The triple energizer is the pathway for the transportation and metabolism of qi,blood and body fluid in the body,and the xuanfu(sweat pores)is the way for the ascending,descending,exiting,and entering of qi movement in the muscular striae and the exterior.Professor Li Huilin believes that the pathogenesis of acne is usually due to the dysfunction of triple energizer and the stagnation of depressed yang-heat,which result into the abnormal opening and closing of the xuanfu and the accumulation of heat-toxin in the muscular striae.For the treatment of acne with traditional Chinese medicine,it is necessary to pay attention to the regulation of triple energizer-xuanfu.The treatment should be based on unblocking therapy,and the therapeutic principle of unblocking triple energizer and opening xuanfu should be taken into account.In clinical practice,it is necessary to identify the syndromes of upper energizer,middle energizer and lower energizer.The syndrome of the upper energizer is often due to fire-heat,which results from the wind-heat in lung meridian or the exuberance of heart fire.The upper-energizer syndrome can be treated by the therapy of relieving and clearing the pathogens with light and mild drugs,expelling fire-heat to open sweat pores,and through the modified use of Mahuang Lianqiao Chixiaodou Decoction,Ma Xing Shi Gan Decoction,or Puji Xiaodu Decoction.The syndrome of the middle energizer is usually due to the qi stagnation,which results from intense stomach-heat,damp-heat in the spleen and stomach,liver depression and qi stagnation,or spleen deficiency with dampness accumulation.The middle-energizer syndrome can be treated by the therapy of regulating qi movement to relieve stagnation and open sweat pores,and through the modified use of Qingwei san,Sanren Decoction,Huanglian Wendan Decoction,Chaihu Shugan Powder,or Heqi Powder.The syndrome of the lower energizer is often due to healthy-qi deficiency,which results from yin deficiency of liver and kidney,or deficiency-cold in lower energizer.The lower-energizer syndrome can be treated by the therapy of cultivating the vital essence and consolidating vital base,supplementing deficiency to open sweat pores,and through the modified use of Liuwei Dihuang Pills or Yanghe Decoction.

Objective To investigate the acupoint selection patterns for treating diabetic cardiac autonomic neuropathy(DCAN)using data mining techniques,providing evidence for clinical practice.Methods Literature on acupuncture treatment for DCAN was retrieved from CNKI,Wanfang,VIP,and PubMed.The publication dates of the included literature ranged from the inception of each database to April 2024.Descriptive analysis,association rule analysis,and cluster analysis were performed on acupoint prescriptions,with the selection patterns of meridians and acupoints were summarized.Results A total of 27 articles were included,involving 18 acupoints.The top 10 high-frequency acupoints were Neiguan(PC6),Xinshu(BL15),Pishu(BL20),Zusanli(ST36),Sanyinjiao(SP6),Shenmen(HT7),Taixi(KI3),Lingtai(GV10),Shendao(GV11),and Shenshu(BL23).The primary meridians selected were the bladder meridian of foot-taiyang and the pericardium meridian of hand-jueyin.Specific acupoint categories predominantly included back-shu points and five transport points.Association rule and cluster analyses identified core acupoint combinations centered on Xinshu,Neiguan,Pishu,and Zusanli.Conclusion The core acupoint combination for treating DCAN with acupuncture comprises Xinshu,Neiguan,Pishu,and Zusanli.

