Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

The Major Principles of the Five Elements is a collection of Yin-Yang and Five Elements theories in the middle ancient period of China.The Xiangshu model of Yin-Yang and Five Elements is the basic paradigm to clarify the world and its existence."Constitution"and"Function"are a pair of important categories used in ancient philosophy to describe the relationship be-tween the nature and function of ontology.Based on the two temporal and spatial rhythms of the Heluo Heaven and Earth Five Elements view and the Jiugong Bafeng spatiotemporal view constructed by the Xiangshu model,The Major Principles of the Five Elements explains the connotation and characteristics of traditional medical constitution and function,aiming to elucidate the evolution process of the path-ogenesis of constitution and function,guide the dialectical thinking of constitution and function,and flexibly select and combine drug properties and flavors to harmonize the human constitution and function.This paper provides a unique perspective and method for ex-plaining the concept and connotation of constitution and function in traditional Chinese medicine by glimpsing the gradual changing way of thinking in traditional medicine from the Pre-Qin period to the Tang Dynasty.

Objective:To evaluate the validity and reliability of Positive Beliefs About Rumination Scale(PBRS)in Chinese college students.Methods:A total of 968 college students were selected.Exploratory factor a-nalysis,criterion validity and internal consistency reliability test were performed on sample 1(n=496).The Rumi-native Responses Scale(RRS),Metacognitions Questionnaire(MCQ)and Beck Depression Inventory-Ⅱ(BDI-Ⅱ)were used as criteria for criterion validity test.Confirmatory factor analysis and Measurement invariance across gen-der were performed on sample 2(n=472).The 87 college studentsin sample 1 were retested 6 weeks later.Results:The exploratory factor analysis found 1 factor,which explained 54.39％of the total variance.The confirmatory factor analysis showed that the 1-factor model fitted well(x2/df=3.38,CFI=0.962,TLI=0.940,SRMR=0.043,RMSEA=0.071).The scores of the Positive Beliefs About Rumination Scale were positively cor-related with the scores of RRS,MCQ and BDI-Ⅱ(ICC=0.37,0.41,0.12,Ps＜0.01).The Cronbach α coefficient of the Positive Beliefs About Rumination Scale was 0.89.The retest reliability(ICC)of the Positive Beliefs About Rumination Scale was 0.72.The configural,weak,strong and strict invariance of the PBRS across gender were all acceptable(△CFI,△TLI＜0.01).Conclusion:The Positive Beliefs About Rumination Scale has good validity and reliability in Chinese college students.

Objective:To explore the changes of iron metabolism in patients with hepatitis B cirrhosis and esophageal and gastric varices complicated with portal vein thrombosis.Methods:This study was a cross-sectional study. 253 patients with hepatitis B cirrhosis with esophageal and gastric varices who were hospitalized in the Zhongshan Hospital, Fudan University from January 1, 2020 to December 31, 2021 were included in this study. They were divided into portal vein thrombosis group ( n=57) and non portal vein thrombosis group ( n=196) according to the presence or absence of portal vein thrombosis. The iron metabolism characteristics of the two groups were compared, and subgroups were analyzed according to the presence or absence of ascites, platelet count level, D-dimer level, and Child grade. The factors related to portal vein thrombosis were screened through multivariate logistic regression analysis. Results:The ratio of Child pugh B/C, ascites, D-dimer and platelet count in patients with hepatitis B cirrhosis and esophageal and gastric varices complicated with portal vein thrombosis was higher (all P<0.05). Patients with portal vein thrombosis had higher levels of soluble transferrin receptor [2.4(1.8, 3.6)mg/L vs 1.8(1.3, 2.7)mg/L, P=0.006], and lower levels of ferritin [33.1(18.9, 63.3)ng/ml vs 57.7(19.4, 142.5)ng/ml, P=0.038]. Layered analysis showed that ascites, platelet count levels, D-dimer levels, and Child-pugh grade did not affect the negative correlation trend between ferritin and portal vein thrombosis, and the positive correlation trend between soluble transferrin receptors and portal vein thrombosis. Moreover, soluble transferrin receptors showed a statistically significant positive correlation with portal vein thrombosis in the absence of ascites, low D-dimer levels, and Child-pugh grade A. Multivariate analysis suggested that after weighing Child-pugh grading, platelet count, and D-dimer levels, ferritin ( OR=0.943, 95% CI: 0.904-0.983, P=0.006) and soluble transferrin receptor ( OR=1.034, 95% CI: 0.001-1.067, P=0.044) were independently associated with portal vein thrombosis. Conclusions:In patients with hepatitis B cirrhosis with esophageal and gastric varices, the characteristics of iron metabolism in patients with portal vein thrombosis are different from those in patients without thrombosis, with higher levels of soluble transferrin receptor and lower levels of ferritin.

