ObjectiveTo observe the clinical effectiveness of horticultural therapy involving the planting of Chinese medicinal herbs （mint and lily potted plants） combined with intradermal needling therapy for generalized anxiety disorder （GAD） of liver depression transforming into fire syndrome under transcranial magnetic stimulation and basic psychological therapy， and to explore the possible mechanisms of action. MethodsA total of 180 patients with GAD of liver depression transforming into fire syndrome were randomly divided into three groups， horticultural therapy group， intradermal needling group， and horticultural therapy+intradermal needling group， with 60 patients in each. All groups received basic treatment including basic psychological therapy and transcranial magnetic stimulation. The horticultural therapy group received horticultural therapy in addition to the basic treatment； the intradermal needling group received intradermal needling therapy once a week for 8 weeks in addition to the basic treatment； the horticultural therapy+intradermal needling group received both horticultural therapy and intradermal needling therapy， following the same procedures and duration. Hamilton Anxiety Rating Scale （HAMA）， Self-Rating Anxiety Scale （SAS）， and Pittsburgh Sleep Quality Index （PSQI） scores were assessed at baseline and after 2， 4， 6， and 8 weeks of treatment. Serum levels of adrenocorticotropic hormone （ACTH） and corticosterone （CORT） were measured before treatment and after 8 weeks of treatment. Motor-evoked potential （MEP） baseline levels were recorded before treatment， and MEP amplitude ratios were compared after 1 week and 8 weeks of treatment. Clinical effectiveness and safety were evaluated after 8 weeks of treatment. Pearson correlation analysis was used to examine the relationships between serum ACTH and CORT levels， MEP amplitude， and anxiety. ResultsIn the horticultural therapy group and intradermal needling group， HAMA， SAS and PSQI scores after 4， 6， and 8 weeks treatment were lower than baseline scores （P＜0.05）. In the horticultural therapy+intradermal needling group， these scores showed a significant decline starting after 2 weeks treatment and continuing through 8 weeks after treatment （P＜0.05）. The HAMA， SAS， and PSQI scores in the horticultural therapy+intradermal needling group were significantly lower than those in the other two groups after 2， 4， 6， and 8 weeks treatment （P＜0.05）. After 8 weeks of treatment， serum CORT and ACTH levels in the horticultural therapy+intradermal needling group were significantly lower than baseline levels （P＜0.05） and were also lower than those in the horticultural therapy group and intradermal needling group at the same time point （P＜0.01）. When comparing the level after 8 weeks treatment to that after 1 week treatment， under PAS10 stimulation， the MEP amplitude ratio in the intradermal needling group decreased at 30 minutes， while in the horticultural therapy+intradermal needling group， the MEP amplitude ratio decreased at all time points （P＜0.05 or P＜0.001）； under PAS25 stimulation， the MEP amplitude ratio in the horticultural therapy group increased at 20 minutes， and in the intradermal needle group at 10 minutes （P＜0.05）. In the horticultural therapy+intradermal needling group， the MEP amplitude ratio increased significantly at all time points after treatment （P＜0.001）. The cure rate in the horticultural therapy+intradermal needling group （74.14%， 43/58） was significantly higher than that in the horticultural therapy group （30.00%， 18/60） and the intradermal needling group （48.28%， 28/58， P＜0.05）. Correlation analysis revealed that serum ACTH and CORT levels were positively correlated with HAMA scores （r = 0.488， P＜0.01； r = 0.428， P＜0.01）. Following PAS10 intervention， the MEP amplitude ratio was positively correlated with HAMA scores （r = 0.458， P＜0.01）， whereas after PAS25 intervention， the MEP amplitude ratio was negatively correlated with HAMA scores （r = -0.562， P＜0.01）. ConclusionHorticultural therapy combined with intradermal needling treatment， under transcranial magnetic stimulation and basic psychological therapy， demonstrates significant clinical effectiveness in patients with GAD of liver depression transforming into fire syndrome. Its mechanism of action may be related to the regulation of hyperactivation of the hypothalamic-pituitary-adrenal （HPA） axis and the reduction of cortical excitability.

