Based on spleen deficiency-phlegm dampness as the core pathogenesis of obesity， and integrating recent advances in modern medicine regarding the key role of immune inflammation in obesity， this paper proposes a multidimensional pathogenic network of "obesity-spleen deficiency-phlegm dampness-immune imbalance". Various traditional Chinese medicine （TCM） herbs that strengthen the spleen， regulate qi， and resolve phlegm and dampness can treat obesity by improving spleen-stomach transport and transformation， promoting water-damp metabolism， and regulating immune homeostasis. This highlights immune inflammation as an important entry point to elucidate the TCM concepts of "spleen deficiency-phlegm dampness" and the therapeutic principle of "strengthening the spleen and eliminating dampness to treat obesity". By systematically analyzing the intrinsic connection between "spleen deficiency generating dampness， internal accumulation of phlegm dampness" and immune dysregulation in obesity， this paper aims to provide theoretical support for TCM treatment of obesity based on dampness.

Pulpotomy, which belongs to vital pulp therapy, has become a strategy for managing pulpitis in recent decades. This minimally invasive treatment reflects the recognition of preserving healthy dental pulp and optimizing long-term patient-centered outcomes. Pulpotomy is categorized into partial pulpotomy (PP), the removal of a partial segment of the coronal pulp tissue, and full pulpotomy (FP), the removal of whole coronal pulp, which is followed by applying the biomaterials onto the remaining pulp tissue and ultimately restoring the tooth. Procedural decisions for the amount of pulp tissue removal or retention depend on the diagnostic of pulp vitality, the overall treatment plan, the patient's general health status, and pulp inflammation reassessment during operation. This statement represents the consensus of an expert committee convened by the Society of Cariology and Endodontics, Chinese Stomatological Association. It addresses the current evidence to support the application of pulpotomy as a potential alternative to root canal treatment (RCT) on mature permanent teeth with pulpitis from a biological basis, the development of capping biomaterial, and the diagnostic considerations to evidence-based medicine. This expert statement intends to provide a clinical protocol of pulpotomy, which facilitates practitioners in choosing the optimal procedure and increasing their confidence in this rapidly evolving field.
Humans ; Calcium Compounds/therapeutic use* ; Consensus ; Dental Pulp ; Dentition, Permanent ; Oxides/therapeutic use* ; Pulpitis/therapy* ; Pulpotomy/standards*

Objective To explore the application effect of key point nursing from the perspective of cluster analysis in preventing complications among patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI).Methods A total of 97 AMI patients who un-derwent PCI in the cardiology department of our hospital from March 2022 to October 2023 were se-lected and divided into control group with 51 patients(March to December 2022)and observation group with 46 patients(January to October 2023)based on their admission time.The control group received routine nursing,while the observation group received key point nursing from the perspective of cluster analysis.The emergency nursing conditions,occurrence of complications during hospitaliza-tion,major adverse cardiovascular events(MACE),and satisfaction of patients were compared be-tween the two groups.Results The door-to-balloon(D2B)time,results of time to myocardial injury markers,and length of hospital stay were shorter in the observation group than those in the control group(P＜0.05).The incidence rates of reperfusion arrhythmia during surgery,total vascular com-plications after surgery,unplanned extubation,and total MACE within 6 months after surgery were lower in the observation group than those in the control group(P＜0.05).The overall satisfaction rate with nursing in the observation group was 95.65％(44/46),which was higher than 82.35％(42/51)in the control group(P＜0.05).Conclusion Key point nursing from the perspective of cluster analysis can shorten the rescue time and length of hospital stay for patients undergoing PCI,reduce the incidence of vascular complications and MACE during hospitalization,and improve satis-faction of patients.

Objective To explore the impact of the three-level assistance model based on the narrative nursing theory on the mental health status of medical staff.Methods 140 medical staff working in a third class hospital in Xiangyang City were selected as the research object.The three-level assistance model based on narrative nursing theory was used to intervene them from September 2021 to July 2022.The symptom self-assessment scales before and after the intervention were compared.Results Before the intervention,the total score of SCL-90(156.37±32.56)points and the scores of various symptom factors of medical staff were higher;After the intervention,the total score of SCL-90(133.35±43.48)points and the scores of various symptom factors were lower than those before the intervention and the difference was statistically significant(P<0.05).Conclusion The three-level assistance model based on narrative nursing theory can reduce the total score of SCL-90 and the scores of various symptom factors,improve the mental health status and mental health level.

