ObjectiveTo compare the clinical efficacy of traditional Chinese medicine （TCM） manipulative reduction combined with small splint fixation versus surgical treatment for type A distal radius fracture （DRF） and to explore the factors influencing the choice of treatment. MethodsA multi-center retrospective study was conducted， collecting data from 1237 type A DRF patients treated in 11 hospitals in Jiangsu province from September， 2023 to April， 2025. Among them， 851 patients in the TCM group received manipulative reduction combined with small splint fixation， and 386 patients in the surgical group underwent open reduction and internal fixation. Visual analog scale （VAS） scores for pain and radiographic indicators including palmar tilt， ulnar deviation， and radial height were compared before treatment， 5-7 days after treatment， and 4-6 weeks after treatment. The wrist joint function scores including Dienst and Gartland-Werley scores at 12 weeks after treatment were recorded. Subgroup analysis was conducted for the excellent rate of Dienst and Gartland-Werley scores， stratified by age （＜50， 50-59， 60-69， ≥70 years old） and AO subtypes （A1， A2， A3）. A multivariate logistic regression model was used to identify independent factors influencing treatment choice. ResultsOn 5-7 days after treatment， the surgical group had lower VAS scores than the TCM group， while 4-6 weeks after treatment， the TCM group showed lower VAS scores than the surgical group （P＜0.01）. In terms of radiographic indicators， except for the palmar tilt before treatment being higher in the surgical group than in the TCM group （P＜0.01）， there were no significant differences in palmar tilt， ulnar deviation， and radial height at other timepoints （P＞0.05）. Twelve weeks after treatment， the surgical group had a higher average Gartland-Werley score and the excellent rate than the TCM group （P＜0.01）. Subgroup analysis showed that in patients with A2 type DRF aged 50-59 and 60-69 years old， the excellent rates of Dienst and Gartland-Werley scores in the TCM group were higher than those in the surgical group （P＜0.05）. Multivariate logistic regression analysis revealed that age， palmar tilt， ulnar deviation， and the degree of swelling on the affected side were independent factors influencing the choice of treatment （P＜0.05）. ConclusionBoth TCM manipulative reduction combined with small splint fixation and surgical treatment for type A DRF can achieve good therapeutic effects. TCM manipulative reduction combined with small splint fixation has certain advantages in medium- and long-term pain relief， especially in elderly patients， where wrist joint function recovery is more stable. Age， palmar tilt， ulnar deviation， and swelling degree are the main factors influencing the treatment choice.

ObjectiveTo evaluate the clinical efficacy of Zuogui Pill （左归丸，ZGP） decoction on neurological function， motor function， and activities of daily living in patients with ischemic stroke （IS） of liver-kidney yin deficiency syndrome， and to assess its potential mechanisms from the perspectives of cerebral perfusion and corticospinal tract （CST） remodeling. MethodsA total of 108 patients with IS of liver-kidney yin deficiency syndrome and onset time ≤14 days were enrolled and randomly divided into a control group and a treatment group， with 54 cases in each group. The control group received conventional western medicine， while the treatment group received ZGP decoction （one dose per day） in addition to the conventional treatment. Both groups were treated for 90 days. The National Institutes of Health Stroke Scale （NIHSS）， modified Rankin Scale （mRS）， modified Barthel Index （MBI）， Fugl-Meyer Assessment （FMA）， and Chinese medicine syndrome score （CMS） were evaluated before treatment and after （90±3） days of treatment. Three-dimensional arterial spin labeling （3D-ASL） and diffusion tensor imaging （DTI） were performed to obtain ipsilesional cerebral blood flow （CBF） in the unaffected and affected hemispheres， relative CBF （rCBF）， and fractional anisotropy （FA） of the CST. Nodal analysis of FA values along the CST was also conducted. Correlation analysis was used to assess the relationships between post-treatment cerebral perfusion parameters （CBF and rCBF）， and FA values with clinical neurological function scores. ResultsAfter treatment， both groups showed significantly decreased NIHSS， mRS and CMS scores， together with significantly increased FMA and MBI scores （P＜0.01）. Intergroup comparison showed that NIHSS， mRS， and CMS scores in the treatment group were significantly lower than those in the control group ， while MBI and FMA scores were significantly higher （P＜0.01）. The 3D-ASL results revealed that CBF and rCBF values in the affected hemisphere significantly increased in both groups after treatment， and the treatment group had significantly higher values （P＜0.01）. DTI showed that the FA value of the CST on the affected side in the treatment group was significantly higher than that in the control group after treatment （P＜0.05）. Nodal analysis along the CST further demonstrated that the continuity of FA values at lesion-related nodes 45~99 in the treatment group was significantly better than that in the control group （P＜0.01）， with significant increases at nodes 65~71 and 76~81 compared with baseline （P＜0.05 or P＜0.01）， whereas the control group showed a decreasing trend at nodes 80~93 （P＜0.05）. Correlation analysis indicated that CBF and rCBF values in the affected hemisphere were negatively correlated with NIHSS and mRS scores and positively correlated with MBI score （P＜0.05）. FA value of the CST on the affected side， both before and after treatment， were negatively correlated with NIHSS score and positively correlated with FMA score （P＜0.05 or P＜0.01）. ConclusionZGP decoction can effectively improve neurological function， motor function， and activities of daily living in IS patients with liver-kidney yin deficiency syndrome， and its mechanism may be related to enhanced cerebral perfusion in the affected hemisphere and corticospinal tract structural remodeling.

