ObjectiveTo evaluate the clinical efficacy of Zuogui Pill （左归丸，ZGP） decoction on neurological function， motor function， and activities of daily living in patients with ischemic stroke （IS） of liver-kidney yin deficiency syndrome， and to assess its potential mechanisms from the perspectives of cerebral perfusion and corticospinal tract （CST） remodeling. MethodsA total of 108 patients with IS of liver-kidney yin deficiency syndrome and onset time ≤14 days were enrolled and randomly divided into a control group and a treatment group， with 54 cases in each group. The control group received conventional western medicine， while the treatment group received ZGP decoction （one dose per day） in addition to the conventional treatment. Both groups were treated for 90 days. The National Institutes of Health Stroke Scale （NIHSS）， modified Rankin Scale （mRS）， modified Barthel Index （MBI）， Fugl-Meyer Assessment （FMA）， and Chinese medicine syndrome score （CMS） were evaluated before treatment and after （90±3） days of treatment. Three-dimensional arterial spin labeling （3D-ASL） and diffusion tensor imaging （DTI） were performed to obtain ipsilesional cerebral blood flow （CBF） in the unaffected and affected hemispheres， relative CBF （rCBF）， and fractional anisotropy （FA） of the CST. Nodal analysis of FA values along the CST was also conducted. Correlation analysis was used to assess the relationships between post-treatment cerebral perfusion parameters （CBF and rCBF）， and FA values with clinical neurological function scores. ResultsAfter treatment， both groups showed significantly decreased NIHSS， mRS and CMS scores， together with significantly increased FMA and MBI scores （P＜0.01）. Intergroup comparison showed that NIHSS， mRS， and CMS scores in the treatment group were significantly lower than those in the control group ， while MBI and FMA scores were significantly higher （P＜0.01）. The 3D-ASL results revealed that CBF and rCBF values in the affected hemisphere significantly increased in both groups after treatment， and the treatment group had significantly higher values （P＜0.01）. DTI showed that the FA value of the CST on the affected side in the treatment group was significantly higher than that in the control group after treatment （P＜0.05）. Nodal analysis along the CST further demonstrated that the continuity of FA values at lesion-related nodes 45~99 in the treatment group was significantly better than that in the control group （P＜0.01）， with significant increases at nodes 65~71 and 76~81 compared with baseline （P＜0.05 or P＜0.01）， whereas the control group showed a decreasing trend at nodes 80~93 （P＜0.05）. Correlation analysis indicated that CBF and rCBF values in the affected hemisphere were negatively correlated with NIHSS and mRS scores and positively correlated with MBI score （P＜0.05）. FA value of the CST on the affected side， both before and after treatment， were negatively correlated with NIHSS score and positively correlated with FMA score （P＜0.05 or P＜0.01）. ConclusionZGP decoction can effectively improve neurological function， motor function， and activities of daily living in IS patients with liver-kidney yin deficiency syndrome， and its mechanism may be related to enhanced cerebral perfusion in the affected hemisphere and corticospinal tract structural remodeling.

