Objective:To develop a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle, and to verify its effectiveness and repeatability.Methods:A retrospective observational study was conducted. A total of 40 necroses of foot and ankle pedicled flaps were selected by 2 senior surgeons based on the flap surgery performed by the same surgical group in Department of Orthopaedic Surgery, the 920 Hospital of Joint Logistic Support Force of PLA from January 2010 to January 2022. A grading system for pedicled flap necrosis was proposed by a working group and the 40 necrotic flaps were graded. The coincidence rate was calculated to evaluate the effectiveness of the grading system through correlation studies between grading and clinical treatment. One photo of a typical postoperative necrotic flap was collected from each of the 40 flaps. Then 5 extramural surgeons were asked to grade the necroses shown on the photos according to the proposed grading system. Moreover, weighted Kappa analysis was performed on the results of proposed grading system and also on the standard grading currently in use, to evaluate the repeatability of the proposed grading system. Evaluated data were expressed by Mean±SD, and the coincidence rate was expressed by percentage. The reproducibility was studied by weighted Kappa analysis.Results:Of the 40 necrotic flaps, 7 flaps were classified in Grade I, 16 in Grade Ⅱ, 12 in Grade Ⅲ and 5 in Grade IV. In comparison with the actual treatment methods, the overall coincidence rate of the grading system was 92.5%. It indicated that the proposed grading system could effectively guide the selection of a treatment procedure. The average weighted Kappa coefficient of surgeons was at 0.628 with a 95% confidence interval (95%CI) between 0.460-0.796, which was strongly consistent with the standard of the grading system currently in use.Conclusion:The grading system for necrosis of pedicled flap in reconstruction of foot and ankle proposed in this study is simple and clear. It is able to effectively guide the treatment of flap necrosis. The preliminary validation shows that the classification system has good repeatability.

Objective:To evaluate the effect of Qishi Tongguan Prescription on pregnancy outcomes after interventional recanalisation in patients with tubal infertility (TFI).Methods:This was a retrospective study based on real-world and propensity score matching. Totally 260 patients with TFI from January 2020 to October 2021 in Shuguang Hospital of Shanghai University of Traditional Chinese Medicine and Maternal and Child Health Hospital of Pudong New Area were selected as observation subjects, and were divided into 123 cases in the TCM combination group and 137 cases in the control group based on whether they were treated with Qishi Tongguan Prescription in combination with interventional revascularization. Propensity score matching (PSM) was used as a covariate to obtain a new sample of inter group covariate equilibrium, and confounding factors that may affect the pregnancy outcome of TFI patients undergoing interventional recanalization surgery were used as covariates. The intrauterine pregnancy rate, ectopic pregnancy rate, biochemical pregnancy rate, early abortion rate and adverse reactions of the two groups of patients within 12 months of follow-up were compared, and the influence of TFI intervention and recanalization combined with Qishi Tongguan Prescription on intrauterine pregnancy rate was evaluated.Results:Age, years of infertility, type of infertility, history of miscarriage, history of ectopic pregnancy, history of biochemical pregnancy, history of uterine surgery, history of pelvic laparotomy, and degree of tubal patency had an effect on whether intrauterine pregnancy was achieved after interventional reversal in patients with TFI ( P<0.05), with age [ OR (95% CI) was 0.843 (0.769, 0.926)], history of pelvic laparotomy [ OR (95% CI) was 0.477 (0.248, 0.920)] and the degree of tubal obstruction [ OR (95% CI) was 0.152 (0.046, 0.500)] were independent factors ( P<0.01 or P<0.05). 81 patients were seen in each of the 2 groups after PSM, of whom the intrauterine pregnancy rates in the combined herbal group at 9 and 12 months after recanalisation were 48.1% (39/81) and 58.0% (47/81) respectively, compared with 32.1% (26/81) and 35.8% (29/81) in the control group, with statistical significance between the 2 groups ( χ2 values of 4.34 and 8.03, respectively, P<0.01); there was no statistical significance in the ectopic pregnancy rate, biochemical pregnancy rate and early abortion rate between the 2 groups ( P>0.05). There were no significant adverse reactions during the treatment. Conclusion:Qishi Tongguan Prescription combined with interventional recanalization can effectively improve the intrauterine pregnancy rate and shorten the waiting time for pregnancy in patients with TFI with higher safety.

