Based on the theory of "shaoyang（少阳） resembling the pivot" and collateral diseases， this article proposes that pulmonary fibrosis （PF） can be divided into three stages including wind bi （痹）， constraint bi， and atrophy bi. The core pathogenesis of PF is the obstruction of the pivot and pulmonary collateral obstruction. In terms of treatment， the basic principles are to harmonize and regulate the pivot， and to promote the circulation of the lung collaterals. Depending on the different characteristics of the "essence-attribute-function"， treatment methods such as harmonizing and regulating the pivot， resolving phlegm and removing stasis， supplementing deficiency and harmonizing collaterals are suggested. This approach ensures the regulation of the pivot， smooth circulation of qi and blood， unblocking of the lung collaterals and nourishing the lung body， achieving the goals of balancing the ascending and descending of qi， removing phlegm and stasis， and relieving cough and wheezing.

ObjectiveTo investigate the current status of emergency management for severe mental disorders in Shanghai, and to provide countermeasures and suggestions for the establishment of a sound emergency management system for severe mental disorders and the enhancement of emergency management capability. MethodsA questionnaire survey and qualitative interviews were used to conduct an investigation into the emergency management in 17 district-level mental illness prevention and control institutions in Shanghai, which includes the basic situation of emergency management for severe mental disorders, the construction of emergency response teams and personnel, emergency preparedness drills and training, emergency management plans and rules and regulations, and problems encountered in emergency management. ResultsIn terms of emergency management mechanism and basic situation, resources such as personnel allocation, security funds and green channel were well equipped in each district-level mental illness prevention and control institution in Shanghai. However, the equipment of some hardware facilities was still insufficient to some extent. Therefore, further improvement on the emergency management mechanism for severe mental disorders was needed. With regard to the construction of emergency team and personnel allocation, the majority were those aged between 35‒<45 years old, with a bachelor’s degree, and more than 10 years of working experience. For example, 90.27% staff in district-level mental illness prevention and control institution had a bachelor’s degree or above, which was higher than that among the staff in community-level (73.60%); staff majored in clinical medicine in district-level institution accounted for the proportion at 52.71%, higher than that among the staff in community-level (28.86%); 57.24% staff in district-level institution had an intermediate professional title, higher than that among the staff in community-level (42.28%); and 69.90% staff in district-level institution had more than 10 years of working experience, higher than that among the staff in community-level (43.62%). In the aspect of emergency drills and training, all district-level mental illness prevention and control institutions in Shanghai had a high demand for emergency training, and the weak aspects mainly focused on lack of emergency service protocols, skills of addressing technical challenges, and construction of effectiveness evaluation system. Moreover, the teaching methods were primarily centered on case analysis, simulation drills, interactive discussions, and so forth. Concerning emergency management plans and rules and regulations, all districts in Shanghai had relatively established well-developed systems for emergency response plans, emergency response leadership groups, and emergency response operational task forces for severe mental disorders. About half of the institutions had established other rules and regulations related to emergency management of severe mental disorders in addition to emergency plans. ConclusionShanghai has initially established an emergency management system for severe mental disorders, but it is still fragile in specialized training for emergency management of severe mental disorders, construction of emergency management mechanisms, and the building-up of grassroots emergency teams. Further priorities should include strengthening emergency management training, enhancing the construction of emergency management personnel teams, and gradually establishing a more comprehensive and integrated emergency management mechanism for severe mental disorders.

Regarding the challenge of early identification of critically ill patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),a radiomics-clinical fusion model is proposed based on non-contrast CT images of accessory respiratory muscles to predict life-threatening conditions.A retrospective study is conducted involving 233 AECOPD patients(153 non-life-threatening and 80 life-threatening cases).Patients are divided into a training set(n=186)and a test set(n=47)at a 4:1 ratio.A total of 1 874 radiomic features are extracted from the erector spinae and pectoralis muscle regions delineated by radiologists on non-contrast CT images,and the features selection is performed using maximum relevance minimum redundancy and least absolute shrinkage and selection operator(LASSO)algorithms.Meanwhile,clinical data are analyzed with t-test and LASSO for variable screening.The selected features are input into C-support vector classification,Logistic regression,random forest,adaptive boosting(AdaBoost),and extreme gradient boosting(XGBoost)to construct radiomics model,clinical model,and fusion model.Predictive performance and clinical practicality are evaluated in the test set using receiver operating characteristic curve,area under the curve(AUC),and decision curve analysis.The radiomics-clinical fusion model built with XGBoost outperformed standalone radiomics and clinical models,achieving an AUC of 0.902(95％CI 0.846,0.994),with accuracy,sensitivity,specificity,and precision of 0.837,0.933,0.786,and 0.7,respectively.Results demonstrate that the fusion model based on the non-contrast CT radiomics of accessory respiratory muscles and clinical data exhibits promising diagnostic performance,highlighting its potential clinical significance for stratified management and preemptive critical care intervention in AECOPD patients.

