To summarise the clinical experience of treating insomnia with the method of resolving depression， regulating the middle， and tranquilising mind. It is believed that the key to the pathogenesis of insomnia lies in qi depression， disharmony of qi pivot， and disharmony of qi and blood， and the core treatment is to resolve depression， regulating the middle， and tranquilising mind. The self-prescribed Jieyu Anmian Formula （解郁安眠方） could be used as the basic treatment， then modified according to the performance of the patient and syndromes. For syndrome of liver depression restricting spleen， the treatment should soothe liver and invigorate spleen， resolve depression and regulate the middle； for syndrome of liver depression and phlegm coagulation， the treatment should resolve depression and phlegm， support the earth and free the wood； for syndrome of liver depression transforming into fire， the treatment should soothe liver and clear fire， resolve depression and dysphoria； for syndrome of qi stagnation and blood stasis， the treatment should activate blood and regulate the middle， resolve depression and tranquilise mind.

OBJECTIVE: To explore clinical efficacy of membrane-induced technique combined with gastrocnemius muscle flap transposition in treating traumatic osteomyelitis of the upper tibia. METHODS: A retrospective analysis was conducted on 7 patients with traumatic osteomyelitis of the upper tibia who were treated with membrane-induced technique combined with gastrocnemius muscle flap transposition from January 2022 to December 2023. Among them, there were 4 males and 3 females; aged from 29 to 57 years old; 4 patients were treated after open fracture, 2 patients were treated after closed fracture, and 1 patient was treated after scalding; the courses of disease ranges from 2 weeks to 8 years; sinus tracts were present in all patients, and the lesion range of the tibia ranged from 5 to 9 cm. The results of deep tissue bacterial culture showed that 2 patients were negative, 3 patients were staphylococcus aureus, 1 patient was methicillin-resistant staphylococcus aureus, and 1 patient was pseudomonas aeruginosa and 1 patient was klebsiella pneumoniae. After debridement, the range of bone defect ranged from 8 to 12 cm, and the cortical defect accounted for approximately 30% of the circumference. The area of soft tissue defect ranged from 8.0 cm×2.0 cm to 10.0 cm×6.0 cm. At the first stage, vancomycin-loaded/meropenem/gentamicin-loaded bone cement was implanted. The gastrocnemius muscle flap was repositioned to cover the wound surface and free skin grafting was performed. After an interval of 7 to 10 weeks, the stageⅡsurgery was performed to remove bone cement. Autologous iliac bone mixed with vancomycin/gentamicin and calcium sulfate artificial bone was transplanted, and the wound was sutured. One patient retained the original internal plants, one patient removed the internal plants and replaced them with steel plate external fixation, one patient replaced the internal plants and added steel plate external fixation, and three patients were simply fixed with steel plate external fixation. One year after operation, the recovery of knee joint and ankle joint functions was evaluated by using Hospital for Special Surgery (HSS) knee joint score and Kofoed ankle joint function score respectively. RESULTS: All patients had their wounds closed simultaneously with bone cement implantation and healed well. All patients were followed up for 12 to 17 months after operation, and satisfactory bone healing was achieved at 6 months after stageⅡsurgery. Twelve months after operation, all patients had good bone healing without obvious limping was observed when walking. At 12 months after operation HSS knee joint score ranged from 93 to 100 points, and Kofoed ankle function score ranged from 96 to 100 points. CONCLUSION For traumatic osteomyelitis of the upper tibia, a staged treatment plan combining membrane-induced technique and gastrocnemius flap transposition on the basis of thorough debridement could safely cover the wound surface, effectively control bone infection and achieve satisfactory bone healing, without adverse effects on limb function.
Humans ; Male ; Female ; Middle Aged ; Osteomyelitis/surgery* ; Adult ; Surgical Flaps ; Retrospective Studies ; Tibia/injuries* ; Muscle, Skeletal/surgery*

