The key pathogenesis of coronary heart disease （CHD） is spleen deficiency and phlegm stasis， and dysfunctional high-density lipoprotein （dys-HDL） may be the biological basis for the occurrence of CHD due to spleen deficiency and phlegm stasis. Considering the biological properties and effects of high-density lipoprotein （HDL）， it is believed that the structure and components of HDL are abnormal in the state of spleen deficiency which led to dys-HDL； and dys-HDL contributes to the formation of atherosclerotic plaques through two major pathways， namely， mediating the dysfunction of endothelial cells and mediating the foaminess of macrophages and smooth muscle cells， thus triggering the development of CHD. It is also believed that dys-HDL is a microcosmic manifestation and a pathological product of spleen deficiency， and spleen deficiency makes foundation for the production of dys-HDL； dys-HDL is also an important biological basis for the phlegm-stasis interactions in CHD. The method of fortifying spleen， resolving phlegm， and dispelling stasis， is proposed as an important principle in the treatment of CHD by traditional Chinese medicine， which can achieve the therapeutic purpose by affecting the changes in the structure and components of dys-HDL， thus revealing the scientific connotation of this method， and providing ideas for the diagnosis and treatment of CHD by traditional Chinese medicine.

With the advent of an aging society,Alzheimer's disease(AD)has gradually become a major ailment affecting the elderly.AD is a neurodegenerative disorder associated with cognitive impairments.In AD patients,brain network connections are disrupted,and their topological properties are also affected,leading to the disintegration of anatomical and functional connections.Anatomical connections can be tracked and evaluated using structural magnetic imaging(MRI)and diffusion tensor imaging(DTI),while functional connections are detected through functional MRI to assess their connectivity status.This review incorporates the findings of previous scholars and summarizes the current research of AD.It mainly discusses the imaging characteristics of large-scale brain network changes in AD patients,so as to provide researchers with scientific and objective imaging markers for AD prediction and early diagnosis,as well as future research.

Objective To investigate the predictive value of white blood cell count,LDL-C and fasting blood glucose on the occur-rence of AMI in elderly patients with coronary atherosclerotic heart disease(CAD).Methods A total of 210 elderly patients with CAD were selected and divided into the AMI group as the case group and the chronic CAD group as the control group based on clinical manifes-tations and laboratory and coronary angiography results.The general data,laboratory data,coronary angiography results,and other clinical information of the two groups were retrospectively analyzed.We used the Logistic regression analysis to explore the risk factors for acute myocardial infarction in elderly CAD patients and the receiver operating characteristic curve(ROC)to evaluate the predictive efficacy of white blood cell count,LDL-C and fasting blood glucose on the occurrence of AMI in elderly CAD patients.Results Compared with the chronic CAD group,the AMI group had a higher smoking rate,white blood cell count,CRP,ALT,AST,D-D dimer,fasting blood glu-cose,total cholesterol,LDL-C and Gensini score and lower LVEF(P＜0.05).The Logistic regression analysis showed that white blood cell count(β=0.859,P＜0.001,OR=2.361),LDL-C(β=1.003,P=0.009,OR=2.728)and fasting blood glucose(β=0.495,P=0.007,OR=1.641)were independent risk factors for AMI in elderly CAD patients.The ROC curve analysis showed that when the cut-off values of fasting blood glucose,white blood cell count,and LDL-C were 4.895mmol/L,7.19 x 109/L and 2.635 mmol/L respectively,the area under the curve for predicting AMI was the largest,with values of 0.734,0.859 and 0.735.The area un-der the ROC curve of the combination of the three is 0.902.Conclusion White blood cell count,LDL-C and fasting blood glucose are associated with AMI in elderly patients with CAD.Higher levels of white blood cell count,LDL-C and fasting blood glucose indicate a higher risk of AMI.The combination of the three can serve as a more valuable predictive index.

Objective: Patients with late life depression sometimes refuse to receive electroconvulsive therapy (ECT) owing to its adverse reactions. To alleviate patient’s resistance, a novel ECT stimulation strategy named mixed-strategy ECT (msECT) was designed in which patients are administered conventional ECT during the first three sessions, followed by low energy stimulation during the subsequent sessions. However, whether low energy electrical stimulation in the subsequent stage of therapy affect its efficacy and reduce adverse reactions in patients with late life depression remains unknown. To explore differences between msECT and regular ECT(RECT) with respect to clinical efficacy and side effects Methods: This randomized, controlled trial was conducted from 2019 to 2021 on 60 patients with late life depression who were randomly assigned to two groups: RECT or msECT. A generalized estimating equation (GEE) was used to compare the two stimulation strategies regarding their efficacy and side effects on cognition. Chi-squared test was used to compare side effects in the two strategies. Results: In the intent-to-treat group, the GEE model suggested no differences between-group difference in Hamilton Depression Rating Scale-17 score over time (Wald χ2=7.275, p=0.064), whereas the comparison of side effects in the two strategies favored msECT (Wald χ2=8.463, p=0.015) as fewer patients had adverse events during the second phase of treatment with msECT (χ2 =13.467, p=0.004). Conclusion msECT presents its similar efficacy to RECT. msECT may have milder side effects on cognition.

