ObjectiveTo explore the elements， distribution and characteristics of traditional Chinese medicine （TCM） syndromes in depressive episodes of bipolar disorder （BD）. MethodsBasic information， along with the four examination information， the Hamilton Depression Scale and Young Mania Rating Scale scores， were collected from 293 outpatients with BD at Beijing Anding Hospital， Capital Medical University. The four examination information with an occurrence rate greater than 12% were retained. The R language “dist” function was used to calculate the distances between samples using the Euclidean distance method. The hierarchical clustering of the four examination information was performed using the “hclust” function and the squared Euclidean distance method. A team of five researchers was formed to determine the nature and location of the essential elements of TCM syndrome in BD based on the clustering results. The PC algorithm was used to construct a Bayesian network model of the essential elements. The working group combined the essential elements of TCM syndromes in the Bayesian network according to the reference model results， and then extracted common TCM syndromes. The score of each patient based on the essential elements was matched with the common TCM syndromes to determine the syndrome type of each patient. The working group then performs conformity and revision based on this， obtaining the final distribution of TCM syndromes for the patients. ResultsThere were 77 common TCM symptoms in BD with a frequency greater than 12%. The top 15 symptoms with higher frequencies were slippery pulse， mental fatigue and lack of strength， wiry pulse， excessive rumination， preference for solitude， vexation， agitation and irritability， dry mouth， palpitations， profuse dreaming， unwarranted worries， chest oppression， thin white coating， amnesia， frequent sighing， and poor appetite. TCM syndrome elements of BD can be grouped into 11 categories. The nature of disease-related essential elements included fire， qi deficiency， blood deficiency， qi counterflow， yin deficiency， dampness， heat， fire from constraint， and phlegm. The location of disease-related essential elements included heart， liver， spleen， stomach， kidney， bladder channel， and gallbladder. By constructing a Bayesian network model and considering the opinions from the experts， six common syndromes of BD were identified， among which the highest proportion was heart-stomach heat accumulation， accounting for 27.99% （82 cases）， followed by heart-spleen deficiency （55 cases， 18.77%）， non-interaction between the heart and the kidney （49 cases， 16.72%）， liver constraint and blood deficiency （42 cases， 14.33%）， heart qi deficiency （37 cases， 12.63%）， and damp-heat in the liver and gallbladder （28 cases， 9.56%）. ConclusionsThe nature of disease-related elements of BD are predominantly fire and heat， while the location of disease-related essential elements are primarily associated with the heart， liver， and spleen. The most common TCM syndromes are heart-stomach heat accumulation and heart-spleen deficiency.

ObjectiveTo analyze the relationship between somatic symptoms， five-state personality and emotional symptoms of bipolar disorder （BD）， and to provide a reference for the clinical diagnosis and treatment of BD. MethodsThe basic information of the BD patients was collected， and the self-administered somatic symptom questionnaire was used to investigate the somatic symptoms with a frequency of ＞20%， which were scored as the somatic symptom scores； the 24-item Hamilton Depression Scale （HAMD） was used to evaluate the patients' depressive symptoms， the Young Mania Rating Scale （YMRS） was used to evaluate the patients' manic symptoms， the Hamilton Anxiety Scale （HAMA） was used to evaluate the patients' anxiety symptoms， and Five-State Personality Test was used to evaluate the patients' five-state personality （including taiyang personality， shaoyang personality， yin-yang balance personality， shaoyin personality， and taiyin personality）. Network analysis and linear regression were used to analyse the correlation between the somatic symptom scores and the five-state personality scores， HAMD scores， YMRS scores， and HAMA scores. ResultsThere were 269 patients with BD included， and 19 somatic symptoms with a frequency of ＞20%， the top three being lack of strength （152 cases， 56.51%）， dry mouth （137 cases， 50.93%）， and preference for cold drinks （112 cases， 41.64%）， and the somatic symptom scores were ［7.0 （0，10.0）］ points； the YMRS scores were ［3.0 （0， 7.5）］ points； the HAMD scores were ［11.0 （5.0， 18.0）］ points； and HAMA score was ［6.0 （2.0， 10.0）］ points. Among the five-state personalities， taiyang personality ［10.0 （7.0， 13.0）］ score； shaoyang personality ［10.0 （7.5， 13.0）］ score； yin-yang balance personality ［5.0 （3.0， 7.0）］ score； shaoyin personality ［13.0 （10.0， 16.0）］ score； and taiyin personality ［14.0 （9.0， 18.0）］ score. Complex network analysis showed that BD somatic symptoms were positively correlated with taiyin personality score （r = 0.23）， HAMD score （r = 0.21）， and YMRS score （r = 0.13）； taiyin personality score was positively correlated with HAMD score （r = 0.17） and negatively correlated with YMRS score （r = -0.03）. Linear regression analyses showed that somatic symptom scores were positively correlated with HAMD score （β = 0.138， P = 0.003）， YMRS score （β = 0.128， P = 0.006）， and taiyin personality scores （β = 0.182， P＜0.001）. ConclusionDepression， mania， and taiyin personality are independent risk factors for somatic symptoms in patients with BD， and taiyin personality is strongly associated with somatic symptoms in patients with BD.

