ObjectiveTo investigate the effect and underlying mechanism of the Wulao Qisun prescription on pathological new bone formation in ankylosing spondylitis （AS）. MethodsSynovial fibroblasts were isolated from the hip joints of AS patients and observed under a microscope to assess cell morphology. The cells were identified using immunofluorescence staining. The isolated AS fibroblasts were divided into blank group， low drug-containing serum group， medium drug-containing serum group， high drug-containing serum group， and positive drug group. After drug intervention， cell proliferation was measured using the cell counting kit-8 （CCK-8） assay to observe fibroblast growth and determine the optimal intervention time. Alkaline phosphatase （ALP） activity was measured using the alkaline phosphatase assay. Protein expression of osteocalcin （OCN）， osteopontin （OPN）， and runt-related transcription factor 2 （Runx2） was detected by Western blot. The mRNA expression levels of Wnt5a， β-catenin， and Dickkopf-1 （DKK-1） were measured by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared with the blank group， each drug-containing serum group of Wulao Qisun prescription and the positive drug group inhibited the proliferation of AS fibroblasts and reduced ALP expression （P<0.01）. Compared with the blank group， the low drug-containing serum group of Wulao Qisun prescription downregulated β-catenin mRNA expression （P<0.05）. The medium and high drug-containing serum groups and the positive drug group significantly downregulated Wnt5a and β-catenin mRNA expression （P<0.05， P<0.01）， with the positive drug group showing the most pronounced effect （P<0.01）. The high drug-containing serum group and the positive drug group significantly upregulated DKK-1 mRNA expression （P<0.01）. Compared with the blank group， the low drug-containing serum group of Wulao Qisun prescription inhibited the expression of OPN and Runx2 proteins （P<0.05， P<0.01）， while the medium and high drug-containing serum groups and the positive drug group inhibited the expression of OCN， OPN， and Runx2 proteins （P<0.05， P<0.01）. ConclusionThe Wulao Qisun prescription can inhibit the proliferation and osteogenic differentiation of AS fibroblasts， thereby delaying the formation of pathological new bone in AS. The possible mechanism involves the regulation of Wnt/β-catenin-related gene expression， further inhibiting the transcription of downstream target genes.

ObjectiveTo investigate the effect and mechanism of Qingre Sanzhuo decoction in treating gouty arthritis （GA） combined with hyperuricaemia （HUA）. MethodsSixty male SD rats were randomized into normal， model， colchicine （0.5 mg·kg^-1）， and low-， medium-， and high-dose （17， 34， 68 g·kg^-1， respectively） Qingre Sanzhuo decoction groups （n=10）. The rats in other groups except the normal group were treated with the modified method for the modeling of GA combined with HUA. The drug intervention groups were administrated with corresponding drugs by gavage in the afternoon every day and the normal group and the model group were administrated with an equal volume of sterile normal saline by gavage. The level of uric acid （SUA） in the serum was measured 2 h after the last administration. The degree of ankle joint swelling was calculated 0.5， 12， 24， 48 h after modeling， and joint inflammation was scored. The pathological changes of ankle joints were observed by hematoxylin-eosin staining， and the serum levels of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， C reactive protein （CRP）， and interleukin-18 （IL-18） were measured by enzyme-linked immunosorbent assay. Real-time PCR was performed to determine the mRNA levels of NOD-like receptor protein 3 （NLRP3）， apoptosis-associated speck-like protein containing CARD （ASC）， cysteinyl aspartate-specific protease-1 （Caspase-1）， gasdermin D （GSDMD）， and nuclear factor-kappa B （NF-κB） in the synovial tissue of ankle joints. Western blot was employed to determine the protein levels of NLRP3， ASC， and Caspase-1 in ankle joints. The immunohistochemical method was used to detect the expression of GSDMD and NF-κB in the synovial tissue of ankle joints. ResultsCompared with the normal group， the model group showed increased SUA in the serum （P<0.05）， ankle joint swelling and joint inflammation （P<0.05）， increased number of blood vessels in the synovium， inflammatory cell foci in the synovial bursa， elevated serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and up-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. Compared with the model group， the medium- and high-dose Qingre Sanzhuo decoction groups showed reduced SUA in the serum （P<0.05）， alleviated ankle joint swelling and joint inflammation （P<0.05）， lowered serum levels of TNF-α， IL-1β， CRP， and IL-18 （P<0.05）， and down-regulated mRNA and protein levels of NLRP3， ASC， Caspase-1， GSDMD， and NF-κB in the synovial tissue of ankle joints （P<0.05）. However， in terms of ameliorating the pathological changes of ankle joints， only the high-dose Qingre Sanzhuo decoction group showed normal morphology of the synovial membrane of ankle joints and no obvious lesion in the articular cartilage. ConclusionQingre Sanzhuo decoction may play a role in preventing and controlling GA combined with HUA by down-regulating the activity of NLRP3/ASC/Caspase-1 pathway and inhibiting the expression of inflammatory cytokines， such as TNF-α， IL-1β， CRP， and IL-18.

