Abstract:Objective To analyze the causes of misdiagnosis of uterine fibroids as endometrial cancer and the ultrasonographic features.Methods A patient who was initially misdiagnosed as having endometrial cancer in April 2023 but was eventually confirmed to have uterine fibroids was selected.By reviewing and analyzing the ultrasound and clinical data of the patient,the common ultrasonographic features of uterine fibroids and the key points for differentiating them from endometrial cancer were summarized.In the meantime,the causes of misdiagnosis were analyzed,and suggestions for improving the diagnostic accuracy were proposed.Results The patient presented with irregular vaginal bleeding for 1 year.Physical examination showed a uterus enlarged to the size of a 70+d gestation with an irregular surface.Ultrasound examination showed the possibility of endometrial cancer,but pathological examination of a diagnostic curettage sample only showed smooth muscle tissue.Contrast-enhanced magnetic resonance imaging revealed a submucosal uterine fibroid(low signal intensity on T2-weighted imaging with clear borders).After conservative treatment failed,hysterectomy was performed.The pathological diagnosis was uterine leiomyoma(4.0 cm×2.6 cm in size,with a gray-white,whorled cut surface and microscopically observed palisading arrangement of smooth muscle cells).The misdiagnosis lasted 33 d.The patients were followed up for 6 months with good prognosis.Conclusion Generally,ultrasound examination can quickly and accurately obtain the sonographic features of uterine fibroids.However,when the fibroids are large in size or have special pathological types and locations,they may be misdiagnosed as other uterine diseases.During the ultrasound examination,paying attention to observing the details of the images and combining the relevant medical history are conductive to avoiding missed diagnosis and misdiagnosis.

Abstract:Objective To investigate the efficacy of Dulaglutide combined with Insulin and Calcitriol in the treatment of type 2 diabetes mellitus(T2DM)complicated with osteoporosis,as well as its effects on glucose metabolism,bone metabolism and intestinal flora.Methods We selected 120 patients with T2DM who visited the hospital from January 2022 to January 2024.According to the inclusion and exclusion criteria,120 patients with osteoporosis were selected as the study subjects.After obtaining the patients'consent,they were divided into the control group and the observation group using the random number table method,with 60 patients in each group.The control group was treated with Insulin combined with Calcitriol as the conventional therapy,while the observation group was treated with Dulaglutide on the basis of the control group.The clinical efficacy and the occurrence of adverse reactions during the treatment period of the two groups were evaluated and compared.The blood glucose indicators,bone density,bone metabolism indicators and intestinal flora of the two groups before and after treatment were compared.Results The total clinical effective rate of the observation group was 93.33%(56/60),which was superior to that of the control group[76.67%(46/60)](P<0.05).At 12 months after treatment,the fasting plasma glucose,2-hour postprandial blood glucose,glycosylated hemoglobin,and serum β-crosslaps levels of the observation group were lower than those of the control group,while the bone mineral density of the L1-4 lumbar spine,femoral neck,and total hip joint,as well as the serum alkaline phosphatase levels were higher than those of the control group(P<0.05).At 12 months after treatment,the relative abundances of Firmicutes,Bacteroidetes,and Verrucomicrobia in the observation group was higher than that of the control group,while the relative abundances of Proteobacteria and Actinobacteria were lower than those of the control group(P<0.05).During the treatment period,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05),and no serious adverse reactions were observed in either group.Conclusion Dulaglutide combined with Insulin and Calcitriol for T2DM patients with osteoporosis is an effective approach.It not only can comprehensively improve the patients'glucose and bone metabolism conditions,but also can indirectly promote bone metabolism by regulating the intestinal flora,and has good safety.

