Varicocele is a common disease of the male reproductive system, and the pampiniform plexus in the spermatic cord manifests abnormal dilatation, extension, and circuity, which is a vasculopathy. In this article, we believe that the relevance of the essence chamber collaterals to the spermatic vein in terms of anatomical morphology and physiological function is high and that when pathogenic qi invades the essence chamber, the qi and collaterals of the essence chamber are out of harmony, the fluid collaterals are impassable, and the blood collaterals are obstrcuted, and the essence chamber collaterals are blockaded with several pathological products, and even intermingled phlegm and blood stasis in the blood collaterals and form vascular clusters, resulting in the formation and development of varicocele. Based on this, this article proposes the core treatment principle of healing, harmonizing, activating, and dredging the collaterals, with the basic treatment method of nourishing qi and harmonizing collaterals, activating blood collaterals, and dredging blood stasis to, respectively treat degree Ⅰ, Ⅱ, and Ⅲ varicocele, aiming to prevent the change of the varicocele, dredge the curvature of the varicocele, and dissipate the knots of the varicocele. The proposal of essence chamber collaterals is of great significance to understanding the common law and pathological aspects of the occurrence and development of essence collateral and vascular lesions from the perspective of integrated traditional Chinese and Western medicine.

Objective:To examine the prevalence of malnutrition and evaluate the impact of nutritional support on clinical outcomes in elderly patients diagnosed with gastric and colorectal cancer.Methods:A retrospective cohort study was conducted, analyzing elderly patients with gastrointestinal tumors who underwent surgical treatment in the general surgery department from January 2019 to June 2020.The Global Leadership Initiative on Malnutrition(GLIM)criteria were utilized to diagnose malnutrition, and the effects of malnutrition and nutritional support on clinical prognosis were investigated.Results:A total of 426 elderly hospitalized patients with gastric and colorectal tumors who underwent surgical treatment were included in this study.This cohort comprised 199 cases of gastric cancer and 227 cases of colorectal cancer, with ages ranging from 65 to 91 years(mean age: 72.05±5.99).According to the GLIM criteria, 43.7%(186/426)of the patients were diagnosed with malnutrition, of which 25.6%(109/426)were moderately malnourished and 18.1%(77/426)were severely malnourished.Among the gastric cancer patients, 73.4%(146/199)were identified as having nutritional risk, with 48.7%(97/199)being malnourished and 22.6%(45/199)experiencing severe malnutrition.In the colorectal cancer group, 63.9%(145/227)were at nutritional risk, 39.2%(89/227)were malnourished, and 14.1%(32/227)had severe malnutrition.Additionally, 60.3%(257/426)of the patients received nutritional support therapy: 25.4%(108/426)received parenteral nutrition(PN), 11.3%(48/426)received enteral nutrition(EN), 23.7%(101/426)received a combination of EN and PN, while 39.7%(169/426)did not receive any nutritional support.Regardless of the presence or degree of malnutrition, patients who received nutritional support had significantly shorter total hospital stays compared to those who did not receive nutritional support, and this difference was statistically significant( t=5.58, 3.69, 2.21, 3.03, all P<0.05). Conclusions:Providing nutritional support to malnourished patients can reduce the length of hospital stay and improve clinical outcomes.

Objective:To investigate the association between the metabolic score for visceral fat(METS-VF)and sarcopenia in older adults in China.Methods:A retrospective cohort study was conducted.A total of 1 262 participants aged ≥60 years old who did not diagnose with sarcopenia in 2011 and had complete follow-up data in 2015 were selected from the China health and retirement longitudinal survey(CHARLS). Participants were divided into the low METS-VF group (n=621)and the high METS-VF group (n=641), and then the corrleation between METS-VF and sarcopenia was analyzed.Results:The inverse probability of treatment weighting(IPTW)was used to balance all covariates between the low METS-VF group and high METS-VF group.The results showed that 30 participants in the low METS-VF group and 47 participants in the high METS-VF group were diagnosed with sarcopenia, with prevalence rates of 4.83%(30/621)and 7.33%(47/641), respectively.The difference in the prevalence of sarcopenia between the two groups was statistically significant after IPTW ( χ2=3.934, P=0.048, SMD=0.150). Logistic regression analysis showed that, after adjusting for various confounders, high METS-VF was significantly associated with an increased risk of sarcopenia in older adults( OR=2.130, 95% CI: 1.294~3.572, P=0.003). Subgroup analyses further indicated that individuals without cardiovascular disease had a relatively higher risk of sarcopenia( P for interaction=0.032). Conclusions:METS-VF is associated with an increased risk of sarcopenia in older adults in China, and its predictive and diagnostic value warrants further investigation.

