ObjectiveTo evaluate the clinical effectiveness and safety of Modified Zhigancao Granules （炙甘草汤加味颗粒） for preventing the early recurrence following radiofrequency ablation in patients with atrial fibrillation （AF） of qi-yin deficiency syndrome. MethodsA multi-center， randomized， double-blind， placebo-controlled trial was designed. A total of 116 patients with atrial fibrillation of qi-yin deficiency syndrome who underwent radiofrequency ablation for the first time were enrolled from 3 centers， and they were randomly divided into a treatment group （59 cases） and a control group （57 cases）. Both groups received basic western medicine treatment after surgery. In addition， the treatment group was given oral Modified Zhigancao Granules， while the control group was given oral placebo granules. The dosage for both groups was 20 g each time， twice a day， with continuous treatment for 12 weeks. The recurrence of atrial fibrillation in both groups was recorded at 24 hours， 4 weeks， 8 weeks， and 12 weeks after surgery. The serum levels of B-type natriuretic peptide （BNP）， interleukin-6 （IL-6）， high-sensitivity C-reactive protein （hs-CRP）， and tumor necrosis factor-α （TNF-α） were detected before treatment and 12 weeks after treatment in both groups. The scores of Atrial Fibrillation Effect on QualiTy-of-life （AFEQT） Questionnaire （including scores of the daily life dimension， symptom dimension， treatment worry dimension， treatment satisfaction dimension， and total score） and traditional Chinese medicine （TCM） syndrome scores were compared before treatment and at 4 weeks， 8 weeks， and 12 weeks between groups. Safety indicators such as blood routine， urine routine， liver function， and renal function were monitored before and after treatment. ResultsNine of the treatment group and seven of the control group dropped out. Finally， 50 patients in each group were included in the statistical analysis. At 24 hours， 4 weeks， 8 weeks， and 12 weeks after surgery， the recurrence rates of AF in the treatment group were 2.0% （1/50）， 2.0% （1/50）， 4.0% （2/50）， and 10.0% （5/50）， respectively； while those in the control group were 2.0% （1/50）， 26.0% （13/50）， 28.0% （14/50）， and 34.0% （17/50）， respectively. Compared with the control group at the same time points， the early recurrence rates of AF in the treatment group were significantly lower at 4 weeks， 8 weeks， and 12 weeks after surgery （P＜0.01）. Compared with the baseline within group， BNP， hs-CRP， IL-6， and TNF-α in the treatment group all decreased after 12 weeks of treatment （P＜0.05）； the difference in hs-CRP levels （before vs. after treatment） in the treatment group was higher than that in the control group （P＜0.01）. Compared with the baseline within group， both groups showed decreases in the total score of AFEQT Questionnaire， scores of the daily life dimension， treatment worry dimension， symptom dimension， and TCM syndrome scores at 4 weeks， 8 weeks， and 12 weeks after treatment. Meanwhile， the score of the treatment satisfaction dimension of AFEQT increased in both groups （P＜0.01）， and the improvements in all the above scores in the treatment group were superior to those in the control group at all time points （P＜0.05 or P＜0.01）. All safety indicators of patients in both groups were within the normal range before treatment and at 12 weeks after treatment， and no adverse reactions or adverse events occurred in either group. ConclusionModified Zhigancao Granules can reduce the early recurrence rate following radiofrequency ablation in AF patients with qi-yin deficiency syndrome， improve clinical symptoms and quality of life， suppress inflammatory response， and show good safety.

