ObjectiveTo analyze the distribution characteristics of traditional Chinese medicine （TCM） syndrome elements in different risk populations of heart failure complicated with type 2 diabetes. MethodsClinical data of 675 type 2 diabetes patients were retrospectively collected. Lasso-multivariate Logistic regression was used to construct a clinical prediction nomogram model. Based on this， 441 non-heart failure patients were divided into a low-risk group （325 cases） and a high-risk group （116 cases） according to the median risk score of heart failure complicated with type 2 diabetes. TCM diagnostic information （four diagnostic methods） was collected for both groups， and factor analysis was applied to summarize the distribution of TCM syndrome elements in different risk populations. ResultsLasso-multivariate Logistic regression analysis identified age， disease duration， coronary heart disease， old myocardial infarction， arrhythmia， absolute neutrophil count， activated partial thromboplastin time， and α-hydroxybutyrate dehydrogenase as independent risk factors for heart failure complicated with type 2 diabetes. These were used as final predictive factors to construct the nomogram model. Model validation results showed that the area under the curve （AUC） of the receiver operating characteristic （ROC） curve for the modeling group and validation group were 0.934 and 0.935， respectively. The Hosmer-Lemeshow test （modeling group P = 0.996， validation group P = 0.121） indicated good model discrimination. Decision curve analysis showed that the curves for All and None crossed in the upper right corner， indicating high clinical utility. The low-risk and high-risk groups each obtained 14 common factors. Preliminary analysis revealed that the main disease elements in the low-risk group were qi deficiency （175 cases， 53.85%）， dampness （118 cases， 36.31%）， and heat （118 cases， 36.31%）， with the primary locations in the spleen （125 cases， 38.46%） and lungs （99 cases， 30.46%）. In the high-risk group， the main disease elements were yang deficiency （73 cases， 62.93%）， blood stasis （68 cases， 58.62%）， and heat （49 cases， 42.24%）， with the primary locations in the kidney （84 cases， 72.41%） and heart （70 cases， 60.34%）. ConclusionThe overall disease characteristics in different risk populations of type 2 diabetes patients with heart failure are a combination of deficiency and excess， with deficiency being predominant. Deficiency and heat are present throughout. The low-risk population mainly shows qi deficiency with dampness and heat， related to the spleen and lungs. The high-risk population shows yang deficiency with blood stasis and heat， related to the kidneys and heart.

Since the first successful transcatheter aortic valve replacement (TAVR) was performed globally in 2002, the TAVR technology has become increasingly mature. With more than a decade of development in China, its application experience, device research and development, procedural improvements, evidence-based medicine, and guideline updates have continuously progressed, leading to a significant increase in the number of procedures conducted. Compared to traditional surgical operations, TAVR has different postoperative monitoring points and principles for the prevention and management of complications, necessitating the formulation of corresponding monitoring and treatment protocols that align with the technical characteristics of the procedure. This guideline is based on clinical practice and incorporates both domestic and international literature as well as the experiences of Fuwai Hospital. It distills and organizes routine postoperative monitoring practices, process optimization, and complication management for TAVR, establishing a set of practical guidelines for postoperative monitoring in China. These guidelines have strong practical value for optimizing postoperative management strategies and preventing and managing complications, which is beneficial for early functional recovery of patients, shortening hospital stays, and reducing complication rates. They provide guidance and reference for domestic peers and support the standardized development and quality improvement of postoperative management for TAVR in China.

Tourette syndrome(TS)is a chronic neurodevelopmental disorder.Acupuncture can effectively improve the clinical symptoms of TS patients.This article systematically summarized the clinical research status of acupuncture for the treatment of TS in recent years from the aspects of characteristic acupuncture methods,characteristic needles and comprehensive therapies,and put forward suggestions and prospects for systematically elaborating the peripheral-central mechanism of acupuncture for TS around the intestinal immunity and brain network mechanism in the future,so as to provide reference for optimizing clinical research and treatment.

Objective To explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. Methods From December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. Results There were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.

Objective To explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. Methods From December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. Results There were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.

