Perimenopausal syndrome （MPS）， a common endocrine system disease， is one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in endocrinology， gynecology， and interdisciplinary fields of both Western and Chinese medicine to discuss the advantages and challenges of diagnosing and treating MPS with Western medicine， TCM， and integrative medicine. Experts at the conference believe that MPS is initiated by estrogen decline and rooted in deficiency， with the pathogenesis being imbalance between Yin and Yang in the kidney. The hormone replacement therapy in Western medicine for menopause can rapidly alleviate related symptoms by quickly restoring the estrogen level and timely detect and delay complications of menopause， whereas such a therapy has certain risks， necessitating close monitoring of adverse reactions. Moreover， the various contraindications and precautions limit the clinical application of the hormone replacement therapy. TCM has advantages in synergistically alleviating symptoms such as hot flashes， sweating， sleep disorders， and emotional abnormalities of MPS without causing obvious adverse reactions. However， its efficacy is slower than the hormone replacement therapy， and the TCM evidence for preventing and treating complications of menopause remains unclear. Three suggestions were proposed for the future development of both Western and TCM for ameliorating MPS. First， an integrated diagnosis and treatment system for MPS with both Western and Chinese medicine should be established. Second， high-quality evidence-based interventions for MPS should be developed with TCM alone or in combination with Western medicine. Third， efforts should be made to promote the new TCM drug development and the interdisciplinary cooperation for treating MPS.

Objective:To analyze the clinical characteristics of monkeypox patients.Methods:The clinical data and laboratory findings of 4 patients with monkeypox patients diagnosed at Yiwu Central Hospital in July 2023 were analyzed. Herpes fluid and skin tissue samples were collected, the viruses were isolation and cultured in African green monkey kidney cells (Vero) and identified with whole gene sequencing.Results:All four patients were male, aged 24-35 years. All patients had male-to-male behavior within 21 days before onset of the disease. Among them, one patient has AIDS and one patient has syphilis. Four patients presented with perineal skin lesions with itching, and 3 patients were found to have enlarged lymph nodes upon admission. Laboratory testing: lymphocyte abnormality (4.57×10 9/L) in 1 case; increased procalcitonin (0.25 ng/mL) in 1 case; elevated IL-10 levels ( 7.11 ng/L and 9.42 ng/L) in 2 cases; increased IL-6 (66 ng/L) and IL-4 (3.24 ng/L) in 1 case, respectively. One case had abnormal myocardial zymogram with a elevated lactate dehydrogenase level of 313 U/L. The monkeypox virus was isolated from lesion tissue and herpes fluid, and the whole gene sequencing identified it as the B. 1.3 subtype of the IIb evolutionary branch, exhibiting typical pathological effects on Vero cells. Conclusion:The clinical manifestations of the 4 monkeypox patients confirmed in Zhejiang province are mild, patients had a definitive history of male-to-male sexual behavior and the virus strains belong to the B. 1.3 lineage of the IIb evolutionary branch.

Objective:To evaluate and summarize the best evidence of exercise management of cancer-related fatigue in cancer patients.Methods:Evidence-based questions were identified using the PIPOST model to determine retrieval strategies and inclusion and exclusion criteria. According to the "6S" evidence model, the clinical decision-making, best clinical practice, guidelines, systematic review and expert consensus on the exercise management of cancer-related fatigue in cancer patients were searched in UpToDate, British Medical Journal Best Practice, Joanna Briggs Institute Evidence-based Health Care Center Database, Cochrane Library, National Institute for Health and Clinical Excellence, National Comprehensive Cancer Network, Guidelines International Network, Canadian Medical Association: Clinical Practice Guidelines, PubMed, Web of Science, Embase, CINAHL, China National Knowledge Infrastructure, WanFang Data, VIP, China Biology Medicine disc and professional association platform. The retrieval time limit was from the establishment of the database to January 31, 2022. Three researchers evaluated the quality of the literature and collated, evaluated and integrated the evidence.Results:A total of 20 articles were included, including 1 clinical decision-making, 4 guidelines, 2 evidence summaries, 10 systematic reviews, and 3 expert consensus. A total of 25 best evidences were summarized from 8 aspects, namely, safety and effectiveness of exercise, exercise timing, exercise evaluation, exercise principle, exercise mode, exercise intensity and duration, exercise compliance and exercise risk management.Conclusions:The best evidence on the exercise management of cancer-related fatigue in cancer patients provides evidence-based evidence support and reference opinions for clinical standardized exercise. It is suggested that medical and nursing staff should select the best evidence according to the specific clinical situation and individual differences of patients in the process of evidence transformation, and formulate a personalized exercise management plan to alleviate the cancer-related fatigue of patients.

