To summarise the clinical experience of treating perimenopausal syndrome with self-prescribed Gengnian Formula （更年方）. It is believed that the key mechanism of perimenopausal syndrome is the imbalance of heart and liver， and it is common to see the syndrome of blazing of heart-liver fire， so the treatment should be based on calmness of qi and blood. It is advocated that using the method of clearing the heart and pacifying liver， prescribing Gengnian Formula as the basic formula， and modifying according to the symptoms， so as to regulate heart and liver and balance yin and yang.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.

Objective:To investigate the risk factors of postoperative recurrence in patients with primary brain glioma and to construct a prediction model.Methods:A total of 98 patients with primary brain glioma treated by radical surgery in Nanchong Central Hospital from January 2018 to January 2021 were retrospectively included, and were divided into recurrent group (40 cases) and non-recurrent group (58 cases) according to whether there was recurrence or not during the follow-up period. The independent influencing factors for postoperative recurrence in patients with primary brain glioma were evaluated by multivariate logistic regression. Logistic prediction model of postoperative recurrence risk of patients with primary brain glioma was established, and the predictive efficacy of each index was calculated by receiver operator characteristic (ROC) curve.Results:There were statistically significant differences between recurrent group and non-recurrent group in glioma World Health Organization (WHO) grade ( χ2=12.48, P<0.001), isocitrate dehydrogenase (IDH) 1/2 mutation ( χ2=13.24, P<0.001), mean platelet volume (MPV) ( t=5.34, P<0.001), and MPV/platelet count (PLT) ( t=9.73, P<0.001). Multivariate analysis showed that WHO grade Ⅲ-Ⅳ ( OR=8.54, 95% CI: 1.62-44.99, P=0.011), IDH1/2 wild type ( OR=9.08, 95% CI: 1.68-49.19, P=0.010), low MPV ( OR=0.46, 95% CI: 0.21-0.99, P=0.048) and low MPV/PLT ( OR=0.02, 95% CI: 0.01-0.03, P<0.001) were independent risk factors for postoperative recurrence in patients with primary brain glioma. The logistic prediction model based on the above indicators was logit ( P) =11.78+2.15×WHO grade+2.21×IDH1/2 mutation situation-0.78×MPV-200.70×MPV/PLT ( R2=0.785). The ROC curve analysis results showed that WHO grade, IDH1/2 mutation, MPV, MPV/PLT, and logistic prediction model P-value could all be used to predict the risk of postoperative recurrence in patients with primary brain glioma; The areas under the curve were 0.681, 0.684, 0.783, 0.920 and 0.964, respectively. In the area under ROC curve comparison of each indicator, the predictive performance of the logistic regression model P-value was significantly higher than that of other indicators (all P<0.05) . Conclusion:Postoperative recurrence in patients with primary brain glioma may be related to glioma WHO grade, IDH1/2 mutation and platelet related laboratory indexes. The model constructed based on the above indicators can be used to predict the recurrence risk in patients with primary brain glioma after surgery.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Objective:To explore the effect of online and offline blended teaching in gynecology and obstetrics nursing.Methods:From February to July 2021, 139 second-year nursing undergraduates from the Chinese Academy of Medical Sciences & Peking Union Medical College in 2019 were selected as the research subject by the convenience sampling. The online and offline blended teaching was applied in the course of gynecology and obstetrics nursing. A self-designed questionnaire was used to investigate the evaluation of undergraduate nursing students on teaching preparation, teaching implementation and teaching effect.Results:A total of 87.05% of the students had a very good/good experience of using the online learning platform. 99.28% of students could watch online videos before class. 97.84% of the students were very satisfied/satisfied with the teaching.Conclusions:The online and offline blended teaching is conducive to improving students' autonomous learning ability, promoting the understanding and mastery of obstetrics and gynecology nursing knowledge, and improving learning interest.