Abstract:Objective To analyze the causes and prognostic factors of patients with acute liver failure(ALF)and acute-on-chronic liver failure(ACLF).Methods A total of 124 patients with ALF and ACLF who were admitted from January 2020 to January 2025 were selected as the study subjects.The causes of the patients and the treatment methods[including artificial liver(plasma exchange method)and simple internal medicine treatment]were retrospectively analyzed.The study subjects were divided into the effective group(n=53)and the ineffective group(n=71)based on the treatment effect.The general data and laboratory test indicators of the two groups were compared,and then a multivariate logistic regression analysis was conducted to identify the factors related to the prognosis of the patients.The receiver operating characteristic(ROC)curve was used to analyze the value of relevant indicators in predicting the treatment ineffectiveness of the patients.Results The primary cause of ALF and ACLF was hepatitis B virus infection in 37 cases(29.84%).The second most common cause was drug poisoning(23 cases,18.55%),among which 13 cases were caused by traditional Chinese medicine.Another 23 cases(18.55%)were secondary to other organ failures.Patients with ALF and ACLF induced by drug poisoning,secondary to biliary obstruction,secondary to other organ failures,various toxic substance poisoning,immune hepatitis,and hepatolenticular degeneration received simple internal medical treatment or artificial liver treatment,and the effective rate was relatively high.However,patients with ALF and ACLF caused by hepatitis B virus,other viral hepatitis,and unexplained etiology had a lower effective rate.Only patients secondary to biliary obstruction or various toxic poisonings showed a higher effective rate after receiving artificial liver treatment.There was no significant difference in the total effective rate between simple internal medical treatment and artificial liver treatment for all ALF or ACLF patients with various causes(P>0.05).Multivariate logistic regression analysis showed that the total bilirubin(TBil)level on the third day was an independent risk factor affecting the prognosis of ALF and ACLF patients(P<0.05).ROC curve analysis showed that when the TBil level on the third day was>184.9 μmol/L,the area under the curve for predicting ineffective treatment in ALF and ACLF patients was 0.656,with a sensitivity of 64.15%and a specificity of 66.20%.Conclusion The mortality rates of ALF and ACLF patients are high,and hepatitis B remains the leading cause.Additionally,drug poisoning and acute liver failure secondary to other organ failures have been increasing year by year.Artificial liver treatment does not effectively improve the prognosis of patients with ALF and ACLF.The TBil level on the third day of admission has good predictive value for the prognosis of patients with ALF and ACLF.

Abstract:Objective To analyze the reasons for missed diagnoses caused by negative results of virus antigen detection in a sporadic norovirus infection case,and to explore the clinical significance of applying multiple laboratory detection techniques in combination for avoiding missed diagnoses and improving diagnostic accuracy.Methods For the fecal sample of a patient with acute gastroenteritis who visited the hospital in March 2025 and had a clear epidemiological history but whose norovirus antigen test was negative,both real-time fluorescent quantitative polymerase chain reaction and metagenomic next-generation sequencing(mNGS)techniques were used for detection,and the results were compared and analyzed.Results This patient visited the hospital due to nausea and vomiting for 3 h.The result of the norovirus antigen test was negative,while the nucleic acid test was positive(Ct value 27.2).The results of the mNGS showed that it was norovirus GⅡ.17 type,with a homology of 99.30%.Conclusion For patients suspected with norovirus infection,relying solely on antigen detection may sometimes lead to missed diagnoses due to insufficient methodological sensitivity.In clinical practice,it is necessary to establish a collaborative detection network that uses antigen detection as the initial screening tool,nucleic acid testing as the basis for diagnosis,and mNGS technology as the means for tracing the source.This is crucial for avoiding missed diagnoses of norovirus infection,achieving early intervention,and blocking the spread of the epidemic.

Abstract:Coronary heart disease(CHD)is a common cardiovascular disorder in clinical practice,with relatively high morbidity and mortality among the elderly population.Angina pectoris is a common symptom of CHD,severely affecting the quality of life and physical and mental health of patients.The clinical efficacy of Western medicine alone has certain limitations,while the integrated traditional Chinese and Western medicine therapy has significant advantages in the management of elderly patients with angina pectoris in CHD.Professor Zhang Limei believes that the overall pathogenesis of angina pectoris in CHD in elderly patients is a mixture of deficiency and excess,with deficiency as the foundation and excess as the manifestation.Elderly patients have weakness and imbalances in the five Zang organs,with phlegm turbidity and blood stasis as the manifestation,and based on the theory of phlegm turbidity and blood stasis,Professor Zhang Limei treats elderly patients with angina pectoris in CHD,using various methods such as promoting blood circulation and resolving blood stasis,unblocking the meridians and relieving pain,dissolving phlegm and dispersing nodules,soothing the chest and regulating qi,reinforcing the healthy qi and eliminating pathogenic factors,and treating both the root and branch,showing excellent clinical efficacy.This article summarizes Professor Zhang Limei's clinical experience in the treatment of angina pectoris in CHD in elderly patients based on the theory of phlegm turbidity and blood stasis.

