Addressing the enduring challenge of evaluating traditional Chinese medicines (TCMs), the integrated evidence chain-based effectiveness evaluation of TCMs (Eff-iEC) has emerged. This paper explored its capacity through a demonstration study that evaluated the effectiveness evidence of six commonly used anti-hepatic fibrosis Chinese patent medicines (CPMs), including Biejiajian Pill (BP), Dahuang Zhechong Pill (DZP), Biejia Ruangan Compound (BRC), Fuzheng Huayu Capsule (FHC), Anluo Huaxian Pill (AHP), and Heluo Shugan Capsule (HSC), using both Eff-iEC and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The recognition of these CPMs within the TCM academic community was also assessed through their inclusion in relevant medical documents. Results showed that the evidence of BRC and FHC received higher assessments in both Eff-iEC and GRADE system, while the assessments for others varied. Analysis of community recognition revealed that Eff-iEC more accurately reflects the clinical value of these CPMs, exhibiting superior evaluative capabilities. By breaking through the conventional pattern of TCMs effectiveness evaluation, Eff-iEC offers a novel epistemology that better aligns with the clinical realities and reasoning of TCMs, providing a coherent methodology for clinical decision-making, new drug evaluations, and health policy formulation.

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 explore the efficacy of a new classification system proposed by us applied to the treatment of irreducible intertrochanteric femoral fractures.Methods:A retrospective study was conducted to analyze the clinical data of the 225 patients with irreducible intertrochanteric femoral fracture who had been treated between January 2023 and November 2024 at Zhengzhou Orthopedic Hospital (78 cases), The First Affiliated Hospital of Zhengzhou University (61 cases), Zhengzhou Central Hospital Affiliated to Zhengzhou University (28 cases), Zhengzhou Hospital of Traditional Chinese Medicine (34 cases), and Puyang Hospital of Traditional Chinese Medicine (24 cases). There were 86 males and 139 females, with an age of (74.8±7.9) years. Satisfactory reduction had failed in all patients even after 3 attempts at closed reduction. The patients were divided into 2 groups based on whether the new classification system proposed by our research team in our previous study was used to guide the treatment. The observation group of 116 cases were treated through an extended incision at the head of the intramedullary nail for reduction and fixation under the guidance of the new classification system while the control group of 109 cases were treated by reduction and fixation through a direct anterolateral incision. The operation time, intraoperative blood loss, fracture healing time, Harris hip scores at 3 months after operation and the last follow-up, and incidence of complications were compared between the 2 groups.Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (12.6±2.5) months after operation. The operation time, intraoperative blood loss, and fracture healing time [(39.5±9.7) minutes, (106.6±54.8) mL, and (3.1±0.7) months] in the observation group were significantly less than those in the control group [(70.2±11.1) minutes, (322.8±55.5) mL, and (4.5±0.7) months] ( P<0.05). The Harris hip scores at 3 months after operation and the last follow-up in the observation group [(90.3±3.4) points and (93.7±3.2) points] were significantly higher than those in the control group [(75.1±3.8) points and (78.7±3.6) points] ( P<0.05). The incidence of complications in the observation group was 6.0% (7/116), significantly lower than that in the control group [14.7% (16/109)] ( P<0.05). Conclusion:In the treatment of irreducible intertrochanteric femoral fractures, compared with the conventional anterolateral approach for intramedullary nailing, the extended intramedullary head nail approach guided by our new classification system can reduce operation time, intraoperative blood loss, fracture healing time, and incidence of postoperative complications, and improve postoperative hip joint function.