Objective:To study the risk factors for acute kidney injury (AKI) following one-stage revision surgery combined with intra-articular antibiotics infusion for periprosthetic joint infection (PJI) of the hip joint.Methods:A retrospective analysis was conducted on the data of 168 patients with hip PJI who underwent one-stage revision surgery combined with intra-articular antibiotics infusion in the Department of Joint Surgery, the First Affiliated Hospital of Xinjiang Medical University, from May 1, 2010 to April 30, 2024. There were 87 males and 81 females with an average age of 60.1±14.6 years (range: 21-89 years). The body mass index (BMI) was 24.9±4.6 kg/m 2 (range: 17-41 kg/m 2). PJI was diagnosed according to the criteria of Musculoskeletal Infection Society (MSIS) in 2011. AKI was diagnosed and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. For AKI group and non-AKI group, risk factors were screened by univariate analysis on their age, gender, BMI, BMI≥30 kg/m 2 (yes/no), American Society of Anesthesiologists (ASA) score (II/III), hypertension, diabetes, chronic kidney disease (CKD), surgical side (left/right), duration of intravenous antibiotic use, duration of intra-articular antibiotic use, preoperative blood transfusion, postoperative blood transfusion, baseline hemoglobin value, anemia grade (none/mild/moderate), baseline serum creatinine value, baseline serum creatinine grade (normal/below normal range/above normal range). Variables with P<0.10 were included in the multivariate logistic regression model to identify independent risk factors. Results:The overall incidence of AKI was 9.52%(16/168), among which 50%(8 cases) were stage I AKI, transient and requiring no special treatment. 12.5% (2 cases) were stage II AKI and did not undergo dialysis. 37.5%(6 cases) were stage III AKI. One case needed temporary hemodialysis, and there was no patient requiring long-term dialysis. There were significant differences in age, diabetes, chronic kidney disease and ASA score between AKI group and non-AKI group ( P<0.05). The univariate logistic regression analysis revealed that there were significant differences in age ( P=0.005), BMI ( P=0.078), ASA score level Ⅲ ( P=0.037), diabetes ( P=0.025), CKD ( P=0.003), and low baseline serum creatinine level ( P=0.056). Multivariate logistic regression analysis showed that age, CKD and low baseline serum creatinine level were independent risk factors for AKI ( P<0.05). Conclusions:The incidence of AKI after one-stage revision surgery combined with local antibiotic use in the joint cavity was relatively low in the treatment of PJI after total hip arthroplasty. Hower elderly patients with a history of CKD, or a low baseline serum creatinine level before surgery were at higher risk of developing AKI.

OBJECTIVES: To investigate the effect of Shenge powder (SGP) on myocardial fibrosis in rats with heart failure after myocardial infarction and its relation with lysyl oxidase like protein 2 (LOXL2)/transforming growth factor-β1 (TGF-β1)/IL-11 signaling pathway. METHODS: Seventy-two SPF male SD rats were divided into blank control group, model control group, SGP small dose group, SGP large dose group, positive control group, SGP large dose+LOXL2 activator group, with 12 rats in each group. Except for the blank control group, post-myocardial infarction heart failure was induced by coronary constriction. Corresponding treatments were given immediately after successful modeling, once a day for 4 weeks. Left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF) in rats were detected by color Doppler ultrasound imaging. Levels of IL-1β and IL-6 in serum were analyzed by ELISA method. Myocardial collagen volume fraction (CVF) was evaluated by Masson staining. Expressions of collagen Ⅰ and α-smooth muscle actin (α-SMA) in myocardial tissue were detected by immunohistochemical staining. The mRNA expressions of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) in myocardial tissue were detected by qRT-PCR. Expression of LOXL2, TGF-β1, and IL-11 proteins in myocardial tissue were detected by Western blotting. RESULTS: Compared with the blank control group, the LVFS and LVEF of the model control group decreased, the levels of serum IL-6 and IL-1β elevated, and the CVF value, the expressions of collagen Ⅰ and α-SMA in myocardial tissue, MMP-9 and TIMP-1 mRNA, and LOXL2, TGF-β1, IL-11 proteins increased (all P<0.05). Compared with the model control group, the LVFS and LVEF of SGP small dose group, SGP large dose group and positive control group increased, the levels of serum IL-6 and IL-1β decreased, and the CVF value, the expressions of collagen Ⅰ and α-SMA in myocardial tissue, MMP-9 and TIMP-1 mRNA, and LOXL2, TGF-β1, IL-11 proteins decreased (all P<0.05); while LOXL2 activator reversed the improvement effect of high-dose SGP on myocardial fibrosis in heart failure rats after myocardial infarction. CONCLUSIONS Shenge powder may inhibit myocardial fibrosis in heart failure rats after myocardial infarction by inhibiting the LOXL2/TGF-β1/IL-11 pathway.