A 20-year old female patient diagnosed with right distal tibial giant cell tumor underwent a surgery of resection of distal tibial giant cell tumor, residual cavity liquid nitrogen and electrocauterization inactivation and local arthroplasty on March 17, 2023. Preoperatively a life-size distal tibia model was 3D printed using polylactic acid (PLA) material based on the CT data of patient's distal tibia. Tumor resection was simulated on the model, preserving the surrounding normal bone and articular cartilage unaffected by the tumor. The residual cavity was filled with bone cement and the distal tibial articular surface was shaped using the talar articular surface as a template. The 3D CT data of bone cement was collected and reconstructed. The irregular bone and cartilage defect data were trimmed to form a regular arc shape, which was used as the data for fabricating local arthroplasty prosthesis. The local arthroplasty prosthesis composed of a titanium base and a VE polyethylene liner was 3D printed. During the operation, the test models of titanium alloy base and VE polyethylene liner were used to test the matching degree with the bone and cartilage defect. Minor adjustments were made by removing a portion of the lateral wall of the residual cavity and modifying the base height to achieve proper alignment of the distal tibial articular surface with the talar surface. After confirming a satisfactory fit, the local arthroplasty prosthesis was implanted. Intraoperative fluoroscopic confirmed accurate placement of the prosthesis, good anatomical match with the defect, and restoration of the joint line. The postoperative follow-up was conducted at 2, 4, 12, 20, 48, 72 and 92 weeks. Wound healing was closely monitored, along with radiologic assessment for prosthesis bone ingrowth and local tumor recurrence. Functional evaluations were performed using the AOFAS and Kofoed scoring systems. Postoperatively, the patient experienced plantar numbness and sensory disturbance, which gradually resolved after three weeks. Assisted ambulation began at two weeks postoperatively, and the patient resumed a normal gait by 12 weeks. The Mayo ankle arthroplasty evaluation criteria at postoperative at 48 weeks were excellent. The AOFAS score and Kofoed score were 97 points and 94 points respectively, indicating excellent functional outcomes. Postoperative X-ray indicated that no bone ingrowth was observed at 2 weeks and 4 weeks after the operation, minor ingrowth at 12 weeks postoperatively, significant bone ingrowth at 20 weeks, and complete osseointegration by 48 to 64 weeks. Postoperative CT imaging at 92 weeks confirmed full prosthesis osseointegration, while MRI at 72 weeks showed no evidence of tumor recurrence.

Asthenospermia is one of the important causes of male infertility,and its etiology and pathogenesis are complex.Traditional Chinese medicine(TCM)offers unique advantages in treating this disease.The"kidney deficiency and toxic-stasis"theory reveals the dynamic relationship between kidney essence deficiency and the interaction of toxic-stasis in disease pathogenesis,which can be applied clinically to guide the differentiation and treatment of asthenospermia.The formation of asthenospermia is closely related to the deficiency of kidney essence and the blockage of toxic stasis.The kidney essence is the source of reproductive essence.If the kidney essence is depleted for a long time and the kidney essence is deficient,the essence chamber cannot be enriched,resulting in spermatozoa dysfunction and poor spermatozoa mobility.The poison stasis interferes with the spermatozoa and turns into spermatotoxin,which directly harms spermatozoa fertility and leads to the decrease of spermatozoa mobility.Tongjing Jiedu Formula takes tonifying kidney to supply essence,diuresis and detoxification,activating blood circulation and removing blood stasis as the treatment principle,focusing on tonifying kidney to fill essence and nourishing healthy qi to restore the nourishing effect of kidney essence,and also emphasizes clearing heat and detoxification,activating blood circulation and removing blood stasis,promoting diuresis and dredging collaterals to remove poisonous damp-heat and static blood and harmonize blood and vessel,improving spermatogenic environment and improving sperm vitality to help men have children.This article analyzes the application of Tongjing Jiedu Formula in treating asthenospermia from the perspective of"kidney deficiency and toxic stasis",aiming to provid new ideas and methods for the explanation of the pathogenesis of the disease and TCM treatment.

