Objective To report a case of tibial synovial sarcoma and review relevant literature to enhance understanding of this disease.Methods The clinical data of a patient with tibial synovial sarcoma treated at Kaifeng Central Hospital were retrospectively analyzed.A literature search was conducted in domestic and international databases,including China National Knowledge Infrastructure(CNKI),Wanfang Data,PubMed,Web of Science,and Embase,up to July 2024.Relevant literature was comprehensively reviewed to summarize the imaging and pathological characteristics,treatment,and prognosis of synovial sarcoma.Results A 29-year-old female patient was admitted with left lower extremity pain.X-ray examination revealed a proximal tibia space-occupying lesion suggestive of malignancy,and a mid-tibial space-occupying lesion considered benign.Contrast-enhanced computed tomography(CT)and plain magnetic resonance imaging(MRI)of the proximal tibial lesion also suggested malignancy.Ultrasound-guided biopsy of the proximal tibial tumor revealed a poorly differentiated malignant tumor.Immunohistochemistry results indicated monophasic synovial sarcoma,requiring genetic testing for definitive diagnosis.The patient underwent wide resection of the proximal left tibial malignancy with tumor-type artificial joint replacement,combined with curettage and bone cement filling for the left mid-tibial lesion under anesthesia.Postoperative pathology of space-occupying lesions in the proximal tibia confirmed monophasic synovial sarcoma,and fluorescence in situ hybridization(FISH)demonstrated a rupture of the synovial sarcoma translocation gene(SYT)(i.e.,SS18 positive).There was no recurrence or metastasis found in the patient during the reexamination 6 months after postoperative chemotherapy.As of July 2024,15 cases of genetically confirmed primary intraosseous synovial sarcoma have been reported internationally.Symptoms included pain and swelling,with a medical history of 1-2 years.The X-ray and CT findings showed osteolytic destruction with bone cortical discontinuity.In 13 cases,the intraosseous masses extended to the extraosseous area;in 2 cases,punctate calcifications were detected within the masses.Plain MRI scan showed iso-signal or hypo-signal on T1WI and hyper-signal,iso-signal,and hypo-signal on fat-suppressed T2WI,and enhanced MRI scan demonstrated heterogeneous enhancement.Pathological examination showed spindle-shaped cells under microscopy.Immunohistochemistry results showed positive epithelial membrane antigen(EMA),broad-spectrum cytokeratin(AE1/AE3),Ewing's sarcoma marker(CD99),and transducin-like enhancer of Split 1(TLE1).Twelve patients underwent surgical treatment;6 patients received adjuvant chemotherapy after surgery,of whom 4 developed local recurrence or distant metastasis at initial diagnosis,and 3 died during follow-up.Among the 6 patients who did not receive adjuvant chemotherapy,3 suffered from recurrence or distant metastasis.Conclusions Primary intraosseous synovial sarcoma is a rare malignant tumor with non-specific clinical manifestations.Imaging features typically include osteolytic destruction and intraosseous masses extending extraosseously,suggesting an intraosseous origin.Pathology and immunohistochemistry aid diagnosis,but definitive confirmation relies on further genetic testing.At present,the main treatment regimens for synovial sarcoma involve comprehensive therapies such as surgery and adjuvant chemotherapy,and the prognosis of patients is poor.

Objective To compare the application effects of plankton multiplex polymerase chain reac-tion-capillary electrophoresis(PCR-CE),SYBR Green Ⅰ real-time quantitative PCR(qPCR)and microwave digestion-vacuum filtration-automated scanning electron microscopy(MD-VF-Auto SEM)in the diagnosis of drowning.Methods Lung,liver and kidney tissues from 212 drowned corpses and 30 non-drowned corpses were examined respectively by the three drowning-related plankton testing methods,and the detection rates of plankton in each tissue by three methods were compared.Results In drowned corpses,the total detection rates of PCR-CE,qPCR,and MD-VF-Auto SEM were 93.9%,96.2%,and 95.3%,respectively,with no statistically significant difference(P>0.05).The detection rate of lung tissue by MD-VF-Auto SEM(100%)was higher than those of PCR-CE and qPCR(P<0.05),and there was no significant difference in the detection rates of the three methods in liver or kidney tissues(P>0.05).In non-drowning corpses,a small number of diatoms(less than 10 cells/10 g)were detected by MD-VF-Auto SEM method,only in liver and kidney tissues,while the other two methods yielded negative results for all tissues.Conclusion All three methods have good efficacy in the examination of drowned corpses.The MD-VF-Auto SEM method directly observes diatom morpho-logical characteristics through scanning electron microscopy,and the qualitative and quantitative analy-ses are intuitive and accurate.It has great advantages in the examination of difficult degradation samples.The PCR-CE method and qPCR method have a low sample demand(0.5 g),are easy to operate and have short detection time(4-7 h).They are easy to be applied in the grassroots depart-ments and are suitable for the rapid determination of drowned corpses in routin cases.The combina-tion of the two DNA methods with the MD-VF-Auto SEM method can increase the detection rate of plankton,ensuring the reliability of examination results.This combined use is of significant importance in the application of drowning diagnosis.

