Gorham-Stout disease(GSD) is a rare osteolytic disorder characterized by spontaneous and progressive osteolysis, along with abnormal angiogenesis and lymphangiogenesis, with no new bone formation. We present a case of a 15-year-old female admitted due to " recurrent right leg pain for 5 years, 11 months after undergoing right femoral fracture surgery". Through comprehensive integration of the patient's clinical phenotype, laboratory tests, imaging findings, pathological examinations, and molecular biological test results, GSD was considered highly likely. A multidisciplinary treatment approach was conducted, including a combination of zoledronic acid and sirolimus to inhibit osteolysis, along with rehabilitation training and orthopedic intervention, providing a personalized and comprehensive treatment strategy.

ObjectiveThis paper aims to conduct the feature analysis and correlation analysis on the ocular collateral features and differential metabolites in patients with chronic hepatitis B （CHB） complicated by glucose metabolism disorder （GMD），particularly those with the damp-heat syndrome type，by integrating shadowless scleral imaging and metabolomics technologies. MethodsA total of 313 patients were recruited from the Hepatology and Endocrinology Outpatient Departments of Public Health Clinical Center of Chengdu according to the inclusion/exclusion criteria，and they were divided into a CHB group and a CHB complicated by GMD groups （damp-heat syndrome group and non-damp-heat syndrome group）. All patients underwent high-definition ocular image acquisition and feature extraction using an intelligent analysis system for shadowless scleral imaging to analyze the differences in the counting of morphological feature scores of ocular collaterals among groups. By using a digital sampling method，24 patients from each group were randomly selected，along with 20 healthy volunteers，for untargeted metabolomic analysis of peripheral serum. Differential metabolites were identified，statistically analyzed，and subjected to potential biomarker analysis and pathway enrichment. Spearman method was performed to conduct the correlation analysis on the differential ocular collateral features and differential metabolites，followed by correlation network construction. ResultsCompared with those in the CHB group，patients with CHB complicated by GMD showed significant changes in ocular collateral feature scores such as "hillock"，"blood vessels"，and "pale dusky coloration" （P<0.05）. In comparison with those in the healthy group，metabolites including N-acetylglucosamine，acetylhomoserine，and myo-inositol （AUC>0.7） were identified as potential biomarkers for the disease. Compared with those in the CHB complicated by GMD group with non-damp-heat syndrome，patients with damp-heat syndrome exhibited significant changes in feature scores of "plaques"，"yellow coloration"，"spleen"，and "gallbladder" （P<0.05）. In comparison with those in the healthy group，metabolites such as O²′-4a-cyclic tetrahydrobiopterin，theobromine，xanthurenic acid，and L-glutamic acid 5-phosphate （AUC>0.7） were identified as potential biomarkers for the damp-heat syndrome type. The Spearman correlation analysis reveals weak to moderate linear correlations between the differential scleral collateral features and metabolites. By constructing a "disease-syndrome" network of ocular diagnosis and metabolites，"xanthurenic acid-gallbladder" and "theobromine-plaque/yellow coloration" were identified as specific molecular-phenotypic correlated biomarker clusters for CHB complicated by GMD with dampness-heat syndrome. ConclusionPatients with CHB complicated by GMD demonstrate differential ocular diagnostic features and serum metabolites corresponding to disease states and dampness-heat syndrome. These objective biomarkers can guide both clinical syndrome differentiation and medication. The macro-micro integration based on ocular feature clusters and potential metabolic biomarkers offers an innovative approach to a combined traditional Chinese and Western medicine diagnosis and treatment model for this disease.

Effective symptom management can alleviate the physical and psychological distress experienced by patients with cancer, improve quality of life, and contribute to treatment adherence and improve clinical outcomes. However, most existing guidelines are developed for healthcare professionals, and patients and the public have limited access to standardized and comprehensible guidance on symptom management. To address this gap and to facilitate effective communication and shared decision-making, this study proposes the development of a patient version of the cancer symptom management guideline. The development process will adhere to the methodological framework recommended by the Guidelines International Network and the World Health Organization. The GRADE approach will be employed to assess the certainty of evidence and to formulate recommendations. In addition, the process will be informed by the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument and the Reporting Items for Practice Guidelines in Healthcare-Public or Patient Versions of Guidelines (RIGHT-PVG). This protocol outlines the establishment of the guideline working group, the identification and prioritization of key questions, evidence retrieval and appraisal, and the formulation of recommendations, with the aim of ensuring methodological rigor and transparency in the development of the patient guideline and providing methodological reference for similar guideline initiatives.

