AIM:To investigate the therapeutic effect of Qingre sanzhuo decoction on rats with hyperuri-caemia combined with gouty arthritis and its effect on TLR4/Myd88/NF-κB signalling pathway.METHODS:Forty-eight SD male rats were randomly divided into blank,model,and colchicine groups(0.3 mg·kg-1·d-1),and Origre sanzhou decotion low,medium and high-dosage groups(7.42,14.85,29.70 g·kg-1·d-1),which were treated with the modified Coderre method for hyperuricemia combined with acute gouty arthritis via gavage of yeast paste combined with potassium oxa-late,which was used for the treatment of acute gouty arthritis combined with hyperuricemia.A composite rat model of acute gouty arthritis was constructed by combining yeast paste with potassium oxalate gavage to cause hyperuricaemia,combined with the modified Coderre method.After 7 days of intervention,the circumference of the right ankle joint of rats was measured and the swelling of the ankle joint was calculated,the blood uric acid(HUA)level of rats was determined by biochemical method,the histopatho-logical and morphological changes of the synovial membrane of the ankle joint of rats were examined by HE staining,and the serum levels of inflammatory factors,tumour necrosis factor-alpha(TNF-α),inter-leukin-6(IL-6),and IL-1β were determined by enzyme-linked immunosorbent assay(ELISA),and Western blotting was performed to determine the levels of inflammatory factors,TNF-α,and IL-1β.The protein expression levels of Toll-like receptor 4(TLR4),myeloid differentiation factor 88(Myd88),and nuclear factor-κB(NF-κB)in the synovial tissues of the ankle joints of the rats were determined by Western blot method,and the mRNA expression of TLR4,Myd88,and NF-κB in the rat was determined by real-time fluorescence quantitative polymerase chain reaction(Real-time PCR).RESULTS:Compared with the blank group,rats in the model group showed significantly lower ankle joint swelling(P<0.01),increased levels of HUA,dis-organised synovial tissue structure,large number of inflammatory cells infiltration,and significantly higher serum levels of TNF-α,IL-6,and IL-1β(P<0.01),and the protein and mRNA expression levels of TLR4,Myd88,and NF-κB in the synovial membrane of the ankle joints of the model group were significantly increased(P<0.01).levels were significantly increased(P<0.01);compared with the model group,joint swelling was significantly reduced in the colchicine group,and the medium-and high-dose groups of Qingre sanzhuo decoction(P<0.05);synovial hyperplasia and inflam-matory cell infiltration were improved in the colchicine group and the medium-and high-dose groups of Qingre sanzhuo decoction,and the HUA and the levels of TNF-α,IL-6,and IL-1β were significantly decreased in the dosing groups(P<0.05,P<0.01),and compared with the model group,the medium-and high-dose groups of Qingre sanzhuo decoction could significantly reduce the expression of TLR4,Myd88,and NF-κB protein and mRNA(P<0.01).CONCLUSION:Qingre sanzhuo decoction reduces the release of inflamma-tory factors by inhibiting the TLR4/Myd88/NF-κB pathway,and plays a role in the treatment of hyper-uricaemia combined with gouty arthritis.

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.

Starting from the connotation of "New Medicine" in the context of Healthy China, Guangxi Medical University has launched a reform of medical humanities education based on the concept of holistic medicine and the competency-based approach. With the construction of first-class courses and majors as the starting point, the university aims to position itself, clarify goals, and innovate concepts based on "value orientation", and it reconstructs the education system and reshapes the education model with the integration of medical humanities and the combination of learning and practice, thereby establishing a holistic education system with the integration of medical humanities centered on longitudinally sequenced medical humanities curricula. The university also constructs a participatory teaching method based on online-offline platforms, pre-class/post-class engagement, and on-campus/off-campus collaboration, as well as a teaching assessment system with multiple subjects, multiple dimensions, dynamic evolution, and virtue orientation. The university has also built a diversified collaborative educational practice platform among universities, hospitals, and communities, thereby forming a comprehensive medical humanities teaching model with the teaching of humanistic knowledge, the cultivation of humanistic spirit, and the training of good behaviors.

