Objective To observe the therapeutic effect and mechanism of external application with Shilian Powder combined with oral administration of Shumai Capsules for the treatment of rats with diabetic foot ulcer(DFU).Methods Eight male rats with successfully modeled foot ulcer(DF)were used as the control group.While 24 male rats with successfully modeled DFU were randomly divided into DFU group,Shumai Capsules group and Shilian Powder combined with Shumai Capsules group,with eight rats in each group.After the corresponding interventions,we determined the wound healing rate,histopathological changes of wound,levels of inflammatory factors such as interleukin(IL)-6,IL-1β and vascular endothelial growth factor(VEGF)in serum,levels of Apelin and Relaxin,and protein expressions of phosphatidylinositol 3-kinase(PI3K),protein kinase B(AKT)and VEGF in wound tissue,as well as mRNA expressions of PI3K,AKT,Relaxin and Apelin.Results Compared with the control group,the DFU group showed a significant decrease in wound healing rate,VEGF level in serum and wound,wound Relaxin level,protein and mRNA levels of wound AKT(P<0.05),and a significant increase in serum IL-6 and IL-1β levels,wound Apelin level,wound PI3K protein and mRNA levels(P<0.05),and the reduced wound granulation tissue and formation of new capillaries and increased inflammatory cell infiltration were seen under the microscope.Compared with the DFU group,the wound healing rate,VEGF level in serum and wound,wound Relaxin and Apelin levels,protein and mRNA levels of wound PI3K and AKT in the Shumai Capsules group and Shilian Powder combined with Shumai Capsules group were significantly increased(P<0.05),and serum IL-6 and IL-1β levels were significantly decreased(P<0.05),and the increased wound granulation tissue and formation of new capillaries and reduced inflammatory cell infiltration were seen under the microscope.Compared with the Shumai Capsules group,the wound healing rate,wound VEGF level,wound Relaxin and Apelin levels,protein and mRNA levels of wound PI3K and AKT in Shilian Powder combined with Shumai Capsules group were significantly increased(P<0.05),and the serum IL-6 and IL-1β levels were significantly decreased(P<0.05),and the increased wound granulation tissue and formation of new capillaries and reduced inflammatory cell infiltration were seen under the microscope.Conclusion External application with Shilian Powder combined with oral administration of Shumai Capsules can promote the wound healing in rats with DFU,its mechanism is related to the activation of PI3K/AKT/Relaxin/Apelin signaling pathway.

Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

Objective:To investigate the relationship between sagittal position parameters and screw loosening after unilateral biportal endoscopic (UBE) combined with percutaneous pedicle screw fixation for single-segment lumbar spinal stenosis.Methods:A total of 180 patients with single-level lumbar spinal stenosis who received UBE combined with percutaneous pedicle screw internal fixation in our hospital from June 2020 to June 2023 were enrolled. According to the postoperative follow-up, they were divided into the non-loosening group (112 cases) and the loosening group (68 cases). The demographics, operative parameters and sagittal position [pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA)] before and after operation were compared between the two groups. The indicators with significant differences between the two groups were included in the multivariate logistic regression analysis to analyze the influencing factors of screw loosening. The dose-response relationship between sagittal position parameters and screw loosening was analyzed by restricted cubic spline model.Results:At 6 months and 1 year postoperatively, the fusion rates in the loosening group were 47.1% and 55.9%, respectively, which were significantly lower than the rates (85.7% and 100.0%) in the non-loosening group, respectively ( P<0.05). Postoperatively, the SS in the non-loosening group (36.16°±5.35°) and the loosening group (32.02°±5.54°) and the LL in the loosening group (51.26°±6.35°) were all significantly lower than preoperative values (40.51°±6.11°, 40.49°±6.08°, and 54.08°±6.21°) ( P<0.05). Meanwhile, the PT in the non-loosening group (15.24°±2.69°), TK in the non-loosening group (32.46°±7.29°), PI in the loosening group (56.82°±5.23°), PT