OBJECTIVE To systematically evaluate medication risk prediction models for hospitalized adult patients and provide references for their development and clinical application. METHODS Databases including PubMed， Embase， Web of Science， CNKI， Wanfang data， VIP and CBM were searched for studies on medication risk prediction models from their inception to May 2024. After screening the literature， extracting data， and evaluating the quality of the literature， descriptive analysis was performed on the results of the included studies. RESULTS A total of 13 studies were included， involving 12 models. Nine studies used Logistic regression algorithm for modeling， and the number of included predictive factors ranged from 3 to 11； the area under the receiver operating characteristic curve ranged from 0.65 to 0.865. The literature quality evaluation results showed that 10 studies had high risk of bias； 10 studies had high applicability risk. A total of 31 predictive factors were extracted， including 15 items of basic patient information， 3 test indicators， and 5 items of medication information， and 8 others. CONCLUSIONS The existing medication risk prediction models for hospitalized adult inpatients are mainly Logistic regression algorithm， with predictive factors mainly focusing on basic indicators such as demographics. The overall prediction performance of the models needs to be improved， and the overall risk of bias is relatively high.

Objective: To retrospectively analyze the prevalence of hepatitis C virus (HCV) infection among voluntary blood donors in Qinghai Province over a ten-year period and to provide evidence for refining blood safety screening strategies. Methods: Blood samples from 362 066 blood donors in Qinghai collected between January 2015 and April 2024 were simultaneously screened using enzyme-linked immunosorbent assay (ELISA) and nucleic acid testing (NAT). Follow-up was conducted for donors with reactive HCV RNA screening results, and alanine transaminase (ALT) was detected by rate method. Results: The HCV positive rate among blood donors in Qinghai was 0.22%. Gender, marital status, number of blood donations, and educational level were associated with HCV infection. Significant differences in HCV positive rates were observed among donors across regions and ethnic groups. The HCV positive rate among donors in Golog Tibetan Autonomous Prefecture (with an average altitude of 4 330 m) was significantly higher than that in Xining (0.52% vs 0.21%, P<0.001). Positivity rates were also significantly higher in Salar (0.84%), Hui (0.81%), Zang (0.60%), and Tu (0.45%) ethnic groups compared to the Han ethnic group (0.17%) (P<0.001). The abnormal rate of ALT in HCV-positive donors was higher than in non-HCV donors (6.13% vs 1.55%) (P<0.001). Conclusion: The relatively high HCV positivity rate among blood donors in Qinghai highlights the need for further investigation into viral sources, risk factors, and transmission routes. Optimized screening strategies are essential to ensure blood safety.

