As a patented characteristic medicine of Yi ethnic minority， Pingxuan capsules have the effects of nourishing the liver and kidney， pacifying the liver， and subduing Yang. With the main indications of dizziness， headache， palpitations， tinnitus， insomnia， dreaminess， waist and knee soreness caused by liver-kidney deficiency and liver Yang upward disturbance， Pingxuan capsules are widely used in the treatment of posterior circulation ischemic vertigo， vestibular migraine， benign paroxysmal positional vertigo. However， the current knowledge is limited regarding the efficacy， syndrome differentiation， and safety of this medicine. On the basis of summarizing the experience of clinicians and the existing evidence， this study invites clinical experts of traditional Chinese and Western medicine， pharmaceutical experts， and methodological experts from relevant fields across China to conduct evidence-based evaluation of Pingxuan capsules. The evaluation follows the Specifications for the Development of Clinical Expert Consensus on Chinese Patent Medicines issued by the Standardization Office of the China Association of Chinese Medicine， and reaches 5 recommendations and 16 consensus suggestions. The consensus clarifies the clinical applications， efficacy， dose， course of treatment， combination of medicines， precautions， and contraindications of Pingxuan capsules in the treatment of vertigo and explains the safety of clinical application. This consensus is applicable to clinicians （traditional Chinese medicine， Western medicine， and integrated traditional Chinese and Western medicine） and pharmacists in tertiary hospitals， secondary hospitals， and community-level medical and health institutions across China， providing a reference for the rational use of Pingxuan capsules in the treatment of vertigo. It is hoped that the promotion of this consensus can facilitate the rational use of drugs in clinical practice， reduce the risk of drug use， and give full play to the advantages of Pingxuan capsules in the treatment of vertigo diseases. This consensus has been reviewed and published by the China Association of Chinese Medicine， with the number GS/CACM330-2023.

Objective:To analyse the clinical application value of Lone-Star perineal exposure technique in performing abdominal perineal resection (APR).Methods:Conducted a retrospective review of 17 rectal cancer patients, including 13 males, 4 females, aged from 44 to 82 years old, with the average age of (67.6±9.7) years who underwent APR at Anqing Municipal Hospital from January 2020 to July 2024. The Lone-Star retractor-assisted (LSR) exposure method was employed for the perineal operation. After incising the skin and subcutaneous tissue, a Lone-Star retractor was utilized, with eight small hooks used to extend the incision in multiple directions, facilitating the release of deep tissues. The hooks were dynamically adjusted to optimize surgical field exposure.Results:All 17 patients were successfully underwent laparoscopic-assisted APR. Fifteen operations were independently performed by a single surgeon, while 2 required assistance for intraoperative arterial hemostasis. No perforations occurred, and all specimens had a negative circumferential resection margin (CRM). Postoperative complications were observed in 4 patients, including urinary retention in one, pulmonary infection in one, wound seroma in one, and stoma mucosal detachment in one, all of which were classified as Clavien-Dindo grade 3 or lower and cured.Conclusions:The LSR exposure technique may significantly improve perineal exposure during APR for rectal cancer. It could potentially enhance intraoperative safety and efficiency, and facilitate single-operator surgery.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

In the field of dental aesthetics,digital aesthetic design plays a crucial role in helping dentists to predict treatment outcomes vis-ually,as well as in enhancing the consistency of knowledge and understanding of aesthetic goals between dentists and patients.It serves as the foundation for achieving ideal aesthetic effects.However,there is no clear standard for this digital process currently in China and abroad.Many dentists lack of systematic understanding of how to carry out digital aesthetic design for treatment.To establish standardized processes for dental aesthetic design and to improve the homogeneity of treatment outcomes,Chinese Society of Digital Dental Industry(CSD-DI)convened domestic experts in related field to compile this consensus.This article elaborates on the key aspects of digital aesthetic data collection,integration steps,and the digital aesthetic design process.It also formulates a decision tree for dental aesthetics at macro level and outlines corresponding workflows for various clinical scenarios,serving as a reference for clinicians.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective To explore the evaluation on the curative effect of digital subtraction angiography(DSA)-guided radiofrequency ablation in patients with lumbar disc herniation(LDH)based on infrared thermal imaging technology.Methods A total of 90 patients with LDH treated in the hospital were enrolled as the research objects between February 2019 and February 2022.According to different treatment methods,they were divided into observation group(n=45)and control group(n=45).The control group was treated with radiofrequency ablation,while observation group was treated with DSA-guided radiofrequency ablation.The scores of visual analogue scale(VAS),Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA),and levels of serologic indexes[interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]were compared between the two groups before treatment and at 1 month and 3 months after treatment.The skin temperature of lesions was detected by infrared thermal imaging,and its correlation with VAS,ODI and JOA scores was analyzed by Pearson correlation analysis.Results Before treatment,there was no significant difference in VAS score between the two groups(P＞0.05).At 1 month and 3 months after treatment,VAS scores in both groups were decreased,which were lower in observation group than control group(P＜0.05).Before treatment,there was no significant difference in ODI and JO A scores between the two groups(P＞0.05).At 1 month and 3 months after treatment,ODI scores in both groups were decreased,which were lower in observation group than control group,while JOA scores were increased,which were higher in observation group than control group(P＜0.05).Before treatment,there was no significant difference in levels of serum IL-1β,IL-6 and TNF-α between the two groups(P＞0.05).At 1 month and 3 months after treatment,levels of serum IL-1 β,IL-6 and TNF-α in both groups were decreased,which were lower in observation group than control group(P＜0.05).Before treatment,there was no significant difference in skin temperature of lesions between the two groups(P＞0.05).At 1 month and 3 months after treatment,skin temperature of lesions in both groups was decreased,which was lower in observation group than control group(P＜0.05).Pearson correlation analysis showed that skin temperature of lesions was positively correlated with VAS,ODI and JOA scores at 1 month and 3 months after treatment(r=0.455,0.502,0.523,0.675,0.659,0.611,P＜0.05).Conclusion Curative effect of DSA-guided radiofrequency ablation is good on LDH patients,and infrared thermal imaging can effectively evaluate the curative effect.

