ObjectiveTo interpret the main contents of the Expert Consensus on Clinical Application of Yifei Zhike Capsules （hereinafter referred to as the Consensus）， analyze its evidence basis， and explore future research directions， thus providing a reference for rational drug use in clinical practice. MethodsThe core contents of the Consensus are summarized. Focusing on clinical issues， this paper summarizes the recommendations and consensus suggestions in the Consensus and explains them from aspects such as indications， key advantages， usage and dosage， combined medication， contraindications， precautions， and safety. ResultsThe Consensus clearly states that Yifei Zhike capsules can be used for acute or chronic bronchitis， pulmonary tuberculosis and other respiratory system diseases. It for the first time proposes that the applicable TCM syndrome of Yifei Zhike capsules is Qi-Yin deficiency together with combined phlegm and stasis. For different diseases， the Consensus provides specific usage instructions， dosage， and treatment course recommendations， supplementing the contents not covered in the drug instructions. In terms of combined medication， the Consensus emphasizes the principle of using this drug in combination with standardized chemotherapy regimens or conventional Western medicines and the applicability for the treatment of pulmonary tuberculosis and moderate to severe acute or chronic bronchitis. In terms of safety， the Consensus proposes methods for identifying common adverse reactions， drug contraindications， and precautions based on a review of the existing data and preliminarily builds a risk management framework. However， the evidence on which the Consensus is based are mostly early studies， with small sample sizes， which result in the low evidence grades （mainly C and D） of some recommendations. ConclusionThe Consensus provides specific guidance for the clinical use of Yifei Zhike capsules. However， due to the limited quality of the existing research evidence， more high-quality clinical studies are needed in the future to further verify its efficacy， safety， and explore its broader application prospects.

Salvia miltiorrhiza (S. miltiorrhiza) represents a crucial component of traditional Chinese medicine, demonstrating effects on blood circulation activation and stasis removal, and has been widely utilized in asthma treatment. This study isolated a novel phenolic acid (S1) from S. miltiorrhiza and investigated its anti-asthmatic activity and underlying mechanisms for the first time. An allergic asthma (AA) model was established using ovalbumin (OVA). The mechanism of S1's effects on AA was investigated using multi-factor joint analysis, flow cytometry, and co-culture systems to facilitate clinical asthma treatment. S1 (10 or 20 mg·kg^-1) was administered daily to mice with OVA-induced AA (OVA-AA) during days 21-25. The study examined airway responsiveness, lung damage, inflammation, and levels of immunoglobulin E (IgE), PGD2, interleukins (IL-4, 5, 10, 13, 17A), tumor necrosis factor α (TNF-α), GM-CSF, CXCL1, CCL11, and mMCP-1. Additionally, mast cell (MC) activation and degranulation were explored, along with T helper type 17 (Th17)/Treg immune cells and TLR4 pathway biomarkers. The antagonistic activity of that specific antagonist of TLR4 (TAK-242) (1 µmol·L^-1), a specific TLR4 blocker, against S1 (10 µmol·L^-1) was examined in co-cultured 16HBE cells and bone marrow-derived cells (BMDCs) or splenic lymphocytes (SLs) induced with LPS (1 µg·mL^-1) to elucidate the TLR4 pathway's mediating role. S1 demonstrated reduced airway responsiveness, lung damage, and inflammation, with downregulation of IgE, PGD2, interleukins, TNF-α, GM-CSF, CXCL1, CCL11, and mMCP-1. It also impeded MC activation and degranulation, upregulated IL-10, and influenced Th17/Treg immune cell transformation following OVA challenge. Furthermore, S1 inhibited the TLR4 pathway in OVA-AA mice, and TLR4 antagonism enhanced S1's positive effects. Analysis using an OVA-AA mouse model demonstrated that S1 alleviates AA clinical symptoms, restores lung function, and inhibits airway response. S1's therapeutic effects occur through regulation of Th17/Treg immune cells and inflammation, attributable at least partially to the TLR4 pathway. This study provides molecular justification for S1 in AA treatment.

