Objective:To evaluate the clinical efficacy of the operation treated of unilateral unstable sacral fracture with S 1 dysplasia by bi-perforative screws of the middle and posterior pelvic columns. Methods:A retrospective analysis was conducted on 18 patients with proximal S 1 dysplasia and unilateral unstable sacral fractures treated at Tianjin Hospital, from January 2018 to January 2023. The cohort included 10 males and 8 females, with an average age of 46.3±1.2 years (range, 18-56 years). The causes of injury were traffic accidents in 12 cases and falls in 6 cases. All patients had combined anterior pelvic ring injuries, including 14 cases of simple fractures and 4 cases of fractures combined with pubic symphysis injuries. Preoperative neuro-magnetic resonance imaging (MRI) confirmed that the lumbosacral nerves were not compressed by fracture fragments or displaced bone ends. According to the Dennis classification, there were 8 cases of type I and 10 cases of type II sacral fractures. Abnormalities in S 1 development included 9 cases of steep slopes, 6 cases of anterior rim depression, and 3 cases of both deformities simultaneously. There were 2 cases of nerve injury, both of which were Gibbons grade II. The average time from injury to surgery was 5.4±1.7 days (range, 4-14 days). All patients underwent combined anterior and posterior pelvic fixation in a single stage, with sacral fractures fixed using bi-perforative screws of posterior pelvic ring. The following parameters were recorded: screw placement time, intraoperative blood loss, fluoroscopy time, fracture healing time, accuracy of internal fixation placement, postoperative infection rate, and iatrogenic injury incidence. The Mears scoring system was used to evaluate the satisfaction rate of sacral fracture reduction, the Gibbons classification was used to assess neurological recovery, and the Majeed score was used to evaluate pelvic function. Results:The average screw placement time was 38.7±3.5 min for S 1 and 16.5±1.3 min for the posterior column. The average blood loss during screw placement was 30.53±1.61 ml, and the average fluoroscopy time was 11.3±3.2 s. No vascular or nerve injuries occurred in any case after the operation. All sacral fractures healed, with an average healing time of 7.6±2.2 months (range, 3-12 months). No cases of fracture re-displacement or internal fixation failure were observed. The Mears evaluation results showed anatomical reduction in 12 cases, satisfactory reduction in 4 cases, and unsatisfactory reduction in 2 cases. All internal fixations were accurately placed. All 18 patients were followed up with an average of 18.2±2.5 months (range, 12-36 months). At the last follow-up, the average Majeed score was 87.4±2.9, with 11 cases rated as excellent, 4 as good, and 3 as fair. The two patients with Gibbons grade II nerve injuries improved to grade I postoperatively. Conclusion:Bi-perforative screws fixation for the middle and posterior pelvic columns offers several advantages, including straightforward operation, precise minimally invasive placement, safety and efficacy, robust fixation, and low complication rates, resulting in satisfactory clinical outcomes.

Objective To observe the effects of Yixintai on lipid metabolism and the protein expressions of CPT-1 and CD36 in rats with heart failure;To explore the mechanism of its treatment of heart failure.Methods 106 out of 120 SD rats were selected to establish the heart failure model induced by myocardial infarction by ligating the left anterior descending coronary artery,and 14 rats were selected as the sham-operation group.The successful model rats were randomly divided into model group,trimetazidine group and Yixintai low-,medium-and high-dosage groups,with 14 rats in each group.The administration group was given corresponding drugs by gavage once a day for 4 weeks.LVEF,LVFS,LVIDd and LVIDs were measured by color doppler ultrasonography,the contents of ANP,BNP,LA and FFA in serum were detected by ELISA,the contents of TG,TC,LDL and HDL were detected by automatic biochemical analyzer,HE and Masson staining were used to observe the morphology of myocardial tissue,the expressions of CPT-1 and CD36 protein in myocardial tissue were detected by Western blot.Results Compared with the sham-operation group,LVEF and LVFS in the model group decreased(P<0.05),the LVIDs and LVIDd increased(P<0.05);the contents of serum ANP,BNP,LA,FFA,TG,TC and LDL increased(P<0.05),while the content of HDL decreased(P<0.05),with myocardial edema,irregular arrangement of myocardial fibers,increased inflammatory cell infiltration and collagen fiber deposition;the protein expressions of CPT-1 and CD36 in myocardial tissue decreased(P<0.05).Compared with the model group,the LVEF and LVFS in Yixintai each dosage groups and trimetazidine group increased(P<0.05),LVIDs and LVIDd decreased(P<0.05);the contents of ANP,BNP,LA,FFA,TG,TC and LDL in serum of Yixintai medium-and high-dosage groups and trimetazidine group decreased(P<0.05),the content of HDL increased(P<0.05);myocardial edema was improved,inflammatory cell infiltration was reduced,collagen fiber deposition was reduced,and the protein expressions of CPT-1 and CD36 in myocardial tissue increased(P<0.05).Conclusion Yixintai may improve myocardial energy metabolism and treat heart failure by increasing the expression of CPT-1 and CD36 protein in myocardial tissue and promoting fatty acid β oxidation.

