The"season-visceral-related"theory originated from Huangdi Neijing,and its content contains the"holism of five viscera"and"correspondence between nature and humans"in the theoretical system of traditional Chinese medicine(TCM).Recently,the prevalence of post-stroke cognitive impairment(PSCI)has gradually increased with the increasing incidence of stroke.TCM believes that PSCI is located in the brain,however,the causative factors such as phlegm,depression,deficiency,and stasis are caused by the lesions of the five zang viscera.Therefore,PSCI can not be treated with the brain alone.Based on the"season-visceral-related"theory,this article discusses the etiology,pathogenesis,and treatment ideas for PSCI from the four seasons and five zang viscera.Xiaoyao Pill was selected as a treatment for patients with qi imbalance in spring to disperse stagnated liver qi to relieve qi stagnation.Tianwang Buxin Dan was selected as a treatment for patients with blood loss and spirit injury in the summer to nourish the blood and calm the heart and brain.Kaixin Powder was selected as a treatment for patients with spleen deficiency and phlegm blockage in late summer to strengthen the spleen,awaken the mind,and remove stasis.Wenfei Jiangzhuo Decoction was selected as a treatment for patients with qi deficiency and spirit departure in autumn to nourish the lungs,reduce turbidity,and nourish the mind.Dihuang Yinzi was selected as a treatment for patients with marrow reduction and internal toxin in winter to expel phlegm and fill the mind.Treating PSCI using the"season-visceral-related"theory reflects the overall concept of TCM and the hypothesis of syndrome differentiation and treatment and provides novel method for treating PSCI.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Conventional chemotherapy based on cytotoxic drugs is facing tough challenges recently following the advances of monoclonal antibodies and molecularly targeted drugs. It is critical to inspire new potential to remodel the value of this classical therapeutic strategy. Here, we fabricate bisphosphonate coordination lipid nanogranules (BC-LNPs) and load paclitaxel (PTX) to boost the chemo- and immuno-therapeutic synergism of cytotoxic drugs. Alendronate in BC-LNPs@PTX, a bisphosphonate to block mevalonate metabolism, works as both the structure and drug constituent in nanogranules, where alendronate coordinated with calcium ions to form the particle core. The synergy of alendronate enhances the efficacy of paclitaxel, suppresses tumor metastasis, and alters the cytotoxic mechanism. Differing from the paclitaxel-induced apoptosis, the involvement of alendronate inhibits the mevalonate metabolism, changes the mitochondrial morphology, disturbs the redox homeostasis, and causes the accumulation of mitochondrial ROS and lethal lipid peroxides (LPO). These factors finally trigger the ferroptosis of tumor cells, an immunogenic cell death mode, which remodels the suppressive tumor immune microenvironment and synergizes with immunotherapy. Therefore, by switching paclitaxel-induced apoptosis to mevalonate metabolism-triggered ferroptosis, BC-LNPs@PTX provides new insight into the development of cytotoxic drugs and highlights the potential of metabolism regulation in cancer therapy.

Objective To analyze the micronucleus rate of radiation workers and to provide accurate occupational health monitoring basis in radiation workers exposed to low-level ionizing radiation for a long time. Methods The radiation group consisted of 353 radiation workers who had been exposed to ionizing radiation during work, while the control group consisted of 41 radiation workers who had not yet been exposed to ionizing radiation before work. The cytokinesis-block micronucleus method was used to determine the micronucleus rate. Results The average micronucleus rate in the radiation group was significantly higher than that in the control group (t = −2.95, P < 0.05). In the radiation group, the micronucleus rate gradually increased with age, and the difference was statistically significant (F = 8.36, P < 0.05). The micronucleus rates of workers with > 10 and > 30 years of service were significantly higher than those of workers with < 10 years of service (χ² = −44.79, −60.47, P < 0.05). The micronucleus rate in females was significantly higher than that in males (t = 3.93, P < 0.05). The micronucleus rates in the diagnostic radiology group and the industrial detection group were significantly higher than that in the control group (t = 3.51, 3.65, P < 0.05). Conclusion The micronucleus rate has increased among the radiation workers exposed to low-level ionizing radiation for a long time. It is necessary to further strengthen occupational health monitoring and radiation protection education for radiation workers, especially the medical workers that constitute the largest population of radiation exposure workers.

