Senile chronic heart failure(CHF)complicated with sarcopenia can further degrade patients'quality of life,and increase the occurrence of falls,disability and mortality.Currently,western medicine preventive and treatment for sarcopenia mainly depend on nutritional support and exercise therapy,but their efficacy remained uncertain.Traditional Chinese medicine(TCM)therapy has the advantages of holism and syndrome differentiation and treatment,and its application in senile CHF complicated with sarcopenia is worthy of further exploration.This paper sorted out the relevant statements in the Treatise on Exogenous Febrile and Miscellaneous Diseases,and concluded that the clinical manifestations of senile CHF complicated with sarcopenia are similar to those of heart water and consumptive disease in the Treatise on Exogenous Febrile and Miscellaneous Diseases.The statements in Treatise on Exogenous Febrile and Miscellaneous Diseases will guide the identification of etiology and pathogenesis as well as the diagnosis and treatment for senile CHF complicated with sarcopenia.The analysis of the pathogenesis indicated that heart water and consumptive disease were induced by deficiency of heart and spleen and kidney,five kinds of overstrain and seven types of impairment,water pathogen insulting heart,and internal stagnation of blood stasis.Therefore,it is proposed that the core pathogenesis of senile CHF complicated with sarcopenia is due to the deficiency of heart,spleen and kidney yang,and water blended with blood stasis.The classical prescriptions such as Ling Gui Zhu Gan Tang,Zhenwu Tang,Sini Tang,Shenqi Pills,Jianzhong Tang and Wuling Powder can be used by modification or combination based on syndrome differentiation in treating senile CHF complicated with sarcopenia.For both of the congenital and acquired origin(spleen and kidney)of elderly patients with CHF complicated with sarcopenia are deficient,the utilization of herbs for invigorating spleen and boosting kidney on the basis of syndrome differentiation may achieve good efficacy.

Objective To analyze the correlation between venous thromboembolism(VTE)and traditional Chinese medicine(TCM)constitution types in elderly frail patients.Methods A retrospective study was conducted on 1 428 elderly frail patients admitted to the Second Comprehensive Department of Guangdong Provincial Hospital of Chinese Medicine from January 2019 to June 2023.Patients were divided into a venous thrombsis(VT)group(n=187)and a non-VT group(n=1 241)based on VTE occurrence.Baseline data,including age distribution,Padua scores,Wells scores,and TCM constitution types,were compared between the two groups.Multivariate logistic regression analysis was performed to identify factors for influencing VTE in elderly frail patients.Results(1)Compared with the non-VT group,the VT group had significantly higher total hospitalization costs,length of stay,age,Fried scores,Padua scores,and Wells scores,with statistically significance(P＜0.001).(2)Compared with the non-VT group,the VT group had a higher proportion of high VTE-risk individuals and those with Wells scores of 2 points,with statistically significance(P＜0.001).(3)The age distribution of VTE patients showed an increasing trend in the age groups of 60-69,70-79,80-89,and ≥90-year-old,with a significant difference compared to the non-VT group(P＜0.001).(4)The VT group had a higher proportion of qi-deficiency,blood-stasis,and qi-depression constitutions than the non-VT group(P＜0.05 or P＜0.001).(5)Multivariate logistic regression analysis(after adjusting age,gender,frailty,and other scores)showed that qi-deficiency and yang-deficiency constitutions were non-susceptible,while damp-heat,blood-stasis,and qi-depression constitutions were susceptible to VTE in elderly frail patients(P＜0.05 or P＜0.01).Conclusion VTE in elderly frail patients is significantly correlated with TCM constitution types.Deviated constitutions are characteristic of TCM constitution types in elderly frail patients,and damp-heat,blood-stasis,and qi-depression constitutions are risk factors for VTE in this population.

