Guishenwan （GSW）， originating from Jingyue Quanshu （Zhang Jingyue's Complete Works）， is a classic traditional Chinese medicine （TCM） formula with a history of over 400 years. Designed for kidney essence deficiency syndrome， it is clinically applied to treat diseases associated with essence-blood deficiency， such as ovarian insufficiency diseases in women， oligospermia-induced infertility in men， and lumbar disc herniation. Numerous studies have confirmed its significant efficacy and advantages in managing ovarian insufficiency diseases， including diminished ovarian reserve （DOR）， premature ovarian insufficiency （POI）， and premature ovarian failure （POF）. According to recent literature， the therapeutic mechanisms of GSW in treating ovarian insufficiency diseases involve regulating the hypothalamic-pituitary-ovarian axis （HPOA） function， ameliorating reproductive endocrine disorders， improving ovarian function， modulating relevant signaling pathways， and exerting immunoregulatory and anti-inflammatory effects. A review of GSW in clinical treatment revealed that clinical applications of GSW， particularly in combination with Western medicine， not only alleviate symptoms but also compensate for the limitations of hormone replacement therapy， thereby reducing recurrence， minimizing adverse reactions， and enhancing safety. This review aims to provide a scientific basis for the rational clinical use of GSW in ovarian insufficiency diseases， offer innovative TCM strategies for developing novel ovarian-protective drugs， promote the integration of TCM and Western medicine in reproductive medicine， and ultimately contribute a Chinese approach to global management of ovarian insufficiency diseases.

AIM: To compare the diagnostic efficiency of binocular uncorrected distance visual acuity(UCDVA), pre-cycloplegia refraction spherical equivalent(PR-SE), axial length(AL)difference, and their different combinations in the screening of anisometropia in children and adolescents, and to evaluate the practical value of different indicator combinations in simplifying the screening process when taking cycloplegic retinoscopy results as the gold standard for diagnosing anisometropia.METHODS: This was a retrospective study. A total of 500 consecutive cases of children and adolescents aged 6-18 years with known refractive status were included. Taking cycloplegic retinoscopy results as the gold standard for anisometropia diagnosis, the binocular UCDVA, PR-SE, and AL difference were incorporated into ROC curve analysis to assess the diagnostic efficacy of each indicator. Furthermore, predictive models were constructed and reliability analysis was performed.RESULTS: The average age of the included cases was 10.75±2.24 years, including 239 males and 261 females. The AUC of the interocular PR-SE difference(0.972, 95%CI: 0.960-0.984)was significantly higher than that of other indicators. The Youden index was the largest when the bincular UCDVA difference was 0.25, the PR-SE difference was 0.743, and the AL difference was 0.31. When the interocular PR-SE difference used 0.743 and 1.00 D as screening cutoffs, the former had a higher AUC(AUC=0.924, 95%CI: 0.895-0.953). Comparison of different constructed predictive models showed that when the binocular PR-SE difference was ≥0.743 D, the negative predictive value reached 98.89%, making it suitable for initial screening. The combination of UCDVA+PR-SE+AL had the highest specificity and positive predictive value, while the PR-SE+AL combination had the highest consistency rate.CONCLUSION: The binocular PR-SE difference is the best choice for single-indicator screening. Combining UCDVA and AL can increase the specificity to 98.00% and the positive predictive value to 88.24%. The PR-SE+AL combination can achieve the highest consistency rate.