Abstract:Objective To analyze the clinical efficacy and blood loss of combined external fixator and locking plate internal fixation in the treatment of elderly patients with high-risk proximal humerus fractures.Methods Forty-five elderly patients with high-risk proximal humeral fractures who were admitted from January 2022 to December 2023 were selected.Based on the different surgical approaches,20 patients treated with combined external fixator were included in the external fixator group,and 25 patients treated with locking plate internal fixation were included in the locking plate group.The perioperative indicators and blood loss of the two groups were compared.The visual analogue scale(VAS)pain scores,Constant-Murley scores,and the range of motion(ROM)of shoulder flexion,abduction,and external rotation before surgery,and at 1,3,and 6 months after surgery were compared between the two groups.The occurrence of postoperative complications in the two groups was observed.Results The duration of operation,incision length and length of hospital stay in the external fixator group were all shorter than those in the locking plate group(P<0.05).There was no significant difference in the fracture healing time between the external fixator group and the locking plate group(P>0.05).The total blood loss,visible blood loss and hidden blood loss in the external fixator group were less than those in the locking plate group(P<0.05).Before surgery and at 1 and 6 months after surgery,there was no significant difference in VAS pain scores,Constant-Murley scores,shoulder flexion ROM,shoulder abduction ROM,and shoulder external rotation ROM between the two groups(P>0.05).At 3 months after surgery,there was no significant difference in VAS pain scores,Constant-Murley scores,shoulder flexion ROM,and shoulder external rotation ROM between the two groups(P>0.05),but the external fixator group had better abduction ROM than the locking plate group(P<0.05).At 1,3 and 6 months after surgery,the VAS pain scores of both groups showed a decreasing trend over time(P<0.05),while the Constant-Murley scores,shoulder flexion ROM,shoulder abduction ROM and shoulder external rotation ROM all showed an increasing trend over time(P<0.05).No complications such as incision infection,needle tract infection,deep vein thrombosis,loosening or breakage of internal or external fixators,or non-union of fractures occurred in either group after surgery.Conclusion Both internal fixation with locking plates and combined external fixators have excellent clinical efficacy for elderly patients with high-risk proximal humeral fractures.The combined external fixation technique is closed reduction,with less surgical trauma,simple operation,and less impact on the amount of blood loss for patients.It is more appropriate for elderly patients with high risks whose fractures have smaller displacements and poorer physical conditions.During clinical treatment,the appropriate surgical method should be selected based on the specific conditions of patients with proximal humeral fractures.

Abstract:Objective To analyze the clinical manifestations of 17α-hydroxylase/17,20-lyase deficiency(17OHD)and CYP17A1 gene mutation characteristics.Methods We collected the clinical data,laboratory test results and CYP17A1 gene mutation status of 6 children with 17OHD who were admitted from June 2020 to December 2024,and summarized the clinical characteristics of 17OHD.Results Among the 6 children,5 had a social gender of female and 1 had a social gender of male.Four of them had onset during puberty,while 5 had peripheral blood karyotype of 46,XY,and 1 had 46,XX.Five had female genital phenotypes and pre-adolescent immature vulvas,and only 1 had insufficient male genitalia(short penis,downward curvature,hypospadias,cryptorchidism,and split scrotum).Two had low blood potassium levels,3 had pigmentation on the skin and mucous membranes,and 4 had hypertension.All the children's laboratory tests showed low estrogen and testosterone levels,high progesterone levels,normal 17-hydroxyprogesterone levels,and hypogonadotropic gonadal dysfunction.The 3 children with normal basal cortisol levels had no hyperplasia on adrenal CT,and further examination suggested adrenal cortical insufficiency.The CYP17A1 gene mutation analysis showed that 4 patients had a deletion mutation in exon 6,among which 1 case was a homozygous mutation of c.985_987delTACinsAA(p.Y329KfsTer90).One patient carried a heterozygous mutation in exon 5,and 1 carried a splicing mutation in exon 7.To our knowledge,these cases had not been reported previously,and the pathogenicity was predicted with uncertain significance based on the guidelines of the American College of Medical Genetics and Genomics.Conclusion 17OHD rarely causes adrenal crisis,so it is prone to missed diagnosis or misdiagnosis.For children with hypokalemia accompanied by hypertension,hypergonadotropic hypogonadism and delayed puberty development,17OHD should be vigilantly suspected.This study identified novel missense mutations and splicing mutations,and the clinical manifestations suggested a possible association with partial 17OHD.Analyzing the clinical characteristics of 17OHD patients can help in early detection and timely identification,thus avoiding misdiagnosis and mistreatment.

