OBJECTIVE To investigate the effects and mechanism of the Yishen paidu formula on renal fibrosis in rats with chronic renal failure （CRF） through the reactive oxygen species （ROS）/thioredoxin-interacting protein （TXNIP）/NOD-like receptor thermal protein domain associated protein 3 （NLRP3） pathway. METHODS Rats were randomly divided into control group， model group， Yishen paidu formula low-dose （Yishen paidu formula-L） group， Yishen paidu formula high-dose （Yishen paidu formula- H） group， Yishen paidu formula-H+pcDNA-NC group， and Yishen paidu formula-H+ pcDNA-TXNIP group， with 10 rats in each group. Except for control group， all other rats were fed a diet containing 0.5% adenine to establish a CRF model； the rats were then administered corresponding drugs or normal saline intragastrically or via tail vein， once daily， for 8 consecutive weeks. After the last administration， the levels of serum creatinine （Scr）， blood urea nitrogen （BUN）， ROS， superoxide dismutase （SOD）， malondialdehyde （MDA）， tumor necrosis factor-α （TNF-α）， interleukin （IL）-6， and IL-1β were measured in each group. Pathological changes in renal tissue were observed， and the protein expression levels of Collagen Ⅲ， α-smooth muscle actin （α-SMA）， transforming growth factor-β1 （TGF-β1）， TXNIP and NLRP3 in renal tissue were detected. RESULTS Compared with model group， the renal histopathological damage and fibrosis of rats in Yishen paidu formula-L group and Yishen paidu formula-H group were significantly alleviated. The levels of Scr， BUN， ROS， MDA， TNF- α， IL-6 and IL-1β， and the protein expressions of Collagen Ⅲ， α-SMA， TGF-β1， TXNIP and NLRP3 were significantly decreased， while SOD levels were significantly increased （P＜0.05）. Moreover， the changes were more pronounced in the Yishen paidu formula-H group （P＜0.05）. Compared with Yishen paidu formula-H+pcDNA-NC group， above indexes of rats in Yishen paidu formula-H+pcDNA-TXNIP group were reversed significantly （P＜0.05）. CONCLUSIONS Yishen paidu formula can inhibit renal fibrosis in CRF rats by suppressing the ROS/TXNIP/NLRP3 pathway.

Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy. Approximately 50% to 60% of patients with OSCC are diagnosed at a locally advanced stage (clinical staging III-IVa). Even with comprehensive and sequential treatment primarily based on surgery, the 5-year overall survival rate remains below 50%, and patients often suffer from postoperative functional impairments such as difficulties with speaking and swallowing. Programmed death receptor-1 (PD-1) inhibitors are increasingly used in the neoadjuvant treatment of locally advanced OSCC and have shown encouraging efficacy. However, clinical practice still faces key challenges, including the definition of indications, optimization of combination regimens, and standards for efficacy evaluation. Based on the latest research advances worldwide and the clinical experience of the expert group, this expert consensus systematically evaluates the application of PD-1 inhibitors in the neoadjuvant treatment of locally advanced OSCC, covering combination strategies, treatment cycles and surgical timing, efficacy assessment, use of biomarkers, management of special populations and immune related adverse events, principles for immunotherapy rechallenge, and function preservation strategies. After multiple rounds of panel discussion and through anonymous voting using the Delphi method, the following consensus statements have been formulated: 1) Neoadjuvant therapy with PD-1 inhibitors can be used preoperatively in patients with locally advanced OSCC. The preferred regimen is a PD-1 inhibitor combined with platinum based chemotherapy, administered for 2-3 cycles. 2) During the efficacy evaluation of neoadjuvant therapy, radiographic assessment should follow the dual criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and immune RECIST (iRECIST). After surgery, systematic pathological evaluation of both the primary lesion and regional lymph nodes is required. For combination chemotherapy regimens, PD-L1 expression and combined positive score need not be used as mandatory inclusion or exclusion criteria. 3) For special populations such as the elderly (≥ 70 years), individuals with stable HIV viral load, and carriers of chronic HBV/HCV, PD-1 inhibitors may be used cautiously under the guidance of a multidisciplinary team (MDT), with close monitoring for adverse events. 4) For patients with a poor response to neoadjuvant therapy, continuation of the original treatment regimen is not recommended; the subsequent treatment plan should be adjusted promptly after MDT assessment. Organ transplant recipients and patients with active autoimmune diseases are not recommended to receive neoadjuvant PD-1 inhibitor therapy due to the high risk of immune related activation. Rechallenge is generally not advised for patients who have experienced high risk immune related adverse events such as immune mediated myocarditis, neurotoxicity, or pneumonitis. 5) For patients with a good pathological response, individualized de escalation surgery and function preservation strategies can be explored. This consensus aims to promote the standardized, safe, and precise application of neoadjuvant PD-1 inhibitor strategies in the management of locally advanced OSCC patients.