Objective:To investigate the surgical techniques and clinical efficacy of arthroscopic-assisted posterior malleolus reduction for the management of ankle fracture-dislocation.Methods:A retrospective analysis was performed on the clinical data of 27 patients who underwent arthroscopy-assisted posterior malleolar reduction via the posterior approach for the surgical management of ankle fracture-dislocation at the Third Affiliated Hospital of Nanjing Medical University (Changzhou No.2 People's Hospital) between January 2022 and June 2023. The cohort comprised 17 males and 10 females, with a mean age of 43.67±9.56 years (range, 25-63 years). Based on the Bartonícek and Rammelt classification, there were 15 type II cases, 9 type III cases, and 3 type IV cases. The operation time, posterior ankle arthroscopy duration, and postoperative complications, such as neurovascular injury, wound infection, or skin necrosis, were recorded. X-ray and 3D CT imaging were utilized to assess joint surface reduction quality, tibiofibular matching and fracture healing status. The ankle plantarflexion, dorsiflexion and hallux flexion contractures were recorded at the last follow-up. Functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Olerud-Molander ankle score (OMAS), while pain was evaluated using the visual analogue scale (VAS).Results:All 27 patients were followed up postoperatively, with a mean follow-up duration of 14.30±1.38 months (range, 12-18 months). Postoperatively, one patient experienced wound exudation, while another developed intermuscular venous thrombosis in the calf. No cases of neurovascular injury, wound infection, skin necrosis, or hallux flexion contracture occurred, and no reduction loss was observed. The mean operation time was 96.11±11.55 min (range, 80-120 min), and the posterior ankle arthroscopy duration was 35.74±5.67 min (range, 30-45 min). Postoperative X-ray evaluations demonstrated no loss of fracture reduction, and all fractures achieved bony union. The mean fracture healing time was 3.78±0.75 months (range, 3-5 months). Postoperative CT evaluations showed no joint surface malalignment, and distal tibiofibular matching was satisfactory. At the final follow-up, mean ankle plantarflexion was 46.74°±4.73° (range, 33°-50°), and dorsiflexion was 20.96°±3.29° (range, 14°-26°). There was no hallux flexion contracture occurred. The mean AOFAS ankle-hindfoot score was 92.11±7.19 (range, 74-100), with 20 excellent, 5 good, and 2 fair, yielding an excellent-good rate of 93%. The mean OMAS score was 94.44±7.25 (range, 75-100), comprising 20 excellent and 7 good results, yielding an excellent-good rate of 100%. The mean VAS score was 0.70±0.95 (range, 0-3).Conclusion:Arthroscopy-assisted posterior malleolar reduction in ankle fracture-dislocation surgery provides optimal soft tissue protection and ensures precise fracture reduction and fixation.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To evaluate the effectiveness and safety of zoledronic acid in patients with Paget′s disease of bone based on clinical data from a single medical center.Methods:This retrospective study included 24 patients diagnosed with Paget′s disease of bone and treated with zoledronic acid at Peking Union Medical College Hospital between January 2009 and June 2020. Demographic data, clinical symptoms, treatment efficacy, and safety outcomes were collected. The primary efficacy measure was serum alkaline phosphatase(ALP) levels. Treatment was considered effective if ALP levels returned to normal or decreased by more than 75% from baseline in the difference between the ALP level and its normal median value.Results:Among the 24 patients with Paget′s bone disease, the most commonly affected site was the skull(in 17 cases). All patients received a single 5 mg intravenous infusion of zoledronic acid. Serum ALP levels significantly decreased after treatment. Among the 15 patients who completed at least 3 months of follow-up, all achieved treatment success. The median time for serum ALP levels to reach the target was 13.1(9.4, 26.1) weeks. In 12 patients, ALP levels normalized within a medium of 16.9(11.5, 37.3) weeks, and remained stable over a medium follow-up of 4.56(2.42, 5.71) years. The most common side effects were hypocalcemia(21 cases, 87.5%) and flu-like symptoms(17 cases, 70.8%). Seven patients had severe hypocalcemia(serum calcium<1.75 mmol/L), and they had higher baseline levels of ALP, calcium, and phosphorus compared to those with mild hypocalcemia.Conclusions:Zoledronic acid 5 mg intravenous infusion effectively controlled disease activity in patients with Paget′s disease of bone. Generally, Most patients achieved treatment goals within 3-4 months, with sustained remission for a median of 4 years. Hypocalcemia was the most frequent side effect, underscoring the importance of timely calcium and vitamin D supplementation.