Objective:To retrieve, evaluate, and integrate the best evidence for the management of neurogenic bowel dysfunction (NBD) in spinal cord injury patients both domestically and internationally, providing a basis for relevant evidence-based practices.Methods:The guidelines, expert consensus, clinical decision-making, and systematic review of NBD management for spinal cord injury patients were electronically searched in various databases and professional association websites at home and abroad. The search period was from database establishment to March 31, 2023.Results:A total of 13 articles were included, including five guidelines, five evidence summaries, two expert consensus, and one clinical decision-making. A total of 33 recommendations for NBD management in spinal cord injury patients were summarized from five aspects of medical history assessment, medication management, physical therapy, diet and exercise, and health education.Conclusions:The best evidence for NBD management in spinal cord injury patients summarized is scientific and practical. Medical and nursing staff should selectively apply the best evidence based on clinical practice.

Objective:To explore the status quo and influencing factors of self-management behavior of patients with diabetic retinopathy (DR) based on the ABC-X model.Methods:Totally 315 DR patients who were hospitalized in the Department of Ophthalmology of Henan Provincial People's Hospital from May to September 2022 were selected by convenience sampling and investigated with the general information questionnaire, Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Distress Scale (DDS) and Social Support Rating Scale (SSRS). A total of 315 questionnaires were distributed, and 305 valid questionnaires were recovered, with an effective recovery rate of 96.8%.Results:The SDSCA, DDS and SSRS scores of 305 DR patients were (39.59±9.49), (37.44±10.53) and (37.42±3.65), respectively; self-management behavior was positively correlated with the number of hospitalizations and social support ( P<0.01), negatively correlated with psychological distress ( P<0.01). The results of multiple linear regression analysis showed that the type of residence, course of disease, number of hospitalizations, psychological distress of diabetes and social support were the influencing factors of self-management behavior of DR patients ( P<0.05) . Conclusions:The level of self-management behavior of DR patients is yet to be improved. Medical and nursing staff should provide targeted interventions to improve their quality of life and prognosis.

【Objective】 To investigate the clinical features and gene analysis of one pedigree with multiple endocrine neoplasia type 2A （MEN2A） so as to clarify the diagnosis and classification of the disease， guide treatment and prevention， and improve prognosis. 【Methods】 The clinical data of a 36-member MEN2A family， including 6 probands， with medullary thyroid carcinoma， were investigated， and the peripheral blood genomic DNA of 28 family members （blood sample of one proband was not collected） was extracted. PCR amplification was performed on exons 8， 10， 11， 13， 14， 15 and 16 of the RET gene， and the products were directly sequenced. 【Results】 Review of the medical history showed that two probands with medullary thyroid carcinoma were accompanied with hyperparathyroidism， and one family member had pheochromocytoma. The RET gene mutation test confirmed that 13 family members， consisting of 5 probands and 8 family members， had the RET proto-oncogene exon 10 missense mutation. The heterozygous missense had mutation c.1852T>A， leading to the conversion of cysteine （TGC） at position 618 to serine （AGC） （Cys618Ser）. All subjects carrying RET gene Cys618Ser mutation had abnormal thyroid ultrasound change， accompanied with elevated calcitonin levels. Subjects carrying wild type of RET gene had normal calcitonin levels. The family was finally diagnosed with MEN2A by RET gene detection. 【Conclusion】 RET gene detection plays key role in the diagnosis and treatment of patients with MEN2A family and has guiding value in the follow-up and prognosis of asymptomatic carriers. There is a positive correlation between calcitonin level and the RET protooncogene mutation Cys618Ser. Patients suspected of MEN2A should be screened in time.

