ObjectiveTo investigate the awareness and clinical practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. MethodsFrom July 19 to December 31， 2024， a self-designed electronic questionnaire was distributed via the WeChat mini program to collect related data from 1 588 clinicians nationwide， including their awareness and practice based on 18 questions regarding testing and referral， diagnosis and treatment， and follow-up. ResultsAmong all respondents， only 350 clinicians correctly understood all the updated key points of antiviral indications and treatment for special populations in the 2022 edition of guidelines for the prevention and treatment of chronic hepatitis B， with an overall awareness rate of 22.0%. Only 20% ‍—‍ ‍40% of the patients with positive HBV DNA and an age of >30 years receive antiviral therapy， while 80% ‍—‍ ‍100% of the patients with positive HBV DNA and a family history of hepatitis B cirrhosis or hepatocellular carcinoma receive antiviral therapy. The median follow-up rates at 1 year， 3 years， and 5 years were 67.5% 57.5% and 47.5%，respectively， showing a trend of gradual reduction， which might be associated with the influencing factors such as insufficient time for follow-up management by clinicians， insufficient awareness of the disease among patients， and poor adherence to follow-up. ConclusionThere is a gap between the awareness and practice of guidelines for the prevention and treatment of chronic hepatitis B （2022 edition） among clinicians. It is recommended to further strengthen training and focus on the whole process of “detection， diagnosis， treatment， and management” for patients with chronic hepatitis B in healthcare institutions， in order to promote the implementation of the guidelines.

This article summarized Professor Liu Qiquan's clinical experience in treating urethral syndrome from the perspective of"regulating the five internal organs to calm the spleen and stomach".It is believed that urethral syndrome is located in the urethra,and its core pathogenesis is disharmony between the spleen and stomach,obstruction of dampness,and unfavorable water channel.Therefore,"tranquilizing the spleen and stomach"should be carried out throughout the treatment.At the same time,the occurrence of the disease is closely related to the disorder of the five internal organs.External sensation,internal injury,emotion,diet,fatigue and visceral disorders will affect the function of the five internal organs and then the disease will occur.In clinical practice,based on the idea of"regulating the five internal organs to calm the spleen and stomach",according to the symptoms and manifestations of the patients,the treatment can be guided by comprehensively using the methods of raising the clear and lowering the turbid to harmonize the stomach and dredge the drench,nourishing the heart and clearing the heart to purge heat and dredge the drench,benefiting the lung and purging heat to relieve dampness and dredge the drench,tonifying the kidney and warming the yang to dissipate qi and dredge the drench,dredging the liver and clearing the liver to promote the flow of qi and dredge the drench,which can make the five internal organs harmonious,benefit the waterways.Finally,the symptoms would be reduced and the disease would be cured.

Objective:To evaluate the efficacy and safety of antaitasvir phosphate 100 mg or 200 mg combined with yiqibuvir for 12 weeks in patients with various genotypes of chronic hepatitis C, without cirrhosis or compensated stage cirrhosis.Methods:Patients with chronic hepatitis C (without cirrhosis or compensated stage cirrhosis) were randomly assigned to the antaitasvir phosphate 100 mg+yiqibuvir 600 mg group (100 mg group) or the antaitasvir phosphate 200 mg+yiqibuvir 600 mg group (200 mg group) in a 1∶1 ratio. The drugs were continuously administered once a day for 12 weeks and observed for 24 weeks after drug withdrawal. The drug safety profile was assessed concurrently with the observation of the sustained virological response (SVR12) in the two patient groups 12 weeks following the drug cessation. The intention-to-treat concept was used to define as closely as possible a full analysis set, including all randomized cases who received the experimental drug at least once. The safety set was collected from all subjects who received the experimental drug at least once (regardless of whether they participated in the randomization group) in this study. All efficacy endpoints and safety profile data were summarized using descriptive statistics. The primary efficacy endpoint was SVR12. The primary analysis was performed on a full analysis set. The frequency and proportion of cases were calculated in the experimental drug group (antaitasvir phosphate capsules combined with yiqibuvir tablets) that achieved "HCV RNA