Objective:To construct a hierarchical management model of performance objectives,and to explore its application value in the management of medical equipment procurement process.Methods:The procurement performance evaluation indicators were screened from the medical equipment procurement declaration level,process level,use level and disposal level,and the comprehensive evaluation model was developed by entropy weight method and data envelopment analysis(DEA)method to form the process management plan at the level of personnel,system,data and equipment.A total of 717 sets of medical equipment purchased by Beijing Youan Hospital from 2019 to 2022 were selected,and the conventional management mode(348 units)and hierarchical management mode(369 units)were used for management according to different performance objectives evaluation methods.The performance objectives achievement,the quality of procurement process management and the satisfaction of clinical allocation management of medical equipment procurement under different management modes were compared.Results:The 369 units of equipment under the hierarchical management model included operating room equipment,laboratory equipment,inpatient treatment equipment,disinfection supply equipment and other medical equipment,and the performance objectives achievement of the procurement were(96.10±3.46)%,(96.76±2.65)%,(95.59±2.52)%,(96.06±2.34)%and(96.88±1.75)%,respectively,which were higher than those of the management model,the difference was statistically significant(t=2.663,2.801,2.858,4.111,3.548,P＜0.05)The effective ratio of DEA in the comprehensive evaluation of the medical equipment procurement declaration level,process level,use level and disposal level under the hierarchical management model were 96.7%,98.6%,94.6%and 99.7%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(x2=10.983,9.327,7.270,12.309,P＜0.05).The satisfaction of clinical departments with the procurement and use of medical equipment under the hierarchical management model were(95.82±2.83)%and(97.25±1.96)%,respectively,which were higher than those of the conventional management model,the difference was statistically significant(t=5.575,5.248,P＜0.05).Conclusion:The hierarchical management model can effectively implement the performance objectives of medical equipment procurement,improve the management quality of medical equipment procurement process,improve satisfaction of clinical departments and management personnel after procurement,and ensure the quality of equipment operation.

Objective To explore the medication law of Professor Ding Ying in the treatment of Henoch-Sch?nlein purpura;To analyze Professor Ding Ying's academic thought and clinical experience in the treatment of Henoch-Sch?nlein purpura.Methods Professor Ding Ying's prescriptions for the treatment of Henoch-Sch?nlein purpura in The First Affiliated Hospital of Henan University of Chinese Medicine from January 2013 to January 2020 were selected.Through the analysis of the Integrated Platform for Inheriting Famous Doctors,drug-drug and drug-symptom networks were constructed,and in-depth analysis of its core drug groups and their associated patterns was conducted.Results Totally 195 cases were included in the study,involving 585 times of diagnosis and 585 prescriptions.153 kinds of Chinese materia medica were involved in the prescriptions,with a total frequency of 8 017 times.The medicinal properties were mainly cold,warm and neutral,the medicinal taste was mainly bitter,and the meridians are mainly liver meridian and heart meridian.The analysis of drug weight grade showed that Rehmanniae Radix,Angelicae Sinensis Radix,Forsythiae Fructus,Lonicerae Japonicae Caulis,Moutan Cortex,Arnebiae Radix,Chuanxiong Rhizoma,Kochia Fructus,Piperis Kadsurae Caulis,Trachelospermi Caulis et Folium,Cynanchi Paniculati Radix et Rhizoma,Tripterygium wilfordii,Coicis Semen,Scutellariae Radix,Bubali Cornu,Amomi Fructus,Paeoniae Radix Alba,Spirodelae Herba and Glycyrrhizae Radix et Rhizoma were the core prescriptions for the treatment of Henoch-Sch?nlein purpura.Drug-drug co-occurrence analysis showed that Rehmanniae Radix-Angelicae Sinensis Radix,Rehmanniae Radix-Moutan Cortex,Forsythiae Fructus-Moutan Cortex,Kochia Fructus-Lonicera Japonicae Caulis,Chuanxiong Rhizoma-Lonicera Japonicae Caulis,Lonicerae Japonicae Caulis-Angelicae Sinensis Radix,Kochia Fructus-Forsythiae Fructus,Moutan Cortex-Arnebiae Radix,Angelicae Sinensis Radix-Moutan Cortex,Rehmanniae Radix-Forsythiae Fructus,Forsythiae Fructus,Rehmanniae Radix-Lonicera Japonicae Caulis were commonly used in the treatment of Henoch-Sch?nlein purpura.Clustering analysis showed 10 potential drug groups.Conclusion Professor Ding Ying emphasizes the combination of disease,syndrome,and symptoms in the treatment of Henoch-Sch?nlein purpura,as well as the application of couplet medicines.Clinical treatment follows the concept of"dispelling pathogens and calming the collaterals",making good use of heat clearing and detoxifying drugs,heat clearing and wind dispelling drugs,and heat clearing and dampness dispelling drugs to"dispel pathogens",and making good use of blood activating and cooling drugs,as well as blood nourishing and unblocking drugs to"calm the collaterals".

