Diabetic foot (DF) is one of the most serious chronic complications of diabetes. The incidence rate among global diabetes patients is as high as 15% to 25%, and about 50% of patients will develop contralateral foot ulcers within 5 years after the first unilateral ulcer. As a non-invasive prevention and control solution, the application progress of functional insoles is mainly reflected in the following aspects:(1) Material innovation. The application of new composite materials and smart materials has significantly enhanced the pressure reduction effect and comfort. (2) Structural optimization. The development of multi-layer design and local pressure reduction structure has achieved more precise pressure distribution regulation. (3) Manufacturing process. 3D printing and parametric design have enabled the personalized customization of functional insoles. (4) Intelligent monitoring. It integrates functions such as pressure sensing and temperature monitoring, achieving real-time monitoring and early warning of foot conditions. Clinical research has confirmed that personalized functional insoles could reduce the incidence of foot ulcers and shorten the healing time of ulcers. At present, the research hotspots mainly focus on the development of smart materials, the construction of multi-functional integration and remote monitoring systems. However, in-depth research is still needed in the aspects of biomechanical mechanisms, standardized evaluation systems and long-term efficacy assessment. The development of future functional insoles should focus on the coordinated advancement of "personalization-intelligence-standardization", with the aim of providing more effective solutions for the prevention and treatment of DF.
Humans ; Diabetic Foot/therapy* ; Foot Orthoses

Mid-to-late stage ankle arthritis is a chronic degenerative disease that is extremely common in clinical practice.It is characterized by significant cartilage degeneration and subchondral bone sclerosis,accompanied by the formation of osteophytes around the joint,often leading to joint deformity.This condition causes severe pain in the patients during walking,severely restricts their activities,and affects their qualities of life.In recent years,with the continuous improvement of medical standards,the treatment methods for mid-to-late stage ankle arthritis have shown a diversified development trend.Non-surgical treatments primarily include activity restriction,orthotic devices,oral non-steroidal anti-inflammatory drugs(NSAIDs),and intra-articular injections of the talocrural joint.The surgical treatments primarily include joint distraction arthroplasty,periacetabular osteotomy,total ankle arthroplasty,and ankle arthrodesis.Tissue engineering therapy,as an emerging method,has also received considerable attention.This article systematically reviewed the selection principles and research progress of various treatment options for mid-to-late stage ankle arthritis,including traditional treatments,non-surgical treatments,surgical treatments,and tissue engineering treatments.By deeply analyzing the basic principles and advantages and disadvantages of each treatment method,and combining the latest research findings on clinical outcomes,a scientific and comprehensive clinical decision-making reference system was constructed to provide clearer and more comprehensive treatment choices for both doctors and patients,thereby effectively improving treatment outcomes and enhancing the quality of life for the patients.

Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.

Objective To analyze the effect of low-dose methylprednone sodium succinate combined with erythromycin in the treatment of Mycoplasma pneumoniae infection with elevated lactate dehydrogenase(LDH)in children.Methods Children with Mycoplasma pneumoniae pneumonia(MPP)complicated with elevated LDH were divided into control group and treatment group by random number table method.The control group was given erythromycin treatment,and the treatment group was given low-dose methylprednisolone sodium succinate combined with erythromycin treatment.Clinical efficacy and clinical symptom disappearance time were recorded in both groups.Pulmonary X-ray signs,immune function[T cell subsets(CD4+,CD8+,CD4+/CD8+)],immunoglobulin(Ig)A,IgM and serum LDH were compared between the two groups before and after treatment,and the adverse drug reactions of treatment were observed.Results There were 51 cases in control group and 51 cases in treatment group.The total effective rate in treatment group was 96.00％,which was significantly higher than 81.63％in control group(P＜0.05).The fever abatement times in treatment group and control group were(4.22±0.87)and(5.46±0.98)d;cough disappearance times were(6.31±0.98)and(7.49±1.10)d;disappearance times of pulmonary rales were(7.36±1.14)and(8.61±1.23)d,all with significant difference(all P＜0.05).After treatment,the patchy infiltrating shadow sign rates in treatment group and control group were 2.00％and 16.33％;the bronchial wall thickening sign rates were 4.00％and 18.37％,all with significant difference(all P＜0.05).After treatment,IgA levels in treatment group and control group were(0.55±0.11)and(0.68±0.12)g·L-1;IgM levels were(0.90±0.19)and(1.18±0.21)g·L-1;LDH levels were(229.45±10.30)and(240.18±11.17)U·L-1,all with significant difference(all P＜0.05).The total incidence of adverse drug reactions in treatment group and control group were 6.00％and 4.08％respectively,without significant difference(P＞0.05).Conclusion Erythromycin combined with low-dose methylprednone in systemic treatment of children with MPP and elevated LDH has a significant efficacy,and it can promote the reductions of inflammation and immune disorders and accelerate the disease outcomes,and it is safe and reliable.