Objective:To discuss the biological function of the spacer domain of ADAM metalloproteinase with thrombospondin type 1 motifs 13(ADAMTS13)in the cleaving process of von Willebrand factor(vWF),and to clarify the role of ADAMTS13 in the pathogenesis of thrombotic thrombocytopenic purpura(TTP).Methods:The point mutation method was introduced sequentially into the amino acid residues TEDRLPR of the ADAMTS13 spacer domain(mutants M1-M7)by site-directed mutagenesis.The constructed ADAMTS13 and its mutants plasmids were transfected into the human embryonic kidney HEK293 cells,and the recombinant proteins were purified after stable expression.The cleavage capabilities of both wild type and mutant ADAMTS13 were observed under denaturation conditions,shear stress,and after treatment with ADAMTS13 antibodies.Results:The fluorescence resonance energy transfer(FRET)assay results showed that compared with wild type ADAMTS13,the cleavage abilities of ADAMTS13 mutant M4(R635A)and mutant M7(R638A)on the FRET-vWF73 were decreased(P＜0.05).Under denaturation conditions,the wild-type ADAMTS13 could cleave the vWF multimers;compared with wild-type ADAMTS13,the cleavage activities of ADAMTS13 mutant M4(R635A)and mutant M7(R638A)were significantly decreased(P＜0.01).Under in vitro shear stress,compared with wild type ADAMTS13,the abilities of ADAMTS13 mutant M4(R635A)and mutant M7(R638A)to cleave vWF multimers were significantly decreased(P＜0.01).Compared with wild type ADAMTS13,the binding affinity between vWF and ADAMTS13 mutant M4(R635A)and mutant M7(R638A)had no significant difference(P＞0.05),indicating there were multiple binding sites between C-terminal of ADAMTS13 and vWF.The ADAMTS13 antibodies were able to inhibit the cleavage ability of both wild-type and mutant ADAMTS13 to some extent.Conclusion:The activity of ADAMTS13 after spacer domain mutation is decreased.The ADAMTS13 mutant M4(R635A)and mutant M7(R638A)may be the important action sites for AD AMTS 13 in substrate recognition.

Objective To analyze and compare the auxiliary value and significance of γ-interferon release assay (IGRA) in the diagnosis of tuberculosis. Methods A retrospective analysis was conducted to collect the test results of 462 suspected tuberculosis patients who underwent IGRA detection in the outpatient department of Tianjin Tuberculosis Control Center from January 2020 to December 2021. According to the diagnostic results, they were divided into a tuberculosis group of 229 cases (203 cases of pulmonary tuberculosis and 26 cases of extrapulmonary tuberculosis) and a non-tuberculosis group of 233 cases. The auxiliary diagnostic value of IGRA for tuberculosis was analyzed and compared with two methods of Mycobacterium tuberculosis culture and Xpert MTB/RIF. Results The positive rates of IGRA, Mycobacterium tuberculosis culture, and Xpert MTB/RIF in TB patients were 76.42%, 29.26% and 40.62%, respectively, compared with the non-TB group (38.20%, 0.00%, 0.00%), with statistically significant differences (P<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of IGRA alone in the detection of tuberculosis were 76.42%, 61.80%, 69.29%, and 72.73% respectively, those of Mycobacterium tuberculosis culture were 29.26%, 98.28%, 94.37%, and 63.43%, and those of Xpert MTB/RIF were 40.60%, 100%, 100%, and 63.14%. The positive rates of IGRA were 76.85% and 73.08% in patients with pulmonary tuberculosis and extrapulmonary tuberculosis, respectively, with no statistical significance (P>0.05). The positive rates of IGRA in bacterial positive patients and non-tuberculosis patients were 79.34% and 38.20%, respectively, with statistical significance (χ2=54.526, P<0.001). The positive rates of IGRA in patients with and without tuberculosis were 73.15% and 38.20%, respectively, with significant difference (χ2=36.456, P<0.001). Conclusions IGRA has a relatively high sensitivity in the diagnosis of tuberculosis and also has certain advantages in the screening of extrapulmonary tuberculosis and mycobacterium-negative It provides important reference basis for the clinical diagnosis of tuberculosis.

