ObjectiveTo observe the clinical efficacy of modified Jinwei Guben Decoction （金卫固本汤， MJGD） combined with Bailing Capsule （百令胶囊， BC） in the treatment of chronic obstructive pulmonary disease （COPD） patients in the stable stage with qi deficiency， blood stasis and phlegm obstruction syndrome， in addition to conventional western medicine treatment. MethodsA total of 102 patients with stable COPD and qi deficiency， blood stasis， and phlegm obstruction syndrome were included in the study. According to the patients'preferences， they were divided into treatment group （49 cases） and control group （53 cases）. The control group received conventional western medicine treatment， while the treatment group was given MJGD （1 dose daily） combined with BC （2.0 g each time， three times a day） additionally. The treatment period was 3 months， and the patients were followed up for 1 year after the treatment. The acute exacerbation frequency （mild， moderate， severe） before treatment， during treatment， at 6-month follow-up， and at 1-year follow-up was compared between groups. Additionally， the lung function indicators such as FEV₁， FEV₁%pred， FVC， and FEV₁/FVC ratio， traditional Chinese medicine （TCM） syndrome scores， modified British Medical Research Council （mMRC） dyspnea scale， and the COPD Assessment Test （CAT） scores before and after treatment were compared. A logistic regression model was constructed to analyze the impact of MJGD combined with BC on clinical efficacy. ResultsFour patients dropped out from the treatment group and eight from the control group， leaving 45 patients of each group for statistical analysis. The number of mild and moderate acute exacerbations in the treatment group was lower than that in the control group during the treatment period， at 6-month follow-up and within 1 year of follow-up （P＜0.05） .The number of severe acute exacerbations was only lower in the treatment group than in the control group at 6-month follow-up （P＜0.05）. Compared with that before treatment， the number of acute exacerbations of all degrees in the treatment group was significantly reduced within 1 year of follow-up （P＜0.05），while only the number of mild acute exacerbations in the control group was significantly reduced within 1 year of follow-up （P＜0.05）. The treatment group showed significant improvement in FEV₁ and FEV₁%pred and FEV₁/FEV， while the control group showed a significant decline in FEV₁ and FVC （P＜0.05）. After treatment， both groups showed significant reductions in TCM syndrome scores， including coughing， sputum， wheezing， chest tightness， shortness of breath， and fatigue， as well as mMRC and CAT scores （P＜0.05）， with the treatment group having significantly lower scores than the control group （P＜0.05）. The overall clinical effective rate of in the treatment group was 93.33% （42/45）， significantly higher than that of the control group， 75.56% （34/45， P＜0.05）. Multivariate logistic regression analysis showed that the use of MJGD combined with BC （OR = 4.68， 95%CI： 1.15 - 19.09， P = 0.03） was positively correlated with clinical efficacy. ConclusionsIn addition to conventional western medicine treatment， the combination of MJGD and BC can reduce the frequency of acute exacerbations， delay the decline of lung function， improve clinical symptoms， and significantly enhance the clinical efficacy in patients with stable COPD and qi deficiency， blood stasis， and phlegm obstruction syndrome.

