ObjectiveThis paper aims to investigate the material basis of the anti-inflammatory efficacy and mechanism of action of Bushen Tongdu prescription （BSTDP）. MethodsThe chemical components of BSTDP and its blood-absorbed components in vivo were systematically identified by using ultra-performance liquid chromatography-linear ion trap-electrostatic field orbitrap high-resolution mass spectrometry （UPLC-LIT-Orbitrap-MS）. Network pharmacology was employed to screen blood-absorbed bioactive components and potential targets of this formula. A protein-protein interaction （PPI） network of core targets was constructed to conduct enrichment analysis. Molecular docking was further utilized to verify the binding affinity between key components and targets. The inflammatory model was established and verified in vivo by using a transgenic zebrafish Tg （mpx： GFP）. At three days post-fertilization （3 dpf）， larvae of zebrafish were randomly assigned to blank group， model group， positive drug dexamethasone acetate group （75 μmol·L^-1）， and BSTDP groups with low， medium， and high doses （500， 1 000， and 2 000 mg·L^-1）. The distribution and quantity of neutrophils in the yolk sac region were observed under a fluorescence microscope. The mRNA expression levels of key genes in the toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor kappa-B （NF-κB） signaling pathway and inflammatory factors including interleukin （IL）-1β， IL-6， and tumor necrosis factor-α （TNF-α） were detected by Real-time quantitative polymerase chain reaction （Real-time PCR）. ResultsA total of 120 chemical components were identified in BSTDP， among which 26 original components were confirmed by using serum pharmacochemical methods. A total of 227 common targets linking rheumatoid arthritis （RA） and the blood-absorbed components were screened by network pharmacology. It is suggested that pseudobrucine， vomicine， sinapine， rehmannioside， cinnamyl alcohol glycoside， and methylephedrine exert anti-inflammatory effects by acting on core targets including protein kinase B1 （Akt1）， signal transducer and activator of transcription 3 （STAT3）， tumor necrosis factor （TNF）， TLR4， mitogen-activated protein kinase 14 （MAPK14）， and phosphatidylinositol-4，5-bisphosphate 3-kinase catalytic subunit α （PIK3CA）， thereby modulating multiple signaling pathways such as TLR4 and NF-κB. In vivo verification in zebrafish demonstrates that the maximum tolerable concentration of Bushen Tongdu Formula is 2 000 mg·L^-1. Compared to those in the blank group， zebrafish in the model group showed a significantly higher number of neutrophils in the yolk sac region （P<0.01） and rising mRNA levels of TLR4， MyD88， NF-κB， TNF-α， IL-6， and IL-1β （P<0.01）. Compared to that in the model group， the number of neutrophils was significantly reduced in BSTDP groups with medium and high doses， as well as the dexamethasone acetate group （P<0.05， P<0.01）. There was no statistically significant difference in the low dose group. The mRNA expression levels of TLR4， MyD88， NF-κB， TNF-α， IL-6， and IL-1β were significantly down-regulated （P<0.05， P<0.01）. ConclusionThis paper identifies the material basis of the efficacy of BSTDP， demonstrating that the formula can exert an anti-inflammatory effect through the TLR4/MyD88/NF-κB signaling pathway. The results provide scientific experimental evidence for its further clinical application.