This article presents a case of acute ST-segment elevation myocardial infarction (STEMI) in a pregnant woman caused by coronary artery dissection. The 41-year-old patient had undergone cardiac valve surgery at the age of 1 and had no risk factors such as hypertension, diabetes, smoking, alcohol use, or a family history of coronary artery disease. At 31 +1 weeks of gestation, she experienced sudden chest pain for 4 hours and was emergently referred to Peking University First Hospital on June 1, 2021. Electrocardiogram revealed ST-segment elevation in leads I, aVL, and V 2 to V 6. Biochemical assays showed elevated levels of high-sensitivity cardiac troponin I and creatine kinase-MB. Echocardiography indicated segmental ventricular wall motion abnormalities (apical) and reduced left ventricular function, confirming the diagnosis of acute anterior wall STEMI. The patient promptly underwent emergency coronary angiography and percutaneous coronary intervention and confirmed coronary artery dissection. Postoperative care included antiplatelet, anticoagulation, and supportive treatment. At 34 +3 weeks of gestation, with the condition of acute anterior wall STEMI being relatively stable, a cesarean section was successfully performed. Regular cardiology follow-ups were scheduled postpartum, and cardiac function was normal in two years after discharge.

Objective:To clarify whether CLDN5 is involved in the pathogenesis of sensitive skin (SS) through inflammation.Methods:From January 2018 to March 2020, in the Dermatology Laboratory of the First Affiliated Hospital of Kunming Medical University, facial tissues were collected from 5 patients diagnosed with sensitive skin and 5 cases of normal facial skin. The organizational experiment was divided into two groups: SS group and normal skin (NS) group. The cell experiment was divided into two groups: sh-CLDN5 group in which CLDN5 was knocked down and sh-NC group with normal expression of CLDN5. After paraffin embedding and sectioning, immunohistochemical staining was performed to determine the expression of claudin-5 in sensitive skin and normal skin. In cell experiments, lentivirus shRNA was transfected into HaCaT cells. Three cases in sh-CLDN5 group and three cases in sh-NC group were collected for transcriptome sequencing, and differentially expressed pro-inflammatory factor mRNA was screened from the sequencing results. Western blot or ELISA was used to verify the protein level expression of differentially expressed pro-inflammatory cytokines mRNA in HaCaT cells, and Western blot was used to detect the expression of key proteins in MAPK pathway and NF-κB in the sh-CLDN5 group and sh-NC group.Results:Immunohistochemical staining showed that claudin-5 was localized in the interstitial cells of the normal skin granular layer. Patients with sensitive skin had thinner epidermis than normal skin and significantly reduced claudin-5 expression. In HaCaT cells, the expression of pro-inflammatory cytokine IL-23A was increased, and IL-8 was elevated in the sh-CLDN5 group [(272.91±30.25) pg/ml, n=3] compared with sh-NC group [(55.58±7.07) pg/ml, n=3] ( P<0.01). There was no statistically significant difference in secretion volume between sh-NC group [(8.04±1.34) pg/ml, n=3] and sh-CLDN5 group [(12.15±3.07) pg/ml, n=3]. The expression of P-JNK, p-ERK, and P-p38 in the MAPK pathway was significantly increased ( P<0.01). Conclusions:CLDN5 is an important gene involved in the pathogenesis of SS. CLDN5 upregulates IL-23A and IL-8 in HaCaT and activates the MAPK pathway, which is involved in the process of early SS inflammation.

Objective:To compare the correlation and consistency of central corneal thickness (CCT) measured by four different instruments, specular microscope SP-1P, IOLMaster 700, Pentacam HR and RTVue XR-OCT.Methods:A diagnostic test study was performed.A total of 50 right eyes of 50 consecutive outpatients who planned to undergo corneal refractive surgery at Hanyang Aier Eye Hospital from January to May 2022 were included.CCT was measured with the specular microscope SP-1P, IOLMaster 700, Pentacam HR and RTVue XR-OCT, respectively.The differences of CCT measurements by the four instruments were compared.The correlation and consistency between the CCT values was analyzed by Pearson linear analysis and Bland-Altman test, respectively.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Hanyang Aier Eye Hospital (No.HYEYE20221229JM).Written informed consent was obtained from each subject.Results:The mean CCT values measured by SP-1P, IOLMaster 700, Pentacam HR and RTVue XR-OCT were (522.68±30.08), (544.06±32.85), (541.00±31.75) and (528.86±31.60)μm, respectively, with a statistically significant overall difference ( F=5.09, P=0.002).CCT measurements obtained with SP-1P were lower than those obtained with IOLMaster 700 and Pentacam HR, while the IOLMaster 700 measurements were higher than those of RTVue XR-OCT, showing statistically significant differences (all at P<0.05).Pearson correlation analysis revealed significant positive correlations of CCT measurements between SP-1P and IOLMaster 700, SP-1P and Pentacam HR, SP-1P and RTVue XR-OCT, IOLMaster 700 and Pentacam HR, IOLMaster 700 and RTVue XR-OCT, Pentacam HR and RTVue XR-OCT ( r=0.988, 0.980, 0.988, 0.981, 0.982, 0.973; all at P<0.01).Bland-Altman consistency analysis showed that the 95% limits of agreement (95% LoA) for CCT measurements between SP-1P and RTVue XR-OCT, IOLMaster 700 and Pentacam HR were -16.46-6.14 and -10.56-14.48 μm, respectively, with 3(6%) and 2(4%) data points outside the 95% LoA, respectively.The mean difference lines for the CCT measurements were close to 0, indicating good consistency and clinically acceptable differences without statistical significance. Conclusions:CCT values measured with specular microscope SP-1P and RTVue XR-OCT, as well as those measured with IOLMaster and Pentacam HR, are relatively close in patients with low to moderate myopia, show good consistency and can therefore be considered interchangeable.

