A 20-year-old male patient presented to the Department of Dermatology of Peking Union Medical College Hospital with complaints of an 8-year history of facial scarring, swelling of the lower limbs, and a 4-year history of scalp thickening. Physical examination showed thickening furrowing wrinkling of the skin on the face and behind the ears, ciliary body hirsutism, blepharoptosis, and cutis verticis gyrate. Both lower limbs were swollen, especially the knees and ankles. The skin of the palms and soles of the feet was keratinized and thickened. Laboratory examination using bone and joint X-ray showed periostosis of the proximal middle phalanges and metacarpals of both hands, distal ulna and radius, tibia and fibula, distal femurs, and metatarsals.Genetic testing revealed two variants in SLCO2A1, c.1658T > A and c.96+4A > C.Through multidisciplinary consultation, we confirmed the diagnosis of pachydermoperiostosis.

Idiopathic pulmonary fibrosis （IPF） can be classified as pulmonary collateral disease，and its pathogenesis is mainly characterized by the loss of Qi meridian nourishment，the loss of Yin meridian nourishment，and the formation of blood stasis in the blood vessels. Qi Yin deficiency is the pathological basis that runs through IPF，and obstruction of meridians and collaterals is a key element in the development of the disease. The dysfunction of "spleen being in charge of the defensive function" is closely related to the formation of the pathological pattern of "lung deficiency and collateral stasis" in IPF. The term "spleen being in charge of the defensive function" originated from the Yellow Emperor's Inner Canon. If the spleen is healthy，the Qi will be filled with vitality. Positive energy is stored inside，evil cannot be dried up. Its concept is quite similar to the immune defense function in modern medicine. If the principle of "spleen being in charge of the defensive function" is lost，the key structure and function of the IPF alveolar epithelial barrier may be abnormal，and it can interact with various innate immune cells to promote inflammation and fibrosis processes. Therefore，this article explains the imbalance of immune homeostasis in IPF alveolar epithelium from two aspects：the barrier function of alveolar epithelial cells（AECs） and their interaction with innate immune cells. And based on the theory of "spleen being in charge of the defensive function"，using traditional Chinese medicine for strengthening the spleen and nourishing Qi to treat IPF from the perspective of the spleen. This not only strengthens the scientific connotation of "spleen being in charge of the defensive function" in the pathogenesis of IPF，but also provides new research directions and ideas for its future clinical prevention and treatment.

Objective To explore the efficacy and safety of the Huoxue Tongluo recipe iontophoresis(HTRI)combined with butylphthalide sequential therapy(BST)in patients with cerebral ischemic stroke(CIS)hemiplegia.Methods 87 patients with CIS hemiplegia treated in Chuzhou Chinese and Western Medicine Hospital affiliated to Anhui University of Chinese Medicine from January 2020 to January 2023 were retrospectively selected as study subjects,and were divided into the BST group(BST treatment)and the combination group(BST in combination with HTRI treatment)according to the treatment regimens.The main observation indicators were total treatment response rate and incidence of adverse reactions after 4 weeks of treatment;the secondary observation indicators were cerebral artery flow velocity[anterior cerebral artery(ACA),middle cerebral artery(MCA)and posterior cerebral artery(PCA)],neurological function[National Institutes of Health Stroke Scale(NIHSS)score,Chinese Stroke Scale(CSS)score]and limb function[Fugl-Meyer Motor Function Scale(FMA)score,Barthel index(BI)score].Results A total of 87 patients were included,including 43 patients in the BST group and 44 patients in the combination group.The total response rate in the combination group was significantly higher than that in the BST group(P<0.05),and no adverse reactions were observed in both groups.Before treatment,there were no significant differences in cerebral artery blood flow velocity,nerve function and limb function between the two groups(P>0.05).After treatment,the flow velocity of ACA,PCA and MCA,and the scores of FMA and BI were significantly higher than those before treatment(P<0.05),while the scores of NIHSS and CSS decreased significantly(P<0.05).Conclusion Compared with BST therapy,HTRI combined with BST has a more significant effect in CIS patients with hemiplegia,with no increase in the incidence of adverse reactions,and has higher safety.