ObjectiveThis paper aims to investigate the material basis of the anti-inflammatory efficacy and mechanism of action of Bushen Tongdu prescription （BSTDP）. MethodsThe chemical components of BSTDP and its blood-absorbed components in vivo were systematically identified by using ultra-performance liquid chromatography-linear ion trap-electrostatic field orbitrap high-resolution mass spectrometry （UPLC-LIT-Orbitrap-MS）. Network pharmacology was employed to screen blood-absorbed bioactive components and potential targets of this formula. A protein-protein interaction （PPI） network of core targets was constructed to conduct enrichment analysis. Molecular docking was further utilized to verify the binding affinity between key components and targets. The inflammatory model was established and verified in vivo by using a transgenic zebrafish Tg （mpx： GFP）. At three days post-fertilization （3 dpf）， larvae of zebrafish were randomly assigned to blank group， model group， positive drug dexamethasone acetate group （75 μmol·L^-1）， and BSTDP groups with low， medium， and high doses （500， 1 000， and 2 000 mg·L^-1）. The distribution and quantity of neutrophils in the yolk sac region were observed under a fluorescence microscope. The mRNA expression levels of key genes in the toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor kappa-B （NF-κB） signaling pathway and inflammatory factors including interleukin （IL）-1β， IL-6， and tumor necrosis factor-α （TNF-α） were detected by Real-time quantitative polymerase chain reaction （Real-time PCR）. ResultsA total of 120 chemical components were identified in BSTDP， among which 26 original components were confirmed by using serum pharmacochemical methods. A total of 227 common targets linking rheumatoid arthritis （RA） and the blood-absorbed components were screened by network pharmacology. It is suggested that pseudobrucine， vomicine， sinapine， rehmannioside， cinnamyl alcohol glycoside， and methylephedrine exert anti-inflammatory effects by acting on core targets including protein kinase B1 （Akt1）， signal transducer and activator of transcription 3 （STAT3）， tumor necrosis factor （TNF）， TLR4， mitogen-activated protein kinase 14 （MAPK14）， and phosphatidylinositol-4，5-bisphosphate 3-kinase catalytic subunit α （PIK3CA）， thereby modulating multiple signaling pathways such as TLR4 and NF-κB. In vivo verification in zebrafish demonstrates that the maximum tolerable concentration of Bushen Tongdu Formula is 2 000 mg·L^-1. Compared to those in the blank group， zebrafish in the model group showed a significantly higher number of neutrophils in the yolk sac region （P<0.01） and rising mRNA levels of TLR4， MyD88， NF-κB， TNF-α， IL-6， and IL-1β （P<0.01）. Compared to that in the model group， the number of neutrophils was significantly reduced in BSTDP groups with medium and high doses， as well as the dexamethasone acetate group （P<0.05， P<0.01）. There was no statistically significant difference in the low dose group. The mRNA expression levels of TLR4， MyD88， NF-κB， TNF-α， IL-6， and IL-1β were significantly down-regulated （P<0.05， P<0.01）. ConclusionThis paper identifies the material basis of the efficacy of BSTDP， demonstrating that the formula can exert an anti-inflammatory effect through the TLR4/MyD88/NF-κB signaling pathway. The results provide scientific experimental evidence for its further clinical application.

BACKGROUND:The surgical treatment of severe lumbar fractures is mainly based on posterior short-segment fixation,and different pedicle screw fixation methods have differences in biomechanical properties.OBJECTIVE:To simulate three different screw fixation techniques in the treatment of severe L1 vertebral fractures using three-dimensional finite element technology,and to compare and analyze the biomechanical characteristics of the upper and lower intervertebral discs,fractured vertebrae,and internal fixation devices during the simulated spinal movement.METHODS:A three-dimensional model of the T11-L3 spine was established to simulate severely unstable fracture of the lumbar 1 vertebral body using the designed three pedicle screw fixation methods:Model A with 4 traditional pedicle screws(2 in each T12 and L2),model B with 4 Universal Spine System pedicle screws(2 in each T12 and L2),and Model C were bilateral intermediate fixation with 6 pedicle screws(2 in each of T12,L1,and L2).Restraint and load were applied to simulate the maximum stress and maximum displacement of the internal fixation,the displacement of the L1 vertebral body,and stress on the intervertebral discs superior and inferior to the injured vertebra during the anterior flexion,posterior extension,left-sided bending,right-sided bending and left-right rotation of the lumbar spine.RESULTS AND CONCLUSION:(1)The maximum displacement and motion range of the lumbar 1 vertebra with Model C in flexion and extension,left bending,right bending,left rotation,and right rotation were lowest in the tested motion states;the maximum stress of the screws and connecting rods was the smallest;and the maximum stress of intervertebral discs superior and inferior to the injured vertebra was the smallest.This was followed by the Model B,while the maximum displacement and motion range of the lumbar 1 vertebra and the stress and displacement of the screw connecting rod in the Model A were highest,but it showed the worst biomechanical stability and was more prone to adjacent segment degeneration.(2)These results show that bilateral intermediate fixation with six pedicle screws during the treatment of severe lumbar fractures is more dispersed in internal fixator stress and exhibits the least displacement and motion range of the vertebral pedicle screws and rods compared with four universal spinal system pedicle screws and four traditional pedicle screws.Thus,it can effectively reduce the occurrence of internal fixation failure and the adjacent segment degeneration.

