Premature ejaculation refers to a sexual dysfunction in which men experience a short intravaginal ejaculation latency and a lack of control over ejaculation during sexual activity. The onset of this condition is often accompanied by anxiety and depression, which can seriously affect the quality of the patient′s sexual life and the relationship between partners. Based on the "integration of body and spirit" theory in traditional Chinese medicine, our team believes that this condition is a comorbidity of physical and spiritual factors. We propose that the core pathogenesis of this disease lies in the "loss of form and essence, impairment of spirit, and depression of the mind, "while the primary treatment principle involves "nourishing form and regulating spirit." As a result, a new diagnosis and treatment approach of "four-dimensional integration" is summarized in this study. The disease is treated through the four dimensions of shape, body, spirit, and emotion. Traditional Chinese medicine is used to adjust the shape in cases where the physical form is damaged. For individuals with depression of heart and liver qi, the treatment focuses on soothing the heart and smoothing liver qi, and the modified Wangyou Powder and Xuanzhi Decoction is used. In cases where the heart and kidney function are compromised, the treatment involves nourishing both the heart and kidney while restoring interaction between the heart and the kidney, and modified Jihuo Yansi Elixir is used. To reduce the sensitivity of the glans penis, the patient′s body is washed with a traditional Chinese medicine formula, and a delicate fumigation formula is decocted for external washing. For those who are not in tune with their god, psychological counseling can be used to regulate their spirit and advocate "self-partner" and psychotherapy. If there are issues with intimacy, partners should focus on cooperating during foreplay, sexual intercourse, and post-coital interactions. Overall, the treatment aims to harmonize the body and spirit, addressing both physical and psychological factors through a comprehensive, multi-dimensional approach. This method provides new perspectives and ideas for the clinical diagnosis and treatment of this condition.

Objective:To investigate the association between blood pressure variability (BPV) and all-cause mortality and cardiovascular events in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and provide reference for clinical management in CAPD patients.Methods:This retrospective cohort study included patients who received CAPD at Guangdong Provincial People's Hospital between May 1, 2010, and July 31, 2023. Baseline and clinical data of the patients were collected. Coefficient of variation of systolic blood pressure (CVSBP) was used to assess BPV. The patients were divided into CVSBP T1, CVSBP T2 and CVSBP T3 groups based on CVSBP tertiles, and the differences among the three groups were compared. Diastolic blood pressure and mean arterial pressure were used to further assess BPV and sensitivity analysis was conducted. The primary endpoint was the composite outcome of all-cause mortality and cardiovascular events. Kaplan-Meier survival curve and Cox regression analysis were used to analyze the association between CVSBP and the primary endpoint.Results:A total of 358 CAPD patients were included, with age of (43.6±13.3) years, and 197 males (55.0%). The proportion of males, proportion of smoking, baseline blood urea nitrogen, serum creatinine and serum albumin in CVSBP T2 (9.08%≤CVSBP<12.55%, n=120) group and CVSBP T3 (CVSBP≥12.55%, n=119) group were lower than those in CVSBP T1 group (CVSBP<9.08%, n=119), and baseline systolic blood pressure, residual kidney Kt/V and total Kt/V were higher than those in CVSBP T1 group, with statistically significant difference among the three groups (all P<0.05). During follow-up of 37(23, 76) months, 49 patients (13.7%) experienced the composite endpoint events, including 12 patients (3.4%) of all-cause deaths and 42 patients (11.7%) of cardiovascular events. Kaplan-Meier survival analysis showed that the incidence of composite endpoint events in CVSBP T3 group was higher than that in CVSBP T1 group and CVSBP T2 group, but the difference was not statistically significant (Log-rank χ2=3.795, P=0.150). Multivariate Cox regression analysis showed that, after adjusting for age, sex, diabetes, baseline systolic blood pressure, residual renal function, and serum albumin, as a continuous variable, CVSBP was not associated with the risk of composite outcome in CAPD patients ( HR=1.058, 95% CI 0.985?1.135, P=0.122); as a categorical variable, with CVSBP T1 group as reference, CVSBP T2 group and CVSBP T3 group were not associated with the risk of composite outcome ( HR=1.222, 95% CI 0.471?3.167, P=0.681; HR=1.827, 95% CI 0.737?4.530, P=0.193). The sensitivity analysis showed that increased variability of diastolic blood pressure ( HR=1.162, 95% CI 1.063?1.270, P=0.021) and increased variability of mean arterial pressure ( HR=1.114, 95% CI 1.030?1.204, P=0.007) were correlated with higher risk of composite outcome in CPAD patients. Conclusions:Systolic blood pressure variability during follow-up is not associated with risk of composite outcome of all-cause mortality and cardiovascular events in CAPD patients. Increased variability of diastolic blood pressure and increased variability of mean arterial pressure are associated with a higher risk of composite outcome in CPAD patients. Interventions to reduce BPV may be helpful to improve the long-term prognosis of CAPD patients.

