Objective To explore the mediating role of activities of daily living (ADL) in pain and depressive symptoms in the elderly in China. Methods Utilizing the data from 2020 China Health and Retirement Longitudinal Study, 4403 Chinese elderly individuals aged ≥ 60 years old were selected as the research subjects. Depression Scale (CES-D 10) of the Center for Epidemiological Survey and ADL scale were used in the study. The PROCESS4.1 macro was used to test the mediating effect of daily living activities between pain and depressive symptoms, and the Bootstrap method was applied for verification of the mediating variables. Results A total of 2368 cases of depressive symptoms were detected in the elderly in China, with a detection rate of 53.78%. Pain was positively correlated with depressive symptoms (r=0.27, P<0.01), and activities of daily living were negatively correlated with pain and depressive symptoms (r=-0.27, -0.337, P<0.01). The results showed that the total effect value of pain on depressive symptoms was 0.33, the direct effect value was 0.24, and the mediating effect value of daily living activities was 0.09, accounting for 27.27%. Conclusion Pain and activities of daily living are important factors influencing depressive symptoms in the elderly, and activities of daily living play a partial mediating role in the relationship between pain and depressive symptoms in the elderly.

This paper summarized Professor XU Jingfan's clinical experience of using Zisu （Perillafrutescens） for the treatment of spleen and stomach diseases. According to the disease characteristics， Professor XU flexibly selected the different parts of Zisu. It is believed that the leaf of Zisu is good at dispersing， dredging qi movement， and good at treating external contraction as well as internal damage due to depression or stagnation， and being effective in relieving abdominal lumps and fullness with vomiting； its stem is good at widering chest and diaphragm， smoothing qi and the middle， and dredging the twelve meridians， which can treat qi stagnation， especially suitable for distention and fullness in the midline of body like throat， esophagus， and stomach. Perilla seed is good at depressing qi and eliminating phlegm， loosening bowels to relieve constipation， which can be used in diseases of combined phlegm and qi， and combined treatment of lung and intestines to treat long-term constipation. In clinic， Huanglian （Coptis chinensis）- Zisu leaf is often used as pungent dispersing and bitter descending， promoting qi movement to treat persistent nausea and vomiting； Xiangfu （Cyperi Rhizoma）-Zisu stem is employed as regulating qi to smooth the middle， soothing qi to disperse liver stagnation for various syndromes of qi stagnation； Huomaren （Cannabis Fructus）-Zisu seed is utilized to clear the lungs and benefit qi， and moisten intestines by purgation for chronic constipation. The original ancient formulas are flexibly modified and tailored， so usually modified Banxia Houpo Decoction （半夏厚朴汤） is used to treat plum-stone qi （globus hystericus） and esophageal disorders， while modified Buzhong Yiqi Decoction （补中益气汤） combined with Xiangsu Powder （香苏散） is used to treat gastroptosis， then self-prescribed Jixing Tuxie Formula （急性吐泻方） is used for acute diarrhea， and Xiexie Waizhi Formula （泄泻外治方） is applied for chronic cold-dampness diarrhea.

The climate on the plateau is characterized by hypobaria and hypoxia,where the natural environment is harsh,which poses a serious threat to the health and combativeness of troops.As a vital organ of the human body,the kidney has a complex vascular structure,large oxygen consumption,and is vulnerable to damage from hypoxia and other factors.This paper outlines the special changes of renal function and current diagnosis and treatment of kidney injury by taking into consideration the actual conditions on the plateau and renal blood and oxygen supply.Meanwhile,related countermeasures are recommended to facilitate the prevention and treatment of kidney injury in warfare on the plateau.

Objective To evaluate the effect of photo-activated disinfection(PAD)as a kind of adjuvant treatment on moderate to severe chronic periodontitis.Methods 21 patients with the chronic periodontitis(totally 218 selected sites)were randomly enrolled and divided into group A(minocycline hydrochloride),group B(PAD),group C(PAD + minocycline hydrochloride),and group D(no adjunctive therapy)for the adjunctive treatment after receiving the scaling and root planing(SRP).Periodontal indexs as probing depth(PD),bleeding on probing(BOP)and clinical attachment loss(CAL)were examined at the baseline,6 and 12 weeks after the treatment.Meanwhile,periodontal pathogens as Porphyromonas gingivalis(Pg)and Tannerella forsythia(Tf)from subgingival plaque of group A,B and C were detected by Real-time PCR.Results Compared with the baseline,the periodontal inflammations of all groups were improved signiffcantly at 6 and 12 weeks after the treatment(P<0.001),and group A,group B and group C were better than group D(P<0.001),group C was better than group A(P<0.001);Furthermore,the concentration of Pg and Tf was decreased significantly(P<0.001),and there was no difference among the three groups with adjunctive therapy.Conclussion As the adjunctive treatment of SRP,PAD could achieve the same and even better effect than minocycline hydrochloride ointment.