BACKGROUND:The surgical treatment of severe lumbar fractures is mainly based on posterior short-segment fixation,and different pedicle screw fixation methods have differences in biomechanical properties.OBJECTIVE:To simulate three different screw fixation techniques in the treatment of severe L1 vertebral fractures using three-dimensional finite element technology,and to compare and analyze the biomechanical characteristics of the upper and lower intervertebral discs,fractured vertebrae,and internal fixation devices during the simulated spinal movement.METHODS:A three-dimensional model of the T11-L3 spine was established to simulate severely unstable fracture of the lumbar 1 vertebral body using the designed three pedicle screw fixation methods:Model A with 4 traditional pedicle screws(2 in each T12 and L2),model B with 4 Universal Spine System pedicle screws(2 in each T12 and L2),and Model C were bilateral intermediate fixation with 6 pedicle screws(2 in each of T12,L1,and L2).Restraint and load were applied to simulate the maximum stress and maximum displacement of the internal fixation,the displacement of the L1 vertebral body,and stress on the intervertebral discs superior and inferior to the injured vertebra during the anterior flexion,posterior extension,left-sided bending,right-sided bending and left-right rotation of the lumbar spine.RESULTS AND CONCLUSION:(1)The maximum displacement and motion range of the lumbar 1 vertebra with Model C in flexion and extension,left bending,right bending,left rotation,and right rotation were lowest in the tested motion states;the maximum stress of the screws and connecting rods was the smallest;and the maximum stress of intervertebral discs superior and inferior to the injured vertebra was the smallest.This was followed by the Model B,while the maximum displacement and motion range of the lumbar 1 vertebra and the stress and displacement of the screw connecting rod in the Model A were highest,but it showed the worst biomechanical stability and was more prone to adjacent segment degeneration.(2)These results show that bilateral intermediate fixation with six pedicle screws during the treatment of severe lumbar fractures is more dispersed in internal fixator stress and exhibits the least displacement and motion range of the vertebral pedicle screws and rods compared with four universal spinal system pedicle screws and four traditional pedicle screws.Thus,it can effectively reduce the occurrence of internal fixation failure and the adjacent segment degeneration.

OBJECTIVE: To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). METHODS: A prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups ( n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups ( P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. RESULTS: In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels ( P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group ( P>0.05), there were significant differences at other time points of two groups compared to preoperative score ( P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours ( P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points ( P<0.05). No significant difference was found in Bromage motor block scores between the groups ( P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference ( P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups ( P>0.05). CONCLUSION Ultrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Nerve Block/methods* ; Male ; Female ; Pain, Postoperative/etiology* ; Tourniquets/adverse effects* ; Prospective Studies ; Middle Aged ; Ropivacaine/administration & dosage* ; Aged ; Ultrasonography, Interventional ; Anesthetics, Local/administration & dosage* ; Pain Measurement ; Fascia ; Osteoarthritis, Knee/surgery* ; Treatment Outcome ; Arthritis, Rheumatoid/surgery*

Allergen-specific immunotherapy（AIT） remains the only therapeutic approach with the potential to modify the natural course of allergic rhinitis（AR）. Nevertheless, considerable inter-individual variability exists in patients'responses to AIT. To facilitate more reliable assessment of treatment efficacy, the China Rhinopathy Research Cooperation Group（CRRCG） convened young and middle-aged nasal experts in China to formulate the present consensus. The recommended subjective outcome measures for AIT comprise symptom scores, medication scores, combined symptom and medication scores, quality-of-life assessments, evaluation of disease control, and assessment of comorbidities. Objective indicators may supplement these measures. Currently available objective approaches include skin prick testing, nasal provocation testing, and allergen exposure chambers. However, these methods remain constrained by practical limitations and are not yet appropriate for routine implementation in clinical efficacy evaluation. In addition, several biomarkers, including sIgE and the sIgE/tIgE ratio, sIgG4, serum IgE-blocking activity, IgA, cytokines and chemokines, as well as immune cell surface molecules and their functional activity, have been shown to have associations with AIT outcomes. While these biomarkers may complement subjective assessments, they are subject to significant limitations. Consequently, large-scale multicenter trials and real-world evidence are required to strengthen the evidence base. The present consensus underscores the necessity of integrating patients'subjective experiences with objective testing throughout the treatment process, thereby providing a more comprehensive and accurate framework for efficacy evaluation. Looking forward, future investigations should prioritize the incorporation of multi-omics data and artificial intelligence methodologies, which hold promise for overcoming current limitations in assessment strategies and for advancing both the standardization and personalization of AIT.
Humans ; Allergens/immunology* ; China ; Consensus ; Desensitization, Immunologic ; Immunoglobulin E ; Quality of Life ; Rhinitis, Allergic/therapy* ; Treatment Outcome ; East Asian People