Biliary tract carcinoma (BTC) is a highly aggressive malignancy,and the majority of patients present with advanced stage at first diagnosis which resulting in poor prognosis. Traditional chemotherapy and monotherapy have shown limited efficacy in treating BTC. However,with the continuous emergence of clinical research findings and updates to relevant guidelines,there have been some breakthroughs in systemic therapies for BTC. This paper analyzes domestic and international literature on neoadjuvant therapy and conversion therapy for BTC,aiming to provide a reference for clinical research. Overall,research on neoadjuvant therapy and conversion therapy remains in the preliminary exploration phase. Current evidence suggests that combination strategies involving immunotherapy and chemotherapy,with or without targeted therapy,have demonstrated promising clinical efficacy,offering new hope for neoadjuvant therapy and conversion therapy in BTC. Furthermore,the evolution of precision targeted therapies offers better opportunities for personalized treatment,and the combination of local interventions and systemic therapies demonstrates promising therapeutic potential. However,the optimal strategies and timing for surgery of neoadjuvant therapy and conversion therapy have not yet been standardized. Moreover,most studies lack precise designs to address the heterogeneity of BTC,new therapies have not yet reached the ideal stage of personalized treatment,further research is warranted to address these challenges.

Objective To observe the clinical effect of doing Huatuo five-animal play treating blood-stasis-type silent myocardial ischemia(SMI)and its influence on coronary hemodynamics.Methods Ninety patients diagnosed as silent myocardial ischemia were randomly divided into a five-animal play group(n=45,age:51.56±11.00 years,24 males and 21 females)and a regular exercise group(n=45,age:52.44±7.19 years old,24 males and 21 females)according to a random number table.The five-animal play group practised the traditional five-animal play,while the regular exercise group con-ducted daily 30-minute moderate-intensity treadmill aerobic exercise,five times a week,for 4 weeks.The changes in the number of abnormal ST-T segment occurrences,myocardial oxygen consumption(CMO),coronary ischemia threshold(CIT),and blood smoothness index(BSD)within 24-hour ambu-latory electrocardiogram before and after the intervention were observed in both groups,with the thera-peutic effect and hemodynamic characteristics of both groups evaluated.Results The average number of ST-T segment abnormalities decreased after intervention in both groups(P<0.001),with significantly greater improvement in the five-animal play group than the regular exercise group(P<0.001).More-over,the average CMO decreased significantly,while the average CMR and BSD increased significant-ly in both groups after intervention(P<0.05),with significantly greater improvement in the five-ani-mal play group than the other group.Meanwhile,the total effective rate in the five-animal play group was significantly higher than the regular exercise group(P<0.01).Conclusion Undergoing the five-ani-mal play and moderate intensity treadmill aerobic exercise both are effective in treating silent myocardi-al ischemia.However,the former therapy is superior to the latter in bettering CMO,CIT and BSD.

Objective To observe the clinical effect of doing Huatuo five-animal play treating blood-stasis-type silent myocardial ischemia(SMI)and its influence on coronary hemodynamics.Methods Ninety patients diagnosed as silent myocardial ischemia were randomly divided into a five-animal play group(n=45,age:51.56±11.00 years,24 males and 21 females)and a regular exercise group(n=45,age:52.44±7.19 years old,24 males and 21 females)according to a random number table.The five-animal play group practised the traditional five-animal play,while the regular exercise group con-ducted daily 30-minute moderate-intensity treadmill aerobic exercise,five times a week,for 4 weeks.The changes in the number of abnormal ST-T segment occurrences,myocardial oxygen consumption(CMO),coronary ischemia threshold(CIT),and blood smoothness index(BSD)within 24-hour ambu-latory electrocardiogram before and after the intervention were observed in both groups,with the thera-peutic effect and hemodynamic characteristics of both groups evaluated.Results The average number of ST-T segment abnormalities decreased after intervention in both groups(P<0.001),with significantly greater improvement in the five-animal play group than the regular exercise group(P<0.001).More-over,the average CMO decreased significantly,while the average CMR and BSD increased significant-ly in both groups after intervention(P<0.05),with significantly greater improvement in the five-ani-mal play group than the other group.Meanwhile,the total effective rate in the five-animal play group was significantly higher than the regular exercise group(P<0.01).Conclusion Undergoing the five-ani-mal play and moderate intensity treadmill aerobic exercise both are effective in treating silent myocardi-al ischemia.However,the former therapy is superior to the latter in bettering CMO,CIT and BSD.

