ObjectiveTo explore the mechanisms of Yangjing Tongluo prescription （YJTL） in the treatment of intrauterine adhesion （IUA） from the perspective of oxidative stress mediated by the Kelch-like ECH-associated protein 1/nuclear factor erythroid 2-related factor 2/heme oxygenase-1 （Keap1/Nrf2/HO-1） signaling pathway. MethodsA total of 48 rats with normal estrous cycles were selected and randomly divided into a normal group （n=8） and a modeling group （n=40）. An IUA rat model was established using a dual-injury method combining surgical curettage and infection. Eight rats were randomly selected from the modeling group for a pilot experiment to confirm successful model establishment. After successful modeling， the remaining 32 rats were randomly divided into a model group， a low-dose YJTL group （YJTL-L）， a high-dose YJTL group （YJTL-H）， and a Progynova group. Rats in the normal and model groups were administered purified water （15 mL·kg^-1） by gavage daily， while rats in the YJTL-L， YJTL-H， and Progynova groups received YJTL at doses of 6.43 and 12.86 g·kg^-1 and Progynova at 2.06 × 10^-4 g·kg^-1， respectively， for 14 consecutive days. The general condition， uterine morphology， and uterine index of the rats were monitored. Histopathological changes in uterine tissue were observed using hematoxylin-eosin （HE） staining. Serum levels of reactive oxygen species （ROS） and glutathione peroxidase （GSH-Px） were measured by enzyme-linked immunosorbent assay （ELISA）. Protein expression levels of Keap1， Nrf2， and HO-1 in endometrial tissue were detected by Western blot. Immunofluorescence （IF） was used to assess the distribution of Nrf2 and HO-1， as well as the expression of Nrf2 in the cytoplasm and nucleus. ResultsCompared with the normal group， rats in the model group exhibited poor mental status and reduced mobility， markedly edematous and tortuous uterine morphology， decreased gland number， and inflammatory reactions in the endometrium， along with an increased uterine organ index （P<0.05）. Serum ROS levels were significantly increased （P<0.05）， while serum GSH-Px levels were significantly decreased （P<0.05）. In endometrial tissue， Keap1 protein expression was increased （P<0.05）， whereas Nrf2 and HO-1 protein expression was decreased. Mild nuclear translocation of Nrf2 was observed， accompanied by increased relative fluorescence intensity of nuclear Nrf2 and decreased relative fluorescence intensity of cytoplasmic HO-1. Compared with the model group， all treatment groups showed varying degrees of improvement in the above symptoms and pathological changes. Serum ROS levels were reduced （P<0.05）， serum GSH-Px levels were increased （P<0.05）， Keap1 protein expression in endometrial tissue was decreased， and Nrf2 and HO-1 protein expression was increased in a dose-dependent manner （P<0.05）. Notably， significant nuclear translocation of Nrf2 was observed， with correspondingly increased relative fluorescence intensity of nuclear Nrf2 and enhanced relative fluorescence intensity of cytoplasmic HO-1. ConclusionYJTL may enhance antioxidant capacity and repair oxidative damage to the endometrial basal layer by regulating the Keap1/Nrf2/HO-1 signaling pathway.

OBJECTIVE To investigate the protective effect of 2-dodecyl-6-methoxy-2，5-diene-1，4-cyclohexanedione （DMDD）， an active component from Averrhoa carambola root， on myocardial injury in diabetic mice based on the nuclear receptor coactivator 4/ferritin heavy chain 1/autophagy-related protein 8 （NCOA4/FTH1/ATG8） axis. METHODS The successfully modeled diabetic mice were randomly divided into model group and DMDD low-， medium-， and high-dose （12.5， 25， 50 mg/kg） groups， while an additional non-modeled control group was established， with 6 mice in each group. Each group received the corresponding drug solution or an equal volume of normal saline intragastically once daily for 21 consecutive days. After the administration， the levels of fasting blood glucose （FBG）， serum lactate dehydrogenase （LDH）， and creatine kinase isoenzyme MB （CK-MB） were measured. Myocardial pathological changes， degree of fibrosis， and myocardial cell ultrastructure were observed. Myocardial cell death index and NCOA4 protein positive index were detected. The protein expression levels of NCOA4， FTH1， ATG8， solute carrier family 7 member 11 （SLC7A11）， and glutathione peroxidase 4 （GPX4） in cardiac tissue were measured. RESULTS Compared with model group， each DMDD group showed significant alleviation of cardiac pathological injury and varying degrees of improvement in the myocardial cell ultrastructure. The FBG and serum LDH and CK-MB levels， the myocardial cell death index and NCOA4 protein positive index，the protein expression levels of NCOA4， FTH1， and ATG8 in cardiac tissue were significantly decreased （ P ＜0.001）， while the protein expression levels of SLC7A11 and GPX4 were significantly increased （ P ＜0.001）. CONCLUSIONS DMDD can reduce blood glucose levels， alleviate myocardial histopathological injury， and inhibit cell death in diabetic mice. The mechanism is associated with inhibiting excessive activation of the NCOA4/FTH1/ATG8 axis and reducing ferritinophagy.

