Objective:To investigate the prevalence and associated factors of anxiety and depression in outpatients with chronic obstructive pulmonary disease (COPD) visiting the Yuetan Community Health Service Center in Beijing.Methods:This cross-sectional study enrolled COPD patients who visited the center between January 1, 2022, and December 31, 2023, using convenience sampling. After pulmonary function tests, participants completed questionnaires covering demographic characteristics, GOLD classification, number of hospitalizations for acute exacerbations in the past year, modified Medical Research Council (mMRC) dyspnea scale score, COPD Assessment Test (CAT) score, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). The status and influencing factors of anxiety and depression were analyzed with univariate and multivariate Logistic regression.Results:A total of 243 COPD patients were included, with 74.1% (180/243) being male and a mean age of 67±9 years. The prevalence rates of anxiety and depression were 17.3% (42/243) and 21.0% (51/243), respectively. Multivariate logistic regression analysis identified the following independent factors associated with anxiety (all P<0.05): CAT score 31-40 ( OR=26.621, 95% CI: 4.451-159.209), mMRC score ≥2 ( OR=5.387, 95% CI: 1.589-18.209), GOLD grade ≥3 ( OR=3.227, 95% CI: 1.205-8.645), presence of ≥1 comorbidity ( OR=8.571, 95% CI: 1.132-64.920), being divorced/separated/widowed ( OR=3.125, 95% CI:1.369-7.136), and ≥1 hospitalization for acute exacerbation in the past year ( OR=3.523, 95% CI:1.422-8.726). Independent factors associated with depression (all P<0.05) were: CAT score ≥21 ( OR=3.326, 95% CI:1.038-10.653), mMRC score≥1 ( OR=7.468, 95% CI:1.706-32.697), GOLD grade ≥3 ( OR=3.160, 95% CI:1.225-8.148), presence of ≥1 comorbidity ( OR=5.624, 95% CI:1.295-24.422), smoking history ≥40 pack-years ( OR=2.689, 95% CI: 1.092-6.623), and ≥1 hospitalization for acute exacerbation in the past year ( OR=2.663, 95% CI:1.093-6.486). Conclusions:The prevalence of anxiety and depression among COPD outpatients in this Beijing community health center is considerable. CAT score, mMRC grade, GOLD grade, number of comorbidities, marital status, and history of hospitalization for acute exacerbation are risk factors of anxiety, while CAT score, mMRC grade, GOLD grade, number of comorbidities, smoking pack-years, and hospitalization history are risk factors for depression.

Objective:To explore the clinical efficacy of the fourth-generation minimally invasive surgery (MIS) for the treatment of hallux valgus.Methods:A retrospective analysis was conducted on 26 patients (42 feet) who underwent fourth-generation MIS for hallux valgus at Peking University People's Hospital from October 2019 to March 2023. The patients included 5 males (9 feet) and 21 females (33 feet), with an average age of 49.9±15.1 years (range 19-75 years). The hallux valgus deformity was corrected through minimally invasive extra-articular transverse osteotomy of the distal metatarsal combined with Akin osteotomy, fixation with a single fully threaded screw, and lateral soft tissue release after osteotomy. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured before surgery and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and the visual analogue scale (VAS) were used to evaluate the treatment efficacy.Results:All 26 patients (42 feet) were followed up for a mean duration of 9.6±5.2 months (range 6-30 months). All 42 feet successfully underwent surgery, with an average operation time of 69.1±16.2 minutes (range 30-105 minutes) and an average blood loss of 10.0±7.4 ml (range 1-30 ml). No serious complications such as major vessel, nerve, or tendon damage occurred during the surgery for any patient. During the follow-up, one foot developed stiffness in the first metatarsophalangeal joint due to a lack of timely functional exercise after surgery. No other complications such as recurrence, delayed union, or nonunion were observed. By the final follow-up, one patient (2 feet) requested removal of the internal fixation. The HVA before surgery and at the final follow-up was 29.5±7.4 and 9.2±4.6, respectively, while the IMA was 11.9±3.8 and 5.0±3.6. The AOFAS score improved from 56.6±10.2 to 91.7±6.8, and the VAS score decreased from 5.2±2.3 to 0.9±1.1, all with significant differences ( P<0.05). Conclusion:The fourth-generation minimally invasive surgery for hallux valgus, characterized by minimally invasive transverse osteotomy, fixation with a single fully threaded screw, lateral soft tissue release after osteotomy, and Akin osteotomy is simple, safe, effective and easy to operate with fewer complications.

