The concept of "spirit" in traditional Chinese medicine （TCM） aligns closely with "the liver governs the designing of strategy". By exploring the relationship between the liver and executive function decline， it is proposed that prolonged liver constraint leads to indecisiveness in strategy designing， which is the initiating factor for executive function decline； liver blood deficiency causes difficulties in executing strategy， which forms an essential foundation for the progression of executive function decline； obstruction in the "liver-du mai-brain" pathway leads to unclear strategy designing， which accelerates executive function decline. This relationship is examined from the perspectives of TCM， modern medicine， and cognitive psychology， aiming to provide insights into addressing executive function decline through treatments focused on the liver.

This case report presents a 16-year-old male patient with deficiency of adenosine deaminase 2(DADA2). The patient had a history of Raynaud′s phenomenon with digital ulcers since childhood. As the disease progressed, the patient developed retinal vasculitis, intracranial hemorrhage, skin necrosis, severe malnutrition, refractory hypertension, and gastrointestinal bleeding. Genetic testing revealed compound heterozygous mutations in the ADA2 gene (paternal c.1072G > A pathogenic mutation + maternal c.1065C > A variant of unknown clinical significance). ADA2 enzyme activity was significantly reduced (0.1 U/L). A multidisciplinary treatment team developed an individualized plan to address key issues, including nutritional support, blood pressure control, rehabilitation, pain management, and balancing anticoagulation/bleeding risks. After systematic intervention, the patient′s condition showed partial improvement. This case reveals clinical challenges such as anticoagulation decisions and nutritional support of DADA2. It also emphasizes the importance of early molecular diagnosis, tumor necrosis factor-α inhibitor targeted therapy, and multidisciplinary collaboration in management, underlining the core value of precision medicine in rare disease management.

Through collecting the existing clinical evidences on acupuncture and moxibustion for urticaria, the distribution of evidence in this field was mapped. A systematic search of Chinese and English literature was conducted in CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library for treatment of urticaria with acupuncture and moxibustion, published up to December 31, 2023 since inception of each database. The research status in this field was summarized using an evidence mapping approach, and methodological quality was assessed. A total of 323 randomized controlled trials (RCTs) and 22 systematic reviews were included. The number of studies on acupuncture and moxibustion for urticaria has been increasing, with a significant rise in recent years. In most RCTs, the study scale was small, and the subjects focused on chronic spontaneous urticaria in adolescents and middle-aged adults, aged 14 to 60 years. Regarding the intervention measures, the single therapy of acupuncture and moxibustion was predominant such as acupoint injection, acupoint embedding thread, and filiform needling. In acupuncture with filiform needles, the commonly used acupoints were Quchi (LI11), Xuehai (SP10), Sanyinjiao (SP6), Zusanli (ST36) and Hegu (LI4). The main outcome measures referred to effectiveness rate, score of disease severity, recurrence rate, laboratory indexes, and score of quality of life; and the short-term effect was evaluated specifically. The overall methodological quality of the included studies was relatively low. It is suggested that the future research should focus on large-scale, multi-center, high-quality clinical trials, optimize the protocols for acupuncture and moxibustion intervention, standardize the outcomes, and draw the attention to the evaluation of long-term efficacy, so as to provide clinical evidences of high certainty for urticaria treated with acupuncture and moxibustion.
Humans ; Moxibustion ; Acupuncture Therapy ; Urticaria/therapy* ; Acupuncture Points ; Randomized Controlled Trials as Topic ; Adolescent ; Adult ; Young Adult

Objective:To explore the flight adaptability of the senior military flying cadets with small-diopter exotropia treated by surgery and the principles of aeromedical assessment.Methods:Two cases of senior military flying cadets with exotropia were analyzed on clinical diagnosis, treatment, and aeromedical assessment. The related literatures were reviewed and the suggestions for aeromedical assessment were put forward.Results:Two cases were diagnosed as small-diopter exotropia, and no contraindications were found in ophthalmic examination. They received corrective surgery. Three months later, the recheck showed that their primary position of eye and visual acuity were normal, tertiary visual function was in the normal range, and the degree of strabismus was in the standard. According to the pilot′s physical examination standard, the pilots were qualified for flight. They normally participated in the flight training with original aircraft type, and the regular ophthalmic examination showed that they were within normal range.Conclusions:For the senior military flying cadets with small-diopter exotropia and treated by surgery qualification could be decided in case of such conditions as standard visual acuity, no diplopia, normal tertiary visual function, strabismus is less than 10 Δ, and the stable condition maintained for more than 3 months are fulfilled. Operation is an effective method to treat minor exotropia in senior flying cadets.

