Senile chronic heart failure(CHF)complicated with sarcopenia can further degrade patients'quality of life,and increase the occurrence of falls,disability and mortality.Currently,western medicine preventive and treatment for sarcopenia mainly depend on nutritional support and exercise therapy,but their efficacy remained uncertain.Traditional Chinese medicine(TCM)therapy has the advantages of holism and syndrome differentiation and treatment,and its application in senile CHF complicated with sarcopenia is worthy of further exploration.This paper sorted out the relevant statements in the Treatise on Exogenous Febrile and Miscellaneous Diseases,and concluded that the clinical manifestations of senile CHF complicated with sarcopenia are similar to those of heart water and consumptive disease in the Treatise on Exogenous Febrile and Miscellaneous Diseases.The statements in Treatise on Exogenous Febrile and Miscellaneous Diseases will guide the identification of etiology and pathogenesis as well as the diagnosis and treatment for senile CHF complicated with sarcopenia.The analysis of the pathogenesis indicated that heart water and consumptive disease were induced by deficiency of heart and spleen and kidney,five kinds of overstrain and seven types of impairment,water pathogen insulting heart,and internal stagnation of blood stasis.Therefore,it is proposed that the core pathogenesis of senile CHF complicated with sarcopenia is due to the deficiency of heart,spleen and kidney yang,and water blended with blood stasis.The classical prescriptions such as Ling Gui Zhu Gan Tang,Zhenwu Tang,Sini Tang,Shenqi Pills,Jianzhong Tang and Wuling Powder can be used by modification or combination based on syndrome differentiation in treating senile CHF complicated with sarcopenia.For both of the congenital and acquired origin(spleen and kidney)of elderly patients with CHF complicated with sarcopenia are deficient,the utilization of herbs for invigorating spleen and boosting kidney on the basis of syndrome differentiation may achieve good efficacy.

Objective To analyze the correlation between venous thromboembolism(VTE)and traditional Chinese medicine(TCM)constitution types in elderly frail patients.Methods A retrospective study was conducted on 1 428 elderly frail patients admitted to the Second Comprehensive Department of Guangdong Provincial Hospital of Chinese Medicine from January 2019 to June 2023.Patients were divided into a venous thrombsis(VT)group(n=187)and a non-VT group(n=1 241)based on VTE occurrence.Baseline data,including age distribution,Padua scores,Wells scores,and TCM constitution types,were compared between the two groups.Multivariate logistic regression analysis was performed to identify factors for influencing VTE in elderly frail patients.Results(1)Compared with the non-VT group,the VT group had significantly higher total hospitalization costs,length of stay,age,Fried scores,Padua scores,and Wells scores,with statistically significance(P＜0.001).(2)Compared with the non-VT group,the VT group had a higher proportion of high VTE-risk individuals and those with Wells scores of 2 points,with statistically significance(P＜0.001).(3)The age distribution of VTE patients showed an increasing trend in the age groups of 60-69,70-79,80-89,and ≥90-year-old,with a significant difference compared to the non-VT group(P＜0.001).(4)The VT group had a higher proportion of qi-deficiency,blood-stasis,and qi-depression constitutions than the non-VT group(P＜0.05 or P＜0.001).(5)Multivariate logistic regression analysis(after adjusting age,gender,frailty,and other scores)showed that qi-deficiency and yang-deficiency constitutions were non-susceptible,while damp-heat,blood-stasis,and qi-depression constitutions were susceptible to VTE in elderly frail patients(P＜0.05 or P＜0.01).Conclusion VTE in elderly frail patients is significantly correlated with TCM constitution types.Deviated constitutions are characteristic of TCM constitution types in elderly frail patients,and damp-heat,blood-stasis,and qi-depression constitutions are risk factors for VTE in this population.