ObjectiveTo investigate the impact of portal vein tumor thrombus （PVTT） classification on rebleeding in hepatocellular carcinoma （HCC） patients with different PVTT subtypes and esophagogastric variceal bleeding （EGVB）， and to provide a reference for formulating rational treatment regimens for such patients. MethodsA retrospective study was performed for 130 patients with HCC and PVTT who were treated due to EGVB in Beijing Ditan Hospital， Capital Medical University， from July 2020 to January 2025， and according to whether endoscopic treatment was performed， the patients were divided into endoscopic treatment group with 97 patients and conservative treatment group with 33 patients. Demographic and clinical data were collected from all patients， and the two groups were compared in terms of hemostasis success rate and rebleeding rate. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to estimate the cumulative incidence rate of rebleeding in patients with different subtypes of PVTT. Propensity score matching （PSM） was performed for the endoscopic treatment group and the conservative treatment group to balance the baseline data of the two groups. The Cox proportional hazards model was used to perform univariate and multivariate analyses and identify independent risk factors for rebleeding. ResultsThe endoscopic treatment group had a significantly lower cumulative rebleeding rate within 6 months than the conservative treatment group （35.1% vs 57.6%， hazard ratio ［HR］=0.480， 95% confidence interval ［CI］： 0.272—0.851， P=0.019）. The PVTT Ⅲ—Ⅳ group had a significantly higher cumulative rebleeding rate within 6 months than the PVTT Ⅱ group （52.2% vs 37.5%， HR=1.744， 95%CI： 1.008 — 3.018， P=0.022）. After PSM， there was no significant difference in rebleeding rate between the endoscopic treatment group and the conservative treatment group （38.1% vs 14.3%，HR=1.500，95%CI：0.125 — 2.002， P=0.588）， while the PVTT Ⅲ—Ⅳ group had a significantly higher cumulative rebleeding rate than the PVTT Ⅱ group （58.8% vs 12.5%，HR=1.561，95%CI：1.195 — 12.499，P=0.033）. The multivariate Cox regression analysis showed that PVTT subtype （HR=1.412， 95%CI： 0.998 — 1.997， P=0.049）， platelet count （HR=1.006， 95%CI： 1.001 — 1.010， P=0.021）， C-reactive protein （HR=1.011， 95%CI： 1.001 — 1.021， P=0.026）， and ascites （HR=1.803， 95%CI： 1.059 — 3.068， P=0.030） were independent risk factors for rebleeding. ConclusionFor HCC patients with PVTT and EGVB， endoscopic treatment can successfully achieve hemostasis， while it fails to significantly reduce rebleeding rates. PVTT classification can affect the risk of rebleeding， and patients with PVTT types Ⅲ—Ⅳ have a relatively high rebleeding rate.

Objective To investigate the value of chest contrast-enhanced CT(C-CECT)combined with artificial intelligence iterative reconstruction(AIIR)for bronchial artery(BA)imaging.Methods Seventy patients who underwent C-CECT were prospectively enrolled.The images were reconstructed with AIIR(AIIR group)and hybrid iterative reconstruction(HIR,HIR group),respectively.The overall image quality,the traceability of BA,the sharpness of BA and the diagnostic confidence of abnormalities of BA were subjectively graded using a 5-point scale by two radiologists,respectively.The subjective scores and inter-observer agreement were compared between groups.The noise(SD)in reconstructed images of thoracic aorta,pulmonary trunk,BA and spinal erectors,the contrast-to-noise ratio(CNR)of the above 3 arteries relative to spinal erectors,and the diameters of BA at the origin,bifurcation and pulmonary hilum were compared between groups.Results The scores of the overall image quality,the traceability of BA,the sharpness of BA and the diagnostic confidence of abnormalities of BA were all significantly higher in AIIR group than those in HIR group(all P＜0.001),all with good inter-observer agreement(Kappa=0.46-0.73).SD of the aorta,pulmonary artery trunk,BA and erector spinal muscle in AIIR group were lower than those in HIR group,while CNR of above 3 arteries were higher than those in HIR group(all P＜0.05).No significant difference of the diameter of BA at each position was found between groups(all P＞0.05),while the consistency of measurement of AIIR group was higher than that of HIR group(intra-class correlation coefficient:0.89-0.94 vs.0.63-0.78).Conclusion C-CECT combined with AIIR could significantly improve imaging quality and diagnostic confidence of BA.