Objective:To explore the evaluation and relationship of hepatitis B virus(HBV)surface antigen(HBsAg)in clinical laboratory in different detection systems,further scientifically and reasonably to explain the test results for serving clinical practices.Methods:During the period from June 2021 to July 2022,100 425 specimens of patients with screened,suspected and confirmed HBV infections were collected from the clinical departments(mainly infectious hepatology)of Nanyang Central Hospital.Detection methodology included quantitative(electrochemiluminescence and chemiluminescence),qualitative(gold standard),semi-quantita-tive(ELISA),and highly sensitive HBV-DNA(RT-PCR)methods,and then analyzed the strengths and weaknesses and closeness be-tween each methodology.The relationship between the two Roche HBsAg detection systems was analyzed by correlation analysis.The HBsAg efficacy analysis was validated using Cut/Off value setting and detection limit,which in turn analyzed the distribution of false-positive and false-negative reporting models.Results:Detection results for low-and medium-concentration HBsAg showed a correla-tion between the electrochemical luminescence semi-quantitative method and ELISA method.ELISA method still had advantages in terms of sensitivity and specificity when detecting HBsAg,and there were no significant differences compared to domestic and interna-tional HBsAg quantitative detection systems.Performance validation conducted in accordance with the CNAS-GL038 document showed that the minimum detection limit for HBsAg calculated using the ELISA method in this laboratory was 0.1 U/ml.When the ROC curve Cut/Off value was set to 0.105,the area under the curve was the largest(AUC=0.986).Based on Roche's semi-quantitative electroche-miluminescence detection and patient medical history,in the common reporting model for hepatitis B five-item detection using ELISA method,HBsAg false positives occurred most frequently when HBsAg was positive alone,and HBsAg occurred most frequently in the false positive range when the OD value was less than 0.5.In ELISA method for detecting HBsAg,as the OD value increased from 0.01 to 0.10,the number of false-negative results also increased.Roche Elecsys HBsAg Ⅱ Quant Ⅱ and Elecsys HBsAg Ⅱ testing systems exhibited good linearity under certain conditions,with a ratio of approximately 1/0.18.In Elecsys HBsAg Ⅱ Quant Ⅱ detection sys-tem,the test results of HBsAg samples diluted 400 times were highly consistent with the original test results with a coefficient of deter-mination R2=0.993 8.Conclusion:There was a certain relationship between various detection systems of HBsAg at a suitable concen-tration.The detection of HBsAg by ELISA can meet the needs of clinical detection.

Objective:To explore the evaluation and relationship of hepatitis B virus(HBV)surface antigen(HBsAg)in clinical laboratory in different detection systems,further scientifically and reasonably to explain the test results for serving clinical practices.Methods:During the period from June 2021 to July 2022,100 425 specimens of patients with screened,suspected and confirmed HBV infections were collected from the clinical departments(mainly infectious hepatology)of Nanyang Central Hospital.Detection methodology included quantitative(electrochemiluminescence and chemiluminescence),qualitative(gold standard),semi-quantita-tive(ELISA),and highly sensitive HBV-DNA(RT-PCR)methods,and then analyzed the strengths and weaknesses and closeness be-tween each methodology.The relationship between the two Roche HBsAg detection systems was analyzed by correlation analysis.The HBsAg efficacy analysis was validated using Cut/Off value setting and detection limit,which in turn analyzed the distribution of false-positive and false-negative reporting models.Results:Detection results for low-and medium-concentration HBsAg showed a correla-tion between the electrochemical luminescence semi-quantitative method and ELISA method.ELISA method still had advantages in terms of sensitivity and specificity when detecting HBsAg,and there were no significant differences compared to domestic and interna-tional HBsAg quantitative detection systems.Performance validation conducted in accordance with the CNAS-GL038 document showed that the minimum detection limit for HBsAg calculated using the ELISA method in this laboratory was 0.1 U/ml.When the ROC curve Cut/Off value was set to 0.105,the area under the curve was the largest(AUC=0.986).Based on Roche's semi-quantitative electroche-miluminescence detection and patient medical history,in the common reporting model for hepatitis B five-item detection using ELISA method,HBsAg false positives occurred most frequently when HBsAg was positive alone,and HBsAg occurred most frequently in the false positive range when the OD value was less than 0.5.In ELISA method for detecting HBsAg,as the OD value increased from 0.01 to 0.10,the number of false-negative results also increased.Roche Elecsys HBsAg Ⅱ Quant Ⅱ and Elecsys HBsAg Ⅱ testing systems exhibited good linearity under certain conditions,with a ratio of approximately 1/0.18.In Elecsys HBsAg Ⅱ Quant Ⅱ detection sys-tem,the test results of HBsAg samples diluted 400 times were highly consistent with the original test results with a coefficient of deter-mination R2=0.993 8.Conclusion:There was a certain relationship between various detection systems of HBsAg at a suitable concen-tration.The detection of HBsAg by ELISA can meet the needs of clinical detection.