Objective To explore the construction idea and application method of knowledge base and knowledge mining system for the prevention and treatment of diseases in traditional Chinese medicine.Methods Guided by the theory of traditional Chinese medicine(TCM),firstly,the knowledge system of TCM Prevention and treatment was sorted out,and the structure and relationship of TCM Prevention and treatment knowledge base were designed according to the classification method of TCM Prevention and treatment;Secondly,according to the needs of pre treatment research,the ancient and modern literature data sources and knowledge collection methods of TCM pre treatment database are proposed;Then,under the framework of the pre treatment classification system,the core knowledge is studied in the aspects of professional annotation,relationship extraction,knowledge audit,and a variety of data mining algorithms are introduced to analyze and mine the knowledge;Finally,the massive data obtained are combined with big data analysis and computer machine learning to realize intelligent information collection,disease analysis and diagnosis and treatment suggestions.Results Under the guidance of traditional Chinese medicine theory,the knowledge base of traditional Chinese medicine for prevention and treatment of diseases can digitize,digitize and intellectualize the basic knowledge and clinical knowledge of traditional Chinese medicine for prevention and treatment of diseases,and can objectively mine and analyze the data,providing a basis for the service and sharing of knowledge of traditional Chinese medicine for prevention and treatment of diseases.Conclusion The knowledge base of TCM Prevention and treatment is an important way for the digital storage of TCM Prevention and treatment knowledge,and provides literature knowledge support and objective evidence of data mining for TCM Prevention and treatment research.

Objective:To explore the clinical application effect of allogeneic acellular dermal matrix (ADM) in the repair of asymmetric nail fold deformity after complete syndactyly surgery in children.Methods:A retrospective analysis was conducted on the clinical data of children with secondary asymmetric nail fold deformity after complete syndactyly surgery treated at the Department of Burn and Plastic Surgery, Children’s Hospital of Nanjing Medical University, from January 2022 to December 2023. The patients required a secondary surgical repair due to insufficient soft tissue capacity with or without scar contracture, causing asymmetry of the nail fold after finger separation at the distal end following syndactyly surgery. During the operation, continuous Z-plasty was designed along the original surgical scar axis and incised towards the proximal end of the lateral nail fold, followed by thorough scar release. Scar debulking surgery was performed if there was significant local scar hyperplasia. A tunnel was created from the incision site near the lateral nail fold to reach the fingertip subcutaneously. ADM was filled into this tunnel until a satisfactory appearance of the lateral nail fold was achieved. The flaps were then closed by cross-suturing. Regular follow-up observations were conducted on the incision healing, scar, and appearance of the finger, and aesthetic evaluation according to Bulic’s standards was performed, classifying them into four grades: excellent, good, fair, and poor.Results:The study enrolled 12 patients, and nail fold asymmetry appeared 3 to 6 months after surgery, with 8 males and 4 females, ranging from 1 to 9 years old (average age 4.6 years). Affected digits included both hands in 7 cases and one hand in 5 cases, totaling 38 fingers. All 12 cases including 25 fingers presented with insufficient distal capacity in their fingers; seven cases including 16 fingers also had scar contracture resulting in poor appearance. All procedures were successfully performed. Post-operatively, one case of necrosis at the tip of the scar flap was observed after 12 days of removing the dressing but healed after dressing changes, and no infections or flap necrosis occurred in the remaining patients, with the incisions healing primarily. Follow-up periods ranged from 1 to 24 months, with an average duration of 13.6 months. All patients achieved the restoration of soft tissue capacity in the finger lateral nail fold, varying degrees of correction for asymmetrical nail fold deformities, and complete release for scar contracture, with 7 fingers in 4 cases rated as excellent, 12 fingers in 5 cases as good, 4 fingers in 2 cases as fair, and 2 fingers in one case as poor in evaluation of fingertip appearance.Conclusion:The use of ADM for filling is effective in restoring soft tissue capacity and correcting asymmetrical deformities caused by secondary nail fold abnormalities after complete syndactyly repair surgery in children. It has shown good clinical outcomes with minimal complications.

