Osteoarthritis （OA） and stroke are common clinical diseases that reduce patients' quality of life and place a burden on families and society. Ruyi Zhenbaowan， a classic prescription in Tibetan medicine， have the functions of clearing heat， awakening the brain and opening orifices， relaxing tendons and promoting meridian circulation， and eliminating yellow water. Clinically， they are used to treat osteoarthritis， post-stroke sequelae， neuropathic pain， and other related conditions. Modern pharmacological studies have demonstrated their anti-inflammatory， analgesic， and nerve-repairing effects. However， current research remains insufficient regarding the appropriate indications， timing， and efficacy of this medicine in treating relevant diseases. To enhance clinicians' understanding of this medicine and promote its standardized and rational clinical use， a panel of national experts， including clinical specialists， Tibetan medicine practitioners， pharmacologists， and methodologists， formulated this consensus based on clinical experience and evidence-based practice. The Cochrane systematic review framework， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system， and the nominal group method were employed to generate seven graded recommendations and 19 consensus-based suggestions. These recommendations clearly define the key points in the clinical application of Ruyi Zhenbaowan， including therapeutic indications， dosage and administration， treatment duration， and medication safety. The consensus specifically addresses the clinical efficacy， appropriate timing of administration， dosage strategies， treatment cycles， and combination medication strategies for treating osteoarthritis and stroke and provides an overview of safety considerations. The aim is to provide standardized guidance for hospitals and healthcare institutions nationwide to ensure the rational application of Ruyi Zhenbaowan in the treatment of osteoarthritis and stroke， reduce medication-related risks， and further leverage its clinical advantages. This consensus has been approved and issued by the China Association of Chinese Medicine， with the standard number GS/CACM 369-2024.

ObjectiveTo investigate the effects of spleen-Yin deficiency on gastrointestinal absorption， water metabolism and intestinal flora in rats with spleen-Yin deficiency syndrome. MethodA rat model of spleen-Yin deficiency syndrome was established by using the composite factors， including irregular meat and vegetable diet， weight-bearing fatigue swimming and gavage with warm-heat injury-Yin drugs. The changes of body weight， food intake， water intake and duration of swimming in the blank and model groups were observed. Hematoxylin-eosin（HE） staining was used to observe the histopathological damage of the stomach and colon. Urinary excretion rate of D-xylose was determined by phloroglucinol method. The content of gastrin（GAS） in serum was determined by enzyme-linked immunosorbent assay（ELISA）. The relative expression levels of vasoactive intestinal peptide（VIP）， aquaporin 3（AQP3） and AQP4 in gastric tissues were detected by Western blot. The relative mRNA expression levels of VIP， AQP3 and AQP4 in gastric tissues were detected by Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR）， and the changes of intestinal flora were analyzed by 16S rDNA sequencing. ResultCompared with the blank group， the results of general physical signs showed that the body weight and food intake of rats in the model group were significantly decreased， the water intake was significantly increased（P<0.05， P<0.01）， and the duration of swimming was significantly decreased（P<0.01）. Pathological examination results showed that in the mucosa of gastric tissues of rats in the model group appeared to be misaligned， the mucosa of colonic tissues could be seen to be obviously thinned or mutilated， and the epithelial cells appeared to be necrotic or even exfoliated. Compared with the blank group， the urinary D-xylose excretion rate of rats in the model group was significantly decreased（P<0.01）， and the serum GAS content was significantly decreased（P<0.05）. Compared with the blank group， Western blot results showed that the relative expression level of VIP protein in gastric tissues of rats in the model group was significantly decreased， while the relative expression levels of AQP4 and AQP3 proteins were significantly increased（P<0.01）. Compared with the blank group， Real-time PCR results showed that the relative expression level of VIP mRNA in gastric tissues of rats in the model group was significantly decreased（P<0.01）， and the relative mRNA expression levels of AQP3 and AQP4 were significantly increased（P<0.05， P<0.01）. Compared with the blank group， the results of intestinal flora analysis showed that the number of operational taxonomic units（OTUs） and α-diversity increased and β-diversity decreased significantly in the model group， the abundance of Porphyromonadaceae was increased significantly， and the abundance of Oscillibacter_ruminantium was decreased significantly（P<0.05）. Spearman correlation analysis showed that Porphyromonadaceae was significantly positively correlated with AQP4 protein level， while Oscillibacter_ruminantium was significantly positively correlated with VIP protein level， and negatively correlated with AQP3 and AQP4 protein levels（P<0.05）. Linear discriminant analysis effect size（LEfSe） analysis results showed that there were significant differences in a variety of intestinal bacteria between groups， and the intestinal bacteria of the model group were significantly enriched in the phylum/order/family/genus of Elusimicrobia， Betaproteobacteria， Burkholderiales， Sutterellaceae and Parasutterella（P<0.05）. ConclusionSpleen-Yin deficiency syndrome can weaken the digestion and absorption capacity of gastrointestinal tract， and cause the disturbance of water metabolism and intestinal flora. AQP4， AQP3 and VIP protein levels of gastric mucosa are closely related to Porphyromonadaceae and Oscillibacter_ruminantium. And AQP4， AQP3 and VIP may be involved in the regulation of intestinal flora in order to affect the physiological function of spleen governing transportation and transformation.