in the loosening group (17.01°±3.64°), and TK in the loosening group (34.87°±7.21°) were all significantly higher than preoperative values (13.12°±3.19°, 30.25°±5.17°, 52.84°±5.12°, 13.15°±3.21°, and 30.26°±5.12°) ( P<0.05). Postoperatively, the loosening group had significantly lower SS (32.02°±5.54°), LL (51.26°±6.35°), and SVA (-0.87±1.06 cm) than the non-loosening group (36.16°±5.35°, 53.73°±6.27°, and -0.51±1.04 cm), respectively ( P<0.05). Conversely, the PI (56.82°±5.23°), PT (17.01°±3.64°), and TK (34.87°±7.21°) in the loosening group were significantly higher than those in the non-loosening group (53.48°±5.20°, 15.24°±2.69°, and 32.46°±7.29°), respectively ( P<0.05). Binary logistic regression analysis indicated that PT, SS, LL, and SVA were independent risk factors for screw loosening ( P<0.05). The restricted cubic spline model revealed a nonlinear dose-response relationship between sagittal parameters (PT, SS, LL, and SVA) and screw loosening ( P<0.05). With increasing PT, the odds ratio (OR) for screw loosening increased, whereas increasing SS, LL, and SVA reduced the OR for screw loosening. Conclusion:After UBE combined with percutaneous pedicle screw fixation in single-level lumbar spinal stenosis patients, sagittal position parameters PT were positively correlated with screw loosening, while SS, LL and SVA were negatively correlated with screw loosening.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objectives:To explore the relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic(UBE)spinal surgery in patients with lumbar disc herniation of different ages.Methods:200 patients with lumbar disc herniation who underwent UBE surgery in our hospital from December 2018 to October 2022 were selected as the study subjects.They were divided into two groups according to ages:94 patients under 45 years old were included in the young and middle-aged group,and 106 patients at 45 years old and over were included in the middle-aged and elderly group.The spinal-pelvic sagittal sequence parameters,including thoracic kyphosis(TK),pelvic incidence(PI),pelvic tilt(PT),lumbar lordosis(LL),sacral slope(SS),were measured on preoperative lateral X-ray films of the entire spine.The relationship between spinal-pelvic sagittal parameters and age was studied using Pearson analysis.After discharge,the patients were followed up for 2 years and divided into a recurrent group(n=33)and a non-recurrent group(n=167)based on the recurrence condition during the follow-up period.Multivariate logis-tic regression analysis was conducted to identify the influencing factors of recurrence.The receiver operating characteristic curve(ROC)was adopted to evaluate the predictive value of spinal-pelvic sagittal parameters for recurrence;And the area under the ROC curve(AUC)was determined,and the 95％confidence interval(CI)was calculated.Results:The LL,PI,PT,and SS of the middle-aged and elderly group were lower than those of the young and middle-aged group(t=5.960,2.163,2.245,2.296,P＜0.05).Pearson analysis showed that LL,PI,PT,and SS were negatively correlated with age(r=-0.67,-0.72,-0.65,-0.63,P＜0.001).The proportion of patients aged ≥45 years and with a annulus fibrosus rupture＞5mm in the recurrent group was higher than that in the non-recurrent group,while LL,PI,and SS were lower than those in the non-recurrent group(P＜0.05).Multivariate logistic regression analysis showed that age ≥45 years old was an independent risk factor for recurrence(OR=2.694,95％CI:2.231-2.945,P＜0.05),while elevated LL(OR=0.623,95％CI:0.435-0.895,P＜0.05)and elevated SS were protective factors for recurrence(OR=0.687,95％CI:0.412-0.738,P＜0.05).The ROC curve results showed that the AUC for predicting patient recurrence using LL and SS were 0.743(95％CI:0.670-0.856)and 0.754(95％CI:0.669-0.872),respectively.The AUC for predicting patient recurrence us-ing both methods was 0.852(95％CI:0.769-0.903).Conclusions:The parameters of the spinal-pelvic sagittal sequence are closely related to age and postoperative recurrence risk.Age ≥45 years is an independent risk factor for postoperative recurrence,while higher LL and SS are protective factors.Preoperative evaluation of spinal-pelvic sagittal sequence,especially LL and SS,can help identify high-risk populations for UBE postop-erative recurrence and provide important references for individualized surgical strategies.

