Objective:To investigate the effect of nourishing yin and tonifying yang method on inflammatory response and bone metabolism in patients with T2DM complicated with osteoporosis (OP).Methods:A randomized controlled trial. From January 2022 to December 2023,80 patients with T2DM and OP in our hospital were selected as the observation objects, and they were divided into two groups by random number table method, with 40 cases in each group.On the basis of conventional treatment, the control group chewed vitamin D calcium chewable tablets, and the observation group added nourishing yin and tonifying yang Chinese medicine.Both groups were treated for 6 months. TCM syndrome scores were performed before and after treatment ;the levels of fasting blood glucose (FPG), 2 hPG and HbA1c were detected by intelligent blood glucose monitor;the levels of serum neutrophils and lymphocytes were detected by automatic blood analyzer, and the neutrophil/lymphocyte ratio (NLR) was calculated;the levels of serum IL-1β and TNF-α were detected by automatic chemiluminescence analyzer, the levels of type I procollagen amino terminal propeptide (PINP), type I collagen carboxy terminal peptide β special sequence (β-CTX) and 25-hydroxy vitamin D3 [25-(OH)D3] were detected by ELISA;Bone mineral density (BMD) was detected by bone mineral density detector. The adverse reactions during treatment were observed and recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 92.5 %(37/40) in the observation group and 75.0 % (30/40) in the control group,the difference between the two groups was statistically significant ( χ2=4.50, P=0.034).After treatment, the scores of soreness and weakness of waist and knees, soreness and pain of waist and back, clear and long urine, pale tongue and white coating in the observation group were lower than those in the control group ( t=3.11, 3.75, 3.51, 3.74, P<0.01);the levels of serum FPG, 2 hPG and HbA1c in the observation group were lower than those in the control group ( t=3.11,3.20,3.39, P<0.01).The levels of serum NLR (2.63 ± 0.68 vs. 3.24 ± 0.79, t=3.70), IL-1β [(81.65 ± 8.30) ng/L vs. (89.03 ± 8.98) ng/L, t=3.82] and TNF-α [(35.14 ± 5.11) μg/L vs. (39.96 ± 5.38) μg/L, t=4.11] in the observation group were lower than those in the control group ( P<0.01). After treatment, the levels of PINP [(29.83 ± 3.92) ng/L vs. (34.02 ± 4.03) ng/L, t=4.71] and β-CTX [(21.30 ± 3.95 ) ng/L vs. (25.32 ± 4.18) ng/L, t=4.42] in the observation group were lower than those in the control group ( P<0.01), the levels of 25-(OH)D3 [(42.86 ± 5.12) μg/L vs. (38.08 ± 4.55) μg/L, t=4.41] and BMD [(0.90 ± 0.18) g/cm 3vs. (0.78 ± 0.16) g/cm 3, t=3.15] were higher than those in the control group ( P<0.01).During the treatment, the incidence of adverse reactions was 12.5% (5/40) in the observation group and 10.0 % (4/40) in the control group,there was no significant difference between the two groups ( χ2=0.13, P=0.723). Conclusion:The method of nourishing yin and tonifying yang can effectively improve the TCM syndromes of T2DM patients with OP, reduce the levels of blood glucose and inflammatory factors, improve bone metabolism, improve clinical efficacy and have good treatment safety.

Objective To examine the causes of incision infections following lower extremity open fractures and develop a predictive model for assessing the risk.Methods A total of 104 patients with open fractures of the lower extremity,who received internal fixation from January 2022 to August 2023.According to whether there was incision infection after the operation,the patients were divided into infection group and non-infection group.The aim of the study was to analyze the distribution of pathogenic bacteria causing postoperative incision infections.Single-factor and multifactor Logistic regression analyses were employed to examine the factors influencing postoperative incisional infections.Subsequently,a risk prediction model for these infections was developed.The predictive capacity of this model was assessed using ROC curves.Results In the cohort of 104 patients with open fractures of the lower limb,the occurrence rate of postoperative incision infections was 19.23％.A total of 45 non-repeated pathogenic bacteria were isolated,among which gram-positive bacteria accounted for 53.33％,gram-negative bacteria 42.22％,fungi 4.44％.Gram-positive bacteria showed 100％resistance to ampicillin/sulbactam and penicillin,while resistance rates for erythromycin and clindamycin exceeded 90％.Among gram-negative bacteria,resistance rates to cefazolin,sulfamethoxazole/trimethoprim,levofloxacin,ampicillin/sulbactam,ciprofloxacin,and gentamicin were all above 67％.Notably,resistance rates for cefazolin,sulfamethoxazole,and trimethoprim surpassed 90％.Univariate and multifactorial logistic stepwise regression analysis highlighted that time elapsed from injury to surgery,duration of surgery,length of hospital stay,perioperative prophylactic medication,and Gustilo classification were significant risk factors for postoperative incisional infections in patients with the condition(P＜0.05).The ROC curves illustrated that the risk prediction model accurately forecasted the incidence of postoperative incisional infections in patients with open fractures of the lower extremity,with an area under the curve of 0.861(95％ CI:0.811 to 0.911),boasting a sensitivity of 90.50％and a specificity of 72.92％.Conclusion The main pathogen of wound infection after open fracture of lower extremity is Gram-negative,the time from injury to operation,operation time,hospitalization time,prophylactic medication during perioperative period and GUSTILO classification were the influencing factors of postoperative wound infection.In addition,the establishment of risk prediction model has a good prediction effect on the incidence of postoperative wound infection in patients with this disease.

Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Objective To examine the causes of incision infections following lower extremity open fractures and develop a predictive model for assessing the risk.Methods A total of 104 patients with open fractures of the lower extremity,who received internal fixation from January 2022 to August 2023.According to whether there was incision infection after the operation,the patients were divided into infection group and non-infection group.The aim of the study was to analyze the distribution of pathogenic bacteria causing postoperative incision infections.Single-factor and multifactor Logistic regression analyses were employed to examine the factors influencing postoperative incisional infections.Subsequently,a risk prediction model for these infections was developed.The predictive capacity of this model was assessed using ROC curves.Results In the cohort of 104 patients with open fractures of the lower limb,the occurrence rate of postoperative incision infections was 19.23％.A total of 45 non-repeated pathogenic bacteria were isolated,among which gram-positive bacteria accounted for 53.33％,gram-negative bacteria 42.22％,fungi 4.44％.Gram-positive bacteria showed 100％resistance to ampicillin/sulbactam and penicillin,while resistance rates for erythromycin and clindamycin exceeded 90％.Among gram-negative bacteria,resistance rates to cefazolin,sulfamethoxazole/trimethoprim,levofloxacin,ampicillin/sulbactam,ciprofloxacin,and gentamicin were all above 67％.Notably,resistance rates for cefazolin,sulfamethoxazole,and trimethoprim surpassed 90％.Univariate and multifactorial logistic stepwise regression analysis highlighted that time elapsed from injury to surgery,duration of surgery,length of hospital stay,perioperative prophylactic medication,and Gustilo classification were significant risk factors for postoperative incisional infections in patients with the condition(P＜0.05).The ROC curves illustrated that the risk prediction model accurately forecasted the incidence of postoperative incisional infections in patients with open fractures of the lower extremity,with an area under the curve of 0.861(95％ CI:0.811 to 0.911),boasting a sensitivity of 90.50％and a specificity of 72.92％.Conclusion The main pathogen of wound infection after open fracture of lower extremity is Gram-negative,the time from injury to operation,operation time,hospitalization time,prophylactic medication during perioperative period and GUSTILO classification were the influencing factors of postoperative wound infection.In addition,the establishment of risk prediction model has a good prediction effect on the incidence of postoperative wound infection in patients with this disease.

Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Spinal microglia and astrocytes are both involved in neuropathic and inflammatory pain, which may display sexual dimorphism. Here, we demonstrate that the sustained activation of spinal astrocytes and astrocyte-derived interleukin (IL)-17A promotes the progression of mouse bone cancer pain without sex differences. Chemogenetic or pharmacological inhibition of spinal astrocytes effectively ameliorates bone cancer-induced pain-like behaviors. In contrast, chemogenetic or optogenetic activation of spinal astrocytes triggers pain hypersensitivity, implying that bone cancer-induced astrocytic activation is involved in the development of bone cancer pain. IL-17A expression predominantly in spinal astrocytes, whereas its receptor IL-17 receptor A (IL-17RA) was mainly detected in neurons expressing VGLUT2 and PAX2, and a few in astrocytes expressing GFAP. Specific knockdown of IL-17A in spinal astrocytes blocked and delayed the development of bone cancer pain. IL-17A overexpression in spinal astrocytes directly induced thermal hyperalgesia and mechanical allodynia, which could be rescued by CaMKIIα inhibitor. Moreover, selective knockdown IL-17RA in spinal Vglut2 ⁺ or Vgat ⁺neurons, but not in astrocytes, significantly blocked the bone cancer-induced hyperalgesia. Together, our findings provide evidence for the crucial role of sex-independent astrocytic signaling in bone cancer pain. Targeting spinal astrocytes and IL-17A/IL-17RA-CaMKIIα signaling may offer new gender-inclusive therapeutic strategies for managing bone cancer pain.

