Wilson disease is a copper metabolism disorder caused by mutations in the ATP7B gene， which encodes a copper-transporting ATPase β， and can result in multisystem damage. The kidneys are the third most commonly affected organs after the liver and brain. In recent years， numerous diagnostic and treatment guidelines for Wilson disease have emerged. However， most of these focus primarily on hepatic and neurological manifestations and their management， with limited coverage of renal involvement. The high incidence， low awareness， and lack of clinical specificity of Wilson disease-related renal damage （WDRD） have made early detection and intervention particularly challenging in clinical practice. To further optimize the treatment of patients with WDRD， improve clinical diagnosis and management， and enhance patients' quality of life， the Neurology Committee of the Chinese Association of Integrative Medicine， in April 2024， initiated a revision of the first expert consensus on the integrated diagnosis， treatment， and management of WDRD. This effort brought together experts in hepatology， encephalopathy （neurology）， and nephrology from many tertiary-level grade A hospitals and research institutions across China. Through comprehensive literature review and integration of frontline clinical experience， the expert group jointly developed Chinese Expert Consensus on Integrated Chinese and Western Medicine Management of Wilson Disease-related Renal Damage （hereinafter referred to as the "Consensus"）. This article provides a detailed interpretation of the Consensus in terms of diagnostic criteria， traditional Chinese medicine （TCM） syndrome differentiation and treatment classification， and comprehensive disease management， aiming to better guide clinical application. Regarding diagnostic criteria， the Consensus integrates the latest standards in China and abroad， highlights the importance of biochemical diagnosis， and compensates for the limitations of genetic testing. In the area of TCM syndrome differentiation and treatment， the Consensus refines four major syndrome types， introduces a newly defined syndrome， i.e.， phlegm， blood stasis， and heat accumulation， and elaborates on treatment principles， prescriptions， and clinical modification rules for each syndrome. For comprehensive disease management， the Consensus emphasizes multi-dimensional intervention strategies， including diet， exercise， emotional regulation， medication， and medical care， with the goal of maximally controlling the progression of renal dysfunction and helping patients achieve a better quality of life.

Mild cognitive impairment due to Alzheimer′s disease is an inevitable pathological stage in the early development of Alzheimer′s disease, which can be classified as "microlumps in the brain collaterals" in traditional Chinese medicine. Based on the theory of latent toxin blocking collaterals, this article discusses the etiology and pathogenesis, clinical sequelae, and traditional Chinese medicine intervention strategies for mild cognitive impairment due to Alzheimer′s disease. The onset of mild cognitive impairment due to Alzheimer′s disease is very similar to the latent pathogen theory, which states that "the latent pathogen is latent and then develops, the poison is deep and difficult to cure, and the development can be recognized but the latent pathogen cannot be detected." Combining clinical experience, our team believes that the basic nature of the disease is a slight deficiency and a slight excess of symptoms. A slight deficiency of the five zang viscera and six fu viscera as root and a latent toxin colling collaterals of qi, fire, phlegm, and blood stasis as manifestaion. These usually start from the qi depression and develop into phlegm coagulation and blood stasis, then end up in latent toxin and gradually become the healthy qi deficiency. Therefore, the deficiency of vital qi and incubation of evil, latent toxin blocking collaterals the pathogenesis of early intervention of this disease should be carried out, upholding the idea that "the upper workman treats the disease before it is diagnosed." The principle of strengthening vital qi to eliminate pathogenic factors, slowing down and promoting pathogenic factors elimination, establishing the method of supporting correctness and wisdom, simultaneously detoxifying and clearing the blood stasis, pattern differentiation as the main and the disease differentiation as the first, combining the disease and pattern, and adjusting the macroscopic and microscopic, focusing simultaneously on eliminating and replenishing, dispel phlegm and remove blood stasis, achieve a strong vital qi and the elimination of evil, and enhance intelligence, delay or even block the progression of mild cognitive impairment due to Alzheimer′s disease, improve patients′ quality of life, and provide a theoretical basis for the early clinical prevention and treatment of Alzheimer′s disease.