Animals ; Male ; Rats, Sprague-Dawley ; Myocardial Infarction/complications* ; Transforming Growth Factor beta1/metabolism* ; Signal Transduction/drug effects* ; Drugs, Chinese Herbal/therapeutic use* ; Rats ; Heart Failure/pathology* ; Myocardium/metabolism* ; Fibrosis ; Amino Acid Oxidoreductases/metabolism* ; Interleukin-11/metabolism* ; Tissue Inhibitor of Metalloproteinase-1/metabolism* ; Matrix Metalloproteinase 9/metabolism*

Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective:To study the risk factors for acute kidney injury (AKI) following one-stage revision surgery combined with intra-articular antibiotics infusion for periprosthetic joint infection (PJI) of the hip joint.Methods:A retrospective analysis was conducted on the data of 168 patients with hip PJI who underwent one-stage revision surgery combined with intra-articular antibiotics infusion in the Department of Joint Surgery, the First Affiliated Hospital of Xinjiang Medical University, from May 1, 2010 to April 30, 2024. There were 87 males and 81 females with an average age of 60.1±14.6 years (range: 21-89 years). The body mass index (BMI) was 24.9±4.6 kg/m 2 (range: 17-41 kg/m 2). PJI was diagnosed according to the criteria of Musculoskeletal Infection Society (MSIS) in 2011. AKI was diagnosed and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. For AKI group and non-AKI group, risk factors were screened by univariate analysis on their age, gender, BMI, BMI≥30 kg/m 2 (yes/no), American Society of Anesthesiologists (ASA) score (II/III), hypertension, diabetes, chronic kidney disease (CKD), surgical side (left/right), duration of intravenous antibiotic use, duration of intra-articular antibiotic use, preoperative blood transfusion, postoperative blood transfusion, baseline hemoglobin value, anemia grade (none/mild/moderate), baseline serum creatinine value, baseline serum creatinine grade (normal/below normal range/above normal range). Variables with P<0.10 were included in the multivariate logistic regression model to identify independent risk factors. Results:The overall incidence of AKI was 9.52%(16/168), among which 50%(8 cases) were stage I AKI, transient and requiring no special treatment. 12.5% (2 cases) were stage II AKI and did not undergo dialysis. 37.5%(6 cases) were stage III AKI. One case needed temporary hemodialysis, and there was no patient requiring long-term dialysis. There were significant differences in age, diabetes, chronic kidney disease and ASA score between AKI group and non-AKI group ( P<0.05). The univariate logistic regression analysis revealed that there were significant differences in age ( P=0.005), BMI ( P=0.078), ASA score level Ⅲ ( P=0.037), diabetes ( P=0.025), CKD ( P=0.003), and low baseline serum creatinine level ( P=0.056). Multivariate logistic regression analysis showed that age, CKD and low baseline serum creatinine level were independent risk factors for AKI ( P<0.05). Conclusions:The incidence of AKI after one-stage revision surgery combined with local antibiotic use in the joint cavity was relatively low in the treatment of PJI after total hip arthroplasty. Hower elderly patients with a history of CKD, or a low baseline serum creatinine level before surgery were at higher risk of developing AKI.

Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective:To investigates the clinical efficacy of the trabecular metal acetabular revision system (TMARS) in one-stage reconstruction of acetabular deficiencies associated with periprosthetic joint infection (PJI).Methods:This is a retrospective case series study,including the data of 59 patients with PJI underwent acetabular defect reconstruction by TMARS during one-stage revisions in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021. There were 32 males and 27 females, aged (59.5±14.6) years (range: 26 to 84 years). Among them, 29 cases used tantalum cups, 13 cases used tantalum cups and tantalum reinforcing blocks, 9 cases used cup-cage, and 8 cases used multi-cup reconstruction techniques. The surgery procedure, Harris Hip score (HHS), recovery of the hip rotation center, implant survival rate, postoperative reinfection rate, and complications were recorded. Data were compared using the Wilcoxon rank-sum test.Results:All of the 59 patients underwent the operations successfully. Operation time was (188.9±48.4) minutes (range: 110 to 340 minutes), and intraoperative bleeding volume was ( M(IQR)) 1 000(400)ml (range: 600 to 1 800 ml). After a postoperative follow-up of 5.1 (2.6) years (range: 2.0 to 10.5 years), the prosthesis survival rate was 94.9% (56/59). Recurrence of infection occurred in 3 cases (5.1%), aseptic loosening in 1case(1.7%), and hip dislocation in 4 cases (6.8%). At the last follow-up, HHS improved significantly(84 (12) vs. 44 (9), Z=-6.671, P<0.01), and the center of rotation of the hips were recovered in all cases. Conclusions:In one-stage revision surgeries aimed at reconstructing acetabular defects, utilizing the TMARS can provide stable initial fixation, restore a more natural center of rotation, significantly enhance early postoperative hip joint function, and reduce the likelihood of infection recurrence. This approach stands as a reliable choice for addressing acetabular defects during revision surgeries for infected hip joints.

