OBJECTIVE To systematically evaluate the clinical efficacy of dapagliflozin in the treatment of heart failure with diabetes mellitus type 2. METHODS The clinical trials of dapagliflozin in the treatment of heart failure with diabetes mellitus type 2 were searched in Embase, PubMed, Web of Science, Cochrane Library, VIP, CNKI and Wanfang databases from the establishment of the database to March 18, 2022. The RevMan 5.3 software was used for meta-analysis, and the TSA 0.9 software was used for sequential analysis. RESULTS The 31 RCT studies meeting the criteria were finally included, involving 2 906 patients. Meta-analysis showed that compared with the control group, the experimental group significantly improved LVEF[MD=4.43, 95% CI(3.35, 5.50), P<0.000 01], total effective rate[MD=4.19, 95%CI(2.52, 6.99), P<0.000 01], and reduced NT-proBNP[MD=–451.84, 95%CI(–608.09, –295.60), P<0.000 01], LVEDD[MD=–2.74, 95%CI(–3.67, –1.82), P<0.000 01, Hb1ac[MD=–0.88, 95%CI(–1.19, –0.57), P<0.000 01], FPG[MD=–1.10, 95%CI(–1.45, –0.75), P<0.000 01], 2hPG[MD=–2.52, 95%CI(–3.37, –1.66), P<0.000 01] and the incidence of adverse reactions[MD=0.63, 95%CI(0.47, 0.83), P=0.001]. Sequential analysis showed that the effect of dapagliflozin on LVEF in patients with heart failure with type 2 diabetes was accurate, and the possibility of excluding false positive was possible. CONCLUSION The treatment of heart failure with diabetes mellitus type 2 with good efficacy and safety is achieved by dapagliflozin, but it still needs to be included in more high-quality RCT studies for further demonstration.

Keloid is a common skin disease, and the mechanism of its occurrence is not fully understood. There is evidence to show that multiple factors such as genetics, race, age, gender, hormones, infection, immunity, and oxidative stress, etc. may be related to the occurrence of keloids. Metabolic remodeling and protein acylation modification, as two important biological processes, play important roles in various skin related diseases. Based on this, this article reviews the roles of metabolic remodeling and protein acylation modification in keloids and the interrelationship between the two biological processes, and explores the application prospects of targeting the two biological processes in the prevention and treatment of keloids.

Objective:To investigate the diagnostic value of ultrasonography in Poland′s syndrome.Methods:From February 2016 to December 2020, the ultrasonographic images of 15 patients with Poland′s syndrome diagnosed by Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed, and the ultrasonographic features were summarized.Results:High-frequency ultrasound could clearly show the anatomical structures of each layer of the chest wall of the patients with Poland′s syndrome. The sonogram of Poland′s syndrome mainly showed the absence of all or part of the pectoralis major on the affected side, some of which were combined with the absence of pectoralis minor. The difference between the thickness of the affected chest wall and the healthy side was statistically significant ( P<0.01). Among the 15 cases of Poland′s syndrome, 11 cases had brachydactyly or syndactyly. Ultrasound showed that the bifurcation position of the common palmar digital artery of the middle finger was lower than that of the healthy side. Conclusions:The ultrasonography is an effective imaging method for diagnosis of Poland′s syndrome.

Objective:To investigate the value of ultrasound in the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.Methods:From July 2010 to July 2020, 12 patients with hourglass-like fascicular constrictions of the anterior interosseous nerve diagnosed in Shandong Medical Imaging Research Institute Affiliated to Shandong University were retrospectively analyzed. The characteristics of the high-frequency ultrasonographic images were summarized and compared with clinical surgery.Results:The hourglass-like fascicular constrictions of the anterior interosseous nerve were all located in the median nerve of the distal upper arm in 12 patients, including 9 cases of single hourglass change and 3 cases of multiple hourglass like changes. High-frequency ultrasound can accurately locate the location of the hourglass-like fascicular constrictions of the anterior interosseous nerve and the extent of neuropathy. The sonogram of hourglass-like fascicular constrictions of the anterior interosseous nerve showed single or multiple hourglass-like changes in the median nerve of the distal upper arm. The nerve fasciculars on both sides of hourglass-like changes were thickened. There was significant difference between the diameter of the affected fascicular and the corresponding position of the contralateral fascicular[(0.20±0.04)cm vs (0.11±0.03)cm, P<0.01]. There was significant difference between the cross-sectional area of the median nerve at the widest part of the lesion side and the corresponding position of the contralateral side[(0.14±0.03)cm 2 vs (0.09±0.03)cm 2, P<0.01]. Conclusions:High-frequency ultrasound is the preferred image method for the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.

