ObjectiveTo develop and preliminarily validate a prediction model for brace treatment failure risk in patients with adolescent idiopathic scoliosis (AIS), based on information obtained before brace treatment and during initial brace fitting. MethodsA total of 191 patients with AIS who initiated thoracolumbosacral orthosis treatment at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from March, 2015 to August, 2024 and had determinable outcomes were retrospectively included. Patients were divided according to a prespecified scheme into a training set (n = 133) and a validation set (n = 58). Brace treatment failure was defined as progression of the major-curve Cobb angle by ≥ 5° from baseline during follow-up or at brace weaning, or a final major-curve Cobb angle > 45°. Logistic regression, random forest, support vector machine with radial basis function kernel, and extreme gradient boosting (XGBoost) models were developed using routinely available clinical and radiographic variables before brace treatment and during initial brace fitting. Stratified five-fold cross-validation was used for hyperparameter tuning in the training set. Model performance was evaluated in the validation set using the area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (AUPRC), Brier score, calibration curves, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) was used to interpret the main explanatory model. ResultsIn cross-validation of the training set, both random forest and XGBoost showed good discriminative performance, with cross-validation-AUC values of 0.871 and 0.880, respectively. In the validation set, the AUC values of random forest and XGBoost were 0.888 and 0.899, the AUPRC values were 0.678 and 0.830, and the Brier scores were 0.086 and 0.076, respectively. Random forest was selected as the primary model for interpretation, with a calibration intercept of 0.091 and a calibration slope of 0.995. SHAP analysis indicated that the in-brace correction rate and the major-curve Cobb angle measured in the brace contributed most to the model predictions. ConclusionThe random forest model developed using routinely available pretreatment and initial-fitting variables shows preliminary predictive value for brace treatment failure risk in AIS, and may provide quantitative support for follow-up scheduling, brace-fit reassessment and early adherence-oriented management.

OBJECTIVE: To investigate the effectiveness of delayed replantation of degloving skin preserved at 4℃ in treatment of limb degloving injuries. METHODS: Between October 2020 and October 2023, 12 patients with limb degloving injuries were admitted. All patients had severe associated injuries or poor wound conditions that prevented primary replantation. There were 7 males and 5 females; age ranged from 29 to 46 years, with an average of 39.2 years. The causes of injury included machine entanglement in 6 cases, traffic accidents in 5 cases, and sharp instrument cuts in 1 case. Time from injury to hospital admission was 0.5-3.0 hours, with an average of 1.3 hours. Injury sites included upper limbs in 7 cases and lower limbs in 5 cases. The range of degloving skin was from 5 cm×4 cm to 15 cm×8 cm, and all degloving skins were intact. The degloving skin was preserved at 4℃. After the patient's vital signs became stable and the wound conditions improved, it was trimmed into medium-thickness skin grafts for replantation. The degloving skin was preserved for 3 to 7 days. At 4 weeks after replantation, the viability of the degloving skin grafts was assessed, including color, elasticity, and sensation of pain. The Vancouver Scar Scale (VSS) was used to assess the scars of the skin grafts during follow-up. RESULTS: At 4 weeks after replantation, 8 cases of skin grafts completely survived and the color was similar with normal skin, with a survival rate of 66.67%. The elasticity of skin grafts (R0 value) ranged from 0.09 to 0.85, with an average of 0.55; moderate pain was reported in 4 cases, mild pain in 3 cases, and no pain in 5 cases. All patients were followed up 12 months. Over time, the VSS scores of all 12 patients gradually decreased, with a range of 4-11 at 12 months (mean, 6.8). CONCLUSION For limb degloving injuries that cannot be replanted immediately and do not have the conditions for deep low-temperature freezing preservation, the method of preserving the degloving skin at 4℃ for delayed replantation can be chosen.
Humans ; Male ; Adult ; Replantation/methods* ; Female ; Degloving Injuries/surgery* ; Middle Aged ; Skin Transplantation/methods* ; Treatment Outcome ; Extremities/injuries* ; Time Factors ; Skin/injuries* ; Tissue Preservation/methods*

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.