BACKGROUND:With the continuous improvement of artificial biological materials and surgical techniques,total knee arthroplasty has become the preferred way to improve the quality of life of patients with knee osteoarthritis. However,patients with knee osteoarthritis have severe pain after knee arthroplasty,and there is no good treatment at present. Electroacupuncture therapy is a low-cost option for pain relief and has wide application prospects in combination with preemptive analgesia.OBJECTIVE:To investigate the effect of opposing needling acupuncture with preemptive analgesia on postoperative analgesia after initial unilateral total knee arthroplasty in patients with knee osteoarthritis.METHODS:Using a randomized controlled design,120 participants were selected from Shanghai Guanghua Hospital of Integrative Medicine. All of them received the initial unilateral total knee arthroplasty. The patients were divided into three groups by using the statistical software SPSS 25:pre-electroacupuncture group,post-electroacupuncture group,and sham group,with 40 patients in each group. In pre-electroacupuncture group,opposing needling acupuncture was performed 1 day before operation,30 minutes before anesthesia induction,and 1-3 days after operation. In post-electroacupuncture group,opposing needling acupuncture was performed with the same acupoints and parameters 1-3 days after operation,thus the sham electroacupuncture was performed 1 day before operation and 30 minutes before anesthesia induction. The sham group was treated with the same acupuncture point parameters with five times of sham electroacupuncture. The improvement of numerical rating scale after operation,the consumption of remifentanil and propofol used during operation,the time when patient first used the patient-controlled analgesia,the number of postoperative nausea and vomiting,the increase rate of thigh circumference,and the success rate of blind method were compared among the three groups.RESULTS AND CONCLUSION:(1) Compared with the pre-electroacupuncture group,the improvement of numerical rating scale at rest between post-electroacupuncture group and sham group on day 4 after operation was significantly reduced;the improvement of numerical rating scale at rest in sham group on day 7 after operation was significantly reduced (P<0.05). (2) Compared with the pre-electroacupuncture group,the improvement of numerical rating scale score between post-electroacupuncture group and sham group on day 4 after operation was significantly reduced (P<0.05),and the improvement of numerical rating scale with movement on day 7 after operation was not significant among the three groups (P>0.05). (3) Compared with the pre-electroacupuncture group,the remifentanil consumption was significantly increased in post-electroacupuncture group and sham group (P<0.05). (4) Compared with the pre-electroacupuncture group,the first time used the patient-controlled analgesia pump was significantly shortened in post-electroacupuncture group and sham group (P<0.05). (5) Compared with the pre-electroacupuncture group,the number of postoperative nausea was increased in post-electroacupuncture group and sham group (P<0.05). (6) Compared with the pre-electroacupuncture group,the increase rate of thigh circumference in post-electroacupuncture group and sham group was significantly increased on day 3 and day 7 after operation (P<0.05). Compared with the post-electroacupuncture group,the increase rate of thigh circumference in sham group was significantly increased on day 3 and day 7 after operation (P<0.05). (7) There was no significant difference in the success rate of blind method among the three groups (P>0.05). (8) The artificial knee prosthesis has good biocompatibility. To conclude,opposing needling acupuncture with preemptive analgesia can relieve acute pain after total knee arthroplasty,reduce the consumption of intraoperative anesthesia,prolong the time of postoperative analgesia,alleviate postoperative adverse reactions,and reduce the increase rate of thigh circumference.