ObjectiveTo study the effect of Jinwei Pingchuan decoction combined with conventional Western medicine on the number of acute exacerbations， lung function， and clinical symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease （COPD） with phlegm-heat obstruction in lung syndrome. MethodsA non-randomized controlled trial was conducted to include 60 patients with acute exacerbation of COPD with phlegm-heat obstruction in lung syndrome. Patients were divided into a treatment group and a control group based on whether they received Jinwei Pingchuan decoction， with 30 patients in each group. The treatment group received Jinwei Pingchuan decoction combined with conventional Western medicine therapy， while the control group received conventional Western medicine therapy alone. Both groups received treatment for 7 days. The number of acute exacerbations and lung function indices were followed up and recorded before treatment and three months after treatment. The following outcomes were observed before and after treatment： the number of acute exacerbations， lung function indices （forced expiratory volume in one second ［FEV₁］， percentage of predicted value ［FEV₁%pred］， forced vital capacity ［FVC］， and FEV₁/FVC ratio）， the degree of acute exacerbation， TCM syndrome score， COPD assessment test （CAT） score， modified British Medical Research Council Dyspnea Questionnaire （mMRC） score， C-reactive protein （CRP）， and white blood cell （WBC） count. ResultsAfter 3 months of follow-up， the treatment group showed a significant reduction in the number of acute exacerbations compared with the pre-treatment values （P<0.05）. After treatment， the treatment group had fewer acute exacerbations than the control group （P<0.05）. The degree of acute exacerbation in the treatment group improved significantly compared with the pre-treatment values （P<0.05）. After treatment， the degree of acute exacerbation in the treatment group was improved compared to the control group （P<0.05）. Regarding lung function， FEV₁， FEV₁%pred， FVC， and FEV₁/FVC ratio increased significantly in the treatment group compared with the pre-treatment values （P<0.05）， and similar improvements were observed in the control group （P<0.05）. After treatment， FEV₁ and FVC were higher in the treatment group than the control group （P<0.05）. Regarding TCM syndrome scores， the scores for individual symptoms such as wheezing， cough， expectoration， chest tightness， shortness of breath， and fatigue， as well as the total score， decreased significantly in the treatment group compared with the pre-treatment values （P<0.05）. In the control group， the scores for cough， expectoration， chest tightness， fatigue， and palpitation， as well as the total score， also decreased （P<0.05）. After treatment， the treatment group showed significantly lower scores for wheezing， cough， chest tightness， shortness of breath， and the total score than the control group （P<0.05）. Regarding the CAT score， the scores for cough， expectoration， chest tightness， climbing stairs， going out， activity， and energy， as well as the total score， decreased significantly in the treatment group compared with the pre-treatment values （P<0.05）. In the control group， the scores for cough， expectoration， chest tightness， sleep， energy， and the total score decreased （P<0.05）. After treatment， the treatment group showed significantly lower scores for cough， expectoration， chest tightness， activity， and going out than the control group （P<0.05）. Regarding the mMRC score， CRP level， and WBC count， all these parameters decreased significantly in the treatment group compared with the pre-treatment values （P<0.05）， and similar reductions were observed in the control group （P<0.05）. ConclusionJinwei Pingchuan decoction can reduce the number of acute exacerbations and the degree of acute exacerbation in patients with acute exacerbation of COPD with phlegm-heat obstruction in lung syndrome. It also improves lung function and symptoms such as cough and chest tightness， thereby enhancing the quality of life of patients.

ObjectiveTo study the effect of Jinwei Pingchuan decoction combined with conventional Western medicine on the number of acute exacerbations， lung function， and clinical symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease （COPD） with phlegm-heat obstruction in lung syndrome. MethodsA non-randomized controlled trial was conducted to include 60 patients with acute exacerbation of COPD with phlegm-heat obstruction in lung syndrome. Patients were divided into a treatment group and a control group based on whether they received Jinwei Pingchuan decoction， with 30 patients in each group. The treatment group received Jinwei Pingchuan decoction combined with conventional Western medicine therapy， while the control group received conventional Western medicine therapy alone. Both groups received treatment for 7 days. The number of acute exacerbations and lung function indices were followed up and recorded before treatment and three months after treatment. The