Objective:To investigate the incidence of hearing loss among helicopter flying personnel, and to analyze the contributing factors.Methods:Basic data of 443 male helicopter flying personnel who received physical examinations at Beidaihe Rehabilitation and Recuperation Center of PLA between March and June 2024 was collected. The hearing threshold levels were measured at 8 frequencies: 250, 500, 1 000, 2 000, 3 000, 4 000, 6 000 and 8 000 Hz. Routine blood tests and blood biochemical tests were performed. Based on the results of pure-tone audiometry, the participants were divided into 2 groups: the hearing loss group (hearing threshold ≤20 dB HL) and the normal hearing group (hearing threshold >20 dB HL). The basic data, routine blood results, and blood biochemical indicators were compared between the 2 groups before the contributors to hearing loss were analyzed.Results:A total of 443 helicopter flying personnel were included in the study, with 82 cases (18.51%) in the hearing loss group and 361 cases (81.49%) in the normal hearing group. There were significant differences in age and pulse between the flying personnel in the 2 groups ( t=2.13, 2.78, P=0.034, 0.006). Among the blood routine indicators, only the mean platelet volume (MPV) was significantly different ( t=2.26, P=0.025). Among the blood biochemical indicators, only homocysteine (HCY) revealed statistically significant difference ( Z=2.30, P=0.021). The determinants of hearing loss in helicopter flying personnel were age ( OR=1.046, 95% CI: 1.060-1.361), pulse ( OR=1.201, 95% CI: 1.060-1.361), MPV ( OR=1.365, 95% CI: 1.016-1.834) and HCY ( OR=1.065, 95% CI: 1.033-1.097). Conclusions:Age, pulse, the MPV and HCY levels can all contribute to hearing loss, and the MPV and HCY can serve as potential biomarkers for hearing loss in helicopter flying personnel. Potential hearing loss should be detected early and personalized interventions should be implemented. Noise exposure should be monitored more rigorously to reduce the risk of occupational hearing loss for helicopter flying personnel and ensure flight safety.

The shortage of donor organs is the primary factor limiting the availability of liver transplantation (LT) and is a leading cause of death among patients on the waiting list. The reuse of liver allografts, while rare, represents a significant and unconventional donor resource, offering a promising strategy to expand the donor pool. This approach has been documented in international literature, demonstrating favorable surgical outcomes and long-term follow-up results. Here, we report the first case of liver allograft reuse in the Liver Transplantation Center, Department of General Surgery, Huashan Hospital, Fudan University. In this case, the first recipient underwent orthotopic LT for acute liver failure and hepatic encephalopathy. However, their condition deteriorated on the seventh postoperative day, culminating in brain death. Following evaluation and maintenance, the liver allograft was successfully re-transplanted into a second recipient, who had undergone LT six days earlier but experienced acute hepatic artery embolism leading to rapid liver function deterioration. The second recipient's liver function recovered smoothly after surgery, and they were discharged on the 28th postoperative day. This case highlights the significant value of liver allograft reuse in expanding the donor pool and providing life-saving options for critically ill patients requiring urgent LT.

Knee adduction moment(KAM)is a key biomechanical index in knee joint biomechanics research,which is closely related to the occurrence and development of knee osteoarthritis(KOA).Therefore,understanding the factors influencing KAM is important for the diagnosis and treatment of KOA diseases.This review summarizes the factors that may affect KAM based on relevant research.

