ObjectiveTo investigate the efficacy and safety of Babaodan Capsule （BBD） in the treatment of patients with chronic hepatitis B virus （HBV） infection with damp-heat in the liver and gallbladder comorbid with gallbladder polyps. MethodsA randomized， double-blinded， placebo-controlled single-center trial was conducted among 120 patients with chronic HBV infection who were admitted to Beijing YouAn Hospital， Capital Medical University， from August 2020 to April 2023， and they were divided into treatment group （BBD） and control group （placebo）， with 60 patients in each group. The course of treatment was 24 weeks， and follow-up assessments were conducted every 4 weeks. The primary outcome measures were the number and maximum diameter of gallbladder polyps （assessed by ultrasound）， and the secondary outcome measures included traditional Chinese medicine （TCM） syndrome score， blood lipid levels， and liver function parameters. The independent-samples t test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups； the Wilcoxon rank-sum test was used for comparison of ranked data between two groups； the generalized estimating equation was used to analyze repeated measures data. ResultsAfter 8 weeks of treatment， the treatment group had a significantly smaller diameter of polyps and a significantly lower number of polyps than the control group （Z=-1.76 and -1.80， both P<0.05）， and after 24 weeks of treatment， the treatment group had a significantly higher polyp reduction rate than the control group （30.51% vs 10.91%， P<0.05）. The subgroup analysis showed that patients receiving combined antiviral therapy， male patients， patients with a diameter of polyps of <5 mm， and patients with multiple polyps tended to achieve significantly greater benefits. At week 8 of treatment， the treatment group had a significantly better TCM syndrome score than the control group （Z=-2.35， P<0.05）； after treatment， compared with the control group， the treatment group had a significantly greater increase in high-density lipoprotein （Z=-1.85， P<0.05） and significantly lower levels of alanine aminotransferase （Z=-2.06， P <0.05）， aspartate aminotransferase （Z=-2.13， P<0.05）， total bilirubin （Z=-2.12， P<0.05）， and direct bilirubin （Z=-3.09， P<0.05）. No serious adverse events were reported in either group. ConclusionBBD can effectively reduce the size of gallbladder polyps， improve TCM syndrome score， and reduce the level of bilirubin in patients with chronic HBV infection with damp-heat in the liver and gallbladder， with a favorable safety profile， and it may be more suitable for patients receiving combined antiviral therapy and specific subgroups （male patients， patients with a diameter of polyps of <5 mm， and patients with multiple polyps.

Objective:To explore the efficacy of the fifth metatarsal perforator flap of the lateral plantar artery in repairing the wounds on the anterolateral side of the foot.Methods:This study was a retrospective observational study. Eight patients with skin and soft tissue defects on the anterolateral side of the foot and conformed to the inclusion criteria were admitted to the Department of Plastic Surgery of Hanzhong Central Hospital from July 2020 to July 2023. There were 6 males and 2 females, aged 22 to 72 years. Among the patients, there were three patients with electrical burns, four patients with trauma, and one patient with plantar wart. Preoperatively, a Doppler blood flow detector was used to clarify the number and location of the fifth metatarsal perforating vessels. The area of the wounds measured during the operation ranged from 4.0 cm×3.0 cm to 7.0 cm×5.0 cm, and the fifth metatarsal perforator flaps of the lateral plantar artery with area of 4.0 cm×4.0 cm to 9.0 cm×6.0 cm were designed and harvested to repair the wounds. The wounds in the flap donor sites were repaired with medium-thickness skin grafts from lower limb on the same side. The duration of surgery and intraoperative blood loss volume were recorded. The survivals of the transplanted flap and skin graft were observed after surgery. At the last follow-up, the appearance of the flap and the occurrence of complication were observed, the two-point discrimination distance of the flap was measured, and the shape of the flap donor site as well as the sensation and other functions of the affected foot were observed.Results:The duration of surgery ranged from 70 to 100 min, with an average of 84.6 min. The intraoperative blood loss volume ranged from 30 to 80 mL, with an average of 53.5 mL. After surgery, all flaps survived completely; only one patient developed partial necrosis of the skin graft in the wound in flap donor site, and the wound healed completely after dressing change and re-grafting medium-thickness skin graft from lower limb on the same side. Postoperative follow-up was conducted for 6 to 24 months, with an average of 13.8 months. At the last follow-up, none of the patients developed bloated and deformed flaps or pressure ulcers, and the two-point discrimination distance of the flap ranged from 5 to 13 mm. No tendon adhesion or scar hyperplasia was observed in the flap donor sites, and the sensation, weight-bearing, and walking functions of the affected feet were normal.Conclusions:The use of the fifth metatarsal perforator flap of the lateral plantar artery for repairing the wounds on the anterolateral side of the foot has the advantages of flexible flap design, minimal damage to the flap donor site, simple and feasible surgical operation, and good postoperative foot appearance and function, which is worthy of clinical application and promotion.