Objective To discuss the short-term efficacy and safety of primary percutaneous reduction combined with robotic-assisted screw placement for the treatment of Sanders type Ⅲ and Ⅳ calcaneal frac-tures.Methods A total of 52 patients(52 feet)with Sanders type Ⅲ and Ⅳ calcaneal fractures admitted to this hospital from August 2022 to October 2024 were selected as the study subjects.33 patients were treated with robot assisted screw placement(the observation group),including 23 cases of Sanders type Ⅲ patients(4 cases of AC type,16 cases of AB type,3 cases of BC type)and 10 cases of Sanders type Ⅳ patients;19 patients underwent manual screw placement under C-arm X-ray fluoroscopy(the control group),including 14 cases of Sanders type Ⅲ(5 cases of AC type,9 cases of AB type)and 5 cases of Sanders Ⅳ type.The B?hler angle,Gissane angle,calcaneal height,calcaneal width,and calcaneal length were compared between the two groups at 3 and 12 months after surgery.The differences in the time from injury to surgery,intraoperative blood loss,number of intraoperative fluoroscopies,total incision length,operation time,number of screws inserted,num-ber of punctures,hospital stay,fracture healing time,and proportion of tarsal sinus incision-assisted reduction between the two groups were evaluated and compared.The American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score,excellent rate of function and visual analog scale(VAS)pain score after surgery were also compared,and the incidence of postoperative complications between the two groups were compared to evaluate safety.Results Both groups of patients were followed up for more than 12 months after surgery.At 3 and 12 months postoperatively,B?hler's angle,Gissane's angle,calcaneal length,calcaneal height,and calcaneal width in both groups showed significant improvements compared to preopera-tive measurements,but there was no statistically significant difference between the two groups(P＞0.05).The intraoperative blooding loss,number of intraoperative fluoroscopies,operation time,and number of punc-tures in the observation group were all lower than those in the control group,and the differences were statisti-cally significant(P＜0.05);There was no statistically significant difference in the time from injury to surger-y,total incision length,number of screws inserted,hospital stay,fracture healing time,proportion of tarsal si-nus incision-assisted reduction,and excellent rate of function between the two groups of patients(P＞0.05).The AOFAS ankle and hindfoot function score of the observation group was higher than that of the control group at 3 months after surgery,and the VAS pain scores in the early postoperative period was lower than that of the control group,the differences were statistically significant(P＜0.05).The incidence of complications such as lower ankle pain,traumatic arthritis,and plantar pain in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion Com-pared with manual screw placement,primary percutaneous reduction combined with robotic-assisted screw placement for the treatment of Sanders type Ⅲ and Ⅳ calcaneal fractures is more effective,safe,precise,mini-mally invasive and efficient,with less intraoperative bleeding and lower incidence of complications.

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 explore the efficacy of a new classification system proposed by us applied to the treatment of irreducible intertrochanteric femoral fractures.Methods:A retrospective study was conducted to analyze the clinical data of the 225 patients with irreducible intertrochanteric femoral fracture who had been treated between January 2023 and November 2024 at Zhengzhou Orthopedic Hospital (78 cases), The First Affiliated Hospital of Zhengzhou University (61 cases), Zhengzhou Central Hospital Affiliated to Zhengzhou University (28 cases), Zhengzhou Hospital of Traditional Chinese Medicine (34 cases), and Puyang Hospital of Traditional Chinese Medicine (24 cases). There were 86 males and 139 females, with an age of (74.8±7.9) years. Satisfactory reduction had failed in all patients even after 3 attempts at closed reduction. The patients were divided into 2 groups based on whether the new classification system proposed by our research team in our previous study was used to guide the treatment. The observation group of 116 cases were treated through an extended incision at the head of the intramedullary nail for reduction and fixation under the guidance of the new classification system while the control group of 109 cases were treated by reduction and fixation through a direct anterolateral incision. The operation time, intraoperative blood loss, fracture healing time, Harris hip scores at 3 months after operation and the last follow-up, and incidence of complications were compared between the 2 groups.Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (12.6±2.5) months after operation. The operation time, intraoperative blood loss, and fracture healing time [(39.5±9.7) minutes, (106.6±54.8) mL, and (3.1±0.7) months] in the observation group were significantly less than those in the control group [(70.2±11.1) minutes, (322.8±55.5) mL, and (4.5±0.7) months] ( P<0.05). The Harris hip scores at 3 months after operation and the last follow-up in the observation group [(90.3±3.4) points and (93.7±3.2) points] were significantly higher than those in the control group [(75.1±3.8) points and (78.7±3.6) points] ( P<0.05). The incidence of complications in the observation group was 6.0% (7/116), significantly lower than that in the control group [14.7% (16/109)] ( P<0.05). Conclusion:In the treatment of irreducible intertrochanteric femoral fractures, compared with the conventional anterolateral approach for intramedullary nailing, the extended intramedullary head nail approach guided by our new classification system can reduce operation time, intraoperative blood loss, fracture healing time, and incidence of postoperative complications, and improve postoperative hip joint function.