Objective:To detect the expression of autophagy-related genes (ATGs) involved in the late stage of autophagy in peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS), analyze the difference and explore its possible clinical significance.Methods:① Peripheral blood specimens and clinical data were collected from 90 AS patients (AS group) who attended the outpatient clinic of the Department of Rheumatology and Immunology of the Affiliated Hospital of North Sichuan Medical College from March 2022 to August 2023, among which 30 patients were treated with secukinumab monoclonal antibody for 24 weeks (the treatment group), and clinical data and peripheral blood specimens from 45 healthy individuals (the HC group) who had medical checkups in the Affiliated Hospital of Chuanbei Medical College during the same period were used as the control group. As the control group, the mRNA expression levels of six ATGs (ATG5, ATG7, LC3-Ⅱ, ATG4B, ATG2A, ATG10) involved in the late autophagy stage were detected in PBMCs of peripheral blood specimens by RT-qPCR, and were compared among different groups, and the measured data conformed to the normal distribution were analyzed using the paired t-test, and the abnormal distribution date were analyzed using the Wilcoxon signed-rank test. Wilcoxon signed-rank test was used for measurement data, and Spearman correlation analysis was used for correlation analysis. ② Receiver operating curve (ROC) was used to verify the difference in the expression of ATGs in the late stage of autophagy between AS group and HC group to evaluate its value in the diagnosis of AS and the inflammatory state of the disease. Results:① Compared with the HC group, ATG2A [2.00(1.10, 2.70)×10 -3, 7.50(4.60, 10.0)×10 -3, Z=-6.67, P<0.001], ATG5 [3.60 (2.30, 5.30)×10 -3, 7.20(5.50, 9.20)×10 -3, Z=-3.63, P=0.001], LC3Ⅱ[25.70(8.50, 35.00)×10 -3, 52.20(45.00, 69.10)×10 -3, Z=-5.87, P<0.001] and ATG7[5.50(3.20, 8.10)×10 -3, 8.30(5.20, 9.80)×10 -3, Z=-2.38, P=0.017] the mRNA expressions were significantly decreased in the AS group. ②ATG5 mRNA expression was negatively correlated with platelet count ( r=-0.35, P=0.008), LC3-Ⅱ was negatively correlated with estimated glomerular filtration rate ( r=-0.33, P=0.017), ATG7 was positively correlated with absolute basophil count ( r=0.33, P=0.011),ATG10 was negatively correlated with estimated glomerular filtration rate and C-reactive protein (CRP) was negatively correlated ( r=-0.30, P=0.032). ③ The area under the ROC curve (AUC) of ATG2A mRNA expression level for predicting AS was 0.910, and the sensitivity and specificity were 94.6% and 83.8% respectively. ④ After 24 weeks of treatment with secukinumab, the mRNA expression levels of ATG2A[2.00(1.20, 2.90)×10 -3, 4.90(0.10, 7.40)×10 -3, Z=-3.75, P<0.001] and LC3-Ⅱ[2.00(1.20, 2.90)×10 -3, 4.90(0.10, 7.40)×10 -3, Z=-3.75, P<0.001]were elevated in the AS patients. Conclusion:Late autophagy-related genes ATG2A, ATG5, LC3II, ATG7 may be involved in AS development.The AUC of ATG2A in AS is 0.91, suggesting that ATG2a is expected to be a biological indicator for early diagnosis of AS. Secukinumab may be involved in the regulation of autophagy by affecting the expression of late autophagy genes, but the specific mechanism needs to be further explored.

Objective:To analyze the disease burden and changing trend of pancreatic cancer in our country from 1990 to 2021, and predict the incidence and mortality trends of pancreatic cancer from 2022 to 2036.Methods:Utilizing the data from the Global Burden of Disease 2021 Study, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and disability-adjusted life rate (DALY) of pancreatic cancer in our country from 1990 to 2021 were evaluated. DALY is calculated by adding the number of years of life lost due to pancreatic cancer to the years of life lost due to disability. The Joinpoint model was used to calculate the average annual percentage change (AAPC), the age-period-cohort model was applied to control the influence of age, period and birth cohort, and the Bayesian age-period-cohort model was used to predict the incidence and mortality trends of pancreatic cancer in our country from 2022 to 2036.Results:Compared with 1990, the data of ASIR, ASMR and age-standardized disability-adjusted life years (DALY) rates of pancreatic cancer in our country in 2021 all increased, and the increase in men was more significant than that in women. The peaks of morbidity and mortality in 1990 and 2021 were both occurred in the elderly. The incidence rate, mortality rate and changes of men in all age groups were higher than those of women. The changes in the age-standardized DALY rate were mainly reflected in the male population. The first peaks of the age-standardized DALY rate in 1990 and 2021 both occurred at the age of 70-74, and the second peak of the age-standardized DALY rate in 2021 shifted to the age of 85-89. The peak rate of age-standardized DALY in females is earlier than that in males. The AAPC of ASIR and ASMR for all genders of pancreatic cancer in our country from 1990 to 2021 was 0.72 (95% CI: 0.50-0.94, P<0.001) and 0.56 (95% CI: 0.31-0.82, P<0.001), respectively, and the difference was statistically significant. In our country men with pancreatic cancer, ASIR (AAPC=0.89, 95% CI: 0.68-1.10, P<0.001) and ASMR (AAPC=0.71, 95% CI: 0.49-0.93, P<0.001) were compared with ASIR (AAPC=0.48, 95% CI: ) in women. 0.22-0.73, P<0.001) and ASMR (AAPC=0.33, 95% CI: 0.08-0.58, P=0.010) increased rapidly, and the difference was statistically significant. The ASDR of all genders showed an upward trend (AAPC=0.36, 95% CI: 0.18-0.54, P<0.001), and the difference was statistically significant. The incidence rate and mortality rate of all genders are on the rise. When the age of the population is over 60 years old, the incidence and mortality of specific diseases show an upward trend with the delay of the birth cohort. It is expected that from 2022 to 2036, the ASIR and ASMR of both men and women will increase annuallyand eventually double. Conclusion:From 1990 to 2021, the burden of pancreatic cancer in our country has generally shown an increasing trend, and it is expected that the disease burden will further increase in the future.