This paper summarizes Professor SUN Yuanzheng's academic thought and clinical experience in treating diabetic retinopathy (DR) with yuan-primary and luo-connecting meridian-regulating acupuncture. Professor SUN considers that the fundamental cause of DR lies in visceral dysfunction, with stagnation in the ocular collateral vessels and impairment of the mysterious orifices being the core pathogenesis. He proposes the treatment model of "regulating viscera, unblocking ocular collaterals, and opening mysterious orifices" based on yuan-primary and luo-connecting meridian-regulating acupuncture. Yuan-primary and luo-connecting points are used to balance qi, blood, yin, and yang of the viscera. Baihui (GV20) is stimulated with transcranial repetitive acupuncture to activate the yang qi of the governor vessel and invigorate qi in the twelve meridians, improving systemic microcirculation. Combining this with stimulation of ocular areas, Fengchi (GB20), and periocular points, the stasis in the ocular collaterals are cleared and the mysterious orifices are unblocked, addressing both the root and manifestations of DR.
Humans ; Diabetic Retinopathy/physiopathology* ; Acupuncture Therapy/history* ; Meridians ; Acupuncture Points ; Qi

The therapeutic efficacy and possible mechanism of action of superficial needling therapy for knee osteoarthritis(KOA)are reviewed by analyzing relevant medical literature.Superficial needling therapy exerts certain efficacy in treating KOA,and the clinical efficacy could be further improved by combining it with conventional acupuncture,as well as Chinese medicine and other acupuncture methods alone.The therapy of stimulation of meridian qi and invigoration of yang qiare in line with the pathogenesis of KOA.Superficial needling therapy exerts certain effect on KOA by enhancing acupuncture stimulation,enlarging the treatment area,and releasing muscle and fascia.

Objective:To analyze the changing trend of cervical cancer epidemiological characteristics and disease burden in cancer registration areas of Guangxi Zhuang Autonomous Region (Guangxi) from 2010 to 2017, and to provide scientific basis for the development of cervical cancer prevention and control strategies in Guangxi.Methods:Using descriptive analysis method, based on the incidence and death data of cervical cancer in the tumor registration areas of Guangxi from 2010 to 2017, Crude morbidity, crude mortality, age-standardized morbidity and mortality (referred to as the winning rate), disability adjusted life years (DALYs) rate and the annual percentage change (APC) and average annual percentage change (AAPC) of the above indicators were calculated, and stratified analysis was conducted for urban and rural areas and different age groups.Results:From 2010 to 2017, the crude incidence rate of cervical cancer in Guangxi showed a significant upward trend, rising from 10.31/10 5 in 2010 to 19.94/10 5 in 2017, with an average annual growth rate of 7.9% ( P＜0.05). However, after age standardization, the trend of the age-standardized incidence rate of cervical cancer was not statistically significant ( P＞0.05). During the same period, the crude mortality rate of cervical cancer increased from 2.69/10 5 to 6.21/10 5, with an average annual growth rate of 13.1% ( P＜0.05), and the trend of the age-standardized mortality rate was basically consistent with that of the crude mortality rate. The analysis of urban-rural differences showed that the growth rates of the crude incidence rate and crude mortality rate of cervical cancer in rural areas were higher than those in urban areas from 2010 to 2017 (AAPC incidence rate: 21.3% vs. 2.3%; AAPC mortality rate: 20.1% vs. 8.4%). The analysis of age differences showed that the crude incidence rate and crude mortality rate of cervical cancer in all age groups increased to varying degrees, among which the growth rate of the incidence rate (AAPC=16.2%, P＜0.05) and mortality rate (AAPC=14.7%, P＜0.05) of cervical cancer in women aged 65 and above was the fastest. In addition, the DALYs rate of cervical cancer in Guangxi increased from 50.6/10 5 in 2010 to 111.0/10 5 in 2017, with an average annual increase of 11.9% ( P＜0.05). The growth rate of the DALYs rate in rural areas was higher than that in urban areas, and the growth rate of the DALYs rate in the 50-59 age group was higher than those in other age groups. Conclusions:From 2010 to 2017, the incidence rate, mortality rate and DALYs rate of cervical cancer in Guangxi showed an upward trend. Comprehensive prevention and control measures for cervical cancer, such as improving the early diagnosis and treatment system, promoting the popularization of HPV vaccination and strengthening health education, should be taken to reduce the disease burden of cervical cancer.

