This paper summarizes Professor YAN Huimin's clinical experience in the staged treatment of pediatric IgA vasculitis. It is believed that the pathogenesis in the acute stage is characterized by fire and heat entering the blood and damaging the collaterals， and the treatment should focus on clearing heat and stopping bleeding， using the self-formulated Qingzi Liangxue Formulation （青紫凉血方）. In the remission stage， the pathogenesis is qi rebellion leading to blood extravasation. The treatment principle is to regulate qi and stabilize blood， using the self-formulated Heqi Ningxue Formulation （和气宁血方）. During the protracted stage， the pathogenesis is latent pathogenic factors due to yin deficiency， and the treatment should aim to nourish the collaterals and strengthen the root， with the self-formulated Yangluo Guben Formulation （养络固本方）. Meanwhile， the method of promoting blood stasis resolution is consistently applied throughout the entire treatment process.

OBJECTIVE: To summarize the early clinical results and safety of Stand-alone OLIF application of lumbar lesions, and explored its surgical indications. METHODS: Total of 92 cases of lumbar spine lesions treated with Stand-alone OLIF at two medical centers from October 2014 to December 2018 were retrospectively analyzed, including 30 males and 62 females with an average age of (61.20±12.94) years old ranged from 32 to 83 years old. There were 20 cases of lumbar spinal stenosis, 15 cases of lumbar disc degeneration, 11 cases of lumbar degenerative spondylolisthesis, 6 cases of discogenic low back pain, 7 cases of giant lumbar disc herniation, 13 cases of primary lumbar discitis, 6 cases of adjacent vertebral disease after lumbar internal fixation surgery, and 14 cases of degenerative lumbar scoliosis. Pre-operative dual energy X-ray bone density examination 31 cases' T-values ranged from -1 to -2.4, 8 cases' T-values ranged from -2.5 to -3.5, and the rest had normal bone density. The number of fusion segments: 68 cases of single segment, 9 cases of two segment, 12 cases of three segment , and 3 cases of four segment. Fusion site:L_1,2 1 case, L_2,3 4 cases, L_3,4 10 cases, L_4,5 53 cases, L_2,3-L_3,4 3 cases, L_3,4-L_4,5 6 cases, L_1,2L_2,3L_3,4 1 case, L_1,2L_3,4L_4,5 1 case, L_2,3L_3,4L_4,5 10 cases, L_1,2L_2,3L_3,4L_4,5 3 cases. The clinical results and imaging results of this group of cases were observed, as well as the complications. RESULTS: The surgical time ranged from 40 to 140 minutes with an average of (60.92±27.40) minutes. The intraoperative bleeding volume was 20 to 720 ml with an average of (68.22±141.60) ml. The patients had a follow-up period of 6 to 84 months with an average of (38.50±12.75) months. The height of the intervertebral space recovered from (9.23±1.94) mm in preoperative to (12.68±2.01) mm in postoperative, and (9.11±1.72) mm at the last follow-up, there was a statistically significant difference(F=6.641, P=0.008);there was also a statistically significant difference between the postoperative and preoperative height of the intervertebral space(t=9.27, P<0.000 1);and there was also a statistically significant difference (t=10.06, P<0.000 1) between the last follow-up and postoperative height of the intervertebral space. At the last follow-up, cage subsidence grading was as follows:level 0 in 69 cases (76 segments), levelⅠin 17 cases (43 segments), level Ⅱin 5 cases (14 segments), and level Ⅲ in 1 case (1 segment);according to the number of segments, normal subsidence accounts for 56.72%, abnormal subsidence accounts for 43.28%. Bone mineral desity of normal subsidence groups was -0.50±0.07 whinch was better than that the abnormal subsidence groups -2.10±0.43, and the difference was statistically significant(χ²=2.275, P=0.014). As well as there was a statistically significant difference in the patient's VAS of backache from (6.28±2.11) in preoperative to (1.48±0.59) in last follow-up(t=8.56, P<0.05). The ODI recovered from (36.30±7.52)% before surgery to (10.20±2.50)% at the last follow-up, with a statistically significant difference (t=7.79, P<0.000 1). Complications involved 4 cases of intraoperative vascular injury, 21 cases of endplate injury, and 4 cases of combined vertebral fractures. The incision skin has no necrosis or infection. There were 4 cases of left sympathetic chain injury, 4 cases of transient left hip flexion weakness, 2 cases of left thigh anterolateral numbness with quadriceps femoris weakness, and 1 case of incomplete intestinal obstruction;8 cases were treated with posterior pedicle screw fixation due to fusion cage settlement accompanied by stubborn lower back pain, and 6 cases were treated with fusion cage settlement and lateral displacement. According to the actual number of cases, there were 38 complications, with an incidence rate of 41.3%. CONCLUSION The application of Stand alone OLIF in lumbar spine disease fusion has achieved good early results, with obvious clinical advantages, but also there are high probability of complications. It is recommended to choose carefully. It is necessary to continuously summarize and gradually clarify and complete the surgical indications and specific case selection criteria.