OBJECTIVE: To systematically evaluate the efficacy of Shengmai San in patients with cardiotoxicity of anthracyclines. METHODS: Randomized controlled trials (RCTs) were identified by searching China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, and Embase Databases from the inceptions until December 2020. The Cochrane Handbook was used to evaluate the risk of bias in the included studies. Data analysis was conducted using RevMan 5.3 software. RESULTS: Totally 19 RCTs with 2,331 participants were included in this review. Results showed that in improving arrhythmia (13 RCTs, n=1,877, RR=0.37, 95%CI 0.25 to 0.52, P<0.00001), the treatment group was superior to the control group. In terms of reducing left ventricular end-diastolic diameter (LVEDD, 2 RCTs, n=128, MD=-0.79, 95%CI -0.93 to -0.65, P<0.00001) and left ventricular end systolic diameter (LVESD, 2 RCTs, n=128, MD=-0.58, 95%CI -0.82 to -0.35, P<0.00001), the treatment group was also better than the control group. In reducing myocardial enzymes such as creatine kinase (CK) [(3 RCTs, n=256, SMD=-0.80, 95%CI -1.16 to -0.44, P<0.0001), (2 RCTs, n=126, SMD=-0.62, 95%CI -0.98 to -0.26, P=0.0007)], the treatment group was superior to the control group. CONCLUSION Shengmai San has a positive effect on the treatment of cardiotoxicity from anthracyclines. However, in the future, it is still necessary to conduct high-quality RCTs to verify its efficacy.
Anthracyclines/adverse effects* ; Cardiotoxicity/etiology* ; Drug Combinations ; Drugs, Chinese Herbal/adverse effects* ; Humans

Objective : To investigate the relationship between the 24 h ambulatory blood pressure c ircadian rhythm abnormalities and kidney damage in the patients of lupus nephritis (LN) . Methods : A total of 103 patients with LN patients were enrolled retrospectively. All patients were accepted 24 h ambulatory blood pressure monitoring (ABPM) . The patients were divided into 2 groups according to the 24 h ambulatory blood pressure c ircadian rhythm, including nocturnal blood pressure meaning average declining during the day ( > 10% ) and non⁃dipper type blood pressure group ( < 10% ) . The kidney damage index of LN patients with or without hypertension or nocturnal blood pressure and non⁃dipper type blood pressure was analyzed. The influencing factors of the circadian rhythm of LN blood pressure were analyzed by binary Logistic regression. Results : Among the 103 LN patients, 66 patients were hypertension, 37 patients were none hypertension. Fifty⁃nine patients were non⁃dipper type blood pressure in LN with hypertension group, and 30 patients were non⁃dipper type blood pressure in LN without hypertension. There was no significant difference in the frequency of non⁃dipper type blood pressure between the two groups (81. 1% vs 89. 4% , χ2 = 1. 395, P = 0. 238) . Compared with hypertension group, the levels of serum creatinine (Z = 2. 911, P = 0. 004), urea ( Z = 3. 348, P = 0. 001) and uric acid levels ( t = 2. 017, P = 0. 047 ) were significantly higher than those of LN without hypertension patients, whereas the levels of glomerular filtration rate (eGFR) (Z = 4. 846, P < 0. 001) were significantly lower than those of LN without hypertension patients. In the group of LN with hypertension, the levels of uric acid (Z = 2. 893, P = 0. 004) were significantly higher than those of nocturnal blood pressure subgroup patients compared with no dipper type blood pressure subgroup patients, and the levels of eGFR (Z = 2. 017, P = 0. 0440) were significantly lower. Nevertheless, in the group of LN without hypertension, the kidney damage index had no significant difference between the two subgroups. Univariate and multivariate analysis showed that uric acid was associated with an abnormal rhythm of LN combined with hypertension. Conclusion Abnormal blood pressure rhythms are common in LN patients with or without hypertension. Renal damage significantly increases in the non⁃dipper group of LN compared with hypertension patients.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective Comprehensively considering the effectiveness and safety of massage, a method for evaluating the pros and cons of oscillation excitation and pulse excitation for lumbar oblique-pulling manipulation was proposed, and lumbar oblique-pulling manipulation under oscillation excitation was optimized. Methods A multi-rigid body biomechanical model of thoracolumbar spine was established. The manipulation force was used as the input force of the model. Using MATLAB/Simulink, variation of the displacement and acceleration of each lumbar segment with time was simulated. For the optimization of lumbar massage manipulation, the core elements of massage force, namely, frequency (f) and operand (n) were changed, and then the maximum relative displacement and maximum acceleration of each lumbar segment were compared. A new index z was proposed to comprehensively evaluate effectiveness and safety of the manipulation. Results The maximum relative displacement of each lumbar segment was almost equal when lumbar oblique-pulling manipulation under two kinds of excitation was applied. For lumbar oblique-pulling manipulation, the maximum acceleration of each lumbar segment under oscillation excitation was significantly smaller than that under pulse excitation. When the frequency of massage was 1-2.5 Hz, the overall effect of massage was better, and the overall effect had no relation with the operands, and the force of massage lasted for one operand; when the frequency of message was 3.33 Hz and the operands were more than 5, the massage had the best effect, meanwhile the strength of each lumbar segment was relatively large; when the frequency of massage exceeded 5 Hz, and the overall performance of massage was not good. Conclusions Lumbar oblique-pulling manipulation under oscillation excitation is safer than that under pulse excitation. The research findings provide doctors with a reasonable range of operating parameters for lumbar oblique-pulling manipulation under pulse excitation.