Objective:To investigate the association between blood pressure variability (BPV) and all-cause mortality and cardiovascular events in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and provide reference for clinical management in CAPD patients.Methods:This retrospective cohort study included patients who received CAPD at Guangdong Provincial People's Hospital between May 1, 2010, and July 31, 2023. Baseline and clinical data of the patients were collected. Coefficient of variation of systolic blood pressure (CVSBP) was used to assess BPV. The patients were divided into CVSBP T1, CVSBP T2 and CVSBP T3 groups based on CVSBP tertiles, and the differences among the three groups were compared. Diastolic blood pressure and mean arterial pressure were used to further assess BPV and sensitivity analysis was conducted. The primary endpoint was the composite outcome of all-cause mortality and cardiovascular events. Kaplan-Meier survival curve and Cox regression analysis were used to analyze the association between CVSBP and the primary endpoint.Results:A total of 358 CAPD patients were included, with age of (43.6±13.3) years, and 197 males (55.0%). The proportion of males, proportion of smoking, baseline blood urea nitrogen, serum creatinine and serum albumin in CVSBP T2 (9.08%≤CVSBP<12.55%, n=120) group and CVSBP T3 (CVSBP≥12.55%, n=119) group were lower than those in CVSBP T1 group (CVSBP<9.08%, n=119), and baseline systolic blood pressure, residual kidney Kt/V and total Kt/V were higher than those in CVSBP T1 group, with statistically significant difference among the three groups (all P<0.05). During follow-up of 37(23, 76) months, 49 patients (13.7%) experienced the composite endpoint events, including 12 patients (3.4%) of all-cause deaths and 42 patients (11.7%) of cardiovascular events. Kaplan-Meier survival analysis showed that the incidence of composite endpoint events in CVSBP T3 group was higher than that in CVSBP T1 group and CVSBP T2 group, but the difference was not statistically significant (Log-rank χ2=3.795, P=0.150). Multivariate Cox regression analysis showed that, after adjusting for age, sex, diabetes, baseline systolic blood pressure, residual renal function, and serum albumin, as a continuous variable, CVSBP was not associated with the risk of composite outcome in CAPD patients ( HR=1.058, 95% CI 0.985?1.135, P=0.122); as a categorical variable, with CVSBP T1 group as reference, CVSBP T2 group and CVSBP T3 group were not associated with the risk of composite outcome ( HR=1.222, 95% CI 0.471?3.167, P=0.681; HR=1.827, 95% CI 0.737?4.530, P=0.193). The sensitivity analysis showed that increased variability of diastolic blood pressure ( HR=1.162, 95% CI 1.063?1.270, P=0.021) and increased variability of mean arterial pressure ( HR=1.114, 95% CI 1.030?1.204, P=0.007) were correlated with higher risk of composite outcome in CPAD patients. Conclusions:Systolic blood pressure variability during follow-up is not associated with risk of composite outcome of all-cause mortality and cardiovascular events in CAPD patients. Increased variability of diastolic blood pressure and increased variability of mean arterial pressure are associated with a higher risk of composite outcome in CPAD patients. Interventions to reduce BPV may be helpful to improve the long-term prognosis of CAPD patients.

Biliary tract carcinoma (BTC) is a highly aggressive malignancy,and the majority of patients present with advanced stage at first diagnosis which resulting in poor prognosis. Traditional chemotherapy and monotherapy have shown limited efficacy in treating BTC. However,with the continuous emergence of clinical research findings and updates to relevant guidelines,there have been some breakthroughs in systemic therapies for BTC. This paper analyzes domestic and international literature on neoadjuvant therapy and conversion therapy for BTC,aiming to provide a reference for clinical research. Overall,research on neoadjuvant therapy and conversion therapy remains in the preliminary exploration phase. Current evidence suggests that combination strategies involving immunotherapy and chemotherapy,with or without targeted therapy,have demonstrated promising clinical efficacy,offering new hope for neoadjuvant therapy and conversion therapy in BTC. Furthermore,the evolution of precision targeted therapies offers better opportunities for personalized treatment,and the combination of local interventions and systemic therapies demonstrates promising therapeutic potential. However,the optimal strategies and timing for surgery of neoadjuvant therapy and conversion therapy have not yet been standardized. Moreover,most studies lack precise designs to address the heterogeneity of BTC,new therapies have not yet reached the ideal stage of personalized treatment,further research is warranted to address these challenges.