[Objective]To analyze the manipulation and acupoint selection rules of Tuina treatment for adolescent idiopathic scoliosis(AIS).[Methods]Clinical research literature on Tuina treatment for AIS was searched in databases such as China National Knowledge Infrastructure(CNKI),VIP Database,WanFang Data,China Biology Medicine disc(CBMdisc)and PubMed from database establishment date to November 31,2024.Frequency statistics,association rules and cluster analysis were performed on the data by using R Studio 4.3.0 software,and the analysis results were visualized.[Results]A total of 122 clinical research articles on Tuina treatment for AIS were included,among which 116 were Chinese articles and 6 were English articles.These studies were extracted 122 tuina prescriptions,which involved 75 types of Tuina techniques,with a total application frequency of 376 times.The technique with the highest application frequency was the kneading method.A total of 19 acupoint prescriptions were extracted,involving 48 acupoints with a frequency of 119,among which Shenshu was the most frequently used acupoint.The acupoints mainly belonged to the Bladder Meridian of Foot-Taiyang,the Governing Vessel,the Kidney Meridian of Foot-Shaoyin,the Liver Meridian of Foot-Jueyin and some Extra-meridian Points.Among the combinations of manipulations and acupoints,kneading and Shenshu were used most frequently in combination with other manipulations and acupoints.Association rule network analysis showed that Dachangshu,Shenshu,Weizhong and Chengfu were strongly correlated among acupoints;kneading,pressing and Tuina were strongly correlated among manipulations.In the cluster analysis results,high-frequency acupoints formed 5 effective clusters and high-frequency manipulations formed 3 effective clusters.[Conclusion]Tuina treatment of AIS mainly uses loosening and pulling manipulations as a supplement,focusing on adjusting the balance of Yin and Yang of the spine;the selection of acupoints is mainly in local part combined with those along the meridians.

[Objective]To analyze the manipulation and acupoint selection rules of Tuina treatment for adolescent idiopathic scoliosis(AIS).[Methods]Clinical research literature on Tuina treatment for AIS was searched in databases such as China National Knowledge Infrastructure(CNKI),VIP Database,WanFang Data,China Biology Medicine disc(CBMdisc)and PubMed from database establishment date to November 31,2024.Frequency statistics,association rules and cluster analysis were performed on the data by using R Studio 4.3.0 software,and the analysis results were visualized.[Results]A total of 122 clinical research articles on Tuina treatment for AIS were included,among which 116 were Chinese articles and 6 were English articles.These studies were extracted 122 tuina prescriptions,which involved 75 types of Tuina techniques,with a total application frequency of 376 times.The technique with the highest application frequency was the kneading method.A total of 19 acupoint prescriptions were extracted,involving 48 acupoints with a frequency of 119,among which Shenshu was the most frequently used acupoint.The acupoints mainly belonged to the Bladder Meridian of Foot-Taiyang,the Governing Vessel,the Kidney Meridian of Foot-Shaoyin,the Liver Meridian of Foot-Jueyin and some Extra-meridian Points.Among the combinations of manipulations and acupoints,kneading and Shenshu were used most frequently in combination with other manipulations and acupoints.Association rule network analysis showed that Dachangshu,Shenshu,Weizhong and Chengfu were strongly correlated among acupoints;kneading,pressing and Tuina were strongly correlated among manipulations.In the cluster analysis results,high-frequency acupoints formed 5 effective clusters and high-frequency manipulations formed 3 effective clusters.[Conclusion]Tuina treatment of AIS mainly uses loosening and pulling manipulations as a supplement,focusing on adjusting the balance of Yin and Yang of the spine;the selection of acupoints is mainly in local part combined with those along the meridians.