Objective:To explore the clinical efficacy value of the medical failure mode,and failure mode and effect analysis(FMEA)mode in equipment management of the department of optimizing blood purification equipment.Methods:Based on the management concept of medical FMEA,a FMEA management mode for equipment was constructed to manage the hemodialysis equipment in the blood purification department of the First Affiliated Hospital of Hebei North University.A total of 83 used hemodialysis equipment in the blood purification department of our hospital from October 2022 to September 2024 were selected,and they were managed respectively by using conventional management mode and FMEA management mode.The differences of operation quality of equipment,comprehensive efficiency of equipment and the management capabilities of managers who used the equipment between two kinds of management modes were compared.Results:The average values of failure rate of equipment,self-repair rate,maintenance rate,and standardized operation rate of using FMEA management mode were respectively(4.72±0.11)%,(90.62±3.44)%,(95.42±2.43)%and(96.22±1.48)%.The failure rate of FMEA management mode was lower than that of conventional management mode,while the self-repair rate,maintenance rate,and standardized operation rate were higher than those of conventional management mode,and the differences were statistically significant(t=108.568,13.658,9.318,10.354,P＜0.05).The average values of availability ratio of equipment,ratio of performance index,and ratio of quality index of adopting FMEA management mode were respectively(91.04±2.65)%,(96.94±2.31)%and(97.66±1.19)%,which were higher than those of conventional management mode,and the differences were statistically significant(t=19.330,13.085,14.889,P＜0.05).The scores of job responsibilities,basic knowledge for equipment,guarantee capabilities for operation and management performance of manager were respectively(94.12±2.76),(92.03±2.50),(91.35±2.62)and(93.65±3.28)in using the FMEA management mode,which were all higher than those of the conventional management mode,and the differences were statistically significant(t=7.630,11.027,17.311,11.645,P＜0.05).Conclusion:The application of medical FMEA management mode in the management for hemodialysis equipment in the blood purification department can improve the quality of equipment operation,and reduce the failure frequency of equipment,and enhance the overall utilization efficiency of equipment,and improve the quality of clinical services in the department.

ObjectiveBased on ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS）， network pharmacology and molecular docking techniques， to explore the pharmacodynamic material basis and mechanism of Renshen Wuweizi Tang in treating spleen-lung Qi deficiency syndrome. MethodsThe chemical components in the decoction of Renshen Wuweizi Tang were systematically characterized and identified by UPLC-Q-TOF-MS/MS， and network pharmacology was used to screen potential active ingredients， collect component targets and gene sets related to spleen-lung Qi deficiency syndrome， and obtain protein interaction relationships through STRING. Cytoscape 3.9.1 was used to construct a "formula-syndrome" association network and calculate topological feature values. Gene ontology（GO） function and Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway enrichment analysis were performed on core genes to explore potential pharmacodynamic links， the average shortest path between the formula-drug target network and the pharmacodynamic link gene network was calculated to discover dominant pharmacodynamic links， and MCODE plugin was used to identify core gene clusters from the dominant pharmacodynamic links， which were validated using Gene Expression Omnibus（GEO）， and molecular docking was performed between key components and core targets. ResultsOne hundred and thirty-seven components were identified in the negative ion mode， and eighty components were identified in the positive ion mode. After deduplication， a total of 185 components were identified， mainly composed of triterpenoid saponins（49） and flavonoids（54）. Based on the "formula-syndrome" correlation network analysis， energy metabolism was determined to be the dominant pharmacodynamic link of Renshen Wuweizi Tang in the treatment of spleen-lung Qi deficiency syndrome. The results of molecular docking showed that 7 components（adenosine， atractylenolide Ⅱ， atractylenolide Ⅲ， ginsenoside Rg₁， glycyrrhizin B₂， glycyrrhizin E₂ and campesterol） from 4 medicinal materials（Ginseng Radix et Rhizoma， Atractylodis Macrocephalae Rhizoma， Glycyrrhizae Radix et Rhizoma and Poria） in this formula might regulate energy metabolism by acting on 6 targets， namely cyclic adenosine monophosphate-response element binding protein 1（CREB1）， glyceraldehyde-3-phosphate dehydrogenase（GAPDH）， interleukin（IL）-6， nuclear transcription factor（NF）-κB1， peroxisome proliferator-activated receptor α（PPARα）， and tumor necrosis factor（TNF）， thus improving the symptoms of diseases related to spleen-lung Qi deficiency syndrome. ConclusionThis study established a UPLC-Q-TOF-MS/MS for rapid characterization and identification of chemical components in the decoction of Renshen Wuweizi Tang， expanding the understanding of the material composition of this formula， and found that 7 components might act on the key advantageous pharmacodynamic link "energy metabolism" through 6 targets to improve the related symptoms of spleen-lung Qi deficiency syndrome. This can provide a reference for the subsequent exploration of the material benchmark and mechanism of the famous classical formula.