BACKGROUND:With the continuous improvement of artificial biological materials and surgical techniques,total knee arthroplasty has become the preferred way to improve the quality of life of patients with knee osteoarthritis. However,patients with knee osteoarthritis have severe pain after knee arthroplasty,and there is no good treatment at present. Electroacupuncture therapy is a low-cost option for pain relief and has wide application prospects in combination with preemptive analgesia.OBJECTIVE:To investigate the effect of opposing needling acupuncture with preemptive analgesia on postoperative analgesia after initial unilateral total knee arthroplasty in patients with knee osteoarthritis.METHODS:Using a randomized controlled design,120 participants were selected from Shanghai Guanghua Hospital of Integrative Medicine. All of them received the initial unilateral total knee arthroplasty. The patients were divided into three groups by using the statistical software SPSS 25:pre-electroacupuncture group,post-electroacupuncture group,and sham group,with 40 patients in each group. In pre-electroacupuncture group,opposing needling acupuncture was performed 1 day before operation,30 minutes before anesthesia induction,and 1-3 days after operation. In post-electroacupuncture group,opposing needling acupuncture was performed with the same acupoints and parameters 1-3 days after operation,thus the sham electroacupuncture was performed 1 day before operation and 30 minutes before anesthesia induction. The sham group was treated with the same acupuncture point parameters with five times of sham electroacupuncture. The improvement of numerical rating scale after operation,the consumption of remifentanil and propofol used during operation,the time when patient first used the patient-controlled analgesia,the number of postoperative nausea and vomiting,the increase rate of thigh circumference,and the success rate of blind method were compared among the three groups.RESULTS AND CONCLUSION:(1) Compared with the pre-electroacupuncture group,the improvement of numerical rating scale at rest between post-electroacupuncture group and sham group on day 4 after operation was significantly reduced;the improvement of numerical rating scale at rest in sham group on day 7 after operation was significantly reduced (P<0.05). (2) Compared with the pre-electroacupuncture group,the improvement of numerical rating scale score between post-electroacupuncture group and sham group on day 4 after operation was significantly reduced (P<0.05),and the improvement of numerical rating scale with movement on day 7 after operation was not significant among the three groups (P>0.05). (3) Compared with the pre-electroacupuncture group,the remifentanil consumption was significantly increased in post-electroacupuncture group and sham group (P<0.05). (4) Compared with the pre-electroacupuncture group,the first time used the patient-controlled analgesia pump was significantly shortened in post-electroacupuncture group and sham group (P<0.05). (5) Compared with the pre-electroacupuncture group,the number of postoperative nausea was increased in post-electroacupuncture group and sham group (P<0.05). (6) Compared with the pre-electroacupuncture group,the increase rate of thigh circumference in post-electroacupuncture group and sham group was significantly increased on day 3 and day 7 after operation (P<0.05). Compared with the post-electroacupuncture group,the increase rate of thigh circumference in sham group was significantly increased on day 3 and day 7 after operation (P<0.05). (7) There was no significant difference in the success rate of blind method among the three groups (P>0.05). (8) The artificial knee prosthesis has good biocompatibility. To conclude,opposing needling acupuncture with preemptive analgesia can relieve acute pain after total knee arthroplasty,reduce the consumption of intraoperative anesthesia,prolong the time of postoperative analgesia,alleviate postoperative adverse reactions,and reduce the increase rate of thigh circumference.