BACKGROUND: Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions. RESULTS: A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission ( P = 0.02) and the length of hospital stay ( P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions. CONCLUSION: For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; CRD 42022363945.
Humans ; Randomized Controlled Trials as Topic ; Fluid Therapy ; Hypovolemia ; Pancreatitis/therapy*

Objective: The research was aimed at exploring the effects of mandelic acid on the proliferation , apoptosis and migration of H1299 lung adenocarcinoma (LUAD) cells and the related molecular mechanisms. Methods: CCK⁃8 was used to detect changes in the proliferation ability of H1299 cells;Hoechst 33258/PI double⁃staining assay was used to analyze the apoptosis of H1299 cells;Transwell and migration assays were used to analyze changes in the invasive and migration ability of H1299 cells;Western blot was used to detect the expression of proliferation ,apoptosis and migration⁃related pathway proteins. Results : Different concentrations of mandelic acid inhibited the proliferation viability and invasion and migration ability of H1299 cells (P < 0. 05) . Mandelic acid induced high expression of bax and cl⁃caspase⁃3 and low expression of p ⁃stat3 in proliferation and apoptosis pathways (P < 0. 05) .In addition , it inhibited the expression of MMP⁃9 and Vimentin proteins ,which were related to invasion and migration (P < 0. 01) . Conclusion Mandelic acid inhibited the proliferation of H1299 LUAD cells and elevated the level of apoptosis , and molecular biological mechanism might be closely related to the decreased activation of stat3 and activation of bax/caspase⁃3 signaling axis. The inhibition of invasive and migrational ability of H1299 cells induced by mandelic acid was associated with the decreased expression of MMP⁃9 and Vimentin proteins.

Objective:To analyze the effect of percutaneous transluminal angioplasty (PTA) in the treatment of autogenous arteriovenous fistula (AVF) stenosis and influcing factors of restenosis/loss of function after PTA.Methods:The medical records of 104 patients with AVF stenosis treated by PTA in People′s Hospital of Huadu District from March 2019 to July 2020 and the 1-year follow-up were retrospectively analyzed. Kaplan-meier curves were used to analyze the primary patency rates at 3 months, 6 months and 1 year. COX regression was used to analyze the influencing factors of restenosis/loss of function after PTA.Results:The primary patency rates of AVF at 3, 6 and 12 months after PTA were 86.2%, 83.2% and 64.7%, respectively. Guide wire entry into the distal end of radial artery, the use of two balloons in stepwise mode, postoperative dilatation diameter, and dialysis blood flow after PTA were independent risk factors for restenosis/loss of fuction after PTA for AVF stenosis (all P<0.05). Conclusions:The guide wire into the distal end of the artery and passive use of more than two balloons are important factors affecting AVF restenosis/loss of function after PTA .

Objective:To evaluate the placental micro-vascular circulation by microvascular flowing imaging (MVFI) method, and to explore the clinical value of microvascular index (MVI) for the diagnosis of fetal growth restriction (FGR).Methods:A total of 21 fetuses at 24-34 weeks of gestation at the Peking Union Medical College Hospital from October to November 2019 were enrolled in this study, including 7 fetal growth restriction (FGR) fetuses, and 14 normal fetuses as control group. The fetuses of the two groups were matched according to the gestational weeks at the ratio of 1∶2. Fetal biometry parameters were measured and the placenta was observed by two-dimensional ultrasound.Uterine artery pulse index (UtA-PI), middle cerebral artery pulse index (MCA-PI), and umbilical artery S/D ratio were evaluated by color and pulse-wave Doppler. The placenta mico-circulation was displayed by the MVFI method and MVI was measured.Results:The study included 14 normal fetuses and 7 FGR fetuses. Compared with the control group, more placenta in the FGR group manifested as thickened and heterogeneous with decreased MVI and increased UtA-PI. There was statistically significant difference in placental mean MVI between two groups ( P=0.044). Besides, a trend towards significant negative correlation was observed between MVI and placenta thickness, although this was not statistically significant ( rs=-0.35, P=0.065). MVI had a higher specificity (100%) in the prediction of FGR. Conclusions:MVFI can display the micro-circulation of the placenta, and provide a direct and quantitative assessment method for placental perfusion.

To investigate the prenatal sonographic feature in the early diagnosis of amniotic band syndrome at 11 －14 weeks′ gestation . Methods A retrospective study was conducted to analysis and summarize the ultrasonographic features of 4 fetuses without band‐like echoes in amniotic cavity at 11－14 weeks′gestation ,but verified as amniotic band syndrome in Peking Union M edical College Hospital . Results T wo cases ( cases 1 ,2) showed the fixed head position with skull defect and intracranial structure disorders . Cases 3 and 4 showed one upper limb in a fixed position ,and the hand seemed to adhere to the umbilical cord isolatedly . In addition ,case 1 showed complete chorioamniotic membrane separation . T here were multiple band‐like echoes adhered to body of 3 fetals during the follow‐up scan at 14 －18 weeks . T he parents of cases 1 and 2 chose to terminate the pregnancy after counseling ,the other 2 cases also induced labor due to intrauterine fetal death at 15+2 weeks and 19+2 weeks respectively . All 4 cases were confirmed as amniotic band syndrome by pathology . Conclusions When the fetal sonographic images showed fixed head position ,disordered intracranial structure ,or adhesion between umbilical cord and hand with limited movement at 11 －14 weeks′ gestation ,it should be paid attention to observing the band‐like echoes and followed up closely to prevent missed diagnosis of amniotic band syndrome .