Hepatolenticular degeneration (HLD) is a rare genetic metabolic disorder of the nervous system with complex and diverse clinical phenotypes and is difficult to diagnose. The common lesions of HLD brain area are basal ganglia, thalamus, cerebellum and other anatomical structures, the classic manifestations of brain magnetic resonance imaging are symmetrical bilateral lenticular nucleus with low signal on T 1WI and high signal on T 2WI, and it is extremely rare for cases with high signal intensity on diffusion weighted imaging (DWI) of the brain stem, bilateral cerebral peduncles, thalamus, and basal ganglia. This article reported a case of HLD with high signal on DWI for clinical reference.

Objective To investigate the changes of postprandial serum insulin and C-peptide concentration of type 2diabetes mellitus (T2DM) patients with different fasting blood glucose concentrations, and to study the islet function of them.Methods There were 492T2DM patients from January 2016to June 2017in our hospital were selected and divided into three groups according to different fasting plasma glucose (FPG) levels:group A, 7.0mmol/L≤FPG＜11.1mmol/L;group B, 11.1mmol/L≤FPG＜14.0mmol/L;group C, FPG≥14.0mmol/L.Meanwhile, 50healthy examinees were collected as the control group.A standard 75g OGTT were performed in 492T2DM patients and 50healthy controls, and 2mL of venous blood of them were collected at 0.5, 1.0, 2.0and 3.0h.The concentration of insulin and C-peptide at each point was measured by chemiluminescence method, and then compared with the control group.Results The concentration of insulin and C-peptide in T2DM patients were slightly higher than those in the control group, but there was no statistical significance (P＞0.05).The serum insulin and C-peptide post-meal in the A, B and C groups and control group increased, but the 1.0hpostprandial blood glucose of control group increased to a peak, and gradually returned to normal at 3.0h;the 2.0hpostprandial blood glucose of A, B and C groups increased to a peak, and decreased at 3.0h, but did not return to normal level.The concentrations of insulin and C-peptide in the A, B and C groups at 0.5, 1.0, and 2.0hpost-meal were significantly lower than those in the control group (P＜0.05).Conclusion The function of isletβcells in T2DM patients decreases with the increase of blood glucose.The determination of insulin and C-peptide can provide a scientific evidence for judging the severity of disease and guiding treatment.

Objective To evaluate the efficacy and safety of lenalidomide in a real-world clinical practice in Chinese patients with multiple myeloma (MM).Methods It was a prospective,multi-center,observational study.A total of 165 consecutive patients with MM treated with lenalidomide-based regimens were enrolled in 12 hospitals from June 2013 to November 2015.Relevant information was recorded,such as baseline clinical data,cytogenetic abnormalities,treatment regimens,and duration of treatment,safety,and survival.Results (1)There were 126 relapsed and refractory MM (RRMM) patients,25 newly diagnosed patients and 19 maintenance patients.The evaluable RRMM patients accounted for 120 cases,among which 74 cases(61.7％) reached the partial response (PR) or above,and a very good partial response (VGPR) in 16 patients (13.3％),a complete response (CR) in 14 cases (11.7％),a strictly complete response (sCR) in 4 cases (3.3％).Thus,a VGPR or above in 34 patients accounted for 28.3％.(2)The median follow-up was 13 months,the median time to progression 12 months.The median survival after receiving lenalidomide was 19 months,and the median overall survival (OS) was 62 months.(3) The univariate analysis in 120 RRMM patients suggested that prognostic factors for significant improvement in PFS included normal karyotype,international staging system (ISS) Ⅰ-Ⅱ,t(4;14) negative (detected by fluorescence in situ hybridization),non-bortezomib resistance and response to previous regimens.As to OS,nonbortezomib resistance,response to previous regimens and non-primary refractoriness were positive factors.Multivariate analysis showed that the response to previous regimens (PR or better) was an independent good prognostic factor for progress-free survival (PFS),non-bortezomib resistance and non-primary refractoriness for OS.(4) Grade 3 or 4 adverse events that occurred in more than 10％ of all enrolled patients were neutropenia (12.7％),leukocytosis (11.5％) and thrombocytopenia (12.7％).Owing to intolerance of toxic side effects,7 cases withdrew lenalidomide.Conclusions No matter what combination,regimens containing lenalidomide are effective to RRMM patients with overall response rate 61.7％,a time to progression 12 months and an overall survival 62 months.The toxicity is quite tolerable and manageable.In addition,the response to previous treatment (reached PR or above) is the independent good prognostic factor for PFS,non-bortezomib resistance and non-primary refractoriness for OS.Clinical trail registration Clinicaltrials.gov,NCT01947309

