ObjectiveThis paper aims to evaluate the intervention effect of Gandou Fumu Decoction （GDFMD） in treating hepatolenticular degeneration with liver fibrosis of liver-kidney deficiency and phlegm-blood stasis syndrome， thereby providing evidence-based medical evidence for the treatment of Wilson's disease （WD）-related liver fibrosis with traditional Chinese medicine through clinical efficacy analysis. MethodsA total of 70 patients with WD-related liver fibrosis of liver-kidney deficiency and phlegm-blood stasis syndrome meeting the inclusion criteria were enrolled from Anhui Provincial Hospital of TCM from October 1， 2023， to October 1， 2024. Participants were divided into a control group and an observation group， with 35 cases in each group. The control group received conventional copper chelation therapy with sodium dimercaptopropanesulfonate （DMPS）. On this basis， the observation group was additionally administered GDFMD orally. Each treatment course lasted eight days， for a total of four treatment courses. Efficacy evaluations were performed before treatment and after the second and fourth treatment courses， respectively. The clinical efficacy and safety of GDFMD in the treatment of WD-related liver fibrosis were assessed by comparing the changes in liver stiffness measurement （LSM）， liver serological markers ［alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， type Ⅳ collagen （C-Ⅳ）， laminin （LN）， N-terminal propeptide of type Ⅲ procollagen （PⅢNP）， and hyaluronic acid （HA）］， fibrosis index based on 4 factors （FIB-4）， AST to platelet ratio index （APRI）， unified Wilson's disease rating scale part Ⅱ （UWDRS-Ⅱ）， traditional Chinese medicine （TCM） syndrome score， 24-hour urinary copper， and safety indicators between the two groups before and after treatment. ResultsCompared with those before treatment， LSM levels decreased in both groups after two and four treatment courses （P<0.05）. Compared with those after treatment， there was no statistically significant difference in the improvement of LSM levels in the observation group after two treatment courses， and the improvement of LSM levels in the observation group was more obvious after four treatment courses （P<0.05）. Compared with those before treatment， the levels of HA， LN， PⅢNP， and C-Ⅳ decreased in both groups after two and four treatment courses （P<0.05）. Compared with those after treatment， there was no statistically significant difference in the improvement of the C-Ⅳ levels in the observation group after two treatment courses， and the levels of HA， LN， and PⅢNP were more obvious （P<0.05）. After four treatment courses in the observation group， the levels of HA， LN， PⅢNP， and C-Ⅳ were improved more significantly （P<0.05）. Compared with those before treatment， ALT and AST levels decreased in both groups after two and four treatment courses （P<0.05）. Compared with the control group after treatment， there was no statistically significant difference in the improvement of ALT and AST levels in the observation group after two treatment courses， and the improvement of ALT and AST levels in the observation group was more obvious after four treatment courses （P<0.05）. Compared with those before treatment， APRI score and FIB-4 index level decreased in both groups after two and four treatment courses （P<0.05）. Compared with those in control group after treatment， there was no statistically significant difference in the improvement of APRI score and FIB-4 index level in the observation group after two treatment courses， and the APRI score in the observation group was more obvious after four treatment courses （P<0.05）， with no statistically significant improvement in the FIB-4 index difference. Compared with those before treatment， the levels of TCM syndrome scores decreased in both groups after two and four treatment courses （P<0.05）. Compared with that of the control group after treatment， there was no statistically significant difference in the improvement of the level of TCM syndrome scores in the observation group after two treatment courses， and the improvement of the level of TCM syndrome scores in the observation group was more obvious after four treatment courses （P<0.05）. Compared with those before treatment， the UWDRS-Ⅱ scores in both groups after two treatment courses were not improved obviously， and the UWDRS-Ⅱ scores in both groups decreased after four treatment courses （P<0.05）. Compared with those of the control group after treatment， there was no statistically significant difference in the improvement of the UWDRS-Ⅱ scores in the observation group after two treatment courses， and the improvement of the UWDRS-Ⅱ scores in the observation group after four treatment courses was more obvious （P<0.05）. Compared with those before treatment， the 24-h urine copper levels were significantly higher in both groups after two and four treatment courses （P<0.05）. Compared with those in the control group after treatment， the 24-h urine copper levels in the observation group were significantly higher after two and four treatment courses （P<0.01）. After two treatment courses， the 24-h urine copper level in the observation group showed a gradual decreasing trend， although it was higher than that before treatment. After four treatment courses， the control group had an improvement rate of 91.43%， an effective rate of 34.29%， and an apparent rate of 2.86%. The observation group had an improvement rate of 94.29%， an effective rate of 71.43%， and an apparent rate of 8.57%. The efficacy of the observation group was better than that of the control group （P<0.05）. Conclusion① The efficacy of GDFMD combined with DMPS therapy in patients with WD-related liver fibrosis of liver-kidney deficiency and phlegm-blood stasis syndrome is significantly better than that of single DMPS therapy， and the advantages of the combined therapy are more obvious with the prolongation of the treatment cycle. ② GDFMD combined with the DMPS therapy program in the long-term application exhibits no obvious adverse reactions with good safety， which is worthy of clinical popularization and application.

