Traditional Chinese medicine(TCM)tongue diagnosis has obvious advantages,but its strong subjectivity,susceptibility to environmental influences,and lack of a unified standard greatly affect the objectivity and accuracy of diagnostic results,and it is difficult to integrate into the modern scientific system.Therefore,developing tongue diagnosis equipment to objectively and normatively extract tongue image information,and simulating human brain thinking to construct an objective diagnostic model of TCM tongue image-disease syndrome,and promoting the quantitative and intelligent research of TCM tongue diagnosis have become the trend of future development.This article reviews the research status and application prospects of TCM tongue diagnosis equipment,in order to provide methodological references and research ideas for the research and application of this field.

Objective:To develop a nomogram based on the monocyte-to-lymphocyte ratio (MLR) for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hematoma.Methods:This single-center retrospective cohort study screened consecutive patients with acute uncomplicated type B aortic intramural hematoma treated at the Emergency and Cardiovascular Medicine Departments of the General Hospital of the Northern Theater Command from April 2018 to April 2024. Patients were divided into two groups based on the optimal MLR cut-off value for predicting aortic-related adverse events: low MLR and high MLR group. MLR was defined as the ratio of monocytes to lymphocytes. Aortic-related adverse events were defined as a composite of aortic-related death or aortic intramural hematoma progression (including aortic dissection and penetrating aortic ulcers) within 30 days. The receiver operating characteristic (ROC) curve identified the optimal MLR cut-off value. Multivariate logistic regression was used to identify independent predictors of aortic-related adverse events within 30 days, based on which nomogram models were constructed: the clinical characteristics model and the clinical characteristics-MLR model. The DeLong test was used to evaluate the diagnostic performance of different risk models. The additional predictive value of MLR was assessed using the net reclassification index (NRI) and integrated discrimination improvement (IDI).Results:A total of 332 patients were included, of whom 217 were male (65.4%), with an average age of (64.3±9.4) years. A total of 107 aortic-related adverse events occurred during the 30-day follow-up period. The optimal cut-off value for MLR was 0.529. There were 189 cases in the low MLR group (MLR<0.529) and 143 cases in the high MLR group (MLR≥0.529). The rate of aortic-related adverse events was higher in the high MLR group compared to the low MLR group (44.1% (63/143) vs. 23.3% (44/189), P<0.001), mainly due to a higher rate of progression to aortic dissection (9.8% (14/143) vs. 1.1% (2/189), P<0.001) and penetrating aortic ulcers (31.5% (45/143) vs. 20.6% (39/189), P=0.025). Multivariate analysis identified diabetes ( OR=0.25, 95% CI 0.08-0.78, P=0.017), anemia ( OR=3.45, 95% CI 1.28-9.27, P=0.014), maximum descending aorta diameter ( OR=1.08, 95% CI 1.02-1.15, P=0.007), ulcer-like projections ( OR=4.04, 95% CI 2.26-7.24, P<0.001), and MLR ( OR=6.61, 95% CI 2.50-17.46, P<0.001) as independent predictors of aortic-related adverse events during the 30-day follow-up period. The clinical characteristics model includes diabetes, anemia, ulcer-like projections and maximum diameter of the descending aorta, and the clinical characteristics-MLR model includes the above clinical characteristics and MLR. The results of the DeLong test showed that the clinical characteristic-MLR model demonstrated a higher area under the ROC curve compared to the clinical characteristic model alone (0.784 (95% CI 0.736-0.841) vs. 0.742 (95% CI 0.691-0.788), P=0.031). The continuous NRI was 0.461 (95% CI 0.237-0.685, P<0.001) and the IDI was 0.077 (95% CI 0.043-0.112, P<0.001), indicating that the inclusion of the MLR in the model significantly improved the predictive accuracy. Conclusion:The integration of MLR with other clinical characteristics improves the early identification of high-risk patients with acute uncomplicated type B aortic intramural hematoma, optimizing clinical decisions and improving patient outcomes.