Objective To compare the clinical efficacy of unilateral biportal endoscopy(UBE)and percutaneous transforaminal endoscopic discectomy(PTED)in treatment of far lateral lumbar disc herniation(FLLDH).Method A retrospective analysis was conducted on 42 patients with FLLDH who underwent surgery from March 2021 to March 2023.The UBE group included 18 patients,and the PTED group included 24 patients.The surgery duration,intraoperative fluoroscopy times,length of hospital stay,perioperative complications were recorded and compared between the two groups.The degree of pain was evaluated by visual analogue scale(VAS)score for pain,the Oswestry disability index(ODI)for dysfunction was used,and the Macnab scoring standard was used to evaluate the clinical efficacy.Result The operation time of the UBE group was(95.56±20.94)min,which was longer than that of the PTED group(78.25±17.23)min,and the intraoperative blood loss was(69.17±8.95)mL,which was more than that of the PTED group(23.96±5.89)mL,the differences were statistically significant(P<0.05).The hospitalization time of the UBE group was(5.67±1.28)d,compared with that of the PTED group(5.33±1.05)d,the difference was not statistically significant(P>0.05).The intraoperative fluoroscopy times in the UBE group was(3.00±0.77)times,which was significantly less than that in the PTED group(7.42±0.93)times,and the difference was statistically significant(P<0.05).The VAS score and ODI of the two groups of patients after the operation were significantly lower than those before the operation,and the differences were statistically significant(P<0.05).Three days after the operation,the VAS score of leg pain in the UBE group was(3.28±0.58)and ODI was(41.17±4.30)%,which were significantly lower than those in the PTED group(4.13±0.74)and(45.50±3.91)%,and the differences were statistically significant(P<0.05).However,when comparing the VAS score and ODI of the two groups 3 months and one year after the operation,the differences were not statistically significant(P>0.05).There was no statistically significant difference in the excellent and good rate between the two groups of patients(88.9%vs 87.5%,P=0.563).Two cases of nerve injury occurred in the PTED group,while no nerve injury was reported in the UBE group.No infections,recurrences,or major bleeding complications occurred in either group.Conclusion Both PTED and UBE are safe and effective for treatment of FLLDH.There is less intraoperative fluoroscopy time,clearer endoscopic view,and significantly lower risk of nerve injury in UBE.

Objective:To explore the clinical risk factors and pregnancy outcomes in women with hyperglycemia in pregnancy (HIP) complicated with hypertensive disorders of pregnancy (HDP).Methods:This retrospective cohort study included 43 973 singleton live births delivered at the Obstetrics and Gynecology Hospital of Fudan University between September 2017 and December 2022. Participants were categorized into four groups: HH group (HIP with HDP, n=1 011), HIP group ( n=5 469), HDP group ( n=3 486), and control group ( n=34 007). Baseline characteristics and perinatal outcomes were compared using the Chi-square test (or Fisher's exact test). Logistic regression identified risk factors and adverse outcome risks and analyze the impact of HH on neonatal weight. Results:HH accounted for 15.6% (1 011/6 480) of HIP cases, with an overall incidence of 2.3% (1 011/43 973). HIP and HDP were strongly correlated [ OR=1.803, 95% CI: 1.672-1.945]. Advanced maternal age (≥35 years at estimated due date), primiparity, and pre-pregnancy overweight/obesity (body mass index ≥24 kg/m2) were independent risk factors for HH [ OR (95% CI): 1.305 (1.113-1.529), 1.845 (1.545-2.203), and 2.316 (1.981-2.718), respectively]. Compared to the HIP group, the HH group had significantly higher risks of preterm birth [10.3% (104/1 011) vs. 6.3% (344/5 469), OR=1.627 (95% CI:1.280-2.068)], cesarean delivery [57.0% (576/1 011) vs. 41.9% (2 289/5 469), OR=1.701 (95% CI:1.474-1.963)], and neonatal birth weight < P10 [13.9% (141/1 011) vs. 9.0% (494/5 469), OR=1.668 (95% CI:1.336-2.083)]. Stratified analysis revealed a 73.4% increased risk of birth weight < P10 in the gestational diabetes mellitus A1 with HDP subgroup ( aOR=1.734, 95% CI: 1.416-2.125). Conclusions:Advanced age, pre-pregnancy overweight/obesity, and primiparity are risk factors for HH. Compared to isolated HIP, HH is associated with elevated risks of preterm birth, cesarean delivery, and abnormal neonatal birth weight, though the impact on birth weight may vary by HIP subtype.