Objectives:To explore the incidence and risk factors of adjacent vertebral fractures(AVF)in pa-tients with osteoporotic vertebral compression fractures(OVCF)after percutaneous vertebroplasty(PVP)treatment.Methods:A retrospective analysis was conducted on 482 OVCF patients who underwent PVP at our hospital from June 2017 to January 2022.There were 146 males and 336 females,with an average age of 68.4±3.1 years(63-86 years).The average follow-up time was 42.9±10.2 months(24-70 months).Based on whether AVF occurred during the follow-up period,the patients were divided into an AVF group and a non-AVF group.The time of AVF occurrence was recorded,and the incidence rate of AVF was calculated using the Ka-plan-Meier method to obtain a survival curve.Intergroup comparisons were made in terms of clinical factors including gender,age,body mass index(BMI),adjacent vertebral CT value,and bone metabolism related index-es[total procollagen type Ⅰ N-terminal propeptide(tP Ⅰ NP),[3-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX),and 25-hydroxyvitamin D(25-OHD)];Imaging factors such as whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accom-panied by an intravertebral vacuum cleft(IVC),preoperative vertebral body height,wedge angle,and kyphosis angle;And surgical factors including bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle,restoration of kyphosis angle and whether bone cement leakage occurred.Indicators that were significant in the univariate analysis were included in the multivariate logistic regression analysis.Results:AVF occurred in 47 cases(9.75％)in 17.9±14.7 months(1-55 months)after PVP.The Kaplan-Meier survival curve showed that the incidence of AVF in the group with upper endplate fractures was significantly higher than that in the group without upper endplate fractures(P＜0.001).There were no statistically significant differences between the AVF group and the non-AVF group in terms of gender,BMI,tP Ⅰ NP,[3-CTX,25-OHD,preoperative vertebral body height,wedge angle,kyphosis angle,bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle and restoration of kyphosis angle(P＞0.05).Statistically significant differences were found in age,adjacent vertebral CT value,whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accompanied by an IVC,and whether bone cement leakage occurred(P＜0.05).Further multivariate logistic regression analysis showed that advanced age(OR=1.187,95％CI=1.084-1.300,P＜0.001),low CT value of adjacent vertebra(OR=0.928,95％CI=0.892-0.964,P＜0.001),presence of upper endplate fracture(OR=3.514,95％CI=1.444-8.551,P=0.006),presence of IVC(OR=2.804,95％CI=1.238-6.349,P=0.013),and bone cement leakage(OR=2.415,95％CI=1.134-5.146,P=0.022)were the risk factors for AVF after PVP.Conclusions:Advanced age,low CT value of adjacent vertebra,upper endplate fracture,IVC,and bone cement leakage are the independent risk factors for postoperative AVF in OVCF patients undergoing PVP.