Objective To analyze the expression and diagnostic value of procalcitonin(PCT),white blood cell count(WBC),and C-reactive protein(CRP)in respiratory infections in the intensive care unit(ICU),and their correlation with the clinical pulmonary infection score(CPIS).Methods A total of 105 patients with respiratory infections admitted to the ICU from March 2019 to June 2024 were selected as the observation group,while 117 patients with no respiratory infection in the ICU were selected as the control group.PCT levels in both groups were measured using the Zybio-Q7 immunoquantitative analyzer,WBC levels were measured using XT-4000i white blood cell analyzer,and CRP levels were measured using the immunoturbidimetric method.The relationship between the expression of PCT,WBC and CRP and the clinical characteristics and CPIs score of respiratory infection in ICU were analyzed.Results The proportion of patients in the observation group with ICU stay>15 days and mechanical ventilation>7 days was significantly higher than that in the control group(P<0.05).Compared to the control group,the levels of PCT,WBC,CRP and CPIS score in the observation group were elevated,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that ICU stay>15 days(OR=4.087),PCT(OR=6.543),WBC(OR=2.652),and CRP(OR=8.964)were risk factors for the occurrence of respiratory infections in the ICU.Pearson correlation analysis indicated a positive correlation between PCT and CPIS scores(r=0.925,P=0.001),a positive correlation between WBC and CPIS scores(r=0.739,P=0.001);and a positive correlation between CRP and CPIS scores(r=0.948,P=0.001).The ROC curve demonstrated that the combined diagnostic value of the three markers for ICU respiratory infections was higher than that of PCT,WBC,or CRP alone(P=0.002).Conclusion The combination of PCT,WBC,and CRP has high diagnostic value for ICU respiratory infections and is positively correlated with CPIs scores.Therefore,the above indicators can provide a reliable basis for the early diagnosis of respiratory infection in ICU.

Aim To investigate the clinical characteristics and related factors of post-implantation syndrome(PIS)following the prophylactic application of non-steroidal anti-inflammatory drugs(NSAID)after thoracic endovascular aortic repair(TEVAR).Methods A total of 510 adult patients who had received prophylactic NSAID after TEVAR at General Hospital of Northern Theater Command from September 2013 to April 2024 were consecutively included in the study.The patients were divided into two groups based on the occurrence of PIS postoperatively:the PIS group(34 pa-tients,6.67％)and the non-PIS group(476 patients,93.33％).General information,past medical history and surgical features were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to i-dentify predictors of PIS.The ROC curve was used to assess the overall diagnostic performance of the risk factors.Results The baseline data and clinical characteristics of PIS group and non-PIS group were compared.The rate of gen-der as male,chest and back pain on adimission,limb ischaemia on admission,systolic blood pressure on admission,use of angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)drugs during hospitalization,preop-erative white blood cell(WBC)count and surgical approach involving an incision in PIS group were higher than those in non-PIS group,and the age,preoperative estimated glomerular filtration rate(eGFR)level and use of statin drugs during hospitalization were lower than those in non-PIS group,all differences were statistically significant.Postoperative C-reac-tive protein level,incidence of clinical adverse events during postoperative hospitalization,and time of postoperative hospi-talization were increased in PIS group compared with those in non-PIS group.There was no significant difference in the incidence of aortic adverse events between the two groups(P＜0.05).Univariate and multivariate Logistic regression a-nalysis identified patients' age＜60 years(OR=4.671,95％CI:1.348～16.188,P=0.015),increased preoperative WBC count(OR=3.582,95％CI:1.469～8.735,P=0.005),and surgical approach involving an incision(OR=8.339,95％CI:1.849～37.610,P=0.006)as independent predictors for PIS.The results of the ROC curve analysis showed that the area under the curve of patients' age＜60 years,increased preoperative WBC count,femoral arteriotomy ac-cess,and the three combined diagnoses in predicting the occurrence of PIS after TEVAR were 0.653(95％CI:0.573～0.733),0.686(95％CI:0.600～0.771),0.699(95％CI:0.627～0.770),0.826(95％CI:0.765～0.887).Conclusion Despite the prophylactic use of NSAID,some patients develop PIS after TEVAR.Patients' age＜60 years,elevated preoperative WBC count,and femoral artery incision approach are independent risk factors for PIS after preventive medication.Additionally,the incidence of PIS increased with the number of independent risk factors present.