Abstract:Objective To analyze the clinical characteristics and causes of misdiagnosis in patients with central lung cancer(CLC),and to summarize countermeasures to prevent such misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 9 patients with central lung cancer who were initially misdiagnosed from January 2022 to December 2023.Results Two patients presented with symptoms of cough,fever,white frothy sputum,and dyspnea.X-ray showed pulmonary parenchymal lesions and blurred hilar regions,and CT showed round high-density opacities in the perihilar region accompanied by emphysema or atelectasis,based on which they were misdiagnosed with infiltrative pulmonary tuberculosis.Four patients presented with respiratory symptoms such as cough.X-ray showed blurred hilar regions and disordered textures,and CT showed round mass shadows in the perihilar region.They were misdiagnosed with pulmonary tuberculosis.Two patients presented with chest tightness,shortness of breath,and swelling in the neck.X-ray showed widened mediastinum,and CT showed mediastinal round masses accompanied by atelectasis,based on which they were misdiagnosed with mediastinal tumors.One patient presented with long-term fever,purulent sputum cough,and chest pain.CT showed solid lesions in the lungs with cavity formation,blurred edges or spicules,and the patient was misdiagnosed with lung abscess.Six patients were diagnosed by bronchoscopic biopsy,and three patients were diagnosed by positive cancer cells in sputum combined with imaging findings.All were diagnosed as CLC,with misdiagnosis periods ranging from 1 to 5 months.Three patients received conservative treatment(with one patient remaining stable)or chose to discontinue treatment due to poor cardiac and pulmonary function or extensive metastasis(two patients died).Three patients experienced tumor stabilization or shrinkage after chemotherapy,one patient had no recurrence after radiotherapy and chemotherapy,and two patients died within 5 d after diagnosis due to septic shock and massive hemoptysis asphyxia respectively.Conclusion The early symptoms of CLC are not typical,and it is prone to misdiagnosis.Understanding its clinical and imaging characteristics,maintaining a high index of suspicion for high-risk individuals,and promptly using diagnostic tools such as bronchoscopy biopsy and sputum cytological examination,along with careful differential diagnosis,can help reduce misdiagnosis.

Abstract:Objective To investigate the clinical characteristics,causes of misdiagnosis,and preventive measures for hand skin and soft tissue defects.Methods A retrospective analysis was conducted on the case data of 7 patients with hand skin and soft tissue defects who were misdiagnosed as having other diseases from January 2022 to June 2024.Results Three patients presented with local skin damage accompanied by mild pain,with irregular wound edges and pale bases.They were initially diagnosed as having superficial skin abrasions.After conventional debridement and bandaging treatment,the wounds continued to exude fluid and failed to heal.Subsequently,bacterial culture of the wounds identified Staphylococcus aureus in two patients and Pseudomonas aeruginosa in one patient.Histopathological examination showed necrosis of the dermis with inflammatory cell infiltration.Finally,they were diagnosed as infectious skin and soft tissue defects.Two patients presented with progressive swelling of the hand,increased skin temperature,and tenderness.Due to the obvious swelling,no clear skin break was palpable.They were initially diagnosed as cellulitis,but empirical use of broad-spectrum antibiotics for one week was ineffective.Magnetic resonance imaging examination showed subcutaneous fat layer defect with involvement of the fascia layer.Combined with the history of trauma,they were diagnosed as traumatic skin and soft tissue defects.The other two patients presented with chronic ulcers at the metacarpophalangeal joint,and the wound edges were undermined with serous exudate.Based on medical history,they were initially diagnosed as diabetic dermopathy and were treated with wound dressing changes and blood sugar control for 2 weeks,but the wound area expanded.Color Doppler ultrasound of the blood vessels showed stenosis of the radial artery branch,and the transcutaneous oxygen partial pressure was<30 mmHg.Finally,they were diagnosed as ischemic skin and soft tissue defects.The duration of misdiagnosis was 2 to 6 weeks.After diagnosis,infected patients underwent thorough debridement+sensitive antibiotic treatment;trauma patients underwent local flap transfer repair;ischemic patients received vascular interventional angioplasty combined with negative pressure drainage.After 3 months of follow-up,6 cases of wounds healed completely,and 1 ischemic patient needed secondary blood supply reconstruction due to poor vascular conditions.Conclusion The clinical manifestations of hand skin and soft tissue defects are not typical,and they are prone to misdiagnosis as common diseases such as superficial abrasions and cellulitis.In clinical practice,it is essential to enhance awareness of differential diagnosis.Combined imaging,microbiological and pathological examinations should be conducted when necessary to improve the diagnostic accuracy.

Abstract:Objective To compare the application effect of methylene blue and carbon nanoparticles in axillary reverse mapping(ARM)in patients with breast cancer.Methods Eighty female patients with breast cancer who received ARM and axillary lymph node dissection from February 2021 to July 2024 were selected,and divided into methylene blue group(n=40)and carbon nanoparticles group(n=40)by random envelope method.Methylene blue was used as a tracer in methylene blue group and carbon nanoparticles were taken as a tracer in carbon nanoparticles group.The axillary lymph node staining status,lymph node detection status,lymph node metastasis diagnosis results(axillary lymph node metastasis rate and sensitivity,false negative rate and accuracy rate of ARM examination),surgical indications and occurrence of complications were compared between groups.Results The success rate of staining in carbon nanoparticles group[97.50%(39/40)]was higher than 80.00%(32/40)in methylene blue group(P<0.05).There was no significant difference in the mean number of stained lymph nodes between the two groups(P>0.05).The number of small lymph nodes detected in carbon nanoparticles group was more than that in methylene blue group(P<0.05),but there was no significant difference in the number of detected lymph nodes between the two groups(P>0.05).The time required for intraoperative identification of axillary lymph node and staining time in carbon nanoparticles group were shorter than those in methylene blue group while the fading time was longer than that in methylene blue group(P<0.05).There were no significant differences in axillary lymph node metastasis rate,and sensitivity,false negative rate and accuracy rate of ARM examination between groups(P>0.05).The total incidence rate of complications revealed no significant difference between groups(P>0.05).Conclusion As ARM tracers,methylene blue and carbon nanoparticles have similar application value in the diagnosis of lymph node metastasis in patients with breast cancer.Compared with methylene blue,carbon nanoparticles have a higher success rate of lymph node staining and a higher detection rate of small lymph nodes,shorter time required for intraoperative identification of axillary lymph node and staining time,and longer fading time is longer,but relatively higher cost.In clinical practice,appropriate tracers can be selected according to the wishes and disease conditions of patients.