OBJECTIVE: To retrospectively analyze the clinical characteristics, co-mutated genes in newly diagnosed acute myeloid leukemia (AML) patients with NRAS and KRAS gene mutations, and the impact of NRAS and KRAS mutations on prognosis. METHODS: The clinical data and next-generation sequencing results of 80 newly diagnosed AML patients treated at our hospital from December 2018 to December 2023 were collected. The clinical characteristics, co-mutated genes of NRAS and KRAS , and the impact of NRAS and KRAS mutations on prognosis in newly diagnosed AML patients were analyzed. RESULTS: Among 80 newly diagnosed AML patients, NRAS mutations were detected in 20 cases(25.0%), and KRAS mutations were detected in 9 cases(11.3%). NRAS mutations predominantly occurred at codons 12 and 13 of exon 2, as well as codon 61 of exon 3, while KRAS mutations were most commonly occurred at codons 12 and 13 of exon 2, all of which were missense mutations. There were no statistically significant differences observed in terms of age, sex, white blood cell count(WBC), hemoglobin(Hb), platelet count(PLT), bone marrow blasts, first induction chemotherapy regimen, CR1/CRi1 rates, chromosome karyotype, 2022 ELN risk classification and allogeneic hematopoietic stem cell transplantation(allo-HSCT) among the NRAS mutation group, KRAS mutation group and NRAS/KRAS wild-type group (P >0.05). KRAS mutations were significantly correlated with PTPN11 mutations (r =0.344), whereas no genes significantly associated with NRAS mutations were found. Survival analysis showed that compared to the NRAS/KRAS wild-type group, patients with NRAS mutation had a relatively higher 5-year overall survival (OS) rate and relapse-free survival (RFS) rate, though the differences were not statistically significant (P =0.097, P =0.249). Compared to the NRAS/KRAS wild-type group, patients with KRAS mutation had a lower 5-year OS rate and RFS rate, with no significant differences observed (P =0.275, P =0.442). There was no significant difference in the 5-year RFS rate between the KRAS mutation group and NRAS mutation group (P =0.157), but the 5-year OS rate of patients with KRAS mutation was significantly lower than that of patients with NRAS mutation (P =0.037). CONCLUSION In newly diagnosed AML patients, KRAS mutation was significantly correlated with PTPN11 mutation. Compared to patients with NRAS/KRAS wild-type, those with NRAS mutation showed a more favorable prognosis, while patients with KRAS mutation showed a poorer prognosis; however, these differences did not reach statistical significance. Notably, the prognosis of AML patients with KRAS mutation was significantly inferior compared to those with NRAS mutation.
Humans ; Leukemia, Myeloid, Acute/diagnosis* ; Mutation ; Prognosis ; Proto-Oncogene Proteins p21(ras)/genetics* ; GTP Phosphohydrolases/genetics* ; Retrospective Studies ; Membrane Proteins/genetics* ; Female ; Male ; Middle Aged ; Adult ; Aged

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

Clear aligner treatment is a novel technique in current orthodontic practice. Distinct from traditional fixed orthodontic appliances, clear aligners have different material features and biomechanical characteristics and treatment efficiencies, presenting new clinical challenges. Therefore, a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique. This expert consensus discusses case selection and grading of treatment difficulty, principle of clear aligner therapy, clinical procedures and potential complications, which are crucial to the clinical success of clear aligner treatment.
Humans ; Consensus ; Orthodontic Appliance Design ; Orthodontic Appliances, Removable ; Tooth Movement Techniques/methods* ; Malocclusion/therapy* ; Orthodontics, Corrective/instrumentation*

Early correction of childhood malocclusion is timely managing morphological, structural, and functional abnormalities at different dentomaxillofacial developmental stages. The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion. This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence, aiming to provide general guidance on appropriate imaging examination selection, comprehensive and accurate imaging assessment for early orthodontic treatment patients.
Humans ; Malocclusion/diagnostic imaging* ; Child ; Consensus

