Objective:To analyze the effect of joint management of type 2 diabetes mellitus (T2DM) between specialty and community under the model of National Diabetes Prevention and Control Center (DPCC).Methods:A total of 2 527 T2DM patients managed by DPCC Pingshan Center of Shenzhen from January 1, 2022 to December 31, 2024 were retrospectively included. After management, the rate of downturn, reexamination rate, blood pressure compliance rate, metabolic indicators (waist circumference, body mass index, fasting blood glucose, glycosylated hemoglobin, blood lipids) and screening rate of chronic complications of diabetes (atherosclerotic cardiovascular disease, microvascular disease, diabetic peripheral neuropathy) were analyzed. Those included 2022 ( n=564), 2023 ( n=1 477), and 2024 ( n=2 527). Results:The downturn rate in 2022, 2023 and 2024 increased year by year (22.8% vs 67.2% vs 89.9%, P<0.01), and the review rate (41.1% vs 62.2% vs 52.7%, P<0.01), complication screening rate (51.6% vs 85.3% vs 62.2%, P<0.01), blood pressure compliance rate (53.1% vs 78.0% vs 67.2%, P<0.01), body mass index compliance rate (13.2% vs 17.3% vs 28.6%, P<0.01), fasting blood glucose meeting rate (46.4% vs 60.2% vs 68.5%, P<0.01), glycated hemoglobin meeting rate (58.4% vs 63.2% vs 45.6%, P<0.01) were relatively improved. Waist circumference compliance rate (30.6% vs 27.7% vs 21.6%) and blood lipid compliance rate (33.6% vs 35.5% vs 31.9%) were not significantly improved, and the review rate, blood pressure compliance rate and complication screening rate in 2024 were lower than those in 2023 and higher than those in 2022. Conclusions:The combined management of type 2 diabetes under the DPCC model has significant effects on improving the down-conversion rate, rediagnosis rate, blood pressure compliance rate, metabolic index compliance rate and the screening rate of diabetes-related chronic complications in patients with diabetes. At the same time, it was also found that with the progress of hierarchical diagnosis and treatment, the review rate, complication screening rate, blood pressure, waist circumference, blood lipid and glycosylated hemoglobin reached the standard of patients decreased compared with the previous situation, which needs to be further analyzed and improved.

Objective To analyse the efficacy of Gao Mo therapy in the treatment of aromatase inhibitor-related osteoarticular symptoms in breast cancer patients.Methods A total of 80 breast cancer patients with aromatase inhibitor-related osteoarticular symptoms were selected from the breast clinic of a Tier-IIIA hospital in Guangdong Province between January and August 2024.The patients were divided into an intervention group and a control group according to the random number table,with 40 patients per group.Patients in the control group received routine nursing care,while the patients in the intervention group received Gao Mo therapy for 4 weeks based on the intervention of the control group.The two groups were compared with in terms of pain level,index of knee osteoarthritis,and quality of life of the patients with breast cancer before intervention and at 1st,2nd and 4th weeks after intervention.Results Before the intervention,the two groups presented no significant differences in scores of pain assessment,knee osteoarthritis index and quality of life(P>0.05).Analysis of variance for repeated measures showed that the main effects of time and group as well as the interaction effect,were statistically significant in scores of pain assessments in both groups(both P<0.05).The main effects of time and the interaction effect were statistically significant in scores of knee osteoarthritis index and quality of life assessments at different time points(both P<0.05),but there was no statistically significant difference in the main effect between groups(both P>0.05).After 4 weeks of intervention,the intervention group demonstrated significantly lower scores in knee function and pain assessments with a significantly higher scores in the total quality of life assessment in comparison with those of the control group(all P<0.05).Conclusion Gao Mo therapy can mitigate the aromatase inhibitor-related osteoarticular symptoms in breast cancer patients,enhance the function of knees,and improve the quality of life of the patients with breast cancer.