Objective:To explore the clinical efficacy of a free superficial palmar branch of the radial artery (SPBRA)-pedicled wrist crease flap for bridging and repairing finger C-shape soft tissue defect.Methods:From March 2021 to January 2023, the clinical data of patients with finger C-shape soft tissue defects in Department of Orthopedics, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University were retrospectively analyzed. Preoperatively, color Doppler was used to locate the perforator point, and the position and size of the flap were designed. A free SPBRA-pedicled wrist crease flap was used in a Flow-through method to bridge and repair the defects. Postoperatively, the survival, color, texture, sense, and shape of the skin flap were observe, and the healing of the donor site was assessed. The clinical efficacy was evaluated using Evaluation Trail Standards for Replantation Function of Chinese Society of Hand Surgery.Results:All 10 patients completed the entry result analysis, including 8 males and 2 females. The age ranged from 22 to 54 years old. Among them, 3 cases involved the index finger, 5 cases involved the middle finger, and 2 cases involved the ring finger. All of them showed segmental defects of the unilateral volar medial artery with combined digital nerve defects, including 7 cases of radial injury and 3 cases of ulnar injury. 3 cases of the vascular defect ranged in the proximal phalanx areas, 6 cases in the middle phalanx region, and 1 case in the middle to distal phalanx region. The length of the proper artery defect ranged from 1.0 cm to 1.8 cm, the area of skin defect ranged from 1.0 cm×2.5 cm to 2.2 cm×4.0 cm, and the harvested flap area range ranged from 1.2 cm×2.8 cm to 2.5 cm×5.0 cm. The patients were followed up for 10 to 19 months. All flaps survived and healed well, with no bulky appearance, and a texture similar to normal finger skin. The static two-point discrimination ranged from 7.0~ 10.0 mm (average 8.5 mm). Superficial infection around the flap occurred in 1 case after surgery. It improved after dressing change. No vascular crisis occurred. The wounds at the donor site healed primarily, leaving linear scars. The flexion and extension activities of the wrist joint were not affected. According to the Evaluation Trail Standards for Replantation Function of Chinese Society of Hand Surgery: 8 cases received excellent results, 2 cases were good, and the patient satisfaction was high.Conclusion:The free SPBRA-pedicled wrist crease flap has good and accurate efficacy in bridging and repairing finger C-shape soft tissue defects. It has the advantages of convenient harvesting, minimal trauma, and low complication rate, and has clinical promotion and application value.

To investigate the bone health status and potential influencing factors of bone mineral density in adult patients with hemophilia, providing a reference for improving their bone health and for the prevention, treatment, and rehabilitation intervention of osteoporosis.

Addressing the challenge of traditional physical/semi physical simulation methods being difficult to achieve full process and full element simulation of extravehicular activities,virtual reality technology is utilized to break through the limitations of physical environments and establish a virtual reality simulation system for extravehicular activities.Based on the application characteristics of space station extravehicular activity engineering,with the goal of improving system practicality and usability,integrating the visual immersion of virtual images,the ontology of real operation,and the consistency of virtual and real space perception,a three-dimensional scene simulation,multi-mode joystick interaction paradigm,continuous operation actions simulation of extravehicular operations,and interactive operation virtual/real space consistency method that were proposed and designed for the realistic visual perception and extravehicular operation.The system has been successfully applied to astronaut training,program validation,joint exercise,and flight control support for sixteen extravehicular activities from SZ-12 to SZ-18.The results showed that the complete reproduction of the static/dynamic realistic comprehensive scene was achieved on the ground for the human-machine operation in the entire process of extravehicular activity,and the system is an essential and important means of ground simulation for extravehicular activity.

Objective To evaluate the application of flipped classroom(FC)approach in endocrine system integrated course for students from 4+4 clinical medicine pilot class at Peking Union Medical College(PUMC).Methods The study included the students of 4+4 clinical medicine pilot class grades 2019-2023 in PUMC.The students of grades 2019-2021(n=77)served as the control receiving traditional teaching method,while the students of grades 2022 and 2023(n=76)were selected as the experimental group,which were taught by FC approach.The selected teaching content is thyroid theme.The scoring rates of thyroid related questions in the final exam were as-sessed and a questionnaire survey was conducted to evaluate teaching satisfaction and effectiveness.Results The scoring rates of experimental group were significantly higher as compared to that of control group(P＜0.05).Over 90％of the students in the experimental group strongly satisfied or satisfied with the teaching content arrangement,design form,classroom atmosphere,teacher-student interaction of FC and expressed willingness to continue with this methodology.In addition,over 90％of the students strongly agreed or agreed that FC stimulated learning inter-est,improved self-learning ability,strengthened the connection between theory and clinical practice,inspired clini-cal reasoning,enhanced the abilities to analyze and solve problems,and cultivated communication and teamwork skills.Conclusions The application of FC approach in endocrine system integrated course achieved excellent teaching outcomes with high satisfaction of the students.