ObjectiveTo evaluate the clinical efficacy and safety of Huaban Jiedu Formulation （化斑解毒方， HJF） in treating psoriasis vulgaris with blood-heat syndrome. MethodsA randomized， double-blind， placebo-controlled study was conducted with 60 patients diagnosed with psoriasis vulgaris of blood-heat syndrome. Patients were randomly assigned to either a treatment group or a control group， with 30 cases in each. The treatment group received HJF granules orally， one dose a day， combined with topical Qingshi Zhiyang Ointment （青石止痒软膏）， while the control group received placebo granules， one dose a day， combined with the same topical ointment. Both groups were topically treated twice daily of 28 days treatment cours. Psoriasis area and severity index （PASI）， visual analogue scale for pruritus （VAS）， traditional Chinese medicine （TCM） syndrome scores， dermatology life quality index （DLQI）， and psoriasis life stress inventory （PLSI） were assessed before treatment and on day 14 and day 28. Response rates for PASI 50 （≥50% reduction） and PASI 75 （≥75% reduction）， as well as overall clinical efficacy， were compared between groups. Serum levels of interleukin-6 （IL-6） and interleukin-17 （IL-17） were measured before and after 28 days of treatment. Adverse reactions during treatment were recorded. ResultsAfter 28 days of treatment， both groups showed significant reductions in PASI total score， lesion area score， erythema， scaling， and infiltration scores， pruritus VAS score， TCM syndrome score， DLQI， PLSI， and serum IL-6 and IL-17 levels （P＜0.05）. Compared to the control group， the treatment group had significantly greater improvements in PASI total score and erythema score， TCM syndrome score， serum IL-6 and IL-17 levels， and PASI 50 response rate after 28 days （P＜0.05）. Between-group comparisons of score differences before and after 28-day treatment revealed that the treatment group showed significantly better improvements in PASI total， lesion area score， erythema score， TCM syndrome score， DLQI， PLSI， and inflammatory markers （P＜0.05 or P＜0.01）. The total effective rate on day 14 and day 28 was 40.00% （12/30） and 83.33% （25/30） in the treatment group， versus 6.90% （2/29） and 41.38% （12/29） in the control group， respectively. The clinical efficacy in the treatment group was significantly superior to that in the control group （P＜0.05）. Mild gastric discomfort occurred in 3 patients in the treatment group and 1 in the control group. ConclusionHJF can effectively improve skin lesions and TCM symptoms relieve pruritus， enhance quality of life， and reduce inflammatory markers IL-6 and IL-17， in patients with blood-heat syndrome of psoriasis vulgaris， with a good safety profile.

OBJECTIVE: To summarize the research and clinical application progress of foot lengthening surgery. METHODS: Relevant research literature on foot lengthening surgery in recent years at home and abroad was reviewed, and a summary was made from aspects such as the types of lengthening surgery, the types of foot diseases treated by clinical application, effectiveness, and complications. RESULTS: Bone defects and shortening deformities of the foot are relatively common clinically. As an innovative treatment method, foot lengthening surgery has gradually attracted attention, mainly including the Ilizarov technique and one-stage bone grafting lengthening surgery. The former promotes bone regeneration based on the tension-stress principle and is widely used in the treatment of calcaneal defects and congenital metatarsal brachymetatarsia, achieving good curative effects. However, there are also complications such as pin-tract infection, joint stiffness and contracture, non-union and delayed union of bone, re-fracture, and alignment deviation. The latter has a short treatment cycle, but the lengthening length is limited. Bone graft resorption and soft tissue complications are its main complications. CONCLUSION Foot lengthening surgery will develop towards the direction of personalization, intelligence, and precision. With the help of multi-center research, biological materials, and intelligent technologies, the effectiveness and safety will be further improved to better restore the function and appearance of the foot.
Humans ; Bone Transplantation/methods* ; Bone Lengthening/methods* ; Ilizarov Technique ; Osteogenesis, Distraction/methods* ; Foot Deformities/surgery* ; Postoperative Complications ; Treatment Outcome ; Foot/surgery*

Myocardial fibrosis is a serious cause of heart failure and even sudden cardiac death. However, the mechanisms underlying myocardial ischemia-induced cardiac fibrosis remain unclear. Here, we identified that the expression of sterile alpha and TIR motif containing 1 (SARM1), was increased significantly in the ischemic cardiomyopathy patients, dilated cardiomyopathy patients (GSE116250) and fibrotic heart tissues of mice. Additionally, inhibition or knockdown of SARM1 can improve myocardial fibrosis and cardiac function of myocardial infarction (MI) mice. Moreover, SARM1 fibroblasts-specific knock-in mice had increased deposition of extracellular matrix and impaired cardiac function. Mechanically, elevated expression of SARM1 promotes the deposition of extracellular matrix by directly modulating P4HA1. Notably, by using the Click-iT reaction, we identified that the increased expression of ZDHHC17 promotes the palmitoylation levels of SARM1, thereby accelerating the fibrosis process. Based on the fibrosis-promoting effect of SARM1, we screened several drugs with anti-myocardial fibrosis activity. In conclusion, we have unveiled that palmitoylated SARM1 targeting P4HA1 promotes collagen deposition and myocardial fibrosis. Inhibition of SARM1 is a potential strategy for the treatment of myocardial fibrosis. The sites where SARM1 interacts with P4HA1 and the palmitoylation modification sites of SARM1 may be the active targets for anti-fibrosis drugs.