Objective:To investigate the current status of preimplantation genetic testing for aneuploidies (PGT-A) in China in 2024 and to provide recommendations for ensuring the consistency of PGT-A results.Methods:This study was a nationwide external quality assessment research. The National Center for Clinical Laboratories of the National Health Commission conducted two surveys in June and December 2024, with participation from 31 laboratories across China. During each survey, quality control samples of varying concentrations were distributed: the first survey distributed 6 samples (Batch Nos. 202401-202406) and the second survey distributed 3 samples (Batch Nos. 202431-202433). Participating laboratories were required to submit information including detection platforms, single-cell amplification methods, library construction methods, sequencing instruments, and test results. Collected data were statistically analyzed using Microsoft Excel to evaluate laboratories' PGT-A testing capabilities and determine whether results met predefined quality control requirements.Results:All 31 laboratories submitted results for both surveys. In the first survey, 90.3% (28/31) met qualification criteria with a 9.7% failure rate (3/31). For individual batches, pass rates were 90.3% (28/31) for batches 202401-202403 and 100% (31/31) for batches 202404-202406. The second survey achieved 100% (31/31) compliance across all three batches (202431-202433), with each batch maintaining a 100% pass rate.Conclusion:The detection quality of PGT-A in China is generally good, but with differences, and factors such as sample concentration, transportation conditions and detection methods affect the consistency of the results. The study highlights the urgent need for nationwide external quality assessment of PGT-A in China. This will help identify issues in laboratories in a timely manner and ensure the consistency of PGT-A test results.

Objective:To investigate the current status of preimplantation genetic testing for aneuploidies (PGT-A) in China in 2024 and to provide recommendations for ensuring the consistency of PGT-A results.Methods:This study was a nationwide external quality assessment research. The National Center for Clinical Laboratories of the National Health Commission conducted two surveys in June and December 2024, with participation from 31 laboratories across China. During each survey, quality control samples of varying concentrations were distributed: the first survey distributed 6 samples (Batch Nos. 202401-202406) and the second survey distributed 3 samples (Batch Nos. 202431-202433). Participating laboratories were required to submit information including detection platforms, single-cell amplification methods, library construction methods, sequencing instruments, and test results. Collected data were statistically analyzed using Microsoft Excel to evaluate laboratories' PGT-A testing capabilities and determine whether results met predefined quality control requirements.Results:All 31 laboratories submitted results for both surveys. In the first survey, 90.3% (28/31) met qualification criteria with a 9.7% failure rate (3/31). For individual batches, pass rates were 90.3% (28/31) for batches 202401-202403 and 100% (31/31) for batches 202404-202406. The second survey achieved 100% (31/31) compliance across all three batches (202431-202433), with each batch maintaining a 100% pass rate.Conclusion:The detection quality of PGT-A in China is generally good, but with differences, and factors such as sample concentration, transportation conditions and detection methods affect the consistency of the results. The study highlights the urgent need for nationwide external quality assessment of PGT-A in China. This will help identify issues in laboratories in a timely manner and ensure the consistency of PGT-A test results.

Endothelial dysfunction is one of the early triggers of vascular remodeling during pulmonary hypertension (PH) with complex predisposing mechanisms, mainly via an unbalanced generation of vasoactive factors, increased expression of growth factors, prothrombotic elements, and inflammatory markers. Conventional treatment regimens are restricted to a single therapeutic pathway, which usually leads to limited clinical outcomes. Combination therapies targeting multiple cells and several signaling pathways are increasingly adopted in PH treatment. Herein, inspired by the cocrystal pleomorphism theory, we prepared rod-shaped nanococrystals of the endothelin-1 (ET-1) receptor antagonist (bosentan, BST) and the anti-inflammatory drug (andrographolide, AG) for targeting the pulmonary endothelium and alleviating PH. The 525 nm-sized co-delivery system displayed a rod-like morphology, preferentially accumulated in the pulmonary endothelium and alleviated pulmonary artery (PA) remodeling. A three-week treatment with the preparation significantly alleviated the monocrotaline (MCT)- or Sugen 5416/hypoxia (SuHx)-induced PH by reducing the pulmonary artery pressure, increasing the survival rate, improving the hemodynamics, and inhibiting vascular remodeling. Mechanistically, the nanococrystals collaboratively repaired endothelial dysfunction by suppressing the pathways of ET-1/NF-κB/ICAM-1/TNF-α/IL-6. In conclusion, the cocrystal-based strategy offers a promising approach for constructing co-delivery systems. The developed rod-shaped nanococrystals effectively target the pulmonary endothelium and relieve experimental PH.

