Objective To investigate the therapeutic effect of Huangkui capsules on targeted drug-related proteinuria in patients with hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on clinical data of HCC patients with targeted drug-related proteinuria from June 2023 to December 2024 at Zhongshan Hospital, Fudan University. According to the treatment plan, patients were divided into the conventional treatment group and the Huangkui combination treatment group (Huangkui capsules combined with conventional treatment), and the clinical efficacy between the two groups was compared. The logistic regression analysis was used to identify the main factors affecting treatment efficacy. Results The Huangkui combination treatment group (n＝29) showed a significantly higher overall effective rate (79.3% vs 42.3%, P＝0.005), and an earlier proteinuria improvement (median time: 3 months vs 6 months, P＝0.008) than the conventional treatment group (n＝26) . The multivariate logistic regression analysis showed angiotensin-converting enzyme inhibitor (ACEI) or angiotensin Ⅱ receptor blocker (ARB) using (OR＝0.190, 95%CI 0.045-0.808, P＝0.025), targeted drug adjustment (OR＝0.132, 95%CI 0.030-0.581, P＝0.007), and Huangkui capsules using (OR＝0.168, 95%CI 0.039-0.730, P＝0.017) were protective factors for treatment efficacy of targeted drug-related proteinuria. Conclusions On the basis of conventional treatment, additive treatment with Huangkui capsules can alleviate targeted drug-related proteinuria faster and more effectively in HCC patients.

Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Depression has a high prevalence rate and often leads to severe social impairment. The dilemma of clinical diagnosis and treatment of major depressive disorder, especially in adolescents, is still a major challenge in psychiatric clinical practice. The affective symptoms serve as the primary symptom criteria for the diagnosis of major depressive disorder, but an increasing number of studies have proven that cognitive dysfunction is also one of the core symptoms of major depressive disorder. Both affective symptoms and cognitive impairment play an equally important role in the clinical manifestations and the progression. Moreover, there is a close and complex association between affective symptoms and cognitive impairment. The comprehension of the intricate interplay between cognitive dysfunction and emotional symptoms among patients with major depressive disorder is crucial for guiding clinical assessment, intervention, and overall prognosis improvement.

Depression has a high prevalence rate and often leads to severe social impairment. The dilemma of clinical diagnosis and treatment of major depressive disorder, especially in adolescents, is still a major challenge in psychiatric clinical practice. The affective symptoms serve as the primary symptom criteria for the diagnosis of major depressive disorder, but an increasing number of studies have proven that cognitive dysfunction is also one of the core symptoms of major depressive disorder. Both affective symptoms and cognitive impairment play an equally important role in the clinical manifestations and the progression. Moreover, there is a close and complex association between affective symptoms and cognitive impairment. The comprehension of the intricate interplay between cognitive dysfunction and emotional symptoms among patients with major depressive disorder is crucial for guiding clinical assessment, intervention, and overall prognosis improvement.