Objective:To explore the validity and safety of flat-tipped injection needle and conical catheter these 2 instruments in the hydrodynamic releasing treatment of fecal calculus incarceration in the colonic diverticulum.Methods:From 1 May 2022 to 31 July 2023, 77 patients with fecal calculus incarceration in colonic diverticulum detected by colonscopy at the Endoscope Center of Shantou Central Hospital were prospectively selected. According to the random number table method, 77 patients were randomly divided into the flat-tipped injection needle group (39 cases, 51 fecal stone embedded) and the conical catheter group (38 cases, 49 fecal stone embedded). The successful rate of fecal stone releasing, operation time and complications of 2 groups were observed. Independent samples t test and chi-square test were used for statistical analysis. Results:The successful rate of fecalith releasing of flat-tipped injection needle group was higher than that of the conical catheter group (100.0%, 51/51 vs. 83.7%, 41/49), and the difference was statistically significant ( χ2=9.05, P=0.002). There was no significant difference in the operation time of successful cases between the flat-tipped injection needle group and the conical catheter group ((5.7±1.2) s vs. (5.9±0.8) s, P>0.05). There were no cases of intraoperative or postoperative bleeding or perforation in the process of fecal stone releasing in both groups. Missed submucosal injection occurred in 4 cases of the flat-tipped injection needle group and occurred in three cases of the conical catheter group, and there was no significant difference in the incidence of complications between the 2 groups ( P>0.05). Conclusion:Both instruments are effective and safe in the hydrodynamic releasing treatment of fecal calculus incarceration in the colonic diverticulum, and the success rate of flat-tipped injection needle is higher than that of conical catheter.

Objective:To evaluate the new model of group screening combined with opportunistic screening for the diagnosis and treatment of gastric cancer.Methods:Group screening combined with opportunistic screening was used for gastric cancer screening. (1) Group screening. Cluster sampling was used to screen gastric cancer by endoscopy in high-risk population (aged 40-<70 years) of rural residents in Weihai from July 2017 to December 2020, and biopsy was obtained for histopathology if necessary. Main collection parameters included the detection rate of advanced gastric cancer, early gastric cancer and high-grade intraepithelial neoplasia (HGIN). (2) Opportunistic screening. The changes of the detection rates of early gastric cancer in opportunistic screening in 2 hospitals in Weihai area were observed during the same period of time.Results:(1) In group screening, from July 2017 to December 2020, the first batch of 8 000 cases of gastric cancer screening were completed. The cases of advanced gastric cancer, early gastric cancer and HGIN were 36, 28, and 62, respectively. The detection rates of gastric cancer and early gastric cancer were 0.80% (64/8 000) and 43.75% (28/64), respectively. The proportion of early gastric cancer+HGIN who received endoscopic submucosal dissection (ESD) was 77.78% (70/90), and the rate of curative resection was 100.00%(70/70). (2) Opportunistic screening: from July 2017 to December 2020, the annual early gastric cancer detection rates in opportunistic screening in Wendeng District Traditional Chinese and Western Medicine Hospital were 16.67% (1/6), 20.00% (3/15), 23.53% (4/17), and 33.33% (6/18) in the consecutive 4 years, respectively. The annual detection rates of early gastric cancer in opportunistic screening in Ru Shan Peoples Hospital were 14.74% (14/95), 23.80% (60/252), 25.49% (65/255), and 24.04% (50/208), respectively. The detection rates of opportunistic screening for early gastric cancer in hospitals in Weihai city increased year by year.Conclusion:In areas with high incidence of gastric cancer, a certain scale of group screening can lead to a wider range of opportunistic screening, resulting in the increase of the detection rate of early gastric cancer. The new model of diagnosis and treatment of gastric cancer is worth recommendation.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