With advancements in in vitro culture techniques, the morula has emerged as a promising candidate for selective embryo transfer due to its critical compaction phase. The compaction process involves not only structural reorganization but also complex intercellular signaling mechanisms that significantly influence embryonic developmental potential and cellular fate determination. Clinical data reveal comparable live birth rates between day 4 morula transfers and day 5 blastocyst transfers, coupled with reduced in vitro culture duration. However, challenges persist regarding standardized evaluation criteria and long-term safety confirmation. Current morphological assessment methods exhibit inherent subjectivity, while emerging technologies integrating genetic screening, metabolic analysis, and time-lapse imaging show potential for enhanced selection accuracy. Personalized synchronization assessments, including endometrial receptivity analysis, may further optimize transfer protocols. This study focuses on day 4 embryo transfer, systematically reviewing its embryonic development processes, evaluation protocols, comparative outcomes of transferred embryos, and research advances in frozen-thawed embryo transfer. The study aims to deepen scientific understanding of day 4 embryo transfer and promote its adoption as a critical option in personalized reproductive medicine, thereby enhancing clinical success rates and safety.

Objective:To establish a day 4 embryo evaluation protocol by analyzing embryonic characteristics affecting blastocyst formation, and validate its clinical effectiveness.Methods:This retrospective cohort study included clinical data from 1 037 patients who underwent fresh in vitro fertilization and embryo transfer (IVF-ET) on day 4 in Center for Reproductive Medicine of Xingtai Meihe Reproductive and Genetic Hospital between January 2018 and April 2024. Morphological assessments were performed at (92±2) h post-fertilization. After excluding 1 326 embryos selected for fresh transfer, 2 723 embryos underwent blastocyst culture. To address selection bias in transferred embryos, the scoring system was primarily based on high-quality blastocyst formation rates. Multivariate binary regression analysis evaluated how day 4 developmental stage, fragmentation rate, stage-specific cleavage patterns, multinucleation/vacuolization affected transferable blastocyst formation rate and high-quality blastocyst rate. Regression coefficients determined parameter weights for high-quality blastocyst formation, establishing a day 4 embryo scoring protocol that compared outcomes across different grades. The scoring system was validated by comparing transferable blastocyst formation rate, high-quality blastocyst rate, and implantation rate among different day 4 embryo grades. All embryos were further rescored according to three previously reported evaluation schemes [Feil 2008, Gemma 2015, and European Society of Human Reproduction and Embryology (ESHRE) 2011]. The predictive values of these three day 4 scoring systems and the day 4 scoring system established in this study were compared using the area under the curve (AUC) receiver operating characteristic (ROC) curve in predicting the formation rate of transferable blastocyst, the formation rate of high-quality blastocyst, and implantation rate. Results:In the prediction of high-quality blastocyst formation, early blastocyst showed the highest influence weight compared to embryos with the ratio of blastomere numbers on day 4 to those on day 3 (BNR) <1.2 ( B=3.398, OR=29.915, P<0.001), followed by fragmentation <10% versus ≥50% ( B=1.263, OR=3.535, P<0.001), a stage-specific cleavage pattern ( B=0.903, OR=2.467, P=0.005), and absence of multinucleation or vacuoles ( B=0.797, OR=2.218, P=0.007). Using the newly developed day 4 scoring system, embryos were graded A, B, C, D, E. Transferable blastocyst formation rates were 88.57% (279/315), 76.99% (241/313), 56.11% (280/499), 40.27% (238/591) and 14.22% (143/1 005), respectively; high-quality blastocyst rates were 51.42% (162/315), 35.46% (111/313), 20.04% (100/499), 9.47% (56/591) and 3.98% (40/1 005). All inter-group differences were statistically significant (all P<0.005). Implantation rates for transferred embryos of grades A-E declined sequentially: 63.18% (381/603), 56.19% (322/573), 38.29% (54/141), 26.53% (13/49) and 9.67% (3/31). The day 4 embryo scoring system proposed in this study demonstrated significantly higher predictive efficacy for transferable blastocyst formation rate (AUC=0.812), high-quality blastocyst formation rate (AUC=0.804), and implantation rate (AUC=0.603) compared with Feil 2008 (AUC=0.797, P<0.001; AUC=0.781, P<0.001; AUC=0.585, P<0.001), Gemma 2015 (AUC=0.773, P<0.001; AUC=0.771, P<0.001; AUC=0.542, P=0.006), and ESHRE 2011 (AUC=0.710, P<0.001; AUC=0.745, P<0.001; AUC=0.592, P<0.001). We also observed the presence of pseudo-compacted embryo, whose transferable blastocyst formation rate [38.28% (49/128)] and high-quality blastocyst formation rate [7.03% (9/128)] were similar to those of cleavage-stage embryos with a BNR≥1.2. Conclusion:The established day 4 morphological assessment system reliably predicts the potential to transferable blastocyst and high-quality blastocyst, and effectively forecasts implantation rates.