Objective:To analyze the factors influencing the success rate of external cephalic version (ECV) and to create a preoperative scoring scale for stratified management of pregnant women who were preparing for ECV.Methods:This prospective study was conducted on singleton pregnant women who underwent ECV without anesthesia in Fujian Maternity and Child Health Hospital from January 1, 2017, to December 31, 2019. Univariate (two independent samples t-test, Mann-Whitney U test, and Chi-square test) and multivariate logistic regression were used to screen the clinical characteristics affecting the success of ECV, and receiver operating characteristic (ROC) curve was used to determine the cut-off value and convert quantitative variables into dichotomous variables. The independent variables were scored according to the regression coefficient in multivariate logistic regression analysis, and then a preoperative scoring scale was created. The ROC curve was used to calculate the cut-off value for the scoring scale. The subjects were divided into low and high score groups according to the cut-off value. The area under the ROC curve was used for evaluating the effectiveness of the scale in predicting the success of ECV. The success rate of ECV, difficulty of the operation and mode of delivery were compared between the two groups. Results:A total of 1 338 pregnant women met the inclusion criteria during the study period. After the exclusion of 885 women, 165 refused ECV in favor of direct cesarean section, 27 spontaneously converted to cephalic position before ECV, 261 who voluntarily accepted ECV were finally enrolled. ECV succeeded in 202 cases and failed in 59. (1) Favorable factors for ECV without anesthesia were the distance between the fetal breech and ischial spine <－3.5 cm ( OR=0.177, 95% CI: 0.071-0.438, P=0.009), the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm ( OR=0.225, 95% CI: 0.094-0.537, P=0.001), amniotic fluid index ≥12 cm ( OR=0.399, 95% CI: 0.164-0.969, P=0.042), the surgeon's ability to hold the fetal head or breech with one hand ( OR=0.241, 95% CI: 0.098-0.589, P=0.002; OR=0.219, 95% CI: 0.087-0.546, P=0.001), and the fetal head located on the right or left upper abdomen of the mother ( OR=0.184, 95% CI: 0.059-0.568, P=0.003; OR=0.253, 95% CI: 0.084-0.760, P=0.014). (2) The area under the ROC curve of the preoperative score for predicting the success of ECV was 0.881 (95% CI: 0.821-0.941) and the cut-off value was 5.5. The subjects were divided into low (0-5 scores) and high (6-11 scores) score groups and the area under the ROC curve for predicting the success of ECV by grouping was 0.843 (95% CI: 0.774-0.912). Compared with the low score group, the high score group had a shorter ECV duration [2.0 min (0.5-10.0 min) vs 10.0 min (0.9-25.8 min), Z=－6.83, P<0.001], less attempts [1.0 times (1.0-4.0 times) vs 3.0 times (1.0-5.0 times), Z=－8.41, P<0.001], higher success rate [92.7% (190/205) vs 21.4% (12/56), χ2=127.64, P<0.001], higher rate of vaginal birth [75.4% (147/195) vs 18.5% (10/54)] and lower cesarean section rate [24.6% (48/195) vs 81.5% (44/54)] ( χ2=58.70, P<0.001). Conclusions:Preoperative scoring based on the factors influencing the success rate of ECV (the distance between the fetal breech and ischial spine, the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm, amniotic fluid index ≥12 cm, the surgeon's ability to hold the fetal head or breech with one hand, and the fetal head locating on the right or left upper abdomen of the mother) is conducive to the individualized evaluation of the difficulty and the success rate of ECV as well as the success rate of vaginal delivery after ECV, which can provide a reference for clinical stratified management of ECV patients.

OBJECTIVE：To screen the effective compo nent in antioxi dant active fraction of Pueraria lobata . METHODS ：The antioxidant active fraction sample （S1-S20） of 20 batches of P. lobata were prepared. HPLC method was adopted. The determination was performed on SepaxBio-C 18 column with mobile phase consisted of methanol-water （gradient elution ）at the flow rate of 0.6 mL/min. The column temperature was set at 25 ℃，and detection wavelength was set at 250 nm. HPLC fingerprints of 20 batches of P. lobata were established by the Similarity Evaluation System of TCM Chromatographic Fingerprints （2012 edition），and common peaks were identified. Cluster analysis ，principal component analysis （PCA）and orthogonal partial least squares discriminant analysis （OPLS-DA）were used to screen the effective components in antioxidant active fraction of P. lobata . RESULTS：There were 18 common peaks in HPLC fingerprints of 20 batches of antioxidant active fraction in P. lobata ，and the similarity was more than 0.99. Eight common peaks were identified ，which were 3′-hydroxypuerarin（peak 2），puerarin（peak 3）， 3′-methoxypuerarin（peak 4），daidzein（peak 5），genistein（peak 7），formononetin（peak 11），daidzein（peak 13）and genistein （peak 16）. The results of cluster analysis and PCA analysis showed that samples S 1，S3，S4，S6，S8，S18 and S 19 were clustered into one category ，and samples S 2，S5，S7，S9-S17 and S 20 were clustered into one category ；peak 2，peak 3，peak 10，peak 11 and peak 13 had great influence on principal component 1；peak 8 and peak 9 had great influence on principal component 2. OPLS-DA analysis showed that peak 4，peak 3，peak 2，peak 16，peak 13 and peak 11 had great influence on the quality of antioxidant active fraction of P. lobata . CONCLUSIONS ： HPLC fingerprint for active fraction of P. lobata is established in the study and 8 components are identified ；among them ， com puerarin，3′-hydroxypuerarin，daidzein and formononetin maybe the material basis of antioxidant fraction of P. lobata .