Objective:To explore the feasibility and preliminary effectiveness of case-based learning (CBL) teaching based on network resources in standardized residency training for nuclear medicine.Methods:Open network resources of CBL curriculum (13 sessions in total) were used to perform the collective teaching of 21 residents who received training in our professional base, with a total of 61 person-times. The residents received the test on objective questions before class, immediately after class, and at 1 week after class (7-10 days) to assess the learning effect of residents at these time points, and an evaluation form of teaching effectiveness was used after each class to assess the teaching effect. SPSS 23.0 was used to perform a one-way analysis of variance.Results:As for the test score of objective questions, there were 61 valid scores before class, 61 valid scores immediately after class, and 51 valid scores at 1 week after class (7-10 days), with a mean score of (49.43±13.37), (84.43±14.44), and (80.88±10.04), respectively (with 100 points as the total score), which showed a significant difference ( F=105.80, P<0.01). As for the evaluation of teaching effectiveness, a total of 61 valid forms were received, and the results of "very satisfied, satisfied, fairly good, and dissatisfied" accounted for 34.4% (21/61), 52.5% (32/61), 9.84% (6/61), and 3.28% (2/61), respectively, with an overall satisfaction rate (very satisfied+satisfied) of 86.9% (53/61). Conclusion:It is feasible and effective to make full use of network resources to carry out CBL teaching in standardized residency training for nuclear medicine, which has achieved a good preliminary effect.

Patients with non-small cell lung cancer (NSCLC) are treated in a variety of ways. In addition to radiotherapy, chemotherapy and targeted therapy, breakthroughs have been made in immune checkpoint inhibitors, in particular, programmed cell death 1 (PD-1) and its ligand (PD-L1) inhibitors have achieved survival benefits for NSCLC patients, and some of them have been approved as first-line drugs by the US Food and Drug Administration. Currently, commonly used PD-L1 inhibitors are atezolizumab, durvalumab and avelumab. Combination therapies include combination with chemotherapy, anti-vascular endothelial growth factor drugs, molecular targeted therapy and immunotherapy.

It has been reported that ACE2 is the main host cell receptor of 2019-nCoV and plays a crucial role in the entry of virus into the cell to cause the final infection. To investigate the potential route of 2019-nCov infection on the mucosa of oral cavity, bulk RNA-seq profiles from two public databases including The Cancer Genome Atlas (TCGA) and Functional Annotation of The Mammalian Genome Cap Analysis of Gene Expression (FANTOM5 CAGE) dataset were collected. RNA-seq profiling data of 13 organ types with para-carcinoma normal tissues from TCGA and 14 organ types with normal tissues from FANTOM5 CAGE were analyzed in order to explore and validate the expression of ACE2 on the mucosa of oral cavity. Further, single-cell transcriptomes from an independent data generated in-house were used to identify and confirm the ACE2-expressing cell composition and proportion in oral cavity. The results demonstrated that the ACE2 expressed on the mucosa of oral cavity. Interestingly, this receptor was highly enriched in epithelial cells of tongue. Preliminarily, those findings have explained the basic mechanism that the oral cavity is a potentially high risk for 2019-nCoV infectious susceptibility and provided a piece of evidence for the future prevention strategy in dental clinical practice as well as daily life.