As the core vehicle for preserving and transmitting traditional Chinese medicine（TCM） academic thought and clinical experience， the establishment of a robust quality evaluation system for TCM clinical case reports is a crucial component in the current standardization and modernization of TCM. Based on the practical experience of constructing the China Clinical Cases Library of Traditional Chinese Medicine by the China Association of Chinese Medicine， this study conducted a comprehensive analysis of critical challenges， including insufficient authenticity and unfocused evaluation criteria. It proposed a three-dimensional evaluation framework grounded in the structure-process-outcome logic， encompassing three dimensions of authenticity and standardization， characteristics and advantages， application and translational impact. This framework integrated 12 key evaluation indicators in a systematic manner. The model preserved the academic characteristics of TCM syndrome differentiation and treatment， while aligning with modern scientific research standards， achieving a balance between individualized TCM experience and standardized evaluation. Concurrently， this study provided theoretical foundations and methodological guidance for evaluating the quality of TCM clinical cases， contributing significantly to the inheritance of TCM knowledge， evidence-based practice， and the reform of talent evaluation mechanisms.

With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To explore the position and length of anchor placement during the repair of anterior talofibular ligament (ATFL) in adolescents with unclosed epiphyseal plates by measuring the relevant data in three-dimensional CT.Methods:A total of 100 three-dimensional CT images of adolescent patients with unclosed epiphyseal plates were collected from the database of the Radiology Center of Renhe Hospital Affiliated to China Three Gorges University from January 1, 2017 to January 1, 2024. There were 69 males and 31 females, aged 12.38±0.90 years (range, 11-14 years), 47 on the left side and 53 on the right side, with a height of 155.72±5.84 cm (range, 145-175 cm), a weight of 48.02±5.93 kg (range, 40-72 kg), and a body mass index (BMI) of 19.77±1.61 kg/m 2 (range, 17.69-24.91 kg/m 2). The built-in measurement tool of the picture archiving and communication system (PACS) was used to measure the angle (α) between the direction of the nail placement and the longitudinal axis of the fibula, the distance between the nail placement point and the posterior edge of the fibula ( d), and the height from the nail placement point to the level of the fibula tip ( h) to evaluate the position and length of the anchor placement. Results:In adolescent patients, α was 47.50°±3.28° (range, 40.00°-56.00°), d was 17.12±1.80 mm (range, 11.70-21.90 mm), and h was 5.21±1.17 mm (range, 3.40-7.90 mm). The α, d and h of male patients were 47.48°±3.13° (range, 42.00°-56.00°), 17.49±1.54 mm (range, 14.45-21.90 mm) and 5.25±1.07 mm (range, 3.70-7.90 mm), respectively. Those of female patients were 47.55°±3.66° (range, 40.00°-53.00°), 16.30±2.07 mm (range, 11.65-20.30 mm) and 5.07±1.56 mm (range, 3.40-7.00 mm), respectively. There was a significant difference in d between male and female patients ( t=3.193, P=0.002), but there was no significant difference in α and h ( t=0.098, P=0.922; t=0.296, P=0.770). Conclusions:The safe range of anchor placement during ATFL anatomical repair in adolescents with unclosed epiphyseal plates is about 3.40-7.90 mm above the tip of fibula and 56°-90° with the longitudinal axis of fibula. Male patients with unclosed epiphyseal plates should choose anchors with a length of 14 mm and shorter, while females should choose anchors with a length of 10.8 mm.

BACKGROUND:Developmental dysplasia of hip refers to the deformity of acetabulum and proximal femur,which can lead to hip instability and hip osteoarthritis. Periacetabular osteotomy is the main treatment for non-terminal developmental dysplasia of hip in adolescents and adults. Pelvic inclination plays an important role in biomechanics of hip joint,which determines the stress direction of hip joint. In hip joint diseases,pelvic compensatory tilt can occur to minimize the abnormal stress of hip joint.OBJECTIVE:To observe whether periacetabular osteotomy changes pelvic sagittal tilt in patients with developmental dysplasia of hip,and to investigate the effect of acetabular covering on pelvic sagittal tilt.METHODS:A retrospective analysis was performed on 29 patients who underwent periacetabular osteotomy due to developmental dysplasia of hip in West China Hospital of Sichuan University from August 2019 to June 2022. Anteroposterior X-rays of the standing pelvis were collected before and 6 months after surgery. The pelvic tilt parameters,including the lateral center-edge angle,pubic symphysis to sacroiliac joint distance,pubic symphysis to sacroiliac joint midline distance,sacrofemoral-pubic angle,and pelvic tilt,were measured. Hip functions of all patients were assessed by hip disability and osteoarthritis score and Harris score before and 6 months after surgery.RESULTS AND CONCLUSION:(1) The lateral center-edge angle,pubic symphysis to sacroiliac joint midline distance,and sacrofemoral-pubic angle were significantly increased 6 months postoperatively compared to preoperative values (P<0.05). Tonnis angle and pelvic tilt were significantly decreased (P<0.05). There was no significant difference in pubic symphysis to sacroiliac joint distance between preoperative and postoperative measurements (P>0.05). (2) The hip disability and osteoarthritis scores and Harris scores were significantly increased 6 months after operation (P<0.01). (3) It is indicated that periacetabular osteotomy surgery can significantly improve acetabular coverage and the pelvis showed significant anteversion changes in patients with developmental dysplasia of hip.

