Objective: To evaluate the efficacy of the left spermatic vein transposition to the great saphenous vein in treating left varicocele (VC) secondary to nutcracker syndrome (NCS). Methods: Clinical data of 8 patients treated during Feb.2020 and Feb.2023 in our hospital were retrospectively analyzed.A meticulous preoperative evaluation of the vascular status of the spermatic vein and the great saphenous vein was performed using color Doppler ultrasound.A spermatic vein-great saphenous vein shunt surgery was performed in patients who were strictly selected.The clinical symptoms and hemodynamics of renal vein were compared before and after operation. Results: The median age of patients was 23.5(18-33) years.There was a notable reduction in post-exercise scrotal and lower back pain in all patients，and the score of scrotal pain decreased to 0 in 7 patients. The median quantification of urinary protein was 352.8(54.4-687.3) mg prior to surgical intervention，which significantly diminished to 125.5(25.9-255.1) mg 6 months after operation.Notably，3 cases of preoperative positive urine occult blood tests were undetectable in the subsequent postoperative assessments.The median peak blood flow velocity at the site of stenosis in the left renal vein measured at 74.4(48.7-117.6) cm/s preoperatively，subsequently reduced to 45.1(25.5-61.2) cm/s postoperatively.During the 6-month follow-up，no recurrence of varicocele，vascular anastomotic stenosis or thrombosis were observed. Conclusion: Our research indicates that spermatic vein to great saphenous vein bypass is safe and feasible in the treatment of left varicocele secondary to nutcracker syndrome for strictly selected patients，which can effectively alleviate renal vein congestion without significant complications.

ObjectiveTo analyze the prevalence and influencing factors of overweight and obesity among primary school students in a community of Fengxian District, Shanghai, and to provide references for formulating prevention and control strategies against overweight and obesity. MethodsData on height and weight of all primary school students in a community in Fengxian District, Shanghai, in 2023 were obtained by physical examination, and 1 759 primary school students were included according to the entry criteria. Overweight and obesity were determined using body mass index (BMI). Additionally, a questionnaire survey was performed to 1 045 students to collect their demographic characteristics, dietary behaviors, dietary habits, sleep and physical activity information. Chi-square test and logistic regression analysis were used to analyze the influencing factors of overweight and obesity. ResultsIn 2023, among the 1 759 primary school students in the community in Fengxian District, 923 (52.47%) were male and 836 (47.53%) were female, with an overweight/obesity detection rate of 28.08%. The detection rate of overweight and obesity was 33.37% in males and 22.25% in females, which was significantly higher in males than that in females (χ²=26.845, P<0.001). Students aged 10‒12 years had a higher overweight/obesity detection rate (32.55%) than those aged 6‒<10 years (26.53%), and the difference was statistically significant (χ²=10.925, P<0.001). Logistic regression analysis revealed that being female, with young age, parental education level of bachelor’s degree and above, a high global dietary recommendation healthy (GDR-healthy) score, preference for vegetables and sweeter home-cooked meals, and a slow eating speed were negatively correlated with overweight/obesity. Whereas, parental overweight and obesity, binge eating, and a faster eating pace than same-age, same-gender peers may be positively correlated with overweight/obesity. ConclusionThe detection rate of overweight and obesity among primary school students in the community in Fengxian District of Shanghai is higher than the national level. Gender, age, parental BMI, parental education level, dietary behaviors and habits are the main influencing factors of overweight/obesity among primary school students.