Objective:To investigate the clinical diagnostic value of autotaxin(ATX) and its product lysophosphatidic acid(LPA) in patients with pancreatic cancer.Methods:Peripheral blood samples and related clinical data of 114 patients with pancreatic cancer (pancreatic cancer group) and 94 patients with benign pancreatic disease (benign pancreatic disease group) diagnosed in the Northern Theater General Hospital from January 2015 to May 2021 were collected, and peripheral blood of 120 healthy volunteers was used as control group. Patients′ gender, age, smoking history, history of alcohol consumption, family history of pancreatic cancer, tumor site and size, lymph node metastasis or not, peripheral nerve infiltration and the like were all recorded. Serum ATX, LPA and CA19-9 level was detected by ELISA. The receiver operating characteristic curve (ROC) of ATX alone, LPA alone and(or) combined with CA19-9 for the clinical diagnosis of pancreatic cancer was plotted, and the area under the curve (AUC) was calculated. Maximal Youden index method was used to determine the cutoff, and the sensitivity and specificity were calculated.Results:There were 54(47.3%) patients with high sugar diet and 60(52.6%) patients with smoking in pancreatic cancer group, which were higher than 15(16.1%) and 11(11.7%) in benign pancreatic disease group, and 24(20%) and 26(21.7%) in control group ( n=120). The serum ATX, LPA and CA19-9 of early and advanced pancreatic cancer [294.9(262, 1 455)ng/ml, 15.75(8.3, 92)μg/ml and 131.1(23, 289)U/ml; 422(312, 1 620)ng/ml, 24.6(9.5, 97.3)μg/ml and 217.4(32, 970)U/ml] were all greatly increased, and all the differences were statistically significant (all P value<0.05). The AUC values of serum ATX for early and advanced pancreatic cancer were 0.71 (95% CI 0.52-0.87) and 0.92 (95% CI 0.81-0.98), respectively; the Youden index was 0.57, the cutoff was 286 ng/ml, and the sensitivity was 65.3% and 89.6%, respectively; the specificity was 80%. The AUC values of LPA were 0.75 (95% CI 0.67-0.91) and 0.95 (95% CI 0.89-0.99); the Youden index was 0.48, the cutoff was 10.7 μg/ml, and the sensitivity was 80.7% and 95.7%, respectively; the specificity was 69.4%. The AUC values of CA19-9 were 0.82 (95% CI 0.71-0.85) and 0.86 (95% CI 0.78-0.93); the Youden index was 0.47, the cutoff was 57 U/ml, and the sensitivity was 77.3% and 82.3%, respectively; the specificity was 75.0%. Compared to control group and benign pancreatic disease group, the predictive efficiency of serum ATX+ CA19-9 and CA19-9+ ATX+ LPA for the diagnosis of early pancreatic cancer was significantly higher than that of CA19-9 alone, and the difference was statistically significant (all P value<0.05), while the predictive efficiency of serum ATX+ CA19-9 and CA19-9+ ATX+ LPA for the diagnosis of advanced pancreatic cancer was not significantly different from that of CA19-9 alone. Conclusions:The combined detection of serum LPA, ATX and CA19-9 can improve the diagnostic efficiency of early pancreatic cancer.

Objective:To evaluate the clinical value of endoscopic release therapy for fecal impaction in the colorectal diverticulum.Methods:Data of patients with fecal impaction in the colorectal diverticulum who received endoscopy in Shantou Central Hospital from January 2018 to September 2020 were included in this study. Among them, 85 patients treated with endoscopic release therapy were assigned to the observation group (2 patients were excluded from the observation group due to acute appendicitis), and 43 patients receiving no treatment were assigned to the control group. The relief of abdominal symptoms was used as an index to evaluate the clinical value of endoscopic release therapy for fecal impaction in the colorectal diverticulum.Results:In the observation group, 42.2% (35/83) were successfully released at one time. The successful comprehensive measures accounted for 25.0% (12/48) of the first release failure, and the total success rate was 56.6% (47/83). There were no complications related to endoscopy in the observation group. One week after the treatment, patients in the observation group were followed up by telephone. Among the 45 patients who were successfully released, positive symptoms of 30 patients disappeared or significantly improved with the effective rate of 90.9% (30/33). Among the 38 patients who failed to release the fecal impaction, 19 had positive symptoms and 16 improved in varying degrees with the effective rate of 55.2% (16/29). The overall effective rate of the observation group was higher than that of the control group [55.4% (46/83) VS 7.0% (3/43)], showing significant difference( χ2=23.354, P<0.01). The effective rate were significant differences in the successful release group [65.2% (30/46)], unsuccessful release group [29.7% (11/37)] and the control group [7.0% (3/43), χ2=33.792, P<0.01]. By pairwise comparison, the effective rate of the successful release group was the highest, followed by the unsuccessful release group, and that of the control group was the lowest with significant difference ( P<0.017). Conclusion:The endoscopic release therapy for fecal impaction in the colorectal diverticulum is relatively simple, which can relieve and reduce related symptoms, avoid complications, missed diagnosis and misdiagnosis, and show definite curative effects. When colorectal diverticulum with fecal impaction is found in the process of endoscopy, it is of great practical significance to release the incarcerated feces by means of different methods.