Although carbon monoxide (CO)-based treatments have demonstrated the high cancer efficacy by promoting mitochondrial damage and core-region penetrating ability, the efficiency was often compromised by protective autophagy (mitophagy). Herein, cannabidiol (CBD) is integrated into biomimetic carbon monoxide nanocomplexes (HMPOC@M) to address this issue by inducing excessive autophagy. The biomimetic membrane not only prevents premature drugs leakage, but also prolongs blood circulation for tumor enrichment. After entering the acidic tumor microenvironment, carbon monoxide (CO) donors are stimulated by hydrogen oxide (H₂O₂) to disintegrate into CO and Mn²⁺. The comprehensive effect of CO/Mn²⁺ and CBD can induce ROS-mediated cell apoptosis. In addition, HMPOC@M-mediated excessive autophagy can promote cancer cell death by increasing autophagic flux via class III PI3K/BECN1 complex activation and blocking autolysosome degradation via LAMP1 downregulation. Furthermore, in vivo experiments showed that HMPOC@M+ laser strongly inhibited tumor growth and attenuated liver and lung metastases by downregulating VEGF and MMP9 proteins. This strategy may highlight the pro-death role of excessive autophagy in TNBC treatment, providing a novel yet versatile avenue to enhance the efficacy of CO treatments. Importantly, this work also indicated the applicability of CBD for triple-negative breast cancer (TNBC) therapy through excessive autophagy.

Background:Gastroesophageal reflux disease(GERD)is a common digestive disorder,but its underlying causes are still unclear.Patients with GERD often experience anxiety,depression,and ineffective esophageal motility.However,there have been limited studies on the relationship between anxiety/depression and esophageal motility.Aims:To investigate the mental state of patients with different subtypes of GERD and explore its correlation with esophageal motility.Methods:From September 2018 to June 2022,a total of 96 outpatients presenting typical acid reflux and heartburn symptoms with a GerdQ score≥10 were enrolled at Jincheng People's Hospital.They were divided into two groups based on gastroscopy findings:non-erosive reflux disease(NERD)group(77 cases)and reflux esophagitis(RE)group(19 cases).General data,clinical symptoms,anxiety/depression scores,and high-resolution esophageal manometry results were compared between the two groups using t-test,chi-square test,and Spearman correlation analysis.Results:There was a statistically significant difference between the NERD group and RE group(P<0.05),with more females in the NERD group.The self-rating anxiety scale(SAS)scores were significantly higher in the NERD group[44.00(29.00-58.00)]compared to the RE group[23.00(20.00-29.38)],indicating a greater presence of anxiety in the NERD group than in the RE group;this difference was statistically significant(P<0.01).However,there was no significant difference in self-rating depression scale(SDS),Hamilton anxiety scale(HAMA),or Hamilton depression scale(HAMD)scores between the two groups.Furthermore,a negative correlation was observed between distal contractile integral(DCI)values and SAS scores among GERD patients(P<0.05).Additionally,a small negative correlation existed between DCI values and SDS,HAMA,and HAMD(P>0.05).Conclusions:The NERD group exhibits a more pronounced anxiety state compared to the RE group.Furthermore,there exists a negative correlation between the anxiety state of GERD patients and DCI,suggesting that anxiety may influence esophageal motility involvement in the pathogenesis of GERD.

