Objective To determine the diagnostic criteria of quantitative syndrome differentiation of toxin syndrome of diabetic kidney disease.Methods The questionnaire scale was developed through literature research and expert consultation.Points were assigned for the 5 major symptoms in 294 patients with DKD,and according to the TCM syndrome differentiation standard of toxic syndrome syndrome formulated by experts,it is divided into toxic syndrome group and non-toxic syndrome group.The symptom items were screened from the aspects of sensitivity,differentiation and representativeness by statistical method,and the weight value of the items was given by factor analysis.The threshold and the best diagnosis model were determined under the ROC curve.Finally,through the verification group data to verify the scale model,evaluate the diagnostic ability of the scale,and finally construct the diagnostic standard scale model of DKD toxin syndrome.Results 14 symptom items were selected as TCM related symptoms of DKD toxin syndrome,and the diagnostic threshold was determined to be 140.The diagnostic criteria of quantitative syndrome differentiation of DKD toxin syndrome were as follows:total score=fatigue * 10+edema * 10+turbid urine * 10+sore waist and knees * 10+dizziness * 10+tongue purple * 10+dark complexion * 9+limb numbness * 8+loose stools * 7+dry mouth * 4+dry eyes * 4+frequent urination at night * 3+abdominal distension * 3+greasy moss * 3.The degree of each item without this symptom should be multiplied by weight value by 0,mild by weight by 1,moderate by weight by 2,severe by weight by 3,and the total score≥140 could be diagnosed as toxin syndrome.The verification results showed that the sensitivity of the study group was 92.24%,the specificity was 96.19%,the Kappa value was 0.882,and the sensitivity,specificity and Kappa value of the verification group were 87.50%,96.97%and 0.836,respectively.Conclusion The standard scale of DKD toxin syndrome differentiation and diagnosis is constructed,and it has good diagnostic ability,which provides certain application value for clinical and scientific research.

Objective:To compare postoperative inflammatory markers and surgical outcomes between open reduction and internal fixation versus double reverse traction closed reduction and percutaneous internal fixation for tibial plateau fractures.Methods:A retrospective analysis was conducted of the data of 229 patients with tibial plateau fracture who had been admitted to Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University from January 2023 to December 2023. There were 155 males and 74 females with an age of (48.7±10.9) years. According to the surgical methods, the patients were divided into 2 groups. A conventional group of 87 cases were treated by open reduction and internal fixation while a minimally invasive group of 142 cases treated with double reverse traction closed reduction and percutaneous internal fixation. The 2 groups were compared in terms of hematological indexes [white blood cell count (WBC), neutrophil count (NEUT), lymphocyte count (LYM), monocyte count (Mono), platelet count (PLT), and albumin (ALB)] and composite inflammatory indexes [neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI)] before operation and on the first day after operation, intraoperative blood loss, operation time, fracture healing time, Hospital for Special Surgery (HSS) knee score and incidence of thrombosis.Results:There were no significant differences in baseline characteristics or treatment variables between the 2 groups, indicating comparability ( P > 0.05). All the 229 patients were followed up for (16.5±2.8) months. In each group, comparisons between preoperation and postoperation showed that LYM and ALB significantly decreased while WBC, NEUT, Mono, PLT, NLR, PLR, SII and SIRI significantly increased on the first day after operation ( P < 0.05). Preoperatively, there were no significant differences between the 2 groups in terms of hematological or composite inflammatory indexes ( P > 0.05). On the first day after operation, there was no significant difference in WBC, NEUT, LYM, ALB or NLR between the 2 groups ( P > 0.05), but Mono, PLT, PLR, SII and SIRI in the minimally invasive group were significantly lower than those in the conventional group ( P < 0.05). The intraoperative blood loss, operation time, fracture healing time, HSS knee score and incidence of thrombosis in the minimally invasive group were significantly better than those in the conventional group ( P < 0.05). Conclusion:In the treatment of tibial plateau fractures, compared with conventional open reduction and internal fixation, double reverse traction closed reduction and percutaneous internal fixation shows obvious advantages in reducing inflammatory indicators and leads to better surgical outcomes.