ObjectiveThis paper aims to evaluate the intervention effect of Gandou Fumu Decoction （GDFMD） in treating hepatolenticular degeneration with liver fibrosis of liver-kidney deficiency and phlegm-blood stasis syndrome， thereby providing evidence-based medical evidence for the treatment of Wilson's disease （WD）-related liver fibrosis with traditional Chinese medicine through clinical efficacy analysis. MethodsA total of 70 patients with WD-related liver fibrosis of liver-kidney deficiency and phlegm-blood stasis syndrome meeting the inclusion criteria were enrolled from Anhui Provincial Hospital of TCM from October 1， 2023， to October 1， 2024. Participants were divided into a control group and an observation group， with 35 cases in each group. The control group received conventional copper chelation therapy with sodium dimercaptopropanesulfonate （DMPS）. On this basis， the observation group was additionally administered GDFMD orally. Each treatment course lasted eight days， for a total of four treatment courses. Efficacy evaluations were performed before treatment and after the second and fourth treatment courses， respectively. The clinical efficacy and safety of GDFMD in the treatment of WD-related liver fibrosis were assessed by comparing the changes in liver stiffness measurement （LSM）， liver serological markers ［alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， type Ⅳ collagen （C-Ⅳ）， laminin （LN）， N-terminal propeptide of type Ⅲ procollagen （PⅢNP）， and hyaluronic acid （HA）］， fibrosis index based on 4 factors （FIB-4）， AST to platelet ratio index （APRI）， unified Wilson's disease rating scale part Ⅱ （UWDRS-Ⅱ）， traditional Chinese medicine （TCM） syndrome score， 24-hour urinary copper， and safety indicators between the two groups before and after treatment. ResultsCompared with those before treatment， LSM levels decreased in both groups after two and four treatment courses （P<0.05）. Compared with those after treatment， there was no statistically significant difference in the improvement of LSM levels in the observation group after two treatment courses， and the improvement of LSM levels in the observation group was more obvious after four treatment courses （P<0.05）. Compared with those before treatment， the levels of HA， LN， PⅢNP， and C-Ⅳ decreased in both groups after two and four treatment courses （P<0.05）. Compared with those after treatment， there was no statistically significant difference in the improvement of the C-Ⅳ levels in the observation group after two treatment courses， and the levels of HA， LN， and PⅢNP were more obvious （P<0.05）. After four treatment courses in the observation group， the levels of HA， LN， PⅢNP， and C-Ⅳ were improved more significantly （P<0.05）. Compared with those before treatment， ALT and AST levels decreased in both groups after two and four treatment courses （P<0.05）. Compared with the control group after treatment， there was no statistically significant difference in the improvement of ALT and AST levels in the observation group after two treatment courses， and the improvement of ALT and AST levels in the observation group was more obvious after four treatment courses （P<0.05）. Compared with those before treatment， APRI score and FIB-4 index level decreased in both groups after two and four treatment courses （P<0.05）. Compared with those in control group after treatment， there was no statistically significant difference in the improvement of APRI score and FIB-4 index level in the observation group after two treatment courses， and the APRI score in the observation group was more obvious after four treatment courses （P<0.05）， with no statistically significant improvement in the FIB-4 index difference. Compared with those before treatment， the levels of TCM syndrome scores decreased in both groups after two and four treatment courses （P<0.05）. Compared with that of the control group after treatment， there was no statistically significant difference