Osteosarcoma(OS)is a common primary malignant bone tumor with high mortality,disability,metastasis,and recurrence rates and a complex pathogenesis,Resulting in serious effects on patient quality of life and huge economic burdens on families and society.Traditional Chinese medicine(TCM)has"multi-target,multi-component and multi-pathway"characteristics.Recent studies using animal and cell models demonstrated that the mechanism of OS progression was related to Notch,mitogen-activated protein kinase,Wnt/β-catenin,phosphatidylinositol 3-kinase/AKT,Hedgehog and nuclear factor-κB,transforming growth factor-β/Smad and signal transducer and activator of transcription pathways.TCM can exert anti-tumor effects by influencing biological processes such as cell proliferation,migration,invasion,apoptosis,and autophagy via interfering with the above signaling pathways.This review considers the roles of these signaling pathways in OS and summarizes the current research status of TCM interventions in the prevention and treatment of OS,with the aim of providing a reference for future studies of TCM treatments of OS and to provide new ideas for its clinical treatment.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To evaluate the clinical outcomes of patients with paroxysmal sympathetic hyperactivity (PSH) after moderate to severe brain injury.Methods:Clinical data describing 580 patients of the Rehabilitation Center of Fuxing Hospital with moderate to severe brain injury were analyzed retrospectively. They were divided into a PSH group and a non-PSH group depending on whether PSH attacks occurred. Propensity score matching was performed to create a 1∶1 ratio between the two groups. The patients′ baseline characteristics were analyzed before the matching and with the matched cohorts, and the clinical outcomes of the patients in the matched cohorts were compared.Results:Seventy-five of the patients experienced PSH attacks and were included in the PSH group, while the others formed the non-PSH group. Before matching, the two groups had significant differences in age, atrial fibrillation, hypertension, chest trauma, Glasgow Coma Scale (GCS) score, tracheotomy, hydrocephalus, heart rate at admission, respiration rate, muscle tone, and limited joint activity. After the propensity score matching, 67 patients were included in the PSH and non-PSH groups. The differences in heart rate, respiration rate, muscle tone, and limited joint activity between the two groups at admission were then statistically significant. However, unlike the non-PSH group, the PSH group showed a significant decrease in its average GCS score and Glasgow Outcome Scale (GOS) score at discharge, as well as a significant increase in its average Disability Rating Scale score. Compared with the non-PSH group at the same time point, the GOS score of the PSH group had decreased by 0.47 at discharge ( CI: 0.41-0.56). Then, three months after discharge the average GOS score of the PSH group had decreased by 0.55 ( CI: 0.48-0.61. By six months that was 0.75 ( CI: 0.66-0.82) and by twelve months 0.87 ( CI: 0.77-0.97). Conclusions:PSH can affect the consciousness of patients with moderate to severe brain injury and their ability in the activities of daily life. The prognosis of PSH patients is relatively poor.

Objective To analyze the correlation between the duration of hyperbaric oxygen(HBO)therapy and oral medication clonazepam reduction in patients with paroxysmal sympathetic hyperactivity(PSH).Methods Clinical data of patients with secondary PSH after severe brain injury at Capital Medical University Affiliated Fuxing Hospital from September 2017 to July 2023 were retrospectively included,covering general information,etiology,lesion location,comorbidities,vital signs at admission,PSH attack characteristics,HBO treatment frequency,PSH treatment drugs and dosage.According to the number of HBO treatments,PSHpatients were divided into HBO short course group(10 treatments)and HBO long course group(＞10 treatments).Multiple logistic regression and rank correlation analysis were used to investigate the correla-tion between the duration/frequency of HBO treatment and the reduction of clonazepam.Results A total of 75 PSH patients who met the inclusion and exclusion criteria were selected,including 38 cases(50.7％)who re-ceived reduced doses of clonazepam.There were 32 cases(42.7％)in the HBO short course group and 43 ca-ses(52.3％)in the HBO long course group.The reduction rate of clonazepam in the HBO short course group was lower than that in the HBO long course group[31.3％(10/32)vs.65.1％(28/43),crude OR=4.11(95％CI:1.55-10.90),P=0.004].After adjusting for confounding variables,a multivariate Logistic re-gression model showed a significant correlation between HBO long course and clonazepam reduction(OR=3.76,95％CI:1.23-11.55,P=0.021).Rank correlation analysis showed a positive correlation between HBO treatment frequency and clonazepam reduction(rs=0.331,P=0.004).Conclusions Long course HBO treatment was positively correlated with oral reduction of clonazepam in PSH patients,which may help re-duce the side effects caused by clonazepam and become a non-pharmacological treatment option for PSH.