Humans ; Male ; Female ; Middle Aged ; Spinal Fusion/methods* ; Lumbar Vertebrae/injuries* ; Aged ; Adult ; Retrospective Studies ; Aged, 80 and over

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective To compare the efficacy of blood letting under pain point touch and ultrasound-guided puncture de-compression in the treatment of acute supraspinatus muscle calcifying tendinitis.Methods From January 2020 to January 2023,45 patients with acute supraspinatus muscle calcifying tendinitis were selected and divided into treatment group and control group.In the treatment group,a total of 22 patients were treated with ultrasound-guided puncture decompression,in-cluding 16 females and 6 males,aged from 20 to 64 years old(39.31±5.80)years old,11 on the left shoulder and 11 on the right shoulder.In the control group,there were 23 cases,including 15 females and 8 males,aged from 19 to 66 years old(40.67±6.13)years old,12 on the left shoulder and 13 on the right shoulder.The treatment was treated with pain point touch bloodletting therapy.The visual analog scale(VAS)pain score,University of California,Los Angeles(UCLA)shoulder system score and shoulder Constant-Murley score were used to evaluate the therapeutic effect before treatment,1 weeks,1 month and 3 months after treatment,respectively.Results One patient in the control group gave up follow-up for personal reasons after 1 week of treatment,and the other 44 patients completed all follow-up.Six months after treatment,there were no recurrence cases in both groups.After statistical analysis,VAS pain score,UCLA score and Constant-Murley score of the treatment group and the control group were significantly different from those before treatment(P＜0.05),and the improvement was more obvious in the treatment group.There was no statistical significance between the two groups(P＞0.05).Conclusion Bloodletting under pain point touch and ultrasound-guided puncture decompression are effective in the treatment of acute calcific supraspinatus tendinitis,with simple operation and low cost,which can effectively reduce local pain and effectively improve shoulder joint function.Primary hospitals can selectively operate treatment according to their own conditions.

Objective To explore the differences in scapular motion and shoulder function between patients suffering from rotator cuff tears(RCT)with and without type Ⅲ scapular dyskinesis(SD).Meth-ods Between September 2021 and March 2023,sixteen patients suffering from rotator cuff tears with SD(SD group)and 17 counterparts without SD(non-SD group)were recruited from the Sports Hospital of the General Administration of Sport of China.Their scapular motion was assessed by measuring three parameters in the X-rays,including scapular spine line(LSS),scapular upward rotation angle(SU-RA),and coracoid upward shift distance(CUSD).Moreover,their shoulder range of motion in flexion,abduction and external rotation were recorded,and further evaluated using the Pain Visual Analog Scale(VAS)and American Shoulder and Elbow Surgeons Score(ASES).Results No significant differenc-es were found between the two groups in the average score of SURA,CUSD and LSS at 0°～30° shoul-der abduction,or in that of CUSD and LSS at 60°～90°shoulder abduction.However,the average SU-RA score of the SD group at 60°～90°shoulder abduction was significantly greater than the other group(P<0.05).The shoulder ranges of motion during active flexion,abduction and external rotation were significantly smaller in the SD group than in the non-SD group(P<0.05).Moreover,the average VAS score in the SD group was significantly higher than the non-SD group(P<0.05),while the average ASES score was significantly lower than the latter group(P<0.05).Conclusions RCT patients type III SD exhibits greater scapular upward rotation during shoulder abduction compared to those without SD.Moreover,the former patients suffer from more severe pain and have worse shoulder range of motion and functional performance than the latter.