in the improvement of the level of TCM syndrome scores in the observation group after two treatment courses， and the improvement of the level of TCM syndrome scores in the observation group was more obvious after four treatment courses （P<0.05）. Compared with those before treatment， the UWDRS-Ⅱ scores in both groups after two treatment courses were not improved obviously， and the UWDRS-Ⅱ scores in both groups decreased after four treatment courses （P<0.05）. Compared with those of the control group after treatment， there was no statistically significant difference in the improvement of the UWDRS-Ⅱ scores in the observation group after two treatment courses， and the improvement of the UWDRS-Ⅱ scores in the observation group after four treatment courses was more obvious （P<0.05）. Compared with those before treatment， the 24-h urine copper levels were significantly higher in both groups after two and four treatment courses （P<0.05）. Compared with those in the control group after treatment， the 24-h urine copper levels in the observation group were significantly higher after two and four treatment courses （P<0.01）. After two treatment courses， the 24-h urine copper level in the observation group showed a gradual decreasing trend， although it was higher than that before treatment. After four treatment courses， the control group had an improvement rate of 91.43%， an effective rate of 34.29%， and an apparent rate of 2.86%. The observation group had an improvement rate of 94.29%， an effective rate of 71.43%， and an apparent rate of 8.57%. The efficacy of the observation group was better than that of the control group （P<0.05）. Conclusion① The efficacy of GDFMD combined with DMPS therapy in patients with WD-related liver fibrosis of liver-kidney deficiency and phlegm-blood stasis syndrome is significantly better than that of single DMPS therapy， and the advantages of the combined therapy are more obvious with the prolongation of the treatment cycle. ② GDFMD combined with the DMPS therapy program in the long-term application exhibits no obvious adverse reactions with good safety， which is worthy of clinical popularization and application.

Objective To systematically evaluate the therapeutic effects of video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracic surgery (RATS) in treating mediastinal tumors. Methods A computer search was conducted on PubMed, Embase, Cochrane Library, Web of Science, Wanfang, CNKI, CBM, VIP databases for literature comparing the clinical efficacy of VATS and RATS in treating mediastinal tumors, with the search time from inception to March 31, 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included cohort studies, and Review Manager 5.4 software was used to perform a meta-analysis. Results A total of 32 articles were included, with 7868 patients. The NOS scores of the included cohort studies were all≥7 points. Meta-analysis results showed that compared with the VATS group, the RATS group had less intraoperative blood loss [MD=−16.71, 95%CI (−23.88, −9.54), P<0.001], lower conversion rate to open thoracotomy [OR=0.41, 95%CI (0.26, 0.67), P=0.003], lower overall postoperative complication rate [OR=0.66, 95%CI (0.48, 0.92), P=0.01], shorter postoperative drainage time [MD=−0.64, 95%CI (−0.92, −0.36), P<0.001], and shorter postoperative hospital stay [MD=−1.03, 95%CI (−1.28, −0.78), P<0.001]. There was no statistical difference between the two groups in terms of tumor size [MD=−0.06, 95%CI (−0.31, 0.19), P=0.64] or operation time [MD=5.52, 95%CI (−2.35, 13.40), P=0.17]. The RATS group had higher hospitalization costs than the VATS group [MD=1.69, 95%CI (1.26, 2.13), P<0.001]. Conclusion In mediastinal tumors resection, RATS is superior to VATS in terms of intraoperative blood loss, conversion rate to open thoracotomy, overall postoperative complication rate, postoperative drainage time, and postoperative hospital stay, but it increases hospitalization costs.