Cutaneous T-cell lymphomas are a relatively rare group of mature T-cell lymphomas mainly manifesting in the skin, and its common subtype is mycosis fungoides. Total skin electron irradiation is one of the important conventional treatment methods, but there are many disadvantages, such as uneven dose distribution, poor position repetition, and long treatment time, which affect the clinical efficacy and patient prognosis. With the emergence and gradual popularization of helical tomotherapy in recent years, more and more medical institutions are gradually expanding their applications in total skin irradiation due to their ability to treat ultra-long targets and achieve dose-sculpted distribution, aiming to further explore its good or bad, and confirm whether it can replace the traditional total skin electron irradiation. In this article, research progress on total skin irradiation using helical tomotherapy was reviewed, the development of treatment technology, clinical efficacy and current concerns and controversies were illustrated.

Objective:To explore the value of prognostic model based on ferroptosis-related long non-coding RNA (lncRNA) in predicting the prognosis of patients with colon cancer.Methods:Ferroptosis-related genes were downloaded from FerrDb database, and the RNA sequencing gene data and clinical data of colon cancer patients from the establishment of the database to November 2021 were downloaded from the Cancer Genome Atlas (TCGA) database. Through R3.6.3 software, the colon cancer gene expression data obtained from TCGA database and ferroptosis-related genes obtained from FerreDb database were analyzed to obtain differentially expressed ferroptosis-related genes in colon cancer and normal tissues. The expression correlation between ferroptosis-related genes and lncRNA in colon cancer was calculated by using R3.6.3 software to determine ferroptosis-related lncRNA in colon cancer. The survival-related differentially expressed ferroptosis-related lncRNA was screened and included in the multivariate Cox proportional hazards model to construct a colon cancer prognosis model; and the risk score of colon cancer patients was calculated by the prognostic model according to the lncRNA expression. According to the median risk score, the clinical cases collected from TCGA database were divided into high-risk group and low-risk group with 223 cases in each group. Kaplan-Meier survival analysis was performed for the two groups. The receiver operating characteristic (ROC) curve was used to analyze the effect of prognostic model risk score and clinical characteristics on predicting the survival of all patients. GSEA 4.1.0 software was used for gene set enrichment analysis (GSEA) of lncRNA in high-risk and low-risk groups, and ggpubr package of R3.6.3 software was used for single sample GSEA (ssGSEA) of immune cells and immune function of differentially expressed lncRNA between high-risk and low-risk groups.Results:According to the intersection of ferroptosis-related genes and differentially expressed genes obtained from databases, 65 differentially expressed ferroptosis-related genes were obtained, and 24 lncRNA related to the prognosis of colon cancer were analyzed, and then prognostic model was constructed based on lncRNA. Kaplan-Meier survival analysis showed that the survival of low-risk group was better than that of high-risk group ( P < 0.001); ROC curve analysis showed that the area under the curve (AUC) of 1-, 2-, 3-year survival predicted by the prognostic model risk score was more than 0.75, and the AUC of 1-year survival predicted by the risk score for all patients was greater than age, gender, the National Comprehensive Cancer Network (NCCN), T staging, N staging and M staging. GSEA showed that differentially expressed lncRNA in high-risk and low-risk groups concentrated in tumor and immune-related pathways; ssGSEA showed that there were differences in T cells, macrophages, mast cells, neutrophils, immune stimulation, human leukocyte antigen, type Ⅰ and type Ⅱ interferon response between high-risk group and low-risk group (all P < 0.05), and the expression levels of CD200 and TNFRSF14 at the immune checkpoint were significantly different (both P < 0.01). Conclusions:Ferroptosis-related lncRNA may play an important role in tumor immunity of colon cancer, and it can be used for the prognosis analysis of patients with colon cancer.