Objective To explore the risk factors of respiratory failure(RF)in patients with Klebsiella pneumoniae pneumonia(KPN).Methods A total of 79 KPN patients admitted to Jilin Provincial People's Hospital from July 2023 to July 2024 were selected as subjects.Patients were divided into RF group(n=42)and non-RF group(n=37)based on RF comorbidity status.Independent risk factors for RF comorbidity were identified through univariate analysis and multivariate Logistic regression,with model predictive performance evaluated using receiver operating characteristic(ROC)curve.Results Compared to non-RF group,serum procalcitonin(PCT)levels were higher and serum albumin(ALB)and oxygenation index were lower in RF group(P＜0.05).Univariate analysis identified age,bedridden status,number of comorbidities,PCT,oxygenation index,ALB,multi-lobar infiltration,and mechanical ventilation as significant predictors of RF development in KPN patients.Multivariate Logistic analysis showed that elevated PCT levels,decreased oxygenation index,and reduced ALB were independent risk factors for RF in KPN patients,with area under the ROC curve of predictive model being 0.884.Conclusion When blood PCT is elevated,blood ALB is reduced,and the oxygenation index is decreased,the likelihood of RF in KPN patients is significantly increased.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

This article reports the diagnosis and treatment of a patient with diffuse large B-cell lymphoma (DLBCL) initially manifested as acquired von Willebrand syndrome (AvWS), along with a literature review. The patient, a 22-year-old male, was diagnosed with hereditary von Willebrand disease at the initial stage due to repeated mucosal bleeding, and was later diagnosed with DLBCL (non germinal center type, Ann Arbor stage Ⅳ) due to chest wall mass. Through chemotherapy combined with autologous hematopoietic stem cell transplantation and zebutinib maintenance therapy, the patient achieved sustained complete remission, and the coagulation function returned to normal. This case provides an important reference for the diagnosis and treatment of lymphoma associated AvWS, and highlights the importance of early recognition of basic diseases.

Objective:To explore the impact of the stimulator of interferon genes(STING)-interferon regulatory factor 3(IRF3)pathway on the senescence of rapid pacing HL-1 myocytes.Methods:HL-1 cells were divided into five groups: the control group(HL-1 cells without any treatment), pacing group(HL-1 cells paced for 48 hours), STING siRNA group(HL-1 cells paced for 48 hours and transfected with STING siRNA), NC siRNA group(HL-1 cells paced for 48 hours and transfected with NC siRNA), and H151 inhibitor group(HL-1 cells paced for 48 hours with the addition of 1 μmol/L STING inhibitor H151). Mitochondrial membrane potential was assessed in control and pacing group cells, and mitochondrial MitoTracker and TFAM co-localization staining was performed on these cells.Cellular senescence was evaluated using β-galactosidase staining in each group, and the positive rate of cellular senescence was observed and calculated.Western blotting was employed to detect the expression levels of STING, IRF3, P-IRF3, P16, P21, and P53 proteins in all groups.Immunofluorescence was utilized to examine the expression distribution of STING and P21 across the various groups.ELISA was performed to measure the concentrations of interleukin(IL)-1β, IL-6, and IL-8 in the cell supernatants from each group as part of the senescence-associated secretory phenotype(SASP).Results:Compared with the control group, the ratio of mitochondrial JC-1 multimer to monomer was significantly decreased in the pacing group( t=16.42, P<0.05), the co-localization of mitochondrial MitoTracker and TFAM in the cells was significantly weakened, the proportion of cells with positive cellular senescence-associated β-galactosidase staining significantly increased in the pacing group, the expression levels of STING, P-IRF3/IRF3, P16, P21, and P53 proteins were significantly elevated in the pacing group, and the concentrations of IL-1β, IL-6, and IL-8 in the cell supernatants were markedly increased.Compared with the pacing group, the proportion of cells with positive cellular senescence-associated β-galactosidase staining decreased in the STING siRNA group and H151 inhibitor group ( F= 18.13, P<0.05), the expression levels of STING, P-IRF3/IRF3, P16, P21, and P53 were reduced in the STING siRNA group and H151 inhibitor group ( F=16.84, 26.56, 74.70, 31.80, 31.23, all P<0.05), and the concentrations of IL-1β, IL-6, and IL-8 in the cell supernatants decreased( F=197.80、1 339.00、1 308.00, all P<0.001). Conclusions:Rapid pacing of HL-1 cells can promote mtDNA release into the cytoplasm, activate the STING-IRF3 pathway, accelerate cellular senescence, and enhance the secretion of SASP.Inhibiting the expression of STING can delay the senescence induced by the rapid pacing of HL-1 cells and reduce SASP secretion.