Objective To evaluate the dissolution effects of pediatric ammonium urate stones in solutions with different pH values, so as to provide reference for the clinical treatment of this type of stones. Methods Eight pure ammonium urate stones(ammonium urate content ≥90%)of similar size and mass(median mass 4.6 g)were obtained from 8 children(＜14 years)undergoing percutaneous nephrolithotomy at the People's Hospital of Xinjiang Uygur Autonomous Region. The stones were placed in sodium chloride solutions with pH values of 5.0, 6.0, 7.0, and 8.5 and artificial urine with pH values of 4. 6, 5.0, 7.0, and 8.5 at a constant temperature of 37 ℃. The mass of the stones was recorded before placement and at 24, 48, and 72 h after placement. The dissolution rates of the stones were calculated. Results The pediatric ammonium urate stones could be dissolved in sodium chloride solution, and the total dissolution rate was the highest(94.6%)after 72 hours when the pH value was 6.0. The total dissolution rate of ammonium urate stones in artificial urine after 72 hours were all over 50%, and the total dissolution rate was the highest(79.7%)when the pH value was 4.6. Conclusion Pediatric ammonium urate stones are soluble in sodium chloride solution and artificial urine, and the total dissolution rate is higher in acidic environment.

ObjectiveThe quality of fresh Gastrodiae Rhizoma directly determines the efficacy of its terminal products. According to the theory of excellent shape， high quality， and superior effect of authentic medicinal materials， this study aimed to develop a novel quality evaluation system for fresh Gastrodiae Rhizoma by systematically quantifying and integrating appearance traits with bioactive components. MethodsFresh Gastrodiae Rhizoma samples were collected from four major producing regions. After herbal textural research and a literature review， tuber weight， width， length， and aspect ratio were selected as quantitative indicators of appearance， and they were measured by an electronic balance and a digital vernier caliper. Key active components， including gastrodin， p-hydroxybenzyl alcohol， parishins， and total polysaccharides， were quantified via ultra performance liquid chromatography-tandem mass spectrometry （UPLC-MS/MS） and the phenol-sulfuric acid method. Descriptive statistics and K-means clustering analysis were employed to establish the threshold ranges for the excellent shape and high quality indicators. ResultsTwo specific quantitative evaluation systems for characterizing the excellent shape and high quality of fresh Gastrodiae Rhizoma were established. System 1： tuber weight > 83.90 g， tuber width > 3.50 cm， total gastrodin and p-hydroxybenzyl alcohol content > 0.277%， and total parishin content > 0.561%. System 2： tuber length < 9.89 cm， aspect ratio < 3.41， and total polysaccharide content > 195.274 mg·g^-1. The verification results showed that the systems effectively identified fresh Gastrodiae Rhizoma samples with both excellent appearance features and stable bioactive components. ConclusionThis study establishes a multi-dimensional evaluation and grading system for fresh Gastrodiae Rhizoma based on the correlation between shape and quality. This framework provides a scientific basis for the quality control and resource grading of fresh Gastrodiae Rhizoma and lays a methodological foundation for the efficient utilization of both the medicinal and edible value of this herbal medicine.

Objective To prepare a thermosensitive hydrogel scaffold loaded with bone marrow mesenchymal stem cells（BMSCs） and resveratrol liposomes （RSV-LIP） to form a therapeutic unit and evaluate its treatment efficacy for traumatic brain injury （TBI）. Methods BMSCs were extracted from rats, and RSV-LIP was prepared and characterized. Cell models were constructed to investigate the pharmacological effects of BMSCs combined with RSV-LIP. BMSCs and RSV-LIP were then loaded into the hydrogel, and a TBI mouse model was established to evaluate the therapeutic effects of the hydrogel. Results The RSV-LIP had a particle size of 127.8 nm, a Zeta potential of −4.9 mV, an encapsulation efficiency of 78.50%, and a drug loading content of 2.37%. Live-dead staining indicated good biocompatibility of the hydrogel. The combination of BMSCs and RSV-LIP significantly inhibited TNF-α and reduced ROS levels, promoting cell migration in scratch assays. Compared to the control group, the hydrogel group showed significantly lower mNSS scores （P<0.01）, higher hanging scores （P<0.001）, and reduced stepping errors （P<0.001）. Conclusion The combination of BMSCs and RSV-LIP exhibited antioxidative stress, anti-inflammatory, and neurogenic cell migration-promoting effects. When loaded into a hydrogel scaffold and locally implanted, it could improve the motor and sensory functions in TBI mice.