Objective:To explore the characteristics of the changes in risk score for intensive care unit (ICU) patients during hospitalization by the intelligent calculation method, and to provide evidence for the risk prevention.Methods:In this retrospective study, ICU patients of the Fifth Central Hospital in Tianjin from November 3, 2021 to March 28, 2022 were enrolled and divided into ≥ 14 days group, 10-13 days group, 7-9 days group, and 3-6 days group according to the ICU length of stay. Risk scores assessed by the intelligent calculation method of the ICU patients were collected, including nutritional risk screening 2002 (NRS 2002), Caprini score and Padua score. NRS 2002 score for all patients, Caprini score for surgical patients and Padua score for internal medicine patients were selected. Trends in change of each score were compared between patients admitted to ICU 1, 3, 7 (if necessary), 10 (if necessary), and 14 days (if necessary).Results:A total of 138 patients were involved, including 79 males and 59 females, with an average age of (61.71±18.86) years and an average hospital stay of [6.00 (4.00, 9.25)] days. ① in the group with ICU length of stay ≥ 14 days (21 cases): there was no significant change in the NRS 2002 scores of the patients within 10 days, but the NRS 2002 score was significantly decreased in 14 days as compared with 1 day [3.00 (2.50, 3.50) vs. 4.00 (3.00, 5.00), P < 0.05]; both Caprini and Padua score were increased with prolonged hospital stay and compared with 1 day, the scores at the other time points were significantly increased, especially at 14 days [Caprini score: 5.00 (3.25, 7.00) vs. 2.50 (1.25, 5.50), Padua score: 6.00 (6.00, 7.00) vs. 3.00 (1.00, 3.00), both P < 0.05].② in the group with ICU length of stay from 10-13 days (15 cases): with the prolonged hospital stay, there was no significant change in NRS 2002 score, but both Caprini and Padua score were increased at 3, 7, 10 days, especially at 10 days [Caprini score: 3.00 (2.00, 4.75) vs. 2.00 (0.25, 2.75), Padua score: 5.00 (3.50, 6.00) vs. 2.00 (0.50, 4.00), both P < 0.05].③ in the group with ICU length of stay from 7-9 days (23 cases): compared with 1 day, the NRS 2002 score at 3 days and7 days were decreased, but the Caprini and Padua score were increased, especially at 7 days [NRS 2002 score: 2.00 (1.00, 4.00) vs. 2.00 (2.00, 4.00), Caprini score: 3.00 (2.00, 5.50) vs. 2.00 (0.25, 3.00), Padua score: 5.00 (4.00, 6.00) vs. 2.00 (0, 2.00), all P < 0.05]. ④ in the group with ICU length of stay from 3-6 days (79 cases): compared with 1 day, the NRS 2002 score at 3 days was decreased [NRS 2002 score: 2.00 (1.00, 3.00) vs. 2.00 (1.00, 3.00), P < 0.05], Caprini and Padua score were significantly increased [Caprini score: 3.00 (2.00, 4.00) vs. 2.00 (1.00, 3.00), Padua score: 5.00 (4.00, 5.00) vs. 2.00 (1.00, 3.00), both P < 0.05]. Conclusion:Based on dynamic assessment of intelligent calculation methods, the risk of thrombosis in ICU patients increased with hospital length of stay, and the nutritional risk was generally flat or reducing in different hospitalization periods.