Leishmania is a protozoan parasite that causes leishmaniasis,a disease prevalent in tropical regions.Vis-ceral leishmaniasis,also known as kala-azar in Asian countries,and cutaneous leishmaniasis are distributed world-wide.Chemotherapy with sodium stibogluconate and amphotericin B has shown significant effects.However,cur-rent treatment methods for leishmaniasis have various defects,including multiple side effects,prolonged treat-ment duration,varying efficacy across different regions,and the emergence of drug resistance.To address this ur-gent need,it is imperative to identify safer and more effective alternative treatment methods and seek for appropri-ate pharmacological targets.This review discusses key metabolic pathways that represent potential pharmacologi-cal targets,as well as emerging therapeutic strategies for leishmaniasis.

Objective To study the clinical effect of floating needle combined with muscle patch in the treatment of acute ankle sprain.Methods A total of 99 patients with acute ankle sprain who visited Armed Police Fujian Provincial General Team Hospital from December 2023 to April 2025 were selected.According to the random number table method,they were divided into group A(33 cases with floating needle combined with muscle patch fixation treatment),group B(33 cases with muscle patch fixation treatment)and group C(33 cases with conventional bandage fixation treatment).The visual analogue scale(VAS)scores,ankle swelling,American Orthopedic Foot and Ankle Society ankle-hindfoot scale(AOFAS-AHS)scores before and after treatment and clinical efficacy were compared between three groups of patients.Results The VAS scores of three groups of patients decreased with the extension of treatment time,the ankle swelling value decreased with the extension of treatment time,and the AOFAS-AHS score increased with the extension of treatment time(P＜0.05).At different time points after treatment,there were statistically significant differences in the VAS scores,ankle swelling values,and AOFAS-AHS scores among three groups of patients(P＜0.05).Three weeks after treatment,the VAS score and ankle swelling value in group A were lower than those in group B and group C(P＜0.05),and group B were lower than those in group C(P＜0.05).The AOFAS-AHS scores in group A were significantly higher than those in group B and group C(P＜0.05),and group B was higher than that in group C(P＜0.05).There was a statistically significant difference in the excellent and good rates among three groups of patients(x2=10.768,P=0.014),with group A＞group B＞group C.Conclusion The combination of floating needles and muscle patches for the treatment of acute ankle sprains can quickly relieve pain,reduce swelling,and promote rapid recovery of the ankle joint.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To evaluate the efficacy of eculizumab in treating hematopoietic stem cell transplantation-associated thrombotic microangiopathy (TA-TMA) .Methods:This retrospective study included 11 patients who developed TA-TMA after allogeneic hematopoietic stem cell transplantation and subsequently received eculizumab treatment at Peking University People′s Hospital between June 2018 and May 2024. The incidence of TA-TMA, treatment details, and clinical outcomes were analyzed.Results:Among the 11 included patients [4 males, 7 females; median age: 29 years (range: 9-56) ], underlying diseases were severe aplastic anemia (SAA) in 5 patients, acute lymphoblastic leukemia (ALL) in 3 patients, and acute myeloid leukemia (AML) in 3 patients. The median time to TA-TMA diagnosis was 48 days post-transplantation (range: 4-213 days), and all patients met the diagnostic criteria for high-risk TA-TMA. The median interval from TA-TMA diagnosis to the initiation of eculizumab treatment was 12 days (range: 1-56 days). Patients received a median of 3 doses of eculizumab (range: 1-14). Ten of the 11 patients were assessed as having no response (NR) to eculizumab at the end of treatment or at death. One patient achieved a partial response (PR) but subsequently died after TA-TMA relapsed due to infection. At the last follow-up, all patients were either lost to follow-up or had died. The median follow-up duration was 88 days (range: 33-326 days), and the median time from TA-TMA diagnosis to the last follow-up was 31 days (range: 21-113 days) .Conclusion:Eculizumab demonstrated poor efficacy in this TA-TMA cohort. This might be attributable to the critical and complex condition of the patients, delayed initiation of eculizumab treatment, and insufficient dosage.