Objective:To investigate the dynamic imaging characteristics of hepatocellular carcinoma (HCC) following Yttrium-90 selective internal radiation therapy ( 90Y-SIRT) and to compare these with imaging findings after transarterial chemoembolization (TACE). Methods:This retrospective case-control study included 24 HCC patients who received 90Y-SIRT at Zhongda Hospital, Southeast University, and West China Hospital, Sichuan University, between September 2021 and June 2023, establishing the 90Y-SIRT group. Additionally, 45 HCC patients who underwent their first TACE treatment at Zhongda Hospital, Southeast University during the same period were included as the TACE group. Patients underwent MRI and/or CT follow-ups at 1-3 months (first follow-up) and 3-6 months (second follow-up) after treatment. The analyzed imaging features included tumor characteristics, peritumoral features, and measurements of tumor and liver volumes, with postoperative change rates calculated. Imaging differences between the 90Y-SIRT and TACE groups were statistically compared using the Mann-Whitney U test or χ2 test. Results:At the first follow-up, compared to baseline, a higher proportion of lesions in the 90Y-SIRT group exhibited a reduction in arterial phase enhancement in the viable region (10/13) than in the TACE group (10/29), with a statistically significant difference ( P=0.040). The necrotic region of the tumor on T 1WI showed significantly lower signal intensity in the 90Y-SIRT group than in the TACE group ( Z=2.98, P=0.006). The change in the apparent diffusion coefficient value in the viable region compared to baseline was 157.0×10 -3(-62.0×10 -3, 311.5×10 -3) mm2/s in the 90Y-SIRT group and -56.0×10 -3 (-216.8×10 -3, 110.0×10 -3) mm2/s in the TACE group, with a statistically significant difference ( Z=-2.71, P=0.008). At the first and second follow-up, the contralateral liver lobe volume increased significantly in the 90Y-SIRT group, with a statistically significant difference from the TACE group ( Z=-3.21, -3.78, both P=0.001). Regarding peritumoral imaging characteristics, a statistically significant difference was observed between the two groups in the low signal intensity of the liver lobe or segment where the tumor waslocated during the hepatobiliary phase ( P=0.020, 0.040). Both HCC groups exhibited progressive tumor volume reduction after treatment. In the 90Y-SIRT group, the change rates of lesion volume relative to baseline at the two follow-ups were -23.0% (-45.6%, 7.9%) and -68.7% (-82.7%, -28.5%), respectively. In the TACE group, the values were -29.8% (-53.6%, -2.7%) and -38.0% (-65.3%, -10.7%). The differences between the two groups were not statistically significant ( Z=-0.52, P=0.605; Z=-1.79, P=0.073). Conclusion:There is a statistically significant difference in the tumor imaging features and peritumoral imaging characteristics between 90Y-SIRT and TACE. 90Y-SIRT demonstrates a notable advantage in promoting contralateral liver lobe regeneration while also contributing to tumor size reduction.

Objective To investigate the effect of osthole(Ost)on neuroinflammation in IS rats by regulating the HMGB1-RAGE signaling pathway.Methods After rat IS model was established with middle cerebral artery occlusion by intraluminal suture,40 model rats were grouped into model group,low-and high-dose Ost(Ost-L and Ost-H)groups,and Ost-H+recombinant rHMGB1(Ost-H+rHMGB1)group,with 10 rats in each groups.Another 10 rats served as sham operation group.Zea-Longa scoring was used to evaluate the neurological function.Serum nerve growth factor(NGF)and LDH levels,and hippocampal TNF-α,IL-10,and IL-1β contents were detected by ELISA.Triphenyltetrazolium chloride staining,Nissl staining,and TUNEL staining were applied respectively to observe the volume of cerebral infarction,hippocampal morphology,and apoptosis in hippocampal tissue cells.The activity of superoxide dismutase(SOD)in the hip-pocampus was detected by hydroxylamine assay,and that of catalases(CAT)was by ammonium molybdate.The content of malonic dialdehyde(MDA)was determined by thiobarbituric acid method.Western blotting was used to measure the protein expression of cleaved Caspase-3,HMGB1,RAGE,NF-κB,and p-NF-κB in brain tissue.Results The model group showed obvious damage in the hippocampal tissues,higher neurological function score,increased stroke volume percentage,serum LDH level and hippocampal TNF-α and IL-1βlevels,elevated neuronal apoptot-ic rate and MDA content,and up-regulation of cleaved Caspase-3,HMGB1,RAGE,and p-NF-κB/NF-κB proteins,while decreased serum NGF level,hippocampal IL-10 content and SOD and CAT activities when compared with the sham group(P＜0.05).Low-and high-dose Ost treatment re-sulted in obviously declined damage in the hippocampal tissue,decreased neurological function score,lower stroke volume percentage,reduced serum LDH level and hippocampal tissue TNF-αand IL-1β contents,lower neuronal apoptotic rate and MDA content,and down-regulated cleaved Caspase-3,HMGB1,RAGE,and p-NF-κB/NF-κB protein,while raised serum NGF level,hipp-ocampal IL-10 content and SOD and CAT activities when compared with the model group(265.84±34.76 pg/ml and 394.52±41.68 pg/ml vs 187.56±23.54 pg/ml,P＜0.05;41.84±5.67 pg/ml and 68.57±8.39 pg/ml vs 16.73±3.52 pg/ml,P＜0.05;87.49±12.53 U/mg and 109.86±14.67 U/mg vs 52.73±8.46 U/mg,P＜0.05;45.38±5.72 U/mg and 67.43±8.91 U/mg vs 21.54±3.47 U/mg,P＜0.05).rHMGB1 could alleviate the improvement effect of Ost on nerve damage in IS rats.Conclusion Ost can attenuate neuroinflammation,oxidative stress,and neuronal apoptosis in IS rats,which may be through its inhibiting the HMGB1-RAGE signaling pathway.

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 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.

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.

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.