Xiang thinking is a cognitive approach that reflects the relationships between phenomena and their underlying principles by analyzing their external manifestations through methods such as analogy， reasoning， deduction， and symbolism. This article applied xiang thinking to analyze the etiology and pathogenesis of "wind， fire， phlegm， and blood stasis" in stroke， thereby exploring its impact on the principles of syndrome differentiation and treatment of this condition. Meanwhile， the article traced the construction process of xiang thinking， and interpreted the concept of "toxin pathogen" in traditional Chinese medicine from four perspectives， state， attribute， origin， and law. Furthermore， the relationship between the process of constructing xiang thinking and the origin of etiology， identification methods， pathogenesis evolution， and treatment strategies for stroke with syndrome of combined blood stasis and toxin was explored， so as to provide insights into research on the etiology and pathogenesis of stroke， as well as clinical diagnosis and treatment approaches.

OBJECTIVE: To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium alloy Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK)-Cage in the treatment of single-segment cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). METHODS: The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2023 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-printed microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, at 3 months after operation, and at last follow-up, and the vertebral height at the fusion segment and Cobb angle were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. RESULTS: The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly shorter than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage or displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR (95%CI)=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and at last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (P>0.05). At 3 months after operation and at last follow-up, the vertebral height at the fusion segment and Cobb angle significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the incidence of prosthesis subsidence in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). CONCLUSION The application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the incidence of prosthesis subsidence, and reduce the incidence of dysphagia.
Humans ; Spinal Fusion/instrumentation* ; Titanium ; Cervical Vertebrae/surgery* ; Diskectomy/instrumentation* ; Bone Plates ; Male ; Printing, Three-Dimensional ; Female ; Retrospective Studies ; Middle Aged ; Treatment Outcome ; Benzophenones ; Adult ; Spondylosis/surgery* ; Aged ; Polymers ; Ketones ; Polyethylene Glycols

Xiang thinking is the key way of thinking to construct the life model of human body in traditional Chinese medicine （TCM）， and the theory of ascending and descending of qi movement is an important manifestation of xiang thinking in the theory of TCM. Based on the theory of qi movement， this paper interpreted the mechanism of ischemic stroke through the perspective of xiang thinking "earth weakness - wood constraint - fire hyperactivity"， as "earth weakness in the central and dampness accumulated to phlegm" "wood constraint and stirring wind led to blood stasis" and "fire hyperactivity and fire toxin showed flaming upward" due to disorder of qi movement. Combined with the "xiang of medicinal properties and therapy methods" to discuss the treatment and prescriptions of ischaemic stroke， applying wind medicinals to elevate ji-earth （己土） and yi-wood （乙木）， so that phlegm and stasis can be eliminated， and cold medicinals to descend jia-wood （甲木） and wu-earth （戊土） so that fire toxin can be cleared， with a view to restore ascending and descending of qi movement for ischaemic stroke.

Objective To observe the value of synthetic MRI(SynMRI)and diffusion tensor imaging(DTI)for evaluating grade and isocitrate dehydrogenase-1(IDH-1)status of adult gliomas.Methods Totally 115 patients with adult glioma were retrospectively enrolled and divided into adult low-grade glioma(aLGG)group(n=44)and adult high-grade glioma(aHGG)group(n=71)according to WHO classification.There were 30 cases of IDH-1 mutant type,2 cases of wild type and 12 cases of undetermined gliomas in aLGG group,whereas 26 cases of IDH-1 mutant type,24 cases of wild type and 21 cases undetermined gliomas in aHGG group,respectively.SynMRI and DTI parameters,including T1 value,T2 value,proton density(PD),apparent diffusion coefficient(ADC)and fractional anisotropy(FA)were compared between groups,and the efficacy of each parameter for distinguishing aLGG and aHGG,as well as IDH-1 mutant type and wild type was analyzed.Results Significant differences of T1 value,T2 value,ADC and FA were found between groups,also between IDH-1 mutant type and wild type gliomas within aHGG group(all P＜0.05).The area under the curve(AUC)of the above parameters for distinguishing aLGG and aHGG was 0.731,0.686,0.930 and 0.710,respectively,while for distinguishing IDH-1 mutant type and wild type in aHGG group was 0.775,0.729,0.817 and 0.705,respectively,among which ADC had the highest AUC(all P＜0.05).Conclusion SynMRI and DTI parameters such as T1 value,T2 value,ADC and FA were helpful for distinguishing aLGG and aHGG,IDH-1 mutant type and wild type,among which ADC had the highest efficacy.