Objective To analyze the disease burden and trends of bladder cancer in China and globally from 1992 to 2021.  Methods Using the GBD 2021 database, the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates of bladder cancer in China and globally from 1992–2021 were analyzed. Average annual percentage change (AAPC) was calculated using Joinpoint regression. Subgroup analyses by sex and age were conducted, and a Bayesian age-period-cohort (BAPC) model was used to predict trends in age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for the next 15 years.  Results In 2021, China reported 106 000 new cases (ASIR: 5.14/100 000), 571 000 prevalent cases (age-standardized prevalence rate, ASPR: 26.61/100 000), 43 000 deaths (ASMR: 2.34/100 000), and a DALY rate of 45.31/100 000. From 1992–2021, China showed upward trends in ASIR and ASPR but declines in ASMR and DALYs, while global ASIR, ASMR, and DALYs decreased overall with slow ASPR growth. The peak cases in China and globally were both concentrated in the 65-79 age group, with a significantly higher burden on males than females. In China, smoking-related ASMR and ASDR exceeded global averages and rose, whereas high glucose-related indexes were lower and declined. Projections for 2021–2036 indicated that the global incidence and mortality rates would be rising, but ASIR/ASPR would be declining, while in China, the incidence rate would continue to rise, and the mortality rate will stabilize, with a significant increase in ASIR and a gradual decrease in ASPR.  Conclusion From 1992 to 2021, the incidence of bladder cancer in China has shown a continuous upward trend and is projected to persist in the future, with significant gender and age differences. Particular attention should be given to elderly males aged 85-89. The disease burden of bladder cancer attributable to smoking continues to rise, highlighting the urgent need to strengthen tobacco control policies.

BACKGROUND:Based on the principle of vertical tooth movement,a personalized orthodontic appliance is created through digital design combined with 3D printing,so that the personalized orthodontic appliance forms a support system with the individual incisors.With the help of the absolute support of the micro-implant,the single tooth is precisely controlled in a three-dimensional direction.OBJECTIVE:To design personalized orthodontic appliances with 11,12,21,and 22 intrusion and extrusion based on biomechanical principles,and analyze the safety of the personalized orthodontic appliances in terms of their movement effect on the teeth by means of the three-dimensional finite element method.METHODS:Three-dimensional finite element models of alveolar bone-periodontium-maxillary incisors-personalized cantilever micro-implant-connecting plates-personalized brackets in the maxillary anterior region(teeth numbers 11,12,21,and 22)were established using Mimics,Geomagic Wrap,SolidWorks,and Ansys Workbench software,respectively.Personalized orthodontic appliances with low pressure movement and extended movement were set up at each tooth position.The stress level of each component of the personalized orthodontic appliances was analyzed,and the tooth displacement and periodontal stress distribution were calculated under loading of 300 g tensile or thrust force.RESULTS AND CONCLUSION:(1)The maximum equivalent force on the personalized intrusion mobile orthodontic appliance was 162.90 MPa,and the maximum equivalent force on the personalized extrusion mobile orthodontic appliance was 239.57 MPa.The maximum equivalent stress on both devices was located in the vertical portion of the personalized bracket loading attachment.The equivalent stresses on each part of the personalized orthodontic appliance were all within the yield strength,and they had good safety.(2)The initial displacement of the teeth under the action of the personalized orthodontic appliances showed a tendency towards overall intrusion or extrusion,with the displacement in the vertical direction far exceeding that in the horizontal and sagittal directions.The equivalent stress peak appeared at the root tip or neck of the periodontal membrane,and the equivalent stress concentration area appeared in the periodontal membrane of the root apical region.(3)The results show that the personalized orthodontic appliance allows 11,12,21,and 22 to approximate either intrusion movement or extrusion movement,initially confirming the effectiveness of the personalized vertical movement orthodontic appliance.

