Consumptive thirst is widely discussed in Huangdi Neijing and it is classified as a"strange disease"in Suwen·Strange Diseases Treatise,which reflects the intractable nature of consumptive thirst.This paper explores and analyzes consumptive thirst based on the core concept in Huangdi Neijing.First,this paper approaches the subject through the use of image thinking method from Huangdi Neijing,recognizing that consumptive thirst can lead to changes in the internal climate of the human body.Then,guided by the theories of essence and qi,yin and yang,and the five elements in Huangdi Neijing,it deconstructs and analyzes the causes of these changes and the laws of qi transformation.It points out that the changing climate of consumptive thirst is characterized by"heat symptoms".The main cause of"heat symptoms"is spleen deficiency and excessive dampness,and its qi transformation law is the heat transformation of Shaoyin.The intractable nature of consumptive thirst is mainly reflected in the uncontrolled"heat symptoms"caused by the imbalance of the five elements.Based on the understanding of the heat symptoms of consumptive thirst,this paper proposes a treatment strategy for preventing the disease by resolving dampness and regulating the spleen,harmonizing kidney qi to prevent progression,and balancing yin and yang to treat chronic and recalcitrant conditions.The aim is to provide a reference for optimizing the treatment of consumptive thirst.

ObjectiveThis study aimed to evaluate the clinical efficacy of Ruyi Zhenbaowan（RYZBW）in the treatment of initial and early knee osteoarthritis （KOA） through a prospective multicenter，randomized，double-blind，and placebo-parallel controlled trial. MethodFrom October 13^th， 2021 to December 25^th， 2021， 240 KOA subjects meeting the acceptance criteria were enrolled in 15 sub-centers including Wangjing Hospital， Chinese Academy of Chinese Medical Sciences， and they were randomly divided into observation group and control group， with 120 cases in each group. The intervention measures for the observation group were RYZBW + health education， and the intervention measures for the control group were RYZBW placebo + health education. The intervention period in both groups was four weeks， and they were followed up for four weeks after the intervention. The primary outcome measure was the total score of Western Ontario and McMaster University Osteoarthritis Index score （WOMAC score）， and the secondary outcome measures were the response rate of visual scale （VAS） pain score， WOMAC sub item scores （joint pain， joint stiffness， and joint function）， quality of life （SF-12） score， and traditional Chinese medicine （TCM） syndrome score. Result（1） Efficacy evaluation. The marginal model results showed that the observation group was better than the control group in improving the WOMAC total score and WOMAC pain score in the treatment of KOA with RYZBW， and the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in improving VAS score response rate， WOMAC function score， WOMAC stiffness score， SF12-PCS （quality of life-physical health） score， SF12-MCS （quality of life-mental health） score， and TCM syndrome score. （2） Subgroup analysis. ① In terms of VAS score response rate， the response rate of the observation group was higher than that of the control group for subjects with baseline VAS score of （4， 5］， and the difference was statistically significant （P<0.05）. ② In terms of TCM syndrome score， for subjects aged ［56， 60］ and ［61， 65］， the decrease in total TCM syndrome score in the observation group was better than that in the control group， and the difference was statistically significant （P<0.05）. ConclusionTibetan medicine RYZBW has good clinical efficacy in improving WOMAC total score， VAS score response rate， WOMAC pain score， WOMAC function score， and TCM syndrome score for patients with initial and early KOA， which can fill the lack of Tibetan medicine RYZBW in the treatment of KOA and make a demonstration study for the inheritance and development of ethnic medicine.

From the perspectives of traditional Chinese medicine （TCM） information knowledge base and assisted decision-making knowledge base， the construction status， quality evaluation status and existing problems of current TCM knowledge bases have been sorted out. And based on the quality evaluation strategies and dimensions of know-ledge bases in other disciplines， the evaluation indexes for TCM knowledge base is discussed， and the evaluation framework is initially formed， providing ideas for the improvement of the TCM knowledge base evaluation system. In terms of the evaluation indexes， there are basic evaluation dimensions which include data sources， data collection， and data application. The specific evaluation dimension of the information-based knowledge base is data quality， while that of the assisted decision-making knowledge base is data matching. Except for the data application dimension which counts the valid data items in the database for calculation， other indexes are scored based on the qualitative evaluation of "yes"， "no" or "unknown". The basic evaluation score and the specific evaluation score are added to obtain the total score. The knowledge base is graded according to the score， and the results are presented in the form of grade plus number.