Objective:To investigate the value of a deep learning model based on diffusion-weighted imaging (DWI) in quick identification of the TOAST etiology classification in patients with acute ischemic stroke (AIS).Methods:In this cross-sectional study, imaging and clinical data of 504 patients with AIS admitted to the First Affiliated Hospital of Xinjiang Medical University from March 2023 to February 2024 were retrospectively reviewed. Using the TOAST etiology classification, there were 252 large artery atherosclerosis type and 252 small-artery occlusion type. The 504 cases were divided into a training set ( n=302), a validation set ( n=101) and a test set ( n=101) using stratified randomization in the ratio of 6∶2∶2. All cases had DWI data. A DenseNet network framework was used to construct DenseNet models by optimizing the model configurations of different layers. Three DenseNet models with different layers (121, 169, 201) were constructed, named DenseNet169 model, DenseNet121 model, and DenseNet201 model. The data enhancement, Adam optimizer and cross-entropy loss function methods were used to improve the convergence speed and robustness of the model, and to balance the positive and negative sample imbalance problem. Independent sample t-test or χ2 was used to compare the clinical data of patients with large artery atherosclerosis type and small-artery occlusion type AIS. Receiver operating characteristic curves and area under the curve (AUC) were performed to evaluate the efficacy of each model in identification of patients with large artery atherosclerosis type and small-artery occlusion type AIS. Results:There were statistically significant differences in age, National Institutes of Health Stroke Scale score at admission, and stenosis or occlusion of large vessels between patients with large artery atherosclerosis type and small-artery occlusion (all P<0.05). In the test set, the AUC, sensitivity, accuracy, and F1 score values of the DenseNet201 model for discriminating patients with large artery atherosclerosis type AIS and small-artery occlusion type AIS (0.826, 0.902, 0.743, 0.780, respectively) were higher than those of DenseNet121 (0.801, 0.647, 0.723, 0.702, respectively) and DenseNet169 model (0.778, 0.882, 0.733, 0.769). Conclusions:The deep learning models based DWI constructed in this study can help with the TOAST etiology classification of AIS cases. DenseNet201 model shows the best and stable performance in the deep learning-based classification.

Objective: To investigate loneliness and associated factors among adolescents with mixed anxiety and depressive disorder(MADD), and to provide reference for drawing up effective and targeted interventions. Methods: Using convenience sampling method, 265 adolescents with MADD in Daqing Third Hospital were selected from September 2020 to June 2021. General information questionnaire, Pittsburgh sleep quality index(PSQI), Resilience Scale for Chinese Adolescents(RSCA), Child and Adolescent Peer Relationship Scale and UCLA Loneliness Scale were used to investigate the status and influencing factors of loneliness among adolescents with MADD. Results: The average score of UCLA among 265 adolescents with MADD was (56.49±10.83). The results of univariate analysis showed that age, gender, burden of medical expenses, drinking behavior and parents migrant work had statistically significant differences in the UCLA scores. The results of Pearson correlation analysis showed that loneliness in MADD adolescents was negatively correlated with psychological resilience( F/t=57.65, -60.62, 21.92, 8.52, 16.22, P <0.01), and positively correlated with sleep quality and interpersonal distress( F/t=-0.69, 0.76, 0.50, P <0.01). The results of multiple stepwise regression analysis showed that phase of study, sex, burden of medical expenses, interpersonal distress, sleep quality and resilience were the influencing factors of loneliness among adolescents with MADD( B=0.11, 0.13, 0.09, 0.46, 0.10,-0.24, P <0.01). Conclusion Adolescents with MADD have moderate loneliness, which needs to be improved. Nursing staff should pay attention to the negative emotional experience such as loneliness among adolescents with MADD, and reduce their loneliness by improving sleep quality and resilience, reducing interpersonal distress.

Brain diseases in traditional Chinese medicine were complex and difficult to diagnosis and treatment， and new diagnostic and therapeutic ideas are urgently needed. The onset of the disease was the result of the struggle between healthy qi and pathogenic qi. Common types of the onset of diseases included sudden onset， slow onset， latent onset， secondary onset， and recurrent onset， reflecting the strength of the healthy qi and pathogenic qi， the pathogenic qi that reduced diseases， the site of onset， and other informatin. “Identificating the onset of diseases” was simple and easy to operate， and helped to clarify the complex development of encephalopathy. When applying it， we should first identify urgency and importance， focus on the characteristics； grasp the tendency of diseases， and know the overall situation of the disease； compare similarities and differences horizontally； and carefully observe and dynamically understand the disease. “Identificating the onset of diseases” has the characteristics of comprehensiveness and prognosis， and can lay the foundation for pattern identification and treatment and “treating disease before its onset”.