Objective To construct a decision support education program for the family members of patients with advanced cancer and to investigate its application effects,so as to improve understanding and acceptance of hospice care for family members of advanced cancer patients.Methods Using the Ottawa Decision Support Framework as a theoretical guide,the program was initially drafted based on a literature review,qualitative interview and expert consultation.From September 2023 to January 2024,a convenience sampling method was used to select patients' families in a tertiary-level hospital in Tianjin as the research subjects,and they were randomly divided into an experimental group and a control group.The experimental group received the decision support education program in addition to routine care,while the control group received routine care.Family members' knowledge about hospice,the scores on the Death Attitude Profile Scale,and their willingness to choose hospice care were compared before and after the interventions.Results The program finally included 4 first-level items,15 second-level items,and 59 third-level items.During the program implementation phase,4 cases withdrew from the study,resulting in 46 cases in the experimental group and 47 cases in the control group.After intervention,the experimental group had higher scores on hospice knowledge and positive attitude towards death than the control group,while scores on negative attitude towards death were lower(P＜0.05);their willingness to choose hospice care for themselves and for the patients was higher than that of the control group(P＜0.05).Conclusion The hospice care decision support education program is scientific,feasible and practical,which can improve the knowledge of hospice care of the family members,improve their attitude towards death,and ultimately improve their willingness to choose hospice care.

Objective To construct a decision support education program for the family members of patients with advanced cancer and to investigate its application effects,so as to improve understanding and acceptance of hospice care for family members of advanced cancer patients.Methods Using the Ottawa Decision Support Framework as a theoretical guide,the program was initially drafted based on a literature review,qualitative interview and expert consultation.From September 2023 to January 2024,a convenience sampling method was used to select patients' families in a tertiary-level hospital in Tianjin as the research subjects,and they were randomly divided into an experimental group and a control group.The experimental group received the decision support education program in addition to routine care,while the control group received routine care.Family members' knowledge about hospice,the scores on the Death Attitude Profile Scale,and their willingness to choose hospice care were compared before and after the interventions.Results The program finally included 4 first-level items,15 second-level items,and 59 third-level items.During the program implementation phase,4 cases withdrew from the study,resulting in 46 cases in the experimental group and 47 cases in the control group.After intervention,the experimental group had higher scores on hospice knowledge and positive attitude towards death than the control group,while scores on negative attitude towards death were lower(P＜0.05);their willingness to choose hospice care for themselves and for the patients was higher than that of the control group(P＜0.05).Conclusion The hospice care decision support education program is scientific,feasible and practical,which can improve the knowledge of hospice care of the family members,improve their attitude towards death,and ultimately improve their willingness to choose hospice care.

BACKGROUND:In orthodontic treatment,full-mouth treatment is usually used to treat single-root severely twisted teeth,and single-tooth treatment is less common.OBJECTIVE:To design a personalized orthodontic device based on biomechanical principles to address the rotation of teeth 11,12,13,21,22,and 23,and evaluate the device's impact on tooth movement using three-dimensional finite element method.METHODS:Based on the biomechanical principle of tooth rotation and movement,a personalized orthodontic device was made by digital design combined with three-dimensional printing,so that the personalized orthodontic device and the tooth formed an anchorage system.The absolute anchorage of the micro-implant was used to precisely control the single-root twisted tooth in the three-dimensional direction.The CBCT data of the maxillary alveolar bone and tooth tissue of a female volunteer were collected.The three-dimensional finite element models of the twisted tooth-periodontal ligament-maxillary bone-personalized orthodontic device were established using Mimics,Geomagic Wrap,SolidWorks,3-matic Research 15.0,and Ansys Workbench software.The equivalent stress distribution characteristics of the personalized orthodontic device,the movement trend of the tooth,and the equivalent stress distribution characteristics of the periodontal ligament were calculated under a thrust of 60 g.RESULTS AND CONCLUSION:(1)The maximum equivalent stress observed on the personalized orthodontic device was 47.71 MPa.(2)The initial tooth displacement under the device demonstrated a rotational trend.The peak equivalent stress in the periodontal ligament was concentrated at the neck,while lower stress was observed in the apex region.(3)The safety and feasibility of the personalized orthodontic device designed in this study for severely rotated single-rooted teeth were preliminarily verified through finite element analysis.