Objective:To explore the association between the spontaneous neural activity and memory function in depressive patients with different sleep quality.Methods:Totally 58 patients with depressive disorder and 58 gender-, age-, education-matched healthy controls (HC) completed 3.0 T MRI Scanning and clinical assessment including Wechsler memory scale (WMS), 24 Hamilton depression scale(HAMD-24) and Pittsburgh sleep quality index (PSQI). According to the score of PSQI, patients were divided into poor sleep quality group (PS, n=38) and good sleep quality group (GS, n=20). Amplitude of low frequency fluctuations (ALFF) were calculated and compared among three groups.Correlation analyses between the brain activity and the score of WMS were conducted as well. Results:Memory quotient of WMS showed differences among three groups( F=14.163, P<0.01), and the lowest score was found in patients with low sleep quality.The brain areas showed significant differences among three groups located in the left medial superior frontal gyrus (lmSFG, MNI: x=-10, y=30, z=58; K=56), right orbital inferior frontal gyrus (roIFG, MNI: x=26, y=20, z=-26; K=24) and left middle frontal gyrus (lMFG, MNI: x=-40 y=32, z=42; K=25) (voxel size P<0.001, cluster size P<0.05, GRF corrected). Compared with GS group, the ALFF of PS group showed significantly increased in the lmSFG, which was negatively correlated with memory quotient ( r=-0.327, P=0.045) and short term memory( r=-0.388, P=0.016). Compared with HC group, the ALFF of PS group showed increased in the lmSFG and lMFG, GS group showed increased ALFF in the roIFG. Conclusion:The impairment of memory function is more serious in patients with depression of low sleep quality, and the activity of frontal lobe is abnormally increased, which is related to memory function.Their association suggests that poor sleep quality in depressive patients may impair memory function by disrupting neural plasticity and synaptic pruning in the frontal lobes.

Objective To evaluate the value of nested polymerase chain reaction (PCR) for the rap-id detection of pathogens in children with severe pneumonia. Methods We prospectively enrolled the pa-tients with severe community-acquired pneumonia admitted to pediatric intensive care unit (PICU) in Shang-hai Children′s Hospital from January 2017 to June 2018. The sputum for PCR were collected within 24 h after PICU admission. Both nested PCR and routine microbiological methods were performed. Respiratory Panel (R-Panel) based on nested PCR could detect 17 kinds of respiratory pathogen at the same time. Results A total of 65 patients were enrolled in this study and the samples were detected using both R-Panel and routine microbiological method. (1) A total of 15 patients (23. 08 %) showed positive routine microbiological de-tection including 13 cases with virus-positive and 2 cases with mycoplasma-positive; (2) A total of 38 pa-tients (58. 46%) showed positive results using R-Panel within 2 h including 46 cases with virus-positive and 5 cases with mycoplasma-positive. The mainly primary infection was human rhinovirus and enterovirus in 15 cases (23. 08%),followed by adenovirus in 10 cases (15. 38%); and the positive rate of 2 or more patho-gens was 18. 46% (12/65);(3) The rate of adenovirus-positive using R-Panel was significantly higher than that using routine microbiological methods (15. 38 % vs. 4. 62%,χ2 ＝4. 188,P＝0. 041); the sensitivity of R-Panel for detection of adenovirus,respiratory syncytial virus,and parainfluenza virus was significantly high-er than those of routine microbiological methods (100% vs. 30%,χ2 ＝107. 692;50. 00% vs. 16. 67%,χ2 ＝ 24. 442;100% vs. 80%,χ2 ＝22. 222;100% vs. 40%,χ2 ＝85. 714; all P <0. 001). Conclusion R-Panel using nested PCR is a rapid,sensitive,and specific method for the detection of pathogens in children with severe community acquired pneumonia,which is valuable for targeted therapy in time.