Objective To investigate the clinical efficacy of Chailian Lvping Granules(mainly composed of Bupleuri Radix,Coptidis Rhizoma,Paeoniae Radix Alba,Angelicae Sinensis Radix,Salviae Miltiorrhizae Radix et Rhizoma,Citri Sarcodactylis Fructus,and Ziziphi Spinosae Semen)in treating post-stroke anxiety and to observe their effect on serum neurotransmitters and oxidative stress.Methods A total of 104 patients with post-stroke anxiety of liver-qi stagnation and heart-fire exuberance type were randomly divided into an observation group and a control group,52 cases in each group.The control group was treated with conventional western medicine of Paroxetine,and the observation group was treated with Chailian Lvping Granules on the basis of treatment for the control group.The course of treatment lasted for eight weeks.The two groups were observed in the changes of Hospital Anxiety and Depression Scale(HADS)score,Hamilton Anxiety Scale(HAMA)score,serum neurotransmitter parameters of brain-derived neurotrophic factor(BDNF),dopamine(DA),5-hydroxytryptamine(5-HT)and norepinephrine(NE),and oxidative stress indicators of malondialdehyde(MDA),superoxide dismutase(SOD),and glutathione peroxidase(GSH-Px)before and after treatment.Moreover,the clinical efficacy and total incidence of adverse reactions were compared between the two groups.Results(1)After eight weeks of treatment,the total effective rate of the observation group was 94.23％(49/52),and that of the control group was 76.92％(40/52).The intergroup comparison(tested by chi-square test)showed that the curative effect of the observation group was significantly superior to that of the control group(P＜0.05).(2)After treatment,the HADS score and HAMA score for the axienty degree in the two groups were decreased compared with those before treatment(P＜0.05),and the decrease of HADS score and HAMA score in the observation group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the serum level of neurotransmitter BDNF in the two groups was increased while the serum levels of DA,5-HT and NE were decreased compared with those before treatment(P＜0.05).The increase of serum BDNF level and the decrease of serum DA,5-HT and NE levels in the observation group were significantly superior to those in the control group(P＜0.01).(4)After treatment,the serum level of oxidative stress indicator MDA in the two groups was decreased while the serum levels of SOD and GSH-Px were increased compared with those before treatment(P＜0.05).The decrease of serum MDA level and the increase of serum SOD and GSH-Px levels in the observation group were significantly superior to those in the control group(P＜0.05 or P＜0.01).(5)The total incidence of adverse reactions in the observation group was 5.77％(3/52),and that in the control group was 9.62％(5/52).There was no significant difference between the two groups(P＞0.05).Conclusion On the basis of conventional western medicine treatment,Chailian Lvping Granules exert certain effect in the treatment of patients with post-stroke anxiety of liver-qi stagnation and heart-fire exuberance type.The combined therapy is effective and safe on alleviating the anxiety symptoms of patients,decreasing the degree of neurological impairment and stress response level,and has few adverse reactions.

Oligoasthenoteratozoospermia(OAT)is a common male infertility condition characterized by a decreased sperm count and poor sperm motility.The pathogenesis of OAT is rather complicated,involving such factors as lifestyle,genetic abnormalities,en-vironmental pollutants,and others.In recent years,significant progress has been made in the study of sperm proteomics,particularly in its application to the diagnosis and treatment of OAT.This review summarizes the advances in the proteomic studies of sperm and se-minal plasma in OAT patients,provides an overview of the potential differentially expressed proteins associated with sperm count and motility,aiming for a deeper insight into the pathogenesis of OAT and improvement of its diagnosis and identification of its related new biomarkers.