Objective To evaluate economics of Bailing capsules combined with western medicine conventional treatment compared with western medicine conventional treatment in diabetic kidney disease.Methods Meta-analysis was performed to investigate clinical efficacy and safety of Bailing capsules combined with western medicine conventional treatment(Bailing capsules group)compared with western medicine conventional treatment(control group)in diabetic kidney disease.From the perspective of health system in China,cost-effectiveness analysis was conducted by establishing a decision tree model.After the efficacy and safety results were obtained by meta-analysis,the short-term economics of the two treatment regimens were comprehensively evaluated.The efficacy index was the total effective rate and the time horizon was 3 months.One-way sensitivity analysis,probabilistic sensitivity analysis and scenario analysis were used to evaluate the robustness of the results.Results A total of 34 RCTs involving 3 114 patients were included in meta-analysis.The results of meta-analysis showed that when the treatment time was 3 months,the total effective rate of Bailing capsules group was higher than that of control group(RR=1.32,95％CI 1.25 to 1.39,P＜0.001),while its safety was similar to control group.Cost-effectiveness analysis showed that compared with the conventional western medicine treatment alone,the ICER value of Bailing capsule combined with western medicine conventional treatment was 5 223 yuan,and sensitivity analysis showed that the dosage of Bailing capsules and the total effective rate of the two therapies had great influence on the results.When the willingness-to-pay value was higher than 5 150 yuan,the probability of Bailing capsules combined with western medicine conventional treatment was more economical than 50％.Conclusion When time horizon was 3 months,compared with western medicine conventional treatment,Bailing capsules combined with western medicine conventional treatment is more economical for patients with diabetic kidney disease who are willing to pay more than 5 150 yuan.

Objective To study the effect of Ditan Decoction combined with aripiprazole and olanzapine in the treatment of schizophrenia and its influence on serum inflammatory factors chnage.Methods Seventy-seven patients with schizophrenia meeting the requirements visiting the outpatient department and hospitalized in Dazu District Hospital of Traditional Chinese Medicine and Dazu District Mental Health Center from July 2021 to March 2023 were selected as the study subjects and divided into the observation group(n=38)and control group(n=39).The control group was treated with aripiprazole and olanzapine,and the observation group was combined with Ditan Decoction on the basis of the control group.After 8 weeks of treatment,the TCM syndrome scores,Positive and Negative Syndrome Scale(PANSS)score,serum inflammatory factors(IL-6,IL-1β,IL-17)levels were compared between the two groups.Results The total effective rate was 97.37％in the observation group and 84.65％in the control group,and the difference was statistically signifi-cant(P＜0.05).The TCM syndrome score of each item and total scores after treatment in the observation group were lower than those in the control group(P＜0.05),the PANSS positive symptoms,negative symp-toms,general psychopathology and total scores in the observation group were lower than those in the control group(P＜0.05).The IL-17,IL-6 and IL-1β levels after treatment in observation group were lower than those in the control group(P＜0.05).Conclusion Ditan Decoction combined with aripiprazole and olanzapine has significant clinical efficacy in the treatment of schizophrenia,which could further reduce the symptom score of the patients and improve the serum inflammatory factors levels.The treatment is highly safe and worthy of clinical recommendation.

Rheumatoid arthritis(RA)is an autoimmune disease characterized by chronic synovial in-flammation.Moxibustion treatment can significantly improve RA immune disorders and reduce synovial in-flammation,but its mechanism of action needs to be further deepened.Senescence is a key factor that induces the occurrence and development of RA,and macrophages,as the key sentinel sites of the immune system to monitor aging,play an important role in the onset process of RA.The circadian clock dominates the circadian rhythm of the body,regulates the expression of a variety of proteins and cell functions,and is widely involved in the physiological and pathological processes of a variety of diseases.The circadian clock is involved in mac-rophage senescence and has the effect of regulating immune disorders.Among the mechanisms affecting the occurrence and development of RA,macrophage senescence has received more and more attentions as an im-portant breakthrough point.Therefore,this article mainly elucidates the possible pathogenesis of RA from the perspective of the involvement of the biological clock in macrophage senescence and analyzes the feasibility of moxi-bustion in the treatment of RA by regulating the biological clock and participating in macrophage senescence.