Objective To evaluate the clinical efficacy of Pinggan Capsules(derived from modified Longdan Xiegan Decoction)in the treatment of hypertension complicated with anxiety and depression,so as to provide more clinical evidence to support the therapy for hypertension from the perspective of simultaneous treatment of heart and liver.Methods A total of 150 patients with hypertension complicated with anxiety and depression of upper hyperactivity of liver yang type who admitted to the Cardiovascular Department of Guangdong Second Traditional Chinese Medicine Hospital from January 2022 to December 2023 were randomly divided into a control group and an observation group by simple randomization method,with 75 patients in each group.The control group was treated with conventional western drugs of antihypertension,and the observation group was treated with Pinggan Capsules on the basis of treatment for the control group.The course of treatment covered eight weeks.The changes of systolic blood pressure(SBP),diastolic blood pressure(DBP),and the scores of Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)before and after treatment in the two groups of patients were observed.After treatment,the traditional Chinese medicine(TCM)syndrome efficacy and the safety of medication in the two groups of patients were evaluated.Results(1)Six cases in the observation group and four cases in the control group fell off during the study,and a total of 140 patients were finally included in the efficacy statistics,including 69 cases in the observation group and 71 cases in the control group.(2)After eight weeks of treatment,the total effective rate for TCM efficacy in the observation group was 91.8％(64/69),and that in the control group was 66.2％(47/71);the intergroup comparison(tested by non-parametric rank sum test)showed that the TCM syndrome efficacy in the observation group was significantly superior to that in the control group(P＜0.01).(3)After treatment,SBP and DBP in the two groups were decreased significantly compared with those before treatment(P＜0.01),and the decrease in the observation group was significantly superior to that in the control group(P＜0.01).(4)After treatment,the SAS and SDS scores in both groups were decreased significantly compared with those before treatment(P＜0.01),and the decrease in the observation group was significantly superior to those in the control group(P＜0.01).(5)During the treatment,no obvious adverse reactions were found in the two groups of patients,and the laboratory findings of liver and kidney function of the two groups were normal,showing relatively high safety.Conclusion Pinggan Capsules can significantly reduce the somatic symptoms and negative emotions of patients with hypertension complicated with anxiety and depression of upper hyperactivity of liver yang type,and their combined use with antihypertensive drugs exert obvious antihypertensive effects,without obvious adverse reactions while with higher safety.

Objective To investigate the clinical efficacy of Pinggan Capsules(composed of six Chinese herbs,i.e.Gentianae Radix et Rhizoma,Prunellae Spica,Rehmanniae Radix,Gastrodiae Rhizoma,Gardeniae Fructus and Plantaginis Herba)in treating patients with hypertension complicated with anxiety and depression of liver-yang hyperactivity type,and to explore the related influencing factors of efficacy.Methods A total of 150 patients diagnosed as hypertension complicated with anxiety and depression of liver-yang hyperactivity type treated at Guangdong Second Traditional Chinese Medicine Hospital from January 2022 to January 2023 were enrolled.The patients were randomly divided into the trial group and the control group using a random number table,with 75 cases in each group.The control group received conventional medicine treatment(Amlodipine Besylate Tablets plus Losartan Potassium Tablets),while the trial group received Pinggan Capsules in addition to the conventional treatment.The treatment for the two groups lasted for 8 weeks.Before and after treatment,the changes in blood pressure,Self-Rating Anxiety Scale(SAS)scores,Self-Rating Depression Scale(SDS)scores,and scores of each domain of World Health Organization Quality of Life-BREF(WHO-QOL-BREF)were observed in the two groups.Antihypertensive efficacy,TCM syndrome efficacy,and drug safety in the two groups were evaluated,and the main factors influencing the efficacy of Pinggan Capsules were analyzed.Results(1)During the treatment period,6 cases dropped out from the trial group and 4 cases dropped out from the control group.A total of 140 patients completed the full course of treatment,including 69 in the trial group and 71 in the control group.(2)After 8 weeks of treatment,the total effective rate for antihypertensive efficacy in the trial group was 89.86%(62/69),significantly higher than that in the control group[64.79%(46/71)].The intergroup(tested by chi-square test)showed that the antihypertensive efficacy of the trial group was significantly superior to that of the control group(P＜0.05).(3)After 8 weeks of treatment,the total effective rate for TCM syndrome efficacy in the trial group was 92.75%(64/69),significantly higher than that in the control group[66.20%(47/71)].The intergroup(tested by chi-square test)showed that the TCM syndrome efficacy of the trial group was significantly superior to that of the control group(P＜0.05).(4)After treatment,systolic blood pressure and diastolic blood pressure were improved in both groups compared to those before treatment(P＜0.05),and the improvement in the trial group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the scores of all domains(physical,psychological,social relationships,and environmental)of WHO-QOL-BREF scale were significantly improved in both groups compared to those before treatment(P＜0.05),and the improvement in the trial group was significantly superior to in the control group(P＜0.05).(6)After treatment,SAS and SDS scores were significantly improved in both groups compared to those before treatment(P＜0.05),and the improvement in the trial group was significantly superior to that in the control group(P＜0.05).(7)No significant adverse reactions occurred in either group during the treatment period,indicating high safety.(8)Sankey diagram and correspondence analysis showed that patients aged＜65 years,male,grade 1 hypertension,mild anxiety,and mild depression achieved significant hypotensive effect and symptom-relief effect(P＜0.05).Conclusion Pinggan Capsules have significant clinical efficacy in treating hypertension complicated with anxiety and depression of liver-yang hyperactivity type and is worthy of clinical promotion and application.