Objective To construct a continuous nursing quality evaluation indicator system for inflam-matory bowel disease patients and provide a basis for the evaluation of continuous nursing quality.Methods On the basis of Donabedian's three-dimensional(structure,process,and outcome)quality structure,we employed liter-ature review,qualitative interview,Delphi method,and hierarchical analysis to determine the content and weights of indicators of continuous nursing quality for the patients with inflammatory bowel disease.Results A total of 15 experts completed 2 rounds of consultation,which had the questionnaire recovery rates of 100％,the expert authority coefficients of 0.930 and 0.919,and the Kendall harmony coefficients of 0.149 and 0.177(both P＜0.001),respectively.The established nursing quality evaluation indicator system included 3 first-level indicators,10 sec-ond-level indicators,and 39 third-level indicators.Conclusion The continuous nursing quality evaluation indi-cator system for the patients with inflammatory bowel disease that was constructed in this study was reasonable,reliable,and practical,providing reference for evaluating the continuous nursing quality for the patients with in-flammatory bowel disease.

The methanol extract of Huperzia serrata was separated and purified by ODS, AB-8 macroporous adsorption resin, dextran gel Sephadex LH-20 and silica gel column chromatography combined with the semi-pre HPLC. The chemical structures of the isolated compounds were identified by MS, IR, NMR, etc. Four compounds were isolated from Huperzia serrata and identified, named as serratinine C (1), lycobeline C (2), diphaladin A (3) and crenatine (4). Compound 1 is a new alkaloid, compounds 2-4 were isolated for the first time. In vitro biological activity experiments showed that compound 1 could significantly reduce the levels of nitric oxide and reactive oxygen species in glial cells induced by lipopolysaccharide and had significant antioxidant biological activity.

Objective:To determine the median effective dose (ED 50) of sufentanil in inhibiting responses to tracheal intubation when combined with ciprofol in patients with Parkinson′s disease. Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients with Parkinson′s disease, aged 18-64 yr, with body mass index of 18.5-30.0 kg/m 2, of Mallampati grade Ⅰ or Ⅱ, undergoing elective deep brain stimulator implantation with tracheal intubation in the Brain Hospital Affiliated to Nanjing Medical University from July 2022 to January 2024, were selected. Sufentanil, ciprofol 0.40 mg/kg and rocuronium 0.60 mg/kg were administrated intravenously and sequentially, and endotracheal intubation was performed after onset of muscle relaxation. A positive response was defined as an increase in heart rate or mean arterial pressure by more than 20% of the baseline value within 2 min after tracheal intubation. The initial dose of sufentanil was set at 0.36 μg/kg, the dose in the next patient was determined according to the response to tracheal intubation, and the ratio between the two successive doses was 1.2. The ED 50 and 95% confidence interval of sufentanil in inhibiting responses to tracheal intubation were calculated using the Dixon-Mood method. Results:The ED 50 (95% confidence interval) of sufentanil in inhibiting responses to tracheal intubation was 0.335 (0.298-0.378) μg/kg when combined with ciprofol. Conclusions:When combined with ciprofol 0.40 mg/kg, the ED 50 of sufentanil in inhibiting responses to tracheal intubation is 0.335 μg/kg in patients with Parkinson′s disease.

Objective To investigate the clinical efficacy of self-made Bushen Huoxue Lishui Prescription for the treatment of patients with infertility due to hydrosalpinx.Methods Seventy patients with infertility due to hydrosalpinx differentiated as spleen deficiency and phlegm blended with blood stasis type were randomly divided into the control group and the observation group,with 35 patients in each group.Patients in both groups were given minimally invasive surgery by using a combined hysteroscopy-laparoscopy approach,and additionally,the control group was given the postoperative routine treatment(including the use of antibiotics to prevent infections,regular monitoring of the basal body temperature,and the review of the uterine adnexa ultrasound),and the observation group was treated with Bushen Huoxue Lishui Prescription based on the treatment for the control group.The medication was performed for 21 days during a menstrual cycle,and the treatment lasted for three continuous menstrual cycle.Before and after treatment,the changes in the scores of the fallopian tube obstruction and scores of traditional Chinese medicine(TCM)syndrome in the two groups were observed.Three months after the operation,the pregnancy outcomes,the recurrence of hydrosalpinx in the non-pregnant patients,and the safety of the medication in the two groups were evaluated.Results(1)Three months after the operation,the total pregnancy rate of the observation group was 51.43%(18/35),and the intrauterine pregnancy rate was 48.57%(17/35);in the control group,the total pregnancy rate was 25.71%(9/35)and the intrauterine pregnancy rate was 20.00%(7/35).The intergroup comparison(by chi-square test)showed that the total pregnancy rate and intrauterine pregnancy rate of the observation group were significantly superior to those of the control group,and the differences were statistically significant(P＜0.05).(2)After treatment,the scores of the fallopian tube obstruction in the two groups were significantly improved when compared with those before treatment(P＜0.05),and the improvement of tubal obstruction scores in the observation group was significantly superior to that in the control group,with statistically significant differences in the post-treatment scores and in the pre-and post-treatment score difference between the two groups(P＜0.05).(3)After treatment,the TCM syndrome scores in the two groups were significantly improved when compared with those before treatment(P＜0.05),and the improvement of TCM syndrome score in the observation group was significantly superior to that in the control group,with statistically significant differences in the post-treatment scores and in the pre-and post-treatment score difference between the two groups(P＜0.01).(4)Three months after the operation,the recurrence rate of hydrosalpinx in the observation group was 5.88%(1/17),and lower than that in the control group(38.46%,10/26),with statistically significant differences(P＜0.05).(5)During the treatment,no obvious adverse reactions occurred in the two groups,and the safety was high.Conclusion Bushen Huoxue Lishui Prescription has markedly efficacy in the treatment of patients with infertility due to hydrosalpinx differentiated as spleen deficiency and phlegm blended with blood stasis type,and the prescription is effective on increasing the pregnancy rate of the patients,decreasing the recurrence of hydrosalpinx,and improving the clinical symptoms,with fewer adverse reactions and high safety.