Objective To investigate the correlations of calmodulin 1(CNN1)and asymmetric dimethylarginine(ADMA)expression with Wnt/β-catenin pathway in tissues of gastric cancer and their values for prognosis.Methods Surgical specimens and serum samples from 110 patients with gastric cancer,along with serum samples from 60 healthy individuals in the hospital were collected.Immunohistochemistry and real-time fluorescent quantitative PCR were used to detect the expression levels of CNN1 protein and CNN1 mRNA in gastric cancer tissues respectively;the enzyme-linked immunosorbent assay(ELISA)was used to detect the expression of ADMA in the serum of gastric cancer patients.The relationships of the CNN1 and ADMA expression with the clinicopathological characteristics in gastric cancer patients were analyzed.Kaplan-Meier survival curve was used to an-alyze the influence of CNN1 and ADMA expression on prognosis of gastric cancer patients;Cox re-gression analysis was used to explore independent factors affecting the prognosis of gastric cancer pa-tients;the Pearson correlation analysis was used to explore the correlation between CNN1 and ADMA expression in gastric cancer tissues,and to analyze the correlations of CNN1 mRNA and ADMA mRNA with Wnt/β-catenin signaling pathway-related indicators.Results The positive ex-pression rate of CNN1 protein in gastric cancer tissues was 38.18％(42/110),which was signifi-cantly lower than 57.27％(63/110)in adjacent tissues(x2=8.035,P=0.005).The serum ADMA level in gastric cancer patients was(0.54±0.17)μmol/L,which was significantly higher than(0.42±0.14)μmol/L in healthy individuals(t=4.752,P＜0.001).Patients with lymph node metastasis and advanced tumor stages had significantly decreased CNN1 protein positivity in gastric cancer tissues and increased serum ADMA expression(P＜0.05).The survival rate was 73.80％in the high CNN1 expression group(n=42),which was significantly higher than 39.71％in the low CNN1 expression group(n=68)(x2=22.300,P＜0.001);the survival rate was 45.68％in the high ADMA expression group(n=81),which was significantly lower than 72.41％in the low ADMA expression group(n=29)(x2=4.791,P=0.029).Univariate and multivariate Cox regression analysis showed that lymph node metastasis,advanced tumor staging,low CNN1 pro-tein expression,and high serum ADMA expression were independent risk factors for poor prognosis in gastric cancer patients(P＜0.05).The expression level of CNN1 mRNA in gastric cancer tissues was(0.41±0.13),which was significantly lower than(1.16±0.35)in adjacent tissues(t=21.068,P＜0.001).The expression levels of wnt3a mRNA and β-catenin mRNA in gastric cancer tissues were(2.02±0.42)and(2.59±0.58)respectively,both were significantly higher than(1.25±0.28)and(1.18±0.42)in adjacent tissues(t=15.999,P＜0.001;t=20.651,P＜0.001).CNN1 expression in gastric cancer tissues was negatively correlated with serum ADMA ex-pression in gastric cancer patients(r=-0.794,P＜0.001);CNN1 mRNA expression in gastric cancer tissues was negatively correlated with the expression of Wnt/β-catenin signaling pathway-re-lated indicators wnt3a mRNA and β-catenin mRNA(P＜0.001);serum ADMA mRNA expression in gastric cancer patients was positively correlated with the expression of Wnt/β-catenin signaling pathway-related indicators wnt3a mRNA and β-catenin mRNA(r=0.763,P＜0.001;r=0.874,P＜0.001).Conclusion The decreased expression of CNN1 and the increased expression of ser-um ADMA are independent risk factors for poor prognosis in gastric cancer patients,and their ex-pression levels are related to lymph node metastasis and tumor TNM staging.The expression levels of CNN 1 and ADMA are negatively correlated in gastric cancer tissues,which may be mediated by reg-ulating the Wnt/β-catenin signaling pathway.