Objective To explore the selection strategy of diagnostic and therapeutic regimens and assess the efficacy for postoperative infection following internal fixation of patellar fractures. Methods A retrospective analysis was conducted on the clinical data of 12 patients with postoperative infection after internal fixation of patellar fractures. Results A total of 6 patients underwent complete removal of the internal fixation devices during debridement and were subsequently fixed with knee braces, while the other 6 had their original internal fixation devices removed and replaced with Kirschner wire fixation. Three patients developed septic arthritis and underwent knee arthroscopic lavage treatment. All 12 patients underwent bacterial culture and metagenomic next-generation sequencing (mNGS) testing, and the key pathogenic bacteria were successfully identified by mNGS. All wounds achieved primary healing within 2 weeks after closure. At the final follow-up, all patients exhibited good fracture healing, with Böstman patellar fracture function scores ranging from 24 to 29 (mean score of 26.58), and the outcomes were evaluated as excellent in 7 cases and good in 5, resulting in an excellent and good rate of 100.0%. Conclusion For patients with early and delayed postoperative infections following internal fixation of patellar fractures, removal of the internal fixation devices can help reduce the risk of infection recurrence. For patients with concurrent septic arthritis, early diagnosis and timely implementation of arthroscopic joint debridement and irrigation and drainage are crucial.

Objective:To investigate the prognosis of liver transplantation (LT) elderly recipients and analyze the influencing factors for prognosis.Methods:The retrospective cohort study was conducted. The clinicopathological data of 400 LT recipients who were admitted to three medical centers from January 2015 to June 2020 were collected, including 368 cases in the First Affiliated Hospital of Zhejiang University School of Medicine, 17 cases in the Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine and 15 cases in the Affiliated Hospital of Qingdao University. There were 297 males and 103 females, aged from 22 to 75 years, with a median age of 60 years. Of the 400 LT recipients,200 cases aged ≥60 years were divided into elderly recipients (ER) group and 200 cases aged <60 years were divided into non-elderly recipients (NER) group. Reci-pients underwent orthotopic LT or modified piggyback LT. Observation indicators: (1) survival of recipients and grafts for two groups; (2) influencing factors for death of LT recipients; (3) stratification analysis of ER group. Follow-up using the outpatient examination and telephone interview was conducted to detect survival and prognosis of patients up to May 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Kaplan-Meier method was used to calculate survival rates and draw survival curves. Log-Rank test was used for survival analysis. COX regression model was used for univariate and multivariate analyses. Results:(1) Survival of recipients and grafts for two groups: 400 recipients were followed up for 1 day to 71.7 months, with a median follow-up time of 16.3 months. Survival analysis showed that the 1-, 3-year overall survival rates and 1-, 3-year graft survival rates for ER group were 72.70%, 60.66% and 72.70%, 59.64%, respectively, versus 78.84%, 75.48% and 78.84%, 74.22% for NER group, showing significant differences in the overall survival and graft survival between the two groups ( χ2=5.712, 5.681, P<0.05). (2) Influencing factors for death of LT recipients: results of univariate analysis showed that age, score of model for end stage liver disease, Child-Pugh score, cold ischemia time(CIT) of liver donor, hypertension, blood type of recipients and donors, volume of intraoperative blood loss, volume of intraoperative red blood cell transfusion, volume of intraoperative plasma transfusion, volume of intraoperative crystalloid fluid transfusion, the maximum alanine aminotransferase within postoperative 7 days, the maximum aspartate aminotransferase within postoperative 7 days, total bilirubin were related factors for death of LT recipients ( odds ratio=1.026, 1.022, 1.084, 1.070, 1.701, 2.728, 1.000, 1.056, 1.089, 1.000, 1.000, 1.000, 1.003, 95% confidence interval as 1.006-1.045, 1.005-1.040, 1.060-1.170, 1.011-1.132, 1.133-2.554, 1.701-4.374, 1.000-1.001, 1.031-1.082, 1.039-1.142, 1.000-1.003, 1.001-1.004, 1.000-1.002, 1.001-1.004, P<0.05). Results of multivariate analysis showed that age, blood type of recipients and donors, the maximum aspartate aminotransferase within postoperative 7 days, total bilirubin were independent influencing factors for death of LT recipients ( odds ratio=1.022, 2.761, 1.000, 1.007, 95% confidence interval as 1.001-1.044, 1.612-4.727, 1.000-1.001, 1.002-1.012, P<0.05). (3) Stratification analysis of ER group: ① of 200 recipients in ER group, cases with 0 hour≤CIT≤8 hours, 8 hours12 hours were 96, 73, 31 ,respectively. The 1-year overall survival rates for above recipients were 77.46%, 73.33%, 54.07%, and the 3-year overall survival rates were 62.67%, 65.05%, 41.30%. There was a significant difference in the overall survival between the three groups ( χ2=6.708, P<0.05). ② Of 200 recipients in ER group,182 cases were ABO compatible and 18 were ABO incompatible. The 1-year overall survival rates for above recipients were 77.32%, 27.78%, and the 3-year overall survival rates were 64.63%, 22.22%. There was a significant difference in the overall survival between the two groups ( χ2=23.165, P<0.05). Conclusions:The overall survival of ER is inferior to NER. Age, blood type of recipients and donors, the maximum aspartate aminotransferase within postoperative 7 days, total bilirubin are indepen-dent influencing factors for death of LT recipients. Controlling CIT within 12 hours and avoiding ABO incompatible-liver transplantation can significantly improve the prognosis of ER.

