ObjectiveNonalcoholic fatty liver disease （NAFLD） is a metabolic stress liver injury. Ferroptosis is involved in the occurrence and development of NAFLD. Exploring the efficacy and mechanism of schisandrin B in treating NAFLD facilitates the development of strategies for the prevention and treatment of NAFLD. MethodsThe molecular structure of schisandrin B was obtained by searching against PubChem， and the related targets were predicted by SwissTargetPrediction. The active ingredients and their targets were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） and the high-throughput experiment- and reference-guide database of traditional Chinese medicine （HERB）. GeneCards and FerrDb were searched for the targets of NAFLD and ferroptosis. The common targets were taken as the core targets， and the protein-protein interaction network of the core targets was established. DAVID was used for gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） analyses. Finally， molecular docking was performed between schisandrin B and core targets， and the binding energy was calculated. C57BL/6 mice were fed with a methionine and choline-deficiency （MCD） diet for the modeling of NAFLD. Mice were randomized into normal， model， positive drug （essentiale）， and low- and high-dose schisandrin B groups. The body mass and liver index of mice were measured after drug administration. The levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in the serum and those of total cholesterol （TC）， triglyceride （TG）， malondialdehyde （MDA）， glutathione （GSH）， and Fe²⁺ in the liver homogenate were measured by biochemical assay kits. The pathological changes of the liver tissue were observed by hematoxylin-eosin （HE） and red oil O staining. Enzyme-linked immunosorbent assay was employed to determine the levels of interleukin （IL）-6， IL-1β， tumor necrosis factor （TNF）-α， and 4-hydroxynonenal （4-HNE） in the serum. Western blotting and real-time PCR were employed to determine the protein and mRNA levels， respectively， of solute carrier family 7 member 11 （SLC7A11）， solute carrier family 3 member 2 （SLC3A2）， glutathione peroxidase 4 （GPX4）， transferrin， and ferritin heavy chain （FTH） in the liver tissue. ResultsA total of 2 370， 2 547， and 1 451 targets of schisandrin B， NAFLD， and ferroptosis were obtained， in which 90 common targets were shared by the three. Enrichment analyses predicted 505 GO terms and 92 KEGG pathways. Molecular docking suggested that schizandrin B had strong binding affinity with the key targets of ferropstosis （SLC7A11 and SLC3A2）. Animal experiments showed that schizandrin B significantly decreased the liver index， lowered the levels of ALT， AST， TC， TG， IL-6， IL-1β， and TNF-α， alleviated hepatocyte ballooning and inflammatory cell infiltration， and reduced lipid accumulation in the liver of NAFLD mice. In addition， schisandrin B significantly lowered the levels of MDA， 4-HNE， and Fe²⁺， elevated the level of GSH， up-regulated the protein and mRNA levels of SLC7A11， SLC3A2， and GPX4， and down-regulated the protein and mRNA levels of transferrin in the liver tissue. ConclusionSchisandrin B can alleviate NAFLD by inhibiting ferroptosis in hepatocytes.

Takotsubo syndrome is a transient, reversible syndrome characterized by acute regional dysfunction of the left ventricle, with symptoms resembling those of acute coronary syndrome. Takotsubo syndrome can lead to left ventricular thrombus formation, which may embolize and cause ischemic stroke. However, such cases are relatively rare. A case of acute ischemic stroke with middle cerebral artery occlusion caused by Takotsubo syndrome is reported in this article. The patient presented primarily with left-sided limb weakness. Cerebral angiography indicated occlusion of the right middle cerebral artery, and complete vascular recanalization was achieved after endovascular thrombectomy. Cranial magnetic resonance imaging indicated multiple infarctions in both the anterior and posterior circulations. Transthoracic echocardiography showed apical thrombus formation in the left ventricle and significantly reduced left ventricular systolic function. After a short course of anticoagulation combined with antiplatelet therapy, the apical thrombus resolved, and left ventricular systolic function significantly improved. This case indicates that although large-vessel occlusion acute ischemic stroke caused by Takotsubo syndrome is relatively rare, comprehensive etiological evaluation should be emphasized in patients with suspected cardioembolic stroke. Dynamic monitoring of echocardiographic changes is important for accurate diagnosis of the underlying cause.

Lactylation, a newly discovered post-translational modification, has been reported to be involved in various physiological and pathological processes. Recent studies have found that lactylation is potentially linked to the pathological processes and repair mechanisms of ischemic stroke. This article explores the impact and role of lactylation after the occurrence of ischemic stroke on neuroinflammation, energy metabolism regulation, oxidative stress, signaling pathway modulation, and angiogenesis. It may serve as a bridge connecting lactylation and ischemic stroke, offering insights and guidance for future research and clinical strategies in ischemic stroke.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To describe the clinical characteristics of the urinary system involvement in patients with IgG4-related disease (IgG4-RD), and to identify the risk factors for progression to glomerular filtration rate (GFR) less than 60 ml/min.Methods:A retrospective review was carried out using the medical records of 71 cases with IgG4-RD complicated with renal and urinary lesions diagnosed in the First Affiliated Hospital of Zhejiang University School of Medicine between January 2017 and December 2021. Cox proportional hazards model was performed to assess the factors associated with the risk of GFR<60 ml/min.Results:We studied 71 patients with IgG4-RD who had renal and urinary lesions with a mean follow-up of (31.5±19.5)months. Among these, 60 patients were male, and the mean disease onset age was (63.1±10.8)years, and 41(57.7%) patients had IgG4-related kidney disease (IgG4-RKD). Twenty-four patients had IgG4-RKD confirmed after kidney biopsy, with all biopsies showing tubulointerstitial nephritis and one showing membranous nephropathy. Urine immunoglobulin G[ HR(95% CI)=1.218(1.026, 1.446), P=0.025] was associated with a higher risk of GFR less than 60 ml/min. Conclusion:The most common type of urinary system involvement in patients with IgG4-RD is IgG4-RKD. Meanwhile the most common pathological type of IgG4-RKD is TIN. Urine immunoglobulin G is associated with a higher GFR less than 60 ml/min rate.

Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Object·To explore the effects of comorbid obsessive-compulsive personality disorder(OCPD)on the behavioral inhibition system(BIS)/behavioral activation system(BAS)in patients with obsessive-compulsive disorder(OCD).Methods·A total of 247 patients with unmedicated OCD diagnosed in the Mental Health Center,Shanghai Jiao Tong University School of Medicine from 2014 to 2018 were included and divided into an OCD group(n=202),and an OCD+OCPD group(n=45),and 107 healthy controls were recruited as a comparison group.Yale-Brown Obsessive-Compulsion Scale(YBOCS),BIS/BAS Scale,Hamilton Depression Scale(HAMD),and Hamilton Anxiety Scale(HAMA)were used to assess psychopathological features.Gender differences among the three groups were analyzed using the x2 test.One-way analysis of variance(ANOVA)was used to compare differences in demographic characteristics,psychopathological features,and BIS/BAS scores,followed by the least significant difference(LSD)test for pairwise comparisons.Regression analysis was conducted to explore the relationships between psychopathological features and BIS/BAS scores.Results·There were no significant differences in gender,age,and years of education among the three groups.The scores of YBOCS(t=2.925,P=0.004),HAMD(t=2.130,P=0.034)and HAMA(t=2.568,P=0.011)in the OCD+OCPD group were significantly higher than those in the OCD group.There were statistically significant differences in BIS and BAS scores among the three groups(BIS:F=39.573,P＜0.001;BAS:F=3.915,P=0.021).The results showed that for BIS,there were statistically significant differences in pairwise comparisons among the three groups(OCD+OCPD vs OCD:P=0.002;OCD+OCPD vs HC:P＜0.001;OCD vs HC:P＜0.001),and the scores were OCD+OCPD＜OCD＜HC from low to high.For BAS,the OCD group scored significantly higher than the OCD+OCPD and HC groups(OCD+OCPD vs OCD:P=0.018;OCD vs HC:P=0.043),but there was no significant difference between the OCD+OCPD and HC groups.Regression models of BIS and BAS were constructed for OCD patients with OCPD,and the results showed that the overall prediction effect of the model was significant for BIS total scores(F=2.599,P=0.013).Only the severity of OCPD symptoms can significantly predict BIS scores(t=-2.282,P=0.023).For BAS total scores,the overall prediction effect of the model was not significant(F=1.438,P=0.191).Conclusion·Comorbid OCPD may be an adverse factor for abnormal BIS and a protective factor for abnormal BAS in patients with OCD.

Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Object·To explore the effects of comorbid obsessive-compulsive personality disorder(OCPD)on the behavioral inhibition system(BIS)/behavioral activation system(BAS)in patients with obsessive-compulsive disorder(OCD).Methods·A total of 247 patients with unmedicated OCD diagnosed in the Mental Health Center,Shanghai Jiao Tong University School of Medicine from 2014 to 2018 were included and divided into an OCD group(n=202),and an OCD+OCPD group(n=45),and 107 healthy controls were recruited as a comparison group.Yale-Brown Obsessive-Compulsion Scale(YBOCS),BIS/BAS Scale,Hamilton Depression Scale(HAMD),and Hamilton Anxiety Scale(HAMA)were used to assess psychopathological features.Gender differences among the three groups were analyzed using the x2 test.One-way analysis of variance(ANOVA)was used to compare differences in demographic characteristics,psychopathological features,and BIS/BAS scores,followed by the least significant difference(LSD)test for pairwise comparisons.Regression analysis was conducted to explore the relationships between psychopathological features and BIS/BAS scores.Results·There were no significant differences in gender,age,and years of education among the three groups.The scores of YBOCS(t=2.925,P=0.004),HAMD(t=2.130,P=0.034)and HAMA(t=2.568,P=0.011)in the OCD+OCPD group were significantly higher than those in the OCD group.There were statistically significant differences in BIS and BAS scores among the three groups(BIS:F=39.573,P＜0.001;BAS:F=3.915,P=0.021).The results showed that for BIS,there were statistically significant differences in pairwise comparisons among the three groups(OCD+OCPD vs OCD:P=0.002;OCD+OCPD vs HC:P＜0.001;OCD vs HC:P＜0.001),and the scores were OCD+OCPD＜OCD＜HC from low to high.For BAS,the OCD group scored significantly higher than the OCD+OCPD and HC groups(OCD+OCPD vs OCD:P=0.018;OCD vs HC:P=0.043),but there was no significant difference between the OCD+OCPD and HC groups.Regression models of BIS and BAS were constructed for OCD patients with OCPD,and the results showed that the overall prediction effect of the model was significant for BIS total scores(F=2.599,P=0.013).Only the severity of OCPD symptoms can significantly predict BIS scores(t=-2.282,P=0.023).For BAS total scores,the overall prediction effect of the model was not significant(F=1.438,P=0.191).Conclusion·Comorbid OCPD may be an adverse factor for abnormal BIS and a protective factor for abnormal BAS in patients with OCD.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.