BACKGROUND: Generalized pustular psoriasis (GPP), a rare and recurrent autoinflammatory disease, imposes a substantial burden on patients and society. Awareness of GPP in China remains limited. METHODS: This cross-sectional survey, conducted between September 2021 and May 2023 across 14 hospitals in China, included GPP patients of all ages and disease phases. Data collected encompassed demographics, clinical characteristics, economic impact, disease severity, quality of life, and treatment-related complications. Risk factors for GPP recurrence were analyzed. RESULTS: Among 127 patients (female/male ratio = 1.35:1), the mean age of disease onset was 25 years (1st quartile [Q1]-3rd quartile [Q3]: 11-44 years); 29.2% had experienced GPP for more than 10 years. Recurrence occurred in 75.6% of patients, and nearly half reported no identifiable triggers. Younger age at disease onset ( P  = 0.021) and transitioning to plaque psoriasis ( P  = 0.022) were associated with higher recurrence rates. The median diagnostic delay was 8 months (Q1-Q3: 2-41 months), and 32.3% of patients reported misdiagnoses. Comorbidities were present in 53.5% of patients, whereas 51.1% experienced systemic complications during treatment. Depression and anxiety affected 84.5% and 95.6% of patients, respectively. During GPP flares, the median Dermatology Life Quality Index score was 19.0 (Q1-Q3: 13.0-23.5). This score showed significant differences between patients with and without systemic symptoms; it demonstrated correlations with both depression and anxiety scores. Treatment costs caused financial hardship in 55.9% of patients, underscoring the burden associated with GPP. CONCLUSIONS The substantial disease and economic burdens among Chinese GPP patients warrant increased attention. Patients with early onset disease and those transitioning to plaque psoriasis require targeted interventions to mitigate the high recurrence risk.
Humans ; Male ; Female ; Psoriasis/pathology* ; Adult ; Cross-Sectional Studies ; Adolescent ; Child ; Young Adult ; Quality of Life ; Middle Aged ; China/epidemiology* ; Recurrence ; Risk Factors ; Surveys and Questionnaires ; East Asian People

Objective:To explore the impact of anterior cruciate ligament(ACL) augmented repair versus autologous hamstring tendon single-bundle reconstruction on long-term joint function and radiological outcomes in patients with ACL tear.Methods:A prospective study was conducted, including medical records of 100 patients with anterior cruciate ligament (ACL) tears admitted to the 983rd Hospital of the Joint Logistic Support Force of the Chinese People′s Liberation Army from January 2020 to January 2023. There were 68 males and 32 females, who were aged from 35 to 63 years old, with a mean age of (44.73±6.31) years. The lesion was on the left side in 41 cases and on the right side in 59 cases. According to the Sherman classification, 43 cases were type Ⅰ and 57 cases were type Ⅱ. Patients were sequentially numbered according to admission order, and a random integer generator was used to assign random numbers (1 or 2). Patients assigned "1" were included in the Group 1, while those assigned "2" were allocated to the Group 2, with 50 cases in each group.The Group 1 received ACL augmented repair, while the Group 2 was treated with autologous hamstring tendon single-bundle reconstruction. After treatment, the two groups