Abstract:Objective To investigate the application effect of the multidisciplinary diagnosis and treatment model combined with sequential cardiac rehabilitation exercise in patients with acute myocardial infarction(AMI)who underwent percutaneous coronary intervention(PCI).Methods A retrospective analysis was conducted on the clinical data of 160 patients with AMI who underwent PCI from January 2022 to May 2024.These patients were divided into groups A(n=64),B(n=52),and C(n=44)based on the different postoperative intervention methods.Group A received a multidisciplinary diagnosis and treatment model combined with sequential cardiac rehabilitation exercises,Group B received sequential cardiac rehabilitation exercises,and Group C received conventional postoperative rehabilitation intervention.The self-management ability,self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,cardiopulmonary function,rehabilitation status,and occurrence of adverse cardiovascular events were compared among the three groups.Results After the intervention,the scores of self-management ability(both individual scores and total score),left ventricular ejection fraction,peak oxygen uptake,peak oxygen pulse,and peak metabolic equivalent in groups A and B were higher than those in group C,and group A had higher scores than group B(P<0.05).After the intervention,the SAS and SDS scores of groups A and B were lower than those of group C,which were lower in group A than in group B(P<0.05).The length of hospitalization and the time to off-bed activity in groups A and B were shorter than those in group C,which were shorter in group A than in group B(P<0.05).The 6-minute walking distance on day 4 and the 12-minute walking distance on day 6 in groups A and B were greater than those in group C,which were greater in group A than in group B(P<0.05).The total incidence of adverse cardiovascular events in groups A and B was lower than that in group C(P<0.05).Conclusion Multidisciplinary diagnosis and treatment model combined with sequential cardiac rehabilitation exercise has a good application effect in patients undergoing PCI for AMI.It can effectively enhance patients'self-management ability,improve their cardiopulmonary functions,rehabilitation status and negative emotions,reduce the risk of adverse cardiovascular events,and effectively improve the prognosis of patients.

Abstract:Objective To investigate the effects of applying the concentrated growth factor(CGF)membrane alone on osteogenesis,pain,and complications in patients with different sinus floor morphologies after transcrestal sinus floor elevation(TSFE).Methods A total of 88 patients who underwent TSFE and received implant placement simultaneously from January 2022 to October 2024 were retrospectively included.The morphology of the maxillary sinus floor was classified as flat type,inclined type,and depressed type based on preoperative cone-beam computed tomography(CBCT)of the oral cavity.The patients were divided into the observation group(n=45)and the control group(n=43)according to whether they used grafting materials.In the observation group,only a CGF membrane was applied to cover the elevated sinus membrane,while no biomaterials were placed in the control group.Preoperatively and immediately after surgery,at 6 months and 12 months after surgery,the implant protrusion length into the maxillary sinus(IPL),alveolar bone height at the implant site(ABH),endo-sinus bone gain height(ESBG),and bone height at the apical area of the implant(BHAA)were measured using CBCT.The postoperative visual analogue scale(VAS)pain scores and complications were compared between the two groups.Results There was no significant difference in IPL immediately after surgery between the two groups(P>0.05),nor significant difference in IPL immediately after surgery among patients with different maxillary sinus floor morphologies in the observation group(P>0.05).At 6 and 12 months after surgery,the ESBG,BHAA,and ABH in the observation group were higher than those in the control group(P<0.05).At 6 and 12 months after surgery,the ESBG,BHAA,and ABH in patients with flat sinus floor morphology in the observation group were lower than those in patients with inclined or depressed sinus floor morphology(P<0.05).At one week after surgery,the VAS pain score in the observation group was lower than that in the control group(P<0.05).Within 2 weeks after surgery,the total incidence of complications in the observation group was 8.89%(4/45),which was lower than 25.58%(11/43)in the control group(P<0.05).Conclusion The application of CGF membranes alone is beneficial for the osteogenesis after TSFE surgery,promoting new bone formation,reducing pain,and minimizing complications.However,its osteogenic efficacy is affected by the morphology of the maxillary sinus floor.The spatial maintenance ability and osteogenic volume in the flat sinus floor are lower than those in the inclined and depressed types.

