AIM: To investigate the relationship between microvascular density in macular area and anti-vascular endothelial growth factor(VEGF)response in patients with diabetic macular edema(DME). METHODS: Retrospective case-control study. Clinical data of DME patients who received anti-VEGF treatment in the hospital from January 2021 to August 2025 were collected. All patients received intravitreal anti-VEGF treatment once a month for a total of 3 times. The patients were divided into the good response group and the poor response group based on the anti-VEGF treatment response. The vascular density of superficial capillary plexus(SCP)and deep capillary plexus(DCP)were compared between the two groups before treatment. Multivariate logistic regression models were used to analyze the factors affecting the anti-VEGF treatment response in DME patients. The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of SCP and DCP vascular density for anti-VEGF treatment response in DME patients. RESULTS: The study included a total of 315 DME patients 315 eyes, including 172 males and 143 females with the mean age of 62.06±7.38 y. After completing three treatments, there were 211 cases 211 eyes in the good response group, including 114 males and 97 females with the mean age of 61.92±7.52 y. There were 104 cases in the poor response group, including 58 males and 46 females with the mean age of 62.35±7.10 y. The course of diabetes in the poor response group was longer than that in the good response group, the central retinal thickness before treatment was greater than that in the good response group, the level of glycosylated hemoglobin(HbA1c)before treatment was higher than that in the good response group, and the proportion of patients with serous retinal detachment was higher than that in the good response group. Before treatment, the vascular density of SCP and DCP in the poor response group was lower than that in the good response group(all P<0.01). Multivariate Logistic regression analysis showed that SCP and DCP vascular density were both influencing factors of anti-VEGF treatment response in DME patients(both P<0.05). ROC curves showed that the area under the curve(AUC)of the pre-treatment SCP vascular density, pre-treatment DCP vascular density alone, and their combined model for predicting poor response to anti-VEGF therapy in DME patients were 0.812, 0.797 and 0.901, respectively, indicating high predictive value.CONCLUSION: The microvascular density in the macular area is closely related to the anti-VEGF treatment response in DME patients. The vascular density of SCP and DCP before treatment can be used as important indicators to predict treatment response, and targeted preventive and therapeutic interventions can be adopted in clinical practice.

To implement the Opinions of the State Council of the Central Committee of the Communist Party of China on Promoting the Inheritance and Innovative Development of Traditional Chinese Medicine， delve into the diseases specifically responding to traditional Chinese medicine （TCM）， and serve the building of advantageous specialties， clinical talent cultivation， national research layout， and academic innovation， the Chinese Association of Chinese Medicine sponsored the salons in multiple fields to discuss the diseases specifically responding to TCM. On August 26， 2023， the 25^th salon on the diseases specifically responding to TCM was held in Shanghai. In view of the advantages of TCM and integrated traditional Chinese and Western medicine in the diagnosis and treatment of psoriasis， Chinese and western medicine experts and interdisciplinary researchers carried out extensive and in-depth discussions and formed specific suggestions and consensus on the diagnosis and treatment of psoriasis with TCM and integrated traditional Chinese and Western medicine. However， there was still a lack of detailed research path. Under the guidance of the Chinese Association of Chinese Medicine， this paper analyzes the problems in the diagnosis and treatment of psoriasis from the occurrence and development of psoriasis. According to the advantages and characteristics of TCM and integrated traditional Chinese and Western medicine in the diagnosis and treatment of psoriasis， this paper puts forward the main points of research layout for psoriasis from the three aspects of psoriasis diagnosis and treatment， comorbidity prevention， and chronic disease management as follows： ① optimization of the syndrome differentiation system for psoriasis， ② optimization of assessment indicators for psoriasis， ③ recurrence mechanisms of psoriasis， ④ construction and research of TCM prevention and treatment of psoriasis recurrence， ⑤ construction of the comorbidity spectrum and TCM theoretical system of psoriasis， ⑥ comorbidity mechanisms of psoriasis. Furthermore， this article proposed the research layout and directions， expected goals and values， and funding priorities. Therefore， on the basis of the series of salons about psoriasis as a disease specifically responding to TCM， this article puts forward the research paradigm of psoriasis， aiming to facilitate the high-quality development of TCM and provide reference for the national research layout， the research and development of new TCM preparations， the selection of research topics， and the formulation of guidelines and consensus.