Pancreatic cancer is one of the most malignant tumors with a 5-year survival rate of 13%. Difficulty in early diagnosis,high tumor heterogeneity,high rate of drug resistance,and lack of effective new drugs are the main reasons for the poor therapeutic effect. Traditional cell line models cannot simulate the tumor environment in vitro and cannot reflect the heterogeneity of pancreatic cancer,while animal models have a long culture process and cannot be used for high-throughput screening. Pancreatic cancer organoids can be continuously expanded and cultured in vitro,which can realistically reflect the heterogeneity of pancreatic cancer and allow high-throughput drug screening,making it an ideal tool for individualized precision diagnosis and treatment of pancreatic cancer. According to recent studies on the evaluation of clinical drug efficacy using pancreatic cancer organoids,the drug sensitivity of pancreatic cancer organoids is highly consistent with the clinical efficacy,demonstrating the feasibility of drug sensitivity of pancreatic cancer organoids in guiding clinical therapy,comfirming the ability to discover potential therapeutic drugs through high-throughput drug screening of pancreatic cancer organoids. At the same time,this review reveals the importance of pancreatic cancer organoids as a model of the pancreatic cancer microenvironment for the development of new drugs and tumor microenvironment research. and the role of pancreatic cancer organoids as a model that can reflect the specific microenvironment of pancreatic cancer for new drug discovery and microenvironmental evaluation. Pancreatic cancer organoids and organ-on-chips are powerful tools for precision companion therapy and new drug discovery.

Objective:To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among acute respiratory infection (ARI) cases in 16 provinces of China from 2009 to 2023.Methods:The data of this study were collected from the ARI surveillance data from 16 provinces in China from 2009 to 2023, with a total of 28 278 ARI cases included in the study. The clinical specimens from ARI cases were screened for HRSV nucleic acid from 2009 to 2023, and differences in virus detection rates among cases of different age groups, regions, and months were analyzed.Results:A total of 28 278 ARI cases were enrolled from January 2009 to September 2023. The age of the cases ranged from<1 month to 112 years, and the age M ( Q1, Q3) was 3 years (1 year, 9 years). Among them, 3 062 cases were positive for HRSV nucleic acid, with a total detection rate of 10.83%. From 2009 to 2019, the detection rate of HRSV was 9.33%, and the virus was mainly prevalent in winter and spring. During the Corona Virus Disease 2019 (COVID-19) pandemic, the detection rate of HRSV fluctuated between 6.32% and 18.67%. There was no traditional winter epidemic peak of HRSV from the end of 2022 to the beginning of 2023, and an anti-seasonal epidemic of HRSV occurred from April to May 2023. About 87.95% (2 693/3 062) of positive cases were children under 5 years old, and the difference in the detection rate of HRSV among different age groups was statistically significant ( P<0.001), showing a decreasing trend of HRSV detection rate with the increase of age ( P<0.001). Among them, the HRSV detection rate (25.69%) was highest in children under 6 months. Compared with 2009-2019, the ranking of HRSV detection rates in different age groups changed from high to low between 2020 and 2023, with the age M (Q1, Q3) of HRSV positive cases increasing from 1 year (6 months, 3 years) to 2 years (11 months, 3 years). Conclusion:Through 15 years of continuous HRSV surveillance analysis, children under 5 years old, especially infants under 6 months old, are the main high-risk population for HRSV infection. During the COVID-19 pandemic, the prevalence and patterns of HRSV in China have changed.