Abstract:Chronic wounds refer to those that often fail to progress through the normal healing stages despite conventional treatment,and may be defined as chronic infected wounds if they are complicated by infection.There are various types of chronic wounds in clinical practice,as they can be infected by various pathogenic microorganisms,leading to complex healing pathways.Additionally,it has been observed in clinical settings that various chronic wounds contain senescent cells,which can impede healing and increase the risk of infection.Platelet-rich plasma has emerged as a novel treatment method for chronic wounds in clinical settings,and studies have found that platelet-rich plasma can promote the healing of chronic wounds by regulating the Notch signaling pathway.Based on the current research status of platelet-rich plasma in treating various wounds at home and abroad in recent years,this paper reviews its main physiological processes and the connections with the Notch signaling pathway,providing a reference for the study of the mechanism by which platelet-rich plasma promotes wound healing.

Abstract:Objective To investigate the value of magnetic resonance imaging(MRI)features in assessing the disease activity in patients with ankylosing spondylitis(AS)and their relationship with traditional Chinese medicine(TCM)syndrome types.Methods From October 2018 to April 2021,102 patients with AS who were admitted to the hospital were selected as the study group,and 100 healthy volunteers who underwent physical examinations during the same period were selected as the control group.The study group was subdivided into the active subgroup(n=54)and the stable subgroup(n=48)based on the Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)score.All the subjects underwent MRI examinations,and their MRI manifestations and Spondyloarthritis Research Consortium of Canada(SPARCC)score were observed.In the meantime,the clinical data,MRI features and imaging grading of patients with different TCM syndrome types(liver and kidney deficiency syndrome,damp-heat syndrome,and governor vessel cold syndrome)were compared.Results Among the 102 enrolled patients,52 patients developed bone marrow edema,presenting as hyperintensity on apparent diffusion coefficient maps,hypointensity on T1-weighted imaging,and hyperintensity on proton density-weighted imaging.The main MRI manifestations of the sacroiliac joints in patients with AS included bone marrow edema,bone destruction,erosion,and fat deposition.The SPARCC scores of the active subgroup and the stable subgroup[(22.35±5.43),(16.57±4.34)points]were higher than that of the control group(3.25±1.22 points),which were higher in the active subgroup than in the stable subgroup(P<0.05).The BASDAI and SPARCC scores of patients with damp-heat syndrome and governor vessel cold syndrome in patients with AS were higher than those of patients with liver-kidney deficiency syndrome(P<0.05).The incidence of bone cystic changes on the joint surface and the imaging grade of AS patients with damp-heat syndrome were higher than those of patients with governor vessel cold syndrome and liver-kidney deficiency syndrome(P<0.05).Conclusion The MRI features can reflect the disease activity of patients with AS and have a certain correlation with the TCM syndrome types.This suggests that the MRI features can provide an objective basis for the TCM syndrome differentiation of AS.

Abstract:Objective this study To investigate the efficacy and mechanism of modified Zhigancao decoction in the treatment of primary Sjögren's syndrome(pSS)based on helper T lymphocytes(Th)17/regulatory T lymphocytes(Treg)immune regulation.Methods In total,60 patients with pSS who visited the hospital from April to June 2024 were enrolled as study subjects.They were divided into the traditional Chinese medicine(TCM)group and the Western medicine group using a random number table,with 30 patients in each group.The TCM group was treated with modified Zhigancao decoction,while the Western medicine group was treated with Sulfasalazine Hydrochloride tablets.The clinical efficacy,TCM syndrome scores before and after treatment,Th17/Treg cell balance indicators(Th17 cell percentage,Treg cell percentage,Th17/Treg),exocrine gland function indicators(saliva flow rate and tear flow rate),and adverse reactions during treatment were compared between the two group.Results After treatment,the total effective rate of the TCM group was 93.33%(28/30),which was higher than that of the Western medicine group at 73.33%(22/30,P<0.05).After treatment,the scores of various TCM syndromes in both groups were lower than those before treatment,and compared with the Western medicine group,the scores of the TCM group were lower(P<0.05).After treatment,the Th17 cell percentage and Th17/Treg in both groups decreased compared with those before treatment,while Treg cell percentage increased compared with those before treatment;compared with the Western medicine group,the changes in the TCM group were more significant(P<0.05).After treatment,the salivary flow rate and tear flow rate of both groups increased(P<0.05),but there was no significant difference between the two groups(P>0.05).During the treatment period,there was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The modified Zhigancao decoction is effective in the treatment of pSS.It can alleviate TCM symptoms and improve the function of exocrine glands,with good safety.Its mechanism is related to the regulation of the Th17/Treg cell balance.