following outcomes were observed before and after treatment： the number of acute exacerbations， lung function indices （forced expiratory volume in one second ［FEV₁］， percentage of predicted value ［FEV₁%pred］， forced vital capacity ［FVC］， and FEV₁/FVC ratio）， the degree of acute exacerbation， TCM syndrome score， COPD assessment test （CAT） score， modified British Medical Research Council Dyspnea Questionnaire （mMRC） score， C-reactive protein （CRP）， and white blood cell （WBC） count. ResultsAfter 3 months of follow-up， the treatment group showed a significant reduction in the number of acute exacerbations compared with the pre-treatment values （P<0.05）. After treatment， the treatment group had fewer acute exacerbations than the control group （P<0.05）. The degree of acute exacerbation in the treatment group improved significantly compared with the pre-treatment values （P<0.05）. After treatment， the degree of acute exacerbation in the treatment group was improved compared to the control group （P<0.05）. Regarding lung function， FEV₁， FEV₁%pred， FVC， and FEV₁/FVC ratio increased significantly in the treatment group compared with the pre-treatment values （P<0.05）， and similar improvements were observed in the control group （P<0.05）. After treatment， FEV₁ and FVC were higher in the treatment group than the control group （P<0.05）. Regarding TCM syndrome scores， the scores for individual symptoms such as wheezing， cough， expectoration， chest tightness， shortness of breath， and fatigue， as well as the total score， decreased significantly in the treatment group compared with the pre-treatment values （P<0.05）. In the control group， the scores for cough， expectoration， chest tightness， fatigue， and palpitation， as well as the total score， also decreased （P<0.05）. After treatment， the treatment group showed significantly lower scores for wheezing， cough， chest tightness， shortness of breath， and the total score than the control group （P<0.05）. Regarding the CAT score， the scores for cough， expectoration， chest tightness， climbing stairs， going out， activity， and energy， as well as the total score， decreased significantly in the treatment group compared with the pre-treatment values （P<0.05）. In the control group， the scores for cough， expectoration， chest tightness， sleep， energy， and the total score decreased （P<0.05）. After treatment， the treatment group showed significantly lower scores for cough， expectoration， chest tightness， activity， and going out than the control group （P<0.05）. Regarding the mMRC score， CRP level， and WBC count， all these parameters decreased significantly in the treatment group compared with the pre-treatment values （P<0.05）， and similar reductions were observed in the control group （P<0.05）. ConclusionJinwei Pingchuan decoction can reduce the number of acute exacerbations and the degree of acute exacerbation in patients with acute exacerbation of COPD with phlegm-heat obstruction in lung syndrome. It also improves lung function and symptoms such as cough and chest tightness， thereby enhancing the quality of life of patients.

Objective: To investigate the environmental contamination of norovirus in nurseries and primary/secondary schools, so as to provide a scientific basis for effective prevention and control measures. Methods: A total of 483 external environmental samples were collected from 34 cluster outbreaks of norovirus gastroenteritis in kindergartens and primary/secondary schools in Linhai City from 2021 to 2024. Pathogen detection was conducted using a rapid nucleic acid extraction kit and realtime fluorescence RT-PCR, and the results were analyzed using the χ2 test or Fishers exact test. Results: Among the collected external environmental samples, the total positive rate of surface contamination was 13.66%. The positive rates in kindergartens and primary/secondary schools were 12.20% and 15.82%, respectively. In kindergartens, the five surfaces with the highest detection rates were desks/chairs (23.33%), toilet stool troughs (20.69%), urinal troughs (12.00%), washbasins/sinks (11.11%), and toilet mops (9.38%). In primary/secondary schools, the top five were toilet stool troughs (38.30%), urinal troughs (23.53%), toilet door handles (13.04%), toilet mops (12.50%), and drinking cups (11.11%). The difference in positive detection rates among different external environments in primary/secondary schools was statistically significant (Fishers exact probability test, P<0.01). The positive detection rate in sanitary toilets was higher than that in classroom environments (χ2=17.38), while the positive detection rate in classroom environments of kindergartens was higher than that in primary/secondary schools (χ2=5.42)(P<0.05). Conclusions Norovirus exhibits a high contamination rate in nurseries and schools, particularly in restroom areas. Strengthening sanitation and disinfection in highrisk environments, and improving hygiene awareness among children and staff, are essential for the effective prevent and control of norovirus.