Objective To explore the medication rules of Professor Li Huilin in treating Hashimoto's thyroiditis(HT)complicated with hypothyroidism using data mining techniques based on the R language.Methods Prescription data of the patients with HT complicated with hypothyroidism treated by Professor Li Huilin in outpatient clinics from March 2023 to March 2024 were collected.A database was established using Microsoft Excel 2021,and R language was employed to analyze the frequency,efficacy,properties and flavors,and meridian tropism of the medicinals from Chinese herbal prescriptions.Additionally,correlation analysis,association rule analysis,and cluster analysis were performed on the medicines from Chinese herbal prescriptions.Results A total of 57 Chinese herbal prescriptions involving 125 medicinals with 782 medication frequencies were included.The top 10 frequently-used medicinals were Glycyrrhizae Radix et Rhizoma Praeparata cum Melle(Zhigancao),Angelicae Sinensis Radix(Danggui),Atractylodis Macrocephalae Rhizoma(Baizhu),Astragali Radix(Huangqi),Bupleuri Radix(Chaihu),Cinnamomi Ramulus(Guizhi),Leonuri Herba(Yimucao),Paeoniae Radix Alba(Baishao),Poria(Fuling),and Fici Simplicissimae Radix(Wuzhimaotao).Most of the medicinals had therapeutic action of tonifying deficiency.The analysis of properties and flavors showed that the majority of medicinals were mild or warm in nature,and sweet in flavor.The top three meridians having the tropism of medicinals were the liver,lung,and spleen meridians.Correlation analysis identified five strongly-correlated herbal combinations.Association rule mining revealed a core herbal combination consisting of seven medicinals of Zhigancao,Huangqi,Danggui,Chaihu,Codonopsis Radix(Dangshen),Baizhu,and Cyperi Rhizoma(Xiangfu).Cluster analysis of medicinals with a frequency of≥5 yielded five groups of herbal combination.Conclusion For the treatment of HT complicated with hypothyroidism,Professor Li Huilin follows the principle of addressing the root cause of the disease,and focuses on strengthening the spleen and replenishing qi.Moreover,attention is given to soothing the liver and regulating qi,harmonizing qi and blood simultaneously,and treating symptoms and root cause simultaneously.

The clinical data of one child with metanephric stromal tumor (MST) and BRAF V600E gene mutation admitted to the First Affiliated Hospital of Zhengzhou University in June 2022 was analyzed retrospectively.Literature was reviewed.The patient, a 2-year-old girl, was diagnosed with a tumor in the left abdomen.The maximum diameter of the tumor was 10.5 cm.A radical nephrectomy was performed on the left kidney, and postoperative pathology revealed MST.Microscopically, the tumor had no envelope and exhibited expansive growth.The tumor cells were fusiform or stellate, and nuclear division was visible in the cell-rich region.Dysplastic blood vessels were seen inside the tumor.The tumor cells around the blood vessels and invaginated renal tubules were arranged like onion skin.CD34 was detected positive by immunohistochemical staining, and BRAF V600E mutation was also detected positive by fluorescent polymerase chain reaction.A total of 21 relevant case reports were retrieved, including 16 in English and 5 in Chinese.Fifty-eight MST patients, including the one in this report were analyzed.These patients were aged 2 days to 15 years, with a median age of 2 years.Except for 2 patients with unknown sex, the ratio of male to female was about 1.4∶1.0.Most MST patients were asymptomatic, with an average tumor size of 5.3 cm.The tumor cell CD34 showed positive expression in different degrees.Eight patients received the BRAF V600E mutation detection, and the results were all positive.Fifty-eight patients underwent nephrectomy and were followed up for 0-156 months, of which 7 patients were assisted with radiotherapy and chemotherapy.During the follow-up, 1 patient died, and 1 patient had a relapse.MST is a rare benign renal stromal tumor. BRAF V600E mutations are detected in a variety of malignancies.This paper is the first to report MST with BRAF V600E mutation in China and points out the importance of molecular detection of BRAF mutation for accurate diagnosis of MST.