Objective:To investigate the relationship between sagittal position parameters and screw loosening after unilateral biportal endoscopic (UBE) combined with percutaneous pedicle screw fixation for single-segment lumbar spinal stenosis.Methods:A total of 180 patients with single-level lumbar spinal stenosis who received UBE combined with percutaneous pedicle screw internal fixation in our hospital from June 2020 to June 2023 were enrolled. According to the postoperative follow-up, they were divided into the non-loosening group (112 cases) and the loosening group (68 cases). The demographics, operative parameters and sagittal position [pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA)] before and after operation were compared between the two groups. The indicators with significant differences between the two groups were included in the multivariate logistic regression analysis to analyze the influencing factors of screw loosening. The dose-response relationship between sagittal position parameters and screw loosening was analyzed by restricted cubic spline model.Results:At 6 months and 1 year postoperatively, the fusion rates in the loosening group were 47.1% and 55.9%, respectively, which were significantly lower than the rates (85.7% and 100.0%) in the non-loosening group, respectively ( P<0.05). Postoperatively, the SS in the non-loosening group (36.16°±5.35°) and the loosening group (32.02°±5.54°) and the LL in the loosening group (51.26°±6.35°) were all significantly lower than preoperative values (40.51°±6.11°, 40.49°±6.08°, and 54.08°±6.21°) ( P<0.05). Meanwhile, the PT in the non-loosening group (15.24°±2.69°), TK in the non-loosening group (32.46°±7.29°), PI in the loosening group (56.82°±5.23°), PT in the loosening group (17.01°±3.64°), and TK in the loosening group (34.87°±7.21°) were all significantly higher than preoperative values (13.12°±3.19°, 30.25°±5.17°, 52.84°±5.12°, 13.15°±3.21°, and 30.26°±5.12°) ( P<0.05). Postoperatively, the loosening group had significantly lower SS (32.02°±5.54°), LL (51.26°±6.35°), and SVA (-0.87±1.06 cm) than the non-loosening group (36.16°±5.35°, 53.73°±6.27°, and -0.51±1.04 cm), respectively ( P<0.05). Conversely, the PI (56.82°±5.23°), PT (17.01°±3.64°), and TK (34.87°±7.21°) in the loosening group were significantly higher than those in the non-loosening group (53.48°±5.20°, 15.24°±2.69°, and 32.46°±7.29°), respectively ( P<0.05). Binary logistic regression analysis indicated that PT, SS, LL, and SVA were independent risk factors for screw loosening ( P<0.05). The restricted cubic spline model revealed a nonlinear dose-response relationship between sagittal parameters (PT, SS, LL, and SVA) and screw loosening ( P<0.05). With increasing PT, the odds ratio (OR) for screw loosening increased, whereas increasing SS, LL, and SVA reduced the OR for screw loosening. Conclusion:After UBE combined with percutaneous pedicle screw fixation in single-level lumbar spinal stenosis patients, sagittal position parameters PT were positively correlated with screw loosening, while SS, LL and SVA were negatively correlated with screw loosening.

Objectives:To explore the relationship between preoperative spinal-pelvic sagittal sequence and postoperative recurrence after unilateral biportal endoscopic(UBE)spinal surgery in patients with lumbar disc herniation of different ages.Methods:200 patients with lumbar disc herniation who underwent UBE surgery in our hospital from December 2018 to October 2022 were selected as the study subjects.They were divided into two groups according to ages:94 patients under 45 years old were included in the young and middle-aged group,and 106 patients at 45 years old and over were included in the middle-aged and elderly group.The spinal-pelvic sagittal sequence parameters,including thoracic kyphosis(TK),pelvic incidence(PI),pelvic tilt(PT),lumbar lordosis(LL),sacral slope(SS),were measured on preoperative lateral X-ray films of the entire spine.The relationship between spinal-pelvic sagittal parameters and age was studied using Pearson analysis.After discharge,the patients were followed up for 2 years and divided into a recurrent group(n=33)and a non-recurrent group(n=167)based on the recurrence condition during the follow-up period.Multivariate logis-tic regression analysis was conducted to identify the influencing factors of recurrence.The receiver operating characteristic curve(ROC)was adopted to evaluate the predictive value of spinal-pelvic sagittal parameters for recurrence;And the area under the ROC curve(AUC)was determined,and the 95％confidence interval(CI)was calculated.Results:The LL,PI,PT,and SS of the middle-aged and elderly group were lower than those of the young