ObjectiveUsing the Delphi method and analytic hierarchy process （AHP） to screen diagnostic items for qi stagnation syndrome and determine their weights， providing a reference for the development of a diagnostic scale of qi stagnation syndrome. MethodsLiterature related to qi stagnation syndrome were screened from databases including CNKI， Wanfang， VIP， SinoMed （from inception to October 31， 2020）. Through systematic review of literature and expert discussions， the information on the four examinations of traditional Chinese medicine were organized and an item pool was constructed. The Delphi method was used to screen the item indicators， while the AHP was employed to determine their weights. Statistical methods such as mean value， full score ratio， rank sum， unimportant percentage， and coefficient of variation were used for item screening， with the weights calculated by AHP serving as the item weights. ResultsA total of 235 articles and books were included for analysis， resulting in an item pool of 16 items. After three rounds of expert consultation， a total of 84 valid questionnaires were collected， with a total expert enthusiasm coefficient of 99% and authority coefficient of 0.86， 0.84， 0.83， respectively， and the coordination coefficients were 0.45， 0.49， and 0.29， respectively. Through the statistics analysis， 8 diagnosis items were screened out， including distension （stuffi-ness） or distending pain or scurrying pain， wiry pulse， depressed emotions， frequent sighing， deep and wiry pulse， irritability， pale red tongue， and thin white coating. The AHP showed that the order of weights of the first-level indicators from high to low was clinical symptoms， pulse manifestation， and tongue manifestation； the order of weights of the second-level indicators from high to low was distension （stuffiness） or distending pain or scurrying pain， wiry pulse， depressed emotions， frequent sighing， deep and wiry pulse， irritability， pale red tongue， and thin white coating. ConclusionBy applying the Delphi method and AHP to analyze and evaluate the diagnostic items for qi stagnation syndrome， key diagnostic items were screened and their weights determined， laying the foundation for the development of a diagnostic scale for qi stagnation syndrome.

PPG(photoplethysmography)holds significant application value in wearable and intelligent health devices.However,during the acquisition process,PPG signals can generate motion artifacts due to inevitable coupling motion,which diminishes signal quality.In response to the challenge of real-time detection of motion artifacts in PPG signals,this study analyzed the generation and significant features of PPG signal interference.Seven features were extracted from the pulse interval data,and those exhibiting notable changes were filtered using the dual-sample Kolmogorov-Smirnov test.The real-time detection of motion artifacts in PPG signals was ultimately based on decision trees.In the experimental phase,PPG signal data from 20 college students were collected to formulate the experimental dataset.The experimental results demonstrate that the proposed method achieves an average accuracy of(94.07±1.14)%,outperforming commonly used motion artifact detection algorithms in terms of accuracy and real-time performance.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Hypertensive intracerebral hemorrhage(HICH)is a disease with a rapid onset,rapid progression,high mortality rate,and long-term impact on the ability to function.Non-contrast agent-based CT(NCCT)is a common method for evaluating and identifying HICH.Recent radiomics in image processing and machine learning(ML)have enabled the extraction of high-dimensional feature information from medical images,which can be used to rapidly and accurately diagnose HICH and predict its course of disease.The paper describes the application of radiomics and ML techniques in HICH diagnosis and treatment,and identifies possible directions for future research.