AIM To investigate the renoprotective effects and mechanism of Caragana sinica roots,Astragali Radix and their combination use on the rat model of diabetic kidney disease(DKD).METHODS Sixty SD rats were randomly divided into the normal group,the model group,the Empagliflozin group(10 mg/kg),the C.sinica roots group(3.1 g/kg),the Astragali Radix group(3.1 g/kg),and the C.sinica roots plus Astragali Radix group(6.2 g/kg).In contrast to the intact rats of the normal group,rats of the other groups underwent left nephrectomy and intraperitoneal injection of streptozotocin(STZ)followed by 8-week intragastric gavage of the corresponding agent,during which their levels of FBG and 24 h urinary microprotein(24 h U-mAlb)were detected regularly.The rats killed at the end of the trial had their levels of Scr,BUN and Cystatin C detected;their renal pathological changes observed by HE,PAS and Masson stainings;their expressions of macrophage marker proteins CD68 and iNOS detected by immunohistochemistry;their expressions of renal JNK/SAPK pathway proteins such as JNK,p-JNK,TNF-α,IL-1β and ICAM-1 detected by Western blot;and their serum levels of TNF-α,IL-1β and ICAM-1 detected by ELISA as well.RESULTS Compared with the normal group,the model group displayed increased levels of FBG,24 h U-mAlb,BUN,Scr and Cystatin C(P＜0.01);more renal pathological damage,and increased levels of TNF-α,IL-1β and ICAM-1 in the renal tissue and serum(P＜0.01);and increased renal protein expressions of JNK and p-JNK(P＜0.01).Compared with the model group,all of the groups intervened with an agent shared decreased levels of FBG,24 h U-mAlb,BUN,Scr and Cystatin C(P＜0.05,P＜0.01);alleviated renal pathological damage,and decreased levels of TNF-α,IL-1β and ICAM-1 in renal tissue and serum(P＜0.01).There existed no group difference between the Astragali Radix group and the C.sinica roots group in terms of all indices levels(P＞0.05).The C.sinica roots plus Astragali Radix group demonstrated its superiority over either C.sinica roots group or Astragali Radix group in terms of all the indices levels(P＜0.05,P＜0.01).CONCLUSION C.sinica roots,Astragali Radix or their combination use can alleviate the renal pathological damage and improve the renal function of DKD rats through inhibiting the M1 macrophages,reducing the secretion of inflammatory factors,whose mechanism may lie in the inhibition of JNK/SAPK signal pathway activation.A better effect can be anticipated by the combination use of C.sinica roots and Astragali Radix.

AIM To investigate the impact of the combination use of Caragana sinica Radix and Astragali Radix on a rat model of diabetic kidney disease(DKD).METHODS The SD rats were randomly divided into the normal group,the model group,the Engelgin group,the Caragana sinica Radix group,the Astragali Radix group and the Caragana sinica Radix-Astragali Radix compatibility group,with 10 rats in each group.Following the successful establishment of a DKD model by unilateral amputate renal combined with intraperitoneal injection of streptozotocin(STZ),the corresponding gastric gavage of drugs were administered for 8 weeks.The rats had their 24 h urinary microalbumin(24 h U-mALB)detected at 0,4 and 8 weeks;their levels of Scr,BUN,CysC,MDA and SOD activity detected by ELISA;their renal ROS expression detected by fluorescence probe method;their renal pathological changes observed by HE,PAS,Masson and PASM-Masson staining;their renal expressions of NOX4,Drp1,MFN2 and P62 detected by immunohistochemistry;and their renal expressions of PINK1,MFN2,Parkin,LC3-Ⅱ/Ⅰ,P62 and p-Drp1 proteins detected by Western blot.RESULTS Compared with the model group,each treatment group displayed lower contents of 24 h U-mALB,BUN,Scr and CysC in the serum of rats(P＜0.01);reduced pathological structure damage of the renal tissue;decreased MDA level in serum and kidney(P＜0.01);increased SOD activity(P＜0.01);increased renal protein expressions of PINK1,MFN2,Parkin and LC3-Ⅱ/Ⅰ(P＜0.05,P＜0.01);and decreased protein expressions of p-Drp1 and P62(P＜0.01).And the Astragali Radix group and the Caragana sinica Radix-Astragali Radix compatibility group took the lead(P＜0.05,P＜0.01).CONCLUSION Upon the rat model of DKD,the compatibility of Caragana sinica Radix and Astragali Radix may alleviate their renal pathological damage and improve their renal function by activating the mitochondrial autophagy to improve mitochondrial dynamics and inhibit their oxidative stress via PINK1/MFN2/Parkin pathway.