Endodontic diseases are a kind of chronic infectious oral disease.Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha.However,it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT).Recent research,encompassing bacterial etiology and advanced imaging techniques,contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT.Success in RCT hinges on factors like patients,infection severity,root canal anatomy,and treatment techniques.Therefore,improving disease management is a key issue to combat endodontic diseases and cure periapical lesions.The clinical difficulty assessment system of RCT is established based on patient conditions,tooth conditions,root canal configuration,and root canal needing retreatment,and emphasizes pre-treatment risk assessment for optimal outcomes.The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT.These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Purpose: To assess the feasibility of applying ultra-widefield fundus (UWF) images for macular staphyloma area (MSA) measurement and investigate the associated factors with MSA. Methods: This is a retrospective study. MSA was measured by UWF imaging. Central foveal thickness, subfoveal choroidal thickness, subfoveal scleral thickness were measured on spectral domain optical coherence tomography. Intraclass correlation coefficients of MSA measurement would be evaluated. Multiple linear regression analysis was used to analyze the associated factors with MSA. Results: In total, 135 eyes of 92 patients were enrolled. The mean age was 64.73 ± 10.84 years. Mean MSA on UWF image was 279.67 ± 71.70 mm2. Intraclass correlation coefficients of MSA measurement was 0.965 (95% confidence interval [CI], 0.946 to 0.977; p < 0.001). In the multiple linear regression analysis, after adjusting for subfoveal choroidal thickness, best-corrected visual acuity, central foveal thickness, and subfoveal scleral thickness, the factors independently related to MSA were axial length (β = 8.352; 95% CI, 3.306 to 13.398; p = 0.001), sex (β = -26.673; 95% CI, -51.759 to -1.586; p = 0.037), age (β = 1.184; 95% CI, 0.020 to 2.348; p = 0.046). Conclusions It is feasible to measure MSA on UWF image. Female, longer axial length, and older age may indicate larger MSA.

Objective:To detect serum levels of vitamin A (Vit A), vitamin D(Vit D)25-hydroxy vitamin D[25-(OH)D] and vitamin E(Vit E) in children aged 0-6 years in Tibetan Plateau of Garzi Prefecture, thus providing references for physical examinations and prevention of 4 key diseases (rickets, malnutrition anemia, pneumonia and diarrhea) in children in plateau areas by relevant government departments.Methods:A total of 2 122 children who participated in physical examination in 12 townships of Xiangcheng County and 14 townships of Daocheng County, Garzi Tibetan Autonomous Prefecture, Sichuan Province from April 2017 to April 2019 with 0-6 years old were recruited for surveying physical measurements and collection of venous blood.Serum Vit A and Vit E levels were detected by high performance liquid chromatography.Serum levels of 25-(OH)D were detected by high performance liquid chromatography tandem mass spectrometry.The relationship between Vit A, Vit E and 25-(OH)D levels with the gender, age, seasonal change and altitude was analyzed.Results:The serum Vit A level, subclinical Vit A deficiency rate and marginal vitamin A deficiency rate were(1.05±0.27) μmol/L, 8.15%(173/2 122 cases) and 45.99%(976/2 122 cases), respectively in 2 122 children with 0-6 years old.There were significant differences in the serum Vit A level, the subclinical Vit A deficiency rate and the marginal vitamin A deficiency rate in children with different ages, seasons and altitudes (all P<0.05). The serum level of 25-(OH)D and 25-(OH)D deficiency rate insufficient rate were (24.65±6.45) ng/L, 6.03%(128/2 122 cases) and 16.59%(352/2 122 cases), respectively.There were significant differences in the serum level of 25-(OH)D, 25-(OH)D deficiency rate and 25-(OH)D insufficient rate in children with different ages and seasons (all P<0.05). The mean serum Vit E level, Vit E deficiency rate and Vit E insufficient rate were (7.81±1.74) mg/L, 2.78%(59/2 122 cases) and 29.59%(628/2 122 cases), respectively.There were significant differences in serum Vit E level, Vit E deficiency rate and Vit E insufficient rate in children with different ages and seasons (all P<0.05). The mean serum levels of Vit A and Vit D remained the lowest before the age of 1 year, and their deficiencies at this age were the most significant.The mean serum level of Vit E remained the lowest in >1-2 years old, and its deficiency and insufficient at this age were the most significant.Vit A, D and E levels were significantly affected by seasonal changes, which were significantly higher in the summer than in the spring, autumn and winter.In addition, Vit A and 25-(OH)D were significantly affected by the altitude, which were the lowest above 4 km altitude. Conclusions:The overall serum levels of Vit A, 25-(OH) D and E in children with 0-6 years old in Tibetan Plateau areas of Ganzi Prefecture are lower than those in plain areas.Vit A, 25-(OH) D and Vit E levels significantly differed in the age, season and altitude, which are related to the lack of local resources, insufficient maternal nutrition during pregnancy and insufficient intake after birth, as well as temperature and light caused by changes in local seasons and altitude.Therefore, it is necessary to make reasonable supplements during pregnancy to prevent vitamin deficiency.