With the research progress on the biology and pathogenesis of cancer, immune checkpoint inhibitors (ICIs) have come into being, bringing a new hope for the survival of patients with advanced cancer and opening a new era of cancer immunotherapy. However, with the wide application of immunotherapy in clinical practice, ICI-related adverse events (irAEs) have gradually emerged and are widely known by first-line clinicians. ICIs primarily activate T cells that can attack normal tissues and organs in the body and cause a variety of adverse reactions. Checkpoint inhibitor pneumonitis (CIP) is one of the rare complications with poor prognosis in irAEs. This article reviews the therapeutic mechanism of some ICIs; the incidence, risk factors, pathogenesis, and clinical and imaging manifestations of CIP; and the classification and treatment management of CIP.

Objective:To investigate the current situation of sharp instrument injuries among medical workers in a tertiary general hospital in Fuzhou, so as to provide basis for formulating relevant policies.Methods:In June 2019, medical personnel working in a tertiary general hospital in Fuzhou, who may have sharp instrument injuries were selected as the research object. A total of 2720 questionnaires were received, including 2688 valid questionnaires, with an effective rate of 98.8%. The age, type of work, professional title, working years, operating habits, occurrence and reporting of sharp instrument injuries among medical staff from June 2018 to May 2019 were investigated.Results:The incidence of sharp instrument injury was 37.6% (1011/2688) . Among them, 20.6% (208/1011) had multiple sharp instrument injuries. The exposure rate of contaminated sharp instruments was 15.1% (405/2688) . With the increase of age, professional title and working years, the incidence of sharp instrument injury decreased year by year (χ 2trend=12.393, 33.339, 15.160, P<0.05) . The first three causes of sharp instrument injury were breaking glass ampoules by hand (39.1%, 395/1011) , extracting liquid medicine (10.4%, 105/1011) and handling sharp instruments by hand (10.3%, 104/1011) . The main sharp instruments causing sharp injury were ampoules (43.2%, 437/1011) , syringe needles (20.3%, 205/1011) and suture needles (9.6%, 97/1011) . 874 (86.4%) medical staff had missed reports after sharp instrument injuries. Conclusion:The occurrence of sharp instrument injury in this hospital is still serious, and the protection of sharp instrument injury should be strengthened.

Objective:To investigate the current situation of sharp instrument injuries among medical workers in a tertiary general hospital in Fuzhou, so as to provide basis for formulating relevant policies.Methods:In June 2019, medical personnel working in a tertiary general hospital in Fuzhou, who may have sharp instrument injuries were selected as the research object. A total of 2720 questionnaires were received, including 2688 valid questionnaires, with an effective rate of 98.8%. The age, type of work, professional title, working years, operating habits, occurrence and reporting of sharp instrument injuries among medical staff from June 2018 to May 2019 were investigated.Results:The incidence of sharp instrument injury was 37.6% (1011/2688) . Among them, 20.6% (208/1011) had multiple sharp instrument injuries. The exposure rate of contaminated sharp instruments was 15.1% (405/2688) . With the increase of age, professional title and working years, the incidence of sharp instrument injury decreased year by year (χ 2trend=12.393, 33.339, 15.160, P<0.05) . The first three causes of sharp instrument injury were breaking glass ampoules by hand (39.1%, 395/1011) , extracting liquid medicine (10.4%, 105/1011) and handling sharp instruments by hand (10.3%, 104/1011) . The main sharp instruments causing sharp injury were ampoules (43.2%, 437/1011) , syringe needles (20.3%, 205/1011) and suture needles (9.6%, 97/1011) . 874 (86.4%) medical staff had missed reports after sharp instrument injuries. Conclusion:The occurrence of sharp instrument injury in this hospital is still serious, and the protection of sharp instrument injury should be strengthened.

Objective To study classification of vascular sign of tiny ground glass nodules-like lung adenocarcinoma in HRCT, and explore its value to differentiate benign from malignant of the ground glass nodules(GGN).Methods 87 patients with tiny ground glass nodules-like lung adenocarcinoma examined on HRCT were retrospectively evaluated.According to the new pathological classification standard of lung adenocarcinoma,they were divided into three groups:(1)pre-invasive group(n=25),including 14 cases of atypical adenomatous hyperplasia(AAH)and 11 cases of adenocarcinoma in situ(AIS);(2)minimally invasive adenocarcinoma (MIA)group(n=35);(3)invasive adenocarcinoma(IAC)group(n=27).The lesions were divided into three types according to the grinding of glass composition proportion:Type A,pure ground glass nodules(pGGN);Type B,mixed ground glass nodules (mGGN)which contained glass composition≥50%;Type C,mGGN which contained glass composition < 50%.The vascular sign of GGN were divided into four types:Type 1,without vessels passing through the GGN,or vessels passing by GGN;Type 2,intact vessels passing through GGN,but vascular morphology is normal;Type 3,single vessels passing through GGN,and distorted,stiff vessels seen within GGN;Type 4,two or more vessels passing through GGN,and branches between vessels formed in GGN,and the diameter of vessel was irregular,partial enlargement.The relationship among the size of the GGN,content of the grinding of glass proportion and the vascular sign of GGN were analyzed both in axial images and reconstruction images.Results There were significant differences in size among the three groups(P=0.032,P=0.000,P=0.000).There were significant differences between content of the grinding of glass proportion and classification of vascular sign of GGN(P=0.000).Type 1 and type 2 vascular sign were dominant in the infiltrating former group,a total of 24 cases(96%).The incidence of type 3 and type 4 vascular sign in MIA group and IAC group was 60% and 74% respectively,and there were significant differences with the infiltrating former group(P=0.000,0.000).Further analysis indicated that type 3 was more commonly seen in MIA with comparison to type 4 which was more likely seen in IAC,the difference was statistically significant(P=0.043).Conclusion To study HRCT vascular sign of tiny ground glass nodules-like lung adenocarcinoma can improve the ability of the GGN benign and malignant diagnosis,provide reliable basis for clinical diagnosis and treatment.