Establishing a comprehensive mechanism for the initiation and review of investigator-initiated trial(IIT) plays an important role in ensuring the scientific validity of clinical research and improving research quality.Since 2021, Zhongshan Hospital affiliated to Fudan University had actively explored improvements in the project management of IIT. The hospital had established a standardized grading review management process, developed an integrated clinical research management system, established a three-level clinical research training system, built a methodological support platform, and formulated research plan templates, gradually formed a standardized grading project approval review management mode. As of February 2024, the hospital had completed 400 quick reviews and more than 400 expert letter reviews based on the integrated clinical research management system. The efficiency and quality of IIT project approval had been improved. At the same time, over 40 academic salons and forums had been held, cultivating a group of young clinical research talents, providing data management training for more than 30 clinical departments, and promoting the improvement of the quality of research protocol. In the future, hospitals should further optimize their information systems, expand the influence of their training systems, enhance the capabilities of their methodological support platforms, and improve the efficiency of the application of clinical research protocol templates, so as to escort the establishment and implementation of high-quality clinical research projects and provide references for other hospitals′ IIT project management.

Autoimmune diseases of the nervous system are a group of diseases caused by the body′s immune system attacking its own nervous system, resulting in structural damage and functional impairment of the corresponding tissues. Interventional clearance of pathogenic auto-antibodies has been shown to be effective in reducing immune damage, inhibiting disease progression and improving prognosis through extensive basic research and long-term clinical practice. The neonatal Fc receptor (FcRn)-mediated circulating protection mechanism of IgG contributes to the long half-life and high plasma levels of IgG. FcRn inhibitors are able to target and block the binding of FcRn to IgG, accelerating IgG clearance and reducing IgG levels. Therefore, the use of FcRn inhibitors in the treatment of autoimmune diseases of the nervous system could theoretically help to accelerate the clearance of pathogenic IgG, achieve good clinical efficacy and have promising applications. Research in this area has made considerable progress in recent years and this article will review this.

Objective:To explore the value of jellyfish sign, an abnormal ultrasonographic sign, in predicting adverse perinatal outcomes of women with complete placenta previa combined with placenta accreta spectrum disorders (PAS).Methods:This retrospective study analyzed the ultrasound images of 72 singleton gravidas, diagnosed with complete placenta previa combined with PAS, who underwent cesarean section at the First Affiliated Hospital of Nanjing Medical University between January 2020 and February 2023. Based on the presence and absence of the jellyfish sign in ultrasound images, these gravidas were divided into the jellyfish-sign group (15 cases, 20.8%) and the non-jellyfish-sign group (57 cases, 79.2%). The clinical data and perinatal outcomes of the two groups were analyzed. The adverse perinatal outcomes encompassed conditions such as abdominal aorta balloon block, uterine artery embolism, hysterectomy, postpartum hemorrhage, and neonatal intensive care unit (NICU) admission of their neonates. Statistical analysis was performed using two independent samples t-test, the Mann-Whitney U test and the Chi-square (or Fisher's exact) test. Results:(1) The jellyfish-sign group exhibited a higher parity [(1.6±0.7) times vs (1.2±0.6) times, t=2.01] and higher prenatal scores of placenta accreta [(12.3±1.5) scores vs (8.6±2.9) scores, t=6.59] than those in the non-jellyfish-sign group (both P<0.05). Among the 57 cases in the non-jellyfish-sign group, there were 14 cases of placenta creta (24.6%), 40 cases of placenta increta (70.2%), and three cases of placenta percreta (5.3%). Among the 15 cases in the jellyfish-sign group, nine cases were diagnosed with placenta increta, six with placenta percreta, and none with placenta creta. The difference in distribution between the two groups was statistically significant (Fisher's exact test, P<0.001). (2) Intraoperative blood loss [(for those who accepted abdominal aorta balloon block, 1 973±1 057) ml vs (1 211±576) ml, t=2.55], red blood cells transfused [4.0 U (2.0-23.0 U) vs 2.5 U (0.0-11.0 U), Z=－2.53], postoperative hospitalization time [(9.7±2.4) vs (7.5±2.2) d, t=3.36], the incidence of abdominal aorta balloon block [15/15 vs 38.6% (22/57), χ2=17.92], uterine artery embolism [for those who accepted abdominal aorta balloon block, 3/15 vs 1.8% (1/57), Fisher's exact test], and requiring blood transfusion [15/15 vs 63.2% (36/57), Fisher's exact test] were higher in the jellyfish-sign group than those in the non-jellyfish-sign group. However, the non-jellyfish-sign group had lower gestational age at delivery [(33.6±1.5) weeks vs (35.2±1.8) weeks, t=－3.24], and lower neonatal Apgar score at 1 min and 5 min [1 min: 8 scores (3-10 scores) vs 9 scores (4-10 scores), Z=－2.46; 5 min: 9 scores (7-10 scores) vs 10 scores (6-10 scores), Z=－2.02] (all P<0.05). There were no significant differences in emergency surgery rate, 24 h postoperative blood loss, neonatal birth weight, and proportion of NICU admission between the two groups. Additionally, no cases of hysterectomy or death were observed in the two groups. Conclusions:Ultrasound examination revealing jellyfish signs in patients with complete placenta previa and PAS is associated with an increased likelihood of adverse perinatal outcomes. Consequently, the management of these patients should be given greater attention.