Disharmony between nutritive qi(ying)and defensive qi(wei)is the core pathogenesis of insomnia.The normal function of ying-wei in the generation,dispersion,divergence and aggregation is the precondition for the realization of the coordination between ying and wei.The disordered function of ying-wei in the generation,dispersion,divergence and aggregation will cause the disharmony between ying and wei,and then the insomnia occurs.For the treatment of insomnia caused by the disordered function of ying-wei in the generation,Guizhi Decoction associated prescriptions are used for strengthening middle energizer and nourishing ying and wei.For the treatment of insomnia caused by the disordered function of ying-wei in the dispersion,Mahuang Decoction associated prescriptions are used to relieve the exterior and eliminate the pathogen for insomnia patients with the manifestations of the attack of exopathogens,and Xiao Chaihu Decoction associated prescriptions are used to dredge the triple energizer for insomnia patients with the dysfunction of the triple energizer.For the treatment of insomnia caused by the disordered function of ying-wei in the divergence,Rhei Radix et Rhizoma associated bitter-cold prescriptions are used to purge the interior heat for insomnia patients with abundant interior heat syndrome,Gypsum Fibrosum associated pungent-cold prescriptions are used to release muscles and clear heat for insomnia patients with the interior heat complicated by exterior syndrome,Natrii Sulfas Exsiccatus associated salty-cold prescriptions are used to clear heat,moisten dryness and dissipate the masses for insomnia patients with interior heat complicated by dryness syndrome,sour-cold medicines are used to clear heat and remove retained water,supplement deficiency and relieve exterior for insomnia patients with interior heat complicated by water-retention syndrome,deficiency syndrome and exterior syndrome,and Ophiopogonis Radix associated prescriptions and Lillli Bulbus associated prescriptions are used to clear heat and nourish ying for insomnia patients with the consumption of ying and yin.For the treatment of insomnia caused by the disordered function of ying-wei in the aggregation,the compatibility of Poria and Cinnamomi Ramulus is used for warming yang and resolving fluid retention in patients with fluid retention,Taohong Siwu Decoction associated prescriptions are used to activate blood and remove stasis in patients with predominance of blood stasis syndrome,the compatibility of Poria and Paeoniae Radix Alba are used to treat retained water and blood stasis in patients with water-blood co-morbidity.Treating insomnia caused by disharmony between ying and wei from the perspective of the function of ying-wei in the generation,dispersion,divergence and aggregation is aimed at the core pathogenesis of insomnia,which makes the treatment easy to be carried out,and can provide reference for clinical differentiation and treatment of insomnia.

Objective To systematically evaluate the germplasm resources of Polygonatum odoratum(Mill.)Druce from the main producing areas in China.Methods A total of 35 tubers of Polygonatum odoratum from the main producing areas of China were collected to detect the water content,and the contents of nutrients including crude ash and crude fat,etc.and two medicinal components(polysaccharides and total flavonoids),and then the germplasm resources of Polygonatum odoratum were comprehensively evaluated by the coefficient of variation,correlation analysis and cluster analysis.Results In different Polygonatum odoratum tuber resources,the water content was 64.43%-83.78%,crude ash content was 1.03%-6.43%,lignin content was 2.83%-18.38%,cellulose content was 1.88%-4.73%,crude fat content was 2.85%-5.16%,crude protein content was 47.12-184.20 g/kg,the contents of polysaccharide and total flavonoids were 33.85-155.79 mg/g and 0.49-1.78 mg/g,respectively.Among them,the coefficients of variation for polysaccharide,crude ash,lignin,crude protein and total flavonoids were 0.45,0.42,0.38,0.31 and 0.30,respectively,showing large variations.There was a significant positive correlation between water content and contents of polysaccharide as well as various ingredient indexes in Polygonatum odoratum.The Polygonatum odoratum germplasm from different producing areas were mainly clustered into two types as follows:the first type was mainly from Guangdong and Hunan producing areas,the total flavonoids content being commonly higher,and the polysaccharide content of Polygonatum odoratum belongs to the second type in other producing areas was commonly higher.Four breeding materials with high content of medicinal ingredients were screened out by combining above indexes.Conclusion The high-quality germplasm was screened out through analyzing main nutrients and medicinal ingredients of Polygonatum odoratum tubers from different producing areas,contributing to providing data and material support for the evaluation of Polygonatum odoratum germplasm resources and strain breeding.