were compared in terms of knee joint function[International Knee Documentation Committee (IKDC) score], motor function(Tegner score), knee joint stability(pivot shift test) at 12 and 24 months after surgery; the incidence of active pain[visual analog scale (VAS) score] at 1-3 months, 4-6 months, 7-12 months, and 13~24 months after surgery; radiological outcomes; and the rate of secondary revision. Measurement data with normal distribution were expressed as mean ± standard deviation( ± s), and comparisons between the two groups were performed using t-test. Comparisons among multiple time points within the group were conducted using repeated measures analysis of variance. Count data were presented as cases and percentages [ n(%)], and comparisons between groups were made using the chi-square test. Ranked data were analyzed using the Wilcoxon signed-rank test. Results:As of the last follow-up, a total of 45 patients were included in Group 1 (the repair group), and 48 patients were included in Group 2 (the reconstruction group). At 12 and 24 months postoperatively, the IKDC scores in the repair group showed significant improvements compared to preoperative values ( t =11.29, P<0.05; t=14.86, P<0.05), as did the Tegner scores ( t=36.13, P<0.05; t=52.21, P<0.05). Additionally, pivot-shift test results demonstrated significant improvement ( χ2=79.33, P<0.05; χ2=90.00, P<0.05). Similarly, in the reconstruction group, both IKDC scores ( t=10.02, P<0.05; t=13.73, P<0.05) and Tegner scores ( t=44.87, P<0.05; t=60.65, P<0.05) significantly increased at 12 and 24 months postoperatively, with pivot-shift test results also showing marked improvement ( χ2=89.33, P<0.05; χ2=96.00, P<0.05). However, no statistically significant differences were observed between the repair and reconstruction groups in Tegner scores or pivot-shift test results at either time point. However, no statistically significant differences were observed between the two groups for any outcome at either time point (IKDC: t=0.93, P>0.05 at 12 months; t=0.75, P>0.05 at 24 months; Tegner: t=1.52, P>0.05; t=0.77, P>0.05; pivot-shift: χ2=1.16, P>0.05; χ2=1.34, P>0.05). The duration of postoperative activity-related pain was significantly shorter in the repair group (3.24±0.61 months) compared to the reconstruction group (4.48±0.59 months) ( t=9.95, P<0.05). During postoperative months 1-3 and 4-6, pain levels were also significantly lower in the repair group ( t=5.32, P<0.05; t=8.71, P<0.05). However, no statistically significant differences in pain levels were observed between groups at postoperative 7th to 12th months ( t=0.40, P>0.05) and 13th to 24th months ( t=0.37, P>0.05). At 24th months postoperatively, the majority of patients in both groups exhibited ligament thicknesses approaching normal levels, with fibro-osseous bridging between the ligament and bone tunnel walls. The revision rates were 2.2% (1/45) in the repair group and 2.1% (1/48) in the reconstruction group, with no statistically significant difference between groups ( χ2=0.00, P>0.05). Conclusions:The effects of ACL augmented repair for treating ACL tears on patients′ knee joint function, knee joint stability, motor function, and ligament healing are comparable to those of autologous hamstring tendon single-bundle reconstruction. However, ACL augmented repair can reduce the incidence of early active pain in patients.