Objective:To investigate the application effect of preoperative prerehabilitation in elderly patients with knee arthroplasty combined with sarcopenia.Methods:A total of 164 elderly patients who were hospitalized and underwent artificial knee arthroplasty combined with sarcopenia in Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University from July 2020 to December 2021 were included by the convenient sampling method. According to random number table method, they were divided into the control group and the observation group, with 82 cases in each group. The control group received routine preoperative nursing, and the observation group received preoperative pre-rehabilitation intervention on the basis of the control group. Knee range of motion, Hospital for Special Surgery Knee Score (HSS) , skeletal muscle mass index and grip strength were evaluated before intervention and 1 month after operation. Length of stay and postoperative complications were recorded and compared between the two groups.Results:Knee range of motion, HSS of two groups at 1 month after operation were higher than those before intervention, and the differences were statistically significant ( P<0.05) . One month after surgery, the knee range of motion, HSS and grip strength of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The skeletal muscle mass index of the observation group was higher one month after surgery than before intervention, but the difference was not statistically significant ( P>0.05) . The hospitalization time of observation group was shorter than control group, and the difference was statistically significant ( P<0.05) . The incidence of complications in the observation group and control group was respectively 15.85% (13/82) and 39.02% (32/82) , and the difference was statistically significant ( P<0.05) . Conclusions:Preoperative rehabilitation can effectively improve the knee range of motion and joint function of elderly patients with sarcopenia after knee rarthroplasty, alleviate sarcopenia, shorten the length of hospital stay and reduce postoperative complications.

Rheumatoid arthritis is a chronic, systemic autoimmune disease predominantly based on joint lesions with an extremely high disability and deformity rate. Several drugs have been used for the treatment of rheumatoid arthritis, but their use is limited by suboptimal bioavailability, serious adverse effects, and nonnegligible first-pass effects. In contrast, transdermal drug delivery systems (TDDSs) can avoid these drawbacks and improve patient compliance, making them a promising option for the treatment of rheumatoid arthritis (RA). Of course, TDDSs also face unique challenges, as the physiological barrier of the skin makes drug delivery somewhat limited. To overcome this barrier and maximize drug delivery efficiency, TDDSs have evolved in terms of the principle of transdermal facilitation and transdermal facilitation technology, and different generations of TDDSs have been derived, which have significantly improved transdermal efficiency and even achieved individualized controlled drug delivery. In this review, we summarize the different generations of transdermal drug delivery systems, the corresponding transdermal strategies, and their applications in the treatment of RA.