Objective:To explore the flight adaptability of the senior military flying cadets with small-diopter exotropia treated by surgery and the principles of aeromedical assessment.Methods:Two cases of senior military flying cadets with exotropia were analyzed on clinical diagnosis, treatment, and aeromedical assessment. The related literatures were reviewed and the suggestions for aeromedical assessment were put forward.Results:Two cases were diagnosed as small-diopter exotropia, and no contraindications were found in ophthalmic examination. They received corrective surgery. Three months later, the recheck showed that their primary position of eye and visual acuity were normal, tertiary visual function was in the normal range, and the degree of strabismus was in the standard. According to the pilot′s physical examination standard, the pilots were qualified for flight. They normally participated in the flight training with original aircraft type, and the regular ophthalmic examination showed that they were within normal range.Conclusions:For the senior military flying cadets with small-diopter exotropia and treated by surgery qualification could be decided in case of such conditions as standard visual acuity, no diplopia, normal tertiary visual function, strabismus is less than 10 Δ, and the stable condition maintained for more than 3 months are fulfilled. Operation is an effective method to treat minor exotropia in senior flying cadets.

Objective:To investigate gender differences in arterial velocity pulse index(AVI), which is an indicator of vascular stiffness, across various age groups.Additionally, the study will also examine the risk factors associated with AVI.Methods:This cross-sectional study enrolled 4311 patients with an average age of 57.8±12.8 years at Jiading Branch of Shanghai First People's Hospital between August 2020 and September 2021.Patients were divided into three groups based on age: young(<45 years old, n=755), middle-aged(45-59 years old, n=1260), and elderly(≥60 years old, n=2 296). The AVI of the subject was obtained using the cuff oscillation wave method.The subject's AVI was acquired using the cuff oscillation wave.High AVI, indicating arteriosclerosis, was defined as AVI≥33.The subjects were then divided into two groups: the high AVI group(122 cases)and the normal AVI group(4 189 cases).Results:The ankle-brachial index(AVI)was found to be 12.8±3.7, 17.5±5.7, and 19.8±6.5 in the young, middle-aged, and elderly groups, respectively.The study revealed that AVI increased with age( Ftrend=767.819, P<0.01). Additionally, the incidence of high AVI in middle-aged women was found to be(2.8% or 20/722), which was higher than that in men 0.9%(5/538)in the same age group.This difference was statistically significant( χ2=5.371, P<0.05). The results of the multivariate logistic regression analysis indicate that being overweight, having a higher height, and a pulse rate greater than 80 BPM are protective factors in preventing a high incidence of AVI.The odds ratios( OR)with 95% confidence intervals( CI)for these factors were 0.468(0.317-0.690), 0.926(0.895-0.958), and 0.143(1.026-2.432), respectively, all with a P-value less than 0.01.On the other hand, old age, systolic blood pressure of 140 mmHg or higher, and diastolic blood pressure of 90 mmHg or higher were identified as risk factors for AVI.The ORs with 95% CIs for these factors were 2.119(1.322-3.396), 6.652(4.136-10.699), and 1.580(1.026-2.432), respectively, all with a P- value less than 0.05l. Conclusions:Arterial stiffness, as measured by the ankle-brachial index(ABI), tends to increase with age.In middle-aged subjects, women have a higher incidence of high ABI than men.Independent risk factors for high ABI include age and increased blood pressure, while factors such as overweight and height may affect the measured value of ABI.

OBJECTIVE: To compare the parental acceptance of dental treatment under general anesthesia and deep sedation in children and assess the changes in postoperative oral health-related quality of life and treatment efficacy. METHODS: The parents of 131 children undergoing dental treatment in the Department of Stomatology of Sichuan Provincial People's Hospital from January, 2022 to June, 2022 were surveyed using a questionnaire of children's advanced oral behavior management, and 83 children receiving general anesthesia or deep sedation for dental treatment between January, 2018 and December, 2021 were also investigated for changes in quality of life after the treatment using a questionnaire. The treatment efficacy was assessed at the 1-year follow-up visit in 149 children who received dental treatment under general anesthesia or deep sedation during the same period. RESULTS: The survey of perantal acceptance showed that 62.6% of the parents preferred deep sedation, 29.01% preferred general anesthesia, and 8.4% preferred compulsory treatment. Dental treatments under general anesthesia and deep sedation both significantly improved oral health-related quality of life of the children. While dental surgeries under general anesthesia resulted in the most significant improvement of pain symptoms, deep sedation was associated with both obvious relief of the children's pain symptoms and reduction of the parents' pressure level. No significant difference was found in the efficacy of treatments under general anesthesia and deep sedation at the 1-year follow-up. CONCLUSION Dental treatment in children under deep sedation has the highest parental acceptance, followed by treatment under general anesthesia, and the acceptance of compulsory treatment is the lowest. The treatments under general anesthesia and deep sedation significantly improve the quality of life of the children and their parents and both have good treatment efficacy.
Humans ; Child ; Quality of Life ; Deep Sedation ; Child Behavior ; Treatment Outcome ; Anesthesia, General ; Parents ; Pain ; Dental Care ; Dental Caries