Aging is characterized by a gradual deterioration of the physiological integrity of cells,tissues,and or-gans,resulting in a decrease in the body's physiological functions and an acceleration of the onset of age-related diseases,ultimately leading to death.The aging of the liver,which is a critical metabolic organ,is closely linked to various chronic liver diseases,such as hepatitis,liver fibrosis,and cirrhosis,and it ex-acerbates their prognosis and is a primary risk factor for their development at all stages.Therefore,a comprehensive understanding of the causes,mechanisms,and potential therapeutic targets associated with liver aging holds significant clinical importance for delaying or potentially reversing liver aging and for treating chronic liver diseases.Stem cells,which are potential anti-aging agents,present a promising and effective alternative for managing liver aging.In this review,we systematically assess the driving factors,characteristics,and underlying mechanisms of liver aging.We then discuss the current status of the use of stem cells to mitigate liver senescence and address related liver diseases.The review reveals that a stem cell-based approach represents a promising therapeutic strategy for combating liver aging and associated diseases.

Objective To investigate the cognition of both doctors and patients in the neurology department of a tertiary hospital in Linyi City regarding graded diagnosis and treatment,and to explore its influencing factors.Methods Convenient sampling was used to select 456 survey subjects from 20 medical institutions within the medical consortium of a tertiary hospital in Linyi City,including 191 medical staffs and 265 patients;A total of 35 medical staffs and patients were interviewed.Results The overall awareness of graded diagnosis and treatment among medical staff and patients was(3.731±0.563)points and(3.136±0.367)points,respectively.The influencing factors of medical staff on grading diagnosis and treatment are professional title,years of work experience,and hospital grade.The influencing factors of patient on grading diagnosis and treatment are age,type of medical insurance,average monthly income,and whether they had a transfer experience.Conclusion While strengthe-ning information technology construction,government supervision and investment,and enhancing the capacity building of grassro-ots medical institutions,it is also necessary to actively promote the construction of close medical consortia to accelerate the forma-tion of a standardized and orderly new system for medical treatment and diagnosis.

Objective To investigate the cognition of both doctors and patients in the neurology department of a tertiary hospital in Linyi City regarding graded diagnosis and treatment,and to explore its influencing factors.Methods Convenient sampling was used to select 456 survey subjects from 20 medical institutions within the medical consortium of a tertiary hospital in Linyi City,including 191 medical staffs and 265 patients;A total of 35 medical staffs and patients were interviewed.Results The overall awareness of graded diagnosis and treatment among medical staff and patients was(3.731±0.563)points and(3.136±0.367)points,respectively.The influencing factors of medical staff on grading diagnosis and treatment are professional title,years of work experience,and hospital grade.The influencing factors of patient on grading diagnosis and treatment are age,type of medical insurance,average monthly income,and whether they had a transfer experience.Conclusion While strengthe-ning information technology construction,government supervision and investment,and enhancing the capacity building of grassro-ots medical institutions,it is also necessary to actively promote the construction of close medical consortia to accelerate the forma-tion of a standardized and orderly new system for medical treatment and diagnosis.