Objective:To investigate the related factors of cognitive impairment in middle-aged and old-aged patients with type 2 diabetes mellitus(T2DM).Methods:A total of 970 patients with T2DM(585 middle-aged group and 385 old-aged group)were selected from residents of a large community in Beijing from September to December 2018.The Mini-Mental State Examination(MMSE)was used to assess the cognitive func-tion.Multivariate logistic regression was used to analyze the related factors.Results:The detection rates of cognitive impairment were 12.0％and 13.5％in middle-aged and old-aged patients with T2DM,respectively.Among mid-dle-aged patients with T2DM,work(OR=0.22,95％CI:0.03-0.77)and education at the junior college or un-dergraduate level and above(OR=0.18,95％CI:0.04-0.55)were protective factors for cognitive impair-ment.Myocardial infarction(OR=4.13,95％CI:1.26-13.63)was a risk factor for cognitive impairment.Among old-aged patients with T2DM,drinking tea 1-2 times a week(OR=0.11,95％CI:0.01-0.58)and education at the junior college or undergraduate level and above(OR=0.19,95％CI:0.05-0.54)were protective factors for cognitive impairment.Stroke(OR=3.64,95％CI:1.55-8.39)and good sleep self-assessment(OR=2.75,95％CI:1.13-7.35)were risk factors for cognitive impairment.Conclusion:Cognitive impairment in middle-aged pa-tients with T2DM is related to work,education level and myocardial infarction,and cognitive impairment in old-aged patients with T2DM is related to lifestyle,education level and stroke.

Objective:To explore the predictive value of the difference in average CT attenuation values between renal pelvis urine and bladder urine on the risk of pyonephrosis, and to establish a nomogram model in combination with other parameters and to verify its predictive ability.Methods:The clinical data of patients with obstructive hydronephrosis who came to our hospital for emergency percutaneous nephrostomy (PCN) between January 2020 and December 2022 were retrospectively analyzed. There were 16 men and 33 women, with the age of (57.59, 14.67) years. Body mass index was (23.34, 3.11) kg/m 2. Urine nitrite was positive in 14 cases. Urine culture was positive in 21 cases. In the routine blood test, the median white blood cell count was 10.96 (7.21, 15.15) ×10 9/L, haemoglobin (115.08, 22.71) g/L and platelets (263.00, 97.20)×10 9/L. The difference in average CT attenuation values between renal pelvis urine and bladder urine (mean CT value of pyelonephritis-mean CT value of cysturia) was -2.19 (-7.04, 4.05) HU. Patients were divided into pyonephrosis group and hydronephrosis group according to whether the drainage fluid after PCN was pus. Single-factor and multi-factor logistic regression models were used to analyze the independent predictors of pyonephrosis and to construct nomograms. The discrimination of the model was assessed by the area under the curve (AUC) of the receiver operating characteristics (ROC), the accuracy by the calibration curve and the clinical efficacy by the decision curve analysis (DCA). Results:There were 49 cases in this study, 31 cases in the hydronephrosis group and 18 cases in the pyonephrosis group. The average CT attenuation values of renal pelvis urine were 3.35(0.56, 8.96) HU and 7.78 (3.75, 18.38) HU, respectively, and the difference between the two groups was statistically significant ( P=0.023). The average CT attenuation values of bladder urine were (7.81±6.15)HU and (7.22±7.50)HU, respectively, and there was no significant difference between the two groups ( P=0.780). The difference in average CT attenuation values between renal pelvis urine and bladder urine were -3.98(-7.54, 0.60)HU and 2.13 (-5.15, 9.36)HU, respectively, and the difference between the two groups was not statistically significant ( P=0.059); the white blood cells were 9.82(7.04, 12.46) ×10 9/L and 13.99(9.75, 18.44) ×10 9/L, respectively, and the difference between the two groups was statistically significant ( P=0.048). Platelet