Objectives:This study aims to investigate the association between cumulative fasting blood glucose(FBG)and presence of coronary artery calcification(CAC). Methods:A total of 1 113 participants were recruited from the Beijing Community-based Cohort of Atherosclerosis.Anthropometric measurements and laboratory examinations including FBG were performed in 1998,2008-2009 and 2013-2014 respectively,and coronary CT scan was performed in 2013-2014.Participants were classified into 4 groups according to the level of cumulative FBG(10-year weighted cumulative value of at least 2 FBGs):<50.0 mmol/L group(n=495),50.0-55.9 mmol/L group(n=345),56.0-69.9 mmol/L group(n=176),and≥70.0 mmol/L group(n=97).CAC score>0 was defined as presence of CAC.Multivariable logistic regression model was applied to analyze the impact of cumulative FBG exposure on the risk of CAC,and subgroup analyses were conducted according to factors such as sex and age. Results:The mean age of enrolled participants was(59.7±6.4)years,523(47.0%)were male and 478(42.9%)had CAC.The proportion of subjects with CAC increased with the increment of cumulative FBG.Compared with the<50.0 mmol/L group,the multivariable-adjusted OR(95%CI)for CAC in the 50.0-55.9 mmol/L group,56.0-69.9 mmol/L group,and≥70.0 mmol/L group were 1.43(1.04-1.98),1.92(1.24-2.99)and 2.79(1.35-5.77),respectively(Ptrend<0.05).The risk for CAC increased by 34%per 10 mmol/L increase in cumulative FBG,with OR(95%CI)of 1.34(1.12-1.59).There was no statistically significant difference in the risk of CAC presence for each 10 mmol/L increase in cumulative FBG level between the subgroups(all P≥0.05). Conclusions:Elevated cumulative FBG is a risk factor for the prevalence of CAC,indicating the importance of maintaining healthy FBG in preventing the occurrence of CAC.

Objective:To describe the current situation of mental health service utilization of community pa-tients with five mental disorders in Inner Mongolia Autonomous Region and provide reference for health education and formulating relevant policies.Methods:The multistage stratified sampling method with unequal probability was used to select a total of 12 315 community residents aged 18 and over in Inner Mongolia Autonomous Region.Using Composite International Diagnostic Interview,mood disorders,anxiety disorders,substance use disorders,intermit-tent explosive disorders,and eating disorders,and health service utilization were investigated.Descriptive statistics was completed by single factor analysis method.Results:The lifetime rates of consultation and treatment of any mental disorder were 18.7％and 10.2％,respectively.The highest proportion of patients received treatment by non-medical professionals was 31.4％,followed by psychiatrists in psychiatric hospital or psychologists in general hospitals.Among the patients,1.1％of them received medication,and 2.5％received psychotherapy.Conclusion:The utilization rate of mental health services in community patients with five mental disorders is relatively low.It is necessary to conduct health education for medical help seeking properly.

Objective:To explore the characteristic of dynamic function network connectivity (dFNC) of resting brain networks in internet gaming disorder (IGD) adolescents.Methods:Forty-four adolescent IGD subjects (IGD group, male/female: 38/6) and fifty healthy controls (HC group, male/female: 40/10) were collected, and the subjects completed demographic questionnaires, Young internet addiction scale(YIAS), Chinese adolescents' maladaptive cognitions scale(CAMAS), and functional magnetic resonance imaging (fMRI) tests. The fMRI data were preprocessed on the Matlab platform, and the preprocessed data was divided into 64 components for group level independent component analysis.The dynamic functional connectivity of obtained 18 effective independent components was analyzed by sliding time window technique, and the difference of dynamic functional connectivity of brain triple network between the IGD group and HC group was compared using SPSS 22.0 software.Results:Four repeated dFNC states were identified through cluster analysis.Each state indicated that different functional networks had different connection strengths.State 3, the most frequent state, had been indicated that the whole brain network of the subject was in a state of weak functional connectivity.The second frequent state was state 1, which indicated enhanced functional connectivity within the subject's central executive network (CEN).State 2 had been indicated enhanced functional connectivity within the subject's salience network (SN).State 4 had been indicated generally enhanced functional connectivity in the subjects' brain networks, and this state was the least frequent.The results of non-parametric permutation test on the time attribute showed that compared with the HC group, the IGD group had a longer time score (IGD group: 0.24±0.19, HC group: 0.13±0.15, t=1.19, P<0.05, non-parametric substitution test) for state 1 with strong connectivity within the CEN, which was positively correlated with the YIAS score and game time ( r=0.418, P=0.003; r=0.515, P=0.004).Compared with HC group, the functional connectivity of ICD group between the internal insula of the SN and the dorsal anterior cingulate cortex was enhanced ( P<0.05, FDR corrected), while the average residence time in weakly connected state 3 was longer ( Z=2.09, P<0.05, nonparametric substitution test). Conclusions:The difference in dynamic functional connectivity of the triple network in the brain of IGD adolescents under resting state is mainly manifested by strong connections in CEN, functional connections between insula and dorsal anterior cingulate cortex in SN is enhanced, and weakening of overall functional connections, which may play an important role in the pathological mechanism of IGD.