Objective:To explore the efficacy of the fifth metatarsal perforator flap of the lateral plantar artery in repairing the wounds on the anterolateral side of the foot.Methods:This study was a retrospective observational study. Eight patients with skin and soft tissue defects on the anterolateral side of the foot and conformed to the inclusion criteria were admitted to the Department of Plastic Surgery of Hanzhong Central Hospital from July 2020 to July 2023. There were 6 males and 2 females, aged 22 to 72 years. Among the patients, there were three patients with electrical burns, four patients with trauma, and one patient with plantar wart. Preoperatively, a Doppler blood flow detector was used to clarify the number and location of the fifth metatarsal perforating vessels. The area of the wounds measured during the operation ranged from 4.0 cm×3.0 cm to 7.0 cm×5.0 cm, and the fifth metatarsal perforator flaps of the lateral plantar artery with area of 4.0 cm×4.0 cm to 9.0 cm×6.0 cm were designed and harvested to repair the wounds. The wounds in the flap donor sites were repaired with medium-thickness skin grafts from lower limb on the same side. The duration of surgery and intraoperative blood loss volume were recorded. The survivals of the transplanted flap and skin graft were observed after surgery. At the last follow-up, the appearance of the flap and the occurrence of complication were observed, the two-point discrimination distance of the flap was measured, and the shape of the flap donor site as well as the sensation and other functions of the affected foot were observed.Results:The duration of surgery ranged from 70 to 100 min, with an average of 84.6 min. The intraoperative blood loss volume ranged from 30 to 80 mL, with an average of 53.5 mL. After surgery, all flaps survived completely; only one patient developed partial necrosis of the skin graft in the wound in flap donor site, and the wound healed completely after dressing change and re-grafting medium-thickness skin graft from lower limb on the same side. Postoperative follow-up was conducted for 6 to 24 months, with an average of 13.8 months. At the last follow-up, none of the patients developed bloated and deformed flaps or pressure ulcers, and the two-point discrimination distance of the flap ranged from 5 to 13 mm. No tendon adhesion or scar hyperplasia was observed in the flap donor sites, and the sensation, weight-bearing, and walking functions of the affected feet were normal.Conclusions:The use of the fifth metatarsal perforator flap of the lateral plantar artery for repairing the wounds on the anterolateral side of the foot has the advantages of flexible flap design, minimal damage to the flap donor site, simple and feasible surgical operation, and good postoperative foot appearance and function, which is worthy of clinical application and promotion.

Objective To observe the clinical effect of automated peritoneal dialysis(APD)in urgent-start peritoneal dialysis patients with stage 5 chronic kidney disease(CKD).Methods A total of 60 patients with end-stage renal disease who underwent urgent-start peritoneal dialysis in Shenyang Red Cross Hospital from June 2021 to December 2023 were selected as study objects.According to peritoneal dialysis,patients were divided into APD group and intermittent peritoneal dialysis(IPD)group,with 30 patients in each group.Renal function,electrolyte,parathyroid hormone,inflammatory factors,nutritional indexes,brain natriuretic peptide,blood pressure,urine volume,ultrafiltration volume and adverse reactions were compared between two groups.Results After treatment,serum creatinine,urea nitrogen,uric acid,potassium,phosphorus,parathyroid hormone,C-reactive protein,interleukin-6,brain natriuretic peptide,systolic blood pressure and diastolic blood pressure in two groups were significantly lower than before treatment,and urine volume was significantly higher than before treatment(P＜0.05).Serum creatinine,urea nitrogen,uric acid,potassium,phosphorus,parathyroid hormone,C-reactive protein,interleukin-6,brain natriuretic peptide,systolic blood pressure and diastolic blood pressure in APD group were significantly lower than those in IPD group,and ultrafiltration volume in APD group was significantly higher than that in IPD group(P＜0.05).After treatment,there was no significant difference in urine volume between two groups(P＜0.05).No serious complications and death were observed during treatment.Conclusion APD is safe and effective,and is a good choice for urgent-start peritoneal dialysis in stage 5 CKD patients.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Objective:To investigate the clinical features,gene mutation profile,efficacy and prognostic factors of primary extranodal diffuse large B-cell lymphoma(EN-DLBCL).Methods:A retrospective analysis was performed for 382 patients with primary EN-DLBCL with complete clinical data who were treated in West China Hospital from January 2013 to January 2023,and their clinical characteristics,gene mutation profile,efficacy and prognostic factors were analyzed.Results:The median age of the 382 patients with EN-DLBCL was 56 (18-89 )years old.The male-to-female ratio was 1.12∶1,and the most common primary sites were gastrointestinal tract (31.7％),Wechsler ring (19. 1％)and breast gland (7.1％).A total of 51 gene mutations were fund,and the most common frequencies of gene mutations were TP53 (32.5％),MYD88 (32.5％),and CD79B (30.0％).The median follow-up was 63 months,and the 5-year progression-free survival (PFS)rate was 74.5％ and the 5-year overall survival (OS)rate was 89.6％. The adverse factors on PFS were as follows:>1 extranodal sites involvement (P<0.001),P53≥50％(P<0.001),hyper double expression(hDEL)of C-myc>50％/Bcl-2>70％(P<0.001).The adverse factors affecting the OS of patients were as follows:>1 extranodal sites involvement (P<0.001),P53≥50％(P<0.001),hDEL(P<0.001). Chemotherapy combined with local radiotherapy could improve PFS (P=0.041)and OS (P=0.003),while R-CHOP+X (molecule agents as BTKi、HDACi、Lenalidomide)failed to show a significant difference in PFS (P=0.075)and OS (P=0.767 ).Among the 40 patients who underwent next-generation sequencing at high risk,there was no significant in PFS (P=0.849)and OS (P=0.500)of patients with positive MYD88 and/or CD79B mutations (MCD subtype)treated with BTKi and patients with negative MYD88 and CD79B mutations.Conclusion:Primary EN-DLBCL can involve multiple organs or tissue sites.TP53,MYD88,and CD79B are the most common gene mutations.The efficacy of BTKi in patients with positive MCD subtypes at intermediate and high risk is not inferior to that in MCD-negative control patients.