Objectives:To explore the incidence and risk factors of adjacent vertebral fractures(AVF)in pa-tients with osteoporotic vertebral compression fractures(OVCF)after percutaneous vertebroplasty(PVP)treatment.Methods:A retrospective analysis was conducted on 482 OVCF patients who underwent PVP at our hospital from June 2017 to January 2022.There were 146 males and 336 females,with an average age of 68.4±3.1 years(63-86 years).The average follow-up time was 42.9±10.2 months(24-70 months).Based on whether AVF occurred during the follow-up period,the patients were divided into an AVF group and a non-AVF group.The time of AVF occurrence was recorded,and the incidence rate of AVF was calculated using the Ka-plan-Meier method to obtain a survival curve.Intergroup comparisons were made in terms of clinical factors including gender,age,body mass index(BMI),adjacent vertebral CT value,and bone metabolism related index-es[total procollagen type Ⅰ N-terminal propeptide(tP Ⅰ NP),[3-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX),and 25-hydroxyvitamin D(25-OHD)];Imaging factors such as whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accom-panied by an intravertebral vacuum cleft(IVC),preoperative vertebral body height,wedge angle,and kyphosis angle;And surgical factors including bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle,restoration of kyphosis angle and whether bone cement leakage occurred.Indicators that were significant in the univariate analysis were included in the multivariate logistic regression analysis.Results:AVF occurred in 47 cases(9.75％)in 17.9±14.7 months(1-55 months)after PVP.The Kaplan-Meier survival curve showed that the incidence of AVF in the group with upper endplate fractures was significantly higher than that in the group without upper endplate fractures(P＜0.001).There were no statistically significant differences between the AVF group and the non-AVF group in terms of gender,BMI,tP Ⅰ NP,[3-CTX,25-OHD,preoperative vertebral body height,wedge angle,kyphosis angle,bone cement injection volume,postoperative restoration of vertebral height,restoration of wedge angle and restoration of kyphosis angle(P＞0.05).Statistically significant differences were found in age,adjacent vertebral CT value,whether the fracture was located in the thoracolumbar segment,whether it was accompanied by an upper endplate fracture,whether it was accompanied by an IVC,and whether bone cement leakage occurred(P＜0.05).Further multivariate logistic regression analysis showed that advanced age(OR=1.187,95％CI=1.084-1.300,P＜0.001),low CT value of adjacent vertebra(OR=0.928,95％CI=0.892-0.964,P＜0.001),presence of upper endplate fracture(OR=3.514,95％CI=1.444-8.551,P=0.006),presence of IVC(OR=2.804,95％CI=1.238-6.349,P=0.013),and bone cement leakage(OR=2.415,95％CI=1.134-5.146,P=0.022)were the risk factors for AVF after PVP.Conclusions:Advanced age,low CT value of adjacent vertebra,upper endplate fracture,IVC,and bone cement leakage are the independent risk factors for postoperative AVF in OVCF patients undergoing PVP.

Objective:To evaluate the screw placement guided by C-arm computer navigation in the fixation and fusion of instability of the atlantoaxial joint using atlantoaxial pedicle screws.Methods:A retrospective study was conducted to analyze the clinical data of 30 patients who had been treated for atlantoaxial instability by pedicle screw fixation and fusion at Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University from October 2020 to November 2022. The patients were divided into 2 groups according to whether the C-arm computer navigation system had been used to assist their screw placement. In the observation group, there were 12 patients [9 males and 3 females with an age of (55.6±7.3) years] whose screw placement was assisted by C-arm computer navigation; in the control group, there were 18 patients [13 males and 5 females with an age of (52.4±8.1) years] whose screw placement was assisted by conventional X-ray fluoroscopy. The 2 groups were compared in terms of surgery time, intraoperative bleeding volume, intraoperative fluoroscopy time, incidence of postoperative complications, and neck disability index (NDI) and visual analogue scale (VAS) at 3 months after surgery.Results:The 2 groups were comparable because there were no significant differences in the preoperative general data between them ( P>0.05). All the 30 patients were followed up for (23.8±6.1) months after surgery. The surgery time, intraoperative fluoroscopy time, and intraoperative bleeding volume in the observation group were significantly shorter or smaller, respectively, than those in the control group [(109.5±19.3) min versus (135.6±23.2) min; (43.5±11.7) s versus (68.8±24.5) s; (240.6±65.8) mL versus (320.4±95.6) mL)] ( P<0.05). No vascular or neural injuries or other complications occurred in any of the patients. There was no statistically significant difference between the observation group and the control group in the NDI or VAS pain score at 3 months after surgery [(18.6±7.3) points versus (20.4±9.3) points; (1.6±0.6) points versus (1.4±0.5) points] ( P>0.05). Follow-ups observed no loosening or breakage of implants, no recurrence of instability of the atlantoaxial joint, or no nonunion of the bone grafts. Conclusion:In the treatment of atlantoaxial instability with atlantoaxial pedicle screw fixation and fusion, compared with conventional X-ray fluoroscopy guidance, the screw placement guided by C-arm computer navigation can result in the same therapeutic efficacy but shorter surgery time, less intraoperative blood loss and less radiation exposure.

Cancer-associated thromboembolism(CAT)is one of the most common complications and the second direct cause of mortality in patients with malignant tumors,which seriously affect patients'life quality and prognosis.In recent years,with the deepening of mechanism researches of cancer and thrombosis,treatment strategies of CAT were also improved.The current status and progresses of clinical treatment of CAT were reviewed in this article.