Objectives:This study aims to investigate the incidence,characteristics and clinical outcomes of vagal response(VR)during pulmonary vein isolation(PVI).Methods:A total of 702 patients with nonvalvular atrial fibrillation(AF)who received the first PVI radiofrequency ablation in Central China Fuwai Hospital from January 2022 to December 2023 were consecutively enrolled.PVI was initiated from right superior pulmonary vein(RSPV),followed by other pulmonary veins(PVs).The VR was defined as atrioventricular block(AVB),asystole or a 50%increase in the RR interval.Results:Among 702 patients with AF,380 patients(54.1%)were paroxysmal AF and 322 patients(45.9%)were persistent AF.77 patients(11.0%)developed 81 VR episodes,which were more common in paroxysmal group than in persistent AF group(19.5%vs.0.9%,P<0.001).VR manifestations included 51 sinus arrest(63.0%),26 sinus bradycardia(32.1%),and 4 atrioventricular block(AVB,4.9%).Most VR episodes were observed in the left superior ganglionated plexi(67[82.7%]).Paroxysmal AF(OR=18.667,95%CI:6.638-52.491,P<0.001),body mass index(BMI)≥28.0 kg/m2(OR=2.361,95%CI:1.376-4.051,P=0.002)and left ventricular ejection fraction(LVEF)≥62.0%(OR=1.964,95%CI:1.119-3.447,P=0.019)were independent risk factors of VR.During a mean of(13.0±7.1)months follow up,among paroxysmal AF patients,6 patients(8.1%)with VR and 33 patients(10.8%)without VR experienced AF recurrence(P=0.496).Kaplan-Meier curves estimated that the AF-free survival rate was similar between VR group and non-VR group among paroxysmal AF patients(log-rank P=0.735).Conclusions:The most common sites of VR when initiating PVI from right RSPV occur in left superior ganglionated plexi.Paroxysmal AF,BMI≥28.0 kg/m2 and LVEF≥62.0%are independent risk factors of VR.VR does not affect AF-free survival.

Amide proton transfer-weighted (APTw) imaging is a kind of new magnetic resonance molecular imaging that rapidly developed in recent years. APTw imaging reflects the protein concentration and acid-base changes in tissues by detecting amide protons in free proteins and peptides in tissues. APTw imaging is a complementary technique to the existing magnetic resonance techniques, which can provide new molecular biological information for central nervous system diseases. In this article, the basic principle of APTw imaging and its application in common central nervous system diseases such as brain tumor, ischemic stroke, and neurodegenerative diseases are reviewed to provide new methods for promoting the transformation of APTw imaging from the research stage to routine clinical application, and facilitating the precise diagnosis and treatment of central nervous system diseases.

Objective:To compare the mid-term efficacy of one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) in the treatment of obesity and metabolic syndrome, and related postoperative complications.Method:Clinical data of patients undergoing indirect OAGB or SG from Jan to Dec 2022 was enrolled. Firty-eight patients were included in the OAGB group and 178 patients were included in the SG group. Propensity matching scores was performed with matching ratio of 1∶1. Eighty-four patients (42 in each group) were included in the analysis finally. We compared the differences in weight loss, metabolic syndrome remission, and postoperative complications among different groups.Result:The 2-year follow-up results show that the OAGB group and SG group showed similar improvements in weight, BMI, percentage of total weight loss, percentage of excess weight loss [(71.60±11.47)kg vs. (72.90±11.21)kg, t=0.529, P>0.05;(26.13±4.16)kg/m 2vs. (26.86±4.12)kg/m 2, t=0.805, P>0.05; (30.89%±9.68%) vs. (27.59%±7.74%), t=1.726, P>0.05; (99.25%± 36.35%) vs. (97.02%±40.97%), t=0.264, P>0.05]. In terms of metabolic complications, the OAGB group had a higher remission rate. The OAGB group showed more significant improvements in fasting plasma glucose, glycated Hemoglobin A1c, triglycerides, uric acid [(5.11±0.36)mmol/L vs. (5.40±0.63)mmol/L, t=2.593, P<0.05; (5.13%±0.4%) vs. (5.38%±0.36%), t=2.889, P<0.05; (0.94±0.35)mmol/L vs. (1.12±0.41)mmol/L, t=2.145, P<0.05; (330.60±73.73)μmol/L vs. (394.30±111.43)μmol/L, t=3.089, P<0.05]. There was no statistically significant difference in hemoglobin and albumin, but the serum iron in the OAGB group was lower than SG group, and the difference was statistically significant [(14.45±7.75)μmol/L vs.(17.78±6.58)μmol/L, t=2.118, P<0.05]. There was no difference between the two groups in terms of postoperative complications. Conclusion:OAGB has similar weight loss effects and postoperative complication rates compared to SG, and effectively improves metabolic symptoms.