[Objective] To evaluate the effects of preoperative ureteroscopy (URS) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). [Methods] Data of 712 UTUC patients who received RNU in West China Hospital during May 2003 and Jun.2019 were retrospectively analyzed. Patients were divided into URS group (n=187) and non-URS group (n=525) according to whether URS was performed before RNU. Kaplan-Meier curves were used to analyze the overall survival (OS), cancer-specific survival (CSS), and intravesical recurrence-free survival (IVRFS). Cox proportional risk model was used for risk assessment. Subgroup analysis and interaction test were used to further verify the results. [Results] Significant differences were observed between the two groups in terms of body mass index (BMI), diabetes mellitus, surgical method, hydronephrosis, tumor location, tumor grade, lymph node metastasis, lymphovascular invasion and tumor diameter (P<0.05). Kaplan-Meier survival analysis showed that IVRFS was significantly lower in the URS group than in the non-URS group (P<0.001), and the difference was more pronounced in renal pelvis carcinoma (P<0.001); there were no differences in OS and CSS between the two groups (P>0.05). Cox multivariate regression showed that URS was an independent risk factor for intravesical recurrence (HR=2.12, 95%CI: 1.34-3.36, P<0.001). [Conclusion] Preoperative URS can increase the recurrence rate of UTUC, but it has no effect on the OS and CSS.

Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Objective:To investigate the clinical effect of jujube core-shaped tissue resection technique in the treatment of alar reduction.Methods:A retrospective analysis was performed for the clinical data of patients who underwent alar reduction from February 2019 to June 2022. A spindle-shaped incision line was designed along the outer edge of the base of the nasal lobule, with a width of 4-5 mm and a length of 8-12 mm. The incision line was 1-2 mm away from the alar groove, and the inner side of the design line was extended to the inside of the nasal vestibule. After the incision was made, the subcutaneous tissue was undermining dissected with curved sharp scissors, and the shape of the extended excision tissue was similar to that of jujube core. After reduction, the incision was closed with vertical mattress suture. The surgical effect and complications were followed up after surgery, and an independent attending plastic surgeon evaluated the outcome and scarring based on photos before and at the last postoperative follow-up using the global aesthetic improvement scale (GAIS) and the Vancouver scar scale (VSS). GAIS is graded as 1, 2, 3, 4, and 5 points, and the lower the score, the better the improvement(≤3 points as effective improvement). VSS includes four parameters: color (0-3 points), thickness (0-4 points), vascular distribution (0-3 points), and softness (0-5 points). The higher the score, the more significant the scar is.Results:A total of 20 patients were enrolled, including 6 males and 14 females, aged 20 to 33 years, with an average age of 24.9 years. Before the operation, there were different degrees of alar flare and alar hypertrophy. After surgery, 13 patients had mild swelling, ecchymosis, which resolved after 3 days. There were no major complications as infection, incision dehiscence, and delayed healing. After 3 to 16 months of postoperative follow-up, 2 patients gradually developed cartilage deformation and affected the appearance of the nostrils 6 to 9 months after surgery due to the combination of rib-based rhinoplasty, and the satisfactory results were obtained after revision surgery. The symmetry of the nostrils was significantly improved. The GAIS score of 20 patients was (1.20±0.41) points, of which, 16 patients were rated as 1 point and 4 patients were rated as 2 points, all of which met the improvement criteria, and the VSS score was (1.45±0.60) points, in which the average score for color, thickness, vasculature and compliance are 0.60, 0.05, 0.55 and 0.30 points respectively.Conclusion:The application of jujube core-shaped tissue resection technique for alar reduction can increase the amount of tissue removal with the same incision width, which can not only fully narrow the alar effectively but also correct the hypertrophy of the alar tissue.