Objective:To analyze the clinical and pathological characteristics of colorectal laterally spreading tumor (CLST) and provide reference for clinical diagnosis and treatment of CLST.Methods:From January 1, 2016 to June 30, 2021, the clinical data of patients with CLST who underwent endoscopic resection at the Second Affiliated Hospital of Dalian Medical University were retrospectively collected. The clinical and pathological characteristics of CLST were analyzed in terms of lesion location (right colon, left colon, rectum) and morphological type (granular-homogeneous type, granular-mixed type, flat-elevated type, and pseudo-depressed type). One-way analysis of variance, Pearson′s chi-square test and Fisher′s exact test were used for statistical analysis.Results:A total of 266 patients with CLST and 296 CLST lesions were included. The most common maximum diameters of the lesions were 10 to 29 mm, accounting for 85.1% (252/296). The main morphological type was granular type, accounting for 81.4% (241/296), and the main pathological type was adenoma, accounting for 79.7% (236/296), and the most common histological type was low-grade intraepithelial neoplasia (LGIN), accounting for 81.1% (240/296). The maximum diameter of CLST lesion of rectum was larger than that of the right colon and the left colon ((24.20±16.97), (18.38±8.24) and (18.59±7.95) mm, respectively), and the difference was statistically significant ( F=6.62, P<0.001). The detection rate of granular-homogeneous type CLST in rectum was lower than that in the right colon and the left colon (22.0%, 11/50, 53.5%, 69/129 and 58.9%, 69/117, respectively), while the detection rate of granular-mixed type CLST in rectum was higher than that in the right colon and the left colon (50.0%, 25/50; 29.4%, 38/129 and 24.8%, 29/117, respectively), and the differences were statistically significant ( χ2=20.06 and 10.67, both P<0.01). The incidence of adenoma in CLST in the right colon was lower than that in the left colon and rectum (68.2%, 88/129; 87.2%, 102/117 and 92.0%, 46/50, respectively), while the incidence of serrated adenoma in CLST in the right colon was higher than that in the left colon and rectum (30.2%, 39/129; 12.8%, 15/117 and 4.0%, 2/50, respectively), and the differences were statistically significant ( χ2=19.25 and 20.85, both P<0.001). The CLST in left colon was mostly treated by endoscopic submucosa dissection (94.9%, 111/117), while the CLST in rectum was mostly treated by endoscopic mucosal resection (20.0%, 10/50), and the difference was statistically significant ( χ2=8.77, P=0.012). The maximum diameter of the pseudo-depressed type CLST was larger than that of the granular-homogeneous type, granular-mixed type and flat-elevated type ((24.18±14.07), (15.96±5.70), (23.49±13.80) and (21.21±8.02) mm), and the difference was statistically significant ( F=13.40, P<0.001). The incidence of adenoma in flat-elevated type CLST was higher than that of the granular-homogeneous type, granular-mixed type and pseudo-depressed type (92.1%, 35/38; 71.1%, 106/149; 86.9%, 80/92 and 15/17, respectively), and the difference was statistically significant ( χ2=14.13, P=0.003). The incidence of serrated adenoma in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (28.9%, 43/149; 10.9%, 10/92; 5.3%, 2/38 and 1/17, respectively), and the difference was statistically significant ( χ2=19.98, P<0.001). The incidence of adenocarcinoma in the pseudo-depressed type CLST was higher than that of the granular-homogeneous type, granular-mixed type and flat-elevated type (1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38, respectively), and the difference was statistically significant (Fisher′s exact test, P=0.049). The incidence of LGIN in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (90.6%, 135/149; 76.1%, 70/92; 65.8%, 25/38 and 10/17, respectively), while the incidences of high-grade intraepithelial neoplasia and carcinoma in the pseudo-depressed type CLST were higher than those of the granular-homogeneous type, granular-mixed type and flat-elevated type (6/17; 9.4%, 14/149; 21.7%, 20/92; 31.6%, 12/38 and 1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38), and the differences were statistically significant( χ2=21.58 and 16.81 and Fisher′s exact test, all P<0.05). Conclusions:The clinicopathological characteristics of CLST have certain specificity. The maximum diameter and malignant potential of the rectal CLST are both larger and higher than those of the colonic CLST. Although the granular-mixed type CLST is the granular type, it shows a larger maximum diameter and a higher degree of malignancy.

Objective: This study was devoted to identifying natural thrombin inhibitors from traditional Chinese medicine (TCM) and evaluating its biological activity in vitro and binding characteristics. Methods: A combination strategy containing molecular docking, thrombin inhibition assay, surface plasmon resonance (SPR) and molecular dynamics simulation were applied to verify the study result. Results: Gallic acid was confirmed as a direct thrombin inhibitor with IC