and middle-aged group(t=5.960,2.163,2.245,2.296,P＜0.05).Pearson analysis showed that LL,PI,PT,and SS were negatively correlated with age(r=-0.67,-0.72,-0.65,-0.63,P＜0.001).The proportion of patients aged ≥45 years and with a annulus fibrosus rupture＞5mm in the recurrent group was higher than that in the non-recurrent group,while LL,PI,and SS were lower than those in the non-recurrent group(P＜0.05).Multivariate logistic regression analysis showed that age ≥45 years old was an independent risk factor for recurrence(OR=2.694,95％CI:2.231-2.945,P＜0.05),while elevated LL(OR=0.623,95％CI:0.435-0.895,P＜0.05)and elevated SS were protective factors for recurrence(OR=0.687,95％CI:0.412-0.738,P＜0.05).The ROC curve results showed that the AUC for predicting patient recurrence using LL and SS were 0.743(95％CI:0.670-0.856)and 0.754(95％CI:0.669-0.872),respectively.The AUC for predicting patient recurrence us-ing both methods was 0.852(95％CI:0.769-0.903).Conclusions:The parameters of the spinal-pelvic sagittal sequence are closely related to age and postoperative recurrence risk.Age ≥45 years is an independent risk factor for postoperative recurrence,while higher LL and SS are protective factors.Preoperative evaluation of spinal-pelvic sagittal sequence,especially LL and SS,can help identify high-risk populations for UBE postop-erative recurrence and provide important references for individualized surgical strategies.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

BACKGROUND:Heterotopic ossification is a dynamic growth process.Diverse heterotopic ossification subtypes have diverse etiologies or induction factors,but they exhibit a similar clinical process in the intermediate and later phases of the disease.Acquired heterotopic ossification produced by trauma and other circumstances has a high incidence. OBJECTIVE:To summarize the molecular biological mechanisms linked to the occurrence and progression of acquired heterotopic ossification in recent years. METHODS:The keywords"molecular biology,heterotopic ossification,mechanisms"were searched in CNKI,Wanfang,PubMed,Embase,Web of Science,and Google Scholar databases for articles published from January 2016 to August 2022.Supplementary searches were conducted based on the obtained articles.After the collected literature was screened,131 articles were finally included and summarized. RESULTS AND CONCLUSION:(1)The occurrence and development of acquired heterotopic ossification is a dynamic process with certain concealment,making diagnosis and treatment of the disease difficult.(2)By reviewing relevant literature,it was found that acquired heterotopic ossification involves signaling pathways such as bone morphogenetic protein,transforming growth factor-β,Hedgehog,Wnt,and mTOR,as well as core factors such as Runx-2,vascular endothelial growth factor,hypoxia-inducing factor,fibroblast growth factor,and Sox9.The core mechanism may be the interaction between different signaling pathways,affecting the body's osteoblast precursor cells,osteoblast microenvironment,and related cytokines,thereby affecting the body's bone metabolism and leading to the occurrence of acquired heterotopic ossification.(3)In the future,it is possible to take the heterotopic ossification-related single-cell osteogenic homeostasis as the research direction,take the osteoblast precursor cells-osteogenic microenvironment-signaling pathways and cytokines as the research elements,explore the characteristics of each element under different temporal and spatial conditions,compare the similarities and differences of the osteogenic homeostasis of different types and individuals,observe the regulatory mechanism of the molecular signaling network of heterotopic ossification from a holistic perspective.It is beneficial to the exploration of new methods for the future clinical prevention and treatment of heterotopic ossification.(4)Meanwhile,the treatment methods represented by traditional Chinese medicine and targeted therapy have become research hotspots in recent years.How to link traditional Chinese medicine with the osteogenic homeostasis in the body and combine it with targeted therapy is also one of the future research directions.(5)At present,the research on acquired heterotopic ossification is still limited to basic experimental research and the clinical prevention and treatment methods still have defects such as uncertain efficacy and obvious side effects.The safety and effectiveness of relevant targeted prevention and treatment drugs in clinical application still need to be verified.Future research should focus on clinical prevention and treatment based on basic experimental research combined with the mechanism of occurrence and development.