Objective:To evaluate the clinical efficacy of the operation treated of unilateral unstable sacral fracture with S 1 dysplasia by bi-perforative screws of the middle and posterior pelvic columns. Methods:A retrospective analysis was conducted on 18 patients with proximal S 1 dysplasia and unilateral unstable sacral fractures treated at Tianjin Hospital, from January 2018 to January 2023. The cohort included 10 males and 8 females, with an average age of 46.3±1.2 years (range, 18-56 years). The causes of injury were traffic accidents in 12 cases and falls in 6 cases. All patients had combined anterior pelvic ring injuries, including 14 cases of simple fractures and 4 cases of fractures combined with pubic symphysis injuries. Preoperative neuro-magnetic resonance imaging (MRI) confirmed that the lumbosacral nerves were not compressed by fracture fragments or displaced bone ends. According to the Dennis classification, there were 8 cases of type I and 10 cases of type II sacral fractures. Abnormalities in S 1 development included 9 cases of steep slopes, 6 cases of anterior rim depression, and 3 cases of both deformities simultaneously. There were 2 cases of nerve injury, both of which were Gibbons grade II. The average time from injury to surgery was 5.4±1.7 days (range, 4-14 days). All patients underwent combined anterior and posterior pelvic fixation in a single stage, with sacral fractures fixed using bi-perforative screws of posterior pelvic ring. The following parameters were recorded: screw placement time, intraoperative blood loss, fluoroscopy time, fracture healing time, accuracy of internal fixation placement, postoperative infection rate, and iatrogenic injury incidence. The Mears scoring system was used to evaluate the satisfaction rate of sacral fracture reduction, the Gibbons classification was used to assess neurological recovery, and the Majeed score was used to evaluate pelvic function. Results:The average screw placement time was 38.7±3.5 min for S 1 and 16.5±1.3 min for the posterior column. The average blood loss during screw placement was 30.53±1.61 ml, and the average fluoroscopy time was 11.3±3.2 s. No vascular or nerve injuries occurred in any case after the operation. All sacral fractures healed, with an average healing time of 7.6±2.2 months (range, 3-12 months). No cases of fracture re-displacement or internal fixation failure were observed. The Mears evaluation results showed anatomical reduction in 12 cases, satisfactory reduction in 4 cases, and unsatisfactory reduction in 2 cases. All internal fixations were accurately placed. All 18 patients were followed up with an average of 18.2±2.5 months (range, 12-36 months). At the last follow-up, the average Majeed score was 87.4±2.9, with 11 cases rated as excellent, 4 as good, and 3 as fair. The two patients with Gibbons grade II nerve injuries improved to grade I postoperatively. Conclusion:Bi-perforative screws fixation for the middle and posterior pelvic columns offers several advantages, including straightforward operation, precise minimally invasive placement, safety and efficacy, robust fixation, and low complication rates, resulting in satisfactory clinical outcomes.

Chronic heart failure(CHF)is a common end-stage manifestation of cardiovascular disease,and the"spleen-small intestine-heart"axis is its important mechanism.Current studies have shown that the"spleen"in TCM and mitochondria function are similar,and the physiological dysfunction of the"small intestine"is also closely related to intestinal bacterial dysbiosis,and the pathology of the spleen and the small intestine will be transmitted to the heart to accelerate the occurrence and development of CHF.Based on the relevant theory of spleen-small intestine-heart,this article described the correlation between abnormal mitochondrial energy metabolism and imbalance of intestinal flora and CHF from the aspects of the spleen,small intestine and heart,and believed that the essence of CHF is a pathological condition formed by mitochondrial energy metabolism crisis and intestinal microecological disorders,which could provide theoretical references for the TCM prevention and treatment of CHF.

Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) on the cognition and ability in the activities of daily living (ADL) of persons with cerebral small vessel disease.Methods:A total of 71 patients with cognitive impairment due to cerebral small vessel disease were randomly divided into a control group ( n=35) and a treatment group ( n=36). The treatment group was further divided into a group with mild cognitive impairment (a score of 21 to 26 on the mini-mental state exam, n=23) and a moderate cognitive impairment group (scoring 10 to 20, n=13). The treatment groups received 10Hz rTMS, while the control group received sham rTMS. Before and after 90 days of treatment, all were assessed using the mini-mental state examination (MMSE) and the cognitive subscale of the vascular dementia assessment scale (VaDAS-cog). Ability in the activities of daily living was quantified using the Barthel Index (BI). Results:After treatment, significantly increased MMSE and BI scores, but significantly decreased VaDAS-cog scores were observed in both groups. At that point the treatment group showed a significantly higher average post-treatment MMSE score (25.61±2.94) and BI score (80.00±7.85), but a significantly lower average VaDAS-cog score (44.06±3.41) than the control group. The average MMSE scores were not significantly different between the mild and moderate cognitive impairment subgroups. No severe adverse reactions were observed during the rTMS treatment.Conclusions:The 10Hz rTMS can effectively improve the cognition and daily living ability of persons with cerebral small vessel disease.

Chronic heart failure(CHF)is a common end-stage manifestation of cardiovascular disease,and the"spleen-small intestine-heart"axis is its important mechanism.Current studies have shown that the"spleen"in TCM and mitochondria function are similar,and the physiological dysfunction of the"small intestine"is also closely related to intestinal bacterial dysbiosis,and the pathology of the spleen and the small intestine will be transmitted to the heart to accelerate the occurrence and development of CHF.Based on the relevant theory of spleen-small intestine-heart,this article described the correlation between abnormal mitochondrial energy metabolism and imbalance of intestinal flora and CHF from the aspects of the spleen,small intestine and heart,and believed that the essence of CHF is a pathological condition formed by mitochondrial energy metabolism crisis and intestinal microecological disorders,which could provide theoretical references for the TCM prevention and treatment of CHF.

Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) on the cognition and ability in the activities of daily living (ADL) of persons with cerebral small vessel disease.Methods:A total of 71 patients with cognitive impairment due to cerebral small vessel disease were randomly divided into a control group ( n=35) and a treatment group ( n=36). The treatment group was further divided into a group with mild cognitive impairment (a score of 21 to 26 on the mini-mental state exam, n=23) and a moderate cognitive impairment group (scoring 10 to 20, n=13). The treatment groups received 10Hz rTMS, while the control group received sham rTMS. Before and after 90 days of treatment, all were assessed using the mini-mental state examination (MMSE) and the cognitive subscale of the vascular dementia assessment scale (VaDAS-cog). Ability in the activities of daily living was quantified using the Barthel Index (BI). Results:After treatment, significantly increased MMSE and BI scores, but significantly decreased VaDAS-cog scores were observed in both groups. At that point the treatment group showed a significantly higher average post-treatment MMSE score (25.61±2.94) and BI score (80.00±7.85), but a significantly lower average VaDAS-cog score (44.06±3.41) than the control group. The average MMSE scores were not significantly different between the mild and moderate cognitive impairment subgroups. No severe adverse reactions were observed during the rTMS treatment.Conclusions:The 10Hz rTMS can effectively improve the cognition and daily living ability of persons with cerebral small vessel disease.