Objective:To investigate the therapeutic efficacy of spleen-invigorating, dampness-removing and stasis-dissolving formula (SDSF) combined with endocrinotherapy for metastatic hormone-sensitive prostate cancer (mHSPC).Methods:A retrospective case control study was conducted. The clinical data of 193 mHSPC patients treated at First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, the Second Hospital of Tianjin Medical University, and Tianjin First Central Hospital from January 2018 to March 2021 were retrospectively analyzed. All patients were treated with continuous endocrinotherapy and they were divided into the combination therapy group (82 cases) and the monotherapy group (94 cases) based on whether they received SDSF treatment or not. Prostate specific antigen (PSA), serum testosterone, blood lipids (triglyceride, total cholesterol), fasting blood glucose, and international prostate symptoms score (I-PSS) and Karnofsky score were compared between the 2 groups. Kaplan-Meier method was used to analyze the progression-free survival (PFS), and log-rank test was performed. The Cox proportional risk model was used to make univariate analysis and multivariate analysis on the influencing factors of PFS.Results:A total of 176 mHSPC patients were finally enrolled and the age was 67±11 years. There were no statistically significant differences in terms of PSA, serum testosterone, triglyceride, total cholesterol and fasting blood glucose, I-PSS score and Karnofsky score between the two groups (all P > 0.05). A total of 91 mHSPC patients developed metastatic castration resistant prostate cancer (mCRPC), including the combination therapy group (40 cases) and the monotherapy group (51 cases), and 9 patients died because of the progression to mCRPC. The median PFS time of all patients was 19 months, that was 17.9 months in the monotherapy group and 20.4 months in the combination therapy group; and the difference was statistically significant between the 2 groups ( P = 0.001). Multivariate Cox regression analysis results showed that combination therapy with SDSF and the lowest testosterone level were independent influencing factors of PFS ( P = 0.001). The total cholesterol at 6-, 9-, 12-month in the combination therapy group was lower than that in the monotherapy group (all P < 0.05), triglyceride at 3-, 6-, 9-, 12-month in the combination therapy group was lower than that in the monotherapy group (all P < 0.05); and the differences in fasting blood glucose after treatment at different time points were not statistically significant between the 2 groups (all P > 0.05); I-PSS score at 9-, 12-month in the monotherapy group was lower than that in the monotherapy group (both P < 0.05). Conclusions:The combination of SDSF with endocrinotherapy can delay the progression of mHSPC, improve treatment-related complications, and enhance patients' quality of life.

Abstract OBJECTIVE To explore the material basis and mechanism of Crataegi Fructus in improving metabolic hypertension(MH) by using network pharmacology and molecular docking technique.METHODS The components of Crataegi Fructus were collected by HERB, ETCM database and literature survey; screening all ingredients of Crataegi Fructus to improve MH targets through databases such as SwissTargetPrediction and GeneCards; build "active ingredient-target-disease" network of Crataegi Fructus with Cytoscape software; DAVID was used to analyze GO enrichment and KEGG pathway. The core components and core targets were verified by molecular docking with Autodock software. RESULTS The total of 89 active components were screened from Crataegi Fructus and acted on 84 targets. Among them, the core active components of Crataegi Fructus to improve MH were maslinic acid, fomefficinic acid B, linolenic acid, linoleic acid, methyl-n-nonylketone, apigenin, ursolic acid, etc. The core targets were CYP19A1, PPARA, ESR1, PTGS2, PPARG, NR3C1, MMP9, TNF, etc. The mechanism of action mainly involved multiple signaling pathways such as inflammation, glycolipid metabolism, and vascular endothelial function. Molecular docking showed that the core active ingredients of Crataegi Fructus had high affinity with core targets. CONCLUSION Crataegi Fructus may regulate multiple signaling pathways such as TNF, IL-17, AGE-RAGE, HIF-1, cGMP-PKG through multi-component regulation, thereby inhibiting inflammatory response, improving glucose and lipid metabolism abnormalities, and improving vascular endothelial function, so as to comprehensively exert the role of improving MH in various aspects.