Objective:To explore the characteristics of pyroptosis-related genes in colon cancer cells screened by bioinformatics, and to verify the constructed prognostic model of colon cancer based on differentially expressed pyroptosis-related genes.Methods:Genetic data of RNA sequencing and clinical data of colon cancer patients were downloaded from The Cancer Genome Atlas (TCGA) database. Fifty-two genes associated with pyroptosis were identified by searching the literature and compared with the RNA sequencing gene dataset of colon cancer and normal colon tissues obtained from TCGA database to obtain differentially expressed pyroptosis-related genes in clinical samples. The protein interaction network of differentially expressed pyroptosis-related genes was analyzed by using STRING website and R software. Based on the differential expression of pyroptosis-related genes in clinical samples of TCGA database, colon cancer patients in TCGA database were divided into pyroptosis and non-pyroptosis groups, and genes with significant differential expression between the two groups were screened at P < 0.05 according to gene expression; based on these differentially expressed genes, LASSO Cox regression was used to construct a prognostic model of colon cancer associated with pyroptosis. Patients collected from TCGA database were divided into high risk (≥ median value) and low risk (< median value) groups according to the median value of risk scores calculated by the model, and the overall survival of the two groups was analyzed by Kaplan-Meier survival function. The time ROC package of R software was used to analyze the efficacy of applying risk scores to predict the different survival time of colon cancer patients in TCGA database. Multivariate Cox regression was used to analyze the effects of clinicopathological factors and risk scores calculated by the model on the survival of patients in TCGA database. R software was used to analyze and obtain the differential genes between high and low risk groups of colon cancer patients in TCGA database. R software was used to conduct Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and single sample gene set enrichment analysis of immune cells and immune function (ssGESA) for differentially expressed pyroptosis-related genes. Results:Thirty-eight differentially expressed pyroptosis-related genes between colon cancer tissues and normal tissues of clinical samples were obtained based on data of TCGA database. A prognostic model consisting of 13 pyroptosis-related genes was established by applying LASSO Cox regression, the risk score = 0.118×MID2+0.354×IL20RB+0.083×HOXC11+0.011×TMEM88+0.021×SYNGR3+0.246×UPK3B+0.030×EGFL7+0.109×TMPRSS11E+0.138×IFITM10+0.161×RNF207+0.097×LINGO1+0.202×HEYL+0.025×ROBO3. Survival analysis showed that TCGA database had worse overall survival in the high-risk group than in the low-risk group ( P < 0.001). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve of the prognostic model risk score in predicting the survival of colon cancer patients in TCGA database at 1, 3 and 5 years was all > 0.7. Multivariate Cox regression analysis showed that risk score was an independent influencing factor for survival of colon cancer patients in TCGA database (high risk vs. low risk HR = 3.988, 95% CI 2.865-5.551, P < 0.001). GO and KEGG enrichment analysis showed that the differentially expressed genes between high and low risk groups (SULF1, FBLN2, COL1A1, DES, SFRP2, FNDC1, MYH11, APOE, C3, SPP1, COL1A2, COL10A1, THBS2, AEBP1, CNN1, IGHG1, and SFRP4) were upregulated in the high risk group, which were mainly associated with cellular matrix structural components and extracellular matrix (ECM) receptor interactions. ssGSEA analysis showed that the level of immune cell infiltration was higher in high risk group, especially B cells, macrophages, mast cells, helper T cells, and tumor-infiltrating lymphocytes were higher than those in low risk group; for immune function, chemokine receptors, immune checkpoints, human leukocyte antigens, parainflammation, T cell suppression, T-cell stimulation, and type Ⅱ interferon response in high risk group were higher than those in low risk group. Conclusions:The constructed prognostic model of colon cancer based on pyroptosis-related genes is valuable for predicting the prognosis of colon cancer patients. Pyroptosis-related genes may play an important role in tumor immunity of colon cancer and can be used for prognostic analysis of colon cancer patients.