Pulmonary vascular remodeling is the core pathological feature in the onset and pro-gression of pulmonary arterial hypertension(PAH).Currently,there is no well-defined therapeutic strategy that can effectively delay or reverse this process.Despite the widespread clinical application of targeted vasodilator drugs,patients still face a high risk of mortality and adverse cardiovascular e-vents,suggesting an urgent need to explore new pathological mechanisms and therapeutic targets.In recent years,the relationship between dyslipidemia and PAH has garnered increasing attention.This article aimed to review the role of lipid metabolism disorders in pulmonary vascular remodeling in pul-monary arterial hypertension and its underlying mechanism,with the hope of providing new interven-tion targets for the treatment of PAH,thereby improving patient survival rates and quality of life.

Objective To investigate the effect and mechanism of cinobufotalin in inhibiting hepatocellular carcinoma(HCC)metastasis by regulating epithelial-mesenchymal transition(EMT).Methods A total of 36 male BALB/c nude mice,aged 6 weeks,were given injection of MHCC97H cells via the caudal vein to establish a model of HCC lung metastasis,and then the mice were randomly divided into high-and low-dose cinobufotalin groups and control group.Since the day of modeling,the mice in the high-and low-dose cinobufotalin groups were given intraperitoneal injection of cinobufotalin at a dose of 120 μL/kg and 60 μL/kg,respectively,and those in the control group were given intraperitoneal injection of normal saline,twice a week.After 8 weeks,HE staining was performed for lung tissue to measure the lung metastasis rate of HCC.MHCC97H cells were treated with high-dose(2.5 μL/mL)or low-dose(5 μL/mL)cinobufotalin for 24 hours,and wound healing assay,RT-PCR,and Western blot were used to measure cell migration ability and the expression of EMT-related molecules.MHCC97H cells were induced in a simulated hypoxic environment with CoCl2 incubation,with high-and low-dose cinobufotalin added for intervention,and wound healing assay and Western blot were used to investigate the effect of cinobufotalin on cell migration ability and EMT induced by hypoxia.Transcriptome analysis was used to investigate the effect mechanism of cinobufotalin on MHCC97H cells,and Western blot was used to observe the effect of cinobufotalin on the expression levels of protein kinase B(AKT)and phosphorylated AKT(P-AKT)in MHCC97H cells.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the independent-samples t test was used for comparison of categorical data between two groups.Results Compared with the control group,the cinobufotalin group had a significant reduction in the lung metastasis rate of HCC.Compared with the control group,cinobufotalin intervention reduced the wound healing rate of MHCC97H cells,upregulated the expression of epithelial-type molecules(t=2.860,P<0.05),and downregulated the expression of EMT transcription factors(EMT-TFs)and mesenchymal molecules(t=3.545,2.022,2.852,and 2.341,all P<0.05).Hypoxia induction upregulated the wound healing rate of MHCC97H cells and the expression levels of mesenchymal molecules and EMT-TFs(P<0.05),and cinobufotalin intervention reversed EMT change and inhibited wound healing(P<0.05).The transcriptome analysis of MHCC97H cells showed significant gene differences between the cinobufotalin group and the control group,and cinobufotalin mainly affected the expression of genes associated with tumor,metabolism,immunity,and signal transduction,with the largest number of differentially expressed genes in the AKT signal transduction pathway.Further measurement showed that cinobufotalin intervention downregulated the expression levels of AKT,P-AKT,and P-AKT/AKT in MHCC97H cells(t=2.434,3.401,and 2.258,all P<0.05).Conclusion Cinobufotalin can inhibit the metastasis of HCC,especially hypoxia-induced HCC metastasis,and regulation of EMT mediated by the AKT signal transduction pathway in HCC cells might be one of its mechanisms of action.

Nanocrystal technology changes the solubility and dissolution rate of insoluble drugs by reducing the particle size to the nanometer level.This technology is not limited by carrier materials and encapsulation rate.It is suitable for a variety of drug delivery routes and easy for industrial production.It has gradually become a cutting-edge hot technology in the international pharmaceutical field to improve the absorption of insoluble drugs and improve their bioavailability.This article introduces the influencing factors and challenges of nanocrystal drugs(NC)in parenteral,ocular,transdermal and pulmonary administration,and focuses on nanocrystal drugs that have been marketed or are still in the preclinical or clinical trial stages of these delivery systems,in order to provide some insight for the further development of poorly soluble drug nanocrystal preparations.

Background::Atopic dermatitis (AD) affects approximately 10% of adults worldwide. CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling. This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD.Methods::This multicenter, randomized, double-blind, placebo-controlled, phase 2b trial was conducted in 21 medical institutions in China from February to November 2021. Totally 120 eligible patients were enrolled and randomized (1:1:1) to receive subcutaneous injections of 300 mg CM310, 150 mg CM310, or placebo every 2 weeks for 16 weeks, followed by an 8-week follow-up period. The primary endpoint was the proportion of patients achieving ≥75% improvement in the Eczema Area and Severity Index (EASI-75) score from baseline at week 16. Safety and pharmacodynamics were also studied.Results::At week 16, the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups (70% [28/40] for high-dose and 65% [26/40] for low-dose) than that in the placebo group (20%[8/40]). The differences in EASI-75 response rate were 50% (high vs. placebo, 95% CI 31%–69%) and 45% (low vs. placebo, 95% CI 26%–64%), with both P values <0.0001. CM310 at both doses also significantly improved the EASI score, Investigator’s Global Assessment score, daily peak pruritus Numerical Rating Scale, AD-affected body surface area, and Dermatology Life Quality Index compared with placebo. CM310 treatment reduced levels of thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase, and blood eosinophils. The incidence of treatment-emergent adverse events (TEAEs) was similar among all three groups, with the most common TEAEs reported being upper respiratory tract infection, atopic dermatitis, hyperlipidemia, and hyperuricemia. No severe adverse events were deemed to be attributed to CM310. Conclusion::CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.Trial Registration::ClinicalTrials.gov, NCT04805411.