Objective:To explore the clinical efficacy of the fourth-generation minimally invasive surgery (MIS) for the treatment of hallux valgus.Methods:A retrospective analysis was conducted on 26 patients (42 feet) who underwent fourth-generation MIS for hallux valgus at Peking University People's Hospital from October 2019 to March 2023. The patients included 5 males (9 feet) and 21 females (33 feet), with an average age of 49.9±15.1 years (range 19-75 years). The hallux valgus deformity was corrected through minimally invasive extra-articular transverse osteotomy of the distal metatarsal combined with Akin osteotomy, fixation with a single fully threaded screw, and lateral soft tissue release after osteotomy. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured before surgery and at the final follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and the visual analogue scale (VAS) were used to evaluate the treatment efficacy.Results:All 26 patients (42 feet) were followed up for a mean duration of 9.6±5.2 months (range 6-30 months). All 42 feet successfully underwent surgery, with an average operation time of 69.1±16.2 minutes (range 30-105 minutes) and an average blood loss of 10.0±7.4 ml (range 1-30 ml). No serious complications such as major vessel, nerve, or tendon damage occurred during the surgery for any patient. During the follow-up, one foot developed stiffness in the first metatarsophalangeal joint due to a lack of timely functional exercise after surgery. No other complications such as recurrence, delayed union, or nonunion were observed. By the final follow-up, one patient (2 feet) requested removal of the internal fixation. The HVA before surgery and at the final follow-up was 29.5±7.4 and 9.2±4.6, respectively, while the IMA was 11.9±3.8 and 5.0±3.6. The AOFAS score improved from 56.6±10.2 to 91.7±6.8, and the VAS score decreased from 5.2±2.3 to 0.9±1.1, all with significant differences ( P<0.05). Conclusion:The fourth-generation minimally invasive surgery for hallux valgus, characterized by minimally invasive transverse osteotomy, fixation with a single fully threaded screw, lateral soft tissue release after osteotomy, and Akin osteotomy is simple, safe, effective and easy to operate with fewer complications.

Objective:To investigate the prevalence and associated factors of anxiety and depression in outpatients with chronic obstructive pulmonary disease (COPD) visiting the Yuetan Community Health Service Center in Beijing.Methods:This cross-sectional study enrolled COPD patients who visited the center between January 1, 2022, and December 31, 2023, using convenience sampling. After pulmonary function tests, participants completed questionnaires covering demographic characteristics, GOLD classification, number of hospitalizations for acute exacerbations in the past year, modified Medical Research Council (mMRC) dyspnea scale score, COPD Assessment Test (CAT) score, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). The status and influencing factors of anxiety and depression were analyzed with univariate and multivariate Logistic regression.Results:A total of 243 COPD patients were included, with 74.1% (180/243) being male and a mean age of 67±9 years. The prevalence rates of anxiety and depression were 17.3% (42/243) and 21.0% (51/243), respectively. Multivariate logistic regression analysis identified the following independent factors associated with anxiety (all P<0.05): CAT score 31-40 ( OR=26.621, 95% CI: 4.451-159.209), mMRC score ≥2 ( OR=5.387, 95% CI: 1.589-18.209), GOLD grade ≥3 ( OR=3.227, 95% CI: 1.205-8.645), presence of ≥1 comorbidity ( OR=8.571, 95% CI: 1.132-64.920), being divorced/separated/widowed ( OR=3.125, 95% CI:1.369-7.136), and ≥1 hospitalization for acute exacerbation in the past year ( OR=3.523, 95% CI:1.422-8.726). Independent factors associated with depression (all P<0.05) were: CAT score ≥21 ( OR=3.326, 95% CI:1.038-10.653), mMRC score≥1 ( OR=7.468, 95% CI:1.706-32.697), GOLD grade ≥3 ( OR=3.160, 95% CI:1.225-8.148), presence of ≥1 comorbidity ( OR=5.624, 95% CI:1.295-24.422), smoking history ≥40 pack-years ( OR=2.689, 95% CI: 1.092-6.623), and ≥1 hospitalization for acute exacerbation in the past year ( OR=2.663, 95% CI:1.093-6.486). Conclusions:The prevalence of anxiety and depression among COPD outpatients in this Beijing community health center is considerable. CAT score, mMRC grade, GOLD grade, number of comorbidities, marital status, and history of hospitalization for acute exacerbation are risk factors of anxiety, while CAT score, mMRC grade, GOLD grade, number of comorbidities, smoking pack-years, and hospitalization history are risk factors for depression.