counts were (248.06±87.87)×10 9/L and (288.72±109.29)×10 9/L, respectively, and there was no statistical difference between the two groups ( P=0.189). The proportion of urine protein positive was higher in the pyonephrosis group (17 vs. 20, P=0.048). Between the two groups, sex, age, body mass index, clinical symptoms (with or without low back pain), surgical history of upper urinary tract stones, underlying diseases (including hypertension, diabetes, coronary heart disease, etc.), location of hydronephrosis (left, right, and both sides), reasons of obstruction [upper urinary tract stones, other factors (such as tumor, ureteral stricture, etc.)], haemoglobin, were not statistical different. There were no significant difference in blood glucose, blood potassium, blood sodium, urine leukocytes, urine erythrocytes, urine nitrite and urine culture ( P>0.05). Multivariate logistic regression analysis showed that the difference in average CT attenuation values between renal pelvis urine and bladder urine ( OR=1.196, 95% CI 1.055-1.437, P=0.018), white blood cells ( OR=1.252, 95% CI 1.036-1.615, P=0.038), and platelets ( OR=1.014, 95% CI 1.003-1.030, P=0.025) were independent predictors of pyonephrosis. According to the above indicators, the nomogram model was established and the AUC value of the model was 0.767 (95% CI 0.616-0.918), the sensitivity was 0.611 and the specificity was 0.935. The calibration curve showed that there is a good fit between the observed value and the predicted value. The DCA analysis showed that the nomogram model has a net gain in a wide threshold range, demonstrating its predictive accuracy and clinical practicality in predicting the risk of pyonephrosis. When the cut-off value of the difference between the average CT values of pyelonephritis and cystourethrosis was 6.54 HU, the AUC value of the independent prediction of pyonephrosis was 0.690(95% CI 0.564-0.816), the sensitivity was 0.444 and the specificity was 0.935. Conclusions:The difference in average CT attenuation values between renal pelvis urine and bladder urine is an independent risk factor for predicting pyonephrosis, and the nomogram constructed by combining it with white blood cells and platelets has a good predictive effect for predicting the risk of pyonephrosis. If the difference in average CT attenuation values between renal pelvis urine and bladder urine is greater than 6.54HU, it should be alert to the occurrence of pyonephrosis.

Objective:To investigate the related factors of cognitive impairment in middle-aged and old-aged patients with type 2 diabetes mellitus(T2DM).Methods:A total of 970 patients with T2DM(585 middle-aged group and 385 old-aged group)were selected from residents of a large community in Beijing from September to December 2018.The Mini-Mental State Examination(MMSE)was used to assess the cognitive func-tion.Multivariate logistic regression was used to analyze the related factors.Results:The detection rates of cognitive impairment were 12.0％and 13.5％in middle-aged and old-aged patients with T2DM,respectively.Among mid-dle-aged patients with T2DM,work(OR=0.22,95％CI:0.03-0.77)and education at the junior college or un-dergraduate level and above(OR=0.18,95％CI:0.04-0.55)were protective factors for cognitive impair-ment.Myocardial infarction(OR=4.13,95％CI:1.26-13.63)was a risk factor for cognitive impairment.Among old-aged patients with T2DM,drinking tea 1-2 times a week(OR=0.11,95％CI:0.01-0.58)and education at the junior college or undergraduate level and above(OR=0.19,95％CI:0.05-0.54)were protective factors for cognitive impairment.Stroke(OR=3.64,95％CI:1.55-8.39)and good sleep self-assessment(OR=2.75,95％CI:1.13-7.35)were risk factors for cognitive impairment.Conclusion:Cognitive impairment in middle-aged pa-tients with T2DM is related to work,education level and myocardial infarction,and cognitive impairment in old-aged patients with T2DM is related to lifestyle,education level and stroke.