BACKGROUND: Children and adolescents are in the growth and development stage, so the use of the same reconstruction methods as adults is easy to induce complications including limb length differences, high graft failure rate and re-surgical intervention. Simultaneously, the occurrence of osteoarthritis will also be advanced. OBJECTIVE: To explore the anatomical characteristics of the anterior cruciate ligament between children, adolescents and adults on MRI, and to provide an anatomical basis for the reconstruction of the anterior cruciate ligament in children and adolescents. METHODS: A retrospective analysis of patients undergoing knee MRI examination in Qingdao Municipal Hospital from October 2016 to October 2018 was conducted. These patients were divided into child and adolescent group and adult group (n=48 per group). The angle between the anterior cruciate ligament and the tibia and femur on the sagittal plane and the position of the anterior cruciate ligament tibial insertion, the angle between the anterior cruciate ligament and the tibia on the coronal plane, the tibial insertion of the anterior cruciate ligament and femur, and the position of the femur stop point on the axial position were measured in both groups. The data obtained from the measurement of the anterior cruciate ligament of children and adolescents were processed. The growth curves of the shape and position of the anterior cruciate ligament of children and adolescents were drawn, and the law of its growth changes was analyzed. RESULTS AND CONCLUSION: (1) The angle between the sagittal plane of the anterior cruciate ligament and the femur (t=﹣2.906, P<0.05), the angle between the sagittal plane of the anterior cruciate ligament and the tibia (t=﹣10.280, P < 0.05), the anterior cruciate ligament angle between the coronal plane and the tibia (t=﹣5.714, P<0.05) were smaller in the child and adolescent group than those of the adult group, and the difference was significant. (2) The ratio of the tibia coronal plane of the anterior cruciate ligament (t=﹣7.263, P < 0.05) and the ratio of the anterior cruciate ligament and femur axial plane (t=﹣7.378, P < 0.05) were lower in the child and adolescent group than those of the adult group, and the difference was significant. (3) There was no significant difference in the anterior cruciate ligament and tibia sagittal plane ratio (t=﹣1.588, P>0.05) and anterior cruciate ligament and femoral coronal surface ratio (t=﹣1.647, P>0.05) between the child and adolescent group and the adult group. (4) The growth curve results showed that during the growth and development, the angle between the anterior cruciate ligament and the femur and tibia on the sagittal plane and the angle with the tibia on the coronal plane changed from small to large (P<0.05). The relative position of the tibial insertion in the coronal position changed from small to large, which indicates that during the growth and development, the tibial insertion moved from inside to outside relative to the inside of the tibial plateau on the coronal plane (P < 0.05). (5) The relative position of femoral insertion in the axial position changed from small to large, suggesting that during the growth and development, the femoral insertion moved from the outside to the inside relative to the lateral femoral condyle (P<0.05). (6) There was no significant difference in the tibial insertion and the femoral insertion between the child and adolescent group and adult group (P>0.05).

Objective:To investigate the relationship between TP53 gene mutation and overall survival (OS) time of myelodysplastic syndrome (MDS).Methods:Databases, including PubMed, Cochrane Library and Embase were searched for relevant studies published up to 20 October, 2019. The corresponding hazard ratio ( HR) and their 95% confidence interval ( CI) for OS from multivariate Cox proportional hazard models were extracted. The combined HR with their 95% CI was calculated by using fixed or random effect models. Meta-analysis was performed by using Revman 5.3 software. Results:A total of 1 033 patients from 6 studies were enrolled. Meta-analysis results showed that OS time in TP53 gene mutation group was shorter than that in wild type group for patients with MDS ( HR = 2.16, 95% CI 1.52-3.07, P < 0.01). The prognostic risk for post-transplantation patients with MDS ( HR = 2.69, 95% CI 1.63-4.43, P < 0.01) was lower compared with that for patients treated by azacitidine( HR = 2.89, 95% CI 1.37-6.08, P = 0.005). Conclusion:TP53 gene mutation is a risk factor affecting OS of MDS patients.