OBJECTIVE: To explore the effect of premenstrual syndrome( PMS) on the quality of life( QOL) of female medical staffs. METHODS: By convenient sampling method,1 007 female medical workers from three Grade A class 3 hospitals were selected as study subjects and investigated by PMS Scale,World Health Organization Quality of Life Assessment Instrument Brief Version,Simplified Coping Style Questionnaire and Social Support Rating Scale. RESULTS: The detection rate of PMS among medical staffs was 52. 0%,and the total score of QOL of PMS medical staffs was lower than that of non-PMS medical staffs [( 84. 3 ± 12. 4) vs( 90. 5 ± 11. 6),P < 0. 01]. The multivariate linear logistic regression analysis results showed that the PMS medical staffs who often stay up late,with higher degree of dysmenorrhea,higher job stress,lower positive coping style score,higher negative coping style score,and poor support have lower QOL( P < 0. 05). The coping style and social support of PMS medical staffs can directly affect the QOL. The social support can also indirectly affect the QOL through coping style. CONCLUSION: Coping style is a mediator of social support and QOL.Adopting coping style can improve the QOL of PMS medical staffs.

Objective To investigate the risk factors of anastomotic leakage after radical gastrectomy for gastric cancer and establish a risk prediction scoring model for postoperative anastomotic leakage.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 757 patients who underwent radical gastrectomy for gastric cancer in the First People's Hospital of Yibin from February 2000 to December 2017 were collected.There were 1 207 males and 550 females,aged (59± 11) years,with a range from 48 to 70 years.Observation indicators:(1) follow-up situations;(2) risk factors analysis of anastomotic leakage after radical gastrectomy for gastric cancer;(3) establishment of risk prediction scoring model and verification;(4) risk prediction scores and probability of anastomotic leakage in patients with different scores.Follow-up using outpatient examination and telephone interview to detect anastomotic leakage after radical gastrectomy and reoperation or death caused by anastomotic leakage up to June 2018.Measurement data with normal distribution were represented as Mean±SD.Count data were described as absolute number.The univariate analysis and multivariate analysis were performed using the chi-square test and Logistic regression model respectively.The discrimination and fitting degree of the model were detected by the Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve.Results (1) Follow-up situations:800 of 1 757 patients were followed up at 1 week,1 month,3 months and 6 months after discharge.During the follow-up,75 had anastomotic leakage,60 of which recovered after conservative treatment,9 recovered after reoperation,6 died of complications including septic shock and cardiac and respiratory failure.(2) Risk factors analysis of anastomotic leakage after radical gastrectomy for gastric cancer:results of univariate analysis showed that patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin and volume of intraoperative blood loss were related factors affecting anastomotic leakage after radical gastrectomy for gastric cancer (x2=5.604,4.975,18.563,35.688,P＜0.05).Results of multivariate analysis showed that patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin ＜ 30 g/L and volume of intraoperative blood loss ＞ 400 mL were independent risk factors affecting anastomotic leakage after radical gastrectomy for gastric cancer (odds ratio=2.337,1.946,3.478,4.357,95％ confidence interval:1.136-4.804,1.022-3.705,1.871-6.464,2.678-7.090,P＜0.05).(3) Establishment of risk prediction scoring model and verification.Risk prediction equation was established according to the multivariate Logistic regression results:P =1/1 +exp (4.092-0.666 * X1-0.849 * X2-1.246 * X3-1.472 * X4).The fitting degree of the model was detected by the Hosmer-Lemeshow test (P=0.287).The discrimination of the model was detected by the ROC curve,with the area under curve as 0.734 (95％ confidence interval:0.689-0.834,P=0.002).(4) Risk prediction scores and probability of anastomotic leakage in patients with different scores:the risk prediction scores of anastomotic leakage after radical gastrectomy for gastric cancer were 1,1,2,2 in patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin ＜ 30 g/L and volume of intraoperative blood loss ＞400 mL,respectively.The incidence of anastomotic leakage of patients with risk prediction scores of 0,1,2,3,4,5,6 was 1.6％,3.2％,5.9％,10.1％,19.3％,31.8％ and 47.6％,respectively.The incidence of anastomotic leakage was 13.7％ of patients with score ≥3 and 3.5％ of patients with score ＜ 3.Conclusions Patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin ＜ 30 g/L and volume of intraoperative blood loss ＞ 400 mL are independent risk factors affecting anastomotic leakage after radical gastrectomy for gastric cancer.Establishment of a risk prediction scoring model for anastomotic leakage after radical gastrectomy for gastric cancer can effectively identify high-risk patients with anastomotic leakage after radical gastrectomy.