Objective Under the operation background of Diagnosis-Intervention Packet(DIP),whether there is interaction between reducing medical cost and average length of stay combined with pre-hospitalization mode,and whether there is difference between different departments and diseases in interaction.Methods Based on real-world data from 71 453 patients admitted to Guizhou Provincial People's Hospital from July to December 2021,a two-way analysis of variance was employed.When the interaction effect was statistically significant,parameter estimation was used to determine the magnitude and direction of the interaction effect,followed by subgroup analyses by department and disease.Results Without adjustment,both total medical costs and average length of stay exhibited a negative interaction effect(P＜0.05).Subgroup analyses revealed that in terms of total medical costs,the effect size for the surgical system was 0.18％,lower than that for the internal medicine system(0.70％);for core diseases,it was 6.62％,lower than that for comprehensive diseases(7.71％).Regarding average length of stay,the effect size for the surgical system was 0.55％,better than that for the internal medicine system(0.22％);for core diseases,it was 8.70％,higher than that for comprehensive diseases(2.90％).Conclusion The combination of DIP payment reform and pre-admission management model demonstrates a synergistic effect,effectively reducing patients' medical costs and length of stay.This effect is influenced by disease complexity and the standardization of diagnostic and treatment processes.

Objective Under the operation background of Diagnosis-Intervention Packet(DIP),whether there is interaction between reducing medical cost and average length of stay combined with pre-hospitalization mode,and whether there is difference between different departments and diseases in interaction.Methods Based on real-world data from 71 453 patients admitted to Guizhou Provincial People's Hospital from July to December 2021,a two-way analysis of variance was employed.When the interaction effect was statistically significant,parameter estimation was used to determine the magnitude and direction of the interaction effect,followed by subgroup analyses by department and disease.Results Without adjustment,both total medical costs and average length of stay exhibited a negative interaction effect(P＜0.05).Subgroup analyses revealed that in terms of total medical costs,the effect size for the surgical system was 0.18％,lower than that for the internal medicine system(0.70％);for core diseases,it was 6.62％,lower than that for comprehensive diseases(7.71％).Regarding average length of stay,the effect size for the surgical system was 0.55％,better than that for the internal medicine system(0.22％);for core diseases,it was 8.70％,higher than that for comprehensive diseases(2.90％).Conclusion The combination of DIP payment reform and pre-admission management model demonstrates a synergistic effect,effectively reducing patients' medical costs and length of stay.This effect is influenced by disease complexity and the standardization of diagnostic and treatment processes.

Objective:To analyze the changing trend of cervical cancer epidemiological characteristics and disease burden in cancer registration areas of Guangxi Zhuang Autonomous Region (Guangxi) from 2010 to 2017, and to provide scientific basis for the development of cervical cancer prevention and control strategies in Guangxi.Methods:Using descriptive analysis method, based on the incidence and death data of cervical cancer in the tumor registration areas of Guangxi from 2010 to 2017, Crude morbidity, crude mortality, age-standardized morbidity and mortality (referred to as the winning rate), disability adjusted life years (DALYs) rate and the annual percentage change (APC) and average annual percentage change (AAPC) of the above indicators were calculated, and stratified analysis was conducted for urban and rural areas and different age groups.Results:From 2010 to 2017, the crude incidence rate of cervical cancer in Guangxi showed a significant upward trend, rising from 10.31/10 5 in 2010 to 19.94/10 5 in 2017, with an average annual growth rate of 7.9% ( P＜0.05). However, after age standardization, the trend of the age-standardized incidence rate of cervical cancer was not statistically significant ( P＞0.05). During the same period, the crude mortality rate of cervical cancer increased from 2.69/10 5 to 6.21/10 5, with an average annual growth rate of 13.1% ( P＜0.05), and the trend of the age-standardized mortality rate was basically consistent with that of the crude mortality rate. The analysis of urban-rural differences showed that the growth rates of the crude incidence rate and crude mortality rate of cervical cancer in rural areas were higher than those in urban areas from 2010 to 2017 (AAPC incidence rate: 21.3% vs. 2.3%; AAPC mortality rate: 20.1% vs. 8.4%). The analysis of age differences showed that the crude incidence rate and crude mortality rate of cervical cancer in all age groups increased to varying degrees, among which the growth rate of the incidence rate (AAPC=16.2%, P＜0.05) and mortality rate (AAPC=14.7%, P＜0.05) of cervical cancer in women aged 65 and above was the fastest. In addition, the DALYs rate of cervical cancer in Guangxi increased from 50.6/10 5 in 2010 to 111.0/10 5 in 2017, with an average annual increase of 11.9% ( P＜0.05). The growth rate of the DALYs rate in rural areas was higher than that in urban areas, and the growth rate of the DALYs rate in the 50-59 age group was higher than those in other age groups. Conclusions:From 2010 to 2017, the incidence rate, mortality rate and DALYs rate of cervical cancer in Guangxi showed an upward trend. Comprehensive prevention and control measures for cervical cancer, such as improving the early diagnosis and treatment system, promoting the popularization of HPV vaccination and strengthening health education, should be taken to reduce the disease burden of cervical cancer.

