Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

Objective:To explore the risk factors of fungal infection in patients with upper urinary tract calculi after surgery and construct a risk prediction nomograph model.Methods:The clinical data of 2 329 patients who had undergone upper urinary calculus surgery in the Second Affiliated Hospital of Zhengzhou University from January 2019 to December 2023 were retrospectively analyzed. According to the presence or absence of fungal infection within 3 months after surgery, the patients were divided into fungal infection group (n=97) and non-fungal infection group (n=2 232). Univariate logistic regression analysis and LASSO regression were used to screen the potential influencing factors. The enrolled patients were randomly divided into a training set (n=1 630) and a validation set (n=699) at a ratio of 7∶3. Based on the training set, multivariate logistic stepwise regression was used to screen independent risk factors and to construct a nomogram. Based on the validation set, ROC curve, calibration curve and decision curve were drawn to evaluate the model's differentiation, accuracy and clinical applicability.Results:Univariate logistic regression analysis showed that female gender, age, diabetes mellitus, history of malignant tumor, long-term bedridden disease, long-term use of immunosuppressants, hemoglobin on admission, serum creatinine, uric acid, white blood cell count on admission, neutrophil count on admission, degree of hydronephrosis, preoperative indwelling ureteral stent, duration of surgery, postoperative fever within 48 hours, white blood cell count, neutrophil count, CRP, urinary catheter indwelling time, length of hospital stay, use of carbapenem antibiotics, the duration of antibiotic use and the duration of postoperative ureteral stent indwelling were related to fungal infection. screening after upper urinary calculi surgery ( P<0.05). Univariate logistic regression results were screened after LASSO regression. Multivariate logistic stepwise regression analysis for the training set showed that age ( OR=1.041, 95% CI 1.017-1.066, P=0.001), diabetes( OR=3.138, 95% CI 1.517-6.492, P=0.002), long-term bed-rest ( OR=10.627, 95% CI 3.671-30.767, P<0.001), history of malignant tumor( OR=11.934, 95% CI 5.473-26.022, P<0.001), white blood cell count on admission( OR=1.276, 95% CI 1.134-1.436, P<0.001), postoperative fever within 48 hours ( OR=3.940, 95% CI 1.956-7.937, P<0.001), use of carbapenem antibiotics( OR=5.826, 95% CI 2.783-12.196, P<0.001), length of hospital stay( OR=1.201, 95% CI 1.131-1.277, P<0.001), and postoperative retention time of ureteral stent( OR=1.205, 95% CI 1.104-1.315, P<0.001) were independent risk factors for fungal infection after upper urinary calculi surgery.The nomogram model was constructed based on independent risk factors. The results of ROC curve analysis showed that the AUC of the nomogram model in the prediction validation set was 0.955(95% CI 0.926-0.984). The calibration curve of the model was well fitted to the ideal curve. The results of decision curve analysis proved that the net benefit rate of the prediction model within the threshold range was higher than the two extreme lines when the threshold probability was <86%, indicating that the model was of good clinical applicability. Conclusions:Age, diabetes, history of malignant tumor, long-term bed-rest disease, white blood cell count on admission, postoperative fever within 48 hours, use of carbapenem antibiotics, length of hospital stay, and postoperative retention time of ureteral stent are independent risk factors for fungal infection in patients with upper urinary calculi after surgery. The model constructed in this study has good predictive ability and clinical applicability for the risk of fungal infection in patients with upper urinary calculi after surgery.

Obesity, as a chronic recurrent disease, has become a major public health challenge in China. To implement the requirements of the Healthy China Initiative (2019—2030), under domestic guidelines or consensus statements on overweight and obesity, and in alignment with the latest scientific advances globally, the Quality control protocol for adult overweight and obesity screening in health management (examination) institutions (2025 edition) was developed. This protocol was drafted by the Health Management Center of Shanghai Changzheng Hospital and formulated through multiple rounds of deliberation by experts in China’s health examination quality control field. The protocol establishes unified standards for screening facilities, personnel qualifications, and measurement or testing procedures. It defines specific screening items, outlines a standardized screening pathway, and sets requirements for the final medical review, ensuring the scientific validity, effectiveness, and safety of the screening process. The implementation of this protocol will enhance the consistency of weight management practices for adults across health examination institutions and strengthen the quality control of overweight and obesity screening programs.