Objective To investigate the adhesion levels in uropathogenic Escherichia coli with various degree of drug resistance.Methods One hundred strains of Escherichia coli isolated from urine specimen were collected from patients admitted to 4 Grade A tertiary hospitals in Tianjin during March 2012 to October 2015.Escherichia coli were divided into drug sensitive group and drug resistant group by drug sensitivity tests with 50 strains in each group.The expressions of fimH,fimA,fimB genes of type I fimbriae and papA,papB,papC,papGII genes of P fimbriae were detected by polymerase chain reaction(PCR)and real-time fluorescence quantitative RCR (RT-PCR),respectively.Adhesion ability of type I fimbriae and P fimbriae were tested by yeast cell adhesion test and erythrocyte agglutination test.Chi square test and t(Z) test were used to analyze the data.Results The positive rate of papGII in drug resistant group (42.0%) was significantly higher than that in the drug sensitive group (16.0%)(χ2 =8.208,P <0.05),while there were no significant differences in the positive rates of fimH,fimA,fimB,papA,papB and papC genes between two groups(all P >0.05).The expression levels of fimH,fimB and papC genes in the sensitive group were higher than those in the resistant group(Z =3.427,t =5.182 and 8.120,all P <0.05).The adhesion ability of strains carrying type I fimbriae in sensitive group was stronger than that of resistant group (χ2 =5.769,P <0.05).Conclusions The decline in adhesion ability of type I fimbriae in drug resistant E.coli strains is possibly associated with the adaptive cost of bacteria,the transcription and deficiency of other genes encoded by fim and pap gene cluster will also affect the adhesion function of type I pili and type P pili.

This article compares and analyzes the content and theoretical structure of the concept of pathogenesis from the national textbooks of Basic Theory of Chinese Medicine and Diagnostics in Chinese Medicine from the first to the ninth version.The authors consider the mechanism as the main content of pathogenesis concept in contemporary Chinese medicine.During the construction of this concept,the concept of pathology has a profound influence,wh ich differs a lot from the emphasis on key in ancient pathogenesis content,mainly reflected in clinical diagnosis and treatment ideas transferring from dealing with key issues to dealing with abstract concept.This change is associated with the impact of western medicine on modern Chinese medicine,emphasizing the mechanism and so on,so that the ancient Xiang (象) concept is marginalized.

Objective To evaluate the application of abbreviated protocol (AP) of magnetic resonance imaging (MRI) in screening of breast cancer with dense breast tissue.Methods Total 478 patients with dense breast tissue,who had negative X-ray mammography (MG),underwent dynamic contrast-enhanced MRI (DCE-MRI).The AP MRI,which consisted of first postcontrast subtracted (FAST) and maximum-intensity projection (MIP),and full diagnostic protocol (FDP) MRI images were analyzed by Breast Imaging Reporting and Data System (BI-RADS).Among 478 patients the histopathological diagnosis was available in 39 cases (41 breast lesions).With pathological diagnosis as gold standard,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of AP and FDP in breast cancer detection were evaluated.Results In 41 breast lesions there were 16 malignant lesions and 25 benign lesions.FDP detected all 16 malignant lesions,including 9 cases of ductal carcinoma in situ,6 cases of invasive ductal carcinoma and 1 case of mucinous carcinoma;AP detected 15 out of 16 cases of breast cancer.The sensitivity of FDP and AP in detection of breast malignant lesions was 16/16 and 15/16,respectively (x2 =0.725,P =0.224).The specificity of FDP and AP was 92％ (23/25) and 76％ (19/25),respectively (x2 =6.327,P =0.012).Conclusion For women with dense breast tissue AP of MRI can be used in early screening of breast cancer.