Objective:To establish a disease risk prediction model for the newborn screening system of inherited metabolic diseases by artificial intelligence technology.Methods:This was a retrospectively study. Newborn screening data ( n=5 907 547) from February 2010 to May 2019 from 31 hospitals in China and verified data ( n=3 028) from 34 hospitals of the same period were collected to establish the artificial intelligence model for the prediction of inherited metabolic diseases in neonates. The validity of the artificial intelligence disease risk prediction model was verified by 360 814 newborns ' screening data from January 2018 to September 2018 through a single-blind experiment. The effectiveness of the artificial intelligence disease risk prediction model was verified by comparing the detection rate of clinically confirmed cases, the positive rate of initial screening and the positive predictive value between the clinicians and the artificial intelligence prediction model of inherited metabolic diseases. Results:A total of 3 665 697 newborns ' screening data were collected including 3 019 cases ' positive data to establish the 16 artificial intelligence models for 32 inherited metabolic diseases. The single-blind experiment ( n=360 814) showed that 45 clinically diagnosed infants were detected by both artificial intelligence model and clinicians. A total of 2 684 cases were positive in tandem mass spectrometry screening and 1 694 cases were with high risk in artificial intelligence prediction model of inherited metabolic diseases, with the positive rates of tandem 0.74% (2 684/360 814)and 0.46% (1 694/360 814), respectively. Compared to clinicians, the positive rate of newborns was reduced by 36.89% (990/2 684) after the application of the artificial intelligence model, and the positive predictive values of clinicians and artificial intelligence prediction model of inherited metabolic diseases were 1.68% (45/2 684) and 2.66% (45/1 694) respectively. Conclusion:An accurate, fast, and the lower false positive rate auxiliary diagnosis system for neonatal inherited metabolic diseases by artificial intelligence technology has been established, which may have an important clinical value.

Objective: To evaluate the application effect of the medication management training based on Precede-Proceed Model in schizophrenic inpatients. Methods: In this self-control study, 60 schizophrenic inpatients were chosen for this investigation and were undergoing the medication management training on Precede-Proceed Model with conventional nursing care. By using Insight and Treatment Attitudes Questionnaires (ITAQ), The Brief Psychiatric Rating Scale (BPRS) and Nurses′ Observation Scale for Inpatient Evaluation (NOSIE) after the first 3 months and 6 months of the intervention, in order to evaluate their results with their initial readings. Results: The total scores of ITAQ, the total scores of BPRS, lacking in activity factor, reaction factor, hostile-suspiciousness factor, the total scores of NOSIE, total positive and negative factors before the intervention were (183.3±15.0) points, (71.7±10.9) points and (13.6±8.8) points; three months after intervention were (189.0±15.8) points, (75.3±11.1) points and (11.6±7.2) points; six months after intervention were (193.8 months after intervention were15.2) points, (71.8 ±9.6) points and (10.1±7.0) points. There were significant differences between the total score and the total negative factor score before and after treatment (F=43.244, 23.060, P<0.05). Conclusion The Precede-Proceed Model on medication management training in schizophrenic inpatients plays a positive role in promoting recovery and it is worth extending in clinical practice.