Objective:To compare the efficacy of lateral placement of the intramedullary nail guide pin versus that of median placement of the intramedullary nail guide pin in the closed reduction of metaphyseal fracture of the distal tibia.Methods:A retrospective cohort study was conducted to analyze the clinical data of 48 patients with metaphyseal fracture of the distal tibia who had been admitted to Department of Trauma Orthopaedics, The Second General Hospital of Fuzhou from May 2019 to July 2023. There were 37 males and 11 females, aged (46.0±12.4) years. According to the AO classification, 37 patients were classified as type A1, and 11 ones as type A2. The patients were divided into 2 groups according to the distal positioning of the intramedullary nail guide pins during operation. In the lateral placement group of 26 patients, the distal positioning of the guide pins was located at 1/3 lateral to the articular surface of the distal tibia. In the median placement group of 22 patients, the distal positioning of the guide pins was located at the midpoint of the articular surface of the distal tibia. The operation time, intraoperative blood loss, hospital stay, fracture healing time and fracture reduction were recorded and compared between the 2 groups. Moreover, the visual analogue scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion of the affected ankle were compared between the 2 groups, as well as within the 2 groups. The complications were compared between the 2 groups at the last follow-up.Results:There were no significant differences in the demographic data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (19.6±4.4) months. The operation time [(81.7±17.3) min], intraoperative blood loss [(78.4±12.2) mL], hospital stay [(5.7±2.1) d] and fracture healing time [(4.3±1.1) months] in the lateral placement group were significantly less than those in the median placement group [(103.0±13.4) min, (111.4±11.7) ml, (8.6±3.5) d, and (6.1±1.3) months] ( P<0.05). There was no significant difference in the VAS pain score between the 2 groups before operation or at the last follow-up ( P>0.05). At the last follow-up, the AOFAS ankle-hindfoot score [(93.6±1.6) points], ankle dorsiflexion (17.9°±1.6°) and plantar flexion (41.9°±1.9°) in the lateral placement group were significantly better than those in the median placement group [(87.8±3.2) points, 15.1°±1.2°, and 38.5°±2.7°] ( P<0.05). In both groups, significant improvements were achieved at the last follow-up in VAS pain score, the AOFAS ankle-hindfoot score, ankle dorsiflexion and plantar flexion compared with the preoperative period ( P<0.05). The incidence of fracture angulation deformity in the lateral placement group (11.5%, 3/26) was lower than that in the median placement group (31.8%, 7/22) ( P>0.05). There was no significant difference in the incidence of complications between the lateral placement group (3.8%, 1/26) and the central placement group (18.2%, 4/22) ( P>0.05). Conclusion:In the closed reduction of metaphyseal fracture of the distal tibia, compared with median placement of the intramedullary nail guide pin, lateral placement of the intramedullary nail guide pin assisted with a Kirschner wire demonstrates advantages of more rapid and effective closed reduction of the fracture, shortened operation time, reduced intraoperative blood loss and promoted postoperative rehabilitation.