Objective To evaluate the effects of problem-based learning (PBL) teaching model in breast cancer medical imaging education based on multidisciplinary treatment (MDT). Methods The PBL teaching practice of breast cancer imaging based on MDT was carried out in the 192 clinical medicine students in Grade 2014 of Guangzhou Medical University. The students were randomly divided into four groups (group A, B, C and D) and each group was further divided into 1 to 5 teams, with 9 to 11 students in each team. The MDT teaching team consisted of clinical physicians in medical imaging, radiation oncology, surgery (specialized in breast tumor), and other disciplines. The formative assessment method was used to evaluate the teaching effects and the problems involved wereanalyzed. Results Firstly, with a full score of 100 points, the quantitative evaluation of each teaching team on the performance of students in PBL were (86.6±7.8), (87.1±8.1), (83.9±6.5), (88.1±4.5), and (85.1±8.2), respectively. No significant difference was found among each tutor team’s quantitative evaluation (F=1.014, P=0.388). Secondly, the whole posi-tive evaluation rate of students for tutors was 96.28%, with the highest and lowest positive rates as 98.36% and 94.08%, respectively. Significant difference was found among parts of the tutors ( χ2=10.554, P=0.032), specifically between team 1 and 5 (Z=2.245,P=0.025), 3 and 4 (Z=2.217,P=0.027) and 3 and 5 (Z=2.761,P=0.006) respectively. Lastly, the positive and negative evaluation rates of student's self-assessment were 87.33% and 12.67% respectively. Conclusion The effects of PBL based on MDT in breast cancer imaging teaching practice is encouraging, and the formative assessment method can objectively and effectively evalu-ate the effects of this kind of teaching model. However, the standards of evaluation still need to be further perfected and improved.

Objective To explore the prevalence and possible risk factors of depressive /anxious symptoms of patients with digestive disease .Methods Totally 245 patients with digestive diseases were recruited consecutively .Face-to-face interview and the hospital anxiety and depression scale ( HADS) ,self-rating anxiety scale ( SAS) and self-rating depression scale ( SDS) were employed to collect the clinical data .The non-condition logistic regression was performed to analyze the data .Results The prevalence of depression and anxiety in patients with organic diseases in digestive system was 36.3%.Among them,the higher incidence of depression and anxiety symptoms were digestive system tumors , peptic ulcer , acute pancreatitis and cirrhosis .The educational degree was correlated with simple depression,pure anxiety,depression complicated with anxiety (χ2 =8.781,P=0.013;χ2 =7.976,P=0.018;χ2 =15.807,P=0.003),the degree of high school or above was a protective factor ,the OR values were 0.347, 0.373,0.301.The gender was also correlated with depression ,anxiety,depression complicated with anxiety (χ2 =4.343,P=0.031;χ2 =1.056,P=0.017;χ2 =2.382,P=0.03),female was the risk factor of mental illness ,the OR values were 2.72,2.438,2.671.The age was correlated with depression ,depression complicated with anxiety (χ2 =9.872,P=0.002;χ2 =15.710,P=0.031),the age of over 40 years old was the risk factor of mental illness ,the OR values were 5.137,5.731.The occupation was correlated with depression (χ2 =6.017,P=0.017),the non-physical labor was the risk factors of depression , the OR value was 2.752.Conclusion There is a higher prevalence of depression and anxious symptoms in patients with digestive organic diseases .Female,senior high school or lower ,older than 40 years,and non-manual work are the risk factors of these symptoms .

The design of research protocol and quality control are the key to ensure the quality of clinical trial. A randomized clinical trial regarding the effects of medication combined with acupuncture on live birth rate in polycystic ovary syndrome (PCOS), which was initially designed as a comparative effectiveness research, then added with an acupuncture control group and finally became a factorial analysis, is taken as an example to explain the protocol design and optimization process, demonstrating the high level of methodology design and international recognization. By a series of measurements, such as unified purchase of acupuncture equipment, multiple trainings and assessments for acupuncturists' knowledge and operation standardization, in-site supervision of local center experts, the standard operation of acupuncture could be ensured and the credibility and scientificity of research results could be improved.