ObjectiveTo observe the clinical effectiveness and safety of Xiaozhong Zhitong Mixture （消肿止痛合剂） combined with antibiotic bone cement in the treatment of diabetic foot ulcer （DFU） with damp-heat obstructing syndrome. MethodsA total of 72 DFU patients with damp-heat obstructing syndrome were randomly assigned to treatment group （36 cases） and the control group （36 cases）. Both groups received standard treatment and topical antibiotic bone cement for ulcer wounds， while the treatment group received oral Xiaozhong Zhitong Mixture （50 ml per time， three times daily） in additionally. Both groups underwent daily wound dressing changes for 21 consecutive days. Ulcer healing rate， serum levels of tumor necrosis factor-alpha （TNF-α）， interleukin-1 beta （IL-1β）， malondialdehyde （MDA）， superoxide dismutase （SOD）， C-reactive protein （CRP）， and white blood cell （WBC） count were observed before and after treatment， and visual analog scale （VAS） scores for wound pain， traditional Chinese medicine （TCM） syndrome scores， and the DFU Healing Scale （DMIST scale） were also compared. Liver and kidney function were evaluated before and after treatment， and adverse events such as allergic reactions， worsening ulcer pain were recorded. ResultsTotally 35 patients in the treatment group and 33 in the control group were included in the final analysis. The ulcer healing rate in the treatment group was （87.93±9.34）%， significantly higher than （81.82±12.02）% in the control group （P = 0.035）. Compared to pre-treatment levels， both groups showed significant reductions in serum CRP， WBC， MDA， IL-1β， and TNF-α levels， with an increase in SOD level （P＜0.05）. TCM syndrome scores， VAS， and DMIST scores also significantly decreased in both groups （P＜0.05）， with greater improvements in the treatment group （P＜0.05）. No significant adverse reactions were observed in either group during treatment. ConclusionXiaozhong Zhitong Mixture combined with antibiotic bone cement has significant advantages in promoting DFU healing， reducing inflammatory response， and alleviating oxidative stress in DFU patients with damp-heat obstructing syndrome， with good safety for DFU patients with damp-heat obstructing syndrome.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.

Objective To understand the clinical characteristics of patients with Streptococcus anginosus group(SAG)pulmonary abscess and resistance of SAG.Methods 67 patients with pulmonary abscess admitted to a hos-pital from January 2018 to May 2022 were retrospectively analyzed,clinical data of patients with SAG pulmonary abscess were analyzed,and the minimum inhibitory concentration of antimicrobial agents to 18 SAG strains was de-tected by microbroth dilution method,the carriage of resistance genes and virulence genes of SAG were detected by high-throughput sequencing technology.Results Among 67 patients with pulmonary abscess,SAG accounted for 29.9％(20/67),out of which 2 were excluded due to bacterial inactivation,and 18 patients were included for fur-ther studies.18 patients with SAG pulmonary abscess were all community acquired,with an average age of(60.9±9.1)years.There were 13(72.2％)male patients,most patients(94.4％)complicated chronic pulmonary disease,with cough(94.4％)and expectoration(88.9％)as the initial symptoms,some patients(44.4％)had chest pain,and more than half(61.1％)didn't have fever.The proportion of neutrophils,erythrocyte sedimentation rate,and C-reactive protein were mostly elevated,while procalcitonin was normal.The resistance rate of 18 SAG strains to erythromycin,clindamycin,and tetracycline was＞65％,out of which 14 strains carried resistance gene ermB,13 strains carried resistance gene tetM,and 1 strain carried both resistance gene msrD and mefA.18 SAG strains were detected virulence gene psaA,out of which 3 strains were detected virulence gene nan A.Conclusion SAG is an im-portant pathogen that causes pulmonary abscess,and the patients'complications are mainly chronic pulmonary di-seases,with non-specific clinical manifestations;Most strains carry ermB and tetM genes,mediating resistance to macrolides,lincosamides,and tetracyclines.