Objective:To explore the predictive value of the difference in average CT attenuation values between renal pelvis urine and bladder urine on the risk of pyonephrosis, and to establish a nomogram model in combination with other parameters and to verify its predictive ability.Methods:The clinical data of patients with obstructive hydronephrosis who came to our hospital for emergency percutaneous nephrostomy (PCN) between January 2020 and December 2022 were retrospectively analyzed. There were 16 men and 33 women, with the age of (57.59, 14.67) years. Body mass index was (23.34, 3.11) kg/m 2. Urine nitrite was positive in 14 cases. Urine culture was positive in 21 cases. In the routine blood test, the median white blood cell count was 10.96 (7.21, 15.15) ×10 9/L, haemoglobin (115.08, 22.71) g/L and platelets (263.00, 97.20)×10 9/L. The difference in average CT attenuation values between renal pelvis urine and bladder urine (mean CT value of pyelonephritis-mean CT value of cysturia) was -2.19 (-7.04, 4.05) HU. Patients were divided into pyonephrosis group and hydronephrosis group according to whether the drainage fluid after PCN was pus. Single-factor and multi-factor logistic regression models were used to analyze the independent predictors of pyonephrosis and to construct nomograms. The discrimination of the model was assessed by the area under the curve (AUC) of the receiver operating characteristics (ROC), the accuracy by the calibration curve and the clinical efficacy by the decision curve analysis (DCA). Results:There were 49 cases in this study, 31 cases in the hydronephrosis group and 18 cases in the pyonephrosis group. The average CT attenuation values of renal pelvis urine were 3.35(0.56, 8.96) HU and 7.78 (3.75, 18.38) HU, respectively, and the difference between the two groups was statistically significant ( P=0.023). The average CT attenuation values of bladder urine were (7.81±6.15)HU and (7.22±7.50)HU, respectively, and there was no significant difference between the two groups ( P=0.780). The difference in average CT attenuation values between renal pelvis urine and bladder urine were -3.98(-7.54, 0.60)HU and 2.13 (-5.15, 9.36)HU, respectively, and the difference between the two groups was not statistically significant ( P=0.059); the white blood cells were 9.82(7.04, 12.46) ×10 9/L and 13.99(9.75, 18.44) ×10 9/L, respectively, and the difference between the two groups was statistically significant ( P=0.048). Platelet counts were (248.06±87.87)×10 9/L and (288.72±109.29)×10 9/L, respectively, and there was no statistical difference between the two groups ( P=0.189). The proportion of urine protein positive was higher in the pyonephrosis group (17 vs. 20, P=0.048). Between the two groups, sex, age, body mass index, clinical symptoms (with or without low back pain), surgical history of upper urinary tract stones, underlying diseases (including hypertension, diabetes, coronary heart disease, etc.), location of hydronephrosis (left, right, and both sides), reasons of obstruction [upper urinary tract stones, other factors (such as tumor, ureteral stricture, etc.)], haemoglobin, were not statistical different. There were no significant difference in blood glucose, blood potassium, blood sodium, urine leukocytes, urine erythrocytes, urine nitrite and urine culture ( P>0.05). Multivariate logistic regression analysis showed that the difference in average CT attenuation values between renal pelvis urine and bladder urine ( OR=1.196, 95% CI 1.055-1.437, P=0.018), white blood cells ( OR=1.252, 95% CI 1.036-1.615, P=0.038), and platelets ( OR=1.014, 95% CI 1.003-1.030, P=0.025) were independent predictors of pyonephrosis. According to the above indicators, the nomogram model was established and the AUC value of the model was 0.767 (95% CI 0.616-0.918), the sensitivity was 0.611 and the specificity was 0.935. The calibration curve showed that there is a good fit between the observed value and the predicted value. The DCA analysis showed that the nomogram model has a net gain in a wide threshold range, demonstrating its predictive accuracy and clinical practicality in predicting the risk of pyonephrosis. When the cut-off value of the difference between the average CT values of pyelonephritis and cystourethrosis was 6.54 HU, the AUC value of the independent prediction of pyonephrosis was 0.690(95% CI 0.564-0.816), the sensitivity was 0.444 and the specificity was 0.935. Conclusions:The difference in average CT attenuation values between renal pelvis urine and bladder urine is an independent risk factor for predicting pyonephrosis, and the nomogram constructed by combining it with white blood cells and platelets has a good predictive effect for predicting the risk of pyonephrosis. If the difference in average CT attenuation values between renal pelvis urine and bladder urine is greater than 6.54HU, it should be alert to the occurrence of pyonephrosis.