Objective We aimed to investigate the relationship between microscopic pattern of blood stasis and renal pathological grade and related physical and chemical indexes in children with Henoch-Sch?nlein purpura nephritis(HSPN).Methods We conducted a retrospective analysis of 800 HSPN children from the medical records of the First Affiliated Hospital of Henan University of Chinese Medicine.Laboratory indicators(blood routine test,urine routine test,coagulation test,liver function)and renal pathological indicators of them were collected.According to the severity of renal pathological microscopic lesions,the microscopic pattern of blood stasis was divided into three types,including choroidal discord,dead blood coagulation and intracarenal disease accumulation.The classification of renal microscopic pattern of blood stasis and the correlation between laboratory indexes and renal pathological index were analyzed by Spearman grade correlation and binary Logistic regression analysis.Results(ⅰ)There was no statistical difference of the distribution of the renal microscopic pattern of blood stasis in the different traditional Chinese medicine patterns.(ⅱ)There were significant differences in the contents or the grade of albumin and fibrinogen in the HSPN children with different microscopic pattern of blood stasis(all P＜0.05).(ⅲ)The maximum area under the receiver operating characteristic(ROC)curve between fibrinogen and intracarenal disease accumulation was 0.594(95％CI from 0.540 to 0.633,P＜0.001);sensitivity was 0.447,specificity was 0.725;the best threshold on the ROC curve of 0.172 was 3.755 g/L.(ⅳ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the scores of intracarenal disease accumulation type(r=0.176,r=0.315,r=0.656;all P＜0.001).(ⅴ)There were positive correlations between the content of fibrinogen,ISKDC grade and Bohle A grade respectively with the renal microscopic pattern of blood stasis(r=0.157,r=0.377,r=0.429;all P＜0.001).Conclusion The microscopic renal pattern of blood stasis can not only reflect the severity of renal blood stasis,but also reflect the severity and long-term prognosis of renal diseases.Albumin and urinary protein grade can reflect the early stage of the microscopic renal pattern of the blood stasis(choroidal discord).The content of fibrinogen increases with the aggravation of renal microscopic pattern of blood stasis,reflecting the end-stage of HSPN,which has the correlation with the formation and severity of related indexes.Fibrinogen can be used as a laboratory indicator to assist in the diagnosis of irreversible lesionsin the renal pathology of HSPN children.

This article is based on the core pathogenesis of yin-yang poisoning recorded in the Synopsis of the Golden Chamber and clarifies the characteristics of"yin poisoning"and"yang poisoning"as considered during the Han and Tang dynasties.It is found that the classification criteria for the two are based on the manifestation of syndromes rather than the cold and heat of the pathogenesis.By analyzing the syndrome of yin-yang poisoning in the Synopsis of the Golden Chamber and combining the records with people's understanding of the efficacy of various medicinals in Shengma Biejia Decoction during the Han and Tang dynasties,it is demonstrated that the core pathogenesis is stagnation,mainly reflected in three aspects:accumulation of toxins,stagnation of qi and blood,and stagnation of yang qi.Among these,the degree and location of stagnation of yang qi are the reasons for the difference between yin poisoning and yang poisoning.The disease of yang poisoning is characterized by sufficient yang qi in the body,obstruction of pathogenic factors on the surface,and intense competition between vital qi and evil qi.Therefore,yang stagnation on the surface is more severe and leads to heat symptoms.The disease of yin poisoning is characterized by deficient yang qi in the body,an inability to resist pathogen,and the deepening of evil qi.The yang qi is suppressed by depression and is relatively mild,making it unable to circulate and warm the body,resulting in cold symptoms.Therefore,when treating yang poisoning,ZHANG Zhongjing used medicinals that were pungent,warm and dispersed to relieve the yang depression on the surface.If the yang depression was dispersed,the heat would naturally dissipate.When treating yin poisoning,only internal medicine is used to relieve internal yang qi stagnation,and when yang qi is extended,cold will naturally disappear.In summary,we aimed to enhance our understanding of the efficacy of Shengma Biejia Decoction from the perspectives of promoting the dispersion of toxins,promoting blood circulation,and promoting yang stagnation,in order to provide new ideas for the clinical use of this formula and expand its application scope.