Objective:To compare and validate the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS ) and the ADNEX model in the diagnosis of malignant ovarian-adnexal lesions.Methods:A total of 275 patients who underwent surgery for ovarian-adnexal lesions at Tianjin Medical University Cancer Institute and Hospital from December 2020 to December 2022 were retrospectively collected. The clinical, pathological aud ultrasound dates of the patients were collected.Statistical methods, including chi-square tests and ROC curve analysis, were employed to assess the diagnostic performance of O-RADS and the ADNEX model for ovarian-adnexal lesions.Results:Among the 275 patients included in this study, 127 (46.2%) had benign lesions, and 148 (53.8%) had malignant lesions.Based on the O-RADS classification, 46 cases (16.7%) were O-RADS 2, 50 cases (18.2%) were O-RADS 3, 66 cases (24.0%) were O-RADS 4, and 113 cases (41.1%) were O-RADS 5. The malignancy rates for O-RADS 2, O-RADS 3, O-RADS 4, and O-RADS 5 were 0%, 0.08%, 56.06%, and 94.7%, respectively. ROC curve analysis for malignant ovarian-adnexal lesions yielded an area under ROC curve of 0.93(95% CI=0.90-0.96) for O-RADS and 0.94(95% CI=0.91-0.97) for the ADNEX model. Using O-RADS ≥4 and ADNEX model ≥10% as cutoff values, there was no significant difference in sensitivity between the two methods( P=0.740), but O-RADS exhibited higher specificity compared to the ADNEX model (72.4% vs 56.7%, P=0.044). Conclusions:When O-RADS ≥4 and the ADNEX model ≥10% are used as cutoff values, both methods demonstrate excellent diagnostic performance for malignant ovarian-adnexal lesions, with O-RADS exhibiting higher specificity.

Objective:To investigate the ultrasonographic features of medullary thyroid carcinomas (MTCs) of different sizes and supply valid information for separating MTCs from papillary thyroid carcinomas (PTCs).Methods:There were 87 patients with MTC and 220 patients with PTC detected by ultrasonography and confirmed by pathology at Tianjin Medical University Cancer Institute and Hospital from June 2018 to March 2022. Nodules were divided into the large nodule group (the maximum diameter of the tumor was＞1 cm) and the small nodule group (the maximum diameter of the tumor was ≤1 cm). There were 97 cases in the small nodule group, including 28 cases of MTC and 69 cases of PTC. There were 210 cases in the large nodule group, including 59 cases of MTC and 151 cases of PTC. After stratification by thyroid nodules, ultrasonographic features of thyroid nodules and metastatic lymph nodes, preoperative serum calcitonin (CT) and carcinoembryonic antigen (CEA) levels were compared between MTC and PTC patients.Results:In the small nodule group, the proportion of MTCs exhibiting hypoecho, smooth margins, and having blood flow signals was higher than that of PTCs, with statistically significant differences (all P＜0.05). In the large nodule group, the proportion of MTCs showing cystic solidity, hypoecho, smooth margins, blood flow, and the type Ⅳvascular distribution was higher than PTCs, and the difference of calcification type between them was also statistically significant (all P＜0.05). In contrast, the differences in the number of lesions and aspect ratio between MTCs and PTCs were not statistically significant regardless of nodule size (all P＞0.05). In the small nodule group,6 metastatic lymph nodes of medullary thyroid carcinoma (LNM-MTC) and 11 metastatic lymph nodes of papillary thyroid carcinoma (LNM-PTC) were correctly diagnosed by ultrasound, respectively. The diagnostic compliance rate of ultrasound was 78.6% (22/28) and 78.3% (54/69), respectively, with no statistically significant difference ( P=0.973). In the large nodule group, 28 LNM-MTC and 11 LNM-PTC were correctly diagnosed by ultrasound, respectively. The diagnostic compliance of ultrasound was 88.1% (52/59) and 73.5% (111/151), respectively, which was statistically significant ( P=0.022). Among them, 82.1% of LNM-MTC and 56.6% of LNM-PTC showed abnormal blood flow signals, with a statistically significant difference ( P=0.016). There were significant differences in preoperative serum CT and CEA levels of different sizes of MTCs (all P＜0.05). Conclusions:Different sizes of MTCs require diverse demonstrative criteria. Abnormal blood flow signal is of great significance in the diagnosis of LNM-MTC. Within the absence of ultrasonic characteristics, preoperative serum CT test can provide confidence for the diagnosis of MTC.