Objective To determine the diagnostic criteria of quantitative syndrome differentiation of toxin syndrome of diabetic kidney disease.Methods The questionnaire scale was developed through literature research and expert consultation.Points were assigned for the 5 major symptoms in 294 patients with DKD,and according to the TCM syndrome differentiation standard of toxic syndrome syndrome formulated by experts,it is divided into toxic syndrome group and non-toxic syndrome group.The symptom items were screened from the aspects of sensitivity,differentiation and representativeness by statistical method,and the weight value of the items was given by factor analysis.The threshold and the best diagnosis model were determined under the ROC curve.Finally,through the verification group data to verify the scale model,evaluate the diagnostic ability of the scale,and finally construct the diagnostic standard scale model of DKD toxin syndrome.Results 14 symptom items were selected as TCM related symptoms of DKD toxin syndrome,and the diagnostic threshold was determined to be 140.The diagnostic criteria of quantitative syndrome differentiation of DKD toxin syndrome were as follows:total score=fatigue * 10+edema * 10+turbid urine * 10+sore waist and knees * 10+dizziness * 10+tongue purple * 10+dark complexion * 9+limb numbness * 8+loose stools * 7+dry mouth * 4+dry eyes * 4+frequent urination at night * 3+abdominal distension * 3+greasy moss * 3.The degree of each item without this symptom should be multiplied by weight value by 0,mild by weight by 1,moderate by weight by 2,severe by weight by 3,and the total score≥140 could be diagnosed as toxin syndrome.The verification results showed that the sensitivity of the study group was 92.24%,the specificity was 96.19%,the Kappa value was 0.882,and the sensitivity,specificity and Kappa value of the verification group were 87.50%,96.97%and 0.836,respectively.Conclusion The standard scale of DKD toxin syndrome differentiation and diagnosis is constructed,and it has good diagnostic ability,which provides certain application value for clinical and scientific research.

Objective:To compare postoperative inflammatory markers and surgical outcomes between open reduction and internal fixation versus double reverse traction closed reduction and percutaneous internal fixation for tibial plateau fractures.Methods:A retrospective analysis was conducted of the data of 229 patients with tibial plateau fracture who had been admitted to Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University from January 2023 to December 2023. There were 155 males and 74 females with an age of (48.7±10.9) years. According to the surgical methods, the patients were divided into 2 groups. A conventional group of 87 cases were treated by open reduction and internal fixation while a minimally invasive group of 142 cases treated with double reverse traction closed reduction and percutaneous internal fixation. The 2 groups were compared in terms of hematological indexes [white blood cell count (WBC), neutrophil count (NEUT), lymphocyte count (LYM), monocyte count (Mono), platelet count (PLT), and albumin (ALB)] and composite inflammatory indexes [neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI)] before operation and on the first day after operation, intraoperative blood loss, operation time, fracture healing time, Hospital for Special Surgery (HSS) knee score and incidence of thrombosis.Results:There were no significant differences in baseline characteristics or treatment variables between the 2 groups, indicating comparability ( P > 0.05). All the 229 patients were followed up for (16.5±2.8) months. In each group, comparisons between preoperation and postoperation showed that LYM and ALB significantly decreased while WBC, NEUT, Mono, PLT, NLR, PLR, SII and SIRI significantly increased on the first day after operation ( P < 0.05). Preoperatively, there were no significant differences between the 2 groups in terms of hematological or composite inflammatory indexes ( P > 0.05). On the first day after operation, there was no significant difference in WBC, NEUT, LYM, ALB or NLR between the 2 groups ( P > 0.05), but Mono, PLT, PLR, SII and SIRI in the minimally invasive group were significantly lower than those in the conventional group ( P < 0.05). The intraoperative blood loss, operation time, fracture healing time, HSS knee score and incidence of thrombosis in the minimally invasive group were significantly better than those in the conventional group ( P < 0.05). Conclusion:In the treatment of tibial plateau fractures, compared with conventional open reduction and internal fixation, double reverse traction closed reduction and percutaneous internal fixation shows obvious advantages in reducing inflammatory indicators and leads to better surgical outcomes.