Objective:To evaluate the effect of short-term very low-calorie restriction(VLCR) on glycemic control in overweight/obese patients with type 2 diabetes, and to explore mechanisms through identifying markers of gut microbiota.Methods:This trial was conducted in 14 adult overweight/obese patients with type 2 diabetes. They received VLCR for 9 days in the hospital(calorie intake 300-600 kcal/d). Before and after VLCR, body weight(BW), waist circumference(WC), blood pressure(BP), and heart rate(HR) were measured, and body mass index(BMI) was calculated according to their height and weight. Fasting blood glucose(FBG), 2 h postprandial blood glucose(2hPBG), fasting insulin(FINS), triglycerides(TG), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), and low-density lipoprotein-cholesterol(LDL-C) were determined, and yielded the homeostasis model assessment for insulin resistance(HOMA-IR). Additional lab tests such as liver and kidney function and electrolytes were performed. The estimated glomerular filtration rate(eGFR) was calculated to evaluate renal function. All data were analyzed using the SPSS Sample Power software. Feces samples were collected before and after VLCR. Fecal samples were tested for microbial diversity using 16S rDNA technology. Professional software was used to analyze the differences of gut microbiota in feces before and after VLCR.Results:After 9 days of VLCR, BW, BMI, WC, BP, HR, FBG, 2hPBG, FINS, HOMA-IR, alkaline phosphatase, TG, and blood urea nitrogen of 14 overweight/obese patients with type 2 diabetes were significantly reduced( P<0.05). No effect was seen on serum alanine aminotransferase, aspartate amino transferase, gamma glutamyl transferase, TC, HDL-C, LDL-C, creatinine, eGFR, uric acid, albumin, calcium, and phosphorus( P>0.05). The gut microbiota diversity did not differ before and after VLCR. The abundance of Bacteroidetes increased significantly, and the Firmicutes/Bacteroidetes ratio decreased from 11.79 to 4.20. Between groups analysis showed the abundance of Parabacteroides distasonis increased significantly after VLCR. Conclusion:VLCR can improve body weight and glucose and lipid metabolism in overweight/obese patients with type 2 diabetes, with no serious adverse events. Parabacteroides distasonis may be a marker of VLCR.

Objective:To evaluate the outcomes of aortic root repair in acute type A aortic dissection (ATAAD) with aortic sinus involvement.Methods:The clinical data of patients with ATAAD involving the aortic sinus and an aortic root diameter of ≤45 mm who were treated from January 1, 2015, to December 31, 2016, were collected. Patients were divided into group A (involvement of one aortic sinus or part of one aortic sinus) and group B (involvement of more than one aortic sinus). The effectiveness of aortic root repair in ATAAD with sinus involvement was analyzed by comparing the preoperative imaging characteristics and postoperative results between the two groups.Results:The study cohort comprised 155 patients, including 100 patients in group A and 55 in group B. There were no differences between the two groups in baseline characteristics, aortic root diameter, 30-day mortality, and complication rates. During an average follow-up of(49.1±14.6) months, there was no difference between the two groups in the survival rate (92.0% vs. 89.5%, P=0.61). The aortic root diameter at follow-up showed no progressive expansion compared with preoperatively in either of the two groups[(38.1±3.6) mm vs. (37.9±3.5)mm, P=0.92, A; (38.4±4.1) mm vs. (38.3±3.6) mm, P=0.74, B]; furthermore, there was no difference between the two groups in aggravation of aortic regurgitation. Conclusion:Aortic root repair achieves satisfactory medium-term outcomes in ATAAD with more than one aortic sinus involved, but the long-term outcomes need to be evaluated.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To compare the efficacy and safety of glucocorticoids (GCs), rituximab (RTX), and GCs combined with RTX in the treatment of active moderate-to-severe Graves′ ophthalmopathy (GO).Methods:A total of 42 patients with GO who were hospitalized in the Endocrinology Department of Jiangsu Integrated Traditional Chinese and Western Medicine Hospital from August 2017 to July 2019 were included and divided into GCs group (18 cases), RTX group (7 cases), GCs combined with RTX group (17 cases). Patients in the GCs group were received 500 mg intravenous methylprednisolone once a week for 6 weeks, followed by 250 mg intravenous methylprednisolone once a week for 6 weeks. In RTX group, patients were given intravenous RTX 100 mg every 2 weeks for 2 times. GCs combined with RTX group, i. e. RTX combined with methylprednisolone pulse therapy. At 12 and 24 weeks after treatment, CAS and NOSPECS classes were evaluated in each group. The altered course of thyroid stimulating receptor antibody were compared among the three groups. All adverse events were recorded.Results:The proportion of CAS decreased≥2 or total scores<3 points in the GCs, RTX and combined groups were 88.9%, 85.7% and 100%, with no statistical difference among the three groups ( P=0.321). At 24 weeks, CAS and NOSPECS classes decreased significantly in all three groups compared with those before treatment ( P<0.05). The reduction of CAS in the combined group was greater than in the GCs group (-3.12±1.02 vs -2.39±1.02, P=0.036) and RTX group (-3.12±1.02 vs -2.14±0.90, P=0.034). One patient in the combined group developed optic neuropathy at 24 weeks after treatment, all other patients had no severe adverse events. Conclusion:Low-dose RTX alone is not inferior to intravenous GCs in the treatment of active moderate to severe GO. GCs combined with RTX is more effective in improving patients′ CAS than either drugs alone.

