This paper discusses the treatment of polycystic ovary syndrome(PCOS)based on the midnight-noon ebb-flow theory.The midnight-noon ebb-flow theory is a Chinese medicine science that combines the time and space of nature with the internal rhythm of the human body.PCOS is characterized by disappearance of the reproductive monthly rhythm.Its etiology is based on kidney deficiency.The key to its pathogenesis is the excess of yin and deficiency of yang,the hyperactivity of yang and deficiency of yin,and the lack of smooth connection between yin and yang.PCOS patients have circadian rhythm disorders,and the oscillation of the core clock gene is attenuated,which leads to the interruption of the circadian rhythm gene in the ovary,the imbalance of yin and yang trans-formation in the kidney,and the asynchrony of qi and blood flow with the time rhythm.Therefore,the treatment focuses on harmonizing yin and yang and rebuilding the normal reproductive rhythm of women.Using the midnight-noon ebb-flow theory,combined with the reproductive physiological characteristics of women,choosing different drug administration time and selecting meridians and acupoints according to the time will be helpful to unlock the"time code"of the female reproductive system,and assist clinical menstruation regu-lation,pregnancy and treatment of diseases.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To study the clinical application of a new classification on location of hepatolithiasis in guiding treatment using percutaneous transhepatic choledochoscopic lithotomy (PTCSL).Methods:The clinical data of 85 consecutive patients with preoperatively diagnosed hepatolithiasis who underwent PTCSL at the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were prospectively collected. There were 27 males and 58 females, aged from 15 to 86(62±14) years. Hepatolithiasis was classified into five types of stone location based on preoperative imagings: type Ⅰ ( n=12) , stones located in central bile duct, including hilar bile duct and common hepatic duct; type Ⅱ ( n=17) in unilateral hepatic duct with multiple branches; type Ⅲ ( n=24) in unilateral hepatic duct with multiple branches plus central bile duct; type Ⅳ ( n=31) in bilateral hepatic ducts with multiple branches; and type Ⅴ ( n=1) in unilateral hepatic duct with a single branch. Fistulation path, number of procedures, number of bile duct fistula, and complications were recorded. The residual stone rate and stone recurrence rate were compared among the five types. The follow-up was performed to analyse prognosis. Results:A total of 99 biliary fistulae were performed, with one single tract created in 74 patients, two tracts in 9 patients, three tracts in 1 patient, and four tracts in 1 patient. The fistulation path was B2 in 12 patients, B3 in 18 patients, B4 in 1 patient, B5 in 4 patients, B6 in 10 patients, B7 in 4 patients, and B8 in 50 patients. Altogether, 151 choledochoscopic lithotomy procedures were performed (1-3 times per patient, mean 1.78 times). For the 9 patients with residual stones (10.6%, 9/85), there were 3 patients with type Ⅱ and 6 patients with type Ⅳ. There were significant differences in the residual stone rates among the 5 types (χ 2=11.13, P=0.025). Stone recurrence developed in 33 (38.8%) patients, including 2 patients with type Ⅰ, 7 patients with type Ⅱ, 10 patients with type Ⅲ and 14 patients with type Ⅳ (χ 2=9.07, P=0.046). The total intraoperative and postoperative complications rates was 28.2% (24/85). The follow-up period was 4-58 months with the median follow-up time of 30 months. Twelve patients died during the follow-up period, including 1 patient who died from postoperative bleeding, 3 cholangiocarcinoma, 7 biliary cirrhosis-related liver failure, and 1 stone-unrelated disease. Conclusion:Type Ⅳ in the location classification of hepatolithiasis based on PTCSL had significantly higher rates of residual stones and stone recurrence. This new classification is helpful for clinicaians to determine the optimal path using a smaller number of fistulation tracts to clear stones. It improved the efficacy of PTCSL in treating hepatolithiasis.