Objective:To investigate the correlation between serum complement C1q/tumor necrosis factor associated protein 3 (CTRP3) and carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD).Methods:From January 2018 to December 2019, 111 T2DM patients hospitalized in the Endocrinology Department of Nantong Third People ′s Hospital Affiliated to Nantong University, and 30 healthy physical examiners in the physical examination center of Nantong Third People 's Hospital Affiliated to Nantong University in the same period were selected. Thirty cases of healthy physical examination were the control group, 111 cases of T2DM were divided into 52 cases of T2DM group and 59 cases of T2DM+NAFLD group according to whether they were combined with NAFLD. The cross-sectional study method was used to collect the relevant clinical data of three groups. The comparison data between multiple groups conformed to the normal distribution and the variance was uniform. One way ANOVA was used. SNK- q test was used for pairwise comparison, χ2 test for qualitative data comparison. The correlation between carotid intima-media thickness (IMT) and influencing factors was analyzed by partial correlation analysis, and the influencing factors of carotid IMT were analyzed by multi factor linear regression. Results:In the control group, T2DM group and T2DM+NAFLD group, body mass index (BMI) (23.65±2.81), (25.52±3.12), (24.90±2.94) kg/m 2,systolic blood pressure (119.43±15.81), (130.63±10.20), (139.37±14.11) mmHg, diastolic blood pressure (72.93±9.74), (73.40±9.44), (77.97±10.00) mmHg, and fasting blood glucose (5.12±0.77), (9.78±1.37), (9.24±1.46) mmol/L,glycosylated hemoglobin (HbA1c) (4.87±1.43)%, (7.99±1.10)%, (8.56±1.29)%,homeostasis model assessment of insulin resistance (HOMA-IR)(1.56±0.37),(2.80±1.00), (3.47±0.94), high density lipoprotein cholesterol (HDL-C) (1.52±0.34),(1.23±0.31), (1.22±0.31) mmol/L,low density lipoprotein cholesterol (LDL-C) (2.41±0.53), (2.73±0.61), (2.93±0.59) mmol/L, CTRP3 (292.93±68.54), (241.69±61.01), (150.80±56.67) μg/L, the difference between groups were statistically significant ( F=3.712,23.023,4.074,134.285,90.818,47.105,10.139,7.941,60.035,all P<0.05). Pairwise comparison shows that the systolic blood pressure, diastolic blood pressure, HbA1c and HOMA-IR in T2DM+NAFLD group were higher than those in control group and T2DM group,and CTRP3 was lower than those in control group and T2DM group, the difference was statistically significant (all P<0.05). BMI, fasting blood glucose, HbA1c, HOMA-IR, HDL-C and LDL-C in T2DM group were higher than those in the control group, CTRP3 was lower than that in the control group (all P<0.05). In the control group, T2DM group and T2DM+NAFLD group, IMT were (0.75±0.13), (1.11±0.17) and (1.25±0.15) cm; Crouse scores were (1.28±0.97), (3.22±1.42) and (4.54±1.22); the plaque detection rates 16.7%(5/30), 65.4%(34/52) and 78.0%(46/59), and there were significant differences between the two groups ( F=105.941,67.063, χ2=32.108, all P<0.001). There were significant differences between the two groups (all P<0.05). T2DM+NAFLD group was the highest, followed by T2DM group, and the control group was the lowest. Partial correlation analysis showed that carotid IMT was positively correlated with systolic blood pressure, fasting blood glucose, HbA1c, HOMA-IR, triglyceride and LDL-C ( r=0.356, 0.572, 0.575, 0.620, 0.172, 0.291, all P<0.05), and negatively correlated with HDL-C and CTRP3 ( r=-0.335, -0.675, all P<0.001). Multivariate linear regression analysis showed that HbA1c, HDL-C and ctrp3 were the influencing factors of carotid atherosclerosis ( t=2.621, -3.764, -7.280, all P<0.05) Conclusion:Serum CTRP3 is associated with carotid atherosclerosis in T2DM patients with NAFLD,and may have a protective effect on vascular lesions in T2DM patients with NAFLD.