Objective:To establish a quantitative diagnostic standard for Crohn's disease with dampness syndrome based on clinical data using a disease syndrome combination model and conduct bidirectional validation.Methods:256 patients with Crohn's disease from the Department of Spleen and Stomach Diseases at Guangdong Provincial Hospital of Chinese Medicine, the Department of Gastroenterology at the Sixth Affiliated Hospital of Sun Yat-sen University, and the Outpatient Department of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to January 2022 were selected as the observation objects. They were divided into an operation group of 205 patients and a verification group of 51 patients in an 8:2 ratio using a random number table method. The frequency advantage method, χ2 test, and binary logistic regression analysis were used to screen for relevant standard factors. The conditional probability method was used to assign scores to relevant items, and the maximum likelihood method was used to determine the quantitative diagnostic threshold. A quantitative diagnostic standard for Crohn's disease with dampness syndrome based on disease syndrome combination was established, and it was retrospectively analyzed and prospectively verified. Results:On the basis of the 20 candidate quantitative diagnostic criteria items for Crohn's disease dampness syndrome, binary logistic regression analysis was performed to calculate the OR values between each item. The quantitative diagnostic criteria for Crohn's disease with dampness syndrome included tongue coating greasiness (7 points), body heaviness (13 points), waist and knee soreness (8 points), head weight (9 points), bland mouth (6 points), anal heaviness (8 points), uncomfortable bowel movements (8 points), and sticky stools (7 points), with a quantitative diagnostic threshold of 11. Conclusion:The scoring of relevant items in the quantitative diagnostic criteria for Crohn's disease with dampness syndrome is reasonable and has good diagnostic value, which can provide reference for further quantitative research on Crohn's disease syndromes.

Objective To observe the effects of Yixintai on lipid metabolism and the protein expressions of CPT-1 and CD36 in rats with heart failure;To explore the mechanism of its treatment of heart failure.Methods 106 out of 120 SD rats were selected to establish the heart failure model induced by myocardial infarction by ligating the left anterior descending coronary artery,and 14 rats were selected as the sham-operation group.The successful model rats were randomly divided into model group,trimetazidine group and Yixintai low-,medium-and high-dosage groups,with 14 rats in each group.The administration group was given corresponding drugs by gavage once a day for 4 weeks.LVEF,LVFS,LVIDd and LVIDs were measured by color doppler ultrasonography,the contents of ANP,BNP,LA and FFA in serum were detected by ELISA,the contents of TG,TC,LDL and HDL were detected by automatic biochemical analyzer,HE and Masson staining were used to observe the morphology of myocardial tissue,the expressions of CPT-1 and CD36 protein in myocardial tissue were detected by Western blot.Results Compared with the sham-operation group,LVEF and LVFS in the model group decreased(P<0.05),the LVIDs and LVIDd increased(P<0.05);the contents of serum ANP,BNP,LA,FFA,TG,TC and LDL increased(P<0.05),while the content of HDL decreased(P<0.05),with myocardial edema,irregular arrangement of myocardial fibers,increased inflammatory cell infiltration and collagen fiber deposition;the protein expressions of CPT-1 and CD36 in myocardial tissue decreased(P<0.05).Compared with the model group,the LVEF and LVFS in Yixintai each dosage groups and trimetazidine group increased(P<0.05),LVIDs and LVIDd decreased(P<0.05);the contents of ANP,BNP,LA,FFA,TG,TC and LDL in serum of Yixintai medium-and high-dosage groups and trimetazidine group decreased(P<0.05),the content of HDL increased(P<0.05);myocardial edema was improved,inflammatory cell infiltration was reduced,collagen fiber deposition was reduced,and the protein expressions of CPT-1 and CD36 in myocardial tissue increased(P<0.05).Conclusion Yixintai may improve myocardial energy metabolism and treat heart failure by increasing the expression of CPT-1 and CD36 protein in myocardial tissue and promoting fatty acid β oxidation.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma. Despite the scarcity of reported BIA-ALCL cases in Asia, it is imperative to research early diagnosis. The crucial diagnostic criteria for BIA-ALCL include the presence of ALK - and CD30 + T cells exceeding 10% in the delayed seroma fluid. Furthermore, laboratory tests, such as histological examination of capsulectomies and analysis of clonal T-cell receptor (TCR) gene rearrangements, serve as important auxiliary diagnostic indicators. This article reported the case of a 56-year-old female patient who underwent bilateral breast augmentation with implants over 20 years ago. She presented with hardness, enlargement, and mild discomfort in her left breast. She was admitted to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in January 2023. MRI suggested implant rupture. Therefore, bilateral implant removal surgery was performed on February 2, 2023. Pathological examination of the fluid within the capsule of the left implant revealed a small number of ALK - and CD30 + T cells, with monoclonality observed in TCRγ gene rearrangement, indicating early changes suggestive of BIA-ALCL. Long-term follow-up is needed. The authors suggest that patients suspected of BIA-ALCL should undergo TCR gene rearrangement testing in addition to cytological and immunological examinations, which can provide guidance for the diagnosis, treatment, and necessary long-term follow-up of these patients.