Objective:To investigate the application of transoral robotic thyroidectomy (TORT) in overweight patients.Methods:Clinical data of 109 thyroid tumor patients who underwent TORT at 960th Hospital of People’s Liberation Army from May. 2020 to Aug. 2023 were retrospectively collected and analyzed. After excluding 10 patients who underwent prophylactic lateral neck dissection, a total of 99 patients were included in this study. According to the World Health Organization (WHO) guidelines, which define people with BMI:25-29.9 kg/m 2 as overweight, we divided the 99 patients into normal weight group (n=69) and overweight group (n=30) . To make the baseline data consistent between the two groups and ensure comparability, 20 matched pairs were generated using a 1∶1 propensity score matching (PSM) method, considering four clinicopathologic factors: age, gender, diameter of tumor and operation scope. In the normal-weight group, there were 18 females and 2 males, aged (32.82±9.51) years (range: 17-53 years) , and there exhibited 18 females and 2 males in the overweight group, aged (35.14±10.63) years (range: 18-55 years) . Results:All patients successfully underwent the operation without conversions to open surgery. After matching, both groups had 2 cases of thyroid adenoma and 18 cases of papillary thyroid carcinoma ( P=1) , with no statistically significant difference in the surgical scope between the two groups ( P=0.376) . There was no statistically significant difference in the mean tumor diameter between the normal-weight group and the overweight group (5.38±1.79 mm vs. 5.61±3.32 mm, P=0.575) . All malignant tumor cases in both groups were classified as T1 stage, and there was no statistically significant difference in N stage ( P=0.186) . All patients with malignant tumors underwent central lymph node dissection, there was no significant difference in the number of central lymph nodes dissected ( P=0.623) and metastatic lymph nodes ( P=0.109) between the two groups. There were no statistically significant differences in operative duration (217.53±62.83 min vs. 220.67±73.73 min, P=0.808) , median postoperative hospital stay [6 (6,7.75) days vs. 6 (6,7) days, P=0.682], or 24-hour drainage volume (78.52±30.49 mL vs. 68.23±29.11 mL, P=0.180) between the normal-weight group and the overweight group. There was no permanent hypoparathyroidism, postoperative hemorrhage, lymphatic fistula, mental nerve injury, postoperative infection in both groups. In both groups, there occurred one case of transient hypoparathyroidism. As for other complications, 1 case of temporary recurrent laryngeal nerve injury and oral tearing occurred in the overweight group, while the normal-weight group had 1 case of skin scald. Conclusions:Among patients who underwent TORT, the overweight group exhibited comparable surgical outcomes and postoperative complications to those in the normal-weight group. TORT is a safe and feasible surgical option for overweight patients, which provides more surgical options for this patient population.

Viruses,as important biological agents influencing human health and social development,have played a key role in the spread of epidemics and the evolution of diseases since ancient times.Upon infecting hosts,viruses often trigger a series of com-plex responses,including innate and adaptive immunity,inflammatory responses and pathological damage.Despite advances in mod-ern antiviral drugs development,chemical drugs typically rely on a single molecular target within the viral life cycle,making them highly susceptible to the emergence of drug resistance and the induction of systemic toxic side effects.In contrast,traditional Chi-nese medicines(TCMs),posing the distinctive advantage of multi-component,multi-target,and multi-pathway,have exerted a pivotal role in viral prevention and viral treatment.In recent years,fresh herbs have gained increasing attention for their ability to preserve intact bioactive components.Fresh herb-derived nanovesicles possess excellent biocompatibility,targeting and cross-species regula-tory capabilities.These fresh herb-derived nanovesicles can effectively encapsulate and deliver a variety of antiviral components,demonstrating significant potential in antiviral immunomodulation,inflammation control and viral-induced pathologies.This review systematically sorts out the mechanisms of viral infection,and summarizes the advantages of fresh herbs,and the application pros-pects of fresh herb-derived nanovesicles in antiviral therapy.Furthermore,it focuses on summarizing the research progress of fresh herb-derived nanovesicles in the field of antiviral therapy,with the aim of providing insights and references for the development of fresh herb-derived nanovesicles-based antiviral strategies,as well as offering novel approaches and perspectives for the clinical treat-ment of viral diseases.