Objective To explore the feasibility of harmonic waves analysis for observing morphological brain network changes in patients with depressive disorder(DD).Methods Whole brain 3D high resolution T1WI of 55 DD patients(DD group)and 46 normal controls(NC group)were acquired.Six kinds of morphological features brain network were constructed with FreeSurfer tool,including the number of brain region vertices,surface area,gray matter volume,average cortical thickness,Gaussian curvature and fold index.Laplace operator was applied to obtain common harmonic wave.The harmonic power of different morphological features and the gray matter volume in different brain regions were compared between groups.Results No significant difference of total harmonic energy was found between groups.The specific harmonic wave energies were significantly different between groups,including the number of brain region vertices corresponding to the 2nd,6th,15th,44th and 57th harmonic waves,surface area corresponding to the 2nd,6th,16th and 57th harmonic waves,gray matter volume corresponding to the 2nd,12th,13th,15th and 57th harmonic waves,average cortical thickness corresponding to the 2nd,19th,35th,36th and 44th harmonic waves,Gaussian curvature corresponding to the 34th,40th,54th and 57th harmonic waves,as well as fold index corresponding to the 5th,16th,21st and 57th harmonic waves.Gray matter volumes of transverse temporal gyrus in left hemisphere in DD group were significantly larger than that in NC group(t=2.900,P=0.004).Conclusion Harmonic waves analysis was feasible for observing morphological brain network changes in DD patients.

Objective The imaging findings of X-ray defecography(XRD)and magnetic resonance defecog-raphy(MRD)of patients with Solitary Rectal Ulcer syndrome(SRUS)were retrospectively analyzed to provide important information for clinical diagnosis and treatment.Methods 19 patients with SRUS confirmed by clinical,pathological and colonoscopy were included in this study.Among them,15 patients underwent XRD and 7 patients underwent MRD,and 3 patients underwent both XRD and MRD.Data of all enrolled patients were collected and pelvic floor function was measured.Results In the results of XRD,3 patients(20%)showed rectal intussusception.8 patients(53.3%)showed external rectal prolapse and 2 patients(13.3%)showed moderate rectocele.In addition,there were 2 patients of puborectal muscle hypertrophy,and 1 patient of bladder prolapse and uterine prolapse,respectively.For MRD,3 patients(42.9%)showed rectal mucosal prolapse(partial prolapse).At 4 patients(57.1%)with rectocele,3 patients(all female)had moderate rectocele,1 patient had mild rectocele.3 patients were also observed related anterior and middle compartment organ descent.2 patients of pubulorectal muscle hypertrophy,no sigmoidocoele.Conclusion Defecography can evaluate the structural and functional abnormalities of pelvic floor in SRUS patients,such as external rectal prolapse,rectal protrusion,rectal mucosal prolapse,and rectal intussusception,which has guiding significance for the treatment of SRUS patients.

Objective To investigate the prediction of diffusion kurtosis imaging(DKI)and intra voxel incoherent motion(IVIM)imaging global histogram parameters for the efficacy of neoadjuvant chemotherapy(NAC)in patients diagnosed with breast invasive ductal carcinoma.Methods A total of 69 patients with breast invasive ductal carcinoma confirmed by penetration pathology were retrospectively selected.Prior to undergoing NAC,all patients underwent sequential scans including MR conventional(T1WI,T2WI),dynamic contrast enhancement(DCE),DKI,and IVIM.After surgery,the patients were divided into significant group(40 patients)and non-significant group(29 patients)based on the efficacy of NAC,which was evaluated using the Miller-Payne(MP)grading method criteria.The differences in global histogram parameters of DKI[mean diffusivity(MD),mean kurtosis(MK)]and IVIM(D value,f value,D*value)between the significant group and the non-significant group were compared by the two-independent sample t-test and Mann-Whitney U test.In addition,the receiver operating characteristic(ROC)curve was plotted,and Spearman rank correlation analysis was used to evaluate the diagnostic efficacy and correlation of DKI and IVIM global histogram parameters in predicting NAC efficacy.The DeLong test was used to compare whether there was statistical significance in area under the curve(AUC)differences among histogram parameters.Results The DKI MD value(90th percentile,mean,median,maximum,range,root mean square),IVIM D value(mean,range,root mean square,median)and D*value(entropy,90th percentile)of patients with breast invasive ductal carcinoma in the significant group with efficacy of NAC were higher than those in the non-significant group,while the DKI MK value(mean and median)were lower than those in the non-significant group,and all the differences mentioned above were statistically significant(P＜0.05).The AUC,sensitivity and specificity of DKI combined with IVIM global histogram parameters were the highest,which were 0.816,72.41％and 90.00％,respectively.MD value,D value and D*value were negatively correlated with the efficacy of NAC in breast invasive ductal carcinoma.MK value was positively correlated with NAC efficacy significance.Conclusion DKI combined with IVIM global histogram parameters can effectively predict the efficacy of NAC in patients with breast invasive ductal carcinoma and provide effective value for clinical NAC preoperative efficacy evaluation.