Literature related to children's adenoid hypertrophy was retrieved to form an expert questionnaire.According to the group standard writing rules of the China Association of Chinese Medicine,the peer consultation,quality evaluation and suitability eval-uation were completed through three rounds of Delphi expert questionnaire surveys and expert discussion meetings,and the Clinical Practice Guidelines for TCM in Children with Adenoidal Hypertrophy was finally formed.The guidelines have been formulated to clarify the scope of application of the guidelines,normative reference documents,terms and definitions,diagnosis,syndrome differentiation,treatment,prevention and care,and to provide an important reference for the clinical practice and diagnosis and treatment norms of tra-ditional Chinese medicine for children with adenoid hypertrophy.

Objective:To investigate the ultrasonographic features of medullary thyroid carcinomas (MTCs) of different sizes and supply valid information for separating MTCs from papillary thyroid carcinomas (PTCs).Methods:There were 87 patients with MTC and 220 patients with PTC detected by ultrasonography and confirmed by pathology at Tianjin Medical University Cancer Institute and Hospital from June 2018 to March 2022. Nodules were divided into the large nodule group (the maximum diameter of the tumor was＞1 cm) and the small nodule group (the maximum diameter of the tumor was ≤1 cm). There were 97 cases in the small nodule group, including 28 cases of MTC and 69 cases of PTC. There were 210 cases in the large nodule group, including 59 cases of MTC and 151 cases of PTC. After stratification by thyroid nodules, ultrasonographic features of thyroid nodules and metastatic lymph nodes, preoperative serum calcitonin (CT) and carcinoembryonic antigen (CEA) levels were compared between MTC and PTC patients.Results:In the small nodule group, the proportion of MTCs exhibiting hypoecho, smooth margins, and having blood flow signals was higher than that of PTCs, with statistically significant differences (all P＜0.05). In the large nodule group, the proportion of MTCs showing cystic solidity, hypoecho, smooth margins, blood flow, and the type Ⅳvascular distribution was higher than PTCs, and the difference of calcification type between them was also statistically significant (all P＜0.05). In contrast, the differences in the number of lesions and aspect ratio between MTCs and PTCs were not statistically significant regardless of nodule size (all P＞0.05). In the small nodule group,6 metastatic lymph nodes of medullary thyroid carcinoma (LNM-MTC) and 11 metastatic lymph nodes of papillary thyroid carcinoma (LNM-PTC) were correctly diagnosed by ultrasound, respectively. The diagnostic compliance rate of ultrasound was 78.6% (22/28) and 78.3% (54/69), respectively, with no statistically significant difference ( P=0.973). In the large nodule group, 28 LNM-MTC and 11 LNM-PTC were correctly diagnosed by ultrasound, respectively. The diagnostic compliance of ultrasound was 88.1% (52/59) and 73.5% (111/151), respectively, which was statistically significant ( P=0.022). Among them, 82.1% of LNM-MTC and 56.6% of LNM-PTC showed abnormal blood flow signals, with a statistically significant difference ( P=0.016). There were significant differences in preoperative serum CT and CEA levels of different sizes of MTCs (all P＜0.05). Conclusions:Different sizes of MTCs require diverse demonstrative criteria. Abnormal blood flow signal is of great significance in the diagnosis of LNM-MTC. Within the absence of ultrasonic characteristics, preoperative serum CT test can provide confidence for the diagnosis of MTC.