BACKGROUND:Human femur medul ary cavity has torsional anatomic structure. If the femur medul ary cavity’s torsional structure is copied to the stem of the prosthesis, the prosthesis wil transform the force loaded to torque between femur medul ary cavity and prosthesis stem, and the torque is transmitted to the proximal femur when the prosthesis is inserted in the medul ary cavity and load force on the prosthesis. OBJECTIVE:To optimize the force transmission of the proximal femur, and to avoid the stress shielding at the proximal end of the prosthesis. METHODS:We reconstructed a three-dimensional (3D) model of the femoral canal with the CT images of specimen femur and took the 3D model as the design model for prosthesis stem. The customized stem model and the proximal model of standard prosthesis could be put together to form customized prosthesis. We took advantage of robot grinding technology to manufacture the customized prosthesis, and matched it with specimen femur canal. Finite element analysis simulation and experimental methods were used to analyze the relationship between the loading force on the prosthesis and the micromotion of proximal end of the prosthesis. RESULTS AND CONCLUSION:The simulation and experimental results showed that the torsional structure matching by femoral canal and stem could effectively transmit the force on the prosthesis to the proximal end of the prosthesis in the form of torque. The torsional fretting of the proximal end of the prosthesis was related to the movement of the handle body. However, stem micromotion can be control ed by varying the matching size between stem and medul ary cavity.

Background:Despite the recent development of new therapies, multiple myeloma (MM) remains an incurable disease. Thus, new, effective treatments are urgently needed, particularly for relapsed or refractory MM (RRMM). In an earlier phase I study, a novel form of recombinant human Apo2L/tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) that is currently in clinical development for the treatment of hematologic malignancies, i.e., circularly permuted TRAIL (CPT), was well tolerated at a dose of 2.5mg/kg per day and showed promising preliminary activity in patients with RRMM. This phase II, open-label, multicenter study further investigated the effcacy and safety of 2.5-mg/kg per day CPT as single-agent therapy for patients with RRMM. Methods:Patients with RRMM were treated once daily with CPT (2.5mg/kg, intravenously) for 14 consecutive days for each 21-day cycle. Clinical response and toxicity were assessed after each treatment cycle. Results:Twenty-seven patients received CPT. Using the European Group for Blood and Marrow Transplantation criteria, we calculated the overall response rate of 33.3% with 1 near-complete response (nCR) and 8 partial responses (PRs). The clinical beneift rate (48.1%) included 1 nCR, 8 PRs, and 4 minimal responses. The most common treatment-related adverse events (TRAEs) were fever, aspartate aminotransferase elevation, alanine aminotransferase elevation, leucopenia, rash, neutropenia, and thrombocytopenia. We graded toxicity using the Common Toxicity Criteria for Adverse Events, version 3.0, and determined that 37.0% of patients had at least 1 grade 3–4 TRAE. Conclusions:CPT as a single agent can elicit a response in patients with RRMM and is well tolerated. Further clinical investigation is warranted.