Objective:To evaluate the screw placement guided by C-arm computer navigation in the fixation and fusion of instability of the atlantoaxial joint using atlantoaxial pedicle screws.Methods:A retrospective study was conducted to analyze the clinical data of 30 patients who had been treated for atlantoaxial instability by pedicle screw fixation and fusion at Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University from October 2020 to November 2022. The patients were divided into 2 groups according to whether the C-arm computer navigation system had been used to assist their screw placement. In the observation group, there were 12 patients [9 males and 3 females with an age of (55.6±7.3) years] whose screw placement was assisted by C-arm computer navigation; in the control group, there were 18 patients [13 males and 5 females with an age of (52.4±8.1) years] whose screw placement was assisted by conventional X-ray fluoroscopy. The 2 groups were compared in terms of surgery time, intraoperative bleeding volume, intraoperative fluoroscopy time, incidence of postoperative complications, and neck disability index (NDI) and visual analogue scale (VAS) at 3 months after surgery.Results:The 2 groups were comparable because there were no significant differences in the preoperative general data between them ( P>0.05). All the 30 patients were followed up for (23.8±6.1) months after surgery. The surgery time, intraoperative fluoroscopy time, and intraoperative bleeding volume in the observation group were significantly shorter or smaller, respectively, than those in the control group [(109.5±19.3) min versus (135.6±23.2) min; (43.5±11.7) s versus (68.8±24.5) s; (240.6±65.8) mL versus (320.4±95.6) mL)] ( P<0.05). No vascular or neural injuries or other complications occurred in any of the patients. There was no statistically significant difference between the observation group and the control group in the NDI or VAS pain score at 3 months after surgery [(18.6±7.3) points versus (20.4±9.3) points; (1.6±0.6) points versus (1.4±0.5) points] ( P>0.05). Follow-ups observed no loosening or breakage of implants, no recurrence of instability of the atlantoaxial joint, or no nonunion of the bone grafts. Conclusion:In the treatment of atlantoaxial instability with atlantoaxial pedicle screw fixation and fusion, compared with conventional X-ray fluoroscopy guidance, the screw placement guided by C-arm computer navigation can result in the same therapeutic efficacy but shorter surgery time, less intraoperative blood loss and less radiation exposure.

Objective:To investigate the value of a nomogram predicting the outcome of intracerebral hemorrhage (ICH) based on clinical characteristics and diffusion-weighted imaging (DWI) of hyperintense lesions.Methods:A case-control study. Consecutive patients, aged 30-88(59±13) years old, with ICH were recruited at the Stroke Center of Zhengzhou People′s Hospital from January 2018 to August 2021. Patients were divided into a group with DWI lesions and a group without DWI lesions depending on whether there were DWI hyperintense lesions distant from the hematoma. Prognosis was evaluated at 90 days via the modified Rankin Scale (mRS). Univariate and multivariable logistic regression models were used to identify independent predictors of a poor ICH outcome (mRS score≥4), and a nomogram model was developed. The performance of the nomogram was validated via the area under the receiver operating characteristic curve (AUC) and a calibration chart.Results:Of the 303 patients included in the study, 24.8% presented with DWI lesions; 17.5% with asymptomatic DWI lesions and 7.3% with symptomatic DWI lesions. Poor outcomes were significantly more frequent in the group with DWI lesions than in the group without DWI lesions ( χ2=21.32, P<0.001). In multivariable regression analysis, age [odds ratio ( OR)=1.032, 95% confidence interval ( CI) 1.002-1.063, P=0.035], hematoma volume ( OR=1.050, 95% CI 1.011-1.090, P=0.012), hematoma location ( OR=3.839, 95% CI 1.248-11.805, P=0.019), DWI lesions ( OR=3.955, 95% CI 1.906-8.206, P<0.001), and baseline NIHSS scores ( OR=1.102, 95% CI 1.038-1.170, P=0.001) were independent predictors of a poor outcome. In subgroup analysis patients with asymptomatic DWI lesions had a 3-fold greater risk of a poor outcome compared to those without DWI lesions ( OR=3.135, 95% CI 1.382-7.112, P=0.006), and patients with symptomatic DWI lesions had a 7-fold greater risk of a poor outcome compared to those without DWI lesions ( OR=7.126, 95% CI 2.279-22.277, P=0.001). A nomogram model was established based on the independent predictors for a poor outcome. The AUC of the nomogram was 0.846 (95% CI 0.795-0.898), and a calibration chart indicated good consistency between values predicted by the nomogram and actual observed values. Conclusions:DWI lesions are an independent risk factor for a poor outcome in patients with ICH-particularly symptomatic DWI lesions. A nomogram model based on clinical characteristics and DWI lesions exhibited good efficacy when predicting the outcome of ICH.