Objective: To understand parents attitudes towards adolescent sexual education in Baoshan City of Yunnan Province, and to explore the correlation between attitudes and their proactive behavior in adolescent sexual education, so as to provide reference for improving parents initiative in adolescent sexual health education. Methods: From November to December 2022, a stratified random cluster sampling method was used to select 7 389 parents of students from 35 primary, middle, and high schools in Baoshan City of Yunnan Province for a questionnaire survey on adolescent sexual health education in parents schools. Chi-square tests were conducted to compare the attitudes of parents towards sexual health education among different groups and their proactive behavior in providing sexual health education to their children. A multivariate Logistic regression model was used to analyze the correlation between parents attitudes towards sexual education and proactive sexual health education. Results: Totally 43.17% ( 3 190 ) of parents had a more open attitude towards sex education for their children, with parents of girls, parents of elementary school students, mothers, <30 years old, junior high school education, workers, service personnel, married, harmonious relationships with their children and democratic parents had a higher rate of actively providing sex education for their children ( χ 2=4.65, 401.92, 23.53 , 197.50, 38.18, 13.65, 6.54, 8.07, 32.17, 96.58, P <0.05). Parents with a more conservative attitude towards sex education and parents of boys were negatively correlated with parents actively providing adolescent sexual health education to their children ( OR =0.86, 0.38, P <0.05). Parents who were <30, 30-<40, 40-50 years old, individuals/businesses, married, divorced, had a good and decent relationship with their children were positively correlated with their parents proactive adolescent sexual health education for their children ( OR =1.50, 1.90, 1.37, 1.22, 1.60, 1.32, 1.94, 1.53, P <0.05). Conclusion A more open attitude towards adolescent sexual health education can serve as a predictive factor for proactive adolescent sexual health education. In order to increase the rate of family sexual health education, it is recommended to enhance parents awareness of their responsibility for their children s sexual health education, promote harmonious parent-child relationships between parents and children, and communicate with their children with an open attitude.

Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.

Objective:To use the Global Leadership Initiative on Malnutrition(GLIM)criteria to assess the incidence of malnutrition in hospitalized elderly stroke patients, and to investigate the correlation between the criteria and clinical outcomes.Methods:A cross-sectional study was conducted from March 2012 to August 2021 to evaluate malnutrition in 658 elderly stroke inpatients aged 65-92 years, the GLIM criteria were used, and the correlation between the criteria and clinical outcomes was explored.Results:Of the 658 patients, men showed higher values in height, weight, Bady mass index, upper arm circumference, calf circumference and creatinine(all P<0.05), but lower total cholesterol( P<0.05). The incidence of malnutrition diagnosed with the GLIM criteria was 9.12%(60 cases). Based on the GLIM criteria, those with malnutrition had lower weight, Bady mass index, upper arm circumference, calf circumference, albumin and total cholesterol(all P<0.05), while age, duration of hospitalization, infectious complications and mortality was higher than those without malnutrition( P<0.05). Using the mini nutritional assessment-short form(MNA-SF), 14.74%(97 cases)of the patients had malnutrition.Results from the GLIM criteria and the MNA-SF were moderately consistent(sensitivity: 59.4%, specificity: 100.0%, positive predictive value: 100.0%, negative predictive value: 93.1%, Kappa=0.712). Malnutrition diagnosed with the GLIM criteria was associated with a longer duration of hospitalization( OR=1.022, 95% CI: 1.005-1.039, P<0.01), increased infectious complications( OR=16.614, 95% CI: 8.130-33.952, P<0.01), and increased risk of death( OR=2.810, 95% CI: 1.393-3.548, P<0.05). Conclusions:The incidence of malnutrition in hospitalized elderly stroke patients based on the GLIM criteria is lower than that based on the MNA-SF, and malnutrition is associated with adverse clinical outcomes.