Objectives:To evaluate the effect of extended single prone positioning ventilation on survival and weaning rate of acute respiratory distress syndrome (ARDS) patients supported by VV-ECMO.Methods:ARDS patients supported by VV-ECMO admitted to Jinhua Central Hospital, the Fourth Affiliated Hospital of Zhejiang University School of Medicine and the First Hospital of Jiaxing from September 2014 to May 2025 were retrospectively enrolled into the study. The clinical data, ECMO and ventilator related parameters and outcomes of the patients were collected. The patients were divided into the extended prone positioning group and prone positioning group according to whether the duration of prone position ventilation was greater than 24 h. The clinical data of the two groups were compared to explore the effects on 30-day survival in-hospital survival and ECMO withdraw rate of these patients. Multivariate logistic regression analysis was used to explore the relationship between the duration of single prone position ventilation and the success of ECMO weaning, 30-day survival and hospital survival.Results:Total of 163 ARDS patients supported by VV-ECMO receiving prone positioning ventilation were included in study, 64 in extended prone positioning group and 72 in prone positioning group. The 30-day survival (54.7% vs. 52.8%) in-hospital survival (51.6% vs. 48.6%) and ECMO withdraw rate (57.8% vs. 61.1%) between the two groups were not statistically different ( P>0.05) as well as the duration of ECMO support [12(10,15)d vs. 11(10,13)d] the duration of ventilation [16(13,18)d vs. 16(12,18)d] the duration of ICU stay [26(15,32)d vs. 26(19,29)d] and the duration of hospital stay [32(15,42)d vs. 34(28,35)d]. Logistic regression analysis revealed that the duration of each prone position ventilation was not associated with successful weaning ( OR=0.979, 95% CI:0.952-1.006), 30-day survival ( OR=1.015, 95% CI: 0.975-1.056) and hospital survival ( OR=1.014, 95% CI: 0.974-1.055) even after adjusting for the severity of illness, age, and type of pneumonia. Conclusions:For ARDS patients supported by VV-ECMO, extended single prone positioning ventilation for more than 24 hours neither increase 30-day survival in-hospital survival and successful ECMO weaning rate, nor shorten ECMO support duration.

Objective To explore the clinical characteristics and risk factors of upper urinary tract stones complicated with non-alcoholic fatty liver disease(NAFLD),so as to provide reference for the prevention of this disease.Methods The clinical data of 158 NAFLD patients undergoing surgical treatment in our hospital during Jan.2022 and Jul.2023 were retrospectively analyzed.According to whether the patients were complicated with NAFLD,they were divided into the NAFLD group(n=56)and non-NAFLD group(n=102).The general data,laboratory indexes and 24-h urinary metabolic indexes were compared between the two groups,and the risk factors were analyzed with univariate and multivariate logistic regression analyses.Results Compared with the non NAFLD group,the NAFLD group had higher BMI[(28.17±4.17)vs.(24.11±3.72),P＜0.001],blood uric acid[(354.13±111.01)μmol/L vs.(294.41±93.72)μmol/L,P＜0.001],and 24-h urinary oxalate level[(37.74±15.00)mmol vs.(27.73±15.27)mmol,P＜0.001].Multivariate logistic analysis showed that BMI(OR=1.311,P＜0.001),24-h urinary oxalate(OR=1.046,P=0.004),and 24-h urinary magnesium(OR=0.599,P=0.002)were the independent factors for NAFLD with upper urinary tract stones.Conclusion NAFLD complicated with upper urinary tract stones is significantly associated with high BMI,high 24-h urinary oxalate,and low 24-h urinary magnesium.

Keratoconus is a blinding eye disease characterized by central or paracentral corneal thinning, forward conical protrusion, and high myopia with irregular astigmatism.There are still no effective radical treatments for keratoconus.Current methods mainly include the prevention and treatment of risk factors, non-surgical optical correction and surgical treatment.The main risk factor prevention and treatment measures include intervention of eye rubbing behavior, symptomatic treatment of allergic diseases and systemic diseases, and correction of poor sleeping position.Non-surgical optical correction uses spectacles or corneal/scleral contact lenses to improve corrected vision.Surgical treatments include intracorneal ring segment implantation to improve corrected vision, corneal collagen cross-linking to increase the biomechanical stiffness of the cornea, and corneal transplantation to treat patients with severe keratoconus or corneal scarring.In addition, femtosecond laser-assisted keratoplasty, lenticule intrastromal keratoplasty combined with corneal collagen cross-linking have been gradually applied in clinical treatment, and tissue engineering based on biosynthetic substitutes, 3D bioprinting technology and cell engineering based on stem cell therapy have provided research prospects for the treatment of keratoconus.This article summarizes the prevention and treatment of clinical risk factors, non-surgical optical correction and surgical treatment, and discusses the research perspective of innovative treatment, in order to provide personalized treatment for patients with keratoconus.