BACKGROUND: Pre-transplant exposure to immune checkpoint inhibitors (ICIs) significantly increases the risk of allograft rejection after liver transplantation (LT); however, whether ICI-related rejection leads to increased graft loss remains controversial. Therefore, this study aimed to investigate the association between ICI-related allograft rejection and perioperative graft loss. METHODS: This was a retrospective analysis of adult liver transplant recipients with early biopsy-proven T-cell-mediated rejection (TCMR) at Liver Transplantation Center of Sun Yat-sen Memorial Hospital from June 2019 to September 2024. The pathological features, clinical characteristics, and perioperative graft survival were analyzed. RESULTS: Twenty-eight patients who underwent early TCMR between June 2019 and September 2024 were included. Based on pre-LT ICI exposure, recipients were categorized into ICI-related TCMR (irTCMR, n = 12) and conventional TCMR (cTCMR, n = 16) groups. Recipients with irTCMR had a higher median Banff rejection activity index (RAI) (6 vs . 5, P = 0.012) and more aggressive tissue damage and inflammation. Recipients with irTCMR showed higher proportion of treatment resistance, achieving a complete resolution rate of only 8/12 compared to 16/16 for cTCMR. Graft loss occurred in 5/12 of irTCMR recipients within 90 days after LT, with no graft loss in cTCMRs recipients. Cox analysis demonstrated that irTCMR with an ICI washout period of <30 days was an independent risk factor for perioperative graft loss (hazard ratio [HR], 6.540; 95% confidence interval [CI], 1.067-40.067, P = 0.042). CONCLUSION IrTCMR is associated with severe pathological features, increased resistance to treatment, and higher graft loss in adult liver transplant recipients.
Humans ; Liver Transplantation/adverse effects* ; Male ; Female ; Middle Aged ; Retrospective Studies ; Graft Rejection/immunology* ; Immune Checkpoint Inhibitors/therapeutic use* ; Adult ; T-Lymphocytes/drug effects* ; Graft Survival/immunology* ; Aged