Objective: To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture. Methods: From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded. Results: Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L₃-T₁₀ level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion. Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results.

Objective To evaluate the value of multi-slice spiral computed tomography angiography(MSCTA)scanning and reconstruction technology in detecting anomalous origin of coronary artery(AOCA).Methods Retrospective analysis was done in 3 856 patients who accepted MSCTA.Volume rendering(VR),multi-planar reformation(MPR),curved planar reformation(CPR)and maximum intensity projection(MIP)were used to observe the origin and course of coronary artery.Results 42 patients with AOCA were detected among 3 856 objects,and the detection rate was 1.09%.The detection rates had no statistically significant difference between male(1.17%)and female(0.98%).The rate of patients with anomalous origin of left coronary artery was 30.95%(13/42), and 9 objects(69.23%,9/13)of them had the anomalous origin of left circumflex.The rate of patients with anomalous origin of right coronary was 66.67%(28/42),and 35.71% of them(17/28)were found to have the anomalous origin of right coronary artery from the left sinus of valsalva.Conclusion MSCTA scanning and reconstruction technology is noninvasive,rapid,accurate and intuitive.

Objective To observe the regularities of distribution of TCM syndrome types and correlation between TCM syndrome types and cardiovascular prognosis risk factors of elderly hypertensive patients in three different urban and rural communities.Methods Totally 299 elderly hypertensive patients who conformed to the hypertensive diagnostic criteria from 896 respondents which participated in the health monitoring questionnaire drafted by health management team of China Academy of Chinese Medical Sciences were screened. The syndrome types were differentiated according to Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine (for Trial Implementation). The levels of some risk indicators, such as blood glucose, blood lipid, CREA, ET, Hcy and mALB were measured by radioimmunoassay, enzymatic cycling assay and other methods. Age, gender, BMI and pulse pressure were recorded.Results The TCM syndrome types of 299 elderly hypertensive patients were deficiency of yin and yang type (74 cases), hyperactivity of yang due to yin deficiency type (65 cases), blood stasis syndrome type (62 cases), stagnation of phlegm-dampness type (61 cases), hyperactivity of liver-fire type (37 cases). Single factor analysis showed that there existed statistical significance among BMI, FBG, GHbA1c, CREA, TC, LDL-C, ET, Hcy and mALB in the 5 TCM syndromes (P<0.05,P<0.01), and the statistical significance was more apparent in the stagnation of phlegm-dampness type, blood stasis syndrome type and hyperactivity of yang due to yin deficiency type. Discriminant analysis showed BMI and Hcy have certain reference value for the diagnosis of TCM syndrome types in elderly hypertensive patients. Binary-Logistic regression analysis showed that the course of disease had a positive correlation with syndrome of deficiency of yin and yang.Conclusion Compared with other types of elderly hepertensive patients, stagnation of phlegm-dampness type and blood stasis syndrome type are more closely related to hypertension cardiovascular prognosis risk factors.

PurposeTo explore the value of transesophageal echocardiography (TEE) monitoring mini-incision transthoracic occlusion of ventricular septal defect (VSD) with asymmetric ventricular defects occlude in preoperative selection of patients, intraoperative guidance monitoring and postoperative evaluation.Materials and MethodsForty-five cases of VSD undertook mini-incision transthoracic occlusion with asymmetric ventricular defects occlude were enrolled, their clinical data was analyzed retrospectively, preoperative transthoracic echocardiography (TTE) was applied for choosing appropriate cases. During surgery, TEE was employed for evaluating the VSD and in which perimembranous VSD was found in 21 cases, intracristal VSD in 15 cases and subpulmonic VSD in 9 cases, suitable eccentric type occluders were chosen, guide occluder was placed, and the occlusion effect was evaluated right after operation.ResultsThe procedures were completed successfully in 42 cases, with a successful rate of 93.3%, of which 21 cases had perimembranous VSD, 15 cases had intracristal VSD, and 6 cases had subpulmonic VSD. The diameter of the VSD ranged from 3 to 7 mm, averaging (4.5±0.7) mm, the diameter of occluders ranged from 4 to 8 mm, averaging (5.7±1.2) mm, there was a good positive correlation between size of VSD and occlude (r=0.87,P<0.05). All patients received follow-ups from 3 months to 24 months after operation, all the occluders located normally, with no more than mildly residual shunt, valve regurgitation or severe arrhythmia discovered.ConclusionMini-incision transthoracic occlusion of ventricular septal defect (VSD) with asymmetric ventricular defects occlude has high success rates, minimal injury, and lower complication rate. TEE can play a vital role by improving the success rate and safety of surgery.