Gout is a metabolic disease closely associated with hyperuricemia and urate deposition. Because of the complex pathogenesis， high morbidity， multiple complications， and increasingly young patients， gout has received worldwide attention. Currently， western medicine mainly treats gout by lowering the uric acid level and reducing inflammation， which， however， causes serious adverse reactions and has contraindications. Phellodendri Chinensis Cortex （PCC） is the dried bark of Phellodendron chinense， with the effects of clearing heat， drying dampness， purging fire， detoxifying， and treating sores. Studies have shown that PCC and its active components have anti-inflammatory， pain-relieving， uric acid-lowering， and anti-gout activities， with extensive sources and high safety. PCC and its active components could prevent and treat gout through multi-targets and multi-pathways， whereas the systematic review remains to be carried out. Therefore， this paper summarized the pharmacological activities and mechanisms of PCC and its active components in the treatment of gout. The available studies have shown that PCC and its active components exert the anti-gout effect by lowering the uric acid level， reducing inflammation， alleviating oxidative stress， and regulationg intestinal flora， and protecting the kidneys. Particularly， the active components represented by alkaloids contribute obviously to the therapeutic effect of of PCC. Herein， we analyzed the problems and future development of the research on PCC， aiming to provide theoretical support and a scientific basis for the research and development of new drugs against gout.

Objective:To observe the correlation between the frontal P-wave axis and the severity of chronic obstructive pulmonary disease (COPD) and the prognosis evaluation system.Methods:Patients with COPD>45 years old who were followed up in the outpatient department of Hunan Chest Hospital from January to July 2022 were continuously selected as subjects. At the same time, the healthy people who examined in the health management center of our hospital were in the control group. Both groups of subjects completed electrocardiogram and pulmonary function tests. The level of frontal P-wave axis and the results of pulmonary function examination were recorded, and the differences of frontal P-wave axis between the COPD group and the control group were compared, so as to clarify the value of frontal P-wave axis in the diagnosis, disease severity and prognosis evaluation of COPD.Results:The level of forced expiratory volume in the first second/forced vital capacity(FEV1/FVC )in the COPD group was significantly lower than that in the control group, while the level of P-wave axis was significantly higher than that in the control group (all P<0.05). The receiver operating characteristic (ROC) curve of P-wave axis showed that the AUC of P-wave axis in predicting COPD was 0.96 ( P<0.001), the best cut-off value was 63.80, the sensitivity was 0.89, and the specificity was 0.93. There were significant difference in P-wave axis level, the forced expiratory volume in one second to forced vital capacity ratio (FEV 1%pred), body mass index (BMI) and BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index between groups according to the degree of airflow limitation (all P<0.05). Correlation analysis showed that P-wave axis level was positively correlated with BODE index ( r=0.77, P<0.001), and negatively correlated with pulmonary function FEV 1%pred ( r=-0.76, P<0.001). Conclusions:There is a good correlation between the level of frontal P-wave axis and the severity of COPD and the prognosis evaluation system, which has clinical application value.

The incidence of augmented renal clearance (ARC) in intensive care patients (ICU) is exceptionally high, and these patients are often co-morbid with infection. The occurrence of ARC will significantly increase the clearance rate of antibiotics, making it difficult for conventional doses to reach effective therapeutic concentrations and affect the patient's anti-infective treatment effect and prognosis. It can be seen that it is crucial to formulate a reasonable dosing regimen for ICU patients with ARC. Regrettably, few reports in China about the adjustment strategy of antibiotic dosing regimens for ARC patients. Therefore, this article reviews the domestic and foreign literature for reference to provide evidence for medical personnel to adjust the dose of antibacterial drugs for such patients.