Objective:To explore the feasibility of predicting TP53 mutation risk by immunohistochemical staining (IHC) pattern of P53 in Chinese diffuse large B-cell lymphoma (DLBCL) and its correlation with a prognostic difference.Methods:Between January 2021 and December 2021, 51 DLBCL cases at Beijing Boren Hospital were gathered. These cases had both IHC and next-generation sequencing (NGS) results. IHC classified the P53 protein expression pattern into a loss (<1% ) , diffuse (>80% ) , and heterogeneous (1% -80% ) . The sensitivity and specificity of the predicting TP53 mutation by IHC were assessed by comparing the results of the NGS, and the TP53 high mutation risk group included both loss and diffuse expression of P53. From June 2016 to September 2019, Peking University Cancer Hospital collected 131 DLBCL cases with thorough clinicopathological and follow-up data. From their tumor blocks, tissue microarray blocks were made for IHC evaluation of P53 expression pattern, and prognosis effect of P53 studies.Results:Among 51 cases with both IHC and NGS results, 23 cases were classified as TP53 high mutation risk (7 cases loss and 16 cases diffuse) , 22/23 cases were proved with mutated TP53 by NGS. Only 1 of the 28 cases classified as TP53 low mutation risk was proved with mutated TP53 by NGS. IHC had a sensitivity and specificity of 95.7% and 96.4% for predicting TP53 mutation. NGS identified a total of 26 TP53 mutations with a mutation frequency of 61.57% (13.41% -86.25% ) . In the diffuse group, 16 missense mutations and 2 splice mutations were detected; 6 truncating mutations and 1 splice mutation were detected in the loss group; 1 truncating mutation was detected in the heterogeneous group. Multivariate analysis demonstrated that TP53 cases with high mutation risk have impartial adverse significance for the 131 patients included in survival analysis ( HR=2.612, 95% CI 1.145-5.956, P=0.022) . Conclusion:IHC of P53 exhibiting loss (<1% ) or diffuse (>80% ) pattern indicated TP53 high mutation risk, IHC can predict TP53 mutation with high specificity and sensitivity. TP53 high mutation risk is an independent predictor for adverse survival.

Objective:To discuss the effects of half-dose vitipofen photodynamics (PDT) treaing central serous chorioretinopathy (CSC) adopted a pilot to flight and the principle of related aeromedical evaluation.Methods:A pilot with central serous chorioretinopathy was analyzed on clinical diagnosis, treatment, and aeromedical evaluation. The related literatures were reviewed.Results:CSC of the pilot had been diagnosed for 6 months and the conservative treatment was inefficient. No contraindications were found in ophthalmic examination before the treatment. As the half-dose vatipofen photodynamic(3.0 mg/ m 2) was injected into vein for 15 minutes, the pilot was irradiated by a wavelength of 689 nm with the energy of 50 J/cm 2 for 83 s, and then he was asked to keep light out for 48 h. One month later, the re-examination showed that the right-eye metamorphopsia disappeared and normal vision returned. The examinations of spontaneous fluorescence of the fundus, contrast sensitivity, and amsler grid returned to normal, and the macular OCT showed that the pigment epithelium in the macular area was slightly disturbed and the liquid under the retina was completely absorbed. The flight qualification was decided according to the pilot’s physical examination standard. After the treatment, the pilot had completed 60 h--flight in his original type of aircraft (including 20 h of night flight). Conclusions:If the military pilot with chronic CSC treated by half-dose PDT and returned normal visual function the flying qualification would be considered. Besides the reference on regular visual function examination, the evaluation of flight adaptability should also include such examination as fundus spontaneous fluorescence, contrast sensitivity, Amsler lattice examination, macular OCT and other special ophthalmic tests related to CSC. Half-dose PDT is an effective method to treat chronic CSC in military pilots.

Objective:To discuss the effects of half-dose vitipofen photodynamics (PDT) treaing central serous chorioretinopathy (CSC) adopted a pilot to flight and the principle of related aeromedical evaluation.Methods:A pilot with central serous chorioretinopathy was analyzed on clinical diagnosis, treatment, and aeromedical evaluation. The related literatures were reviewed.Results:CSC of the pilot had been diagnosed for 6 months and the conservative treatment was inefficient. No contraindications were found in ophthalmic examination before the treatment. As the half-dose vatipofen photodynamic(3.0 mg/ m 2) was injected into vein for 15 minutes, the pilot was irradiated by a wavelength of 689 nm with the energy of 50 J/cm 2 for 83 s, and then he was asked to keep light out for 48 h. One month later, the re-examination showed that the right-eye metamorphopsia disappeared and normal vision returned. The examinations of spontaneous fluorescence of the fundus, contrast sensitivity, and amsler grid returned to normal, and the macular OCT showed that the pigment epithelium in the macular area was slightly disturbed and the liquid under the retina was completely absorbed. The flight qualification was decided according to the pilot’s physical examination standard. After the treatment, the pilot had completed 60 h--flight in his original type of aircraft (including 20 h of night flight). Conclusions:If the military pilot with chronic CSC treated by half-dose PDT and returned normal visual function the flying qualification would be considered. Besides the reference on regular visual function examination, the evaluation of flight adaptability should also include such examination as fundus spontaneous fluorescence, contrast sensitivity, Amsler lattice examination, macular OCT and other special ophthalmic tests related to CSC. Half-dose PDT is an effective method to treat chronic CSC in military pilots.