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.

The objective of this study was to evaluate the toxicity and safety of novel Mycobacterium tuberculosis fusion strain protein derivatives,referred to as B/R strain active proteins.In cellular experiments,RAW264.7 cells were treated with each vaccine preparation,and apoptosis rates were measured.In subsequent animal experiments,C57BL/6 mice were immunized via subcutaneous injection,and their survival and body weight changes were monitored and recorded at 2,4,8,12,and 16 weeks.The lungs and spleens were harvested to calculate organ coefficients,and pathological examinations were conducted.At the eighth week of immunization,the mice were infected with high concentrations of BCG,and pathological changes in the lungs and spleens were observed 4 weeks post-infection.The apoptosis rate at 6 hours was significantly higher in the experimental group than the PBS group(P<0.05).At 12 and 24 hours,the apoptosis rate in the experimental group remained higher than that in the PBS group,although this difference was not statistically significant.After immunization,mice in all four groups exhibited normal growth patterns,as indicated by stable body weight changes.At 4 and 12 weeks post-immunization,the lung coefficients in the protein group were significantly higher than those in the PBS group at the same time points.Additionally,the lung coefficients in the BCG group were significantly elevated across all time periods(P<0.05).The spleen coefficients in the protein and BCG groups were significantly higher than those in the PBS group at 2,4,8,12,and 16 weeks,whereas the ICD B/R group showed higher spleen coefficients than the PBS group only at week 8(P<0.05).Pathological examination revealed normal lung and spleen tissues in the PBS group.However,during the 2-8 weeks immunization period,lung and spleen tissues in all experimental groups exhibited varying degrees of damage,which gradually diminished by 12-16 weeks.Notably,no tuberculosis nodules were observed in any experimental group.After infection with high concentrations of BCG,no overt pathological changes were observed on the surfaces of the lungs and spleens in any group.Microscopic examination revealed less severe pathological changes in the lungs and spleens of mice in the experimental groups than the PBS group.Furthermore,no statistically significant differences were observed between the protein group and the BCG group.Our findings suggested that the B/R strain active proteins'toxicity and safety profiles were comparable to those of BCG,and showed immunoprotective effects.This study provides an experimental foundation for the development of a novel tuberculosis vaccine.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

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.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To observe the effects of tetrandrine tablets combined with montelukast sodium on respiratory function,inflammatory mediators,serum matrix metalloproteinase-9(MMP-9)and basic fibroblast growth factor(bFGF)levels in pneumoconiosis patients.Methods:120 pneumoconiosis patients who were admitted to our hospital from January 2023 to June 2024 were selected,they were divided into control group(montelukast sodium treatment,n=60)and study group(tetrandrine tablets combined with montelukast sodium treatment,n=60)by random number table method.The pulmonary function indexes[first second forced expiratory volume(FEV1),forced vital capacity(FVC),maximum ventilation volume(MVV)],6-minute walking test(6MWT)disitance,St.George Respiratory Questionnaire(SGRQ)score,Improved Medical Research Council Dyspnea(mMRC)index,and inflammatory mediators[Cystatin C(Cys C),interleukin-2 receptor(IL-2R),C-reactive protein(CRP)]and serum MMP-9,bFGF levels were compared between the two groups.The occurrence of adverse reactions were observed.Results:FEV1,FVC,MVV,6MWT distance in the study group at 6 months after treatment were higher than those in the control group,and SGRQ score,mMRC index,CysC,IL-2R,CRP,MMP-9,bFGF were lower than those in the control group(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion:Tetrandrine tablets combined with montelukast sodium in the treatment of pneumoconiosis patients can effectively improve respiratory function,increase exercise endurance,regulate inflammatory mediators and serum MMP-9,bFGF levels,which is safe and reliable.