AIM:To investigate the mechanism of flavonoid extract from Dracocephalum rupestre hance(DRHF)in the treatment of gouty arthritis through network pharmacology,molecular docking and animal experiment.METHODS:Literature re-trieval was used to explore the main active chemi-cal components and targets of DRHF.Gouty arthri-tis disease targets were obtained using Gene Cards and OMIM databases,and drug-disease intersect-ing targets were obtained using Wayne online tools.protein-protein interactions(PPI)and other related network diagrams were constructed using Cytoscape software.GO and KEGG enrichment analyses were performed on the shared intersect-ing targets using Metascape database.A rat model of gouty arthritis was established by Coderre meth-od;the swelling degree of ankle joint,gait behav-iour scores of rats were observed,and hematoxylin-eosin(HE)staining was performed.ELISA and real-time PCR were used to detect the key targets pre-dicted by the network pharmacology,and the ef-fects of DRHF on the molecular mechanism and key targets of gouty arthritis were observed.RESULTS:A total of 7 active compounds and 129 candidate targets for the treatment of GA were obtained,in-cluding IL-6,IL-1β,RELA,TNF,PPARG,etc.and the KEGG enrichment results suggested that DRHF may be involved in PI3K-Akt,TNF,IL-17 and other signal transduction pathways.Animal results:HE staining showed that the thickening of synovial tissue was not obvious in each administered group,and syno-vial cell proliferation and inflammatory cell infiltra-tion were significantly improved;compared with the normal group,the serum levels of TNF,IL-6,and IL-1β in the model group were significantly higher(P＜0.05),and the mRNA of PPARG,IL-6,and RELA in the synovial tissues were significantly high-er;compared with the model group,the levels of TNF,IL-6,and IL-1β were significantly lower(P＜0.05)in the low group of DRHF(0.45 g/kg)and high group of DRHF(0.9 g/kg),TNF,IL-6,IL-1β lev-els were significantly reduced(P＜0.05);PPARG,IL-6,RELA mRNA in synovial tissue were significantly reduced.CONCLUSION:DRHF inhibits IL-17/PI-3K/TNF signaling pathway by down-regulating the ex-pression of IL-6,PPARG and RELA mRNA,decreas-ing the levels of IL-6,IL-1β and TNF,and then treat-ing gouty arthritis.

[Objective]To summarize Professor ZHANG Yonghua's clinical experience in treating emotional-type insomnia based on the"wind movement smoothening the Xuanfu(pores)"theory for clinical reference.[Methods]Through learning,case collection,literature review and combining modern medical mechanisms,the article explains Professor ZHANG's understanding of the pathogenesis of emotional-type insomnia,explores the syndrome differentiation methods and treatment approaches based on the"wind movement smoothening the Xuanfu"theory,and provides a clinical case for verification.[Results]The core pathogenesis of insomnia caused by emotional disorders is the blockage of the"Xuanfu".Professor ZHANG points out that patients with emotional disorders suffer from the blockage of the"Xuanfu"due to the disharmony of Qi movement,internal disturbance of depressed fire,deficiency of Qi and blood,and accumulation of phlegm and blood stasis,which lead to prolonged and difficult-to-treat insomnia.His treatment approach often starts from"unblocking the Xuanfu",advocating the basic therapeutic method of"wind movement smoothening Xuanfu",using wind herbs to relieve depression and regulate Qi,disperse fire and clear heat,tonify deficiency and nourish the spirit,remove phlegm and resolve blood stasis to unblock the Xuanfu,and harmonize Yin and Yang to restore balance.The attached medical case was a patient of insomnia due to dissociative conversion disorder,whose main pathogenesis was the blockage of the Shaoyang pivot and the internal hyperactivity of the heart fire of the Shaoyin,presenting the syndrome of depressed gallbladder and phlegm-heat.The treatment approach was to resolve phlegm and clear heat,subdue the floating Yang,further regulate the exterior and interior,harmonize Yin and Yang,and unblock the Xuanfu to relieve depression,so as to enable the patient to sleep peacefully.[Conclusion]Professor ZHANG's treatment of emotional-type insomnia based on the"wind movement smoothening the Xuanfu"theory is highly effective and offers a new approach to treating insomnia with traditional Chinese medicine,which is worth promoting and applying.