Background and Aims:Implant-based breast reconstruction is one of the most common reconstructive approaches after mastectomy for breast cancer.However,the incidence of postoperative complications remains significant,and the associated risk factors have not been fully elucidated.This study aimed to analyze the incidence of surgical complications following implant-based breast reconstruction in patients undergoing mastectomy at our center and to identify potential risk factors.Methods:A retrospective analysis was conducted on patients who underwent mastectomy and implant-based breast reconstruction at Sun Yat-sen Memorial Hospital between May 2004 and August 2022.Patients were grouped according to the presence or absence of postoperative surgical complications,and multivariate Logistic regression was used to identify independent risk factors.Results:A total of 545 patients with 602 reconstructed breasts were included.Surgical complications occurred in 13.6%(82/602)of the cases,including infection,wound dehiscence/poor healing,flap or nipple-areola necrosis,and implant leakage/rupture.Multivariate analysis revealed that nipple-areola complex resection(OR=1.934,95%CI=1.056-3.542,P=0.033),postoperative radiotherapy(OR=2.483,95%CI=1.527-4.036,P<0.001),implant volume≥300 mL(OR=1.663,95%CI=1.025-2.696,P=0.039),and surgeon experience with fewer than 10 cases(OR=1.804,95%CI=1.092-2.979,P=0.021)were all independent risk factors for complications.Conclusion:NAC resection,radiotherapy,large implant volume,and limited surgical experience are important independent risk factors for postoperative surgical complications following implant-based breast reconstruction.Thorough preoperative evaluation and appropriate surgical planning are essential to minimize risks.

Background and Aims:Implant-based breast reconstruction is one of the most common reconstructive approaches after mastectomy for breast cancer.However,the incidence of postoperative complications remains significant,and the associated risk factors have not been fully elucidated.This study aimed to analyze the incidence of surgical complications following implant-based breast reconstruction in patients undergoing mastectomy at our center and to identify potential risk factors.Methods:A retrospective analysis was conducted on patients who underwent mastectomy and implant-based breast reconstruction at Sun Yat-sen Memorial Hospital between May 2004 and August 2022.Patients were grouped according to the presence or absence of postoperative surgical complications,and multivariate Logistic regression was used to identify independent risk factors.Results:A total of 545 patients with 602 reconstructed breasts were included.Surgical complications occurred in 13.6%(82/602)of the cases,including infection,wound dehiscence/poor healing,flap or nipple-areola necrosis,and implant leakage/rupture.Multivariate analysis revealed that nipple-areola complex resection(OR=1.934,95%CI=1.056-3.542,P=0.033),postoperative radiotherapy(OR=2.483,95%CI=1.527-4.036,P<0.001),implant volume≥300 mL(OR=1.663,95%CI=1.025-2.696,P=0.039),and surgeon experience with fewer than 10 cases(OR=1.804,95%CI=1.092-2.979,P=0.021)were all independent risk factors for complications.Conclusion:NAC resection,radiotherapy,large implant volume,and limited surgical experience are important independent risk factors for postoperative surgical complications following implant-based breast reconstruction.Thorough preoperative evaluation and appropriate surgical planning are essential to minimize risks.