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 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.

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 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.

Iraq is a multi-ethnic, multi-religious federal country located in southwest Asia and northeast of the Arabian Peninsula. Medical insurance is based on the primary health care model, supplemented by private medical care. Traditional medicine in Iraq is dominated by Islamic medicine. With the support of the Chinese government, the first Traditional Chinese Medicine (TCM) center was established in 2000. However, due to safety issues, the management of the center had problems such as insufficient staff, limited medical experience, and non-persistentsupport. At present, TCM has not been included in the Iraqi medical insurance system, which has affected the people’s medical choice and hindered the development of TCM. It is recommended to strengthen the construction of existing TCM centers, improve the accessibility of TCM education, and strengthen the cooperation and exchanges of traditional medicine between the two countries to promote the spread and development of TCM in Iraq.

Serbia is a parliamentary republic country in Southeast Europe. It implements a health security system with social insurance as the mainstay and social assistance as a supplement. Ischemic heart disease, stroke and Alzheimer’s disease are the major causes of death, and the mortality rates of cardiomyopathy and chronic kidney disease are increasing. Serbia has relevant legislation on traditional medicine. Acupuncture, as the main form of Traditional Chinese Medicine (TCM), has been introduced to Serbia in an early stage. Acupuncture was recognized as a legal medical method in 2005, and then the corresponding educational institutions of TCM were established soon. However, the limitation of acupuncture treatment application, difficulty in access to Chinese medicine, and undeveloped of TCM education system, all of them restrict the development of TCM in Serbia. It is recommended to improve the development and dissemination of Chinese medicine in Serbia, like to increase the promotion of acupuncture, pay attention to the Chinese medicine for preventive health care, and strengthen TCM education.