Objective:To explore the severe complications, such as blindness, brain infarction and even death caused by cosmetic autologous fat filler injection and their underlying mechanisms.Methods:From May 2022 to October 2023, 64 male New Zealand rabbits were selected in the clinical laboratory of Shaanxi University of Chinese Medicine and divided into 8 groups with 8 rabbits in each group. They were divided into grinding fat group, fat granule group, fat lipid group and normal saline group, and each group was further divided into 0.2 ml group and 0.4 ml group. Fat was cut from the rabbit groin, then chopped or treated with collagenase I, and centrifuged to separate fat lipids and fat particles, as well as other tissues. The rabbit facial artery was exposed along the incision below the mandibular angle, and 0.2 or 0.4 ml of chopped fat, fat particles, and lipids were retrogradely injected into the facial artery in each group, and then the incision was closed under the microscope. Ophthalmic and neurological symptoms were observed and recorded after surgery, and visual electrophysiology and fundus microscopy were performed to verify visual acuity and fundus artery obstruction.Results:Two weeks after surgery, the incidence of ophthalmic symptoms in the 0.2 ml injection group was 100% in the grinding fat group, 62.5% in the fat granule group, 0 in the lipid group and 0 in the normal saline group. The complication rates of 0.4 ml embolic injection were 100%, 87.50%, 12.5% and 0, respectively. The incidence of neurological symptoms was 62.5%, 25.0%, 0 and 0, respectively. Mortality rates were 37.5%, 12.5%, 0 and 0 after injection of 0.2 ml, and 100%, 50%, 0 and 0 after injection of 0.4 ml, respectively.Conclusions:Animal models have shown that grinding adipose tissue without collagenase I treatment is more likely to cause serious complications, simple lipid entry into blood vessels does not block relevant arteries, and fat volume is positively correlated with the incidence of postoperative complications.

Purpose To evaluate the short-term efficacy of Gefitinib based on the non-contrast CT radiomics model in patients with advanced lung adenocarcinoma before treatment.Materials and Methods Seventy-one patients with advanced lung adenocarcinoma and treated with Gefitinib in the First Affiliated Hospital of Harbin Medical University from January 2020 to May 2022 were retrospectively analyzed,the efficacy of the treatment was evaluated in the third month after receiving the treatment,and all patients were divided into the treatment-effective group(n=41)and the treatment-ineffective group(n=30)according to the criteria for evaluating the efficacy of solid tumors.All patients were randomized into the training group and the validation group according to 7∶3,the least absolute shrinkage and selection operator were used in the training group to screen the best radiomics features,and eight models were established,including K-proximity,Logistic regression,support vector machine,adaptive enhancement,gradient boosting,random forest,ensemble algorithm and Gaussian naive Bayes.The optimal model was selected by comparing the area under the receiver operating characteristic curve(AUC)and accuracy.The optimal model performance was tested in the validation group,the clinical usability of the best model was tested using decision curves,the accuracy of the predictive models was visualized using calibration curves.Results The seven best radiomics features were obtained by least absolute shrinkage and selection operator regression screening,the best model Logistic regression was selected in a variety of models,the AUC value of Logistic regression in the validation group was 0.774(95%CI 0.536-0.951),with a sensitivity of 0.846,a specificity of 0.556,an accuracy of 0.727,a recall of 0.846,and an F1-score of 0.733.Conclusion It is possible to screen out the sensitive population of advanced lung adenocarcinoma for targeted therapy based on CT radiomics models.

Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

OBJECTIVE To evaluate the effects of ABCB1 genotypes on the efficacy and safety of taxanes in the treatment of breast cancer. METHODS By searching Embase，the Cochrane Library， PubMed， CNKI， and Wanfang databases， cohort studies and case-control studies about taxanes in the treatment of breast cancer were collected from the establishment of the database to July 2023. After screeningliterature， extracting data and evaluating quality， meta-analysis was performed by using RevMan 5.3 software. RESULTS A total of 11 studies were included， involving 1 321 patients. There was no correlation between the three genotypes and effective rate， the incidence of myelosuppression， the incidence of neurotoxicity （except for the allele and recessive model of ABCB1 C1236T）， and the incidence of hypersensitivity reactions （P＞0.05）. The subgroup analysis showed that there was a correlation between ABCB1 C1236T dominant model and effective rate when using anthracyclines+5-fluorouracil+cyclophosphamide+taxanes （P＜0.05）， there was a correlation between ABCB1 C3435T recessive model and effective rate when using taxanes+trastuzumab （P＜0.05）. ABCB1 C1236T allele model and recessive model were correlated with sample size ≥100 and using cyclophosphamide+epirubicin+5- fluorouracil+paclitaxel or cyclophosphamide+epirubicin+paclitaxel+trastuzumab or cyclophosphamide+epirubicin+5-fluorouracil+ trastuzumab+paclitaxel regimens； recessive model with sample size ＜100 and the African region were correlated with the incidence of peripheral neuropathy； recessive model was correlated with cutaneous adverse reactions （P＜0.05）. ABCB1 C3435T recessive model was correlated with the incidence of reduced neutrophil count with sample size ≥100； the incidence of white blood cell count reduction with sample size ＜100 and using docetaxel+epirubicin+cyclophosphamide was correlated with both the allele model and the dominant model； the incidence of infections was correlated with the dominant model （P＜0.05）. The incidence of neutrophil count reduction with the sample size ＜100 was correlated with allele model of ABCB1 G2677T/A； the incidence of edema with sample size ≥100 was correlated with allele model and recessive model； the incidence of infection was correlated with allele model and dominant model， especially in patients with neutrophil count complicated with fever （P＜0.05）. CONCLUSIONS ABCB1 genotypes are not correlated with effective rate of taxanes in the treatment of breast cancer， but ABCB1 C3435T genotype is associated with decreased neutrophil counts， decreased white blood cell counts and infections； ABCB1 C1236T genotype is associated with neurotoxicity and cutaneous adverse reactions； ABCB1 G2677T/A genotype is associated with decreased neutrophil counts， infections， and edema.

Objective To establish the framework of a prediagnostic risk assessment system for outpatient dental care and to provide references for ensuring patient safety and improving the quality of medical services.Methods A total of 15 medical workers in a tertiary-care stomatology hospital in Sichuan Province were selected for qualitative interviews between October 2019 and December 2019.On the basis of the results of literature analysis and the interviews,an expert consultation form for prediagnostic risk assessment system for outpatient dental care was developed.Then,consultation of 10 experts in the field of oral health care and nursing was conducted between June 2020 and December 2020.Eventually,the framework of prediagnostic risk assessment system for outpatient dental care was formulated.Results Four themes emerged from the qualitative interviews.Firstly,prediagnostic risks of dental outpatients involved mainly syncope,cardiovascular emergencies,and other emergency medical risks.Secondly,medical risks came from three sources,patients,healthcare professionals,and the environment.Thirdly,medical professionals of outpatient dental care had limited awareness of the prediagnostic medical risks of patient.Fourthly,medical professionals of outpatient dental care showed inadequate response to and management of the prediagnostic medical risks of patient.The expert consultation helped finalize the Dental Outpatient Prediagnostic Risk Assessment Questionnaire,which included 3 primary indicators(namely,general information,medical history[including history of allergy],and medication assessment),12 secondary indicators(including patient demographics,patients'status upon admission,oral hygiene habits and special lifestyle habits,sensory disorders,special periods for female patients[ie,menstruation,pregnancy,and breastfeeding],allergy history[history of oral treatment-related allergies],past/present medical history,types of medication,route of medication administration,duration of medication administration,accuracy of medication administration,and adverse drug reactions),and 39 tertiary indicators.The effective recall rate of the expert consultation form was 100%,expert positivity was 100%,and the authority coefficient was 0.83.Kendall's harmony coefficient ranged from 0.808 to 0.839,which was statistically significant(P<0.001).Conclusion The framework of prediagnosis risk assessment system for outpatient dental care is found to be scientific and specific,but its applicability still needs further validation in clinical practice.

It is difficult to treat severe burn combined injury caused by high voltage. This paper reports the successful treatment of a patient with large cranial area third degree burn, skull exposure, local skull carbonization combined with cerebrospinal fluid leakage caused by ten thousand volts high voltage current. Vacuum sealing drainage was given to protect the wounds from infection after multiple limited debridement in the early stage. The external of the inactivated skull was cleaned in the later stage. Finally, the bilateral anterolateral thigh flap combined with multiple burr holes was used to repair the wound. There were no severe postoperative complications, and the therapeutic effect was satisfactory.