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To study the effect of senescence gene silent information regulator 6 (Sirt6) knockout on the brain of aged mice.Methods:Sirt6-flox transgenic mice were constructed, and the mouse brain tissue was specifically knocked out by Emx1-Cre tool mice.According to genotyping, 11 wild-type mice were selected as control group(WT group) and 10 Sirt6 gene konckout mice were selected as conditional knockout group(cKO group). Body size and body weight of the aged mice were measured and cerebral cortex thickness was measured by HE staining.Brain neurogenesis was analyzed with EdU markers.The expression of RNA-binding protein HuR and apoptosis-related protein Caspase-3 were detected by Western blot.Meanwhile, histone acetylation levels in the cortex were detected.Results:Sirt6 brain tissue-specific knocked out mice were successfully constructed.Compared with the brain tissue area((2.07±0.22) cm 2)and cortical thickness ((970.56±80.91) μm) of WT mice in the 12-month-old group, the brain tissue area ((1.61±0.14)cm 2) and cortical thickness ((822.88±53.94) μm) in Sirt6 cKO group were smaller, and the differences were statistically significant (both P<0.05). EdU incorporation into nerve cells showed that the number of EdU incorporation into periventricular nerve cells in cKO group was lower ((4.75±1.48)) than that in WT group ((10.29±1.93)). The difference was statistically significant ( P<0.001). In the experiment of 17 months age group, mice in cKO group were smaller in body size, lower in body weight ((29.00±1.08) g) and smaller in brain area ((1.54±0.55)cm 2)compared with WT group in body size, body weight ((35.25±4.17) g) and brain tissue area ((1.98±0.18) cm 2)(both P<0.05). The expression of Caspase-3 and HuR in cortical proteins of these two age groups decreased( t=2.95, 5.38, both P<0.05), and the expression of H3K9ac and H3K56ac increased( t=3.53, 2.78, both P<0.05), but the expression of Sirt1 homologous gene remained unchanged( t=1.26, P>0.05). Conclusion:The specific deletion of Sirt6 in brain tissue can lead to the decrease of brain neurogenesis in aged mice, and the aggravation of aging and the increase of apoptosis, which may be the reason for the thinning of cerebral cortex and brain tissue atrophy.The molecular mechanism is speculated to be related to the increase of acetylation level after Sirt6 knockout

Objectives To detect the level of soluble programmed death 1 (sPD-1) and soluble programmed death ligand 1 (sPD-L1) in serum and urine of children with primary nephrotic syndrome (PNS),and explore its clinical significance.Methods From July 2017 to November 2017,children with PNS admitted to the Children's Hospital Affiliated to Soochow University were divided into onset group (36 cases) and remission group (33 cases).Thirty healthy children who underwent medical examination for enrollment,undersize or overweight in the outpatient department of pediatric health care and inpatient department of Endocrinology were selected as healthy control group.Serum and urine samples were collected,in which the levels of sPD-1 and sPD-L1 were detected by enzyme-linked immunosorbent assay (ELISA).The correlation between serum and urine sPD-1,sPD-L1 levels and lymphocyte subsets,urinary protein were analyzed by Pearson and Spearman correlation analysis.Results The level of sPD-1 in serum was lower in remission group than those in healthy controlgroup [1.60(0.48,8.15) ng/ml vs 7.38(2.15,19.02) ng/ml,P ＜ 0.01].The level of urinary sPD-1 in onset group was higher than that in remission group [1.21(0.61,2.56) pg/μg vs 0.51(0.31,0.97) pg/μg,P ＜0.001] and healthy control group [1.21(0.61,2.56) pg/μg vs 0.82(0.34,1.15) pg/μg,P ＜ 0.01].The levels of sPD-L1 in serum and urine were higher in onset and remission group than those in healthy control group (P ＜ 0.001).The level of sPD-1 in the serum was positive correlated with the numbers of CD3+,CD3+CD4+,CD3+ CD8+ T lymphocytes and CD3-CD19+,CD19+CD23+ B lymphocytes (r=0.537,0.478,0.454,0.429 and 0.374;P=0.002,0.008,0.012,0.018 and 0.042).The level of sPD-1 in the urine had positive relation with the ratio of 24 hours urinary albumin and weight (24 h UmAlb/Wt),N-acetylglucosaminidase and urinary creatinine (UNAG/Cr) and β2 microglobulin and urinary creatinine (Uβ2MG/Cr) (r=0.409,0.588 and 0.276;P=0.016,0.000 and 0.032).Conclusions The dynamic changes of sPD-1 and sPD-L1 in serum and urine suggested that PD-1/PD-L1 signaling pathway is involved in the development process of childhood primary nephrotic syndrome.