Psoriasis is a common chronic inflammatory systemic disease in dermatology. Its high prevalence， recurrence rate， and numerous comorbidities impose a significant physical and mental burden on patients. With the continuous advancement of modern medicine， the emergence of biological agents has improved clinical efficacy， making it possible to overcome psoriasis， in addition to classical treatments. However， in clinical practice， adverse reactions， drug resistance， recurrence rates， and immune drift cannot be ignored. Traditional Chinese medicine （TCM） has a history of thousands of years in treating psoriasis， demonstrating good efficacy， high safety， and a low recurrence rate， but a standardized management system is lacking. Therefore， the 25^th Clinical Diseases Responding Specially to TCM Treatment Series （Psoriasis） Youth Salon， hosted by the Chinese Association of Chinese Medicine and organized by the Youth Committee of the Chinese Association of Chinese Medicine， invited 29 experts and scholars from TCM， Western medicine， and interdisciplinary fields to actively discuss the "Advantages， Challenges， and Clinical Transformation of TCM and Western Medicine in the Diagnosis and Treatment of Psoriasis". The experts at the meeting concluded that the advantages of TCM in the treatment of psoriasis are as follows. Firstly， in the TCM-led treatment plan， TCM's understanding of psoriasis follows the principle of combining the differentiation of disease and syndrome. This approach distinguishes the basic contradiction from the current main contradiction and enables a clear grasp of the dynamic process of psoriasis development. Based on the system of syndrome differentiation and treatment， TCM intervention is applied to address the current main contradiction， and the optimal TCM treatment plan is formulated by combining internal and external treatments. Adhering to the principle of "what is visible outside must be addressed inside"， TCM can prevent and treat psoriasis comorbidities early by differentiating syndrome types. Secondly， in the integrated TCM and Western medicine treatment plan， the combination of both methods not only enhances efficacy but also reduces the adverse reactions of immunosuppressants and biological agents， lowering the recurrence rate. This conference provides a reference for the diagnosis and treatment of psoriasis using TCM and integrated TCM and Western medicine， opening up new ideas for clinical and basic research and guiding future research directions.

ObjectiveTo investigate the role and mechanism of podoplanin （PDPN） in hepatic stellate cell （HSC） activation and liver fibrosis. MethodsLiver biopsy samples were collected from 75 patients with chronic hepatitis B who attended Department of Infectious Diseases， Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine， for the first time from September 2019 to June 2022， and RT-PCR and immunohistochemistry were used to measure the expression of PDPN in liver tissue of patients in different stages of liver fibrosis. A total of 12 male C57/BL6 mice were randomly divided into control group and model group. The mice in the model group were given intraperitoneal injection of 10% CCl₄， and those in the control group were injected with an equal volume of olive oil， for 6 weeks. HE staining and Sirius Red staining were used to observe liver histopathological changes； primary mouse liver cells were separated to measure the mRNA expression of PDPN in various types of cells； primary mouse HSCs were treated with PDPN protein， followed by treatment with the NF-‍κB inhibitor BAY11-708， to measure the expression of inflammatory factors in HSCs induced by PDPN. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. The Spearman correlation analysis was used to investigate data correlation. ResultsAs for the liver biopsy samples， there was a relatively low mRNA expression level of PDPN in normal liver， and there was a significant increase in the mRNA expression level of PDPN in liver tissue of stage S3 or S4 fibrosis （all P<0.001）. Immunohistochemical staining showed that PDPN was mainly expressed in the fibrous septum and the hepatic sinusoid， and the PDPN-positive area in S4 liver tissue was significantly higher than that in S0 liver tissue （t=8.892， P=0.001）. In normal mice， PDPN was mainly expressed in the hepatic sinusoid， and there was a significant increase in the expression of PDPN in CCl₄ model mice （t=0.95， P<0.001）， mainly in the fibrous septum. RT-PCR showed a significant increase in the mRNA expression of PDPN in the CCl₄ model mice （t=11.25， P=0.002）. Compared with hepatocytes， HSCs， Kupffer cells， and bile duct endothelial cells， hepatic sinusoidal endothelial cells showed a significantly high expression level of PDPN （F=20.56， P<0.001）. Compared with the control group， the primary mouse HSCs treated by PDPN protein for 15 minutes showed significant increases in the mRNA expression levels of the inflammation-related factors TNFα， CCL3， CXCL1， and CXCR1 （all P<0.05）， and there were significant reductions in the levels of these indicators after treatment with BAY11-7082 （all P<0.05）. ConclusionThere is an increase in the expression of PDPN mainly in hepatic sinusoidal endothelial cells during liver fibrosis， and PDPN regulates HSC activation and promotes the progression of liver fibrosis via the NF-κB signaling pathway.