Objective:To investigate the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Methods:This paper retrospectively collected and analyzed the data of human composition and laboratory index in elderly patients with diabetes(n=106)and non-diabetic(n=153)patients in the Nutrition Department of Beijing Hospital, compared the differences between two groups, and explored the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Phase angle was detected by bioelectrical impedance which was calculated as reactance/resistance× 180/π.Results:Phase angle was lower in elderly diabetic patients(5.17±0.65)°than in non-diabetic elderly patients(5.37±0.76)°( t=-2.075. P<0.05); age and fasting blood glucose were higher in elderly diabetic patients than in non-diabetic elderly patients(all P<0.05).There was no significant difference between the two groups in body mass index, fat, body fat percentage, visceral fat area, skeletal muscle index, body cell mass, total protein, albumin, and hemoglobin(all P>0.05).Correlation analysis results showed that in elderly diabetic patients, the phase angle was negatively correlated with body mass index( r=0.288, P<0.01), age( r=-0.680, P<0.01), was positively correlated with skeletal muscle( r=0.477, P<0.01), skeletal muscle index( r=0.505, P<0.01)and hemoglobin( r=0.382, P<0.01); and in the elderly non-diabetic group, phase angle was negatively correlated with age( r=-0.666, P<0.01)and positively correlated with body mass index( r=0.296, P<0.01), skeletal muscle( r=0.504, P<0.01), fat free mass( r=0.161, P<0.05), skeletal muscle index( r=0.441, P<0.01), body cell volume( r=0.496, P<0.01), and hemoglobin( r=0.420, P<0.01).The bioelectrical impedance apectroscopy detected skeletal muscle mass index<7.0 kg/m 2 for male and<5.7 kg/m 2 for female were used as the diagnosis standard for reduced muscle mass.The detection rate of muscle mass reduction was higher in elderly diabetic patients(17 cases, 16.04%)than in elderly non-diabetic patients(12 cases, 7.84%, χ2=4.229, P<0.05).The results of multiple regression analysis showed that the decrease of muscle mass in elderly diabetic patients was related to low phase angle( OR=0.413, 95% CI: 0.280-0.973, P<0.05)and aging( OR=2.174, 95% CI: 1.574-3.003, P<0.01). Conclusions:The phase angle is lower in diabetic elderly patients than in non-diabetic elderly patients, and the incidence of muscle mass reduction is higher in diabetic elderly patients than in non-diabetic elderly people.Decreased phase angle and increased age are related to the decrease of muscle mass in elderly diabetic patients.

Objective:The medical-related patent transformation level is relatively low in China for a long time. However, with the support and advancement of a series of national policies, domestic patents and other medical intellectual property projects are increasing year by year, and medical transformation is also receiving more and more attention. Zhongshan Hospital affiliated to Fudan University actively promotes the transformation of hospital patents through various channels, and actively explores how to carry out patent transformation and how to improve the success rate of transformation. This article aims to analyze and explore the feasibility of multi-channel promotion of patents, and to open up a new path for the use of new media to promote patent conversion.Methods:Through Excel analysis of " Zhongshan Patent Hero Post" WeChat public account and official Weibo platform weekly page views data and patent salon project data, as well as the patent application and transformation of Zhongshan Hospital in the past 6 years, and analyze the effect of patent promotion.Results:Through multiple channels and various links of effective promotion methods, the patent application and conversion situation of Zhongshan Hospital has doubled in the past 6 years.Conclusions:The hospital will further actively explore the patent application and transformation process, the full-cycle promotion method of each link, and provide a transfer and transformation consulting docking and promotion platform for the scientific research results or patent technologies related to hospitals and enterprises, and help the transformation of medical patents.