Objective To find out fluorine content in drinking water in Yi County,and to provide ascientific basis for prevention of endemic fluorosis and children's dental caries.Methods According to FluorideDistribution Survey Program in Drinking Water of Hebei Province,an administrative village was taken as a unit,one drinking water sample was randomly collected from every village with centralized water supply.For villages withdecentralized water supply,five drinking water samples were randomly collected according to directions (east,west,south,north and centre) if there were more than five water sources in the village;samples from all the water sourceswere collected if there were less than five.Fluorine content was determined with drinking water standard testmethods (GB/T 5750.2-2006).Analysis and comparison of fluoride content in drinking water of different landscapes,water types and different well depth were carried out.Results The range of water fluoride content was 0.00-18.39 mg/L,and water fluorine median was 0.24 mg/L in 1 024 water samples in 27 towns in the county.Watersamples of 490,505 and 29 copies were collected in the hills,plains and mountains,and water fluorine medianwas 0.26,0.22 and 0.21 mg/L,respectively.Concerning water fluorine content in drinking water,mountains werehigher than hills and plains (x2 =71.71,17.74,all P ＜ 0.01).There was no significant difference between waterfluoride content in hills and plains (x2 =2.48,P ＞ 0.05).Water samples of 742,228 and 54 copies were collected,respectively,in household well water,tap water and mountain spring water,and water fluoride median was 0.22,0.24 and 0.33 mg/L,respectively.Concerning water fluoridation content in drinking water,spring water were higherthan tap water and household well water (x2 =53.16,50.85,all P ＜ 0.01).There was no significant differencebetween water fluoridation content in tap water and household well water (x2 =2.97,P ＞ 0.05).Water samples of583 and 441 copies were collected,respectively,in well depth ＜ 40 m and well depth ≥40 m,and water fluoride median was 0.24 and 0.23 mg/L,respectively,and there was no significant difference between water fluoridation content in the well depth ＜ 40 m and the well depth ≥40 m (Hc =0.17,P ＞ 0.05).Conclusions Fluoride content of drinking water in Yi County is not high,endemic fluorosis disease does not occur.

termined by serum cotinine determination.Effects of tobacco exposure on arterial elasticity in residents of poor areas in north China were more than those in urban residents.

In order to explore the effects of testicular infection of murine cytomegalovirus (MCMV) on mature sperm viability at different periods following MCMV inoculation in mice, 91 BALB/c mice without MCMV infection were randomly divided into two groups: an experimental group (n = 56) and a control group (n = 35). The mice in the experimental group were treated by inoculating MCMV intratesticularly, while those in the controlled group were directly inoculated with DMEM without MCMV. The mice in both groups were sacrificed separately on the day 1, 1. 5, 2, 4, 6, 9 and 14 post-inoculation (D1) 1. 5, 2, 4, 6, 9 and 14 PI). The MCMV M83 mRNA gene was detected in the testis by in situ hybridization (ISH) with MCMV late-mRNA probe labeled with digoxin. Sperm viability of mature sperm in the epididymis cauda was measured. The results demonstrated the positive signal of ISH of MCMV was found mainly in the cytoplasm of the testicular interstitial cells and spermatogenic cells in the experimental group. Compared with that in the controlled group, the sperm viability in the experimental group was decreased significantly on D1 PI and D1.5 PI (P < 0.05). No statistically significant difference in the sperm viability was found after D2 PI between two groups (P > 0.05). This suggested that sperm viability in mice might be descended significantly shortly after MCMV infection and might return to normal with time, indicating that MCMV acute infection might temporarily degrade sperm quality and influence procreation transiently.
Cytomegalovirus Infections/*physiopathology ; Mice, Inbred BALB C ; Orchitis/*virology ; Random Allocation ; Sperm Motility/*physiology ; Spermatozoa/cytology ; Spermatozoa/*physiology