Objective:To compare the efficacy of lateral placement of the intramedullary nail guide pin versus that of median placement of the intramedullary nail guide pin in the closed reduction of metaphyseal fracture of the distal tibia.Methods:A retrospective cohort study was conducted to analyze the clinical data of 48 patients with metaphyseal fracture of the distal tibia who had been admitted to Department of Trauma Orthopaedics, The Second General Hospital of Fuzhou from May 2019 to July 2023. There were 37 males and 11 females, aged (46.0±12.4) years. According to the AO classification, 37 patients were classified as type A1, and 11 ones as type A2. The patients were divided into 2 groups according to the distal positioning of the intramedullary nail guide pins during operation. In the lateral placement group of 26 patients, the distal positioning of the guide pins was located at 1/3 lateral to the articular surface of the distal tibia. In the median placement group of 22 patients, the distal positioning of the guide pins was located at the midpoint of the articular surface of the distal tibia. The operation time, intraoperative blood loss, hospital stay, fracture healing time and fracture reduction were recorded and compared between the 2 groups. Moreover, the visual analogue scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion of the affected ankle were compared between the 2 groups, as well as within the 2 groups. The complications were compared between the 2 groups at the last follow-up.Results:There were no significant differences in the demographic data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (19.6±4.4) months. The operation time [(81.7±17.3) min], intraoperative blood loss [(78.4±12.2) mL], hospital stay [(5.7±2.1) d] and fracture healing time [(4.3±1.1) months] in the lateral placement group were significantly less than those in the median placement group [(103.0±13.4) min, (111.4±11.7) ml, (8.6±3.5) d, and (6.1±1.3) months] ( P<0.05). There was no significant difference in the VAS pain score between the 2 groups before operation or at the last follow-up ( P>0.05). At the last follow-up, the AOFAS ankle-hindfoot score [(93.6±1.6) points], ankle dorsiflexion (17.9°±1.6°) and plantar flexion (41.9°±1.9°) in the lateral placement group were significantly better than those in the median placement group [(87.8±3.2) points, 15.1°±1.2°, and 38.5°±2.7°] ( P<0.05). In both groups, significant improvements were achieved at the last follow-up in VAS pain score, the AOFAS ankle-hindfoot score, ankle dorsiflexion and plantar flexion compared with the preoperative period ( P<0.05). The incidence of fracture angulation deformity in the lateral placement group (11.5%, 3/26) was lower than that in the median placement group (31.8%, 7/22) ( P>0.05). There was no significant difference in the incidence of complications between the lateral placement group (3.8%, 1/26) and the central placement group (18.2%, 4/22) ( P>0.05). Conclusion:In the closed reduction of metaphyseal fracture of the distal tibia, compared with median placement of the intramedullary nail guide pin, lateral placement of the intramedullary nail guide pin assisted with a Kirschner wire demonstrates advantages of more rapid and effective closed reduction of the fracture, shortened operation time, reduced intraoperative blood loss and promoted postoperative rehabilitation.

As a practical carrier for promoting the tiered diagnosis and treatment model, the medical consor-tium is of great significance for balancing medical resources and boosting medical service efficiency. The construction of medical consortiums not only improves the accessibility of high-quality medical resources for patients, but also enhances the diagnostic and treatment level of member units. Meanwhile, it provides space for the leading hospital to adjust the structure of diseases and improve the level of discipline construction. As the core of medical insurance payment reform, DRG, through indicators such as the case mix index(CMI) and the number of diagnosis related group (DRG), provides objective and quantified data support for case management and disease structure optimization, thus effectively guiding the rational allocation of medical resources and the adjustmentof diseases and surgical types within the medical consortium. Comprehensive use of DRG evaluation indicators can construct a multidimensional medical consortium construction evaluation system, provides a clear direction for medical consortium cooperation, thereby promoting the overall healthy and sustainable development of medical consortiums and achieving a win-win situation for all parties involved. This paper, based on the "1+5+1" medical consortium cooperation model centered around Peking Union Medical College Hospital, utilizes DRG indicators to analyze the benefits for patients, member hospitals, and the leading hospital during the medical consortium construction process, with the hope of providing reference for the construction of a medical consortium evaluation system.