Aim To investigate the mechanisms of Ke-chuanting granules(KCT)inhibiting the IL-33/ILC2s pathway and pathogenic T cells to intervene in allergic airway inflammation.Methods Network pharmacolo-gy was utilized to analyze the potential targets and mechanisms of KCT-treated asthma.Allergic asthma models were induced in mice using OVA.Lung histo-pathology was conducted to observe injury changes.ELISA and quantitative PCR were utilized to measure key inflammatory factors and their mRNA expression levels in Th2-type asthma.Western blot was used to detect the phosphorylation levels of relevant proteins in the MAPK pathway.Flow cytometry was performed to evaluate the proportions of ILC2s,Th1,Th 17,Th2 and Treg cells.Results Network pharmacology iden-tified 227 main active components and 143 key targets of KCT in treating asthma,primarily enriched in signa-ling pathways such as MAPK and IL-17.Further vali-dation experiments demonstrated that KCT significantly alleviated lung inflammatory injury in asthmatic mice,reduced the number of B cells,production of I L-4,TNF-α and TGF-β,downregulated JNK phosphoryla-tion levels in lung tissue,as well as mRNA levels of Il-33,Bcl11b,Rorα,Tcf-7,Jun,Mapk3 and Mapk14.KCT intervention reduced the numbers of ILC2s and Th 17 cells in lungs and spleens of mice,and inhibited Th2 cell infiltration in lungs.Conclusions KCT ex-hibits therapeutic effects on allergic airway inflamma-tion in asthma,closely associated with the inhibition of the IL-33/ILC2s pathway,pathogenic T cell subsets,and JNK-MAPK signaling pathway.

Purpose To explore the changes in biventricular volume and mass in chronic kidney disease(CKD)patients with preserved ejection fraction using cardiac magnetic resonance(CMR),and evaluate cardiac function using tissue-tracking strain analysis.Materials and Methods The retrospective analysis of 40 CKD patients without symptoms of cardiovascular disease,diabetes and the estimated glomerular filtration rate<60 ml/(min·1.73 m2)who were treated at the First Affiliated Hospital of Anhui Medical University from October 2020 to June 2023 and 25 age-and gender-matched healthy volunteers.All participants underwent 1.5T CMR scans to calculate left and right ventricular function,myocardial strain and native T1 and T2 values,and differences in various imaging parameters between the two groups were compared.Results The native T1 value[(1 109.6±35.9)ms]and T2 value[(58.1±2.9)ms]of CKD patients were significantly higher than those in control group[(1 046.3±15.9)ms,(53.3±2.3)ms](t=8.296,6.916,both P<0.001).The left ventricular end-diastolic volume index,left ventricular end-systolic volume index,left ventricular mass index,right ventricular end-diastolic volume index,right ventricular end-systolic volume index and right ventricular mass index of CKD patients were significantly increased compared with the control group(t=3.233,3.350,5.751,7.746,5.937,2.363,all P<0.05),while the left and right ventricular strain parameters,left ventricular global longitudinal strain,left ventricular global circumferential strain,left ventricular global radial strain,right ventricular global longitudinal strain,right ventricular global circumferential strain and right ventricular global radial strain were significantly decreased(t=9.506,9.072,-10.603,10.496,11.574,-4.018,all P<0.001),and the estimated glomerular filtration rate exhibited significant correlations with left ventricular global longitudinal strain(r=-0.636),left ventricular global radial strain(r=0.688),right ventricular global longitudinal strain(r=-0.513),right ventricular global circumferential strain(r=-0.827)and right ventricular global radial strain(r=0.514)(all P<0.001).Conclusion CMR can quantitatively assess myocardial fibrosis and edema in patients with CKD,and tissue tracking strain analysis can detect myocardial motion abnormalities before changes in ventricular ejection fraction,offering value in the early detection of cardiac involvement in CKD patients..