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 clinical application effect of allogeneic acellular dermal matrix (ADM) in the repair of asymmetric nail fold deformity after complete syndactyly surgery in children.Methods:A retrospective analysis was conducted on the clinical data of children with secondary asymmetric nail fold deformity after complete syndactyly surgery treated at the Department of Burn and Plastic Surgery, Children’s Hospital of Nanjing Medical University, from January 2022 to December 2023. The patients required a secondary surgical repair due to insufficient soft tissue capacity with or without scar contracture, causing asymmetry of the nail fold after finger separation at the distal end following syndactyly surgery. During the operation, continuous Z-plasty was designed along the original surgical scar axis and incised towards the proximal end of the lateral nail fold, followed by thorough scar release. Scar debulking surgery was performed if there was significant local scar hyperplasia. A tunnel was created from the incision site near the lateral nail fold to reach the fingertip subcutaneously. ADM was filled into this tunnel until a satisfactory appearance of the lateral nail fold was achieved. The flaps were then closed by cross-suturing. Regular follow-up observations were conducted on the incision healing, scar, and appearance of the finger, and aesthetic evaluation according to Bulic’s standards was performed, classifying them into four grades: excellent, good, fair, and poor.Results:The study enrolled 12 patients, and nail fold asymmetry appeared 3 to 6 months after surgery, with 8 males and 4 females, ranging from 1 to 9 years old (average age 4.6 years). Affected digits included both hands in 7 cases and one hand in 5 cases, totaling 38 fingers. All 12 cases including 25 fingers presented with insufficient distal capacity in their fingers; seven cases including 16 fingers also had scar contracture resulting in poor appearance. All procedures were successfully performed. Post-operatively, one case of necrosis at the tip of the scar flap was observed after 12 days of removing the dressing but healed after dressing changes, and no infections or flap necrosis occurred in the remaining patients, with the incisions healing primarily. Follow-up periods ranged from 1 to 24 months, with an average duration of 13.6 months. All patients achieved the restoration of soft tissue capacity in the finger lateral nail fold, varying degrees of correction for asymmetrical nail fold deformities, and complete release for scar contracture, with 7 fingers in 4 cases rated as excellent, 12 fingers in 5 cases as good, 4 fingers in 2 cases as fair, and 2 fingers in one case as poor in evaluation of fingertip appearance.Conclusion:The use of ADM for filling is effective in restoring soft tissue capacity and correcting asymmetrical deformities caused by secondary nail fold abnormalities after complete syndactyly repair surgery in children. It has shown good clinical outcomes with minimal complications.

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.

Objective:To evaluate the clinical efficacy and safety of retrograde intrarenal surgery(RIRS) and miniaturized percutaneous nephrolithotomy(mini-PCNL) in the treatment of lower pole kidney stones with a diameter <1.5 cm.Methods:The data of 95 patients with lower pole kidney stones with a diameter <1.5 cm treated in Renmin Hospital of Wuhan University from June 2017 to October 2020 were retrospectively analyzed. According to different surgical methods, the patients were divided into RIRS group and mini-PCNL group. There were 51 cases in RIRS group and 44 cases in mini-PCNL group. There was no significant difference in age [(48.2±11.4) years vs. (46.4±14.1) years], body mass index [(21.9±2.4) kg/m 2 vs. (20.7±3.2) kg/m 2], gender [male/female: 37/14 vs. 24/20], stone CT [(746.42±164.24)HU vs. (858.62±148.72)HU], creatinine [(71.3±21.6)μmol/L vs. (63.5±20.3)μmol/L], stone location (left/right: 26/25 vs. 23/21), stone diameter [(10.5±2.1) mm vs. (12.5±2.4) mm], infundibulopelvic angle [(43.32±9.42) degrees vs. (43.82±10.34) degrees], infundibular length [(24.92±4.85)mm vs. (24.37±5.26)mm] and infundibular [(9.26±3.04)mm vs.(9.46±2.94)mm] between the two groups ( P>0.05). The operation time, stone-free rate, hospital stay and postoperative complications between the two groups were compared. Results:Compared with the mini-PCNL group, the RIRS group had significantly smaller decrease in postoperative hemoglobin [(1.53±0.92) g/L vs. (4.54±2.46) g/L, P<0.05], the postoperative hospital stay was shorter [(2.52±0.94) d vs. (4.51±1.25)d, P<0.05], and postoperative visual analogue score was lower [(2.43±0.92) vs. (3.24±0.76), P<0.05]. The operation time of the mini-PCNL group was shorter than that of the RIRS group [(42.32±13.28) min vs. (54.24±14.43)min, P<0.05]. There was no significant difference in postoperative complications [5.9% (3/51) vs. 11.4% (5/44), P>0.05], postoperative cveatinine [(71.3±21.6) μmol/L vs. (63.5±20.3) μmol/L, P>0.05], postoperative intestinal function recovery time [(25.46±10.28)h vs. (32.43±9.25)h, P>0.05] and stone-free rate [92.2% (47/51) vs. 97.7% (43/ 44), P>0.05] between the two groups. Conclusions:Both RIRS and mini-PCNL are effective and safe minimally invasive treatments for lower pole kidney stones with a diameter < 1.5 cm. RIRS has shorter operation time, less blood loss, lower pain score and faster postoperative recovery.