Objective:To investigate clinical features, imaging characteristics, etiology, and potential mechanisms of medullary "comma-shaped" infarctions.Methods:Patients with common-shaped infarction treated at Weihai Central Hospital Affiliated to Qingdao University from January 2020 to September 2023 were retrospectively collected, and their clinical manifestations, imaging findings, treatment, and outcome were analyzed and summarized.Results:A total of 9 patients with medullary common-shaped infarction were enrolled, including 3 males, aged 67.22±14.66 years (ranging from 39 to 83 years). Main clinical symptoms and signs included the decreased pain and temperature sensation on the contralateral limb (66.67%, 6/9), coughing or choking while drinking liquids/dysphagia (66.67%, 6/9), ipsilateral pharyngopalatine muscle paralysis (66.67%, 6/9), and dizziness (66.67%, 6/9). Seven patients (77.78%, 7/9) had severe stenosis or occlusion at the ipsilateral vertebral artery, one (11.11%, 1/9) had occlusion at the left middle cerebral artery, and one (11.11%, 1/9) did not have large vessel stenosis. At 90 days after onset, the follow-up showed that the modified Rankin Scale scores were all <2.Conclusions:Medullary comma-shaped infarctions are rare in clinical practice, its main manifestations include the decreased pain and temperature sensation on the contralateral limb, coughing or choking while drinking liquids/dysphagia, ipsilateral pharyngopalatine muscle paralysis, dizziness, etc. The pathogenesis is mainly hypoperfusion caused by vertebral artery stenosis.

Metabolic syndrome(MS)is a complex syndrome based on metabolic disorders in the human body,and is a risk factor for cardiovascular diseases and even certain tumors,with a complicated etiology and unclear pathogenesis.Helicobacter pylori(Hp)is one of the most common pathogenic bacteria,closely associated with the occurrence and development of various diseases.Currently,there are numerous studies both domestically and internationally on the relationship between Hp and MS and its components.Most studies suggest that there is an association between Hp and MS and Hp influences the occurrence and development of MS through multiple pathways.Eradicating Hp may become a new option for treating MS.Based on recent studies from both domestic and international sources,this paper discusses the association between Hp and MS,analyzes the effects of Hp on obesity,blood glucose,blood lipids,and blood pressure,and aims to provide new ideas for the prevention and treatment of MS.

Objective:To investigate the distribution characteristics of conjugate eye deviation on MRI in patients with posterior circulation ischemic stroke (PCIS) presenting as isolated acute vestibular syndrome (AVS), and its relationship with infarct lesions.Methods:Patients with PCIS presenting as isolated AVS admitted to Weihai Central Hospital Affiliated to Qingdao University from January 2022 to June 2024 were included retrospectively. The infarct distribution and eye deviation were detected by MRI within 3 days of admission. If the gaze deviation of both eyes horizontally towards the same side is observed, it was defined as radiological conjugate eye deviation (RCED); if one eye was deviated while the other eye was not; it was defined as radiological non-conjugate eye deviation (RDED). Multivariate logistic regression analysis was to determine the independent influencing factors of RCED. Results:A total of 82 patients with PCIS presenting with isolated AVS were included. Among them, there were 61 males (74.4%), mean aged 66.20±12.50 (range, 31-91) years. Seventy-two patients (87.8%) had cerebellar infarction, 9 (11.0%) had medullary infarction, 2 (2.4%) had caudal pontine infarction, 1 had both cerebellar and medullary infarction. MRI revealed RCED in 42 cases (51.2%), RDED in 22 cases (26.8%), and no deviation in 18 cases (22.0%). Of the 42 patients with RCED, 32 had cerebellar infarction, accounting for 44.4% of all patients with cerebellar infarction; there were 2 patients with caudal pontine infarction and 9 with medullary infarction. All 22 patients with RDED had cerebellar infarction. Univariate analysis showed that there was significant difference between the RCED group and the non-RCED group in age and the proportion of patients with lesions involving the cerebellar hemisphere and medullary infarction (all P<0.05). Multivariate logistic regression analysis showed that the lesion involvement in the cerebellar hemisphere was an independent influencing factor for RCED (odds ratio 0.169, 95% confidence interval 0.033-0.876; P=0.034). Conclusions:Cerebellar infarction is the most common in patients with PCIS presenting as isolated AVS. Both patients with medullary infarction and pontine infarction present with RCED, while the incidence of RCED in patients with cerebellar infarction is 44.4%. RDED is only seen in patients with cerebellar infarction. Compared with RCED, RDED is more common in patients with infarction involving the cerebellar hemisphere.