Objective:To investigated the prevalence of anxiety and depression symptoms in patients with colorectal polyps in part of Xinjiang area and to explore the associated influencing factors related to psychological status, and to provide evidence and clues to promote the diagnosis and treatment of psychosomatic diseases in digestive system.Methods:From December 2021 to June 2022, at the First Affiliated Hospital of Shihezi University, the Fourth Division Hospital of Xinjiang Production and Construction Corps, the Third Division Hospital of Xinjiang Production and Construction Corps (Kashgar Hospital), the Thirteenth Division Red Star Hospital of Xinjiang Production and Construction Corps, the Tenth Division Beitun Hospital of Xinjiang Production and Construction Corps, the Seventh Division Hospital of Xinjiang Production and Construction Corps, the Fifth Division Hospital of Xinjiang Production and Construction Corps, patients who underwent colonoscopy and colorectal polyps detected were enrolled. The generalized anxiety disorder scale-7 (GAD-7) was used to screen anxiety symptoms, and the patient health questionaire-8 (PHQ-8) was performed to screen depression symptoms, and the general situation questionnaire was used to collect clinical information of patients. The questionnairs were completed via the Questionnaire Star platform or paper questionnaire, and a database was established. The patients were divided into groups according to whether with anxiety and depression symptoms. Multivariable logistic regression models was performed to analyze the factors related to anxiety and depression.Results:A total of 516 questionnaires were distributed and collected, among which 9 questionnaires were incomplete and 507 questionnaires were valid, the effective rate of questionnaires was 98.26%. The detection rates of anxiety and depression symptoms in 507 patients with colorectal polyps were 21.50%(109/507) and 19.33%(98/507), respectively. The results of multivariable logistic analysis revealed that female ( OR=3.87, 95% confidence interval (95% CI) 2.30 to 6.51, P<0.001), maximum diameter of polyp ( OR=1.74, 95% CI 1.14 to 2.67, P=0.011), perception of polyps as cancer ( OR=13.96, 95% CI 1.48 to 132.07, P=0.022), and the occurrence of gastrointestinal symptoms after polyp detection ( OR=5.43, 95% CI 1.74 to 16.92, P=0.004) were independent risk factors of anxiety in patients with colorectal polyps. Female ( OR=2.42, 95% CI 1.47 to 4.00, P=0.001), the number of polyps ( OR=1.07, 95% CI 1.01 to 1.13, P=0.028) and the count of gastrointestinal symptoms ( OR=2.04, 95% CI 1.34 to 3.10, P=0.001) were independent risk factors of depression in patients with colorectal polyps. Conclusion:Gender, polyp size, number of polyps, disease perception, and concomitant gastrointestinal symptoms are associated with anxiety and depression in patients with colorectal polyps.