Objective To determine the levels of coagulation and inflammatory factors in women with moderate and severe ovarian endometriosis so as to investigate the possible role of coagulation and inflammatory factors in the pathogenesis, diagnosis and treatment of this disease. Methods From June 2015 and June 2017,clinical data of 366 patients with pathologically diagnosed moderate and severe ovarian endometriosis (case group) and 244 patients with pathologically diagnosed benign ovarian cysts (control group)in Women′s Hospital of Zhejiang University School of Medicine were retrospectively analyzed.The levels of coagulation indicators, inflammatory factors and serum tumor markers were measured. Then, the values of these indicators in diagnosis of endometriosis were analyzed. Results(1)The levels of plasma prothrombin time(PT)and thrombin time(TT)in patients with ovarian endometriosis [median: 12.8 s (range:12.4-13.2 s)and 15.5 s(range:15.1-15.9 s),respectively]were significantly shorter than those with benign ovarian cysts[median:13.0 s(range:12.5-13.4 s)and 15.7 s(range:15.3-16.1 s),respectively;all P<0.01].The levels of plasma fibrinogen(FIB)and D-dimer[D-D;median:3.1 g/L(range:2.8-3.5 g/L)and 0.9 mg/L(range:0.6-2.1 mg/L),respectively]in patients with ovarian endometriosis were significantly higher than those with benign ovarian cysts[median:2.8 g/L(range:2.6-3.2 g/L)and 0.6 mg/L(range:0.4-1.2 mg/L), respectively; P=0.000]. Moreover, neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio [PLR; median: 2.3 (range: 1.8-3.1) and 144 (range: 113-179), respectively] in patients with ovarian endometriosis were significantly higher than those with benign ovarian cysts [median: 2.1 (range: 1.6-2.8) and 128 (range: 104-165), respectively; P<0.01]. Furthermore, in patients with ovarian endometriosis, the levels of PT were significantly shorter in stage Ⅳ endometriosis than that in stage Ⅲ endometriosis (P<0.05).The levels of FIB and PLR in patients with stageⅣendometriosis were significantly higher than those in patients with stage Ⅲ endometriosis(P<0.01).(2)The cut-off value of CA125was 27.2 kU/L with a sensitivity of 83.6%,the cut-off value of FIB was 3.1 g/L with a sensitivity of 53.2%,while the sensitivity of combination index(FIB×CA125)was 84.9%.Conclusion The abnormality of coagulation and inflammatory factors may be involved in the pathogenesis of moderate and severe ovarian endometriosis,and the detection of coagulation and inflammatory factors may be have important clinical significance for the diagnosis and treatment of moderate and severe ovarian endometriosis.

Objective To evaluate the long-term safety of sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue in breast cancer patients.Methods 198 breast cancer patients with clinical negative axillary lymph node received sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue.Patients were followed up and regional lymph node recurrence,disease free survival(DFS) and overall survival(OS) were analyzed.Results After a median follow-up of 70 months,2 patients had ipsilateral lymph node recurrence with a regional lymph node recurrence rate of 1％ (2/198).14 patient had recurrence or metastasis and 6 patients died of distant metastasis.The estimated 6 years DFS was 94.4％ and OS was 96.5％.The incidence of arm lymphoedema within patients who received axillary lymph node dissection was 4.5％ and it was 2.5％ in patients who received sentinel lymph node biopsy.Conclusions The sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue was safe and reliable method for further staging axillary lymph node stastus.

Objective:To analyze the magnetic resonance imaging (MRI) features of parasellar cavernous haemangioma and improve the diagnosis and differential diagnosis accuracy.Methods:13 patients with parasellar cavernous haemangioma were collected.All the patients were diagnosed by MRI and confirmed by pathology.Based on the pathologic findings,the MRI features were discussed.Results:9 cases presented horizontal dumbbell.The lesions located in the parasellar were larger than the sella turcica.The main body position of the lesions were centered lateral to the parasellar and encasesed the intracavernous internal carotid artery (ICICA).While,1 cases were similar in size and shape.1 case was located in the sella turcica.2 cases was centered lateral to the ICICA.pituitary were detected obscurity in 7 cases and displaced in 6 cases,6 cases appeared extremely high homogeneous intensity on T2-weighted images:as bright as cerebrospinal fluid signal.Only 5 cases underwent three-dimensional arterial spin labelling perfusion imaging (3D-ASL).The lesions revealed marked hypoperfusion.The cases of misdiagnosis were 9,including 4 cpituitary adenomas and 5 meningiomas.Conclusions:The characteristics of MR images ofparasellar cavernous haemangioma were horizontal bottle gourd form,the main body position of the lesions were centered lateral to the parasellar and encasesed the (ICICA),and their extremely high homogeneous intensity on T2-weighted images:as bright as cerebrospinal fluid signal.In cases that are equivocal,3D-ASL were useful in differentiating cavernous haemangiomas from parasellar meningiomas,which could decrease mistaken diagnosis.Graspping the imaging feature and differential diagnosis were helpful for the diagnosis of this disease.