ObjectiveTo observe the clinical efficacy and safety of Sizi Powder （四子散， SP） orientation osmotherapy in the treatment of stroke patients with hemiplegia. MethodsIn this study， 94 patients with post-stroke hemiplegia were randomly divided into a control group and a treatment group with 47 patients in each group. The control group received conventional treatment， nursing and rehabilitation training， while the treatment group was treated with SP orientation osmotherapy in addition to the treatments in the control group. The treatment consisted of 20 minutes per session， once daily， 5 times a week， 2 weeks per course， with a total of 2 courses. Before the intervention， after 2 weeks intervention and after 4 weeks intervention， the upper limb motor function was evaluated by using the Fugl-Meyer Assessment （U-FMA）. The modified Ashworth Scale （MAS） was used to assess upper limb spasticity， and joint range of motion was measured for shoulder flexion， extension， abduction， internal rotation， external rotation， elbow flexion， wrist palmar flexion， dorsiflexion， ulnar deviation， and radial deviation. Clinical efficacy for spasticity was evaluated after 2 and 4 weeks of treatment. Skin conditions， including burns， allergic reactions， and blisters， were monitored during the treatment process. ResultsA total of 44 patients in the treatment group and 45 patients in the control group completed the study. The results showed that after 2 and 4 weeks of intervention， the U-FMA scores of both groups increased， with the treatment group showing higher scores than the control group （P＜0.05）. After 4 weeks of treatment， the MAS score distribution improved significantly in both groups （P＜0.05）， although no significant difference was found between the groups after 2 and 4 weeks treatment（P＞0.05）. The total effective rate of spasticity clinical efficacy in the treatment group after 2 and 4 weeks was 15.91% （7/44） and 40.91% （18/44）， respectively， while in the control group， it was 11.11% （5/45） and 22.22% （10/45）. There was no significant difference after 2 weeks treatment （P＞0.05）， but the treatment group showed a significantly higher total effective rate after 4 weeks treatment （P＜0.05）. After 2 and 4 weeks of treatment， the joint range of motion in the upper limbs was greater in both groups （P＜0.05）. After 2 weeks of intervention， the treatment group showed greater range of motion in shoulder flexion， extension， and abduction than the control group， and after 4 weeks of intervention， the treatment group demonstrated greater range of motion in shoulder flexion， extension， abduction， internal rotation， external rotation， and elbow flexion compared to the control group （P＜0.05）. During the treatment， one patient in the treatment group experienced mild skin allergy， while no other severe adverse reactions， such as intense pain， itching， blisters， or infection， were observed in any patients. ConclusionSP orientation osmotherapy can effectively improve upper limb motor function and joint range of motion in stroke patients with hemiplegia. After 4 weeks of treatment， it can reduce upper limb spasticity and improve clinical efficacy， with good safety.

Objective:To investigate the effect of nourishing yin and tonifying yang method on inflammatory response and bone metabolism in patients with T2DM complicated with osteoporosis (OP).Methods:A randomized controlled trial. From January 2022 to December 2023,80 patients with T2DM and OP in our hospital were selected as the observation objects, and they were divided into two groups by random number table method, with 40 cases in each group.On the basis of conventional treatment, the control group chewed vitamin D calcium chewable tablets, and the observation group added nourishing yin and tonifying yang Chinese medicine.Both groups were treated for 6 months. TCM syndrome scores were performed before and after treatment ;the levels of fasting blood glucose (FPG), 2 hPG and HbA1c were detected by intelligent blood glucose monitor;the levels of serum neutrophils and lymphocytes were detected by automatic blood analyzer, and the neutrophil/lymphocyte ratio (NLR) was calculated;the levels of serum IL-1β and TNF-α were detected by automatic chemiluminescence analyzer, the levels of type I procollagen amino terminal propeptide (PINP), type I collagen carboxy terminal peptide β special sequence (β-CTX) and 25-hydroxy vitamin D3 [25-(OH)D3] were detected by ELISA;Bone mineral density (BMD) was detected by bone mineral density detector. The adverse reactions during treatment were observed and recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 92.5 %(37/40) in the observation group and 75.0 % (30/40) in the control group,the difference between the two groups was statistically significant ( &chi;2=4.50, P=0.034).After treatment, the scores of soreness and weakness of waist and knees, soreness and pain of waist and back, clear and long urine, pale tongue and white coating in the observation group were lower than those in the control group ( t=3.11, 3.75, 3.51, 3.74, P<0.01);the levels of serum FPG, 2 hPG and HbA1c in the observation group were lower than those in the control group ( t=3.11,3.20,3.39, P<0.01).The levels of serum NLR (2.63 ± 0.68 vs. 3.24 ± 0.79, t=3.70), IL-1β [(81.65 ± 8.30) ng/L vs. (89.03 ± 8.98) ng/L, t=3.82] and TNF-α [(35.14 ± 5.11) μg/L vs. (39.96 ± 5.38) μg/L, t=4.11] in the observation group were lower than those in the control group ( P<0.01). After treatment, the levels of PINP [(29.83 ± 3.92) ng/L vs. (34.02 ± 4.03) ng/L, t=4.71] and β-CTX [(21.30 ± 3.95 ) ng/L vs. (25.32 ± 4.18) ng/L, t=4.42] in the observation group were lower than those in the control group ( P<0.01), the levels of 25-(OH)D3 [(42.86 ± 5.12) μg/L vs. (38.08 ± 4.55) μg/L, t=4.41] and BMD [(0.90 ± 0.18) g/cm 3vs. (0.78 ± 0.16) g/cm 3, t=3.15] were higher than those in the control group ( P<0.01).During the treatment, the incidence of adverse reactions was 12.5% (5/40) in the observation group and 10.0 % (4/40) in the control group,there was no significant difference between the two groups ( &chi;2=0.13, P=0.723). Conclusion:The method of nourishing yin and tonifying yang can effectively improve the TCM syndromes of T2DM patients with OP, reduce the levels of blood glucose and inflammatory factors, improve bone metabolism, improve clinical efficacy and have good treatment safety.

