Objective To observe the effect of Shenkang-Ⅱ on hypothalamus-pituitary-adrenal axis (HPA axis) in nephrotic syndrome rats during high-dose glucocorticoids withdrawal, and provide a theoretical basis for clinical application of Shenkang-Ⅱ during the withdrawing and maintaining stages of glucocorticoids in the treatment of nephrotic syndrome. Methods The models of nephrotic syndrome in rats were established with adriamycin, and treated with high-dose glucocorticoid which can cause HPA axis suppression. After the HPA axis was suppressed, the hormone was reduced gradually. At the same time, the rats were treated by intragastric administration with different doses of Shenkang-Ⅱ. The changes of serum ACTH, cortisol and adrenal morphological in large dose of Shenkang-Ⅱ group, small dose of Shenkang-Ⅱ group, hormone control group, nephrotic syndrome model group and normal group were observed after two weeks. Results In the stage of withdrawing glucocorticoids, there were some amelioration in the changes of serum ACTH, cortisol in every group. After 2 weeks, those changes didn’t return to normal level. However, compared with the level of hormone control group, there were obvious increases in the levels of serum ACTH and cortisol in the large and small dose of Shenkang-Ⅱ group (P

Objective:To explore the clinical characteristics of hemoglobin H (HbH) disease during pregnancy, and evaluate the impact of prepregnant anemia on maternal and fetal outcomes.Methods:Clinical data of 12 pregnant women, who were diagnosed with HbH disease by genetic testing in the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2017, to December 31, 2022, were retrospectively collected. Thalassemia genotypes, general conditions before and during pregnancy, and perinatal outcomes were analyzed using descriptive analysis.Results:The 12 patients were categorized into moderate anemia (Hb<90 g/L, n=5) and mild anemia (Hb≥90 g/L and <110 g/L, n=7) groups according to the level of Hb before conception. In the moderate anemia group, with one deletional HbH disease and four non-deletional type, all had blood transfusion histories, and four developed severe anemia during pregnancy with four cases of fetal growth restriction. The mild anemia group comprised six deletional and one non-deletional genotype, with no severe anemia or transfusion requirement during pregnancy. In terms of maternal and fetal outcomes, two moderate anemia cases opted for pregnancy termination, while three delivered via cesarean section with two preterm infants having mild asphyxia and one full-term. In the mild anemia group, one case terminated due to intrauterine fetal death, and the remaining six continued the pregnancies, including two were delivered normally, one was assisted by forceps, and three through cesarean section. Among the six delivered cases, one was preterm birth, one infant was born with severe asphyxia and four mothers developed postpartum complications such as puerperal infection and postpartum hemorrhage. Conclusions:Clinical manifestations of HbH disease vary greatly. Individualized management should be offered based on the degree of anemia before pregnancy. For women with moderate anemia, close monitoring and appropriate intervention are required during pregnancy to improve both maternal and infant outcomes.

Acute Stanford type A aortic dissection with important branches involved is more complex, could lead to organ malperfusion syndrome even organ failure. The understanding of pathological anatomy, classification, staging, and the pathophysiological change has increasingly mature, but not complete. In addition, the treatment strategy for complex lesions is diversified, some questions may not reach consensus. Fully understanding of the anatomical and pathophysiology is very important for surgeons to choose reasonable treatment strategy. As the rapid development of the basic research, imaging techniques and the concept of surgery procedures, the manage technique of Stanfrod type A dissection and branch vessels at the same time is getting seriously, the related issues also need further discussions.

Objective Meta-analysis was used to evaluate the effect of the solution-focused brief therapy on im-proving the anxiety and depression status of patients with HIV/AIDS.Methods Computer search of PubMed,Embase,Web of Science,Cochrane Library,CINAHL,PsycINFO,Chinese Biomedical Literature Database,China Na-tional Knowledge Infrastructure,Wanfang Database,CQVIP were conducted,and the search time frame was from the establishment of databases until April 9,2023.There were 2 investigators who independently screened the literature according to inclusion and exclusion criteria,extracted data and performed quality evaluation,and performed Meta-analysis using RevMan 5.4 software.Results A total of 11 publications were included,including 9 randomized controlled trials and 2 quasi-experimental studies,with a total of 1 219 patients with HIV/AIDS.Meta-analysis re-sults showed that solution-focused brief therapy reduced anxiety scores(SMD=-1.89;95%CI:-2.79～-0.99,P＜0.001),depression scores(SMD=-2.45;95%CI:-3.51～-1.39,P＜0.001).Subgroup analysis showed that improved anxiety(SMD=-4.16;95%CI:-7.97～-0.35,P＜0.001),depression(SMD=-5.69;95%CI:-11.20～-0.19,P＜0.001)in pregnant HIV/AIDS patients was significantly better than that in ordinary patients.Conclusion Solution-focused brief therapy is effective in improving anxiety and depression levels in patients with HIV/AIDS,and the application of this model in pregnant patients with HIV/AIDS has a more significant improvement effect,but high-quality,multicenter,large-sample clinical trial studies are needed to further confirm this conclusion in the future.

Objective:To evaluate the clinical efficacy of modified all-arthroscopic reconstruction of medial patella femoral ligament (MPFL) for the treatment of recurrent patellar dislocation.Methods:A retrospective case series study was conducted to analyze the clinical data of 38 patients (46 knees) with recurrent patellar dislocation, who were treated at First Affiliated Hospital of Shenzhen University from January 2017 to January 2020. The patients included 12 males (12 knees) and 26 females (34 knees), aged 14-40 years [(24.6±5.4)years]. All patients underwent the modified all-arthroscopic MPFL reconstruction procedure. The femoral tunnel locations were assessed by 3D-CT immediately after surgery. The MRI was performed at 6 and 12 months after operation to assess the healing morphology of the reconstructed MPFL. The Lysholm score and Kujala score were used to assess the knee function before operation, at 6 months after operation, at 12 months after operation and at the last follow-up. The time to return to sports as well as complications were observed.Results:All patients were followed up for 26-48 months [(32.4±8.6)months]. Postoperative 3D-CT examination showed that the femoral tunnels were located in the groove area of the medial epicondyle of the femur and the adductor tubercle. At 6 and 12 months after operation, MRI T2 images showed that the reconstructed MPFL had a low signal and well tensioned ligament tissue, indicating that the MPFL was healed well. The Lysholm scores at 6 and 12 months postoperatively and at the last follow-up were (81.1±12.0)points, (91.2±3.8)points, and (92.2±9.8)points, respectively, being significantly higher than the preoperative (52.4±10.6)points (all P<0.01). The Kujala scores at 6 and 12 months postoperatively and at the last follow-up were (85.4±3.9)points, (91.4±3.6)points, and (93.1±8.5)points, respectively, being significantly higher than the preoperative (55.2±6.8)points (all P<0.01). Compared with 6 months postoperatively, the Lysholm score and Kujala score were significantly improved at 12 months postoperatively and at the last follow-up (all P<0.05). All patients returned to sports, with the time to return to sports for 3-12 months [(8.7±2.3)months] after operation. One patient had poor wound healing but was healed after dressing changes. No wound infection, nerve injury, joint stiffness, patella re-dislocation or other complications occurred. Conclusion:For recurrent patellar dislocation, the modified all-arthroscopic MPFL reconstruction has advantages of accurate bone tunnel positioning, good ligament healing, good function recovery, early return to sports, and less postoperative complications.