Objectives:To evaluate the valvular and cardiac function,cardiac reverse remodeling at 6-month after transcatheter edge-to-edge repair(TEER)for patients with functional and degenerative mitral valve regurgitation,and summarize the experience of echocardiography application. Methods:The clinical data of 93 patients with moderate to severe mitral regurgitation(MR)treated with TEER and completed 6-month follow-up in Yunnan Fuwai Cardiovascular Hospital from July 2022 to February 2023 were retrospectively analyzed.Patients were divided into functional mitral regurgitation(FMR)and degenerative mitral regurgitation(DMR)groups according to MR etiology.The valve characteristic parameters,as well as valvular function,chamber volume and cardiac functional parameters before and at 6 months after operation were compared.The key points of echocardiography application were summarized. Results:Among all patients,71 were FMR and 22 were DMR.There were differences in valve structure between the two groups.Mitral TEER were successfully accomplished and all patients completed 6-month follow-up.The key points of echocardiography application included:valve structure analysis,atrial septal puncture location,device delivery process monitoring and image optimization during clamping process.The mitral regurgitation grade and NYHA grade were significantly improved in all patients at 6 months after TEER(P<0.05),and the mean mitral valve pressure gradient was higher than that before operation(P<0.05).Left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left atrial volume index in FMR group were significantly decreased(P<0.05),while left ventricular and left atrial volume in DMR group remained unchanged(P>0.05).There were no significant changes in left ventricular ejection fraction and left ventricular global strain in both groups during the observation period(P>0.05).The changes of LVEDV and LVESV before and after operation were more significant in FMR group than those in DMR group(P<0.05). Conclusions:Mitral TEER can reduce the degree of regurgitation and improve cardiac function in the early postoperative period for moderate and severe MR patients with different etiologies.There are differences in preoperative valve structure and postoperative cardiac reverse remodeling between FMR and DMR patients.Echocardiography is an important imaging technique for the evaluation and monitoring process before,during and post mitral TEER.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objectives: . Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system. Methods: . We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables. Results: . The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16–2.57); were older (MD, 5.47 years, 95% CI, 2.44–8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33–2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56–3.44 cm); exhibited limited mouth opening (MD, −0.52 cm; 95% CI, −0.88 to −0.15 cm); had limited neck flexibility (MD, −10.05 cm; 95% CI, −14.10 to −6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07–5.48). Conclusion . We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.

The use of checkpoint-blockade antibodies is still restricted in several malignancies due to the modest efficacy, despite considerable success in anti-tumor immunotherapy. The poor response of cancer cells to immune destruction is an essential contributor to the failure of checkpoint therapy. We hypothesized that combining checkpoint therapy with natural-product chemosensitizer could enhance immune response. Herein, a targeted diterpenoid derivative was integrated with the checkpoint blockade (anti-CTLA-4) to improve immunotherapy using thermosensitive liposomes as carriers. In vivo, the liposomes enabled the co-delivery of the two drug payloads into the tumor. Consequently, the regulatory T cell proliferation was restrained, the cytotoxic T cell infiltration was enhanced, and the profound immunotherapeutic effect was achieved. In addition, the immunotherapeutic effect of another clinically used checkpoint antibody, anti-PD-1, also benefited from the diterpenoid derivative. Of note, our mechanism study revealed that the targeted diterpenoid derivative increased the sensitivity of cancer cells to immune attack via THBS1 downregulation and the resultant destruction of THBS1-CD47 interaction. Collectively, co-delivering THBS1 inhibitor and checkpoint blockade is promising to boost cancer immunotherapy. We first time discovered that THBS1 suppression could strengthen checkpoint therapy.