With advancements in in vitro culture techniques, the morula has emerged as a promising candidate for selective embryo transfer due to its critical compaction phase. The compaction process involves not only structural reorganization but also complex intercellular signaling mechanisms that significantly influence embryonic developmental potential and cellular fate determination. Clinical data reveal comparable live birth rates between day 4 morula transfers and day 5 blastocyst transfers, coupled with reduced in vitro culture duration. However, challenges persist regarding standardized evaluation criteria and long-term safety confirmation. Current morphological assessment methods exhibit inherent subjectivity, while emerging technologies integrating genetic screening, metabolic analysis, and time-lapse imaging show potential for enhanced selection accuracy. Personalized synchronization assessments, including endometrial receptivity analysis, may further optimize transfer protocols. This study focuses on day 4 embryo transfer, systematically reviewing its embryonic development processes, evaluation protocols, comparative outcomes of transferred embryos, and research advances in frozen-thawed embryo transfer. The study aims to deepen scientific understanding of day 4 embryo transfer and promote its adoption as a critical option in personalized reproductive medicine, thereby enhancing clinical success rates and safety.

Objective:To establish a day 4 embryo evaluation protocol by analyzing embryonic characteristics affecting blastocyst formation, and validate its clinical effectiveness.Methods:This retrospective cohort study included clinical data from 1 037 patients who underwent fresh in vitro fertilization and embryo transfer (IVF-ET) on day 4 in Center for Reproductive Medicine of Xingtai Meihe Reproductive and Genetic Hospital between January 2018 and April 2024. Morphological assessments were performed at (92±2) h post-fertilization. After excluding 1 326 embryos selected for fresh transfer, 2 723 embryos underwent blastocyst culture. To address selection bias in transferred embryos, the scoring system was primarily based on high-quality blastocyst formation rates. Multivariate binary regression analysis evaluated how day 4 developmental stage, fragmentation rate, stage-specific cleavage patterns, multinucleation/vacuolization affected transferable blastocyst formation rate and high-quality blastocyst rate. Regression coefficients determined parameter weights for high-quality blastocyst formation, establishing a day 4 embryo scoring protocol that compared outcomes across different grades. The scoring system was validated by comparing transferable blastocyst formation rate, high-quality blastocyst rate, and implantation rate among different day 4 embryo grades. All embryos were further rescored according to three previously reported evaluation schemes [Feil 2008, Gemma 2015, and European Society of Human Reproduction and Embryology (ESHRE) 2011]. The predictive values of these three day 4 scoring systems and the day 4 scoring system established in this study were compared using the area under the curve (AUC) receiver operating characteristic (ROC) curve in predicting the formation rate of transferable blastocyst, the formation rate of high-quality blastocyst, and implantation rate. Results:In the prediction of high-quality blastocyst formation, early blastocyst showed the highest influence weight compared to embryos with the ratio of blastomere numbers on day 4 to those on day 3 (BNR) <1.2 ( B=3.398, OR=29.915, P<0.001), followed by fragmentation <10% versus ≥50% ( B=1.263, OR=3.535, P<0.001), a stage-specific cleavage pattern ( B=0.903, OR=2.467, P=0.005), and absence of multinucleation or vacuoles ( B=0.797, OR=2.218, P=0.007). Using the newly developed day 4 scoring system, embryos were graded A, B, C, D, E. Transferable blastocyst formation rates were 88.57% (279/315), 76.99% (241/313), 56.11% (280/499), 40.27% (238/591) and 14.22% (143/1 005), respectively; high-quality blastocyst rates were 51.42% (162/315), 35.46% (111/313), 20.04% (100/499), 9.47% (56/591) and 3.98% (40/1 005). All inter-group differences were statistically significant (all P<0.005). Implantation rates for transferred embryos of grades A-E declined sequentially: 63.18% (381/603), 56.19% (322/573), 38.29% (54/141), 26.53% (13/49) and 9.67% (3/31). The day 4 embryo scoring system proposed in this study demonstrated significantly higher predictive efficacy for transferable blastocyst formation rate (AUC=0.812), high-quality blastocyst formation rate (AUC=0.804), and implantation rate (AUC=0.603) compared with Feil 2008 (AUC=0.797, P<0.001; AUC=0.781, P<0.001; AUC=0.585, P<0.001), Gemma 2015 (AUC=0.773, P<0.001; AUC=0.771, P<0.001; AUC=0.542, P=0.006), and ESHRE 2011 (AUC=0.710, P<0.001; AUC=0.745, P<0.001; AUC=0.592, P<0.001). We also observed the presence of pseudo-compacted embryo, whose transferable blastocyst formation rate [38.28% (49/128)] and high-quality blastocyst formation rate [7.03% (9/128)] were similar to those of cleavage-stage embryos with a BNR≥1.2. Conclusion:The established day 4 morphological assessment system reliably predicts the potential to transferable blastocyst and high-quality blastocyst, and effectively forecasts implantation rates.