Objective:To investigate the clinical effectiveness of Du Meridian moxibustion combined with brisk walking on negative symptoms, cognitive function, and social function in patients with stable schizophrenia, aiming to provide a feasible adjunctive treatment for clinical practice.Methods:A randomized controlled trial was conducted using convenience sampling to recruit 140 patients with stable schizophrenia hospitalized at the Affiliated Brain Hospital of Guangzhou Medical University from April 1, 2023, to March 31, 2024. Patients were randomly assigned to a control group, Du Meridian moxibustion group, brisk walking group, or combined group, with 35 patients in each group. The control group received standard care. On this basis, the Du Meridian moxibustion group received moxibustion on the Du Meridian, the brisk walking group participated in slow walking exercises, and the combined group received both interventions for 12 weeks. Assessments were conducted at baseline, at 6 and 12 weeks during the intervention, and at 12 weeks post-intervention using the Scale for the Assessment of Negative Symptoms, Mini-Mental State Examination, and Social Functioning Scale for Inpatient Psychiatric Patients.Results:A total of 134 patients completed the study: control group ( n = 34), Du Meridian moxibustion group ( n = 34), brisk walking group ( n = 35), and combined group ( n = 31). The combined group demonstrated significantly lower SANS scores at the 12th week of intervention (49.71 ± 4.66) and at 12 weeks post-intervention (53.45 ± 5.34) compared to the Du Meridian moxibustion group (54.91 ± 4.79) and (59.56 ± 5.84), the brisk walking group (56.69 ± 5.59) and (58.51 ± 5.42), control group (65.71 ± 4.95) and (66.21 ± 4.33), with statistically significant differences ( t values were 3.81-13.37, all P<0.05). Regarding cognitive function, the MMSE scores in the combined group at the 12th week of intervention (28.23 ± 1.28) and at 12 weeks post-intervention (27.35 ± 1.76) were higher than those in the Du Meridian moxibustion group (26.79 ± 1.85) and (25.59 ± 2.27) and the brisk walking group (25.88 ± 2.23) and (25.43 ± 1.84), control group (23.65 ± 2.17) and (22.32 ± 2.14), with statistically significant differences ( t values were - 10.28 to - 3.48, all P<0.001). For social function, the SSPI scores in the combined group at the 12th week of intervention (35.71 ± 3.63) and at 12 weeks post-intervention (32.58 ± 3.71) were also significantly higher than those in the Du Meridian moxibustion group (32.21 ± 3.91) and (28.47 ± 3.70) and the brisk walking group (31.83 ± 3.54) and (30.31 ± 3.59), control group (24.53 ± 4.12) and (24.15 ± 3.50) with statistically significant differences ( t values were - 11.56 to - 2.52, all P<0.05). Conclusions:The combination of Du Meridian moxibustion and brisk walking is an effective adjunctive intervention for patients with stable schizophrenia, as it significantly reduces negative symptoms, enhances cognitive function, and improves social functioning.

Keratoconus is a blinding eye disease characterized by central or paracentral corneal thinning, forward conical protrusion, and high myopia with irregular astigmatism.There are still no effective radical treatments for keratoconus.Current methods mainly include the prevention and treatment of risk factors, non-surgical optical correction and surgical treatment.The main risk factor prevention and treatment measures include intervention of eye rubbing behavior, symptomatic treatment of allergic diseases and systemic diseases, and correction of poor sleeping position.Non-surgical optical correction uses spectacles or corneal/scleral contact lenses to improve corrected vision.Surgical treatments include intracorneal ring segment implantation to improve corrected vision, corneal collagen cross-linking to increase the biomechanical stiffness of the cornea, and corneal transplantation to treat patients with severe keratoconus or corneal scarring.In addition, femtosecond laser-assisted keratoplasty, lenticule intrastromal keratoplasty combined with corneal collagen cross-linking have been gradually applied in clinical treatment, and tissue engineering based on biosynthetic substitutes, 3D bioprinting technology and cell engineering based on stem cell therapy have provided research prospects for the treatment of keratoconus.This article summarizes the prevention and treatment of clinical risk factors, non-surgical optical correction and surgical treatment, and discusses the research perspective of innovative treatment, in order to provide personalized treatment for patients with keratoconus.