［摘要］ 目的：寻找多发性骨髓瘤（MM）基因芯片数据集中的潜在致病基因、疾病诊断和预后相关因子并阐明其作用机制。 方法：获取基因芯片数据集GSE13591 和Zhan Myeloma，使用R 语言进行基因差异表达分析。对共同高表达基因进行Meta 分 析，得到P 值中位秩次TOP10 基因。CCLE 数据库分析TOP10 基因在各肿瘤细胞系中的mRNA表达情况，筛选出蛋白酶体通路 相关基因8（DCAF8）。cBioPortal 数据库中分析DCAF8 基因在各肿瘤细胞系的突变率。WB检测DCAF8 蛋白在骨髓瘤细胞系中 的表达情况。SPSS 和Graph Pad 软件分析DCAF8 表达量和MM患者临床特征之间的相关性，进行受试者工作特征曲线（ROC曲 线）绘制和生存分析。R语言Custer Profiler Package 和Metascape 数据库对DCAF8 互作蛋白基因和共表达基因进行GO和KEGG 功能富集分析。结果：数据集GSE13591 和Zhan Myeloma 的上调基因取交集得到477 个共同高表达基因。在合并数据集中对上 述基因进行Meta 分析，得到P 值中位秩次TOP10 基因，DCAF8 在MM细胞系中的平均表达水平最高。DCAF8 基因在浆细胞骨 髓瘤中的突变率位于各肿瘤细胞系的第一位。DCAF8 蛋白在多种MM细胞系中的表达量显著升高（P<0.01）。DCAF8 表达量与 MM患者的肿瘤负荷显著正相关，1q21 扩增阳性组的DCAF8 的表达量显著高于1q21 阴性组。ROC曲线显示DCAF8 的表达水平 可以很好地区分MM患者和正常人（P<0.01）。DCAF8 高表达组比DCAF8 低表达组中位生存时间显著缩短。蛋白互作网络显示 DCAF8 可与XPO1 蛋白直接相互作用。GO和KEGG功能富集分析结果表明，DCAF8 与蛋白酶体功能、剪切体活性、组蛋白乙酰 化酶活性、RNA转运等功能相关。结论：DCAF8 在MM中显著高表达，其表达水平可以很好地区分MM患者和正常人；其高表 达与MM患者的生存预后显著负相关，且与1q21 扩增和XPO1 蛋白相关。

Objective:To evaluate the role of high frequency ultrasonography in diagnosis of closed volar plate injury of proximal interphalangeal joint.Methods:From May 2015 to may 2021, 41 patients with acute closed volar plate injury confirmed by Department of Hand and Foot Surgery of the Provincial Hospital Affiliated to Shandong First Medical University were examined by high frequency ultrasonography. The sonographic features were analyzed and classified.Results:High frequency ultrasonography could not only clearly show the thickness, shape and echo of volar plate, but also the degree of injury and avulsion fracture of volar plate, according to which the closed volar plate injury could be divided into three types: A, B and C. Type A(13 cases): Avulsion fracture of the middle phalangeal base was found with volar plate rupture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and avulsion fracture was found at the distal end of the volar plate. Type B(11 cases): Complete rupture of the volar plate attachment of the middle phalangeal base was found without avulsion fracture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and the end of the volar plate contracted and thickened. Type C(17 cases): Tear of the volar plate was found, the sonogram showed enlarging volar plates, heterogeneous internal echo, and liquid dark area was visible in some cases. The average thickness of the three types of closed volar plate injury of the proximal interphalangeal joint measured by ultrasound was (0.33±0.05)cm, and the average thickness of the volar plate at the same position of the corresponding finger on the opposite side was (0.22±0.03)cm. There was significant difference between the two groups ( t=7.864, P=0.006). Conclusions:High frequency ultrasonography is the preferred imaging examination method for the diagnosis of closed volar plate injury in proximal interphalangeal joint, which has an important guiding significance for the selection of clinical treatment.