Objective To investigate the compliance status of ankle pump movement(APM)in high-risk patients with deep venous thrombosis(DVT)of the lower limbs and analysis the related influencing factors.Methods From January 2019 to March 2023,a total of 302 patients with high-risk lower limb DVT who admitted to our hospital were selected as the research objects.The APM compliance scale,clinical data sheet,visual analog scale(VAS),family support scale,self-efficacy scale,self-rating anxiety scale,and self-rating depression scale were used to evaluate the research subjects,and the evaluation results were analyzed.Results Among the 302 patients with high-risk DVT,171 patients had APM compliance,with a compliance rate of 56.62％.The results of univariate analysis showed that there were statistically significant differences in APM compliance among patients of different age groups,gender,education level,marital status,family economic income,work status,family support,medical insurance type,place of residence,reason for hospitalization,comorbidities,pain level,APM prescription time,self-efficacy,and psychological status(all P＜0.05).The results of multivariate Logistic analysis showed that comorbidities(≥2 types),pain(moderate and above),and prescription time(≥7d)were risk factors for APM compliance in DVT high-risk patients(all P＜0.05),while education level(college or above),family support(moderate and above),and self-efficacy(moderate and above)were protective factors for APM compliance(all P＜0.05).Conclusion The comorbidities,degree of pain,APM prescription time,educational level,family support,and patient self-efficacy can affect ankle pump compliance in high-risk patients with lower limb deep vein thrombosis,and should be given attention and targeted intervention.

Objective:To investigate the prognosis and risk factors of IgA vasculitis nephritis (IgAVN) in children.Methods:A retrospective cohort study was conducted. Clinical data were collected from 264 children who were pathologically diagnosed with IgAVN at Department of Pediatric Nephrology, Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology, between January 2011 and December 2017. All patients had a follow-up period of more than 3 years. Clinical characteristics, renal pathology, 3-year and 5-year prognosis were analyzed. The patients were grouped based on gender, age of onset (≤6 years, >6-9 years, and >9 years), pathological classification (≤Ⅲ and>Ⅲ),whether the prognosis was complete remission at 3 and 5 years. Independent sample t-tests, ANOVA or chi-squared test were used for intergroup comparisons. Spearman correlation analysis was applied for ordinal data, and multivariate Logistic regression was used to analyze factors affecting the prognosis. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of these factors. Results:Of the 264 children with IgAVN, 153 were male and 111 were female, the age of onset was 8.3 (6.7, 10.3) years, 118 patients (45%) with onset age >6-9 years accounted for the highest proportion. All patients presented with skin purpura and renal involvement, primarily manifesting as hematuria and/or proteinuria. Microscopic hematuria was observed in 253 patients (95.8%), while 246 patients (93.2%) showed proteinuria. In 256 patients (97.0%), hematuria or proteinuria urinalysis was detected within 6 months of skin purpura onset, and 243 patients (92.0%) underwent renal biopsy within 6 months of renal involvement. The most common clinical subtype in 264 IgAVN children was hematuria and proteinuria (204 cases, 77.3%), with grade Ⅲ being the predominant pathological classification (181 cases, 68.6%). Among children ≤6 years old, the 3-year complete remission rate was higher in males than in females (83.9% (26/31) vs. 7/16, χ2=8.12, P=0.012). Factors independently associated with poor 5-year prognosis included time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission 3 years post-biopsy ( OR=5.41, 1.39, 6.02, 95% CI 1.40-20.86, 1.04-1.84, 2.61-13.88, all P<0.05). The serum cholesterol has a predictive value for 5-year prognosis ( P=0.020, AUC=0.62, 95% CI 0.52-0.71, Youden index=0.27, cutoff=4.37). Conclusions:For children with IgAVN aged≤6 years, the 3-year prognosis is better in males than in females. Time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission at 3 years post-biopsy may be independent risk factors for poor 5-year prognosis in children with IgAVN.