in semen volume, sperm motility, curvilinear velocity, straight-line velocity, average path velocity, or sperm morphology normal rate (all P>0.05). The FA level in the high Hcy group was lower than that in the normal group [(4.44±1.79) nmol/L vs. (7.64±3.68) nmol/L, P<0.05]. The sperm DFI in the high Hcy group was higher than that in the normal group [(19.21±8.85)% vs. (13.07±6.43)%, P<0.05]. Serum Hcy level showed a negative correlation with FA level (r=-0.369, P<0.05) and a positive correlation with sperm DFI (r=0.351, P<0.05). Conclusion Serum Hcy level is associated with sperm concentration, FA and sperm DFI, suggesting that serum Hcy may affect sperm quality.

BACKGROUND:Many studies have focused on acupuncture,such as silver needles,for the treatment of lumbar disc herniation,but there are few studies based on the myofascial trigger point theory. OBJECTIVE:To observe the effects of silver needle comprehensive therapy on the ultrasound morphology and clinical efficacy of multifidus muscles in patients with lumbar disc herniation based on the theory of myofascial trigger points. METHODS:A total of 159 patients with lumbar disc herniation who were seen from January 2022 to April 2023 were selected as the research subjects and randomly divided into three groups:conventional group(n=53),traditional acupuncture group(n=53),and silver needle group(n=53).The conventional group received routine western medicine treatment;the traditional acupuncture group used traditional acupuncture therapy based on meridian pathways and symptom localization;and the silver needle group used silver needle warm acupuncture at myofascial trigger points for intervention.All three groups received continuous treatment for 4 weeks.The number of myofascial trigger points,pain assessment,lumbar function evaluation,ultrasound morphology changes of multifidus muscles,clinical efficacy,and traditional Chinese medicine symptom score were recorded before and after treatment in the three groups. RESULTS AND CONCLUSION:(1)After treatment,the number of myofascial trigger points in the lumbar muscles decreased in all groups,and the silver needle group showed a significant reduction compared with the traditional acupuncture group and the conventional group(P<0.05).(2)The pain rating index score,visual analogue scale score,present pain intensity score,Oswestry disability index score,and Roland-Morris disability questionnaire score in the silver needle group were lower than those in the traditional acupuncture group and the conventional group(P<0.05).(3)The ultrasound morphology indexes of multifidus muscles in the silver needle group were superior to those in the traditional acupuncture group and the conventional western medicine group(P<0.05).(4)Traditional Chinese medicine symptom scores in the silver needle group were lower than those in the traditional acupuncture group and the conventional western medicine group(P<0.05).(5)There were significant differences in clinical efficacy among the three groups(P<0.05).To conclude,applying silver needle comprehensive therapy based on the theory of myofascial trigger points can effectively reduce pain,improve clinical efficacy,and enhance lumbar spine dysfunction and multifidus muscle morphology in patients with lumbar disc herniation.

Objective : To explore the value of combined indicators of prognostic nutritional index ( PNI) ，nutri- tional risk screening 2002 scale ( NRS2002 ) ，body mass index ( BMI) ，monocyte / lymphocyte ratio ( MLR) ， platelet / lymphocyte ratio ( PLR) ，and neutrophil / lymphocyte ratio ( NLR) in evaluating the severity of pulmonary tuberculosis ( PTB) ． Methods : A total of 175 patients with pulmonary tuberculosis were selected as the study group，and 175 healthy subjects who underwent physical examination during the same period were selected as the control group．According to the range of lung lesions，the patients were divided into mild to moderate group ( ＜3 lung fields，n = 110) and severe group ( ≥3 lung fields，n = 65) ，PNI，NRS2002，BMI and peripheral blood MLR , PLR and NLR levels were compared between the two groups．Spearman rank correlation was used to analyze their correlation with the severity of the disease．A multivariate logistic regression model was established．A nomo- gram was drawn，and the efficiency of the model was evaluated by receiver operating characteristic ( ROC) curve， calibration curve，decision curve． Results: The PNI，BMI，peripheral blood lymphocyte and albumin levels in the study group were lower than those in the control group ( P＜0. 05) ，while the MLR , PLR and NLR levels were sig- nificantly higher than those in the control group ( P＜0. 05) ．The NRS2002，MLR , PLR and NLR levels in the se- vere group were higher than those in the mild and moderate group ( P＜0. 05) ，while the PNI and BMI levels were lower than those in the mild and moderate group ( P＜0. 05) ．NRS2002 and peripheral blood MLR , PLR and NLR levels in patients with pulmonary tuberculosis were positively correlated with the severity of the disease ( r = 0. 250， 0. 509，0. 431 and 0. 488) ．PNI and BMI were negatively correlated with the severity of the disease ( r = －0. 516， - 0. 231) ．Multivariate Logistic regression showed that NRS2002 and NLR were independent risk factors for severe disease，while PNI was a protective factor．The areas under the curve ( AUC) of NRS2002，NLR , PNI，and com- bined detection for evaluating the severity of pulmonary tuberculosis were 0. 692，0. 777，0. 786，and 0. 860，re- spectively，the sensitivity of the combined prediction was 81. 54% and the specificity was 76. 36%．The combined detection had better evaluation efficiency for severe pulmonary tuberculosis than the single indicator ( P ＜0. 05) ． Conclusion NRS2002 and NLR are independent risk factors for severe disease，while PNI is a protective factor． The combined detection model has a good fit，which can improve the evaluation efficiency and has potential for clin- ical application．