Objective:To preliminarily explore the application of directional electrodes with perceivable subthalamic nucleus-deep brain stimulation (STN-DBS) for Parkinson′s disease (PD).Methods:A retrospective analysis was conducted on 56 patients with primary PD who underwent STN-DBS treatment across multiple neurosurgical centers, including the Department of Neurosurgery of the First Medical Center of the Chinese People′s Liberation Army General Hospital, the Department of Neurosurgery of Hua′an Brain Hospital Affiliated to Anhui Medical University, and the Department of Neurosurgery of Hefei Second People′s Hospital, from January to December 2024. The cohort included 26 patients in the directional+perception group and 30 in the conventional group. The directional+perception group had activation contacts selected based on electrode branch contact locations and local field potential data recorded by the perceptible deep brain stimulation (DBS) system. The conventional group used contact testing to determine therapeutic contacts. Unified Parkinson′s Disease Rating Scale-Ⅲ (UPDRS-Ⅲ) assessments were performed in the medication-off state under continuous STN-DBS therapy at postoperative activation, 1, 3, and 6 months, comparing postoperative data with preoperative baseline. Initial programming outcomes were also compared between groups.Results:By combining directional electrodes with sensing capabilities, therapeutic contacts can be selected more quickly and effectively. The directional+ perception group showed significantly shorter initial programming time compared to the conventional group [(30.1±4.7) min vs (65.0±6.8) min, respectively], with a statistically significant difference ( t=-22.159, P<0.001). Compared to preoperative baseline, UPDRS-Ⅲ scores improved markedly at postoperative activation and at 1, 3, and 6 months, with improvements of 59.8%(20.6±5.2 vs 51.2±8.7), 62.1%(19.4±6.2 vs 51.2±8.7), 55.5%(22.8±7.2 vs 51.2±8.7), and 61.7%(19.6±13.9 vs 51.2±8.7), respectively. The scores of tremor showed the greatest improvement of 72.2% [2.5(0, 4.3) vs 9.0(0, 13.0)], 61.1% [3.5(0, 5.0) vs 9.0(0, 13.0)], 72.2% [2.5(0, 5.0) vs 9.0(0, 13.0)], 63.3% [0(0, 3.3) vs 9.0(0, 13.0)], respectively, followed by rigidity. Axial symptoms, postural stability, and gait improved moderately, while speech showed no significant change. Conclusions:In the treatment of PD, the combined use of directional electrodes and a perceivable DBS system allows precise selection of therapeutic contacts. This approach not only safely and effectively improves patients′ motor symptoms but also significantly reduces the time required for initial programming compared to conventional DBS systems, demonstrating clear clinical advantages.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

To explore the variation laws of volatile oil during the extraction process of Artemisiae Argyi Folium and its impact on the quality of the medicinal solution, as well as to achieve precise control of the extraction process, this study employed headspace solid phase microextraction gas chromatography-mass spectrometry(HS-SPME-GC-MS) in combination with multiple light scattering techniques to conduct a comprehensive analysis, identification, and characterization of the changes in volatile components and the physical properties of the medicinal solution during the extraction process. A total of 82 volatile compounds were identified using the HS-SPME-GC-MS technique, including 21 alcohols, 15 alkenes, 14 ketones, 9 acids, 6 aldehydes, 5 phenols, 3 esters, and 9 other types of compounds. At different extraction time points(15, 30, 45, and 60 min), 71, 72, 64, and 44 compounds were identified in the medicinal solution, respectively. It was observed that the content of volatile components gradually decreased with the extension of extraction time. Through multivariate statistical analysis, four compounds with significant differences during different extraction time intervals were identified, namely 1,8-cineole, terpinen-4-ol, 3-octanone, and camphor. RESULTS:: from multiple light scattering techniques indicated that at 15 minutes of extraction, the transmittance of the medicinal solution was the lowest(25%), the particle size was the largest(0.325-0.350 nm), and the stability index(turbiscan stability index, TSI) was the highest(0-2.5). With the extension of extraction time, the light transmittance of the medicinal solution improved, stability was enhanced, and the particle size decreased. These laws of physicochemical property changes provide important basis for the control of Artemisiae Argyi Folium extraction process. In addition, the changes in the bioactivity of Artemisiae Argyi Folium extracts during the extraction process were investigated through mouse writhing tests and antimicrobial assays. The results indicated that the analgesic and antimicrobial effects of the medicinal solution were strongest at the 15-minute extracting point. In summary, the findings of this study demonstrate that the content of volatile oil in Artemisiae Argyi Folium extracts gradually decreases with the extension of extraction time, and the variation in volatile oil content directly influences the physicochemical properties and pharmacological efficacy of the medicinal solution. This discovery provides important scientific reference for the optimization of Artemisiae Argyi Folium extraction processes and the development and application of process analytical technologies.
Oils, Volatile/pharmacology* ; Artemisia/chemistry* ; Gas Chromatography-Mass Spectrometry ; Drugs, Chinese Herbal/pharmacology* ; Chlorogenic Acid/pharmacology* ; Solid Phase Microextraction ; Quality Control

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.