Objective:To elucidate the quasispecies variation of 3′ half-length genome in HIV-1 CRF103_01B-infected patients in Beijing using single genome amplification (SGA).Methods:This study enrolled six CRF103_01B-infected patients who were diagnosed during a drug resistance monitoring for newly diagnosed cases or newly treated cases with antiviral therapy in Beijing from 2017 to 2020. RNA was extracted from their plasma samples, and 3′ end of cDNA was diluted by serial dilution method after reverse transcription. Nested PCR was used to amplify the 3′ half-length genome sequences of HIV-1 quasispecies. MEGA 11 was used to construct Neighbor-Joining (NJ) tree and calculate the intrahost genetic distance. Genetic variation in HIV-1 quasispecies was visualized by online Highlighter tool. BootScan analysis was performed using Simplot 3.5 software to analyze inter-quasispecies recombination. Virus tropism was predicted by online Geno2pheno tool.Results:Among the six CRF103_01B-infected patients, five were men who have sex with men. A total of 144 3′ half-length genome SGA sequences (19-36 sequences/case) were obtained. The NJ tree based on the 3′ half-length genome of HIV-1 quasispecies revealed different degrees of genetic diversity. The HIV-1 quasispecies in BL4748-00 case of acute infection has the least variation with the intrahost distance of 0.002±0.000, showing genetic homogeneity. The quasispecies sequences from BL4981-00, BL3150-00 and BL3558-00 cases formed at least three subclusters, respectively, with different evolutionary directions, and their intrahost distance ranked from 0.031±0.004 to 0.016±0.002 (BL3150-00>BL3558-00>BL4981-00). The quasispecies sequences from the couple BL3022-00 (female) and BL3023-00 clustered into a large monophyletic cluster (bootstrap value=100%), and the intrahost distance of the latter (0.025±0.003) was higher than that of the former (0.019±0.002). Inter-quasispecies recombination was observed in BL3558-00 case. The quasispecies from the six patients were CCR5-tropic viruses.Conclusions:The diversity of quasispecies variation in CRF103_01B-infected patients is related to disease progress. Genetic homogeneity is observed in acute HIV infection, while multiple evolutionary directions are detected in chronic infection. Co-infection or superinfection cases are not found, but there are recombination events among quasispecies in some cases.

Objective:To investigate the correlation between interleukin-17(IL-17) and non-calcified coronary plaque load in patients with type 2 diabetes mellitus.Methods:From January 2022 to November 2022, 150 patients with type 2 diabetes mellitus in the Fifth Affiliated Hospital of Xinjiang Medical University were retrospectively collected as the observation group, and 150 healthy adults were collected as the healthy control group at the same time. The levels of IL-17 and coronary non-calcified plaque load between the two groups were compared. The correlation between serum IL-17 level and non-calcified plaque load was analyzed by Pearson test. The patients with type 2 diabetes mellitus were followed up for 1 year, the predictive value of IL-17 and coronary non-plaque load on adverse cardiovascular events in type 2 diabetes patients were analyzed by receiver operating characteristic (ROC) curve.Results:The levels of IL-17, fasting blood glucose, body mass index, non-calcified plaque volume, non-calcified plaque load and carotid intima-media thickness in the observation group were higher than those in thehealthy control group: (60.34 ± 15.94) ng/L vs. (36.30 ± 14.29) ng/L, (9.38 ± 1.47) mmol/L vs. (5.98 ± 0.61) mmol/L, (26.85 ± 3.42) kg/m 2 vs. (24.84 ± 3.00) kg/m 2, (165.20 ± 27.37) mm 3 vs. (107.33 ± 36.72) mm 3, (27.82 ± 4.68)% vs. (17.98 ± 6.17)%, (1.40 ± 0.16) mm vs. (1.22 ± 0.16) mm; the left ventricular ejection fraction was lower than that in the normal control group: (56.58 ± 7.73)% vs. (67.07 ± 7.95)%, there were statistical differences ( P<0.05). The results of Pearson test showed that the level of IL-17 were significantly positively correlated with non-calcified plaque volume, non-calcified plaque load and carotid intima-media thickness in type 2 diabetes mellitus patients ( r = 0.161, 0.180 and 0.178, P<0.05). The results of ROC curve analysis showed that the level of IL-17, non-calcified plaque load, and non-calcified plaque volume had high predictive value for adverse cardiovascular events in type 2 diabetes mellitus patients within 1 year, the area under the curve were 0.735(95% CI 0.637 - 0.832, P = 0.001), 0.766 (95% CI 0.636 - 0.896, P<0.001), 0.774(95% CI 0.648 - 0.901, P<0.001). Conclusions:The increase of IL-17 in type 2 diabetes mellitus patients is related to the increase of non-calcified plaque load of coronary arteries, and has a high value in predicting adverse cardiovascular events.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Under the backdrop of the "Healthy China 2030" strategy, running has become the most common form of exercise. Fitness running is a kind of endurance aerobic exercise. Compared with swimming, aerobics, and other sports with high activity and intensity, the risk of lower limb fatigue injury during fitness running is higher. In this review paper, the risk factors for running-related injuries were summarized by consulting and analyzing the database and focuses on discussing and analyzing the impact of running on joints. The results showed that hip adduction, knee bending, and ankle joint abnormalities are the three joint-related factors that cause the main injuries during running. Four rehabilitation intervention methods for running-related injuries were proposed, that can guide patients to generate personalized rehabilitation treatment plans through training.