Objective:To explore the predictive value of electrocardiogram repolarization related parameters combined with serum brain natriuretic peptide(BNP)and 25 hydroxyvitamin D3[25-(OH)-D3]for malignant arrhythmia(MA)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction.Methods:This study was a prospective single-center study,120 patients with acute myocardial infarction who underwent PCI in our hospital from June 2022 to June 2024 were selected,they were divided into combined group(n=25)and non combined group(n=95)based on whether MA occurred within 72 h after PCI.All patients underwent routine electrocardiogram examination,the mean R wave to R wave(RR)interval,QRS start to T end(QT)interval,T wave time,corrected QT(QTc)interval,T wave peak to T wave end(Tp-e)interval,T wave amplitude,and other electrocardiogram repolarization related parameters between two groups were measuredand compared.The serum BNP and 25-(OH)-D3 levels between two groups were detected and compared.Influencing factors were analyzed by single and multiple logistic regression analysis.Predict value was analyzed by receiver operating characteristic(ROC)curve.Results:The mean QT interval and QTc interval in the combined group were significantly lower than those in the non combined group(P＜0.05).The serum BNP levels in the combined group was significantly higher than that in the non combined group,and the serum 25-(OH)-D3 level was significantly lower than that in the non combined group(both P＜0.05).Univariate analysis showed that there were statistically significant differences in terms of age,number of vascular lesions,cardiac troponin I(cTnI),and creatine kinase MB(CK-MB)(P＜0.05).Multiple logistic regression analysis showed that serum CK-MB and BNP were independent risk factors for MA after PCI in patients with acute myocardial infarction,while mean QT interval,mean QTc interval,and elevated 25-(OH)-D3 were independent protective factors(P＜0.05).Draw ROC curves,and the results show that the mean QT interval,mean QTc interval,serum BNP,and 25-(OH)-D3 levels alone predict the area under curve(AUC)for postoperative MA after PCI was 0.762(0.706-0.817),0.822(0.772-0.871),0.809(0.757-0.862),and 0.709(0.642-0.775),respectively,the AUC for combined prediction was 0.882(0.843-0.920).Conclusion:Electrocardiogram repolarization related parameters such as mean QT interval and QTc interval for MA after PCI in patients with acute myocardial infarction were lower,serum BNP is increased,and 25-(OH)-D3 is decreased,the combined detection of these indicators has high predictive value for postoperative MA after PCI.

Objective:To investigate the clinicopathological characteristics and diagnosis of high-grade succinate dehydrogenase-deficient renal cell carcinoma (SDH-RCC).Methods:Three cases of high-grade SDH-RCC diagnosed by immunohistochemical staining and/or molecular testing were collected from Affiliated Hospital of Qingdao University and 971 Hospital of Navy of Chinese People′s Liberation Army from January 2015 to December 2023. The clinicopathological characteristics and immunohistochemical features were summarized using light microscopy. Two cases were tested for gene mutations by next-generation sequencing.Results:Of the 3 cases, 2 were male and 1 was female. The ages were 49, 61, and 53 years, respectively. Gross examination revealed that all tumors were single nodules with diameters of 7.0, 4.5, and 5.2 cm, respectively, grayish white in color with irregular borders. Cases 1 and 2 exhibited solid cut sections, whereas case 3 had cystic and solid cut sections. Microscopically, all cases had high WHO/ISUP nuclear grade (3 or 4) and overt invasion. Case 1 exhibited a solid, sheet-like growth pattern with numerous scattered glandular ducts or acinar structures. Case 2 displayed a diffusely growth pattern reminiscent of sarcoma. Case 3 demonstrated intracystic papillary and nodular infiltrative growth patterns. Large clear cytoplasmic vacuoles could be observed in the focal areas of case 1 and case 3. Prominent peritumoral lymphocytes in stroma were noted in case 1. Case 1 was diagnosed with regional lymph node metastasis, and case 2 was diagnosed with renal vein thrombosis. Immunohistochemical staining revealed that SDHB and SDHA were deficiently expressed in 3 cases, while PAX8, FH, and INI-1 exhibited diffuse expression. CD10 (1/3), CA9 (1/3), and CK20 (1/3) were occasionally expressed. The Ki-67 proliferation index ranged from 10% to 50%. Two cases underwent next-generation sequencing and were both found to harbor pathogenic mutations in SDHA (case 2 had a frameshift mutation, and case 3 had a splice site mutation). All 3 cases were followed up for 11 to 112 months. Case 2 died 11 months post-operation, while case 1 and case 3 survived for 19 and 112 months, respectively, without any recurrence or metastasis.Conclusions:High-grade SDH-RCC is a rare subtype of SDH-RCC. The tumor exhibits various architectural patterns and is often misdiagnosed as other types of renal cell carcinoma. The presence of cytoplasmic vacuoles may be indicative for diagnosis. Compared to typical SDH-RCC, the high-grade subtype generally shows a larger tumor size, higher TNM stage, greater invasive potential, and poorer prognosis. For high-grade SDH-RCC, routine SDHB immunohistochemical staining may be necessary. The occurrence of high-grade SDH-RCC may be associated with mutations in SDHA.