Objective:To investigates the clinical efficacy of the trabecular metal acetabular revision system (TMARS) in one-stage reconstruction of acetabular deficiencies associated with periprosthetic joint infection (PJI).Methods:This is a retrospective case series study,including the data of 59 patients with PJI underwent acetabular defect reconstruction by TMARS during one-stage revisions in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021. There were 32 males and 27 females, aged (59.5±14.6) years (range: 26 to 84 years). Among them, 29 cases used tantalum cups, 13 cases used tantalum cups and tantalum reinforcing blocks, 9 cases used cup-cage, and 8 cases used multi-cup reconstruction techniques. The surgery procedure, Harris Hip score (HHS), recovery of the hip rotation center, implant survival rate, postoperative reinfection rate, and complications were recorded. Data were compared using the Wilcoxon rank-sum test.Results:All of the 59 patients underwent the operations successfully. Operation time was (188.9±48.4) minutes (range: 110 to 340 minutes), and intraoperative bleeding volume was ( M(IQR)) 1 000(400)ml (range: 600 to 1 800 ml). After a postoperative follow-up of 5.1 (2.6) years (range: 2.0 to 10.5 years), the prosthesis survival rate was 94.9% (56/59). Recurrence of infection occurred in 3 cases (5.1%), aseptic loosening in 1case(1.7%), and hip dislocation in 4 cases (6.8%). At the last follow-up, HHS improved significantly(84 (12) vs. 44 (9), Z=-6.671, P<0.01), and the center of rotation of the hips were recovered in all cases. Conclusions:In one-stage revision surgeries aimed at reconstructing acetabular defects, utilizing the TMARS can provide stable initial fixation, restore a more natural center of rotation, significantly enhance early postoperative hip joint function, and reduce the likelihood of infection recurrence. This approach stands as a reliable choice for addressing acetabular defects during revision surgeries for infected hip joints.

Objective To explore the expression of autophagy-related gene 5(ATG5)in human malignant pleural mesothelioma(MPM)cells and tissues and analyze the correlation between ATG5expression and patient clinicopathological parameters and prognosis.Methods Real-time quantitative PCR and Western blotting were used to detect differences in ATG5 expression between normal human pleural mesothelial cells and MPM cells and between non-MPM pleural mesothelial tissues and MPM tissues.The Cancer Genome Atlas was used to analyze correlations between ATG5 expression and clinicopathological characteristics and prognosis of patients with MPM.A Cox proportional hazard model was constructed to analyze factors affecting the prognosis of patients with MPM.The Gene Expression Profiling Interactive Analysis database was used to evaluate the correlation between ATG5and MPM tumor markers and novel serum markers.Tumor Immune Estimation Resource was used to analyze correlations between ATG5 and MPM immune cell infiltration and key immune regulatory genes.Results ATG5 was highly expressed in MPM cells and tissues and positively correlated with tumor stage(P<0.05).High ATG5 expression indicated poor prognosis(P<0.05).ATG5expression was significantly associated with various MPM tumor markers(MTAP,SETD2,NF2,and FIB3)and novel serum markers(HMGB1,SMPR,THBS2,and KRAS)(P<0.05).ATG5was associated with immune cell infiltration in MPM(B cells,CD4+T cells,and macrophages)and expression of immune-related genes(CD28,CUL48B,CD166,and MMP14)(P<0.05).Conclusion ATG5 is upregulated in MPM and is associated with poor prognosis and immune cell infiltration.ATG5 could be a key biomarker for early screening,diagnosis,and prognostic assessment of MPM.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.