Cerebrovascular disease is one of the leading causes of death and disability across the world. Vascular homeostasis and recovery is critical to the body. Klotho is an important endogenous pleiotropic protein involved in a variety of pathophysiological processes,such as aging and calcium and phosphorus metabolism,which is closely associated with vascular disease. Recent clinical studies have demonstrated close links between low Klotho levels and various risk factors for cerebrovascular disease,suggesting that Klotho has the potential of predicting the risk of ischemic and hemorrhagic cerebrovascular diseases and poor prognosis. Basic studies have also shown that Klotho plays a crucial role in the maintenance of vascular homeostasis. Klotho can promote the production of nitric oxide,inhibit the expression of inflammatory factors,and mediate antioxidant and anti-aging effects,which can delay atherosclerosis and vascular calcification. Therefore,Klotho may serve as a new target for the prevention and treatment of cerebrovascular disease. This review provides an overview of the relationship between Klotho and cerebrovascular disease and its potential biological mechanisms.

Objective:To investigate the clinical efficacy of oblique intervertebral fusion in the treatment of failed internal fixation of thoracolumbar fractures.Methods:A retrospective study was conducted to analyze the clinical data of 14 patients who had undergone revision surgery for failed internal fixation of thoracolumbar fracture at Department of Orthopedics, The First Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. There were 6 men and 8 women with a mean age of 47.5 (42.0, 54.3) years. Fracture segments: T 12 in 2 cases, L 1 in 3 cases, L 2 in 4 cases, L 3 in 3 cases, and L 4 in 2 cases; AO classification: type A in 1 case, type B in 7 cases, and type C in 6 cases. Their prior surgical method was posterior internal fixation with pedicle screws. The revision surgery consisted of subtotal vertebral resection through the oblique lateral approach, bone column reconstruction and lateral screw-rod internal fixation for intervertebral fusion after posterior internal fixation reset. The operation time, intraoperative bleeding, postoperative hospital stay, and incidence of complications were recorded. Compared were visual analogue scale (VAS) and Oswestry disability index (ODI) scores for low back pain at preoperation, 3 days and 3 months postoperation, and the last follow-up, fusion at the last follow-up, and Frankel grading for neurological function at preoperation and postoperation. Results:All the 14 patients underwent surgery successfully and were followed up for 23 (18, 24) months. The operation time was (175.1±28.2) min, the intraoperative bleeding (300.4±122.6) mL, and the postoperative hospital stay 6 (6, 7) d. One case developed postoperative transient hip flexion weakness but was discharged after restoration of normal muscle strength by conservative treatment. Both VAS and ODI scores for low back pain at all postoperative time points were significantly improved compared with the preoperative values ( P<0.05), with a significant trend of 3 days postoperation >3 months postoperation > the last follow-up ( P<0.05). In the 12 patients with preoperative neurological damage, the Frankel grading rose by at least 1 level postoperatively ( Z=-3.110, P=0.002). The last follow-up revealed no loosening or fracture of the internal fixation. Complete bony fusion was visible in all CT sagittal reconstructions. Conclusion:For patients with thoracolumbar fracture undergoing failed internal fixation, oblique intervertebral fusion is an alternative minimally invasive surgical treatment due to its satisfactory overall outcomes.