Objective:To evaluate the volume status of hemodialysis patients with hypertension by bioelectrical impedance vector analysis, and investigate the effect of high volume status on the prognosis of patients with hypertension.Methods:The study subjects came from the patients with pre-dialysis systolic blood pressure>160 mmHg (mean systolic blood pressure of 6 times of treatment) in the Affiliated BenQ Hospital of Nanjing Medical University. According to the volume status assessed by bioelectrical impedance vector analysis, patients were divided into two groups: fluid overload group and non-overload group (including normal fluid status and fluid decline). The clinical data, laboratory test results, ratio of intracellular and extracellular water (ICW and ECW), body cell mass, lean body mass and the percentage of total body weight, fat percentage of body weight, resistance/height, reactance/height, phase angle and illmarker were compared between two groups. Kaplan-Meier survival curve was used to compare the difference of survival rate between the two groups.Results:A total of 51 hemodialysis patients with hypertension were enrolled in this study, including 19 patients in fluid overload group and 32 patients in non-overload group (27 patients with normal volume status and 5 patients with decreased volume). The levels of albumin, prealbumin, hemoglobin, hematocrit and serum phosphorus in patients with fluid overload decreased significantly compared with non-overload patients (all P<0.05), and the proportion of lymphocytes increased in fluid-overload patients ( P<0.05). The ratio of extracellular water and illmarker index in fluid overload group were significantly higher than those in the other group (both P<0.01). However, phase angle, resistance/height, reactance/height were lower than those in patients with non-overload (all P<0.01). After 20 months of clinical observation, the control rate of blood pressure (pre-dialysis systolic blood pressure<160 mmHg) in fluid overload group was lower than that in the non-overload group (26.3% vs 43.8%), but not statistically significant ( P=0.218). The all-cause mortality rate of patients in the fluid overload group was higher than non-overload group (26.3% vs 15.6%). Kaplan-Meier survival curve analysis suggested that the difference in survival rate between the two groups was not statistically significant. Conclusions:The extracellular fluid of hemodialysis patients with hypertension and fluid overload increases significantly, and the nutritional status evaluation index decreases compared with that of patients without increased volume. Increased proportion of lymphocytes may be related to the micro-inflammatory status. Blood pressure is more difficult to control in hypertensive patients with fluid overload and the clinical prognosis can be worse in patients without increased volume.

Objective To investigate the diagnostic value of fine needle aspiration biopsy combined with BRAFV600E gene mutation detection in elderly patients with thyroid nodules.Methods A total of 168 elderly patients with thyroid nodules suspicious for malignancy on ultrasound from January 2017 to December 2017 at our hospital were enrolled in this study.Using color Doppler ultrasound,185 thyroid nodules were found.Fine needle aspiration cytology(FNAC)and BRAFV600E gene mutation detection were performed before surgery and the findings were compared with postoperative pathological results.The diagnostic value of single and combined detection of FNAC and BRAFV600E gene mutation was evaluated.Results Among 185 thyroid nodules,there were 146 malignant lesions including 137 papillary carcinomas and 9 follicular carcinomas,and 39 benign lesions including 31 cases of nodular goiter,5 cases of Hashimoto's thyroiditis and 3 cases of adenoma.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of FNAC were 79.5％,59.0％,75.1％,75.2％,and 45.6％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of BRAFV600E gene mutation detection were 78.1％,51.3 ％,72.4 ％,84.4 ％ and 51.2 ％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined detection were 93.4％,77.5％,86.2％,90.8％ and 53.4％,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined detection were higher than those of either method used alone (all P＜0.05).Conclusions For some thyroid nodules that cannot be unequivocally diagnosed as benign or malignant by FNAC,the combined detection of FNAC and BRAFV600E gene mutation can significantly improve the sensitivity,specificity and accuracy of malignancy detection,differentiate between benign and malignant nodules,and help formulate operation plans and subsequent treatment.