Objective:To determine the characteristics of cervical neuroblastoma and the effect of resection extent on survival and outcomes.Methods:We performed a retrospective review of 32 children with cervical neuroblastoma treated at Beijing Children′s Hospital between April 2013 and August 2020. Data were collected from the medical record. The individualized therapy was designed based on staging and risk group. Based on the extent of resection, patients were divided into incomplete and complete resection groups. Event free and overall survival rates were compared between two groups using the Kaplan-Meier method.Results:The ages of patients ranged from 1 month to 81 months, with a median age of 11 months, including 7 males and 15 females. Twenty-nine patients (90.6%) presented with cervical painless mass. The average diameter of the primary tumors was (5.12±1.43) cm. Tumors were located in the parapharyngeal space in 25 cases (78.1%) and in the root of the neck in 7 cases (21.9%). None had MYCN amplification. According to International Neuroblastoma Staging System (INSS), 15 patients (46.9%) were identified as stage 1, 11 patients (34.3%) as stage 2B, 3 patients (9.4%) as stage 3 and 3 patients (9.4%) as stage 4. There were 12 patients (37.5%) at low risk, 17 patients (53.1%) at intermediate risk and 3 patients at high risk according to Children′s Oncology Group (COG) risk classification system. All patients underwent tumor resection. Postoperatively Horner′s syndrome occurred in 13 patients (40.6%), pneumonia in 9 patients (28.1%), pharyngeal dysfunction in 8 patients (25.0%) and transient hoarseness in 4 patients (12.5%). At a median follow-up of 36.5 months, the overall survival rate was 96.4%, with no significant difference between incomplete and complete resection groups (100.0% vs. 96.3%, χ 2=0.19, P=0.667); the event free survival rate was 78.1%, with a significant difference between the two groups (40.0% vs. 85.2%, χ2=6.71, P=0.010). Conclusions:Primary cervical neuroblastoma has a young onset age, mostly in low and medium risk groups, and represents favorable lesions with good outcomes after multidisciplinary therapy. Less aggressive surgery with preservation of important structures is recommended. Complete resection should not be attempted if it would compromise vital structures.

Objective: To investigate the relationship between daily outdoor activity time both on and off campus and respiratory symptoms of junior middle school students, then to provide evidence for the prevention of respiratory diseases in adolescents. Methods: In 2016, two middle schools were selected in Wuhan，in which a total of 860 eighth grade students were surveyed, generalized linear analysis was conducted by SAS 9.4 software. Results: Average outdoor activity time out of campus during weekdays in boys and was (1.84±2.30) hours, which was higher than in girls (1.51±1.99) hours (t=2.19, P<0.05). Average outdoor activity time in campus in boys was (1.74±1.50) hours, which was significantly higher than that of girls (1.49±1.20) hours (t=2.68, P<0.05). According to the results of generalized linear analysis, after controlled for gender, age and self-perceived physical condition, the longer the time adolescents spent outside the classroom during weekday, the less likely they were to have symptoms of throat and nasal cavity(estimated value=-0.06,-0.07, P<0.05). Conclusion Adolescents who spend more time outside the classroom during weekday can effectively prevent the occurrence of respiratory related diseases.

Objective: To explore the status of anticipatory grief in major caregivers of patients with advanced cancer and its influencing factors. Methods: There were 329 major caregivers of patients with advanced cancer recruited between October 2017 and May 2018. The basic data questionnaire, Anticipatory Grief Scale and Perceived Social Support Scale were used in the investigation. Results: The scores of anticipatory grief and perceived social support were 88.49±16.47 and 60.33±11.58 respectively. The result of multiple linear regression revealed that relationship with patients, perceived social support, gender and religion were associated with anticipatory grief and could explain 54.2% of the total variance. Conclusions Medical workers should provide assistance to the major caregivers of patients with advanced cancer, respect and encourage the appropriate participation of religious activities, encourage caregivers to fully express their feelings, decrease their adverse emotional reactions and improve their bereavement outcome.