Objective:To analyze the risk factors of Intensive Care Unit-Acquired Weakness, and to develop and verify the model.Methods:A total of 247 patients admitted to ICU patients from November 2018 to October 2019 were selected, and risk factors between ICU acquired weakness group ( n=106) and non-ICU acquired weakness group( n=141)were compared using logistic regression for model construction.The Hosmer-Lemeshow test was used to verify the goodness of fit of the model. The area under the ROC curve was used to test the model to predict the effects. From November 2019 to May 2020, 106 patients were recruited for application of the model. Results:The incidence of ICU acquired weakness in this study was 42.91%(106/247), and 44.34%(47/106),the study finally included age ( OR=1.043) ,mechanical ventilation time ( OR=1.140) , APACHE II score ( OR=1.081) , blood sugar ( OR=1.117) , lactic acid( OR=1.459) ,and neuromuscular blockers ( OR=3.499) to construct the risk prediction. The model formula was P=1/1+exp (- Z) =1/1+exp (8.808-0.042×age -1.252×neuromuscular blockers-0.078×APACHE II score -0.110×blood sugar -0.378×lactic acid -0.131×mechanical ventilation time. The area under the ROC curve of this model was 0.896 (95% CI: 0.824-0.914) , the maximum value of the Youden index was 0.577, and the corresponding sensitivity was 0.754,the specificity was 0.823,the cutoff value was 0.503. The model verification results the sensibility of 70.2%, the specificity of 88.1%, and the accuracy of 80.2%. Conclusion:The predictic model of ICU acquired weakness couducted in this study has satisfactory prediction effect, which can provide a reference for clinical screening of high-risk patients.

Objective:To explore the risk factors for myelosuppression in elderly lung cancer patients undergoing chemotherapy and construct a risk prediction model for myelosuppression in elderly lung cancer patients undergoing chemotherapy.Methods:Using the convenient sampling method, data of 228 elderly patients with lung cancer undergoing chemotherapy in Respiratory Department of a Class Ⅲ Grade A hospital in Zhenjiang from May 2018 to May 2019 were selected, and risk factors of adverse reactions of myelosuppression in patients were analyzed statistically. The binomial Logistic regression was applied to construct the prediction model and the area under the ROC curve was used to test the prediction effect of the model. The patient data from January to May 2020 were collected to validate the model.Results:Among the 228 patients, 75 patients developed myelosuppression, with an incidence of 32.89%. Multivariate analysis results showed that platinum-containing chemotherapy regimens, combined with other adverse reactions, decreased albumin before chemotherapy and decreased hemoglobin before chemotherapy were independent risk factors for myelosuppression in elderly lung cancer patients during chemotherapy ( P<0.05) , which were included in the model. The area under the ROC curve of the final model was 0.823, the maximum Youden index was 0.5, sensitivity was 81.3%, and specificity was 70.5%. The results of the verification data showed that the area under the ROC curve was 0.846, sensitivity was 90.4% and specificity was 68.2%. Conclusions:The prediction effect of this model is good, which can provide reference basis for clinical treatment and formulating nursing measures to prevent myelosuppression.

Angiokinases, such as vascular endothelial-, fibroblast- and platelet-derived growth factor receptors (VEGFRs, FGFRs and PDGFRs) play crucial roles in tumor angiogenesis. Anti-angiogenesis therapy using multi-angiokinase inhibitor has achieved great success in recent years. In this study, we presented the design, synthesis, target identification, molecular mechanism, pharmacodynamics (PD) and pharmacokinetics (PK) research of a novel triple-angiokinase inhibitor WXFL-152. WXFL-152, identified from a series of 4-oxyquinoline derivatives based on a structure-activity relationship study, inhibited the proliferation of vascular endothelial cells (ECs) and pericytes by blocking the angiokinase signals VEGF/VEGFR2, FGF/FGFRs and PDGF/PDGFR simultaneously . Significant anticancer effects of WXFL-152 were confirmed in multiple preclinical tumor xenograft models, including a patient-derived tumor xenograft (PDX) model. Pharmacokinetic studies of WXFL-152 demonstrated high favourable bioavailability with single-dose and continuous multi-dose by oral administration in rats and beagles. In conclusion, WXFL-152, which is currently in phase Ib clinical trials, is a novel and effective triple-angiokinase inhibitor with clear PD and PK in tumor therapy.