Objective To develop and evaluate a diagnostic model for autoimmune liver disease(AILD)using clinical indicators.Methods A total of 181 AILD patients(AILD group)diagnosed in the Department of Gastroenterology or Rheumatology and Immunology,the First Medical Center of Chinese PLA General Hospital,from June 2019 to February 2024,133 patients with hepatitis B virus cirrhosis(HBVC)(HBVC group),and 100 healthy individuals(HC group)were included in the study cohort for retrospective analysis.Clinical data,blood routine tests,and biochemical indicators were compared among the groups.Propensity score matching was used to balance the effects of factors such as gender and age.Multivariate logistic regression analysis was applied to identify characteristic indicators for AILD.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of single and combined indicators,and the optimal diagnostic model for AILD was constructed.The Hosmer-Lemeshow test was performed to assess the model's goodness-of-fit,while ROC analysis was employed to evaluate the predictive validity.Additionally,an independent validation cohort,including 91 AILD patients(AILD validation group),82 HBVC patients(HBVC validation group),and 40 healthy individuals(HC validation group)who visited during the same period,was used to validate the diagnostic model.False-positive and false-negative rates were calculated to assess the diagnostic efficacy and clinical utility of the model.Results The age and the proportion of male patients in AILD and HBVC groups were higher than those in HC group,and the proportion of male patients in AILD group was higher than in HBVC group,the differences were statistically significant(P＜0.05).Prior to matching,compared with HC group,HBVC group and AILD group had significantly lower levels of hemoglobin(HB),red blood cell count(RBC),white blood cell count(WBC),platelet count(PLT),and albumin(ALB)(P＜0.05),but significantly higher levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyl transferase(GGT),total bilirubin(TBIL),and direct bilirubin(DBIL)(P＜0.05).Compared with HBVC group,AILD group had significantly higher levels of WBC,PLT,ALB,ALP,and GGT(P＜0.05 or P＜0.001)but significantly lower levels of TBIL and DBIL(P＜0.001).After maching,compared with HC group,AILD group still had significantly lower levels of HB,RBC,WBC,PLT,and ALB,but significantly higher levels of ALT,AST,ALP,GGT,TBIL,and DBIL(P＜0.05).Compared with HBVC group,AILD group had significantly higher levels of HB,RBC,WBC,PLT,ALB,ALT,ALP,and GGT,but significantly lower levels of DBIL(P＜0.05).ROC analysis results showed that AST,GGT,ALP,and DBIL had high predictive values for differentiating AILD from HC(AUC=0.843,0.804,0.802,0.773),while PLT,WBC,GGT,and ALP had high predictive values for differentiating AILD from HBVC(AUC=0.780,0.739,0.729,0.702).For distinguishing AILD from HC,the combined model of AST,ALP,and DBIL(Model e)had an AUC of 0.887,with a sensitivity of 82.2％,and a specificity of 94.7％.For distinguishing AILD from HBVC,the combined model of ALP,GGT,and PLT(Model D)had an AUC of 0.829,with a sensitivity of 78.5％and a specificity of 80.6％.Conclusions The combined diagnostic model based on AST,ALP,and DBIL can effectively differentiate healthy individuals without liver diseases from AILD patients,while the combined diagnostic model based on PLT,ALP,and GGT can effectively distinguish HBVC from AILD patients.

Clinically,carotid atherosclerotic stenosis(CASS)is an important cause of stroke in China.The optimal treatment option for asymptomatic carotid atherosclerotic stenosis(ACAS)has not been conclusive,which is still a hot issue in recent years.With the development of endovascular interventional technique,and patient's higher requirements for recovery speed and comfort level,the carotid artery stenting(CAS)has been used more frequently than carotid endarterectomy(CEA).Therefore,the relative benefit of CAS for the treatment of ACAS requires further evaluation.This paper aims to make a comprehensive review about CAS for the treatment of ACAS,focusing on the indications,efficacy,complications and factors affecting curative efficacy,so as to provide reference for selecting the treatment method of the patients.