Objective:To investigate the synergistic effect of sarcopenia and osteoporosis on the occurrence of spinal osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA).Methods:A total of 389 hospitalized RA patients and 156 age and sex-matched normal subjects (control group) were recruited. Dual energy X-ray absorptiometry (DEXA) method was used to measure bone mineral density (BMD) of lumbar spine and hip, and bioelectrical impedance method was applied to determine skeletal muscle mass of limbs. X-ray examination of spin was conducted and spinal OPF was diagnosed according to semi-quality method. Student's t test was used for comparison of measurement date between the two groups, χ2 test was used for comparison of intergroup rates, and Logistic Regression(Backward LR) method was used for multivariate Regression analysis of binomial classification data. Results:BMD of all test sites in RA patients was significantly lower than that in the control group ( P<0.01). The incidence of total OP in RA group was significantly higher than that in the control group [(32.9% vs 12.8%), χ2=22.706, P<0.01]. A total of 84 patients with RA developed spinal OPF, with an incidence of 21.6% which was higher than that in the control group [(3.8%), χ2=25.439, P<0.01]. The incidence of sarcopenia in RA was 54.8%, significantly higher than that in the control group [(9.6%), χ2=93.241, P<0.01]. The incidence of sarcopenia combined with osteoporosis in RA group (28.5%) was significantly higher than that in the control group [(5.8%), χ2=118.110, P<0.01]. Comparison of the incidence of spinal OPF in RA patients among groups with different bone mass (normal bone mass, osteopenia, osteoporosis) showed that the incidence of spinal OPF among these groups was statistically different ( χ2=43.373, P<0.01), and the incidence of spinal OPF increased along with the decrease of bone mass ( χ2=43.003, P<0.01). The incidence of spinal OPF in RA patients with sarcopenia (27.2%, 58/213) was significantly higher than that in RA patients without sarcopenia [(14.8%, 26/176), χ2=8.833, P=0.003]. All participants were divided into three groups: group 1=no OP and sarcopenia, group 2=with sarcopenia or OP, group 3=both sarcopenia and OP. Difference of incidence of spine OPF in RA patients among three groups was statistically significant ( χ2=33.832, P<0.01), and the incidence of spinal OPF raised gradually in group 1 and 3, ( χ2=37.164, P<0.01). Incidences of sarcopenia, OP and spinal OPF in RA treated with glucocorticoid (GC) were higher than those in RA without GC ( P<0.05, P<0.01). Results of logistic regression showed advanced age[ OR(95% CI)=1.069(1.038, 1.101), P<0.01], usage of GC [ OR(95% CI)=3.169(1.679, 5.984), P<0.01] and sarcopenia combined with OP [ OR(95% CI)=2.113(1.430, 3.124), P<0.01] were risk factors for spinal OPF in RA patients. Conclusion:Incidences of sarcopenia, OP and spinal OPF in RA patients are higher than that in normal controls. Sarcopenia and OP have a synergistic effect on spinal OPF in RA patients.

Digital medical technologies or computer aided medical procedures have greatly promoted the progress of craniomaxillofacial surgery. Digital three-dimensional reconstruction, 3D printing, digital imaging simulated surgery and osteotomy guide plate have revolutionized the treatment strategy, reduced the difficulty of treatment, and improved the accuracy and predictability of treatment outcome. Now, they have become the routine diagnosis and treatment options in craniomaxillofacial surgery. It is believed that craniomaxillofacial surgery will achieve further development with the continuous improvement of dynamic navigation and research and application of intelligent surgical robots.

Digital medical technologies or computer aided medical procedures have greatly promoted the progress of craniomaxillofacial surgery. Digital three-dimensional reconstruction, 3D printing, digital imaging simulated surgery and osteotomy guide plate have revolutionized the treatment strategy, reduced the difficulty of treatment, and improved the accuracy and predictability of treatment outcome. Now, they have become the routine diagnosis and treatment options in craniomaxillofacial surgery. It is believed that craniomaxillofacial surgery will achieve further development with the continuous improvement of dynamic navigation and research and application of intelligent surgical robots.

In 2013,the Chinese Society of Endocrinology published the'Management ofhyperuricemia and gout:Chinese experts consensus'.In the following five years,a large number of basic researches,clinical studies,and epidemiological results had emerged and need to be popularized in order to improve the understanding and standardizing management of these conditions in general physicians.On the other hand,the methodology of developing clinical guidelines has become more and more scientific,standardized and international.Therefore,based on the 2013 version of the consensus,Chinese Society of Endocrinology decided to develop a guideline for the diagnosis and management of hyperuricemia and gout under standardized methods and procedures of evidence-based clinical practice guidelines.This article will give a review of the status of clinical practice guideline development in China and explain the methods and procedures followed when developing this guideline.We hope this work may provide some useful recommendations for other developers to draft evidence-based clinical practice guidelines.