Objective:To investigate the clinical characteristics, pathological features and surgical efficacy of adult gangliogliomas.Methods:Seven patients with gangliogliomas underwent surgical treatment in our hospital from August 2010 to December 2021, were chosen; their clinical data were retrospectively analyzed, and the CT and MRI manifestations and histopathological features of gangliogliomas and surgical efficacy of these patients were concluded.Results:In these 7 patients, solid-mass type was identified in 1 patient, cystic-solid mixed type in 4 patients, and diffuse infiltrating type in 2 patients. The solid part showed slightly low or equal density on CT, and mostly showed slightly low signal on T1, slightly high signal on T2, high or slightly high signal on T2 FLAIR, and equisignal or slightly low signal on DWI of MRI. Immunohistochemical staining showed that in the tumor specimens, glial cell components were positive for glial fibrillary acidic protein, oligodendrocyte transcription factor and S-100 protein, and ganglion cell components were positive for neuronal nuclear antigen and synaptophysin. Gross total resection was achieved in 5 patients, subtotal resection in 1 patient, and partial resection in 1 patient; gangliogliomas without total resection were diffuse infiltrative type. The median Karnofsky performance status scores were 80. There was no death during the follow-up period of 7 months-11 years.Conclusions:Adult gangliogliomas are mostly cystic and solid lesions with clear boundary on imaging, and the histopathological characteristics of mixed neoplastic ganglion cells and glial cells are the main basis for their diagnosis. The surgical efficacy is usually good, but the diffuse infiltrating type is difficult to achieve total resection.

Objective:To investigate the clinical characteristics, pathological features and surgical efficacy of adult gangliogliomas.Methods:Seven patients with gangliogliomas underwent surgical treatment in our hospital from August 2010 to December 2021, were chosen; their clinical data were retrospectively analyzed, and the CT and MRI manifestations and histopathological features of gangliogliomas and surgical efficacy of these patients were concluded.Results:In these 7 patients, solid-mass type was identified in 1 patient, cystic-solid mixed type in 4 patients, and diffuse infiltrating type in 2 patients. The solid part showed slightly low or equal density on CT, and mostly showed slightly low signal on T1, slightly high signal on T2, high or slightly high signal on T2 FLAIR, and equisignal or slightly low signal on DWI of MRI. Immunohistochemical staining showed that in the tumor specimens, glial cell components were positive for glial fibrillary acidic protein, oligodendrocyte transcription factor and S-100 protein, and ganglion cell components were positive for neuronal nuclear antigen and synaptophysin. Gross total resection was achieved in 5 patients, subtotal resection in 1 patient, and partial resection in 1 patient; gangliogliomas without total resection were diffuse infiltrative type. The median Karnofsky performance status scores were 80. There was no death during the follow-up period of 7 months-11 years.Conclusions:Adult gangliogliomas are mostly cystic and solid lesions with clear boundary on imaging, and the histopathological characteristics of mixed neoplastic ganglion cells and glial cells are the main basis for their diagnosis. The surgical efficacy is usually good, but the diffuse infiltrating type is difficult to achieve total resection.