Objective:To explore the diagnosis and treatment of acquired hemophilia A (AHA ) based on the analysis of clinical data.Methods:A retrospective analysis was conducted on the clinical manifestations,laboratory characteristics,treatment,and outcomes of 25 patients diagnosed with AHA who were admitted to the Second Hospital of Hebei Medical University. Results:Among all patients,11 cases had secondary factors,including 5 cases of autoimmune diseases,3 cases of pregnancy-related disease,1 case of pemphigoid,1 case of Graves'disease,and 1 case of monoclonal gammaglobulinemia of unknown significance (MGUS ).The bleeding sites include the skin,mucous membrane,muscle,joint cavity and brain tissue.Twenty-three patients were treated with prednisone combined with cyclophosphamide (CP regimen),one patient with rituximab combined with cyclophosphamide because of femoral head necrosis,and one case with rituximab monotherapy because of gastrointestinal bleeding after prednisone treatment. Among them,23 cases achieved complete remission (CR),2 cases were partial remission (PR),and 8 cases relapsed after CR.All of 10 patients including 2 cases with PR and 8 relapsed cases after CR were treated with rituximab.At last,8 patients achieved CR,and 2 patients (both were patients with recurrence after first CR)achieved PR.These two patients achieving PR were treated with low-dose rituximab combined with bortezomib (RB regimen ).One patient reached CR after 4 cycles and the other reached CR after 6 cycles of RB regimen.After CR,4 of the 10 patients treated with rituximab received maintenance therapy with rituximab monotherapy for 1.5 to 2 years,in which,none of them relapsed.Among the 6 patients who did not receive maintenance therapy,4 patients relapsed after CR,and the median time to relapse was 15 months.Eight patients treated with CP regimen developed common infections,and two patients treated with rituximab developed severe pneumonia.All 25 patients survived until the end of follow-up.Conclusion:Skin ecchymosis,mucous hemorrhage and muscle hematoma are the most common hemorrhagic manifestations in AHA,and joint hemorrhage and cerebral hemorrhage can also occur.CP regimen is the preferred option of first-line therapy for AHA.Rituximab can be used for patients with steroid contraindication or who failed to respond to the above therapy or relapsed after effective treatment,and maintenance therapy is recommended to reduce the risk of recurrence.Meanwhile,close attention should be paid to the occurrence of infection events during rituximab treatment.Rituximab in combination with bortezomib can also be used in patients with refractory or relapsing AHA.