Objective:To analyze the clinical outcomes of total ankle arthroplasty (TAA) using the INBONE Ⅱ prosthesis in patients ≤50 years old with end-stage ankle arthritis.Methods:A retrospective analysis was conducted of the consecutive patients who had undergone TAA using the INBONE Ⅱ prosthesis between September, 2016 and August, 2021 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University. There were 12 males and 16 females with an age of (46.0±4.0) years and a body mass index of (24.9±3.3) kg/m 2. The clinical outcomes recorded and compared between pre-surgery and the last follow-up were tibial articular surface (TAS) angle, talar tilt (TT) angle, tibial lateral surface (TLS) angle, ankle plantarflexion angle, ankle dorsiflexion, ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, MOS item short form health survey (SF-36), foot function index (FFI), and visual analog scale (VAS) for pain. Patient satisfaction by 5-point Likert scale and complications were recorded. Results:All patients were followed up for (49.8±15.3) months. Except for plantar flexion and TAS, for all patients at the last follow-up, TT angle [0.4° (0, 0.6°)], FFI [20.0 (7.3, 48.0) points], and VAS pain score [2.0 (1.0, 2.8) points] were significantly reduced compared with the preoperative values [1.6° (0.3°, 4.4°), (99.9±40.6) points, and 6.0 (4.0, 6.8) points], while TLS angle (86.3°±2.8°), ankle dorsiflexion (13.5°±5.4°), ankle ROM (34.7°±7.9°), AOFAS ankle-hindfoot score [82.0 (74.0, 89.0) points], and SF-36 score [122.5 (112.8, 130.2) points] were all significantly higher than the preoperative values [78.9°±5.7°, 10.3°±8.0°, 31.1°±12.0°, (49.9±3.2) points, and 97.7(89.8, 101.6) points] (all P<0.05). The rate of patient satisfaction at the last follow-up was 89.3% (25/28). No serious postoperative complications occurred and no revision surgery was required. Conclusion:TAA using the INBONE Ⅱ prosthesis has shown good clinical outcomes and a high rate of patient satisfaction in younger patients ≤50 years old with end-stage ankle arthritis.

Objective:To evaluate the early-to-mid-term efficacy of supramalleolar osteotomy (SMO) in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture.Methods:A retrospective study was conducted to analyze the clinical data of 29 patients who had been treated for traumatic ankle arthritis secondary to old peri-ankle fracture by SMO from March 2018 to March 2023 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 14 males and 15 females, 39.0 (25.0, 49.0) years in age. Types of old fracture: 4 lower tibiofibular fractures, 19 ankle fractures, and 6 pilon fractures. Surgery was conducted for 16 cases and conservative treatment for the remaining 13 cases. The interval between the old fracture and the current surgery was 10.0 (2.0, 19.5) years. The clinical efficacy was evaluated using the ankle-hindfoot score of American Association of Foot and Ankle Surgery (AOFAS), foot function index (FFI), and visual analog scale (VAS) pain score. Imaging analysis was conducted and imaging comparisons were made between pre-surgery and post-surgery in terms of tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, talar tilt (TT) angle, and changes in modified Takakura staging. Complications were recorded. Surgical satisfaction was investigated at the final follow-up.Results:The 29 patients were followed up for 17.0 (14.0, 23.5) months. The AOFAS ankle-hindfoot score [(84.2±9.6) points], FFI [7.0 (3.0, 10.9) points], VAS pain score [2.0 (1.0, 3.0) points], and TAS angle [90.84° (86.70°, 92.50°)] at the final follow-up for all patients were significantly better than the pre-surgery values [(68.0±16.7) points, 20.9 (6.1, 29.1) points, 5.0 (2.0, 8.0) points, and 78.63° (74.30°, 85.00°)] (all P<0.05). At the final follow-up, the ankle arthritis grading did not show any significant change ( P>0.05) and there were no significant differences in TT angle or TLS angle between pre-surgery and post-surgery ( P>0.05). Incision failed to heal in 1 case, incision healing was delayed in 3 cases, and ankle arthritis progressed on imaging in 6 cases. As for patient self-assessed satisfaction, 23 cases felt very satisfactory, 4 cases quite satisfactory, and 2 cases common, giving an overall satisfaction rate of 93.1% (27/29). Conclusions:SMO has led to good early-to-mid-term efficacy in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture, showing obvious pain relief and functional improvement after correction of the ankle joint alignment, limited postoperative complactions and a high rate of patient satisfaction.