Abstract:Objective To investigate the rehabilitation effect of combined therapy applying Governor Vessel-regulating acupuncture and repetitive transcranial magnetic stimulation(rTMS)in patients with post-stroke cognitive impairment(PSCI).Methods A total of 82 patients with PSCI who were admitted from January 2021 to January 2024 were included.They were divided into the control group and the study group using a random number table.The control group(n=41)received rTMS,while the study group(n=41)was supplemented with Governor Vessel-regulating acupuncture on the basis of the control group.Both groups were treated for 4 weeks.The rehabilitation effects and safety of the two groups were compared.The Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)were used to evaluate the cognitive function of the two groups before and after treatment.The Fugl-Meyer Assessment(FMA)scale and Modified Barthel Index(MBI)were used to evaluate the limb function and activity of daily living(ADL)of the two groups respectively.The levels of serum vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BDNF)before and after treatment were compared between the two groups.Results The total effective rate of rehabilitation in the study group was 95.12%(39/41),which was higher than that of the control group at 80.49%(33/41,P<0.05).After treatment,the scores of the cognitive function assessment scales(MMSE and MoCA),FMA,and MBI in both groups increased compared with those before treatment,which were higher in the study group than in the control group(P<0.05).After treatment,the levels of serum VEGF and BDNF in both groups increased compared with those before treatment,which were higher in the study group than in the control group(P<0.05).There was 1 case(2.44%)of headache and dizziness in the control group,and 1 case(2.44%)of skin redness and swelling in the study group.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Combined therapy using Governor Vessel-regulating acupuncture and rTMS in patients with PSCI can improve cognitive function,limb function and ADL,improve neurological function of patients,and promote the rehabilitation process,with good safety and reliability.

Abstract:Objective To study the therapeutic effect of Tongmai Zhitong decoction on patients with angina pectoris after percutaneous coronary intervention(PCI)for coronary heart disease(CHD).Methods Sixty patients with angina pectoris undergoing PCI for CHD admitted from February 2021 to March 2023 were divided into two groups by random number table method,with 30 patients in each group.The control group was given conventional treatment,and on this basis,the observation group was supplemented with Tongmai Zhitong decoction.The course of treatment was 2 months.The efficacy,traditional Chinese medicine(TCM)syndrome scores,Seattle Angina Quantification Scale(SAQ),6-minute walk test(6 MWT),Self-rating Anxiety Scale(SAS),36-Item Short Form Health Survey(SF-36),improvement in New York Heart Association(NYHA)functional class,adverse reactions and major adverse cardiovascular events(MACE)were compared between the two groups.Multivariate logistic regression analysis was used to analyze the related factors influencing the occurrence of MACE.Results The distribution of efficacy and the improvement in NYHA functional class after treatment in the observation group were better than those in the control group(P<0.05).After treatment,the scores of TCM syndromes and SAS in the observation group were lower than those in the control group,while the scores of SAQ,6 MWT and SF-36 were higher than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).After 1 year of follow-up,1 patient in the control group was lost to follow-up.The total incidence of MACE in the observation group was 3.33%(1/30),which was lower than 27.59%(8/29)in the control group(P<0.05).The supplementation with Tongmai Zhitong decoction was an independent influencing factor of MACE(OR=0.102;95%CI:0.012,0.887;P=0.039).Conclusion Tongmai Zhitong decoction is helpful to improve the clinical symptoms,negative emotions and cardiopulmonary function in patients with angina pectoris after PCI for CHD,and has certain advantages in reducing the occurrence of MACE.

Abstract:Objective To investigate the clinical characteristics,causes of misdiagnosis,and imaging characteristics of granulomatous lobular mastitis(GLM).Methods A retrospective analysis was performed on 21 patients with GLM that were initially misdiagnosed with having other diseases and were admitted from July 2020 to July 2024.Results All patients presented with breast mass as the main manifestation,accompanied by pain or skin redness.Nine patients were initially diagnosed with having breast cancer due to palpable hard mass with irregular edge and skin adhesion,and then diagnosed with having GLM by needle biopsy.Seven patients were misdiagnosed with having acute mastitis because of ipsilateral axillary lymph node enlargement and skin redness and swelling.Empirical anti-infective treatment was ineffective,and they were diagnosed with having GLM by histopathological examination.Three patients were misdiagnosed with having breast fibroadenoma by ultrasound because of the clear boundary and regular shape of the mass,and were diagnosed with having GLM by postoperative pathological examination.Two patients were misdiagnosed as breast hyperplasia due to moderate mass texture and periodic pain,and were diagnosed with having GLM by postoperative pathological examination.Ultrasound examination was performed in 21 patients,mammography in 16 patients,and magnetic resonance imaging in 12 patients.Ultrasound showed hypoechoic mass with unclear boundary,with posterior acoustic shadow attenuation.Asymmetric dense shadow with fuzzy or spiculate edge was common in mammography,which was more likely to be misdiagnosed as being malignant.Magnetic resonance imaging showed slightly high signal on T2-weighted imaging,and enhanced scan showed rapid progressive enhancement.The duration of misdiagnosis ranged from 2 to 16 weeks.All patients received surgical treatment after diagnosis,and 16 patients with extensive lesions or abscess were given low-dose Glucocorticoids to control inflammation before operation.All patients were followed up for 3 to 6 months,the clinical symptoms disappeared completely,and no recurrence was found by ultrasound examination.Conclusion The clinical manifestation and imaging characteristics of GLM lack specificity,making it prone to misdiagnosis as breast cancer,mastitis,or mammary hyperplasia.Improving awareness of this disease,combining ultrasound imaging characteristics,and timely pathological examination are key to reducing misdiagnosis.