Objective To compare the effectiveness of TiRobot assisted F screw technique and inverted triangle parallel nail internal fixation in the treatment of unstable femoral neck fractures.Methods A retrospective analysis was conducted on 72 patients with unstable femoral neck fractures who were treated with percutaneous cannulated screw fixation assisted with TiRobot Orthopaedic robot from December 2019 to April 2021.Among them,37 patients were treated with F screw internal fixa-tion,including 16 males and 21 females,aged47 to 64years old with an average of(53.87±5.28)years old;According to Pauwels classification,there were 1 case of type Ⅰ,19 cases of type Ⅱ,17 cases of type Ⅲ;8 cases of combined medical diseases;17 cases of falling,8 cases of traffic accident and 12 cases of falling from height;The time from injury to operation was 29 to 49 hours with average of(35.00±7.34)hours.Another 35 cases used internal fixation with an inverted triangle parallel nail,including 13 males and 22 females with an average age of 46 to 63 years old(52.36±5.05)years old;According to the Pauwels injury classifi-cation:there were 2 cases of type Ⅰ,21 cases of type Ⅱ,12 cases of type Ⅲ;6 cases of medical diseases,15 cases of falling in-jury,9 cases of traffic accident,11 cases of falling injury;The time from injury to operation was 30 to 45 hours with an average of(33.00±6.83)h.The intraoperative blood loss,operation time,intraoperative fluoroscopy times,follow-up time,fracture healing time,postoperative complications were observed and compared between the two groups.The hip joint function was e-valuated by Harris score at 6 months and 12 months after operation.Results There was no significant difference in operation time,intraoperative blood loss,intraoperative fluoroscopy times and other intraoperative data between two groups(P＞0.05).Both groups were followed up regularly,and the follow-up time was 12 to 16 months.The fracture healing time and Harris score of the F screw internal fixation group were better than those of the inverted triangle parallel nail internal fixation group(P＜0.05).There was 1 case of femoral neck shortening in the F screw internal fixation group,1 case of nonunion,1 case of nail withdrawal,and 1 case of lower extremity deep vein thrombosis in the inverted triangle internal fixation group.The incidence of complications in the F screw internal fixation group was lower than that in the inverted triangle parallel nail internal fixation group(P＜0.05).Conclusion Percutaneous cannulated F screw technique using Tirobot navigation positioning system is a safe and effective treatment for patients with unstable femoral neck fractures.It can significantly shorten the fracture healing time,reduce the incidence of postoperative complications,significantly improve hip joint function,and improve the quality of life.

Objective:To explore the mediating effect of empowerment between self-perceived burden and medication adherence in kidney transplant recipients, so as to provide reference for improving medication adherence in kidney transplant recipients.Methods:This study was a cross-sectional survey. From August to December 2022, convenience sampling was used to select 240 kidney transplant recipients who were followed up at the Kidney Transplantation Center of Shanghai General Hospital as the research subject. A survey was conducted on subjects using the General Information Questionnaire, Self-Perceived Burden Scale (SPBS), Client Empowerment Scale (CES), and Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS) to analyze the correlation between patient self-perceived burden, empowerment, and medication compliance, as well as the mediating effect of empowerment between the two.Results:A total of 240 questionnaires were distributed, and 226 valid questionnaires were collected, with a valid response rate of 94.2% (226/240). Among 226 kidney transplant recipients, the total scores of SPBS, CES, and BAASIS were (27.34±8.03), (159.86±13.45), and (5.05±1.75), respectively. The SPBS score of the recipient was negatively correlated with the CES score ( r=-0.366, P<0.05), and positively correlated with the BAASIS score ( r=0.448, P<0.05). The CES score was negatively correlated with the BAASIS score ( r=-0.456, P<0.05). The above differences were statistically significant. Empowerment partially mediated the association between self-perceived burden and medication adherence in kidney transplant recipients, with a mediating effect ratio of 38.7%. Conclusions:Renal transplant recipients have poor medication adherence, and empowerment is a mediating variable between self-perceived burden and medication adherence. Medical and nursing staff should attach importance to and enhance the empowerment of kidney transplant recipients, in order to alleviate the negative impact of self-perceived burden, increase medication compliance of recipients, and improve their health outcomes.