Objective To observe the effects of probiotics and lactulose synergistic action on gastroin-testinal motility,mucosal function and disease progression in elderly patients with type 2 diabetes mellitus(T2DM)nephropathy constipation.Methods A total of 108 elderly patients with T2DM nephropathy consti-pation admitted and treated in this hospital from May 2021 to March 2023 were selected as the study subjects and divided into the observation group,control group 1 and control group 2 by the random number table meth-od,36 cases in each group.The control group 1 was treated with bifidobacterium tetrad tablet,the control group 2 adopted the lactulose treatment,and the observation group was treated with bifidobacterium tetrad tablet combined with lactulose.The clinical efficacy,constipation symptoms before treatment and in 1,4 weeks after treatment,gastrointestinal motility,serum cerebrointestinal peptide[substance P(SP),nitric oxide(NO),vasoactive intestinal peptide(VIP)],intestinal mucosal barrier function[D-lactic acid(DLC),diamine oxidase(DAO),lipopolysaccharide(LPS)],renal function[creatinine(Cr),urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)]and Toll-like receptor 4(TLR4)/nuclear factor κB(NF-κB)mRNA ex-pression were compared between the groups.Results After 1-,4-week treatment,the total effective rate,bari-um discharge rate at different time points in the observation group were higher than those in the control group 1 and control group 2,and the scores of rectal,abdominal and fecal traits in the observation group were lower than those in the control group 1 and control group 2(P＜0.05),but there was no statistically significant difference between the control group 1 and control group 2(P＞0.05).The serum NO and VIP levels in the observation group were lower than those in the control group 1 and control group 2(P＜0.05),the SP level was higher than that in the control group 1 and control group 2(P＜0.05).After 4-week treatment,the levels of serum DLC,DAO and LPS in the observation group were lower than those in the control group 1 and con-trol group 2(P＜0.05);the Cr and BUN levels,TLR mRNA expression and NF-κB mRNA expression in the observation group and control group 1 were decreased compared with before treatment(P＜0.05),the eGFR level was increased compared with before treatment(P＜0.05),but the above indexes had no statistically sig-nificant difference between these two groups(P＞0.05).Conclusion Probiotics and lactulose in the treat-ment of elderly patients with T2DM nephropathy constipation could play a synergistic role,alleviate the con-stipation symptom,promote the gastrointestinal motility and restore the intestinal mucosal barrier function,which may be reach the anti-inflammation and anti-apoptosis goal by inhibiting TLR4/NF-κB,so as to inhibit the further development of diabetic nephropathy.

Objective To investigate the incidence and severity of symptoms in patients with gastric cancer who received chemotherapy,we constructed a symptom network to explore core symptoms and bridge symptoms.Furthermore,the study explores the association between core symptoms and Traditional Chinese Medicine(TCM)constitutions.Methods Patients with gastric cancer who received chemotherapy in the medical oncology and surgical oncology department from March to August 2023 were selected for the study using a convenience sampling method.The MD Anderson Symptom Inventory Gastrointestinal Cancer was used for evaluating gastrointestinal symptoms and their severity among patients receiving chemotherapy for gastric cancer,as well as assessing the classification of TCM constitution among patients.The symptom network model was constructed using the R programming language,and the central index was analyzed to determine the core symptoms and bridge symptoms.Binary logistic regression analysis was employed to assess the association between different physical conditions and the occurrence of core symptoms.Results A total of 346 electronic questionnaires were collected,with 340 valid ones,and the effective recovery rate was 98.3％.The 3 most prevalent and severe symptoms among the 340 patients with gastric cancer were fatigue(85.59％),lack of appetite(82.35％),and taste alteration(81.18％).The centrality index results indicated that grief exhibited the highest intensity,medium,and compactness centrality values(rs=8.23,rb=2.00,rc=0.03),making it the core symptom of this condition.Sleep disorders,lack of appetite,drowsiness,and taste alteration were identified as bridging symptoms with bridge intensities of 0.74,0.76,0.99,and 0.94 respectively.The results of Spearman correlation analysis showed that there was a positive correlation between sadness and qi-deficiency constitution,phlegm-dampness constitution(P＜0.05).The phlegm-dampness constitution was positively correlated with the taste alterations(P＜0.05).Conclusion In patients with gastric cancer,fatigue emerges as the most prominent symptom,while sadness assumes the core symptom.Additionally,sleep disorder,lack of appetite,drowsiness,and taste alteration are bridge symptoms.According to the principles of TCM constitution,qi-deficiency and phlegm-dampness are constitutions associated with a higher risk of experiencing sadness,and phlegm-dampness is a constitution associated with a higher risk of taste changes.Nurses can integrate core symptoms and TCM constitutions characteristics to optimize the strategies for symptom intervention.