Based on mass spectrometry(MS)-guided separation strategy, compound 1 was obtained from the roots of Rhus chinensis. By comprehensive analysis of high resolution-electrospray ionization-mass spectrometry(HR-ESI-MS), nuclear magnetic resonance(NMR) data, and quantum chemical calculation of NMR(qcc-NMR) parameters, compound 1 was elucidated as rhuslactone, a 17-epi-dammarane triterpenoid with a rare 17α-side chain. An HPLC-ELSD method for its quantification in R. chinensis was established and adopted for the quantification of rhuslactone in different batches of R. chinensis. Rhuslactone displayed a good linear relationship within the range of 0.021 3-1.07 μmol·mL~(-1 )(r=0.997 6), and the average recovery was 99.34% [relative standard deviation(RSD) 2.9%). Moreover, the results of the evaluation test of the preventive effects of rhusalctone on coronary heart disease(CHD) and thrombosis showed that rhuslactone(0.11 nmol·mL~(-1)) significantly alleviated heart enlargement and venous congestion and increased cardiac output(CO), blood flow velocity(BFV), and heart rate, thereby reducing thrombus formation in zebrafish with CHD. The effects of rhuslactone on CO and BFV were superior to that of digoxin(1.02 nmol·mL~(-1)), and its effect on improving heart rate was comparable to that of digoxin. This study provides experimental references for the isolation, identification, quality control, and application of rhuslactone from R. chinensis against CHD. It is worth mentioning that this study has discussed some omissions in the determination of the stereochemistry of C-17 in dammarane triterpenoids in the present coursebook Chemistry of Chinese Medicine and some research papers, that is, the compound may be 17-epi-dammarane triterpenoid. This paper has also proposed steps for the establishment of C-17 stereochemistry.
Animals ; Zebrafish ; Rhus/chemistry* ; Triterpenes/analysis* ; Coronary Disease ; Thrombosis

Cinnabaris is a traditional Chinese medicine(TCM) commonly used for sedation and tranquilization in clinics, and its safety has always been a concern. This study intends to investigate the species and tissue distribution of mercury in rats after continuous administration of Cinnabaris. In the experiment, 30 rats were randomly divided into the control group(equivalent to 0.5% carboxy-methyl cellulose sodium), low-dose Cinnabaris group(0.2 g·kg~(-1)), high-dose Cinnabaris group(2 g·kg~(-1)), pseudogerm-free control group(equivalent to 0.5% sodium carboxymethyl cellulose), and pseudogerm-free Cinnabaris group(2 g·kg~(-1)). They were orally administered for 30 consecutive days. Ultrasound-assisted acid extraction method combined with high performance liquid chromatography and inductively coupled plasma-mass spectrometry(HPLC-ICP-MS) was adopted to determine inorganic mercury [Hg(Ⅱ)], methylmercury(MeHg), and ethylmercury(EtHg) in different tissue, plasma, urine, and feces of rats. The optimal detection conditions and extraction methods were optimized, and the linearity(R~2>0.999 3), precision(RSD<7.0%), and accuracy(spike recoveries ranged from 73.05% to 109.5%) of all the mercury species were satisfied, meeting the requirements of analysis. The results of mercury species detection showed that Hg(Ⅱ) was detected in all the tissue of the five experimental groups, and the main accumulating organs were the intestinal tract, stomach, and kidney. MeHg existed at a low concentration in most tissue, and EtHg was not detected in all groups. In addition, pathological examination results showed that hepatocyte vacuolar degeneration, loose cytoplasm, light staining, and mononuclear cell infiltration were observed in the high-dose Cinnabaris group, low-dose Cinnabaris group, and pseudogerm-free Cinnabaris group, with slightly milder lesions in the low-dose Cinnabaris group. Hydrous degeneration of renal tubular epithelium could be seen in the high-dose Cinnabaris group and pseudogerm-free Cinnabaris group, but there was no significant difference between the other groups and the control group. No abnormal changes were found in the brain tissue of rats in each group. This paper studied the different mercury species and tissue distribution in normal and pseudogerm-free rats after continuous administration of Cinnabaris for 30 days and clarified its effects on the tissue structure of the liver, kidney, and brain, which provided supporting evidence for the safety evaluation of Cinnabaris.
Rats ; Animals ; Mercury/analysis* ; Tissue Distribution ; Methylmercury Compounds/analysis* ; Chromatography, High Pressure Liquid/methods* ; Sodium