Objective To explore the clinical characteristics and risk factors of upper urinary tract stones complicated with non-alcoholic fatty liver disease(NAFLD),so as to provide reference for the prevention of this disease.Methods The clinical data of 158 NAFLD patients undergoing surgical treatment in our hospital during Jan.2022 and Jul.2023 were retrospectively analyzed.According to whether the patients were complicated with NAFLD,they were divided into the NAFLD group(n=56)and non-NAFLD group(n=102).The general data,laboratory indexes and 24-h urinary metabolic indexes were compared between the two groups,and the risk factors were analyzed with univariate and multivariate logistic regression analyses.Results Compared with the non NAFLD group,the NAFLD group had higher BMI[(28.17±4.17)vs.(24.11±3.72),P＜0.001],blood uric acid[(354.13±111.01)μmol/L vs.(294.41±93.72)μmol/L,P＜0.001],and 24-h urinary oxalate level[(37.74±15.00)mmol vs.(27.73±15.27)mmol,P＜0.001].Multivariate logistic analysis showed that BMI(OR=1.311,P＜0.001),24-h urinary oxalate(OR=1.046,P=0.004),and 24-h urinary magnesium(OR=0.599,P=0.002)were the independent factors for NAFLD with upper urinary tract stones.Conclusion NAFLD complicated with upper urinary tract stones is significantly associated with high BMI,high 24-h urinary oxalate,and low 24-h urinary magnesium.

Objective:To investigate the independent risk factors for the occurrence of early urinary incontinence after Holmium laser enucleation of the prostate(HoLEP), and to construct a clinical risk predictive model for postoperative urinary incontinence.Methods:A retrospective analysis was conducted on the clinical data of 384 patients who underwent HoLEP between February 2019 and July 2024 at the Second Affiliated Hospital of Zhengzhou University. The cohort had a mean age of (68.3 ± 6.5) years, with a body mass index (BMI) of 22.45 (20.11, 24.39) kg/m 2. The median duration of lower urinary tract symptoms was 60 (36, 60) months. Of the patients, 104 (27.1%) had a history of diabetes mellitus, 139 (36.2%) had hypertension, and 54 (14.1%) had a preoperative indwelling urinary catheter. Additionally, 136 patients (35.4%) had a preoperative prostate-specific antigen (PSA) level ≥ 4 ng/ml, and 197 patients (51.3%) had a preoperative residual urine volume ≥ 50 ml. The International Prostate Symptom Score (IPSS) was ≥ 19 in 227 cases (59.1%). Preoperative detrusor instability was observed in 169 cases (44.0%), with a median maximal urinary flow rate of 5.9 (4.5, 9.3) ml/s and a median urinary flow rate of 4.0 (3.4, 7.3) ml/s. Moreover, 148 cases (38.5%) had a preoperative prostate volume ≥ 65 ml, and the preoperative median maximum urethral length (MUL) was 13.99 (12.40, 16.24) mm. Postoperative follow-up allowed for division of the patients into two groups: those with recovery of urinary control function and those with early postoperative urinary incontinence. The general characteristics of both groups were compared. Independent risk factors for early postoperative urinary incontinence were identified through multifactorial logistic regression. Variables with statistically significant differences were included in a column chart model created using R software. Internal validation was performed through repeated sampling with the Bootstrap method to assess the model's discriminative ability. Calibration curves were plotted to examine the consistency between predicted and actual outcomes, and the Hosmer-Lemeshow test was used to evaluate the model's fit. Results:This study included 384 patients, with 313 in the urinary control function recovery group and 71 in the early incontinence group. There were statistically significant difference between the two groups in age [≥70 years old: 91 (29.1%) vs. 33 (46.5%)], prostate volume [≥65 ml: 110 (35.1%) vs. 38 (53.5%)], MUL [14.21 (12.63, 16.24) mm vs. 13.12 (12.21, 13.95) mm], and non-inhibitory contraction of the urethra muscle in both groups [125 (39.9%) vs. 44 cases (62.0%)] ( P < 0.05). No significant differences were observed between the two groups in terms of BMI, disease duration, history of diabetes mellitus, preoperative catheterization, IPSS, preoperative PSA, residual bladder urine volume, maximum urinary flow rate, average urinary flow rate, operative time, or duration of indwelling urinary catheterization ( P > 0.05). Multifactorial logistic regression analysis revealed that age ≥ 70 years ( OR = 0.414, 95% CI 0.230-0.746, P = 0.003), prostate volume ≥ 65 ml ( OR=0.451, 95% CI 0.251-0.812, P=0.008), MUL( OR=0.688, 95% CI 0.590-0.802, P<0.001), and detrusor instability, uninhibited detrusor contraction ( OR=0.526, 95% CI 0.279-0.994, P=0.048) were independent risk factors for early postoperative urinary incontinence following HoLEP. A prediction model was developed based on these findings, and internal validation showed a C-index of 0.753. The calibration curve was close to the ideal curve, indicating that the model has good predictive performance. Conclusions:Age ≥70 years, prostate volume ≥65 ml, MUL, and uninhibited contraction of the urethra muscle were independent influences on early urinary incontinence after HoLEP, and the nomogram constructed in this way had good predictive performance for the risk of developing early urinary incontinence after HoLEP.