AIM:To investigate the mechanism of flavonoid extract from Dracocephalum rupestre hance(DRHF)in the treatment of gouty arthritis through network pharmacology,molecular docking and animal experiment.METHODS:Literature re-trieval was used to explore the main active chemi-cal components and targets of DRHF.Gouty arthri-tis disease targets were obtained using Gene Cards and OMIM databases,and drug-disease intersect-ing targets were obtained using Wayne online tools.protein-protein interactions(PPI)and other related network diagrams were constructed using Cytoscape software.GO and KEGG enrichment analyses were performed on the shared intersect-ing targets using Metascape database.A rat model of gouty arthritis was established by Coderre meth-od;the swelling degree of ankle joint,gait behav-iour scores of rats were observed,and hematoxylin-eosin(HE)staining was performed.ELISA and real-time PCR were used to detect the key targets pre-dicted by the network pharmacology,and the ef-fects of DRHF on the molecular mechanism and key targets of gouty arthritis were observed.RESULTS:A total of 7 active compounds and 129 candidate targets for the treatment of GA were obtained,in-cluding IL-6,IL-1β,RELA,TNF,PPARG,etc.and the KEGG enrichment results suggested that DRHF may be involved in PI3K-Akt,TNF,IL-17 and other signal transduction pathways.Animal results:HE staining showed that the thickening of synovial tissue was not obvious in each administered group,and syno-vial cell proliferation and inflammatory cell infiltra-tion were significantly improved;compared with the normal group,the serum levels of TNF,IL-6,and IL-1β in the model group were significantly higher(P＜0.05),and the mRNA of PPARG,IL-6,and RELA in the synovial tissues were significantly high-er;compared with the model group,the levels of TNF,IL-6,and IL-1β were significantly lower(P＜0.05)in the low group of DRHF(0.45 g/kg)and high group of DRHF(0.9 g/kg),TNF,IL-6,IL-1β lev-els were significantly reduced(P＜0.05);PPARG,IL-6,RELA mRNA in synovial tissue were significantly reduced.CONCLUSION:DRHF inhibits IL-17/PI-3K/TNF signaling pathway by down-regulating the ex-pression of IL-6,PPARG and RELA mRNA,decreas-ing the levels of IL-6,IL-1β and TNF,and then treat-ing gouty arthritis.

[Objective]To summarize Professor ZHANG Yonghua's clinical experience in treating emotional-type insomnia based on the"wind movement smoothening the Xuanfu(pores)"theory for clinical reference.[Methods]Through learning,case collection,literature review and combining modern medical mechanisms,the article explains Professor ZHANG's understanding of the pathogenesis of emotional-type insomnia,explores the syndrome differentiation methods and treatment approaches based on the"wind movement smoothening the Xuanfu"theory,and provides a clinical case for verification.[Results]The core pathogenesis of insomnia caused by emotional disorders is the blockage of the"Xuanfu".Professor ZHANG points out that patients with emotional disorders suffer from the blockage of the"Xuanfu"due to the disharmony of Qi movement,internal disturbance of depressed fire,deficiency of Qi and blood,and accumulation of phlegm and blood stasis,which lead to prolonged and difficult-to-treat insomnia.His treatment approach often starts from"unblocking the Xuanfu",advocating the basic therapeutic method of"wind movement smoothening Xuanfu",using wind herbs to relieve depression and regulate Qi,disperse fire and clear heat,tonify deficiency and nourish the spirit,remove phlegm and resolve blood stasis to unblock the Xuanfu,and harmonize Yin and Yang to restore balance.The attached medical case was a patient of insomnia due to dissociative conversion disorder,whose main pathogenesis was the blockage of the Shaoyang pivot and the internal hyperactivity of the heart fire of the Shaoyin,presenting the syndrome of depressed gallbladder and phlegm-heat.The treatment approach was to resolve phlegm and clear heat,subdue the floating Yang,further regulate the exterior and interior,harmonize Yin and Yang,and unblock the Xuanfu to relieve depression,so as to enable the patient to sleep peacefully.[Conclusion]Professor ZHANG's treatment of emotional-type insomnia based on the"wind movement smoothening the Xuanfu"theory is highly effective and offers a new approach to treating insomnia with traditional Chinese medicine,which is worth promoting and applying.

Objective To observe the value of dual-energy CT bone marrow analysis technology for distinguishing different stages of rib fracture.Methods Totally 273 ribs with fractures in 60 patients who underwent dual-energy CT scanning were retrospectively enrolled and divided into hematoma inflammation stage group(n=166),fibrous callus stage group(n=35)and bony callus-plastic stage group(n=72)according to the stage of rib fracture.The increment 1 and 2 of standardized CT value were calculated based on original CT images and virtual noncalcium color coded maps,respectively,and then were compared among 3 groups and between each 2 groups,and their values for distinguishing different stages of rib fracture were analyzed.Results Significant differences of increment 1 and 2 of standardized CT value were found among 3 groups(both P＜0.05).Increment 1 of standardized CT values were significantly different between fibrous callus stage group and bony callus-plastic stage group(P＜0.05),while increment 2 of standardized CT values were significantly different between each 2 groups(all P＜0.05).Taken 81.575 HU as the cutoff value,the area under the curve(AUC)of increment 1 of standardized CT value for distinguishing fibrous callus stage and bony callus-plastic stage rib fracture was 0.652.Taken 55.700 and 37.625 HU as the cutoff values,AUC of increment 2 of standardized CT value for distinguishing hematoma inflammation stage and fibrous callus stage rib fracture,and fibrous callus stage and bony callus-plastic stage rib fracture was 0.668 and 0.905,respectively.Conclusion Increment of standardized CT value based on dual-energy CT bone marrow analysis technology was helpful for distinguishing different stages of rib fracture,especially fibrous callus stage and bony callus-plastic stage rib fracture.