AIM To investigate the clinical effects of Xuanfei Jiejing Decoction combined with conventional treatment on patients with asthma of Wind-Phlegm Obstructing Lung Pattern.METHODS One hundred and fifty patients were randomly assigned into control group(75 cases)for 4-week intervention of conventional treatment,and observation group(75 cases)for 4-week intervention of both Xuanfei Jieshi Decoction and conventional treatment.The changes in clinical effects,TCM syndrome scores,airway inflammatory indices(ECP,IL-4,IgE),lung function indices(FVC,FEV1/FVC,PEF)and putum and mucus indices(4 h sputum volume,sputum viscosity,mucin 5AC)were detected.RESULTS The observation group demonstrated higher total effective rate than the control group(P＜0.05).After the treatment,the two groups displayed decreased TCM syndrome scores,airway inflammatory indices,putum and mucus indices(P＜0.05),and increased lung function indices(P＜0.05),especially for the observation group(P＜0.05).CONCLUSION For the patients with asthma of Wind-Phlegm Obstructing Lung Pattern,Xuanfei Jiejing Decoction combined with conventional treatment can reduce airway inflammatory levels,inhibit airway mucus secretion,improve lung functions,and alleviate clinical symptoms.

Objective: To investigate the pathological features and the clinicopathological significance of TERT detection in those tumors that were difficult to diagnosis. Methods: A total of 93 cases of fibroepithelial tumors without definite diagnosis were collected from the Affiliated Hospital of Qigndao University between 2013 and 2021. The clinical details such as patients' age and tumor size were collected. All slides were re-reviewed and the pathologic parameters, including stromal cellularity, stromal cell atypia, stromal cell mitoses, and stromal overgrowth were re-interpreted. Sanger sequencing was used to detect TERT promoter status, and immunohistochemistry was performed to detect TERT protein expression. The relationship between TERT promoter mutation as well as protein expression levels and the clinicopathological parameters were also analyzed. Results: The patients' ages ranged from 30 to 71 years (mean of 46 years); the tumor size ranged from 1.2 to 8.0 cm (mean 3.8 cm). These tumors showed the following morphologic features: leafy structures in the background of fibroadenoma, or moderately to severely abundant stromal cells. The interpretations of tumor border status were ambiguous in some cases. The incidence of TERT promoter mutation was high in patients of age≥50 years, tumor size≥4 cm, and stromal overgrowth at ×4 or ×10 objective, and these clinicopathologic features were in favor of diagnosis of phyllodes tumors. TERT protein expression levels was not associated with the above clinicopathologic parameters and its promoter mutation status. Conclusions: The diagnostic difficulty for the breast fibroepithelial tumors is due to the difficulty in recognition of the leafy structures or in those cases with abundant stromal cells. A comprehensive evaluation combined with morphologic characteristics and molecular parameters such as TERT promoter may be helpful for the correct diagnosis and better evaluating recurrence risk.
Humans ; Adult ; Middle Aged ; Aged ; Female ; Neoplasms, Fibroepithelial/pathology* ; Phyllodes Tumor/genetics* ; Stromal Cells ; Fibroadenoma/pathology* ; Breast Neoplasms/pathology* ; Mutation ; Telomerase/genetics*

OBJECTIVE: To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly. METHODS: The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy. RESULTS: All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred. CONCLUSION The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.
Male ; Female ; Humans ; Aged ; Infant ; Constriction, Pathologic/surgery* ; Spinal Stenosis/surgery* ; Decompression, Surgical/methods* ; Retrospective Studies ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Treatment Outcome