Objective:To explore the value of CT portal vein imaging combined with liver function indexes in predicting the risk of esophageal variceal bleeding in patients with liver cirrhosis.Methods:A total of 82 patients with liver cirrhosis complicated with gastric fundus esophageal varices in Wanbei Coal-Electricity Group General Hospital were selected and divided into bleeding group (24 cases) and non-bleeding group (58 cases) according to the occurrence of gastric fundus esophageal varices bleeding within 6 weeks after admission. General data of the two groups, CT portal vein imaging parameters at admission including diameter of main portal vein (MPV), diameter of splenic vein (SPV), diameter of left gastric vein (LGV), serum liver function indexes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) levels were compared between the two groups, and analyzed the value of CT portal vein imaging parameters and serum liver function indexes levels in predicting the risk of gastric fundus esophageal varices bleeding.Results:The age and diameter of MPV, SPV, LGV in bleeding group were higher than those in the non-bleeding group: (55.17 ± 12.02) years vs. (53.71 ± 10.48) years, (18.05 ± 2.74) mm vs. (15.22 ± 2.18) mm, (13.68 ± 1.35) mm vs. (12.26 ± 1.43) mm, (6.82 ± 1.38) mm vs. (5.30 ± 0.94) mm; the levels of serum ALT, AST, TBIL in bleeding group were lower than those in the non-bleeding group: (23.71 ± 5.74) U/L vs. (34.95 ± 8.26) U/L, (27.65 ± 6.61) U/L vs. (39.29 ± 10.24) U/L, (17.20 ± 5.49) U/L vs. (26.13 ± 7.85) U/L, there were statistical differences ( P<0.05). The results of receiver operating characteristic curve showed that the area under the curve (AUC) of combined index to predict gastric fundus esophageal varices bleeding was 0.889 (95% CI 0.812-0.967), and the sensitivity and specificity were 83.34% and 81.03%, respectively. Conclusions:CT portal vein imaging combined with liver function indexes has a good value in predicting the risk of gastric fundus esophageal varices bleeding in liver cirrhosis.

Objective:To investigate the clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography (CTA) in repairing skin and soft tissue defects around the knee or in proximal lower leg.Methods:A retrospective cohort study was conducted. From May 2015 to October 2019, 17 patients with skin and soft tissue defects around the knee or in proximal lower leg were admitted to the Department of Orthopedics of Jizhong Energy Xingtai Mig General Hospital, including 12 males and 5 females, aged 16-65 years, with an average age of 35 years. The areas of skin and soft tissue defects after debridement ranged from 6.0 cm×3.0 cm to 15.0 cm×9.0 cm. The retrograde anterolateral thigh perforator flaps were designed according to the origin and distribution of the perforating branches in flaps and the length of the vascular pedicle examined with CTA and the condition of the wound to repair the wounds. The areas of resected flaps ranged from 6.5 cm×3.5 cm to 15.5 cm×9.5 cm. The wounds in donor sites of flaps were sutured directly or covered with medium-thickness skin grafts from healthy upper leg. The sources of the perforating branches in flaps were recorded. The lateral circumflex femoral artery, its branches, and the relative length of the vascular pedicle were compared between preoperative CTA detection and intraoperative observation. The survivals of the flaps were observed. At the last follow-up, the effects of flaps in repairing wounds were evaluated according to evaluation standard of efficacy satisfaction; the motion ranges of flexion and extension of the knee joint were measured, and the knee joint function was evaluated according to the Hohl knee joint function evaluation standard; the sensory function in the flap area was evaluated according to the sensory function evaluation standard formulated by the British Medical Research Council; the wound healing and the occurrence of complication affecting motor function of limb of flap donor sites was observed. Data were statistically analyzed with paired sample t test. Results:The perforating branches in flaps originated from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery in 7, 6, and 4 patients, respectively. The flaps with blood supply from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery were type 1, 2, and 3 retrograde anterolateral thigh perforator flaps, respectively. The preoperative CTA examination of lateral circumflex femoral artery and its branches were consistent with those observed during operation. The relative lengths of vascular pedicles of type 1, 2, and 3 retrograde anterolateral thigh perforator flaps calculated after CTA examination were 0.32±0.13, 0.56±0.07, and 0.56±0.15, which were close to 0.35±0.12, 0.52±0.10, and 0.53±0.12 measured and calculated during operation, respectively ( t=0.45, 0.80, 0.31, P>0.05). All flaps survived in 17 cases without vascular crisis. At the last follow-up, 16 patients were satisfied with effects of flaps in wound repair, with 1 patient feeling average about the effect; the flexion range of knee joint was 100-120°, and the extension range of knee joint was -2-0°; knee joint function was evaluated as excellent in 9 cases, good in 7 cases, and poor in 1 case; the sensory function of the flap area reached S 4 level in 2 cases, S 3 level in 8 cases, and S 2 level in 7 cases; the wounds in flap donor sites healed well; there was no adverse effect in motor function of limbs. Conclusions:Retrograde anterolateral thigh perforator flap is an effective method for repairing skin and soft tissue defects around the knee or in proximal lower leg. Preoperative CTA examination can fully show the anatomical characteristics of the branches of the lateral circumflex femoral artery and the perforating vessels of each branch, which can guide preoperative flap design and operation, thus shortening operation time and improving flap survival rate, with good clinical effects.