Objective:To explore the efficacy and safety of tislelizumab combined with zanubrutinib in the treatment of refractory diffuse large B-cell lymphoma (DLBCL).Methods:A prospective observational study was conducted. A total of 10 patients with refractory DLBCL admitted to Beijing Chaoyang District Third Ring Cancer Hospital, a specialist medical consortium of Cancer Hospital Chinese Academy of Medical Sciences from November 2020 to February 2023 were prospectively collected. All the 10 refractory DLBCL patients at least received first-line systemic therapy containing rituximab; and they were given tislelizumab 200 mg, intravenous infusion, on day 1 and zanubrutinib 160 mg, orally, twice a day, day 1-day 21, with 21 days as 1 cycle; 6 patients received second-line therapy and 4 patients received ≥ third-line therapy. Subsequent regimens were added with rituximab (375 mg/m 2, intravenous infusion on day 1). The primary endpoint will be reached 12 months after enrollment if there was no disease progression or other events that were scheduled to withdraw from the study. The therapeutic efficacy was summarized at the end of the follow-up in March 2023. Kaplan-Meier method was used to make survival analysis and the adverse reactions were summed up. Results:There were 6 males and 4 females, all at stage Ⅲ-Ⅳ; and age [ M ( Q1, Q3)] was 55 years (50 years, 69 years). All 10 patients completed 90 cycles of treatment with tislelizumab and zanubrutinib, with the cycle number of 8 cycles (2 cycles, 24 cycles). The follow-up time was 19 months (11 months, 28 months); 4 cases achieved complete remission, 3 cases achieved partial remission and 1 case had the stable disease. The progression-free survival was 8.5 months (1.3 months, 27.0 months); the median remission duration time and median overall survival time were not reached. Treatment-related adverse reactions included 2 cases of neutropenia, 1 case of anemia, and 1 case of elevated alanine aminotransferase and aspartate aminotransferase, all of which were grade 1-2. Conclusions:Tislelizumab combined with zanubrutinib has good clinical efficacy and safety in the treatment of refractory DLBCL.

Objective To observe the effect of ultrasound-guided iliopsoas plane block(IPB)on the quality of postoperative recovery in patients undergoing hip arthroplasty.Methods Sixty patients who underwent hip arthroplasty were selected,37 males and 23 females,aged 40-79 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ.The patients were divided into two groups by random number table method:the iliopsoas plane block group(group IPB)and the femoral nerve block(FNB)group(group FNB),30 pa-tients in each group.Before anesthesia induction,IPB was performed with 0.5%ropivacaine 10 ml and lat-eral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group IPB.And FNB was performed with 0.5%ropivacaine 10 ml and lateral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group FNB.The dosages of propofol,remifentanil,and cis-atracurium during operation were recorded.The quality of recovery-15(QoR-15)scale was evaluated preoperatively and postoperatively 1 day,2 and 3 days.The max VAS(VASmax)pain score and manual muscle test(MMT)score of quadri-ceps muscle were recorded 12,24,and 48 hours after surgery.The time of getting out of bed for the first time,opioid dosage,and patient satisfaction were recorded.The incidence of nerve injury,vascular injury,puncture site infection,and local anesthetic poisoning were recorded.The postoperative complications of diz-ziness,nausea and vomiting,deep vein thromboses,and elirium were also recorded.Results There was no significant difference in the dosage of propofol,remifentanil,and cis-atracurium between the two groups.Compared with group FNB,the QoR-15 scale score in group IPB was significantly higher 1 day,2 and 3 days after operation(P＜0.05).Compared with group FNB,the MMT scores of quadriceps muscle was sig-nificantly higher in group IPB 12 and 24 hours after surgery(P＜0.05),and the first time of getting out of bed was shortened in group IPB(P＜0.05).However,there were no significant differences in the VASmax pain score,MMT score of quadriceps muscle 48 hours after surgery,opioid dosage,and patient satisfaction between the two groups.No nerve block related complications were found in both groups.There were no sig-nificant differences in postoperative complications between the two groups.Conclusion The iliopsoas plane block can improve the quality of postoperative recovery and accelerate the recovery of patients with hip re-placement,and the effect is better than that of femoral nerve block.