Objective: To investigate the clinical effects of Qinghuang powder, low-intensity chemotherapy and Qinghuang powder alternated with low-intensity chemotherapy in the treatment of elderly acute myeloid leukemia patients progressed from myelodysplastic syndromes (MDS-AML). Methods: A total of 32 elderly patients with MDS-AML treated in Xiyuan Hospital, China Academy of Chinese Medical Sciences from January 2014 to December 2017 were retrospectively analyzed. Of them, 12 patients received Qinghuang powder (Qinghuang powder group), 6 patients received Qinghuang powder alternated with low-intensity chemotherapy (alternating group), and 14 patients received low-intensity chemotherapy (low-intensity chemotherapy group), based on the real world of patient's voluntary choice of treatment. The efficacy and adverse reactions in the 3 groups were observed. Results: The overall response number of Qinghuang powder, alternating, and low-intensity chemotherapy groups were 2, 2 and 4 cases, respectively, there was no significant difference among the 3 groups (P > 0.05). The median overall survival time of 3 groups were 14, 12 and 8 months, respectively, there was no significant difference among the 3 groups (P > 0.05). Two cases in Qinghuang powder group presented with gastrointestinal reactions; 3 cases in alternating group with myelosuppression, 2 cases with liver function damage, and 2 cases with gastrointestinal reaction; 11 cases in low-intensity chemotherapy group presented with bone marrow suppression, 3 cases with liver function damage, 7 cases with gastrointestinal reactions, and 2 cases with myocardial enzyme changes. The incidences of myelosuppression, liver function damage and myocardial enzyme changes in Qinghuang powder group were lower than those in the alternating group and low-intensity chemotherapy group. Conclusion The efficacy of Qinghuang powder or Qinghuang powder alternated with low-intensity chemotherapy for the treatment of elderly MDS-AML is not worse than the low-intensity chemotherapy, furthermore Qinghuang powder or Qinghuang powder alternated with low-intensity chemotherapy has fewer adverse reactions and better tolerance.

Objective To investigate the survival of oral arsenic-containing Qinghuang Powder (QHP) and low intensive chemotherapy (LIC) in the treatment of elderly patients with acute myeloid leukemia (AML).Methods Forty-two AML patients older than 60 years in Xiyuan Hospital from January 2015 to December 2017 were retrospectively analyzed.Of them,20 cases were treated with QHP (QHP group),22 cases were treated with LIC (LIC group).The survivals of the two groups were compared.Results There was no significant difference of median survival time (13 months vs.13.5 months,x2 =0.096,P =0.757),1-year survival rates (59.1％ vs.70.0 ％,x2 =0.543,P =0.461),2-year survival rates (13.6 ％ vs.15.0 ％,x2 =0.016,P ＞ 0.05),and 3-year survival rates (4.6 ％ vs.5.0 ％,x2 =0.005,P ＞ 0.05) between LIC and QHP groups.There was no significant difference of median survival time in age ≥75 year (12 months vs.12.5 months,x2 =1.317,P =0.251),performance status scores ＞ 2 (12 months vs.12 months,x2 =0.834,P =0.361),hematopoietic stem cell transplantation with combined disease index ＞ 2 (12 months vs.13 months,x2 =1.726,P =0.189),secondary AML (10 months vs.14 months,x2 =1.552,P =0.213),and poor cytogenetics (12 months vs.8 months,x2 =0.479,P =0.489) between LIC and QHP group.Conclusion The survival of elderly AML patients is considerable in patients treated with oral QHP and LIC,which suggests that oral QHP may be an equivalent alternative treatment since elderly AML (especially more than 75 years) patients refused to LIC therapy.