Abstract:Objective To investigate the rescue effectiveness of Internet+smart pre-hospital emergency integration model in patients with severe pneumonia complicated by respiratory failure.Methods Sixty patients with severe pneumonia complicated by respiratory failure treated from September 2022 to August 2024 were selected.Among them,30 patients who received conventional emergency treatment from September 2022 to August 2023 were included in the control group,and 30 patients who received the Internet+smart pre-hospital emergency integration model from September 2023 to August 2024 were included in the observation group.The efficacy of emergency care,dispatch response time,onsite management time,time from reception to diagnosis,arrival time of medical personnel to the resuscitation room,total resuscitation time,incidence of complications,vital signs[heart rate,respiratory frequency,partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2)],prognosis recovery[length of ICU stay,duration of mechanical ventilation and length of hospital stay]and emergency care satisfaction were compared between two groups.Results There was no significant difference in the rescue success rates between the two groups(P＞0.05).However,the marked improvement rate in the observation group[60.00％(18/30)]was significantly higher than that in the control group[33.33％(10/30)](P＜0.05).In the observation group,dispatch response time,time from reception to diagnosis,onsite management time,arrival time of medical personnel to the resuscitation room,and total resuscitation time were shorter than those in the control group(P＜0.01);the incidence of complications in the observation group was 6.67％(2/30)lower than that in the control group[32.14％(9/28)](P＜0.05).PaO2 was higher and heart rate,respiratory rate and PaCO2 were lower in the observation group than in the control group after emergency care(P＜0.05,P＜0.01).Length of ICU stay,duration of mechanical ventilation and length of hospital stay of the observation group were shorter than those of the control group(P＜0.01).Emergency care satisfaction in the observation group was 100.00％(30/30)higher than that in the control group[78.57％(22/30)](P＜0.05).Conclusion The application of the Internet+smart pre-hospital emergency integration model in patients with severe pneumonia complicated by respiratory failure can shorten the emergency care time and stabilize the vital signs of patients,thus reducing the risk of complications and improving the emergency care effect,as well as improving patients' prognosis and satisfaction.

Abstract:Objective To investigate the influencing factors of hearing loss in elderly patients with refractory hypertension,and to construct a risk warning model,so as to provide guidance for health management centers in taking timely prevention and control measures.Methods A total of 153 elderly patients with refractory hypertension admitted from January 2022 to October 2023 were selected.The demographic characteristics and clinical data of the patients were collected.Multivariate logistic regression model and random forest ensemble classification algorithm were used to analyze the influencing factors of hearing loss in elderly patients with refractory hypertension,and the predictive efficacy of the two was compared.Results Among 153 elderly patients with refractory hypertension,the incidence of hearing loss was 58.17％(89/153);age,diabetes,sleep disorders,serum C reactive protein(CRP),24-hour mean systolic blood pressure(SBP),and 24-hour SBP coefficient of variation were risk factors for hearing loss in elderly patients with refractory hypertension,and the 8-item Morisky Medication Adherence Scale(MMAS-8)score was its protective factor(P＜0.01).The factors influencing hearing loss in elderly patients with refractory hypertension,ranked in descending order of importance,were 24-hour mean SBP,MMAS-8 score,24-hour SBP coefficient of variation,serum CRP,diabetes,sleep disorders,and age.The two prediction models had good predictive efficacy in predicting the risk of hearing loss in elderly patients with refractory hypertension,but the performance of the risk warning model constructed by the random forest algorithm was better than that of the logistic regression model,and the area under the curve was 0.914(95％CI:0.858,0.953).Conclusion The random forest prediction model based on age,diabetes,sleep disorders,serum CRP,24-hour mean SBP,24-hour SBP coefficient of variation,and MMAS-8 score has good predictive efficacy and can be applied to clinical practice.It provides a scientific basis for the prevention and control of hearing loss in elderly patients with refractory hypertension.