Objective:To explore the influencing factors and effectiveness of community follow-up in patients with cardiac implantable electronic device (CIED) implantation.Method:A total of 132 patients who received CIED implantation in the Department of Cardiology of Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2021 to February 2022 were enrolled in this prospective cohort study. Among them 33 patients were followed up in community health service centers associated with Tongren Hospital (community follow-up group) and 99 matched patients were followed up in the CIED outpatient clinic of the hospital (outpatient follow-up group) with a ratio of 1∶3. The clinical data of the selected patients were collected through a questionnaire survey; the follow-up data were extracted through the CarelinkExpress electronic follow-up platform and the CIED outpatient information system of Tongren Hospital. Adjustment of the treatment protocol or CIED parameters at follow-up, and the referral from the community health service centers were defined as visit with-an-action (VWA). The endpoint of follow-up was the occurrence of major adverse events. The multivariate logistic regression model was used to analyze the factors influencing patient selection for community follow-up.Results:The univariate analysis showed that the frequency of visits to community health service centers and the service contracting rate in community follow-up group were higher than those of outpatient follow-up group ( P<0.05). The multivariate logistic regression analysis showed that the contracted community physician service was an independent influencing factor of patient choosing community follow-up ( OR=2.143, 95% CI: 1.103-4.166, P=0.025). A total of 469 visits of followed up occurred in 132 patients, including 45 community visits and 424 outpatient visits. VWA accounted for 22.2% (10/45) in the community follow-up group, and 17.2% (73/424) in the outpatient follow-up group ( P>0.05). There was no significant difference in the safety and effectiveness indicators (VWA, major adverse events, and unplanned follow-up) between the two groups ( P>0.05). More patients in the community follow-up group walked to the hospital than the outpatient follow-up group ( P<0.05);and the main transportation for the later was by bus or taxi(42(42.4%)or 41(41.4%)). The average waiting time in the community follow-up group was significantly shorter than that in outpatient follow-up group ( P<0.05). The total time required for a single follow-up in the community follow-up group was 50.0 (45.0, 59.5) minutes, which was significantly shorter than that in the routine outpatient follow-up group (107.0 (90.0, 135.0) minutes, P<0.05). Conclusions:The contracting with community physicians is an independent influencing factor for CIED implanted patients to choose community follow-up. The safety and effectiveness of community follow-up are comparable to routine outpatient follow-up, and community follow-up is more convenient.

ObjectiveTo assess the anxiety and depression symptoms and sleep quality in patients with menstrual migraine， so as to provide references for the prevention and treatment of menstrual migraine and its comorbidity. MethodsAccording to the diagnostic criteria of the International Classification of Headache Disorder， third edition （ICHD-3）， 501 female migraine patients， including 112 patients with menstrual migraine and 389 patients with non-menstrual migraine， who attended the outpatient clinic of the Affiliated Hospital of North Sichuan Medical College from February 2019 to February 2020， were selected for the study. The general and clinical data of the patients were collected， meantime， patients were assessed using Hamilton Anxiety Scale （HAMA）， Hamilton Depression Scale-24 item （HAMD-24）， 6-item Headache Impact Test （HIT-6） and Pittsburgh Sleep Quality Index （PSQI）. ResultsThe detection rates of pure anxiety， pure depression， comorbid anxiety-depression and sleep disorders in patients with menstrual migraine were higher than those in patients with non-menstrual migraine （χ²=4.198， 4.355， 5.236， 8.624， P<0.05 or 0.01）. Patients with menstrual migraine had higher scores of HAMA、HAMD-17、PSQI and HIT-6 than those of non-menstrual migraine patients （Z=-3.550、-2.723、-2.482、-4.717，P<0.05 or 0.01）. Correlation analysis showed that PSQI score of menstrual migraine patients was positively correlated with HAMA score （r=0.338， P<0.01）， HAMD-24 score （r=0.372， P<0.01） and HIT-6 score （r=0.192， P<0.05）. ConclusionCompared with non-menstrual migraine patients， patients with menstrual migraine experience more severe anxiety and depression symptoms and sleep problems and suffer greater negative life impacts. In addition， the influence of anxiety and depression symptoms and headache on daily life is associated with sleep quality.

Objective: To provide guidelines for the prevention of post-stroke dementia, we investigated whether stroke patients were aware of post-stroke dementia and their level of dementia-related knowledge. Methods: Five dementia-related questions were designed. A field survey was conducted in a question-and-answer method using the designed questions. The surveys assessed 3000 stroke patients (2 weeks-6 months after stroke attacks) from 14 hospitals/clinical centers in 7 provinces and cities across China. Results: Among 3000 stroke patients, 80.5％had heard of dementia, 39.1％knew that stroke can lead to dementia, 55.7％ believed dementia can be prevented, 50.8％ thought dementia can be cured, and only 8.8％had ever seen a doctor because of memory deterioration. Then, patients were classified into three groups, including a no cognitive impairment (NCI) group, a mild cognitive impairment (MCI) group, and a mild dementia (MD) group. Among the MCI and MD groups, only 8.7％ (75/861) and 9.9％ (64/649) of patients, respectively, had ever seen a doctor because of memory deterioration. According to our results, patients with a higher level of cognitive impairment had a lower awareness of dementia (P<.001). Conclusion: The awareness of dementia in stroke patients in China is low, and the consultation rate is even lower. Moreover, patients with a higher level of cognitive impairment have a lower awareness of dementia. To improve public awareness and improve prevention, more emphasis should be put on ed-ucation regarding post-stroke dementia. Routine cognitive function screening should be conducted on stroke patients as an effective way to assess dementia.