Objective    To explore the surgical technique and preliminary results of endoscopic nipple-sparing mastectomy (E-NSM) and immediate pre-pectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) via single axillary incision for breast cancer patients. Methods    The clinical data of 9 consecutive female patients who underwent E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra from  March to May 2021 were retrospectively analyzed. The mean age of patients was 40.6 (22-60) years. The operation time, early complications were collected, and the patients' social and mental health, breast satisfaction and chest function before and after the operation were assessed with the BREAST-Q questionnaire. Results    All the patients had unicentric tumor with a mean diameter of 2.4 (0.6-4.7) cm. The mean distance from the tumor to the nipple was 2.5 (2-4) cm. There were 2 patients with tumor stage 0 and 7 patients with stageⅠ. The mean operation time was 161.1 (125-201) min, the mean blood loss was 41.1 mL and the hospital stay time was 1.5 d. There were 5 patients in the day-care unit. All the patients were successfully followed up with a median follow-up time of 1 (1-2) month. One (11.1%) patient with depigmentation of the nipple-areola complex caused by mild ischemia. None of the patients had incision complications, subcutaneous emphysema, hematoma, infection, nipple-areola or skin flaps necrosis, implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Chest well-being was decreased in the first month after the surgery compared with preoperative status, and the difference was statistically significant (P=0.001). There was no statistical difference in the breast satisfaction or psychosocial function scores between pre- and post-operation (P>0.05). Conclusion    E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra via single axillary incision has minimal trauma, rapid postoperative recovery, short operation time, few early complications and good early cosmetic effect, and the short-term result is satisfactory.

【Objective】 To analyze the cause of single-ELISA reactive of four blood screening items in 18 blood stations in Henan, so as to provide the basis for improving the quality of blood screening. 【Methods】 The single-ELISA reactive rate of HBsAg, anti-HCV, HIV Ag/Ab and anti-TP of 18 blood station laboratories in Henan throughout 2019 was calculated, and the causes were analyzed according to different ELISA reagent combinations and gray area settings in each laboratory. 【Results】 The overall single-ELISA reactive rates of HBsAg, anti-HCV, HIV Ag/Ab and anti-TP were 1.740(2 154/1 237 789), 0.564‰(698/1 237 789), 1.421‰(1 759/1 237 789) and 1.561‰(1 932/1 237 789), respectively, showing significant differences by detection items (P <0.05). Person correlation analysis showed that the single-ELISA reactive rate was independent of the gray area settings.but dependent on laboratories and reagent combinations. The single-ELISA reactive rate of HBsAg, anti-HCV, HIV Ag/Ab and anti-TP in D laboratory was the highest and higher than that in other labs using the same reagent.The laboratories with high HBsAg single-ELISA reactive rate were mostly those using a combination of imported reagents and domestic reagents, including the top 6 laboratories. The laboratories with high anti-HCV single-ELISA reactive rate were mostly those using certain domestic reagents. No obvious rules was noticed by single-ELISA reactive for anti-HIV. Laboratories with high anti-TP single-ELISA reactive rate were mostly those using combination 4. 【Conclusion】 The HBsAg single-ELISA reactive rate was the highest in the four blood screening items of blood station laboratories in Henan. The single-ELISA reactive rate is related to the laboratory itself and the reagent manufacturer, suggesting that laboratory quality control should be strengthened and proper reagent combination should be selected to reduce the waste of blood.