Objective To explore the relationship between non-high density lipoprotein cholesterol(non-HDL-C)level and leptomeningeal collateral circulation in patients with acute middle cerebral artery occlusion.Methods A total of 85 patients with first-onset acute cerebral infarction with middle cerebral artery M1 segment occlusion were enrolled.According to the results of DSA,LMC circulation was assessed by American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Circulation Assess-ment System.All patients were assigned to better LMC circulation group(score 2～4,n = 30)and worse LMC circulation group(score 0～1,n = 55),and the levels of non-HDL-C were compared between the two groups.Results The levels of LDL-C and non-HDL-C in worse LMC circulation group were significantly higher than those of the better LMC circulation group(P = 0.026,P = 0.010).non-HDL-C was an independent risk factor for the worse LMC circulation(OR = 3.019,95%CI:1.053～8.658,P = 0.04).LMC circulatory score of patients was negatively correlated with the levels of non-HDL-C level(r =-0.228,P = 0.036).The AUC of non-HDL-C predicted for the worse LMC circulation was 0.638(95%CI:0.521～0.755,P = 0.036).Conclusions non-HDL-C in patients with acute cerebral infarction was significantly related to worse LMC circulation,and was a risk factor for worse LMC circulation.It is suggested that the higher expression of non-HDL-C could be used to predict worse LMC circulation as a serological indicator.

In this study, we designed a core competency-oriented formative assessment system for standardized residency training. A formative assessment information platform was established according to this formative assessment system. We described the business process design in detail and how to use information technology for assessment data application. The corresponding data were fed back to residents, instructors, rotation departments, specialty bases, and residency training management departments to promote continuous quality improvement. Meanwhile, we demonstrated the difficulties, deficiencies, and future direction of the construction of formative assessment information platform.

Objective:To explore the effect of 3D printing technology on ankle fracture surgery.Methods:This study was a case-control study.Forty five patients with ankle fractures admitted to the Department of Orthopaedics of the Affiliated Hospital of North China University of Science and Technology from January 2017 to May 2022 were selected. Divide into an observation group and a control group using the random number table method. The control group received open reduction and internal fixation of the ankle joint under X-ray assistance, while the observation group used Mimics software modeling and 3D printing models to assist in open reduction and internal fixation of the ankle joint. Compare the surgical time, intraoperative bleeding volume, intraoperative X-ray exposure frequency, postoperative physician fatigue scale 14 (FS-14) score, fracture reduction quality, fracture healing time, and ankle joint function at 6 months after surgery between the two groups of patients. The measurement data is represented by ± s, and the two groups are compared using t-tests with two independent samples; Counting data is represented by examples (%), χ 2 test is used for inter group comparison, and rank sum test is used for inter group comparison of rank data. Results:The observation group had shorter surgical time than the control group [(134.16±25.61) minutes compared to (163.38±41.90) minutes], with less intraoperative bleeding and fewer intraoperative X-ray exposure times than the control group [(46.32±29.29) mL compared to (99.62±77.85) mL, (13.68±3.50) times compared to (18.54±6.09) times], and lower postoperative physician fatigue scores than the control group [(9.77±2.02) points compared to (12.13±1.73) points], The differences between groups were statistically significant (t-values in decibels were 2.69, 3.20, 3.12, and 4.20, all P<0.05). The quality of postoperative fracture reduction in the observation group was excellent in 12 cases, good in 5 cases, and poor in 2 cases; The quality of postoperative fracture reduction in the control group was excellent in 7 cases, good in 16 cases, and poor in 3 cases. Compared between groups, the observation group had better postoperative fracture reduction quality than the control group ( Z=-2.05, P=0.040). At a follow-up of 6 months after surgery, there was no statistically significant difference in bone healing time between the two groups ( P>0.05). The AOFAS score in the observation group was higher than that in the control group (91.63±2.83) compared to (88.92±3.92), and the difference was statistically significant ( t=2.56, P=0.014). Conclusions:Using Mimics software modeling and 3D printing technology to assist ankle fracture surgery can shorten the operation time, reduce the use rate of X-ray, reduce the fatigue of doctors, and improve the quality of joint reduction and ankle function.