Aim To explore the MST1 knockdown at-tenuates the inhibitory effect of salvianolic acid B(Sal B)on pERK anti-renal fibrosis.Methods In vitro experiments stimulated human renal cortical proximal tubular epithelial cells(HK-2)with XMU-XP-1(10μmol·L-1)inhibitor;in vivo experiments induced wild-type(WT)and MST1 systemic knockout mouse(MST1-/-)renal fibrosis models with DEN/CCl4/C2H5OH(DCC)and interfered with Sal B(15 mg·kg-1·d-1,ig)intervention.Renal histopathology was observed by HE and Masson staining;α-SMA and pERK protein expression was detected by Western blot;and pERK protein expression was detected by im-munofluorescence.Results In vitro results showed that Sal B could inhibit pERK protein expression.In vivo results showed that Sal B could improve DCC-in-duced renal tissue pathological injury and inhibit α-SMA and pERK protein expression;MST1-/-aggrava-ted pathological injury and significantly up-regulated α-SMA and pERK protein expression.Conclusion Sal B reduces the stimulatory effect of XMU-MP-1 on HK-2 cells by inhibiting the phosphorylation of ERK protein;Sal B exerts its anti-renal fibrosis effect by inhibiting the phosphorylation of α-SMA protein and ERK pro-tein;and MST1-/-,aggravating the pathological inju-ry of renal tissue,significantly up-regulated the expres-sion of α-SMA and pERK protein,which in turn atten-uated the antirenal fibrosis effect of Sal B.

Purpose To analyze the sonographic features of incarcerated gravid uterus and evaluate the diagnostic value of ultrasonography.Materials and Methods Clinical data of eight patients diagnosed with incarcerated gravid uterus at Sichuan Provincial Maternity and Child Health Care Hospital from January 2018 to December 2023 were retrospectively analyzed.Clinical manifestations,sonographic characteristics,management approaches and pregnancy outcomes were evaluated.Results Among the eight confirmed cases,seven presented with initial symptoms of dysuria and urinary retention,while one reported irregular lower abdominal pain.Ultrasonography consistently demonstrated:retroverted and retroflexed uterine position with the uterine body posterior to the cervix.Elongated cervix(range:4.0-8.6 cm)displaced anteriorly.Overdistended,elongated and superiorly displaced bladder in seven cases.Management included successful manual reduction via knee-chest position after catheterization in seven patients.One patient was managed conservatively with close monitoring and delivered by cesarean section at term.All eight patients achieved successful term deliveries with favorable maternal and neonatal outcomes.Conclusion Prenatal ultrasonography plays a crucial role in diagnosing and managing incarcerated gravid uterus.Early recognition of characteristic sonographic features facilitates prompt diagnosis and intervention,thereby mitigating risks of adverse pregnancy outcomes.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective:To compare the clinical outcomes between all-inside and conventional transtibial tunnel reconstructions for posterior cruciate ligament (PCL) injuries.Methods:A retrospective study was conducted to analyze the clinical data of the 108 patients who had been treated for PCL injuries at Department of Arthrosis Surgery, Xuzhou Renci Hospital, from March 2021 to March 2023. There were 48 females and 60 males, with an age of (30.3±10.8) years and an injury-to-surgery interval of (25.7±6.4) days. Of them, 49 left and 59 right knees were affected. By the difference in the tunnel reconstruction, the patients were divided into 2 groups: an all-inside group ( n=52) in which the PCL was reconstructed using the all-inside techniques and a conventional group in which the PCL was reconstructed using the conventional techniques. The following were observed and compared: operation time and postoperative hospital stay; visual analogue scale (VAS) pain scores, The International Knee Documentation Committee (IKDC) subjective scores and Lysholm knee function scores at preoperation, postoperative 3 months and the last follow-up; posterior drawer test, posterior sag sign, reverse Lachman test and the diameter and morphology of the PCL shown by the knee joint MRI at the last follow-up. Results:The baseline characteristics were comparable between the 2 groups ( P>0.05). All patients were followed up for (12.3±1.2) months. The all-inside group incurred significantly longer operation time [(128.3±7.6) min] than the conventional group [(103.5±6.9) min] ( P<0.05), but no significant difference was observed in postoperative hospital stay between the 2 groups ( P> 0.05). There was no significant difference in VAS pain score, IKDC subjective score, or Lysholm score between the 2 groups at preoperation, postoperative 3 months or the last follow-up ( P>0.05). In both groups, the VAS pain scores, IKDC subjective scores and Lysholm scores at postoperative 3 months and the last follow-up were significantly improved compared with those at preoperation ( P<0.05). At the last follow-up, the posterior drawer test, posterior sag sign, reverse Lachman test were negative in both groups, and the knee joint MRI showed good diameter and morphology of the PCL reconstructed. Conclusions:Both conventional and all-inside reconstructions yield satisfactory clinical outcomes for PCL injuries, demonstrating comparable functional recovery and complication incidence. However, the all-inside technique requires longer operation time than the conventional approach.