Objective:To compare the efficacy of ulnar Z-shaped shortening osteotomy combined with arthroscopic deep suture anchor repair of the triangular fibrocartilage complex (TFCC) and ulnar Z-shaped shortening osteotomy alone in the treatment of ulnar impaction syndrome with moderate or severe distal radioulnar joint instability.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with ulnar impaction syndrome accompanied by moderate or severe distal radioulnar joint instability, who were admitted to Affiliated Hospital of Qingdao University from January 2016 to June 2023, including 16 males and 14 females, aged 27-58 years [(42.4±9.9)years]. All the patients presented with positive ulnar variance and TFCC type IB injury, with the deep layer of TFCC affected. Fifteen patients were treated with Z-shaped shortening osteotomy of the ulna alone (osteotomy alone group), while the other 15 patients received Z-shaped shortening osteotomy of the ulna combined with arthroscopic suture anchor repair of the deep layer of TFCC (osteotomy combined with repair group). The operation time, intraoperative blood loss, and length of ulnar shortening were compared between the two groups. The forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, visual analogue scale (VAS), patient-rated wrist evaluation (PRWE) score, modified Mayo wrist score, and disabilities of the arm, shoulder, and hand (DASH) questionnaire score were assessed preoperatively, at 6 and 12 months postoperatively, and at the last follow-up. The incidence of postoperative complications was recorded.Results:The patients were followed up for 6-24 months [(15.8±4.9)months]. The operation time in the osteotomy combined with repair group was 3.0 (2.3, 3.0)hours, longer than 1.5 (1.3, 2.0)hours in the osteotomy alone group ( P<0.01). There were no significant differences in intraoperative blood loss and the length of ulnar shortening between the two groups ( P>0.05). There were no significant differences in forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, VAS, PRWE score, modified Mayo wrist score, and DASH score between the two groups preoperatively ( P>0.05). At 6 and 12 months postoperatively, and at the last follow-up, the forearm rotation degrees in the osteotomy combined with repair group were (130.3±8.8)°, (135.2±7.9)°, and (141.9±6.9)°, greater than (120.5±9.4)°, (123.7±10.2)°, and (130.9±8.5)° in the osteotomy alone group; the ulnar-radial deviation angles in the osteotomy combined with repair group were 23.0 (23.0, 26.5)°, 33.0 (30.0, 36.0)°, and 36.0 (32.5, 41.5)°, greater than 22.0 (20.0, 23.0)°, 23.0 (23.0, 28.0)°, and 25.0 (23.0, 33.5)° in the osteotomy alone group ( P<0.05 or 0.01). In the osteotomy combined with repair group, the palmar-dorsal flexion angles at 12 months postoperatively and at the last follow-up were (125.8±10.8)° and (132.9±16.8)°, greater than those in the osteotomy alone group [(99.1±15.7)° and (121.2±17.4)°] ( P<0.01), while there was no significant difference in the palmar-dorsal flexion angle between the two groups at 6 months postoperatively ( P>0.05). In the osteotomy combined with repair group, the grip strength at 6 months postoperatively was (14.6±1.0)N, greater than (12.8±1.8)N in the osteotomy alone group ( P<0.05), while there was no significant difference in grip strength between the two groups at 12 months postoperatively and at the last follow-up ( P>0.05). At 6, 12 months postoperatively, and at the last follow-up, the VAS scores in the osteotomy combined with repair group were (4.3±1.9)points, (2.7±1.1)points, and (2.1±0.7)points, lower than (6.5±2.5)points, (4.7±1.4)points, and (4.3±0.9)points in the osteotomy alone group; the PREW scores were (57.6±4.1)points, (47.3±2.4)points, and (35.0±3.4)points, lower than (67.8±4.5)points, (53.1±4.4)points, and (43.5±4.1)points in the osteotomy alone group ( P<0.05 or 0.01). The modified Mayo wrist scores in the osteotomy combined with repair group at 6, 12 months postoperatively, and at the last follow-up were (78.3±2.9)points, (80.1±3.0)points, and (83.5±3.9)points, higher than those in the osteotomy alone group [(69.0±4.3)points, (75.5±2.9)points, (78.8±2.4)points] ( P<0.01). The DASH scores in the osteotomy combined with repair group at 12 months postoperatively and at the last follow-up were (35.8±4.6)points and (28.4±5.4)points, lower than (43.3±5.0)points and (34.2±4.4)points in the osteotomy alone group ( P<0.01), while there was no significant difference in DASH scores between the two groups at 6 months postoperatively ( P>0.05). In both groups, forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, and modified Mayo wrist scores at all time points postoperatively were all higher than the preoperative values ( P<0.05), while the postoperative VAS, PREW, and DASH scores were lower than the preoperative values ( P<0.05), with statistically significant differences among different time points postoperatively ( P<0.01). The incidence of postoperative complications in the osteotomy combined with repair group was 6.7% (1/15), lower than 46.7% (7/15) in the osteotomy alone group ( P<0.05). Conclusion:Compared with the ulnar Z-shaped shortening osteotomy alone, ulnar Z-shaped shortening osteotomy with arthroscopic suture anchor deep repair of TFCC has the advantages of increased wrist range of motion, reduced pain, improved function, and lower incidence of complications, etc in treating ulnar impaction syndrome with moderate or severe instability of the distal radioulnar joint.