Objective:To investigate the clinical manifestation, diagnosis and treatment of chronic lymphocytic leukemia patients with renal involvement.Methods:The clinical data of a chronic lymphocytic leukemia patient with nephrotic syndrome as the initial manifestation in Fujian Provincial People's Hospital in October 2020 were retrospectively analyzed, and the related literature was reviewed.Results:The patient was a 68-year-old male with recurrent edema and foam urine as the initial manifestations, and he was diagnosed as nephrotic syndrome in the nephrology department. After treatment, the symptoms showed no significant improvement, and the lymphocyte count gradually increased. The patient was diagnosed as chronic lymphocytic leukemia in the hematology department. After ibrutinib monotherapy, the lymphocyte count and urine protein gradually decreased to normal levels, and the clinical efficacy evaluation of the patient was complete remission at the end of follow-up.Conclusions:Chronic lymphocytic leukemia with nephrotic syndrome as the initial manifestation is rare, and the clinical presentations are variable. Early diagnosis is the guarantee of successful treatment. The efficacy and safety of first-line Bruton tyrosine kinase inhibitor monotherapy are good.

Seven indole alkaloid glycosides containing a 1'-(4″-hydroxy-3″,5″-dimethoxyphenyl)ethyl unit (-) were isolated from an aqueous extract of leaves (da qing ye). Their structures were determined by spectroscopic data analysis combined with enzymatic hydrolysis as well as comparison of their experimental CD (circular dichroism) and calculated ECD (electrostatic circular dichroism) spectra. Based on analysis of and/or Cotton effect (CE) data of -, two simple roles to assign location and/or configuration of -glycopyranosyloxy and 1'-(phenyl)ethyl units in the indole alkaloid glycosides are proposed. Stereoselectivity in plausible biosynthetic pathways of - is discussed. Compounds and and their mixture in a 3:2 ratio showed activity against KCNQ2 in CHO cells. The mixture of and (3:2) exhibited antiviral activity against influenza virus H1N1 PR8 with IC 64.7 μmol/L (ribavirin, IC 54.3 μmol/L), however, the individual or was inactive. Preliminary structure-activity relationships were observed.

Eight new C-diterpenoid alkaloid arabinosides, named aconicarmichosides E-L (-), were isolated from an aqueous extract of the lateral roots of (Fu Zi). Their structures were determined by spectroscopic and chemical methods including 2D NMR experiments and acid hydrolysis. Compounds -, together with the previously reported four neoline 14--arabinosides from the same plant, represent the only examples of glycosidic diterpenoid alkaloids so far. At a dose of 1.0 mg/kg (i.p.), as compared with the black control, compounds , , and - exhibited analgesic effects with >65.6% inhibitions against acetic acid-induced writhing of mice. Structure-activity relationship was also discussed.

Five new sulfur-enriched alkaloids isatithioetherins A-E (-), and two pairs of scalemic enantiomers (+)- and (-)-isatithiopyrin B ( and ) and isoepigoitrin and isogoitrin and ), along with the known scalemic enantiomers epigoitrin and goitrin ( and ), were isolated and characterized from an aqueous extract of the roots. Their structures were determined by extensive spectroscopic data analysis, including 2D NMR and theoretical calculations of electronic circular dichroism (ECD) spectra based on the quantum-mechanical time-dependent density functional theory (TDDFT). Compounds - represent a novel group of sulfur-enriched alkaloids, biogenetically originating from stereoselective assemblies of epigoitrin-derived units. Isolation and structure characterization of and support the postulated biosynthetic pathways for the diastereomers and a rare thio-Diels-Alder reaction. Compounds and showed antiviral activity against the influenza virus A/Hanfang/359/95 (H3N2, IC 0.60 and 1.92 μmol/L) and the herpes simplex virus 1 (HSV-1, IC 3.70 and 2.87 μmol/L), and also inhibited Coxsackie virus B3 (IC 0.71 μmol/L).