BACKGROUND:In total hip replacements, aseptic loosening of uncemented femoral hip prosthesis is the main reason for the failure of artificial hip replacement, the prerequisite of reducing aseptic loosening of prosthesis is to increase fil ing area of femoral prosthesis in femoral cavity.
OBJECTIVE:To obtain the fil ing rate of customized femoral prosthesis in femoral cavity and verify the validity of the methods of CAD/CAM/Robotic integration and the robot grind.
METHODIn this paper, the CT data of femur were used to reconstruct three-dimensional model of femoral cavity. According to this model, a custom uncemented femoral hip prosthesis was designed, then the model of this custom prosthesis was imported into the CAD/CAM/Robotic software to generate cut path. After the cut path was imported into the robotic control er, the custom prosthesis can be fabricated, then this custom prosthesis was inserted into the femoral cavity, and the fil ing result of the custom prosthesis in femoral cavity was analyzed.
RESULTS AND CONCLUSION:The experiment results showed that the customized prosthesis in femoral cavity achieved good fil ing result, the structure of femoral cavity resisted the rotation of the customized prosthesis in femoral cavity, and the customized prosthesis obtained stable fixation in the femoral cavity.

Objective:To explore the influence of lymph node factors on postoperative radia-tion efficacy in patients with esophageal cancer.Methods 156 patients with esophageal cancer opera-tion were treated with three dimensional conformal radiotherapy.95%PTV =DT:50 to 60 Gy/25 to 30 fx.If shortest diameter of the mediastinal lymph node was greater than 0.8 cm or the margin was posi-tive,then radiation dose increased to 60 Gy.Results The 1,3 and 5 years overall survival rates of 156 esophageal cancer patients with postoperative radiotherapy were 88.5%,57.1% and 46.0% re-spectively.The median survival time was 49.08 months.The 1,3 and 5 years survival rates of lymph node-positive group and lymph node negative group were 8 2 .3 % ,4 7 .8 % ,4 1 .1 % and 9 4 .8 % , 66.9%,50.8% respectively(P =0.049).The 1,3 and 5 years survival rates of one to two positive nodes group and three or more positive lymph nodes group were 88.3%,51.7%,42.7% and 63.2%, 35.5%,35.5% respectively(P =0.028).The 1,3,5 years survival rate of lymph node metastasis rate ≤ 0.15 group and >0.15 group were 93.0%,65.0%,50.3% and 75.6%,35.6%,32.4%respectively(P =0.036).Conclusion The numbers of lymph node metastasis and lymph node me-tastasis rate show a significant influencing on survival rate of esophageal cancer patient with prophylac-tic irradiation.The larger the number of lymph node metastasis is,the lower the survival rate is.Value of concurrent chemoradiotherapy in high-risk postoperative esophageal cancer patients should be ex-plored further.

Objective:To explore the influence of lymph node factors on postoperative radia-tion efficacy in patients with esophageal cancer.Methods 156 patients with esophageal cancer opera-tion were treated with three dimensional conformal radiotherapy.95%PTV =DT:50 to 60 Gy/25 to 30 fx.If shortest diameter of the mediastinal lymph node was greater than 0.8 cm or the margin was posi-tive,then radiation dose increased to 60 Gy.Results The 1,3 and 5 years overall survival rates of 156 esophageal cancer patients with postoperative radiotherapy were 88.5%,57.1% and 46.0% re-spectively.The median survival time was 49.08 months.The 1,3 and 5 years survival rates of lymph node-positive group and lymph node negative group were 8 2 .3 % ,4 7 .8 % ,4 1 .1 % and 9 4 .8 % , 66.9%,50.8% respectively(P =0.049).The 1,3 and 5 years survival rates of one to two positive nodes group and three or more positive lymph nodes group were 88.3%,51.7%,42.7% and 63.2%, 35.5%,35.5% respectively(P =0.028).The 1,3,5 years survival rate of lymph node metastasis rate ≤ 0.15 group and >0.15 group were 93.0%,65.0%,50.3% and 75.6%,35.6%,32.4%respectively(P =0.036).Conclusion The numbers of lymph node metastasis and lymph node me-tastasis rate show a significant influencing on survival rate of esophageal cancer patient with prophylac-tic irradiation.The larger the number of lymph node metastasis is,the lower the survival rate is.Value of concurrent chemoradiotherapy in high-risk postoperative esophageal cancer patients should be ex-plored further.