Objective To explore the structure changes of white matter in the first-episode schizo-phrenic patients with never-medicated(FESZ)and the relationship between facial emotion perception and white matter(WM)integrity.Methods Sixty-three schizophrenic patients and thirty health control subjects underwent diffusion tensor imaging(DTI)scans.Voxel-based analysis was used to compared fractional ani-sotropy(FA)map between the two groups.Correlations were analyzed with pearson relative analysis between impaired facial emotion perception tested by facial emotion categorization(FEC)and severity of symptoms measured by the Positive and Negative Syndrome Scale(PANSS).Results (1)Compared with controls, FESZ patients showed overall decreased FA in WM of the body of left ventral frontal lobe((MNI(x,y,z):-18,26,-4;t=4.43)),right supramarginal gyrus((MNI(x,y,z):32,-50,26;t=4.27)),left middle oc-cipital gyral((MNI(x,y,z):-26,-60,0;t=4.89)),right middle occipital gyral((MNI(x,y,z):28,-70, 14;t=4.18)),left fusiform gyrus((MNI(x,y,z):-40,-50,0;t=3.92)),left cerebellum anterior lobe ((MNI(x,y,z):-32,-56,-28;t=4.57)),right parahippocampa gyrus1((MNI(x,y,z):32,-10,-14;t=4.16)),right parahippocampa gyrus2((MNI(x,y,z):16,-6,-14;t=4.56)),left anterior cingulate ((MNI(x,y,z):-2,4,-6;t=4.41)),left extra-nuclear((MNI(x,y,z):-2,-10,-6;t=4.44)),right thalamus((MNI(x,y,z):10,-10,2;t=4.20)),left thalamus((MNI(x,y,z):-22,-28,12;t=4.01)), and right caudate((MNI(x,y,z):14,12,8;t=4.87)).(2)Compared with controls,the patients with schizo-phrenia showed a higher shift point and a steeper slope than control subjects in FEC.Correlational analysis re-vealed that the negative correlations were found between the slope and negative factor(r=-0.298,P=0.036),between positive factor and the FA value in WM of the right middle occipital gyral(r=-0.322,P=0.023)and the left middle occipital gyral(r=-0.288,P=0.043),and between the FA value in the left cere-bellum anterior lobe and shift point(r=-0.393,P=0.005),but the positive correlation was found between disorganized/concrete factor and the FA value in the right parahippocampal gyrus(r=0.429,P=0.002).Con-clusions There are extensive microstructural abnormalities in WM of patients with FESZ.Disrupted WM in-tegrity in these regions may constitute a potential neural pathological basis for the facial emotion perception impairments in schizophrenia.

Objective · To explored the correlation of preoperative peripheral blood neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) with clinical characteristics and prognosis of ovarian cancer. Methods · Patients' clinicopathological data of 127 cases of benign tumors and 286 cases of malignant tumor were collected, and the correlation between the level NLR and PLR in patients with ovarian cancer clinical pathology indicators and overall survival was analyzed. Results · preoperative NLR and PLR levels in patients with ovarian cancer were higher than those in benign tumors(P=0.000). The optimal cut-off point of NLR and PLR were 3.0 and 151. There was statistical significant difference between the high level of NLR group (NLR ≥ 3) and the low level of NLR group in pathological type, FIGO staging, lymph node metastasis, CA125 level and the amount of ascites (P<0.05). There was statistical significant difference between the high level of PLR group (PLR ≥ 151) and the low level of PLR group in FIGO stage,transfer status, CA125 level and quantity of ascites (P<0.05). The median survival time for NLR/PLR in the high level group were 33 and 33.5 months lower than that ofthe corresponding group of 44.5 and 49.5 months (P=0.044, P=0.000). Multivariate Cox regression analysis showed that PLR ≥ 151 were independent risk factors affectOS in ovarian cancer patients (HR=1.936, 95% CI=1.013-3.698, P=0.045). Conclusion · The elevated blood preoperative PLR indicates poor prognosis of ovarian cancer patients. Preoperative PLR may serve as an important independent prognostic factor for ovarian cancer patients.