Objective:To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair (F/B-TEVAR) in patients with complex aortic arch disease.Methods:The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed .Results:There were 46 cases suffering from postoperative complications (22.8%). The risk factors with statistical significance included aortic atherosclerotic plaque [ OR=2.843; 95% CI (1.4-5.6); P<0.01], aortic intramural thrombosis [ OR=2.358; 95% CI (1.2-4.6), P=0.011], the aortic dilatation [ OR=4.219; 95% CI (1.6-11.3), P<0.01], the history of stroke [ OR=2.088; 95% CI (1.1-4.1), P=0.032], smoking history [ OR=2.680; 95% CI: (1.3-5.5); P<0.01], duration of surgery [ OR=1.9; 95% CI: (1.2-2.9); P=0.042].While the application of 3D printing assistive technology [ OR=0.392; 95% CI: (0.2-0.9); P=0.048] was in a negative correlation with postoperative complication. Conclusions:The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque, aortic intramural thrombosis, the aortic dilatation, the history of stroke, smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.

Clinical data of a teenager with slipped capital femoral epiphysis (SCFE) combined with primary hyperparathyroidism (PHPT) treated in the Children′s Hospital of Soochow University in May 2022 were retrospectively analyzed.A girl, aged 13 years and 5 months, had claudication of both lower limbs for 1.5 years, and the symptom was aggravated for 1 month.X-ray examination of the hip joint showed bilateral SCFE.However, the patient had a body mass index of 18.2 kg/m 2 and no trauma, which did not meet the typical characteristics of SCFE.Further ultrasound examination of the parathyroid gland shows parathyroid adenoma.And parathyroid adenoma was considered to cause PHPT, which in turn triggered SCFE.After surgical resection of the PHPT, the patient had a better fusion of the femoral head and femoral neck and improved hip joint function.Therefore, SCFE fixation was not performed.The diagnosis and treatment of this patient indicated that for similar patients with SCFE and PHPT, SCFE may not be treated with internal fixation, if the femoral head and femoral neck have been fused, the hip joint function has improved, and the pain has been relieved after resection of PHPT.In patients with SCFE and PHPT, the management of hyperparathyroidism takes precedence over the treatment of SCFE.Acute and acute-on-chronic slip, with or without PHPT-induced hypercalcemia, should be treated first by SCFE fixation, and excising parathyroid adenoma should be performed simultaneously or as soon as possible.For chronic slip patients who have mild to moderate hypercalcemia and one or more related symptoms, parathyroidectomy should be performed firstly, and then the SCFE fixation should be considered after parathyroid hormone and blood calcium levels become stable.

Objective To investigate the predictive value of CALLY index for ischemic post-stroke depression(PSD).Methods The clinical data of 179 patients with ischemic stroke were included,and the demographic information,medical history,stroke severity and laboratory indicators at admission were collected.After 6 months of follow-up,all patients were assessed for depressive symptoms using the 17-item Hamilton Depression Scale(HAMD-17).Patients were divided into the PSD group(48 cases)and the non-PSD group(131 cases).Differences in clinical characteristics were compared between the PSD group and the non-PSD group.CALLY index was calculated from C-reactive protein(CRP),albumin(ALB)and lymphocyte counts.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CALLY index to PSD.Spearman correlation analysis was used for the correlation between CALLY index and neurological and cognitive function in PSD patients.K-M curve and Cox regression were used for analyzing the influence of CALLY index on PSD.Results The CALLY index of 179 patients ranged from 0.54 to 1.79,with a median of 1.08.ROC curve analysis showed that the optimal critical value of CALLY index to predict PSD was 1.09,and the area under ROC curve was 0.757(95%CI:0.687-0.818).Compared with the non-PSD group,the proportion of females was higher in the PSD group,and the proportion of patients with hyperlipidemia was increased with shorter years of education.The serum C-reactive protein(CRP)was higher,and albumin(ALB)and CALLY index were lower(P＜0.05).The K-M curve showed that the incidence of PSD was significantly higher in the low CALLY index group(CALLY≤1.08)than that in the higher CALLY index group(CALLY＞1.08,33.0%vs.20.5%,Log rank χ2=8.553,P=0.004).Cox regression analysis showed that after adjusting for other covariates,the decreased CALLY index was an independent risk factor for PSD(HR=2.651,95%CI:1.269-5.540,P＜0.05).Conclusion CALLY index has a certain predictive value for PSD in acute ischemic stroke patients,which is helpful for early identification and timely intervention to improve the prognosis of patients.