Aim To investigate the clinical characteristics and related factors of post-implantation syndrome(PIS)following the prophylactic application of non-steroidal anti-inflammatory drugs(NSAID)after thoracic endovascular aortic repair(TEVAR).Methods A total of 510 adult patients who had received prophylactic NSAID after TEVAR at General Hospital of Northern Theater Command from September 2013 to April 2024 were consecutively included in the study.The patients were divided into two groups based on the occurrence of PIS postoperatively:the PIS group(34 pa-tients,6.67％)and the non-PIS group(476 patients,93.33％).General information,past medical history and surgical features were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to i-dentify predictors of PIS.The ROC curve was used to assess the overall diagnostic performance of the risk factors.Results The baseline data and clinical characteristics of PIS group and non-PIS group were compared.The rate of gen-der as male,chest and back pain on adimission,limb ischaemia on admission,systolic blood pressure on admission,use of angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)drugs during hospitalization,preop-erative white blood cell(WBC)count and surgical approach involving an incision in PIS group were higher than those in non-PIS group,and the age,preoperative estimated glomerular filtration rate(eGFR)level and use of statin drugs during hospitalization were lower than those in non-PIS group,all differences were statistically significant.Postoperative C-reac-tive protein level,incidence of clinical adverse events during postoperative hospitalization,and time of postoperative hospi-talization were increased in PIS group compared with those in non-PIS group.There was no significant difference in the incidence of aortic adverse events between the two groups(P＜0.05).Univariate and multivariate Logistic regression a-nalysis identified patients' age＜60 years(OR=4.671,95％CI:1.348～16.188,P=0.015),increased preoperative WBC count(OR=3.582,95％CI:1.469～8.735,P=0.005),and surgical approach involving an incision(OR=8.339,95％CI:1.849～37.610,P=0.006)as independent predictors for PIS.The results of the ROC curve analysis showed that the area under the curve of patients' age＜60 years,increased preoperative WBC count,femoral arteriotomy ac-cess,and the three combined diagnoses in predicting the occurrence of PIS after TEVAR were 0.653(95％CI:0.573～0.733),0.686(95％CI:0.600～0.771),0.699(95％CI:0.627～0.770),0.826(95％CI:0.765～0.887).Conclusion Despite the prophylactic use of NSAID,some patients develop PIS after TEVAR.Patients' age＜60 years,elevated preoperative WBC count,and femoral artery incision approach are independent risk factors for PIS after preventive medication.Additionally,the incidence of PIS increased with the number of independent risk factors present.

Traditional Chinese medicine(TCM)tongue diagnosis has obvious advantages,but its strong subjectivity,susceptibility to environmental influences,and lack of a unified standard greatly affect the objectivity and accuracy of diagnostic results,and it is difficult to integrate into the modern scientific system.Therefore,developing tongue diagnosis equipment to objectively and normatively extract tongue image information,and simulating human brain thinking to construct an objective diagnostic model of TCM tongue image-disease syndrome,and promoting the quantitative and intelligent research of TCM tongue diagnosis have become the trend of future development.This article reviews the research status and application prospects of TCM tongue diagnosis equipment,in order to provide methodological references and research ideas for the research and application of this field.