Objective To compare the predicted efficiency ofmacular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery.Methods This is a prospective exploratory clinical study.A total of 63 patients (63 eyes) with idiopathic MH,who received vitrectomy,inner limiting membrane peeling and gas tamponade,were enrolled in this study.All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=(M+N) /BASE,M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole,respectively.BASE is the length of MH base.MHCI1 was measured by built-in caliper of OCT software,MHCI2 was measured by ImageJ software.The minimum macular diameter (MHD) was measured by built-in caliper of OCT software.Based on the OCT images,the anatomical outcomes were classified grade A (bridge-like shape closure),grade B (complete closure) and grade C (poor closure).Grade A and B are considered as good closure,grade C as poor closure.Patients were followed up at 3,6 and 12 months after surgery.The closure grades at last visit were the final outcome.The relationship between MHCI 1,MHCI2 and closure grades was analyzed.And the predicted efficiency of MHD,MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied.Results The mean MHCI1 was 0.68±0.21 (0.30-1.35),MHCI2 was 0.95±0.26 (0.41-1.55),and MHD was (476.24±210.18) μm (127-956 μm).MHCI1 and MHCI2 were both negative correlated with the closure grades (r=-0.665,-0.691;P＜0.001).The receiver operating characteristic (ROC) curve analysis ofMHCI1,MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928,0.957 and 0.916 respectively,and 0.505,0.67 and 559 μm were set as the lower cut-offvalue.The sensitivity was 96.2％,92.3％ and 90.9％ respectively,and specificity was 81.8％,72.7％ and 76.9％ respectively.Accordingly,the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840,0.847 and 0.653 respectively,and 0.705,0.965 and 364 μm were set as the upper cut-off value.The sensitivity was 80.0％,82.9％,63.4％ respectively and specificity was 75.0％,85.7％,65.9％.Conclusion MHCI1 and MHCI2,measured by built-in caliper of OCT software or ImageJ software,both have good predictive efficiency for the anatomical outcomes of MH surgery.

Objective To observe visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation.Method The data of 39 ROP patients (73 eyes) who received laser photocoagulation were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex were matched with ROP group.There were 24 males (45 eyes) and 15 females (28 eyes) in ROP group,with an average age of (7.0± 1.28) years.The first laser treatment was carried out at postnatal age (PA) of (38.74±3.82) weeks,the birth weight (BW) of (1402.33 ±369.61) g and the number of laser burns was (517.86 ± 277.40).The control group included 7 females (13 eyes) and 6 males (12 eyes),with an average age of (7.17 ± 0.96) years.The age (t=0.691) and gender (x2=1.425) were comparable between the two groups (P=0.491,0.233).The data of patients and controls were retrospectively analyzed including best corrected visual acuity,refractive examination,automated perimetry test.The differences of the mean deviation (MD) of visual field and the spherical equivalent (SE) between these two groups were comparatively observed.ROP patients were divided into no VF loss group (MD≤2 dB) and VF loss group (MD＞2 dB),mild VF loss group (MD ≤ 6 dB) and moderate VF loss group (MD ＞6 dB) according to the results of automated perimetry test,the differences of gestational age (GA),PA,BW,number of laser burns and SE between these groups were comparatively observed.Results The MD in ROP group and control group were 4.87±5.12 dB and 1.27 ± 3.34 dB,respectively;the difference between the two groups was statistically significant (t=-4.01,P＜ 0.001).The subgroup analysis showed that BW,number of laser burns,and SE were significantly different between no VF loss group and VF loss group (t=2.074,-1.996,-2.162;P=0.042,0.026,0.034);while the GA was not significantly different between these two groups (t=1.973,P=0.052).The difference of PA was not statistical significant different between mild VF loss group and moderate VF loss group (t=2.03,P=0.051) and SE was significantly different between the above two groups (t=3.283,P=0.002).For refractive outcomes,the BW and ROP stage correlated with SE significantly (r=-0.304,-0.387;P=0.015,0.002).The mean BCVA in ROP group was 0.84±0.23,and 59 eyes (91.2％) with BCVA better than 0.5.Conclusion Laser treatment for ROP tends to have less effect on long term refractive status and VF loss,with good visual outcome.