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective:To evaluate the effect and causality of serum metabolites on the pathogenesis of ulcerative colitis (UC), so as to provide reference for nutritional programs for patients with UC.Methods:Two-sample Mendelian randomization (MR) analysis was performed to estimate the causal relationship between serum metabolites and UC. Genome-wide association studies (GWAS) of 1 400 metabolites were performed, with the metabolites as exposure and UC as outcome. Inverse-variance weighted (IVW) was used to calculate causal estimates. Four other MR methods with different modeling assumptions including MR-Egger, weighted median, weighted mode, and simple mode were used as additional analyses to improve the stability of the results. The results were validated through heterogeneity and pleiotropy tests. Finally, the possible causal metabolites were analyzed by metabolic pathway analysis.Results:MR analysis revealed that 85 metabolites had a possible causal relationship with UC. Among them, phosphatidylglycerol 1,2-dipalmitoyl-gpc (DPPC) ( P=2.75×10 -6) and isovaleryl carnitine (C5) ( P=1.84×10 -5) were significant risk factors for UC. Metabolic pathway analysis identified 5 metabolic pathways that might be affected by these metabolites (all P<0.05), among which the porphyrin ( P=0.004) and pyrimidine metabolic pathways ( P=0.008) had higher confidence in impacting UC. Conclusions:There are causal relationships between some serum metabolites (in particular 1,2-dipalmitoyl-GPC and isovalerylcarnitine) and the risk of UC. The porphyrin and pyrimidine metabolic pathways may impact the pathogenesis of UC.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective:To evaluate the effect and causality of serum metabolites on the pathogenesis of ulcerative colitis (UC), so as to provide reference for nutritional programs for patients with UC.Methods:Two-sample Mendelian randomization (MR) analysis was performed to estimate the causal relationship between serum metabolites and UC. Genome-wide association studies (GWAS) of 1 400 metabolites were performed, with the metabolites as exposure and UC as outcome. Inverse-variance weighted (IVW) was used to calculate causal estimates. Four other MR methods with different modeling assumptions including MR-Egger, weighted median, weighted mode, and simple mode were used as additional analyses to improve the stability of the results. The results were validated through heterogeneity and pleiotropy tests. Finally, the possible causal metabolites were analyzed by metabolic pathway analysis.Results:MR analysis revealed that 85 metabolites had a possible causal relationship with UC. Among them, phosphatidylglycerol 1,2-dipalmitoyl-gpc (DPPC) ( P=2.75×10 -6) and isovaleryl carnitine (C5) ( P=1.84×10 -5) were significant risk factors for UC. Metabolic pathway analysis identified 5 metabolic pathways that might be affected by these metabolites (all P<0.05), among which the porphyrin ( P=0.004) and pyrimidine metabolic pathways ( P=0.008) had higher confidence in impacting UC. Conclusions:There are causal relationships between some serum metabolites (in particular 1,2-dipalmitoyl-GPC and isovalerylcarnitine) and the risk of UC. The porphyrin and pyrimidine metabolic pathways may impact the pathogenesis of UC.

Objective:To investigate corneal transparency alteration in patients with type 2 diabetes and its influencing factors.Methods:A case-control study was conducted.A total of 52 patients with type 2 diabetes mellitus (DM) (104 eyes) and 23 age-matched healthy controls (46 eyes) were enrolled as DM group and normal control group in the Second Affiliated Hospital of Anhui Medical University from October 1, 2020 to October 30, 2021.Patients with DM were further divided into non-diabetic retinopathy (non-DR) and DR groups according to their fundus conditions.Corneal densitometry (CD) was evaluated using the Pentacam.According to its built-in program, the cornea was divided into anterior, intermediate, and posterior layers and subdivided into 0-2 mm, >2-6 mm, >6-10 mm, and >10-12 mm annular regions with the corneal apex as the center of the circle.Pentacam automatically calculated the CD value of each corneal layer and region as well as the total CD value.The influencing factors of total CD value in diabetes group were analyzed by a multivariate linear regression analysis model.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (No.YX2023-129[F1]).Written informed consent was obtained from each subject before any medical examination.Results:The total CD value of diabetes group was 20.24±3.10, which was significantly higher than 18.79±3.31 of normal control group ( t=-2.583, P=0.011).The CD values of the anterior layer, intermediate layer, 0-2 mm, and >2-6 mm regions were significantly higher in diabetes group than in normal control group (all at P<0.05).The CD values in the anterior layer were higher in non-DR and DR groups than in normal control group, and the CD values and total CD values in the middle and posterior layers were higher in non-DR group than in normal control group and DR group, and the differences were statistically significant (all at P<0.05).The CD values in the 0-2 mm and >2-6 mm regions were significantly higher in non-DR group than in normal control group, and the CD value in the >6-10 mm annular region was significantly higher in non-DR group than in DR group and normal control group (all at P<0.05).Multivariate linear regression analysis showed that age and glycosylated hemoglobin (HbA1c) level were the main influencing factors for the increase in CD values in diabetic patients ( β=0.266, P<0.001; β=0.423, P=0.003). Conclusions:The decrease of corneal transparency precedes the appearance of DR in patients with diabetes.Poor control of HbA1c level in diabetic patients may cause the decline of corneal transparency.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.