Objective: To investigate the indications and long-term outcomes of endoscopy-assisted removal of parotid gland calculi via a transoral approach. Methods: From August 2005 to December 2016, 158 consecutive patients with parotid gland calculi underwent endoscopy-assisted lithectomy transorally. They included 71 males and 87 females, with an age of 5-84 years. The immediate safety and effectiveness were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical manifestations, sialography, scintigraphy and sialometry. Postoperative sialograms were categorized into 2 types: ①type Ⅰ, the main duct was normal or had ectasia and stenosis, but no persistent contrast was seen on the functional film; ②type Ⅱ, the main duct had ectasia or stenosis, with persistent contrast media on the functional film. Results: Under one endoscopic procedure, the stones (or foreign bodies) were completely removed in 134 cases and almost completely removed in 10 cases, with a success rate of 91.1% (144/158). Of the 144 successful cases, the treatment options included direct basket retrieval or forceps grasping in 77 cases, basket entrapment with direct ostium incision in 36, basket capture with perio-ostium incision in 23 and perio-ostium incision in 8 cases with impacted stones. In two of the initial 14 failure cases, the stones were discharged spontaneously 3 months after operation. During 3-120 months′ follow-up (mean 36 months) of the 146 patients, one had recurrent stone, two developed ductal obturation, 16 had mild symptoms, and the remaining 127 cases were asymptomatic. Of the postoperative sialograms in 34 stone-free patients 25 were type Ⅰ, 9 were type Ⅱ. Both scintigraphy and saliva flow rate indicated an improvement of the affected gland function in some degree (P<0.05). Conclusions Transoral endoscopy-assisted removal of parotid gland calculi is a safe and effective technique. It is mainly indicated for mobile stones in the main duct or impacted stones in the anterior third of the Stensen′s duct. Sialography, scintigraphy and sialometry show postoperative improvement of gland function in most of the cases.

OBJECTIVES: To investigate the genetic causes of hearing loss with enlarged vestibular aqueduct (EVA) in two children from unrelated two Chinese families. METHODS: Sanger sequencing of all coding exons in SLC26A4 (encoding Pendrin protein) was performed on the two patients, their sibling and parents respectively. To predict and visualize the potential functional outcome of the novel variant, model building, structure analysis, and in silico analysis were further conducted. RESULTS: The results showed that the proband from family I harbored a compound heterozygote of SLC26A4 c.1174A>T (p.N392Y) mutation and c.1181delTCT (p.F394del) variant in exon 10, potentially altering Pendrin protein structure. In family II, the proband was identified in compound heterozygosity with a known mutation of c.919-2A>G in the splice site of intron 7 and a novel mutation of c.1023insC in exon 9, which results in a frameshift and translational termination, consequently leading to truncated Pendrin protein. Sequence homology analysis indicated that all the mutations localized at high conservation sites, which emphasized the significance of these mutations on Pendrin spatial organization and function. CONCLUSION: In summary, this study revealed two compound heterozygous mutations (c.1174A>T/c.1181delTCT; c.919- 2A>G/c.1023insC) in Pendrin protein, which might account for the deafness of the two probands clinically diagnosed with EVA. Thus this study contributes to improve understanding of the causes of hearing loss associated with EVA and develop a more scientific screening strategy for deafness.
Asian Continental Ancestry Group ; Child ; Clinical Coding ; Computer Simulation ; Deafness ; Exons ; Extravehicular Activity ; Frameshift Mutation ; Hearing Loss ; Heterozygote ; Humans ; Introns ; Mass Screening ; Parents ; Sequence Homology ; Siblings ; Vestibular Aqueduct