Objective:To investigate the etiological characteristics and drug resistance of non-typhoid Salmonella isolated from stool samples of children under 5 years old with diarrhea in Henan Province. Methods:Intestinal bacteria were isolated from fecal samples of 4 250 diarrhea children under five years old in five monitoring sites in Henan Province from 2015 to 2018. Serotypes and drug sensitivity of Salmonella strains were analyzed. The annual change in drug resistance was analyzed by Chi-square test and all data were analyzed retrospectively. Results:The detection rate of non-typhoid Salmonella in fecal samples was 8.73% (371/4 250). The highest detection rate was in the 0-1 age group (51.75%) and the peak season for Salmonella infection was from May to October. The most common serotype was Salmonella enteritidis (36.93%), followed by 4, 5, 12: i: - Salmonella (14.82%) and Salmonella typhimurium (14.02%). The non-typhoid Salmonella isolates were resistant to ampicillin and sulfamethoxazole with drug resistance rates of more than 80%, but more sensitive to ceftazidime, cefepime and cefoxitin. There were significant differences in drug resistance to cefepime, levofloxacin, ciprofloxacin, amikacin, doxycycline, chloramphenicol and compound neoforman among the strains isolated in different years ( P<0.05). Multidrug-resistant strains accounted for 86.52%. Conclusions:There was diversity in the serotypes of non-typhoid Salmonella in diarrheal children under five years old in Henan Province. The predominant serotype was Salmonella enteritidis. Drug resistance to common antibiotics was detected in the isolates, and most of them were multidrug-resistant.

ObjectiveA HPLC-FLD method was developed to determine the levels of serum AAA in CRIpatients, and to studythe variationof serum AAAinCRI patientsanditsclinical significances. MethodsSerumsampleswerecollected from100healthcontrolsand 80CRI patients. According to 2002 National Kidney Foundation (NKF) staging diagnosis, CRI patients included 4 of stage 2, 12 of stage 3, 12 of stage 4, 52 of stage 5. According to pathogenesis, CRI patients were also divided into 3 groups :chronic nephritis group ( n = 32), DM group ( n = 36), hypertension group ( n = 12 ).Serums were deproteinized by equal volume of 5％ (v/v) PCA and supernate were analyzed direcdy. External standard method was used as quantitative method. The analytical column was Megres C18. 10％ acetonitrile in water was used as mobile phase. Flow rote was 1.0 ml/min. The wavelengths of fluorescence excitation and emission were changed with specific time. The levels of Tyr, Phe and Trp in CRI groups, different CKD stages and different pathogenesis were compared with healthy control groups to evaluated the sensitivity and specificity of serum AAA for CRI diagnosis. ResultsThe linear ranges of the method were 0. 550 -275.000, 3. 050 - 1220. 000 and 0. 049 -49. 000 pμmol/L for Tyr, Phe and Trp, respectively. The limit of detection (LOD) was 0.014 μmol/L for Tyr, 0.500μmol/L for Phe, and 0.005 μmol/L for Trp. The average recovery was 100. 9％, 101.3％ and 98. 5％ for Tyr, Phe and Trp, respectively. Intra-day CVwas 3. 18％ -4. 20％ ( mean was 3. 13％ )and inter-day CV was 3. 18％ -4. 20％ ( mean was 3. 58％ ). The concentration of serum AAA, Tyr and Trp and the ratio of Tyr/Phe in CRI patients were( 135.74 ±23.23 )μmol/L, (52.27 +8.25) μmol/L, (21.49 ±4.25) μmol/L and[0.87(0.68 - 1.05)]μmol/L. which were lower than that in healthy groups (t value was -14. 709, 4.452, 22. 100, U value was 266.000,respectively, P＜0. 05). The concentration of serum AAA, Tyr and Trp and the ratio of Tyr/Phe in healthy groups were ( 174. 47 ± 11.57 ) μmol/L, ( 63.53 ± 4. 68 ) μmol/L, (44. 22 ± 3. 67 ) μmol/L and[0. 97(0. 94 - 1.00)]μmoL/L. There were no statistically significant difference between the different stage of CRI. Compared with the concentration of Tyr, Phe and Trp among chronic nephritis group, DM group,hypertension group, the concentration of Tyr had no significant changes among these three kinds of diseases (P ＞ 0. 05 ). The concentration of Phe had significant changes between Chronic nephritis group and DM group, Chronic nephritis group and hypertension group ( U = 395.00, 114. 00, P ＜ 0. 05 ) ; the concentration of Trp haad significant changes between Chronic nephritis group and DM group ( U = 349.00, P ＜ 0. 05 ).The diagnostic sensitivity and specificity of serum AAA for CRI were 90％ (72/80) and 100. 0％ (100/100).ConclusionsThe method of high-performance liquid chromatography with fluorescence detection ( HPLC-FLD) is simple, rapid, sensitive and specific. Simultaneous determination of serum AAA was benefit to the diagnosis and evaluation of CRI patients.