Objective To explore the CT manifestations and clinical features of checkpoint inhibitor-related pneumonitis(CIP).Methods Chest CT images and clinical data of 34 patients with CIP in Ningbo No.2 Hospitael were collected to retrospectively analysis.According to the site of tumor occurrence,22 patients were divided into lung cancer group and 12 patients in other malignant tumor group,and the differences in CT manifestations between two groups were compared.Results Cough(70.59％)and dyspnea(52.94％)were the common clinical symptoms.CIP occurred earlier and over a greater time span in lung cancer group 114.5(41.50,281.50)d than in other maligment tumor group 144(55.75,226.25)d.Eosinophil count was significantly higher only in other maligment tumor group(P=0.009).After hormonal therapy 18 patients improved,8 were stable and 8 progressed or even died.CT signs were prevalent in ground glass shadow(70.59％)and solid shadow(76.47％),and the imaging pattern was dominated by organic pneumonia pattern(47.6％),which was not related to type of primary tumor,and some of them could show nodular granulomatous reaction.Compared to lung cancer group,the other maligment tumor group was more likely to exhibit symmetrical infiltration(58.33％)distribution.Conclusion The clinical features of CIP are nonspecific,compared with other patients with primary malignancies,lung cancer patients are more likely to develop CIP,which is difficult to relieve after treatment,and are easy to develop severe disease.

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 explore the suitable prostate cancer screening mode under the medical community for primary hospitals.Methods:From April 2021 to April 2022, a total of 16007 male population ≥50 years from 9 branches of the medical community of the second hospital of Yinzhou participated in this study. They were divided into four groups according to age with group 1 of 50-59 years old, group 2 of 60-69 years old, group 3 of 70-79 years old, and group 4 of 80 years old and above. Serum tPSA was added to the routine physical examination, and the screening positive patients were referred to the referral hospital for further diagnosis and treatment under the mode of medical community. We proposed multi-parametric MRI (mpMRI) for those with serum PSA ≥4 ng/ml and suspicious lesions should be scored according to PI-RADS V2. The ultrasound-guided transperineal targeted prostate biopsy was performed for those with PI-RADS ≥3 and those with PI-RADS < 3 but tPSA ≥10 ng/ml. The tPSA follow-up examinations were performed every 6 months for tPSA < 10 ng/ml and PI-RADS < 3 points and once a year for tPSA < 4 ng/ml.Results:Among the 16 007 male population ≥50 years, 2 007(12.54%) were found serum PSA ≥4 ng/ml, and 634(31.59%)were referred to the referral hospital through the medical community system. Combining tPSA and mpMRI, 271 patients underwent ultrasound-guided transperineal targeted prostate biopsy. Among them, 162 were finally diagnosed with PCa, with a biopsy positive rate of 59.78%. The detection rate of PCa in all the subjects was 1.01%. According to the pathological grade, 5(3.08%) were in ISUP group 1, 95(58.64%) in ISUP group 2-3, and 62(38.27%) in ISUP group 4-5. There were 102(62.96%), 39(24.07%) and 21(12.96%) with localized, locally advanced or metastatic PCa, respectively. The levels of tPSA in the four groups were (1.13±1.44)ng/ml, (1.77±3.45)ng/ml, (3.27±17.58)ng/ml, and (4.26±11.48)ng/ml, respectively, with statistically significant differences ( P<0.01). The positive number of biopsy in each group was 1 case(0.06%), 56 cases(0.79%), 81 cases(1.36%) and 24 cases(1.82%) respectively, with statistically significant differences ( P<0.01). The number of ISUP 4-5 grades in each group was 0, 17(30.35%), 29(35.80%), and 16(66.67%) respectively, with statistically significant differences ( P<0.01). Conclusions:Based on the medical community system, according to the tPSA screening results of the primary hospitals, it is feasible and effective to refer suspicious patients to the referral hospitals for mpMRI examination, and screen prostate cancer by ultrasound-guided transperineal prostate fusion biopsy.