Objective:To evaluate the diagnostic value of rapid on-site evaluation (ROSE) performed by endoscopists for solid pancreatic lesions requiring tissue for immunohistochemistry (IHC) staining with different approach of endoscopic ultrasound-guided tissue acquisition (EUS-TA).Methods:After screening 1 573 cases who underwent EUS-TA operation at the Endoscopy Center of Peking Union Medical College Hospital between August 2018 and October 2022, a total of 65 cases of solid pancreatic lesions whose diagnosis rely on IHC staining was collected and summarized with clinical data of each case. Among 65 cases, there were 46 cases of pancreatic neuroendocrine tumors (PNETs), 13 cases of pancreatic solid pseudo-papillary tumors (SPTs), and 6 cases of lymphomas and mesenchymal. Patients were categorized into ROSE group (36 cases) and non-ROSE group (29 cases) according to the presence or absence of endoscopists performed ROSE during EUS-TA operation. They were further divided into subgroups of FNA-ROSE (26 cases), FNB-ROSE (10 cases), FNA-non-ROSE (24 cases) and FNB-non-ROSE (5 cases) according to the type of EUS-TA. Diagnostic accuracy and IHC success rate were compared between different groups and subgroups. Binomial logistic multifactorial regression analysis was used to evaluate the influence of ROSE and EUS-TA type on diagnostic accuracy and IHC success rate.Results:There were no statistically significant differences between ROSE group and non-ROSE group in terms of age, gender, bilirubin level, CA19-9 level, lesion site, lesion size, composition ratio of diagnosis, and surgical rate. The differences in mean size of lesions, needle gauge, location of puncturation, and number of needle pass between subgroups were not statistically significant. The diagnostic accuracy was 88.9% in ROSE group and 79.3% in non-ROSE group, and the difference between the two groups was statistically significant ( P=0.023). The diagnostic accuracy of FNA-ROSE group was higher than that of FNA-non-ROSE group (88.5% vs 75.0%), but the difference was not statistically significant ( P>0.100). The differences in diagnostic accuracy and success rate of IHC between FNB-ROSE group and FNB-non-ROSE group were not statistically significant. Binomial logistic multifactorial regression analysis did not reveal any independent influences on diagnostic accuracy. Conclusions:ROSE performed by endoscopists improved diagnostic accuracy of EUS-TA in solid pancreatic lesions requiring IHC staining, and therefore is potentially valuable for improving the diagnostic efficiency of EUS-TA for such diseases.

Diabetic dry eye is a prevalent ocular surface disease and has a profound impact on patients'quality of visual acuity.The pathological changes of diabetic dry eye are influenced by a multitude of factors,involving the effects of hyperglycemia on the ocular surface microenvironment and corneal nerves,oxidative stress and the accumulative effect of glycation end products.Current therapeutic strategies include physiotherapy,tear replacement therapy,promotion of ocu-lar surface repair,and anti-inflammatory therapy.However,these treatments have certain limitations.This article presents a summary of the research conducted on the pathogenesis and clinical treatment of diabetic dry eye in recent years,aiming to provide clinicians with new ideas for developing personalized treatment plans for diabetic dry eye patients.

Objective:To explore the application effect of the teaching method combining process-oriented-guided inquiry learning (POGIL) theory and micro-class in orthopedic clinical internship.Methods:The 118 interns who completed internship from January 2022 to December 2022 were randomly divided into a control group (58) and an experimental group (60). The control group received traditional teaching, while the experimental group received a teaching method combining POGIL theory and micro-class. After the internship, the two groups were compared for assessment scores (basic theoretical knowledge and professional theoretical knowledge), learning status (classroom performance and self-learning ability), clinical practice ability (Leicester Assessment Scale), and teaching satisfaction. The t-test and chi-square test were performed using SPSS 21.0. Results:After the internship, the assessment scores, classroom performance, self-directed learning ability scores, clinical skills, case writing scores, and teaching satisfaction of the experimental group were all higher than those of the control group ( t/ χ2=5.01, 3.72, 2.20, 6.57, 3.56, 4.52, P<0.05). Conclusions:The teaching method combining POGIL theory and micro-class can enhance the master of theoretical knowledge by orthopedic interns, optimize classroom performance, cultivate self-learning ability, and improve clinical practice ability and teaching satisfaction.